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About Borderline Personality
Disorder
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What
is Borderline Personality Disorder (BPD)? |
Borderline
personality disorder (BPD) is a serious psychiatric illness. The
diagnosis
encompasses patients with a pervasive pattern of affective instability,
severe difficulties in interpersonal relationships, problems with
behavioral
or impulse control (including suicidal behaviors), and disrupted
cognitive
processes. This instability often disrupts family and work life,
long-term planning, and
the individual’s sense of self-identity. The estimated prevalence of BPD
in the general adult population
is
about 2%, mostly affecting young women. It has also been estimated that
11% of outpatients and 20% of
psychiatric inpatients presenting for treatment meet the criteria for
the
disorder.
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What
are the symptoms of BPD? |
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Frantic
efforts to avoid real or imagined abandonment.
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Pattern
of unstable and intense interpersonal relationships characterized
by alternating between extremes of idealization and devaluation.
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Identity
disturbance: markedly and persistently unstable self-image or
sense of self.
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Impulsivity
in at least two areas that are potentially self-damaging (e.g.
spending, sex, substance abuse, reckless driving, binge eating).
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Recurrent
suicidal behavior, gestures or threats, or self-mutilating behavior.
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Affective
instability due to a marked reactivity of mood.
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Chronic
feelings of emptiness.
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Inappropriate,
intense anger or difficulty controlling anger.
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Transient,
stress, related paranoid ideation or severe dissociative symptoms.
(DSM IV)
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People
with BPD often have
highly unstable patterns of social relationships. While
they can develop intense but stormy
attachments, their attitudes toward family, friends, and loved ones may
suddenly shift from idealization (great admiration and love) to
devaluation
(intense anger and dislike). Even with
family members, individuals with BPD are highly sensitive to rejection,
reacting with anger and distress to such mild separations as a
vacation, a
business trip, or a sudden change of plans.
Distortions in thinking and sense of self
can lead to frequent changes
in
long-term goals, career plans, jobs, friendships, gender identity, and
values.
Sometimes people with BPD view themselves as fundamentally bad, or
unworthy. They may feel unfairly misunderstood or
mistreated, bored, empty, and have little idea who they are. Such
symptoms are
most acute when people with BPD feel isolated and lacking in social
support,
and may result in frantic efforts to avoid being alone by acting out;
i.e. impulsive
behavior or suicide attempts.
People with
BPD exhibit
other impulsive behaviors, such as excessive spending, binge eating and
risky
sex. BPD often occurs together with other psychiatric problems,
particularly
bipolar disorder, depression, anxiety disorders, substance abuse, and
other
personality disorders. |
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Treatments |
People with
BPD often need
extensive mental health services, and account for 20 percent of
psychiatric
hospitalizations. Treatments for BPD
have improved in recent years, and group and individual psychotherapy,
as well
as the use of medication have been effective for many patients.
Within the past 15 years, a
new psychosocial treatment termed Dialectical Behavior Therapy (DBT)
has been
developed specifically to treat BPD, and this technique has looked
promising in
treatment studies. Pharmacological treatments are often prescribed
based on
specific target symptoms shown by the individual patient.
Antidepressant drugs
and mood stabilizers may be helpful for depressed and/or labile mood.
Antipsychotic drugs may also be used when there are distortions in
thinking. With help, many improve over
time and are eventually able to lead productive lives. |
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What
should I consider when seeking treatment for BPD?
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The
agency/institution/hospital:
a. By whom?
b. For what?
c. Date of most recent licensing?
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How many years has the agency been
actively treating persons with BPD?
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Maximum number of clients in
program(s)?
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Number of staff and their disciplines
and level of education?
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Client/staff ratio?
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Facilities
and services:
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What are
the
criteria for admission to the program?
- Who
provides
the referral information?
- What
kind(s) of
treatment(s) are available: individual therapy, group,
family, residential, medication?
- How often
is
each type of therapy offered per week?
- Treatment
orientation? e.g. Dialectical Behavior Therapy (DBT); Psychodynamic?
- What kind
of
training has the staff had to specifically treat persons with
BPD?
- Anticipated
length of stay (LOS)?
- Handbook
of
rules: program expectations, i.e., days absent, if outpatient;
visiting hours, if inpatient.
- What kind
of
family involvement: sessions, family group, contact with staff?
- Are there
any
support groups in the area?
- Is there
any
contact maintained with most previous treater (e.g., community
psychiatrist)?
- When does
planning for discharge start and who is included in the discussions?
- Does the
agency
take responsibility to identify the possible aftercare
options?
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If someone signs themselves out of the
program, who is
notified?
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Financial
aspects:
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Cost: Flat charges? Extra charges? How
often billed? Terms
of payment?
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What
funding is
accepted: Medicaid, Medicare, private insurance, self-pay?
- Is an
agency
financial counselor available to explain charges and billing
procedures? For example, is SSI affected?
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