Transcript Polycystic Ovarian Syndrome

Borderline Personality
Disorder
-Presentation by:
Cathy Rehfus-Wilsek
Medical Student from
All Saints University School of Medicine
September 2011
Borderline Personality
Disorder
Definition:
“Borderline personality disorder is a condition in which people have long-term
patterns of unstable or turbulent emotions, such as feelings about themselves and
others. These inner experiences often cause them to take impulsive actions and
have chaotic relationships.”
Source: National Center for Biotechnology Information, U.S. National Library of Medicine
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001931/
Borderline Personality
Disorder
Epidemiology:
-Borderline personality disorder (BPD) has a higher prevalence than previously
considered within the general population, approximately 6%. There seems to
be an equal prevalence among women and men, where as before it was
considered more prevalent among women.
-Additionally, BPD is often seen with comorbidities most commonly:
-Bipolar disorder
-Narcissistic personality disorder
-Schizotypal
-Substance abuse (drugs and/or alcohol)
Borderline Personality
Disorder
Pathogenesis:
-The actual mechanism of disease in borderline personality disorder is not fully
known or understood. However, there is a strong genetic and family
component as well as social factors or environmental causes.
-Risk factors include but are not limited to:
-Abandonment in childhood or adolescence
-Disrupted family life
-Poor communication in the family
-Sexual abuse
Borderline Personality
Disorder
Borderline Personality Disorder Diagnosis
DSM-IV Diagnostic 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 five (or more) of the following:
(1) Frantic efforts to avoid real or imagined abandonment.
(2) A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of
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 (e.g., spending, sex, substance abuse, reckless
driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
(5) Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
Borderline Personality
Disorder
Borderline Personality Disorder Diagnosis (Cont.)
DSM-IV Diagnostic Criteria
(6) 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).
(7) Chronic feelings of emptiness.
(8) Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger,
recurrent physical fights).
(9) Transient, stress-related paranoid ideation or severe dissociative symptoms.
John Gunderson, M.D., adds that borderline may be subdivided into these four phenotypes:
(1) Interpersonal hypersensitivity (criteria 1, 2 and 7)
(2) Affect (emotional) dysregulation (criteria 6, 8 and 7)
(3) Behavioral dyscontrol (Impulsivity) (criteria 4 and 5)
(4) Disturbed self (criteria 3 and 9)
Borderline Personality
Disorder
Treatment:
-There are no specific medicinal treatments for BPD, however in cases of
comorbidity, certain mood stabilizing drugs may be of significant aid to
reduce or alleviate symptoms.
-Most effective treatment options:
-Dialectical behavioral therapy
-Group therapy
-Optional medications
Borderline Personality
Disorder
Treatment: (Cont.)
-Dialectical behavioral therapy
-A component of cognitive-behavioral therapy (CBT), dialectical behavior therapy
(DBT) gives importance to the psychosocial aspects of treatment.
-There is strong evidence that some BPD patients react in a more intense and ‘out-ofthe-ordinary’ manner than the general population when placed in certain emotional
circumstances, most commonly relating to family and friends, but especially in
romantic partnerships situations.
-DBT theory works to reduce BPD patient’s stimulation levels in these conditions,
while assisting them in decreasing the time required for their return to
a baseline arousal level.
Borderline Personality
Disorder
Treatment: (Cont.)
-Group therapy
-This form of treatment offers psychotherapy in a setting of one therapist and a certain
number of patients with similar or related conditions.
-Sometimes the group format is better suited for a BPD patient than individual therapy
possibly due to the ability to understand they are not alone with their condition
and
may receive better insight from fellow suffers of the same disorder.
-There has been evidence that receiving feedback from group members will help BPD
patients deal in a more socially acceptable manner in these stressful situations.
**The problem for many of these patients is that they tend not to seek psychotherapeutic
help, either in individual or group settings. If they have, they dismiss the process with a
splitting reactionary behavior mechanism i.e., ‘I had one bad experience therefore all
Borderline Personality
Disorder
Treatment: (Cont.)
-Optional medications
-In recent years there have been studies showing the lack of response of BPD patients on SSRI
therapy. Currently the medications of choice are the atypical antipsychotic (see list with
MOA below) or even mood stabilizing drugs.
-There are two points that should be noted:
-BPD patients should NOT receive benzodiazepines as they have been shown to increase
length
and intensity of symptoms
-Medication alone has been shown to be ineffective. Patients should also receive some form
of
DBT or CBT
Borderline Personality
Disorder
Treatment: (Cont.)
-Optional medications list
-Atypical Antipsychotic Medications with MOA (partial list):
-Aripiprazole (Abilify)- partial agonist D2, 5-HT1A, 5-HT2C; antagonist D3, D4, 5-HT2A, 5HT7
-Asenapine (Saphris)- antagonist ALL serotonin, dopamine, histamine, & alpha adrenergic
receptors
-Clozapine (Clozaril)- while a dibenzo, there is high affinity for serotonin and dopamine receptors
-Iloperidone (Fanapt)- antagonist serotonin and dopamine receptors
-Olanzapine (Zyprexa)- antagonist serotonin and dopamine receptors
-Paliperdone (Invega)- antagonist serotonin and dopamine receptors
-Quetiapine (Seroquel)- antagonist serotonin and dopamine receptors
-Risperidone (Risperdal)- antagonist serotonin and dopamine receptors
-Ziprasidone (Geodon)- antagonist serotonin and dopamine receptors
Borderline Personality
Disorder
Prognosis and Complications:
-Unfortunately borderline personality disorder is not curable, though in many
patients the symptoms are controllable, through dialectic and cognitive
behavioral therapy as well as adjunct pharmacotherapy. As previously stated,
sadly many BPD patients do not seek or do not continue with therapy.
-BPD patients have a constellation of complications, however, the most significant
and important one to monitor for is suicidal behavior. It is estimated that up-to
10% of BPD patients have a successful suicide attempt and nearly 75% of all
BPD have suicidal (or even homicidal/suicidal sometimes called crimes of
passion) ideation. While almost 100% have done acts of self-harm.
-The good news is that with therapy the incidence of suicide attempts and intervals
between attempts decreases (see figure below).
Borderline Personality
Disorder
Source: Grohol, J. Another Treatment for Borderline Personality Disorder. Psych
Central. Retrieved on September 19, 2011, from
http://psychcentral.com/blog/archives/2009/09/17/another-treatment-for-borderline-
Borderline Personality
Disorder
Conclusion:
Borderline personality disorder is a lifelong diagnosis. Patients are volatile,
impulsive, and self destructive. That said, all is not lost for these patients. Advances
in drug therapy and psychotherapy offer these patients the chance to live normal
even happy existences. Coexisting in peace in what would have otherwise been
chaos for them and the ones around them.
If more BPD patients would seek the help that is available to them, the incidence of
self-harm, suicide and homicide in this population could drop drastically.
If you know someone who is thinking about suicide please call the suicide
prevention hotline @ 1-800-273-8255
Borderline Personality
Disorder
References:
Borderline personality disorder. National Center for Biotechnology Information, U.S.
National Library of Medicine. Retrieved on September 9, 2011, from
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001931
Grant BF, Chou SP, Goldstein RB, Huang B, Stinson FS, Saha TD, Smith SM, Dawson DA,
Pulay AJ, Pickering RP, Ruan WJ. Prevalence, correlates, disability, and comorbidity of
DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiologic
Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry. 2008;69(4):533–
545.
Grohol, J. Another Treatment for Borderline Personality Disorder. Psych Central. Retrieved
on September 9, 2011, from http://psychcentral.com/blog/archives/2009/09/17/anothertreatment-for-borderline-personality-disorder/
Gunderson, J. G. (2011). A BPD Brief: An Introduction to Borderline Personality Disorder
Diagnosis, Origins, Course, and Treatment. National Education Alliance for Borderline
Personality Disorder.
Borderline Personality
Disorder
References: (Cont.)
Herkov, M. (2006). About Group Therapy. Psych Central. Retrieved on September 19, 2011,
from http://psychcentral.com/lib/2006/about-group-therapy/
Psych Central. (2007). An Overview of Dialectical Behavior Therapy. Psych Central.
Retrieved on September 19, 2011, from http://psychcentral.com/lib/2007/an-overview-ofdialectical-behavior-therapy/