Borderline Personality Disorder

What is a common analogy used to describe the life of individuals with Borderline Personality Disorder (BPD)?

Life analogous to a soap opera

What emotional experiences are typical for individuals with Borderline Personality Disorder (BPD)?

Wrought with emotional ups and downs

How are individuals with Borderline Personality Disorder (BPD) often described in terms of their emotional stability?

Unstable and especially angry

What kind of interpersonal needs do individuals with Borderline Personality Disorder (BPD) experience?

Intense interpersonal needs and sudden shifts of opinions about others

How can others be perceived by individuals with Borderline Personality Disorder (BPD)?

Loving, sensitive, and intelligent one minute; accused of neglect and betrayal the next

What feelings do individuals with Borderline Personality Disorder (BPD) often experience?

Intolerable loneliness and emptiness

What behavior might result from the emotional experiences of individuals with Borderline Personality Disorder (BPD)?

Clinginess via dramatic and drastic measures

What dissociative experience might individuals with Borderline Personality Disorder (BPD) encounter during stressful times?

Experience dissociative states

What are the three levels of functioning recognized by early analysts?

Normal, Neurotic, Psychotic

What did Freud claim about the libido in psychotic individuals?

Freud claimed that their libido was withdrawn totally into the self.

Why is the libido in psychotic individuals considered inaccessible?

It is considered inaccessible given the usual analytic tools.

Freud's Theory was

of the whole mind

As a therapy, Freud's theory could only be applied to

Neurotic (or normal) individuals

Any patients who showed good reality contact was

- not psychotic
- analyzable

What other group did analysts begin to notice

Troubled individuals who
- were not psychotic
- failed to benefit from standard psychoanalytic therapy

What phrase did Stern coin in 1938

"borderline group of neuroses"
- thought to be neurotic, but resistant to the couch (i.e. analysis)

What are some of Stern's 10 characteristics

- Quickness to anger
- Depression or anxiety in response to interpretive probes about self-esteem
- The use of projection to attribute internal anger to hostile sources in the environment
- "Difficulties in reality testing"
• i.e. nonpsychotic deficits in judgment and empathic accuracy

What can Stern's 10 characteristics be thought of as

precursors to the current diagnostic criteria

What did Schmideberg (1947, 1959) say about the borderline?

It is not just quantitatively halfway between the neuroses and psychoses.

What is a key characteristic of borderline reactions according to Schmideberg?

The blending and combination of these modes of reaction produce something qualitatively different.

How does Schmideberg describe the stability of borderlines?

Borderlines are stable in their instability.

What do all borderlines experience according to Schmideberg?

Disturbances affecting almost every area of their personality and life, particularly in personal relations and depth of feeling.

What is the primary idea of Kernberg's (1967) levels of organization in personality?

It draws attention to a quality of integration of intrapsychic elements.

How stable are Kernberg's levels of organization in personality over time?

They are stable over time.

Where do Kernberg's levels of organization fall on the continuum?

They fall midway on the continuum from neurosis to psychosis.

How does Kernberg's concept differ from borderline states or conditions?

It is different than the idea of borderline states or conditions.

What did Kernberg posit about personality disorders?

He posited that all the personality disorders could be put on the continuum from neurosis to psychosis.

Cognitive Conceptualizations of BPD

• Linehan's Dialectical-Behavioral View
• Beckian formulations
• Young's Schema Mode Model

What characterizes patients with Borderline Personality Disorder (BPD)?

A dysfunction in emotion regulation.

What is thought to be the cause of dysfunction in emotion regulation in patients with BPD?

It is thought to be temperamental.

What are two consequences of the dysfunction in emotion regulation in BPD patients?

Strong reactions to stressful events and a long time until emotions return to baseline.

What type of environment do patients with BPD often experience?

An invalidating environment.

How does invalidation affect patients with BPD?

It contributes to their problems in regulating, understanding, and tolerating emotional reactions.

What behavior do patients with BPD often exhibit towards themselves?

They often begin to invalidate themselves.

What type of view of emotions do patients with BPD tend to adopt?

An over-simplistic view of emotions.

What stance is taken with patients in Linehan's Dialectical-Behavioral View?

Dialectical stance

What does acceptance mean in Linehan's Dialectical-Behavioral View?

Accepting the emotional pain instead of trying to change it

What does change refer to in Linehan's Dialectical-Behavioral View?

Changing the antecedents of the stress and the ways the patient copes with emotions

What was Linehan's Dialectical-Behavioral Therapy originally used to treat?

Self-injurious patients

What is a common diagnosis for patients originally treated with Linehan's Dialectical-Behavioral Therapy?

Borderline Personality Disorder (BPD)

What does mindfulness consist of in Linehan's Dialectical-Behavioral View

- observation
- participation
- description

What do judgements do according to Linehan's Dialectical-Behavioral View

"It defines your core beliefs, experiences, and mood

What do Beckian Formulations stress the role of?

Assumptions

What is one of the three key assumptions in Beckian Formulations?

The world is dangerous and malevolent

What is a second key assumption in Beckian Formulations?

I am powerless and vulnerable

What is the third key assumption in Beckian Formulations?

I am inherently unacceptable

What cognitive characteristic involves heightened awareness of threats?

Hyper-vigilance

What cognitive characteristic involves viewing situations in black and white?

Dichotomous thinking

What cognitive characteristic refers to a lack of a clear sense of self?

Weak sense of identity

What is a poorly articulated self-schema associated with?

Weak sense of identity

What role do assumptions and cognitive characteristics play in Beckian Formulations?

The maintenance of the disorder and targets of therapy

What are Beckian Formulations characterized by?

Unstable and extreme interpersonal behavior

What belief characterizes dependent assumptions in Beckian Formulations?

The belief of the patient to be weak and incapable, whereas others are strong and capable

What belief characterizes paranoid assumptions in Beckian Formulations?

The belief that others cannot be trusted and are malevolent

What contributes to emotional turmoil and extreme decisions in Beckian Formulations?

Dichotomous thinking

What does a lack of ability to see shades of gray contribute to in Beckian Formulations?

Abrupt shifts in behavior

What is the core pathology of Borderline Personality Disorder (BPD)?

Highly frightened, abused child

What does the frightened child in BPD feel about the world?

Left alone in a malevolent world

What does the child with BPD long for?

Safety and help

Why is the child with BPD distrustful?

Fear of further abuse and abandonment

Four central schema modes (organized patterns of thinking) central to BPD

- The abandoned child mode
- The angry/impulsive child mode
- The punitive parent mode
- Healthy adult mode

What does the healthy adult mode schema denote

the healthy side of the patient