Biomedical subjects

Joel Paris

Publications and source records attributed to Joel Paris.

23 records · Page 2Linked to original sources

PubMedDate not supplied

Implications of long-term outcome research for the management of patients with borderline personality disorder.

Fifteen- and 27-year follow-up studies of patients with borderline personality disorder show that most of them no longer meet full criteria for the disorder by age 40, and that even more show improvement by age 50. The mechanisms behind remission could include maturation, social learning, and the avoidance of conflictual intimacy. Affective instability is slower to change than impulsivity. Suicide rates in patients with this disorder are close to 10%, with most completions occurring late in the course of illness; early mortality from all causes exceeds 18%. All of these findings have clinical implications. Although treatment effects must be assessed in the context of naturalistic improvement, therapy can hasten remission.

Affect↗

PubMedDate not supplied

Half in love with easeful death: the meaning of chronic suicidality in borderline personality disorder.

Chronic suicidality is a central feature of borderline personality disorder. While suicidal thoughts and attempts are highly prevalent in borderline patients, completion is relatively unpredictable. Self-cutting seems to function as a means of affective regulation. In borderline personality disorder, suicidality performs a set of psychological functions and can sometimes become "a way of life." Strategies developed for acutely suicidal patients may not be effective in chronic suicidality. Since there is no evidence that hospitalization prevents completion, an ambulatory approach to the management of chronically suicidal patients may be most useful.

Attitude to Death↗

PubMedDate not supplied

Borderline or bipolar? Distinguishing borderline personality disorder from bipolar spectrum disorders.

This article addresses the question whether borderline personality disorder (BPD) can be understood as a variant of bipolar disorder. In the past, borderline pathology has been seen as a variant of psychosis, depression, or posttraumatic stress disorder, but there are important differences between all of these conditions and BPD. The proposal that BPD falls within the bipolar spectrum depends on the assumption that affective instability develops through the same mechanism in both diagnostic categories. There are major differences in phenomenology, family history, longitudinal course, and treatment response between BPD and bipolar disorder, and the findings of comorbidity studies are equivocal. Thus, existing evidence is insufficient to support the concept that BPD falls in the bipolar spectrum.

Bipolar Disorder↗

PubMedDate not supplied

Understanding self-mutilation in borderline personality disorder.

Self-mutilation is common in borderline personality disorder, but this pattern of behavior does not usually carry suicidal intent. Instead, it serves other functions, including regulation of dysphoric affect, communication of distress, expression of emotions, and coping with dissociative states. Multiple causal factors, including biological, psychological, and social risks, influence thresholds for self-mutilation. Management of this behavior can be informed by understanding its psychological functions.

Borderline Personality Disorder↗

PubMedDate not supplied

Predicting and preventing suicide: do we know enough to do either?

In population studies, many risk factors are associated with suicide completion. Yet we cannot accurately predict whether any individual patient will die by suicide. Completers are a distinct population from attempters and do not necessarily present for treatment by mental health professionals. Research on suicide prevention has yielded some promising findings but has not shown that interventions produce definitive results. The strongest evidence for successful prevention derives from reducing access to means. A population-based strategy may be more effective than a high-risk strategy focusing on patients with suicidal ideas or attempts. Much more research is needed before developing effective suicide prevention programs.

Attitude↗