borderline personality disorder and other PD's

Question 1

Personality Disorders

What are the 3 clusters (broad strokes) of personality disorders?

Answer 1

A - Odd/eccentric: Schizoid, Schizotypal, Paranoid

B – Dramatic/Emotional: Borderline (BPD), Narcissistic, Antisocial, Histrionic

C – Anxious/Fearful: Dependant, Avoidant, Obsessive-Compulsive Personality Disorder (this is NOT The same at OCD)

Question 2

Personality Disorders

What is a personality disorder?

Answer 2

Enduring pattern of inner experience & behaviour that deviates markedly from expectations of one’s culture.

Manifests in 2+

- cognition 
- affectivity 
- interpersonal functioning 
- impulse control

Question 3

Personality Disorders

Paranoid

Answer 3

distrust and suspiciousness of others such that their motives are interpreted as malevolent

Question 4

Personality Disorders

schizoid

Answer 4

detachment from social relationships and a restricted range of expression of emotions in an interpersonal setting

Question 5

Personality Disorders

schizotypal

Answer 5

social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentric behaviour

Question 6

Personality Disorders

antisocial

Answer 6

disregard for and violating the rights of others, lying, stealing, defaulting on debts, neglect of children and other dependents

Question 7

Personality Disorders

borderline

Answer 7

instability of interpersonal relationships, self-image, and control over impulses

Question 8

Personality Disorders

histrionic

Answer 8

excessive emotionality and attention seeking

Question 9

Personality Disorders

narcissistic

Answer 9

grandiosity, need for admiration, lack of empathy

Question 10

Personality Disorders

avoidant

Answer 10

social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation

Question 11

Personality Disorders

dependent

Answer 11

feelings of inadequacy, inability to make own decisions, submissiveness, avoidance of confrontation for fear of losing source of support

Question 12

Personality Disorders

obsessive-compulsive

Answer 12

preoccupation with perfectionism, mental and interpersonal control, and orderliness, at the expense of flexibility, openness and efficiency

Question 13

Personality Disorders

Epidemiology borderline personality disorder (age, sex, comorbidities)

Answer 13

age: onset teen to early adult
sex: F>M

Comorbidities:

• PTSD
• Eating disorder
• Substance use disorder
• Other personality disorders

Question 14

Personality Disorders

Borderline PD patho

Answer 14

multiple factors

• neurobiologic
• psychosocial
• genetic

Question 15

Personality Disorders

Borderline PD factors associated w/ remission

Answer 15

Remission occurs in 45%

• 35% within 2 years
• 91% within 10 years
• 78% of these had sustained remission for > 8 years

Factors that are associated w/ shorter time to remission:

• Age > 25
• Good functioning at work or school in 2 years prior
• No hx childhood sexual abuse
• No hx substance misuse
• Absence of comorbid anxiety disorder
• Low neuroticism
• High agreeableness and affiliating tendencies

Recurrence is common!

Question 16

Personality Disorders

Signs and symptoms of borderline personality disorder (3 main categories)

Answer 16

• impaired relatedness (identity disturbance, unstable relationships)
• affective dysregulation (anger, affective labillity)
• behaviour dysregulation (impulsivity, suicidality, self-injury)

Question 17

Personality Disorders

Borderline PD red flags

Answer 17

8-12% die by suicide
Take ALL attempts/ideation/plans/threats seriously

Factors for chronic risk:
- impulsivity, negative affectivity, poor psychosocial fntn

Factors for acute risk:

• recent depression
• adverse life events
• substance misuse
• recent loss

Question 18

Personality Disorders

Borderline PD Dx Criteria

Answer 18

5 or more:
1. Frantic efforts to avoid real or imagined abandonment.

2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
4. Impulsivity in at least two areas that are potentially self-damaging
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
6. Affective instability due to a marked reactivity of mood
7. Chronic feelings of emptiness.
8. Inappropriate, intense anger or difficulty controlling anger
9. Transient, stress-related paranoid ideation or severe dissociative symptoms.

Question 19

Personality Disorders

overall treatment strategies for borderline PD

Answer 19

• Containment
• Consistency
• Boundaries
• Work as a team
• Validation
• Resist playing into your role if split
• “DBT light”
• Reframing behaviours:
- Manipulation = attempting to get their needs met
- Splitting = this is unintentional/unconscious

Question 20

Personality Disorders

What are the 4 components of DBT (first-line therapy for BPD)?

Answer 20

dialectical behavioural therapy

• core mindfulness
• interpersonal effectiveness
• distress tolerance
• affective regulation

Question 21

Personality Disorders

Symptom-focused pharm management for patients with cognitive perceptual experiences (dissociation, disturbed identity, hallucinations)

Answer 21

low-dose 2nd-gen antipsychotic

*avoid antidepressant/mood stabilizer

Question 22

Personality Disorders

Symptom-focused pharm management for patients with severe impulsivity/behavioural dyscontrol

Answer 22

mood stabilizer

*avoid antidepressant/antipsychotic

Question 23

Personality Disorders

Symptom-focused pharm management for patients with severe affective dysregulation (depression, mood liability)

Answer 23

mood stabilizer

• avoid antidepressant