Individuals with Borderline Personality Disorder are afflicted with a continual state of emotional conflict and chaos, often swinging from one extreme of emotion to another. Patients with BPD are traditionally known to exhibit symptoms of depression, anger and anxiety at varying times, and traditionally demonstrate self-injurious behavior. The road to treatment and recovery is often a different one, as traditional psychotherapeutic approaches often fail treating patients with DSM-IV. There is recent evidence that suggests that an integrative approach for treating BPD is best. This type of approach would combine cognitive behavioral therapy, pharmacological intervention and traditional psychotherapy techniques to find the best possible outcome for BPD patients.
DSM-IV for Borderline Personality Disorder
The DSM-IV identifies symptom and behavior-based criteria for diagnosing this disorder. The diagnostic criteria for identifying borderline personality disorder according to the DSM-IV include: "a pervasive pattern of instability of interpersonal relationships, self-image and affects marked by impulsivity beginning by early adulthood" (APA, 1994). The DSM-IV further suggests that a traditional psychotherapeutic approach be utilized when treating BPD.
This emotional instability present in borderline personality patients may be present in many different forms and contexts, and generally is indicated via the following criteria: (1) "frantic efforts to avoid real or imagined abandonment," (2) pattern of unstable interpersonal relationships that generally "alternate between extremes of idealization and devaluation," (3) "identity disturbance that includes a marked unstable self-image and sense of self," (4) impulsivity that can be self damaging and may including excessive spending, sex or binge eating (5) instability associated with a "marked reactivity or mood" (6) irritability and anxiety that occurs as episodic, (7) frequent anger or tantrums, (8) inappropriate displays of anger and (9) transient or stress related "paranoid ideation" (APA, 1994:654). A person with BPD will exhibit several of the criteria mentioned above. Characteristically a patient with BPD is recognized as having extreme mood swings and a poor sense of self-image that may lead to suicidal tendencies.
Because borderline personality disorder is complex in nature and difficult to label, differential diagnostic criteria and theoretical orientations have been established for assessing the disorder (Cottrell & Jones, 2000). Thus a therapist might encounter differing behavioral, symptomatic and psychodynamic formulations and findings that form the basis of diagnostic categorization of BPD (Cottrell & Jones, 2000). Differential diagnostic criteria may include: identity diffusion, contradictory aspects of self and others, splitting defenses, projective identification, idealization and omnipotence as well as denial and de-valuation of the self (Cottrell & Jones, 2000). The specificity of borderline personality disorder remains in question however because patients vary in symptomology and personality despite fitting into diagnostic criteria (Cottrell & Jones, 2000).
Some researchers have in fact suggested that dimensional rather than diagnostic measures of behavior might be more appropriate for BPD patients, including analysis of differential characteristics and dimensions such as cognition, impulsivity, emotional liability and anxiety (Silk, 2002). Patients with BPD might also meet differential criteria for disorders including anti-social and shizotypal personality disorders (Cottrell & Jones, 2000; Silk, 2002). In fact as many as half of BPD patients exhibit the criteria for these other disorders (Silk, 2002). What differentiates BPD patients include the impulsive feelings, self-deprecating behaviors and suicide attempts common in BPD patients (Cottrell & Jones, 2000). Scales useful for determining the patient include the Gunderson Diagnostic Interview and Perry Borderline Personality Scale (Cottrell & Jones, 2000).
Traditional therapy has focused on pharmacological