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Therapy for Patients with Personality Disorder
Personality disorder can be described as a set of behaviors where individuals can identify themselves with and relate to the environment. Most mental health disorders are difficult to diagnose since there is no lab point out for sure what it is. Bipolar personality disorder like most mental health disorder have similar symptoms that are subjective, and so the clinician depends on what the person tells them how they feel. According to the American Psychiatric Association. (, 2013). A personality disorder is an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment. For this paper, I will be discussing borderline personality disorder, its treatment, both psychotropic and psychotherapy.
Borderline personality disorder (BPD) is a pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity as defined in Diagnostic and statistical Manual-5 (DSM-5) American Psychiatric Association. (, 2013). BPD symptoms are characterized by the inability of the patient to maintain stable relationships, excessive worrying, feeling lonely, or thinking no one loves them, having problems of being able to regulate their emotions leading to frequent irritability, and feeling depressed and injurious behaviors. Borderline personality disorder (BPD) is a severe mental disorder with symptoms such as affective instability, impulsivity, and self-harm according to Beck, E., et al. (2016). Proper treatment depends on properly identifying the correct personality disorder since many behaviors exist with similar symptoms and comorbid disorders. This comorbidity makes it difficult for a PMHNP who is just beginning difficulty and challenging to treat. In this case, monotherapy is usually not very effective, and hence use of psych pharmacology and psychotherapies should be encouraged, targeting each symptom described or observed by the clinician. BPD may co-occur with substance use disorder (SUD). Research has indicated that chronic, excessive use of substances and problems due to excessive use are potential indicators of the BPD diagnosis that is the BPD impulsivity criterion, according to Trull, T. J., et al. (2018).
Evidence-based practice research has shown that Mentalization-based behavior group (MBT) therapy and dialectical behavioral therapy (DBT) effectively treat BPD. As for the MBT, the primary goal is to strike a balance between the authority and structure of each session with an open mind to explore the curious stance of the patient. The patients’ profound difficulties with interpersonal functioning and affect regulation require therapeutic techniques potent enough to counteract the difficulties that can arise during sessions. According to Beck, E., et al. (2016). MBT is based on attachment theory and psychodynamic principles and has a high degree of structure and a clear treatment goal of improving patients’ mentalizing skills and may last up to a year. DBT, on its part, focuses on the patient’s inability to control their emotions. It is based on the fact people with BPD are especially sensitive in their reactions and the difficulties to control their tempers either due to their environment they grew up in or due to trauma during childhood or adolescence. The goal here is to train the mind to manage their emotions when exposed to uncomfortable situations. DBT is a good research psychosocial treatment that has been found effective for treating BPD. DBT helps them avoid being so judgmental and critical about themselves as good for nothing person leading to suicidal thoughts.
Treating BPD with psychopharmacology drugs focuses on the priority symptoms that the person is most concerned about or display as destroying his/her life. Psychotic symptoms such as irritability, suicide ideation, or attempt or self-injurious behaviors might begin with psychotic medications such as Depakote, topiramate, Lamictal, which are anticonvulsants drugs, use off label to treat this disorder. Also, lithium and atypical antipsychotics such as Olanzapine and Abilify that have proven effective in decreasing this disorder. Patients might benefit from antidepressants if they exhibit depression symptoms too. Care must be taken in selecting this medication as their side effects might lead to medication non-compliant. Depakote and lithium levels need to be monitored to avoid toxicity. One will have to assess for insomnia as people with this condition might express irritability and emotional instability.
Diagnosing BPD, like most mental health illnesses, must be done with care, empathy but at At the same time setting professional boundaries. These patients often take offense when told about their diagnosis as they are often in denial, attentional seeking behaviors, for instance, stating that they were going to hurt themselves. The diagnosis, therefore, must be presented in a manner that validates them with offers to assist them in overcoming their difficulties in controlling like their depression, irritability, suicide ideations, not feeling loved or abandoned by their loved ones.
American Psychiatric Association. (, 2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Beck, E., Bo, S., Gondan, M., Poulsen, S., Pedersen, L., Pedersen, J., & Simonsen, E. (2016). Mentalization-based treatment in groups for adolescents with borderline personality disorder (BPD) or subthreshold BPD versus treatment as usual (M-GAB): study protocol for a randomized controlled trial. Trials, 17(1), 1-13.
Rizvi, S. L., Hughes, C. D., & Thomas, M. C. (2016). The DBT Coach mobile application as an adjunct to treatment for suicidal and self-injuring individuals with borderline personality disorder: A preliminary evaluation and challenges to client utilization. Psychological services, 13(4), 380.
Trull, T. J., Freeman, L. K., Vebares, T. J., Choate, A. M., Helle, A. C., & Wycoff, A. M. (2018). Borderline personality disorder and substance use disorders: an updated review. Borderline personality disorder and emotion dysregulation, 5(1), 15.
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