Cluster B: Borderline PD Flashcards
(9 cards)
Cluster B
Dramatic, emotional, erratic - Wild
Criteria
5 or more of the following
* Frantic efforts to avoid real or imagined abandonment
* a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
* identity disturbance markedly and persistently unstable self-image or sense of self
* impulsivity and at least two areas that are potentially self-damaging
* E.g. spending, sex, substance abuse, reckless driving, binge eating
* recurrent suicidal Behavior gestures or threats or self-mutilating behavior
* affective instability due to a marked reactivity of mood
* E.g. intense episodic dysphoria irritability or anxiety usually lasting a few hours or only rarely more than a few days
* chronic feelings of emptiness
* inappropriate intense anger or difficulty controlling anger
* transient stress-related paranoid ideation or severe dissociative symptoms
Main characteristics
- Instability in interpersonal relationships, self-image, and affects
- Marked impulsivity
Associated features
- Instability in multiple aspects of life
- Reports of ACEs (adverse childhood experiences)
- Several common co-ocurring disoders
- High prevalence of co-ocurring disorders: depressive and bipolar disorders, PTSD, ADHD, eating disorders, substance use
- behavior may result in job loss, academic disruptions, or relationship instability
- Emotionally intense, sensitive to rejection, and reactive to interpersonal slights
Diagnostic features
- Core symptoms include emotional dysregulation, impulsivity, relationship instability, and unstable self-concept.
- Commonly reported behaviors include self-sabotage (e.g., quitting just before success), splitting (idealizing/devaluing others), and suicidal/self-injurious behaviors.
- Often report Adverse Childhood Experiences (ACEs), including abuse, neglect, or parental loss.
- May develop brief psychotic symptoms during stress (e.g., hallucinations, body distortions, or ideas of reference).
- Prefer inanimate transitional objects over actual relationships for emotional comfort.
Differential diagnoses
- Depressive/Bipolar Disorders: Co-occurring is common. Avoid diagnosing BPD based only on mood episodes; look for enduring patterns.
- Histrionic PD: Both are attention-seeking and manipulative, but BPD includes self-destructiveness, emptiness, and unstable identity.
- Schizotypal PD: Shares paranoid ideas, but BPD symptoms are more interpersonally reactive and transient.
- Paranoid/Narcissistic PD: Both may have anger issues, but BPD is more unstable, impulsive, and emotionally reactive.
- Antisocial PD: Both may manipulate, but BPD manipulates for emotional response (caretaking), while ASPD manipulates for material gain.
- Dependent PD: Both fear abandonment; BPD reacts with rage and clinging, while dependent PD reacts with submissiveness and appeasement.
- Identity Problems: Adolescents may show temporary identity crises that do not indicate BPD.
- Personality Change Due to Another Medical Condition: Exclude conditions that could mimic BPD symptoms.
- Substance Use Disorders: Exclude symptoms caused by substance intoxication or withdrawal.
Gender and prevalence
- Prevalence: 1.6-5.9%
- 6% in primary care, 10% in outpatient, and 20% in inpatient settings
- About 75% of diagnosed cases are female
- May be underdiagnosed in males and misattributed to other disorders
Cultural considerations
- Present globally in various cultures.
- Adolescents and young adults may show transient symptoms due to identity crises, cultural expectations, or life stressors—not necessarily indicative of BPD.
- Clinicians should consider developmental and cultural context before diagnosing.
Early signs
- Family history of BPD, substance use disorders, antisocial PD, bipolar, or depression increases risk.
- Early emotional sensitivity, intense mood swings, and difficulty managing emotions.
- Childhood experiences of physical or sexual abuse, parental loss, neglect, or hostile/conflicted family dynamics are common precursors.
- Early signs of impulsivity, identity confusion, and interpersonal turmoil may emerge in adolescence.
