What Is the Most Common Treatment for Borderline Personality Disorder?

The existence of Borderline Personality Disorder (BPD) is controversial. Some people deny the existence of this disorder and consider it not a subtype of personality disorder. Personality disorders do not have this subtype in China's "Classification and Diagnostic Standards for Mental Disorders in China 3rd Edition" (CCMD-3), so the diagnosis of this disease has been difficult for some time, and it is often misdiagnosed clinically as emotional disorders, mental disorders Schizophrenia, neurosis, etc. ICD-10 and DSM-IV consider it to be a kind of interpersonal relationship, self-awareness and emotional instability, and have a general pattern of obvious impulsiveness. It may have self-harm behaviors and transient psychotic symptoms. , And this situation should start in childhood or adolescence, not after adulthood.

Marginal

1. Genetic factors: personality is highly hereditary, marginal

In DSM-IV-, borderline personality disorder has four characteristics, namely "unstable interpersonal relationships, unstable emotions, unstable self-images, and obvious impulsivity. The prominent manifestations of borderline personality disorder are the instability of interpersonal relationships, emotions, self-images and behavioral impulses, persistent emptiness, loneliness, and some temporary mental symptoms. The "stability of all" "Change" model is the basic characteristic of borderline personality disorder ^[4]

1. The 10th edition of the International Classification of Diseases and Related Health Problems (ICD-10) has two subtypes of emotionally unstable personality disorders: impulsive and marginal. Unstable personality disorder has a prominent tendency, that is, behavioral impulses, regardless of consequences, with emotional instability. Borderline personality disorder belongs to this category and also has the above characteristics. In addition, the patient's own self-image, purpose and inner preferences (including sexual preferences) are often ambiguous or distorted. They usually have a constant sense of emptiness. Because patients are prone to get involved in strong and unstable relationships, they may lead to continuous emotional crises, they may inspire to avoid being abandoned, and they may be accompanied by a series of suicide threats or self-harm behaviors. Occurs in the case of obvious triggers)

2. Diagnostic criteria for borderline personality disorder in DSM-IV: no less than 5 items are required

Crazy efforts to avoid being abandoned, real or imagined. Note: Does not include suicide or self-harm.

Unstable and tense interpersonal relationships alternate between extreme idealization and extreme depreciation.

Identity disorder: Self-image or self-perception is persistently and significantly unstable.

Impulsiveness manifests in at least two aspects: it may cause self-harm (for example, consumption, sexual desire,

Behavioral abnormalities are related to neurochemical abnormalities, and the formation of personality traits has its neurochemical basis, which suggests that many personality traits are determined by biology rather than just acquired. Even if there are acquisition factors in personality, it will in turn lead to neurochemical changes. Therefore, it is the goal of treatment to maintain the normal neurochemical level of the central nervous system ^[4] .

medical treatement

Lithium salt: emotional instability is an important manifestation of borderline personality disorder, so it is appropriate to give lithium salt as an emotional stabilizer.

Anticonvulsants: Carbamazepine is effective for emotional instability and poor impulse control. Carbamazepine should not be used if patients with borderline type suffer from depression.

Naltrexone: There are reports in the literature that the opiate antagonist naltrexone is effective for some patients with borderline personality disorder, and in particular, self-harm behavior can be reduced.

Antipsychotics: The mechanism of traditional antipsychotics for borderline personality disorder is its anti-impulsive-aggressive and antipsychotic effects. Atypical antipsychotics, such as olanzapine, clozapine, and risperidone, can simultaneously antagonize dopamine D2 and 5-TH2 receptors. 5-TH2 receptor abnormalities are related to anxiety, depression, psychosis, and suicide. Therefore, Atypical antipsychotics control these symptoms in patients with borderline personality disorder.

Antidepressants: Nefazodone, tricyclic antidepressants, SSRI, SNRI drugs are effective for borderline personality disorder. Monoamine oxidase inhibitors (MAOIs) have limited efficacy in treating borderline personality disorder and large adverse reactions, and their use is limited.

Psychosurgery

Directional destruction surgery on certain parts of the brain can improve impulsive behavior, but surgery leads to local irreversible brain damage, so surgical treatment should take a cautious attitude.

Education, training and arrangements

This requires close cooperation in many aspects to provide long-term and stable services and management to patients.

Psychotherapy

There are relatively few studies on the treatment of Borderline Personality Disorder (BPD) in China. Most foreign scholars agree with two points: Treatment is effective, can reduce symptoms, improve the quality of life of patients, and get a comparative comparison Good prognosis. The treatment of BPD should be mainly psychological therapy, supplemented by drug therapy, and the treatment cycle is very long, requiring a lot of energy from the therapist, and the cure rate is very low.

Beneficial psychological treatments for patients with personality disorders include supportive psychotherapy, psychoanalysis and psychoanalytic psychotherapy, cognitive therapy, cognitive analysis therapy, interpersonal psychotherapy, dialectical behavior therapy, and psychological education.

. Dialectical Behavior Therapy (DBT): DBT is a clinically proven and effective method of psychotherapy for BPD. It addresses the dysfunction of BPD's unique emotion regulation system, and combines the behavioral change principles and social psychology principles of cognitive behavioral therapy. The combination of visitor-centered therapy and Zen acceptance theory helps patients understand themselves, learn how to deal with emotional trauma, regulate negative emotions, establish effective interpersonal relationships, and learn how to endure the unavoidable pain in life.

DBT carries out 4 forms of treatment at the same time: Personal psychotherapy: mainly uses behavioral therapy to achieve a balance between patients on the one hand, accepting themselves and reality on the one hand, and allowing change on the other. Group therapy: observe the patient's participation level, defense style, and interpersonal processing methods in training activities, train patients in conflict management skills in interpersonal relationships, emotional adjustment skills, improve their chaotic interpersonal relationships, and enhance self-esteem. Telephone guidance: The therapist maintains telephone contact with the patient in order to seek help when the patient needs it, strengthen the patient's use of the skills learned in the actual situation, and give support and encouragement. Supervision meeting: The therapists meet once a week to discuss and analyze difficult cases, exchange experiences, and accept supervision if necessary.

. Family therapy: Family therapy is increasingly used in the treatment of BPD, which is helpful for patients to restore close relationships, get social support, and reduce suicide rates. Most therapists believe that individual treatment combined with home treatment can significantly change the pathological cognition and behavior of patients with BPD. However, there are different opinions on the timing of family therapy. Some experts believe that it is very useful to combine family therapy in the early stage of treatment. On the one hand, it can make some intractable empathy transfer to family therapy. On the other hand, it helps the therapist to remain objective. Alleviate counter-empathy for marginalized youth and use their observation to bring reflection to family members. But Masterson, as early as the 1970s when he tried early combined family therapy, thought that this would create a greater sense of conflict and abandonment, and cause patients to take further action.

. Empathy Center Therapy (TPF): TPF is based on the theory of object relationship in psychodynamics. It emphasizes the establishment of good relationships for treatment, and pays attention to the role played by the therapist and the patient during the treatment. Lowwald believes that the treatment activity is based on the patient's internalization of the new object relationship, that is, the object relationship with the therapist. If patients can apply this new relationship to their daily lives, treatment will be effective.

Because the chaotic interpersonal relationship of BPD patients will definitely be brought into treatment, the first step in the beginning of treatment is to establish a clear and clear external contract. The details are repeatedly agreed by both parties to let the patient recognize that the therapist is different from other people. Maintain a positive attitude towards treatment. Even if empathy or conflict occurs, patients can realize that they are doing treatment, understand that they have the responsibility to maintain treatment and ultimately achieve treatment goals, and to prevent patients from responding or even interrupting treatment. During the treatment process, the therapist should pay attention to the fluctuation of the relationship between himself and the patient while examining his anti-transference. At this time, the empathy relationship is explained here so that the patient's empathy and the therapist's attachment. Relations are unified, and the object relationship between therapist and therapist is internalized and applied to daily life. In this process, once the doctor-patient relationship intensifies, it must become the primary content of discussion. The therapist creates a tolerant atmosphere to encourage patients to express their dissatisfaction with the treatment, conflicts in the inner world, and negative emotions that are awakened. Understand and create a more complete therapeutic alliance.

. Sandplay therapy: There are already some cases of sandplay therapists applying this technology to successfully treat BPD. Psychoanalytic research on the psychopathological mechanism of BPD believes that the imbalance of mother-child relationship in childhood, that is, "mother over-involved" and "misreading and inappropriate reactions of mothers' needs for children" lead to the development of BPD patients. Morbid psychology, and patients will naturally return to childhood unconsciously in sand table games. Sand table games help players engage in conscious and unconscious dialogue. Most sand table game therapists believe that in the treatment of severe BPD patients, in order to avoid unnecessary resistance and regression, it is best not to use sand table technology in the early stage of treatment.

In general, the traumatic themes conveyed by the sandboxes of BPD patients in the first few sandbox games are isolation, threats, and restrictions, and the characters representing themselves appear to be lonely (there may be two or more characters representing themselves), Far from the lively crowd; there are fences, hedges, etc. in the sand table to isolate the outside world or protect themselves; there may be bridges, but they cannot serve any connection. In the event of impedance or regression, there will also be babies or recurring themes of trauma that have appeared in previous sandboxes.

As the treatment progresses, the topic of injury is getting less and less. Instead, the topics of healing, such as connection, rebirth, and conversation, are replaced by therapists. The therapist only observes and records during the sand table game. Experience the world of sandboxes in depth, give metaphorical or questionable interpretations, and help patients to introspect.