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Intro to Abnormal Psychology > BPD > Flashcards

BPD Flashcards

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1
Q

BPD

A

Pervasive instability of relationships, self-image, emotion and impulsivity

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2
Q

DSM-5 Criteria for BPD

A

At least 5+ of the below:

  • Frantic efforts to avoid abandonment
  • Unstable/intense relationships
  • Unstable sense of self
  • Impulsivity in 2+ self-damaging areas
  • Recurrent self-harm
  • Intense, brief emotional shifts
  • Chronic feelings of emptiness
  • Inappropriate anger
  • Transient, stress-related paranoid ideation/dissociation (out of body experience)
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3
Q

Areas of dysregulation in BPD

A
  • Emotional
  • Behavioural
  • Interpersonal
  • Identity/self
  • Cognitive
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4
Q

Emotional dysregulation

A
  • Unstable emotions/mood

- Intense anger/difficulty controlling anger

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5
Q

Behavioural dysregulation

A
  • Impulsive/self-destructive behaviours

- Suicide/self-harm

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6
Q

Interpersonal dysregulation

A
  • Unstable/intense relationships

- Frantic efforts to avoid abandonment

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7
Q

Identity/self dysregulation

A
  • Unstable sense of self/identity

- Feelings of emptiness

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8
Q

Cognitive dysregulation

A
  • Stress related paranoid thoughts

- Dissociation

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9
Q

Prevalence of BPD

A
  • ~6% of population
  • Ratio of women to men who have it used to be thought of as 3:1 but now it’s looking about equal according to recent studies
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10
Q

Course of BPD

A
  • 85% remit in 10-15 years (not lifelong disorder)
  • 75% self harm
  • 10% die by suicide (mental illness with second highest rate of suicide)
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11
Q

Issues in diagnosing BPD

A
  • Underdiagnosis and misdiagnosis
  • Gender bias in diagnosis
  • Heterogeneity in population
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12
Q

Differential diagnosis (BPD vs. bipolar)

A
  • Commonly confused
  • Differences include:
    1) Speedy and frequency of mood shifts
    2) Baseline mood
    3) Context of impulsive behaviours
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13
Q

Environmental risk factors

A
  • 75% report abuse histories
  • Most report invalidating environment (parents who criticize or discount emotional responses; parents who punish individuation and separation)
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14
Q

Biological risk factors

A
  • Closer relatives have higher rates (9-25%; MZ = 35-42%)
  • Heritability = 0.46
  • Impulsivity/emotionality may be underlying heritable traits
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15
Q

Linehan’s Biosocial Model of BPD Diagram

A

See notes

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16
Q

Biosocial Model - Emotional Vulnerability

A
  • Emotional sensitivity: More easily triggered emotions (thinner emotional skin; respond to things that wouldn’t trigger the same response in others)
  • Emotional reactivity: More intense emotions (increased emotional baseline)
  • Slower return to baseline: Emotions stick around longer
17
Q

Biosocial model - Invalidation

A
  • Emotional fit
  • Reciprocal effects
  • Absence/abuse/neglect
  • Denial/suppression of emotions
18
Q

Emotional fit

A

Clashes occur if your emotions are intense and you have very rational parents; they just won’t get it

19
Q

Reciprocal effects

A

More intense emotions -> more invalidation (“What’s wrong with you, why are you acting like that?”)

20
Q

Denial/suppression of emotions

A

You’re told not to express certain emotions (e.g. “Don’t cry”)

21
Q

BPD Treatments

A
  • Dialectal behavioural therapy
  • Mentalization-based therapy
  • Schema-focused therapy
  • Transference-focused therapy
22
Q

Development of DBT

A
  • Developed by Dr. Linehan at U of Washington b/c CBT was not working for clients with chronic suicidality and BPD
  • Solution: Dialectics, Validation, multi-modal treatment and treatment hierarchy
23
Q

Why was CBT not working for clients with BPD?

A
  • Change focus was invalidating
  • BUT you also can’t validate everything they say or else they won’t get better, so you have to strike a balance in treatment that CBT can’t accomplish
  • Unrelenting crisis interfered with treatment/skills acquisition
24
Q

Dialectics

A 
Thesis = my emotions make sense
Anti-thesis = my emotions aren't helping
Synthesis = my emotions make sense BUT they aren't helping me in this situation
25
Q

Multi-modal treatment

A

Many different components
Individual therapy - to help with crises and keep the individual going
Group skills - teach them coping skills
Phone calls - coach them on what skills they can apply in different situations
Therapist consultation team - therapists get burned out pretty easily, so no one does DBT by themselves; so therapists meet once a week and help each other (therapy for therapists)

26
Q

DBT goals and skills

A
  • Cognitive dysregulation -> mindfulness (mindfulness helps people understand what’s going on (e.g. people with BPD often forget why they were so upset))
  • Impulsivity -> distress tolerance
  • Labile emotions (rapid changes in mood and very strong emotions) -> emotional regulation
  • Interpersonal chaos -> interpersonal effectiveness
27
Q

Stage 1 of DBT: Stabilization

A
  • Focus: Mainly trying to keep people alive (hell -> misery)

- Goal: Move from behavioural dyscontrol to control to achieve a normal life expectancy

28
Q

Treatment hierarchy in stabilization stage

A
  • Reduced life threatening behaviours: Suicide, NSSI
  • Reduce therapy-interfering behaviours: e.g. missing sessions, not completing homework, behaviors that interfere with therapists’ motivation to treat client
  • Reduce quality-of-life-interfering behaviour: e.g. substance use, eating disorder behaviours, inability to keep employment, educational issues
  • Increase skills that replace ineffective coping: replace dysfunctional behaviours
29
Q

Stage II of DBT: Suffering in Silence

A

Begin to build life up

30
Q

Focus of Stage II

A
  • Address inhibited emotional experiencing

- Reduce PTSD symptoms

31
Q

Goal of Stage II

A

Move from quiet desperation to full emotional experiencing

32
Q

Stage III of DBT: Build a life worth living

A
  • Focus: Problems in living

- Goal: Life of ordinary happiness and unhappiness

33
Q

Stage IV of DBT: Address issues of meaning (Optional)

A
  • Focus: Spiritual fulfillment and connectedness to greater whole
  • Goal: Move from incompleteness to ongoing capacity for experiences of joy and freedom
34
Q

Research shows improvement in:

A
  • Suicidal behaviour
  • NSSI
  • Depression
  • Anger control
  • Emotional dysregulation
  • Anxiety
  • Emotional regulation
  • Experiential avoidance
  • Assertive anger
  • Hospitalizations

Intro to Abnormal Psychology (7 decks)

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