Borderline Personality Disorder Simplified | Diagnosis & Treatment of BPD | A Psychiatrist Explains

hi everyone welcome to hub bites i'm Sanil Rege consultant psychiatrist if you're new   to this channel we cover all things psychiatry  and mental health related so if that's your thing   don't forget to subscribe to our channel today  i'll be covering borderline personality disorder   bpd now borderline personality disorder is quite  a controversial term there's been arguments   that because of its stigmatizing  nature and there have been studies   actually done um Appelby for example  did a study where they found that when   the term borderline personality disorder was  applied to patients diagnoses that they actually   they were treated differently compared to  patients without that diagnosis . Patients were often   thought about as manipulative, taking NHS time etc  so it can be a very stigmatizing term i personally   don't like the term borderline personality  it has been misused in many many ways   so there has been an argument to change the  term to complex trauma disorder mainly because   there is a very strong association between  borderline personality disorder and trauma   so that's been one argument that's come up the  term borderline actually came from psychodynamic   terms but it's been completely misused in a  way and become more sort of derogatory and   that's that's the difficulty so you know sometimes  applying the word borderline personality structure   so it's a certain personality structure that  the individual has or complex trauma disorder   is is some of the ways i communicate to other  clinicians so just keep that aspect in mind   when we're thinking about borderline personality  disorder but let's look at what is it okay   now in order to understand borderline personality  we've got to understand what personality disorder   means now it's not a weakness it's not a  defect in a way it essentially means that   here it says there is something not quite right  about someone's personality that's what it implies   right but that's not actually what is meant by the  term the term personality disorder helps health   professionals group a set of typical features for  people with aspects of the personality that they   and others may find difficult to deal with so  those personality traits may create significant   distress both for the patient and impact on their  life in general resulting in a pattern of behavior   and inner experience that causes distress both  to themselves others and hence is classified   as a disorder so it's really a pattern of  inner experience and behavior that begins   you know sort of early in life adolescence  moves throughout adulthood and is persistent   it's enduring so it's not something that comes  and goes it's persistent enduring and this   predominant sort of pattern of inexperience  and behaviour impacts on the person's life   so borderline personality disorder is a mental  health disorder that impacts the way you think   and feel about yourself and others causing  problems functioning in everyday life you   know broadly it includes self-image issues  difficulty managing emotions and behaviour   and a pattern of unstable relationships so we'll  look specifically at the criterion both from a   dsm perspective and icd perspective so what  are the risk factors so of course genetics   um individuals so for example if the parent has  borderline personality disorder there might be a   higher risk of borderline personality disorder  in the child now this might be due to genetic   or environmental influences or both brain  abnormalities there's some evidence that they may   be neurobiological aspects linked to borderline  personality um so for example interestingly   women with adhd tend to have a higher risk of this  cognitive emotional arousal symptoms and therefore   can be diagnosed or there might be an overlap  with borderline personality disorder stressful   childhood which includes you know exposure to high  levels of criticism for example higher levels of   i say violence for example and as you can see  physical and emotional abuse or sexual abuse also   is closely linked to the development  of borderline personality disorder   now one of the things that i found very  useful when come to signs and symptoms is   professor Satya Rao who's an expert in borderline  personality disorder describes it in a very very   nice way he talks about have a think about a car  and when we think about the brakes of the car   that's the frontal lobe right so the frontal lobe  acting on the brakes and the accelerator bring   the limbic system the limbic system is a threat  in the emotional area for brain now if you're   driving a car where we have well-functioning  brakes right and the accelerator we know   we have a good feel for the accelerator  the car is going to move smoothly   but if we have faulty brakes in  which case the frontal lobe's faulty   and we have hypersensitivity hypersensitive  accelerators so limbic systems firing then we're   going to be driving extremely erratically fast  right get into accidents hurt maybe others all of   those problems right can occur so in a way it's  a disorder of faulty breaks and hypersensitive   accelerators and the aim is to help the individual  get a feel for those accelerators and help   them develop those brakes a lot better and that's  what we'll see in the treatment okay so it's sort   of this battle between the frontal lobe and the  limbic system so signs and symptoms may include   intense fear of abandonment even going to extreme  measures to avoid real or imagined separation   or rejection a pattern of unstable intense  relationships such as idealizing someone and then   suddenly believing the person doesn't care enough  this is known as idealization and denigration   then we have rapid changes in self-identity and  self-image including shifting goals and values   and seeing yourself as as bad or as if you don't  exist at all periods of stress-related paranoia   and loss of contact with reality lasting for a few  minutes to a few hours sometimes people talk about   you know just dissociate can be they may have  severe anger outburst discontrol and then might   just not remember actually what happened during  that period impulsive and risky behavior such   as gambling reckless driving unsafe sex bending  sprees binge eating drug abuse sabotaging success   sabotaging treatment happens quite  a bit suddenly quitting a good job   ending a positive relationship suicidal threats  or behavior or self-injury often in response to   fear of separation or rejection really important  this is not attention-seeking at all this is a   coping mechanism wide mood swings lasting from a  few hours to few days which can include intense   happiness irritability shame or anxiety ongoing  feelings of emptiness inappropriate intense   anger such as frequently losing a temper being  sarcastic or bitter or having physical fights   how is it diagnosed so this is the dsm 5 criteria  so what we've got is broadly we've got impairments   and personality functioning remember personality  it's really a pattern of inner experience and um   behavior right now we all move along  a spectrum we all some of us might   might have avoidant traits perfectionistic traits  we might have uh certain uh borderline traits   uh even right we have a range but what we might be  able to do is to moderate these traits according   to the situations we're in so we don't use one  particular way to deal with situations all the   time or they're not heightened we moderate them  right but in borderline personality disorder here   there's impairments and personality functioning  as you can see firstly in self impairments in   self functioning and this is identity which is  markedly impoverished poorly developed   or unstable self-image often associated with  excessive self-criticism chronic feelings of   emptiness and dissociative states under stress  plus self-direction instability and goals values   aspirations or career plans so you often find one  of the questions that we ask is you know what's   been your longest job what's been your longest  relationship right so we get a feel for how many   jobs have they changed what's been the longest  time they've stayed in a relationship or a job etc   which these all suspicious doesn't mean  that just because someone's been in a   short term relationship that it's borderline  remember psychiatry is all about probabilities   adding on several things if this comes up with  a few other things then the probability goes up   impairments interpersonal so self interpersonal  right so inner experience and behaviour   in interpersonal functioning it's empathy  compromised ability to recognize the   feelings and needs of others associated with  interpersonal hypersensitivity so prone to   feeling slighted or insulted perceptions of others  selectively bias towards negative attributes or   vulnerabilities next intimacy intense  unstable and conflicted close relationships   marked by mistrust neediness and anxious  preoccupation with real or imagined abandonment   close relationships often viewed in extremes  of idealization and devaluation as i mentioned   idealization or denigration alternating  between over-involvement and withdrawal   so being very close or then pushing the person  away along with pathological personality traits   negative affectivity emotional ability anxiousness  separation insecurity depressivity disinhibition   impulsivity risk-taking and antagonism which is  hostility their anger now very important here   for all personality disorders impairments in  personality functioning and the individual   personality trait expression are relatively stable  across time and consistent across situations   not better understood as normative  for the individual's development   a stage or socio-cultural environment and traits  are not due to a direct physiological substance   use for example or general medical conditions  those had to be ruled out now ICD -11 has a borderline   pattern qualifier you'll see the similarities  here but essentially the borderline pattern   qualifier may be applied to individuals with  pattern or personality disturbance characterized   by a pervasive pattern of instability or of  interpersonal relationships self-image and affects   and marked impulsivity as indicated by five or  more of the following frantic efforts to avoid   real or imagine abandonment pattern of unstable  and intense interpersonal relationships typically   characterized by alternating between extremes of  idealization and devaluation very similar to what   we've gone through identity disturbance  manifested in markedly and persistently   unstable self-image or sense of self impulsivity  manifested in potentially self-damaging behaviours   risky sexual behaviour reckless driving  excessive alcohol substance use binge eating   recurrent episodes of self-harm suicide  attempts or gestures self-mutilation   emotional instability due to a marked reactivity  of mood and these are fluctuations of mood may   be triggered either internally or by external  events as a consequence the individual experiences   intense dysphoric mood states which typically last   for a few hours but may last for up to several  days chronic feelings of emptiness inappropriate   intense anger or difficulty controlling anger  manifested in frequent displays of tempo   yelling screaming throwing breaking things  getting into physical fights transient   dissociative symptoms of psychotic like features  brief hallucinations paranoia in situations of   high affective arousal other manifestations of  a borderline pattern not all of which which may   be present at any one given time may include a  view of the self as being disgusting bad guilty   experience of the self is profoundly  different and isolated from other people   painful self-sense of alienation and  pervasive loneliness proneness to rejection   hypersensitivity problems in establishing and  maintaining consistent appropriate levels of   trust in interpersonal relationships frequent  misinterpretation of social signals so these are   some of the borderline pattern qualifiers that are  present now how is it treated it is a treatable   condition and evidence suggests that over time the  disorder improves now treatment options mainstay   is psychotherapy and specific psychotherapy  is dialectical behavioral psychotherapy   dbt now of course cognitive behavioral  therapy psychodynamic psychotherapy are also   evidence-based but dbt tends to be one of the most  prominent ones used developed by marsha linahan   and very effective as well it has a group  component and if available it's something that   should be utilized it consists of components  mindfulness emotional regulation distress   tolerance and interpersonal effectiveness so  all these components help in enhancing emotional   regulation enhancing distress tolerance enhancing  interpersonal effectiveness and controlling   emotions through mindfulness strategy so these  are some of the components next medications now   there's no real medication that treats the  disorder okay medications often prescribed   yes to treat other disorders because remember  borderline personality can be comorbid with other   conditions depression can occur post-traumatic  stress disorder can occur anxiety can occur so   just because someone is diagnosed with borderline  personality disorder doesn't mean their other   conditions can't be treated or shouldn't be  treated in fact even medical conditions are   closely associated thyroid autoimmunity autoimmune  thyroiditis and polycystic ovarian syndrome are   closely linked to borderline personality disorder  and hence why carrying out a hormonal panel   becomes very very important and as i mentioned  adhd can be uh comorbid as well right um and the   polycystic ovarian syndrome hypothesis thyroid  autoimmunity may be linked to that trauma aspect   trauma impacting in the hypothalamic pituitary  adrenal access resulting in hormonal dysfunction   now in terms of medication in clinical practice  lamotrigine can be a very useful tool lamotrigine also known as trade name Lamictal lamotrigine  starting off at low dose increasing to anywhere   between 50 to 75 mg. (recent study actually showed that lamotrigine may not be a clinically effective strategy) of course this is not advice  needs to be discussed with the doctor it's not   applicable for everyone has side effects  that need to be monitored as well rash   so but it can be very helpful in treating the  mood instability the heightened reactivity   and also has evidence for reducing the self-harming behavior can be a   useful tool and short term hospitalization  can be very very helpful uh during periods   of extreme stress so providing containment and  most importantly as part of treatment the trust   between the doctor and patient because is  so so important in borderline personality   disorder treatment why because you see  psychodynamic mechanisms such as projection   and projective identification can induce feelings  of helplessness anger hopelessness in the doctor   in the psychiatrist and one should ensure that  it doesn't result in impulsive decisions such   as discharging the patient or getting angry with  the patient because that itself can can sabotage   the success of the of the relationship so it's  important openness transparency honesty become   important um components of that doctor-patient  relationship so with that i hope that you found   this video helpful um and overview and borderline  personality disorder if you liked it do leave us   a like click the like button and of course  subscribe to our channel as well i look   forward to seeing you in another edition of hub  bites take care stay safe see you next time bye

Channel: Psychiatry Simplified - Dr Sanil Rege

Views: 114,165

Keywords: borderline personality disorder, emotionally unstable personality disorder, borderline personality disorder dsm criteria, borderline personality disorder icd 11 criteria, BPD

Id: 4ZjCr_xlIGg

Length: 16min 48sec (1008 seconds)

Published: Tue Feb 15 2022