The public’s interest in and understanding surrounding personality and relationships are increasing tremendously as the taboo surrounding mental illness is lifted and with each new revelation of how seriously it affects life and death.
The psychologization of media representations, celebrity behavior, representations of damaged superheroes and villains, and journalistic analysis is exponentially becoming more sophisticated.
Not So Sexy
Borderline personality disorder (BPD) frequently grabs the public’s attention, usually through romanticized portrayals of tormented heroes and anti-heroes battling demons in a starkly moral setting. Despite brief bursts of exhilaration and excitement, reality is less optimistic.
Chronic feelings of emptiness, emotional instability, agonizing fears of abandonment and rejection, identity disturbance with a shaky sense of self, difficulty with impulse control leading to reckless behavior, difficulty with anger management leading to aggression, persistently intense interpersonal relationships with dysfunctional “either/or” thinking (“splitting” and “projection”), suicidal and/or self-destructive thoughts and behaviors, and periods of depression are all characteristics of BPD.
1.4 percent of people have BPD, and over 9 percent of people suffer from personality disorders, according to the National Institute of Mental Health (NIMH). BPD is prevalent in mental healthcare settings, affecting 13% of outpatients, 24% of those who are hospitalised for psychiatric treatment, and over 30% of populations involved in forensic investigations.
Borderline personality disorder frequently co-occurs with depression, drug or alcohol abuse, a history of abuse or trauma, difficulties performing personal or work-related tasks, and other characteristics, increasing the likelihood of major health issues and other negative outcomes.
Treatment options include transcranial magnetic stimulation (TMS), ketamine, transcranial magnetic stimulation, dialectical behavior therapy (DBT), intensive therapy (e.g., in a structured treatment setting), treatment of co-occurring issues, and long-lasting behavioral change (e.g., changes in self-care approach and routines).
Beyond symptomatic relief, it is crucial for long-term wellbeing to comprehend the longer-term lifestyle-related aspects linked to performing better or worse after care.
How can we get a handle on these long-term risk and protective factors?
Grenyer et al. (2022) examined major daily elements linked with successful outcomes after tracking a group of BPD patients for a year following the completion of therapy. The results were published in their study in the journal Personality and Mental Health.
Learning From Patients
48 BPD patients who had received proper assessment, a brief intervention, and a referral for ongoing personality disorder treatment in an outpatient mental health environment were studied.
They were interviewed by a qualified research psychologist who was not involved in their past care one year after finishing the program. In addition to demographic information, participants also received ratings based on a number of metrics.
In addition to participating in semi-structured interviews to gauge their progress, participants were asked to indicate subjectively how much they believed their performance had improved.
Standard qualitative analysis was used to assess the themes from these interviews, allowing for both quantitative conclusions based on numerical ratings as well as the creation of recurrent, universal motifs from actual patient experiences.
Two Post-Treatment Paths for Borderline Personality Disorder
Overall, researchers found that two major categories performing well and functioning poorly best matched the function data. The demographics, baseline function, and social support of these two groups were comparable.
Participants in the group that was doing well reported better employment and occupational function as well as stronger social ties a year later. When they did work, they appeared to be more productive and lost fewer workdays. People in the group that were doing well reported higher clinical evaluations and subjective improvement in all areas.
People in the group who were not functioning well reported making little progress and had a bad opinion of it.
Distilling Personal Stories
Analysis of the semi-structured interviews revealed three overarching themes that distinguished the functioning well from the functioning poorly group:
Love of Self and Others. People who were in good health reported having closer, higher-quality connections that lasted through hardship. They claimed that having children was crucial to loving yourself and others. Taking care of others was a major incentive since it improved children’s wellbeing in this group and gave them meaning and purpose. They were more likely to rate themselves favorably.
People who performed poorly in relationships reported more relationship instability and loss. They said that their friends’ and families’ support had decreased. They also reported having more people in their lives who were struggling without mentioning the advantages of supportive interactions for boosting resilience, and less connections.
Making a Contribution Through Work and Study. The relevance of meaningful activities was mentioned by those in the functioning well group. Self-efficacy and self-esteem are improved by productivity and success. Participants underlined the significance of meaning in work, citing supporting underprivileged children as one important aspect.
While some members of the group that was not operating well said they were satisfied with their jobs, many said it was a struggle. Participants reported having trouble finishing school or keeping a career.
Others reported having trouble juggling their academic and professional responsibilities, which may indicate problems with time management or self-organization as well as the inherent effort needed.
Others claimed that social exclusion and avoidance made it difficult to feel good, such as when they skipped class because of depression or social anxiety, which affected their performance. Motivating oneself was frequently problematic.
Stability in Everyday Life. People in the functioning well group said that stress and unresolved trauma interrupted their daily lives less. Traumatic memories still surfaced, but they were less emotionally upsetting and simpler to accept. Stressors (such as managing money concerns) were viewed as challenges that could be overcome rather than as evidence that everything was wrong.
They tended to value and emphasize the good things in life, such as appreciating having their basic needs covered, working steadily, having family and friends, and enjoying being productive with an optimistic outlook on the future.
In contrast, those in the low functioning group viewed stressful events as crises, had trouble adapting (such as problem-solving, reappraisal), and a propensity to see the worst in everything (i.e., catastrophizing, all-or-nothing thinking, and over-generalization).
They found it more difficult to remain in the present and place stressors in a larger framework. They claimed to be having more trouble meeting necessities like housing and financial stability.
This study identifies several key elements that are pertinent to those who have BPD and has larger implications for what influences overall life happiness. There was no medium group in this study of an outpatient psychiatric population; instead, patients tended to be doing either quite well or quite poorly a year following therapy.
While co-morbid conditions like depression and complicated PTSD were not directly measured in this study or reported on, they undoubtedly have a significant impact in determining who performs better and who performs worse.
A focus on strengthening drivers of the three themes of love of self and others, making contributions through work and study, and stability in daily life would help identify who is at risk before discharge from treatment and develop an ongoing plan, likely converting some from poorly functioning to well functioning.
Long-term quality of life may also be improved by addressing personality traits that impair productivity and enjoyment, such as increased neurosis, decreased conscientiousness and agreeableness, and decreased openness.
Patients with co-occurring psychiatric or addiction issues, reduced resilience as shown by lower support, self-efficacy, and difficulty coping, fewer external resources, and unstable relationships would probably benefit from psycho education about when to seek help and intermittent check-ins, which would enable close monitoring and early intervention after discharge. It also implies that after being released from the primary program, extra treatment would have been beneficial.
On the basis of these discoveries, future research can improve the results. Individuals to aid in self-evaluation and assist them change for the better in order to improve their health and well-being can use this information.