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Early Interventions – Borderline Personality Disorder

Early Interventions – Borderline Personality Disorder. Kate Sloan Nurse Practitioner in Psychotherapy. Early Interventions. Detect illness Early treatment Reduce risk of relapse Evidence within mental health, physical health and health promotion. What about BPD?.

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Early Interventions – Borderline Personality Disorder

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  1. Early Interventions – Borderline Personality Disorder Kate Sloan Nurse Practitioner in Psychotherapy

  2. Early Interventions • Detect illness • Early treatment • Reduce risk of relapse • Evidence within mental health, physical health and health promotion

  3. What about BPD? • Common mental health problem • Costly to services – recurrent re-admissions, crisis interventions, social functioning. • Disabling condition – impacting relationship functioning and employment

  4. No longer a diagnosis of Exclusion - 2004 • Attitude has been less than favourable • Seen as being to blame for their problems (Becker, 2000) • Less empathy (Markham and Tower, 2003) • Malignant alienation (Watts and Morgan, 2004)

  5. Diagnosis • Mean age of onset – 18 years • Issues around diagnosis with young people: • Difficulty distinguishing between BPD and normal adolescence • Ethical concerns • Risks associated with early interventions • Instability of the diagnosis

  6. Precursors to BPD • Highly lightly that there are precursors to the development of BPD • What are the early signs that may lead an individual on a trajectory towards adult BPD. • Crick et al, 2001

  7. Failure to negotiate salient development tasks • Hostile paranoid view of the world • Intense, unstable and inappropriate emotional expression • Overly close relationships • Impulsivity • Lack of coherent sense of self • More studies needed to explore theory further • Geiger and Crick, 2001

  8. Is BPD treatable? • Yes – Matrix, 2008 • Mentalization based therapy – (Bateman and Fonagy, 1999) • Dialectical Behavioural Therapy – (Linehan, 1994) • Cognitive Behavioural Therapy (Davidson, 2009) • Schema Focused Therapy – (Young, 1990)

  9. Early Interventions • Minding the baby • Cognitive Analytical Therapy – with Adolescents • Few studies but a desire to develop more

  10. How do we assess for BPD – Dimensional model • Dysphoric affect • Disturbed cognition • Impulsive behaviour • Troubled relationships • Zanarini et al, 1989

  11. Talk openly • Share diagnosis or the potential to develop the diagnosis • Share how you came to this thinking • Share formulation

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