UNDERSTANDING BORDERLINE PERSONALITY DISORDER: DIAGNOSIS, DEVELOPMENT, AND CLINICAL PRESENTATION
Foundations of Personality and Personality Disorders
- Understanding Personality
- Definition of personality and enduring psychological patterns
- Components of personality development
- Interaction of temperament, environment, and attachment
- Distinguishing personality traits vs. personality disorders
- What Makes Personality “Disordered”
- Adaptive vs maladaptive personality functioning
- Personality disorders as characterological conditions
- Long-term functional impairment across life domains
- Cultural expectations and personality pathology
- DSM-5-TR™ Framework for Personality Disorders
- Diagnostic criteria for personality disorders
- Alternative DSM-5™ Model for Personality Disorder
- Personality disorder clusters
- Prevalence and clinical challenges
Recognize Personality Disorders in Clinical Practice
- Clinical Interview Indicators
- Ego-syntonic behavior patterns
- External locus of control
- Chronic interpersonal conflict
- Difficulty forming collaborative therapeutic alliances
- Behavioral and Relational Warning Signs
- “Therapist hopping”
- Chronic instability in relationships and work
- Recurrent crises and life disruptions
- Escalating interpersonal drama
- The Drama Triangle in Personality Disorders
- Victim, rescuer, persecutor
- Role shifts in clinical relationships
- How therapists become pulled into dysfunctional roles
- Identify personality patterns in session
Clinical Framework for Treating Personality Disorders
- Working with personality vs. symptoms
- Core principles for treatment
- Essential clinical competencies
- Burnout prevention strategies
- Exercise: Therapist Resilience Reflection
Borderline Personality Disorder – Clinical Overview
- Historical Development of the Diagnosis
- Early conceptualization of “borderline” conditions
- Contributions from psychoanalytic theory
- Evolution of modern diagnostic frameworks
- Define Borderline Personality Disorder
- Instability in emotional regulation
- Disturbances in identity and self-image
- Interpersonal hypersensitivity
- Impulsivity and behavioral dysregulation
- DS-5-TR™ Diagnostic Criteria for BPD
- Exercise: Rapid Interpretation: The Meaning-Making Process
Epidemiology, Development, and Risk Factors for BFD
- Prevalence
- Gender differences
- Socioeconomic vulnerabilities
- Developmental risk factors
- Biological contributors
- Cultural considerations in borderline personality disorder
TREATMENT, RISK MANAGEMENT, AND CLINICAL INTERVENTION STRATEGIES
Core Psychological Features of BFD
- Identify disturbance
- Cognitive distortions
- Emotional dysregulation
- Interpersonal instability
Differential Diagnosis
- Distinguishing BPD from Bipolar Disorder
- Mood instability vs mood episodes
- Environmental vs neurological triggers
- Emotional depth and empathy differences
- Other differential diagnoses
Assessment and Treatability Evaluation
- Diagnostic Interview Strategies
- Evaluate general personality disorder criteria
- Identify long-term relational patterns
- Standardized Assessment Tools
- BPD-specific measures
- Evaluating treatability
Management Strategies for BPD
- Purpose of Clinical Management
- Reduce harm and escalation
- Stabilize functioning
- Prevent therapeutic rupture
- When to Use management vs treatment
- Staying Out of the Drama Triangle
- Slow emotional escalation
- Maintain therapist neutrality
- Avoid emotional blackmail
- Identify Behavioral Targets
- Focus on one behavior at a time
- Interrupt escalation patterns
- Reinforce adaptive behaviors
Boundaries, Therapeutic Language, Treatment Goals and More
- Effective boundary-setting
- Language that escalates conflict
- Therapeutic neutrality
- Treatment Goals
- Treatment Contracts
- Responding to Contract Violations
The Borderline Personality Disorder Treatment Toolbox
- Expanding the Self
- Strengthening the Observing Ego
- Reducing Drama
- Building Problem-Solving Capacity
- DBT Skills for BPD
- The biosocial model: understanding emotion dysregulation as the core of BPD
- Dialectics in practice: balancing acceptance and change
- Mindfulness – building the “wise mind” and reducing reactivity
- Distress Tolerance – crisis survival skills (TIPP, radical acceptance, self-soothing) to replace self-harm and impulsive behaviors
- Emotion Regulation – identifying, labeling, and modulating intense emotions; reducing emotional vulnerability
- Interpersonal Effectiveness – DEAR MAN, GIVE, and FAST skills for boundaries and relationships
- Chain analysis: mapping the links from trigger to problem behavior
- Research, risks, and limitations
Psychopharmacology in BPD
- Medication Classes Used in BPD
- Limitations of Medication
Suicide Risk and Self-Harm Management
- Suicide Risk in BPD
- Non-suicidal self-injury as emotional regulation
- Risk Assessment Strategies
Ethics, Supervision, and Professional Boundaries
- The 4 Nonnegotiables in working with BPD
- Clinician Self-care
- Clinician’s Responses in Treatment Outcome
- Navigating Countertransference
- Case Study Application


