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Borderline Personality Disorder

Walker and Kulkarni 2020 state that borderline personality disorder (BPD) is characterized by emotional dysregulation, an unstable sense of self, difficulty forming relationships, repeated self-destructive behaviors with an elevated risk of suicide. People with BPD having continual changes to their self-image, mood and conduct that often times lead to impulsive behavior and relationship turmoil. BPD is usually caused by a major trauma, physical, sexual, and emotional abuse.

According to Parker and Naeem 2019 there is no pharmacotherapy regimen that improves the overall symptoms of borderline personality disorder; however, when used for six months or less, antipsychotics can improve paranoia, dissociation, mood lability, anger, and global functioning in clients with BPD. A 2011 meta-analysis evaluated the effectiveness of first- and second-generation antipsychotics on improving specific symptom domains of borderline personality disorder, with aripiprazole (Abilify), olanzapine (Zyprexa), lamotrigine (Lamictal), topiramate (Topamax), omega-3 fatty acids, and valproate (Depacon) showing that when used for six months or less, they can decrease anger, anxiety, depression, and impulsivity (Parker and Naeem). As it relates to psychotherapy Wheeler 2014 states that dialectical behavior therapy (DBT) is the best option for clients with BPD, because of the use of coping skills for emotional regulation. DBT involves the application of cognitive and behavioral strategies but also has a number of additional characteristics, and some of its defining characteristics include the dialectic between acceptance and change processes; the active teaching of skills in emotion regulation, interpersonal effectiveness, distress tolerance and mindfulness; and the use of validation strategies.

 The strength of the therapeutic alliance increases the likelihood of engagement in psychotherapy, medication adherence and improved functional outcomes; therefore, it is most important prior to start building this alliance from the first meeting with the client during the intake process (Easter, Pollock, Pope, Wisdom & Smith, 2016).   That said, when explaining the disease process, it’s very important to help the client understand that they have a disease that can be treated, just like any other disease. Explaining, that like many other diseases, it takes working together with the clinician and the client to come up with a viable treatment plan. This will help them overcome, somewhat, the stigma that is attached to having a diagnosis of BPD.

Reference:

Easter, A., Pollock, M., Pope, L. G., Wisdom, J. P., & Smith, T. E. (2016). Perspectives of Treatment Providers and Clients with Serious Mental Illness Regarding Effective Therapeutic Relationships. The Journal of Behavioral Health Services & Research, 43(3), 341–353. https://doi-org.ezp.waldenulibrary.org/10.1007/s11414-015-9492-5

Parker, J. D., & Naeem, A. (2019). Pharmacologic Treatment of Borderline Personality Disorder. American Family Physician, 99(5), Online.

Roscoe, P., Petalas, M., Hastings, R., & Thomas, C. (2016). Dialectical behaviour therapy in an inpatient unit for women with a learning disability: Service users’ perspectives. Journal of Intellectual Disabilities : JOID, 20(3), 263–280. https://doi-org.ezp.waldenulibrary.org/10.1177/1744629515614192

Walker, P., & Kulkarni, J. (2020). Re-framing borderline personality disorder. Australasian Psychiatry : Bulletin of Royal Australian and New Zealand College of Psychiatrists, 28(2), 237–238. https://doi-org.ezp.waldenulibrary.org/10.1177/1039856219889304