Borderline Personality Disorder

1
Borderline Personality Disorder

• How to Recognize, Empathize, and Assist people
  with Borderline Personality Disorder (BPD)
• Jamie Miller, MSW, LCSW-C _at_ JMiller_at_JHHC.com

2
Goals of the Training

• How common is the diagnosis of BPD?
• How can you identify people struggling w/ BPD
  (without over-identifying it)?
• How can you empathize with someone who has BPD?
• What are the Dos and Donts of effective
  communication with someone who has BPD?

3
How Common is BPD?

• 2 of the general population
• 75 of all people w/ BPD are women
• 90 of people w/ BPD will attempt suicide
• 10 of people w/ BPD will commit suicide
• 20 of all IP Psych patients have BPD
• 10 of all OP psych patients have BPD
• The A.P.A.
• The World Health Organization

4
How do you Identify someone w/ BPD?

• Frantic efforts to avoid abandonment
• A pattern of unstable/intense relationships w/
  extremes in idealization and devaluation
• Marked/persistent unstable self-image
• Impulsive/self-damaging behavior
• Recurrent suicidal behavior
• Affective instability
• Chronic feelings of emptiness
• Inappropriate/intense anger
• Paranoid ideation or dissociative symptoms

5
Case Example

• Jackie
• Please take up to five (5) minutes to read the
  case example of Jackie
• Much of the rest of the presentation will refer
  back to this case example
• (see handout)

6
Review of Case Example

• Jackie has the following S/Sxs of BPD
• Frantic efforts to avoid abandonment
• Unstable/intense relationships
• Unstable self-image
• Impulsive self-damaging
• Recurrent suicidal behavior
• Affective instability
• Inappropriate/intense anger
• Stress related paranoid thinking

7
How do you Empathize with BPD?

• Jackie has an expectation that her needs are not
  going to be met in any relationship
• Her needs are primative, preverbal, and are basic
  to anyones feelings of safety security
• She feels misunderstood, mistreated, bored,
  empty, rejected, worthless, she fears for her
  safety/security when left alone
• All of her S/Sxs feel and look worse when she
  feels isolated or abandoned
• There is no maliciousness to her behavior
• only fear anger that shell never have her
  basic needs met by others

8
How do you Assist someone w/ BPD?

• Be clear about maintain your boundaries
• Know your role in the relationship
• Know your buttons and limits
• Know you are never the idealized or the devalued
  object
• Have insight to empathy w/ the feelings
  experiences of the person with BPD
• Practice active listening and be prepared to
  calmly repeat your message in several ways
• Encourage/motivate for active treatment
• Dialectical Behavioral Therapy (DBT)
• Anti-Depressant, Mood Stabilizing, and/or
  Anti-Psychotic medications are helpful

9
Assisting (slide 2)

• Own acknowledge your mistakes
• Model appropriate emotional behavioral control
• Validate the feelings/perceptions of BPD while
  introducing consensual perception (reality)
• Have a 24/7 safety plan in place
• Be sensitive to predict situations that could
  be perceived as abandonment
• I.e. vacations, changes in appointments, etc
• Identify your call to self-defense as a clue
  theres been a miscommunication

10
Assisting (slide 3)

• Remember
• BPD behaviors are primitive/mal-adaptive ways of
  getting the security they need
• Not intended to be manipulative/malicious
• Violence can occur (to the self others) when
  acutely stressed
• Be prepared, trust your gut, have a plan
• Give people with BPD a transitional object during
  separations
• A business card
• An appointment card

11
For More Information on BPD

• Jerold J. Kreisman M.D., Hal Straus. I Hate You,
  Don't Leave Me Understanding the Borderline
  Personality (Avon Books Harper Collins
  Publishers, 1989)
• Swartz M, Blazer D, George L, Winfield I.
  Estimating the prevalence of borderline
  personality disorder in the community. Journal of
  Personality Disorders, 1990 4(3) 257-72.
• Soloff PH, Lis JA, Kelly T, Cornelius J, Ulrich
  R. Self-mutilation and suicidal behavior in
  borderline personality disorder. Journal of
  Personality Disorders, 1994 8(4) 257-67.
• Gardner DL, Cowdry RW. Suicidal and parasuicidal
  behavior in borderline personality disorder.
  Psychiatric Clinics of North America, 1985 8(2)
  389-403.
• Zanarini MC, Frankenburg FR, DeLuca CJ, Hennen J,
  Khera GS, Gunderson JG. The pain of being
  borderline dysphoric states specific to
  borderline personality disorder. Harvard Review
  of Psychiatry, 1998 6(4) 201-7.
• Koerner K, Linehan MM. Research on dialectical
  behavior therapy for patients with borderline
  personality disorder. Psychiatric Clinics of
  North America, 2000 23(1) 151-67.

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More Information (continued)

• Siever LJ, Koenigsberg HW. The frustrating
  no-mans-land of borderline personality disorder.
  Cerebrum, The Dana Forum on Brain Science, 2000
  2(4).
• Zanarini MC, Frankenburg. Pathways to the
  development of borderline personality disorder.
  Journal of Personality Disorders, 1997 11(1)
  93-104.
• Zanarini MC. Childhood experiences associated
  with the development of borderline personality
  disorder. Psychiatric Clinics of North America,
  2000 23(1) 89-101.
• Davidson RJ, Jackson DC, Kalin NH. Emotion,
  plasticity, context and regulation perspectives
  from affective neuroscience. Psychological
  Bulletin, 2000 126(6) 873-89.
• Davidson RJ, Putnam KM, Larson CL. Dysfunction in
  the neural circuitry of emotion regulation - a
  possible prelude to violence. Science, 2000
  289(5479) 591-4.www.
• Zanarini MC, Frankenburg FR. Treatment histories
  of borderline inpatients. Comprehensive
  Psychiatry, in press.
• nimh.nih.gov
• www.borderlinepersonalitytoday.com