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Unformatted text preview: Borderline Personality Disorder
Alicia Deal CJ 660 SHSU What is Personality
o Personality traits are "enduring patterns of perceiving, relating to, and thinking about the environment and oneself that are exhibited in a wide range of social and personal contexts (DSM_IV-TR, 2000; 686). What is a Personality Disorder?
o An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture
A A A A Pervasive and inflexible Onset in adolescence or early adulthood Stable over time Leads to distress or impairment (DSM-IV-TR, 2000). PD Clusters Cluster A: odd or eccentric Paranoid Schizoid schizotypal Antisocial Borderline Histrionic Narcisstic Avoidant Dependent Obsessive-Compulsive Cluster B: dramatic, emotional, or erratic Cluster C: fearful or anxious Borderline Personality Disorder Historically, identified as a form of schizophrenia that "bordered" along psychosis and neurosis BPD: DSM-IV Criteria 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 contexts, as indicated by 5 (or more) of the following: Frantic efforts to avoid real or imagined abandonment A pattern of unstable & intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation Identity disturbance markedly & persistently unstable self-image or sense of self Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior 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) Chronic feelings of emptiness Inappropriate, intense anger or difficulty controlling anger (e.g. frequent displays of temper, constant anger, recurrent physical fights) Transient, stress-related paranoid ideation or severe dissociative symptoms (DSM-IVTR, 2000; 710) Defining Characteristics Behavioral style: Resentful, impulsiveness, helpless Interpersonal: Paradoxical instability, separation anxiety Cognitive: inflexible, don't learn from experience, poorly developed evocation memory Affective: extreme mood instability; mood shifts; emptiness, intense anger Len Sperry, M.D. 2003; 93 Parental injunction: "if you grow up, bad things will happen to me (parent);" overprotective, demanding, inconsistent parenting Self-view: "I don't know who I am or where I am going;" identity problems (ex. Gender, career, loyalties and values) World-view: "people are great. No, they are not. Having goals is good. No, it is not. If life doesn't go my way, I can't tolerate it. Don't commit to anything." Triggering event: "Frantic efforts to avoid real or imagined abandonment" BPD: Outcome and Course Risk of suicide and impairment peak in early adulthood Stabilizes during 30s and 40s Can be detected as young as 14 Yet can also burn out by age 25 Prevalence 2 % of general population 20% psychiatric inpatients 10% outpatient health clinics 75% women 5x more likely if first degree relative has BPD BPD: Characteristics Consequences: physical handicaps Premature death Frequent job losses Interrupted education Failed marriages Physical/sexual child abuse Neglect Hostile conflict Early parental loss or separation Childhood Histories Comorbidity Comorbidity: Mood disorders Substance-related disorders Eating disorders PTSD ADHD Other personality disorders BPD and Suicide 75-81% of individuals attempt suicide 8-10% are successful Threats of separation or rejection or by expectations that they assume increased responsibility usually precede attempts Dubo et.al. (1997): 79% BPD patients had histories of self-mutilation Self-mutilation often alleviates emotional pain by reaffirming the ability to feel or by expiating the individual's sense of being evil Treatment Cognitive behavior therapy: most common Dialectical behavior therapy (DBT): most effective Medication: SSRIs most effective About half no longer exhibit symptoms after ten years of being admitted into outpatient mental health facilities Proposed Causes of BPD Genetic predispositions Biopsychosocial: Diathesis-stress model Traumatic events Dysfunctional family life: child abuse/neglect Sociocultural and political forces: rapid social change Attachment Theory Attachment Theory: Definition Attachment: the emotional bond that develops between child and caregiver Thus effecting the child's capacity to from relationships in adulthood Predisposition to participate in social inaction Related to British object relations theory Biological application John Bowlby first proposed attachment theory Attachment: major tenets Survival value: safety through proximity to the caregiver Primary aim: physical state, not object Replaced by psychological goal: feeling of closeness to the caregiver Therefore, the caregiver's reaction to the child will greatly impact the attachment system "because if the child perceives the attachment goal to have been attained this will affect the system of behaviors (Fonagy, 2001; 8-9)." Attachment Styles Secure Insecure (Bowlby) Anxious Ambivalent partial rejection from parents, not complete Attachment Styles: cont. Bartholomew (1990) Preoccupied: Dependent, O-C, histrionic Fearful: Paranoid Dismissing: Schizoid Preoccupied-fearful: avoidant Fearful-dismissing: antisocial, narcisstic, schizotypal Disorganized: BPD BPD and Attachment Research has shown the importance of attachment on the development of personality traits and disorders Salzman et.al. 1997 Dubo et.al. 1997 Gunderson, 1996 Meyer et.al., 2001 BPD & Attachment Gunderson determined that the BPD criterion that is associated with the individual's intolerance to being alone relates to the "basic failures in the early attachment to primary caretakers (756)." Salzman: in the presence or absence of child abuse, "an attachment framework may provide a more adequate basis for understanding borderline personality structure (88)." Questions? ...
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- Spring '05