Clear understanding of the issues that are involved in any study is very essential in the generation of the clear picture in relation to the holistic significance played by the study and ensuring that the approaches assimilated are articulated in the correct context. This chapter forms the initial part of this study and therefore sets the stage for the later sections. It presents the background of the problem and the significance of the study to further present a clearer picture for the readers.
Besides, it gives an overview of the methodology and analysis that will be employed in the latter chapter three and four of the study to generate the most acceptable and viable results. 1. Background of the problem a) BPD causes and persistence Borderline Personality Disorders (BPD) persistence in adolescent and adult stages of human life has led to the need for establishing the actual causes of the problem.
Though the causes of the problem are believed to be indeed very complex in nature; with prior researchers citing aspects such as brain abnormalities, environmental factors, predisposition of generic factors, as well as neurobiological factors, little has been done to establish the possible affect of childhood aspects on it. The complexity of the problem causes has further made it hard to effectively treat and prevent its resilience. Neurotransmitters involved in Bipolar Personality Disorder include acetycholine, serotonin, and norepinephrine which are related to human moods and emotions.
To add to that, GABA is also involved as a major inhibitory neurotransmitter responsible for mood stabilization and change while glutamine is responsible for excitement. Previous researchers suggests that the activation of amygdala and as well as the pre-frontal cortex in the brain indicate general efforts of controlling intensive emotions. Alteration in the serotonin functions of the brain has been cited to cause aggression and compulsivity in Borderline Personality Disorders (BPD) patients (Bateman and Fonagy, 2004; Gunderson, 2009).
According to Hodges (2003), many of the people who have been diagnosed with borderline personality disorders have been exposed to different environmental factors that may have either contributed to the condition onset or deterioration with time. Though it is actually hard to measure the different effects of environmental factors as they impeach on BPD, most of the patients indicate having experienced physical or sexual harassment at the child age while others indicate being victims of crime.
It is worth noting that these considerations have long term implications on the affected person and therefore make the symptoms of BDP to resurface at different instances. Though crime statistics indicate that violent crime and rape statistics are on the decline; the number of people suffering from such cases are still very high (Banyard et al, 2000; Wurgaft, 1976). However, it is the effects posted by the problem that have led to search for the most effective solution in addressing it.
Indeed, the problem has been cited to have a strong affect on majority of the social realms of an individual. According to Linehan (1993), people suffering from Borderline Personality Disorder have the feeling that their cases have been overlooked. It is estimated that about two percent of the adult population in US suffer from BPD; amounting to over 20% of the total psychiatric related problems hospitalizations in the country while more cases go unreported (National Institute of Mental Health, 2008; Oldham, 2004; Santoro et al, 1997; Sugarman, 2006; Wurgaft, 1976).
b) Erickson eight negative stages of development According to Salsman (2008), Erickson’s eight stages of development denote a holistic socialization process through which an individual undergoes to effectively fit in the society. Unlike Sigmund Freud who believed that the development only takes place for a short period of time up to the age of five years, Erickson believed that development is a continuous process that occurs in an individual’s lifetime.
Erickson pointed out that all stages of human existence are unique and present an individual with particularistic challenges that determine their overall ability to address them (Zanarini and Frankenburg, 1997; Wilson et al, 2001; Van der Kolk, 1987; Silk, 1994; Shiner, 2006; Erikson, 1950). Notably, the Erickson’s eight stages of life development depict eight crises which are demonstrated by the traumas visible in many Borderline Personality Disorder cases. Bower (1995) argues that the entire psychosocial crisis must be dealt with effectively at every stage in order to develop the correct system of addressing the later stages requirements.
The researcher believes that when the eight crises are not totally or effectively resolved, they directly culminate to the symptoms of Borderline Personality Disorder at different life stages. According to (Keenam, 2002), all the eight stages are anchored on interaction of three main facets of life development at different stages. To begin with, the somatic system denotes the biological system where various processes constantly take place exerting variant pressure to an individual. At different stages, human body development presents variant developmental demands to effectively assume the required growth in an individual.
In addition, the ego which forms the central reasoning and thinking demand of an individual is a major determinant of how an individual approaches the different problems that face them. Indeed, as American Psychiatric Association (2000) explains, the ego forms one of the most important aspects of human development in that it is possible to evaluate the costs and benefits of the different actions taken to ensure that only the best solutions are considered. Finally, the societal facet views the individual as part of the extended community which requires every individual to live and operate within a given framework that is acceptable by all.
Though this has been cited to be much flexible especially in the modern communities where the boundaries have been extended especially for the social institutions; the administrative authorities that ruthlessly deal with the extreme cases of misbehavior posse major stresses to the human beings at different stages. i) Oral sensory stage (trust versus mistrust stage) This stage takes approximately one year Wurgaft, L. (1976), after birth and is mostly associated with building trust for the infant by the caregivers or the parents to the infant.
At this stage, feeding forms the focal point of the major child demands upon which it communicates when hungry by crying. It is however worth noting that taking is not only by the mouth, but through all sensory organs of the infant that aid in generating the necessary confidence on those immediate to the infant. Erickson emphasized that failure to attend to the child’s demands leads to strong mistrust of the immediate caregivers which becomes worse in the next stage if not resolved (Schnell, 1980; Cohen, M. 2007).
Neglect at this stage leads to frustration and withdrawal by the infant which further escalates to lack of self confidence. ii) Early childhood stage (Autonomy versus doubt) This stage encompasses approximately the 2nd and the 3rd years of an infant’s life. In this stage, a child gets pleasure in sphincter muscle mastering and other body operations like walking, holding, urinating, destroying objects and losing others. As indicated earlier, this stage is highly dependent on the first stage of development as the child requires getting the necessary confidence in order to proceed to the next stage with effectively.
Strong support from the parents is very essential to enhance consistency and stronger attachment to their environment. However, failure to provide this platform with necessary support like disapproval and over-protection lead to the child doubting its abilities and shame development when conducting different actions. This would strongly hamper the later stages development that require strong sense of choice, independence and control over different actions (Erickson, 1974; Eriksson, 1950; Crunden, 1973; Holmes, 2004; Wurgaft, 1976).
iii) Play stage (initiative versus guilt) At the third stage which occurs through the ages of three to six years, the child further learns to become more responsible as they establish strong curiosity, locomotion, language skills, and the overall ability to set different goals. The earlier stages are very significant to this preschool going stage in that it is via trust and confidence that the child will be able to exercise the highly required autonomy for their development.
Erickson believed that poor development of the earlier stages sets the correct platform for a strong sense of guilt in any initiative that the child establishes believing that it is wrong to be independent (Gasperini, 1991; Masson, 1974; Douvan, 1997). This stage has been a major setback for many children especially those brought up by the caregivers who may not have enough time for them to generate the necessary reassurance and encouragement to proceed after several failures.
iv) Elementary and middle school years (Industry versus inferiority) This stage lasts between the ages of 6-12 years when the child gets to school and therefore is exposed to the wider community apart from the ordinary caregivers and the parents he/she was used to. Therefore, by being exposed to new environment that consist of more friends and different people, the child has a chance of learning and gaining more skills while being transformed to a world of peers.
Failure to effectively complete stage one to three precipitates to strong sense of inferiority which may be very hard to address at the later stages. According to Biederman (1997), a sense of inferiority has been cited as a major factor in orienting the youths to bad peers. Consequent guidance should be provided to enhance better decision making at this stage. v) Adolescent stage (identity versus role confusion) According to Erickson theory of development, identity crisis is the single most significant aspect that individuals must face in the course of their life development.
At this stage, the healthy resolution of the previous stages conflicts to generate the necessary sense of trust, sense of competence, control, and independence must be incorporated. Success in the earlier stages therefore brings out a strong sense of identity and therefore readiness to plan for the future. However, prior failure will lead to further confusion where the adolescent will be faced with difficulties in making the correct decisions and choices (Coles and Fitzpatrick, 1976; Hoffman, 1993; Kaplan, 1978).
In particular, they are faced with vocation problems and sexual orientation. Like in stage four, the adolescent easily becomes a subject of bad peer pressure that lead them conflicts with the community, the authority, and eventual cumulative stresses that culminate to BPD symptoms (Erikson, 1974: Cohen, 2007; Butler and Gross, 2009; Davidson, 2000; Erikson, 1950). vi) Young adults (intimacy versus isolation) This stage takes place between the age of 19 years and 40 years marking the major passage of an individual from teenager to adulthood.
Success in the earlier stages is marked by a strong capability of intimacy by an individual. With this stage being strongly linked to events of love and relationships, Erickson theory indicates that individuals without clear sense of identities fear commitments and may retreat to isolation (Skodol et al 2007; Towbin, 1993; Erikson, 1950). This notion has over the years been linked to the economic background of an individual as many people view financial stability to be a major step for later progresses. vii) Middle adulthood stage (generativity versus stagnation)
The seventh stage which occurs between the ages of 40 years to 65, as Erickson indicated in his developmental theory, provides an individual with the ability to have an extended view and therefore offer care to others. Successful completion of the earlier stages culminates to the adults needing the children as they equally need them mostly on the basis to leave a legacy. The adults seek new identities where thoughts of death are overshadowed by their efforts to generate greater levels of goodwill in the society (Andersen, 1993; Roazen, 1993; Brenman-Gibson, 1997).
However, if this crisis is not addressed people will mostly be highly self centered and therefore experience a strong sense of stagnation. viii) Late adulthood (integrity versus despair) This stage marks the final level of development and takes place from the age of 65 years until one dies. It forms a period upon which an individual reflects one’s life and its bigger picture which involves evaluation of the successes and failures on the long journey from childhood (Bondurant yet al, 1971; Strozier, 1976).
Erickson indicated that when an individual have a sense of achievement about his/her life coupled with a sense of unity with themselves and others, they will easily accept death with a strong sense of integrity. The healthy adults will not fear death as a healthy child does not fear life. However, sense of failure and lack the necessary achievements in life poses despair to the elderly as they are filled with strong regrets of the past life therefore strongly fearing death. 2. Purpose of the study
According to Chrysostomos (2005), an understanding of the purpose of any study is essential in guiding the research thesis through out the period of the research. The researcher believes that the individuals who do not resolve the negative eight crises that take place in the human body are prone to suffering from BPD later in their lives as adults. Presently, the high levels of Borderline Personality Disorder have been contributed by lack of clear understanding of the main causes of the complication in the human beings.
As indicated earlier, the problem is believed to be caused by environmental, hereditary, and/ or neurobiological factors. By establishing interlink between the Erickson eight negative stages of human development with BPD, it will be easier to understand the actual strategy that can be used at any particular stage of the human development to address the problem (Zanarini, 2000; Skodol et al, 2007; ). As indicated earlier, the cases of BPD have been on the increase year after year with over two percent of the population being diagnosed with it in US.
As a result, the researcher seeks to generate a cohesive system where there can be an effective model of understanding the condition and therefore treating it in the most effective manner. In this respect, the researcher seeks to establish and compare the different symptoms of the borderline personality disorder and those of the Erickson’s eight negative stages of personality development. Following a successful completion, it will be possible to establish effective coping strategies that patients can be able to employ in addressing the problem of Borderline Personality Disorder as an alternative mechanism.
Previous researchers have indicated that most of the Borderline Personality Disorder patients’ behaviors have been found by many clinicians to be exasperating (Bradley et al, 2005; Ullrich and Coid, 2009). In this respect, this study seeks to generate the correct understanding of the BPD patients’ behavior at different stages by the clinicians to generate the most effective treatment system. Effective behavioral treatment can only be achieved through working in partnership between the patients and the clinicians without creating a sense of intrusion or sabotage.
Though analysts argue that this consideration should be evident in all the psychologists if they have to effectively operate, the same is not replicated in the diagnostic and treatment consideration of BPD. 3. Theoretical framework a) Underlying theories related to BPD This study is based on the work of Erickson development theory which he believes as provided by the later hypothesis; has a strong interlink with the Borderline Personality symptoms. According to Siever and Koenigsberg (2000), in mid 20th century, Erickson Erik found out that human development takes place through out an individuals’ lifetime.
As indicated earlier, the theory of personality development pointed out that during these development stages, all aspects of human ability to cope with instantaneous life demands are determined by the biological systems, the ego, and the immediate environment upon which the individual exist (Goethals, 1976; Eagle, 1997). As the basement of this study, the researcher seeks to link these stages with the symptoms of Borderline Personality Disorder traits and its recurrence in US.
Though Erickson’s theory has been largely employed in the study as the main supporting framework, it has other varying elements of related theories like the Freud’s theory of personality development. Indeed, as Sanderson (2008) points out, Erickson’s work was greatly influenced by the works of Sigmund Freud. This is evident especially in the first three stages of development where the symptoms and traits assimilated by an individual have great similarities in both theories. According to Sigmund theory, personality is considered to be like an iceberg and exist below the human capacity to address the resultant problems.
Most of the personality processes, as an iceberg exists, are below the conscious awareness of any human being to control. However, Erickson strongly differs with Sigmund who indicated that personality development only takes place during the first five years of infant development. In contrast, as indicated by the Erickson’s eight stages of development, the development of any individual is continuous and lasts throughout his lifetime (Salters, 2008; Kernberg, 1967). b) Borderline personality disorder symptoms and eight stages of development compared.
It is worth noting as Santoro (1997) points out; BPD has a strong sense of inflexibility where the individuals are unable to cope with the different instantaneous demands and changes in the society. They view their options to be highly idealized and therefore see the community in an inverted model which is strongly related with their isolation and trauma in the society. i) Confusion and lack of identity Confusion presented by Borderline Personality Disorder patients has been cited to have great similarities with identity crisis posted in various stages of the Erickson’s eight stages of development.
In stage five of Ericsson’s eight stages of personality development as Wilkinson- and Westen (2001) explain, confusion is evident with the individuals lacking a sense of inner consideration of agency. It is clear that indeed, this sense of identity loss is directly correlated to poor earlier stages crisis resolution. Identity is the ability of any individual to be able to address the correct industrial d3evelopmental avenue, generate the necessary intimacy, and fit within the holistic society configuration where its demands are effectively met without conflicting interest.
However, lack of the necessary cohesion and relationship with the others and environment puts an individual in a state of hegemony with their demands thereby displacing them into a state of confusion (Zanarini et al, 1997; Stone, 1980; Silk, 1995). In some instances as Westen and Cohen (1993) pointed out, there arises a sense of negative identity where an individual tries to generate or fit his traits within the groups that accept him/her. However, the negative identities make the individual to be looked down upon by the community as they directly negate its culture.
To add to that, identity confusion has also been indicated by lack of consistency in values posted by an individual, values that are un-harmonic with the societal demands, and lack of the necessary societal ideals. ii) Childhood abuse and neglect As indicated earlier, many of the BPD patients have records of abuse and/ or neglect during their childhood stages. As noted earlier, the earlier stages of a child development are very essential in generating trust and confidence to the people and the community too at the later stages.
Explicit poor emotional relationship between at the latter stages after the initial abuse has been cited to have a long inculcation in their memories especially when not effectively resolved. Many of the BPD clinicians generally agree that the ability to address the different problems that affect the young people is entirely dependent on the understanding of the problem sources (Weaver et al, 1993). iii) Anger and sense of neglect buy the community Parker (2006) believes that bulk of the BPD affected individuals have vast anger issues which are anchored on childhood frustrations.
According to Erickson’s personality developmental theory, aggression originates from the early stages when the child lacks the necessary trust and confidence on the immediate environment and people around him/her. However, it is the failure to resolve the problem and taking of the trait to the higher level of growth and development that makes it dangerous for an individual and the community too. According to Paris (2007) Borderline Personality Disorder is also characterized by a strong sense of emptiness and neglect by the community.
Most of the behavioral clinicians believe that most of the individuals suffering BPD undergo intensification of emotion which acts as a major facet for enhancing unwarranted behavior that culminates to self damaging considerations. Ginsberg (1992) agrees with the eight stages of personality development theory by claiming that self damaging effects indicate a final stage of the BPD patients in the community. iv) Depression One of the most unmistakable aspects of BPD is depression which recurs in most of the later stages of Erickson’s eight personality developmental stages.
Depression is mostly tied to a chain of events which point to a final indication that amounts from frustrations or rejection. Depression has been cited as a major cause of the rising levels of suicides and suicide attempts. As most of the clinicians indicate, depressed people require clear understanding of the problem to be able to address the underlying conflicts by the clinicians (Zanarini et al, 2007; Yabroff, 1990; Weaver and Clum, 1993). 4. Research questions To achieve the purpose/ objectives of the study, the researcher will seek to answer the following questions;
i) What is the reliability of the Borderline Personality Disorder diagnosis through use of DSM IV criteria? ii) What other methods exist for diagnosing BPD? If there are, how viable are they in treatment of BPD iii) Does comorbidity affect Bipolar Personality Disorder? iv) How effective is the Erickson’s eight stages of development in the treatment of Borderline Personality Disorder? v) Is it possible to combine DBT with Erickson’s eight stages of development to establish a more effective system of treating BPD patients? 5. Hypothesis of the study
The following hypotheses have been developed to assist in answering the research questions while generating cohesion throughout the study. H0: Combining the Erickson’s eight stages of development understanding with DBT does not provide a better system of treating Borderline Personality Disorder. H1: Combining the Erickson’s eight stages of development understanding with DBT provides a better system of treating Borderline Personality Disorder. 6. Significance of the study The researcher aims at strongly to the academic realms by contributing to the understanding of the problem and its solutions too.
It is worth noting that the researcher will employ the academic procedures of data collection and analysis to get the different correlations upon which the conclusions will be effectively drawn. Indeed, the study will be based on the past and the current status of the problem and therefore generate the most up to date findings regarding the information on the problem and its best treatment methods. In this respect, this study will serve both as a critique for the previous systems and a solution the problem both in the theoretical understanding as well as in practice.
As a medical professional, the researcher seeks to contribute to the current debate on the causes, treatment and prevention of Borderline Personality Disorder in the society. The study will therefore go a long way in seeking reduction of the number of hospitalizations related to BPD in US and other regions globally. It is clear that with the ambiguity posted in their symptoms, treatment, and the high recurrence of BPD in the society, an urgent solution is eminent to enhance further increased community productivity. 7.
Methodology a) Research design An understanding of the methods that will be employed during the study forms a major facet in determining the viability of the results to be achieved. Borderline Personality Disorder has attracted strong interest from many researchers due to its strong negative effects to the society. It is apparent from the available literature on different stages of development as presented by Erickson model have strong impacts to the severity of the problem (Ocasio and Knight, 2003: Korfine and Hooley, 2009).
It is this understanding that plays the major role in the assimilation of the study methodology. Application of quantitative research design has been due to the nature of the study questions established earlier on in this chapter. The nature of the research questions indicates that a descriptive and an inferential systematic approach are necessary to generate effective results which can lead to the correct analysis to test the hypotheses of the study.
Following the vast diversities that revolve around the causes and treatment of BPD, the research approach which quantifies the results is likely to be more effective in establishment of the most concise conclusion which inculcates holistic inference from other studies. Application of quantitative research design is therefore in harmony with the problem nature and particular relevance to the hypothesis testing at the end of the study. b) Research scope and population Research scope forms a key icon in determining the extent to which a given study could be accepted before it can be assimilated into the new system (Bryman and Bell, 2007).
The study will be limited to US to give it a stronger focus and allow intrinsic evaluation of the assimilated data. Further focus will be given to the different health care facilities that offer treatment to the BPD patients. To add to that, research institutions related to behavior problems at different stages will also be included in the samples frame. Though other global examples may be given special reference to support the recommendations, U. S was considered to be ideal for its long term history of BPD related researches and documentation.
The target population of the study will be two fold to enhance greater acceptability and viability of the results from the research. The major focus will be given to the BPD specialists while the patients’ response statistics will be important in determining the efficacy of the methods applied. The inclusion of the BPD specialists is essential to enhance the accuracy of the data collected on the variables involved in the system due to their intrinsic understanding of the problem. c) Data and data collection
Data collection forms a major step in any quantitative research and determines the levels of accuracy that can be attained at any particular instance. The researcher intends to use secondary literature to gather data as the source of his statistics upon which further analysis will be assimilated. Due to the controversies and high levels of BPD in the society, vast researches have been established in relation to its causes and treatment. Besides, its impacts to the people have also been widely studied.
Therefore, the available literature will provide an effective pool of resources in assessment of the prior statistics and related information. This method was considered to be better in that it provides the researcher with a strong backup of the outcome of the system and therefore generates the correct trends over the period of consideration thereby increasing the viability of the study. Studies involving Borderline Personality Disorder like any other behavioral related problem requires a long time to study and derive the necessary conclusions.
This is generally tied to the fact that conclusions are related to the human well being and therefore must be precise (Torgersen, 1994; Smith et, 2004; Mitchell, 1995; Koerne and Linehan, 2000). In this respect, the researcher seeks to use primary data from the current practices of the BPD in the society. Questionnaires on the effectiveness of the current methods being used to diagnose BPD will be administered to random strategically selected practitioners to enhance better systems of management.
d) Data analysis and presentation Clear understanding of the research data analysis methods to be employed after data collection is essential in enhancing the necessary viability of any research findings (Chrysostomos, 2005). With this study being quantitative in nature, the researcher will employ SPSS special software to analyze and derive the necessary correlations between the different Erickson’s eight negative stages of development and the symptoms of Borderline Personality Disorder variables.
This method was considered to be more effective due to its great efficiency in minimizing the error margin and therefore increasing the viability of the result findings. The result findings will then be presented in form of charts, graphs and polygons for easier understanding by the readers. 8. Limitations and ethics in the study i) Previous errors replication To effectively derive the relationship between Erickson’s eight developmental stages, use of the existing literature was considered to be more effective due to its added advantage over the other systems.
However, this method is seen by the researcher to have possible previous researches replicating effects where previous errors have a high possibility of affecting the overall outcome of the study results. As indicated earlier on, borderline personality disorder understanding and treatment is at the midst of major controversies and therefore demanding for a highly particularistic system that would provide the best solution. Though it is clear that integration of the previous researchers’ understanding on the same problem is essential to avoid reinventing the wheel, their errors could direct it to the same ambiguous direction.
ii) Poor availability and access of literature To add to that, previous literature may be hard to get and consolidate taking into consideration that many of the previous researchers took different views and approaches that were highly differentiated but focused on the same problem. According to Korfine and Hooley (2009), Borderline Personality Disorder has different aspects which could be studied from various angles that the researchers approach the problem from.
According to American Psychiatric Association (2000) many of the researchers have tendered to concentrate on the developmental stages that have the most problems like adolescents and early adults. In this respect, the study may lack the holistic approach that the researcher seeks to generate in line with the research purpose and the guiding hypothesis questions. However, the researcher seeks to address this consideration by use of the primary data where the current practitioners will aid in shedding light on the stages that may have been skipped by the earlier researchers.
Indeed, this consideration has been pointed to give the study a hybrid vigor in terms of comparative advantage over a purely primary or secondary based study. Taking into consideration that the secondary data will not be available from one source only, it is worth noting that its collection will be very tedious. With most of the research institutions and health facilities acting as the major source of the information to be used, the researcher will be required to establish the necessary links with them to effectively acquire the most essential resources. This may be hard in that mos