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PubMedDate not supplied

Memories of abuse in borderline patients: true or false?

This review will examine issues related to the validity of memories of child abuse in patients with borderline personality disorder (BPD). A large body of research has shown that all memories are distorted by cognitive schema, and that "recovered memories" may be particularly unreliable. Empirical findings on trauma in BPD will be reviewed, as well as the difficulties in verifying trauma histories. Evidence will be examined suggesting that borderline patients have a distorted perception of interpersonal events. Clinical recommendations will be made for the evaluation of memories of abuse in patients with BPD.

Borderline Personality Disorder↗
PubMed2004

Olanzapine versus placebo in the treatment of borderline personality disorder.

BACKGROUND: Atypical antipsychotics are increasingly used in clinical practice in the management of borderline personality disorder (BPD), and a small but growing body of literature supports their efficacy. Here, we report the results of a double-blind, placebo-controlled study of olanzapine as a treatment for BPD. METHOD: Forty BPD patients (25 female, 15 male) were randomly assigned in equal numbers to olanzapine and placebo. Diagnoses were made using the Structured Clinical Interview for DSM-IV Axis II Personality Disorders and the Mini-International Neuropsychiatric Interview. Patients with schizophrenia, bipolar disorder, or current major depression were excluded. Olanzapine dosage was flexible, and the dose range was 2.5 to 20 mg/day, with most patients receiving 5 to 10 mg/day. No concomitant psychotropic medications were allowed. Patients were assessed at baseline and at 2, 4, 8, and 12 weeks. The primary outcome was change in the total score for the 9 BPD criteria on a 1-to-7 Likert scale, the Clinical Global Impressions scale modified for borderline personality disorder (CGI-BPD), using an analysis of covariance model including baseline score as covariate. Data were collected from July 2000 to April 2002. RESULTS: Olanzapine was found to be significantly (p <.05) superior to placebo on the CGI-BPD at endpoint, with separation occurring as early as 4 weeks. Similar results were found for the single-item Clinical Global Impressions scale. Weight gain was significantly (p =.027) greater in the olanzapine group. CONCLUSIONS: This study supports the efficacy of olanzapine for symptoms of BPD in a mixed sample of women and men. Further studies with olanzapine and other atypical antipsychotics are needed.

Adolescent↗
PubMed2004

Combined dialectical behavior therapy and fluoxetine in the treatment of borderline personality disorder.

BACKGROUND: This study examines the therapeutic effect of fluoxetine, a selective serotonin reuptake inhibitor, added to dialectical behavior therapy (DBT), an empirically supported psychosocial therapy, for the treatment of borderline personality disorder. METHOD: This is a 12-week, randomized, double-blind, placebo-controlled study of patients with borderline personality disorder (identified using the Structured Clinical Interview for DSM-IV Axis II Disorders). All subjects received individual and group DBT. Of the 20 subjects that completed treatment, 9 were randomly assigned to receive up to 40 mg/day of fluoxetine and 11 were randomly assigned to the placebo condition. Subjects were evaluated at baseline and at week 10 or 11 on self-report measures of depression, anxiety, anger expression, dissociation, and global functioning. The study was conducted between January 1998 and February 2000. RESULTS: Time-by-group interaction effects revealed no significant group differences in scores from pre-treatment to posttreatment on any measure. However, within the DBT/placebo group, there were significant pretreatment/posttreatment differences in the direction of improvement on all measures. No significant pre-treatment/posttreatment differences were found within the DBT/fluoxetine condition. CONCLUSION: The data suggest that adding fluoxetine to an efficacious psychosocial treatment does not provide any additional benefits. Further studies with larger sample sizes are warranted.

Adult↗
PubMed2005

Open-label study of atypical neuroleptic quetiapine for treatment of borderline personality disorder: impulsivity as main target.

BACKGROUND: Recent studies indicate that atypical neuroleptics may be safe and useful in treating many symptoms of borderline personality disorder (BPD), including impulsivity, which can constitute the core dimension of this pathology. This study aimed to evaluate the efficacy and safety of quetiapine in patients with well-defined BPD. It was hypothesized that quetiapine would reduce impulsivity (primary hypothesis) and also affective and micropsychotic symptoms, resulting in improved social and global functioning (secondary hypothesis). METHOD: Twenty-three outpatients with BPD according to DSM-IV criteria and the revised Diagnostic Interview for Borderlines completed a 12-week open-label study with quetiapine. The study was conducted from May 2001 to May 2003. The clinical efficacy was assessed using the following: Hamilton Rating Scales for Depression and Anxiety, Hopelessness Scale, Brief Psychiatric Rating Scale, Barratt Impulsivity Scale, Buss-Durkee Hostility Inventory, Temperament and Character Inventory, Social Adjustment Scale, and Global Assessment of Functioning. RESULTS: The mean daily dose of quetiapine (251 +/- 50 mg; range, 175-400 mg) was well tolerated. Impulsivity was significantly improved by quetiapine (p = .0015), as were most of our outcome measures: hostility, depression, anxiety, character dimensions, and social and global functioning (p < .05). In the small subgroup of patients with psychotic symptoms at baseline, there was a significant reduction in these symptoms (N = 8, p = .018). CONCLUSION: In a sample of patients with severe BPD without or with only few psychotic symptoms, a low dose of quetiapine was associated with a strong positive clinical impact, including improvement of impulsivity.

Adolescent↗
PubMedDate not supplied

Managing the 'unmanageable': training staff in the use of dialectical behaviour therapy for borderline personality disorder.

Ninety-four staff from a regionally based mental health service and associated health and human services completed a two-day workshop introducing dialectical behaviour therapy, with a smaller number also undertaking advanced training. Survey and focus group data were collected on participants' demographics, attitudes, knowledge and experience of working with persons with this disorder, prior to and at one-month and six-months following completion of the introductory workshops. Quantitative and qualitative findings indicated that involvement in the training program was a positive experience for the majority of participants, with knowledge regarding detection and treatment and staff attitudes toward consumers being improved following exposure to the principles and practice of dialectical behaviour therapy. Discourse analysis of the focus group interview data pre- and post-training indicated a significant shift in the meanings staff associate with borderline personality disorder, with a pervasive therapeutic pessimism being displaced by more optimistic understandings and outlooks. Improved therapeutic outlook is likely to have positive implications for staff engagement with service users with borderline personality disorder. While this article provides a brief overview of the findings of the survey, the main purpose is to report the findings of the focus group interviews.

Adult↗
PubMed2004

[Crisis interventions with patients with borderline personality disorder. Part 1: Preventive and resolving approaches in individual psychodynamic therapy].

Patients suffering from borderline personality disorder have by definition a poorly functional personality which is readily reacting to changes and psychosocial stressors with recurrent crises. A personality disorder is necessarily fraught with interpersonal difficulties, and it is often within the individual psychotherapeutic encounter that such clashes develop. This article discusses basic principles offering clinicians ways to prevent or structure crisis intervention adapted to borderline personality disorder within the individual psychotherapy context. It thus reviews various clinical issues such as suicidal or homicidal threats, conflicts related to requests expressed by the patient, the absence of the therapist or attempts at breaking the therapeutic framework in order to offer intervention modalities for the resolution of these crises.

Borderline Personality Disorder↗
PubMedDate not supplied

Using mentalisation to treat patients with borderline personality disorder.

This article provides an overview of personality disorders, before focusing on borderline personality disorder. The role of mentalisation in the development of borderline personality disorder is explored. It is suggested that mentalisation-based treatment can greatly improve outcomes for patients.

Adult↗
PubMed1991

Treatment of the borderline patient in partial hospitalization.

Current reimbursement trends are forcing a search for less expensive alternatives to hospitalization for the mentally ill. Much of the literature on the treatment of patients with severe borderline personality disorders has focused on inpatient treatment, often on the pros and cons of long-term versus short-term programs. Little has been written about the treatment of patients with borderline disorders in partial hospitalization programs. This paper emphasizes the usefulness of such a setting and describes its staffing, program components, and approaches for intensive reconstructive treatment. Special emphasis is placed on admission and discharge boundaries, careful coordination of treatment, and crisis management.

Borderline Personality Disorder↗
PubMed1999

Managing aggressive behavior in patients with obsessive-compulsive disorder and borderline personality disorder.

Obsessive-compulsive disorder (OCD) is one of the most common psychiatric disorders, occurring in 2% to 3% of the U.S. population. Borderline personality disorder is found in 2% of the U.S. population. These disorders denote the endpoints on a spectrum of compulsive and impulsive disorders. One endpoint marks compulsive or risk-aversive behaviors characterized by overestimation of the probability of future harm, highlighted by OCD. The other endpoint designates impulsive action characterized by the lack of complete consideration of the negative results of such behavior, such as borderline and antisocial personality disorders. This article examines studies testing the efficacy of different medications in treating compulsive and impulsive disorders. Mood stabilizers such as divalproex, selective serotonin reuptake inhibitors, monoamine oxidase inhibitors, and neuroleptics have documented efficacy in treating aggression and affective instability in impulsive patients.

Aggression↗
PubMed2000

Exploring the inner world of self-mutilating borderline patients: a Rorschach investigation.

Psychiatric patients who engage in self-destructive behavior by cutting, burning, or abrading their skin are currently one of the most difficult-to-treat groups in both inpatient and outpatient settings. The complexities of treating these patients, the risk factors associated with this symptom, and the rise in the prevalence of self-mutilation in America's adolescents and young adults provided the impetus for the current study. This article explores aspects of aggression, dependency, object relations, defensive structure, and psychic boundary integrity that may contribute to the genesis and maintenance of self-mutilation. Rorschach protocols from 90 borderline personality-disordered inpatients (48 self-mutilators and 42 non-self-mutilators) were scored using five psychoanalytic content scales. Results indicate that self-mutilating patients exhibit greater incidence of primary process aggression, severe boundary disturbance, pathological object representations, defensive idealization, devaluation, and splitting than did a matched group of non-self-mutilating borderline patients. Clinical theory and technical recommendations are considered in light of the current empirical findings.

Adult↗
PubMed2001

An investigation of the psychological characteristics of stalkers: empathy, problem-solving, attachment and borderline personality features.

This study examined the psychological characteristics of a sample of self-reported stalkers in comparison with a control group, on measures of empathy, problem-solving skills, attachment, and borderline personality features. Stalkers were identified by their endorsement of specific behavioral items, consistent with a widely adopted definition of stalking, denoting behaviors that: (a) are repeatedly directed toward an identified target; (b) are intrusive and unwanted; and (c) evoke fear in the victim. Stalkers scored significantly higher than controls on measures of insecure attachment and borderline personality features, suggesting that the stalking group demonstrates a general pattern of inadequate interpersonal attachment, has limited abilities to form and maintain appropriate relationships, is emotionally labile and unstable, and experiences ambivalence regarding their interpersonal relationships. Treatment implications are discussed herein.

Adolescent↗
PubMedDate not supplied

[Biological markers in schizotypal and borderline personality disorders].

A preliminary but growing body of evidence supports the existence of biological substrates in personality disorders. Based on a review of the literature, the article deals with the major biological markers: genetic, cognitive, biochemical, electrophysiological and organic markers, of schizotypal and borderline personality disorders. In addition, the article compares these findings in these two types of pathological personality. In the field of genetics, we notice several indices in favour of a relationship between schizotypal personality disorder (SPD) and chronic schizophrenia. In contrast, in borderline personality disorder (BPD), indices were lacking for such a relationship between this disorder and one of the axis I diagnosis, or a clear genetic transmission. In the field of cognitive tests, we can note in both SPD and BPD, that the abnormalities which would be at the level of temporal and frontal lobes, may be implicated in the observable cognitive troubles in these two disorders. In the field of neurobiochemistry, the dopaminergic and serotonergic systems seem to be implicated in the etiology of SPD while several data point out the fact that several neurotransmitter systems (dopaminergic, serotonergic, noradrenergic and cholinergic) seem to be involved in the etiology of BPD. Finally, in the field of electrophysiology, we notice that some of these tests observed in SPD (smooth pursuit eye movements, evoked potentials, modification of the electrodermic response) seem reinforcing the relationship between SPD and schizophrenia while those observed in BPD seem reinforcing either a relationship between BPD and depression (sleep studies), or a relationship between BPD and schizophrenia (evoked potentials, smooth pursuit eye movements).

Biomarkers↗
PubMed2001

[Prevalence and structure of borderline mental disorders in adolescent groups].

328 schoolchildren and students of 13-17 years of age were examined by clinical epidemiological method. Point prevalence of borderline mental disorders and of their separate clinical forms were compared in two groups: pupils of secondary schools (148 cases) and students of the professional technical schools (PTS) (180 individuals). General prevalence of the borderline mental disorders was equal to 58.2%. It was higher in the group of pupils of secondary schools (66.7%) as compared with PTS students (49.3%). Neurotic disorders were more frequently found in pupils, while pathology of the personality--in PTS students. As the adolescent were of the same age and were under the influence of the same biologic factors (puberty period), the conclusion is made that the main factors in the formation of these differences were related to the social and cultural conditions.

Adaptation, Psychological↗
PubMed2002

[Borderline disorders in childhood and adolescence].

Borderline disorders are situated in the area between neurosis and (schizophrenic) psychosis. In psycho-analytical terms, a "borderline personality organization" is characterized by the following criteria: weak sense of identity, poor reality control, permeable ego boundaries, multifarious defense reactions to impulsivity, disturbed object-relatedness with inappropriate relationship to the environment, and the assumption of a disorder/trauma during early childhood. Some 90% of the children have a history of traumatization in the past, e.g. a severe illness or sexual abuse. Various models are used to explain the multifarious disorders. What can be compensated in childhood via so-called "emergency maturation" and adaptation to the prevailing situation, is far more difficult from early adolescence onward. Then, external regulators, such as alcohol or drugs play a greater role in the re-establishment of inner equilibrium.

Adolescent↗
PubMedDate not supplied

[Factors associated to the diagnoses of borderline personality disorder in psychiatric out-patients].

INTRODUCTION: Borderline personality disorder (BPD) is the most common personality disorder in clinical settings, however, this disorder presents diagnostic difficulties because of the own heterogeneous character. The purpose of this study was to describe and examine the possible relationship between clinic-psychobiographical aspects of the patients and diagnoses of BPD. METHOD: A transversal study was assessed in 73 psychiatric outpatients, by protocol of data collection about social and demographic aspects, psychobiographic aspects about childhood, sexual history and psychiatric earlier. International Personality Disorders Examination (IPDE) was used to evaluate the personality disorder. RESULTS: Borderline patients self-reported of traumatics experiences, physical and/or sexual abuse in childhood in more percentage than the group without BPD. Sexual identity disturbance and homosexual relations were associated with BPD. Psychiatry earlier of hospitalization, suicide attempts and substance use disorders were more frequent in BPD patients. CONCLUSIONS: These results suggest a profile that can be use to suspect a BPD and help to do precocious diagnoses.

Adolescent↗
PubMed1992

Specialized extended hospital treatment for borderline patients.

The intensive psychoanalytically oriented hospital treatment described by the authors was developed specifically for borderline patients. This unique treatment, an integrated multimodal approach, is based on the theory that the disturbed behaviors and relationships of borderline patients are manifestations of intrapsychic impairment. The authors use a detailed case report to illustrate how the theory is transformed into technical precepts and applied to all aspects of the treatment.

Activities of Daily Living↗
PubMed2003

[Postpartum borderline depressive states in women].

The study aimed at determination of the structure of postpartum depressions in mothers and specification of the influence of some social and personality factors on their development. Nineteen mothers with borderline depression presented 3 types of depressive disorders: "maternity blues" syndrome, anxiety and agitated depression. All the women were exposed to special psychotherapeutic intervention. The differences were found between the study and control groups by social indices. The patients of the former one were featured by higher frequencies of first delivery and unregistered marriages, and their care-taking behavior bore formal character when mother fulfilled punctually all medical recommendations ignoring individual child's needs. Being evaluated according to A. Fogel et al, the types of mother-child interactions were determined as follows: reciprocal (symmetrical)--6 cases; unipolar (asymmetrical)--6 (maternal--3 and children--3); formal--6; disharmonic (uncoordinated)--1. The authors conclude that family aspect of psychotherapeutic effect is extremely important for the treatment of patients with postpartum borderline depressions.

Borderline Personality Disorder↗
PubMed1992

Learning disabilities in children with borderline personality disorder.

Children with borderline personality disorder are known to have a variety of school problems, including low achievement. Clinicians working with these youngsters have estimated that one third or more may be learning disabled; however, no empirical studies have confirmed these estimates. The author reports the results of a study of 56 hospitalized borderline children in which score profiles from academic and cognitive measures were cluster analyzed. She examines the incidence of independent learning disabilities as well as subgroup membership, and discusses implications for treatment.

Achievement↗