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PubMed1993

A Rorschach study of narcissism, defense, and aggression in borderline, narcissistic, and cluster C personality disorders.

We examined the differences between narcissism, mode of defense, and level of aggression on the Rorschach. We also investigated differences in borderline, narcissistic, and Cluster C personality disorders by examining responses to Rorschach content variables. The Lerner Defense Scale (P. Lerner & H. Lerner, 1980), the aggressive content section of the Holt (1977) method for assessing primary process manifestations, a modified version of Exner's (1986a) Egocentricity Index, Wagner's (1965) exhibitionistic M score, and grandiosity were scored on the Rorschach protocols of 17 borderline, 17 narcissistic, and 17 Cluster C personality disorders. Borderlines were found to employ primitive defensive structures to a greater degree and severity, show more intense and overall aggression as well as more responses on the three forms of aggression in the Holt method, and have higher levels of grandiosity. Narcissists evinced significantly higher levels of egocentricity than borderlines and higher levels of idealization than the Cluster C group. Convergent validity was found on the measures of defense and aggression, which showed a strong relationship between primitive aggression and primitive defense.

Adult↗
PubMed1993

Psychodiagnosis of personality structure. II: Borderline personality organization.

The borderline conditions have been the focus of considerable debate and controversy for over 30 years. This article, second in a series of three articles focusing on Kernberg's (1975, 1984) psychostructural diagnosis of personality organization, examines Rorschach contributions to the description and diagnosis of borderline personality organization. Rorschach approaches integrating nomothetic and idiographic data are applied to borderline personality functioning and appraised in light of the Rorschach's contribution to the clarification of the controversial and poorly delineated borderline diagnosis.

Borderline Personality Disorder↗
PubMed1996

Primitive defenses, object relations, and symptom clusters in borderline psychopathology.

In this study, I examined associations between selected defense mechanisms and characteristic object relations in borderline personality disorder and the role of these variables in predicting symptomatic expression. A canonical correlation analysis was performed on self-report questionnaire data collected on 53 borderline patients. Two significant correlations of moderate magnitude were obtained; the first set of canonical variables offered evidence supportive of Kernberg's notions of a reciprocal relation between splitting mechanisms and pathognomonic object ties in borderline pathology, and the second set supported the view of a differentiation between borderline and narcissistic defenses. Regression analyses suggested that unique combinations of defense and object relations underlie specific symptomatic expression.

Adult↗
PubMed2005

Borderline personality disorder features and utilization of treatment over two years.

This study assessed the relationship between borderline personality disorder (BPD) features and treatment utilization over a 2-year time period. Participants included 349 18-year-old nonclinical young adults, approximately one-half of whom endorsed significant borderline features. The laboratory phase of the study involved the administration of self-report and interview-based assessments of BPD psychopathology at Wave 1, as well as interviews targeting Axis I psychopathology and treatment utilization history at Wave 2 (2 years later). Results indicated that borderline features prospectively predicted utilization of psychopharmacological treatment above and beyond what was accounted for by gender, lifetime Axis I psychopathology, and nonBPD Axis II psychopathology. The borderline feature most strongly associated with treatment utilization was affective instability.

Adult↗
PubMed2006

The BPQ: a scale for the assessment of borderline personality based on DSM-IV criteria.

The aim of the study was to develop a self-report measure that assesses borderline personality traits as defined by DSM-IV criteria, including separate subscales for each criterion. A sample of normal subjects from community colleges in the midwestern region of the United States was used to develop the scale. The psychometric properties of the scale were examined using an additional United States sample and student samples from England and Australia. The scale was compared with existing measures of borderline and schizotypal personality. Evidence for the internal consistency and convergent and divergent validity of the new scale is presented. The results of several analyses of variance comparing males and females in the three national groups are reported. A Principal Components Analysis of the subscales suggested either a single factor or two correlated factors. Oblique rotation yielded a structure that distinguished identity/interpersonal and impulsivity borderline personality traits. It is concluded that the new scale provides a useful tool for clinicians and researchers interested in screening for borderline personality traits in both general and clinical populations. Suggestions for further research are indicated.

Adult↗
PubMed1986

Borderline personality disorder and alcoholism treatment: a one-year follow-up study.

One year following treatment, alcoholic patients with a documented borderline personality disorder were compared with alcoholic patients who did not show borderline personality features. Both groups of alcoholic patients showed significant and comparable decreases in alcohol use through the follow-up year. Nonborderline alcoholics showed significant decreases in drug use through the follow-up. Borderline alcoholics showed a significant decrease in drug use for the first 6 months of follow-up, with uncertain results thereafter. Borderline alcoholics also showed significant improvements in their ratings of satisfaction with family, decreased hospitalizations and greater leisure satisfaction. There were also trends toward improvements in their relations with children and self-ratings of health and a decrease in accidents. The study documents that alcoholic patients with severe character pathology can significantly benefit from treatment in a short-term psychiatrically oriented alcoholism treatment program.

Accidents↗
PubMed2009

An outlook on ovarian cancer and borderline ovarian tumors: focus on genomic and proteomic findings.

Among the gynaecological malignancies, ovarian cancer is one of the neoplastic forms with the poorest prognosis and with the bad overall and disease-free survival rates than other gynaecological cancers. Ovarian tumors can be classified on the basis of the cells of origin in epithelial, stromal and germ cell tumors. Epithelial ovarian tumors display great histological heterogeneity and can be further subdivided into benign, intermediate or borderline, and invasive tumors. Several studies on ovarian tumors, have focused on the identification of both diagnostic and prognostic markers for applications in clinical practice. High-throughput technologies have accelerated the process of biomolecular study and genomic discovery; unfortunately, validity of these should be still demonstrated by extensive researches on sensibility and sensitivity of ovarian cancer novel biomarkers, determining whether gene profiling and proteomics could help differentiate between patients with metastatic ovarian cancer and primary ovarian carcinomas, and their potential impact on management. Therefore, considerable interest lies in identifying molecular and protein biomarkers and indicators to guide treatment decisions and clinical follow up. In this review, the current state of knowledge about the genoproteomic and potential clinical value of gene expression profiling in ovarian cancer and ovarian borderline tumors is discussed, focusing on three main areas: distinguishing normal ovarian tissue from ovarian cancers and borderline tumors, identifying different genotypes of ovarian tissue and identifying proteins linked to cancer or tumor development. By these targets, authors focus on the use of novel molecules, developed on the proteomics and genomics researches, as potential protein biomarkers in the management of ovarian cancer or borderline tumor, overlooking on current state of the art and on future perspectives of researches.

Ovarian cancer↗
PubMed1991

On the nature of attachment in a borderline population: a preliminary investigation.

Analyses of interpersonal behavior within a borderline population usually focus on object relations variables. In contrast, this preliminary research focuses on the nature of attachment styles and its relation to behavioral pathology. 24 hospitalized borderline patients were administered an Attachment Style Inventory and Millon Clinical Multiaxial Inventory. Analysis confirms predicted differences in attachment style between the borderline and normal control samples as well as indicates that a dependent style of attachment within this borderline sample is associated with less pathology than an avoidant, hostile, or resistant/ambivalent style. The implications of this preliminary work for full-scale research are addressed.

Adolescent↗
PubMedDate not supplied

Group therapy for people with borderline personality disorder: interventions associated with positive outcomes.

Group psychotherapy is becoming a more prevalent treatment option for people with borderline personality disorder. Various types of group approaches have been discussed; however, data about specific interventions and their relationship to outcomes for subgroups of people with borderline personality disorder are lacking. The purpose of this study was to explicate the interventions used in a successful group therapy program developed for community mental health center clients with borderline personality disorder. Two independent raters used the Hill Counselor Verbal Response Category System-Revised to describe and categorize the therapists' verbal responses. Coding of eight videotaped sessions indicated that the therapists' level and type of verbal activity did not change over time. The most frequently utilized interventions across sessions were providing information and seeking information. These responses are indicative of a moderate and high degree of structure. The results suggest that clinicians must consider the unique needs of serious and persistently ill people with borderline personality disorder and plan group interventions accordingly.

Adult↗
PubMedDate not supplied

The role of psychodynamic concepts in the diagnosis of borderline personality disorder.

This review examines the role of psychodynamic concepts in the diagnosis of borderline personality disorder. The author discusses the current status of psychodynamic diagnosis of borderline personality disorder and outlines those psychodynamic features of borderline personality upon which most contemporary theorists agree. Psychodynamic concepts add essential dimensions to the diagnostic process in the following ways: (1) they give coherence to seemingly unconnected behavioral phenomena in a way that the descriptive approach to diagnosis does not, (2) they predict clinical dilemmas that arise in working with individuals with borderline personality disorder that are not predicted by DSM-III-R criteria, and (3) they explain important limitations inherent in the diagnostic process that may prevent accurate diagnosis in an initial assessment.

Borderline Personality Disorder↗
PubMed2006

Psychological therapies including dialectical behaviour therapy for borderline personality disorder: a systematic review and preliminary economic evaluation.

OBJECTIVES: To summarise the available evidence on the clinical effectiveness and cost-effectiveness of psychological therapies including dialectical behaviour therapy (DBT) for borderline personality disorder (BPD). DATA SOURCES: Electronic databases were searched up to March 2005. REVIEW METHODS: Relevant studies were assessed using standard checklists and data were abstracted by two reviewers using standardised forms. Separate economic evaluations were undertaken for six selected randomised controlled trials (RCTs). Cost-effectiveness was assessed in terms of cost per parasuicide event avoided in all six trials and cost per quality-adjusted life-year (QALY) in four of them. All results are at 2003-4 prices and for 12 months follow-up. RESULTS: Nine RCTs and one non-RCT of moderate to poor quality were identified in the clinical effectiveness review. They provided some evidence that DBT is more effective than treatment as usual (TAU) for the treatment of chronically parasuicidal and drug-dependent borderline women; that DBT-orientated therapy is more effective than client-centred therapy (CCT) for the treatment of BPD; and that DBT is as effective as comprehensive validation therapy plus 12-Step for the treatment of opioid-dependent borderline women. There was also some evidence that partial hospitalisation is more effective than TAU in the treatment of BPD, good evidence that manual-assisted cognitive behavioural therapy (MACT) is no more effective than TAU in the treatment of BPD and some evidence that interpersonal group therapy is no more effective than individual mentalisation-based partial hospitalisation (MBT) for the treatment of BPD. However, these results should be interpreted with caution as not all studies were primarily targeted to borderline symptoms and there were considerable differences between the studies. The assessment of cost-effectiveness found a mix of results in the four trials of DBT, along with the high levels of uncertainty and the limitations in the analyses. The findings do not support the cost-effectiveness of DBT though they suggest it has the potential to be cost-effective. The results for MBT are promising, though again surrounded by a high degree of uncertainty and for MACT, the analysis suggests that the intervention is unlikely to be cost-effective. CONCLUSIONS: The overall efficacy of psychological therapies is promising; however, at this stage the evidence is inconclusive. The cost-effectiveness of the intervention in six RCTs examined, however, does not support the cost-effectiveness of DBT although potential is suggested. There is a need for considerable research in this area. This research should involve appropriately powered head-to-head RCTs of psychological therapies; a survey of current practice and the use of the full range of services by people with BPD to inform future economic analyses; full resource-use data collected in the context of pragmatic clinical trials; psychometric assessment of the validity of the EQ-5D or other generic and condition-specific preference-based measures in BPD, and the development of a more formal cost-effectiveness model using the above data.

Behavior Therapy↗
PubMed2002

Divalproex sodium treatment of women with borderline personality disorder and bipolar II disorder: a double-blind placebo-controlled pilot study.

BACKGROUND: The intent of this study was to compare the efficacy and safety of divalproex sodium and placebo in the treatment of women with borderline personality disorder and comorbid bipolar II disorder. METHOD: We conducted a placebo-controlled double-blind study of divalproex sodium in 30 female subjects aged 18 to 40 years who met Revised Diagnostic Interview for Borderlines and DSM-IV criteria for borderline personality disorder and DSM-IV criteria for bipolar II disorder. Subjects were randomly assigned to divalproex sodium or placebo in a 2:1 manner. Treatment duration was 6 months. Primary outcome measures were changes on the interpersonal sensitivity, anger/hostility, and depression scales of the Symptom Checklist 90 (SCL-90) as well as the total score of the modified Overt Aggression Scale (MOAS). RESULTS: Twenty subjects were randomly assigned to divalproex sodium; 10 subjects to placebo. Using a last-observation-carried-forward paradigm and controlling for baseline severity, divalproex sodium proved to be superior to placebo in diminishing interpersonal sensitivity and anger/hostility as measured by the SCL-90 as well as overall aggression as measured by the MOAS. Adverse effects were infrequent. CONCLUSION: The results of this study suggest that divalproex sodium may be a safe and effective agent in the treatment of women with criteria-defined borderline personality disorder and comorbid bipolar II disorder, significantly decreasing their irritability and anger, the tempestuousness of their relationships, and their impulsive aggressiveness.

Adult↗
PubMed2026

Ovarian Carcinoma Presenting Mucoepidermoid Carcinoma-Like Features in Association With Seromucinous Borderline Tumor: A Real Seromucinous Carcinoma?

Ovarian seromucinous carcinoma is generally classified within the spectrum of endometrioid carcinoma. We report a rare ovarian carcinoma with mucoepidermoid carcinoma-like features arising in direct association with a seromucinous borderline tumor. A 56-year-old postmenopausal female presented with a 10-cm pelvic multilocular cystic tumor and markedly elevated carbohydrate antigen 19-9. Histopathological examination showed a seromucinous borderline tumor with transition to invasive carcinoma composed of mucinous epithelial cells and p40-positive intermediate-like cells. The tumor was diffusely positive for PAX8 and negative for cytokeratin 20, supporting Mullerian differentiation. The p40-positive cell population persisted in the borderline, invasive, and para-aortic lymph node metastatic components. Comprehensive genomic profiling identified KRAS p.G12D without CTNNB1, PTEN, or ARID1A mutations. The patient developed platinum-resistant recurrence and died 11 months after diagnosis. This case is compatible with a potential endometriosis-independent pathway from seromucinous borderline tumor to an aggressive mucoepidermoid-like carcinoma.

mucoepidermoid carcinoma↗
PubMedDate not supplied

[Problems in diagnosis of borderline disorders in childhood].

While, for adults, there exists an instrument for diagnosing borderline-disorders (DSM-III-R, ICD 10), this is not the case for children and adolescents. Several attempts of classifying borderline-disorders are discussed (Bemporad et al., Pine, Vela et al.). Exemplified by a case study of the treatment of a ten-year-old borderline girl originally diagnosed as "hysteria", eight criteria are listed and explained that seem relevant for diagnostic purposes: (1) heredity and affective disorders, (2) diseases and traumata during the first year of life, (3) development in early childhood, (4) character and intensity of anxiety, (5) self-destructiveness, (6) defensive mechanisms, (7) object relationships, (8) countertransference. Attention is drawn to a large-scale empirical study in which, by means of an elaborate questionnaire, child psychiatrists and therapists are asked to characterize symptoms, personality traits and aetiological factors of young borderline patients. This will hopefully solve some problems of differential diagnosis discussed in the article.

Adaptation, Psychological↗
PubMed2005

[Educational practices in families with children suffering from borderline disorders and healthy volunteers in comparison].

Standardized assessment of education is not used routinely although these factors may play an important role in the course of psychological disorders in children. Thus the aim of the present study was to investigate families of Borderline children with regard to differences with regard to education in their families. Families of 115 Borderline children (aged 6-12y), diagnosed by means of the Mannheim's Parents Interview (Esser et al. 1989) were included for evaluation and compared with a matched control group. Parents were asked to complete a form assessing education ("Erziehungspraktiken", Schneewind et al. 1985). Group comparison was made by the Mann-Whitney-U-test. The results show that there are less emotional attention, less material reinforcers and more physical punishment in families whose children belong to the Borderline children" group. It could be shown, that there seems to be a significant influence of Borderline symptomatology on education which should make therapists focus their efforts not only on the "index" children as such but also on their families.

Adolescent↗
PubMed2005

[Childhood trauma in the etiology of borderline personality disorder].

Serious, prolonged intrafamilial childhood sexual abuse is considered to be the main etiological factor in about half of the patients with borderline personality disorder in the USA. Special features of childhood interpersonal trauma leading to the development of borderline personality disorder are the seriousness of the trauma and the fact that it is sexual in nature. Serious intrafamilial childhood abuse can lead not only to the classic post-traumatic stress syndrome, but can influence all aspects of personality development, including the distortion of the sense of identity, self-regulation, and the patterns of interpersonal relations. Viewed from the perspective of the trauma concept, the entire range of adult borderline symptoms are considered as being the consequences of severe complex traumatic experiences. Other clinicians regard such an abuse as a marker of the severity of familial dysfunction and emphasize the role of other pathogenic factors, such as biparental neglect and biological vulnerability of the pre-borderline child.

Adult↗
PubMed1991

The depressed borderline: one disorder or two?

Depression in the borderline patient may present as a reactive mood state, an expression of character, or an independent comorbid affective disorder. The symptom picture is most often heterogeneous, "atypical," and chronic. Pharmacologic trials with tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) produce modest improvement on a variety of symptoms, though not always on depression. Medication effects on depressed mood in borderline personality disorder (BPD) are independent of comorbid diagnoses of major depression, atypical depression, or hysteroid dysphoria. Residual symptoms are the rule. A literature review, including studies of comorbidity, longitudinal followup, family history, and laboratory and pharmacotherapy studies, suggests that the borderline patient has both a core biologic affective dysregulation and a pathologic personality organization. The combination of constitutional and psychodynamic etiologies for borderline pathology requires consideration of both pharmacotherapy and psychotherapy in any comprehensive treatment.

Borderline Personality Disorder↗
PubMed1991

A comparison of four measures to diagnose DSM-III-R borderline personality disorder in outpatients.

After three decades of clinical controversy and research, a clinical consensus has formed that borderline personality disorder (BPD) exists as a unique entity which can be defined by DSM-III-R diagnostic criteria. The purpose of this study was to evaluate the relative abilities of four different approaches to the identification of borderlines and to differentiate a DSM-III-R BPD group from a control group of other diagnoses. The approaches were the Kernberg's Structural Interview, the Diagnostic Interview for Borderline Personality Disorders (DIB), the Borderline Syndrome Index (BSI), and the Million Clinical Multiaxial Inventory (MCMI). Sixty outpatient volunteers (27 men and 33 women) from a community mental health center served as subjects. The volunteers included 30 BPDs and 30 other diagnoses, including 11 non-BPD personality disorders. Point biserial correlations indicated that the best method for identifying DSM-III-R BPD was the DIB, and the second best was the Kernberg Structural Interview, although all four identified DSM-III-R BPDs at better than chance levels. Multiple regression results showed that the DIB accounted for 61.5% of the BPD variance, while the Kernberg approach added 4.9% more unique variance prediction. MCMI dimensions and personal history characteristics were used to identify differentiators of BPD from all other diagnoses and from other personality disorders.

Adolescent↗