Early Interventions

1
Early Interventions Borderline Personality
Disorder

• Kate Sloan
• Nurse Practitioner in Psychotherapy

2
Early Interventions

• Detect illness
• Early treatment
• Reduce risk of relapse
• Evidence within mental health, physical health
  and health promotion

3
What about BPD?

• Common mental health problem
• Costly to services recurrent re-admissions,
  crisis interventions, social functioning.
• Disabling condition impacting relationship
  functioning and employment

4
No longer a diagnosis of Exclusion - 2004

• Attitude has been less than favourable
• Seen as being to blame for their problems
  (Becker, 2000)
• Less empathy (Markham and Tower, 2003)
• Malignant alienation (Watts and Morgan, 2004)

5
Diagnosis

• Mean age of onset 18 years
• Issues around diagnosis with young people
• Difficulty distinguishing between BPD and normal
  adolescence
• Ethical concerns
• Risks associated with early interventions
• Instability of the diagnosis

6
Precursors to BPD

• Highly lightly that there are precursors to the
  development of BPD
• What are the early signs that may lead an
  individual on a trajectory towards adult BPD.
• Crick et al, 2001

7
Failure to negotiate salient development tasks

• Hostile paranoid view of the world
• Intense, unstable and inappropriate emotional
  expression
• Overly close relationships
• Impulsivity
• Lack of coherent sense of self
• More studies needed to explore theory further
• Geiger and Crick, 2001

8
Is BPD treatable?

• Yes Matrix, 2008
• Mentalization based therapy (Bateman and
  Fonagy, 1999)
• Dialectical Behavioural Therapy (Linehan, 1994)
• Cognitive Behavioural Therapy (Davidson, 2009)
• Schema Focused Therapy (Young, 1990)

9
Early Interventions

• Minding the baby
• Cognitive Analytical Therapy with Adolescents
• Few studies but a desire to develop more

10
How do we assess for BPD Dimensional model

• Dysphoric affect
• Disturbed cognition
• Impulsive behaviour
• Troubled relationships
• Zanarini et al, 1989

11
Talk openly

• Share diagnosis or the potential to develop the
  diagnosis
• Share how you came to this thinking
• Share formulation