Social Functioning in Patients with BPD - Borderline Personality ...

Social Functioning in Patients with
BPD
I am the most
foolish idiot
No! the most
foolish idiot
is me!!
No,
it`s me
Mar$n Bohus, CIMH Mannheim

No conflict of interest

Age at first psychiatric admission of
pa4ents with BPD in Germany
Mannheim-­‐Study: 367 adult pa4ents
BPS Patientinnen
10
Prozent
9
8
7
6
5
4
3
2
1
0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41
Alter bei erster psychiatirscher Behandlung
Bohus, Kleindienst et al., in prep.

Hospitalisa4on for inten4onal self-­‐harm
in 2002/03 in New Zealand
Life-­‐cycle age groups

Age at Parasuicide Markers
Age
50
45
40
35
30
25
20
15
10
5
0
Age at Assessment
Age at Most Severe Parasuicide
Subjects
Age at First Parasuicide
(Linehan Suicide Workshop)

Non-­‐Suicidal Self-­‐Injury in German Adolescents:
Heidelberg School Study (Brunner et al., 2007)
Did you injure yourself inten$onally within the last
year (cuAng; burning; etc)
n=5522; age= 15
boys
girls
never 89.9% 80.1%
1-­‐3x year 8.0% 14.0%
>3x year 2.1% 5.9%

Bullying vic4misa4on and risk of self harm in
early adolescence: longitudinal cohort study
Fisher et al., BMJ 2012;344:e2683 doi: 10.1136/bmj.e2683 (Published 26 April 2012)
• Prospek$ve Study incl. 1116 twins
• 5; 7; 9; 12
• Self-­‐harm at the age of 12: 3%
• „Frequent bullying: 56%
• Controlled for: Emo$onal
Instability; Conduct Disorders; IQ;
Social background
• Social vicitmized show 5 $mes
increased risc for cuAng!
• NSSI correlates with suicide
adempts in the family, abuse and
axis I disorders in the family

Adolescent borderline symptoms in the
community: Prognosis for func4oning over 20
years: G. Winograd et al., 2008
– Prospec$ve Cohort Analysis n= 748: age: 14; 22; 33;
– Diagnosis: PDQ (parent and youth report); SKID II
– BPD-­‐diagnosis 30 adolescents
– BPD // social func$on// life sa$sfac$on

Adolescent borderline symptoms in the
community: Prognosis for func4oning over 20 years: G.
Winograd et al., 2008

Adolescent borderline symptoms in the
community: Prognosis for func4oning over 20
years: G. Winograd et al., 2008
• BPD at mean age 13.7
were related to
– Lower level of educa$on
– Occupa$onal adainment
– Roman$c partners
involvement
– Adainment of
developmental
milestones

Employment – Status
• Lofgren et al.; American J. Psych. 1991:
– Follow up of 19 Adolescents with BPD ajer 29 years: only
25% reported school-­‐leafing qualifica$on or job

Mannheim Study: Employment of BPD
Arbeitsverträge
Arbeitslos
χ 2 =387.03,
df=2, p

Borderline-­‐Störung
10-­‐Jahre Remissionsraten (Zanarini et al., 2010)
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
93%
30%
86%
15%
50%
34%
N= 275
Only 15% of the clients abain stable psychosocial recovery

Established Psychosocial Treatments
18 months: MBT vs. SCM
Bateman & Fonagy, 2009
3 months: DBT-­‐PTSD vs. TAU
Bohus et al., 2012
GAF
GAF
12 months: TFP vs. TAU
Doering et al., 2011
GAF

Established Psychosocial Treatments
12 months: DBT vs. GPM
McMain et al., 2009
3 years: SFT vs. TFP
Giessen-­‐Blo et al., 2006
EQ-­‐5D
EQ-­‐5D

Global Assessment of Functioning
80
75
70
65
60
55
PDP
DBT
50
45
40
Pre 3 Months 6 Months 9 Months 12 Months
Pistorello, FruzzeA et al., 2012; JCCP

Established psychosocial treatments do
not seem to be highly appropriate for
improvement of social func$oning in BPD

Borderline Psychopathology
Emo4on
Dysregula4on
Iden4ty Disturbance
Social Interac4on
Problems

Social informa$on processing model
(adapted from Crick and Dodge 1994, Lemerise and Arsenio 2000,
and Bugental, 2000)
Database (schemas,
knowledge, rules)
Emo$on processing
Percep$on
of social
s$muli
Inter-­preta$on
Matching
with indi-­vidual
goals
Behavior
plan
An$cipa$on
of conse-­quences
Behavior
Evalua$on
of
behavior
Time

Social informa$on processing model
(adapted by M. Bohus from Crick and Dodge 1994, Lemerise and Arsenio 2000; D. Bugental 2000 )
Database (schemas,
knowledge, rules)
Emo$on processing
Percep$on of
social s$muli
Interpre-­ta$on
Matching
with
individual
goals
Behavior
plan
An$cipa$on
of
consequences
Behavior
Evalua$on
of Behavior
Trust and Care
to Protectors and
Protegees
Coopera$on
Group
Cohesion
Hierarchical
Structures
Ma$ng

Social informa$on processing model
(adapted by M. Bohus from Crick and Dodge 1994, Lemerise and Arsenio 2000; D. Bugental 2000 )
Database (schemas,
knowledge, rules)
Emo$on processing
Percep$on of
social s$muli
Interpre-­ta$on
Matching
with
individual
goals
Behavior
plan
An$cipa$on
of
consequences
Behavior
Evalua$on
of Behavior
Trust and Care
to Protectors and
Protegees
Coopera$on
Group
Cohesion
Hierarchical
Structures
Ma$ng

Social informa$on processing model
(adapted by M. Bohus from Crick and Dodge 1994, Lemerise and Arsenio 2000; D. Bugental 2000 )
Database (schemas,
knowledge, rules)
Emo$on processing
Percep$on of
social s$muli
Interpre-­ta$on
Matching
with
individual
goals
Behavior
plan
An$cipa$on
of
consequences
Behavior
Evalua$on
of Behavior
Trust and Care
to Protectors and
Protegees
Coopera$on
Group
Cohesion
Hierarchical
Structures
Ma$ng

Social informa$on processing model
(adapted by M. Bohus from Crick and Dodge 1994, Lemerise and Arsenio 2000; D. Bugental 2000 )
Database (schemas,
knowledge, rules)
Emo$on processing
Percep$on of
social s$muli
Interpre-­ta$on
Matching
with
individual
goals
Behavior
plan
An$cipa$on
of
consequences
Behavior
Evalua$on
of Behavior
Trust and Care
to Protectors and
Protegees
Coopera$on
Group
Cohesion
Hierarchical
Structures
Ma$ng

Social informa$on processing model
(adapted by M. Bohus from Crick and Dodge 1994, Lemerise and Arsenio 2000; D. Bugental 2000 )
Database (schemas,
knowledge, rules)
Emo$on processing
Percep$on of
social s$muli
Interpre-­ta$on
Matching
with
individual
goals
Behavior
plan
An$cipa$on
of
consequences
Behavior
Evalua$on
of Behavior
Trust and Care
to Protectors and
Protegees
Coopera$on
Group
Cohesion
Hierarchical
Structures
Ma$ng

Social informa$on processing model
(adapted by M. Bohus from Crick and Dodge 1994, Lemerise and Arsenio 2000; D. Bugental 2000 )
Database (schemas,
knowledge, rules)
Emo$on processing
Percep$on of
social s$muli
Interpre-­ta$on
Matching
with
individual
goals
Behavior
plan
An$cipa$on
of
consequences
Behavior
Evalua$on
of Behavior
Trust and Care
to Protectors and
Protegees
Coopera$on
Group
Cohesion
Hierarchical
Structures
Ma$ng

Social informa$on processing model
(adapted by M. Bohus from Crick and Dodge 1994, Lemerise and Arsenio 2000; D. Bugental 2000 )
Database (schemas,
knowledge, rules)
Emo$on processing
Percep$on of
social s$muli
Interpre-­ta$on
Matching
with
individual
goals
Behavior
plan
An$cipa$on
of
consequences
Behavior
Evalua$on
of Behavior
Trust and Care
to Protectors and
Protegees
Coopera$on
Group
Cohesion
Hierarchical
Structures
Ma$ng

Outlook: Training of social
competence for BPD pa$ents (Bohus et al.,
in prepara+on)
Prac$cing … to adapt the algorithms of social life: (according to D. Bugental)
• use and recogni$on of social dominance (hierarchical power domain);
• how to tolerate and use hierarchical structures
• iden$fica$on and maintenance of the lines dividing "us" and
"them" (coali$onal group domain);
– -­‐ how to get acquainted with and stay in groups
• nego$a$on of matched benefits with func$onal equals (reciprocity
domain);
• -­‐ how to cooperate with colleagues
• selec$on and protec$on of access to sexual partners (ma$ng domain)
• how to maintain in$mate rela$onships
• for proximity-­‐maintenance within a protec$ve rela$onship (adachment
domain);
– how to trust and take care of your fosters
-­‐ -­‐

Thank you for your aben4on