Borderline Personality Disorder (BPD) is characterized by unstable moods, behavior, and relationships. It was first included in the DSM-III in 1980. BPD involves a pervasive pattern of instability in interpersonal relationships, self-image, and emotions that begins in early adulthood. Dialectical Behavior Therapy (DBT) is the gold standard treatment for BPD and focuses on mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness skills. DBT aims to reduce self-harming behaviors and improve relationships through individual therapy and skills training groups over several treatment stages with the goal of maintaining treatment gains.

1. Borderline Personality
Disorder
Submitted by,
MaNaSaGS
MScApplied Psychology

2. Description OfThe Disorder
• Adolf stern in 1938 used the term borderline.
• It described a group of patients who were on
a border between neurosis and psychosis. He
thought this as a mild form of schizophrenia.
• Current trend is to call it “Emotional Intensity
Disorder”
• In 1980, DSM-III listed BPD as a diagnosable
illness for the first time.

3. • Mental illness marked by unstable moods, behavior,
and relationships.
• Most psychiatrists and other mental health
professionals use the DSM to diagnose mental
illnesses.
• The DSM IV describes BPD as “ 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 context”.

4. • According to DSM-IV-TR, to be diagnosed with BPD,
a person must show an enduring pattern of
behavior that includes at least 5 of the following
symptoms:
Frantic attempts to avoid real or imagined
abandonment.
Unstable and intense relationships alternating
between idealization (extreme closeness and
love) and devaluation (to extreme dislike or
anger )
Markedly unstable self image or sense of self.
Potentially self damaging impulsive behavior in
at least 2 areas, such as unsafe sex, substance
abuse, reckless driving, and binge eating

5. Suicidal or parasuicidal behavior.
Intense and highly changeable moods, with each
episode lasting from a few hours to a few days
Chronic feelings of emptiness.
Inappropriate and uncontrollable anger.
Having stress-related paranoid thoughts or
severe dissociative symptoms, such as feeling cut
off from oneself, observing oneself from outside
the body, or losing touch with reality.

6. • Linehan reorganized DSM-IV diagnostic
criteria into five spheres of dysregulation.
1. Emotion Dysregulation
2. Behavioral Dysregulation
3. Interpersonal Dysregulation
4. Cognitive Dysregulation and
5. Self Dysregulation

7. Causes
• Genetic and environmental factors
– Studies on twins with BPD suggest that the
illness is strongly inherited.
– Another study shows that a person can inherit
his or her temperament and specific personality
traits, particularly impulsiveness and aggression.
– Scientists are studying genes that help regulate
emotions and impulse control for possible links
to the disorder.

8. • Social or cultural factors
– Unstable family relationships may increase a
person's risk for the disorder.
– Impulsiveness, poor judgment in lifestyle
choices, and other consequences of BPD may
lead individuals to risky situations.
– Adults with BPD are considerably more likely to
be the victim of violence, including rape and
other crimes.

9. Epidemiology
– 1 to 2 percent in general population.
– About 10% in psychiatric outpatient
populations& 20% inpatient population.
– 50% of personality-disordered inpatients are
diagnosed with BPD.
– Nearly 75% of individuals diagnosed with BPD
are women
– Age is negatively associated with grater
prevalence and severity of BPD.

10. – Comorbidity of Axis I disorders with BPD is high,
like major depressive disorder, bipolar disorder,
and anxiety disorders.
– Paranoid, avoidant, and dependent personality
disorders are high among BPD.

11. Assessment
• BPD is often under diagnosed or misdiagnosed
• can detect BPD based on a thorough interview and
a discussion about symptoms.
• A careful and thorough medical exam can help rule
out other possible causes of symptoms.
• The diagnostic assessment of BPD is complicated.
• High rates of comorbidity complicate the diagnostic
picture.

12. • Snapshot observation and self-report information
are primarily used for diagnosis. But this data may
not be characteristic of the individual’s behavior
and affect. Self report data may be unreliable.
Diagnosis must be based on longitudinal
observation.
• The mental health professional may ask about
symptoms and personal and family medical
histories, including any history of mental illnesses.
• This information can help the mental health
professional decide on the best treatment

13. • Women with BPD are more likely to have co-
occurring disorders such as major depression,
anxiety disorders, or eating disorders.
• In men, BPD is more likely to co-occur with
disorders such as substance abuse or antisocial
personality disorder.
• Other illnesses that often occur with BPD include
diabetes, high blood pressure, chronic back pain,
arthritis.
• These conditions are associated with obesity, which
is a common side effect of the medications
prescribed to treat BPD and other mental disorders.

14. Course And Prognosis
• Course is variable.
• Most commonly follows a pattern of chronic
instability in early adulthood with episodes of
serious affective and impulsive dyscontrol.
• The impairment and the risk of suicide are the
greatest at the young adult years and gradually
wane with advancing age.
• In the 4th and 5th decades of life, these individuals
tend to attain greater stability in their relationship
and functioning.
• Emerges in the late teens and early 20s.
• Chronic disorder , presenting symptoms for many
years.

15. RecommendedData-based Treatments
 BRIEF DESCRIPTION
 TREATMENT STAGES
 MULTIMODAL TREATMENT
 WORKPLACE ACCOMMODATIONS
 MAINTENANCE OF GAINS/RELAPSE PREVENTION
 WORKPLACE STRATEGIES

16. BRIEF DESCRIPTION
– Developed by Dr. Marsha Linehan and her
colleagues, DBT is an empirically validated
cognitive-behavioral treatment for BPD.
– Dialectical behavior therapy (DBT) focuses on
the concept of mindfulness, or being aware of
and attentive to the current situation.
– DBT teaches skills to control intense emotions,
reduces self-destructive behaviors, and improves
relationships.
– In DBT problems are defined, analyzed and
solved in a collaborative fashion.

17. • Cause is hypothesized according to operant,
respondent, and observational learning models.
• Solutions fall into one of four categories: skills
training, cognitive restructuring, exposure
techniques, or contingency management.
• In DBT, behavior therapy is balanced with
acceptance therapy and housed in a framework that
is dialectical in nature.
• The core acceptance strategy in DBT is validation

18. • Validation is used to
– Provide a balance to the push for change
– Reinforce clinical progress
– Teach self-validation and
– Strengthen therapeutic relationship
• Mindfulness is the core acceptance skill taught in
DBT

19. TREATMENT STAGES
• DBT provides stage-based hierarchical structure:
– Pretreatment stage:
• Assessment, orientation to treatment, initial
commitment to participate in therapy
– Stage 1 targets
• suicidal and parasuicidal behaviors
• Therapy- interfering behaviors
• Behaviors that severely interfere with a
reasonable quality of life

20. – Stage 2 targets
• reduction of posttraumatic stress
– Stage 3 targets
• Increasing self-respect
• Working on other problems and issues with
which the client may desire help

21. MULTIMODAL TREATMENT
• DBT clients participate two primary modes of therapy
Individual Therapy and Skills Training Group
• Individual Therapy motivate the individual to
use skillful behavior
• Emotional, cognitive, and environmental
obstacles for skillfulness are assessed and
treated
• Group skills training improves client’s
capabilities
• Training occurs in four primary skill sets:
mindfulness , distress tolerance, emotion
regulation, and interpersonal effectiveness

22. WORKPLACE ACCOMMODATIONS
• Allow self-initiated removal from stressful stimuli
• Mindfulness skills are taught
• Early release a few days a week in order to attend
therapy
• Environments to be validating of the difficulties and
needs of BPD
• Validate the realness of the individual’s problem
without invalidating his or her capabilities and
strengths
• Approach of consulting with the client rather than
intervening directly in his or her environment

23. MAINTENANCE OF GAINS/RELAPSE
PREVENTION
• Thoughtful strategies for preserving clinical change
• Continuing therapy
• Termination of therapy after clients complete Stage
2.
• Development of Social support in the client’s
natural environment
• To further assist maintenance of client gains and
prevention of relapse, a self-management skills unit
may be established

24. WORKPLACE STRATEGIES
• Supervisors should reinforce the change in behavior
through acknowledgement or praise.
• Validate(acknowledge non judgmentally) the
individuals report of emotion and the difficulty of
change in behavior.
• BPD are encouraged to consider whether the work
place is or is not validating.
• Supervisors should give support to the BPD when
needed, give sufficient training to achieve new
behavior.

25. HOPE YOU HAVE ENJOYED THE PRESENTATION
THANKYOU…