college 5 - borderline Flashcards
personality disorder
Personality disorder
▪Personality
▪Characteristics and behaviour of a person in line with interests, drives, and values
▪Stable over time (often start in adolescence and continues in adulthood, but it does not have to be life long (there are treatment options))
▪Adjust to varying situations
▪Psychopathology related to personality traits
▪Is part of the ‘self’, in contrary to syndrome disorders
▪Emerges during the development over time
▪Dysfunctional
influnce BPD different facets of life
▪Cognition/thinking
▪Affect regulation
▪Interpersonal functioning
▪Impulse regulation
3 P’s
▪Problematic –unusual and distress for self or others
▪Pervasive –starting in adolescence and continues in adulthood
▪Persistent –affecting different areas of functioning (e.g relations, school, work)
Cluster A PD
odd/ eccentric
> paranoid pd, schizoid pd, schizotypical (these people often need medication)
Cluster B PD
dramatic/ emotional/ impulsive
> antisocial (often also categorized in A), histrionic, narcissistic, emotionally unstable, borderline personality disorder
Cluster C PD
anxious/inhibited
> avoidant, obsessive compulsive personality disorder (more about excessive perfectionism), dependent personality disorder
characteristics BPD
emotional lability
feelings of abandonment
unstable self image
idealistaion & deavalueation
impulsivity & risk-taking
feeling empty
recurrent suicidal behaviour/ self harm
inappropriate anger
paranoia and dissociation
Etiology BPD
▪Genetics -vulnerability
▪Neurobiological
▪Neurotransmitter serotonin
▪Brain development
▪Environmental factors (similarily to attachment issues)
▪Physical, sexual or emotional (!) abuse
▪Trauma
▪Emotional abandonment
▪Psychopathology in the family
treatment BPD
▪Good treatment options available
▪BPD is not necessarily for the rest of your life
▪Different types of psychotherapy, e.g.
▪Dialectical Behaviour Therapy (DBT, focussed on emotional regulation skills)
▪Schema Focussed Therapy (SFT)
▪Mentalisation Based Therapy (MBT)
▪Often long and intensive therapies
▪Require a good therapeutic relationship and experience and training from the therapist
Stigma
social rejection resulting from negatively perceived characteristics
three different forms:
1.Public or societal stigma
2. Associative stigma
3. Self-stigma
▪BPD is associated with heavy stigma
▪Attitudes and behaviours towards BPD tend to be more negative than other disorders.
▪Health professionals view patients with BPD as manipulative, faking symptoms and distress, disorganizing emergency and psychiatric units and putting in danger the team’s cohesion
effect stigma
▪Negative reactions to BPD can lead to:
▪Premature termination of treatment
▪Rationalization of treatment failures
▪Lower likelihood of forming an effective treatment alliance with patients
▪Emotional and social distancing
▪Lack of belief in recovery
pro’s diagnosing BPD
1.It is better for prevention and early intervention
2.Features of BPD are robust markers for severity
3.Features of BPD are robust markers for future problems
4.Adolescence is a critical period for early intervention
5.It improves treatment and might reduce drop-out
6.Inappropriate or ineffective treatment might cause harm
7.It might actually help to reduce stigmatization
con’s diagnosing BPD
▪The nature and transitional period of puberty and adolescents
▪Specifically, the personality is still developing
▪Stigma around BPD
▪Adolescents that have BPD traits do not fulfil criteria all the time
▪The conventional classification tools in diagnosing BPD are not tailored/ adequate for adolescents
▪Lack of standardisation due to personalised circumstance of adolescents
▪Diagnosing in general: How about the underlying mechanisms
AMPD criterion B
Pathological personality traits (criterion B)
▪Negative Affectivity–Emotional instability, anxiety, hostility, and frequent mood shifts.
▪Detachment–Social withdrawal, emotional coldness, and avoidance of intimacy.
▪Antagonism–Manipulativeness, deceitfulness, grandiosity, and callousness.
▪Disinhibition–Impulsivity, irresponsibility, and risk-taking behavior.
▪Psychoticism–Unusual beliefs, eccentric thinking, and perceptual distortions
BPD switch in adultood - Videler
symptomatic switch from impulsivity, affective dysregulation and suicidality to maladaptive interpersonal functioning & functional impairments. (with subsquent periods od remission and relapse of full categorical BPD diagnosis)
> behavioural symptoms leess stable than personality traits (e.g. dysphoria, feelings of emptiness)
predictors of good outcomes - Videeler
- higher IQ
- prior full time vocational functioning
-higher levels of extraversion - higher levels of agreeableness
- lower levels of neuroticism
predictors poor outcomes - Videler
great severity & chronicity of disorder, comorbidity, history of childhood adversity
declination BPD - Videler
lower prevalence in adulthood and even lower in late life
- due to risk premature death
- decline externalizing aspects BPD
(les self harm, impulsivity, however abondement issues, lack of empathy, selfishness stays)
> substantial age related differences in BPD symptom expression
> current categorical BPD diagnosis is not age neutral (AMPD especialle crit. A better)
why is diagnosing BPD ethical - Hutsebaut
- Prevention and early intervention are common strategies in health care
- Features of borderline PD are robust markers of severity of present psychopathology
- Borderline PD features are robust markers for future problems (multifinality)
- Adolescence (and young adulthood) is a sensitive period for the development of chronic psychosocial disability
- Regular treatment is often inaccessible or less effective for young persons with BPD
- Inappropriate or ineffective treatment might cause iatrogenic harm
- Early detection and intervention might have anti-stigmatizing side-effects
Catthoor & Feenstra results
Results:
1) treatment-seeking adolescents with severe mental health problems experience a high burden of stigma;
2) treatment-seeking adolescents with PDs experience more stigma than treatment-seeking adolescents with other severe and treatment refractory psychiatric Axis I disorders;
3) borderline PD is the strongest predictor of experiences of stigma, when controlled for other types of personality pathology;
4) more severely personality disordered adolescents – as measured by the number of PD traits – tend to experience the highest levels of stigma.
First of all, these youngsters often lack a unique sense of self, clearly delineated from others, making them extra vulnerable for incorporating negative critique on their behavioral and emotional problems.
Second, lifelong patterns of difficulties at home and at school, the confrontation with being troublesome and difficult in interpersonal relationships, can lead to feelings of social exclusion and discrimination.
> All these arguments point into the direction of substantial societal stigma, comparable to other condition-specific stigma in previous research
