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Borderline personality of our age

Borderline personality of our age . Dusica Lecic Tosevski Institute of Mental Health Belgrade . De natura hominis (Peri fusiV anqrwpon HpokrathV). It is more important to know what person has a disease, than to know what disease a person has. . Content. Borderline personality disorder

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Borderline personality of our age

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  1. Borderline personality of our age Dusica Lecic Tosevski Institute of Mental Health Belgrade

  2. De natura hominis (Peri fusiV anqrwpon HpokrathV) It is more important to know what person has a disease, than to know what disease a person has.

  3. Content • Borderline personality disorder • Borderline personality of our age • Our borderline age

  4. Crisis of meaning 1 • Civilised world is mortal • “Malady of death” - our most hidden inner recesses governs: - the military and economic domains, social and political bonds - once noble realm of the mind

  5. Crisis of meaning 2 • Power of destructive forces within the individual and society • Destruction of nature, life and economic resources • Outbreak or a more patent manifestation of psychosis, depression, anxiety and personality disorders • Disaster of the mind

  6. Disaster of the mind Greater prevalence of personality disorders?

  7. Literature • Classical theatre - conflicts of neurotic disorders • Theatre of the absurd - borderline conditions • Samuel Becket - Waiting for Godot • Albert Camus - The Fall • J. P. Sartre - Hell is other people

  8. Personality disorders - modern concepts and controversies • Classification • Definition/diagnostics (borderline personality disorder) • Aetiology

  9. Classification DSM-III and IV Disputable personality disorders • schizotypal (sch spectrum) • schizoid (no patients) • avoidant PD (social phobia?) • dependent (a separate entity?) • depressive (masochistic) • passive-aggressive(defense mechanism)

  10. Advantages schizotypal PD enduring personality changes passive-aggressive PD Disadvantages narcissistic PD borderline PD - emotionally labile PD Classification ICD-10

  11. 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)

  12. Three concepts of BPD • Borderline personality disorder (Gunderson & Kolb, 1978) • Borderline personality organisation (Kernberg, 1967-1989) • Borderline level of functioning (Berelowitz & Tarnopolski, 1993; Lecic-Tosevski & Divac-Jovanovic, 1993 -2004)

  13. Borderline personality disorder • Most BPD patients - other cluster B diagnoses • Dissociative identity disorder • Affective instability - comorbid mood disorders • Five of nine criteria - arbitrary

  14. Borderline personality organisation Structural criteria • diffuse identity • primitive defences • intact reality testing

  15. Splitting • clinical marker of severe personality disorders • defence of neglected child • pre-ambivalence • chaotic interpersonal relationships • contradictory emotions and cognition • perceptive alterations of self and objects

  16. Borderline level of functioning • level of dysfunction of personality disorders • a non-specific marker of severity of PDs • dynamic, transitory dimension • masks of borderline personality disorder (“chameleon style”) • manifestation of depression (Lecic-Tosevski, 1993) • attenuated (subclinical variant) of affective disorders (Akiskal) • core BPD

  17. Loss Trauma Affective instability Impulsivity Parental failure Biological risk factors Psychological risk factors BPD Social disintegration Social risk factors Biopsychosocial model of borderline personality disorder (J. Parris, 1994)

  18. Social influences • Personality disorders - growing violence? • Guiltless participation in sadistic behaviour (Milgram,1964) • Severe and chronic criminality - Licensed Mass Murder (Dick, 1972) • Malignant narcissism • Social disintegration - episodic antisocial behaviour

  19. Borderline age • Personality disorders - sociocultural phenomena? • Culture of narcissism - “Me culture” • Collective diffuse identity • Globalization and creation of a new Babylon • Regression to primitive levels of functioning • Development of borderline personalities?

  20. Disaster of the mind? • Moral behaviour depends upon the social structure (social corruption) • New age favours: a) prevalence of personality disorders? b) the expression of personality disorders?

  21. “Ήθος ανθρώπου δαίμων” Ηράκλειτος Σκοτεινός Fragment 117

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