Recognizing Bpd
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Recognizing Bpd



How to recognize borderline personality disorder and determine if someone can benefit from DBT

How to recognize borderline personality disorder and determine if someone can benefit from DBT



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Recognizing Bpd Recognizing Bpd Presentation Transcript

  • Recognizing Borderline Personality Traits: How to know if someone can benefit from DBT Paula Mendenhall, LMHC, LPHA
  • Personality Disorder An enduring patter of inner experience and behavior that deviates markedly from the expectations of the individual's culture. This pattern is manifested in two or more ways: Cognition Affect Interpersonal Functioning Impulse Control
  • Borderline Personality Disorder Pervasive pattern of instability in:  Interpersonal relationships  Self Image  Affect  Marked Impulsivity  Beginning in early adulthood  Present in a variety of contexts  View slide
  • Five or More of these Frantic efforts to avoid abandonment  Pattern of intense, unstable relationships –  idealization & devaluation Identity disturbance: unstable image of self  Impulsivity in at least 2 areas that are potentially self  damaging Recurrent suicidal gestures, threats OR self  mutilation Mood instability, reactivity of mood  Chronic feelings of emptiness  Inappropriate intense anger or difficulty controlling  anger Transient, stress related paranoid ideation or severe  dissociative symptoms View slide
  • BPD in a nutshell “Borderline individuals are the psychological equivalent of third- degree-burn patients. They simply have, so to speak, no emotional skin. Even the slightest touch or movement can create immense suffering.” Marsha Linehan “The methods of self-harm that borderlines choose can be gruesomely creative. One psychologist related to me an incident of a woman who used fingernail clippers to pull off slivers of her skin.” “BPD is a disorder that could be called the ‘I don’t fit in’ disorder”. “Back from the Edge”, Borderline Personality Disorder Resource Center quot;Everyone talks about [BPD], but it usually seems that no one knows quite what to do about it.“ Duke University Psychiatrist
  • Emotional Chaos “People with BPD seem to have no internal governor. They are powerfully connected to the people close to them and terrified by the possibility of losing them - yet they attack those people so unexpectedly that they often ensure the very abandonment they fear. When they want to hold, they claw instead! What defines BPD -and makes it so explosive - is the sufferers' inability to modulate their feelings and behavior. When faced with an event that makes them depressed or angry, they often become inconsolable or enraged”.
  • BPD ~ What to Look For • History of hospitalization or baker acts; • Suicide attempts and other self destructive, impulsive threats/acts; • Demanding or aggressive behavior; • Problems with identifying a sense of self (self invalidation); • Problems regulating their emotions: over or undercontrolled emotions; • Unrelenting crises: DRAMA • Apparent competence, Active Passivity • Pervasive problems with interpersonal relationships – very limited support system, isolation;
  • Things you may notice • You are becoming uncommonly frustrated/angry at the individual; • You become uncommonly close to the individual (wanting to rescue); • Symptoms tend to improve spontaneously as they age – They may tell you they USED to cut – They may have had a decrease in hospitalizations – They may no longer keep suicide as an option when they have children – They may find a stable relationship, eventually
  • Facts of BPD Effects 1-2% of population; but is grossly under diagnosed;  Mostly female 70%;Males are often diagnosed with anti-social  personality 75% engage in deliberate self-harm such as cutting, burning,  picking skin; 73% attempt suicide; 4 - 10% commit suicide;  Affects all cultures, levels of intelligence and social classes;  Co-exists with other disorders (bipolar disorder, mood, anxiety,  eating disorders, substance abuse,PTSD, dissociative, and psychotic); About 69% have a substance abuse problem versus 9.5% in general population Increased family history for Substance-Related Disorders (e.g.,  drug abuse), Antisocial Personality Disorder, and Mood Disorders, like depression or bipolar disorder; Quite often a history of abuse(75%): sexual, emotional or  physical; early loss of parent or sibling (38%).
  • How Does BPD Cause Problems Borderline personality disorder makes it hard for the  person to maintain relationships, sometimes jobs, and in general, stability. People with this disorder often cause a great amount of stress or conflict in relationships with others, especially significant others and close family members. It is not uncommon to see many unrelenting crises  in the BPD’s life: divorce, physical, sexual or emotional abuse, substance abuse, additional emotional problems (such as an eating disorder or depression), self-harm, job instability, estrangement from one’s family, and much more.
  • You might be dealing with BPD IF: They tell you things have been You can’t seem to get them to think   bad for a long time and they are differently about things – Black and always misunderstood. They say White, “all or nothing” thinking. they have been in therapy a long Their emotions seem to get the best  time. of them and they are highly reactive They are acting in self defeating, and can’t seem to calm down.  impulsive or emotionally extreme Their lives are in chaos, or they have  ways and they are NOT on drugs many crises. or alcohol. They tell you there is nothing wrong   They try to play you against with their behavior and attitude -- another person. it’s the other person who doesn’t They are obviously trying to understand!  manipulate – and don’t disguise it They just don’t seem to be able to  well. If they were skilled at it, you function in a consistent way. wouldn't know you were being manipulated.
  • Linehan, Marsha M. 1993. Skills Training Manual for Treating Borderline Personality Disorder. The Guilford Press, New York, NY.
  • Two levels of functioning: High Functioning-Acting Out Low functioning-Acting In •Episodes of raging •Episodes of self harm •Holds a job – with •Threats of suicide or attempts responsibility •Unable to hold job or working •Is capable of maintaining below level friendships •Trouble with ADLs •Can act “normal” when •Risky behaviors necessary •Primary emotion: •Primary emotion: ANGER FEAR/ANXIETY
  • The Four Sub-Types Ego centric, narcissistic type: Attention seeking; high expectations of others. Anti-social type: Self hatred, can be cruel to others without remorse. Jealous, critical, easily slighted. Shame based type: Overwhelming feelings of worthlessness, helplessness, hopelessness and despair. Very fearful. Isolative type: Fearful, seek control, potential for disaster everywhere. Critical of others - reflects their inner shame.
  • Criteria for DBT Borderline personality disorder OR borderline traits  Ability to comprehend written material  Cognitively functioning at at least an 8th grade level  Ability to remember and apply new learning  Substance abuse manageable  Refer for SA first if severe  Motivation for treatment  Voluntary  Ability to attend classes eventually and to keep  regular appointments
  • ONLINE TEST FOR BPD • Self help • Exclusive self tests • Borderline Personality Disorder •
  • References American Psychiatric Association, 1994. Diagnostic and Statistical Manual IV, Washington, DC Back from the Edge, Borderline Personality Disorder Resource Center, New York Presbyterian Hospital, Westchester Division, White Plains, NY. BPD Today Newsletter, Available on line: Linehan, Marsha M. 1993. Cognitive Behavioral Treatment of Borderline Personality Disorder, The Guilford Press, New York, NY. Kreger, R. & Shirley, JP, 2002. Walking on Eggshells, New Harbinger Publications, Oakland, CA. The Angry Heart Therapy Center for BPD, BPD Facts. Available on line: