week 8- boderline personality

Question 1

what is borderline personality disorder?

Answer 1

“It is characterised by significant instability of interpersonal relationships, self-image and
mood, and impulsive behaviour. There is sometimes a pattern of rapid fluctuation from
periods of confidence to despair, with fear of abandonment, rejection, and a strong tendency
towards suicidal thinking and self-harm. It is often comorbid with depression, anxiety, eating
disorders, post-traumatic stress disorder, alcohol and drug misuse, and bipolar disorder

Question 2

how may the patient be feeling with borderline personality disorder?

Answer 2

• feel very worried about people abandoning them
• have very intense emotions that can change quickly
• not have a strong sense of who they are or what thy want from life
• find it very hard to make and keep stable relationships or friendships
• act impulsively and do things that could harm them (such as binge eating, using drugs or driving dangerously)
• have suicidal thoughts
• Self-harm
• feel empty and lonely a lot of the time
• get very angry, and struggle to control anger
• struggle to trust other people
When Very Stressed, they may feel
• feel paranoid
• have psychotic experiences
• feel numb or ‘checked out’ and not remember things very well after they’ve happened
(known as dissociation)

Question 3

whats the epidemiology of BPD?

Answer 3

• The most commonly diagnosed Personality Disorder
• Approx 1% of the whole population
• > 20% of the current inpatient population
• Environmental and Social Circumstances
• Early Life Experiences
• Genetic Factors
• Women>Men

Question 4

what are trigger factors for BPD?

Answer 4

• using a lot of drugs or alcohol
• problems getting on with family/friends or partner
• money problems
• anxiety, depression or other mental health problems
• important events
• stressful situations
• loss, such as death of a loved one

Question 5

what are some comorbidity with BPD?

Answer 5

Mental disorder (Prevalence comorbidity) • –Substance misuse (65%) (M>F) • –anxiety disorders (74%): e.g. OCD, PTSD • –affective disorders (32-83%) e.g. Depression and Bipolar • –Eating disorder (14-53%) (F>M)

Physical • –Hypertension, CVD • –GI disease • –Arthritis • –STDs

Question 6

what is the borderline PD medication?

Answer 6

• Do not use for BPD or individual symptoms, no licensed
drug treatments – 75% BPD patients receive polypharmacy• Treat comorbid conditions as appropriate
• In crisis – Consider short term sedative meds- e.g.
antihistamine (Promethazine) no longer than 1 week• Lowest effective dose • Prescribe few tablets
• Agree target symptoms, monitoring arrangements,
duration Rx
• Agree plan for adherence • Discontinue if target symptoms not improved • Insomnia – Zopiclone, zolpidem• Cochrane systematic review showed beneficial effects of
mood stabilisers (Topiramate, Lamotrigine, Valproate) and
2nd generation antipsychotics (Aripiprazole, Olanzapine),
however, no evidence with SSRI’s