Chapter 12 Borderline Personality Disorder

1. Chapter 12 Borderline Personality Disorder

2. Borderline Personality Disorder: Diagnostic Criteria • Frantic efforts to avoid real or imagined abandonment • A pattern of unstable and/or intense interpersonal relationships • Persistent and markedly unstable self-image or sense of self • Impulsivity in at least two potentially self-damaging areas (e.g. substance abuse, binge eating, sex) • Recurrent suicidal behavior, gestures, or threats, and/or self-injury • Intense, usually brief, mood swings • Chronic feelings of emptiness • Inappropriate, intense anger • Transient, stress-related paranoid ideation or severe dissociation • [To meet criteria for BPD, must meet 5+ criteria]

3. Borderline Personality Disorder • Elevated risk for self-destructive behaviors • 10% commit suicide • 80% self-injure • Risky sexual behaviors, disordered eating, substance abuse • Associated with many other psychiatric disorders • Mood disorders ( > 80%) • Anxiety disorders (> 80%), including PTSD (> 50%) • Substance use disorders (> 50%) • Other personality disorders, esp. anxious cluster (> 50%)

4. Borderline Personality Disorder • Course • Developmental origins in early childhood • Many patients with BPD report having experienced BPD-related symptoms (e.g., self-injury, emotional lability, fears of abandonment)years before diagnosed • Usually diagnosed in late adolescence/early adulthood • Historically considered to be “life-sentence,” but research suggests a more hopeful, positive prognosis • ~75% of BPD inpatients remit within 6 years • Low rates of recurrence (< 6%)

5. Borderline Personality Disorder • Course: Predictors of failure to remit • Anxiety cluster personality disorder (e.g., avoidant) • May reflect underlying anxious-inhibited temperament • Substance use disorders • PTSD • Mood or anxiety disorder • Eating disorder

6. Borderline Personality Disorder • Risk factors • BPD results from combination of biologically-based vulnerabilities and childhood environmental stressors • Biologically-based vulnerabilities • Affective dysfunction • Impulsivity • Insecure attachment • Environmental stressors • Childhood abuse • Emotional/physical neglect, emotional invalidation • Early prolonged parental separation and/or loss (e.g., absence of parent, parental illness, parental death)

7. Treatments for BPD • Dialectical Behavior Therapy • Empirically-supported cognitive-behavioral therapy composed of both individual and group treatments • Associated with reduced self-injurious/suicidal behaviors, substance abuse, and anger, fewer hospitalizations, higher global functioning • Treatment targets four different areas • Emotion Regulation • Distress Tolerance • Interpersonal Effectiveness • Mindfulness

8. Treatments for BPD • Dialectical Behavior Therapy: Treatment Domains • Emotion Regulation • Increasing emotional awareness and clarity • Decreasing emotional vulnerability • Learning adaptive strategies for modulating emotions • Distress Tolerance • Distraction • Self-soothing • Acceptance/willingness

9. Treatments for BPD • Dialectical Behavior Therapy: Treatment Domains • Interpersonal Effectiveness • Getting your objectives met • Maintaining relationships • Maintaining self-respect • Mindfulness • “What” skills: Observing, describing, participating • “How” skills: Non-judgmentally, one-mindfully, effectively • Skills promote present moment focus, non-judgmental awareness, and attentional flexibility • Goal is to develop a lifestyle of participating with awareness