1. Borderline personality disorder and personal distress Shalini Choudhary & Komilla Thapa University of Allahabad, Allahabad, India
Borderline Personality Disorder (BPD) is a serious personality disorder.
Individuals with BPD show a pattern of behavior characteristics marked by impulsivity and instability in interpersonal relationships, self-image, and moods.
These problematic features of the disorder interact and reinforce each other leading to a ‘‘stable instability’’.
To attempt to arrive at a composite, systematic, comprehensive and detailed analysis of BPD patients.
To examine the cases of Borderline Personality Disorder patients and to identify the factors that intensify personal distress in BPD Patients.
Participants:
Potential patient participants were considered for entry into the study if they were diagnosed or were suspected to have borderline personality disorder by the psychiatrists and clinical psychologists.
All eligible patients provided written informed consent as approved by the Institutional Ethics Committee of University of Allahabad, Allahabad.
Six sample cases of BPD were taken from the Nur Manzil Psychiatric Centre, Lucknow. Their ages ranged from 17 to 21 years old, only 1 was 35 years old. 5 male patients and 1 female patient reported for psychiatric aid. 3 were inpatients and 3 were accessed in the outpatient department.
Clinical Techniques:
Case History Method: In-depth clinical interviews were conducted
Mental Status Examination (MSE):
The clinical methods for assessing BPD used semi-structured interview schedule including DSM-IV-TR criteria, four broader BPD features that encompass these criteria and DIB-R (Diagnostic Interview For Borderlines-Revised by Gunderson) symptoms.
Procedure:
Patients, accessed from the psychiatric centre, were interviewed using a semi structured interview schedule.
Information pertaining to general medical condition (Axis III, DSM-IV-TR) and psychosocial and environmental problems (Axis IV, DSM-IV-TR) was done.
Informants’, doctor’s and nurses’ reports about those patients were obtained. Hospital records of the inpatients and prescription files of the outpatients were also accessed.
Evaluation of the patient included a detailed psychiatric and social history, demographic variables and clinical features.
Causes of Personal Distress were identified in the case history reports.
Themes were also analysed using, DSM-IV-TR Criteria and DIB-R symptoms. Specific features and commonly found defining characteristics of BPD were identified from the detailed case history.
This study attempted to delineate borderline personality disorder in Indian cultural context. It was explored that how an individual’s sense of what is real is shaped and structured.
The case histories of patients were examined by identifying themes and categories. The comprehensive analysis of BPD patients lead to the emergence of the following defining features of BPD.
Substance related problems
Academic failure
Affect disturbance and Signs of depression
Suicidal threats
Social dysfunction and dependency on others
Feelings of loneliness, guilt and boredom.
Denial of the problem by the family (Ignorance, negligence & unwillingness to seek psychiatric care.
Analysis of Interviews revealed causes or factors that intensified Personal Distress in BPD Patients.
All six cases belonged to a low economic status background and five of them (one who was a housewife excluded) were unemployed hence susceptible to poverty.
Financial and economic condition plays an important role in constructing misery and distress. Experience of poverty aggravates personal distress and social misery.
BPD features can be drawn from the social foundations of personal experience as the reality of personal distress is socially constructed and shaped.
A major problem encountered in Indian clinical population was the family attitude. Family of the BPD patients formed a social reality for these patients providing them an invalidating environment and intensify the experience of distress because of ignorance, negligence and reluctance to seek therapy because of stigma of ‘being mentally sick’.
Social, Occupational, Familial and Personal dysfunction, adjustment and Affect related problems are the major areas where BPD patient suffer a lot of difficulties.
Family attitude or ignorance about the disorder interfered diagnosis and thus treatment.
Low economic status, unemployment, financial problems and poverty proneness aggravates the feeling off distress in BPD individuals. Family of BPD patients create personal distress which is socially constructed and shaped.
ANALYSIS
INTRODUCTION
OBJECTIVES
DEFINING BPD FEATURES
METHOD
PERSONAL DISTRESS
CONCLUSION