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PubMed1985

Prolonged psychotic states in borderline personality disorder.

This paper reviews the literature concerning the phenomenology and duration of psychosis in borderline patients and presents empirical findings concerning a sample of eight borderline women with psychosis. Little work has yet been done to establish the duration of so called "transient psychotic episodes," but the clinical consensus up to now has been that such episodes last less than two weeks. The patients in the current study experienced psychotic symptoms lasting between three weeks and four months. They were characterized by hysterical features, visual disturbances, and a possible history of sexual trauma. The diagnostic and therapeutic implications of these prolonged psychotic episodes is discussed.

Adolescent↗
PubMed1984

The structural interview method for diagnosing borderline disorders: a critique.

The authors discuss difficulties in the assumptions that underlie Kernberg's Structural Interview method for diagnosing borderline personality organization and demonstrate methodological limitations in the studies that have reported results from its use. Further data analysis leads to the conclusion that, in the population studied, the Structural Interview diagnosis of borderline personality disorders is essentially equivalent to the clinical diagnosis of the presence of any personality disorder. A predictive formula to determine the presence or absence of clinically diagnosed personality disorder is derived using logistic regression.

Borderline Personality Disorder↗
PubMed1986

Separation crisis in a family with a borderline adolescent.

The case discussed illustrates the crisis value of separation strivings in borderline families. Dynamic and interpersonal issues were approached from a focus on (a) patterns of projective identification; (b) parental definitions interfering with the child's ego structure formation; and (c) the deterioration of a borderline personality toward frankly schizophrenic functioning under the double pressure of the developmental task of separation and binding parental maneuvers.

Adult↗
PubMed1985

Separation and loss in psychoanalytic therapy with borderline patients: further remarks.

This paper is a continuation of an earlier one concerning borderline patients, and I can recapitulate only a few of the many areas touched upon here. The borderline individual is faced continually with the threat of loss, either of his tenuously established individual identity, through fusion with the other person, or of his fragile interpersonal relatedness, through uncontrollable flight into autism of psychotic degree. A basic theme in one's work with these persons is that of unconscious, fantasied omnipotence, variously an aspect of the patient's unconscious self-image or projected into the therapist. The acting-out which the patient does consists in his inflicting loss, deprivation, and other forms of injury upon his introjects of part-aspects of the therapist. The grief involved in the relinquishment of so-called bad introjects is discussed. The patient early in therapy is aware of his inability to grieve, and endeavors to conceal this deficiency by spurious emotionality. I give examples of patients' manifesting regressive dedifferentiation to fusion with elements of the nonhuman environment, as an unconscious defense against feelings of separation and loss. Effective therapy with these patients involves the therapist's deeper working through of his own losses. The significant losses occurred so early in these patients' lives that the therapeutic exploration of these areas may enable the therapist to gain access to comparably early losses on his own part, losses from a developmental era which many a training analysis may not have explored at all adequately.

Anxiety, Separation↗
PubMed1991

A comparison of demographic, behavioral, and ego function data in borderline and eating disorder patients.

Seven borderline personality and ten eating disorder patients were compared using demographic, descriptive/behavioral, and ego function measures on admission to an inpatient unit. Demographic and descriptive data analysis revealed areas of overlap, consistent with other reports of co-morbidity between the two groups. Ratings of intrapsychic function were made using Bellak's Ego Function Assessment profiles, and showed that the two groups shared deficits in the areas of impulse/affect control and sense of identity, but had otherwise easily distinguishable profiles. The authors feel that studying ego functioning is a useful way of assessing co-morbidity in borderline personality and eating disorder patients.

Adult↗
PubMed1999

[The operational diagnostic approach of the borderline personality disorder. An interview of psychiatrists and psychologists according to their concept of the syndrome].

Despite the diagnostic criteria of the ICD-10 and DSM-IV, the term borderline has been used in a non-specific way for a long time. For our investigation we constructed a questionnaire, which contained the ICD-10 diagnostic criteria for the borderline personality disorder (BPD), plus the criteria for the other personality disorders and for the schizotype disorder. The two additional criteria for the BPD used by the DSM-IV were added. 800 psychiatrists and psychologists were asked to mark all criteria, which they thought were typical for the BPD. By using the operational diagnostic approach for ICD-10 and DSM-IV a disorder was diagnosed from each of the 162 received questionnaires based on the marked criteria. 92.0% of the questionnaires contained marked criteria for the diagnosis of the BPD by ICD-10 and 96.3% by DSM-IV. In addition each questionnaire contained up to eight other diagnosis. This is a sign for the difficulty to separate the BPD from other personality disorders or the schizotype disorder by using operationalized criteria. Looking at the lack of specificity of the operational diagnostic systems for personality disorders, e.g. for the BPD which has been discussed by many authors for years, modification of the diagnostic systems should be considered.

Adult↗
PubMed2005

Impaired platelet [3H]paroxetine binding in female patients with borderline personality disorder.

RATIONALE: There have been few studies of platelet paroxetine binding in borderline personality disorder (BPD). OBJECTIVE: Our aim was to determine whether female BPD subjects show abnormalities in platelet paroxetine binding. METHODS: Twenty-one female BPD subjects and 16 age- and gender-matched normal control subjects were assessed using the following: (1) Diagnostic Interview for Borderlines, Revised, (2) Diagnostic Assessment for Personality Pathology: Brief Questionnaire, and (3) Barratt Impulsivity Scale. Platelets were collected and assayed for platelet paroxetine binding. RESULTS: Bmax was lower in the BPD group (p < 0.0001), but differences in Kd only reached a trend level. There were no associations with trait dimensions independent of diagnosis. CONCLUSIONS: Reduced platelet paroxetine binding in female BPD patients may reflect presynaptic serotonin dysfunction.

Adult↗
PubMed2005

Psychoanalytic psychotherapy for severely disturbed borderline patients: observations on the supervision group of psychotherapists.

The authors describe the role of a supervision group of psychotherapists within a wider therapeutic field for severely disturbed borderline patients. The group concentrates on the transference and countertransference, seen according to Racker's distinction between concordant and complementary identifications. The implications of the prevalence of the complementary identifications over the concordant identifications of the therapists to their patients and the resulting regression to primitive defense mechanisms can be counterbalanced by the group's integrative functioning as receiver (1) of a variety of information about the patient, (2) of the therapist's attempt to understand and synthesize, and (3) of the therapist's countertransference reactions to his patient. The major discrepancies between the various conceptions of the borderline patients' psychic world and the appropriate therapeutic technique to be applied are also discussed, as well as the way the group filters the information and integrates the therapeutic thought. It might be said, therefore, that, in the "inpatient" phase of the individual psychotherapy, the group of psychotherapists functions, for the patient and the treatment, in a synthesizing context, as it provides the therapist with a space of integration for his split-off part of self and object representations, which the therapist makes use of for his patient.

Borderline Personality Disorder↗
PubMed2005

A case study of borderline anxiety and the process of analytic transformation.

Borderline patients present particular treatment problems and require close, devoted understanding of their often chaotic and shifting intrapsychic conflicts. Many of these patients act out, making it difficult to maintain an analytic process. In fact, many terminate early on. When they do stay for longer periods, they exhibit particular constellations of defense, anxiety, and conflict. One extensive case report is used to examine the overlapping cycles of treatment with this population. Frequently, self-destructive acting-out is present in the transference and extra-transference. This acting-out is often followed by the self-destructive, anti-change attitude of the death instinct. These ways of relating to the self and the object are mobilized within the vehicle of projective identification and are best understood as primitive defenses against core fantasies of loss and persecution. These issues of loss and fear are the final and vital phase of treatment with borderline patients, who are often able to make major fundamental changes in their internal sphere, but only if patient and analyst can tolerate and understand these three levels of intrapsychic experience.

Acting Out↗
PubMed2004

New developments in the neurobiology of borderline personality disorder.

Within the past several years, research on the clinical phenomena and neurobiology of borderline personality disorder has increased substantially. Borderline personality disorder is currently best thought of in terms of dimensions rather than as a categorical disorder. This article reviews the most recent findings on two of the core dimensions--affective dysregulation and impulsivity. Most of the neuropsychologic, physiologic, endocrinologic, and neuroimaging data support the theory that a dual brain pathology, affecting prefrontal and limbic circuits, may underlie this hyperarousal-dyscontrol syndrome.

Borderline Personality Disorder↗
PubMed1990

CSF metabolites in borderline personality disorder compared with normal controls.

Cerebrospinal metabolites were measured in 17 patients with borderline personality disorder and 17 normal controls. There were no significant differences between the two groups in levels of 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid (HVA), or 3-methoxy-4-hydroxyphenylglycol (MHPG). Within the borderline group, lower levels of CSF 5-HIAA were significantly associated with a history of genuine suicide attempts, but were not associated with violence, self-mutilation, or with the presence of major depression. Thus, CSF 5-HIAA levels are not distinctively low in a diagnostic group characterized by impulsivity and suicidal behavior, but within that group may be associated with genuine suicide attempts.

Adult↗
PubMed1993

Ambulatory polysomnography of never-depressed borderline subjects: a high-risk approach to rapid eye movement latency.

The sleep parameters of never-depressed borderline subjects and age- and sex-matched normal controls were compared by continuous 48-hr ambulatory electroencephalographic (EEG) monitoring. Borderline subjects had a significantly shorter rapid eye movement latency, normal architecture of rapid eye movements sleep, and had familial risks for mood disorders four times greater than in the families of controls. Reduced latency of rapid eye movement can be a trait indicator of liability to depression, present before the clinical appearance of the disorder, and demonstrable in a putative high-risk population.

Adult↗
PubMed1996

TRH stimulation and dexamethasone suppression in borderline personality disorder.

The link between borderline personality disorder (BPD) and affective disorders is controversial. The dexamethasone suppression test (DST) and the thyrotropin-releasing hormone (TRH) stimulation test, which are useful in the study of affective illness, might help to elucidate this possible link. This report assessed these endocrine tests in a sample of 20 borderline patients without a concomitant diagnosis of major depression (but showing depressive symptoms) in comparison to a group of sex- and age-matched patients with major depressive disorder (MDD) without BPD. Only 5 of our BPD patients were DST nonsuppressors compared to 13 MDD patients at a threshold of 50 micrograms/L. With a threshold of delta max TSH < 5 microU/mL following TRH, 1 BPD patient showed a blunted TSH response compared to 9 MDD patients. BPD patients displayed significantly less perturbed tests. These results show no evidence of an endocrine biological link between BPD and the MDD. The depressive symptoms observed in BPD patients might not have the same biological substrates as those found in patients with MDD.

Adult↗
PubMedDate not supplied

Diagnosis and clinical features of borderline personality disorder in the east and west: a preliminary report.

In the first clinical study of the borderline personality disorder (BPD) in Asia, the Diagnostic Interview for Borderlines (DIB) was performed on 85 female outpatients aged 18 to 30 years in Japan. BPD was diagnosed in 32 (38%) of these patients. The International Classification of Diseases-9 (ICD-9) diagnoses made at the initial examination of the DIB-identified BPD patients were, in order of frequency, neurotic disorders, anorexia nervosa and other eating disorders, and manic-depressive psychoses. The DSM-III axis I diagnoses of the DIB-identified BPD patients were affective disorders in 63%, eating disorders in 34%, and substance use disorders in 22%. This study suggests that there are indeed BPD patients in Japan. An exception is made of the low incidence of substance use disorders, and of the fact that most Japanese patients continue to maintain stormy one-to-one or masochistic relationships with their parents because they live at home--their clinical picture is not different from that of American patients.

Adolescent↗
PubMed1987

A Markov model for predicting levels of psychiatric service use in borderline and antisocial personality disorders and bipolar type II affective disorder.

This study examines the relationship between borderline personality disorder (BPD) and the use of psychiatric services in a naturalistic follow-up comparison with antisocial personality disorder and bipolar type II affective disorder. In the first follow-up series, borderline psychopathology was associated with higher levels of psychiatric service use (emergency, daycare, and inpatient). Markov analyses indicated that the transition between levels of psychiatric service use followed a stationary, second order process (i.e. the immediate past and current service use, predicted use on the next follow-up, and the relationship did not depend on the point in time examined in the follow-up series). Further, the transition probabilities generated from this model did not depend significantly on diagnosis. Predictions from the Markov model about the cumulative probability that subjects would use the highest level of psychiatric services were tested on a second series of follow-ups on the same subjects 20 months later. The model-based predictions (starting from the observed levels in the first two follow-ups of the second series) clustered into three groups, of high, middle, and low predicted probabilities. The subject group with the lowest predicted likelihood had a cumulative probability of 0.19 for using emergency, daycare, or inpatient hospitalization by 22 months of follow-up, whereas the group with the highest likelihood (containing a disproportionate number of BPD subjects) had a cumulative observed probability of 0.80. The Markov model generated from this second series supported the stationarity of the transition process. BPD subjects began using high levels of psychiatric services, but their transition from one level to another over time followed a process similar to that of non-BPD subjects.

Antisocial Personality Disorder↗
PubMed1983

The TRH test in patients wih borderline personality disorder.

Fifteen patients with a primary diagnosis of borderline personality disorder were studied with the thyrotropin-releasing hormone (TRH) test. Twelve carried the additional diagnosis of depression, substance abuse, or both. A blunted thyroid-stimulating hormone (TSH) response to TRH was found in seven patients, two of whom were neither depressed nor had the additional diagnosis of depression and/or substance abuse. TSH blunting was unrelated to such factors as thyroid status, serum cortisol, weight, height, or body surface. Since TSH blunting occurs in about 25% of patients with major depression but not in schizophrenia, the findings suggest that some patients with borderline personality disorder share a neuroendocrine abnormality with some affective disorder patients.

Adolescent↗
PubMed1988

EEG sleep, lithium transport, dexamethasone suppression, and monoamine oxidase activity in borderline personality disorder.

Twenty-one patients who met DSM-III criteria for borderline personality disorder (BPD) and also scored at least 7 on the Diagnostic Interview for Borderlines (DIB) were assessed on four biological markers: electroencephalographic (EEG) sleep, in vitro lithium ratio, platelet monoamine oxidase (MAO), and dexamethasone suppression test (DST). REM latency averaged 58.66 (SD 14.39); platelet MAO averaged 21.74 (SD 10.33); and lithium ratio was 0.357 (SD 0.139) in the BPD patients. All of those values were significantly abnormal. Many patients had abnormalities on three or four measures. These patients in general had multiple Axis I diagnoses from the Diagnostic Interview Schedule (DIS), and these Axis I diagnoses tended to produce patient clusters. Patients with a DIS diagnosis of schizophrenia, mania, hypomania, or schizoaffective mania had elevated lithium, low MAO, and normal EEG sleep, while those patients with coexisting major depression tended to have short rapid eye movement (REM) latency, high REM density, and normal MAO and lithium ratio. Only two patients were nonsuppressors on the DST, confirming recent reports of normal DST results in personality disorders.

Adult↗
PubMed1996

Pain and self-injury in borderline patients: sensory decision theory, coping strategies, and locus of control.

Fifteen women with borderline personality disorder who do not experience pain during self-injury were found to discriminate more poorly between imaginary painful and mildly painful situations, to reinterpret painful sensations (a pain-coping strategy related to dissociation), and to have higher scores on the Dissociative Experiences Scale than 24 similar female patients who experience pain during self-injury and 22 age-matched normal women. "Analgesia' during self-injury in borderline patients may be related to a cognitive impairment in the ability to distinguish between painful and mildly painful situations, as well as to dissociative mechanisms.

Adaptation, Psychological↗