Borderline Personality Disorder

Question 1

Clinical symptoms

Answer 1

• Profound emotional pain
• Instability in mood (anger/guilt/hate; severe response to stress), self-image, and relationships
• Impulsivity: risky behavior and self-harm
• High level of mortality from suicide: 10%
• ~75% report paranoid ideas or dissociative episodes (often stress-related)

Question 2

Epidemiology

Answer 2

• Prevalence of 1-2% of general population

- High propensity for patients to both utilize treatment resources and terminate treatment prematurely (instability)

Question 3

Comorbidities

Answer 3

BPD patients very likely to have comorbidities: major depression, dysthymia, bipolar, eating disorders, PTSD, substance use. Large overlap with mood disorders.

Question 4

Psychosocial factors

Answer 4

• Trauma and early live adversity often reported. Physical abuse, sexual abuse, neglect during childhood. Parents absent. Discord between parents. Physical violence in family.
• Problems with attachment in close relationships. High levels of interpersonal impairment and extreme concern of abandonment. Prominent feelings of emptiness, lack of sense of identity, self-harming behaviors, inability to appropriate self-smooth in times of stress.

Question 5

Interventions

Answer 5

• Pharmacological: SSRIs (for depression, aggression, impulsivity), atypical antipsychotics (for aggression and impulsivity, anxiety, paranoia, sensitivity), anti-epileptic drug and mood stabilizers
• Psychological: best known treatment is DBT, which was specifically created for patients with BPD
• Psychodynamic: mentalization based on attachment theory
• Transference-focused psychotherapy (TFP): clarification, confrontation, interpretation
• Schema-focused therapy (SFT): uses cognitive, behavioral, and experiential techniques to explore and modify 4 schemas/underlying beliefs - the detached protector, punitive parent, abandoned/abused child, angry/impulsive child