Year: 2022

Essential Aspects That Patients Diagnosed With Borderline Personality Disorder Should Know

Borderline Personality Disorder (BPD) is a mental pathology that affects all facets of a patient’s life. Although there is no longer as much stigma behind this disease as there was a few years ago, it is still difficult for many people who suffer from it to accept, so it is not surprising that they prefer not to be treated by mental health professionals. But receiving a diagnosis can change a patient’s life forever. We share some points about the disease that these patients need to know.

Specialized Treatment Can Be Done:

Individuals diagnosed with BPD should not be so concerned about the label of the disease and the stigmatized information they find on the Internet. They should focus on the fact that treatment can be tailored to their specific symptoms and problems, which often creates interpersonal, emotional, and psychological barriers. The diagnosis is the beginning of a treatment plan designed specifically for the symptoms that are causing problems for you.

Diagnosis Exploration May Lead to Greater Understanding:

Receiving a diagnosis can lead to psychological relief in finally knowing the correct diagnosis. Having a disease name to call what happens to them and a specific treatment plan that works based on evidence can relieve them of great emotional tension.

BPD can help identify the "whys" of intense emotions and conflict in relationships:

Many people who are struggling with BPD symptoms such as intense emotional reactions, fear of abandonment, low self-esteem and lack of identity are happy to finally understand “why” they have suffered so much in their social and interpersonal relationships for years. Due to the constant challenges within relationships of all kinds, the person with BPD may begin to attribute the difficulties in their relationships to the product of the education they received, the culture they were born into, or a problem of ethics or values. Knowing that one suffers from this disease interrupts this incorrect point of view.

Medication management may begin with the goal of symptom relief:

Medications are important if depression, anxiety, or psychotic symptoms are present. Although medication cannot “cure” BPD, it can reduce symptoms such as depression or anxiety that contribute to self-injurious behavior, suicidal thoughts, or depressed and anxious mood. If psychotic symptoms are present (paranoia, hallucinations, delusions, etc.), medications can help stabilize the individual.

The emotional roller coaster in which they live stops:

Individuals with BPD have problems in their relationships with other people. It is shown that these patients suffer more divorces, abusive behaviors, and difficulties to control their anger within the community, as well as obsessive or paranoid behaviors. With proper treatment, the individual can better understand why their relationships tend to be chaotic and unstable. Therapies to work on relationship stability is an important step toward building healthier relationships.

They can begin to investigate ways to help themselves:

When you don't know exactly what you're fighting against, you can feel powerless over how to find ways to help yourself. That way you will start taking steps in the right direction.

Your family and friends can help:

Being able to share your illness with loved ones can make them more empathetic to what they are experiencing. They will know (or learn) how to help and support you, and may even begin to educate themselves on how your relationships with them are affected.

Know how to identify triggers:

Having a correct diagnosis can help you identify triggers for your symptoms. For example, for individuals who suffer from BPD, a trigger is often fear of abandonment within relationships. Knowing that you have characteristic symptoms of BPD can make it easier to identify these feelings that make you feel more vulnerable within your relationships. They can also learn about the aspects that lead to relationship problems that cause them to completely break down emotionally.

What is Borderline Personality Disorder?

Borderline Personality Disorder ( BPD) is one of the most complex challenges that a clinician has to face. It is a disorder in which fundamental functional areas are affected, such as:

• cognition
• affectivity
• interpersonal activity
• and impulse control

The term ” borderline ” was popularized by Adolph Stern (1938) when he characterized the limit between neurosis and psychosis. It appeared in the DSM in 1980, in its third revision. With this definition, it was constituted as a picture with its entity and not as a limit between two disorders.

Currently, due to the confusion that the term “borderline” generates in the community and among professionals, a review is underway in favor of the use of “emotion regulation disorder” (ERD).

How does it manifest?

The essence of BPD is the persistent instability that appears in all the indicated areas.

This pattern of instability translates into high mood reactivity, extreme impulsiveness, recurrent behaviors of self-mutilation or suicide, ambivalent thoughts and attitudes towards oneself, chaotic and intense interpersonal relationships, and feelings of emptiness and boredom. BPD has a vital prevalence of between 1 and 2% in the general population, between 6 and 10% among patients who attend mental health centers, and 20% among hospitalized psychiatric patients.

BPD comorbidity

This personality disorder presents high comorbidity with other mental disorders, mainly:

• Mood disorders
• Problems Related to Substance Use
• Impulse Control Disorders
• Attention Deficit Disorders,
• Eating disorder
• Post Traumatic Stress Disorder
• And other Anxiety disorders.

This pattern of functioning is highly dysfunctional and causes great discomfort. The chronic emotional instability that characterizes these patients makes them find themselves in a state of almost constant suffering.

Possible causes

According to the literature, it seems that these individuals have not been able to form an integrated set of schemas about themselves, which may be related to failures in early attachment processes.

Persistent instability and impulsiveness may explain why these patients live in constant uncertainty about their own identities. Borderline patients can range from helpless and unable to take charge of their lives, to fully competent. The problem is that both extreme patterns can occur in the same individual, but it is difficult to find an intermediate point. This is one of the essential characteristics to take into account to understand the pathology of BPD and its dichotomy.…

The 4 Signs That Can Lead To Suspicion Of A Borderline Personality Disorder

Borderline personality disorder (BPD) is a serious and disabling psychiatric disorder that affects approximately 2% of the general adult population. It is characterized by 4 groups of symptoms: extreme impulsiveness, mood instability, interpersonal problems, and identity disturbances.

Specifically, regarding the four groups of symptoms of people with BPD, this expert describes that high impulsivity can be related to self-harm, aggressiveness towards others, or compulsive shopping.

While emotional instability is characterized because they are people with roller-coaster experiences, where they can change their emotional state in a matter of seconds, often connecting with vital life circumstances, or with changes in internal mental states.

Thirdly, Identity alterations in people with borderline personality disorder, another group of symptoms related to a great emptiness existential, with a bad relationship with themselves, low self-esteem.

They are social chameleons, they are people with great power of self-criticism, many directors do not know what they are, they have feelings of loneliness, they stop feeling their emotions in a way protective, and many of them stop connecting with their being.

The fourth sign of BPD is related to the difficulties that these people have in maintaining intimate relationships and also at a superficial level, and that is closely related to fear of rejection, social anxiety, or mistrust.

In principle, there are already some manifestations during adolescence, “but not strictly from the concept of BPD, but from comorbidities such as behavioral disorders, drug abuse, eating disorders”; which does not mean, that all people who present behavior disorders, eating disorders or drug abuse during adolescence will develop BPD.

At the gender level, the clinical psychologist asks to differentiate between clinical and community samples. Specifically, at the level of mental health consultations, she cites that more women attend than men.

Gender determines how symptoms are manifested within heterogeneity, with men being more impulsive and at greater risk of committing antisocial acts, while in women, in principle, there is a greater difficulty with ties, these are more ambivalent, more of love and hate.

Empirical studies, with observation periods of 10 to 15 years, indicate that around a third no longer meet the diagnostic criteria after this time, and with a specific treatment of at least two years.

The 4 signs that can lead to suspicion of a borderline personality disorder

The doctor in psychology emphasizes that in a quarter of the patients it has been seen that, if these children already had a sensitive temperament, and then have been raised in normative environments, with a certain overprotective nuance, this has meant for them a “highly dangerous combination” that helps explain a quarter of BPD cases.

The treatment, as recommended, should be around 3-5 years, and should consist of individual therapy, it also says that group therapy is recommended, as well as pharmacological treatment, in addition to advice from social work, on legal issues in case there are to give these people a disability, or a sheltered job.…

How To Detect And Prevent Borderline Personality Disorder?

Rebelliousness, irritability, and fear are characteristic of adolescence, although when they are combined with impulsive reactions, isolation, substance abuse, and lack of self-confidence, they can be signs of the presence of a borderline personality disorder (BPD).

It is a group of disorders of psychiatry and psychology that is characterized by alterations in behavior, but not in judgment, so they have preserved thinking. But they do have behavioral changes such as suicide attempts, addictions, or rebellion.

Young boys who are taken for being rebellious, and impulsive, have a self-image or self-confidence disorder underneath and, therefore, have a significant problem of immaturity.

In this sense, the cause of the appearance of this disorder is due to a biological-genetic predisposition, but also due to educational factors that have to do with the absence of healthy bonds in childhood, situations of abuse or abuse, bullying, substance use in early adolescence or having suffered from attention deficit hyperactivity disorder (ADHD) in childhood.

It is closely related to bullying because in most cases they present either some type of abuse in childhood, a situation of detachment, or problems of ‘bullying’ around the ages of 10 and 12. This is important and is significant when it comes to knowing when to start prevention, commented the expert.

However, and as a result of the fact that these signs are often confused with the personality of adolescence, only a third of those affected receive adequate treatment.

The expert has recognized that BPD has not been treated “well” by the medical community because, as there are no thought disorders, they have been considered to be only “stubborn, annoying and, at times, defiant” people. The appropriate treatment, which allows a normal life during adulthood, consists of continuous care, psychotherapy, and intense psychological rehabilitation, both for the patient and her own family, which plays a “very important” role in the development, maintenance, and evolution of the disorder and also needs “a lot of help and advice” because they are young “very difficult to manage”.

In addition, and especially at the beginning of therapy, pharmacological treatment is also required to control and improve mood, reduce anxiety and produce emotional stabilization so that the patient does not react in an “explosive” way. The earlier this disorder is detected, the better the treatment, which requires time and needs to be carried out in an affective bond through the therapeutic team that helps the patient to promote self-knowledge of emotions, identity, self-image, and, in addition, It teaches you skills to regulate emotions, control behavior, and improve social skills.

Nursing Approach To Borderline Personality Disorder

The first thing these people have to face is the stigma of their disorder, whether it be their own, family, social or institutional. On the other hand, these are patients who encounter “great barriers” on a day-to-day basis, let’s not forget that their greatest difficulty is having the ability to regulate their emotions and feelings, which leads them to extreme situations both emotionally and emotionally as well as behaviorally.

The functions of nursing professionals in this field are very diverse, framed in the work of a multidisciplinary team, and aimed at promoting the autonomy and empowerment of the affected person.

In this way, nursing work ranges from psychoeducation, therapeutic support, behavioral management, the application and supervision of treatments and containment measures, to intervention in the event of a crisis.

In addition, the support and advice to the family environment is a fundamental part that the nursing staff develops, together with the rest of the team.

Thus, the nursing procedures and techniques applied to address BPD will vary depending on the situation in which the patient finds himself. To do this, professionals use “the Nursing Care Process, through which personalized care is provided and adjusted to the phase we are facing.”

Daily work with people with a borderline personality disorder is “complex”, explains this nurse, based on the person and their environment, with a relational component that makes “the day very intense”. In the first place, the day begins with a reading of all the incidents that occurred the previous day and a sharing of all the members of the therapeutic team. Next, and according to the individual patient care plan, “the development of each of the appropriate interventions begins.”

“During the day, the nurse must be able to respond to the needs of the person with borderline personality disorder in a non-threatening way”, observing the patients perceive any significant changes. In addition, it is also common for professionals to offer care to those affected, in a group or individually, “providing tools and strategies with which both the patient and their environment can accept the disorder and live with it, helping them to identify any risk situation to be able to deal with it.”

Communication and nursing education

In this way, the approach to communication with this type of patient varies depending on the situation or the person with whom one is interacting. For this process to be correct, we must take into account several aspects, such as active listening, avoiding generalizations, leaving response time, using appropriate language, or choosing the place where we can speak. In addition, it is very important to respect silences and “of course, non-verbal communication.

Regarding the nurse-patient relationship, the aforementioned becomes “crucial”; that is, “the better the communication with the person, the better bond will be established, which will allow detecting any change or preventing relapses in the person with personality disorder”. Through the relationship of help and empathy, the creation of these ties between the two parties can be favored.

What we need for the helping relationship is to offer resources to the other person, to overcome and adequately face a difficult situation, focus on their needs and accompany them”. On the other hand, when it comes to empathy, it can be said that it is the main tool in this helping relationship; This last one is an attitude, It allows us, professionals, to capture and understand the world of the other while being aware of our internal world. Being close but with professionalism: that is the barrier.…

Variations On The Personality Over The Years

When BPD was first described, its symptoms were thought to border on what were then the two main categories of psychiatric problems: psychotic illnesses and neurotic disorders.

Both the concept of BPD and the diagnostic classification of psychiatric disorders have evolved since then.

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) removed neurosis as a diagnostic category, and authors working on the next edition have proposed changes that would further distance BPD from psychotic disorders such as schizophrenia.

Because BPD is a particularly severe form of personality disorder, those affected often make up a relatively large proportion of patients in mental health treatment.

• It affects 1% to 2% of American adults, but approximately 10% of psychiatric outpatients and 15% to 20% of inpatient psychiatric patients.
• Between 69% and 80% of BPD patients have suicidal behavior (including suicide attempts and life-threatening actions), and up to 9% of BPD patients die by suicide.

For many years, childhood adversity and abuse, particularly sexual abuse, were considered major risk factors for developing BPD.

Some studies reported that 81% to 91% of BPD patients had experienced abuse as children.

But other researchers have argued that risk is not the same as causation and that some of the earlier studies may have been subject to recall bias, especially when patients were consulted years later.

The current thinking about BPD is that it develops due to the interaction of multiple factors, such as trauma in children who are temperamentally or genetically vulnerable. Family and twin studies suggest that BPD is 69% heritable, meaning that genes account for the majority of susceptibility to developing this disorder.

Studies conducted by researchers at the University of Washington have concluded that dialectical behavior therapy is effective in reducing self-mutilation and suicide attempts, as well as the number of days spent in psychiatric hospitals.

In a study involving 101 women with BPD who had attempted suicide at least twice in the past five years, researchers randomly assigned half to treatment with dialectical behavior therapy and the other half to treatment by medical experts (defined as experienced and associated with prestigious institutions). ) Both interventions lasted one year.

The researchers found that patients who underwent dialectical behavior therapy were half as likely as others to attempt suicide and were less likely to self-mutilate or be hospitalized.

Therapists focus on building the therapeutic relationship and use techniques such as guided imagery, assertiveness training, and role-playing to help the patient cope with daily experiences and past traumatic events. Essential psychological schemes have restructured the help the manifestations of fear. Therapy must continue for at least two years to be effective.

In a randomized, controlled study involving 86 patients, researchers at the Academic Hospital Maastricht in the Netherlands compared schema-focused therapy with transference-focused psychotherapy.

The patients underwent therapy twice a week for three years. Both treatments relieved BPD symptoms and improved patients’ quality of life and psychological functioning.

In general, however, schema-focused therapy was more likely to lead to recovery.

At the end of the study, 46% of patients assigned to schema-focused therapy (20 of 44) had recovered (as defined by a clinical instrument that assesses BPD symptoms), compared with 24% of those assigned to transference-focused therapy (10 of 42).

One long-term study reported that mentalizing-based treatment reduced the use of antipsychotics and the number of suicide attempts, and increased the chance of recovery five years after completing treatment.

Because the researchers conducted their initial research in a partial hospital setting, they conducted a separate study in an outpatient setting.

In an 18-month study, they randomly assigned 134 patients with BPD to mentalizing-based treatment or structured clinical treatment (consisting of case management, supportive counseling, and problem-solving sessions).

Although patients in both interventions improved significantly (measured by a decrease in suicide attempts, hospitalizations, and other crisis events), those assigned to mentalization-based treatment improved substantially more than those who received structured clinical treatment.…