What’s in a name …….. emotional instability in Adolescence Demelza Heneghan CNM 2 St. Josephs Adolescent Day Hospital,Demelza Heneghan CNM 2 St. Josephs.

What’s in a name …….. What’s in a name …….. emotional instability in emotional instability in

AdolescenceAdolescence

• Demelza Heneghan CNM 2 St. Josephs Adolescent Day Hospital, Demelza Heneghan CNM 2 St. Josephs Adolescent Day Hospital,

Emotionally Unstable [Borderline] Personality Disorder F60.3 - ICD10 Description, World Health Organization

Emotionally unstable [borderline] personality disorder is characterized by a definite tendency to act impulsively and without consideration of the consequences; the mood is unpredictable and capricious. There is a liability to outbursts of emotion and an incapacity to control the behavioural explosions. There is a tendency to quarrelsome behaviour and to conflicts with others, especially when impulsive acts are thwarted or censored. Two types may be distinguished:

Impulsive TypeImpulsive Type Borderline TypeBorderline Type

•Emotional instability

•lack of impulse control

( In addition) by disturbances in •self-image, aims, and internal preferences, by chronic feelings of emptiness, by intense and unstable interpersonal relationships, and by a tendency to self-destructive behaviour, including suicide gestures and attempts.

Borderline Personality Disorder - Diagnostic Criteria, American Psychiatric Association DSMAn individual diagnosed with borderline personality disorder needs to show at least 5 of the

following criteria

•Frantic efforts to avoid real or imagined abandonment. •A pattern of unstable and intense interpersonal relationships characterized by

alternating between extremes of idealization and devaluation.

•Identity disturbance: markedly and persistently unstable self-image or sense of self.

•Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, Substance Abuse, reckless driving, binge eating).

•Recurrent suicidal behaviour, gestures, or threats, or self-mutilating behavior.

•Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more

than a few days).

•Chronic feelings of emptiness.

•Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).

•transient, stress-related paranoid ideation or severe dissociative symptoms.

• This enduring pattern of inner experience and behavior must deviate markedly from the expectations of the individual's culture.

• This enduring pattern is inflexible and pervasive across a broad range of personal and social situations.

• This enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning.

DSM – IV states , ‘personality disorder categories may be applied to children or adolescents in those relatively unusual instances in which

the individual's particular maladaptive personality traits appear to be pervasive , persistent and unlikely to be limited to a particular

developmental; stage or an episode of and Axis 1 disorder……………..severe enough that behavioural manifestations

persistently interfere with the an adolescents daily functioning over the course of 1 year or longer.

Fact or fiction: Diagnosing borderline personalitydisorder in adolescents

Alec L. Miller, Jennifer J. Muehlenkamp , Colleen M. Jacobson

Received 15 March 2007; received in revised form 7 February 2008; accepted 13 February

To name or not to To name or not to name……..name……..

One example……..One example……..

Day HospitalDay Hospital

CAMHS CAMHS Paediatric Paediatric inpatient inpatient

assessmentassessment

Adolescent Adolescent Inpatient Inpatient

UnitUnit

Inpatient admission Inpatient admission Overlap x4 weeksOverlap x4 weeks

with the day hospitalwith the day hospital

Day Hospital admission Day Hospital admission X 2 weeks X 2 weeks

Ind. / parent Ind. / parent

Discharge overlap Discharge overlap with CAMHS x 2 weeks with CAMHS x 2 weeks

Integrated Care PlanIntegrated Care Plan

Nursing Care PlanNursing Care Plan

1.1. PsychoeducationPsychoeducation using a DBT Framework using a DBT Framework – Interpersonal effectivenessInterpersonal effectiveness– Distress toleranceDistress tolerance– Emotional regulation Emotional regulation – MindfulnessMindfulness

Both with young Both with young person & parent/carer person & parent/carer

2. Skills training2. Skills training

• Utilising the DECIDER Programme on Utilising the DECIDER Programme on an individual basisan individual basis

As a serviceAs a service ….• Individualised care plan Individualised care plan

• Intensive psychoeducationIntensive psychoeducation

• Careful consideration of multiple service Careful consideration of multiple service involvement and the yp moving through involvement and the yp moving through thisthis

Randi Kreger and Paul T. Mason explain in their book “Stop Walking on Eggshells,” you may inadvertently trigger a BPD emotional outburst but your behavior didn’t cause it.

Thank you !!

Fortunately, the critical importance of prevention, early identification, andearly intervention has gained traction for all forms of illness, and mentaldisorders in particular have been referred to as the chronic diseases of theyoung. Brain development during childhood and adolescence is complex

As adolescents are expected to engage in more independent emotion regulation and self-control strategies, deficits in self-regulatory skills

become more apparent during this developmental period.

Can one accurately assess and identify BPD in children and adolescents?

How does one understand the development or early precursors of BPD in Children and adolescents.