Borderline Personality Disorder

What is personality

set of characteristics that endures across time and contexts \n typically thought of as traits (MBTI) or types (Big 5) - more flexible

What marks a personality disorder

inner experiences and behaviour does not meet individual's cultural expectations \n pervasive and inflexible \n adolescent or early adulthood onset \n stable over time \n leads to distress and impairment

BPD: symptoms

unstable relationships \n unstable self-image \n unstable affect \n marked impulsivity

Unstable relationships

\n fear of abandonment - frantic efforts to avoid real or imagined abandonment \n alternate between idealization and devaluation

Unstable self-image

marked and persistent \n unstable sense of self \n sudden shifts in goals, values, types of friends \n RARE to feel like you don't exist

Unstable affect

recurrent suicidal behaviours, gestures, or threats \n marked reactivity of mood \n inappropriate intense anger or difficulty controlling anger \n transient, stress-related paranoid ideation or severe dissociative symptoms

Marked impulsivity

chronic feelings of emptiness - bored and looking for something to do \n dopamine under-activation

Impulsivity in at least 2 areas that is potentially self-damaging

spending \n sex \n substance abuse \n reckless driving \n binge eating

Prevalence

1\.6%-5.9% \n more common in more severe settings (psychiatric inpatient)

What lowers the prevalence of BPD

suicide

Self-inflicted injury

NSSI (non-suicidal self-injury) \n self harm is form of emotion dysregulation \n negatively reinforcement - provides temporary relief

NSSI: criteria

in past year, on 5 or more days, engaged in NSSI \n engaged: relief from negative feelings/thoughts, resolve interpersonal difficulty, induce positive state \n either used to cope or has become a 'craving'

Linehan's Biosocial Theory of BPD

sensitive child within an invalidating environment - keeps child in cycle of escalating emotions \n poor relational scripts being established

Characteristics of a sensitive child

heightened emotional sensitivity \n inability to regulate intense emotional experiences \n slow to return to emotional baseline \n sensitivity eventually leads to development of emotion-dysregulation \n perfectionism

Characteristics of an invalidating environment

lack of emotional expression \n anger at child for expressing emotion \n distress at child's emotions \n mocking, ridicule, threatening \n lack of awareness about child's emotions (common)

Invalidating environments

challenging peer relationships \n maltreatment or neglect by parents \n physical or sexual abuse \n parents who reinforce extreme emotional expression (MOST COMMON) - pay attention only to most extreme expressions

Interaction between environment and child

\n emotionally sensitive child receives less validation -> invalidation increases emotional sensitivity

Poor impulse control related to

some of the comborbidity with impulse control disorders

When can you be diagnosed with BPD

diagnosis cannot be made until young adulthood

Predictors of elevated rising trajectory

child-reported ADHD \n child-reported somatization symptoms \n child-reported reactive temperament \n being bullied

Disorganized attachment

conflicting strategies (approach and avoidance) towards a caregiver \n physiological dysregulation of stress response

Assessment

clinical interview \n personality measures \n important to establish symptoms across a variety of situations and across time

Dialectical Behaviour Therapy (DBT)

third wave CBT = mindfulness based \n individual and group treatment \n focus on building skills needed to navigated day-to-day life

DBT: mindfulness skills

learning to be in the present moment without getting caught up in the emotional reaction \n staying away from extremes in thinking, feeling, and doing

DBT: distress tolerance skills

learning to endure distress long enough not to act on it \n focus on distraction

DBT: emotion-regulation skills

managing anxiety and depression \n riding the wave of emotions - allowing emotions to pass through without trying to change/fix them \n addressing lifestyle factors that contribute to challenging emotions

DBT: interpersonal effectiveness

skills needed to navigate relationships with others without either being pushed around or being aggressive