337 BPD & ASPD Flashcards
1
Q
history of BPD
A
- origins in psychoanalytics
- Stern: hypersensitive, problems with reality testing, negative reactions in therapy (patients getting worse with Tx)
- patients not clearly neurotic or psychotic = on the ‘border’ (very broad name for someone not responding to Tx)
- Knight: pseudo-neurotic schizophrenia (both psychosis and neurosis)
- DSM-III: intense affect, impulsivity, relationship problems, brief psychotic experiences
- now stuck with the name despite it being not descriptive (“emotionally unstable disorder”)
2
Q
emotional instability
A
- emotions change rapidly and repeatedly (intense and unpredictable)
- difficult to control - angry outbursts common
- family members feel shifts to be unpredictable, don’t understand triggers
- people with BPD have increased amygdala activation for fearful and happy faces (below conscious awareness)
- giving more resources for emotional content = hypervigilance and hypersensitivity to emotional fluctuations
3
Q
neurochemistry of BPD
A
- low 5-HT (serotonin: mood regulation)
- treated with SSRIs = improvements in aggressive impulsivity (but not overall reduced symptoms, no effect on emotion instability)
- some evidence of DA dysfunction (antipsychotic meds effective as Tx, inferred through behaviours like impulsivity, sensation-seeking, emotion dysregulation)
4
Q
unstable relationships in BPD
A
- emotional instability often triggered by loss, rejection, disappointment (perceived/real)
- unstable representations of others (idealization to devaluation)
- fear of rejection + fear of becoming too attached = ‘testing’ others to get them to prove that they care
- don’t trust that others will stay
5
Q
spousal abuse in BPD
A
- men with BPD often high on BPD characteristics
- they have unreasonable standards, idealization/devaluation, blame partner when things go wrong, poor impulse control = violence
- could see the same pattern in women, but not studied
6
Q
unstable self-concept in BPD
A
- difficult to conceptualize a coherent self, often tends to be negative
- sense of ‘emptiness’ - feel as though they have no substance when alone and define themselves in relation to others
- value relationships highly: threat to relationship = threat to self
7
Q
unstable behaviour in BPD
A
- impulsive and self-damaging
- alcohol/substance abuse, spending sprees, risky sexual behaviours, gambling, eating binges
- NSSI conceptualized as unstable behaviour (suicide behaviours can also be conceptualized that way, though not impulsive)
8
Q
NSSI and suicide in BPD
A
- NSSI very common in BPD (partly because it’s a criterion)
- threat to relationship/loved one leaving is a common trigger for NSSI to regulate negative affect
- suicidal ideation very common, attempts as well (1 in 10 die by suicide)
- reasons for attempts: to escape, to punish self, revenge (rare), to make others better off (more common), assumption of manipulative intent but maybe just trying to communicate
9
Q
dissociation in BPD
A
- 75% experience paranoid ideas or episodes of dissociation
- more common and more intense in people with BPD, and triggered by lower required levels of stress
- endorse dissociation even more than people with PTSD
- dissociation understood as misperception, paranoid beliefs aren’t as firm as delusions
10
Q
BPD epidemiology
A
- prevalence = 1-2% (higher in clinical settings), more common in women
- runs in families, also find higher rates of externalizing, SUDs, MDD
- has a genetic component (twin studies)
- psychosocial stress factors are very important (early trauma, abuse, neglect have strong associations but nonspecific)
- wide heterogeneity in presentation (debate about what are the core features of the disorder, no criterion A)
11
Q
BPD comorbidity
A
- MDD 60%
- PTSD 35%
- BP 20%
- EDs 17%
12
Q
in BPD a distinct diagnosis?
A
- as a variant of depression: more chronic form (but evidence of distinct neural signatures)
- as a variant of PTSD (but you can have BPD without trauma, trauma not unique to BPD or PTSD)
13
Q
BPD course
A
- chronic
- evidence that a large majority can be treated
- more severe in younger populations
- suicidal and impulsive bx can improve with Tx, mood reactivity often persists but people learn how to cope
14
Q
dialectical behaviour therapy for BPD
A
- Marsha Linehan
- form of cognitive therapy, practice both acceptance and change
- need to accept the person for who they are AND try to change the way they live their lives to align with their values
- recognize emotions and their triggers
15
Q
biosocial theory of BPD
A
- biological predisposition toward big emotional responses, sensitivity to environment, problems regulating emotions
- paired with a chronically invalidating environment: parents minimizing, blaming, rejecting, attributing pejorative responses to kid’s emotions = even more difficulty regulating
- punished for your emotions = emotions become scary and threatening
- “i’m sad” “no you’re not” (met with erratic and out-of-touch responses) = teaching the kid that they’re wrong about their emotions or stop communicating emotions, emotions threatening
16
Q
psychodynamic theory of BPD
A
- innate aggression interferes with normal development, cannot integrate positive and negative perspectives of the self and others
- unresponsive family environment disrupts development of a stable sense of self + unable to self-soother because they can’t remember positive images of nurturing
17
Q
biological factors in BPD
A
- affective instability may be inherited
- serotonin linked with suicide and impulsivity
- dopamine linked with novelty seeking, reward pathways
- oxytocin interacting with family functioning (important in child-parent bonding)
- limbic and prefrontal abnormalities - uncinate fasciculus, OFC in emotion control, amygdala disconnection from PFC
18
Q
executive neurocognition
A
- being able to delay or terminate a given response (cognitive or motor) for the purpose of achieving another goal or reward that is less immediate
- cognitive/behavioural/motivational inhibition, interference control
19
Q
cognitive factors in BPD
A
- executive neurocognition deficits
- verbal/nonverbal memory deficits (autobiographical)
- social cognition: attending to negative cues, biases in emotion recognition, less likely to rate strangers as trustworthy
20
Q
EE in BPD and Tx
A
- criticism and hostility not linked to poorer outcomes
- people with BPD fare better in Tx with emotional overinvolvement (perhaps process it better because of fear of abandonment)
21
Q
pharmacological Tx for BPD
A
- antipsychotics and antidepressants, anticonvulsants, benzodiazepines, lithium
- modest benefits, not much research
