1. Credit for this presentation goes to
Scott Fairweather, LISW-CP, CAC-I
Transformative Behavioral Health LLC
1620 Suite B Lady St.
Columbia, SC 29204
phone: (303) 241-2632
fax: (803)451-7604
Credit for this presentation goes to
Scott Fairweather, LISW-CP, CAC-I
Transformative Behavioral Health LLC
1620 Suite B Lady St.
Columbia, SC 29204
phone: (303) 241-2632
fax: (803)451-7604

2. Borderline Personality Disorder Borderline Personality Disorder
Presented by: Scott Fairweather,
LISW-CP, CAC-I
Clinical Instructor – USC School of Medicine Department of Neuropsychiatry
and Behavioral Science.
Owner / Therapist – Transformative Behavioral Health LLC

3. Session Objectives
– Participants will be introduced to symptoms of
Borderline Personality Disorder (BPD) and
characteristics of the disorder.
– Participants will understand how BPD differs
from other types of mental illness.
– Participants should recognize changes occurring
in relation to diagnosis and treatment of BPD.
– Participants will be introduced to community
resources for referral, treatment, and additional
information.

4. DSM-IV TR Diagnostic Criterion for
Borderline Personality Disorder (BPD)
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:
American Psychiatric Association. (1994) Diagnostic and Statistical Manual of
Mental disorders: DSM-IV-TR (4th ed.)
Washington, DC: Author.

5. BPD Criterion Continued
–
Frantic efforts to avoid real or imagined abandonment. note: do not
include suicidal or self-mutilating behavior in criterion 5.
–
A pattern of unstable and intense interpersonal relationships
characterized by alternating between extremes of idealization and
devaluation.
–
Identity disturbance: markedly and persistently unstable self-image or
sense of self.
–
Impulsivity in at least two areas that are potentially self-damaging (e.g.,
spending, sex, substance abuse, reckless driving, binge eating) note: do
not include suicidal or self mutilating behavior covered in criterion 5.
–
Recurrent suicidal behavior, gestures, threats, or self mutilating
behavior.
–
Affective instability due to a marked reactivity of mood (e.g., frequent
displays of temper, constant anger, recurrent physical fights)
–
Transient, stress-related paranoid ideation or severe dissociative
symptoms.
American Psychiatric Association. (1994) Diagnostic and Statistical Manual of
Mental disorders: DSM-IV-TR (4th ed.)
Washington, DC: Author.

6. DSM V – Definition of Personality
Disorders
– A new definition for personality disorder:
First, the definition of what a personality disorder
is, in general, has changed. The proposed revision
suggests that instead of a pervasive pattern of
thinking/emotionality/behaving, a personality
disorder reflects "adaptive failure" involving:
"Impaired sense of self-identity" or "Failure to
develop effective interpersonal functioning".
http://www.borderlinepersonalitydisorder.com/DSM-V_News.shtml

7. DSM V and BPD: Diagnostic Changes
•
The essential features of a personality disorder are
impairments in personality (self and interpersonal)
functioning and the presence of pathological personality
traits. To diagnose borderline personality disorder, the
following criteria must be met:
•
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 self-criticism;
chronic feelings of emptiness; dissociative states under stress.
•
b. Self-direction: Instability in goals, aspirations, values, or career
plans.
http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=17

8. BPD DSM V cont..
.
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 lability: Unstable emotional experiences and
frequent mood changes; emotions that are easily aroused, intense,
and/or out of proportion to events and circumstances.
http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=17

9. BPD DSM V cont..
•
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.
http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=17

10. BPD DSM V cont.
2. Disinhibition, characterized 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, characterized by:
•
a. Hostility: Persistent or frequent angry feelings; anger
or irritability in response to minor slights and insults.
http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=17

11. BPD DSM V cont..
•
C. The impairments in personality functioning and the
individual•s personality trait expression are relatively
stable across time and consistent across situations.
•
D. The impairments in personality functioning and the
individual•s personality trait expression are not better
understood as normative for the individual•s
developmental stage or socio-cultural environment.
•
E. The impairments in personality functioning and the
individual•s personality trait expression are not solely
due to the direct physiological effects of a substance
(e.g., a drug of abuse, medication) or a general medical
condition (e.g., severe head trauma).
http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=17

12. BPD compared with other forms of MI
in US population.
www.nimh.nih.gov/statistics/1ANYANX_ADULT.shtml

13. Medications and BPD
• Medications are most useful for treating
underlying symptoms of anxiety, depression,
and impulsiveness.
• Anti-depressants (SSRI•s) • help to regulate
depression and labile moods.
• Mood Stabilizers • help to regulate emotions
and reduce impulsiveness and anger.
• Atypical Antipsychotics • help reduce impulsive
and reckless behavior.
http://www.webmd.com/mental-health/tc/borderline-personality-disorder-
medications

14. Video links:
• http://www.cbsnews.com/2300-204_16210008846.
html?tag=page
• http://www.nytimes.com/2011/06/23/health/2
3lives.html?pagewanted=all

15. Treatment Approaches for BPD
•
Dialectical Behavioral Therapy (DBT) • teaches coping skills in four
areas; Mindfulness, Distress Tolerance, Emotion Regulation, and
Interpersonal Effectiveness. Includes individual therapy weekly.
•
Cognitive Behavioral Therapy (CBT) • focus is on restructuring
thinking patterns (thoughts, assumptions, and beliefs).
•
Transference-focused therapy (TFP) • an adaptation of
psychoanalysis designed to change the distortions in the patients
perception of significant others and the therapist.
•
Schema-focused therapy (SFT) • focuses on changing psychological
problems by examining repetitive life patterns and by changing core
life themes.
•
Mentalization-based therapy (MBT) • psychodynamic therapy
focused on building the capacity to understand behavior and
feelings associated with mental states in oneself and others.
http://www.bpdfamily.com/bpdresources/nk_a107.htm

16. Bio Social Model
Dysregulation Disorder symptoms =
Biological Sensitivity AND Invalidating environment
Invalidating
Environment
Biology
Invalidating
Environment
Biology
Invalidating
Environment
Biology
Gresham, A., & Kivedra, C. (2010, April) Dialectical Behavioral Therapy
[PowerPoint Slides].

17. Bio-Social Model cont..
• High Sensitivity
• High reactivity
• Slow return to baseline
• Often •Transactional• with the Environment
Gresham, A., & Kivedra, C. (2010, April) Dialectical Behavioral Therapy
[PowerPoint Slides].

18. DBT vs. Treatment as Usual (TAU)
• Appears to be more effective than (TAU) in reducing
suicidal behaviors, self mutilating behaviors, and
admission to inpatient hospital stays.
• Treatment attendance retention, global functioning,
and social adjustment appears to be greater with
DBT than TAU.
• Effective working with adults, adolescents, and
elderly.
• Effective in treating substance dependence, eating
disorders, trauma related disorders, compulsive
disorders, treatment resistant depression, and a
variety of personality disorders.
http://depts.washington.edu/brtc/sharing/publications/research-and-articles-on-
dialectical-behavior-therapy

19. Referrals
• Columbia Area Mental Health •
(803) 898-8888
• Three Rivers Behavioral Health
(803)796-9911
• Three Springs DBT • Greenville, SC
(864) 242-5551
• Scott Fairweather, LISW-CP, CAC-I
(303) 241-2632.
• Palmyra Powell, LISW-CP
(803) 586-1499.

20. Books on BPD
Kreisman, Jerold., & Straus, Hal. (1989) I Hate You • don•t leave me.
Avon Books. New York, NY.
Linehan, Marsha. (1993) Cognitive Behavioral Treatment of
Borderline Personality Disorder. The Guildford Press. New
York, NY.
Manning, Shari. (2011) Loving Someone with Borderline
Personality Disorder. The Guildford Press. New York, NY.
Mason, Paul T., Kreger, Randy. (1998) Stop walking on eggshells:
Taking your life back when someone you care about has
Borderline Personality Disorder. New Harbinger
Publications. Oakland, CA.

21. Questions?

22. Where to learn more
• www.behavioraltechllc.com
• www.dbtselfhelp.com
• http://www.ticllc.org/