Module 7 - Personality Disorders

Specific Personality Disorders: Borderine Personality Disorder

People with Borderline Personality Disorder have a poor sense of their own identity and chronic feelings of emptiness. They have unstable relationships and their view of family, carers or peers changes between positive and negative depending on the circumstances. This is associated with a fear that they will be abandoned and desperate attempts will be made to prevent this from happening. Difficulties in managing mood, emotions, anger and behaviour lead to recurrent crises with dramatic threats and actual attempts of self-harm and suicide. They are often viewed as manipulative due to their threats and impulsive behaviours although it is likely that their ability to understand their actions and take control of them is extremely limited. In crisis there can be a range of impulsive behaviours including drug and alcohol use; unsafe sexual behaviour and sexual promiscuity; and gambling. At times of stress there can also be short-lived paranoid or dissociative symptoms which may include hallucinations. Mood and anxiety disorders and drug and alcohol use are common co-morbid conditions in people with borderline personality disorder.

The DSM-V criteria for borderline personality disorder are as follows:

A. Significant impairments in personality functioning manifest by: 1. Impairments in self functioning (a or b): a. Identity: Markedly impoverished, poorly developed, or unstable self-image, often associated with excessive selfcriticism; chronic feelings of emptiness; dissociative states under stress. b. Self-direction: Instability in goals, aspirations, values, or career plans. AND 2. Impairments in interpersonal functioning (a or b): a. Empathy: Compromised ability to recognize the feelings and needs of others associated with interpersonal hypersensitivity (i.e., prone to feel slighted or insulted); perceptions of others selectively biased toward negative attributes or vulnerabilities. b. 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 and alternating between over involvement and withdrawal. B. Pathological personality traits in the following domains: 1. Negative Affectivity, characterized by: a. Emotional liability: Unstable emotional experiences and frequent mood changes; emotions that are easily aroused, intense, and/or out of proportion to events and circumstances. b. Anxiousness: Intense feelings of nervousness, tenseness, or panic, often in reaction to interpersonal stresses; worry about the negative effects of past unpleasant experiences and future negative possibilities; feeling fearful, apprehensive, or threatened by uncertainty; fears of falling apart or losing control. c. Separation insecurity: Fears of rejection by – and/or separation from – significant others, associated with fears of excessive dependency and complete loss of autonomy. d. Depressivity: Frequent feelings of being down, miserable, and/or hopeless; difficulty recovering from such moods; pessimism about the future; pervasive shame; feeling of inferior self-worth; thoughts of suicide and suicidal behavior. 2. Disinhibition, characterised by: a. Impulsivity: Acting on the spur of the moment in response to immediate stimuli; acting on a momentary basis without a plan or consideration of outcomes; difficulty establishing or following plans; a sense of urgency and self-harming behavior under emotional distress. b. Risk taking: Engagement in dangerous, risky, and potentially self-damaging activities, unnecessarily and without regard to consequences, lack of concern for one’s limitations and denial of the reality of personal danger. 3. Antagonism, characterised by: a. Hostility: Persistent or frequent angry feelings; anger or irritability in response to minor slights and insults.
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