L9: Borderline & Histrionic PD

Question 1

DSM Borderline

Answer 1

instability of interpersonal relationships, self-image, affects, marked impulsivity.l
1. efforts to avoid real/imagined abandonment
2. unstable and intense interpersonal relationships (splitting, extreme)
3. identity disturbance
4. impulsivity (>2 areas, possible self-damaging)
5. suicidal/self-mutilating
6. affective instability
7. chronic feeling of emptiness
8. anger
9. transient, stress-related paranoid ideation

Question 2

prevalences BPD

Answer 2

general population: 3%
primary care: 6,4%
outpatient: 10-12%
inpatient: 20-22%

Question 3

paranoid ideation vs delusion

Answer 3

PI is temporary transient, stress-related

Question 4

gender differences in BPD

Answer 4

BPD in clinical samples more females, but in community samples we see equality!

Question 5

3 treatments for BPD

Answer 5

• dialectical behaviour therapy DBT
• mentalization based therapy MBT
• schema therapy ST

Question 6

op welke symptomen hebben die behandelingen wél effect, en op welke symptomen niet?

Answer 6

wel: general severity & affective instability
niet: impulsivity, suicidality, anger, dissociation

Question 7

non-suicidal self-injury

Answer 7

Socially unacceptable behaviour where a person intentionally damages bodily tissue without the intent to die

Question 8

prevalentie NSSI in BPD

Answer 8

61-90%

most commonly met diagnostic criterion for BPD in adolescence

Question 9

emotional cascade model =

Answer 9

there is a vicious cycle between negative affect (anger, anxiety) and negative cognition (rumination, devaluation, low self-worth).

NSSI breaks this cycle temporarily, to reduce the tension build up during the cascade

Question 10

why is the ECM particularily strong in teenagers

Answer 10

• amygdala upregulated
• PFC downregulated

Question 11

waarom niet perse praten over pijn bij NSSI

Answer 11

omdat sommige mensen geen pijn ervaren, het kan zijn dat pijnreceptoren bij hen niet zijn geactiveerd

Question 12

wat is de cycle van NSSI

Answer 12

NSSI provides short term relief, to reduce the tension created due to the emotional cascade model. It provides positive affect within 13 minutes.

But long-term effects (up to 1 year) are negative. it leads to shame and guilt which exacerbates the negative effects.
They are stuck in a loop, cut away the stress and then they have nothing to do in therapy. In addition to this, scarring leads to body image problems.

zie schrift

Question 13

4 factor model of NSSI

Answer 13

zie schrift

avoid relief, elicit
individual, social
feeling too much, not feeling enough

Question 14

wat zijn de meest voorkomende achterliggende redenen voor NSSI

Answer 14

• tension relief (by far meeste)
• reduce unpleasant feelings
• self-punishment
• regain control
• regain awareness of physical sensations
• regain sense of reality
• gain attention
• improve mood

Question 15

control in NSSI

Answer 15

having full control over physical pain can soothe a fragile sense of self:

• i need to see blood to know that i am alive/that i am me/that i am real
• i need to feel where my body ends and the outside world starts
• in this unpredictable world, i decide when/how to injure myself

Question 16

wat moet je niet doen bij NSSI

Answer 16

je kan de patient niet forceren om te stoppen met NSSI!!!
- ineffectief: want cliënten zitten vaak in een andere gemoedstoestand dan wanneer ze dit beloven
- iatrogenic effects: behaviours become more covert (symptom shifting) -> hiermee kan je suicididale symptomen induceren

Question 17

psychic equivalence=

Answer 17

the thought in my head is 100% true. there is nothing other in the world (no ‘but’s’ or ‘howevers’)

Question 18

hoe komt NSSI overeen met addiction/verslaving

Answer 18

short term relief, long term more need for engaging in the behaviours. also building of habits: whole day is scheduled around that.

Question 19

iatrogenic effects=

Answer 19

wanneer je goede intenties hebt als therapeut maar het eigenlijk veel erger maakt

Question 20

splitting=

Answer 20

very fast switching between idealization and devaluation

Question 21

idealization=

Answer 21

attributing overly positive qualities to another person/thing

in order to deal with the fear of abandonment -> keeping the fantasy of perfection intact.

it is very scary to assume there is some ambivalence in that other person. if you admit someone has a bad day/quality, then they may leave you. this is intolerable: therefore avoid this thought at all cost

Question 22

devaluation =

Answer 22

attributing exaggerated negative qualities to another person or thing

(imagined) sense of ambivalence -> leaving before they get left themselves

Question 23

paranoid ideation=

Answer 23

focuses on the belief that others have malicious intentions

feeling threatened, persecutied or conspired against.

transient, stress-related paranoia

Question 24

epistemic hypervigilance =

Answer 24

focuses on the distrust of information and its sources rather than the intent behind it

Question 25

dus verschil paranoid ideation en epistemic hypervigilance

Answer 25

paranoid ideation = distrust of person
epistemic hypervigilance = distrust of information and source (content)

Question 26

splitting is ook wel….

Answer 26

the inability to hold opposing thoughts, the positive or negative attributes of a person or event are not weighed/cohesive

• black/white
• all or nothing
• you notice this in the therapeutic relationship
• affect fluctuates with splitting
• linked to trauma/abuse/neglect

Question 27

waar leidt splitting toe

Answer 27

intense boosheid

other person on pedestal makes slight misstep -> didn’t think they were ever able of doing that -> i have been lied to, i have been fooled by all of you -> betrayal, intense anger

Question 28

hoe is splitting gerelateerd aan childhood trauma/abuse/neglect

Answer 28

unstable relationships: soms is alles goed, soms is alles heel slecht.

normal development:
(object-relations theory) in a childs mind, these objects (mom loves me vs mom is not here) are two seperate things. then they learn that even though mom is not here, they still love them (the objects are combined)

trauma:
the child does not learn that there are these ambivalences. therefore those two remain separate: either very good or very bad. then splitting occurs

Question 29

trauma in BPD

Answer 29

• 90% van patienten hebben complex trauma meegemaakt
• number of traumatic events matters
• difficulty defining/maintaining self-other boundaries

Question 30

complex trauma =

Answer 30

• repeated (persistent)
• multiple sources

Question 31

self-other distinction=

Answer 31

distinguish ones own body, actions, and mental states from those of others (essential to interaction with others, while maintaining a stable sense of self)

Question 32

experiment self-other distinction

Answer 32

synchronous stroking. gradually their face mophed into another face. had to say whenever the face was more like someone elses.

BPD: hadden minder sense of self, zeiden dus pas later dat het niet meer op hun gezicht leek (terwijl het dus al iemand anders’ gezicht was)

Question 33

frontoparietal MNS

Answer 33

shared representational (SR) system

experiencing mental state ourselves vs. observing others experiencing the same mental states.

Question 34

MSA system

Answer 34

develops with increasing healthy interpersonal experience

• leads to more cognitive & controlled reflection on mental state
• centrally involved in SOD

Question 35

wat is aangetast in mensen met BPD

Answer 35

MSA system -> hierdoor is mentalizing zo moeilijk voor hen

Question 36

histrionic PD DSM

Answer 36

pervasive pattern of excessive emotionality and attention-seeking, at least 5:
1. uncomfortable when not the centre of attention
2. inappropriate sexually seductive or provocative behaviours
3. rapidly shifting and shallow expression of emotions
4. use physical appearance to draw attention to self
5. impressionistic and surface level speech
6. self-dramatization, theatricality
7. suggestible (easily influenced by others or circumstances)
8. considers relationships more intimate than they actually are

Question 37

hoe zie je histrionic PD in klinische praktijken

Answer 37

• excessive public display of emotions: big hug!!!
• appearance fills identity void: my new outfit: a lot of time/energy/money spend on clothes/grooming, fishing for compliments, unflattering photograph/critical comment
• considers relationships more intimate then they are, impressionistic speech that lacks in detail: my best friend, a wonderful human being (no specific traits that make ‘wonderful’)

Question 38

wat komt overeen tussen NPD, BPD en bipolar disorder met HPD

Answer 38

• attention seeking
• manipulation
• shifting affect
• grandiosity
• excessive talking

Question 39

wat is alleen bij NPD van die 3

Answer 39

• reaffirming own grandiosity (vs. willing to look weak/like a victim for attention

Question 40

wat is alleen bij BPD van die 3

Answer 40

• self-harm
• anger
• chronic emptiness
• identity

Question 41

wat is alleen bij bipolaire stoornis van die 3

Answer 41

• longer-term mood polarization

Question 42

wat is de relatie tussen uiterlijk en innerlijk in HPD

Answer 42

uiterlijk is evenredig met hoe leeg ze zich voelen

Question 43

wat zorgt bij BPD voor die emptiness

Answer 43

lack of self-other distinction

Question 44

wat is goed en wat is minder fijn aan frontoparietal MNS

Answer 44

+ leidt tot empathie, connectie en cooperation
- conflated experience of self and other (dus is mushed samen)