november 20 2008

Paper on Borderline Personality Disorder I wrote for Abnormal Psych class
Disorder Paper: Borderline Personality Disorder
Borderline personality disorder is a complicated disorder characterized by black and white thinking also known as all or nothing thinking. Most borderlines are manipulative and insecure. They have low self-esteem and nearly no self-confidence. They have not learned effective coping mechanisms and are unable to distinguish between themselves and the world that they grew up in. Most borderlines have issues with boundaries and limits. They do not have their own and have a hard time allowing others to have boundaries. They tend to be impulsive in their actions and unable to think before acting for the most part. The diagnostic statistical manual for mental health disorders states,
Diagnostic criteria for 301.83 Borderline Personality Disorder- 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, as indicated by five (or more) of the following:
Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
Identity disturbance: markedly and persistently unstable self-image or sense of self
Impulsivity in atleast two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
Chronic feelings of emptiness
Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
Transient, stress-related paranoid ideation or severe dissociative symptoms. (DSM IV-TR)
Dr. Corelli describes Borderline Personality Disorder as, “There is a deep-seated feeling that one is flawed, defective, damaged, or bad in some way, with a tendency to go to extremes in thinking, feeling, or behavior. Under extreme stress or in severe cases there can be brief psychotic episodes with loss of contact with reality or bizarre behavior or symptoms” (Corelli). “Sometimes people with BPD view themselves as fundamentally bad, or unworthy. They may feel unfairly misunderstood or mistreated, bored, empty, and have little idea who they are. Such symptoms are most acute when people with BPD feel isolated and lacking in social support, and may result in frantic efforts to avoid being alone” (NIMH 2008). “A person with this disorder can often be bright and intelligent, and appear warm, friendly, and competent. They sometimes can maintain this appearance for a number of years until their defense structure crumbles, usually around a stressful situation like the breakup of a romantic relationship or the death of a parent” (Corelli). Symptoms appear to minimize as the Borderline ages. This may be due to life experience as they grow; they seem to manage their symptoms better. Their lives seem to settle down and become more stable. They commence to be able to function and manage better as they age.
There is an influential connection between child abuse, neglect, and Borderline Personality Disorder. More women than men are identified as having BPD. According to an article, “Borderline personality disorder (BPD) is a common and severe condition with substantial morbidity and mortality. BPD has a point prevalence of 1% to 2% in the general population, but the rate climbs to 10% to 20% in the mental health treatment settings. BPD is manifested by a wide array of symptoms and is associated with significant functional impairment and mortality rates approaching 10% in long-range naturalistic studies” (Gregory, Remen 2008). The DSM IV-TR states, “Physical and sexual abuse, neglect, hostile conflict, and early parental loss or separation are more common in the child-hood histories of those with Borderline Personality Disorder” (DSM IV-TR, pg.708). It also states, Borderline Personality Disorder is about five times more common among first-degree biological relatives of those with the disorder than in the general population” (DSM IV-TR, pg.709). There is some evidence of biological connection although studies have not shown clear evidence of what genetic links there are in BPD.
During recent years, there have been many studies done and treatment for BPD is more widespread now than a decade ago. There is still a stigma against people diagnosed with BPD in the world and the mental health system itself. One article advises, “Individuals with Borderline Personality Disorder are often unfairly discriminated against within the broad range of mental health professionals because they are seen as ‘trouble-makers'” While they may indeed need more care than many other patients, their behavior is caused by their disorder” (Levin 2001). It also states, “Many professionals are turned-off by working with people with this disorder, because it draws many negative feelings from the clinician” (Levin 2001). An article on the web says, “People with borderline personality disorder are among the most difficult to treat with psychotherapy, in part because their relationship with their therapist may become as intense and unstable as their other personal relationships” (Personality Disorders). Treatment providers need to set and stick with clear limits. They need to be able to provide support to the borderline but not allow the borderlines manipulative behavior to interfere in the treatment they are providing.
Over the past decade or so there have been many treatments suggested for treating borderlines but not many have shown to be effective in the long-term treatment of Borderline Personality Disorder. An article reads, “Treatment includes psychotherapy which allows the patient to talk about both present difficulties and past experiences in the presence of an empathetic, accepting, and non-judgemental therapist. The therapy needs to be structured, consistent and regular, with the patient encouraged to talk about his or her feelings rather than to discharge them in his or her usual self-defeating ways” (Corelli). The most effective treatment that has shown to be effective is DBT. Dialectical behavioral therapy first introduced by Marsha Linehan has shown to be the most effective in helping the borderline learn to live their life to the fullest they are capable of. An article states, “Therapy should help to alleviate psychotic or mood-disturbance symptoms and generally integrate the whole personality. With this increased awareness and capacity for self-observation and introspection, it is hoped the patient will be able to change the rigid patterns tragically set earlier in life and prevent the pattern from repeating itself in the next generational cycle” (Corelli). Treatment of the borderline client and its effectiveness depends on the investment of the client. They borderline needs to want to change to effectively benefit from any treatment that is provided including but not limited to; DBT, psychotherapy, medications, or other methods that has not been mentioned but may help. Borderline Personality Disorder needs to be studied more to find more beneficial treatments.

Works Cited:
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.
Corelli M.D., Richard J., “Borderline Personality Disorder”, Retrieved October 17, 2008.
NIMH., “Borderline Personality Disorder”. Retrieved October 15, 2008. Last reviewed: June 26, 2008.
“Personality Disorders”, Microsoft Encarta Online Encyclopedia 2008. Retrieved October 15, 2008. Http:// © 1997-2008 Microsoft Corporation. All Rights Reserved.


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