Bipolar And Borderline Powerpoint 4 10 08

Borderline Personality Disorder

Stephanie EllingtonChristina Fraser

Loredana PampinellaBrianne Whitmire

Borderline Personality DisorderExtent of the Problem

• A serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior.

• Instability often disrupts family and work life, long-term planning, and the individual's sense of self-identity (NEA-BPD, NIMH).

DSM-IV General Diagnostic Criteria:

Personality Disorders

A. An enduring pattern of inner experience and behaviorthat deviates markedly from the expectations of the individual’s culture. This pattern is manifested in two (or more) of the following areas: 1. Cognition (i.e., ways of perceiving and interpreting

self, other people, and events2. Affectivity (i.e., the range, intensity, lability, and

appropriateness of emotional response)3. Interpersonal functioning4. Impulse control

DSM-IV General Diagnostic Criteria:

Personality DisordersB. The enduring pattern is inflexible and pervasive across

a broad range of personal and social situations.C. The enduring pattern leads to clinically significant

distress or impairment in social, occupational, or other important areas of functioning.

D. The pattern is stable and of long duration, and its onset can be traced back at least to adolescence or early adulthood.

E. The enduring pattern is not better accounted for as a manifestation of or consequence of another mental disorder.

F. The enduring pattern is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medicaiton) or a general medical condition (e.g. head trauma).

DSM-IV Diagnostic Criteria:Borderline Personality Disorder

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:• Frantic efforts to avoid real of imagined

abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.

• 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). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.

• Recurrent suicidal behavior, 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


• Less well known than schizophrenia or bipolar disorder, yet BPD is more common.

• Affects 2% of adults, mostly females (NEA-BPD, NIMH).


• An individual with borderline personality disorder was originally described as being on the "borderline" of psychosis, but BPD is now known to be a disorder of emotion regulation (NIMH).

• Borderline individuals exhibit high rates of self-injury, with and without suicidal intent (NIMH).


• Borderline personality disorder is commonly comorbid with depression (Clarkin, 1993).

• BPD accounts for 20% of psychiatric hospitalizations (NIMH).

• Many individuals with BPD receive counseling & medication, and are able to live productive lives (NIMH).

Women & Borderline

• Johnson (1991) reports that the literature shows that every social work setting includes BPD clients and that most are women.

Women & Borderline

• Weaver (1993) found that BPD women in their study:– were significantly more depressed– had more severe & chronic

psychiatric histories– had more bipolar diagnoses than the

non-BPD women

Women & Borderline

• Weaver (1993) studied 36 depressed women roughly half with a BPD diagnosis and half without.– Study found that early childhood

trauma of sexual abuse is a significant predictor of BPD diagnosis.

Borderline Personality DisorderBehavioral Characteristics

• Clarkin (1993) found significantly high rates of neuroticism, hostility and impulsiveness, suspicion, alienated feelings, and pleasure seeking behaviors.

• Extremely self-conscious and vulnerable• High rate of comorbidity with depression. • Neuroticism and agreeableness related to

unstable relationships, suicidal behavior, identity diffusion, and fear of abandonment (Clarkin, 1993).


• Weaver (1993) found that the family of origin of a BPD client is reported to be more conflictual and more controlling, as well as less cohesive and less expressive.


• Individuals with BPD exhibit behavior that is dramatic, emotional, and/or erratic.

• The borderline traits are ingrained in the individual’s character and cause maladaptive thoughts and behavior in their relations with others (Kreisman, 1989).


• Trull (1995) found that participants exhibiting BPD characteristics were significantly different than participants not exhibiting BPD characteristics, via self-report inventory on the measures of personality, mood-affect, coping styles, interpersonal stress, and general psychopathological symptoms.


• Grilo (2004) found that suicidal manifestation or self-injurious behavior was predictive of an 80% likelihood that the patient would meet the full criteria for BPD.

• The presence of paranoia and dissociation were predictive factors in 1/3 to 1/2 of the diagnoses of borderline.

• Affective instability is the most common symptom of BPD (Grilo, 2004).

Borderline Personality DisorderVideo

• http://youtube.com/watch?v=pxJn0kmJnXI

http://youtube.com/watch?v=pxJn0kmJnXI

http://youtube.com/watch?v=pxJn0kmJnXI

Borderline Personality DisorderForms of Treatment/Therapy

• The literature shows that psychotherapy is significantly helpful for the individual with BPD (Clarkin, 2006).

• Effective therapeutic interventions include psychodynamic, cognitive, and a combination psychodynamic and cognitive approaches (Clarkin, 2006).

• Dialectical behavioral therapy (DBT) is the most highly regarded approach, with evidence of reducing suicidal behavior and other borderline symptoms (Clarkin, 2006).

Borderline Personality Disorder Forms of Treatment/Therapy

• Johnson (1991) encourages counselors to learn about medications.

• Counselor needs to know when to refer for psychiatric intervention or medication and how to monitor the patient who has begun pharmaceutical treatment (Johnson, 1991).

• Understand biological aspects of the disorder & teach the client about the underlying reasons for their symptoms.

Borderline Personality DisorderSuggested Strategies for Counselors

• Johnson (1991) notes BPD client aggression toward therapist, which accompanies hostility and dependent feelings.

• The client’s mood alternates between extreme idealization and great disappointment.

• Borderline patients tend to terminate therapy abruptly when asked to face painful issues (Johnson, 1991).

Borderline Personality DisorderConclusions

• BPD is a common disorder and difficult to treat.

• There is hope in effective therapeutic intervention and adjunct pharmaceutical intervention.

• Counselors must educate themselves about this disorder, as the diagnosis of BPD is more common than bipolar and schizophrenia, yet it is less well known (NEA-BPD, 2007; NIMH, 2007).

Borderline Personality DisorderConclusions

• Borderline clients are notoriously difficult to work with.– Counselors will need extensive training,

education, and supervision to adequately treat this population.

– Individuals with borderline personality disorder are present in all mental health settings.

– Attention to literature and training courses will help the counselor to better serve and advocate for the client with BPD.

References1. Clarkin, J.F., Hull, J.W., Cantor, J., & Sanderson, C. (1993). Borderline personality disorder and

personality traits: A comparison of SCID-II BPD and NEO-PI. Psychological Assessment, 5, 472-476.

2. Clarkin, J.F., & Levy, K.N. (2006). Psychotherapy for patients with borderline personality disorder: Focusing on the mechanisms of change. Journal of Clinical Psychology, 62, 405-410.

3. Grilo, C.M., Becker, D.F., Anez, L.M., & McGlashan, T.H. (2004). Diagnostic efficacy of DSM-IV criteria for borderline personality disorder: An evaluation in Hispanic men and women with substance use disorders. Journal of Consulting and Clinical Psychology, 72, 126-131.

4. Johnson, H.C. (1991). Borderline clients: Practice implications of recent research. Social Work, 36, 166-173.

5. Kreisman, J.J., & Straus, H. (1989). I hate you – don’t leave me. Los Angeles, CA: Avon Books.

6. National Education Alliance for Borderline Personality Disorder. (2007). What is borderline personality disorder. Retrieved November 27, 2007, from http://www.neabpd.org/index.html

7. National Institute of Mental Health. (2007). Suicide in the U.S.: Statistics and prevention. Retrieved November 27, 2007, from http://www.nimh.nih.gov/health/publications/borderline-personality-disorder.shtml

8. Trull, T.J. (1995). Borderline personality disorder features in nonclinical young adults: 1. Identification and validation. Psychological Assessment, 7, 33-41.

9. Weaver, T.L., & Clum, G.A. (1993). Early family environments and traumatic experiences associated with borderline personality disorder. Journal of Consulting and Clinical Psychology, 61, 1068-1075.

http://www.nimh.nih.gov/health/publications/borderline-personality-disorder.shtml








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Bipolar And Borderline Powerpoint 4 10 08