all things week 4/5 and betty (borderline personality disorder)

what happens when you call 911?

• location of emergency

  • if calling from a land line, this info is already provided

  • if calling from a cell phone, 911 can track your location to between 200 meters and 50 meters 

• phone number you are calling from

  • they already know this, but the technology is not fool-proof

• nature of the emergency

  • they need to know who to dispatch to your location

• details about emergency 

  • emergency responders need understand what they are walking into  

do 911 operators go through CIT training?

yes

marcus alert

• named for marcus david peters who was killed by richmond police in 2018

• this alert is meant to identify 911 callers experiencing mental health issues, and if the situation is deemed to be safe, send a clinician to the scene as opposed to law enforcement

• the marcus alert system is not being tested in approximately 10 different jurisdictions in VA including prince william county

personality disorder includes…

• borderline PD

• antisocial PD

• narcissistic PD

• histronic PD

• schizoid PD

• obsessive compulsive PD

• etc.

9% of US population can be diagnosed with a personality disorder

how personality disorders are different…

organic and non-organic

organic

• schizophrenia

• bipolar

• depression

• anxiety

• etc

non-organic

these stem from a problem or event (or anything but theres a reason)

• personality disorders

• PTSD

out experiences during childhood shape the way we view the world

many different things play a role in the development of that lense (our own specific lense built from childhood, which is true for everyone)

1. gender

2. religion

3. sexual orientation

4. financial resources

5. education

6. race

7. personal experience

8. etc. 

personality disorders act like a filter for an individuals perceptions of a situation…

coloring the way they view what is happening in the world around them

traits of Borderline Personality Disorder (BPD)

1. frantic efforts to avoid real or imagined abandonment 

2. unstable and intense interpersonal relationships

3. unstable self-image or sense of self 

4. chronic feelings of emptiness

5. impulsivity in at least two areas that are potentially self-damaging

6. transient, stress-related paranoid ideation 

7. affective instability lasting a few hours and inappropriate, intense anger or difficulty controlling anger

frantic efforts to avoid real or imagined abandonment

the most important of all diagnostic criteria because it informs many of the other aspects of this disorder

• an individual with BPD is likely to do two things when meeting someone new

  • cling to them (if i hold them close they cant leave)

  • try and scare them away (once they leave after they scare them away, they say “they would have left me anyway”)

unstable and intense interpersonal relationships

characterized by alternating between idealization and devaluation 

• “lancelot”

• “i know youre cheating on me you bastard!”

Borderline Personality Disorder is drive by an intense fear of _______

abandonment

unstable self image or sense of self

1. they have no idea who they are or what they believe in and feel non-existent”

2. you take your identity from the people around you 

3. your identity changes based on who you may be hanging out with so its unstable 

4. some patients of BPD report having a hard time understanding where they “end” and another person begins 

chronic feelings of emptiness

an average person would rate themselves a 6, 7, or 8 on a scale of 1-10 while a BPD individual would rate themselves a 1 or 2

impulsivity in at least two areas that are potentially self-damaging 

in this case, betty moved in with eric after only dating for three weeks 

transient, stress-related paranoid ideation

this is driven by fear of abandonment

affective instability lasting a few hours and inappropriate, intense anger or difficulty controlling anger

affect

• is reactive and has an “object”

• this is a reaction to something that is heard, seen, or felt in some other way

• think of affect as another way to say “emotions”

• affect is “here and now”

mood

• non-reactive and has no “object”

• this is the overall feeling state when not reacting to stimuli

• you. can wake up in a “mood” without being able to articulate the reason or the preceding incident 

do people with BPD have the ability to feel “simultaneous emotions”?

no, they feel one emotion very intensely 

do BPD individuals experience recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior 

yes

conceptualization of BPD…

has increased for men and decreased for women

conceptualization of antisocial personality disorder

increased for men and decreased for women

Conceptualization has changed because they realized that the criteria for borderline personality disorder was…

gender biased

men with BPD can present differently…

1. more anger

2. bored easily/seeking attention

3. controlling/abusive 

4. antisocial behaviors 

if you want to create a personality disorder in a child…

1. ignore valid emotional reactions 

2. shame valid emotional reactions (“why are you crying over a stupid lego set?”

3. mock the child (“what? are you going to cry like a baby because someone ruined your legos?”)

issue with ignoring, shaming, and mocking

these teach the child nothing about handling emotional issues and forces them to problem solve the issue themselves

one incident isnt enough to create a personality disorder

long lasting pattern (ex: 10 years)

does the specific personality disorder that develops depend on the way the child handles the situation? 

yes

narcissistic personality disorder

“my lego bridge was the best lego bridge ever. everyone is never going to know how good i am at building legos.”

paranoid personality disorder

always guarding the lego and watching everuthing around them for potential threats

obsessive compulsive personality disorder

“last time he broke my stuff I was listening to the frozen CD… so i wont do that again when building legos.”

schizotypal personality disorder

“if my legos will always get ruined, i’ll retreat into my fantasy books or tv shows and live in that world where these bad things dont happen to me.”

histrionic personality disorder

“if crying when my legos are smashed isn’t enough for mom and dads attention, i’ll up the ante” 

borderline personality disorder

“I cant trust people to be around, and that is terrifying, especially those close to me. so im going to learn how to decipher all their subtle actions for any signs that they may not be there for me.”

childhood physical, sexual, and emotional abuse (as well as neglect) are breeding grounds for personality disorders because…

these behaviors are all too often ignored

• around 75-85% of individuals diagnosed with borderline personality disorder have histories of victimiztation 

the reason cutting works is because of a phenomena called…

pain offset release

most people (generally speaking) dont enjoy pain…

however, when we experience pain, we have a specific set of physiological reactions “fight or flight” response

• people chase the physiological reaction 

why dont BPD people (like betty) try other things to give the same feeling?

(betty) has a persistently unstable self-image and low sense of self-worth