Lecture 20 - BPD

Question 1

Prevalence - cultural findings and suicide

Answer 1

Prevalence
o Community: 1.2-6%
o Clinical settings: 10%
o Inpatients: 20%
- 40-90% engage in parasuicidal and suicidal behaviours
- 10% commit suicide (often later in the illness)
- Identified in all countries studied
- Same prevalence and heritability across cultures

Question 2

Core symptoms

Answer 2

o Affect instability
o Impulsivity
Exists as a personality trait across human population, but this symptom in people with BPD is different
o Difficulties with interpersonal relationships

Question 3

Affective symptoms

Answer 3

• Affective instability
• Inappropriate, intense anger or difficulty controlling anger
• Chronic feelings of emptiness

Question 4

Impulsive symptoms

Answer 4

• Recurrent suicidal behaviour, gestures or threats or
• Self-mutilating behaviour
• Self-damaging (ex: spending, substance abuse, reckless driving, binge eating)
• Usually self-destructive in response to disappointments from someone close

Question 5

Interpersonal symptoms

Answer 5

Interpersonal symptoms (this is what differs b/w bipolar and BPD; more black and white thinking)  
- Fear of abandonment 
• Frantic efforts to avoid real or imagined abandonment 
• A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation

Question 6

Cognitive symptoms

Answer 6

Transient, stress-related paranoid ideation or severe dissociative symptoms

Question 7

Common comorbidities

Answer 7

• Depression: 24-74%
• Bipolar: 4-20%
• Substance abuse: 67%
• Eating disorder: 25% of people with bulimia have BPD

don’t need to know percentages

Question 8

Behavioural genetics

Answer 8

• Heritability of BPD symptoms: 69%
• genetics is really important and a bad early environment isn’t enough to start BPD*
• often correlates in families with other mental disorders*

Question 9

Trauma as a predictors of BPD

Answer 9

• History of reported neglect, physical abuse, sexual abuse
• No specific type of trauma linked to BPD
• Many people exposed to trauma don’t develop BPD…
  Sooo, again, bad early environment isn’t enough*

Question 10

Course

Answer 10

• Many have some symptoms in adolescence; (ex: excessive impulsiveness, cutting, relationship issues, moodiness, suicide attempts, violent rages, excessive drug use)
• 15-27 year follow up
  
  • Many people with BPD do not meet criteria by age 40, and less by age 50
  • Impulsivity especially goes down with age
• *could have many different mechanisms, but nevertheless, overtime it gets better**

Question 11

Biological vulnerability

Answer 11

o BPD lower serotonin synthesis across frontal-limbic regions
o Altered activity in frontal-limbic circuitry
o Some serotonergic and dopamine genes have been implicated
o Recent study also epigenetic factors, though more evidence needed
o know serotonin and dopamine play a role, but non-specific to BPD

Question 12

Linehan: BPD is disorder of emotion dysregulation

Answer 12

o Bio-psycho-social theory
o Emerges from transactions between individuals with biological vulnerabilities and specific environmental influences
o The most well known theory of BPD
o Biological dysfunction in emotional regulations interacts with invalidating environment

Question 13

Invalidating environment

Answer 13

• Characterized by intolerance toward the expression of private emotional experiences
  • In particular, emotions that are not supported by observable events
  
  • The child does not learn to understand, label, regulate, or tolerate emotional responses
  • Learn to oscillate between emotional inhibition and extreme emotional responding
  • Fails to learn how to solve problems contributing to these emotional reactions

Question 14

Risky family environments

Answer 14

- Disorganized family 
 • Pervasive neglectful maltreating 
- Perfect family 
 • Expression of negative emotion is taboo 
- Normal family 
 • Poor fit with the child

Question 15

Dialectical behaviour therapy (DBT)

Answer 15

o Balancing acceptation and changes
- Emphasis on validation
o Individual therapy
o Group skills training
- Mindfulness
- Emotion regulation
- Interpersonal effectiveness
- Distress tolerance
o Coaching calls/consultation with the client
o Initial protocol: therapy last 1 year
o Good results – Study: comparing DBT or treatment as usual (client centered, talking)
- Parasuicidal behaviour went down way more
o People in DBT more likely to stay in therapy compared to other therapies and less likely to have hospitalization
o Meta-analyses show improved overall functioning, decreased self-harm, decreased suicidality

Question 16

Pharmacological treatment

Answer 16

o Antipsychotics, mood stabilizers, SSRIs

However…they’ll reduce anger and impulsivity, but not unstable affect