Personality disorder - borderline ... Cause of borderline personality disorder (BPD) is unknown. Genetic, family, and social factors are thought to play roles. Risk factors for BPD include: Abandonment ...
... Names Personality disorder - borderline References American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing. 2013. ...
The term ‘Borderline Personality Disorder’ (BPD) refers to a psychiatric syndrome that is characterized by emotion dysregulation, impulsivity, risk-taking behavior, irritability, feelings of emptiness, self-injury and fear of abandonment, as well as unstable interpersonal relationships. BPD is not only common in psychiatric populations but also more prevalent in the general community than previously thought, and thus represents an important public health issue. In contrast to most psychiatric disorders, some symptoms associated with BPD may improve over time, even without therapy, though impaired social functioning and interpersonal disturbances in close relationships often persist. Another counterintuitive and insufficiently resolved question is why depressive symptoms and risk-taking behaviors can occur simultaneously in the same individual. Moreover, there is an ongoing debate about the nosological position of BPD, which impacts on research regarding sex differences in clinical presentation and patterns of comorbidity. In this review, it is argued that many features of BPD may be conceptualized within an evolutionary framework, namely behavioral ecology. According to Life History Theory, BPD reflects a pathological extreme or distortion of a behavioral ‘strategy’ which unconsciously aims at immediate exploitation of resources, both interpersonal and material, based on predictions shaped by early developmental experiences. Such a view is consistent with standard medical conceptualizations of BPD, but goes beyond classic ‘deficit’-oriented models, which may have profound implications for therapeutic approaches. PMID:26929090
... Children Autism Spectrum Disorder (ASD) Eating Disorders Among Adults - Anorexia Nervosa Eating Disorders Among Adults - Binge Eating Disorder Eating ... Children Autism Spectrum Disorder (ASD) Eating Disorders Among Adults - Anorexia Nervosa Eating Disorders Among Adults - Binge Eating Disorder Eating ...
Full Text Available ... arise and they are feeling unstable. A Treatable Disorder Diagnosis is often a relief ... with emotionally intense mental images of themselves and others. The therapist helps ...
Full Text Available ... The therapist helps the patient unconsciously reassign extreme positive or negative images associated with one person to ... and others. Patients are encouraged to express and think about their emotions and experiences with other people ...
Sansone, Randy A.; Sansone, Lori A.
Gender differences in patients with borderline personality disorder are potentially relevant because they may guide clinicians in assessment and treatment. To date, a number of clinical features in borderline personality disorder have been examined for gender differences. As for prevalence, earlier research concluded that a higher proportion of women than men suffer from borderline personality disorder, although more recent research has determined no differences in prevalence by gender. In ad...
Bech, Morten; Elklit, Ask; Simonsen, Erik
Borderline personality disorder is a severe psychiatric illness. A key feature of the disorder is a disorganized sense of self often referred to as identity diffusion. Autobiographical memory is memory for personal life events. One of the main functions of these memories is to enable us to...... understand who we are by connecting past, present and future experiences. It seems that autobiographical memory is in some way disrupted in individuals with borderline personality disorder. A systematic review is conducted looking at studies that focus on the potential connections. We find that although a......, autobiographical memory and borderline personality disorder....
James, A; Berelowitz, M; Vereker, M
The study of the presentation, symptomatology and family characteristics of an exclusively adolescent sample of patients with borderline personality disorder (BPD) was undertaken. Twenty-four cases of borderline personality disorder, 20 females, 4 males, identified using chart review and meeting the criteria of the Diagnostic Interview for Borderlines (DIB) and DSM III-R, were matched with psychiatric controls. Adolescents with borderline personality disorder were found to have high rates of affective symptomatology with Axis I diagnosis of major depressive disorder MDD (DSM-III-R), and high rates of interpersonal psychopathology, i.e., manipulation, devaluation, and a pervasive sense of boredom. The latter seem to be characteristic as for adults with borderline personality disorder. The families were particularly angry and volatile. PMID:9117533
Ogłodek, Ewa; Araszkiewicz, Aleksander
For many years, the borderline personality disorders have mainly been researched in terms of psychoanalytical theories, such as theories on relations with the object. Nowadays, there are three kinds of concepts that are distinguishable. The first ones are those which are group models, serving attempts to made characteristic sets of qualities, represented by individuals suffering from the borderline personality disorders, more precise. The remaining concepts are models of conflict and deficit, which explain complicated mechanisms of interactions of social, psychological and biological factors, and therefore, contribute to better understanding of the genesis of the symptoms of this disorder. Upon the basis of the attempts made so far in the field of describing the borderline personality disorders, one may indicate certain criteria, representative for the entire group of individuals with this diagnosis, regardless of the assumptions applicable to the genesis of the disorder and its symptoms, even though the population of the infirm suffering from the borderline personality disorders is not internally homogenous. The interest of psychologists, attempting to describe the borderline personality disorders, is focused upon certain sets of qualities, presented as the examples of descriptive models. Among the researchers, working on the issues of the borderline personality disorders in this manner, there are: Gunderson, Kernberg, Kohut, Winnicot, Guntrip, Fairbaim, Adler and Buie. PMID:21936354
Sansone, Randy A.; Sansone, Lori A.
Borderline personality is an Axis II disorder that has historically encompassed a number of different psychiatric symptoms. In empirical studies, these multiple psychiatric symptoms appear to manifest as numerous comorbid Axis I and II diagnoses. In echoing these findings in primary care settings, individuals with borderline personality exhibit prolific somatic symptoms. Rather than the type of symptom, are the number of symptoms suggestive of this disorder, such that proliferative psychiatri...
The aim of the study was to investigate gender differences and similarities in patients with borderline personality disorder (BPD) with respect to axis I comorbidity, axis II comorbidity, general psychopathology (Symptom Checklist 90-Revised), and dimensional personality traits (NEO-Personality-Inventory Revised, NEO-PI-R, and the Dimensional Assessment of Personality Profile Basic questionnaire, DAPP-BQ). Fifty-seven men and 114 women with BPD were included in the study. Regarding axis I and...
Suvak, Michael K.; Sege, Christopher T.; Sloan, Denise M.; Shea, M. Tracie; YEN, SHIRLEY; Litz, Brett T.
This study examined whether individuals with borderline personality disorder (BPD) would exhibit augmented emotional responses to picture stimuli after being challenged with an ideographic interpersonal conflict script. Participants were 24 adults diagnosed with BPD, 23 adults diagnosed with obsessive compulsive personality disorder (OCPD), and 28 normal controls. Participants viewed emotionally evocative pictures before and after listening to the interpersonal script while a variety of physi...
Suggests that early identification, through psychosocial assessment and intake interviews, of clients who have borderline personality disorder aids in planning an effective multidisciplinary team approach for the particular problems these clients present. Describes characteristics of this population and recommends interventions. (Author)
Hubbard, J R; Saathoff, G B; Bernardo, M J; Barnett, B L
The first step in the management of borderline personality disorder is making the correct diagnosis. A clinical example illustrates symptoms of a patient with borderline personality disorder in a family practice setting. Major characteristics of borderline personality disorder include severe mood instability, fear of abandonment, chronic boredom, self-injury, unstable interpersonal relationships, "splitting," identity instability and borderline rage. Early diagnosis may help prevent potential management problems and possible doctor-patient conflicts. PMID:7653428
Posner, Michael I.; Rothbart, Mary K.; Vizueta, Nathalie; Levy, Kenneth N.; Evans, David E.; Thomas, Kathleen M.; Clarkin, John F.
We consider whether disruption of a specific neural circuit related to self-regulation is an underlying biological deficit in borderline personality disorder (BPD). Because patients with BPD exhibit a poor ability to regulate negative affect, we hypothesized that brain mechanisms thought to be involved in such self-regulation would function abnormally even in situations that seem remote from the symptoms exhibited by these patients. To test this idea, we compared the efficiency of attentional...
Clarkin, John F; Posner, Michael
Understanding the biological connections to mental processes was one of the original goals of psychoanalysis, and the development of cognitive and affective neuroscience and its methods might contribute to actualizing this goal. Personality disorders provide an opportunity to examine the complex mental structures of individuals experiencing extreme difficulties in interacting with their social environment. We provide initial information on a collaboration exploring an approach to one of the most serious personality disorders, borderline personality disorder, based upon the study of normal attention, individual differences in temperament, self definition and attachment organization, with the potential to illuminate the psychology and psychobiology of the disorder and to contribute to psychotherapeutic intervention. This developing model of borderline personality disorder can relate the symptoms to more enduring temperamental aspects of the patients. The goal is to understand the development of neural networks that underlie the abnormalities of adults, and eventually work out the interaction between temperament, genes, and experience that produce the disorder, and potentially inform intervention. PMID:15802943
Full Text Available The association between bipolar disorder and borderline personality has been studied by several researchers. Comorbidity has been emphasized by some authors which observe a prognostic impairment of bipolar disorder because the delay of the diagnostic. Symptoms related with alcohol and drugs abuse, suicidary behaviour and impulsivity, often present in borderline patients, make the treatment difficult. Other authors consider these symptoms as being part of the bipolar disease, proposing a continuum between the two entities. In this case, borderline personality would be a mild form of an affective disorder. We will discuss different opinions and their cli- nical and therapeutic consequences.
Pazzagli, A; Monti, M R
A close examination of dysphoria, anger and aloneness (three main characteristics of the borderline syndrome) provides a theoretical model of reference for the therapist. Dysphoria results from the cyclical emotional oscillation between hope for stability and disappointment in its inattainability; a dependent-anaclitic depression arises from the mixture of anger, aloneness and inner emptiness which is so characteristic of the borderline syndrome. The tendency to be immersed in the here-and-now, an intra-festum mentality, exacerbates the sense of isolation, causing more irritation, mute frustration and, consequently, anger. The effects and ramifications of anger, and the resultant precarious cohesion of the self, are explored in the borderline syndrome; they are especially illuminated by the application of Kernberg's pain-anger-hate-vengefulness cycle concept. Meanings of solitude, in its forms of aloneness and loneliness, are explored in their pertinence. Aloneness - the constant needy search for, but condemnation to never finding, objects to fill an inner sense of emptiness - is especially germane. Suggestions for assisting subjects with borderline personality disorder to overcome aloneness and the lack of historical progression are made. PMID:10867581
Berlin, Heather.; Iverson, Susan.; Edmund Rolls, Susan Iverson
Damage to the orbitofrontal cortex (OFC) has been associated with disinhibited or socially inappropriate behaviour and emotional irregularities in both humans and monkeys. Prominent characteristics of several personality disorder syndromes, in particular Borderline Personality Disorder (BPD), are impulsivity and affective instability. This investigation aimed to determine if certain aspects of the Borderline Personality syndrome, in particular impulsivity, are associated with ...
Bernhardt, James Lawrence
This paper explores the findings and current state of research on the familial characteristics of persons with borderline personality disorder (BPD). A review of the borderline personality disorder emphasizes the development of the term, etiological issues, and treatment issues related to BPD. Two formal approaches for obtaining accurate diagnosis…
Sansone, Randy A.; Sansone, Lori A.
According to the empirical literature, substance use disorders are commonly comorbid with a number of psychiatric disorders, including the personality disorders and especially borderline personality disorder. With regard to borderline personality disorder, eight studies of varying sample types (e.g., inpatient, outpatient, community) indicate prevalence rates of substance use disorders from 14 percent (current rate) to 72 percent (lifetime rate). As expected, lifetime prevalence rates of subs...
Sansone, Randy A.; Wiederman, Michael W.; Sansone, Lori A.
Reviews possible links between obesity and borderline-personality disorder and discusses treatment approaches for those individuals demonstrating such comorbidity. Approaches include modification of current techniques for obesity treatment and incorporation of psychodynamic counseling specific to borderline-personality disorder. (Author/GCP)
Reed, Lawrence Ian; Zanarini, Mary C.
The aim of the current study was to compliment previous studies identifying negative states present in borderline personality disorder by investigating the presence of positive affective and cognitive states. Ninety-six patients with criteria-defined borderline personality disorder and 24 axis II comparison participants completed the Positive Affect Scale, a 50-item self-report measure designed to assess positive states thought to be characteristic of borderline patients (and axis II comparis...
Full Text Available Ondrej Pec,1,2 Petr Bob,1,3 Jiri Raboch1 1Center for Neuropsychiatric Research of Traumatic Stress, Department of Psychiatry, First Faculty of Medicine, Charles University, Prague, 2Psychotherapeutic and Psychosomatic Clinic ESET, Prague, 3Central European Institute of Technology, Faculty of Medicine, Masaryk University, Brno, Czech Republic Background: Dissociation likely plays a key role in schizophrenia and borderline personality disorder (BPD, although empirical studies that compare specific manifestations of these symptoms in schizophrenia and BPD are rare. In this context, the purpose of this study was to compare the occurrence of dissociative and other psychopathological symptoms in these disorders, and to assess the possible influence of antipsychotic medication on the dissociative symptoms. Methods: We assessed 31 patients with schizophrenia and 36 patients with BPD. Dissociative symptoms were measured by the Dissociative Experiences Scale (DES, symptoms related to stress and traumatic experiences were assessed using the Trauma Symptom Checklist-40 (TSC-40, and other psychopathological symptoms were measured with the Health of the Nation Outcome Scales (HoNOS. We also assessed actual daily doses of antipsychotic medication in chlorpromazine equivalents in all participants. Results: The results show that symptoms of traumatic stress measured by the TSC-40 had significantly higher scores in the BPD group. The data also show that dissociative symptoms (DES were significantly correlated with symptoms of traumatic stress (TSC-40 and with symptoms assessed by the HoNOS. Remarkably significant correlations were found between levels of antipsychotic medication and the DES and between antipsychotic medication and the depersonalization/derealization component of the DES in BPD patients. Conclusion: The results support an important role of dissociative processes in schizophrenia and BPD and suggest a significant relationship between manifestations
Full Text Available Abstract Background The aims of this study were to assess the prevalence of a comorbid Attention Deficit Hyperactivity Disorder (ADHD diagnosis in Borderline Personality Disorder (BPD, and its impact on the clinical presentation of BPD in adolescents, and to determine which type of impulsivity specifically characterizes adolescents with BPD-ADHD. Methods ADHD diagnoses were sought in a sample of 85 DSM-IV BPD adolescents drawn from the EURNET BPD. Axis-I and -II disorders were determined with the K-SADS-PL and the SIDP-IV, respectively. Impulsivity was assessed with the BIS-11. Results 11% (N = 9 of BPD participants had a current ADHD diagnosis. BPD-ADHD adolescents showed higher prevalence of Disruptive disorders (Chi2 = 9.09, p = 0.01 and a non-significant trend for a higher prevalence of other cluster B personality disorders (Chi2 = 2.70, p = 0.08. Regression analyses revealed a significant association between Attentional/Cognitive impulsivity scores and ADHD (Wald Z = 6.69; p = 0.01; Exp(B = 2.02, CI 95% 1.19-3.45. Conclusions Comorbid ADHD influences the clinical presentation of adolescents with BPD and is associated with higher rates of disruptive disorders, with a trend towards a greater likelihood of cluster B personality disorders and with higher levels of impulsivity, especially of the attentional/cognitive type. A subgroup of BPD patients may exhibit developmentally driven impairments of the inhibitory system persisting since childhood. Specific interventions should be recommended for this subsample of BPD adolescents.
Full Text Available BACKGROUND: One of the core symptoms of borderline personality disorder (BPD is the instability in interpersonal relationships. This might be related to existent differences in mindreading between BPD patients and healthy individuals. METHODS: We examined the behavioural and neurophysiological (fMRI responses of BPD patients and healthy controls (HC during performance of the 'Reading the Mind in the Eyes' test (RMET. RESULTS: Mental state discrimination was significantly better and faster for affective eye gazes in BPD patients than in HC. At the neurophysiological level, this was manifested in a stronger activation of the amygdala and greater activity of the medial frontal gyrus, the left temporal pole and the middle temporal gyrus during affective eye gazes. In contrast, HC subjects showed a greater activation in the insula and the superior temporal gyri. CONCLUSION: These findings indicate that BPD patients are highly vigilant to social stimuli, maybe because they resonate intuitively with mental states of others.
Borderline personality disorders are complex clinical states with highly polymorphic symptoms and signs, leading to delays in their diagnosis and treatment. All international classifications emphasize certain clinical criteria such as unstable identity and interpersonal relationships, feelings of emptiness or boredom, and pathological impulsiveness. The prevalence is about 2%, with a female-male sex ratio of 2 or 3 to 1. Both adolescents and adults may be affected There is a high risk of suicide, addictive behaviors, eating disorders, and criminality. These individuals frequently have a history of trauma in early childhood, such as separation, loss, physical or sexual abuse, or affective privation. Subjective signs and symptoms are particularly important in the diagnostic and therapeutic evaluation, and this requires an empathic and subtle approach. Standardized and semi-structured interviews may help to identify comorbidities such as thymic disorders, anxiety, addiction, eating disorders, and, in some cases, psychotic symptoms. The psychiatric bio-psycho-social model takes into account multiple pathogenic factors, such as trauma during early development, temperamental instability and other emotional disorders, as well as psychosocial, neurobiological (5HT etc.) and genetic vulnerabilities. Treatment requires optimal integration of psychotherapeutic and pharmacotherapeutic approaches. Emergency intervention must be available in case of delirious or suicidal behavior The clinical course is often lengthy and complex, but outcome may be favorable, provided the principal risk--suicide--is correctly managed, PMID:23815019
Zimmerman, Mark; Morgan, Theresa A
It is clinically important to recognize both bipolar disorder and borderline personality disorder (BPD) in patients seeking treatment for depression, and it is important to distinguish between the two. Research considering whether BPD should be considered part of a bipolar spectrum reaches differing conclusions. We reviewed the most studied question on the relationship between BPD and bipolar disorder: their diagnostic concordance. Across studies, approximately 10% of patients with BPD had bi...
Sansone, Randy A.; Sansone, Lori A.
According to clinical experience, the Diagnostic and Statistical Manual of Mental Disorders, and authorities in the field, patients with borderline personality disorder tend to be hyper-reactive to environmental stimuli. In addition to the preceding clinical impressions and experiences, the majority of empirical studies in this area have concluded that patients with borderline personality disorder are indeed hyper-responsive to experimental environmental stimuli, whether the stimuli are negat...
Rojas, Elizabeth; Cummings, Jenna, R.; Bornovalova, Marina A.; Hopwood, Christopher J.; Racine, Sarah E.; Keel, Pamela K.; Sisk, Cheryl; Neale, Michael,; Boker, Steven; Burt, Alexandra S.; Klump, Kelly L.
Previous research indicates that Borderline Personality Disorder (BPD) is well conceptualized as a dimensional construct that can be represented using normal personality traits. A previous study successfully developed and validated a BPD measure embedded within a normal trait measure, the Minnesota Borderline Personality Disorder Scale (MBPD). The current study performed a further validation of the MBPD by examining its convergent validity, external correlates, and heritability in a sample of...
van Dijke, A.
The aim of this dissertation was to provide a systematic exploration of the nature and distribution of dysfunctional affect regulation, its associated phenomena, and retrospectively reported potentially traumatizing events in 475 patients diagnosed with borderline personality disorder (BPD), somatoform disorder (SoD), comorbid BPD+SoD, and a psychiatric comparison group (PC) to provide a baseline against which to compare the hypothesized elevations in dysfunctional self and affect regulation....
Tryon, Georgiana Shick; And Others
Discusses problems and methodology of diagnosis and counseling of college students with borderline personality disorder. Recommends that providing these students with structure through consistent limit setting can produce positive changes in their behavior. (Author/ABL)
Hagenhoff, Meike; Franzen, Nele; Koppe, Georgia; Baer, Nina; Scheibel, Niki; Sammer, Gebhard; Gallhofer, Bernd; Lis, Stefanie
Different domains of executive function such as working memory and response inhibition were investigated together with elementary cognitive processes in borderline personality disorder (BPD). Patients with BPD (N=28) were compared to nonpatient controls (NP, N=28) on eight tasks (e.g. n-back, Go/NoGo, CPT-AX). In order to separate impairments in different cognitive domains and to assess the influence of more elementary cognitive processes on executive functioning, tasks were embedded in a reaction-time-decomposition approach. BPD patients solved tasks with accuracies comparable to those of nonpatients. The only exception was the n-back task, for which working memory is required: here, error rates were higher and increased more prominently in BPD patients depending on working memory load. In most tasks, movement times were shorter for BPD patients than for nonpatients, while the quality of task-solving was comparable. The faster processing in the BPD group was observable starting with the simplest task, i.e. a simple reaction-time task. These findings suggest that domains of executive functioning are differentially affected in BPD. In contrast to load-dependent deficits in working memory, response inhibition processes were unimpaired. Faster action-related processes could be observed in BPD patients in a variety of tasks; however, these did not influence executive functioning. PMID:23764434
Full Text Available Many typical symptoms of borderline personality disorder (BPD occur within interpersonal contexts, suggesting that BPD is characterized by aberrant social cognition. While research consistently shows that BPD patients have biases in mental state attribution (e.g., evaluate others as malevolent, the research focusing on accuracy in inferring mental states (i.e., cognitive empathy is less consistent. For complex and ecologically valid tasks in particular, emerging evidence suggests that individuals with BPD have impairments in the attribution of emotions, thoughts, and intentions of others (e.g., Preißler et al., 2010. A history of childhood trauma and co-morbid PTSD seem to be strong additional predictors for cognitive empathy deficits. Together with reduced emotional empathy and aberrant sending of social signals (e.g., expression of mixed and hard-to-read emotions, the deficits in attribution might contribute to behavioral problems in BPD. Given the importance of social cognition on the part of both the sender and the recipient in maintaining interpersonal relationships and therapeutic alliance, these impairments deserve more attention.
Full Text Available BACKGROUND: Borderline personality disorder (BPD is a common and serious mental illness, associated with a high risk of suicide and self harm. Those with a diagnosis of BPD often display difficulties with social interaction and struggle to form and maintain interpersonal relationships. Here we investigated the ability of participants with BPD to make social inferences from faces. METHOD: 20 participants with BPD and 21 healthy controls were shown a series of faces and asked to judge these according to one of six characteristics (age, distinctiveness, attractiveness, intelligence, approachability, trustworthiness. The number and direction of errors made (compared to population norms were recorded for analysis. RESULTS: Participants with a diagnosis of BPD displayed significant impairments in making judgements from faces. In particular, the BPD Group judged faces as less approachable and less trustworthy than controls. Furthermore, within the BPD Group there was a correlation between scores on the Childhood Trauma Questionnaire (CTQ and bias towards judging faces as unapproachable. CONCLUSION: Individuals with a diagnosis of BPD have difficulty making appropriate social judgements about others from their faces. Judging more faces as unapproachable and untrustworthy indicates that this group may have a heightened sensitivity to perceiving potential threat, and this should be considered in clinical management and treatment.
Aviram, Ron B; Brodsky, Beth S; Stanley, Barbara
Borderline personality disorder (BPD) is often viewed in negative terms by mental health practitioners and the public. The disorder may have a stigma associated with it that goes beyond those associated with other mental illnesses. The stigma associated with BPD may affect how practitioners tolerate the actions, thoughts, and emotional reactions of these individuals. It may also lead to minimizing symptoms and overlooking strengths. In society, people tend to distance themselves from stigmatized populations, and there is evidence that some clinicians may emotionally distance themselves from individuals with BPD. This distancing may be especially problematic in treating patients with BPD; in addition to being unusually sensitive to rejection and abandonment, they may react negatively (e.g., by harming themselves or withdrawing from treatment) if they perceive such distancing and rejection. Clinicians' reactivity may be self-protective in response to actual behavior associated with the pathology. As a consequence, however, the very behaviors that make it difficult to work with these individuals contribute to the stigma of BPD. In a dialectical relationship, that stigma can influence the clinician's reactivity, thereby exacerbating those same negative behaviors. The result is a self-fulfilling prophecy and a cycle of stigmatization to which both patient and therapist contribute. The extent to which therapist distancing is influenced by stigma is an important question that highlights the possibility that the stigma associated with BPD can have an independent contribution to poor outcome with this population. A final issue concerns the available means for identifying and limiting the impact of stigmatization on the treatment of individuals with BPD. PMID:16990170
Harned, Melanie S.; Valenstein, Helen R.
Anxiety disorders are highly prevalent among individuals with borderline personality disorder, with comorbidity rates of up to 90%. Anxiety disorders have been found to reduce the likelihood of achieving remission from borderline personality disorder over time and to increase the risk of suicide and self-injury in this population. Evidence-based treatments for borderline personality disorder have not sufficiently focused on targeting anxiety disorders, and their effects on these disorders are...
Full Text Available Background and Objectives: Human coprophagia is a rare phenomenon with severe medical and social consequences. So far, coprophagia has mainly been associated with severe mental retardation, schizophrenia, dementia, and depression. We report a case of coprophagia in a 30-year-old woman with Borderline Personality Disorder (DSM-IV. This case report illustrates the severity of symptoms and maladaptive social consequences of severe personality disorders, comparable to those of patients with schizophrenia. Pharmacological interventions and, particularly intensive psychotherapy might be effective for patients diagnosed with borderline personality disorder displaying severe behavior disorders. The treatment of choice for coprophagia is aversive behavioral intervention.
Zimmerman, M; Mattia, J I
Borderline personality disorder (PD) has been the most studied PD. Research has examined the relationship between borderline PD and most axis I diagnostic classes such as eating disorders, mood disorders, and substance use disorders. However, there is little information regarding the relationship of borderline PD and overall comorbidity with all classes of axis I disorders assessed simultaneously. In the present study, 409 patients were evaluated with semistructured diagnostic interviews for axis I and axis II disorders. Patients with a diagnosis of borderline PD versus those who did not receive the diagnosis were assigned significantly more current axis I diagnoses (3.4 v 2.0). Borderline PD patients were twice as likely to receive a diagnosis of three or more current axis I disorders (69.5% v 31.1%) and nearly four times as likely to have a diagnosis of four or more disorders 147.5% v 13.7%). In comparison to nonborderline PD patients, borderline PD patients more frequently received a diagnosis of current major depressive disorder (MDD), bipolar I and II disorder, panic disorder with agoraphobia, social and specific phobia, posttraumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), eating disorder NOS, and any somatoform disorder. Similar results were observed for lifetime diagnoses. Overall, borderline PD patients were more likely to have multiple axis I disorders than nonborderline PD patients, and the differences between the two groups were present across mood, anxiety, substance use, eating, and somatoform disorder categories. These findings highlight the importance of performing thorough evaluations of axis I pathology in patients with borderline PD in order not to overlook syndromes that are potentially treatment-responsive. PMID:10428182
Goldberg, R L; Mann, L S; Wise, T N; Segall, E A
This study explores the contribution of parental qualities to the borderline personality disorder. The Parental Bonding Inventory is used to compare four parental qualities (caring mother, caring father, overprotective father, and overprotective mother) across three groups (borderline personality disorders, assorted psychiatric controls and normal controls). The major finding was that the borderline patients perceived their parents to be significantly less caring and more overprotective than both the psychiatric control or nonclinical control groups. This study was verified previous reports that patients diagnosed with an affective illness (in either the borderline group or psychiatric control group) reported no significant differences on the inventory. Pinpointing parental characteristics which antecede mental disorders may be an important first step in devising primary preventive interventions for adult disorders. PMID:4077030
Sansone, Randy A.; Sansone, Lori A.
Borderline personality disorder is characteristically associated with a broad variety of psychiatric symptoms and aberrant behaviors. In this edition of The Interface, we discuss the infrequently examined association between borderline personality disorder and criminality. According to our review of the literature, in comparison with the rates of borderline personality disorder encountered in the general population, borderline personality disorder is over-represented in most studies of inmate...
Nasiri, Hamid; Abedi, Ahmad; Ebrahimi, Amrollah; Ameli, Sedigheh Sadr; Samouei, Rahele
Introduction: The main objective of the present study is to review the psychological profile of female patients with borderline personality disorder in the women referring to the Centers of Counseling and Psychological Services at Isfahan city based on MMPI-2 test and comparing them with ordinary women. Method: The present study is of the type of cause-comparative and the selection of examinees was done in form of random sampling with 50 women with the BPD and 50 ordinary women and through co...
Sansone, Randy A; Sansone, Lori A
According to clinical experience, the Diagnostic and Statistical Manual of Mental Disorders, and authorities in the field, patients with borderline personality disorder tend to be hyper-reactive to environmental stimuli. In addition to the preceding clinical impressions and experiences, the majority of empirical studies in this area have concluded that patients with borderline personality disorder are indeed hyper-responsive to experimental environmental stimuli, whether the stimuli are negative, positive, or even neutral or ambiguous. While two empirical studies did not find hyper-responsiveness, both were undertaken in inpatients with borderline personality disorder, and the potential for emotional blunting from psychotropic medications may have been a potential confound. These findings have several clinical implications in both mental health and primary care settings. PMID:20941347
Koch, Alberta; Ingram, Timothy
Suggests an integrated systemic-psychodynamic approach to the treatment of characterological disorders within conjoint marital therapy. Draws from object relations and systemic therapies in developing a treatment approach to marriages which include at least one borderline personality disorder spouse. A case example illustrates the…
Weinberg, Anna; Klonsky, E. David; Hajcak, Greg
Recent research suggests that emotional dysfunction in psychiatric disorders can be reflected in autonomic abnormalities. The present study examines sympathetic and parasympathetic autonomic nervous system activity in individuals with Borderline Personality Disorder (BPD) before, during, and following a social stressor task. Data were obtained…
The included five studies assessed disturbance in interpersonal functioning and cognition as hallmarks of borderline personality disorder (BPD). In the first three studies interpersonal functioning in BPD was empirically explored. The first study's objective was to empirically assess cognitive and emotional empathy in patients with BPD and narcissistic personality disorder (NPD). The study's method was that 27 patients with BPD, forty-seven patients with NPD, and 53 healthy controls were ...
Bach, B; Sellbom, M; Bo, S;
OBJECTIVE: Borderline Personality Disorder (BPD) is a highly prevalent diagnosis in mental health care and includes a heterogeneous constellation of symptoms. As the field of personality disorder (PD) research moves to emphasize dimensional traits in its operationalization, it is important...
Bornovalova, Marina A.; Hicks, Brian M.; Patrick, Christopher J.; Iacono, William G.; McGue, Matt
Although large epidemiological data sets can inform research on the etiology and development of borderline personality disorder (BPD), they rarely include BPD measures. In some cases, however, proxy measures can be constructed using instruments already in these data sets. In this study, the authors developed and validated a self-report measure of…
Fonagy, P.; Luyten, P.; Strathearn, L.
We discuss the neural and neurobiological underpinnings of the core features of borderline personality disorder (BPD), including emotion dysregulation, impulsivity, disturbed interpersonal functioning, identity diffusion, and feelings of inner pain. We review neurobiological research that supports a developmental, biobehavioral switch-model of the relationship between mentalization, stress, and attachment. Although it is likely that there are different developmental pathways to BPD, involving...
Argues that the dichotomous nature of poetry may lend itself well to the complementary structural deficits of well-defined borderline personality disordered patients. Suggests that the emotive aspects of the poem may permit the patient to engage in the work, whereas the more rational, structured aspects of the poem facilitate personality…
Rojas, Elizabeth C; Cummings, Jenna R; Bornovalova, Marina A; Hopwood, Christopher J; Racine, Sarah E; Keel, Pamela K; Sisk, Cheryl L; Neale, Michael; Boker, Steven; Burt, S Alexandra; Klump, Kelly L
Previous research indicates that borderline personality disorder (BPD) is well conceptualized as a dimensional construct that can be represented using normal personality traits. A previous study successfully developed and validated a BPD measure embedded within a normal trait measure, the Minnesota Borderline Personality Disorder Scale (MBPD). The current study performed a further validation of the MBPD by examining its convergent validity, external correlates, and heritability in a sample of 429 female twins. The MBPD correlated strongly with the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II) screener for BPD and moderately with external correlates. Moreover, the MBPD and SCID-II screener exhibited very similar patterns of external correlations. Additionally, results indicated that the genetic and environmental influences on MBPD overlap with the genetic and environmental influences on the SCID-II screener, which suggests that these scales are measuring the same construct. These data provide further evidence for the construct validity of the MBPD. PMID:24364505
Carpenter, Ryan W.; Trull, Timothy J.
Following Linehan’s biosocial model, we conceptualize emotion dysregulation in borderline personality disorder (BPD) as consisting of four components: emotion sensitivity, heightened and labile negative affect, a deficit of appropriate regulation strategies, and a surplus of maladaptive regulation strategies. We review the evidence supporting each of these components. Given the complexity of the construct of emotion dysregulation and its involvement in many disorders, there is a need for rese...
Self-identity is disrupted in people with borderline personality disorder (BPD) and depersonalization disorder (DPD), fluctuating with sudden shifts in affect in BPD and experienced as detached in DPD. Measures of implicit self-esteem, free from conscious control and presentation biases, may highlight how such disruptions of self-concept differentially affect these two populations on an unconscious level. We examined implicit self-esteem using the Implicit Association Test, along with measure...
van Dijke, A.; Ford, J.D.; Van der Hart, O.; Van Son, M.J.M.; Van der Heijden, P.G.M.; Buerhing, M.
Disorders of Extreme Stress Not Otherwise Specified (DESNOS), also known as Complex posttraumatic stress disorder, was assessed in a sample (N = 472) of adult psychiatric patients with confirmed diagnoses of Borderline Personality Disorder (BPD), Somatoform Disorders (SoD), comorbid BPD + SoD, or Af
Elzy, Meredith B.
The relationship between childhood sexual abuse and borderline personality disorder is a prominent issue in the etiological research on borderline personality disorder. This study further explored the relationship between childhood sexual abuse and the development of borderline personality features while evaluating the moderating role of a primary…
Borderline personality disorder is a serious mental health problem for which one of its main characteristics is significant difficulties in relationships with others. These relational problems have the unfortunate consequence of fostering negative attitudes among mental health professionals and contributing to the stigmatization of people suffering from this disorder. In this article, the author emphasizes the importance of taking into account the parameter of the therapeutic frame within which the feeling of facing a stalemate in the treatment of borderline personality disorder patients occurs. Six general strategies are presented that enable the therapist to limit or hinder the risk of stalemate in treatment. This article then presents the commonalities between treatments teams that tend to feel comfortable and efficacious in their management of borderline personality disorder patients. Finally, a case history is used to illustrate how some stalemates can in fact be seen as opportunities for growth for both the patient and the therapist. In order to avoid the vicious circle of negative interactions with patients already hypersensitive to inconsistencies and rejection, the author concludes by insisting on the necessity that more mental health professional have access to training programs and workshops specifically addressing how to better manage and treat people with BPD. PMID:21761087
von Wild, T; Namdar, T; Stollwerck, P L; Mailänder, P; Siemers, F
Self-mutilations are one of the major characteristics of patients with borderline personality disorder (BPD). Thermal injuries of BPD should be treated by a plastic surgeon who is faced to a challenge in the plastic-reconstructive strategy because of the most complex psychiatric disease. This means the need of a multidisciplinary strategy. Based on 3 case reports such conflict between best plastic reconstructive treatment of the burns wound and the psychiatric limit with the appropriate therapy options are presented. PMID:21863546
Fleischer, Monika; Schafer, Michael; Coogan, Andrew; Hassler, Frank; Thome, Johannes
Borderline personality disorder (BPD) is characterised by a deep-reaching pattern of affective instability, incoherent identity, self-injury, suicide attempts, and disturbed interpersonal relations and lifestyle. The daily activities of BPD patients are often chaotic and disorganized, with patients often staying up late while sleeping during the day. These behavioural patterns suggest that altered circadian rhythms may be associated with BPD. Furthermore, BPD patients ...
Michael H. Stone
There are currently three major psychotherapeutic approaches to the management of borderline personality disorder (BPD): the psychodynamic, the cognitive-behavioral, and the supportive. There are special varieties within each: e.g., transference-focused psychotherapy (psychodynamic) or dialectic behavioral therapy (cognitive-behavioral). Though differing in basic conceptions and in methodology, all approaches aim at the amelioration of both the symptom-aspects that dominate the...
Ford, Julian D.; Courtois, Christine A
Complex PTSD (cPTSD) was formulated to include, in addition to the core PTSD symptoms, dysregulation in three psychobiological areas: (1) emotion processing, (2) self-organization (including bodily integrity), and (3) relational security. The overlap of diagnostic criteria for cPTSD and borderline personality disorder (BPD) raises questions about the scientific integrity and clinical utility of the cPTSD construct/diagnosis, as well as opportunities to achieve an increasingly nuanced understa...
Brettschneider, Christian; Riedel-Heller, Steffi; König, Hans-Helmut
Purpose The borderline personality disorder is a common mental disorder. It is frequently associated with various mental co-morbidities and a fundamental loss of functioning. The borderline personality disorder causes high costs to society. The aim of this study was to perform a systematic literature review of existing economic evaluations of treatments for borderline personality disorder. Materials and Methods We performed a systematic literature search in MEDLINE, EMBASE, PsycINFO and NHSEE...
Distel, Marijn A.; Irene Rebollo-Mesa; Gonneke Willemsen; Derom, Catherine A.; Trull, Timothy J.; Martin, Nicholas G; Boomsma, Dorret I.
Borderline personality disorder is a severe personality disorder for which genetic research has been limited to family studies and classical twin studies. These studies indicate that genetic effects explain 35 to 45% of the variance in borderline personality disorder and borderline personality features. However, effects of non-additive (dominance) genetic factors, non-random mating and cultural transmission have generally not been explored. In the present study an extended twin-family design ...
Ebner-Priemer, Ulrich W; Welch, Stacy S; Grossman, Paul; Reisch, Thomas; Linehan, Marsha M; Bohus, Martin
Many experts now believe that pervasive problems in affect regulation constitute the central area of dysfunction in borderline personality disorder (BPD). However, data is sparse and inconclusive. We hypothesized that patients with BPD, in contrast to healthy gender and nationality-matched controls, show a higher frequency and intensity of self-reported emotions, altered physiological indices of emotions, more complex emotions and greater problems in identifying specific emotions. We took a 24-hour psychophysiological ambulatory monitoring approach to investigate affect regulation during everyday life in 50 patients with BPD and in 50 healthy controls. To provide a typical and unmanipulated sample, we included only patients who were currently in treatment and did not alter their medication schedule. BPD patients reported more negative emotions, fewer positive emotions, and a greater intensity of negative emotions. A subgroup of non-medicated BPD patients manifested higher values of additional heart rate. Additional heart rate is that part of a heart rate increase that does not directly result from metabolic activity, and is used as an indicator of emotional reactivity. Borderline participants were more likely to report the concurrent presence of more than one emotion, and those patients who just started treatment in particular had greater problems in identifying specific emotions. Our findings during naturalistic ambulatory assessment support emotional dysregulation in BPD as defined by the biosocial theory of [Linehan, M.M., 1993. Cognitive-Behavioral Treatment of Borderline Personality Disorder. The Guildford Press, New York.] and suggest the potential utility for evaluating treatment outcome. PMID:17321599
Bateman, Anthony; Fonagy, Peter
Mentalizing is the process by which we make sense of each other and ourselves, implicitly and explicitly, in terms of subjective states and mental processes. It is a profoundly social construct in the sense that we are attentive to the mental states of those we are with, physically or psychologically. Given the generality of this definition, most mental disorders will inevitably involve some difficulties with mentalization, but it is the application of the concept to the tre...
Zanarini, Mary C.; Barison, Leah K.; Frankenburg, Frances R.; Reich, D. Bradford; Hudson, James I
The purpose of this study was to assess the familial coaggregation of borderline personality disorder (BPD) with a full array of axis I disorders and four axis II disorders (antisocial personality disorder, histrionic personality disorder, narcissistic personality disorder, and sadistic personality disorder) in the first-degree relatives of borderline probands and axis II comparison subjects. Four hundred and forty-five inpatients were interviewed about familial psychopathology using the Revi...
This article describes a conceptual framework for describing borderline personality disorder (BPD) based on empirical studies of the phenotypic structure and genetic architecture of personality. The proposed phenotype has 2 components: (1) a description of core self and interpersonal pathology-the defining features of personality disorder-as these features are expressed in the disorder; and (2) a set of traits based on the anxious-dependent or emotional dysregulation factor of the four-factor model of PD. Four kinds of traits are described: emotional (anxiousness, emotional reactivity, emotional intensity, and pessimistic-anhedonia), interpersonal (submissiveness, insecure attachment, social apprehensiveness, and need for approval), cognitive (cognitive dysregulation), and self-harm (behaviors and ideas). Formulation of the phenotype was guided by the conceptualization of personality as a system of interrelated sub-systems. The psychopathology associated with BPD involves most components of the system. The trait structure of the disorder is assumed to reflect the genetic architecture of personality and individual traits are assumed to be based on adaptive mechanisms. It is suggested that borderline traits are organized around the trait of anxiousness and that an important feature of BPD is dysregulation of the threat management system leading to pervasive fearfulness and unstable emotions. The interpersonal traits are assumed to be heritable characteristics that evolved to deal with interpersonal threats that arose as a result of social living. The potential for unstable and conflicted interpersonal relationships that is inherent to the disorder is assumed to result from the interplay between the adaptive structure of personality and psychosocial adversity. The etiology of the disorder is discussed in terms of biological and environmental factors associated with each component of the phenotype. PMID:18312122
Sansone, Randy A.; Sansone, Lori A.
Borderline personality disorder is a complex psychiatric syndrome that is characterized by a number of pathological interpersonal and behavioral symptoms. Because of these symptoms, individuals with borderline personality disorder tend to have difficulties in their relationships with others, including mental health clinicians. Through a literature review, we examined the perceptions and reactions of mental health clinicians toward patients with borderline personality disorder. Our findings in...
Schienle, Anne; Haas-Krammer, Alexandra; Schöggl, Helmut; Kapfhammer, Hans-Peter; Ille, Rottraut
Clinical experience suggests that the emotion disgust plays an important role in borderline personality disorder (BPD). We investigated 30 female patients with BPD and 30 healthy women who answered different measures of trait disgust, specifically disgust proneness, disgust sensitivity, and self-disgust. Moreover, all participants rated affective facial expressions as well as affective scenes according to perceived or elicited basic emotions. The patients with BPD reported elevated trait disgust, especially for the area of self-disgust. They also rated facial expressions of disgust as more intense than did the healthy women but only when the person who displayed this emotion was male. This sex-specific disgust bias was independent of depression and experienced sexual/physical abuse in the clinical group. Altogether, the patients with BPD showed a broad spectrum of altered disgust processes, which was positively correlated with disorder severity. Consequently, the assessment of disgust reactivity should be introduced as a diagnostic tool for this disorder. PMID:23364118
Full Text Available According to popular opinions therapeutic relationship in cognitive-behavioral therapy is not equally important as techniques. It is often assumed that cognitive therapists view relationship with a patient only as a prerequisite to change, that this relationship doesn't lead to change by itself and that they overlook important emotions between patient and therapist. Contrary to these opinions some streams of CBT to a large extent make use of therapeutic relationship. In this paper the Schema Therapy of Jeffrey Young (Young's Schema Therapy – YST in work with borderline personality disorder is presented. Young assumes, that borderline personality disorder developes, when a person with a reactive temperament in maladaptive ways deals with emotions and unfulfilled needs. The aim of therapy is showing patients another patterns of thinking, behaving and treating their own needs. Therapist uses a method of a limited parenting, trying to engage therapeutic relationship in a process of change. YST therapist should be flexible and responsive to emotional shifts in a patient during the session and work differently with different schema modes. Limits setting also has a curing function. During supervision schemas of a therapist are discussed and their influence on the therapy process.
Hobson, R. P.; Patrick, M; Crandell, L.; Garcia-Perez, R.; Lee, A.
The principal aim of this study was to assess personal relatedness and attachment patterns in 12-month-old infants of mothers with borderline personality disorder (BPD). We also evaluated maternal intrusive insensitivity toward the infants in semistructured play. We videotaped 10 mother-infant dyads with borderline mothers and 22 dyads where the mothers were free from psychopathology, in three different settings: a modification of Winnicott's Set Situation in which infants faced an initially ...
Brand, Bethany L; Lanius, Ruth A
Emotion dysregulation is a core feature of chronic complex dissociative disorders (DD), as it is for borderline personality disorder (BPD). Chronic complex DD include dissociative identity disorder (DID) and the most common form of dissociative disorder not otherwise specified (DDNOS, type 1), now known as Other Specified Dissociative Disorders (OSDD, type 1). BPD is a common comorbid disorder with DD, although preliminary research indicates the disorders have some distinguishing features as well as considerable overlap. This article focuses on the epidemiology, clinical presentation, psychological profile, treatment, and neurobiology of chronic complex DD with emphasis placed on the role of emotion dysregulation in each of these areas. Trauma experts conceptualize borderline symptoms as often being trauma based, as are chronic complex DD. We review the preliminary research that compares DD to BPD in the hopes that this will stimulate additional comparative research. PMID:26401297
Larivière, Nadine; Couture, Élise; Blackburn, Catherine; Carbonneau, Manon; Lacombe, Christophe; Schinck, Shella-Ann; David, Pierre; St-Cyr-Tribble, Denise
Studies examining recovery through the service users' perspectives have mainly included persons with schizophrenia or bipolar disorder. Giving voice to those with borderline personality disorder (BPD) would enrich our understanding of recovery, as their specific experiences may bring new dimensions, obstacles and facilitators. The objective of this study was to qualitatively capture the experience of recovery in women with BPD. Participants were women between 18 and 65 years old who had a diagnosis of BPD and completed at least 2 years in a program for persons with BPD. During the first meeting, they produced a picture collage, followed by an interview on their experience of recovery. The second meeting was a phone interview to discuss new thoughts. In addition, their medical records were reviewed. A thematic analysis of the interviews was conducted and organized with the Person-Environment-Occupation model. Although recovery was not the best term to name their experience, they all talked about a process towards stability and wellbeing (n = 12). Dimensions of recovery included, for example, letting go of the past (person), being involved in meaningful activities (occupation) and having healthy relationships (environment). Facilitators included social support and participation in a specialized therapy program. The main obstacle was unstable family relationships. The findings from this study showed similar dimensions to previous recovery studies, new perspectives on certain dimensions, as well as new ones. They also reinforced the importance to incorporate intervention outcomes that target the person with BPD, their social environment and meaningful occupations. PMID:25736797
Berenson, Kathy R.; Downey, Geraldine; Rafaeli, Eshkol; Coifman, Karin; Leventhal, Nina
Though longstanding clinical observation reflected in the DSM-IV suggests that the rage characteristic of borderline personality disorder (BPD) often appears in response to perceived rejection, the role of perceived rejection in triggering rage in BPD has never been empirically tested. Extending basic personality research on rejection sensitivity to a clinical sample, a priming-pronunciation experiment and a 21-day experience-sampling diary examined the contingent relationship between perceived rejection and rage in participants diagnosed with BPD compared to healthy controls. Despite the differences in these two assessment methods, the indices of rejection-contingent rage that they produced were both elevated in the BPD group, and were strongly interrelated. They provide corroborating evidence that reactions to perceived rejection significantly explain the rage seen in BPD. PMID:21500875
Sharma, Binali; Dunlop, Boadie W.; Ninan, Philip T.; Bradley, Rebekah
Objective: The authors describe the use of dialectical behavior therapy (DBT) in treating borderline personality disorder during psychiatry residency, and assess the status of DBT education within psychiatry residencies in the United States. Method: The authors present a patient with borderline personality disorder treated by a resident using DBT,…
Bateman, Anthony; Fonagy, Peter
Mentalization is the process by which we implicitly and explicitly interpret the actions of ourselves and others as meaningful based on intentional mental states (e.g., desires, needs, feelings, beliefs, and reasons). This process is disrupted in individuals with comorbid antisocial (ASPD) and borderline personality disorder (BPD), who tend to misinterpret others' motives. Antisocial characteristics stabilize mentalizing by rigidifying relationships within prementalistic ways of functioning. However, loss of flexibility makes the person vulnerable to sudden collapse when the schematic representation is challenged. This exposes feelings of humiliation, which can only be avoided by violence and control of the other person. The common path to violence is via a momentary inhibition of the capacity for mentalization. In this article, the authors outline their current understanding of mentalizing and its relation to antisocial characteristics and violence. This is illustrated by a clinical account of mentalization-based treatment adapted for antisocial personality disorder. Treatment combines group and individual therapy. The focus is on helping patients maintain mentalizing about their own mental states when their personal integrity is challenged. A patient with ASPD does not have mental pain associated with another's state of mind; thus, to generate conflict in ASPD by thinking about the victim will typically be ineffective in inducing behavior change. PMID:20795523
Bateman, Anthony; Fonagy, Peter
Mentalization is the process by which we implicitly and explicitly interpret the actions of ourselves and others as meaningful based on intentional mental states (e.g., desires, needs, feelings, beliefs, and reasons). This process is disrupted in individuals with comorbid antisocial (ASPD) and borderline personality disorder (BPD), who tend to misinterpret others' motives. Antisocial characteristics stabilize mentalizing by rigidifying relationships within prementalistic ways of functioning. However, loss of flexibility makes the person vulnerable to sudden collapse when the schematic representation is challenged. This exposes feelings of humiliation, which can only be avoided by violence and control of the other person. The common path to violence is via a momentary inhibition of the capacity for mentalization. In this article, the authors outline their current understanding of mentalizing and its relation to antisocial characteristics and violence. This is illustrated by a clinical account of mentalization-based treatment adapted for antisocial personality disorder. Treatment combines group and individual therapy. The focus is on helping patients maintain mentalizing about their own mental states when their personal integrity is challenged. A patient with ASPD does not have mental pain associated with another's state of mind; thus, to generate conflict in ASPD by thinking about the victim will typically be ineffective in inducing behavior change. PMID:18186112
Sansone, Randy A.; J David Sinclair; Wiederman, Michael W.
BACKGROUND AND OBJECTIVE: Few studies have examined the relationship between disability and borderline personality symptomatology, and, among those that have, findings have been inconsistent. In the present study, the relationship between medical disability and borderline personality symptomatology was examined in a sample of chronic pain patients.METHODS: In a consecutive insured sample of male and female chronic pain patients (n=117), who were being initially evaluated by an outpatient pain...
Jackiewicz, Martyna; Marcinów, Mira
This article describes history of borderline personality disorder from the antiquity to the present. The authors begin their discussion with the presentation of the changes in the method of diagnosis of personality disorders, including the borderline personality disorder. These changes are caused by the introduction of the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The purpose of this paper is to present conceptions that could be called precursory in relat...
Brendel, Gary R; Stern, Emily; Silbersweig, David A
Functional neuroimaging recently has been used to localize brain dysfunction in borderline personality disorder (BPD). Initial studies have examined baseline activity or emotional reactivity, and our group has investigated what we consider to be a crucial interaction between negative emotion and behavioral (dys)control. This research is beginning to identify abnormal frontolimbic circuitry likely underlying core clinical features of this condition. We review the evidence for dysfunction in specific frontolimbic regions, leading to a mechanistic model of symptom formation in BPD. In addition, we offer an integration of these neuroimaging findings with developmental perspectives on the emergence of borderline psychopathology, focusing on the ways in which early psychosocial experience may interact with developing brain systems. We also consider possible mechanisms of psychotherapeutic change at the neural systems level in BPD. Finally, we propose that future neuroimaging studies of BPD should integrate multiple levels of observation (structural, functional, neurochemical, genetic, and clinical) in a model-driven fashion to further understand the dynamic relationship between biological and psychological factors in the development and treatment of this difficult condition. PMID:16613437
Amamou, Badii; Salah, Walid Bel Hadj; Mhalla, Ahmed; Benzarti, Nejla; Elloumi, Hend; Zaafrane, Ferid; Gaha, Lotfi
Patients with borderline personality disorder (BPD) show significant impairment in functioning, particularly in the interpersonal and social domains. Prior reports suggest that clozapine may be effective in the management of BPD. We present the case of a patient with BPD who experienced persistent suicidal ideation and was treated with clozapine at a state psychiatric hospital. After treatment failure with other psychotropic medications, clozapine medication was initiated; not only did suicidal ideation cease, but social and professional functioning also greatly improved to the point of no longer requiring intensive levels of observation or restrictive procedures. Clozapine appears to be efficacious in the management of suicide attempts and self-injurious behavior. Moreover, it appears to be promising as a therapeutic measure for ameliorating the global functioning of patients with severe BPD. Larger, randomized, blinded, and controlled prospective studies are needed to confirm these findings and to determine optimal dosage. PMID:27121437
Sauer, Shannon E; Baer, Ruth A
The current study examined relationships among childhood emotional vulnerability, an invalidating childhood environment, thought suppression, and symptoms of borderline personality disorder (BPD). Emotional vulnerability and an invalidating childhood environment are described by Linehan (1993) as important biosocial precursors to the development of BPD. Using a student sample selected to have a wide range of BPD symptoms, we examined whether thought suppression mediates the relationship between these biosocial precursors and symptoms of BPD. Results supported the hypothesis that thought suppression fully mediates the relationship between invalidating environment and BPD symptoms. Mixed support was found for the hypothesis that thought suppression mediates the relationship between emotional vulnerability and BPD symptoms. We also examined whether fear of emotions mediates the relationship between the biosocial precursors and thought suppression. Results supported this hypothesis, and also suggested that fear of emotion contributes independently to mediating the relationship between biosocial precursors and BPD symptoms. PMID:19267661
Ripoll, Luis H; Snyder, Rebekah; Steele, Howard; Siever, Larry J
We present a neurobiological model of empathic dysfunction in borderline personality disorder (BPD) to guide future empirical research. Empathy is a necessary component of interpersonal functioning, involving two distinct, parallel neural networks. One form of empathic processing relies on shared representations (SR) of others' mental states, while the other is associated with explicit mental state attribution (MSA). SR processing is visceral and automatic, contributing to attunement, but also emotional contagion. MSA processing contributes to deliberate, perspectival forms of empathic understanding. Empathic dysfunction in BPD may involve hyper-reactivity of SR networks and impairment of MSA networks. Nevertheless, this empathic dysfunction is subtle, but contributes to interpersonal difficulties. Interaction between genetic factors and traumatic attachment stressors may contribute to development of BPD, with painful attachment insecurity and disorganization affecting SR and MSA network functioning. Future avenues for BPD research will include developmental assessment of attachment and neurobiological functioning under varying conditions. PMID:23389774
Rosenthal, M Zachary; Ahn, Roianne; Geiger, Paul J
Individuals with borderline personality disorder (BPD) are widely considered to have problems with emotional reactivity. However, the specific kinds of stimuli that are associated with heightened emotional reactivity in BPD have not been well characterized. Thus, it is unclear whether the emotional dysfunction in BPD occurs in response to any emotionally evocative stimuli, or to specific classes of stimuli. In this study, we used subjective measures (self-report and interview-based) to compare reactivity to sensations (auditory, gustatory, olfactory, tactile, visual) between participants with BPD (n = 30) and healthy controls (n = 50). Controlling for trait negative emotional reactivity, individuals with BPD reported being significantly more reactive across sensory stimuli. However, the difference between controls and BPD was significantly greater for reactivity to auditory stimuli compared to other sensory stimuli. Findings from this study provide preliminary data suggesting individuals with BPD may be characterized by heightened self-reported reactivity to aversive sounds. PMID:22023306
Sharp, Carla; Kalpakci, Allison
The current special issue focuses on the potential of mentalizing as a translational construct for the understanding and treatment of borderline personality disorder (BPD). Mentalizing, which provides the central construct around which mentalization-based therapy (MBT) and theory is organized, refers to the capacity to meaningfully reflect on the mind of others as well as the self. In this introductory article to the special issue, we begin by discussing the need for and nature of translational research. We contend that translational research in mental health and personality disorder, in particular, lags behind that of other medical disorders because of the challenges inherent in meeting translational criteria. We discuss these criteria and we demonstrate the potential of the construct of mentalizing to meet translational criteria in the context of BPD. This article thereby provides the context for the other 3 papers in this special issue which each represent a different point along the translational spectrum. In all, our aim is to provide a foundation for the further evaluation of the usefulness and potential of mentalizing as translational construct in the context of BPD. PMID:26436578
Examination of 115 women with eating disorders revealed a secondary diagnosis of borderline personality disorder associated with a history of childhood sexual abuse. A model involving background features, precipitants, and immediate and long-term psychological consequences is suggested to explain the link to childhood abuse, and implications for…
Full Text Available This article describes history of borderline personality disorder from the antiquity to the present. The authors begin their discussion with the presentation of the changes in the method of diagnosis of personality disorders, including the borderline personality disorder. These changes are caused by the introduction of the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5. The purpose of this paper is to present conceptions that could be called precursory in relation to current understanding of borderline disorder. The authors refer to psychoanalytic theories, on the basis of which the term “borderline” came into being and to an alternative approach designed to highlight the main features and symptoms of borderline disorder. They also refer to descriptions of borderline personality disorder contained in Polish literature. At the end they show the main, modern approaches to the issue of borderline personality disorder and return to the topic signalized in the introduction talking about changes in the method of diagnosis of borderline personality disorder in DSM–V together with the criticism of this conceptualization.
Full Text Available Background: Attention Deficit Hyperactivity Disorder (ADHD is a risk factor for Borderline Personality Disorder (BPD during adulthood. Studying the relationship between childhood ADHD disorder symptoms and depression and borderline personality disorder symptoms among students was the main aim of this study. Materials and Methods: A total of 291 students, who were studying in Shiraz and Tabriz universities inThe academic year of 2010-2011, were selected from three groups of Humanities, Basic Sciences, and Technical-Engineering Sciences using simple sampling method. They participated in the study through completing Wender Utah Rating Scale (WURS, Borderline Personality Scale (STB and Beck Depression Inventory (BDI-II. Pearsons correlation coefficient and multiple regression analysis were used to analyze the data. Results: The results showed that there is a significant positive relationship between childhood ADHD and borderline Personality Disorder (BPD in adulthood and childhood ADHD is able to predict BPD in adulthood (p<0.01. Similarly, the relationship between symptoms of childhood ADHD and depression was positive and significant (p<0.01. Conclusion: There is a relationship between symptoms of childhood ADHD, BPD and depression in students. It is recommended to pay due attention to the comorbidity disorders such as BPD and depression in the treatment of ADHD disorder.
Hidalgo-Mazzei, Diego; Walsh, Emily; Rosenstein, Lia; Zimmerman, Mark
Bipolar disorder (BD) and borderline personality disorder (BPD) are disabling and life-threatening conditions. Both disorders share relevant comorbidities, particularly the risk of having a lifetime substance use disorder (SUD). We tested the hypothesis that patients with both BD type I (BDI) or II (BDII) and BPD would have a higher rate of SUD than would patients with either disorder alone. A total of 3651 psychiatric patients were evaluated with semistructured diagnostic interviews for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, axis I and II disorders. A total of 63 patients were diagnosed with both BD and BPD, and these patients were significantly more likely to have a SUD compared with BDII patients without BPD (76% vs. 50%, χ = 9.69, p disorders increased the risk of having a SUD especially when compared with BDII alone. PMID:25494335
Kerr, Ian B; Finlayson-Short, Laura; McCutcheon, Louise K; Beard, Hilary; Chanen, Andrew M
Some concept of self has been used by many, although not all, researchers and clinicians as an 'organising construct' for borderline personality disorder (BPD). There is considerable variation in this usage and how clearly researchers have defined the self. Given this diversity, and that 'self' is often used interchangeably with parallel concepts (e.g., psyche, brain-mind, 'person') or with features of self (e.g., self-awareness, identity), unqualified use of the term is problematic. This is further complicated by the heterogeneity and 'comorbidity' of BPD and the limitations of syndromally based psychiatric nosology. Still, BPD remains in current classification systems and can be reliably diagnosed. A considerable body of research on self and BPD has accrued, including a recent profusion and confluence of neuroscientific and sociopsychological findings. These have generated supporting evidence for a supra-ordinate, functionally constituted entity of the self ranging over multiple, interacting levels from an unconscious, 'core' self, through to a reflective, phenotypic, 'idiographic' and relational self constituted by interpersonal and sociocultural experience. Important insights have been generated regarding emotional and social-cognitive dysregulation, disorder of self-awareness, relationality, identity, and coherence and continuity of the self. Many of these are shared by various trauma-related, dissociative disorders. A construct of the self could be useful as an explanatory principle in BPD, which could be construed as a 'self-state' (and relational) disorder, as opposed to a less severe disorder of aspects of the self (e.g., mood or memory). We offer a tentative description of 'Self' in this context, noting that any such construct will require a clear definition and to be evaluable. PMID:26346462
O'Neill, Aisling; Frodl, Thomas
The spotlight on borderline personality disorder (BPD) has been growing in recent years, with the number of papers discussing potential causes and triggers of the disorder rapidly on the increase. Also on the increase, though still lacking sufficient numbers to produce well-supported hypotheses, are studies employing neuroimaging techniques as investigative tools in BPD. In this review, we investigate the current state and findings of neuroimaging studies in BPD, focusing in particular, on the studies examining structural, functional, and neurometabolic abnormalities in the disorder. Some suspected trends in the data are highlighted, including reductions in the hippocampi and amygdalae of BPD patients compared to healthy controls, exaggerated amygdala activity in BPD patients when confronted with emotion-related stimulus, and negative correlations between increases in left amygdalar creatine and reductions in amygdalar volume, reductions in absolute N-acetylaspartate concentration in the dorsolateral prefrontal cortex of BPD patients, and increases in glutamate concentration in the anterior cingulate cortices of BPD patients. We also discuss the limitations of some of the current studies including hindrances due to sample effects and techniques used and the potential of future neuroimaging research in BPD. PMID:22252376
Fritzsche, Klaus H.; Brunner, Romuald; Henze, Romy; Meinzer, Hans-Peter; Stieltjes, Bram
As with other mental disorders, the causes of borderline personality disorder (BPD) are complex and not fully understood. In this study we aimed to determine whether adults with BPD exhibit microstructural abnormalities using diffusion tensor imaging (DTI). 56 female right-handed individuals (age range, 14-18 years), 19 with a DSM-IV diagnosis of BPD, 18 patients with a DSM-IV defined current psychiatric disorder and 19 healthy control subjects were included. Groups were matched for age and IQ. DTI Images were analyzed using Tract-Based Spatial Statistics (TBSS). The analysis revealed significanty reduced fractional anisotropy (FA) values in the group of BPD patients compared to the normal controls. Similar FA reductions could not be found comparing BPD patients to clinical controls. Several clusters of increased radial (DR), axial (DA), and mean (MD) diffusivity were consistently identified when comparing the BPD patients to clinical as well as to healthy controls. None of the measures showed significant differences between the clinical and healthy controls. Diverse possible factors have been suggested to play a role in the disease, including environmental factors, neurobiological factors, or brain abnormalities. The presented results may play an important role in this ongoing debate.
Armbrust, Michael; Ehrig, Christian
The emotionally instable personality disorder, mostly called borderline disorder, shows central abnormalities in impulse control as well as instability of mood and identity. It is composed of behaviour problems in creating relationships and in self-management, first of all by high psychophysiological tension. The prevalence of this disorder is 10 % in outpatients and 20 % in inpatients and has therefore high relevance for the medical-psychotherapeutic care system. The treatment is deemed to be complex and interminable. Regarding all evaluated techniques of treatment the best examined is the Dialectical Behavioral Therapy (DBT). This specific therapy, developed in the eighties by Marsha M. Linehan, can be used for inpatient and outpatient treatment and combines single and group sessions. It is essential in mental health care of this disorder, but not available everywhere. Essential part of DBT is the skill training, a specific technique for the acquirement and for exercising skills for mindfulness, modulation of tension, regulation of emotions, structuring of social competence and developing self value. The central goal of DBT is to ensure the survival of the patients, to reduce self- and external aggressive behaviour and to provide inpatient crisis interventions. For sustained crisis management skills for reality acceptance are best fitting. But before, fast available sensory and active body-related skills should be used. Radical acceptance is the most important, since most effective, skill. The skills training, although in use for only twenty years, is permanently expanding in practice and is meanwhile also used for other disorders such as, for example, PTSD or ADHD. Since 2010, there also exists an elaborated DBT-version for adolescents. For medical care politics and health-economic reasons a supply with skills training for in- and outpatients all over the country is desirable. PMID:27388871
Kreisel, Stefan Henner; Labudda, Kirsten; Kurlandchikov, Oleg; Beblo, Thomas; Mertens, Markus; Thomas, Christine; Rullkötter, Nina; Wingenfeld, Katja; Mensebach, Christoph; Woermann, Friedrich G; Driessen, Martin
Borderline personality disorder (BPD) may be associated with smaller hippocampi in comparison to hippocampal size in controls. However, specific pathology in hippocampal substructures (i.e., head, body and tail) has not been sufficiently investigated. To address hippocampal structure in greater detail, we studied 39 psychiatric inpatients and outpatients with a DSM-IV diagnosis of BPD and 39 healthy controls. The hippocampus and its substructures were segmented manually on magnetic resonance imaging scans. The volumes of hippocampal substructures (and total hippocampal volume) did not differ between BPD patients and controls. Exploratory analysis suggests that patients with a lifetime history of posttraumatic stress disorder (PTSD) may have a significantly smaller hippocampus - affecting both the hippocampal head and body - in comparison to BPD patients without comorbid PTSD (difference in total hippocampal volume: -10.5%, 95%CI -2.6 to -18.5, significant). Also, patients fulfilling seven or more DSM-IV BPD criteria showed a hippocampal volume reduction, limited to the hippocampal head (difference in volume of the hippocampal head: -16.5%, 95%CI -6.1 to -26.8, significant). Disease heterogeneity in respect to, for example, symptom severity and psychiatric comorbidities may limit direct comparability between studies; the results presented here may reflect hippocampal volumes in patients who are "less" affected or they may simply be a chance finding. However, there is also the possibility that global effects of BPD on the hippocampus may have previously been overestimated. PMID:25624067
Full Text Available Self-identity is disrupted in people with borderline personality disorder (BPD and depersonalization disorder (DPD, fluctuating with sudden shifts in affect in BPD and experienced as detached in DPD. Measures of implicit self-esteem, free from conscious control and presentation biases, may highlight how such disruptions of self-concept differentially affect these two populations on an unconscious level. We examined implicit self-esteem using the Implicit Association Test, along with measures of emotion, behavior, and temperament, in BPD (n=18, DPD (n=18, and healthy control (n=35 participants. DPD participants had significantly higher implicit self-esteem and were more harm avoidant than BPD and control participants, while BPD participants had more ‘frontal’ behaviors and impulsivity and less self-directedness and cooperativeness than DPD and control participants. Thus, while BPD and DPD commonly overlap in terms of dissociative symptoms and emotional irregularities, differences in self-esteem, behavior, and temperament can help identify where they diverge in terms of their cognition, behavior, and ultimately underlying neurobiology.
Mancke, Falk; Herpertz, Sabine C; Bertsch, Katja
This article proposes a multidimensional model of aggression in borderline personality disorder (BPD) from the perspective of the biobehavioral dimensions of affective dysregulation, impulsivity, threat hypersensitivity, and empathic functioning. It summarizes data from studies that investigated these biobehavioral dimensions using self-reports, behavioral tasks, neuroimaging, neurochemistry as well as psychophysiology, and identifies the following alterations: (a) affective dysregulation associated with prefrontal-limbic imbalance, enhanced heart rate reactivity, skin conductance, and startle response; (b) impulsivity also associated with prefrontal-limbic imbalance, central serotonergic dysfunction, more electroencephalographic slow wave activity, and reduced P300 amplitude in a 2-tone discrimination task; (c) threat hypersensitivity associated with enhanced perception of anger in ambiguous facial expressions, greater speed and number of reflexive eye movements to angry eyes (shown to be compensated by exogenous oxytocin), enhanced P100 amplitude in response to blends of happy versus angry facial expressions, and prefrontal-limbic imbalance; (d) reduced cognitive empathy associated with reduced activity in the superior temporal sulcus/gyrus and preliminary findings of lower oxytocinergic and higher vasopressinergic activity; and (e) reduced self-other differentiation associated with greater emotional simulation and hyperactivation of the somatosensory cortex. These biobehavioral dimensions can be nicely linked to conceptual terms of the alternative Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) model of BPD, and thus to a multidimensional rather than a traditional categorical approach. PMID:26191822
Fleischer, Monika; Schäfer, Michael; Coogan, Andrew; Häßler, Frank; Thome, Johannes
Borderline personality disorder (BPD) is characterised by a deep-reaching pattern of affective instability, incoherent identity, self-injury, suicide attempts, and disturbed interpersonal relations and lifestyle. The daily activities of BPD patients are often chaotic and disorganized, with patients often staying up late while sleeping during the day. These behavioural patterns suggest that altered circadian rhythms may be associated with BPD. Furthermore, BPD patients frequently report suffering from sleep disturbances. In this review, we overview the evidence that circadian rhythms and sleep are disturbed in BPD, and we explore the possibility that personality traits that are pertinent for BPD may be associated with circadian typology, and perhaps to circadian genotypes. With regards to sleep architecture, we review the evidence that BPD patients display altered non-REM and REM sleep. A possible cue to a deeper understanding of this temporal dysregulation might be an analysis of the circadian clock at the molecular and cellular level, as well as behavioural studies using actigraphy and we suggest avenues for further exploration of these factors. PMID:22806005
This review examined evidence supporting stepped care for borderline personality disorder as an alternative to routine extended treatment. Empirical studies have shown that patients with borderline personality disorder have a heterogeneous course, but symptomatic improvement can sometimes be relatively rapid. Currently, there is no evidence that any long-term treatment is superior to briefer interventions for borderline personality disorder. Long-term therapy may not be necessary for all patients, and its routine use leads to access problems. A stepped-care model, similar to models applied to other severe mental disorders, might provide a better use of resources. Stepped care can be used to limit the use of expensive programs and reduce waiting lists. Not all patients with borderline personality disorder can be treated briefly, but a stepped-care model allows those with less severe symptoms to be managed with fewer resources, freeing up more time and personnel for the treatment of those who need treatment the most. PMID:23945913
Schuppert, H. Marieke; Timmerman, Marieke E.; Bloo, Josephine; van Gemert, Tonny G.; Wiersema, Herman M.; Minderaa, Ruud B.; Emmelkamp, Paul M. G.; Nauta, Maaike H.
Objective: To evaluate the effectiveness of Emotion Regulation Training (ERT), a 17-session weekly group training for adolescents with borderline personality disorder (BPD) symptoms. Method: One hundred nine adolescents with borderline traits (73% meeting the full criteria for BPD) were randomized to treatment as usual only (TAU) or ERT + TAU.…
Deckers, J.W.; Lobbestael, J.; Wingen, G.A. van; Kessels, R.P.C.; Arntz, A.; Egger, J.I.
BACKGROUND: Borderline personality disorder (BPD) is characterized by severe difficulties in interpersonal relationships and emotional functioning. Theories of BPD suggest that individuals with BPD have heightened emotional sensitivity, increased stress reactivity, and problems in making sense of in
Deckers, J.W.M.; Lobbestael, J.; Wingen, G.A. van; Kessels, R.P.C.; Arntz, A.R.; Egger, J.I.M.
Background Borderline personality disorder (BPD) is characterized by severe difficulties in interpersonal relationships and emotional functioning. Theories of BPD suggest that individuals with BPD have heightened emotional sensitivity, increased stress reactivity, and problems in making sense of int
J.W.M. Deckers; J. Lobbestael; G.A. van Wingen; R.P.C. Kessels; A. Arntz; J.I.M. Egger
Background: Borderline personality disorder (BPD) is characterized by severe difficulties in interpersonal relationships and emotional functioning. Theories of BPD suggest that individuals with BPD have heightened emotional sensitivity, increased stress reactivity, and problems in making sense of in
M.L.M. Hermens; P.T. van Splunteren; A. van den Bosch; R. Verheul
Objective: This study determined the gap between actual care and optimal care (recommended in the clinical guideline) for patients with borderline personality disorder in the Netherlands. Factors that affected guideline implementation were identified. Methods: Ten specialized mental health organizat
Scott, Lori N.; Levy, Kenneth N.; Pincus, Aaron L.
Previous studies have demonstrated that insecure attachment patterns and a trait disposition toward negative affect and impulsivity are both associated with borderline personality disorder (BPD) features. According to attachment theory, insecure attachment patterns impart greater risk for the maladaptive personality traits underlying BPD. Hence, insecure attachment might be indirectly related to BPD through its association with these traits. The current cross-sectional study used structural e...
Renneberg, Babette; Heyn, Katrin; Gebhard, Rita; Bachmann, Silke
Borderline personality disorder (BPD) is characterized by marked problems in interpersonal relationships and emotion regulation. The assumption of emotional hyper-reactivity in BPD is tested regarding the facial expression of emotions, an aspect highly relevant for communication processes and a central feature of emotion regulation. Facial expressions of emotions are examined in a group of 30 female inpatients with BPD, 27 women with major depression and 30 non-patient female controls. Participants were videotaped while watching two short movie sequences, inducing either positive or negative emotions. Frequency of emotional facial expressions and intensity of happiness expressions were examined, using the Emotional Facial Action Coding System (EMFACS-7, Friesen & Ekman, EMFACS-7: Emotional Facial Action Coding System, Version 7. Unpublished manual, 1984). Group differences were analyzed for the negative and the positive mood-induction procedure separately. Results indicate that BPD patients reacted similar to depressed patients with reduced facial expressiveness to both films. The highest emotional facial activity to both films and most intense happiness expressions were displayed by the non-clinical control group. Current findings contradict the assumption of a general hyper-reactivity to emotional stimuli in patients with BPD. PMID:15950175
Chalker, Samantha A; Carmel, Adam; Atkins, David C; Landes, Sara J; Kerbrat, Amanda H; Comtois, Katherine Anne
Few studies have examined effects of challenging behaviors of clients with borderline personality disorder (BPD) on psychotherapy outcomes. Dialectical behavior therapy (DBT) is an evidence-based treatment designed to treat chronic suicidality, self-directed violence (SDV), and emotion dysregulation, while targeting challenging behaviors. DBT has been shown to be effective with clients with BPD. We evaluated whether therapist reported challenging behaviors, such as high volume phone contacts or violating the therapist's limits, during DBT would be associated with dropping out of DBT, severity and frequency of SDV, emotion regulation deficits, psychological symptom severity and client's and therapist's satisfaction of treatment. The current study examined challenging behaviors reported by therapists in a sample of 63 psychiatrically disabled outpatient DBT clients diagnosed with BPD (73% women, average age 37 years). More frequent phone contacts were associated with a decrease in dropout and psychological symptoms, and an increase in client and therapist satisfaction. More avoidance/disengagement behavior was associated with more than twice the risk of SDV and a decrease in therapist satisfaction. Findings suggest that the phone coaching might serve to maximize client satisfaction and reduce the likelihood of dropout. PMID:26496225
Katalin Merza; Gábor Papp; Ildikó Kuritárné Szabó
Background and Objectives: There is a growing body of evidence suggesting the role of childhood abuse in the etiology of borderline personality disorder (BPD). Studies found that complex traumatization related to BPD include emotional/physical/sexual abuse and neglect. This study examines self-reported experiences of childhood traumatization in Hungarian inpatients with a diagnosis of borderline personality disorder and reveal which etiological factors are most strongly associated with the de...
Barnow, Sven; Spitzer, Carsten; Grabe, Hans J.; Kessler, Christoph; Freyberger, Harald J.
Objective: The aim of this study was to examine individual characteristics, familial experience, and psychopathology of children of mothers with borderline personality disorder (BPD). Method: Children of mothers with BPD were compared to children of mothers (1) with depressive disorders, (2) with cluster C personality disorders, and (3) without…
Stone, Michael H
Information concerning the longitudinal course of Borderline Personality Disorder (BPD) derives mainly from (a) long-term (10 to 25 year) retrospective follow-up studies, primarily those conducted during the 1980s/1990s, (b) brief (1 to 3 year) follow-up studies of recent randomized controlled trials (RCTs) of several different treatment approaches, and (c) prospective follow-up studies. The patients contacted in the retrospective studies had been treated mostly by psychoanalytically informed approaches or supportive. Though there was a significant suicide rate of 3 to 9%, about two-thirds of the BPD patients eventually achieved a global assessment score in the 60s or beyond. BPD represents a heterogeneous group of patients, whose outcome is a function of many variables, including personality traits (paranoid and narcissistic conducing to less favorable outcomes), cultural differences, socio-economic level, intelligence level, gender, and age of onset. The RCT studies focused on amelioration of the symptom components of BPD, especially tendencies to self-injury and suicide. The currently favored treatment methods showed in a large percentage of patients, a lessening of these self-destructive behaviors after a year or two of treatment. The time spans were too brief to allow assessment of improvement in key life areas (attainment of self-sufficiency in work, widening of the circle of friends, and success in forming satisfactory intimate partnerships). The prospective studies are based on reassessments at regular intervals of BPD patients and a control group with other personality disorders. Over the past 16 years the BPD patients, compared with controls, were slower to achieve remission, and more apt to show cognitive peculiarities initially-though they showed appreciable improvement over time. The "recovered" BPD patients, compared with the non-recovered patients, showed twice the likelihood of achieving a successful intimate relationship. At 16 years the Mc
Samuel, Douglas B.; Miller, Joshua D.; WIDIGER, THOMAS A; Lynam, Donald R.; Pilkonis, Paul A.; Ball, Samuel A.
The Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 Personality and Personality Disorders Work Group proposed the elimination of diagnostic criterion sets in favor of a prototype matching system that defines personality disorders using narrative descriptions. Although some research supports this general approach, no empirical studies have yet examined the specific definitions proposed for DSM–5. Given the wide interest in borderline personality disorder (BPD), it is crucial to d...
Fertuck, Eric A.; Karan, Esen; Stanley, Barbara
Background Individuals with Borderline Personality Disorder (BPD) may experience a qualitatively distinct depression which includes “mental pain.” Mental pain includes chronic, aversive emotions, negative self-concept, and a sense of pervasive helplessness. The present study investigated whether mental pain is elevated in BPD compared to Depressive Disorders (DD) without BPD. Methods The Orbach and Mikulincer Mental Pain Scale (OMMP) was administered to BPD (N = 57), DD (N = 22), and healthy ...
Glick, Ira D.; DULIT, REBECCA A.; WACHTER, EILEEN; CLARKIN, JOHN F.
The authors review recent controlled studies on the interrelationship of the family and its members with borderline disorder and propose a new model for understanding and managing this relationship. The focus of the model is on psychopathology, evaluation, and treatment of patient and family as they influence each other. In the authors’ view this illness originates in cerebral dysfunction, in the patient in combination with impaired relationships among family members. When t...
Full Text Available Background and Objectives: There is a growing body of evidence suggesting the role of childhood abuse in the etiology of borderline personality disorder (BPD. Studies found that complex traumatization related to BPD include emotional/physical/sexual abuse and neglect. This study examines self-reported experiences of childhood traumatization in Hungarian inpatients with a diagnosis of borderline personality disorder and reveal which etiological factors are most strongly associated with the development of BPD. Methods: Traumatic childhood experiences of 80 borderline inpatients, 73 depressed inpatients and 51 healthy controls were assessed with the Traumatic Antecedents Questionnaire and the Sexual Abuse Scale of Early Trauma Inventory. Results: Adverse childhood experiences (neglect, emotional abuse, physical abuse, sexual abuse, witnessing trauma were more prevalent among borderline patients than among depressed and healthy controls. Borderline patients reported severe sexual abuse, characterized by incest, penetration and repetitive abuse. Sexually abused borderline patients experienced more physical and emotional abuse than borderlines who were not sexually abused. The strongest predictors of borderline diagnosis were sexual abuse, intrafamilial physical abuse and neglect by the caretakers. Conclusions: Overall, our results suggest that a reported childhood history of abuse and neglect are both common and highly discriminating for borderline patients in Hungary as well.
Thome, Janine; Liebke, Lisa; Bungert, Melanie; Schmahl, Christian; Domes, Gregor; Bohus, Martin; Lis, Stefanie
Dysfunctions of social-cognitive processes such as the recognition of emotions have been discussed to contribute to the severe impairments of interpersonal functioning in borderline personality disorder (BPD). By investigating how patients with BPD experience the intensity of different emotions in a facial expression and how confident they are in their own judgments, the current study aimed at identifying subtle alterations of emotion processing in BPD. Female patients with BPD (N = 36) and 36 healthy controls were presented with faces that displayed low-intense anger and happiness or ambiguous expressions of anger and happiness blends. Subjects were asked to rate (a) the intensity of anger and happiness in each facial expression and (b) their confidence in their judgments. Patients with BPD rated the intensity of happiness in happy faces lower than did controls, but did not differ in regard to the assessment of angry or ambiguous facial stimuli or the rating of anger. They reported lower confidence in their judgments, which was particularly pronounced for the assessment of happy facial expressions. The reduced rating of happiness was linked to higher state anger, whereas the reduced confidence in the assessment of happy faces was related to stronger feelings of loneliness and the expectation of social rejection. Our findings suggest alterations in the processing of positive social stimuli that affect both the experience of the emotional intensity and the confidence subjects experience during their assessment. The link to loneliness and social rejection sensitivity points to the necessity to target these alterations in psychotherapeutical interventions. (PsycINFO Database Record PMID:26389624
Schoenleber, Michelle; Berghoff, Christopher R; Tull, Matthew T; DiLillo, David; Messman-Moore, Terri; Gratz, Kim L
Extant research on emotional lability in borderline personality disorder (BPD) has focused almost exclusively on lability of individual emotions or emotion types, with limited research considering how different types of emotions shift together over time. Thus, this study examined the temporal dynamics of emotion in BPD at the level of both individual emotions (i.e., self-conscious emotions [SCE], anger, and anxiety) and mixed emotions (i.e., synchrony between emotions). One hundred forty-four women from the community completed a diagnostic interview and laboratory study involving 5 emotion induction tasks (each of which was preceded and followed by a 5-min resting period or neutral task). State ratings of SCE, anger, and anxiety were provided at 14 time points (before and after each laboratory task and resting period). Hierarchical linear modeling results indicate that women with BPD reported greater mean levels of SCE and Anxiety (but not Anger), and greater lability of Anxiety. Women with BPD also exhibited greater variability in lability of all 3 emotions (suggestive of within-group differences in the relevance of lability to BPD). Results also revealed synchrony (i.e., positive relations) between each possible pair of emotions, regardless of BPD status. Follow-up regression analyses suggest the importance of accounting for lability when examining the role of synchrony in BPD, as the relation of SCE-Anger synchrony to BPD symptom severity was moderated by Anger and SCE lability. Specifically, synchronous changes in SCE and Anger were associated with greater BPD symptom severity when large shifts in SCE were paired with minor shifts in Anger. (PsycINFO Database Record PMID:27362623
Stepp, Stephanie D.
Recognizable symptoms and features of borderline personality disorder (BPD) appear during adolescence. However, there has been resistance to diagnose or research this disorder prior to adulthood because of clinical lore that BPD is a long-standing illness and that personality traits are not stable until adulthood. This has resulted in little…
Nagata, Toshihiko; Yamada, Hisashi; Teo, Alan R.; Yoshimura, Chiho; Kodama, Yuya; van Vliet, Irene
Background Screening scales for bipolar disorder including the Mood Disorder Questionnaire (MDQ) and Bipolar Spectrum Diagnostic Scale (BSDS) have been plagued by high false positive rates confounded by presence of borderline personality disorder. This study examined the accuracy of these scales for detecting bipolar disorder among patients referred for eating disorders and explored the possibility of simultaneous assessment of co-morbid borderline personality disorder. Methods Participants w...
Burke, Jeffrey D.; Stepp, Stephanie D.
Very few studies have prospective information, especially regarding males, on the prediction of Borderline Personality Disorder (BPD) in adulthood from psychiatric disorders in childhood. Certain childhood disorders, however, have notably similar features in common with BPD. In particular, the affective dysfunction, hostility and interpersonal…
LeBoeuf, Amélie; Guilé, Jean-Marc; Labelle, Réal; Luck, David
Borderline personality disorder (BPD) is being increasingly recognized by clinicians working with adolescents, and the reliability and validity of the diagnosis have been established in the adolescent population. Adolescence is known to be a period of high risk for BPD development as most patients identify the onset of their symptoms to be in the adolescent period. As with other mental health disorders, personality disorder, are thought to result from the interaction between biological and environmental factors. Functional neuroimaging studies are reporting an increasing amount of data on abnormal neuronal functions in BPD adult patients. However, no functional neuroimaging studies have been conducted in adolescents with BPD.Objectives This pilot project aims to evaluate the feasibility of a functional magnetic resonance imaging (fMRI) study coupled with clinical and psychological measures in adolescent girls with a diagnosis of BPD. It also aims to identify neuronal regions of interest (ROI) for the study of BPD in adolescent girls.Method Six female adolescents meeting DSM-IV criteria for BPD and 6 female adolescents without psychiatric disorder were recruited. Both groups were evaluated for BPD symptoms, depressive symptoms, impulsivity, affective lability, and other potential psychiatric comorbidities. We used fMRI to compare patterns of regional brain activation between these two groups as they viewed 20 positive, 20 negative and 20 neutral emotion-inducing pictures, which were presented in random order.Results Participants were recruited over a period of 22 months. The protocol was well tolerated by participants. Mean age of the BPD group and control group was 15.8 ± 0.9 years-old and 15.5 ± 1.2 years-old respectively. Psychiatric comorbidity and use of medication was common among participants in the BPD group. This group showed higher impulsivity and affective lability scores. For the fMRI task, BPD patients demonstrated greater differences in activation
Full Text Available Affective instability and self-injurious behavior are important features of Borderline Personality Disorder. Whereas affective instability may be caused by a pattern of limbic hyperreactivity paired with dysfunctional prefrontal regulation mechanisms, painful stimulation was found to reduce affective arousal at the neural level, possibly underlying the soothing effect of pain in BPD.We used psychophysiological interactions to analyze functional connectivity of (para- limbic brain structures (i.e. amygdala, insula, anterior cingulate cortex in Borderline Personality Disorder in response to painful stimulation. Therefore, we re-analyzed a dataset from 20 patients with Borderline Personality Disorder and 23 healthy controls who took part in an fMRI-task inducing negative (versus neutral affect and subsequently applying heat pain (versus warmth perception.Results suggest an enhanced negative coupling between limbic as well as paralimbic regions and prefrontal regions, specifically with the medial and dorsolateral prefrontal cortex, when patients experienced pain in addition to emotional arousing pictures. When neutral pictures were combined with painful heat sensation, we found positive connectivity in Borderline Personality Disorder between (para-limbic brain areas and parts of the basal ganglia (lentiform nucleus, putamen, as well areas involved in self-referential processing (precuneus and posterior cingulate.We found further evidence for alterations in the emotion regulation process in Borderline Personality Disorder, in the way that pain improves the inhibition of limbic activity by prefrontal areas. This study provides new insights in pain processing in BPD, including enhanced coupling of limbic structures and basal ganglia.
Treloar, Amanda Jane Commons; Lewis, Andrew J.
This paper reviews the history of the recognition of borderline personality disorder as a clinical disorder, followed by a review of the contemporary practice of diagnosing borderline personality disorder in psychiatric settings. Many researchers have cautioned against the conflation of difficult patients with the diagnostic category of borderline…
Marijn A Distel
Full Text Available Borderline personality disorder is a severe personality disorder for which genetic research has been limited to family studies and classical twin studies. These studies indicate that genetic effects explain 35 to 45% of the variance in borderline personality disorder and borderline personality features. However, effects of non-additive (dominance genetic factors, non-random mating and cultural transmission have generally not been explored. In the present study an extended twin-family design was applied to self-report data of twins (N = 5,017 and their siblings (N = 1,266, parents (N = 3,064 and spouses (N = 939 from 4,015 families, to estimate the effects of additive and non-additive genetic and environmental factors, cultural transmission and non-random mating on individual differences in borderline personality features. Results showed that resemblance among biological relatives could completely be attributed to genetic effects. Variation in borderline personality features was explained by additive genetic (21%; 95% CI 17-26% and dominant genetic (24%; 95% CI 17-31% factors. Environmental influences (55%; 95% CI 51-60% explained the remaining variance. Significant resemblance between spouses was observed, which was best explained by phenotypic assortative mating, but it had only a small effect on the genetic variance (1% of the total variance. There was no effect of cultural transmission from parents to offspring.
This article reviews the possibility and pertinence of diagnosing borderline personality disorder in adolescents. The etiology and clinical manifestations of this disorder in adolescents are discussed, and its management is addressed in terms of psychotherapy, pharmacology, hospitalization issues, and family involvement considerations.
P. Wetzelaer; J. Farrell; S.M.A.A. Evers; G.A. Jacob; C.W. Lee; O. Brand; G. van Breukelen; E. Fassbinder; H. Fretwell; R.P. Harper; A. Lavender; G. Lockwood; I.A. Malogiannis; U. Schweiger; H. Startup; T. Stevenson; G. Zarbock; A. Arntz
Background: Borderline personality disorder (BPD) is a severe and highly prevalent mental disorder. Schema therapy (ST) has been found effective in the treatment of BPD and is commonly delivered through an individual format. A group format (group schema therapy, GST) has also been developed. GST has
Sauer, Shannon E.; Baer, Ruth A.
Linehan's biosocial theory suggests that borderline personality disorder (BPD) results from a transaction of two childhood precursors: emotional vulnerability and an invalidating environment. Until recently, few empirical studies have explored relationships between these theoretical precursors and symptoms of the disorder. Psychometrically sound…
Sauer-Zavala, Shannon; Bentley, Kate H; Wilner, Julianne G
Borderline personality disorder (BPD) is a severe, difficult-to-treat psychiatric condition that represents a large proportion of treatment-seeking individuals. BPD is characterized by high rates of co-occurrence with depressive and anxiety disorders, and recently articulated conceptualizations of this comorbidity suggest that these disorders may result from common temperamental vulnerabilities and functional maintenance factors. The Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UP) was developed to address these shared features relevant across frequently co-occurring disorders. The purpose of the present study was to explore the preliminary efficacy of the UP for treatment of BPD with comorbid depressive and/or anxiety disorders in a clinical replication series consisting of five cases. For the majority of cases, the UP resulted in clinically significantly decreases in BPD, anxiety, and depressive symptoms, as well as increases in emotion regulation skills. PMID:25710737
Full Text Available There are still many unanswered questions about psychological and social factors that may affect the development and treatment of borderline personality disorder (BPD. Religion/spirituality (R/S is a factor that could influence the lives of people with BPD.The aim of this study was to evaluate the relationship between religiosity, religious attendance and borderline personality traits.Four hundred twenty- nine medical students of Tehran University of medical sciences participated in this study, and their information on demographics, responses to the Duke University Religion Index (DUREL, and the Structured Clinical Interview for DSM-IV Axis II Disorders (the self-administered section on BPD was obtained.The total score of SCID-II questionnaire and the number of positive borderline personality characteristics on the SCID-II were inversely related with the DUREL total score and individual DUREL items. Those with higher levels of borderline personality traits had lower total DUREL score and lower DUREL subscale scores.Religiosity and religious attendance are negatively correlated with borderline personality traits, especially with anger, instability of mood, feeling of emptiness and self-harming behaviors. These findings are important for understanding the causes of BPD and in developing treatments for this disorder.
Full Text Available Much recent research has shown that personality disorders are associated with an altered emotion perception. Whereas most of this research was conducted with stimuli such as faces, the present study examined possible differences in the perception of emotions expressed via body language and body movements. 30 patients with borderline personality disorder and 30 non-patients observed video scenes of emotional human interactions conveyed by point–light displays, rated the depicted valence, and judged their confidence in this rating. Patients with borderline personality disorder showed no altered emotion perception (i.e., no biased perception in either a negative or a positive direction. They did not perceive and evaluate depicted emotions as being more extreme than healthy controls. However, patients with borderline personality disorder showed less confidence in their perception of depicted emotions, especially when these were difficult to identify. The findings extend insights on altered emotion perception in persons with borderline personality disorder to include the field of body movements.
Hobson, R Peter; Patrick, Matthew; Crandell, Lisa; García-Pérez, Rosa; Lee, Anthony
The principal aim of this study was to assess personal relatedness and attachment patterns in 12-month-old infants of mothers with borderline personality disorder (BPD). We also evaluated maternal intrusive insensitivity toward the infants in semistructured play. We videotaped 10 mother-infant dyads with borderline mothers and 22 dyads where the mothers were free from psychopathology, in three different settings: a modification of Winnicott's Set Situation in which infants faced an initially unresponsive ("still-face") stranger, who subsequently tried to engage the infant in a game of give and take; the Strange Situation of Ainsworth and Wittig; and a situation in which mothers were requested to teach their infants to play with miniature figures and a toy train. In relation to a set of a priori predictions, the results revealed significant group differences as follows: (a) compared with control infants, toward the stranger the infants of mothers with BPD showed lower levels of "availability for positive engagement," lower ratings of "behavior organization and mood state," and a lower proportion of interpersonally directed looks that were positive; (b) in the Strange Situation, a higher proportion (8 out of 10) of infants of borderline mothers were categorized as Disorganized; and (c) in play, mothers with BPD were rated as more "intrusively insensitive" toward their infants. The results are discussed in relation to hypotheses concerning the interpersonal relations of women with BPD, and possible implications for their infants' development. PMID:16761548
Zimmerman, Mark; Morgan, Theresa A
It is clinically important to recognize both bipolar disorder and borderline personality disorder (BPD) in patients seeking treatment for depression, and it is important to distinguish between the two. The most studied question on the relationship between BPD and bipolar disorder is their diagnostic concordance. Across studies approximately 10 % of patients with BPD had bipolar I disorder and another 10 % had bipolar II disorder. Likewise, approximately 20 % of bipolar II patients were diagnosed with BPD, though only 10 % of bipolar I patients were diagnosed with BPD. While the comorbidity rates are substantial, each disorder is, nonetheless, diagnosed in the absence of the other in the vast majority of cases (80-90 %). In studies examining personality disorders broadly, other personality disorders were more commonly diagnosed in bipolar patients than was BPD. Likewise, the converse is also true: other axis I disorders such as major depression, substance abuse, and post-traumatic stress disorder are more commonly diagnosed in patients with BPD than is bipolar disorder. Studies comparing patients with BPD and bipolar disorder find significant differences on a range of variables. These findings challenge the notion that BPD is part of the bipolar spectrum. While a substantial literature has documented problems with the under-recognition and under-diagnosis of bipolar disorder, more recent studies have found evidence of bipolar disorder over-diagnosis and that BPD is a significant contributor to over-diagnosis. Re-conceptualizing the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, diagnostic criteria for bipolar disorder as a type of test, rather than the final word on diagnosis, shifts the diagnostician from thinking solely whether a patient does or does not have a disorder to considering the risks of false-positive and false-negative diagnoses, and the ease by which each type of diagnostic error can be corrected by longitudinal observation
Golomb, A; Ludolph, P; Westen, D; Block, M J; Maurer, P; Wiss, F C
Psychoanalytic writers have traced the etiology of borderline personality disorder (BPD) to be a preoedipal disturbance in the mother-child relationship. Despite the prevalence of theories focusing on the role of mothering in the development of BPD, few empirical studies have tested the hypothesis that borderlines were the recipients of unempathic mothering. The current preliminary study compared 13 mothers of borderline adolescents with 13 mothers of normal adolescents. This study found that mothers of borderlines tended to conceive of their children egocentrically, as need-gratifying objects, rather than as individuals with distinct and evolving personalities. This study also found that the mothers of borderlines reported raising their daughters in extremely chaotic families struggling to cope with multiple hardships, including divorce and financial worries. The stressful environmental circumstances reported by the mothers likely affected the borderline daughters directly as well as the mothers' ability to parent effectively and empathically. The results of this study suggest that, as predicted by psychoanalytic theory, a problematic mother-child relationship may play a significant role in the genesis of borderline pathology; however, the life circumstances that contextualize the mother-child relationship also need to be considered when accounting for the etiology of BPD. PMID:8040554
Stepp, Stephanie D.; Scott, Lori N.; Jones, Neil P.; Whalen, Diana J.; Hipwell, Alison E.
Negative emotionality is a distinguishing feature of borderline personality disorder (BPD). However, this person-level characteristic has not been examined as a marker of vulnerability in the development of this disorder. The current study utilized a multi-method approach to examine the interplay between negative emotional reactivity and cumulative exposure to family adversity on the development of BPD symptoms across three years (ages 16–18) in a diverse, at-risk sample of adolescent girls (...
Hopwood, Christopher J.; Zanarini, Mary C.
Objective: Decisions about the composition of personality assessment in the "Diagnostic and Statistical Manual of Mental Disorders" (5th ed.; DSM-V) will be heavily influenced by the clinical utility of candidate constructs. In this study, we addressed 1 aspect of clinical utility by testing the incremental validity of 5-factor model (FFM)…
Beeney, Joseph E.; Stepp, Stephanie D.; Hallquist, Michael N.; Scott, Lori N.; Wright, Aidan G.C.; Ellison, William D.; Nolf, Kimberly A.; Pilkonis, Paul A.
Theory and research point to the role of attachment difficulties in borderline personality disorder (BPD). Attachment insecurity is believed to lead to chronic problems in social relationships, due, in part, to impairments in social cognition, which comprise maladaptive mental representations of self, others, and self in relation to others. However, few studies have attempted to identify social cognitive mechanisms that link attachment insecurity to BPD and to assess whether such mechanisms a...
Dixon-Gordon, Katherine Lee
The primary aim of this research was to examine the effects of different emotion regulation strategies on emotions, psychophysiology, and behavioural urges among persons with BPD. Findings from several studies suggest that persons with borderline personality disorder (BPD) demonstrate heightened emotional vulnerability and a tendency to regulate emotions with potentially maladaptive avoidance strategies. Despite accumulating research on emotional responding in BPD, there is a dearth of resear...
Welch, Stacy Shaw; Linehan, Marsha M.; Sylvers, Patrick; Chittams, Jesse; Rizvi, Shireen L.
Nonsuicidal self-injury (NSSI) and suicide attempts (SAs) are especially prevalent in borderline personality disorder. One proposed mechanism for the maintenance of NSSI and SAs is escape conditioning, whereby immediate reductions in aversive emotional states negatively reinforce the behaviors. Psychophysiological and subjective indicators of…
Helleman, M.; Goossens, P.J.J.; Kaasenbrood, A.; Achterberg, T. van
Brief admission is a crisis intervention for patients with borderline personality disorder (BPD), and refers to a clinical admission at a psychiatric hospital for a period of 1-5 nights. Patients formulate a treatment plan together with their community mental health nurse about the maximum frequency
The aims of the present thesis were: * To investigate how women patients with borderline personality disorder (BPD) perceive their suffering, quality of life and encounter with psychiatric care (paper 11 and III). * To describe BPD patients' and psychiatric professionals' perceptions of receiving and giving dialectical behavioural therapy, DBT (paper I). * To investigate how starting treatment of BPD patients with DBT affected the psychia...
Stepp, Stephanie D.; Smith, Tiffany D.; Morse, Jennifer Q.; Hallquist, Michael N.; Pilkonis, Paul A.
This study examined the prospective relationships among borderline personality disorder (BPD) symptoms, interpersonal problems, and types of aggressive behaviors (i.e., experiencing psychological and physical victimization and perpetrating psychological and physical aggression) in a psychiatric sample (N = 139) over the course of 2 years. We…
Slotema, C. W.; Daalman, K.; Blom, J. D.; Diederen, K. M.; Hoek, H. W.; Sommer, I. E. C.
Background. Auditory verbal hallucinations (AVH) in patients with borderline personality disorder (BPD) are frequently claimed to be brief, less severe and qualitatively different from those in schizophrenia, hence the term 'pseudohallucinations'. AVH in BPD may be more similar to those experienced
Grilo, Carlos M.; Sanislow, Charles A.; Gunderson, John G.; Pagano, Maria E.; Yen, Shirley; Zanarini, Mary C.; Shea, Tracie M.; Skodol, Andrew E.; Stout, Robert L.; Morey, Leslie C.; McGlashan, Thomas H.
The authors examined the stability of schizotypal (STPD), borderline (BPD), avoidant (AVPD) and obsessive-compulsive (OCPD) personality disorders (PDs) over 2 years of prospective multiwave follow-up. Six hundred thirty-three participants recruited at 4 collaborating sites who met criteria for 1 or more of the 4 PDs or for major depressive…
J. Lobbestael; A. Arntz
Background: One of the core postulated features of borderline personality disorder (BPD) is extreme emotional reactivity to a wide array of evocative stimuli. Findings from previous experimental research however are mixed, and some theories suggest specificity of hyper emotional responses, as being
B. Koekkoek; B. van Meijel; A. Schene; G. Hutschemaekers
The objective of this research was to assess the problems that professionals perceive in the community mental health care for patients with severe borderline personality disorder that do not fit into specialized therapy. A group of national experts (n = 8) participated in a four-phase Delphi-procedu
Koekkoek, B.W.; Snoek, R. van der; Oosterwijk, K.; Meijel, B.K.G. van
PURPOSE. The purpose of this study was to establish the preliminary effects of preventive psychiatric admission of patients with severe borderline personality disorder (BPD) on the rate of agreement over treatment, patient service use, and patient views on the intervention. DESIGN AND METHODS. A ret
van Asselt, A D I; Dirksen, C D; Arntz, A; Severens, J L
BACKGROUND: Borderline personality disorder (BPD) is a highly prevalent, chronic condition. Because of its very problematic nature BPD is expected to be associated with substantial societal costs, although this has never been comprehensively assessed. OBJECTIVE: Estimate the societal cost of BPD in
Neiditch, Emily R.
Borderline personality disorder (BPD) puts great stress on the family system as family members cope with difficult symptoms, accompanying stigma, and caregiver burden. However, development and research on family interventions for BPD lags behind that of other serious mental illnesses. The current study describes a sample of family members,…
Lindenboim, Noam; Comtois, Katherine Anne; Linehan, Marsha M.
Dialectical Behavior Therapy (DBT) is an evidence-based practice for borderline personality disorder (BPD) and suicidal behavior that has been replicated with a variety of populations. Patients' practice of behavioral skills taught in the group skills training component of DBT may be partly responsible for the positive treatment outcomes according…
Thomsen, Marianne Skovgaard; Ruocco, Anthony C; Uliaszek, Amanda A;
Patients with borderline personality disorder (BPD) have deficits in neurocognitive function that could affect their ability to engage in psychotherapy and may be ameliorated by improvements in symptom severity. In the current study, 18 patients with BPD completed neurocognitive tests prior to...
Draper, Matthew R.; Faulkner, Ginger E.
This case study examines the dynamics and challenges associated with counseling a client experiencing borderline personality disorder in the small college institutional context. The work of counseling centers at small private institutions has been relatively unexplored in the extant college counseling literature. To help fill this gap, the current…
Bernardon, Stephanie; Pernice-Duca, Francesca
Borderline personality disorder (BPD) presents a number of symptoms and adjustment issues for individuals, but it is also associated with a myriad of risks for the larger family system. A systemic perspective is crucial to comprehending the development of BPD. Promoting healthy relationships with one or more supportive adult enables the child to…
Kliem, Soren; Kroger, Christoph; Kosfelder, Joachim
Objective: At present, the most frequently investigated psychosocial intervention for borderline personality disorder (BPD) is dialectical behavior therapy (DBT). We conducted a meta-analysis to examine the efficacy and long-term effectiveness of DBT. Method: Systematic bibliographic research was undertaken to find relevant literature from online…
Panepinto, Amberly R.; Uschold, Carissa C.; Olandese, Michelle; Linn, Braden K.
The study investigated the efficacy of a dialectical behavior therapy (DBT) program with a general college counseling center population, not limited to students diagnosed with borderline personality disorder. A review of records of 64 students found that obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety, paranoia,…
Rizvi, Shireen L.; Linehan, Marsha M.
This study sought to pilot test a short-term intervention for maladaptive shame in borderline personality disorder (BPD) based on the skill of "opposite action" from dialectical behavior therapy. Five women with BPD were treated with the intervention using a single-subject, multiple-baseline design. Results indicate that, although state ratings of…
Joshua D. Miller; Morse, Jennifer Q.; Nolf, Kimberly; Stepp, Stephanie D.; Pilkonis, Paul A.
The proposal for the diagnosis of personality disorders (PDs) in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5; American Psychiatric Association, in preparation) involves, in part, the use of elevated scores on dimensional personality traits. For instance, the diagnosis of borderline personality disorder (BPD) in the DSM-5 will require evidence of self- and interpersonal impairment as well as elevated scores on traits of emotional lability, anxiousness, separat...
Bateman, Anthony; Fonagy, Peter
Borderline personality disorder (BPD) frequently co-occurs with mood disorders and each influences the course and response to treatment of the other, potentially reducing beneficial outcome. Mentalizing, the ability to infer one's own and others' mental states, is a key factor in both disorders, being a major component of affect regulation and self-identity as well as a central aspect of interpersonal relationships and social function. In this article, we suggest that using mentalization-based treatment may lead to better outcome by addressing the mentalizing problems arising from the dual pathway that leads from depressed mood and BPD to disruption of mentalizing. Some clinical interventions are described to address the mentalizing problems associated with depression and BPD. PMID:26190067
Beeney, Joseph E; Stepp, Stephanie D; Hallquist, Michael N; Scott, Lori N; Wright, Aidan G C; Ellison, William D; Nolf, Kimberly A; Pilkonis, Paul A
Theory and research point to the role of attachment difficulties in borderline personality disorder (BPD). Attachment insecurity is believed to lead to chronic problems in social relationships, attributable, in part, to impairments in social cognition, which comprise maladaptive mental representations of self, others, and self in relation to others. However, few studies have attempted to identify social-cognitive mechanisms that link attachment insecurity to BPD and to assess whether such mechanisms are specific to the disorder. For the present study, empirically derived indices of mentalization, self-other boundaries, and identity diffusion were tested as mediators between attachment style and personality disorder symptoms. In a cross-sectional structural equation model, mentalization and self-other boundaries mediated the relationship between attachment anxiety and BPD. Mentalization partially mediated the relationship between attachment anxiety and antisocial personality disorder (PD) symptoms, and self-other boundaries mediated the relationship between attachment anxiety. PMID:25705979
Hernandez, Ana; Arntz, Arnoud; Gaviria, Ana M; Labad, Antonio; Gutiérrez-Zotes, José Alfonso
This study examines the relationship of different types of childhood maltreatment and the perceived parenting style with borderline personality disorder (BPD) criteria. Kendall's Tau partial correlations were performed controlling for the effect of simultaneous adverse experiences and Axis I and II symptoms in a sample of 109 female patients (32 BPD, 43 other personality disorder, and 34 non-personality disorder). BPD criteria were associated with higher scores on emotional and sexual abuse, whereas parenting style did not show a specific association with BPD. Findings of the present study help clarify the effects of overlapping environmental factors that are associated with BPD. PMID:23013341
Full Text Available Borderline personality disorder is a complex mental disorder which has severe impact on the quality of an individual's life. Although it is the most common type of personality disorder in the population of people with mental disorders, it has so far proven to be rather resistant to pharmacological treatments. This may suggest that effective psychotherapeutic methods need to be developed to help people with this diagnosis. There have been several attempts to develop successful therapeutic interventions for borderline personality disorder. Most of them were developed either from cognitive-behavioural or from psychoanalytic paradigm. More recent studies have focused on developing a more holistic approach. One such approach is the STEPPS program. This programme combines elements from cognitive-behavioural and systemic approaches. STEPPS is a 20-week, manually based group treatment for patients with borderline personality disorder. In comparison with other established approaches, the STEPPS program does not interfere with patient's other ongoing treatments. In this article we present the basics of the STEPPS program. We also provide a review of studies, investigating the effectiveness of the program. We also discuss advantages and disadvantages of the program and suggest some topics for further research.
Beblo, Thomas; Mensebach, Christoph; Wingenfeld, Katja; Rullkoetter, Nina; Schlosser, Nicole; Driessen, Martin
Background It is still a matter of debate as to whether patients with Borderline Personality Disorder (BPD) suffer from memory deficits. Existing studies indicate no or small impairments in memory test performance. However, it was shown in patients with related disorders, such as depression, that self-reported impairment exceeds test malfunction. In the present study we assessed memory performance of BPD patients through the use of memory tests and a questionnaire for subjective memory co...
Marylène Cloitre; Garvert, Donn W.; Brandon Weiss; Eve B. Carlson; Bryant, Richard A.
Background: There has been debate regarding whether Complex Posttraumatic Stress Disorder (Complex PTSD) is distinct from Borderline Personality Disorder (BPD) when the latter is comorbid with PTSD. Objective: To determine whether the patterns of symptoms endorsed by women seeking treatment for childhood abuse form classes that are consistent with diagnostic criteria for PTSD, Complex PTSD, and BPD. Method: A latent class analysis (LCA) was conducted on an archival dataset of 280 women with h...
do Prado-Lima, P A S; Kristensen, C H; Bacaltchuck, J
We report on a woman with borderline personality disorder and a history of childhood trauma that showed significant clinical response with low dosage of topiramate. We propose that topiramate changed some of the main features of this disorder, such as catastrophic reaction to real or imaginary abandonment or rejection, improving adaptive functioning. We hypothesize that topiramate might facilitate memory extinction, therefore decreasing emotional and behavioural reactivity. PMID:16635055
Stepp, Stephanie D.; Whalen, Diana J.; Scott, Lori N.; Zalewski, Maureen; Loeber, Rolf; Hipwell, Alison E.
Theories of borderline personality disorder (BPD) postulate that high-risk transactions between caregiver and child are important for the development and maintenance of the disorder. Little empirical evidence exists regarding the reciprocal effects of parenting on the development of BPD symptoms in adolescence. The impact of child and caregiver characteristics on this reciprocal relationship is also unknown. Thus, the current study examines bidirectional effects of parenting, specifically har...
Tolfree, R. J.
Borderline personality disorder (BPD) is a severe and complex disorder, historically believed to be ‘untreatable’. This view has been challenged through the success of various therapies in enabling individuals with this diagnosis to create ‘a life worth living’. However despite this progress little is known about how or why these treatments work. This thesis aims to contribute to this understanding through exploring the role of mentalization in BPD. Part 1 is a literature review which critica...
Rogosch, Fred A.; Cicchetti, Dante
Potential precursors to borderline personality disorder (BPD) were investigated in a sample of 185 maltreated and 175 nonmaltreated school-aged children attending a summer camp research program. Self-report, peer-report, and counselor-report measures were utilized to assess developmental constructs conceptualized to constitute vulnerability for later emerging BPD. These areas, including personality features, representational models of self, parent, and peers, interpersonal relationship diffic...
Boritz, Tali; Barnhart, Ryan; McMain, Shelley F
The aim of this study was to determine the influence of posttraumatic stress disorder (PTSD) on treatment outcomes in patients with borderline personality disorder (BPD). Participants were 180 individuals diagnosed with BPD enrolled in a randomized controlled trial that compared the clinical and cost effectiveness of dialectical behavior therapy (DBT) and general psychiatric management (GPM). Multilevel linear models and generalized linear models were used to compare clinical outcomes of BPD patients with and without PTSD. BPD patients with comorbid PTSD reported significantly higher levels of global psychological distress at baseline and end of treatment compared to their non-PTSD counterparts. Both groups evidenced comparable rates of change on suicide attempts and non-suicidal self-injury (NSSI), global psychological distress, and BPD symptoms over the course of treatment and post-treatment follow-up. DBT and GPM were effective for BPD patients with and without PTSD across a broad range of outcomes. PMID:26305394
This study identifies childhood personality traits that are precursors of adult Borderline Personality Disorder (BPD) features. In a longitudinal study, childhood personality traits were assessed at age 11 (N = 100) using the California Child Q-set (CCQ: Block and Block, 1980). A number of these Q-items were found to be significantly correlated (p personality dimensions: Impulsivity and Nonconformity/Aggression. The findings thus provide evidence that childhood personality traits predict adult BPD features. Identifying such childhood precursors provides an opportunity for early intervention. PMID:27027659
Keuroghlian, Alex S; Palmer, Brian A; Choi-Kain, Lois W; Borba, Christina P C; Links, Paul S; Gunderson, John G
The effect that attending a 1-day workshop on Good Psychiatric Management (GPM) had on attitudes about borderline personality disorder (BPD) was assessed among 297 clinicians. Change was recorded by comparing before and after scores on a 9-item survey previously developed to assess the effects of workshops on Systems Training for Emotional Predictability and Problem Solving (STEPPS). Participants reported decreased inclination to avoid borderline patients, dislike of borderline patients, and belief that BPD's prognosis is hopeless, as well as increased feeling of competence, belief that borderline patients have low self-esteem, feeling of being able to make a positive difference, and belief that effective psychotherapies exist. Less clinical experience was related to an increased feeling of competence and belief that borderline patients have low self-esteem. These findings were compared to those from the STEPPS workshop. This assessment demonstrates GPM's potential for training clinicians to meet population-wide needs related to borderline personality disorder. PMID:26111249
Borderline personality disorder (BPD) is a complex, serious, and high-cost psychiatric disorder. The high prevalence of patients with BPD and co-occurring depression, eating disorders, and substance-use disorders in primary care and mental health settings contribute to their high use of resources in these practice settings. Regardless of treatment challenges associated with BPD, researchers suggest a more positive outlook in the treatment of this complex psychiatric condition. This article focuses on areas in which nurses can strengthen their understanding of underpinnings and multimodal approaches, assess the patient's immediate needs, and manage distressful emotional states and impulsivity. PMID:27229283
Schaefer, Carola; Enning, Frank; Mueller, Juliane K; Bumb, J Malte; Rohleder, Cathrin; Odorfer, Thorsten M; Klosterkötter, Joachim; Hellmich, Martin; Koethe, Dagmar; Schmahl, Christian; Bohus, Martin; Leweke, F Markus
Borderline personality (BPD) and complex posttraumatic stress disorders (PTSD) are both powerfully associated with the experience of interpersonal violence during childhood and adolescence. The disorders frequently co-occur and often result in pervasive problems in, e.g., emotion regulation and altered pain perception, where the endocannabinoid system is deeply involved. We hypothesize an endocannabinoid role in both disorders. We investigated serum levels of the endocannabinoids anandamide and 2-arachidonoylglycerol and related fatty acid ethanolamides (FAEs) in BPD, PTSD, and controls. Significant alterations were found for both endocannabinoids in BPD and for the FAE oleoylethanolamide in PTSD suggesting a respective link to both disorders. PMID:24253425
Full Text Available PURPOSE: The borderline personality disorder is a common mental disorder. It is frequently associated with various mental co-morbidities and a fundamental loss of functioning. The borderline personality disorder causes high costs to society. The aim of this study was to perform a systematic literature review of existing economic evaluations of treatments for borderline personality disorder. MATERIALS AND METHODS: We performed a systematic literature search in MEDLINE, EMBASE, PsycINFO and NHSEED for partial and full economic evaluations regarding borderline personality disorder. Reported cost data were inflated to the year 2012 and converted into US-$ using purchasing power parities to allow for comparability. Quality assessment of the studies was performed by means of the Consensus on Health Economic Criteria checklist, a checklist developed by a Delphi method in cooperation with 23 international experts. RESULTS: We identified 6 partial and 9 full economic evaluations. The methodical quality was moderate (fulfilled quality criteria: 79.2% [SD: 15.4%] in partial economic evaluations, 77.3% [SD: 8.5%] in full economic evaluations. Most evaluations analysed psychotherapeutic interventions. Although ambiguous, most evidence exists on dialectical-behavioural therapy. Cognitive behavioural therapy and schema-focused therapy are cost-saving. Evidence on other interventions is scarce. CONCLUSION: The economic evidence is not sufficient to draw robust conclusions for all treatments. It is possible that some treatments are cost-effective. Most evidence exists on dialectical-behavioural therapy. Yet, it is ambiguous. Further research concerning the cost-effectiveness of treatments is necessary as well as the identification of relevant cost categories and the validation of effect measures.
Smith, Michael A.
Discusses a case example on the use of poetry therapy with an adolescent with Borderline Personality Disorder (BPD). Presents a brief overview of treatment of borderline clients, poetry therapy, and use of poetry therapy with troubled adolescents. Discusses implications for the use of poetry therapy with this population. (SC)
Giesen-Bloo, Josephine; van Dyck, Richard; Spinhoven, Philip; van Tilburg, Willem; Dirksen, Carmen; van Asselt, Thea; Kremers, Ismay; Nadort, Marjon; Arntz, Arnoud
CONTEXT: Borderline personality disorder is a severe and chronic psychiatric condition, prevalent throughout health care settings. Only limited effects of current treatments have been documented. OBJECTIVE: To compare the effectiveness of schema-focused therapy (SFT) and psychodynamically based tran
Veague, Heather Barnett; Hooley, Jill Miranda
Interpersonal difficulties, which are characteristic of Borderline personality disorder (BPD), may be related to problems with social cognition. We explored facial emotion recognition in 44 women (15 with BPD, 15 healthy controls, and 14 with a history of childhood trauma but no BPD) examining the role of BPD and abuse history in the ability to detect fearful, angry and happy cues in emotional faces. In Task 1, participants viewed pictures of morphed faces containing different percentages of ...
Selby, Edward A.; Bulik, Cynthia M; Thornton, Laura; Brandt, Harry A.; Crawford, Steve; Fichter, Manfred M.; Halmi, Katherine A.; Jacoby, Georg E.; Johnson, Craig L; Jones, Ian; Kaplan, Allan S.; Mitchell, James E; Nutzinger, Detlev O.; Strober, Michael; Treasure, Janet
One of the primary facets of borderline personality disorder (BPD) is behavioral dysregulation, a wide array of behaviors that are difficult to control and harmful to the individual. The purpose of this study was to explore the association between BPD and a variety of dysregulated behaviors, some of which have received little empirical attention. Using a large sample of individuals diagnosed with anorexia nervosa, 41 individuals diagnosed with BPD were compared to the rest of the sample on th...
Clinical features of Borderline Personality Disorder (BPD) as an unstable and dysregulated control over behavior, emotion, and cognition as well as clinical descriptions of temporary disturbances of perception and cognition led to the question of neuropsychological deficits. Although neuropsychological investigations of BPD did not provide a consistent constellation of findings, some evidence is available for a non-domain-specific impairment in multiple domains of memory, attention, visuo-spa...
Background Previous research has investigated the experience of having a mental health diagnosis and being a parent. However, there is very limited research that examines the experience of being a mother with a diagnosis of Borderline Personality Disorder (BPD). The current research that is available around parenting with this diagnosis focuses on outcomes of children to these parents and the difficulties that people with this diagnosis may have with parenting. The lived experience is lost...
De Panfilis, C; Riva, P; Preti, E; Cabrino, C; C. Marchesi
Increasing evidence suggests that individuals with borderline personality disorder (BPD) might feel rejected even when socially included by others. A psychological mechanism accounting for this response bias could be that objective social inclusion violates BPD patients' underlying implicit needs of "extreme" inclusion. Thus, this study investigated whether, during interpersonal exchanges, BPD patients report more rejection-related negative emotions and less feelings of social connection than...
A brief review of the development of the concept of Borderline Personality Disorder is given, together with a more detailed consideration of theorists who have made significant contributions to its psychodynamic understanding. Examples of the extreme limits of this diagnostic category are illustrated, using the symbolism of Humpty-Dumpty and Rapunzel. The theories of Winnicott and Kohut, which both elaborate on the concept of a developmental defect, are compared and contrasted. Some implications for therapy are considered. PMID:2421706
Silvio Bellino; Paola Bozzatello; Camilla Rinaldi; Filippo Bogetto
Antipsychotics are recommended for the treatment of impulsive dyscontrol and cognitive perceptual symptoms of borderline personality disorder (BPD). Three reports supported the efficacy of oral risperidone on BPD psychopathology. Paliperidone ER is the metabolite of risperidone with a similar mechanism of action, and its osmotic release reduces plasmatic fluctuations and antidopaminergic effects. The aim of this study is to evaluate efficacy and safety of paliperidone ER in BPD patients. 18 o...
Albert Feliu-Soler; Juan Carlos Pascual; Joaquim Soler; Víctor Pérez; Antonio Armario; Javier Carrasco; Antoni Sanz; Francisco Villamarín; Xavier Borràs
The aim of this study was to determine if patients with Borderline Personality Disorder (BPD) present higher emotional response than healthy controls in a laboratory setting. Fifty participants (35 patients with BPD and 15 healthy controls) underwent a negative emotion induction procedure (presentation of standardized unpleasant images). Subjective emotional responses were assessed by means of self-reported questionnaires while biological reactivity during the procedure was measured through l...
Selby, Edward A.; Anestis, Michael D.; Bender, Theodore W.; Joiner, Thomas E.
The Emotional Cascade Model proposes that the emotional and behavioral dysregulation of individuals with borderline personality disorder (BPD) may be fundamentally linked through emotional cascades, vicious cycles of intense rumination and negative affect that may induce aversive emotional states. In order to reduce this aversive emotion, dysregulated behaviors such as non-suicidal self-injury may then be used as distractions from intense rumination. This study explored emotional cascades in ...
Scott, Lori N.; Levy, Kenneth N.; Granger, Douglas A.
Several clinical theories propose that borderline personality disorder (BPD) is characterized by a biologically based affective vulnerability to intense affective experiences and impaired modulation of affective states, which might manifest in high emotional intensity, hyperreactivity, and impaired recovery to baseline. However, few studies have tested these theories based on emotional and biological responses of BPD participants in response to psychosocial stressors. This study examined cort...
Smoski, Moria J.; Salsman, Nicholas; Wang, Lihong; Smith, Veronica; Lynch, Thomas R.; Dager, Stephen R.; LaBar, Kevin S.; Linehan, Marsha M.
Opiate dependence (OD) and Borderline Personality Disorder (BPD), separately and together, are significant public health problems with poor treatment outcomes. BPD is associated with difficulties in emotion regulation, and brain imaging studies in BPD individuals indicate differential activation in prefrontal-cingulate cortices and their interactions with limbic regions. Likewise, a similar network is implicated in drug cue responsivity in substance abusers. The present, preliminary study use...
Koekkoek, B.; Meijel, van, B.; Schene, A.; Hutschemaekers, G.
The objective of this research was to assess the problems that professionals perceive in the community mental health care for patients with severe borderline personality disorder that do not fit into specialized therapy. A group of national experts (n = 8) participated in a four-phase Delphi-procedure to identify and prioritize the problems. A total of 36 problems reflecting five categories was found: patient-related, professional-related, interaction-related, social system-related, and menta...
Baskin-Sommers, Arielle R.; Hooley, Jill M.; Dahlgren, Mary K; Gönenc, Atilla; Yurgelun-Todd, Deborah A.; Gruber, Staci A.
Background: Emotion dysregulation is central to the clinical conceptualization of borderline personality disorder (BPD), with individuals often displaying instability in mood and intense feelings of negative affect. Although existing data suggest important neural and behavioral differences in the emotion processing of individuals with BPD, studies thus far have only explored reactions to overt emotional information. Therefore, it is unclear if BPD-related emotional hypersensitivity extends to...
Arielle Ryan Baskin-Sommers; Jill eHolley; Mary eDahlgren; Atilla eGonenc; Deborah eYurgelun-Todd; Staci eGruber
Background: Emotion dysregulation is central to the clinical conceptualization of Borderline Personality Disorder (BPD), with individuals often displaying instability in mood and intense feelings of negative affect. Although existing data suggest important neural and behavioral differences in the emotion processing of individuals with BPD, studies thus far have only explored reactions to overt emotional information. Therefore, it is unclear if BPD-related emotional hypersensitivity extends to...
Wingenfeld, Katja; Kuehl, Linn K.; Janke, Katrin; Hinkelmann, Kim; Dziobek, Isabel; Fleischer, Juliane; Otte, Christian; Roepke, Stefan
The mineralocorticoid receptor (MR) is highly expressed in the hippocampus and prefrontal cortex. MR have an important role in appraisal processes and in modulating stress-associated emotional reactions but it is not known whether the MR affects empathy. Borderline personality disorder (BPD) is characterized by disturbed emotion regulation and alterations in empathy. In the current study, we examined whether stimulation of the MR enhances empathy in patients with BPD and healthy individuals. ...
Uncontrollable emotional lability and impulsivity are a paramount phenomenon of Borderline Personality Disorder (BPD). This paper aims to review theories that entertain emotion dysregulation as the core deficit of BPD and a key factor in the etiology of BPD, in order, then, to propose the author's own theory, which arguably transcends certain limitations of the earlier ones. The author asserts that his psychodynamic theory explains the symptoms of BPD more thoroughly and it inspires a more pa...
Eizirik, M.; Fonagy, P.
Objective: To describe the concept of mentalization, and its application in understanding the development of psychopathology in patients with borderline personality disorder; to give an account of the main features of mentalization-based treatment; to summarise the evidence supporting its effectiveness. Discussion: Mentalization is a predominantly preconscious mental activity that enables the individual to understand him/herself and others in terms of subjective states and mental processes. P...
Fonagy, P.; Luyten, P.
The precise nature and etiopathogenesis of borderline personality disorder (BPD) Continues to elude researchers and clinicians. Yet, increasing evidence from various strands of research converges to suggest that affect dysregulation, impulsivity, and unstable relationships constitute the core feature,,, of BPD. Over the last two decades, the mentalization-based approach to BPD has attempted to provide a theoretically consistent way of conceptualizing the interrelationship between these core f...
Chatterjee, Seshadri Sekhar; Mitra, Sayantanava
Dermatitis artefacta lies in a gray zone, between the specialities of psychiatry and dermatology. The condition could mimic a number of other lesions and therefore is a source of much confusion in clinical practice. Here, we describe a case of dermatitis artefacta in an 11-years old girl, which resembled self-harming behavior in Borderline personality disorder. We then discuss how the two could be differentiated and why this becomes imperative while dealing with such cases. PMID:27489388
Carpenter, Ryan W; Wood, Phillip K; Trull, Timothy J
Borderline personality disorder (BPD) is comorbid with substance use disorders (SUDs). However, most epidemiological work on BPD and SUDs has collapsed nonalcohol substances into a drug use disorder indicator, potentially obscuring patterns of association between BPD and individal SUDs. Using a nationally representative sample (National Epidemiologic Survey on Alcohol and Related Conditions; N = 34,481), the authors examined the association between lifetime BPD and nine lifetime SUDs. First, the authors examined the bivariate association of BPD and each SUD. BPD was associated with all nine SUDs. Second, they added relevant covariates (demographic variables, additional psychopathology) to each model. Seven SUDs remained significant. Finally, to account for shared variance across SUDs, the authors conducted a multivariate logistic regression with the nine SUDs and covariates as predictors. Alcohol, cocaine, and opiate use disorder were the only significant SUD predictors, indicating a unique association between BPD and these three SUDs. Future research should explore factors involved in the association of BPD with these specific SUDs. PMID:25893556
Sledge, William; Plakun, Eric M.; Bauer, Stephen; Brodsky, Beth; Caligor, Eve; Clemens, Norman A; Deen, Serina; Kay, Jerald; Lazar, Susan; Mellman, Lisa A; Myers, Michael; Oldham, John; Yeomans, Frank
The objective was to review established literature on approaches to the psychotherapy of borderline personality disorder with specfic reference to suicide in order to determine if there were common factors across these efforts that would guide future teaching, practice and research. The publications from the proponents of five therapies for the treatment of suicidal behavior in individuals with borderline personality disorder (BPD), were reviewed and discussed by the members of the Group for ...
Weinstein, Yana; Gleason, Marci E.J.; Oltmanns, Thomas F.
We examined the relationship between personality pathology and the frequency of self-reported psychological and physical partner aggression in a community sample of 872 adults aged 55–64. Previous research suggests that antisocial and borderline personality disorder (PD) symptoms are associated with partner aggression. Controlling for gender, education, alcohol dependence, and other personality pathology, we found that borderline PD symptoms, which include abandonment fears, unstable identity...
Herpertz, Sabine C; Bertsch, Katja
Borderline personality disorder is characterized by three domains of dysfunction: affect dysregulation, behavioral dyscontrol, and interpersonal hypersensitivity. Interpersonal hypersensitivity is associated with a (pre)attentive bias toward negative social information and, on the level of the brain, enhanced bottom-up emotion generation, while affect dysregulation results from abnormal top-down processes. Additionally, the problems of patients with borderline personality disorder in interpersonal functioning appear to be related to alterations in the (social) reward and empathy networks. There is increasing evidence that the oxytocinergic system may be involved in these domains of dysfunction and may thus contribute to borderline psychopathology and even open new avenues for targeted pharmacotherapeutic approaches. From studies in healthy and clinical subjects (including first studies with borderline personality disorder patients), the authors provide a conceptual framework for future research in borderline personality disorder that is based on oxytocinergic modulation of the following biobehavioral mechanisms: 1) the brain salience network favoring adaptive social approach behavior, 2) the affect regulation circuit normalizing top-down processes, 3) the mesolimbic circuit improving social reward experiences, and 4) modulating brain regions involved in cognitive and emotional empathy. In addition, preliminary data point to interactions between the oxytocin and cannabinoid system, with implications for pain processing. These mechanisms, which the authors believe to be modulated by oxytocin, may not be specific for borderline personality disorder but rather may be common to a host of psychiatric disorders in which disturbed parent-infant attachment is a major etiological factor. PMID:26324303
Yi-gan san (YGS, yokukan-san in Japanese) was developed in 1555 by Xue Kai as a remedy for restlessness and agitation in children. Prompted by the increasing life expectancy of the Japanese population, geriatricians have begun to use this traditional regimen for behavioral and psychological symptoms of dementia in the elderly. Moreover, we reported that YGS therapy is a well-tolerated and effective remedy that improves the symptoms of schizophrenia., borderline personality disorder, Charles Bonnet Syndrome, pervasive developmental disorder. Asperger's disorder, neuroleptics induced tardive dyskinesia, and restless legs syndrome. In a pilot investigation, we administered YGS as an open-label adjunct to antipsychotic medication to patients with treatment-resistant shizophrenia, borderline personality disorder, Charles Bonnet Syndrome, pervasive developmental disorder, Asperger's disorder, neuroleptics induced tardive dyskinesia. The present lecture summarizes the available data based on the above our data. In addition, we extend our discussion to the potential applications of YGS for combining this treatment with cellular and molecular therapy. PMID:23094294
Matthies, Swantje D; Philipsen, Alexandra
Considerable overlap in diagnostic criteria and shared psychopathologic symptoms in attention deficit hyperactivity disorder (ADHD) and borderline personality disorder (BPD) have stimulated research activities in this field. Longitudinal studies have shown that BPD is frequently diagnosed in adult patients who had been diagnosed with ADHD in childhood. The question of whether ADHD and BPD randomly co-occur as comorbidities, have similar origins or share common pathological mechanisms remains ...
Huỳnh, Christophe; Guilé, Jean-Marc; Breton, Jean-Jacques; Godbout, Roger
Sleep-wake patterns are rarely examined in adolescents with borderline personality disorder (BPD) or bipolar disorder (BD). Within a developmental perspective, this study explores the sleep-wake cycle of adolescents aged 12-17 years with BPD or BD and healthy controls (HC) during periods with and without entrainment by school/work schedules. Eighteen euthymic BPD, six euthymic BD, and 20 HC adolescents wore wrist actigraphy during nine consecutive days to assess sleep-wake patterns. During school/work days, BPD adolescents spent more time awake when they were in bed compared to HC and BD adolescents (p = 0.039). On schedule-free days, BPD and BD youths spent more time in bed compared to HC adolescents (p = 0.015). BPD adolescents woke up over 1 h later compared to HC (p = 0.003). Total sleep time was more variable between nights in BPD adolescents compared to the HC group (p = 0.031). Future research should explore if sleep-wake pattern disruptions are a cause or a consequence of BPD symptomatology in adolescents. Addressing sleep-wake pattern during clinical assessment and treatment of BPD adolescents may potentially reduce their symptoms; this therapeutic effect still needs to be evaluated. PMID:26003420
Marissen, Marlies A E; Meuleman, Linda; Franken, Ingmar H A
Emotional dysregulation is one of the key symptoms of patients with borderline personality disorder (BPD). In the present study it is hypothesized that borderline patients display a cortical hyper-responsivity to emotional stimuli compared with a healthy control group. Further, we aimed to examine whether BPD patients were able to suppress stimuli with negative emotional valence as well as healthy control participants could. This is the first study addressing the electrophysiological processing of emotional stimuli in BPD. The electrophysiological response to emotional information was studied among 30 BPD patients and compared with the response in 30 normal controls using event-related potentials (ERPs). Participants were shown pictures selected from the International Affective Picture System with neutral, positive, and negative valence. After performing an attentional task, the participants were asked to perform a reappraisal task. The assignment was to consciously suppress emotions that might occur after viewing pictures with an unpleasant content. Borderline patients displayed larger late positive potentials (LPP) to pictures with an unpleasant valence as compared with the control group, indicating an enhanced elaborative processing of unpleasant stimuli. However, they did not differ on the reappraisal task. Borderline patients show an enhanced emotional cortical reactivity to unpleasant stimuli as compared with a control group. This suggests an emotional dysfunctioning in BPD patients. This feature might be an important focus in the treatment of BPD. PMID:20153144
The import of this observation resides in the significance of the patient's destiny and in the poor organization of his personality, indicating that defense mechanisms may have been prevented from building up as a result of the bearing of real and phantasmic events on his mental working. We speculate that a mechanism as essential as interiorization could not develop, as a direct result of the continuous confrontation of conflicts with a disrupted reality and the recollection of this last. The limits constituted by death and incest could not be normally interiorized and integrated within the psychic organization of this young boy, "doomed" at the age of four, and perhaps even earlier. PMID:6320412
Kolly, Stéphane; Despland, Jean-Nicolas; de Roten, Yves; Marquet, Pierre; Kramer, Ueli
Therapist adherence describes the quality of interventions according to the imperatives of a treatment model. We examined the relationship between therapist adherence and symptom change in the context of a short-term treatment with respect good psychiatric management (GPM) principles. Based on a parent trial, borderline personality disorder patients (N = 40) benefited from a 10-session intervention. Adherence to GPM was assessed using a GPM Adherence Scale (GPMAS). The psychometric properties of the GPMAS were excellent, and the adherence to GPM explained 16% of the general symptom improvement (t(1) = 2.38, β = 0.40, p = 0.02) and 23% of the borderline symptom improvement (t(1) = 2.46, β = 0.48, p = 0.02). Because GPM adherence predicts the outcome after only 10 sessions, GPMAS is a valuable measure early on in psychiatric practice as part of an initial step to longer-term treatment, to quickly detect problems and correct them. PMID:27187770
Choi-Kain, Lois W; Zanarini, Mary C; Frankenburg, Frances R; Fitzmaurice, Garrett M; Reich, D Bradford
The literature on borderline personality disorder (BPD) describes interpersonal disturbances as a core sector of psychopathology. The longitudinal course of these features remains poorly understood. Our aim is to describe the course of interpersonal features of BPD in a more detailed way than has been done previously. Twenty interpersonal aspects of borderline psychopathology were assessed using two reliable semi-structured diagnostic interviews at baseline and at five successive two-year follow-up waves in the ongoing McLean Study for Adult Development. Behaviorally-oriented features, such as recurrent breakups, sadism, demandingness, entitlement, regression in treatment, and boundary violations, remitted quickly and were rare at the end of follow-up. The interpersonal features slowest to remit were affective responses to being alone, active caretaking, discomfort with care, and dependency. The behavioral interpersonal features of BPD remit rapidly, while core affectively-oriented features related to intolerance of aloneness and conflicts over dependency are more persistent. PMID:20545500
Haaf, B; Pohl, U; Deusinger, I M; Bohus, M
The operationalized diagnosis of borderline personality disorder (BPD) by DSM-IV and ICD-10 (research criteria) is meanwhile considered as valid and reliable. A disturbed or inappropriate body image within the group of borderline patients is not assessed by these instruments. Using the "Frankfurter Körperkonzeptskalen" , we compared the body concept of 47 female patients with BPD with a group of patients with the diagnosis of Bulimia nervosa and with a representative sample of healthy subjects. We found highly significant differences between patients with BPD and the clinical controls as well as to the norm group. Neither dissociative symptoms nor sexual child abuse correlate with the extent of the negative body concept. Correlations between self-concept (Giessen-Test) and body concept as well as clinical implications of these findings are discussed. PMID:11447658
Storebø, Ole Jakob; Simonsen, Erik
pointed at shared aetiology or the risk for development of one disorder, when the other disorder is present. The data do not evaluate how treatment factors or other factors mediate the risk or how overlap of diagnostic criteria adds to the statistical association. More research is much needed, in......Background: Several studies report associations between adults with borderline personality disorder (BPD) and a history of attention-deficit hyperactivity (ADHD) symptoms in childhood. Aims: To explore the association between BPD and a history of ADHD in childhood. Method: A comprehensive search of......: Most of the 15 articles showed a statistical association between ADHD and BPD. The data, most strongly provided a basis for the hypotheses that ADHD is either an early developmental stage of BPD, or that the two disorders share an environmental and genetic aetiology. Furthermore, one of the disorders...
Alicia Domínguez Bermejo
Full Text Available The borderline personality disorder (BPD is defined as a pervasive pattern of instability in interpersonal relationships, self-image and emotions with marked impulsivity. The clinical management of patients diagnosed with BPD is difficult for nurses due to the clinical characteristics of these subjects. This study seeks to address the emotions expressed by nurses working in units of personality disorder.Objectives: To determine the emotions experienced by nurses working in personality disorders treatment units during the care of patients diagnosed with BPD. To describe the type of emotions experienced, positive or negative; to identify the triggering situations for different types of emotions; to explore the influence of the experienced emotions when acting with these patients; to address the different ways to handle emotions based on the received training and professional experience during the care of patients diagnosed with BPD and to address the different ways to handle emotions according to the gender of the nurses. Methodology: Qualitative research in health. The information generation techniques employed are in-depth interviews and focus/debate groups.
Oldham, John M
It is interesting to consider whether impairment in the capacity to mentalize might be a persuasive way to describe the core pathology in most patients with a personality disorder (PD). It has long been recognized that a dimensional approach to understanding PDs is more useful than the traditional categorical diagnostic model. Studies are pointing to an underlying general factor as a latent dimension of borderline personality disorder (BPD), perhaps reflecting shared or common genetic endophenotypes as risk factors for the development of BPD or other PDs. With regard to the focus on mentalizing in particular, however one thinks about impairment in mentalizing as a core reflection of personality pathology, it is helpful to drill down to deeper levels. In these pages, the authors do a remarkable job of unpacking, to the granular level, the many components of mentalization and the attachment process. PMID:26436584
Stepp, Stephanie D.; Burke, Jeffrey D.; Hipwell, Alison E.; Loeber, Rolf
Little empirical evidence exists regarding the developmental links between childhood psychopathology and borderline personality disorder (BPD) in adolescence. The current study addresses this gap by examining symptoms of attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) as potential precursors. ADHD and BPD…
Weitzner, M A; Lehninger, F; Sullivan, D; Fields, K K
Bone marrow transplantation (BMT) is rapidly becoming a part of conventional cancer treatment. However, it remains a 'last-ditch' treatment option for patients who have exhausted other treatment modalities. Patients experience a significant amount of emotional distress during all stages of the BMT process. Patients with personality disorders experience even more emotional distress than average and their behavior is often detrimental to effective patient-staff interactions. A case of a borderline patient is presented with a discussion of the ethical issues involved in the evaluation of these patients and the determination of their appropriateness for transplant. PMID:10202782
Lewis, Katie C; Meehan, Kevin B; Cain, Nicole M; Wong, Philip S; Clemence, A Jill; Stevens, Jennifer; Tillman, Jane G
While studies have demonstrated connections between impairments in object relations and self-destructive behaviors in individuals with borderline personality disorder (BPD), few have investigated whether these impairments relate to actual suicidal behaviors. The current study utilized the Social Cognition and Object Relations Scale-Global Method to investigate object relational functioning and suicidal behaviors in 131 residential treatment patients. Cognitive but not affective aspects of internalized representations predicted past suicidal behavior in BPD subjects; no relationships were found between quality of object representations and suicide in other-PD subjects. Implications of these findings for research, theory, and treatment of suicidal individuals are discussed. PMID:25710732
Jani, Suni; Johnson, R Scott; Banu, Sophia; Shah, Asim
Borderline personality disorder (BPD) is an internationally recognized disorder, although it is slightly varied in its nosology in the International Classification of Diseases, 10th Revision (ICD-10), the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), and the Chinese Classification of Mental Disorders (CCMD). While it is recognized by genetic and neurobiological patterns, instability of affect, impaired interpersonal relationships, and unstable sense of self, its manifestation is extremely varied based on environmental factors, particularly culture. Several studies of the manifestation of BPD between and across countries, particularly in immigrant populations, identify variations in symptom prevalence based on culture. These findings reveal a need for more unified dimensional-based categorization of BPD to reduce cross-cultural bias and improve identification. PMID:27294587
Herpertz, S C; Schwenger, U B; Kunert, H J; Lukas, G; Gretzer, U; Nutzmann, J; Schuerkens, A; Sass, H
The aim of this study was to assess psychophysiological affect correlates, in addition to the usual self-report in borderline personality disorder (BPD) compared with avoidant personality disorder (APD) and normal controls (NCs), when responding to standardized experimental stimuli. In 24 BPD female patients, 23 APD female patients, and 27 female NCs, skin conductance response (SCR), heart rate (HR) change, and startle response were recorded while the subjects viewed slides with emotional content. Neither the self-report nor the psychophysiological data supported the hypothesis that affective responses of BPD individuals are generally stronger than those with APD. BPD patients showed no potentiation of the affective modulation of the startle reflex and their electrodermal reactivity was lower than in either the APD subjects or the NCs. The hypothesis of a general affective hyperresponsivity could not be confirmed. Low somatic arousal in BPD can interfere with the anticipation of signal stimuli and may explain the exaggerated openness borderline personalities show to stimuli, particularly in interpersonal situations. PMID:11204341
Donges, Uta-Susan; Dukalski, Bibiana; Kersting, Anette; Suslow, Thomas
Background Instability of affects and interpersonal relations are important features of borderline personality disorder (BPD). Interpersonal problems of individuals suffering from BPD might develop based on abnormalities in the processing of facial affects and high sensitivity to negative affective expressions. The aims of the present study were to examine automatic evaluative shifts and latencies as a function of masked facial affects in patients with BPD compared to healthy individuals. As ...
Selby, Edward A; Bulik, Cynthia M; Thornton, Laura; Brandt, Harry A; Crawford, Steve; Fichter, Manfred M; Halmi, Katherine A; Jacoby, Georg E; Johnson, Craig L; Jones, Ian; Kaplan, Allan S; Mitchell, James E; Nutzinger, Detlev O; Strober, Michael; Treasure, Janet; Woodside, D Blake; Kaye, Walter H; Joiner, Thomas E
One of the primary facets of borderline personality disorder (BPD) is behavioral dysregulation, a wide array of behaviors that are difficult to control and harmful to the individual. The purpose of this study was to explore the association between BPD and a variety of dysregulated behaviors, some of which have received little empirical attention. Using a large sample of individuals diagnosed with anorexia nervosa, 41 individuals diagnosed with BPD were compared to the rest of the sample on the presence of dysregulated behaviors using logistic regression analyses. Anorexia nervosa subtypes, age, and other Cluster B personality disorders were used as covariates. Results support an association between BPD and alcohol misuse, hitting someone/breaking things, provoking fights/arguments, self-injury, overdosing, street drug use, binge-eating, impulsive spending, shoplifting/stealing, and risky sexual behaviors. Differences between dichotomous and continuous measures of BPD yielded somewhat different results. Information on co-occurring anorexia nervosa and BPD was generated. PMID:22448667
Silberschmidt, Amy; Lee, Susanne; Zanarini, Mary; Schulz, S Charles
This study aims to extend previous research by considering gender differences in borderline personality (BPD) using both dimensional self-reported and clinical measures of symptomatology. Drawing from a cross-cultural, clinical trial sample, the authors compared female and male BPD subjects (N = 770; 211 male) between the ages of 18 and 65 using diagnostic and self-report data. The authors found that women with BPD have greater hostility and relationship disruption than men. Gender differences in eating disorders, particularly bulimia, are more divergent than in the general population. Generally, gender differences in BPD in this sample are consistent with known general population differences. Women show greater overall symptomatology, including depressive, anxious, and somatic symptoms. Men have higher rates of antisocial personality disorder and a trend toward higher rates of narcissistic personality disorder. However, several gender differences consistently found in the general population are not present in this BPD sample. There are no differences in aggression, suicidality, substance abuse, panic disorder, or obsessive-compulsive disorder. Gender differences in major depression and posttraumatic stress disorder are attenuated. These findings support the conclusion that BPD may diminish normal gender differences. PMID:25562535
Siefert, Caleb J
As part of their overall care, patients with borderline personality disorder may require inpatient hospitalization for containment and stabilization in the context of severe distress, increased risk for self-harm, or after self-harming acts. Though data suggests that such patients are frequently hospitalized, the benefits of brief hospitalizations can sometimes be questionable. In some cases, the hospitalization environment may increase patient distress. Additionally, frequent serial hospitalizations can disrupt or sidetrack longer-term outpatient treatments. The present paper presents a Goal-Oriented Limited-Duration Borderline Personality Disorder Inpatient Treatment approach. The approach integrates elements from many other expert-based approaches for working in brief hospital settings and centers on the creation of a preadmission treatment agreement with a planned discharge date. This agreement involves clear goals for treatment and specifies how staff will be involved. Establishing a discharge date early in treatment allows staff to immediately begin working with feelings of rejection or abandonment. At discharge, recommendations are made and criteria for future admissions are set forth. This paper provides a description of the approach, information to consider in determining appropriateness, discussion of methods for clarifying goals, review of the discharge planning approach, and several examples of clinician-patient exchanges. This paper concludes with a case example in which the approach was used and discussions of future directions and potential benefits and limitations of the approach. PMID:22181025
Miskewicz, Kelly; Fleeson, William; Arnold, Elizabeth Mayfield; Law, Mary Kate; Mneimne, Malek; Furr, R. Michael
This article tested a contingency-oriented perspective to examine the dynamic relationships between in-the-moment borderline personality disorder (BPD) symptom events and in-the-moment triggers. An experience sampling study with 282 adults, including 77 participants with BPD, obtained reports of situational triggers and BPD symptom events five times daily for two weeks. Triggers included being rejected, betrayed, abandoned, offended, disappointed, having one’s self-concept threatened, being in a boring situation, and being alone. BPD was associated with increased situational triggers. Multilevel models revealed significant within-person associations between situational triggers and BPD symptoms for the average participant in the study, with significant individual variance in the strength and direction of trigger-symptom contingencies. Most trigger-symptom contingencies were stronger for individuals with higher borderline symptomatology, suggesting that triggers are meaningfully related to BPD. These findings highlight possible proximal mechanisms that maintain BPD and help explain the course of a disorder often described as chaotic and unpredictable. PMID:26200848
Amini, Mehdi; Pourshahbaz, Abbas; Mohammadkhani, Parvaneh; Ardakani, Mohammad-Reza Khodaie; Mozhgan LOTFI
Background: The goal of this study was to examine the construct validity of the diagnostic and statistical manual of mental disorder-5 (DSM-5) conceptual model of antisocial and borderline personality disorders (PDs). More specifically, the aim was to determine whether the DSM-5 five-factor structure of pathological personality trait domains replicated in an independently collected sample that differs culturally from the derivation sample. Methods: This study was on a sample of 346 individual...
Mehdi Amini; Abbas Pourshahbaz; Parvaneh Mohammadkhani; Mohammad-Reza Khodaie Ardakani; Mozhgan Lotfi
Background: The goal of this study was to examine the construct validity of the diagnostic and statistical manual of mental disorder-5 (DSM-5) conceptual model of antisocial and borderline personality disorders (PDs). More specifically, the aim was to determine whether the DSM-5 five-factor structure of pathological personality trait domains replicated in an independently collected sample that differs culturally from the derivation sample. Methods: This study was on a sample of 346 indivi...
Mehdi Amini; Abbas Pourshahbaz; Parvaneh Mohammadkhani; Mohammad-Reza Khodaie Ardakani; Mozhgan Lotfi
Background: The goal of this study was to examine the construct validity of the diagnostic and statistical manual of mental disorder-5 (DSM-5) conceptual model of antisocial and borderline personality disorders (PDs). More specifically, the aim was to determine whether the DSM-5 five-factor structure of pathological personality trait domains replicated in an independently collected sample that differs culturally from the derivation sample. Methods: This study was on a sample of 346 indivi...
Full Text Available Background: The goal of this study was to examine the construct validity of the diagnostic and statistical manual of mental disorder-5 (DSM-5 conceptual model of antisocial and borderline personality disorders (PDs. More specifically, the aim was to determine whether the DSM-5 five-factor structure of pathological personality trait domains replicated in an independently collected sample that differs culturally from the derivation sample. Methods: This study was on a sample of 346 individuals with antisocial (n = 122 and borderline PD (n = 130, and nonclinical subjects (n = 94. Participants randomly selected from prisoners, out-patient, and in-patient clients . Participants were recruited from Tehran prisoners, and clinical psychology and psychiatry clinics of Razi and Taleghani Hospital, Tehran, Iran. The SCID-II-PQ, SCID-II, DSM-5 Personality Trait Rating Form (Clinician′s PTRF were used to diagnosis of PD and to assessment of pathological traits. The data were analyzed by exploratory factor analysis. Results: Factor analysis revealed a 5-factor solution for DSM-5 personality traits. Results showed that DSM-5 has adequate construct validity in Iranian sample with antisocial and borderline PDs. Factors similar in number with the other studies, but different in the content. Conclusions: Exploratory factor analysis revealed five homogeneous components of antisocial and borderline PDs. That may represent personality, behavioral, and affective features central to the disorder. Furthermore, the present study helps understand the adequacy of DSM-5 dimensional approach to evaluation of personality pathology, specifically on Iranian sample.
BEAUCHAINE, THEODORE P.; Klein, Daniel N.; Crowell, Sheila E.; Derbidge, Christina; Gatzke-Kopp, Lisa
Although antisocial personality disorder (ASPD) is more common among males and borderline personality disorder (BPD) is more common among females, some (e.g., Paris, 1997) have suggested that the two disorders reflect multifinal outcomes of a single etiology. This assertion is based on several overlapping symptoms and features, including trait impulsivity, emotional lability, high rates of depression and suicide, and a high likelihood of childhood abuse and/or neglect. Furthermore, rates of A...
Wright, Aidan G C; Zalewski, Maureen; Hallquist, Michael N; Hipwell, Alison E; Stepp, Stephanie D
In recent years, major gains toward understanding the emergence of borderline personality disorder (BPD) pathology, which is typically first noted during adolescence, have been made. Simultaneously, a profound shift has occurred in the adult personality pathology literature, in which empirical evidence rebuts the idea that personality disorders (PDs) are intractable disorders that do not develop or otherwise change over time, and therefore cannot be treated. The present study addresses a gap in our understanding of within-person change in BPD symptoms across adolescence and contributes to the limited literature on outcomes associated with adolescent BPD. Using an at-risk community sample of girls (N = 2,450), the authors used bivariate latent growth curve models to analyze the codevelopment of BPD symptoms with eight domains of psychosocial functioning (e.g., academic achievement, social skills, sexual behavior) across ages 14-17. Findings revealed moderate to strong effect sizes for the associations between BPD symptoms and every domain of psychosocial functioning, suggesting that the development of BPD was coupled with poorer outcomes across development. Controlling for depression and conduct disorder features revealed unique associations between BPD and self-perception, social skills, and sexual behavior. These results highlight the increased need for extending advancements in the adult PD literature to research on PDs in adolescence, and for greater recognition of adolescent BPD in clinical settings. PMID:26067158
Both bipolar disorder and borderline personality disorder (BPD) are serious mental health disorders resulting in significant psychosocial morbidity, reduced health-related quality of life, and excess mortality. Yet research on BPD has received much less funding from the National Institute of Health (NIH) than has bipolar disorder during the past 25 years. Why hasn't the level of NIH research funding for BPD been commensurate with the level of psychosocial morbidity, mortality, and health expenditures associated with the disorder? In the present article, the author illustrates how the bipolar disorder research community has done a superior job of "marketing" their disorder. Studies of underdiagnosis, screening, diagnostic spectra, and economics are reviewed for both bipolar disorder and BPD. Researchers of bipolar disorder have conducted multiple studies highlighting the problem with underdiagnosis, developed and promoted several screening scales, published numerous studies of the operating characteristics of these screening measures, attempted to broaden the definition of bipolar disorder by advancing the concept of the bipolar spectrum, and repeatedly demonstrated the economic costs and public health significance of bipolar disorder. In contrast, researchers of BPD have almost completely ignored each of these four issues and research efforts. Although BPD is as frequent as (if not more frequent than) bipolar disorder, as impairing as (if not more impairing than) bipolar disorder, and as lethal as (if not more lethal than) bipolar disorder, it has received less than one-tenth the level of funding from the NIH and has been the focus of many fewer publications in the most prestigious psychiatric journals. The researchers of BPD should consider adopting the strategy taken by researchers of bipolar disorder before the diagnosis is eliminated in a future iteration of the DSM or the ICD. PMID:25893554
Cohen, Lisa J; Tanis, Thachell; Ardalan, Firouz; Yaseen, Zimri; Galynker, Igor
Diagnostic criteria for borderline personality disorder (BPD) and mood and psychotic disorders characterized by major mood episodes (i.e., major depressive, bipolar and schizoaffective disorder) share marked overlap in symptom presentation, complicating differential diagnosis. The current study tests the hypothesis that maladaptive interpersonal schemas (MIS) are characteristic of BPD, but not of the major mood disorders. One hundred psychiatric inpatients were assessed by SCID I, SCID II and the Young Schema Questionnaire (YSQ-S2). Logistic regression analyses tested the association between MIS (measured by the YSQ-S2) and BPD, bipolar, major depressive and schizoaffective disorder. Receiver operator characteristic (ROC) curve analyses assessed the sensitivity and specificity of MIS as a marker of BPD. After covariation for comorbidity with each of the 3 mood disorders, BPD was robustly associated with 4 out of 5 schema domains. In contrast, only one of fifteen regression analyses demonstrated a significant association between any mood disorder and schema domain after covariation for comorbid BPD. ROC analyses of the 5 schema domains suggested Disconnection/Rejection had the greatest power for identification of BPD cases. These data support the specific role of maladaptive interpersonal schemas in BPD and potentially contribute to greater conceptual clarity about the distinction between BPD and the major mood disorders. PMID:27394052
Chapman, Alexander L; Dixon-Gordon, Katherine L
Chapman and Dixon-Gordon were invited to write this commentary, they were concerned that they did not know enough about mentalization to make coherent comments on this interesting series. As it turns out, they were among a shrinking minority, as the past decade has witnessed a surge research on mentalization. Work in this field has been pioneered, in no small part, by the authors of the present issue. Collectively, this set of articles provides a useful summary of the state of mentalization research for the uninitiated and makes a compelling case for mentalization as a key translational construct, particularly with regard to borderline personality disorder (BPD). Mentalization deserves attention in further translational research as well as in treatment refinement for BPD and other clinical problems. Future work should also involve the development of effective, objective ways to assess mentalization. Ultimately, the use of translational constructs to loosen the boundaries between evidence-based treatment approaches may help us move toward more refined, accessible, and effective treatment for BPD and other complex mental health problems. PMID:26436582
Raynal, Patrick; Chabrol, Henri
The aim of the study was to examine the association of schizotypal and borderline personality traits to cannabis use. Participants were 476 college students (95 males; 381 females; mean age of males=21; mean age of females=20.7) who completed self-report questionnaires assessing cannabis use, schizotypal and borderline personality traits. Problematic cannabis use, depressive symptoms, borderline and schizotypal traits were significantly inter-correlated. A logistic regression analysis showed that only borderline traits contributed significantly to cannabis use in the total sample. A multiple regression analysis showed that only schizotypal traits were positively and uniquely associated to problematic cannabis use symptoms among users. These results may imply that schizotypal traits are not a risk factor for initiating use, but may facilitate the development of problematic use symptoms among users. This study showed the necessity of taking into account schizotypal traits when exploring the relationships between depressive symptoms, borderline traits and cannabis use. PMID:27149691
Annemiek van Dijke
Full Text Available Background: Although affect dysregulation is considered a core component of borderline personality disorder (BPD and somatoform disorders (SoD, remarkably little research has focused on the prevalence and nature of affect dysregulation in these disorders. Also, despite apparent similarities, little is known about how dysfunctional under- and overregulation of affect and positive and negative somatoform and psychoform dissociative experiences inter-relate. Prior studies suggest a clear relationship between early childhood psychological trauma and affect dysregulation, especially when the caretaker is emotionally, sexually, or physically abusing the child, but how these relate to under- and overregulation while differentiating for developmental epochs is not clear. Although an elevated risk of childhood trauma exposure or complex posttraumatic stress disorder (CPTSD symptoms has been reported in BPD and SoD, trauma histories, dysfunctional affect regulation, dissociation, PTSD, and CPTSD were never assessed in unison in BPD and/or SoD. Method: BPD and/or SoD diagnoses were confirmed or ruled out in 472 psychiatric inpatients using clinical interviews. Dysfunctional under- and overregulation of affect and somatoform and psychoform dissociation, childhood trauma-by-primary-caretaker (TPC, PTSD, and CPTSD were all measured using self reports. Results: No disorder-specific form of dysfunctional affect regulation was found. Although both BPD and SoD can involve affect dysregulation and dissociation, there is a wide range of intensity of dysfunctional regulation phenomena in patients with these diagnoses. Evidence was found for the existence of three qualitatively different forms of experiencing states: inhibitory experiencing states (overregulation of affect and negative psychoform dissociation most commonly found in SoD, excitatory experiencing states (underregulation of affect and positive psychoform dissociation most commonly found in BPD, and
van Asselt, Antoinette D I; Dirksen, Carmen D; Arntz, Arnoud; Giesen-Bloo, Josephine H; van Dyck, Richard; Spinhoven, Philip; van Tilburg, Willem; Kremers, Ismay P; Nadort, Marjon; Severens, Johan L
BACKGROUND: Schema-focused therapy (SFT) and transference-focused psychotherapy (TFP) for borderline personality disorder were recently compared in a randomised multicentre trial. AIMS: To assess the societal cost-effectiveness of SFT v. TFP in treating borderline personality disorder. METHOD: Costs
Treatment Differences in the Therapeutic Relationship and Introject during a 2-Year Randomized Controlled Trial of Dialectical Behavior Therapy versus Nonbehavioral Psychotherapy Experts for Borderline Personality Disorder
Bedics, Jamie D.; Atkins, David C.; Comtois, Katherine A.; Linehan, Marsha M.
Objective: The present study explored the role of the therapeutic relationship and introject during the course of dialectical behavior therapy (DBT; Linehan, 1993) for the treatment of borderline personality disorder. Method: Women meeting "DSM-IV" criteria for borderline personality disorder (N = 101) were randomized to receive DBT or community…
Stepp, Stephanie D.; Epler, Amee J.; Jahng, Seungmin; Trull, Timothy J.
We assessed the effect of DBT skills utilization on features of borderline personality disorder as measured by the Personality Assessment Inventory-Borderline Features Scale (PAI-BOR). Participants were outpatients (N = 27) enrolled in a dialectical behavior therapy (DBT) program in a university-affiliated community mental health clinic. Diary cards were collected each week to track self-reported skills use. At the beginning of each new skills training module, patients completed another PAI-BOR. Univariate and multilevel analyses indicated significant improvement on the total PAI-BOR score and on several PAI-BOR subscale scores. Results also revealed that overall DBT skills use increased significantly over time, as did individual skills related to mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance. Multilevel modeling results indicated that overall skills use showed a significant effect on PAI-BOR total scores, Affective Instability scores, Identity Problems scores, and Negative Relationships scores, even after controlling for initial levels of distress and diary card compliance. PMID:19072676
Levy, Kenneth N
Borderline personality disorder (BPD) is a highly prevalent, chronic, and debilitating psychiatric problem characterized by a pattern of chaotic and self-defeating interpersonal relationships, emotional lability, poor impulse control, angry outbursts, frequent suicidality, and self-mutilation. Recently, psychopathology researchers and theorists have begun to understand fundamental aspects of BPD such as unstable, intense interpersonal relationships, feelings of emptiness, bursts of rage, chronic fears of abandonment and intolerance for aloneness, and lack of a stable sense of self as stemming from impairments in the underlying attachment organization. These investigators have noted that the impulsivity, affective lability, and self-damaging actions that are the hallmark of borderline personality occur in an interpersonal context and are often precipitated by real or imagined events in relationships. This article reviews attachment theory and research as a means of providing a developmental psychopathology perspective on BPD. Following a brief review of Bowlby's theory of attachment, and an overview of the evidence with respect to the major claims of attachment theory, I discuss individual differences, the evidence that these differences are rooted in patterns of interaction with caregivers, and how these patterns have important implications for evolving adaptations and development. Following this discussion, I present recent work linking attachment theory and BPD, focusing on the implications for understanding the etiology and treatment of BPD. In conclusion, I address some of the salient issues that point to the direction for future research efforts. PMID:16613426
Sansone, Randy A.; Sansone, Lori A.
The assessment and management of chronic pain is challenging and, according to the existing literature, oftentimes associated with various forms of psychopathology, including borderline personality disorder. Since 1994, eight studies have explored the relationship between chronic pain syndromes and borderline personality disorder. In averaging the prevalence rates in these studies, 30 percent of participants with chronic pain harbor this Axis II disorder. Related studies suggest that individu...
Lobbestael, Jill; Arntz, Arnoud
Childhood abuse is an important precursor of borderline personality disorder (BPD) and antisocial personality disorder (ASPD). The current study compared the emotional reactivity to abuse-related stress of these patients on a direct and an indirect level. Changes in self-reported affect and schema modes, psychophysiology and reaction time based cognitive associations were assessed following confrontation with an abuse-related film fragment in patients with BPD (n=45), ASPD (n=21), Cluster C personality disorder (n=46) and non-patient controls (n=36). Results indicated a hyperresponsivity of BPD-patients on self-reported negative affect and schema modes, on some psychophysiological indices and on implicit cognitive associations. The ASPD-group was comparable to the BPD group on implicit cognitions but did not show self-reported and physiological hyper-reactivity. These findings suggest that BPD and ASPD-patients are alike in their implicit cognitive abuse-related stress reactivity, but can be differentiated in their self-reported and physiological response patterns. PMID:19854433
Houben, Marlies; Bohus, Martin; Santangelo, Philip S; Ebner-Priemer, Ulrich; Trull, Timothy J; Kuppens, Peter
In an attempt to better understand the nature of emotion dysregulation in the daily lives of persons with a borderline personality disorder (BPD), Houben et al. (2016) recently identified emotional switching, which refers to the tendency to make large changes between positive and negative emotional states over time, as a possible defining characteristic of the emotion dynamics observed in BPD. The goal of this study was to examine the specificity of these previous findings in 2 samples by comparing BPD patients (N = 43 in sample 1; N = 81 in sample 2) to patients with bulimia nervosa (N = 20), posttraumatic stress disorder (N = 28), or healthy controls (N = 28) in sample 1, and to patients with depressive disorder (N = 50) in sample 2, with respect to measures of emotional switching. Analyses of these 2 experience sampling datasets revealed that contrary to expectations, BPD patients did not differ from the clinical groups regarding their mere tendency to switch between positive and negative emotional states on consecutive moments over time and regarding the magnitude of such changes between positive and negative emotional states over time. However, all clinical groups did differ from healthy controls regarding all switch measures in dataset 1. These results indicate that emotional switching, similar to other more traditional indicators of overall changes in emotional intensity in daily life, might reflect a feature of emotional responding characterizing a range of disorders with mood disturbances. (PsycINFO Database Record PMID:26882282
Hopwood, Christopher J.; Morey, Leslie C.; Edelen, Maria Orlando; Shea, M. Tracie; Grilo, Carlos M.; Sanislow, Charles A.; McGlashan, Thomas H.; Daversa, Maria T.; Gunderson, John G.; Zanarini, Mary C.; Markowitz, John C.; Skodol, Andrew E.
Interview methods are widely regarded as the standard for the diagnosis of borderline personality disorder (BPD), whereas self-report methods are considered a time-efficient alternative. However, the relative validity of these methods has not been sufficiently tested. The current study used data from the Collaborative Longitudinal Personality…
Morton, Jane; Snowdon, Sharon; Gopold, Michelle; Guymer, Elise
A pilot study of a brief group-based Acceptance and Commitment Therapy (ACT) intervention (12 two-hour sessions) was conducted with clients of public mental health services meeting four or more criteria for borderline personality disorder (BPD). Participants were randomly assigned to receive the ACT group intervention in addition to their current…
Harned, Melanie S.; Linehan, Marsha M.
Despite the high rate of trauma and PTSD among individuals with borderline personality disorder (BPD), no studies have specifically evaluated the treatment of PTSD in a BPD population. These case studies illustrate the use of a protocol based on prolonged exposure therapy that can be integrated into standard dialectical behavior therapy to treat…
Spinhoven, Philip; Giesen-Bloo, Josephine; van Dyck, Richard; Kooiman, Kees; Arntz, Arnoud
This study investigated the quality and development of the therapeutic alliance as a mediator of change in schema-focused therapy (SFT) and transference-focused psychotherapy (TFP) for borderline personality disorder. Seventy-eight patients were randomly allocated to 3 years of biweekly SFT or TFP. Scores of both therapists and patients for the…
McGlashan, T H
Schizotypal and borderline personality disorders (SPD and BPD, respectively) appear to be different at follow-up, yet they are poorly discriminated from each other by current DSM-III symptom criteria. In the Chestnut Lodge Follow-up Study, three axis II study cohorts (pure SPD, n = 10; pure BPD, n = 81; mixed SPD/BPD, n = 18) with distinctive outcomes are defined using current borderline systems. This study compares the relative frequency with which individual symptom criteria from each system discriminate across study cohorts. Findings suggest that for SPD, the most characteristic (core) DSM-III symptoms are odd communication, suspiciousness/paranoid ideation, and social isolation, while the least discriminating symptom is illusions/depersonalization/derealization; the core DSM-III symptoms for BPD are unstable relationships, impulsivity, and self-damaging acts, while the least discriminating symptoms are inappropriate anger and intolerance of aloneness; depression as a symptom does not discriminate between SPD and BPD; and transient psychoses and brief paranoid experiences and/or regression in treatment discriminate for SPD but against BPD and therefore fit better as SPD criteria. Results support the retention of some, but the elimination of other, DSM-III symptom criteria for the diagnosis of SPD and BPD. PMID:3813809
Rosenthal, M Zachary; Cheavens, Jennifer S; Lejuez, Carl W; Lynch, Thomas R
The purpose of this study was to examine the relationships among negative affect, childhood sexual abuse (CSA), thought suppression, and diagnostic symptoms of borderline personality disorder (BPD) in a community sample (n=127). Findings suggest that the temperamental variable negative affect intensity/reactivity was a stronger predictor of BPD symptoms than CSA. In addition, results indicated that higher thought suppression mediated the relationship between negative affective intensity/reactivity and BPD symptoms, after controlling for a history of CSA. Overall, findings suggest that (a) negative affectivity may be a better predictor of BPD symptoms than CSA, and (b) chronic efforts to suppress unpleasant thoughts may be a regulation strategy underlying the relationship between intense negative emotions and BPD symptoms. PMID:16005704
Full Text Available Uncontrollable emotional lability and impulsivity are a paramount phenomenon of Borderline Personality Disorder (BPD. This paper aims to review theories that entertain emotion dysregulation as the core deficit of BPD and a key factor in the etiology of BPD, in order, then, to propose the author’s own theory, which arguably transcends certain limitations of the earlier ones. The author asserts that his psychodynamic theory explains the symptoms of BPD more thoroughly and it inspires a more parsimonious interpretation of brain imaging findings. In closing, the author draws implications of the proposed theory for clinical practice. He reports an efficacy study for treatment of emotion dysregulation based on that theory.
Nunes, Paulo Menezes; Wenzel, Amy; Borges, Karinne Tavares; Porto, Cristianne Ribeiro; Caminha, Renato Maiato; de Oliveira, Irismar Reis
Individuals with borderline personality disorder (BPD) often exhibit impulsive and aggressive behavior. The hippocampus and amygdala form part of the limbic system, which plays a central role in controlling such expressions of emotional reactivity. There are mixed results in the literature regarding whether patients with BPD have smaller hippocampal and amygdalar volume relative to healthy controls. To clarify the precise nature of these mixed results, we performed a meta-analysis to aggregate data on the size of the hippocampus and amygdala in patients with BPD. Seven publications involving six studies and a total of 104 patients with BPD and 122 healthy controls were included. A significantly smaller volume was found in both the right and left hippocampi and amygdala of patients with BPD compared to healthy controls. These findings raise the possibility that reduced hippocampal and amygdalar volumes are biological substrates of some symptoms of BPD. PMID:19663654
This study explored registered psychiatric nurses\\' (RPNs\\') interactions and level of empathy towards service users with a diagnosis of borderline personality disorder (BPD). A qualitative approach was used, and 17 RPNs were interviewed using a semistructured interview schedule incorporating the "staff-patient interaction response scale" (SPIRS). Four themes emerged following data analysis: "challenging and difficult," "manipulative, destructive and threatening behaviour," "preying on the vulnerable resulting in splitting staff and other service users," and "boundaries and structure." Additionally, low levels of empathy were evident in the majority of participants\\' responses to the SPIRS. The findings provide further insight on nurses\\' empathy responses and views on caring for service users with BPD and further evidence for the need for training and education for nurses in the care of service users diagnosed with BPD.
Full Text Available This study explored registered psychiatric nurses' (RPNs' interactions and level of empathy towards service users with a diagnosis of borderline personality disorder (BPD. A qualitative approach was used, and 17 RPNs were interviewed using a semistructured interview schedule incorporating the “staff-patient interaction response scale” (SPIRS. Four themes emerged following data analysis: “challenging and difficult,” “manipulative, destructive and threatening behaviour,” “preying on the vulnerable resulting in splitting staff and other service users,” and “boundaries and structure.” Additionally, low levels of empathy were evident in the majority of participants' responses to the SPIRS. The findings provide further insight on nurses' empathy responses and views on caring for service users with BPD and further evidence for the need for training and education for nurses in the care of service users diagnosed with BPD.
Full Text Available Both Emotional Cascade Theory and Linehan's Biosocial Theory suggest dysregulated behaviors associated with Borderline Personality Disorder (BPD emerge, in part, because of cycles of rumination, poor emotional recognition and poor emotion regulation. In this study we examined relationships between rumination, alexithymia, and emotion regulation in predicting dysregulated behaviors associated with BPD (e.g. self-harm, substance use, aggression, and explored both indirect and moderating effects among these variables. The sample comprised 2261 college students who completed self-report measures of the aforementioned constructs. BPD symptoms, stress, family psychological illness, and alexithymia exerted direct effects on behaviors. Symptoms had an indirect effect on behaviors through rumination, alexithymia and emotional dysregulation. In addition, the relationship between symptoms and dysregulated behaviors was conditional on level of rumination and alexithymia. Implications for early identification and treatment of BPD and related behaviors in college settings are discussed.
Meaney, Rebecca; Hasking, Penelope; Reupert, Andrea
Both Emotional Cascade Theory and Linehan's Biosocial Theory suggest dysregulated behaviors associated with Borderline Personality Disorder (BPD) emerge, in part, because of cycles of rumination, poor emotional recognition and poor emotion regulation. In this study we examined relationships between rumination, alexithymia, and emotion regulation in predicting dysregulated behaviors associated with BPD (e.g. self-harm, substance use, aggression), and explored both indirect and moderating effects among these variables. The sample comprised 2261 college students who completed self-report measures of the aforementioned constructs. BPD symptoms, stress, family psychological illness, and alexithymia exerted direct effects on behaviors. Symptoms had an indirect effect on behaviors through rumination, alexithymia and emotional dysregulation. In addition, the relationship between symptoms and dysregulated behaviors was conditional on level of rumination and alexithymia. Implications for early identification and treatment of BPD and related behaviors in college settings are discussed. PMID:27348858
Kanske, Philipp; Schulze, Lars; Dziobek, Isabel; Scheibner, Hannah; Roepke, Stefan; Singer, Tania
Diagnostic criteria for borderline personality disorder (BPD) include instability in identity and interpersonal relationships. Here, we probed whether instability is already present in BPD patients' thoughts about themselves and others. We tested BPD patients (N=27) and healthy controls (N=25) with a mind-wandering task that assesses content and variability of stimulus-independent self-generated thoughts. Multi-level modeling revealed that while BPD patients and healthy controls mind-wander to a similar extent, BPD patients' thoughts are colored predominantly negatively. Most importantly, although their thoughts concerned the self and others as much as in controls, they fluctuated more strongly in the degree to which their thoughts concerned themselves and others and also gave more extreme ratings. Self- and other related thoughts that were more extreme were also more negative in valence. The increased variability supports current conceptualizations of BPD and may account for the instability in identity and interpersonal relationships. PMID:27318635
Dettenborn, Lucia; Kirschbaum, Clemens; Gao, Wei; Spitzer, Carsten; Roepke, Stefan; Otte, Christian; Wingenfeld, Katja
A number of studies have reported on dysfunctions in steroid secretion, including altered cortisol and testosterone levels in borderline personality disorder (BDP) patients compared to healthy controls. The present study extends findings from blood and saliva studies to the cumulative measure of hair steroids. We investigated women with BPD (n=18) and age- and education-matched healthy women (n=17). We did not find differences between BPD patients and healthy women (p=0.40) concerning hair cortisol levels but increased hair testosterone levels among BPD patients compared to controls (p=0.03). These results remained when restricting the analyses to unmedicated patients. Our data indicate altered long-term testosterone but not cortisol levels in females with BPD. Future studies should address the possible impact of altered testosterone on medical illness processes including metabolic syndrome in this population. PMID:27290653
Herr, Nathaniel R; Rosenthal, M Zachary; Geiger, Paul J; Erikson, Karen
Problems with interpersonal functioning and difficulties with emotion regulation are core characteristics of borderline personality disorder (BPD). Little is known, however, about the interrelationship between these areas of dysfunction in accounting for BPD symptom severity. The present study examines a model of the relationship between difficulties with emotion regulation and interpersonal dysfunction in a community sample of adults (n = 124) with the full range of BPD symptoms. Results showed that difficulties with emotion regulation fully mediated the relationship between BPD symptom severity and interpersonal dysfunction. An alternative model indicated that interpersonal problems partially mediated the relationship between difficulties with emotion regulation and BPD symptom severity. These findings support existing theories of BPD, which propose that difficulties with emotion regulation may account for the types of interpersonal problems experienced by individuals with BPD and suggest further examination of the possibility that interpersonal dysfunction may worsen these individuals' difficulties with emotion regulation. PMID:24343962
Gonzalez de Artaza, Maider; Bustamante, Sonia; Orgaz, Pablo; Osa, Luis; Angosto, Virxinia; Valverde, Cristina; Bilbao, Amaia; Madrazo, Arantza; van Os, Jim; Gonzalez-Torres, Miguel Angel
Background Facial emotion recognition (FER) is essential to guide social functioning and behaviour for interpersonal communication. FER may be altered in severe mental illness such as in psychosis and in borderline personality disorder patients. However, it is unclear if these FER alterations are specifically related to psychosis. Awareness of FER alterations may be useful in clinical settings to improve treatment strategies. The aim of our study was to examine FER in patients with severe mental disorder and their relation with psychotic symptomatology. Materials and Methods Socio-demographic and clinical variables were collected. Alterations on emotion recognition were assessed in 3 groups: patients with first episode psychosis (FEP) (n = 64), borderline personality patients (BPD) (n = 37) and healthy controls (n = 137), using the Degraded Facial Affect Recognition Task. The Positive and Negative Syndrome Scale, Structured Interview for Schizotypy Revised and Community Assessment of Psychic Experiences scales were used to assess positive psychotic symptoms. WAIS III subtests were used to assess IQ. Results Kruskal-Wallis analysis showed a significant difference between groups on the FER of neutral faces score between FEP, BPD patients and controls and between FEP patients and controls in angry face recognition. No significant differences were found between groups in the fear or happy conditions. There was a significant difference between groups in the attribution of negative emotion to happy faces. BPD and FEP groups had a much higher tendency to recognize happy faces as negatives. There was no association with the different symptom domains in either group. Conclusions FEP and BPD patients have problems in recognizing neutral faces more frequently than controls. Moreover, patients tend to over-report negative emotions in recognition of happy faces. Although no relation between psychotic symptoms and FER alterations was found, these deficits could contribute to a
Marcos Hirata Soares
de ese sujeto para relacionarse adecuadamente con otras personas; así, es de fundamental importancia que los miembros del equipo de salud analicen sus sentimientos, actitudes e reacciones en relación al comportamiento del cliente, una vez que la relación con esta clientela es considerada una de las más complejas en salud mental.OBJECTIVE: This study had the objective of reviewing, in the literature, the diagnostic criteria and the intervention in personality disorders, Antisocial and Borderline types. METHODS: A manual research was performed in the author's private collection of books, selecting 12 references; other research has been systematically developed in the period 1990-2008, in January 2009, in the Virtual Health Library, selecting 23 papers. RESULTS: Our findings indicated two approaches - one that classifies as an illness, but that needs to review the diagnostic criteria and evaluation, and the second, that classifies them as moral problems. CONCLUSION: Regardless the type of approach, is necessary that nurses enhance their knowledge and understand the difficulty of this subject to relate properly with others; thus, it is crucial that members of the healthcare team examine their feelings, attitudes and reactions related to the client's behavior, since the relationship with this type of customer is considered one of the most complex in the mental health field.
Stepp, Stephanie D; Scott, Lori N; Jones, Neil P; Whalen, Diana J; Hipwell, Alison E
Negative emotionality is a distinguishing feature of borderline personality disorder (BPD). However, this person-level characteristic has not been examined as a marker of vulnerability in the development of this disorder. The current study utilized a multimethod approach to examine the interplay between negative emotional reactivity and cumulative exposure to family adversity on the development of BPD symptoms across 3 years (ages 16-18) in a diverse, at-risk sample of adolescent girls (N = 113). A latent variable of negative emotional reactivity was created from multiple assessments at age 16: self-report, emotion ratings to stressors from ecological assessments across 1 week, and observer-rated negative affectivity during a mother-daughter conflict discussion task. Exposure to family adversity was measured cumulatively between ages 5 and 16 from annual assessments of family poverty, single parent household, and difficult life circumstances. The results from latent growth curve models demonstrated a significant interaction between negative emotional reactivity and family adversity, such that exposure to adversity strengthened the association between negative emotional reactivity and BPD symptoms. In addition, family adversity predicted increasing BPD symptoms during late adolescence. These findings highlight negative emotional reactivity as a marker of vulnerability that ultimately increases risk for the development of BPD symptoms. PMID:25925083
Guitart-Masip, Marc; Pascual, Juan Carlos; Carmona, Susanna; Hoekzema, Elseline; Bergé, Daniel; Pérez, Víctor; Soler, Joaquim; Soliva, Joan Carles; Rovira, Mariana; Bulbena, Antoni; Vilarroya, Oscar
A common approach to study neuronal aspects of emotional reactivity of borderline personality disorder (BPD) is to study the brain response to emotional faces with functional magnetic resonance imaging (fMRI). 10 BPD patients and 10 matched controls were submitted to an emotional discrimination task in which subjects had to identify an emotional face from a neutral face while fMRI data was acquired. BPD patients made more mistakes than controls in the discrimination task when negative faces were involved. The emotional discrimination task activated brain areas that are known to participate in processing of emotional faces (fusiform gyrus, insula and amygdala) regardless of the psychiatric condition. Additionally, BPD showed higher activation than controls in the middle and inferior temporal cortical areas, brain areas that participate in the processing of face features that carry emotional value. Furthermore, activity at this site correlated with impulsivity score in the Zuckerman-Kuhlman Personality Questionnaire. Our findings may be related to cognitive impairment that may be characteristic of the disorder. PMID:19748540
Full Text Available According to popular opinions therapeutic relationship doesn't play a significant role in cognitive-behavioral therapy. Furthermore it is frequently assumed that cognitive therapist doesn't pay attention to processes taking place during the session, focuses solely on a realization of an earlier planned protocol and convinces patient to rational thinking minimizing the role of emotions. Contrary to this beliefs CBT therapists often focus on a therapeutic relationship and use it in a process of treatment. This applies especially to personality disorders. The aim of this paper is to present a therapy falling into the third wave of CBT – dialectical behavior therapy of Marsha Linehan (dialectical behavior therapy – DBT – emphasizing unappreciated and curing aspects of a relationship between patient and therapist. DBT therapist discusses with a patient important matters in their relationship, is responsive and flexible during the session and concentrates on a work with emotions of a patient. In this paper are discussed: the theoretic model of a borderline personality disorder according to DBT, basic assumptions of therapy, contingency management, methods of limits setting, possible difficulties of a therapist and ways of dealing with them.
ZHONG Jie; LEUNG Freedom
@@ Borderline personality disorder (BPD) is a serious Bpersonality disorder characterized by a pervasive pattern of disturbances in mood regulation, impulse control, self-image and interpersonal relationships.1 In the United States, the prevalence of BPD has been estimated at 1%-2% of the general population, 10% of psychiatric outpatients, and 20% of inpatients.2,3 According to the 4th text revision of diagnostic and statistical manual of mental disorders (DSM-Ⅳ-TR),1 about 75% of BPD patients are women. The BPD diagnosis has been associated with heightened risk (8.5% to 10.0% among BPD patients) for completed suicide, a rate almost 50times higher than in the general population.4
Baschnagel, Joseph S.; Coffey, Scott F.; Hawk, Larry W.; Schumacher, Julie A.; Holloman, Garland
This study assessed physiological measures to study emotional dysregulation associated with borderline personality disorder (BPD). Two patient groups, individuals with BPD-only (n = 16) and individuals with BPD and co-occurring Substance Use Disorders (SUDs; n = 35), and a group of healthy controls (n = 45) were shown standardized pictures of varying valance and arousal levels while the affective modification of the startle eye-blink response, heart rate, facial electromyography (EMG; corruga...
Bornovalova, Marina A.; Huibregtse, Brooke M; Hicks, Brian M.; Keyes, Margaret; McGue, Matt; Iacono, William
We used a longitudinal twin design to examine the causal association between sexual, emotional, and physical abuse in childhood (before age 18) and borderline personality disorder (BPD) traits at age 24 using a discordant twin design and biometric modeling. Additionally, we examined the mediating and moderating effects of symptoms of childhood externalizing and internalizing disorders on the link between childhood abuse and BPD traits. Although childhood abuse, BPD traits, and internalizing a...
Rose Diana; Henderson Claire; Sutherby Kim; Leese Morven; Hogg Joanna; Byford Sarah; Barrett Barbara; Flach Clare; Borschmann Rohan; Moran Paul; Slade Mike; Szmukler George; Thornicroft Graham
Abstract Background Borderline Personality Disorder (BPD) is a common mental disorder associated with raised mortality, morbidity and substantial economic costs. Although complex psychological interventions have been shown to be useful in the treatment of BPD, such treatments are expensive to deliver and therefore have limited availability and questionable cost-effectiveness. Less complex interventions are required for the management of BPD. A Joint Crisis Plan (JCP) is a record containing a ...
Simor, Péter; Horváth, Klára
The aim of the study was to review the literature regarding sleep disturbances in Borderline Personality Disorder (BPD) and to relate the reported sleep alterations to the underlying core dimensions of BPD pathology. We present a qualitative and theoretical review regarding the empirical studies that investigated objective and subjective sleep quality in BPD and in different psychiatric conditions showing high co-morbidity with this disorder. We show that disturbed sleep including sleep fragmentation, alterations in Slow Wave Sleep and REM sleep, and dysphoric dreaming are prevalent symptoms in BPD. We provide a framework relating the specific sleep alterations to the core dimensions of BPD pathology in order to clarify the inconsistencies of the different findings. The specific sleep disturbances in BPD seem to be related to different dimensions of psychopathological functioning and may have detrimental consequences on waking affect and cognition. Investigating disturbed sleep in BPD in relation to waking symptoms and underlying neural functioning would shed more light on the nature of this complex disorder. Moreover, a stronger emphasis on sleep disturbances would enrich the treatment protocols of BPD. PMID:23574575
Schredl, Michael; Paul, Franc; Reinhard, Iris; Ebner-Priemer, Ulrich Walter; Schmahl, Christian; Bohus, Martin
Previous research has demonstrated disturbances in sleep continuity in subjects with borderline personality disorders (BPD). Moreover, depression-like sleep abnormalities like reduced REM latency have been found in BPD subjects, even without comorbid major depression disorder. Yet it is still unknown what the effect is of co-morbid posttraumatic stress disorder on sleep continuity and dream content in BPD patients group. The present study compared 27 unmedicated female BPD subjects and healthy controls. The patients exhibited increased sleep fragmentation, increased REM density, and reduced REM latency. The findings were independent from co-morbid posttraumatic stress response (PTSD), which was present in 33% of the patient sample. Negatively toned dreams obtained by REM awakenings and nightmares were also reported more often by the patients-also irrespective of co-morbid PTSD-whereas dreams of specific BPD behavior, like self-mutilation, were rare. Taking these finding into account, one might productively investigate whether the sleep abnormalities improve during successful treatment of BPD and whether efficient methods for treating nightmares can be beneficial for this patient group. PMID:22657954
Sauer, Christina; Arens, Elisabeth A; Stopsack, Malte; Spitzer, Carsten; Barnow, Sven
Heightened emotional reactivity is one of the core features of borderline personality disorder (BPD). However, recent findings could not provide evidence for a general emotional hyper-reactivity in BPD. The present study examines the emotional responding to self-relevant pictures in dependency of the thematic category (e.g., trauma, interpersonal interaction) in patients with BPD. Therefore, women with BPD (n=31), women with major depression disorder (n=29) and female healthy controls (n=33) rated pictures allocated to thematically different categories (violence, sexual abuse, interaction, non-suicidal self-injury, and suicide) regarding self-relevance, arousal, valence and the urge of non-suicidal self-injury. Compared to both control groups, patients with BPD reported higher self-relevance regarding all categories, but significantly higher emotional ratings only for pictures showing sexual abuse and interpersonal themes. In addition, patients with BPD and comorbid posttraumatic stress disorder showed higher emotional reactivity in violence pictures. Our data provide clear evidence that patients with BPD show a specific emotional hyper-reactivity with respect to schema-related triggers like trauma and interpersonal situations. Future studies are needed to investigate physiological responses to these self-relevant themes in patients with BPD. PMID:25066960
Bellino, Silvio; Brunetti, Chiara; Bozzatello, Paola
Borderline personality disorder (BPD) represents a significant therapeutic challenge. Critical factors in psychotherapeutic treatment of patients with BPD are noticeable and strictly related to the psychopathological dimensions of this disorder: affective and relational instability, behavioral impulsivity and precarious definition of identity. These features are emphasized by therapeutic intervention and become evident during the course of the treatment. Psychotherapeutic setting induces BPD patient to actualize the dysfunctional relational patterns that have been acquired during childhood. Specific critical factors concern the characteristics of the patient (risk of suicide, aggressive behaviors, chronic course of the disorder, disorganized attachment style), of the therapist (therapeutic skills, training, countertransference, risk of burnout) and of the setting of psychotherapy (patients selection, therapeutic alliance, need to set limits, duration and end of therapy). In Otto Kernberg's and Marsha Linehan's models of psychotherapy specific for DBP the authors identify substantially overlapping objectives and modalities of intervention. In particular, therapists should take care of patient safety, maintain boundaries of therapeutic setting and promote the development of psychotherapeutic process. The aim of this article is to analyze the main critical factors affecting psychotherapeutic process in patients with BPD. Objectives and priorities that therapist should consider to address these issues will be discussed. We will also try to make clear why interpersonal psychotherapy adapted to DBP can represent one of the therapeutic models that may be useful to manage and resolve these difficulties. PMID:27030345
Full Text Available Background: There has been debate regarding whether Complex Posttraumatic Stress Disorder (Complex PTSD is distinct from Borderline Personality Disorder (BPD when the latter is comorbid with PTSD. Objective: To determine whether the patterns of symptoms endorsed by women seeking treatment for childhood abuse form classes that are consistent with diagnostic criteria for PTSD, Complex PTSD, and BPD. Method: A latent class analysis (LCA was conducted on an archival dataset of 280 women with histories of childhood abuse assessed for enrollment in a clinical trial for PTSD. Results: The LCA revealed four distinct classes of individuals: a Low Symptom class characterized by low endorsements on all symptoms; a PTSD class characterized by elevated symptoms of PTSD but low endorsement of symptoms that define the Complex PTSD and BPD diagnoses; a Complex PTSD class characterized by elevated symptoms of PTSD and self-organization symptoms that defined the Complex PTSD diagnosis but low on the symptoms of BPD; and a BPD class characterized by symptoms of BPD. Four BPD symptoms were found to greatly increase the odds of being in the BPD compared to the Complex PTSD class: frantic efforts to avoid abandonment, unstable sense of self, unstable and intense interpersonal relationships, and impulsiveness. Conclusions: Findings supported the construct validity of Complex PTSD as distinguishable from BPD. Key symptoms that distinguished between the disorders were identified, which may aid in differential diagnosis and treatment planning.
Full Text Available BACKGROUND: Symptom improvement in Borderline Personality Disorder (BPD is more common than previously hypothesised. However, it remains unclear whether it reflects service users' personal goals of recovery. The present study aimed to explore what service users with BPD view as recovery. METHODS: 48 service users were recruited from secondary mental health services and their views on their personal goals and the meaning of recovery were explored in in-depth semi-structured interviews. The study drew on grounded theory and thematic analysis. RESULTS: Service users believed that recovery involved developing self-acceptance and self-confidence, gaining control over emotions, improving relationships, employment, and making progress in symptoms like suicidality and self-harming. They felt that psychotherapies for BPD often had an extreme focus on specific areas, like self-harming or relationships, and that some of their goals were neglected. Although full recovery was seen as a distant goal, interviewees felt that they could learn how to deal with their problems in more effective ways and make meaningful progress in their lives. CONCLUSIONS: Specialist therapies for BPD explicitly address some of the recovery goals that are important to service users, whereas other goals are only indirectly or poorly addressed. Professionals might need to work with service users towards devising comprehensive individualised case formulations, including all treatment targets that are important to service users, their priorities, and long-term plans on how their targets might be met and which services might be involved.
Splitting is defined from a viewpoint of experiencing time as an 'episodic loss or sudden shift of experiencing time induced by two opposing representational groups'. According to this definition splitting phenomena are examined in four cases arranged on a spectrum from multiple personality and hysteria to borderline personality disorder (BPD). The degree of splitting was most prominent in BPD. In Contrast to the hypermnesia associated with hysteria, that of BPD had the potential to develop into paranoia. Splitting phenomena were considered to operate as a defense mechanism against the development to paranoia. In all four cases it could be seen that the overflow of 'parole', corresponding to the hypermnesia, could not be fruitfully conceptualized due to the splitting phenomena. Assuring new integration was indispensable to the therapy of the four presented cases. PMID:8190843
Nicol, K; Pope, M; Romaniuk, L; Hall, J
Childhood trauma is believed to contribute to the development of borderline personality disorder (BPD), however the mechanism by which childhood trauma increases risk for specific symptoms of the disorder is not well understood. Here, we explore the relationship between childhood trauma, brain activation in response to emotional stimuli and psychotic symptoms in BPD. Twenty individuals with a diagnosis of BPD and 16 healthy controls were recruited to undergo a functional MRI scan, during which they viewed images of faces expressing the emotion of fear. Participants also completed the childhood trauma questionnaire (CTQ) and a structured clinical interview. Between-group differences in brain activation to fearful faces were limited to decreased activation in the BPD group in the right cuneus. However, within the BPD group, there was a significant positive correlation between physical abuse scores on the CTQ and BOLD signal in the midbrain, pulvinar and medial frontal gyrus to fearful (versus neutral) faces. In addition there was a significant correlation between midbrain activation and reported psychotic symptoms in the BPD group (P<0.05). These results show that physical abuse in childhood is, in individuals with BPD, associated with significantly increased activation of a network of brain regions including the midbrain in response to emotional stimuli. Sustained differences in the response of the midbrain to emotional stimuli in individuals with BPD who suffered childhood physical abuse may underlie the vulnerability of these patients to developing psychotic symptoms. PMID:25942040
Martín-Blanco, Ana; Patrizi, Barbara; Villalta, Laia; Gasol, Xero; Soler, Joaquim; Gasol, Miquel; Pascual, Juan C
Many individuals with borderline personality disorder (BPD) receive medical treatment in clinical practice, although to date, there are no drugs specifically available for BPD. The recent Cochrane guideline suggests a benefit from using second-generation antipsychotics such as olanzapine or aripiprazole; nevertheless, side effects limit their use. Asenapine is a novel FDA-approved atypical antipsychotic for schizophrenia and bipolar disorder. However, it has not yet been tested for BPD. The goal of this observational open-label study was to assess the safety, tolerability and efficacy of asenapine in a series of cases of patients with BPD. Twelve individuals with BPD were recruited and treated with asenapine during an 8-week period. Eight individuals completed the study; a significant improvement was observed in the CGI-BPD (P<0.001) and BSL-23 (P<0.048) scales for BPD symptomatology. Besides, there was a significant improvement in the general psychopathology domains (BPRS, P<0.004), whereas no significant differences were observed in depressive symptoms. No serious adverse effects were reported and a significant weight reduction was observed (P=0.002). Asenapine appears to be a safe and effective agent in the treatment of patients with BPD, especially when other alternatives are not tolerated. These preliminary findings should be replicated in a controlled clinical trial. PMID:23962963
Berthoud, Laurent; Kramer, Ueli; de Roten, Yves; Despland, Jean-Nicolas; Caspar, Franz
A comprehensive understanding of the patient's problems is essential for a constructive therapeutic behaviour, especially in borderline personality disorder (BPD) where difficult interpersonal patterns are persistent. In these circumstances, the use of an integrative case formulation approach such as Plan Analysis, developed by K. Grawe and F. Caspar, can be of help for therapy planning. The focus here is on instrumental relations between behaviours and the hypothetical Plans and motives 'behind' those behaviours. The present qualitative study aimed at setting a prototypical Plan structure for n = 15 patients presenting a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnosis of BPD using Plan Analysis. The first psychotherapeutic session of every outpatient was video-taped and evaluated according to the Plan Analysis procedure. Inter-rater reliability was established between two independent raters and was considered sufficient. The detailed prototypical Plan structure of BPD showed two main tendencies: first, the important presence of support-seeking among these patients and second, the will to be in control and to protect oneself. This study confirms the existence of several core similarities in the functioning of patients with BPD. These findings are in line with earlier studies and expand the latter with the aim of contributing to the understanding of BPD psychopathology. Clinical implications are discussed. PMID:21882297
Helleman, Marjolein; Goossens, Peter J J; Kaasenbrood, Ad; van Achterberg, Theo
Brief admission is a crisis intervention for patients with borderline personality disorder (BPD), and refers to a clinical admission at a psychiatric hospital for a period of 1-5 nights. Patients formulate a treatment plan together with their community mental health nurse about the maximum frequency allowed for these brief admissions. The purpose of the study was to describe the lived experiences of patients with BPD with use of the brief admission intervention. The study used a phenomenological approach. Inclusion criteria were a diagnosis of BPD, according to the Diagnostic and Statistical Manual of Mental Disorders-IV criteria; experience with brief admission, and sufficient understanding of the Dutch language. A total of 16 female patients and one male patient participated in the study. Thematic analysis of the transcripts of the interviews revealed four major meaning units: (i) organization of the brief admission; (ii) contact with a nurse; (iii) time out from daily life; and (iv) experienced value for the patient. Patients highlighted the quality of the contact with a nurse as the most important aspect of the brief admission. Nurses should be aware of the importance of connecting with patients who have BPD during a brief admission, particularly in light of the interpersonal hypersensitivity that characterizes these patients. PMID:24890615
Ruocco, Anthony C
Complaints of cognitive dysfunction are common in patients with borderline personality disorder (BPD), and they are often accompanied by deficits on neuropsychological testing. Prior studies of BPD, however, did not evaluate compliance on neuropsychological performance validity testing, which could partially account for cognitive deficits observed in patients. The aims of the current study were to evaluate the frequency at which patients with BPD show less than adequate compliance on performance validity testing, and whether patients showing less compliance perform lower on standardized neuropsychological measures. Fifty outpatients with BPD completed the Victoria Symptom Validity Test, a 2-alternative, forced-choice recognition test as part of a larger neuropsychological test battery for research on cognitive functioning in BPD. As a group, patients with BPD made more errors and had longer response latencies on seemingly difficult items as compared to healthy individuals. Based on established guidelines for interpretation of performances on the Victoria Symptom Validity Test, 2% of the sample was classified as probably not compliant, 10% questionably compliant, and 88% compliant. Patients with questionably or probably not compliant performances had lower estimated premorbid intellectual functioning and displayed poorer response control on neuropsychological testing than compliant patients. These findings highlight the value of incorporating performance validity testing in neuropsychological studies of patients with BPD and suggest that prior research on the disorder should be interpreted with caution because the results may not be based on valid performances. (PsycINFO Database Record PMID:26121384
van Eijk, Julia; Sebastian, Alexandra; Krause-Utz, Annegret; Cackowski, Sylvia; Demirakca, Traute; Biedermann, Sarah V; Lieb, Klaus; Bohus, Martin; Schmahl, Christian; Ende, Gabriele; Tüscher, Oliver
Impulsivity is central to borderline personality disorder (BPD). Response inhibition, addressing the ability to suppress or stop actions, is one aspect of behavioral impulse control which is frequently used to assess impulsivity. BPD patients display deficits in response inhibition under stress condition or negative emotions. We assessed whether response inhibition and its neural underpinnings are impaired in BPD when tested in an emotionally neutral setting and when co-morbid attention-deficit/hyperactivity disorder (ADHD) is excluded. To this end, we studied response inhibition in unmedicated BPD patients and healthy controls (HC) in two independent samples using functional magnetic resonance imaging during Simon-, Go/nogo-, and Stopsignal tasks. BPD patients and HC did not differ significantly in their performance in the Go/nogo and the Stopsignal tasks. Response interference in the Simon task was increased in BPD patients in one sample, but this could not be replicated in the second sample. In both samples, no significant differences in brain activation patterns during any of the tasks were present while the neural impulse control network was robustly activated during the inhibition tasks in both groups. Our results provide evidence that under emotionally neutral conditions response inhibition is not impaired in patients with BPD without co-occurring ADHD. PMID:26483213
Selby, Edward A; Anestis, Michael D; Bender, Theodore W; Joiner, Thomas E
The emotional cascade model proposes that the emotional and behavioral dysregulation of individuals with borderline personality disorder (BPD) may be fundamentally linked through emotional cascades, vicious cycles of intense rumination and negative affect that may induce aversive emotional states. In order to reduce this aversive emotion, dysregulated behaviors such as non-suicidal self-injury may then be used as distractions from intense rumination. This study explored emotional cascades in a sample enriched with participants meeting diagnostic criteria for BPD. The first part of the study explored a structural equation model that examined the mediational effects of emotional cascades on the relationship between BPD symptoms and dysregulated behavior and found evidence for full mediation, even after controlling for symptoms of depression and other Cluster B disorders. The second part of the study examined the effects of a rumination induction conducted with the intention of eliciting emotional cascades in those diagnosed with BPD. The results demonstrated that individuals with BPD experienced greater reactivity and intensity of negative affect, but not of positive affect, following the procedure-even when controlling for current depressive symptoms. Future directions and clinical implications for the emotional cascade model are discussed. PMID:19413411
Leppänen, Virpi; Kärki, Anna; Saariaho, Tom; Lindeman, Sari; Hakko, Helinä
Borderline personality disorder (BPD) is a relatively common and severe psychiatric disorder that can impair quality of life in many ways. The aim of this study was to determine whether a combined treatment model for BPD patients, utilising major principles from schema-focused therapy (SFT) and dialectical behavioral therapy (DBT), could be more effective in relieving early maladaptive schemas of BPD patients, compared to treatment as usual (TAU). This study is a part of the Oulu BPD study conducted at mental health care services run by Oulu city social and health care services. The study is a multisite, randomized controlled trial conducted over a one year period, involving two groups of patients with severe BPD: (1) Community Treatment By Experts (CTBE) patients (n = 18) receiving the combined treatment model, and 2) TAU patients (n = 27). The patients' schemas were assessed using the Young Schema Questionnaire (YSQ-L3a) before and after one year of treatment. The results reveal that CTBE patients who attended the combined treatment model showed a statistically significant reduction in eight out of 18 early maladaptive schemas, while patients receiving treatment as usual did not demonstrate any significant changes in schemas. The cognitive therapeutic treatment model can be applied for clinical use in public mental health settings using existing professionals, and appears to produce positive changes in patients with BPD. PMID:25358652
Lawn, S; McMahon, J
There is limited understanding of the experience of family carers of people diagnosed with borderline personality disorder (BPD). This study aimed to explore their experiences of being carers, their attempts to seek help for the person diagnosed with BPD and their own carer needs. An invitation to participate in an online survey was distributed to carers across multiple consumer and carer organizations and mental health services, by the Private Mental Health Consumer Carer Network (Australia) in 2011. Responses from 121 carers showed that they experience significant challenges and discrimination when attempting to engage with and seek support from health services. Comparison with consumers' experiences (reported elsewhere) showed that these carers have a clear understanding of the discrimination faced by people with this diagnosis, largely because they also experience exclusion and discrimination. Community carer support services were perceived as inadequate. General practitioners were an important source of support; however, they and other service providers need more education and training to support attitudinal change to address discrimination, recognize carers' needs and provide more effective support. This study provides the first detailed account of BPD carers' experiences across a broad range of support needs and interactions with community support and health services. PMID:25857849
Gravitt, Wendy Jones
This exploratory study was designed to determine if three people with the diagnosis of Borderline Personality Disorder (BPD) viewed religion in characteristic and unique ways. The data was analyzed using Object Relations Theory, Attachment Theory, and an integrated cognitive, affect, and object relations theory. I concluded that the participants shared a faith style that resulted from an early developmental failure and that their image and response to God and the moral universe were a re-enactment of the dysfunctional mother/infant dyad. Specifically, God's character was seen as (1) self-evident and inescapable and (2) stationary and large. God was envisioned (3) as a person who is (4) magical; (5) inexplicable, and therefore, unreliable. Participants believed that (6) God's task was to provide and that (7) God created a moral universe. Their responses had an intense and desperate quality, were typified by ambivalence, and emphasized a power differential. Finally, the women's relationship with God took the form of a deal: if she was dependent, then God would provide. The interface between BPD and psychological and spiritual well-being is discussed and a tentative application of the findings is made to the field of mental health nursing. I suggest that an understanding of BPD religious constructs and the sensitive application of a few principles can contribute to the spiritual and psychological well-being of the BPD inpatient. PMID:21574844
Scott, Lori N; Levy, Kenneth N; Granger, Douglas A
Several clinical theories propose that borderline personality disorder (BPD) is characterized by a biologically based affective vulnerability to intense affective experiences and impaired modulation of affective states, which might manifest in high emotional intensity, hyperreactivity, and impaired recovery to baseline. However, few studies have tested these theories based on emotional and biological responses of BPD participants in response to psychosocial stressors. This study examined cortisol, alpha-amylase, and subjective emotional reactivity to social evaluative stress among women with BPD compared with two healthy female control groups: a trait-matched (TM) group scoring similarly to the BPD group on trait measures of negative affect and impulsivity, and a non-trait-matched (NTM) group. Results generally suggested high emotional intensity and high baseline psychobiological arousal among individuals with BPD, but not emotional hyperreactivity or impaired recovery specific to the stressor. Relative to both control groups, BPD participants had higher baseline and overall subjective negative affect, higher baseline cortisol levels, and attenuated stress-related cortisol reactivity. In addition, both the BPD and TM groups had attenuated alpha-amylase reactivity in comparison to the NTM group. The differences between BPD and TM groups on most of the dependent measures suggest that emotional dysregulation in BPD is not merely an extreme variant of normative personality traits. These results suggest that women with BPD demonstrate intense and chronic negative affectivity along with high resting psychobiological arousal and attenuated psychobiological reactivity specific to laboratory stressors. PMID:23244772
Rizvi, Shireen L.; Dimeff, Linda A.; Skutch, Julie; Carroll, David; Linehan, Marsha M.
Dialectical behavior therapy (DBT) has received strong empirical support and is practiced widely as a treatment for borderline personality disorder (BPD) and BPD with comorbid substance use disorders (BPD-SUD). Therapeutic success in DBT requires that individuals generalize newly acquired skills to their natural environment. However, there have…
Mellesdal, Liv; Gjestad, Rolf; Johnsen, Erik; Jørgensen, Hugo A; Oedegaard, Ketil J; Kroken, Rune A; Mehlum, Lars
We investigated whether posttraumatic stress disorder (PTSD) was predictor of suicidal behavior even when adjusting for comorbid borderline personality disorder (BPD) and other salient risk factors. To study this, we randomly selected 308 patients admitted to a psychiatric hospital because of suicide risk. Baseline interviews were performed within the first days of the stay. Information concerning the number of self-harm admissions to general hospitals over the subsequent 6 months was retrieved through linkage with the regional hospital registers. A censored regression analysis of hospital admissions for self-harm indicated significant associations with both PTSD (β = .21, p treatment targets for a reduction in the risk of severe self-harm in high-risk psychiatric patients. PMID:26581019
Martinho, Eduardo; Frankenburg, Frances R.; Fitzmaurice, Garrett M.; Zanarini, Mary C.
The use of PRN (as-needed) psychotropic medication in borderline patients has not been well characterized. This study had three purposes: (i) to describe the prevalence of PRN psychotropic medication use among borderline patients and other personality-disordered comparison subjects over 14 years of prospective follow-up; (ii) to examine the rates reported by ever-recovered and never-recovered borderline patients; and (iii) to examine the reasons for taking PRN medication reported by these pat...
Annemiek van Dijke
Full Text Available Affect regulation is often compromised as a result of early life interpersonal traumatization and disruption in caregiving relationships like in situations where the caretaker is emotionally, sexually or physically abusing the child. Prior studies suggest a clear relationship between early childhood attachment-related psychological trauma and affect dysregulation. We evaluated the relationship of retrospectively recalled childhood traumatization by primary caretaker(s (TPC and affect dysregulation in 472 adult psychiatric patients diagnosed with borderline personality disorder (BPD, somatoform disorder (SoD, both BPD and SoD, or disorders other than BPD or SoD, using the Bermond-Vorst Alexithymia Questionnaire, the self-report version of the Structured Interview for Disorders of Extreme Stress, the Self-rating Inventory for Posttraumatic Stress Disorder (SRIP and the Traumatic Experiences Checklist. Almost two-thirds of participants reported having experienced childhood TPC, ranging from approximately 50% of patients with SoD or other psychiatric disorders to more than 75% of patients with comorbid BPD + SoD. Underregulation of affect was associated with emotional TPC and TPC occurring in developmental epoch 0–6 years. Over-regulation of affect was associated with physical TPC. Childhood trauma by a primary caretaker is prevalent among psychiatric patients, particularly those with BPD, and differentially associated with underand over-regulation of affect depending on the type of traumatic exposure.For the abstract or full text in other languages, please see Supplementary files under Reading Tools online
Helleman, M.; Goossens, P.J.J.; Kaasenbrood, A.; Achterberg, T. van
PURPOSE: To review the available evidence-based literature on the components of brief inpatient psychiatric hospital admission as an intervention for patients with borderline personality disorder. DESIGN AND METHOD: Systematic literature search, narrative literature review. Content analysis. FINDING
Adler, Jonathan M.; Chin, Erica D.; Kolisetty, Aiswarya P.; Oltmanns, Thomas F.
While identity disturbance has long been considered one of the defining features of Borderline Personality Disorder (BPD), the present study marks only the third empirical investigation to assess it and the first to do so from the perspective of research on narrative identity. Drawing on the rich tradition of studying narrative identity, the present study examined identity disturbance in a group of 40 mid-life adults, 20 with features of BPD and a matched sample of 20 without BPD. Extensive l...
Neacsiu, Andrada D.; Lungu, Anita; Harned, Melanie S.; Rizvi, Shireen L.; Linehan, Marsha M.
Evidence suggests that heightened negative affectivity is a prominent feature of Borderline Personality Disorder (BPD) that often leads to maladaptive behaviors. Nevertheless, there is little research examining treatment effects on the experience and expression of specific negative emotions. Dialectical Behavior Therapy (DBT) is an effective treatment for BPD, hypothesized to reduce negative affectivity (Linehan, 1993a). The present study analyzes secondary data from a randomized controlled t...
Sandra Preißler; Isabel Dziobek; Kathrin Ritter; Heekeren, Hauke R.; Stefan Roepke
Disturbed relatedness is a core feature of borderline personality disorder (BPD), and impaired social cognition or deficits in “mentalization” are hypothesized to underlie this feature. To date, only weak empirical evidence argues for impairment in the recognition of emotions, thoughts, or intentions in BPD. Data from facial emotion recognition research indicate that these abilities are altered in BPD only if tasks are complex. The present study aims to assess social cognitive abilities in BP...
Silvers, JA; Hubbard, AD; Biggs, E; Shu, J.; Fertuck, E; Chaudhury, S.; Grunebaum, MF; Weber, J.; Kober, H; Chesin, M; Brodsky, BS; Koenigsberg, H; Ochsner, KN; Stanley, B.
The present neuroimaging study investigated two aspects of difficulties with emotion associated with Borderline Personality Disorder (BPD): affective lability and difficulty regulating emotion. While these two characteristics have been previously linked to BPD symptomology, it remains unknown whether individual differences in affective lability and emotion regulation difficulties are subserved by distinct neural substrates within a BPD sample. To address this issue, sixty women diagnosed with...
Winter, Dorina; Herbert, Cornelia; Koplin, Katrin; Schmahl, Christian; Bohus, Martin; Lis, Stefanie
Previous research has suggested that patients meeting criteria for borderline personality disorder (BPD) display altered self-related information processing. However, experimental studies on dysfunctional self-referential information processing in BPD are rare. In this study, BPD patients (N = 30) and healthy control participants (N = 30) judged positive, neutral, and negative words in terms of emotional valence. Referential processing was manipulated by a preceding self-referential pronoun, an other-referential pronoun, or no referential context. Subsequently, patients and participants completed a free recall and recognition task. BPD patients judged positive and neutral words as more negative than healthy control participants when the words had self-reference or no reference. In BPD patients, these biases were significantly correlated with self-reported attributional style, particularly for negative events, but unrelated to measures of depressive mood. However, BPD patients did not differ from healthy control participants in a subsequent free recall task and a recognition task. Our findings point to a negative evaluation bias for positive, self-referential information in BPD. This bias did not affect the storage of information in memory, but may be related to self-attributions of negative events in everyday life in BPD. PMID:25612212
Williams, Gregory E; Daros, Alexander R; Graves, Bryanna; McMain, Shelley F; Links, Paul S; Ruocco, Anthony C
Risk for potentially lethal self-injurious behavior in borderline personality disorder (BPD) may be associated with deficits in neuropsychological functions and social cognition. In particular, individuals with BPD engaging in more medically damaging self-injurious behaviors may have more severe executive function deficits and altered emotion perception as compared to patients engaging in less lethal acts. In the current study, 58 patients with BPD reporting a lifetime history of self-injurious behavior were administered neuropsychological measures of response inhibition, planning and problem-solving,and tests of facial emotion recognition and discrimination. Patients who engaged in more medically lethal self-injurious behaviors reported engaging in impulsive behaviors more frequently and displayed neuropsychological deficits in problem-solving and response inhibition. They were also less accurate in recognizing happy facial expressions and in discerning subtle differences in emotional intensity in sad facial expressions. These findings suggest that patients with BPD that engage in more physically damaging self-injurious behaviors may have greater difficulties with behavioral control and employ less efficient problem-solving strategies. Problems in facial emotion recognition and discrimination may contribute to interpersonal difficulties in patients with BPD who self-injure. PMID:25602784
Fitzpatrick, Skye; Kuo, Janice R
Basic emotion theory suggests that the effectiveness of different emotion regulation strategies vary with the intensity of the emotionally-salient stimulus. Although findings from studies using healthy samples are concordant with what is proposed by theory, it is unclear whether these relationships hold true among individuals with borderline personality disorder (BPD). Twenty-five individuals with BPD and 30 HCs were exposed to negative images of varying levels of emotional arousal and were instructed to either react as they normally would, distract, or use mindful awareness. Self-reported negativity ratings, heart rate, and skin conductance level (SCL) were monitored throughout. SCL data indicated that increases in image arousal resulted in larger reductions in SCL when distracting but not when implementing mindful awareness. Self-report data suggested that, in HCs, the effectiveness of mindful awareness decreased to a greater extent than distraction when image arousal increased. These findings are consistent with basic emotion research and suggest that some forms of emotion regulation (distraction) are more suited to high emotion arousal contexts than others (mindful awareness) and that, compared with HCs, individuals with BPD may be more resilient to the deteriorating effectiveness of mindful awareness with respect to increasing emotional arousal. PMID:27203152
Full Text Available Previous research has suggested that patients meeting criteria for borderline personality disorder (BPD display altered self-related information processing. However, experimental studies on dysfunctional self-referential information processing in BPD are rare. In this study, BPD patients (N = 30 and healthy control participants (N = 30 judged positive, neutral, and negative words in terms of emotional valence. Referential processing was manipulated by a preceding self-referential pronoun, an other-referential pronoun, or no referential context. Subsequently, patients and participants completed a free recall and recognition task. BPD patients judged positive and neutral words as more negative than healthy control participants when the words had self-reference or no reference. In BPD patients, these biases were significantly correlated with self-reported attributional style, particularly for negative events, but unrelated to measures of depressive mood. However, BPD patients did not differ from healthy control participants in a subsequent free recall task and a recognition task. Our findings point to a negative evaluation bias for positive, self-referential information in BPD. This bias did not affect the storage of information in memory, but may be related to self-attributions of negative events in everyday life in BPD.
Winter, Dorina; Krause-Utz, Annegret; Lis, Stefanie; Chiu, Chui-De; Lanius, Ruth A; Schriner, Friederike; Bohus, Martin; Schmahl, Christian
Evidence is heterogeneous regarding whether patients with borderline personality disorder (BPD) display disturbed emotional inhibition in the emotional Stroop task. Previous findings suggest that state dissociation may influence cognitive inhibition of task-irrelevant material, particularly with negative content. Our aim was to examine performance in an emotional Stroop task including negative, neutral, and positive words in BPD patients and healthy controls during functional magnetic resonance imaging. In advance, half of the BPD patients underwent a dissociation induction using script-driven imagery. BPD patients without dissociation induction showed behavioural performance comparable to that of healthy controls but displayed stronger neural responses, especially to positive stimuli, in the superior temporal gyrus, dorsomedial prefrontal cortex, and anterior cingulate cortex. BPD patients with dissociation induction showed overall slower and less accurate responses as well as increased reaction times for negative versus neutral words compared with BPD patients without dissociation induction. Moreover, they showed comparatively decreased neuronal activity in the fusiform gyrus and parietal cortices independent of valence, but elevated activity in the left inferior frontal gyrus in response to negative versus neutral words. In conclusion, experimentally induced dissociation in BPD was associated with inefficient cognitive inhibition, particularly of negative stimuli, in the emotional Stroop task. PMID:26254542
Krause-Utz, Annegret; Keibel-Mauchnik, Jana; Ebner-Priemer, Ulrich; Bohus, Martin; Schmahl, Christian
Previous research suggests disturbed emotional learning and memory in borderline personality disorder (BPD). Studies investigating the neural correlates of aversive differential delay conditioning in BPD are currently lacking. We aimed to investigate acquisition, within-session extinction, between-session extinction recall, and reacquisition. We expected increased activation in the insula, amygdala, and anterior cingulate, and decreased prefrontal activation in BPD patients. During functional magnetic resonance imaging, 27 medication-free female BPD patients and 26 female healthy controls (HC) performed a differential delay aversive conditioning paradigm. An electric shock served as unconditioned stimulus, two neutral pictures as conditioned stimuli (CS+/CS-). Dependent variables were blood-oxygen-level-dependent response, skin conductance response (SCR), and subjective ratings (valence, arousal). No significant between-group differences in brain activation were found [all p(FDR) > 0.05]. Within-group comparisons for CS+unpaired > CS- revealed increased insula activity in BPD patients but not in HC during early acquisition; during late acquisition, both groups recruited fronto-parietal areas [p(FDR) CS during extinction. During extinction recall, there was a trend for stronger SCR to CS+ > CS in BPD patients. Amygdala habituation to CS+paired (CS+ in temporal contingency with the aversive event) during acquisition was found in HC but not in patients. Our findings suggest altered temporal response patterns in terms of increased vigilance already during early acquisition and delayed extinction processes in individuals with BPD. PMID:25814470
Bellino, Silvio; Bozzatello, Paola; Rinaldi, Camilla; Bogetto, Filippo
Antipsychotics are recommended for the treatment of impulsive dyscontrol and cognitive perceptual symptoms of borderline personality disorder (BPD). Three reports supported the efficacy of oral risperidone on BPD psychopathology. Paliperidone ER is the metabolite of risperidone with a similar mechanism of action, and its osmotic release reduces plasmatic fluctuations and antidopaminergic effects. The aim of this study is to evaluate efficacy and safety of paliperidone ER in BPD patients. 18 outpatients with a DSM-IV-TR diagnosis of BPD were treated for 12 weeks with paliperidone ER (3–6 mg/day). They were assessed at baseline, week 4, and week 12, using the CGI-Severity item, the BPRS, the HDRS, the HARS, the SOFAS, the BPD Severity Index (BPDSI), and the Barratt Impulsiveness Scale (BIS-11). Adverse events were evaluated with the DOTES. Paliperidone ER was shown to be effective and well tolerated in reducing severity of global symptomatology and specific BPD symptoms, such as impulsive dyscontrol, anger, and cognitive-perceptual disturbances. Results need to be replicated in controlled trials. PMID:21826264
Wingenfeld, Katja; Kuehl, Linn K; Janke, Katrin; Hinkelmann, Kim; Dziobek, Isabel; Fleischer, Juliane; Otte, Christian; Roepke, Stefan
The mineralocorticoid receptor (MR) is highly expressed in the hippocampus and prefrontal cortex. MR have an important role in appraisal processes and in modulating stress-associated emotional reactions but it is not known whether the MR affects empathy. Borderline personality disorder (BPD) is characterized by disturbed emotion regulation and alterations in empathy. In the current study, we examined whether stimulation of the MR enhances empathy in patients with BPD and healthy individuals. In a placebo-controlled study, we randomized 38 women with BPD and without psychotropic medication, and 35 healthy women to either placebo or 0.4 mg fludrocortisone, an MR agonist. Subsequently, all participants underwent two tests of social cognition, the Multifaceted Empathy Test (MET) and the Movie for the Assessment of Social Cognition (MASC), measuring cognitive and emotional facets of empathy. Eighteen BPD patients and 18 healthy women received placebo, whereas 20 BPD patients and 17 healthy women received fludrocortisone. In the MET, fludrocortisone enhanced emotional empathy across groups, whereas cognitive empathy was not affected. In the MASC, no effect of fludrocortisone could be revealed. In both tests, BPD patients and healthy women did not differ significantly in cognitive and emotional empathy and in their response to fludrocortisone. Stimulation of MR enhanced emotional empathy in healthy women and in BPD patients. Whether fludrocortisone might have a therapeutic role in psychotherapeutic processes, remains to be elucidated. PMID:24535100
Peters, Jessica R; Geiger, Paul J
Shame has emerged as a particularly relevant emotion to the maintenance and exacerbation of borderline personality disorder (BPD) features; however, little attention has been paid to the potentially differing effects of other forms of self-conscious affect. While guilt has been demonstrated to have adaptive functions in the social psychology literature, it has not been previously explored whether a lack of socially adaptive guilt might also contribute to BPD-related dysfunction. The present study examined the relationship between BPD features and self-conscious emotions in a sample of undergraduate students (n = 839). Increased shame and decreased guilt independently accounted for significant variance in the association between BPD features and anger, hostility, and externalization of blame. Only increased shame significantly mediated the association between BPD features and anger rumination, and only decreased guilt significantly mediated the relationship between BPD features and aggression. These findings suggest BPD and its associated problems with anger and externalizing may be characterized not only by high levels of shame, but also by lower levels of guilt. Clinical implications include the need to differentiate between self-conscious emotions and teach adaptive responses to warranted guilt. (PsycINFO Database Record PMID:26866901
Veague, Heather Barnett; Hooley, Jill M
Interpersonal difficulties, which are characteristic of Borderline personality disorder (BPD), may be related to problems with social cognition. We explored facial emotion recognition in 44 women (15 with BPD, 15 healthy controls, and 14 with a history of childhood trauma but no BPD) examining the role of BPD and abuse history in the ability to detect fearful, angry and happy cues in emotional faces. In Task 1, participants viewed pictures of morphed faces containing different percentages of specific emotions and reported the emotion they saw. In Task 2, participants were asked to increase the intensity of a specific emotion on an initially neutral face until they could detect that emotion in the face. Across both tasks, BPD predicted the earlier detection of anger in male faces. BPD symptoms also predicted the misidentification of anger in male faces containing no anger cues. Although participants with BPD were slower to recognize happiness in male faces, their overall ability to recognize happiness was unimpaired. Abuse history did predict problems with happiness recognition. Finally, recognition of fear was unrelated to abuse history and BPD. Findings suggest that BPD is associated with a bias toward seeing anger in males and that this is independent of abuse history. PMID:24485062
Full Text Available Background and Objectives: Previous studies reported a high prevalence of nightmares and dream anxiety in Borderline Personality Disorder (BPD and the severity of dream disturbances correlated with daytime symptoms of psychopathology. However, the majority of these results are based on retrospective questionnaire-based study designs, and hence the effect of recall biases (characteristic for BPD, could not be controlled. Therefore our aim was to replicate these findings using dream logs. Moreover, we aimed to examine the level of dream disturbances in connection with measures of emotional instability, and to explore the protective factors against dream disturbances. Methods: 23 subjects diagnosed with BPD, and 23 age and gender matched healthy controls were assessed using the Dream Quality Questionnaire, the Van Dream Anxiety Scale, as well as the Neuroticism, Assertiveness and Fantasy scales of the NEO-PI-R questionnaire. Additionally, subjects were asked to collect 5 dreams in the three-week study period and to rate the emotional and phenomenological qualities of the reported dreams using the categories of the Dream Quality Questionnaire. Results: Dream disturbances (nightmares, bad dreams, night terror-like symptoms, and dream anxiety were more frequent in patients with BPD than in controls. Dream disturbances correlated positively with Neuroticism, while Fantasy proved to be a negative correlate of dream disturbances. Conclusions: Our study provides further support for the association between dream disturbances and BPD, links the presence of dream disturbances to the levels of emotional instability, and suggests that fantasy is a potential protective factor against dysfunctional dreaming.
De Panfilis, Chiara; Riva, Paolo; Preti, Emanuele; Cabrino, Chiara; Marchesi, Carlo
Increasing evidence suggests that individuals with borderline personality disorder (BPD) might feel rejected even when socially included by others. A psychological mechanism accounting for this response bias could be that objective social inclusion violates BPD patients' underlying implicit needs of "extreme" inclusion. Thus, this study investigated whether, during interpersonal exchanges, BPD patients report more rejection-related negative emotions and less feelings of social connection than controls unless they are faced with conditions of extreme social inclusion. Sixty-one BPD patients and 61 healthy controls completed a modified Cyberball paradigm. They were randomly assigned to a condition of ostracism, social inclusion, or overinclusion (a proxy for extreme social inclusion). They then rated their emotional states and feelings of social connection immediately and 20 min after the game. BPD patients reported greater levels of negative emotions than controls in the ostracism and the inclusion conditions, but not when overincluded. Furthermore, only for BPD participants was overinclusion associated with experiencing less negative emotions than the ostracism condition. However, BPD patients reported lower feelings of social connection than controls in any experimental situation. Thus, in BPD, a laboratory condition of "overinclusion" is associated with a reduction of negative emotions to levels comparable to those of control participants, but not with similar degrees of social connection. These results suggest that for BPD patients, even "including contexts" activate feelings of rejection. Their implicit expectations of idealized interpersonal inclusion may nullify the opportunity of experiencing "real" social connection and explain their distorted subjective experiences of rejection. PMID:26147068
Full Text Available Antipsychotics are recommended for the treatment of impulsive dyscontrol and cognitive perceptual symptoms of borderline personality disorder (BPD. Three reports supported the efficacy of oral risperidone on BPD psychopathology. Paliperidone ER is the metabolite of risperidone with a similar mechanism of action, and its osmotic release reduces plasmatic fluctuations and antidopaminergic effects. The aim of this study is to evaluate efficacy and safety of paliperidone ER in BPD patients. 18 outpatients with a DSM-IV-TR diagnosis of BPD were treated for 12 weeks with paliperidone ER (3–6 mg/day. They were assessed at baseline, week 4, and week 12, using the CGI-Severity item, the BPRS, the HDRS, the HARS, the SOFAS, the BPD Severity Index (BPDSI, and the Barratt Impulsiveness Scale (BIS-11. Adverse events were evaluated with the DOTES. Paliperidone ER was shown to be effective and well tolerated in reducing severity of global symptomatology and specific BPD symptoms, such as impulsive dyscontrol, anger, and cognitive-perceptual disturbances. Results need to be replicated in controlled trials.
Palomares, Nerea; Montes, Ana; Díaz-Marsá, Marina; Carrasco, José L
The aim of the present study is to test the efficacy of palmitate paliperidone long-acting injection for patients with borderline personality disorder (BPD). A total of 16 patients with BPD were treated with intramuscular paliperidone palmitate (IMPP) over 12 weeks. Effectiveness measures included the CGI-BPD, HARS, MADRS, BIS-11, and STAXI-2. Functional improvement was assessed using the Global Assessment of Functioning scale. A list of adverse events was provided to clinicians and patients. Treatment with IMPP was associated with a significant average reduction of 1.6 (95% confidence interval: 1192-2008; P>0.01) in CGI-BPD scores and an average increase of psychosocial functioning as scored by the Global Assessment of Functioning scale of 13.3 (95% confidence interval: 8.35-18.31; P>0.01) was obtained. The treatment decreased impulsive-disruptive behaviors and improved general functioning. An acceptable tolerance was observed. The average weight gain was clinically irrelevant despite being statistically significant. No other relevant adverse side effects were reported, with the exception of galactorrhea, which required suspension of treatment in three patients. IMPP seems to be a well-tolerated alternative to other second-generation antipsychotics in the treatment of BPD. More controlled studies replicating these results should be proposed in the future. PMID:26230268
Legris, Jeannette; Links, Paul S; van Reekum, Robert; Tannock, Rosemary; Toplak, Maggie
A range of executive function (EF) deficits have been associated with Borderline Personality (BPD), a disorder characterized by high rates of suicide. However, the role of EF and suicide risk in BPD has not been examined. This exploratory study compared working memory, Stroop interference, motor inhibition (SSRT) and Iowa Gambling Task (IGT) decision making performance in 42 women with BPD and 41 healthy controls. The sensitivity of EF to suicidal risk as assessed by the Suicide Behaviour Questionnaire-R (Osman et al., 2001) was also tested. Women with BPD performed similar to controls on all EF except decision making. Weaker Stroop interference control, however, was the only significant EF contributor to suicide risk, demonstrating near equivalent contributions to that of depression. EF and depression collectively explained 34% of the adjusted variance in total suicide risk. Contrary to expectations, IGT decision making and motor inhibition were not associated with overall suicide risk. Only Stroop interference control contributed significantly to lifetime suicide intent/attempt beyond depression or BPD severity. As prior suicide attempt remains the strongest predictor of future attempt (Soloff et al., 2003), the sensitivity of stroop performance to suicidal risk may be clinically important. Interference control may represent a "diathesis" for suicide that is independent of psychiatric diagnoses. PMID:22377570
Simeon, D; Bartz, J; Hamilton, H; Crystal, S; Braun, A; Ketay, S; Hollander, E
Oxytocin has known stress-reducing and attachment-enhancing effects. We thus hypothesized that oxytocin would attenuate emotional and hormonal responses to stress in borderline personality disorder (BPD). Fourteen BPD and 13 healthy control (HC) adults received 40 IU intranasal oxytocin or placebo in double-blind randomized order followed by the Trier Social Stress Test. Subjective dysphoria (Profile of Mood Changes) and plasma cortisol levels were measured. Childhood trauma history, attachment style, and self-esteem were also rated. A significant "Group × Drug × Time" interaction effect for dysphoria (p=.04) reflected a proportionately greater attenuation of stress-induced dysphoria in the BPD group after oxytocin administration. Additionally, a marginally significant "Group × Drug" interaction effect for cortisol (p=.10) reflected a tendency toward greater attenuation of the stress-induced cortisol surge in the BPD group after oxytocin administration. In the combined sample, the oxytocin-placebo difference in the emotional stress reactivity was significantly predicted by childhood trauma alone (p=.037) and combined with self-esteem (p=.030), whereas the oxytocin-placebo difference in cortisol stress reactivity was predicted only by insecure attachment (p=.013). Results suggest that oxytocin may have a beneficial impact on emotional regulation in BPD, which merits further investigation and could have important treatment implications. PMID:21546164
Smoski, Moria J; Salsman, Nicholas; Wang, Lihong; Smith, Veronica; Lynch, Thomas R; Dager, Stephen R; LaBar, Kevin S; Linehan, Marsha M
Opiate dependence (OD) and borderline personality disorder (BPD), separately and together, are significant public health problems with poor treatment outcomes. BPD is associated with difficulties in emotion regulation, and brain-imaging studies in BPD individuals indicate differential activation in prefrontal cingulate cortices and their interactions with limbic regions. Likewise, a similar network is implicated in drug cue responsivity in substance abusers. The present, preliminary study used functional MRI to examine activation of this network in comorbid OD/BPD participants when engaged in an "oddball" task that required attention to a target in the context of emotionally negative distractors. Twelve male OD/BPD participants and 12 male healthy controls participated. All OD/BPD participants were taking the opiate replacement medication Suboxone, and a subset of participants was positive for substances of abuse on scan day. Relative to controls, OD/BPD participants demonstrated reduced activation to negative stimuli in the amygdala and anterior cingulate. Unlike previous studies that demonstrated hyperresponsivity in neural regions associated with affective processing in individuals with BPD versus healthy controls, comorbid OD/BPD participants were hyporesponsive to emotional cues. Future studies that also include BPD-only and OD-only groups are necessary to help clarify the individual and potentially synergistic effects of these two conditions. PMID:22448769
Pfaltz, Monique C; Schumacher, Sonja; Wilhelm, Frank H; Dammann, Gerhard; Seifritz, Erich; Martin-Soelch, Chantal
Earlier studies have demonstrated emotional overreactions to affective visual stimuli in patients with borderline personality disorder (BPD). However, contradictory findings regarding hyper- versus hyporeactivity have been reported for peripheral physiological measures. In order to extend previous results, the authors investigated emotional reactivity and long-term habituation in the acoustic modality. Twenty-two female BPD patients and 19 female nonclinical controls listened to emotionally negative, neutral, and positive sounds in two identical sessions. Heart rate, skin conductance, zygomaticus/corrugator muscle, and self-reported valence/arousal responses were measured. BPD patients showed weaker skin conductance responses to negative sounds than controls. The elevated zygomaticus activity in response to positive sounds observed in controls was absent in BPD patients, and BPD patients assigned lower valence ratings to positive sounds than controls. In Session 2, patients recognized fewer positive sounds than controls. Across both groups, physiological measures habituated between sessions. These findings add to growing evidence toward partial affective hyporeactivity in BPD. PMID:25710735
Elices, Matilde; Soler, Joaquim; Fernández, Cristina; Martín-Blanco, Ana; Jesús Portella, María; Pérez, Víctor; Alvarez, Enrique; Carlos Pascual, Juan
According to Linehan's biosocial model, the core characteristic of borderline personality disorder (BPD) is emotional dysregulation. In the present study, we investigated two components of this model: baseline emotional intensity and emotional reactivity. A total of 60 women, 30 with BPD diagnosis and 30 age and sex-matched healthy subjects (HCs), participated in two experiments. In the first experiment, we evaluated emotional responses to six films designed to elicit discrete emotions (anger, fear, sadness, disgust, amusement and neutral). The second experiment evaluated emotional reactions to three emotion-eliciting films containing BPD-specific content (sexual abuse, emotional dependence and abandonment/separation). Skin conductance level, heart rate, and subjective emotional response were recorded for each film. Although self-reported data indicated that negative emotions at baseline were stronger in the BPD group, physiological measures showed no differences between the groups. Physiological results should be interpreted with caution since most BPD participants were under pharmacological treatment. BPD subjects presented no subjective heightened reactivity to most of the discrete emotion-eliciting films. Subjective responses to amusement and "BPD-specific content" films revealed significant between-group differences. These findings suggest that the main characteristic of BPD might be negative emotional intensity rather than heightened emotional reactivity. PMID:22884218
Full Text Available According to the Biosocial theory, Borderline Personality Disorder (BPD is developed by a biological predisposition to hyperarousal and hyperreactivity combined with an invalidating environment. Although widely supported by subjective measures, the impaired insight present in BPD may skew results, and thus psychophysiological measures have been suggested as an alternative method of examining possible biological differences in BPD. The current review aimed to critically assess psychophysiological research of BPD by electronic searching of relevant databases, with 22 articles meeting inclusion criteria. Results showed that in contrast to the hyperarousal proposed in the Biosocial theory, BPD was associated with hypoarousal and hyporeactivity to non-emotionally valenced stimuli. However, there was also evidence of BPD hyperreactivity towards negatively valenced stimuli, and impaired habituation during stressor tasks. As current psychophysiological results were inconsistent, it has been postulated that there may be possible subtypes of BPD. Further, evolutionary-based theories do not appear to adequately explain the complexity of emotion dysregulation in BPD, thus the Emotional Coherence theory has been proposed as an alternate method of conceptualising the role of psychophysiology in BPD. From the lack of clear or consistent findings, further research in the area appears necessary to determine the role of psychophysiology in BPD.
Arielle Ryan Baskin-Sommers
Full Text Available Background: Emotion dysregulation is central to the clinical conceptualization of Borderline Personality Disorder (BPD, with individuals often displaying instability in mood and intense feelings of negative affect. Although existing data suggest important neural and behavioral differences in the emotion processing of individuals with BPD, studies thus far have only explored reactions to overt emotional information. Therefore, it is unclear if BPD-related emotional hypersensitivity extends to stimuli presented below the level of conscious awareness (preattentively. Methods: Functional magnetic resonance imaging (fMRI was used to measure neural responses to happy, angry, fearful, and neutral faces presented preattentively, using a backward masked affect paradigm. Given their tendency toward emotional hyperreactivity and altered amygdala and frontal activation, we hypothesized that individuals with BPD would demonstrate a distinct pattern of fMRI responses relative to those without BPD during the viewing of masked affective versus neutral faces in specific regions of interest (ROIs. Results: Results indicated that individuals with BPD demonstrated increases in frontal, cingulate and amygdalar activation represented by number of voxels activated and demonstrated a different pattern of activity within the ROIs relative to those without BPD while viewing masked affective versus neutral faces. Conclusions: These findings suggest that in addition to the previously documented heightened responses to overt displays of emotion, individuals with BPD also demonstrate differential responses to positive and negative emotions, early in the processing stream, even before conscious awareness.
Comtois, Katherine Anne; Carmel, Adam
The goals of this study were to (1) assess prevalence rates of borderline personality disorder (BPD) in public mental health patients and (2) compare research assessment rates to clinical record rates in those with and without a history of high utilization of inpatient psychiatric hospitalization. One hundred and sixty participants randomly selected from county mental health centers were fully assessed. Among the non-high utilizers, 10% met criteria for BPD on research diagnosis, 4.5% on clinical record diagnosis, and 1.5% on both. Among high utilizers, 42% met criteria for BPD on research diagnosis, 19% on clinical record diagnosis, and 19% on both. For the non-high utilizers, the sensitivity of the clinical record diagnosis (compared to the gold standard of the research diagnosis) was 15% and the specificity was 97%. For the high utilizer group, the sensitivity of the clinical record diagnosis was 45% and specificity was 100% indicating that there was never an incorrect clinical diagnosis of BPD among the high utilizers. Thus, while the specificity of the clinical record was high, the sensitivity of the clinical record diagnosis was quite low, and the clinical record greatly underestimated the prevalence of BPD in this sample. Further, since effective outpatient treatment has been developed for these expensive high utilizers with BPD, the under-recognition of BPD has significant implications for the planning of outpatient mental health services in public sector settings. PMID:24875431
Lobbestael, Jill; McNally, Richard J
The authors tested whether borderline personality disorder (BPD) is characterized by interpretation bias for disambiguating stimuli in favor of threatening interpretations, especially concerning abuse, abandonment, rejection, and anger-core emotional triggers for BPD patients. A mixed sample of 106 patients with marked BPD traits and nonpatients were assessed with SCID I and II and were presented with vignettes depicting ambiguous social interactions. Interpretations of these vignettes were assessed both in a closed and an open answer format. Results showed that BPD traits were related to a rejection- (closed and open answer formats) and an anger-related interpretation bias (closed answer option only). Cluster C traits were associated with self-blame interpretations. Aside from further validating the cognitive model of BPD, these findings denote interpretation bias as a key feature in patients with BPD that might contribute to their emotional hyperreactivity and interpersonal problems. These findings also highlight the importance of therapeutically normalizing interpretative bias in BPD and cluster C patients. PMID:25893553
Buchheim, Anna; Erk, Susanne; George, Carol; Kächele, Horst; Kircher, Tilo; Martius, Philipp; Pokorny, Dan; Ruchsow, Martin; Spitzer, Manfred; Walter, Henrik
Functional imaging studies have shown that individuals with borderline personality disorder (BPD) display prefrontal and amygdala dysfunction while viewing or listening to emotional or traumatic stimuli. The study examined for the first time the functional neuroanatomy of attachment trauma in BPD patients using functional magnetic resonance imaging (fMRI) during the telling of individual stories. A group of 11 female BPD patients and 17 healthy female controls, matched for age and education, told stories in response to a validated set of seven attachment pictures while being scanned. Group differences in narrative and neural responses to "monadic" pictures (characters facing attachment threats alone) and "dyadic" pictures (interaction between characters in an attachment context) were analyzed. Behavioral narrative data showed that monadic pictures were significantly more traumatic for BPD patients than for controls. As hypothesized BPD patients showed significantly more anterior midcingulate cortex activation in response to monadic pictures than controls. In response to dyadic pictures patients showed more activation of the right superior temporal sulcus and less activation of the right parahippocampal gyrus compared to controls. Our results suggest evidence for potential neural mechanisms of attachment trauma underlying interpersonal symptoms of BPD, i.e. fearful and painful intolerance of aloneness, hypersensitivity to social environment, and reduced positive memories of dyadic interactions. PMID:18635342
Sledge, William; Plakun, Eric M; Bauer, Stephen; Brodsky, Beth; Caligor, Eve; Clemens, Norman A; Deen, Serina; Kay, Jerald; Lazar, Susan; Mellman, Lisa A; Myers, Michael; Oldham, John; Yeomans, Frank
The objective was to review established literature on approaches to the psychotherapy of borderline personality disorder with specfic reference to suicide in order to determine if there were common factors across these efforts that would guide future teaching, practice and research. The publications from the proponents of five therapies for the treatment of suicidal behavior in individuals with borderline personality disorder (BPD), were reviewed and discussed by the members of the Group for the Advanced of Psychiatry, Psychotherapy Committee (GAPPC). Twenty nine published research and summary reports were reviewed of the specific treatments noted above along with two other reviews of common factors for this group of treatments. We used expert consensus as to the salient articles for review and the appropriate level of abstraction for the common factor definition. We formulated a definition of effectiveness and identified six common factors: 1) negotiation of a specific frame for treatment, 2) recognition and insistence on the patient's responsibilities within the therapy, 3) provision to the therapist of a conceptual framework for understanding and intervening, 4) use of the therapeutic relationship to engage and address suicide, 5) prioritization of suicide as a topic to be actively addressed whenever it emerges, and 6) provision of support for the therapist in the form of supervision, consultation or peer support. We discuss common factors, their formulation, and implications for development and teaching of psychotherapeutic approaches specific to suicide in patients with borderline personality disorder and note that there should be greater attention in practice and education to these issues. PMID:26401300
The aim of this article is to describe the normal and abnormal development of mentallisation and development of borderline personality disorder as a mentallisation dysfunction, in the context of development of attachment relation. Borderline personality disorder is a distinct clinical syndrome with important implications for public health; patients show reduced capacities to mentalise, which inevitably leads to problems in interpersonal relationships, identity disturbance, impulsivity, emotio...
... Personality disorder - borderline; Narcissism References American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing. 2013. ...
Martín-Blanco, Ana; Ferrer, Marc; Soler, Joaquim; Arranz, Maria Jesús; Vega, Daniel; Calvo, Natalia; Elices, Matilde; Sanchez-Mora, Cristina; García-Martinez, Iris; Salazar, Juliana; Carmona, Cristina; Bauzà, Joana; Prat, Mónica; Pérez, Víctor; Pascual, Juan C
Current knowledge suggests that borderline personality disorder (BPD) results from the interaction between genetic and environmental factors. Research has mainly focused on monoaminergic genetic variants and their modulation by traumatic events, especially those occurring during childhood. However, to the best of our knowledge, there are no studies on the genetics of hypothalamus-pituitary-adrenal (HPA) axis, despite its vulnerability to early stress and its involvement in BPD pathogenesis. The aim of this study was to investigate the contribution of genetic variants in the HPA axis and to explore the modulating effect of childhood trauma in a large sample of BPD patients and controls. DNA was obtained from a sample of 481 subjects with BPD and 442 controls. Case-control differences in allelic frequencies of 47 polymorphisms in 10 HPA axis genes were analysed. Modulation of genetic associations by the presence of childhood trauma was also investigated by dividing the sample into three groups: BPD with trauma, BPD without trauma and controls. Two FKBP5 polymorphisms (rs4713902-C and rs9470079-A) showed significant associations with BPD. There were also associations between BPD and haplotype combinations of the genes FKBP5 and CRHR1. Two FKBP5 alleles (rs3798347-T and rs10947563-A) were more frequent in BPD subjects with history of physical abuse and emotional neglect and two CRHR2 variants (rs4722999-C and rs12701020-C) in BPD subjects with sexual and physical abuse. Our findings suggest a contribution of HPA axis genetic variants to BPD pathogenesis and reinforce the hypothesis of the modulating effect of childhood trauma in the development of this disorder. PMID:26182893
Study Protocol for a randomized controlled trial of mentalization based therapy against specialist supportive clinical management in patients with both eating disorders and symptoms of borderline personality disorder
Robinson, P.; Barrett, B; Bateman, A.; HAKEEM A; Hellier, J; Lemonsky, F.; Rutterford, C.; Schmidt, U.; Fonagy, P.
Background The NOURISHED study: Nice OUtcomes for Referrals with Impulsivity, Self Harm and Eating Disorders. Eating Disorders (ED) and Borderline Personality Disorder (BPD) are both difficult to treat and the combination presents particular challenges. Both are associated with vulnerability to loss of mentalization (awareness of one’s own and others’ emotional state). In BPD, Mentalization Based therapy (MBT) has been found effective in reducing symptoms. In this trial we investigate the eff...
Wingenfeld, Katja; Schaffrath, Camille; Rullkoetter, Nina; Mensebach, Christoph; Schlosser, Nicole; Beblo, Thomas; Driessen, Martin; Meyer, Bjorn
Posttraumatic stress disorder (PTSD) is an important possible outcome of exposure to traumatic events that occur in childhood. However, early traumatic experiences are also an important risk factor for several other mental disorders, such as borderline personality disorder and major depressive disorder. Furthermore, chronic stress, including daily…
Riemann, G.; Weisscher, N.; Goossens, P.J.J.; Draijer, N.; Apenhorst-Hol, M.; Kupka, R.W.
BACKGROUND: Bipolar disorder (BD) and borderline personality disorder (BPD) both are severe and chronic psychiatric disorders. Both disorders have overlapping symptoms, and current research shows that the presence of a BPD has an adverse effect on the course of BD. The limited research available sho
Stone, Michael H
Borderline Personality Disorder (BPD) has been often described recently as a condition characterized by emotional dysregulation. Several other conditions share this attribute; namely, Bipolar Disorder (BD), Attention-Deficit/Hyperactivity Disorder (ADHD), Intermittent Explosive Disorder (IED), and Major Depressive Disorder (MDD). The dysregulation is not always in the same direction: BPD, BD, ADHD, and IED, for example, show over-reactivity or "hyperactivity" of emotional responses, whereas patients with MDD show emotional sluggishness and underactivity. At the clinical/descriptive level the "over-reactive" conditions appear separate and distinct. BPD constitutes a large domain within the psychopathological arena, appearing to contain within it a variety of etiologically diverse subtypes. Among the latter is a type of BPD linked closely with Bipolar Disorder; family studies of either condition show an overrepresentation of both: BPD patients with bipolar relatives; Bipolar patients with BPD relatives. A significant percentage of children with ADHD go on to develop either BPD or BD as they approach adulthood. If one shifts the spotlight to neurophysiology, as captured by MRI studies, however, it emerges that an important subtype of BPD, and also BD, ADHD, and IED-share common features of abnormalities and peculiarities in the limbic system and in the cortex, especially the prefrontal cortex. Deeper subcortical regions such as the periaqueductal gray may also be implicated in strong emotional reactions. The diversity of clinical "over-reactive" conditions appear to harken back to a kind of unity at the brain-change level. There are therapeutic implications here, such as the advisability of mood stabilizers in many cases of BPD, not just for Bipolar Disorder. PMID:24001165
Skrzypińska, Dagna; Szmigielska, Barbara
This paper presents an analysis of dream-reality confusion (DRC) in relation to the characteristics of borderline personality disorder (BPD), based on research findings and theoretical considerations. It is hypothesized that people with BPD are more likely to experience DRC compared to people in non-clinical population. Several variables related to this hypothesis were identified through a theoretical analysis of the scientific literature. Sleep disturbances: problems with sleep are found in 15-95.5% of people with BPD (Hafizi, 2013), and unstable sleep and wake cycles, which occur in BPD (Fleischer et al., 2012), are linked to DRC. Dissociation: nearly two-thirds of people with BPD experience dissociative symptoms (Korzekwa and Pain, 2009) and dissociative symptoms are correlated with a fantasy proneness; both dissociative symptoms and fantasy proneness are related to DRC (Giesbrecht and Merckelbach, 2006). Negative dream content: People with BPD have nightmares more often than other people (Semiz et al., 2008); dreams that are more likely to be confused with reality tend to be more realistic and unpleasant, and are reflected in waking behavior (Rassin et al., 2001). Cognitive disturbances: Many BPD patients experience various cognitive disturbances, including problems with reality testing (Fiqueierdo, 2006; Mosquera et al., 2011), which can foster DRC. Thin boundaries: People with thin boundaries are more prone to DRC than people with thick boundaries, and people with BPD tend to have thin boundaries (Hartmann, 2011). The theoretical analysis on the basis of these findings suggests that people who suffer from BPD may be more susceptible to confusing dream content with actual waking events. PMID:26441768
Goodman, Marianne; Carpenter, David; Tang, Cheuk Y.; Goldstein, Kim E.; Avedon, Jennifer; Fernandez, Nicolas; Mascitelli, Kathryn A.; Blair, Nicholas J.; New, Antonia S.; Triebwasser, Joseph; Siever, Larry J.; Hazlett, Erin A.
Objective Siever and Davis’ (1991) psychobiological framework of borderline personality disorder (BPD) identifies affective instability (AI) as a core dimension characterized by prolonged and intense emotional reactivity. Recently, deficient amygdala habituation, defined as a change in response to repeated relative to novel unpleasant pictures within a session, has emerged as a biological correlate of AI in BPD. Dialectical behavior therapy (DBT), an evidence-based treatment, targets AI by teaching emotion-regulation skills. This study tested the hypothesis that BPD patients would exhibit decreased amygdala activation and improved habituation, as well as improved emotion regulation with standard 12-month DBT. Methods Event-related fMRI was obtained pre- and post-12-months of standard-DBT in unmedicated BPD patients. Healthy controls (HCs) were studied as a benchmark for normal amygdala activity and change over time (n = 11 per diagnostic-group). During each scan, participants viewed an intermixed series of unpleasant, neutral and pleasant pictures presented twice (novel, repeat). Change in emotion regulation was measured with the Difficulty in Emotion Regulation (DERS) scale. Results fMRI results showed the predicted Group × Time interaction: compared with HCs, BPD patients exhibited decreased amygdala activation with treatment. This post-treatment amygdala reduction in BPD was observed for all three pictures types, but particularly marked in the left hemisphere and during repeated-emotional pictures. Emotion regulation measured with the DERS significantly improved with DBT in BPD patients. Improved amygdala habituation to repeated-unpleasant pictures in patients was associated with improved overall emotional regulation measured by the DERS (total score and emotion regulation strategy use subscale). Conclusion These findings have promising treatment implications and support the notion that DBT targets amygdala hyperactivity—part of the disturbed neural
Full Text Available Objective: Recently, some studies have been examining the relationship between Borderline Personality Disorder (BPD features and Experiential Avoidance (EA, Thought Suppression (TS and Distress Intolerance (DI. This interest arose from data which showed a strong link between the previous constructs and problematic behaviors (e.g. self-harm related to BPD. These dimensions describe a more general inability to withstand undesirable present-moment experiences. The aims of this work are to evaluate the extent of this problem in BPD and to hypothesize if it would be considered another core feature of BPD in addition to emotion dysregulation. Method: We included studies which show relationships between BPD features and EA, TS, DI, using valid and reliable instruments (e.g. PAI-BOR; AAQ; WBSI; DTS. Cohen’s d was computed as effect size measure. Overall pooled effect sizes (dw was estimated. Heterogeneity in effect sizes was computed using Q statistic and I² index. We proposed multiple comparisons of each outcome variable using Bonferroni correction. Bias publication was evaluated (Egger’s regression. Results: The final sample included 21 studies (4823 subjects. Large effect sizes were found in general inability to withstand present-moment experiences (dw= 0,92, EA (dw= 0,98 and TS (dw= 1,04. Medium effect size emerged in DI (dw= 0,60. It was observed high heterogeneity for overall effect size (I² =79,51%. Publication bias was not detected. Further, DI was significantly less manifest than EA and TS in BPD. Conclusions: These results show that the inability to withstand present-moment experiences is largely manifest in BPD and they suggest that this difficulty it might represent another core feature of BPD. These findings support mindfulness-based intervention in treating BPD. In addition, future research will be necessary to explain the relationship between emotion dysregulation, EA, TS and DI.
Full Text Available Aim. The aim of the study was a relation between the borderline personality disorder and psychological gender, and tendency to use various manipulation tactics in everyday life and therapeutic context.Methods. The study used the Psychological Gender Inventory (A. Kuczyńska, 1992, and self-developed questionnaire for evaluating the tendency to use manipulation tactics and a survey evaluating manipulation in therapeutic contact. The studied group included: 30 patients with diagnosed BPD, 30 people a control group and 125 therapists.Results. The study of psychological gender showed that in the patient group the level of masculinity was significantly lower. Results showed that 88% of the therapists participating in the study confirmed that they have experienced manipulation attempts from patients. The therapists assessed the tendency of patientsto use manipulation tactics as greater than it was declared by the patients themselves. When compared to the control group, the patients indeed demonstrated a greater tendency to use the tactics of begging,threatening and threatening to break a close relationship and a lesser tendency to use the tactic of seduction. In the view of the therapists, during therapy patients most often used the tactics of lying and guilt induction.Conclusions. Manipulation is frequently used by BPD patients both in everyday life and in therapeutic contact. The most common reasons for using manipulation is to obtain benefits and to avoid negativeconsequences. It is necessary to conduct further research in this field and educate those who work with psychiatric patients in order to make them develop the ability to detect manipulation attempts and cope with such tactics.
Full Text Available Borderline personality disorder (BPD is characterized by stable instability of emotions and behavior and their regulation. This emotional and behavioral instability corresponds with a neurocognitive triple network model of psychopathology, which suggests that aberrant emotional saliency and cognitive control is associated with aberrant interaction across three intrinsic connectivity networks (ICN (i.e. the salience, default mode, and central executive network, SN, DMN, CEN. The objective of the current study was to investigate whether and how such triple network intrinsic functional connectivity (iFC is changed in patients with BPD. We acquired resting-state functional magnetic resonance imaging (rs-fMRI data from fourteen patients with BPD and sixteen healthy controls (HC. High-model order independent component analysis (ICA was used to extract spatiotemporal patterns of ongoing, coherent blood-oxygen-level-dependent (BOLD signal fluctuations from rs-fMRI data. Main outcome measures were iFC within networks (intra-iFC and between networks (i.e. network time course correlation inter-iFC.Aberrant intra-iFC was found in patients’ DMN, SN, and CEN, consistent with previous findings. While patients’ inter-iFC of the CEN was decreased, inter-iFC of the SN was increased. In particular, a balance index reflecting the relationship of CEN-and SN-inter-iFC across networks was strongly shifted from CEN to SN connectivity in patients. Results provide first preliminary evidence for aberrant triple network intrinsic functional connectivity in BPD. Our data suggest a shift of inter-network iFC from networks involved in cognitive control to those of emotion-related activity in BPD, potentially reflecting the persistent instability of emotion regulation in patients.
Teschler, Stefanie; Gotthardt, Julia; Dammann, Gerhard; Dammann, Reinhard H
Borderline personality disorder (BPD) is a serious psychic disease with a high risk for suicide. DNA methylation is a hallmark for aberrant epigenetic regulation and could be involved in the etiology of BPD. Previously, it has been reported that increased DNA methylation of neuropsychiatric genes is found in the blood of patients with BPD compared to healthy controls. Here, we analyzed DNA methylation patterns of the ribosomal RNA gene (rDNA promoter region and 5'-external transcribed spacer/5'ETS) and the promoter of the proline rich membrane anchor 1 gene (PRIMA1) in peripheral blood samples of 24 female patients (mean age (33 ± 11) years) diagnosed with DSM-IV BPD and in 11 female controls (mean age (32 ± 7) years). A significant aberrant methylation of rDNA and PRIMA1 was revealed for BPD patients using pyrosequencing. For the promoter of PRIMA1, the average methylation of six CpG sites was 1.6-fold higher in BPD patients compared to controls. In contrast, the methylation levels of the rDNA promoter region and the 5'ETS were significantly lower (0.9-fold) in patients with BPD compared to controls. Thus, for nine CpGs located in the rDNA promoter region and for four CpGs at the 5'ETS decreased methylation was found in peripheral blood of patients compared to controls. Our results suggest that aberrant methylation of rDNA and PRIMA1 is associated with the pathogenesis of BPD. PMID:26742039
Full Text Available Borderline personality disorder (BPD is a serious psychic disease with a high risk for suicide. DNA methylation is a hallmark for aberrant epigenetic regulation and could be involved in the etiology of BPD. Previously, it has been reported that increased DNA methylation of neuropsychiatric genes is found in the blood of patients with BPD compared to healthy controls. Here, we analyzed DNA methylation patterns of the ribosomal RNA gene (rDNA promoter region and 5′-external transcribed spacer/5′ETS and the promoter of the proline rich membrane anchor 1 gene (PRIMA1 in peripheral blood samples of 24 female patients (mean age (33 ± 11 years diagnosed with DSM-IV BPD and in 11 female controls (mean age (32 ± 7 years. A significant aberrant methylation of rDNA and PRIMA1 was revealed for BPD patients using pyrosequencing. For the promoter of PRIMA1, the average methylation of six CpG sites was 1.6-fold higher in BPD patients compared to controls. In contrast, the methylation levels of the rDNA promoter region and the 5′ETS were significantly lower (0.9-fold in patients with BPD compared to controls. Thus, for nine CpGs located in the rDNA promoter region and for four CpGs at the 5′ETS decreased methylation was found in peripheral blood of patients compared to controls. Our results suggest that aberrant methylation of rDNA and PRIMA1 is associated with the pathogenesis of BPD.
Dammann, Gerhard; Teschler, Stefanie; Haag, Tanja; Altmüller, Franziska; Tuczek, Frederik; Dammann, Reinhard H
Borderline personality disorder (BPD) is a complex psychiatric disease of increasing importance. Epigenetic alterations are hallmarks for altered gene expression and could be involved in the etiology of BPD. In our study we analyzed DNA methylation patterns of 14 neuropsychiatric genes (COMT, DAT1, GABRA1, GNB3, GRIN2B, HTR1B, HTR2A, 5-HTT, MAOA, MAOB, NOS1, NR3C1, TPH1 and TH). DNA methylation was analyzed by bisulfite restriction analysis and pyrosequencing in whole blood samples of patients diagnosed with DSM-IV BPD and in controls. Aberrant methylation was not detectable using bisulfite restriction analysis, but a significantly increased methylation of HTR2A, NR3C1, MAOA, MAOB and soluble COMT (S-COMT) was revealed for BPD patients using pyrosequencing. For HTR2A the average methylation of four CpG sites was 0.8% higher in BPD patients compared to controls (p = 0.002). The average methylation of NR3C1 was 1.8% increased in BPD patients compared to controls (p = 0.0003) and was higher at 2 out of 8 CpGs (p ≤ 0.04). In females, an increased average methylation (1.5%) of MAOA was observed in BPD patients compared to controls (p = 0.046). A similar trend (1.4% higher methylation) was observed for MAOB in female BPD patients and increased methylation was significant for 1 out of 6 CpG sites. For S-COMT, a higher methylation of 2 out of 4 CpG sites was revealed in BPD patients (p ≤ 0.02). In summary, methylation signatures of several promoter regions were established and a significant increased average methylation (1.7%) occurred in blood samples of BPD patients (p < 0.0001). Our data suggest that aberrant epigenetic regulation of neuropsychiatric genes may contribute to the pathogenesis of BPD. PMID:22139575
Full Text Available Increasing evidence has documented subtle changes in brain morphology and function in patients with borderline personality disorder (BPD. However, results of magnetic resonance imaging volumetry in patients with BPD are inconsistent. In addition, few researchers using voxel-based morphometry (VBM have focused on attachment and childhood trauma in BPD. This preliminary study was performed to investigate structural brain changes and their relationships to attachment and childhood trauma in a homogenous sample of young adults with BPD.We examined 34 young adults with BPD and 34 healthy controls (HCs to assess regionally specific differences in gray matter volume (GMV and gray matter concentration (GMC. Multiple regressions between brain volumes measured by VBM and attachment style questionnaire (ASQ and childhood trauma questionnaire (CTQ scores were performed.Compared with HCs, subjects with BPD showed significant bilateral increases in GMV in the middle cingulate cortex (MCC/posterior cingulate cortex (PCC/precuneus. GMC did not differ significantly between groups. In multiple regression models, ASQ insecure attachment scores were correlated negatively with GMV in the precuneus/MCC and middle occipital gyrus in HCs, HCs with more severe insecure attachment showed smaller volumes in precuneus/MCC and middle occipital gyrus, whereas no negative correlations between insecure attachment and GMV in any region were found in BPD group. In addition, CTQ total scores were not correlated with GMV in any region in the two groups respectively.Our findings fit with those of previous reports of larger precuneus GMV in patients with BPD, and suggest that GMV in the precuneus/MCC and middle occipital gyrus is associated inversely with insecure attachment style in HCs. Our finding of increased GMV in the MCC and PCC in patients with BPD compared with HCs has not been reported in previous VBM studies.
Holtmann, Jana; Herbort, Maike C; Wüstenberg, Torsten; Soch, Joram; Richter, Sylvia; Walter, Henrik; Roepke, Stefan; Schott, Björn H
Previous studies of cognitive alterations in borderline personality disorder (BPD) have yielded conflicting results. Given that a core feature of BPD is affective instability, which is characterized by emotional hyperreactivity and deficits in emotion regulation, it seems conceivable that short-lasting emotional distress might exert temporary detrimental effects on cognitive performance. Here we used functional magnetic resonance imaging (fMRI) to investigate how task-irrelevant emotional stimuli (fearful faces) affect performance and fronto-limbic neural activity patterns during attention-demanding cognitive processing in 16 female, unmedicated BPD patients relative to 24 age-matched healthy controls. In a modified flanker task, emotionally negative, socially salient pictures (fearful vs. neutral faces) were presented as distracters in the background. Patients, but not controls, showed an atypical response pattern of the right amygdala with increased activation during emotional interference in the (difficult) incongruent flanker condition, but emotion-related amygdala deactivation in the congruent condition. A direct comparison of the emotional conditions between the two groups revealed that the strongest diagnosis-related differences could be observed in the dorsal and, to a lesser extent, also in the rostral anterior cingulate cortex (dACC, rACC) where patients exhibited an increased neural response to emotional relative to neutral distracters. Moreover, in the incongruent condition, both the dACC and rACC fMRI responses during emotional interference were negatively correlated with trait anxiety in the patients, but not in the healthy controls. As higher trait anxiety was also associated with longer reaction times (RTs) in the BPD patients, we suggest that in BPD patients the ACC might mediate compensatory cognitive processes during emotional interference and that such neurocognitive compensation that can be adversely affected by high levels of anxiety. PMID
Full Text Available Previous studies of cognitive alterations in Borderline Personality Disorder (BPD have yielded conflicting results. Given that a core feature of BPD is affective instability, which is characterized by emotional hyperreactivity and deficits in emotion regulation, it seems conceivable that short-lasting emotional distress might exert temporary detrimental effects on cognitive performance. Here we used functional magnetic resonance imaging (fMRI to investigate how task-irrelevant emotional stimuli (fearful faces affect performance and fronto-limbic neural activity patterns during attention-demanding cognitive processing in 16 female, unmedicated BPD patients relative to 24 age-matched healthy controls. In a modified flanker task, emotionally negative, socially salient pictures (fearful versus neutral faces were presented as distracters in the background. Patients, but not controls, showed an atypical response pattern of the right amygdala with increased activation during emotional interference in the (difficult incongruent flanker condition, but emotion-related amygdala deactivation in the congruent condition. A direct comparison of the emotional conditions between the two groups revealed that the strongest diagnosis-related differences could be observed in the dorsal and, to a lesser extent, also in the rostral anterior cingulate cortex (dACC, rACC where patients exhibited an increased neural response to emotional relative to neutral distracters. Moreover, in the incongruent condition, both the dACC and rACC fMRI responses during emotional interference were negatively correlated with trait anxiety in the patients, but not in the healthy controls. As higher trait anxiety was also associated with longer reaction times in the BPD patients, we suggest that in BPD patients the ACC might mediate compensatory cognitive processes during emotional interference and that such neurocognitive compensation that can be adversely affected by high levels of
Lowyck, Benedicte; Luyten, Patrick; Vanwalleghem, Dominique; Vermote, Rudi; Mayes, Linda C; Crowley, Michael J
The mentalization-based approach to borderline personality disorder (BPD) argues that impairments in mentalizing are a key feature of BPD. Most previous research in this area has concentrated on potential impairments in facial emotion recognition in BPD patients. However, these studies have yielded inconsistent results, which may be attributable to methodological differences. This study aimed to address several limitations of previous studies by investigating different parameters involved in emotion recognition in BPD patients using a novel, 2-step dynamically changing facial expression paradigm, taking into account the possible influence of mood, psychotropic medication, and trauma exposure. Twenty-two BPD patients and 22 matched normal controls completed this paradigm. Parameters assessed were accuracy of emotion recognition, reaction time (RT), and level of confidence, both for first and full response and for correct and incorrect responses. Results showed (a) that BPD patients were as accurate in their first, but less accurate in their full emotion recognition than normal controls, (b) a trend for BPD patients to respond more slowly than normal controls, and (c) no significant difference in overall level of confidence between BPD patients and normal controls. Mood and psychotropic medication did not influence these results. Exposure to trauma in BPD patients, however, was negatively related to accuracy at full expression. Although further research is needed, results suggest no general emotion-recognition deficit in BPD patients using a dynamic changing facial recognition paradigm, except for a subgroup of BPD patients with marked trauma who become less accurate when they have to rely more on controlled, reflective processes. PMID:26461044
Wapp, Manuela; van de Glind, Geurt; van Emmerik-van Oortmerssen, Katelijne; Dom, Geert; Verspreet, Sofie; Carpentier, Pieter Jan; Ramos-Quiroga, Josep Antoni; Skutle, Arvid; Bu, Eli-Torlid; Franck, Johan; Konstenius, Maija; Kaye, Sharlene; Demetrovics, Zsolt; Barta, Csaba; Fatséas, Melina; Auriacombe, Marc; Johnson, Brian; Faraone, Stephen V.; Levin, Frances R.; Allsop, Steve; Carruthers, Susan; Schoevers, Robert A.; Koeter, Maarten W.J.; van den Brink, Wim; Moggi, Franz
Borderline personality disorder (BPD) and substance use disorders (SUDs) often co-occur, partly because they share risk factors. In this international multicenter study, risk factors for BPD were examined for SUD patients. In total, 1,205 patients were comprehensively examined by standardized interviews and questionnaires on psychiatric diagnosis and risk factors, and it was found that 1,033 (85.7%) had SUDs without BPD (SUD) and 172 (14.3%) had SUD with BPD (SUD + BPD). SUD + BPD patients were significantly younger, more often females and more often diagnosed with comorbid adult attention deficit/hyperactivity disorder. SUD + BPD patients did not differ from SUD patients on most risk factors typical for SUD such as maternal use of drugs during pregnancy or parents having any SUD. However, SUD + BPD patients did have a higher risk of having experienced emotional and physical abuse, neglect, or family violence in childhood compared to SUD patients, suggesting that child abuse and family violence are BPD-specific risk factors in patients with SUDs. PMID:25832736
Thaler, Lea; Gauvin, Lise; Joober, Ridha; Groleau, Patricia; de Guzman, Rosherrie; Ambalavanan, Amirthagowri; Israel, Mimi; Wilson, Samantha; Steiger, Howard
DNA methylation allows for the environmental regulation of gene expression and is believed to link environmental stressors to such mental-illness phenotypes as eating disorders. Numerous studies have shown an association between bulimia nervosa (BN) and variations in brain-derived neurotrophic factor (BDNF). BDNF has also been linked to borderline personality disorder (BPD) and to such traits as reward dependence. We examined the extent to which BDNF methylation corresponded to bulimic or normal-eater status, and also to the presence of comorbid borderline personality disorder (BPD) and childhood abuse. Our sample consisted of 64 women with BN and 32 normal-eater (NE) control women. Participants were assessed for eating-disorder symptoms, comorbid psychopathology, and childhood trauma, and then they were required to provide blood samples for methylation analyses. We observed a significant site×group (BN vs. NE) interaction indicating that women with BN showed increases in methylation at specific regions of the BDNF promoter. Furthermore, examining effects of childhood abuse and BPD, we observed significant site×group interactions such that groups composed of individuals with childhood abuse or BPD had particularly high levels of methylation at selected CpG sites. Our findings suggest that BN, especially when co-occurring with childhood abuse or BPD, is associated with a propensity towards elevated methylation at specific BDNF promoter region sites. These findings imply that hypermethylation of the BDNF gene may be related to eating disorder status, developmental stress exposure, and comorbid psychopathology. PMID:24801751
Ellison, William D; Rosenstein, Lia; Chelminski, Iwona; Dalrymple, Kristy; Zimmerman, Mark
Although dimensional models of borderline personality disorder (BPD) are consistent with findings showing that minimal levels of pathology are associated with substantial increases in psychosocial impairment, it is still unclear whether different individual BPD criteria are each clinically significant on their own. The current study uses semistructured interview data from 1,870 adults presenting for outpatient psychiatric treatment to investigate whether the BPD criteria of impulsivity, affective instability, emptiness, and anger are each related to psychosocial morbidity when met in the absence of the other eight criteria. Analyses showed that each of these criteria was associated with dysfunction in comparison with a control group meeting zero BPD criteria, but only the emptiness criterion was a marker of impairment on all indices of psychosocial morbidity: suicidality, history of suicide attempts and psychiatric hospitalizations, social and work dysfunction, Axis I comorbidity, and global functioning. Implications for the study of borderline pathology are discussed. PMID:25893552
Desrosiers, Lyne; Saint-Jean, Micheline; Laporte, Lise
Objectives More than half of suicidal adolescents, a large proportion of which manifest borderline personality disorder (BPD), drop out from treatment. The consequences of their premature termination are cause for concern given the recurrence of their suicidal attempts and that they present elevated risk for major mental disorders during adulthood. The study sought to gain a broader appreciation of processes involved in the treatment dropout among adolescents with BPD.Method A constructivist grounded theory was chosen using a multiple-case research design. Twelve cases were examined. Three groups of informants were recruited (adolescents, parents, and therapists involved in the treatment) and 34 interviews were conducted to document the cases. Theoretical sampling and the different stages of analysis specific to grounded theory were performed according to the iterative process of constant comparative analysis.Results Various dropout vulnerabilities specific to adolescents with BPD and their parents, including psychological characteristics, help-seeking context and perception of mental illness and mental healthcare were identified. Care-setting response including management of accessibility problems, adaptation of services to needs of adolescents with BPD, preparation for treatment, and consideration for the health professional's disposition to treat were also found to be determinant to their engagement to treatment. The processes of disengagement from treatment have also been specified. Negative perceptions regarding treatment, clinicians and receiving treatment have been shown to generate emotional activation. The aforementioned lead to counterproductive attitudes that evolve into outright disengagement behaviours. In this context, responses from the care-setting, such as an insufficient regulation of the engagement, therapeutic faux pas and paradoxical demands, precipitate premature treatment termination. Finally, the processes involved in the abandonment of
Blonigen, Daniel M.; Sullivan, Elizabeth A; Hicks, Brian M.; Patrick, Christopher J.
Despite the high prevalence of trauma exposure in female prisoners, few studies have examined the link between psychopathy and posttraumatic stress disorder (PTSD)—or the potential mediating role of borderline personality disorder traits. Using a sample of incarcerated women, we identified differential associations across facets of psychopathy, as assessed via the Psychopathy Checklist–Revised (PCL–R; R. D. Hare, 2003), with potentially traumatic events (PTE) and symptoms of PTSD. Specificall...
Evardone, Milagros; Alexander, Gerianne M.; Morey, Leslie C.
Borderline personality is diagnosed in clinical settings three times more often in women than in men, and symptom severity in women appears sensitive to circulating sex steroid levels. In non-human mammals, prenatal hormones contribute to the development of sex-linked behavior and their responsiveness to postnatal hormones. Therefore, this study examined the hypothesis that prenatal hormones may influence the development of borderline personality traits by measuring a marker of perinatal andr...
Bonnington, Oliver; Rose, Diana
This study explores experiences of stigma and discrimination amongst people diagnosed with bipolar disorder (BD) or borderline personality disorder (BPD). Inspired by Margaret Archer's morphogenetic sequence and the ontological depth of critical realism, a temporal framework for stigmatisation, incorporating structure and agency, is developed and used to situate these experiences. A literature review found very little existing research on the subjective experience of stigma amongst these diagnostic groups. Indeed, most mental illness stigma research is quantitative and focussed on schizophrenia and depression. In-depth interviews were conducted with twenty-nine people diagnosed with BD or BPD, along with five 'friendship' mini-focus groups within the UK. Participants were recruited via charities and participant networking. Using thematic analysis, along with abductive and retroductive inference, experiences and anticipation of stigma and discrimination for participants with one of the two diagnoses in various contexts of social interaction were found to coincide with 'four faces' of oppression: cultural imperialism (pathologisation, normalisation and stereotyping), powerlessness, marginalisation and violence. Such experiences implied a range of antecedent social and cultural structures. Implications for the stigma concept are discussed. PMID:25462600
Goodman, G; Hull, J W; Clarkin, J F; Yeomans, F E
Structured clinical interviews of 107 female inpatients diagnosed with borderline personality disorder (BPD) were used to determine whether antisocial personality disorder (APD) diagnostic criteria evident prior to age 15 could be used to predict current Axis I and Axis II psychopathology. Diagnostic information was gathered using the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) and the Structured Clinical Interview for DSM-III-R-Patient Version (SCID-P). Childhood APD criteria were subjected to principal-components analysis, and three factors--rule-breaking, assault, and sadism--emerged. The severity of the childhood APD criteria was related to psychotic symptoms, as well as to the unstable relationships and labile affect BPD criteria and the current overall severity of BPD criteria. Sadism predicted psychotic symptoms and BPD severity, while rule-breaking predicted unstable relationships and BPD severity. Childhood APD severity also had a larger effect on BPD severity than on psychotic symptoms. Possible explanations for these findings are explored and discussed. PMID:10228925
Personality disorder - borderline; Narcissism ... A person with narcissistic personality disorder may: React to criticism with rage, shame, or humiliation Take advantage of other people to achieve his or her ...
Adler, Jonathan M; Chin, Erica D; Kolisetty, Aiswarya P; Oltmanns, Thomas F
While identity disturbance has long been considered one of the defining features of Borderline Personality Disorder (BPD), the present study marks only the third empirical investigation to assess it and the first to do so from the perspective of research on narrative identity. Drawing on the rich tradition of studying narrative identity, the present study examined identity disturbance in a group of 40 mid-life adults, 20 with features of BPD and a matched sample of 20 without BPD. Extensive life story interviews were analyzed for a variety of narrative elements and the themes of agency, communion fulfillment (but not communion), and narrative coherence significantly distinguished the stories of those people with features of BPD from those without the disorder. In addition, associations between the theme of agency and psychopathology were evident six and twelve months following the life story interview. This study seeks to bridge the mutually-informative fields of research on personality disorders and normal identity processes. PMID:22867502
Sauer, Christina; Sheppes, Gal; Lackner, Helmut Karl; Arens, Elisabeth A; Tarrasch, Ricardo; Barnow, Sven
Emotion dysregulation is a core feature of borderline personality disorder (BPD). So far, many studies have tested the consequences of the implementation of certain emotion regulation (ER) strategies, but there have been no investigations about ER choices in BPD. Thus, the aim of this study was to investigate habitual ER choices by self-report questionnaires and experimentally by testing the preference to select between distraction and reappraisal when facing different emotional intensities (high vs. low) and contents (borderline-specific vs. unspecific negative) in patients with BPD (n=24) compared with clinical controls (patients with major depression, n=19) and a healthy control group (n=32). Additionally, heart rate (HR) responses were continuously assessed. Main results revealed that both patient groups showed maladaptive self-reported ER choice profiles compared with HC. We found, however, no differences between the groups in the choice of distraction and reappraisal on the behavioral level and in HR responses. In BPD, within-group analyses revealed a positive correlation between symptom severity and the preference for distraction under high-intensity borderline-specific stimuli. Our findings provide preliminary evidence of ER choices in BPD and show the robustness of the choice effect in patients with affective disorders. PMID:27344452
Staebler, Katja; Gebhard, Rita; Barnett, Winfried; Renneberg, Babette
Stability of subjective emotional responses to positive and negative film stimuli was examined in female patients with borderline personality disorder (BPD, n=30), depressed patients (n=27) and a non-clinical control group (n=30). At first assessment (t1) clinical participants were inpatients. The second assessment was conducted 8 months later, when clinical participants were not in an acute crisis. Positive emotions and other-focused negative emotions were successfully induced in all participants. Altogether, more negative baseline emotionality describes both patient groups better than differences in emotional reactivity. Our findings contradict the hypothesis of general emotional hyperreactivity in BPD patients for both positive and negative emotions. PMID:18533129
Full Text Available Social dysfunction is a prominent and disabling aspect of Borderline Personality Disorder. We reconsider traditional explanations for this problem – especially early disruption in the way an infant feels physical care from it’s mother – in terms of recent developments in computational psychiatry. In particular, social learning may depend on reinforcement learning though embodied simulations. Such modeling involves calculations based on structures outside the brain such as face and hands, calculations on one’s own body that are used to make inferences about others. We discuss ways to test the role of embodied simulation in BPD and potential implications for treatment.
Full Text Available There is a general agreement that physical pain serves as an alarm signal for the prevention of and reaction to physical harm. It has recently been hypothesized that "social pain," as induced by social rejection or abandonment, may rely on comparable, phylogenetically old brain structures. As plausible as this theory may sound, scientific evidence for this idea is sparse. This study therefore attempts to link both types of pain directly. We studied patients with borderline personality disorder (BPD because BPD is characterized by opposing alterations in physical and social pain; hyposensitivity to physical pain is associated with hypersensitivity to social pain, as indicated by an enhanced rejection sensitivity.Twenty unmedicated female BPD patients and 20 healthy participants (HC, matched for age and education played a virtual ball-tossing game (cyberball, with the conditions for exclusion, inclusion, and a control condition with predefined game rules. Each cyberball block was followed by a temperature stimulus (with a subjective pain intensity of 60% in half the cases. The cerebral responses were measured by functional magnetic resonance imaging. The Adult Rejection Sensitivity Questionnaire was used to assess rejection sensitivity.Higher temperature heat stimuli had to be applied to BPD patients relative to HCs to reach a comparable subjective experience of painfulness in both groups, which suggested a general hyposensitivity to pain in BPD patients. Social exclusion led to a subjectively reported hypersensitivity to physical pain in both groups that was accompanied by an enhanced activation in the anterior insula and the thalamus. In BPD, physical pain processing after exclusion was additionally linked to enhanced posterior insula activation. After inclusion, BPD patients showed reduced amygdala activation during pain in comparison with HC. In BPD patients, higher rejection sensitivity was associated with lower activation differences during
Full Text Available The aim of this article is to describe the normal and abnormal development of mentallisation and development of borderline personality disorder as a mentallisation dysfunction, in the context of development of attachment relation. Borderline personality disorder is a distinct clinical syndrome with important implications for public health; patients show reduced capacities to mentalise, which inevitably leads to problems in interpersonal relationships, identity disturbance, impulsivity, emotional regulation and suicidal threats. In this article author present a review of a construct of mentallisation as it is developed by P. Fonagy and his collaborators. Mentalising is the process of making sense of mental states in oneself and other persons in terms of subjective states and mental processes. The concept of mentallisation is rooted in attachment theory. The author reviews the biobehavioural switch–model of the relationship between attachment, arousal or stress, mentallisation, and development of borderline personality disorder.
Amini, Mehdi; Pourshahbaz, Abbas; Mohammadkhani, Parvaneh; Khodaie Ardakani, Mohammad Reza; Mozhgan LOTFI
Background: Fundamental problems with Personality Disorders (PD) diagnostic system in the previous version of DSM, led to the revision of DSM. Therefore, a multidimensional system has been proposed for diagnosis of personality disorder features in DSM-5. In the dimensional approach of DSM-5, personality disorders diagnosis is based on levels of personality functioning (Criteria A) and personality trait domains (Criteria B). Objectives: The purpose of this study was firstly, to examine the DSM...
Jacob, Gitta A; Hellstern, Kathrin; Ower, Nicole; Pillmann, Mona; Scheel, Corinna N; Rüsch, Nicolas; Lieb, Klaus
Emotional dysregulation is hypothesized to be a core feature of borderline personality disorder (BPD). In this study, we investigated the course of emotions in response to standardized emotion inductions in BPD. A total of 26 female BPD patients, 28 matched healthy control subjects, and 15 female patients with major depressive disorder listened to short stories inducing an angry, joyful, or neutral mood. Before and immediately after each story as well as 3 and 6 minutes later, participants rated their current anger, joy, anxiety, shame, and sadness. All 3 groups showed the same increase and decrease of emotions. However, strong group differences in the general level of all negative emotions occurred. While sadness was stronger both in BPD and major depressive disorder as compared with healthy controls, all other negative emotions were significantly increased in BPD only independent of comorbid depression. Extreme negative affectivity may be a more appropriate description of BPD-related emotional problems than emotional hyperreactivity. PMID:19996718
Full Text Available Objective: This study aimed to examine the effect of dialectic behavior therapy on the reduction of impulsiveness in women with comorbidity of borderline personality disorders and substance abuse. Method: An experimental single system research design using multiple baselines was employed for this study. Based on the structured diagnostic interview and entry criteria, four participants among female patients with borderline personality disorders and substance abuse were selected via purposive sampling method. All four subjects received twelve dialectic behavior therapy sessions. Then, Impulsiveness Bart Scale (IBS was used to measure impulsiveness. Results: Dialectic behavior therapy led to the significant reduction of impulsiveness scores in women with borderline personality disorders and substance abuse. Graphs pertaining to the effectiveness and effect size indicate a significant decrease in participants’ impulsiveness. Conclusion: Dialectic behavior therapy interventions can contribute to the decrease of impulsiveness and bring about desired practical implications in the treatment and prevention of substance abuse.
周敏; 骆加文; 谢斌
目的 探讨边缘型人格障碍的临床特征及与其他相关人格障碍的表现异同.方法 对住院诊断为人格障碍的49例病史资料进行调查登记和再诊断.然后对各型人格障碍的临床特点进行比较分析.结果 边缘型人格障碍的临床表现与其他类型有相似重叠之处但又不完全相同.结论 边缘型人格障碍可能是一个亚型,与冲动型人格之间有较大联系.%Objective To compare the clinical characteristics of borderline personality disorder with other related personality disorders.Methods A total of 49 files of inpatients with personality disorder diagnosed according to CCMD -2- R or CCMD -3 were retrospectively reviewed and rediagnosed according to DSM -Ⅳ.Clinical characteristics were compared among the rediagnosed subgroups.Results The clinical profiles of borderline personality disorder had much overlaps as well as some differences with other personality disorders.Conclusion Borderline personality disorder might be a independent subtype of personality disorder.It has close relationship with the impulsive personality disorder.
Full Text Available Personality disorders (PDs are highly prevalent in patients receiving psychiatric services, and are associated with significant personal and social costs. Over the past two decades, an increasing number of treatment studies have documented the effectiveness of treatment for patients with PDs, especially when it comes to reduction of symptom distress, risk taking behavior, self-harm, or suicide attempts. However, less is known about the more complex aims of improving the personality structure itself, such as identity- and interpersonal disturbances. Emotional dysfunction is closely associated with PD pathology. The present study investigated changes in affect consciousness (AC in patients with avoidant or borderline PD, and how these changes were associated with clinical status after 3 years of follow-up. The study included 52 individuals; 79 percent were females, and mean age was 30 years. The evaluations included the Affect Consciousness Interview, Symptom Checklist-90-R, Circumplex of Interpersonal Problems, the Index of Self-Esteem, and three domains (Identity Integration, Relational Capacities, and Self-Control of the Severity Indices of Personality Problems (SIPP-118. There was a significant increase in the Global AC and AC scores for most of the specific affects from baseline to follow-up. As the present study did not include a control group, it cannot be concluded that changes in AC are effects of psychotherapy, and the possibility of age-related maturation processes cannot be excluded. The change in Global AC contributed significantly to explained variance in the follow-up levels of Circumplex of Interpersonal Problems, and the two SIPP-118 domains Relational Capacities and Identity Integration. Improved AC was not associated with change in the Self-Control domain or the Global Severity Index of Symptom Checklist-90-R. The results suggest that AC may be altered for patients with borderline and avoidant PDs, and this is the first study to
Normann-Eide, Eivind; Johansen, Merete Selsbakk; Normann-Eide, Tone; Egeland, Jens; Wilberg, Theresa
Personality disorders (PDs) are highly prevalent in patients receiving psychiatric services, and are associated with significant personal and social costs. Over the past two decades, an increasing number of treatment studies have documented the effectiveness of treatment for patients with PDs, especially when it comes to reduction of symptom distress, risk taking behavior, self-harm, or suicide attempts. However, less is known about the more complex aims of improving the personality structure itself, such as identity- and interpersonal disturbances. Emotional dysfunction is closely associated with PD pathology. The present study investigated changes in affect consciousness (AC) in patients with avoidant or borderline PD, and how these changes were associated with clinical status after 3 years of follow-up. The study included 52 individuals; 79 percent were females, and mean age was 30 years. The evaluations included the Affect Consciousness Interview, Symptom Checklist-90-R, Circumplex of Interpersonal Problems, the Index of Self-Esteem, and three domains (Identity Integration, Relational Capacities, and Self-Control) of the Severity Indices of Personality Problems (SIPP-118). There was a significant increase in the Global AC and AC scores for most of the specific affects from baseline to follow-up. As the present study did not include a control group, it cannot be concluded that changes in AC are effects of psychotherapy, and the possibility of age-related maturation processes cannot be excluded. The change in Global AC contributed significantly to explained variance in the follow-up levels of Circumplex of Interpersonal Problems, and the two SIPP-118 domains Relational Capacities and Identity Integration. Improved AC was not associated with change in the Self-Control domain or the Global Severity Index of Symptom Checklist-90-R. The results suggest that AC may be altered for patients with borderline and avoidant PDs, and this is the first study to report that
Full Text Available Background: Patients with posttraumatic stress disorder (PTSD are prone to dissociation, which in theory should interfere with successful treatment. However, most empirical studies do not substantiate this assumption. Objective: The primary objective was to test whether state dissociation predicts the success of an adaptation of dialectical behavior therapy designed for the treatment of patients with PTSD after childhood sexual abuse (CSA (DBT-PTSD. We further explored whether the operationalization of dissociation as state versus trait dissociation made a difference with respect to prediction of improvement. Methods: We present a hypothesis-driven post hoc analysis of a randomized controlled trial on the efficacy in patients with PTSD after CSA. Regression analyses relating pre–post improvements in the Clinician-Administered PTSD Scale (CAPS and the Posttraumatic Diagnostic Scale (PDS to dissociation were applied to the women who participated in the active treatment arm (DBT-PTSD. Multivariate models accounting for major confounders were used to relate improvements in both the CAPS and the PDS to (1 state dissociation as assessed after each treatment session and (2 trait dissociation as assessed at baseline. Results: State dissociation during psychotherapy sessions predicted improvement after DBT-PTSD: patients with low state dissociation during treatment had a higher chance to show substantial improvement. This relation consistently emerged across subgroups of PTSD patients with and without borderline personality disorder. The operationalization of dissociation as state versus trait dissociation made a difference as improvement was not significantly predicted from trait dissociation. Conclusions: Dissociation during treatment sessions may reduce success with trauma-focused therapies such as DBT-PTSD. Accordingly, clinical studies aimed at improving ways to address dissociation are needed.
Bozzatello, Paola; Bellino, Silvio
Few investigations evaluated the long-term effects of psychotherapies in borderline personality disorder (BPD). In a previous study, we compared efficacy of combination of fluoxetine and interpersonal psychotherapy adapted to BPD (IPT-BPD) versus single fluoxetine administered for 32 weeks. This study is aimed to investigate whether the results obtained with the addition of IPT-BPD persist during a follow-up period. Forty-four patients who completed the 32 weeks trial underwent 24 months of follow-up receiving fluoxetine 20-40 mg/day. Clinical Global Impression Severity (CGI-S), Hamilton Rating Scales for Depression and Anxiety (HDRS, HARS), Social and Occupational Functioning Assessment Scale (SOFAS), Satisfaction Profile (SAT-P), and Borderline Personality Disorder Severity Index (BPDSI) were repeated at 6, 12, and 24 months. Statistical analysis was performed with the general linear model. Results showed that most of the differences between combined therapy and single pharmacotherapy at the end of the 32 weeks trial were maintained after 24 months follow-up. The addition of IPT-BPD to medication produced greater effects on BPD symptoms (impulsivity and interpersonal relationships) and quality of life (perception of psychological and social functioning) that endured after termination of psychotherapy. On the contrary, different effects on anxiety symptoms and affective instability were lost after 6 months. PMID:27107668
Leppänen, V; Hakko, H; Sintonen, H; Lindeman, S
The implementation of effective psychotherapies in community mental health care is challenging. This study aimed to create a well-structured and easily applicable treatment model for patients with severe borderline personality disorder (BPD). We integrated a schema therapy based psycho-educational group into an available individual therapy. Two groups were formed: (1) community treatment by experts (CTBE) patients (n = 24) receiving new treatment and (2) treatment as usual (TAU) patients (n = 47). Changes in symptoms were measured by Borderline Personality Disorder Severity Index-IV interview and quality of life by the 15D health-related quality of life questionnaire. After 1 year the CTBE patients showed a significant reduction in a wider range of BPD symptoms and better quality of life than TAU patients. The results of this study are encouraging. A well-structured treatment model was successfully implemented into community mental health care with improved patient adherence to treatment and superior treatment outcomes compared to TAU patients. PMID:25824852
Drass, Jessica Masino
Art therapy has shown benefits for people with borderline personality disorder and borderline personality traits by alleviating interpersonal difficulties such as affect regulation, an unstable sense of self, self-injurious behaviors, and suicidal ideation. Borderline personality disorder is currently viewed as a trauma spectrum disorder, because…
Few, Lauren R; Miller, Joshua D; Grant, Julia D; Maples, Jessica; Trull, Timothy J; Nelson, Elliot C; Oltmanns, Thomas F; Martin, Nicholas G; Lynskey, Michael T; Agrawal, Arpana
[Correction Notice: An Erratum for this article was reported in Vol 28(1) of Psychological Assessment (see record 2015-54029-001). The FFI-BPD values for Sample 3 in Table 2 should read 1.42 (0.44), 0.83.] The aim of the current study was to examine the reliability and validity of a trait-based assessment of borderline personality disorder (BPD) using the NEO Five-Factor Inventory. Correlations between the Five-Factor Inventory-BPD composite (FFI-BPD) and explicit measures of BPD were examined across 6 samples, including undergraduate, community, and clinical samples. The median correlation was .60, which was nearly identical to the correlation between measures of BPD and a BPD composite generated from the full Revised NEO Personality Inventory (i.e., NEO-BPD; r = .61). Correlations between FFI-BPD and relevant measures of psychiatric symptomatology and etiology (e.g., childhood abuse, drug use, depression, and personality disorders) were also examined and compared to those generated using explicit measures of BPD and NEO-BPD. As expected, the FFI-BPD composite correlated most strongly with measures associated with high levels of Neuroticism, such as depression, anxiety, and emotion dysregulation, and the pattern of correlations generated using the FFI-BPD was highly similar to those generated using explicit measures of BPD and NEO-BPD. Finally, genetic analyses estimated that FFI-BPD is 44% heritable, which is comparable to meta-analytic research examining genetics associated with BPD, and revealed that 71% of the genetic influences are shared between FFI-BPD and a self-report measure assessing BPD (Personality Assessment Inventory-Borderline subscale; Morey, 1991). Generally, these results support the use of FFI-BPD as a reasonable proxy for BPD, which has considerable implications, particularly for potential gene-finding efforts in large, epidemiological datasets that include the NEO FFI. PMID:25984635
Wong, Hiu-Mei; Leung, Henry Chi-Ming; Chow, Lai-Yin; Kam, Wai-Kwok; Tang, Alan Ka-Lam
This study examined the point prevalence of Borderline Personality Disorder (BPD) and its clinical correlates in patients with recent deliberate self-harm (DSH) in Hong Kong. A representative consecutive sample (n = 160) of patients with DSH referred to Prince of Wales Hospital from April 1, 2007 to March 31, 2008 was recruited. Their BPD status was determined according to the BPD subscale of the Chinese version of Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). The point prevalence of BPD was calculated. Subjects with and without BPD were compared in terms of demographic and clinical characteristics. Thirty out of 160 (18.8%) DSH patients were found to suffer from BPD. DSH patients with BPD were more likely to be female (p = .020), more often reported history of childhood physical (p = 0.043) and sexual abuse (p disorder (p = 0.043) and eating disorder (p = 0.040) than those without BPD. Being female, having history of childhood sexual abuse and current alcohol and substance use disorder were found to be independent predictors of BPD status by binary logistic regression. PMID:21158601
Marcos Hirata Soares
OBJETIVO: Este estudo objetivou revisar, na literatura, os critérios diagnósticos e as intervenções nos transtornos de personalidade do tipo Antissocial e Borderline. MÉTODOS: Uma pesquisa manual foi realizada no acervo bibliográfico particular do autor, selecionando-se 12 referências; outra pesquisa sistematizada foi desenvolvida no período de 1990 a 2008, no mês de janeiro de 2009, na Biblioteca Virtual em Saúde, selecionando-se 23 artigos. RESULTADOS: Os achados indicaram duas abordagens -...
the concept of mentalization in music therapy treatment of people with diagnosed personality disorder. It will be based on integrating the theoretical perspective, on the process of therapy with focus on musical improvisation mostly. The clinical material will consist of exemplifying......Mentalization is a core concept in the modern treatment model for psychotherapy with personality disorders. The mentalization based treatment model presents a new view on how to understand the process of therapy, and has a view on how the therapist shall act and intervene in order to help the...
Cohen, Patricia; Chen, Henian; Gordon, Kathy; Johnson, Jeffrey; Brook, Judith; Kasen, Stephanie
Low socioeconomic status (SES) background has been identified as a risk for several mental disorders. However evidence regarding SES and the developmental course of personality disorder (PD) has not been addressed. Nor is it clear whether an SES relationship to PD symptom course may be attributable to known associated risks. Further, specificity of such relationships to a particular PD diagnostic pattern independent of comorbidity with other PD or with depression has not been investigated. Da...
Hjalmarsson, Erik; Kaver, Anna; Perseius, Kent-Inge; Cederberg, Kerstin; Ghaderi, Ata
The aim of this paper was to investigate the feasibility and impact of dialectical behaviour therapy (DBT) for patients with borderline personality disorder (BPD) in a clinical outpatient setting. Eighteen clinicians were trained and supervised in using DBT. Twenty-seven female patients were assessed on a number of variables before the treatment,…
Levy, Kenneth N.; Meehan, Kevin B.; Kelly, Kristen M.; Reynoso, Joseph S.; Weber, Michal; Clarkin, John F.; Kernberg, Otto F.
Changes in attachment organization and reflective function (RF) were assessed as putative mechanisms of change in 1 of 3 year-long psychotherapy treatments for patients with borderline personality disorder (BPD). Ninety patients reliably diagnosed with BPD were randomized to transference-focused psychotherapy (TFP), dialectical behavior…
Pizzarello, Scott; Taylor, Jeanette
Objective: To determine if the substance use patterns of one's close friends and romantic partners would be a significant contributor to the co-occurrence of borderline personality disorder (BPD) features and drug use problems above and beyond impulsivity and negative emotionality. Participants: Participants were 2,202 undergraduates who attended…
Mikołajczyk, Iwona; Wawrzyniak, Zbigniew
It was described the case of 25-years-old person's dependent from medicines (reassuring, sleeping and analgesic)and alcohol from coexisting rare disorders happened in the detox squad. Establish that person, during the treatment metrical he is the man and possesses the characteristic genotype for the Klinefelter's syndrome, the features of the personality of type borderline and the eating disorders (bulimic side of annorexia). Her autobiography, psychical state (she underlined that he felt the woman despite the sex mentally by the whole time of the stay) her behavior are the interesting therapeutics problems. In the article was introduced the test explanation of mechanisms her psychical functioning, and the difficulty which appeared in the process of diagnosis and psychotherapy. The Klinefelter's syndrome was differentiated with transsexualism seldom in the aim of the more exact understanding of above mentioned difficulties. Medical and psychoterapeutic strategies were proposed for that person. PMID:19391512
In the D.S.M. IV, classification system of the American Psychiatric Association (1), which is the most used document in investigation and communication in psychiatry, it is stated that the Depressive Disorder affects between 5 and 9% in women and 2 per cent and 3 per cent of men, while border line personality disorder, correspond to 2% of the general population. Both pathological disorders share dimensions of regulation of affection and control of impulses (2). In these pathologies there are important impaired functions in at least three common systems of neurotransmission with behavioral features such as the cholinergic system, noradrenergic system and serotoninergic systems (3). In this paper an intracomparisson of brain blood flow is reported of a group of patients with Mayor Depression and Borderline Personality, in basal conditions versus activation conditions with the Wisconsin Test, as well an intercomparisson between the results of both pathologies are reported. In this work brain blood flow is quantified by SPECT Tc99m HMPAO evaluating the compromise in areas of the brain cortex, which are part of the three brain separate circuits (4) such as the frontal orbit circuit, the anterior cyngulate and the dorsolateral prefrontal circuit, with its afferences and efferences (5). In the analysis of results we can see a compromise shared in structures linked to motivation, where the anterior cyngulate stands out, while the hipofuncionality induced by the Wisconsin test in borderline patients (P< 0.00005 to the right and< 0.0003 to the left) is more marked than in depressive patients ( P< 0.002 to the right and < 0.003 to the left). The same happens in the area 32 of Brodmann (part of the limbic system), and the area 25 mentioned by Damasio (6) as the area of the 'anhedonia' where the compromise exists in both pathologies. There is only in borderline patients a significative compromise of the dorsolateral prefrontal area or executive area induced by the stress of the
Infurna, Maria Rita; Brunner, Romuald; Holz, Birger; Parzer, Peter; Giannone, Francesca; Reichl, Corinna; Fischer, Gloria; Resch, Franz; Kaess, Michael
This study examined a broad variety of adverse childhood experiences in a consecutive sample of female adolescent inpatients with borderline personality disorder (BPD; n = 44) compared with a clinical control (CC; n = 47) group with mixed psychiatric diagnoses. BPD was diagnosed using a structured clinical interview; different dimensions of childhood adversity were assessed using the Childhood Experiences of Care and Abuse Questionnaire, the Parental Bonding Instrument, and the Family Assessment Device. A history of childhood adversity was significantly more common in patients with BPD than in the CC group. Using a multivariate model, sexual abuse (OR = 13.8), general family functioning (OR = 8.9), and low maternal care (OR = 7.6) were specific and independent predictors of adolescent BPD. The results increase our knowledge of the specific role of different dimensions of childhood adversity in adolescent BPD. They have important implications for prevention and early intervention as they highlight the need for specific strategies for involving the family. PMID:25905734
Winter, Dorina; Koplin, Katrin; Schmahl, Christian; Bohus, Martin; Lis, Stefanie
People's memory of past social encounters influences current social interactions. Social rejection has been shown to increase people's memory for social events particularly when referring to others rather than themselves. Social rejection and neglect often characterize biographies of individuals with borderline personality disorder (BPD). Using a social memory task, we investigated whether the evaluation and memory of social events is altered in BPD and whether this depends on reference to the self or others. 30 patients with BPD and 30 healthy controls evaluated the valence of positive, neutral, and negative standardized events, which were either social or nonsocial. Subsequently, participants had to recall these events. BPD patients evaluated social events of negative and neutral valence as more negative than healthy controls. Further, only BPD patients tended to preferentially recall self-referential social events. These findings suggest altered self-referential processing of social events that affects both the evaluation and the memory for social events. PMID:27078755
Dixon-Gordon, Katherine L; Gratz, Kim L; Breetz, Alisa; Tull, Matthew
This study sought to build upon existing research on interpersonal sensitivity in borderline personality disorder (BPD) by examining whether emotion dysregulation mediates the relationship between BPD and cognitive and emotional responses to social rejection. Participants with (n = 53) and without (n = 34) BPD reported on levels of negative affect and threat to four social needs (perceived control, belonging, selfesteem, and meaningful existence) in response to a laboratory-based social ostracism task (Cyberball). Results revealed heightened interpersonal (rejection) sensitivity among BPD (vs. non-BPD) participants, as evidenced by heightened threat to all social needs and nonspecific distress (although not overall negative affect) in response to the task. Furthermore, both overall emotion dysregulation and the specific dimensions involving emotion modulation strategies, emotional clarity, and the control of behaviors when distressed mediated the relationship between BPD status and several cognitive (threats to meaningful existence, belonging, and self-esteem) and emotional (nonspecific distress) responses to the task. PMID:23514181
Maurex, Liselotte; Zaboli, Ghazal; Wiens, Stefan; Asberg, Marie; Leopardi, Rosario; Ohman, Arne
The Iowa Gambling Task (IGT) was used to examine (i) social decision-making in women with borderline personality disorder (BPD), and (ii) the relationship between impaired decision-making and the tryptophan hydroxylase-1 (TPH-1) gene, involved in serotonin synthesis. Forty-two women with BPD and a history of suicide attempts were genotyped, and the frequency of a TPH-1 haplotype previously uniquely associated with BPD was calculated. The BPD group scored significantly lower than a control group in the IGT. Furthermore, the TPH-1 haplotype displayed a significantly higher frequency in BPD participants with impaired decision making, compared to BPD participants with normal scores. These findings suggest that impaired decision-making as determined by the IGT is a feature of BPD and may be (i) associated with serotonin dysfunction, and (ii) possibly relevant for suicidal behavior. PMID:18826425
Webber, Troy A; Kiselica, Andrew M; Arango, Alejandra; Rojas, Elizabeth; Neale, Michael C; Bornovalova, Marina A
Borderline personality disorder (BPD) is a barrier to treatment, yet the relationship between BPD features and other psychopathology symptoms in residential addictions treatment samples is understudied. Using a sample of adults enrolled in a residential drug treatment facility measured at baseline and 2-3 month follow-up, the authors examined the prospective relationship between BPD features and five indices of psychopathology: depression, anxiety, interpersonal sensitivity, hostility, and psychoticism, as well as psychopathology global severity. There was no effect of time on any of the forms of psychopathology, but females reported higher levels of BPD features, anxiety symptoms, and interpersonal sensitivity than males. A series of latent change score models indicated that BPD features predicted increases in all psychopathology scales at follow-up, while the reverse was not true. These results suggest that targeting BPD features in residents of drug treatment facilities may reduce the emergence of new psychopathology in the short term. PMID:25562538
Schuppert, Hermine Maria
Borderline persoonlijkheidsstoornis is een ernstig psychiatrisch beeld dat zich kenmerkt door heftige stemmingswisselingen, zelfbeschadiging (snijden), impulsief gedrag en zwart-wit denken. Hoewel de gevolgen op lange termijn vaak ernstig zijn wordt de stoornis, zeker bij jongeren, nauwelijks onderk
the concept of mentalization in music therapy treatment of people with diagnosed personality disorder. It will be based on integrating the theoretical perspective, on the process of therapy with focus on musical improvisation mostly. The clinical material will consist of exemplifying......Mentalization is a core concept in the modern treatment model for psychotherapy with personality disorders. The mentalization based treatment model presents a new view on how to understand the process of therapy, and has a view on how the therapist shall act and intervene in order to help the...... patient enhance their capacity to mentalize. This improved ability to mentalize is at the core of the treatment model, and is considered to be essential to recovery. There are no prior writings about mentalization in a music therapeutical context. This chapter investigates and discusses the relevance of...
Part one of the thesis reviews the literature on whether antisocial personality disorder (ASPD) and psychopathy represent distinct categories. This question was addressed by identifying studies with populations of individuals meeting criteria for ASPD and exploring the samples in terms of other constructs. Studies are divided into four areas; cluster analytic studies, studies of emotional processing, theory of mind and mentalizing, and executive functioning. The review suggests that those who...
Turner, Brianna J; Dixon-Gordon, Katherine L; Austin, Sara B; Rodriguez, Marcus A; Zachary Rosenthal, M; Chapman, Alexander L
Although non-suicidal self-injury (NSSI) occurs in people with and without borderline personality disorder (BPD), few studies have compared the clinical characteristics of these two groups. The present study sampled adults with a history of NSSI and compared those with and without BPD on (a) NSSI features, (b) co-occurring psychiatric disorders, and (c) severity of depression, suicidal ideation and emotion dysregulation. Participants (NSSI+BPD, n=46; NSSI Only, n=54) completed semi-structured interviews and self-report measures. Whereas the groups did not differ in age of NSSI onset, the NSSI+BPD group engaged in more frequent, recent and severe NSSI, and reported higher rates of skin carving, head banging, self-punching and self-scratching than the NSSI Only group. Participants with BPD also showed greater diagnostic comorbidity, particularly for anxiety disorders, but did not differ from participants without BPD in rates of mood, substance or psychotic disorders. The NSSI+BPD group reported more severe depressive symptomatology, suicidal ideation and emotion dysregulation than the NSSI Only group. Supplementary analyses on the subset of participants with recent (past year) NSSI revealed similarly medium to large differences between those with and without BPD. Implications for assessment and treatment are discussed. PMID:26315664
Patrícia Helena Vaz Tanesi
Full Text Available Adesão é um comportamento complexo, envolve desde pequenas recusas ao tratamento até o uso inadequado dos serviços de saúde e abandono do tratamento. O presente trabalho é um estudo qualitativo com seis pacientes com transtorno de personalidade borderline sobre adesão ao tratamento, utilizando análise qualitativa em entrevista aberta, questionário psicossocial, classificação diagnóstica pela SCID I e II e acompanhamento clínico. Os resultados mostraram que impulsividade, manipulação, dissociação afetiva, tentativa de suicídio, tendência à regressão e agressividade dificultaram ou impossibilitaram a adesão ao tratamento. Concluímos que os casos que abandonaram o tratamento colocaram a equipe em uma situação de impotência e apelo para estratégias sociais como forma de manejo da situação. É levantada a hipótese de que familiares saudáveis podem ser importantes para a adesão ao tratamento. Nos casos que não abandonaram o acompanhamento, a não-adesão se manifestou como ataques ao vínculo, ataques a melhora, e agressividade voltada à equipe e à instituição.Compliance is a complex behavior, ranging from minor instances of treatment refusal to the inappropriate use of health services or even treatment abandonment. The study comprises a qualitative analysis of six patients with borderline personality disorder submitted to an open interview, a psychosocial questionnaire, a diagnostic classification through SCDI I and II and a clinical follow-up. Six behaviors made treatment compliance either difficult or impossible: impulsivity, manipulation, affective dissociation, attempted suicide, tendency to regression, and aggression. The participants who abandoned the treatment made the health team impotent, requiring social strategies to manage the situation. We hypothesized that healthy families are of great importance for compliance to treatment. For the cases in which treatment was not abandoned, non-compliance was
Bellino, Silvio; Bozzatello, Paola; Rocca, Giuseppe; Bogetto, Filippo
Omega-3 fatty acids have received increasing interest due to their effects in stabilizing plasmatic membranes and regulating cell signaling. The efficacy of omega-3 fatty acids in psychiatric disorders, in particular mood disorders, has been studied. There have been two trials on eicosapentanoic acid (EPA) and docosahexanoic acid (DHA) in the treatment of borderline personality disorder (BPD). The present 12-week controlled trial aimed to assess the efficacy of the association of EPA and DHA with valproic acid, compared to single valproic acid, in 43 consecutive BPD outpatients. Participants were evaluated at baseline and after 12 weeks with: Clinical Global Impression - Severity (CGI-S), Hamilton Scales for depression and anxiety (HAM-D, HAM-A), Social and Occupational Functioning Assessment Scale (SOFAS), borderline personality disorder severity index (BPDSI), Barratt Impulsiveness Scale - version 11 (BIS-11), Modified Overt Aggression Scale (MOAS), Self-Harm Inventory (SHI) and Dosage Record Treatment Emergent Symptom Scale (DOTES). PMID:24196948
Gratz, Kim L; Rosenthal, M Zachary; Tull, Matthew T; Lejuez, C W; Gunderson, John G
Despite the emphasis on emotional reactivity and delayed emotional recovery in prominent theoretical accounts of borderline personality disorder (BPD), research in this area remains limited. This study sought to extend extant research by examining emotional reactivity (and recovery following emotional arousal) to 2 laboratory stressors (one general, and the other involving negative evaluation) and exploring the impact of these stressors on subjective responding across the specific emotions of anxiety, irritability, hostility, and shame. We hypothesized that outpatients with BPD (compared to outpatients without a personality disorder; non-PD) would demonstrate heightened subjective emotional reactivity to both stressors, as well as a delayed return to baseline levels of emotional arousal. Results provide evidence for context- and emotion-specific reactivity in BPD. Specifically, BPD participants (compared to non-PD participants) evidenced heightened reactivity to the negative evaluation but not the general stressor. Furthermore, results provide support for shame-specific reactivity in BPD, with BPD participants (vs non-PD participants) evidencing a significantly different pattern of change in shame (but not in reported anxiety, irritability, or hostility) across the course of the study. Specifically, not only did BPD participants report higher levels of shame in response to the negative evaluation, their levels of shame remained elevated following this stressor (through the post-recovery period at the end of the study). Findings suggest the importance of continuing to examine emotional reactivity in BPD within specific contexts and across distinct emotions, rather than at the general trait level. PMID:20399337
Gratz, Kim L; Tull, Matthew T; Gunderson, John G
Although research on the temperamental vulnerabilities associated with borderline personality disorder (BPD) has focused primarily on the role of impulsive-aggression, affective instability, and emotional vulnerability, growing evidence suggests that anxiety sensitivity (AS) also may increase vulnerability for BPD. This study provides preliminary data on the relationship between AS and BPD, examining whether AS distinguishes outpatients with BPD from outpatients without a personality disorder (non-PD), and whether the relationship between AS and BPD is mediated by experiential avoidance (i.e., attempts to avoid unwanted internal experiences, such as anxiety). Findings indicate that BPD outpatients reported higher levels of AS than non-PD outpatients and AS reliably distinguished between these two groups. Furthermore, the relationship between AS and BPD was mediated by experiential avoidance. Finally, results indicate that AS (and experiential avoidance as a mediator) accounted for a significant amount of additional variance in BPD status above and beyond both negative affect and two well-established temperamental vulnerabilities for BPD (affect intensity/reactivity and impulsivity). Findings suggest the need to further explore the role of AS in the pathogenesis of BPD. PMID:17637464
Disentangling Emotion Processes in Borderline Personality Disorder: Physiological and Self-reported Assessment of Biological Vulnerability, Baseline Intensity, and Reactivity to Emotionally-Evocative Stimuli
Kuo, Janice R.; Linehan, Marsha M.
This study investigated Linehan’s (1993) theory that individuals meeting criteria for borderline personality disorder (BPD) have high biological vulnerability to emotion dysregulation, including high baseline emotional intensity and high reactivity to emotionally-evocative stimuli. Twenty individuals with BPD, 20 age-matched individuals with generalized social anxiety disorder (SAD), and 20 age-matched normal controls (NC) participated in two separate emotion induction conditions, a standardi...
Axelrod, Seth R.; Perepletchikova, Francheska; Holtzman, Kevin; Sinha, Rajita
Background Dialectical Behavior Therapy (DBT) identifies emotion dysregulation as central to the dangerous impulsivity of borderline personality disorder (BPD) including substance use disorders, and DBT targets improved emotion regulation as a primary mechanism of change. However, improved emotion regulation with DBT and associations between such improvement and behavioral outcomes such as substance use has not been previously reported. Objective Thus, the goal of this study was to assess for improvement in emotion regulation and to examine the relationship between improvements in the emotion regulation and substance use problems following DBT treatment. Method Emotion regulation as assessed by the Difficulties in Emotion Regulation Scale, depressed mood as assessed by the Beck Depression Inventory, and their associations with substance use frequency were investigated in 27 women with substance dependence and BPD receiving 20 weeks of DBT in an academic community outpatient substance abuse treatment program. Results indicated improved emotion regulation, improved mood, and decreased substance use frequency. Further, emotion regulation improvement, but not improved mood, explained the variance of decreased substance use frequency. Conclusions This is the first study to demonstrate improved emotion regulation in BPD patients treated with DBT and to show that improved emotion regulation can account for increased behavioral control in BPD patients. Significance and Future Research Emotion regulation assessment is recommended for future studies to further clarify the etiology and maintenance of disorders associated with emotional dyregulation such as BPD and substance dependence, and to further explore emotion regulation as a potential mechanism of change for clinical interventions. PMID:21091162
Kopala-Sibley, Daniel C; Zuroff, David C; Russell, Jennifer J; Moskowitz, D S; Paris, Joel
This study examined whether the personality traits of self-criticism and dependency respectively moderated the effects of perceived inferiority and emotional insecurity on negative affect during interpersonal interactions in individuals with borderline personality disorder (BPD). A sample of 38 patients with BPD and matched community comparison participants completed event-contingent record forms after each significant interaction for a 20-day period. Multilevel models showed that, controlling for baseline levels of depressive symptoms and neuroticism, as well as lagged negative affect, event-level elevations in perceived inferiority and emotional insecurity were related to more negative affect in both groups. Event-level perceived inferiority was more strongly associated with negative affect in patients with BPD who reported higher levels of self-criticism, while event-level perceived emotional insecurity was more strongly associated with negative affect in patients with BPD who reported higher levels of dependency. No significant interactions emerged for the comparison group. These findings further our understanding of differences among patients with BPD and support the application of personality-vulnerability or diathesis-stress models in predicting negative affect in BPD. Results have implications for the design of therapies for patients with BPD. PMID:22686873
Belsky, D. W.; Caspi, A.; Arseneault, L; Bleidorn, W.; Fonagy, P.; Goodman, M.; Houts, R.; Moffitt, T.E.
It has been reported that borderline personality related characteristics can be observed in children, and that these characteristics are associated with increased risk for the development of borderline personality disorder. It is not clear whether borderline personality related characteristics in children share etiological features with adult borderline personality disorder. We investigated the etiology of borderline personality related characteristics in a longitudinal cohort study of 1,116 ...
Wingenfeld, Katja; Wolf, Oliver T
Stress hormones influence a wide range of cognitive functions, including memory performance and executive function. It is well established that glucocorticoids enhance memory consolidation but impair memory retrieval. While most of the effects have been attributed to glucocorticoid receptors (GR), the importance of mineralocorticoid receptors (MR) has been also emphasized. Dysfunctions in hypothalamic-pituitary-adrenal (HPA) axis have been reported for several mental disorders. While major depressive disorder (MDD) as well as borderline personality disorder (BPD) seem to be characterized by enhanced cortisol release in concert with a reduced feedback sensitivity of the HPA axis, in posttraumatic stress disorder (PTSD) a contrary picture has been reported. Despite the fact that altered GR function has been discussed for these disorders only very few studies have investigated the effects of glucocorticoids on cognitive performance in these patients so far. In a series of studies, we investigated the effects of glucocorticoids on cognition (i.e. declarative memory, working memory and response inhibition) in different mental disorders such as MDD, PTSD and BPD. While in patients with MDD cortisol administration failed to effect memory retrieval, patients with PTSD and BPD showed enhanced rather than impaired memory retrieval after cortisol administration. These results indicate an altered sensitivity to cortisol in these disorders. Results from one of our recent studies in the field of social cognition underline the importance of the MR. We found that emotional empathy was enhanced through stimulation of the MR via fludrocortisone in healthy participants and women with BPD. This review aims to integrate these findings and discuss potential mechanisms and implications. PMID:25462901
The mental health of preschoolers in a Norwegian population-based study when their parents have symptoms of borderline, antisocial, and narcissitic personality disorders: at the mercy of unpredictability
Berg-Nielsen, Turid Suzanne; Wichstrøm, Lars
Background: Clinical studies have shown that children of parents with mental health problems are most likely to develop psychiatric problems themselves when their parents have a Personality Disorder characterized by hostility. The Personality Disorders that appear most associated with hostility, with the potential to affect children, are Borderline Personality Disorder, Antisocial Personality Disorder and Narcissistic Personality Disorder. The question addressed in this study is whether the r...
The mental health of preschoolers in a Norwegian population-based study when their parents have symptoms of borderline, antisocial, and narcissistic personality disorders: at the mercy of unpredictability
Berg-Nielsen Turid; Wichström Lars
Abstract Background Clinical studies have shown that children of parents with mental health problems are most likely to develop psychiatric problems themselves when their parents have a Personality Disorder characterized by hostility. The Personality Disorders that appear most associated with hostility, with the potential to affect children, are Borderline Personality Disorder, Antisocial Personality Disorder and Narcissistic Personality Disorder. The question addressed in this study is wheth...
Distel, Marijn A; Smit, Johannes H; Spinhoven, Philip; Penninx, Brenda W J H
Anxiety and depression frequently co-occur with borderline personality disorder. Relatively little research examined the presence of borderline personality features and its main domains (affective instability, identity problems, negative relationships and self-harm) in individuals with remitted and current anxiety and depression. Participants with current (n=597) or remitted (n=1115) anxiety and/or depression and healthy controls (n=431) were selected from the Netherlands Study of Depression and Anxiety. Assessments included the Personality Assessment Inventory - Borderline Features Scale and several clinical characteristics of anxiety and depression. Borderline personality features were more common in depression than in anxiety. Current comorbid anxiety and depression was associated with most borderline personality features. Anxiety and depression status explained 29.7% of the variance in borderline personality features and 3.8% (self-harm) to 31% (identity problems) of the variance in the four domains. A large part of the variance was shared between anxiety and depression but both disorders also explained a significant amount of unique variance. The severity of anxiety and depression and the level of daily dysfunctioning was positively associated with borderline personality features. Individuals with a longer duration of anxiety and depression showed more affective instability and identity problems. These findings suggest that patients with anxiety and depression may benefit from an assessment of personality pathology as it may have implications for psychological and pharmacological treatment. PMID:27183108
The objective of the present study is to demonstrate the traits of the psychopathology of Borderline Personality Disorder (BPD) compared with hysterical neurosis. A total of 48 subjects with BPD and 40 subjects with hysterical neurosis both defined by DSM-III-R were assessed by Diagnostic Interview for Borderlines (DIB). Statistical analysis was done by quantification of the second type, a multivariate data analysis. The total scores of DIB were BPD group, 6.13 +/- 1.52; hysterical neurosis group, 4.9 +/- 2.12 (t = 3.05, P = 0.0016). The correlation ratio (index of to what extent the two groups are discriminated) was 0.2442. Among the four parameters of: (i) affect, (ii) cognition, (iii) impulse-action pattern, (iv), and interpersonal relationships, the partial coefficient correlations of (iii) and (iv) were significantly high (0.342, 0.287, P aloneness (0.3797), demanding nature (0.3768), self-mutilation (0.3609), visual hallucination (0.3395). Those with low score of independent coefficients were counterdependency (0.0533), identity disturbance (0.1010), depression (0.1551), loneliness (0.1752), hypomanic episode (0.1936). Both of BPD and hysterical neurosis groups were not so fairly well discriminated. However, these results suggested that impulse-action pattern and disorder of interpersonal relationships were traits of borderline personality disorder. We could admit manipulation, intolerance of aloneness as its symptoms. In addition, counterdependency, identity disturbance were comparatively common to both. There were some borderline personality traits symptomatically in hysterical neurosis. PMID:11285092
Full Text Available Abstract Background Borderline Personality Disorder (BPD is a common mental disorder associated with raised mortality, morbidity and substantial economic costs. Although complex psychological interventions have been shown to be useful in the treatment of BPD, such treatments are expensive to deliver and therefore have limited availability and questionable cost-effectiveness. Less complex interventions are required for the management of BPD. A Joint Crisis Plan (JCP is a record containing a service user's treatment preferences for the management of future crises and is created by the service user with the help of their treating mental health team. These plans have been shown to to be an effective way of reducing compulsory treatment in people with psychosis. However, to date they have not been used with individuals with BPD. This exploratory trial will examine whether use of a JCP is an effective and cost-effective intervention for people with BPD for reducing self-harm. Methods/Design In this single blind exploratory randomized controlled trial, a total of 120 participants (age >18 years with a primary diagnosis of DSM-IV borderline personality disorder will be recruited from community mental health teams and, after completing a baseline assessment, will be assigned to one of two conditions: (1 a Joint Crisis Plan, or (2 treatment as usual. Those allocated to the JCP condition will take part in a facilitated meeting, the purpose of which will be to agree the contents of the plan. Following the meeting, a typed version of the JCP will be sent to the patient and to any other individuals specified by the participant. All participants will be followed-up at 6 months. The primary outcome measures are: any self-harm event, time to first episode of self-harm and number of self-harm events over the follow-up period. Secondary outcome measures are length of time from contemplation to act of self-harm, help-seeking behaviour after self-harm, cost, working
Mariana Eizirik; Peter Fonagy
OBJECTIVE: To describe the concept of mentalization, and its application in understanding the development of psychopathology in patients with borderline personality disorder; to give an account of the main features of mentalization-based treatment; to summarise the evidence supporting its effectiveness. DISCUSSION: Mentalization is a predominantly preconscious mental activity that enables the individual to understand him/herself and others in terms of subjective states and mental processes. P...
Relationship between emotion regulation and emotional intelligence in borderline personality disorder [Strategie regulacji emocji a inteligencja emocjonalna u pacjentów z zaburzeniem osobowości borderline
Aim. A typical trait of borderline personality disorder is emotional instability. The strategies that patients with BPD use to regulate their affects are not yet known. The purpose of presented research was an attempt to find the often used emotion regulation strategies, the eventual differences in value of emotional intelligence between BPD patients and healthy controls, and a relationship between emotion regulation and emotional intelligence in BPD. The work on FrAGe (an own self-descriptiv...
Baschnagel, Joseph S; Coffey, Scott F; Hawk, Larry W; Schumacher, Julie A; Holloman, Garland
This study assessed physiological measures for the study of emotional dysregulation associated with borderline personality disorder (BPD). Two patient groups, the first comprised of individuals with BPD only (n = 16) and the second, individuals with BPD and co-occurring substance-use disorder (SUD; n = 35), and a group of healthy controls (n = 45) were shown standardized pictures of varying valance and arousal levels. Affective modification of startle eye-blink responses, heart rate, facial electromyography (EMG, including corrugator and zygomatic activity), and skin-conductance responses were collected during picture presentation and during a brief recovery period. Startle data during picture presentation indicated a trend toward the expected increase in startle response magnitude to negative stimuli, to be moderated by group status, with patients with BPD-SUD showing a lack of affective modification and the BPD-only group showing similar affective modification to that of controls. Heart-rate data suggested lower reactivity to negative pictures for both patient groups. Differences in facial EMG responses did not provide a clear pattern, and skin-conductance responses were not significantly different between groups. The data did not suggest differences between groups in recovery from exposure to the emotional stimuli. The startle and heart-rate data suggest a possible hyporeactivity to emotional stimuli in BPD. PMID:23088207
Minzenberg, Michael J; Poole, John H; Vinogradov, Sophia
Borderline personality disorder (BPD) is a paradigmatic disorder of adult attachment, with high rates of antecedent childhood maltreatment. The neurocognitive correlates of both attachment disturbance and maltreatment are both presently unknown in BPD. This study evaluated whether dimensional adult attachment disturbance in BPD is related to specific neurocognitive deficits, and whether childhood maltreatment is related to these dysfunctions. An outpatient BPD group (n=43) performed nearly 1 SD below a control group (n=26) on short-term recall, executive, and intelligence functions. These deficits were not affected by emotionally charged stimuli. In the BPD group, impaired recall was related to attachment-anxiety, whereas executive dysfunction was related to attachment-avoidance. Abuse history was correlated significantly with executive dysfunction and at a trend level with impaired recall. Neurocognitive deficits and abuse history exhibited both independent and interactive effects on adult attachment disturbance. These results suggest that (a) BPD patients' reactivity in attachment relationships is related to temporal-limbic dysfunction, irrespective of the emotional content of stimuli, (b) BPD patients' avoidance within attachment relationships may be a relational strategy to compensate for the emotional consequences of frontal-executive dysregulation, and (c) childhood abuse may contribute to these neurocognitive deficits but may also exert effects on adult attachment disturbance that is both independent and interacting with neurocognitive dysfunction. PMID:18211741
Unruh, Brandon T; Gunderson, John G
While the public health burden posed by borderline personality disorder (BPD) rivals that associated with other major mental illnesses, the prevailing disposition of psychiatrists toward the disorder remains characterized by misinformation, stigma, aversive attitudes, and insufficient familiarity with effective generalist treatments that can be delivered in nonspecialized health care settings. Residency training programs are well positioned to better equip the next generation of psychiatrists to address these issues, but no consensus or guidelines currently exist for what and how residents should be taught about managing BPD. Instead, disproportionately limited curricular time, teaching of non-evidence-based approaches, and modeling of conceptually confused combinations of techniques drawn from specialty BPD treatments are offered. In this article, we (1) explain why training in a generalist model is sensible and why alternative approaches are not appropriate for residents, (2) propose a plan for giving residents adequate training via a generalist model, highlighting minimal didactic and clinical-training objectives (dubbed "core competencies" and "milestones") and a model curriculum developed at the Massachusetts General Hospital/McLean Hospital residency program, and (3) describe obstacles to implementation of effective generalist training posed by infrastructural, faculty-centered, and resident-centered variables. PMID:27603744
Buchheim, Anna; Erk, Susanne; George, Carol; Kächele, Horst; Martius, Philipp; Pokorny, Dan; Spitzer, Manfred; Walter, Henrik
Individuals with borderline personality disorder (BPD) are characterized by emotional instability, impaired emotion regulation and unresolved attachment patterns associated with abusive childhood experiences. We investigated the neural response during the activation of the attachment system in BPD patients compared to healthy controls using functional magnetic resonance imaging (fMRI). Eleven female patients with BPD without posttraumatic stress disorder (PTSD) and 17 healthy female controls matched for age and education were telling stories in the scanner in response to the Adult Attachment Projective Picture System (AAP), an eight-picture set assessment of adult attachment. The picture set includes theoretically-derived attachment scenes, such as separation, death, threat and potential abuse. The picture presentation order is designed to gradually increase the activation of the attachment system. Each picture stimulus was presented for 2 min. Analyses examine group differences in attachment classifications and neural activation patterns over the course of the task. Unresolved attachment was associated with increasing amygdala activation over the course of the attachment task in patients as well as controls. Unresolved controls, but not patients, showed activation in the right dorsolateral prefrontal cortex (DLPFC) and the rostral cingulate zone (RCZ). We interpret this as a neural signature of BPD patients’ inability to exert top-down control under conditions of attachment distress. These findings point to possible neural mechanisms for underlying affective dysregulation in BPD in the context of attachment trauma and fear. PMID:27531977
Bales, Dawn L; Timman, Reinier; Andrea, Helene; Busschbach, Jan J V; Verheul, Roel; Kamphuis, Jan H
The present study extends the body of evidence regarding the effectiveness of day hospital Mentalization-Based Treatment (MBT) by documenting the treatment outcome of a highly inclusive group of severe borderline personality disorder (BPD) patients, benchmarked by a carefully matched group who received other specialized psychotherapeutic treatments (OPT). Structured diagnostic interviews were conducted to assess diagnostic status at baseline. Baseline, 18-month treatment outcome and 36-month treatment outcome (after the maintenance phase) on psychiatric symptoms (Brief Symptom Inventory) and personality functioning (118-item Severity Indices of Personality Problems) were available for 29 BPD patients assigned to MBT, and an initial set of 175 BPD patients assigned to OPT. Propensity scores were used to determine the best matches for the MBT patients within the larger OPT group, yielding 29 MBT and 29 OPT patients for direct comparison. Treatment outcome was analysed using multilevel modelling. Pre to post effect sizes were consistently (very) large for MBT, with a Cohen's d of -1.06 and -1.42 for 18 and 36 months, respectively, for the reduction in psychiatric symptoms, and ds ranging from 0.81 to 2.08 for improvement in domains of personality functioning. OPT also yielded improvement across domains but generally of moderate magnitude. In conclusion, the present matched control study, executed by an independent research institute outside the UK, demonstrated the effectiveness of day hospital MBT in a highly inclusive and severe group of BPD patients, beyond the benchmark provided by a mix of specialized psychotherapy programmes. Interpretation of the (large) between condition effects warrants cautionary caveats given the non-randomized design, as well as variation in treatment dosages. PMID:25060747
Full Text Available OBJECTIVE: To describe the concept of mentalization, and its application in understanding the development of psychopathology in patients with borderline personality disorder; to give an account of the main features of mentalization-based treatment; to summarise the evidence supporting its effectiveness. DISCUSSION: Mentalization is a predominantly preconscious mental activity that enables the individual to understand him/herself and others in terms of subjective states and mental processes. Psychological trauma in childhood is associated with deficits in mentalization and with the development of borderline personality disorder. Mentalization-based treatment is a psychodynamically-oriented manualized psychotherapy for borderline personality disorder that aims to develop a therapeutic process in which the patient's capacity for mentalization becomes the focus of treatment. Randomized controlled trials have demonstrated the effectiveness of this treatment for patients with borderline personality disorder. CONCLUSIONS: The development of a psychodynamically-oriented therapeutic intervention that specifically targets the deficits involved in the psychopathology of borderline personality disorder is a crucial step in increasing the effectiveness of treatment. Mental health professionals should be adequately prepared to deliver effective interventions to their patients, such as mentalization-based treatment.OBJETIVO: Descrever o conceito de mentalização e sua aplicação no entendimento do desenvolvimento da psicopatologia em pacientes com transtorno de personalidade borderline; descrever as principais características da terapia de mentalização; sumarizar as evidências que demonstram sua efetividade. DISCUSSÃO: Mentalização é uma atividade mental predominantemente pré-consciente que capacita o indivíduo a compreender a si mesmo e aos outros em termos de estados subjetivos e processos mentais. Trauma psicológico na infância está associado
Treating Co-Occurring Axis I Disorders in Recurrently Suicidal Women with Borderline Personality Disorder: A 2-Year Randomized Trial of Dialectical Behavior Therapy versus Community Treatment by Experts
Harned, Melanie S.; Chapman, Alexander, L.; Dexter-Mazza, Elizabeth T.; Murray, Angela; Comtois, Katherine A.; Linehan, Marsha M.
This study evaluated whether dialectical behavior therapy (DBT) was more efficacious than treatment by nonbehavioral psychotherapy experts in reducing co-occurring Axis I disorders among suicidal individuals with borderline personality disorder (BPD). Women with BPD and recent and repeated suicidal and/or self-injurious behavior (n = 101) were…
Schmahl, Christian; Herpertz, Sabine C.; Bertsch, Katja; Ende, Gabriele; Flor, Herta; Kirsch, Peter; Lis, Stefanie; Meyer-Lindenberg, Andreas; Rietschel, Marcella; Schneider, Miriam; Spanagel, Rainer; Treede, Rolf-Detlef; Bohus, Martin
The last two decades have seen a strong rise in empirical research in the mechanisms of emotion dysregulation in borderline personality disorder. Major findings comprise structural as well as functional alterations of brain regions involved in emotion processing, such as amygdala, insula, and prefrontal regions. In addition, more specific mechanisms of disturbed emotion regulation, e.g. related to pain and dissociation, have been identified. Most recently, social interaction problems and thei...
Day hospital Mentalization-based treatment versus intensive outpatient Mentalization-based treatment for patients with severe borderline personality disorder: protocol of a multicentre randomized clinical trial
Laurenssen, E.; Smits, M.L.; Bales, D.L.; Feenstra, D. J.; Eeren, H.V. (Hester V.); Noom, M.J.; Koster, M.A.; Lucas, Z.; Timman, R.; Dekker, J.; Luyten, Patrick; Busschbach, J.; Verheul, R.
Background Borderline personality disorder (BPD) is associated with a high socioeconomic burden. Although a number of evidence-based treatments for BPD are currently available, they are not widely disseminated; furthermore, there is a need for more research concerning their efficacy and cost-effectiveness. Such knowledge promises to lead to more efficient use of resources, which will facilitate the effective dissemination of these costly treatments. This study focuses on the efficacy and cost...
Laurenssen, E. M.; Westra, D.; Kikkert, M.J.; Noom, M.J.; Eeren, H.V. (Hester V.); van Broekhuyzen, A.J.; Peen, J.; Luyten, Patrick; van Busschbach, J. J.; Dekker, J.J.
Background Severe borderline personality disorder is associated with a very high psychosocial and economic burden. Current treatment guidelines suggest that several manualized treatments, including day hospital Mentalization-Based Treatment (MBT-DH), are effective in these patients. However, only two randomized controlled trials have compared manualized MBT-DH with treatment as usual. Given the relative paucity of data supporting the efficacy and cost-effectiveness of MBT-DH, the possible inf...
Kvarstein, Elfrida H; Pedersen, Geir; Urnes, Øyvind; Hummelen, Benjamin; Wilberg, Theresa; Karterud, Sigmund
Objectives Few studies outside United Kingdom have documented effects of mentalization-based treatment (MBT) for patients with borderline personality disorder (BPD). This study aimed to investigate outcomes for BPD patients treated in an MBT programme in a Norwegian specialist treatment unit and compare benefits of the implemented MBT with the unit's former psychodynamic treatment programme. Design A naturalistic, longitudinal, comparison of treatment effects for BPD patients before and after...
Macfie, Jenny; Swan, Scott A.
Borderline personality disorder (BPD) represents a severe distortion in the development of attachment, self, and emotion regulation. Study of children at high risk of developing BPD may inform precursors to BPD. In a low socioeconomic status sample of 30 children aged 4–7 whose mothers have BPD and 30 normative comparisons, representations of the caregiver–child relationship and of the self, and emotion regulation were assessed with a story-stem completion measure. In contrast to comparisons ...
Beeney, Joseph E; Hallquist, Michael N; Ellison, William D; Levy, Kenneth N
Individuals with borderline personality disorder (BPD) display an impoverished sense of self and representations of self and others that shift between positive and negative poles. However, little research has investigated the nature of representational disturbance in BPD. The present study takes a multimodal approach. A card sort task was used to investigate complexity, integration, and valence of self-representation in BPD. Impairment in maintenance of self and other representations was assessed using a personality representational maintenance task. Finally, functional MRI (fMRI) was used to assess whether individuals with BPD show neural abnormalities related specifically to the self and what brain areas may be related to poor representational maintenance. Individuals with BPD sorted self-aspects suggesting more complexity of self-representation, but also less integration and more negative valence overall. On the representational maintenance task, individuals with BPD showed less consistency in their representations of self and others over the 3-hr period, but only for abstract, personality-based representations. Performance on this measure mediated between-groups brain activation in several areas supporting social cognition. We found no evidence for social-cognitive disturbance specific to the self. Additionally, the BPD group showed main effects, insensitive to condition, of hyperactivation in the medial prefrontal cortex, temporal parietal junction, several regions of the frontal pole, the precuneus and middle temporal gyrus, all areas crucial social cognition. In contrast, controls evidenced greater activation in visual, sensory, motor, and mirror neuron regions. These findings are discussed in relation to research regarding hypermentalization and the overlap between self- and other-disturbance. PMID:26011577
Neacsiu, Andrada D.; Lungu, Anita; Harned, Melanie S.; Rizvi, Shireen L.; Linehan, Marsha M.
Evidence suggests that heightened negative affectivity is a prominent feature of Borderline Personality Disorder (BPD) that often leads to maladaptive behaviors. Nevertheless, there is little research examining treatment effects on the experience and expression of specific negative emotions. Dialectical Behavior Therapy (DBT) is an effective treatment for BPD, hypothesized to reduce negative affectivity (Linehan, 1993a). The present study analyzes secondary data from a randomized controlled trial with the aim to assess the unique effectiveness of DBT when compared to Community Treatment by Experts (CTBE) in changing the experience, expression, and acceptance of negative emotions. Suicidal and/or self-injuring women with BPD (n = 101) were randomly assigned to DBT or CTBE for one year of treatment and one year of follow-up. Several indices of emotional experience and expression were assessed. Results indicate that DBT decreased experiential avoidance and expressed anger significantly more than CTBE. No differences between DBT and CTBE were found in improving guilt, shame, anxiety, or anger suppression, trait, and control. These results suggest that DBT has unique effects on improving the expression of anger and experiential avoidance, whereas changes in the experience of specific negative emotions may be accounted for by general factors associated with expert therapy. Implications of the findings are discussed. PMID:24418652
Schwarze, Cornelia E; Hellhammer, Dirk H; Stroehle, Verena; Lieb, Klaus; Mobascher, Arian
Borderline personality disorder (BPD) is characterized by a pattern of intense but unstable interpersonal relationships. These interpersonal dysfunctions may originate from impaired bonding and attachment that is determined during early life. Remarkably, it has been reported that the quality of mother-infant relationship is influenced by the feeding mode. Thus, bottle feeding instead of breastfeeding and possible lack of maternal bonding-related behavior may increase the risk for later psychopathology and attachment problems as seen in BPD. A total of 100 BPD patients and 100 matched healthy controls underwent semistructured interviews, based on retrospective information about early risk factors and breastfeeding during infancy. The authors' analyses revealed that BPD patients were significantly less breastfed compared to healthy controls (no breastfeeding in BPD: 42.4%; no breastfeeding in controls: 18.2%; p maternal bonding (p = .006). Breastfeeding may act as an early indicator of the mother-infant relationship that seems to be relevant for bonding and attachment later in life. PMID:25248013
Full Text Available Disturbed relatedness is a core feature of borderline personality disorder (BPD, and impaired social cognition or deficits in mentalization are hypothesized to underlie this feature. To date, only weak empirical evidence argues for impairment in the recognition of emotions, thoughts, or intentions in BPD. Data from facial emotion recognition research indicate that these abilities are altered in BPD only if tasks are complex. The present study aims to assess social cognitive abilities in BPD. Sixty-four women with BPD and 38 healthy controls watched the Movie for the Assessment of Social Cognition (MASC, a newly developed film displaying social interactions, and asking for an assessment of the intentions, emotions, and thoughts of the characters. In addition, participants completed an established but less ecologically valid measure of social cognition (Reading the Mind in the Eyes; RME. In the RME task, BPD patients did not display impairment in social cognition compared to healthy controls. By contrast, on the more sensitive MASC, women with BPD showed significantly impaired abilities in social cognition compared to healthy controls in their recognition of emotions, thoughts, and intentions. Comorbid PTSD, intrusions, and sexual trauma negatively predicted social cognitive abilities on the more sensitive MASC. Thus, our results suggest impaired social cognitive abilities in BPD. Especially for comorbid PTSD, intrusive symptoms and history of sexual trauma predicted poor outcomes on social cognition tasks.
Vega, Daniel; Vilà-Balló, Adrià; Soto, Àngel; Amengual, Julià; Ribas, Joan; Torrubia, Rafael; Rodríguez-Fornells, Antoni; Marco-Pallarés, Josep
Background The presence of non-suicidal self-injury acts in Borderline Personality Disorder (BPD) is very prevalent. These behaviors are a public health concern and have become a poorly understood phenomenon in the community. It has been proposed that the commission of non-suicidal self-injury might be related to a failure in the brain network regulating executive functions. Previous studies have shown that BPD patients present an impairment in their capacity to monitor actions and conflicts associated with the performance of certain actions, which suppose an important aspect of cognitive control. Method We used Event Related Potentials to examine the behavioral and electrophysiological indexes associated with the error monitoring in two BPD outpatients groups (17 patients each) differentiated according to the presence or absence of non-suicidal self-injury behaviors. We also examined 17 age- and intelligence- matched healthy control participants. Results The three groups did not show significant differences in event-related potentials associated with errors (Error-Related Negativity and Pe) nor in theta power increase following errors. Conclusions This is the first study investigating the behavioral and electrophysiological error monitoring indexes in BPD patients characterized by their history of non-suicidal self-injury behaviors. Our results show that error monitoring is preserved in BPD patients and suggest that non-suicidal self-injury acts are not related to a dysfunction in the cognitive control mechanisms. PMID:26636971
Dixon-Gordon, Katherine L; Gratz, Kim L; Tull, Matthew T
Emotional reactivity has been theorized to play a central role in borderline personality (BP) pathology. Although growing research provides evidence for subjective emotional reactivity in BP pathology, research on physiological or biological reactivity among people with BP pathology is less conclusive. With regard to biological reactivity in particular, research on cortisol reactivity (a neurobiological marker of emotional reactivity) in response to stressors among individuals with BP pathology has produced contradictory results and highlighted the potential moderating role of PTSD-related pathology. Thus, this study sought to examine the moderating role of PTSD symptoms in the relation between BP pathology and both subjective (self-report) and biological (cortisol) emotional reactivity to a laboratory stressor. Participants were 171 patients in a residential substance use disorder treatment center. Consistent with hypotheses, results revealed a significant main effect of BP pathology on subjective emotional reactivity to the laboratory stressor. Furthermore, results revealed a significant interaction between BP pathology and PTSD symptoms in the prediction of cortisol reactivity, such that BP pathology was associated with heightened cortisol reactivity only among participants with low levels of PTSD symptoms. Similar findings were obtained when examining the interaction between BP pathology and the reexperiencing and avoidance/numbing symptoms of PTSD specifically. Results highlight the moderating role of PTSD symptoms in the BP-reactivity relation. PMID:23375184
Prehn, Kristin; Schulze, Lars; Rossmann, Sabine; Berger, Christoph; Vohs, Knut; Fleischer, Monika; Hauenstein, Karlheinz; Keiper, Peter; Domes, Gregor; Herpertz, Sabine C
OBJECTIVE. In the present study, we aimed to investigate the influence of concurrently presented emotional stimuli on cognitive task processing in violent criminal offenders primarily characterized by affective instability. METHODS. Fifteen male criminal offenders with antisocial and borderline personality disorder (ASPD and BPD) and 17 healthy controls underwent functional magnetic resonance imaging (fMRI) while performing a working memory task with low and high working memory load. In a second experimental run, to investigate the interaction of emotion and cognition, we presented emotionally neutral, low, or high salient social scenes in the background of the task. RESULTS. During the memory task without pictures, both groups did not differ in general task performance and neural representation of working memory processes. During the memory task with emotional background pictures, however, ASPD-BPD subjects compared to healthy controls showed delayed responses and enhanced activation of the left amygdala in the presence of emotionally high salient pictures independent of working memory load. CONCLUSIONS. These results illustrate an interaction of emotion and cognition in affective instable individuals with enhanced reactivity to emotionally salient stimuli which might be an important factor regarding the understanding of aggressive and violent behaviour in these individuals. PMID:22381099
Simeon, Daphne; Knutelska, Margaret; Smith, Lisa; Baker, Bryann R; Hollander, Eric
The goal of the current study was to investigate subjective and neurohormonal reactivity to acute psychosocial stress in borderline personality disorder (BPD) as a function of dissociative symptoms. Five BPD subjects with high dissociation, 8 BPD subjects with low dissociation, and 11 healthy control subjects were compared in basal urinary cortisol and norepinephrine, as well as in plasma cortisol and norepinephrine reactivity to the Trier Social Stress Test (TSST). Subjective stress rating and emotional response to the TSST were also measured. The three groups differed significantly in cortisol stress reactivity, with the high-dissociation BPD group demonstrating the most robust response. The three groups did not significantly differ in norepinephrine stress reactivity. In the combined BPD sample, dissociation severity tended to be inversely correlated with basal urinary norepinephrine, was positively correlated with norepinephrine stress reactivity. Childhood trauma was inversely correlated with basal urinary cortisol. In conclusion, despite its small sample size this pilot study suggests that dissociative symptomatology may be a marker of heightened biological vulnerability to stress in BPD, and merits further study. PMID:17169436
Ruocco, Anthony C.; Rodrigo, Achala H.; McMain, Shelley F.; Page-Gould, Elizabeth; Ayaz, Hasan; Links, Paul S.
Self-harm is a potentially lethal symptom of borderline personality disorder (BPD) that often improves with dialectical behavior therapy (DBT). While DBT is effective for reducing self-harm in many patients with BPD, a small but significant number of patients either does not improve in treatment or ends treatment prematurely. Accordingly, it is crucial to identify factors that may prospectively predict which patients are most likely to benefit from and remain in treatment. In the present preliminary study, 29 actively self-harming patients with BPD completed brain-imaging procedures probing activation of the prefrontal cortex (PFC) during impulse control prior to beginning DBT and after 7 months of treatment. Patients that reduced their frequency of self-harm the most over treatment displayed lower levels of neural activation in the bilateral dorsolateral prefrontal cortex (DLPFC) prior to beginning treatment, and they showed the greatest increases in activity within this region after 7 months of treatment. Prior to starting DBT, treatment non-completers demonstrated greater activation than treatment-completers in the medial PFC and right inferior frontal gyrus. Reductions in self-harm over the treatment period were associated with increases in activity in right DLPFC even after accounting for improvements in depression, mania, and BPD symptom severity. These findings suggest that pre-treatment patterns of activation in the PFC underlying impulse control may be prospectively associated with improvements in self-harm and treatment attrition for patients with BPD treated with DBT. PMID:27242484
Anthony Charles Ruocco
Full Text Available Self-harm is a potentially lethal symptom of borderline personality disorder (BPD that often improves with dialectical behavior therapy (DBT. While DBT is effective for reducing self-harm in many patients with BPD, a small but significant number of patients either does not improve in treatment or ends treatment prematurely. Accordingly, it is crucial to identify factors that may prospectively predict which patients are most likely to benefit from and remain in treatment. In the present preliminary study, twenty-nine actively self-harming patients with BPD completed brain-imaging procedures probing activation of the prefrontal cortex during impulse control prior to beginning DBT and after seven months of treatment. Patients that reduced their frequency of self-harm the most over treatment displayed lower levels of neural activation in the bilateral dorsolateral prefrontal cortex prior to beginning treatment, and they showed the greatest increases in activity within this region after seven months of treatment. Prior to starting DBT, treatment non-completers demonstrated greater activation than treatment-completers in the medial prefrontal cortex and right inferior frontal gyrus. Reductions in self-harm over the treatment period were associated with increases in activity in right dorsolateral prefrontal cortex even after accounting for improvements in depression, mania, and BPD symptom severity. These findings suggest that pre-treatment patterns of activation in the prefrontal cortex underlying impulse control may be prospectively associated with improvements in self-harm and treatment attrition for patients with BPD treated with DBT.
New, Antonia S
The articles assembled in this special issue demonstrate the broadening acceptance that a failure of "mentalization" is central in borderline personality disorder (BPD). This idea has emerged from a number of places, from astute clinicians who recognized that individuals with BPD were often limited in their ability to recognize and describe their own emotions to empirical work on emotion recognition in BPD. These articles provide a compelling argument that mentalization, with its relatively distinct and testable cognitive components, is a fertile ground for translational research. They also suggest a pathway by which empirical studies can illuminate clinical understanding. To highlight this point, it is now the routine to explain the laboratory evidence for deficits in emotional interoception to patients with BPD. This has been useful in helping to explain the internal and nuanced nature of patients' difficulties (apparent in laboratory testing but not obvious in casual encounters. This translational discussion with patients maps very closely onto an approach the editors argue for in this special issue. PMID:26436583
Mohammad Reza Mohammadi
Full Text Available This study aimed to assess the prevalence of borderline personality symptoms in 16-18 year old adolescents.In this cross sectional - descriptive study, 422 high school students (211 boys, 211 girls aged 16-18 were selected by cluster random sampling and simple random sampling in 2011-2012. The participants were assessed using the revised diagnostic interview for borderline questionnaire (DIB-R and demographic questionnaire. Data were analyzed using Pearson correlation coefficient and Spearman correlation coefficient.Of the participants, 0/9% (0/22 % of the 16 year olds, 0.45 % of the 17 year olds and 0/22% of the 18 year olds were diagnosed with borderline personality symptoms. Also, the prevalence of borderline personality symptoms in boys was 0/45 % of the total sample and it was 0/45 % of the total sample in girls. With respect to the relationship between demographic variables (age, sex, location, parents' occupation, parents' kinship, parents' education and birth order and borderline personality symptoms, only parents' kinship showed a weak correlation with borderline personality symptoms.In the view of the prevalence of 0.9% of the borderline personality symptoms in adolescents, attention should be paid to the diagnosis and treatment of this disorder. Furthermore, works need to be done to improve the mental health and quality of life of adolescents.
Koenigsberg, H W; Harvey, P D; Mitropoulou, V; New, A S; Goodman, M; Silverman, J; Serby, M; Schopick, F; Siever, L J
This study examines the degree to which two putative biologically influenced personality traits, affective instability and impulsive aggression, are associated with some of the interpersonal and intrapsychic disturbances of borderline personality disorder (BPD) and with choice of defense mechanism. In a sample of 152 personality disorder patients, affective instability and impulsive aggression were measured. Defense mechanisms were assessed in 140 of these patients using the Defensive Style Questionnaire (DSQ). The correlations between the traits of affective instability and impulsive aggression and the eight DSM-III-R criteria for borderline personality disorder and 20 DSQ defenses were examined. Affective instability was significantly correlated with the DSM-III-R criteria of identity disturbance, chronic emptiness or boredom, inappropriate anger, suicidality, and the affective instability criteria. It also was associated with the defenses of splitting, projection, acting out, passive aggression, undoing, and autistic fantasy. Impulsive aggression was related to unstable interpersonal relationships, inappropriate anger and impulsiveness and with the defense of acting out. It was negatively correlated with the defenses of suppression and reaction formation. A number of the interpersonal and experiential disturbances and defense mechanisms that are features of BPD are associated with the traits of affective instability and impulsive aggression among patients with personality disorders. PMID:11556702
Dixon-Gordon, Katherine L; Gratz, Kim L.; Tull, Matthew T.
Emotional reactivity has been theorized to play a central role in borderline personality (BP) pathology. Although growing research provides evidence for subjective emotional reactivity in BP pathology, research on physiological or biological reactivity among people with BP pathology is less conclusive. With regard to biological reactivity in particular, research on cortisol reactivity (a neurobiological marker of emotional reactivity) in response to stressors among individuals with BP patholo...
Sansone, Randy A.; Sansone, Lori A.
Clinical observations and empirical studies indicate that patients with borderline personality are both sensitive and insensitive to pain. This dichotomy may be explained by the context of the pain. For acute self-induced pain, borderline patients seem to experience attenuated pain responses. For chronic endogenous pain, borderline patients appear pain intolerant. In this paper, we explain this unusual paradox. We then discuss the psychiatric assessment of chronic pain, emphasizing the import...
Kaiser, Stefan; Roth, Alexander; Rentrop, Mirjam; Friederich, Hans-Christoph; Bender, Stephan; Weisbrod, Matthias
Intra-individual reaction time variability (IIV) in neuropsychological task performance reflects short term fluctuations in performance. Increased IIV has been reported in patients with schizophrenia and could be related to a deficient neural timing mechanism, but the role of IIV in adult patients with other psychiatric disorders has not been…
Susan Brown; Francine Shapiro; 方莉
Individuals diagnosed with borderline personality disorder（BPD） usually experience significant impairment in their ability to function.Impulsivity,affect instability,interpersonal difficulties,and identity problems are hallmark features of this disorder,f%边缘型人格障碍（BPD）患者通常有显著的功能行使能力损害。其特征是冲动、情绪不稳、人际困难和身份认同问题,常常导致自杀行为和自杀姿态。虽然传统上认为BPD是一种慢性持久的障碍,但近期的研究却提示它可能会随着时间流逝而有所缓解,而且心理治疗可以促进缓解。BPD的病因与童年期虐待和不恰当的依恋关系有关。由于童年期虐待和创伤的重要意义,被公认有效的创伤治疗方法——眼动脱敏与再加工（EMDR）可能作为BPD的合理备选治疗方案之一。本文中的个案所获得的良好疗效阐明了EMDR在BPD治疗中的运用,提示有理由进行深入的
Meaney, Rebecca; Reupert, Andrea
Objective: To determine pooled prevalence of clinically significant traits or features of Borderline Personality Disorder among college students, and explore the influence of methodological factors on reported prevalence figures, and temporal trends. Data Sources: Electronic databases (1994–2014: AMED; Biological Abstracts; Embase; MEDLINE; PsycARTICLES; CINAHL Plus; Current Contents Connect; EBM Reviews; Google Scholar; Ovid Medline; Proquest central; PsychINFO; PubMed; Scopus; Taylor & Francis; Web of Science (1998–2014), and hand searches. Study Selection: Forty-three college-based studies reporting estimates of clinically significant BPD symptoms were identified (5.7% of original search). Data Extraction: One author (RM) extracted clinically relevant BPD prevalence estimates, year of publication, demographic variables, and method from each publication or through correspondence with the authors. Results: The prevalence of BPD in college samples ranged from 0.5% to 32.1%, with lifetime prevalence of 9.7% (95% CI, 7.7–12.0; p < .005). Methodological factors contributing considerable between-study heterogeneity in univariate meta-analyses were participant anonymity, incentive type, research focus and participant type. Study and sample characteristics related to between study heterogeneity were sample size, and self-identifying as Asian or “other” race. The prevalence of BPD varied over time: 7.8% (95% CI 4.2–13.9) between 1994 and 2000; 6.5% (95% CI 4.0–10.5) during 2001 to 2007; and 11.6% (95% CI 8.8–15.1) from 2008 to 2014, yet was not a source of heterogeneity (p = .09). Conclusions: BPD prevalence estimates are influenced by the methodological or study sample factors measured. There is a need for consistency in measurement across studies to increase reliability in establishing the scope and characteristics of those with BPD engaged in tertiary study. PMID:27171206
Samuel, Douglas B.
An editorial comment on Kendler K, Meyers J, Reichborn-Kjennerud T “Borderline personality disorder traits and their relationship with dimensions of normative personality: A web-based cohort and twin study”
This paper draws attention to various similarities between Borderline Personality Disorder and Post-traumatic Stress Disorder. It is argued that the former may be considered to be an equivalent of the latter, with the difference that the trauma has either undergone repression or, having been suffered before the establishment of speech, has not been registered in verbal form. The criteria for Borderline Personality Disorder are presented in terms of symptoms of failed attachment consistent with early trauma, and various research papers linking these concepts are considered. Other research in infant attachment suggests intergenerational links between disorganised attachment patterns in infancy and parents with unresolved problems with their own parents. Research concerning the biochemical underpinning of emotional responses is quoted to link these conditions more securely, and may offer a conceptual framework in which to understand the need of these patients for a therapeutic milieu in which early developmental needs may be understood. PMID:8363532
EFFECTIVENESS OF DIALECTICAL BEHAVIOR THERAPY VERSUS COLLABORATIVE ASSESSMENT AND MANAGEMENT OF SUICIDALITY TREATMENT FOR REDUCTION OF SELF-HARM IN ADULTS WITH BORDERLINE PERSONALITY TRAITS AND DISORDER
Andreasson, Kate; Krogh, Jesper; Wenneberg, Christina;
were: severity of borderline symptoms, depressive symptoms, hopelessness, suicide ideation, and self-esteem. RESULTS: At 28 weeks, the number of participants with new self-harm in the DBT group was 21 of 57 (36.8%) versus 12 of 51 (23.5%) in the CAMS treatment (OR: 1.90; 95% CI: 0.80-4.40; P = .14......BACKGROUND: Many psychological treatments have shown effect on reducing self-harm in adults with borderline personality disorder. There is a need of brief psychotherapeutical treatment alternative for suicide prevention in specialized outpatient clinics. METHODS/DESIGN: The DiaS trial was designed...... behavior therapy (DBT) versus up to 16 weeks of collaborative assessment and management of suicidality (CAMS) treatment. The primary composite outcome was the number of participants with a new self-harm (nonsuicidal self-injury [NSSI] or suicide attempt) at week 28 from baseline. Other exploratory outcomes...
Richter, Christoph; Steinacher, Bruno; zum Eschenhoff, Anna; Bermpohl, Felix
The present study aimed to assess (1) the amount of inpatient and day clinic DBT treatment places for patients with borderline personality disorder and (2) the relationship between supply and demand in a given study region. Survey of inpatient and day clinic facilities in the German DBT network. 42 inpatient units and day clinics responded, representing 75 % of the DBT network members contacted. These institutions offer 527 DBT treatment places and treat about 2310 patients per year. The mean waiting period prior to treatment was 14.3 weeks. 700 DBT inpatient or day clinic places exist in Germany in 2011. 3000 patients receive DBT inpatient or day clinic treatment per year. This approximates a ratio of 820 borderline patients for one existing DBT inpatient or day clinic place in Germany. The long waiting time reflects the great demand for this treatment and could be interpreted as an imbalance between supply and demand. PMID:26323785
Winsper, Catherine; Lereya, Suzet Tanya; Marwaha, Steven; Thompson, Andrew; Eyden, Julie; Singh, Swaran P
Controversy surrounds the diagnosis of Borderline Personality Disorder (BPD) in youth. This meta-analysis summarised evidence regarding the aetiological and psychopathological validity of youth BPD (the extent to which youth and adult BPD share common risk factors and psychopathology). We identified 61 studies satisfying predetermined inclusion criteria. Statistically significant pooled associations with youth (19years of age and under) BPD were observed for sexual abuse (all youth: odds ratio=4.88; 95% confidence interval=3.30, 7.21; children: OR=3.97; 95% CI=1.51, 10.41; adolescents: OR=5.41; 95% CI=3.43, 8.53); physical abuse (all youth: 2.79 [2.03, 3.84]; children: 2.86 [1.98, 4.13]; adolescents: 2.60 [1.38, 4.90]); maternal hostility/verbal abuse (all youth: 3.28 [2.67, 4.03]; children: 3.15 [2.55, 3.88]; adolescents: 4.71 [1.77, 12.53]); and neglect (all youth: 3.40 [2.27, 5.11]; children: 2.87 [1.73, 4.73]; adolescents: 4.87 [2.24, 10.59]). Several psychopathological features were also associated with youth BPD, including comorbid mood (3.21 [2.13, 4.83]), anxiety (2.30 [1.44, 3.70]) and substance use (2.92 [1.60, 5.31]) disorders; self-harm (2.81 [1.61, 4.90]); suicide ideation (all youth: 2.02 [1.23, 3.32]; children: 6.00 [1.81, 19.84]; adolescents: 1.75 [1.20; 2.54]) and suicide attempt (2.10 [1.21, 3.66]). Results demonstrate that adult and youth BPD share common aetiological and psychopathological correlates. This offers some support for the diagnostic validity of youth BPD and indicates the need for clinical recognition in this age group. PMID:26709502
Arola, Riikka; Antila, Henna; Riipinen, Pirkko; Hakko, Helinä; Riala, Kaisa; Kantojärvi, Liisa
Various psychiatric problems in adolescence and early adulthood have been shown to associate with criminal behaviour. In this study the association of personality disorders (PDs) with criminal behaviour was examined in adolescents treated in psychiatric hospitals. The study sample consisted of 508 adolescents (age 13-17) admitted to acute psychiatric impatient care between April 2001 and March 2006. Crime data was obtained from the Finnish Legal Register Centre on September 2013. The Schedule for Affective Disorder and Schizophrenia for School-Age Children Present and Lifetime (K-SADS-PL) was used to assess psychiatric diagnoses in adolescence. The information on PDs in early adulthood was based on follow-up information on psychiatric treatments in either out- or inpatient settings until the end of 2012, and was extracted from the National Care Register for Health Care provided by the Finnish National Institute for Health and Welfare. A total of 22 (39%) of the 57 subjects with PD had committed a crime. In women, the likelihood for violent criminality was significantly increased in those with Borderline PD (OR 6.09, CI 1.24-29.84, p=0.009) and was also associated with conduct disorder (OR 4.26, CI 1.38-13.19, p=0.012), child welfare placement (OR 11.82, CI 3.61-38.76, pBorderline PD showed an increased risk for violent offending. This suggests Borderline PD as a potential explanatory factor for violent assaults by females and highlights the importance of recognizing the risk for violence in young women with a Borderline PD. PMID:27399875
Cheavens, Jennifer S; Zachary Rosenthal, M; Daughters, Stacey B; Nowak, Jennifer; Kosson, David; Lynch, Thomas R; Lejuez, C W
The current study examined the relationships among biological predisposition, social environment, emotion regulation, and features characteristic of Borderline Personality Disorder (BPD). Using an analogue sample, we examined whether thought suppression mediated the relationship of negative affective intensity/reactivity and perceived parental criticism with a composite of BPD features including impulsivity, interpersonal sensitivity, and aggression. Results indicated that thought suppression fully mediated the relationship between negative affect intensity/reactivity and BPD features and partially mediated the relationship between BPD features and perceived parental criticism. Clinical implications, directions for further research, and limitations of the present study are discussed. PMID:15629754
De Moor, Marleen H. M.; Distel, Marijn A.; Trull, Timothy J.; Boomsma, Dorret I.
Borderline personality disorder (BPD) is more often diagnosed in women than in men, and symptoms tend to decline with age. Using a large community sample, the authors investigated whether sex and age differences in four main features of BPD, measured with the "Personality Assessment Inventory-Borderline Features" scale (PAI-BOR; Morey, 1991), are…
Xu, Tingting; Cullen, Kathryn R; Mueller, Bryon; Schreiner, Mindy W; Lim, Kelvin O; Schulz, S Charles; Parhi, Keshab K
Borderline personality disorder (BPD) is associated with symptoms such as affect dysregulation, impaired sense of self, and self-harm behaviors. Neuroimaging research on BPD has revealed structural and functional abnormalities in specific brain regions and connections. However, little is known about the topological organizations of brain networks in BPD. We collected resting-state functional magnetic resonance imaging (fMRI) data from 20 patients with BPD and 10 healthy controls, and constructed frequency-specific functional brain networks by correlating wavelet-filtered fMRI signals from 82 cortical and subcortical regions. We employed graph-theory based complex network analysis to investigate the topological properties of the brain networks, and employed network-based statistic to identify functional dysconnections in patients. In the 0.03-0.06 Hz frequency band, compared to controls, patients with BPD showed significantly larger measures of global network topology, including the size of largest connected graph component, clustering coefficient, small-worldness, and local efficiency, indicating increased local cliquishness of the functional brain network. Compared to controls, patients showed lower nodal centrality at several hub nodes but greater centrality at several non-hub nodes in the network. Furthermore, an interconnected subnetwork in 0.03-0.06 Hz frequency band was identified that showed significantly lower connectivity in patients. The links in the subnetwork were mainly long-distance connections between regions located at different lobes; and the mean connectivity of this subnetwork was negatively correlated with the increased global topology measures. Lastly, the key network measures showed high correlations with several clinical symptom scores, and classified BPD patients against healthy controls with high accuracy based on linear discriminant analysis. The abnormal topological properties and connectivity found in this study may add new knowledge
Full Text Available ... changing beliefs and behaviors by teaching skills to: Control intense emotions Reduce self-destructive behaviors Improve relationships ... BPD behaviors, relieve symptoms of depression, and improve quality of life. Dynamic Deconstructive Therapy (DDT) DDT aims ...
Full Text Available ... accepting BPD and changing beliefs and behaviors by teaching skills to: Control intense emotions Reduce self-destructive ... BPD behaviors, relieve symptoms of depression, and improve quality of life. Dynamic Deconstructive Therapy (DDT) DDT aims ...
... they are. As a result, their interests and values can change rapidly. Other symptoms include Frantic efforts ... help people with BPD identify and change core beliefs and/or behaviors that underlie inaccurate perceptions of ...
Full Text Available ... therapy appears to be dialectical behavior therapy (DBT). This type of therapy focuses on the concept of ... therapy for BPD include: Transference-Focused Psychotherapy (TFP) This form of therapy is rooted in the patient’s ...
Full Text Available ... interact with others, and cope with problems or stress. Systems Training for Emotional Predictability and Problem Solving ( ... fluctuate and become impaired when they are under stress (particularly the stress of rejection or disappointing interactions ...
Full Text Available ... exercises, and concrete things they can do to manage their emotions when certain challenging situations arise and ... the transformation from acting out to verbalizing psychological conflicts and developing adaptive outlets for emotions. X X ...
Full Text Available ... and behaviors by teaching skills to: Control intense emotions Reduce self-destructive behaviors Improve relationships With DBT, ... concrete things they can do to manage their emotions when certain challenging situations arise and they are ...
Full Text Available ... treatment options exist. Transference-Focused Psychotherapy (TFP) Dialectical Behavior Therapy (DBT) Other forms of therapy for BPD ... STEPPS can help reduce symptoms and problem BPD behaviors, relieve symptoms of depression, and improve quality of ...
Full Text Available ... crisis and encourage small gains over time. This approach encourages the transformation from acting out to verbalizing psychological conflicts and developing adaptive outlets for emotions. X X For Professionals Disclaimer Privacy Notice © 2016 NewYork-Presbyterian Hospital
Full Text Available ... cope with problems or stress. Systems Training for Emotional Predictability and Problem Solving (STEPPS) This treatment consists ... to help patients identify and verbally express their emotions, describe their interactions with other people, and talk ...
Full Text Available ... by teaching skills to: Control intense emotions Reduce self-destructive behaviors Improve relationships With DBT, people learn ... the patient distorts his or her sense of self and images of other people. Therapy addresses intense ...
Full Text Available ... options exist. Transference-Focused Psychotherapy (TFP) Dialectical Behavior Therapy (DBT) Other forms of therapy for BPD include: ... than acting out these emotions impulsively. Schema-Focused Therapy (SFT) This type of therapy focuses on reframing “ ...
Navarro-Haro, María V; Wessman, Inga; Botella, Cristina; García-Palacios, Azucena
Different dysfunctional emotion regulation strategies are observed in patients with borderline personality disorder (BPD) and comorbid eating disorders (EDs) who report non-suicidal self-injury (NSSI). The objective of this study was to investigate the relationship of two well-defined emotion regulation strategies (i.e. expressive suppression and cognitive reappraisal) and dissociation with NSSI. The participants were sixty-eight women diagnosed with BPD and comorbid ED. A cross-sectional research design was used, and clinical interviews and self-report questionnaires were administered to collect data. Multiple regression was conducted to analyze the relationship of two emotion regulation strategies and dissociation with NSSI. According to the results, for low cognitive reappraisal scores, an increase in dissociation leads to an increase in NSSI; however, as cognitive reappraisal increases, higher dissociation is associated with fewer NSSI. When expressive suppression is low, an increase in cognitive reappraisal is associated with a decrease in NSSI; however, as suppression increases, a higher cognitive reappraisal has less effect on decreasing NSSI. These findings indicate that cognitive reappraisal reduces the harmful effects that dissociation has on NSSI, and that expressive suppression interferes with the beneficial effects of cognitive reappraisal on NSSI. Therefore, targeting expressive suppression before cognitive reappraisal is conducted may enhance treatment outcomes for patients with BPD and comorbid ED. PMID:26555500
Clarke, Stephanie B.; Rizvi, Shireen L.; Resick, Patricia A.
Many studies report that comorbid borderline personality pathology is associated with poorer outcomes in the treatment of Axis I disorders. Given the high rates of comorbidity between borderline personality pathology and posttraumatic stress disorder (PTSD), it is essential to determine whether borderline symptomatology affects PTSD treatment…
Individual differences in components of impulsivity and effortful control moderate the relation between borderline personality disorder traits and emotion recognition in a sample of university students.
Preti, Emanuele; Richetin, Juliette; Suttora, Chiara; Pisani, Alberto
Dysfunctions in social cognition characterize personality disorders. However, mixed results emerged from literature on emotion processing. Borderline Personality Disorder (BPD) traits are either associated with enhanced emotion recognition, impairments, or equal functioning compared to controls. These apparent contradictions might result from the complexity of emotion recognition tasks used and from individual differences in impulsivity and effortful control. We conducted a study in a sample of undergraduate students (n=80), assessing BPD traits, using an emotion recognition task that requires the processing of only visual information or both visual and acoustic information. We also measured individual differences in impulsivity and effortful control. Results demonstrated the moderating role of some components of impulsivity and effortful control on the capability of BPD traits in predicting anger and happiness recognition. We organized the discussion around the interaction between different components of regulatory functioning and task complexity for a better understanding of emotion recognition in BPD samples. PMID:27086219
Disentangling emotion processes in borderline personality disorder: physiological and self-reported assessment of biological vulnerability, baseline intensity, and reactivity to emotionally evocative stimuli.
Kuo, Janice R; Linehan, Marsha M
This study investigated M. Linehan's (1993) theory that individuals meeting criteria for borderline personality disorder (BPD) have high biological vulnerability to emotion dysregulation, including high baseline emotional intensity and high reactivity to emotionally evocative stimuli. Twenty individuals with BPD, 20 age-matched individuals with generalized social anxiety disorder (SAD), and 20 age-matched normal controls (NCs) participated in 2 separate emotion induction conditions, a standardized condition, and a personally relevant condition. Respiratory sinus arrhythmia (RSA), skin conductance response (SCR), and self-report measures were collected throughout the experiment. BPD participants displayed heightened biological vulnerability compared with NCs as indicated by reduced basal RSA. BPD participants also exhibited high baseline emotional intensity, characterized by heightened SCR and heightened self-reported negative emotions at baseline. However, the BPD group did not display heightened reactivity, as their physiological and self-reported changes from baseline to the emotion inductions tasks were not greater than the other 2 groups. PMID:19685950
Gratz, Kim L.; Latzman, Robert D.; Tull, Matthew T.; Reynolds, Elizabeth K.; Lejuez, C. W.
Most of the extant literature on borderline personality disorder has focused on the course, consequences, and correlates of this disorder among adults. However, little is known about childhood borderline personality (BP) features, or the factors associated with the emergence of BP pathology in childhood. A greater understanding of childhood BP…
Sajadi, Seyede Fateme; Arshadi, Nasrin; Zargar, Yadolla; Mehrabizade Honarmand, Mahnaz; Hajjari, Zahra
Background: Numerous studies have demonstrated that early maladaptive schemas, emotional dysregulation are supposed to be the defining core of borderline personality disorder. Many studies have also found a strong association between the diagnosis of borderline personality and the occurrence of suicide ideation and dissociative symptoms. Objectives: The present study was designed to investigate the relationship between borderline personality features and schema, emotion regulation, dissociati...
Craig, Stephen E.; Fall, Kevin A.
Borderline-personality disorder in adolescence is thought to develop through environmental sources, and object-relations theory posits a developmental arrest in the separation-individuation phase of development. This article discusses gender and race considerations, issues related to counseling, general treatment strategies such as coping-skills…
Carlson, Elizabeth A; Egeland, Byron; Sroufe, L Alan
The antecedents and developmental course of borderline personality disorder symptoms were examined prospectively from infancy to adulthood using longitudinal data from a risk sample (N = 162). Borderline personality disorder symptom counts were derived from the Structured Clinical Interview for DSM Disorders diagnostic interview at age 28 years. Correlational analyses confirmed expected relations between borderline symptoms and contemporary adult disturbance (e.g., self-injurious behavior, dissociative symptoms, drug use, relational violence) as well as maltreatment history. Antecedent correlational and regression analyses revealed significant links between borderline symptoms in adulthood and endogenous (i.e., temperament) and environmental (e.g., attachment disorganization, parental hostility) history in early childhood and disturbance across domains of child functioning (e.g., attention, emotion, behavior, relationship, self-representation) in middle childhood/early adolescence. Process analyses revealed a significant mediating effect of self-representation on the relation between attachment disorganization on borderline symptoms. The findings are discussed within a developmental psychopathology framework in which disturbance in self-processes is constructed through successive transactions between the individual and environment. PMID:19825270
Full Text Available Aim. The aim of the researches was to inspect the relation between borderline personality and Machiavellianism as well as the tendency to apply various manipulation tactics in everyday life and in therapy.Method. The test used an original/ authors’ survey for testing the tendency to employ manipulation tactics as well as a MACH-IV questionnaire (Christie, Geis, 1970 for measuring Machiavellianism. The studied group included 30 patients with diagnosed BPD, 37 therapists and 30 persons in the control group.Results. No differences were noted in the general indicator of Machiavellianism; however, the patients scored lower on the Tactics scale than people from the control group. Patients preferred employing the tactics of taking offense, lying and begging in everyday life. Compared to people from the control group, patients presented a larger tendency to employ tactics of begging, threatening and threatening to break off a close relationship, and a lower tendency to employ seduction. According to therapists, during the therapy patients most often resorted to lying and arousing guilt. Therapists assessed the patients’ tendency to employ manipulation tactics higher than the patients themselves.
Gratz, Kim L; Dixon-Gordon, Katherine L; Tull, Matthew T
Despite evidence for the efficacy of several treatments for deliberate self-harm (DSH) within borderline personality disorder (BPD), predictors of response to these treatments remain unknown. This study examined baseline demographic, clinical, and diagnostic predictors of treatment response to an adjunctive emotion regulation group therapy (ERGT) for DSH among women with BPD. A recent RCT provided evidence for the efficacy of this ERGT (relative to a treatment-as-usual only waitlist condition). Participants in this study include the full intent-to-treat sample who began ERGT (across treatment and waitlist conditions; n = 51). Baseline diagnostic and clinical data were collected at the initial assessment, and outcome measures of DSH and self-destructive behaviors, emotion dysregulation/avoidance, and BPD symptoms (among others) were administered at pretreatment, posttreatment, and 3- and 9-months posttreatment. Notably, both demographic variables and characteristics of participants' ongoing therapy in the community had minimal impact on treatment response. However, several indicators of greater severity in domains relevant to this ERGT (i.e., baseline emotion dysregulation and BPD criteria, lifetime and recent DSH, and past-year hospitalization and suicide attempts) predicted better responses during treatment and follow-up across the primary targets of treatment. Likewise, several co-occurring disorders (i.e., social phobia, panic disorder, and a cluster B personality disorder) predicted greater improvements in BPD symptoms during treatment or follow-up. Finally, although co-occurring generalized anxiety disorder, posttraumatic stress disorder, and cluster A and C personality disorders were associated with poorer treatment response during follow-up, most of these effects reflected a lack of continued improvements during this period (vs. worsening of symptoms). PMID:24588066
Stringer, Barbara; Meijel, Berno van; Koekkoek, Bauke; Kerkhof, Ad; Beekman, Aartjan
Structured psychotherapy is recommended as the preferred treatment of personality disorders. A substantial group of patients, however, has no access to these therapies or does not benefit. For those patients who have no (longer) access to psychotherapy a Collaborative Care Program (CCP) is developed
Unoka, Zsolt Szabolcs; Fogd, Dóra; Seres, Imola; Kéri, Szabolcs; Csukly, Gábor
Disturbed interpersonal relationships specific to borderline personality disorder (BPD) suggest biased processing of social information. The goal of this study was to examine alterations in mental state decoding (MSD) and their associations with early maladaptive schemas (EMS) that may lead to the misinterpretation of incoming information. In addition, the authors' aim was to evaluate the effects of a co-occurring current major depressive episode (MDE) on the MSD performance of BPD patients. Seventy-eight BPD patients (34 with MDE) and 76 matched healthy controls (HC) were assessed for Reading the Mind in the Eyes Test (RMET) and the level of EMS. The authors found that impairment in the total RMET performance, as well as specific impairment regarding the recognition of positive and neutral items, was associated with EMS, and enhanced vigilance to negative mental states was characteristic to BPD with MDE. Results suggest that MSD ability is altered in two independent ways in BPD. PMID:24932871
We study a sample of 18 patients in basal conditions and 31 patients with diagnosis of Borderline Personality Disorder (DSM-IV Criteria) during cortical activation by means of the Wisconsin card sorting test and assessing function/cerebral blood flow by means of HMPAO Tc 99m NeuroSPECT. The results of changes of cerebral blood flow are shown statistically in a parametric image expressing standard deviations above or below the means of a normative data base for the corresponding age of the patient. We consider only as having significance levels below 2 standard deviations of the normal means . Over this parametric map we project a matrix of Brodmann areas developed by our group in order to precisely localize the areas of abnormality observed. We express our results as percentages of the areas of Brodmann that demonstrates hypoperfusion and we compare the results in a population studied in basal conditions (n=18) and (n=31) during activation by means of the Wisconsin card sorting test. In our results we highlight, in order of importance areas of paradoxical hypoperfusion in conditions of activation versus basal measurements in anterior cyngulate gyrus (Area 24) in both hemispheres. This is followed in importance by Subgenual area (Area 25), area 40 and area 32 in the left hemisphere, and area 28 in the right hemisphere, then followed by area 28 and area 36 in the left hemisphere, area M* and area 44 in both hemispheres, and areas 32, 9 and 46 of Brodmann in the right hemisphere. We concluded that there is a dysfunctional correlation of frontal function in borderline personality disorder. Particularly noticeable is the lack of motivation when there are changes in plans and conduct, lack of pleasure and loss of the meaning of a task during the cortical stimulation. In particular, the Brodmann areas 24, 25 and 32, linked to motivation show a wider involvement when they are exposed to changes in planning and in coping strategies, as it happens during the Wisconsin Test
Relates personality disorders to career development issues and counseling interventions. Case examples suggesting career-focused treatment interventions for dependent, borderline, obsessive-compulsive, and passive-aggressive personality disorders are presented. (Author/JBJ)
Full Text Available Borderline personality disorder (BPD is a common psychiatric condition associated with self-harm. Self-harm is poorly understood and there is currently no treatment for acute presentations with self-harm urges.By using a new task (Self-relevant Task; SRT, to explore emotions related to one's own person (PERSON task and body (BODY task, to study the correlations of these emotions, specifically disgust, with self-harm urge level changes, and to test the task's potential to be developed into an experimental model of self-harming for treatment trials.17 BPD patients, 27 major depressive disorder (MDD patients, and 25 healthy volunteers performed the SRT. Emotion labels were extracted from task narratives and disgust and self-harm urge level changes measured by visual analogue scales. We used validated rating scales to measure symptom severity.The SRT was effective at inducing negative emotions and self-harm urge changes. Self-harm urge changes correlated with borderline symptom severity. Post-task disgust levels on the visual analogue scales were higher in BPD patients than in healthy controls in the PERSON task, and higher than in both control groups in the BODY task. Changes in disgust levels during the task were significantly greater in the patient groups. Post-task disgust levels or changes in disgust were not associated with self-harm urge changes (except the latter in MDD in the PERSON task, but self-harm urge changes and disgust (but no other emotion narrative labels were on a whole sample level.Although associations with the analogue scale measures were not significant, self-disgust reported in the narrative of patients may be associated with a higher probability of self-harm urges. Further research with larger sample sizes is needed to confirm this relationship and to examine whether reducing self-disgust could reduce self-harm urges. The SRT was effective and safe, and could be standardized for experimental studies.
Walters, Kristy Nichelle
Despite widespread theorizing regarding the role of heightened emotionality in the difficulties of persons with borderline personality disorder (BPD), few studies have examined whether persons with BPD features experience heightened emotional reactions to emotional stimuli in the laboratory. Existing research suggests that persons with BPD may experience heightened reactivity primarily to interpersonal stressors. Thus, for the present study, a new social rejection laboratory stressor was deve...
Full Text Available Introducción. Tanto la depresión como la impulsividad han sido asociadas a disfunciones del sistema serotoninérgico y ambas responden al tratamiento con inhibidores selectivos de la recaptura de serotonina. En este trabajo se estudia el efecto diferencial de fluoxetina sobre la impulsividad y los síntomas depresivos en pacientes con trastorno límite de personalidad. Sujetos y método. A 38 pacientes con trastorno límite de personalidad y sin patología del Eje I, se les administró fluoxetina en dosis flexibles por siete semanas. Fueron evaluados semanalmente mediante BPRS, GAF, escala de depresión de Hamilton y una escala de impulsividad. Se estudió la variación temporal del puntaje de estas escalas en dos grupos de pacientes: uno con elevada impulsividad y otro con baja impulsividad. Resultados. Hubo una mejoría de la sintomatología global y de los síntomas depresivos y la impulsividad en el grupo total de pacientes. En el grupo de sujetos más impulsivo hubo una mayor reducción de la impulsividad en las dos primeras semanas de tratamiento. En cambio, en los pacientes menos impulsivos hubo una mayor reducción de los síntomas depresivos a partir de la tercera semana de tratamiento. Ambas diferencias fueron estadísticamente significativas. Conclusiones. La fluoxetina tuvo un efecto diferencial sobre los síntomas depresivos y la impulsividad en los pacientes con trastorno límite de personalidad estudiados. Estos resultados concuerdan con los de otros autores y sugieren que los ISRS actúan por diferentes mecanismos neurobiológicos en ambos tipos de síntomas.Introduction. Depression and impulsivity has been associated to a dysfunction of serotonergic system and are treated with serotonin reuptake inhibitors (SSRI. In this work we study differential effects of fluoxetine on impulsivity and depressive symptoms in borderline personality disorders patients. Subjects and method. 38 borderline personality disorders patients without
Kawamura S, Maesawa C, Nakamura K, Nakayama K, Morita M, Hiruma Y, Yoshida T, Sakai A, Masuda T
Full Text Available Satoshi Kawamura1, Chihaya Maesawa2, Koji Nakamura1, Kazuhiko Nakayama1, Michiaki Morita1, Yohei Hiruma1, Tomoyuki Yoshida3, Akio Sakai3, Tomoyuki Masuda41Department of Psychiatry, Tokyo Jikei University school of Medicine, Tokyo, Japan; 2Department of Tumor Biology, Division of Bioscience, center for Advanced Medical science, Iwate Medical University school of Medicine, Morioka, Japan; 3Department of Neuropsychiatry, Iwate Medical University school of Medicine, Morioka, Japan; 4Department of Pathology, Iwate Medical University school of Medicine, Morioka, JapanAbstract: Polycystic ovary syndrome (PCOS is a common lifestyle-related endocrinopathy in women of reproductive age and is associated with several mental health problems. We examined the genotypic distributions of IRS-1 Gly972Arg and CYP11B2 -344T/C, which were previously described as influencing PCOS, and assayed the serum levels of interleukin-6 (IL-6 and tumor necrosis factor-alpha (TNF-α, in a set of female patients with borderline personality disorder (BPD with comorbid major depressive disorder (MDD (n = 50 and age-matched control subjects (n = 100, to investigate the predisposition for BPD with MDD. The results showed that the patients were more frequently IRS-1 972Arg variant allele carriers (P = 0.013; OR 6.68; 95% CI = 1.30-34.43 and homozygous for the CYP11B2 -344C variant allele (P = 0.022; OR = 3.32; 95% CI = 1.18-9.35 than the control subjects. The IL-6 level was significantly higher in the patients than in the controls (P < 0.0001. There was no significant difference in the serum TNF-α level between patients with BPD with MDD and the healthy comparison group (P = 0.5273. In conclusion, the predisposition for BPD with MDD is associated with that for PCOS, in the female Japanese population. An elevated serum IL-6 level is considered to be a possible biomarker of BPD with MDD.Keywords: borderline personality disorder, depression, polycystic ovary syndrome, genetic
Full Text Available Abstract Background Structured psychotherapy is recommended as the preferred treatment of personality disorders. A substantial group of patients, however, has no access to these therapies or does not benefit. For those patients who have no (longer access to psychotherapy a Collaborative Care Program (CCP is developed. Collaborative Care originated in somatic health care to increase shared decision making and to enhance self management skills of chronic patients. Nurses have a prominent position in CCP's as they are responsible for optimal continuity and coordination of care. The aim of the CCP is to improve quality of life and self management skills, and reduce destructive behaviour and other manifestations of the personality disorder. Methods/design Quantitative and qualitative data are combined in a comparative multiple case study. This makes it possible to test the feasibility of the CCP, and also provides insight into the preliminary outcomes of CCP. Two treatment conditions will be compared, one in which the CCP is provided, the other in which Care as Usual is offered. In both conditions 16 patients will be included. The perspectives of patients, their informal carers and nurses are integrated in this study. Data (questionnaires, documents, and interviews will be collected among these three groups of participants. The process of treatment and care within both research conditions is described with qualitative research methods. Additional quantitative data provide insight in the preliminary results of the CCP compared to CAU. With a stepped analysis plan the 'black box' of the application of the program will be revealed in order to understand which characteristics and influencing factors are indicative for positive or negative outcomes. Discussion The present study is, as to the best of our knowledge, the first to examine Collaborative Care for patients with severe personality disorders receiving outpatient mental health care. With the chosen
Sansone, Randy A.; Watts, Daron A.; Wiederman, Michael W.
Objective: The extant literature indicates that individuals with borderline personality disorder generally report higher levels of pain than individuals without this disorder. This study examined relationships between borderline personality symptomatology, pain, and pain catastrophizing (a related aspect of the pain experience).
Gualtieri, C. Thomas C.; And Others
The use of the diagnosis "borderline" was evaluated with 16 children (6 to 13 years old) who were referred for comprehensive evaluation. None met DSM III criteria for borderline personality disorder. The borderline label had a negative impact on some children and was not helpful for treatment planning or disposition. (Author/SEW)
Population heterogeneity of trait anger and differential associations of trait anger facets with borderline personality features, neuroticism, depression, Attention Deficit Hyperactivity Disorder (ADHD), and alcohol problems.
Lubke, Gitta H; Ouwens, Klaasjan G; de Moor, Marleen H M; Trull, Timothy J; Boomsma, Dorret I
Anger is an emotion consisting of feelings of variable intensity ranging from mild irritation to intense fury. High levels of trait anger are associated with a range of psychiatric, interpersonal, and health problems. The objectives of this study were to explore heterogeneity of anger as measured by the Spielberger Trait Anger Scale (STAS), and to assess the association of the different anger facets with a selection of psychiatric disorders covering externalizing and internalizing problems, personality disorders, and substance use. Factor mixture models differentiated between a high and low scoring class (28% vs. 72%), and between three factors (anger-temperament, anger-reaction, and immediacy of an anger response). Whereas all psychiatric scales correlated significantly with the STAS total score, regressing the three STAS factors on psychiatric behaviors model showed a more detailed pattern. Only borderline affect instability and depression were significantly associated with all three factors in both classes whereas other problem behaviors were associated only with 1 or 2 of the factors. Alcohol problems were associated with immediacy only in the high scoring class, indicating a non-linear relation in the total sample. Taking into account these more specific associations is likely to be beneficial when investigating differential treatment strategies. PMID:26454404
Factors associated with co-occurring borderline personality disorder among inner-city substance users: the roles of childhood maltreatment, negative affect intensity/reactivity, and emotion dysregulation.
Gratz, Kim L; Tull, Matthew T; Baruch, David E; Bornovalova, Marina A; Lejuez, C W
The co-occurrence of borderline personality disorder (BPD) among individuals with substance use disorders is a common and clinically relevant phenomenon in need of further empirical investigation. The present study adds to the extant literature on the factors associated with co-occurring BPD among substance users, examining the relationships between childhood maltreatment (in the form of sexual, physical, and emotional abuse and emotional and physical neglect), negative affect intensity/reactivity, emotion dysregulation, and BPD pathology (both diagnostic status and symptom count) among a sample of 76 inner-city treatment-seeking substance users. Emotion dysregulation was expected to mediate the relationships between childhood maltreatment and negative affect intensity/reactivity (and their interaction) and BPD pathology. Results indicate that the presence of a BPD diagnosis was associated with higher levels of both childhood maltreatment and negative affect intensity/reactivity. However, only childhood maltreatment emerged as a unique predictor of BPD diagnostic status. Conversely, both childhood maltreatment and negative affect intensity/reactivity accounted for unique variance in the number of endorsed BPD symptoms. Moreover, emotion dysregulation fully mediated the relationships between maltreatment and negative affect intensity/reactivity and BPD symptom count, as well as the relationship between emotional abuse in particular and BPD diagnostic status. Contrary to hypotheses, results provided no support for the interaction between maltreatment and negative affect intensity/reactivity in the prediction of BPD pathology (diagnosis or symptom count), above and beyond the main effects of these factors. PMID:18970909
Bowles, David P; Armitage, Chris J; Drabble, Jennifer; Meyer, Björn
An experimental study investigated self-esteem and other-esteem responses to either fully supportive or less supportive interpersonal feedback in college students with avoidant and borderline personality disorder features (APD and BPD respectively). Disturbances in self-esteem and in evaluations of others are central to definitions of both APD and BPD, but the extent to which such interpersonal appraisals are responsive to contextual features, such as evaluative feedback from others, is not yet clear. In theory, we would expect that individuals with pronounced PD features would show more inflexible and more negative self-evaluations and others- evaluations than those without PD features. In this study with 169 undergraduates, APD but not BPD features were associated with other-contingent state self-esteem and other-esteem. A significant interaction indicated that highly avoidant respondents felt particularly negatively about themselves and their close others in situations that conveyed subtle criticism but not in situations signalling unequivocal support. This suggests that their self-esteem and other-esteem, rather than being rigidly negative, are instead highly contingent upon interpersonal feedback. Such context contingency has implications for the trait-like description of diagnostic characteristics within current taxonomies and is in line with contemporary dynamic models of personality structure and process. PMID:24343980
Busch, Alexander J; Balsis, Steve; Morey, Leslie C; Oltmanns, Thomas F
The literature on the prevalence of borderline personality disorder (BPD) across gender reveals multiple trends. A number of studies indicate that women have a higher prevalence. Others indicate no difference, and a few even reveal that men have a higher prevalence. Yet existing studies are plagued by sampling biases, use mainly self-reported information, and tend to report general prevalence of BPD categorically defined. The current investigation attempted to shed new light on this literature by analyzing BPD features dimensionally in a representative epidemiological sample of adults ages 55-64, using both self- and informant-reported perspectives. Data from the St. Louis Personality and Aging Network study revealed a significant interaction across gender and perspective, F(1, 1360) = 23.46, p < .01. Gender differences were found for self-report only, such that men reported greater BPD severity. Meanwhile, informant report indicated no gender difference. Trends underscore the importance of epidemiological sampling and multiple assessment perspectives when analyzing BPD. PMID:26067157
Personality disorders are a group of mental illnesses. They involve long-term patterns of thoughts and behaviors ... serious problems with relationships and work. People with personality disorders have trouble dealing with everyday stresses and ...
... for Building a Healthy Self-Image and Improving Self-Esteem 8 Things You Should Know About Body Dysmorphic ... personality disorder. Personality disorders are usually recognizable by adolescence or earlier, continue throughout adulthood, and become less ...
The DiaS trial: dialectical behavior therapy versus collaborative assessment and management of suicidality on self-harm in patients with a recent suicide attempt and borderline personality disorder traits - study protocol for a randomized controlled trial
Background In Denmark 8,000 to 10,000 people will attempt suicide each year. The Centre of Excellence in Suicide Prevention in the Capital Region of Denmark is treating patients with suicidal behavior, and a recent survey has shown that 30% of the patients are suffering from borderline personality disorder. The majority of patients (70% to 75%) with borderline personality disorder have a history of deliberate self-harm and 10% have a lifetime risk to die by suicide. The DiaS trial is comparing dialectical behavior therapy with collaborative assessment and management of suicidality-informed supportive psychotherapy, for the risk of repetition of deliberate self-harm in patients with a recent suicide attempt and personality traits within the spectrum of borderline personality disorder. Both treatments have previously shown effects in this group of patients on suicide ideation and self-harm compared with treatment as usual. Methods/Design The trial is designed as a single-center, two-armed, parallel-group observer-blinded randomized clinical superiority trial. We will recruit 160 participants with a recent suicide attempt and at least two traits of the borderline personality disorder from the Centre of Excellence in Suicide Prevention, Capital Region of Denmark. Randomization will be performed though a centralized and computer-generated approach that conceals the randomization sequence. The interventions that are offered are a modified version of a dialectical behavior therapy program lasting 16 weeks versus collaborative assessment and management of suicidality-informed supportive psychotherapy, where the duration treatment will vary in accordance with established methods up to 16 weeks. The primary outcome measure is the ratio of deliberate self-harming acts including suicide attempts measured at week 28. Other exploratory outcomes are included such as severity of symptoms, suicide intention and ideation, depression, hopelessness, self-esteem, impulsivity, anger
The mental health of preschoolers in a Norwegian population-based study when their parents have symptoms of borderline, antisocial, and narcissistic personality disorders: at the mercy of unpredictability
Full Text Available Abstract Background Clinical studies have shown that children of parents with mental health problems are most likely to develop psychiatric problems themselves when their parents have a Personality Disorder characterized by hostility. The Personality Disorders that appear most associated with hostility, with the potential to affect children, are Borderline Personality Disorder, Antisocial Personality Disorder and Narcissistic Personality Disorder. The question addressed in this study is whether the risk to children’s mental health extends to the normal population of parents who have subclinical symptomlevels of these disorders. Methods This inquiry used data from a Trondheim, Norway community sample of 922 preschoolers and one parent for each child. The mean age of the children was 53 months (SD 2.1. Parents reported symptoms of Borderline, Antisocial and Narcissistic Personality Disorders on the DSM-IV ICD-10 Personality Questionnaire, and the children’s symptoms of DSM-IV behavioral and emotional diagnoses were measured with the Preschool Age Psychiatric Assessment, a comprehensive interview. Multigroup Structural Equation Modeling was used to assess the effect of parents’ symptoms on their preschoolers’ behavioral and emotional problems. Results The analyses yielded strongly significant values for the effect of parents’ Personality Disorder symptoms on child problems, explaining 13.2% of the variance of the children’s behavioral symptoms and 2.9% of the variance of internalizing symptoms. Biological parents’ cohabitation status, i.e., whether they were living together, emerged as a strong moderator on the associations between parental variables and child emotional symptoms; when parents were not cohabiting, the variance of the children’s emotional problems explained by the parents’ Personality Disorder symptoms increased from 2.9% to 19.1%. Conclusions For the first time, it is documented that parents’ self
Mentalization-based treatment in groups for adolescents with borderline personality disorder (BPD) or subthreshold BPD versus treatment as usual (M-GAB): study protocol for a randomized controlled trial
Beck, Emma; Bo, Sune; Gondan, Matthias; Poulsen, Stig Bernt; Pedersen, Liselotte; Pedersen, Jesper; Simonsen, Erik
Background: Evidence-based outpatient psychotherapeutic programs are first line treatment of Borderline Personality Disorder (BPD). Early and effective treatment of BPD is crucial to the prevention of its individual, psychosocial, and economic consequences. However, in spite of recent advantages in diagnosing adolescent BPD, there is a lack of cost effective evidence-based treatment programs for adolescents. Mentalization-Based Treatment is an evidence-based program for BPD, originally develo...
Harned, Melanie S.; Korslund, Kathryn E.; Foa, Edna B.; Linehan, Marsha M.
This study focused on the development and pilot testing of a protocol based on Prolonged Exposure (PE) that can be added to Dialectical Behavior Therapy (DBT) to treat PTSD in suicidal and self-injuring individuals with borderline personality disorder (BPD). Women with BPD, PTSD, and recent and/or imminent serious intentional self-injury (n=13) received one year of DBT with the DBT PE Protocol, plus three months of follow up assessment. The treatment was associated with significant reductions in PTSD, with the majority of patients no longer meeting criteria for PTSD at post-treatment (71.4% of DBT PE Protocol completers, 60.0% of the intent-to-treat sample). A minority of patients (27.3%) engaged in intentional self-injury during the study. Improvements were also found for suicidal ideation, dissociation, trauma-related guilt cognitions, shame, anxiety, depression, and social adjustment. There was no evidence that the DBT PE Protocol led to exacerbations of intentional self-injury urges or behaviors, PTSD, treatment dropout, or crisis service use. Overall, the results indicate that this integrated BPD and PTSD treatment is feasible to implement within one year of treatment, highly acceptable to patients and therapists, safe to administer, and shows promise as an effective intervention for PTSD in this complex and high-risk patient population. PMID:22503959
Brüne, Martin; Walden, Sarah; Edel, Marc-Andreas; Dimaggio, Giancarlo
Borderline personality disorder (BPD) is characterized by a range of interpersonal difficulties, which are, in part, related to adverse experiences during childhood. Unresponsive parenting and traumatization may cause functional impairment of mentalization, i.e. the ability to reflect upon own and others' mental states. However, the relationship of poor parenting, trauma and mentalization in BPD has not exhaustively been studied. Thirty patients diagnosed with BPD and 30 matched control subjects were asked to sequence a novel cartoon-based mentalization task involving complex emotions such as jealousy, shame, guilt etc. In addition, they were required to reason about cognitive and affective mental states of the cartoon characters. The quality of parental care was assessed using a self-report measure for recalled parental rearing style, and childhood trauma was measured in retrospect using the Childhood Trauma Questionnaire. Patients with BPD performed more poorly in all aspects of the cartoon task. Mentalizing skills, particularly relating to affective mental states, were uniquely associated with the quality of recalled parental care and childhood trauma. Together, the quality of parental care and the experience of childhood trauma negatively impact on mentalization in BPD, even in an experimental "offline" task. PMID:26350276
Marco, José H; Garcia-Alandete, Joaquín; Pérez, Sandra; Guillen, Verónica; Jorquera, Mercedes; Espallargas, Pilar; Botella, Cristina
Non-suicidal self-injury (NSSI) is considered one of the defining features of people diagnosed with Borderline Personality Disorder (BPD). Longitudinal studies are needed to identify factors predicting future NSSI in BPD participants. Several studies have shown that low meaning in life is associated with mental health problems, addiction problems, depression, hopelessness, and suicide. The purpose of this paper is to examine whether meaning in life predicts the frequency of NSSI behaviors during the one-year follow-up. The sample was composed up of 80 participants with a BPD diagnosis. We assessed the frequency of NSSI behaviors over a 12-month follow-up period. The results suggest that the participants who had low meaning in life had more frequency of NSSI, depression, and hopelessness at baseline, and more frequency of NSSI during the follow-up, than participants with high meaning in life. The predictor variables: Frequency of NSSI at base line, depression, hopelessness, and meaning in life, significantly predicted the frequency of NSSI during the one-year follow-up. Therefore, meaning in life was the only predictor of NSSI during the follow-up period. PMID:26493324
Relationship between emotion regulation and emotional intelligence in borderline personality disorder [Strategie regulacji emocji a inteligencja emocjonalna u pacjentów z zaburzeniem osobowości borderline
Full Text Available Aim. A typical trait of borderline personality disorder is emotional instability. The strategies that patients with BPD use to regulate their affects are not yet known. The purpose of presented research was an attempt to find the often used emotion regulation strategies, the eventual differences in value of emotional intelligence between BPD patients and healthy controls, and a relationship between emotion regulation and emotional intelligence in BPD. The work on FrAGe (an own self-descriptive tool which asks about different emotion regulation strategies, has also been included in this research. Methods. The investigation – which is a part of a wider project – was conducted in the Clinic of Psychiatry and Psychotherapy Bethel in Bielefeld, Germany. Subjects were 19 patients with diagnosis of BPD and 20 healthy people as a control group. Tools used in the diagnostic part of the research were: Mini – DIPS, SKID II. In order to verify the hypothesis were used: 1. to assess emotion regulation: FrAGe, ERQ, DERS, 2. to assess EI: MSCEIT, TEMINT; 3. for the assessment of general intelligence: LPS – K. Results. BPD patients reported severe impairments in emotion regulation – there are significant differences between groups in frequency of using the individual strategies of emotional regulation, negative and positive as well – but did not exhibit impairments of ability EI. The results do not prove the dependence between emotion regulation strategies and the global value of EI. Conclusions. Emotional dysfunction in BPD might affect a self perceived behaviour of the patients rather than their abilities: patients seems to possess a sufficient theoretical knowledge about functioning in the emotional context.
Hawes, David J.; Helyer, Rebekah; Herlianto, Eugene C.; Willing, Jonah
This study tested if children and adolescents with high levels of borderline personality features (BPF) exhibit the same shame-prone self-concept previously found to characterize adults with borderline personality disorder (Rusch et al., 2007). Self-concept was indexed using the Implicit Association Test, in a community sample of…
Wolke, Dieter; Schreier, Andrea; Zanarini, Mary C.; Winsper, Catherine
Background: Abuse by adults has been reported as a potent predictor of borderline personality disorder (BPD). Unclear is whether victimisation by peers increases the risk of borderline personality symptoms. Method: The Avon Longitudinal Study of Parents and Children (ALSPAC) prospective, longitudinal observation study of 6050 mothers and their…
Sansone, Randy A; Wiederman, Michael W; Hatic, Anna; Flath, Laura
Abstract Objective. The purpose of this study was to determine if patients with borderline personality emotionally react any differently than controls to theoretical media events of different valences. Methods. In this cross-sectional sample of convenience, we examined among 70 primary care patients the relationship between borderline personality disorder, according to two diagnostic measures (the borderline personality scale of the Personality Diagnostic Questionaire-4 and the Self-Harm Inventory), and emotional reactions to three types of theoretical media events - positive, negative, and neutral events. Results. Participants with versus without borderline personality evidenced no emotional differences to the various media events according to the Personality Diagnostic Questionnaire-4. However, according to the Self-Harm Inventory, participants with borderline personality symptomatology were more likely to rate neutral events with greater emotional intensity, but not positive or negative events. Conclusions. These findings suggest that patients with borderline personality may tend to respond more dramatically to ambiguous stimuli, such as neutral environmental events. We discuss the potential implications of these findings. PMID:24922472
Mortensen, Jørgen Assar; Evensmoen, Hallvard Røe; Klensmeden, Gunilla; Håberg, Asta Kristine
Uncertainty is recognized as an important component in distress, which may elicit impulsive behavior in patients with borderline personality disorder (BPD). These patients are known to be both impulsive and distress intolerant. The present study explored the connection between outcome uncertainty and impulsivity in BPD. The prediction was that cue primes, which provide incomplete information of subsequent target stimuli, led BPD patients to overrate the predictive value of these cues in order to reduce distress related to outcome uncertainty. This would yield dysfunctional impulsive behavior detected as commission errors to incorrectly primed targets. We hypothesized that dysfunctional impulsivity would be accompanied by aberrant brain activity in the right insula and anterior cingulate cortex (ACC), previously described to be involved in uncertainty processing, attention-/cognitive control and BPD pathology. 14 female BPD patients and 14 healthy matched controls (HCs) for comparison completed a Posner task during fMRI at 3T. The task was modified to limit the effect of spatial orientation and enhance the effect of conscious expectations. Brain activity was monitored in the priming phase where the effects of cue primes and neutral primes were compared. As predicted, the BPD group made significantly more commission errors to incorrectly primed targets than HCs. Also, the patients had faster reaction times to correctly primed targets relative to targets preceded by neutral primes. The BPD group had decreased activity in the right mid insula and increased activity in bilateral dorsal ACC during cue primes. The results indicate that strong expectations induced by cue primes led to reduced uncertainty, increased response readiness, and ultimately, dysfunctional impulsivity in BPD patients. We suggest that outcome uncertainty may be an important component in distress related impulsivity in BPD. PMID:27199724
Tebartz van Elst, Ludger; Fleck, Max; Bartels, Susanne; Altenmüller, Dirk-Matthias; Riedel, Andreas; Bubl, Emanuel; Matthies, Swantje; Feige, Bernd; Perlov, Evgeniy; Endres, Dominique
Introduction: An increased prevalence of pathological electroencephalography (EEG) signals has been reported in patients with borderline personality disorder (BPD). In an elaborative case description of such a patient with intermittent rhythmic delta and theta activity (IRDA/IRTA), the BPD symptoms where linked to the frequency of the IRDAs/IRTAs and vanished with the IRDAs/IRTAs following anticonvulsive therapy. This observation raised a question regarding the prevalence of such EEG abnormalities in BPD patients. The aim of this retrospective study was to identify the frequency of EEG abnormalities in a carefully analyzed psychiatric collective. Following earlier reports, we hypothesized an increased prevalence of EEG abnormalities in BPD patients. Participants and Methods: We recruited 96 consecutive patients with BPD from the archive of a university clinic for psychiatry and psychotherapy, and compared the prevalence of EEG abnormalities to those of 76 healthy controls subjects. The EEGs were rated by three different blinded clinicians, including a consultant specializing in epilepsy from the local epilepsy center. Results: We found a significant increase in the prevalence of IRDAs and IRTAs in BPD patients (14.6%) compared to the control subjects (3.9%; p = 0.020). Discussion: In this blinded retrospective case-control study, we were able to confirm an increased prevalence of pathological EEG findings (IRDAs/IRTAs only) in BPD patients. The major limitation of this study is that the control group was not matched on age and gender. Therefore, the results should be regarded as preliminary findings of an open uncontrolled, retrospective study. Future research performing prospective, controlled studies is needed to verify our findings and answer the question of whether such EEG findings might predict a positive response to anticonvulsive pharmacological treatment. PMID:26941624
Mortensen, Jørgen Assar; Evensmoen, Hallvard Røe; Klensmeden, Gunilla; Håberg, Asta Kristine
Uncertainty is recognized as an important component in distress, which may elicit impulsive behavior in patients with borderline personality disorder (BPD). These patients are known to be both impulsive and distress intolerant. The present study explored the connection between outcome uncertainty and impulsivity in BPD. The prediction was that cue primes, which provide incomplete information of subsequent target stimuli, led BPD patients to overrate the predictive value of these cues in order to reduce distress related to outcome uncertainty. This would yield dysfunctional impulsive behavior detected as commission errors to incorrectly primed targets. We hypothesized that dysfunctional impulsivity would be accompanied by aberrant brain activity in the right insula and anterior cingulate cortex (ACC), previously described to be involved in uncertainty processing, attention-/cognitive control and BPD pathology. 14 female BPD patients and 14 healthy matched controls (HCs) for comparison completed a Posner task during fMRI at 3T. The task was modified to limit the effect of spatial orientation and enhance the effect of conscious expectations. Brain activity was monitored in the priming phase where the effects of cue primes and neutral primes were compared. As predicted, the BPD group made significantly more commission errors to incorrectly primed targets than HCs. Also, the patients had faster reaction times to correctly primed targets relative to targets preceded by neutral primes. The BPD group had decreased activity in the right mid insula and increased activity in bilateral dorsal ACC during cue primes. The results indicate that strong expectations induced by cue primes led to reduced uncertainty, increased response readiness, and ultimately, dysfunctional impulsivity in BPD patients. We suggest that outcome uncertainty may be an important component in distress related impulsivity in BPD. PMID:27199724
Vanesa Carina Góngora
Full Text Available The interest for the systematic study of personality disorder in patients with eating disorders starts in 1980 with the edition of the DSM III multiaxial classification system. Since then, several publications have been focused on the prevalence and the effect on treatment of personality disorders in bulimic and anorexic patients. These researches showed inconsistent results due to conceptual and methodological divergences. In this paper, the more relevant findings of these studies are presented and the possible sources of discrepancy are analyzed. In general, there is a moderate comorbidity between personality disorders and eating disorders. The most frequent disorders are borderline, histrionic, obsessive-compulsive, dependent and avoidant personality disorders. Borderline and histrionic personality disorders are more frequently associated with bulimia, whereas avoidant and obsessive- compulsive personality disorders are more characteristic of anorexia nervosa. Nevertheless, the effect of the relationship between eating disorders and personality disorders in treatment remains uncertain, giving raise to several controversies and researches.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing. 2013. Blais MA, Smallwood P, Groves JE, Rivas-Vazquez RA. Personality and ...
Full Text Available Abstract Background This study investigates the outcome of crisis intervention for chronic post traumatic disorders with a model based on the theory that such crises manifest trauma in the present. The sufferer's behavior is in response to the current perception of dependency and entrapment in a mistrusted relationship. The mechanism of disorder is the sufferer's activity, which aims to either prove or disprove the perception of entrapment, but, instead, elicits more semblances of it in a circular manner. Patients have reasons to keep such activity private from therapy and are barely aware of it as the source of their symptoms. Methods The hypothesis is that the experimental intervention will reduce symptoms broadly within 8 to 24 h from initiation of treatment, compared to treatment as usual. The experimental intervention sidesteps other symptoms to engage patients in testing the trustworthiness of the troubled relationship with closure, thus ending the circularity of their own ways. The study compares 32 experimental subjects with 26 controls at similar crisis stabilization units. Results The results of the Brief Psychiatric Rating Scale (BPRS supported the hypothesis (both in total score and for four of five subscales, as did results with Client Observation, a pilot instrument designed specifically for the circular behavior targeted by the experimental intervention. Results were mostly non-significant from two instruments of patient self-observation, which provided retrospective pretreatment scores. Conclusions The discussion envisions further steps to ascertain that this broad reduction of symptoms ensues from the singular correction that distinguishes the experimental intervention. Trial registration Protocol Registration System NCT00269139. The PRS URL is https://register.clinicaltrials.gov
Tyrer, Peter; Mulder, Roger; Crawford, Mike;
Personality disorder is now being accepted as an important condition in mainstream psychiatry across the world. Although it often remains unrecognized in ordinary practice, research studies have shown it is common, creates considerable morbidity, is associated with high costs to services...... increasing evidence that some treatments, mainly psychological, are of value in this group of disorders. What is now needed is a new classification that is of greater value to clinicians, and the WPA Section on Personality Disorders is currently undertaking this task....... and to society, and interferes, usually negatively, with progress in the treatment of other mental disorders. We now have evidence that personality disorder, as currently classified, affects around 6% of the world population, and the differences between countries show no consistent variation. We are also getting...
L.M.C. van den Bosch; R. Verheul
Subject of this chapter is the often found combination of personality disorders and substance abuse disorders. The serious nature of this comorbidity is shown through the discussion of prevalence and epidemiological data. Literature shows that the comorbidity, hampering the diagnostic process, is s
Schuppert, H. Marieke; Albers, Casper J.; Minderaa, Ruud B.; Emmelkamp, Paulus; Nauta, Maaike H.
The development of borderline personality disorder (BPD) has been associated with parenting styles and parental psychopathology. Only a few studies have examined current parental rearing styles and parental psychopathology in relationship to BPD symptoms in adolescents. Moreover, parenting stress ha
H.M. Schuppert; C.J. Albers; R.B. Minderaa; P.M.G. Emmelkamp; M.H. Nauta
The development of borderline personality disorder (BPD) has been associated with parenting styles and parental psychopathology. Only a few studies have examined current parental rearing styles and parental psychopathology in relationship to BPD symptoms in adolescents. Moreover, parenting stress ha
People diagnosed with borderline personality disorder (BPD) are highly prevalent in acute mental health wards, with staff nurses identifying a challenge in working with people who can be significantly distressed. This has contributed to a negative stereotype verging on stigmatization. Mentalization-based therapy (MBT) is a psychological therapy which has been shown to be of benefit to people with a diagnosis of BPD, yet it has been utilized and evaluated only in partial hospitalization and outpatient settings. Despite this, most people diagnosed with BPD will continue to be treated in generic inpatient settings such as acute mental health. Mentalization-based therapy skills training (MBT-S) is a new and cost-effective 2-day workshop aiming to provide generalist practitioners with MBT skills for use in generic settings. This study aimed to capture staff perceptions of the impact of MBT-S on their practice when working with people with a diagnosis of BPD in acute mental health. Through two focus groups, this study assessed the perceptions of nine staff nurses. An interpretive phenomenological approach was utilized in data analysis. Participants found the approach easy to grasp, improving of consistency between staff and flexible in its use in planned or 'off the cuff' discussions. MBT-S promoted empathy and humane responses to self-harm, impacted on participants ability to tolerate risk and went some way to turning the negative perception of BPD through changing the notion of patients as 'deliberately difficult'. Staff felt empowered and more confident in working with people with a diagnosis of BPD. The positive implication for practice was the ease in which the approach was adopted and participants perception of MBT-S as an empowering skill set which also contributed to attitudinal change. In acute mental health environments, which may not have the resources to provide long-term structured treatments to patients, MBT-S could be viewed as ideal as participants
Full Text Available Background: There are models of the development of personality disorders which include individual differences in attachment relationships as causal factors contributed in explanation of these phenomena. The dimensional view of personality disorders represents these conditions as extreme variants of normal personality continua. This study investigated main and interactional effects of attachment styles and personality traits in relation to borderline characteristics. Materials and Methods: The current study was conducted in expo fact context. Randomly selected 603 participants (134 male 469 female from Tabriz Payam-e-Noor, Tarbait Moallem of Azarbaijan and Sarab Payam-e-Noor university students took part in this research. Participants answered to Borderline Personality Inventory (BPI, Eysenck Personality Questionnaire Revised, Short form (EPQ-RS and Adult Attachment Inventory (AAI. Data were analyzed using two way analysis of variance method.Results: Results indicate main effects of attachment styles and personality traits, so, individual with ambivalent insecure attachment experience more intensity of borderline traits than individual with avoidant insecure and secure attachments. Individual with high psychoticim and neuroticism traits experience more intensity of borderline characteristics than individual with extraversion personality traits. Also, there are no interactional effects of attachment styles and personality traits in relation to borderline characteristics. Conclusion: These findings reiterate contribution of childhood risk factors in developing borderline personality disorder, especially in children with emotionally vulnerability.
Treatment differences in the therapeutic relationship and introject during a 2-year randomized controlled trial of dialectical behavior therapy versus non-behavioral psychotherapy experts for borderline personality disorder
Bedics, Jamie D.; Atkins, David C.; Comtois, Katherine A.; Linehan, Marsha M.
Objective The purpose of the present study was to explore the role of the therapeutic relationship and introject during the course of dialectical behavior therapy (DBT; Linehan, 1993) for the treatment of borderline personality disorder. Method Women meeting DSM-IV criteria for borderline personality disorder (N = 101) were randomized to receive DBT or community treatment by experts. The Structural Analysis of Social Behavior (SASB; Benjamin, 1974) was used to measure both the therapeutic relationship and introject. Results Using hierarchical linear modeling, DBT patients reported the development of a more positive introject including significantly greater self-affirmation, self-love, self-protection, and less self-attack during the course of treatment and one-year follow-up relative to community treatment by experts. The therapeutic relationship did not have an independent effect on intrapsychic or symptomatic outcome but did interact with treatment. DBT patients who perceived their therapist as affirming and protecting reported less frequent occurrences of non-suicidal self-injury. Conclusions The study showed positive intrapsychic change during DBT while emphasizing the importance of affirmation and control in the therapeutic relationship. Results are discussed in the context of understanding the mechanisms of change in DBT. PMID:22061867
Mohammad Reza Mohammadi; Morteza Shamohammadi; Maryam Salmanian
Objective This study aimed to assess the prevalence of borderline personality symptoms in 16-18 year old adolescents. Methods In this cross sectional - descriptive study, 422 high school students (211 boys, 211 girls) aged 16-18 were selected by cluster random sampling and simple random sampling in 2011-2012. The participants were assessed using the revised diagnostic interview for borderline questionnaire (DIB-R) and demographic questionnaire. Data were analyzed using Pearson correlation coe...
刘文俐; 陈哲; 蔡蓉; 彭咏梅; 周世杰
目的:探讨早期有关成长经历与青少年边缘型人格障碍症状的关系.方法:使用人格诊断问卷(PDQ-4+)、父母教养方式问卷(PBI)、童年期创伤经历问卷(CTQ)、依恋问卷(AAQ)对67名工读学校学生和283名普通中职学校学生进行测量.结果:边缘型人格障碍阳性筛查率为26%;BPD阳性检出组与阴件组在PBI、CTQ和AAQ各因子(除性虐待、躯体忽视外)上得分存在显著差异;BPD症状与PBI、CTQ和AAQ各因子间除父亲角色倒置外均存在显著的相关;情感虐待、对母亲愤怒、母亲角色倒置、父亲控制因子对BPD有显著预测作用,共解释BPD总变异的28%.结论:童年期情感虐待、不良的亲子关系模式和父亲控制过严的教养行为是边缘型人格障碍的危险因素.%Objective: To investigate the related factors of borderline personality disorder. Methods: Personality Diagnostic Questionnaire(PDQ-4+) was administered to a sample which consisted of 76 approved school students and 283 secondary vocational school students. Parental Bonding Instrument (PBI), Childhood Trauma Questionnaire (CTQ) and Adult Attachment Questionnaire (AAQ) was also administered to the same sample. Results: The total prevalence of borderline personality disorders among 350 subjects was 26％. There were significant differences on the scores of PBI, CTQ and AAQ between the BPD group and normal group, except for sexual abuse and physical neglect. Significant correlation was found between BPD and most factors of PBI, CTA, and AAQ. Stepwise regression analysis showed that emotional abuse, anger to mother, the control of father predict BPD significantly (R2=0.28). Conclusion: Childhood emotional abuse, over-control of father, motherhood inverted are the risky factors of borderline personality disorders.
Baskin-Sommers, Arielle R.; Vitale, Jennifer E.; MacCoon, Donal; Newman, Joseph P.
An instructed fear-conditioning paradigm was used to measure fear-potentiated startle (FPS) in a sample of 80 Caucasian, female offenders assessed using the Personality Assessment Inventory-Borderline Features Scale (Morey, 1991). As predicted, women with higher levels of Borderline Personality Disorder (BPD) symptoms showed significantly greater FPS than women with lower levels when required to focus attention on the threat-relevant dimension of the experimental stimuli. However, FPS was not...
Emotion processing and regulation are fundamental for stable mental functioning and healthy interpersonal relationships. Borderline personality disorder (BPD) is a severe mental disorder where emotional dysregulation is a core feature, yet the neural processes underlying this dysfunction remain poorly understood. We examined bottom-up and top-down mechanisms involved in emotion processing among females selected for high and low levels of BPD traits (HBT and LBT groups). Study 1 (30 participan...
Lis, Eric; Myhr, Gail
Cognitive behavioral therapy (CBT) is an evidence-based psychotherapeutic approach which has been shown to be an effective intervention for most psychiatric disorders. There are conflicting data in the literature regarding whether a comorbid personality disorder worsens the prognosis of CBT for depression, anxiety, and other complaints. This study examined data collected before and after courses of CBT for patients with significant borderline (n=39, 11.5%) or obsessive-compulsive (n=66, 19.4%) personality pathology or no personality disorder (n=235, 69.1%). A diagnosis of personality pathology was not a significant predictor of outcome in CBT as measured by the reliable change index. However, patients with borderline personality pathology did demonstrate a greater response to CBT than other patients in terms of improvement on several measures of symptoms. Patients with borderline personality pathology appear to enter therapy with greater subjective depression and interpersonal difficulty than other patients but achieve larger gains during therapy. Implications and directions for future research are discussed. PMID:27427839
McGowan, Amelia; King, Hannah; Frankenburg, Frances F.; Fitzmaurice, Garrett; Zanarini, Mary C.
The first objective of this study was to assess the rates of adult experiences of verbal, emotional, physical, and sexual abuse reported by borderline patients and axis II comparison subjects over ten years of prospective follow-up. The second objective was to determine time-to-cessation, recurrence, and new onset of each type of abuse. The Abuse History Interview was administered to 290 borderline patients and 72 axis II comparison subjects at baseline. The AHI Follow-up Version was administ...
In this article the author examines some significant passages of his treatment of a patient with borderline personality structure, with the intention of giving a formative contribution to the delicate issue of the search for congruence between theory and clinic operations. This reflection is therefore an opportunity to integrate these aspects. The individualization of the therapeutic relationship in the theoretical framework of group analysis allowed the emotional investment in the person of ...
Dependent personality disorder is a mental condition in which people depend too much on others to meet their emotional ... Causes of dependent personality disorder are unknown. The disorder usually ... It is one of the most common personality disorders and ...
Law, Mary Kate; Fleeson, William; Arnold, Elizabeth Mayfield; Furr, R. Michael
While emotional difficulties are highly implicated in borderline personality disorder (BPD), the dynamic relationships between emotions and BPD symptoms that occur in everyday life are unknown. The current paper examined the function of negative emotions as they relate to BPD symptoms in real time. Experience sampling methodology with 281 participants measured negative emotions and borderline symptoms, expressed as a spectrum of experiences, five times daily for two weeks. Overall, having a B...
Mulder, Roger; Chanen, Andrew M
Personality disorders affect up to 50% of psychiatric out-patients. Most treatment studies have been performed in patients with borderline personality disorder. Structured psychosocial interventions for people with borderline personality disorders appear to have similar efficacy. There is some evidence that non-structured, non-specialised treatments offered by psychiatric general services might be ineffective and possibly harmful in patients with personality disorders. Cognitive analytic therapy is a time-limited, integrative psychotherapy, which appears to be effective for a range of personality disorders and superior to treatment as usual. Its practical nature and relatively short time limit may make it suitable for front-line clinical services. PMID:23377206