Borderline personality disorder

Question 1

What is the DSM criteria for BPD?

Answer 1

> Affective disturbance
Disturbed cognition
Impulsivity
Intense unstable relationships

Question 2

What is BPD typically comorbid with?

Answer 2

> Major depression
> Substance misuse
> PTS
> Anxiety disorders
> Eating disorders

Question 3

What is the heritability of BPD?

Answer 3

~47% (Skodol et al, 2002; Livesley et al, 1998)

Question 4

What are the treatments of BPD?

Answer 4

> CBT (Dialectical Behaviour Therapy)

> Psychodynamic therapy (mentalisation therapy)

Question 5

What is the mentalisation theory of BPD?

Answer 5

> BPD is a deficit in attachment-related mentalisation

> Biological and/or environmental causes

Question 6

What is attachment theory?

Answer 6

> Parent/child emotional bond
Child develops internal working model of relationships
Model shapes self-perceptions, expectations and social behaviours
Model forms basis for future relationships

Question 7

What are the types of attachment?

Answer 7

> Securely attached
Anxious/avoidant
Anxious/resistant
Disorganised

Question 8

What is mentalisation?

Answer 8

The ability to understand and respond appropriately to own and others’ state of mind

Question 9

What are the features of mentalisation deficit?

Answer 9

> Difficulty distinguishing thoughts and reality
Withdrawal into mental world
Reliance on observable proof of mental states
Internalised view of self as evil

Question 10

What did Bateman and Fonagy (1999) find?

Answer 10

> Mentalisation therapy (MT) v Psychiatric treatment
MT 6 months sig fewer suicide attempts
MT 9 months sig less anxiety and depression
MT 12 months sig less self-harm
MT 18 months sig fewer psychiatric hospitalisations
MT fewer interpersonal difficulties

Question 11

What is the Biosocial theory of BPD?

Answer 11

> Emotional vulnerability is heightened sensitivity and reaction to emotional stimuli
Invalidation is punishing, trivialising or ignoring expression of emotions
Interaction can lead to BPD

Question 12

What does the Biosocial theory of BPD state about BPD symptoms?

Answer 12

Emotional vulnerability / dysregulation and maladaptive coping strategies

Question 13

What is Dialectical Therapy?

Answer 13

> Form of CBT

> Based on combined capacity deficit

Question 14

What are the functions of Dialectical Behaviour Therapy?

Answer 14

> Enhance capabilities
> Increase motivation to change
> Enhance environmental generalisation
> Structure the environment
> Enhance therapist capabilities and motivation to treat

Question 15

What are the stages of Dialectical Behaviour Therapy?

Answer 15

> Eliminate suicidal behaviour
Desperation shifting -> emotional experiencing
Addresses living problems
Develop capacity for freedom and joy

Question 16

What are the techniques used in Dialectical Behaviour Therapy?

Answer 16

> Validate emotions and behaviours

> Change patient’s techniques

Question 17

What skills does Dialectical Behaviour Therapy develop?

Answer 17

> Mindfulness
Interpersonal effectiveness
Emotion regulation
Distress tolerance

Question 18

What did Linehan (2006) find?

Answer 18

> DBT v regular treatment
DBT = fewer suicide attempts
No difference in depression or psychiatric hospitalisations

Question 19

What are the main contributors to positive outcome?

Answer 19

> Supportive relationship with therapist
Belief therapy will help
Increased sense of self-efficacy