Therapy For Personality Disorders Essay
Therapy For Personality Disorders Essay
Description of the Condition Selected
The selected personality disorder is borderline personality disorder (BPD). The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) lists 10 personality disorders divided into the 3 clusters (A, B, and C). BPD is 1 of 4 Cluster-B disorders that include borderline, antisocial, narcissistic, and histrionic (American Psychiatric Association, 2013). The condition is characterized by hypersensitivity to rejection and resulting instability of interpersonal relationships, self-image, affect, and behavior. Also, BPD causes significant impairment and distress and is associated with multiple medical and psychiatric co-morbidities. Surveys have estimated the prevalence of BPD to be 1.6% in the general population and 20% of the psychiatric inpatient population (Brüne, 2016).Therapy For Personality Disorders Essay
The DSM-5 diagnostic criteria for BPD include a pervasive pattern of instability of interpersonal relations, self-image, and affects as well as marked impulsivity beginning by early adulthood (American Psychiatric Association, 2013). BPD present in a variety of contexts as indicated by five or more of the symptoms such as frantic efforts to avoid real or imagined abandonment, a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes and idealization and devaluation, and identity disturbances. Also, patients diagnosed with BPD must report impulsivity in at least two potentially self-damaging areas, such as spending, substance abuse, binge eating, sex, and reckless driving. They should also present affective instability due to a marked reactivity of moods, such as intense episodic dysphoria, irritability, or anxiety lasting for a few hours (American Psychiatric Association, 2013).Therapy For Personality Disorders Essay
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Therapeutic Approaches for BPD
Since patients with BPD suffer considerable morbidity and mortality, BPD causes a therapeutic challenge for clinicians. First-line treatment for BPD is psychotherapy. However, symptom targeted medications have also been found useful. The psychotherapies that have been adapted to treat patients with BPD are; Dialectical behavior therapy (DBT), Mentalization-based therapy, Transference-focused therapy, Cognitive-behavioral therapy (CBT), and Schema-focused therapy (Kulacaoglu & Kose, 2018). These therapies provide active and focused interventions that emphasize current functioning and relationships. These therapy modalities also offer a structured manual supporting the therapist and providing recommendations for common clinical problems. They are structured so that they encourage increased activity, proactivity, and self-agency for the patients.Therapy For Personality Disorders Essay
According to the literature, the pharmacological treatment for BPD is limited. It is suggested that the patient with BPD who continues to experience severe, impairing symptoms such as affective dysregulation, impulsive-behavioral dyscontrol, and perceptual symptoms despite receiving psychotherapy, should receive symptom-focused, adjunctive medication treatment (Wheeler, 2014). Low-dose antipsychotic drugs are more useful for cognitive and perceptual symptoms such as dissociation, paranoid ideation, and hallucinations compared with antidepressants or mood stabilizers. Mood stabilizers are found to be more effective for impulsivity, aggression, and behavior control in BPD. Mood stabilizers in the meta-analyses were lamotrigine, topiramate, valproate, and lithium (Brüne, 2016). Lithium is also found to be effective in preventing suicide in BPD patients, as reported by a retrospective study. But lithium has limited usage due to significant side effects.Therapy For Personality Disorders Essay
How to Share the BPD Diagnosis to Patients
Training communication strategies is essential when communicating BPD diagnosis to clients due to the stigma associated with it. There are two primary strategies of communicating the BPD diagnosis to clients without damaging a therapeutic relationship. The first strategy is to withhold BPD in favor of axis I diagnosis. Clinicians should use various tactics to communicate their patients’ mental health conditions, generally without directly giving the diagnosis of BPD (Sulzer et al., 2016). For example, clinicians often chose to discuss co-morbid mood disorders like depression and anxiety without disclosing the borderline diagnosis. The second strategy is to withhold BPD in favor of euphemistic diagnosis (Sulzer et al., 2016). Clinicians should employ involved the use of euphemisms such as cluster B symptoms, borderline traits, difficulty regulating emotions. These expressions were used in place of a diagnosis when explaining to the patient that they had a mental health condition Therapy For Personality Disorders Essay
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Brüne, M. (2016). Borderline Personality Disorder: Why ‘fast and furious’?. Evolution, medicine, and public health, 2016(1), 52–66. https://doi.org/10.1093/emph/eow002
Kulacaoglu, F., & Kose, S. (2018). Borderline Personality Disorder (BPD): In the Midst of Vulnerability, Chaos, and Awe. Brain sciences, 8(11), 201. https://doi.org/10.3390/brainsci8110201
Sulzer, S. H., Muenchow, E., Potvin, A., Harris, J., & Gigot, G. (2016). Improving patient-centered communication of the borderline personality disorder diagnosis. Journal of mental health (Abingdon, England), 25(1), 5–9. https://doi.org/10.3109/09638237.2015.1022253
Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.Therapy For Personality Disorders Essay
Personality disorders are a diagnostic category of psychiatric disorders that affect approximately 10% of the population. This group of disorders is characterized by problematic thinking patterns; problems with emotional regulation; and difficulty achieving a balance between spontaneity and impulse control. Personality Disorder Definition
Research indicates that personality disorders are correlated with substance use disorders. Associations have been found between borderline personality disorder, alcohol abuse and abuse of sedatives/benzodiazepines. Antisocial personality disorder has also been frequently associated with alcohol abuse and misuse. Read about substance abuse treatment to know your options.
Since everyone has a personality, but not everyone has a personality disorder, these disorders are considered a variant form of normal, healthy personality.Therapy For Personality Disorders Essay
However, the most significant and defining feature of personality disorders is the negative effect these disorders have on interpersonal relationships.
People with personality disorders tend to respond to differing situations and demands with a characteristically rigid constellation of thoughts, feelings, and behavior.
This inflexibility and difficulty in forming nuanced responses represents the primary difference between healthy and disordered personalities.
Diagnosis
The diagnosis of personality disorders is often very complex as these disorders frequently co-occur with each other and with other psychiatric categories of disorders. The current diagnostic system of the DSM-5 (APA, 2013) relies upon a categorical approach that outlines the following criteria to meet a personality disorder diagnosis:
Significant impairments in interpersonal functioning and self-identity that are relatively consistent across time and situations.Therapy For Personality Disorders Essay
The impairments have no discernable cause outside of the individual’s personality trait domains, like psychological or head trauma, sociological/cultural environment and are not due to the effects of using a substance.
Causes of a Personality Disorder
The exact cause of personality disorders remains uncertain. However, it is clear there are both biological and psychosocial factors that influence the development of personality and personality disorders.
Several psychological theories of personality disorders attempt to explain the psychosocial origins of personality disorders. The following psychological theories of personality disorders were reviewed:
Object relations theory.
Attachment theory (including mentalization).
Cognitive-behavioral theory (including dialectical behavior theory and schema theory).Therapy For Personality Disorders Essay
Treatment
Not too long ago, personality disorders were thought to be untreatable. There are now several highly effective treatments for personality disorders that derive from the same psychological theories previously reviewed, with pharmacological interventions serving as an important adjunct. These treatments include:
Transference-focused therapy (TFP).
Mentalization-based therapy (MBT).
Cognitive-behavioral therapy (CBT).
Dialectical behavior therapy (DBT).
Schema therapy.
In conclusion, recent technological advancements and improvements to diagnostic methodologies have enabled researchers to study personality and personality disorders as never before.
As a result, we now have a much greater understanding of these disorders.
Furthermore, this research has facilitated the development of several highly effective treatments for personality disorders that are evidenced-based.
As research continues, these treatment approaches will be further refined.Therapy For Personality Disorders Essay
The term “Personality Disorder” implies there is something not-quite-right about someone’s personality. However, the term “personality disorder” simply refers to a diagnostic category of psychiatric disorders characterized by a chronic, inflexible, and maladaptive pattern of relating to the world. This maladaptive pattern is evident in the way a person thinks, feels, and behaves. The most noticeable and significant feature of these disorders is their negative effect on interpersonal relationships. A person with an untreated personality disorder is rarely able to enjoy sustained, meaningful, and rewarding relationships with others, and any relationships they do form are often fraught with problems and difficulties.Therapy For Personality Disorders Essay
To be diagnosed with a “personality disorder” does not mean that someone’s personality is fatally flawed or that they represent some freak of nature. In fact, these disorders are not that uncommon and are deeply troubling and painful to those who are diagnosed with these disorders. Studies on the prevalence of personality disorders performed in different countries and amongst different populations suggest that roughly 10% of adults can be diagnosed with a personality disorder (Torgersen, 2005).Therapy For Personality Disorders Essay
Many types of disorders are evidenced by a complete and total deviation from normal and healthy functioning (e.g., epilepsy). However, personality disorders cannot be understood independently from healthy personalities. Since everyone has a personality (but not everyone has epileptic seizures), personality disorders reflect a variant form of normal, healthy personality. Thus, a personality disorder exists as a special case of a normal, healthy personality in much the same way as a square is a special case of the more general construct of a rectangle. Therefore, it is useful for us to begin our discussion of personality disorders by first discussing the broader, more general construct of personality.Therapy For Personality Disorders Essay