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Borderline Personality Disorder UNIVERSITY OF HAWAI‘I AT HILO ◆ HOHONU 2020 ◆ VOL. 18 Borderline Personality or self-injury are the most useful indications for a correct diagnosis” (74). Klaus Lieb et al. state Disorder in their paper “Borderline Personality Disorder” Braden Savage that affective disturbance, disturbed cognition, Psychology 100 and comorbidity are additional the indicators for Abstract diagnosing borderline personality disorder (453- Borderline personality disorder is a relatively 454). Dysphoria is a common symptom of border- ambiguous disorder and has a multifaceted eti- line personality disorder. Despite a strong correla- ology. It is characterized by suicidality, intense tion of factors with the disorder, however, there is dysphoria, self-harm, impulsivity, and unstable much room for individual variation in diagnosis. personal relationships. Causes of the disorder can According to Leichsenring et al., “there are 151 likely be attributed to both environmental and theoretical possible ways of diagnosing this disor- physiological factors. History of sexual abuse is der” (74). The multiplicity of diagnoses could po- common in patients with borderline personality - disorder; however, this is not the only factor to agnosis of borderline personality disorder, which which the disorder can be attributed. Physical ab- normalities in the hippocampus and amygdala are proper treatment or not. common in patients with the disorder, which may Borderline personality disorder can be associ- contribute to emotional dysregulation. Various treatments exist for the disorder, including partial factor has been determined to be a sole cause of hospitalization, transference-focused psychother- the disorder. From what has been discerned, the apy, dialectical behavior therapy, and supportive etiology of borderline personality disorder can be attributed to a range of variables, including ge- aspect of the disorder, though a treatment has not yet been discovered that can consistently treat the disorder overall. Antidepressants and neuroleptics a result of one another has yet to be determined. can be used to supplement treatment. Further re- Lieb et al. state that “[v]arious types of adverse - events during childhood, including ongoing expe- look in treatment for the disorder. riences of neglect and abuse, are reported in many Although borderline personality disorder has a patients,” and they explain that abuse, particularly “weighted prevalence… [of] 1-8% in the USA,” that which is of a sexual nature, “is reported by (Lieb et al., 453) the exact cause of the disorder 40-71% of inpatients with borderline personal- is still unknown. Several factors have been identi- ity disorder” (454). The severity of the abuse seems to affect the severity of the disorder, which disorder is characterized by suicidality, instability leads many to believe that the disorder is a form in relationships with others as well as with one- of “chronic post-traumatic stress disorder” (Lieb self, and utilization of multiple treatment methods et al., 454-455). Kenneth R. Silk et al. observe (Lieb et al, 453; Leichsenring et al., 74). Studies in their paper “Borderline Personality Disorder - Symptoms and Severity of Sexual Abuse” how cult disorder, as well as a variety of treatments that the abuse type, the duration of the abuse, and who assist in reducing symptoms, including suicidality. performed the abuse affect the expression of bor- Exact causes and a most effective treatment, how- derline personality disorder, giving each a score ever, have yet to be ascertained. relating to the Diagnostic Interview for Borderline A chief indicator of borderline personality Personality (DIB) items (1060-1062). From the their paper “Borderline Personality Disorder as“a in all patients, “[o]ngoing sexual abuse… pre- pervasive pattern of instability in interpersonal re- dicted suicide,” and in an analysis of only women lationships, identity, impulsivity, and affect” (74). patients, it also predicted “parasuicide and regres- Leichsenring et al. add that “suicidal tendency sion in therapy” (Silk et al., 1062). Additionally, 50 UNIVERSITY OF HAWAI‘I AT HILO ◆ HOHONU 2020 ◆ VOL. 18 “[s]ex with a parent predicted chronic hopeless- to determine the best personalized treatment for ness and worthlessness,” and in women, it was an individual, one must observe what symptom or found to predict an “intolerance of being alone” symptoms express themselves most prominently (Silk et al., 1062). While the correlation is strong and model a treatment plan according to those between sexual abuse and borderline personality traits (Lieb at al., 456). Since patients with bor- disorder, it cannot be concluded that it is the sole derline personality disorder necessitate individual- cause of the disorder. We might use sexual abuse ized treatments, they commonly use a large variety as an indicator to predict whether or not an indi- of treatments (Lieb et al., 455). vidual can be diagnosed with the disorder. (Silk et Several methods of treatment for border- al., 1063). Neurobiology and genetics have line personality disorder are dialectical behav- been speculated as being key in the expression of ior therapy, transference-focused psychotherapy, borderline personality disorder. Lieb et al. explain supportive treatment, and partial hospitalization. that “[s]tructural and functional neuroimaging has In a study by Clarkin et al., dialectical behavior revealed a dysfunctional network of brain regions therapy, transference-focused psychotherapy, and that seem to mediate important aspects of border- supportive treatment are compared in terms of ef- line personality symptomatology,” which include fectiveness, as well as what symptoms of border- “the anterior cingulate cortex…, the orbitofrontal line personality disorder they appear to improve. and dorsolateral prefrontal cortex, the hippocam- Dialectical behavior therapy focuses on “the learn- pus, and the amygdala” (455). The hippocampus ing of emotional regulation skills” and “consist[s] and amygdala have been shown to have decreased of a weekly individual and group session and avail- volume. Both the volumes of the hippocampus able telephone consultation” (Clarkin et al., 923). and the amygdala have been shown to have a de- Transference-focused psychotherapy focuses “on creased volume in patients with borderline person- the dominant affect-laden themes that emerge in ality disorder, which could account for or be a re- the relationship between patient and therapist” sult of the patients’ emotional dysregulation (Lieb and “consist[s] of two individual weekly sessions” et al., 455). The disturbance in these brain areas (Clarkin et al., 923). Supportive treatment focuses causes a faulty serotonin secretion, which could be on giving “advice on the daily problems facing the a cause of patients’ aggression (Lieb et al., 455). patient,” and “consist[s] of one weekly session, Leichsenring et al. elaborate that “some genes that which could be supplemented with additional ses- might be linked to psychopathological changes in sions as needed” (Clarkin et al., 923). The study the disorder are involved in the serotonergic sys- found that transference-focused psychotherapy tem” (76). This implies a possible correlation be- and dialectical behavior therapy helped improve tween serotonin and the expression of borderline suicidality; transference-focused psychotherapy personality disorder symptoms, although, as with and supportive treatment helped improve anger; the other factors, its exact purpose has yet to be transference-focused psychotherapy helped im- determined. prove “Barratt Factor 2 impulsivity, irritability, How, then, is a treatment supposed to be de- verbal assault, and direct assault;” and all three veloped for a disorder, the causes of which remain helped improve “depression, anxiety, global func- relatively ambiguous? As John Clarkin et al. state tioning, and social adjustment” (Clarkin et al., in their paper “Evaluating Three Treatments for Borderline Personality Disorder: A Multiwave distinguish what treatment method a patient will - ing effective treatment for borderline personality most prominently express. disorder is to show that a given treatment is as- Anthony Bateman and Peter Fonagy com- sociated with improvement in relevant dimensions pared a control group of patients with borderline of pathology beyond self-damaging behaviors” personality disorder to a group of patients that (922). The best approach to treating the disorder received partial hospitalization over a period of is by observing how individual symptoms of the eighteen months. Control group patients received “regular psychiatric review… inpatient admission 51 UNIVERSITY OF HAWAI‘I AT HILO ◆ HOHONU 2020 ◆ VOL. 18 as appropriate… and outpatient and community Works Cited follow-up” (Bateman and Fonagy, 1565). The Bateman, Anthony, and Peter Fonagy. partially hospitalized group received “once-week- “Effectiveness of Partial Hospitalization in the ly individual psychoanalytic psychotherapy… Treatment of Borderline Personality Disorder: thrice-weekly group analytic psychotherapy… A Randomized Control Trial.” The American once-a-week expressive therapy oriented toward Journal of Psychiatry, vol. 156, issue 10, 1 psychodrama techniques… and… a weekly com- Oct 1999, pgs. 1563-1569. munity meeting” (Bateman and Fonagy, 1565). - Clarkin, John F., et al. “Evaluating Three tially hospitalized group, the median number of Treatments for Borderline Personality self-mutilations per
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