Test: For borderline personality disorder
Mental illness is not something to be said, so about borderline personality disorder - its symptoms, treatment regimens, medical prognosis - is much less known than about schizophrenia or depression. However, a large number of people are experiencing the manifestations of this diagnosis, which requires raising public awareness. Why does this problem arise and what to do with it?
What are borderline states in psychiatry?
If a patient is diagnosed with a weak level of mental disorders - when the patient manages to control reality and the nature of the pathology of the disease is far away - in medicine this is noted as a borderline state. Such disorders are represented by a number of disorders and even symptom complexes:
This term in official medicine was introduced in the middle of the 20th century and today is strongly associated with the diagnosis of the diagnosis of “borderline personality disorder”, in ICD-10 having the code F60.31. For a long time, psychiatrists attributed any mental disorders to borderline conditions, which created a "diagnostic chaos" and the inability to bring out clear signs for an accurate diagnosis.
Causes of disease
According to statistics, about 3% of the world's population live with borderline personality disorder (PRL), but the disease is “in the shadow” of the more complex, so some cases have not been taken into account. Manifestations of such mental disorders develop mainly in persons aged 17–25 years, but they may appear in a child, but are not diagnosed due to the physiological instability of the child’s psyche. The causes leading to this disease are divided into 4 groups:
- Biochemical - due to an imbalance of neurotransmitters: chemicals that are responsible for regulating the manifestations of emotions. Lack of serotonin causes depression, with a lack of endorphin, the nervous system cannot withstand stress, and a decrease in dopamine results in a lack of satisfaction.
- Hereditary predisposition - experts do not exclude the option in which an unstable psyche can be embedded in DNA, therefore, people with close relatives also have psycho-emotional behavior disorders often suffer from PRL.
- Lack of attention or violence in childhood - if the child did not feel parental love or was faced with the death / departure of loved ones at an early age, frequent physical or emotional violence was noticed after the parents (especially for high demands placed on the child), this may be the cause psychological trauma.
- Education in the family - for the harmonious development of the personality, the child should feel parental love, but know the boundaries and concept of discipline. When the microclimate in the family is violated with a dictatorial position or excessive encouragement, this becomes the cause of difficulties in subsequent social adaptation.
Border Mental Disorders - Symptoms
Borderline syndrome (abbreviated from the English-language name for the disease "borderline personality disorder) can have a long list of manifestations that are not necessarily present in full even in a seriously ill person. According to official data, patients who are diagnosed with PRL are often observed:
- increased anxiety
- depressive states (in a severe case - mental anesthesia),
- loss of control over emotions
- intense dysphoria, alternating with euphoria,
- problems with social adaptation,
- autoidentification violations
- demonstration of antisocial behavior (before drug addiction, alcohol abuse, criminal acts).
There were episodes in my life when I inflicted damage on myself (I cut my hands with a razor, burned my skin with a cigarette, etc.
Symptoms of borderline personality disorder include: a recurring pattern of instability in relationships, attempts to avoid abandonment, identity disorder, impulsivity, emotional instability, and chronic feelings of emptiness, among other symptoms.
The main feature of borderline personality disorder (BAP) is the prevailing picture of instability in interpersonal relationships, self-esteem and emotions. People with borderline personality disorder are also usually very impulsive, often demonstrating harmful behavior (for example, risky sexual behavior, reduction or suicide attempts).
Borderline personality disorder occurs in most people in early adulthood. The unstable structure of interaction with other people in this state persists for many years and is usually closely associated with a person’s self-esteem and early social interactions. The model of behavior is present in various conditions (for example, not only at work or at home) and is often accompanied by a similar lability (fluctuating back and forth, sometimes quickly) of human emotions and feelings.
What is borderline personality disorder?
Border disorder refers to the states of psychopathy, as an emotionally unstable state, leading to the negative consequences of the existence of the individual. This pathology has its counterparts in the classification of WHO, ICD 10 and in the JSM-American classification. For the first time, she tried to understand Nancy Mack Williams' individuality; she applied this term in psychotherapy and developed the types of personality diagnostics that she had in such. This disorder is called borderline, because it does not reach a psychotic state, but it nevertheless intensifies a bad state more pronouncedly than neurotic states. This is a kind of boundary between the norm and pathology. The functioning of such persons depends on these people themselves and on their desires. This condition is not a sentence at all, given the possibilities of psychotherapy, but these patients are quite difficult to treat.
Various developments have contributed to the development of the theory of borderline personalities, and since the end of the 20th century these data have been available in all classifications. It cannot be said that this pathology has its own properties or is decisive for a diagnosis. It is rather a vector, which later allows you to choose the correct diagnosis and assess the level of social functioning of the individual.
This pathology is not uncommon, since it has very common causes of occurrence and in general does not interfere with the continuation of the genus, passing the borderline personality disorder further into the generations. This disorder is common in 2% of the world's inhabitants, and, depending on the type of borderline disorder, it is correlated differently in the sexual aspect.
Borderline personality disorder in women occurs in certain types, and certain states - exclusively male wealth. Very often, borderline personality disorder goes hand in hand with drug addiction; this is a common combination due to the particular nervous system of such a person. Completed suicidal attempts, that is, those that led to mortality, in this group make up 29% of the population, which is 24% higher than the public statistics.
Forensic psychiatrists were the first to address these conditions, since they noticed that there are much more such conditions in the practice of the courts. The tendency of such frontier persons to criminal acts became the subject of a thorough study of forensic psychiatrists, and they found interesting data, the very first records were made by them, but such states were widely publicized only in the works of famous psychoanalysts.
There are data in which it is described that many famous people had similar states. For example, Princess Diana is considered an example of a person with this kind of disorder. Many psychiatrists worked on this condition, and Diana was described as an example of such a disorder. Her difficulties in relationships and her dependent states and relations are connected with this.
This condition is a pathological development of the personality and leaves a response to the perception of the world; it cannot remain the same in a person with a similar disorder. It is inadequate response entails incorrect forms of behavior. This condition often continues in a vicious circle more and more complicating the life of the person suffering from them.
Causes of borderline disorder
Many cases of borderline personality disorders remain in the shadow of great psychiatry. Pathology comes from childhood, so they learn to adapt and hide their essence. The reasons are not fully investigated because of the impossibility of cure or because of the less pronounced severity of the manifestations compared with the pathologies from the spectrum of great psychiatry.
The biochemical theory of the development of borderline disorder is known. It is believed that the neurotransmitter imbalance leads to chronic discontent and emotional decline. This is in many ways a predictor of the formation of a dependent state. The most important in the neurotransmitter plan for mental disorders are dopamine and serotonin, each with its own influence. And with the lack of any of them, serious pathologies are formed. Also a low level of endorphins affects this kind of pathology, especially in case of a dependent disorder - this is a sign.
In borderline personality disorders, heredity is often the decisive feature. It is believed that biologically predetermined the presence or absence of the opportunity to experience empathy, empathize and be human. In these disorders, the brain is basically not capable of such feelings. It is impossible to teach, the individual will invariably become a sociopath and a manipulator. Sadly, it sounds, but the DNA code itself contains whether a person has a stable psyche and how she will look at the world - through the eyes of a psychopath or with a look of a firm, self-confident individual. It is noticeable that in such persons, close relatives also have borderline personality disorder or other pathology, akin to psychiatric.
Features of raising a child can directly affect the formation of personality, then this disorder will be acquired, but not innate. There is a statement that it is easier to deal with him. The "unwillingness" of a child is always felt by him and leaves a mark on his psyche. Also, the death of a loved one, especially significant for the child. Many children in general have difficulty tolerating conditions such as the death of their relatives, since the very feeling and concept of death is alien to them. It is important to prepare the child to understand this condition. The life of a child under heavy oppression of violence also greatly affects the state of a small individual, he is subject to excessive stress, which later produces incorrect behavioral patterns. In the conditions of modern information loads on children, the risk of development and progression of such disorders increases.
In addition to the importance of the family itself, the attitude towards the child and his upbringing is important. There are pathological types of education that form the child’s pathological features and, subsequently, borderline personality disorders. In general, the formation of the personality is very much influenced by the relatives, they are essentially the basic core, which gives the individual the opportunity to further develop, based on the basics. Parental care gives awareness of good qualities, and rigor simultaneously develops self-discipline. But excessive demands and rigor in which the child, as in a trap, will not be beneficial, and even more so, beating and inadequate punishment of the child will not benefit. Excessive hyper-care and a relationship as an idol with all the permission can also play a cruel joke on the character of the child. Such a child often becomes demonstrative.
Symptoms of borderline personality disorder
Border disorder consists of several diagnostic criteria. Most significantly, this disorder affects the sphere of behavioral characteristics, but in general it affects all psycho-neurological spheres.
The signs of borderline personality disorder manifest themselves as a powerful personality pathology that involves several areas of psychological functioning. Of the mental areas that are most often affected by this kind of pathology, isolated affective or emotional. It includes manifestations of mood and emotional response. Very often, an important symptom is a high degree of excitability, especially with some kind of environmental changes with which such a person is difficult to resign.
The signs of borderline personality disorder consist of some desire control disorders. Very often, such people do not hold the framework, trying to get what they want. This is a difficult condition, as the border person knows the rules, but does not want to adhere to them at all. This kind of personal disharmony is very noticeable and repels others. A big role is played by the subspecies of the pathology and the ability of the patient to adapt, pretend and reassure himself.
Another symptom of borderline personality disorder is the chronicity and stability of manifestations, that is, a person always has this condition and is not dependent on some factors, it is more a constant companion than a disease. This is a kind of deviation in the most personal manifestation. This style of behavior is always maladaptive and removing a person from normal life.
Often, the violation goes on in the spheres of thought; the perception and attitude towards the environment partially change. It happens even psychomotor agitation of a nature that requires professional stopping. The stability of these patho-manifestations is expressed in the inability of the individual to bring some peace in his life. It begins with childhood, usually greatly aggravated in puberty and does not go away when growing up. The border of a person cannot be overgrown, it can only be changed during long-term personal psychotherapeutic work, but it will last without exaggeration for decades.
Borderline personality disorder in women always entails expressive distress, which, nevertheless, does not always necessarily affect all areas and does not always affect productivity.
Signs of borderline personality disorder may be different, given the subspecies. In paranoid borderline disorder, there is excessive suspicion, as an additional manifestation in the structure. Schizoid type consonant with his word, from which it comes not in vain. The person is autistic, antisocial, apathetic, but naturally there is no defect formation.
Dissocial disorder is dangerous for society, since it strongly violates all social norms and is a carrier of danger to the environment. Borderline personality disorder in women is often manifested as a demonstrative disorder. They are fanciful, love to attract attention and hysteria.
Anankastnaya disorder manifests itself excessive anxiety and experiential, the desire to meticulously follow certain absurd rules and norms.
Anxiety disorder is characterized by unconditioned fears, especially in everyday things.
Dependent disorder is characterized by the manifestation of dependence on various hazards.
All of these components can be mixed, creating a mixed disorder that consists of several symptoms. These hotel symptoms are always combined with a general description, which is given at the very beginning.
Treatment of borderline personality disorder
The first link for such a disorder is psychotherapeutic therapy. Therapy for borderline personality disorder is to find the right approach. Techniques that are based on the rational level will not work for these states, since the problem for an individual follows from the subconscious. Thus, it is worth sweeping away the transactional analysis, which can only make out what is wrong with the patient. You must be wary of the patient’s mind and not reproach him. The fact that he came and agreed to work on something in himself is a great start. After all, the person had to admit that there is a problem in something and start changing it somehow.
Care should be taken in choosing methods of deep psychological implantation, since this can lead to a regression of the level of the personality structure and bring the person to a state of psychotic level. Psychoanalytic techniques are basic for such an individual and with long-term therapy can help. But the people themselves with such conditions do not often want to be treated. Therapy for borderline personality disorder includes Jungian approaches and client-centered psychotherapy.
Иногда при таких расстройствах формируется возбуждение и тогда проводится его купирование с применением Неулептила и седативных препаратов. В целом лечение применяется зависимо от выраженности и проявления симптомов, которые могут быть влиятельными и подобными на известные патологии. Thus, with reduced mood apply Amitriptyline, Anafranil, Paroxetine. Also relevant is the use of means for sedation, especially of plant origin. It is possible to use tranquilizers if necessary. Therapy for borderline personality disorder includes Gidazepam, Xanax, Adaptol, Afobazol.
Therapy for borderline personality disorder works in a complex and loves a combination of approaches. It is very important for such persons the influence of society, the selection of a special support group, healthy family relationships. Favorite work and a cozy home undoubtedly contribute to stopping such exacerbated conditions. Occupational therapy is also essential for people with this disorder.
Border Disorder Test
There are a large number of psycho-questionnaires that are focused on identifying such borderline radicals. But still the best test in such cases is life situations and long-term observation. The most effective is the Lychko questionnaire, which reveals a separate subtype. Also well suited to the questionnaire MMPI, which has a large number of questions and subsequently demonstrates a large number of scales, which can talk about certain deviations of different levels of severity.
Psychiatrists for their diagnosis using diagnostic criteria for the ICD, naturally given the behavior of the person, reviews honey. staff, if the patient is inpatient and relatives reviews, which can give a relatively reliable view from the outside. It must be remembered that relatives can pursue their own goals, so it is important to check their information whenever possible.
For the psychoanalyst, it is important to identify the type of inner experience, while the person has its own characteristics that a professional can reveal. The cognitive sphere can manifest itself in some special characteristics, especially significant is the division of the world into "I" and the rest. Some kind of early egocentric position. Manifestations of somewhat inadequate emotionality, not reaching the same affective disorders.
Very often, relatives will pay attention to the features of the drives, the individual does what he wants, and everything else does. These are very important criteria, since people with borderline disorder always have problems with the will. Control of drives and needs is broken up to complete non-control of oneself. Moreover, the degree of this already depends only on the person herself and on the framework that is put in front of him. After all, there are families where it is impossible to break this line, no matter how hard he tries. Evaluation of attitudes towards others is also important because it demonstrates interpersonal problems.
This deviation is not caused by a specific situation and does not manifest itself in one area. The peculiarity of this disorder is the total defeat of all spheres. It can not manifest itself only in one thing, it is then an accentuation or the consequences of a psychotrauma, but not a border disorder.
Often there is the presence of personal discomfort or complaints from society. If a person does not interfere with anyone, then this is hardly a borderline disorder. The availability of data on the stability and duration of the course of the disorder, ideally with the onset of childhood age.
This pathology is an exception and cannot be exposed if the deviation is caused by another kind of psychiatric pathology. It is important that these symptoms are not a consequence of something else. Frontier personality disorder in women, especially in a demonstrative manner, always has implications for family relationships and can lead to intimate disorders.
Frequent is the symptom of the impossibility of experiencing emotions, but for a long time, they learn to play them and manipulate people in this way. Impulsiveness is a very significant symptom; no organic disturbance is detected, that is, physically, at least at the macroscopic level, the person is healthy.
All criteria are relative and require careful examination of the patient’s condition, since some disorders can be confused and cause harm to the human psyche.
Followers of this theory believe that the deviation is caused by a violation of the ratio of neurotransmitters of the brain. As you know, human emotional reactions are regulated by three main substances: serotonin, dopamine and endorphin. Shortages or excessive production of one of them upsets the balance and leads to mental abnormalities.
Thus, depressive, depressed states develop with serotonin deficiency, lack of endorphins leads to a decrease in resistance to stress and increased psycho-emotional stress, and insufficient production of endorphins deprives a person of the joy of life, turning it into a meaningless existence.
Researchers have noticed that this type of mental disorder is more common among those who grew up in a dysfunctional social environment. Parents who abuse alcohol or drugs, demonstrate asocial behavior, practically do not deal with a child who copies their behavior at a subconscious level and cannot adapt to normal life in the future.
Against the background of such adverse conditions, personality deformation occurs, self-esteem decreases, generally accepted standards of behavior are distorted, and a person hardly fits into society.
Defects of education
A full-fledged personality is formed only with proper upbringing, in which a balance is maintained between rigor, love and respect for the little man. If a healthy, benevolent microclimate is maintained in the family, then a child in abundance receives love and support.
In cases where the child is faced with the despotic dictatorship of native people, as a result, an alarming personality can form. And, on the contrary, against the background of permissiveness and the absence of a restrictive framework, a demonstrative person grows up who does not take into account other people and puts his own interests above all.
Many experts believe that the traumatic situation experienced in childhood plays an important role in the development of the disease. This may be the departure of one of the parents from the family, the loss of loved ones, physical, emotional or sexual abuse.
Representatives of the weaker sex suffer from borderline disorders more often than men. Experts explain this pattern with a more subtle mental organization, low resistance to stress, increased anxiety and low self-esteem.
The borderline personality disorder does not have specific symptoms and may manifest itself in different ways, which significantly complicates the diagnosis of the disease. Psychiatrists identify the following signs, which can be suspected of having a mental disorder:
- reduced self-esteem
- fear of change
- impulsivity, loss of control and the absence of "brakes" in behavior,
- manifestations of paranoia bordering on psychosis
- “I want to live here and now”,
- instability of mood, problems with building interpersonal relationships,
- categorical in judgments and evaluations,
- fear of loneliness, depressive or suicidal feelings.
The tendency to self-destruction is an important feature characteristic of individuals and borderline personality disorders. Against the background of emotional instability, a person is prone to undue risk, alcohol or drug abuse. This type of person can perform any actions related to the destruction of health or life-threatening. For example, to arrange races by car, to participate in risky events that can end fatally.
People with borderline personality disorder experience the fear of loneliness, which goes back to early childhood. Hence, impulsive behavior, low self-esteem, instability in relationships. Fearing to be rejected, a person often first interrupts communication or, on the contrary, tends to be close at all costs, falling into psychological dependence. At the same time, a person with pathological deviations either idealizes a partner and places unrealistic hopes on him, or is deeply disappointed and completely stops communicating.
In borderline disorders, a person cannot cope with his emotions, often conflicts, irritates and experiences anger, and then feels remorse and emptiness. He can start a quarrel out of the blue and even provoke a fight, and, when exposed to strong stress factors, cling to paranoid ideas.
Characteristic statements with borderline state
What characteristic statements does a person with borderline states describe his feelings? Here are the basic settings:
- Nobody needs me and will always be lonely. No one will protect or take care of me.
- I am not attractive, no one wants to learn about my inner world and become a close person.
- I can not cope with difficulties on my own, I need a person who will solve my problems.
- I do not believe anyone, people at any time can substitute and betray, even the closest.
- I have lost my individuality and must adapt to the wishes of other people so that they will not reject me.
- I am afraid of losing control over my emotions, I cannot fully discipline myself.
- I feel guilty about a bad thing and deserve punishment.
Such attitudes are formed in early childhood and are fixed in adulthood, first as stable patterns of thinking, which then turn into behavior patterns. The world around us is seen as hostile and dangerous, therefore, people with borderline disorders experience fear and powerlessness.
Diagnosis of borderline personality disorders is hampered by unstable and diverse symptoms. An experienced psychiatrist makes a preliminary diagnosis after talking with the patient, based on his complaints and test results.
This takes into account the feelings that the patient describes as emptiness, resistance to change, the expectation of a special approach. There is a tendency to self-destructive behavior, guilt feelings, inadequate reactions (anger, unwarranted anxiety).
- fear of loneliness
- the tendency to enter into unstable, strained relations, accompanied by rapid differences in depreciation to idealization,
- the instability of your own self and your image
- impulsiveness aimed at harming oneself (bulimia, alcoholism, drug addiction, sexual promiscuity, dangerous escapades associated with the risk to life),
- suicidal feelings, threats or hints of suicide,
- mood swings
- feeling of emptiness, lack of joy of life,
- difficulties with self-control, frequent outbursts of anger,
- paranoid ideas under stressful situations.
If there are 5 or more of the listed symptoms that persist for a long time, the patient will be diagnosed with borderline personality disorder.
The patient's condition in this disease may be complicated by additional disorders, which are expressed by panic attacks, depressive conditions, attention deficit disorder, and food disorders (overeating, anorexia). Sometimes these patients have excessive emotional reactions, antisocial behavior, or anxiety disorders, which cause them to avoid contact with other people.
Conversations with a psychotherapist or psychologist are aimed at understanding and rethinking existing problems, as well as at developing skills to control behavior and emotions. The main task of the doctor and the patient is to socially adapt, to build interpersonal relations, to form protective mechanisms that help overcome panic fears, anxiety and develop resistance to daily stresses.
To change the way of thinking and to develop optimal patterns of behavior in society, the methods of cognitive-behavioral or dialectical therapy best help. They are aimed at developing the ability to adapt to any unpleasant and uncomfortable situations. A good result gives family and psychodynamic therapy aimed at overcoming the internal conflict and increasing self-esteem. A psychologist offers to many patients to attend classes in support groups. Basic psychotherapeutic methods:
- Dialectical behavioral therapy. This trend is most effective when there are self-destructive symptoms in the behavior. It helps to get rid of bad habits, to rethink behavior, to avoid undue risk in deeds. The therapeutic effect is achieved by replacing negative attitudes with positive thinking patterns.
- Cognitive-analytical method. It consists in the creation of a specific model of behavior that excludes manifestations of borderline disorder (anxiety, irritability, anger). In the process of treatment, methods are developed that allow to stop the attacks of aggression, other asocial habits. A person is taught to critically interpret what is happening, to control his behavior and to independently deal with the symptoms of the disease.
- Family therapy. This method is more often used in the rehabilitation process, after undergoing a course of treatment. The family and close people of a sick person are involved in the process, who take part in psychotherapy and jointly solve the accumulated problems.
The following groups of medications are used in the treatment of borderline personality disorders:
- Neuroleptics. Antipsychotics are prescribed in conjunction with the methods of psychotherapy in order to control excessive impulsivity, prevent attacks of anger and aggression. Neuroleptics of the first generation are now rarely used, because they do not provide the desired efficiency. Of the drugs of the last generation most often prescribed risperidone or olanzapine.
- Antidepressants. The action of medicines is aimed at stabilizing the emotional background, arresting a depressed state, improving mood. Of the extensive group of antidepressants, selective serotonin reuptake inhibitors are best suited to eliminate the symptoms of borderline disorders. The main representatives of this category are drugs Sertralin, Paroxetine, Fluoxetine.
Taking these medications helps to eliminate the imbalance of neurotransmitters and allow you to correct mood swings. Treatment with such drugs is long, the therapeutic effect develops gradually, the dose of drugs must be adjusted to take into account many factors, starting with the most minimal. Such tools have an extensive list of contraindications and can cause serious adverse reactions, so the treatment is carried out under the supervision of a physician.
Mood stabilizers - A group of drugs whose action is aimed at stabilizing the mood in mental disorders. These include several groups of medicines - based on lithium salts derived from carbamazepine. Drugs of the new generation - valproate, Cyclodol, Lamotrigine are more easily tolerated by patients, cause fewer side effects and can be used for a long time without causing addiction. In case of borderline personality disorders, doctors recommend taking such remedies from the first days of the disease.
Borderline personality disorder is a fairly common, but rarely diagnosed pathology. The disease significantly complicates the life of the patient, creates difficulties with social adaptation and problems in personal relationships. Therefore, it is necessary to make the correct diagnosis as soon as possible and start a comprehensive and effective treatment in a timely manner.