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Personality Disorders > BPD - Lecture 9 > Flashcards

BPD - Lecture 9 Flashcards

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1
Q

What are the general characteristics of BPD?

A

A pervasive pattern of instability in relationships, self-image, and affects, as well as marked impulsivity that starts in adulthood and is present in many contexts

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2
Q

What are some other important features of the disorder?

A
  • Trying to avoid real or imagined abandonment -> Such intense fear leads to inappropriate anger
  • Impulsive actions, e.g. self-mutilating, or suicidal behavior might arise from trying to avoid the feared abandonment
    -> Highest risk of suicide occurs in young adult years, although mean age at suicide was 37.3 years, which indicates that
    suicide completions occur late in the course of the illness, even though attempts at suicide commonly occur in patients in their 20s.
  • Display uncertainty about who they are, therefore their interests and values can change rapidly
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3
Q

What is considered to be the Borderline pattern with regards to emotions?

A

!!! The main feature of BPD and the Borderline pattern is emotional dysregulation !!!
- Other than Emotional Dysregulation (ED), there’s also instability in relationships, cognition and sense of self
!!! Another core feature of the BPD pattern is affective lability !!!
-> Characterized by unstable and reactive moods (anger, anxiousness, tendency to worry and ruminate etc.)
!!! The above two constitute the emotional core of BPD !!!
- This core also includes (also features just not so important as the above two):
-> hypersensitivity: experience everything intensely
-> therefore everything feels overwhelming and intrusive

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4
Q

What other patterns is the BPD pattern of emotions strongly associated to?

A

!!! Cognitive dysregulation !!!
- Characterized by disorganized and confused thinking
!!! Attachment problems !!! -> Insecure and submissive attachment

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5
Q

In general, what is considered the core feature of BPD?

A

ED, but others also believe it’s impulsivitity
- Deliberate self-harm and many other impulsive acts are considered to be secondary to ED.
-> Such acts are usually planned (patients anticipate when and how they’ll carry out these acts

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6
Q

What other disorder is BPD similar to (according to WHO)?

A

Emotionally unstable PD, includes two subtypes:
- Borderline
- Impulsive

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7
Q

What other subtypes of BPD have been proposed?

A

Discouraged, Petulant, Impulsive, and self-destructive
- Someone can have none of these, one, or multiple

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8
Q

What 5 group of symptoms are there in BPD?

A

The five group of symptoms the five areas in which there is dysregulation:
- Emotional
- Cognition
- Behavior
- Sense of self
- Relationships

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9
Q

What are the prevalence rates in BPD?

A

1.5 - 6%
- In outpatient and mental health settings it’s about 20%
- More in females (75%)
- More in young people than older people
- accounts for 20% of hospitalizations

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10
Q

History - 1900’s

What were some first observations about this specific disorder from Stern?

A

Patients with this problem didn’t progress in therapy but became worse.
- Stern said that these patients were unsuitable for treatment because they were borderline between neurosis and psychosis
- Symptoms included difficulties in reality testing, inordinate hypersensitivity

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11
Q

What other similar observations were made about BPD?

A
  • Outcome of treating patients was unstable (Schmideberg)
  • After 5 years, there was little change (Grinker)
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12
Q

What happened in the 1950’s regarding the definition of BPD?

A

The concept of BPD was termed to describe those on the border between neurosis and psychosis.
- This implied that many believed how psychosis and PD’s were related biologically
- Others disagreed with this though

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13
Q

What was a problem with this definition of BPD?

A

It was defined on the basis of theories about mental mechanisms rather than observable behaviors
-> Roy Grinker did a study that gave more weight to clinical observation than to psychodynamic speculations

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14
Q

Who changed this above definition?

A

Gunderson showed that the disorder could be understood in terms of observable behavior criteria and that a semi-structured interview could yield a reliable diagnosis

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15
Q

What did Linehan propose?

A

He proposed the theory that BPD develops mainly from ED.
- Makes sense given that patients with this disorder have more intense emotions to begin with, as well as difficulty regulating them and rapidly shift from one emotion to another

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16
Q

Development and Causes

What is the most common pattern of BPD?

A

Chronic instability in early adulthood, as well as episodes of serious affective and impulsive dys-control

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17
Q

What have been some findings regarding the role of biology in BPD?

A
  • Prognosis for BPD is five times more likely in 1st degree relatives than in the general population
  • Increased familial risk for SUD’s, ASPD, and mood disorders
  • Chromosome 9 was linked to BPD
  • 42% of variation on BPD was features is due to genes, the rest due to environment
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18
Q

What is generally believed about the gene x environment interaction in BPD?

A

The interaction of biology and environment reaches a certain critical level of brain dysfunction
- Can be more biological than environmental dysfunction
- Can be more environmental than biological dysfunction
- Can be an equal contribution from both

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19
Q

What are some important environmental influences for BPD?

A
  • Many people with BPD report having experienced abuse, neglect, or traumatic life experiences throughout their lives
  • Many people have also been exposed to unstable relationships, and there is a strong relationship between child abuse, especially child sexual abuse and BPD
  • Family breakdown is also a risk, although the specific forms of breakdown are not consistent
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20
Q

Effects and Costs

What is the biggest risk factor associated to BPD?

A

Suicide
- 75% of people with BPD will attempt suicide
- 10% will commit suicide
- Repeatedly cutting themselves, trying to hang themselves, or overdosing are also common

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21
Q

What are some problems associated with the diagnosis of BPD?

A
  • There’s a lot of stigma for those diagnosed with the disorder
  • Professionals avoid diagnosing the disorder because of the complexity of it’s symptoms
  • Patient’s behavior: Keeping their appointments erratically in spite of repeatedly requiring emergency responses -> these arouse negative feelings in the therapists and a statement of therapeutic pessimism
    -> These behaviors are seen as intentional and as attention-seeking behaviors
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22
Q

What disorder is BPD usually mistaken for?

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A

Bipolar mood disorder
- Due to similarity of symptoms and more info available to the public about bipolar
DIFFERENCES:
- Mood swings for BPD are more consistent than they are for Bipolar
-> in BPD they occur as part of the person’s general pattern of behaviors rather than as result of situations and cycles

23
Q

In Society

What are two characteristics of this disorder that make them problematic in society?

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A

People’s tendency to lie and manipulate others to gain info
- These characteristics stigmatize people with the diagnosis
(Dramatic portrayals in movies and media also contribute to this stigma)

24
Q

How does society contribute to the development of BPD?

Study These Flashcards
A
  • Traditional societies don’t allow so much for BPD to effect them so much: Anyone who has ED and is impulsive will also be contained by powerful social structures
  • Modern society:
    -> Encourages individuals to separate from parents and assign importance to peers. If peers engage with drugs or sex, one is likely to succumb to that influence. If you’re emotional and impulsive you might be trapped in a path that runs out of control
    !!! In other words, BPD is considered to be a socially sensitive disorder -> Prevalence changes with time and circumstances !!!
25
# At Work How are people with BPD affected in the workplace?
- Their intense emotions make it difficult for them to control their focus and concentration - Difficulties may lead to impaired job performance
26
What is true about BPD in the workplace?
Lower functioning and more disability even when SES, medical conditions and psychiatric problems were controlled - More common for females to experience such disabilities
27
Can BPD be helpful in some professions?
Yes, in the professions that require "black or white thinking" (e.g. police officer, military offices, prison guard and more) - These fields entail positions and situations for power and control over others, being in the “good guy” role, caring for others, or putting bad guys in their place
28
# In relationships What is the general characteristic of people with BPD regarding their relationships?
People with BPD can be very sensitive to how they're treated by others - Feelings about others can shift rapidly from love or admiration to anger and dislike when disappointed or threatened with loss of self-esteem in the eyes of someone they value
29
What is the above pattern of behavior also called (hint: psychodynamic mechanism)
Splitting (shift from idealizing others to devaluating them) - Combined with mood disturbances, splitting can undermine relationships
30
What is true about attachment in patients with BPD?
Demonstrate insecure, avoidant. ambivalent behaviors or preoccupied attachment in relationships - Romantic relationships are characterized by conflict and increased levels of chronic stress
31
What is true about BPD and men?
Traits and temperaments linked to BPD run contrary to gender stereotypes about how men should be. This may create shame in men. In order to deny their insecurity they're be willing to accept the label of ASPD, impulse control disorder or depression because they sound more manly (In other words, they use cover for the real issues)
32
# Theory and Research High sensitivity to rejection is another important symptom of BPD. What brain functions have been shown to be linked to it?
Executive functions. They're the mediator between rejection sensitivity and and BPD symptoms - High executive functions might protect those with high sensitivity to rejection from BPD symptoms
33
What other association is there between a BPD symptom and brain functions?
Impulsivity and poor working memory
34
What's the relationship between parenting and BPD?
Two types of parental behavior has been shown to be associated with BPD: - Neglectful - Overprotective
35
What is the relationship between BPD and abuse?
25-73% of patients have reported severe physical abuse !!! Relationship between sexual abuse and BPD has been most studied !!! - 70% of patients report that type of abuse - 1/3 reported abuse involving an incestuous perpetrator, severe sexual abuse, and high frequency or long duration !!! All of the above indicate that trauma is an important etiological factor for BPD !!!
36
Comorbidities with BPD?
-75% -> Another mood disorder (especially MDD and B1) - 75% -> Another anxiety disorder - 73% -> SUD - 40% -> PTSD
37
Gender differences in comorbidities?
- Females: more PTSD - Males: more SUD
38
Other comorbid PD's with BPD?
!!! More than 2/3's of those with BPD also have criteria for another Axis 2 Disorder !!! - Most prevalent comorbid PD's: Cluster A Disorders (around 50%) - Comorbidity with Cluster B Disorders: NPD>ASPD>HPD
39
Gender differences in comorbidities?
- Females: more PTSD - Males: more SUD
40
Why is BPD controversial as a distinct diagnostic entity?
Many features of BPD meet the criteria for other PD's as well. These suggest that BPD is an artificially circumscribed category to distinguish it from other diagnoses, and it might refer more o a severe personality dysfunction, rather than a distinct diagnostic entity
41
What is the Diagnostic Interview for Borderline Patients (DIB)
A semi-structured interview that assesses people's psychopathology in (different than main 5) four domains of BPD psychopathology (affective, cognitive, impulsive, interpersonal) - Each domain is scored separately, with a maximum score of 10 - 8/10 on each domain is the cutoff for BPD
42
What is observed in people with BPD on their scores on the BIG 5?
High on neuroticism, low on conscientiousness and agreeableness !!! Since most PD's tend to be continuous with normal personality traits, this is a main argument in support of a dimensional system !!! - Although it's good for describing traits that underlie BPD, such a dimensional system can't account for BPD's symptoms
43
What has been observed regarding facial expressions and how people with BPD perceive them?
They're unusually sensitive to facial expressions and are particularly accurate in identifying negative emotions, while others with BPD are very hypersensitive to faces expressing fear. - Other experience neutral faces as threatening
44
What are the findings regarding brain differences in BPD (compared to healthy people)?
- Amygdala: -> Smaller and less activation = explains how they experience emotions stronger and for longer (especially negative emotions) - Hippocampus: Smaller - PFC: Less activity - Elevated cortisol production, leading to a hyperactive HPA. This explains elevated stress, which explains as well increased susceptibility to irritability, as well as increased risk for suicide - Anterior insula: Less activity, involved in emotional responses to all kinds of stimuli. Explains why those with BPD have problems with trust - Other parts of the brain: Activate in healthy people when responding to disturbing emotional scenes. These brain regions don't activate in those with BPD. Explains why they can't use those parts of their brain to regulate emotions - Important for ED: Increased activity in brain circuits when coupled with reduced activation of brain circuits that normally regulate these painful emotions, brings about dysfunction in fronto-limbic systems = Leads to experience of heightened emotional discomfort
45
What is the relationship between thought discomfort and BPD?
Influences the relationship between an invalidating environment and BPD symptoms
46
Relationship between brain regions and opioid receptors?
Had more receptors for opioids but less of the chemical itself. Explains the self-harm tendencies of such patients
47
# Treatment (Repetition of basic stuff on BPD)
Most common PD in those among treatment, 30 to 60% of patients with BPD have a diagnosis of BPD
48
What should therapists focus on for treating the disorder?
The comorbid disorders - Half of BPD patients experience hallucinations as well as other cognitive symptoms, such as sub-paranoid feelings, and these require specific management
49
What is the current treatment choice for BPD?
Long-term psychotherapy, specifically DBT and psychodynamic approaches
50
Is it effective?
Not really (same shit as other PD's) - During first 5 sessions of therapy 30% of patients drop out
51
What is the lapse between when people develop the disorder and get the right diagnosis?
5 years
52
What seem to be the most effective treatments?
DBT and Mentalization based treatments (MBT). - They share many similarities
53
What are the features of DBT?
- They help patients accept themselves as they are - Integrates traditional cognitive behavioral therapy (CBT) elements with mindfulness, acceptance, and techniques to increase a person’s stress tolerance and emotional control.
54
What medication is used to treat PD's?
- Antidepressants to treat impulsivity - Anticonvulsants to balance emotions and reduce impulsive outbursts !!! No medication demonstrates promise for the core symptoms of BPD, such as chronic feelings of emptiness, identity disturbance, and abandonment

Personality Disorders (7 decks)

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