personality disorder

Personality Disorder
Borderline personality disorder (BPD) is characterized by variations in moods, behavior, and self-image. These symptoms usually lead to impulsive actions and challenges in relationships. A person with BPD will always portray excessive anxiety, anger, and depression. The DSM-5 (diagnostic and statistical manual of mental disorders) provides the diagnostic information for psychiatric disorders like BPD and other related conditions. For every disease, the DSM-5 documents the list of symptoms that includes a statement of the number of signs required to warrant the diagnosis of the disorder. The paper comprehensively explores the diagnostic criteria for BPD including the psychotherapy and psychopharmacological treatment and the clinical features of the disease.

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Diagnostic Criteria for BPD
BPD is a condition featured by unstable interpersonal relationships, intense emotions, and unstable self-image (American Psychiatric Association, 2013). The disease is also characterized by impulsivity among other symptoms as indicated by five (or more) of the clinical features listed below:
Ø Frantic efforts with the aim of avoiding imagined or real abandonment
Ø A series of intense and unstable interpersonal relationships usually featured by extremes between devaluation and idealization
Ø Identity substance characterized by unstable self-image
Ø Impulsive behavior manifested by at least two potentially self-destructive behaviors that include extravagance, drug abuse, binge eating, sex or reckless driving
Ø Recurring patterns of suicidal behavior, threats, gestures, or behavior which can be self-harming
Ø Emotional instability in the reactions to daily events which are manifested by intense episodic sadness, anxiety, or irritability
Ø Chronic feelings of emptiness
Ø Excessive anger or experiencing difficulties in controlling the anger as indicated by frequent temperaments, recurring physical fights, and constant anger
Ø Transient, stress-related paranoid ideation or severe dissociative symptoms (American Psychiatric Association, 2013).

Psychotherapy and Psychopharmacological Treatment for BPD
Psychotherapy is the first line treatment for BPD. There are four psychosocial treatments for BPD which include transference-focused therapy (TFP), mentalization-based treatment (MBT), dialectal behavioral therapy (DBT), and schema-focused therapy (SFT) (Skodol, 2016). The TFP applies Kernberg’s model which indicates that excessive early aggression makes the young child to riven her negative and positive images of herself from her mother. The aim of applying TFP in the treatment of BPD is to reduce self-destructive behavior and symptomatology by modifying self-representation. DBT plays a significant role in emotional dysregulation (Beatson & Rao, 2014).
MBT helps in increasing the curiosity of the patient in identifying his or her thoughts and feelings as well as for the other people. There are four life schemas maintaining the dysfunction and psychopathology of BPD patients. These are punitive parent, impulsive/angry child, detached protector and abused or abandoned child. SFT eliminates these dysfunctional schemas controlling one’s life (Skodol, 2016). The psychopharmacological treatment involves the use of various drugs such as antidepressants, anticonvulsants, mood stabilizers, and antipsychotic medications in eliminating the adverse effects of BPD (Ripoll, 2013). Medications such as the antipsychotics have found to be effective in reducing anxiety, impulsivity, aggression, and psychotic symptoms (Bridler et al., 2015).

Clinical Features
A patient with BPD will display various symptoms. Some of these include abandonment-related fears, unstable self-image, self-destructive behaviors, unstable relationships, self-harm, explosive anger, extreme emotional mood swings, and chronic feelings of emptiness among others (Paris, 2018). These clinical features are similar to the ones contained in the DSM-5 for BPD. For instance, identity substance characterized by unstable self-image documented in the DSM-5 criteria is identical to an unstable self-image symptom. Conclusion
The DSM-5 provides a comprehensive list of symptoms for mental disorders and states the number of signs required to rule the presence of a particular condition. The BPD is characterized by numerous clinical symptoms including unstable self-image, self-destructive behaviors, and unstable relationships and self-harm among others. Psychotherapy is the first line treatment for BPD that includes a variety of techniques such as TFP, DBT, MBT, and SFT. Drugs such as antidepressants, anticonvulsants, mood stabilizers, and antipsychotic medications have also been used in the psychopharmacological treatment of BPD.

References


1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
2. Beatson, J., and Rao, S. (2014). Psychotherapy for borderline personality disorder. Australasian Psychiatry, 22(6), 529-532.
3. Bridler, R., Häberle, A., Müller, S. T., Cattapan, K., Grohmann, R., Toto, S., ... and Greil, W. (2015). Psychopharmacological treatment of 2195 in-patients with borderline personality disorder: a comparison with other psychiatric disorders. European Neuropsychopharmacology, 25(6), 763-772.
4. Paris, J. (2018). Clinical features of borderline personality disorder. Handbook of Personality Disorders: Theory, Research, and Treatment, 419.
5. Ripoll, L. H. (2013). Psychopharmacologic treatment of borderline personality disorder. Dialogues in clinical neuroscience, 15(2), 213.
6. Skodol, A. (2016). Psychotherapy for borderline personality disorder.

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