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Review of Literature


People who display long-term behavioral patterns that seem rigid and are unable to adapt to a wide range of settings are likely to suffer from one among many mental illnesses that make up personality disorders. There exists different kinds of these personality disorders, and the characteristics and symptoms vary significantly, according to each type of disorders. The commonly diagnosed personality disorders include: antisocial personality disorder, obsessive-compulsive personality disorder, schizoid personality disorder, avoidant personality disorder and borderline personality disorder. Statistics from the national institute of mental health indicate that a significant part of population, which is about 9.1% of the adult population in the US experience a personality disorder in a year’s prevalence period. This paper reviews the literature available in strategies, techniques and methodologies used in counseling and treatment of bipolar and personality disorders.

Literature Review

The study by Beaumont and Hollins-Martin (2015) reviews and summarizes research findings on the use of Comparison-Focused Therapy (CFT) in the treatment of psychology-related disorders. The study focused on researches that have utilized CFT in treatment of clients, experiencing mental health issues, such as personality disorders, trauma symptoms, and schizophrenia-spectrum disorder. The study established that CFT is effective therapeutically when used both during one-to-one therapy and within groups. Moreover, CFT is more effective when used in combination with approaches, such as Cognitive Behavioral Therapy (Beaumont & Hollins-Martin, 2015).

Lorains, Cowlishaw, and Thomas (2011) conducted a study concerning the prevalence of comorbid disorders, such as: substance use disorders, depression, nicotine dependence, anxiety disorders, in population representative’s samples of problem and pathological gamblers. The study conducted a search for peer-reviewed articles from 1998-2010, where the studies that met the criteria were synthesized using meta-analysis techniques to establish the estimated and weighted effect size and heterogeneity across studies. Results show that problem and pathological gamblers had high rates of comorbid disorders, with the highest prevalence rate being 60.1% for nicotine dependence, 57.5% for substance use disorder and 37.4% for anxiety disorder. The study established the problem that pathological gamblers experience high levels of other comorbid mental health disorders, thus recommending screening for comorbid disorders in treating gambling problems (Lorains et al., 2011).

Borderline Personality Disorder patients have been reported by physicians and primary care specialists to experience pain problems. An enquiry by Biskin, Frankenburg, Fitzmaurice and Zanarini (2014) sought to study the occurrence of pain symptoms in BPD patients, paralleled to other personality disorders, in addition to ascertaining the factors that envisage pain experience in BPD patients. 290 inpatients diagnosed with Borderline and DSM-II-R criteria for BPD and 72 patients who met DSM-III-R criteria for other personality disorder were assessed at baseline, using semi structured reviews and self-report measures. Scores of pain were evaluated 16 years after initial diagnosis and matched amongst diagnostic clusters using t-tests. Regression analysis was employed to ascertain predictors of pain amid BPD patients. The outcomes indicated that BPD patients are likely to feel pain, and their pain is even more severe in comparison to individuals with other personality disorders. Predictors of harshness of pain comprise older age, occurrence of depressive disorder and juvenile abuse (Biskin et al., 2014).

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Late stage Bipolar Disorder (BD) patients have been described to undergo elevated relapse rates and inferior quality of life (QoL), in comparison to initial stage patients. Additionally, current psychological interventions seem to be ineffective during this stage. An investigation by Murray, Leitan, Berk, Thomas, Michalak, and Berk (2015) established an online mindfulness-based intervention aimed at QoL in late stage BD, and described an open pilot trial of Online Recovery-focused Bipolar Individual Therapy (ORBIT). 26 Patients between the ages of 18-65 with primary diagnosis of BD, under the care of professional medical practitioner accessed the internet and were assessed for QoL. Primary outcome was modified (baseline-post-treatment) on the brief quality of life of bipolar disorder (Michalak & Murray, 2010). As a matter of fact, secondary outcomes were stress, depression, and anxiety measured on the DASS scales. The results show that online delivery for late stage BD of mindfulness based psychological therapy seem effective and feasible, and ORBIT warrants full development (Murray et al., 2015).

Research described an association between cognitive impairments and bipolar disorder, even for euthymic patients. However, the findings are inconsistent across previous meta-analysis and primary studies. A study by Bourne et al. (2013) analyzed 31 primary datasets as a single large sample (where N=2,876) aimed at providing a more definitive view. Control data and individual patients were obtained from original authors for 11 measures from four common neuropsychological tests; Rey Verbal Learning Task (VLT), Trail Marking Test (TMT), Digital Span and Wisconsin Card Sorting Task. The study found weakening for all 11 test-measures in the bipolar cluster after regulating for gender, IQ and age. The weakened were also found not to be related to drug treatment. Some test-measures were weakly correlated with ailment harshness, signifying that some sicknesses may trail disorder progression. The results support digital Span, VLT and TMT as robust measures of cognitive impairments in bipolar disorder patients (Bourne et al., 2013)

Personality Disorders (PDs) are often associated with a wide range of adverse health outcomes, resulting in high costs to the healthcare system. A study by Dixon-Gordon, Whalen, Layden, and Chapman (2015) sought to systematically review available literature on health conditions amongst people with PDs. The research reviewed 20 peer-reviewed articles exploring the association of PDs and health outcomes over the last 15 years. They specifically examined the connection between PDs and conditions like obesity, sleep disturbance, and pain conditions among others. The study also evaluated the candidate mechanisms, underlying health problems and the possible treatment for such disorder. The results indicate there are numerous deleterious health problems, associated with PDs and their potential treatments. For instance, people with borderline personality disorder tend to suffer from chronic sleep disturbances (Dixon-Gordon et al., 2015).

A study by Forster, Berthollier, and Rawlinson (2014) acknowledges that there is increased understanding on how to handle and treat people with PDs, but also points out the gap in knowledge about how the available interventions work. They critique available literature and knowledge about the mechanisms of change in psychotherapies for people with PDs. Systematic electronic searches through online journal databases were used to gather relevant literature for analysis. 21 empirical selected studies showed that rapture resolution, therapeutic alliance, reflective functioning, therapist interpretation, emotional regulation, personality organization, experimental avoidance and cognitive change are conceivable mechanisms of change in individual psychotherapeutic interventions. The study established that there is more evidence on the use of therapeutic alliance and resolution of its rapture, compared to other potential mechanisms of change. The choice of mechanism of change has Implication for clinical practice, and further research into change process for PDs patients is required (Forster et al., 2014).

In a study by Hofmann, Asnaani, Vonk, Sawyer, and Fang (2015), sought to provide a comprehensive survey of meta-analysis, examining the efficacy of CBT. A sample of 106 examining CBT for problems, such as personality disorders, anger and depression, criminal behavior, substance use disorder, and schizophrenia, among other related disorders. The strongest support exists for CBT of anxiety disorders, anger control problems, somatoform disorders and general stress. The study found that CBT shows high efficacy levels in handling addictions and substance abuse. CBT is even more efficient when done in multiple sessions, compared to brief interventions or single sessions. In conclusion, the study established that CBT is effective in helping substance abuse and personality disorder victims, and CBT is even more effective when used in combination with motivational approaches and relapse prevention (Hofmann et al., 2015).

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Stratford, Cooper, Simplicio, Blackwell, and Holmes (2014) carried out a literature review, seeking to ascertain the level of efficacy of psychosomatic therapy in decreasing comorbid anxiety disorders and anxiety indications in BPSD patients. The review was guided by Cochrane Collaboration’s handbook (2011). A total of 22 studies fitting the selection criteria were reviewed. Some employed mindfulness based cognitive therapy (MBCT) in groups, others employed psycho-education in groups and one used exposure and response prevention (ERP) on an individual basis. These studies expected all the patients to continuously take mood-stabilizing medications. Results show that the addition of anxiety control components in an existing CBT treatment for BPSD produced positive results in controlling anxiety scores and comorbid anxiety. Furthermore, evidence gathered indicates that the addition of CBT anxiety components to standard BPSD provide a useful route for treatment development, although it is not possible to make a firm conclusion from the number of studies that are currently available (Stratford, et al., 2014).

A study by Hebert, Caughy, and Shuval (2011) on qualitative and quantifiable studies studied whether people constituted of adequate primary care workers, in addition to assessing their approach and perception concerning PA counseling. The study established that most primary care workers have confidence that PA is essential and they have a part to play in upholding PA among their patients. These care workers, however, are unclear regarding the efficacy of psychotherapy, and some are not comfortable in providing comprehensive advices on PA. Other problems they face comprise lack of appropriate preparation, lack of time and compensations. In conclusion, the study established that primary care workers are open to the idea of PA use in clinical settings, although numerous individual and organizational problems need to be addressed to successfully integrate PA therapy in primary care (Hebert et al., 2011).


There has been a lot of research in areas related to counseling and treatment and handling patients with Bipolar and personality disorders. Psychotherapy is the most widely used way of dealing with and treating bipolar, substance dependency and personality disorders. Different cognitive behavioral therapy treatments are suited for different personality disorders. It is important to note that most therapists use a combination of behavioral and cognitive therapies in treating personality disorders. It is fundamental that people who are directly and indirectly involved in the care and treatment of such patients will be constantly refreshing their skills using new research findings that are being published regularly.