Lecture 8: Borderline PD & Histrionic PD Flashcards
What are the diagnostic criteria for BPD
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
1. Frantic efforts to avoid real or imagined abandonment. (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.)
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.)
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days.
7. Chronic feelings of emptiness.
8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
9. Transient, stress-related paranoid ideation or severe dissociative symptoms.
Explain whether there are gender differences in BPD and if so, what they look like
It is assumed that BPD is more common in females over males. We actually see equal prevalences in community samples, however in clinical samples we do see more females than males with BPD.
Two potential reasons for this are that females are generally more likely to seek help, and that the characteristics of this disorder are more stereotypically related to women
Which 2 traits can easily be changed with treatment (of BPD) and which 4 are resistant to treatment
Easily changed:
- general severity
- affective instability
Resistant to change:
- impulsivity
- suicidality
- anger
- dissociation
Explain the emotional cascade model (ECM)
Negative affect (anger and anxiety), associated with increased amygdala response, leads to negative cognition (rumination, devaluation and low self-worth), associated with decreased prefrontal cortex activity, which then leads to more negative affect (and so on and so on)
—> this leads to NSSIs = non-suicidal self-injury
What are the short-term and long-term effects of NSSI
Short-term; increase in positive affect and decrease in negative affect —> short-lived
Long-term; increased negative affect and decreased positive affect —> shame, guilt and negative body image
What are two reasons for the fact that the emotional cascade in the ECM is particularly strong in adolescence
- Prefrontal cortex is still maturing so there’s reduced impulse control
- High amygdala response to stress
Explain the different aspects of the spectrum of NSSI and what belongs to them
Individual-avoid/relief; ‘feeling too much’ = reality is too raw/overwhelming, psychic equivalence
- emotion regulation
- attempt to stop escalation
- resembling addictive cycle (bc of short term relief, build up to do it and feeling of isolation)
- cry for help/of pain
Individual-elicit; ‘not feeling enough’ = i feel nothing at all, i am empty/numb, i feel cut off from the outside world
- eliciting positive affect
- antidissociative function
- self-punishment
Social-avoid/relief; avoiding social responsibilities
Social-elicit;
- influence on/from friends
- gaining access to privileges
- manipulation
What is the strongest motive for NSSI
Tension relief
What are 2 reasons for the fact that you cannot force a patient to stop engaging in NSSI
- Ineffective = patients are in a different state of mind when they promise this compared to when they self-harm
- Iatrogenic effect = behaviors become more covert, symptom shifting takes place —> different symptoms come up to replace the NSSI that you are trying to suppress (eg. Suicidality)
Psychic equivalence
= the belief that the thought that you have is fully and completely true and there are no other alternatives
Explain the concepts of idealization and devaluation and how they are related
Idealization = attributing overly positive qualities to another person/thing
—> dealing with fear of abandonment; keeping the fantasy of perfection intact
Devaluation = attributing exaggerated negative qualities to another person/thing
—> (imagined) sense of ambivalence; leaving before they get left
These two concept combined are called splitting = the inability to hold opposing thought; positive or negative attributed of a person/events are not weighed/cohesive —> someone is either absolutely perfect or they are the worst person in the world after having disappointed you
- black or white/all or nothing
- affects fluctuates with splitting
- linked to complex childhood trauma
Explain the concept of paranoid ideation and how it differs from epistemic hypervigilance
Paranoid ideation = focuses on the belief that others have malicious intentions
—> it’s about the source or the interaction/relation with someone that is not being trusted;
epistemic hypervigilance it is specifically about a piece of information that is not being trusted –> focuses on the distrust of information and its sources rather than the intent behind it
What does splitting lead to
Intense anger; other person on pedestal makes slight misstep —> Didn’t think they were ever capable of doing that —> ‘I have been lied to, I have been fooled by all of you’ —> betrayal, intense anger
Explain the concept of SOD and a study that was done related to this concept
Self-other distinction = the ability to distinguish one’s own body, actions and mental states from those of others, which is essential to interacting with others while maintaining a stable sense of self
Study; they had people look at the face and simultaneously look at another person’s face while stroking both with a small brush (synchronous stroking), they then showed the patient’s face slowly morphing into the other person’s face and asked them to identify when the face starts looking like not your own
—> healthy controls indicated this was about halfway through the process but BPD patients really struggled to indicate this
What are two systems related to SOD and what happens in BPD patients
- Frontoparietal MNS = shared representational (SR) system; experiencing mental states ourselves and observing others experiencing the same mental states —> working adequately (or even better) in BPD patients
- MSA system = develops with increasing healthy interpersonal experience; more cognitive and controlled reflection on mental state; centrally involved in SOD —> underdeveloped/impaired in BPD patients
