Borderline Personality Disorder in Late Adolescence to Early Adulthood: Emergence and Key Concepts (Vocabulary Flashcards)

Vocabulary flashcards covering key concepts from the lecture notes on Borderline Personality Disorder in youth, including criteria, prevalence, etiologies, theories, development, and intervention.

Borderline Personality Disorder (BPD)

A personality disorder marked by instability in self image, emotions, and relationships, impulsivity, and fear of abandonment; onset in adolescence to early adulthood; core features include emotional dysregulation and identity disturbance.

DSM-IV-TR Criteria for Borderline Personality Disorder

Nine criteria; diagnosis requires five or more: frantic efforts to avoid real or imagined abandonment; unstable relationships; identity disturbance; impulsivity; recurrent suicidal or self injurious behavior; affective instability; chronic feelings of emptiness; inappropriate anger; transient paranoid ideation or dissociation.

Enduring pattern (DSM criterion)

An inflexible, pervasive pattern across cognition, affectivity, interpersonal functioning, or impulse control; causes distress or impairment; stable across situations; onset in adolescence or early adulthood.

Affective instability

Rapid, intense mood changes with strong reactivity to emotional stimuli; a hallmark of BPD.

Frantic efforts to avoid abandonment

Intense fear of real or imagined abandonment leading to frantic attempts to maintain relationships.

Identity disturbance

Marked and persistent instability in self image or sense of self.

Impulsivity

Engaging in self damaging behaviors in at least two areas such as spending, sex, substances, reckless driving, or binge eating.

Parasuicidal behavior

Recurrent suicidal gestures, threats, or self mutilation common in BPD.

Transient stress related paranoid ideation or dissociation

Brief paranoid thoughts or dissociative symptoms under stress.

Prevalence of BPD in the general population

Approximately 2 percent in the general population; higher rates in clinical settings (about 10% of outpatients, 20% of inpatients); 30–60% of those with any personality disorder have BPD; predominance in females (~75%).

Gender differences in adolescent BPD

Females tend to have more severe and persistent symptoms; males with similar symptoms more likely to follow an antisocial trajectory.

Five Factor / Little Five model in BPD

Dimensional model of personality used in youth research; features include high neuroticism and low agreeableness and conscientiousness associated with borderline pathology.

Big Five traits as applied to BPD

Five factor model domains neuroticism, extraversion, openness, agreeableness, conscientiousness; maladaptive expression often seen as high neuroticism and low agreeableness/conscientiousness in BPD.

Comorbidity with PTSD

Anxiety disorders, particularly PTSD, frequently co-occur with BPD but are distinct conditions.

Comorbidity with mood disorders

Mood disorders commonly co-occur with BPD; symptoms may overlap with depression or bipolar disorder.

ADHD and BPD comorbidity

ADHD can co-occur with BPD in youth; impulsivity and attentional issues overlap.

Eating disorders and BPD

BPD commonly co-occurs with eating disorders; binge eating is one DSM criterion for BPD.

Etiology: family context in BPD

Pathways rooted in disturbed family relationships and maltreatment; childhood trauma is a major risk factor.

Childhood maltreatment statistics (BPD)

High rates of childhood maltreatment reported in adults with BPD; sexual abuse, emotional neglect, and inconsistent parenting common.

Disorganized attachment and BPD

Disorganized attachment linked to BPD; trauma and unstable caregiving contribute to dissociation and identity instability.

Object relations theory in BPD

BPD explained through early internal representations of self and others; defense mechanisms such as splitting; boundary and differentiation problems.

Splitting

Defense of perceiving self or others as all good or all bad to manage intense emotions; hinders integration.

Emotional object constancy

Ability to maintain a stable representation of attachment figures and integrate positive and negative feelings toward them.

Mahler's separation-individuation

Developmental process of differentiating self from caregiver; arrest in BPD linked to identity and boundary problems.

Kernberg and Pine perspectives

Kernberg emphasizes rage and internal representation disruption; Pine emphasizes anxiety and ego function deficits; both highlight splitting and poor self/other differentiation.

Dissociation in BPD

Defense mechanism involving detachment from reality; linked to trauma and self-harm; can be persistent in BPD.

Neurochemical correlates (serotonin)

Serotonin deficits associated with impulsivity, aggression, affective instability, and self-harm in BPD.

HPA axis and stress response

Dysregulated stress response system; chronic stress elevates reactivity; cortisol regulation issues linked to BPD.

Genetic influences on BPD

Heritability estimates for BPD features range roughly 42–50%; monozygotic twins show higher similarity than dizygotic twins.

Neuroanatomy findings in BPD youth

Brain imaging shows reduced left anterior cingulate volume and reduced prefrontal/orbitofrontal gray matter in adolescents with BPD, linked to impulsivity and parasuicidality.

Collaborative Longitudinal Personality Disorders Study (CLPS) findings

Trauma history is common and trauma severity relates to greater BPD symptomatology; high rates of PTSD symptoms in BPD cases.

Geiger & Crick integrative model

Developmental precursors to BPD include hostile worldview, affective instability, impulsivity, relationship preoccupation, and lack of self notion; emphasizes mentalization deficits.

Mentalization (Fonagy & Luyten)

Impaired ability to understand mental states of self and others; deficits linked to trauma and invalidating parenting; related to theory of mind.

Transactional effects (temperament and environment)

Reciprocal interactions between child temperament and caregiver behavior influence risk for BPD through development.

Linehan's Biosocial Model overview

BPD arises from an interaction between biological vulnerability (emotional instability and impulsivity) and an invalidating environment; reciprocal transactions amplify risk.

DBT for adolescents

Dialectical Behavior Therapy adapted for teens; combines cognitive behavioral strategies with mindfulness; includes individual and family components; evidence shows reduced self-harm and hospitalizations.

CAT (Cognitive Analytic Therapy)

Brief, structured therapy combining object relations with cognitive psychology; 16 sessions; used with adolescents with BPD; focuses on self states and integration.

Dialectical dilemmas in DBT for adolescents

Tensions such as excessive leniency vs control, normalizing pathology vs pathologizing, forcing autonomy vs dependence; addressed with family involvement.

Family therapy for BPD

Systemic approaches to reinforce boundaries and differentiation; involve family to support adolescent autonomy.

Prognosis and resilience in BPD

Some youth remit with maturation; outcomes vary; fewer Axis II comorbidities and male gender linked to greater resilience in some studies.

Chestnut Lodge follow-up study outcomes

Longitudinal follow up showing many adults with childhood BPD achieved good outcomes after long term treatment; some remained symptomatic but functioning improved.

Relational aggression and BPD trajectories

Relational aggression in childhood can relate to later BPD features; gender differences influence trajectories.

Projective Identification

Interpersonal defense where unwanted emotions are projected onto another person who then embodies them; can shape treatment dynamics in BPD.

Impact of parenting on BPD risk

Caregiver invalidation and parental psychopathology, including maternal BPD, associated with higher risk for child BPD symptoms.

Disorganized attachment as predictor

Early disorganized attachment predicts dissociation and BPD symptoms across adolescence into adulthood.

Temperament and BPD risk

Emotionally reactive or impulsive temperament increases vulnerability to BPD in the context of invalidating parenting.