Borderline Personality Disorder

Borderline Personality Disorder

Personality is the individual ways of thinking, expressing feelings, behavior, and relation to others. The development of personality is a dynamic process that develops from childhood, where people learn from their surroundings and different factors that influence their personality. However, at some point in life when the person becomes an adult, their personality remains constant and does not change (MedlinePlus, 2019). Borderline personality disorders are a group of mental disorders that involve any indwelling characterized by pervasive instability of interpersonal relationships and self-image, and symptoms may begin in early adulthood.  Individuals with this disease present with an intense fear of abandonment, are sensitive to environmental circumstances, and may drastically change from idealizing people to devaluing them (MedlinePlus, 2019).

Controversies Surrounding Borderline Personality Disorders

            Borderline personality disorder has controversy surrounding its etiology, diagnosis, and treatment approaches (Campbell et al., 2020). To begin with the controversy about the diagnosis criteria, it is argued that the diagnostic criteria are subjective and, at times, overlap with the signs present in other mental disorders. This therefore complicates the process of diagnosis and it is difficult to come up with a definite diagnosis. Secondly, the controversy revolves around the occurrence where research about the occurrence is gender biased. For instance, this disorder is perceived to have a higher prevalence in women. Also, some research outlines that there exist differences in the presentation of symptoms based on one’s gender. This influences treatment approaches and creates incongruences in the care. Thirdly, the existing stigma around borderline personality disorder creates a controversy, which makes the patients ailing from this disorder face discrimination and negatively stereotyped, affecting their health-seeking urge along with impaired interactions with health professionals. Lastly, there is a controversy about the validity of the disorder due to its symptoms overlapping with other disorders. This controversy calls for further research to clarify the mechanisms and boundaries of the disorder (Campbell et al., 2020).

Professional Beliefs about the Disorder and the Rationale

Despite the controversies revolving around the etiology, diagnosis, and treatment of borderline personality disorder, there exists professional evidence that rationalizes the beliefs about the disease. Firstly, borderline personality disorder exists as a distinct mental health issue. This is rationalized by the research and studies that state how individuals with borderline personality disorder have distinct symptoms, such as irregular emotions, behavior, and cognition, that differentiate them from other psychiatric illnesses (Leichsenring et al., 2024).

Secondly, the etiology of this disorder is influenced by the interaction of many factors, including biological, psychological, and social factors, which, together with environmental factors, contribute to the development of the disorder. This belief is rationalized by the existence of the biopsychosocial model of etiology which states that genetic predisposition, childhood experiences, and environmental settings contribute to the development of the disorder. After conceptualizing this, it is important to use a holistic approach in the management of the condition (Mishra et al., 2023).

The third professional belief is that the treatment of borderline personality disorder is evident to be effective. The approach that is believed to provide a high standard of care is dialectical behavior therapy, which is used to regulate emotions and enhance overall functioning. Also, the importance of using the strength-based approach to focus on the client’s strengths resources, as well as coping mechanisms is apparent. This makes them feel empowered and helps them remain strong in their recovery journey with optimality in them. Lastly, clients are the main participants in their healing process. This belief transgresses me to empathetically listen to the clients and value their perspectives, preferences, and goals. These help create a therapeutic environment conducive to healing. (Leichsenring et al., 2024).

Strategies for Maintaining the Therapeutic Relationship with a Patient

Due to the characteristics of the disease, such as emotional dysregulation, establishing and maintaining a therapeutic relationship with these patients is, at times, difficult. However, professional strategies exist to aid in eliminating this challenge. The first strategy is to define clear boundaries at the onset of therapy to help establish safety and patient predictability. The boundaries should maintain professionalism along with demonstrating empathy and compassion. The second strategy is to remain non-judgmental to the patient’s emotions and experiences. This helps to establish and maintain trust and rapport with the patient. The third strategy is to be supportive and consistent in encouraging the patient to adapt to the challenging coping strategies. Fourthly, it is important to involve the patient in decision-making to promote their autonomy and recognition of their priorities. This helps open communication and evaluation of the therapeutic relationship become easier (Köhne et al., 2020).

Ethical Consideration and Their Relevance

When attending to patients with borderline personality disorder, it remains paramount to take into consideration the ethical issues that safeguard patient safety, improve the effectiveness of care, and maintain the patient’s dignity as a human. These ethical considerations include informed consent in decision-making concerning treatment and intervention selectivity. Secondly, it is important to maintain patient confidentiality and privacy of the patient but can be compromised when the patient is at risk to harm others and themselves. Thirdly, it is ethical to maintain professional boundaries and not engage in a dual relationship with the patient to avoid jeopardizing the therapeutic relationship. Lastly, as supported by Marks et al., (2022), it is essential to appreciate the cultural differences in working with the client.

References

Campbell, K., Clarke, K., Massey, D., & Lakeman, R. (2020). Borderline Personality Disorder: To diagnose or not to diagnose? That is the question. International Journal of Mental Health Nursing, 29(5), 972–981. https://doi.org/10.1111/inm.12737

Köhne, S., Schweiger, U., Jacob, G. A., Braakmann, D., Klein, J. P., Borgwardt, S., Assmann, N., Rogg, M., Schaich, A., & Faßbinder, E. (2020). Therapeutic Relationship in eHealth—A Pilot Study of Similarities and Differences between the Online Program Priovi and Therapists Treating Borderline Personality Disorder. International Journal of Environmental Research and Public Health, 17(17). https://doi.org/10.3390/ijerph17176436

Leichsenring, F., Fonagy, P., Heim, N., Kernberg, O. F., Leweke, F., Luyten, P., Salzer, S., Spitzer, C., & Steinert, C. (2024). Borderline personality disorder: a comprehensive review of diagnosis and clinical presentation, etiology, treatment, and current controversies. World Psychiatry: Official Journal of the World Psychiatric Association (WPA), 23(1), 4–25. https://doi.org/10.1002/wps.21156

Marks, J. A., Palermo, J. C., & Knoll, J. L. (2022). Ethical Challenges in the Treatment of Personality Disorders. FOCUS, 20(4), 416–419. https://doi.org/10.1176/appi.focus.20220061

MedlinePlus. (2019). Personality Disorders. Medlineplus.gov; National Library of Medicine. https://medlineplus.gov/personalitydisorders.html

Mishra, S., Rawekar, A., & Sapkale, B. (2023). A Comprehensive Literature Review of Borderline Personality Disorder: Unraveling Complexity From Diagnosis to Treatment. Cureus, 15(11). https://doi.org/10.7759/

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Explain the controversy that surrounds borderline personality disorder.
Explain your professional beliefs about this disorder, supporting your rationale with at least three scholarly references from the literature.

Borderline Personality Disorder

Explain strategies for maintaining the therapeutic relationship with a patient who may present with this disorder.
Finally, explain ethical and legal considerations related to this disorder that you need to bring to your practice and why they are important.