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By N. Roland. Warren Wilson College. 2018.

While the syndrome can be identified with reasonable reliability discount apcalis sx 20mg visa, the fundamental nature of the disorder remains unclear cheap apcalis sx 20 mg amex. buy discount apcalis sx 20mg line. purchase apcalis sx 20 mg with visa. It is a worldwide phenomenon generic 20 mg apcalis sx with mastercard, being described in the U. Articles in Family Physician and Nursing journals describe them as demanding, manipulative, disruptive, frustrating, non-compliant, and hostile - especially when not medicated properly. Untreated, a borderline lives an emotional vertigo - experiencing totally unstable moods. These mood swings and most any stress cause a horribly progressive dysphoria. They intensely feel almost every painful emotion at once. Borderlines desperately search for relief, usually by endorphin releasing behaviors that are ultimately self-destructive - such as binge eating, binge spending, aberrant sexual behavior, substance abuse, and reckless driving. When a severe borderline is extremely dysphoric, cutting the skin causes no physical pain and actually relieves the dysphoria. Because untreated borderlines live with constant mood swings and frequent dysphoria, normal psychological functioning is crippled. Understanding this enables the Family Physician to help. Borderlines need to understand their illness, and to be treated properly. Mood Swings: Mood swings are a fundamental devastating symptom of borderline. Moods can shift inappropriately from hour to hour, even minute to minute. Without appropriate environmental of though-provoked justification. It can be triggered by mood swings, stress, and emotional pain. Once dysphoria begins, it tens to steadily intensify - possibly due to limbic system malfunction. Because of the psychotic episodes, borderlines are said to live at the "border" between reality and psychosis. The main psychotic symptoms are moods, physical sensations and perceptual distortions. The dominant psychotic moods center around worthlessness, badness, rage, and self-destruction. The physical sensations are remarkably similar to temporal lobe epilepsy and include unreality, derealization (familiar things become unreal). Deja-vu, out-of-body experiences, depersonalization (as though no longer yourself), unawareness spells, and feeling like body parts are numb and no longer part of oneself. Psychosis can also be brought on by drugs, especially alcohol and marijuana. This immature psychological defense persists in borderlines, resulting in "black and white thinking. When things are good, the borderline frequently feels vulnerable, and fears the black returning - often leading again to dysphoria. While intelligence is not impaired, organization and structure are - borderlines have trouble following through and completing tasks. Chronic anger, fear of abandonment (often resulting in manipulative behavior), lack of trust, impulsivity, feelings of emptiness and/or boredom, jumping to incorrect conclusions, and severe PMS are commonly experienced. Comorbidity: Borderlines frequently suffer from other psychiatric illnesses. The most common include depression, anxiety, substance abuse, alcohol abuse, other personality disorders, and eating disorder (approximately 40% of eating disorder inpatients suffer from the borderline). Borderlines have significant biological abnormalities - see Table 2.

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