Borderline personality disorder (BPD) belongs to a class of personality disorders that commonly disrupt the normal behavioral response of individuals suffering from these disorders and depending on the point on the continuum of dysfunction, going from mild to severe, these mental disorders can cause severe havoc in the lives of the sufferers, their family members, and others emotionally attached to these afflicted persons. Some other common personality disorders are obsessive-compulsive disorder (OCD), schizotypal disorder, and narcissistic personality disorder. As highlighted by the DSM-V, BPD is a psychological and emotional disorder characterized by unstable personal relationships, impulsive and irrational behavior, particularly regarding spending, sexual activity, or illicit substance use, and recurrent suicidal behavior or self-mutilation (APA, 2013). The common traits of this disorder appear generally in early adulthood, and its root causes are often linked to certain genetic and environmental factors, which are not completely understood. Wheeler (2014) presented BPD under the name of borderline character structure and discussed the psychodynamic psychotherapeutic approach to treating these individuals.
The use of the word “borderline” in these individuals arose from the behavioral peculiarities manifested by these patients, in that their limited emotional capabilities to deal with such life stressors as rejection or disappointment can cause explosive emotional outbursts that border on psychosis (Sadock, Sadock, & Ruiz, 2014). Indeed, one distinguishing factor of BPD versus some of the other mental disorders is the real or imagined fear of abandonment. This fear elicits from the BPD patient extreme swings in mood and a sense of self-loathing, which sometimes lead to violent and aggressive behavioral outbursts.
The diagnostic criteria for BPD are based on a patient meeting 5 or more of 9 criteria, among which are included frantic efforts to avoid abandonment, identity disturbance, unstable and intense interpersonal relationships, impulsivity in such areas as sex, spending, and eating; and intense anger, characterized by uncontrolled emotional outbursts (APA, 2013). The manifestations of my client which led me to my BPD diagnosis are that she was always in a state of crisis, had variable and frequent mood swings, going from argumentative to depressed and helpless, and evinced short-lived psychotic behavior. Fortunately for her, BPD is treatable if properly diagnosed, and the evidence-based general course of intervention includes such talk therapies as cognitive behavioral therapy (CBT) and psychodynamic psychotherapy, this latter a modality providing a means for the patient to process relational trauma via the ongoing therapeutic relationship. Key therapeutic attributes of this modality, and aspects that are critical, include consistent support from the therapist, counterconditioning, which occurs when the patient begins to feel safety and nurturance from the therapy, and repeated but gentle exposure to relational trauma (Wheeler, 2014). Evidence-based psychopharmacology for BPD patients include antipsychotics, antidepressants, and even anticonvulsants. Because neurobiologic research had implicated disturbances of the serotonin system in the suicidality and impulsive aggression characteristics of BPD patients, the best validated pharmacology for this disorder include the selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), for example, fluoxetine (Prozac, an SSRI) and venlafaxine (SNRI), as well as anticonvulsants like lamotrigine and topiramate (Triebwasser & Siever, 2006). As with many other psychological disorders, BPD is usually comorbid with other mental disorders such as bipolar and depressive disorder and is more prevalent in females than in males (Sadock et al., 2014); thus, the mental health practitioner should be mindful of this consideration during diagnosis, treatment, and management.
American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.
Triebwasser, J. & Siever, L., J. (2006). Pharmacology of personality disorders. Psychiatric `Times, 23(8). Retrieved from http://www.psychiatrictimes.com/pharmacology- personality-disorders
Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how- to guide for evidence-based practice. New York: Springer.
Great post on your assigned personality disorder of borderline personality disorder this week. I was assigned the Antisocial Personality disorder. Antisocial Personality Disorder has clinical features of disregard for consequences and rights of others. People who have the Antisocial Personality Disorder often commit unlawful, deceitful and reckless acts. They complete these acts with no remorse and often find pleasure in breaking the law. They often try to rationalize their behaviors and put the blame on their victims. In comparison to the differential diagnoses of Borderline Personality Disorder, people with Antisocial Personality Disorder are manipulative to get what they want, while people with Borderline Personality Disorder do manipulative acts to feel wanted and nurtured as well as accepted by others.
These two disorders both fall under the “Cluster B” of personality disorders (American Psychiatric Association, 2013). This cluster is overly dramatic, emotional and unpredictable. Antisocial disorder consists of very few emotions while as Borderline Personality disorder has extreme emotions, mood swings and a strong inability to regulate emotions in a functional way (Jackson & Westbrook, 2009). This is one characteristic trait to differentiate the two disorders. Another difference is that Borderline Personality Disorder is much easier to treat than antisocial personality disorder. Research has shown that Metallization-based therapy (MBT) is used to treat each disorder.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington, DC: American Psychiatric Association; 2013.
Holzer, K. J., & Vaughn, M. G. (2017). Antisocial personality disorder in older adults: A critical review. Journal of Geriatric Psychiatry and Neurology, 30(6), 291–302. https://doi-org.ezp.waldenulibrary.org/10.1177/0891988717732155
Jackson, M. H., & Westbrook, L. F. (2009). Borderline personality disorder. [electronic resource] : new research. New York : Nova Science Publishers, c2009. Retrieved from https://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=cat06423a&AN=wal.EBC3018386&site=eds-live&scope=site
Rosenström, T., Ystrom, E., Torvik, F. A., Czajkowski, N. O., Gillespie, N. A., Aggen, S. H., … Reichborn-Kjennerud, T. (2017). Genetic and Environmental Structure of DSM-IV Criteria for Antisocial Personality Disorder: A Twin Study. Behavior Genetics, 47(3), 265–277. https://doi-org.ezp.waldenulibrary.org/10.1007/s10519-016-9833-
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
Discussion: Treatment of Personality Disorders
Personality disorders occur in 10–20% of the population. They are difficult to treat as individuals with personality disorders are less likely to seek help than individuals with other mental health disorders. Treatment can be challenging as they do not see their symptoms as painful to themselves or others.
In this Discussion, you will explore personality disorders in greater detail and discuss treatment options using evidence-based research.
Analyze diagnostic criteria for personality disorders
Analyze evidence-based psychotherapy and psychopharmacologic treatments for personality disorders
Analyze clinical features of clients with personality disorders
Align clinical features with DSM-5 criteria
Compare differential diagnostic features of personality disorders
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click submit, you cannot delete or edit your own posts, and cannot post anonymously. Please check your post carefully before clicking Submit!
To prepare for this Discussion:
By Day 5 of Week 2, your Instructor will have assigned you a personality disorder, which will be your focus for your initial post for this Discussion.
Review the Learning Resources.
By Day 3
Explain the diagnostic criteria for your assigned personality disorder.
Explain the evidenced-based psychotherapy and psychopharmacologic treatment for your assigned personality disorder.
Describe clinical features from a client that led you to believe this client had this disorder. Align the clinical features with the DSM-5 criteria.
Support your rationale with references to the Learning Resources or other academic resources.
By Day 6
Respond to at least two of your colleagues by comparing the differential diagnostic features of the disorder you were assigned to the diagnostic features of the disorder your colleagues were assigned. What are their similarities and differences? How might you differentiate the two diagnoses?
Borderline Personality Disorder
Borderline personality disorder falls within what is known as Cluster B personality disorders. Cluster B includes Antisocial, Histrionic, Narcissistic and Borderline personality disorders (APA, 2013). It is common to have some overlap of criteria amongst the personality disorders in Cluster B.
The diagnostic criteria for Borderline personality include relationship issues, fear of abandonment, impulsivity, suicidality, labile affect, feelings of emptiness, anger that is difficult to control and paranoia or dissociative symptoms (APA, 2013). These symptoms must be pervasive and regardless of context. At least five of the diagnostic criteria must be present for a diagnosis of borderline personality disorder.
Individuals with borderline personality disorder have relationship issues, including idealizing the object of their affection in one moment and villainizing them in the next moment. They have a distorted self-image that is changeable suddenly and frequently. They are often impulsive and with their unstable affect, they are vulnerable to suicidal thoughts and actions, with or without dissociation.
Treatment for Borderline Personality Disorder
Personality disorders are not generally treatable with medication; however, some do respond well to therapy. Borderline personality disorder can be helped by utilization of dialectical behavioral therapy (DBT). DBT is a lengthy process of examining thoughts, feelings and behaviors, with a goal of changing negative thought, feelings and behaviors to something more positive. Linehan (2015) originally developed DBT to treat the suicidal borderline patient.
Current Clinic Patient
Currently in my clinical practicum, I have seen a borderline patient with very classic symptoms. She presents with occasional suicidal thoughts, as well as chronic self-injurious behavior in the form of cutting. She has presented within the last 6 weeks to the emergency department with three separate self-inflicted injuries, each requiring sutures. She describes her husband as very supportive and helpful, in one breath, and in the next breath she states that he is horrible and expresses homicidal ideation towards him. She states that she gets angry beyond what the situation calls for and feels that she cannot control her anger. She is impulsive, as evidenced not only by her cutting behaviors, but also by her tendency to shoplift items that she could easily pay for. She states that she feels invincible and she knows that she will not get caught. This patient, rightfully, carries a diagnosis of borderline personality disorder.
Treatment for this patient is focusing on keeping her safe. She does have a supportive husband and she is able to take her medications (which consist of mood stabilizers and sleep medications appropriately. She is seen in clinic for medication management and has been referred to neurology for assessment of a possible seizure disorder. She has been referred to intensive outpatient treatment and will, hopefully, learn some DBT skills.
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, (5th ed.). Arlington, VA, American Psychiatric Association, 2013.
Linehan, M. M. (2013). DBT Skills Training Manual (2nd ed.). New York, NY: The Guilford Press.