Lecture 5 Flashcards
What was the early distinction between neurosis and psychosis in psychoanalytic thinking ?
Neurosis involved chronic distress but no delusions/hallucinations, while psychosis involved a loss of touch with reality
Who first used the term “borderline” in relation to mental health, and when ?
Stern (1938) described patients on the border between neurosis and psychosis
When was BPD first classified in the DSM ?
DSM-III in 1980
What is the prevalence of BPD in the general population ?
1-2.7%
What percentage of psychiatric outpatients and inpatients have BPD ?
- 15-20% (outpatients)
- 15-40% (inpatients)
Is BPD equally prevalent in men and women ?
- In the general population: yes (50-50)
- In psychiatric samples: 75% are women.
Can BPD be diagnosed in adolescence?
Yes & it predicts poor psychosocial functioning and more syndromal disorders later in life
How does BPD impact life ?
Leads to immense personal suffering, interferes with work, relationships, and recreation, and is linked to poor societal functioning and frequent psychiatric facility attendance
How many DSM-5 criteria must be met for a BPD diagnosis ?
At least 5 out of 9
What is “splitting” in BPD ?
Seeing people as either all good or all bad, leading to unstable interpersonal relationships
What are the four major domains of BPD symptoms ?
- Affective
- Behavioral
- Interpersonal
- Cognitive
What are the three core features of BPD ?
- Emotional dysregulation
- Impulsivity
- Unstable relationships
What are the four areas of personality impairment in BPD ?
- Identity
- Self-direction
- Empathy
- Intimacy
What pathological traits are required for the alternative model of BPD ?
At least one of:
- Impulsivity
- Risk-taking
- Hostility
Why is BPD one of the most stigmatized mental disorders ?
It is often misunderstood, misdiagnosed, and some mental health professionals refuse to treat it
What interventions help reduce stigma ?
Workshops like:
- Systems Training for Emotional Predictability and Problem Solving (STEPPS)
- Dialectical Behavior Therapy training
What disorders commonly co-occur with BPD ?
- Mood disorders (depression, bipolar, anxiety, PTSD)
- Eating disorders
- Substance abuse
- Other personality disorders
What percentage of BPD patients attempt suicide ?
1 in 3
What is the lifetime suicide attempt average for BPD patients ?
3.4 attempts
What are common self-injury methods in BPD ?
Cutting, scratching, burning, head banging, applying toxic chemicals
What are the functions of self-harm in BPD ?
- Emotion regulation
- Self-punishment
- Influencing others
- Avoiding tasks
- Attempting suicide
What factors are associated with a better prognosis in BPD ?
- High intelligence
- Giftedness
- Physical attractiveness
What factors worsen BPD prognosis ?
- Low education
- Low socio-economic status
- Ongoing abuse
Is BPD itself heritable ?
No, but susceptibility to traits like emotional dysregulation and impulsivity is heritable (~45%)
What neurotransmitters are implicated in BPD ?
- Serotonin (negative affectivity, impulsivity)
- Dopamine (psychosis, substance abuse, anger)
What environmental factors contribute to BPD ?
- Childhood adversity
- Insecure attachment
- Maternal overinvolvement/hostility
- Low parental affection
- Parental psychopathology
How does stress response differ in BPD ?
BPD patients have dysregulated HPA axis function, leading to abnormal cortisol secretion & emotional sensitivity
What brain abnormalities are seen in BPD ?
Reduced frontolimbic areas, including hippocampus, amygdala, orbitofrontal cortex & anterior cingulate gyrus
What are the four major evidence-based treatments for BPD ?
- Dialectical Behavior Therapy (DBT)
- Mentalization-Based Treatment (MBT)
- Schema Therapy (ST)
- Transference-Focused Psychotherapy (TFP)
What is the core idea of DBT in treating BPD ?
Emotionally vulnerable individuals in invalidating environments are at high risk for BPD
-> DBT teaches emotion regulation and distress tolerance
How does Schema Therapy explain BPD ?
Maladaptive childhood experiences lead to dysfunctional schemas that influence thought patterns and behaviors in adulthood
What is the role of mentalization in BPD treatment ?
Mentalization-Based Therapy (MBT) helps patients understand their own and others’ mental states, improving interpersonal relationships
