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Borderline Personality Disorder
Transcript of Borderline Personality Disorder
In epidemiological studies of adults in the USA, prevalence for borderline personality disorder were between 0.5% and 5.9% in the general US population with a median prevalence of 1.35 as assessed by Torgersen and colleagues. Borderline Personality
Disorder Lin Yanting SA918109
Steven Choi BB203719
Cheang Kaka SB217405
Kinwell Chan BB20105
Rex Chan SB019723
Abbi Mitchell-Morley SA921053 Definition Borderline personality disorder (BPD), also referred to as emotionally unstable personality disorder, is a personality disorder in which patients suffer with personality dysfunction.
Persons diagnosed with BPD tend to suffer with intense mood swings which in turn affect cognition and interpersonal relations. Temperamental factors Etiology Neurochemistry and Cortical Localization Characterological factors Trauma;
Early or childhood trauma is often linked to Personality Disorder
Sexual abuse appears to be consistently reported more frequently in BPD groups whereas physical abuse is found to be equally prevalent in other Personality Disorders
Shown to have long-term effects on the individual’s neurobiological make-up. It creates a hyper- responsiveness in the hypothalamic-pituitary-adrenal system and impairs prefrontal and frontal lobe functioning (responsible for arousal and attention)
Not pathogenic in itself, traumatic experiences tend to ‘amplify’ various underling personality traits depending on genetic predisposition. Parenting and Attachment Sociocultural Influences Symptoms Delusional Thinking: Reckless Behavior: Self Destructive Behavior: Turbulent Personal
Relationships: Inability to Control Anger: Erratic Moods: Suddenly depressed
Anxious Chronically angry
Quick to take offense
Enraged for reasons
not obvious to others Cannot tolerate solitude
nor keep company
without constant conflict Reckless driving
Promiscuity Suicide attempts
Self-mutilation Paranoid thoughts Splitting: Criticize or praise others and even themselves In general, people with BPD
are difficult to live and work
with and respond poorly to
stress and change. Their interests
and values may change rapidly.
They tend to see things in terms
of extremes. Diagnosis Characteristics: Frantic efforts to avoid real or imagined abandonment
Unstable and intense interpersonal relationships
Recurrent suicidal behavior
Chronic feelings of emptiness
Inappropriate anger or difficulty controlling anger
Delusions or severe dissociative symptoms BPD Borderline personality disorder Millon's Subtypes Discouraged borderline Features; Avoidant
Dependent Impulsive borderline Features; Histrionic
Antisocial Petulant borderline Features; Negativistic
Passive agressive Self-destructive borderline Features; Depressive
Therapy (CBT) Dialectical Behavior
Therapy (DBT) Focuses on cognition (thinking) and behavior.
Explores problems and behaviors that you want to work on ‘Dialectical’: Everything is made out of opposing forces or contradictions.
DBT treatment model is a non-shaming, non-blaming approach.
Linehan (1993): “function within dysfunction"
Clients with BPD are encouraged to accept the current situation of themselves but also the need to change. Comorbidity with
other disorders Psychotic disordersSomatoform disorders
Performing aggressive behaviors Dialectical Behavior
Therapy (DBT) Standard DBT involves three components;
Explaination of the biosocial theory and symptoms;
Discussions to set common specific goals (e.g. decreasing self-harm urges).
Suicidal behaviors (including Para-suicidal)
Understand how your behaviors make sense and affirming struggles.
Build motivation for change and make a commitment to the therapy. DBT’s Assumptions:
BPD clients lack important interpersonal, self-regulatory, and distress tolerance skills that causes them to exhibit dysfunctional behavioral patterns.
Personal and environmental factors prevent them from exhibiting adaptive behavioral responses in various situations and reinforce their dysfunctional behaviors.
DBT helps BPD clients to:
Understand his or her behavior and embrace opposite concepts, feelings, actions, and ideas. As well as to propose ways that they will ultimately be able to change
Improving skills to tolerate negative emotions
Controlling impulsive behavior
Improving social skills Skills training: Core mindfulnessDistress tolerance skills Interpersonal effectiveness skillsEmotion regulation skillsSelf-management Prognosis & Statistics In order to be diagnosed people are assessed by a professional who cross reference both the patients experience and clinical observations. There is no evidence that
borderline personality disorder
is more common in women. In clinical populations, BPD is the most common personality disorder, with a prevalence of 10% of all psychiatric outpatients and between 15% and 25% of inpatients. In a study of a non-clinical sample, a high rate of BPD was reported (5.9%), indicating that many individuals with this disorder do not seek psychiatric treatment. General
Population People with
BPD 2% Evidence has emerged that genetic factors
contribute to the development of borderline
personality disorder; however, no specific
genes have yet been clearly identified as causative. For dimensional representations of borderline personality disorder traits (ie, their quantitative intensity), a moderate heritability has been reported. In studies of twins, heritability scores for the full diagnosis were 0·65 to 0·75, consistent with heritability estimates for personality disorders in general (40%–60%). Famous People With BPD Zelda Sayre
Fitzgerald Wife of
F. Scott Fitzgerald Marilyn Monroe 1960's sex symbol Angelina Jolie Actress and director Princess Diana Member of the British royal family
and Philanthropist END Questions & comments? Genetic factors;
Family studies suggest a direct heritable link with BPD, as opposed to there simply being a link between depression and BPD.
Aggression in BPD reflects an underlying genetic vulnerability, found that BPD has a unique temperamental profile in that such individuals display high levels of the heritable dimensions of novelty-seeking and harm avoidance. Increased activity in the dopaminergic system is related to psychotic thoughts
Activity is enhanced in the amygdala and pre-frontal regions in BPD patients. As a result, emotional reactions tend to subside slowly in reaction to relatively benign stressors.
When arousal in the prefrontal cortex of the brain exceeds normal thresholds, the individual shifts from flexibly responding to others to a freeze or fight-flight response. There is some evidence that parental loss and separation play an aetiological role.
Individuals from families that cohere around a rigid denial of problems or exhibit a high degree of discord appear to be most vulnerable; parental over-involvement is important
Over-involvement is a general indicator of possible psychopathology and appears to be equally represented in BPD, neurotic, and normal groups.
Invalidation in primary relationships is viewed as a key aetiological factor in Dialectical Behaviour Therapy.
Although no clear causal link between attachment style and BPD has been established, there are indications that attachment styles that prevent the esta- blishment of a secure base may render the child vulnerable
Fonagy and colleagues have linked the lack of a secure base to deficits in mentalization, a commonly recognised problem in BPD
Fonagy and colleagues (2000) were able to show that the mothers’ deficits in reflective capacity prior to birth of their child were predictive of the development of attach- ment problems within the first year of life.
Extra-familial factors are just as important as familial factors in the development of personality Culture: a direct psychogenic/pathoplastic influence V.S. Culture: an influential interpretive vertex. As a psychogenic/pathoplastic influence, cultural meaning systems and practices are seen to influence the development of BPD.
Conversely, sociocultural factors may also act as a protective factor against the development of certain psychopathologies
Rapid social change and the societal disruption that this brings may well have an influ- ence on the development of personality disorder. The lack of social structure, normlessness, and the absence of useful social roles, prominent features of rapid social change, appear to be important risk factors Amy Winehouse Singer/Songwriter Adolf Hitler Politician, Soldier, Artist & Writer (Dead or Alive)