In today’s society, more and more people are being diagnosed with some form of mental or personality disorder. Whether it be post traumatic stress disorder, obsessive compulsive disorder, seasonal affective disorder, attention deficit hyperactivity disorder, or some form of depression or anxiety, hundreds of thousands of Americans are afflicted with some form of psychological abnormality. I have personally dealt with certain personality “issues” for most of my life. As a young child I suffered from anxiety, extreme shyness, and social phobias. As I grew older, I began throwing frequent temper tantrums, in an attempt to get my way, which later turned into all out rages and extended bouts with depression. I remember having a talk with my father, as a young teenager, about my behavior and how I knew, after the fact, that it was inappropriate, but couldn’t seem to control it in the moment. I remember he mentioned the possibility of a chemical imbalance in my brain. And, I remember that nothing else was really done about it – because my parents simply could not afford psychiatric treatment.
As an adult I was first diagnosed with clinical depression by our family doctor and prescribed Prozac. Later, I was diagnosed with bipolar disorder by another general practitioner who prescribed various different drugs, including anti-depressants, anti-psychotics, and mood stabilizers, over several years. A little over a year ago, I started seeing a psychologist who has diagnosed me with mild bipolar II disorder as well as borderline personality disorder. She made some suggestions with regards to my meds, but mainly helped me understand these illnesses and what can be done to combat them aside from pharmaceuticals. I have done much research on bipolar disorder since my first diagnoses, but have not done the same for borderline personality disorder as of yet. This knowledge is important because the first step in treating any mental or personality disorder is an understanding of what effects it has on a person and their daily interactions. In researching and writing this paper I intend to provide a clearer understanding of borderline personality disorder including what it is, its causes, and its treatment. What is borderline personality disorder?
According to Ruocco, Lam, and Mcmain, “Borderline personality disorder is a severe psychiatric illness affecting 1% to 2% of adults, and upwards of 20% of psychiatric inpatients,” (2014). So what is borderline personality disorder? Mason and Kreger state that, “The very definition of a personality disorder is that it causes distress for both the person who has the disorder and those who interact with him or her,” (2010). This is certainly true of borderline personality disorder, which produces stress by generating significant emotional instability in the afflicted individual.
Those with this condition often feel emotions much more readily and much more deeply than those without it. This is caused by problems with regulating emotions, as well as thoughts. Anger, impulsiveness, and intermittent mood swings are all common. According to the Mayo Clinic, “With borderline personality disorder, you may have a severely distorted self-image and feel worthless and fundamentally flawed,” (2012). Acting on these intense emotion feelings and skewed self view frequently leads to an array of stressful mental and behavioral problems. This can cause severe interpersonal difficulties, and even push away close friends and loving relationships.
Borderline personality disorder can undermine many aspects of one’s life. Not only can it have a negative effect on intimate relationships, but also jobs, school, and social activities. Broken marriages and recurring job losses are not uncommon. Self-injury, such as cutting, is also prevalent and suicide rates high among those with borderline personality disorder. Risky and impulsive behavior can cause susceptibility to promiscuity , sexually transmitted diseases, unplanned pregnancies, car accidents, physical fights, and abusive relationships. In addition, borderline personality disorder rarely stands alone, but rather is often accompanied by other psychological disorders including, but not limited to, alcoholism and/or drug abuse, clinical depression, anxiety disorders, eating disorders, and bipolar disorder. The good news is it is thought that this disorder can be “cured”, or rather brought into remission. Those who are properly motivated and seek proper treatment can lead satisfying productive lives and feel better about them selves.
The causes of borderline personality disorder
Like many other psychological disorders, the causes of borderline personality disorder are not completely understood as of yet. In addition, “No research has examined what specific factors may contribute to functional disability in borderline personality disorder,” (Ruocco, Lam, Mcmain, 2014). However, there is agreement that the disorder results from a combination of factors. According to Hafizi, Tabatabaei, and Koenig, “Both genetic and environmental factors have been shown to interact in the genesis of this disorder,” (2014). Brain abnormalities, including the improper function of chemicals like serotonin, are also thought to possibly play a role in causing this disorder. According to the Mayo Clinic, “Some research has shown changes in certain areas of the brain involved in emotion regulation, impulsivity and aggression,” (2012). Clearly, there is no complete and consistent explanation for this personality disorder.
It is known that an individual’s personality is formed by environmental factors, including childhood experiences. “The term ‘invalidating’ environment is used as a more general description of childhood environmental variables which interactively contributes to the development of borderline personality disorder,” (Joyce, McKenzie, Luty, Mulder, Carter, Sullivan, & Cloninger, 2003). This may include neglect or physical abuse, but research suggests these are not required for borderline personality disorder to form. “Currently, some clinicians believe that childhood abuse is the cause of borderline personality disorder; but the data here show that while it is an important risk factor, it is neither necessary nor sufficient,” (Joyce, McKenzie, Luty, Mulder, Carter, Sullivan, & Cloninger, 2003).
Separation from caregivers or loved ones at an early age can also lend to this disorder, as can some belief systems and religious practices. “Overall religiosity and religious attendance in particular were negatively correlated with BPT, especially with symptoms of anger, instability of mood, feeling of emptiness and self-harming behavior,” (Hafizi, Tabatabaei, Koenig, 2014). This may be because religion can often add to the severity of an already unstable negative self image. In the end, the exact causes of borderline personality disorder can not be stated, but rather only the risk factors involved.
The treatment for borderline personality disorder
The treatment of an individual for borderline personality disorder may include psychotherapy, medications, and in extreme cases hospitalization. Medications may be used to treat co-occurring clinical problems, such as depression, impulsiveness and anxiety, but they can not cure borderline personality disorder. According to Brunner, Chanen, and Kaess, “There is no current evidence for any specific pharmacotherapy as a first-line treatment of borderline personality disorder,” (2014). The most fundamental approach to treatment of this disorder is psychotherapy. This is also referred to as talk therapy. There are different types of psychotherapy which can be effective when treating borderline personality disorder. These include dialectical behavior therapy, which is a form of cognitive behavior therapy, and metalization-based psychotherapy.
Dialectical behavior therapy uses a skills-based approach which consists of a blend of behavioral problem-solving techniques. These are often combined with meditation and physical exercises to help the patient learn how to regulate emotions, tolerate distress, and improve relationships. According to Bedics, Atkins, Comtois, & Linehan, “Dialectical behavior therapy is a cognitive behavioral therapy originally developed for the treatment of individuals exhibiting suicidal behavior and later expanded to those meeting criteria for borderline personality disorder,” (2012). Treatment is organized based on dialectical processes, where the primary dialectic is acceptance and change. This type of psychotherapy can be applied through group or individual counseling; often both are utilized.
Mentalization-based therapy is rooted in attachment relationships and mentalizing approaches. Borderline personality disorder patients are
typically unable to make sense of their own internal experiences, those of others, and the separation of the two. “Mentalizing refers to the capacity to interpret the self and others in terms of internal mental states such as feelings, emotions, wishes, desires, attitudes and values,” (Laurenssen, Westra, Kikkert, Noom, Eeren, van Broekhuyzen, & Dekke, 2014). A growing body of research continues to indicate that impairment in mentalizing is a core characteristic of borderline personality disorder. This form of psychotherapy helps the patient identify their thoughts and feelings, and separate them from those of the people around them. It also emphasizes thinking before reacting.
In researching and writing this paper I have formed a clearer understanding of borderline personality disorder including what it is, its causes, and its treatment. This knowledge is important because the first step in treating any mental or personality disorder is an understanding of what effects it has on a person’s daily interactions. The greatest help to me in combating the effects of this disorder has come in the form of mindfulness. Being mindful of my thoughts and emotions and where they are leading or could lead. When beginning to feel irritated or frustrated with a situation, I either find a new way to view the situation or simply remove myself from it. In either case, I am being mindful of my surroundings and what effect they are having on me. It is practically impossible for a human to never feel anger or other negative emotions, but it is completely possible to prevent them from lingering or even worse, growing in magnitude. Awareness goes a long way in helping one to control their thought patterns and the resulting emotions.
About BPD. (2014). National Educational Alliance for Borderline Personality Disorder, Retrieved from http://www.borderlinepersonalitydisorder.com/about-bpd/ Bedics, J. D., Atkins, D. C., Comtois, K. A., & Linehan, M. M. (2012). Treatment Differences in the Therapeutic Relationship and Introject during a 2-Year
Randomized Controlled Trial of Dialectical Behavior Therapy versus Nonbehavioral Psychotherapy Experts for Borderline Personality Disorder. Journal Of Consulting And Clinical Psychology, 80(1), 66-77. Borderline Personality Disorder. (2012). Diseases and Conditions. Mayo Clinic website. Retrieved from http://www.mayoclinic.org/diseases-conditions/borderline-personality-disorder/basics/definition/con-20023204 Brunner, R., Chanen, A., Kaess, M., (2014). Borderline Personality Disorder in Adolescence. Official Journal of the American Academy of Pediatrics, 134(4), 782 -793. Joyce, P., McKenzie, J., Luty, S., Mulder, R., Carter, J., Sullivan, P., & Cloninger, C. (2003). Temperament, childhood environment and psychopathology as risk factors for avoidant and borderline personality disorders. Australian & New Zealand Journal Of Psychiatry, 37(6), 756-764. Hafizi, S., Tabatabaei, D., & Koenig, H. G. (2014). Borderline Personality Disorder and Religion: A perspective from a Muslim country. Iranian Journal Of Psychiatry, 9(3), 137-141. Laurenssen, E. P., Westra, D., Kikkert, M. J., Noom, M. J., Eeren, H. V., van Broekhuyzen, A. J., & … Dekke, J. M. (2014). Day Hospital Mentalization-Based Treatment (MBT-DH) versus treatment as usual in the treatment of severe borderline personality disorder: protocol of a randomized controlled trial. BMC Psychiatry, 14(1), 194-218. doi:10.1186/1471-244X-14-149 Mason, P.T., Kreger, R. (2010). Stop Walking on Eggshells: Taking your life back when someone you care about has borderline personality disorder (2nd ed.). Oakland, CA: New Harbinger Publications, Inc. Ruocco, A. C., Lam, J., & Mcmain, S. F. (2014). Subjective cognitive complaints and functional disability in patients with borderline personality disorder and their nonaffected first-degree relatives. Canadian Journal Of Psychiatry, 59(6), 335-344.