The condition is borderline. Borderline Clinic

Borderline personality disorder (according to ICD-10, a subtype of emotionally unstable disorder) is a mental illness that is difficult to diagnose; it can often be confused with neurosis or psychosis, since the initial symptoms are very similar, treatment is difficult and lengthy.

The patient is suicidal. Therefore, it is very important to show maximum patience and attention to such people.

Borderline personality disorder is a mental illness. It is accompanied by impulsiveness, emotional instability, lack or rather low level of self-control, difficulties in relationships, increased anxiety and mistrust.

The disease almost always occurs at an early age, adolescence or young adulthood. Has a stable character. It manifests itself throughout the patient’s life.

This mental disorder occurs in 3% of the population, and 75% of them are women. The first symptoms are not pronounced and therefore subtle.

What Causes Borderline Personality?

Out of every 100 people, two have a borderline condition. But researchers are still finding it difficult to say what exactly is its immediate cause. It can be attributed to both an imbalance of neurotransmitters that help regulate our mood and a hereditary predisposition to mental illness.

People who find themselves in this condition, according to researchers, often belong to the group of those who have experienced physical or emotional abuse, early loss of parents or separation from them in childhood. When these traumas are combined with personality traits that include severe stress reactions or high anxiety, the risk of developing borderline disorder is greatly increased.

Borderline mental states often develop against the background of depressive disorders, as well as alcohol and drug abuse.

By the way, the well-known fact that this disease is often accompanied by disruption of the functioning of certain parts of the brain has not yet shed light on whether this problem is the cause of the borderline state or its consequence.

Literature

• Kernberg, Otto.
  Severe personality disorders = Severe personality disorders. - M.: Class, 2000. - 464 p. — (Library of psychology and psychotherapy). — 2000 copies. — ISBN 5-86375-024-3, ISBN 0-300-05349-5.
• McWilliams, Nancy.
  Levels of development of personality organization //
  Psychoanalytic diagnosis: Understanding personality structure in the clinical process
  = Psychoanalytic diagnosis: Understanding personality structure in the clinical process. - Moscow: Class, 1998. - 480 p. — ISBN 5-86375-098-7.

• Reuben Fine, Herbert S. Strean.
  Current and Historical Perspectives on the Borderline Patient. - Psychology Press, 1989. - ISBN 978-0-87630-506-5.

Specific features of the borderline state

The borderline state, from the point of view of psychoanalysis, differs from psychosis by the patient’s ability to recognize reality, relying on common sense and drawing the line between subjective and objective impressions.

Although the key feature of the borderline state is still instability caused by the constant fear of being abandoned by others, even if this threat does not actually correspond to reality. This, by the way, can sometimes force a person to reject others first, which cannot but lead to an increase in problems in relationships.

• People with this condition may experience attacks of anxiety and depression frequently and usually for no apparent reason.
• Such a person has a very unstable concept of the significance of his own personality - from complete self-abasement to exaltation of his own merits.
• Interpersonal relationships among these people are also unstable: they can quite quickly switch from idealizing the personal qualities of an acquaintance to contempt for him (and for no apparent reason).

Causes of collective mental trauma

During this period, for the vast majority of the population, not only general, social, but also personal problems generated by them arise and become relevant - for example, fear for the future of children, the danger of being drafted into the army, and the like. In these cases, three main protective psychological mechanisms were identified.

Firstly, older people idealize their past life with its system of relationships, which helps them escape the problems of today; secondly, the denial of any life values ​​and guidelines, “passive drift” through life; thirdly, the replacement of real socio-psychological problems with excessive concern for one’s health, “withdrawal into illness,” and increased interest in a magical explanation of events. Knowledge of national traditions and culture helps to anticipate and promptly stop the neuroticization of society, since among the social factors causing the development of social stress disorders, a significant place belongs to the “motivation of the nation.”

Borderline condition: symptoms

In addition, people who are borderline have at least several of the following disorders.

Thus, they may act under the influence of a momentary impulse, for example, spend money extravagantly, have many sexual partners, overeat heavily, or drive a car at risk to their life.

The borderline clinic is characterized by a feeling of prolonged emptiness or surges of difficult-to-control anger, which result in getting into fights. Emotionally excessive reactions or repeated suicidal attempts are also very typical for such people.

In order for a diagnosis of borderline disorder to be made, these symptoms must be sufficiently severe and long-lasting to cause communication problems.

Clinical manifestations of the disorder

Borderline personality disorder is a pathological condition manifested by emotional instability and uncontrollable impulsivity.
A person with this disorder usually experiences anger or fear if they are rejected or simply ignored. For him, there is nothing worse than loneliness, so he makes every effort not to be left alone. But, on the other hand, with his behavior such a patient alienates those around him, which is why he is able to fall into a state of crisis. What are the consequences of borderline disorder for work and personal life?

Not only the patient himself suffers from borderline disorder, but also his family, friends and loved ones. The behavior of such a person can ruin or even destroy his personal life, relationships with colleagues and friends, and make the patient himself deeply unhappy.

When should or can you start treating borderline disorder?

It is definitely worth contacting a professional if it becomes clear that something wrong is happening with a person, his emotional sphere, behavior, and sense of self. There is no need to wait until the problem gets completely out of control and consumes the person.

Will I be registered with a psychoneurological dispensary?

Our clinic is private, and therefore respects the principle of anonymity. In view of this, you can be sure that the reputation of patients and their loved ones will not suffer.

Driver's license and borderline disorder

The presence of borderline disorder cannot cause problems with obtaining and using a driver’s license of any category. Moreover, everything that happens within the walls of the “MSK-Clinic” remains only within it and does not go beyond the center.

Panic attacks are part of the borderline state

Panic attacks are also considered borderline conditions. They occur unpredictably and manifest as attacks of acute anxiety. Patients also complain of increased heart rate, cold sweat and a feeling of lack of air. Dizziness, lightheadedness, tremors, and blood pressure changes may occur.

A state bordering on panic occurs, as a rule, against the background of experienced stress, which means that the brain gives a signal to the body about danger. At the same time, to ensure active actions, hormones are released into the blood, which provide muscle tone and increased heart rate.

Despite the fact that panic attacks cause great anxiety in people, they, according to experts, are not dangerous, although they require mandatory treatment so that dependence on this condition does not develop. And this, as a rule, leads to self-restraint and the addition of other fears.

Borderline state has signs of various diseases

In addition to all the listed signs, borderline mental states have another important feature - they are on the border between health and illness. That is, they are characterized by nonspecific manifestations of the disease, which are included in the symptoms of various pathological processes - mental, somatic, and neurological. This can be asthenia (a state of increased fatigue, weakness and exhaustion), and autonomic dysfunction, and obsessive states.

The initial symptoms of neurotic disorders in our medicine are also classified as borderline conditions. Typically this is:

• irritability;
• emotional instability;
• periodic headache;
• sleep disorders.

All these symptoms require careful examination and clarification of the diagnosis.

Help for patients with neurotic disorders involves a complex of therapeutic interventions, including, along with psychotherapy, treatment with psychopharmacological and restorative drugs. Physiotherapeutic procedures and exercise therapy are widely used. Social measures aimed at eliminating conflicts, mental and physical stress, traumatic situations, as well as removing the patient from such situations are of great importance. Considering the fact that a significant part of this contingent is observed in the general medical network or receives specialized care in extramural conditions (neurosis rooms, psychotherapy, psychohygienic rooms, PND), outpatient therapy is becoming one of the main methods of treating neurotic conditions.

Outpatient treatment is primarily given to favorably occurring, subsyndromal forms of neurotic disorders - subclinical panic attacks, monosymptomatic obsessions, transient, hysteroconversion, asthenovegetative and agrypnic disorders.

The wide possibilities of outpatient therapy do not solve, however, all the problems associated with the treatment of neurotic conditions. While maintaining a sense of reality, we must not forget about the significant role that hospitals continue to play to this day in the system of medical care for patients with borderline mental disorders.

Treatment of neurotic disorders is best carried out in specialized departments; they are most often called sanatoriums or departments (clinics) of neuroses. It is important, however, that such definitions characterize the specifics of the patient population, as well as a different, less stringent regime, but not a limited scope of medical care. In treatment units of this type, as well as in units intended for patients with psychosis, active therapy is carried out.

Most often, hospitalization is associated with the need for intensive treatment. This primarily applies to acute anxiety-phobic disorders (manifest panic attacks, generalized anxiety, panphobia, hysterophobic and dissociative states). Appropriate conditions are created in the hospital for patients with protracted (displaying a tendency towards a chronic course) development of the disease, due to signs of resistance, who require long-term intensive psychopharmacotherapy.

It must be emphasized that for some patients the length of hospitalization should be limited. The clinical picture in these cases is dominated by hysteroipochondriacal, conversion manifestations, hypochondriacal phobias and agoraphobia, accompanied by increasing psychopathization. A long stay in the hospital and the associated inactivity and weakening of contacts with the outside world lead to aggravation of personality disorders and the development of hospitalism phenomena. One should not insist on a long stay in the hospital for a certain category of patients with quite acute painful manifestations, who, due to either the characteristics of the latter or personality disorders, do not tolerate hospital conditions well. Obstacles to staying in a hospital can be obsessions that complicate interpersonal contacts (mysophobia, nosophobia, fear of fulfilling physiological needs in front of strangers, etc.), as well as the sensitivity, shyness and suspiciousness inherent in patients with social phobia. Constantly being outside the usual solitude, surrounded by unfamiliar people, becomes painful for such patients.

The effect of treating neurotic disorders is quite high. Improvement can be achieved in 60-80% of cases. However, long-term stabilization of the condition does not always occur. If immediately after the end of treatment for anxiety-phobic disorders the effect is observed in 66% [Smulevich A. B. et al., 1998] of cases, then, judging by the long-term results (data from a 3-year follow-up), the positive effect of treatment remains in only 51% sick.

Among the predictors of a favorable outcome of therapy is an average age of 30-40 years (after 50 years of age, resistance to treatment especially increases). Female patients and married individuals respond better to therapy.

Drug therapy for obsessive-compulsive disorders

carried out with drugs of the main psychopharmacological classes. First of all (especially in cases of comorbidity of anxiety-phobic and affective disorders) serotonergic antidepressants are used. Among them, tricyclic derivatives occupy one of the first places. Of these drugs, clomipramine (Anafranil) is the most effective in relieving both panic attacks and a number of other obsessive-phobic disorders. The antiobsessive activity of other tricyclic antidepressants - amitriptyline, imipramine (melipramine), desmethylimipramine (pertofran), especially in the treatment of obsessions that are resistant to psychopharmacotherapeutic effects, is not so high. However, these drugs are quite effective in complex anxiety-depressive conditions, especially in cases of syndromic comorbidity, when obsessions act as an obligate manifestation of affective disorders (obsessive ideas of self-blame, sinfulness, contrasting ideas, in a pathologically transformed form, reflecting ideas of guilt).

Along with tricyclic derivatives, selective serotonin reuptake inhibitors are widely used - fluoxetine (Prozac), sertraline (Zoloft), fluvoxamine (fevarin), used in the treatment of both panic attacks and other obsessive-phobic disorders, in doses exceeding daily amounts of the same medications prescribed for depression.

Despite data from a number of placebo-controlled studies confirming the high anti-obsessive activity of selective serotonin reuptake inhibitors, determining the real place of this group of psychotropic drugs in the treatment of anxiety-obsessive disorders is a matter of the future. At the same time, the high anti-obsessive activity of individual representatives of these antidepressants is already obvious: fluvoxamine (fevarin) - for panic attacks [Kolyutskaya E.V. et al., 1998], sertraline (Zoloft) - for contrasting obsessions [Dorozhenok I. Yu .et al., 1988].

Among antidepressants—MAO inhibitors—the reversible selective MAO-A inhibitor moclobemide (Aurorix) has antiphobic activity, the range of clinical effects of which extends to social phobias [Montgomery S. et al., 1998].

Of the drugs of other psychopharmacological classes prescribed as anti-anxiety and anti-obsessive drugs, the first place belongs to tranquilizers. Drugs from most chemical groups are used (benzodiazepine derivatives, glycerol derivatives - meprobamate, methane diphenyl - hydroxyzine, etc.). Tranquilizers such as meprobamate and hydroxyzine (atarax) are prescribed for episodic anxiety-phobic reactions caused by both psychogenic influences and changes in the somatic state, with subsyndromal obsessive disorders and isolated phobias. The advantage of these drugs is the minimal severity of side effects, and even their long-term use does not entail the formation of drug dependence. The most commonly used derivatives are benzodiazepines. Their list and doses are presented in table. 4.

The advantages of benzodiazepine derivatives include a rapid effect (especially when administered parenterally) and a wide range of anxiolytic activity, low mortality in overdose, and minor unwanted interaction with psychotropic and somatotropic drugs.

Benzodiazepines are used for both anxiety-phobic and obsessive-compulsive disorders, including acute forms (panic attacks, generalized anxiety) and protracted psychopathological conditions. At the same time, benzodiazepine derivatives are most effective in cases where somatovegetative manifestations predominate in the structure of obsessive-phobic disorders. When stopping panic attacks, alprazolam (Xanax) and clonazepam (Rivotril) are indicated; parenteral - intramuscular and intravenous drip administration of benzodiazepines such as diazepam (Valium), chlordiazepoxide (Lib-rium, Elenium) is also used. The use of benzodiazepines is associated with some restrictions due to the possibility of developing signs of drug dependence. Sometimes, when interrupting a course of therapy or attempting to complete treatment with benzodiazepines, signs of withdrawal syndrome are detected (anxiety, insomnia, asthenia, headaches, rapid heartbeat, sweating, nausea, loss of appetite, paresthesia, muscle twitching, and in rare cases, convulsions) [Roy-Byme PP , Hommer D., 1988]. Considering the possibility of drug addiction phenomena, benzodiazepine derivatives are not recommended to be prescribed to persons suffering from drug addiction, prone to abuse of psychoactive substances and alcohol. The use of benzodiazepines in long courses is carried out according to strict indications, mainly in cases of chronic anxiety with recurrent panic attacks. To avoid withdrawal syndrome or exacerbation of the symptoms of the underlying disease, treatment with benzodiazepines (with long-term use) is completed gradually, with a reduction in the daily dose of the drug over weeks, sometimes months. Most often, benzodiazepine derivatives are prescribed in short courses or used in combination therapy, combining them with antidepressants or antipsychotics.

Table 4. Tranquilizers widely used in the treatment of neuroses

The possibilities of neuroleptic therapy for neurotic conditions, including obsessions and phobic disorders, are limited. This circumstance is due to the undesirable somatotropic effect of neuroleptics, exacerbation of the vegetative component of obsessive syndrome, and a high risk of side effects.

Neuroleptic drugs are indicated for phobias (miso-, agoraphobia), accompanied by a complex system of protective rituals, for abstract obsessions [Snezhnevsky A.V., 1983], realized mainly in the ideational sphere (obsessive philosophizing, obsessive counting, obsessive decomposition of words into syllables, etc. etc.), with a combination of obsessions with delusional (ideas of damage, relationships, persecution) or catatonic formations. Attempts to prescribe antipsychotics in combination with antidepressants or tranquilizers are justified in cases of body resistance to the main anti-obsessive drugs.

The prognosis for treatment of obsessive disorders is largely determined by their psychopathological structure. Thus, in the treatment of anxiety-phobic disorders, the best results can be expected with panic attacks acting as an isolated symptom complex, determined by a combination of cognitive and somatic anxiety or manifesting as a vegetative crisis. When a panic attack is combined with persistent symptoms of agoraphobia or hypochondriacal phobias, the prognosis worsens. In cases of anxiety-phobic disorders with a predominance of agoraphobia, the relatively low effectiveness of treatment is associated with the pathological persistence of psychopathological formations and resistance to therapy. In anxiety-phobic disorders with a predominance of hypochondriacal phobias, the possibilities of therapeutic intervention are limited by the tendency to relapse despite the high sensitivity to the effects of psychotropic drugs.

Drug therapy for hysteroconversion disorders,

especially in case of episodic, short-term hysterical reactions, it is carried out with tranquilizers prescribed in small doses and short courses. Acute conditions with severe hysterical attacks, accompanied by the addition of dissociative disorders, are treated with the help of parenteral (intravenous drip) administration of tranquilizers. In some cases, when hysterophobic manifestations become protracted, there is a need for combination therapy - the addition of antipsychotic drugs (neuleptil, eglonil, chlorprothixene).

Drug treatment of neurasthenia

includes the use of psychotropic drugs, as well as restorative therapy aimed at activating metabolism and restoring body functions (vitamins, angioprotectors - sermion, vinpocetine, trental, cinnarizine; antioxidants - mexidol, emoxepin; calcium antagonists - verapamil, heptral, etc.). Psychopharmacotherapy of neurasthenia with symptoms of mental hyperesthesia is carried out mainly with tranquilizers. During the period when complaints of fatigue, irritability, and a feeling of internal tension predominate, tranquilizers are administered parenterally (intramuscularly, intravenously). Outpatients with mild asthenic manifestations are prescribed so-called daytime tranquilizers that do not have a noticeable sedative and muscle relaxant effect (meprobamate, atarax, tazepam, grandaxin, etc.). In cases where the clinical picture is not dominated by hyperesthesia and symptoms of irritable weakness, but by a feeling of weakness, intolerance to everyday stress, impaired mental and motor activity, nootropics (piracetam, encephabol, aminalon, pyritinol, etc.) are widely used along with tranquilizers. as well as stimulants (Sidnocarb, Meridil, etc.).

For drug therapy of persistent sleep disorders

- one of the frequent manifestations of neurosis - psychopharmacological drugs with hypnotic properties are indicated. In this case, two groups of hypnotics are of greatest practical importance: benzodiazepine derivatives, including hypnotics of both short (triazolam - Halcion, midazolam - Dormicum) and long-acting (flunitrazepam - Rohypnol, flurazepam - Dolmadorm, nitrazepam - Radedorm) effects, as well as representatives of new chemical groups - cyclopyrron derivatives - zopiclone (Imovan), imidazopyridine - zolpidem (Stilnox, Ivadal), related to short-acting hypnotics. The advantages of zopiclone and zolpidem include a minimal level of side effects. The use of these drugs is not accompanied by daytime somnolence and muscle relaxation.

In some cases, for persistent sleep disorders resistant to benzodiazepine derivatives and other sleeping pills, antipsychotics (chlorprothixene, sonapax, teralen, propazine, tizercin) or antidepressants (amitriptyline, doxepin, insidon, trimipramine - surmontil, gerfonal) are used, which have a pronounced hypnotic effect. For mild presomnic or intrasomnic disorders, antihistamines (diphenhydramine, hydroxyzine - atarax, pipolfen) are used. Physical methods of treatment are also effective - hydrotherapy, darsonvalization, electrophoresis with calcium and bromine ions, electrosleep, etc.

Psychotherapy.

The idea of ​​neuroses as psychogenic disorders explains the adequacy of the use of various psychotherapy techniques, differentiated in accordance with one or another type of disorder. Psychotherapy for anxiety-phobic and obsessive-compulsive disorders has become increasingly relevant in recent years, due to the clarification of ideas about the clinical and pathogenetic polymorphism of anxiety1. Psychotherapeutic interventions are aimed at reducing anxiety and correcting inappropriate forms of behavior (avoidance in anxiety-phobic and decreased self-control in obsessive-compulsive disorders), transformation of pathological behavioral patterns, teaching the patient the basics of relaxation. The use of both group and individual methods of psychotherapy is shown. When phobic disorders predominate, psychoemotional support therapy is effective in improving the patient’s psychological well-being, although the phobic symptoms themselves may persist. To eliminate phobias, more active psychotherapeutic interventions are required, mainly various modifications of behavioral therapy that desensitize the patient to phobic stimuli. To do this, he is trained to resist the feared object, using various types of relaxation, including hypnosis. The result is reciprocal inhibition: suppressing fear reduces anxiety, and reducing anxiety makes it easier to overcome fear. Rational psychotherapy, built on logical argumentation (explaining the true essence of the disease, persuading and reorienting the patient towards an adequate understanding of the manifestations of the disease and the need for treatment), is shown and contrasted with suggestive methods.

For obsessive-compulsive disorder, various forms of behavioral psychotherapy are effective, among which the exposure and response prevention method stands out. The latter consists of the patient’s purposeful and consistent contact with the stimuli he is avoiding and the conscious slowing down of the resulting pathological reaction. Similar techniques of desensitization, thought stopping, immersion, and aversive conditioning are also used. In the latter case, inhibition of pathological forms of behavior (in particular, rituals) is achieved by developing a conditioned reflex between obsessive actions and negative reinforcement (for example, electric shocks). With a more gentle technique, instructions are used as an aversive stimulus aimed at reviving in the patient’s mind painful, aversive ideas associated with obsessions. In some cases, insight psychotherapy is effective. However, in most patients, obsessive-compulsive symptoms are extremely persistent. Supportive and family psychotherapy are indicated in the complex of social rehabilitation measures.

Classical psychoanalysis, considered a specific approach to the psychotherapy of hysterical disorders, helps only a small part of patients who positively perceive this approach. For most patients, integrative psychotherapy is more effective, based on the synthesis of various psychotherapeutic concepts and borrowing elements of suggestive and cognitive, individual and group, behavioral and other types of psychotherapy. When conversion manifestations dominate in the clinical picture, hypnosis is used, which has a positive, but sometimes short-term effect. With the help of hypnotic suggestion, it is possible to return repressed ideas, emotions, memories to the patient’s sphere of consciousness and thereby stop the phenomena of hysterical dissociation (psychogenic amnesia, dissociative fugue with partial or complete amnesia, amnestic barriers in multiple personality disorder with restoration of self-control). Directly confronting the patient with his own underlying psychological problems can be the first step in the therapeutic process. In some cases, the use of directive suggestion is indicated, but the use of this method requires experience, high qualifications and a certain caution.

In the course of further therapy, neurolinguistic programming is also used, based on the postulate of multiple descriptions of any occurring event. The hypothesis underlying neurolinguistic programming allows us to present any unfavorable fact in a favorable light and consider it as a source of positive resources for the patient. Under the influence of this method, the individual’s attitude towards the environment and himself changes.

Borderline Center: Help You Need

People with this disorder need specialized psychological help; consultation with a psychologist is not enough for them. By the way, psychoanalysis is especially undesirable for such people, since the high anxiety to which they are prone can do a “disservice” and spur the development of a borderline state into a mental disorder.

To treat patients, a department of borderline conditions is often created at a multidisciplinary somatic institution, in which people suspected of having this disorder are admitted. As a rule, these are patients who are in a state of psychological crisis with a risk of suicide attempts or who have committed such. They need temporary exclusion of traumatic situations, as well as psychotherapeutic and drug treatment.

Treatment

Treatment is selected individually. To provide adequate care, it is important to assess the role of social, biological and psychological factors in the development of disease behavior. Accordingly, various therapeutic approaches are used: psychotherapy, drug treatment, physiotherapy, isolation or change of environment, work with family, etc. In severe cases, examination and treatment may require hospitalization in a hospital.

Of all types of psychotherapy, the cognitive-behavioral direction is the most effective. The most commonly used pharmacotherapy is neurometabolic therapy, mood stabilizers (lamotrigine, carbamazepine) and antipsychotics (periciazine, aripiprazole, olanzapine, etc.).

What is hidden behind the borderline states of newborns?

Despite the external similarity of the definition, borderline conditions in newborns have nothing to do with the ailments listed above. For babies who have just been born, these are natural physiological reactions that manifest the body’s adaptation to existence in new conditions.

In pediatrics, this condition is assessed as transient (transitional), lasting no more than 3-4 weeks and being physiologically normal. As a rule, it disappears on its own by the end of the specified period, but in case of insufficient care, disruption of the baby’s adaptive capabilities, or under unfavorable conditions in the external environment, these processes can turn into pathological and require treatment.

How does the borderline state manifest in newborns?

Borderline conditions of newborns are manifested in a physiological decrease in their body weight in the first days after birth. It can decrease by 10% of the initial weight. These same phenomena also include changes in the condition of the child’s skin, which are expressed in its redness after wiping with vernix.

A third of newborns demonstrate the occurrence of toxic erythema, in which blisters with serous fluid appear on the baby’s skin, located in the area of ​​the joints, on the buttocks or on the chest.

Exposure to maternal estrogen hormones leads to a hormonal crisis, and the restructuring of the intestines and the passage of original feces are accompanied by dysbiosis, which disappears by the end of the first week of life.