Term Paper: Borderline Personality Disorder Definitions and Historical Foundations

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Borderline Personality Disorder

Definitions and historical foundations

Diagnostic and Statistical Manual of Mental Disorders (DSM

Etiology

DBT

Genetics

Environmental Conditions

Neurological issues

Diagnoses and related issues

Comorbidity

Psychopharmacological approaches

Dialectical Behavioral Therapy

Empirical support

Theoretical aspects of DBT

The dialectical model

Etiology

Praxis

This study is intended to present a clear overview of the characteristics, history, etiology, diagnosis and treatment of Borderline personality Disorder. This disorder has been the subject of much contention and debate over the years and has not only been difficult to define but also to diagnose due to its theoretical and practical proximity to other disorders. The advent of Lineham's Dialectical Behavioral Therapy however has provided a more structured and theoretically integrated approach and means of dealing with and treating Borderline personality Disorder. This study will pay special attention to the emergence and praxis of Dialectical Behavioral Therapy.

The overall intention of the study is to provide an in-depth view of the cardinal aspects relating to a comprehensive understanding of Borderline personality Disorder. To this end only the most important and pertinent aspects have been discussed in an attempt to provide a consecutive and integrate overview, leading to an evaluation of Dialectical Behavioral Therapy. This has also meant that not every aspect or component of Borderline personality Disorder is dealt with. However, the cardinal areas are discussed and analyzed within the space and parameters of the study.

Section one: Overview of Borderline personality Disorder

1. Definitions and historical foundations

Borderline personality disorder (BPD) is defined as pervasive pattern of impulsivity and instability in interpersonal relationships and self-image Its primary diagnostic criteria include extreme efforts to avoid abandonment; instability in relationships, affect, and identity; and reckless impulsivity. (Coker & Widiger, 2005, p. 212)

Another definition summarizes the essence of this complex area as follows:

personality disorder characterized by extreme instability and impulsivity, fear of abandonment and self-injurious behavior." (What is Borderline Personality Disorder?) However these brief definitions do not go very far in exploring or explaining this complex condition. The Diagnostic and Statistical Manual of Mental Disorders summarizes the central aspects of the disorder as follows. "The essential feature of the Borderline Personality Disorder is a pervasive pattern of unstable interpersonal relationships, self-image, and affect. There is marked impulsivity that begins by early adulthood (DSM-IV™, 1994, p. 650).

Furthermore the Internationals Classification of Diseases (ICD-10) refers to BPD as "...the Emotionally Unstable Personality Disorder which is characterized by impulsivity, unpredictable moods, outbursts of emotion, behavioral explosions, quarrelsome behavior, and conflicts with others. " (ICD-10, 1994, p. 228). The ICD-10 divides BPD into two types:

the impulsive type (characterized by emotional instability and lack of impulse control) and the borderline type (characterized by disturbances of self-image, aims, and internal preferences; chronic feelings of emptiness; intense and unstable interpersonal relationships; and self-destructive behavior) (ICD-10, 1994, p. 228).

Borderline personality disorder is a relative newcomer to the arena of diagnosable psychiatric illnesses. Recognition of the complex of Borderline Personality Disorder grew from the original diagnosis of hysteria as a medical condition in the early 1800's. (Hodges, 2003 p 409) The modern origins of the term Borderline stems from an ambiguity and uncertainty in diagnosis; when it was found that a patient manifested a combination of both neurotic and psychotic symptoms. "Many clinicians thought of these clients as being on the border between neurotic and psychotic, and thus the term borderline came into the diagnostic lexicon. "(Hodges, 2003 p 409)

Before the 1970's there were many different terms used to describe a patient exhibiting the symptoms we now describe as Borderline Personality Disorder. In 1938, Stern referred to the borderline between neuroses and psychoses and in 1941 "Zilboorg described a disorder that he considered to be a mild version of schizophrenia; patients with this disorder had disturbances of reality testing, associative thinking, shallowness of affect, and pervasive anger." (Excerpt from Personality Disorder: Borderline) Similarly, Deutch described a group of patients who had symptoms that are now classified as BPD in 1942. These patients had symptoms characterized by a lack of a consistent sense of identity and source of inner direction. Deutch subsequently classified these patients as "as-if personalities" because "...the patients completely identified with those upon whom they were dependent. "(Excerpt from Personality Disorder: Borderline)

Later, Hoch and Polatin were later to create the term pseudoneurotic schizophrenia to describe a disorder characterized by panphobias, pananxiety, and pansexuality. (Excerpt from Personality Disorder: Borderline)

The first description of borderline disorder as a disorder of character was applied in 1959 by Schmideberg. This was followed by Grinker who "...made the first efforts to describe borderline personality through systematic empirical investigation.." (Excerpt from Personality Disorder: Borderline)

In terms of the original Diagnostic and Statistical Manual of Mental Disorders (DSM-I), a patient with the present-day borderline pathology would have been diagnosed as an "emotionally unstable personalities."

At present the DSM-IV reports that the borderline personality has become one of the "...most common of the Axis II presentations in both the public sector and in private practice."(Hodges, 2003 p 409) BPD has throughout its history been considered as a complex that straddled the borders between psychosis and neurosis.

In general terms BPD is characterized by marked instability in functioning; affect; mood; interpersonal relationships; reality testing and manifestation of extreme anger. (Excerpt from Personality Disorder: Borderline) Another general aspect is the dissatisfaction with the projected image of self on others as well as a strong ambivalence as to personal function and purpose. The continuity between BPD from childhood to adulthood is areas that is still unclear and in need off further research.

One of the first and most obvious aspects of Borderline Personality Disorder or BPD is not only the complexity and sometimes seemingly ambiguous nature of the diagnostic criteria, but also the fact that those who suffer for this condition also need to make use of multiple support systems due to the complexities involved in treatment of this disorder.

One of the factors that makes the classification and definition of BDP more complex is that,

The symptoms of borderline patients are similar to those for which most people seek psychiatric help: depression, mood swings, the use and abuse of drugs and alcohol as a means of trying to feel better; obsessions, phobias, feelings of emptiness and loneliness, inability to tolerate being alone, problems about eating.

What is Borderline Personality Disorder?)

However, there are additional aspects that have to be considered in understanding the BDP patient; one of which is the marked difficulty in controlling "ragefulness" and an unusually sharp impulsiveness and ambiguity in relationships.

A they are unusually impulsive, they fall in and out of love suddenly; they tend to idealize other people and then abruptly despise them. A consequence of all this is that they typically look for help from a therapist and then suddenly quit in terrible disappointment and anger. www.bpdresourcecenter.org/what.htm"

What is Borderline Personality Disorder?)

There is also contention and debate as to the exact nature of Borderline Personality Disorder and there are differing perceptions of the disorder from some quarters. There is little doubt that that Borderline Personality Disorder is one of the most controversial diagnoses in psychology today. "Since it was first introduced in the DSM, psychologists and psychiatrists have been trying to give the somewhat amorphous concepts behind BPD a concrete form. "(Borderline Personality Disorder)

One of the most general views of this disorder is Kernberg's explication of what he calls Borderline Personality Organization. (Borderline Personality Disorder) A more scientific approach to the disorder has been taken by Gunderson. An example of the often subtle variations and approach to the meaning and understanding of BDP is clear from the following quotation.

Some researchers, like Judith Herman, believe that BPD is a name given to a particular manifestation of post-traumatic stress disorder: in Trauma and Recovery, she theorizes that when PTSD takes a form that emphasizes heavily its elements of identity and relationship disturbance, it gets called BPD; when the somatic (body) elements are emphasized, it gets called hysteria, and when the dissociative/deformation of consciousness elements are the focus, it gets called DID/MPD. Others believe that the term "borderline personality" has been so misunderstood and misused that trying to refine it is pointless and suggest instead simply scrapping the term.

Borderline Personality Disorder)

Notwithstanding this debate, a clear and comprehensive definition and outline of Borderline Personality Disorder is provided by Beck and Freeman (1990). This definition includes four central markers of the disorder; namely, poorly integrated identity, primitive defenses, relatively firm self-object boundaries (compared to those of a psychotic), and reasonably intact reality testing (also compared to a psychotic). (Boucher, 1999, p. 32)

Beck and Freeman then build on these basic starting points and add the most obvious and characteristic features of the disorder. These include: intense emotional reactions, changeable moods, and great variety of symptoms

Specific indictors of the disorder are as follows.

Diverse assortment of problems and symptoms that may shift

Unusual symptoms or unusual combinations of symptoms

Intense emotional reactions out of proportion to situation; poor anger control

Self-punitive… [END OF PREVIEW]

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