Borderline of psychotic or neurotic patient groups

Borderline Personality Disorder (BPD or Borderline) is a severe, complex psychiatric disorder characterised by a pervasive instability in moods, impulsive and self-destructive behaviour, outbursts of anger and violence, distorted self-image, and an instability in interpersonal relationships. This disorder distorts one’s thinking and perceptions of self and others, which causes ongoing emotional distress and misunderstandings in their daily life. Many people with BPD frequently come to medical attention because of suicidal threats and acts of self-harm. The first description of individuals demonstrating the symptoms of Borderline was in medical literature almost three thousand years ago, says Robert O. Friedel, M.D. on his website, Borderline Personality Disorder Demystified. American psychoanalyst, Adolph Stern, introduced the term “borderline personality” referring to a group of patients that existed on the “borderline” of psychotic or neurotic patient groups since they did not fully fit the charactics of either. Many of the symptoms now considered criteria for the diagnosis of the disorder he described. Although it is not nearly as widely known as other mental illnesses, such as Schizophrenia, it affects about twice as much of the population. So far, it seems to be more prevalent among women. However, in his article, The 10 Personality Disorders, on Psychology Today, Neel Burton M.D. says that some argue that this is so because women presenting with angry, promiscuous behaviour tend to be labelled with it, while men engaging in similar behaviour are instead diagnosed with Antisocial Personality Disorder, which is characterised by a callous unconcern for the feelings and well-being of others, often irritable and hostile, acting impulsively and failing to learn from experience (Burton). Borderline is, as indicated by the name, a personality disorder. It often gets confused with other disorders, such as Bipolar Disorder, because it’s symptoms are very similar to other neurotic and psychotic disorders. It’s symptoms include an intense fear of abandonment, “a pattern of intense and unstable relationships with family, friends, and loved ones, often swinging from extreme closeness and love (idealisation) to extreme dislike or anger (devaluation), distorted and unstable self-image or sense of self, engaging in impulsive and often dangerous behaviours, self-harming behaviour . . . recurring thoughts of suicidal behaviours or threats,  intense and highly changeable moods, with each episode lasting from a few hours to a few days, chronic feelings of emptiness, and inappropriate, intense anger or problems controlling anger” according to the National Institute of Mental Health’s (NIMH) website. Because of this, Borderline took a long time to be widely accepted as an actual disorder, previously being described as a “wastebasket” diagnosis, for it seemed to lack in diagnostic precision and validity. Unfortunately, despite much research and current scientific literature, many medical health professionals still believe this to be true. According to NIMH, “the cause of Borderline Personality Disorder is not yet clear, but research suggests that genetics, brain structure and function, and environmental, social factors play a role, or may increase the risk for developing Borderline” ( People with close family members with the disorder may be at higher risk for developing it. Structural and functional changes in certain areas of the brain that deal with impulse control and emotional regulation, such as the limbic system, are shown in people with BPD. The amygdala is an important component of the limbic system; it deals with fear and arousal in response to signals from other parts of the brain that perceive threat. The prefrontal cortex acts to dampen the activity of the circuit that regulates negative emotion. However, it is not known whether brain abnormalities in these areas are risk factors for developing Borderline or if they are caused by the disorder. Personality traits, such as impulsivity and aggression may play a role in the development of the disorder, heightening its severity. Many people with Borderline report having experience with trauma — such as abuse, abandonment, or adversity during childhood — exposure to unstable, invalidating relationships, and hostile conflicts, says NIMH, however, exposure to these risk factors does not mean a person will develop BPD. Historically, this disorder has been viewed as difficult to treat. However, newer, evidence-based treatment has improved the quality of life, reducing the symptoms in people diagnosed with Borderline to few or none. “Psychotherapy is the first-line treatment for people with Borderline Personality Disorder”, according to NIMH. Dialectical Behaviour Therapy (DBT) was made for people diagnosed with BPD. It uses mindfulness, or being aware of and attentive to a person’s current situation and emotional state. DBT teaches skills to help a person control intense emotions, reduce self-destructive behaviours, and improve their interpersonal relationships. Medication is not usually the go-to for BPD because the benefits are still unclear. However, Borderline is often accompanied by other disorders, such as Depression, Anxiety, Attention Deficit Hyperactivity Disorder (ADHD), etc. For this, medical professionals may recommend medications that treat specific symptoms that co-occur in other mental illnesses, such as mood swings, depression, anxiety, etc. Because serotonin is one of the chemical messengers in the circuit that deals with the regulation of emotions, such as anger and sadness, drugs that augment the release of serotonin in the brain may improve emotional symptoms in those with BPD. Likewise, people who experience mood swings may benefit from mood-stabilising medications that are known to increase the activity of GABA, which is the primary inhibitory neurotransmitter in the central nervous system and is responsible for reducing neuronal activity throughout the nervous system. Some examples of medications one may be prescribed are: Citalopram (brand names: Celexa, Cipramil, etc.) which is an antidepressant; Amphetamine XR or IR (brand name Adderall) which is a central nervous system (CNS) stimulant that is used to treat Attention Deficit Disorder (ADD), ADHD, narcolepsy, and obesity; and Aripiprazole (brand name Abilify) which is an antipsychotic that is used to treat the symptoms of Schizophrenia and Bipolar Disorder. While some people with BPD aren’t so severe and may only need to use a few outpatient treatments, others may need intensive, inpatient care, or hospitalisation. If left untreated, the prognosis for a person with BPD is poor. This complex disorder is polymorphic in nature and its symptoms change and may worsen over time. The problem with this disorder is that, if left to their own devices, people with Borderline will likely find other ways to cope with their pain, anxiety, frustration, etc. by turning to addictive substances. Not only that, but, because of their mood swings and outburst of anger, they tend to push people away and, if they indulge in self-harm or suicidal tendencies, may not have anyone to help them when they no longer need, or want, to deal with the chaos of life.Before people started publishing books about Borderline and the struggles of living with it or with someone who has been diagnosed with it, not many people outside of medical professionals who have dealt with it really knew what it was. Once these books were published, greater public awareness emerged. However, because the treatment of Borderline Personality Disorder has only recently begun to work and improve the lives of those affected, most people don’t realise how different those with BPD have begun acting. Previously, patients with Borderline were considered problem patients who never improved and were avoided by clinicians. References to BPD in movies, TV, and other fictional media often portrayed those affected as wild, suicidal, and dangerous. Borderline was, and still is, often grouped with Schizophrenia, and Bipolar disorder to explain their erratic behaviour. Although, at one point in time this might have been true, quite a bit has changed since people first started hearing about it. We, as a society, need to change our thinking on, not only Borderline Personality Disorder, but on mental illness in general. There seems to be this aura of taboo surrounding mental illness, which is not fair to those affected by it. People can say they have cancer, but they can’t seem to have anything to do with Depression or Bipolar Disorder. Why is that? Is having cancer somehow worse or sadder than having mental illness? People act like it’s some sort of STD, like AIDS; they can’t seem to get far enough away from those affected. Fortunately, some mental illnesses have been widely accepted by society, such as Alzheimer’s. I believe this is because it is fairly common — about 11% of adults over age 65 are affected — and people are aware that it’s common. What we need to do is educate people about all mental illness, not just Alzheimer’s and Schizophrenia. In health class, for example, the teacher only touches upon Depression and ADD and a couple other disorders. But, that was it; she just mentioned it in passing as if a person’s mental health is not as important as their physical health. She went into detail about obesity and cancer, though. We had a whole unit dedicated to different types of cancer and their causes. That is what we need to do about mental health. Instead of letting people be ignorant and judgemental about those affected by Depression or Borderline, etc., we should teach them that it is not a choice. It is not just the person being dramatic or asking for attention when they no longer feel the need to live. It is a sickness. Even if you can’t see the effects on the person physically, that does not mean they aren’t suffering.


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