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PubMed1985

Prognostic indicators in the psychotherapy of borderline patients.

Although diagnostic and therapeutic difficulties, including countertransference problems, in borderline patients make prognostic estimates hazardous, practical necessity often requires a prognostic judgment regarding treatability. This paper proposes a list of prognostic indicators in borderline patients which may be useful to the psychotherapist in the evaluation of treatability. Unfavorable prognostic indicators include history of brutalized early environment, severe behavior problems in childhood, antisocial behavior, addictions, egosyntonicity, superficial or highly disturbed relationships, marked narcissistic features, injurious social environment; and, in the course of therapy, strong negative reaction of the therapist toward the patient, and antisocial acting out. Suggesting a more favorable prognosis for psychotherapy are: nonspecific personality traits which may promote the therapeutic relationship (likeableness, warmth, reliability, or interest in people), and intact sublimatory outlets (talents, skills). In general, the quality of object relations, especially the therapist-patient relationship, including the countertransference, is crucial to prognosis. The unfavorable prognostic implications of certain atypical forms of anxiety, depression, and dependency, as well as anhedonia and abulia, are discussed. Borderline patients with infantile features probably have better prognosis than is generally recognized; with narcissistic features, a worse prognosis than generally recognized.

Adult↗
PubMed1989

Update on psychodynamic thinking regarding the diagnosis of the borderline patient.

An ego-psychological diagnostic approach to the borderline patient has been presented and detailed in previous publications. This paper modifies and expands this approach, providing a new, up-to-date model. This new model tries to accomplish the somewhat contradictory tasks of: (1) providing a current generally accepted psychodynamic framework, and (2) being more compatible with DSM-III-R. Both historical and current concepts of the borderline patient are reviewed and related to this new model. The concept of the borderline patient as someone with a specific structural configuration, to be differentiated from the normal-neurotic, the narcissistic, and the psychotic configurations, is retained.

Borderline Personality Disorder↗
PubMed1990

Dilemmas in the management of suicidal behavior in individuals with borderline personality disorder.

Managing suicidal behavior of individuals with borderline personality disorder presents both therapeutic and ethical/legal dilemmas. It is argued in this paper that clinicians treating borderline individuals need to carefully discriminate "acute" from "chronic" suicidal states. For "acute" suicidal situations, traditional management approaches are appropriate. However, for "chronic" situations, common among borderline individuals, traditional management approaches may be therapeutically counterproductive. A number of proposals for managing chronic suicidal behavior are reviewed. Unfortunately, current ethical standards and laws have evolved from considering suicide in an "acute" context and are insensitive to the "chronic" situation. Recommendations are made for clinicians to effectively manage chronic suicidal behaviors within present ethical and legal guidelines, and some suggestions for legal reform are offered.

Borderline Personality Disorder↗
PubMed1986

Descriptive, biological, and theoretical aspects of borderline personality disorder.

Although the diagnosis of borderline personality disorder has reasonable interrater and test-retest reliability, its discriminative validity is poor. The authors review studies indicating that the patient group subsumed by the borderline category actually includes those with various affective, organic, and schizotypal disorders. They speculate that borderline personality disorder represents a broad range of affective disorders resulting in part from childhood object loss, which may impair the reinforcement mechanisms necessary for the development of competent object relations.

Animals↗
PubMed1989

Clinicians' experiences in combining medication and psychotherapy in the treatment of borderline patients.

Combining pharmacotherapy and psychotherapy in the treatment of borderline personality disorder is increasingly common, yet the experiences of clinicians who use the two modalities have not been studied. Forty psychotherapists were surveyed about their prescribing practices with borderline patients. Results corroborate the clinical impression that therapists' decisions about medication use are influenced by psychosocial factors as well as by target symptoms. Therapists were most likely to prescribe medications when they felt pessimistic about patients' capacity to benefit from psychotherapy and were rarely willing to prescribe medications for patients who had a history of substance abuse or suicide attempts. An average of 47 percent of the borderline patients in the therapists' practices misused prescription medications. Patients were most likely to abuse medications after experiencing an interpersonal loss or failure.

Adult↗
PubMed1990

The effect of borderline personality disorder on the hospital course of affective illness.

Two groups of patients with affective disorders, one group with a coexistent axis II diagnosis of borderline personality disorder and one group without, were compared to determine if the presence of borderline personality disorder affects the hospital course of patients with affective illness. Response to hospital treatment was assessed using standard psychiatric rating scales administered at admission, after one week of hospitalization, and before discharge. Although the patients with borderline personality disorder were more severely impaired than the comparison group, they were as likely as patients without the disorder to improve over the course of hospitalization.

Adult↗
PubMed1991

Epidemiology of borderline personality disorder.

The limited epidemiological data available on borderline personality disorder suggest that the prevalence of the disorder is between .2 and 1.8 percent in the general community, 15 percent among psychiatric inpatients, and 50 percent among psychiatric inpatients with a diagnosis of personality disorder. No data on the incidence--the rate of new cases--of the disorder have been reported, and inferences about incidence based on prevalence rates are complicated by differences in the formal designation of personality disorders before and after DSM-III was issued. Current findings suggest that about 76 percent of borderline patients are female. Epidemiological study of borderline personality disorder has been hindered by the lack of a brief semistructured interview that can be used with large population samples and that does not require substantial clinical expertise. The authors discuss alternative research methods, including use of lay interviewers, recoding of existing data, telephone interviews, and self-report inventories.

Borderline Personality Disorder↗
PubMed1991

Standardized approaches to individual psychotherapy of patients with borderline personality disorder.

Recent developments in individual psychotherapy for patients with borderline personality disorder include psychodynamic, interpersonal, behavioral, and cognitive treatments. The author provides an overview of standardized treatment approaches--that is, modes of treatment that have a clear theoretical rationale and specific strategies and techniques--for borderline personality disorder. Evaluations of the efficacy of these approaches are discussed. Although there is little empirically based knowledge about the effectiveness of these treatments, their adaptation for the specific treatment of borderline personality disorder represents an important step for treatment and research in this area.

Behavior Therapy↗
PubMed1996

Increasing staff knowledge of and improving attitudes toward patients with borderline personality disorder.

This study examined the effect of a self-instructional program on nurses' knowledge of and attitudes and behavioral intentions toward patients with borderline personality disorder. The sample consisted of registered nurses working on inpatient psychiatric units of general hospitals: 19 in the experimental group and 13 in the control group. The Questionnaire on Borderline Personality Disorder was administered before and after nurses completed the program. Significant postintervention differences in knowledge of and attitudes toward patients with the disorder were found between the experimental group and the control group. Self-instruction may improve nurses' care of patients with borderline personality disorder.

Adult↗
PubMed1986

A preliminary report on defenses and conflicts associated with borderline personality disorder.

The authors present preliminary psychodynamic findings from a naturalistic study of borderline personality disorder compared to antisocial personality disorder and bipolar type II (depression with hypomania) affective disorder. An independent psychodynamic interview of each subject was videotaped from which ratings were made of the presence of 22 defense mechanisms and 11 psychodynamic conflicts. A factor analysis of ratings from 81 subjects supported the separation of borderline (splitting, projective identification) from narcissistic defenses (devaluation, omnipotence, idealization, mood-incongruent denial). While certain groups of defenses were associated with each diagnosis, defense ratings did not significantly discriminate the three diagnostic groups, suggesting a limit to their diagnostic value. Among 27 subjects rated, borderline personality was strongly associated with two conflicts: separation-abandonment, and a global conflict over the experience and expression of emotional needs and anger. Antisocial personality was psychodynamically distinct and more heterogeneous. Bipolar type II was associated with two hypothesized depressive conflicts: dominant other and dominant goal. Chronic depression, which was more common in both personality disorder groups than in bipolar type II, was associated with a third depressive conflict, overall gratification inhibition. Overall, conflicts were powerful discriminators of the three diagnostic groups. The heuristic value of these findings is discussed.

Adult↗
PubMed1988

The effect of therapist interventions on the therapeutic alliance with borderline patients.

The authors draw attention to the problems of establishing and maintaining a therapeutic alliance in the psychotherapy of the borderline patient. They elaborate an extensive methodology designed to study the manner in which shifts in collaboration occur in response to therapist interventions. This report demonstrates how one particular borderline patient increased his ability to collaborate with the therapist in response to a transference focus in the psychotherapy. Methodological problems are noted as are directions for future research. Only a series of patients studied with this or with similar methodology will allow for a sophisticated and empirical rationale for choosing a particular form of psychotherapy for a particular kind of borderline patient.

Adult↗
PubMed1991

New uses of countertransference for the inpatient treatment of borderline personality disorder.

The author describes the uses of countertransference for the inpatient treatment of borderline personality disorder. Differences from usage in the dyadic outpatient situation are noted. In particular, the countertransference induced in staff may provide a crucial signal function reflecting the patient-ward system. Understanding these feelings provides information not only about the patient's inner world but also about general system features such as the staff's needs, therapeutic capacity and unresolved feelings from previous borderline patients. The signal function may also have diagnostic and treatment implications. A conceptualization of countertransference that encompasses the unique system aspects of inpatient psychiatry is helpful in the care of borderline patients.

Ambulatory Care↗
PubMed1993

Life events in borderline personality disorder.

In order to examine the role of life events in the clinical presentation of borderline personality disorder, the Life Experience Survey was given to three groups of subjects; one consisting of patients suffering from borderline personality disorder and two consisting of control subjects for the purpose of comparison. The results showed that patients suffering from borderline personality disorder did not experience a greater number of life events, but those life events that they did report were related to their psychopathology, which were, in turn, associated with the break-ups of important relationships or with effects of impulsive actions.

Adult↗
PubMed1994

Psychological risk factors for dissociation and self-mutilation in female patients with borderline personality disorder.

The purposes of this study were to determine whether or not dissociation in female patients suffering from personality disorder is related to sexual and physical abuse or to abuse parameters and whether or not self-mutilation in the personality disorders is related to psychological risk factors or to dissociation. The sample was divided into 78 borderline and 72 nonborderline personality disorders. Psychological risk factors were measured through histories of childhood sexual abuse, physical abuse and separation or loss as well as scores on the Parental Bonding Index. Dissociation was measured by the Dissociative Experiences Scale. On the diagnostic interview, 48 subjects scored positive for self-mutilation. Dissociative Experiences Scale scores were associated with a borderline diagnosis but not with childhood sexual abuse or physical abuse. The parameters of abuse were not related to dissociation. Subjects who mutilated themselves had higher rates of both childhood sexual abuse and dissociation in univariate analyses. However, in multivariate analyses only diagnosis was significant. None of the other psychological risk factors were significantly linked to self-mutilation. The findings do not support theories that dissociation and self-mutilation in borderline personality disorder are associated with childhood trauma.

Adult↗
PubMed1996

Psychopathology in offspring of mothers with borderline personality disorder: a pilot study.

OBJECTIVE: Children of mothers with borderline personality disorder (BPD) were hypothesized to be at greater risk for psychopathology, particularly impulse spectrum disorders, than children of mothers with other personality disorders. METHOD: Twenty-one index children were compared with 23 children of mothers with a nonborderline personality disorder. Diagnoses were obtained using the Kiddie Schedule for Affective Disorders and Schizophrenia-Episodic Version (KSADS-E) and the Child Diagnostic Interview for BPD (CDIB), and functioning was rated with the Child Global Assessment Schedule (CGAS). Physical, sexual, and verbal abuse, as well as family violence and placements, were also assessed. RESULTS: The children of the borderline mothers, as compared with controls, had more psychiatric diagnoses, more impulse control disorders, a higher frequency of child BPD, and lower CGAS scores. There were no differences between the groups for trauma. CONCLUSION: The offspring of borderline mothers are at high risk for psychopathology.

Adolescent↗
PubMed1984

Comparison of borderline personality subcategories to schizophrenic and affective disorders.

This clinical research report identified 4 subcategories of the hospitalized borderline personality disorder: developmental, affective disorder, attentional deficit/learning disabled, and organic. Developmental and affective disorder subcategories are predominantly composed of females, while males are overly represented in the attentional deficit/learning disabilities subcategory . Comparison of the borderline patients with schizophrenic and affective disorder control groups supports the hypothesis that the borderline personality disorder is a diagnostic entity distinct from schizophrenia, but perhaps not from affective disorders.

Borderline Personality Disorder↗
PubMed1993

Sexual abuse and eating disorders. Borderline personality disorder as a mediating factor?

Sexual abuse appears to be causally linked to eating disorders, particularly those involving bulimic features. However, the psychological factors that mediate between these two phenomena are not understood. Recent findings suggest that borderline personality disorder may explain some of the association. The present research investigates the potential links between reported sexual abuse, borderline personality disorder, and eating psychopathology in a case series of 100 women with eating disorders. The results suggest that borderline personality disorder is a psychological factor that explains a small part of the causal link between sexual abuse and bulimic behaviour--especially frequency of bingeing. However, other factors are likely to be involved, and further research is suggested to investigate these.

Adult↗