Borderline Personality DisorderPresented by: APS HealthcareSouthwestern PA Health Care Quality Unit(HCQU) July, 2009/eas
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Note of Clarification While mental retardation (MR) is still recognized as a clinical diagnosis, in an effort to support the work of self-advocates, the APS SW PA HCQU will be using the terms intellectual and/or developmental disability (I/DD) to replace mental retardation (MR) when feasible.
Objectives Upon completion of the session the participant will: • Define Borderline Personality Disorder • List symptoms of BPD • Recall current treatment methods for BPD
Personality Disorders • Enduring pattern of inner experience and behavior that deviates from the expectations of the person’s culture • AXIS II Disorder • Pervasive and inflexible • Onset in adolescence/early adulthood • Stable over time • Leads to stress or impairment
Borderline Personality Disorder Definition A pervasive pattern of instability of interpersonal relationships, self-image and affects, and marked impulsivity that begins by early adulthood and is present in a variety of contexts
BPD Symptoms • Frantic efforts to avoid abandonment • Pattern of unstable and intense interpersonal relationships
BPD Symptoms • Identity disturbances • Impulsivity • Suicidal/self-injurious behavior
BPD Symptoms • Affective instability • Chronic feelings of emptiness • Difficulty controlling feelings of anger
Splitting • “Black and white” thinking • People are viewed as either “good” or “bad” • One day idolizes caretaker, the next day devalues them • Difficulty tolerating human ambiguities and inconsistencies
Co-occurring Disorders • Mood Disorders • Eating Disorders • Substance Related Disorders • Posttraumatic Stress Disorder • Attention-Deficit/Hyperactivity Disorder • Other Personality Disorders
BPD Facts • 2% of the general population • About 80% are women • Chronic, severe problems continue for years • Tends to “burn out” in middle age • Females more likely to have mood disorder and be self-destructive • 1/10 succeed in committing suicide
BPD Facts • History of abuse is common • Resistant to treatment • Males with BPD prone to domestic violence, rage attacks • Males more likely to also have attention-deficit disorder or antisocial personality disorder
Causes of BPD • No single cause • Genetic predisposition • Neurofunction
Causes of BPD • Environment • Child abuse, trauma, or neglect • Environment lacks consistent expectations and emotional security • Invalidating environment • Vary with individuals
Validating vs. Invalidating Statements • Validating Statements • Encourage Coping Skills • Validate the person’s feelings • Promote healthy expression • Invalidating Statements • Teach suppression of emotions • Cause anger or rage attacks • Prevent coping skills
Treatment of BPD • Rule out possible medical conditions • Dialectical Behavior Therapy (DBT) • Marsha Linehan, PhD • Medications
Dialectical Behavior Therapy (DBT) • Cognitive-behavioral treatment targeted to treat people with complex, difficult-to-treat mental disorders • The goal is “a life worth living” • DBT skills training • Mindfulness • Emotion Regulation • Interpersonal Effectiveness • Distress Tolerance
Medications • Never the only answer • Typically used to treat co-occurring disorders • Antidepressants • Selective Serotonin Reuptake Inhibitors (SSRIs) • Mood stabilizers • Antipsychotics • Be aware of side effects
Positive Approaches • All behavior is meaningful • People have good reasons to do what they do • People do the best they can with what they know at that point in time and in that context
Supporting a Person with BPD • Don’t take things personally • Validate • Build mastery • Be aware of your moods and affect • Communicate with team and therapist • Encourage healthy diet, sleep, exercise • Take care of yourself
References • The Clinical Characteristics and Management of Borderline Personality Disorder in Mentally Retarded Persons, MHDD 1988/Vol 7/N0 7&8. Hurley, A. and Sovner, R. • Diagnostic and Statistical Manual of Mental Disorders, Fourth Revision, Text Revised. 2000, American Psychiatric Association. • “I Hate You, Don’t Leave Me: Understanding the Borderline Personality”, Jerold J. Kriesman, M.D. and Hal Straus. • Skills Training Manual for treating Borderline Personality Disorder, Linehan, Marsha M., Ph.D. 1993.
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EvaluationPlease take a few moments to complete the evaluation form found in the back of your packets.Thank You!
Test ReviewThere will be a test review after all tests have beencompleted and turned in to the Instructor.