For Adolescents and Adults
Borderline Personality Treatment Goals
Disorder of borderline personality is common in various clinical settings and it is prevalent in diverse cultures all over the world. Borderline personality disorder is not easily diagnosed in clinical practice. It is a condition that causes distinct distress in both social and occupational functioning. This disorder is linked with a high rate of behavior of a self-destructive kind. Patients suffering with BPD (Borderline Personality Disorder) invariably make several suicide attempts.
Characteristics of BPD and how they are assessed
The major features characterizing this disorder include pervasive patterns of instability of self-image and interpersonal relationships. Such characteristics have a tendency of beginning during early adulthood and they are found to be present in various contexts. An early assessment is made by a psychiatrist who studies the patient and establishes the setting of a prescribed mode of treatment. As suicide attempts and suicidal ideation are common with this disorder, the psychiatrists tend to give priority to issues of safety and a complete safety evaluation is done. Such an assessment determines whether the treatment will be done in an inpatient or an outpatient setting.
Laying out a framework for treatment objectives
A framework is laid out and it includes establishment of getting the patient to agree with the goals of treatment. There are various options that may be available for treating borderline personality disorder. They include psychotherapy complemented by pharmacotherapy, psychiatric management and talk therapy. DBT (Dialectical Behavior Therapy), MBT (Metallization Based Therapy) and TFP (Transference Focused Therapy).
• Psychiatric Management – This forms the basis of treatment for most patients suffering with this disorder. This is considered as a primary form of treatment for BPD and it is complemented by pharmacotherapy that is symptom-targeted. Psychiatric management involves a large array of activities carried out on an ongoing basis along with interventions that are inducted by psychiatrists throughout the course of this therapy. The components of this type of psychiatric management include response to crisis and assessing the safety conditions for the patient. They also include establishment and maintenance of a therapeutic framework that provides training and education about BPD and how it will be treated. The coordination for psychiatric treatment is supported by clinicians who monitor the progress of the patients and reassess the plan of treatment and its effectiveness. The psychiatrists have to be aware of managing potential problems that involve splitting disorder and its boundaries. The main objective of this kind of therapy is to determine internalized pathologic representations concerning interpersonal relationships. The therapists will need adequate systems of support and that will include access to extended hospitalization, if necessary. Affective instability and impulsivity are significant manifestations when studying borderline pathology and they may call for pharmacologic treatment. Several classes of antidepressants are prescribed such as Naltrexone or Risperidone and SSRIs or selective serotonin reuptake inhibitors are preferred strongly.
• Talk Therapy – Current research has shown that this kind of therapy has helped bring down the symptoms as well as the suffering of patients with borderline personality disorder. In many cases, talk therapy is regarded as the first choice among treatments that are prescribed. Treatment of this kind involves a couple of sessions in a week with mental health counselors. For this type of therapy to become effective, patients have to be comfortable with the interaction with their therapists. Talk therapy is taken as a first line approach for treating BPD despite facing obstacles in the form of impulsive behavior, overwhelming affect and patient regression. This kind of treatment is helpful in reducing emotions such as anger and also it is helpful in bringing down the potentiality of suicide attempts or self-harm. It is quite effective in improving social adjustment of the patients and their overall functioning.
• DBT – Dialectical Behavior Therapy – This kind of treatment will focus on mindfulness and laying emphasis on the present emotional state of the patients. It involves skills that are helpful in controlling intense emotions and in reducing behavior of a self-destructive nature. This therapy is useful in managing distress and it helps improve personal relationships. It brings in a balance between changing and accepting behaviors. It is a kind of a problem-solving approach that has been designed exclusively to treat borderline personality disorders. The treatment involves therapy sessions and skills training in group settings. This kind of a therapy is a slight modification of the techniques of standard cognitive behavior. Currently, this is the only kind of therapy for treating BPD that is supported by data. DBT was originally developed as a program on outpatient basis but it has been recently modified so that it can be used in hospitalization settings and among diverse populations. The focus is on allowing patients to concentrate on mindfulness, emotional regulation and interpersonal effectiveness.
• MBT – Metallization Based Therapy – This is also a variant of talk therapy and it helps patients in the identification and understanding of what other people may be feeling or thinking in relation to their present condition.
• TFP – Transference-Focused Therapy – This kind of therapy helps the patients in understanding their own emotions and the interpersonal problems that they may be going through in their interaction with their therapists. Patients are then helped to apply various insights that they may learn to different situations. Another view concerning regressive transference that results from treatment which is analytically oriented is that it may often be detrimental to the mental health of the patients. A supportive and a reality-oriented kind of approach could be introduced as the therapy’s goal and this will involve social adjustments done on a gradual basis in the frameworks of therapeutic relationships. Experiences may benefit the patients. The therapists have to remain and control emotions such as anger or anxiety and they have to constantly remain emotionally available. In such settings, patients have to learn to be tolerant towards destructive and hateful feeling that may rise on account of transference. They have to be taught to replace such feelings with positive and more constructive reactions. The patients have to internalize a soothing and a supportive object.
These are the main treatment goals for handling borderline personality disorders. It is a well known fact that medications are not really helpful in curing BPD but they can come in handy in treating other conditions that usually accompany borderline personality disorder like impulsivity, depression and extreme anxiety. Patients suffering with BPD are generally encouraged to coordinate with their prescribing therapists or physicians on what they can expect from medications being given to them and their possible side effects.
Many therapists also prescribe self-care activities along with medication or a selected therapy and these activities include good sleeping habits, regular exercise, nutritious diet and stress management. This kind of self-care will help in reducing common BPD symptoms like impulsive behavior, mood changes and irritability.