Download Borderline Personality Disorder

Survey
yes no Was this document useful for you?
   Thank you for your participation!

* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project

Document related concepts

Hidden personality wikipedia , lookup

Obsessive–compulsive personality disorder wikipedia , lookup

Community mental health service wikipedia , lookup

Bipolar II disorder wikipedia , lookup

Emergency psychiatry wikipedia , lookup

Panic disorder wikipedia , lookup

Factitious disorder imposed on another wikipedia , lookup

Victor Skumin wikipedia , lookup

Bipolar disorder wikipedia , lookup

Excoriation disorder wikipedia , lookup

Asperger syndrome wikipedia , lookup

Child psychopathology wikipedia , lookup

Borderline personality disorder wikipedia , lookup

Schizoaffective disorder wikipedia , lookup

Controversy surrounding psychiatry wikipedia , lookup

Generalized anxiety disorder wikipedia , lookup

Abnormal psychology wikipedia , lookup

Depersonalization disorder wikipedia , lookup

Schizoid personality disorder wikipedia , lookup

Mental disorder wikipedia , lookup

History of mental disorders wikipedia , lookup

History of psychiatry wikipedia , lookup

Conversion disorder wikipedia , lookup

Spectrum disorder wikipedia , lookup

Pyotr Gannushkin wikipedia , lookup

Classification of mental disorders wikipedia , lookup

Personality disorder wikipedia , lookup

Conduct disorder wikipedia , lookup

Dissociative identity disorder wikipedia , lookup

Diagnostic and Statistical Manual of Mental Disorders wikipedia , lookup

Antisocial personality disorder wikipedia , lookup

Narcissistic personality disorder wikipedia , lookup

Transcript
Assessing Borderline Personality Disorder
in the Primary Care Setting
Presented by: Jonathan Betlinski, MD
Date: 11/13/2014
Disclosures and Learning Objectives
• Learning Objectives
–
–
–
Be able to list the diagnostic criteria for
Borderline Personality Disorder
Know at least 3 mental health
comorbidities of BPD
Know at least 3 physical health
comorbidities of BPD
Disclosures: Dr. Jonathan Betlinski has nothing to disclose.
Assessing Borderline Personality Disorder
•
•
•
•
•
Review epidemiology
Review mental health comorbidities
Review physical health comorbidities
Review Prognosis
Review diagnostic criteria
• Next Week's Topic
Borderline Personality Disorder
•
1-4% of the general population
•
8-27% in outpatient mental health (15-51% inpatient)
•
6% of a primary care clinic population (or 26%???)
– 21% current suicidal ideation
– 21% Bipolar Disorder
– 36% Major Depressive Disorder
– 57% Anxiety Disorder
– 50% had no mental health treatment that year
– 43% not recognized by PCP has having any
emotional or mental health problems.
http://archinte.jamanetwork.com/article.aspx?articleID=210746
Borderline Personality Disorder Co-Occurs
•
60% have MDD
•
70% have Dysthymic Disorder
•
25% have Eating Disorders
•
35% meet criteria for Substance Abuse
•
15% Bipolar Disorder
•
25% Antisocial Personality Disorder
•
25% Narcissistic Personality Disorder
•
Up to 80% have suicidal behaviors
•
4-9% die from suicide
http://www.nimh.nih.gov/health/publications/borderline-personalitydisorder/Borderline_Personality_Disorder_508_141959.pdf
http://www.nami.org/Template.cfm?Section=By_Illness&Template=/TaggedPage/TaggedPageDisplay.cfm&TPLID=54&
Borderline Personality Disorder
•
Higher rates of common health problems
–
–
–
–
–
•
Diabetes
Hypertension
Chronic Back Pain
Arthritis
Fibromyalgia
May be due to medication-induced
obesity
http://www.nimh.nih.gov/health/publications/borderline-personalitydisorder/Borderline_Personality_Disorder_508_141959.pdf
Borderline Personality Disorder
•
•
•
•
•
•
Fewer PCP visits per year
Lower mental/emotional health ratings
Similar physical health self-rating
Much higher rates of hospitalization
Much higher rates of mental health care
Much higher rates of psychiatric
medications
http://archinte.jamanetwork.com/article.aspx?articleID=210746
Borderline Personality Disorder, Prognosis
•
•
•
•
•
•
•
First five years are most crisis-ridden
60% readmitted within the first 6 months
35% readmission in 18-24 months
40-50% remission in 2 years
85% remission in 10 years
After remission, only 6% relapse
25% achieve social stability
http://www.borderlinepersonalitydisorder.com/documents/A_BPD_Brief_REV2011.pdf
http://www.nimh.nih.gov/health/publications/borderline-personalitydisorder/Borderline_Personality_Disorder_508_141959.pdf
Borderline Personality Disorder, DSM-IV TR
A 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, as indicated by 5 (or
more) of the following:
•
Frantic efforts to avoid abandonment
•
A pattern of unstable, intense relationships
•
Identity disturbance
•
Impulsivity in potentially damaging areas
•
Recurrent suicidal behaviors
•
Chronic feelings of emptiness
•
Inappropriate intense anger or difficulty controlling anger
•
Transient paranoia or severe dissociative symptoms
http://www.psi.uba.ar/academica/carrerasdegrado/psicologia/sitios_catedras/practicas_profesionales/820_clinica_tr_pe
rsonalidad_psicosis/material/dsm.pdf
Borderline Personality Disorder, DSM-5
Impairments in personality (self and interpersonal) functioning AND the
presence of pathological personality traits. These criteria must be met:
•
Significant impairments in personality functioning
•
Impairments in self functioning (a or b)
•
Identity (unstable self image, chronic emptiness, dissociative states, self-criticism)
•
Self-direction (instability in goals, aspirations, values or career plans)
•
•
AND Impairments in interpersonal functioning (a or b)
•
Empathy (and hypersensitivity)
•
Intimacy (intense, unstable, and conflicted close relationships, alternating extremes)
Pathological Personality Traits in the following domains
•
Negative Affectivity, characterized by
•
Emotional lability
•
Anxiousness
•
Separation insecurity
•
Depressivity
http://www.psi.uba.ar/academica/carrerasdegrado/psicologia/sitios_catedras/practicas_profesionales/820_clinica_tr_pe
rsonalidad_psicosis/material/dsm.pdf
Borderline Personality Disorder, DSM-5
•
Disinhibition, characterized by
•
Impulsivity
•
Risk-taking
•
Antagonism, characterized by
•
Hostility
•
These impairments are relativity stable across time and
consistent across situations
•
The impairments are not better understood as normative for
developmental stage or socio-cultural environment
•
The impariments are not solely due to the direct physiologic
effects of a substance or a general medical condition
http://www.psi.uba.ar/academica/carrerasdegrado/psicologia/sitios_catedras/practicas_profesionales/820_clinica_tr_pe
rsonalidad_psicosis/material/dsm.pdf
Summary
•
Borderline Personality Disorder
–
–
–
•
More common in Primary Care settings
Commonly misunderstood
Can disrupt care
Borderline Personality Disorder
–
–
Gets better!
Accurate recognition increases chances
for recovery
http://www.nami.org/Template.cfm?Section=Borderline_Personality_Disorder_(BPD)&Template=/ContentManagement/
ContentDisplay.cfm&ContentID=81017
The End!
Next Week's
Topic:
Treatment of
Borderline
Personality
Disorder