Borderline Personality Disorder

Presented by : Nurul Syazwani Binti Ramli 080100315 K5

Definition
Pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts.

Borderline: On the borderline between neurosis and psychosis

30 to 60% of patients with personality disorders

2 % of the general population Females 3 times the rate of males

Epidemiology 20 % of acute psychiatry inpatients 10 % of psychiatry outpatients

Etiology
Genetic
Neuro-transmitter
Twin Studies : two-in-three chance No evidence that there is a gene for BPD Reduced level of serotonin in brain Low levels of catecholamines (norepinephrine and dopamine neurotransmitters)

Neurobiology

Three parts of the brain were either smaller than expected or had unusual levels of activity ( amygdala, hippocampus and orbitofrontal cortex )

Environmental Factors

emotional, physical or sexual abuse chronic fear or distress and neglected by growing up with another family member who had a serious mental health condition

instability in functioning, affect, mood, interpersonal relationships

sustained impairment in social, occupational, or academic functioning

Clinical features

overwhelming anger when in a state of crisis

Psychotic symptoms

The Diagnostic and Statistical Manual of Mental Disorders, fourth edition, DSM IV-TR

Laboratory studies (abnormal results with dexamethasone suppression testing and with abnormal thyrotropin-releasing hormone testing)

Diagnosis
Imaging Studies (not specific) Other test
abnormal, diffuse, slow activity on EEG findings shortened rapid eye movement (REM) latency and sleepcontinuity disturbances

Paranoid personality disorder

Psychotic Disorders

Mood Disorders

Dependent personality disorder

Differential Diagnosis

Personality change secondary to a general medical condition

Narcissistic personality disorder

Histrionic personality disorder

Antisocial personality disorder

Schizotypal personality disorder

Treatment
Hospitalization Restricted to the management of crises Can monitor the impact of new medications in a controlled environment Dialectical Behavior Therapy (DBT) Transference focused psychotherapy (TFP)

Psychotherapy

Pharmacotherapy

Selective serotonin reuptake inhibitors and other antidepressants Atypical antipsychotics or mood stabilizers
Educate family member improve communication, decrease alienation, and relieve family burdens gather together to discuss common problems learn from persons with similar life experiences

Family Interventions

Group Therapies

Prognosis
often make good progress 40-50% of borderline patients remit within two years and this rate rises to 85% by 10 years

60% of hospitalized BPD patients are readmitted in the first six months, this rate declines to about 35% in the eighteen months to two-year period following an initial hospitalization
25% of the patients diagnosed with BPD eventually achieve relative stability through close relationships or successful work

THANK YOU