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Borderline Personality Disorder Explored
Transcript of Borderline Personality Disorder Explored
Symptom overlap with other personality disorders
Can have comorbidity with Axis I disorders
Difficult clients can be hastily labeled: "wastebasket diagnosis"
What are Personality Disorders?
What are the Major Social Issues Associated with Borderline Personality Disorder?
Highly stigmatized and misunderstood illness
Patients have ongoing social and occupational problems
Treatment is an uphill battle
Some providers are not willing to work with clients suffering from BPD
Can you tell the difference?
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.
Gohol, J. (2013). DSM-5 Changes: Personality Disorders (Axis II). Psych Central. Retrieved on August 13, 2013, from http://pro.psychcentral.com/2013/dsm-5-changes-personality-disorders-axis-ii/005008.htmlr
Dziegielewski, S. (2010). DSM-IV-TR in action: Second edition. Hoboken, NJ: John Wiley and Sons, Inc.
Elliott, B., & Weissenborn, O. (2010). Employment for persons with borderline personality disorder. Psychiatric Services, 61(4), 417.
Gunderson, J. G. (2010). Revising the borderline diagnosis for DSM-V: An alternative proposal. Journal Of Personality Disorders, 24(6), 694-708.
The Mayo Clinic. (2013). Borderline Personality Disorder. Retrieved from http://www.mayoclinic.com.
Miller, J. D., Morse, J. Q., Nolf, K., Stepp, S. D., & Pilkonis, P. A. (2012). Can DSM-IV borderline personality disorder be diagnosed via dimensional personality traits? Implications for the DSM-5 personality disorder proposal. Journal Of Abnormal Psychology, 121(4), 944-950.
National Alliance on Mental Illness. (2013). Borderline Personality Disorder. Retrieved from http://www.nami.org.
By Kelly McCrillis
Maladaptive behavioral pattern
Deviation from cultural norms
Pervasive and inflexible
Onset in youth
Stable over time (sx, not moods)
Results in distress or impairment
Overview of Personality Disorder Types
Cluster A: Odd and Eccentric
Cluster B: Dramatic
Cluster C: Anxious and Fearful
(Mayo Clinic 2013) (DSM IV-TR)
How Does a Client with
Borderline Personality Disorder Present?
Emotional and Behavioral Signs and Symptoms:
Emotionally intense and unstable relationships
Weak identity, unstable sense of self
Impulsivity in areas such as sex, gambling, etc.
Self-injury - burning, cutting, bruising
Attention-seeking suicidality, suicide attempts
Feelings of emptiness
Transient, stress-related paranoia or dissociation
"Ask me about Borderline Personality Disorder..."
BP or BPD?
(DSM IV-TR) (Mayo Clinic 2013)
Borderline Personality Disorder:
Mayo Clinic reports BPD occurs equally in males and females
DSM-IV-TR reports diagnostic prevalence of 75% in females.
Estimated to effect about 4%-6% of the population, about 1 in 25
Five times more prevalent in children whose parents have BPD
Risk of suicide is 8%-10% in persons with BPD
Changes to Expect in Personality Disorders
Categorical model of the 10 personality disorders remains the same
Diagnostic criteria will be expanded to include personality dimensions in Five Factor Model (Section III)
Using the Hybrid Model: Clinicians will assess personality and diagnose a personality disorder based on an individual’s particular difficulties in personality functioning (how an individual typically experiences himself or herself as well as others) and on specific patterns of those pathological traits.
(Gunderson 2010) (Miller 2012)
(NAMI 2013) (Elliott 2010)
Let's play a game...
Borderline Personality Disorder
• Dialectical Behavioral Therapy – teaches coping skills in four
areas; Mindfulness, Distress Tolerance, Emotion Regulation, and
Interpersonal Effectiveness. Includes individual therapy weekly.
• Cognitive Behavioral Therapy – focus is on restructuring
thinking patterns (thoughts, assumptions, and beliefs).
• Transference-focused therapy – an adaptation of
psychoanalysis designed to change the distortions in the patients
perception of significant others and the therapist.
• Schema-focused therapy – focuses on changing psychological
problems by examining repetitive life patterns and by changing core
• Mentalization-based therapy – psychodynamic therapy
focused on building the capacity to understand behavior and
feelings associated with mental states in oneself and others.
Treatment Approaches for BPD
• However, it’s important to recognize that people with BPD don’t want to make your life, or theirs, miserable. They don’t want the relationship to end badly, it just does.
DSM 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
The DSM IV goes on to say:
The essential feature of Borderline Personality Disorder is a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity that begins by early adulthood and is present in a variety of contexts.