Univerzita Pavla Jozefa Šafárika v Košiciach

Filozofická fakulta

Borderline personality disorder

Literature review

Predmet: Anglický jazyk II.

Vyučujúci: Mgr. Zuzana Kolaříková, PhD.
Vypracoval: Kristína Čižmárová
Študijný program: psychológia
Forma štúdia: denná
Akademický rok: 2022/23
Semester: letný
INTRODUCTION
Borderline personality disorder (BPD) is a serious mental disorder associated
with severe emotional, behavioral, cognitive and interpersonal dysfunction,
extensive functional impairment and frequent self-destructive behaviour,
including deliberate self-harm and suicidal behaviour. For quite some time, BPD
has been viewed as a chronic disorder and borderline patients as extremely
difficult to treat, doomed to a life of misery. However, those views are changing
and there is an increasing recognition that BPD has a far more benign course
than previously thought.

WHAT ARE THE SYMPTOMS OF BPD?

According to the DSM-5, individuals with BPD exhibit some or all of the
following symptoms:

 Efforts to avoid real or imagined abandonment.

 Intense bouts of anger, depression, or anxiety that may last only hours or,
at most, a few days. These may be associated with episodes of impulsive
aggression, self-injury, and drug or alcohol abuse.
 Distortions in thoughts and sense of self can lead to frequent changes in
long-term goals, career plans, jobs, friendships, identity, and values.
Sometimes people with BPD view themselves as fundamentally bad or
unworthy. They may feel bored, empty, or unfairly misunderstood or
mistreated, and they have little idea who they are.
 Recurrent suicidal behavior.
 Transient, stress-related paranoid thinking, or dissociation ("losing touch"
with reality).
People with BPD often have highly unstable patterns of social relationships.
While they can develop intense but stormy attachments, their attitudes toward
family, friends, and loved ones may suddenly shift from idealization (great
admiration and love) to devaluation (intense anger and dislike). Thus, they may
form an immediate attachment and idealize another person, but when a slight
separation or conflict occurs, they switch unexpectedly to the opposite extreme
and angrily accuse the other person of not caring for them at all.
Most people can tolerate the ambivalence of experiencing two contradictory
states at one time. People with BPD, however, shift back and forth between
good and bad states. If they are in a bad state, for example, they have no
awareness of the good state.

WHAT CAN CAUSE BPD?

Many studies over the last 8 years have linked the diagnosis of borderline
personality disorder to a history of trauma during childhood. Some studies
looked solely at sexual abuse, others at sexual and physical abuse, and still
others included traumas such as witnessing or being involved in other forms of
violence, particularly domestic violence. (Kenneth R. Silk, M.D., Sharon Lee,
M.D., Elizabeth M. Hill, Ph.D., and Naomi E. Lohr, Ph.D. 1995). Despite
methodological differences among studies, all are consistent in finding a high
frequency of reported childhood sexual abuse among patients with borderline
personality disorder. The majority of sexual abuse reported by patients with
borderline personality disorden was not a single, nonpenetrating event with a
stranger. Clearly then, studies that attempt to understand the relationship
between sexual abuse and borderline personality disorder symptoms need to
examine not only the occurrence of sexual abuse but the nature and the severity
of that abuse as well.

Neuroscience is revealing brain mechanisms underlying the impulsivity, mood

instability, aggression, anger, and negative emotion seen in BPD. Studies
suggest that people predisposed to impulsive aggression have impaired
regulation of the neural circuits that modulate emotion. The brain's amygdala, a
small almond-shaped structure, is an important component of the circuit that
regulates negative emotion. In response to signals from other brain centers
indicating a perceived threat, it marshals fear and arousal, which may be more
pronounced under the influence of stress or drugs like alcohol. Areas in the front
of the brain, in the prefrontal cortex, act to dampen the activity of this circuit.
Recent brain-imaging studies show that individual differences in the ability to
activate regions of the prefrontal cortex thought to be involved in inhibitory
activity predict the ability to suppress negative emotion.
Serotonin, norepinephrine, and acetylcholine are among the chemical
messengers in these circuits that play a role in the regulation of emotions,
including sadness, anger, anxiety, and irritability. Drugs that enhance brain
serotonin function may improve emotional symptoms in BPD.
HOW TO TREAT BPD
Evidence-based advances in the treatment of BPD include a delineation of
generalist models of care in contrast to specialist treatments, identification of
essential effective elements of dialectical behavioral therapy (DBT), and the
adaptation of DBT treatment to manage post-traumatic stress disorder (PTSD)
and BPD. Studies on pharmacological interventions remain limited and have not
provided evidence that any specific medications can provide stand-alone
treatment.
Dialectical Behavioral Therapy (DBT)
The most well-known, well researched, and widely available treatment for BPD
is DBT. Informed by clinical experience with suicidal personality disordered
patients who did not improve with standard cognitive behavioral therapy
intervention, Linehan developed DBT by incorporating the concept of dialectics
and the strategy of validation into a treatment focused on skills acquisition and
behavioral shaping. DBT formulates the problems of BPD as a result of the
transaction between individuals born with high emotional sensitivity and
“invalidating environments” that is, people or systems (i.e., families, schools,
treatment settings, workplaces) that cannot perceive, understand, and respond
effectively to their vulnerabilities.
DBT proposes that individuals with BPD can become more effective in
managing their sensitivities and interactions with others through acquisition of
skills that enhance mindfulness and enable them to better tolerate distress,
regulate their emotions, and manage relationships. (Choi-Kain, L.W., Finch,
E.F., Masland, S.R. et al. What Works in the Treatment of Borderline
Personality Disorder. Curr Behav Neurosci Rep 4, 21–30 (2017).

SUMMARY
The findings of longitudinal studies raise doubts about the validity of the
definition in the DSM, which implies that personality disorders must necessarily
be chronic. However, it should be noted that even the most encouraging findings
do not show full recovery since the majority of patients seem to suffer from
some residual symptoms. These findings have very important clinical
implications and borderline patients should be told that they can expect
improvement, no matter how intense their current emotional pain. However, we
still lack evidence-based findings on mechanisms that lie behind the recovery
process in BPD. Future research should explore the mechanisms of recovery in
BPD.
References :
Paris, Joel. "Borderline personality disorder." Cmaj 172.12 (2005): 1579-1583.
Choi-Kain, Lois W., et al. "What works in the treatment of borderline
personality disorder." Current behavioral neuroscience reports 4 (2017): 21-30.
https://www.psychologytoday.com/us/conditions/borderline-personality-disorder
Silk, Kenneth R., Sharon Lee, and Elizabeth M. Hill. "Borderline personality
disorder symptoms." Am J Psychiatry 152 (1995): 1059-1064.
Leichsenring, Falk, et al. "Borderline personality disorder." The
Lancet 377.9759 (2011): 74-84.
National Collaborating Centre for Mental Health (UK. "Borderline personality
disorder: treatment and management." (2009).
Linehan, Marsha M. "Dialectical behavior therapy for borderline personality
disorder: Theory and method." Bulletin of the Menninger Clinic 51.3 (1987):
261.