Sunday, April 28, 2013

Time Over Treatment with Borderline Personality Disorder

When we discussed Borderline Personality Disorder in class, there wasn’t much said about BPD treatment beyond consistency. On the other hand, I feel like from my grasp on psychology’s current predilection of practices that psychotherapy is just as out as Freud is outdated. The combination of these resulted in an immediate interest in the first line of an article** in the Psychiatric Times called “Treatment Approaches for Borderline Personality Disorder” by Frank E. Yeomans, Kenneth N. Levy and Kevin B. Meehan: “Borderline Personality Disorder is the only disorder to date for which the American Psychiatric Association’s treatment guidelines specify psychotherapy as the treatment of choice.” The article suggested overall, as was mentioned in class, that success in treatment and reduction of behavioral issues akin to BPD relies on consistent treatment. The article did, however, point out that “regular” treatment was not as beneficial in the case of BPD. The article mentions many studies that juxtaposed different treatment styles and recorded success in terms of mental (self-reported reduced issues) and physical (reduced self-harm and suicide attempts).

The article compared different cognitive-behavioral therapies and then different psychodynamic therapies. One thing that I found interesting about the more successful cognitive-behavioral therapies is that they seemed to indirectly deal with unconscious issues through dealing with subconscious issues in a more direct manner. Limited re-parenting, for example, is a treatment that targets BPD as if it was an issue of nurture. The article says that the “core emotional needs” of the patient were not met during their childhood, and experiences being re-parented can help counteract this, especially in cases (as is usually with BPD) where there is trauma. In my own (limited) understanding of psychology, this portion of the article was reminiscent of Freud’s idea of unconscious trauma during the psychosexual stages. Because the issue with BPD patients is most often their interpersonal interaction, the idea of re-parenting also aims to establish positive connotations and beliefs so to encourage attachment. To me, trying to fix current relationships by examining parental relationships seems to align with psychotherapy.

While dealing with childhood (I assume) might be commonly present in mot therapies, I felt also reading the article that BPD patients were often treated as one would a child. I have only known one person who has been diagnosed BPD, but the one adjective that seems typically attached to people with BPD is oversensitive. One approach to treatment was called STEPPS (Systems Training for Emotional Predictability and Problem Solving). The main focus of STEPPS was based on the conceptualization of BPD as an “emotional intensity disorder.” I thought this was kind of brilliant. If I ever accused my friend who is diagnosed BPD as having BPD, I would immediately become the worst person on the planet in her eyes. But she herself laughs about how emotional she can get over such little things. For example, she told me about how she thought so-and-so hated her because she thought she caught them glaring at her once. The STEPPS approach seems to better cater to the sensitivity of patients with BPD in terms of their own self-image. I feel this approach is similar to how one might address an issue with a child that they do not believe the child is fully capable of comprehending themselves (i.e. touch the doll where the man touched you).

The article concluded, as emphasized in class, that treatment of BPD is highly subjective and should be considered on an individual basis. But the article also did point out that some benefitted from a mix of individual and group therapy (dialectical behavioral therapy). This was also something that I thought leads to another point about BPD. The article later mentions how BPD can inhibit the patient’s ability to be mindful of others as well as self. In my own experience, my friend with BPD talks much about being mindful of others, but is always the last one to do so. It is an interesting contradiction that I’m not sure if she is aware of. I do know that at her worst is when she refused to go see her specialists anymore and instead decided to do a cognitive workbook on her own and by herself. I can’t imagine how detrimental being alone with a mental disorder is for management. While I’m sure it creates a security around not having to hear about your disorder all of the time, I think the biggest issue with BPD is that the patient has issues within their own mental process that are not apparent until there is an outside perspective. Or, perhaps, more so the last statement is true of most mental disorders.       
One thing that I did not know before class was that BPD is considered a lifelong disorder. This is the supposed necessity for consistent treatment. The issue with BPD treatment is that telling a person with BPD their negative traits can be perceived as an attack. I think perhaps the reason that psychotherapy is a suggested treatment might have more to do with lack of confrontation. Going around the problem and trying to sort out the unconscious root of the issue might be too much a direct route for most psychiatric patients, but with BPD patients it might be the best way to keep them in therapy. It might not reduce the symptoms of BPD as much as a more direct route, but the actual consensus for the best treatment for BPD is simply keeping it consistent and keeping the patient from dropping out. It may require catering to oversensitivity, relying on outdated practices, and not dealing with issues head on, but for a life-long disorder, the best treatment seems to be based on lifetime investment rather than a specific approach. 

**The article can be found in Pratt Library Social Science Databases**

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