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Borderline Personality Disorder: an Overview of History, Diagnosis and Treatment in Adolescents Linah Al-Alem University of Kentucky, [email protected]

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Borderline Personality Disorder: an Overview of History, Diagnosis and Treatment in Adolescents Linah Al-Alem University of Kentucky, Linah.Al-Alem@Uky.Edu University of Kentucky UKnowledge Pharmacology and Nutritional Sciences Faculty Pharmacology and Nutritional Sciences Publications 12-2008 Borderline Personality Disorder: An Overview of History, Diagnosis and Treatment in Adolescents Linah Al-Alem University of Kentucky, [email protected] Hatim A. Omar University of Kentucky, [email protected] Right click to open a feedback form in a new tab to let us know how this document benefits oy u. Follow this and additional works at: https://uknowledge.uky.edu/pharmacol_facpub Part of the Medical Nutrition Commons, Medical Pharmacology Commons, and the Pharmacology, Toxicology and Environmental Health Commons Repository Citation Al-Alem, Linah and Omar, Hatim A., "Borderline Personality Disorder: An Overview of History, Diagnosis and Treatment in Adolescents" (2008). Pharmacology and Nutritional Sciences Faculty Publications. 20. https://uknowledge.uky.edu/pharmacol_facpub/20 This Article is brought to you for free and open access by the Pharmacology and Nutritional Sciences at UKnowledge. It has been accepted for inclusion in Pharmacology and Nutritional Sciences Faculty Publications by an authorized administrator of UKnowledge. For more information, please contact [email protected]. Borderline Personality Disorder: An Overview of History, Diagnosis and Treatment in Adolescents Notes/Citation Information Published in International Journal of Adolescent Medicine and Health, v. 20, no. 4, p. 395-404. © Freund Publishing House Ltd. The opc yright holder has granted permission for posting the article here. Digital Object Identifier (DOI) http://dx.doi.org/10.1515/IJAMH.2008.20.4.389 This article is available at UKnowledge: https://uknowledge.uky.edu/pharmacol_facpub/20 ©Freund Publishing House Ltd. Int J Adolesc Med Health 2008;20(4):395-404 Borderline personality disorder: An overview of history, diagnosis and treatment in adolescents 1 2 3 Linah Al-Alem, MSc ' and Hatim A Omar, MD 1Department of Molecular and Biomedical Pharmacology, 20bstetrics and Gynecology, University of Kentucky College of Medicine, 3 Division of Adolescent Medicine, Department of Pediatrics, ·University of Kentucky College of Medicine, Lexington, United States ofAmerica Abstract: Borderline personality disorder (BPD) is a cluster B personality disorder. It is characterized by erratic behaviors, emotional instability and one of its hallmarks is self injurious behavior, which starts in adolescence. Patients with BPD are difficult to treat, most have a history of child sexual abuse, about a quarter present with sexual abuse from a caretaker. Although personality disorders are diagnosed only in adults, BPD manifests itself in adolescence in the form of uncontrollable anger, self mutilations, dissociation and other such behaviors. Hence, there is a growing number of scientists discussing the possibility of diagnosing BPD in adolescents. Here, we give an overview of the history and development of BPD in general; and in the adolescent population in particular. We also touch upon pharmacological and clinical interventions available for patients being diagnosed and/or possessing traits ofBPD. Keywords: Borderline Personality Disorder, adolescents, mental health, diagnosis, treatment Correspondence: Hatim A Omar, MD, Division of Adolescent Medicine, Department of Pediatrics, Room J422, University of Kentucky, Lexington, KY 40536-0284 United States. Tel: 859-323-5643; Fax: 859-257-7706; Email: [email protected] Submitted: June 02, 2008. Revised: July 17, 2008. Accepted: July 25, 2008. INTRODUCTION psychological term and included in the The diagnosis of borderline personality DSM III (Diagnostic and Statistical Manual disorder (BPD) has been used for over 30 III) (2) and later as a cluster B personality years to label patients who are "hopeless", disorder, together with histrionic, antisocial, those who get therapists upset, and is one of and narcissistic personality disorders (3). the most controversial diagnoses in The most general description of borderline psychology today. The term borderline personality is given by Kernberg (4), came into existence because such patients whereas the most scientific description is were believed to lie on the borderline by Gunderson (5). The diagnostic interview between psychosis and neurosis, w ith the for BPD was developed by Gunderson, label "borderline" first coined by Adolph Kolb, and Zanarini (6). Stern in 193 8 ( 1). Although the advent of The most prominent view and studies this disorder was in 193 8, it was not until today come from Marsha Linehan, who has 1980 when it was accepted as a developed a special therapy for BPD (7). 396 BORDERLINE PERSONALITY DISORDER Linehan's sociobiological theory rests on manipulative behavior, and rapidly shifting the knowledge that people with BPD are emotions just like BPD, but in BPD there is born with a tendency to react more self-destructiveness, angry disruptions in intensely to lower levels of stress and take a close relationships, and chronic feelings of longer time to recover and seem to be deep emptiness and loneliness (3,5,6). raised in invalidating environments (7). Paranoid personality disorder can be BPD patients often view themselves as characterized by an angry reaction to minor helpless victims in a dangerous world, and stimuli, but the stability of self-image and that they are unacceptable in society. They lack of self-destructiveness, impulsivity, are known to have reduced "facial expres­ and abandonment concerns distinguishes it siveness" (8), as well as a great need of from BPD (3). As for antisocial personality nurturance and self-assurance. The chaos disorder, individuals are often manipulative that characterizes borderline patients makes to gain profit or power, whereas in BPD them difficult cases for therapists. A patient their main goal is to gain the attention and with BPD may be continuously suicidal for nurturance of a caregiver (3). In contrast to months or years. Moreover, many of the dependent personality disorder, people with same problems that patients have with other BPD react to abandonment with feelings of people arise in their relationships with emotional emptiness, and rage and incon­ helping professionals (7). sistent relationships (3). In I Hate You -- Don't Leave Me! (9), whose name is consistent with the clinging EPIDEMIOLOGY and distancing behaviors (9) of the border­ About 3% of the population suffers from line, the authors refer to BPD as BPD (12). Additionally, BPD is the most common personality disorder seen in "emotional hemophilia; [a borderline} clinics, in fact, it accounts for more than lacks the clotting mechanism needed to 50% in certain clinical settings (13). In moderate his spurts offeeling. Stimulate another resource, BPD is diagnosed in 10% a passion, and the borderline emotionally of psychiatric outpatients and about 20% of bleeds to death. " inpatients (14). The disorder is more prev­ alent in women than in men, in fact 76% of Persons with BPD have a very hard time borderline patients are women ( 15). The controlling their emotions and may feel American Psychiatric Association (APA) ruled by them. Marsha Linehan (10) said, specifies that 1.5% to 2.5% of the adult population has BPD, but in specific clinical "People with BPD are like people with populations it encompasses about 50% (3): third degree burns over 90% of their bodies. Lacking emotional skin, they feel ETIOLOGY agony at the slightest touch or movement. " Most patients with BPD have some sort of physical or sexual abuse history, as well as . Borderline personality was often confused dysfunctional family dynamics. In reality, with histrionic personality disorder, paranoid about a quarter to 30% of the patients. personality disorder, antisocial personality present with a history of sexual abuse from . disorder, and dependent personality disorder a caretaker and a third report severe forms (3, ll ). Histrionic personality disorder can of abuse ( 1, 16). Sexual abuse seen in BPD • also be characterized by attention seeking, patients tends to happen at a very early age . L AL-ALEM AND HA OMAR 397 ( 17). The high rates of child sexual abuse depression, anger, and anxiety. Borderline presence in this group led many investi­ patients often need to feel suicidal to know gators to wonder whether this condition is that they can escape from their dysphoric another form of post traumatic stress disorder feelings, and this feeling actually seems to (PTSD) ( 16). Investigators believing in this give them a sense of reassurance that there notion tend to focus on unraveling the past. is a way out if all fails ( 1) . However, no evidence has be presented showing that these methods are successful. BIOLOGICAL FACTORS In fact, there is some reason to suspect they Many personality disorders have been can make patients worse, by focusing too associated with dysfunction of the serotonin much on the past and not enough on the system, particularly traits of aggression and present. In addition, borderline patients in impulsivity (19). Abnormal dopamine, sero­ psycho-therapy are particularly prone to tonin, acetylcholine, monamine oxidase, develop false memories ( 16). HPA (hypothalamic pituitary axis) hormones, Although it forms a risk factor, child or thyrotrophic releasing hormone activity abuse is not specific to BPD (1, 16). This (16) are seen in different personality view is consistent with the knowledge that disorders. Studies showed a decrease in the adverse life events and environments are level of the serotonin metabolite 5 hydroxy­
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