Abstract This paper includes an extensive literature review of the role of trauma in the development of BPD, along with a clinical case study of a girl with BPD, and a transcript of an actual conversation between therapist and patient. BPD is characterized by a combination of impulsive, emotional, and cognitive deficits in personality functioning. The disorder seems to develop as a result of early childhood trauma, especially traumatic experiences related to parental neglect and abuse. Children who are classified as being highly abused tend to have greater tendencies toward developing BPD than non-abused children. This paper explores the association between childhood trauma and the development of borderline personality disorder in adult females.
From the Paper "Borderline Personality Disorder is characterized by an array of symptoms that are most prevalent in females. According to the DSM-IV, BPD is defined as: A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: 1. Frantic efforts to avoid real or imagined abandonment 2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. 3. Identity disturbance: markedly and persistently unstable self-image or sense of self. 4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). 5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior. 6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days). 7. Chronic feelings of emptiness. 8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights). 9. Transient, stress-related paranoid ideation or severe dissociative symptoms. (American Psychiatric Association, 1995) "
Abstract This paper discusses borderline personality disorder (BPD), a complex and severe psychopathology that is characterized by the presence of certain instabilities. According to the paper, the most commonly practiced interventions for the treatment of BPD are psychodynamic programs and dialectical behavior therapy (DBT). The paper goes on to review DBT, which is based on dialectical philosophy and a biosocial theory of BPD.
Outline:
Mechanisms of Change in Dialectical Behavior Therapy (DBT)
Research Supporting DBT
The Effectiveness of DBT in Males Versus Females
DBT Intervention Development
From the Paper "The benefits of DBT experienced by individuals with BPD may be enhanced through accompanied administration of psychopharmaceutical medication. Soler et al. (2005) examined the combined effects that DBT and olanzapine have on psychiatric symptoms experienced by individuals with BPD. Results of the study showed that this combined treatment was associated with significant improvements in anxiety, depression and aggressive/impulsive behavior in comparison to a placebo group. The researchers suggested that this combination therapy of DBT and olanzapine acts to lower attrition rates and is an overall effective treatment for BPD (Soler et al., 2005). Other pharmaceuticals may not prove to be so beneficial. A study by Simpson et al. (2004) demonstrated that the addition of fluoxetine to an already effective DBT treatment program is not additionally beneficial."
Abstract The paper reveals that borderline personality disorder (BPD) is an increasingly common diagnosis amongst American psychiatric patients. The paper covers three specific areas related to BPD; (1) a description of BPD, including its symptoms, diagnosis and treatment protocols, (2) comorbidities which can commonly occur with BPD and how they can differ from patient to patient and (3) a review of current research to demonstrate new findings in the diagnosis and treatment of BPD.
Outline:
Introduction
Causes of BPD Comorbidities with BPD Treatment for BPD Newer Methods in Treating and Diagnosing BPD Conclusion
From the Paper "BPD's definition has changed over time. The current description of BPD includes antisocial disorder, eating disorder and generalized anxiety.
A complete list of BPD's diagnostic signs includes emotional vulnerability, self-invalidation, unrelenting crises, inhibited grieving, active passivity and apparent competence. This last symptom may seem contradictory to the earlier signs, but means that the individual may present him/herself as being much more competent than they really are. Thus, as with the earlier diagnostic signs, a basis of low self-esteem and deceptive behavior is consistent with that symptom(2), BPD is often associated with affective disorder in 66% of cases, according to initial studies(3)."
Abstract This paper explains that individuals with Borderline Personality Disorder (BPD) are afflicted with a continual state of emotional conflict and chaos, often swinging from one extreme of emotion to another. Patients with BPD are traditionally known to exhibit symptoms of depression, anger and anxiety at varying times and traditionally demonstrate self injurious behavior. The paper contends that the road to treatment and recovery is often a different one, as traditional psychotherapeutic approaches often fail treating patients with BPD. The paper presents recent evidence that suggests that an integrative approach for treating BPD is best. This type of approach would combine cognitive behavioral therapy, pharmacological intervention and traditional psychotherapy techniques to find the best possible outcome for BPD patients.
Outline
Introduction
DSM-IV for Borderline Personality Disorder
Cognitive Behavioral Perspective
Conclusions
From the Paper "Because borderline personality disorder is complex in nature and difficult to label, differential diagnostic criteria and theoretical orientations have been established for assessing the disorder (Cottrell & Jones, 2000). Thus a therapist might encounter differing behavioral, symptomatic and psychodynamic formulations and findings that form the basis of diagnostic categorization of BPD (Cottrell & Jones, 2000). Differential diagnostic criteria may include: identity diffusion, contradictory aspects of self and others, splitting defenses, projective identification, idealization and omnipotence as well as denial and de-valuation of the self (Cottrell & Jones, 2000). The specificity of borderline personality disorder remains in question however because patients vary in symptomology and personality despite fitting into diagnostic criteria (Cottrell & Jones, 2000). "
Abstract This paper presents the work of many researchers who have studied the connection between childhood abuse and the development of borderline personality disorder. The author believes that chronic abuse leads to dysfunction in the processes of ego and personality development, attachment and affective stability. The paper concludes that the traumatic effects of physical and sexual abuse on the development of borderline personality disorder need to be examined in light of other potential etiological factors such as genetic predisposition, neurotransmitter imbalances, and other avenues that are currently receiving attention in the BPD research community. Abstracts and excerpts from Articles.
Table of Contents
Introduction
Abuse and BPD Statistics
Physical and Sexual Abuse
Conclusions
From the Paper "Wilkins has also found that the chaotic behavior associated with borderline women is a reaction to traumatic experiences. Unable to gain security from their relationships, a dysfunction of the attachment system occurs. The symptoms associated with BPD diagnosis, therefore, can be seen as a reaction to early relationships with significant others, perceived trauma, and experiences of real abuse, which are then internalized. The adaptive behavior of the borderline adult is a direct consequence of the messages received in childhood. They frantically seek to avoid further abandonment and isolation."
Abstract This paper describes bipolar disorder and its comorbidities. It also describes the emerging bipolar spectrum, which is a new way of looking at bipolar disorders. The paper also describes borderline personality disorder (BPD) and describes the arguments for and against its inclusion within the bipolar spectrum. It particularly describes the similarities between BPD and bipolar disorders.
Table of Contents:
Abstract
Axis I Comorbidity
Axis II Comorbidity
Bipolar Spectrum and Temperament
Do Some Diagnoses Deserve a Bipolar Subgroup?
From the Paper "The understanding of bipolar disorders is in a state of flux. Traditionally, the disorder was defined as a period of severe manic and depressive episodes with periodic switches between these two poles and was referred to as manic- depression, and now bipolar disorder I. In the 1980's, it was recognized that there were clinical manifestations resembling manic-depression, however, the extremes in mania were not as severe (hypomania). This was termed bipolar II disorder. In situations where an individual experiences 2 or more years of the hypomanic symptoms with subthreshold periods of depressive symptoms a diagnosis of cyclothymic disorder is made. These diagnoses are included in the DSM-IV."
Abstract The paper discusses various treatments available for the borderline personality disorder. The paper looks at transference focused therapy (TFP), selective serotonin reuptake inhibitors (SSRI) and dialectical behavioral therapy (DBT). The paper emphasizes that, as with other disorders, treatment effectiveness can vary from one patient to another. The paper relates that further research is being conducted on BPD by the National Institute of Mental Health and other researching bodies.
From the Paper "The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision [DSM-IV-TR] (American Psychiatric Association [APA], 2000) defines borderline personality disorder (BPD), an Axis II personality disorder, as "a pattern of instability in interpersonal relationships, self-image, affects, and marked impulsivity" (p. 686). To meet the DSM-IV-TR's diagnostic criteria for BPD one must present by early adulthood, with five of the eight behaviors associated with borderline, which may include, but are not limited to: a pattern of unstable relationships, irrational fear of abandonment, suicidality, self-mutilation, identity disturbance, self-damaging impulsivity, poor self-concept, and a constant feeling of emptiness."
Abstract This paper examines the prevalence of manic depression (or bipolar disorders) in children and adolescents. It discusses the symptoms and the diagnosis and describes the difficulties in diagnosis due to the complexity of bipolar disorder (BPD) in children and adolescents. It also looks at how these difficulties in diagnosis affect the ability to treat the disorder.
Table of Contents:
Introduction
Diagnosis in Children and Adolescents
Outpatient Treatment
Specific Outpatient Treatments
Inpatient Treatment
Medication
Comorbid Diagnosis: Attention Deficit Hyperactivity Disorder
Comorbid Diagnosis: Substance Abuse
Methodology
Conclusion
From the Paper "As a result of the research reviewed, future research should examine the effectiveness of specific family interventions such as IFT, FFT, and CBT, due to the profound impact families have on the success of treatment in youth with BPD. Empirical research should be developed to conclude best practice therapeutic techniques for the reduction of depression and mania in children, as well as pharmacological interventions. It would be useful to study, over a period of at least six months, the efficacy of specific family treatment modalities in bipolar diagnosed children. This would be based on psychotherapeutic goal achievement in areas such as social, emotional, and school functioning while focusing on family interaction and education. Controlled and experimental groups are needed to empirically determine which psychosocial approaches demonstrate the greatest efficacy (Rivas-Vazquez et al., 2002)."
Abstract The basis of this study looks at the effects of a therapy derived from eastern Zen practices and western psychodynamic theory, known as Dialectical Behavioral Therapy, on the treatment of patients afflicted with Borderline Personality Disorder. DBT is a treatment paradigm created by Marsha M. Linehan of Washington University, and is the first and only treatment paradigm to be tested in clinical settings. The importance of DBT stems from the belief that BPD is the most treatment-resistant of all mental disorders outlined in the Diagnostic and Statistical Manual: Vol. IV. The study tests the hypothesis that DBT will effectively reduce targeted behaviors of BPD as compared to treatment as usual (TAU) groups, and suggests that because of the structured nature of DBT, it is the most effective of all present treatments of BPD.
From the Paper "Dialectical Behavior Therapy (DBT) is the application of a broad array of cognitive and behavior therapy strategies to the problems of Borderline Personality Disorder (BPD), including suicidal behaviors (Heard & Linehan 1994). DBT also has a number of distinctive defining characteristics. As its name suggests, its overriding characteristic is an emphasis on "dialectics" - that is, the reconciliation of opposites in a continual process of synthesis. The most fundamental dialectic is the necessity of accepting patients just as they are within a context of trying to teach them to change. This emphasis on acceptance as a balance to change flows directly from the integration of Eastern Zen practice with Western psychodynamic theory (Linehan 1993a)."
Abstract This paper is an examination of Dialectic Behavioral Therapy (DBT), an approach to the treatment of borderline personality disorder (BPD) developed by Marsha M. Linehan. The paper shows that BPD is a relatively prevalent psychological disorder that does not respond well to typical therapies. DBT is the only therapeutic approach which has been shown to be effective in lessening the borderline tendency toward suicide and parasuicide. The paper explains that it has also been proven to be useful in keeping sufferers in therapy long enough to begin to treat some of the impulsivity, identity disturbance, intense anger, and other characteristics of this complex disorder. It shows that Linehan's approach is based on her theories regarding the conditions likely to produce BPD and relies largely on a systematic attempt to retrain patients who have previously been unable to deal effectively or realistically with their own emotions.
From the Paper "DBT rests on eight basic assumptions (Linehan, 1993, pp. 106-108). The first is that patients are doing the best they can, the best they know how. The second is that they want to improve. The third is that they need to do better, try harder, and become more motivated to change. The fourth and fifth are that patients may not have caused all their own problems or be responsible for their situation, but, nevertheless, they have responsibility for solving them, as their lives are currently unbearable. The sixth and seventh assumptions are that patients must learn new behaviors and how to apply them, and that they cannot fail in therapy."
Tags: therapeutic, pharmacotherapy, Pamona, Assessment, Center
Abstract The paper discusses many points of similarity between these two disorders: borderline personality disorder (BPD) and obsessive-compulsive disorder (OCD). The paper explains that they both have an emphasis on attachment and both BPD and OCD sufferers are in constant need of feedback and reassurance and are characterized by social ineptitude and self-involvement. The paper emphasizes that the distinct classification of these disorders means that that there are obviously various different identifying symptoms and diagnostic criteria of each disorder.
Outline:
Introduction
BPD OCD
Comparison
From the Paper "One of the most troubling and complex personality disorders is Borderline Personality Disorder or BPD. Borderline Personality Disorder is defined as "... a pervasive pattern of instability in interpersonal relationships, self-image, emotional adjustments, and marked impulsivity demonstrated in a variety of contexts" (UNDERSTANDING BORDERLINE PERSONALITY DISORDER AND OBSESSIVE-COMPULSIVENESS). Another disorder which has been compared to BPD in some respects is Obsessive-Compulsive Disorder or OCD. In simplistic and general terms an individual with OCD is described as someone who experiences "... illogical and irresistible thoughts or impulses that they consider absurd and attempt to resist."
Abstract Borderline personality disorder (BPD) is lifelong, notoriously hard to treat, and includes aspects that have long puzzled researchers. Yet despite this, BPD is a relatively common disorder found in 11% of all psychiatric outpatients and 19% of all psychiatric inpatients. This paper discusses the characteristics of the disorder and then presents the Beck-Young cognitive models and Kernberg's psychodynamic model, of understanding and treating BPD for comparison. In the final part, the author presents his view as to which framework he would prefer to use and why.
From the Paper "The treatment models proposed by the two frameworks first appear to be very different from one another. Psychoanalysis proposes that we are protected from our unconscious thoughts by a variety of defence mechanisms to disguise any unconscious material that might leak into our consciousness. Therefore in therapy, psychoanalysis attempts to expose the unconscious processes and assumes that the ego, relieved of its burden of trying to seal off the unconscious material, will then provide realistic corrections. In cognitive therapy, the distorted/illogical thought processes are exposed to the patient through reality testing and thus relies to the patient to use her rationality to correct her irrationality (Beck, 1985). Because psychoanalysis for BPD probes into the patient's unconscious and is primarily a 'transference' based technique that does not focus on specific symptoms, it can typically take up to 7 years to complete. On the other hand cognitive therapy for BPD targets symptoms directly and produces results on a much shorter time scale - typically 1-2 years (Beck et al., 1990). "
Abstract "A personality disorder is characterized by an enduring pattern of inner experience and outward behavior that consistently deviates from the expectations of the individual's culture (Linehan, Oldham, & Silk, 1995).
From the Paper "A personality disorder is characterized by an enduring pattern of inner experience and outward behavior that consistently deviates from the expectations of the individual's culture (Linehan, Oldham, & Silk, 1995). Ten personality disorders are currently recognized, and this paper will discuss just one such disorder - borderline personality disorder. It will present a review of the literature on borderline personality disorder, a treatment plan for a patient with the disorder, and discuss the therapeutic alliance between a patient with borderline personality disorder and his/her therapist.
An estimate of the prevalence of personality disorders in a community population is from two percent to 14 percent (Linehan Oldham, & Silk, 1995; Hubbard, Saathoff, Bernardo, & Barnett, 1995; Coreeli, 1998). Although the disorder occurs in both men ..."
Abstract This paper explores two different forms of therapy and their likely impact as counseling aids among a target population. This is done through utilizing a case study approach in which a subject that is representative from the target population receives counseling through these two forms of therapy. Through using the case study approach, it is demonstrated how the use of reality therapy and solution-focuses therapy can potentially impact members of the target population when used in a counseling setting.
From the Paper "The problem of interest in this case study approach is that of neglect and abandonment. Adolescents tend to be driven to find a community in which they belong and they seek to identify themselves with that community."
Abstract The paper attempts to gain qualitative insight on the nature of the psychiatric community's levels of inattention to the treatment of the Axis II disorders. The paper explains that current research is limited regarding personality disorders so a group of researchers planned to publicize the need for research of personality disorders. To best capture the reaction of the therapists on the matter, the research team conceived a plan to commission a thirty-person focus group of therapists, licensed in the Washington, DC Metropolitan area. The paper describes the study in detail.
Outline:
Research Question
Introduction
Method
Participants
Materials
Conclusion
From the Paper "In an exhaustive research effort the researchers associated with this cause found that most of the current research was limited regarding personality disorders. The literature was sparse in comparison to issues related to the Axis I psychological disorders, such as the Mood disorders (Coccaro, 1989). However, in the current journal articles that were published the majority of the information was on Borderline Personality disorder, with little convincing claims regarding the disorders effective treatment options (Staurt, Pfohl, Battaglia. Bellodi, & Grove, 1998). There are fourteen personality disorders listed in the DSM TR V (American Psychiatric Association. 2000) and the research has led to a small number of articles on illness such as Schizoid affective disorder, Narcissistic personality disorder, and Histrionic personality disorder, to name a few. Of the three hundred and fourty-six studies currently sponsored by the National Institute of Mental Health, two studies are related to personality disorders. Thus, the claim that there is a gap in the research of the treatment modalities for personality disorders."
