Borderline Personality Disorder

Introduction

This is a serious mental illness that is characterized by pervasive instability in moods, interpersonal relationships, self image and behavior. This instability often disrupts family and work life, long term planning and individuals sense of identity.  Originally thought to be at the "borderline" of psychosis, people with BPD suffer from a disorder of Emotion regulation.  While less well known than schizophrenia or bipolar disorder, BPD is more common affecting two percent of adults' mostly young women. There is a high rate of self injury without suicide intent, as well as a significant rate of suicide attempts and completed suicide in severe cases. Patients often need extensive mental health care services, and account for twenty percent of psychiatric hospitalizations. Yet, with help many improve over time and are eventually able to live productive lives. This paper will discuss about this illness; borderline personality disorder.

History of Borderline Personality Disorder

Borderline personality disorder was first reported in 1941, when Gregory Zilboorg a psychoanalyst and historian of psychiatry. Discovered a disorder which he thought was a moderate version of schizophrenia. The patients who had this disorder which he referred to as associative thinking, shallowness of effect, pervasive anger and disturbing of reality thinking. Later in 1942, another psychiatrist Deutsch created the term "As- if personalities" saying some patients were not having a continuous sense of identity which lacked an inner direction, because they recognized only the people they were dependent on. Later the term" Pseudoneurotic schizophrenia" was created by Polatin and Hoch; the term described a condition characterized by Pansexuality, Pananxiety and Panphobias. Later in 1959 Melita schmideberg a well known psychoanalyst described Borderline personality disorder as a character disorder. In 1975 Kemberg conceptualized BPD, saying it was a disorder whose patients had a primitive defense mechanism. In 1938 the term Border Personality Disorder was formed by Stern, who referred to the Borderline between psychoses and neuroses. The disorder is recognized by unstable functioning, interpersonal relationships, mood and effect. (History of Borderline Personality Disorder)

Causes and risk factors

Borderline personality disorder has both psychological and biological factors that lead to the development of the condition. Ways for developing the disorder are unique for anyone, having different factors such as psychological, biological and socio- cultural sources when one has BPD it is more likely he was born having a biological predisposition and being person who is emotionally sensitive. When parents have not experienced intense emotions, they may not know what there kids are going through. The child may feel misunderstood and the parent feels he is weak in parenting. This therefore leads to great difficulties for all parties. Genetics is also believed to cause personality; there are chances that 50% personality is inherited. Researches done on identical and non identical twins whose parents have BPD, shows that identical twin have a 35% chance of having the disorder whereas non identical twins have 7% chance (Krawitz Roy, Jackson Wendy; Borderline personality disorder)

When one is brought up in a neglectful or abusive environment, this has a psychological impact on him making him attain adulthood without enough confidence, psychological skills and self esteem. BPD patients have recorded cases of sexual and physical abuse, childhood emotional abuse and childhood neglect. With about 70% of people having the disorder saying they have undergone sexual abuse. But also you may not have a history of sexual abuse so as to have BPD. This is because 30% of BPD patients reported they were not sexually abused when they were young (Krawitz Roy, Jackson Wendy; Borderline Personality Disorder)

A study carried out to identify different risk factors that may lead to BPD, four risk factors associated were found to have dissociative symptomatology of BPD. They include Continuous treatment by a caregiver, one witnessing sexual violence when young and sexual abuse by a care giver. Results of this study showed that sexual trauma and anything instric to the Disorder are risk factors for Borderline personality patients. Another study carried out showed that, patients with BPD report levels of dissociation which increase with level of childhood trauma. The study also showed that neglect and Emotional abuse is as important as physical and sexual abuse for the development of Dissociative symptoms. (Hales E. Robert, American Psychiatric publishing; The American psychiatric publishing textbook of psychiatry)

Symptoms of borderline personality disorder

Patients with BPD have one main common feature, they fear being abandoned and due to this fear they hold on to those around them. This behavior often affects the relationship the patient has with those around him. Patients diagnosed with the disorder may have the following symptoms. They tend to make efforts that avoid them being abandoned or imagine being abandoned. They also have difficult relationships, which are caused by the patient hating particular people and him liking particular people. The patient also is not sure of his or her own image and has an unstable self image. Another symptom is that the patient behaves or acts in a strange manner, like driving carelessly, having frequent and unprotected sex, drugs abuse etc. (Borderline Personality Disorder Symptoms).

The other symptoms of BPD are, the patient has suicidal thoughts or even tries to commit suicide and the patient often injures himself through mutilation. The patient also experiences intense mood swings, which he also feels depressed or anxious and this may only last a few hours but some cases they last a day or two. The patient may also have problems controlling anger, this often leads him to be involved in fights or get temper tantrums. One may also be always having suspicions towards others for no good reason (paranoia), He may even be losing a sense of reality. Not everyone with these symptoms can be diagnosed with Borderline Personality Disorder, for one to be diagnosed with the disorder the symptoms recorded have to be severe and is to be long enough to cause problems functioning in relationships. One may have short episodes of psychosis with BPD, Especially when undergoing a personal crisis. Suicide attempts are common with BPD, with 10% of BPD patients committing suicide. One can reduce the risks of committing suicide by treating symptoms of BPD and depression (Borderline Personality Disorder).

Epidemiology

For over thirty years clinics have focused on the etiology of BPD, in 1997 Zanarini and Frankenburg discussed conceptualizations of the word Borderline; in their studies they concluded that "development of BPD is a unique pathway which is a painful variation on an unfortunate but familiar theme". Also in 1984 Gunderson conceptualized borderline personality disorder as a specific distinguishable from other DSM3-R and DSM-3. Zanarini (2000) said that efforts that explained BPD development were coming from a psychnalytic community that was focusing on Kornberg's theories (1975).  Also Adler and Buie (1979) suggested that when a child has problems when growing up, leads to the child's inability to view him and others during times of stress (Bjorklund Kay Pamela)

Later Masterson suggested that when one is afraid of being abandoned, resulting from luck of environmental support for maturation. This resulted to the first generation research to focus on childhood phenomena illustrated by these theories. And they included divorce of parents or loss and disturbed parental involvement.  Second generation research on environmental causes come mainly from the first generation, it was discovered that children diagnosed with BPD have a history of physical and sexual abuse. The third generation research's shared both methodological and conceptual features, which mainly focused on childhood experiences. Given that women are the most victims of sexual abuse; this partly explains why BPD is mainly divided by gender. The different Research studies done show that difficult childhood experiences and forms of neurological and biochemical dysfunctions vary (Bjorklund Kay Pamela).

Diagnosis

The disorder is easy to illustrate, when one is always angry and is not at peace with his friends it is said he has a personality problem. But he does not show other symptoms of the disorder so as to fit the axis 2 categories. The problem can be specified to illustrate the same symptoms such as anger, since it characterizes several personality disorders. Anger is a symptom which is a mark of disorders in erratic cluster on Axis 2.  Antisocial personality disorder (ASP), Borderline personality disorder (BPD), Narcissistic personality disorder and Histrionic personality disorder. In addition to anger, the four diagnostic groups share other symptoms such as forms of self centeredness and exploitativeness. (Clarkin J.F, et al).

A lot of structured and or semi structured self reports and interviews have evolved due to efforts that have evolved to resolve problems with diagnosing personality. Frances and widiger noted that some interviews showed adequate reliability to some disorders and not all. A lot of diagnostic signs for personality disorders cannot be accepted socially due to the self approach that is especially plagued. Moreover information retrieved from the patient may be incorrect. If the patient wishes to be real to such acts especially Exploitativeness, manipulativeness and unreasonable anger. And if the disorders nature shows that the patient's information cannot be trusted, then how a questionnaire about his or her report is be used to create the diagnosis. Should a BPD say that he or she shows unreasonable anger, is unstable or is disturbed by his identity? Even if one can describe himself in such negative manner, the challenge remains in objectifying concepts such as "instability" or "lack of remorse." (Clarkin J.F, et al).

Treatment

Borderline personality disorder is extremely hard to treat; psychiatrists often use more than one treatment in their efforts to battle the diagnosis and its varied associated problems. Some form of psychotherapy and trials of medication during the course of treatment is given to both inpatient and outpatient. Apart from this pharmacotherapy and individual Psychodynamic therapy, BPD patients could also be given cognitive and Behavioral therapy, family therapy, group therapy, hospital milieu treatment marital therapy, community residential treatment or day hospitalization. (Clarkin J.F et al).

There are many combined ways of treatment that can be used in the treatment of Borderline patients; the following are there for combined ways of treating the disorder. These treatments are often cited in literature which has been the subject of the less existing Empirical studies. And they are hospital treatment and individual psychotherapy, pharmacotherapy and individual psychotherapy, Family therapy and individual psychotherapy and Group psychotherapy and individual psychotherapy. The focus is on the rationale for each combination plus the Empirical work is done until to this date, therefore this makes implications of this preliminary work to be for the future research studies (Clarkin J.F et al).

There are a few drugs that have been tried and used to treat borderline personality disorder, there is evidence that flouvoxamine reduces some depression and aggressiveness found in BPD patients. Also that Lithium decreases some suicidality, irritability and anger. Similarly medications used for antiseizure, have also been used in the treatment of mood changes in bipolar disorder, they also can be helpful in the treatment of BPD. The latest anti psychotic medications; such as Olanzapine has seemingly decreased the symptoms of BPD especially when it's taken alone, or maybe as a supplement to psychotherapy. Because at times patients often tend to abuse drugs or engage themselves in suicidal attempts. So when using drugs therapy extreme precautions must be followed (Kring Ann et al).

Pertinent issues

There are some strange facts about Borderline personality disorder which many did not know about, that exist and these facts are that there are 2% of adults who have this disorder. Also that 20% of patients are in psychiatric hospitals and 11% are in outpatient clinic. Another fact is that 69%- 75% show signs of self destructive behavior such as suicidal attempts, self mutilation, eating disorder and chemical dependency. About 8-10% of BPD patients die of suicide and this is mainly because there was no impulse control over depression and there are about 50% patients who experience clinical depression (Borderline Personality disorder facts).

Borderline research treatment to its patients shows that patients that have received community based outpatient and inpatient treatment, reveal that this treatment is barely ineffective this is after it is measured 2-3 years later. Researches also showed that migraine and severe headaches tend to be more common with people having BPD than the general public. The presence of decreased glucose uptake especially in medial orbital frontal Cortex can be associated with diminished regulation in impulsive character In Borderline Personality Disorder. It has also been discovered, that there is no possible link between schizophrenia and ERD. The ability to act responsibly has being affected by the presence of Cormobid conditions present in BPD. These are some of the many facts about Borderline personality Disorder that the general public did not know about.(Borderline personality disorder facts).

Conclusion

Borderline personality disorder is a serious mental disorder that is characterized by pervasive instability in moods, interpersonal relationships, self image and behavior. This instability often disrupts family and work life, long term planning and individuals sense of identity.  Originally thought to be at the "borderline" of psychosis, people with BPD suffer from a disorder of Emotion regulation.  While less well known than schizophrenia or bipolar disorder, BPD is more common affecting two percent of adults' mostly young women. Borderline personality disorder was first reported in 1941, when Gregory Zilboorg a psychoanalyst and historian of psychiatry. Discovered a disorder which he thought was a moderate version of schizophrenia.

Borderline personality disorder has both psychological and biological factors that lead to the development of the condition. Ways for developing the disorder are unique for anyone, having different factors such as psychological, biological and socio- cultural sources. Patients with BPD have one main common feature, they fear being abandoned and due to this fear they hold on to those around them. This behavior often affects the relationship the patient has with those around him. Patients diagnosed with the disorder may have the following symptoms. The patient has suicidal thoughts or even tries to commit suicide and the patient often injures himself through mutilation. The patient also experiences intense mood swings, which he also feels depressed or anxious and this may only last a few hours but some cases they last a day or two

Borderline personality disorder is extremely hard to treat; psychiatrists often use more than one treatment in their efforts to battle the diagnosis and its varied associated problems. Some form of psychotherapy and trials of medication during the course of treatment is given to both inpatient and outpatient.