Borderline Personality Disorder (Bpd)

Borderline personality disorder is characterized by a pervasive pattern of instability and hypersensitivity in interpersonal relationships, the instability of self-image, extreme mood swings, and impulsivity. Diagnosis is based on clinical criteria. Treatment includes psychotherapy and medications.

(See also personality disorders overview.)

Borderline personality disorder is characterized by a pervasive pattern of instability and hypersensitivity in interpersonal relationships, the instability of self-image, extreme mood swings, and impulsivity. Diagnosis is based on clinical criteria. Treatment includes psychotherapy and medications. (. See also personality disorders at a glance) patients with borderline personality disorder can not bear to be alone; they make desperate efforts to avoid a relationship demolition and create crises such. B. suicidal gestures in a way that brings others to save them and to look after them. The prevalence of borderline personality disorder varies, but is probably between 1.7 and 3% in the general population, but up to 15 to 20% in patients who are being treated for mental illness. In clinical 75% of patients are women with this condition, but in the general population, the ratio of men to women 1: 1. comorbidities are common. Patients often have a number of other disturbances, especially depression, anxiety disorder (z. B. panic disorder) and post-traumatic stress disorder, as well as eating disorders and disorders of substance means use. Etiology stresses during early childhood can contribute to the development of borderline personality disorder. A childhood history with physical and sexual abuse, neglect, separation from caregivers and / or loss of a parent is common in patients with borderline personality disorder. Certain people may have a genetic tendency to pathological reactions to stress in life, and borderline personality disorder seems clearly to have a hereditary component. In first-degree relatives of patients with borderline personality disorder, it is five times more likely to get the disorder than the general population. Interference in regulatory functions of the brain and neuropeptide systems can also help, but are not present in all patients with borderline personality disorder. Symptoms and complaints If patients feel with borderline personality disorder, that they be abandoned or neglected, they feel intense fear or anger. For example, they can be panicked or angry when someone who is important to them, a few minutes late or cancels an appointment. You think that this task means that they are bad. They partially have a fear of abandonment, because they do not want to be alone. These patients tend to change their view of other abrupt and dramatic. You can idealize a potential caregivers or lovers early in the relationship, require a lot of time to spend with each other and share everything. Suddenly, she may feel that the person does not care enough, and they are disillusioned; then they can feel degraded or they are angry at the person. This shift from idealization towards devaluation reflects the black-and-white thinking resist (splitting, polarization of good and bad). Patients with borderline personality disorder can sympathize with someone and take care of a person, but only if they feel that another person will be there for them whenever necessary. Patients with this disorder have difficulty controlling their anger and are often inappropriate and intense anger. You can express their anger with biting sarcasm, bitterness or angry tirades often directed against their caregivers or lovers, due to neglect or abandonment. After the outbreak, they are ashamed and often feel guilty about what you feel strengthened to be bad. Patients with borderline personality disorder may also change abruptly and dramatically their self-image, thereby showing that they suddenly change their goals, values, beliefs, careers or friends. You may be in need of one minute and the next furiously angry about being treated badly. Although they consider themselves generally even as bad, they sometimes feel that they do not existieren- z. As if they have no one to look after them. They often feel empty inside. The changes in mood (. Eg intense dysphoria, irritability, anxiety) usually last only a few hours and rarely more than a few days; they can reflect the extreme sensitivity to interpersonal stress in patients with borderline personality disorder. Patients with borderline personality disorder often sabotage themselves when they are about to achieve a goal. For example, they can fly from the school shortly before graduation, or they can ruin a promising relationship. Impulsivity that leads to self-harm, is widely used. These patients to continue gambling, operate unsafe sex, have a food addiction, drive recklessly, abusing substances or overspend. Suicidal behavior, gestures and threats and self-mutilation (z. B. cutting, burning) are very common. Although many of these self-destructive actions have not intended to take his own life, the risk of suicide in these patients is 40 times higher than in the general population. About 8 to 10% of these patients die by suicide. This self-destructive actions are usually triggered by rejecting, by a possible abandonment of disappointment or by a (r) caregiver or lover / in. Patients may self-mutilate to compensate for their badness or may feel during a dissociative episode of their ability to insure dissociative episodes, paranoid thoughts and sometimes psychotic symptoms (eg. As hallucinations, Beziehungsgsideen) can be triggered by extreme stress are usually afraid of abandonment, whether real or imaginary. These symptoms are temporary and usually not severe enough to be considered as a separate disease into consideration. The symptoms disappear in most patients; the recurrence rate is very low. However, the functional status does not improve as dramatically as a rule. Diagnosis Clinical criteria (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [DSM-5]) found. For a diagnosis of borderline personality disorder patients have persistent pattern of unstable relationships, self-image and emotions have shown (ie emotional dysregulation) and marked impulsivity, as with ? 5 the following: to be left to avoid the desperate efforts (real or perceived) Unstable intense relationships that alternate between idealization and devaluation of the other person an unstable self-image or self-esteem impulsivity in ? 2 areas that could harm them (eg. as unsafe sex, binge eating, reckless driving) Repeated suicidal behavior, gestures or threats or self-mutilation Rapid changes in mood, usually last only a few hours and only rarely more than a few days Persistent feeling of emptiness Unpasse to control nd intense anger or problems that anger Temporary paranoid thoughts or severe dissociative symptoms triggered triggered by stress addition symptoms must have begun in early adulthood, but can occur during puberty. A differential diagnosis borderline personality disorder is most often misdiagnosed as bipolar disorder, due to the large fluctuations in mood, behavior and sleep. In borderline personality disorder sichStimmung and behavioral change, however, very quickly in response to stressors, especially interpersonal, while more sustainable and less reactive in bipolar disorder, moods. Other personality disorders have similar symptoms. Patients with histrionic personality disorder or narcissistic personality disorder can search the attention and be manipulative, but those with borderline personality disorder see themselves as bad and feel empty it. Some patients meet the criteria for more than one personality disorder. The borderline personality disorder can be distinguished against rejection of mood and anxiety disorders on the basis of a negative self-image, uncertain Attachment and sensitivity, the outstanding features of borderline personality disorder and usually absent in patients with a mood or anxiety disorder. The differential diagnosis of a borderline personality disorder including without substance abuse disorders and post-traumatic stress disorder; many disorders in the differential diagnosis of borderline personality disorder co-exist with it. Therapy Psychotherapy Medicines The general treatment of borderline personality disorder is the same as with all personality disorders. The identification and treatment of diseases of coexisting diseases is important for effective treatment of borderline personality disorder. Psychotherapy The most important treatment for borderline personality disorder is psychotherapy. Many psychotherapeutic interventions are effective to reduce suicidal behavior, to alleviate depression and improve function in patients with this disease. Cognitive behavioral therapy focuses on emotional dysregulation and lack of social skills. It shall consist of: Dialectical behavior therapy (a combination of individual and group sessions with therapists who act as behavioral coaches and round the clock available) System Training for Emotional Predictability and Problem Solving (Stepps) Other interventions focus on disturbances in the way and how patients and others see themselves emotionally. These interventions include: mentalization-based treatment transmission focused psychotherapy schema-oriented therapy mentalizing refers to reflect and understand his own state of mind and the state of mind of others to the ability of people. Mentalizing is to be learned by a secure attachment to the caregiver. based Mentalization therapies help patients to do: regulate effectively their emotions (. eg calm down when they are upset) Understanding how they treat their problems and difficulties with others over the minds of others to think and understand this way it helps to contact them with empathy and compassion to others in relationship. The transmission-focused psychotherapy focuses on the interaction between patient and therapist. The therapist asks questions and helps patients think about their responses so that they can examine during the meeting their exaggerated, distorted and unrealistic images of themselves. The current moment (for example, how patients are at their therapist) is more emphasized than the past. When a shy, for example, a quiet patient is suddenly hostile and argumentative, the therapist can ask if the patient notices a shift of emotion and then the patient ask to think about how the patient experienced himself the therapist and when things changed , The purpose is to patients enable them to develop a more stable and realistic perception of themselves and others him a healthier dealings with others by transmitting to the therapist to convey the schema-oriented therapy is an integrative therapy, cognitive behavioral therapy, attachment theory, psychodynamic concepts and emotion-focused therapy combined. It focuses on lifelong maladaptive patterns of thinking, feeling, behavior and coping (so-called. Schemes), affective change techniques and the therapeutic relationship, with limited Reparenting. The purpose is to help patients to change their schemes. The treatment has three stages: identifying the schemes when in daily life affect behavior change: The determination of the teeth awareness replacing negative thoughts, feelings and behaviors with healthier Some of these are specialized and require special training and supervision. Some interventions are not, however; such an intervention, which was developed for the practitioner is General (or good) psychiatric treatment This intervention provides an individual therapy once a week before and sometimes the use of drugs. Supportive Psychotherapy is also useful. The goal is to achieve an emotional, encouraging, supportive relationship with the patient and help the patient to develop healthy defense mechanisms, especially in interpersonal Beziehungen.Arzneimittel drugs work best when used sparingly and targeted for specific symptoms become. SSRIs are well tolerated in general; the chance of fatal overdose is minimal. However, SSRIs are only marginally effective for depression and anxiety in patients with borderline personality disorder. The following drugs are effective to alleviate the symptoms of borderline personality disorder: mood stabilizers like lamotrigine: For depression, anxiety, mood lability and impulsivity antipsychotics. (In fear, anger and cognitive symptoms, including temporary stress-related cognitive distortions such as paranoid thoughts , black and white thinking, severe cognitive disorganization) benzodiazepines and stimulants can also help to relieve the symptoms, but are not recommended, as addiction and turning to drugs are among the risks.

Health Life Media Team

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