Transcript Medications - Southwestern PA Health Care Quality Unit

Borderline Personality Disorder
Presented by: APS Healthcare
Southwestern PA Health Care Quality Unit
(HCQU)
July, 2009/eas
© 2009 APS Healthcare, Inc.
1
Disclaimer
Information or education provided by the HCQU is not
intended to replace medical advice from the consumer’s
personal care physician, existing facility policy or federal,
state and local regulations/codes within the agency
jurisdiction. The information provided is not all inclusive of
the topic presented.
Certificates for training hours will only be awarded to those who attend a
training in its entirety. Attendees are responsible for submitting
paperwork to their respective agencies.
© 2009 APS Healthcare, Inc.
2
Note of Clarification
While mental retardation (MR) is still recognized as a clinical
diagnosis, in an effort to support the work of self-advocates,
the APS SW PA HCQU will be using the terms intellectual
and/or developmental disability (I/DD) to replace mental
retardation (MR) when feasible.
© 2009 APS Healthcare, Inc.
3
Objectives
Upon completion of the session the participant will:
© 2009 APS Healthcare, Inc.
1.
Define Borderline Personality Disorder
2.
List symptoms of BPD
3.
Recall current treatment methods for BPD
4
Personality Disorders






© 2009 APS Healthcare, Inc.
Enduring pattern of inner experience and behavior that
deviates from the expectations of the person’s culture
AXIS II Disorder
Pervasive and inflexible
Onset in adolescence/early adulthood
Stable over time
Leads to stress or impairment
5
Borderline Personality Disorder Definition
A pervasive pattern of instability of interpersonal
relationships, self-image and affects, and marked impulsivity
that begins by early adulthood and is present in a variety of
contexts
© 2009 APS Healthcare, Inc.
6
BPD Symptoms

Frantic efforts to avoid abandonment

Pattern of unstable and intense interpersonal relationships
© 2009 APS Healthcare, Inc.
7
BPD Symptoms

Identity disturbances

Impulsivity

Suicidal/self-injurious behavior
© 2009 APS Healthcare, Inc.
8
BPD Symptoms

Affective instability

Chronic feelings of emptiness

Difficulty controlling feelings of anger
© 2009 APS Healthcare, Inc.
9
Splitting

“Black and white” thinking

People are viewed as either “good” or “bad”

One day idolizes caretaker, the next day devalues them

Difficulty tolerating human ambiguities and inconsistencies
© 2009 APS Healthcare, Inc.
10
Co-occurring Disorders

Mood Disorders

Eating Disorders

Substance Related Disorders

Posttraumatic Stress Disorder

Attention-Deficit/Hyperactivity Disorder

Other Personality Disorders
© 2009 APS Healthcare, Inc.
11
BPD Facts

2% of the general population

About 80% are women

Chronic, severe problems continue for years

Tends to “burn out” in middle age

Females more likely to have mood disorder and be selfdestructive

1/10 succeed in committing suicide
© 2009 APS Healthcare, Inc.
12
BPD Facts

History of abuse is common

Resistant to treatment

Males with BPD prone to domestic violence, rage attacks

Males more likely to also have attention-deficit disorder or
antisocial personality disorder
© 2009 APS Healthcare, Inc.
13
Causes of BPD

No single cause

Genetic predisposition

Neurofunction
© 2009 APS Healthcare, Inc.
14
Causes of BPD

Environment
– Child abuse, trauma, or neglect
– Environment lacks consistent expectations and emotional
security
– Invalidating environment
– Vary with individuals
© 2009 APS Healthcare, Inc.
15
Validating vs. Invalidating Statements
 Validating Statements
• Encourage Coping Skills
• Validate the person’s feelings
• Promote healthy expression
 Invalidating Statements
• Teach suppression of emotions
• Cause anger or rage attacks
• Prevent coping skills
© 2009 APS Healthcare, Inc.
16
Treatment of BPD

Rule out possible medical conditions

Dialectical Behavior Therapy (DBT)
–

© 2009 APS Healthcare, Inc.
Marsha Linehan, PhD
Medications
17
Dialectical Behavior Therapy (DBT)

Cognitive-behavioral treatment targeted to treat people with
complex, difficult-to-treat mental disorders

The goal is “a life worth living”

DBT skills training
–
–
–
–
© 2009 APS Healthcare, Inc.
Mindfulness
Emotion Regulation
Interpersonal Effectiveness
Distress Tolerance
18
Medications






© 2009 APS Healthcare, Inc.
Never the only answer
Typically used to treat co-occurring disorders
Antidepressants
– Selective Serotonin Reuptake Inhibitors (SSRIs)
Mood stabilizers
Antipsychotics
Be aware of side effects
19
Positive Approaches

All behavior is meaningful

People have good reasons to do what they do

People do the best they can with what they know at that point
in time and in that context
© 2009 APS Healthcare, Inc.
20
Supporting a Person with BPD

Don’t take things personally

Validate

Build mastery

Be aware of your moods and affect

Communicate with team and therapist

Encourage healthy diet, sleep, exercise

Take care of yourself
© 2009 APS Healthcare, Inc.
21
References

The Clinical Characteristics and Management of Borderline
Personality Disorder in Mentally Retarded Persons, MHDD
1988/Vol 7/N0 7&8. Hurley, A. and Sovner, R.

Diagnostic and Statistical Manual of Mental Disorders, Fourth
Revision, Text Revised. 2000, American Psychiatric Association.

“I Hate You, Don’t Leave Me: Understanding the Borderline
Personality”, Jerold J. Kriesman, M.D. and Hal Straus.

Skills Training Manual for treating Borderline Personality
Disorder, Linehan, Marsha M., Ph.D. 1993.
© 2009 APS Healthcare, Inc.
22
To register for future trainings,
or
for more information on this or any other
physical or behavioral health topic, please
visit our website at
www.hcqu.apshealthcare.com
© 2009 APS Healthcare, Inc.
23
© 2009 APS Healthcare, Inc.
24
Evaluation
Please take a few moments to complete the
evaluation form found in the back of your packets.
Thank You!
Test Review
There will be a test review after all tests have been
completed and turned in to the Instructor.