Borderline Personality Disorder and Substance Abuse Essay

Psychiatric research on Borderline Personality Disorder (BPD) has increased in popularity over the past few decades. It was included into the Diagnostic and Statistical Manual for Mental Disorders (Third Edition) in 1980. Over the years, professionals have found dramatically effective treatments for a disorder that was once considered disabling. Even though Borderline Personality Disorder can be hard to treat, it’s usually comorbid with other disorders like depression and anxiety. Throughout this paper, I will be focusing on background information, symptoms, and treatments of Borderline Personality Disorder.

This article is about Dialectical Behavior Therapy (DBT) and its evidence based treatment for Borderline Personality Disorder (Chapman, PhD & Fraser, 2006). The article also discusses how DBT can be used to help parasuicidal women with borderline personality disorder (BPD) as well as those with Substance Use Disorders (SUDs), binge-eating disorders and depression in older folks (Chapman, PhD & Fraser, 2006). DBT includes aspects of cognitive-behavioral therapy, and cognitive restructuring. The five functions of treatment with DBT are also discussed; enhancing capabilities, generalizing capabilities, improving motivation and reducing dysfunctional behaviors, enhancing and maintaining therapist capabilities and motivation and structuring the environment.

The use of the term borderline has however, resulted in a heated controversy between the health care fraternity and patients. Patients argue that this term appears to be somehow discriminatory and that it should be removed and the disorder renamed. Patients point out that an alternative name, such as emotionally unstable personality disorder, should be adopted instead of borderline personality disorder. Clinicians, on the other hand, argue that there is nothing wrong with the use of the term borderline. Opponents of this term argue that the terms used to describe persons suffering from this disorder, such as demanding, treatment resistant, and difficult among others, are discriminatory. These terms may create a negative feeling of health professionals towards patients, an aspect that may lead to adoption of negative responses that may trigger self-destructive behavior (Giesen-Bloo et al, 2006). The fact however, is that the term borderline has been misunderstood and misused so much that any attempt to redefine it is pointless leaving scrapping the term as the only option.

Co-occurring mental health and substance abuse disorders are quite prevalent in today’s society. Treatment and prevention of co-occurring disorders are both critical topics. Example of co-occurring disorders are the combinations of major depression with cocaine addiction, alcohol addiction with panic disorder, and borderline personality disorder. Although the focus of this is on dual disorders, some patients have more than two disorders. The principles that apply to dual disorders generally apply also to multiple disorders.

Borderline Personality Disorder (BPD) is often associated with internalized aggressions that manifest in suicidal behaviors or self-mutilation, but can result in impulsive, externalized aggression. When the impulsivity and aggression associated with Borderline Personality Disorder becomes externalized towards others is when it can often also result in violent crimes such as domestic violence, property damage, homicide, rape, etc. Borderline Personality Disorder affects between 1-2% of the general population but can be seen to affect around 30% of inmates. In addition, it has been seen that those with antisocial personality also have borderline personality, close to 57% of offenders who have a diagnosis of borderline personality also meet the

BPD affects about four percent of the community, but can be as high as twenty percent in many clinical psychiatric populations. It can be difficult to treat because it responds poorly to most conventional methods of treatment and because of how little we still know about it. There have been many great discoveries about BPD in only a few decades. There are still many questions to be answered about this disorder, but it has gone from a label attached to those who did not quite fit into other categories to a completely separate and somewhat understood mental illness.

4) Gunderson, J. G. (2011). Borderline personality disorder. The New England Journal of Medicine, 364(21), 2037-2042. Retrieved from https://ez.salem.edu/login?url=https://search.proquest.com/docview/869106178?accountid=13657

(Linehan et. al, 1999; Koons et. al, 2001; & Linehan, Dimeff, Reynolds, Comtois, Welch, Heagerty, et al, 2002). Koons et. al(2001), looked at a sample of twenty women veterans who met the criteria for borderline personality disorder. Half of the women received DBT while the other half received treatment as usual (TAU). According to Koons et. al(2001), "Of the 11 variables patients in DBT changed significantly more than did the patients in TAU on 4 variables(suicidal ideation, hopelessness, Beck depression, and anger out). On 4 others only patients in DBT condition changed significantly..(number of parasuicides, number of hospitalizations, anger in, and dissociation"(p.384). In other words those in DBT showed significant more positive change in 8 of the 11 variables than those patients in TAU. Linehan et. al(1999) did a randomized sample of people diagnosed with BPD and SUD. Half of the sample received DBT while the other half received DBT. 64% of those receiving DBT stayed in treatment while only 27% of patients in TAU stayed. Those in DBT also had significant loss in drug abuse than those who received TAU. Those in DBT compared to those in TAU also had greater increases in social adjustment. Linehan et. al, (2002) did a study on a randomized sample of people diagnosed with BPD and SUD who either

1.6 % of adults are diagnosed with BPD each year. It is usually shown that BPD begins in early adulthood/adolescence, but has also been seen to show symptoms in early childhood. (National Institute of Mental Health, 2014) It is unlikely to be diagnosed before the age of 16 (National Center for Biotechnology Information,

“Personality disorders have been documented in approximately 9 percent of the general U.S. population” (Angstman, Rasmussen, 2011). Emotional dysregulation disorder or its common name borderline personality disorder is a very serious and chronic disorder. The Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) describes borderline personality disorder as “a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity that begins by early adulthood and is present in a variety of contexts” (Gardner, 2006). Within the last 20 years, psychologists and other mental health professionals have made tremendous strides in research on what exactly borderline personality disorder, some of its triggers and possible effective treatment options. Borderline personality disorder is defined as a disorder that generates severe emotional instability which can be a springboard that can lead to other stress induced mental and behavioral problems.

Though several personality disorders are highly complex and a challenge to treat, there are effective treatments available (“Treating Borderline” 1). The various treatments are broken down by method, the first of which being cognitive behavioral therapy, which attempts to alter the conscious thoughts and behavioral patterns of patients (Daniel); (“Treating Borderline” 2). Cognitive behavior therapy itself is broken down into two therapies, dialectical behavioral therapy and schema-focused therapy (“Treating Borderline” 2). Dialectical behavioral therapy, developed by Dr. Linehan, is centered on the basis that personality disorders are formed when hypersensitive patients are in situations which lack the emotional support they require, therefore leading to their “inability to regulate emotions” (“Treating Borderline” 2). Thus, the treatment serves to help the patient gain control over their emotion and behavior (“Treating Borderline” 2). The treatment itself consists of group and individual sessions and typically lasts approximately one year (“Treating Borderline” 2). During the group sessions, patients learn to become more aware of their behaviors and emotions through sessions pertaining to “problem solving, mindfulness meditation, and breath training“(“Treating Borderline” 2). In personal sessions, referred to as psychotherapy, the psychiatrist explains to the patient how the lessons from the group therapy sessions are applicable

As the name BPD infers, it was thought to be on the border between psychotic and neurotic behavior. With stigmatizing negative association, BPD is slowly changing to no longer be considered a relevant term for diagnosing. There is a movement to change the terminology of the diagnosis to Emotional Unstable. This new term may more accurately depict what someone is going through as well as remove the negative stigmatism associated with BPD.

This article will examine the benefit and indications of applying one of a contemporary organized psychological theory to a patient that the writer has already worked with as a summative case study. A brief history of the patient ailment which is borderline personality disorder (BPD) will be discussed as well as treatment plan and choices in accordance with a chosen psychotherapy (mentalisation base therapy MBT). The author will legitimize the purpose behind the chosen treatment and conclude his discussion. For Nursing Midwifery Council (NMC, 2012) policy on confidentiality, the patient under discussion will allude to as 'K '.

The history of BPD can be traced back to 1938 when Adolph Stern first described the symptoms of the disorder as neither being psychotic nor psychoneurotic; hence, the term ‘borderline’ was introduced (National Collaborating Centre for Mental Health, 2009, p. 15). Then in 1960, Otto Kernberg coined the term ‘borderline personality organization’ to describe persistent patterns of behavior and functioning consisting of instability, and distressed psychological self-organization (National Collaborating Centre for Mental Health, 2009, p. 15).

Over the past few units, I have greatly expanded my knowledge about several different psychological topics. Though many of the topics that were discussed sparked my interest, there were two types of disorders that furthered my knowledge, but also eliminated some stereotypes that I had about them. The two main areas that I learned more about regarding these disorders were characteristics of the disorders and different methods of treatment. A common theme that has been discussed in multiple different units is that several psychological disorders can have similar symptoms and characteristics. It is crucial to understand what makes one psychological disorder different than another one. Determining what type of disorders an individual might have can lead to better and more accurate treatment options; treatments methods are important because they help individuals manage their disorders. The two disorders that I found to be the most important and most interesting are borderline personality disorder and schizophrenia.