(BPD) DSM-3 Criteria
Intense affect
Impulsivity
Relationship problems
Brief psychotic experiences
BPD
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
BPD Diagnostic Criteria (5+)
1) frantic efforts to avoid real of imagined abandonment
2) a pattern of unstable and intense interpersonal relationships
3) Identity disturbance
4) impulsivity in at least two areas that are potentially self-damaging
5) Recurrent suicidal behaviors, gestures, threats, or self-mutilating behavior
6) affective instability due to a marked reactivity of mood
7) chronic feelings of emptiness
8) inappropriate, intense anger, or difficulty controlling anger
9) transient, stress-related paranoid ideation or severe dissociative symptoms
(BPD) Emotional Instability
-Emotions INTENSELY felt
-More difficult to control
-Angry outbursts often a part of the clinical picture
-Family members often report “walking on eggshells”
(BPD) Backwards Masking Paradigm
show emotional face for 30 milliseconds (such a short time that it is under conscious awareness) only and then same actors face shown neutral 170 milliseconds
BPD Amygdala Activity
-when viewing fearful vs. happy faces - viewing fearful and happy faces below the level of where they are able to report that they saw them
-Consistent with it that they are detecting emotional content where even other psychiatric patients are not really see it - reacting to things that other people are not even processing
BPD & Serotonin
-low 5-HT (serotonin) activity
-treated with SSRIs show improvements in aggressive impulsivity but not overall symptoms
BPD & Dopamine
-evidence for dopamine dysfunction
- because antipsychotic meds moderately effective in treating BPD
-Also inferred through behaviors:
Impulsivity, sensation-seeking, emotion dysregulation
(BPD) Relationship Instability
-Emotional instability often triggered by loss, rejection, disappointment
-Perceived or experienced
-Unstable representations of others
-Switch from idealizing to anger and wanting to punish
(BPD) Fear of Rejection
-coupled with fear of becoming too attached
-Leads to “testing” significant others
-want close relationships very badly, but they know that attachment is very scary because of there is this break in it - that relationship is going away
BPD Relationship Insight
-Almost always have insight into the fact that they tend to have these catastrophic relationships with people
-don’t always have insight into why these relationships are/often turn out this way
BPD & Spousal Abuse
-Men who engage in spousal abuse often very high on BPD characteristics
-About 40% engaging in this violence meet criteria
-Susceptible because they set unreasonably high standards for their partner, they blame partner when things go wrong and get really angry, poor impulse control
(BPD) Unstable Sense of Self
-Self-concept very fragile - typically very negative
-Persistent sense of “emptiness” - hard to tolerate being alone
-better understand themselves through relationships with other people, threat to relationships = threat to sense of self
BPD & Risky Behaviour
-High rates of alcohol, substance abuse
-Spending sprees
-Risky sexual behaviors
-Gambling
-Eating binges
-Non-suicidal self-injury & suicide risk
BPD & NSSI
VERY common in BPD, prevalence estimates vary
BPD & Suicide
-Suicidal ideation very common
-Suicide attempts: as many as 70%
-With an average of 3-4 attempts
-Often seen in those who profoundly lack resources to be able to communicate with others, so they feel it’s the only way to make others lives better or to bring attention to the issue
(BPD) Reasons for Suicide Attempts
-Often a manipulation attempt - trying to control other people
-To get away, or escape from an intolerable pain
-To punish self
-Revenge
-Most common: to make others better off
(BPD) Dissociation
Some 75% experience intensely paranoid ideas and/or episodes of dissociation
(BPD) Stiglmayr Experiment
-BPD > stress than clinical controls and healthy controls (represents conflict with other people)
-BPD > dissociative experiences (frequency and intensity) - dissociative experiences even seen however in healthy controls, for example, zoning out while driving etc.
-Dissociation linked to stress for all groups - present in BPD even under relatively low levels of stress
(BPD) Group 1
Non-labile type; lack of affective instability and low levels of dissociative symptoms and fear of abandonment, but pretty high levels of identity disturbance, unstable relationships, impulsivity
(BPD) Group 2
dissociative / paranoid type; high levels of dissociative and paranoid symptoms but low abandonment fears and identity disturbance
(BPD) Group 3
Interpersonally unstable type; high efforts to avoid abandonment and interpersonal aggression
BPD Prevalence
1-2%
Higher in clinical settings (10-15%)
BPD Genetics
-BPD runs in families
-Also find higher rates of SUD, APD, externalizing, MDD in family members of those with BPD
-Has a genetic component (twin studies) but it’s not totally clear why
