Posted: February 17th, 2022

Borderline Personality Disorder

Borderline personality disorder

Introduction

A borderline personality disorder is a mental disorder that is characterized by unstable and severe mood swings, difficulty forming stable relationships, and impulsive behaviors. A patient with BPD displays intense and dangerous relationships with family and friends fluctuating from extreme closeness and love to extreme dislike or anger, resulting in an unstable and distorted sense of self (Gunderson et al., 2018). Individuals diagnosed with this condition often feel on edge, have high levels of anger and distress. The causes of BPD are genetics, environmental factors, or brain abnormalities. 

The controversy that surrounds Borderline personality disorder

Since its conception, borderline personality disorder has had several controversies, but the understanding constantly evolves to eliminate the associated disputes. Controversy arises in BPD mainly because of associated stigma with this diagnosis whereby many specialists disagree on how to understand personality disorders as the diagnosis process does not consider enough social contexts during diagnosis resulting in stigmatization of the diagnosis. Individuals with BPD view their feelings, behaviors, or relationships as practical life experiences without considering various life experiences (Campbell et al., 2020). They do not focus on finding problems with suspected patients to enhance diagnosis. Another controversy surrounding BPD is the therapeutic nihilism held by professionals who encounter patients with personality disorders in the acute healthcare setting. 

Personal, professional beliefs about borderline personality disorder

From my professional perspective, BPD is a complex condition that involves a struggle with thoughts, feelings and, beliefs about oneself and others, resulting in unstable behaviors, emotions and, relationships. According to Cases et al. (2020), individuals with BPD feel exposed and confused, causing emotional volatility triggered by small things. Clinical therapy for clients with personality disorders is among the most challenging for professionals due to the client’s wide range of clinical presentations and lack of the specialized training required to provide the client with quality, ethical and legal successful treatment (Mammen et al., 2020). Drawing from professional experiences, just like other mental illnesses, BPD is treatable and manageable to avoid push over by symptoms and enhance emotional regulation.

Strategies for maintaining the therapeutic relationship with a client with the Borderline personality disorder

A therapeutic relationship refers to the relationship between a healthcare professional and the client to enhance engagement to achieve beneficial changes. A good therapeutic relationship includes a suitable alliance and is significant for clients to get the most out of therapy, remain in treatment, and achieve the desired clinical outcomes. The practitioner-client relationship is based on respect, trust, and sensitivity to enhance harmony and healing. The therapeutic relationship is vital towards achieving body and mind harmony during the patient engagement, resulting in a win-win situation of personal growth and positive patient wellness. Creating and fostering therapeutic relations is achieved through the following strategies;

• Creating a good rapport and conducive environment to make the client feel welcome. This is achieved by introducing oneself to the patient, initiating a handshake during the initial meeting, and establishing respect (Rodríguez-Nogueira et al., 2020). This enhances comfortability and openness from the beginning.
• Establishing trust by ensuring confidentiality and privacy when providing care creates good relations between client and professional. The patient is encouraged to be honest and open up because they believe what is said is confidential and can only provide quality treatment. 
• Adopting effective verbal and non-verbal  communication to ensure  understanding and achieve successful therapeutic process  
• Actively and empathetic listening to the client is a practical approach to guide care to achieve wellness as it enhances understanding of patient concern showing genuine concern (Chanen et al., 2020). 
• Additionally, maintaining eye contact and smiling during the care process enhances engagement and encourages communication. According to Gunderson et al. (2018), a patient can relate to the profession, creating an understanding environment that shows care and willingness to help with the issues. This creates an open relationship whereby the client is honest and ready to help.
• Maintaining professional boundaries provides guidelines on what to do and not do, creating a professional therapeutic relationship (Rodríguez-Nogueira et al., 2020). In some cases, a professional may decide to provide therapeutic touch whole other issues. It is considered inappropriate. Therefore understanding when to set certain boundaries and rules ensures mutual respect.
• Respecting clients’ backgrounds, cultures, and beliefs enhances a therapeutic relationship and mutual trust (Cases et al., 2020).

Ethical and legal considerations related to Borderline personality disorder practice

Challenges arise when making ethically informed and legal treatment decisions. Evidence-based practice enhances adherence to ethical and legal considerations, ensuring clients get accessible, affordable, and cost-effective treatment. Ethical review related to borderline personality disorders requires careful risk-benefit analysis by collaborating with the patient to provide integrative care approaches most suited for personality disorders (Opitz‐Welke & Konrad, 2020). A professional is ethically obligated to encourage voluntary participation, ensure patient privacy, confidentiality, and anonymity during collaboration. Also, before initiating treatment, obtaining a signed consent give the professional permission to provide the best care.  

Legally, a professional should be qualified and competent to treat personality disorders with sufficient education and training to make empirical evidence decisions for treatment. According to Mammen et al. (2020), legally, a psychologist is obligated to take further measures to protect the client if a patient is at risk of self-harm or disclose matters if the patient is a danger to others risk to others. 

References

Campbell, K., Clarke, K. A., Massey, D., & Lakeman, R. (2020). Borderline Personality Disorder: To diagnose or not to diagnose? That is the question. International journal of mental health nursing, 29(5), 972-981. https://doi.org/10.1111/inm.12737 https://onlinelibrary.wiley.com/doi/abs/10.1111/inm.12737

Cases, C., Lafont Rapnouil, S., Gallini, A., Arbus, C., & Salles, J. (2020). Evidence of practice gaps in emergency psychiatric care for borderline personality disorder: how can this be explained?. BMC psychiatry, 20(1), 1-9. DOIhttps://doi.org/10.1186/s12888-020-02892-7

                        https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-020-02892-7

Chanen, A. M., Nicol, K., Betts, J. K., & Thompson, K. N. (2020). Diagnosis and treatment of borderline personality disorder in young people. Current psychiatry reports, 22(5), 1-8. DOIhttps://doi.org/10.1007/s11920-020-01144-5

 https://link.springer.com/article/10.1007/s11920-020-01144-5

Gunderson, J. G., Herpertz, S. C., Skodol, A. E., Torgersen, S., & Zanarini, M. C. (2018). Borderline personality disorder. Nature Reviews Disease Primers, 4(1), 1-20. DOIhttps://doi.org/10.1038/nrdp.2018.29

                        https://www.nature.com/articles/nrdp201829

Mammen, O., Tew, J., Painter, T., Bettinelli, E., & Beckjord, J. (2020). To mitigate malpractice risk, communicating suicide risk to families of chronically suicidal borderline personality disorder patients. General hospital psychiatry. https://doi.org/10.1016/j.genhosppsych.2020.08.014https://www.sciencedirect.com/science/article/abs/pii/S016383432030133X

Opitz‐Welke, A., & Konrad, N. (2020). Ethical Considerations Involving Psychopathic Disorders. The Wiley International Handbook on Psychopathic Disorders and the Law, 597-604. https://doi.org/10.1002/9781119159322.ch73https://onlinelibrary.wiley.com/doi/abs/10.1002/9781119159322.ch73

Rodríguez-Nogueira, Ó., Morera Balaguer, J., Nogueira López, A., Roldán Merino, J., Botella-Rico, J. M., Del Río-Medina, S., & Moreno Poyato, A. R. (2020). The psychometric properties of the person-centered therapeutic relationship in physiotherapy scale. PloS one, 15(11), e0241010. https://doi.org/10.1371/journal.pone.0241010

                        https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241010

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