BPD

Question 1

DSM-5

Answer 1

Instability, impulsivity, interpersonal difficulties. 5 om;

1. Efforts to avoid real/imagined abandonment
2. Unstable/intense interpersonal relationship altering between idealization/devaluation
3. Identity disturbance, markedly unstable sense of self
4. Impulsivity in at least 2 damaging areas
5. Recurrent suicidal behavior/gesters/threats
6. Affective instability due to reactivity of mood
7. Chronic feelings of emptiness
8. Inappropriate/intense anger. difficulty controling anger
9. Stress-related paranoid ideation/dissociation.

Question 2

Prev

Answer 2

General population: 2.7-5.9%
Clinical: 15-28%

Comorbid:
- Depressive
- Bipolar
- Anxiety (shared underlying trait)
- PTSD
- SUD (impulsivity/emotion regulation)
- Eating disorders
- ADHD

Mostly explained by overlap in symptoms in these disorders. Cause poorer outcomes + more suicide attempts

Question 3

NSSI and suicide

Answer 3

BPD commit suicide 50x more often than general pop.

above 90% evolve in NSSI

Question 4

Neurological alterations

Answer 4

Reduced gray matter, abnormalities in amygdala/insula (emotion processing) and areas involved in regulatory control.

Impaired top down decision making wr to trustworthiness appraisal.

Question 5

assessment

Answer 5

1. Establish chief complaint
   - Not just focus on symptoms, but on life in general. 3 spheres; love/sex, work/career, leisure.
   - Need to consult w former treaters/family
   - Extra care for suicidality, attempts NSSI etc.
2. Focus on background to the problem (hisotry
3. Obtain relevant developmental/family history
4. Formulate initial diagnosis (wr to comorbid)

Question 6

(Counter)transference

Answer 6

Transference:
- Narcissistic (attempt to control)
- Erotic
- Depressive (after devaluation)

counter:
- Special/overinvolved (favourite patient, excessive self-disclosure, guilt/pity etc)
- Sexualized
- Criticized/mistreated (undervalued, inadequate compared to other patients)
- Parental (re parenting, compensating)

Question 7

Effective treatment

Answer 7

DBT (change & acceptance)
CBT (Altering core beliefs)
ST (adapt schema modes)
MBT (Increasing mentalization)
TFP (Object-relations, adresses identity disturbance/suicide behaviour)
DSP
GPM

NO MEDICATION USE

Question 8

Mentalizing

Answer 8

Overreliance on affective dominated and highly externally based mentalizing

empathy paradox (higher mentalizing capacity) is explained by tendency to hypermentalize when making sense of external cues (negative attentio bias).

Hightened SR activity, immpaired MSA