Borderline Personality Disorder [PsychSessions Episode 31]

Borderline Personality Disorder [PsychSessions Episode 31]


People with borderline personality:
– have a strong sense of abandonment(when someone doesn’t meet them/respond to them when they want them to; for e.g. when a friend does not respond to their text immediately in seconds etc., – they feel slighted & rejected as a consequence & they have a massive abreaction (an emotional release following recall of a painful experience) to that & experience intense loneliness, personal emptiness
– The sufferer often engages in “mind reading”
– They often have low emotional intelligence skills
– Are at greater risk of a psychotic episode
– make Intensive efforts to avoid being alone
– Have patterns of intense, unstable interpersonal relationships
– Have patterns in poor self identity (sense of chaos inside themselves)
– Experience recurrent suicidal behaviour in response to stressors
– they struggle with impulse control, struggle with managing thoughts & emotions
– Paranoia dissociation is often short-lived & is without hallucinations (psychotic episodes seldom develop into schizophrenia-type disorders – however, they often receive such a diagnosis if they present to an emergency ward – & yet the brief psychotic episode only lasts 2 to 4 hrs)
– Behaviours & moods can last anywhere from minutes to hours
– It is not uncommon for them to feel sad and withdraw
– Self harm – such as cutting behaviours – do not always persist into adulthood [note there are many disorders which involve cutting – for e.g. PTSD, anxiety, major depressive disorder
– On the surface there is often depression and anxiety (& anger)
– At a deeper level (or at core) there is:
– Fear of abandonment
– Empty self
– Variable self image
– Intense loneliness
[these core issues drive the surface behaviours)

BPD is an extremely difficult mood disorder to live with – When triggered:
– They may act out (Engage in inappropriate behaviours)
– Go after others (Immediately call friend; Text friend hundreds of times)
– They may self harm
– They may bang their head

The interviewee talks about:
– how people with BPD “burn their life down” on a regular basis
– I.e. are the things you are doing now (behaviourally) burning down what you are also trying to build now in your life?
– The movie “Gone Girl” is a good representation of a person with BPD
– BPD presents along a continuum (they may have only mild to moderate – rather than extreme – borderline personality traits)
– Females tend to be diagnosed more often with BPD
– Be transparent about diagnosis – As the therapist
– Have solid boundaries – As the therapist
– BPD is often misdiagnosed & most commonly as bipolar disorder
– females are also more likely to have co-occurring disorders

Key factors that distinguish BPD from Bipolar Disorder:
– intensive efforts to avoid being alone
– unstable, intense interpersonal relationships
– disturbed sense of identity/self
– recurrent suicidal behaviour, threats, gestures, self-harm in response to any stressor
– paranoia / dissociation
– mood states last for minutes to hours and then go back to their base line
Bipolar Disorder
– mood episodes tend to be more discrete & longer duration
– they often present without any obvious trigger
– accompanied by changes in a person’s typical behaviour
– a lot of impulsivity in both hypomania (milder form of mania) & hypermania
– cycle of ups and downs
[the gold standard for differential diagnosis is whether there is a trigger or not]
[if there is a trigger which is identifiable – BPD not bipolar disorder]
[Borderline does not sustain behaviours – they get tired; Bipolar Disorder – stay the course]

Bipolar Disorder
– is a very difficult disorder to live with and manage

Treatment for Borderline Personality Disorder
– dialectical behaviour therapy (This therapy is responsible for making borderline personality disorder to now be considered treatable where is it was formally considered untreatable)(Also BPD is considered to be the most treatable of all of the personality disorders)
– Note: not all BPD sufferers respond to DBT – therefore look at the client and their needs
– For example interpersonal therapy is also useful; Also object relations theory
– It is difficult treatment & requires courage & commitment
– To obtain client buy-in, he sells the surface level and deeper level/core issues to the client

Prognosis for BPD
– it is quite good, subject to whether it is a mild BPD traits
– people “age-out” of behaviours – self-harm, acting out, violence/aggression (less common in their 50s compared with their 20s


How to Distinguish BPD from other Personality Disorders
– Do not care about Abandonment
Narcissistic Personality Disorder
– Do not have an “empty self” or difficulties with self identity
– They do not feel alone
– The rest of the world has the problem
Histrionic Personality Disorder
– The person wants attention, attention, attention
– They may have some sense of abandonment but it is not as extreme
– They may have some degrees of loneliness but it is not as intense, empty or dark



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