Borderline Personality Disorder Flashcards
What is the origin of BPD?
- Stern-> hypersensitive, problems with reality resting, negative reactions in therapy
- Knight-> Between psychose and neurose
What were the DSM-III criteria for borderline?
DSM-III→ developed specific criteria
- intense affect→ strong emotional responses
- impulsivity
- relationship problems
- brief psychotic experiences
What is the name of Boderline PD in the International Classification of Diseases?
Emotionally Unstable Disorder
What are the critertia for a diagnosis of Borderline PD?
Def→ pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts
Five or more of following symptoms
- Frantic efforts to avoid real or imagined abandonment
- A pattern of unstable and intense interpersonal relationships
- Identity disturbance
- Impulsivity in at least two areas that are potentially self damaging
- Recurrent suicidal behavior, gestures, or threats, or self mutilating behavior
- Affective instability due to a marked reactivity of mood
- Chronic feelings of emptiness
- Inappropriate, intense anger, or difficulty controlling anger
- Transient, stress related paranoid ideation or severe dissociative symptoms
—>lot of room for heterogeneity (126 different combinations of symptoms)
What is the general prevelance and clinical prevalence of borderline PD?
Prevalence→ 1-2%
- clinical settings→ 10-15%
Is BPD more coomon in womne than men?
75% of cases of BPD are women
- might be due to samplings in clinical settings
- two population based studies have reported no gender differences
What are the comorbidity rates of Borderline PD?
Comorbidity
- very high
- mood disorder (80%)
-anxiety disorders (85%)
- substance use disorders (78%)
More specifically
- 60% with MDD
- 35% with PTSD
- 20% with bipolar
- 17% eating disorders (bulimia, binge eating disorder)
- substance abuse problems (14%)
–>comorbid with both externalizing and internalizing symptoms
What are the possible etiology of Borderline PD?
Genetics→ runs in families
- prevalence of 14% in relative of proband (x3 more risks)
- twin study-> 35% for MZ VS 7% for DZ
–>familial aggregation
- also higher rates of SUD, APD, externalizing and MDD
–>but probable that transdiagnostic symptoms are inherited (neuroticism, negative affectivity…)
Environment→ early trauma, abuse and neglect play large role
- 6.1% of BPD had no history of childhood trauma
- 61.5% of controls had no such history
—>common to many disorders
Biosocial theory→ Marsha Linehan
- biological predisposition towards difficulty regulating emotions
- +failure in child’s environment/ invalidating family environment
= inability to regulate strong emotional responses
—>cannot learn through caregivers and start to question their emotions
—>start to see their emotions as threatening, out of control loke their parents
What were the findings concerning emotional instability of the backward masking paradigm study?
Baskin-Sommers→ study with women with and without BPD
- backward masking paradigm with target faces with emotions followed by neutral faces mask
—>hypervigilant to all emotions even happy and fearful
Negative biases in facial emotion recognition
- appraise social interactions more negatively
- results suggest that depends on sex of the individual
- more likely to misidentidy anger in males
- longer to recognize happiness in males
What are the potential neurological explanation of BPD?
Neurotransmission→ serotonin and dopamine
- evidence for low 5-HT serotonin in BPD
- might be at the level of serotonin receptors
- when treated with SSRIs show improvement in aggressive impulsivity
- evidence for dopamine dysfunction→ moderate effects of antipsychotics meds on BPD and specific allele of DAT1 more present depressed patients with BPD
Oxytocin-> polymorphism of this gene show susceptibility to effect of good or bad parenting
- not the same for boys and girls
-Norepinephrine-> modulate aggression
- positive correlation between levels of urinary norpinephrine and severity of dissociation
- reduction in hippocampus and amygdala and parts of PFC
–>every one found in other disorders
What are the different findings concerning the relationship instability in BPD?
Emotional stability usually triggered by loss, rejection or disappointment
- perceived or experienced
Unstable representations of others
- idealizing to anger
- wanting to punish others
- do not trust people
Fear of rejection
- fear of becoming too attached because fear of vulnerability
- testing others
- ex: testing the therapist before they leave on vacation
Insecure attachment style in most of the patients
What were the findings of Don Dutton concerning the link between spousal abuse and BPD?
Don Dutton→ 40% of men engaging in spousal abuse met criteria for BPD
- set unreasonably high standards
- blame partner when things go wrong
- poor impulse control leading to violence
What is the sense of self like for someone with BPD?
Very fragile self-concept
- typically very negative view of oneself
- sense of emptiness compared to others→ no central coherent self
- hard to tolerate being alone→ because define themselves by how people interact with them
- threat to relationships then becomes a threat to sense of self
What are the suicide rates and reasons in BPD?
In general pop→ 1-4% of adults and 13-23% of teens report lifetime hisotry of NSSI
- very common in BPD
Suicidal attempt→ as many as 70% with BPD
- average of 3-4 attempts
- 10% die by suicide
Reasons for suicide attempts
- get away or escape
- punish self
- revenge
- to make others better off→ most reported reason
How frequent are dissociative states in BPD?
Dissociation-> Feeling of being outside of oneself
- 75% experience paranoid ideas or episodes of dissociation
- hallucinations less common than in schizophrenia, more insight into their condition
What did the Stiglmayr study found for diassociatve states in BPD?
Stiglmayr→ BPD, clinical control and control
- provide hourly rating of stress, dissociation for 48h
- BPD > stress than CC or C
- BPD > dissociative experiences(more frequent and intense)
—>usually dissociation linked with high level of stress
—>for BPD, dissociation present even under low levels of stress
How chronic is BPD and it is treatable?
Chronic
- BUT evidence that as many as 88% can be successfully treated
- often become less severe wen older
Treatment
- suicidal and impulsive behaviors decrease
- mood reactivity often persists but better able to cope
- DBT→ dialectical behavioural therapy
What are the different forms of executive neurofunctioning and their role in BPD?
Interference control-> ex: stroop task
Cognitive inhibition-> suppress info from working memory
Behavioral inhibition-> ex: go/no go task
Motivational or affective inhibition-> ex: emotional stroop task
–>patients with BPD show impairments on task challenging inhibitory processes
