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PubMed1982

A comparison of hospitalized and nonhospitalized borderline patients.

The author compared 14 hospitalized borderline patients with 24 nonhospitalized patients given the same diagnosis. Twenty-nine clinical features of borderline patients were examined using the semistructured Diagnostic Interview for Borderlines. Although a few specific differences emerged in such areas as drug abuse, self-mutilation, and psychotherapy experience, both hospitalized and nonhospitalized patients manifested characteristic borderline traits of disturbed impulse-action patterns, psychotic experiences, poor regulation of affect, and disturbed interpersonal relationships. These findings are consistent with those of other studies and suggest that hospitalized and nonhospitalized borderline patients represent the same diagnostic entity.

Adolescent↗
PubMed1983

History of suicidal behavior in depressed borderline inpatients.

The DSM-III definition of borderline personality disorder emphasizes affective symptoms. The authors hypothesized that depressed patients with borderline personality disorder would be more likely to be suicidal than those without this diagnosis. Of 53 inpatients treated for depression, 46 manifested personality disorders; borderline personality disorder was the most prevalent axis II diagnosis. That borderline patients had more complicated courses than the other depressed patients was evidenced by their histories of suicidal behavior. Most patients diagnosed as having borderline personality disorder continued to fulfill criteria for this diagnosis even when suicide attempts were excluded as a diagnostic criterion.

Adolescent↗
PubMed1990

The borderline diagnosis in adolescents: symptoms and developmental history.

Adult criteria for borderline personality disorder distinguished a group of 27 inpatient adolescent girls from 23 nonborderline inpatient female comparison subjects. The two groups were compared on retrospectively assessed variables measuring psychological, familial, and constitutional factors. Variables most likely to predict borderline personality disorder included history of disrupted attachments, maternal neglect, maternal rejection, grossly inappropriate parental behavior, number of mother and father surrogates, physical abuse, and sexual abuse. Families of borderline adolescents were chronically disrupted, particularly during the patients' early childhoods. The traumatic childhood experiences of the borderline adolescents were similar to those of adults with borderline personality disorder in recent studies.

Adolescent↗
PubMed1990

Substance use in borderline personality disorder.

The authors investigated the prevalence of substance abuse in 137 inpatients with DSM-III borderline personality disorder. Ninety-two (67%) of these patients were given DSM-III substance use disorder diagnosis. The most frequently used substances were alcohol and sedative-hypnotics. When substance abuse was not used as a diagnostic criterion for borderline personality disorder, 32 (23%) of the 137 patients no longer met borderline criteria. These patients differed significantly from the rest of the patients in severity and course of illness. These data suggest that there might be a subgroup of borderline patients for whom substance use plays a primary role in the development of borderline psychopathology.

Adult↗
PubMed1991

Neuropsychological testing of patients with borderline personality disorder.

OBJECTIVE AND METHOD: This study examined whether a battery of neuropsychological tests could detect cognitive deficits--particularly in the areas of perception, learning, and memory--in patients with borderline personality disorder. The test battery was completed by 16 research outpatients with borderline personality disorder, typified by behavioral dyscontrol and diagnosed according to DSM-III-R criteria and the Diagnostic Interview for Borderline Patients. A comparison group of 16 normal volunteers also completed the test battery. RESULTS: The performance of the borderline patients was significantly impaired in comparison with that of the normal group on memory tests requiring uncued recall of complex, recently learned material. Cues given on an auditory memory task partially corrected that deficit. The patients' performance was also significantly impaired on several visual perceptual tests. These deficits do not appear to have been attributable to attentional problems, psychomotor impairment, current major depression, or history of alcohol abuse. CONCLUSIONS: The observed difficulties in separating essential from extraneous visual information and in recalling complex material may be relevant in understanding some of the clinical features of borderline personality disorder. The observed memory improvement resulting from cueing suggests specific strategies that may be used to aid patients' recall of complex material.

Adult↗
PubMed1991

The comorbidity of borderline personality disorder and other DSM-III-R axis II personality disorders.

OBJECTIVE: This study examines the comorbidity of DSM-III-R borderline personality disorder and the other axis II personality disorders. The extent and direction of overlap provides a measure of the clarity of its diagnostic boundaries and descriptive validity. METHOD: In 110 outpatients without concurrent major axis I conditions, axis II diagnoses were assessed in semistructured format and all DSM-III-R personality disorder criteria were rated. Multiple diagnoses were recorded. RESULTS: Twenty-two patients (20%) met criteria for borderline personality disorder; 18 (82%) had at least one additional personality disorder diagnosis. Using measures of frequencies and intercorrelation coefficients, the authors found that overlap was extensive and not confined to any one of the three designated axis II clusters. Factor analysis revealed 1) a group containing borderline personality disorder with paranoid, histrionic, narcissistic, antisocial, and passive-aggressive personality disorders and 2) another grouping of schizoid, schizotypal, avoidant, obsessive-compulsive, and self-defeating personality disorders. CONCLUSIONS: Borderline personality disorder appears to constitute a broad, heterogeneous category with unclear boundaries that embraces a general personality disorder concept. Both further refinement of the borderline personality disorder construct and investigation into alternative models to the DSM-III-R axis II classification system are suggested.

Adolescent↗
PubMed1991

Parents' emotional neglect and overprotection according to the recollections of patients with borderline personality disorder.

OBJECTIVE: The purpose of this study was to test clinical hypotheses about the role of emotional neglect and overprotection in the childhood of patients with borderline personality disorder. METHOD: The subjects were male and female borderline (N = 62) and nonborderline (N = 99) patients from a general hospital psychiatric clinic and a university student mental health clinic. Both groups were administered the Parental Bonding Instrument, which measures subjects' recollections of parenting on dimensions of care and protection. RESULTS: The findings showed that the patients with borderline personality disorder remembered both their fathers and their mothers as having been significantly less caring and more controlling than did the nonborderline patients. The results were the same for male and female subjects and for subjects from both sites. CONCLUSIONS: The recollections provide support for psychodynamic theories about the childhood of borderline patients and for a theory of biparental failure in the development of borderline pathology.

Adult↗
PubMed1993

Psychopathology in the families of children and adolescents with borderline personality disorder.

OBJECTIVE: The purpose of this study was to determine whether rates of psychopathology differed between the families of a group of children and adolescents with borderline personality disorder and the families of a psychiatric comparison group. METHOD: The rates of psychiatric disorders in the families of 44 child and adolescent outpatients with borderline personality disorder were compared with the rates in the families of a psychiatric comparison group of 100 children and adolescents, none of whom had a diagnosis of borderline personality disorder. Psychopathology in family members was ascertained by the family history method with the use of information from semistructured interviews with the subjects in the two study groups and with their parents or guardians. The adults were systematically interviewed regarding specific DSM-III-R disorders in their families. RESULTS: The families of the patients with borderline personality disorder had significantly greater rates of psychopathology, particularly in the areas of depressive, substance abuse, and antisocial disorders. CONCLUSIONS: The finding of higher rates of psychopathology among the family members of the group with borderline personality disorder supports the hypothesis that a history of significant family psychopathology is associated with the disorder.

Adolescent↗
PubMed1993

Continuation pharmacotherapy of borderline personality disorder with haloperidol and phenelzine.

OBJECTIVE: The aim of this study was to assess the effectiveness of low-dose neuroleptic medication and monoamine oxidase inhibitor (MAOI) antidepressant medication in continuation pharmacotherapy of patients with borderline personality disorder. METHOD: The authors conducted a double-blind, placebo-controlled study comparing continuation therapy with a neuroleptic (up to 6 mg/day of haloperidol), an MAOI antidepressant (up to 90 mg/day of phenelzine), and placebo in 14 men and 40 women with borderline personality disorder. Continuation medication trials lasted 16 weeks, following 5 weeks of acute therapy. RESULTS: Continuing haloperidol demonstrated efficacy only for the treatment of irritability. Higher levels of depression, hypersomnia, and leaden paralysis were noted in the patients who received haloperidol than in those who received phenelzine and those who received placebo. The dropout rate during the first 8 weeks of the continuation study was significantly higher for the patients receiving haloperidol (64%) than for those receiving placebo (28%). Continued phenelzine demonstrated only modest efficacy for the treatment of depression and irritability. An activating effect of phenelzine was shown on measures of excitement and reactivity. CONCLUSIONS: No evidence of efficacy was found for continuation therapy with haloperidol in the treatment of borderline personality disorder other than in the treatment of irritability. Little evidence of efficacy was found for continuation therapy with phenelzine for borderline personality disorder other than modest improvements in irritability and depressive symptoms. There is currently no clear pharmacological treatment of choice for the continuation therapy of borderline personality disorder.

Adult↗
PubMed1994

Interpersonal outcome of cognitive behavioral treatment for chronically suicidal borderline patients.

OBJECTIVE: This study reports the efficacy of a cognitive behavioral outpatient treatment on interpersonal outcome variables for patients diagnosed with borderline personality disorder. METHOD: In a 1-year clinical trial, 26 female patients with borderline personality disorder were randomly assigned to either dialectical behavior therapy or a treatment-as-usual comparison condition. All subjects met criteria of DSM-III-R and Diagnostic Interview for Borderline Patients for borderline personality disorder and were chronically suicidal. RESULTS: In both the intent-to-treat and treatment completion groups, dialectical behavior therapy subjects had significantly better scores on measures of anger, interviewer-rated global social adjustment, and the Global Assessment Scale and tended to rate themselves better on overall social adjustment than treatment-as-usual subjects. CONCLUSIONS: These results suggest that dialectical behavior therapy is a promising psychosocial intervention for improving interpersonal functioning among severely dysfunctional patients with borderline personality disorder.

Adaptation, Psychological↗
PubMed1994

Dissociative phenomena in women with borderline personality disorder.

OBJECTIVE: This study was conducted to determine whether trauma variables and certain behavioral correlates are differentially prevalent in borderline personality disorder patients with greater and those with lesser dissociative experience. METHOD: Subjects were 62 female inpatients, all meeting DSM-III-R criteria for borderline personality disorder, 14 of whom also had a concomitant dissociative disorder diagnosis. Structured interviews and published scales were used to collect data addressing a priori hypotheses. RESULTS: Univariate analyses supported hypotheses that patients with borderline personality disorder and greater dissociative experience are characterized by more self-reported traumatic experiences, posttraumatic symptoms, behavioral dyscontrol, self-injurious behavior, and alcohol abuse. Multivariate analyses suggested that scores on the Dissociative Experiences Scale were predicted particularly by adult sexual assault, behavioral dyscontrol, and both sexual and physical abuse in childhood. CONCLUSIONS: These results support the use of the Dissociative Experience Scale as a brief screening instrument to aid in the identification of borderline personality disorder patients with prominent posttraumatic and dissociative disorders. Patients with borderline personality disorder seem to be characterized by somewhat different life experiences, treatment histories, and behavioral presentations depending on their level of dissociative experience, even though they meet the same DSM-III-R criteria. Neither extreme view of the overlap in diagnostic populations was supported.

Adolescent↗
PubMed1995

Borderline personality disorder symptoms and severity of sexual abuse.

OBJECTIVE: This study explored the relationship of specific symptoms of borderline personality disorder to dimensions of severity of sexual abuse experiences in childhood. METHOD: A group of 41 patients with borderline personality disorder who retrospectively reported a childhood history of sexual abuse on the Familial Experiences Interview were studied. Six items from the Diagnostic Interview for Borderline Patients (DIB) were chosen on the basis of their univariate (chi-square) association with a sexual abuse severity scale that was developed by the authors and their research team. These six DIB items were each modeled in a logistic regression. Predictor variables were the most severe experience within each of three dimensions of sexual abuse: 1) perpetrator (sexual abuse by a parent), 2) duration (sexual abuse that was ongoing), and 3) type (sexual abuse that involved penetration). RESULTS: The severity dimension that was most frequently found to be a significant predictor of the sum of the six DIB items as well as the total scaled DIB score was the duration dimension. Ongoing sexual abuse predicted parasuicidal behavior as well. CONCLUSIONS: Ongoing sexual abuse may be a strong determinant of specific aspects of the disordered interpersonal behavior and functioning found in patients with borderline personality disorder. The expectation that the world is an empty, malevolent place may have some of its roots in the repetition of sexual abuse experiences in childhood. This expectation of malevolence among patients with borderline personality disorder may manifest itself in psychotherapy through regressive and distancing behavior.

Adolescent↗
PubMed1997

Characteristics of borderline personality disorder associated with suicidal behavior.

OBJECTIVE: This study examined the relationship between characteristics of borderline personality disorder and suicidal behavior. The authors hypothesized that a specific feature of borderline personality disorder, impulsivity, and childhood trauma, a possible etiological factor in the development of impulsivity, would be associated with suicidal behavior. METHOD: Information on lifetime history of suicidal behavior was obtained from 214 inpatients diagnosed with borderline personality disorder by structured clinical interview. The authors examined the relationship between DSM-III-R criteria met and the following measures of suicidal behavior: presence or absence of a previous suicide attempt, number of previous attempts, and lethality and intent to die associated with the most lethal lifetime attempt. RESULTS: Impulsivity was the only characteristic of borderline personality disorder (excluding the self-destructive criterion) that was associated with a higher number of previous suicide attempts after control for lifetime diagnoses of depression and substance abuse. Global severity of pathology of borderline personality disorder was not associated with suicidal behavior. History of childhood abuse correlated significantly with number of lifetime suicide attempts. CONCLUSIONS: The trait of impulsivity is associated with number of lifetime suicide attempts and may therefore be a putative risk factor for a future suicide attempt. If so, impulsivity is a potential target therapeutically for prevention of future suicide attempts. The association between childhood abuse and number of lifetime suicide attempts is consistent with the hypothesis that childhood abuse is an etiological factor in the development of self-destructive behaviors.

Adolescent↗
PubMed2006

Predictors of 2-year outcome for patients with borderline personality disorder.

OBJECTIVE: The primary purpose of this report was to investigate whether characteristics of subjects with borderline personality disorder observed at baseline can predict variations in outcome at the 2-year follow-up. METHOD: Hypothesized predictor variables were selected from prior studies. The patients (N=160) were recruited from the four clinical sites of the Collaborative Longitudinal Personality Disorders Study. Patients were assessed at baseline and at 6, 12, and 24 months with the Structured Clinical Interview for DSM-IV Axis I Disorders; the Diagnostic Interview for DSM-IV Personality Disorders, a modified version of that instrument; the Longitudinal Interval Follow-Up Evaluation; and the Childhood Experiences Questionnaire-Revised. Univariate Pearson's correlation coefficients were calculated on the primary predictor variables, and with two forward stepwise regression models, outcome was assessed with global functioning and number of borderline personality disorder criteria. RESULTS: The authors' most significant results confirm prior findings that more severe baseline psychopathology (i.e., higher levels of borderline personality disorder criteria and functional disability) and a history of childhood trauma predict a poor outcome. A new finding suggests that the quality of current relationships of patients with borderline personality disorder have prognostic significance. CONCLUSIONS: Clinicians can estimate 2-year prognosis for patients with borderline personality disorder by evaluating level of severity of psychopathology, childhood trauma, and current relationships.

Adult↗
PubMed2002

Characterizing affective instability in borderline personality disorder.

OBJECTIVE: This study sought to understand affective instability among patients with borderline personality disorder by examining the degree of instability in six affective domains. The authors also examined the subjective intensity with which moods are experienced and the association between instability and intensity of affect. METHOD: In a group of 152 patients with personality disorders, subjective affective intensity and six dimensions of affective instability were measured. The mean scores for lability and intensity for each affective domain for patients with borderline personality disorder were compared with those of patients with other personality disorders through analyses that controlled for other axis I affective disorders, age, and sex. RESULTS: Greater lability in terms of anger and anxiety and oscillation between depression and anxiety, but not in terms of oscillation between depression and elation, was associated with borderline personality disorder. Contrary to expectation, the experience of an increase in subjective affective intensity was not more prominent in patients with borderline personality disorder than in those with other personality disorders. CONCLUSIONS: By applying a finer-grained perspective on affective instability than those of previous personality disorder studies, this study points to patterns of affective experience characteristic of patients with borderline personality disorder.

Adult↗
PubMed2003

Diminished impulsivity in older patients with borderline personality disorder.

OBJECTIVE: The aim of this study was to test, in terms of impulsivity, the hypothesis that borderline personality disorder "burns out" with age. METHOD: Linear regression analyses, with age as a predictor variable, were conducted on subsection scores of the Revised Diagnostic Interview for Borderlines (DIB-R) for 123 individuals with a diagnosis of borderline personality disorder who were accepted into an outpatient-based psychotherapy program. The subsection scores of the DIB-R allow quantification of the core features of the disorder: affective disturbance, relationship disturbance, cognitive disturbance, and impulsive behavior. RESULTS: Older patients with borderline personality disorder showed less impulsivity than younger patients, but there was no difference in terms of affect disturbance, identity disturbance, and interpersonal problems. CONCLUSIONS: The view that borderline personality disorder burns out with age is supported in terms of impulsivity.

Adaptation, Psychological↗
PubMed2002

Chronic suicidality among patients with borderline personality disorder.

OBJECTIVE: This paper reviews research on chronic suicidality among patients with borderline personality disorder. METHODS: MEDLINE and PsycINFO databases were searched for all English-language articles published between 1984 and 2000 containing the keywords "borderline personality disorder" and "suicide" or "suicidality." A total of 170 articles located through this search and additional key articles published before 1990 were reviewed. The most relevant articles were selected of review. RESULTS AND CONCLUSIONS: One in ten patients with borderline personality disorder completes suicide, but this outcome is not readily preventable and does not necessarily occur during the course of treatment. In outpatient psychotherapy, chronic suicidal behavior by patients with borderline personality disorder can be best understood as a way of communicating distress. Hospitalization is of unproven value in preventing suicide by these patients and can sometimes have negative effects. Clinicians' fear of potential litigation resulting from a completed suicide should not be the basis for admission. With no evidence that full hospitalization prevents suicide completion by patients with borderline personality, suicidal risk is not a contraindication for day hospital treatment.

Borderline Personality Disorder↗
PubMed1995

The borderline patient: update on the diagnosis, theory, and treatment from a psychodynamic perspective.

This paper presents an overview regarding the borderline patient including historical background, diagnosis, developmental theory, prognosis, and psychotherapy, all from a psychodynamic perspective. The overview is succinct, current, and practical; it is comprehensive although certainly not all-inclusive. Five clinical vignettes are presented, reflecting various aspects of borderline patients. These vignettes are used to illustrate phenomena elaborated later in the paper. Regarding diagnosis, an approach based on ego strengths and ego weaknesses is detailed. This "ego-psychological diagnostic approach" leans on the ideas of Kernberg, but simplifies and occasionally modifies his work, in addition to including aspects of the borderline patient not stressed by him. It provides a simple, integrated summary of current psychodynamic diagnostic thinking. The paper compares and contrasts two of the most useful developmental theories regarding the borderline patient, those of Kernberg and Adler. The clinical usefulness of the two theories is noted, as is their relationship to etiology. Relying on the work of Stone, there is a brief section on prognosis, followed by an even briefer discussion of referral yield. The paper concludes with a discussion of psychotherapy. A continuum of psychodynamically related psychotherapies is detailed, then related to borderline individuals.

Adult↗