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1
Links, Paul S., M. Janice E. Mitton, and Meir Steiner. "Stability of Borderline Personality Disorder." Canadian Journal of Psychiatry 38, no. 4 (May 1993): 255–59. http://dx.doi.org/10.1177/070674379303800406.
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This study examines the course of illness and stability of borderline personality disorder (BPD) in a group of inpatients seen at a two-year follow-up. The diagnosis of borderline personality disorder, as established by the use of the Diagnostic Interview for Borderlines, did not change in 39 of the 65 subjects (60%) studied. Subjects who continued to show evidence of borderline psychopathology experienced more acute episodes of illness during the follow-up period and tended to be more involved in substance abuse. Impulsiveness and young age when first psychiatric care was received significantly predicted the presence of BPD features at follow-up.
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Rao, Sathya, and Jillian Broadbear. "Borderline personality disorder and depressive disorder." Australasian Psychiatry 27, no. 6 (October 1, 2019): 573–77. http://dx.doi.org/10.1177/1039856219878643.
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Objective: Borderline personality disorder (BPD) is frequently accompanied by low mood, the features of which may satisfy the diagnostic criteria for major depressive disorder (MDD). Treatment of depressive symptoms in the absence of BPD-appropriate treatment is less effective and may cause iatrogenic harm. This paper briefly reviews the co-occurrence of BPD and depressive disorder and suggests ways of differentiating these disorders and optimising treatment within the Australian Mental Health context. Conclusions: Depressive symptoms are present in the majority of people with BPD. To address the difficulty differentiating clinically distinct MDD from depressive symptoms that are integral to BPD psychopathology, it is suggested that depressive symptoms arising from a primary diagnosis of BPD (i) may exhibit transience and be stress reactive, (ii) lack a robust clinical response to antidepressant medication and/or electroconvulsive treatment and (iii) are responsive to BPD-appropriate psychotherapy.
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Hansenne, M., W. Pitchot, and M. Ansseau. "Serotonin, personality and borderline personality disorder." Acta Neuropsychiatrica 14, no. 2 (April 2002): 66–70. http://dx.doi.org/10.1034/j.1601-5215.2002.140203.x.
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Serotonin is one of the neurotransmitters implicated in normal personality. Many psychobiological models of personality include some dimensions related to serotonin. For instance, the harm avoidance dimension of the biosocial model developed by Cloninger is related to serotonergic activity. Higher scores on the harm avoidance dimension should theoretically reflect increased serotonergic activity. However, correlation studies related serotonin activity to harm avoidance dimension have not yielded consistent findings. These controversial results are probably related to the complexity of the neurotransmitter systems, and the different assessment techniques used in these studies. Finally, recent genetic studies have examined the association between personality dimensions and serotonergic receptor polymorphisms with mixed results. Serotonin is not only related to some dimensions of normal personality. Several psychopathological disorders are associated with serotonergic dysfunction. More particularly, borderline personality disorder (BPD) can be defined by many of the symptoms associated with serotonergic dysregulation, including affective lability, suicidal behaviours, impulsivity and loss of impulse control. Indeed, several reports have demonstrated the efficacy of selective serotonin re-uptake drugs in treating the depressive and impulsive symptoms of patients with BPD. Moreover, some challenge studies have reported a lower serotonergic activity in BPD. Because these challenges are not specific, we have assessed the serotonergic activity in BPD with the flesinoxan challenge. Preliminary results showed that the prolactine responses to flesinoxan were significantly lower in BPD patients compared to those observed in controls.
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Barker, V., L. Romaniuk, R. N. Cardinal, M. Pope, K. Nicol, and J. Hall. "Impulsivity in borderline personality disorder." Psychological Medicine 45, no. 9 (January 20, 2015): 1955–64. http://dx.doi.org/10.1017/s0033291714003079.
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BackgroundImpulsivity is a core feature of borderline personality disorder (BPD) and is most frequently measured using self-rating scales. There is a need to find objective, valid and reliable measures of impulsivity. This study aimed to examine performance of participants with BPD compared with healthy controls on delay and probabilistic discounting tasks and the stop-signal task (SST), which are objective measures of choice and motor impulsivity, respectively.MethodA total of 20 participants with BPD and 21 healthy control participants completed delay and probabilistic discounting tasks and the SST. They also completed the Barratt Impulsiveness Scale (BIS), a self-rating measure of impulsivity.ResultsParticipants with BPD showed significantly greater delay discounting than controls, manifest as a greater tendency to accept the immediately available lesser reward rather than waiting longer for a greater reward. Similarly they showed significantly greater discounting of rewards by the probability of payout, which correlated with past childhood trauma. Participants with BPD were found to choose the more certain and/or immediate rewards, irrespective of the value. On the SST the BPD and control groups did not differ significantly, demonstrating no difference in motor impulsivity. There was no significant difference between groups on self-reported impulsivity as measured by the BIS.ConclusionsMeasures of impulsivity show that while motor impulsivity was not significantly different in participants with BPD compared with controls, choice or reward-related impulsivity was significantly affected in those with BPD. This suggests that choice impulsivity but not motor impulsivity is a core feature of BPD.
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Beatson, Josephine. "Borderline personality disorder and auditory verbal hallucinations." Australasian Psychiatry 27, no. 6 (July 15, 2019): 548–51. http://dx.doi.org/10.1177/1039856219859290.
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Objective: Auditory verbal hallucinations (AVH) frequently co-occur with borderline personality disorder (BPD) and can lead to misdiagnosis with schizophrenia (SCZ) or other primary psychotic disorders. Misdiagnosis is more common when AVH meet criteria for Schneiderian first rank symptoms (FRS). This paper’s objective is to improve diagnostic accuracy by outlining particular clinical features that can assist the distinction between BPD and psychotic disorders in these cases. Conclusion: The overall clinical presentation when AVH occur in BPD can assist in determining a primary diagnosis of BPD when frank psychotic disorder is absent. AVH in BPD cannot be distinguished phenomenologically from AVH in SCZ. Clinical experience and increasing research suggest that AVH in BPD are often dissociative in origin and highly correlated with the presence of FRS, elevated levels of dissociation and a history of childhood trauma. When AVH occur in BPD in the absence of co-occurring psychotic disorder, formal thought disorder is usually absent, negative symptoms minimal or absent, bizarre symptoms absent, affect reactive and the patient retains sociability. Psychotropic medication may be less effective for the AVH in these cases, while they may improve or remit during psychotherapy for BPD.
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Paris, Joel. "Suicidality in Borderline Personality Disorder." Medicina 55, no. 6 (May 28, 2019): 223. http://dx.doi.org/10.3390/medicina55060223.
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Borderline personality disorder (BPD) is associated with suicidal behaviors and self-harm. Up to 10% of BPD patients will die by suicide. However, no research data support the effectiveness of suicide prevention in this disorder, and hospitalization has not been shown to be useful. The most evidence-based treatment methods for BPD are specifically designed psychotherapies.
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Links, Paul S., Ronald Heslegrave, and Robert van Reekum. "Prospective Follow-up Study of Borderline Personality Disorder: Prognosis, Prediction of Outcome, and Axis II Comorbidity." Canadian Journal of Psychiatry 43, no. 3 (April 1998): 265–70. http://dx.doi.org/10.1177/070674379804300305.
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Objective: To examine the rate of persistence of borderline personality disorder (BPD), the existence of concomitant personality disorders on follow-up, and the predictors of outcome in patients who met criteria for BPD compared with patients with borderline features who failed to meet all of the criteria. Method: This prospective cohort study reassessed subjects for BPD diagnosis and cooccurring personality pathology at 7 years follow-up. Initial measures of borderline and comorbid personality psychopathology were used to predict levels of borderline or other personality disorder psychopathology at follow-up. Results: Of the 5 7 subjects who initially met the criteria for BPD, 30 (52.6%) were found to have remitted BPD, and 27 (47.4%) were characterized as having persistent BPD. The remitted group met significantly fewer comorbid personality disorder diagnoses than the persistent group (mean = 0.8, mean = 3.5 respectively; P < 0.05). Results also indicated that the initial level of borderline psychopathology was predictive of borderline psychopathology at follow-up, which explained 17% of the variance. Conclusions: This prospective follow-up study found that almost 50% of former inpatients with BPD continue to test positive for BPD at 7 years follow-up, and these persistent BPD patients also had significantly more comorbid personality psychopathology. Borderline psychopathology at follow-up was primarily predicted by the level of borderline psychopathology recorded at the initial assessment.
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Byrne, Sharyn, and Anne Jeffers. "The borderlines of bipolar affective disorder." Irish Journal of Psychological Medicine 26, no. 4 (December 2009): 202–5. http://dx.doi.org/10.1017/s0790966700000720.
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AbstractThis paper provides an overview of the major studies of bipolar affective disorder (BAD) and borderline personality disorder (BPD), and assesses whether the disorders might be better understood as variants of the same basic disorder. There is a shortage of research that delineates the features of both disorders within their representative samples. As a consequence the symptomatic overlap of the disorders, detected by categorical assessment instruments, is often misconstrued as an indication of the disorders' high rates of comorbidity (up to 81%).In paying particular attention to features of both disorders, eg. affective instability and impulsivity, the paper provides evidence that BPD attenuates bipolar disorder along the spectrum of affective disorders, from non-classical bipolar presentation through to severe BAD with borderline features. The paper cites clinical, research and pharmacologic support of the contention that BPD, rather than representing a distinct disorder, is merely an attenuation of Axis I disorders, most especially bipolar affective disorder. Borderline personality is evident across the bipolar spectrum and exacerbates symptomatology and leads to poorer recovery prognosis.
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Kjellander, Carole, Bruce Bongar, and Ashley King. "Suicidality in Borderline Personality Disorder." Crisis 19, no. 3 (May 1998): 125–35. http://dx.doi.org/10.1027/0227-5910.19.3.125.
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Recent research on the relationship between borderline personality disorder (BPD) and suicidal behavior is reviewed. Risk factors for attempted and completed suicide as well as the effect of the comorbidity of BPD with other Axis I and II disorders are considered. Explanations for suicidality in BPD are discussed. General assessment strategies are offered, along with treatment recommendations. Specifically, research has shown that borderline patients improve in the long-term, decreasing in suicidality, self-destructiveness, and interpersonal maladjustment, if survival is effectively managed during the turbulent years of youth. Clinical lore at times can lead clinicians to disregard the danger of suicide completion among chronically parasuicidal patients, which can prevent effective intervention during suicidal crises and result in unfortunate outcomes.
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Stein, Dan J. "Borderline Personality Disorder: Toward Integration." CNS Spectrums 14, no. 7 (July 2009): 352–56. http://dx.doi.org/10.1017/s1092852900022999.
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ABSTRACTSeveral psychiatric disorders, including borderline personality disorder (BPD), are characterized by emotional dysregulation and impulse dyscontrol. More specifically, symptoms in patients with BPD often occur within the context of disruptions in attachment and related distortions in cognitive-affective processing of the self and others. From a neurocircuitry perspective, findings include prefrontal hypoactivity, amygdala hyperreactivity, and alterations in prefrontal-limbic interaction. Molecular pathways relevant to these circuits include the serotonergic, noradrenergic, and dopaminergic systems, and there is some evidence that pharmacotherapy with agents that act on these systems may be useful. Given the disruptions in attachment and schemas of the self and others in BPD, establishing a therapeutic alliance is crucial while psychotherapy remains the cornerstone of an integrated approach to management.
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Chapman, Alexander L. "Borderline personality disorder and emotion dysregulation." Development and Psychopathology 31, no. 3 (June 6, 2019): 1143–56. http://dx.doi.org/10.1017/s0954579419000658.
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AbstractBorderline personality disorder (BPD) is a severe and complex disorder characterized by instability across many life domains, including interpersonal relations, behavior, and emotions. A core feature and contributor to BPD, emotion dysegulation (ED), consists of deficits in the ability to regulate emotions in a manner that allows the individual to pursue important goals or behave effectively in various contexts. Biosocial developmental models of BPD have emphasized a transaction of environmental conditions (e.g., invalidating environments and adverse childhood experiences) with key genetically linked vulnerabilities (e.g., impulsivity and emotional vulnerability) in the development of ED and BPD. Emerging evidence has begun to highlight the complex, heterotypic pathways to the development of BPD, with key heritable vulnerability factors possibly interacting with aspects of the rearing environment to produce worsening ED and an adolescent trajectory consisting of self-damaging behaviors and eventual BPD. Adults with BPD have shown evidence of a variety of cognitive, physiological, and behavioral characteristics of ED. As the precursors to the development of ED and BPD have become clearer, prevention and treatment efforts hold great promise for reducing the long-term suffering, functional impairment, and considerable societal costs associated with BPD.
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Semiz, Umit, Cengiz Basoglu, Mesut Cetin, Servet Ebrinc, Ozcan Uzun, and Berk Ergun. "Body dysmorphic disorder in patients with borderline personality disorder: prevalence, clinical characteristics, and role of childhood trauma." Acta Neuropsychiatrica 20, no. 1 (February 2008): 33–40. http://dx.doi.org/10.1111/j.1601-5215.2007.00231.x.
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Objective:The prevalence of body dysmorphic disorder (BDD) in patients with borderline personality disorder (BPD) is unidentified. We hypothesised that BDD would be more common than realised in patients with BPD and comorbidity with BDD would result in a more severe clinical profile. Also, childhood trauma may play a predictive role in this association.Methods:The study included 70 BPD in-patients and 70 matched healthy controls. The subjects were evaluated with a comprehensive assessment battery using Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) diagnostic tool for BDD, Global Assessment of Functioning, Traumatic Experiences Checklist and Hamilton Depression Rating Scale.Results:The prevalence of BDD was 54.3% in the borderline sample. The BPD patients with BDD had significantly lower overall functioning and higher levels of BPD pathology, childhood traumatic experiences, suicide attempts, substance abuse and self-mutilation than those without BDD. Traumatic experiences were significant predictor of comorbid BDD diagnosis in BPD patients.Conclusions:Our results suggest a relatively high prevalence of BDD among patients with BPD, and co-occurrence of BDD and BPD remains to be clarified. The additional diagnosis of BDD in patients with BPD may cause a more severe global illness, and these two disorders may share, at least partly, a common psychopathologic mechanism.
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Brahim, S., M. H. Aoun, O. Charaa, M. Henia, A. Abid, and L. Zarrouk. "Factors for suicide attempt recurrence among patients with borderline personality disorder." European Psychiatry 64, S1 (April 2021): S585. http://dx.doi.org/10.1192/j.eurpsy.2021.1561.
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IntroductionThe prevalence of borderline personality disorder (BPD) is significant, ranging from 0.5% to 5.9% in the general population. This personality disorder is associated with high rates of suicide attempt and for suicide attempt recurrence.ObjectivesReview recent studies of predictors of suicide attempt and for suicide attempt recurrence in patients with borderline personality disorder.MethodsThis is a literature review via Medline and Sciences Direct. The database was searched using the combination of the keywords “borderline” with “suicide”, “borderline personality disorder” with “suicide”, “borderline personality disorder” with “suicide attempts” “borderline personality disorder” with “suicide recurrence”.ResultsRecently it has been shown that BPD has a greater correlation with suicidal behavior than that of characterized depressive disorders. Several studies have shown that suicidal behavior in patients with BPD was associated with the coexistence of antisocial personality disorder, depression, hostility, impulsivity, a high number of suicide attempts and a first suicide attempt at a young age. Recently it has been established that the predictors of suicidal recidivism are the high number of suicide attempts, the female sex and single life status.ConclusionsSpecial attention should be paid to predictive factors for suicide attempt and for suicide attempt recurrence in the clinical evaluation of patients with borderline personality disorder, especially in suicidal crisis.
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Rosowsky, Erlene, and Bennett Gurian. "Borderline Personality Disorder in Late Life." International Psychogeriatrics 3, no. 1 (March 1991): 39–52. http://dx.doi.org/10.1017/s1041610291000509.
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Records of eight elderly patients identified as BPD by a geriatric team were analyzed for compliance with DIB-R and DSM-III-R criteria. A nonborderline control group was randomly selected and matched for age, gender and residence. Clinicians experienced in geriatric mental health performed retrospective chart reviews and found that not one clinically diagnosed BPD patient was identified by either instrument. Although there appear to be a number of constant features of BPD throughout life, this study delineated two major areas of change in BPD in late life.
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Lietor, M. D. C. Molina, I. Cuevas, and M. Blanco Prieto. "Pharmacotherapy for borderline personality disorder: A review." European Psychiatry 64, S1 (April 2021): S439. http://dx.doi.org/10.1192/j.eurpsy.2021.1172.
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IntroductionBorderline personality disorder (BPD) is characterized by instability of interpersonal relationships, self-image, and emotions, and by impulsivity. Although patients with BPD are misdiagnosed, some of them receive mental health treatment. Even if the first-line treatment of this disorder is psycotherapy, the patients with BPD may be highly symptomatic and are often prescribed multiple medications in a manner unsupported by evidence.ObjectivesThe aim of this study is to study the available evidence about the pharmacotherapy for borderline personality disorder.MethodsA review of the available literature about the management of borderline personality disorder and de pharmacotherapy for personality disorders was performed.ResultsFirst-line treatment of the personality disorders is psycotherapy. The treatment plan for BPD may include individual and group therapy, medication, self-education, specialized substance use disorder treatment, partial hospitalization, or brief hospitalization during times of crises. Medications are generaly used only as adjuncts to psychotherapy and the adjunctive use of symptom targeted medications has been found to be useful. There is limited information to guide pharmacotherapy; preliminary evidence limits the practice of polypharmacy. Sympton-domain focused medication treatment is recommeded by some guidelines: cognitive-perceptual symtoms (low-dose antipsychotic drugs), impulsive-behavioral dyscontrol (mood stabilizers), affective dysregulation (mood stabilizers and low-dose antipsychotic drugs) and self-harm (omega-3 fatty acids).ConclusionsBPD cause significant distress and impariment of social, occupational and role functioning. The first-line treatment for BPD is psychotherapy; however symptom-focused, medication treatment of BPD is generally considered to be an adjunct to psychotherapy. The data support the efficacy of low dose antipsychotic drugs and mood stabilizers.
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Slavin-Stewart, Claire, Khrista Boylan, and Jeffrey D. Burke. "Subgroups of Adolescent Girls With Borderline Personality Disorder Symptoms." Journal of Personality Disorders 32, no. 5 (October 2018): 636–53. http://dx.doi.org/10.1521/pedi_2017_31_317.
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The aim of this study was to determine whether borderline personality disorder (BPD) can be differentiated from other disorders in a clinical sample of adolescent girls. Participants (N = 75) were grouped based on the pattern of BPD symptom endorsement using a latent class analysis. Four latent classes were identified. The most impaired class endorsed seven BPD symptoms and an average of three comorbid disorders. An intermediate class endorsed three BPD symptoms and had the highest prevalence of PTSD (41.7%). A third class reported two BPD symptoms and had a high prevalence of anxiety disorders (62%). The fourth class had no BPD symptoms and, on average, one comorbid disorder. Only a small subset of these teenage girls met criteria for BPD, and they had distinct and severe impairment. The results suggest the modest likelihood of a BPD diagnosis in clinical samples of teenage girls, and to also be vigilant for PTSD.
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Bray, Amanda. "Moral Responsibility and Borderline Personality Disorder." Australian & New Zealand Journal of Psychiatry 37, no. 3 (June 2003): 270–76. http://dx.doi.org/10.1046/j.1440-1614.2003.01177.x.
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Objective: To examine the concepts of free will and moral responsibility in a psychiatric context, and to consider whether those with borderline personality disorder (BPD) may be considered responsible for their actions. Method: A wide, but necessarily incomplete, range of literature was reviewed in the fields of psychiatry and philosophy. I offer a set of criteria for responsible action and examine some features of BPD in the light of these criteria. Results: Impulsivity, acting out and the less severe forms of dissociation do not vitiate responsibility. Severe dissociative and psychotic symptoms may well render people with BPD less morally responsible for their actions. Conclusions: Comorbid conditions in BPD may also affect the ability to act responsibly.
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Hörz-Sagstetter, Susanne, Diana Diamond, John F. Clarkin, Kenneth N. Levy, Michael Rentrop, Melitta Fischer-Kern, Nicole M. Cain, and Stephan Doering. "Clinical Characteristics of Comorbid Narcissistic Personality Disorder in Patients With Borderline Personality Disorder." Journal of Personality Disorders 32, no. 4 (August 2018): 562–75. http://dx.doi.org/10.1521/pedi_2017_31_306.
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This study examines psychopathology and clinical characteristics of patients with borderline personality disorder (BPD) and comorbid narcissistic personality disorder (NPD) from two international randomized controlled trials. From a combined sample of 188 patients with BPD, 25 also fulfilled criteria for a comorbid diagnosis of NPD according to DSM-IV. The BPD patients with comorbid NPD, compared to the BPD patients without comorbid NPD, showed significantly more BPD criteria (M = 7.44 vs. M = 6.55, p < .001), fulfilled more criteria of comorbid histrionic (M = 3.84 vs. M = 1.98, p < .001), paranoid (M = 3.12 vs. M = 2.27, p = .014), and schizotypal (M = 1.64 vs. M = 1.02, p = .018) personality disorders, and were more likely to meet criteria for full histrionic PD diagnosis (44.0% vs. 14.2%, p < .001). The BPD-NPD group also reported significantly fewer psychiatric hospitalizations in the previous year (M = 0.40 vs. M = 0.82, p = .019) and fewer axis I disorders (M = 2.68 vs. M = 3.75, p = .033). No differences could be found in general functioning, self-harming behavior, and suicide attempts.
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Hill, J., P. Pilkonis, J. Morse, U. Feske, S. Reynolds, H. Hope, C. Charest, and N. Broyden. "Social domain dysfunction and disorganization in borderline personality disorder." Psychological Medicine 38, no. 1 (September 25, 2007): 135–46. http://dx.doi.org/10.1017/s0033291707001626.
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BackgroundSocial dysfunction in personality disorder is commonly ascribed to abnormal temperamental traits but may also reflect deficits in social processing. In this study, we examined whether borderline and avoidant personality disorders (BPD, APD) may be differentiated by deficits in different social domains and whether disorganization of social domain functioning uniquely characterizes BPD.MethodPatients were recruited from psychiatric clinics in Pittsburgh, USA, to provide a sample with BPD, APD and a no-personality disorder (no-PD) comparison group. Standardized assessments of Axis I and Axis II disorders and social domain dysfunction were conducted, including a new scale of ‘domain disorganization’ (DD).ResultsPervasive social dysfunction was associated with a 16-fold increase in the odds of an Axis II disorder. Both APD and BPD were associated with elevated social dysfunction. Romantic relationship dysfunction was associated specifically with BPD symptoms and diagnosis. DD was associated specifically with a categorical BPD diagnosis and with a dimensional BPD symptom count.ConclusionsA focus on the inherently interpersonal properties of personality disorders suggests specific mechanisms (within and across interpersonal domains) that may help to account for the origins and maintenance of some disorders. In particular, BPD reflects disturbances in romantic relationships, consistent with a role for attachment processes, and in the organization of functioning across social domains.
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Kulacaoglu, Filiz, and Samet Kose. "Borderline Personality Disorder (BPD): In the Midst of Vulnerability, Chaos, and Awe." Brain Sciences 8, no. 11 (November 18, 2018): 201. http://dx.doi.org/10.3390/brainsci8110201.
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Borderline personality disorder (BPD) is a chronic psychiatric disorder characterized by pervasive affective instability, self-image disturbances, impulsivity, marked suicidality, and unstable interpersonal relationships as the core dimensions of psychopathology underlying the disorder. Across a wide range of situations, BPD causes significant impairments. Patients with BPD suffer considerable morbidity and mortality compared with other populations. Although BPD is more widely studied than any other personality disorder, it is not understood sufficiently. This paper briefly reviews the recent evidence on the prevalence, etiology, comorbidity, and treatment approaches of borderline personality disorder (BPD) by examining published studies, and aims to offer a more coherent framework for the understanding and management of borderline personality disorder.
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Savero, Nico, Aulia Aji, Avicenna Alim, I. Suryananda, Ruth Pradibdo, Happy Hapsari, and Dearisa Yudhantara. "HALLUCINATION IN PATIENTS WITH BORDERLINE PERSONALITY DISORDER." Journal of Psychiatry Psychology and Behavioral Research 3, no. 1 (March 26, 2022): 40–42. http://dx.doi.org/10.21776/ub.jppbr.2022.003.01.10.
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In modern practice, hallucinations found in patients with borderline personality disorder (BPD) are often identified as ‘pseudohallucinations’ to state the suspicion that they do not qualify as true hallucinations. In the interest of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for BPD, it is stated that during times of tremendous stress, transient ideation of paranoid or dissociative symptoms may occur. BPD is defined as a mental health disorder with remarkable impulsivity, instability of mood and interpersonal relationships, along with suicidal behavior that can complicate medical treatment. It is crucial to identify this diagnosis to plan for further treatment. The existence and severity of hallucinations in BPD patients are closely related to posttraumatic stress disorder (PTSD), prior childhood adversities, as well as current adult life stressor. Auditory verbal hallucinations (AVH) were reported to be the most commonly observed types of hallucinations in patients with BPD. Similarities of the AVH characteristics between BPD patients and those with schizophrenia make it hard to diagnose and manage the hallucinations in BPD patients. Pharmacological management including both typical and atypical antipsychotic drugs may be beneficial in order to treat hallucinations in these patients, however, low-dose antipsychotics are preferred due to its adverse reaction. Psychotherapy such as cognitive behavior therapy (CBT) and non-invasive brain stimulation techniques may be helpful as well. Questioning patient’s psychotic symptoms in an untrue or “made-up” form is rarely advantageous and may leads to undesired therapeutic alliance dismissal. Keywords: hallucination, borderline personality disorder, depression.
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Miano, Annemarie, Isabel Dziobek, and Stefan Roepke. "Characterizing Couple Dysfunction in Borderline Personality Disorder." Journal of Personality Disorders 34, no. 2 (April 2020): 181–98. http://dx.doi.org/10.1521/pedi_2018_32_388.
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Relationship dysfunction is a key criterion of borderline personality disorder (BPD). Nevertheless, little is known about the characteristics of romantic relationship functioning in BPD. In this study, couples in which the women were diagnosed with BPD (BPD couples) and healthy control couples (HC) were compared in their perceived relationship characteristics (e.g., relationship quality) and interpersonal experience variables (e.g., attachment). The hypothesis was tested that insecure attachment styles account for group differences in relationship characteristics. Variables were measured by self-report. Romantic relationships were appraised as more negative and conflictual by both members of BPD couples compared to HC. The perception of women with BPD was often more negative than that of their male partners, indicating potential biases in BPD patients' relationship evaluation. Insecure attachment styles only partially explained group differences in relationship characteristics, showing that attachment style is one, but not the only predictor of decreased relationship functioning in BPD couples.
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Stone, Michael H. "Borderline Personality Disorder: Clinical Guidelines for Treatment." Psychodynamic Psychiatry 50, no. 1 (March 2022): 45–63. http://dx.doi.org/10.1521/pdps.2022.50.1.45.
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Borderline personality disorder (BPD) is fundamentally a syndrome composed of symptoms (primarily of emotional dysregulation) and a number of true personality traits (such as inordinate anger, impulsivity, and a tendency to stress-related paranoid ideation). Whereas schizotypal personality disorder, with its cognitive peculiarities (ideas of reference, odd beliefs, eccentric speech), is closely linked as a genetic condition—”borderline” to the major condition schizophrenia—BPD is less closely linked to bipolar disorder. Some cases of BPD are linked genetically to and are in the “border” of bipolar disorder. But the condition can also arise from adverse post-natal factors: parental cruelty or neglect, or incest. In some BPD patients, both are present: risk genes for bipolar disorder and adverse conditions within the family. The genetic risk is often overlooked. To avoid this, initial evaluations should always include a careful and extensive family history for mood disorders, and should extend out to grandparents, aunts, uncles, and cousins. Where the history suggests a genetic link to bipolar disorder, a mood stabilizer such as lithium or lamotrigine, even in modest doses, may be particularly beneficial, more so than conventional antidepressants. In some patients, ADHD was present in childhood, BPD was diagnosed during or after puberty, and a form of bipolar disorder becomes apparent during their 20s. As for the psychotherapeutic component, the patient's cognitive style and capacity for introspection will help determine whether a primarily expressive (psychoanalytically oriented) technique is preferable or a primarily cognitive-behavioral technique. Flexibility is necessary, since during emotional crises, supportive and limit-setting interventions will be needed, along with psychotropic medications, and where necessary, programs to help combat substance abuse (which is common among patients with BPD).
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Hudson, J. I., M. C. Zanarini, K. S. Mitchell, L. W. Choi-Kain, and J. G. Gunderson. "The contribution of familial internalizing and externalizing liability factors to borderline personality disorder." Psychological Medicine 44, no. 11 (January 9, 2014): 2397–407. http://dx.doi.org/10.1017/s0033291713003140.
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BackgroundIndividuals with borderline personality disorder (BPD) frequently display co-morbid mental disorders. These disorders include ‘internalizing’ disorders (such as major depressive disorder and anxiety disorders) and ‘externalizing’ disorders (such as substance use disorders and antisocial personality disorder). It is hypothesized that these disorders may arise from latent ‘internalizing’ and ‘externalizing’ liability factors. Factor analytic studies suggest that internalizing and externalizing factors both contribute to BPD, but the extent to which such contributions are familial is unknown.MethodParticipants were 368 probands (132 with BPD; 134 without BPD; and 102 with major depressive disorder) and 885 siblings and parents of probands. Participants were administered the Diagnostic Interview for DSM-IV Personality Disorders, the Revised Diagnostic Interview for Borderlines, and the Structured Clinical Interview for DSM-IV.ResultsOn confirmatory factor analysis of within-person associations of disorders, BPD loaded moderately on internalizing (factor loading 0.53, s.e. = 0.10, p < 0.001) and externalizing latent variables (0.48, s.e. = 0.10, p < 0.001). Within-family associations were assessed using structural equation models of familial and non-familial factors for BPD, internalizing disorders, and externalizing disorders. In a Cholesky decomposition model, 84% (s.e. = 17%, p < 0.001) of the association of BPD with internalizing and externalizing factors was accounted for by familial contributions.ConclusionsFamilial internalizing and externalizing liability factors are both associated with, and therefore may mutually contribute to, BPD. These familial contributions account largely for the pattern of co-morbidity between BPD and internalizing and externalizing disorders.
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Elsner, Daniel, Jillian H. Broadbear, and Sathya Rao. "What is the clinical significance of chronic emptiness in borderline personality disorder?" Australasian Psychiatry 26, no. 1 (October 16, 2017): 88–91. http://dx.doi.org/10.1177/1039856217734674.
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Objective: The objective of this study was to review the clinical significance of the experience of chronic emptiness in borderline personality disorder (BPD). Methods: A systematic search of the literature was conducted using MEDLINE and PubMed, employing search terms including ‘emptiness’, ‘personality disorder’ and ‘borderline personality disorder’. The most relevant English-language articles and books were selected for this review. Results: Published literature and clinical experience suggest that chronic emptiness represents a substantial component of the symptom burden experienced by people with BPD, contributes to functional impairment and may distinguish BPD from other disorders such as major depressive disorder. Conclusions: Further research will elucidate the significance of chronic emptiness with regard to diagnosis, prognosis and treatment of BPD.
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Buchman-Wildbaum, Tzipi, Zsolt Unoka, Robert Dudas, Gabriella Vizin, Zsolt Demetrovics, and Mara J. Richman. "Shame in Borderline Personality Disorder: Meta-Analysis." Journal of Personality Disorders 35, Supplement A (March 2021): 149–61. http://dx.doi.org/10.1521/pedi_2021_35_515.
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Shame has been found to be a core feature of borderline personality disorder (BPD). To date, there is no existing systematic review or meta-analysis examining shame in individuals with BPD as compared to healthy controls (HCs). A meta-analysis of 10 studies comparing reported shame in BPD patients to HCs was carried out. Demographic and clinical moderator variables were included to see if they have a relationship with the effect size. Results showed that those with BPD had more reported shame than healthy controls. In addition, in BPD patients and HCs, higher education level was related to lower reported shame. In HCs, it was found that those who were younger reported a higher level of shame. Finally, among BPD patients, there was a relationship between levels of reported shame and elevated PTSD symptomatology. These findings emphasize the clinical relevance of shame in individuals with BPD and the need to formulate psychotherapeutic strategies that target and decrease shame.
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Zandersen, Maja, and Josef Parnas. "Exploring schizophrenia spectrum psychopathology in borderline personality disorder." European Archives of Psychiatry and Clinical Neuroscience 270, no. 8 (July 9, 2019): 969–78. http://dx.doi.org/10.1007/s00406-019-01039-4.
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Abstract We have previously argued that the current borderline personality disorder (BPD) diagnosis is over-inclusive and clinically and conceptually impossible to distinguish from the schizophrenia spectrum disorders. This study involves 30 patients clinically diagnosed with BPD as their main diagnosis by three BPD dedicated outpatient treatment facilities in Denmark. The patients underwent a careful and time-consuming psychiatric evaluation involving several senior level clinical psychiatrists and researchers and a comprehensive battery of psychopathological scales. The study found that the vast majority of patients (67% in DSM-5 and 77% in ICD-10) in fact met the criteria for a schizophrenia spectrum disorder, i.e., schizophrenia (20%) or schizotypal (personality) disorder (SPD). The schizophrenia spectrum group scored significantly higher on the level of disorders of core self as measured by the Examination of Anomalous Self-Experiences Scale (EASE). The BPD criterion of “identity disturbance” was significantly correlated with the mean total score of EASE. These findings are discussed in the light of changes from prototypical to polythetic diagnostic systems. We argue that the original prototypes/gestalts informing the creation of BPD and SPD have gone into oblivion during the evolution of polythetic criteria.
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Bozzatello, Paola, Claudia Garbarini, Paola Rocca, and Silvio Bellino. "Borderline Personality Disorder: Risk Factors and Early Detection." Diagnostics 11, no. 11 (November 18, 2021): 2142. http://dx.doi.org/10.3390/diagnostics11112142.
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Personality disorders (PDs) exert a great toll on health resources, and this is especially true for borderline personality disorder (BPD). As all PDs, BPD arises during adolescence or young adulthood. It is therefore important to detect the presence of this PD in its earlier stages in order to initiate appropriate treatment, thus ameliorating the prognosis of this condition. This review aims to highlight the issues associated with BPD diagnosis in order to promote its early detection and treatment. To do so, we conducted a search on PubMed database of current evidence regarding BPD early diagnosis, focusing on risk factors, which represent important conditions to assess during young patient evaluation, and on diagnostic tools that can help the clinician in the assessment process. Our findings show how several risk factors, both environmental and genetic/neurobiological, can contribute to the onset of BPD and help identify at-risk patients who need careful monitoring. They also highlight the importance of a careful clinical evaluation aided by psychometric tests. Overall, the evidence gathered confirms the complexity of BDP early detection and its crucial importance for the outcome of this condition.
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Pérez-Solá, V. "Treatment resistance in borderline personality disorder." European Psychiatry 26, S2 (March 2011): 2024. http://dx.doi.org/10.1016/s0924-9338(11)73727-0.
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Borderline Personality Disorder (BPD) is the most common personality disorder which afflicts an estimated 2% of the general population, 10% of individuals seen in outpatient mental health clinics and 15–20% of psychiatric inpatients. Patients with BPD present a large variety of symptoms, high rates of comorbid conditions, substantial use of healthcare resources and constitute a significant social and economic burden. This disorder often is resistant to psychotherapeutic and pharmacological interventions. These therapeutic difficulties lead to common psychotropic drug prescription for BPD patients in clinical practice and, according to our results, in Spain virtually all patients with BPD are prescribed drug treatment and polypharmacy is common. It is possible that polypharmacy may also be a reflection of the severe difficulties encountered during the management of these patients. Another explanation could be the psychiatrist's ‘desperation’ due to the patients’ deterioration or lack of improvement, so that polypharmacy may be used to compensate the lack of funded and sustained psychotherapy programmes which would be required to successfully treat these patients in the long term.
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Bodner, E., S. Cohen-Fridel, and I. Ianco. "Staff attitudes towards patients with borderline personality disorder." European Psychiatry 26, S2 (March 2011): 1010. http://dx.doi.org/10.1016/s0924-9338(11)72715-8.
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IntroductionBDP is a common diagnosis in hospitals and community settings, estimated at 20% and 11%, respectively. Nevertheless, the attitudes and skills of all mental health professionals regarding the treatment of these patients had hardly been studied.ObjectivesDevelop tools and use them to understand staff attitudes towards BDP patients.Aims(1)To develop two inventories for the measurement of cognitive and emotional attitudes towards borderline personality disorder (BPD) patients and their treatment;(2)To use these tools to understand and compare attitudes of psychiatrists, psychologists and nurses toward BPD patients.MethodTwo lists of items referring to cognitive and emotional attitudes towards BPD patients were formulated. Nurses, psychologists and psychiatrist (n = 57), working in public psychiatric institutions rated their level of agreement with each item. Both lists of attitudes yielded three factors (cognitive: required treatment, suicidal tendencies, and antagonistic judgment, and emotional: negative emotions, experienced difficulties in treatment, and empathy, respectively).ResultsPsychologists scored lower than psychiatrists and nurses on antagonistic judgments. Nurses scored lower than psychiatrists and psychologists on empathy. Regression stepwise analyses on the three emotional attitudes separately showed that suicidal tendencies of BPD patients mainly explained negative emotions and difficulties in treating these patients. All groups were interested in learning more about the treatment of these patients.ConclusionsSuicidal tendencies of BPD patients provoke antagonistic judgments among the three professions. Psychiatrists, psychologists and nurses hold distinctive cognitive and emotional attitudes towards these patients. Staff training programs regarding BDP patients should consider these differences and concerns.
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Daros, A. R., K. K. Zakzanis, and A. C. Ruocco. "Facial emotion recognition in borderline personality disorder." Psychological Medicine 43, no. 9 (November 13, 2012): 1953–63. http://dx.doi.org/10.1017/s0033291712002607.
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BackgroundEmotion dysregulation represents a core symptom of borderline personality disorder (BPD). Deficits in emotion perception are thought to underlie this clinical feature, although studies examining emotion recognition abilities in BPD have yielded inconsistent findings.MethodThe results of 10 studies contrasting facial emotion recognition in patients with BPD (n = 266) and non-psychiatric controls (n = 255) were quantitatively synthesized using meta-analytic techniques.ResultsPatients with BPD were less accurate than controls in recognizing facial displays of anger and disgust, although their most pronounced deficit was in correctly identifying neutral (no emotion) facial expressions. These results could not be accounted for by speed/accuracy in the test-taking approach of BPD patients.ConclusionsPatients with BPD have difficulties recognizing specific negative emotions in faces and may misattribute emotions to faces depicting neutral expressions. The contribution of state-related emotion perception biases to these findings requires further clarification.
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Gvirts, H. Z., Y. Braw, H. Harari, M. Lozin, Y. Bloch, K. Fefer, and Y. Levkovitz. "Executive dysfunction in bipolar disorder and borderline personality disorder." European Psychiatry 30, no. 8 (October 21, 2015): 959–64. http://dx.doi.org/10.1016/j.eurpsy.2014.12.009.
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AbstractObjectiveThe boundary between bipolar disorder (BD) and borderline personality disorder is a controversial one. Despite the importance of the topic, few studies have directly compared these patient groups. The aim of the study was to compare the executive functioning profile of BD and BPD patients.MethodExecutive functioning (sustained attention, problem-solving, planning, strategy formation, cognitive flexibility and working memory) was assessed in BD (n= 30) and BPD outpatients (n= 32) using a computerized assessment battery (Cambridge Neuropsychological Test Automated Battery, CANTAB). The groups were compared to one another as well as to healthy controls.ResultsBD patients showed deficits in strategy formation and in planning (indicated by longer execution time in the ToL task) in comparison to BPD patients and healthy controls. BPD patients showed deficits in planning (short deliberation time in the ToL task) in comparison to BD patients and in comparison to healthy controls. In comparison to healthy controls, BPD patients displayed deficits in problem-solving.ConclusionsDifferences in executive dysfunction between BD and BPD patients suggest that this cognitive dimension may be relevant for the clarification of the boundary between the disorders.
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Gunderson, John G., Alan Fruzzetti, Brandon Unruh, and Lois Choi-Kain. "Competing Theories of Borderline Personality Disorder." Journal of Personality Disorders 32, no. 2 (April 2018): 148–67. http://dx.doi.org/10.1521/pedi.2018.32.2.148.
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The authors review four theories that propose different conceptualizations of borderline personality disorder's (BPD) core psychopathology: excess aggression, emotional dysregulation, failed mentalization, and interpersonal hypersensitivity. The theories are compared in their ability to explain BPD's coaggregation of four usually distinct sectors of psychopathology, their high overlap with other disorders, their ability to distinguish BPD from other disorders, their integration of heritability, and their clinical applicability. The aims of this review are to increase awareness of these theories, to stimulate improved theories, and to f ster testable hypotheses so that research can advance our knowledge about BPD's core.
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Qian, Xinyu, Michelle L. Townsend, Wan Jie Tan, and Brin F. S. Grenyer. "Sex differences in borderline personality disorder: A scoping review." PLOS ONE 17, no. 12 (December 30, 2022): e0279015. http://dx.doi.org/10.1371/journal.pone.0279015.
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Borderline Personality Disorder (BPD) is often perceived to be a female-predominant disorder in both research and clinical contexts. Although there is growing recognition of possible sex differences, the current literature remains fragmented and inconclusive. This scoping review aimed to synthesize available research evidence on potential sex differences in BPD. PsycINFO, PubMed, Scopus and Web-of-Science were searched from January 1982 to July 2022 surrounding the key concepts of sex and BPD. Data searching and screening processes followed the Joanna Briggs Institute methodology involving two independent reviewers, and a third reviewer if necessary, and identified 118 papers. Data regarding BPD symptoms, comorbid disorders, developmental factors, biological markers, and treatment were extracted. Data was summarized using the vote counting method or narrative synthesis depending on the availability of literature. Males with BPD were more likely to present externalizing symptoms (e.g., aggressiveness) and comorbid disorders (e.g., substance use), while females with BPD were more likely to present internalizing symptoms (e.g., affective instability) and comorbid disorders (e.g., mood and eating disorders). This review also revealed that substantially more research attention has been given to overall sex differences in baseline BPD symptoms and comorbid disorders. In contrast, there is a dearth of sex-related research pertaining to treatment outcomes, developmental factors, and possible biological markers of BPD. The present scoping review synthesized current studies on sex differences in BPD, with males more likely to present with externalizing symptoms in contrast to females. However, how this might change the prognosis of the disorder or lead to modifications of treatment has not been investigated. Most studies were conducted on western populations, mainly North American (55%) or European (33%), and there is a need for future research to also take into consideration genetic, cultural, and environmental concomitants. As the biological construct of ‘sex’ was employed in the present review, future research could also investigate the social construct ‘gender’. Longitudinal research designs are needed to understand any longer-term sex influence on the course of the disorder.
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Kelleher, Ian, and Jordan E. DeVylder. "Hallucinations in borderline personality disorder and common mental disorders." British Journal of Psychiatry 210, no. 3 (March 2017): 230–31. http://dx.doi.org/10.1192/bjp.bp.116.185249.
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SummaryHallucinations are classically associated with psychotic disorders. Recent research, however, has highlighted that hallucinations frequently occur outside of the context of psychosis. Despite this, to our knowledge, there has been no epidemiological research to compare the prevalence of hallucinations across common mental disorders with the prevalence in borderline personality disorder (BPD). Using data from the Adult Psychiatric Morbidity Survey (n = 7403), we investigated the prevalence of hallucinations in individuals with a range of mental disorders and BPD. Hallucinations were prevalent in all disorders (range 11–24%). Hallucinations were no more prevalent in individuals with BPD (13.7%) than in individuals with a (non-psychotic) mental disorder (12.6%) (χ2 = 0.03, P = 0.92).
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Nivoli, A., L. F. Nivoli, M. Antonioli, L. Floris, L. Folini, P. Milia, L. I. Vento, C. Depalmas, and L. Lorettu. "Dissociative Symptoms in Borderline Personality Disorder." European Psychiatry 41, S1 (April 2017): S258. http://dx.doi.org/10.1016/j.eurpsy.2017.02.059.
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ObjectiveTo study the association of dissociative symptoms and specific psychopathological dimensions in a sample of patients with Borderline Personality Disorder (BPD).MethodsAn observational analytic study was conducted. Patients with BPD were administered the Diagnostic Interview for Borderline (DIB-R) and Dissociative Experience Scale (DES–II).ResultsParticipants were 34 adult patients with BPD. The majority presented with dissociative symptoms (65.6%; n = 21). A statistical significant correlation was found between DES total score and DIB-R subscales: depression (P = 0.04), feeling of loneliness and emptiness (P = 0.005), sexual deviation (P = 0.002) and intolerance to loneliness (P = 0.01). Furthermore, depersonalization was statistically correlated with the severity of borderline psychopathology (DIB-R total score- P = 0.04), suicidal behavior (P = 0.001) and interpersonal problems (P = 0.04). Derealization was significantly correlated with cognition (P = 0.02), psychotic thought (P = 0.004) and intolerance to loneliness (P = 0.02).ConclusionsDissociative symptoms are not easy to detect in the clinical daily work. More than a half of patients with BPD presented with dissociative symptoms detected with a specific rating scale. Particularly, only some specific psychopathological dimensions are correlated with dissociation and need to be assessed in patients with BPD.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Miano, Annemarie, Isabel Dziobek, and Stefan Roepke. "Understanding Interpersonal Dysfunction in Borderline Personality Disorder." Clinical Psychological Science 5, no. 2 (March 2017): 355–66. http://dx.doi.org/10.1177/2167702616683505.
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The core interpersonal dysfunction in borderline personality disorder (BPD) has not yet been conclusively explained. We used a naturalistic dyadic paradigm to test for the presence of functional empathic inaccuracy in BPD, which is a reduced understanding of the partner’s feelings in relationship-threatening situations. A total of 64 heterosexual couples ( N = 128) were videotaped while engaging in (a) neutral (favorite films), (b) personally threatening (personal fears), and (c) relationship-threatening (separation from partner) conversations. Females were either diagnosed with BPD or healthy controls. Empathic accuracy (EA) was measured from the recorded interactions. Healthy couples’ EA was lower during relationship-threatening compared with personally threatening situations. In contrast, women with BPD showed increased EA, relative to the controls, for relationship- versus personally threatening situations. Reduced EA in response to relationship-threatening situations is likely to be relationship protective. This mechanism appears to be defective in women with BPD, which might explain the interpersonal difficulties experienced by BPD individuals.
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Marziali, Elsa, Heather Munroe-Blum, and Paul Links. "Severity as a Diagnostic Dimension of Borderline Personality Disorder." Canadian Journal of Psychiatry 39, no. 9 (November 1994): 540–44. http://dx.doi.org/10.1177/070674379403900905.
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The purpose of this study was to identify diagnostic and severity subgroups within a cohort of patients with borderline personality disorder (BPD). Of 171 patients clinically diagnosed with BPD, 132 were Diagnostic Interview for Borderlines (DIB) positive. Through a process of random selection, 41 of the DIB positive subjects were also interviewed with the revised version of the DIB (DIBR) and approximately one half with two semi-structured research interviews, the Schedule for Affective Disorders (SADS) and the Personality Disorder Examination (PDE). All subjects completed four self-report measures of problematic behaviours, symptoms and social adaptation. The analyses included examination of: 1. the correspondence of the BPD diagnosis across the DIB, the DIBR and the PDE; 2. the association between DIBR scoring levels and scores on measures of symptoms and behavioural status; and 3. the co-occurrence of BPD with Axis I and other Axis II disorders. Correlations and analyses of variance between both the DIB and DIBR scoring levels and the scores on the four symptom and behavioural measures showed that the scoring levels (DIB 7 to 10; DIBR 8 to 10) could be used to distinguish three subgroups of BPD. The three groups differed in terms of concordance for BPD with the PDE and in terms of patterns of overlap with DSM-III-R, Axis I and other Axis II disorders. This study shows that BPD subgroups can be located on a continuum of symptomatic and behavioural severity and that each subgroup has a specific pattern of overlap with Axis I and other Axis II disorders.
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May, Jennifer M., Toni M. Richardi, and Kelly S. Barth. "Dialectical behavior therapy as treatment for borderline personality disorder." Mental Health Clinician 6, no. 2 (March 1, 2016): 62–67. http://dx.doi.org/10.9740/mhc.2016.03.62.
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Abstract Dialectical behavior therapy (DBT) is a structured outpatient treatment developed by Dr Marsha Linehan for the treatment of borderline personality disorder (BPD). Dialectical behavior therapy is based on cognitive-behavioral principles and is currently the only empirically supported treatment for BPD. Randomized controlled trials have shown the efficacy of DBT not only in BPD but also in other psychiatric disorders, such as substance use disorders, mood disorders, posttraumatic stress disorder, and eating disorders. Traditional DBT is structured into 4 components, including skills training group, individual psychotherapy, telephone consultation, and therapist consultation team. These components work together to teach behavioral skills that target common symptoms of BPD, including an unstable sense of self, chaotic relationships, fear of abandonment, emotional lability, and impulsivity such as self-injurious behaviors. The skills include mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance. Given the often comorbid psychiatric symptoms with BPD in patients participating in DBT, psychopharmacologic interventions are oftentimes considered appropriate adjunctive care. This article aims to outline the basic principles of DBT as well as comment on the role of pharmacotherapy as adjunctive treatment for the symptoms of BPD.
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Korn, C. W., L. La Rosée, H. R. Heekeren, and S. Roepke. "Social feedback processing in borderline personality disorder." Psychological Medicine 46, no. 3 (October 15, 2015): 575–87. http://dx.doi.org/10.1017/s003329171500207x.
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BackgroundPatients with borderline personality disorder (BPD) show negative and unstable self- and other-evaluations compared to healthy individuals. It is unclear, however, how they process self- and other-relevant social feedback. We have previously demonstrated a positive updating bias in healthy individuals: When receiving social feedback on character traits, healthy individuals integrate desirable more than undesirable feedback. Here, our aim was to test whether BPD patients exhibit a more negative pattern of social feedback processing.MethodWe employed a character trait task in which BPD patients interacted with four healthy participants in a real-life social interaction. Afterwards, all participants rated themselves and one other participant on 80 character traits before and after receiving feedback from their interaction partners. We compared how participants updated their ratings after receiving desirable and undesirable feedback. Our analyses included 22 BPD patients and 81 healthy controls.ResultsHealthy controls showed a positivity bias for self- and other-relevant feedback as previously demonstrated. Importantly, this pattern was altered in BPD patients: They integrated undesirable feedback for themselves to a greater degree than healthy controls did. Other-relevant feedback processing was unaltered in BPD patients.ConclusionsOur study demonstrates an alteration in self-relevant feedback processing in BPD patients that might contribute to unstable and negative self-evaluations.
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De Jonge, L., S. Petrykiv, J. Fennema, and M. Arts. "Relationship between borderline personality disorder and migraine." European Psychiatry 41, S1 (April 2017): S490. http://dx.doi.org/10.1016/j.eurpsy.2017.01.596.
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IntroductionBorderline personality disorder (BPD) is characterized by pervasive instability in moods, impulsivity, intense and unstable or disturbed interpersonal relationships and self-image, and often self-destructive behaviour. BPD seems to be more common in patients suffering from migraine. However, typical migraine characteristics in this population remain partly unknown.Objectives & aimsTo present the specific clinical characteristics of migraine patients with BPD and to assess their response to migraine treatment.MethodsWe examined 10 patients with migraine and previously diagnosed with BPD (group 1), 10 patients with migraine and no history of BPD (group 2), and 10 patients with migraine and no history of BPD matched to group 1 for age, gender, and frequency of headache. Migraine was treated in group 1 and 3 and pharmacological treatment outcome was assessed after 6 months.ResultsThe group of migraine patients with coexisting PBD was associated with female gender, increased prevalence of medication overuse headache, higher rates of self-reported depression, increased migraine-related disability, and a decreased response to pharmacological migraine treatment.ConclusionPatients with migraine and previously diagnosed BPD can be regarded as a distinct population. They are more suffering from depressive symptoms, more disabled by their migraine, are more resistant to pharmacological treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Ferreira, C., S. Alves, C. Oliveira, and M. J. Avelino. "Is Borderline Personality Disorder a Neuroendocrine Disease?" European Psychiatry 41, S1 (April 2017): S631—S632. http://dx.doi.org/10.1016/j.eurpsy.2017.01.1031.
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IntroductionBorderline personality disorder (BPD) is a disabling heterogeneous psychiatric disorder characterized by poor affect regulation and impulse control, with a high reactivity and vulnerability to stress. It has been hypothesized that these patients may have a dysregulation of the neuroendocrine system.AimsThe goal of this work is to systematically review the scientific knowledge regarding the role of the neuroendocrine system in the physiopathology of BPD.MethodsThe literature was reviewed by online searching using PubMed®. The authors selected scientific papers with the words “borderline personality disorder” and “neuroendocrine”/“endocrine” in the title and/or abstract, published in English.Results and discussionThere is scientific evidence for an enhanced cortisol release and HPA axis hyperactivity in BPD. The dexamethasone suppression test has been used in BPD, finding high rates of non-suppressors in that sample. There also seems to be a reduced volume of the amygdala and anterior cingulate cortex, suggesting an involvement of those regions in the emotional disturbances in BPD. Symptoms of impulsivity, aggression and suicidal behavior seem to be strongly mediated by the serotonergic system. The available research suggests a serotoninergic dysfunction in BPD, with lower levels of serotonin in those patients.ConclusionsThere seems to be several neuroendocrine changes related to BPD, namely a hyperactivity of the HPA axis with stimulated cortisol release together with disturbances of the serotonergic system. Also some brain structural alterations in BPD are scientifically depicted. Further studies are needed to clarify the neurobiology of BPD improving both psychotherapeutic and psychopharmacological treatment in these patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Stanley, Barbara, M. Mercedes Perez-Rodriguez, Christa Labouliere, and Steven Roose. "A Neuroscience-Oriented Research Approach to Borderline Personality Disorder." Journal of Personality Disorders 32, no. 6 (December 2018): 784–822. http://dx.doi.org/10.1521/pedi_2017_31_326.
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Traditionally, the study of personality disorders had been based on psychoanalytic or behavioral models. Over the past two decades, there has been an emerging neuroscience model of borderline personality disorder (BPD) grounded in the concept of BPD as a condition in which dysfunctional neural circuits underlie its pathological dimensions, some of which include emotion dysregulation (broadly encompassing affective instability, negative affectivity, and hyperarousal), abnormal interpersonal functioning, and impulsive aggression. This article, initiated at a joint Columbia University- Cornell University Think Tank on BPD with representation from the Icahn School of Medicine at Mount Sinai, suggests how to advance research in BPD by studying the dimensions that underlie BPD in addition to studying the disorder as a unitary diagnostic entity. We suggest that linking the underlying neurobiological abnormalities to behavioral symptoms of the disorder can inform a research agenda to better understand BPD with its multiple presentations.
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Rowe, Sarah L., Jennifer Jordan, Virginia V. W. McIntosh, Frances A. Carter, Cynthia M. Bulik, and Peter R. Joyce. "Impact of Borderline Personality Disorder on Bulimia Nervosa." Australian & New Zealand Journal of Psychiatry 42, no. 12 (January 1, 2008): 1021–29. http://dx.doi.org/10.1080/00048670802512040.
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Objective: The primary aim of the present study was to examine whether the presence of borderline personality disorder (BPD) adversely impacted on outcome 3 years after treatment among women with bulimia nervosa (BN), in comparison to those women with either other personality disorders (other PD) or no personality disorder (no PD). Method: Participants were 134 women who received cognitive behaviour therapy for BN. The sample was divided into three groups: BPD (n=38), other PD (n=37), and no PD (n=59). Eating disorder (ED) symptoms and attitudes, and personality traits were examined at pretreatment assessment, 1 year and 3 year follow up. Results: At pretreatment assessment the BPD group had higher purging frequency, more comorbidity and poorer general functioning than the other PD and no PD groups. By 3 year follow up, however, no significant differences were found in ED symptomatology and general functioning among the groups. Pretreatment differences between the BPD and no PD groups on the personality measures of harm avoidance, self-directedness and cooperativeness disappeared over the course of 3 years. Conclusion: Although women with BN and comorbid BPD appear more impaired at pretreatment assessment, they do not have poorer outcome than the other PD and no PD groups. The rate and level of improvement across the groups is not affected by the presence of BPD.
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Duică, Lavinia, Elisabeta Antonescu, Maria Totan, Gabriela Boța, and Sînziana Călina Silișteanu. "Borderline Personality Disorder “Discouraged Type”: A Case Report." Medicina 58, no. 2 (January 21, 2022): 162. http://dx.doi.org/10.3390/medicina58020162.
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Borderline Personality Disorder (BPD) is a mental illness associated with a significant degree of distress and impairment because of the difficulties in effectively regulating emotions. BPD is frequently associated with Depressive Disorders, most commonly Major Depressive Disorder and Dysthymia. Here, we present a case report of an 18-year-old female patient hospitalized with a severe depressive episode and psychotic symptoms. A few months after discharge, the interpersonal difficulties, unstable self-image, fear of chronic abandonment, feeling of emptiness, paranoid ideation, helplessness, obsessive-compulsive elements, perfectionism, and social retreat led to the patient’s impaired functionality. The spectrum of signs and symptoms presented were characteristic of BPD. The specific presentation of mixed dependent/avoidant pattern of personality, with persistent feelings of guilt and shame, social anxiety, emotional attachments, obsessions, and feelings of inadequacy have further narrowed the diagnosis to discouraged BPD, as described by Theodore Millon. In our case, this particular subtype of personality disorder can be understood as BPN associated with social perfectionism. Both BPD and perfectionism, as a trait personality, were thought to exacerbate issues with self-conception and identity formation in this patient.
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Ruocco, Anthony C., Alexander R. Daros, Jie Chang, Achala H. Rodrigo, Jaeger Lam, Justine Ledochowski, and Shelley F. McMain. "Clinical, personality, and neurodevelopmental phenotypes in borderline personality disorder: a family study." Psychological Medicine 49, no. 12 (October 10, 2018): 2069–80. http://dx.doi.org/10.1017/s0033291718002908.
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AbstractBackgroundBorderline personality disorder (BPD) is characterized by a heterogeneous clinical phenotype that emerges from interactions among genetic, biological, neurodevelopmental, and psychosocial factors. In the present family study, we evaluated the familial aggregation of key clinical, personality, and neurodevelopmental phenotypes in probands with BPD (n = 103), first-degree biological relatives (n = 74; 43% without a history of psychiatric disorder), and non-psychiatric controls (n = 99).MethodsParticipants were assessed on DSM-IV psychiatric diagnoses, symptom dimensions of emotion dysregulation and impulsivity, ‘big five’ personality traits, and neurodevelopmental characteristics, as part of a larger family study on neurocognitive, biological, and genetic markers in BPD.ResultsThe most common psychiatric diagnoses in probands and relatives were major depression, substance use disorders, post-traumatic stress disorder, anxiety disorders, and avoidant personality disorder. There was evidence of familial aggregation for specific dimensions of impulsivity and emotion dysregulation, and the big five traits neuroticism and conscientiousness. Both probands and relatives reported an elevated neurodevelopmental history of attentional and behavioral difficulties.ConclusionsThese results support the validity of negative affectivity- and impulse-spectrum phenotypes associated with BPD and its familial risk. Further research is needed to investigate the aggregation of neurocognitive, neural and genetic factors in families with BPD and their associations with core phenotypes underlying the disorder.
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Sarkar, Jaydip. "Borderline personality disorder and violence." Australasian Psychiatry 27, no. 6 (October 10, 2019): 578–80. http://dx.doi.org/10.1177/1039856219878644.
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Objective: This paper aims to provide a selective review of the co-occurrence of borderline personality disorder (BPD) and violence, a much less explored aspect of aggression with this cohort. Conclusions: Violence in BPD patients is expressed particularly towards intimate partners and known persons, usually in the homes of perpetrators. Anger, impulsivity and avoiding abandonment are traits associated with violence while suicidal behaviour, identity disturbance and affective instability are not. These patients are disproportionately found in higher levels of secure care although most violence occurs in the community. In males it is more likely driven by substance use, often at transition from adolescence to adulthood, while more severe borderline pathology is implicated in women. Early identification of an at-risk cohort is recommended with development of collaborative safety plans with patients that include identification of a ‘risk signature’ that guides risk management. A multi-modal approach using risk management protocols with availability of contingency plans within a multi-agency forum in a local context is recommended.
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Turki, M., N. Gargouri, M. Abdellatif, S. Ellouze, O. Abidi, N. Halouani, and J. Aloulou. "Borderline Personality Disorder And Childhood Trauma: Witch Relationship?" European Psychiatry 65, S1 (June 2022): S374. http://dx.doi.org/10.1192/j.eurpsy.2022.949.
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Introduction Borderline Personality Disorder (BPD) is a pervasive pattern of impulsiveness, emotional dysregulation, and difficult interpersonal relationships. Several studies showed that its onset depends on the combination of biological and psychosocial factors, particularly between biological vulnerabilities and traumatic experiences during childhood. Objectives We aimed to explore the mediators of the effects of childhood trauma in BPD vulnerability. Methods We conducted a literature review using “PubMed” database and keywords “borderline personality disorder”, “childhood trauma”, “hypothalamic-pituitary-adrenal axis”, “stress”, adverse childhood experiences”. Results Several studies showed that a diagnosis of BPD is associated with child abuse and neglect more than any other personality disorders, with a range between 30 and 90% in BPD patients. All types of abuse and neglect happen to be significantly associated with BPD features. Besides, the exposure to multiple types of maltreatment through multiple development periods increased the severity of BPD. Several studies highlighted the role of alterations in Hypothalamic-Pituitary-Adrenal axis, in neurotransmission, in the endogenous opioid system and in neuroplasticity in the childhood trauma-associated vulnerability to develop BPD. Besides, morphological changes in several BPD brain areas and in particular in those involved in stress response have also been incriminated. Conclusions Our findings regarding the role of childhood trauma in the development of BPD would help identify and develop early intervention services for a vulnerable population. The critical role of psychotherapy in treating individuals with early life stress may partially explain why the prevailing empirically validated treatments for BPD are psychotherapeutic. Disclosure No significant relationships.
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Turki, M., M. Abdellatif, N. Gargouri, S. Ellouze, S. Blanji, A. Daoud, N. Halouani, and J. Aloulou. "Disease Burden Of Co-Occurring Borderline Personality Disorder In Patients With Bipolar Disorder." European Psychiatry 65, S1 (June 2022): S459—S460. http://dx.doi.org/10.1192/j.eurpsy.2022.1166.
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Introduction In recent years, advances in the areas of both bipolar disorder (BD) and borderline personality disorder (BPD) have generated considerable interest in the relationship between these two conditions, since that they are commonly comorbid. Objectives We aimed to investigate the impact of BPD on course of illness in patients with BP. Methods We conducted a cross-sectional, descriptive and analytical study among 30 psychiatric outpatients diagnosed with BD in the Psychiatry « B » department, Hedi Chaker Hospital (Sfax, Tunisia). The McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) was used to screen for BPD. Clinical outcomes (hospital stays, comorbidities, suicidality…) were compared between BD- patients with or without BPD comorbidity. Results The mean age was 41.63 years, with a sex ratio of ½. Among the patients, 2/3 were diagnosed with BD-I, while 1/3 presented a BD-II. Physical comorbidities, comorbid anxious and eating disorders were noted respectively in 36.7%; 16.7% and 43.3% of patients. Suicidal attempts were reported in 46.7% of cases. According to MSI-BPD, a comorbid BPD was noted in 30% of our sample. Patients with BD-II were significantly more likely to present BDP traits (50%) than those with BD-I (20%) (p<0.001). Patients with BPD were significantly more likely to attempt suicide (p=0.033), and to present physical comorbidities (p<0.001) and comorbid eating disorders (p<0.001). Conclusions Our study showed that BPD darkens the prognosis of BD, because of worse outcomes related to suicide, physical and psychiatric comorbidities. Thus, its co-occurrence complicates the management of BD. Disclosure No significant relationships.
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Links, Paul S., Meir Steiner, David R. Offord, and Alan Eppel. "Characteristics of Borderline Personality Disorder: A Canadian Study." Canadian Journal of Psychiatry 33, no. 5 (June 1988): 336–40. http://dx.doi.org/10.1177/070674378803300504.
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This study presents data on a Canadian sample of inpatients with the diagnosis of Borderline Personality Disorder (BPD). Inpatients with BPD were compared to inpatients with borderline traits. The results indicate that the BPD inpatients have a chronic severe disorder, which onsets in adolescence, and are likely to have suffered early deprivation or abuse.