Fairweather scott bpd_presentation


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Fairweather scott bpd_presentation

  1. 1. Credit for this presentation goes to Scott Fairweather, LISW-CP, CAC-I Transformative Behavioral Health LLC 1620 Suite B Lady St. Columbia, SC 29204 phone: (303) 241-2632 fax: (803)451-7604 Credit for this presentation goes to Scott Fairweather, LISW-CP, CAC-I Transformative Behavioral Health LLC 1620 Suite B Lady St. Columbia, SC 29204 phone: (303) 241-2632 fax: (803)451-7604
  2. 2. Borderline Personality Disorder Borderline Personality Disorder Presented by: Scott Fairweather, LISW-CP, CAC-I Clinical Instructor – USC School of Medicine Department of Neuropsychiatry and Behavioral Science. Owner / Therapist – Transformative Behavioral Health LLC
  3. 3. Session Objectives – Participants will be introduced to symptoms of Borderline Personality Disorder (BPD) and characteristics of the disorder. – Participants will understand how BPD differs from other types of mental illness. – Participants should recognize changes occurring in relation to diagnosis and treatment of BPD. – Participants will be introduced to community resources for referral, treatment, and additional information.
  4. 4. DSM-IV TR Diagnostic Criterion for Borderline Personality Disorder (BPD) A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by 5 (or more) of the following: American Psychiatric Association. (1994) Diagnostic and Statistical Manual of Mental disorders: DSM-IV-TR (4th ed.) Washington, DC: Author.
  5. 5. BPD Criterion Continued – Frantic efforts to avoid real or imagined abandonment. note: do not include suicidal or self-mutilating behavior in 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 two 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, threats, or self mutilating behavior. – Affective instability due to a marked reactivity of mood (e.g., frequent displays of temper, constant anger, recurrent physical fights) – Transient, stress-related paranoid ideation or severe dissociative symptoms. American Psychiatric Association. (1994) Diagnostic and Statistical Manual of Mental disorders: DSM-IV-TR (4th ed.) Washington, DC: Author.
  6. 6. DSM V – Definition of Personality Disorders – A new definition for personality disorder: First, the definition of what a personality disorder is, in general, has changed. The proposed revision suggests that instead of a pervasive pattern of thinking/emotionality/behaving, a personality disorder reflects "adaptive failure" involving: "Impaired sense of self-identity" or "Failure to develop effective interpersonal functioning". http://www.borderlinepersonalitydisorder.com/DSM-V_News.shtml
  7. 7. DSM V and BPD: Diagnostic Changes • The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits. To diagnose borderline personality disorder, the following criteria must be met: • A. Significant impairments in personality functioning manifest by: . 1. Impairments in self functioning (a or b): • a. Identity: Markedly impoverished, poorly developed, or unstable self-image, often associated with excessive self-criticism; chronic feelings of emptiness; dissociative states under stress. • b. Self-direction: Instability in goals, aspirations, values, or career plans. http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=17
  8. 8. BPD DSM V cont.. . 2. Impairments in interpersonal functioning (a or b): • a. Empathy: Compromised ability to recognize the feelings and needs of others associated with interpersonal hypersensitivity (i.e., prone to feel slighted or insulted); perceptions of others selectively biased toward negative attributes or vulnerabilities. • b. Intimacy: Intense, unstable, and conflicted close relationships, marked by mistrust, neediness, and anxious preoccupation with real or imagined abandonment; close relationships often viewed in extremes of idealization and devaluation and alternating between over involvement and withdrawal. • B. Pathological personality traits in the following domains: . 1. Negative Affectivity, characterized by: • a. Emotional lability: Unstable emotional experiences and frequent mood changes; emotions that are easily aroused, intense, and/or out of proportion to events and circumstances. http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=17
  9. 9. BPD DSM V cont.. • b. Anxiousness: Intense feelings of nervousness, tenseness, or panic, often in reaction to interpersonal stresses; worry about the negative effects of past unpleasant experiences and future negative possibilities; feeling fearful, apprehensive, or threatened by uncertainty; fears of falling apart or losing control. • c. Separation insecurity: Fears of rejection by • and/or separation from • significant others, associated with fears of excessive dependency and complete loss of autonomy. • d. Depressivity: Frequent feelings of being down, miserable, and/or hopeless; difficulty recovering from such moods; pessimism about the future; pervasive shame; feeling of inferior self-worth; thoughts of suicide and suicidal behavior. http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=17
  10. 10. BPD DSM V cont. 2. Disinhibition, characterized by: • a. Impulsivity: Acting on the spur of the moment in response to immediate stimuli; acting on a momentary basis without a plan or consideration of outcomes; difficulty establishing or following plans; a sense of urgency and self-harming behavior under emotional distress. • b. Risk taking: Engagement in dangerous, risky, and potentially self-damaging activities, unnecessarily and without regard to consequences; lack of concern for one•s limitations and denial of the reality of personal danger. .3. Antagonism, characterized by: • a. Hostility: Persistent or frequent angry feelings; anger or irritability in response to minor slights and insults. http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=17
  11. 11. BPD DSM V cont.. • C. The impairments in personality functioning and the individual•s personality trait expression are relatively stable across time and consistent across situations. • D. The impairments in personality functioning and the individual•s personality trait expression are not better understood as normative for the individual•s developmental stage or socio-cultural environment. • E. The impairments in personality functioning and the individual•s personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma). http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=17
  12. 12. BPD compared with other forms of MI in US population. www.nimh.nih.gov/statistics/1ANYANX_ADULT.shtml
  13. 13. Medications and BPD • Medications are most useful for treating underlying symptoms of anxiety, depression, and impulsiveness. • Anti-depressants (SSRI•s) • help to regulate depression and labile moods. • Mood Stabilizers • help to regulate emotions and reduce impulsiveness and anger. • Atypical Antipsychotics • help reduce impulsive and reckless behavior. http://www.webmd.com/mental-health/tc/borderline-personality-disorder- medications
  14. 14. Video links: • http://www.cbsnews.com/2300-204_16210008846. html?tag=page • http://www.nytimes.com/2011/06/23/health/2 3lives.html?pagewanted=all
  15. 15. Treatment Approaches for BPD • Dialectical Behavioral Therapy (DBT) • teaches coping skills in four areas; Mindfulness, Distress Tolerance, Emotion Regulation, and Interpersonal Effectiveness. Includes individual therapy weekly. • Cognitive Behavioral Therapy (CBT) • focus is on restructuring thinking patterns (thoughts, assumptions, and beliefs). • Transference-focused therapy (TFP) • an adaptation of psychoanalysis designed to change the distortions in the patients perception of significant others and the therapist. • Schema-focused therapy (SFT) • focuses on changing psychological problems by examining repetitive life patterns and by changing core life themes. • Mentalization-based therapy (MBT) • psychodynamic therapy focused on building the capacity to understand behavior and feelings associated with mental states in oneself and others. http://www.bpdfamily.com/bpdresources/nk_a107.htm
  16. 16. Bio Social Model Dysregulation Disorder symptoms = Biological Sensitivity AND Invalidating environment Invalidating Environment Biology Invalidating Environment Biology Invalidating Environment Biology Gresham, A., & Kivedra, C. (2010, April) Dialectical Behavioral Therapy [PowerPoint Slides].
  17. 17. Bio-Social Model cont.. • High Sensitivity • High reactivity • Slow return to baseline • Often •Transactional• with the Environment Gresham, A., & Kivedra, C. (2010, April) Dialectical Behavioral Therapy [PowerPoint Slides].
  18. 18. DBT vs. Treatment as Usual (TAU) • Appears to be more effective than (TAU) in reducing suicidal behaviors, self mutilating behaviors, and admission to inpatient hospital stays. • Treatment attendance retention, global functioning, and social adjustment appears to be greater with DBT than TAU. • Effective working with adults, adolescents, and elderly. • Effective in treating substance dependence, eating disorders, trauma related disorders, compulsive disorders, treatment resistant depression, and a variety of personality disorders. http://depts.washington.edu/brtc/sharing/publications/research-and-articles-on- dialectical-behavior-therapy
  19. 19. Referrals • Columbia Area Mental Health • (803) 898-8888 • Three Rivers Behavioral Health (803)796-9911 • Three Springs DBT • Greenville, SC (864) 242-5551 • Scott Fairweather, LISW-CP, CAC-I (303) 241-2632. • Palmyra Powell, LISW-CP (803) 586-1499.
  20. 20. Books on BPD Kreisman, Jerold., & Straus, Hal. (1989) I Hate You • don•t leave me. Avon Books. New York, NY. Linehan, Marsha. (1993) Cognitive Behavioral Treatment of Borderline Personality Disorder. The Guildford Press. New York, NY. Manning, Shari. (2011) Loving Someone with Borderline Personality Disorder. The Guildford Press. New York, NY. Mason, Paul T., Kreger, Randy. (1998) Stop walking on eggshells: Taking your life back when someone you care about has Borderline Personality Disorder. New Harbinger Publications. Oakland, CA.
  21. 21. Questions?
  22. 22. Where to learn more • www.behavioraltechllc.com • www.dbtselfhelp.com • http://www.ticllc.org/