BORDERLINE PERSONALITY

DISORDER
Rop Kipkemoi Titus
HSN211-0036/2020
 PERSONALITY DISORDERS
• Personality – derived from the Greek term
persona.
• DSMIV-5-Defn personality traits as enduring
patterns of perceiving, relating to, and thinking
about the environment and oneself that are
exhibited in a wide range of social and personal
contexts.
• Personality disorders occur when these traits
become inflexible and maladaptive and cause
either slight functional impairment or subjective
distress.
 Conti..
• Personality dev occurs in response to
bio & psych influences e.g. heredity,
temperament, experiential learning
and social interaction.
 DSM-5: Criteria for Dx
1. Cluster A: Behaviours described as odd or
eccentric
a) paranoid personality disorder
b) schizoid personality disorder
c) schizotypal personality disorder
2. Cluster B: Behaviours described as dramatic,
emotional or erratic
a) antisocial personality disorder
b) borderline personality disorder
C) schizotypal personality disorder
 Conti..
3. Cluster C: Behaviours described as anxious or
fearful
a) avoidant personality disorder
b) dependent personality disorder
c) obsessive – compulsive personality disorder
d) passive-aggressive personality disorder
 Borderline Personality Disorder

• Most common form of PD occurring in every

culture
• Prevalence estimates 2-3% of general
population
• More common in than men than women
ratios being estimated as 4:1
• ICD-10 – emotionally unstable disorder
 Defining characteristics
• Relationships with others are intense and
unstable, and alternate between intense
dependence and rejection.
• Behaviours are often impulse and self-
damaging (eg spending, unsafe, sex,
substance abuse, reckless driving, binge
eating)
• Recurrent suicidal and/or self mutilating
behaviours are common, often in response to
perceived threats of rejection, separation.
 Conti..
• Chronic feelings of emptiness or boredom, and
an absence of self-satisfaction.
• Frantic efforts to avoid real or imagined
abandonment
• Intense affect is manifested in outbursts of anger,
hostility, depression and primitive anxiety.
• Intense and primitive rage often counters
therapy and takes the form of extreme sarcasm,
ending bitterness and angry outbursts at others.
 Conti.
• Major defense is splitting which often
manifests in putting one person or group
against another (good guy Vs bad guys)
• Splitting is only one form of manipulation that
individuals with BPD use.
• Rapid idealization devaluation is a classic
signal behaviour suggestive of borderline
psychopathology or some other primitive
personality.
 Conti..
• Transient quasi:-psychotic symptoms may
develop in the form of paranoid or dissociate
symptoms during lines of stress.
Nursing guidelines
• Set realistic goals, use clear action words.
• Be aware of manipulative behaviours (flattery,
seductiveness, guilt instilling)
• Provide clear and consistent boundaries and
limits
 Conti..
• Use clear and straight forward communication
• When behavioural problems emerges calmly
review the thematic goals and boundaries of
treatment
• Avoid rejecting or rescuing
• Assess for suicidal and self-mutilating
behaviours especially during times of stress.
.
 Treatment
• No guaranteed treatment for BDP
• Psychodynamically oriented therapy is
commonly recommended.
• Dialectical behavioural therapy – behaviorally
based testament which targets the highly
dysfunctional behaviours seen in patient with
BPD.
• Short-term hospitalization during periods of
suicidal or self-mutilating behaviour or severe
depression
 Conti..
• Long-term OPD therapy
• Carefully chosen group therapy if appropriate
for paitent.
• A combination of psychotherapy and
medicines.
• Medicines can decrease anxiety, depression,
and disruptive impulses
• Decrease dose antipsychotics may be useful
for severity cognitively disturbed individuals.
 Conti..
• SSRIs may help in anger control
• Carbamazepine can decrease frequency and
severity of behavioural dyscontrol episodes,
suicidality and temper outbursts.