ABA in the Treatment of Borderline Personality Disorder
Before delving into the analysis and treatment of borderline personality disorder, it is necessary to recognize what it is and show its characteristics. According to National Institute of Mental Health, it is:
“A mental illness marked by an ongoing pattern of varying moods, self-image, and behavior.”–NIMH, Borderline personality disorder overview
The syndrome is also characterized by poor impulse control and fits of pique that can last for days or even weeks. Often these episodes are followed by depression, which can lead to a misdiagnosis of bipolar disorder. The chief difference between the two is that the episodes of mania and depression are distinctly separate in the latter while they elide in the former.
The Behavioral Issues with BPD and Their Accompanying Solutions
There are many behaviors that will possibly manifest themselves in subjects with the condition. A partial list includes:
•Staving off abandonment whether real or imagined
•Engaging in “Night and day” relationships that vacillate at irregular intervals
•Having a distored sense of self
•Feeling “empty” all the time
•Finding it difficult to trust anyone
•Thinking of suicide whether or not one actually attempts it
Each subject will be different in the presentation of the condition, so mental healthcare providers must be vigilant regarding these and any other symptoms that crop up. It must also be borne in mind that not everyone will experience every symptom. Sometimes, subjects will experience one set of symptoms at one time and another set of symptoms at a different time.
In almost all cases, modern strategies and techniques, as applied to previous treatment options, offer much more hope than the treatments did in the past. There have been numerous studies performed in both clinical and field environments, and the data from these have been nearly universally promising.
The first treatment is a variant on traditional psychotherapy. The gist now is not only on the understanding of one’s problems but also heavily focused on control strategies and how to seek help from others without shame or mistrust. The subject learns to recognize intense emotions that drive one to self-destructive behaviors and apply learned techniques to combat the harming urges. Similar techniques also show the subject that there truly are others upon whom one can count, such as parents, other family members, good friends, and spiritual advisors. This mindfulness is part of an overall strategy called Dialectical Behavior Therapy.
Once the subject can trust others and recognize problems, the learned techniques for combating them are part of the second sphere of therapy: Cognitive Behavioral Therapy. The idea is to stress what is true about the person and not the false narratives that the person creates as part of the condition. For example, if a person thinks that he or she is hated by a group of peers and begins to cut him or herself to “punish” him or herself for engendering the imagined hatred of the group, the therapist can show the person that there is no hatred. The therapist can instruct the person to apply critical thinking strategies to determine the true feelings of the group.
In some cases, mere therapy is ineffective, either because of the severity of the BPD or because of comorbid mental conditions. In these instances, treatment will usually also include medication, particularly if severe depression, thoughts of suicide, or both are present. Rarely, admittance to a hospital psychiatric ward is appropriate, such as cases where a person has actually attempted suicide or has become violent.
Preparing for a Career Treating BPD
There are a few careers that will interact with people who have BPD. They include:
•Nurses or nurse practitioners
Support workers might be able to help the person around the home and reduce the person’s stress level by “emptying the household inbox” daily. The idea would be: The less the person has to do around the house, the lower the person’s stress level would be.
Therapists would be those people who have earned their doctorates in psychology and who are licensed by their respective states to practice as therapists. They might base their practice on any one of a number of different fields that focus on certain aspects of therapy. Unlike medical doctors or nurse practitioners, they are not able to prescribe medications, but they usually work closely together with colleagues who can if their patients need medication.
Nurses support the work of doctors and nurse practitioners. They are the ones who carry out the medical orders and are responsible for nearly all primary care. In cases where a person is either hospitalized or committed because of his or her mental illness, there will be nurses who are trained in the support of such conditions.
Doctors and nurse practitioners perform diagnoses, order tests, and prescribe medications based on their findings. Conscientious doctors and practitioners will consult with everyone who has had contact with a patient as part of working up that patient’s history. Even a support worker might have observations or experiences with the patient that are worthwhile. In actuality, successful treatment of patients with BPD, or any other mental illness for that matter, is a team effort that includes all medical professionals of any qualification level and also the patient’s family and friends.
Interested parties can peruse the website of the National Institute of Mental Health and any websites of reputable facilities, such as the Mayo Clinic, The John Hopkins Hospital, and Massachusetts General Hospital. Anyone who wishes to dig deeper can go to any library and access Dissertations Abstracts International and search by topic to find anything on borderline personality disorder and any associated conditions. These peer-reviewed papers will provide insight into the assessment, treatment, and study of BPD and give the reader a much more-informed perspective than from a simple website.
If someone is an active participant in his or her own treatment, it bolsters the person’s sense of self-worth and accomplishment and can become part of the treatment process itself. The same holds true regarding family members and friends. The patient can then see that others care enough to make themselves part of the process, too, and that will also buttress the patient’s psyche.
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