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PubMed1989

Identification of borderline personality disorder with the NIMH Diagnostic Interview Schedule.

No lay-administered interviews are currently available to identify persons with borderline personality disorder. The authors studied 79 subjects with the NIMH Diagnostic Interview Schedule (DIS), a lay-administered interview, and the Diagnostic Interview for Borderline Patients (DIB) and used the results to construct a DIS-based diagnostic index to identify borderline personality disorder. Using the clinician-administered DIB as the diagnostic standard, the authors found that the DIS borderline index had a sensitivity of 85.7%, a specificity of 86.2%, and a kappa of 0.67. The DIS borderline index is a promising extension of the DIS that will facilitate studies of borderline personality disorder in clinical and community settings.

Adolescent↗
PubMed1989

Childhood trauma in borderline personality disorder.

Subjects with borderline personality disorder (N = 21) or borderline traits (N = 11) and nonborderline subjects with closely related diagnoses (N = 23) were interviewed in depth regarding experiences of major childhood trauma. Significantly more borderline subjects (81%) gave histories of such trauma, including physical abuse (71%), sexual abuse (68%), and witnessing serious domestic violence (62%); abuse histories were less common in those with borderline traits and least common in the subjects with no borderline diagnosis. These results demonstrate a strong association between a diagnosis of borderline personality disorder and a history of abuse in childhood.

Adult↗
PubMed1990

Structured interviews for borderline personality disorder.

The authors compared three instruments used to diagnose borderline personality disorder--the Diagnostic Interview for Borderline Patients (DIB), the Schedule for Interviewing Borderlines, and the Structured Interview for DSM-III Personality Disorders--in 56 patients with personality disorders. A borderline diagnosis was made according to the DIB in 30%, the Structured Interview for DSM-III Personality Disorders in 48%, and the Schedule for Interviewing Borderlines in 55% of the patients. Diagnostic agreement was only 52%, which has implications for the generalizability of results of validation studies of the borderline diagnosis. Improvement in diagnostic agreement requires modification of current criteria sets and/or the use of dimensional models.

Adolescent↗
PubMed1993

The impact of mother-child interaction on the development of borderline personality disorder.

OBJECTIVE: Two major psychodynamic theories of the etiology of borderline personality disorder posit two aspects of mother-child interaction as uniquely pathogenic: maternal over-involvement with the child and mismanagement and inappropriateness of maternal guidance and support of the child. This study is an attempt to examine these putative risk factors empirically, using epidemiologic methods. METHOD: Mother-child interaction, father-child interaction, maternal personality, and adolescent diagnoses of personality disorders were measured on two occasions, 2.5 years apart, in a random sample of 776 adolescents. RESULTS: Maternal inconsistency in upbringing of the child predicted a persistence or an emergence of borderline personality disorder, but not of any other axis II disorder. However, this effect occurred only in the presence of high maternal overinvolvement. Neither maternal overinvolvement nor maternal inconsistency alone predicted emergence of borderline personality disorder. Pathological features of maternal personality did not account for the combined effect of maternal overinvolvement and inconsistency on borderline personality disorder. CONCLUSIONS: The two child-rearing risk factors hypothesized to be important by two psychodynamic models of borderline personality disorder were found to be pathogenic only when they coexisted. Their effect could not be accounted for by the biological or environmental vulnerability represented by maternal borderline personality traits.

Adolescent↗
PubMed1994

Risk factors for suicidal behavior in borderline personality disorder.

OBJECTIVE: This study identified potential risk factors for suicidal behavior in patients with borderline personality disorder defined by the Diagnostic Interview for Borderline Patients and by DSM-III-R criteria for patients who did and did not attempt suicide. METHOD: Histories of suicide attempts and attempt characteristics were obtained by Schedule for Affective Disorders and Schizophrenia interviews from 84 patients with borderline personality disorder and were related to severity of borderline pathology, diagnostic comorbidity, and state and trait symptoms. RESULTS: There were 61 patients with a lifetime history of suicide attempts (72.6%), with an average of 3.39 (SD = 2.87) attempts per patient. Attempters were significantly older than nonattempters, with more impulse actions, antisocial personality disorder comorbidity, and state depression. State depression was significantly less severe in patients who had attempted suicide in the present episode (or past year) than in patients who had attempted suicide only in the past. A comorbid diagnosis of major depression, alcoholism, or drug use disorder did not distinguish attempters from nonattempters. Suicide attempt in the present episode was best predicted by the number of prior lifetime attempts. A highly serious intent to commit suicide was predicted by the number of lifetime attempts and subjective depression, while a low intent was predicted by a mixed subtype of borderline personality disorder plus schizotypal personality disorder and paranoid ideation. A high degree of medical lethality was predicted by number of lifetime attempts, older age, and hysteroid dysphoria, while low lethality attempts were associated with high degrees of anger. CONCLUSIONS: Risk factors for suicidal behavior in patients with borderline personality disorder include older age, prior suicide attempts, antisocial personality, impulsive actions, and depressive moods but not comorbid affective disorder, alcoholism, or drug use disorders.

Adult↗
PubMed1995

Psychological dimensions of depression in borderline personality disorder.

OBJECTIVE: The authors' goal was to test empirically a commonly held assumption that the depression in borderline personality disorder is primarily anaclitic. METHOD: The Depressive Experiences Questionnaire and the Hamilton Rating Scale for Depression were administered to 26 patients with borderline personality disorder (16 of whom were depressed) and 12 depressed patients without borderline personality disorder. RESULTS: Patients with borderline personality disorder showed more self-criticism but did not endorse more anaclitic items than depressed patients without borderline personality disorder. CONCLUSIONS: These findings suggest that self-criticism is an underemphasized characteristic of depression in borderline personality disorder.

Adult↗
PubMed1997

Reported pathological childhood experiences associated with the development of borderline personality disorder.

OBJECTIVE: The purpose of this study was to assess a full range of pathological childhood experiences reported by patients with criteria-defined borderline personality disorder and comparison patients with other personality disorders. METHOD: The pathological childhood experiences reported by 467 inpatients with personality disorders were assessed by interviewers who used a semistructured research interview and were blind to clinical diagnosis. RESULTS: Of the 358 patients with borderline personality disorder, 91% reported having been abused, and 92% reported having been neglected, before the age of 18. The borderline patients were significantly more likely than the 109 patients with other personality disorders to report having been emotionally and physically abused by a caretaker and sexually abused by a noncaretaker. They were also significantly more likely to report having a caretaker withdraw from them emotionally, treat them inconsistently, deny their thoughts and feelings, place them in the role of a parent, and fail to provide them with needed protection. The borderline patients with a childhood history of sexual abuse were significantly more likely than those without such a history to report having experienced all but one of the types of abuse and neglect studied. When all significant risk factors were considered together, four were found to be significant predictors of a borderline diagnosis: female gender, sexual abuse by a male noncaretaker, emotional denial by a male caretaker, and inconsistent treatment by a female caretaker. CONCLUSIONS: The results suggest that sexual abuse is neither necessary nor sufficient for the development of borderline personality disorder and that other childhood experiences, particularly neglect by caretakers of both genders, represent significant risk factors.

Adolescent↗
PubMed1999

Affective responsiveness in borderline personality disorder: a psychophysiological approach.

OBJECTIVE: The aim of the study was to investigate affective responses to emotional stimuli in subjects with borderline personality disorder. METHOD: Twenty-four female patients with borderline personality disorder and 27 normal female comparison subjects were examined. The test stimuli were a set of standardized photographic slides with pleasant, neutral, or unpleasant emotional valence. In addition to self-reports, emotional reactions to the slides were measured by heart rate, skin conductance, and startle response. Psychometric tests for various aspects of impulsiveness were also completed. RESULTS: Neither self-report nor physiological data gave any evidence that the borderline patients showed more intense affective responses than did the normal subjects. The borderline subjects did not produce higher levels of startle amplitude, and while viewing unpleasant slides, they showed a startle potentiation effect that was largely similar to that of the comparison group. In fact, the borderline patients showed low electrodermal responses to all three stimulus categories, which points to physiological underarousal. CONCLUSIONS: The results do not agree with the hypothesis that there is a fundamental, biologically based affective hyperresponsiveness in borderline personality disorder, as is suggested by current theories of affect dysregulation in the disorder. Autonomic underarousal may seriously interfere with a flexible adaptation to environmental stimuli.

Adult↗
PubMed2006

Prediction of the 10-year course of borderline personality disorder.

OBJECTIVE: The purpose of this study was to determine the most clinically relevant baseline predictors of time to remission for patients with borderline personality disorder. METHOD: A total of 290 inpatients meeting criteria for both the Revised Diagnostic Interview for Borderlines and DSM-III-R for borderline personality disorder were assessed during their index admission with a series of semistructured interviews and self-report measures. Diagnostic status was reassessed at five contiguous 2-year time periods. Discrete survival analytic methods, which controlled for baseline severity of borderline psychopathology and time, were used to estimate hazard ratios. RESULTS: Eighty-eight percent of the patients with borderline personality disorder studied achieved remission. In terms of time to remission, 39.3% of the 242 patients who experienced a remission of their disorder first remitted by their 2-year follow-up, an additional 22.3% first remitted by their 4-year follow-up, an additional 21.9% by their 6-year follow-up, an additional 12.8% by their 8-year follow-up, and another 3.7% by their 10-year follow-up. Sixteen variables were found to be significant bivariate predictors of earlier time to remission. Seven of these remained significant in multivariate analyses: younger age, absence of childhood sexual abuse, no family history of substance use disorder, good vocational record, absence of an anxious cluster personality disorder, low neuroticism, and high agreeableness. CONCLUSIONS: The results of this study suggest that prediction of time to remission from borderline personality disorder is multifactorial in nature, involving factors that are routinely assessed in clinical practice and factors, particularly aspects of temperament, that are not.

Adult↗
PubMed2002

Confirmatory factor analysis of DSM-IV criteria for borderline personality disorder: findings from the collaborative longitudinal personality disorders study.

OBJECTIVE: This study tested the factor structure of the DSM-IV criteria for borderline personality disorder by using confirmatory methods for the analysis of covariance structures in a large group from a multisite study. METHOD: A total of 668 primarily treatment-seeking subjects were reliably assessed for personality disorders by using the Diagnostic Interview for DSM-IV Personality Disorders. Associations among criteria for borderline personality disorder were examined. A confirmatory factor analysis was performed to test diagnosis as a unitary construct and to test an earlier-reported three-factor model comprising disturbed relatedness, behavioral dysregulation, and affective dysregulation. The three-factor model was subsequently tested by using a subset (N=498) of the study group that was reassessed 2 years later by independent evaluators who were blind to original diagnoses. RESULTS: Internal consistency of the borderline personality disorder diagnosis was adequate for both baseline and follow-up assessments. A confirmatory factor analysis model testing the borderline personality disorder diagnosis as a unitary construct provided good fit, and the three-factor model offered a significantly better fit for the baseline assessment. The three-factor model was replicated with the 2-year follow-up data. CONCLUSIONS: The diagnostic criteria for borderline personality disorder appear to reflect a statistically coherent construct. Three homogeneous components were supported empirically, lending conceptual clarity to different classes of the criteria for borderline personality disorder.

Adolescent↗
PubMed1986

Comparison of self-rated and observer-rated scales in DSM-III borderline personality disorder.

The relationship of self-rated to observer-rated scales has been infrequently studied in patients with DSM-III defined borderline personality disorder. This study was designed to determine a) the amount of correlation between these two types of rating scales in borderline patients and b) whether borderline patients scored significantly higher than dysthymic controls on self or observer-rated scales. Results indicated that self-rated scale scores were higher within the borderline group. Self and observer-rated scales were highly correlated within the borderline group. Borderline patients did not differ from controls when scores of self and observer-rated scales were compared between groups. The relationship of these results to previous findings was equivocal.

Adolescent↗
PubMed1984

'Borderline personality': diagnostic attitudes at the Maudsley Hospital.

About a quarter of the psychiatrists at the Maudsley Hospital use the diagnosis of 'borderline' personality. The description of the borderline patient obtained in this study does not overlap with any existing ICD personality disorder but has characteristics of the schizoid, paranoid, hysteric, explosive, anankastic and antisocial personalities. The item that discriminated best between borderlines and controls was 'brief, unsystematized , psychotic episodes', which is not included in the DSM-III definitions of borderline diagnoses. Items of the DSM-III 'schizotypal' set--e.g. 'suspiciousness' and 'ideas of reference'--discriminated better between borderline cases and controls, whereas items of the DSM-III 'borderline personality' set--e.g. 'impulsivity' or 'unpredictability'--scored more frequently in both groups. These are similar to American findings.

Attitude of Health Personnel↗
PubMed1983

MMPI characteristics of the DSM-III borderline personality disorder.

This study explored the characteristics of the Borderline Personality Disorder classification, specified in DSM-III. MMPI profiles of 29 male veteran inpatients with a diagnosis of Borderline Personality Disorder were compared with the profiles of 26 similar inpatients with diagnoses of other personality disorders. The borderline group had higher elevations (p less than .05) on six of the 13 standard MMPI scales. Analyses showed the borderline profiles to be of a significantly higher elevation but no different in either profile shape or dispersion. A discriminant analysis accounted for 43.7% of the variance and correctly classified 78.2% of the patients. Results are discussed in terms of possible explanations for the high F scores of the borderline group. Implications regarding characteristics of the Borderline Personality Disorder are discussed.

Adult↗
PubMed1985

Borderline manifestations in the Rorschachs of male transsexuals.

It was hypothesized that male transsexuals manifest a character structure consistent with Kernberg's criteria for borderline personality organization. Exploring this hypothesis, Kernberg's criteria for borderline personality organization were operationalized using Rorschach measures. The following variables were examined: aggression (Holt System Aggressive Content Section), object relations (Urist's Mutuality of Autonomy Scale), reality testing (Exner System X + %), and self/object differentiation (Exner System Special Scorings). A group of male college students, a group of male borderlines, and a group of male transsexuals were compared on the above variables. Compared to the normals, the transsexuals and borderlines displayed significantly more intense levels of aggression, a lower level of object relations, poorer reality testing, and impaired boundary differentiation. The transsexuals and borderlines did not differ significantly. The results were taken as suggesting that male gender dysphorics may be a sub-group of the wider borderline diagnostic category.

Aggression↗
PubMed2004

Autobiographical memory in depressed and non-depressed patients with borderline personality disorder.

OBJECTIVES: The present study investigated the specificity of autobiographical memories among depressed and non-depressed borderline patients, compared with depressed patients and controls. The influence of childhood trauma, intrusions of traumatic events, avoidance of intrusions, dissociation and depression on memory specificity was also studied. METHOD: The Autobiographical Memory Test (AMT), a trauma interview and self-report measures of intrusions, avoidance, depression and dissociation were administered to 83 borderline outpatients, 26 depressed outpatients and 30 controls. RESULTS: Depressed borderline patients and depressed patients reported fewer specific memories than controls. Depressed patients generated fewer specific memories than non-depressed borderline patients. Neither trauma nor traumatic intrusions, avoidance of intrusions or dissociation were related to the specificity of memories. Level of depressive symptoms (BDI) was also not related, but the presence of a depression was. CONCLUSION: In this large sample of outpatients with borderline personality disorder, only the subgroup with a co-morbid diagnosis of depression had trouble remembering specific events from the past. Trauma, intrusions, avoidance of intrusions and dissociation seem to be unrelated to the specificity of autobiographical memories in borderline personality disorder.

Adult↗
PubMed2001

Relationships of borderline features to parental mental illness, childhood abuse, Axis I disorder, and current functioning.

Although a number of studies have investigated single, putative etiological factors for borderline personality disorder (BPD), few studies have assessed the relations between multiple etiological factors and borderline features within the same study. Borderline features, parental psychopathology, childhood physical and sexual abuse, lifetime Axis I disorder, and current functioning were assessed in 65 nonclinical participants, a portion of which exhibited significant BPD features. Multivariate models were tested and results indicated that parental mental illness and lifetime Axis I disorder were significant and unique predictors of borderline scores. Borderline features accounted for significant variance in current functioning beyond what was accounted for by other predictors; borderline scores mediated the relations between lifetime Axis I disorder and current functioning.

Adult↗
PubMed2001

The relationship between traumatic experiences, dissociation, and borderline personality pathology among male forensic patients and prisoners.

In the present study the relationship between traumatic experiences, dissociation, and borderline personality disorder pathology is examined in a group of 39 male forensic patients and 192 male prisoners. Sexual and emotional abuse are significantly more common among forensic patients than among prisoners. Patients also report a broader range of different kinds of traumas. Prisoners report significantly more dissociative symptoms. Analyses of the relationship of type of trauma on the one hand and dissociation and borderline personality pathology on the other show that sexual abuse is significantly associated with borderline personality pathology but not with dissociation among the patients. In the prison sample these associations are found only for familial but not extrafamilial sexual abuse. When the subjects are grouped on account of presence or absence of a borderline personality disorder, highly significant differences on dissociation are found between both groups. The results from this study lend support to the hypothesis that sexual abuse is not related to dissociative symptoms but merely to borderline personality pathology. Because most subjects in this study are not patients, these findings are not likely to be confounded by false memories of traumatic events that are recovered by psychotherapy. Furthermore, dissociative symptoms are found to be related to borderline personality pathology and not to the experience of traumatic events.

Adult↗
PubMed2001

Substance abuse in borderline personality disorder: clinical and etiological correlates.

This work examines differences between female borderline patients with and without substance abuse problems and between borderline patients from different treatment settings. A total of 64 female borderline patients were recruited from mental health services (n = 34) and addiction treatment services (n = 20); 35 had a substance abuse problem. Patient groups were compared with regard to both clinical and etiological factors using multivariate analysis of variance for 47 continuous variables and logistic regression for 15 dichotomous variables. Borderline patients with substance abuse problems reported less hostility, suspicion, and anger but more anxiety, insufficiency, and suicide attempts. Patients from addiction treatment services reported less avoidant and more antisocial behavior. The differences between borderline patients with and without substance abuse problems are limited in number and size. Therefore, there is no empirical justification for the exclusion of borderline patients with substance abuse problems from general treatment services or clinical trials.

Adult↗