Saturday, January 21, 2012

Borderline Personality Disorder

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Borderline Personality Disorder is considered a personality disorder by DSM-IV, or, as first described as by Schmideberg in 15, as a disorder of character. The name comes from the observation that Borderline Personality Disorder people have natures on the border between neurosis and psychosis. However, this is a misnomer for now psychiatrists do not believe that there is an underlying psychosis anymore. Simply put to have Borderline Personality disorder is to simply be emotionally unstable. Going into more detail, it is characterized mainly by a tendency to act impulsively without consideration of the consequences, a lack of ability to plan, and instability with interpersonal relationships, self-image, and thinking patterns. It is estimated that people with Borderline Personality Disorder makes up % of the general population, 10% of all mental health outpatients, and 0% of psychiatric inpatients. 75% of those diagnosed are women and 75% have been physically or sexually abused.

When diagnosing Borderline Personality Disorder, psychiatrists look for five or move of the following symptoms as determined by the DSM

Frantic efforts to avoid real or imagined abandonment. [Not including 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

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Identity disturbance markedly and persistently unstable self-image of sense of self

Acts impulsively in at least two areas that are potentially self-damaging (Examples sex, substance abuse, reckless driving) [not including suicidal or self-mutilating behavior covered in Criterion 5]

Recurrent suicidal behaviors, gestures, or threats, or self-mutilating behavior

Affective instability due to a marked reactivity of mood (Examples 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 (Examples frequent displays of temper, constant anger, recurrent physical fights)

Transient, stress-related paranoid ideation or severe dissociative symptoms

Treatment for the disorder is restricted to limited amounts of psychotherapy and medication to help with emotions. Psychotherapy is used to help those inflicted with Borderline to learn to set limits. Unfortunately, only a few of them are sufficiently motivated to persist with long-term psychotherapy. Some of their emotional instability can be so dangerous as to make long-term psychotherapy impossible. Antipsychotic, antidepressant, and antianxiety drugs are the only medications used for treatment, and are usually used to control the person with the disorder’s anger, anxiety, and/or depression that may occur.

The person in the case study was diagnosed with Borderline Personality Disorder in 174, but she did not learn of it until 14. After learning about her diagnosis, she started seeing a therapist for a short while before it was too expensive, too long, and useless. She says she is not sure if the therapist knew how to treat Borderline Personality Disorder. Therefore, she started reading many books, and using the knowledge gained from them to adjust her life. Some of her symptoms include having multiple boyfriends at the same time and drinking too much all while cutting words into her arm and with the blood write the same words onto walls. She becomes panicky “…when [she] loses my car in a parking lot, loses [her] husband at a flea market, or learn that a good friend is going on vacation. [She gets] a sick feeling when someone close arrives late, or when [she is supposed] to be somewhere and arrive late. The same panicky feeling comes when [her] plans fall through…” It is impossible for her to form friendships. She sees things as either all good or all bad. There is no gray area so to speak with her. She experiences feeling of emptiness. She is very quick to anger. This is what she experiences with Borderline Personality Disorder, and it disrupts her ability to function in society enough that she gets Social Security.

Unfortunately, there is no cure for Borderline Personality Disorder. If those afflicted have therapy for many years, the most that could happen is that they learn how to function in society and how to manage their emotions.

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