Borderline Personality Disorder

Borderline Personality Disorder

Individuals with borderline personality disorders usually have a sense of insecurity, abandonment, insecurity, emptiness, and rejection. They usually think in two ways, either the right way or the wrong way. In cases where such individuals are rejected by their partners, they often devalue their partners and raise their emotions (Porter et al., 2019). Borderline personality disorder patients also have intense emotions, impulsivity, and agitation. The patients also describe that they usually feel like they are on a rollercoaster, on top of the world, and can even develop suicidal ideation and attempts. The symptoms presented by borderline personality disorder are almost similar to those of bipolar disorder. The mood in borderline disorders can last for hours and even days, which is significantly longer than in bipolar disorder patients (Porter et al., 2019). Still, bipolar disorder patients can have mood swings lasting for days and even weeks. Therefore, anxiety in borderline personality disorder goes into an abrupt panic attack, and depression develops.

According to the American Psychiatric Association, the DSM-5 Criteria for borderline personality disorder is diagnosed based on either a pervasive pattern of instability in interpersonal relations, self-image, and affect or increased impulsivity starting in early adulthood and present in different contexts (Busmann et al., 2019). Some of the indicators of borderline personality disorder include frantic struggles to avoid abandonment, unbalanced and extreme relations, and identity disturbance marked by persistently unstable self-image. Additionally, impulsive behaviors can cause detrimental effects such as overspending. Gambling, risky sexual behaviors, substance abuse, and any form of risky behavior can also be indicators of borderline personality disorder (Busmann et al., 2019). Persistent presentations of anger and temper, bouts of paranoia, and dissociative symptoms are also indicators of borderline personality disorder.

Therapeutic Approach and Modality

The therapeutic approach I would recommend for the patient is dialectical behavior therapy (DBT). This therapeutic approach usually includes individual and group therapy customized specifically to manage borderline disorder (Kothgassner et al., 2021). DBT utilizes a skills-based approach to teach a patient how to manage their emotions, improve relationships, and tolerate distressing situations. DBT encourages stability of change and acceptance through validation and problem-solving approaches and recognizing reality as it is (Kothgassner et al., 2021). Dialectical behavior therapy uses three specific stages, including target barriers, concentration on the course plan, and commitment to contribute throughout the specific timeframe towards preventing risky behaviors and promoting health. DBT is one of the leading evidence-based therapeutic approaches for treating borderline personality disorder (Kothgassner et al., 2021). The therapy is a variation of cognitive behavioral therapy but incorporates radical acceptance and mindfulness. Studies show that DBT has been effective in managing impulsive behaviors associated with borderline personality disorder.

Therapeutic Relationship in Psychiatry

Since borderline personality disorder patients are often emotional, changeable, and present with patterns of unstable and intense relationships, they may identify the ideal caregivers for them during the first or second meeting. Borderline personality disorder patients usually demand more time with their caregivers and are more likely to share critical or sensitive information during the early stages of therapy. The patients demand a lot of time and are afraid of being abandoned or rejected. I would share my diagnosis of this disorder with the client by first outlining the diagnostic criteria. Next, I would explain the diagnosis and the available treatments or interventions. I would try and approach the patient when they are in a good or stable mood so that they do not react impulsively. Thereafter, I would share my psychoeducation with the patient as well as the treatment plan I would start them on. The available options will be discussed with the patient, and they select what they are comfortable with.

References

Busmann, M., Wrege, J., Meyer, A. H., Ritzler, F., Schmidlin, M., Lang, U. E., Gaab, J., Walter, M., & Euler, S. (2019). Alternative Model of Personality Disorders (DSM-5) Predicts Dropout in Inpatient Psychotherapy for Patients With Personality Disorder. Frontiers in Psychology, 10. https://doi.org/10.3389/fpsyg.2019.00952

Kothgassner, O. D., Goreis, A., Robinson, K., Huscsava, M. M., Schmahl, C., & Plener, P. L. (2021). Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: a systematic review and meta-analysis. Psychological Medicine, 1–11. https://doi.org/10.1017/s0033291721001355

Porter, C., Palmier‐Claus, J., Branitsky, A., Mansell, W., Warwick, H., & Varese, F. (2019). Childhood adversity and borderline personality disorder: a meta‐analysis. Acta Psychiatrica Scandinavica, 141(1), 6–20. https://doi.org/10.1111/acps.13118

*The selected articles are all peer-reviewed and published in reputable scholarly journals and thus considered scholarly.

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Borderline Personality Disorder

How would you use therapeutic communication and principles of cognitive behavioral therapy with the client?

Describe your assessment process. What are some likely co-morbid conditions? List one nursing diagnosis and appropriate nursing intervention.

What interdisciplinary referrals might be appropriate?