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Block 5 Unit 1 Borderline Personality Disorder

1. Discuss cluster A personality disorders.

Cluster A personality disorders are characterised by odd or eccentric behaviours. These include:

• Paranoid personality disorder: Individuals with this disorder exhibit irrational suspicions and mistrust of others. They may be hostile, quarrelsome, litigious, or, alternatively, passive, submissive and humiliated. They believe others dislike them and will do them down, but feel unable to act on it.
• Schizoid personality disorder: People with schizoid personality disorder lack interest in social relationships and prefer to be alone. They do not see a purpose in spending time with others and tend to be solitary.
• Schizotypal personality disorder: This disorder is characterised by odd behaviour or thinking.

2. What are the characteristic features of cluster B personality disorders?

Cluster B personality disorders are marked by dramatic, emotional, or erratic behaviours. These include:

• Antisocial personality disorder: Individuals show a disregard for the law and the rights of others. They are often impulsive, irresponsible, and callous, with a history of violence and substance abuse.
• Borderline personality disorder: This disorder features unstable interpersonal relationships, mood, behaviour, and self-image. Individuals experience extreme mood changes, stormy relationships, and self-destructive behaviour. They also have difficulty with their own identity and can see the world in extremes, viewing experiences and others as either "black" or "white".
• Histrionic personality disorder: People with histrionic personality disorder are characterised by attention-seeking behaviour, including inappropriate sexual seductiveness, and shallow or exaggerated emotions.
• Narcissistic personality disorder: This disorder is characterised by self-centeredness, a lack of empathy, and an exaggerated sense of self-importance. People with this disorder have a need for admiration and can be exploitative of others.

3. Elucidate all the personality disorders under cluster C and highlight their characteristics.

Cluster C personality disorders are characterised by anxious or fearful behaviours. These include:

• Avoidant personality disorder: Individuals with this disorder show social inhibition, feelings of inadequacy, and extreme sensitivity to negative evaluation, leading to avoidance of social interaction.
• Dependent personality disorder: People with this disorder show a pervasive psychological dependence on others. They have difficulty making decisions or undertaking projects on their own.
• Obsessive-compulsive personality disorder: This disorder is marked by a preoccupation with orderliness, perfectionism, and control.

4. Explain major personality disorders and their main characteristics.

Major personality disorders, as classified in the DSM-IV, include:

• Paranoid Personality Disorder: Characterised by a pervasive distrust and suspiciousness of others.
• Schizoid Personality Disorder: Characterised by detachment from social relationships and a restricted range of emotional expression.
• Schizotypal Personality Disorder: Characterised by eccentricities in thought, perception, and behaviour.
• Antisocial Personality Disorder: Characterised by a disregard for the rights of others and a lack of remorse.
• Borderline Personality Disorder: Characterised by instability in relationships, self-image, and emotions.
• Histrionic Personality Disorder: Characterised by excessive emotionality and attention-seeking behaviour.
• Narcissistic Personality Disorder: Characterised by grandiosity, a need for admiration, and a lack of empathy.
• Avoidant Personality Disorder: Characterised by social inhibition and hypersensitivity to criticism.
• Dependent Personality Disorder: Characterised by a need to be taken care of by others and a fear of being alone.
• Obsessive-Compulsive Personality Disorder: Characterised by a preoccupation with orderliness, perfectionism, and control.

5. What are the main symptoms of personality disorder?

Individuals with personality disorders often show:

• Self-centeredness, manifesting as a "me-first" attitude.
• A lack of accountability, blaming others for their problems.
• A lack of empathy and caring.
• Manipulative and exploitative behaviour.

6. Discuss the causes and treatment of personality disorder.

• Causes: The causes of personality disorders are complex and not fully understood, but may involve a combination of factors. This can include biological vulnerabilities, ways of thinking and social stressors.
• Treatment: Treatment is tailored to the specific personality disorder. For example:
• For obsessive-compulsive personality disorder, medication may be used for associated anxiety.
• For dissocial personality disorder, drugs may be used to control impulsivity and aggression.
• Inpatient self-help groups and therapeutic communities may offer some benefit. The goal of treatment is generally to help patients live more comfortably and safely with themselves, as personality is considered relatively fixed in adult life.

7. Explain the characteristic features of borderline personality disorder. 

According to DSM-IV, a person with borderline personality disorder has unstable interpersonal relationships and self-image. Additional symptoms include:

• A pattern of unstable and intense interpersonal relationships.
• Instability in affect (mood) or feelings.
• Impulsive behaviours.
• Efforts to avoid real or imagined abandonment.
• A pattern of unstable and intense interpersonal relationships, alternating between extremes of idealisation and devaluation.
• Identity disturbance: unstable self-image or sense of self.
• Impulsivity in at least two areas that are potentially self-damaging.
• Recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour.
• Affective instability due to a marked reactivity of mood.
• Chronic feelings of emptiness.
• Inappropriate, intense anger, or difficulty controlling anger.
• Transient, stress-related paranoid ideation or severe dissociative symptoms.

8. What are the causes of borderline personality disorder? 

Borderline personality disorder is understood to be a result of a combination of:

• Biological vulnerabilities, which can have a genetic component. A major twin study found that if one identical twin met criteria for borderline personality disorder, the other also met criteria in 35% of cases.
• Ways of thinking.
• Social stressors.
• Childhood experiences, particularly abuse, denial of feelings, lack of protection, neglect, and inconsistent treatment by caregivers.
• Family environment also plays a contributing role.

9. Discuss the treatment and prognosis of borderline personality disorder.

• Treatment: Treatment involves:

  • Dialectical Behaviour Therapy (DBT) to build skills in mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness.
  • Cognitive Behaviour Therapy (CBT) to understand the connections between thoughts and behaviours.
  • Interpersonal Psychotherapy (IPT) to address relationship problems.
  • Psychoanalytic therapy.
  • Medications like antidepressants, mood stabilisers and antipsychotics.

• Prognosis: While there is no "cure", symptoms tend to diminish over time. Prognosis is influenced by:

  • The severity of the disorder at the start of treatment.
  • The individual's current personal relationships.
  • A history of childhood abuse.
  • Whether appropriate treatment is received.
  • Co-occurring issues such as depression, other emotional problems, or low conscientiousness.

10. What do you mean by personality disorder? Discuss the major personality disorders.

A personality disorder is an enduring pattern of inner experience and behaviour that deviates from cultural expectations, is rigidly pervasive, starts in adolescence or early adulthood, is stable over time, and leads to distress and impairment. Major personality disorders include: Paranoid, Schizoid, Schizotypal, Antisocial, Borderline, Histrionic, Narcissistic, Avoidant, Dependent, and Obsessive-Compulsive.

11. Describe the causes and treatment of personality disorder.

The causes are thought to be a combination of biological vulnerabilities, ways of thinking, and social stressors. Treatment varies depending on the specific disorder, but may include medication for specific symptoms, individual or group therapy, and support within therapeutic communities.

12. Prepare a clinical picture of borderline personality disorder.

Borderline personality disorder is characterised by a history of unstable interpersonal relationships, a fluctuating self-image, and rapidly changing emotions. Individuals can be impulsive, engage in self-harming behaviours, have chronic feelings of emptiness, display inappropriate anger, and experience transient paranoid thoughts.

13. What are the causes of borderline personality disorder?

Causes include a mix of genetic predisposition, ways of thinking, social stressors, and early childhood experiences, especially abuse, neglect, inconsistent parenting and a negative family environment.

14. Discuss the treatment and prognosis of borderline personality disorder.

Treatment includes Dialectical Behaviour Therapy (DBT), Cognitive Behaviour Therapy (CBT), Interpersonal Therapy (IPT), psychoanalytic therapy, and medications to address specific symptoms. Prognosis depends on the severity of the symptoms, the quality of relationships, history of abuse, and whether the individual is receiving appropriate treatment. Symptoms can diminish over time, but co-occurring conditions may increase relapse risk.

15. Explain the diagnostic features of personality disorder.

Diagnostic Features of Personality Disorder

• Enduring patterns: Personality disorders are characterised by long-standing and inflexible patterns of relating to the environment and oneself. These patterns are not just isolated incidents but are consistent across a range of situations.
• Deviation from cultural norms: The behaviours and inner experiences associated with personality disorders deviate markedly from the expectations of an individual's culture.
• Rigidity and pervasiveness: These patterns are rigid and pervasive, meaning they are not easily changed and affect many areas of a person’s life.
• Onset: The onset of these patterns typically occurs in adolescence or early adulthood.
• Stability: These patterns are stable over time.
• Impairment and distress: Personality disorders lead to unhappiness, functional impairment, and personal distress.
• Axis II Diagnosis: Personality disorders are noted on Axis II of the DSM-IV-TR.
• Clusters: The DSM-IV-TR categorises personality disorders into three clusters:
  • Cluster A (odd or eccentric): Paranoid, Schizoid, Schizotypal.
  • Cluster B (dramatic, emotional, or erratic): Antisocial, Borderline, Histrionic, Narcissistic.
  • Cluster C (anxious or fearful): Avoidant, Dependent, Obsessive-Compulsive.

Diagnostic Features of Borderline Personality Disorder (BPD)

• Unstable relationships: Individuals with BPD experience a pattern of unstable and intense interpersonal relationships, which are often characterised by alternating between extremes of idealisation and devaluation.
• Identity disturbance: There's an unstable self-image or sense of self.
• Impulsivity: Individuals with BPD exhibit impulsivity in at least two areas that are potentially self-damaging, such as spending, sex, substance abuse, reckless driving or binge eating.
• Self-harm and suicidality: Recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour are common.
• Emotional instability: There's affective instability due to a marked reactivity of mood such as intense episodic dysphoria, irritability or anxiety, which usually lasts for between a few hours and several days.
• Chronic emptiness: People with BPD often experience chronic feelings of emptiness.
• Inappropriate anger: They may show inappropriate, intense anger, or have difficulty controlling anger.
• Transient paranoia and dissociation: They may experience transient, stress-related paranoid ideation or severe dissociative symptoms.
• Fear of abandonment: Sufferers of BPD may have intense fears of abandonment, whether real or imagined, and they may engage in extreme behaviours to avoid it.

16. Discuss the symptoms and treatment of personality disorder.