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PubMed2005

Linguistic adaptation and validation into Spanish of the Diagnostic Interview for Borderline Personality Disorders-Revised (DIB-R).

OBJECTIVE: This paper describes the linguistic adaptation and psychometric validation into Spanish of the Diagnostic Interview for Borderlines-Revised (DIB-R) scale for diagnosing borderline personality disorder (BPD). METHODS: A conceptual equivalence approach was undertaken, including forward and backward translations of the scale and patient debriefing in a pilot phase. BPD and control patients were included in the validation study, and all of them were administered the scale by well trained interviewers, blinded to the clinical diagnosis. Reference diagnosis for BPD was done according to DSM-IV criteria. The interview was independently administered in a subset of patients by different interviewer to test inter-rater reliability . Reliability and validity of the instrument were tested by calculating the Cronbach alpha and Guttman split-half coefficients and by receiver operating characteristic (ROC) curve analysis, kappa agreement coefficient determination and assessment of sensitivity and specificity of the scale. RESULTS: A cohort of 111 subjects, 84 BPD patients (33.6 +/- 9.3 years) and 27 control subjects (34.9 +/- 9.3 years), were included in the study. A cut-off point > or = 7 showed a kappa agreement coefficient of 0.853 (95% confidence intervals: 0.739-0.967, p < 0.00001). The figures for sensitivity and specificity values were 0.964 (0.899-0.993) and 0.889 (0.708-0.977) respectively. Inter-rater reliability showed a kappa coefficient of 0.783 (p < 0.0001). CONCLUSION: The Spanish version of the DIB-R showed adequate psychometric properties for diagnosing BPD in Spain.

Adult↗
PubMed1987

Borderline personality. A review of recent research.

Borderline personality has been, for many years, a discredited diagnostic concept. In 1979 a review of the literature concluded that its validity status was very uncertain. The authors have reviewed research conducted since then and discuss it in terms of the Robins & Guze (1970) criteria. In spite of existing unclear issues, the balance is tipping in favour of the validity of borderline personality, as diagnosed with new research criteria. This development is taking place in the context of a growing interest in the area of personality disorders.

Borderline Personality Disorder↗
PubMed1991

Borderline and schizotypal disorders in children and adolescents.

Until recently, research on borderline disorder in children has sought the common denominator of the symptoms. In recent years there have been attempts to circumscribe the definition with the help of DSM-III criteria and the DIB. This approach appears fruitful. The scanty data on schizotypal children suggest that the validity of this diagnosis in childhood should be investigated. In adolescence it is possible to discern those with borderline and schizotypal disorders whose symptoms meet both DIB and DSM-III-R criteria respectively. No data exist, however, concerning the predictive validity of such disorders in adolescents. Classification on an empirical basis is advocated in order to refine the diagnosis of these and related disorders in children and adolescents.

Adolescent↗
PubMed1985

Discriminant validity of the MMPI for borderline personality disorder.

This study explores the discriminant validity of the MMPI in relationship to the DSM-III and the Diagnostic Interview for Borderlines (DIB) constructs of Borderline Personality Disorder (BPD). A two-way analysis of variance model assessed differences between inpatients (n = 42) and outpatients (n = 42) and between BPD and nonBPD patients. We compare the best discriminant model for the current samples with previous BPD discriminant functions. The present study assesses a wider range of psychopathology in which the MMPI appears to be relatively insensitive to the BPD construct while retaining the high specificity reported in previous studies. Implications for the use of the MMPI as a diagnostic instrument are discussed.

Adult↗
PubMed1988

The borderline personality disorder and gay people.

This paper examines the diagnostic category called Borderline Personality Disorder (BPD) and its relationship to gay people. It discusses the psychoanalytic definition of borderline personalities, and to it adds a cultural definition. In the light of these cultural variables, the diagnosis is defined as a metaphor for the complexities and confusions of modern life. These confusions are important in the lives of gay people, who, it is suggested, are currently more prone to be diagnosed as BPD. Through the life study of a gay man, both the psychoanalytic and cultural variables are identified, then generalized to the problems of gay people in our transitional society.

Adult↗
PubMed1999

The identification and characteristics of the partially dissociated states of patients with borderline personality disorder.

A developmental and structural model of borderline personality disorder is described. Partial dissociation provoked by trauma and deprivation in childhood is seen to result in the persistence of separate self states. The characteristics of these and alternations between them are seen to account for the main features of the condition. The identification and characterization of states through clinical procedures and the use of the states grid are described and case illustrations are given. The states identified by the grid method in a series of 20 borderline patients are described and classified into six groups, named abuser rage, victim rage, passive victim, ideal, coping and zombie. The clinical value and nosological implications of the model and these findings are briefly discussed.

Adult↗
PubMed2001

Autobiographical memory and parasuicide in borderline personality disorder.

BACKGROUND: Several studies have found that parasuicidal patients are poor at recalling specific autobiographical memories when tested with the word-cueing paradigm and two studies have reported some evidence that over-general recall is a risk factor for repetition of parasuicide. The aim of the present study was to test whether this association could be replicated with a sample of patients suffering from borderline personality disorder (BPD). METHOD: Twenty-three patients with BPD completed a version of the Autobiographical Memory Test (AMT) and self-report measures of depression, anxiety and trait anger. In a structured interview, they also reported the number of times they had engaged in parasuicidal acts during the previous 4 months. RESULTS: The number of general memories produced on the AMT made a significant contribution to the prediction of the frequency of parasuicidal acts in a multiple regression analysis but the partial correlation in the final equation was negative. That is, those who showed greatest over-general recall reported fewest parasuicidal acts. Anxiety and depression, but not trait anger, also made significant independent contributions to the prediction of parasuicide. CONCLUSION: Over-general autobiographical recall may help to protect borderline individuals from parasuicidal acts by helping them to avoid distressing memories.

Adolescent↗
PubMed2006

Resolving threats to the therapeutic alliance in cognitive analytic therapy of borderline personality disorder: a task analysis.

BACKGROUND: Alliance ruptures and premature drop out from psychotherapy are very common with patients who have a diagnosis of borderline personality disorder, limiting the clinical effectiveness of treatment. AIM: To test and refine a model of how therapists successfully resolve threats to the therapeutic alliance involving enactment of problematic relationship patterns in the cognitive analytic therapy of borderline personality disorder. METHOD: Task analysis (Greenberg, 1984a) of 107 enactments from 66 sessions in four good outcome cases, compared with 35 enactments from 16 sessions in two poor outcome cases. This systematically compares a rational model of process with empirically coded transcripts of therapy sessions where independent raters have identified an alliance threat event. RESULTS: The process stages of the rational model were observed, and 20 refinements were made, including a new process stage, heuristic principles and 'when-then' steps. Therapists were found to cycle between stages. Therapists in good outcome cases recognized the majority of these enactments and focused attention to them in contrast to poor outcome cases where therapists usually failed to notice or draw attention to the alliance threat and did not adhere to the model. CONCLUSION: Competent resolution of alliance-threatening events is crucially dependent on therapists' ability to recognize them, and secondarily on their adherence to the principles in the refined model. The model is consistent with prior research and can be used in supervision and quality improvement strategies.

Adolescent↗
PubMed2003

Antithyroid antibody-linked symptoms in borderline personality disorder.

Circulating thyroid autoantibodies are more prevalent in patients with mood disorders than in the general population, but longitudinal clinical data that establish a relationship between thyroid antibody status and the course of any psychiatric syndrome have been lacking. In addition, scant attention has been paid to thyroid hormones and autoimmunity in borderline personality disorder (BPD). We report a case of a patient with classic BPD whose fluctuating mood and, especially, psychotic symptoms-rated using a double-blind method-were directly linked to antithyroglobulin antibody titers serially determined over an inpatient period of 275 d. Significantly lower psychosis and depression ratings were seen during a 4-wk period of relatively low antithyroid antibody titers, during blinded treatment with carbamazepine, than were observed during two high autoantibody epochs. The significant positive correlations between nurse- and patient-rated depression and thyroid autoantibodies over the entire period of inpatient study were similar to those also observed between urinary free cortisol levels and depression; the positive correlation between antithyroglubulin antibody titers and psychotic symptoms was stronger (r = +0.544; p < 0.002). Although this patient had biochemical indices of primary hypothyroidism, she showed only marginal improvement to triiodothyronine (T3) and no apparent clinical response to sustained levorotatory thyroxine (T4) administration; neither were antithyroid antibody titers significantly associated with changes in T3, free T4, or thyroid-stimulating hormone concentrations. She clinically deteriorated during a 50-d fluoxetine trial. The present data demonstrate a clinically significant, longitudinal correlation between fluctuating antithyroid antibody titers and symptoms of borderline psychopathology in our patient. It will be of interest to determine the prevalence, pathophysiologic mechanisms, and treatment implications of this putative autoimmune- BPD link.

Adult↗
PubMed2005

Borderline personality disorder.

Borderline personality disorder is a chronic psychiatric disorder characterized by marked impulsivity, instability of mood and interpersonal relationships, and suicidal behaviour that can complicate medical care. Identifying this diagnosis is important for treatment planning. Although the cause of borderline personality disorder is uncertain, most patients improve with time. There is an evidence base for treatment using both psychotherapy and psychopharmacology. The clinical challenge centres on managing chronic suicidality.

Adult↗
PubMed2006

Sense of reality, reality testing and reality processing in borderline patients.

Although borderline patients are suitable for it, they often undergo repeated testing of fantasies against objective reality without success. A reason for these partial failures is that subjects have not been able to build a solid sense of reality and have found many difficulties for processing reality demands and possibilities. The author puts forward some thoughts on this question, such as the importance of working through the depressive position and the Oedipus complex in the process of building up a solid sense of reality. A sense of reality also favours continuous reality processing. When reality processing becomes as continuous as life itself, the repetition of individual reality tests becomes less frequent and necessary, and more satisfying. The author also presents some recommendations for the psychoanalytic treatment of such patients, stressing the importance and the difficulties of the introduction of the borderline patient into the triangular situation because primitive defences--such as disavowal and denial--are mobilized.

Adult↗
PubMed2001

Psychodynamic psychotherapy of borderline personality disorder: a contemporary approach.

Recent trends in the economics of mental health care threaten to undermine the use of psychodynamic psychotherapy for the treatment of patients with borderline personality disorder. These trends are driven in part by the assumption that such treatment of these challenging patients is very expensive. The author highlights empirical research that supports both the usefulness and the cost-effectiveness of this treatment approach. He also reviews some effective clinical strategies with borderline patients.

Adult↗
PubMed2003

The development of an attachment-based treatment program for borderline personality disorder.

The treatment of borderline personality disorder (BPD) remains controversial. The authors have developed an evidence-based treatment program rooted in attachment theory that integrates research on constitutional factors with environmental influences. BPD is conceived of as a disorder in the self-structure brought about through environmentally induced distortion of psychological functioning, which decouples key mental processes necessary for interpersonal and social function. The primary mental function involved is mentalization, which is enfeebled by an absence of contingent and marked mirroring during development. Treatment strategies target mentalization in order to foster the development of stable internal representations, to aid the formation of a coherent sense of self, and to enable to borderline patient to form more secure relationships in which motivations of self and other are better understood. Destabilization of the self leads to emotional volatility, so treatment also needs to focus on identification and appropriate expression of affect. This article describes some of the techniques used to enhance mentalization within the context of group and individual psychotherapy. Targeting of current symptomatology and behavior is insufficient. Therapists need to retain their own ability to mentalize, maintain mental closeness, focus on current mental states, and avoid excessive use of conflict interpretation and metaphor while paying careful attention to the use of transference and countertransference.

Affect↗
PubMed2001

The impact of borderline personality disorder on process group outcome among women with posttraumatic stress disorder related to childhood abuse.

The outcome of a 12-week interpersonal process group therapy for women with postraumatic Stress Disorder (PTSD) related to childhood sexual abuse with and without borderline personality disorder (BPD) was assessed by comparing three naturally occurring treatment conditions: groups that did not have any members with borderline personality disorder (BPD-) (n = 18), groups in which at least one member carried the diagnosis (BPD+)(n = 16), and a 12-week waitlist (WL) (n = 15). PTSD, anger, depression, and other symptoms were significantly reduced in the BPD- groups. However, the BPD+ and WL conditions did not show any pre- to posttreatment improvements. Furthermore, the BPD+ condition showed a significant worsening on measures of anger. Analyses within the BPD+ condition indicated that women with and without the diagnosis experienced equal posttreatment increases in anger problems. These latter results suggest the presence of an anger "contagion" effect. That is, women without BPD did well in the BPD- groups but showed increased anger similar to the BPD+ women when treated in groups with them. Implications for client-treatment matching considerations in PTSD group therapy are discussed.

Adult↗
PubMed1992

Incest, Freud's seduction theory, and borderline personality.

In the early 1890s Freud expressed the belief that many cases of hysteria had a basis in childhood incest. Later he expressed a different view, emphasizing childhood fantasies of sexual intimacies with a parent that never actually took place. Freud never totally repudiated his original seduction theory, however, maintaining to the end of his life that at least some cases of actual incest occurred and that these instances underlay certain types of psychopathology. In our era we have become aware that incest is frequently a forerunner of subsequent borderline disorders, especially in women hospitalized with borderline personality disorder (B.P.D.). All the clinical manifestations of B.P.D. can be related to the prior incest experiences.

Battered Child Syndrome↗
PubMed2001

Are the interpersonal and identity disturbances in the borderline personality disorder criteria linked to the traits of affective instability and impulsivity?

This study examines the degree to which two putative biologically influenced personality traits, affective instability and impulsive aggression, are associated with some of the interpersonal and intrapsychic disturbances of borderline personality disorder (BPD) and with choice of defense mechanism. In a sample of 152 personality disorder patients, affective instability and impulsive aggression were measured. Defense mechanisms were assessed in 140 of these patients using the Defensive Style Questionnaire (DSQ). The correlations between the traits of affective instability and impulsive aggression and the eight DSM-III-R criteria for borderline personality disorder and 20 DSQ defenses were examined. Affective instability was significantly correlated with the DSM-III-R criteria of identity disturbance, chronic emptiness or boredom, inappropriate anger, suicidality, and the affective instability criteria. It also was associated with the defenses of splitting, projection, acting out, passive aggression, undoing, and autistic fantasy. Impulsive aggression was related to unstable interpersonal relationships, inappropriate anger and impulsiveness and with the defense of acting out. It was negatively correlated with the defenses of suppression and reaction formation. A number of the interpersonal and experiential disturbances and defense mechanisms that are features of BPD are associated with the traits of affective instability and impulsive aggression among patients with personality disorders.

Adult↗
PubMed2001

The development of a psychodynamic treatment for patients with borderline personality disorder: a preliminary study of behavioral change.

This study examines the effectiveness of a modified psychodynamic treatment called Transference Focused Psychotherapy (TFP) designed specifically for patients, with borderline personality disorder (BPD). Twenty-three female patients diagnosed with DSM-IV BPD began twice-weekly TFP. Patients were assessed at baseline and at the end of 12 months of treatment with diagnostic instruments, measures of suicidality, self-injurious behavior, and measures of medical and psychiatric service utilization. Compared to the year prior to treatment, the number of patients who made suicide attempts significantly decreased, as did the medical risk and severity of medical condition following self-injurious behavior. Compared to the year prior, study patients during the treatment year had significantly fewer hospitalizations as well as number and days of psychiatric hospitalization. The dropout rate was 19.1%. This uncontrolled study is highly suggestive that this structured and manualized psychodynamic treatment modified for borderline patients shows promise for the ambulatory treatment of these patients and warrants further study.

Adaptation, Psychological↗
PubMed2001

Predicting self-damaging and suicidal behaviors in female borderline patients: reasons for living, coping, and depressive personality disorder.

The aims of this study are to examine (1) whether reasons for living predict self-damaging and suicidal behaviors, (2) the associations of reasons for living with coping strategies and depressive personality disorder (PD), and (3) the unique predictive validity of reasons for living in a multivariate predictor model. Reasons for living (RFL), coping strategies, and depressive personality disorder were measured at baseline in 38 patients who met DSM-IV criteria for borderline personality disorder (BPD). Frequency of self-damaging and suicidal behaviors in the 6-month period following baseline was measured prospectively at 3- and 6-month follow-ups. The RFL has only one subscale that predicts parasuicidal behaviors (i.e. Survival and Coping Beliefs [SCB]). Participants who scored low on this subscale were 6.8 times more likely to exhibit self-damaging and suicidal behaviors in the follow-up period than their high-scoring counter-parts. However, SCB was substantially correlated with the coping strategies "reassuring thoughts," "active coping," and "palliative reaction pattern," as well as with depressive personality traits. In a multivariate model, the predictive power of SCB appeared to be accounted for by reassuring thoughts and depressive PD. Coping scales might be preferable over the RFL as a predictor of self-damaging and suicidal behaviors in borderline patients.

Adaptation, Psychological↗