Borderline Personality Disorder - 2nd Edition

Educational Objectives

Upon completing this educational activity, participants will be able to:
1. Utilize knowledge of recent developments in genetics and neuroscience to more effectively diagnose and manage psychiatric disorders.
2. Discuss optimal diagnosis, treatment, and clinical understanding of bipolar disorder.
3. Identify and overcome barriers to the effective management of personality disorders.
4. Identify and manage key factors that may affect a patient's risk for violent behavior.
5. Recognize common causes of treatment failures in patients suffering with anxiety and depression.
6. Implement therapy techniques for managing patients with somatic disorders.

Summary

Borderline Personality Disorder

John G. Gunderson, MD, Professor of Psychiatry, Harvard Medical School, Boston, Massachusetts, and Director, Personality and Psychosocial Research Program, McLean Hospital, Belmont, Massachusetts

Introduction: training for disorder inconsistent; little information from previous generation; update needed with growth in knowledge; prevalence 1% to 3%; equal gender ratio

Borderline personality disorder: no clear relationship to socioeconomic status, cultural background; common in nonpsychiatric settings; 9 criteria for diagnosis; 1980 first classification system; sectors of interpersonal relationships, emotions, behavior, cognitions or identity; interpersonal sector most discriminating; modified criteria; traits of high neuroticism, low agreeableness; diagnosis can be made in adolescents; comorbidities: major depression, bipolar disorders, post-traumatic stress disorder, substance abuse; 20% remit by 1 year; 40% 2 years, 85% 8 to 10 years; 12% rate of relapse; no functional improvement with signs and symptoms remission; worse prognosis associated with chronicity; 3% to 10% suicide (young female common); heritability 55%; unified structure; genetic research validated integrity of diagnosis; interpersonal, emotional genetically determined; developmental factors essential; prediction factors: insecure attachments, hypersensitivity; family life characterized by dysfunction; parental psychiatric illness common; neglect most prevalent, clinically significant; hyperactive amygdala, underresponsive frontal cortex, elevated cortisol levels; neurohormone abnormality; high sensitivity to interpersonal relationships, aversion, misread social cues

Treatment: 1970 to 1990 >50 books documented problems; earlier treatments likely harmful; 1993 Marsha Linehan, Dialectical Behavioral Therapy; preventing repeated self-harm; coaching, combined individual and group therapy; reductions in hospital, emergency department usage; improve depression, decrease self-harm, decrease suicidality; mentalization-based treatment (Peter Fonagy, Anthony Bateman); transference focused psychotherapy (based on work of Otto Kernberg et al.); resource intensive; extended treatment; generalist model; therapist active and supportive, focus on adverse interpersonal events, recognize and accept emotions; model easily taught; now in training programs; psychopharmacologic treatments not proven useful

Summary: undefined boundaries, ineffective treatments; good prognosis for gradual recovery; responsive to psychosocial treatments; genetics insufficient to cause disorder without environmental factors; disorder stigma; Fatal Attraction led to erroneous prototype; persistent disorder; patients not easy to treat; goal for disorder inclusion in standard training

Readings

Disclosures

Acknowledgements

CME/CE INFO

Accreditation:

The Audio- Digest Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Audio- Digest Foundation designates this enduring material for a maximum of 0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Audio Digest Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's (ANCC's) Commission on Accreditation. Audio Digest Foundation designates this activity for 0 CE contact hours.

Lecture ID:

PSBR160137

Expiration:

This CME course qualifies for AMA PRA Category 1 Credits™ for 3 years from the date of publication.

Instructions:

To earn CME/CE credit for this course, you must complete all the following components in the order recommended: (1) Review introductory course content, including Educational Objectives and Faculty/Planner Disclosures; (2) Listen to the audio program and review accompanying learning materials; (3) Complete posttest (only after completing Step 2) and earn a passing score of at least 80%. Taking the course Pretest and completing the Evaluation Survey are strongly recommended (but not mandatory) components of completing this CME/CE course.

Estimated time to complete this CME/CE course:

Approximately 2x the length of the recorded lecture to account for time spent studying accompanying learning materials and completing tests.

More Details - Certification & Accreditation