Introduction
The two articles under review grapple with different
aspects of borderline personality disorder with one concentrating on
psychosocial functioning of patients while the other extends to assess time for
remission and recovery. Bothe papers paint a grim picture of BPD relative to
other disorders. A Dynamic Deconstructive Psychotherapy (DDP) hinged on the
fact borderline patients suffer from certain neurocognitive deficits can be an
appropriate treatment.
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Summary of articles
The first article sets out to assess how people with
borderline personality disorder (BPD) attain and maintain psychosocial functioning
(2010, p.104). Those with at least an emotionally fulfilling relationship and a
successful work/school record were taken to be having a good psychosocial
functioning. The study was carried out over a period of 10 years to allow for
follow-ups at intervals of two years. It came out from the study that BPD
patients differ in their ability to attain and retain psychosocial functioning.
Patients lacking this ability at the beginning of the study found it difficult
to attain during the course of the study. Similarly, there was a difficulty in
regaining it once lost. Also interesting is the fact that most borderline
patients tend to lack only in the vocational aspect of psychosocial
functioning.
Using the same set of data and a methology, albeit with a
few modifications, the second article sought to determine the relative length
of time to attain symptom remission and recovery among BPD patients and those
with other disorders(2012,476).The course of this study extended for six more
years over the 10 year period used in the first article. The second study was also different from the
first in that psychosocial functioning of BPD patients was not its major
subject. As compared to comparison
disorder patients, the study found that remission and recovery in BPD patients
is slower. Remission rates were higher in both BPD and comparison patients over
the course of the study.
Methods
Both studies relied on a sample of 362 former inpatients
at McLean hospital in Belmont of which 290 and 72 patients had BPD and other
Axis II disorders respectively. Interviewing was the major method of collecting
data. Great care was taken to ensure that only patients who met the two
criteria for BPD and Axis II disorders participated. There was an initial
assessment of psychosocial and treatment history of the patients. This initial
assessment also touched on diagnostic aspects. Follow-up assessments were done
at intervals of two years for the next 10 years in the case of the first study
with a further six years in the second. Psychosocial
functioning as used in both studies was defined as the position of at least
being able to have an emotionally fulfilling relationship and a successful
work/school record. On its part, the second study defined remission as a
situation where a patient no longer met the study criteria while recovery was
defined by using Global Assessment Functioning Score of 61.
Results
At index admission, which was two years prior to the
admission of the study, 215 BPD and 30 axis II comparison patients had no
lacked psychological functioning. Both groups attained this function over time
with axis II patients doing so at a higher rate than their borderline
counterparts (2010, p.106). 82 BPD patients were unable to achieve good
psychosocial functioning over time. A majority of those failing to achieve good
psychosocial functioning were doing so due to their lack of vocational record. A
majority of those who had good functioning at baseline lost that ability over
the course of the 10 years with a half losing it within the first two years.
The loss of functioning was mostly pronounced on the vocational side. A trend could be seen indicating borderline
patients who lost their functioning regaining it across the study period.
In respect of the second study, borderline patients were
able to achieve remission over the 16 year course. Relative to that of other
disorders, borderline patients achieve remission at a slower pace. In addition,
borderline patients who achieve remission are more likely to experience
recurrence than other patients. Recurrence is, however, slow in cases where
remission has lasted for a sustained period of time. This trend is also evident
in the time to recovery where borderline patients recover at a relatively
slower rate.
Interventions
Overall therapy Plan
I will be using a therapy approach called Dynamic Deconstructive Psychotherapy (DDP)
in treating the borderline patients mentioned in the articles. This treatment
plan deals with both the psychosocial and vocational aspects exhibited by the
patients. It will take for a predetermined period of one year. The plan
presupposes that borderline patients suffer from certain neurocognitive
deficits as well as an embedded sense of badness. As such, the treatment will
seek to remedy these neurocognitive deficits in the hope that doing so will
help patients relinquish their embedded sense of badness. The fact that some of
the patients were also obese may justify the existence of an embedded sense of
badness in them. Some may feel unworthy, ugly and many other negative things.
Weekly sessions will be scheduled for the first year, reducing it to biweekly
in the second and monthly sessions in the final year. Each season will lastly
at least two hours with time per session increasing as frequency of decreases.
Session One
The tasks in this session may extend well into the other
sessions given that sessions can lastly on too long for them to be meaningful.
The main goal of the session to establishing a frame for the entire treatment
plan. The entire treatment may succeed or fail merely because this treatment
failed. The first task at the session would be to gather the history of the
patient even as the therapist performs a mental evaluation. It would be
important at this stage to ask the patient to state their major complaint. Most
patients would not do this explicitly.
Upon the evaluation of the history of the patient, the
therapist will also manage to determine whether that history suggests that
there is BPD. It would not be appropriate to continue treating the patient when
his/her history does not indicate BPD. Lastly, the therapist will have to ask
the patient whether treatment should commence.
Conclusion
The severity of BPD is evident from the foregoing
paragraphs. For instance, remission and recovery tends to take much longer to
attain relative to other disorders. Even when they are finally attained,
sustaining them becomes difficult. Only a well thought out treatment plan such
as DPP may help achieve sustainable results.
References
Zanarini,M.C., Frakenburg, F.R., Reich,D.B.,&
Fitzmaurice.(2010). The 10-year course of psychosocial
functioning among patients with borderline personality disorder and axis II comparison subjects.Acta Psychiatrica Scandinavic,
122,123-109.
Zanarini,M.C., Frakenburg, F.R., Reich,D.B.,&
Fitzmaurice.(2012).Attainment and Stability of Sustained
Symptomatic Remission and Recovery Among
Patients With Borderline Personality
Disorder and Axis II Comparison Subjects:
A 16-Year Prospective Follow- Up
Study.American Journal of Psychiatry,169,476-483.
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