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PubMed1980

Staff countertransference reactions in the hospital treatment of borderline patients.

The aim of this paper is to elucidate a systematic framework for understanding the nature of the borderline patient's reactions to the hospital milieu and for comprehending the responses of hospital staff to such patients. The theory and principles of the therapeutic milieu or milieu therapy are not the focus of this paper; rather, the unique ways in which borderline patients create their own reality and interact with that reality are examined. The borderline patients considered here constitute a group who present severe character pathology, including pronounced distortions in reality testing, marked paranoid trends, minimal distinction between self and others, and multiple hospitalizations that have proven ineffectual. Overall, these patients are functioning at a level more regressed than most borderline patients and their histories often reveal many psychotic episodes. Because of their severe psychopathology, long-term intensive treatment in a hospital setting, termed "reconstructive hospital treatment" by Zee (1975), is indicated. The goal of such treatment is to augment the patient's failing ego functioning, to help the patient develop constructive alternatives for dealing with conflict, and to aid the patient develop constructive alternatives for dealing with conflict, and to aid the patient in embarking upon a psychoanalytically oriented exploration of his highly conflicted object relations. Without the use of the hospital as a treatment modality these patients tend to continue in a downward spiral of destructive relationships. These remarks, therefore, are addressed to the effect severely ill borderline patients have upon the hospital milieu and to the impact of the milieu upon them.

Adult↗
PubMed1992

An empirical examination into the sexuality of women with borderline personality disorder.

In the last decade, a great deal of research has been accomplished in the study of borderline personality, but the literature is yet to systematically examine the intimate relationships of individuals with this particular personality disorder. In doing so, this study compared a sample of female borderlines with an adequately matched sample of non-personality disorders (aged 23-33 years) using the following measures: the Hurlbert Index of Sexual Assertiveness, the Sexual Opinion Survey, the Sexuality Scale, and the Index of Sexual Satisfaction. In the borderline sample, about 50% of the women reported a childhood history of physical or sexual abuse, as compared to about 15% in the control group. Also, borderline women were found to have significantly higher sexual assertiveness, greater erotophilic attitudes, and higher sexual esteem. Despite these findings, the borderline group evidenced significantly greater sexual preoccupation, sexual depression, and sexual dissatisfaction. Implications for these findings and treatment issues are discussed.

Adult↗
PubMedDate not supplied

Developmental aspects of borderline personality disorder.

This study examined whether patients with borderline personality disorder and controls with other personality disorders remember their childhoods differently with respect to separation difficulties, evocative memory, temperamental factors such as frustration tolerance and mood reactivity, and onset of symptoms. Two hundred and ninety patients with borderline personality disorder and 72 with other personality disorders were assessed using an instrument to rate memories of separation difficulties, temperamental problems, and onset of symptoms before age 18. Patients with borderline personality disorder remembered more difficulties with separation between ages 6 and 17 years, more mood reactivity and poorer frustration tolerance between ages 6 and 17, and the onset of more symptoms (most prominently sadness, depression, anxiety, and suicidality) before age 18 than did patients with other personality disorders. The groups did not differ in reports of evocative memory before age 18. These results indicate that many of the features of adult patients with borderline personality disorder may initially appear during childhood and adolescence and that these features may be used to differentiate borderline from other personality disorders.

Adult↗
PubMedDate not supplied

Is borderline personality disorder part of the bipolar spectrum?

In recent years, advances in the areas of both bipolar and borderline personality disorders have generated considerable interest in the clinical interface between these two conditions. Developments in the study of the neurobiology of borderline personality disorder suggest that many patients with this diagnosis have etiological features in common with those diagnosed with bipolar disorders. This claim is supported by new insights into the phenomenology of both disorders and by evidence that mood stabilizers are efficacious in the pharmacological management of borderline patients. This area of research is an important one because of the considerable morbidity and public health costs associated with borderline personality disorder. Since borderline patients can be so challenging to care for, it may be that a reframing of the disorder as belonging to the broad clinical spectrum of bipolar disorders holds benefits for patients and clinicians alike.

Bipolar Disorder↗
PubMed2005

Distinct pattern of P3a event-related potential in borderline personality disorder.

P3a and P3b event-related brain potentials to auditory stimuli were recorded for 17 unmedicated patients with borderline personality disorder, 17 matched healthy controls and 100 healthy control participants spanning five decades. Using high-resolution fragmentary decomposition for single-trial event-related potential analysis, distinctive disturbances in P3a in borderline personality disorder patients were found: abnormally enhanced amplitude, failure to habituate and a loss of temporal locking with P3b. Normative age dependencies from 100 controls suggest that natural age-related decline in P3a amplitude is reduced in borderline personality disorder patients and is likely to indicate failure of frontal maturation. On the basis of the theories of Hughlings Jackson, this conceptualization of borderline personality disorder is consistent with an aetiological model of borderline personality disorder.

Acoustic Stimulation↗
PubMed2001

Diatheses and stressors in borderline pathology of childhood: the role of neuropsychological risk and trauma.

OBJECTIVE: To determine the relative contributions of neuropsychological deficits and psychosocial stressors to the presence of borderline pathology in children. METHOD: The subjects were 86 school-age children (75 males, 11 females) referred for psychiatric day treatment. Thirty-five of the children met criteria for borderline pathology. Data on psychosocial risk factors were obtained for each child from a questionnaire completed by members of the child's clinical team and were based on interviews with parents and children, as well as reports from schools and social agencies. Neuropsychological measures included computerized versions of the Wisconsin Card Sorting Test and the Continuous Performance Test. RESULTS: Both deficits in executive function and psychological trauma made significant and independent contributions to the variance in borderline pathology. Inclusion of both sets of risk factors produced a model that explained 48% of the variance in borderline diagnosis. CONCLUSIONS: Both environmental risks and neurobiological vulnerability should be taken into account to understand the etiology of borderline pathology in children.

Borderline Personality Disorder↗
PubMed1985

Information processing in borderline patients.

An experiment was conducted to determine whether depressed borderline patients could be distinguished from normal controls and psychotic patients on the basis of a visual backward masking task that measures speed of information processing. Results showed that a) borderline patients could not be distinguished from normal controls on the information-processing task; b) both the borderline patients and the normal controls were superior to psychotic patients with diagnoses of major depressive, schizoaffective, and manic disorders; and c) among the three psychotic groups, the schizoaffective subjects were the most impaired. The data support the idea that borderline patients have normal-range information-processing functions. In distinction, all three psychotic groups showed disruption of this fundamental ego function by which information is processed. The results of related experiments indicate that schizotypal patients (in distinction to borderline patients) are abnormal information processors. Taken together, these findings support the contention that the schizotypal/borderline distinction is valid.

Adult↗
PubMed1986

An empirical study of borderline personality disorder and psychiatric suicides.

Borderline personality disorder (BPD) is closely related to suicidal behavior, and suicide attempts per se are considered a diagnostic criterion. However, there has been no previous study of completed suicides and BPD. The present study is based on a population of 134 consecutive psychiatric suicides from 1961 to 1980 in a catchment area of 250,000 inhabitants. Clinical records were retrospectively diagnosed according to the Diagnostic Interview for Borderlines and DSM-III. There was a progressive increase in proportion of borderline suicides during the time period. The overall proportion of BPD, however, was only 12%, indicating that borderline patients are not seriously overrepresented among patients committing psychiatric suicides. Demographic variables, earlier psychiatric care, and suicidal behavior in the borderline group are described and analyzed.

Adult↗
PubMed2004

The borderline syndrome in psychosomatic dermatology. Overview and case report.

The borderline syndrome is one of the most severe disturbances of psychosomatic dermatology. Patients with borderline syndrome are situated 'on the border' of psychosis, neurosis and personality disorders. The skin as a borderline organ carries a symbolic role. The clinical picture includes artefactual skin diseases due to self-mutilation by conscious or unconscious cutting, and rubbing, scratching or para-artefactual manipulations of pre-existing dermatoses. Leading symptoms of the borderline syndrome are poor impulse control, emotional instability and poor ego strength with low frustration tolerance and unstable personal relationships. We present the case of a 38-year-old female patient with borderline syndrome suffering from para-artefactual skin diseases of the face and a massive hyperhidrosis of the hands and feet. Within 9 months she was treated in four acute psychiatric hospitals and by 12 psychiatrists and psychotherapists. Early and accurate diagnosis and high-quality, sophisticated long-term therapy are necessary.

Adult↗
PubMed1986

Characterizing somatization, hypochondriasis, and hysteria in the borderline personality disorder.

Somatization, hypochondriasis, and hysteria have often been considered as associated features of the borderline personality disorder. This study was designed to characterize these three syndromes in the borderline patient. Inpatients with DSM-III borderline personality disorder were compared with controls with dysthymic disorder. Scales and items from standardized rating instruments which measured the three syndromes were scored and compared between groups. Although the hysteria-obvious and hypochondriasis scales of the MMPI and the Hamilton Depression Scale item measuring hypochondriasis were elevated in the borderline group, there were no significant differences between groups. Scores of dysthymic patients significantly exceeded those of borderline patients on four of five MMPI codetypes measuring the three syndromes. Findings are discussed in light of previous psychodynamic, empirical, and research literature.

Adolescent↗
PubMed1987

Multiple neuroendocrinological responses in borderline personality disorder patients.

Male patients suffering from borderline personality disorder (n = 13), major depression (n = 13) or schizophrenia (n = 13) were investigated on several psychopathological (HDRS, BPRS) and neuroendocrinological (DST and TSH, PRL, GH responses to TRH) parameters. Comparisons were made between the borderline group and the other groups of patients. Borderline patients differed from schizophrenics psychopathologically (BPRS) and neuroendocrinologically (DST). Also, borderline patients differed from major depressives in the HDRS, but behaved like them concerning DST. Our findings support the hypothesis that there are neuroendocrinological similarities between borderline personality disorder and major depressive patients, especially on the hypothalamo-pituitary-adrenal axis.

Adult↗
PubMed2004

Axis II comorbidity of borderline personality disorder: description of 6-year course and prediction to time-to-remission.

OBJECTIVE: The purpose of this study was to compare the axis II comorbidity of 202 patients whose borderline personality disorder (BPD) remitted over 6 years of prospective follow-up to that of 88 whose BPD never remitted. METHOD: The axis II comorbidity of 290 patients meeting both DIB-R and DSM-III-R criteria for BPD was assessed at baseline using a semistructured interview of demonstrated reliability. Over 96% of surviving patients were reinterviewed about their co-occurring axis II disorders blind to all previously collected information at three distinct follow-up waves: 2-, 4-, and 6-year follow-up. RESULTS: Both remitted and non-remitted borderline patients experienced declining rates of most types of axis II disorders over time. However, the rates of avoidant, dependent, and self-defeating personality disorders remained high among non-remitted borderline patients. Additionally, the absence of these three disorders was found to be significantly correlated with a borderline patient's likelihood-of-remission and time-to-remission; self-defeating personality disorder by a factor of 4, dependent personality disorder by a factor of 3 1/2, and avoidant personality disorder by a factor of almost 2. CONCLUSION: The results of this study suggest that axis II disorders co-occur less commonly with BPD over time, particularly for remitted borderline patients. They also suggest that anxious cluster disorders are the axis II disorders which most impede symptomatic remission from BPD.

Adult↗
PubMed1981

Borderline states: prognosis and psychotherapy.

In the authors' opinion the borderline concept covers a group of patients difficult to define and to delineate but nevertheless a group different from the conventional diagnostic groups of neurosis and psychosis. During work with a follow-up study of borderline patients it occurred to the authors that the classification of Grinker et al., which makes it possible to divide borderline patients into four groups, can fruitfully be combined with the object relation theory of "the English school" of psychoanalysis. A patient's belonging to one of Grinker's groups is shown to be informative as to how this patient has "solved" what Fairbairn calls "the schizoid dilemma". The conceptual framework thus set up is useful in planning the treatment of borderline patients: each subgroup of borderline patients as described by the authors can be given its own indications and contra-indications as far as working alliance and treatment plan are concerned.

Adult↗
PubMed1995

Differentiation between patients with schizophrenia and borderline disorders in the Percept-genetic Object-Relation Test, PORT.

Schizophrenics (12 males), borderline patients (12 males), and self-selected normal controls (11 males, 17 females) were compared using PORT (Percept-genetic Object-Relation Test), a projective test, diagnosis being on the basis of DSM-III and Kernberg's six descriptive borderline criteria. The aim of the study was to compare the three groups in order to distinguish the two clinical groups from the control group, but also to distinguish the borderlines from the schizophrenic patients with specified diagnosis. The two patient groups differed from the controls on 15 different PORT signs/patterns. In addition, the borderline patients and the three schizophrenics of unspecified diagnosis showed signs in PORT of dissolution anxiety, splitting, whole configuration (fusion) and sexualization as defence, which the schizophrenics with specified diagnosis did not, although catatonic/hebephrenic, simplex, and paranoid schizophrenics could be distinguished in the test. Characteristic of the schizophrenics was also diffusion of domains of object relationships. In a blind prediction study with PORT involving five male and five female patients with severe psychiatric disorders (diagnosed by DSM-III-R), borderline patients could also be distinguished satisfactorily from schizophrenics.

Adult↗
PubMed2000

[Two cases of HIV infection accompanied with borderline personality disorder].

We report here two cases of HIV infection with a borderline personality disorder. Case 1 was a 25-year-old male patient who was diagnosed with HIV infection 4 years ago. Borderline personality disorder was also diagnosed at that time. Although he was referred to our hospital in 1999, we had to refer him to another hospital for his regular outpatient hemodialysis. Case 2 was a 24-year-old male patient who had borderline personality disorder since 1996. He was diagnosed with HIV infection in 1999 and referred to our hospital. He ignored rules in visiting clinics such as prior reservations and frequently called doctors, case-workers and nurses. After several visit he intentionally took excessive sedative medicines and called a case-workers at our hospital. He was admitted to our hospital for three days. After he was discharged, we set limitations for his behavior not to harm himself and to obey the rules in visiting clinics. In other countries investigators report that borderline personality disorder is more common in HIV-infected persons. It may be because persons with borderline personality disorder are more likely to engage in high-risk sexual behavior, which is also applicable to these two cases. As HIV infection is rapidly prevailing in Japan, it is possible that the chance are that this disorder will be seen more frequently in HIV infected cases.

Adult↗
PubMed1981

A study of impulse control in the borderline patient.

This study focuses on the ego function of impulse control in the borderline patient. An attempt is made to ascertain whether the borderline patient is characterized by an obvious defect in this area, and whether this defect can distinguish the borderline patient from other groups of patients. 94 schizophrenics, 34 borderline patients and 21 patients with character disorders admitted to the psychiatry service at a Veterans Administration hospital were compared. The conclusion was that there was an obvious defect in impulse control in the borderline group, quantitatively different from the character disorder group, and qualitatively different from the schizophrenic group.

Borderline Personality Disorder↗
PubMed1985

Affective and behavioral features of DSM-III borderline personality disorder. Are they valid?

This study was designed to determine if a set of seven clinical features, closely reflecting Diagnostic and Statistical Manual III criteria, were individually and collectively more common in borderlines compared to patients with schizophrenia, affective disorders, and anxiety disorders. A 7-item borderline subscale was generated from the expanded Brief Psychiatric Rating Scale and administered to 1,762 psychiatric inpatients. Results indicated that scores on the total borderline scale were significantly higher in borderline patients compared to the control groups. Borderline patients manifested significantly more hostility, uncooperativeness, manipulativeness, impulsiveness, emotional lability, and antisocial trends compared to controls.

Adult↗
PubMed1981

The diagnostic interview for borderline patients.

The authors describe the content, administration, reliability, construct validity, and training requirements for a semistructured diagnostic interview for borderline patients. The interview is composed of operationally defined and scored variables that assess five areas of functioning considered most characteristic of borderline patients--social adaptation, impulse/action patterns, affects, psychosis, and interpersonal relations. Their results show that the interview provides a reasonably constructed and reliable method for researchers and clinicians interested in identifying the syndrome of borderline personality disorders. Although existing research supports the clinical utility of defining borderline patients with the diagnostic interview for borderline patients, both the diagnosis and the content of the interview may require revisions.

Borderline Personality Disorder↗