Borderline Personality Disorder (BPD)

  1. Symptoms: a pervasive pattern of instability in self-image, interpersonal relationships, and mood; difficult to be alone; intense, unstable relationships that can be seen as manipulative; mood may shift rapidly and inexplicably; intense anger that may be accompanied by temper tantrums, physical assault, or suicidal threats/gestures; identity disturbance, alternating between unrealistically positive view of the self and unrealistically negative views of the self; uncertainty about issues such as personal values, sexual preferences, and career alternatives; chronic feelings of emptiness and boredom; anxiousness; separation insecurity; submissiveness; depressivity; hostility; impulsivity; risk taking
  2. Diagnosis: Must have a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated in 5 of more of the following: 1. Frantic efforts to avoid real or imagined abandonment, 2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation, 3. Identity disturbance: markedly and persistently unstable self-image or sense of self, 4. Impulsivity in at least two areas that are potentially self-damaging (spending, sex, substance abuse, reckless driving, binge eating), 5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior, 6. Affective instability due to a marked reactivity of mood (intense episodic dysphoria, irritability, or anxiety), 7. Chronic feeling of emptiness, 8. Inappropriate. Intense anger or difficulty controlling anger (frequent displays of temper, constant anger, recurrent physical fights), 9. Transient, stress-related paranoid ideation or severe dissociative symptoms
  3. Course and Outcome: recovery rqates are relatively high among those with BPD ; if treatment is initialized early in their twenties and followed through into their thirties and forties, only 1 in 4 still qualify got the BPD diagnosis
  4. Frequency of Disorder: overall lifetime prevalence of having at least 1 personality disorder is 10%; at least 50% of people that meet the diagnostic criteria for 1 personality disorder meet the criteria for another disorder; 75% of those who meet the diagnostic criteria for a personality disorder also meet the criteria for another syndrome such as major depression, substance abuse, or an anxiety disorder; BPD is among the most common personality disorder among patients treated at a mental health facility (both inpatient and outpatient setting) accounting for 30%; BPD is somewhat more prevalent in women than men
  5. Etiology: Genetic factors; environmental factors; parental loss, neglect, and mistreatment during childhood; problematic relationships with parents; lack of supervisions, frequently witnessing domestic violence, and being subjected to inappropriate behaviors by parents/adults (verbal, physical, and sexual abuse)
  6. Treatment(s): Psychotherapy; psychodynamic therapy; ½ to 2/3 of BPD patients discontinue treatment within the first several weeks; dialectical behavior therapy (DBT)- DBT shows a higher improvement in women than those who have treatment as usual, spent fewer days in psychiatric hospitals, reduced frequency and severity of suicide attempts; psychotropic medication, though there is no disorder specific drug

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