Borderline Personality Disorder

From the 1950s, post-traumatic stress disorder (PTSD) has been associated with far-reaching psychological impacts as a consequence of accompanying clinical manifestations. Further research into the overall impact of PTSD on trauma patients has recently drawn a correlation between the condition and an increased risk of developing debilitating personality disorders such as borderline personality disorder (BPD) (Zanarini, 2018). The result has often been the emergence of an enduring pattern of deviant behavior largely incongruent with a predominant culture and its core values. Patients are often forced to grapple with a degree of impairment and distress which is likely to have a considerable effect on their quality of life. BPD is a complex psychiatric condition whose exact origin is unknown but characterized by mood swings, issues linked to self-image and demeanor. The 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) identifies the continual presence of unstable interpersonal relationships, impulsivity, and problems linked to self-image as major factors to consider in a BPD diagnosis (American Psychiatric Association, 2013). BPD is classified under section 301.83 (F60.3), with its onset becoming apparent during early adulthood. The diagnostic criterion for a BPD diagnosis is based on the presence of at least five of the following symptoms:

  1. Severe feelings of emptiness.
  2. Frantic attempts to avoid real or imagines abandonment.
  3. Unstable self-image.
  4. Impulsivity.
  5. Recurrent suicidal ideations.
  6. A clear pattern of unstable interpersonal relationships.
  7. Affective instability.

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Historical Context of Borderline Personality Disorder (BPD)

The term “borderline personality disorder” was first used by early psychiatrist in 1938 to describe individuals who would tend to regress and revert back to borderline schizophrenia. Included together with this nascent introduction was the condition’s reliance upon specific situations in order to manifest. However, Otto Kernberg presented new findings suggesting that BPD was middle phase of neurosis and psychosis (American Psychiatric Association, 2013). Such individuals displayed an overall inability to develop or foster psychological defense resulting in a worsening of their current state. As a result, BPD patients would resort to projective identification and splitting as a defense mechanism during crises. The next phase in its advancement is then characterized by the emergence of a pattern of major symptoms associated with the disorder. BPD was formally included in the 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-3) in early 1980, although the most appropriate treatment option l remains elusive. This was until the inaugural introduction of dialectic behavior therapy (DBT) in 1993 by Marsha Linehan as one of the most promising treatment options. Ever since, BPD has continuously morphed in definition and scope in order to provide an accurate description of the condition. This process has been delayed, partly by BPD symptoms overlapping with those present in other psychiatric disorders. Its complexity initially prompted psychoanalysts to deem it “untreatable” prior to the introduction of feasible interventions. In 2008, the gravity of BPD as a leading public health concern within the United States resulted in a declaration the National Borderline Personality Disorder Awareness Month and marked every May (Jones, 2014).  BPD’s current recognition as a separate disorder is currently credited with an overall improvement in the diagnostic process to ensure patients are appropriately classified to receive the most suitable care alternative.

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Causes of Borderline Personality Disorder

The exact cause of BPD has long remainedunknowndue to its overall complexity and the fact that experts are yet to fully understand its pathophysiology. Today, the most commonly accepted causes of BPD are genetic factors, brain chemicals anomalies, and deficiencies in neural development.

Genetic factors and individual’s ability to pass genetic material on to their respective offspring is one of the major reasons why it is regarded as a major cause of BPD. It is currently estimated that twins run a 2-in-3 chance of developing BPD from a comparative perspective (Oldham, 2018). Yet, it is important to acknowledge that conclusive proof has not been presented on this claim and one of the primary reasons why this factor must be approached cautiously.

      Brain chemicals anomalies are also associated with BPD cases. The most widely accepted speculation is that persons with BPD also display deficiencies in brain neurotransmitters (Chanen et al., 2017). The result is a compromised communication network where messenger chemicals are unable to transmit signals to different parts of the brain. This may further result in an increased frequency in violent outburst and destructive tendencies.

Problems with neural development are also associated with the emergence of BPD.  Magnetic resonance imaging (MRI) is one of the most accurate techniques to apply to ascertain the actual presence of developmental issues in the brain commonly associated with BPD. The presence of unusual activity in the amygdala, hippocampus, and the orbitofrontal cortex is an indication of defects capable of impacting human behavior (Chanen et al., 2017).

Environmental factors also predispose at-risk persons to developing BPD. Such factors include exposure to abuse, distress as a child, and parental neglect, and growing up around a family member with an adverse health condition such as bipolar disorder (Karmi, 2005).  An unstable family background is also ranked highly among notable environmental factors in terms of its influence in developing BPD.

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Borderline Personality Disorder Treatment

As a rule of thumb, the first line of treatment for BPD is psychotherapy coupled with the use of pharmacological options. Psychotherapy essentially provides an avenue through which patients can discuss their illness and its current impact on patient’s lives. Also discussed during talk therapy is the actual applicability of the intervention based solely on patient’s needs. Ultimately, psychotherapy seeks to improve patient’s ability to function in their current state and in managing their emotions. Psychotherapy also gauges patient’s level of impulsiveness to evaluate whether they are making headway or in need on alternative intervention. The patient is also meant to acknowledge the fractured and poor-quality relationships in their life and work towards improving them while gaining a firm comprehension of the defining elements.

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Dialectic behavior therapy (DTB) is one of the main aspects of psychotherapy and valued in addressing BPD using learned techniques for emotional regulation and improving interpersonal relationships. Mentalization-based therapy (MBT) is a version of talk therapy useful in the management of BPD by acknowledging prevailing thoughts and emotions at any given moment and an appropriate response (Oldham, 2018). MBT urges deep contemplation as opposed to being reactionary. Schema-focused therapy is also suitable as a form of talk-therapy when addressing BPD. It allows patients to identify any unmet desires which may be to blame for their current predicament. This type of psychotherapy ultimately aims to create a framework where these needs are met within a positive and safe space. Additionally, psychotherapy may also involve the application of a 20-week systems training for emotional predictability and problem-solving (STEPPS) to supplement the current psychiatric state. This is part of best-practice in relation to psychiatric management based on case management while addressing psychological aspects of the condition. Antipsychotics and antidepressants are ideal in managing BPD, although internment

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Prevention

One of the most noteworthy aspects of BPD is the actual fact that it is treatable. Since the condition is known for having a severe adverse effect on patients, early intervention is prudent and may allow treatment to occur during the formative stages. Untreated BPD is likely to have a severe impact on patients, with effects ranging from personal to socio-economic implications, leading to a degree of functional disability and a burden of mental disorders (Jones, 2014, p. 60). Patient’s employability is also a major issue of concern since BPD patients have a hard time holding a stable job and may require disability support. Prevention is, therefore, linked to the actual accessibility of mental health screening for mental disorders during the initial onset. This averts what is commonly referred to as “later intervention” when the condition has progressed and become too severe to handle. Prevention efforts should, thus, be anchored in patient education to ensure patients have a firm understanding of the condition, its impact, and how to address it during the determinative stages. BPD is a major cause of disability and a primary reason why early intervention is prudent in persons with the condition to avoid the financial burden associated with the condition.  Current estimates of the yearly financial cost of BPD are currently placed at $14,606 and a further $45, 573 on insurance costs (Chanen et al., 2017). Early intervention is, therefore, necessary as one of the most effective alternatives when aspiring to implement a suitable and timely solution to the condition. The training of clinical staff is also among one of the major aspects of prevention strategies today, especially with regard to the actual application of evidence-based strategies during treatment.

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Cross-Cultural Issues and Borderline Personality Disorder

            A clear and definite intersection exists between culture and BPD. One of the primary concerns when evaluating this particular domain is the role of the contemporary urban environment inn causing symptoms mimicking BPD. Culture among many urban dwellers ultimately becomes a major explanatory tool for pathological behavior. External circumstances within such settings create a sense a degree of transiency in the condition. The actual presence of unresolved intra-psychic concerns results in constant mood swings, unpredictability, and instability among at-risk populations before culminating in suicidal behavior. Passivity among Asian-American and Native-Americans may be to blame for the onset of a pessimistic disposition and psychosis linked to the actual depth of cultural practices among such communities (Elliott & Smith, 2020). Acculturation and the emerging need to fit in exacerbate the condition and may impact an individual’s capacity to cope during highly taxing crises. This is particularly why patient’s background comes into question during routine treatment for BPD, in addition to its overall impact on the individual in question. Awareness of this reality sees the recommendation of some of the most appropriate interventions while identifying a flexible and applicable treatment regimen (Putz, 2020). This cultural intersection is also best addressed by relying upon psychodynamic psychotherapy to maintain stability among patients and ultimately reduce distortions in their outlook at any given moment during its progression. Constant dissection of clients is, therefore, necessary in order to provide additional supportive emphasis based on psychological mindfulness and patient’s attitude to treatment options. Culture is, therefore, a significant concern when subscribing to the most appropriate treatment option and with the aim of guaranteeing improved outcomes.

Biblical Worldview of Borderline Personality Disorder

The Christian Worldview on mental health disorders has always taken the spiritual dimension into account. Thus, the spiritual nature of a psychiatric disorder such as BPD is essential when seeking to avoid the actual impact of mental suffering on individuals. Persons with psychiatric disorders such as BPD typically display a distortion in their thought process and pattern of thought, which is then in conflict with their respective cultures (Lazarus, 2015). BPD greatly affects every aspect of a sufferer’s life and may ultimately result in suicidal ideations due to an overall lack of fulfillment. The implementation of actionable solutions to transform patterns of thought and behavior, therefore, go a long way in ensuring that patients manage their condition appropriately. Corinthians 10: 5 speaks of the importance of taking every thought captive in order to stay in control at any given moment. This will ensure that persons with BPD adhere to recommended solutions to their current problem and steadily work towards ensuring they live in accordance to God’s will. James 1:19 advices Christians to be slow to anger and is crucial in the context of persons with BPD since they are known to regularly display violent outburst due to a heightened irritability. The individual in question should, thus, acknowledge their role in this particular scheme and avoid being pushed to sinful ways.

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Conclusion

Recent research on Post-Traumatic Stress Disorder (PTSD) identifies a clear link between the condition and personality disorders such as borderline personality disorder (BPD). The latter is characterized by poor interpersonal relationships, a distorted self-image, feelings of emptiness, and instability. Over the years, BPD has undergone numerous transformations in its definition and is now included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a stand-alone psychiatric disorder. Genetic factors, chemical imbalances in the brain, neural damage, and environmental factors are some of the primary causes of the condition. Early intervention, patient education, and improving clinical staff’s diagnostic skills also go long way in preventing its onset. Furthermore, considering cultural issues such as residing in today’s modern environment and the Biblical worldview of avoiding scenarios that may lead to sinful ways are also essential in managing the condition.

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