Introduction feelings for her would change from utter

Introduction

Growing
up a young woman fell in love with a young man named Alex. They dated for
nearly a year in high school, and during that time she experienced what would
come to be known to her as the most chaotic relationship of her life. Looking
back, it should have been clear why his feelings for her would change from
utter infatuation one day to an explosive distain the next. Why his
characteristic over reactions to situations that most people would simply brush
off were not in fact “just a phase”. Or how they way he pushed her away in one
breath, and then frantically begged her not to leave with another wasn’t
something he would simply grow out of. The stories of how similar he was to his
abusive father, or of the abandonment from his mother, could have been
indicators in themselves for what was taking place. Unfortunately, it wasn’t
until Alex attempted suicide his senior year, and received the help he so desperately
needed, that she would realize he was suffering from Borderline Personality
Disorder. While this story is merely an example of the very real struggles
countless people go through with BPD, the disorder is very real. This paper
will utilize an analytical lens to discuss BPD through its diagnostic criteria,
causes and symptoms, treatments, history and prevalence, and finally social
effects. It is the goal of this author to shed light on this disorder, in hopes
of helping others to understand the very real struggles those with BPD
experience.

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Diagnostic criteria

BPD
is defined by the DSM-5 as being “a pervasive pattern of instability of
interpersonal relationships, self image, and affects, and marked impulsivity,
beginning by early adulthood and present in a variety of contexts” (American
Psychiatric Association, 2013). More specifically, in order to be diagnosed
with BPD, individuals must present with at least five out of eight specific symptoms
involving their interpersonal relationships, personal identity and behavior.
Patients with BPD often times experience patterns of intense and unstable interpersonal
relationships that are mostly characterized by fluctuations between devaluation
and idolization of their significant others. These dramatic shifts can be
driven by the fear of and frantic effort to avoid abandonment, either real or
imaginary in nature.  Combined with
conflicts of personal identity such as chronic feelings of emptiness or an
unstable self-image, these patients often times are at risk for unsafe
behaviors. The most common of these behaviors seen in BPD are impulsivity in
potentially self-damaging areas such as sex, drug use, suicidal ideation, self
mutilation, inappropriate defensiveness, intense and difficult to control
anger, stress related paranoia, and even severe dissociative symptoms (American
Psychiatric Association, 2013).  When a
person experiences multiples of these three areas over a short period of time,
they can be clinically diagnosed and treated for BPD. 

Causes and Symptoms

Borderline
Personality Disorder has been found to have multi faceted causes rooted in both
nature and nurture. Researchers believe that early childhood trauma contributes
to the development of BPD, however to what extent is still unknown. What is
known however is that over 90% of patients with BPD report having experienced
some form of physical or sexual abuse in their childhood (Ball & Links,
2009).  A second indicator of BPD has
been found to be hereditary predisposition. Studies from Vrike University in
Amsterdam followed thousands of fraternal and identical twins across Europe and
discovered that genetic influence accounted for nearly 42% of the variation in
BPD, with the other 58% possibly being from unique environmental influences
that individuals experience growing up (Distel, Trull & Boomsma,
2009).  This means that in households
where parents suffer from the disorder, it is likely that their children will
therefor inherit the problem as well.

People
with BPD are at high risk of exhibiting the detrimental effects of the
condition due in part to a triple vulnerability (Barlow et al., 2012). In this
model, the first vulnerability to these symptoms comes from a genetic
vulnerability to emotional reactivity based on their specific brain function.
The second vulnerability is a generalized psychological source, in which the person
tends to perceive the world as a hostile and threatening place, and in turn
responds harshly to perceived threats. The third and final aspect can be seen
in specific psychological vulnerability, where the person utilizes learned
behavior from traumas experienced in their youth to increase their sensitivity
to perceived threats, and respond accordingly. All three of these vulnerabilities
are present in patients with BPD, which causes their biological predisposition
to over react to stressors to combine with their psychological tendencies to
feel threatened. This results in the extreme outbursts, aggression, defensiveness
and suicidal tendencies often times seen in people with this disorder (Linehand
& Dexter-Mazza, 2008).

Treatments

In
1998 American Psychologist Marsha Linehan introduced a cognitive-behavioral
treatment plan for BPD known as Dialectical Behavior Therapy (DBT). This
approach specifically deals first with the stressors with cause people to
exhibit suicidal behaviors, followed by those that interfere with therapy, and finally
those that interfere with the patient’s quality of life. Because BPD has so
much to do with patient’s inability to control their own emotions and reactions
to perceived stress, DBT focuses on helping individuals identify their feelings
and then teaches them how to respond to them in a healthy manner. Studies suggest
that DBT has had a significant impact on reducing suicides and hospitalizations
for BPD related issues since its inception (Linehan, 2008). Sometimes patients
may require hospitalization for DBT treatment, however more stable individuals typically
only require weekly individual therapy sessions in order to see positive
results.

Many
psychiatrists who teat BPD also prescribe medication along side DBT in order to
address other conditions that often present alongside the disorder, such as
depression, anxiety and impulsivity. For individuals who experience
uncontrolled anger or sadness related to BPD, a class of drug known as mood
stabilizers have been shown to be effective (Silk, 2012). While those with
depression may be given Selective Serotonin Reuptake Inhibitors or SSRIs to
treat their symptoms. However, in those patients who also experience drug abuse
problems or who are non-compliant with treatments, prescription drug use can
become an unreliable form of treatment. This issue is further complicated by
the fact that nearly 72% of patients with BPD experience lifetime prevalence
rates of some type of substance abuse (Sansone, 2011). 

Other
treatments such as Mentallization-based therapy or Transference-focused therapy
are also used to treat BPD, as they both help individuals suffering from the
disorder to identify how others might be thinking or feeling, as well as how
their own emotions and interpersonal problems effect their relationships. These
forms of talk-therapy are traditionally the first line of treatment, however they
have not proven to be as effective as DBT. Patients can also help to better
manage their symptoms with positive self care activities such as exercise, regular
sleep habits and a balanced diet, all of which help to reduce extremes in behavior
seen in BPD (Zanarini, 2010).

 

 

History and Prevalence

It
has only been within the last 80 years that BPD has been described
professionally. Over the course of this time, the disorder was placed into
multiple categories as it was considered to be atypical forms of different disorders
such a bipolar disorder, depression, and even schizophrenia. In 1938 Adolph
Stern outlined many of the current diagnostic criteria for BPD, and first
coined the term for those suffering from the disorder as being in “the borderline
group.” In 1967 Otto Kernberg defined the spectrum between neurosis and psychosis,
and placed BPD in the middle of the two. It would not be until 1980 however
until BPD would first appear in the DMS-III, with only minor changes in its
description occurring in the DSM-IV and DSM-5.

According
to Norwegian psychologist Svenn Torgersen, BPD is one of the most common
personality disorders observed in clinical settings, with an occurrence of
about 1-2% of the general population of every culture (Torgersen, 2012).  Women are also far more likely to have BPD, accounting
for approximately 75% of people diagnosed with the disorder. The reasons for
this great discrepancy between men and women is currently unknown, but has been
speculated to be at least partially due to women being more likely to seek out
treatment for the disorder, as well as men being diagnosed as having other disorders
such as PTSD or depression instead of BPD (Widiger, 1991).  The prevalence of BPD may also be much
greater then reported, as it is estimated that upwards to 85% of patients with
the disorder also have a co-occurring disorders, making diagnosis even more
complicated and potentially flawed.

Social effects

People
suffering from untreated or undiagnosed BPD can have a very difficult time functioning
in normal society. Due to their significant emotional instability, those with
the disorder tend to have difficulty in all aspects of social life. The
inability to regulate their temper and responses to stressful situations makes
them unprepared to function in many work environments where these tools are
key.  This often times leads to these
patients being unable to maintain a steady income due to repeated job losses.
This same issue occurs in relationships, where self-destructive behaviors,
paranoia, and fears of abandonment interfere with normal interpersonal
interactions. People with untreated BPD rarely find stable relationships, as
their behavior is so outside of the social norm that nobody is willingly accept
their behavior for prolonged periods of time. A lack of social interaction,
coupled with feelings of worthlessness, often times leads to depression, which
can result in behaviors of self harm, repeated trips to the hospital for
injury, drug and alcohol abuse, physical violence and incarceration.  To make matters worse, a significant portion
of those suffering from BPD, nearly 6%, succeed in committing suicide (McGirr
et al., 2009). The outlook is not completely bleak however, as recent studies
have shown that the long term outcome for patients with BPD who seek help are
as high as 88% achieving remission more then a decade after their first
treatment (Zanarini et al., 2006).

Conclusion

As
this paper has outlined, several effective treatments exist for those who
suffer from BPD.  As with any problem,
the first step to helping these individuals begins with recognition of their
issues and application of professional intervention. It is important to
understand that people with this disorder are often times unaware of the
socially unacceptable effects of their behavior until it is too late, which can
lead them toward seclusion, depression and even suicide. As a society, we must
learn to recognize these issues as being a cry for help, instead of just
blindly dismissing them as disruptive or inappropriate. By further working to
prevent abuse in all regards, we can make a significant impact on the development
of nearly all psychological disorders. While the evidence is not conclusive, it
goes without saying that physical and sexual abuse are a large factor in the development
of a wide range of psychological issues, to include BPD.  A preliminary look into this disorder may
offer little comfort to those who have experienced it first hand, however it is
important to remember that there is hope for these individuals when treatment
is obtained.

 

 

 

 

 

 

 

 

Introduction

Growing
up a young woman fell in love with a young man named Alex. They dated for
nearly a year in high school, and during that time she experienced what would
come to be known to her as the most chaotic relationship of her life. Looking
back, it should have been clear why his feelings for her would change from
utter infatuation one day to an explosive distain the next. Why his
characteristic over reactions to situations that most people would simply brush
off were not in fact “just a phase”. Or how they way he pushed her away in one
breath, and then frantically begged her not to leave with another wasn’t
something he would simply grow out of. The stories of how similar he was to his
abusive father, or of the abandonment from his mother, could have been
indicators in themselves for what was taking place. Unfortunately, it wasn’t
until Alex attempted suicide his senior year, and received the help he so desperately
needed, that she would realize he was suffering from Borderline Personality
Disorder. While this story is merely an example of the very real struggles
countless people go through with BPD, the disorder is very real. This paper
will utilize an analytical lens to discuss BPD through its diagnostic criteria,
causes and symptoms, treatments, history and prevalence, and finally social
effects. It is the goal of this author to shed light on this disorder, in hopes
of helping others to understand the very real struggles those with BPD
experience.

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For You For Only $13.90/page!


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Diagnostic criteria

BPD
is defined by the DSM-5 as being “a pervasive pattern of instability of
interpersonal relationships, self image, and affects, and marked impulsivity,
beginning by early adulthood and present in a variety of contexts” (American
Psychiatric Association, 2013). More specifically, in order to be diagnosed
with BPD, individuals must present with at least five out of eight specific symptoms
involving their interpersonal relationships, personal identity and behavior.
Patients with BPD often times experience patterns of intense and unstable interpersonal
relationships that are mostly characterized by fluctuations between devaluation
and idolization of their significant others. These dramatic shifts can be
driven by the fear of and frantic effort to avoid abandonment, either real or
imaginary in nature.  Combined with
conflicts of personal identity such as chronic feelings of emptiness or an
unstable self-image, these patients often times are at risk for unsafe
behaviors. The most common of these behaviors seen in BPD are impulsivity in
potentially self-damaging areas such as sex, drug use, suicidal ideation, self
mutilation, inappropriate defensiveness, intense and difficult to control
anger, stress related paranoia, and even severe dissociative symptoms (American
Psychiatric Association, 2013).  When a
person experiences multiples of these three areas over a short period of time,
they can be clinically diagnosed and treated for BPD. 

Causes and Symptoms

Borderline
Personality Disorder has been found to have multi faceted causes rooted in both
nature and nurture. Researchers believe that early childhood trauma contributes
to the development of BPD, however to what extent is still unknown. What is
known however is that over 90% of patients with BPD report having experienced
some form of physical or sexual abuse in their childhood (Ball & Links,
2009).  A second indicator of BPD has
been found to be hereditary predisposition. Studies from Vrike University in
Amsterdam followed thousands of fraternal and identical twins across Europe and
discovered that genetic influence accounted for nearly 42% of the variation in
BPD, with the other 58% possibly being from unique environmental influences
that individuals experience growing up (Distel, Trull & Boomsma,
2009).  This means that in households
where parents suffer from the disorder, it is likely that their children will
therefor inherit the problem as well.

People
with BPD are at high risk of exhibiting the detrimental effects of the
condition due in part to a triple vulnerability (Barlow et al., 2012). In this
model, the first vulnerability to these symptoms comes from a genetic
vulnerability to emotional reactivity based on their specific brain function.
The second vulnerability is a generalized psychological source, in which the person
tends to perceive the world as a hostile and threatening place, and in turn
responds harshly to perceived threats. The third and final aspect can be seen
in specific psychological vulnerability, where the person utilizes learned
behavior from traumas experienced in their youth to increase their sensitivity
to perceived threats, and respond accordingly. All three of these vulnerabilities
are present in patients with BPD, which causes their biological predisposition
to over react to stressors to combine with their psychological tendencies to
feel threatened. This results in the extreme outbursts, aggression, defensiveness
and suicidal tendencies often times seen in people with this disorder (Linehand
& Dexter-Mazza, 2008).

Treatments

In
1998 American Psychologist Marsha Linehan introduced a cognitive-behavioral
treatment plan for BPD known as Dialectical Behavior Therapy (DBT). This
approach specifically deals first with the stressors with cause people to
exhibit suicidal behaviors, followed by those that interfere with therapy, and finally
those that interfere with the patient’s quality of life. Because BPD has so
much to do with patient’s inability to control their own emotions and reactions
to perceived stress, DBT focuses on helping individuals identify their feelings
and then teaches them how to respond to them in a healthy manner. Studies suggest
that DBT has had a significant impact on reducing suicides and hospitalizations
for BPD related issues since its inception (Linehan, 2008). Sometimes patients
may require hospitalization for DBT treatment, however more stable individuals typically
only require weekly individual therapy sessions in order to see positive
results.

Many
psychiatrists who teat BPD also prescribe medication along side DBT in order to
address other conditions that often present alongside the disorder, such as
depression, anxiety and impulsivity. For individuals who experience
uncontrolled anger or sadness related to BPD, a class of drug known as mood
stabilizers have been shown to be effective (Silk, 2012). While those with
depression may be given Selective Serotonin Reuptake Inhibitors or SSRIs to
treat their symptoms. However, in those patients who also experience drug abuse
problems or who are non-compliant with treatments, prescription drug use can
become an unreliable form of treatment. This issue is further complicated by
the fact that nearly 72% of patients with BPD experience lifetime prevalence
rates of some type of substance abuse (Sansone, 2011). 

Other
treatments such as Mentallization-based therapy or Transference-focused therapy
are also used to treat BPD, as they both help individuals suffering from the
disorder to identify how others might be thinking or feeling, as well as how
their own emotions and interpersonal problems effect their relationships. These
forms of talk-therapy are traditionally the first line of treatment, however they
have not proven to be as effective as DBT. Patients can also help to better
manage their symptoms with positive self care activities such as exercise, regular
sleep habits and a balanced diet, all of which help to reduce extremes in behavior
seen in BPD (Zanarini, 2010).

 

 

History and Prevalence

It
has only been within the last 80 years that BPD has been described
professionally. Over the course of this time, the disorder was placed into
multiple categories as it was considered to be atypical forms of different disorders
such a bipolar disorder, depression, and even schizophrenia. In 1938 Adolph
Stern outlined many of the current diagnostic criteria for BPD, and first
coined the term for those suffering from the disorder as being in “the borderline
group.” In 1967 Otto Kernberg defined the spectrum between neurosis and psychosis,
and placed BPD in the middle of the two. It would not be until 1980 however
until BPD would first appear in the DMS-III, with only minor changes in its
description occurring in the DSM-IV and DSM-5.

According
to Norwegian psychologist Svenn Torgersen, BPD is one of the most common
personality disorders observed in clinical settings, with an occurrence of
about 1-2% of the general population of every culture (Torgersen, 2012).  Women are also far more likely to have BPD, accounting
for approximately 75% of people diagnosed with the disorder. The reasons for
this great discrepancy between men and women is currently unknown, but has been
speculated to be at least partially due to women being more likely to seek out
treatment for the disorder, as well as men being diagnosed as having other disorders
such as PTSD or depression instead of BPD (Widiger, 1991).  The prevalence of BPD may also be much
greater then reported, as it is estimated that upwards to 85% of patients with
the disorder also have a co-occurring disorders, making diagnosis even more
complicated and potentially flawed.

Social effects

People
suffering from untreated or undiagnosed BPD can have a very difficult time functioning
in normal society. Due to their significant emotional instability, those with
the disorder tend to have difficulty in all aspects of social life. The
inability to regulate their temper and responses to stressful situations makes
them unprepared to function in many work environments where these tools are
key.  This often times leads to these
patients being unable to maintain a steady income due to repeated job losses.
This same issue occurs in relationships, where self-destructive behaviors,
paranoia, and fears of abandonment interfere with normal interpersonal
interactions. People with untreated BPD rarely find stable relationships, as
their behavior is so outside of the social norm that nobody is willingly accept
their behavior for prolonged periods of time. A lack of social interaction,
coupled with feelings of worthlessness, often times leads to depression, which
can result in behaviors of self harm, repeated trips to the hospital for
injury, drug and alcohol abuse, physical violence and incarceration.  To make matters worse, a significant portion
of those suffering from BPD, nearly 6%, succeed in committing suicide (McGirr
et al., 2009). The outlook is not completely bleak however, as recent studies
have shown that the long term outcome for patients with BPD who seek help are
as high as 88% achieving remission more then a decade after their first
treatment (Zanarini et al., 2006).

Conclusion

As
this paper has outlined, several effective treatments exist for those who
suffer from BPD.  As with any problem,
the first step to helping these individuals begins with recognition of their
issues and application of professional intervention. It is important to
understand that people with this disorder are often times unaware of the
socially unacceptable effects of their behavior until it is too late, which can
lead them toward seclusion, depression and even suicide. As a society, we must
learn to recognize these issues as being a cry for help, instead of just
blindly dismissing them as disruptive or inappropriate. By further working to
prevent abuse in all regards, we can make a significant impact on the development
of nearly all psychological disorders. While the evidence is not conclusive, it
goes without saying that physical and sexual abuse are a large factor in the development
of a wide range of psychological issues, to include BPD.  A preliminary look into this disorder may
offer little comfort to those who have experienced it first hand, however it is
important to remember that there is hope for these individuals when treatment
is obtained.

 

 

 

 

 

 

 

 

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