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Mental health refers to state of well-being in which an individual realizes his abilities and is able to work in a productive and fruitful manner. It can help an individual in dealing with the stresses in his life which can help him in contributing to the community. Borderline personality disorder (BPD) refers to illness that is marked by ongoing pattern of different moods, behaviour and self-image (Trull et al., 2018). The people who have borderline personality disorder have to face intense episodes of anger and depression which have been found to last for a few days. The condition is characterised by difficulties of an individual in regulating his emotion and they feel emotions in an intense manner. The people face difficulty in returning to stable baseline after they undergo an emotionally triggering event. The difficulty creates the way for impulsivity and poor self-image and it causes intense emotional responses to the stressors. The individuals struggle with their self-regulation which creates the way for dangerous behaviours like self-harm. This essay throws light on prevalence of borderline personality disorder and gender differences which is manifested in regard to the mental health disorder. This essay discusses about signs and the symptoms of borderline personality disorder and the risks that are associated with the disorder. This essay elaborates on effective pathway of care for an individual and particular setting within which care should be provided.
Epidemiology of BPD at population level has been mainly studied in United States and it shows varying rates in between 0.5 % and 1.4 %. It have been found that Australia has population prevalence of around 1-4 % which creates a great burden on the country. Research has elicited the fact that on the basis of population prevalence within South Australia, around 17,000-68,000 Australians are living under the brunt of BPD (Sahealth.sa.gov.au., 2021). International research has brought out the fact that prevalence of BPD among the people who make use of psychiatric services have been found to be 23 % for the outpatient populations and around 43 % for the inpatient populations. Borderline personality disorder (BPD) is indicative of debilitating condition and it has global prevalence in between 1.4 % and 5.9 % within general population (Psychiatryonline.org., 2021). The epidemiological research within Australia have been found to be limited and recent Australian data have identified prevalence of 1 % for general population of Australia.
It have been found that since 1980 which is the year of initial standardisation of criteria for the personality disorders, the versions of Diagnostic and Statistical Manual of Mental Disorders have found that BPD is more common in women when compared to the men. It have been diagnosed predominantly in the women and estimated gender ratio have been found to be 3: 1. The disorder is often missed in the men and it have been found that they receive diagnosis of narcissistic personality disorder (Cristea et al., 2017). The investigators have talked about the fact that clinicians have subtle female gender bias in regard to diagnosis of BPD. It can be stated that clinician bias have contributed to misperception regrading female predominance. The men who have BPD are characterised by the explosive temperaments and they have high levels of novelty seeking (Choi-Kain et al., 2017). The women who have BPD on the other hand have been found to have high levels of the harm avoidance but they are not novelty seeking.
The people who have borderline personality disorder possess intense fear of abandonment and they face difficulty in being alone. The inappropriate anger and impulsiveness which is manifested by an individual can drive other people away which can raise hindrances in the path of an individual (Fonagy et al., 2017). It have been found that this disorder starts in early adulthood and the condition worsens with the onset of young adulthood. It have been found that situation often gets better with advancing age which can help a person in leading a fulfilling life. The condition of an individual who has BPD can get better over the passage of time with the help of treatment and it can help people in leading satisfying lives. The symptoms of BPD is manifested in the fact that it has an effect on feelings and behaviour patterns of an individual. BPD makes an individual undergo an intense fear of the abandonment and they often go to extreme measures so that they can avoid real or the imagined separation (Trull et al., 2018). They have to face pattern of the unstable intense relationships and it have been found that they idealise a person in one moment which can soon turn into hatred. They go through rapid changes in regard to self-identity which is inclusive of shifting goals and the values. They face periods of paranoia which is related to stress and they lose contact with the reality. They undergo rapid mood swings which lasts from few hours to few days and it can be inclusive of intense happiness and shame. There are various kinds of risks which are associated with the mental disorder which can leave an adverse effect on mental condition of an individual. They become vulnerable to impulsive risky behaviour which can create a bad impression on other people who are around them (Porter et al., 2020). They manifest signs of extreme reactions if they feel that they are abandoned by other people. An individual who has BPD faces the problem of weight fluctuations owing to eating disorder behaviours. The cognitive symptoms that are manifested in an individual is that they have to face fear of paranoia and delusions which leaves a great scar on life of an individual. It have been found to impair social functioning of an individual and he tries to dissociate himself from other people who are around him (Shah & Zanarini, 2018). The people who have borderline personality disorder suffer from this illness for longer duration of time before they receive any kind of proper diagnosis. It can be said that if the disorder is left untreated then it damages different areas of life of an individual. BPD in the event of being left untreated can create the way for demoralised sense of the self and he is unable to maintain the healthy relationships. He is found to suffer from depression and he has to undergo frequent hospitalisations which deteriorates quality of life of a person.
There are effective pathway of care which should be provided to a person who has BPD which can lead to recovery of an individual. There should be multi-disciplinary team and they should involve themselves in thorough discussion which can help in proper risk assessment of an individual who is suffering from BPD. The clinician should have problem list with the associated goals which are identified by service user which can help in recovery of an individual who has BPD (Ellison et al., 2018). The outcome should be properly provided to service user in a respectable manner which can help him in recovering from his present condition. He should be furnished with sufficient time for asking questions which can help in clearing his doubts about his present condition. The documentation should be completed for patients who have BPD which can help in recording his present situation (Videler et al., 2019). There should be collaborative care planning and all kinds of steps should be taken for drawing up care plan with the help of collaboration with service user which can help in improving the condition of the person. It have been found that professionals often have different opinions and meeting should be held between them which can help in removing confusion that can improve the mental state of an individual.
The low intensity programmes can be gained access to with the help of Intensive Support Programme (ISP) which can bear psychological benefits and they can be delivered within acute mental health services. The staff at all the levels should teach and coach people so that they can use new skills which can help the client in coping with his present mental state. Dialectical Behaviour Therapy (DBT) can help in providing psychological treatment for people who have suicidal tendencies and have been diagnosed with borderline personality disorder (Fitzpatrick, Wagner & Monson, 2019). There should be agreement of goals in between client and the therapist which can help client in gaining from therapy and help him in reaching targets of the treatment. Cognitive analytical therapy (CAT) is indicative of integrated and time-limited therapy which can prove to be helpful for the people who manifest signs of BPD. It makes use of cognitive behaviour therapy methods aspects of the psychoanalytical therapy which can help in facilitating positive change in the client (Iliakis et al., 2019). It can prove to be useful for people who had to face childhood abuse and trauma and it can help him in overcoming the problems in his life.
The psychiatrist should first perform initial assessment of patient which can help in determining treatment setting (inpatient or the outpatient). It have been found that patients who have borderline personality disorder have to face suicidal ideation and safety issues should be prioritised during initial assessment (Beck et al., 2020). The safety evaluations should be properly carried out before deciding whether he is inpatient, outpatient or deserves another level of the care. The determination of treatment setting should be followed by comprehensive evaluation and it can aid in the assessment of co-morbid disorders and kinds of functional impairment. The psychiatrist should be able to understand that there are biological, interpersonal and social dimensions which are crucial for recovering health of patients. The bio-psycho-social approach lays stress on significance of understanding human health and the illness to the fullest extent (Stoffers-Winterling, Storebø & Lieb, 2020). This approach considers social, psychological and biological factors and how complex interaction which takes place in between them can create the way for proper health care delivery which can help in patient recovery. The humanistic qualities are greatly laid stress on in present times and it is believed that they can transform adverse health impacts of the patient. The patients having BPD are not able to develop and sustain the trusting relationships and this should be treated which can help in addressing psychological dimensions of the treatment (Cristea et al., 2017). The patient should accept treatment plan which can help in building alliances which can help him in reaching his treatment goals. The reflection should be promoted instead of impulsive action which can help patient in understanding how the behaviours originate from internal motivations of an individual. There exists the problem of sustained return of the symptoms in the event of BPD and medications can prove to be of great use in addressing problems in the patient. The medications can prove to be of great use in modulating intensity of affective and cognitive symptoms. The clinician should identify situational precipitants and he should facilitate improved coping which can help in treating the symptoms in the proper manner. The social contact can be said to be of great importance and befriending schemes can be provided to the patient which can help in facilitating his physical activity and bring about improvements in his mental state. The group therapy can be useful in BPD and it can aid in successfully treating the client.
The people having borderline personality disorder exhibit fear of abandonment and they are not able to stay alone. They have the tendency of giving way to angry outbursts and they act impulsively which have been found to drive them away from other people in social situations. The multi-disciplinary team can be of great use and they should engage themselves in discussion that can help in properly assessing the risk factors. Dialectical behaviour therapy can be useful and it can aid in recovering people who show signs of BPD. It can provide psychological treatment for the people who have BPD and are prone to suicidal behaviour. The treatment plan should be accepted by patient which can help in fostering alliances and it can aid him in reaching his treatment goals.
Beck, E., Bo, S., Jørgensen, M. S., Gondan, M., Poulsen, S., Storebø, O. J., ... & Simonsen, E. (2020). Mentalization‐based treatment in groups for adolescents with borderline personality disorder: a randomized controlled trial. Journal of Child Psychology and Psychiatry, 61(5), 594-604.
Choi-Kain, L. W., Finch, E. F., Masland, S. R., Jenkins, J. A., & Unruh, B. T. (2017). What works in the treatment of borderline personality disorder. Current behavioral neuroscience reports, 4(1), 21-30.
Cristea, I. A., Gentili, C., Cotet, C. D., Palomba, D., Barbui, C., & Cuijpers, P. (2017). Efficacy of psychotherapies for borderline personality disorder: a systematic review and meta-analysis. Jama psychiatry, 74(4), 319-328.
Ellison, W. D., Rosenstein, L. K., Morgan, T. A., & Zimmerman, M. (2018). Community and clinical epidemiology of borderline personality disorder. Psychiatric Clinics, 41(4), 561-573.
Fitzpatrick, S., Wagner, A. C., & Monson, C. M. (2019). Optimizing borderline personality disorder treatment by incorporating significant others: A review and synthesis. Personality Disorders: Theory, Research, and Treatment, 10(4), 297.
Fonagy, P., Luyten, P., Allison, E., & Campbell, C. (2017). What we have changed our minds about: Part 1. Borderline personality disorder as a limitation of resilience. Borderline personality disorder and emotion dysregulation, 4(1), 1-11.
Iliakis, E. A., Sonley, A. K., Ilagan, G. S., & Choi-Kain, L. W. (2019). Treatment of borderline personality disorder: is supply adequate to meet public health needs?. Psychiatric Services, 70(9), 772-781.
Porter, C., Palmier‐Claus, J., Branitsky, A., Mansell, W., Warwick, H., & Varese, F. (2020). Childhood adversity and borderline personality disorder: a meta‐analysis. Acta Psychiatrica Scandinavica, 141(1), 6-20.
Psychiatryonline.org. (2021). Retrieved 23 February 2021, from https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/bpd.pdf
Sahealth.sa.gov.au. (2021). Retrieved 23 February 2021, from https://www.sahealth.sa.gov.au/wps/wcm/connect/fd259a8042ad4f2f9d5ebf80c298878e/Borderline+Personality+Disorder+%28BPD%29+Service+Implementation+Plan.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE-fd259a8042ad4f2f9d5ebf80c298878e-mMySc3r#:~:text=The%20NHMRC%20Guideline%20suggests%20Australia,to%20be%20living%20with%20BPD.
Shah, R., & Zanarini, M. C. (2018). Comorbidity of Borderline Personality Disorder: Current Status and Future Directions. The Psychiatric clinics of North America, 41(4), 583-593.
Stoffers-Winterling, J., Storebø, O. J., & Lieb, K. (2020). Pharmacotherapy for borderline personality disorder: an update of published, unpublished and ongoing studies. Current Psychiatry Reports, 22, 1-10.
Trull, T. J., Freeman, L. K., Vebares, T. J., Choate, A. M., Helle, A. C., & Wycoff, A. M. (2018). Borderline personality disorder and substance use disorders: an updated review. Borderline personality disorder and emotion dysregulation, 5(1), 1-12.
Videler, A. C., Hutsebaut, J., Schulkens, J. E., Sobczak, S., & Van Alphen, S. P. (2019). A life span perspective on borderline personality disorder. Current psychiatry reports, 21(7), 1-8.
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