Borderline Personality Disorder And A Clinical Impression

Diane is a twenty-seven-year-old college student with suicidal ideations following an unsuccessful long term love affair. In the last six months had a series of medication and drug overdoses as well as self-harm behaviors (e.g. cutting arms and legs). She had a history of being sexually molested as a minor and was fostered at the age of eight through her adolescent years. Diane has been able to function well at college but lately has had difficulties focusing and feels overwhelmed.

She had made several unwise choices in her intimate relationships which made her believe she is not attractive or intelligent enough to keep the relationships alive. Diane believes is not good at anything as she has “experimented” with both men and women and ended having the same results. Her sexual relationship continued to be manifested by emotional turmoil and instability. Recently at her friend’s house she made a serious suicide attempt by trying to overdose with cocaine.

Diane has started therapy but has found it difficult as she feel the therapist does not help her and give her what she needs; she leaves her therapy sessions unsure if she would survive and will make it to the next appointment. Her friends find it difficult to help her as Diane is always angry at herself and life. Her friends also indicated that she has episodes of depressions in which she isolate from others and does not eat. According to Maddux and Winstead (2008), most persons with Borderline Personality Disorder will show patterns of impulsivity, interpersonal relationship and self-image problems as well as to experience Axis I mental disorders including mood and anxiety disorders (p.235).

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The above clinical case was presented in assignment seven and is a well representation of what personality traits are. The psychopathology of personality traits are enduring patterns of perceiving, relating, and thinking about the surroundings and oneself. When these traits are considerably maladaptive and cause functional problems and subjective distress, they form a personality disorder. According to Maddux and Winstead (2008), most people with psychological problems have a typical manner of feeling, thinking, behaving and connecting to others that are present prior the onset of a clinical disorder (p. 223).

As presented in Diane’s case borderline personality disorder has been seen as something between the border among psychosis and neurosis. It is noticeable by a distinct insecurity in functioning, mood, affect, interpersonal relationships and in some times distortion in reality. According to the American Psychiatric Association (2000), borderline personality disorder is a persistent pattern of instability of self-image, interpersonal relationships, and affects as well as distinct impulsivity that begins by early adulthood. They make hysterical efforts to avoid real or imagined abandonment (p. 706).

The origins and effects of borderline personality disorder include the concept of biologic predisposition along with psychological and environmental factors. During emotional arousal, self images are affected and the person begins to use primal defense methods. According to Mayo Clinic.com (2010), factors that seem likely to play a role in borderline personality disorder are: a) Genetics; some studies (twins and families) proposes that personality disorder may be inherited. b) Environmental factors; many of them have a history of childhood neglect and/or abuse and separation form caregivers. c) Brain abnormalities; research has shown changes in certain areas of the brain concerned in emotion regulation, impulsivity and aggression as well as that certain chemicals that help regulate mood, such a serotonin, may not function properly. To be expected a combination of these problems results in borderline personality disorder (Borderline personality disorder/causes, 2010).

There is also considerable empirical support for a childhood history of physical or sexual abuse as well as neglect and parental variance. Most cases of people with borderline personality disorder experienced post traumatic stress and dissociative disorders. As described in the above case study, borderline personality disorder is an interaction of an emotionally unstable personality with cumulative and evolving series of extremely pathogenic relationship (Maddux, & Winstead, 2008).

Typically, relationships with others are intense, turbulent and unstable with dramatic shifts of complexities in maintaining intimate and close relationships. The person may try or manipulate people and frequently has difficulties trusting others. People with borderline personality disorder also experienced emotional instability and mood swings from lonely depression to irritability and anxiety. Usually they exhibit unpredictable and impulsive behaviors such as gambling, drug and alcohol abuse, promiscuity, physical self-injuries as well as suicide acts or attempts. According to Maddux and Winstead (2008), pathogenic mechanisms of borderline personality disorder are issues of abandonment and exploitative abuse. They usually develop malevolent perceptions and expectations of others as well as persistent feelings of bitterness or rage and the ability to regulate affect (p.235).

Under extreme situations of stress and severe cases they can experience short psychotic episodes in which the loose contact with reality. Still in situations less severe the person will frequently experience significant disruption of relationships and work performance. In most cases borderline personality disorder will develop depression which can cause much suffering and may lead to several hospitalization and serious suicide attempts. Maddux and Winstead (2008) stated that as adults, people with borderline personality disorder may be repeatedly hospitalized due to their affect and impulse dyscontrol, psychotic like and dissociative symptomalogy, and suicide attempts. The risk of suicide is higher with a co-morbid of mood disorder and substance abuse (p. 236).

According to Mayo Clinic.com (2010), for a person to be diagnosed with borderline personality disorder the he or she needs to meet criteria indicated in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and experienced at least five of the following symptoms:

Extreme fears of abandonment

Unstable sense of identity or self-image

Self destructive behaviors and impulsivity

Self-injuries and suicidal behaviors

Extensive mood swings

Persistence feelings of emptiness

Anger problems such as losing temper and having physical fights

Episodes of paranoia and/or loss of contact with reality

The treatment for borderline personality disorder includes psychotherapy allowing the patient to talk about the difficulties about past and present experiences with an empathetic and non-judgmental way. It is imperative that the therapy be structured and consistent motivating the patient to talk about his or her feelings rather than release them in a usual self-defeating way. Because most of the patients have a co-morbid Axis I disorder (e.g. Major Depressive Disorder) medications such as antidepressants and in some cases antipsychotic are helpful during treatment. According to Maddux and Winstead (2008), sessions should emphasize the building of a strong therapeutic association, monitoring self-destructive and suicidal behaviors, validation of suffering and abusive experience and the promotion of self-reflection rather than impulsive actions (p. 238).

Hospitalization sometimes can be necessary throughout extremely stressful episodes if self-destructive behavior and/or suicide threaten to go off. This is necessary as may provide temporary shelter from external stress. Therapeutic goals may include improved self-awareness, impulse control and improved stability of relationships. It is also important that the patient learn how to cope with anxiety and alleviate mood disturbance symptoms. Maddux and Winstead (2008) indicated that dialectical behavior therapy has shown to be for the most part effective treatment for borderline personality disorder. Dialectical behavior therapy is a derivative form of Zen Buddhist principle of overcoming suffering through acceptance. Pain can be conquered when it is accepted as an unavoidable and fundamental part of life (p. 238).

With increased awareness and the ability to develop introspection and/or self-observation the patient will be able to make changes in his/her unhealthy patterns developed earlier and prevent them from repeating itself over again. In order to increase the chances of success, is imperative that the patient follow the treatment plan, practice healthy coping skills, learn about the condition and possible triggers as well as getting treatment for other related problems such as substance or alcohol abuse and having a good support system. Maddux and Winstead (2008) stated that dialectical behavior therapy teaches coping skills focused on emotional control and interpersonal relationships. The person eventually during individual sessions with the therapist will be able to discuss any problems applying the new skills (p. 238).