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DSM definition of BPD
- presence of 5 of 9:
- some describe impulsive dimension (unstable relationships, impulsiveness, inappropriate anger, suicidal threats)
- emotional reactivity dimension (affective instability, identity disturbance, emptiness or boredom, frantic efforts to avoid abandonement)
- cognitive or quasi-psychotic dimension (transient stress-related paranoid ideation or severe dissociative symptoms).
most patients with BPD suffer from cognitive symptoms REF:
Zanarini et al. 1990
Loranger et al. 1994
- Lenzenweger et al. 2007, Torgersen et al., 2001
- at least 1%
Sex makeup of BPD
- approx 75% of BPD and women
- Gunderson 2001
- Although Lenzenweger 2007 says BPD might actually be equal in men and women but women seek more help.
- Depression--Zanarini et al., 1998
- Family studies--link with impulse disorders like antisocial personality and substance abuse more than mood disorders (White et al. 2003)
Course of BPD
- Emerges in adolescence, peaks in young adulthood, tends to "burn out" by middle age.
- Mean age of clinical presentation is 18
- most studies show that 5 years after initial presentation, most patients showed very little change
- In 1980s researchers followed BPD patients for 15 years and found that even though very diverse people from diff places, high concordance of course. after 15 years, 75% no longer met diagnostic criteria (Paris et al. 1987).
Suicide and BPD
- Associated w/ high rate of suicide completeion (10%)--Paris (2001).
- Zanarini-4% died by suicide.
- Most are after age 30, particularly after patients failed a series of treatments.
Symptom of greatest prognostic importance in bpd?
substance abuse (links et al, 1990, stone et al, 1990)
increase in bpd among youth
- Millon 1987, 1993: Changes in social envi. that interfere with the intergenerational transmission of values.
- Paris expanded: modernity reduces protective influence of extended family and social community.
- Social structures offer young people a sense of identity. In disintegrated societies, sense of self breaks down, failure of buffering process for family pathology and for impulsive or affectively unstable personality traits. Integrated societies encourage repression of conflicts rather than people with impulsive traits to act out. (Millon, 1993).