Explain why you suggest this alternative and support your suggestion
Respond to at least two of your colleagues by providing one alternative therapeutic approach. Explain why you suggest this alternative and support your suggestion with evidence-based literature and/or your own experiences with clients.1:
Borderline personality disorder or BPD is symbolized by inability to maintain stable relationships, illogical worry of being abandoned, struggling with regulating emotions, feeling lonely and depressed, and impulsivity. Specific symptoms of borderline personality include self-injurious behavior such as cutting. Trauma can be the cause of BPD (Brine, 2016). Finding the appropriate treatment for BPD can be difficult. As with most mental illness, one treatment option solely may not be enough to properly treat the patient. For example, medication without therapy or vice versa. However, it has been said that psychotherapy is the most influential portion of treatment (Biskin, 2012).
For the therapists to make any progress, it is very important to achieve a therapeutic alliance with the client to avoid the pessimism and hopelessness associated with the ability to treat these mental health clients.( Dixon-Gordon, Turner & Chapman, 2011) I will be honest with my patient as I explain to her the diagnoses and how a full assessment led to her diagnoses. Dialectical behavioral therapy and mentalization-based treatment or MBT can be appropriate treatment of BPD. The focus of DBT is based on the core belief that BPD occurs in individuals who are especially sensitive and who have trouble managing their emotions which comes from growing up in an environment where they were not validated appropriately based on their vulnerabilities. The goal of DBT is to help those individuals better manage their emotions allowing them to respond more appropriately during stressful times and have better relationships. MBT has a goal to help patients strengthen their mentality by remaining more grounded and caring during times of distress when they are in a high-strung, emotional state (Choi-Kai, 2017).
Borderline Personality disorder is complex and the most stigmatized condition in Mental health, Using the DSM-5, there must be five out of nine criteria of self-harming behaviors to diagnose BPD. (Sulzer, Muenchow, Potvin, Harris & Gigot, 2016) Pharmacological treatment for BPD centers on treating the symptoms that the patient is portraying whether it be aggression, impulsivity, psychosis, of struggles with interpersonal relationships. Anticonvulsants such as Lamotrigine, Topiramate, or Valproate, and ayptical antipsychotics such as Abilify and Olanzapine have been proven to be the most updated and effective medication treatment options. Some antidepressants have been proven to be slightly effective in some cases, however, they are mostly effective when the patient has other conditions including anxiety or aggression (Ripoll, 2013).
Diagnosing BPD can be difficult and must have a careful approach in order to avoid damaging therapeutic relationships. The borderline patient could take offense to the diagnosis if it is not presented properly, and they may display attention seeking behavior such as threatening self-harm or suicide. The diagnosis could be presented to the patient in a way that supports the reason that they have it such as not being validated as a child, however, the patient still must be aware of how their actions affect other people.
References
Biskin, R. S., & Paris, J. (2012). Management of borderline personality disorder. CMAJ:
Canadian Medical Association journal = journal de l’Association medicale canadienne, 184(17), 1897–1902. doi:10.1503/cmaj.112055
Brüne M. (2016). Borderline Personality Disorder: Why ‘fast and furious’? Evolution, medicine,
and public health, 2016(1), 52–66. doi:10.1093/emph/eow002
Dixon-Gordon, K. L., Turner, B. J., & Chapman, A. L. (2011). Psychotherapy for personality
disorders. International Review of Psychiatry (Abingdon, England), 23(3), 282–302. https://doi-org.ezp.waldenulibrary.org/10.3109/09540261.2011.586992
Choi-Kain, L. W., Finch, E. F., Masland, S. R., Jenkins, J. A., & Unruh, B. T. (2017). What
Works in the Treatment of Borderline Personality Disorder. Current behavioral neuroscience reports, 4(1), 21–30. doi:10.1007/s40473-017-0103-z
Ripoll L. H. (2013). Psychopharmacologic treatment of borderline personality
disorder. Dialogues in clinical neuroscience, 15(2), 213–224.
Sulzer, S. H., Muenchow, E., Potvin, A., Harris, J., & Gigot, G. (2016). Improving patient-centered
communication of the borderline personality disorder diagnosis. Journal of Mental Health, 25(1), 5–9. https://doi-org.ezp.waldenulibrary.org/10.3109/09638237.2015.1022253
2:Dependent Personality Disorder (DPD)
Psychology Today (2020) defined Dependent Personality Disorder (DPD) as a pervasive and disproportionate need to be cared for, leading to a submissive and clinging behavior, and a fear of being of separation. Psychology Today (2020), explained further that this behavior often begins in the early stages of adulthood with the behavior of dependence occurring, with the notion of being incapable of functioning or completing tasks without being helped. The DSM-5 Dependent Personality Disorder (DPD) according to Skodol, is distinguished by prominent over reliance on others regarding one’s emotions and physical needs, with less than 1% of the population diagnosed with the disorder. This is often due to combination of biological and developmental aspects prevalent in persons brought up by authoritarian and overprotective parents, childhood chronic conditions, and in children that suffer from separation anxiety (Cleveland Clinic, 2020).
Diagnosis and Sharing with Patient
In order to be diagnosed with DPD, An individual must show 5 of 8 diagnostic criteria, plus exhibit severe fear and reliance on others to make decisions for them and regarding their care. The diagnostic criteria includes difficulty with making decisions on their own, relying on someone to control their lives, unable to disagree with others, terrified of not being accepted or supported, unable to live alone, lacks confidence, will do anything to please others, searches for relationship when one ends, and has an unrealistic fear of being left alone to care for self (Bennet, 2017). A humanistic approach will be used in sharing diagnosis with the patient, as this theory deals with individual-centered care. According to Pehlivan and Gunner (2016), the approach of this theory is therapeutic with emphasis on empathy, encouraging clinicians
to view the patient as a whole person and not just the problem and to avoid being judgmental. This approach also creates an environment of trust allowing the patient to share relevant information as well as show willingness to adhere to treatment. After assessing patient’s physical and mental ability to manage self and make rational decisions, patient will be made aware that their behavior is just their perception, and that can be changed through recommended therapy.
Recommended Treatment
Psychodynamic Psychotherapy and Cognitive Behavioral Therapy (CBT) will be the recommended treatment for this patient with PDP. Psychodynamic Therapy will help in identifying the root cause of the behavior. CBT on the other hand according to Wheeler (2014), will provide the patient with a better understanding of distorted thoughts and help the patient change their perception, and teach strategies on how manage condition with an outcome of better quality of life. Anxiety and depression are often associated with individual’s diagnosed with PDP when they feel they’ve been abandoned. This can be managed with therapy, and with antianxiety antidepressants medications in severe instances.
References
Bennet, T. (2017). Dependent Personality Disorder: Causes, symptoms, treatment DSM-5 301.
6(F60.7). Retrieved from: https://thriveworks.com/blog/dependent-personality-disorder/
Cleveland Clinic. (2020). Dependent Personality Disorder. Retrieved from:
https://www.clevelandclinic.org/health/diseases/9783-dependent-personaly-disorder
Pehlivan, T., & Gunner, P. (2016). The use of Theories in Psychiatric Nursing II. 19400
Retrieved from: https://www.journalagent.com/phd/pdfs/PHD-7-2-10010%5BA%
5D.pd
Psychology Today. (2020). Dependent Personality Disorder. Retrieved from:
https://www.psychologytoda.com/us/conditions/dependent-personality-disorder?amp
Skodol, A. (2018). Dependent Personality Disorder (DPD). Retrieved from:
https://www.merckmanuals.com/professional/psychiatric-disorders/personality-disorders/
dependent-personality-disorder-dpd.
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