Borderline Personality Disorder Sample Paper

Research is essential for the advancement of any discipline in academia. As such, anyone undertaking research activities should be able to understand the basics of doing any search of the literature. There are numerous online databases in which one can get work published on similar topics of interest, for a comprehensive literature review. The PICOT format helps in making the search process more effective and conceptualized as one prepares the materials or guidelines that are appropriate for review.

My area of interest is in mental health, more so concerning personality disorders. I chose to review literature about borderline personality disorder. This discussion focuses on how to transform my clinical-based inquiry around borderline personality disorder (BPD) into an answerable PICOT question.

According to Geddes and Andreasen (2020), borderline personality disorder mostly presents in the form of pervasive patterns of impulsivity and unstable relationships that affects self-image and behaviors. The preferred treatment mechanism for BPD, according to Ganti (2018), is Dialectical Behavior Therapy (DBT), which is a composite of cognitive-behavioral therapy, mindfulness skills, as well as group therapy.

Other literature also cites the use of pharmacotherapy intervention in treating psychotic or depressive symptoms (Hutsebaut et al., 2019; Riffer et al., 2019). Bearing in mind the afore-mentioned finding, I had to frame a composite question that would be the basis of my clinical inquiry, namely, that in patients suffering from borderline personality disorder (P), does the use of CBT (I) compared to pharmacologic treatment (C), result in improved socio-occupational functioning (O), over a six-month period (T).

Personality disorders are generally difficult to treat due to lack of insight, and pharmacologic treatment has limited usefulness, thus psychotherapy is the mainstay of treatment (Ganti, 2018). Currently, the management of most psychological conditions is largely through pharmacotherapy, psychotherapy, or a combination of both. When designing the PICOT question, I had to consider the appropriateness of vocabulary use.

According to Palaskar (2017), one should gauge the search results as per the articles found in the initial search and analyze their level of appropriateness. This is one strategy that I can leverage to increase the preciseness, effectiveness, and rigor of my database search. The searches should be adaptable to peculiarities and rules of the databases being searched.

Often, when analyzing a topical issue, one may opt to go for his or her preferences. The same applies to scenarios of searching research evidence that guide professional decision-making and a clinical inquiry. I found that the PICOT format helped me create a good research question that can inform my hypothesis. To increase rigor and effectiveness, I used the FINER (Feasibility, Interesting, Novel, Ethical, and Relevant) mnemonic suggested by Regatieri, Alves and Rocha (2019). My PICOT question is feasible in terms of sufficiency of time, operability, and conducting logistics. The question is interesting and explores new insights that can guide the management of borderline personality disorder. Lastly, it fits within the ethical frameworks of research and is relevant to clinical work.

Conclusion

Undertaking research requires one to consult existing body of information related to the topic of interest, something easily achieved through online databases. Given my interest in researching the effectiveness of psychotherapeutic management of BPD compared to pharmacologic management, I conducted an in-depth search in different databases. Among these were the Walden Library, Cochrane, CNAHL and Google Scholar, with the aim of revealing current treatment and management information relating to the disorder. I believe the information retrieved will enable me develop a better understanding of the problem and inform future research on the condition.

Borderline Personality Disorder Sample Paper References

  • Ganti, L. K. (2018). First aid for the psychiatry clerkship. McGraw Hill Professional.
  • Geddes, J. R., & Andreasen, N. C. (2020). New Oxford textbook of psychiatry. Oxford University Press, USA.
  • Hutsebaut, J., Videler, A. C., Verheul, R., & Van Alphen, S. P. (2019). Managing borderline personality disorder from a life course perspective: Clinical staging and health management. Personality Disorders: Theory, Research, and Treatment, 10(4), 309. https://doi.org/10.1037/per0000341
  • Palaskar, J. (2017). Framing the research question using PICO strategy. Journal of Dental and Allied Sciences, 6(2), 55-55.
  • Regatieri, C. V., Alves, A. V., & Rocha, E. (2019). Medical acumen and scientific approach meet the FINER method. Arquivos Brasileiros De Oftalmologia, 82(4), 1-5. https://doi.org/10.5935/0004-2749.20190069
  • Riffer, F., Farkas, M., Streibl, L., Kaiser, E., & Sprung, M. (2019). Psychopharmacological treatment of patients with borderline personality disorder: comparing data from routine clinical care with recommended guidelines. International Journal of Psychiatry in Clinical Practice, 23(3), 178-188. https://doi.org/10.1080/13651501.2019.1576904

Case Study: Borderline Personality Disorder

Evaluation and Definitive Diagnosis

KK is a woman presenting with a history of cutting her wrist with a razor, a history of drug addiction, and previous hospitalization for a drug overdose. Additionally, she is hostile, demeaning, and caustic to her caretakers, with a track record of unstable personal relationships at work. Based on the symptoms described above, such as self-harm, poor interpersonal relationships, unstable mood, and self-damaging acts such as substance abuse, are suggestive of borderline personality disorder as the definitive diagnosis.

The DSM-V bipolar personality disorder diagnostic criteria are as follows: Self-damaging acts such as unsafe sex and substance abuse, unstable personal relationships, self-harm, suicidal behavior, unstable mood, feelings of emptiness, fear of abandonment, intense anger that can be difficult to control, paranoid, and dissociative episodes (Chapman et al., 2022). Other assessment instruments, including the personality diagnostic questionnaire and the Minnesota borderline personality disorder scale, are available for diagnosis.

Differential Diagnoses

According to DSM V, bipolar or depressive disorders often occur concurrently.  The presentation of other personality disorders, especially those in cluster B, including antisocial, histrionic, and narcissistic personality disorders, commonly overlap with borderline personality disorder. Additionally, non-suicidal self-injury disorder and substance use disorder are also differentials of borderline personality disorder. Hormonal disorders, especially hyperthyroidism and alcohol withdrawal, exhibit similar features as borderline personality disorder.

Neurobiology of Borderline Personality Disorder

The condition has been linked to a strong genetic link. It is approximately five times more common among the first-degree biological relatives of those with the disorder than in the general population. It is also associated with an increased familial risk not only for bipolar and depressive disorders but also for substance use disorders. Additionally, serotonin dysregulation in the brain reduces the sensitivity of the 5HT-1A receptor, which may contribute to borderline personality disorder. Some studies further implicate estrogen in the causation of borderline personality disorder (the University of Illinois at Chicago, 2018). A fundamental explanation for the high prevalence in females compared to males. Culturally, the affected young adults and adolescent population may present with unstable moods accompanied by irritability, anxiety, and intense anger that can be difficult to control, especially when associated with substance use.

Management Plan of Borderline Personality Disorder

A borderline personality disorder is mainly treated using psychotherapy, but medication may be added. However, before treatment, it is essential to test the hormonal blood levels of thyrotropin-releasing hormone and cortisol levels to rule out depression. Moreover, toxicological studies, including drug levels, are important to distinguish borderline disorder from symptoms that may develop in association with persistent substance use.

Evidence-based care effective for patients with borderline personality disorder includes dialectical behavior therapy (DBT), which combines interpersonal and emotion regulation skills with mindfulness practices. Mentalizing-based therapy (MBT) helps patients control their emotional lability by feeling understood and enabling them to learn about the intentions of the people around them (Chapman et al., 2022). Finally, transference-focused psychotherapy (TFP) focuses on internalized images of self and others that organize the patient’s interpersonal experience and sense of self.

Pharmacologically selective serotonin reuptake inhibitors (SSRIs) are preferred over other classes of antidepressants. Fluoxetine 20mg PO qDay may be effective. However, this drug is associated with adverse effects such as insomnia, nausea, headache, nervousness, impotence in men, and decreased libido. Recovery from this disorder seems complicated and varies from patient to patient, requiring long-term follow-up and psychotherapy. Once recovery is attained, the patient can remain stable over some time.

Conclusion

Mental health is a crucial aspect of a person’s overall well-being. The World Health Organization includes mental health as a component in its definition. In that case, borderline personality disorder causes significant impairment and distress and psychiatric co-morbidities. Psychotherapy remains the fundamental treatment approach for borderline personality disorder. However, medications may include antidepressants, antipsychotics, or mood-stabilizing drugs. Hospitalization is also vital to keep patients safe from self-injury or address suicidal thoughts or behaviors.

References

Chapman, J., Jamil, R. T., & Fleisher, C. (2022). Borderline Personality Disorder. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430883/

University of Illinois at Chicago. (2018, May 31). Symptoms worsen around menses for people with borderline personality disorder. Science Daily. https://www.sciencedaily.com/releases/2018/05/180531143106.htm

Also read: NURS 6052 Assignment Evidence-Based Practice and the Quadruple Aim