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Borderline personality disorder is a cluster B (dramatic/erratic) personality disorder. It is characterized by impulsivity and instability in relationships and mood. People with borderline personality experience intense and erratic emotions, and they experience extreme mood swings. They have a tendency to think dichotomously; that is they see situations and people as either all good or all bad. They are prone to engage in self-damaging behavior, have extreme fears of abandonment and have a high risk of suicide.
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Borderline Personality Disorder in the Elderly
Borderline personality disorder typically develops in adolescence or early adulthood. In fact, it is rare for elderly people to meet the diagnostic criteria for borderline personality disorder, and most people who have suffered from borderline personality disorder no longer meet the diagnostic criteria at age 40.
However, some cases of borderline personality disorder do persist in to the late years of life. By this time the case is considered chronic, and therefore harder to treat for that reason. In addition, elderly patients present different treatment problems, such as age-related disorders that involve memory loss and confusion, and a tendency to reject psychotherapy based on the norms during their upbringing. Nevertheless, there are no differences between the types of therapy that are used to treat elderly patients and younger patients with borderline personality disorder. Borderline personality disorder is one of the most difficult of mental illnesses to treat. This is because their interpersonal problems are reflected on the therapist which makes it difficult to develop an effective therapeutic relationship.
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One treatment that has shown to be effective for borderline personality disorder is object-relations psychotherapy. This is a modified psychoanalytic treatment developed by Otto Kernberg. The ultimate goal of the therapy is to strengthen the weak ego of those with borderline personality disorder. Strengthening the ego is thought to reduce or eliminate splitting - the tendency for sufferers of borderline personality disorder to see things as all good or all bad. During therapy defensive behaviour is interpreted and suggestions are made for behaving more adaptively. Object-relations psychotherapy has been shown to relieve symptoms of borderline personality disorder, unlike classical psychoanalytic therapy.
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Dialectical Behaviour Therapy
Dialectical behaviour therapy, developed by Marsha Linehan, is another treatment option for borderline personality disorder and is considered the superior treatment available. Dialectical behaviour therapy combines the client-centered/person-centered components of acceptance and empathy with the cognitive behavioural components of problem-solving and social skills training.
The therapist fully accepts the client the way they are, and offers empathy towards them. This is an important strength of the treatment as it combats the interpersonal problems that patients reflect on the therapist. This allows the fostering of a healthy therapeutic relationship which has been found to be directly related to the outcome of any therapy. The therapist also adopts a firm problem-solving attitude towards the patient's dysfunctional behaviour and makes it clear their behaviour must change.
The cognitive behavioral aspect of the therapy is delivered in four stages. These stages serve to combat the problems that are present in all areas of the patient's life and equips them with strategies that will benefit them in the long term. The first stage addresses the dangerously impulsive behaviours of the patient with the goal of promoting greater control over these behaviours. The second stage focuses on learning to modulate and control extreme emotions. The third stage focuses on improving the patient's relationships and self-esteem. The fourth stage promotes the view that things are not all good or all bad and promotes the long term happiness of the patient.
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Kring, A.M., Davison, G.C., Neale, J.M. & Johnson, S.L. (2007) Abnormal Psychology. USA: John Wiley & Sons.
Livesley, W.J. (2001) Handbook of Personality Disorders: Theory, Research & Treatment. Guilford: Guilford Press.
How Borderline Personality Disorder in the Elderly is Treated
Cluster B personality disorders are notoriously difficult to treat. This series of articles explores some effective treatments for different cluster B personality disorders.