11- Borderline Personality Disorder Explained (Emotionally Unstable Personality Disorder)

Source: https://www.youtube.com/watch?v=IddZY44_-kg

Correct answer: C. A persistent pattern of thinking, feeling, and behaving that deviates from cultural expectations and impairs functioning

Explanation:
Personality disorders involve enduring, inflexible patterns that deviate from cultural norms and cause functional impairment or distress. They are not temporary states and do not always begin in childhood.

Which of the following best defines a personality disorder?

A. A temporary emotional reaction to stress
B. A deviation in personality traits that causes distress but no functional impairment
C. A persistent pattern of thinking, feeling, and behaving that deviates from cultural expectations and impairs functioning
D. A disorder that always begins in childhood

Correct answer: B. Cluster B personality disorder

Explanation:
BPD is a Cluster B personality disorder, characterized by emotional instability, impulsivity, and interpersonal difficulties.

Borderline Personality Disorder (BPD) is classified as which of the following in DSM-5?

A. Cluster A personality disorder
B. Cluster B personality disorder
C. Cluster C personality disorder
D. Trauma-related disorder

Correct answer: C. Emotionally Unstable Personality Disorder

Explanation:
In ICD classifications, BPD is referred to as Emotionally Unstable Personality Disorder (EUPD).

What is the ICD-10 / ICD-11 equivalent name for Borderline Personality Disorder?

A. Dissociative Personality Disorder
B. Emotionally Reactive Personality Disorder
C. Emotionally Unstable Personality Disorder
D. Impulsive Mood Disorder

Correct answer: C. At least 5 of 9

Explanation:
DSM-5 requires five or more of the nine criteria, present across different contexts and over time.

According to DSM-5, how many criteria must be met to diagnose Borderline Personality Disorder?

A. At least 3 of 9
B. At least 4 of 9
C. At least 5 of 9
D. All 9

Correct answer: C. Splitting

Explanation:
Splitting involves viewing people as either entirely good or entirely bad, which contributes to rapid shifts between idealization and devaluation in relationships.

Which defense mechanism is most closely associated with the unstable interpersonal relationships seen in BPD?

A. Projection
B. Intellectualization
C. Splitting
D. Repression

Correct answer: C. Stress-related, transient dissociative or paranoid symptoms

Explanation:
DSM-5 describes stress-related paranoid ideation or dissociative symptoms, which are usually transient, not persistent or progressive.

Which statement best reflects the nature of dissociation in BPD according to DSM-5?

A. Chronic and progressive dissociation
B. Severe dissociation present at all times
C. Stress-related, transient dissociative or paranoid symptoms
D. Dissociation only during depressive episodes

Correct answer: C. Heritability estimates range around 40–60%, with some studies reporting higher values

Explanation:
Twin studies suggest moderate heritability (≈40–60%), sometimes reported higher. However, results may be inflated due to shared environmental factors, which is an important limitation.

Which statement regarding the heritability of BPD is most accurate?

A. BPD is entirely genetic
B. Heritability is approximately 10%
C. Heritability estimates range around 40–60%, with some studies reporting higher values
D. Twin studies conclusively prove genetic causation

Correct answer: C. Childhood abuse and neglect

Explanation:
There is a strong association between emotional, physical, or sexual abuse, neglect, and unstable family environments with later BPD. Around 70% of patients report such histories.

Which childhood factor shows the strongest association with the later development of BPD?

A. Academic failure
B. Parental divorce alone
C. Childhood abuse and neglect
D. Peer rejection only

Correct answer: C. Females are more common in clinical samples, but prevalence is similar in the general population

Explanation:
Clinical samples show a female predominance, but epidemiological studies indicate roughly equal prevalence between males and females in the general population.

Which statement about gender prevalence in BPD is most accurate?

A. BPD occurs only in females
B. Males are more affected than females
C. Females are more common in clinical samples, but prevalence is similar in the general population
D. Gender prevalence is unknown

Correct answer: C. No medication is specifically approved for BPD; psychotherapy is the mainstay

Explanation:
No medication is FDA-approved specifically for BPD. Psychotherapy is the cornerstone of treatment, while medications are used only to target specific symptoms.

Which statement regarding treatment of BPD is correct?

A. Antidepressants are curative
B. Antipsychotics are first-line treatment
C. No medication is specifically approved for BPD; psychotherapy is the mainstay
D. Medication alone is sufficient

Correct answer: C. Mentalization-Based Therapy

Explanation:
Mentalization-Based Therapy (MBT) enhances mentalizing capacity (“thinking about thinking”), which indirectly improves emotional regulation and interpersonal functioning.

Which psychotherapy primarily focuses on improving the patient’s ability to understand their own and others’ mental states?

A. Dialectical Behavior Therapy
B. Cognitive Behavioral Therapy
C. Mentalization-Based Therapy
D. Transference-Focused Psychotherapy

Correct answer: B. Emotional regulation, distress tolerance, and interpersonal effectiveness

Explanation:
DBT emphasizes emotion regulation, mindfulness, distress tolerance, and interpersonal skills, making it particularly effective for self-harm and emotional dysregulation in BPD.

Dialectical Behavior Therapy (DBT) is most strongly associated with improving which of the following?

A. Memory and attention
B. Emotional regulation, distress tolerance, and interpersonal effectiveness
C. Insight into childhood trauma only
D. Reality testing

Correct answer: B. Mood changes are rapid and usually last hours to days

Explanation:
In BPD, affective instability involves rapid mood shifts lasting hours to days, usually triggered by interpersonal stressors. This distinguishes it from bipolar disorder, where mood episodes last days to weeks.

Affective instability duration (hours to days)

Which statement best describes mood changes in Borderline Personality Disorder?

A. Mood episodes typically last weeks to months
B. Mood changes are rapid and usually last hours to days
C. Mood changes occur only during depressive episodes
D. Mood instability is indistinguishable from bipolar disorder

Correct answer: C. Mood reactivity to interpersonal stressors

Explanation:
Mood changes in BPD are reactive and situation-dependent, particularly to perceived rejection or abandonment. Bipolar disorder involves episodic mood changes that are not primarily triggered by interpersonal events.

Differentiation from Bipolar Disorder

Which feature most reliably helps differentiate Borderline Personality Disorder from Bipolar Disorder?

A. Presence of impulsivity
B. Emotional instability
C. Mood reactivity to interpersonal stressors
D. History of suicidal ideation

Correct answer: C. If symptoms are present for at least one year and are pervasive

Explanation:
DSM-5 allows diagnosis under age 18 only if symptoms persist for at least one year and are not limited to a developmental phase.

Diagnosis under age 18 – conditions

Under which condition can Borderline Personality Disorder be diagnosed in individuals under 18 years of age?

A. If symptoms appear during adolescence
B. If symptoms are severe
C. If symptoms are present for at least one year and are pervasive
D. Only after excluding all other psychiatric disorders

Correct answer: B. Academic, occupational, and interpersonal functioning

Explanation:
BPD significantly impairs education, employment, and relationships due to emotional instability, impulsivity, and interpersonal difficulties.

Functional impairment domains

Which of the following areas is most commonly impaired in individuals with Borderline Personality Disorder?

A. Visual–spatial functioning
B. Academic, occupational, and interpersonal functioning
C. Motor coordination
D. Language comprehension

Correct answer: B. Increased exposure to physical injury, sexually transmitted infections, and accidents

Explanation:
Impulsive behaviors such as unsafe sex, reckless driving, and substance misuse directly increase morbidity and mortality, independent of suicide risk.

Risk-taking behaviors as a mechanism of harm

Risky behaviors in Borderline Personality Disorder most directly increase the risk of harm through which mechanism?

A. Neurocognitive decline
B. Increased exposure to physical injury, sexually transmitted infections, and accidents
C. Reduced emotional expression
D. Social withdrawal

Correct answer: C. Multiple comorbid disorders are the rule rather than the exception

Explanation:
BPD has very high comorbidity, commonly involving mood disorders, anxiety disorders, substance use disorders, eating disorders, ADHD, and bipolar disorder.

Comorbidity burden (multiple disorders)

Which statement best describes psychiatric comorbidity in Borderline Personality Disorder?

A. Most patients have no additional psychiatric diagnoses
B. Comorbidity is uncommon
C. Multiple comorbid disorders are the rule rather than the exception
D. Only mood disorders are commonly comorbid

Correct answer: C. Increase awareness of maladaptive interpersonal patterns and self-destructive behaviors

Explanation:
TFP focuses on unconscious interpersonal dynamics as they emerge in the therapist–patient relationship, helping patients recognize and integrate split perceptions of self and others.

Purpose of Transference-Focused Psychotherapy (TFP)

The primary therapeutic goal of Transference-Focused Psychotherapy in BPD is to:

A. Teach mindfulness skills
B. Reduce self-harm through behavioral reinforcement
C. Increase awareness of maladaptive interpersonal patterns and self-destructive behaviors
D. Modify core beliefs using cognitive restructuring