© 2009 APS Healthcare, Inc.
Borderline Personality Disorder
Presented by: APS Healthcare
Southwestern PA Health Care Quality Unit
(HCQU)
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July, 2009/eas

Disclaimer
Information or education provided by the HCQU is not intended to replace medical advice from the consumer’s personal care physician, existing facility policy or federal, state and local regulations/codes within the agency jurisdiction. The information provided is not all inclusive of the topic presented.
Certificates for training hours will only be awarded to those who attend a training in its entirety. Attendees are responsible for submitting paperwork to their respective agencies .
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© 2009 APS Healthcare, Inc.

Note of Clarification
While mental retardation (MR) is still recognized as a clinical diagnosis, in an effort to support the work of self-advocates, the APS SW PA HCQU will be using the terms intellectual and/or developmental disability (I/DD) to replace mental retardation (MR) when feasible.
© 2009 APS Healthcare, Inc.
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Upon completion of the session the participant will:
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Define Borderline Personality Disorder
2.
List symptoms of BPD
3.
Recall current treatment methods for BPD
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 Enduring pattern of inner experience and behavior that deviates from the expectations of the person’s culture
 AXIS II Disorder
 Pervasive and inflexible
 Onset in adolescence/early adulthood
 Stable over time
 Leads to stress or impairment
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A pervasive pattern of instability of interpersonal relationships, self-image and affects, and marked impulsivity that begins by early adulthood and is present in a variety of contexts
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 Frantic efforts to avoid abandonment
 Pattern of unstable and intense interpersonal relationships
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 Identity disturbances
 Impulsivity
 Suicidal/self-injurious behavior
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 Affective instability
 Chronic feelings of emptiness
 Difficulty controlling feelings of anger
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 “Black and white” thinking
 People are viewed as either “good” or “bad”
 One day idolizes caretaker, the next day devalues them
 Difficulty tolerating human ambiguities and inconsistencies
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 Mood Disorders
 Eating Disorders
 Substance Related Disorders
 Posttraumatic Stress Disorder
 Attention-Deficit/Hyperactivity Disorder
 Other Personality Disorders
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 2% of the general population
 About 80% are women
 Chronic, severe problems continue for years
 Tends to “burn out” in middle age
 Females more likely to have mood disorder and be selfdestructive
 1/10 succeed in committing suicide
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 History of abuse is common
 Resistant to treatment
 Males with BPD prone to domestic violence, rage attacks
 Males more likely to also have attention-deficit disorder or antisocial personality disorder
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 No single cause
 Genetic predisposition
 Neurofunction
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 Environment
– Child abuse, trauma, or neglect
– Environment lacks consistent expectations and emotional security
– Invalidating environment
– Vary with individuals
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 Validating Statements
• Encourage Coping Skills
• Validate the person’s feelings
• Promote healthy expression
 Invalidating Statements
• Teach suppression of emotions
• Cause anger or rage attacks
• Prevent coping skills
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 Rule out possible medical conditions
 Dialectical Behavior Therapy (DBT)
– Marsha Linehan, PhD
 Medications
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 Cognitive-behavioral treatment targeted to treat people with complex, difficult-to-treat mental disorders
 The goal is “a life worth living”
 DBT skills training
– Mindfulness
– Emotion Regulation
– Interpersonal Effectiveness
– Distress Tolerance
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© 2009 APS Healthcare, Inc.

 Never the only answer
 Typically used to treat co-occurring disorders
 Antidepressants
– Selective Serotonin Reuptake Inhibitors (SSRIs)
 Mood stabilizers
 Antipsychotics
 Be aware of side effects
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© 2009 APS Healthcare, Inc.

 All behavior is meaningful
 People have good reasons to do what they do
 People do the best they can with what they know at that point in time and in that context
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 Don’t take things personally
 Validate
 Build mastery
 Be aware of your moods and affect
 Communicate with team and therapist
 Encourage healthy diet, sleep, exercise
 Take care of yourself
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© 2009 APS Healthcare, Inc.

 The Clinical Characteristics and Management of Borderline
Personality Disorder in Mentally Retarded Persons, MHDD
1988/Vol 7/N0 7&8. Hurley, A. and Sovner, R.
 Diagnostic and Statistical Manual of Mental Disorders, Fourth
Revision, Text Revised. 2000, American Psychiatric Association.
 “I Hate You, Don’t Leave Me: Understanding the Borderline
Personality”, Jerold J. Kriesman, M.D. and Hal Straus.
 Skills Training Manual for treating Borderline Personality
Disorder, Linehan, Marsha M., Ph.D. 1993.
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© 2009 APS Healthcare, Inc.

© 2009 APS Healthcare, Inc.
To register for future trainings, or for more information on this or any other physical or behavioral health topic, please visit our website at www.hcqu.apshealthcare.com
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© 2009 APS Healthcare, Inc.
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Please take a few moments to complete the evaluation form found in the back of your packets.
Thank You!

There will be a test review after all tests have been completed and turned in to the Instructor.