Borderline Personality Disorder Flashcards
What does the name Borderline reflect?
At the border of psychosis (loss contact with reality) and neurosis (what we now call anxiety-depression).
A type of patient that didn’t fit clearly into any of these two
What term does the world health organization uses instead of borderline personality disorder
emotionally unstable disorder
probably more descriptive of the portrait
DSM-5 criteria of borderline personality disorder
A 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, as indicated by 5 or more of the following
- Frantic efforts to avoid real or imagined abandonment
- A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
- Identity disturbance: markedly and persistently unstable self-image or sense of self
- Impulsivity in at least 2 areas that are potentially self-damaging, for example, spending, substance abuse, reckless driving, sex, or binge eating
- Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
- Affective instability due to a marked reactivity of mood, for example, intense episodic dysphoria, anxiety, or irritability, usually lasting a few hours and rarely more than a few days
- Chronic feelings of emptiness
- Inappropriate, intense anger or difficulty controlling anger, for example, frequent displays of temper, constant anger, or recurrent physical fights
- Transient, stress-related paranoid ideation or severe dissociative symptoms
Is there A criterion for the diagnosis of BPD in the DSM-5?
No A criterion. No cardinal symptoms.
You need 5 of the 9 symptoms.
One of the area of instability that we see in borderline personality disorder is emotional instability. Explain
A lot of people see emotional instability is a main symptom.
Emotions are often described as intense and unpredictable.
Feels so strong and overwhelming, no choice but to express these emotions.
Family members feel like they are walking on eggshells. Have to be hypervigilant.
What were the results of the Baskin-Sommers 2015 study that looked at emotional reactivity in BPD patients compared to healthy controls (You show two faces in very rapid successions.
Target stimulus: some kind of emotional response: presented below conscious perception. Immediately overlaid with a neutral expression)
More activation in BPD group compared to healthy control when viewing happy, angry or fearful faces masked.
Idea is that this is reflective of hypervigilance for emotional content in the BPD group compared to control. They are reactive even to emotional reaction that other people are not reacting to.
There is some evidence that borderline personality disorder patients have decreased 5-HT (serotonin) activity. So people have tried selective serotonin reuptake inhibitors on these patients. What seem to be the results?
Improvements in aggressive impulsivity. But not overall reduction in symptoms.
Another area of instability in BPD is in relationships. Explain
Emotional instability often triggered by loss, rejection, disappointment (perceived or experiences).
Tell therapist about partner: Most amazing person i have met in my life. Then very dramatic shift where suddenly person is evil, careless, hate them.
You might see patient try to test the relationship with the therapist, to see if therapist actually cares about them
Men who engage in spousal abuse are often high on BPD characteristics. Don Dutton at UBC did a study with these men, what percentage met criteria for BPD?
About 40% of the men he was looking at that were engaging in violence against partner were meeting criteria for BPD.
Why men who engaged in spousal abuse were high on BPD characteristics&
- unreasonably high standards
- tendency to blame others
- high emotional and behavioral impulsivity
Another area of instability for borderline personality disorder patients is the sense of self. explain.
Self-concept is very fragile and typically very negative. A lot report a persistent sense of emptiness (hard being alone).
They define themselves a lot with the relationships they have with people. Being in a relationship becomes a priority.
When you don’t really know who you are, when you experience threats to your relationship (people who reflect to you who you are), threat to your sense of self.
another area of instability in BPD is in the behaviours. explain.
very impulsive, often self-damaging: high rates of alcohol, substance abuse, spending sprees, risky sexual behaviors, gambling, eating binges. also non-suicidal self-injury and suicide risk
What is a strong trigger in non-suicidal self injury for BPD patients?
Interpersonal loss
How common is suicidal ideation and suicide in BPD
Suicidal ideation is very common, almost all will report.
Suicidal attempts: as many as 70%
As many as one in ten die by suicide
Around what percentage of people with BPD experience dissociation?
some 75% experience intensely paranoid ideas and episodes of dissociation
what is the prevalence of BPD in the general population?
1-2%
What plays a large role in BPD?
early trauma, abuse, and neglect. In a 2005 study, they found that only 6% of BPD had no history of childhood trauma
What are the most common comorbities with BPD?
MDD, PTSD, bipolar, eating disorders
What percentage of individuals with BPD can be successfully treated?
Up to 88%.
In which population is BPD often most severe?
Younger populations.
What type of therapy is especially effective for treating BPD?
Dialectical Behavior Therapy (DBT).
What is the Biosocial Theory of BPD proposed by Marsha Linehan?
BPD results from a biological predisposition for emotional dysregulation combined with an invalidating environment.
