Borderline PD :Borderline PD No Audio


Definition :Definition Instability interpersonal relationships self-image affects Impulsivity


BDL as style :BDL as style Mercurial always romantically attached intense, emotionally active and reactive uninhibited spontaneous high energy open-minded


BDL :BDL widely studied and most common disorders Why? 1) suffering to self and others 2) overlap with other Axis I and Axis II disorders 3) psychoanalytic origins 256 varieties of the disorder


History :History Hoch and Polatin (1949) – “pseudoneurotic schizophrenia” Kernberg (1967) - borderline personality organization Gunderson and Singer (1975) - identified criteria clearly distinguishing BDL from other conditions DSM-III - BDL first appeared as category Linehan (1980s and 1990s) - developed DBT (dialectical behavior therapy) for the treatment of this condition


Essential Features :Essential Features Identity Disturbance Relationships are Unstable Abandonment is frantically avoided Impulsive Suicidal gestures are made Emptiness is a description of inner self Dissociative Symptoms Affective Instability Paranoid Ideation Anger is poorly controlled Idealization of others, followed by devaluation Negativistic - undermine their efforts and those of others


Epidemiology :Epidemiology 2-3% of general populations 10% of outpatients 30-60% among clinical populations 5x more likely in 1st degree relatives Women to men (3:1)


The Great Imitator :The Great Imitator BDL Substance Use Mood Psychosis Anxiety Eating Sexual Dissociation Impulse


Associated Themes :Associated Themes tend to undermine their successes promiscuity fears of abandonment failure to achieve long-term goals frequent suicidal gestures (burns, etc.)


Self-destruction :Self-destruction purpose regulate affect regulate environment cutting is negatively reinforcing poor boundaries easily influenced by others


Media Examples :Media Examples Fatal Attraction Glenn Close’s character Single White Female Jennifer Jason Leigh’s character


Interview Considerations :Interview Considerations 1) appear normal: you will be surprised to hear of the history 2) remarkably regressed: impulsive and demanding often verbal intense affect and state of turmoil


Associated Features :Associated Features difficult to keep these patients on track a number of crisis to therapy intense anger directed at therapist and others micropsychotic episodes can occur very challenging suicidal behavior, phone calls, self-mutilating behavior you worry they will kill themselves 8-10% complete suicides many more attempt


Interview Considerations :Interview Considerations need to establish a good working relationship trust/honesty be clear and avoid misunderstandings set clear limits in therapy transference issues patients get involved with their therapists countertransference issues theapists react overprotection and rejection seek regular consultation...


Splitting :Splitting abruptly switch alliances idealize then devalue best therapist (builds your ego) to worst therapist a) intrapsychically within oneself (I am bad, I am good) b) interpersonally relative to others (she is good, you are bad) c) transpersonally occurs when the patient’s intrapsychic organization gets played out by others


Etiology :Etiology lots of opinions... biological might have a genetic basis temperamental factors? dysregulation of serotonin? limbic system abnormalities?


Theory :Theory Highly Emotional Vulnerability Poor Emotional Regulation Emotional Dysfunction (biological) Invalidation (environment) Emotional Instability


Theory :Theory Emotional Instability Interpersonal Behavioral Self Cognitive No Audio


Assessment :Assessment No Audio


Slide 22:Avoidant PD


Slide 23:See commentary below slide to understand letters and numbers


MMPI :MMPI MMPI: 3, 4, and 7


MCMI-III :MCMI-III BDL, DEP, HIS