Monday, December 29, 2008

Borderline Personality Disorder;Patient and Family Problems

There are problems in recognising this disorder.The family undergoes severe stress and the patient suffers as she or he does not recieve treatment and help for quite sometime.As the incidence of personality disorders is very high,although not documented(there is no registry for psychiatric diseases and disorders) a major portion of our population remains untreated .The mortality rate must be high too. It is of utmost importance that this disorder is recognised earliest a nd the patient helped.A major group who may be targetted for awareness campaign must be teachers and school staff.The behaviour irregularity if earlier recognised and reported may help the patient as a life saver. Fellow students especially of higher grades may also be inducted in a sort of observer troops such as monitors.
There is agood literature available on web Md which immensly helps to understand this disorder.The following symptoms are apparent;
  • intense mood swings;these maybe so intense and sudden that the family cannot actually physically or emotionally take it.They may need psychiatric support themselves.
  • impulsive behaviours;these may land the patient,and others in severe trouble,accidents and missing persons.(the movie "Killer Movie" amply depicts this sort of behavioural problems.)
  • Problems with relationships;as most of the family and freinds are neither aware of the disorder and are not trained to handle the situations, often flare ups and reactionary behaviour may worsen both the patients symptoms and responses by the family and freinds.Such patients need immense understanding and support to make it through this long and often hopeless situation.
  • low self worth is one of the major hinderance in getting better.The attitude often of intolerance and judgemental of peers,older people and teachers may compound this problem.
  • Other disease such as depression,eating disorders,substance abuse may occur simultaneously and themselves compound the problem.

The symptoms start in early childhood and if recognised and treated may improve over a long period.Most patients with severe symptoms get better over time.

Symptom recognition by patients themselves may help;such as

  • Intense emotions and mood swings.
  • impulsive often disruptive behaviours.
  • temper tantrums.
  • Aggressive behaviour.
  • Feeling of emptiness inside.
  • hurting yourself such as cutting or burning.
  • suicidal attempts;this maybe confused as attention seeking behaviour and not bieng taken seriously by the family.
  • Low self worth;patient may enter illogical relationships and freindships where they maybe taken advantage of or even raped or sexually abused as with older persons.
  • a frantic fear of bieng left alone ,abandoned,this may put personin disadvantaged relationships again.
  • Feeling suspicious of others for no reason;this may include immediate family and kin;This is a tricky situation as if a child is in an abusive environment then his behaviour may appear mistrustful to either parent and he maybe suffering abuse also but not bieng able to report it.

The diagnosis of this disorder is only done by a trained and experienced physician as this maybe confused with anti social peersonality disorder,bipolar disorder.The cause of this disorder are not really known.Genetic or familial history plays a part.Often childhood trauma,abuse,parental seperation,neglect brings about the symptoms to the fore.Treatment is both by medicines and behavioral and analytical psychotherapy.This is very helpful though long and tedious journey but there is no other choice .Relapse and recurrence is a major feature and both support for the immediate caregiver and patient is essential.


NaVeed said...

well i also went through such thing during past few years but i didnt consult any doctor i was about to die it was very tough period of my life for me, for sometime i use to thought may be i m sinner and Allah is sad from me and i turn back to ALlah and since then things are good

dnt know what i have said it was just a comment that i felt to share :)

MEER said...

You know,many young people go through so many dificulties and face things all by themselves.It is the most fortunate that have support and understanding.God blesses all of us whether sinners or not.We should always help other people without thinking of reward in whatever way we can. Only in giving and helping others selflessly lies the greatness and satisfaction which God likes very much too.As I waited with a patient to show to a psychiatrist,Later a woman and a girl were waiting too.It was 1 o clock at night when we were finished and I as is my habit gave them ,lift in my car to drop till bus stop as they had to go to new karachi very far from where the hospital was.The older lady told me that the girl was treated so well as before she was totally "mad" and had to be brought by four people,now she waited peacefully for four hours for her turn.So effective is treatment and so important is support.this lady was her maternal aunt(khala) and a washer woman by profession.