Lecture 8

Question 1

Differential diagnosis

Answer 1

Often comorbid:

Similarities;
- Attention seeking
- Manipulative
- Shifting affect

Differentiate (BPD);
- Self-harm (rarely in HPD unless sexual, ED eg)
- Anger (highly reactive)
- Chronic emptiness
- Identity disturbance

Question 2

Prev & gender diff

Answer 2

BPD
- general population; 2,7-5,9
- clinical outpatient/inpatient: 10-12 / 20-22

HPD:
- general population: 2-3
- Rarely seek treatment, no info on clinical

Gender diff:
More females, also bc misdiagnosis, bias, more female characteristics.

Question 3

Distal mechanisms; biology

Answer 3

Biosocial theory: combo of biology and environment transaction leads to development of PDs.

Biology:
- Genes/hormones/brain structures
- Temperament: High emotional reactivity, low negative affect tolerance

• Personality: High impulsivity, high obsessive-compulsive, high perfectionism.

Question 4

Distal mechanisms; Environment

Answer 4

Growing up in invalidating environment

Attachment ruptures:
- Low support & connection
- High control & criticism

Trauma;
- emotional/physical/sexual
- childhood neglect/abuse

Question 5

Proximal mechanisms; Emotional dysregulation

Answer 5

Stressful situations cause:
Negative affect; anxiety and anger, causes;
Negative cognition: rumination, devaluation

Leads to NSSI
Affective instability, Using self-harm to stop those negative thoughts. All cycle and are linked to symptoms of BPD

Question 6

NSSI 4 functions model

Answer 6

X= Avoid vs elicit Y = Individual vs social (social is clinician report!!)

Avoid x individual
- Reality is overwhelming, feeling too much use NSSI to regulate emotion. Attempt to stop escalation.
- Tension relief is biggest motive!

Individual x elicit
- Not feeling enough. Numb, wanting to feel. Antidissociative, self-punishment

Avoid x social
- Avoid social responsibilities

Social x elicit
- Influence from friends, gaining attention

Question 7

Proximal mechanisms: Mentalizing problems

Answer 7

Stressful situation;

• Interpret negative
• Splitting: either all good or all bad. No integration of good and bad. Splitting as defense.

First:
Idealization. Attributing overly positive.

Than:
- Devaluation. exaggerate negative. Fueld by fear of abandonment.
- Sense of ambivalence, leave before they are left
-Inability to hold opposing thoughts
- interpersonal difficulties, emotion dysregulation, self-harm

Question 8

Proximal mechanisms: identity disturbance + feelings of emptiness

Answer 8

The emotion dysregulation and mentalizing problems cause:

Instability;
- no sense of stability in affect, interpersonal relationship + impulsive behaviour
- Unable to form sense of self, coherent sense of identity. Don’t know who they are
- Consequences: Am I real? Feelings of emptiness, NSSI, who I am depends on my mood, Affective instability, interpersonal difficulties, changing all the time etc.

Lacking an inner compass. No continuity, no coherence, extremely difficult to navigate through life.