¿Cuál es la terapia adecuada para ti?
Psicoterapia Individual.
Individual, uno-a-uno, es el elemento básico de la salud mental. Algunos tipos son mejores para ciertos trastornos.
Individual, uno-a-uno, es el elemento básico de la salud mental. Algunos tipos son mejores para ciertos trastornos.
Terapia
psicodinámica (psicoanálisis) anima a los pacientes a compartir las
cosas que necesitan hablar hasta que llegan a una resolución. Esto puede tomar semanas, meses o
años. El
énfasis principal de la terapia psicoanalítica está en la relación entre el
terapeuta y paciente, que es visto como un modelo de todas las demás relaciones
y es considerado el principal agente de cambio. Funciona
mejor con personalidades histriónicas, trastorno obsesivo-compulsivo, depresión
neurótica, y la mayoría de las formas de ansiedad.
Terapia Cognitivo-Conductual (TCC) que es popular hoy en día, hace hincapié en los cambios de comportamiento y no entra en el pasado como el psicoanálisis, sino que se concentra en el pensamiento y patrones de comportamiento que son contraproducentes, esforzándose por intervenciones aquí-y-ahora para poner al paciente de vuelta en el camino correcto; a menudo se utiliza de manera efectiva con las fobias, trastorno de pánico, y hábitos destructivos tales como fumar o beber o varios trastornos de la alimentación.
Psicoterapia Humanista (incluyendo Terapia Gestalt y centrada en el paciente) se centra en lo que una persona necesita para nutrir su potencial como ser humano. Conciencia de los sentimientos en el aquí y ahora es visto como crucial para lograr el funcionamiento psicológico saludable. Esto funciona bien con las personas deprimidas y todos aquellos que se sienten bloqueados.
Una serie de otras modalidades existen. Incluyen Terapia de Apoyo, que consiste en ayudar a un paciente a través de una crisis. Terapia interpersonal identifica cómo una persona interactúa con otras personas. Cuando una conducta está causando problemas, TIP guía a la persona para cambiar el comportamiento. Terapias físicas como Bioenergética para liberar a una persona de emociones bloqueadas como la ira o la tristeza. Hay mil y un tipo de terapias y todas pueden ser útiles. Lo más importante es que se debe establecer un vínculo de confianza entre el paciente y el terapeuta para cualquier terapia funcione.
Terapia de grupo
Cuando los pacientes están listos, se les anima a participar en la terapia de grupo. En el grupo pueden observar e identificar con otras personas que están pasando por situaciones similares, así como interactuar con ellos. Los grupos proporcionan un ambiente seguro en el que puedan tomar riesgos y ponerse en contacto con sus sentimientos. Esto les ayuda a aprender a tolerar la verdadera intimidad, que implica el flujo de sentimientos positivos y negativos, sin intentar manipular las relaciones que se encuentran.
Terapia Familiar / Terapia de pareja
Familias o parejas disfuncionales pueden beneficiarse de hablar de sus conflictos con la ayuda de un profesional, que medie en las disputas y ofrece retroalimentación constructiva sobre su resolución. A menudo las familias no se ocupan de sus conflictos internos. La mayoría de las familias quieren pensar que son las familias felices y tienden a minimizar o suprimir los conflictos. El primer paso en la terapia familiar, como en cualquier otra terapia, es reconocer los problemas y estar dispuesto a enfrentarse a ellos.
Psicoterapia infantil
Los terapeutas que trabajan con los niños utilizan métodos que están diseñados para determinados grupos de edad. Los niños muy pequeños (menores de seis años) requieren terapia de juego, ya que no son verbales que aún y no suelen entender lo que son los sentimientos; jugando revelan sus sentimientos. Los niños mayores pueden beneficiarse de la terapia de conversación de varias clases. Es importante con los niños, al igual que con los adultos, no culpar a los niños por sus trastornos, sino de estar abiertos a descubrir la verdad, sea lo que sea. Si se trata de un padre que está causando el problema, el padre o los padres deben ponerse en el tratamiento.
Terapia en línea
Cuando los pacientes no pueden venir a la oficina debido a la edad, la discapacidad o estar en una ubicación remota, programas de mensajería instantánea como Skype proporcionan un vehículo para la comunicación terapéutica. Sesiones en línea, al igual que las sesiones de oficina, se llevan a cabo una vez por semana y utilizan las mismas técnicas. La terapia en línea también permite a un paciente elegir entre una multitud de terapeutas en todo el mundo, no sólo los de su propio vecindario. Con los avances en la tecnología, las sesiones en línea pueden ser tan significativas e intensas como terapia en persona.
Terapia Cognitivo-Conductual (TCC) que es popular hoy en día, hace hincapié en los cambios de comportamiento y no entra en el pasado como el psicoanálisis, sino que se concentra en el pensamiento y patrones de comportamiento que son contraproducentes, esforzándose por intervenciones aquí-y-ahora para poner al paciente de vuelta en el camino correcto; a menudo se utiliza de manera efectiva con las fobias, trastorno de pánico, y hábitos destructivos tales como fumar o beber o varios trastornos de la alimentación.
Psicoterapia Humanista (incluyendo Terapia Gestalt y centrada en el paciente) se centra en lo que una persona necesita para nutrir su potencial como ser humano. Conciencia de los sentimientos en el aquí y ahora es visto como crucial para lograr el funcionamiento psicológico saludable. Esto funciona bien con las personas deprimidas y todos aquellos que se sienten bloqueados.
Una serie de otras modalidades existen. Incluyen Terapia de Apoyo, que consiste en ayudar a un paciente a través de una crisis. Terapia interpersonal identifica cómo una persona interactúa con otras personas. Cuando una conducta está causando problemas, TIP guía a la persona para cambiar el comportamiento. Terapias físicas como Bioenergética para liberar a una persona de emociones bloqueadas como la ira o la tristeza. Hay mil y un tipo de terapias y todas pueden ser útiles. Lo más importante es que se debe establecer un vínculo de confianza entre el paciente y el terapeuta para cualquier terapia funcione.
Terapia de grupo
Cuando los pacientes están listos, se les anima a participar en la terapia de grupo. En el grupo pueden observar e identificar con otras personas que están pasando por situaciones similares, así como interactuar con ellos. Los grupos proporcionan un ambiente seguro en el que puedan tomar riesgos y ponerse en contacto con sus sentimientos. Esto les ayuda a aprender a tolerar la verdadera intimidad, que implica el flujo de sentimientos positivos y negativos, sin intentar manipular las relaciones que se encuentran.
Terapia Familiar / Terapia de pareja
Familias o parejas disfuncionales pueden beneficiarse de hablar de sus conflictos con la ayuda de un profesional, que medie en las disputas y ofrece retroalimentación constructiva sobre su resolución. A menudo las familias no se ocupan de sus conflictos internos. La mayoría de las familias quieren pensar que son las familias felices y tienden a minimizar o suprimir los conflictos. El primer paso en la terapia familiar, como en cualquier otra terapia, es reconocer los problemas y estar dispuesto a enfrentarse a ellos.
Psicoterapia infantil
Los terapeutas que trabajan con los niños utilizan métodos que están diseñados para determinados grupos de edad. Los niños muy pequeños (menores de seis años) requieren terapia de juego, ya que no son verbales que aún y no suelen entender lo que son los sentimientos; jugando revelan sus sentimientos. Los niños mayores pueden beneficiarse de la terapia de conversación de varias clases. Es importante con los niños, al igual que con los adultos, no culpar a los niños por sus trastornos, sino de estar abiertos a descubrir la verdad, sea lo que sea. Si se trata de un padre que está causando el problema, el padre o los padres deben ponerse en el tratamiento.
Terapia en línea
Cuando los pacientes no pueden venir a la oficina debido a la edad, la discapacidad o estar en una ubicación remota, programas de mensajería instantánea como Skype proporcionan un vehículo para la comunicación terapéutica. Sesiones en línea, al igual que las sesiones de oficina, se llevan a cabo una vez por semana y utilizan las mismas técnicas. La terapia en línea también permite a un paciente elegir entre una multitud de terapeutas en todo el mundo, no sólo los de su propio vecindario. Con los avances en la tecnología, las sesiones en línea pueden ser tan significativas e intensas como terapia en persona.
Filosofías de la terapia
Hay muchas filosofías de la terapia y muchos enfoques, pero la mayoría de los terapeutas de hoy en día usan un enfoque ecléctico a la terapia, lo que significa que usan cualquier técnica funciona con un paciente en particular. A veces eso requiere un enfoque psicoanalítico, a veces se exige un trabajo conductual o cognitivo y, a veces un enfoque de apoyo. El resultado final es la empatía. Los terapeutas respetan los sentimientos y pensamientos de los pacientes y tratan de entenderlos sin juzgarlos. Este ambiente sin prejuicios ofrece a un paciente el espacio necesario para averiguar las cosas que hay que encontrar.
Un terapeuta no guía, obliga o manipula a los pacientes. En su lugar, él o ella trata de ayudarlos a lograr sus objetivos declarados al aclarar sus conflictos y cómo esos conflictos, personales o profesionales, están afectando su bienestar. El terapeuta guía a los pacientes comprender sus propios sentimientos y pensamientos de manera que puedan tomar mejores decisiones por su cuenta. Sólo cuando los pacientes están en contacto con sus sentimientos pueden vivir una vida auténtica.
Schoenewolf, G. (2016). Which Therapy is Right for You?. Psych Central. Retrieved on February 18, 2016, from http://blogs.psychcentral.com/psychoanalysis-now/2016/02/which-therapy-is-right-for-you/
There are many kinds of therapy and often it is difficult for consumers to figure out which is right for them. Here is a brief overview.
Individual Psychotherapy.
Psychodynamic Therapy (psychoanalysis) encourages clients to talk about the things they need to talk about until they reach a resolution. This may take weeks, months or years. The main emphasis of psychoanalytic therapy is on the relationship between therapist and client, which is seen as a model of all other relationships and is considered the main agent of change. It works best with histrionic personalities, obsessive-compulsive disorder, neurotic depression, and most forms of anxiety.
Cognitive-Behavioral Therapy (CBT), which is popular nowadays, emphasizes behavioral changes and does not go into the past as psychoanalysis does, but instead concentrates on thought and behavioral patterns that are counterproductive, striving through here-and-now interventions to put the client back on the right track; it is often used effectively with phobias, panic disorder, and destructive habits such as smoking or drinking or various eating disorders.
Humanistic Psychotherapy (including Client-Centered Therapy and Gestalt Therapy) focuses on what a person needs in the form of nurturing in order to full their potential as a human being. Awareness of feelings in the here and now is seen as crucial for achieving healthy psychological functioning. This works well with depressed people and all those who feel blocked.
A host of other modalities exist. They include Supportive Therapy, which involves helping a client through a crisis.
Interpersonal Therapy identifies how a person interacts with other people. When a behavior is causing problems, IPT guides the person to change the behavior. Physical therapies such as Bioenergetics or EMDR use exercises to free a person from blocked emotions such as anger or sadness. There are a hundred and one other kinds of therapy and all can be helpful. The main thing is that a bond of trust must be established between the client and therapist for any therapy to work.
Group Therapy
Group therapy fosters a family-like atmosphere that, when it is working well, provides a new, more constructive model of relating. Clients tend to transfer qualities of relating onto members of the group or the group leader, and they then have the opportunity to understand first hand and work through them.
Family Therapy/Couples Therapy
Dysfunctional families or couples can benefit from talking about their conflicts with the help of a professional, who mediates disputes and offers constructive feedback about resolving them. Often families do not deal with their internal conflicts. Most families want to think they are happy families and tend to minimize or suppress conflicts. The first step in family therapy, as in any other therapy, is to acknowledge problems and be willing to face them.
Child Psychotherapy
Therapists who work with children use methods that are designed for particular age groups. Very young children (under six) require play therapy, since they are not that verbal yet and do not usually understand what they are feelings. Their play reveals their feelings. Older children can benefit from talk therapy of various kinds. It is important with children, as with adults, not to blame the children for their disorders, but to be open to finding out the truth, whatever it is. If it is a parent who is causing the problem, the parent or parents should be brought into the treatment.
Online Therapy
When clients cannot come to the office due to age, disability or being in a remote location, instant messenger programs such as SKYPE provide a vehicle for therapeutic communication. Online sessions, like office sessions, are held once a week and utilize the same techniques. Online therapy also enables a client to choose from a multitude of therapists all over the world, not just those in their own neighborhood. With the advances in technology, online sessions can be just as meaningful and intense as in-person therapy. Unfortunately insurance has not caught up with the digital age so online sessions generally must be paid for out of pocket.
Philosophies of Therapy
There are many philosophies of therapy and many approaches, but most therapists today use an eclectic approach to therapy, which means they use whatever technique works with a particular client. Sometimes that requires a psychoanalytic approach, sometimes it demands behavioral or cognitive work and sometimes a supportive approach. The bottom line is empathy. Therapists respect the feelings and thoughts of clients and try to understand them without judging them. This nonjudgmental atmosphere gives a client the space needed to figure out things that need figuring out.
A therapist doesn’t guide or force clients or use any form of manipulation. Instead, he or she attempts to help clients achieve their stated goals by shedding light on their conflicts and how those conflicts, personal or professional, are affecting their well-being. The therapist guides by helping them to understand their own feelings and thoughts so that they can make better decisions on their own. Only when clients are in touch with their feelings can they live an authentic life.
Schoenewolf, G. (2016). Which Therapy is Right for You?. Psych Central. Retrieved on February 18, 2016, from http://blogs.psychcentral.com/psychoanalysis-now/2016/02/which-therapy-is-right-for-you/
What is Borderline Personality Disorder?
Borderline personality disorder (BPD) is a serious mental illness marked by unstable moods, behavior, and relationships. In 1980, theDiagnostic and Statistical Manual for Mental Disorders, Third Edition(DSM-III) listed BPD as a diagnosable illness for the first time. Most psychiatrists and other mental health professionals use the DSM to diagnose mental illnesses.
Because some people with severe BPD have brief psychotic episodes, experts originally thought of this illness as atypical, or borderline, versions of other mental disorders. While mental health experts now generally agree that the name "borderline personality disorder" is misleading, a more accurate term does not exist yet.
Most people who have BPD suffer from:
- Problems with regulating emotions and thoughts
- Impulsive and reckless behavior
- Unstable relationships with other people.
People with this disorder also have high rates of co-occurring disorders, such as depression, anxiety disorders, substance abuse, and eating disorders, along with self-harm, suicidal behaviors, and completed suicides.
Causes
Research on the possible causes and risk factors for BPD is still at a very early stage. However, scientists generally agree that genetic and environmental factors are likely to be involved.
Studies on twins with BPD suggest that the illness is strongly inherited. Another study shows that a person can inherit his or her temperament and specific personality traits, particularly impulsiveness and aggression. Scientists are studying genes that help regulate emotions and impulse control for possible links to the disorder.
Social or cultural factors may increase the risk for BPD. For example, being part of a community or culture in which unstable family relationships are common may increase a person's risk for the disorder. Impulsiveness, poor judgment in lifestyle choices, and other consequences of BPD may lead individuals to risky situations. Adults with borderline personality disorder are considerably more likely to be the victim of violence, including rape and other crimes.
Signs & Symptoms
According to the DSM, Fourth Edition, Text Revision (DSM-IV-TR), to be diagnosed with borderline personality disorder, a person must show an enduring pattern of behavior that includes at least five of the following symptoms:
- Extreme reactions—including panic, depression, rage, or frantic actions—to abandonment, whether real or perceived
- A pattern of intense and stormy relationships with family, friends, and loved ones, often veering from extreme closeness and love (idealization) to extreme dislike or anger (devaluation)
- Distorted and unstable self-image or sense of self, which can result in sudden changes in feelings, opinions, values, or plans and goals for the future (such as school or career choices)
- Impulsive and often dangerous behaviors, such as spending sprees, unsafe sex, substance abuse, reckless driving, and binge eating
- Recurring suicidal behaviors or threats or self-harming behavior, such as cutting
- Intense and highly changeable moods, with each episode lasting from a few hours to a few days
- Chronic feelings of emptiness and/or boredom
- Inappropriate, intense anger or problems controlling anger
- Having stress-related paranoid thoughts or severe dissociative symptoms, such as feeling cut off from oneself, observing oneself from outside the body, or losing touch with reality.
Seemingly mundane events may trigger symptoms. For example, people with BPD may feel angry and distressed over minor separations—such as vacations, business trips, or sudden changes of plans—from people to whom they feel close. Studies show that people with this disorder may see anger in an emotionally neutral face and have a stronger reaction to words with negative meanings than people who do not have the disorder.
Suicide and Self-harm
Self-injurious behavior includes suicide and suicide attempts, as well as self-harming behaviors, described below. As many as 80 percent of people with BPD have suicidal behaviors, and about 4 to 9 percent commit suicide.
Suicide is one of the most tragic outcomes of any mental illness. Some treatments can help reduce suicidal behaviors in people with BPD. For example, one study showed that dialectical behavior therapy (DBT) reduced suicide attempts in women by half compared with other types of psychotherapy, or talk therapy. DBT also reduced use of emergency room and inpatient services and retained more participants in therapy, compared to other approaches to treatment.
Unlike suicide attempts, self-harming behaviors do not stem from a desire to die. However, some self-harming behaviors may be life threatening. Self-harming behaviors linked with BPD include cutting, burning, hitting, head banging, hair pulling, and other harmful acts. People with BPD may self-harm to help regulate their emotions, to punish themselves, or to express their pain. They do not always see these behaviors as harmful.
Who Is At Risk?
According to data from a subsample of participants in a national survey on mental disorders, about 1.6 percent of adults in the United States have BPD in a given year. BPD usually begins during adolescence or early adulthood. Some studies suggest that early symptoms of the illness may occur during childhood.
Diagnosis
Unfortunately, BPD is often underdiagnosed or misdiagnosed.
A mental health professional experienced in diagnosing and treating mental disorders—such as a psychiatrist, psychologist, clinical social worker, or psychiatric nurse—can detect BPD based on a thorough interview and a discussion about symptoms. A careful and thorough medical exam can help rule out other possible causes of symptoms.
The mental health professional may ask about symptoms and personal and family medical histories, including any history of mental illnesses. This information can help the mental health professional decide on the best treatment. In some cases, co-occurring mental illnesses may have symptoms that overlap with BPD, making it difficult to distinguish borderline personality disorder from other mental illnesses. For example, a person may describe feelings of depression but may not bring other symptoms to the mental health professional's attention.
Women with BPD are more likely to have co-occurring disorders such as major depression, anxiety disorders, or eating disorders. In men, BPD is more likely to co-occur with disorders such as substance abuse or antisocial personality disorder. According to the NIMH-funded National Comorbidity Survey Replication—the largest national study to date of mental disorders in U.S. adults—about 85 percent of people with BPD also meet the diagnostic criteria for another mental illness. Other illnesses that often occur with BPD include diabetes, high blood pressure, chronic back pain, arthritis, and fibromyalgia. These conditions are associated with obesity, which is a common side effect of the medications prescribed to treat BPD and other mental disorders.
No single test can diagnose BPD. Scientists funded by NIMH are looking for ways to improve diagnosis of this disorder. One study found that adults with BPD showed excessive emotional reactions when looking at words with unpleasant meanings, compared with healthy people. People with more severe BPD showed a more intense emotional response than people who had less severe BPD.
Treatments
BPD is often viewed as difficult to treat. However, recent research shows that BPD can be treated effectively, and that many people with this illness improve over time.
BPD can be treated with psychotherapy, or "talk" therapy. In some cases, a mental health professional may also recommend medications to treat specific symptoms. When a person is under more than one professional's care, it is essential for the professionals to coordinate with one another on the treatment plan.
The treatments described below are just some of the options that may be available to a person with BPD. However, the research on treatments is still in very early stages. More studies are needed to determine the effectiveness of these treatments, who may benefit the most, and how best to deliver treatments.
Psychotherapy
Psychotherapy is usually the first treatment for people with BPD. Current research suggests psychotherapy can relieve some symptoms, but further studies are needed to better understand how well psychotherapy works.
It is important that people in therapy get along with and trust their therapist. The very nature of BPD can make it difficult for people with this disorder to maintain this type of bond with their therapist.
Types of psychotherapy used to treat BPD include the following:Cognitive behavioral therapy (CBT). CBT can help people with BPD identify and change core beliefs and/or behaviors that underlie inaccurate perceptions of themselves and others and problems interacting with others. CBT may help reduce a range of mood and anxiety symptoms and reduce the number of suicidal or self-harming behaviors.
- Dialectical behavior therapy (DBT). This type of therapy focuses on the concept of mindfulness, or being aware of and attentive to the current situation. DBT teaches skills to control intense emotions, reduces self-destructive behaviors, and improves relationships. This therapy differs from CBT in that it seeks a balance between changing and accepting beliefs and behaviors.
- Schema-focused therapy. This type of therapy combines elements of CBT with other forms of psychotherapy that focus on reframing schemas, or the ways people view themselves. This approach is based on the idea that BPD stems from a dysfunctional self-image—possibly brought on by negative childhood experiences—that affects how people react to their environment, interact with others, and cope with problems or stress.
Therapy can be provided one-on-one between the therapist and the patient or in a group setting. Therapist-led group sessions may help teach people with BPD how to interact with others and how to express themselves effectively.
One type of group therapy, Systems Training for Emotional Predictability and Problem Solving (STEPPS), is designed as a relatively brief treatment consisting of 20 two-hour sessions led by an experienced social worker. Scientists funded by NIMH reported that STEPPS, when used with other types of treatment (medications or individual psychotherapy), can help reduce symptoms and problem behaviors of BPD, relieve symptoms of depression, and improve quality of life. The effectiveness of this type of therapy has not been extensively studied.
Families of people with BPD may also benefit from therapy. The challenges of dealing with an ill relative on a daily basis can be very stressful, and family members may unknowingly act in ways that worsen their relative's symptoms.
Some therapies, such as DBT-family skills training (DBT-FST), include family members in treatment sessions. These types of programs help families develop skills to better understand and support a relative with BPD. Other therapies, such as Family Connections, focus on the needs of family members. More research is needed to determine the effectiveness of family therapy in BPD. Studies with other mental disorders suggest that including family members can help in a person's treatment.
Other types of therapy not listed in this booklet may be helpful for some people with BPD. Therapists often adapt psychotherapy to better meet a person's needs. Therapists may switch from one type of therapy to another, mix techniques from different therapies, or use a combination therapy. For more information see the NIMH website section onpsychotherapy.
Some symptoms of BPD may come and go, but the core symptoms of highly changeable moods, intense anger, and impulsiveness tend to be more persistent. People whose symptoms improve may continue to face issues related to co-occurring disorders, such as depression or post-traumatic stress disorder. However, encouraging research suggests that relapse, or the recurrence of full-blown symptoms after remission, is rare. In one study, 6 percent of people with BPD had a relapse after remission.
Medications
No medications have been approved by the U.S. Food and Drug Administration to treat BPD. Only a few studies show that medications are necessary or effective for people with this illness. However, many people with BPD are treated with medications in addition to psychotherapy. While medications do not cure BPD, some medications may be helpful in managing specific symptoms. For some people, medications can help reduce symptoms such as anxiety, depression, or aggression. Often, people are treated with several medications at the same time, but there is little evidence that this practice is necessary or effective.
Medications can cause different side effects in different people. People who have BPD should talk with their prescribing doctor about what to expect from a particular medication.
Other Treatments
Omega-3 fatty acids. One study done on 30 women with BPD showed that omega-3 fatty acids may help reduce symptoms of aggression and depression. The treatment seemed to be as well tolerated as commonly prescribed mood stabilizers and had few side effects. Fewer women who took omega-3 fatty acids dropped out of the study, compared to women who took a placebo (sugar pill).
With proper treatment, many people experience fewer or less severe symptoms. However, many factors affect the amount of time it takes for symptoms to improve, so it is important for people with BPD to be patient and to receive appropriate support during treatment.
Living With
Some people with BPD experience severe symptoms and require intensive, often inpatient, care. Others may use some outpatient treatments but never need hospitalization or emergency care. Some people who develop this disorder may improve without any treatment.
How can I help a friend or relative who has BPD?
If you know someone who has BPD, it affects you too. The first and most important thing you can do is help your friend or relative get the right diagnosis and treatment. You may need to make an appointment and go with your friend or relative to see the doctor. Encourage him or her to stay in treatment or to seek different treatment if symptoms do not appear to improve with the current treatment.
To help a friend or relative you can:
Offer emotional support, understanding, patience, and encouragement—change can be difficult and frightening to people with BPD, but it is possible for them to get better over time
- Learn about mental disorders, including BPD, so you can understand what your friend or relative is experiencing
- With permission from your friend or relative, talk with his or her therapist to learn about therapies that may involve family members, such as DBT-FST.
Never ignore comments about someone's intent or plan to harm himself or herself or someone else. Report such comments to the person's therapist or doctor. In urgent or potentially life-threatening situations, you may need to call the police.
How can I help myself if I have BPD?
Taking that first step to help yourself may be hard. It is important to realize that, although it may take some time, you can get better with treatment.
To help yourself:
- Talk to your doctor about treatment options and stick with treatment
- Try to maintain a stable schedule of meals and sleep times
- Engage in mild activity or exercise to help reduce stress
- Set realistic goals for yourself
- Break up large tasks into small ones, set some priorities, and do what you can, as you can
- Try to spend time with other people and confide in a trusted friend or family member
- Tell others about events or situations that may trigger symptoms
- Expect your symptoms to improve gradually, not immediately
- Identify and seek out comforting situations, places, and people
- Continue to educate yourself about this disorder.
Borderline Personality Disorder
Conoce Tu Salud Mental :: Trastorno Límite de la Personalidad
12:59:00 PM
El trastorno límite de la personalidad (BPD, Borderline Personality Disorder en inglés) constituye una afección de la salud mental en la cual una persona exhibe patrones emocionales violentos o inestables a largo plazo. Estas experiencias interiores a menudo son la causa de acciones impulsivas y relaciones caóticas con otras personas.
Causas
Se desconoce la causa del trastorno límite de la personalidad. Se cree que los factores genéticos, familiares y sociales pueden incidir en las causas.
Entre los factores de riesgo del BPD encontramos:
- Abandono durante la infancia o la adolescencia
- Vida familiar inestable
- Poca comunicación en la familia
- Abuso sexual, físico o emocional
Este trastorno de la personalidad tiende a aparecer con más frecuencia en mujeres y entre pacientes psiquiátricos hospitalizados.
Síntomas
Las personas con BPD a menudo no se definen con respecto a su identidad. Como resultado, sus intereses y valores pueden cambiar rápidamente. También suelen ver las cosas en términos de extremos, es decir, todo está muy bien o todo está muy mal. Su opinión de otras personas puede cambiar rápidamente. Es posible que la persona a quien hoy admiran sea menospreciada mañana. Estos sentimientos que cambian repentinamente a menudo crean relaciones intensas e inestables.
Otros síntomas del BPD son:
- Miedo intenso al abandono
- Intolerancia a estar solo
- Sentimientos frecuentes de vacío y aburrimiento
- Arranques frecuentes de ira inadecuada
- Impulsividad, como con el abuso de sustancias o las relaciones sexuales
- Crisis repetidas y autolesión, como cortes en las muñecas o sobredosis
Exámenes y pruebas
El BPD se diagnostica según una evaluación psicológica que analiza la historia y la gravedad de los síntomas.
Tratamiento
La terapia de conversación individual puede tratar exitosamente el BPD. Asimismo, la terapia grupal también puede ser de utilidad en ocasiones.
Los medicamentos desempeñan un papel menor en el tratamiento del BPD. No obstante, en algunos casos, pueden mejorar los cambios en el estado de ánimo y tratar la depresión u otros trastornos que pudieran producirse junto a esta afección.
Expectativas (pronóstico)
Las expectativas del tratamiento dependen de la gravedad de la afección y si la persona está dispuesta a aceptar ayuda. Con una terapia de conversación de largo plazo, la persona a menudo mejora gradualmente.
Posibles complicaciones
- Depresión
- Abuso de drogas
- Problemas laborales, familiares y sociales
- Intentos de suicidio y suicidio efectivo
Cuándo se debe contactar con un profesional médico
Consulte con su proveedor de atención médica si usted o una persona que conoce exhibe los síntomas del trastorno límite de la personalidad. Es muy importante buscar ayuda de inmediato si usted o alguien a quien conoce está pensando en cometer suicidio.
Nombres alternativos
Trastorno de la personalidad - límite
Referencias
Blais MA, Smallwood P, Groves JE, Rivas-Vazquez RA. Personality and personality disorders. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds.Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, PA: Elsevier Mosby; 2008:chap 39.
A Surprising Number Of Teens With Depression Aren't Getting Treatment
HuffPost Article
JGI/Jamie Grill via Getty Images
Three months after diagnosis, more than one third of the roughly 4,600 adolescents with depression in the study didn’t receive any treatment at all, and more than two thirds didn’t get a follow-up symptom evaluation with a specialist.
Less than half of the teens put on antidepressants received any follow-up care during those first three months, the study also found.
“If things don’t get better through appropriate treatment and supports, things get worse,” said lead study author Briannon O’Connor, who completed the research at New York University.
“Untreated, adolescents are likely to develop worsening symptoms of both depression and other mental health problems, have increasing difficulties in school performance, withdraw from family and friends, and continue to have difficulties into adulthood,” O’Connor, who now works with Coordinated Care Services Inc of Rochester, New York, said by email.
Major depression is a chronic, disabling condition that affects more than one in 10 teens, with as many as one in four adolescents experiencing at least mild symptoms, O’Connor and colleagues report in the journal JAMA Pediatrics. Generally, they do better the sooner depression is caught and treated.
To see how often depressed teens do get timely treatment, researchers reviewed electronic medical records from three large healthcare systems and analyzed how many services patients received in the first three months after the initial diagnosis.
On average, the teens were around 16 years old and most were girls.
Among about 1,000 youth diagnosed with major depression, 79 percent started treatment within that three-month window, the study found.
But overall, 36 percent received no treatment, 68 percent lacked any follow-up assessment and 19 percent failed to receive any follow-up care during that time.
One limitation of the study is that the analysis of electronic medical records may not have captured follow-up care by phone or treatment that teens received outside of the health system where they were initially diagnosed, the authors note. There was also substantial variation in follow-up care rates in the different health systems in the study.
It’s possible that a “watch-and-wait” approach might be appropriate for some teens with fewer or milder symptoms, noted Dr. Megan Moreno, a specialist in adolescent medicine at the University of Washington and Seattle Children’s Research Institute who wasn’t involved in the study. Some youth might also benefit from therapy without added medication, she said.
“For teens with more serious symptoms, the gold standard treatment is to start both therapy and anti-depressant medication right away,” Moreno said by email. “Ongoing monitoring of symptoms is critical to determine whether escalation or reduction in treatment is needed.”
While it can be challenging for parents to distinguish depression from the periodic mood swings that are a hallmark of the teenage years, certain behaviors can signal that it’s time to seek help, Moreno added.
“In general, teens do go through times of moodiness and may have episodes in which they withdraw from parents,” Moreno said. “However, teens who withdraw from their entire social scene, including parents, peers, and school may have something more serious going on and may benefit from screening.”
SOURCE: bit.ly/1m8GArE JAMA Pediatrics, online February 1, 2016.
10 Warning Signs of Depression You Shouldn’t Ignore
via Top 10 Home Remedies
via Top 10 Home Remedies
People have a tendency to disregard what they can’t physically see as an occasional mood-swing or a short-lived bout of despondency, nothing a tub of chocolate ice cream and a good night’s sleep can’t fix.
For such people, “disorder” and “disease” are terms reserved for things that are more serious, and “feeling depressed” just doesn’t cut it.
Nothing is more harmful to a patient of depression than such ignorant and flippant views.
Yes, it’s normal to feel down when you face challenges in your everyday life, but these feelings usually subside with time and do not alter your life negatively in major ways.
However, depression is a lot more than a temporary emotional reaction.
Depression is a mental disorder. It can cause symptoms that do not get better with the passage of time, completely wreck your daily routine and severely deteriorate the quality of your personal, social and professional life.
Factors such as lack of information, lack of trained medical professionals, poor and incorrect diagnoses, and the general stigma surrounding mental disorders are the reason fewer than half the patients of depression seek and receive adequate treatment.
The first step toward combating any disorder is identifying its symptoms and generating awareness about it.
Here are 10 warning signs of depression you should not ignore.
1. Low Self-Esteem, Guilt & Hopelessness
Lack of self-confidence, feelings of guilt and a bleak vision of what the future holds are trademark symptoms of clinical depression.Some people may not merely hold themselves in low regard, but may feel disgusted with who they are. Some may also express a heightened sense of guilt and blame themselves excessively for past mistakes.
Patients of depression are more unforgiving of themselves, and in only a few cases do they reportedly blame others or express negative feelings toward them. This proves that guilt and self-blame is central to clinical depression.
Out of 132 patients of MDD, 85 percent reported feelings of self-blame and inadequacy as the most troublesome and recurring symptoms, according to a 2015 study published in the Journal of Affective Disorders.
Self-disgust, guilt and shame were the next-reported frequently occurring symptoms, the study further notes.
2. Fatigue
Fatigue is a commonly occurring symptom in patients of depression, according to a 2004 study published in Psychiatry.Serotonin is the neurotransmitter emitted by our brain responsible for creating feelings of happiness. Similarly, epinephrine is the neurotransmitter responsible for creating energy.
Biologically, clinical depression suppresses the levels of serotonin produced by the brain, which in turn triggers a lower production of other neurotransmitters, including epinephrine. This results in chronic fatigue.
Out of 78,463 respondents of the Depression Research in European Society study conducted in six European countries, 73 percent reported tiredness as a major symptom of depression, according to a 2000 study published in European Neuropsychopharmacology.
A patient of depression will feel physically tired even after an adequate night’s sleep and without much physical activity. This will cause mental tiredness as well, rendering the patient incapable of engaging in any activity.
Diagnosis and treatment of fatigue in patients of depression is poor, which leads to more severe and longer-persisting depression, according to a 2014 study published in Depression and Anxiety.
3. Insomnia
The homeostasis process of your body tells you when you have been awake long enough and require sleep. The circadian process of your body maintains the sleepiness and wakefulness during the day.Depression messes up these twin systems that help you sleep.
Out of 531 patients of depression, 97 percent reported insomnia, out of whom 59 percent reported that lack of sleep severely undermined the quality of their lives, 40 percent admitted to daytime napping and 34 percent said insomnia was “very distressing”, according to a 2009 study published in International Journal of Psychiatry in Clinical Practice.
Moreover, non-depressed insomniacs present a two-fold risk of developing depression as opposed to people with no sleep problems, according to a 2011 study published in the Journal of Affective Disorders.
Lastly, insomnia that persists after depression increases the risk of becoming clinically depressed once again, according to a 2000 study published in Sleep Medicine Reviews. It is important to consider this possibility when seeking treatment for depression.
4. Anger & Irritability
Along with a prolonged, obvious and overwhelming sense of despair, there is one other emotion that is characteristic of the initial stage of depression – anger.This is often accompanied with heightened irritability and a tendency to lose one’s cool over seemingly trivial things.
Any tiny and harmless thing can trigger an outburst from a depressed person, and they will not shy away from lashing out at family, friends and even strangers.
A depressed individual, even when they are not verbally expressing rage, might be consumed with anger internally.
Moreover, a depressive condition that is accompanied by anger is more severe in intensity than regular clinical depression and is likely to stay longer too, according to a 2013 study published in the Journal of the American Medical Association.
Such a serious, prolonged and rage-infested depression can also trigger other disorders, such as substance abuse and anxiety disorders, the study further notes.
5. Anxiety
Anxiety is not merely feeling nervous about something that has happened or is yet to occur. Anxiety disorders are capable of terribly interfering with a person’s peace of mind and making them obsess over little things to the point of paranoia.When you are suffering from depression, an anxiety attack can put you on the edge and push you deeper into darkness.
A slight personal setback, for instance, will cause the depressed person to beat themselves over their failure to the point of hopeless despair.
They will be unable to distract themselves and may even display physical symptoms, such as sweating, palpitations and a rapid heartbeat.
Out of 255 patients of depression, 50.6 percent reported anxiety disorders, according to a 2000 study published in Comprehensive Psychiatry.
Out of this total, 27 percent reported fear of social situations, 16 percent reported fear/phobia of different things (including open spaces) and 14 percent reported panic disorder, the study further notes.
6. Lack of Concentration & Short-Term Memory Loss
Today’s fast-paced world may leave you overwhelmed and distracted from time to time. However, if along with constantly feeling miserable, you just cannot seem to concentrate on a single thing longer than a few seconds, you might be depressed.Deteriorated concentration is one of the most frequently occurring symptoms of MDD, according to a 2004 study published in Psychiatry Research.
Patients of depression also reported difficulty recalling information on a short-term basis, according to a 2015 study published in Cognition and Emotion.
You might notice you have become less productive and are constantly forgetting where you put important things like your documents or your keys. This short-term memory loss may indicate depression.
7. Reckless Behavior
People who appear a little too wild and are constantly giving an impression of living life on the edge might just be suffering from depression, especially if this is not how they used to be in the past.Of course, that does not mean that every adventurous person is depressed. However, if a person, who displays other symptoms of depression and is in an emotional turmoil, suddenly becomes interested in a night of binge drinking and substance abuse, you know something is not right.
Alcoholism, gambling, substance abuse and risky sexual behavior might be a person’s coping mechanism against inner suffering and simply a way of escaping unpleasant feelings.
Out of 923 people who frequently engaged in risky sexual behavior, 35.71 percent displayed moderate symptoms of depression while 5.62 percent showed severe depression symptoms, according to a 2015 study published in the Annals of General Psychiatry.
Sadly, these exploits only provide temporary relief and make depression worse over time.
8. Loss of Interest in Pleasurable Activities
A loss of interest in any social activity and social contact, as well as a severely diminished ability to experience pleasure, is medically known as anhedonia.Depressed people may isolate themselves and spend time alone doing nothing since they just cannot seem to derive pleasure from any activity.
According to a 2009 study published in Neuroreport, when healthy people and depressed patients were made to listen to their favorite music followed by an MRI scan of their brains for comparison, the depressed patients showed less activity in the regions of the brain associated with pleasure and reward processing than the healthy people.
Anhedonia is a central characteristic of depression, as well as one of its earliest indicators. So if you or someone around you can no longer be talked into hitting the theater when all they could ever talk about is movies in their spare time, and have been sad lately too, take note and seek medical attention.
9. Weight Changes
Most patients of depression will suffer a sudden drop in appetite, apart from being constantly moody. Just the thought of eating a meal might make them queasy, even if they haven’t had a proper meal in a day. Consequently, they may begin to lose weight in an unhealthy way.Appetite loss is one of the most commonly occurring symptoms of unipolar disorder (MDD), according to a 2002 study published in Progress in Neuropsychopharmacology & Biological Psychiatry.
Contrarily, although less frequent than weight loss, some people may begin to gain weight during depression as they turn to binge eating to comfort themselves.
Patients with severe depression reported a gradual increase in abdominal weight as well as overall body weight, according to a 2009 study published in the American Journal of Public Health.
If you or someone around you displays these symptoms, these might just indicate depression.
10. Recurring Thoughts of Suicide and Death
It is not uncommon for people to think of death, especially as they grow older. However, depression-triggered thoughts of death, especially suicidal death, are a grave cause for concern and need to be addressed urgently.Suicidal thoughts are strongly associated with mood disorders like clinical depression, according to a 2002 study published in The American Journal of Geriatric Psychiatry.
Many factors contribute to an older person’s inclination to harm themselves, and clinical depression is the most common factor among those, according to a 2005 study published in the British Journal of General Practice.
Suicidal tendencies may range from recurrent thoughts, online searches and planning, role-playing and physical self-harm (slashing wrists, for instance).
Ansiedad Social
Terapia Cognitiva-Conductual Podría Aliviar Ansiedad Social por Medio de Reducción de Actividad Cerebral
4:21:00 PM
Artículo Original en Inglés: Psych Central News
Por: Rick Nauert PhD
Un nuevo estudio sueco encuentra que después de tan sólo
nueve semanas de terapia Cognitiva Conductual vía Internet, los cerebros de los
pacientes que sufren de trastorno de ansiedad social, cambian en cuanto a
actividad y volumen - y la ansiedad se
reduce.
Los investigadores observaron que el cerebro es muy
adaptable. Por ejemplo, estudios previos han demostrado que los malabares y los
videojuegos afectan el volumen del cerebro. Sin embargo, sigue habiendo dudas
acerca de cómo pueden cambiar el volumen del cerebro y la actividad neuronal en
áreas específicas.
En la presente investigación, un grupo de investigadores de la Universidad de Linköping y otras universidades suecas, estudiaron cómo la terapia cognitivo conductual dadas vía internet (ICBT) afecta el volumen del cerebro y la actividad.
Los investigadores se centraron en pacientes con
trastorno de ansiedad social (SAD), uno de los problemas de salud mental más
comunes. Para el estudio, la resonancia magnética (MRI), se realizó en todos
los participantes del estudio antes y después de la intervención ICBT. Los
investigadores encontraron que en pacientes con SAD, el volumen del cerebro y
la actividad de la amígdala disminuyo como resultado de ICBT.
Los resultados del
estudio aparecen en la revista Translational Psychiatry
"Cuanto mayor es la mejora que vimos en los
pacientes, menor es el tamaño de su amígdala. El estudio también sugiere que la
reducción del volumen impulsa la reducción de la actividad cerebral,” dijo el
estudiante de doctorado Kristoffer NT Månsson, quien dirigió el estudio.
Månsson se asoció con su colega de Linköping, Dr. Gerhard Andersson y los
investigadores del Instituto Karolinska, la Universidad de Uppsala, Universidad
de Umeå y la Universidad de Estocolmo.
En el estudio participaron 26 personas tratadas a través
de Internet durante nueve semanas, lo que es un estudio relativamente pequeño.
Sin embargo, es único, ya que investiga varios factores al mismo tiempo: los
cambios post-tratamiento, tanto en el volumen cerebral y la actividad cerebral.
"Aunque no son muchos pacientes, este trabajo
proporciona un conocimiento importante - especialmente para todos los enfermos.
Varios estudios han informado de que ciertas áreas del cerebro son diferentes
entre los pacientes con y sin trastornos de ansiedad,” dijo Månsson. "Hemos demostrado que los pacientes pueden mejorar
en nueve semanas - y que esto conduce a diferencias estructurales en sus
cerebros." Månsson ve el estudio como un primer paso de un proyecto más
grande.
Al final, el objetivo es entender mejor los efectos
psicológicos y biológicos de tratamiento con el fin de desarrollar terapias más
eficaces. El equipo de investigación está avanzando
con los estudios en más pacientes. Un estudio tiene como objetivo identificar
el punto durante el tratamiento, donde se produce el cambio en el cerebro. Los expertos creen que los resultados del estudio
ayudarán en el desarrollo de terapias más eficaces para uno de los problemas
más comunes en la salud mental.