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Psychiatric Impact of Childhood Sexual Abuse: Life on the Borderline. Survivors of Abuse – Access to Justice Information Seminar, 14 May 2004 Ian Curtis MBBS FRANZCP FAChAM. Borderland (author BV, with permission). The sand stings The Wind is Howling Of pain past. I know nothing
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Psychiatric ImpactofChildhood Sexual Abuse:Life on the Borderline Survivors of Abuse – Access to Justice Information Seminar, 14 May 2004 Ian Curtis MBBS FRANZCP FAChAM
Borderland(author BV, with permission) The sand stings The Wind is Howling Of pain past. I know nothing The sand in my eyes Of pain present.
I just exist Ask me who “I” am No answer. Gritting sand Prevents looking where The I is. Can’t be heard The Wind is Howling Lonely and worse.
Isolate So as not to feel Contact causes hurt. The Wind is Howling When will I be Whole? (BV)
Prevalence ofBorderline Features • General population 1-2% • Outpatient mental health clinics 10% • Psychiatric inpatient clinics 20% • Special Clinic Populations involving personality disorders 30-60%
Aetiology Early life Physical and Sexual Abuse, Neglect, Hostile Conflict, and early Parental Loss/Separation are more common in the Childhood histories. (Source: Diagnostic and Statistical Manual Mental Disorders, 4th Edition, p708)
General Behavioursof the Borderline • Ambivalence • Emptiness • Anger • Instability • Impulsivity and Recklessness • Deliberate Self-Harm • Immaturity
Ambivalence:alternating betweenextremes of idealisationand devaluation
Pattern of unstable and intense interpersonal relationshipsalternating between extremesof idealisation and devaluation
Instability:affective instability due toa marked reactivity of mood
Anger Management Problemsinappropriate, intense angeror difficulty controlling anger
Self-Harming:impulsivity in at least two areas that are potentially self-damaging(eg spending, sex,substance abuse etc)
Suicidality:recurrent suicidal behaviour, gestures, threats,self-mutilating behaviour
Psychotic Border:stress-related paranoid ideationorsevere dissociative symptoms
And Drug Abuse • Self-treating • Fill emptiness • Isolate interpersonally • Pseudo-closeness • “Control emotions” • Obscure anger • Self-harm
Unique Difficulties Bipolarities Ambivalence Embraced Failure (Abandoned Hope)
Transition to AdulthoodFailed Stalled Over Compensated