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PubMed2006

The impact of client sexual orientation and gender on clinical judgments and diagnosis of borderline personality disorder.

Concerns have been raised that individuals who are having difficulty coming out as gay or bisexual may be misdiagnosed with borderline personality disorder. In this analogue study, 141 psychologists evaluated a hypothetical client with problems that resembled borderline symptoms but were also consistent with a sexual identity crisis. Client descriptions varied by sexual orientation and gender. Results revealed an effect of sexual orientation for male clients, but not female clients. Male clients whom therapists perceived likely to be gay or bisexual, and male clients with partners of unspecified gender, were more likely to be diagnosed with borderline personality disorder. Therapists were more confident and willing to work with female clients and gave them a better prognosis. Therapists' responses are discussed in light of gender role bias and social desirability.

Adult↗
PubMed1984

Indications for hospitalization in the treatment of borderline patients.

Hospitalization is an important component in the treatment of some borderline patients, yet features of the borderline syndrome make the decision to hospitalize a complex one. This paper considers alternatives to hospitalization as well as indications for use of the hospital in the treatment of borderline patients. The roles of brief hospitalization and of extended inpatient treatment are considered separately.

Adult↗
PubMed1983

"Borderline" children.

Sixteen children said to be "borderline" were referred for comprehensive evaluation. None met DSM III criteria for borderline personality disorder. Referring psychiatrists and psychologists seemed to base their impressions on the child's disorganized thinking and irrational, erratic behavior, problems that were better understood and treated from a developmental perspective. The borderline label had a negative impact on some children, and was not helpful for treatment planning or disposition. Clear guidelines for the application of this ambiguous and controversial diagnostic term in child psychiatry are nonexistent.

Adolescent↗
PubMed1997

[Differentiation and therapy of delinquent behavior in borderline disorders. Psychodynamic approach].

In the literature about borderline patients, self-destructive dependency needs are described, as well as oral-aggressive root conflicts. Using case studies, the author points out that in persons with borderline personality organisation, self-destructive forms of delinquency are as likely to manifest themselves as aggressive forms are. The first form is connected with sexual abuse, the second with physical abuse. Therefore, delinquency should be differentiated according to the traumatic experiences. Finally, depending on the direction of delinquency-either directed against oneself or against others-various therapy requirements are outlined: delinquency in the sense of self-mutilation primarily requires the team to perform a holding function, while aggressive delinquency primarily demands a firm setting. The author concludes that the outcome of therapy for borderline personality disorders depends on the assessment of the direction of the delinquency.

Adult↗
PubMed1999

[Treatment of dissociative symptoms in borderline patients with naltrexone].

Dissociative symptoms including flashbacks, i.e. vivid scenic recollections of traumatic episodes, in patients with Borderline Personality Disorder are a serious and often treatment-refractory problem. There is evidence suggesting changes in endogenous opioids in patients with Borderline Personality Disorder. Naltrexone, an opioid receptor antagonist, was administered to three female patients with Borderline Personality Disorder in a dosage of 50 mg (q.i.d.,p.o.) over several weeks. We observed a marked reduction in dissociative symptoms.

Adult↗
PubMed2005

[Incorporation of multiple foreign bodies due to borderline personality disorder].

BACKGROUND: Autoaggressive behaviour is one of the pathognomonic characteristics in patients with borderline personality disorder. Clinical symptoms of such behaviour can be the self-induced incorporation of foreign bodies. In the head and neck area, this form of autoaggressivity causes primary or secondary infectious complications with different clinical manifestations. Below follows a description of diagnosis, therapy and follow-up of such a case, comparing our own findings with the corresponding literature. CASE REPORT: A 24-year-old woman with manifest borderline personality disorder was referred to the Department of Maxillofacial Surgery after developing a swelling in the infra-auricular region. After antibiotic therapy failed to reduce inflammatory symptoms, local revision was performed including excision of two metallic foreign bodies. Comprehensive radiological evaluation identified multiple foreign bodies in the head and neck region and lower arms. A total of 76 metallic foreign bodies was removed surgically. During early surgical follow-up and subsequent psychiatric treatment, the patient incorporated new foreign bodies. DISCUSSION: The case reported represents a pattern of foreign body incorporation which is unusual based on review of the literature but characteristic for patients with borderline personality disorder. Diagnostics and therapy require an individual concept which only can be implemented in close co-operation with psychiatrists. Secondary clinical benefit derived from surgical diagnostics and therapy as well as the possibility of autoaggressive relapse have to be taken into consideration.

Adult↗
PubMed2004

Psychopharmacology of borderline personality disorder.

Psychopharmacology is widely used in the treatment of borderline personality disorder. However, support for this form of treatment has been largely based on case reports, case series, and open-label clinical trials. This evidence-based review examines the most recent randomized controlled trials of psychopharmacology in the treatment of borderline personality disorder, with a goal of highlighting the most promising pharmacotherapy for use in current clinical practice, as well as for future large-scale research testing. The results and limitations of the randomized controlled trial data are presented along with case vignettes illustrating the complexity of the disorder and the heterogeneity of its treatment. To date, there is at least some evidence-based support for the use of antipsychotics (conventional and atypical), monoamine oxidase inhibitors, serotonin reuptake inhibitors, and omega-3 fatty acids in the treatment of borderline personality disorder.

Aggression↗
PubMed1994

Treatment of borderline personality disorder: a challenge for cognitive-behavioural therapy.

Patients with so-called Borderline Personality Disorder are generally considered as extremely difficult to treat. Until recently, conceptualizations of this severe disorder on which cognitive-behavioural therapy could be based were underdeveloped. The present paper presents a cognitive formulation based on previous cognitive and behavioural conceptualizations, and on empirical evidence pertaining to the relationship between childhood traumas and Borderline Personality Disorder. It is assumed that chronic traumatic abuse or neglect in childhood has led to the development of almost unshakeable fundamental assumptions about others (dangerous and malignant), about one's own capabilities (powerless and vulnerable) and upon one's value as a person (bad and unacceptable). These are assumed to underlie the complex symptomatic presentation of borderline patients. A treatment protocol is described, which takes 1.5-4 years, and consists of 5 stages: (1) construction of a working relationship; (2) symptom-management (gaining more control over symptoms); (3) correction of thinking errors; (4) emotional processing and cognitive re-evaluation of the childhood trauma and schema changes; and (5) termination. A case example is presented, and a call for research into the efficacy of this approach is made.

Adult↗
PubMedDate not supplied

Borderline personality in Britain: a preliminary study.

Patients admitted to a psychiatric hospital in England were interviewed using both the Present State Examination (PSE) to obtain a standardized diagnosis and the Diagnostic interview for Borderlines (DIB) to measure their borderline status. Comparison of the patients' symptom profiles showed that borderline patients were similar to neurotic patients, but had greater irritability. They were also more likely to receive a clinical diagnosis of hysterical personality disorder with neurotic depression by a British clinician.

Adult↗
PubMedDate not supplied

Axis I phenomenology of borderline personality disorder.

The Axis I phenomenology of 50 outpatients meeting both Diagnostic Interview for Borderlines (DIB) and DSM-III criteria for Borderline Personality Disorder (BPD), 29 outpatients meeting DSM-III criteria for Antisocial Personality Disorder (APD), and 26 outpatients meeting DSM-III criteria for Dsythymic Disorder as well as DSM-III criteria for some other type of Axis II disorder (dysthymic OPD) was assessed blind to clinical diagnosis using the Structured Clinical Interview for DSM-III (SCID). Borderlines were significantly more likely than antisocial controls to have met DSM-III criteria for an affective disorder, particularly Dysthymic Disorder, and an anxiety disorder. They were also significantly more likely than dysthymic OPD controls but significantly less likely than antisocial controls to have met DSM-III criteria for alcohol abuse/dependence and drug abuse/dependence. The authors conclude that: (1) the link between BPD and unipolar affective disorders is less specific than previously suggested, and (2) there is a link between BPD and impulse disorders that may be of equal, if not greater, importance.

Adult↗
PubMedDate not supplied

Overlap between borderline and schizotypal personality disorders.

Borderline personality was split into two diagnostic categories in DSM-III: borderline personality disorder (BPD) and schizotypal personality disorder (SPD). There remains a great deal of diagnostic overlap between these two categories despite modifications in DSM-III-R. This report discusses four possible hypotheses for this overlap: (1) an independent, random association; (2) artifactual overlap due to imperfections in the criteria sets; (3) a synergistic association of the two personality disorders; and (4) a manifestation of dimensional psychopathology. Empirical evidence for each of the first three hypotheses is weak and contradictory. Recent biologic and treatment studies appear to most strongly support the use of dimensional models of "borderline" and "schizotypal" personality traits.

Borderline Personality Disorder↗
PubMedDate not supplied

Karen Horney's "resigned person" heralds DSM-III-R's borderline personality disorder.

It is shown here that what Karen Horney called the resignation solution to the problem of basic anxiety leads to psychopathology very similar to DSM-III-R's borderline personality disorder (BPD). Both the "resigned person" and the borderline personality show instability of self-image, social relationships, and mood, and live out the associated deficits with similar styles. While not specifically using the term "splitting", Horney showed how alternating expansive and self-effacing trends can coexist in the resigned person, and how these oscillations in self-other-world constitution influence the resigned person's behavior in a way similar to borderline splitting. Horney's descriptive and psychodynamic analysis of the resignation phenomenon elaborates and gives additional credibility to DSM-III-R's BPD as a diagnostic category.

Borderline Personality Disorder↗
PubMedDate not supplied

Effects of depression and borderline personality traits on psychological state and eating disorder symptomatology.

The incidence of current or lifetime affective disorder and borderline personality characteristics were measured in bulimia nervosa patients. The relationship of these variables to the severity of eating disorder symptomatology (Eating Disorder Inventory [EDI]) and general psychiatric symptoms (Hopkins Symptom Checklist [SCL]) was examined. Categorical diagnostic assessments of affective disorder and borderline personality disorder (BPD) were made by Structured Clinical Interviews for DSM-III-R (SCID-I and -II). Affective disorder diagnosis (both current and lifetime) strongly influenced EDI and SCL profiles, while borderline personality characteristics had little influence. An understanding of the broad psychological symptomatology in bulimics requires the consideration of comorbid psychiatric illnesses, especially affective disorders.

Adult↗
PubMed1992

Mood and global functioning in borderline personality disorder: individual regression models for longitudinal measurements.

This report addresses the need for prospective studies of personality disorders, as well as some of the difficulties encountered in longitudinal studies when missing data occur due to subject attrition and variable follow-up intervals. Various statistical methods for handling repeated measurements data are reviewed. Many of these methods are quite complex and require expert statistical skills. A simpler way to handle multivariate data using single-number summary scores is proposed as an alternative which is efficient and more readily understood by professionals in many disciplines. Findings are presented from a prospective study of borderline personality disorder which utilized repeated observations over time. Individual regression models were applied to each subject's repeated measurements to obtain a summary of his or her trend on measures of mood and global functioning. The individual regressions produced separate statistics, slopes summarizing rates of change and intercepts which estimated initial levels of functioning. These summaries were then used in group analyses. Findings indicated that subjects showed mild to moderate impairment in mood and moderate impairment in overall functioning. The individual slopes indicated that little overall change was observed during the 5-year period after initial assessment. Neither presence of borderline diagnosis (definite vs. trait vs. no borderline diagnosis) nor gender predicted initial levels of functioning or rates of change. Further examination of other predictors which may influence longterm outcome, such as history of childhood trauma or presence of schizotypal personality features, is suggested. It is concluded that prospective studies are essential in establishing the validity of personality disorders and in understanding individual variation in outcomes.

Adaptation, Psychological↗
PubMed1981

The borderline patient in the general hospital.

The usefulness of the general hospital inpatient service for the borderline patient is described. The short-term nature of most general hospital units requires a setting that facilitates the rapid establishment of a holding environment and the re-establishment of self-object transferences. Borderline patients have particular difficulty in accepting responsibility for their feelings and behavior and, instead, tend to blame themselves and others. An approach to inpatient care that defines expectations of both patient and family prior to and early in the admission of the patient is elaborated clinically and theoretically. Such an approach offers a way of working with the potential regression in borderline patients, especially around the important issues of responsibility and blaming. The staff's awareness of countertransference problems related to the patient and family as well as to the patient's therapist are described as important ingredients in successful work with these patients.

Attitude of Health Personnel↗
PubMed1990

Sleep patterns in borderline personality disorder.

Sleep patterns of borderline patients with and without a history of affective disorder were compared to each other and to normal reference data. The three groups could not be distinguished in terms of REM latency because a wide spread of values was seen within each group. Borderlines were different from normal controls in other aspects of sleep architecture; they had less total sleep, more stage 1 sleep, and less stage 4 sleep. If one assumes that REM latency is a biological marker for mood disorder, then our results do not support the hypothesis that borderline personality disorder is a variant of affective illness. However, other data suggest that REM latency should not be used to validate the presence of affective illness.

Adult↗
PubMed1989

Cerebral structure in borderline personality disorder.

Computed tomographic (CT) scans of brains of patients with borderline personality disorder and normal volunteers were analyzed for ventricle-brain ratios, third ventricular size, and evidence of frontal lobe atrophy. There were no significant differences between the two groups on any of these measures except for a narrower third ventricle in borderline patients, which could be accounted for by the narrower third ventricle observed in female subjects overall. While borderline patients may show signs of subtle neurological dysfunction, they do not show evidence of structural brain pathology.

Adult↗
PubMed1985

Identification of borderline personality disorders among substance abuse inpatients.

By means of a structured interview procedure, individuals with borderline personality disorders were identified among a sample of 50 patients admitted to an inpatient substance abuse treatment program. When given a series of psychological tests, borderline patients were shown to be more pathological than a nonborderline group of substance abusers in a number of areas including depression, impulse control, antisocial tendencies and reality testing. Time spent in treatment was also shorter for the borderline group. Implications for substance abuse treatment programs and the potential impact of these patients on such programs is discussed.

Adult↗