APNA 28th Annual Conference Session 2026: October 23, 2014

Transcription

1 Dale Knode RN BS HSAD This presenter has no conflict of interest to disclose Intense and unstable emotions Impulsive behaviors See the world in a polarized all or none thinking Poor self identity Poor self direction Lack of empathy for others Intimacy issues due to poor interpersonal functioning Personality traits in negativity affectivity such as emotional liability, anxiety, separation insecurity, and depressivity Disinhibition characterized by impulsivity, risk taking, and antagonism Knode 1

2 1.6% adults in the United States have BDP Rates of suicide is 5-10% and increases with parasuicide BPD is a chronic debilitating problem Medication drop out rates are high and medication misuse is high Parasuicide with BPD is high at 69 to 80% Individualized and Mobile Program of Assertive Community Treatment Dealing with poor communication skills Emotional instability All or none thinking Many substantial issues Behaviors such as cutting, burning, ED or ER, on call use, substance abuse, and unstable relationships. Often other illnesses with BPD is diabetes, high blood pressure, chronic back pain, arthritis, and fibromyalgia Knode 2

3 Cognitive Behavioral Therapy Dialectical Behavior Therapy Cognitive Processing Therapy Prolonged Exposure Schema Therapy - new Assertiveness Training Female, 50 y o Adopted and trauma throughout life Twin Car accident early twenties causing a head injury Numerous hospitalizations at several hospitals Many crisis bed stays less than 24 hours due to poor coping skills Polysubstance abuse Male, 48 y o Multiple suicide survivor Poly substance abuse Burn victim Poor self esteem Poor coping skills Poor recovery skills Started out of a nursing home after burns Now gives speeches on the suicide, recovery, and co-occurring disorders Knode 3

4 Female, 52 y o 16 hospitalizations during a 6 year period Ranging from 1 to 8 days High use of on call Emotional deregulation Numerous Dr visits Poor interpersonal relationships Female, 25 y o Emotional deregulation Cutting often and tried placing a belt around her neck x1 Deaf struggles with knowing her feelings Poor relationships mostly sexual in nature Easily bored Institutionalized since 9 years old Female, 53 y o Multiple medical issues due to diabetes Poor engagement Emotional deregulation Attention seeking Poor follow through with medications Poor feeling identification Financial problems Knode 4

5 Dialectical Behavioral Therapy Cognitive Behavioral Therapy Cognitive Processing Therapy Assertiveness Training Decreased psych/medical hospitalizations Decreased ER/ED visits Assertive communication skills improved Improved relationships Reframing goals in their lives to improve outcomes Prior Impact After Impact Total DC DR JB PP KB TH Knode 5

6 DC DR JB PP KB TB 20 0 Prior Impact After Impact Total Changes in behaviors Improved outcomes on treatment plans Improved communication skills with complex thought processes Research is positive with talk therapies DBT reduces suicide attempts by 50% DBT, CBT, CPT, and EP offer Borderlines with improved outcomes in their lives Less use of services in the community ED/ER, Psych Hospitals, and medical hospitals Assertive communication skills offer improved outcome in care Setting goals to improve outcomes Improved relational skills Knode 6

7 US Department of Health and Human Services, National Institutes of Health. Borderline Personality Disorder. Dialectical Behavior Therapy in the Treatment of Borderline Personality Disorder. Psych Central Staff (2007). Linehan MM, Comtois KA, Murray AM, Brown MZ, Gallop RJ, Heard HL, Korslund KE, Tutek DA, Reynolds SK, Lindenboim N. Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Arch Gen Psychiatry Jul;63(7): Widiger, T.A., & Frances, A.J. (1989). Epidemiology, diagnosis, and comorbidity of borderline personality disorder. IN A. Tasman, R.E. Hales, & A. J. Frances(Eds). American Psychiatric Press Review of Psychiatry, Vol. 8 (pp. 8-24). : American Psychiatric Press. Knode 7