Borderline Personality Disorder. Dr. Matthew Sager Psychiatric Medical Director St. Mary’s Hospital, Madison, WI. Borderline Personality Disorder (BPD). What is it? Perceptions and current diagnosis History Causes Facts Co-occurring diagnoses and differential Treatment
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Dr. Matthew Sager
Psychiatric Medical Director
St. Mary’s Hospital, Madison, WI
Emotional Regulation Disorder
Unstable relationships-splitting example
Feelings of emptiness
Fear of abandonment
Identity disturbance, ‘poor sense of self’
Suicidal behavior or self-injury
Transient paranoia/dissociative states
divided psychosis (delusions, hallucinations) from neurosis (anxiety/distress). The area between, the borderline was the difference that explained why some patients did not act one way or the other.
personality organization to syndrome to disorder
From analytical to medicalization
DSM III (1980)
DSM IV (1994)
DSM V (2013)
Social and cultural factors
(equal to population of New York City)
As an example that focuses on jargon free explanation that patients can understand
ER visits, inpatient medical/psych care
‘Step Down or Up’ Partial hospital(PHP) or Intensive Outpatient Program(IOP)
Outpatient Therapy + Med Management
Sociotherapies (group, family)
Reframing ways people view themselves
Others (problem focused)
Goal is for patient to recognize when they need more active help and trust they will get it
Typical Crisis-express concern, allow patient to ventilate, avoid taking actions but let patient be explicit about situation
Follow-up after crisis
Dr Gunderson views suicidal statements/acts as affecting a patient’s dependence on others and an effort to be cared for.
1. Gunderson, John G, M.D. ‘Borderline Personality Disorder A Clinician’s Guide’, 2001.
2. DSM IV, American Psychiatric Association, 2000.
3. Robert E. Hales, M.D., Yudofsky, Stuart, M.D., Gabbard, Glen, M.D., ‘Textbook of Psychiatry, 5th Edition, 2008.