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PubMed2004

[Alterations of symptoms with borderline personality disorder after fronto-temporal traumatic brain injury. A case study].

We report a case of borderline personality disorder in which severe self-mutilation, sense of futility and tendency to manipulate others disappeared after fronto (orbital cortex and dorso-lateral surface) temporal traumatic brain injury. The patient, a right-handed 34 year-old woman began having severe depressive moods, irritability, and performed recurrent self-mutilation by wrist cutting after her marriage at age 20. She was diagnosed as having borderline personality disorder. At the age of 30, she attempted to kill herself by leaping from a building, and sustained a frontotemporal traumatic brain injury. After 5 years of follow-up, she recovered from Wernicke's-like aphasia, but could not understand anything complex. She also showed disturbances of writing, calculating, attention, working memory, recent and remote memories, motivation, and sense of self. The results of tests of higher brain function were as follows: Wisconsin card sorting test (Keio version), C = 1, D = 2, P = 23; FAB (Frontal Assessment Battery) = 7/18; Trail making test B = impossible. Brain MRI demonstrated left frontal lobe (orbital cortex and dorso-lateral surface) contusions, severe atrophy in the left temporal cortex including the hippocampus and amygdala, and diffuse axonal injury in the left frontal white matter. Although her recurrent self-mutilation had disappeared after brain injury, a certain type of anxiety, which occasionally induced irritability, unstable moods and devaluation of others, occurred without any trigger once or twice a month. This anxiety continued two or three days and faded away within a week. Because of its frequency and duration, this anxiety can be considered to originate not from the traumatic brain injury, but from her intrinsic nature, and seems to be parallel to annihilation anxiety (Reich A, Klein M) and abandonment anxiety (DSM-IV). Because she showed this anxiety after a severe higher brain dysfunction including disturbances of language, attention, working memory, recent and remote memories, motivation, and sense of self, we considered this anxiety to be an unarticulated form of annihilation anxiety and abandonment anxiety.

Adult↗
PubMedDate not supplied

[Pharmacological treatment of borderline personality disorder].

Borderline personality disorder is characterised by a pervasive pattern of instability in affect regulation, impulse control, interpersonal relationships and self image. Clinical signs of the disorder include emotional dysregulation, impulsive aggression, repeated self-injury, and chronic suicidal tendencies, which make these patients frequent users of mental health resources. The treatment of this kind of patients (very dependent, with a great tendency to overestimating the power of the drugs prescribed) must be organized over a psychotherapeutic strategy, which will help them to deal with their troublesome relationships. The psychopharmacological approach is useful but is limited, giving the borderline patients a symptomatic relief. When the affective symptoms are the target, drugs like the SSRI antidepressants are the best choice. If the patient presents a behavioural discontrol pattern, then the psychiatrist will prescribe an SSRI alone or with a mood stabilizer or an antipsychotic. Finally, if the patient has transient psychotic symptoms, then the temporary use of typical or atypical antipsychotics is the rule.

Antidepressive Agents↗
PubMed1992

Borderline personality disorder: diagnosis and management in primary care.

Patients with borderline personality disorder frequently present to primary care physicians. However, the personality disorder, while complicating medical treatment, is often undetected. Symptoms and clinical presentations of this disorder are described. Common co-morbid psychiatric conditions associated with borderline personality disorder include depression and substance abuse. Physically self-damaging behaviors are also common among patients with this disorder. Guidelines for managing these patients in the hospital and ambulatory care clinic are provided.

Adult↗
PubMed1991

[Borderline mental disorders in chronic diseases of the digestive system in children and adolescents].

Based on studies into the mental sphere of gastroenterological patients aged 6 to 16 years, the author systematized borderline neurotic and personality disorders on the clinical and etiopathogenetic basis. The primarily psychogenic origin of the psychopathological symptomatology was recorded in 39.3% of the patients, the primarily somatogenic one in 33.2%. The syndrome of the neurotic phantom of somatic disease, which formed in 27.2% of neurotic patients is described. A concept of the mental constituent of a chronic disease is worded. A system of measures aimed at early diagnosis, correction, treatment and psychoprophylaxis of borderline conditions and psychosocial readaptation of patients is scientifically based.

Adolescent↗
PubMed2006

Treatment of borderline personality disorder with olanzapine.

Borderline personality disorder is one of the most problematic psychiatric disorders with aggressiveness and impulsivity as its two main characteristics. Our objective was to determine the efficacy of olanzapine on 20 patients with borderline personality disorder. Results were found to be affirmative in this respect.

Adult↗
PubMed2006

[Questionary research on individual psychotherapy of borderline personality disorder (BPD)].

The authors researched individual psychotherapy of borderline personality disorder (BPD) in Japan using a questionnaire given to expert therapists. To select the expert therapists, a database search for the keywords "borderline personality disorder" and "border-line case" was carried out in the Japanese literature on psychiatry and clinical psychology. Thus, 280 expert therapists, who were authors of articles related to the psychotherapy of BPD, were selected. Qestionnaires on individual psychotherapy of BPD were sent to them, and 128 responses were obtained. About 60% of these therapists were performing structured individual psychotherapy. This was about half of the psychiatrists and almost all of the clinical psychologists. Most of the structured psychotherapy was performed once a week, with 50 minute sessions. But there also were biweekly, 30-39 minute, 40-49 minute, and 20-29 minute sessions. The basic therapeutic methodology was psychoanalytic psychotherapy, supportive psychotherapy, and eclectic therapy, with each of them constituting about one third of the total, in this order of percentage. In the case of structured individual psychotherapy, what the majority of the therapists performed is as follows. They talked about therapeutic goals. When talking about therapeutic goals, the focus was on realistic issues such as improving social adaptation, controlling impulsive behavior or reducing the symptoms. In the face of self-harm behavior, they talked about the meaning and the utility of self-harm behavior, listened to the progression of the episodes, or said it was definitely not a good thing to do. If the self-harm behaviors were repeated, they told the patients that it was necessary for them to be confined to the closed-ward, or told them that the continuation of psychotherapy might become difficult. When there was intense anger toward the therapists, they validated the rightful parts of it. Concerning the anger and depression of the therapists, they restrained their feelings and considered them later, talked about it with their colleagues and experts, or communicated to the patients their honest feelings. In the case of frequent telephone calls, they told their patients to reduce their calls as much as possible, but when the calls came, talked with them briefly. Or they allotted the times the patients could make a call. Disclosure of the private information of the therapists was not done at all, or was done sometimes according to the situation. They actively talked about the limitations of the therapists and the patient-therapist relationship. They appreciated and praised the achievements of the patients. They talked about the termination of the psychotherapy. When they happened to meet the patients outside of the therapy, they responded to the patients only when they were addressed, or they addressed the patients by themselves but just briefly. The clinical situation of the BPD individual psychotherapy in Japan was not made clear so far. Our research clarified the situation, though there was the methodological limitation of the questionnaire research.

Adult↗
PubMed2006

[Suicidal behaviour in borderline personality disorder].

Patients with borderline personality disorder have a substantially increased risk of self-destructive and suicidal behaviour, and are often seen as difficult to treat efficiently. A strong over-sensitivity to negative happenings in life, affective instability and impulsiveness are important risk factors for repetitive suicidal crises. Clinicians need to assess the suicide risk for individuals in general and more situation-specific risks. If there is a high risk, short term hospitalisation should be considered. Most patients will need long-term specialised treatment rather than a series of shorter treatments that might well worsen the prognosis. Several treatment models are currently available; among them are Dialectical Behaviour Therapy and Mentalisation-Based Therapy. The paper discusses how these treatment models address suicidal behaviour in patients with borderline personality disorder and the results that have been achieved in studies of treatment effectiveness.

Behavior Therapy↗
PubMed1991

[The methodological characteristics of examining and treating patients with borderline mental disorders].

Discussed are problems of the methodology of diagnosing neuroses, neurosis-like and other borderline mental disorders. The necessity is emphasized of complex and systemic analysis of general somatic, psychological and psychopathological states. An important place is taken by dynamic analysis of the development of pathological states. The importance of these methodology problems for pathogenetic treatment of patients with borderline mental diseases is discussed.

Borderline Personality Disorder↗
PubMed1991

[Differential diagnosis of borderline in relation to schizophrenic and neurotic depressive disorders].

The results of studies to explore the discriminative validity of a german version of the "Diagnostic Interview for Borderlines" ("DIB" from Gunderson et al.) are reported. The DIB is suited to differentiate clinically diagnosed borderline personality disorders from schizophrenics and neurotic depressives. The concurrent validity of the DIB may be enlarged by modifications of the proposed scaling system.

Adult↗
PubMed1991

Rorschach indicators of chronic childhood sexual abuse in female borderline inpatients.

Recent research indicates a high incidence of childhood sexual abuse and incest among female patients with a diagnosis of borderline personality disorder (BPD). The author investigated the detection and long-term aftereffects of this abuse using a constellation of Rorschach scores that were predicted to occur more frequently in borderline patients with extended sexual victimization before age 14. Sixty-two subjects were divided into two groups (33 with and 29 without such a history) and compared on the following features: color-dominated percepts, primary-process content, confabulation, activity versus passivity, and two new scores related to dissociative symptoms. Some subjects were also administered the Dissociative Experiences Scale and the DSM-III Structured Clinical Interview for posttraumatic stress disorder. The sexually abused group had significantly higher scores both on the Rorschach features and on the clinical measures. The author contends that the identified Rorschach constellation reflects symptoms associated with these trauma-related syndromes, which are more central to the profile of BPD, both on psychological tests and clinically, than is generally recognized.

Adult↗
PubMed1991

[Borderline patients--management of self- and outwardly destructive behavior in inpatient pediatric and adolescent psychotherapy].

Destructive and self-injurious behavior among children and juveniles with borderline disturbances has brought institutions and staff members involved in child psychotherapy up against the limits of personal and institutional ability to deal with the situation. In order to be able to conduct productive therapy with these "borderline" cases, there is a need for critical examination of inpatient psychotherapy. The present study examines the background and effects of destructive behavior by means of two central types of psychological breakdown, "division" and "working off reactions". In different cases requiring therapy, such as the acting out of processes of division (expulsion, therapeutic isolation), the perpetuation of early behavior patterns, and malign regression, the study shows how important a clear organization of therapy and certain therapeutic attitudes are, particularly where these disturbances are concerned.

Adolescent↗
PubMed1990

Towards a revised theory of borderline object relations: contributions of empirical research.

Object-relations theories share a number of core assumptions that require reconsideration in the light of empirical data. These include the assumptions that (1) a continuum of development is isomorphic with a continuum of pathology, (2) the origin of severe character pathology lies in the pre-oedipal period, (3) certain features of borderline object relations (such as splitting and narcissism) are transcended normatively by the oedipal period, (4) 'object relations' is a unitary phenomenon or developmental line, (5) object-relational stages are culturally invariant, and (6) clinical data from pathological adults are necessary and largely sufficient for constructing and evaluating theories of object relations. Empirical research has begun to clarify the nature of borderline object relations as well as the development of normal and pathological object-relational functioning. Available data suggest a revised working model of the nature, development and pathology of object relations.

Borderline Personality Disorder↗
PubMed1990

[Borderline syndrome in the child].

The borderline syndrome was included in the DSM III as a distinct disease entity in 1980; this syndrome can also be found in children. The disease entity which lies between neurosis and psychosis is delineated based on pathogenesis and symptome. The decisive criterion for the diagnosis in children is the type of defensive mechanisms. In this case report three borderline children are presented. The etiologie has not yet been elucidated. The present therapie of choice is the analytically oriented psychotherapie.

Borderline Personality Disorder↗
PubMed1990

[Primary and secondary process thinking in normal probands, neurotic and borderline patients].

In the present paper normals, neurotics and borderline patients were compared with respect to primary and secondary process thinking. The Holtzman Inkblot Technique was used to assess the different modes of functioning. As it was expected, normals had more indicators of the most severe levels of primary process thinking than neurotics, but less than borderline patients. On the other hand it could be demonstrated that in normals the reality testing ability and synthetic functioning were not impaired compared to neurotics. In the contrary, the normals exceeded the neurotics concerning indicators of abstractive abilities. The results are discussed with regard to the hypothesis of a continuum of normal and deviant thinking and with regard to the concept of adaptive regression in the service of the ego.

Borderline Personality Disorder↗
PubMed1990

Associated diagnoses (comorbidity) in patients with borderline personality disorder.

The authors administered the Diagnostic Interview Schedule to 21 patients with borderline personality disorder. The patients met criteria for various other DSM-III diagnoses, meeting exclusion criteria in some cases, and not in other cases. Frequency distribution of each diagnosis and the diagnoses of each individual patient, are presented. Affective disorder was the most common diagnosis (85%). Of these, 62% had primary major depression, and 23% had secondary depression. Other diagnoses include bipolar disorder, dysthymia, panic, agoraphobia, alcohol and Drug abuse, somatization disorder, and many others. The authors conclude that while borderline disorder may be a sub-affective disorder, a specific diagnostic profile for this disorder that accounts for the presence of other Axis I and Axis II syndromes has yet to be delineated.

Adult↗
PubMed1989

The subacute hospital treatment of the borderline patient: III. Management of suicidal crisis by family intervention.

A family approach to suicidal crises in hospitalized borderline patients is described. The approach is aimed not only at the acute crises, but at the likelihood that repetitive, panic-inducing suicidal episodes provoke shame-producing over-regulation in the short run or exhaustion of support systems (family and treatment team) in the long run. An emergency family session with a hospitalized patient in acute suicidal crisis is presented. Subacute hospital treatment must respond to these crises mindful of long-term as well as acute risks. Subacute hospitalization allows for family intervention to buttress support systems for the long term task of caring for the suicidal borderline patient.

Adult↗
PubMed1989

Open assessment of the safety and efficacy of thioridazine in the treatment of patients with borderline personality disorder.

A 12-week open study was conducted to assess the possible efficacy and safety of low-dose thioridazine in 11 outpatients (8 women, 3 men) with borderline personality disorder (BPD) diagnosed according to DSM-III-R (American Psychiatric Association 1987) and the Diagnostic Interview for Borderline Patients (DIB; Gunderson et al. 1981) criteria. Mean thioridazine dose averaged 92 mg per day across the duration of this study. At endpoint, there was a significant reduction in Brief Psychiatric Rating Scale (BPRS; Overall & Gorham 1988) scores, and patients appeared to be less symptomatic on the impulse action patterns, affects, and psychosis subscales of the DIB (modified to assess change). Subjects completing the entire study (n = 6) also showed improvement in interpersonal relations. On self-report measures, significant improvement was noted on most Hopkins Symptom Checklist-90 (SCL-90; Derogatis et al. 1973) subscales, particularly in hostility and additional depressive features. Subjects completing the entire study showed significant improvement in paranoid ideation, interpersonal sensitivity, and anxiety. Three patients, however, developed sustained melancholic depressions that necessitated their discontinuation from the study and the initiation of anti-depressant treatment. These three individuals were more schizotypal, schizoid, and paranoid at baseline according to Personality Disorder Examination (PDE; Loranger et al. 1987) structured interviews. Weight gain was not a significant problem, but sedation and erectile dysfunction were. Overall, these findings suggest that thioridazine may exert prominent effects on patients with BPD and that double-blind, placebo-controlled studies are warranted.

Adult↗
PubMed1989

Evolving concepts of borderline personality disorders.

The author examines major trends in the definition of borderline conditions in this century. Particular note is taken of the conflicts among psychodynamic, empirical-descriptive, and biological approaches to the problem leading up to DSM-III formulations; current controversies; and the implications of these historical trends for the future of borderline concepts.

Borderline Personality Disorder↗