The Assignment: Respond to at least two of your colleagues by providing one alternative therapeutic approach. Explain why you suggest this alternative and support your suggestion with evidence-based literature and/or your own experiences with clients.  In APA Format, Cite and Provide at least 2 references no more five year old for each responses. Colleagues Respond# 1 Paranoid Personality Disorder (301.0), which comes out of general personality disorder. These individuals have a constant distrust and suspicion of others around them, thinking that everyone has a motive against them. These patients start having problems from childhood and it presents in a variety of ways. Some of them are being apprehensive and doubtful of others thinking they are going to exploit, harm, or deceive them. Constantly preoccupied with unjustified doubts about the loyalty or trustworthiness of the people closest to them. Reluctant to confide with the fear that their information will be used maliciously against them. Persistently bears grudges, perceives attacks on their character when it is not so and quick to react with ager or counterattack (A.P.A., 2013).  These individuals or personality disorders are usually treated with cognitive behavioral therapy, which is a collaborative process of empirical investigation, reality testing, and problem-solving between the therapist and the patient (Wheeler, 2014). Depending on what other underlying issues or disorders they have, other therapeutic therapies can also be introduced but for the most part, CBT is the one that is used often for personality disorders. for PPD medication is usually not given and psychotherapy is the route, but depending on what other extreme symptoms the patient may have like anxiety or depression, then medications can be given for them. Unfortunately, these individuals don’t see that they have problems and usually don’t seek medical help, which makes for a poor quality of life for these individuals. It is common for them to have other comorbidities such as substance misuse disorder, major depressive disorder, agoraphobia and OCD (Vollm et al, 2011). The essential feature here with these patients is distrust and being suspicious of others and their surroundings, therefore in order to be able to have any kind of therapeutic or therapist relationship with them one has to first get their trust completely. Make them feel that you are completely on their side by sharing with them that you respect what they believe but you don’t share it or have the same belief, that you have nothing that can harm them, that you are genuine and are there only for them (Carroll, 2018). Once that is established, which may take some time and patience on the therapist part, then little by little we can point various things out to them to help them see that what they perceived as evil is not it and from these little examples that are clarified then we can explain to them the disorder or problem they have. Colle.

1. The Assignment:
Respond
to at least
two
of your colleagues by providing one alternative therapeutic
approach. Explain why you suggest this alternative and support
your suggestion with evidence-based literature and/or your own
experiences with clients. In APA Format, Cite and Provide at
least 2 references no more five year old for each responses.
Colleagues
Respond# 1
Paranoid Personality Disorder (301.0), which comes out of
general personality disorder. These individuals have a constant
distrust and suspicion of others around them, thinking that
everyone has a motive against them. These patients start having
problems from childhood and it presents in a variety of ways.
Some of them are being apprehensive and doubtful of others
thinking they are going to exploit, harm, or deceive them.
Constantly preoccupied with unjustified doubts about the
loyalty or trustworthiness of the people closest to them.
Reluctant to confide with the fear that their information will be
used maliciously against them. Persistently bears grudges,
perceives attacks on their character when it is not so and quick
to react with ager or counterattack (A.P.A., 2013).
These individuals or personality disorders are usually treated

2. with cognitive behavioral therapy, which is a collaborative
process of empirical investigation, reality testing, and problem-
solving between the therapist and the patient (Wheeler, 2014).
Depending on what other underlying issues or disorders they
have, other therapeutic therapies can also be introduced but for
the most part, CBT is the one that is used often for personality
disorders. for PPD medication is usually not given and
psychotherapy is the route, but depending on what other
extreme symptoms the patient may have like anxiety or
depression, then medications can be given for them.
Unfortunately, these individuals don’t see that they have
problems and usually don’t seek medical help, which makes for
a poor quality of life for these individuals. It is common for
them to have other comorbidities such as substance misuse
disorder, major depressive disorder, agoraphobia and OCD
(Vollm et al, 2011).
The essential feature here with these patients is distrust and
being suspicious of others and their surroundings, therefore in
order to be able to have any kind of therapeutic or therapist
relationship with them one has to first get their trust
completely. Make them feel that you are completely on their
side by sharing with them that you respect what they believe but
you don’t share it or have the same belief, that you have nothing
that can harm them, that you are genuine and are there only for
them (Carroll, 2018). Once that is established, which may take
some time and patience on the therapist part, then little by little
we can point various things out to them to help them see that
what they perceived as evil is not it and from these little
examples that are clarified then we can explain to them the
disorder or problem they have.
Colleagues
Respond# 2

3. Different types of personality disorders disturb an individual
and thus affect the way they think, behave, reason, and act but
in this week’s discussion Post, I chose to discuss Borderline
Personality Disorder (BPD).
Borderline Personality Disorder
BPD is a severe personality disorder categorized by impulsivity,
affective instability, relationship problems, and identity
problems. It affects 1-2% of the overall population, 10% of the
patients in outpatient settings, 15-20% of the patients in
inpatients settings, and 30-60% of the patients diagnosed with
personality disorders. This uncertainty often disrupts family and
work life, long-term planning, and the individual's sense of self-
identity. Originally thought to be at the borderline of psychosis,
people with BPD suffer from a disorder of emotion regulation.
BPD is very normally considered according to the diagnostic
and statistical manual of mental disorders. Additionally,
evaluation of BPD geographies on a measurable or dimensional
scale is gradually used (Jackson, & Westbrook, 2009). This
disorder is frequently detected in women in clinical sections and
young individuals and is often co-morbid with other personality
and axis-I disorders. Researchers using eco-logical temporary
calculation strongly indicates that these individuals react in
abnormal ways to interpersonal convict (Fitzpatrick, Maich,
Carney, & Kuo, 2020). Recently, neurobiological studies
showed that symptoms and behaviors of BPD are partly
associated with alterations in basic neurocognitive processes,
involving glutamatergic, dopaminergic, and serotoninergic
systems. Additionally, neuroimaging studies in BPD patients
indicated differences in the volume and activity of specific
brain regions related to emotion and impulsivity, such as the
prefrontal cortex, cingulate cortex, amygdala, and hippocampus.

4. According to the DSM-IV-R, an individual must have at least 5
out of 9 of the following symptoms present for an accurate
diagnosis to be made. These are extreme efforts to avoid real or
imagined abandonment, unstable and intense interpersonal
relationships, identity disturbance, potentially self-damaging
impulsivity, affective instability due to a marked reactivity of
mood, chronic feelings of emptiness, and inappropriate intense
anger or lack of control of anger (Jackson, & Westbrook, 2009).
Therapeutic Approach
There has not been any specific drug approved by the FDA to
treat BPD, although some have broad product licenses that
cover individual symptoms or symptom clusters. Where there is
a diagnosis of comorbid depression, psychosis, or bipolar
disorder, the use of antidepressants, antipsychotics, and mood
stabilizers respectively would be within their licensed
indications. Where there are depressive or psychotic symptoms,
or affective instability, that fall short of diagnostic criteria for
mental illness, the use of psychotropic drugs is largely
unlicensed or ‘off-label’. Prescribing off-label places additional
responsibilities on the prescriber and may increase liability if
there is an adverse effect. As a minimum, off-label prescribing
should be consistent with a respected body of medical opinion
and be able to withstand logical analysis. The Royal College of
Psychiatrists recommends that the patient be informed that the
drug prescribed is not licensed for the indication it is being
used for, and the reason for use and potential side effects fully
explained (NCCMH, 2009). The mental healthcare nurse
practitioner must do everything possible to avoid the use of
psychotropic drugs for BPD but if the opposite becomes the
fact, then treatment with both pharmacotherapy and
psychotherapy can be utilized when treating this disorder.
Pharmacological treatment is generally recommended in the
acute treatment of the core symptoms of BPD and in cases with
Axis I comorbidity and severe impulse bad control. Over the

5. past decade, antidepressants, specifically SSRIs, in particular,
have been considered the first pharmacological choice in the
treatment of BPD and its associated comorbidities. While, more
recently, meeting evidence specifies the efficacy of other
composites such as mood stabilizers and atypical
antipsychotics. Concerning psychotherapeutic interventions,
long-term approaches including transference-focused
psychotherapy, dialectical-behavioral psychotherapy, and
mentalization-based therapy seem to be particularly beneficial
((Jackson, & Westbrook, 2009).
Sharing Diagnosis
Because people suffering from BPD have relative to the norm
and thus react harshly to emotional systems, especially negative
feeling states such as fear, rage, shame, sadness, guilt, and
jealousy, what others might perceive to be relatively minor
events can result in a powerful wave of emotion in individuals
with them. To help avoid damaging the therapeutic relationship
with these groups of individuals as a mental healthcare nurse
practitioner, I would like to teach them that a diagnosis of BPD
does not warrant a death sentence. That is something that can be
treated, and once the symptoms are gone the person no longer
has the disorder.
Support Approach with Evidence-Based literature
The reason that I would utilize dialectical behavior therapy
(DBT) to treat my patient with BPD is that DBT is recognized
as the gold standard for people with BPD. It centers on the
theory of mindfulness and allocating care to the current
emotion. The therapy teaches the skills to deal with intense
emotions, reduce self-destructive behavior, manage distress, and
improve relationships. It seeks a balance between accepting and
changing behaviors. This proactive, problem-solving approach
was designed specifically to treat BPD. Research shows that

6. DBT is proven to be effective. A study done in 2014 showed
that 77% of participants no longer met criteria for BPD
diagnosis after undergoing treatment. Research suggests that
self-injurious behaviors occur for various reasons. Simeon et al.
(1992) reported that seeking relief from tension is the most
commonly cited reason for self-mutilation. Other reasons
include releasing anger, exercising control, forming identity,
influencing others, acknowledging self-hatred or guilt, releasing
sexual feelings, and achieving euphoria. DBT has been shown to
decrease self-injurious behavior. In a study by Linchan,
Armstrong, Suarex, Alimón, and Heard (1991) individuals
diagnosed with BPD were randomly assigned to either a DBT
treatment group or a control group with treatment as usual and
it was found that a significant reduction in the frequency of
self-injurious behaviors among patients who received DBT
compared to the control group with a rate over 1 year for the
DBT group was 63.6% and for the control group was 95.5%
(Alper, & Peterson, 2001).