Audio Transcript Auto-generated
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Hi my name is Dr Elizabeth Buchanan, and this is the second module
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in the general psychiatric management of borderline personality disorder.
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So, during this module, we're going to understand and explore
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borderline psychopathology,
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something that this module states a lot is that the
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inner personal hypersensitivity is the core of BPD psychopathology.
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Other personality disorders have emotional and behavioral aspects,
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but the interpersonal dynamic
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and its effect on the person's prognosis is very unique to BPD.
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Sure.
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Um
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it is only observable within their own
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interpersonal relationship which are intrinsically context dependent,
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which means they define their relationship
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and how serious it is, or it isn't.
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There is a natural transience which creates complex complexity.
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And again, the interpersonal relationships and the hypersensitivity to them,
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or what distinguished borderline patients from others,
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transitional related nous is one of the more abstract parts of this model,
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and it talks about the client being both within and outside of their person.
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This means that they don't
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or aren't able to differentiate themselves from the outside world
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and how they are perceived within and by others.
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The first quote, not me,
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object that a borderline personality client has is when
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they realize that they are different from their mother.
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Um So it starts at a young age
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and this begins the process of separation and the beginning to understand
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that and often creates the attachment anxiety and separation anxiety that is
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very, very often seen in BPD clients.
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Again, they are unable to differentiate themselves from others.
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So not recognized is not me
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which exists in their own mind
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and is linked to their own creativity and imagination
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of how they are connected to the situation.
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Secondarily,
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they believe that um subconsciously that a
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therapist should be a good enough mother.
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And on the surface that sounds like a very unhealthy dynamic.
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But actually it can be used to demonstrate what good mothering,
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what healthy dynamic would look like with someone that's a mother figure and they
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will see you make mistakes and they will learn from them the same as um
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a quote normal mother or mother that they may not have had.
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So here we are again,
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mentioning that the inner personal hypersensitivity is the core of this disorder.
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And for a long time
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uh the
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BPD was closely connected to environmental factors and bad parenting.
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But in 2001, many twin studies revealed that over 55
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of clients who have a hereditary link
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and a first degree relative with BpD
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mm hmm.
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So this cycle starts at a very young age and
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the interpersonal features are the most discriminating and what that
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means in dr Gunderson's examples are that if a small
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child is hyperactive to the parenting style that is implemented,
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their parents tend to become withdrawn frustrated and they feel
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less functional and they do become less functional.
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This creates a divide between parent and
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child and initiates that attachment and that
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desire to feel connected with someone that
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they aren't receiving from their parents.
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This is part of the interaction ALS model which um gpm is considered and
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is reiterated in therapy and interpersonal relationships
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that move into adult borderline personality.
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Sorry I skipped to the fourth point.
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So moving back to the third point of
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interpersonal events triggering um self interest behaviors,
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dissociation,
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suicidal thoughts when they move into a negative mindset it is
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almost guaranteed that they're an interpersonal
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altercation or event has occurred.
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So in the GPM model it is recommended to directly ask the client
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what happened with your boyfriend.
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What happened when you're mom visited And be very very specific and not open ended.
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So you can identify the problem and begin to
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unravel that and find out how to resolve it.
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And then lastly I'm just going to quickly go over the biology of it.
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Um So the neurobiology shows that there's abnormalities in neuro hormones.
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BPD shows elevated cortisol
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which responds with the HP. A.
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Access which stands for hypothalamic pituitary, adrenal access.
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And this is our body's response to stress creating a reactive response.
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And the neuro hormone in psychology is produced and circulated in the
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body which is often a neurotransmitter that creates an elevated reaction.
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And that is the neuro baseline
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for BPD.
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So clients with borderline
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um go in these cycles usually slowly over time bake and happen very rapidly.
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So their baseline is feeling held or attached.
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This presents as being depressed but cooperatively and pleasantly depressed.
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They remain rejection sensitive.
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They idealize other people and their collaborative with
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other people in an effort to be liked
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when they are rejected.
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It creates a threatened or an activated
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system so they become angry,
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self punitive and very manipulative to do things like try to get someone to stay,
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prevent the rejection from continuing and reverse it
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if none of the efforts in the activated system works.
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Um
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we moved to the alone or primitive cognition.
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This presents as dissociation paranoia and becoming desperately impulsive
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impulsivity in this stage often presents as substance use
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and
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it sounds counterintuitive but this actually brings them back
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out of a dissociative state because it forces
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them to feel more connected with the world and
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feel held onto in some sort of way
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and connected with reality through their substance use.
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So I know that coherence is a little bit confusing so
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I'm going to break it down a little bit more.
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So the again the connected stage is the baseline for these clients
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um real or perceived threat. When it progresses it goes to the activated system.
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If you lean in and provide support as a clinician, family member,
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supportive person in their life,
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the client will return to baseline instead of escalating to
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the aloneness or primitive cognition stage which is the most dangerous
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if they do escalate to this primitive cognition,
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the danger impulsivity again includes things like substance abuse.
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The cycle will resolve when the client feels
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held inter personally which can include being hospitalized,
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being re hospitalized
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many times in a short period of time
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is often seen as manipulative or attention seeking,
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but it's actually often subconsciously an effort to feel cared for by someone
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a stranger in fact and bring them back to that connected baseline.
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One quote that Dr Gunderson said that really resonated and kind of summed
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up the importance of connection for these clients is that they're preoccupied.
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Their preoccupation with love and connectedness is hardwired in them.
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So much so that it's a handicap.
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We'll finish the module by talking
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about some clinical implications so to reiterate
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the patient's sensitivity and reactivity to being
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or feeling held explains um the primary
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phenomenology
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emotional behavior dysfunctions are secondary to this primary
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being productive in connecting systems with interpersonal events
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instead of waiting for them to address it.
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So when they come in distress
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addressing the problem, asking what's wrong?
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Being very specific is what's recommended by this model
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and clinicians will trigger sudden unforeseen responses that reflect
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being held threatened or alone,
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offering an opportunity to work through these emotional states together.
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Is recommended
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because by modeling this in therapy and practicing it,
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they're more likely to apply it well in the outside world