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PubMed1991

Grandiosity in children with narcissistic and borderline disorders. A comparative analysis.

I draw a distinction between two clinical pictures in children, borderline and narcissistic disorders. Both belong to the realm of personality disorder--or, perhaps, disorders in the development of the personality--but only the former has been widely reviewed and thoroughly investigated in the professional literature. I raise the question how and when these disorders emerge, stressing that both derive from the early, preoedipal period, and precede completion of the separation-individuation processes. Both disorders reveal manifestations of grandiosity which I view as a defense against the two underlying emotional experiences of the disorders: the experience of feeling alone in the borderline case, and the experience of "worthlessness" in the narcissistic personality.

Adult↗
PubMedDate not supplied

Emotion processing in borderline personality disorders.

This study examined relationships between the ability to recognize facial affect and affective intensity in women with Borderline Personality Disorder. Women hospitalized with borderline personality disorder and community women without psychiatric disorder (n s = 35/group) were recruited via convenience sampling. The Pictures of Facial Affect and the Affect Intensity Measure were administered to consenting women. Hypotheses related to differences in recognizing facial affect were supported, but further exploration indicated that selected negative emotions accounted for the statistical significance. Implications for practice and research are explored.

Adolescent↗
PubMed2006

No man's land: gender bias and social constructivism in the diagnosis of borderline personality disorder.

The literature on borderline personality disorder (BPD), including its epidemiology, biology, phenomenology, causes, correlates, consequences, costs, treatments, and outcomes is vast. Thousands of articles and books have been published. Because the true prevalence of BPD by sex (gender) in the general population is still unknown, the important question of why women, rather than men, are more frequently diagnosed with BPD remains largely unanswered-despite current evidence for the origin of personality disorder in genetics and neurobiology, and despite recent suggestions that biased sampling is the most likely explanation for gender bias in the diagnosis of BPD. This paper reviews selected literature on (a) the epidemiology of BPD, (b) gender bias in the diagnosis of BPD, and (c) the social construction of diagnosis, particularly the diagnostic entity labeled "Borderline Personality Disorder." It attempts a synthesis of diverse, multidisciplinary literature to address the question of why women outnumber men by a ratio of 3:1 in the diagnosis of BPD. It rests on assumptions that (a) to varying degrees sociocultural factors inevitably play a role in the expression of disease conditions, and that (b) personality disorders, including BPD, have cultural histories. It also rests on the belief, for which there is considerable scholarly support, that the phenomenon called BPD has multiple, complex, interactive, biological, psychological, and constructed sociocultural determinants. Nurses must understand the phenomenon at this level of complexity to provide appropriate care.

Affect↗
PubMedDate not supplied

Borderline personality disorder: gender stereotypes, stigma, and limited system of care.

In North America, there may be no other psychiatric diagnosis more laden with stereotypes and stigma than borderline personality disorder. People who live with this label--the majority being female--are often marginalized or denied access to mental health services. In this article, the author reviews the theoretical underpinnings of the diagnosis, as well as the stigmatizing practices and limited services for seriously ill persons with borderline personality disorder diagnoses. In light of this review, new directions for mental health practice, education, and research are proposed.

Attitude to Health↗
PubMed2003

Developmental protective and risk factors in borderline personality disorder: a study using the Adult Attachment Interview.

Mental representations and attachment in a sample of adults with Borderline Personality Disorder were assessed using the George, Kaplan and Main (1985) Adult Attachment Interview (AAI). Eighty subjects participated in the study: 40 nonclinical and 40 with Borderline Personality Disorder (BPD). The results obtained showed a specific distribution of attachment patterns in the clinical sample: free/autonomous subjects (F) represented only 7%, dismissing classifications (Ds) reached about 20%, entangled/preoccupied (E) 23% and unresolved with traumatic experiences (U) 50%. The two samples differed in their attachment patterns distribution by two (secure vs. insecure status), three (F, Ds and E) and four-way (F, Ds, E and U) categories comparisons. In order to identify more specific protective or risk factors of BPD, 25 one-way ANOVAs with clinical status as variable (clinical vs. nonclinical) were conducted on each scale of the coding system of the interview. Results support the hypothesis that some developmental relational experiences seem to constitute pivotal risk factors underlying this disorder. Results demonstrated potential benefits in using AAI scales in addition to the traditional categories. Implications for research and treatment are discussed.

Adult↗
PubMed1999

Psychotherapy with borderline patients: II. A preliminary cost benefit study.

OBJECTIVE: The aim of this study was to conduct a preliminary cost benefit study of the effect of outpatient psychotherapy, twice a week for 1 year, in 30 borderline patients. METHOD: Costs to the health system in terms of inpatient care for the year before treatment were compared with the costs for the year following treatment. RESULTS: The cost of hospital admissions for the 30 patients for the year before treatment was $684 346 (range = $0-$143 756/patient). The cost of hospital admissions for the year after treatment was $41 424 (range = $0-$12 333/patient). These figures represent an average decrease in costs per patient of $21 431. By using the schedule fee as the basis, the estimated cost of therapy per patient was approximately $13 000, representing a saving/patient of $8431 or approximately $250 000 over the total cohort in the first year after treatment. CONCLUSION: This study suggests that there is a significant cost benefit in the appropriate treatment of borderline patients.

Adult↗
PubMed2006

Association between childhood trauma and dissociation among patients with borderline personality disorder.

OBJECTIVE: To examine the relationship between childhood trauma and dissociative experience in adulthood in patients with borderline personality disorder. METHOD: Dissociative experiences scale scores and subscale scores for the Childhood Trauma Questionnaire were correlated in 139 patients. Patients were dichotomized into high or low dissociators using the Median Dissociative Experiences Scale score as the cut-off. RESULTS: Childhood Trauma Questionnaire Subscale scores for emotional and physical abuse and emotional neglect but not sexual abuse correlated significantly with Dissociative Experiences Scale scores. High dissociators reported significantly greater levels of emotional abuse, physical abuse, emotional neglect and physical neglect but not sexual abuse than low dissociators. CONCLUSION: Patients with borderline personality disorder therefore demonstrated levels of dissociation that increased with levels of childhood trauma, supporting the hypothesis that traumatic childhood experiences engender dissociative symptoms later in life. Emotional abuse and neglect may be at least as important as physical and sexual abuse in the development of dissociative symptoms.

Adolescent↗
PubMed2001

Multiple complex developmental disorder: the "multiple and complex" evolution of the "childhood borderline syndrome" construct.

OBJECTIVES: To provide an overview of the history, evolution, and nosology of the diagnostic constructs for "borderline syndrome of childhood," also known as "multiple complex developmental disorder." METHOD: The authors synthesized information found via electronic searches of databases (MEDLINE, PsycINFO, Current Contents, Humanities Abstracts, and Social Sciences Abstracts) and bibliographic directed searches. RESULTS: Although early publications (prior to 1980) were either highly anecdotal or lacking in scientific rigor, they were nonetheless noted for their historic value and influence on research trends. The recent publications (1990s) were characterized by more rigorous methodology and greater generalizability. Current classifications, proposals for diagnostic criteria, epidemiological data, and nosological suggestions were summarized. CONCLUSION: The literature supports the creation of a new diagnostic label to describe a population of children whose symptoms are currently subsumed under the labels "borderline" or "multiple complex developmental disorder." A full characterization of the syndrome, including its evolution, would require prospective studies and may differ from the known evolution for personality disorders and/or pervasive developmental disorders. The authors propose a process by which a new nomenclature is derived.

Age of Onset↗
PubMed1987

Soft sign neurological abnormalities in borderline personality disorder and normal control subjects.

Patients with borderline personality disorder were found to have a significantly greater number of soft sign neurological abnormalities when compared with a group of normal control subjects. Sensitivity analysis revealed that the presence of two or more soft signs differentiated the two groups statistically. The authors speculate that nonfocal soft sign neurological abnormalities may reflect underlying central nervous system dysfunction, which may in turn be associated with the development of borderline personality disorders.

Adolescent↗
PubMed1988

Use of imipramine for attention deficit disorder in a borderline patient.

A subcategory of patients with borderline personality disorder (BPD) who also meet criteria for attention deficit disorder (ADD) has recently been described. The present case involves a young man with BPD and ADD who failed to respond to methylphenidate but experienced a marked reversal of anxiety, explosiveness, restlessness, and affective lability when treated with imipramine. Tricyclics may prove to be helpful in borderlines who also meet criteria for ADD.

Adult↗
PubMed1989

Comorbidity for borderline and schizotypal personality disorders. A study of alcoholic women.

Twenty-six women alcoholics who fulfilled the criteria for a pure borderline personality disorder (BPD) were compared with 16 women alcoholics who also fulfilled the criteria of a schizotypal personality disorder (called mixed borderline disorder, MBD) based on personal interviews including SADS, SIB, Childhood Environment Scale (CES), and the Premorbid Adjustment Scale (PAC). The MBD women had fewer alcoholic relatives, poorer relationships with parents and siblings, a more deviant score on CES and PAC, a higher incidence of nervous children, and a poorer social network. They also reported more losses and a greater frequency of depressive symptoms during childhood and adolescence, earlier contact with psychiatry, and more frequent hospitalizations. They had a higher frequency of a nonalcoholic axis I disorder (mainly depressive and anxiety disorders), as well as a greater frequency of a paranoid personality disorder. The results show that the MBD women were more psychopathologically disturbed and support a possible link between MBD and affective disorders. The findings also indicate that MBD may be a clinical entity that should be differentiated from the pure BPD group both in clinical work and forthcoming research.

Adult↗
PubMed1991

Assessment of borderline personality disorder. A review of MMPI and Rorschach findings.

This review examines the literature on assessing borderline personality disorder (BPD) using the MMPI and the Rorschach test. Despite the extensive use of these instruments in the assessment of BPD, the degree to which they are successful in identifying the disorder remains unclear. Methodological difficulties in this literature are discussed, including diagnostic and sample heterogeneity, base rate issues, systematic differences in selection criteria among studies, and, for the Rorschach, differing outcome measures. Both MMPI and Rorschach findings suggest a general trend for borderline groups to produce relatively unique findings. Their usefulness in yielding accurate individual diagnoses of BPD, however, has not yet been established. Furthermore, no supportive evidence was found for the commonly held hypothesis that BPD subjects show more impairment on unstructured measures than on objective measures.

Borderline Personality Disorder↗
PubMed1991

Posttraumatic stress disorder among children clinically diagnosed as borderline personality disorder.

Using the Diagnostic Interview for Children and Adolescents, Revised Version (DICA-C-R), the authors evaluated 19 children ages 7 to 14 who had recently been clinically diagnosed as borderline personality disorder by DSM-III-R criteria. The results reveal that 78.9% of these children reported significant traumatic experiences, with 36.8% fitting DICA-C-R criteria for posttraumatic stress disorder. These findings raise the possibility that a diagnosis of borderline personality in childhood can often represent posttraumatic stress disorder.

Adolescent↗
PubMed1992

The Separation-Individuation Inventory. Association with borderline phenomena.

The Separation Individuation Inventory (SII; Christenson and Wilson, J. Nerv. Ment. Dis., 173:561-565, 1985) was designed to assess adult psychopathology construed in terms of the concepts of separation and individuation (Mahler, Pine, and Bergman, The Psychological Birth of the Human Infant: Symbiosis and Individuation, 1975). Its reported use is confined to the original authors' paper, which compared scores of 20 subjects with borderline personality disorder with the scores of staff control subjects. We report the association of the SII with two self-report measures of borderline personality diagnosis and phenomenology. Our British samples, from the staff and residents in a therapeutic community for severely personality-disordered clients, thus complement the original American work. The SII was found to have good internal consistency, respectable screening parameters, and high correlations with indications of trait psychopathology. We suggest a slight modification to the scoring of the inventory and two main areas for additional research.

Adult↗
PubMed1993

Treatment response of borderline inpatients. A growth curve analysis.

This study examined the course of 40 hospitalized female borderline personality disorder patients over 25 weeks of inpatient treatment. Course was measured through weekly administration of the SCL-90-R. Level of identity and interpersonal problems, hypothesized by Kernberg to be at the center of the borderline patient's pathology, were found to be powerful predictors of treatment course. Patients with the most severe identity and interpersonal problems reported more symptoms throughout treatment and increasing symptom levels over time. This was very different from patients with the lowest level of identity and interpersonal problems, who reported fewer symptoms overall and decreasing symptoms over time.

Adult↗
PubMed2001

Evaluations of others by borderline patients.

This study investigated evaluations of other people in specific emotional situations by patients with borderline personality disorder (BPD). BPD patients (N = 16), control patients with cluster C personality disorder (PD; N = 12) and normal controls (N = 15) saw film clips with emotional themes centering on abandonment, rejection and abuse, hypothesized to be specific for borderline pathology. Subjects wrote down their spontaneous reactions to six film personalities, divided over three clips, including what they thought to be characteristic traits of these persons. Spontaneous reactions were coded on two dimensions, based on earlier studies by Westen and colleagues: a) affect-tone of ascribed qualities and b) complexity of evaluations of people. The number of trait dimensions constituted the third scale. The overall pattern of findings suggests that the BPD group, as well as the cluster C group, show poorly differentiated evaluations with a low number of dimensions. Thus, this seems characteristic for personality disorders in general. The BPD group shows a lower affect-tone, reflecting a stronger tendency to view others negatively, compared with both control groups.

Adult↗
PubMed2004

Testing an APA practice guideline: symptom-targeted medication utilization for patients with borderline personality disorder.

BACKGROUND: The goal of this study was to test whether the use of psychotropic medication treatment for borderline personality disorder (BPD) was consistent with proposals in the recently published American Psychiatric Association's Practice Guideline for the Treatment of Patients with Borderline Personality Disorder. METHOD: Medication utilization by patients with BPD was assessed prospectively over a 2-year period prior to the publication of the Guideline. Three BPD symptom clusters--cognitive-perceptual, affective dysregulation, and impulsive-behavioral dyscontrol--along with demographic and functioning variables were used to predict the use of five classes of medication. RESULTS: Symptoms of impulsive-behavioral dyscontrol significantly predicted use of both neuroleptics and anticonvulsants. Cognitive-perceptual symptoms were inversely related to anticonvulsant use. CONCLUSION: While some pre-Guideline medication practices with BPD patients were consistent with the recommended algorithms, physicians may also have been influenced by a variety of considerations, including level of functional impairment and the presence of comorbid Axis I conditions.

Adolescent↗
PubMed2006

Efficacy of pharmacotherapy against core traits of borderline personality disorder: meta-analysis of randomized controlled trials.

We conducted a meta-analysis of published randomized, placebo-controlled clinical trials that evaluated the effect of pharmacotherapy in patients with borderline personality disorder. Comprehensive searches of the MEDLINE, EMBASE, PsychLIT and Cochrane Central Register of Controlled Trials databases were performed using web-based search engines. Twenty articles, reporting 22 placebo-controlled comparisons, were included in the meta-analysis: eight involved antipsychotics, seven antidepressants and seven mood stabilizers. Antidepressants (four studies, standardized mean difference -0.55, 95% confidence interval -0.92, -0.17) and mood stabilizers (six studies, standardized mean difference -1.74, 95% confidence interval -2.76, -0.73) were effective against affective instability and anger, but did not produce significant benefits against impulsivity and aggression, unstable relationships, suicidality and global functioning. Antipsychotics as a class had a positive effect in terms of impulsivity and aggression (three studies, standardized mean difference -0.31, 95% confidence interval -0.63, -0.003), interpersonal relationships (three studies, standardized mean difference -0.52, 95% confidence interval -0.87, -0.17) and global functioning (seven studies, standardized mean difference -0.56, 95% confidence interval -1.00, -0.11). No difference was observed between pharmacotherapy and placebo in terms of participants leaving the study early. Pharmacotherapy can exert a modest beneficial effect on some core traits of borderline personality disorder.

Adolescent↗