Transcript Borderline Personality Disorder

Borderline Personality
Disorder
CADET ANDREW CRANE
12/8/2015
Borderline Personality Overview
• According to a survey conducted by the National Institute of Mental
Health 1.6% of United States citizens have BPD in a given year. 42% of
those diagnosed with disorder are receiving treatment
• The onset of BPD usually occurs during adolescents
• BPD is categorized by instability, impulsivity, and emptiness.
The Influence of Emotional Dysregulation
• Buckholdt et. al. (2015) examined the resolving effect of emotion dysregulation in the relation between
exposure to violence and both Post Traumatic Stress Syndrome and Borderline Personality pathology.
• 144 adolescent participants (50.7% male) admitted into a residential treatment center in Missouri were
assessed.
• Participants were between the ages of 10 and 17 with the mean age being 14.5 years old and a
standard deviation of 1.5.
• 48.9% percent were in middle school, 46.8 percent were in high school, and 4.3% were still in grade
school.
• The Life Events Scale (LES) was used to asses participants for exposure to a wide range of violent
events.
• The Difficulties in Emotional Regulation Scale (DERS) measured the participants levels of emotional
dysregulation across six different domains: nonacceptance of negative emotions, difficulties engaging
in goal-directed behaviors when distressed, difficulties controlling impulsive behaviors when
distressed, limited access to emotion regulation strategies perceived as effective, lack of emotional
awareness, and lack of emotional clarity.
• The Child PTSS Symptom Scale (CPSS) and the Borderline Personality Features Scale for Children
(BPFSC) were used to asses for Post Traumatic Stress Symptoms and Borderline Personality features in
the participants.
Correlations Among Variables Being Studied
Measure
1
2
3
4
5
6
7
Gender
Age
-.09
Race
.01
.19*
Violence Exposure
-.07
.03
.24***
Emotional Dysregulation
-.16
-.04
-.07
.32***
PTSS
-.36***
-.03
-.09
.44***
.56***
BP Pathology
-.31
.02
-.11
.38***
.65***
.62***
Mean
.51
14.26
.64
32.34
94.34
16.44
43.40
SD
.50
1.50
.48
25.95
23.04
11.85
15.95
Range
0-1
10-17
0-1
0-126
38-158
0-46
4-92
N= 144
***p<.001 **p<.01 *p<.05
Race: White=0
Other=1
Conceptual Model
Arousal
.85
.79
Post Truamatic
Stress Symptoms
.83
56%
.43***
Violence
Exposure
.35***
Emotinal
Dysregulation
Re-experience
Avoidance
14%
Identity Dist.
.60***
.79
61%
.79
Borderline
Personality
Features
.77
Affective
Instability
Self-Harm
.71
Negative
Relations
Theory of Mind and Borderline Personality
Disorder
• Baez et. al. assessed the performance of adult individuals with BPD on Theory of the Mind, emotion
regulation, and emotional functioning in an attempt to test the idea that ToM deficits and their variability in
BPD would depend on more basic skills, such as executive functions and emotion recognition.
• 15 participants were selected from the outpatient populations of the Institute of Cognitive Neurology who
met the requirements for BPD diagnosed by a psychiatrist. 15 control participants were selected to match
the BPD counterparts based on age, sex, and years of education.
• They had to complete psychiatric and behavior questionnaires. The Beck Depression Inventory ll to rate
depression, the state-trait anxiety inventory to assess anxiety, and the Barratt impulsiveness scale to
evaluate impulsivity. These tests were used to evaluate emotional functioning.
• They were also evaluated on their emotion recognition using Emotional Morphing and The Awareness of
Social Inference Test. Emotional Morphing is a facial recognition test that measures the ability of the
participant to recognize an emotion. The Awareness of Social Inference Test assessed recognition of
spontaneous emotional expression using videotaped vignettes of everyday social interactions.
• Finally the Theory of Mind of each participants was evaluated using Faux pas test, an assessment of the
emotional and cognitive aspects of the ToM. The Reading the Mind In the Eyes test was also used to assess
the emotional inference aspect of the ToM.
Results
• Findings
• The Clinical Assessment revealed that BPD participants showed more depressive symptoms
that the control group. The mean BDI-II of participants with BDP was 18.6 and the mean of
the control participants was 6.8. BPD participants also exhibited higher anxiety levels than
the controls revealed by the STAI-state test. Similar to the BDI-II tests the mean of the BPD
participants was higher than the mean of the control group on the STAI-state testing.
• The Executive Functioning assessments showed the BPD patients scored particularly worse
than the control group on the IFS total score, lower scores in motor inhibitory control, and
spatial working memory.
• The Emotion Recognition tests revealed little to no difference between the two groups on the
emotion morphing testing. However, BPD participants scored lower overall than the control
group on the TASIT test.
• The FTP test which analyises patients ToM presented that BPD patients showed lower
intentionality and emotional attribution scores. However, the two groups did not much a
difference on the RMET testing p=.51
• By completing regression testing they were able to find that IFS total score was a predictor of
the FPT performance. In contrast with this the IFS score was not an effective predictor of the
RMET scores.
Conclusion
• The participants with BPD showed impaired emotional functioning,
and impaired and preserved ToM and emotion recognition.
• They found that ToM and emotion recognition tasks that involved real
world social clue integration were more sensitive to the impairment
of the individuals with BPD.
• This study also presented that basic functions emotional functioning
and emotion recognition predicted ToM in certain situations.
• After analyzing these two findings they make the claim that ToM
deficits of BPD patients has to do with emotional functioning and the
ability to recognize social ques to identify emotions.
Poor Self Control and Harsh Punishment
• Hallquist et. al. (2015) used longitudinal data from the Pittsburg Girls Study
to examine the influences that harsh parenting, self-control, and negative
emotionality among girls ages 5-14 had on predicting BPD symptoms in
girls ages 14-17.
• The Pittsburg Girls Study consists of 2,450 girls initially assessed at ages 5-8
and followed annually.
• The analyses reported in this publication examines symptoms of BPD
assessed between ages 14 and 17 form the data of 2,228 girls due to the
attrition rate of the longitudinal study.
• In home interviews were conducted annually for each participant by
trained interviewers assessing parenting styles, parent psychopathology,
and the girl’s characteristics. At age 14 the interviewer began assessing for
self reported BPD symptoms.
Methods
• Harsh punishment was assessed in this study using child and caregiver
reports on the Conflict Tactics Scale: Parent-Child version.
• Child negative emotionality was studied by caregiver reports early on then
at age 11 the Emotionality, Activity, and Sociability Temperament Survey
was given to the participants.
• Poor Self control was reported by caregivers at early ages between 5-8, and
between age 10-14 it was measured using caregiver and child reports on
the self-control subscale of the Social Skills Rating Scale.
• At the beginning of this study poverty was evaluated by whether or not the
caregiver was receiving public assistance.
• Borderline Personality symptoms were evaluated using the International
Personality Disorder Examination–Screen.
Results and Conclusion
• Using a structural equation model Hallquist et. al. the effects of harsh punishment,
negative emotionality, and poor self-control on the level and rate of change in BPD
symptoms in adolescence.
• There was a significant association between BPD at age 14 and harsh punishment at age 10. There was
also an association between the rate of growth in harsh punishment between the ages of 10-14 and
BPD symptoms in participants age 14.
• The level and rate of growth in poor self-control between the ages of 10 and 12 significantly predicted
increased BPD symptom severity.
• An increase in negative emotionality at age 11 was predictive of BPD symptoms in participants age 14.
References
Baez, et. al. (2015). Theory of Mind and Its Relationship With Executive Functions
and Emotion Recognition in Borderline Personality Disorder. Journal of
Neuropsychology, 9, 203-218.
Borderline Personality Disorder. (2007). Retrieved December 9, 2015, from
http://www.nimh.nih.gov/health/statistics/prevalence/borderline-personalitydisorder.shtml
Buckholdt, et. al. (2015). Exposure to Violence, Posttraumatic Stress Symptoms, and
Borderline Personality Pathology Among Adolescents in Residential Psychiatric
Treatment: The Influence of Emotion Dysregulation. Child Psychiatry and Human
Development, 46, 884-892.
Hallquist, M. N., Hipwell, A. E., Stepp, S. D. (2015). Poor Self-Control and Harsh
Punishment in Childhood Prospectively Predict Borderline Personality Symptoms
in Adolescent Girls. Journal of Abnormal Psychology, 124, 549-564.