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19/05/2015
Module 1
INTRODUCTION TO BPD
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Welcome
Focus of the course:
• To teach families skills to aid
communication with their loved one and
reduce conflict
• Note: This is a course, not a support
group. Support groups exist such as
Rethink, SANE and Mind.
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Structure of the Course
• Module 1:
Introduction to BPD
• Module 2:
Mindfulness
and Emotion
Management
• Module 3:
Mentalizing
• Module 4:
Validation Skills
• Module 5:
Problem Solving
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Key Areas
• Emotional Problems
• Interpersonal
Problems
• Interpersonal
Sensitivity
• Impulsivity
• Risk
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What is BPD?
1938 – Adolph Stern gave the
name ‘borderline’
• BPD was thought to be on a
border between Psychosis
and Neurosis
We now know they’re not on a
border!
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Criteria in the DSM-5 for BPD
• Avoiding real or imagined abandonment
• Unstable and intense interpersonal relationships
• Identity disturbance
• Impulsivity
• Suicidal or self-mutilating behaviour
• Emotional instability
• Feelings of emptiness
• Inappropriate intense anger
• Stress-related paranoid ideation or severe dissociative symptoms
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How Common is BPD?
• US prevalence: 1.8 – 5.9%
• UK prevalence: 0.7 – 1.0%
• People with BPD are more
likely to visit GP and report psychosocial impairment
Possible factors:
• Culture/family connections
• The way people live
• Earnings gap
• BPD is as common as
schizophrenia, but the public is less aware of it
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Why Do People Develop BPD?
Biology:
• Sensitivity to brain
chemicals
• Overactive amygdala
(emotional brain)
• Underactive prefrontal
cortex (planning and
reasoning brain)
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Why Do People Develop BPD?
Continued...
Genetics and Environment
• Temperament has a genetic
contribution
• ‘Poorness of fit’: Difficult to
parent child with different
temperament
• Cycle of misunderstanding
Attachment Theory
• A temperamentally sensitive
and reactive child can disrupt
the child–parent bond
• How a child develops any
relationship depends on early
experiences
• The attachment process is
where emotion management is
learned
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Assessing Attachment Patterns
Children and mothers can show different patterns of attachment:
• Secure
• Insecure Avoidant
• Insecure Dependent
People with BPD tend to show insecure avoidant or insecure dependent patterns
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How This Ties Together
Biology
Temperament Attachment
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Other Factors
Increased risk of BPD after physical abuse or neglect
• Childhood sexual abuse: 5×more likely to self harm
• People with BPD report high incidence of sexual abuse (40 – 70%)
• In at least 30 – 60% a history of sexual abuse is not present
Having BPD doesn’t mean abuse took place or that parents were bad
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Treatment
4 effective therapies, although
limited NHS availability:
• Dialectical Behaviour Therapy
(DBT)
• Mentalization-Based
Treatment (MBT)
• Schema-Focused Therapy
(SFT)
• Transference-Focused
Therapy (TFT)
Medication:
• No single medication for BPD
• Medication is used to help
associated problems
Structured Clinical Management
For more information:
www.choiceandmedication.org
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More information
Rethink Mental Illness website:
Personality Disorders - Treatments
http://www.rethink.org/diagnosis-
treatment/conditions/personality-disorders/treatments
Mind website:
Mind information sheet: ‘Making sense of dialectical
behaviour therapy’
http://www.mind.org.uk/media/1594506/ms_dbt_2014.
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