Borderline personality disorder is best described as a disorder characterized by
a. downcast mood, feelings of worthlessness, and loss of interest in pleasurable activities.
b. disruptions in a person's identity, memory, or consciousness.
c. an unusual lack of remorse, empathy, or regard for normal social rules and conventions.
d. instability in interpersonal relationships, self-image, and emotion.
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interpersonal deficits featuring acute discomfort with, and reduced capacity for, close relationships, as well as cognitive or perceptual distortions and eccentricities of behavior
- socially isolated. suspicious, odd beliefs. On same continuum with schizophrenia but without some debilitating symptoms, such as hallucinations and delusions.
- psychotic-like symptoms (believing everything relates to them personally), social deficits,
and sometimes cognitive impairments or paranoia.
ODD: how they relate to others, how they dress, think and behave.
IDEAS of REFERENCE.
Schizophrenia - have ideas of reference, too, but not able to "test reality" or see the illogic of their ideas.
"magical thinking," believing they are clairvoyant or telepathic. Illusions, feel presence of another person when alone. Feeling, whereas schizophrenics report there IS someone in the room when there isn't.
Paranoid thoughts, little emotion expressed, dress and behave unusually. Kids are passive, unengaged, hypersensitive to criticism.
CAUSES:
- schizotype used to describe people predisposed to develop schizophrenia. viewed to be phenotype of schizophrenia genotype.
- Similar to schizophrenia behavior: ideas of reference, illusions, paranoid thinking. milder forms, though.
- childhood maltreatment among men, childhood maltreatment results in PTSD among women.
- COGNITIVE ASSESSMENT:
mild decrements in ability to perform memory and learning tests (damage in left hemisphere).
TREATMENT:
- seek help if have anxiety or depression.
- increases risk for developing major depressive disorder
- treatment similar to that for depression.
- ANTIPSYCHOTIC MEDICATION, COMMUNITY TREATMENT (a team providing therapeutic services), social skills training. CBT.
disregard for and violation of the rights of others. Similar to psychopathy, but with greater emphasis on overt behavior than on personality traits.
failing to comply with social norms. perform actions most would find unacceptable, such as stealing from friends and family.
irresponsible, impulsive, deceitful. social predators who charm, manipulate, and ruthlessly plow their way through life, leaving a broad trail of broken hearts, shattered expectations, empty wallets. Lack conscience and empathy, selfishly take what they want and do as they please, violating social norms and expectations without slightest sense of guilt or regret.
substance abuse common.
CONDUCT DISORDER - precursor to antisocial disorder in adults. these boys more than 2x as likely to die in unnatural death because of alcohol abuse, poor self-care, reckless behavior.
children who engage in behaviors that violate society's norms. two subtypes:
1. childhood-onset type (the onset of at least one criterion
characteristic of CD prior to 10 years old)
2. adolescent-onset type (absence of any criteria prior to 10 years old)
new subtype: "with a callous-unemotional presentation" - young person presents characteristics similar to adult with psychopathy.
most often diagnosed in boys. many adults with antisocial disorder or psychopathy had CD or ADHD as children.
INFLUENCES:
- genetic: adopted offspring of felons had higher rate of arrests, conviction, and antisocial personality than
did adopted offspring of normal mothers.
- genetic factors present vulnerability, but actual development of criminality require environmental factors, such as a deficit in early, high-quality contact with parents or parent surrogates.
endophenotype - underlying aspects of disorder that might be more directly influenced by genes. lack of anxiety and fear, serotonin and dopamine levels.
- neurobiological: they are not damaged in the brain. Arousal theories: 1. under-arousal
hypothesis: psychopaths have low levels of cortical arousal, the primary cause of antisocial and risk-taking behaviors. Seek stimulation to boost low levels of arousal. LOWER SKIN CONDUCTANCE ACTIVITY, LOWER HEART RATE DURING REST PERIODS, SLOW-FREQUENCY BRAIN WAVE ACTIVITY.
2. fearlessness hypothesis: psychopaths possess a higher threshold for experiencing fear than most other individuals. Little effect on psychopath.
psychological/social: psychopaths continued to play and lose even
when reward was taken away. non-psychopaths stopped playing after rewards taken away.
- Parents also give in to kids, enabling them
Developmental: truancy and stealing from friends --> extortion, assaults, armed robbery, or other crimes
Integrative: reduced fear conditioning. genetic influences (damage in amygdala).
TREATMENT:
therapists agree with incarcerating people to deter future antisocial acts.
- parent training
PREVENTION:
- early intervention
pattern of instability of interpersonal relationships, self-image, affect, and control over impulses.
- their moods and relationships are unstable, and usually have a poor self-image. feel empty, great risk of dying by their own hands. turbulent relationships, fearing abandonment but lacking control over their emotions.
- one of the most common disorders. Intense, going from anger to deep depression. impulsivity, drug abuse and self-mutilation. chronically bored, difficulties with identity, empty feeling.
MOOD DISORDERS COMMON AMONG PEOPLE WITH BPD
CAUSES:
- genetics
- endophenotypes (emotional reactivity). limbic network.
- environmental risk factor (early trauma, especially sexual and physical abuse and neglect).
integrative model:
- TRIPLE VULNERABILITY theory. 1. biological (emotional reactivity and brain function), 2. psychological (views world as threatening), 3. specific psychological
vulnerability (trauma)
Treatment:
more likely to see treatment than antisocial disordered people.
Ex. mood stabilizer drugs. CBT approach called DIALECTICAL BEHAVIOR THERAPY (DBT).