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PubMed1989

Becoming a constant object for the borderline patient.

Strong evidence that individuals with borderline personality disorder have failed to achieve object constancy has led researchers to conclude that effective therapy requires the therapist to become a constant object for the patient. The authors suggest that to achieve this goal, the therapist must use time as a vehicle for change, make few interventions, and maintain attentive interest without offering interpretations or prescriptions for action. Although frustrating to the borderline patient, such restraint addresses the patient's problems of achieving gradations of feelings, of unease with separateness, and of the fear of abandonment.

Adult↗
PubMed1989

An integration of the views of Kernberg and Adler on borderline pathology.

Kernberg's writings on borderline pathology have greatly influenced the mental health world. More recently, Adler has emerged as another psychodynamic authority on this disorder. Adler challenges Kernberg with a different conceptual framework and posits a different core problem for borderline patients. Some writers have contrasted Kernberg's "conflict" theory with Adler's "deficit" theory. The author contends that it is erroneous to contrapose Kernberg and Adler. He demonstrates that the controversy between conflict and deficit is invalid because, in the final analysis, Kernberg and Adler subscribe to theories that involve both. The author shows how their theories can be combined into an integrated model.

Borderline Personality Disorder↗
PubMed1989

Countertransference dilemmas with borderline patients. The contribution of psychological testing.

Although originally regarded pejoratively, countertransference has come to be viewed as an indispensable clinical tool, especially in the treatment of borderline patients. These patients typically evoke powerful negative experiences in their therapists. Psychological testing can help treaters go beyond such limiting (if not disruptive) reactions to achieve a constructive use of countertransference with borderline patients.

Adult↗
PubMed1988

Psychopharmacologic approaches to the borderline patient.

Five case examples are presented to illustrate the role of psychopharmacology in the treatment of patients diagnosed as Borderline Personality Disorders. The cases range from organic through affective and schizophrenic syndromes which are not infrequently at the "border" of personality disorders, and which often respond to specific pharmacologic interventions. The importance of looking for and recognizing drug treatable syndromes within the wide array of patients who satisfy DSM-III criteria for Borderline Disorders is discussed.

Adult↗
PubMed1989

Acting out of separation conflicts in borderline pathology. An empirical case study.

The acting out of highly conflictual fantasies and feelings that develop around separations from significant others is a typical and challenging phenomenon for psychotherapists who treat borderline patients. The authors present a case study of a hospitalized 27-year-old woman with borderline pathology. Their account focuses on her experience and enactment of separation conflicts that emerged in psychotherapy (in dreams and transference) and in the inpatient milieu. To quantify and study the phenomena, the authors used an observational scheme and an acting-out scale.

Acting Out↗
PubMed1986

[Clinico-epidemiologic characteristics of borderline mental disorders comparison of the Moscow and Batumi populations of students of specialized educational institutions].

On the basis of a comparative clinico-epidemiological study the authors consider the structure and prevalence of borderline mental disorders and accentuations of the character in adolescents living in Moscow and Batumi. Borderline psychic pathology was correlated with schooling disadaptation of adolescents. Cultural factors are shown to affect the severity and direction of adolescent reactions. A number of medicopedagogical recommendations based on the analysis of the structure of training institutions are provided.

Adaptation, Psychological↗
PubMed1987

Current overview of the borderline diagnosis.

The authors review the literature on the diagnosis of borderline personality disorder and describe the core dynamic features that account for its unstable phenomenology and explain in part the complexity of and the controversies associated with the diagnosis. A review of differential diagnosis suggests that the boundary with schizophrenia is well established, that the boundary with affective disorder is becoming clearer, and that the most subtle boundary distinctions lie with other forms of personality disorder. A growing body of evidence about antecedents to and longitudinal aspects of borderline personality disorder confirms its diagnostic validity.

Borderline Personality Disorder↗
PubMed1987

[Clinico-dynamic analysis of the borderline states of advanced age].

On the basis of clinical follow-up of 579 patients with borderline states related to old age the authors have established the peculiarities of the time-course of these states associated with the age stage (involutional and senile) and nosological structure. The role of endocrine-vegetative and microsocial factors in the manifestation of decompensation states in psychopathic patients is considered. The authors describe different variants of the dynamics in the form of latent compensated psychopathic conditions, transformation of a psychotic nature and "late depsychopathization". The role of psychogenic (microsocial), somatogenic and exogenic-organic factors in the development and time course of the main forms of neuroses is considered. Also discussed is the organization of specialized care for patients with borderline states in advanced age.

Aged↗
PubMed1986

Development of melancholia during carbamazepine treatment in borderline personality disorder.

Carbamazepine, an anticonvulsant, has shown efficacy in the treatment of a wide range of psychiatric disorders, including classical affective disorders. Because patients with borderline personality disorder show prominent affective symptomatology on the one hand and symptoms suggestive of an epileptoid disorder on the other, carbamazepine was included in a multidrug, placebo-controlled, double-blind study. During carbamazepine treatment, three of 17 (18%) patients developed melancholia, which remitted on discontinuation of carbamazepine. While carbamazepine may prove to be an effective medication for some patients with borderline personality disorder, careful attention to change in depressive symptoms is suggested.

Adult↗
PubMed1986

Core criteria for diagnosing borderline patients.

This study compares 17 hospitalized borderline personality disorder (BPD) patients with 20 normal control subjects. Four criteria sets--DSM III, Grinker, Gunderson, and Kernberg--were combined and used with the semistructured DIAGNOSTIC INTERVIEW BORDERLINES (DIB) Scale. Findings indicate that among BPD patients the following were most prominent: 1) impulsive episodes 2) unstable relationships 3) chronic feelings of depressive emptiness/loneliness 4) acting out behavior and, somewhat less prevalent, 5) identity disturbance. BPD patients can be discriminated by different patterns of disturbance while sharing other features in common with them. While DSM III requires five of eight items for BPD diagnosis, from the above group significantly less than five adequately made a positive diagnosis in this study. BPD seems to identify a heterogeneous group of patients with behavioral disturbances without particular personality specificity which share certain core characteristics among which additional features may further subtype component members.

Adult↗
PubMed1986

Right on the money: disability forms and the hospitalized borderline patient.

Handling of the hospitalized borderline patient's request for disability compensation reflects the therapists's success or failure in keeping a sustained focus on splitting. This focus is crucial to the subacute hospital treatment of borderline psychopathology. Overprotectiveness or withholding of appropriate support results from countertransference reactions. Splitting is reinforced rather than minimized if the therapist fails to focus both on the damaged and overwhelmed aspect of the personality (how the patient feels) and on the irresponsible and manipulative aspect (what the patient does). The therapist who fails to respond to the disparate aspects in an integrated way risks acting out key aspects of the clinical picture to the detriment of successful subacute hospital treatment. The therapist's awareness of typical patterns of splitting can be enhanced by considering the patient's developmental history; current familial and vocational relations (or lack of them); and the patient's relation to the hospital staff.

Adult↗
PubMedDate not supplied

The psychopharmacology of borderline personality disorders.

DSM-III borderline personality disorder defines a group of patients who are characterised by impulsivity and unpredictable behaviour, inappropriate aggression, intense and unstable relationships and are often associated with repeated suicidal behaviour. A substantial body of research has established an association between disturbance of serotonin and also dopamine and suicidal behaviour in depression. A similar relationship is also seen in studies of personality disorders which suggests the association is not specific to depression. A placebo controlled study of low dose flupenthixol has been shown to significantly reduce subsequent suicidal behaviour in patients with personality disorders without depression or schizophrenia. Evidence points to a biological basis for suicidal behaviour and borderline personality disorder and possibly of pharmacotherapy.

Borderline Personality Disorder↗
PubMed1987

Borderline personality disorder.

The lives of patients with borderline personality disorder are characterized by turmoil, and their interpersonal relationships by conflict. As a result, these patients can be very difficult to treat. However, an accurate diagnosis and an understanding of the psychodynamics and emotional development of borderline patients can lead to improved management.

Borderline Personality Disorder↗
PubMed1984

Identifying and managing borderline personality patients.

Individuals with the borderline personality disorder are less stable than neurotics but do not have sustained psychotic decompensations. These patients are socially insensitive, impulsive, resentful and chronically depressed, and may display fits of anger. Borderline patients experience the greatest difficulty in dealing with intense relationships. Medical problems that require sustained follow-up may bring about a doctor-patient relationship intense enough to stir up turmoil. The cornerstone of treating such patients is maintaining a limited relationship.

Anger↗
PubMed1983

[Existential suffering in the art expression of borderline patients].

The concept of the borderline syndrome is briefly discussed in the light of recently published surveys. In the author's view, the concept as formulated by Benedetti can be usefully applied in the European context. The pictorial creations of borderline patients reveal with striking clarity the general and essential features associated with this polymorphous psychopathological concept, despite its variable symptomatology. Referring to examples drawn from extensive collections of drawings by two female patients, the author demonstrates that existential suffering is definitely a major theme in this expressive work.

Adult↗
PubMed1984

The borderline syndrome in adolescents.

The borderline adolescent is discussed in terms of diagnostic perspectives, characteristic features based on disturbed object relations, and treatment. The disorder is not fully manifest in adolescence but gradually emerges into a definable personality type, the various features of which express the unsatisfactory outcome of a complex psychodynamic struggle related to developmental arrests in psychic structure. Based on clinical observations, the diagnosis of borderline personality, like the schizoid personality, is considered to be compatible with a past, present or future schizophrenic disorder. Finally, therapeutic approaches in a day-treatment program, and individual therapy is considered from a developmental object relations viewpoint.

Adolescent↗
PubMed1983

Treatment of borderline adolescents.

A recent revision of the proposed DSM III description of the borderline category is presented with reference to the work of Masterson (1972) and Grinker (1968). The contributions of Roger Shapiro et al. to a psychoanalytic formulation of the developmental and familial dynamics are summarized with reference to the genetic factors and the lack of validation to date of any general hypothesis. Treatment recommendations of Wolberg, Shapiro and Jacobson (1971) are described. Grinker's operational criteria were chosen for the pilot study: a defect in affectional relationships with no enduring close ties; child-like angry relationships with parental or authority figures, particularly in the dysphoric group; low self-esteem very poor sense of identity; a chronic depression characterized more by loneliness and boredom than by guilt or loss, and a pervading sense of anger or resentment. Cases are presented to illustrate treatment strategies. A brief differential diagnostic statement is made describing "borderline" as a separate category from other disorders manifesting oppositional, antisocial, and violent behavior.

Acting Out↗
PubMed1983

Special problems in borderline adolescents from wealthy families.

Borderline adolescents from wealthy families pose a number of special problems in psychotherapy. The family may use great affluence to cushion the lives of their children in such a way as to diminish motivation for work, avocational pursuits, or anything requiring self-discipline. This in turn may exacerbate problems in the formation of identity, already impaired in the borderline adolescent. Antisocial tendencies may go unchecked because of the wealthy family's unusual ability to get around the authorities whenever its children are apprehended for an offense. Appropriate limit setting, imposed in ordinary families partly out of economic necessity, may fail to be imposed where family wealth has nullified the necessity for it. Parental deprivation, encountered often among the very poor, may also be seen among the wealthy, some of whom insulate themselves against their children to a marked degree, via household servants to whom almost all parental functions may have been allocated. From such deprivation, various character deformations may develop, including pathological narcissism. Clinical vignettes, illustrating these points and containing some suggestions for therapy, have been included.

Achievement↗