1. Marilyn Thorpe BA,MD, FRCPC Psychiatrist
Managing Emotions Information Session Emotion Dysregulation, Borderline Personality Disorder, and Post Traumatic Stress Disorder
Marilyn Thorpe
BA,MD, FRCPC
Psychiatrist

2. Objectives Understanding diagnosis versus symptoms and severity
Symptoms of Emotional Dysregulation
Neurodevelopment of symptoms
Treatment options
Suggestions and Cautions

3. The Trouble With A Diagnosis
Changes with time – mild, moderate, severe
Tells us little about what needs to be changed and what symptoms cause trouble
Ignores the concept of evolution away from a disorder
May promote stigma and misunderstanding
Trouble is about an individual
Semantics

4. Relationships Disturbed
On again, off again
Come closer, come closer, stay away, stay away
I hate you – don’t leave me
Relationships disturbed A I S E D

5. Abandonment Fears You will stop liking me
I will do something to mess this up
Everyone eventually leaves me
Relationships disturbed Abandonment fears A I S E D

6. Affective Lability Emotional rollercoaster
Relationships disturbed Abandonment fears Affective lability A I S E D

7. Anger Sudden/fierce – followed by guilt
Disproportionate “over-reacting”
Relationships disturbed Abandonment fears Affective lability Anger I S E D

8. Impulsivity Shopping Sex Decisions Handling emotion
Relationships disturbed Abandonment fears Affective lability Anger Impulsivity I S E D

9. Identity Disturbance False self
What I do, think and believe changes for others
Relationships disturbed Abandonment fears Affective lability Anger Impulsivity Identity disturbance S E D

10. Self Harm Suicidal Slashing “Default setting”
Relationships disturbed Abandonment fears Affective lability Anger Impulsivity Identity disturbance Self harm E D

11. Emptiness Pervasive sense of emptiness Especially when alone
Relationships disturbed Abandonment fears Affective lability Anger Impulsivity Identity disturbance Self harm Emptiness D

12. Dissociative Episodes
Loose time (even hours) sitting and staring
Derealization (world unreal)
Depersonalization (I am unreal)
Relationships disturbed Abandonment fears Affective lability Anger Impulsivity Identity disturbance Self harm Emptiness Dissociative episodes

13. Borderline Personality Disorder (BPD)
Relationships disturbed
Abandonment fears
Affective lability
Anger
Impulsivity
Identity disturbance
Self harm
Emptiness
Dissociative episodes

14. Borderline Personality Disorder (BPD)
Need 5/6 of 9
Reeks havoc on inner self, interpersonal relationships, school and work (often change each)
Mild ---- moderate ---- severe
Everyone is worse in a crisis

15. The Hungry Heart

16. The Hungry Heart’s goals
I’d like to be sad without being suicidal
An occasional day without wishing to end it all
Think of my life as connected - like a story
Stop thinking of death on a regular basis
Not bottling things up
Feel complete when with others
Have my own personality
Not feel nervous with others – feel like an equal

17. Repeated Childhood Emotional Trauma and BPD
PTSD BPD
Increased Arousal
Hypervigilence; startle fear abandonment
Acting or feeling as if it is recurring anger
Intense distress with cues emotional lability (panic),
Physiological reactivity
Re-experience
Recollections
Enacting Disturbed Relationships
Avoidance – of activities social withdrawal
Detachment or estrangement dissociation, suicidal “default”
Still identity and impulsive

18. The Human Brain Right Left Pituitary Hypothalmus
Autonomic Nervous System (ANS)
Sympathetic
Parasympathetic

19. How Did I Get This Way? The human brain Neuroplasticity
development and pruning

20. TREATMENT (S) 1. Retrain / reprune the brain
Calming, soothing, not acting out
Cognitive practice
2. Corrective Emotional Experience
(Long term relationships to relearn)
New friends - scary
Long term psychotherapies

21. Managing Emotions Program Overview
You are here
Approximately 1 hour
Overview of symptoms, causes, Borderline Personality Disorder Diagnosis, treatment
Distribution of intake packages for
Information Session
Approximately 1 hour with (member of) MH Team
Intake package review and eligibility assessment
Deposit for Foundations of Managing Emotions Module
Currently no formal physician referral necessary
Intake Appointment
6 sessions – 1 hour and 45 minutes each
Introduces: Mindfulness, Distress Tolerance, and Emotion Regulation
Foundations of Managing Emotions Module
Modules are independent – participate in any order
6 – 1 hour and 45 minute sessions per module
Different modules offered throughout the year
Advanced Managing Emotions Modules
Distress Tolerance
Mindfulness and Establishing Identity
Managing Emotions II
Interpersonal Effectiveness
Ready to move on

22. In The Mean Time, What Can I Do?
Learn to be curious about yourself
Stop cutting and self harm as soon as possible – write it down
Reality test - Ask what others think- you are not a mind reader

23. Cautions Don’t mix and match therapists When in trouble:
Too many cooks…
“splitting”
When in trouble:
Avoid acting out – it scares people
?Avoid the label?
Tell people what you need

24. Thanks for listening
Any questions?

25. Acknowledgements Find us @ pitproject.ca
Funding for this initiative was provided by the Specialist Services Committee (SSC), one of four joint collaborative committees representing a partnership of Doctors of BC and the Ministry of Health
Jerold J. Kreisman, Jerold J. & Straus, Hal.  I Hate You - Don't Leave Me: Understanding the Borderline Personality.    New York: Penguin Group (USA) Inc.,  
Terr, Lenore C. "Forbidden Games": Post-traumatic Child's Play.  Journal of American Academy of Child Psychiatry.  :