Bipolar And Borderline Powerpoint 4 10 08

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Bipolar And Borderline Powerpoint 4 10 08

  1. 1. Borderline Personality Disorder Stephanie Ellington Christina Fraser Loredana Pampinella Brianne Whitmire
  2. 2. Borderline Personality Disorder Extent of the Problem <ul><li>A serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior. </li></ul><ul><li>Instability often disrupts family and work life, long-term planning, and the individual's sense of self-identity (NEA-BPD, NIMH). </li></ul>
  3. 3. DSM-IV General Diagnostic Criteria: Personality Disorders <ul><li>A. An enduring pattern of inner experience and behavior </li></ul><ul><li>that deviates markedly from the expectations of the </li></ul><ul><li>individual’s culture. This pattern is manifested in two (or </li></ul><ul><li>more) of the following areas: </li></ul><ul><li>Cognition (i.e., ways of perceiving and interpreting self, other people, and events </li></ul><ul><li>Affectivity (i.e., the range, intensity, lability, and appropriateness of emotional response) </li></ul><ul><li>Interpersonal functioning </li></ul><ul><li>Impulse control </li></ul>
  4. 4. DSM-IV General Diagnostic Criteria: Personality Disorders <ul><li>B. The enduring pattern is inflexible and pervasive across a broad range of personal and social situations. </li></ul><ul><li>C. The enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning. </li></ul><ul><li>D. The pattern is stable and of long duration, and its onset can be traced back at least to adolescence or early adulthood. </li></ul><ul><li>E. The enduring pattern is not better accounted for as a manifestation of or consequence of another mental disorder. </li></ul><ul><li>F. The enduring pattern is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medicaiton) or a general medical condition (e.g. head trauma). </li></ul>
  5. 5. DSM-IV Diagnostic Criteria: Borderline Personality Disorder <ul><li>A pervasive pattern of instability of interpersonal </li></ul><ul><li>relationships, self-image, and affects, and marked </li></ul><ul><li>impulsivity beginning by early adulthood and present in a </li></ul><ul><li>variety of contexts, as indicated by five (or more) of the </li></ul><ul><li>following: </li></ul><ul><li>Frantic efforts to avoid real of imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5. </li></ul><ul><li>A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. </li></ul><ul><li>Identity disturbance: markedly and persistently unstable self-image or sense of self. </li></ul>
  6. 6. DSM-IV Diagnostic Criteria: Borderline Personality Disorder <ul><li>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. </li></ul><ul><li>Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior. </li></ul><ul><li>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) </li></ul>
  7. 7. DSM-IV Diagnostic Criteria: Borderline Personality Disorder <ul><li>Chronic feelings of emptiness. </li></ul><ul><li>Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights). </li></ul><ul><li>Transient, stress-related paranoid ideation or severe dissociative symptoms </li></ul>
  8. 8. Borderline Personality Disorder Extent of the Problem <ul><li>Less well known than schizophrenia or bipolar disorder, yet BPD is more common. </li></ul><ul><li>Affects 2% of adults, mostly females (NEA-BPD, NIMH). </li></ul>
  9. 9. Borderline Personality Disorder Extent of the Problem <ul><li>An individual with borderline personality disorder was originally described as being on the &quot;borderline&quot; of psychosis, but BPD is now known to be a disorder of emotion regulation (NIMH). </li></ul><ul><li>Borderline individuals exhibit high rates of self-injury, with and without suicidal intent (NIMH). </li></ul>
  10. 10. Borderline Personality Disorder Extent of the Problem <ul><li>Borderline personality disorder is commonly comorbid with depression (Clarkin, 1993). </li></ul><ul><li>BPD accounts for 20% of psychiatric hospitalizations (NIMH). </li></ul><ul><li>Many individuals with BPD receive counseling & medication, and are able to live productive lives (NIMH). </li></ul>
  11. 11. Women & Borderline <ul><li>Johnson (1991) reports that the literature shows that every social work setting includes BPD clients and that most are women . </li></ul>
  12. 12. Women & Borderline <ul><li>Weaver (1993) found that BPD women in their study: </li></ul><ul><ul><li>were significantly more depressed </li></ul></ul><ul><ul><li>had more severe & chronic psychiatric histories </li></ul></ul><ul><ul><li>had more bipolar diagnoses than the non-BPD women </li></ul></ul>
  13. 13. Women & Borderline <ul><li>Weaver (1993) studied 36 depressed women roughly half with a BPD diagnosis and half without. </li></ul><ul><ul><li>Study found that early childhood trauma of sexual abuse is a significant predictor of BPD diagnosis. </li></ul></ul>
  14. 14. Borderline Personality Disorder Behavioral Characteristics <ul><li>Clarkin (1993) found significantly high rates of neuroticism, hostility and impulsiveness, suspicion, alienated feelings, and pleasure seeking behaviors. </li></ul><ul><li>Extremely self-conscious and vulnerable </li></ul><ul><li>High rate of comorbidity with depression. </li></ul><ul><li>Neuroticism and agreeableness related to unstable relationships , suicidal behavior, identity diffusion, and fear of abandonment (Clarkin, 1993). </li></ul>
  15. 15. Borderline Personality Disorder Behavioral Characteristics <ul><li>Weaver (1993) found that the family of origin of a BPD client is reported to be more conflictual and more controlling, as well as less cohesive and less expressive. </li></ul>
  16. 16. Borderline Personality Disorder Behavioral Characteristics <ul><li>Individuals with BPD exhibit behavior that is dramatic, emotional, and/or erratic. </li></ul><ul><li>The borderline traits are ingrained in the individual’s character and cause maladaptive thoughts and behavior in their relations with others (Kreisman, 1989). </li></ul>
  17. 17. Borderline Personality Disorder Behavioral Characteristics <ul><li>Trull (1995) found that participants exhibiting BPD characteristics were significantly different than participants not exhibiting BPD characteristics, via self-report inventory on the measures of personality, mood-affect, coping styles, interpersonal stress, and general psychopathological symptoms. </li></ul>
  18. 18. Borderline Personality Disorder Behavioral Characteristics <ul><li>Grilo (2004) found that suicidal manifestation or self-injurious behavior was predictive of an 80% likelihood that the patient would meet the full criteria for BPD. </li></ul><ul><li>The presence of paranoia and dissociation were predictive factors in 1/3 to 1/2 of the diagnoses of borderline. </li></ul><ul><li>Affective instability is the most common symptom of BPD (Grilo, 2004). </li></ul>
  19. 19. Borderline Personality Disorder Video <ul><li>http://youtube.com/watch?v=pxJn0kmJnXI </li></ul>
  20. 20. Borderline Personality Disorder Forms of Treatment/Therapy <ul><li>The literature shows that psychotherapy is significantly helpful for the individual with BPD (Clarkin, 2006). </li></ul><ul><li>Effective therapeutic interventions include psychodynamic, cognitive, and a combination psychodynamic and cognitive approaches (Clarkin, 2006). </li></ul><ul><li>Dialectical behavioral therapy (DBT) is the most highly regarded approach, with evidence of reducing suicidal behavior and other borderline symptoms (Clarkin, 2006). </li></ul>
  21. 21. Borderline Personality Disorder Forms of Treatment/Therapy <ul><li>Johnson (1991) encourages counselors to learn about medications . </li></ul><ul><li>Counselor needs to know when to refer for psychiatric intervention or medication and how to monitor the patient who has begun pharmaceutical treatment (Johnson, 1991). </li></ul><ul><li>Understand biological aspects of the disorder & teach the client about the underlying reasons for their symptoms. </li></ul>
  22. 22. Borderline Personality Disorder Suggested Strategies for Counselors <ul><li>Johnson (1991) notes BPD client aggression toward therapist , which accompanies hostility and dependent feelings. </li></ul><ul><li>The client’s mood alternates between extreme idealization and great disappointment. </li></ul><ul><li>Borderline patients tend to terminate therapy abruptly when asked to face painful issues (Johnson, 1991). </li></ul>
  23. 23. Borderline Personality Disorder Conclusions <ul><li>BPD is a common disorder and difficult to treat. </li></ul><ul><li>There is hope in effective therapeutic intervention and adjunct pharmaceutical intervention. </li></ul><ul><li>Counselors must educate themselves about this disorder, as the diagnosis of BPD is more common than bipolar and schizophrenia, yet it is less well known (NEA-BPD, 2007; NIMH, 2007). </li></ul>
  24. 24. Borderline Personality Disorder Conclusions <ul><li>Borderline clients are notoriously difficult to work with. </li></ul><ul><ul><li>Counselors will need extensive training, education, and supervision to adequately treat this population. </li></ul></ul><ul><ul><li>Individuals with borderline personality disorder are present in all mental health settings. </li></ul></ul><ul><ul><li>Attention to literature and training courses will help the counselor to better serve and advocate for the client with BPD. </li></ul></ul>
  25. 25. References <ul><li>Clarkin, J.F., Hull, J.W., Cantor, J., & Sanderson, C. (1993). Borderline personality disorder and personality traits: A comparison of SCID-II BPD and NEO-PI. Psychological Assessment, 5, 472-476. </li></ul><ul><li>Clarkin, J.F., & Levy, K.N. (2006). Psychotherapy for patients with borderline personality disorder: Focusing on the mechanisms of change. Journal of Clinical Psychology, 62, 405-410. </li></ul><ul><li>Grilo, C.M., Becker, D.F., Anez, L.M., & McGlashan, T.H. (2004). Diagnostic efficacy of DSM-IV criteria for borderline personality disorder: An evaluation in Hispanic men and women with substance use disorders. Journal of Consulting and Clinical Psychology, 72, 126-131. </li></ul><ul><li>Johnson, H.C. (1991). Borderline clients: Practice implications of recent research. Social Work, 36, 166-173. </li></ul><ul><li>Kreisman, J.J., & Straus, H. (1989). I hate you – don’t leave me. Los Angeles, CA: Avon Books. </li></ul><ul><li>National Education Alliance for Borderline Personality Disorder. (2007). What is borderline personality disorder. Retrieved November 27, 2007, from http://www.neabpd.org/index.html </li></ul><ul><li>National Institute of Mental Health. (2007). Suicide in the U.S.: Statistics and prevention. Retrieved November 27, 2007, from http://www. nimh . nih . gov /health/publications/borderline-personality-disorder. shtml </li></ul><ul><li>Trull, T.J. (1995). Borderline personality disorder features in nonclinical young adults: 1. Identification and validation. Psychological Assessment, 7, 33-41. </li></ul><ul><li>Weaver, T.L., & Clum, G.A. (1993). Early family environments and traumatic experiences associated with borderline personality disorder. Journal of Consulting and Clinical Psychology, 61, 1068-1075. </li></ul>

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