Recognizing Borderline Recognizing Borderline Personality Traits: Personality Traits:

How to know if someone How to know if someone can benefit from DBTcan benefit from DBT

Paula Mendenhall, LMHC, LPHA

Personality Disorder

An enduring patter of inner experience and behavior that deviates markedly

from the expectations of the individual's culture. This pattern is manifested in two

or more ways:Cognition

AffectInterpersonal Functioning

Impulse Control

Borderline Personality Disorder

Pervasive pattern of instability in: Interpersonal relationships Self Image Affect Marked Impulsivity Beginning in early adulthood Present in a variety of contexts

Five or More of these

Frantic efforts to avoid abandonment Pattern of intense, unstable relationships –

idealization & devaluation Identity disturbance: unstable image of self Impulsivity in at least 2 areas that are potentially self

damaging Recurrent suicidal gestures, threats OR self

mutilation Mood instability, reactivity of mood Chronic feelings of emptiness Inappropriate intense anger or difficulty controlling

anger Transient, stress related paranoid ideation or severe

dissociative symptoms

Emotional Chaos

“People with BPD seem to have no internal governor. They are powerfully connected to the people close to them and terrified by the possibility of losing them - yet they attack those people so unexpectedly that they often ensure the very abandonment they fear. When they want to hold, they claw instead! What defines BPD -and makes it so explosive - is the sufferers' inability to modulate their feelings and behavior. When faced with an event that makes them depressed or angry, they often become inconsolable or enraged”.

BPD in a nutshell

“Borderline individuals are the psychological equivalent of third-degree-burn patients. They simply have, so to speak, no emotional skin. Even the slightest touch or movement can create immense suffering.”

Marsha Linehan

“The methods of self-harm that borderlines choose can be gruesomely creative. One psychologist related to me an incident of a woman who used fingernail clippers to pull off slivers of her skin.”

“BPD is a disorder that could be called the ‘I don’t fit in’ disorder”.“Back from the Edge”, Borderline Personality Disorder Resource

Center

"Everyone talks about [BPD], but it usually seems that no one knows quite what to do about it.“

Duke University Psychiatrist

BPD ~ What to Look For• History of hospitalization or baker acts;• Suicide attempts and other self destructive,

impulsive threats/acts; • Demanding or aggressive behavior;• Problems with identifying a sense of self (self

invalidation);• Problems regulating their emotions: over or

undercontrolled emotions;• Unrelenting crises: DRAMA• Apparent competence, Active Passivity• Pervasive problems with interpersonal relationships

– very limited support system, isolation;

Things you may notice• You are becoming uncommonly frustrated/angry at

the individual;• You become uncommonly close to the individual

(wanting to rescue);• Symptoms tend to improve spontaneously as they

age– They may tell you they USED to cut– They may have had a decrease in

hospitalizations– They may no longer keep suicide as an option

when they have children– They may find a stable relationship, eventually

Facts of BPD Effects 1-2% of population; but is grossly under diagnosed; Mostly female 70%;Males are often diagnosed with anti-social

personality 75% engage in deliberate self-harm such as cutting, burning,

picking skin; 73% attempt suicide; 4 - 10% commit suicide; Affects all cultures, levels of intelligence and social classes; Co-exists with other disorders (bipolar disorder, mood, anxiety,

eating disorders, substance abuse,PTSD, dissociative, and psychotic); About 69% have a substance abuse problem versus 9.5% in general population

Increased family history for Substance-Related Disorders (e.g., drug abuse), Antisocial Personality Disorder, and Mood Disorders, like depression or bipolar disorder;

Quite often a history of abuse(75%): sexual, emotional or physical; early loss of parent or sibling (38%).

How Does BPD Cause Problems Borderline personality disorder makes it hard for the

person to maintain relationships, sometimes jobs, and in general, stability. People with this disorder often cause a great amount of stress or conflict in relationships with others, especially significant others and close family members.

It is not uncommon to see many unrelenting crises in the BPD’s life: divorce, physical, sexual or emotional abuse, substance abuse, additional emotional problems (such as an eating disorder or depression), self-harm, job instability, estrangement from one’s family, and much more.

You might be dealing with BPD IF:

You can’t seem to get them to think differently about things – Black and White, “all or nothing” thinking. Their emotions seem to get the best of them and they are highly reactive and can’t seem to calm down.Their lives are in chaos, or they have many crises. They tell you there is nothing wrong with their behavior and attitude -- it’s the other person who doesn’t understand!They just don’t seem to be able to function in a consistent way.

They tell you things have been bad for a long time and they are always misunderstood. They say they have been in therapy a long time.

They are acting in self defeating, impulsive or emotionally extreme ways and they are NOT on drugs or alcohol.

They try to play you against another person.

They are obviously trying to manipulate – and don’t disguise it well. If they were skilled at it, you wouldn't know you were being manipulated.

Linehan, Marsha M. 1993. Skills Training Manual for Treating Borderline Personality Disorder. The Guilford Press, New York, NY.

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NEW BASELINE

Two levels of functioning:

High Functioning-Acting Out

•Episodes of raging

•Holds a job – with responsibility

•Is capable of maintaining friendships

•Can act “normal” when necessary

•Primary emotion: ANGER

Low functioning-Acting In

•Episodes of self harm

•Threats of suicide or attempts

•Unable to hold job or working below level

•Trouble with ADLs

•Risky behaviors

•Primary emotion: FEAR/ANXIETY

The Four Sub-TypesEgo centric, narcissistic type:Ego centric, narcissistic type: Attention

seeking; high expectations of others.Anti-social type:Anti-social type: Self hatred, can be cruel to

others without remorse. Jealous, critical, easily slighted.

Shame based type:Shame based type: Overwhelming feelings of worthlessness, helplessness, hopelessness and despair. Very fearful.

Isolative type:Isolative type: Fearful, seek control, potential for disaster everywhere. Critical of others - reflects their inner shame.

Criteria for DBTBorderline personality disorder OR borderline traitsAbility to comprehend written material

Cognitively functioning at at least an 8th grade level Ability to remember and apply new learning

Substance abuse manageable Refer for SA first if severe

Motivation for treatmentVoluntaryAbility to attend classes eventually and to keep regular appointments

ONLINE TEST FOR BPD

http://www.slshealth.com/behavioral Self help

Exclusive self tests Borderline Personality Disorder

ReferencesAmerican Psychiatric Association, 1994. Diagnostic and Statistical

Manual IV, Washington, DCBack from the Edge, Borderline Personality Disorder Resource Center,

New York Presbyterian Hospital, Westchester Division, White Plains, NY.

BPD Today Newsletter, Available on line: www.borderlinepersonalitydisordertoday.com

Linehan, Marsha M. 1993. Cognitive Behavioral Treatment of Borderline Personality Disorder, The Guilford Press, New York, NY.

Kreger, R. & Shirley, JP, 2002. Walking on Eggshells, New Harbinger Publications, Oakland, CA.

The Angry Heart Therapy Center for BPD, BPD Facts.Available on line:

http://www.slshealth.com/angryheart/theangryheartbpdcenter.asp