Speaker: Ron Diamond
Personality Disorder
- we talk about personality characteristics
- what is a personality disorder? means it routinely gets them in trouble, its problems in all areas and ongoing and its pervasive
- there is a stigma around Borderline Personality Disorder more so than other labels such as schizophrenia etc
- when we look at the DSM IV thrree of the characteristics are impulsive, intense anger, affective instability
- lets look at violence and borderline disorder – books say they are more violent BUT the data on BPD and violence differs
- we need to be careful not to further stigmatize this disorder
- the best data is from the MacArthur Violence Risk Assessment Study – if we do associate them with violence it is more likely that the violence is towards themselves
Core Deficits in People with Borderline Disorder
- affective instability
- impulsivity and low frustration tolerance
- sense of self as being damaged or defective from environmental invalidation
- difficulty maintaining their own sese of identity /poor object constancy
- poor understanding of rules of normal personal relationship – we negotiate relationships all the time and if we cant do this the world becomes angry with us and we dont know why
- Discussions Sexual Abuse and some relatedness to BPD
- Discusses study showing 10 year follow up study showing that there is recovery but change takes a long time.
- One goal is to stay in a long term, stable relationships, be aware of your feelings, monitor and regulate interpersonal distance, be aware of ‘splitting’ – being right may be less important than being a team.
-Words that interfere with the consumer relationship – manipulative, treatment resistant, unmotivated, attention seeking, too ill to know what is good for herself. Once we use these words they get in the way of us listening – we need to support the clients own sense of competence.
-We need to focus on increasing self esteem, reduce anxiety,
-Think about the word ‘but’ this word says discount everything you have just said – don’t use it. Connect sentences with ‘and’ not but.
-Assumptions about borderline patients and therapy: patients are doing the best they can and want to improve, patients need to do better, try harder and be more motivated to change,
-Treatment planning is critical: involve the client, plan ahead for the next predictable event, strike when the iron is cold – lets figure out ahead of time what we are going to do. He then discusses a treatment plan for a woman that continually called the crisis line.
-Obtain a careful history: many people with BPD have been in the system for years without a careful history.
-Consider that problem behaviour is exacerbated by other elements
-Be clear about the therapy contract: what are the clients real treatment goals, what would doing better or doing worse mean, what commitment is the client willing or able to make, what will I note tolerate as a clinician and we need to be clear about that.
-Be clear about this contract – what are you able to deliver and what can you tolerate in terms of risk
-Core strategies for therapy: Validation, Problem Solving and Skills Training
-We need to help instil hope
-Suicide means many things.
-When you are stuck enlarge the field and avoid blaming patients for the symptoms of the disorder
- The clinician does not have to’ fix it’ they need to be there to listen and to walk with their patients and give them skills
In summary, we started talking about violence but as mentioned the vast majority of BPD may be violent but towards themselves, we need to focus on being on their side rather than containment.
Questions from the floor (please note not all questions are recorded)
