What’s in a name ……..
emotional instability in
Adolescence
•
Demelza Heneghan CNM 2
Hospital,
St. Josephs Adolescent Day
Emotionally Unstable [Borderline] Personality Disorder F60.3 - ICD10
Description, World Health Organization
Emotionally unstable [borderline] personality disorder is characterized by a definite
tendency to act impulsively and without consideration of the consequences; the mood is
unpredictable and capricious. There is a liability to outbursts of emotion and an
incapacity to control the behavioural explosions. There is a tendency to quarrelsome
behaviour and to conflicts with others, especially when impulsive acts are thwarted or
censored. Two types may be distinguished:
Impulsive Type
Borderline Type
•Emotional instability
•lack of impulse control
( In addition) by disturbances in
•self-image, aims, and internal
preferences, by chronic feelings of
emptiness, by intense and unstable
interpersonal relationships, and by a
tendency to self-destructive behaviour,
including suicide gestures and attempts.
Borderline Personality Disorder - Diagnostic Criteria, American Psychiatric Association DSM
An individual diagnosed with borderline personality disorder needs to show at least 5 of the
following criteria
•Frantic efforts to avoid real or imagined abandonment.
•A pattern of unstable and intense interpersonal relationships characterized by
alternating between extremes of idealization and devaluation.
•Identity disturbance: markedly and persistently unstable self-image or sense of self.
•Impulsivity in at least two areas that are potentially self-damaging (e.g., spending,
sex, Substance Abuse, reckless driving, binge eating).
•Recurrent suicidal behaviour, gestures, or threats, or self-mutilating behavior.
•Affective instability due to a marked reactivity of mood (e.g., intense episodic
dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more
than a few days).
•Chronic feelings of emptiness.
•Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays
of temper, constant anger, recurrent physical fights).
•transient, stress-related paranoid ideation or severe dissociative symptoms.
• This enduring pattern of inner experience and behavior
must deviate markedly from the expectations of the
individual's culture.
• This enduring pattern is inflexible and pervasive across
a broad range of personal and social situations.
• This enduring pattern leads to clinically significant
distress or impairment in social, occupational, or other
important areas of functioning.
DSM – IV states , ‘personality disorder categories may be applied to
children or adolescents in those relatively unusual instances in which
the individual's particular maladaptive personality traits appear to be
pervasive , persistent and unlikely to be limited to a particular
developmental; stage or an episode of and Axis 1
disorder……………..severe enough that behavioural manifestations
persistently interfere with the an adolescents
daily functioning over the course of 1 year or longer.
Fact or fiction: Diagnosing borderline personality
disorder in adolescents
Alec L. Miller, Jennifer J. Muehlenkamp , Colleen M. Jacobson
Received 15 March 2007; received in revised form 7 February 2008; accepted 13 February
To name or not to
name……..
One example……..
CAMHS
Paediatric
inpatient
assessment
Day Hospital
Adolescent
Inpatient
Unit
Inpatient admission
Overlap x4 weeks
with the day hospital
Day Hospital admission
X 2 weeks
Ind. / parent
Discharge overlap
with CAMHS x 2 weeks
Integrated Care Plan
Nursing Care Plan
1. Psychoeducation
using a DBT Framework
– Interpersonal effectiveness
– Distress tolerance
– Emotional regulation
– Mindfulness
Both with young person
& parent/carer
2. Skills training
• Utilising the DECIDER Programme on
an individual basis
As a service ….
• Individualised care plan
• Intensive psychoeducation
• Careful consideration of multiple service
involvement and the yp moving through
this
Randi Kreger and Paul T. Mason explain in their book
“Stop Walking on Eggshells,” you may inadvertently
trigger a BPD emotional outburst but your behavior
didn’t cause it.
Thank you !!
Fortunately, the critical importance of prevention, early identification, and
early intervention has gained traction for all forms of illness, and mental
disorders in particular have been referred to as the chronic diseases of the
young. Brain development during childhood and adolescence is complex
As adolescents are expected to engage in more independent emotion
regulation and self-control strategies, deficits in self-regulatory skills
become more apparent during this developmental period.
Can one accurately assess and identify BPD in children and adolescents?
How does one understand the development or early precursors of BPD in Children and
adolescents.