Transcript Symptoms of BPD/ CTD

FAMILY VIOLENCE &
MENTAL HEALTH IMPACTS
Prof. Jayashri Kulkarni
Monash Alfred Psychiatry research centre
www.maprc.org.au
Violence Against Women
• In Victoria, male intimate partner violence
is found to be the leading contributor to
death, disability and illness for women
aged 15 to 44 years (VicHealth 2004).
• Ref “Preventing violence against women”
http://www.vichealth.vic.gov.au
Violence Against Women
• The Personal Safety Survey is a survey of 16,400 Australians aged
18 years and over conducted by the ABS (2006).
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Some Findings :
Well over one-third of women (40 percent) had experienced physical
and/or sexual violence.
Just under one in three women (29 per cent) had experienced
physical assault.
Nearly one in five (17 per cent) had experienced sexual assault.
Nearly one in seven (15 per cent) had experienced physical and/or
sexual violence by a previous partner.
Two per cent had experienced physical and/or sexual violence by
their current partner (ABS 2006).
Increasing rate of sexual
abuse of girls in Australia
• As seen, there is a greater number of early – mid
teenaged girls with incidences of maltreatment – sexual
abuse, physical violence and/or neglect.
• The biological impact of this is long – lasting, with
obesity, poor education attainment, health services
engagement due to self harm and rage with resultant
poor quality of life.
Early sexualisation of girls
& Mental Illness
• Premature sexualisation is linked with serious mental health
problems like eating disorders, low self-esteem and depression.
• Sexualisation puts girls in danger. It contributes to exploitation and
violence against girls and women. It increases sexism, sex bias, and
sexist attitudes.
• Strong evidence indicates the exposure to ideals of sexual
attractiveness in the media is associated with greater body
dissatisfaction among girls and young women.
• If girls and women are seen exclusively as sexual beings rather than
as complicated people with many interests, talents, and identities,
boys and men may have difficulty relating to them on any level other
than the sexual.
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( Ref Womensforum Australia 2013)
Monash Alfred Psychriatry Reseacrh Centre
Antenatal Domestic
Violence
• Antenatal violence associated with maternal depression in
pregnancy and postpartum.
• Behavioural problems seen in the child up to 4 years.
• Due to impact of cortisol and CRF on fetal neurons.
• Profound impact of maternal depression on baby/child
development.
( Flasch et al 2011 – AVON longitudinal study of parents and children.14,451
pregnancies studies and followed)
What is TRAUMA?
• A direct personal experience of an event that
involves actual or threatened death or serious
injury, or other threat to one’s physical integrity;
or witnessing an event that involves death,
injury, or a threat to the physical integrity of
another person; or learning about an
unexpected or violent death, serious harm, or
threat of death or injury experienced by a family
member or other close associate (APA, 2000, p.
463).
What is Post –Traumatic
Stress Disorder? (PTSD)
• PTSD was reserved as a term for the
collection of symptoms experienced by
war veterans – “shell shock” described in
WW1.
• Definition broadened in the 1960s to
include women and children who
experienced psychological trauma,
following abuse.
PTSD
• Re-experiencing symptoms: Flashbacks reliving the trauma over and over, including
physical symptoms like a racing heart or
sweating. Bad dreams. Intrusive thoughts,
dissociation, prolonged distress with any cues of
the event.
• Avoidance symptoms: Staying away from
places, events, or objects that are reminders of
the experience. Feeling emotionally numb.
PTSD
• Hyperarousal symptoms: Being easily startled,
irritable & angry, recklessness, poor
concentration, self – destructive, poor sleep.
• Negative Alterations in Cognition : Unable to
remember important aspects of the trauma (due
to dissociation), persistent negative beliefs about
self or the world “ I am bad”, self-blame for the
event, guilt/shame, decreased interest in usual
activities,feel detached, unable to feel positive
emotions.
Biology of stress
induced by trauma
Cortisol, Memory & Stress
• Glucocorticoids
(cortisol and corticosterone)
released from the adrenal
cortex during stress have
adverse effects on cognitive
functions such as learning
and memory. Newcomer et al
(1999)
The Brain Biology of Trauma
Many Effects of Trauma
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Depression
Anxiety
Brief reactive psychosis
Complex Trauma Disorder
A Case
• Emma, now 26 – was raised by her single
mother.
• Her father left when Emma was 5.
• She was sexually abused by her mother’s
boyfriend when she was aged 8 to age 14.
• She told her mother who did not believe her.
• Emma left home at age 16 and has a history of
amphetamine abuse, alcohol abuse.
A Case
• She cuts her arms and wrists and says
this makes her feel “alive”.
• Emma could not complete school and said
she was unable to concentrate and has a
“bad memory”.
• She feels empty inside and often looks
“dazed”.
• Emma has angry outbursts over minor
things.
A Case
• Emma is very overweight.
• She has made 11 suicide attempts.
• Emma has had 4 admissions to psychiatry
wards.
• She has a diagnosis of “BORDERLINE
PERSONALITY DISORDER”.
What is BORDERLINE
PERSONALITY DISORDER?
• The DSM 5 term is “Borderline Personality
Disorder”.
• What a useless term!!
• A better term is COMPLEX OR CHRONIC
TRAUMA DISORDER.
Symptoms of BPD/ CTD
• Deep feelings of insecurity
• Difficulty coping with fear of abandonment and loss;
continually seeking reassurance, even for small things;
• Rage & anger towards others whom they consider
responsible for how they feel;
• A fragile sense of self and one’s place in the world.
• Dissociation with stress.
• Self-harm Causing deliberate pain by cutting, burning or
hitting oneself; overdosing on prescription or illegal
drugs; binge eating or starving; abusing alcohol and
other drugs; repeatedly putting oneself in dangerous
situations or attempting suicide.
Symptoms of BPD/ CTD
• Persistent impulsiveness - Abusing alcohol
and other drugs; spending excessively;
gambling; stealing; driving recklessly, or having
unsafe sex.
• Confused, contradictory feelings. Frequent
questioning and changing of emotions or
attitudes towards others, and towards aspects of
life such as goals, career, living arrangements or
sexual orientation.
Symptoms of BPD/ CTD
• Some people with BPD may also have
symptoms of other mental illnesses.
• May experience symptoms associated with
anxiety or mood disorders.
• May experience psychotic symptoms such as
delusions or false beliefs – believing, for
example, they are being deceived, spied on or
plotted against.
• Re-appearance of symptoms at menopause.
BPD/CTD
• BPD is a complex disorder that is often
misunderstood.
• People may self-harm due to low self esteem, to
momentarily express and release emotional pain
or even to punish themselves.
• The anger and rejection that people with BPD
display mean they are sometimes labelled as
‘bad,‘ ‘manipulative’ or ’attention-seeking’.
• “Push –pull” dynamic inrelationships
• People with BPD can get better. While there is
no cure yet, BPD is a treatable disorder.
Relationship between
Abuse/Stress and CTD
Trauma/Abuse (
sexual/physical/
emotional)
Self Harm,
rage,
relationship &
work issues
Ongoing stress
– causing
biological/
psychological
changes
PTSD/Chron
ic Stress
Disorders
Management in General
• SAFETY- may need Police/legal interventions
• Assess whether other conditions e.g: depression
present.
• Psychotherapy – DBT, supportive at times of
crisis, insight directed when possible.
• Medications – for acute crises, accompanying
depression, psychosis
• Education/ support for family/ friends.
• “Re-training” regarding relationship/ suicide
thoughts.