Distinguishing Personality Disorders

Personality is viewed as an abstract piece of our identity, that plays a crucial role in determining how our days go, how we perceive ourselves, and how we perceive others (Nolen-Hoeksema, 2017, pp. 247). The concept of a personality is organized into five traits; “openness vs. closedness to new experience, dependable and reliable vs. undependable, extroversion vs. introversion, agreeableness vs. argumentative, and negative emotionality vs. emotion regulation” (2017, pp. 248). A personality trait is the specific characteristic one consistently displays based on how high or low one is on each of the five main traits (2017, pp.

248). Such as, someone who is high on the extraversion vs. introversion spectrum, may be considered a social butterfly. While someone who is low, may be considered distant. Both of these particular patterns of behavior are considered as having a personality that is functional and normal. Deviation from these patterns to the point in which it interferes with one’s daily life functioning, leads to someone meeting the criteria of a personality disorder (Nolen-Hoeksema, 2017, pp. 247). As cited by Bo, Sharp, Beck, Pedersen, Gondan, and Simonsen, “personality disorders severely undermine social functioning and are related to poor quality of life and high societal costs” (2017, pp. 396). The symptoms displayed by someone with a personality disorder ranges from suicide attempts to isolation from others. Volatile moods, unstable relationships, self-mutilating, and many more are common symptoms portrayed by someone with a specific personality disorder called borderline personality disorder (2017, pp. 396).

The diagnostic criteria for a personality disorder is, “a chronic pattern of maladaptive cognition, emotion, and behavior that begins by adolescence or early adulthood, and continues into later adulthood” (Nolen-Hoeksema, 2017, pp. 251). There are three distinctive clusters defining personality disorder with 10 distinct personality disorders. As described by Nolen-Hoeksema, Cluster A has three disorders, all with the distinctive personality features of odd and eccentric. Cluster B, pertains to a dramatic and emotional personality. There are four disorders characterized under Cluster B. Lastly, Cluster C has similar characteristic of an anxious and fearful personality and three disorders with these behaviors (2017, pp. 251). Borderline personality disorder is categorized under Cluster B. Impulsivity and the knack of placing their safety at risk, is common among people with Cluster B personality disorders. (2017, pp.258). Nevertheless, each of these personality disorders have a diagnostic criteria and treatments.

Etiology. Borderline personality disorder (BPD) differentiates from the other disorders in Cluster B by its distinctive pattern of volatile mood, negative self-image, and unstable relationships with others (Nolen-Hoeksema, 2017, pp. 258). Followed by an intense fear of abandonment, regardless of if it is real or imagined (2017, pp. 258). Females are diagnosed more often than males while Hispanics are most commonly diagnosed with BPD. There are several theories which aim to hypothesize the onset of this particular disorder. BPD is correlated with the feelings of vulnerability, anger, impulsiveness (Dadashzadeh, Hekmati, Gholizadeh, and Abdi, 2016, 23), as well as fear and sadness as cited by Nolen-Hoeksema, (2017, pp. 260). The dysregulation of these emotions is often attributed to a history of neglect and abuse (Nolen-Hoeksema, 2017, pp. 261). Neglect and abuse during childhood is the foundation for a few of the theories. As cited by Nolen-Hoeksema, Linehan predicts that the underdevelopment of certain interpersonal skills leads to their manipulative and impulsive manner. That the exposure to previous mistreatments made extremely difficult for people with this disorder to develop the necessary skills needed for emotion regulation and self-coping (Nolen-Hoeksema, 2017, pp. 261). Nolen-Hoeksema also cites that psychoanalytic theorists suggest that people with this disorder are reactive to real and imagined abandonment due to the inability to distinguish their view of themselves from their view of others (2017, pp. 261). The last few theories suggests that BPD is more biologically caused. BPD can be passed on genetically (Nolen-Hoeksema, 2017, 261). As well as caused by a change occurring within the brain due to the exposure to maltreatments. As cited by Nolen-Hoeksema, Donegan et al. state that the increased hyperactivity in the amygdala, along with the reduced size of the amygdala due to the maltreatments, leads to severe complications seen within someone with BPD (Nolen-Hoeksema, 2017, 261).

Diagnostic criteria. Someone with this disorder typically has the tendency to cling too tightly to others, have a burst of out-of-control emotions, hypersensitivity to abandonment, and a history of hurting themselves. As stated by Nolen-Hoeksema, the DSM-5 diagnostic criteria list the symptoms of BPD to include: “extremely unstable interpersonal relationships, concerns about abandonment, self-damaging behavior, impulsivity, and bouts of depression, anxiety, or anger” (Nolen-Hoeksema, 2017, pp. 259). All in all, one identity lost, their relationships with others is negatively impacted, and they lose a part of their autonomy from having to rely so much on others (2017, pp.259).

Symptoms. There is a sequence in which certain symptoms arise within someone with BPD. People with this diagnosis often feel an emptiness within themselves, which causes them to cling and heavily rely on others (Nolen-Hoeksema, 2017, pp. 259). This dependency leads their manipulative behavior, which then leads to their impulsive, sometimes harming behavior. With the onset of this disorder, suicide is highly probable. Soloff states that approximately 75 percent of people with the diagnosis of this particular disorder attempt suicide, while 10 percent succeed with their suicide attempt (2017, pp. 260). The risk for attempting suicide increases when there is a presence of a comorbid diagnosis. Reas, Pedersen, Karterud, and Ro, (2015), performed a study on 483 women diagnosed with BPD. The participants were then interviewed for personality disorders, other psychological disorders, and assessed for suicide. Reas et al. found “an increase in suicide ideation, self-harm, and suicide attempt” in women who have BPD, and a second psychological disorder (2015, pp. 646). For this study, the comorbid diagnosis was Bulimia Nervosa. Nolen-Hoeksema list other psychiatric disorders that may co-exist within the individual diagnosed with BPD, such as agoraphobia, posttraumatic stress disorder, substance use disorder, anxiety, depression, and more. (Nolen-Hoeksema, 2017, pp. 260).

Evidence-based treatments. There are several treatments and therapies that are offered for people with borderline personality disorder. Each treatment aiming to help the patient improve their sense of self. In a study performed by Sahin, Vinnars, Gorman, Wilczek, Ashberg, and Barber (2018), they assessed the effects of the treatment outcome for borderline personality disorder. The two therapies implemented in the study were, Dialectical Behavior Therapy and Psychodynamic Therapy. Dialectical behavior therapy helps the individual “gain a more positive sense of themselves, learn adaptive skills for solving problems and regulating emotions, and correct dichotomous thinking” (Nolen-Hoeksema, 2017, pp. 262). A specific type of psychodynamic therapy used for treatment of borderline personality disorder is Transference-Focused Therapy, which “uses the relationship between the patient and the therapist to help the patient develop a realistic and healthier understanding of themselves and their relationships” (Nolen-Hoeksema, 2017, 262). For this study, the participants consisted of 106 women between the ages of 19-50, meeting the criteria for borderline personality disorder. The participants were randomized and received either the dialectical based treatment every week for two hours, a version of transference-focused therapy called object-relational psychotherapy biweekly, or Treatment-as-Usual. The therapists met with the patients for one year, unless extra treatment was needed. Their findings consist of all three therapies helping in decreasing suicidal and self-mutilating behaviors (Sahin et al, 2018, 443). However, they also found that the transference-focused therapy was the most beneficial therapy for BPD in some patients with a lower severity of symptoms (2018, pp. 442).

Mentalization-based treatment is also a form of psychodynamic therapy in which it attempts to help the patient appreciate alternatives to their own subjective sense of self and others through providing validation and support (Nolen-Hoeksema, 2017, pp. 262). In the study performed by Bo et al. (2017), 36 adolescents who met the criteria for BPD were placed in a group-based mentalization treatment for one year. The therapists in this study used several scales, including Borderline Personality Features for Children, Beck Depression Inventory for Youth, and Risk-Taking and Self-Harm Inventory for Adolescents (Bo et al., 2017, 398). This treatment resulted in a significant improvement in peer attachment, depression, mentalization, risk-taking behaviors, and a decrease in the borderline personality score. (Bo et al., 2017, pp. 399). Similarly, Laurenssen et al. (2014), found that their patients with BPD also showed improvements with this method of treatment.

Another group intervention available as a treatment for BPD is Systems Training for Emotional Predictability and Problem Solving (STEPPS). This form of therapy “combines cognitions and behavioral techniques addressing self-management and problem-solving” (Nolen-Hoeksema, 2017, pp. 262). In Nolen-Hoeksema’s book, Davidson et al., state that patients receiving STEPPS showed greater improvement in functioning and a reduction in suicide behavior, in comparison to patients receiving a different method of treatment (Nolen-Hoeksema, 2017, 262). However, Black, Allen, St. John, McCormick, and Blum concluded that within their study the STEPPS treatment and improvements within individuals with BPD had a slight interaction (Black et al., 2009, pp. 60).

Medication is also prescribed for BPD. As cited by Nolen-Hoeksema, Lieb states “the medications that have proven most useful for treatment are mood stabilizer arioriprazole and lamotrigine and the atypical antipsychotics, such as olanzapine” (Nolen-Hoeksema, 2017, pp. 262). Mayumi et al., state “several studies have found olanzapine to reduce anger among patients with BPD” (2012, pp. 341). Both types of medications are used to reduce the onset of certain symptoms within the individual.

Social support is crucial for these individuals since a relapse after treatment is feasible, especially if they are exposed to stressful events (Nolen-Hoeksema, 2017, pp. 260). “It is assumed that the dysfunctional or maladaptive schemas are the main causes of personality disorders” (Dadashzadeh et al, 2016, pp. 23). The dysfunctional and maladaptive schemas include neglect, sexual abuse, and physical abuse they may have been exposed to during their childhood. Exposure to these types of maltreatment also have detrimental impacts on the brain, specifically the organs associated with stress and emotion regulation and memories. The hardships that come along with having a personality disorder is internationally known, but it is often portrayed by degrading the victims of these disorders. Hollywood is known to showcase movies that are based of personality disorders. It appears that personality disorders have become a popular genre within the movie industry. For instance, there has been a prevalence in the cliché plot of a successful, happily married man meets a beautiful, seductive woman who becomes infatuated with said man to the point of the woman appearing “obsessed” and “crazy.” Meanwhile, the audience cheers on his wife for killing the mistress. What Hollywood fails to show, is that this is a real life mental illness with an actual onset process that is often tied to a traumatic experience, detectable symptoms, a diagnosis, and a treatment plan with the goal of truly helping this person not only overcome this condition, but to also aid them into viewing themselves in a more positive aspect.

Did you like this example?

439

23