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Borderline Personality Disorder
Borderline Personality Disorder refers to a mental disorder that leads to considerable emotional instability among individuals. It is also referred to as Emotionally Unstable Personality Disorder (EUPD). Borderline Personality Disorder is characterized by abnormal variations in emotions and moods. It usually occurs during adolescence and early adulthood. According to Goodwin (2011), Borderline Personality Disorder usually starts in early adolescence and continues into early adulthood but ends in mid adulthood if treated early. Goodwin (2011) also estimates that an average age of a person who suffers from Borderline Personality Disorder is 20 with severe infections occurring when the person is 25. Borderline Personality Disorder rarely affects people who are 30 or above and it becomes relatively rare among individuals aged 40 and above. An individual with Borderline Personality Disorder often has unstable emotions and unbalanced feelings.
Patients suffering from Borderline Personality Disorder usually perform poorly at school, with approximately forty five percent of Borderline Personality Disorder patients dropping out of school due to persistent failures and poor performances. Employed adults suffering from the disease have also shown poor performance at work (Porr, 2010). Due to their destructive behavior, approximately ten percent of patients suffering from Borderline Personality Disorder commit suicides while thirty percent of Borderline Personality Disorder patients have attempted to commit a suicide at least once in their life. Marriages in which one of the partners is suffering from Borderline Personality Disorder often experience extreme difficulties. Porr (2010) approximates that nearly sixty-three percent of all marriages in which one of the partners suffers from Borderline Personality Disorder end in divorce.
Exploration of the Topic of the Paper
This research paper aims at fully exploring the Borderline Personality Disorder in order to establish and provide a comprehensive understanding of the disease. This would help in recognizing the causes, effects, diagnosis and treatment of the disease.
Confusion of Borderline Personality Disorder with Other Mental Disorders
Initially, it was presumed that Borderline Personality Disorder is similar to schizophrenia because they have almost similar signs and symptoms. It was also believed that Borderline Personality Disorder could not be precisely diagnosed and treated because it lacked a precise diagnostic method. Most physicians believed that Borderline Personality Disorder was only important in patients who had failed to show clear signs and symptoms of other mental illnesses and disorders that are closely related to Borderline Personality Disorder. Thus, the diagnosis of Borderline Personality Disorder involved opportunistic examinations to identify the disease and treatments and medications would only be prescribed upon verification that the patient was not suffering from any of other mental disorders. Most physicians also argued that Borderline Personality Disorder usually responded poorly to treatments. However, recent research studies have now revealed and verified that Borderline Personality Disorder is an independent illness with specific signs and symptoms that are diagnosable and that the disease can also be treatment effectively. Some of these research studies have gone a notch higher to refute the claim that Borderline Personality Disorder overlaps with schizophrenia or other related mental disorders. Recent research studies have shown that Borderline Personality Disorder has clear and distinct diagnostic methods that can be used to identify it. However, some medical researchers also accept as true that Borderline Personality Disorder often co-occurs with other mental disorders. The most common mental disorders that Borderline Personality Disorder co-occurs with include anxiety, depression and post-traumatic stress disorder (PTSD). Borderline Personality Disorder may also co-occur with bipolar disorder and Attention Deficiency Hyperactivity Disorder (ADHP).
Historical Background of the Borderline Personality Disorder
Borderline Personality Disorder was first identified by Zilboorg in June 1941 when he described the disorder as a mild version of schizophrenia (Paris, 2010). Hoch and Polain also conducted an exhaustive research study on Borderline Personality Disorder in 1957. Hoch and Polain devised the term Pseudoneurotic Schizophrenia to describe Borderline Personality Disorder. Later in the mid 1959, Schmideberg first described Borderline Personality Disorder as a disorder of character based on his findings after conducting a research study on two hundred and fifty patients suffering from Borderline Personality Disorder. During the research study, Schmideberg observed that most of the patients were not able to effectively control their behaviors due to poor self-image, lack of understanding of one's self, mood swings and emotional instabilities (Paris, 2010). According to Schmideberg, all the patients suffering from BPD indicated emotional instability, thus he also used the term "Emotionally Unstable Personality Disorder" to describe Borderline Personality Disorder. The name "Borderline Personality Disorder" was conceptualized by Kernberg in 1975; it was used for patients who had primitive and less vulnerable defense mechanisms (Paris, 2010). In the late 1938, Adolph Stern conceptualized the term borderline to describe an illness which he allegedly discovered that shown a borderline between psychoses and neuroses. The following points summarize three major developments in the understanding, diagnosis and treatment of Borderline Personality Disorder as discussed by Gunderson and Links (2008).
a) Superficial and sketchy descriptions of persons suffering from an unknown illness which was only identified as a mental disorder were given by different medical researchers. The descriptions were compiled as medical literature more than three hundred years ago and constituted the signs and symptoms of the illness.
b) In 1938, an American psychoanalyst Adolph Stern gave slightly detailed descriptions of the signs and symptoms of the mental illness which was mentioned earlier by the medical researchers. Adolph Stern critically analyzed the findings of his research study and found that the illness had a borderline between psychoses and neuroses. Stern then conceptualized the term borderline to refer to the disorder. In his descriptions, Adolph Stern used the name borderline disorder to refer to the disease. Between November 1938 and April 1939, Adolph Stern discovered more signs and symptoms of the illness. According to Gunderson and Links (2008), these descriptions of Adolph Stern are today used as the diagnostic criteria for diagnosing Borderline Personality Disorder. Adolph Stern also identified and described the possible causes of Borderline Personality Disorder. In addition, Adolph Stern described a form of psychotherapy which he considered as the best form of treatment for patients of the borderline disorder. According to Gunderson and Links (2008), Adolph Stern referred to patients of the disorder collectively as the borderline group.
c) Between 1941 and 1944, another American psychoanalyst Robert P. Knight described Borderline Personality Disorder using the concept of ego psychology which postulates that mental functionalities enable individuals to perceive events or occurrences in the surrounding environment in a realistic manner by successfully integrating their thinking with emotions and feelings in order to develop appropriate responses to events or occurrences (Gunderson, Links, 2008). Psychoanalyst Robert Knight further suggested that people suffering from Borderline Personality Disorder had impaired ego psychology systems.
Borderline Personality Disorder and Other Mental Disorders
Perugi (2010) asserts that when compared with patients of cyclothymic and bipolar disorders, patients suffering from Borderline Personality Disorder are more reactive and angrier. They tend to show extreme negative responses to frustrations, are highly dependent in relationships and often develop chronic or persistent feelings of emptiness. Patients suffering from Borderline Personality Disorder are also more manipulative in suicidal attempts. Patients suffering from Borderline Personality Disorder also have poorer interpersonal relationship skills than patients suffering from other mental disorders. They also tend to have reactive psychotic symptoms that are brief and less chronic.
Cause of Borderline Personality Disorder
To date, medical researchers have not found any certain cause of Borderline Personality Disorder. However, many theories have been devised to explain the possible causes of Borderline Personality Disorder. Some of these theories include the Theory of Bio-psychosocial Model of Interaction which proposes that Borderline Personality Disorder is caused by biological, psychological or genetic and social factors. The Theory of Bio-psychosocial Model of Interaction suggests that no single factor can cause Borderline Personality Disorder. According to this theory, Borderline Personality Disorder is caused by a combination of psychological factors such as personality and temperament, biological factors and social factors such as nature of interpersonal relationships or level of interaction of an individual with family members during the early stages of development. Researchers also suggest that there is a slight likelihood that Borderline Personality Disorder can be passed on from parents to children.
Signs and Symptoms
Some of the most common signs and symptoms of Borderline Personality Disorder include inconsistency or variability in behaviors, high emotional instability and feelings of worthlessness that often lead to self-destructive behaviors and development of poor interpersonal relationships with family members, friends and other people interacting with the patient. According to Gunderson and Links (2008), the unstable pattern of poor interactions with other people exhibited by patients of Borderline Personality Disorder may persist for several years. This character is usually associated with inability to recognize one's self thus leading to poor self-image.
Wirth-Cauchon (2010) also lists dependent behaviors, continuous search for nurturance, high need for belonging and to be loved, development of close relationships and need for emotional and socio-economic support as the most noticeable symptom of Borderline Personality Disorder. Patients suffering from Borderline Personality Disorder are also easily irritated and often suffer from frustrations and stress. They also show rage and may devalue people who provide them with emotional, social and economic support or assistance. According to Little and Richardson (2010), patients suffering from Borderline Personality Disorder also usually show extremes of idealization and self devaluation. When patients suffering from Borderline Personality Disorder develop fear of abandonment, they often become extremely ill and self-destructive. Most patients suffering from Borderline Personality Disorder are usually diagnosed of other personality disorders such as psychopath personality disorder and mood disorders such as bipolar disorder. According to the U.S. National Institute of Mental Health (2011), every two out five patients suffering from Borderline Personality Disorder become dependent on drugs and abuse substances.
Diagnosis of Borderline Personality Disorder
The diagnosis of Borderline Personality Disorder is usually carried out by a trained mental health professional, usually a psychologist or psychiatrist, who examines the signs and symptoms exhibited by a patient. The diagnosis of the disease does not require conducting laboratory tests, blood analysis or genetic tests. According to Paris (2010), diagnosis of Borderline Personality Disorder usually involves comparing the signs and symptoms shown by the patient with the signs and symptoms discussed above. The diagnosis of Borderline Personality Disorder also involves conducting a review or analysis of the life history of the patient.
Treatment of Borderline Personality Disorder
Borderline Personality Disorder is intrinsically difficult to treat just like other personality disorders (Little, Richardson, 2010). Borderline Personality Disorder treatment usually includes long-term psychotherapy. Medications can also be used to enable the patient to cope with troubling and devastating signs and symptoms. According to Little and Richardson (2010), medications are usually used to control mood swings. Low doses of antipsychotic drugs may also be used. However, the use of antipsychotic drugs is often limited because the drugs usually have short-time effects thus may prevent the patient from fully recovering. In addition, low doses of high-potency neuroleptics such as haloperidol may also be used during treatment. Antipsychotic drugs can also be used to induce psychotic signs and symptoms in order to facilitate proper and accurate diagnosis of Borderline Personality Disorder (Little, Richardson, 2010). According to Paris (2010), selective serotonin reuptake inhibitors (SRI) can also be used together with mood stabilizers to help the patient control his moods swings and to manage changes in impulse rates. On the other hand, Little and Richardson (2010) warn that benzodiazepines and mood-altering chemicals should be used carefully because these medications may worsen the condition of the patient by influencing mood swings and emotional stability.
Psychotherapy involves helping patients understand how to deal with mood swings as well as how to cope with various difficulties and challenges that may arise in their lives. Psychotherapy also concerns emotional regulation. Gunderson and Links (2008) assert that the most successful and effective psychotherapeutic approach that can be used for treatment of Borderline Personality Disorder is Dialectical Behavior Therapy which was developed by Marsha M. Linehan in the late 1980s. Dialectical Behavior Therapy involves instructing the patients on how to control their emotions, how to take control of their lives and how to manage their behaviors and conducts. It involves becoming aware of one's self through acquisition of self-knowledge. The therapy also deals with regulation of one's emotions and cognitive thinking. Generally, the treatment of Borderline Personality Disorder usually lasts for at least one year.
Effects of Borderline Personality Disorder on an Individual and Family
Borderline Personality Disorder usually affects interpersonal relationships among people. According to Latalova and Prasko (2010), Borderline Personality Disorder leads to intense and unstable interpersonal relationships. Patients suffering from Borderline Personality Disorder usually suffer from unstable self-images, lack of sense of self and strong feelings of abandonment and neglect. This makes them be very aggressive and antagonistic in life and towards other people. Latalova and Prasko (2010) also assert that people suffering from Borderline Personality Disorder are usually very impulsive and reckless. This leads to destructive behaviors that may be intolerable in the family and society as a whole. As a consequence, the patient develops poor relationships with other people, for example, a patient may lose ties with his/her spouse and family members. Patients suffering from Borderline Personality Disorder often suffer from idealization and devaluation of both self and other people. This is where an individual develops strong feelings towards or against himself or others. Borderline Personality Disorder usually leads to a variety of other mental disorders such as bipolar disorder and behavioral problems such as Attention Deficit Hyperactivity Disorder (ADHD). Borderline Personality Disorder also distorts self-image and causes feeling of worthlessness. It also causes mood swings which may make people break relationships with their friends, family members, relatives and spouses. The treatment of Borderline Personality Disorder is also quite expensive and may last for several years before the patient fully recovers. This may make the treatment process unaffordable. Extensive and prolonged treatment also results in depletion of family resources especially financial resources (Manning, 2011).
Epidemiology of Borderline Personality Disorder
The U.S. National Institute of Mental Health (2011) approximates that nearly two to three percent of the US population are affected with Borderline Personality Disorder. The disease is also regarded as the most common personality disorder in the world. Borderline Personality Disorder is most common among women than men with an average rate of infection of fifty-three percent among women and forty-seven percent among men (Wirth-Cauchon, 2010). No medical research has ever revealed the factors that lead to this difference in predominance of the disease among women. The risk of being infected by Borderline Personality Disorder also increases considerably with first-degree relations, for example, a person is at higher risk of infection if he/she has a father or brother who has been infected with Borderline Personality Disorder.
New Research Findings on the Disorder
In my view, Borderline Personality Disorder is one of the most researched personality disorders. Various research studies are conducted. This has led to influx of new research findings. One of the most recent research findings on Borderline Personality Disorder is the effectiveness of using new therapy techniques such as Cognitive-Analytic Therapy to treat the disease. Research studies have also found out that more than half of patients suffering from Borderline Personality Disorder are victims of physical and sexual abuse by people who provide them with care (Manning, 2011). Thus, appropriate measures should be taken to prevent and control the vulnerability of Borderline Personality Disorder patients during therapies and care-giving.
In that regard, therapies and caregivers should be discouraged from taking advantage of the mental condition of their patients and molesting or sexually assaulting them. Recent research studies have also found out that Borderline Personality Disorder accounts for more than thirty five percent of broken marriages and dysfunctional families (Manning, 2011). Therefore, appropriate measures should be taken to prevent negative impacts of the disease on families.
In my opinion, people with Borderline Personality Disorder should be given adequate emotional, social and economic support in order to enable them to cope well with the illness. Therapists should also constantly encourage their patients to live positive and productive lifestyles, for instance, by assuring them that there are many other people in the society who have similar disorders but who lead comfortable lives.
I also recommend that additional research studies should be conducted to facilitate better understanding of the disorder and to provide more insights on the most appropriate and accurate diagnosis and treatment techniques for the disorder. A research should also be conducted to determine suitable ways of reducing the high prevalence of Borderline Personality Disorder in the society. Lastly, additional research studies should be conducted to clearly establish the alleged link between parenting and early childhood experiences to higher risks of infection by Borderline Personality Disorder.