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PubMed1992

Some nosological considerations on "borderline case".

The so-called "borderline cases" are classified nowadays into Borderline Personality Disorder (BPD) or Schizotypal Personality Disorder (SPD) according to DSM-III-R. We discussed them as follows: The common pathology to them is their imaginary relationship to the object of identification. The difference between them is the distance from patients to their object. After presenting a case who is situated midway between the borderline case and neurosis, the pathology of borderline case can be described as a failure of repression. After classifying borderline cases in Japan into hysterical borderline or obsessional borderline, their relationship to hysterical neurosis and to obsessional neurosis are respectively discussed.

Adult↗

PubMed1994

The borderline conditions--an introduction from a Scandinavian perspective.

There is a growing conversion, confusion and controversy in clinical psychiatry concerning the usage of the borderline concept. An increasing number of hospitalized patients are classified as borderline conditions. This expansion and popularity of the borderline concept has many explanations and historical roots: the notion of a continuum of mental disorders, the concept of forme fruste of psychotic illnesses: clinicians' uncertainty as to where to categorize some difficult patients--a nondiscriminatory synonym; the psychoanalytic establishment--and decline--in clinical psychiatry in the United States; a field for ideological battles between psychodynamic and biological oriented schools of psychiatry, etc. In ICD-10, the borderline conditions are hierarchically divided and outlined in clinical description and diagnostic guidelines into schizotypal disorder and emotionally unstable personality disorder--impulsive or borderline subcategory. This closer demarcation of prototypes in the classification system may facilitate less confusion in future. All Scandinavian countries have contributed a great deal to the research in the field of borderline conditions, especially with regard to genetic and nosological issues. A brief summary of these contributions is presented. Some important notions in the phenomenologic and prototypically oriented European tradition of classifying personality disorders are explained in order to understand the rather ambiguous reaction to the borderline concept in European countries.

Antipsychotic Agents↗

PubMed1994

Genetics in borderline conditions.

The published and some unpublished studies of the genetic of borderline conditions are reviewed. It appears that the DSM-III-R borderline personality disorder is not genetically transmitted. The evidence for the genetic transmission of schizotypal personality disorder also appears weak. An examination of the 2 personality disorders reveals multidimensionality and heterogeneity. The borderline personality disorder seems to consist of 2 syndromes, an impulsive borderline and an empty borderline syndrome. The schizotypal personality disorder consists of 3 syndromes, one affect-constricted/eccentric, one pseudo-psychotic and one paranoiac isolated syndrome. The impulsive borderline, the affect-constricted/eccentric and the pseudo-psychotic syndromes seem slightly genetically influenced. The affect-constricted/eccentric syndrome appears to be genetically related to schizophrenia. No other Axis I disorders are related to borderline conditions.

Borderline Personality Disorder↗

PubMed1986

Prognosis of the borderline disorders.

The follow-up studies of borderline schizophrenia, the borderline syndrome and borderline personality disorder are examined in the light of modern methodological demands. Few studies reach these standards. The outcome of borderline schizophrenia is variable and close to schizophrenia. Approximately 20% of the cases develop true schizophrenia over time. Grinker's borderline syndrome has also a variable outcome but mostly a poor prognosis. Borderline personality disorder has a variable outcome but better than for schizophrenia. Concomitant major affective disorder is frequently present in borderline personality disorder and influences outcome. The wide range of outcome does not support a single 'natural history' of these disorders. Few predictive factors have been identified. Better studies with the aim of identifying predictive factors are mandatory.

Affective Disorders, Psychotic↗

PubMed1990

Discriminating borderline personality disorder from other axis II disorders.

The authors used the Revised Diagnostic Interview for Borderline Patients to assess 22 clinical features of 120 patients with borderline personality disorder and 103 control subjects with other axis II disorders. Four of the 22 features were common in but nondiscriminating for borderline disorder, 11 were discriminating for but nonspecific to borderline disorder, and seven were more specific to borderline disorder. The authors conclude that many clinical features thought to be indicative of borderline disorder are better viewed as personality disorder traits and that the seven more specific features, alone or in conjunction with one another, may be particularly useful markers for borderline personality disorder.

Adult↗

PubMed1991

Object representations in the early memories of sexually abused borderline patients.

OBJECTIVE: This study analyzed psychological representations in 58 subjects in order to achieve a better understanding of the relation between adult borderline personality disorder and reported histories of childhood sexual and physical abuse. METHOD: The subjects were 29 inpatients with borderline personality disorder diagnosed according to the Diagnostic Interview for Borderlines, 14 nonborderline inpatients with major depressive disorder according to the Research Diagnostic Criteria, and 15 normal comparison subjects recruited from the community and screened for the absence of psychopathology. Earliest memories were used as the source of mental representations in all subjects. The memories were reliably coded for malevolent affect tone, presence of deliberate injury, and effectiveness of helpers. Family histories of childhood sexual and physical abuse were obtained with the Familial Experiences Interview, a structured interview. Abuse histories for a subset of the subjects were corroborated by interviews with family members. RESULTS: A reported history of sexual abuse, but not a reported history of physical abuse, predicted the presence of extremely malevolent representations in these earliest memories as well as representations involving deliberate injury. These two kinds of representations also discriminated borderline patients who reported histories of sexual abuse from borderline patients who did not report sexual abuse. Mean affect tone (from malevolent to benevolent) did not, however, discriminate sexually abused or physically abused subjects. CONCLUSION: The results suggest that malevolent representations associated with the borderline diagnosis in previous research may be partially related to a history of childhood sexual abuse. Implications for the object relations theory of borderline personality disorder are noted.

Adolescent↗

PubMed1995

Aspects of depression associated with borderline personality disorder.

OBJECTIVE: Shared symptoms between borderline personality disorder and depression have resulted in inherent difficulties in evaluating the relationship between these disorders. Some theorists have argued that depression in patients with borderline personality disorder is qualitatively distinct from depression in nonborderline patients. The purpose of this study was to empirically identify aspects of depression most associated with borderline personality disorder. METHOD: Through interview and self-report measures, the authors studied depression in 50 inpatients, 21 of whom had borderline personality disorder. RESULTS: The aspects of depression most associated with borderline personality disorder were self-condemnation, emptiness, abandonment fears, self-destructiveness, and hopelessness; boredom and somatic complaints exhibited no association. CONCLUSIONS: Depression associated with borderline pathology appears to be in some respects unique, as well as distinct from nonborderline depression. The study's implications delineate the importance of considering the phenomenological aspects of depression in borderline personality disorder.

Adult↗

PubMed1999

Differences between clinical and research practices in diagnosing borderline personality disorder.

OBJECTIVE: It has been reported that clinicians are less inclined than researchers to use direct questions in ascertaining the presence of personality disorders, and questions have been raised about the validity of research on personality disorders in which diagnoses are based on semistructured diagnostic interviews. This study examined the influence of assessment method on the diagnosis of borderline personality disorder. METHOD: Diagnoses of borderline personality disorder derived from structured and unstructured clinical interviews were compared in two groups of psychiatric outpatients seen in the same practice setting. Five hundred individuals presenting to a general adult psychiatric practice for an intake appointment underwent a routine unstructured clinical interview. After the completion of that study, the method of conducting diagnostic evaluations was changed, and 409 individuals were interviewed with the borderline personality disorder section of the Structured Interview for DSM-IV Personality. RESULTS: Individuals in the structured interview group were significantly more often diagnosed with borderline personality disorder than individuals in the clinical group. When information from the structured interview was presented to the clinicians, borderline personality disorder was much more likely to be diagnosed by them. CONCLUSIONS: The method used to assess borderline personality disorder has a great impact on the frequency with which it is diagnosed. Without the benefit of detailed information from a semistructured diagnostic interview, clinicians rarely diagnose the disorder during a routine intake evaluation. Providing the results of a semistructured interview to clinicians prompts them to diagnose borderline personality disorder much more frequently. This is inconsistent with the notion that personality disorder diagnoses based on semistructured interviews are not viewed as valid by clinicians.

Adult↗

PubMed2006

Descriptive and longitudinal observations on the relationship of borderline personality disorder and bipolar disorder.

OBJECTIVE: The purpose of this study was to test whether borderline personality disorder is a variant of bipolar disorder by examining the rates of co-occurrence in both disorders, the effects of co-occurrence on a longitudinal course, and whether the presence of either disorder confers the risk for new onsets of the other. METHOD: A prospective repeated-measures design with reliable independent diagnostic measures and 4 years of follow-up was used to assess 196 patients with borderline personality disorder and 433 patients with other personality disorders. RESULTS: Patients with borderline personality disorder had a significantly higher co-occurrence of bipolar disorder (19.4%) than did patients with other personality disorders. However, this co-occurrence did not appear to affect the subsequent course of borderline personality disorder. Although only 8.2% of the borderline personality disorder patients developed new onsets of bipolar disorder, this rate was higher than in patients with other personality disorders. Patients with other personality disorders with co-occurring bipolar disorder generally had more new onsets of borderline personality disorder (25%) than did patients with other personality disorders without co-occurring bipolar disorder (10%). CONCLUSIONS: A modest association between borderline personality disorder and bipolar disorder is reported.

Adolescent↗

PubMed2005

Symptoms of posttraumatic stress disorder and borderline personality disorder in veterans of Operation Desert Storm.

OBJECTIVE: The present report is part of a follow-along investigation focusing on the evolution of trauma-related symptoms in veterans of Operation Desert Storm. The goal of the current report was to examine three hypotheses on the relationship between severity of war-related trauma, symptoms of posttraumatic stress disorder (PTSD), and symptoms of borderline personality disorder with a mixed retrospective/prospective design. METHOD: Ninety-four National Guard reservists completed self-administered measures of combat-related trauma, PTSD symptoms, and borderline personality disorder features after their Gulf War duty. RESULTS: Consistent with study hypotheses, prewar features of borderline personality disorder predicted variability in postwar PTSD symptoms beyond that predicted by combat exposure, combat exposure predicted variability in postwar features of borderline personality disorder, and PTSD severity assessed shortly after combat exposure accounted for additional variability in subsequent features of borderline personality disorder. CONCLUSIONS: Taken together, the present findings suggest that trauma, symptoms of PTSD, and features of borderline personality disorder are related to one another in a complex fashion that may exceed simple linear models. Clinical and research implications for the relationships among trauma, PTSD, and borderline personality disorder are discussed.

Adult↗

PubMed1994

Maternal empathy, family chaos, and the etiology of borderline personality disorder.

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.

Adolescent↗

PubMed2004

[The phenomenology and psychodynamics of affects in borderline patients].

This paper presents a review of the phenomenology and psychodynamics of affects in borderline patients. The first part demonstrates that in most current conceptions of the borderline disorder affective disturbances are regarded as to be characteristic. In this context, the strong overlap between borderline disorders and affective disorders found in many empirical studies is described and different hypotheses are presented to explain this phenomenon. The second part of this review is concerned with the psychodynamics of affects in borderline patients. The role of affects in thinking, behaviour, self perception and the regulation of object relations is discussed. Borderline and other severe personality disorders are assessed from the perspective of affective disturbances. The psychodynamic functions of particularly characteristic affects such as anger, anxiety, depression and boredom are discussed. The close connection between affective and cognitive functioning in borderline patients is described and evaluated with regard to modern theories of affect and cognition. Finally, the role of affects in the treatment of borderline patients is discussed.

Borderline Personality Disorder↗

PubMed1998

The persistence of borderline personality disorder in adolescence.

The stability of borderline personality disorder in adolescents is quite uncertain. To determine the persistence of the borderline personality disorder (BPD) and of separate borderline symptoms in adolescents, a follow-up study was conducted of hospitalized adolescents with (n = 14) and without (n = 22) BPD, according to the diagnostic interview for borderline patients (DIB). Of the 14 borderline adolescents, only two cases were again classified as BPD after 3 years, but some of the separate borderline symptoms were still present. In the nonborderline group, no new borderline cases were found after 3 years.

Adolescent↗

PubMed1996

Sociodemography of borderline personality disorder (PD): a comparison with Axis II PDs and psychiatric symptom disorders convergent validation.

A theoretical objective of the present meta-analysis based upon data derived from a previously reported review (Taub, 1995), was to test two inductive hypotheses empirically regarding educational background and social class across different criteria for the DSM-III diagnosis of borderline personality disorder (PD). A secondary purpose was to determine whether comorbidity of borderline PD with other Axis II PDs would significantly delineate socioeducational variables. Across 7/8 pairwise contrasts which represented five studies, distribution of Hollingshead Redlich (H-R) social classes II-IV borderline PD (N = 326) significantly exceeded that in 457 diagnostic controls with Axis II PDs and psychiatric symptom disorders. Although average differences, as well as, interactions reflected by values of the H-R two-factor scale attained statistical significance these were were less consistent in magnitude and direction versus outcomes yielded by distribution of social classes. For the borderline PD diagnosis, the inductive hypotheses were substantiated by findings of significantly advanced scholastic achievement, as well as the younger age of most cohorts versus diagnostic controls with Axis II PDs and psychiatric symptom disorders; and in pairwise contrasts of outpatients with hospitalized cohorts. Comorbidity of the borderline PD diagnosis was associated with significantly lower social class, scholastic achievement and to a lesser extent, more severe psychopathology. Evidence for predominantly convergent validation relative to the socioeducational variables was substantiated by comparisons with (a) cohorts selected by criteria of the DSM-III-R, Gunderson's DIB and Borderline Personality Scale: (b) Norwegian females admitted to Gaustad Hospital and (c) patients with the DSM-III diagnosis of borderline PD attending an outpatient clinic in Norway.

Adult↗

PubMed1991

[Epidemiology, clinical aspects and prevention of borderline conditions in the regions of Siberia and Far East].

The problem of borderline conditions in the population of Siberia and the Far East is analyzed from the standpoint of a comprehensive multidisciplinary approach. The authors established the indicators, close to the real ones, of the prevalence of borderline disorders, exceeding many times the formal statistic data. Evidence is given of the role of certain personality parameters (rigidity, anxiety) and biological factors (the status of the immune and hormonal systems) in the formation and course of borderline conditions. The clinical studies carried out over time made it possible to specify definite stages in the development of borderline pathology. 3 stages were delineated: initial disorders or reactions; neurotic or neurosis-like conditions; neurotic or pathological developments of the personality. The authors demonstrate imperfection of the existing systems of psychiatric aid in respect to patients with borderline disorders and provide evidence for the necessity of organizing psychiatric services outside dispensary aid. Novel organizational models (the center for borderline conditions, the center for mental health care at industrial enterprises, municipal psychohygienic consultation) developed by the authors are provided as prognosis. These structures made it possible to enhance the efficacy of prevention and treatment of borderline conditions.

Borderline Personality Disorder↗

PubMed1991

[Nosological concepts of borderline disorders].

In spite of its frequent use the diagnostic label "borderline disorder" is still not conceptualized in a unified way. The contemporary borderline concepts are presented and discussed, especially borderline disorder as a form of schizophrenia, borderline disorder as a special type of personality disorder in the sense of the DSM-III, borderline disorder in the sense of an encompassing borderline personality organization, and borderline disorder as a form of an affective disorder. Using this concept, it is always necessary to specify its precise meaning.

Borderline Personality Disorder↗

PubMed1990

Issues involved in combining drugs with psychotherapy for the borderline inpatient.

The hospitalized psychiatric patient is commonly treated with both pharmacotherapy and psychotherapy. This is definitely true of borderline patients whose pathology is contributed to by both biologic and psychodynamic factors. For several reasons, it is particularly difficult to provide these patients the ideal conditions for both approaches within the same inpatient program. First, even the best assessment of a borderline patient may leave the clinical team uncertain as to what degree biologically based pathology plays a part. Second, the current state of research on borderline conditions leaves a clinician very unsure whether to use drugs, what drugs to use, and what form of psychotherapy would be most useful. These two basic sets of uncertainty provide fertile soil for polarization, reductionism, and fuzzy eclecticism. Third, the borderline patient's clinical condition can change rapidly and unpredictably, especially in response to new interventions. The pathology can therefore change before the clinician's eyes. It can be difficult to know whether the dramatic responses reflect efficacy or manifestations of primitive transference reactions. Fourth, the staff members working with the borderline patient commonly have strong emotional reactions, often unconscious ones. The urges to hold, love, rescue, attack and destroy, or the desire to keep a distance can easily influence decisions about whether to prescribe a drug or whether to change the nature of the psychotherapy. These third and fourth factors make it very difficult, once treatments are underway, to evaluate efficacy objectively and to stay the steady course that borderline patients often need above all. Fifth, the case illustration nicely demonstrates that arguments in a team based on philosophical differences, diagnostic disagreements, and fueled by the splitting maneuvers of borderline patients can lead to intrastaff devaluation and mistrust. A number of recommendations have been offered to help with the management of combined inpatient drug-psychotherapy treatment.

Adult↗

PubMed1989

Prevalence and clinical characteristics of borderline patients in an eating-disordered population.

Ninety-four consecutive patients seeking treatment for eating disorders were evaluated for eating attitudes and behaviors, weight history, psychiatric symptoms, psychosocial stressors, social adaptation, family environment, and the presence of borderline personality organization. The patients were divided into borderline and nonborderline groups and were compared on the above dimensions, with 46% of the patients showing borderline personality features. The borderline patients and the nonborderline patients had relatively few differences in the severity of their symptomatic eating behaviors and attitudes. The borderline patients, however, were significantly more disturbed on a number of relevant dimensions, including general psychiatric symptoms, psychosocial adaptation, family environment, self-destructive behavior, and treatment history. The authors suggest, on the basis of their findings and the findings of previous studies, that about one third of eating-disordered patients have marked borderline characteristics. They recommend that research studies in the future control for the eating-disordered patients' character pathologies. They also recommend that clinicians use a combination of long-term relationship-oriented treatment and psychopharmacological treatment with eating-disordered patients who have borderline personality disorder.

Adolescent↗