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PubMed2005

Personal relatedness and attachment in infants of mothers with borderline personality disorder.

The principal aim of this study was to assess personal relatedness and attachment patterns in 12-month-old infants of mothers with borderline personality disorder (BPD). We also evaluated maternal intrusive insensitivity toward the infants in semistructured play. We videotaped 10 mother-infant dyads with borderline mothers and 22 dyads where the mothers were free from psychopathology, in three different settings: a modification of Winnicott's Set Situation in which infants faced an initially unresponsive ("still-face") stranger, who subsequently tried to engage the infant in a game of give and take; the Strange Situation of Ainsworth and Wittig; and a situation in which mothers were requested to teach their infants to play with miniature figures and a toy train. In relation to a set of a priori predictions, the results revealed significant group differences as follows: (a) compared with control infants, toward the stranger the infants of mothers with BPD showed lower levels of "availability for positive engagement," lower ratings of "behavior organization and mood state," and a lower proportion of interpersonally directed looks that were positive; (b) in the Strange Situation, a higher proportion (8 out of 10) of infants of borderline mothers were categorized as Disorganized; and (c) in play, mothers with BPD were rated as more "intrusively insensitive" toward their infants. The results are discussed in relation to hypotheses concerning the interpersonal relations of women with BPD, and possible implications for their infants' development.

Adult↗
PubMed2003

A case study of an extremely violent serial rapist with borderline personality disorder in remission.

OBJECTIVE: To provide evidence that some borderline patients with poor prognosis can obtain complete remission. METHOD: Case of a violent rapist with borderline personality disorder in remission is reported. An attempt was made to reveal the mechanism of recovery in this forensic patient who initially was assessed as psychotherapeutically untreatable. RESULTS: Psychotherapeutic effects and favourable psychosocial factors such as successful college graduation, increased social-emotional capacities and valuable new relationships did also play a very important role in this remission process. CONCLUSION: Controlled studies are necessary to elucidate the mechanism of recovery among criminal patients with borderline personality disorder in order to provide adequate treatment programmes and to construct more reliable prediction methods for prognosis and reoffending.

Adult↗
PubMed1992

Malevolent object representations in borderline personality disorder and major depression.

To study malevolent representations, earliest memories were reliably coded on scales of affect tone. Ss were diagnosed with borderline personality disorder: 31 without and 30 with concurrent major depression. Nonborderline comparison subjects had either major depressive disorder (n = 26) or no psychiatric diagnosis (n = 30). Borderline subjects were discriminated from comparison subjects by their more malevolent representations; they more frequently produced memories involving deliberate injury; and they portrayed potential helpers as less helpful. Results suggest the diagnostic significance of malevolent representations, which need to be explained by any theory of borderline personality disorder.

Adolescent↗
PubMed1990

Borderline children: a closer look at diagnosis and treatment.

In a follow-up study, children who met research criteria for childhood borderline personality disorder were examined for vulnerability to the affective, personality, and anxiety disorders as defined in DSM-III. In addition to provisional borderline, antisocial, or schizotypal personality diagnoses, many subjects had chronic affective conditions, the symptoms of which resembled those typically associated with borderline personality disorder.

Adolescent↗
PubMed2001

Obesity and borderline personality symptomatology: comparison of a psychiatric versus primary care sample.

This study explores the relationship between obesity and borderline personality symptomatology in two clinical settings: a psychiatric vs primary care setting. The body mass indices (BMI) of 48 women from a psychiatric outpatient setting and 83 women from a primary care setting were calculated. Each participant completed the borderline personality scale of the Personality Diagnostic Questionnaire-Revised (PDQ-R). While BMI and PDQ-R were moderately related in the psychiatric sample (r=0.43, P<0.01), there was a lack of association between these variables in the primary care sample (r=0.04, P>0.05). In conclusion, women's increasing body weight appears to have some degree of correlation to borderline personality symptomatology among psychiatric patients, whereas it apparently does not among primary care patients.

Body Mass Index↗
PubMed2005

Positron emission tomography of regional brain metabolic responses to a serotonergic challenge in major depressive disorder with and without borderline personality disorder.

Previous neuroimaging studies of major depression have not controlled for the presence of personality disorders characterized by impulsive aggressive behavior, such as borderline personality disorder (BPD). Using positron emission tomography (PET), we studied regional glucose uptake in response to fenfluramine (FEN) in depressed subjects with BPD (n=11) and depressed patients without Cluster B Axis II disorders (n=8). Subjects were scanned while medication-free after a single blind placebo administration and after FEN on a second day. Brain responses were measured by PET imaging of [18F]fluorodeoxyglucose (FDG) and serial prolactin levels. Scans were compared at a voxel level using statistical parametric mapping. Correlations of changes in relative regional cerebral uptake (rCMRglu) with clinical measures were assessed. Depressed borderline patients had greater relative activity in parietotemporal cortical regions (BA 40, BA 22, and BA 42) before and after FEN activation compared to those without BPD. They also had less relative uptake in the anterior cingulate cortex (BA 32) at baseline compared to depressed patients without BPD and FEN abolished this difference. Impulsivity was positively correlated with rCMRglu in superior and middle frontal cortex (BA 6 and 44). Hostility was positively correlated with rCMRglu in temporal cortical regions (BA 21 and 22). In conclusions, borderline pathology in the context of a Major Depressive Disorder is associated with altered activity in parietotemporal and anterior cingulate cortical regions. Controlling for the presence of BPD in future imaging studies of mood disorders may elucidate similarities and differences in regional serotonergic function in these two often comorbid disorders.

Adult↗
PubMed1999

Towards understanding some complex borderline behaviours.

This article aims to explore and explain some possible antecedents to behaviours revealed by consumers in mental health settings who evoke strong and often negative responses in nurses and other health professionals. The contemporary exemplar par excellence is people who are diagnosed as having a borderline personality disorder. The paper discusses four different but overlapping domains that may contribute to understanding the difficulties many nurses face in relation to working with consumers whose behaviours are complex and distressing. Firstly, these begin with a brief discussion of psychiatric labelling and stereotyping associated with borderline personality disorder. Secondly, the connections between trauma in childhood and psychiatric vulnerability are explored, as nurses and other health professionals sometimes do not appreciate the debilitating and long-term consequences of the survival of childhood abuse or sexual assault. Thirdly, some unconscious defence mechanisms are outlined to partly explain behavioural interactions often displayed by people with a diagnosis of borderline personality disorder. Finally, behavioural concomitants of projection, splitting and projective identification are discussed: they include identity diffusion, self-mutilation and suicide attempts. All of these topics are explored to encourage nurses to support consumers to express pain in more constructive ways.

Adult↗
PubMed1999

A Jacksonian and biopsychosocial hypothesis concerning borderline and related phenomena.

OBJECTIVE: The aim of this paper is to develop an aetiological model for borderline personality disorder. METHOD: The postulates of Hughlings Jackson are used to provide a preliminary explanatory framework for borderline phenomena. As a necessary background to this discussion, the findings concerning abuse in the early history of borderline personality disorder (BPD) and other conditions, notably somatisation disorder and dissociative states, are briefly reviewed. Other data, including family studies, which might have significance in the aetiology of BPD are also reviewed. RESULTS: The hypothesis is put forward that the symptoms of BPD are due to the failure of 'experience-dependent' maturation of a cascade of neural networks, with prefrontal connections, which become active relatively late in development and which coordinate disparate elements of central nervous system function. These networks subserve higher psychological functions, including attentional focus and affect regulation. They also underpin the reflective function necessary to the emergence of self as the stream of consciousness, which appears at about the age of 4 years. CONCLUSION: Adverse developmental circumstances may produce an interrelated set of symptom clusters, with associated neural network disturbances that are amenable to investigation with psychometric and brain imaging techniques. Since these disturbances are seen as 'experience-dependent', they are considered reversible, at least in part.

Adolescent↗
PubMed2006

Aripiprazole pharmacotherapy of borderline personality disorder.

We report three consecutive cases of women with borderline personality disorder with psychotic symptoms, who received pharmacotherapy with the new atypical antipsychotic drug aripiprazole. Therapeutic effects were measured using the SCL-90R (symptom check list) and the BSL (borderline symptom list). We observed different responses to aripiprazole. In the first patient we had to discontinue the drug before we were able to observe any therapeutic effects. The second patient also complained about initial side effects. However, after the dose was lowered, the drug was tolerated and she responded well to aripiprazole with respect to all psychopathological aspects. The third patient did not suffer from any side effects under aripiprazole. She responded partially to the drug. Aripiprazole may have a potential role in the pharmacotherapy of borderline personality disorder and may not only target psychotic symptoms in these patients.

Adolescent↗
PubMedDate not supplied

The management of self-inflicted burn injuries and disruptive behavior for patients with borderline personality disorder.

One of the greatest behavioral and ethical challenges faced by a burn team is the treatment of a patient whose burn injury is the result of parasuicidal behavior. Parasuicidal behavior is defined as intentional self-injurious behavior that, although not fatal, may result in tissue damage or risk of death. There are a number of reasons, usually psychiatric, that patients engage in parasuicidal behavior; however, our contention is that the majority of these patients have a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis II diagnosis of borderline personality disorder. We describe the nature of borderline personality disorder and how it leads to disruptive behavior, including self-harm behavior, on the burn unit, We also argue that if staff members fail to recognize the borderline personality disorder diagnosis, it will lead to responses from staff that can heighten disruptive behavior. We present a series of recommendations for treating such patients with burns and an illustrative case report.

Adult↗
PubMed1993

A critique of conceptual and treatment approaches to borderline psychopathology in light of findings about childhood abuse.

A series of recent research findings has begung to supply strong evidence of a highly significant correlation between borderline psychopathology and experiences of repeated childhood trauma including sexual abuse (especially incest), physical abuse, and the witnessing of severe domestic violence (Bryer et al. 1987; Herman et al. 1989; Western et al. 1990; Zanarini et al. 1989). The replication of these results with different research samples is in contrast to the inconsistent findings associated with earlier etiological theories, in which the roots of borderline pathology were variously linked to schizophrenic or affective illnesses (Akiskal 1981; Akiskal et al. 1985; Klein 1977; Perry 1985), to derailments in the separation-individuation process (Kernberg 1975, 1976; Mahler and Kaplan 1977; Masterson and Rinsley 1975), to actual early losses and separations (Bradley 1979; Paris et al. 1988; Soloff and Millward 1983a, 1983b), to severe empathic failures during the first years of life (Adler and Buie 1979), or to more general family-based pathologies (Frank and Hoffman 1980; Frank and Paris 1981; Grinker et al. 1968; Gunderson and Englund 1981; Gunderson et al. 1980; Links 1990; Walsh 1977; Zinner and Shapiro 1975). Not only do current findings regularly identify 50% to 80% of subjects as victims of childhood abuse and trauma, but also several studies show that factors such as age of onset, severity, and type of abuse reliably discriminate between borderline and other diagnostic groups (Herman et al. 1989; Zanarini et al. 1989).

Adolescent↗
PubMed1993

Studying the treatment contract in intensive psychotherapy with borderline patients.

A pilot study on the process of psychodynamic psychotherapy of borderline personality disorder at the Cornell University Medical College is designed to investigate the teaching and application of a specific model of treatment for borderline patients (Clarkin et al. 1992; Kernberg and Clarkin 1992). The project has involved teaching a group of self-selected trainees and faculty the manualized therapy (Kernberg et al. 1989); taping each of the twice-weekly therapy sessions over a period of 2 years; and rating (1) each therapist's adherence to the manual (Koenigsberg et al. 1985), (2) each therapist's skill, and (3) patient change. The patients are women with borderline personality disorder, between 20 and 40 years of age, diagnosed by DSM-III-R criteria (American Psychiatric Association 1987), SCID-II (Spitzer et al. 1987), and a self-report questionnaire for level of personality organization. At regular intervals, the patients are evaluated for symptom status, change in BPD criteria, and functioning. The therapists are evaluated for adherence to the manual and level of therapeutic skill. In teaching and carrying out the manualized therapy, it became clear that a critical moment in the treatment was the setting up of the treatment contract. A study was organized to look systematically at the adherence of the therapists to the model of treatment with regard to this initial phase of the therapy.

Adult↗
PubMed1996

Cultural factors in the emergence of borderline pathology.

Most of the research and clinical reports concerning borderline personality disorder (BPD) come from highly developed countries. Although BPD can also be diagnosed in developing societies, it is likely that this form of pathology is more prevalent in North America and Europe. However, the personality traits and psychological risk factors underlying borderline personality may also be found in individuals from developing countries. The hypothesis of this paper is that social protective factors suppress the development of these traits into diagnosable personality disorders. This process is illustrated by cases in which borderline pathology emerged only after immigration.

Adult↗
PubMedDate not supplied

Half in love with easeful death: the meaning of chronic suicidality in borderline personality disorder.

Chronic suicidality is a central feature of borderline personality disorder. While suicidal thoughts and attempts are highly prevalent in borderline patients, completion is relatively unpredictable. Self-cutting seems to function as a means of affective regulation. In borderline personality disorder, suicidality performs a set of psychological functions and can sometimes become "a way of life." Strategies developed for acutely suicidal patients may not be effective in chronic suicidality. Since there is no evidence that hospitalization prevents completion, an ambulatory approach to the management of chronically suicidal patients may be most useful.

Attitude to Death↗
PubMed2004

Social skills and sex-role functioning in borderline personality disorder: relationship to self-mutilating behavior.

This study compared the social skills functioning and sex role affiliation of female inpatients diagnosed with borderline personality disorder who engaged in self-mutilating behavior (n = 30) with female patients with borderline personality disorder who did not engage in such behavior (n = 18). Patients with borderline personality disorder who engaged in self-mutilating behavior were found to have relatively poorer skills in communicating non-verbal emotional information to others and in receiving and interpreting such information from others. In terms of sex role orientation, patients who engaged in self-mutilating behavior were significantly more likely than non-mutilators to be typed as undifferentiated using the Bem Sex Role Inventory. These participants were less likely to identify with either masculine or feminine sex roles. Patients who did not self-mutilate were found to be significantly more likely than those who did self-mutilate to identify with the masculine sex role.

Adult↗
PubMed1983

Is there a characteristic pattern to the treatment history of clinic outpatients with borderline personality?

The prior psychiatric histories, dispositions, and treatment plans for a group of patients with borderline personality, evaluated in an outpatient clinic, were compared to those of evaluated patients diagnosed as having neurotic and/or other personality disorders or schizophrenia. Variables that were found to discriminate patients diagnosed as borderline from the other two groups included a history of past hospitalizations and their duration, frequency of prior outpatient treatment, previous use of psychotropic medications, rates of dropout and referral-out of the clinic, and number of treatment sessions received during a 2-year follow-up period. Patients with borderline personality who had the most previous treatment and the most severe symptoms received the least treatment. The histories of extensive previous treatment are consistent with the frequently brief and unsatisfactory nature of the index clinic contacts.

Adult↗
PubMed1989

A critical review of psychotherapeutic treatments of the borderline personality. Historical trends and future directions.

The borderline personality was originally thought to be on the border of psychosis and treatability. Most psychoanalytic writers of the 1940s-1960s gave these patients subschizophrenic labels and emphasized a supportive, limited treatment approach. They noted that these patients often regressed and became worse with analytic treatment. Nevertheless, in the 1970s a major impetus for a renaissance and revitalization of psychoanalytic thought was a recasting of the theory and therapy of the borderline personality. Renewed optimism and vigor characterized the intensive, exploratory treatment approaches to these writings. The 1980s, however, curiously show a fragmentation of and retrenchment from these views, and a return to many of the treatment recommendations of the earlier authors. The literature on the treatment of the borderline personality is critically examined from a historical perspective in this review. Highlighted, in particular, are the commonalities, trends, empirical studies, and future directions in the treatment literature.

Borderline Personality Disorder↗
PubMed1994

Borderline personality disorder and perceived family dysfunction in the eating disorders.

Borderline personality disorder is associated with anorexic and bulimic disorders, but the factors that underlie that association are not understood. This study of a case series of eating disordered women investigates the potential role of perceived family dysfunction as one critical explanatory factor. The syndrome and symptoms of borderline personality disorder are associated with specific features of perceived family interaction. Possible causal mechanisms are proposed to explain the links among family dysfunction, borderline personality disorder, and the eating disorders, although further research is needed to test these models. The clinical implications of these findings are discussed.

Adult↗