Borderline human condition. Borderline conditions

Borderline mental disorders

A group of mental disorders united by nonspecific psychopathological manifestations of a neurotic level.

Psychogenic factors play a major role in their occurrence and decompensation. The concept of borderline mental disorders is largely arbitrary and not generally recognized. However, it has entered the professional vocabulary of doctors and is quite often found in scientific publications. This concept is used mainly to group milder disorders and separate them from psychotic disorders. Borderline states are generally not initial or intermediate (“buffer”) phases or stages of major psychoses, but a special group pathological manifestations with a characteristic onset, dynamics and outcome, depending on the form or type of the disease process. The most common signs of borderline states: ■ the predominance of psychopathological manifestations of the neurotic level throughout the entire course of the disease; ■ the relationship between mental disorders themselves and autonomic dysfunctions, night sleep disorders and somatic diseases; ■ the leading role of psychogenic factors in the occurrence and decompensation of painful disorders; ■ “organic predisposition” for the development and decompensation of painful disorders; ■ the relationship of painful disorders with the personality and typological characteristics of the patient; ■ keeping patients critical of their condition and the main pathological manifestations. In borderline states, there are no psychotic symptoms, progressively increasing dementia and personality changes characteristic of endogenous mental illnesses (schizophrenia, epilepsy). Borderline mental disorders can arise acutely or develop gradually, be limited to a short-term reaction, a relatively long-term condition, or take a chronic course. Taking into account the causes of occurrence in clinical practice, there are various shapes and variants of borderline disorders. At the same time, there are unequal principles and approaches (nosological, syndromic, symptomatic assessment). Pay attention to their stabilization. Taking into account the non-specificity of many symptoms (asthenic, autonomic dysfunctions, dyssomnia, depressive, etc.) that determine the psychopathological structure of various forms and variants of borderline states, their external (“formal”) differences are insignificant. Considered separately, they do not provide grounds for a reasonable differentiation of existing disorders and their delimitation from the reactions of healthy people who find themselves in stressful conditions. The diagnostic key in these cases can be a dynamic assessment of painful manifestations, detection of the causes of their occurrence and analysis of the relationship with the individual typological psychological characteristics of the patient and with other somatic and mental disorders. The variety of etiological and pathogenetic factors allows us to classify the following as borderline forms of mental disorders: ■ neurotic reactions; ■ reactive states (not psychoses); ■ neuroses; ■ pathological personality development; ■ psychopathy; ■ a wide range of neurosis- and psychopath-like manifestations in somatic, neurological and other diseases. In ICD-10, these disorders are represented mainly by: ■ various types of neurotic, stress-related, and somatoform disorders (section F4); ■ behavioral syndromes caused by physiological disorders and physical factors (section F5); ■ “disorders of mature personality and behavior in adults” (section F6); ■ depressive episodes (section F32), etc. The number of borderline states usually does not include endogenous mental illnesses (including low-grade schizophrenia), at certain stages of development of which neurosis- and psychopath-like disorders predominate and even determine their clinical course, largely to the extent that they imitate the basic forms and variants of borderline states themselves. In both neurotic and neurosis-like disorders, there are sufficiently pronounced and mature clinical manifestations that make it possible to differentiate them within certain painful (nosological) conditions. In this case, they take into account: ■ firstly, the onset of the disease (when neurosis or a neurosis-like state arose), the presence or absence of its connection with psychogeny or somatogeny; ■ secondly, the stability of psychopathological manifestations, their relationship with personality-typological characteristics. The main manifestations (symptoms, syndromes, conditions) considered within the framework of borderline mental disorders include the following disorders, which are mainly non-specific for a particular nosological form. ■ Character accents. ■ Apathy. ■ Asthenia. ■ Neurocirculatory dystonia. ■ Ideas are extremely valuable. ■ Hysteria. ■ Sleep disorders ■ Neurasthenia. ■ Obsessive-compulsive neurosis. ■ Manifestations are pre-neurotic (pre-painful). ■ Psychasthenia. ■ Increased irritability. ■ Confusion. ■ Hypochondriacal disorders. ■ Mental disorders in somatic diseases. ■ Mental disorders in emergency situations. ■ Senestopathic disorders. ■ Social stress disorders. ■ Panic disorder. ■ Post-traumatic stress disorder. ■ Generalized anxiety disorder. ■ Chronic pain syndrome. ■ Postencephalic syndrome. ■ Chronic fatigue syndrome. ■ Burnout syndrome. If these disorders are identified, consultation with a psychiatrist is necessary, however, treatment and rehabilitation measures can be carried out by doctors of general medical institutions in outpatient and inpatient practice.

Collapse

CHARACTER ACCENTUATIONS Features of originality in a person’s character that do not go beyond the mental norm, but can, under certain conditions, significantly complicate his relationships with others. Accented personalities occupy an intermediate position between mentally healthy people and patients with psychopathic disorders. Various character traits are intertwined, but there are leading, “predominant” traits. They become sharper, first of all, in unfavorable situations. The most common types of accentuations include: ■ hysterical (demonstrative); ■ hyperthymic; ■ sensitive; ■ psychasthenic; ■ schizoid; ■ epileptoid; ■ emotionally labile.

Collapse

APATHY Indifference, on initial stages- some weakening of drives, desires, aspirations. As the patient's condition worsens, he ceases to be interested in events that do not concern him personally and does not participate in entertainment. With emotional decline, for example, with schizophrenia, the patient calmly reacts to exciting, unpleasant events, although in general the patient is not indifferent to external events. Some patients are little concerned about their own situation and family affairs. Sometimes there are complaints about emotional “dullness”, “indifference”. Extreme degree apathy - complete indifference. The patient's facial expression is indifferent; he is indifferent to everything, including his appearance and cleanliness of his body, his stay in the hospital, and visits from relatives.

Collapse

ASTHENIA Increased fatigue is one of the least specific mental disorders. With minor symptoms, fatigue occurs more often with increased load, usually in the afternoon. In more pronounced cases, even with relatively uncomplicated activities, a feeling of fatigue, weakness, and an objective deterioration in the quality and pace of work quickly appear; rest helps little. Among vegetative disorders, excessive sweating and pallor of the face predominate. Asthenia of extreme severity is accompanied by severe weakness; any activity, movement, or short-term conversation tires. Rest doesn't help. Asthenic disorders are often combined with irritability, impatience, and fussy activity (“fatigue that does not seek rest”).

Collapse

NEUROCIRCULATORY DYSTONIA Manifests itself in polymorphic clinical disorders, including various functional neurotic and neurosis-like symptoms. In clinical psychiatry, manifestations of neurocirculatory dystonia are described primarily as borderline disorders. As an independent diagnostic category, neurocirculatory dystonia in ICD-10 in the section “Mental disorders and behavioral disorders” is interpreted as somatoform autonomic dysfunction of the heart and cardiovascular system (cardiac neurosis, neurocircular asthenia). Currently, certain preferences have emerged in understanding this clinical phenomenon. Internists generally consider neurocirculatory dystonia a nosologically independent diagnostic category; in psychiatry and neurology it is assessed, most often, as a syndrome.

Collapse

IDEAS VERY VALUABLE Pathological judgments arising as a result of real circumstances and on the basis of real facts, acquiring a dominant meaning in the patient’s mind. They are distinguished by their monothematic nature, one-sidedness, emotional richness, and lack of opportunities for critical analysis.

SLEEP DISORDERS

NEURASTHENIA

NEUROSIS OF OBSESSIVE CONDITIONS

Collapse

PRE-NEUROTIC MANIFESTATIONS (PRE-MILLED) Refer to the clinical expression of intense functional activity of the adaptation barrier. They reflect the subthreshold activity of the system of mechanisms that ensure mental adaptation within the limits of functional stability, and the compensating interaction of various biological and socio-psychological factors that shape mental adaptation under stressful conditions. The intense activity of the mental adaptation barrier is not a pathological process; it occurs within the framework of adaptive mechanisms and reflects (is a marker), especially in the first stages, the occurrence of reactions of a physiological (and not pathophysiological) nature aimed at maintaining “mental homeostasis” and at forming the most appropriate programs of behavior and activity in difficult conditions. Pre-neurotic reactions are not the initial manifestations of neurosis, not its mild forms. They express a protective-adaptive function during overstrain of the mental adaptation system. Clinical manifestations of pre-neurotic reactions are polymorphic short-term disorders of the neurotic level, personal decompensations, and autonomic dysfunctions.

Collapse

PSYCHASTHENIA Translated from Greek it means “mental weakness.” Psychasthenia develops mainly in people with the thinking type mental activity and, as it were, the opposite of hysteria. Patients complain that they perceive their surroundings “as in a dream”; their own actions, decisions, and actions seem insufficiently clear and precise. Hence the constant tendency to doubt, indecision, uncertainty, anxious and suspicious mood, timidity, and increased shyness. Previously, psychasthenia was called “the insanity of doubt.” Due to constant doubts about the correctness of what has been done, a person tends to redo something he has just completed. All this creates in the patient a painful feeling of his own inferiority. A fictional trouble is no less, and perhaps more terrible, than an existing one. Patients with psychasthenia often indulge in all sorts of abstract thoughts; in their dreams they are able to experience a lot, but they try in every possible way to avoid participating in reality. The so-called professional lack of will (abulia) of patients with psychasthenia is described, which manifests itself primarily at work, when performing immediate duties, when a person with psychasthenic disorders begins to experience doubts and show indecision. With psychasthenia, various hypochondriacal and obsessive states. Psychasthenic character traits, like many other neurotic disorders, can be observed already in at a young age. However, individual and mildly expressed manifestations do not yet give reason to consider psychasthenia a disease. If, under the influence of psychogenically traumatic circumstances, they grow, become more complicated, and become dominant in a person’s mental activity, we can talk not about the originality of character, but about a painful neurotic state that prevents a person from living and working. Psychasthenic disorders usually exist constantly during illness, but at first the patient copes with them himself. If traumatic circumstances persist and intensify, without systematic treatment, the manifestations of the disease may increase.

IRRITABILITY INCREASED

CONFUSION

Collapse

HYPOCHONDRICAL DISORDERS Unjustifiably increased attention to one’s health, extreme preoccupation with even minor ailments, conviction of the presence of a serious illness in the absence of its objective signs. Hypochondria is usually integral part more complex senestopathic-hypochondriacal, anxiety-hypochondriacal and other syndromes, and is also combined with obsessions, depression, and paranoid delusions.

MENTAL DISORDERS IN SOMATIC DISEASES

Collapse

SENESTOPATIC DISORDERS The appearance in various parts of the body of unpleasant and painful sensations, sometimes unusual and fanciful. When examining a patient, the “diseased” organ or part of the body is not identified and no explanation is found for the unpleasant sensations. When senestopathic disorders stabilize, they largely determine the patient’s behavior and lead him to meaningless examinations. Senestopathic sensations as psychopathological manifestations should be carefully differentiated from the initial symptoms of various somatic and neurological diseases. Senestopathies in mental illness are usually combined with other mental disorders characteristic of sluggish schizophrenia, the depressive phase of manic-depressive psychosis, etc. Most often, senestopathies are part of a more complex senestopathic-hypochondriacal syndrome.

Collapse

SOCIAL STRESS DISORDERS The group of social stress disorders is not included in the ICD-10 diagnostic list. It was identified at the end of the 20th century on the basis of an analysis of the mental health of large groups of the population of Russia and other countries in the context of fundamental changes in the socio-economic and political situation and is not directly related to acute reaction for stress.

CRITERIA FOR DIAGNOSTICS OF SOCIAL STRESS DISORDERS

FEATURES OF BEHAVIOR AND CLINICAL MANIFESTATIONS

PANIC DISORDER

POST-TRAUMATIC STRESS DISORDER

Collapse

GENERALIZED ANXIETY DISORDER Anxiety is a feeling of uncertain danger, an impending catastrophe, which is directed towards the future and contains a mobilizing component. Unlike anxiety, fear is the experience of an immediate, specific threat. Generalized anxiety disorder is a mental illness, the main manifestations of which are primary persistent anxiety not limited to any situation and associated somatovegetative disorders. ICD-10 F41.1 Generalized anxiety disorder. EPIDEMIOLOGY The disease affects 2–5% of the population. As a rule, it begins in middle age. In outpatient practice, women predominate (ratio to men 2:1). DIAGNOSTICS SURVEY PLAN The diagnosis is made based on the long-term and persistent (most days over long periods of time - weeks and months) presence of anxiety and associated symptoms. HISTORY AND PHYSICAL EXAMINATION■ Anxiety, increased restlessness. ■ Anxiety is constant; is not limited, caused or even arisen with obvious preference in connection with any particular life circumstances. ■ Frequent fears (feeling of impending troubles and failures, fear for loved ones, etc.). ■ Constant tension, inability to relax, difficulty falling asleep due to anxiety. ■ Difficulty concentrating or feeling “blank” due to anxiety or worry. ■ Autonomic symptoms: ✧ increased or rapid heartbeat; ✧ sweating, dry mouth (but not from drugs or dehydration); ✧ tremor or trembling; ✧ difficulty breathing, feeling of suffocation; ✧ pain or discomfort in the chest; ✧ nausea or abdominal distress (for example, a burning sensation in the stomach); ✧ hot flashes or chills; ✧ numbness or tingling sensation in various muscle groups; muscle tension or pain. Anxiety symptoms are present most days over long periods of time (weeks and months). LABORATORY EXAMINATION There are no special laboratory or instrumental markers of generalized anxiety disorder. Laboratory and instrumental studies can be carried out for differential diagnostic purposes to exclude other causes of anxiety (endocrine disorders, organic brain disease, use or sudden break in the use of psychoactive substances, etc.). DIFFERENTIAL DIAGNOSTICS Differential diagnosis is carried out with anxiety states of a different nature. ■ Endocrine disorders (such as hyperthyroidism). ■ Anxiety within the framework of affective and hallucinatory-delusional psychoses. ■ Other anxiety disorders (organic anxiety disorder, panic disorder, phobias, etc.). ■ Use disorders psychoactive substances(use of amphetamine-like substances or withdrawal from benzodiazepines). INDICATIONS FOR CONSULTATION WITH OTHER SPECIALISTS Psychiatrist: ■ for newly diagnosed disorder; ■ decompensation of the condition. TREATMENT GOALS OF THERAPY Complete or significant reversal of symptoms, achieving stable remission. INDICATIONS FOR HOSPITALIZATION■ Severity of disorders. ■ The need to remove the patient from a traumatic environment. ■ Resistance to outpatient therapy. As a rule, the patient is hospitalized in the border psychiatry department of a psychiatric or somatic hospital. NON-DRUG TREATMENT Psychotherapy: ■ relaxation methods (autogenic training, self-regulation with feedback); ■ short-term psychodynamic; ■ cognitive-behavioral. DRUG THERAPY■ Benzodiazepine tranquilizers at the beginning of therapy as emergency care in case of severe anxiety and fear, a short course to avoid the formation of dependence. ■ Antidepressants of different groups. The anxiolytic effect increases slowly over several weeks. To achieve stable remission, patients need long-term (up to six months or more) use of the selected drug. APPROXIMATE DURATION OF TEMPORARY DISABILITY Determined individually. MANAGEMENT OF THE PATIENT Carried out by the attending psychiatrist or general practitioner with the advice of a psychiatrist. EDUCATION OF THE PATIENT Training coping behavior on a conscious level. FORECAST The disease is chronic and can last throughout life.

CHRONIC PAIN SYNDROME

POST-SENCEPHALIC SYNDROME

Collapse

CHRONIC FATIGUE SYNDROME A combination of nonspecific polymorphic asthenic, subdepressive, neurasthenic, neurocirculatory disorders. It is not identified as a separate mental disorder by most researchers. Often occurs after an infection (some researchers attach importance to lymphotropic herpesviruses, retroviruses, enteroviruses in the development of chronic fatigue syndrome), is accompanied by slightly pronounced changes in immunity (moderate nonspecific increase in the titer of antinuclear antibodies, a decrease in the content of immunoglobulins and the activity of NK-lymphocytes, an increase in the proportion of T-lymphocytes and etc.). The disorders occur after a flu-like state and tend to drag on. There is no somatic or psychogenic basis for the complaints. Treatment with restoratives, psychotherapy, and antidepressants with an activating component give a fairly pronounced effect. The identification of chronic fatigue syndrome indicates a search for the somatic (“biological”) basis of many nonspecific nonpsychotic (neurotic, borderline) disorders. Along this path, it is possible that pathogenetically based methods of therapy will emerge, primarily the use of immunotropic drugs together with antidepressants and other psychotropic drugs.

Collapse

EMOTIONAL BURNOUT SYNDROME A relatively new designation for a pronounced deformation of emotional experiences in professional activities associated with constant exposure to familiar conditions of emotional stress (for example, the work of a resuscitator, surgeon, psychiatrist, the activities of rescuers, military personnel, etc.).

Mental illness is not something that people usually talk about, so much less is known about borderline personality disorder - its symptoms, treatment regimens, medical prognosis - than about schizophrenia or depression. However, the manifestations of this diagnosis are faced a large number of people, which requires increasing public awareness. Why does this problem occur and what to do about it?

What are borderline states in psychiatry?

If a patient is diagnosed with a weak level of mental disorders - when the patient manages to control reality and the disease is far from the nature of the pathology - in medicine this is noted as a borderline state. Such disorders are represented by a number of disorders and even symptom complexes:

psychosomatic;
neurosis-like;
neurotic;
affective;
neuroendocrine;
neurovegetovisceral.

This term in official medicine was introduced in the mid-20th century and today is strongly associated with the diagnosis of borderline personality disorder, coded F60.31 in ICD-10. For a long time Psychiatrists classified any mental disorders as borderline states, which created “diagnostic chaos” and the inability to derive clear signs for diagnosis. accurate diagnosis.

Causes of the disease

According to statistics, with borderline disorder personalities (BPD) live in about 3% of the population globe, however, this disease is “overshadowed” by more complex ones, so some cases are not taken into account. Manifestations of such mental disorders develop mainly in people aged 17-25 years, but they can appear in children, but are not diagnosed due to the physiological instability of the child’s psyche. The causes leading to this disease are divided into 4 groups:

Biochemical – explained by an imbalance of neurotransmitters: chemical substances responsible for regulating expressions of emotions. Serotonin deficiency causes depression, with a lack of endorphin nervous system cannot withstand stress, and a decrease in dopamine levels leads to a lack of satisfaction.
Hereditary predisposition - experts do not exclude the possibility that unstable psyche can be embedded in DNA, so people often suffer from BPD whose close relatives also had disorders of psycho-emotional behavior.
Lack of attention or violence in childhood– if the child did not feel parental love or faced the death/departure of loved ones in early age, parents have been observed to experience frequent physical or emotional abuse (especially with regard to the high demands placed on the child), this can be the cause of psychological trauma.
Raising in a family - for the harmonious development of personality, a child must feel parental love, but know the boundaries and the concept of discipline. When the microclimate in the family is disturbed with a preponderance of a dictatorial position or excessive encouragement, this becomes the cause of difficulties in subsequent social adaptation.

Borderline mental disorders - symptoms

Borderline syndrome (short for the English name of the disease “borderline personality disorder”) can have a long list of manifestations that will not necessarily be fully present even in a seriously ill person. According to official data, patients diagnosed with BPD often experience:

increased anxiety;
depressive states (in severe case– mental anesthesia);
impulsiveness;
loss of control over emotions;
intense dysphoria followed by euphoria;
problems with social adaptation;
violations of self-identification;
demonstration of antisocial behavior (before drug addiction, alcohol abuse, criminal acts).

Interpersonal relationships

Problems with living in society different forms characteristic of people with borderline personality disorder. Often there is an inability to reach a consensus and a categorical defense of one’s opinion, which constantly leads to confrontation with others. A patient with BPD does not see himself as the guilty party, but believes that no one realizes that he is right and worthwhile. Problems interpersonal relationships are not excluded even in the family, and they can even be accompanied by sexual violence, since they are associated with uncontrollable emotions.

Fear of loneliness

Most forms of borderline personality disorder are characterized by a major general symptom- this is the fear of being alone, even when there are no prerequisites for this. A person may completely reject the feeling of love, which leads to a break in the relationship before the opposite party does so. This provokes difficulties in relationships with a person with borderline personality disorder. Most people (especially young women) who experience this type of anxiety have childhood psychological trauma associated with their parents.

Categorical opinions and judgments

With borderline personality disorder, a person sees the world exclusively in black and white, which becomes the cause of either pure, insane delight at what is happening, or a devastating depression from the situation. Life for such people is either amazing or terrible: there are no half-tones. Even the smallest failures cause serious manifestations of irritability. Due to this perception, the appearance of suicidal thoughts is characteristic of 80% of people with borderline personality disorder.

Tendency to self-destruction

Against the backdrop of frequent depressive states that accompany internal tension, a person suffering from borderline mental disorder experiences suicidal tendencies or attempts at self-punishment. Only 10% of patients commit suicide - for the rest, everything ends in self-harm, which is a way to relieve tension or attract attention, an expression of auto-aggression, a method nonverbal communication and suppression of hyperexcitability. This can manifest itself in any actions leading to deterioration of health and damage to one’s body.

Impaired self-perception

Low self-esteem against the background of idealization of others is a relatively weak sign of BPD, but the most common and comes from childhood. If mental disorder is in a more severe form, the person may experience permanent shift assessments of one’s character and capabilities, and the “switches” themselves will not have clear prerequisites. In some cases, patients even note a feeling of loss of their own personality and the inability to feel the fact of existence.

Lack of behavior control

Availability various kinds mania is a clear symptom of borderline personality disorder, in which one can observe impulsive behavior in any situation. A person with BPD is characterized by uncontrollable emotions, so he may experience painful cravings for anything, disorders eating behavior, to deal with paranoid thoughts, sexual promiscuity, alcoholic and drug addiction. Conditions of sudden changes in thoughts and actions cannot be excluded - for good mood followed by a dysthymic phase or spontaneous outbursts of anger.

Diagnostics

Due to modern look Based on comorbidity in psychiatry, it is difficult to separate BPD from a number of other diseases associated with personality disorder. Patients who receive this diagnosis have a tendency to use psychoactive substances, symptoms of bipolar disorders, social phobias, obsessive-compulsive disorders, and depressive states. Diagnosis is made using:

physical examination;
studying medical history;
parsing clinical manifestations to identify key signs (at least 5);
testing.

Differential diagnosis

In its manifestations, borderline personality disorder is similar to big amount mental illness, but requires special approach in treatment, therefore it is necessary to make a clear differentiation between BPD and schizophrenia, psychosis, bipolar disorders, phobias, affective states. Especially it concerns early stage everyone listed diseases, where the symptoms are almost identical.

Evaluation criteria

When identifying borderline personality disorder, specialists focus on impaired perception of one’s own “I”, constant changes in thinking, hobbies, judgments, and the ease of falling under the influence of others. International classifications diseases 9 and 10 revisions clarify that in addition to common features The patient must have personality disorders:

a pronounced tendency to impulsive actions that cause harm to oneself;
behavioral outbursts against the background of their condemnation by society;
making efforts to prevent the fate of abandonment;
identity disorder;
relapses of suicide attempts;
dissociative symptoms;
paranoid ideas;
feeling of emptiness;
frequent attacks irritability, inability to control anger.

Test

Simple method diagnostic test, which you can even use yourself, is a test of 10 questions. Some experts shorten it for convenience, since suspicions of BPD can be raised after only 3-4 affirmative answers. The list of questions (with yes/no answers) is as follows:

If you have a feeling of manipulation of your consciousness?
Do you notice quick changes in outbursts of anger? calm attitude to the situation?
Do you feel like everyone is lying to you?
Do you receive unwarranted criticism in your relationship?
Are you afraid of being asked to do something for you because the response will make you appear selfish?
Are you being charged with something you didn't do/said?
You're forced to hide own desires and thoughts from loved ones?

Psychotherapeutic treatment

The main way to influence a borderline mental state is psychotherapy sessions, during which the patient must develop strong trust in the specialist. Therapy can be group or individual; dialectical behavioral techniques are predominantly used. Doctors do not recommend classical psychoanalysis for the treatment of borderline disorder, since it contributes to the growth of already higher level the patient's anxiety.

Dialectical behavior therapy

The most effective method of influencing borderline personality disorder is considered to be an attempt to show the patient the possibility of looking at a seemingly hopeless situation from several sides - this is the essence of dialectical therapy. The specialist helps the patient develop skills to control emotions using the following modules:

Individual sessions - discussion of the prerequisites for anxiety-provoking experiences, analysis of sequences of actions, behavioral manifestations that are life-threatening.
Group sessions – doing exercises and homework, conducting role playing games aimed at stabilizing the psyche in post-traumatic under stress, increasing the effectiveness of interpersonal relationships, controlling emotions.
Telephone contact to overcome a crisis, during which a specialist helps the patient use the skills acquired during the sessions.

Cognitive-analytical methods

The essence of such therapy lies in the formation of a model psychological behavior and analysis of the patient’s thinking errors to identify problems that need to be eliminated to eliminate the personality disorder. The emphasis is on inner experience, feelings, desires and fantasies of the patient in order to form a critical attitude towards the symptoms of the disease and develop skills for independent struggle with them.

Family therapy

A mandatory element in the treatment plan for a person with borderline personality disorder is the work of a psychotherapist with his loved ones. The specialist should give recommendations on optimal interaction with the patient, ways to help with critical situations. The psychotherapist’s tasks include creating a friendly environment in the patient’s family in order to reduce the degree of anxiety and bilateral tension.

How to treat borderline neuropsychiatric disorders with medication

Reception medicines with this diagnosis, it is mainly prescribed only in cases of severe depressive states, against the background of which suicide attempts are made, or in the presence of a biochemical prerequisite for BPD. It is possible to introduce medications into the therapeutic course for patients susceptible to panic attacks, or exhibiting obvious antisocial behavior.

Lithium and anticonvulsants

According to medical statistics, borderline personality disorder is predominantly treated with psychotropic drugs based on lithium salts (Micalit, Contemnol), which help with manic phases, severe depression, and suicidal tendencies through their effect on neurotransmitters. Additionally, anticonvulsant mood stabilizers may be prescribed: Carbamazepine, Gabapentin.

Antidepressants

Selective inhibitors Doctors consider it advisable to prescribe serotonin reuptake for BPD, accompanied by mood lability, emotional breakdowns, dysphoria, and outbursts of rage. Mostly doctors recommend Fluoxetine or Sertraline, the effect of which will appear in 2-5 weeks. The dosage of both drugs is determined individually, the initial dose is 20 mg/day in the morning for Fluoxetine and 50 mg/day for Sertraline.

Second generation antipsychotics

The use of atypical antipsychotics does not provoke motor neurological disorders and an increase in prolactin, and on general symptoms personality disorders and cognitive impairment, these drugs act better than first-generation antipsychotics. Mostly for patients with high excitability, doctors prescribe:

Olanzapine – has pronounced anticholinergic activity, affects affective disorders, but can provoke diabetes.
Aripiprazole is a partial antagonist of dopamine and serotonin receptors and is extremely safe.
Risperidone is the most powerful D2 receptor antagonist, suppresses psychotic agitation, but is not recommended for depression.

Normotimics

Mood stabilizers help mitigate or influence the duration of relapses of affective states, smooth out the manifestations sudden changes mood, short temper, dysphoria. Some mood stabilizers have antidepressant properties - this mainly concerns Lamotrigine, or anti-anxiety (valproate group). Nifedipine and Topiramate are often prescribed for the treatment of BPD.

Video

One of the main character traits of people with similar symptoms- this is the difficulty in restraining your emotions, and controlling yourself and your behavior. It is practically impossible for them to restrain their impulses and instincts, desires and desires. Sometimes a person can even try to restrain himself, but a second or two passes - and he breaks down and does what he wants.

Some such individuals find it very difficult to cope with the manifestation of their own aggression towards other people (they explode literally at one moment, often without reason). Sometimes such people are not restrained sexually. They want “diversity” in relationships, and being with only one partner at all times is a very difficult task for them.

Sometimes border guards psychological disorder- people who cannot live without a dose of risk and adrenaline in the blood. They drive cars at high speed, do extreme species sports, in pursuit of thrills, and a state of inner fullness that cannot be obtained in a calm state.

An ordinary person with a healthy psyche is able to pull himself together and understand that some things are not worth doing, and the degree of risk to life and health is too great. And just step aside. But not a person with a borderline personality state, he will most likely walk “on the edge of a knife.”

Do you know what your compatibility with a man is?

To find out, click on the button below.

The ability to pry into someone else's life without asking

One of the symptoms of such behavior is that a person does not perceive that others may have their own personal lives, boundaries, and it is simply impolite and incorrect to pry into the soul or rummage through another person’s underwear. There are no boundaries for border guards - if he wants, he can break into your personal space, and stun anyone with such behavior.

Argue and prove - sometimes they favorite hobby. They are trying with all their might to hack your logic, your point of view - and break you. It is unacceptable for them that there is a different point of view, that there is a different opinion - and such people will try with all possible manipulations, pressure, provocations - to pressure you so that you follow their lead.

They believe that everything should be the way they think is right. If you have different beliefs, opinions, life in the end, they will try to correct your life to suit their patterns. Different ways, sometimes completely unpleasant and creepy for you. Sometimes when communicating with such a person it really becomes creepy - as if you see an abyss, a whirlpool and an abyss of consciousness.

Inadequacy in various situations

U normal person happen every day various situations, in which you need to behave differently. At work we can play the role of a subordinate and obey our boss, at home - a family man, on the street or in a store - a citizen who behaves in a certain way. In any case, the average person understands the context in which he finds himself - and behaves accordingly. He doesn't behave inappropriately.

But this cannot be said about people who need treatment for borderline personality disorder. They can confuse all possible scenarios and show their complete inadequacy in various situations.

Such people can take responsibility for something that is not required of them at all. Or go into the shadows when the responsibility directly or indirectly lies with them. There is a mixture of different roles in their heads, and for those around them, their actions cause surprise and sometimes indignation.

There are no gray tones in life

A child almost always wants a clear understanding that there is good, and on the other side there is bad. This is a very simple picture of the world, and due to incomplete development psychological state children - it’s just easier for them to perceive reality.

Everything is divided into “ours” and “not ours”, into black, and on the other hand, white. And the world around is painted only in these two colors. This is quite normal for children, but not for a mature adult. He is already able to see that sometimes there are different shades, the picture of the world seems to blur. And a person becomes able to see other colors - and not always divide everyone according to the “friend-enemy” principle.

Remember the main thing - your behavior means a lot to a man, but if there is no harmony at the level of signs, then the relationship will be very tense. It would be very desirable to know exact compatibility exactly your zodiac sign with the sign of a man. This can be done by clicking on the button below:

After all, the real real life- they are diverse and amazing. And it is good precisely because it is full of different colors, plays with the whole palette - like a rainbow, and shimmers with all colors. But not for people with borderline mental states.

Due to the fact that their psychological defense mechanism turns on (they are simply not able to live in a state of uncertainty, the nebula of the real world) - they cut this world in half. After all, it’s simpler and more visual.

This is an underdevelopment of the psyche, a certain infantilism (which is inherent in children), but such people do not notice this. And they cope with their internal problems in a similar way.

Dividing everything into just two colors is characteristic feature psyches of such people. And you can notice it well if you pay attention to it.

Only sometimes the program fails - and uncertainty and instability real world- flips their “switch”. And such people first stand until death on one point of view, and then, unexpectedly for everyone (and sometimes for themselves), they switch to another point of view. Literally in one minute.

Confidence in one's rightness - no matter what

These people are identifiable and can be distinguished in a crowd. Their most important difference from ordinary people- this is not the ability to accept that another person can live his own life, have his own truth and point of view. They must necessarily “do good” and not give anyone else the right to have ideas that differ from the “standard” ones.

Sometimes it may seem to you that this is a sign of toughness and strength of character - a certain core inside a person, when he clearly knows what he wants, knows about his ideas, and defends them.

But this is not true, because such people can radically change their point of view in a short period of time. This is the whole point of such a psychological disorder.

It is practically useless to talk about such oddities to such a person - sometimes he may begin to give arguments in his defense, or somehow make excuses. And sometimes he will simply deny everything and blame you for everything. You get involved in such a dispute, and after a while you regret it - why did you even get into a conversation with such an individual?

Characteristics and symptoms of border guards

These people are always on the edge of a knife, in a state between normal condition psyche, and big illness- and the world psychological disorders. Treatment for such disorders is very difficult and often lengthy. And it is far from a fact that a person is able to pass this period.

Another feature of such people is that it is very difficult for them to be in a long-term relationship with one partner. Stable - this is not about them, and they are looking for thrills- throw hysterics, scandals on empty space, break up and get back together again - and make a regular bright show out of life.

You can ask yourself a few questions, and they will help you understand who is next to you: just an impulsive person, or person with borderline personality disorder, and he needs help and treatment:

1. The person you are with is very unstable. Because of this, plans and decisions are constantly changing, the horizon of the future is very unclear for you;

2. You are constantly accused, you are constantly criticized. And you are afraid to show your feelings - because they will be severely attacked;

3. Adequacy and logic are not about the person who is next to you. Sometimes he greatly surprises you with his actions;

4. You must control any of your movements - if you “puncture” somewhere, then your close person he will definitely remember this to you and begin to manipulate you;

5. A very sharp and unusual change in behavior - you see that the person is normal and adequate, and then - as if he is crazy and does not control himself

6. Sometimes it is difficult for you to do anything at all, since your loved one constantly changes his point of view. As a result, no matter what you do, you will still be accused, criticized and made extreme;

conclusions

We kindly ask you not to try to see similar traits in all your friends. Each of us can sometimes behave inappropriately, and in each of us you can find some traits from what is described above.

Just know that if a person has a developed consciousness and psychological state, he can see various facets, compartments of his mind. It’s as if he can walk through many halls of his head. This diversity of thinking, understanding all kinds of rooms and compartments, gives a more complete understanding of the world.

The borderline state of the individual does not allow us to enter any room of our consciousness and limits access. And that’s why a person behaves one way or another.

Now, if one of your friends has a strict restriction - and you see clear symptoms day after day, then you can think about it and show concern about his psychological state. And think about some kind of treatment.

If you want to be with the man you love, you need to figure out whether you are compatible according to your zodiac sign?

Find out your exact compatibility with a man by clicking on the button below.

These are nonspecific painful manifestations. Neurotic disorders, which define borderline states, are included in the structure various diseases- mental, somatic, neurological, and are expressed in a whole complex of disorders of the neurotic level. It can be increased irritability, asthenia, obsessive states, autonomic dysfunction.

Among the visible root causes of the disease are various conflicts of a psychological nature experienced by a person - be it internal or with environment. Often there are deeper reasons - biological predilection, genetically predetermined character traits. Some time ago, Russia experienced a significant increase in the number of borderline conditions, while the main mental illness- schizophrenia, epilepsy, senile psychoses and others - have been at a stable level for a long time. An increase in the number of neurotic, somatoform disorders (i.e. conditions disguised as various diseases other bodies and systems), of course, was directly related to the situation the country was experiencing in terms of economic crisis and political instability. However, it is difficult to give exact figures for this growth, since last years people often turn to various non-governmental institutions, resort to the services of “magicians”, “sorcerers”, as a result such cases in official statistics don't hit.

In addition, many try to “overcome” painful manifestations on their own, so as not to need to seek treatment again. sick leave in fear of losing my job. Many people talk about the “neurotization” of the population, even at the everyday level, in stores, in public transport; everyone has encountered “inappropriate” reactions in conflict situations. Is there such a problem with medical point vision?

Back in 1991, based on analysis mental health population of Russia and former republics Soviet Union It was suggested that there is a group of so-called social stress disorders, determined by the prevailing socio-economic and political situation. Subsequent work confirmed the development of mass manifestations of conditions psycho-emotional stress and mental maladaptation, which can be called collective mental trauma.

Russian psychiatrists noticed this even after revolutionary events 1905. Then pogroms, strikes, dissatisfaction with the economic and social status caused anxiety, fear, depression in many, and changed their character and habitual behavior. The main causes of social stress disorders in our time are, first of all, the consequences of the long reign of the totalitarian regime, which deprived millions of people of the spiritual, environmental, and ecological basis for organizing life. Powerful stress factors were economic and political chaos, unemployment, aggravation of interethnic conflicts, local civil wars and appearance large number refugees, as well as the economic stratification of society, the growth of civil disobedience and crime. But the main thing is that these reasons are protracted and growing in nature.

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

Foreign studies have identified four types of such motivations.

The first group includes North Americans, Australians, and Britons who are “motivated to achieve.” They are characterized by a desire for wealth, which forces them to rationally and, as accurately as possible, calculate their steps in order to succeed.
The second group includes citizens of countries focused on “protective motivation”, who value “their own little world” in which no one would interfere. These include residents of Austria, Belgium, Italy, Greece, Japan and a number of other countries.
The third group is distinguished by “social motivation”. This includes Yugoslavia, Spain, Brazil, Israel, Turkey, as well as Russia. A feature of life in this group is an “equalizing approach”; although people want an improvement in their quality of life, they believe that “it’s better not to change anything so that it doesn’t get worse.”
The fourth group includes residents of Scandinavian countries, also socially motivated, but, unlike the third group, clearly aimed at improving the quality of life.

The breakdown of the “motivation of the nation”, as well as a change in moral and religious foundations, which, moreover, is of a fairly extended nature in time, is certainly accompanied by increased risk development of social stress disorders, which occupy a significant place in the group of borderline mental states. And medicine, of course, cannot fundamentally change the situation here. She only provides medical assistance and draws public attention to this problem.

Neurotic disorders that define borderline states are part of the structure of various diseases - mental, somatic, neurological, and are expressed in a whole complex of disorders at the neurotic level. These may be increased irritability, asthenia, obsessive states, and autonomic dysfunction.

Causes of mental disorders

Among the visible root causes of the disease are various conflicts of a psychological nature experienced by a person - be it internal or with the environment. Often there are deeper reasons - biological predilection, genetically predetermined character traits. Some time ago in Russia there was a significant increase in the number of borderline conditions, while the main mental illnesses - schizophrenia, epilepsy, senile psychoses and others - have been at a stable level for a long time. The increase in the number of neurotic, somatoform disorders (i.e., conditions masquerading as various diseases of other organs and systems), of course, was directly related to the situation the country was experiencing in terms of economic crisis and political instability. However, it is difficult to give exact figures for this growth, since in recent years people have often turned to various non-governmental institutions for help, resorted to the services of “magicians”, “sorcerers”, and as a result such cases are not included in official statistics.

In addition, many try to “overcome” painful manifestations on their own, so as not to apply for sick leave again for fear of losing their job. Many people talk about the “neurotization” of the population, even at the everyday level, in shops, in public transport; everyone has encountered “inappropriate” reactions in conflict situations. Does such a problem exist from a medical point of view?

What is collective mental trauma?

Back in 1991, based on an analysis of the mental health of the population of Russia and the former republics of the Soviet Union, it was suggested that there is a group of so-called social stress disorders, determined by the prevailing socio-economic and political situation. Subsequent work confirmed the development of mass manifestations of states of psycho-emotional stress and mental maladjustment, which can be called collective mental trauma.

Russian psychiatrists noticed something similar even after the revolutionary events of 1905. Then pogroms, strikes, dissatisfaction with the economic and social situation caused anxiety, fear, depression in many, and changed their character and habitual behavior. The main causes of social stress disorders in our time are, first of all, the consequences of the long reign of the totalitarian regime, which deprived millions of people of the spiritual, environmental, and ecological basis for organizing life. Powerful stress factors were economic and political chaos, unemployment, worsening ethnic conflicts, local civil wars and the emergence of a large number of refugees, as well as the economic stratification of society, the growth of civil disobedience and crime. But the main thing is that these reasons are protracted and growing in nature.

Causes of collective mental trauma

Firstly, in older people - idealization of a past life with her system of relationships, which helps them escape from the problems of today; Secondly - denial of any life values and landmarks, “passive drift” through life; Thirdly - replacement of real socio-psychological problems excessive concern for one’s health, “going into illness”, 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.”

Motivations of the Nation

Foreign studies have identified four types of such motivations.

The first group includes North Americans, Australians, and Britons who are “motivated to achieve.” They are characterized by a desire for wealth, which forces them to rationally and, as accurately as possible, calculate their steps in order to succeed.
The second group includes citizens of countries focused on “protective motivation”, who value “their own little world” in which no one would interfere. These include residents of Austria, Belgium, Italy, Greece, Japan and a number of other countries.
The third group is distinguished by “social motivation”. This includes Yugoslavia, Spain, Brazil, Israel, Turkey, as well as Russia. A feature of life in this group is an “equalizing approach”; although people want an improvement in their quality of life, they believe that “it’s better not to change anything so that it doesn’t get worse.”
The fourth group includes residents of Scandinavian countries, also socially motivated, but, unlike the third group, clearly aimed at improving the quality of life.

The breakdown of the “motivation of the nation,” as well as a change in moral and religious foundations, which, moreover, is quite extended in time, is certainly accompanied by an increased risk of developing social stress disorders, which occupy a significant place in the group of borderline mental states. And medicine, of course, cannot fundamentally change the situation here. It only provides medical assistance and draws public attention to this problem.