12- Borderline Personality Disorder Mnemonics (Memorable Psychiatry Lecture)

Source: https://www.youtube.com/watch?v=R8A5c_HO3qA

Correct answer: C. Early psychoanalytic models and clinician burnout shaped pessimistic beliefs

Explanation:
Historical pessimism about BPD was largely driven by early psychoanalytic models, lack of structured treatments, and clinician frustration—not by outcome data. Longitudinal studies later demonstrated high remission rates, disproving the idea that BPD is untreatable.

Which of the following best explains why Borderline Personality Disorder (BPD) was historically considered untreatable?

A. BPD symptoms do not respond to psychotherapy
B. Long-term outcome studies showed no remission
C. Early psychoanalytic models and clinician burnout shaped pessimistic beliefs
D. BPD lacks biological underpinnings

Correct answer: C. Diagnostic remission is common, but functional impairment may persist

Explanation:
Long-term studies show high rates of diagnostic remission; however, many patients continue to experience chronic dysphoria, interpersonal difficulties, and occupational impairment. Symptom reduction does not always equal full functional recovery.

Which statement best reflects current evidence regarding the prognosis of Borderline Personality Disorder?

A. BPD is a lifelong condition with minimal symptom change
B. Most patients fully recover without residual symptoms
C. Diagnostic remission is common, but functional impairment may persist
D. Symptoms worsen progressively over time

Correct answer: C. Speed and interpersonal triggering of mood shifts

Explanation:
In BPD, emotional shifts occur rapidly (minutes to hours) and are typically triggered by interpersonal events. In contrast, mood disorders involve mood changes that evolve over days to weeks and are less reactive to immediate social stimuli.

Which feature most reliably distinguishes emotional instability in BPD from mood disorders such as major depressive disorder or bipolar disorder?

A. Severity of emotional reactions
B. Presence of suicidal ideation
C. Speed and interpersonal triggering of mood shifts
D. Co-occurring anxiety symptoms

Correct answer: C. Dysphoria involves rejection sensitivity, anger, and self-doubt

Explanation:
Dysphoria in BPD differs phenomenologically from depression. It is characterized by emptiness, rejection sensitivity, anger, and emotional volatility, and often responds poorly to antidepressants alone.

Which statement regarding dysphoria in BPD is most accurate?

A. Dysphoria is identical to major depressive disorder
B. Dysphoria responds well to antidepressant medication
C. Dysphoria involves rejection sensitivity, anger, and self-doubt
D. Dysphoria occurs only during interpersonal conflict

Correct answer: C. Emotional regulation and dissociation

Explanation:
Self-injury in BPD is primarily a maladaptive strategy to regulate overwhelming emotional states and induce dissociation. While highly associated with BPD, it is not pathognomonic and can occur in other disorders.

Non-suicidal self-injury (e.g., cutting) in BPD most commonly serves which function?

A. Seeking attention from others
B. Expression of suicidal intent
C. Emotional regulation and dissociation
D. Sensation-seeking behavior

Correct answer: C. They are transient and stress-related

Explanation:
Psychotic-like symptoms in BPD are typically brief, stress-related, and interpersonal in nature. They differ from schizophrenia by lacking sustained delusions or formal thought disorder.

Which statement best characterizes psychotic-like symptoms in Borderline Personality Disorder?

A. They are persistent and progressive
B. They indicate comorbid schizophrenia
C. They are transient and stress-related
D. They require long-term antipsychotic treatment

Correct answer: C. Men with BPD are more likely to present in legal rather than medical settings

Explanation:
Structured research shows equal prevalence in men and women. Men with BPD more often present with substance use or aggression, leading to incarceration rather than psychiatric care, contributing to underdiagnosis.

Why is Borderline Personality Disorder diagnosed more frequently in women in clinical settings?

A. BPD is biologically more common in women
B. Diagnostic criteria exclude male presentations
C. Men with BPD are more likely to present in legal rather than medical settings
D. Women exaggerate emotional symptoms

Correct answer: B. Diagnosis is permitted if symptoms persist for at least one year

Explanation:
DSM-5-TR allows diagnosis of BPD in adolescents when symptoms persist for at least one year and exceed normative developmental instability.

Which statement about diagnosing BPD in individuals under 18 years old is most accurate?

A. BPD cannot be diagnosed before age 18
B. Diagnosis is permitted if symptoms persist for at least one year
C. Diagnosis requires lifelong symptom stability
D. Adolescents lack personality structure

Correct answer: C. Medications may target specific symptoms but do not treat core pathology

Explanation:
No medication treats the core pathology of BPD. Symptom-targeted pharmacotherapy may be used cautiously, but psychotherapy remains the foundation of treatment. Polypharmacy is associated with poorer outcomes.

Which of the following best reflects evidence-based guidance regarding medication use in BPD?

A. Medications are the primary treatment for BPD
B. Polypharmacy improves long-term outcomes
C. Medications may target specific symptoms but do not treat core pathology
D. Antidepressants are universally effective

Correct answer: C. DBT is superior for high-risk behaviors, while GPM offers scalable first-line care

Explanation:
DBT remains the gold standard for reducing self-harm and suicidality, particularly in high-risk patients. GPM shows comparable improvements in general functioning and is more accessible, making it an effective first-line approach.

Which statement correctly compares Dialectical Behavior Therapy (DBT) and Good Psychiatric Management (GPM)?

A. GPM is inferior to DBT in all outcome measures
B. DBT and GPM are equally effective for all patients
C. DBT is superior for high-risk behaviors, while GPM offers scalable first-line care
D. GPM replaces the need for psychotherapy

Correct answer: B. Treating BPD often improves comorbid disorders

Explanation:
Untreated BPD undermines treatment of comorbid conditions. Addressing BPD first often leads to improvement or resolution of secondary diagnoses. Exceptions include conditions requiring immediate stabilization.

Why should clinicians prioritize treatment of BPD over many comorbid conditions?

A. BPD is more biologically dangerous
B. Treating BPD often improves comorbid disorders
C. Other disorders are misdiagnoses
D. Insurance coverage requires it

Correct answer: B. Therapist-driven change reinforces splitting

Explanation:
Over-rescuing fosters splitting and dependency. Effective treatment positions the clinician as a guide, emphasizing patient agency and responsibility for change.

Which principle best explains why clinicians should expect change to come from the patient in BPD treatment?

A. Patients with BPD resist authority
B. Therapist-driven change reinforces splitting
C. BPD patients lack insight
D. Change requires medication adherence

Correct answer: C. Distress resulting from a lack of a stable, coherent sense of self

Explanation:
Painful incoherence describes the distress patients experience due to an unstable and fragmented identity. Unlike normal identity exploration, this instability causes persistent suffering and a sense of being “lost.”

Identity disturbance and “painful incoherence”

The term painful incoherence in Borderline Personality Disorder most accurately refers to:

A. Difficulty recalling autobiographical memories
B. Emotional pain caused by rapid mood shifts
C. Distress resulting from a lack of a stable, coherent sense of self
D. Cognitive disorganization during stress

Correct answer: B. Defining oneself entirely by a single interest or ideology

Explanation:
Some individuals with BPD attempt to cope with identity instability by rigidly defining themselves around one trait (e.g., political ideology, fandom), rather than developing a multifaceted identity.

Over-identification with a single trait or cause

Which behavior best illustrates a compensatory response to identity disturbance in BPD?

A. Avoiding social relationships
B. Defining oneself entirely by a single interest or ideology
C. Persistent indecisiveness
D. Emotional numbing

Correct answer: C. Chronic suicidal ideation with fluctuating intensity

Explanation:
Unlike mood disorders, suicidality in BPD is often chronic and baseline, complicating hospitalization decisions and requiring longitudinal safety planning rather than episodic crisis-only intervention.

Chronic vs episodic suicidality

Which pattern of suicidality is most characteristic of Borderline Personality Disorder?

A. Rare but highly lethal suicide attempts
B. Suicidality limited to depressive episodes
C. Chronic suicidal ideation with fluctuating intensity
D. Suicidal thoughts only during psychosis

Correct answer: B. Suicidality is typically chronic rather than episodic

Explanation:
Because suicidality in BPD is often persistent rather than episodic, brief hospitalizations rarely produce sustained improvement and may reinforce maladaptive behaviors if overused.

Hospitalization limitations in BPD

Why is inpatient hospitalization often less effective for suicidality in BPD compared to mood disorders?

A. Patients refuse treatment
B. Suicidality is typically chronic rather than episodic
C. Hospitals lack trained staff
D. Medications cannot be administered

Correct answer: C. Viewing people as entirely good or entirely bad

Explanation:
Splitting is a defense mechanism involving black-and-white thinking, especially in relationships. It contributes to unstable interpersonal dynamics and intense shifts in perception of others.

Splitting (black-and-white thinking)

Splitting in Borderline Personality Disorder is best described as:

A. Dissociative identity formation
B. Alternating attachment and detachment cycles
C. Viewing people as entirely good or entirely bad
D. Cognitive impairment during stress

Correct answer: C. Intensity and frantic efforts to avoid abandonment

Explanation:
While rejection is painful for everyone, individuals with BPD may respond with extreme distress and frantic behaviors (e.g., threats of self-harm) to prevent perceived abandonment.

Abandonment sensitivity vs normal rejection

Which feature most distinguishes abandonment sensitivity in BPD from typical reactions to rejection?

A. Presence of sadness
B. Duration of emotional response
C. Intensity and frantic efforts to avoid abandonment
D. Associated anxiety symptoms

Correct answer: B. Clinicians fear stigmatizing patients

Explanation:
Clinician reluctance to diagnose or disclose BPD—due to stigma, pessimism, or discomfort—leads to underdiagnosis despite its high base rate in psychiatric settings.

Base-rate and underdiagnosis

Why does Borderline Personality Disorder tend to be underdiagnosed despite its high prevalence?

A. Symptoms are rare in outpatient settings
B. Clinicians fear stigmatizing patients
C. It has a low base rate
D. DSM criteria are unclear

Correct answer: B. Core traits often appear in early childhood and intensify during adolescence

Explanation:
Emotional reactivity and impulsivity may be present early in life, but the full disorder typically emerges in adolescence or early adulthood as identity and relational demands increase.

Developmental course (early traits → later disorder)

Which statement best describes the developmental trajectory of Borderline Personality Disorder?

A. Symptoms emerge abruptly in adulthood
B. Core traits often appear in early childhood and intensify during adolescence
C. BPD is present at birth
D. Symptoms only emerge after trauma

Correct answer: C. Gene–environment interaction

Explanation:
BPD has a substantial heritable component, but environmental factors—especially invalidation and trauma—interact with biological vulnerability to produce the disorder.

Biology + environment interaction

Which model best explains the etiology of Borderline Personality Disorder?

A. Purely psychological
B. Purely trauma-based
C. Gene–environment interaction
D. Neurodegenerative

Correct answer: C. Prioritizing stable roles before romantic relationships

Explanation:
Work or school provides predictable structure and identity stability, whereas romantic relationships often trigger abandonment fears and emotional dysregulation early in treatment.

“Work before love” principle

The principle “work before love” in treating BPD emphasizes:

A. Avoidance of intimacy
B. Employment as a substitute for relationships
C. Prioritizing stable roles before romantic relationships
D. Financial independence as treatment