Borderline Personality Disorder Flashcards
Basic Idea surrounding BPD
→ cluster B
- Dramatic, emotional, unpredictable
- Stern, 1938 “between psychoses and neuroses”, did poorly in therapy
Prevalence of BPD
- 1-2% community
- Most common personality disorder in clinical populations
- High use of mental health services
- 10-12% outpatient, 20-22% inpatient
- Similar rates in males and females
- Prevalence decreases with age, perhaps due to high rate of completed suicide and a reductino of symptoms following treatment
Phenotype of BPD
emotion dysregulation, identity disturbance, behavioural dysregulation
DSM Definition of BPD
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety.
Five of the following:
- frantic efforts to avoid real or imagined abandonment
- a pattern of unstable and intense interpersonal relationships characterised by alternating between extremes of idealisation and devaluation
- identity disturbance
- impulsivity in atleast two areas that are potentially self-damaging
- reccurent suicidal behaviour, gestures, threats, or self-mutiliating behaviour
- affective instability due to a marked reactivity of mood
- chronic feelings of emptiness
- inappropriate, intense anger or difficult controlling anger
- transient, stress-related paranoid ideation or severe dissociative symptoms
What is the hallmark of BPD
Instability of emotion, interpersonal relationships, self-concept, behaviour, cognitive features
Instability of Emotion in BPD
- Rapid, intense, unpredictable changes
- Make them difficult to control
- Duration of fluctuations is shorter than bipolar
- Persistence is throughout life, rather than a discrete episode
- Triggered by external events and particularly susceptible to failure, abandonment etc rather than euphoria etc in bipolar
- “Walking on eggshells around them”
Instability of Interpersonal Emotions in BPD
- Triggered by interpersonal events
- “Exquisitely sensitive” to others behaviours
- Difficulty holding stable representations of other people
- Afraid of become too attached
- Routine separations are experienced as rejection and abandonment, leading to impulsive behaviour
Instability of Self-Concept in BPD
- Fragile to sense of self
- Struggle to know who they are
- Feel empty inside
- Any threat to relationship becomes a threat to the sense of self
- Efforts to avoid abandonment
Instability of Behaviour in BPD
- Angry outburst
- Impulsive and self-damaging behaviour
Suicidal behaviours or repeated non-suicidal self-injury
- Rates of non-suicidal self injury is 68-80%
- Way of being heard and to relieve tension, powerful calming effect
- 46-92% to attempt suicide
- 3-10% to have committed suicide
Instability of Cognitive Features in BPD
- Transient, stress-related paranoid ideation or severe dissociative symptoms
- Transitory auditory hallucinations, often under stress
BPD as Polythetic in Nature
No one symptom is regarded as necessary
- 256 ways they can present
- heterogeneous disorder
Comorbidity of BPD
high, with
- MDD
- PTSD
- Bipolar
- Eating Disorders
BPD stigma
erratic engagements in mental health services
Marsha Linehan’s Biosocial Theory of BPD
- Primarily a disorder of emotional dysregulation
- BPD emerges from transactions between individuals with biological vulnerabilities and specific environmental influences
Proposed that they have broad dysregulation across all aspects of emotional responding
- Emotion sensitivity (low sensitivity)
- Emotion reactivity (high intensity in response)
- Slow return to baseline
- They then go on to have maladaptive coping strategies
