Borderline Borderline personality personality of our age of our age
Dusica Lecic TosevskiInstitute of Mental Health
Belgrade
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De natura hominis De natura hominis
It is more important to know what person has a disease, than to know what disease a person has.
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ContentContent
Borderline personality disorderBorderline personality disorder
Borderline personality of our age Borderline personality of our age
Our borderline age Our borderline age
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Crisis of meaning 1Crisis of meaning 1
Civilised world is mortalCivilised world is mortal ““Malady of death” - our most hidden Malady of death” - our most hidden
inner recesses governs: inner recesses governs:
- the military and economic - the military and economic domains, social and political domains, social and political
bondsbonds
- once noble realm of the mind- once noble realm of the mind
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Crisis of meaning 2Crisis of meaning 2
Power of destructive forces within the Power of destructive forces within the individual and societyindividual and society
Destruction of nature, life and economic Destruction of nature, life and economic resourcesresources
Outbreak or a more patent manifestation Outbreak or a more patent manifestation of psychosis, depression, anxiety and of psychosis, depression, anxiety and personality disorderspersonality disorders
Disaster of the mind Disaster of the mind
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Disaster of the mindDisaster of the mind
Greater prevalence of Greater prevalence of personality disorders? personality disorders?
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Literature Classical theatre - Classical theatre -
conflicts of neurotic conflicts of neurotic disordersdisorders
Theatre of the absurd - Theatre of the absurd - borderline conditionsborderline conditions
Samuel Becket - Samuel Becket - Waiting for GodotWaiting for Godot
Albert Camus - Albert Camus - The FallThe Fall
J. P. Sartre - J. P. Sartre - Hell is Hell is other peopleother people
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Personality disorders - Personality disorders - modern concepts and modern concepts and
controversiescontroversies
ClassificationClassification Definition/diagnostics Definition/diagnostics
(borderline personality disorder)(borderline personality disorder) AetiologyAetiology
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Classification DSM-III and IV
Disputable personality disordersDisputable personality disorders
schizotypal (sch spectrum)
schizoid (no patients)
avoidant PD (social phobia?)
dependent (a separate entity?)
depressive (masochistic)
passive-aggressive (defense mechanism)(defense mechanism)
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Classification Classification ICD-10
AdvantagesAdvantages
schizotypal PDschizotypal PD
enduring personality enduring personality changeschanges
passive-aggressive passive-aggressive PDPD
DisadvantagesDisadvantages
narcissistic PD narcissistic PD
borderline PD - borderline PD - emotionally labile PDemotionally labile PD
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Borderline personality disorder
A non-discriminatory synonym for all personality disorders (Kroll, 1983)
Diagnostic “grab bag”
“An adjective in search of a noun” (Akiskal et al., 1985)
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Three concepts of BPDThree concepts of BPD
Borderline personality disorder Borderline personality disorder (Gunderson & Kolb, 1978)(Gunderson & Kolb, 1978)
Borderline personality organisation Borderline personality organisation (Kernberg, 1967-1989)(Kernberg, 1967-1989)
Borderline level of functioning Borderline level of functioning (Berelowitz & Tarnopolski, 1993; Lecic-Tosevski & (Berelowitz & Tarnopolski, 1993; Lecic-Tosevski & Divac-Jovanovic, 1993 -2004)Divac-Jovanovic, 1993 -2004)
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Borderline personality Borderline personality disorderdisorder
Most BPD patients - other cluster B Most BPD patients - other cluster B diagnoses diagnoses
Dissociative identity disorder Dissociative identity disorder
Affective instability - comorbid mood Affective instability - comorbid mood disorders disorders
Five of nine criteria - arbitraryFive of nine criteria - arbitrary
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Borderline personality Borderline personality organisationorganisation
Structural criteriaStructural criteria
diffuse identitydiffuse identity
primitive defences primitive defences
intact reality testingintact reality testing
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SplittingSplitting
clinical marker of severe personality clinical marker of severe personality disordersdisorders
defence of neglected childdefence of neglected child
pre-ambivalencepre-ambivalence
chaotic interpersonal relationshipschaotic interpersonal relationships
contradictory emotions and cognitioncontradictory emotions and cognition
perceptive alterations of self and perceptive alterations of self and objectsobjects
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Borderline level of Borderline level of functioningfunctioning
level of dysfunction of personality disorders level of dysfunction of personality disorders
a non-specific marker of severity of PDsa non-specific marker of severity of PDs
dynamic, transitory dimensiondynamic, transitory dimension
masks of borderline personality disorder (“chameleon masks of borderline personality disorder (“chameleon style”)style”)
manifestation of depression (Lecic-Tosevski, 1993)manifestation of depression (Lecic-Tosevski, 1993)
attenuated (subclinical variant) of affective disorders attenuated (subclinical variant) of affective disorders (Akiskal) (Akiskal)
core BPD core BPD
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Impulsivity Affectiveinstability
Biological risk factors Psychological risk factors
BPD
Loss
Trauma
Parental failure
Social disintegration
Social risk factors
Biopsychosocial model of borderline personality disorder (J. Parris, 1994)
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Social influencesSocial influences
Personality disorders - growing violence?Personality disorders - growing violence? Guiltless participation in sadistic behaviour Guiltless participation in sadistic behaviour
(Milgram,1964)(Milgram,1964) Severe and chronic criminality - Severe and chronic criminality - Licensed Licensed
Mass MurderMass Murder (Dick, 1972) (Dick, 1972) Malignant narcissism Malignant narcissism Social disintegration - episodic antisocial Social disintegration - episodic antisocial
behaviourbehaviour
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Borderline ageBorderline age
Personality disorders - sociocultural Personality disorders - sociocultural phenomena?phenomena?
Culture of narcissism - “Me culture” Culture of narcissism - “Me culture” Collective diffuse identity Collective diffuse identity Globalization and creation of a new Globalization and creation of a new
BabylonBabylon Regression to primitive levels of Regression to primitive levels of
functioning functioning Development of borderline personalities?Development of borderline personalities?
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Disaster of the mind?
Moral behaviour depends upon the Moral behaviour depends upon the social structure (social corruption)social structure (social corruption)
New age favours: New age favours: a) prevalence of personality a) prevalence of personality
disorders? disorders? b) the expression of b) the expression of
personality personality disorders? disorders?
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““ Ήθος ανθρώπου δαίμωνΉθος ανθρώπου δαίμων” ”
Ηράκλειτος ΣκοτεινόςΗράκλειτος Σκοτεινός
Fragment 117Fragment 117