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PubMed2004

Borderline pathology in children and adolescents.

Mental health nurses have historically been pessimistic about and often unsympathetic towards clients diagnosed with borderline personality disorder. By the time these clients reach adult mental health services their behaviours are often difficult to manage and they often suffer significant re-victimization by health services. Questions need to be raised about how best to avert the consolidation of the problems associated with the disorder. This paper explores the concept of "borderline pathology" in children and adolescents and examines the best available evidence for utilizing an early identification and intervention model for children and adolescents who exhibit this constellation of symptoms.

Adolescent↗
PubMed1993

Gallium-67 scintigraphy in borderline lepromatous leprosy.

A middle aged woman with a pyrexia of unknown origin was shown to have borderline lepromatous leprosy. Early gallium-67 scintigraphy demonstrated increased uptake in the subcutaneous tissues of the face and thighs. As a result of these findings skin biopsy was obtained from the right thigh which gave a diagnosis of borderline lepromatous leprosy. The authors have been unable to find other reports of gallium-67 scintigraphy in leprosy but the pattern of gallium-67 distribution should suggest the diagnosis.

Adult↗
PubMed1984

Frequency of criteria-defined borderline patients among the first-visit patients at a psychiatric clinic.

Five trained psychiatrists evaluated 330 first-visit patients aged from 12 to 30 at a psychiatric outpatient facility using the DSM-III criteria (Axis-I and Axis-II). Seven cases were diagnosed as definite Borderline Personality Disorder and six cases as definite Schizotypal Personality Disorder. Hence, we had a total of 13 criteria-defined borderline patients (3.9%). Discussions were held on some methodological problems involved in collecting information and making diagnostic judgments.

Adolescent↗
PubMed1988

The significance of preadolescent mentality in the treatment of borderline patient.

After reviewing the history of conceptual and procedural changes in borderline patients, the author pointed out that the recent emphasis on the aggression and its origination in infancy in its treatment seems to blur the developmental issues in preadolescence and adolescence and to present difficulty in concluding the treatment. And a borderline case of the patient, a 20-year-old single woman with various symptoms, was presented. An examination of the course of treatment revealed that in order to better understand the process of therapeutic change it would be best to set the third phase with a strong narcissistic coloration between the working-through and separation-termination phases described by Masterson, J.F. Finally, it was emphasized that this narcissistic phase is a repetition not only found in childhood, but also in the preadolescent development and its disturbances.

Adult↗
PubMed1993

Relationship between clinical symptoms and EEG findings in borderline personality disorder.

Borderline personality disorder (BPD) was diagnosed in female patients (N = 41) between the ages of 18 and 30 using the Diagnostic Interview for Borderline Patients (DIB) and DSM-III. Comparing the EEG findings of BPD (N = 18) and non-BPD (N = 21) groups, there were no EEG findings characteristic of BPD. We also assessed the relationship between the EEG findings and DIB items. Positive spikes appeared in patients with high scores for Impulse Action Patterns, while wave and spike phantoms were observed in patients with high scores for Interpersonal Relations. Dividing the patients into BPD and non-BPD groups, a similar tendency to that observed from an analysis of all patients was observed in the non-BPD group, but no such tendency was observed in the BPD group. The results suggest that BPD patients include those in whom vulnerability of cerebral function plays an important role in the development of these two clinical symptoms as well as those in whom vulnerability of cerebral function plays almost no pathogenic role.

Adult↗
PubMed1996

Obsessive-compulsive disorder comorbid with borderline personality disorder: a long-term case study.

Three case reports of patients with borderline personality disorder (BPD) and obsessive-compulsive disorder (OCD) for more than 10 years are used to illustrate the relationship between OCD and borderline pathology. The recognizable features of the obsessive-compulsive symptoms in these reports are: (i) pervasiveness, the symptomatic overlap of obsessive-compulsive symptoms; (ii) poor insight and resistance; and (iii) obsessive control evident in personal relationships. These features are manifestations of OCD psychopathology as well as of a personality disorder. The symptoms with these features are located hypothetically towards the severe end of the symptomatic spectrum of OCD. The comorbidity is not a simple relationship, and the symptomatology of the comorbid patient is derived from OCD pathology linked with the personality disorder rather than from independent BPD pathology.

Adolescent↗
PubMed2004

Three-year follow up of women with and without borderline personality disorder: development of Cloninger's character in adolescence.

The purpose of the present study was to examine the developmental patterns of Cloninger's biogenetic character traits in subjects with borderline personality disorder (BPD). Study subjects met Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised; DSM-III-R) criteria for BPD without comorbid axis I or II disorders, as determined by the Diagnostic Interview for Borderlines-Revised, Structured Clinical Interview for the DSM-III-R, and Diagnostic Interview for Personality Disorders. The BPD subjects and age- and sex-matched healthy comparison subjects were initially interviewed for Cloninger's biogenetic characters and re-interviewed at an interval of 1 year for the following 3 years. There were significant differences in the developmental patterns of self-directedness, cooperativeness, and self-transcendence between BPD and healthy comparison subjects (significant group by time interaction: repeated measures manova, F = 17.3, d.f. = 3,240, P < 0.001; F = 28.5, d.f. = 3,240, P < 0.001; F = 4.7, d.f. = 3,240, P < 0.01, respectively). The BPD subjects had less changes in character-related maturity with increasing age than did healthy comparison subjects. Post-hoc tests with Duncan's statistics revealed that subjects with BPD had significantly lower scores on self-directedness at all assessment time periods (P < 0.01) and lower scores on cooperativeness at the second-year and third-year follow-up assessments as compared to healthy comparison subjects (P < 0.01). The BPD subjects had a distinctively different developmental pattern of Cloninger's character compared to healthy comparison subjects. The character development of BPD patients was more fixed and immature than those of healthy comparison subjects.

Adolescent↗
PubMed2000

Empathy in families of women with borderline personality disorder, anorexia nervosa, and a control group.

This is a study of empathy in the families of 27 women with borderline personality disorder (BPD), 28 women with restricting anorexia nervosa (AN), and 27 women without a clinical diagnosis (NC). The daughters and both parents responded to the Interpersonal Reactivity Index (IRI), an instrument for assessing four dimensions of empathy. In addition, they were personally interviewed, with the Family Interview for Protectiveness and Empathy (FIPE), about the extent of empathy expressed by the parents to their daughter during her development. On the IRI, women with BPD scored highest on the immature and lowest on the mature aspects of empathy, whereas scores of AN and NC women were all within normal limits. Parents of BPDs had the lowest IRI scores, while parents of AN and NC groups were similar to each other and to criterion group scores. IRI scores of AN daughters were positively correlated with their parents' scores whereas BPDs' scores were negatively correlated with those of their parents. There were no correlations between the IRI scores of NC subjects and their parents. On the FIPE, borderline daughters and parents agreed about the relative absence of empathic parenting, whereas AN and NC daughters and parents agreed as to the presence of empathic parenting. The theoretical and clinical implications of these contrasting findings are discussed.

Adolescent↗
PubMed1988

Increasing incidence of borderline states in Denmark from 1970-1985.

In Denmark sex and age standardized rates of first-admission diagnosis of the borderline state (301.83; ICD-8), have significantly increased during the 16 year interval 1970-85. There was no increase in the sex and age standardized rates of first-admission diagnosis of the other borderline state schizophrenia latens (295.59; ICD-8), in the same period. There was not sex difference in application of the 301.83 diagnosis, but a generation effect, the age group 15-34 especially contributed to the increase. Analysis of the geographic variation showed a five-fold relative risk of receiving the 301.83 diagnosis in the metropolitan area of Copenhagen compared with a total of three selected counties. Possible causes of the increase are discussed. There is every probability that the increase is due to change in diagnostic habits, but change in population psychiatric morbidity can not be excluded.

Adolescent↗
PubMed1994

Is there any drug treatment of choice for the borderline patient?

Psychotropic medication is used extensively in the borderline patient in an effort to treat the cognitive, affective, impulsive-behavioral and anxious-fearful symptoms which comprise the state symptoms and trait vulnerabilities of BPD. This paper reviews the efficacy of neuroleptics, antidepressants (TCA, MAOI and SSRI), lithium carbonate, carbamazepine and benzodiazepines against these 4 symptom domains. There is currently no single drug treatment of choice in BPD. Current research supports acute treatment. Maintenance trials are generally lacking or show limited efficacy. A dimensional approach is recommended for clinical practice and future research trials, targeting specific symptom domains with selective medication. Pharmacotherapy should be viewed as a useful adjunct to psychotherapy in the long-term treatment of the borderline patient.

Antidepressive Agents, Tricyclic↗
PubMed1994

Cognitive therapy in the treatment of patients with borderline personality disorders.

Cognitive therapy, originally conceived for the treatment of emotional illnesses, has been successively used also in treating patients with more severe mental disorders. In this article, the results obtained by Shearin & Linehan (this volume) in a few controlled trials of dialectical behavior therapy in patients with borderline personality disorders are discussed. Differences between the treatment approach followed by Shearin & Linehan, which focuses on the modification of specific behaviors, and that favored by the author, which is aimed at restructuring dysfunctional working models of self and environment, are highlighted. In the conclusion it is emphasized that the use of a structured, didactic and cognitive-behaviorally oriented approach focused on personal growth might represent an important and much wanted breakthrough in the treatment of the most disturbed patients with a borderline personality disorder.

Borderline Personality Disorder↗
PubMed1990

Finding the borderline's border: can Martha Rogers help?

The psychodynamics of the client with a borderline personality disorder are reviewed within the context of Martha Rogers' Model of Unitary Human Beings. Emphasis is placed on the phenomena of transference and countertransference, which are viewed as resulting from the continual mutual interaction of human and environmental energy fields. Nursing interventions are postulated based on recognition of the fact that the nurse constitutes a significant part of the borderline client's environmental energy field.

Adolescent↗
PubMed1996

Cognitive therapy for antisocial and borderline personality disorders: single case study series.

Cognitive therapy for affective disorders has been recently adapted and developed for the treatment of personality disorders. In the present study, a specific and detailed cognitive therapy treatment manual for borderline and antisocial personality disorders was evaluated in a pilot study. The results of a single case series demonstrate that important clinical changes in dysfunctional behaviour and attitudes can be achieved with short-term cognitive therapy in patients with antisocial and borderline personality disorders, although these were not, on the whole, statistically significant.

Adult↗
PubMed1982

The theory of transitional phenomena and its application to the psychotherapy of the borderline patient.

Winnicott's theory of transitional phenomena is outlined and the various meanings of the term transitional phenomena are indicated. The psychotherapeutic applications of his theory to the treatment of borderline patients, particularly the implications for the functions, language and timing of verbal interventions are then explored. Finally, his ideas are briefly compared with those of other therapists currently influential in the theory and therapy of borderline patients.

Borderline Personality Disorder↗
PubMed2002

Ocular complications in newly diagnosed borderline lepromatous and lepromatous leprosy patients: baseline profile of the Indian cohort.

AIM: To describe ocular manifestations in newly diagnosed borderline lepromatous (BL) and lepromatous leprosy (LL) patients in India. METHODS: Ocular complications, at enrolment, occurring in all new borderline lepromatous and lepromatous leprosy patients detected by active case finding within the geographically defined leprosy endemic area of the Gudiyattam Taluk in India from 1991 to 1997 who consented to ocular examinations every 6 months, during and 5 years after treatment with multidrug therapy (MDT), were studied. RESULTS: Orbicularis oculi weakness (4.62%), lagophthalmos (4.20%), ectropion (0.42%), trichiasis (0.84%), blocked nasolacrimal ducts (1.68%), pterygium (11.34%), impaired corneal sensation (53%), corneal opacity (10.5%), corneal nerve beading (1.68%), punctate keratitis (1.26%), keratic precipitates (4.62%), iris atrophy (1.68%), and cataract (12.6%) were ocular complications seen in the 301 lepromatous patients at enrolment. 4.6% had blind eyes. Increasing age was associated with ocular complications. 80% of patients were skin smear acid fast bacilli (AFB) positive. The LL/BL ratio was 1:6.4. 71% had some limb deformity. 44% had only leprosy related ocular complications (LROC), 28% had only general ocular complications (GOC) while 14% had both LROC and GOC. Ocular complications were significantly related to leg deformities. Corneal nerve beading was seen most in LL patients (100%) having high bacterial content. Lagophthalmos and muscle weakness were associated with reversal reactions. CONCLUSIONS: Corneal nerve beading occurs in LL patients with high bacillary count. Patients with reversal reaction are more likely to present with orbicularis oculi weakness and lagophthalmos. Leprosy related ocular complications and general ocular complications are significant problems in newly diagnosed lepromatous patients. Elderly, deformed, skin smear positive, lepromatous patients are associated with increased ocular morbidity and form a group that require acceptable and accessible eye care.

Adolescent↗
PubMed1998

CSF monoamine metabolites in relation to the diagnostic interview for borderline patients (DIB).

The cerebrospinal fluid concentrations of the monoamine metabolites 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid (HVA), 3-methoxy-4-hydroxyphenylglycol, and their ratios were studied in relation to the Diagnostic Interview for Borderline patients (DIB) evaluated retrospectively from hospital records for a sample of 202 patients participating in psychobiological programs on mood disorders. No correlations with the total DIB score were significant. Patients with borderline personality disorder (BPD) defined by a total DIB score of at least 7 or 6, respectively, did not differ significantly from non-BPD regarding the metabolites. However, for section II (impulse action pattern) of the DIB, those with an intermediate value of the section score had significantly higher levels of 5-HIAA and HVA, suggesting that such higher than normal concentrations may be protective against impulsive or suicidal behavior generated by an underlying psychiatric morbidity due to other risk factors.

Biogenic Monoamines↗
PubMed2004

Dissociative symptoms in schizophrenia: a comparative analysis of patients with borderline personality disorder and healthy controls.

The aim of this study was to investigate the occurrence of dissociative symptoms in patients with a schizophrenic disorder. The pattern of dissociative experiences was examined in a group of patients with a diagnosis of the schizophrenia spectrum disorder (n = 26; mean age 27.9 years), and a group of patients with a diagnosis of borderline personality disorder (n = 26; mean age 24.0 years) was compared with normal controls of the general population (n = 1,056; mean age 18.7 years). The degree of self-reported dissociative symptoms was measured using the German version of the Dissociative Experiences Scales. The dissociation scores were significantly higher among patients with a diagnosis of borderline personality disorder compared to the group of schizophrenic patients and to the control group. There was no difference in the degree of reported dissociative experiences between the group of schizophrenic patients and the normal volunteers. An analysis of the subdimensions (dissociative amnesia, absorption/imaginative involvement, depersonalization/derealization) of the scale revealed the same strong distinctions between the investigated groups. There was no evidence that dissociative symptoms reflect a specific vulnerability in young schizophrenic patients.

Adolescent↗
PubMed2005

Defining the mechanisms of borderline personality disorder.

Understanding the biological connections to mental processes was one of the original goals of psychoanalysis, and the development of cognitive and affective neuroscience and its methods might contribute to actualizing this goal. Personality disorders provide an opportunity to examine the complex mental structures of individuals experiencing extreme difficulties in interacting with their social environment. We provide initial information on a collaboration exploring an approach to one of the most serious personality disorders, borderline personality disorder, based upon the study of normal attention, individual differences in temperament, self definition and attachment organization, with the potential to illuminate the psychology and psychobiology of the disorder and to contribute to psychotherapeutic intervention. This developing model of borderline personality disorder can relate the symptoms to more enduring temperamental aspects of the patients. The goal is to understand the development of neural networks that underlie the abnormalities of adults, and eventually work out the interaction between temperament, genes, and experience that produce the disorder, and potentially inform intervention.

Borderline Personality Disorder↗