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Borderline Personality Disorder <ul><li>Lucia Merino </li></ul>
Borderline Personality Disorder
Borderline Personality Disorder Main characteristics <ul><li>Pervasive Pattern of Instability </li></ul>Relationships Self...
Borderline Personality Disorder Symptoms  <ul><li>Fear of abandonment - even if the “abandonment” is minor or imagined. Fr...
Differential Diagnosis BORDERLINE PERSONALITY DISORDER Schizotypal Paranoid Mood Disorder -Bipolar- Axis I= Clinical Disor...
 
CASE VIGNETTE MIXIAM   May -2010 First Psychiatric Hospitalization
MIXAME <ul><li>28 y/old F M female </li></ul><ul><li>Children 8, 5 </li></ul><ul><li>Separated/Rltnshps </li></ul><ul><li>...
Class Discussion <ul><li>What other data do we need to be able to make a diagnosis for this client? </li></ul><ul><li>What...
Treatment for BPD Dialectical Behavioral Therapy Marsha Lineham, PhD
Dialectical Behavioral Treatment (DBT) <ul><li>Mindfulness Skills : </li></ul><ul><li>Learning to be in control of your mi...
Summary <ul><li>BPD is a complex condition. At the heart of BPD are three characteristics:  fear of abandonment; unstable ...
Celebrities with  Borderline Personality Disorder
You are the doctor! <ul><li>How would you feel if you had this person in your office? Notice your visceral reaction. </li>...
Associated Features of Borderline Personality Disorder <ul><li>The following features may be seen in conjunction with BPD ...
Associated Features of Borderline Personality Disorder <ul><li>BPD can co-occur with Axis I disorders including: </li></ul...
Statistics on BPD <ul><li>75% of pts with BPD are female </li></ul><ul><li>BPD is identified around the world </li></ul><u...
Mnemonic for BPD PRAISE   <ul><li>P  = Paranoid ideas, dissociations, black-outs </li></ul><ul><li>R  = Relationship, affe...
Borderline Vs Mood Disorder <ul><li>Cross-sectional presentation of BPD </li></ul>Bi B BPD Mood Disorder Same  Symptoms Do...
Bipolar Disorder Symptom Criteria <ul><li>Manic Episode </li></ul><ul><li>Depressive Episode </li></ul><ul><li>Poor Judgme...
Differential Diagnosis BORDERLINE PERSONALITY DISORDER Schizotypal Paranoid Mood Disorder  Episode Axis I = Mood Disorder ...
Differential Diagnosis Borderline  Vs.  Histrionic <ul><li>BPD </li></ul><ul><li>Self-destruction </li></ul><ul><li>Angry ...
Differential Diagnosis Borderline  Vs.  Schizotypal <ul><li>BPD </li></ul><ul><li>More transient </li></ul><ul><li>Interpe...
Differential Diagnosis Borderline  Vs. Paranoid & Narcissistic <ul><li>BPD </li></ul><ul><li>Fear of abandonment </li></ul...
Differential Diagnosis Borderline  Vs.  Antisocial BPD Manipulation to gain concern/nurturance  caregiver/lover Antisocial...
Differential Diagnosis Borderline  Vs.  Dependent <ul><li>BPD </li></ul><ul><li>Reacts to abandonment: </li></ul><ul><li>E...
Differential Diagnosis Borderline Vs. Personality Change BPD Medical Condition Substances Identity Problems
Differential Diagnosis BDP   Vs.  Mood Disorder <ul><li>BPD </li></ul><ul><li>Early onset </li></ul><ul><li>Long-standing ...
Borderline or Mood Disorder?
 
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Borderline personality disorder presentation Slide 1 Borderline personality disorder presentation Slide 2 Borderline personality disorder presentation Slide 3 Borderline personality disorder presentation Slide 4 Borderline personality disorder presentation Slide 5 Borderline personality disorder presentation Slide 6 Borderline personality disorder presentation Slide 7 Borderline personality disorder presentation Slide 8 Borderline personality disorder presentation Slide 9 Borderline personality disorder presentation Slide 10 Borderline personality disorder presentation Slide 11 Borderline personality disorder presentation Slide 12 Borderline personality disorder presentation Slide 13 Borderline personality disorder presentation Slide 14 Borderline personality disorder presentation Slide 15 Borderline personality disorder presentation Slide 16 Borderline personality disorder presentation Slide 17 Borderline personality disorder presentation Slide 18 Borderline personality disorder presentation Slide 19 Borderline personality disorder presentation Slide 20 Borderline personality disorder presentation Slide 21 Borderline personality disorder presentation Slide 22 Borderline personality disorder presentation Slide 23 Borderline personality disorder presentation Slide 24 Borderline personality disorder presentation Slide 25 Borderline personality disorder presentation Slide 26 Borderline personality disorder presentation Slide 27 Borderline personality disorder presentation Slide 28 Borderline personality disorder presentation Slide 29 Borderline personality disorder presentation Slide 30
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Borderline personality disorder presentation

Borderline Personality Disorder Presentation given in Psychopathology II class.
Summer 2010 Argosy University San Francisco
By Lucia Merino, Psychology Doctor Candidate

Borderline personality disorder presentation

  1. 1. Borderline Personality Disorder <ul><li>Lucia Merino </li></ul>
  2. 2. Borderline Personality Disorder
  3. 3. Borderline Personality Disorder Main characteristics <ul><li>Pervasive Pattern of Instability </li></ul>Relationships Self-Image Affects Marked Impulsivity Starts in early adulthood It’s present in a variety of contexts ICD calls it Emotionally Unstable Personality Disorder. It’s a disorder of emotional dysregulation, inability to regulate emotions, and intense emotional reactvity.
  4. 4. Borderline Personality Disorder Symptoms <ul><li>Fear of abandonment - even if the “abandonment” is minor or imagined. Frantic efforts to avoid being alone. </li></ul><ul><li>A pattern of intense, unstable relationships . Quickly attaches to new partner. Lack of boundaries. Idealizes/Devalues –can’t tolerate ambiguity. </li></ul><ul><li>Impulsivity . Self-damaging acts. Inability to control impulsivity: shoplifting, drug abuse, spending sprees, binge eating, etc. </li></ul><ul><li>Emotional instability : frequent and dramatic changes in affect too short to be considered changes in mood –but “moody”. </li></ul><ul><li>Suicidality: threats or gestures –overdose not intended to be lethal, self-mutilation; suicide notes frequently written and left in areas easily found. </li></ul><ul><li>Persistent feelings of emptiness , guilt. </li></ul><ul><li>Inability to regulate emotion : Difficulties with anger control –cutting, slashing, burning, acts of violence. </li></ul><ul><li>Episodes of dissociation , paranoid ideas or illusions are transient and induced by stressful external events. </li></ul><ul><li>Disturbances of self-image /self-concept, bad or inexistent. </li></ul>
  5. 5. Differential Diagnosis BORDERLINE PERSONALITY DISORDER Schizotypal Paranoid Mood Disorder -Bipolar- Axis I= Clinical Disorders Axis II = Personality Disorders Antisocial Histrionic Identity Problem Substances Medical Condition Dependent Narcissistic ED SA PTSD
  6. 7. CASE VIGNETTE MIXIAM May -2010 First Psychiatric Hospitalization
  7. 8. MIXAME <ul><li>28 y/old F M female </li></ul><ul><li>Children 8, 5 </li></ul><ul><li>Separated/Rltnshps </li></ul><ul><li>School/artist/black </li></ul><ul><li>mutilt/pcing/tattoo </li></ul><ul><li>Suicidal ideations </li></ul><ul><li>Depressed/Anx/RT </li></ul><ul><li>Angry/Violent/Fear </li></ul><ul><li>Dissociates/Sex Abu </li></ul><ul><li>Affective instbility </li></ul><ul><li>Emptiness, Self ID </li></ul><ul><li>Guilt, shame, bad </li></ul>
  8. 9. Class Discussion <ul><li>What other data do we need to be able to make a diagnosis for this client? </li></ul><ul><li>What other questions do we have to ask? </li></ul><ul><li>What other symptoms need to be there to meet criteria for a BPD? </li></ul><ul><li>What symptoms do we have to rule out for a differential diagnosis? </li></ul><ul><li>Is there more than one diagnosis? </li></ul>
  9. 10. Treatment for BPD Dialectical Behavioral Therapy Marsha Lineham, PhD
  10. 11. Dialectical Behavioral Treatment (DBT) <ul><li>Mindfulness Skills : </li></ul><ul><li>Learning to be in control of your mind, instead of letting your mind be in control of you. </li></ul><ul><li>RM + EM = Wise Mind </li></ul><ul><li>Distress Tolerance : </li></ul><ul><li>Radical Acceptance: Guidelines to Accept Reality </li></ul><ul><li>Emotion Regulation </li></ul><ul><li>Identify, Understand and tolerate emotions. </li></ul><ul><li>Reduce emotional vulnerability. </li></ul><ul><li>Interpersonal Effectivnss </li></ul><ul><li>Develop Assertiveness, Boundaries, Self-Respect in Relationships. </li></ul>Marsha Lineham –University of Washington at Seattle -behavioraltech.org
  11. 12. Summary <ul><li>BPD is a complex condition. At the heart of BPD are three characteristics: fear of abandonment; unstable pattern in relationships, self-image and affect; and impulsivity. </li></ul><ul><li>People with BPD are “stably unstable” and “predictably unpredictable.” </li></ul><ul><li>Book: I hate you –don’t leave me, captures the turmoil the BPD patient experiences in close relationships. They feel and intense desire to merge with another, but at the same time they fear being engulfed by the relationship. </li></ul><ul><li>This is a disorder of Emotional Instability and Impulsivity. </li></ul>
  12. 13. Celebrities with Borderline Personality Disorder
  13. 14. You are the doctor! <ul><li>How would you feel if you had this person in your office? Notice your visceral reaction. </li></ul><ul><li>What is that you like from this person? </li></ul><ul><li>What is that you dislike from this person? </li></ul><ul><li>What are behaviors you know of this person evidencing borderline traits? </li></ul><ul><li>What would you ask in order to find out if s/he has borderline personality disorder? </li></ul>
  14. 15. Associated Features of Borderline Personality Disorder <ul><li>The following features may be seen in conjunction with BPD symptoms </li></ul><ul><li>Undermining themselves at the moment a goal is about to be realized </li></ul><ul><li>Lack of boundaries: inappropriate self-exposure, promiscuity </li></ul><ul><li>Emotional dysregulation </li></ul><ul><li>Psychotic-like sxs –triggered by stressful situations (relationships) </li></ul><ul><li>More secure with pets than in interpersonal relationship </li></ul><ul><li>Premature death-due to mood, substance use </li></ul><ul><li>Recurrent job losses, interrupted education, broken marriages </li></ul><ul><li>Childhood Sex/Physical Abuse, neglect, hostile conflict, early parental loss and/or separation/invalidating environment </li></ul>
  15. 16. Associated Features of Borderline Personality Disorder <ul><li>BPD can co-occur with Axis I disorders including: </li></ul><ul><li>Mood Disorders </li></ul><ul><li>Substance Related D/O </li></ul><ul><li>Eating Disorders (Bulimia) </li></ul><ul><li>PTSD </li></ul><ul><li>ADHD </li></ul>
  16. 17. Statistics on BPD <ul><li>75% of pts with BPD are female </li></ul><ul><li>BPD is identified around the world </li></ul><ul><li>10% suicide prevalence –premature death </li></ul><ul><li>2% prevalence in population </li></ul><ul><li>10% prevalence in out-patient settings </li></ul><ul><li>20% prevalence in in-patient settings </li></ul><ul><li>Follow-up studies (out-pt) show after 10 yrs ½ of them do no longer meet criteria. </li></ul><ul><li>In their 30-40’s attain greater stability in Rltx & W. </li></ul>
  17. 18. Mnemonic for BPD PRAISE <ul><li>P = Paranoid ideas, dissociations, black-outs </li></ul><ul><li>R = Relationship, affect & self-image, instability </li></ul><ul><li>A = Angry outburst due to abandonment fears </li></ul><ul><li>I = Impulsive behavior, Identity disturbance </li></ul><ul><li>S = Suicidal behavior, gestures, letter, self-mutil </li></ul><ul><li>E = Emptiness, guilt and being evil </li></ul>
  18. 19. Borderline Vs Mood Disorder <ul><li>Cross-sectional presentation of BPD </li></ul>Bi B BPD Mood Disorder Same Symptoms Don’t diagnose BPD based only on cross-sectional presentation without evidence of early onset and long-lasting course of the pattern behavior.
  19. 20. Bipolar Disorder Symptom Criteria <ul><li>Manic Episode </li></ul><ul><li>Depressive Episode </li></ul><ul><li>Poor Judgment Behavior </li></ul><ul><li>Racing Thoughts </li></ul><ul><li>Decreased Need for sleep </li></ul><ul><li>Pressured Speech </li></ul><ul><li>Increased libido </li></ul><ul><li>Increased creativity </li></ul><ul><li>Increased physical/mental energy </li></ul><ul><li>Increased use of substances </li></ul>
  20. 21. Differential Diagnosis BORDERLINE PERSONALITY DISORDER Schizotypal Paranoid Mood Disorder Episode Axis I = Mood Disorder Axis II = Personality Disorders Antisocial Histrionic Identity Problem Substances Medical Condition Dependent Narcissistic
  21. 22. Differential Diagnosis Borderline Vs. Histrionic <ul><li>BPD </li></ul><ul><li>Self-destruction </li></ul><ul><li>Angry disruptions in Reltx </li></ul><ul><li>Chronic emptiness & loneliness </li></ul>Histrionic Similar features: Attention seeking Manipulative Mood swings
  22. 23. Differential Diagnosis Borderline Vs. Schizotypal <ul><li>BPD </li></ul><ul><li>More transient </li></ul><ul><li>Interpersonally reactive </li></ul><ul><li>Stress related </li></ul>Similar feature: Paranoid illusions Schizotypal
  23. 24. Differential Diagnosis Borderline Vs. Paranoid & Narcissistic <ul><li>BPD </li></ul><ul><li>Fear of abandonment </li></ul><ul><li>Self-destructive </li></ul><ul><li>Impulsivity </li></ul>Paranoid Narcissistic Similar feature: Angry reaction to stimuli
  24. 25. Differential Diagnosis Borderline Vs. Antisocial BPD Manipulation to gain concern/nurturance caregiver/lover Antisocial Manipulation for profit, power or material gain Common feature: Manipulation
  25. 26. Differential Diagnosis Borderline Vs. Dependent <ul><li>BPD </li></ul><ul><li>Reacts to abandonment: </li></ul><ul><li>Emptiness </li></ul><ul><li>Demands </li></ul><ul><li>Rage </li></ul><ul><li>UNSTABLE RELATIONSHIPS </li></ul><ul><li>Dependent </li></ul><ul><li>Reacts with: </li></ul><ul><li>Submissiveness </li></ul><ul><li>Quickly replaces relationship </li></ul>Common feature: Fear of abandonment
  26. 27. Differential Diagnosis Borderline Vs. Personality Change BPD Medical Condition Substances Identity Problems
  27. 28. Differential Diagnosis BDP Vs. Mood Disorder <ul><li>BPD </li></ul><ul><li>Early onset </li></ul><ul><li>Long-standing </li></ul><ul><li>Sxs not only during episode </li></ul>Mood Disorder
  28. 29. Borderline or Mood Disorder?
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Borderline Personality Disorder Presentation given in Psychopathology II class. Summer 2010 Argosy University San Francisco By Lucia Merino, Psychology Doctor Candidate

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