Borderline Personality Disorder/Psychotic Disorders

Personality Disorders

• Personality = A person’s characteristic manner of thinking, feeling, behaving, and relating to others

• A collection of inflexible and maladaptive personality characteristics

• Areas affected: cognition, emotion, interpersonal relationships, impulse control

Development and Course of Personality Disorders

• Usually become recognizable during adolescence or early adulthood

• Stable over time

• PD may be worsened by stressors

• Some traits tend to mellow with age

DSM-5 Personality Disorder Clusters

Cluster A

• Paranoid

• Schizoid

• Schizotypal

Cluster B

• Antisocial

• Borderline

• Histrionic

• Narcissistic

Cluster C

• Avoidant

• Dependent

• Obsessive-compulsive

Borderline Personality Disorder (BPD)

Long-term pattern of unstable relationships, distorted sense of self, and strong emotional reactions

Diagnosis in Adolescence

• May be diagnosed in adolescence IF

  • Personality traits are pervasive, persistent (1+ year), and

  • unlikely to be limited to a particular developmental stage or another disorder

• Core personality traits are fairly stable from adolescence to adulthood

• Some teens “grow out of “ BPD

• Others continue to meet criteria years later

Signs of Psychosis

• Marked change in behaviors, thoughts, and emotions

  • Perceptual abnormalities (hallucinations)

  • Unusual beliefs & ideas (delusions)

  • Disorganized or digressive speech

  • Uncharacteristic, peculair behavior

Spectrum of Psychosis

• Psychotic-like symptoms are common

• Psychosis spectrum ranges from normal to illness

Psychosis Continuum

Within Cultural Norms

• No Distress

• Infrequent/rare

• No effect behavior/functioning

• Consistent with cultural beliefs

Attenuated Psychosis

• Increasing frequency (weekly)

• Some distress, bothers them

• Able to question reality

• Little effect on behavior

Subthreshold Psychosis

• Increasing frequency (weekly → daily)

• Increasing distress

• Seems real (b/c it keeps happening), but not convinced

• Starting to affect behavior or impact functioning

Fully Psychotic

• Significant Distress

• Frequent (weekly, daily)

• Convinced it is real

• Effects behavior

• Impairs functioning

DSM-5 Psychotic Disorders

• Delusion Disorder

• Schizoaffective Disorder

• Brief Psychotic Disorder

• Substance/Medication Induced Psychotic Disorder

• Schizophreniform Disorder

• Psychotic Disorder due to a general medical condition

• Schizophrenia

• Catatonia

Schizophrenia: Epidemiology

• Prevalence ~ 1-2%

• Mean age of onset ~20 years

  • Range: 15-35 years

• Onset before puberty is uncommon but can happen

Clinical symptoms of psychotic disorders

Positive

• Delusions

• Hallucinations

• Disordered though

Negative

• Anhedonia

• Asociality

• Avolition

• Flat affect

• Poverty of speech (alogia)

Delusions

• Delusions of persecution: most common - believe that they are being spied upon or there is a conspiracy against them

• Delusions of control: believe their thoughts and actions are being controlled by outside forces

• Delusions of grandeur: believe that they are powerful and/or famous; could be someone specific or a religious figure

• Delusions of reference: believe that they are receiving special messages (e.g., within song lyrics or something said on the radio)

Negative Symptoms

Experience

• Anhedonia: reduction in the experience of pleasure

• Asociality: decreased interest in forming close relationships with others

• Avolition: diminished motivation; difficultly initiating and persisting

Expression

• Flat/blunted/restricted affect: lack of outward expression of emotion (note - this does not mean they do not feel emotions)

• Poverty of speech (alogia): (seen in about 50% of people with SZ)

Environmental Considerations

• Cultural or familial context of the experience

• Exposure to supernatural media content

• Environmental factors

  • Bullying at school, unsafe neighborhood - may feel paranoid for good reason

Developmental Considerations

• Imaginary friends and magical thinking typical for children

• Metacognition (thinking about thinking)

• Give relatively more weight to behavioral observations than self-report

Impairment

• >20% of social security benefits are used to care for individuals with Schizophrenia spectrum

• 25-50% of individuals with schizophrenia will attempt suicide, 10% will complete

How to Help

• Identify problems early

• Listen patiently and compassionately

• Avoid judgement and confrontation

• Ensure safety

Recovery is Possible

• Instill hope

• Control symptoms with medication

• Promote independence and membership in society

• Pursue meaningful goals and roles

• Gains with support from family and other support persons in treatment