Introduction feelings for her would change from utter

IntroductionGrowingup a young woman fell in love with a young man named Alex. They dated fornearly a year in high school, and during that time she experienced what wouldcome to be known to her as the most chaotic relationship of her life. Lookingback, it should have been clear why his feelings for her would change fromutter infatuation one day to an explosive distain the next. Why hischaracteristic over reactions to situations that most people would simply brushoff were not in fact “just a phase”. Or how they way he pushed her away in onebreath, and then frantically begged her not to leave with another wasn’tsomething he would simply grow out of. The stories of how similar he was to hisabusive father, or of the abandonment from his mother, could have beenindicators in themselves for what was taking place.

Unfortunately, it wasn’tuntil Alex attempted suicide his senior year, and received the help he so desperatelyneeded, that she would realize he was suffering from Borderline PersonalityDisorder. While this story is merely an example of the very real strugglescountless people go through with BPD, the disorder is very real. This paperwill utilize an analytical lens to discuss BPD through its diagnostic criteria,causes and symptoms, treatments, history and prevalence, and finally socialeffects. It is the goal of this author to shed light on this disorder, in hopesof helping others to understand the very real struggles those with BPDexperience. Diagnostic criteria BPDis defined by the DSM-5 as being “a pervasive pattern of instability ofinterpersonal relationships, self image, and affects, and marked impulsivity,beginning by early adulthood and present in a variety of contexts” (AmericanPsychiatric Association, 2013). More specifically, in order to be diagnosedwith BPD, individuals must present with at least five out of eight specific symptomsinvolving their interpersonal relationships, personal identity and behavior.

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Patients with BPD often times experience patterns of intense and unstable interpersonalrelationships that are mostly characterized by fluctuations between devaluationand idolization of their significant others. These dramatic shifts can bedriven by the fear of and frantic effort to avoid abandonment, either real orimaginary in nature.  Combined withconflicts of personal identity such as chronic feelings of emptiness or anunstable self-image, these patients often times are at risk for unsafebehaviors. The most common of these behaviors seen in BPD are impulsivity inpotentially self-damaging areas such as sex, drug use, suicidal ideation, selfmutilation, inappropriate defensiveness, intense and difficult to controlanger, stress related paranoia, and even severe dissociative symptoms (AmericanPsychiatric Association, 2013).

  When aperson experiences multiples of these three areas over a short period of time,they can be clinically diagnosed and treated for BPD.  Causes and SymptomsBorderlinePersonality Disorder has been found to have multi faceted causes rooted in bothnature and nurture. Researchers believe that early childhood trauma contributesto the development of BPD, however to what extent is still unknown. What isknown however is that over 90% of patients with BPD report having experiencedsome form of physical or sexual abuse in their childhood (Ball & Links,2009).

  A second indicator of BPD hasbeen found to be hereditary predisposition. Studies from Vrike University inAmsterdam followed thousands of fraternal and identical twins across Europe anddiscovered that genetic influence accounted for nearly 42% of the variation inBPD, with the other 58% possibly being from unique environmental influencesthat individuals experience growing up (Distel, Trull & Boomsma,2009).  This means that in householdswhere parents suffer from the disorder, it is likely that their children willtherefor inherit the problem as well. Peoplewith BPD are at high risk of exhibiting the detrimental effects of thecondition due in part to a triple vulnerability (Barlow et al., 2012). In thismodel, the first vulnerability to these symptoms comes from a geneticvulnerability to emotional reactivity based on their specific brain function.The second vulnerability is a generalized psychological source, in which the persontends to perceive the world as a hostile and threatening place, and in turnresponds harshly to perceived threats.

The third and final aspect can be seenin specific psychological vulnerability, where the person utilizes learnedbehavior from traumas experienced in their youth to increase their sensitivityto perceived threats, and respond accordingly. All three of these vulnerabilitiesare present in patients with BPD, which causes their biological predispositionto over react to stressors to combine with their psychological tendencies tofeel threatened. This results in the extreme outbursts, aggression, defensivenessand suicidal tendencies often times seen in people with this disorder (Linehand& Dexter-Mazza, 2008).TreatmentsIn1998 American Psychologist Marsha Linehan introduced a cognitive-behavioraltreatment plan for BPD known as Dialectical Behavior Therapy (DBT). Thisapproach specifically deals first with the stressors with cause people toexhibit suicidal behaviors, followed by those that interfere with therapy, and finallythose that interfere with the patient’s quality of life.

Because BPD has somuch to do with patient’s inability to control their own emotions and reactionsto perceived stress, DBT focuses on helping individuals identify their feelingsand then teaches them how to respond to them in a healthy manner. Studies suggestthat DBT has had a significant impact on reducing suicides and hospitalizationsfor BPD related issues since its inception (Linehan, 2008). Sometimes patientsmay require hospitalization for DBT treatment, however more stable individuals typicallyonly require weekly individual therapy sessions in order to see positiveresults. Manypsychiatrists who teat BPD also prescribe medication along side DBT in order toaddress other conditions that often present alongside the disorder, such asdepression, anxiety and impulsivity. For individuals who experienceuncontrolled anger or sadness related to BPD, a class of drug known as moodstabilizers have been shown to be effective (Silk, 2012). While those withdepression may be given Selective Serotonin Reuptake Inhibitors or SSRIs totreat their symptoms.

However, in those patients who also experience drug abuseproblems or who are non-compliant with treatments, prescription drug use canbecome an unreliable form of treatment. This issue is further complicated bythe fact that nearly 72% of patients with BPD experience lifetime prevalencerates of some type of substance abuse (Sansone, 2011).  Othertreatments such as Mentallization-based therapy or Transference-focused therapyare also used to treat BPD, as they both help individuals suffering from thedisorder to identify how others might be thinking or feeling, as well as howtheir own emotions and interpersonal problems effect their relationships. Theseforms of talk-therapy are traditionally the first line of treatment, however theyhave not proven to be as effective as DBT.

Patients can also help to bettermanage their symptoms with positive self care activities such as exercise, regularsleep habits and a balanced diet, all of which help to reduce extremes in behaviorseen in BPD (Zanarini, 2010).   History and PrevalenceIthas only been within the last 80 years that BPD has been describedprofessionally. Over the course of this time, the disorder was placed intomultiple categories as it was considered to be atypical forms of different disorderssuch a bipolar disorder, depression, and even schizophrenia.

In 1938 AdolphStern outlined many of the current diagnostic criteria for BPD, and firstcoined the term for those suffering from the disorder as being in “the borderlinegroup.” 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 howeveruntil BPD would first appear in the DMS-III, with only minor changes in itsdescription occurring in the DSM-IV and DSM-5. Accordingto Norwegian psychologist Svenn Torgersen, BPD is one of the most commonpersonality disorders observed in clinical settings, with an occurrence ofabout 1-2% of the general population of every culture (Torgersen, 2012).  Women are also far more likely to have BPD, accountingfor approximately 75% of people diagnosed with the disorder. The reasons forthis great discrepancy between men and women is currently unknown, but has beenspeculated to be at least partially due to women being more likely to seek outtreatment for the disorder, as well as men being diagnosed as having other disorderssuch as PTSD or depression instead of BPD (Widiger, 1991).  The prevalence of BPD may also be muchgreater then reported, as it is estimated that upwards to 85% of patients withthe disorder also have a co-occurring disorders, making diagnosis even morecomplicated and potentially flawed. Social effectsPeoplesuffering from untreated or undiagnosed BPD can have a very difficult time functioningin normal society.

Due to their significant emotional instability, those withthe disorder tend to have difficulty in all aspects of social life. Theinability to regulate their temper and responses to stressful situations makesthem unprepared to function in many work environments where these tools arekey.  This often times leads to thesepatients 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 interpersonalinteractions. People with untreated BPD rarely find stable relationships, astheir behavior is so outside of the social norm that nobody is willingly accepttheir behavior for prolonged periods of time. A lack of social interaction,coupled with feelings of worthlessness, often times leads to depression, whichcan result in behaviors of self harm, repeated trips to the hospital forinjury, drug and alcohol abuse, physical violence and incarceration.

  To make matters worse, a significant portionof those suffering from BPD, nearly 6%, succeed in committing suicide (McGirret al., 2009). The outlook is not completely bleak however, as recent studieshave shown that the long term outcome for patients with BPD who seek help areas high as 88% achieving remission more then a decade after their firsttreatment (Zanarini et al., 2006).ConclusionAsthis paper has outlined, several effective treatments exist for those whosuffer from BPD.  As with any problem,the first step to helping these individuals begins with recognition of theirissues and application of professional intervention.

It is important tounderstand that people with this disorder are often times unaware of thesocially unacceptable effects of their behavior until it is too late, which canlead them toward seclusion, depression and even suicide. As a society, we mustlearn to recognize these issues as being a cry for help, instead of justblindly dismissing them as disruptive or inappropriate. By further working toprevent abuse in all regards, we can make a significant impact on the developmentof nearly all psychological disorders. While the evidence is not conclusive, itgoes without saying that physical and sexual abuse are a large factor in the developmentof a wide range of psychological issues, to include BPD.  A preliminary look into this disorder mayoffer little comfort to those who have experienced it first hand, however it isimportant to remember that there is hope for these individuals when treatmentis obtained.



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