Borderline personality Flashcards Preview

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Flashcards in Borderline personality Deck (19):
1

Epidemiology

1-2 % population
+In women
FHx of depression and substance abuse

2

Etiology

1. The good mother, who provides for, loves, and remains close to the child
2. The hateful, depriving mother, who unpredictably punished and abandons the child.
3. Attribute -ve feelings to environment
4. Separation from mother, early child abuse
5. Disruption of early attachments + trauma= hyperresponsiveness. Poor affect regulation, information processing, memory negatively impacted
6. No reactive capacity mentalisation->ability to understand mentation of others->cannot mind read, Xunderstand mental states, emotions and motivations of others.
7. Distorted attachment: Unpredictable, dangerous
8. Disorganised
9. Ineffective strategies to engage with attachM figure
10. Mood instability, unstable relationships,
manipulative, controlling

3

Clinical features AM SUICIDE

Abandonment issues
Mood and affect instability
Suicide
Unstable/intense relationships
Impulsive
Control of anger poor
Identity disturbance, unstable self image
Depression
Emptiness

1. Affect
2. Cognition->paranoia, quasi-psychosis
3. Behaviour->substance, suicidality, impulsive
4. Interpersonal relationships->instability, dependency, fear abadonment

4

Psychosis in BPD

Brief, no thought disorder.

5

What is projective identification

Intolerable aspects of self are projected on therapist.
Need to react neutrally.
Provoke people to behave in a way which keeps with their beliefs
Feelings congruent with one's owns are induced in another, thereby creating a sense of being understood by or being "at one" with the other person

6

What is splitting

Splitting off a persons good and bad characteristics into two separate and nonoverlapping views of a person which alternate

Will characterise person as all good or all bad depending on which side the split is on

7

Management

Pharmacotherapy
Psychotherapy
-Transference focused
-Mentalisation based therapy
-Dialectical based in first line

8

When might pharmacotherapy be appropriate

For co-morbid aspects->depression, anxiety, impulsive, psychotic episodes

9

Community health management

Crisis management->collaboration with patient, family, identify triggers/risk factors, behaviours, identify key contact person
Case management
-Long term goals
-Psychotherapy
-Pharmacotherapy->SSRIs, atypical antipsychotics, mood stabilisers

10

Acute inpatient

Brief, goal,
avoid negative reactions,
stabilise internal environment
(counselling, supportive)
Stabilise external
(psychosocial, OP treatM,
address stressors)

11

ED management

Managing affect storm-->
Project calm, confidence
Engage
Clarify emotions
Precursor/trigger ID
Posiitive and -ve solutions

Risk assessment-
Remember to consider
Chronic vs acute,
dynamic vs stable->recent change in social network, life events, change in alcohol and drug use

Manage own counter-transference

12

Overall management goals

Effecting change->IPT, emotional insight, defense mechanisms
Risk management
Symptoms relief stabilisers
Improve coping

13

What is reactive capacity mentalisation

Ability to mind read, understand others mental states, emotional awareness

14

Reasons to admit in ED

Uncontainable affect storm
Suicide risk
Crisi intervention
Not to admit-
Calm, ongoing therapy, viable
social support,
Community, risk regression as
in patient

15

What is mentalisation therapy

helps to regulate their
thoughts and feelings by
being attentive to mental
state of self and others

16

What is dialectical based therapy

1. mindfullness->present foccussed, overcome unwanted intrusive thoughts, images and behaviours
2. interpersonal effectiveness
(assertive), negotiating interpersonal challenges, confrontation
3. emotional regulation->skills to replace unhelpful destructive emotion coping,
4. distress tolerance (skills to
tackle extreme emotional
pain) associated with crises

17

Does dialectical based therapy delve into childhood

No, tends to be regressive, and may +suicidal behaviour and acting out

18

Defense mechanisms

Projection
Splitting
Projective identification
Devaluation
Idealisation
Distortion
Acting out

19

What is transference

1. Conflictual thoughts and feelings that constitute the centre of the patient's difficulties are transfereed to the therapist who becomes the object of intense longing, love or hate
2. Recaptulates the experiences with significant others in early childhood
3. Facilitates understanding of how the patient's difficulties arose and their relationship to significant others now