July 2008
Presented By:
Breena Lehan
Lindsey Schaumburg
Kathleen Bies-Jaede


The central feature of BPD is a pervasive pattern of instability,
afflicting patients with mood swings, troubled relationships, frequent
self harm, and a rollercoaster emotional life. The disorder begins by
early adulthood. People with borderline personality disorder are
unpredictable, impulsive, prone to mood swings and erratic, excessive
behaviors such as gambling or sexual promiscuity without consideration
of the consequences. They are prone to outbursts of emotion, and
quarrelsome behavior especially when impulsive acts are thwarted or
censored. They are also easily depressed and tend to class things in
black and white terms.
Why the name borderline?
The name borderline was coined by Adolph Stern in 1938. This name
was used to describe patients who were on a ‘borderline’ between
neurosis and psychosis. Throughout Europe, the same disorder has
been given the more appropriate and less misleading title of
‘Emotionally Unstable Personality Disorder.’





Borderline Personality Disorder is the most commonly
diagnosed personality disorder and one of two
personality disorders associated with self-harm
behavior. One is BPD and the other is antisocial behavior
disorder.
It is estimated that between 2‐3% of the general
population are effected..
75% of people diagnosed with BPD are female and usually
within childbearing age.
People diagnosed with BPD will often have other
psychiatric conditions such as schizophrenia, or other
affective disorders and epilepsy. At least 50% of BPD
sufferers also suffer from a major depressive disorder,
dysthymia, both, or identity and interpersonal issues.
They are frequent users of mental health resources
Between 40 and 71% of BPD patients report having been
sexually abused, usually by a non‐caregiver.




One in ten people with BPD will commit suicide
70 to 80 % of patients meeting the diagnostic criteria
for BPD self mutilate or self harm.
Very little research has been conducted to investigate
BPD in men, however, men with BPD compared with men
suffering from other personality disorders have shown
more evidence of dissociation, image distortion,
frequency of childhood sexual abuse experiences, longer
experiences of physical abuse and experiences of loss at
an early age. Research suggests that male BPD patients
are more regularly diagnosed with substance abuse
problems than female BPD patients are.
Clinicians are often wrongly educated or under educated
about BPD and BPD treatments, believing it hopeless to
treat. There is strong evidence from the McLean Study of
Adult Development that 40% of patients with borderline
personality disorder remit after 2 years, with 88% no
longer meeting Diagnostic Interview for Borderlines
There are many suggested causes of borderline
personality disorder, but no definite answer.
 Developmental
 Often a history of childhood sexual abuse,
physical abuse, witnessing violence in the home,
emotional abuse and neglect. BPD patients
often come from a background of dysfunctional
family relationships. This suggests that trauma
and suffering could be a key factor in why
people may go on to develop BPD.
 It has been suggested that BPD may be a form
of, or similar to post traumatic stress disorder.

 Biological

Genetic
Research evidence exists
indicating that parents with BPD have an
increased likelihood of having children who are
prone to BPD and other mental disorders.
Genetic factors may cause a slight
susceptibility to a person developing BPD. This
susceptibility may only result in a disorder
when nurtured in a triggering environment (i.e.
that of abuse or neglect.)


Some medical professionals also believe that
physical problems in the brain may be a contributing
cause of BPD, (e.g., It has been suggested that
brain damage caused to a baby in the womb or
during or after birth). There is also some evidence
of organic lesions in the brains of people with BPD.
It has been theorized that there may be a chemical
dysfunction in the brains of BPD patients. Hormonal
and chemical imbalances found in subjects may
explain some of the symptoms,) e.g., imbalances of
several chemicals including serotonin, dopamine,
norepinephrine (noradrenaline) and acetylcholine
monoamine oxidase).
Indicated by five (or more):
 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
 Recurrent
suicidal behavior, gestures,
or threats, or self-mutilating behavior
 Affective instability due to a marked
reactivity of mood
 Chronic feelings of emptiness
 Inappropriate, intense anger or difficulty
controlling anger
 Transient, stress-related paranoid ideation
or sever dissociative symptoms
 Borderline
Personality Disorder Video Clip




Difficult to treat
Goal: Independent functioning rather than restructuring
Long term (1 yr +), mostly outpatient, “talk therapy”,
reduce the symptoms
Medication


Treatment usually requires a combination of therapy and
medication. Confounds research study results.
Hospitalization: Suicidal behaviors, Self Mutilations
(Cutting, burning, branding)
Expensive Especially ER visits
 Rarely appropriate
 3 – 4 week inpatient stay (insurance)
 Day treatment is preferred


Self-Help

Most Effective Psychotherapies


Psychotherapy is the most common treatment for BPD, but
there are also some pharmaceutical approaches to control
the symptoms, as well as the use of techniques developed for
post Traumatic stress Disorder (PTSD).
Psychoanalytic
 Transference-Focused Psychotherapy (TFP)
Uses the counselor/client relationship to reflect
TFP may be at least the equal of DBT. TFP has been
associated with improved impulsivity, irritability, verbal
assault, and direct assault. (see case example in notes)
Mentalization-Based Therapy (MBT) Realize mental
states of emotions (see attached notes for case example)




Systems Training for Emotional Predictability &
Problem Solving(STEPP). (see attached notes for case)
Dialectical Behavior Therapy (Marsha Linehan)
 DBT has shown the highest success rate but this
is hardly surprising due to it being designed
specifically for those with this diagnoses.
 DBT Teaches control of lives, emotions, and
themselves
 Use of: self-knowledge, emotion regulation, and
cognitive restructuring
 Group Setting Focus
 Not good for individuals that have a hard time
learning new concepts

 Research
shows that some medications
reduce the symptoms

Should be used with some form of
psychotherapy




Antidepressants - (sadness, low mood, anxiety,
emotional reactivity,
Antipsychotics - (anger/hostility, impulsivity,
paranoid thinking)
Mood Stabilizers/Anticonvulsants - (impulsivity,
rapid mood change)
Anxiolytics (Anti-anxiety) - (Very little research to
support use)
 Concerns
of overmedicating
 Books

Knowledge is power

Recognize
 Symptoms
 Cognitive Thinking
 Behaviors
 Resources

Crisis Hotlines
 Coping
and Control
 Seek treatment
 High
burn out rate working with Individuals
diagnosed with BPD



A lot of crisis situations
Suicidal Concerns or Self Injurious Behavior
Push boundaries/limits


Onset of therapy set boundaries
Inappropriate behavior at times




American Psychiatric Association. (2000).Diagnostic and Statistical Manual of
Mental Disorders IV-TR (4th ed. Text revision). Washington
Bateman, A. and Fonagy, P. (2008). 8-Year Follow-Up of Patients Treated for
Borderline Personality Disorder: Mentalization-Based Treatment Versus
Treatment as Usual. Am J Psychiatry 165:5.
Blum, St. John, Pfohl, et al. (2008). Systems Training for Emotional Predictability
and Problem Solving (STEPPS) for Outpatients With Personality Disorder: A
Randomized Controlled Trial and 1-Year Follow-Up. Am J Psychiatry 2008;
165:468–478.
Hoglend, P. et al. (2008). Transference Interpretations in Dynamic
Psychotherapy: Do They Really Yield Sustained Effects? Am J Psychiatry 2008;
165:763–771

http://psychcentral.com/disorders/sx10t.htm

http://bpd.about.com/od/treatments/a/BPD treat.htm


Silk, K. (2008). Augmenting Psychotherapy for Borderline Personality Disorder:
The STEPPS Program, Am J Psychiatry 165:4
Yaeger, Joel (2007). How Do Psychotherapies for Borderline Personality Disorder
Compare? Transference-focused psychotherapy, a psychodynamically based
therapy, seems effective. Journal Watch Psychiatry, July 30.

www.youtube.com

www.nimh.nih.gov/health/publications/borderline-personality-disorder.shtml