Disorders

The research states that in sexual trauma there is a prevalence of consequent axis II disorders, especially Borderline Personality Disorder (BPD) as well as Post Traumatic Stress Disorder (PTSD) and Substance Use Disorder (SUDS) (Yen et al. , 2002). This heavy correlation between PTSD, borderline personality disorder and substance abuse disorder, create complications in treatment (Ross, Dermatis, Levounis, and Galanter, 2003). The goal of the present paper is three-fold.First, it aims at reviewing current research and theoretical frameworks which are designed to measure the degree of the relationship between PTSD and BPD. It is also sought to trace how it is possible by seeing to the correlation to avoid or neutralize further psycho social problems while reducing harm in substance abuse prevention. Second, the researcher plans to analyze the implications of how failure to address these dynamics in reducing harm and treating co-occurring disturbances may further delay treatment and cr eate relapse.Finally, there is an analysis of the methodologies employed in the treatment theories presented. A particular emphasis is made on the Integrative Treatment Approach suggested by Najavits (2002) and the Dialectical Behavioural Therapy developed by Lineham (1993). The researcher attempts to explain how these theories influenced the understanding of this dilemma. Before proceeding to the first point, it is necessary to clarify the main theoretical concepts, such as BPD and PTSD.Speaking popularly, Post Traumatic Stress Disorder (PTSD) is â€Å"a normal response to an abnormal event† (Schiraldi, 2000, p. 3). Being categorized by the American Psychiatric Association as one of the anxiety disorders, it is typically caused by either or several of the three types of traumatic events: Intentional Human causes, Unintentional Human causes, or Acts of Nature. The presence of the stressor as part of the diagnosis differentiates PTSD from other disorders and makes it a uniquel y complex phenomenon.Besides an exposure to the stressful event, American Psychiatric Association in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (1994, paraphrased in Schiraldi, 2000) lists another four PTSD criteria: persistent (more than one month) re-experiencing of the trauma (this category of symptoms is titled â€Å"intrusive memories† in Johnson, 2004), persistent (more than one month) avoidance of trauma-associated stimuli and suppression of general responsiveness (â€Å"avoidance behavior according to Johnson, 2004), persistent (more than one month) symptoms of hyperarousal (or, according to Johnson, 2004, â€Å"hypervigilance†), and disruption of psychological and functional equilibrium. In its turn, Borderline Personality Disorder (BPD) from the viewpoints of attachment theory and developmental psychopathology is defined as â€Å"a highly prevalent, chronic, and debilitating psychiatric problem† associated with the fo llowing symptoms: â€Å"a pattern of chaotic and self-defeating interpersonal relationships, emotional lability, poor impulse control, angry outbursts, frequent suicidality, and self-mutilation† (Levy, 2005, p. 259).Kernberg (2004), who considered the organization of the personality to be crucially determined by affective responses as displayed under conditions of peak affect states, listed â€Å"identity diffusion and the †¦ predominance of primitive defensive operations centering on splitting† among the key symptoms of this psychological dysfunction noting that they are accompanied by â€Å"the presence of good reality testing† (p. 99). The researcher meant that although the patient imagined himself living in the paranoid and distorted reality, he differentiated between the self and other objects. It is true that many current researchers acknowledge the correlation between PTSD and BPD, the latter being treated as one type of personality disorders (PDs). Bremner (1999) conceptualized BPD as fitting to the psychiatric disorders associated with traumatic stress.From this perspective, an exposure to traumatic events and consequent stress affected structural and functional aspects of the brain so that stress-related psychiatric dysfunctions were developed. The viewpoint was supported by McGlashan et al. (2000) who as relying on the results of a descriptive, prospective, longitudinal, repeated-measures study of a clinical sample of four representative DSM-IV personality disorders called The Collaborative Longitudinal Personality Disorders Study (CLPS) (N = 571) found a high rate of Axis II/II overlap. To specify, PTSD and BPD co-existed in almost a half of the sample. To be even more specific, Yen et al.(2002) conducted a longitudinal, prospective, naturalistic, multisite and cross-sectional study to analyze the correlation of the aforementioned two Axis II disorders within the population of 668 individuals between the ages of 18 and 45 years. Twenty-five percent of those participants (N = 167) exhibited BPD symptoms. Furthermore, BPD participants more often suffered from lifetime PTSD than patients with any other form of PDs (51% of those 191 individuals who reported of a history of traumatic exposure). Overall, Yen et al. (2002) hypothesized that BPD symptoms trigger vulnerability for traumatic exposure which is the key characteristic of PTSD. Bolton, Mueser, and Rosenberg (2006) observed that between 25% and 56% of individuals with BPD exhibit symptoms of current PTSD as compared to approximately 10% of other patients.Upon analysis of the two studies – the index one involving 275 mentally impaired inpatient and outpatient individuals with PTSD (30 patients with BPD among them) and the replication one involving 204 patients (20 people with BPD among them), the researchers stated that comorbid diagnoses of BPD and PTSD were associated with higher rates of severe anxiety and depression. Ross, Dermatis, Levou nis, and Galanter (2003) cited empirical evidence of comorbid PDs being highly associated with Substance Use Disorder (SUDS) in approximately 50% of the samples. They also shared a viewpoint that stress-related dysfunctions predicted worse treatment outcomes, for example, poorer psychosocial functioning, increase drug use, and lower retention rates.In a course of the eight-month research in a specialized inpatient dual diagnosis unit at a public hospital, the researchers observed the population of 100 patients, among which 53% displayed some kind of PDs. Seventy-four percent of the interviewees were targeted as having BPD, whereas twenty-five percent exhibited PTSD symptoms. Patients with comorbid disorders (dual and triple diagnoses) were more likely to abuse substance use (33% – alcohol; 32% – polysubstance; 25% – cocaine; 21% – cannabis; and 13% – heroin). Consequently, such individuals had more inpatient admissions and more severe symptom profi les than the ones with a single diagnosis. The difference between people with the single-, dual- and triple diagnoses was extremely evident in after-hospitalization treatment. Ross et al.(2003) argued that comorbidity of PDs as accompanied by SUDs should put the clinicians on alert as such individuals needed to be guided â€Å"at this critical junction† (p. 275) of a transition from the in- to out-patient environments so that they would be aware of the necessity to comply with after-care therapy. II†¦ The concluding section is dedicated to the analysis of the two innovative and effective therapeutic approaches to treating PDs as combined with SUDs: first, the Dialectical Behavioural Therapy developed by Lineham (1993) and, second, the Integrative Treatment Approach suggested by Najavits (2002). The former approach fits into the problem-solving therapeutic paradigm which is praised for the treatment allowing wide amplification and being clinically effective.Its core assum ption is that antisocial and inadequate behavioral patterns are explained by the scarcity of patients’ psychological resources to cope with their problems in an alternative acceptable manner. Lineham’s Dialectical Behavioural Therapy differentiates from other problem-solving alternatives in its particular attention to the effect of a specific diagnosis on the course of treatment and its extensive preventive measures against poor attendance. Linehan compared the outcomes of her dialectical behavioural therapy (DBT) to the ones of standard outpatient-care methods to find that the ratio of patients who continued treatment with the assistance of a single therapist increased from 42 to 83 percent. The approach utilizes a range of cognitive-behavioural therapeutic techniques as based on a dialectic philosophy.On the one hand, the patient is helped to value his/her self as a precious and integrative phenomenon by eliminating the feelings of guilt, self-abomination and neglect . On the other hand, a therapist assists an individual with multiple disorders in finding stimuli for change. The core concept of the approach is the â€Å"skill† which is defined as â€Å"cognitive, emotional, and overt behavioral (or action) response repertoires together with their integration, which is necessary for effective performance† (Linehan, 1993, p. 329). The scholar described the four broad modules of skills: (1) mindfulness, (2) interpersonal effectiveness, (3) emotion regulation, and (4) distress tolerance.To proceed, the pioneer of this method listed three categories of skills training procedures: (1) skills acquisition, (2) skill strengthening, and (3) skill generalization. An introduction of new skills occurs at the first stage. At the further stages, a patient learns to manage the freshly acquired skills and project them onto the everyday environment. The Integrative Treatment Approach suggested by Najavits (2002) was designed specifically for treatin g PTSD and substance abuse. Therefore it is especially valuable for helping patients with multiple diagnoses. This therapeutic technique is a present-focused one so far as it helps patients to free themselves from the past traumatic experiences and enables them to practice in acquiring safety from trauma/PTSD and substance abuse.Being equally effective for single patients and groups of various backgrounds, Najavits’ methodology relies on the five principles. First, individuals with multiple disorders are stimulated to value safety as the main life goal in regard to relationships, thinking, behavior, and emotions. Second, they are guided into the integrated course of treatment, during which several dysfunctions are seen to at once. Third, individuals are helped in designing ideals to balance against the loss of ideals resulting in PTSD and substance abuse. Fourth, a range of exercises includes cognitive, behavioral, interpersonal, case management practice. Finally, the method heavily relies on clinicians’ activities.