Research Paper: Borderline Personality Disorder the Following Research Report

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Borderline Personality Disorder

The following research report focuses on a population at risk, those diagnosed with Borderline Personality Disorder. The report is offered in three sections. Part I provides an examination which looks at statistics related to the disorder. A definition of the disorder is given, with implicit defining characteristics of the population at risk. Causes are discussed with a relevant literature review. Social justice issues are looked at, with a discourse offered on factors of social oppression related to the population at risk. Part II discusses two courses of treatment with associated issues related to Borderline Personality Disorder, with an in-depth review of Mentalization therapy Dialectical Behavior Therapy. Part III discusses the political and social context of the issues relevant to the population at risk. Research on the NASW Code of Ethics is offered. The strengths perspective is discussed and the role of the Advanced Generalist Model is examined for finding treatment solutions to the at-risk population of those diagnosed with Borderline Personality Disorder. A conclusion is offered to highlight the salient points of the report and to synthesize the topics.

The At-Risk Population: Borderline Personality Disorder

The population-at-risk chosen for the following report are those people that have been diagnosed with Borderline Personality Disorder (BPD). This population was selected due to their high rates of hospitalization, suicide attempts, and suicide. Suicide rates for this population are estimated at 8-10% (Paris, 2002). People diagnosed with BPD typically face a chronic and long-term debilitating psychiatric condition, for which traditional therapies have proven of limited effectiveness. The lifetime prevalence of those diagnosed with BPD in the general population is approximately 5.9% according to a recent study (Grant, et al., 2008), being equally prevalent between men and women (Grant, et al., 2008). Extreme states of physical and mental disability are features of this disorder, especially among women. Psychiatric hospitalizations of those identified with Borderline Personality Disorder are on the magnitude of 20% (BPD Today, 2010).

Borderline Personality Disorder Definitions

Borderline Personality Disorder is a disorder of emotional regulation. People with this diagnosis have extreme difficulty regulating their emotions. Approximately 50% are clinically depressed, and 25% are classified with Post Traumatic Stress Disorder as well (BPD Today, 2010). Sexual abuse as a child is strongly associated with development of BPD, and some studies suggest between 40%-70% of those with BPD have been sexually abused (Bohus, Priebe, Dyer, & Steil, 2009). People with BPD often report severe childhood emotional trauma. Additionally, people with BPD may have predisposing factors, such as genetics, brain and neurobiological issues, and other environmental variables. Moreover, BPD may result from an inability to effectively deal with adolescent stress events (Zanarini & Frankenburg, 1997).

The Diagnostic and Statistical Manual of Mental Disorders defines Borderline Personality Disorder in Axis II, Cluster B Axis II disorders include personality disorders and mental retardation. Category B. includes dramatic, emotional and erratic disorders, such as BPD (American Psychiatric Disorders, 2000). Some critics have stated that BPD should not be on the Axis II disorders, but should instead be moved to Axis IV, which includes psychosocial and environmental issues that contribute to the disorder, or Axis I, which includes clinical, learning, and major mental disorders (New, Triebwasser, & Charney, 2008).

People with BPD experience episodes of intense emotional instability, such as anger, anxiety, aggression, self-injury, or some type of substance abuse. These instances may last for a few hours to a day, yet be of a chronic, long-term nature. These people have distorted cognitions of themselves, and often view themselves as of low value, bad, and unworthy. Maintaining relationships is difficult for a person with Borderline Personality Disorder, and they may range from idealization of their significant other, to devaluation of that person, based upon some small infraction that is out of proportion to reality. Due to their intense emotional disregulation, people with BPD have trouble with social relationships as well. They are extremely sensitive to any criticism, perceiving these as some type of personal rejection. Responses to their emotional distortions on others are anger, distress, fear, aggression, and depression.

The DSM-IV-TR gives the following diagnostic criteria for Borderline Personality Disorder (summarized): frantic efforts to avoid abandonment; a pattern of unstable relationships; unstable image of self; impulsive self-destructive behavior; recurrent low-injury threshold suicide attempts and self-mutilation; highly reactive mood states such as irritability; feelings of emptiness; frequent displays of temper; and stress-related ideation (American Psychiatric Disorders, 2000, p. 710).

Causes

Genetics

Borderline Personality Disorder may be attributed to physiologic biochemical factors, brain abnormalities, environmental factors, or trauma-related issues. Abuse and neglect, often as a child, are strong predictors of developing Borderline Personality Disorder, especially if the child has been identified as ADD or ADHD, with increased risk if accompanied by factors of Conduct Disorder before age 15 (Zanarini & Frankenburg, 1997). A combination of genetics and environment is thought to contribute to BPD; first-degree biological relatives with BPD indicate a five-fold increase in the possibility of developing Borderline Personality Disorder than compared to the general populace (American Psychiatric Disorders, 2000).

Being a victim of some type of violence, especially rape, is a strong predictor of an adult developing BPD. If the violent event has resulted due to poor judgment or risky behavior, these factors support a diagnosis of Borderline Personality Disorder as well (Bohus, Priebe, Dyer, & Steil, 2009).

People diagnosed with BPD often display abnormal brain neural circuitry regulation in emotion regulation. The prefrontal cortex of the brain is involved in dampening fear and stress responses which originate in the amygdala, located in the deep brain structures. MRI imaging of people with BPD show a marked decrease in prefrontal regulation of amygdala-generated neural responses (Ruocco, Medaglia, Ayaz, & Chute, 2010). Additionally, people with BPD have decreased activity in certain brain neurotransmitters, such as serotonin, dopamine, acetylcholine, and norepinephrin, likely due to genetic factors that are aggravated in stress situations (Steele & Siever, 2010). Drugs that act to enhance and sustain levels of these neurotransmitters in the neuron's pre-synaptic gap for longer periods tend to reduce symptoms of Borderline Personality Disorder. Drugs that stabilize the inhibitory neurotransmitter GABA are shown to help stabilize the mood of those with BPD as well, reducing the ideation-mood disturbance episodes common in BPD (Stoffers, Vollm, Rucker, Timmer, Huband, & Lieb, 2010).

While there is a complex interplay of the causes and triggers of BPD, studies exist which attempt to explain discrete elements of the causes of the disorder. Distel et al. (2009) report that 35-45% of the variance in BPD can be explained by genetic factors, though the study did not find much evidence of the cultural transmission of the disorder from parent to offspring, suggesting a strong role for genetics (Distel, et al., 2009).

Bornovalova et al. (2009) state that results from longitudinal twin studies supports a causal link for genetics and environment in BPD, with an overall decline of BPD characteristics with advancing age. This last factor also supports the role of genetics being influenced by the environment in BPD, as greater stability in work, social, and personal relationships tends to be increase in the fourth decade of life and beyond (Bornovalova, Hicks, Iacono, & McGue, 2009).

Abuse, Neglect, Violence, and Trauma

People with Borderline Personality Disorder have reported to be the victim of some type of traumatic event, most likely a violent abuse situation, with sexual abuse being the most commonly reported abuse for women. This event typically occurs in childhood, though BPD can result from adolescent and adult-related trauma as well (Paris, 2002).

McLean and Gallop (2003) report that women who have experienced sexual abuse as a child had significantly higher associations of developing BPD than if they experienced the abuse as an adult, though both groups exhibited early symptoms of both Borderline Personality Disorder and post-traumatic stress disorder (McLean & Gallop, 2003).

People with BPD often verbally attack and verbally abuse those they have relationships with. Indeed, the BPD person was often similarly verbally abused in their past as well. Borderline Personality Disorder often follows the patterns of abuse that the person with BPD has experienced in the past, with the BPD person inflicting domestic (spousal) abuse, physical and emotional abuse of strangers, child abuse, and self-abuse. Breaking the cycle of pain and abuse entails a comprehensive therapeutic approach in both cognitive psychiatric services and pharmacological intervention (Grant, et al., 2008).

Social Justice Issues

The concept of social justice has different meanings in different paradigms of study and thought; for purposes of this report, social justice refers to those diagnosed with Borderline Personality Disorder who have experienced inequality and unfairness due to their disorder. This social justice aspect of the disorder contributes to the risk that this population is encountering.

People who have BPD encounter difficulty in the work environment. This presents a challenge to employers as they struggle to deal with the disability issue at hand. The employee with BPD may not be recognized as having a mental illness, and instead seen as a disruptive element in the workplace. They may be ostracized, demoted, or… [END OF PREVIEW]

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