Borderline Personality Disorder is a condition that affects mood instability and makes it difficult for people to form relationships. According to Brüne (2016), unstable relationships, fear of being abandoned, inability to regulate emotions, feelings of depression, and high-risk behaviors are some of the characteristics of the condition. According to APA (2013), people with the disorder have increased chances of committing suicide. Brüne (2016) says that people suffering from the condition have paranoid ideas, and they always have self-injurious behavior. There are several intervention measures that are being used to manage borderline personality disorder. These intervention measures are generalized to all populations, but they can be adapted to work in specific circumstances such as in sexual minorities.
Causes of the disorder
Several factors predispose a person to borderline personality disorder. Genetics is one factor that can contribute a person to suffering from the condition. According to NHS (2019), genes a person inherits from their parents can make them vulnerable to the disorder. Researchers claim that if an identical twin has the disease. The chances are high that the order twin has the condition. However, there is no reliable research that ties genes to borderline personality disorder. Another factor that is likely to cause the disease is brain chemicals. NHS (2019) reports that people suffering from the disorder are believed to be having something wrong with their neurotransmitters, particularly serotonin. When the amount of serotonin produced is altered, it leads to depression and aggression.
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Another factor that is likely to cause the disease is brain chemicals. NHS (2019) reports that people suffering from the disorder are believed to be having something wrong with their neurotransmitters, particularly serotonin. When the amount of serotonin produced is altered, it leads to depression and aggression. Another factor that causes borderline personality disorder is problems with brain development. NHS (2019) reports that brain scans of people with the disease reveal that they have a small amygdala, hippocampus, and orbitofrontal cortex. The development of these parts of the brain is affected by the early upbringing of a child. These sections of the brain are for regulating moods, and therefore underdevelopment of these parts of the brain leads to the inability of an individual to control their tempers. Environmental factors are also responsible for causing the disorder. Some of these environmental factors are molestations as a child, neglect by parents, and growing up in a dysfunctional family. Unresolved childhood issues such as anger and fear lead a child to grow with distress and, therefore, a distorted thinking pattern that makes them vulnerable to the disorder.
Treatment approaches to borderline personality disorder
Psychotherapy
This is one of the conventional methods for treating the disorder. Its application leads to a reduction of the symptoms that a person with the condition exhibits over time. According to Biskin & Paris (2012), several types of psychotherapy exist that are for managing the disorder. Some of the popular psychotherapies used to manage the condition are dialectical behavior and mentalization-based treatment.
Dialectical behavior therapy
According to Biskins & Paris (2012), this psychotherapy was the first to be found useful in managing borderline personality disorder. This treatment combines Eastern philosophy with behavioral therapies in treating a patient. This therapy is divided into individual and group sessions. In these sessions, the participants are taught skills in mindfulness, regulation of emotions, interpersonal effectiveness, and distress tolerance. Dialectical behavior therapy is made to last for a year. The patient can consult with the psychotherapist over the phone. May, Richardi & Barth (2016) claim that this intervention mechanism was developed by Marsha Linehan in the 1990s, and it was for treating women from a borderline personality disorder. The term “dialectical” in the intervention mechanism refers to the use of “acceptance and change necessities for improvement.” This psychotherapy method treats maladaptive behaviors by replacing them with good behaviors. May, Richard & Barth (2016) affirm that the method is effective in treating conditions like mood disorders, posttraumatic stress disorders, and eating disorders.
How the intervention is used
As indicated earlier, dialectical behavior therapy involves two sessions, one of which is the individual session. During this session, an individual meets with the certified therapist on a one-on-one basis. The therapist ensures the training achieves its therapeutic objectives. The role of the therapist in these individual sessions is to motivate the patient in applying the skills taught to contain the disorder. In group therapy, the members offer each other mutual support through sharing of experiences and encouraging one another. In the group-based sessions, there are also trained therapists who lead the process. Psychology Today (n.d) reports that the training sessions last for two hours, and the group usually meets for about six weeks. In these sessions, members are given questions that test what they have learned from the sessions.
Mentalization-based treatment
Mentalization is the ability of an individual to recognize their mental states. It involves knowing your mental state and the ability to think of the impact of your actions on other people. Mentalization-base therapy focuses on enabling a person to recognize their thoughts and think about the outcome of their behavior. In developing this therapy, Bateman and Fonagy believed that people with the condition are unable to acknowledge their mental states because of problems they encountered as children, which affected the growth of their mentalization. In using this therapy, the focus of the therapist is in the present mental state of the patient and not the past. The therapist works towards enabling the patient to recognize their mental states and emotions. While administering this therapy, the therapist does not give advice and opinion on how the patient should behave. Instead, the therapist helps the patient explore their mental states and how to mentalize. Salters-Pedneault (2019) reports that research supports the use of therapy in managing borderline personality disorder. A randomized controlled study conducted by researchers showed that patients suffering from the disease who were exposed to the mentalization-based therapy reported a reduction in self-harm, depression, and anxiety.
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According to Morken, Binder, Arefjord, & Karterud (2019), a study conducted regarding the application of mentalization-based therapy in people with borderline personality disorder reveals that it increases mentalization in patients. Morken, Binder, Arefjord, & Karterud (2019) say that the therapy, just like dialectical behavior therapy, consists of two sessions, namely individual and group therapies. There are specific aspects of mentalizing that the therapy focuses on. According to Morken, Binder, Arefjord & Karterud (2019), there are several domains of mentalization-based therapy which can be used by the therapist. They are mentalization process, relational mentalization, effective mentalizing narrative, and non-mentalizing modes. The mentalization process is concerned with the mentalizing process. Relational mentalization involves focusing on the relationship between the therapist and the patient. The mentalizing effective narrative requires that therapists focus on narratives and should be concerned with the effect while non-mentalizing modes are applicable when the patient is not in mentalizing mode.
Medications
According to Salters-Pedneault (2019), drugs used to manage anxiety and depression have been found to reduce the symptoms of borderline personality disorders. Currently, there are no specific medications for treating borderline personality disorder. The drugs that are presently being used are those that reduce the symptoms of the disease, but they don’t lead to complete healing from the condition. Among some of the medications that are used are those for managing psychological conditions that usually occur with the condition like major depressive disorder. Independently, medications may not be effective in controlling the disorder, and so they are used with other intervention mechanisms such as psychotherapy.
Types of medications used
Antidepressants
Initially, antidepressants were designed for people suffering from a major depressive disorder. Salters-Pedneault (2019) claims that it was also for managing other mental conditions characterized by low mood. The antidepressants that have been approved for use in managing borderline personality disorder are monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, and tricyclic and tetracyclic antidepressants. Salters-Pedneault (2019) reports that studies indicate that antidepressants are effective in managing sadness, anxiety, and low moods. Some of the commonly used antidepressants are Nardil, Prozac, Zoloft, Effexor, and Wellbutrin.
Antipsychotics
Early psychiatrists discovered that the symptoms of the condition were in the border of psychosis and neurosis. This is why they named the disease “borderline” to imply in the border between the two conditions. Early medications for the disease were antipsychotics. Later, it was found that the antipsychotics were effective in treating other disorders that were no-psychotics. Salters-Pedneault (2019) claims that antipsychotics reduce anxiety, anger, impulsiveness, and paranoid thinking. Some commonly used antipsychotics are Haldol, Zyprexa, Clozaril, Seroquel, and Risperdal.
Mood stabilizers
These medications are used to stabilize the moods of individuals. One of the characteristics of borderline personality behavior is the presence of mood swings. Some of the drugs that are used in this category are Lithobid, Depakote, Lamictal, and Tegretol.
Anxiolytics
Usually, people with the disorder experience anxiety. Anxiolytics are drugs that the patients suffering from the condition are given to manage the disease. Salters-Pedneault (2019) says that little research has been done to ascertain whether the drugs are efficient in treating the condition. There also some anxiety drugs that, when used, can worsen the condition of the patient. This, therefore, requires that proper consultations are done before prescribing the drugs. According to Salters-Pedneault (2019), Benzodiazepines are particularly dangerous when individuals who abuse drugs use it since it is addictive. The anxiolytics commonly used to combat the disorder are Ativan, Klonopin, Xanax, Valium, and Buspar.
The application of the treatment methods in treating marginalized people
Rivera-Segarra et al. (2014) claim that stigmatization has been a hindrance for people with mental conditions from seeking care. Among the marginalized populations are sexual minorities such as bisexuals, gays, and lesbians. Plöderl et al. (2017) allege that sexual minorities experience barriers when seeking treatment for mental illnesses since there is a lack of specific treatment for sexual minorities. Plöderl et al. (2017) further claim that sexual minorities are at risk since they have more stressing factors compared to the rest of the population. Apart from the usual stressors that other people have, other stressing factors for them are fear of being discriminated against and internalized homophobia associated with hiding one’s sexual orientation. Medications operate in the same manner for all people irrespective of their sexual orientations, and therefore there are no different medicines for managing BPD in sexual minorities.
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Therapies in treating sexual minorities with BPD
For sexual minorities, invalidation is the biggest issue that affects them. The dialectical behavioral therapy, which, initially, was developed for treating people with suicidal tendencies, has been adapted for the treatment of people across different settings. According to Skerven, Whicker & LeMaire (2019), the majority of the people being diagnosed with BPD identify as gays, lesbians, or bisexuals. Skerven, Whicker & LeMaire (2019) reiterate the findings of Bradford Reich & Zanarini (2008) that sexual minorities accounted for 75% of patients diagnosed with BPD. Research also affirms that sexual minorities are more likely to have suicidal thoughts and self-harm compared to other people (Whicker & Le Maries, 2019). Dialectical behavioral therapy is being used by therapists to reduce stressor and help the patients regain their self-respect so that they can cope with stress. DBT is the best intervention currently available for sexual minorities since other interventions are aimed at reducing the stressors instead of teaching the patient how to cope with the stress. Skerven, Whicker & LeMaire (2019) allude that DBT addresses the environmental stressors and self-esteem, and therefore it is an effective intervention for the Lesbians Gay Bisexual Transgender Queer (LGBTQ) community. Dialectical behavioral therapy is made of four significant components, namely emotional regulation, interpersonal effectiveness, core mindfulness, and distress tolerance. The four modules of DBT are meant for enabling the client to rein on their emotions. Through individual and group therapies, a therapist guides the client into coping with all kinds of stigma and how they can accept their identity.
Conclusion
A borderline personality disorder is a mental condition that makes a patient have suicidal thoughts, and this can lead to unstable relationships. This condition is characterized by mood swings, whereby the moods of an individual keep changing. Several factors exist which predispose a person to the disorder. They are environmental, brain chemicals, and genetics. Environmental factors are those concerned with the upbringing of an individual. If a person is brought up in a dysfunctional home where abuses are the norm, chances are high that they will develop the disorder when they are grown up. On brain chemicals, lack of proper development of the brain leads to an imbalance in chemicals in the brain. This leads to the inability of an individual to effectively balance emotions. Genetics, even though not yet proven, scientifically is believed to lead to the condition. There are several interventions for treating borderline personality disorder. There are therapies, such as dialectical behavioral and mentalization-based therapies. Medications such as antidepressants are also used to manage the condition. These interventions are used to treat BPD across many settings. Among the minorities that the interventions are used in are sexual minorities. There are generally no specific intervention measures for treating sexual minorities suffering from BPD. The existing mechanisms, such as dialectical behavioral therapy, have been adapted to fit their situation. On medicines, there are no unique medicines for managing BPD for sexual minorities since drugs work in the same manner irrespective of individuals’ sexual orientation.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
Biskin, R., & Paris, J. (2012). Management of borderline personality disorder. Canadian Medical Association Journal, 184(17), 1897-1902. doi: 10.1503/cmaj.112055
Borderline personality disorder – Causes. (2019). Retrieved 13 November 2019, from https://www.nhs.uk/conditions/borderline-personality-disorder/causes/
Brüne, M. (2016). Borderline Personality Disorder. Evolution, Medicine, And Public Health, 2016(1), 52-66. doi: 10.1093/emph/eow002
Dialectical Behavior Therapy | Psychology Today. (2019). Retrieved 13 November 2019, from https://www.psychologytoday.com/intl/therapy-types/dialectical-behavior-therapy
May, J., Richardi, T., & Barth, K. (2016). Dialectical behavior therapy as a treatment for borderline personality disorder. Mental Health Clinician, 6(2), 62-67. doi: 10.9740/mhc.2016.03.62
Morken, K., Binder, P., Arefjord, N., & Karterud, S. (2019). Mentalization-Based Treatment From the Patients’ Perspective – What Ingredients Do They Emphasize?. Frontiers in Psychology, 10. doi: 10.3389/fpsyg.2019.01327
Plöderl, M., Kunrath, S., Cramer, R., Wang, J., Hauer, L., & Fartacek, C. (2017). Sexual orientation differences in treatment expectation, alliance, and outcome among patients at risk for suicide in a public psychiatric hospital. BMC Psychiatry, 17(1). doi: 10.1186/s12888-017-1337-8
Rivera-Segarra, E., Rivera, G., López-Soto, R., Crespo-Ramos, G., & Marqués-Reyes, D. (2014). Stigmatization Experiences among People Living with Borderline Personality Disorder in Puerto Rico. The Qualitative Report, 19(15), 1-18. Retrieved from https://nsuworks.nova.edu/tqr/vol19/iss15/2
Salters-Pedneault, K. (2019). Borderline Personality Disorder Medications Can Treat Symptoms. Retrieved 13 November 2019, from https://www.verywellmind.com/borderline-personality-disorder-medications-425450
Salters-Pedneault, K. (2019). Mentalization-Based Therapy May Help Borderline Personality Disorder. Retrieved 13 November 2019, from https://www.verywellmind.com/mentalization-therapy-for-bpd-425459
Salters-Pedneault, K. (2019). Mentalization-Based Therapy May Help Borderline Personality Disorder. Retrieved 13 November 2019, from https://www.verywellmind.com/mentalization-therapy-for-bpd-425459
Skerven, K., Whicker, D., & LeMaire, K. (2019). Applying dialectical behavior therapy to structural and internalized stigma with LGBTQ+ clients. The Cognitive Behaviour Therapist, 12. doi: 10.1017/s1754470x18000235
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