Borderline Exam II

Question 1

Diagnostic Criteria

Answer 1

▪ Pervasive pattern of instability in interpersonal relationships, self-image, affects, and impulsivity; begins by early adulthood; indicated by five or more symptoms: (AAIIDSS, MEAP)

1. Avoidance abandonment real or imagined
2. Unstable interpersonal relationships
3. Identity disturbance
4. Self-damaging impulsivity
5. Suicidal ideation
6. Mood instability
7. Chronic emptiness
8. Inappropriate, intense anger
9. Paranoid ideation

Question 2

Biosocial Theory

Answer 2

Dysfunction of Emotional Regulation:

1. Biological predisposition
2. Relationship between individual and environment is reciprocal (e.g. invalidating environments and families)

So…

1. High sensitivity to emotional stimuli
2. Intense emotional response
3. Slow return to baseline

Never learns to…

1. Label, regulate, tolerate, trust emotions
2. Develop coherent sense of self

Instead….

1. Constantly scanning the environment for cues about how to act (often misinterpreting)
2. Intense emotional dysregulation

Question 3

Assessment

Answer 3

• SCID-5-PD
• DIB-R (Diagnostic Interview for Borderline)
• BSL (Borderline Symptom List)

Question 4

Stage 1: Attaining Basic Capacities

Answer 4

Create Alliance

1. Set Goals
2. Psychoeducation
3. Commitment
4. Expectations
5. Describe DBT

Order of Intervention
1. Reduce suicidal ideation, behaviors that interfere with therapy and quality of life

2. Increasing Behavioral Skills
   (e. g. emotion regulation, mindfulness)

HW: Diary Cards about NSSI Behavior

(may take 1 year)

Question 5

Stage 2: Quiet Desperation

Answer 5

Goal: Reduce extreme emotional pain

Treatment:

1. Remember and accept earlier traumatic stress
2. Reduce stigmatization and self-blame
3. Reduce denial and intrusive response syndromes
4. Resolve tensions regarding blame for the past

Question 6

Stage 3: Resolve Problems in Living and Increase Self-Respect

Answer 6

Goal: Achieve ordinary happiness/unhappiness

Treatment:

1. Evaluate behaviors non-defensively
2. Trust own responses
3. Hold On to self-evaluations, independent of others

At this point in treatment, therapist should be pulling back and be reinforcing pt.’s ability to make own decisions

Question 7

Stage 4: Attain Capacity for Freedom and Sustained Contentment

Answer 7

Goal:

1. Achieve Freedom
2. Resolve sense of Incompleteness
3. Capacity for sustained contentment

Treatment:
Increase:
-Self-actualization
-Spiritual fulfillment 
-Expanded Awareness

Question 8

Strategies

Answer 8

Specific Dialectical Strategies:

1. Entering the paradox
2. Using metaphors
3. Playing devil’s advocate

Validation
Problem Solving
Case Management