Borderline Personality Disorder
Borderline personality disorder is often misdiagnosed clinically as affective disorder, schizophrenia, neurosis, etc. In is considered to be a generalized pattern of interpersonal, self-awareness, and emotional instability with marked impulsivity, which may include self-injurious behavior and transient psychotic symptoms that should have begun in childhood or adolescence, not in adulthood.
Clinical manifestations
Uncontrollable emotions
An unstable and rapidly changing state of mind is a distinctive feature of borderline personality disorder. Emotional instability is manifested by the experience of a sense of emptiness and insecurity and lack of self-esteem on the one hand, and a sense of euphoria and omnipotence in opposition to the above on the other. In the event of a stressful event or under intense emotional stress, patients are prone to emotional instability, irritability, nervousness, anxiety, panic, despair, and anger. Patients with borderline personality disorder are often in a chronic and persistent sense of emptiness and boredom, feeling worried, pessimistic and anxious, feeling that life is meaningless, often generating a sense of helplessness, hopelessness and worthlessness, and a lack of realistic goals in life. In order to relieve the inner emptiness, the patient is constantly looking for things to do, doing things with no end in sight and accomplishing nothing. The outward perverse activity precisely reflects the deep inner loneliness, and this manifestation is often misdiagnosed as depression in clinical work.
Intense and highly unstable interpersonal patterns
People with BPD are both dependent on and hostile to others, relying heavily on those around them. or sarcasm. This makes it difficult to maintain a deep and intimate relationship, often changing rapidly between extreme closeness and extreme antagonism. The person is either extremely good or extremely bad with others, and has few lasting friends.
Impaired identification of self-identity
Patients with borderline personality disorder have a delayed sense of self identity and remain in a confused stage for a long time, with discontinuous and contradictory self-images.
Impulsivity and self-destructive and suicidal behaviors
Patients with borderline personality disorder have poor ability to control emotions and tolerate frustration, and often exhibit reckless and impulsive behavior. It is difficult to stick to things that take a long time to complete, and they often do not anticipate what might happen. Most patients often regret their actions afterwards.
Fear of abandonment and fear of being alone
When faced with separation, rejection, or imminent loss of external support, strong stress reactions can occur including changes in self-image, emotions, cognition, and behavior, and extreme behaviors such as suicide and self-injury may be used to prevent abandonment. Such patients fear abandonment, are afraid of being alone, and lack the ability to comfort themselves. They often need various stimulating behaviors and substance abuse to relieve their feelings of emptiness and loneliness, and need to be accompanied by someone at all times to obtain emotional comfort.
Stressful psychotic symptoms
They are usually mild and brief, occurring mostly in stressful situations, and can be recovered within minutes to hours. Speech is disorganized, movements are disorganized and purposeless, perception of the surroundings is not real, and depersonalization and a sense of unreality occur, but the ability to test reality is relatively intact. Some patients also present with symptoms such as implicated tube you and dissociative symptoms, or transient or situational, illusions or hallucinations that seem to have a basis in reality, etc. Generally these symptoms resolve quickly after stressful exposure and antipsychotic medication is effective.
Medication
①Lithium: Emotional instability is an important manifestation of borderline personality disorder, so it is appropriate to give the emotion stabilizer lithium.
②Anticonvulsants: Carbamazepine is effective for emotional instability and poor impulse control. If borderline patients have co-morbid depression, carbamazepine should not be applied.
③Naltrexone: There are reports in the literature that the opioid antagonist naltrexone is effective in some patients with borderline personality disorder, especially in reducing self-harm behaviors using.
(iv) Antipsychotics: The mechanism by which traditional antipsychotics are used in borderline personality disorder is their anti-impulsive-aggressive and antipsychotic effects. Atypical antipsychotics, such as olanzapine, clozapine, and risperidone, antagonize both dopamine D2 and 5-TH2 receptors. 5-TH2 receptor abnormalities are associated with anxiety, depression, psychosis, and suicide; therefore, atypical antipsychotics can control the above symptoms seen in patients with borderline personality disorder.
⑤ Antidepressants: nefazodone, tricyclic antidepressants, SSRIs, and SNRIs are effective in borderline personality disorder. The use of monoamine oxidase inhibitors (MAOIs) for borderline personality disorder is limited by their low efficacy and high adverse effects.