Borderline Personality Disorder Milton Brown Behavioral Research & Therapy Clinics University of Washington. Borderline Personality Disorder. What is BPD? How to assess BPD How does BPD develop? BPD in adolescence Intervention options How to respond to challenging BPD clients.
A. An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture. This pattern is manifested in two (or more) of the following areas:
(1) cognition (i.e., ways of perceiving and interpreting self, other people, and events)
(2) affectivity (i.e., the range, intensity, lability, and appropriateness of emotional response)
(3) interpersonal functioning
(4) impulse control
B. The enduring pattern is inflexible and pervasive across a broad range of personal and social situations
C. The enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning
D. The pattern is stable and of long duration, and its onset can be traced back at least to adolescence or early adulthood
E. The enduring pattern is not better accounted for as a manifestation or consequence of another mental disorder
F. The enduring pattern is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., head trauma).
Diagnosis Lifetime Current
Depressive disorder* 97% 89%
Substance abuse/depend. 60%* 31%
PTSD 57% 51%
Social phobia 22% 16%
Panic disorder 52% 40%
Eating disorder 41% 24%
Antisocial PD - 11%
Avoidant - 21%
Depressive disorder 39%
Any anxiety disorder 52%
Eating disorder 18%
Antisocial PD 44%
Depressive disorder 63%
Any anxiety disorder 83%
Eating disorder 13%
Antisocial PD 17%
Substance use disorder 4%
Cues Prescription picked up earlier that day, in room alone, ruminating about criticism roommate made of her earlier in the day
Emotion Dysregulation of shame
Problem Behavior overdose
sleep, stop ruminating, wake reduced shame
Denial of problems (rather than problem-solving)
Dissociation and emotional numbing
Drug and alcohol abuse
Suicide attempts (and suicide)
Secondary emotions to avoid primary emotions
Hospitalization to escape stressful circumstances
Emotion Relief (92%, at least one)
To punish yourself (63% of nonsuicidal self-injury)
BPD becomes noticeable in early adolescence, but begins long before that.
Pathological parenting is an important risk factor.
Biological correlates of emotional instability and impulsivity have been identified
Biological and environmental factors account for BPD.
The path to BPD is a process of reciprocal influences.
avoid stress block avoidance
remove cues challenge fears
isolation build a structured life
focus on emotions
hospitalization alternative coping
is one that balances…
Acceptance and Change
Soothing versus pushing the client
Validation versus demanding
BPD has been associated with worse outcomes in treatments of Axis I disorders such as
because BPD patients have low tolerance for change in the absence of validation
Intervene early before maladaptive patterns become crystallized and refractory to treatment.
Significant Outcomes from DBT Study:
DBT vs. TAU
UW Replication Study
Dimeff, L.A., McDavid, J., Linehan, M.M. (1999). Pharmacotherapy for borderline personality disorder: A review of the literature and recommendations for treatment. Journal of Clinical Psychology in Medical Settings, 6(1), 113-138.
Grossman, R. (2002). Psychopharmacologic treatment of patients with borderline personality disorder. Psychiatric Annals, 32(6), 357-370.
Healy, D. (2003). Lines of evidence on the risks of suicide with selective serotonin reuptake inhibitors. Psychotherapy and Psychosomatics, 72(2), 71-79.