Borderline Personality Disorder (BPD) is a mental ailment typified by a series of varying behavior, emotions, and sense of self-image resulting in spontaneous actions and relationship problems (Choudry, 2017). From a medical viewpoint, BPD has an intricate underlying neurophysiology with genetic vulnerability being a key aspect that changes the neurophysiology of people suffering from this illness. According to Choudry (2017), low cerebral serotonin conditions due to dysfunctional serotonin genes, abnormal frontolimbic neuronal information processing, cortical inhibition deficiency, and autonomic dysregulation which all contribute to the behavioral and symptomology patterns exhibited by BPD patients.
There are various theories that have been spurred by the increased knowledge and research in the disorders mechanisms of emotional dysfunction but the most insightful ones are centred on brain dysfunction, which is connected to dual frontolimbic pathology with special attention given to changes in parts such as prefrontal cortex, insula and amygdala that are attributed to emotional processing. (Choudry, 2017) argues that BDP patients show a fundamental reduction in the volumes of frontal lobe and amygdala, and hyperactivity in anterior cingulated cortex region while the prefrontal lobe regions are responsible for morbid behaviors and impulsivity.
Additionally, an increase in cortical excitation marked by a slight intra-cortical inhibition is common among BPD victims who are also suffering from Attention Deficit Hyperactivity Disorder. Self-destructive contemplations, affective variability and aggressive behavior are instigated by a dysfunctional serotonin system in the frontal cingulated cortex and prefrontal cortex. (Choudry, 2017) further stipulates that dysfunction in serotonin system underpins the connection between cortical inhibition deficiency and BPD, which is caused by the inability of the corticostriatal pathway to produce serotonin. This also sheds light on the role of serotonin genes which prompt impulsivity since low CSF 5-HIAA levels have been found in BPD victims who have earlier shown suicidal behaviors (Choudry, 2017).
Emotional instability in BPD patients results in a dysfunctional endogenous opioid system due to drug abuse, anorexia, unsafe sexual experiences, fear of rejection, and severe stress. Likewise, genetic disposition is also evident in BPD victims whereby some DNA segments are physiologically associated with anxiety in the hypothalamic-adrenal axis (Choudry, 2017). The above knowledge in neurophysiological and genetic components of BDP then forms the basis for patient management and treatment programs as described below.
Once the physician has established the symptoms of BPD mentioned earlier in a patient, can prescribe psychiatric medications, initiate partial hospitalization or implement therapeutic protocols to treat the disorder (Roxanne Dryden-Edwards, 2017). Some of the medications include mood stabilizers such as lamotrigine, carbamazepine, and divalproex; antidepressants such as duloxetine, citalopram, venlafaxine, and sertraline; and antipsychotics such as iloperidone, risperidone, lurasidone, and aripiprazole (Roxanne Dryden-Edwards, 2017). However, these medications may not effectively manage the disorder and thus great care should be observed to shun medications that can be detrimental if overdosed. Conversely, partial hospitalization can also be implemented, whereby the patient is taken through hospital-like treatment in the course of the day but is discharged in the evening (Roxanne Dryden-Edwards, 2017). This allows more medication treatment, psychotherapy and professional assessments to be conducted while also developing a treatment plan after the patient is released from the healthcare facility.
Various psychotherapy procedures can also be implemented to manage and treat the disorder. The physician can adopt a Dialectical Behavior Therapeutic procedure that specially addresses relationship problems, emotional instability and self-image. This treatment protocol attempts to improve the patients interpersonal skills, moods regulation, distress tolerance and mindfulness (Roxanne Dryden-Edwards, 2017). Similarly, Cognitive Behavioral Therapy can also be implemented in helping the BPD patient comprehend how their actions and contemplations affect one another (Roxanne Dryden-Edwards, 2017).
Choudry, U. K. (2017). Neurophysiological Perspectives of Borderline Personality Disorders. Acta Psychopathologica, 3(3).
Roxanne Dryden-Edwards, M. (2017). Borderline Personality Disorder Symptoms, Treatment & Causes. MedicineNet. Retrieved 27 January 2018, from https://www.medicinenet.com/borderline_personality_disorder/article.htm#borderline_personality_disorder_fa
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