Borderline Personality Disorder

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A look at Borderline Personality Disorder (BPD): diagnostic criteria, co-occurring disorders, causes/development and treatment of.

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Borderline Personality Disorder

  1. 1. Borderline Personality Disorder Andy Novinska, MS, LCPC, CADC
  2. 2. Personality Disorders • Personality disorders are associated with ways of thinking and feeling about oneself and others that significantly and adversely affect how an individual functions in many aspects of life. • During the development process of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM- 5), several proposed revisions were drafted that would have significantly changed the method by which individuals with these disorders are diagnosed. • Based on feedback from a multilevel review of proposed revisions, the American Psychiatric Association Board of Trustees ultimately decided to retain the DSM-IV categorical approach with the same 10 personality disorders. http://www.dsm5.org/Documents/Personality%20Disorders%20Fact%20Sheet.pdf
  3. 3. Diagnostic & Statistical Manual (DSM) • DSM-I, 1952 106 disorders, 130 pages • DSM-II, 1968 182 disorders,134 pages • DSM-III, 1980 265 disorders, 494 pages • DSM-IV, 1994 297 disorders, 886 pages • DSM-5, 2013 300 disorders, 947 pages
  4. 4. BorderlinePersonalityDisorder(BPD) Part of the “Cluster B” – Dramatic, Emotional or Erratic • Antisocial - Disregard for the rights of others that begins in childhood/early adolescence and continues into adulthood. Criminal activities common. • Narcissistic - Grandiosity with a need for admiration coupled with a lack of empathy for others. Preoccupied with competence, power and prestige. Closely linked to self-centeredness. • Histrionic - Excessive need for approval. Are often animated, dramatic, enthusiastic, seductive or flirtatious. • Borderline - Poor self-image/identity with an abnormal level of mood swings. Chaotic and unbalanced in their interpersonal relationships.
  5. 5. DSM-5 Borderline Personality Disorder (BPD) 301.83 (Emotionally unstable personality disorder, emotional intensity disorder, borderline type in the ICD-10) Diagnostic criteria require at least 5 of the following features:  Frantic efforts to avoid real or imagined abandonment. (Note: Do not include suicidal or self-mutilating behavior from criterion 5.)  A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.  Identity disturbance: markedly and persistently unstable self-image or sense of self.  Impulsivity in at least 2 areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). (Note: Do not include suicidal or self mutilating behavior covered in criterion 5.)  Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.  Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).  Chronic feelings of emptiness.  Inappropriate, intense anger or difficulty controlling anger (e.g. frequent displays of temper, constant anger, recurrent physical fights).  Transient stress –related paranoid ideation or severe dissociative symptoms.
  6. 6. Common Co-Occurring Disorders • Depressive Disorders • Bipolar Disorder • Substance Use Disorders • Eating Disorders (especially bulimia) • Posttraumatic Stress Disorder • Attention Deficit/Hyperactivity Disorder • Other Personality Disorders (especially other cluster B)
  7. 7. Causes & Development of BPD Nurture • Childhood abuse (especially sexual abuse) • Loss of primary caregivers • Neglect • Hostile conflicts with caregivers or within environment Nature • Chromosomal and neurological abnormalities • Brain region (occipital lobe & amygdala) functioning • 5x’s as likely in first degree biological relatives Temperament, Culture & Development • Diagnosed 75% of the time in females • Adolescents may display transient “symptoms” • Temperament (mood, intensity, adaptability) may mimic traits
  8. 8. Considerations Is Borderline Personality Disorder a “disorder” • Symptom or reaction to trauma, loss, neglect? • A gender stereotype that is expressed in “feminine” terms? Over Diagnosed? • Estimated at 1.6% of the population (might be as high as 5.9%) but can be a dumping ground (“they are acting just like a borderline”) or a dismissive disorder (“oh, they are just a borderline”). Not “Personality” • Symptoms tend to diminish with age. • A lack of emotional development due to drug and alcohol use, abuse, neglect, etc.
  9. 9. Treatment Modalities Individual Therapy (long-term) Dialectic Behavior Therapy (DBT) • Mindfulness • Interpersonal Effectiveness • Emotional Regulation • Distress Tolerance Schema Therapy • Cognitive, behavioral and emotion-focused (including some limited re-parenting) Transference Focused Therapy • Addressing distortions in perceptions
  10. 10. Therapeutic Alliance & Interactions Set Limits • Idealization & devaluation will occur, be consistent. • Splitting in a practice, office, team will occur. Utilize team staffings and stay unified. Validate • Empathize experiences without getting pulled in (or under!). Avoid Hospitalization • Have client partake in the world as much as possible (tricky as you must attend to suicidality and the co-occurring disorders, like depression, that can accompany suicidal thinking and behaviors).
  11. 11. Thank You Andy Novinska, MS, LCPC, CADC http://www.linkedin.com/in/apnovin

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