Borderline Personality Disorder

Borderline Personality Disorder

Personality is defined as a deeply ingrained pattern of behavior that includes modes of perception, relating to and thinking about oneself and surrounding environment. (International Classification of Diseases-10)

Personality disorders occur when aspects of personality become inflexible and maladaptive, and cause hindrance in ones social and occupational life.  Personality disorders have been classified into three categories(DSM-IV-TR)- Cluster A, Cluster B and Cluster C. Borderline Personality disorder is a subset of Cluster B Personality Disorders which in general consists of disorders considered ‘dramatic, emotional and erratic’ and on a psychopathic continuum’. Prevalence of personality disorders for the year 2017-2018 was found to be 9.1% and of Borderline Personality disorder in particular was found to be 1.4%.

The Borderline Personality Disorder is characterized by emotional instability. A person suffering from it may have problems with his/her own self image, aims and internal preferences. It is characterized by mood instability, anger outburst and sudden impulsive behavior, which tends to hamper with stable relationships in a person’s life. It is more common in females than in males and prevails in 3:1 ratio.

CAUSES

The exact cause of borderline personality disorder is not known. Although a number of factors may contribute to the disorder.

  • Environmental Causes– Associated with childhood experiences of abuse and neglect. Lack of proper parenting- Childhood where persons feelings are ignored and dismissed.
  • Genetic Predisposition– Heritability in identical twins and first degree relatives.
  • Neurological causes– Related to abnormality of brain structures (limbic system mostly), Alteration of neurotransmitters.
  • Socio- Cultural Causes– Broken homes and families.

Deprivations

Internal conflicts

Divorce

  • Co-morbid to other psychiatric conditions.

Although no evidences exist as such but borderline personality disorder is known to have some degree of association with substance abuse.

SIGNS AND SYMPTOMS

  • Disturbance of self identity and major issues of life.
  • Rapid shifts of emotions- anger outbursts, impulsivity, anxiety, discomfort, boredom and feeling of loneliness occurs in shifts.
  • Self Harm, Suicidal gestures and related threats are quite common.
  • Constant fear of being abandoned or being left out.
  • Constantly questioning one’s own identity (sometimes even sexual) and coming up with questions such as “Who am I?”
  • Engagement in unstable relationships and lashing out impulsive gestures to keep the other person shut.
  • Indulging in activities which one is well aware of them being harmful and dangerous.
  • Suffering within from a state of internal turmoil and confusion.

Under the borderline personality disorders currently includes Ambulatory Schizophrenia and Pseudoneurotic Schizophrenia which where earlier believed to be types of Schizophrenia.

HOW TO DEAL WITH IT?

  • Recognizing the signs and symptoms– The most difficult yet crucial step for the family members or close ones is to identify the signs and symptoms of the disorder. Many people in close relationship with the one who suffers from the disorder know that there is something wrong with their close one but are often unable to identify it. They should immediately seek professional help without hesitation and should work out possibilities and gather all required information.
  • Establish contact– With a recognized psychiatrist, clinical psychologist or a therapist and prepare the patient as well as other members of the family for what’s coming.
  • First prepare yourself and the family– If you have a loved one suffering from borderline personality disorder be prepared to provide a supportive environment and get acquainted with the therapy sessions by establishing a rapport with the therapist/ counselor.
  • Dealing solo– A person suspecting of the disorder can himself of herself, without involving family members and closed ones could contact the therapist/ counselor without hesitation.
  • When to see a professional?– If the exhibited behavior causes hindrances in your normal social relationships and occupational life and you think of causing self harm or indulging in suicidal tendencies it is high time you must consult a professional.
  • Do not ignore even the mildest signs– As with appropriate intervention, borderline personality disorder has good prognosis.

 

TREATMENT

  • Pharmacological– Although there is not much evidence in the support of drug therapy being given. yet it can be used for specific symptoms- Antipsychotic drugs(Seroquel, Zyprexa) and Mood Stabilizers( Lamictal) are known to play a role.
  • Psychoanalysis or psychoanalytical psychotherapy.
  • Supportive psychotherapy
  • Dialectical Behavioural Theapry( DBT) and Cognitive Behavioural Therapy(CBT)– CBT is based on the work of Aaron Beck and others. It helps the person understand and change negative cognitions (patterns of thinking) and this process brings about a change in behavior. It believes that people act (behavior) in a way they think (cognition) so if the cognition is changed the behavior automatically will.

DBT on the other hand includes CBT along with some other psychological techniques, mindfulness and relaxation.

  • Group Therapy– Making a small group and having interactive tasks and activities to modify behavior is an effective method as well.

COUNCELLING SESSIONS

Counseling sessions prove to be highly productive since the person gets to open up and discuss his/her problems, with full confidentiality, with the counselor  and able to express his/her emotions, feelings, expectations, ideas of self image, his/her desires or goals, expectations in a relationship, problems openly.

The Counselor uses the above mentioned therapy modalities in an interactive and fun way helping the client modify his/her behavior at the same time channelizing his/her energy in a productive way.

Counselor apart from dealing with the client instructs and discusses with the family their ideas and expectations and encourage full support for the patient.

After the scheduled and guided sessions are over the patient sees an improvement in social relationships, is able to manage the surge of emotions better and deviate from negative pattern of behavior.

Identification and seeking correct advice at the right time leads to good prognosis. Just about taking the right step at the right time!

REFRENCES

  1. Ahuja, Niraj,(2011), “A Short Textbook Of Psycaitry”, Jaypee Brothers Medical Publishers(P) Ltd, New Delhi.
  2. Early, M.B.(2017), “ Mental Health Concepts And Techniques for the Occupational Therapy Assistant”, Wolters Kluwer, Philadelphia.
  3. Mayo Clinic (June 2018). Borderline Personality Disorder from https://www.mayoclinic.org/diseases-conditions/borderlinepersonality-disorder/symptoms-causes.
  4. Therapy Tribe, find wellness, (4th June,2019) By Emily Mendez from https://www.therapttribe.com/therapy/borderline-personality-disorder-treatment-therapy/

 

 

 

 

 

 

 

 

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