DSM-5 Diagnostic criteria for Personality Disorders: Personality disorders in general, severely limit an Although Personality Disorders have always been
individual’s approach to living. considered difficult to treat, recent evidence- based
therapies proved to be highly successful in treating
A: an enduring pattern of inner experience and behavior In order to diagnose Personality Disorders, individuals diagnosed with Borderline Personality
that deviates markedly.. (cognition, affectivity, individuals need to be assessed with regard to Disorder.
interpersonal functioning, impulse control) their long-term patterns of functioning over time
B: enduring pattern is inflexible and pervasive across a and across different situations. Both sets of criteria (i.e. General diagnostic criteria for a
broad range of personal and social situations Personality Disorder together with at least 5 specific
C: leads to clinically significant distress or impairment in Personality traits of individuals need to be Diagnostic criteria, for example, for Borderline
social, occupational or other NB areas of functioning separated from other symptoms that may have Personality Disorder) need to be taken into
D: pattern is stable and of long duration. Onsets can be appeared after certain stressors etc.. consideration for fulfilling the conditions for making a
traced back to adolescence or early adulthood diagnosis of Borderline Personality Disorder.
E: not better accounted for as a manifestation or .
Borderline Personality Disorder : (BPD)
consequence of another mental disorder Is characterized by a pattern of instability in
F: not due to the direct physiological effects of a interpersonal relationships, self-image, affect and
substance marked impulsivity.
The problems related to identifying and diagnosing
Borderline Personality Disorder in adolescents within
the South African context.
Diagnostic Criterion for Borderline Personality Aetiology:
Disorder (APA, 2013 p. 663)
The aetiology of Personality disorders is mainly
A pervasive pattern of instability of interpersonal INTRODUCTION attributed to the development of immature and
relationships, self-image, and affects, and marked distorted patterns of personality functioning which
impulsivity beginning in early adulthood and present in a & lead to persistent maladaptive ways of perceiving,
variety of contexts, as indicated by five or more of the FIRST PARAGRAPH OF THE BODY thinking, relating to others, and interacting with
following: frantic efforts to avoid real or imagined the world. Refer to Chapter 14 in your prescribed
abandonment, pattern of unstable and intense
textbook (pages 527-580).
interpersonal relationships, identity disturbance:
markedly and persistently unstable self-image or sense of
self, impulsivity in at least two areas that are potentially
self-damaging (sex, substance abuse, binge eating),
recurrent suicidal behaviour, gestures, threats or self-
mutilating behaviour, affective instability due to a
marked reactivity of mood (intense episodic dysphoria,
irritability), chronic feelings of emptiness, inappropriate,
intense anger or difficulty controlling anger and
transient, stress-related paranoid ideation or severe
dissociative symptoms.
, Quieting the Affective storm of borderline Personality Disorder : Marianne 2. Psychiatric : psychiatric intervention was only obtained at age 15. At first she was
Goodman et al. 2009 diagnosed with major depression as she was isolated and sleeping 14-26 hours a day.
1. Late adolescence she underwent two trials of antidepressant medication but was
Case Study : “V” nonadherent. She saw 8 different therapists. V would flee and then return. She believed
Had a controlling mother with whom she battled constantly. Her father had an she was “too overwhelming” to sustain relationships with her providers.
extramarital affair. The disruption greatly affected V. mother became clinically Trauma : had an inappropriate altercation with her father when she was 17. As a child
depressed and unable to parent effectively (created a sense that V had lost both her mother responded to her tirades by throwing water in her face. She endorsed
parents). As a child V was precocious but moody & unusually sensitive to physical elevated levels of both emotional neglect and abuse and childhood physical abuse.
experiences and to challenges to her autonomy – responded with anger and near Treatment : outset of treatment; V endorsed dramatic mood shifts, verbally explosive
hysteria. Episodes occurred 3-4 times a week. After the divorce (13) her baseline behaviour and awakening with suicidal ideation 3-4 days per week. She expressed
emotional state was characterized by misery, despair and inner turmoil. Behavioural hatred for her body and felt unattractive to men. She was plagued by feelings of
dyscontrol intensified. She experienced intense suicidal ideation and at 15 started emptiness and questions her sense of self.
cutting herself to demonstrate her internal pain. Age 16 behaviours escalated to truancy First two months treatment focused on : orientation to the dialectical behaviour
and physical altercations with police. In college she continued self-injurious behaviour therapy method and fostering a therapeutic alliance. Within the first few weeks V was
as self-punishment and a means to communicate her distress. Emptiness pervaded her endorsing deliberate self-harm on several occasions.
80% of the time. Remained distant from peers and was not involved in any romantic Months 3-5 : notable for continued suicidality. V feared abandonment and believed she
relationships. was too overwhelming for others to handle.
Goodman, M., Hazlett, E.A., New, A.S., Koenigsberg, H.W.,
& Siever, L. (2009). Quieting the affective storm of
Borderline Personality Disorder. American Journal of
Psychiatry, 166, 522- 528.
3. her sense of abandonment escalated and her intolerance of being alone Research Data :
resulted in a fugue-like state in which she walked alone late at night in Structured clinical interviews for axis I and II disorders yielded Borderline Personality
dangerous neighbourhoods. She was then involuntarily hospitalized for 5 days. Disorder. A battery of self-report symptom measures was administered yielding
Months 6-9 : began to employ more effective strategies at work and with her elevated levels of negative affect, aggression and anger explosion. The patients results
roommate and family members. were contrasted with those of a female healthy comparison.
Affective startle is a reliable nonverbal psychophysiological method that is useful for
Last 3 months : Behavioural analyses of targets including increased anxiety
objectively quantifying the waxing and waning of emotional processing.
reactions, newly reported binge eating episodes and excessive lethargy revealed
V showed an augmented startle response during unpleasant pictures compared with the
distorted cognitive beliefs about her neediness, fear of abandonment and guilty healthy subject, as well as augmented response during neutral pictures.
feelings of how her emotional sensitivity as a child affected the family and V showed an increase in startle eyeblink amplitude during the unpleasant pictures
overwhelmed her mother’s ability to cope. whereas the comparison participant showed a slightly decreased response indicating
V traveled to help her mother’s convalescence. She returned more hopeful, less habituation. This may reflect a failure of automatic emotion regulation.
steeped in the past, and with a diminished need to communicate through acting
out. She also started and nurtured a romantic relationship and secured a better
job placement.
individual’s approach to living. considered difficult to treat, recent evidence- based
therapies proved to be highly successful in treating
A: an enduring pattern of inner experience and behavior In order to diagnose Personality Disorders, individuals diagnosed with Borderline Personality
that deviates markedly.. (cognition, affectivity, individuals need to be assessed with regard to Disorder.
interpersonal functioning, impulse control) their long-term patterns of functioning over time
B: enduring pattern is inflexible and pervasive across a and across different situations. Both sets of criteria (i.e. General diagnostic criteria for a
broad range of personal and social situations Personality Disorder together with at least 5 specific
C: leads to clinically significant distress or impairment in Personality traits of individuals need to be Diagnostic criteria, for example, for Borderline
social, occupational or other NB areas of functioning separated from other symptoms that may have Personality Disorder) need to be taken into
D: pattern is stable and of long duration. Onsets can be appeared after certain stressors etc.. consideration for fulfilling the conditions for making a
traced back to adolescence or early adulthood diagnosis of Borderline Personality Disorder.
E: not better accounted for as a manifestation or .
Borderline Personality Disorder : (BPD)
consequence of another mental disorder Is characterized by a pattern of instability in
F: not due to the direct physiological effects of a interpersonal relationships, self-image, affect and
substance marked impulsivity.
The problems related to identifying and diagnosing
Borderline Personality Disorder in adolescents within
the South African context.
Diagnostic Criterion for Borderline Personality Aetiology:
Disorder (APA, 2013 p. 663)
The aetiology of Personality disorders is mainly
A pervasive pattern of instability of interpersonal INTRODUCTION attributed to the development of immature and
relationships, self-image, and affects, and marked distorted patterns of personality functioning which
impulsivity beginning in early adulthood and present in a & lead to persistent maladaptive ways of perceiving,
variety of contexts, as indicated by five or more of the FIRST PARAGRAPH OF THE BODY thinking, relating to others, and interacting with
following: frantic efforts to avoid real or imagined the world. Refer to Chapter 14 in your prescribed
abandonment, pattern of unstable and intense
textbook (pages 527-580).
interpersonal relationships, identity disturbance:
markedly and persistently unstable self-image or sense of
self, impulsivity in at least two areas that are potentially
self-damaging (sex, substance abuse, binge eating),
recurrent suicidal behaviour, gestures, threats or self-
mutilating behaviour, affective instability due to a
marked reactivity of mood (intense episodic dysphoria,
irritability), chronic feelings of emptiness, inappropriate,
intense anger or difficulty controlling anger and
transient, stress-related paranoid ideation or severe
dissociative symptoms.
, Quieting the Affective storm of borderline Personality Disorder : Marianne 2. Psychiatric : psychiatric intervention was only obtained at age 15. At first she was
Goodman et al. 2009 diagnosed with major depression as she was isolated and sleeping 14-26 hours a day.
1. Late adolescence she underwent two trials of antidepressant medication but was
Case Study : “V” nonadherent. She saw 8 different therapists. V would flee and then return. She believed
Had a controlling mother with whom she battled constantly. Her father had an she was “too overwhelming” to sustain relationships with her providers.
extramarital affair. The disruption greatly affected V. mother became clinically Trauma : had an inappropriate altercation with her father when she was 17. As a child
depressed and unable to parent effectively (created a sense that V had lost both her mother responded to her tirades by throwing water in her face. She endorsed
parents). As a child V was precocious but moody & unusually sensitive to physical elevated levels of both emotional neglect and abuse and childhood physical abuse.
experiences and to challenges to her autonomy – responded with anger and near Treatment : outset of treatment; V endorsed dramatic mood shifts, verbally explosive
hysteria. Episodes occurred 3-4 times a week. After the divorce (13) her baseline behaviour and awakening with suicidal ideation 3-4 days per week. She expressed
emotional state was characterized by misery, despair and inner turmoil. Behavioural hatred for her body and felt unattractive to men. She was plagued by feelings of
dyscontrol intensified. She experienced intense suicidal ideation and at 15 started emptiness and questions her sense of self.
cutting herself to demonstrate her internal pain. Age 16 behaviours escalated to truancy First two months treatment focused on : orientation to the dialectical behaviour
and physical altercations with police. In college she continued self-injurious behaviour therapy method and fostering a therapeutic alliance. Within the first few weeks V was
as self-punishment and a means to communicate her distress. Emptiness pervaded her endorsing deliberate self-harm on several occasions.
80% of the time. Remained distant from peers and was not involved in any romantic Months 3-5 : notable for continued suicidality. V feared abandonment and believed she
relationships. was too overwhelming for others to handle.
Goodman, M., Hazlett, E.A., New, A.S., Koenigsberg, H.W.,
& Siever, L. (2009). Quieting the affective storm of
Borderline Personality Disorder. American Journal of
Psychiatry, 166, 522- 528.
3. her sense of abandonment escalated and her intolerance of being alone Research Data :
resulted in a fugue-like state in which she walked alone late at night in Structured clinical interviews for axis I and II disorders yielded Borderline Personality
dangerous neighbourhoods. She was then involuntarily hospitalized for 5 days. Disorder. A battery of self-report symptom measures was administered yielding
Months 6-9 : began to employ more effective strategies at work and with her elevated levels of negative affect, aggression and anger explosion. The patients results
roommate and family members. were contrasted with those of a female healthy comparison.
Affective startle is a reliable nonverbal psychophysiological method that is useful for
Last 3 months : Behavioural analyses of targets including increased anxiety
objectively quantifying the waxing and waning of emotional processing.
reactions, newly reported binge eating episodes and excessive lethargy revealed
V showed an augmented startle response during unpleasant pictures compared with the
distorted cognitive beliefs about her neediness, fear of abandonment and guilty healthy subject, as well as augmented response during neutral pictures.
feelings of how her emotional sensitivity as a child affected the family and V showed an increase in startle eyeblink amplitude during the unpleasant pictures
overwhelmed her mother’s ability to cope. whereas the comparison participant showed a slightly decreased response indicating
V traveled to help her mother’s convalescence. She returned more hopeful, less habituation. This may reflect a failure of automatic emotion regulation.
steeped in the past, and with a diminished need to communicate through acting
out. She also started and nurtured a romantic relationship and secured a better
job placement.
