Borderline personality disorder

Information about Borderline personality disorder

Published on August 1, 2008

Author: onelove



Borderline PD : Borderline PD No Audio Definition : Definition Instability interpersonal relationships self-image affects Impulsivity BDL as style : BDL as style Mercurial always romantically attached intense, emotionally active and reactive uninhibited spontaneous high energy open-minded BDL : BDL widely studied and most common disorders Why? 1) suffering to self and others 2) overlap with other Axis I and Axis II disorders 3) psychoanalytic origins 256 varieties of the disorder History : History Hoch and Polatin (1949) – “pseudoneurotic schizophrenia” Kernberg (1967) - borderline personality organization Gunderson and Singer (1975) - identified criteria clearly distinguishing BDL from other conditions DSM-III - BDL first appeared as category Linehan (1980s and 1990s) - developed DBT (dialectical behavior therapy) for the treatment of this condition Essential Features : Essential Features Identity Disturbance Relationships are Unstable Abandonment is frantically avoided Impulsive Suicidal gestures are made Emptiness is a description of inner self Dissociative Symptoms Affective Instability Paranoid Ideation Anger is poorly controlled Idealization of others, followed by devaluation Negativistic - undermine their efforts and those of others Epidemiology : Epidemiology 2-3% of general populations 10% of outpatients 30-60% among clinical populations 5x more likely in 1st degree relatives Women to men (3:1) The Great Imitator : The Great Imitator BDL Substance Use Mood Psychosis Anxiety Eating Sexual Dissociation Impulse Associated Themes : Associated Themes tend to undermine their successes promiscuity fears of abandonment failure to achieve long-term goals frequent suicidal gestures (burns, etc.) Self-destruction : Self-destruction purpose regulate affect regulate environment cutting is negatively reinforcing poor boundaries easily influenced by others Media Examples : Media Examples Fatal Attraction Glenn Close’s character Single White Female Jennifer Jason Leigh’s character Interview Considerations : Interview Considerations 1) appear normal: you will be surprised to hear of the history 2) remarkably regressed: impulsive and demanding often verbal intense affect and state of turmoil Associated Features : Associated Features difficult to keep these patients on track a number of crisis to therapy intense anger directed at therapist and others micropsychotic episodes can occur very challenging suicidal behavior, phone calls, self-mutilating behavior you worry they will kill themselves 8-10% complete suicides many more attempt Interview Considerations : Interview Considerations need to establish a good working relationship trust/honesty be clear and avoid misunderstandings set clear limits in therapy transference issues patients get involved with their therapists countertransference issues theapists react overprotection and rejection seek regular consultation... Splitting : Splitting abruptly switch alliances idealize then devalue best therapist (builds your ego) to worst therapist a) intrapsychically within oneself (I am bad, I am good) b) interpersonally relative to others (she is good, you are bad) c) transpersonally occurs when the patient’s intrapsychic organization gets played out by others Etiology : Etiology lots of opinions... biological might have a genetic basis temperamental factors? dysregulation of serotonin? limbic system abnormalities? Theory : Theory Highly Emotional Vulnerability Poor Emotional Regulation Emotional Dysfunction (biological) Invalidation (environment) Emotional Instability Theory : Theory Emotional Instability Interpersonal Behavioral Self Cognitive No Audio Assessment : Assessment No Audio Slide 22: Avoidant PD Slide 23: See commentary below slide to understand letters and numbers MMPI : MMPI MMPI: 3, 4, and 7 MCMI-III : MCMI-III BDL, DEP, HIS

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