module 14 pt. 2: boderline personality disorder (BPD)

Borderline personality disorder

A pattern of instability in emotions, interpersonal relationships, behavior, and self-image

Emotional dysregulation

Affective instability, chronic feelings of emptiness, inappropriate anger

Interpersonal dysregulation

Fear of abandonment, unstable and intense relationships

Behavioral dysregulation

Impulsive behaviors, recurrent suicidal behavior or threats

Cognitive dysregulation

Identity disturbance and dissociation

BPD prevalence

1–2% lifetime, 75% women, onset in late adolescence/early adulthood

BPD course

Chronic and distressing, but ~85% show symptom remission over 15 years

Comorbidities

Substance use disorders, mood disorders, other personality disorders

Suicide risk

75% attempt suicide, 10% die by suicide

Biological risk factors

Heritability ~46%, increased amygdala activation, decreased prefrontal cortex activation during negative emotional stimuli

Psychological/social risk factors

Childhood maltreatment, adverse childhood experiences, misinterpretation of emotional cues, poor emotion regulation strategies, increased impulsivity

Emotional regulation theory

Core deficits in managing and responding to emotional stimuli

Dialectical behavior therapy (DBT)

Combines mindfulness and behavioral therapy, balances acceptance and change

DBT treatment hierarchy

Life-threatening behaviors, therapy-interfering behaviors, quality-of-life interfering behaviors, skill-building

DBT skills

Mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness

Psychodynamic treatments

Transference-focused therapy (focus on patient-therapist relationship), Mentalization-based treatment (teach accurate observation of emotions in self and others)

Medication treatments

SSRIs, mood stabilizers (lamotrigine), atypical antipsychotics; medications alone do not improve psychotherapy effectiveness

A young woman has intense relationships, fears abandonment, frequently self-harms, and experiences extreme mood swings. Which disorder fits best?

Borderline personality disorder

A man interprets ambiguous facial expressions as angry, engages in impulsive behaviors, and reports chronic feelings of emptiness. Which disorder is likely?

Borderline personality disorder

Which symptom category of BPD involves fear of abandonment and unstable relationships?

Interpersonal dysregulation

Which therapy for BPD emphasizes balancing acceptance and change through mindfulness and behavioral strategies?

Dialectical Behavior Therapy

Which of the following is a core cognitive symptom of BPD?

Identity disturbance and dissociation

What is the approximate heritability of BPD?

46%

Which skill is NOT a main component of DBT?

Systematic desensitization

What percentage of individuals with BPD attempt suicide?

75%