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PubMed1993

[Association of borderline glucose tolerance to dietary intakes and life style-cross sectional study of urban male workers examined at the annual health examination].

In this study, the association of borderline glucose tolerance to dietary intakes and life style was examined. Subjects were 2215 male workers aged 23 through 69, who visited a medical examination center in Tokyo between January 1987 through February 1989 for an annual health examination. Based on results of a 75 gram glucose tolerance test, subject were divided into three groups: 1. diabetes mellitus,2. borderline glucose tolerance, and 3.normal. Nearly one half of the subjects were found to have borderline glucose tolerance. Clinical results and ages of the borderline glucose tolerance group were between those of the normal and the diabetes mellitus groups. Differences between the borderline glucose tolerance group and the normal group with respect to dietary intake and life style were analyzed by a logistic model. Because associations were found to differ by obesity level (calculated by Katsura method) in the primary analysis, second stage analysis was performed with obesity level. For subjects who were less than 10% overweight, borderline glucose tolerance was more frequent with the following characteristics: age over 40; administrative or sales position; eating and drinking after 9:00 pm; consumption of more than three caps of coffee with sugar per day; having a sweet taste; eating rapidly; positive for Type A personality score. For the subjects who were more than 10% overweight, borderline glucose tolerance was more frequent with the following: age less than 40; consumption of more than three caps of coffee with sugar per day; preferring fatty foods; and positive for Type A personality score. These results indicate the importance of dietary education especially in workers who are less than 10% overweight.

Adult↗
PubMed1983

Psychiatric disorders in the families of borderline patients.

The prevalence of psychiatric disorders was studied among the families of hospitalized borderline patients, defined by Gunderson and Singer's criteria, and compared with the families of schizophrenic and depressed control patients. Among borderline probands, 38.3% have a first-degree relative with depression, 25.5% had one with pathological mood swings, and 23.4% had one with "eccentric or peculiar behavior." There was no significant increase in the prevalence of schizophrenia among the relatives of borderline patients. Depression was more prevalent in the families of schizotypal borderlines compared with unstable or mixed-pattern patients. There were no schizophrenic diagnoses among the impaired relatives of schizotypal borderlines. A relationship is suggested between affective disorder and criteria-defined borderline disorders.

Adult↗
PubMed1983

A comparison of borderline and nonborderline alcoholic patients.

Attempts to document systemically the presence of borderline personality disorder in alcoholic patients were made in 94 alcoholic patients consecutively admitted to an inpatient alcoholism program. Operational diagnoses of borderline or not borderline used Gunderson's semistructured Diagnostic Interview for Borderlines (DIB). With the use of conservative criteria, 12.8% of alcoholic patients could be designated as having borderline disorders. Borderline alcoholics were significantly younger and were more likely to have a history of drug abuse, suicide attempts, and accidents. Diminished satisfaction with self and family life and a greater tendency to experience craving across a variety of situations was reported.

Accidents↗
PubMed1983

The borderline syndrome. II. Is it a variant of schizophrenia or affective disorder?

Recent studies question whether the borderline syndrome represents two entities: borderline schizophrenia (or schizotypal personality) as a variant of schizophrenia and borderline personality disorder as a variant of primary affective disorder. Relevant data are presented from the long-term follow-up of patients at the Chestnut Lodge, Rockville, Md, receiving systematic diagnoses by the retrospective application of diagnostic criteria. Studied were (1) diagnostic overlap at index admission, (2) diagnostic change over follow-up period, and (3) comparative long-term functional outcome between borderline samples and other diagnostic groups. Findings supported the hypothesis that schizotypal personality (as defined by DSM-III) is a variant of schizophrenia but borderline personality disorder (as defined by the DSM-III and Gunderson et al criteria) is not. An affiliation of borderline personality disorder with primary affective disorder is suggested although not conclusive.

Bipolar Disorder↗
PubMed1984

Genetic and nosological aspects of schizotypal and borderline personality disorders. A twin study.

The aim of this study was to investigate etiological and nosological aspects of the schizotypal and borderline personality disorders. The sample consisted of 44 schizotypal, 15 schizotypal and borderline, and ten borderline same-sexed twin probands. The investigation of the co-twins indicated that genetic factors seemed to influence the development of the schizotypal, but not the borderline, personality disorders. The basic genetic core of the schizotypal syndrome seemed to consist of schizoid and paranoidlike features, and not psychoticlike cognitive and perceptual distortions. The study did not indicate any relationship between schizotypal and borderline personality disorders and affective and schizophrenic disorders. Further research is needed to confirm the independent status of the schizotypal syndrome in relation to the schizoid, avoidant, and paranoid personality disorders, and the borderline syndrome in relation to the histrionic , narcissistic, and antisocial personality disorders.

Adult↗
PubMed2006

Outpatient psychotherapy for borderline personality disorder: randomized trial of schema-focused therapy vs transference-focused psychotherapy.

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 transference-focused psychotherapy (TFP) in patients with borderline personality disorder. DESIGN: A multicenter, randomized, 2-group design. SETTING: Four general community mental health centers. PARTICIPANTS: Eighty-eight patients with a Borderline Personality Disorder Severity Index, fourth version, score greater than a predetermined cutoff score. INTERVENTION: Three years of either SFT or TFP with sessions twice a week. MAIN OUTCOME MEASURES: Borderline Personality Disorder Severity Index, fourth version, score; quality of life; general psychopathologic dysfunction; and measures of SFT/TFP personality concepts. Patient assessments were made before randomization and then every 3 months for 3 years. RESULTS: Data on 44 SFT patients and 42 TFP patients were available. The sociodemographic and clinical characteristics of the groups were similar at baseline. Survival analyses revealed a higher dropout risk for TFP patients than for SFT patients (P = .01). Using an intention-to-treat approach, statistically and clinically significant improvements were found for both treatments on all measures after 1-, 2-, and 3-year treatment periods. After 3 years of treatment, survival analyses demonstrated that significantly more SFT patients recovered (relative risk = 2.18; P = .04) or showed reliable clinical improvement (relative risk = 2.33; P = .009) on the Borderline Personality Disorder Severity Index, fourth version. Robust analysis of covariance (ANCOVA) showed that they also improved more in general psychopathologic dysfunction and measures of SFT/TFP personality concepts (P<.001). Finally, SFT patients showed greater increases in quality of life than TFP patients (robust ANCOVAs, P=.03 and P<.001). CONCLUSIONS: Three years of SFT or TFP proved to be effective in reducing borderline personality disorder-specific and general psychopathologic dysfunction and measures of SFT/TFP concepts and in improving quality of life; SFT is more effective than TFP for all measures.

Ambulatory Care↗
PubMed1984

Borderline personality disorder and the MMPI.

Fourteen patients diagnosed as borderline on the basis of the Diagnostic Interview for Borderlines obtained a mean group profile of 8-2-7 similar in configuration, but more elevated than that obtained by a group of 7 diagnostically heterogeneous controls. The borderline patients manifested significantly greater hypochondriasis, depression and hysteria, slightly more schizotypal features, a more deviant self-presentation, and lesser defensiveness. However, considerable heterogeneity in symptomatology was found within the borderline subsample. Further, clinical scales comprised of a higher proportion of relatively subtle and presumably less structured items did not discriminate borderline from control patients more effectively than did those scales made up of a lower proportion of such items. The results offer partial support for the construct validity of the borderline syndrome and for the usefulness of the MMPI in differentiating it from other psychiatric disorders.

Adult↗
PubMed1989

The prevalence of borderline personality symptomatology among women with eating disorders.

This study assessed the prevalence of borderline personality symptomatology among women with eating disorders. The Diagnostic Interview for Borderlines, Millon Clinical Multiaxial Inventory, and Borderline Syndrome Index were administered to 28 women in a hospital-based eating disorders program. Results revealed that 39% were classified as borderline on at least one measure, 29% on at least two measures, and 18% on all three. Recovered restricters were particularly prone to borderline personality symptomatology. This study improves upon previous work in this area by employing multiple measures of borderline personality, assessing eating disorder subgroup differences, and recruiting subjects from a single eating disorder treatment program.

Adult↗
PubMed1990

Methodological variations in the use of the MMPI for diagnosis of borderline personality disorder among alcoholics.

Methodological variations in the scoring and interpretation of the MMPI and their effects on discrimination between borderline and non-borderline personality disordered alcoholics were investigated. Subjects were 49 male and female inpatient alcoholics in an Icelandic psychiatric hospital. Gunderson's Diagnostic Interview for Borderlines and the Michigan Alcoholism Screening Test were used to diagnose borderline personality disorder and alcoholism, respectively. Scoring and interpretation of the MMPI were varied in terms of the use and non-use of high F-scale profiles, and their impact on the frequency of various code types among borderline and non-borderline personality disordered alcoholics was considered. It was found that such methodological variations do not affect the frequency of some profile types, and, consequently, the discrimination between the diagnostic groups. Studies and coding systems should consider methodological variations in the scoring and interpretation of MMPI profiles and their consequent effects on diagnosis.

Adolescent↗
PubMed1993

Features of borderline personality and violence.

This study tested the hypothesis that borderline personality characterizes extreme violence by assessing features of borderline and schizotypal personality in three groups: Murderers, Violent, and Nonviolent adult offenders. Murderers had higher borderline personality scores than nonviolent offenders (p < .04). A test for linear trend indicated a linear increase in borderline scores with increasing degree of violence across the three groups (p < .02). No group differences were observed for schizotypal personality. Borderline traits associated with extreme violence consisted of unstable, intense relationships and affective instability. Group differences were not an artifact of group differences in age, social class, IQ, or number of previous custodies. It is concluded that borderline personality may predispose toward extreme forms of violence.

Adult↗
PubMed1993

Borderline diagnosis and substance abuse in female patients with eating disorders.

To investigate whether alcohol and drug abuse are symptomatic of eating disorders or related to a concomitant borderline personality disorder, we reviewed all female inpatient medical records filed at the Department of Psychosomatic Medicine between 1978 and 1990. Over 300 records were assessable. The patients were reclassified according to DSM-III-R with regard to eating and borderline personality disorders. Alcohol and drug abuse were also taken into account. Nearly 5% of patients had a borderline personality disorder. Nearly 25% of patients suffered from eating disorders, and 11% of them had a concomitant borderline personality disorder. A detailed examination showed the frequency of abuse of alcohol and tranquilizers to be no higher, but that of laxatives and/or diuretics and/or anorexigenics to be significantly higher in borderline patients with concurrent eating disorder. However, the incidence of alcohol abuse was significant in borderline patients.

Body Weight↗
PubMed1991

Morbidity risk for mood disorders in the families of borderline patients.

We analyzed the familial morbidity risk for mood disorders (MR) and the presence of a family history of alcoholism in a group of 58 patients with DSM-III borderline personality disorder (PD). The MR in the families of borderline subjects was not significantly different from that found in a control group of affective patients with other cluster II PD, or without PD. The MR in the families of borderline subjects who had never developed an affective episode was not significantly different from that found in the families of borderline PD with a history of mood disorders. Borderline subjects with mood disorders had higher rates of alcoholism in their families, mainly among parents. Our results support the hypothesis that borderline PD, even in absence of the codiagnosis of a mood disorder in the subject, may be a predictor of higher familial liability to mood disorders, although it may be more informative for the familial clustering of specific subgroups than for mood disorders as a whole.

Adult↗
PubMed1993

Psychotic symptoms in depression and borderline personality disorder.

The authors investigated the prevalence of psychotic symptoms in depression and borderline personality disorder employing the Diagnostic Interview for Borderlines. Clear-cut delusions and hallucinations were rare among the borderlines. However, derealization and depersonalization symptoms were common and were found to be prevalent as among depressives. The prevalence of these symptoms among patients with both borderline personality disorder and depression was similar to that among patients with only borderline personality disorder or depression. The relationship between depression and borderline personality disorder and the significance of psychotic symptoms in these disorders is discussed.

Adolescent↗
PubMed2003

Frontolimbic brain abnormalities in patients with borderline personality disorder: a volumetric magnetic resonance imaging study.

BACKGROUND: Dual frontolimbic brain pathology has been suggested as a possible correlate of impulsivity and aggressive behavior. One previous study reported volume loss of the hippocampus and the amygdala in patients with borderline personality disorder. We measured limbic and prefrontal brain volumes to test the hypothesis that frontolimbic brain pathology might be associated with borderline personality disorder. METHODS: Eight unmedicated female patients with borderline personality disorder and eight matched healthy controls were studied. The volumes of the hippocampus, amygdala, and orbitofrontal, dorsolateral prefrontal, and anterior cingulate cortex were measured in the patients using magnetic resonance imaging volumetry and compared to those obtained in the controls. RESULTS: We found a significant reduction of hippocampal and amygdala volumes in borderline personality disorder. There was a significant 24% reduction of the left orbitofrontal and a 26% reduction of the right anterior cingulate cortex in borderline personality disorder. Only left orbitofrontal volumes correlated significantly with amygdala volumes. CONCLUSIONS: While volume loss of a single brain structure like the hippocampus is quite an unspecific finding in neuropsychiatry, the patterns of volume loss of the amygdala, hippocampus, and left orbitofrontal and right anterior cingulate cortex might differentiate borderline personality disorder from other neuropsychiatric conditions.

Adult↗
PubMedDate not supplied

The dissociative experiences of borderline patients.

The study objective was to assess the severity and quality of dissociative experiences reported by borderline patients. Two hundred ninety criteria-defined borderline patients and 72 axis II controls completed the Dissociative Experiences Scale (DES), a 28-item self-report measure with demonstrated reliability and validity. Thirty-two percent of borderline patients had a low level of dissociation, 42% a moderate level, and 26% a high level similar to that reported by patients meeting criteria for posttraumatic stress disorder (PTSD) or dissociative disorders. The controls had a significantly different distribution of overall DES scores: 71% reported a low level of dissociation, 26% reported a moderate level, and only 3% reported a high level. In addition, borderline patients had a significantly higher score than the controls on 21 of 28 DES items and a significantly higher overall DES score, as well as the score on the 3 factors that have been found to underlie the DES, absorption, amnesia, and depersonalization. The results of this study suggest that the severity of dissociation experienced by borderline patients is more heterogeneous than previously reported. They also suggest that borderline patients have a wider range of dissociative experiences than are commonly recognized, including experiences of absorption and amnesia, as well as experiences of depersonalization.

Adolescent↗
PubMedDate not supplied

Dialectical Behavior Therapy of borderline patients with and without substance use problems. Implementation and long-term effects.

OBJECTIVE: The aim of this article is to examine whether standard Dialectical Behavior Therapy (DBT) (1) can be successfully implemented in a mixed population of borderline patients with or without comorbid substance abuse (SA), (2) is equally efficacious in reducing borderline symptomatology among those with and those without comorbid SA, and (3) is efficacious in reducing the severity of the substance use problems. METHOD: The implementation of DBT is examined qualitatively. The impact of comorbid SA on its efficacy, as well as on its efficacy in terms of reducing SA, is investigated in a randomized clinical trial comparing DBT with treatment-as-usual (TAU) in 58 female borderline patients with (n = 31) and without (n = 27) SA. RESULTS: Standard DBT can be applied in a group of borderline patients with and without comorbid SA. Major implementation problems did not occur. DBT resulted in greater reductions of severe borderline symptoms than TAU, and this effect was not modified by the presence of comorbid SA. Standard DBT, as it was delivered in our study, however, had no effect on SA problems. CONCLUSIONS: Standard DBT can be effectively applied with borderline patients with comorbid SA problems, as well as those without. Standard DBT, however, is not more efficacious than TAU in reducing substance use problems. We propose that, rather than developing separate treatment programs for dual diagnosis patients, DBT should be "multitargeted." This means that therapists ought to be trained in addressing a range of severe manifestations of personality pathology in the impulse control spectrum, including suicidal and self-damaging behaviors, binge eating, and SA.

Adolescent↗
PubMed2003

Discriminating among subgroups of borderline personality disorder: an assessment of object representations.

The purpose of this study was to identify subgroups of borderline personality disorder (BPD) by examining internalized object relations. It was predicted: (a) that the internalized object relations of borderline patients as a group can be differentiated from psychiatric patients (comparison group N = 15), and (b) that BPD subgroups significantly differ in their object-relational profiles. Fifty-seven adult borderline subjects (28 male and 29 female) were separated into three groups based on Horney's description of interpersonal styles (moving away, against, and toward). Object relations were assessed using the Bell Object Relations Inventory and from early memories. Four written early memories were scored using the Social Cognition and Object Relations Scale (SCORS). The results suggest that the malevolent inner object world of borderline patients is fundamentally different from nonborderline psychiatric patients; and that the defined BPD subgroups of moving toward, against, and away differed significantly on specific structural and thematic object-relational dimensions. Aspects from Fairbairn's object relations theory and contributions from the self/representational, ego deficit, and Kernberg's models of borderline psychopathology are used to help interpret the findings. Identifying subtypes of BPD may allow for more precise discriminations in separating BPD from other disorders and may provide meaningful therapeutic and prognostic information for the different subgroups of borderline patients.

Adult↗
PubMed2003

Borderline personality disorder from the perspective of general personality functioning.

The authors extended previous work on the hypothesis that borderline personality disorder (BPD) can be understood as a maladaptive variant of personality traits included within the 5-factor model (FFM) of personality. In each of 3 samples, an empirically derived prototypic FFM borderline profile was correlated with individuals' FFM profiles to yield a similarity score, an FFM borderline index. Results across all samples indicated that the FFM borderline index correlated as highly with existing borderline measures as they correlated with one another, and the FFM borderline index correlated as highly with measures of dysfunction, history of childhood abuse, and parental psychopathology as did traditional measures of BPD. Findings support the hypothesis that BPD is a maladaptive variant of FFM personality traits.

Adult↗