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                              BORDERLİNE PERSONALİTY DİSORDER

Borderline personality disorder is pschiatric disorder which a little mysterious , alittle complicated and lately this disorder has become a frequently used adjectives . Some young people say to each other 'borderline' , and some clients diagnosed with borderline putting themselves however many people do not know exactly what it is even some people think this is cool and they can say themselves ' I am borderline ' . Primarily if we mention generally and briefly ; people who has borderline personality disorder live sense of space , feeling of emptiness can not be filled and they they try to avoid all conflict with their loved people and also they try to act overly compliant . Between 1.5% and 2.5 of the general population are through to suffer from this disorder and close to 75% of those diagnosed are women (1). 

   This article contain researched and selected seven different articles from different researchers . These seven article names are ; Borderline Personality Disorder (by Joel Paris ) , Management Of Borderline Personality Disorder (by Robert S. Biskin MD , Joel Psris MD ) , Effetiveness of Partial Hospitalization in the Treatment of Borderline Personality Disorder (by Antony Bateman ) , Dialectical Behaviour Therapy for Women with Borderline Personality Disorder ( by Roel Verheul , Louise M.C. ...) , Dialectical Behaviour Therapy in the Treatment of Borderline Personality Disorder ( by Richard C. Blennerhassett , Jennifer Wilson O'Raghallaigh ) and Transference-Focused Psychotherapy v. Treatment by Community Psychotherapists for Borderline Personality Disorder ( by Stephan Doering , Susanne Hörz , Peter Buncheim ...)

  The article of Borderline Personality Disorder written by Joel Paris ;  Definition of borderline personality disorder is chronic psychiatric disorder characterized by remarkable impulsivity , instability of mood and interpersonal relationships , and suicidal attempt that can make complex medical care . Identifying this diagnosis is significant for intervention planning . Although the cause of borderline personality disorder is unsure , most patients develop with time . There is an proof basis for treatment using both psychotherapy and psychopharmacology . The clinical invite centres on managing chronic suicidality . 

According to this article example case history  ;'' Colleen , a 22 year old student , is seen for a psychiatric assessment after presenting to the emergency department because of taking an overdose of acetaminophen pills . Although the immediate precipitant to her suicide attempt was a break up with her boyfriend , she has a history of multiple suicide attempts since the age of 14 . Colleen reports that she has daily mood swings , from depression to intense anger , and that she often cuts herself on the wrists and arms to relieve dysphoria . When stressed , she experiences feelings of unreality , sometimes hearing a voice telling her to kill herself . Colleen has had highly problematic relationships with men , falling quickly in and out of love and feeling that her life depends on them , even when they have behaved abusively toward her .'' What is the appropriate diagnosis and explanation of this patient ?

The case revisited 

''Colleeen's symptoms clearly meet the diaagnostic criteria for borderline personality disorder ( mood swings , impulsivity , suicidality , unstable relationships and micropsychotic phenomena), a clinical picture that could not readily be accounted for by a diagnosis of depression alone . Her family physician talks to her about the disorder and refers her to a psychiatrist to confirm the diagnosis . Colleen is seen for weekly  psychotherapy session over the next 6 months by a psychologist at her university student health service , who applies established principles of management for this condition . ''

   According to the Diagnostic and Statistical Manuel of Mental Didorders , fourth edition , text revision (DSM-IV-TR), (2000)  these conditions are defined by maladaptive personality characteristics beginning early in life that have discipline and outlined by maladaptive personality characteristics beginning early in life that have dependable and serious effects on functioning.

Borderline personality disorder's causes may be biological , psychological and social . These all factor play a role at borderline personality disorder. 

People who suffer from borderline personality disorder are seen in psychiatric clinics or in primary care . the aim to administration involve making an accurate diagnosis , maintaining a encouraging relationship with the patient and establishing limited goals. Although borderline personality disorder may persist for years, this does not last forever , and one can be reasonably optimistic that most patients will recover with time . Psychotherapy may encourage speed up this progress . 

The article that Primary care of patients with borderline personality disorder traits by Robert S. Biskin Joel Paris ; First this disorder family physicians have several significant roles . First of all there is much more practical issues that patients with borderline personality disorder need to find a way into the mental health system . According to article the system is becoming prosressively complex and fragmented between different care providers , the GP is often placed in the role of coordinating between these treaters . 

Secondly all the evidence based treatments for borderline personality disorder are time limited . Becoming followed in family medicine is ideally lifelong . 

The third but most significant mark is that patients with borderline personality disorder have critical  meical comorbidities and have a reduced life expectancy (Frankenburg FR ,Zanarini MC , 2004 , Paris J , Zweig-Frank H. , 2001) . This is relatively related to deaths by suicide , however also powerfully related to obesity , hypertension , cardiac disease , smoking , and former chronic health problems . Lats of psychotropics prescribed to patients with  borderline personality disorder exacerbate these conditions .

Article of Effectiveness of Partial Hospitalization in the Treatment of Borderline Personality Disorder by Antony Bateman , 1999 ; This article investigate and compared the effectiveness of psychoanalytically oriented partial hospitalization with standard psychiatric care for patients with borderline personality disorder. This research's outcome measures involved the frequency of suicide attempts and acts of self-harm , the number and duration of inpatient admissions, the use of psychotropic medication , and self-report measures of depression , anxiety , general symptom distress , interpersonal function , and social arrangement . This research conclusion is that ; Psychoanalytically oriented partial hospitalization is superior to standard psychiatric care for patients with borderline personality disorder. Reproduction is needed with larger groups , but these results propose that partial hospitalization may offer an alternative to inpatient treatment .

In one of the few controlled studies of intensive outpatient who is borderline personality disorder treatment , Linehan and colleagues displayed that there was affect of dialectical behavior therapy . Dialectical behavior therapy is a treatment incorporating cagnitive , behavioral and encouraging psychotherapies . Skilled practitioners in an concentrated outpatient program use a conjunction of individual and group approachep centered on a patient-therapist relationship .

RESULT ; To examine predictor of enhancement in the comparatively hospitalized group ,suicide attempts and self mutilation were compounded into a singler variable -self harm- scored as a simple binary variable . Nonparametric  correlation coefficients were computed between the proximity of self harm and demographic , clinical and outcome variables for the relatively hospitalizerd group . 

The article which is Dialectical Behaviour therapy in the Treatment of Borderline Personality Disorder by Richard C. Blennerhassett and Jennifer Wilson; This article include that Linehan and her colleagues have made an significant contribution to research in the area of treatment of borderline personality disorder ; Gunderson (2001) explained  it as ' since 1987 the singular most remarkable entry in therapeutic strategies for borderline patients' . None the less , given the restricted resources in many psychiaric settings , allied to the intensive nature of the programme and argue as to the generalisability of the research findings , further improvement of dialectical behaviour therapy is likely to be limited to specialist settings . 

The article which is Transference - focused psychotherapy v. treatment by Community psychotherapists for Borderline Personality Disorder by Stephan Doering , Michael Rentrop , Peter Buchheim , ... ; This article mention that ; People who suffer from borderline personality disorders' treatments are emprical validation of transference - focused psychotherapy . After this research , researcher realize that treatment long term follow up , since effect of psychotherapy seem to take years to improve and to maintain after termination of treatment . According to Levy KN. , 2008 ; Moreover , given that people now have dialectic behavioral treatment , transference - focused psychotherapy , mentalisation - based therapy and schema - focused therapy as viable treatment for borderline personality disorder  , the specific and potentially dissimilar mechanism of change need to be studied in order to decide which treatment is most effective for which individuals with specific problems . 

The atricle which is Dialectical Behaviour Therapy for women with Borderline Personality Disorder by Roel Verheul , Louise M.C. , Maria A.J , Wim Van Den ; This article's  clinical implication and limitations : For high risk behaviours in patients with borderline personality disorder , dialectical behaviour therapy is an efficious treatment . Indication suggests that dialectical behaviour therapy should be followed by another treatment focusing on other constituents of borderline personality disorder , as soon as the high risk behaviours are adequetely decreased .

REFFERANCES 

1.) Abnormal Psychology , Susan Nolen - Hoeksema / Fifth Edition . McGRAW-HILL INTERNATIONAL EDITION 

2.) Borderline personality disorder , Joel PARİS / Author Affiliations

3.) Diagnostic and statistical manuel of mental disorders . 4th ed , text revision . Washington : American Psychiatric Association ; 2000

4.) Management of borderline personality disorder , Robert S. Biskin MD , Joel Paris MD . 

5.) Primary care of patients with borderline personality disorder traits , Robert S. Biskin Joel Paris . Department of Psychiatry , Instute of Community and Fmily Psychiatry , Sir Mortimer B. Davis Jewish , Dr. Persaud's letter highlights the important role that family phycicians play in the management of patients with borderline personality disorder . 

6.) Frankenburg FR, Zanarini MC. Personality disorders and medical comorbidity. Curr Opin Psychiatry. 2006;19(4):428-31.

7.) Frankenburg FR, Zanarini MC. The association between borderline personality disorder and chronic medical illnesses, poor health-related lifestyle choices, and costly forms of health care utilization. J Clin Psychiatry. 2004;65(12):1660-5.

8.) Paris J, Zweig-Frank H. A 27-year follow-up of patients with borderline personality disorder. Compr Psychiatry. 2001;42(6):482-7.

9.) Effectiveness of Partial Hospitalization in the Treatment of Borderline Personality Disorder: A Randomized Controlled Trial . Anthony Bateman, M.A., F.R.C.Psych.; Peter Fonagy, Ph.D., F.B.A. Am J Psychiatry 1999;156:1563-1569.

10.) Transference-focused psychotherapy v. treatment by community psychotherapists for borderline personality disorder: randomised controlled trial . Stephan Doering, MD , Susanne Hörz, PhD , Michael Rentrop, MD , Melitta Fischer-Kern, MD and Peter Schuster, MD , Cord Benecke, PhD and Anna Buchheim, PhD , Philipp Martius, MD , Peter Buchheim, MD . 

11.) Dialectical behaviour therapy in the treatment of borderline personality disorder . RICHARD C. BLENNERHASSETT, MB, MRCPsych, FRCPI , JENNIFER WILSON O’RAGHALLAIGH, BA, MPhil, DClinPsych

12.) Dialectical behaviour therapy for women with borderline personality disorder . 12-month, randomised clinical trial in The Netherlands . ROEL VERHEUL, PhD ,LOUISE M. C. VAN DEN BOSCH, MA and MAARTEN W. J. KOETER, PhD , MARIA A. J. DE RIDDER, PhD and THEO STIJNEN, PhD , WIM VAN DEN BRINK, PhD.

 

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