BORDERLINE PERSONALITY DISORDER DURING COVID-19 PANDEMIC
DOI:
https://doi.org/10.21776/ub.jppbr.2021.002.02.5Keywords:
borderline personality disorder, COVID-19Abstract
Individuals with pre-existing mental problems are more likely to relapse or experience a recurrence of symptoms during The COVID-19 pandemic. This vulnerability can also manifest in those who suffer from Borderline Personality Disorders (BPD). Pandemic conditions significantly restrict people's social interaction for an extended period of time, resulting in severe restrictions on daily living routines and social isolation. When social interaction is restricted, emotional dysregulation and difficulty reading others' emotional expressions may lead borderline patients to anticipate subtle emotional expressions of fear or anxiety in their significant others, eliciting intense reactions such as outbursts of anger, increased irritability, and impulsive behaviors. Patients with personality disorders are more likely to experience crisis during a pandemic, which can result in self-inflicted injury or suicide. Psychotherapeutic interventions to support individuals with BPD who seek secondary mental health care include Dialectical Behavior Therapy (DBT), Mentalization-Based Therapy (MBT), and Schema-Focused Therapy (SFT), in addition to other briefer skills-based group therapy sessions, many of which have been made difficult to obtain since the COVID-19 pandemic began. Dialectical Behavioral Therapy (DBT) is one of the most effective psychotherapies for borderline personality disorder (BPD). With the adoption of social distancing and the elimination of face-to-face activities, there are challenges to DBT. DBT delivered via telemedicine and telehealth are pragmatic alternatives that have had varying degrees of success during this pandemic.
References
CDC, “Coping with Stress,†2020, 2020. .
Y. Luo, C. R. Chua, Z. Xiong, R. C. Ho, and C. S. H. Ho, “A Systematic Review of the Impact of Viral Respiratory Epidemics on Mental Health: An Implication on the Coronavirus Disease 2019 Pandemic,†Front. Psychiatry, vol. 0, p. 1247, Nov. 2020, doi: 10.3389/FPSYT.2020.565098.
C. Moreno et al., “How mental health care should change as a consequence of the COVID-19 pandemic,†The Lancet. Psychiatry, vol. 7, no. 9, p. 813, Sep. 2020, doi: 10.1016/S2215-0366(20)30307-2.
M. Lenzenweger, M. Lane, A. Loranger, and R. Kessler, “DSM-IV personality disorders in the National Comorbidity Survey Replication,†Biol. Psychiatry, vol. 62, no. 6, pp. 553–564, Sep. 2007, doi: 10.1016/J.BIOPSYCH.2006.09.019.
B. Grant et al., “Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions,†J. Clin. Psychiatry, vol. 69, no. 4, pp. 533–545, 2008, doi: 10.4088/JCP.V69N0404.
K. Wingenfeld, C. Spitzer, N. Rullkötter, and B. Löwe, “Borderline personality disorder: Hypothalamus pituitary adrenal axis and findings from neuroimaging studies,†Psychoneuroendocrinology, vol. 35, no. 1, pp. 154–170, Jan. 2010, doi: 10.1016/J.PSYNEUEN.2009.09.014.
K. Bertsch et al., “Neural correlates of emotional action control in angerprone women with borderline personality disorder,†J. Psychiatry Neurosci., vol. 43, no. 3, pp. 161–170, May 2018, doi: 10.1503/JPN.170102.
A. Bateman and P. Fonagy, “Mentalization-Based Treatment for Personality Disorders,†Ment. Treat. Personal. Disord., Aug. 2016, doi: 10.1093/MED:PSYCH/9780199680375.001.0001.
E. Preti, R. Di Pierro, E. Fanti, F. Madeddu, and R. Calati, “Personality Disorders in Time of Pandemic,†Curr. Psychiatry Rep., vol. 22, no. 12, Dec. 2020.
S. C. Chong, “Psychological impact of coronavirus outbreak on borderline personality disorder from the perspective of mentalizing model: A case report,†Asian J. Psychiatr., vol. 52, Aug. 2020.
T. R. Lynch, M. Z. Rosenthal, D. S. Kosson, J. S. Cheavens, C. W. Lejuez, and R. J. R. Blair, “Heightened sensitivity to facial expressions of emotion in borderline personality disorder,†Emotion, vol. 6, no. 4, pp. 647–655, Nov. 2006, doi: 10.1037/1528-3542.6.4.647.
F. Ãlvaro et al., “Clinical course and predictors in patients with borderline personality disorder during the COVID-19 outbreak: A 2.5-month naturalistic exploratory study in Spain,†Psychiatry Res., vol. 292, Oct. 2020, doi: 10.1016/J.PSYCHRES.2020.113306.
V. Salamin et al., “Adaptations of an outpatient Dialectical Behavioral Therapy during the COVID-19 pandemic and consequences of the confinement on patients with borderline personality disorder,†Ann. Med. Psychol. (Paris)., vol. 179, no. 2, pp. 131–136, Feb. 2021, doi: 10.1016/J.AMP.2020.08.006.
E. Hartveit Kvarstein et al., “Vulnerability of personality disorder during COVID-19 crises: a multicenter survey of mental and social distress among patients referred to treatment.,†Nord. J. Psychiatry, pp. 1–12, Aug. 2021.
R. Calati et al., “Suicidal thoughts and behaviors and social isolation: A narrative review of the literature,†J. Affect. Disord., vol. 245, pp. 653–667, Feb. 2019, doi: 10.1016/J.JAD.2018.11.022.
A. John, J. Pirkis, D. Gunnell, L. Appleby, and J. Morrissey, “Trends in suicide during the covid-19 pandemic,†BMJ, vol. 371, Nov. 2020, doi: 10.1136/BMJ.M4352.
C. M. Grilo and T. Udo, “Association of Borderline Personality Disorder Criteria With Suicide Attempts Among US Adults + Supplemental content,†JAMA Netw. Open, vol. 4, no. 5, p. 219389, 2021, doi: 10.1001/jamanetworkopen.2021.9389.
N. Henry, S. Parthiban, and A. Farroha, “The effect of COVID-19 lockdown on the incidence of deliberate self-harm injuries presenting to the emergency room,†Int. J. Psychiatry Med., vol. 56, no. 4, pp. 266–277, Jul. 2021, doi: 10.1177/0091217420982100.
M. Linehan, H. Heard, and H. Armstrong, “Naturalistic follow-up of a behavioral treatment for chronically parasuicidal borderline patients,†Arch. Gen. Psychiatry, vol. 50, no. 12, pp. 971–974, 1993, doi: 10.1001/ARCHPSYC.1993.01820240055007.
J. Young, Cognitive therapy for personality disorders: A schema-focused approach, 3rd ed. - PsycNET. Professional Resource Press/Professional Resource Exchange, 1999.
A. Bateman and P. Fonagy, “Psychotherapy for Borderline Personality Disorder: Mentalization Based Treatment.†2004.
J. McLoughlin, M. M. O’Grady, and B. Hallahan, “Impact of the COVID-19 pandemic on patients with pre-existing mood disorders,†Ir. J. Psychol. Med., pp. 1–10, Apr. 2021, doi: 10.1017/IPM.2021.38.
M. M. Linehan, “DBT Skills Training Manual, Second Edition,†DBT Ski. Train. Manual, Second Ed., pp. 3–19, 2015.
X. Zhou et al., “Opinion The Role of Telehealth in Reducing the Mental Health Burden from COVID-19,†doi: 10.1089/tmj.2020.0068.
R. Lakeman and J. Crighton, “The Impact of Social Distancing on People with Borderline Personality Disorder: The Views of Dialectical Behavioural Therapists,†Issues Ment. Health Nurs., vol. 42, no. 5, pp. 410–416, 2021, doi: 10.1080/01612840.2020.1817208.
S. J. Landes, J. A. Pitcock, M. S. Harned, S. L. Connolly, L. L. Meyers, and C. M. Oliver, “Provider perspectives on delivering dialectical behavior therapy via telehealth during COVID-19 in the Department of Veterans Affairs.,†Psychol. Serv., Aug. 2021.
