which symptoms imporve after treatmant and which do not
- general severity, impulsivity, suicidality, affective instability, anger, dissociation
improve - general severity and affactive instability
dont improve - impulsivity, suicidality, anger, dissociation
is BPD more common in men or women
in clinical settings female but in general setting equal
what is the prevalence of NSSI and SSI
NSSI - 61-90%
- most commonly met diagnostic criterion
SSI - 9 - 33% of all completed suicides
- 50 x more than in the general populatiion
what is the most effective treatment for BPD
schema therapy
emotional cascade model
- Negative affect(anger, anxiety) and negative cognition(rumination, devaluation, low self worth) exaggerate each other
- Increased activation of amygdala and not developed pfc makes the experience of things more extreme often seen in teens and adults bpd patients
- If this emotional cascade gets rolling NSSI is often used to relieve this
- Short lived effects – (positive) decrease in neg and increase in pos affect
- Long term negative effects – decrease in pos and increase in neg affectt
functions of NSSI
- relief from feeling too much - most common
- to elicit feelings bcs of not feeling enough
- to avoid social responsibilities
- manipulate
why is signing a contract to stop engaging in NSSI a bad idea
- its ineffective - the person is in a different state of mind when signing then when harming
- iatrogenic effect - behaviors become more covert ( a state of ill health or adverse effect caused by medical treatment)
what is paranoid ideation
feeling threatened, persecuted or conspired against, transient stress-related paranoia
what is the difference between paranoid ideation and epistemic hypervigilance
paranoid ideation si about believing that others have malicious intentions distrusting the person,
epistemic hypervigilance si about the distrust of information and the sources of it rather than the intent behind it
splitting
inability to hold opposing thoughts
- black or white
what is healthy ambivalence
- its merging of idealisation and devaluation - healthy ambivalence
- missing in patients with BPD
what is self other distinction and how is it conected to BPD patients
SOD is the ability of distinguishing ones own body, actiona and mental states from those of others, its essential to interacting with others while maintaining a stable sense of self
patients with BPD have poor SOD
- Mental State Attribution system (MSA) - underdeveloped
- frontoparieral mirror neuron system - overactive - shared representational system (SR)
what are the differences and similarities of HPD and mania
simmilaritiy - grandiosity, excessive talking
difference - long term vs brief mood swings
differences and similarities betwen HPD and BPD
similarities - attention seeking manipulative shifting affect
differences - BPD - self harm, anger, chronic emptines, identity issues
differences and similarities betwen HPD and NPD
differences - NPD is abt reaffirming own grandiosity, tehy are willing to look weak for attention
similarities - attention seeking
what are some characteristics of BPD
identity distrubance, unstable relationships, emotional instabiliy, impulsivity
what is the most comorbid disorder of BPD
MDD - higher suicide risk
what are some common countertransferences with BPD
- criticised/mistreated
- distzressing
- overwhelmed
- special/overinvolved
- sexualized
what are some common transferences in BPD
- paranoid
- narcissistic
- erotic
- depressive
what are the 2 primary pitfals when diagnosing BPD with comorbid mood disorders and what are the results of it
- not diagnosing BPD just mood disorders
- leads to ineffective polypharmacy nad increased risk of suicide and hosiptalisatiin - not didagnsing mood disorder
- increased risk of suicidality and hosipitalisation
BPD can and should be treated even if the patient has a mood disorder
name some of the main HPD symptoms
attention seeking, shallow affect, seductivity, excessive emotionality
what is the distinction between someone who is sociable and someone who has HPD
sociable ppl adjust to the social norms while HPD ppl ignore or dont recognise them bcs of intense need for attention
what emotion drives attention seeking in HPD
anxiety
Millon’s HPD Subtypes
- Appeasing: Attention-seeking behavior coupled with a desperate need for friendship and acceptance driven by fear and anxiety; may engage in abusive
or predatory partnerships with codependent traits. - Vivacious: Charming, seductive, but emotionally empty; at times, efferves-
cent to the verge of hypomania; struggles with complex emotional attachment, so relationships’ are short-lived and shallow, with a lack of empathy consistent with narcissistic behavior. - Tempestuous: Emotionally labile, quick to anger, will engage in conflict if it
serves perceived attention needs. Shares several traits with borderline per-
sonality disorder and/or bipolar 2 because of excessive mood lability and irritability. - Disingenuous: Attention-seeking behavior is grounded in a desire to manip-
ulate or control others for the patient’s personal amusement, particularly in
the naïve or unsuspecting; possesses many narcissistic qualities. - Theatrical: Self-promoting and seeks praise and adulation for superficial features such as clothing or appearance. The need for external admiration may
exceed the need to maintain strong friendships. - Infantile SubtypeShares features of its tempestuous counterpart, but behaviors don’t match her developmental age. Behaviors may arrange themselves in a borderline fashion; may pout and cry for attention, or present as volatile and respond inappropriately to perceived “injustices” -cancellation of plans due to work commitments,
