Transcript Borderline Personality Disorder

Corrections & Mental Health
Nineteenth Century, “borderline” described a
condition that was “fuzzy” between two
different psychiatric problems.
 Bordered on or overlapped with schizophrenia
and non-schizophrenic psychosis. “Wastebasket
diagnosis”
 Category 1: neurosis, patients aware of reality
but had emotional problems (i.e., depression,
anxiety).
 Category 2: psychosis, patients who had unusual
thoughts/experiences (hallucinations) not based
on reality. These patients were diagnosed with
disorders such as schizophrenia.

 Psychiatrist
used the term “borderline” for
patients who had a hard time seeing both the
good and bad qualities in people who led
unstable and chaotic lives.
 Problems not serious enough to be labeled
psychotic, but too troubled to be neurotic.
 Borderline
Personality disorder- A person
with borderline personality disorder often
experiences a repetitive pattern of
disorganization and instability in poor self
image, mood, behavior, and personal
relationships.
 Can cause distress with friendships and work
Fear of being abandoned
 May have trouble with anger (have an outburst,
or scared of anger that they avoid it)
 Have difficulty trusting others
 Manipulative
 Frequent shifts of lonely depression to irritability
and anxiety
 Unpredictable and impulsive behavior such as:
excessive spending, gambling, promiscuity,
gambling, substance abuse, shoplifting, overeating, and self-damaging actions.

A
mental health professional experienced in
diagnosing and treating mental disorders
 1. psychiatrist
 2. psychologist
 3. clinical social worker
 4. psychiatric nurse
 Thorough medical exam can help to rule out
other possible causes of symptoms.
 Unsure
of the exact and precise causes-not
fully understood????
 Factors: Genetics, Biological, Environmental,
and brain abnormalities.
 Genetics- Inherited among family members
 Biological- 60% of research suggest the risk of
developing BPD conveyed through genetic
abnormalities. These abnormalities appear to
effect the functioning of brain pathways that
control the behavioral functions and emotion
information, processing, impulse, and
cognitive activity.
 Environmental-
poor parenting, early
separation from parents,
emotion/physical/sexual abuse, incest.
A
pervasive pattern of instability of
interpersonal relationships, self-image,
affects, and marked impulsivity beginning by
early age adulthood. Present by in a variety
of context as indicated by five (5) or more
below:
 1. Frantic efforts to avoid real or imagined
abandonment
 2. A pattern of unstable and intense
interpersonal relationships characterized by
alternating extremes idealization and
devaluation
 3.
Identity disturbance, markedly and
persistently unstable self-image or sense of
self
 4. Impulsivity in at least two areas that are
potentially self-damaging
 5. Recurrent suicidal behavior, gestures,
threats, or self-mutilating behavior
 6. Affective mood instability
 7.
Chronic feelings of emptiness
 8. Inappropriate, intense anger or difficulty
controlling anger
 9. Transient, stress related paranoid ideation
or severe dissociative symptoms
 Must have 5 out of 9 criteria
 BPD
rarely stands alone. Typically co-occurs
with other disorders (i.e., Bipolar,
depression, substance abuse)
 BPD affects 1-2% of the population
 Estimates 10% of outpatients and 20% of
inpatients who present for Tx have BPD.
 More females are diagnosed with BPD than
males, 3 to 1.
 Women's
co-occuring disorder are usually
linked with major depression, anxiety d/o, or
eating d/o. Men are linked with substance
abuse or anti-social personality disorders
 75% of patients self-injure
 Approximately 10% of individuals with BPD
complete suicide
 Up to 80% of people with BPD having suicidal
behaviors
 Major
Depressive- 60%
 Dysthymia70%
 Eating Disorder25%
 Substance Abuse- 35%
 Bipolar Disorder- 15%
 Antisocial25%
 Narcissistic25%
 75-90
% of those diagnosed are women.
 Affects 6-10 million of Americans- or about
the size of New York City (twice that of
Bipolar and Schizophrenia).
 33% of youth who commit suicide have
features or traits of BPD; this number is 400
times higher than the general population and
young women with BPD have suicide rate of
800 times higher.
 Common
dangerous and fear inducing feature
of BPD are self harming behaviors (cutting,
burning, hitting, head banging, hair pulling).
 Physical self harm generates a sense of relief
to alleviate emotional pain.
 This occurs by stimulating the production of
endorphins. The release of the endogenous
opiates produced by the brain provide a
reward to the “self-inflicting” behavior.
Medications: Most effective when used in
conjunction with psychotherapy.
 Reduces symptoms of BPD, does not treat BPD
itself.
 Medications serve to improve chemical processes
required for optimal brain function. Antipsychotic and Mood Stabilizers most useful.
 Anti-depressants:
 1. Nardil (phenelzine
 2.Prozac (fluoxentine)
 3. Zoloft (sertraline)
 4. Effexor (venlafaxine)
 5. Wellbutrin (bupropion)

 Anti-Psychotics:
 1.
Haldol (haloperidol)
 2. Zyprexa (olanzapine)
 3.Clozaril (Clozapine)
 4. Seroquel (quetiapine)
 5. Risperdal (risperidone)
 Mood
Stabilizer:
 1. Lithobid
 2. Depakote
 3.
Lamictal
 4. Tegratol
 Anxiolytics
(Anti-anxiety):
 1. Ativan (lorazapam)
 2. Klonopin (clonazpam)
 3. Xanax (alpazolam)
 4. Valium (diazepam)
 5. Buspar (buspirone)
 Anxiety to treat anxiety symptoms, not BPD.
 Caution for SUD; benzodiazepines
 Dialectical
behavior therapy (DBT)
 Cognitive behavioral therapy (CBT)
 Schema-focused therapy
 Mentalization Based Therapy
 Transference Focused Psychotherapy
 General Psychiatric Management
 Systems Training for Emotional Predictability
and Problem Solving (STEPPS)
A modification of CBT for the treatment of
chronically suicidal and self-injurious individuals
with BPD.
 DBT differs from traditional CBT in its emphasis
on validation. The therapist and patient work on
“accepting” uncomfortable feelings, thoughts,
behaviors v.s. struggling with them.
 Once an identified thought, emotion, behavior is
validated, the process of change no longer
appears impossible, and the goals of gradual
transformation becomes reality.
 DBT focuses on developing coping skills.

 1.
Decrease the frequency and severity of
self destructive behaviors
 2. Increase motivation to change
 3. Teach new coping skills
 4. Provide treatment environment that
emphasizes the strengths of both individual
and their treatments.
 5. Enhance therapist’s motivation to
treatment the client effectively
A
form of treatment that focuses on
examining the relationship between
thoughts, feelings, and behaviors.
 Explore patterns of thinking that lead to self
destructive actions and the beliefs that
direct these thoughts, people can modify
their patterns of thinking to improve coping.
 Involves homework
 Can be used in a variety of disorders such as
mood disorders, anxiety, personality, eating,
sleep, and psychotic, and substance abuse.
 An
integrative approach to treatment that
combines the aspect of cognitive behavioral,
experiential, interpersonal, and
psychoanalytic therapies into one model.
 Focuses on self-defeating, dysfunctional, and
negative patterns/thoughts & feelings that
have been an obstacle for accomplishing
goals in life.
 3 stages:
 1.assessment phase- identify schemas
 2.emotional awareness & experiential phase
 3. behavioral change phase
 Mentalization
Therapy- The process by which
we makes sense of each other and ourselves,
implicitly(implied, indirect) and
explicitly(direct, demonstrated, nothing
implied).
 The object of treatment is that BPD patients
increase mentalization capacity which should
improve affect regulation and interpersonal
relationships.
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Highly structured, twice-weekly modified
psychodynamic treatment. It views the individual
with borderline personality D/O as holding
unreconciled and contradictory internalized
representations of self and significant others. The
defense against these contradictory internalized
views leads to disturbed relationships with others and
with self.
The distorted perceptions of self, others, and
associated affects are the focus of treatment as they
emerge in the relationship with the therapist
(transference).
The intended aim of the treatment is focused on the
integration of split off parts of self and object
representations, and the consistent interpretation of
these distorted perceptions is considered the
mechanism of change.
 BPD
Is one of the top reported disorders
prison inmates are diagnosed with linking the
disorder with criminal behavior.
 25-50% of inmates in prison suffer from BPD,
mostly in women
 Prison based mental health care is
problematic because the lack of resources,
difficulty in making referrals, scarcity of
good mental health providers, and the
inappropriateness of prison as a setting for
care.
It is not uncommon within forensic mental health
services for regional secure units to actively
exclude patients with a primary diagnosis of
personality disorder because they do not
consider this to be their core business.
 In many parts of the country there are no
specific services and when services are offered
they tend to be individualistic.
 In general, people with BPD have difficulty
controlling their emotions and distorted
perceptions of themselves and others. The result
is impairment in functioning at home, work, and
relationships. These impairments all too often
can lead to a life of incarceration.
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 Thanks
for listening!