Comparing Disorders and Mental Illnesses
Borderline personality disorder has been considered as a serious form of personality disorder - Comparing Disorders and Mental Illnesses introduction. What makes such disorder complicated is due in part to its characteristics and features that are often associated with other mental illnesses, making it hard for BDP to be diagnosed. For the foregoing, this paper seeks to analyze the nature and extent of borderline personality disorder as well as its association with other forms of mental illnesses.
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Comparing Disorders and Mental Illnesses
Personality disorders are identified as pervasive psychological disorders that wreck havoc in the lives of many individuals. People suffering from personality disorders tend to have a hard time in establishing their personal, social, and family life. Since such disorders can exist on a continuum level, meaning they can be mild or severe depending on the individual’s personality disorder, they generally interfere with the emotional and psychological functioning of an individual. Some personality disorders are often associated with other mental illnesses, and when these disturbances come together, they develop pervasive patterns of behavior that deviates from the usual behaviors that the society considers (Joseph, 1997). There are ten different types of personality disorders that have various emphases, one of which is the borderline personality disorder (BPD), which is considered as a serious form of personality disorder associated with other mental problems or diagnoses. In this regard, this paper seeks to analyze the nature and extent of borderline personality disorder and its association with other forms of mental illnesses.
Borderline Personality Disorder (BPD): A Brief History
In order to properly define Borderline Personality Disorder, it is highly important to know a little about its history so as understand how it came about as a personality disorder. During the 19th century, the term borderline in the field of psychiatry was used in order to identify people who were suffering from a condition that existed between two types of psychiatric issues (Stone, 2005 cited in Chapman, Gratz, & Hoffman, 2007). It was widely held that only two diverse categories of psychiatric disorders existed during that time. The first type is known as neurosis, which involves patients who are aware of reality but are experiencing emotional issues like anxiety disorder and depression. The second category is psychosis, which is the reverse of neurosis, wherein patients experience unusual thoughts that are not realistic in nature. Schizophrenia falls in the said category. However, there were patients who were suffering from unusual thoughts and experiences that were not serious enough to be tagged as psychotic, yet they were also troubled to be placed in the neurotic category. Hence, such issue paved way for the development of the borderline category. The term borderline was used by psychiatrists for patients who were having trouble with perceiving the good and bad qualities in other people, individuals who were leading a life of instability, causing them chaos in the activities that they engaged in, and for those who were often suffering from emotional distraught (Stone, 205 cited in Chapman et al., 2007). The said perspectives were derived from observations of limited number of individuals but were not based from any scientific researches.
Due to the observed state of borderline patients, researchers conducted studies in order to further understand and identify the said dysfunction. After numerous studies were conducted, the characteristics that constitute what is now called borderline personality disorder were identified along with its associations with other mental illnesses, symptoms, and treatments. Currently, people with BPD are no longer bordering within the categories of psychosis and neurosis. However, continuous studies are being carried out in order to further analyze its association with the two categories and other mental problems (Chapman et al., 2007).
While BPD is less well known compared to other disorders, recent studies found out that the occurrence of BPD is more common compared to schizophrenia and bipolar disorder. According to the American Psychiatric Association (APA) (2000), approximately one to two percent of the adult population, most especially young women, meets the diagnostic criteria for borderline personality disorder (cited in Chapman et al., 2007).
Borderline Personality Disorder Symptoms and Features
Due to the complexity of the disorder as presented from the above origin, Dr. Marsha Linehan (1993a), who developed one of the most effective treatments for BPD, consolidated the symptoms of the disorder into five categories that embody the notable characteristics of BDP (cited in Chapman et al., 2007). It can be noticed that the term dyregulation is consistent in the categories of the symptoms. This is due in part to the idea that BPD is unstable in nature and cannot be controlled. Hence, the term dysregulated which means “not controlled” is appropriate to use in order to simplify the complexity of the symptoms of BPD (Linehan, 1993a cited in Chapman et al., 2007).
The following are the symptom categories. First, emotion dysregulation refers to the instability of emotions and the difficulty to handle one’s emotions. People diagnosed with BPD are often struggling with the emotions and at times are overwhelmed by what they feel (Linehan, 1993a; Lynch et al., 2006; cited in Chapman, Gratz and Hoffman, 2007). Falling under the said category are unstable emotions and mood as well as the inability to control anger. Second, interpersonal dysregulation is identified as having trouble with establishing relationships with other people. BPD patients struggle within their relationships in two particular ways: the unstable relationship itself and the fear of abandonment. Unstable relationships for BPD patients are due to the intensity of their emotions. The fear of abandonment is another symptom of BDP that falls in the category of interpersonal dysregulation. BDP patients are panicky and afraid when they perceive that their relationship with a friend, a family member, intimate partner, or therapist is about to end. Hence, they feel that they are going to live alone without support from others. Third, behavioral dysregulation means that the person’s behavior is out of control which is potentially harmful and may place the individual’s life at risk. The primary ways with which such symptom is apparent are through impulsive behavior like reckless driving, engaging in risky sexual activities, food binging, and being substance dependence or exhibiting self-harming behavior such as suicidal attempts. Fourth, self and identity dysregulation implies that the person does not have a concise or stable sense of who he or she really is and often feels empty. While it is normal for people to act differently during different situations, patients with BDP do not only act differently but also feel that they are a different person in the varying situations that they face. Another notable feature of the disorder is that most of the time, people with BDP feel empty. They always feel something is missing which is an uncomfortable feeling that may last for a long period. Finally, cognitive dysregulation means that the person is inclined to have negative thoughts or experience disconnection with reality whenever he or she is stressed out. However, the occurrence of these symptoms depends on the intensity of stress being felt by the individual. Oftentimes, cognitive dysregulation is characterized by suspicious, negative, and paranoid thinking about other people’s motive. Another aspect of such dysregulation is the experience of dissociation or the feeling of being checked out or a feeling as if the person is not inside his or her own body (Linehan, 1993a; APA, 2000; cited in Chapman et al., 2007).
Diagnoses or Other Problems Associated with Borderline Personality Disorder
Based on the given features and symptoms of BPD, many professionals pointed out that once a person suffers from BPD, the individual is likely to be diagnosed with three or four other disorders that have a close relation with the features and symptoms of BDP. It was also stated that only few people with BDP were diagnosed with “pure” BDP without any other mental health diagnoses (Krawitz and Jackson, 2008).
Studies have shown that there is a considerable relationship between depressive disorder (depression for a dysthymic period of time) and dysthmic disorder (depression for longer period, i.e., more than 2 years) and BPD. According to researches, most of the BDP patients also meet the criteria set for depressive disorder, half of who are suffering from major depressive disorder (MDD) and dysthymia. Although the said patients meet both the criteria for the specified conditions, the descriptive characteristics of the conditions occurring within the patients are still disparate from each other but are not distinct enough, which poses problems for their differentiation. For instance, depressed patients are anergic and miserable, while borderline patients are angry and impulsive. However, recent studies placed a line between the qualities of depression experienced by borderline patients. It was stated that for patients of borderline disorder, the quality of their depressive experiences are more unique and distinct compared to other depressive patients, as studies claim that the behavior of BDP depression highlights the feelings of emptiness, negative insights, primitive guilt and devaluative attitudes (Kurtz & Morey, 1998; Rogers et al., 1995; Western et al., 1992; cited in Gunderson & Links, 2008).
Despite the idea that both BDP and MDD coexist with each other, another difficulty posited by such association is the decision of which diagnosis should be prioritized (Gunderson and Philips, 1991; Rogers et al. 1995; Westen et al. 1992 cited in Gunderson and Links, 2008). The difficulty occurs most especially for patients with MDD under the circumstances of a troubled relationship on the verge of separation and the onset of self-harm or suicidal attempts. For instance, the clinician would have to make a judgment whether the suicidal tendency of the patient is done in order to gain sympathy and a frantic effort to avoid the threat of abandonment, which as stated earlier, is a common dynamic for BDP, or the person was only motivated to do such action because of hopelessness and despair, which is a common behavior for an individual under a depressive mental state. In this regard, the association of BDP and depression posits problem among many clinicians (Gunderson & Links, 2008).
According to researches, there is an indistinct boundary between BDP and Bipolar disorders (Blacker & Tsuang, 1992 cited in Gunderson & Links, 2008). Hence, the overlap between the two is deemed to be controversial. While bipolar I has distinct virtue of manic episodes which makes it easier for clinicians to observe whether a borderline disorder is persisting, the issue of a much complex diagnostic is evident in patients with bipolar II disorder. This is so because the phenomenological features of BDP and bipolar II disorders are very much similar, making it unclear whether the two conditions are independent from each other (Gunderson & Links, 2008).
Recent studies found out that in order to make the differential diagnosis between the two conditions, there should be an emphasis on the lability, reactivity, and the overall symptoms of the disorders in their association with depression. People with borderline disorder experience the depressive affect of the condition in a day to day or even hour to hour variability, while the depressive mood within the bipolar disorder is experienced in a “discrete episode with a clear onset and termination and relatively stable during the episode” (Goodwin, Jamison, & Ghaemi, 2007, p.108). The symptom clusters of bipolar disorder involve changes in their sleep and appetite regulation. However, the said features are not observed in BDP patients while they are in their depressive state, unless bipolar disorder is also existing (Goodwin et al., 2007).
Meanwhile, the evaluation for elevated mood duration is also distinct for each disorder as well as their responsiveness during confrontations and interpretations. Although the mood lability of borderline personality disorder is noted to be extreme, the elevation of such aspect does not last long enough compared to bipolar disorder in order to meet the mania criterion. The mood elevation for borderline disorder may overlap with hypomania and cyclothymia based on its duration, yet the symptoms associated with hypomania such as decreased need for sleep and racing thoughts were not observed for the mood lability of BDP. Hence, the absence of such events suggests that the case is a true bipolar disorder and not BDP (Goodwin et al., 2007). Similarly, differences in the responsiveness of BDP and bipolar II patients are also evident. BDP patients sometimes react in situations constructively or not, while bipolar II patients act as though they are not disturbed by the intervention as if it had not taken place, either by not responding, changing the subject, or rationalizing glibly. Though both disorders make their sufferers respond to external stimuli by flight or rage, borderline patients always react emotionally (Gunderson & Links, 2008). In practical terms, the emphasis on the linkage of BDP with bipolar II disorder is an imperative factor during interventions because more often than not, the diagnosis for bipolar disorder is usually apprehended as a borderline disorder when the features of each disorder are not properly differentiated (Goodwin et al., 2007).
Other than depressive disorder and bipolar disorder, BDP is also associated with many other mental illnesses which include agoraphobia, anxiety disorder, post traumatic stress disorder, social phobia, obsessive-compulsive disorder, alcohol and other substance dependence, and eating disorders to name a few, and it was also discovered to overlap with other personality disorders (Krawitz and Jackson, 2008).
From the above evidences, it may be concluded that borderline personality disorder is a serious form of personality disorder which, without proper medical intervention, can become a ground for the development of other mental health illnesses. Its association with other disorders and mental health issues complicate its intervention in many ways. However, understanding the nature and extent of the specified disorder as well as with proper guidance from a professional the intervention for the disorder would lessen the negative impact of borderline personality disorder among the people suffering from it.
Chapman, A.L., Gratz, K.L., & Hoffman, P.D. (2007). The Borderline Personality Disorder Survival Guide: Everything You Need to Know about Living with BPD. Oakland, CA: New Harbinger Publications.
Goodwin, F., Goodwin K., & Ghaemi, N. (2007). Manic-depressive Illness: Bipolar Disorders and Recurrent Depression. New York: Oxford University Press.
Gunderson, P. & Links, S. (2008). Borderline Personality Disorder: A Clinical Guide. Arlington, VA: American Psychiatric Pub.
Joseph, S. (1997). Personality disorders: New Symptom- Focused Drug Therapy. Binghamton, NY: Haworth Press.
Krawitz, R. & Jackson, W. (2008). Borderline Personality Disorder. New York: Oxford University Press.