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PubMed2003

A screening measure for BPD: the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD).

Borderline personality disorder (BPD) is a common psychiatric disorder that is often overlooked in treatment settings. This report describes the validation of a new self-report screening measure for DSM-IV BPD--the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD). Two hundred subjects with treatment histories whose ages ranged from 18 to 59 filled out the MSI-BPD. Each subject was then interviewed, blind to MSI-BPD results, with the BPD module of the Diagnostic Interview for DSM-IV Personality Disorders (DIPD-IV; Zanarini, Frankenburg, Sickel, & Yong, 1996). Of these 200 subjects, 139 (69.5%) met DSM-IV criteria for BPD as assessed by the BPD module of the DIPD-IV and the remaining 61 subjects (30.5%) did not. Using logistic regression analyses, an MSI-BPD cutoff of 7 or more of the measure's 10 items was judged to be the best cutoff. This was so because it yielded both good sensitivity (.81; percentage of correctly identified cases) and specificity (.85; percentage of correctly identified noncases) for the diagnosis of DSM-IV BPD. For younger subjects, diagnostic efficiency was even greater. For example, sensitivity was .90 and specificity was .93 at a cutoff of 7 for the 63 subjects who were 25 years old or younger. The results of this study suggest that the MSI-BPD may be a useful screening instrument for the presence of DSM-IV borderline personality disorder.

Adolescent↗
PubMed2004

The contribution of cognitive analytic therapy to the treatment of borderline personality disorder.

This article describes ways the theory and practice of cognitive analytic therapy (CAT) can contribute to the treatment and management of patients with borderline personality disorder (BPD). CAT, as its name suggests, was derived initially from an integration of conventionally opposed models. From the beginning, it was delivered within a limited timeframe, usually of 16 weekly sessions, extended to 24 in the case of more disturbed patients. Over time, on the basis of clinical experience, conceptual debate, and research, it has evolved into a general theory and has demonstrated itself to be of value over a wide range of conditions and contexts. The evolution of the basic theory and practice of CAT over the past 25 years is summarized, followed by a description of the theoretical developments concerned specifically with BPD. The techniques used in the individual psychotherapy of borderline patients are described in detail and illustrated with case material. The application of methods and understandings derived from individual therapy to staff supervision and the treatment and management of patients in day hospitals, therapeutic communities, and community mental health centers is then considered. A final section describes research contributions to the development and evaluation of CAT with borderline patients.

Adaptation, Psychological↗
PubMed2006

A randomized controlled trial of cognitive behavior therapy for borderline personality disorder: rationale for trial, method, and description of sample.

This paper describes the rationale for a randomized controlled trial, comparing cognitive behavior therapy in addition to treatment as usual with treatment as usual alone, for borderline personality disorder. Previous pioneering randomized controlled trials of psychotherapies have suffered from methodological weaknesses and have not always been reported clearly to allow adequate evaluation of either the individual study or comparisons across studies to be undertaken. We report on the recruitment and randomization, design, and conduct of an ongoing randomized controlled trial of one hundred and six patients with borderline personality disorder. Primary and secondary hypotheses and their planned analyses are stated. The baseline characteristics of 106 patients meeting diagnostic criteria for borderline personality disorder are described.

Adult↗
PubMed2006

The cost-effectiveness of cognitive behavior therapy for borderline personality disorder: results from the BOSCOT trial.

Borderline personality disorder places a significant burden on healthcare providers and other agencies. This study evaluated the cost-effectiveness of cognitive behavior therapy plus treatment as usual compared to treatment as usual alone for patients with borderline personality disorder. The economic analysis was conducted alongside a multi-center, randomized controlled trial. The costs of primary and secondary healthcare utilization, alongside the wider economic costs, were estimated from medical records and patient self-report. The primary outcome measure used was the quality-adjusted life year (QALY), assessed using EuroQol. On average, total costs per patient in the cognitive behavior therapy group were lower than patients receiving usual care alone (-689 pounds sterling), although this group also reported a lower quality of life (-0.11 QALYs). These differences were small and did not approach conventional levels of statistical significance. The use of cognitive therapy for borderline personality disorder does not appear to demonstrate any significant cost-effective advantage based on the results of this study.

Adult↗
PubMed2006

Disturbed sense of identity in borderline personality disorder.

Traditionally, personal identity is considered to be important for psychological health and adaptive functioning. Identity diffusion and other more severe forms of disturbance associated with personal identity are regarded as being essential parts of the borderline personality disorder. Moreover, disturbances in identity are seen as being part of the dynamic background for many of the symptoms and maladaptive behaviors found in borderline patients. It is argued, that the development of personal identity is intimately related to, and indeed dependent on, elements of modern culture, with significant cultural changes having affected the conditions under which human identity develops. Therefore, the identity diffusion seen in patients with borderline disorders must be understood in relation to not only the individual patient's personal history and inner structures but also contemporary late modern culture and social organization.

Borderline Personality Disorder↗
PubMedDate not supplied

Symptoms and EEG findings in the borderline syndrome.

Symptomatology and electroencephalographic abnormalities were examined in thirty-nine individuals with borderline personality disorder, compared with twenty unipolar depressed patients. Borderline individuals showed a much higher incidence of symptoms commonly seen in complex partial seizures or episodic dyscontrol, and in addition had a much higher incidence of EEG abnormalities, particularly posterior sharp activity. These findings suggest that neurophysiological dysfunction may contribute to the borderline syndrome.

Adolescent↗
PubMed1986

On the consistency of the MMPI in borderline personality disorder.

14 patients diagnosed as having Borderline Personality Disorder were examined on two separate occasions with the MMPI. Results strongly suggest that, as a group, borderline patients are quite consistent responders on the MMPI under test-retest conditions (1 to 58 mo.). The frequency distribution of scale elevations and code types was also examined which showed the often-noted heterogeneity of profile code types within this population. Thus, a note of caution is advised for those investigators who assume that a prototypical borderline MMPI profile exists. Specifically, considerable heterogeneity is seen among this sample of patients with respect to a two-point coding strategy, and individual codes change over time.

Adult↗
PubMed1997

Color preferences of borderline patients and of normal controls.

20 female patients who met the DSM-III-R criteria for the diagnosis of borderline personality disorder and 23 normal female controls were asked to rank-order eight Lüscher color cards, at first with no specific use for the colors mentioned, then as a color for their own dress or jacket, then for their living room, and then as a color they would like their friend to wear. Very few statistically significant differences (p < .01, 2-tailed) between the groups were found. Borderline patients ranked more favourably than controls the use of black color for their living room (Pearson r = .51) and were less likely to favour grey color for this purpose (r = -.45). When no specific use for colors was mentioned, the borderline patients ranked red more favourably than the control group (r = .47). Within the normal control group, statistically significant differences between the ranks of the same color were noted depending on the particular use of the particular color.

Adolescent↗
PubMed1996

Bedside stuffed animals and borderline personality.

We explored the relationship between psychiatric diagnosis and the presence of stuffed animals at the bedside in a population of adult female psychiatric inpatients. One of the authors made approximately weekly surveys of the wardrooms of adult psychiatric inpatients over twelve months for the presence of displayed stuffed animals. The observer was blind to the diagnosis of 80% of the patients, and the study or its hypothesis was not known to other physicians. The discharge diagnoses of patients displaying stuffed animals were recorded and compared with those of the ward population in general. Among 36 female patients who displayed stuffed animals in their rooms, Borderline Personality Disorder was diagnosed in 22 (61%) of these patients. Of 447 adult female patients admitted to the same unit over the same period, only 17% were noted to be diagnosed Borderline Personality Disorder. Stuffed animals as a bedside clinical clue may suggest evaluation for Borderline Personality Disorder.

Adolescent↗
PubMed1995

Long-term psychotherapy in borderline and narcissistic disorders: when is it necessary?

OBJECTIVES: This paper explores the barriers and impediments to psychological change in those patients with borderline and narcissistic character pathology requiring long-term psychotherapeutic treatment. METHOD: Examination of the relevant literature was made and the author's clinical experience included. RESULTS: Those patients with borderline and narcissistic character pathology requiring long-term psychotherapeutic treatment to achieve lasting psychological change are characterised by their experience of severe early developmental trauma. This has resulted in the formation of entrenched adverse relational patterns which are unconscious, difficult to bring into consciousness and slow to change. These patients have failed to establish security of attachment patterns in the course of a depriving and/or traumatic childhood, often in the care of parents with similar character pathology. Such patients will often require a therapeutic relationship with an emotionally responsive therapist sustained over time within a secure therapy frame to achieve lasting psychological change. CONCLUSIONS: Patients with borderline and narcissistic pathology who have sustained severe early developmental trauma will often require long-term psychotherapeutic treatment to achieve lasting psychological change. Such treatment is necessary for the relief of suffering in the patients, and may contribute to the alleviation or prevention of the intergenerational transmission of these disorders.

Borderline Personality Disorder↗
PubMedDate not supplied

Treatment implications of past trauma in borderline personality disorder.

Recent research and clinical experience have shown childhood trauma to be common in the histories of patients with borderline personality disorder. This article reviews the association between borderline personality disorder and early trauma, and how an awareness of the role of trauma may improve the treatment of patients with this disorder. Particularly when early trauma is in the form of childhood abuse, clinicians may be better able to understand the difficulties these patients experience in relational skills, affect tolerance, behavioral control, self-identity, and self-worth. Clinicians may be able to facilitate a stronger therapeutic alliance through acknowledgement of the patient's victimization and empathy with the effects of early trauma on the patient's life. Reframing the patient's experience as a consequence of childhood trauma is essential, especially when making traditional interventions such as interpretation and confrontation. The role of trauma in the development of borderline personality disorder suggests the need for modification of models of individual, family, and group psychotherapies that may allow more productive and successful treatment.

Abreaction↗
PubMed1999

Clozapine reduces severe self-mutilation and aggression in psychotic patients with borderline personality disorder.

BACKGROUND: Clozapine has been reported to be effective in diminishing violence toward others in psychotic patients. This article describes the impact of clozapine on severe self-mutilation among patients with the dual diagnoses of borderline personality disorder and persistent psychoses. METHOD: Seven subjects known to the authors were selected for careful chart audits. These subjects had been admitted to 2 state psychiatric hospitals owing to severe self-mutilation and/or violence and subsequently treated with clozapine. A mirror-image design anchored to the start date of clozapine treatment and extending in either direction to a maximum of 1 year was used to extract data. Data extracted included incidents of self-mutilation (restraint), seclusion, the as and when needed (p.r.n.) use of medications, injuries to staff and peers, hospital privileges, and Global Assessment of Functioning (GAF) scores. RESULTS: The subjects were all white women with a mean age of 37 years. All subjects carried DSM-III-R or DSM-IV borderline personality disorder diagnoses and an Axis I disorder diagnosis. They had received trials of several psychotropic agents, often in combination and mostly without benefit. After clozapine treatment, there were statistically significant reductions in incidents of self-mutilation (restraint), seclusion, the use of p.r.n. antianxiety medications, and injuries to staff and peers. These subjects received higher levels of hospital privileges, and their GAF scores nearly doubled following clozapine treatment. Four subjects were subsequently discharged from hospital. CONCLUSION: These preliminary but nonetheless favorable results suggest that clozapine deserves careful consideration for a controlled study in patients with borderline personality disorder and psychoses, especially if the clinical issues include severe self-mutilation, aggression, and violence. Until such studies are done, the risk-to-benefit ratio of clozapine treatment needs to be carefully evaluated on an individualized basis in such subjects.

Adult↗
PubMed2001

A preliminary double-blind, placebo-controlled trial of divalproex sodium in borderline personality disorder.

BACKGROUND: Borderline personality disorder is characterized by affective instability, impulsivity, and aggression and is associated with considerable morbidity and mortality. Since anticonvulsant agents may be helpful in such symptomatology, we compared divalproex sodium with placebo in patients with borderline personality disorder. METHOD: A 10-week, parallel, double-blind design was conducted. Sixteen outpatients meeting Structured Clinical Interview for DSM-IV Axis II Personality Disorders criteria for borderline personality disorder were randomly assigned to receive placebo (N = 4) or divalproex sodium (N = 12). Change was assessed in global symptom severity (Clinical Global Impressions-Improvement Scale [CGI-I]) and functioning (Global Assessment Scale [GAS]) as well as in specific core symptoms (depression, aggression, irritability, and suicidality). RESULTS: There was significant improvement from baseline in both global measures (CGI-I and GAS) following divalproex sodium treatment. A high dropout rate precluded finding significant differences between the treatment groups in the intent-to-treat analyses, although all results were in the predicted direction. CONCLUSION: Treatment with divalproex sodium may be more effective than placebo for global symptomatology, level of functioning, aggression, and depression. Controlled trials with larger sample sizes are warranted to confirm these preliminary results.

Adolescent↗
PubMed2001

Olanzapine treatment of female borderline personality disorder patients: a double-blind, placebo-controlled pilot study.

BACKGROUND: The intent of this study was to compare the efficacy and safety of olanzapine versus placebo in the treatment of women meeting criteria for borderline personality disorder (BPD). METHOD: We conducted a double-blind, placebo-controlled study of olanzapine in 28 female subjects meeting Revised Diagnostic Interview for Borderlines and DSM-IV criteria for BPD. The subjects were randomly assigned to olanzapine or placebo in a 2:1 manner. Treatment duration was 6 months. Primary outcome measures were self-reported changes on anxiety, depression, paranoia, anger/hostility, and interpersonal sensitivity scales of the Symptom Checklist-90. RESULTS: Nineteen subjects were randomly assigned to olanzapine; 9. to placebo. When random effects regression modeling of panel data was used, controlling for baseline level of severity, olanzapine was associated with a significantly (p < .05) greater rate of improvement over time than placebo in all of the symptom areas studied except depression. Weight gain was modest in the olanzapine-treated group but was significantly higher than in those treated with placebo (p < .02). In addition, no serious movement disorders were noted. CONCLUSION: Olanzapine appears to be a safe and effective agent in the treatment of women with criteria-defined BPD, significantly affecting all 4 core areas of borderline psychopathology (i.e., affect, cognition, impulsivity, and interpersonal relationships).

Adolescent↗
PubMed2004

Clonidine in acute aversive inner tension and self-injurious behavior in female patients with borderline personality disorder.

BACKGROUND: States of strong aversive inner tension and dissociative symptoms are clinical hallmarks of borderline personality disorder and major reasons for self-injurious behavior, a severe clinical condition for which there are no established pharmacologic treatment options. METHOD: The acute effect of 75 and 150 microg of clonidine administered orally in acute states of strong aversive inner tension and urge to commit self-injurious behavior was examined in 14 female patients meeting DSM-IV criteria for borderline personality disorder. Before and 30, 60, and 120 minutes after administration of clonidine, aversive inner tension and dissociative symptoms were assessed using a self-rating instrument for aversive inner tension and dissociation (Dissociation-Tension-Scale acute), and the urge to commit self-injurious behavior and suicidal ideations were assessed using self-rating Likert scales. Blood pressure and heart rate were monitored during the trial. RESULTS: Aversive inner tension and urge to commit self-injurious behavior before administration of clonidine were strong. After administration of clonidine in both doses, aversive inner tension, dissociative symptoms, urge to commit self-injurious behavior, and suicidal ideations significantly decreased. The strongest effects were seen between 30 and 60 minutes after drug intake and correspond to the pharmacokinetics of clonidine with maximum plasma concentrations after 1 hour. Blood pressure and aversive inner tension and dissociative symptoms were positively correlated before and after administration of clonidine. CONCLUSION: Orally given clonidine may be effective for treatment of acute states of aversive inner tension, dissociative symptoms, and urge to commit self-injurious behavior in female patients with borderline personality disorder. Further placebo-controlled studies with larger populations are needed to confirm this finding.

Acute Disease↗
PubMed2004

Topiramate treatment of aggression in female borderline personality disorder patients: a double-blind, placebo-controlled study.

OBJECTIVE: The goal of this study was to compare the efficacy and safety of topiramate versus placebo in the treatment of aggression in women who meet the criteria for borderline personality disorder. METHOD: We conducted a double-blind, placebo-controlled study of topiramate in 29 female subjects (response rate 93.5%) meeting SCID (Structured Clinical Interview for DSM-IV) criteria for borderline personality disorder. The subjects were randomly assigned in a 2:1 ratio to topiramate (N = 21, analysis based on N = 19) or placebo (N = 10). Treatment lasted 8 weeks (November 2003-January 2004). Primary outcome measures were self-reported changes on the anger subscales of the State-Trait Anger Expression Inventory (STAXI). RESULTS: Significant improvements on 4 subscales of the STAXI (state-anger, trait-anger, anger-out, anger-control) were observed in the topiramate-treated subjects after 8 weeks, in comparison with the placebo group. The difference in improvement in score between the 2 groups for state-anger, trait-anger, and anger-out ranged from 21% to 24%, and the difference for anger-control was -13%. As an exception, a difference of only 8.5% (p < .2) was found on the anger-in subscale. Significantly greater weight loss was observed in the topiramate-treated group than in those treated with placebo (difference in weight loss between the 2 groups: 2.3 kg [5.1 lb] [3.2%]; 95% CI = 1.3% to 4.4%, p < .01). All patients tolerated topiramate well. CONCLUSIONS: Topiramate appears to be a safe and effective agent in the treatment of anger in women with borderline personality disorder as defined by SCID criteria. Additionally, significant weight loss can be expected.

Adult↗
PubMed1991

Localized borderline lepromatous leprosy.

A 48-year-old soldier presented with 3 small leprosy lesions localized over the flexor area of the forearm. There was no nerve thickening and clinically the lesions looked like borderline-tuberculoid leprosy. However, these lesions demonstrated a bacteriological index (BI) of 4+ while no acid-fast bacilli (AFB) could be demonstrated from any other site of the body. A lepromin test was negative. Histologically evidence of borderline lepromatous leprosy was conspicuous. The case was diagnosed as localized borderline lepromatous-leprosy and treated with multidrug therapy. After 1 year of treatment, the lesions regressed, a lepromin test was positive (5 mm) and the BI from the lesions fell to 1+.

Forearm↗