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PubMed1995

Enhanced pressor responses to experimental and daily-life stress in borderline hypertension.

OBJECTIVE: It has been suggested that the blood pressure elevation in borderline hypertension is caused by hyperreactivity to stress. We addressed the questions: are subjects with borderline hypertension hyperreactive to mental stress, and, if so, is this reflected in greater blood pressure responses during daily-life activities, and does non-specific pressor amplification by structural vascular changes contribute to reactivity changes? METHODS: Standardized mental stress was performed during invasive monitoring in 54 borderline hypertensive subjects [systolic blood pressure (SBP) 140-160 or diastolic blood pressure (DBP) 84-95 mmHg, or both] and 20 normotensive control subjects (110-130/60-80 mmHg). Sixteen borderline hypertensive subjects had a cardiac index greater than the mean + 1SD of the normotensive control group (hyperkinetic subgroup) and 38 borderline hypertensive subjects had a cardiac index below that level (normokinetic subgroup). Minimal vascular resistance in the forearm and calf was assessed by plethysmography. Ambulatory 24-h blood pressure was recorded. RESULTS: Subjects with hyperkinetic borderline hypertension had similar intra-arterial blood pressure levels to normokinetic borderline hypertensive subjects. Total peripheral resistance was lower in hyperkinetic borderline hypertensive than in normokinetic borderline hypertensive or normotensive control subjects. Hyperkinetic borderline hypertensive subjects had a significantly lower forearm minimal vascular resistance than normokinetic borderline hypertensive subjects. SBP and mean arterial blood pressure responses to stress were augmented in both borderline hypertensive subgroups. Hyperkinetic borderline hypertensive subjects also showed diastolic hyperreactivity in response to mental stress, in comparison both with normokinetic borderline hypertensive and with normotensive control subjects. During ambulatory blood pressure recording, hyperkinetic borderline hypertensive subjects had greater DBP and mean blood pressure increases from night to day than normotensive control and normokinetic borderline hypertensive subjects. CONCLUSION: Borderline hypertension is characterized by pressor hyperreactivity to mental stress. In hyperkinetic borderline hypertensive subjects, stress hyperresponsiveness is also reflected by greater night-to-day blood pressure gradients during 24-h monitoring. Pressor hyperreactivity in hyperkinetic borderline hypertension is not explained by structural changes in the calf or forearm vasculature.

Adolescent↗
PubMed1998

Grade 1 peritoneal serous carcinomas: a report of 14 cases and comparison with 7 peritoneal serous psammocarcinomas and 19 peritoneal serous borderline tumors.

Low-grade peritoneal serous carcinomas have been the subject of limited study, and their distinction from peritoneal serous psammocarcinomas and serous borderline tumors is not always easy. The clinicopathologic features of 14 low-grade serous carcinomas, 7 psammocarcinomas, and 19 serous borderline tumors of peritoneal origin were compared. Average ages were 58 years (low-grade serous carcinomas), 48 years (borderline tumors), and 40 years (psammocarcinomas). Typical clinical presentations were abdominal pain, abdominal mass, or both, with the tumors incidental in 37% (borderline tumors), 43% (psammocarcinomas), and 36% (low-grade serous carcinoma). Operative and gross findings varied from nodules to adhesions to a dominant mass. Treatment was surgical debulking in most cases, with biopsy alone for eight borderline tumors. Seven patients with low-grade serous carcinoma were alive when last seen, but follow-up duration is short (average, 1.2 years): five were without disease, one had recurrent disease and one persistent disease. One patient with serous carcinoma died of disease at 3.5 years, and two patients died of other causes. Three patients with psammocarcinoma were alive without disease (average 3.3 years). Fourteen patients with borderline tumors were alive (average 3 years): 10 were without disease, 2 had persistent disease, and serous carcinoma developed in 2. The low-grade serous carcinomas resembled the invasive implants of ovarian serous borderline tumors. lacked high-grade nuclear atypia, showed tissue, lymphovascular space invasion, or both and had appreciable solid epithelial proliferation. Some serous carcinomas showed abundant psammomatous calcification suggesting psammocarcinoma but had too much epithelial proliferation for that diagnosis. The psammocarcinomas showed at least 75% psammoma bodies, no more than moderate cytological atypia, tissue or lymphovascular space invasion, or both, and rare epithelial proliferation less than 15 cells across. Adequate sampling was necessary to identify invasion, with highest yields of invasive foci in omental samples; individual foci in some cases of carcinoma resembled borderline tumor. The serous borderline tumors resembled the noninvasive implants of ovarian serous borderline tumors, lacked invasion, and did not show nuclear atypia of the degree seen in grade 2 or grade 3 serous carcinoma. Low-grade serous carcinoma, psammocarcinoma, and serous borderline tumors of peritoneal origin share some clinicopathologic features and may be underrecognized at surgery and gross examination. Because of overlapping microscopic patterns, adequate sampling is mandatory to identify small foci of invasion that exclude a borderline tumor and identify significant cellularity that excludes a psammocarcinoma. Conservative therapy is merited for younger women with borderline tumors. Maximum debulking is recommended for bulky symptomatic borderline tumors, low-grade serous carcinoma, and psammocarcinoma. Although short-term outcomes for the carcinomas appear favorable, follow-up is too limited to determine long-term outcomes.

Adult↗
PubMed1996

Comparison of p53 and MIB1 expression in benign and borderline areas of ovarian serous tumors.

Ovarian serous tumors of borderline malignancy frequently show morphologically benign and borderline areas within the same tumor. This study was undertaken to determine if these two morphologically disparate areas differ in their proliferative activity and p53 expression. Formalin-fixed, paraffin-embedded archival tissue from 17 ovarian serous borderline tumors with morphologically benign and borderline areas were immunostained with monoclonal antibodies against p53 and MIB1. The percentage of positive cells was determined by counting 100 consecutive cells for each stain in the most intensely stained areas in morphologically benign and borderline portions of these tumors. There was a significantly increased proliferation (MIB1 expression) in borderline areas compared with benign areas (37.05 +/- 15.3 versus 12.88 +/- 6.7, p = 0.0001). More than 30% of cells were positive for MIB1 in 13/17 borderline areas compared with none of the 17 benign areas (p < 0.0001). The expression of p53 was also higher in borderline areas compared with benign areas (7.12 +/- 8.8 versus 2.94 +/- 4.46, p = 0.0078). More than 10% of cells were p53 positive in 5/17 borderline areas compared with 1/17 benign areas (p = 0.08). However, there was no significant correlation between p53 expression and MIB1 expression in either the benign or borderline areas (p = 0.4 and 0.2, respectively). In summary, morphologically borderline areas show significantly higher p53 expression and proliferation compared with morphologically benign areas in ovarian serous borderline tumors. Alterations of p53 may play a pathogenetic role in some ovarian serous borderline tumors. The lack of correlation between p53 expression and MIB1 expression, however, suggests involvement of other factors, in addition to p53, in determining the proliferative rate of ovarian serous borderline tumors.

Antigens, Nuclear↗
PubMedDate not supplied

Affective instability and impulsivity in borderline personality and bipolar II disorders: similarities and differences.

OBJECTIVES: many studies have reported a high degree of comorbidity between mood disorders, among which are bipolar disorders, and borderline personality disorder and some studies have suggested that these disorders are co-transmitted in families. However, few studies have compared personality traits between these disorders to determine whether there is a dimensional overlap between the two diagnoses. The aim of this study was to compare impulsivity, affective lability and intensity in patients with borderline personality and bipolar II disorder and in subjects with neither of these diagnoses. METHODS: patients with borderline personality but without bipolar disorder (n=29), patients with bipolar II disorder without borderline personality but with other personality disorders (n=14), patients with both borderline personality and bipolar II disorder (n=12), and patients with neither borderline personality nor bipolar disorder but other personality disorders (OPD; n=93) were assessed using the Affective Lability Scale (ALS), the Affect Intensity Measure (AIM), the Buss-Durkee Hostility Inventory (BDHI) and the Barratt Impulsiveness Scale (BIS-7B). RESULTS: borderline personality patients had significantly higher ALS total scores (P<0.05) and bipolar II patients tended to have higher ALS scores than patients with OPD (P<0.06). On one of the ALS subscales, the borderline patients displayed significant higher affective lability between euthymia and anger (P<0.002), whereas patients with bipolar II disorder displayed affective lability between euthymia and depression (P<0.04), or elation (P<0.01) or between depression and elation (P<0.01). A significant interaction between borderline personality and bipolar II disorder was observed for lability between anxiety and depression (P<0.01) with the ALS. High scores for impulsiveness (BISTOT, P<0.001) and hostility (BDHI, P<0.05) were obtained for borderline personality patients only and no significant interactions between diagnoses were observed. Only borderline personality patients tended to have higher affective intensity (AIM, P<0.07). CONCLUSIONS: borderline personality disorder and bipolar II disorder appear to involve affective lability, which may account for the efficacy of mood stabilizers treatments in both disorders. However, our results suggest that borderline personality disorder cannot be viewed as an attenuated group of affective disorders.

Adult↗
PubMed2005

Borderline personality disorder in clinical practice.

OBJECTIVE: Most studies of borderline personality disorder have drawn patients from among hospital inpatients or outpatients. The aims of this study were to examine the nature of borderline personality disorder patients in everyday clinical practice and to use data from a sample of borderline personality disorder patients seen in the community to refine the borderline construct. METHOD: A random national sample of 117 experienced psychiatrists and psychologists from the membership registers of the American Psychiatric Association and American Psychological Association provided data on a randomly selected patient with borderline personality disorder (N=90) or dysthymic disorder (N=27) from their practice. The clinicians provided data on axis I comorbidity, axis II comorbidity, and adaptive functioning, as well as a personality description of the patient using the Shedler-Westen Assessment Procedure-200 (SWAP-200) Q-sort, an instrument designed for assessment and taxonomic purposes. Analyses compared borderline personality disorder and dysthymic disorder groups on variables of interest and aggregated SWAP-200 items across all borderline personality disorder patients to create a composite portrait of borderline personality disorder as seen in the community. RESULTS: The borderline personality disorder sample strongly resembled previously studied borderline personality disorder samples with regard to comorbidity and adaptive functioning. However, the SWAP-200 painted a portrait of borderline personality disorder patients as having more distress and emotion dysregulation, compared to the DSM-IV description. CONCLUSIONS: Borderline personality disorder patients in research samples are highly similar to those seen in a cross-section of clinical practice. However, several studies have now replicated a portrait of borderline personality disorder symptoms that places greater weight than the DSM-IV description on the intense psychological pain of these patients and suggests candidate diagnostic criteria for DSM-V.

Adult↗
PubMed1984

[Borderline--a diagnostic entity?].

In the last years, there has been considerable controversy as to whether the term "borderline" should be introduced into psychiatric diagnostic nomenclature to designate psychiatric disorders not classifiable as psychoses, neuroses or traditional forms of personality disorders. Whereas many psychiatrists, especially those who are psychodynamically oriented, have been using this term for a long time, the more phenomenologically oriented psychiatrists refuse to do so while pointing to its lack of clear-cut definitions and its confusing abundance of meanings. The definitions of the term "borderline" used in the various "borderline" -concepts are reviewed. Some authors (Knight, Kety et al.) consider "borderline schizophrenia" to be a subgroup of schizophrenic psychoses. Others (Klein, Stone) take "borderline" disorders as a heterogeneous group of psychiatric illness encompassing especially some atypical affective disorders. Thirdly the concepts of those authors who conceive "borderline" as a distinct diagnostic entity are reviewed: Kernberg's "Borderline personality organization", Grinker's "Borderline syndrome", Gunderson and Singer's "Borderline personality disorders", Spitzer and Endicott's "Borderline (unstable) personality disorder" and "Schizotypical personality". The "borderline" definitions of all concepts are examined as to whether they fulfil the requirements of a "useful" (according to Kendell) diagnostic category, i.e. whether they yield reliably defined diagnostic criteria, and whether they can be validated by genetic and biological studies, therapy response, and long-term studies. It is pointed out that attempts have been made to establish operationally defined diagnostic criteria for some of the "borderline" concepts, but that research aiming at their validation is still in an initial stage.

Affective Disorders, Psychotic↗
PubMed1985

Borderline hypertension. Circulatory, sympatho-adrenal and psychological reactions to stress.

The purpose of this study was to examine circulatory and sympatho-adrenal responsiveness in borderline hypertensives compared to established hypertensives and normotensive controls under conditions of physical and mental provocation. Measurements of plasma catecholamines or the urinary excretion of their metabolites were used as indicators of sympathetic activity and psychological variables were assessed by means of self-ratings. There were several signs of an increased neurogenic influence in borderline hypertensives. Urinary catecholamine excretion was related to body measures only in this group. During mental stress, induced by a filmed version of Stroop's colour word test, there were signs of an enhanced hypothalamic defence reaction in the borderline group, as judged by increased circulatory responses and higher plasma adrenaline levels. These signs of increased arousal could be associated with a tendency to compensate for a slightly decreased accuracy in task performance compared to controls by increasing effort. This led to a negative relationship between subjective stress and performance, present only in the borderline group. In another group of borderline hypertensives, the effects of personal control over work pace were compared to normotensives. Personal control reduced circulatory responses to mental arithmetics in controls, but had no beneficial effect in the borderline group. Also in this study, there were signs of an enhanced defence reaction in borderline hypertensives. Higher arousal levels in borderline hypertensives may, theoretically, be explained by personality differences. During an isometric handgrip test, borderline hypertensives showed a tendency towards increased alpha-adrenergic vasoconstriction compared to both established hypertensives and controls. A somewhat higher diastolic blood pressure variability, lower plasma volume and higher venous tone compared to normal also suggest increased neurogenic influences in borderline hypertension. There are similarities between the borderline hypertensive state and the circulatory and sympatho-adrenal pattern of the hypothalamic defence reaction. An enhancement of this reaction is particularly evident during mental stress, whereas somatic provocations such as an orthostatic test, a cold pressor test and physical work produce more similar responses compared to established hypertensives and controls. An increased reactivity to mental stress, especially when personal initiative is challenged, may contribute to the increased cardio-vascular morbidity of borderline hypertensives as a group.

Adrenal Glands↗
PubMed2002

Is comorbidity of posttraumatic stress disorder and borderline personality disorder related to greater pathology and impairment?

OBJECTIVE: The authors examined whether patients with comorbid borderline personality disorder and posttraumatic stress disorder (PTSD) have a more severe clinical profile than patients with either disorder without the other. METHOD: Outpatients with borderline personality disorder without PTSD (N=101), PTSD without borderline personality disorder (N=121), comorbid borderline personality disorder and PTSD (N=48), and major depression without PTSD or borderline personality disorder (N=469) were assessed with structured interviews for psychiatric disorders and for degree of impairment. RESULTS: Outpatients with diagnoses of comorbid borderline personality disorder and PTSD were not significantly different from outpatients with borderline personality disorder without PTSD, PTSD without borderline personality disorder, or major depression without PTSD or borderline personality disorder in severity of PTSD-related symptoms, borderline-related traits, or impairment. CONCLUSIONS: The additional diagnosis of PTSD or borderline personality disorder does little to augment the pathology or dysfunction of patients who have either disorder without the other.

Adult↗
PubMed2005

Borderline personality disorder, impulsivity, and the orbitofrontal cortex.

OBJECTIVE: Orbitofrontal cortex lesions produce disinhibited or socially inappropriate behavior and emotional irregularities. Characteristics of borderline personality disorder include impulsivity and affective instability. The authors investigated whether aspects of borderline personality disorder, in particular impulsivity, are associated with orbitofrontal cortex dysfunction. METHOD: Measures of personality, emotion, impulsivity, time perception, sensitivity to reinforcers, and spatial working memory were administered to patients with borderline personality disorder (N=19), patients with orbitofrontal cortex lesions (N=23), patients with lesions in the prefrontal cortex but not in the orbitofrontal cortex (N=20), and healthy comparison subjects (N=39). RESULTS: The patients with orbitofrontal cortex lesions and the patients with borderline personality disorder performed similarly on several measures. Both groups were more impulsive and reported more inappropriate behaviors, borderline personality disorder characteristics, and anger and less happiness than the two comparison groups, and both groups were less open to experience and had a faster perception of time (underproduced time) than the healthy comparison subjects. The patients with orbitofrontal cortex lesions and the borderline personality disorder patients performed differently on other measures. The borderline personality disorder patients were less extraverted and conscientious and more neurotic and emotional than all other groups. Patients with orbitofrontal cortex lesions had deficits in reversing stimulus-reinforcer associations and a faster perception of time (overestimated time) than the healthy comparison subjects. CONCLUSIONS: Orbitofrontal cortex dysfunction may contribute to some core characteristics of borderline personality disorder, in particular impulsivity. Other characteristics of borderline personality disorder, such as high levels of emotionality and personality irregularities, do not appear to be related to the type of dysfunction produced by orbitofrontal cortex damage. The similarities and differences found between the borderline personality disorder patients and the patients with orbitofrontal cortex lesions may lead to a better understanding of the etiology of borderline personality disorder and the functions of the orbitofrontal cortex.

Adolescent↗
PubMed1995

Demography of DSM-III borderline personality disorder (PD): a comparison with Axis II PDs, affective illness and schizophrenia convergent and discriminant validation.

Demographic characteristics of borderline personality disorder (PD) defined according to DSM-III criteria were compared with those found for schizophrenia, affective illness, and other Axis II PDs. Borderline PD, unlike affective illness and most other Axis II PDs, usually occurs before the age of 30. By contrast to antisocial PD and schizophrenia, borderline PD usually occurs after the age of 25. For borderline PD (N = 280) average age was significantly more homogeneous compared with affective illness (N = 157) and Axis II PDs (N = 71) across 9 studies. By contrast, variability for 63 predominantly male schizophrenics in 3 studies was significantly less, reflecting the younger age at admission compared with borderline PD (N = 84). According to predictions based upon an age-of-risk hypothesis (Dahl, 1985) for 106 borderline PD patients, a significantly lower percentage were > or = 40 years of age than diagnostic controls (N = 181) predominantly with DSM-III affective illness. Borderline PD is predominantly diagnosed in females either single or who have been divorced compared with Axis II PDs and affective illness, to a lesser extent. Unlike antisocial PD, as well as schizophrenia, the preponderance of male and single/divorced patients usually occur significantly less than for borderline PD. Borderline PD usually occur significantly less than Axis II PDs, affective illness and schizophrenia and ethnic minorities, particularly Afro-Americans. These differences in ethnic/racial distribution are explained in terms of two hypotheses. From the perspective of demographic variables, borderline PD closely converges with neither (a) schizophrenia, (b) antisocial PC, (c) other Axis II PDs, nor (d) affective illness. Evidence for discriminant and convergent validation of these data is provided by (a) cluster analyses and intersample pairwise contrasts, as well as comparisons with (b) clinical samples selected on the basis of DSM-III-R and criteria of the (c) Diagnostic Interview for Borderline Patients, (d) a longitudinal case registry study conducted in Denmark, and (e) prospective surveys conducted among (i) North Carolina community residents and (ii) first degree (nonpatients) relatives of psychiatric patients in Iowa.

Adult↗
PubMed2004

The association between borderline personality disorder and chronic medical illnesses, poor health-related lifestyle choices, and costly forms of health care utilization.

OBJECTIVE: The physical health of patients with borderline personality disorder has not been well studied. The purpose of this study was to compare the physical health, lifestyle choices affecting physical health, and health care utilization of patients with remitted and nonremitted borderline personality disorder. METHOD: 200 patients who no longer met the Revised Diagnostic Interview for Borderlines (DIB-R) and DSM-III-R criteria for borderline personality disorder and 64 patients who still met study criteria for borderline personality disorder were interviewed from June 1992 through December 2001 concerning their physical health, lifestyle choices, and use of medical care 6 years after their initial participation in a larger study of the longitudinal course of borderline personality disorder. RESULTS: Remitted borderline patients were found to be significantly less likely than non-remitted borderline patients to have a history of a "syndrome-like" condition (i.e., chronic fatigue, fibromyalgia, or temporomandibular joint syndrome) (p = .049) or to have a history of obesity (p = .026), osteoarthritis (p = .025), diabetes (p = .001), hypertension (p = .028), back pain (p < .001), or urinary incontinence (p < .001). They were also found to be significantly less likely to report pack per day smoking (p = .002), daily consumption of alcohol (p = .003), lack of regular exercise (p = .006), daily use of sleep medications (p < .001), and sustained use of pain medications (p = .026). In addition, remitted borderline patients were significantly less likely than nonremitted borderline patients to have had at least 1 medically related emergency room visit (p < .001), 1 medical hospitalization (p = .003), or 1 of each (p< .001). CONCLUSIONS: The failure to remit from borderline personality disorder seems to be associated with a heightened risk of suffering from chronic physical conditions, making poor health-related lifestyle choices, and using costly forms of medical services.

Adolescent↗
PubMed1995

The accuracy of a frozen section diagnosis of borderline ovarian malignancy.

While the accuracy of frozen section in the diagnosis of invasive ovarian neoplasms has been previously addressed, the frozen section diagnosis of borderline ovarian tumors has been less well characterized. The distinction between benign and borderline lesions is critical to the proper operative management of these patients. The records of 48 patients that had a frozen section diagnosis of borderline ovarian malignancy during surgical exploration between 1986 and 1993 were reviewed. Thirty-one patients were Stage I, 2 patients were Stage II, 10 patients were Stage III, and 5 patients were unstaged. Clarifying phrases were used frequently in the frozen section report, and these terms were categorized as "rule out" borderline tumor, borderline tumor, and "at least" borderline tumor. Of 33 cases with a frozen section report of borderline or at least borderline malignancy, no case were subsequently found to be benign. Errors in the intraoperative management could have occurred in 3 of 48 cases (6.25%), when benign neoplasms were thought to be of borderline malignancy on frozen section. However, in each of these cases, the clarifying term rule out was used, indicating the equivocal nature of the frozen section findings. Thirteen of the 48 patients (27.1%) were found to have a focus of invasive cancer within a borderline tumor on final pathologic review; the primary tumors in these 13 cases ranged in maximal diameter from 5 to 26 cm and were of varying histologic types. The level of experience of the pathologist responsible for the frozen section did not influence the accuracy of frozen section determination noted in this study. A frozen section evaluation identifying a borderline ovarian malignancy is accurate in excluding the presence of benign pathology. It is crucial to understand the meaning of specific clarifying terms used in frozen section diagnoses.

Adult↗
PubMed1996

Significance of the Banff borderline biopsy.

In the Banff classification of kidney transplant pathology the "borderline changes" category falls short of a diagnosis of mild acute rejection, with the recommendation that no treatment is a possible clinical approach. We reviewed the clinical course of patients whose renal allograft biopsies showed "borderline changes" to determine how often these histologic findings actually represented acute rejection. Between January 1992 and June 1994, 351 biopsy specimens were obtained from 170 renal allografts and graded according to the Banff criteria. Eighty-one biopsy specimens were classified as "borderline changes" (23%). Of these, 59 had Banff scores of i1, t1, and vO; the remaining 22 had scores of i2, t1, and vO (i = interstitial infiltrate, t = tubulitis, and v = vasculitis). Medical record review showed that nearly all the "borderline" biopsies had been performed because of an elevated creatinine (Cr; 78 of 81 [96%]), with a mean increase of 1.1 +/- 0.1 mg/dL (+/- SE) over baseline. Most of the patients with "borderline changes" and elevated Cr were treated for acute rejection (61 of 78 [78%]); some with pulse steroids alone (29 of 61 [48%]), the rest with antilymphocyte antibody (32 of 61 [52%]). Among all 61 patients with "borderline" biopsies treated for rejection, 26 had a complete response (43%), 17 had a partial response (28%), and 18 had no response (30%). Interpretation of these changes in Cr, however, was confounded by intercurrent conditions in 28 of the patients. A group of 33 patients was therefore identified in whom a "borderline changes" biopsy was obtained, who were treated for rejection, and in whom all other identifiable causes of elevated Cr other than possible acute rejection had been systematically eliminated from consideration. In this group the mean Cr was 2.0 +/- 0.1 mg/dL at baseline, 3.3 +/- 0.2 mg/dL at the time of biopsy, and 2.2 +/- 0.1 mg/dL 1 month after treatment (P < 0.001 Cr at biopsy v Cr 1 month later). Among these 33 patients, 19 had a complete response (58%), 10 had a partial response (30%), and four had no response (12%). Therefore, the Cr in 88% of the patients in this group was lower 1 month after treatment for rejection than it was at the time of the biopsy. Follow-up biopsies were performed within 1 month of the "borderline" biopsy in 24 cases; these showed "borderline changes" (five of 24 [21%]), mild acute rejection (eight of 24 [33%]), or moderate to severe acute rejection (11 of 24 [46%]). We conclude that in the clinical setting of deteriorating renal graft function with mild elevation of serum Cr, the "borderline changes" biopsy frequently represents acute rejection. Antirejection treatment is therefore appropriate in the majority of cases. The reader should bear in mind that the current study is retrospective, with no control group. The risk of loosely interpreting these data is that some patients will be treated without due cause. Banff "borderline changes" should be used as part of an algorithm, but not the sole criterion, for therapeutic decision making.

Biopsy↗
PubMed2004

Major depressive disorder and borderline personality disorder revisited: longitudinal interactions.

BACKGROUND: This report investigates the longitudinal association of changes in major depressive disorder (MDD) and borderline personality disorder. METHOD: A DSM-IV-diagnosed sample of 161 patients with borderline personality disorder who have been followed with repeated measures at 6, 12, 24, and 36 months are investigated to see whether those with co-occurring MDD differ at baseline and in their course. Proportional hazard regression and cross-lagged panel analyses are used to demonstrate whether changes in the course of either disorder have predictable effects on the course of the other. RESULTS: The rate of remissions of borderline personality disorder was not affected by whether patients had co-occurring MDD. The rate of MDD remissions was significantly reduced by co-occurring borderline personality disorder. Both regression analyses and panel analyses indicated that improvements in borderline personality disorder were often followed by improvements in MDD but that improvements in MDD were not followed by improvements in borderline personality disorder. Five of the 9 borderline criteria, including those that most relate to affects, were particularly apt to remit prior to MDD remissions. CONCLUSIONS: When borderline personality disorder and MDD co-occur, they can sometimes have independent courses, but more often improvements in MDD are predicted by prior improvements in borderline personality disorder. Clinicians should not ignore borderline personality disorder in hopes that treatment of MDD will be followed by improvement of borderline personality disorder.

Adult↗
PubMedDate not supplied

[Long-term changes in borderline symptoms of patients after client-centered group psychotherapy].

In a follow-up study the long-term changes of borderline symptomatic of 14 patients with the diagnosis borderline personality disorder (criteria by Kernberg and Rorschach test) are compared with 13 patients with diagnosis schizophrenia and 16 patients with diagnosis depression (each case according to ICD-9 criteria). The Diagnostic Interview for Borderline Patients (DIB) is evaluated to comprehend the structure and kinds of borderline symptoms before and 4 years after treatment. Borderline patients are treated in a setting of client-centred group psychotherapy (twice a week, approximately 100 sessions). The treatment of the patients joining the control group is based on clinical standard. As a result all patients reduced the borderline-like symptoms. However, the most significant changes can be seen in the borderline group. 2 out of 14 borderline patients still fulfill the DIB Criteria of borderline personality disorder. Nevertheless, there are differences in the reduction of specific categories of borderline symptoms. The greatest changes are in the categories "loss of impulse control" and "psychotic episodes", whereas there are only slight improvements in the category "interpersonal relationships".

Adult↗
PubMed2002

[Borderline personality disorder and attentional biases. Theoretical models and empirical findings].

The purpose of this review is to analyse nature, degree and consequences of attentional biases in patients with borderline personality disorder based on existing literature. The clinical importance of these phenomena in patients with borderline personality disorder is strengthened and the link between theoretical models, empirical findings and therapeutic interventions is elaborated. This link between selective attention and borderline personality disorder is demonstrated on the basis of studies, which indicate a context between borderline pathology, affective disorders, anxiety disorders, and attention-deficit/hyperactivity disorders and also give evidence to neuropsychological deficits in patients with borderline personality disorder. The present article comparatively describes three theoretical models of borderline personality disorder and their possible links to attentional biases. The dialectical behavior approach postulates a pronounced attentional narrowing to emotional stimuli in connection with deficits regarding affect regulation. The cognitive approach assumes that rigid dysfunctional schemata initiate a cognitive-emotional circuit, which leads to a reinforcement of the symptomatology as a result of a biased perception and memory. Additionally the present article specifies the trauma approach which emphasizes the relation between borderline pathology and childhood trauma with recourse to theories of attentional biases in patients with traumatic experiences. Preliminary empiricial findings suggest that patients with borderline personality disorder demonstrate a general attentional bias for any emotional negative stimuli and not a selective attentional bias to borderline-specific stimuli. Further studies should clarify, whether therapeutical interventions with the aim to influence attentional processes represent a useful complement to established therapies in patients with borderline personality disorder.

Attention↗
PubMed1993

The quality of depression in adolescents with borderline personality disorder.

OBJECTIVE: The quality of depression in borderline adolescent girls was compared with the quality of depression in depressed, nonborderline girls. Psychoanalytic theories led us to expect signs of anaclitic depression in borderlines as well as a depressive sense of being "all bad." METHOD: Quality of depression was examined by means of Rorschach content analysis and the Depressive Experiences Questionnaire (DEQ). Borderline girls were expected to show greater Rorschach imagery pertaining to oral dependency and oral aggression than would depressed, nonborderline control girls. The borderline diagnosis was based on the Diagnostic Interview for Borderlines. DSM-III-R criteria were used to diagnose depression. Subjects were psychiatric inpatients, ages 14 to 18 years. RESULTS: As expected, it was found that borderline girls scored significantly higher than did controls on Rorschach scales of oral dependency; borderlines scored significantly higher on DEQ factors of dependency and self-criticism. Significant DEQ items reflected the borderlines' abandonment fears. CONCLUSIONS: This study provides empirical support for anaclitic depression in borderline adolescents, and suggests the presence of underlying fears in borderlines of being fundamentally evil or bad.

Adolescent↗
PubMed1984

MMPI characteristics of borderline personality inpatients.

MMPI (Form R) profiles of psychiatric inpatients (N = 45) meeting DSM-III criteria for borderline personality disorder were compared with chronic schizophrenic inpatients (N = 48) and with inpatients with acute psychotic illness (N = 20). Profile shape was similar among the three groups, although the borderline sample showed significantly higher elevations on four of the 10 clinical scales--Depression, Hysteria, Psychopathic Deviate, and Psychasthenia--when compared to the chronic schizophrenic cohorts. The borderline sample showed only one significant deviation on the clinical scales when compared to the acute psychotic sample as evidenced by a higher elevation on the Psychopathic Deviate scale. Clinically, the borderline MMPI responses suggest features of irritability, hostility, and resentfulness. On the validity scales, the borderline sample showed a significantly lower score on the L scale when compared to both comparison groups, although all of the groups' L scale scores were within conventional limits. While significant differences between groups did not emerge on the F scale, the borderline sample attained a clinically elevated score suggestive of weakened ego defenses and unconventional thinking. Analysis was also performed of a composite measure of psychoticism probability (the Goldberg Index) between groups. While the borderline and acute psychotic samples showed Goldberg indices suggestive of increasing likelihood for psychotic illness, the chronic schizophrenic group yielded a Goldberg Index significantly greater than both of the other groups, thus confirming the validity of the hypothesis. Finally, the MMPI borderline profiles were also compared to previously published norms of borderline outpatients and veteran borderline inpatients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗