Lecture 9

Question 1

What is said about BPD?

Answer 1

• Look at the internal conflict to understand the interpersonal conflict
• To treat, longterm and go back to this internal conflict
• Main difference when you’re working with PDs- take control of regulation

Question 2

What does a BPD profile look like? (three parts)

Answer 2

1. Interpersonal relationships and self-image:
   * Efforts to avoid real/imagined abandonment
   * Unstable/intense relations > splitting idealization/devaluation (different reactions-same feeling)
   * Identity disturbance
2. Impulsivity
   * **Turbulence comes from the inside **
   * Self-damaging, self-mutilation, suicidal behavior
3. Affect
   * Marked reactivity > affective instability (swinging more than changing)
   * Anger
   * Paranoid ideation/dissociation

Question 3

What other symptom can be found in BPD that is very differentiating?

Answer 3

Chronic sense of emptiness
* Can lead to detaching behaviors
* It is egosyntonic (as opposed to in MDD)

Question 4

What prevalences are found in BPD? (general-outpatient-inpatient-forensic)

Answer 4

• General: 2.7%
• Outpatient: 10-12%
• Inpatient: 22%
• Forensic: 18-30%

Question 5

What disorders co-occur a lot in BPD (from most to least)?

Answer 5

Mood, anxiety, SUD, other PDs, ADHD, BD (different rates for I and II)

Question 6

When is it difficult to distinguish between BD and BPD? And why is it needed?

Answer 6

• When BPD + affect problems are present
• To pick the right treatment
  > BPD: psychotherapy, BD: medication

Question 7

What treatments are available for BPD?

Answer 7

• DBT
• ST
• Mentalization
• Transference-focused
• TAU (least effective)

Question 8

What symptoms can be difficult to improve in BPD treatment?

Answer 8

Impulsivity, suicidality, dissociation, anger (ISDA)

Question 9

Why is splitting not part of ST?

Answer 9

It originates from psychoanalysis

Question 10

What causes differences in interpretations between patients with BPD and healthy samples?

Answer 10

Different information processing related to the PFC

Question 11

What is self-other distinction and what happens in BPD?

Answer 11

• Equal amount of focus on the self as on the other > co-regulation, connection and social learning
• Impaired
  > Egocentric: rigid focus on self
  > Altercentric: rigid focus on other

Question 12

What is the vicious cycle of BPD?

Answer 12

[vulnerability] > emotional distress
[punitiveness] > problem coping behaviors
[impulsiveness] > adverse life events

Question 13

Why do patients often feel stuck in this cycle?

Answer 13

Changing patterns doesn’t feel safe

Question 14

What is the most important mechanism of change in BPD?

Answer 14

The connection between the healthy adult and the vulnerable child (intrapersonal dynamics are very important)

Question 15

What can be therapist pitfalls in BPD?

Answer 15

Counter-transference:
* Surrendering: passive + increasingly angry
* Self-sacrificing
* High standards
* Emotional restriction

Question 16

What does a profile for someone with HPD look like?

Answer 16

• Attention: need to be the center of attention, sexually seductive/provocative, style of speech impressionistic
• Theatrical: self-dramatization, suggestible, easily influenced, considers relationships more intimate than they actually are
• Emotional shift: rapid, shallow

Question 17

What is a difference between BPD and HPD?

Answer 17

In HPD, the focus is external