Sooner or later, many people think about how to live with a borderline personality: such a mental disorder is quite common, and it has become especially widespread in recent years. Distinctive features of sick people are emotional instability, impulsiveness and a low level of control over their emotions and behavior. Typically, people with BPD are highly desocialized, emotional, and anxious. They are characterized by instability of communication with the real environment.
General information
Many psychiatric books and medical publications tell about how people with borderline personality disorder live. The disorder belongs to the class of diseases, expressed by a sharp change in mood. Patients tend to be impulsive. They have a lack of respect for themselves. It is very difficult for such people to build stablerelationships with others. Often, pathology is accompanied by disorders, disorders of a different plan. It is known that among persons with borderline disorders there are especially many alcoholics and drug addicts, neurotics and people suffering from depressive and eating disorders.
Sometimes psychiatrists have to explain how to live with borderline personality disorder to very young clients: it is known that such a violation is formed at an early age. According to statistics, approximately three out of every hundred adults have such a diagnosis. The main percentage of patients are women, on average, there are three sick women per man. Such people are characterized by suicidal tendencies and self-harming behavior. The rate of completed successful suicide attempt is estimated at an average of 9%.
What provokes? Reasons
Signs of borderline personality disorder have long been known, doctors have many strategies for treating such a disease, but to this day there is no generally accepted opinion as to what exactly provokes it. Some believe that the cause is an imbalance in the chemical balance of brain compounds, neurotransmitters of the nervous system necessary for mood control. In addition, studies have shown that, to some extent, a person's mood is determined by genetic factors. Of course, the surrounding world in which a person is forced to live has a strong influence.
Studies have proven five times more likely, on average, to show symptoms and signs of borderline disorderpersonality, if close relatives had a similar mental problem. Often, such a condition occurs in a person whose relatives include persons with various disorders and deviations in the development of the psyche. Problems related to the abuse of alcohol, narcotic intoxicants play a role, where there is a correlation between borderline violations and antisocial disorders.
Cases and connections
Often, a borderline personality type is inherent in those who, in childhood, suffered a strong traumatic event related to the physical body, emotional sphere, sexual area of life. Deviations are possible in children who are forced to part with their parents or ignored by them in the past. The risks are increased for those whose immediate family members have passed away early. The probability of a borderline deviation is especially high if a trauma has been previously transferred, while the personality is characterized by specific qualities - a low threshold for resistance to stress or increased anxiety.
According to scientists, with borderline disorders in a person, the normal functioning of certain parts of the brain is distorted. At the moment, there are no technologies and tools that can accurately explain whether such a deviation leads to borderline disorder or is provoked by it.
The nuances of manifestation
A classic sign of a borderline personality is instability in relationships and difficulty in controlling impulsive actions. These people tend to rate themselves very low. Manifestations are observed already in childhood. As a disease, borderline disorder has been considered since 68 of the last century. Mostly in the period of 68-80s, American specialists de alt with the problem. Thanks to their efforts, first the pathology got into the local classifier, then into the international one, and at the moment it is mentioned in the ICD-10. Both theoretical research and research projects devoted to the problem at that time were aimed at substantiating the pathology and its isolation. It was necessary to draw a clear line between deviation and neurosis, psychosis.
The borderline personality type is said to be when a person makes a suicide attempt, while the level of its danger is rather low, and an insignificant event becomes the cause. Comorbid depressive disorder causes rare, dangerous suicide attempts. Often, a person tries to inflict such harm on himself due to situations that arise when communicating with other people.
Features of manifestations
Observation of patients showed that all patients, without exception, fear loneliness and social isolation, they are haunted by the fear of being abandoned, although the real likelihood of such an event is minimal. Such fear becomes the reason for trying to keep a loved one with all their might. Another strategy of behavior is also possible: fearing to be abandoned, a person is the first to reject others. In any case, from the outside, the behavior seems eccentric, sooner or later leads to numerous problems in different areas of life.
Clarification of the diagnosis
Assuming a personborderline personality disorder, the doctor must first examine his condition to make an accurate diagnosis. Since the symptoms are similar to some other deviations in the development of the psyche, differential diagnosis comes to the fore: it is necessary to single out cases of a borderline nature and patients with schizophrenia, schizotypy. It is important not to confuse the state in question with affective, anxiety and phobia-related. The current classifier of the signs of the diagnosis is the instability of relationships with other people and a pronounced tendency to act under the influence of an impulse. Patients are characterized by instability of emotions and inadequacy of internal preferences.
The above manifestations first make themselves felt when a person is young. They actively declare their existence in a variety of life situations. The doctor, studying the patient's condition, must analyze how much effort the patient is making in order to eliminate the risk (real or perceived) of being abandoned. Patients are characterized by an identity disorder, instability of the image, a sense of one's self. A person tends to idealize others and devalue people, which is why the likelihood of relationship instability is especially high. Impulsivity manifests itself as reckless spending, irresponsible behavior on the road, the use of substances that affect the psyche. Many people with this disorder tend to eat too much. They are characterized by recurrent suicides, hints, threats to commit suicide, acts of self-harm.
Signals: there is danger
Main symptoms of borderline personality disorderdysphoria and instability to an affective state appear. Such people are characterized by rapid and sharp mood swings. Many note that they are worried about the feeling of emptiness, and this feeling is constantly pursued. They tend to display anger inadequately, and the need to control it creates considerable difficulties. With the considered mental disorder, paranoid ideas are possible. Many clinic patients have dissociative symptoms.
To diagnose borderline personality disorder, a particular patient must have five or more of the symptoms listed above. At the same time, not every person who is found to have these is classified as sick. To make a diagnosis, it is necessary to follow the development of the situation: if the violations persist for a long time, they can be considered the basis for determining the diagnosis. It is known from medical practice that deviation is very often mistaken for other conditions that differ in similar symptoms - for example, dramatic, antisocial disorder.
Nuances and combinations
Symptom of borderline personality is also considered a tendency to suicidal behavior. On average, every tenth patient at least once made such an attempt. Violation leads to the formation of a number of other pathological conditions, which requires an integrated approach to therapy. All additional pathologies that have developed in a particular case complicate the treatment process. In many ways, it is their presence, the individuality of the set of features of a particular case that is the reasonthe fact that it is especially difficult to work with patients with this type of mental deviation.
With borderline pathology, many suffer from panic attacks, they are too active in conditions of lack of attention and ability to concentrate on a task. There are many patients with symptoms of borderline personality who have an eating disorder, a bipolar disorder, a depressive state. Often, the pathology under consideration is combined with dysthymia, which is observed against the background of the abuse of psychoactive substances, alcohol. A combination with other mental disorders is possible: a dramatic disorder in which a person reacts too brightly, emotionally to what is happening, antisocial. There is a possibility of a complex combined case of combination with an anxiety disorder, in which the patient seeks to exclude any social interactions.
What to do?
Borderline personality disorder should be treated by a qualified doctor. At the moment, the allocation of the condition under consideration as an independent disease is disputed by many, while everyone recognizes that the therapeutic course is delayed for a long time and is given to the patient quite hard. This is largely due to the specifics of correcting the situation, due to the emotional state, behavioral reactions. However, such cases are known when, almost immediately after the start of the therapeutic course, significant improvements were observed in the patient's condition.
To a large extent, the success of treatment depends onWhat kind of psychotherapist did you work with? Pharmacological techniques are usually used if the condition in question is combined with other pathological conditions.
We are close
A rather complicated and delicate issue is living with a borderline personality on the same common territory. The patient's relatives face considerable problems, since the patient himself is a very impressionable and too sensitive person to everything, unable to deal with the difficulties that accompany the life path. Such people are constantly in a stressful situation, and relatives usually do not understand how they could help the sufferer. Individuals with borderline disorders have difficulty controlling their thoughts, emotional state, and tend to perform impulsive actions. They are characterized by irresponsible behavior and instability of interaction with others.
In therapy, the borderline has particular difficulty in forming a relationship with the therapist. It is not easy for a doctor to support them; for the patient, the main problem is the frame of contact. A key feature of a pathological personality is a tendency to unstable relationships with other people, while a person literally rushes from one extreme to another. Unconsciously trying to save himself from unnecessary difficulties, the therapist moves away from the client, which also creates obstacles in treatment.
Relevance of the problem and historical background
Borderlines are people who experience significant discomfort in everyday life. At the same time, they create many difficult situations for others. The inconveniences thatrelatives face, range from small embarrassing situations to literally catastrophic for a person's life path.
For the first time it was decided to call such a violation of the border in 1938. The author of the term is Stern, who at that moment was working with a group of patients whose pathology criteria did not fit into the already existing systems of mental illness. In 1942, Deutsch described a group of people in need of psychiatric help who struggled with emptiness. To do this, people were to some extent likened to chameleons, trying to change their emotional state so that it met the expectations of others. In 1953, Knight again applied the concept of "borderline" to the individuals with whom he worked, while recognizing that his group of patients had quite a variety of manifestations of abnormalities. The symptoms could not be summed up under the diagnoses known at that time, but there was no doubt that the nature of the manifestations was the same and the root cause was one disease. In 1967, Kernberg published his vision of the problem, which is now accepted everywhere.
Problems of the issue
The difficulty of treating borderline personality disorder is due to the tendency of such people to harm themselves. Observing masochism, the desire to torture oneself, a he althy person may feel sorry for a potential patient, some have a desire to somehow help, but more often - to withdraw from the situation, isolate themselves and have nothing to do with it.
Persons with borderline disorders show incorrect mentalization. They misperceive and misunderstand their own personality,incorrectly evaluate the meaning of what they do, incorrectly interpret the meaning of the behavior of other people, their motives.
Communication system
As part of the treatment of borderline personalities, a PSP system (set-up) was developed. It was formed as a rigid structure for interaction with people with the described violation, who are in a state of crisis. It is extremely difficult to work with them at this stage, since what psychiatrists call a force field inside a person is being formed: it is filled with chaos, it is almost impossible to get through such protection. The patient feels so alone that it is terrifying, he feels as if those around him are unable to understand him, at the same time he is aware of his own helplessness. The idea of a communication system to work with such sufferers is support, truth and empathy.
The specified system of treatment of borderline personalities involves reporting to the patient that he is understood, while the behavior of the assistant must be persistent. The goals set between the parties of treatment should be strived to be achieved - this should also apply to the patient, not only to the doctor. Speaking about the truth within the framework of such a communication system, they explain to a sick person that it is he who is responsible for his life. No one outside, no matter how eager to help, can take responsibility. The doctor helps the patient to recognize the fact that there is a problem and, in practice, objectively helps to solve the existing difficulties.
Therapy Methods
Cognitive behavioral therapy practiced for borderlinepersonality disorders, dialectical, schematic, and also based on the idea of mentalization. As can be concluded from the statistical reports, among young patients of psychotherapists, after a two-year course of assistance, about 80% no longer meet the criteria for the described pathological condition.
Symptoms in each individual case are extremely individual, and the picture itself is rarely pronounced, so there are a lot of options and methods of treatment. At the same time, there is another difficulty: many approaches in a particular case give insufficiently pronounced results, and it is not easy to find a working option.
About drugs
So far, there is no clear evidence that classic psychotropic drugs produce the desired results when working with a borderline personality. Such medications are usually prescribed to alleviate the symptoms of the pathological process. In recent years, polypharmacy has been practiced, that is, the method of simultaneously prescribing a complex of medicines and a psychotherapeutic course to a patient.
The doctor develops a therapeutic program individually, focusing on the specifics of the case. Preparations are selected based on symptoms, nuances, as well as previously practiced pharmacological assistance and adaptation of the body to various substances. It is necessary to assess which signs of the disease are the most striking, and it is for their correction to choose medicines. They usually start with antidepressants, because with borderline disorders, most patients feel depressed, provoked by emotional instability. SSRI drugs have the best effect in this disorder. They normalize the biochemical composition of neurotransmitters of the nervous system, due to which the mood stabilizes. Most often prescribed:
- "Fluoxetine".
- "Paroxetine".
- Sertraline.
The listed funds do not always have the same effect, a lot depends on the characteristics of the body, so the doctor often chooses the appropriate option empirically. The primary effect can be noticed after 2-5 weeks from the start of the course, so SSRI treatment is possible only under the supervision of a specialist and for a long time, otherwise there will be no benefit from the drugs.
Medicines: what else will help?
Sometimes antipsychotics come to the rescue. Such drugs are prescribed for a narrow list of manifestations that occur in a fairly large percentage of people with borderline disorders. Studies have shown that the first generation of antipsychotics gives a very weak effect in the pathology under consideration, but the second one has a good result. In medicine, it is common to prescribe:
- Risperidone.
- "Aripiprazole".
- Olanzapine.
All these medicines allow you to control the impulsive behavior of the patient. The best result is observed if drug treatment is combined with a psychotherapeutic course.
Normotimics
This term refers to a group of medicines aimed at eliminating anxiety and controlling mood. Studies have shown that the best results are obtained by the use of valproate. The current practice is such that immediately after confirming the diagnosis, the patient is prescribed funds of this particular class. According to some researchers, valproate should be considered the drug of first choice.
Help of a psychotherapist
To support the patient, his relatives and relatives should also visit a doctor who will explain the features of communication with the patient. In addition, it is necessary to undergo a psychotherapeutic course for the correction of a borderline violation. The choice of method remains with the doctor, who evaluates the features of communication with the patient. Most often resort to dialectical behavioral treatment. The doctor, working with the client, identifies negative patterns of behavior, helps to correct them for positive ones. This approach has proven itself in cases where the patient has a tendency to harm himself: it is possible to exclude bad habits and a number of other manifestations characteristic of the case.
Another reliable method is cognitive analytics. An image of psychological behavior is formed, due to violations, key points that need to be eliminated are determined. By imagining their disease, a person gets the opportunity to critically evaluate behavior and symptoms, thereby providing the patient with a tool to fight the disease.
Family psychoeducation is another promising and good approach used in the rehabilitation phase after the patient's recovery. The key is attractionrelatives, loved ones. People attend a psychotherapeutic course together, sharing the complexity of the situation.
