Borderline Personality Disorder Flashcards
What is personality?
- Complex pattern of characteristics (largely outside of awareness)
- Distinctive patterns of perceiving, feeling, thinking, coping, and behaving
• Personality traits
– Prominent, exhibited in a wide range of social and personal contexts
• No sharp division between normal and abnormal personality
– Viewed on a continuum
–> Intrinsic, pervasive, biopsychosocial
Personality Disorder
• An enduring pattern of deviant inner experiences and behavior differing from cultural expectations
– Pervasive and inflexible –> Leading to distress or impairment
• DSM 5-focus (Dx strategy) on disturbances in:
- Self functioning: self-identity and self direction
- Interpersonal functioning: ability to relate to others with empathy or intimacy (scary)
- Schema- a person’s view of the world that filters information and only lets in what is compatible with his/her personal beliefs
• Prevalence=4.4-13.4% (9.6% median)
Personality Disorder Clusters
Odd or Eccentric Behavior: paranoid, schizoid, schizotypal
Dramatic, Emotional, or Erratic Behavior: antisocial, borderline, histrionic, narcissistic
Anxious or Fearful: avoidant, dependent, obsessive-compulsive
BPD: criteria
- unstable interpersonal relationships
- scared of abandonment
- identity disturbance
- impulsivity
- recurrent suicidal behavior
- instability of mood
- chronic feelings of emptiness
- innappropriate/intense anger
- stressed
- -> usually early adulthood
BPD
The person has acquired few strategies for relating, and his/her approach to relationships & the environment is INFLEXIBLE and MALADAPTIVE.
Behavior provokes negative reactions from others.
Remissions common & relapse rates relatively low, sx decrease but psychosocial functioning may not improve
BPD: Cognitive Dysfunction
–Dichotomous thinking: evaluating people, objects & experiences in mutually exclusive ways (good OR bad, trustworthy OR deceitful, success OR failure)
–Catastrophizing: ex. “I didn’t pass this test…I’m never going to be anything”
–Self-attribution errors: inappropriate self-blame
BPD: Dissociation
–>disruption in the normally occurring linkages among subjective awareness, feelings, thoughts behavior & memories.
Examples are:
1. Derealization & depersonalization - feeling the self or environment is strange or UNREAL
– Out of body experiences
– Emotional numbing
– Amnesia for painful experiences (often abuse)
– Not being present during stress “spacing out”
– Alterations in body perceptions
BPD seeking help
- May not seek professional help unless extreme stress/internal distress (ex. self harm or suicide attempt)
- Do not want to burden others
Risk factors
–Childhood physical or sexual abuse
–Lack of stable home, nurturing
BPD adaptation/expectations
- Adaptation skills are characterized by tenuous stability, fragility, and lack of resilience when faced with stressful situations.
- When their unrealistic expectations of self are not met they feel shame, self hate & self directed anger.
Clinical Course
- Diagnosed in young adulthood –> but symptoms start in childhood or adolescence - assess family, tx child/adol
- Appear more competent than they actually are
- Life is one crisis after another, remissions and recurrences
- Emotional reactivity with minimal coping
- Avoidance by others because of intensity of emotions
Epidemiology
- 0.5 to 2.7% (1.6 median) prevalence in general populations
- In clinical populations, BPD is the MOST FREQUENTLY diagnosed personality disorder –> due to self harm and emergent care
- Mostly women
- Mean age of diagnosis is mid-20s
- Coexistence with other disorders (mood, substance abuse, eating, dissociative and anxiety disorders)
• Estimated suicide rate up to 10%
–continually pay attention to this; VERY HIGH suicide rate for BPD
Etiology: Biologic Theories
- CNS dysfunction and possible structural changes (LIMBIC system and FRONTAL LOBE)
• associated with affective instability, transient psychosis, impulsive, aggressive, & suicidal behavior - Possible INCREASED DOPAMINE as reason for transient psychotic states including derealization, paranoid thinking, dissociation & depersonalization
Etiology: Psychoanalytic Theory
- Does NOT achieve separation-individuation: when a child develops a sense of self & a permanent sense of significant others
- Failure to achieve OBJECT CONSTANCY, integration of good and bad in the same person, thus relating to others as a series of disconnected parts leads to SPLITTING (ex. friends, treatment team, etc)
- Projective identification: falsely attributes their own unacceptable feelings to others.
Etiology: Psychological
– Maladaptive cognitive processes (cognitive schema)
– Abandonment depression
Etiology: Biosocial Theory
(Marsha Linehan PhD.)
– Emotional dysregulation (unable to control)
– Emotional vulnerability (innate)
– Invalidating environment