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PubMed1999

[Sequence of time and relation with others in borderline personality disorder].

In order to present some new psychopathological explanations on borderline personality disorder, the authors made a study on 3 borderline patients who could reflectively state their experiences of changes in the sequence of time and the relation with others. The following characteristics are considered to be most important: 1) They needed someone under their noses who always kept his/her eyes upon them. And as soon as they thought that he/she was in close relation with them, his/her intensions toward them were taken as already concluded (or determined) ones in their subjective experiences. 2) Every-time they found that others' intentions were apart from the determined ones, strong rage was evoked in them, because they felt that they were betrayed by others. Thus, their painful experiences were produced successively. 3) Consequently, they took the whole past as congregation of painful experiences, so that they struggled to cut the linkage of the present and the past. For that purpose, they tried to plunge head-long into momentary experiences. But to complete the purpose, they intensified their dependence on others' intentions again as previously stated. This vicious cycle itself is thought to be the significant framework of borderline personality disorder.

Adult↗
PubMedDate not supplied

[Borderline pathology: follow-up study. Preliminary report].

The work is based on the frequent use of the term "borderline" in clinical practice, in spite of the fact that this word still tends to have a controversial and ambiguous meaning. Patients who were admitted to the Psychiatric Clinic at the University of Turin between 1974 and 1980 with diagnoses of borderline pathologies or marginal psychoneurosis were followed-up in the study. The subjects in question were reexamined after an interval of between 8 and 14 years (the majority between 10-12 years). An attempt was made to compare the two diagnoses using DSM III R criteria. Family status and employment were also taken into account. It was observed that the diagnosis of marginal syndromes recorded in the patient's clinical records did not correspond to the DSM III R borderline diagnosis, and rather than referring to a precise syndrome it reflected an area of diagnostic uncertainty. This raises various questions both with regard to the role of psychiatry, and in relation to the incidence of cultural factors in influencing observations.

Adolescent↗
PubMed1992

Adolescence and borderline pathology: characteristics of the relevant psychoanalytic process.

This paper results from a research project on the specific characteristics of borderline adolescents and their analysability. An in-depth understanding of the adolescent process is considered essential because it is superimposed on the specific pathology of the borderline subject. Our cases agree in almost all respects with symptomatologies described in the international literature, although pronounced differences emerge in regard to serious acting out and behavioural disturbances. Separation processes, particularly from the mother, are very important in both cases presented. In the authors' view, this research shows that borderline adolescents constitute a definite clinical reality and that strict psychoanalytic technique can be used successfully with them.

Adolescent↗
PubMedDate not supplied

[A psychoanalytical approach of the borderline personality].

A bibliographic review of the last year's psychoanalytic literature on borderline personality is presented. We expose diagnostic considerations, with special emphasis on those which refer to the boundaries between borderline personality, neurosis and psychosis on one hand, and those which distinguish between borderline personality and narcissistic disorders on the other. Vicissitudes of these patient's object relationships, their bond with other significant persons, their main psychic mechanisms, clinical traits and technical difficulties in the treatment are also described.

Borderline Personality Disorder↗
PubMed2005

[Psychotherapy of trauma-related borderline pathology].

Borderline pathology originating from trauma is characterized by increasingly severe borderline and comorbid symptoms, poor psychosocial function, and poor prognosis in comparison with borderline patients who have never undergone such traumatic experiences. Instead of psychodynamic therapy, other forms of psychotherapy, such as cognitive-behavioral approaches are offered helping to stabilize the patient's life and improve his or her ways of coping with stressors. Trauma recovery depends on appropriate timing and careful preparation, where the patient first must learn to trust the therapist and gain some ego-strength. Failure to be properly prepared can lead to the escalation of former self-destructive defenses once used against the trauma. Typical transference-counter-transference dynamics can be conceptualized as episodes in a drama involving four principal characters: a victim, an abuser, an idealized rescuer, and a betrayer mother. Role enactments oscillate in various complementary pairings between patient and therapist during the course of therapy.

Borderline Personality Disorder↗
PubMed1991

Thinking about thinking: some clinical and theoretical considerations in the treatment of a borderline patient.

This paper addresses a specific aspect of pathological mental functioning in so-called borderline patients. Analytic work with a borderline man is presented to show that an inhibition of, and defences against, the contemplation of one's own and others' mental states may be a hallmark of the resistance encountered in a number of such patients. It is claimed that the analysis of transference and countertransference is a crucial therapeutic factor in tackling this source of resistance. In doing this, the paper draws upon a topical notion from philosophy of mind and recent ideas from child development studies which help to clarify psychoanalytic ideas concerning the nature of the pathology of internal object relations underlying feelings of emptiness and social alienation in borderline functioning.

Adult↗
PubMed1991

Borderline personality disorder: office diagnosis and management.

The management of patients with borderline personality disorder may be difficult, because these patients often make disproportionate demands on the physician's time and they tend to experience complicated and/or incomplete recovery from organic or functional illness. Histories of patients with this disorder reveal a host of self-destructive behaviors, often including suicide attempts. The diagnosis of borderline personality disorder can be confirmed using an adaptation of the Diagnostic Interview for Borderline Patients. A neutral, structured environment and a conservative medical approach can facilitate the management of these challenging patients.

Borderline Personality Disorder↗
PubMed1990

Medication and transference in psychoanalytically oriented psychotherapy of the borderline patient.

The regressive potential of the borderline patient has been recognized ever since the term was first introduced by Adolph Stern in 1938. He believed these patients were "too ill for classical psychoanalysis," and indeed almost all who have written on this subject have supported Stern's view, recognizing the severe regressive potential of a borderline patient in unmodified psychoanalysis. Taking medication is not generally considered to be a particularly regressive experience. It should be remembered, however, that for many patients and especially for patients with borderline personality disorder, medication can be both an overvalued hope and a terrifying assault. Thus, although the pharmacologic action of the medication may help to integrate the patient's ego functioning, the very taking of the medication may at the same time initiate subtle and unanticipated regressive drives. Two forces are then set in motion with potentially different effects. In a treatment where the same physician is prescribing medication and doing psychotherapy, the common pathway of these forces is transference. Thus, pharmacologic action may modify transference. And more importantly, because it is less easily recognized, transference issues may affect the patient's subjective experience of the action of the medication. For this reason, it is particularly important that not only diagnostic issues but also transference issues be understood before medication is prescribed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

The prevalence of cyclothymia in borderline personality disorder.

Sixty patients with personality disorders were evaluated by several different diagnostic instruments to determine the prevalence of cyclothymia in borderline personality disorder (BPD) and in other personality disorders (OPD). Cyclothymia occurred more frequently in BPD than in OPD, regardless of which diagnostic system was used. In contrast, the prevalence of major, minor, and intermittent depression, hypomania, and bipolar disorder was not significantly different in BPD as compared with OPD. Cyclothymic borderlines and noncyclothymic borderlines could not be distinguished on behavioral or functional measures. These results have implications for the diagnostic validity of both BPD and cyclothymia.

Adult↗
PubMed1989

Two kinds of borderline concepts. Conceptual and empirical agreement between DSM-III, DIB, and Kernberg.

The definitional criteria of the 3 systems (DSM-III, DIB and Kernberg) have been compared. While there is rather weak agreement between the criteria of DIB and those of DSM-III, there is no agreement at all between Kernberg's criteria and those of the other 2 systems. When the 3 systems are compared in terms of empirical diagnosis, the agreement between DSM-III and DIB is moderate and clearly stronger than that between Kernberg and either DSM-III or DIB. In terms of sensitivity, the Kernberg borderline comprises the DSM-III and DIB borderlines as subsets. The findings are consistent with the idea that Kernberg's borderline concept is an instance of a severity or maturity level construct, while DSM-III and DIB are characterological constructs, orthogonally related to the level construct.

Borderline Personality Disorder↗
PubMed1989

Prediction of change in borderline personality disorder.

Prediction of change in borderlines is an important effort because it may illuminate the character of this tentatively defined, complex disorder. In future years the disorder will be defined differently in light of its network of relationships with other variables. Presently, the strongest predictors of change in borderlines are receipt of neuroleptics and presence of target symptoms that are affected by these drugs. Other drugs and other treatments may also be found to have a selectively differential effect in which case receipt of these drugs will also predict change but perhaps on other target symptoms. Preliminary evidence implicates monoamine oxidase inhibitors (MAOIs), lithium, and carbamazepine. Response to thiothixene has been found to be related to the patient's Minnesota Multiphasic Personality Inventory (MMPI) profile prior to treatment. Biological predictor variables studied in other disorders have been found to be abnormal in borderlines, but how these variables might relate to change has not been studied. The program of research that is necessary includes other drug treatments, nonphysiological treatments, family history, and personality variables.

Antipsychotic Agents↗
PubMed1989

[Aspects of object relations in borderline and neurotic patients: an empirical study using the Holtzman Inkblot technic].

In the present study hospitalized borderline and neurotic patients were compared concerning certain aspects of object relations. The diagnosis of a borderline disorder was given on the basis of the "Diagnostic Interview for Borderlines" (Gunderson u. Kolb 1978). Certain aspects of object relations were assessed by applying the 7-point scale developed by Urist (1977) to responses in the Holtzman Inkblot Technique. According to the results the two diagnostic groups differ with regard to 5 of the 7 scale levels which are connected with the following interpersonal themes: Being supplied and guided; controlling; sucking out, devouring and damaging; engulfing and overwhelming. The results are interpreted referring to object relation theory. Furthermore hit rates were assessed on the basis of the Urist scale data with relatively good results for sensitivity and specifity.

Adult↗
PubMed1989

Phenelzine, imipramine, and placebo in borderline patients meeting criteria for atypical depression.

In planning psychopharmacologic treatment of patients with borderline personality disorder (BPD), three partially validated subtypes should be considered. The validity of the schizotypal subtype is supported by their favorable response to neuroleptics as well as by familial and genetic studies. The validity of emotionally unstable character disorder (EUCD) is supported by the presence of neurological soft signs, their negative response to antidepressants, and their positive response to chlorpromazine and lithium. The data presented in this paper suggest that some patients who meet borderline criteria and have atypical depression (patients meeting DSM-III-R criteria for major depression or dysthymia who have reactive mood and any atypical symptoms) clearly benefit from treatment with antidepressant medication. Although some patients with atypical depression who meet borderline criteria will improve with tricyclic therapy, a significantly greater proportion will improve with the monoamine oxidase inhibitor (MAOI), phenelzine.

Borderline Personality Disorder↗
PubMed1989

Narcissistic, antisocial, and noncomorbid subgroups of borderline disorder. Are they distinct entities by long-term clinical profile?

This study evaluates the influence of narcissistic and antisocial features on the long-term functioning of individuals with borderline personality disorder. Borderline patients discharged from Chestnut Lodge Hospital, an inpatient residential treatment facility, were followed up an average of 15 years later to assess longitudinal clinical profile. Despite differences in baseline psychopathology, members of Narcissistic, Antisocial, and Noncomorbid Borderline subgroups turned out to be roughly equivalent on almost all long-term course and outcome dimensions. The implications of these results for the nosology and treatment of personality disorders are discussed.

Antisocial Personality Disorder↗
PubMed1987

Psychopharmacology of borderline personality disorder: a review.

Borderline personality disorder poses a significant treatment challenge to the clinician. The frequent presence of comorbid disorders and the occurrence of a wide array of possible target symptoms complicate clinical assessment. Limited data from controlled clinical trials suggest that neuroleptics, monoamine oxidase inhibitors, and the anticonvulsant carbamazepine produce statistically and clinically significant short-term symptom reduction and may be useful components of the treatment approach to borderline personality disorder. Further research is needed to identify subgroups of patients with borderline personality disorder who are particularly responsive to a given medication and to explore the possibility that specific symptom complexes (such as suspiciousness, anhedonia, affective lability, or behavioral dyscontrol) are preferentially responsive to specific agents.

Antipsychotic Agents↗
PubMed1988

Recognizing borderline personality disorder in the primary care client.

The nurse practitioner is responsible for the diagnosis and treatment of a great variety of physical and psychological disorders in the ambulatory client. Frequently the diagnosis of personality disorder is missed, ignored or not even considered. This article will introduce the nurse practitioner to the various personality disorders. The main focus, borderline personality disorder, is estimated to affect 5 to 15 percent of the general population. A picture of the borderline client from etiology to treatment as well as recent research findings and suggestions for history taking and physical exam are covered. Borderline has been a difficult and confusing diagnosis to make because in the past the term has had several different meanings. This article will clarify what this diagnosis means, and will assist the nurse practitioner in the recognition, diagnosis and management of all clients with personality disorders.

Adult↗
PubMed1988

[The diagnosis of borderline disorders: criteria and their empirical evaluation].

Until now "Borderline-Syndrom" is a controversial diagnosis especially because of many uncertainties to determine the definition. In our examination various discrimination analyses were realised on a sampling of 62 patients (32 neurotic and 30 Borderline-Patients) and 47 variables in order to get various selective combinations of variables. Useful as a screening to separate neurotic and Borderline-Patients seems to be a combination of the items "often changing partnership", "homosexually episodes" and "incrimination/disciplinary punishment" with an error rate of 6.5 per cent.

Adolescent↗
PubMed1988

The subacute hospital treatment of the borderline patient--I: An educational component.

Failure to begin the hospital treatment of the "borderline" patient with a formulation of the problems requiring hospitalization is an indication of a lack of integration in the staff's view of the patient's pathology. This failure may dovetail with a basic lack of integration in the patient's personality and recapitulate similar confusion and inconsistency within that patient's family. A 15-minute educational tape about "borderline" illness has been used to enhance integration and formulation of problems by staff and patients in a hospital setting in which stay is limited to one or two months. The program is described, and the taped programs included. "Self-regulatory disorder" is preferred to "borderline personality disorder." After one year's experience with the program, the staff has been better able to formulate difficulties in clinical discussions with patients and their families. The staff has noted a clearcut reduction of disruptive impulsive action in this population of hospitalized nonpsychotic patients.

Borderline Personality Disorder↗