Lecture 9: Borderline and histrionic personality disorder Flashcards
What are the symptoms of BPD?
- avoid real or imagined abandonment
- unstable and intense interpersonal relationships
- identity disturbance
- self-damaging impulsivity
- suicidal behaviour, gestures, threats or self-mutilating behaviour
- affective instability
- chronic feelings of emptiness
- difficulty controlling anger
- transient paranoid ideation or disassociative symptoms
Prevalence of BPD?
General population: 2.7-5.9%
Primary care: 6.4%
Outpatient: 10-12%
Inpatient: 20-22%
What has been found on borderline treatments?
Average effectiveness is moderate to large and largest effect sizes are for specialized treatment
Non- suicidal self-injury
Socially unacceptable behaviour with intention to damage bodily tissue without intent to die. 61-90$ prevalence, most commonly met diagnostic criterion for BPD
Emotional cascade model
Increased amygdala responses which results in negative affect such as anger and anxiety. Reduced prefrontal cortex activity resulting in negative cognition (rumination, devaluation, low self-worth). Both result in NSSI. Both negative affect and negative cognition are short-term, influence each other but result in long-lasting changes like shame and guilt for negative affect and body image for negative cognition
How does BPD affect emotions?
Feel too much and is overwhelming. Feeling is seen as being real (psychic equivalence). Important to regulate emotions to stop escalation, resemble addictive cycle and cry of pain. Could also be to avoid social responsibilities. On the other side is not feeling enough and feeling numb. Important to elicit positive affect, antidissociative function, self-punishment. Can be used to influence friends and manipulate.
Is this reported by clients?
No, only by clinicians
What are the motives for NNSI?
- tension relief
- reduce unpleasant feelings
- self-punishment
- regain control (awareness of sensations, sense of reality)
- gain attention (improve mood, level of suffering, improve concentration, achieve high, pleasure)
How does control over physical pain motivate NNSI?
Soothes a fragile sense of self. But a contract is ineffective as patients are in a different state of mind and iatrogenic effect (behaviours can become more covert so symptoms shift)
Role of idealization?
Attributing excessive positive qualities to someone or something. Also to deal with fear of abandonment and keep fantasy of perfection intact
Role of devaluation?
Can result in splitting between idealization and devaluation. Devaluation is attributing exaggerated negative qualities to another person. There is an imagined sense of ambivalence and leaving before they get left
What is paranoid ideation?
Focussing on belief that others have malicious intentions and can feel threatened, persecuted or conspired against. Can manifest as epistemic hypervigilance which is the distrust of information and sources than the intent behind it
What is splitting?
Central concept in object relation theory for BPD. The inability to hold opposing thoughts as positive or negative attributes are not cohesive.
- black or white/all or nothing
situations/oneself/others/clinicians (CT!)
- affect fluctuates with splitting
- linked to complex childhood trauma/ abuse/neglect
Can result in intense anger at a slight misstep
What is the role of unstable relationships?
linked to complex childhood trauma/ abuse/neglect
prevalence of complex trauma up to 90% in BPD
Number of traumatic events matters
Difficulty defining/maintaining self-other boundaries
self-other distinction
What is self-other distinction
refers to 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
linked to frontoparietal MNS which is the shared representational system which is experiencing the mental state ourselves and observing others experience the same mental state
