Borderline Personality, Term Paper Example

Pathology / Etiology

The precise etiology of borderline personality disorder (BPD) has not been found.  There are many different theories associated with BPD but two are more dominant than others i.e.  Childhood abuse and biological etiology.  Statistics have indicated that those associated with BPD from childhood abuse are 40-71% from sexual abuse and 25-71% from that of physical abuse.  Most of this occurs early in the life of the child with the results manifesting themselves at a later date. (Dejdar, A. 2012).

Very often the child experiencing the abuse is both confused and cannot make any sense of what is happening to them.  This has a long term affect of impacting the victims emotions at a later date as they experience difficulty in relating to the thoughts of others. It that form of dissaciated state in childhood that creates a mental barrier to defend against the great pain. This has often resulted in self-mutilation in the child victim.

The biological etiology has been associated with dysfunction of the limbic system and the amygdala of the hippocampus region of the brain.  This is the area of the brain that regulates emotions associated with conditions like fear, rage, anger and impulsive behaviour.  This can be also associated with the onset of mental illness.  Additional associations are made to the orbital prefrontal cortex of the brain and the chemical serontonin system which goes towards the regulation of emotions. BPD is viewed as a complex disorder that affects both the victims life and those associated with the person. (Dejdar, 2012)

Assessment Findings

Those people diagnosed with BPD have a range of symptoms and this often includes confusion about their identity. It is considered that there are genetic predispositions to BPD but the research on this remains inconclusive.  Other symptoms include mood swings in extremes i.e. good or bad, happy or sad etc. This sort of bi-polar behaviour can prove disastrous on relationships and lead to very unstable personal attachments.  Other synptoms that are associated with BPD include that of:-

• The fear of abandonment
• Sense of isolation, emptiness and confusion
• Displays of rage or anger
• Impulsive and compulsion behaviour i.e. going to extremes
• Intolerant of being alone
• Repeated personal crisis

The diagnosis is often made through psychiatric evaluation in terms of severity and history of the symptoms.

Nursing Interventions And Treatment

There are varied treatment options that include ‘dialectical behavioural therapy’(DBT),  for direct treatment. The use of ‘group therapy’(GP), in order to intervene on destrictive behavioural patterns  and the application of certain drugs.  The preferred treatment modality is that of psychiatric nurses that understand the techniques of psychotherapy and are familiar with the drug treatments that are involved. Medication is an important part of the treatment and in 90% of the cases medication is used. (American Psychiatric Association, 2001)

DBT is often treated with psychodynamic psychotherapy.  BPD patients seem to respond well to this type of therapeutic treatment.  Within this treatment regime there are a number of distinct intervention techniques adopted, for example:-

• Minimize Silence – Stopping the patient lapsing into deep thought but instead get them to discuss their feelings and assist in interpretation of same;
• Tolerating anger – Let the anger and range manifest itself without treatment or containment, essentially allowing the sense of release;
• Impulsive behavior – learning the linkages to what makes certain impulsive behaviour e.g. why did the person get drunk for no good reason, explore the stimuli that triggered the feeling
• Suicide intervention – Research indicates 7-10% of BPD’s have suicidal tendencies and actually take their own lives. This goes beyond nursing evaluation to formal psychiatric medical support and great care has to be taken in drug administration. (Linehan, M.M.1993).

Medications Used

Will vary according to treatment regime, but the following table is an indicative guide.

References

American Psychiatric Association. (2001). Practice Guideline for the Treatment of Patients With Borderline Personality . Washington DC: American Psychiatric Association.

Dejdar, A. (2012, 8 15). Borderline Personality Disorder: Exploring the Etiology. Retrieved from Serendip: http://serendip.brynmawr.edu/bb/neuro/neuro06/web2/adejdar.html

Linehan, M. M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York : The Guildford Press.