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PubMed1997

Transitional objects and borderline personality disorder.

OBJECTIVE: The relationship of possession of transitional objects to the borderline personality disorder diagnosis was explored in a psychiatric inpatient setting. It was hypothesized that a greater proportion of inpatients who bring objects of special meaning with them to the hospital have borderline personality disorder. METHOD: Psychiatric inpatients (N = 146) were administered a semistructured interview to determine the presence of special (i.e., transitional) objects in the hospital, at home, or during childhood. Borderline personality disorder was determined by criteria on a DSM-III-R borderline personality disorder checklist and by DSM-III-R discharge diagnosis. RESULTS: Significantly more patients who endorsed having transitional objects in the hospital or at home had the diagnosis of borderline personality disorder. Sensitivity, specificity, positive predictive power, and negative predictive power of the possession of the transitional object for the borderline personality disorder diagnosis were calculated. Specificity was higher than sensitivity, and negative predictive power was higher than positive predictive power in each instance. While these results suggest that absence of a transitional object is more likely to be associated with absence of borderline personality disorder than the presence of a transitional object is with the presence of borderline personality disorder, the sensitivity of a transitional object during adulthood to predict a diagnosis of borderline personality disorder was 63%, and the positive predictive power was 45%. CONCLUSIONS: A transitional object brought to the hospital may help remind the inpatient with borderline personality disorder of home or provide soothing during separation from home. The persistence of transitional objects into adulthood may inform the therapist of possible transference paradigms that may develop in treatment.

Adolescent↗
PubMed1998

Axis I comorbidity of borderline personality disorder.

OBJECTIVE: The purpose of this study was to assess the lifetime rates of occurrence of a full range of DSM-III-R axis I disorders in a group of patients with criteria-defined borderline personality disorder and comparison subjects with other personality disorders. METHOD: The axis I comorbidity of 504 inpatients with personality disorders was assessed by interviewers who were blind to clinical diagnosis and who used a semistructured research interview of demonstrated reliability. RESULTS: Four new findings emerged from this study. First, anxiety disorders were found to be almost as common among borderline patients (N=379) as mood disorders but far more discriminating from axis II comparison subjects (N=125). Second, posttraumatic stress disorder (PTSD) was found to be a common but not universal comorbid disorder among borderline patients, a finding inconsistent with the view that borderline personality disorder is actually a form of chronic PTSD. Third, male and female borderline patients were found to differ in the type of disorder of impulse in which they "specialized." More specifically, substance use disorders were significantly more common among male borderline patients, while eating disorders were significantly more common among female borderline patients. Fourth, a lifetime pattern of complex comorbidity (i.e., met DSM-III-R criteria for both a disorder of affect and a disorder of impulse at some point before the patients' index admission) was found to have strong positive predictive power for the borderline diagnosis as well as a high degree of sensitivity and specificity. CONCLUSIONS: These results suggest that the lifetime pattern of axis I comorbidity characteristic of borderline patients and distinguishing for the disorder is a particularly good marker for borderline personality disorder.

Adolescent↗
PubMed2000

Comorbidity of borderline personality disorder with other personality disorders in hospitalized adolescents and adults.

OBJECTIVE: The authors examined the comorbidity of borderline personality disorder with other personality disorders in a series of consecutively admitted adolescents. For comparison, the comorbidity of borderline personality disorder with other personality disorders was also examined in a series of adults consecutively admitted to the same hospital during the same period. METHOD: A total of 138 adolescents and 117 adults were reliably assessed with the Personality Disorder Examination, a semistructured diagnostic interview for DSM-III-R personality disorders. Sixty-eight adolescents and 50 adults met the diagnostic criteria for borderline personality disorder. The co-occurrence of other personality disorders in the group of subjects with borderline personality disorder was statistically compared to that in the group without borderline personality disorder, for adolescents and adults separately. RESULTS: For the adults, Bonferroni-corrected chi-square analysis revealed significant diagnostic co-occurrence with borderline personality disorder for antisocial personality disorder only. For the adolescents, borderline personality disorder showed significant co-occurrence with schizotypal and passive-aggressive personality disorders. CONCLUSIONS: In the adults, borderline personality disorder was significantly comorbid only with another cluster B disorder. The adolescents, by comparison, displayed a broader pattern of comorbidity of borderline personality disorder, encompassing aspects of clusters A and C. These results suggest that the borderline personality disorder diagnosis may represent a more diffuse range of psychopathology in adolescents than in adults.

Adolescent↗
PubMed2000

Identity disturbance in borderline personality disorder: an empirical investigation.

OBJECTIVE: Identity disturbance is one of the nine criteria for borderline personality disorder in DSM-IV, yet the precise nature of this disturbance has received little empirical attention. This study examines 1) the extent to which identity disturbance is a single construct, 2) the extent to which it distinguishes patients with borderline personality disorder, and 3) the role of sexual abuse in identity disturbance in patients with borderline personality disorder. METHOD: The authors constructed an instrument that consisted of 35 indicators of identity disturbance culled from relevant clinical and theoretical literature and asked clinicians to rate a patient on each of the items. The patient group consisted of 95 subjects diagnosed with borderline personality disorder (N=34), another personality disorder (N=20), or no personality disorder (N=41). Relevant diagnostic, demographic, and developmental history data were also collected. The authors used factor analysis to ascertain whether identity disturbance is a unitary construct and then examined the relation between dimensions of identity disturbance and borderline diagnosis after controlling for sexual abuse history. RESULTS: Four identity disturbance factors were identified: role absorption (in which patients tend to define themselves in terms of a single role or cause), painful incoherence (a subjective sense of lack of coherence), inconsistency (an objective incoherence in thought, feeling, and behavior), and lack of commitment (e.g., to jobs or values). All four factors, but particularly painful incoherence, distinguished patients with borderline personality disorder. Although sexual abuse was associated with some of the identity factors, particularly painful incoherence, borderline pathology contributed unique variance beyond abuse history to all four identity disturbance factors. The data also provided further evidence for an emerging empirical distinction between two borderline personality disorder types: one defined by emotional dysregulation and dysphoria, the other by histrionic characteristics. CONCLUSIONS: Identity disturbance is a multifaceted construct that distinguishes patients with borderline personality disorder from other patients. Some of its components are related to a history of sexual abuse, whereas others are not. Identity disturbance appears to be characteristic of borderline patients whether or not they have an abuse history.

Borderline Personality Disorder↗
PubMed2000

Characteristics of suicide attempts of patients with major depressive episode and borderline personality disorder: a comparative study.

OBJECTIVE: Suicidal behavior is highly prevalent in borderline personality disorder and major depressive episode, although the characteristics of suicide attempts in the two disorders are believed to differ. Comorbidity of borderline personality disorder and major depressive episode may obscure characteristics of suicide attempts that are uniquely related to the psychopathology of each disorder. We compared suicidal behavior in patients with borderline personality disorder, major depressive episode, and borderline personality disorder plus major depressive episode to determine whether characteristics of suicide attempts differed between groups and if aspects of core psychopathology predicted specific attempt characteristics. METHOD: Eighty-one inpatients with borderline personality disorder, including 49 patients with borderline personality disorder plus major depressive episode, were compared to 77 inpatients with major depressive episode alone on measures of depressed mood, hopelessness, impulsive aggression, and suicidal behavior, including lifetime number of attempts, degree of lethal intent, objective planning, medical damage, and degree of violence of suicide methods. RESULTS: No significant differences were found in the characteristics of suicide attempts between patients with borderline personality disorder and those with major depressive episode. However, patients with both disorders had the greatest number of suicide attempts and the highest level of objective planning. An increase in either impulsive aggression or hopelessness or a diagnosis of borderline personality disorder predicted a greater number of attempts. Hopelessness predicted lethal intent in all three groups and predicted objective planning in the group with both disorders. Medical damage resulting from the most serious lifetime suicide attempt was predicted by number of attempts. CONCLUSIONS: Comorbidity of borderline personality disorder with major depressive episode increases the number and seriousness of suicide attempts. Hopelessness and impulsive aggression independently increase the risk of suicidal behavior in patients with borderline personality disorder and in patients with major depressive episode.

Adolescent↗
PubMed2004

Axis I comorbidity in patients with borderline personality disorder: 6-year follow-up and prediction of time to remission.

OBJECTIVE: The purpose of this study was to assess the prevalence of axis I disorders among patients with borderline personality disorder over 6 years of prospective follow-up. METHOD: A semistructured interview of demonstrated reliability was used to assess presence or absence of comorbid axis I disorders in 290 patients who met Revised Diagnostic Interview for Borderlines criteria and DSM-III-R criteria for borderline personality disorder and 72 patients who did not meet these criteria but did meet DSM-III-R criteria for another axis II disorder. Over 94% of surviving patients were reinterviewed about their axis I disorders at 2-year, 4-year, and 6-year follow-up periods. RESULTS: Although the patients with borderline personality disorder experienced declining rates of many axis I disorders over time, the rates of these disorders remained high, particularly the rates of mood and anxiety disorders. Patients whose borderline personality disorder remitted over time experienced substantial decline in all comorbid disorders assessed, but those whose borderline personality disorder did not remit over time reported stable rates of comorbid disorders. When the absence of comorbid axis I disorders was used to predict time to remission, the absence of substance use disorders was a far stronger predictor of remission from borderline personality disorder than was the absence of posttraumatic stress disorder, mood disorders, other anxiety disorders, or eating disorders, respectively. CONCLUSIONS: The results of this study suggest that axis I disorders are less common over time in patients with initially severe borderline personality disorder, particularly for patients whose borderline personality disorder remits over time. The findings also suggest that substance use disorders are most closely associated with the failure to achieve remission from borderline personality disorder.

Adult↗
PubMed2005

Bone mineral density, markers of bone turnover, and cytokines in young women with borderline personality disorder with and without comorbid major depressive disorder.

OBJECTIVE: The pathogenesis of bone loss in major depressive disorder is a matter of debate. Studies of bone loss in nonpsychiatric medical disorders have found an association between the activation of osteoclastic cells and an imbalance of pro- and antiinflammatory cytokines. Since major depressive disorder is also associated with alterations in serum cytokine concentrations, the authors hypothesized that bone loss in patients with major depressive disorder and comorbid borderline personality disorder may be associated with cytokines capable of activating osteoclastic cells. METHOD: Twenty-two patients with borderline personality disorder and comorbid current or lifetime major depressive disorder were compared with 16 patients with borderline personality disorder who did not have major depressive disorder and 20 healthy volunteers. Bone mineral density was assessed by means of dual-energy x-ray absorptiometry. Markers of bone turnover as well as endocrine and immune measures were determined. RESULTS: The bone mineral density of 10 patients with borderline disorder plus current major depressive episode was significantly lower than that of the healthy subjects and the patients with borderline personality disorder without depression. Values of crosslaps, osteocalcin, serum cortisol, tumor necrosis factor-alpha (TNF-alpha), and interleukin-6 were significantly higher in the patients with borderline disorder plus current major depressive episode than in the healthy subjects. Crosslaps correlated positively with TNF-alpha but negatively with bone mineral density at the lumbar spine. Patients with borderline personality disorder who did not have current or lifetime depression displayed no alterations of either bone mineral density or the immunological and hormonal measures examined. CONCLUSIONS: Young women with comorbid borderline personality disorder and major depressive disorder have an elevated risk for osteoporosis. Borderline personality disorder per se is not associated with low bone mineral density. These data suggest that the immune and endocrine disturbances associated with depressive disorders in the context of borderline personality disorder may play a role in the pathophysiological process underlying bone loss in the patients studied.

Absorptiometry, Photon↗
PubMed1996

Expression of cell regulatory proteins in ovarian borderline tumors.

BACKGROUND: Tumors of borderline malignancy are still a controversial subgroup of ovarian neoplasms. The expression of several cell regulatory proteins was studied to characterize the molecular phenotype of these tumors, and to compare them with their benign and malignant counterparts. METHODS: Specimens from 22 patients with tumors of borderline malignancy (11 serous and 11 mucinous tumors), 12 patients with benign tumors, and 16 patients with invasive ovarian carcinomas were evaluated for expression of epidermal growth factor receptor (EGFR), HER-2/neu, PTP1B, and p53 by immunohistochemical techniques. RESULTS: One or both of the tyrosine kinase growth factor receptors EGFR and HER-2/neu was expressed by 42% of benign, 59% of borderline, and 81% of malignant ovarian tumors. EGFR was expressed in a significantly greater fraction of malignant lesions (69%) than borderline lesions (18%) (P< 0.004). EGFR expression was not observed among the 11 mucinous borderline tumors. HER-2/neu was expressed by 50% of borderline tumors and was not a marker for malignancy. The tyrosine phosphatase PTP1B was expressed by a similar fraction of benign (17%), borderline (27%), and malignant (19%) tumors. The number of cases studied precluded correlation of kinase and phosphatase activity. However, among 12 tumors with PTP1B expression, 9 also expressed EGFR or HER-2/neu. Overexpression of p53 was observed only in malignant serous tumors and was not found in malignant mucinous, borderline, or benign lesions. CONCLUSIONS: Either EGFR or HER-2/neu was detected in a majority of borderline cancers. PTP1B was present only in a minority of these cancers. Frankly malignant serous lesions differed from borderline and benign tumors with regard to expression of EGFR and overexpression of p53.

Carcinoma↗
PubMed2005

Expression of pro-apoptotic (p53, p21, bax, bak and fas) and anti-apoptotic (bcl-2 and bcl-x) proteins in serous versus mucinous borderline ovarian tumours.

BACKGROUND: We examined the expression of apoptosis-related proteins in serous versus mucinous borderline ovarian tumours, in comparison with benign and malignant ovarian tumours. MATERIALS AND METHODS: Immunohistochemical expression of pro-apoptotic (p53, p21, bax, bak, fas) and anti-apoptotic proteins (bcl-2, bcl-x) was determined in 34 borderline (19 mucinous, 15 serous), 20 benign (10 mucinous, 10 serous) and 28 malignant ovarian tumours (9 mucinous, 19 serous). RESULTS: A difference in semi-quantitative p53 expression was found between benign and borderline tumours (P = 0.01), but not between borderline and malignant tumours. Increased p21 expression was found in borderline versus benign tumours (P = 0.004). Bcl-2 expression was lower in borderline than in benign (P = 0.01) and malignant tumours (P = 0.02). No difference in bax, bak, fas or bcl-x expression was observed among the three tumour types. Higher percentage of p21 positive cells was found in serous than in mucinous borderline tumours (P < 0.001). Bcl-2 expression was higher in serous than in mucinous forms of benign (P < 0.001), borderline (P < 0.001), and malignant tumours (P < 0.003). No difference in p53, bax, bak, fas or bcl-x expression was observed between serous and mucinous borderline ovarian tumours. CONCLUSION: Although p53 overexpression was a common feature of both mucinous and serous borderline tumours, p21 and bcl-2 overexpression appeared specific to serous tumours.

Adult↗
PubMed1993

Survey of clinical isolates of Staphylococcus aureus for borderline susceptibility to antistaphylococcal penicillins.

On the basis of the MICs of methicillin and oxacillin, 975 clinical isolates of Staphylococcus aureus were categorized as having resistance, borderline susceptibility or full susceptibility to penicillinase-resistant penicillins (PRPs). The borderline phenotype accounted for 122 isolates (12.5%), whereas 562 isolates were fully susceptible and 290 resistant; one remaining isolate had resistance to methicillin and borderline susceptibility to oxacillin. Reductions in the MICs of methicillin and oxacillin in the presence of sulbactam were greater in strains with borderline PRP susceptibility than in fully susceptible or resistant isolates. Over 99% of fully PRP-susceptible strains, 93% with borderline susceptibility and 71% of resistant strains were susceptible to ampicillin/sulbactam. The production of beta-lactamase, assayed in all strains using nitrocefin as substrate, could be detected without prior induction in 729 strains and after induction only in another 156 strains. With only two exceptions, the beta-lactamase negative strains were part of the fully PRP-susceptible group of organisms (88 of 562 isolates). Among the borderline isolates, strong beta-lactamase reactions were encountered with particular frequency, but not in all strains and not exclusively in borderline strains. Although associated with the majority of borderline strains, beta-lactamase hyperproduction thus did not appear to be an essential feature of the borderline phenotype. The results obtained may have implications for laboratory and clinical medicine, also in the light of recent findings suggesting that other mechanisms besides beta-lactamase hyperproduction may account for borderline susceptibility to PRPs.

Ampicillin↗
PubMed2000

Overexpression of p21WAF1/CIP1 and MDM2 characterizes serous borderline ovarian tumors.

Ovarian epithelial tumors are classically divided into benign, malignant, and borderline or of low malignant potential. It is controversial whether this last group of tumors should be considered benign or malignant. Expression of cell cycle markers has recently been linked to tumor behavior and response to treatment. It has been shown that one of the pathways through which the p53 gene controls the cell cycle is by transactivating p21WAF1/CIP1, a cyclin-dependent kinase (cdk) inhibitor. By inhibiting cdks, p21WAF1/CIP1 blocks the G-1 to S-phase transition in the cell cycle. p53 can be regulated by MDM2 (murine double minute-2) through direct inactivation or promotion of its cytoplasmic degradation. In an attempt to investigate the cell cycle checkpoint mechanisms of these tumors, we studied the expression of p53, Ki-67, MDM2, and p21WAF1/CIP1 by immunohistochemistry. We analyzed the expression of these proteins in 19 cystadenomas (8 serous and 11 mucinous), 40 borderline tumors (31 serous and 9 mucinous), and 18 serous carcinomas of the ovary. p21WAF1/CIP1 was expressed in 7 of 19 (37%) benign cystadenomas, 32 of 40 (80%) borderline tumors (93.5% of serous and 33% of mucinous), and in 9 of 18 (50%) serous carcinomas. Ki-67 was only weakly expressed in 8 of 19 (42%) benign cystadenomas, all borderline tumors showed Ki-67 staining in less than 50% of the cells, and 55% of serous carcinomas stained in more than 50% of tumor cells. p53 was absent in all but 1 of the cystadenomas, was expressed in 9 of 40 (22.5%) borderline tumors (25.8% of serous and 11% of mucinous), and in 10 of 18 (55%) carcinomas. All 11 implants of serous borderline tumors expressed p21WAF1/CIP1. Most serous borderline tumors expressed higher levels of MDM2 compared with the benign cystadenomas and carcinomas. Four of the serous borderline implants (40%) expressed MDM2. Coexpression of p21WAF1/CIP1 and MDM2 characterizes serous borderline tumors of the ovary and their implants, which suggests that these cell cycle control proteins are important in these tumors and may be related to tumor progression. Low expression of p53 protein in serous borderline tumors might be in part mediated by MDM2. This suggests that the p53 pathway is intact in most of these tumors, in contrast with carcinomas, in which high expression of p53 has been related to mutations of this gene.

Biomarkers, Tumor↗
PubMed1985

Vascular hypertrophy in borderline hypertension: relationship to blood pressure and sympathetic drive.

While borderline hypertension increases the chance for cardiovascular disease, most with borderline hypertension will not experience problems. Thus, the risk of intervening probably outweighs benefit for the majority. However, those with target organ damage are probably at higher risk and might benefit from more aggressive management. Therefore, we assessed vascular hypertrophy and average home blood pressures in patients with borderline hypertension which might be of value in therapeutic planning. Minimum forearm vascular resistance (mFAVR) was used as an index of vascular hypertrophy. Comparing ten normotensive controls to twenty individuals with borderline hypertension revealed a significant difference in mFAVR (1.7 +/- 0.06 vs 2.1 +/- 0.1, p less than .05). There were obvious differences in blood pressure between normotensives and borderlines which contributed to differences in mFAVR. However, within the group with borderline hypertension, no relationship was apparent between mean blood pressure and mFAVR, r = 0.13, NS. Among the borderline hypertensives, baseline plasma norepinephrine correlated with mFAVR, r = 0.48, p less than .05, suggesting that the sympathetic nervous system contributes to vascular hypertrophy in this group. In a separate group of individuals with nine normotensives and nine borderline hypertensives we wished to find if average home blood pressure would correlate better with mFAVR than a single laboratory measurement. While both the home (r = 0.56, p less than .05) and laboratory (r = 0.66, p less than .01) MBP correlated significantly with mFAVR, the data did not confirm the hypothesis that the average home blood pressures would better predict the degree of vascular hypertrophy. These data show that a substantial proportion of patients with borderline hypertension have evidence for vascular hypertrophy, sympathetic drive might contribute to vascular hypertrophy in borderline hypertension, average home blood pressures did not aid in separating those with and without evidence for vascular hypertrophy.

Adult↗
PubMed1993

Borderline and invasive epithelial ovarian tumors in young women.

OBJECTIVE: To review the occurrence, morbidity, and mortality of borderline and invasive epithelial ovarian tumors in young women. METHODS: We conducted a 15-year retrospective review of the case records of the Women's Cancer Center, University of Minnesota, and the JL McKelvey Tumor Registry. RESULTS: We identified 67 patients under age 40 with borderline or invasive epithelial ovarian tumors. Fifty patients (75%) had borderline tumors and 17 (25%) had invasive tumors. The mean age at presentation was 31 years (range 14-39) for the borderline group and 34 years (range 23-39) for the invasive group. Pelvic pain and a palpable mass, present for less than 6 months, were the predominant presenting symptom and sign. There was no difference in the age at menarche between the patients with borderline (mean 12 years) and invasive tumors (mean 13 years). Fifty-seven patients were optimally cytoreduced to less than 2.0 cm after primary surgery. Thirty-five patients underwent second-look laparotomy, 15 of which were positive for tumor. A minority of patients in both groups had stage I tumors (17 in the borderline and one in the invasive group). Among patients with borderline tumors, there was no difference between "very young" and "young" patients in the stage at presentation or outcome. Similar proportions of patients presented with early- and late-stage disease. Three very young women (14%) and five young women (17%) have died. Among patients with invasive tumors, no difference existed between young and very young patients for stage at presentation, whereas grade and outcome differed significantly between the age groups (P < .05). Very young patients were more likely to present with grade 1 lesions, whereas patients aged 30-40 years were more likely to have grade 2 or 3 tumors (P < .05). Three (100%) of the very young patients have died, whereas seven (50%) of the young patients aged 30-40 years have died. The median survival of patients with borderline tumors was 36 months (range 2.0-150.5), significantly different from those with invasive tumors, whose median survival was 21 months (range 2.9-89.7) (P < .001). CONCLUSION: Borderline and invasive epithelial ovarian tumors are encountered in young women. Despite the implication of the term "borderline," such tumors are associated with considerable morbidity and mortality.

Adolescent↗
PubMed1985

Depression in borderline patients: a prospective EEG sleep study.

The relationship between borderline personality disorder and primary major depression was studied prospectively using Schedule for Affective Disorders and Schizophrenia-Lifetime Version (SADS-L) interviews and electroencephalographic (EEG) sleep studies. Ten consecutively admitted borderline patients (a prospective sample), defined by Gunderson's Diagnostic Interview for Borderlines (DIB), underwent EEG sleep studies on two consecutive nights and were compared to previously reported samples of nonborderline depressed patients (defined by Research Diagnostic Criteria; RDC), normal controls, and DIB-defined borderline patients who had been referred "to rule out major depression" (a retrospective sample). EEG sleep data were analyzed visually and by automated techniques. Rapid eye movement (REM) latency values were similar in depressed and both borderline groups but significantly different from controls. Eighty-five percent of REM latency values in RDC major depressives were less than or equal to 65 minutes, compared to similar rates of 75% in the prospective sample of borderline patients and 65% in the retrospective sample, versus 35% for controls (chi 2 = 10.7, p less than 0.005). The REM latency in borderline patients did not vary with the severity of depression as measured by the Hamilton Rating Scale for Depression. In the prospective borderline sample, the major SADS-L diagnoses were chronic intermittent depression (five), current major depression (four) (two unipolar, two bipolar II), and labile personality (one). A convergence of nosologic and EEG sleep data is suggested, and supports the concept of a close relationship between criteria-defined borderline personality disorder and affective illness.

Adolescent↗
PubMedDate not supplied

[Relations between anxious, depressive and borderline symptomatology and frequency of cannabis use and dependence].

The aims of this paper is to study the relations between anxious, depressive and borderline symptomatology and cannabis use and dependence in adolescents and young adults. A convenient sample of 212 subjects composed of high-school and college students from Toulouse, France (85 boys, 127 girls; mean age=18.3 1.8 Years) completed questionnaires assessing the patterns of cannabis use, age of first use, the symptoms of dependence using a questionnaire derived from the Mini International Neuropsychiatric Interview, and the anxious, depressive and borderline symptomatology using the STAI-YA (State-Trait Anxiety Inventory; Spielberger et al., 1970), the CES-D (Center for Epidemiological Studies-Depression scale; Radloff, 1977) and the BPI (Borderline Personality Inventory; Leichsenring, 1999), respectively; 54% of subjects reported having used cannabis once during the last 6 Months (45.3% of girls and 66.6% of boys, p=0.002). Frequency of use was higher in boys: eg, 61% of boys used cannabis at least almost daily versus 31% of girls (p<0.00001). Age of first use was lower in boys than in girls (14.6 2.6 versus 15.7 2.3, t=- 2.46, p=0.02). Length of use was higher in boys than in girls (3.9 2.2 versus 3 1.6, t=2.2, p=0.03). Among users, near of 64% of boys and 36% of girls met the criteria for cannabis dependence (p=0.003). BPI, CES-D and STAI-YA scores were compared between non-users and users and between non-dependent and dependent users: the only significant differences were that BPI scores were higher in users versus non-users and in dependent users versus non-dependent users; CES-D and STAI-YA scores did not distinguished users from non-users and dependent users from non-dependent users. BPI and CES-D scores were correlated with the length of cannabis use (Pearson r=0.19 and r=0.19, respectively, p<0.05). In a multiple regression analysis predicting the frequency of cannabis use, we entered age, sex, CES-D, STAI-YA and BPI scores. This model accounted for 23% of the variance of the frequency of use (F5,206=14.4, p<0.0001). Sex, age, and BPI scores were significant predictors (b=- 0.31, t=- 5.03, p<0.0001; b=0.29, t=4.87, p<0.0001, b=0.27, t=3.80, p<0.0001, respectively). CES-D scores were a nearly significant predictor (b=- 0.17, t=- 1.96, p=0.051). STAI-YA scores were not a significant predictor (b=0.11, t=1.29, p=0.20). In a multiple regression analysis predicting the dependence scores, we entered age, sex, frequency of use, CES-D, STAI-YA and BPI scores. This model accounted for 41% of the variance of the dependence score (F6,107=12.6, p=0.005). Frequency of use and BPI scores were significant predictors (b=0.51, t=6.12, p<0.0001; b=0.26, t=2.86, p=0.005, respectively). Age, sex, CES-D and STAI-YA scores were not significant predictors (b=- 1.04, t=- 1.32, p=0.19; b=0.008, t=0.09, p=0.92; b=0.16, t=1.53, p=0.12; b=- 0.14, t=- 1.46, p=0.15, respectively). The frequency of use and dependence observed in this study confirm the results obtained in epidemiological studies of use and dependence in France. The high frequency of daily or almost daily users suggests that a high proportion of subjects were "high" while completing the questionnaires. This is a confounding variable now inevitable in epidemiological studies of cannabis use given the high proportion of daily users. The consequence may be that responses to mood questionnaire express both the acute effect of cannabis consumption and the chronic effect that might be different: the acute euphoriant effect of cannabis may mask a chronic depressive symptomatology induced by chronic cannabis consumption. The antidepressant and anti-anxiety acute effect of cannabis may explain that CES-D and STAI-YA scores did not distinguished users from non-users and dependent users from non-dependent users. The correlation between length of use and CES-D scores may reveal the depressant chronic effect of long-term use. The correlation between length of use and BPI scores suggest that long-term cannabis use induces an increase in borderline symptomatology. Results of the regression analyses suggest that the borderline symptomatology is highly linked to frequency of use and cannabis dependence. This may be due to the increase in borderline symptomatology induced by both acute and chronic effects of cannabis. The relation between cannabis use and dependence on one hand and anxious and depressive symptomatology on the other hand may have been obscured by the acute mood effect of cannabis consumption. Borderline symptomatology appeared to be highly linked to cannabis use and dependence in adolescents and young adults. Borderline personality disorder in adolescents is not the only risk factor for cannabis use and dependence in adolescents: borderline symptomatology even at a subclinical level seems to be a higher risk factor than anxious or depressive symptomatology. The frequency of daily or almost daily users may be a confounding variable for the study of relations between anxiety and depressive disorders in adolescents and young adults.

Adolescent↗
PubMed1998

The relationship of suicide attempts, borderline personality traits, and major depressive disorder in a veteran outpatient population.

BACKGROUND: Suicide attempts have been associated to both Major Depression and Borderline Personality Disorder. This report hypothesized that there would be significant clinical differences between psychiatric outpatients with Major Depression, Major Depression with a history of a suicide attempt (but low Borderline traits) and Major Depression high levels of Borderline personality traits. METHODS: Male psychiatric outpatients who had Major Depression were divided into three groups: No suicide attempts and low Borderline traits (Depression), suicide and low Borderline traits (Suicide) and high Borderline traits (Borderline traits.) A screened control group was also used (Controls). Standardized measures of Axis I and Axis II variables were gathered by trained interviewers. RESULTS: "Suicide" had significantly higher levels of anxiety and depression than all other groups. "Borderline traits" had higher levels of pathological personality traits and familial Generalized Anxiety Disorder (GAD) than all other groups. CONCLUSIONS AND CLINICAL RELEVANCE: The Suicide group appears to identify a group that is more symptomatically severe in Axis I symptoms than other Major Depression groups. Different Major Depression groups may require different treatments. The association between Borderline and GAD warrants further research. LIMITATIONS: This study used male veterans in middle age. The usual cautions about generalizing findings to other demographic groups apply.

Adult↗
PubMed2002

Diagnostic efficiency of borderline personality disorder criteria in hospitalized adolescents: comparison with hospitalized adults.

OBJECTIVE: The authors examined the diagnostic efficiency of borderline personality disorder criteria in adolescent inpatients. For comparison, diagnostic efficiency of borderline personality disorder criteria was also examined in a group of concurrently recruited adult inpatients. METHOD: Adolescents (N=123) and adults (N=106) were reliably assessed with the Personality Disorder Examination, a semistructured diagnostic interview for DSM-III-R personality disorders. Sixty-five adolescents and 50 adults met diagnostic criteria for borderline personality disorder. Conditional probabilities were calculated to determine which borderline personality disorder criteria were most efficient as inclusion criteria and as exclusion criteria. Adolescents and adults were analyzed separately, and the results were compared. RESULTS: There were no significant differences between groups with regard to the base rates of the borderline personality disorder diagnosis nor for any borderline personality disorder criterion. The best inclusion criterion for the adolescents was abandonment fears, though for the adults all symptoms were approximately equivalent in this regard. The most efficient exclusion criterion was uncontrolled anger for the adolescents and impulsiveness for the adults. CONCLUSIONS: In hospitalized patients, borderline personality disorder and its symptoms appear to be as frequent for adolescents as for adults. Despite these surface similarities between groups with respect to symptom patterns, several differences were found at the level of the diagnostic efficiency for individual borderline personality disorder criteria. These differences may shed light on the nature of borderline psychopathology during adolescence.

Adolescent↗
PubMed2004

Clinical outcome of ECT in patients with major depression and comorbid borderline personality disorder.

OBJECTIVE: Previous research suggests that the comorbidity of major depression with a personality disorder, especially borderline personality disorder, is associated with a poorer response to ECT. The authors compared the acute outcome of ECT in depressed patients with borderline personality disorder, with personality disorders other than borderline personality disorder, and with no personality disorder. METHOD: The study subjects were 139 patients with a primary diagnosis of unipolar major depression and scores of at least 20 on the 24-item Hamilton Depression Rating Scale. Patients were treated with suprathreshold right unilateral or bilateral ECT in a standardized manner and were assessed with the Hamilton depression scale within 3 days and 4-8 days after completing ECT. RESULTS: Compared to patients with personality disorders other than borderline personality disorder (N=42) and those with no personality disorder (N=77), patients with borderline personality disorder (N=20) had less symptomatic improvement assessed up to 8 days after ECT. Patients with personality disorders other than borderline personality disorder responded as well to ECT as those with no personality disorder. Borderline personality disorder patients were more likely to be female and to have medication-resistant depression than the patients in the two comparison groups; they were also younger. However, none of these differences accounted for the borderline personality disorder patients' poorer response to ECT. CONCLUSIONS: Patients with borderline personality disorder have a poorer acute response to ECT, but explanations for this finding remain elusive.

Adult↗