Article Abstract:
Borderline personality disorder is marked by instability in mood, self-image and interpersonal behavior. Borderlines tend to either be impulsive and addictive or exhibit other potentially self-damaging behavior. They often have identity and gender disturbances, find it difficult to achieve long-term goals, and tend toward polarized (i.e., all good or all bad) feelings about themselves and others. Twenty-eight psychiatrists and 11 psychologists were interviewed so that their impressions of working psychotherapeutically with borderlines could be assessed. The therapists had an average of 14.2 years of psychotherapeutic work experience and reported an average of 7.9 percent of borderline patients in their current caseloads. Most (76 percent) indicated that they did not expect these patients to become normal, but did expect them to achieve some character change. Thirteen percent stated that their main objective was to stabilize borderline self-destructive behavior. The most common explanations for terminating therapy were that patients either could not see the purpose of treatment, or forced closure through 'acting out behaviors' (e.g., displacing anger in the treatment setting, self-destructive behavior, missing sessions, etc.). A large majority of the therapists (82 percent) described their concept of successful treatment with borderlines as being a psychological movement towards a higher organizational level. Using this criterion, during the entirety of their professional years, they reported an average of improvement in only 8.1 borderline patients after an average treatment duration of 3.4 years. An unexplained finding was that 83 percent of the female therapists versus 48 percent of the male therapists reported 'successful' treatments. The perceptions of psychiatrists and psychologists were very similar, despite the fact that the psychiatrists tended to be more psychoanalytically oriented than the psychologists, who leaned toward a more eclectic orientation. (Consumer Summary produced by Reliance Medical Information, Inc.)
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Article Abstract:
Many patients with borderline personality disorders also are involved in substance abuse. These two situations are frequently regarded as being independent of each other and are treated separately. Others believe that the patient's personality disorder causes the substance abuse behavior and represents an attempt by the patient at self-medication. This self-medication hypothesis is examined with a review of three cases. Evaluations were made of three borderline patients who used substances such as drugs or alcohol to manage their symptoms. It is recommended that, in treating these types of patients, the underlying psychopathology be focused on, with an emphasis on understanding the personality structure of these individuals. This approach will provide some clinical advantages. If these patients are viewed primarily as borderline personalities, clinicians may be more interested in them. Less emphasis will be directed to the substance abuse of the patient and psychologically relevant topics will receive more time; this will also interest the therapist more. Also, if psychological reasons for substance abuse are stressed, the patients will be more inclined to talk; patients are often less reluctant to discuss their feelings than their substance use. An awareness of his internal state will help the patient to develop an understanding of why he has turned to substance abuse. It is recommended that patients be detoxified prior to treatment. In conclusion, the authors feel that substance abuse should be considered a symptom of an underlying disorder, such as borderline personality, and clinical evaluation should be approached in this way. Treatment strategies and the effectiveness of this approach are not discussed. (Consumer Summary produced by Reliance Medical Information, Inc.)
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Article Abstract:
Stress is a major precipitating factor in post-traumatic stress disorder (PTSD), a condition in which a set of physiologic responses and conscious and unconscious emotions and behavior are associated with dealing with the memories of a catastrophe or severe trauma. The hypothalamic-pituitary-adrenal (HPA) axis is a complicated network which works to release hormones that cause the adrenal gland to secrete cortisol. Cortisol is a hormone which is involved in the control of stress and anxiety. To investigate the possibility that there may be an abnormal number of glucocorticoid receptors (cellular binding sites for a steroid hormone produced by the adrenal cortex which has a major effect on cortisol metabolism) in lymphocytes (white blood cells) and a related dysfunction of the HPA axis in PTSD, 15 Vietnam veterans diagnosed with PTSD and 11 healthy volunteers were studied. Blood samples from all subjects were taken in the early morning and late afternoon, and put through a series of laboratory tests and sophisticated measurements and assays. The 15 PTSD patients had a significantly higher number of glucocorticoid receptors than the volunteers, and these differences were significantly greater in the morning than in the afternoon. Cortisol plasma concentrations did not differ between veterans and volunteers. Previous investigations have shown that high levels of glucocorticoid receptors are related to anxiety symptoms consistent with PTSD, while low levels have been found in patients with major depression. Results seem to provide evidence consistent with the theory of a dysfunction of the HPA axis in PTSD, although the exact mechanisms involved are not yet understood. (Consumer Summary produced by Reliance Medical Information, Inc.)
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