Study Guide - Borderline Personality Disorder (DSM-IV-TR) 1

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1 Study Guide - Borderline Personality Disorder (DSM-IV-TR) 1 Pervasive pattern of instability of interpersonal relationships, selfimage, and affects, and marked impulsivity that begins by early adulthood and is present in a variety of contexts Individuals may have a pattern of undermining themselves at the moment a goal is about to be realized (dropping out of school just before graduation; destroying a good relationship just when it is clear that the relationship could last) Some individuals develop psychotic-like symptoms (hallucinations, bodyimage distortions) during times of stress Physical and sexual abuse, hostile conflict, and early parental loss or separation are common in the childhood histories Common co-occurring with other psychiatric disorder such as mood disorder and other personality disorders

2 Study Guide - Borderline Personality Disorder (DSM-IV-TR) 2 The criteria for the diagnosis of Borderline Personality Disorders are organized in this paper as follows: Brief criterion discription Surpportive criterion features Surpportive criterion features Surpportive criterion features Surpportive criterion features An individual with Borderline Personality Disorders must present at least five of nine criteria in the DSM-IV-TR.

3 Study Guide - Borderline Personality Disorder (DSM-IV-TR) 3 Experience intense abandon fears In order to avoid separation, they may performe selfmutilation or have suicidal behavior Intolerance of being alone Separation or rejection can lead to changes in self-image, affect, cognition and behavior Sensitive to environment circumstances (emotional, financial) Unstable and intense relationship May take care of someone expecting that the other person meet their own needs on demand Fast switch between idealizating and devaluating people Dramatic shift in their views of others

4 Study Guide - Borderline Personality Disorder (DSM-IV-TR) 4 Impulsivity in at least two potentially selfdamaging areas Self-destructive acts caused by threats of separation, rejection or stress May gamble, spend money irresponsibly, binge eat, abuse substances, have unsafe sex or drive dangenrously Self-mutilation brings relief by reaffirming the ability to feel or by redeeming the sense of being evil Suicidal behavior and/or self-mutilating behavior. Suicide occurs in 8%- 10% Unstable selfimage or sense of self Self-image based on being evil or bad Sudden changes in values, goals, sexual identity, values and types of friends May feel that they dot not exist

5 Study Guide - Borderline Personality Disorder (DSM-IV-TR) 5 Reactivity of mood - extreme reactivity to interpersonal stresses Easily bored, they may constantly seek something to do Intense sadness, irritability, or anxiety usually lasting a few hours and only rarely more than a few days Individuals may be troubled by chronic feelings of emptiness Sadness, irritability and anxiety feelings disrupted by anger, panic or dispair are rarely relieved by wellbeing feelings

6 Study Guide - Borderline Personality Disorder (DSM-IV-TR) 6 Express inappropriate, intense anger or have difficulty controlling their anger Expressions of anger are often followed by shame and guilt and contribute to the feeling of being evil Individuals may display extreme sarcasm, lasting bitterness or verbal outbursts The anger is expressed when a caregiver or lover is seen as absent or uncaring During periods of extreme stress, brief paranoid ideation or dissociative symptoms (depersonalization) may occur The real or perceived return of the caregiver's attention may result in a remission of symptoms These episodes occur most frequently in response to a real or imagined abandonment

7 Study Guide - Borderline Personality Disorder (DSM-IV-TR) 7 Prevalence and gender 2% in general polupation 75% are women Family Pattern Borderline Personality Disorder is about five times more common among first-degree biological relatives of those with the disorder than in the general population.

8 Study Guide - Borderline Personality Disorder (DSM-IV-TR) 8 Course of the Illness Patterns of Behavior The most common pattern is one of chronic instability in early adulthood, with episodes of serious affective and impulsive dyscontrol and high levels of use of health and mental health resources Adolescents and young adults with identity problems (especially when accompanied by substance use) may transiently display behaviors that misleadingly give the impression of Borderline Personality Disorder The impairment from the disorder and the risk of suicide are greatest in the young-adult years and gradually wane with advancing age Individuals in therapeutic intervention often show improvement beginning sometime during the first year Such situations are characterized by emotional instability, "existential" dilemmas, uncertainty, anxiety-provoking choices, conflicts about sexual orientation, and competing social pressures to decide on careers

9 Study Guide - Borderline Personality Disorder (DSM-IV-TR) 9 What changes would you make? Why? Do you think this section on the DSM-IV-TR is accurate? Do you think it needs revision? After reading the material: Borderline Personality Disorder by DSM-IV-TR How would you as a doctor present the diagnosis to a patient? What are the main characteristics of an individual with Borderline Personality Disorder? What are the key features for the diagnose of Borderline Personality Disorder?

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