The concept "borderline" It is heard more frequently today. However, do we really know what we mean when we use it? Borderline is nothing other than the Borderline Personality Disorder (TLP). A disorder that, little by little, we are getting to know more and more.
In this article we will enter the TLP. We will investigate the diagnosis and the possible causes. In the evaluation and in the treatment. It is not a simple disorder to diagnose. And here we will approach it from the highlights of the scientific literature published so far.
- 1 Borderline Personality Disorder
- 2 A somewhat complicated diagnosis
- 3 Epidemology and Possible Causes
- 4 Evaluation
- 5 Treatment
Borderline personality disorder
The DSM-V, is the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. It has become a reference within the world of psychiatry and psychology to define the different disorders. So that, How does the DSM-V define the Borderline Personality Disorder?
TLP is a general pattern of instability in interpersonal relationships, self-image and effectiveness. As well as a remarkable impulsivity, which begin at the beginning of adulthood and occur in various contexts, as indicated by five (or more) of the following items:
- Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behaviors.
- A pattern of unstable and intense interpersonal relationships characterized by the alternation between extremes of idealization and devaluation.
- Identity alteration: self-image or sense of self accused and persistently unstable.
- Impulsiveness in at least two areas, which is potentially harmful to himself (eg, expenses, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behaviors.
- Behaviors, recurrent suicide attempts or threats, or self-mutilation behavior.
- Affective instability due to a remarkable reactivity of the mood (eg, episodes of intense dysphoria, irritability or anxiety, which usually last a few hours and rarely a few days)
- Chronic feelings of emptiness.
- Inappropriate and intense anger or difficulties controlling anger (eg, frequent signs of temper, constant anger, recurring physical fights).
A somewhat complicated diagnosis
It is a difficult disorder to diagnose due to the variability of its clinical presentations. Therefore, a successful diagnosis usually takes time. As they point out Millon and Davis (1998), "borderline disorderof personality is for many authors the most complex personality disorder and often one of the most serious. "
Epidemology and Possible Causes
For many authors, BPD is one of the most frequent disorders today (Álvarez, 2001). It is estimated that it affects between 30% and 60% of patients diagnosed with personality disorder. According to the DSM, the risk of suffering from this disorder in relatives of people diagnosed with BPD would be up to five times higher than that of the general population.
As for prevalence by sex, it is more frequent in women than in men, around 75% are women. However, this information could be biased since women usually demand more professional help than men (Cervera et al., 2005). So it is difficult to know exactly who is most affected.
Cervera, Haro and Martínez-Raga (2005) they declare it as "the most representative emotional disorder of our time and as the result of a society installed in immaturity, banality and lack of cohesion". These authors point to today's society as one of the possible causes of this disorder. A demanding society to extreme levels, where everything must be done correctly, without the possibility of error. A society obsessed with success and image.
Caballo (2004) points out that part of the origin of this disorder is a interference in the transfer of securities because, among other reasons: family ruptures due to geographical mobility, divorce and rapid social changes. Paris (1996), points out the possible influence of factors such as education, family environment and social structure.
To evaluate the TLP, the "Limit Personality Inventory: BPI" (Leichserring, 1999). This inventory distinguishes between three levels: neurotic, borderline and psychotic. It consists of 53 true-false items. As well as several scales that measure, among other things, diffuse identity, primitive defense mechanisms, reality assessment and fear of compromise.
Other tools who evaluate the TLP:
- Scale for Borderline Personality Disorder: BDP (Perry, 1982).
- Limit Syndrome Index: BSI (Conte et al., 1980).
- Diagnostic Interview for Limit-Revised Patients: DIB-R (Gunderson, 1981).
The treatment of Borderline Personality Disorder can focus on two aspects: the pharmacological Y psychotherapy.
The drugs most used are:
- Antidepressants They have proven effective in symptoms such as irritability, hostility and self-aggression.
- Anxiolytics Effective to reduce anxiety crisis, sleep disturbance and hostility.
- Mood stabilizers and anticonvulsants. They regulate mood swings and stabilize the states of impulsivity and aggression.
- Antipsychotics They are usually prescribed in low doses. Useful for altered cognitions: paranoid ideation, illusions, episodes of derealization or hallucinatory symptoms.
The drugs try to face three big symptoms: the affective, the behavioral disorders and impulsivity Y cognitive disorders.
There are many therapies that can help in Borderline Personality Disorder. So let's highlight the most used.
Within the therapies psychoanalytic, the Support Psychotherapy It is one of the most significant (Díaz, 2001). It is a face to face with the patient to have a better adaptive functioning. It can last for years.
Within cognitive-behavioral therapies, the Behavioral Dialectic Therapy (Soler et al. 2001). It is a therapy focused only on this disorder and works the most problematic aspects such as suicidal behavior or affective instability.
The Beck and Freeman Cognitive Therapy It is also on the table to treat this disorder. It is focused on the patient being able to identify for himself and correct distorted thoughts, assumptions and the most maladaptive and dysfunctional cognitive processes.
The Iconic Therapy for Emotional Stabilization It has also been applied since 1997. This therapy allows the person to anticipate their impulses and facilitate their control. Integrates cognitive and behavioral techniques.
- Álvarez, E. (2001). Cognitive-behavioral therapy of borderline personality disorder. Annals of Psychiatry, 17, 53-60.
- American Psychiatric Association. (2013). DSM-V Diagnostic and Statistical Manual of Mental Disorders. Barcelona: Masson, S.A.
- Caballo, V. (2004). Manual of personality disorders. Description, evaluation and treatment. Madrid: Synthesis.
- Cervera, G., Haro, G. and Martínez-Raga, J. (2005). Borderline personality disorder. Paradigm of psychiatric comorbidity. Madrid: Pan American doctor.
- Díaz, J. (2001). Review of psychotherapeutic treatments in patients with borderline personality disorders. Journal of the Spanish Association of Neuropsychiatry, 21, 51 70.
- Escribano, T. (2006). Borderline Personality Disorder: Study and Treatment. Intelligo, 1 (1), 4-20.
- Millon, T. and Davis, R. D. (1998). Personality disorders. Beyond the DSM-IV. Barcelona: Masson, S.A.
- Paris, J. (1996). Cultural factors in the emergence of borderline pathology. Psychiatry, 59, 185-192.
- Soler, J., Camping, M. J., Pérez, V., Puigdemont, D., Pérez-Blanco, F. and Álvarez, E. (2001). Olanzapine cognitive and behavioral group therapy in borderline personality disorder.Spanish Acts of Psychiatry, 29, 85-90.
- Depression test
- Goldberg depression test
- Self-knowledge test
- how do others see you?
- Sensitivity test (PAS)
- Character test