Borderline personality

Question 1

Epidemiology

Answer 1

1-2 % population
+In women
FHx of depression and substance abuse

Question 2

Etiology

Answer 2

1. The good mother, who provides for, loves, and remains close to the child
2. The hateful, depriving mother, who unpredictably punished and abandons the child.
3. Attribute -ve feelings to environment
4. Separation from mother, early child abuse
5. Disruption of early attachments + trauma= hyperresponsiveness. Poor affect regulation, information processing, memory negatively impacted
6. No reactive capacity mentalisation->ability to understand mentation of others->cannot mind read, Xunderstand mental states, emotions and motivations of others.
7. Distorted attachment: Unpredictable, dangerous
8. Disorganised
9. Ineffective strategies to engage with attachM figure
10. Mood instability, unstable relationships,
    manipulative, controlling

Question 3

Clinical features AM SUICIDE

Answer 3

Abandonment issues
Mood and affect instability
Suicide
Unstable/intense relationships
Impulsive
Control of anger poor
Identity disturbance, unstable self image
Depression
Emptiness

1. Affect
2. Cognition->paranoia, quasi-psychosis
3. Behaviour->substance, suicidality, impulsive
4. Interpersonal relationships->instability, dependency, fear abadonment

Question 4

Psychosis in BPD

Answer 4

Brief, no thought disorder.

Question 5

What is projective identification

Answer 5

Intolerable aspects of self are projected on therapist.
Need to react neutrally.
Provoke people to behave in a way which keeps with their beliefs
Feelings congruent with one’s owns are induced in another, thereby creating a sense of being understood by or being “at one” with the other person

Question 6

What is splitting

Answer 6

Splitting off a persons good and bad characteristics into two separate and nonoverlapping views of a person which alternate

Will characterise person as all good or all bad depending on which side the split is on

Question 7

Management

Answer 7

Pharmacotherapy
Psychotherapy
-Transference focused
-Mentalisation based therapy
-Dialectical based in first line

Question 8

When might pharmacotherapy be appropriate

Answer 8

For co-morbid aspects->depression, anxiety, impulsive, psychotic episodes

Question 9

Community health management

Answer 9

Crisis management->collaboration with patient, family, identify triggers/risk factors, behaviours, identify key contact person
Case management
-Long term goals
-Psychotherapy
-Pharmacotherapy->SSRIs, atypical antipsychotics, mood stabilisers

Question 10

Acute inpatient

Answer 10

Brief, goal,
avoid negative reactions,
stabilise internal environment
(counselling, supportive)
Stabilise external
(psychosocial, OP treatM,
address stressors)

Question 11

ED management

Answer 11

Managing affect storm-->
Project calm, confidence
Engage
Clarify emotions
Precursor/trigger ID
Posiitive and -ve solutions

Risk assessment-
Remember to consider
Chronic vs acute,
dynamic vs stable->recent change in social network, life events, change in alcohol and drug use

Manage own counter-transference

Question 12

Overall management goals

Answer 12

Effecting change->IPT, emotional insight, defense mechanisms
Risk management
Symptoms relief stabilisers
Improve coping

Question 13

What is reactive capacity mentalisation

Answer 13

Ability to mind read, understand others mental states, emotional awareness

Question 14

Reasons to admit in ED

Answer 14

Uncontainable affect storm
Suicide risk
Crisi intervention
Not to admit-
Calm, ongoing therapy, viable
social support,
Community, risk regression as
in patient

Question 15

What is mentalisation therapy

Answer 15

helps to regulate their
thoughts and feelings by
being attentive to mental
state of self and others

Question 16

What is dialectical based therapy

Answer 16

1. mindfullness->present foccussed, overcome unwanted intrusive thoughts, images and behaviours
2. interpersonal effectiveness
   (assertive), negotiating interpersonal challenges, confrontation
3. emotional regulation->skills to replace unhelpful destructive emotion coping,
4. distress tolerance (skills to
   tackle extreme emotional
   pain) associated with crises

Question 17

Does dialectical based therapy delve into childhood

Answer 17

No, tends to be regressive, and may +suicidal behaviour and acting out

Question 18

Defense mechanisms

Answer 18

Projection
Splitting
Projective identification
Devaluation
Idealisation
Distortion
Acting out

Question 19

What is transference

Answer 19

1. Conflictual thoughts and feelings that constitute the centre of the patient’s difficulties are transfereed to the therapist who becomes the object of intense longing, love or hate
2. Recaptulates the experiences with significant others in early childhood
3. Facilitates understanding of how the patient’s difficulties arose and their relationship to significant others now