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Introduction
Mental illness describes conditions and disabilities that impede a person’s capabilities to handle themselves during everyday life. The severity of the ailments can range from intermittent anxiety to suicidal tendencies. Fortunately, modern psychological assessments and treatments, including therapy and medication, can often help those suffering a mental condition if identified in time. An example of this is Borderline Personality Disorder (BPD), which tends to externalize as emotional unpredictability and imprudent actions taken by the patient (Davidson et al., 2010). BPD is a psychological condition that makes individuals highly erratic but can be treated with dialectical behavior therapy.
Description of BPD and a Sample Mental Status Exam
Borderline Personality Disorder (BPD) is a mental condition that tends to manifest as emotional instability, recklessness, and impulsive behavior. Symptoms incorporate but are not limited to, high volatile contractions to changes in mood, binge eating, and intentional endangerment of self (Krawitz & Jackson, 2008). The individual with BPD tends not to have a stable self-identity and often perceives the world dichotomously. Approximately one percent of people living in the developed world suffer from BPD, with seventy-five percent of patients being female (Krawitz & Jackson, 2008). There is some evidence that BPD can be related to genetics, as it tends to appear in family units. Furthermore, because of the range of patient responses to BPD, worldwide statistics may suffer from overdiagnosis, and many might be undergoing issues such as substance abuse (Morrison, 2014). Overall, borderline personality disorder generally manifests as swift, unpredictable mood swings, sometimes culminating in aggressive behavior.
A mental status exam is required to determine if the patient has BPD, during which a specialist will ask questions and note the behavior and appearance of the individual. Generally, such an exam will include assessments of clothing and general self-care to determine self-destructive disorders and lack of personal maintenance. Attention to eye contact and the specialist’s openness level is also relevant (Norris et al. 2016). BPD can, at times, be suppressed, so it is essential to look for signs of erratic behavior outside of the exam, including scars and lack of grooming. It is important to note that mental disorders are not exclusive, and the specialist should be aware that an individual may suffer from more than one condition. Furthermore, the specialist should reserve diagnosis until the end of the exam, as the manifestations of many disorders overlap, for example, BPD and manic depression.
Language is particularly important for determining if the patient suffers from a personality disorder. The rate of speech should be noted, as roughly one hundred words per minute is normal, meaning anyone speaking significantly slower may be suffering from a cognitive disorder (Norris et al. 2016). The tone, memory, and ability to recognize emotions in speech are all relevant to diagnosing BPD. Simple memory tests, such as asking the patient to say three words, then repeat them in five minutes, can be employed. The specialist can repeat questions with various tones of voice to see if the patient can differentiate emotions. A lack of such an ability is indicative of some degree of mental illness (Norris et al. 2016). Overall, since BPD is potentially overdiagnosed, it is important to consider alternatives and to reserve judgment until the end of the investigation.
The Clinical Model of Intervention
The literature suggests that one of the sufficient ways of treating a BPD is the implementation of dialectical behavior therapy (DBT). Dr. Marsha Linehan developed the form of treatment in the 1970s, making it a relatively novel approach (Krawitz & Jackson, 2008). DBT is a method that includes extensive work between a therapist and a patient, who engage in specific recognition and change-based tactics. Interestingly, DBT utilizes the dialectical method, which is defined by argument and contraposition, followed by their overall synthesis, similar to the means of dialectical philosophy. Dr. Linehan herself believed that although individuals were not initiators of their conditions, they are the only ones capable of solving the issues (Krawitz & Jackson, 2008). Thus, psychotherapy is developed to enhance a patient’s emotional management by understanding the catalysts of their behavior and revealing a set of valuable coping skills.
Dialectical behavior therapy has been studied by numerous medical experts to define its effectiveness and determine appropriate classifications. The latest study suggests three distinct subtypes of DBT, including Low Anxiety, Emotional/Disinhibited, and Inhibited (Sleuwaegen et al., 2018). The arrangement was found in the reactive and regulative nature of therapy. The Low Anxiety subtype is distinguished by low levels of Behavioural Inhibition and Activation Systems reactivity (BIS and BAS) (Sleuwaegen et al., 2018). On the other hand, the Emotional/Disinhibited subtype is characterized by high levels of BAS, medium BIS, and a lack of effortful restraint. Overall, individuals listed under this subtype are characterized by higher levels of dissociation than patients with the other two varieties of DBT. Whereas, Inhibited subtype presents low BAS levels, average effortful control, and high levels of BIS.
Notably, inpatient treatment exhibited an example of the successful performance of DBT, as it led to significant improvements. Particularly, the study claims that vital changes were detected in “non-suicidal injury ratings (NSSI), general clinical symptomatology, borderline-related symptoms, and dissociation after a 3-month DBT program in BPD samples” (Sleuwaegen et al., 2018, p. 322). Additionally, various trials employing DBT registered a significant decrease in non-suicidal self-injury (NSSI) occurrences and overdose attempts than a group following treatment-as-usual (TAU) (Fowler et al., 2018). While comparing the three principal subtypes, academics discovered that unlike the Emotional/Disinhibited and Inhibited subtypes, the Low Anxiety one did not provide major changes in clinical and borderline indications and dissociation (Sleuwaegen et al., 2018). On the other hand, studies did not determine significant coping progress variations between the subtypes. Additionally, individual results point out that some patients either did not experience substantial positive alterations in their diagnosis or ended up dropping out of the treatment. Distinctly, similar statistics of dropouts embody all three subtypes of DBT. Although the effects of the DBT treatments can be considered mixed, the majority of patients experienced positive results, which are worth noting.
Conclusion
Psychological therapy incorporates a broad area of studies, as it deals with a variety of mental health conditions. A borderline personality disorder is an illness distinguished by continuous development of inconsistent associations, incomplete understanding of oneself, and extreme emotional responses. Individuals suffering from the disease tend to engage in self-harming practices and regularly show other risky behavior patterns. The disorder can be treated using different clinical models of intervention, most notably dialectical behavior therapy. DBT is divided into three distinguished subtypes, with Low Anxiety being the least effective in reducing the symptomatology. Overall, DBT has proved to be efficient in numerous ways; however, it requires further examination to define its overall performance.
References
Davidson, K. M., Tyrer, P., Norrie, J., Palmer, S. J., & Tyrer, H. (2010). Cognitive therapy v. usual treatment for borderline personality disorder: Prospective 6-year follow-up.The British Journal of Psychiatry: The Journal of Mental Science, 197(6), 456–462. Web.
Fowler, J. C., Clapp, J. D., Madan, A., Allen, J. G., Frueh, B. C., Fonagy, P., & Oldham, J. M. (2018). A naturalistic longitudinal study of extended inpatient treatment for adults with borderline personality disorder: An examination of treatment response, remission, and deterioration.Journal of affective disorders, 235, 323–331. Web.
Krawitz, R., & Jackson, W. (2008). Borderline personality disorder (the facts) (1st ed.). OUP Oxford.
Morrison, J. R. (2014). DSM-5 made easy: The clinician’s guide to diagnosis. The Guilford Press.
Norris, D. R., Molly S. C., & Shipley, S. (2016). The mental status examination.American Family Physician, 94(8), 635-641. Web.
Sleuwaegen, E., Claes, L., Luyckx, K., Wilderjans, T., Berens, A., & Sabbe, B. (2018). Do treatment outcomes differ after 3 months DBT inpatient treatment based on borderline personality disorder subtypes?Personality and Mental Health, 12, 321– 333. Web.
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