Borderline Borderline personality personality of our age of our age

Dusica Lecic TosevskiInstitute of Mental Health

Belgrade

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De natura hominis De natura hominis

It is more important to know what person has a disease, than to know what disease a person has.

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ContentContent

Borderline personality disorderBorderline personality disorder

Borderline personality of our age Borderline personality of our age

Our borderline age Our borderline age

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Crisis of meaning 1Crisis of meaning 1

Civilised world is mortalCivilised world is mortal ““Malady of death” - our most hidden Malady of death” - our most hidden

inner recesses governs: inner recesses governs:

- the military and economic - the military and economic domains, social and political domains, social and political

bondsbonds

- once noble realm of the mind- once noble realm of the mind

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Crisis of meaning 2Crisis of meaning 2

Power of destructive forces within the Power of destructive forces within the individual and societyindividual and society

Destruction of nature, life and economic Destruction of nature, life and economic resourcesresources

Outbreak or a more patent manifestation Outbreak or a more patent manifestation of psychosis, depression, anxiety and of psychosis, depression, anxiety and personality disorderspersonality disorders

Disaster of the mind Disaster of the mind

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Disaster of the mindDisaster of the mind

Greater prevalence of Greater prevalence of personality disorders? personality disorders?

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Literature Classical theatre - Classical theatre -

conflicts of neurotic conflicts of neurotic disordersdisorders

Theatre of the absurd - Theatre of the absurd - borderline conditionsborderline conditions

Samuel Becket - Samuel Becket - Waiting for GodotWaiting for Godot

Albert Camus - Albert Camus - The FallThe Fall

J. P. Sartre - J. P. Sartre - Hell is Hell is other peopleother people

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Personality disorders - Personality disorders - modern concepts and modern concepts and

controversiescontroversies

ClassificationClassification Definition/diagnostics Definition/diagnostics

(borderline personality disorder)(borderline personality disorder) AetiologyAetiology

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Classification DSM-III and IV

Disputable personality disordersDisputable personality disorders

schizotypal (sch spectrum)

schizoid (no patients)

avoidant PD (social phobia?)

dependent (a separate entity?)

depressive (masochistic)

passive-aggressive (defense mechanism)(defense mechanism)

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Classification Classification ICD-10

AdvantagesAdvantages

schizotypal PDschizotypal PD

enduring personality enduring personality changeschanges

passive-aggressive passive-aggressive PDPD

DisadvantagesDisadvantages

narcissistic PD narcissistic PD

borderline PD - borderline PD - emotionally labile PDemotionally labile PD

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Borderline personality disorder

A non-discriminatory synonym for all personality disorders (Kroll, 1983)

Diagnostic “grab bag”

“An adjective in search of a noun” (Akiskal et al., 1985)

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Three concepts of BPDThree concepts of BPD

Borderline personality disorder Borderline personality disorder (Gunderson & Kolb, 1978)(Gunderson & Kolb, 1978)

Borderline personality organisation Borderline personality organisation (Kernberg, 1967-1989)(Kernberg, 1967-1989)

Borderline level of functioning Borderline level of functioning (Berelowitz & Tarnopolski, 1993; Lecic-Tosevski & (Berelowitz & Tarnopolski, 1993; Lecic-Tosevski & Divac-Jovanovic, 1993 -2004)Divac-Jovanovic, 1993 -2004)

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Borderline personality Borderline personality disorderdisorder

Most BPD patients - other cluster B Most BPD patients - other cluster B diagnoses diagnoses

Dissociative identity disorder Dissociative identity disorder

Affective instability - comorbid mood Affective instability - comorbid mood disorders disorders

Five of nine criteria - arbitraryFive of nine criteria - arbitrary

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Borderline personality Borderline personality organisationorganisation

Structural criteriaStructural criteria

diffuse identitydiffuse identity

primitive defences primitive defences

intact reality testingintact reality testing

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SplittingSplitting

clinical marker of severe personality clinical marker of severe personality disordersdisorders

defence of neglected childdefence of neglected child

pre-ambivalencepre-ambivalence

chaotic interpersonal relationshipschaotic interpersonal relationships

contradictory emotions and cognitioncontradictory emotions and cognition

perceptive alterations of self and perceptive alterations of self and objectsobjects

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Borderline level of Borderline level of functioningfunctioning

level of dysfunction of personality disorders level of dysfunction of personality disorders

a non-specific marker of severity of PDsa non-specific marker of severity of PDs

dynamic, transitory dimensiondynamic, transitory dimension

masks of borderline personality disorder (“chameleon masks of borderline personality disorder (“chameleon style”)style”)

manifestation of depression (Lecic-Tosevski, 1993)manifestation of depression (Lecic-Tosevski, 1993)

attenuated (subclinical variant) of affective disorders attenuated (subclinical variant) of affective disorders (Akiskal) (Akiskal)

core BPD core BPD

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Impulsivity Affectiveinstability

Biological risk factors Psychological risk factors

BPD

Loss

Trauma

Parental failure

Social disintegration

Social risk factors

Biopsychosocial model of borderline personality disorder (J. Parris, 1994)

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Social influencesSocial influences

Personality disorders - growing violence?Personality disorders - growing violence? Guiltless participation in sadistic behaviour Guiltless participation in sadistic behaviour

(Milgram,1964)(Milgram,1964) Severe and chronic criminality - Severe and chronic criminality - Licensed Licensed

Mass MurderMass Murder (Dick, 1972) (Dick, 1972) Malignant narcissism Malignant narcissism Social disintegration - episodic antisocial Social disintegration - episodic antisocial

behaviourbehaviour

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Borderline ageBorderline age

Personality disorders - sociocultural Personality disorders - sociocultural phenomena?phenomena?

Culture of narcissism - “Me culture” Culture of narcissism - “Me culture” Collective diffuse identity Collective diffuse identity Globalization and creation of a new Globalization and creation of a new

BabylonBabylon Regression to primitive levels of Regression to primitive levels of

functioning functioning Development of borderline personalities?Development of borderline personalities?

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Disaster of the mind?

Moral behaviour depends upon the Moral behaviour depends upon the social structure (social corruption)social structure (social corruption)

New age favours: New age favours: a) prevalence of personality a) prevalence of personality

disorders? disorders? b) the expression of b) the expression of

personality personality disorders? disorders?

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““ Ήθος ανθρώπου δαίμωνΉθος ανθρώπου δαίμων” ”

Ηράκλειτος ΣκοτεινόςΗράκλειτος Σκοτεινός

Fragment 117Fragment 117