Borderline Personality Disorder Presented by: APS Healthcare Southwestern PA Health Care Quality Unit (HCQU)

1. Borderline Personality DisorderPresented by: APS HealthcareSouthwestern PA Health Care Quality Unit(HCQU) July, 2009/eas

2. Disclaimer Information or education provided by the HCQU is not intended to replace medical advice from the consumer’s personal care physician, existing facility policy or federal, state and local regulations/codes within the agency jurisdiction. The information provided is not all inclusive of the topic presented. Certificates for training hours will only be awarded to those who attend a training in its entirety. Attendees are responsible for submitting paperwork to their respective agencies.

3. Note of Clarification While mental retardation (MR) is still recognized as a clinical diagnosis, in an effort to support the work of self-advocates, the APS SW PA HCQU will be using the terms intellectual and/or developmental disability (I/DD) to replace mental retardation (MR) when feasible.

4. Objectives Upon completion of the session the participant will: • Define Borderline Personality Disorder • List symptoms of BPD • Recall current treatment methods for BPD

5. Personality Disorders • Enduring pattern of inner experience and behavior that deviates from the expectations of the person’s culture • AXIS II Disorder • Pervasive and inflexible • Onset in adolescence/early adulthood • Stable over time • Leads to stress or impairment

6. Borderline Personality Disorder Definition 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

7. BPD Symptoms • Frantic efforts to avoid abandonment • Pattern of unstable and intense interpersonal relationships

8. BPD Symptoms • Identity disturbances • Impulsivity • Suicidal/self-injurious behavior

9. BPD Symptoms • Affective instability • Chronic feelings of emptiness • Difficulty controlling feelings of anger

10. Splitting • “Black and white” thinking • People are viewed as either “good” or “bad” • One day idolizes caretaker, the next day devalues them • Difficulty tolerating human ambiguities and inconsistencies

11. Co-occurring Disorders • Mood Disorders • Eating Disorders • Substance Related Disorders • Posttraumatic Stress Disorder • Attention-Deficit/Hyperactivity Disorder • Other Personality Disorders

12. BPD Facts • 2% of the general population • About 80% are women • Chronic, severe problems continue for years • Tends to “burn out” in middle age • Females more likely to have mood disorder and be self-destructive • 1/10 succeed in committing suicide

13. BPD Facts • History of abuse is common • Resistant to treatment • Males with BPD prone to domestic violence, rage attacks • Males more likely to also have attention-deficit disorder or antisocial personality disorder

14. Causes of BPD • No single cause • Genetic predisposition • Neurofunction

15. Causes of BPD • Environment • Child abuse, trauma, or neglect • Environment lacks consistent expectations and emotional security • Invalidating environment • Vary with individuals

16. Validating vs. Invalidating Statements • Validating Statements • Encourage Coping Skills • Validate the person’s feelings • Promote healthy expression • Invalidating Statements • Teach suppression of emotions • Cause anger or rage attacks • Prevent coping skills

17. Treatment of BPD • Rule out possible medical conditions • Dialectical Behavior Therapy (DBT) • Marsha Linehan, PhD • Medications

18. Dialectical Behavior Therapy (DBT) • Cognitive-behavioral treatment targeted to treat people with complex, difficult-to-treat mental disorders • The goal is “a life worth living” • DBT skills training • Mindfulness • Emotion Regulation • Interpersonal Effectiveness • Distress Tolerance

19. Medications • Never the only answer • Typically used to treat co-occurring disorders • Antidepressants • Selective Serotonin Reuptake Inhibitors (SSRIs) • Mood stabilizers • Antipsychotics • Be aware of side effects

20. Positive Approaches • All behavior is meaningful • People have good reasons to do what they do • People do the best they can with what they know at that point in time and in that context

21. Supporting a Person with BPD • Don’t take things personally • Validate • Build mastery • Be aware of your moods and affect • Communicate with team and therapist • Encourage healthy diet, sleep, exercise • Take care of yourself

22. References • The Clinical Characteristics and Management of Borderline Personality Disorder in Mentally Retarded Persons, MHDD 1988/Vol 7/N0 7&8. Hurley, A. and Sovner, R. • Diagnostic and Statistical Manual of Mental Disorders, Fourth Revision, Text Revised. 2000, American Psychiatric Association. • “I Hate You, Don’t Leave Me: Understanding the Borderline Personality”, Jerold J. Kriesman, M.D. and Hal Straus. • Skills Training Manual for treating Borderline Personality Disorder, Linehan, Marsha M., Ph.D. 1993.

23. To register for future trainings,orfor more information on this or any other physical or behavioral health topic, please visit our website at www.hcqu.apshealthcare.com

25. EvaluationPlease take a few moments to complete the evaluation form found in the back of your packets.Thank You!

26. Test ReviewThere will be a test review after all tests have beencompleted and turned in to the Instructor.