Borderline Personality Disorder

Borderline Personality Disorder

Summary:
– BPD defined: 5 of 9 criteria: impulsivity; emotive, cognitive & behavioural disturbances – one of the core features is affect instability & difficulties regulating affect, including: emotional, stress & impulse regulation | typically features mood swings
– patients typically report: recurring suicidal thoughts, behaviours, gestures &/or threats & self-mutilation to get release; they experience strong arousal from relatively small events which they think they cannot control without resorting to cutting, burning, intoxicating yourself behaviours
– pain threshold is high – cutting brings them back to life – they feel pain again which re-orients them to reality – they have “learned” to bring themselves from aversive, stressful experiences through behaviour which in the short-term is very successful – but which in the long-term is problem-generating – physical performance & social interaction
– patients typically:
– have difficulties in relationships
– they think they are totally dependent on the other person – they believe they totally lose control over their own behaviour, conditions, emotions if the one significant other is out of the room – they are often “addicted” to other people, but they “can’t stand the closeness”
– this results in their longing for a close relationship but becoming afraid when they have one – this leaves the person feeling deeply ashamed, anxious &/or aggressive
– this relationship style oscillates all the time – Which has strong impacts in the long run
– BPD usually starts at the age of 14 to 16
– when diagnosed at the age of 24, they often have no friends apart from social workers, psychiatrists etc.,

So what is the treatment of Borderline Personality Disorder?
– if a person has BPD, they should get professional help
– Generally speaking, the younger the person, the greater the need
– a study is cited: 6% of girls cutting themselves frequently combined with 4 or more suicide attempts in adolescence – only 10% seek treatment
– DBT is an evidence-based treatment
– it is a multi-component treatment:
1) individualised Therapy
– one on one therapy with a patient for approx 2 years
2) skills training
– stress regulation
– emotion regulation
– interpersonal skills
– mindfulness (assists focus and aids acceptance of themselves/way of being)
[usually conducted over 6 months & often repeated for another 6 months
3) telephone consultation
– emergency support during crises
4) multi-disciplinary team consultation – treatment should be broader than just a psychotherapist
– DBT ALSO involves teaching the BPD patient about what BPD is
– modulate emotional responses
– re-integrate into work/education/society & not in the psychiatric system
– Mentalisation: involves monitoring own Cognitions & reflecting upon tHem – what are you inducing within your partner regarding, cognitions, emotions & behaviours
– this is useful because BPD patients often have difficulties monitoring their own Cognitions, emotions & reflect on the impact of their behaviour on other people
– this a neuropsychological training usually done in groups
– Jeffrey Young – Schema-Focused Therapy
– it is derived from Cognitive Therapy
– schemas are cognitive, emotional & pre-verbal states susceptible to triggers
– 18 schemas for all personality disorders
– they teach patient awareness of their schemas & whether they fit now in the current environment
– treatment is dyadic in nature – typically

– 1.5 to 2% of the population are BPD patients

Medical Treatments:
– Olanzapine
– SSRIs
– neuroleptics
– mood stabilisers
– sleeping tablets
– note: most patients are on 4.5 medications
[data issues are discussed]

Aetiology or cause?
– biopsychosocial theory – genetics is thought to explain 50%, but this is controversial
– note just one study | parental symptomatology
– large studies seem to also point to traumatic childhood experiences – in particular, childhood sexual abuse (50%) & physical abuse & emotional abuse/neglect in the family (morphological changes to the amygdala & hippocampus & interaction with the prefrontal cortex)

Source: CPD ONLINE talks to | Podcast date: 10 December 2008

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