Borderline Personality Disorder (BPD)

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Borderline Personality Disorder (BPD)

• Adlyn Perez

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• Prevalence
• 2 of US Population
• Women 3 times more likely to have it
• Definition
• DSM-IV pervasive pattern of instability of
  interpersonal relationships, self-image, and
  affects, and marked impulsivity beginning by
  early adulthood and present in a variety of
  contexts.
• Borderline
• Refers to people on the border between normal,
  adaptive functioning and psychological disability
• term that refers to the great overlap of symptoms
  between BPD and other disorders. This makes BPD
  difficult to diagnose.

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Symptoms 1

• Poorly regulated emotions
• Emotional Storms extreme bouts of emotional
  upheaval (anxiety, fury, loneliness, emptiness)
  that cant be voluntarily controlled easily
• Emotions quickly fluctuate between opposing
  extremes
• Uncontrollable emotions make Borderlines more
  prone to mood disorders (bipolar, major
  depressive disorder) and often have them also.

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Symptoms 2

• Impulsivity
• Examples cutting, gambling, promiscuity,
  drinking, spending, drugs and binge eating.
• Parasuicidal acts- threats of suicide made to
  manipulate, control a situation, or gain
  attention
• Suicide- genuine risk of suicide greater with
  Borderlines who are greatly impulsive and have
  mood disorders in addition to BPD.
• Why? Borderlines may do anything to relieve the
  force of their emotional upheavals by engaging in
  reckless, exciting, distracting, or comforting
  behaviors

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Symptoms 3

• Instability
• Unstable sense of self sense of self depends on
  the attitudes and behaviors of those they want
  care from. Borderlines have values and opinions,
  but the need to be approved of can easily
  override them, and often does.
• Dissociative moments- difficulty recalling what
  they said or did in a specific moment.
• All of these uncontrollable factors foster a
  persistent and deeply rooted sense of insecurity
  with themselves and in what goes on around them.
  This insecurity stems from lack of control over
  their behaviors and emotions or their
  environment.

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Symptoms 4

• Disturbed Relationships
• Idealize Caregivers believe that the people they
  are close to are perfect, doing all that they can
  to ensure theyre caregivers well being and
  thinking that they will make the person feel
  loved, safe, and alive at all times.
• Devaluate Caregivers once the significant other
  cant live up to idealized expectations,
  borderlines perceive that the person is
  completely unsupportive, selfish, and uncaring.
• Fear of Abandonment extreme dependence on
  support and presence of other people
• Fear of Closeness driven by fear of being hurt,
  fear of loosing fragile independence and sense of
  self, or a desire to escape the problems of their
  current relationships
• Borderlines fluctuate between these unrealistic
  perceptions and extremes.

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Making sense of BPD

• Fluctuating, overwhelming emotions impulses
• Unsuccessful attempts to manage/alleviate
  emotions using mostly self-destructive behaviors
• Insecurity
• Reliance on others for stability
• Demand that others be unrealistically constant in
  all aspects and at all moments- intolerance for
  even normal/minor changes in behavior and
  attitude of others.
• Attempts to control others behavior via
  manipulation, or threatening harm to that person
  (aggression) or themselves (parasuicidal acts).

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Causes ???

• Neurological abnormalities in centers which
  regulate emotions hyperactivity of the
  amygdala.
• Genetic source
• Developmental source
• Trauma stress
• Verbal, physical, sexual abuse, neglect (found
  in approx 70 of Borderlines)
• Early separation from parents
• Biological predisposition for disorder may be
  triggered by stress

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Treatment

• Individual psychotherapy medication
• Medication-stabilize emotions, reduce
  impulsivity, facilitate clear, rational thinking.
  
• Low doses of antipsychotic, antidepressants
• Psychotherapy
• Enhance interpersonal skills, manage emotions and
  impulses

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References

• American Psychological Association. (2000).
  Diagnostic and statistical manual of mental
  disorders (4th ed.) Washington, DC Author.
• Friedel, R. O. (2004). Borderline personality
  disorder demystified An essential guide for
  understanding and living with BPD. New York
  Marlowe company.
• Gabbard, G. O. (1996). Psychotherapeutic
  strategies for borderline personality disorders.
  In Guide to psychiatric disorders. (pp. 119-135).
  New York Hatherleigh Press.
• Mauchnik, J., Schmahl, C., Bohus, M. (2005).
  New findings in the biology of borderline
  personality disorder Abstract. Directions in
  Psychiatry, 25(3), 197-215.
• Herpertz, S.C., Dietrich, T.M., Wenning, B.,
  Krings, T., Erberich, S.G., Willmes. K., Thron,
  A. Sass, H. (2001). Evidence of abnormal
  amygdala functioning in borderline personality
  disorder A functional MRI study Abstract.
  Biological Psychiatry, 50(4), 292-8.