Borderline Personality Disorder and Adolescence

SUMMARY

This chapter addresses many of the potential challenges clinicians face when working with adolescents with BPD. First, we present the diagnostic issues related to an adolescent population. Second, we review issues related to the families, peers, and larger systems (e.g., schools) that reciprocally influence the adolescent and the treatment. Third, we discuss specific treatment concerns and propose solutions, including how to effectively manage therapists' own reactions to working with this population. Many of the clinical vignettes and suggested interventions in this chapter derive from our experience working in an outpatient adolescent Dialectical Behavior Therapy (DBT) program. As described later in this book, DBT is an evidence-based treatment effective for suicidal multi-problem individuals with promising data published with suicidal adolescents diagnosed with borderline features (Rathus & Miller, 2002).     

Biological Underpinnings of Borderline Personality Disorder

SUMMARY

Biological understanding of a personality disorder is best achieved by examining the disorder's component dimensions, which for borderline personality disorder include impulsive aggression and affective instability. Current biological research into BPD aims to identify the neurotransmitters and brain regions implicated in each of these key domains. Because of advancing technologies and analytic strategies, structural and functional neuroimaging are at the forefront of such efforts. Structural neuroimaging, primarily in the form of magnetic resonance imaging (MRI) scans, gives information about the anatomy of the brain, while functional neuroimaging, primarily functional MRI (fMRI) and positron emission tomography (PET) scans, gives information about brain activity and neurotransmitter systems at the molecular level. BPD neuroimaging studies to date have implied the involvement of several neurotransmitter systems, principally serotonin, along with dysfunction of select brain regions, including the prefrontal cortex and amygdala, suggesting a “dualbrain pathology”: “hyperarousal-dyscontrol syndrome.” However, the exact mechanisms of all these putative etiologies remain unknown.     

Family Experience of Borderline Personality Disorder

Individuals with borderline personality disorder (BPD) struggle with unbearable emotions that arise out of interpersonal difficulties. Self‐harm and suicidal behaviours serve to regulate these emotions and to gain a sense of well‐being and control in a treatment context where hospital admissions are avoided by mental health services. Clinician engagement with families may be constrained by their knowing the accepted etiology of the disorder, which includes a causal link with the family environment. Other constraining factors include the negativity of those with BPD toward their family, and their clinicians' diagnostic uncertainty or confusion. This qualitative study explored the experience of families whose close relative with BPD has a long history of self‐harm and/or suicide attempts. Family members were found to have chronic and traumatic stress. Family roles and relationships were strained, as were relationships between the family and the mental health system. The findings of this study indicate that treatment for BPD needs to adopt a systemic approach that considers individuals and their significant family relationships, as well as relationships between the family and treatment providers.     

Psychotropic Drug Use Among College Students: Patterns of Use,Misuse, and Medical Monitoring

Abstract

Objective: To assess whether college students who use psychotropic drugs are (1) aware of potential side effects, (2) appropriately monitored by prescribing physicians, and (3) taking medications as prescribed. Participants: Fifty-five college students, currently taking psychotropic medications, were recruited between Summer 2008 and Fall 2009. Methods: Participants were given interviews assessing (1) interactions with prescribing physicians, (2) patterns of psychotropic drug use, and (3) Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) substance use disorders. Results: Twenty-five percent of participants did not remember being assessed for suicidal ideation. A large number of participants took their medications in different quantities or frequencies than prescribed and 35% of participants met DSM criteria for substance dependence. Conclusions: Many students are misusing psychotropic medications and this misuse is not being communicated with prescribing physicians.     

Family Systemic Approaches for Borderline Personality Disorder in Acute Adult Mental Health Care Settings

This thematic literature review explores the contribution of family/systemic approaches in the treatment and care of people with borderline personality disorder (BPD) in acute adult mental health care settings. It recognises the importance of early childhood trauma, family dynamics, and relationships in the aetiology of BPD and outlines key benefits and constraints of a family systems approach. The article discusses institutional, cultural, and power structures that influence the diagnosis and treatment process for adult clients with BPD and the value of relational ethics in guiding or mediating care between the family, healthcare system, and community.     

Heavy Episodic Drinking in College Students: Associations With Features of Psychopathy and Antisocial Personality Disorder

Abstract

Objective: This study extends the college heavy episodic drinking literature by examining the associations between features of psychopathy and antisocial personality disorder (ASPD), on the one hand, and heavy episodic drinking and associated problem behaviors, on the other. Participants: Participants were 159 (85 male, 74 female) undergraduates from a private university. Methods: Participants completed self-report measures assessing alcohol use, frequency, and consequences of heavy episodic drinking, and personality pathology. Results: It was found that psychopathy, independent of ASPD, was related to the prediction of heavy episodic drinking frequency and problems associated with alcohol use. It was also found that the relation between traits of psychopathy and heavy episodic drinking are limited largely to the impulsive and antisocial aspects of this condition. Conclusion: These findings point to the need for further investigation of the association between psychopathy and ASPD traits and heavy episodic drinking behaviors in college students.     

Perceived Stress,Energy Drink Consumption,and Academic Performance Among College Students

Abstract

Objective: This study explored relationships regarding perceived stress, energy drink consumption, and academic performance among college students. Participants: Participants included 136 undergraduates attending a large southern plains university. Methods: Participants completed surveys including items from the Perceived Stress Scale ¹ Cohen, S, Kamarck, T and Mermelstein, R. 1983. A global measure of perceived stress. J Health Soc Behav, 24: 385–396. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar] and items to describe energy drink consumption, academic performance, and demographics. Results: Positive correlations existed between participants’ perceived stress and energy drink consumption. Participants’ energy drink consumption and academic performance were negatively correlated. Freshmen (M = 0.330) and sophomores (M = 0.408) consumed a lower number of energy drinks yesterday than juniors (M = 1.000). Males reported higher means than females for selected energy drink consumption items. Statistically significant interactions existed between gender and year in school for selected energy drink consumption items. Conclusions: Results confirm gender differences in energy drink consumption and illuminate a need for education regarding use of energy drinks in response to perceived stress.     

A Survey of 100 Community Colleges on Student Substance Use,Programming, and Collaborations

Abstract

Objective: The objective was to survey community college personnel about student substance use, and infrastructure (staff and funding), programs, and collaborations dedicated to substance use prevention. Participants: The sample included 100 administrators, faculty, and health services staff at 100 community colleges. Methods: Participants completed a Web-based survey. Results: Participants reported a number of alcohol and other drug (AOD) related concerns. Despite limited staff and funding dedicated to AOD, institutions are implementing a number of programs, although many are not implementing some of the programs popular at traditional 4-year colleges. They are also collaborating with a number of on- and off-campus groups. The availability of staff and funding dedicated to AOD, and the presence of residence halls, is associated with health programming and substance abuse collaborations. Conclusions: Results suggest that there is a need for increased research to understand the most effective AOD prevention strategies for community colleges.     

On-Campus Programs to Support College Students in Recovery

Abstract

The author argues that referral of alcohol-abusing college students to off-campus treatment services, although necessary for some, is not optimal for many. He advocates the implementation of comprehensive on-campus services for students committed to recovery in order to optimize their treatment while allowing them to remain in school and work towards their degree. The author suggests that such on-campus recovery services provide additional benefits to the college or university as well as to other students, and he proposes that on-campus alcohol-abusing students in recovery can serve as important opinion leaders and role models for their peers.     

A Review of Multicomponent Interventions to Prevent and Control Tobacco Use Among College Students

Abstract

Objective: Multicomponent tobacco control programs have been implemented at the state and community levels and have led to a reduction in tobacco use. The purpose was to review the public health research literature on tobacco prevention and control programs on college campuses and derive evidence-based implications for comprehensive program implementation. Methods: MEDLINE, PsycINFO, ERIC, and PubMed databases were used to search the research literature concerning tobacco prevention and control programs conducted on college campuses published between 2000 and 2009. Results: No studies were found that implemented all 5 recommended components of a comprehensive program. Tobacco control programs containing policy and prevention education were used the most and promotion of tobacco-free environments and banning sales of tobacco products were used the least. Conclusion: The review suggests that despite the recommendation of comprehensive tobacco control programs to reduce tobacco use on college campuses, few institutions have implemented and evaluated programs consisting of multiple components.     

Special Considerations in the Treatment of College Students With Bipolar Disorder

Abstract

Bipolar disorder is a relatively common mental disorder that often has its onset during the college years. This means that students simultaneously face both the challenge of late adolescent development and the challenge of adapting to a major mental illness. As a further complication, the college environment is not well suited to the kinds of lifestyle changes that add stability to the lives of people with bipolar disorder. Treatment involves establishing an alliance, education about lifestyle changes, aiding adaptation to the illness, careful medication to minimize side effects, and loosening the affective constriction that can result from fear of relapse. Both the health care provider and student can use the culture of learning and self-discovery in the college setting to the treatment's benefit. As well, the provider can use the time-limited nature of college to lessen ambivalence about making long-term changes.     

Social Networks,Substance Use,and Mental Health in College Students

Abstract

Objectives: The relationship between social network risk (alcohol-using close friends), perceived peer closeness, substance use, and psychiatric symptoms was examined to identify risk and protective features of college students’ social context. Participants: Six hundred and seventy undergraduate students enrolled in a large southeastern university. Methods: An online survey was administered to consenting students. Results: Students with risky networks were at a 10-fold increase of hazardous drinking, 6-fold increase for weekly marijuana use, and 3-fold increase for weekly tobacco use. College students’ who feel very close to their peers were protected against psychiatric symptoms yet were at increased risk for marijuana use. Perceived closeness of peers was highly protective against psychiatric symptoms, adding a natural preventive effect for a population at great risk for mental illness. Conclusions: Results support targeting college students through network-oriented preventive interventions to address substance use as well as mental health.     

Coping and Regulating Emotions: A Pilot Study of a Modified Dialectical Behavior Therapy Group Delivered in a College Counseling Service

Abstract

Objective: To analyze the efficacy of a pilot program, aimed at treating college students with borderline personality disorder (BPD) using short-term, modified group dialectical behavior therapy at an Australian college counseling service (CCS). Participants: Seventeen enrolled college students aged between 18 and 28 (76.5% female), with a diagnosis of BPD completed the program between November 2009 and November 2010. Methods: Participants attended 8 2-hour group therapy sessions, held at the CCS during semester. Participants were assessed for levels of depression, anxiety, BPD traits, and coping strategies, at commencement and completion of the program. Results: There was a reduction in symptoms of depression and BPD traits, and an increase in adaptive coping skills, including problem solving, and constructive self-talk. There was no reduction in anxiety. Conclusions: The findings indicate promise for short-term treatment of college students with BPD. Implications and limitations are discussed, with emphasis on replication with a control group.     

Computerized Behavioral Interventions: Current Products and Recommendations for Substance Use Disorder Treatment

Unlike traditional methods of delivering substance use disorder (SUD) and mental health treatment, computerized behavioral interventions deliver services via computers, smartphones, and other electronic devices. In recent years, there has been a proliferation of Web-based treatment programs designed for certain target populations. Studies have shown that many of these programs are evidence-based, and some are just as effective as traditional in-person interventions. This article reviews current computerized behavioral interventions and makes recommendations for how these tools can be incorporated into SUD treatment services.     

Flourishing,Substance Use,and Engagement in Students Entering College: A Preliminary Study

Abstract

Objective: The purpose of this study was to identify the health topics students received information about, how students obtained health-related information, and perceived believability of those sources. Participants and Methods: Students (N = 1202) were surveyed using the National College Health Assessment (NCHA) of the American College Health Association. Results: Nearly half (46%) of the sample reported not receiving any information, whereas only 0.5% received information on all health topics. The Internet was the most common source of health-related information, but, conversely, was perceived as the least believable source. Health center medical staff and university health educators were perceived to be the most believable sources. Conclusions: Future practice at the university setting should focus on delivering health information through believable messengers utilizing the most commonly reported sources of information. This may have implications towards how students shape their health-related social cognitions and subsequent behaviors.     

Exploring the Relationship Between Experiential Avoidance,Alcohol Use Disorders,and Alcohol-Related Problems Among First-Year College Students

Abstract

Objective: This study explored the relationship of experiential avoidance (eg, the tendency to avoid, suppress, or otherwise control internal experiences even when doing so causes behavioral harm) to alcohol use disorders and alcohol-related problems. Participants: Cross-sectional data were collected from 240 undergraduate college students in their first year in college between December 2009 and April 2010. Methods: Participants completed a diagnostic interview and online self-report survey. Results: Students with a history of alcohol abuse or dependence had significantly higher levels of experiential avoidance relative to students with no alcohol use disorder diagnosis. A hierarchical linear regression analysis found that experiential avoidance significantly predicted alcohol-related problems, even after controlling for gender and psychological distress. Furthermore, experiential avoidance mediated the relationship of psychological distress to alcohol-related problems. Conclusions: These findings suggest that experiential avoidance may play a role in problematic alcohol use among college students.     

Perceived Discrimination and Its Associations With Mental Health and Substance Use Among Asian American and Pacific Islander Undergraduate and Graduate Students

Abstract

Objectives: Racial discrimination experiences can negatively affect health. This study examined perceived discrimination and its relationship with mental health and substance use among Asian American and Pacific Islander (API) undergraduate and graduate students. Participants: A total of 113 API students aged 18–35 completed the study during February–June, 2011. Methods: The authors conducted a cross-sectional, anonymous survey online. Dependent variables included mental health (depressive, anxiety, and somatic symptoms) and substance use (alcohol problems, use of tobacco, marijuana or hashish, and other illegal drugs). Results: Students’ perceived discrimination were significantly, positively associated with depressive, anxiety, and somatic symptoms, but not with substance use. Ethnic identity moderated the relationship between perceived discrimination and somatic symptoms, but not depressive or anxiety symptoms. Conclusions: These findings suggested the negative effect of racial discrimination on API students’ mental health. The buffering effect of ethnic identity may increase resilience in these students when they face racial discrimination.