Transcript of July 2008 Presented By: Breena Lehan Lindsey Schaumburg Kathleen Bies-Jaede.
- Slide 1
- Slide 2
- July 2008 Presented By: Breena Lehan Lindsey Schaumburg
Kathleen Bies-Jaede
- Slide 3
- The central feature of BPD is a pervasive pattern of
instability, afflicting patients with mood swings, troubled
relationships, frequent self harm, and a rollercoaster emotional
life. The disorder begins by early adulthood. People with
borderline personality disorder are unpredictable, impulsive, prone
to mood swings and erratic, excessive behaviors such as gambling or
sexual promiscuity without consideration of the consequences. They
are prone to outbursts of emotion, and quarrelsome behavior
especially when impulsive acts are thwarted or censored. They are
also easily depressed and tend to class things in black and white
terms. Why the name borderline? The name borderline was coined by
Adolph Stern in 1938. This name was used to describe patients who
were on a borderline between neurosis and psychosis. Throughout
Europe, the same disorder has been given the more appropriate and
less misleading title of Emotionally Unstable Personality
Disorder.
- Slide 4
- Borderline Personality Disorder is the most commonly diagnosed
personality disorder and one of two personality disorders
associated with self-harm behavior. One is BPD and the other is
antisocial behavior disorder. It is estimated that between 2 3% of
the general population are effected.. 75% of people diagnosed with
BPD are female and usually within childbearing age. People
diagnosed with BPD will often have other psychiatric conditions
such as schizophrenia, or other affective disorders and epilepsy.
At least 50% of BPD sufferers also suffer from a major depressive
disorder, dysthymia, both, or identity and interpersonal issues.
They are frequent users of mental health resources Between 40 and
71% of BPD patients report having been sexually abused, usually by
a non caregiver.
- Slide 5
- One in ten people with BPD will commit suicide 70 to 80 % of
patients meeting the diagnostic criteria for BPD self mutilate or
self harm. Very little research has been conducted to investigate
BPD in men, however, men with BPD compared with men suffering from
other personality disorders have shown more evidence of
dissociation, image distortion, frequency of childhood sexual abuse
experiences, longer experiences of physical abuse and experiences
of loss at an early age. Research suggests that male BPD patients
are more regularly diagnosed with substance abuse problems than
female BPD patients are. Clinicians are often wrongly educated or
under educated about BPD and BPD treatments, believing it hopeless
to treat. There is strong evidence from the McLean Study of Adult
Development that 40% of patients with borderline personality
disorder remit after 2 years, with 88% no longer meeting Diagnostic
Interview for Borderlines
- Slide 6
- There are many suggested causes of borderline personality
disorder, but no definite answer. Developmental Often a history of
childhood sexual abuse, physical abuse, witnessing violence in the
home, emotional abuse and neglect. BPD patients often come from a
background of dysfunctional family relationships. This suggests
that trauma and suffering could be a key factor in why people may
go on to develop BPD. It has been suggested that BPD may be a form
of, or similar to post traumatic stress disorder.
- Slide 7
- Biological Genetic Research evidence exists indicating that
parents with BPD have an increased likelihood of having children
who are prone to BPD and other mental disorders. Genetic factors
may cause a slight susceptibility to a person developing BPD. This
susceptibility may only result in a disorder when nurtured in a
triggering environment (i.e. that of abuse or neglect.)
- Slide 8
- Some medical professionals also believe that physical problems
in the brain may be a contributing cause of BPD, (e.g., It has been
suggested that brain damage caused to a baby in the womb or during
or after birth). There is also some evidence of organic lesions in
the brains of people with BPD. It has been theorized that there may
be a chemical dysfunction in the brains of BPD patients. Hormonal
and chemical imbalances found in subjects may explain some of the
symptoms,) e.g., imbalances of several chemicals including
serotonin, dopamine, norepinephrine (noradrenaline) and
acetylcholine monoamine oxidase).
- Slide 9
- Indicated by five (or more): 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 in at least two areas that are potentially
self-damaging
- Slide 10
- Recurrent suicidal behavior, gestures, or threats, or
self-mutilating behavior Affective instability due to a marked
reactivity of mood Chronic feelings of emptiness Inappropriate,
intense anger or difficulty controlling anger Transient,
stress-related paranoid ideation or sever dissociative
symptoms
- Slide 11
- Borderline Personality Disorder Video Clip Borderline
Personality Disorder Video Clip
- Slide 12
- Difficult to treat Goal: Independent functioning rather than
restructuring Long term (1 yr +), mostly outpatient, talk therapy,
reduce the symptoms Medication Treatment usually requires a
combination of therapy and medication. Confounds research study
results. Hospitalization: Suicidal behaviors, Self Mutilations
(Cutting, burning, branding) Expensive Especially ER visits Rarely
appropriate 3 4 week inpatient stay (insurance) Day treatment is
preferred Self-Help
- Slide 13
- Most Effective Psychotherapies Psychotherapy is the most common
treatment for BPD, but there are also some pharmaceutical
approaches to control the symptoms, as well as the use of
techniques developed for post Traumatic stress Disorder (PTSD).
Psychoanalytic Transference-Focused Psychotherapy (TFP) Uses the
counselor/client relationship to reflect TFP may be at least the
equal of DBT. TFP has been associated with improved impulsivity,
irritability, verbal assault, and direct assault. (see case example
in notes) Mentalization-Based Therapy (MBT) Realize mental states
of emotions (see attached notes for case example) Systems Training
for Emotional Predictability & Problem Solving (STEPP). (see
attached notes for case)
- Slide 14
- Dialectical Behavior Therapy (Marsha Linehan) DBT has shown the
highest success rate but this is hardly surprising due to it being
designed specifically for those with this diagnoses. DBT Teaches
control of lives, emotions, and themselves Use of: self-knowledge,
emotion regulation, and cognitive restructuring Group Setting Focus
Not good for individuals that have a hard time learning new
concepts
- Slide 15
- Research shows that some medications reduce the symptoms Should
be used with some form of psychotherapy Antidepressants - (sadness,
low mood, anxiety, emotional reactivity, Antipsychotics -
(anger/hostility, impulsivity, paranoid thinking) Mood
Stabilizers/Anticonvulsants - (impulsivity, rapid mood change)
Anxiolytics (Anti-anxiety) - (Very little research to support use)
Concerns of overmedicating
- Slide 16
- Books Knowledge is power Recognize Symptoms Cognitive Thinking
Behaviors Resources Crisis Hotlines Coping and Control Seek
treatment
- Slide 17
- High burn out rate working with Individuals diagnosed with BPD
A lot of crisis situations Suicidal Concerns or Self Injurious
Behavior Push boundaries/limits Onset of therapy set boundaries
Inappropriate behavior at times
- Slide 18
- American Psychiatric Association. (2000).Diagnostic and
Statistical Manual of Mental Disorders IV-TR (4th ed. Text
revision). Washington Bateman, A. and Fonagy, P. (2008). 8-Year
Follow-Up of Patients Treated for Borderline Personality Disorder:
Mentalization-Based Treatment Versus Treatment as Usual. Am J
Psychiatry 165:5. Blum, St. John, Pfohl, et al. (2008). Systems
Training for Emotional Predictability and Problem Solving (STEPPS)
for Outpatients With Personality Disorder: A Randomized Controlled
Trial and 1-Year Follow-Up. Am J Psychiatry 2008; 165:468478.
Hoglend, P. et al. (2008). Transference Interpretations in Dynamic
Psychotherapy: Do They Really Yield Sustained Effects? Am J
Psychiatry 2008; 165:763771
http://psychcentral.com/disorders/sx10t.htm
http://bpd.about.com/od/treatments/a/BPD treat.htm Silk, K. (2008).
Augmenting Psychotherapy for Borderline Personality Disorder: The
STEPPS Program, Am J Psychiatry 165:4 Yaeger, Joel (2007). How Do
Psychotherapies for Borderline Personality Disorder Compare?
Transference-focused psychotherapy, a psychodynamically based
therapy, seems effective. Journal Watch Psychiatry, July 30.
www.youtube.com
www.nimh.nih.gov/health/publications/borderline-personality-disorder.shtml