What are the main treatment challenges in working with clients with borderline personality disorder

What are the main treatment challenges in working with clients with borderline personality disorder

with this diagnosis. Cannot tolerate being alone. Frequent feelings of emptiness. It is most commonly used to treat people with borderline personality disorder, though it is also used as a treatment for several other conditions, including people with substance use disorders, major depressive disorder, bipolar disorder, attention deficit and Borderline personality disorder (BPD) is characterized by fear of abandonment, auto-destructive behavior, distorted self-perception, emotional swings daily, and feelings of numbness and emptiness. Seemingly minor events may trigger disproportionate reactions. Even though your client may be on an emotional roller coaster doesn’t mean you have to be. Nov 2, 2023 · Borderline personality disorder (BPD) is characterized by unstable moods, impulsive behaviors, and volatile relationships. 84 MB. Understanding which treatment works There is an emphasis on sharing the borderline diagnosis with patients, psychoeducation, al-liance building that is based both on contractual (e. Persons who have personality disorders experience distorted perceptions of reality and abnormal affective responses, ultimately manifesting in distress across all aspects of the individual's life, including occupational difficulties Oct 30, 2023 · Objective: Borderline personality disorder (BPD) is the most common personality disorder, affecting 1. 1% for all personality disorders and 1. Unstable and Intense Relationships: Alternating between extremes of idealization and devaluation. Apr 24, 2023 · Other Borderline Personality Disorder symptoms include: Intense fear of being abandoned. Stay calm. The Clinical Practice Guideline for the Management of Borderline Personality Disorder (2012) will assist health professionals to diagnose, treat and manage BPD in adolescents and adults. The Borderline client/patient might alternate between being seductive and abusive or diminishing during treatment, with a Dr. acceptance behaving impulsively, acting on the spur of the moment, and. Impulsive and risky behavior, such as with substance misuse, gambling, binge eating, or sexual relationships. And mentalization-based treatment helps patients regain curiosity about Sep 12, 2011 · This article addresses psychotherapy with a person described as possessing. Patients suffering from major depressive disorder (MDD) display higher rates of comorbidity with personality disorders, often complicating the treatment, and worsening the outcomes. If you have borderline personality disorder, know that many people with this condition get better with treatment. Effective treatments are available to manage the symptoms of Apr 20, 2024 · Borderline personality disorder (BPD) is a mental health condition characterized by pervasive patterns of instability in mood, self-image, and interpersonal relationships. 6% of the U. Has ongoing feelings of emptiness. Like clients with The personality assessment inventory-borderline features scale. Criticism by a co-worker or manager, professional detachment, or moodiness can When Maddi Mathon, a 22-year-old student in Toronto with BPD, first joined Tinder, every time she had a new date she became ebullient, envisioning a future of marriage and children. , goal agreement) and relational factors (e. DBT provides a clear structure for the treatment of BPD using individual psychotherapy, group skills training, and telephone coaching. Jan 10, 2022 · In a 6-year long-term study, patients with borderline personality disorder who were not in remission showed more unhealthy behaviors, such as excessive smoking, increased consumption of alcohol, lack of exercise, daily consumption of sleeping pills, and overdosing on analgesics, and required more diagnostic measures than patients in remission This article focuses on borderline personality disorder. 17 hours ago · As part of a client's treatment plan for borderline personality disorder, the client is engaged in dialectical behavior therapy. Dialectical behavior therapy (DBT) is a structured outpatient treatment based on cognitive-behavioral principles developed by Dr Marsha Linehan in the early 1990s for the treatment of parasuicidal behavior in women with borderline personality disorder (BPD). This review updates and replaces an earlier review (Stoffers‐Winterling 2012). May 24, 2021 · Borderline personality disorder (BPD) is a mental health condition that plays a major role in your mood, behavior, and self-image. Recurrent suicidal behaviors and threats and self-injurious behaviors increase demands An employee or coworker with BPD may be a good worker when not overwhelmed by their symptoms. 4% for bor- May 15, 2018 · A lack of purpose and direction in treatment has been one of the factors contributing to feeling drained when working with patients and clients suffering from Borderline Personality Disorder. D. The nursing process will be applied to caring for a client with borderline personality disorder. Borderline May 23, 2024 · Cognitive behavioral therapy (CBT) can help people with borderline personality disorder identify and change core beliefs and behaviors that come from inaccurate perceptions and problems interacting with others. One older research study found that after 2 years of therapy, 35% of individuals with BPD were in May 8, 2023 · It should not be used in place of the advice of your physician or other qualified healthcare providers. But in some cases, a psychiatrist may recommend medications to treat specific symptoms or co-occurring mental health conditions. This loss of emotional control can increase impulsivity, affect how a person feels about themselves, and negatively impact their relationships with others. BPD is associated with both forms of resistance, and these underlying sources may overlap. Nov 2, 2023 · Dialectical behavior therapy (DBT) is a modified type of cognitive behavioral therapy (CBT). 1 Linehan defines parasuicidal behavior as “any intentional, acute self-injurious behavior Oct 25, 2023 · It can range from self-image issues to varying moods and behavioral changes. This process should not be confused with a method of treatment for BPD itself, which has been the subject of long-standing interest in the field of psychotherapy (Bateman and Fonagy 2006; Kernberg 1984; Linehan 1993; Masterson 1981). Structural stigma involves societal-level conditions, cultural norms, and organizational policies that inhibit the opportunities, resources, and wellbeing of people living with attributes that are the object of stigma. Acting impulsively or taking risks. BPD is a major health problem. Aim/Question Oct 28, 2022 · The therapeutic alliance, a measurable conceptualization of the therapist-patient relationship, is one of the most robust predictors of outcome in psychotherapy [ 3-7 ]. People with this disorder cannot form stable relationships with others due to their extreme emotions, anger, and distorted perception of themselves Nov 21, 2019 · Borderline Personality. Being a therapist of a patient with borderline personality disorder is ‘to be acutely reminded that one is a human being’ (Reference Layden, Newman and Freeman Layden 1993). For people with borderline personality disorder, everyday events can trigger significant changes in mood and Jul 27, 2023 · A lack of purpose and direction in treatment has been one of the factors contributing to feeling drained when working with patients and clients suffering from Borderline Personality Disorder. Such early identification and diagno sis Borderline personality disorder is a mental health condition that affects thoughts, emotions and behaviours. Apr 30, 2018 · Borderline personality disorder is a prevalent psychopathology; thus, most graduate students in psychology, residents in psychiatry, and early career clinicians will encounter patients with this disorder in the course of their training or initial professional practice. Has a strong fear of being alone or abandoned. This kind of trouble challenges both people to try to sit with painful feelings, to try to The benefits of mental health medications for borderline personality disorder are unclear and medications aren’t typically used as the main treatment for the illness. Repeated crises and acts of self-harm. Personality difficulties can significantly affect the alliance, contributing to ruptures that must be attended to carefully [ 8 ]. It is common in both general and clinical populations, affecting roughly 1. Most psychiatrists receive limited guidance during training or as part of continuing medical education about specific risk mana … DBT is an evidence-based treatment program designed to help people with mental health conditions who have problems regulating emotions. Feb 1, 2021 · Dialectical behaviour therapy (DBT) is an intervention with demonstrated efficacy and effectiveness for individuals with borderline personality disorder. This topic describes common treatment issues Research studies have demonstrated that nine percent of Americans have a personality disorder. Up until a few decades ago, those diagnosed with the disorder were thought to be untreatable. Communication is undermined without May 1, 2009 · Borderline personality is a serious psychiatric disorder, with a prevalence of about 4% in the community, but as high as 20% in many clinical psychiatric populations, and significant morbidity. Psychosocial interventions designed to help people with borderline personality disorder cover a wide range of approaches, all of which are ‘talking treatments’ but which differ in intensity, complexity and method (for example, brief psychoeducational approaches, once-weekly psychological therapy sessions and structured programmes of treatment). Dec 11, 2010 · Provide clear, nontechnical answers. Causes can be a mix of family history and environmental factors. They present with a range of symptoms and behaviours, including behavioural disturbance, self-harm, impulsive aggression, and short-lived psychotic symptoms, as well as with intense anxiety, depression and anger. We ourselves often have negative thoughts Abstract. This study reports on 58 consecutive suicides among young people and young adults (aged 15 to 29 years) completed between 1984 and 1987 in Sweden. As part of the therapy, the client is learning how to control and change behavior in response to events. There were more patients with borderline personality disorder or borderline traits (32. Has deep relationships that are not stable. 2022. Comorbid disorders may include: Mood disorders. These guidelines were developed by a multi-disciplinary Guideline Development Committee of clinical, consumer and carer Oct 1, 2023 · Standard psychiatric risk management challenges are routinely amplified in the treatment of patients with primary or co-occurring borderline personality disorder diagnosis. Borderline personality disorder (BPD) refers to a personality disorder whose primary symptoms include significant emotional distress and impairment of interpersonal or occupational functioning or both [1]. population and 20% of the psychiatric inpatient population. 1 Because social workers often serve as intake workers, they are in the unique position of being able to identify these clients early on. Mar 7, 2024 · DBT was developed by Marsha Linehan, Ph. Symptoms of borderline personality disorder and their intensity can be different from person to person. Oct 8, 2018 · Emotional Instability. Five psychotherapeutic approaches are used in the management of BPD. 4%, 10. People with BPD tend to split the world into good and bad. They find it difficult to regulate emotional responses and are often at risk to be overwhelmed by them. Borderline personality disorder (BPD) is a condition characterized by chronic instability in relationships, extreme emotional reactions, and chronic fear of abandonment The management and treatment of personality disorders have caused considerable controversy among psychiatrists in the UK. Some weeks, the therapist is "brilliant," and he's ecstatic he has found him or her. A statistical demonstration of the use of cross-lagged methodology in the context of the impact of case formulation on the alliance process in treatments for borderline personality disorder. Humans. It is difficult to treat (both in the sense of responding poorly and as personally troubling to the therapist and the treatment team) and poorly understood. Borderline Personality Disorder (BPD) is a disorder of emotion regulation, with 5. Fear of Patients Lashing Out. May 20, 2022 · Because the benefits of prescription medication for borderline personality disorder are unclear, healthcare providers typically don’t prescribe medications as the main treatment for BPD. 3. Borderline personality is the most common and serious of the personality disorders, affecting 1% of the general population. However, psychotherapies commonly used for the treatment of BPD are numerous, and little is known about the comparative Jun 9, 2021 · Dialectical behavioral therapy (DBT) may improve symptoms of borderline personality disorder (BPD) by teaching skills that include mindfulness and emotion regulation. . The NHMRC BPD Guidelines seek to improve understanding and recognition of BPD in health services and the community and will assist health professionals to diagnose, treat and manage BPD in adolescents and adults. This feature is probably responsible for labelling them drama queens. It's believed that, when used in conjunction with other types of treatment, such as medications and individual therapy, STEPPS can aide in reducing BPD symptoms and behaviors, such as depression, anxiety, and suicidal ideation, and improve the patient's quality of life. 10 However, emotional responses that are “too positive”, 5 or behaviors that reflect therapists’ needs to protect and “rescue” their patients, 13 have People with borderline personality disorder can often present in a crisis; indeed this is characteristic of many people with the disorder. DBT was originally intended to treat borderline personality disorder (BPD), but Jul 14, 2023 · Group B personality disorders have a consistently dysfunctional pattern of dramatic, overly emotional thinking or unpredictable behavior. At first, a therapist or group members might seem helpful, offering long-anticipated support. Some specialist personality disorder services may have some conditions if you use drugs or drink alcohol. See full list on psychiatryonline. Treatment is very slow, often with interruptions, and it presents a special challenge for contratransferal feelings but at the same time offers a possibility of continuous learning, for the Oct 13, 2022 · Using case formulation for prediction of the therapeutic alliance in treatment for borderline personality disorder. Having strong feelings and moods that change abruptly. In recent years, research has shifted focus to the evaluation of DBT implementation in routine clinical settings. v 11 The treatment of patients with a severe borderline personality disorder is a major focus of many Apr 20, 2018 · “So with borderline patients, the engine is running hot, and the brakes don't work,” he said. Hyde temperament. Jun 8, 2021 · It’s quite challenging when clients engage in behaviors that we view negatively. Diagnostic considerations, prevalence, and the biosocial theory of BPD are reviewed. Mar 21, 2019 · With this in mind, here are seven tips for those working with someone with BPD: 1. self-destructive, impulsive behavior. This situation commonly arises when we work with clients with borderline personality disorder (BPD). Eating disorders. poor self-image. This chapter reviews brief psychological Treatment of borderline personality disorder has some specifics relative to other disorders, which are deriving from nature and structure of those people. Abstract. This increases the likelihood that they will feel attacked when a therapist If you are undergoing treatment for BPD, the best thing to do is understand the challenges that occur in the process of healing so that you can better recognize and learn to handle them. Patients with BPD may have distorted communication patterns, so take care to communicate clearly, concisely, and without jargon that could further distant the patient. They include: Borderline personality disorder. poor physical health. These clients have a history of disturbed relationships and a tendency to engage in maladaptive interpersonal behavior. The nurse identifies the client as learning which type of skills? A. Finding the Right Treatment Team. Nov 1, 2016 · In this chapter, the process of conducting a trauma inquiry with clients who have borderline personality disorder (BPD) will be addressed. Having intense, “rocky” relationships. In DBT, the goal is to reduce borderline personality disorder Typically, STEPPS consists of 20 2-hour sessions. However, the effects of BPD symptoms can vary with different workplace situations, affecting job performance and the ability to “fit in” with the work environment. This can take place in a group or 1 to 1 setting. Anxiety disorders. In an interview with Psychiatric News, Fineberg said her interest in ketamine was piqued by recent studies demonstrating the agent’s possible effectiveness in treating major depression and suicidal thinking, but also by animal research suggesting A serious and complex personality disorder seen primarily in adults between 18 and 35 years old, borderline personality disorder is characterized by mood instability, impulsivity, fears of being alone or abandoned and poor self-image. 3%), and this group were more likely to have made a previous attempt. This paper provides clear and concise guidelines for conducting treatment geared toward the clinician’s developmental level Jun 9, 2021 · BPD is a mental health condition that affects approximately 1. Worrying about being abandoned by loved ones. Borderline personality disorder is a mental illness that severely impacts a person’s ability to regulate their emotions. Symptoms of BPD, include erratic mood shifts, self-harming behaviors, suicidality, intense emotional experiences, sensitivity to problems in your relationships, and problems with impulsive behaviors. This Dec 18, 2023 · People with a borderline personality disorder (BPD) diagnosis or symptoms may experience emotional crises which necessitate use of the emergency department (ED). The treatment targets problems of affect regulation and deficits in interpersonal skills. 10. In a well-reasoned article in a past issue of this journal, Gwen Adshead outlined the main issues relating to the status of personality disorders as nosological entities and their treatability (Reference Adshead Adshead, 2001). The high prevalence of patients with BPD in primary care and mental health settings contributes to their high use of resources in these practice settings. Mood swings, anger and impulsiveness often get better with age. According to a recent meta-analysis (3), the global prev-alence of personality disorders is 7. Table 2 Comparison of GPM and SCM. , trust, reliability, lik-ing), encouragement of family involvement, limited reliance. Symptoms can include feelings of emptiness, low self-esteem, impulsive behaviours and suicidal thoughts. The most common treatment for borderline personality disorder (BPD) is talking therapies. Borderline Personality Disorder / therapy. Therapists have had difficulties engaging in treatment because the interpersonal Sep 8, 2020 · Personality disorders are pervasive, maladaptive, and chronic patterns of behavior, cognition, and mood. If you have a borderline personality disorder (BPD) diagnosis Aug 1, 2007 · This article examines some of the issues that arise in work with people with a diagnosis of Borderline Personality Disorder and offers an application of a larger systems perspective to the Dec 5, 2023 · Coping Skills for Borderline Personality Disorder. Diagnosis involves an assessment is needed by a healthcare Nov 5, 2013 · Borderline Personality Disorder (BPD) is a complex disorder that is difficult to treat. This draining propensity is rather common; it adds to negative countertransference and leads to clinician resistance to working with these patients and clients. Mar 2, 2021 · For people with borderline personality disorder (BPD), a lack of clear identity complicates greatly the telling of this story. 8% of the general population, 10% of psychiatric outpatients, and 15%–25% of psychiatric inpatients. May 30, 2024 · Personality disorders (PD) are described as enduring patterns of markedly deviant and pervasive inner experiences and behaviors, with onset in adolescence, which lead to severe distress or impairment. If you have borderline personality disorder (BPD), your emotions can be overwhelming. There can be long waiting lists for talking therapies on the NHS. CBT may help people reduce mood swings and anxiety symptoms and may reduce the number of self-harming or suicidal behaviors. These include cognitive behavioural therapy, mentalization-based therapy, schema-focused therapy, transference-focused therapy and dialectical behaviour therapy (DBT). As a result they can be regular users of This article summarises the current position of evidence-based psychodynamic psychotherapies aimed at the treatment of borderline personality disorder – mentalisation-based treatment and transference-focused psychotherapy – noting the main challenges they face, especially in the area of dissemination. If you can maintain a friendly, calm and reassuring tone of voice and body language, then your client will often calm down as well. In some cases, a psychiatrist may recommend medications to treat specific symptoms or co-occurring mental disorders such as mood swings or depression. However, treatment occasionally involves medications, especially when someone with BPD has co-occurring disorders. Its main goals are to teach people how to live in the moment, develop healthy ways to cope with stress, regulate their emotions, and improve their relationships with others. BPD is usually treated with psychotherapy. 8%. It may be that not all therapies are Background: Borderline Personality Disorder or BPD is a personality disorder with the main symptoms are emotional instability, impulsive behavior, negative self-concept, and impaired interpersonal Transference-focused psychotherapy helps patients work through the emotional challenges that trigger borderline behavior. Other sessions, he's petulant, argumentative, devaluing, etc. 6% of the general population. Individual differences in treatment response to both ST and DBT have been observed across studies, but the factors driving these differences are largely unknown. Borderline personality disorder (BPD) is a type of personality disorder in which a person has difficulty processing or Borderline personality disorder (BPD) is a disorder characterized by instability in pa-tients’ sense of identity, as expressed in a stable representation of the self across sit-uations and time and the ability to direct oneself in a consistent, deliberate, and productive manner in one’s interpersonal and occupational functioning. g. Individuals with BPD experience intense and rapidly shifting emotions Jan 31, 2024 · The condition is most serious in young adulthood. Mar 27, 2022 · 2. Get in Touch (352) 771-2700. Psychiatric Nursing*. A large proportion of this population also has one or more other mental health disorders. It is characterised by disturbances in mood, interpersonal relationships, sense of self and difficulties in controlling impulsive behaviours such as self-injury and substance use. S. Jul 31, 2009 · Both psychological resistance to treatment and the resistance of symptoms to respond as expected refer to a variety of phenomena that can render generally effective treatments ineffective. 1037/per0000555. Many people with BPD experience extreme fluctuations in moods. unstable, intense, and difficult relationships. Therapists who specialize in working with these clients recommended the following books for clinicians, clients and family members. If staff feel secure in the Jan 20, 2023 · The diagnosis of borderline personality disorder is made only when a person has had many of these symptoms, they are severe in degree, and they are long-lasting. Clients who have been diagnosed with Borderline Personality Disorder or Emotional Instability Disorder may benefit from treatment using a DBT, schema therapy, or cognitive analytic therapy approach. A client with BPD may have comorbid disorders that are increasing their level of distress, which should be assessed during their BPD assessment. Psychotherapeutic treatment of people with borderline personality disorder (BPD) is one of the greatest challenges confronting mental health professionals today. a borderline personality disorder (BPD), or possessing features consistent. This chapter provides a summary of borderline personality disorder (BPD) and dialectical behavior therapy (DBT). venting, 4. Basically the challenge of a borderline person comes in depending on somebody — with all that that brings up, the hunger, the anxiety, the anger and the deep mistrust as to whether you can actually put your weight on the other person’s reliability. However, psychotherapies commonly used for the treatment of BPD are numerous, and little is known about the comparative Jun 1, 2015 · Empirical studies on maternal borderline personality disorder (BPD) are disturbingly scarce given that many mothers are attempting to parent with this debilitating mental health condition and many children are being raised in the context of serious psychopathology (Stepp, Whalen, Pilkonis, Hipwell, & Levine, 2012). Individuals with symptoms of BPD are particularly sensitive to perceived criticism. Practice guidelines recommend psychotherapies as first-line treatments. Sep 1, 1986 · Some cases develop into an escalating, destructive spiral which eventually results in the discharge or transfer of the borderline patient, leaving behind a severely fragmented treatment team struggling to resolve its differences. Dec 7, 2023 · The DSM-5 outlines nine key criteria for BPD, and a diagnosis typically requires that an individual exhibits at least five of these symptoms: Frantic Efforts to Avoid Abandonment: This includes both real and imagined scenarios of abandonment. Recent Findings Evidence-based advances in the treatment of BPD include a delineation of generalist models of care in contrast to specialist treatments, identification of essential effective elements of dialectical behavioral therapy (DBT), and the THE INCLUSION of the borderline personality disorder diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III) is evidence that there is increasing recognition of this syndrome. Clients with BPD are often difficult for nurses to work with, perhaps due to a lack of understanding of the underlying dynamics of the disorder. But the main issues of self-image and fear of being abandoned, as well as relationship issues, go on. When things pdf. They can include: 2. It is a form of cognitive behavioral therapy (CBT), meaning that it focuses on the role of cognition—which includes one's thoughts and beliefs, and behavior or actions—in the development and treatment of BPD. Mar 8, 2016 · Introduction to Dialectical Behavior Therapy. Problems with TOM, emotional and cognitive, work in tandem with alexithymia where knowing what one is feeling and describing feelings are reduced in BPD. Aug 19, 2021 · Borderline personality disorder is a chronic condition that may include mood instability, difficulty with interpersonal relationships, and high rates of self-injury and suicidal behavior. The most important part of any treatment team is the partnership between the mental health professional and the individual seeking Objective: Borderline personality disorder (BPD) is the most common personality disorder, affecting 1. No existing reviews focus specifically on experiences of consumers a, carers b and clinicians in relation to ED presentations by people diagnosed with BPD. venting, 2. People with BPD commonly have distorted perceptions of themselves and others, leading to difficulties in maintaining stable and healthy relationships. Substance use disorder. Antisocial personality disorder and borderline personality disorder have the strongest links with alcohol and drugs. Even the work of the best-intentioned staff in a personality disorder service is likely to be replete with failures to retain impartiality. 8%, with cluster B dis-orders accounting for an estimated total of 2. Jun 28, 2017 · These interventions, while varying in form, all strive to accomplish the same thing: quality care and a better, more supportive environment for those seeking treatment for BPD. , in the early 1990s. (352) 771-2700. [1] This chapter will describe the signs and symptoms of ten personality disorders and associated treatments. In particular, a May 24, 2024 · Signs of borderline personality disorder. BPD is a serious Feb 5, 2022 · Background Specialized evidence-based treatments have been developed and evaluated for borderline personality disorder (BPD), including Dialectical Behavior Therapy (DBT) and Schema Therapy (ST). 9% of the population displaying a characteristic at some point in their life (lifetime prevalence) and accounting for 20% of the psychiatric inpatient population. Jekyll and Mr. Jan 2, 2018 · One of the most promising psychosocial interventions for patients with borderline personality disorder is dialectical behaviour therapy (DBT) (Reference Linehan, Armstrong and Suarez Linehan et al, 1991; Reference Palmer Palmer, 2001, this issue). 1 The diffi Feb 3, 2017 · Purpose of the Review This review summarizes advances in treatments for adults with borderline personality disorder (BPD) in the last 5 years. Download. org May 4, 2020 · Over the decades, a variety of psychological interventions for borderline personality disorder (BPD) have been developed. May 8, 2021 · Despite the myriad challenges in working with borderline personality disorder, clinicians tend to experience a sense of therapeutic optimism and a view of the patient as “special”. suicidal threats or attempts. avoidance, 3. Typically the patient with BPD has a history of a pervasive pattern of chaotic Sep 29, 2022 · Background People with Borderline Personality Disorder (BPD) and their carers/families continue to experience structural stigma when accessing health services. Stay nonjudgmental and encourage the patient to express concerns and questions. The primary treatment for borderline personality disorder is therapy. Pers Disord. Identity disturbance indeed is one of the defining features of the Borderline Personality Disorder (BPD) is a severe form of psychopathology. Oct 15, 2021 · 1. The National Institute of Mental Health suggests a higher fre-quency: 9. Talking therapy might feel intimidating to begin with, but many people find it helps in the long run. Sees self as being unstable or weak. . The age of onset varies but often ranges from adolescence to early adulthood (age 18 to 25 years) [2]. Marked by difficulties with The seven ratings of what you would do indicate your use of the following coping strategies, with the numbers corresponding to the above items: 1. Frequent displays of inappropriate anger. ds tu js xi tk ve pr gp hm ds