Sooner or later many people think about how to live with a borderline personality: such a mental disorder occurs quite often, and its distribution has been especially widespread in recent years. Distinctive features of sick people are emotional instability, impulsivity and a low level of control of their emotions and behavior. Typically, people with borderline impairment are highly desocialized, emotional, and prone to worry. They are characterized by instability of communication with the real environment.
general information
Many psychiatric books and medical publications talk about how people with borderline personality disorder live. The disorder belongs to the class of diseases, expressed by a sharp change in mood. Impulsive actions are characteristic of patients. They have a lack of respect for themselves. It is very difficult for such people to build stable relationships with others. Often, pathology is accompanied by disorders, disorders of a different plan. It is known that among people 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 disorder forms at an early age. According to statistics, approximately three people out of every hundred adults have such a diagnosis. The main percentage of patients is women; on average, there are three sick ladies per man. Such people tend to be suicidal and self-harming behavior. The frequency of completed successful suicide attempts is estimated at an average of 9%.
What provokes? Causes
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 about what exactly provokes it. Some believe that the reason is a violation of the chemical balance of brain compounds, mediators of the nervous system, necessary to control mood. 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, strongly influences.
Studies have shown that on average, five times more likely that the symptoms and signs of borderline personality disorder will appear, if relatives, relatives had a similar mental problem. Often a similar condition occurs in a person among whose relatives there are people with a variety of disorders and deviations in the development of the psyche. The problems associated with the abuse of alcohol and narcotic intoxicants play a role, where there is a correlation between borderline disorders and antisocial disorders.
Cases and Communications
Often, the borderline type of personality is inherent in those who, in childhood, suffered a strong traumatic event related to the physical body, emotional sphere, and sexual area of ​​life. Deviations are possible in children who are forced to leave their parents or are ignored by them in the past. The risks are increased for those whose immediate family members died early. Particularly high is the likelihood of a borderline deviation if a trauma was previously sustained, while individuals have specific qualities - a low threshold for resistance to stress or increased anxiety.
According to scientists, with borderline abnormalities in humans, the normal functioning of individual parts of the brain is distorted. At the moment, there are no technologies and tools that could accurately explain, such a deviation leads to or provokes a borderline disorder.
The nuances of manifestation
A classic sign of a borderline personality is the instability of relationships and the difficulty in controlling impulse actions. Such people tend to evaluate themselves very low. Manifestations are observed already in childhood. As a disease, borderline disorder has been considered since the year 68 of the last century. Mostly during the period of 68-80s, American specialists dealt with the problem. Thanks to their efforts, the pathology first got into the local classifier, then into the international one, and is currently mentioned in the ICD-10. Both theoretical studies and research projects devoted to the problem in that period were aimed at substantiating the pathology and isolating it. It was necessary to draw a clear line between deviation and neurosis, psychosis.
They say about the borderline type of personality if a person makes a suicide attempt, while the level of danger is quite low, and the cause is an insignificant event. Comorbid depressive disorder causes rare, dangerous attempts to end a life. Often, a person tries to inflict such harm on himself because of situations that arise when communicating with other people.
Features of manifestations
Monitoring of patients showed that, without exception, all patients 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 his might. Another strategy of behavior is also possible: for fear of being 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.
Diagnosis
Assuming a person has borderline personality disorder, the doctor must first examine his condition to make an accurate diagnosis. Since the symptomatology is similar to some other deviations in the development of the psyche, differential diagnosis comes to the fore: it is necessary to distinguish cases of a borderline nature and patients with schizophrenia, schizotypy. It is important not to confuse the condition in question and the affective, anxious and caused by phobias. The current classifier of signs of diagnosis is the instability of relations 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 listed 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 makes to eliminate the risk (real or imagined) to be abandoned. Patients are characterized by an identity disorder, an instability of the image, a sense of self. A person is inclined to idealize others and depreciate people, which is why the likelihood of unstable relations is especially high. Impulsivity manifests itself as imprudent expenses, irresponsible behavior on the road, the use of substances affecting the psyche. Many people with this disorder tend to eat too much. They are characterized by relapses of suicides, hints, threats to commit suicide, acts of self-harm.
Signals: there is a danger
The main symptoms of borderline personality disorder are dysphoria and instability to an affective state. Such people are characterized by quick and sharp mood swings. Many note that they are concerned about the feeling of emptiness, and this feeling haunts constantly. They tend to inappropriately show anger, and the need to control it creates considerable difficulties. With the mental disorder in question, paranoid ideas are possible. Many clinic patients have dissociative symptoms.
In order to diagnose borderline personality disorder, a particular patient should have five or more of the above variety of symptoms. At the same time, not every person in whom those will be found is considered a patient. To make a diagnosis, it is necessary to monitor the development of the situation: if the violations persist for a long time period, we can consider them the basis for determining the diagnosis. From medical practice it is known that deviation is often mistaken for other conditions that differ in similar symptoms - for example, dramatic, antisocial disorder.
Nuances and combinations
A symptom of a 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 - the reason that working with patients with this type of mental deviation is especially difficult.
With borderline pathology, many suffer from panic attacks, they are too active in the absence of attention and the ability to concentrate on the task. Among patients with symptoms of a borderline personality, there are many who have a food, bipolar disorder or depression. Often, the pathology in question is combined with dysthymia, which is observed against the background of abuse of psychoactive substances, alcohol. A combination with other mental disorders is possible: a dramatic disorder in which the personality is too bright, emotionally reacting to what is happening, antisocial. There is the likelihood of a complex combined case of combination with anxiety disorder, in which the patient seeks to exclude any social interactions.
What to do?
In borderline personality disorder, a qualified doctor should choose therapy. At the moment, the selection of the condition in question 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 rather 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 in the patient's condition were observed.
In many respects, the success of treatment depends on which psychotherapist has worked with. Pharmacological methods are usually used if the condition in question is combined with other pathological ones.
We are near
A rather complicated and subtle issue is living with a borderline personality in one common territory. Relatives of the patient are faced with considerable problems, because the patient himself is a very impressionable and too sensitive person, unable to deal with the difficulties that accompany his life's journey. Such people are constantly in a stressful situation, and relatives usually do not understand how they could help the sufferer. Individuals with borderline impairments have difficulty controlling thoughts, emotional state, and tend to commit impulsive actions. They are characterized by irresponsible behavior and instability of interaction with others.
In therapy, the borderline person faces particular difficulties in forming relationships with the therapist. It is not easy for a doctor to support them; the main problem for the patient 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 protect himself from unnecessary difficulties, the therapist moves away from the client, which also creates obstacles in treatment.
Actuality of the problem and historical background
Borderline individuals are people who experience significant discomfort in everyday life. At the same time, they create many difficult situations for others. The inconveniences encountered by loved ones range from small awkward situations to literally catastrophic for a person’s life path.
For the first time, it was decided to call such a violation border in 1938. The author of the term is Stern, who worked at that time with a group of patients whose pathology criteria did not fit into the existing systems of mental illness. In 1942, Deutsch described a group of people in need of psychiatric help struggling with emptiness. To do this, people are somewhat likened to chameleons, trying to change their emotional state so that it matches the expectations of others. In 1953, Knight again applied the concept of “borderline” to the personalities with whom he worked, while acknowledging that a rather diverse manifestation of deviations was characteristic of the group of his patients. Symptoms could not be brought under the known diagnoses 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 nowadays universally accepted.
Issue
The complexity of treating borderline personality disorder is due to the tendency of such people to harm themselves. Observing masochism, the desire to torture oneself, a healthy person can feel sorry for a potential patient, some people have a desire to help somehow, but more often - to get out of the situation, fence off and have nothing to do with it.
Persons with borderline disorders show incorrect mentalization. They incorrectly perceive and understand their own personality, incorrectly assess the meaning of what they are doing, incorrectly interpret the meaning of other people's behavior, 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 interacting with people with the described disorder who are in a state of crisis. Working with them at this stage is extremely difficult, because what psychiatrists form is called the force field inside the person: it is filled with chaos, it is almost impossible to reach through such protection. The patient feels lonely so much that it terrifies him, he feels that others are not able to understand him, at the same time he realizes 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 informing the patient that they understand him, while the behavior of the assistant should be persistent. The goals that the treatment parties set among themselves should be sought to achieve - this should apply to the patient, not only to the doctor. Speaking of truth within the framework of such a communication system, they explain to a sick person that he is responsible for his life. No one external, no matter how he seeks to help, can take responsibility. The doctor helps the patient recognize the fact of a problem and in practice objectively helps to solve the existing difficulties.
Therapies
Cognitive-behavioral therapy of borderline personality disorder is practiced, dialectic, schematic, and also based on the idea of ​​mentalization. As can be concluded from the statistical reports, among the young patients of psychotherapists, according to the results of a two-year course of care, about 80% no longer meet the criteria for the described pathological condition.
Symptoms in each case are exclusively 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 an insufficiently expressed result, and finding a working option is not easy.
About drugs
There is no obvious evidence of the fact that classical psychotropic drugs give the desired result 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 to the patient a complex of medicines and a psychotherapeutic course.
The doctor develops a therapeutic program individually, focusing on the characteristics of the case. , , . , , . , , . . , . :
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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 drugs aimed at eliminating an alarming background and controlling mood. Studies have shown that the use of valproate gives the best results. 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 first-choice drugs.
Psychotherapist's help
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 of correction of border violations. The choice of method remains with the doctor, evaluating the features of communication with the patient. Most often resort to dialectic behavioral treatment. The doctor, working with the client, determines 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 eliminate bad habits and a number of other manifestations characteristic of the case.
Another reliable method is cognitive-analytical. An image of psychological behavior due to violations is formed, key points that need to be addressed are determined. Presenting his illness, a person gets the opportunity to critically evaluate behavior and symptoms, thereby providing the patient with a tool to combat the disease.
Family psycho-education is another promising and good approach that is used in the rehabilitation phase after the patient's recovery. The key point is attracting relatives and friends. People attend a psychotherapeutic course together, sharing the complexity of the situation.