Associations between alexithymia and borderline personality criteria in personality disorders.

Should borderline personality disorder be included in the fourth edition of the Chinese classification of mental disorders?

Relationship of Borderline Personality Disorder and Bipolar Disorder

Relationship of Borderline Personality Disorder and Bipolar Disorder

Since the 2001 publication of APA’s Practice Guideline for the Treatment of Patients With Borderline Personality Disorder (1), more studies have been published on borderline personality disorder (BPD) than on any other personality disorder (2, 3). New analyses of the validity of the DSMIV-TR criteria–defined construct of BPD have been published, new data on the prevalence of BPD are available, risk factors for and biological characteristics of BPD are being elucidated, and new studies on the treatment of BPD have been carried out. This guideline watch highlights the most important of these developments.

The purpose of this study was to determine the extent of comorbid substance use disorders in patients referred for treatment of personality disorders. Two hundred inpatients and outpatients were assessed by semistructured interviews for substance use and personality disorders. Univariate odds ratios were calculated for groups of substance use disorders and each DSM-III-R axis II disorder; comorbidity among axis II disorders was controlled in multivariate models predicting current or lifetime substance use disorder groups. The impact of personality disorder on chronicity and overall impairment associated with substance use disorders was evaluated. Close to 60% of subjects with substance use disorders had personality disorders. Borderline personality disorder was significantly associated with current substance use disorders, excluding alcohol and cannabis, and with lifetime alcohol, stimulant, and other substance use disorders, excluding cannabis. Antisocial personality disorder was associated with lifetime substance use disorders other than alcohol, cannabis, and stimulants. These relationships remained significant after controlling for the presence of all other personality disorders. There was no evidence that personality disorders increased the chronicity of substance use disorders, but comorbid personality disorders were associated with greater global impairment. Borderline personality disorder may be associated with a wide variety of substance use disorders, especially among patients seeking treatment for personality problems.

Discriminant efficiency of antisocial and borderline personality disorder criteria in Hispanic men with substance use disorders

Identifying the unique and common characteristics among the dsm-iv antisocial, borderline, and narcissistic personality disorders

Utilisation des services de soin par les patients hospitalisés, présentant un trouble de personnalité borderline en Midi-Pyrénées

Borderline personality disorder (BPD) has been identified as a strong risk factor for suicidal behavior, including suicide attempts. Delineating specific features that increase risk could inform interventions. To examine factors associated with prospectively observed suicide attempts among participants in the Collaborative Longitudinal Study of Personality Disorders (CLPS), over 10 years of follow-up, with a focus on BPD and BPD criteria. The CLPS is a multisite, naturalistic, prospective study of adult participants with 4 personality disorders (PDs) and a comparison group of adults with major depressive disorder and minimal PD features. Participants were all treatment-seeking and recruited from inpatient, partial, and outpatient treatment settings across New York, New York, Boston, Massachusetts, New Haven, Connecticut, and Providence, Rhode Island. A total of 733 participants were recruited at baseline, with 701 completing at least 1 follow-up assessment. The cohorts were recruited from September 1996 through April 1998 and September 2001 through August 2002. Data for this study using this follow-up sample (N = 701) were analyzed between March 2019 and August 2020. Participants were assessed annually using semistructured diagnostic interviews and a variety of self-report measures for up to 10 years. Multiple logistic regression analyses were used to examine baseline demographic and clinical risk factors, including BPD and individual BPD criteria, of suicide attempt assessed over 10 years of prospective follow-up. Of the 701 participants, 447 (64%) identified as female, 488 (70%) as White, 527 (75%) as single, 433 (62%) were unemployed, and 512 (73%) reported at least some college education. Of all disorders, BPD emerged as the most robust factor associated with prospectively observed suicide attempt(s) (odds ratio [OR], 4.18; 95% CI, 2.68-6.52), even after controlling for significant demographic (sex, employment, and education) and clinical (childhood sexual abuse, alcohol use disorder, substance use disorder, and posttraumatic stress disorder) factors. Among BPD criteria, identity disturbance (OR, 2.21; 95% CI, 1.37-3.56), chronic feelings of emptiness (OR, 1.63; 95% CI, 1.03-2.57), and frantic efforts to avoid abandonment (OR, 1.93; 95% CI, 1.17-3.16) emerged as significant independent factors associated with suicide attempt(s) over follow-up, when covarying for other significant factors and BPD criteria. In the multisite, longitudinal study of adults with personality disorders, identity disturbance, chronic feelings of emptiness, and frantic efforts to avoid abandonment were significantly associated with suicide attempts. Identity disturbance, chronic feelings of emptiness, and frantic efforts to avoid abandonment may be clinically overlooked features of BPD in context of suicide risk assessment. In light of the high rates of BPD diagnostic remission, our findings suggest that these criteria should be independently assessed and targeted for further study as suicide risk factors.

The constructs of atypical depression, bipolar II disorder and borderline personality disorder (BPD) overlap. We explored the relationships between these constructs and their temperamental underpinnings. We examined 107 consecutive patients who met DSM-IV criteria for major depressive episode with atypical features. Those who also met the DSM-IV criteria for BPD (BPD+), compared with those who did not (BPD-), had a significantly higher lifetime comorbidity for body dysmorphic disorder, bulimia nervosa, narcissistic, dependent and avoidant personality disorders, and cyclothymia. BPD+ also scored higher on the Atypical Depression Diagnostic Scale items of mood reactivity, interpersonal sensitivity, functional impairment, avoidance of relationships, other rejection avoidance, and on the Hopkins Symptoms Check List obsessive-compulsive, interpersonal sensitivity, anxiety, anger-hostility, paranoid ideation and psychoticism factors. Logistic regression revealed that cyclothymic temperament accounted for much of the relationship between atypical depression and BPD, predicting 6 of 9 of the defining DSM-IV attributes of the latter. Trait mood lability (among BPD patients) and interpersonal sensitivity (among atypical depressive patients) appear to be related as part of an underlying cyclothymic temperamental matrix.

Rates of suicide are increasing. Although borderline personality disorder (BPD) and other psychiatric disorders are associated with suicide, there is a dearth of epidemiological research on associations between BPD and suicide attempts (SAs). Delineating the SA risk associated with BPD and its specific criteria in a nationally representative sample of individuals could inform recognition and intervention efforts for SAs. To examine the association of a BPD diagnosis and specific BPD criteria with SAs in US adults. This cross-sectional study analyzed data from the National Epidemiological Survey on Alcohol and Related Conditions-III (NESARC-III), a psychiatric epidemiological survey of noninstitutionalized US adults aged 18 or older conducted from April 2012 to June 2013. Eligible adults were randomly selected from households within census-defined counties or groups of counties. Data were analyzed from December 2020 to January 2021. Prevalence of Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) psychiatric and personality disorders, BPD and its specific criteria, SAs, and adverse childhood experiences (ACEs), as assessed by structured diagnostic or clinical interviews; prevalence is expressed as weighted means. Multivariable-adjusted logistic regression was used to compare the risk of lifetime and past-year SAs by BPD diagnosis and by each specific BPD criterion. Analyses were adjusted for demographic and clinical factors, including psychiatric comorbidity, age at BPD onset, and ACEs. Of 36 309 respondents, 20 442 (56.3%) were women and 52.9% were non-Hispanic White; the mean (SD) age was 45.6 (17.5) years. The prevalence (SE) of lifetime and past-year SAs among participants with a lifetime diagnosis of BPD based on original NESARC-III diagnostic codes was 22.7% (0.8%) (adjusted odds ratio [AOR], 8.40; 95% CI, 7.53-9.37) and 2.1% (0.2%) (AOR, 11.77; 95% CI, 7.86-17.62), respectively. With use of diagnostic codes requiring 5 BPD criteria to meet social-occupational dysfunction, prevalence (SE) of lifetime and past-year SAs was 30.4% (1.1%) (AOR, 9.15; 95% CI, 7.99-10.47) and 3.2% (0.4%) (AOR, 11.42; 95% CI, 7.71-16.91), respectively. After excluding the BPD criterion of self-injurious behavior (to eliminate criterion overlap), the prevalence (SE) of lifetime and past-year SAs was 28.1% (1.1%) (AOR, 7.61; 95% CI, 6.67-8.69) and 3.0% (0.4%) (AOR, 9.83; 95% CI, 6.63-14.55), respectively. In analyses adjusting for sociodemographic variables, psychiatric disorders, age at BPD onset, and ACEs, BPD diagnosis and specific BPD criteria of self-injurious behaviors and chronic feelings of emptiness were significantly associated with increased odds of lifetime SAs (BPD diagnosis: AOR, 2.10; 95% CI, 1.79-2.45; self-injurious behaviors: AOR, 24.28; 95 CI, 16.83-32.03; feelings of emptiness: AOR, 1.58; 95% CI, 1.16-2.14) and past-year SAs (BPD diagnosis: AOR, 11.42; 95% CI, 7.71-16.91; self-injurious behaviors: AOR, 19.32; 95% CI, 5.22-71.58; feelings of emptiness: AOR, 1.99; 95% CI, 1.08-3.66). In analysis with BPD criteria simultaneously entered (excluding self-injurious behavior), chronic feelings of emptiness were significantly associated with increased odds of lifetime SAs (AOR, 1.66; 95% CI, 1.23-2.24) and past-year SAs (AOR, 2.45; 95% CI, 1.18-5.08). In a national sample of adults, after adjusting for demographic and clinical variables, a BPD diagnosis and the specific BPD criteria of self-injurious behaviors and chronic emptiness were significantly associated with increased SA risk. Although BPD is a complex heterogeneous diagnosis, the results of this study suggest that the criteria of self-injurious behaviors and chronic feelings of emptiness should be routinely considered in suicide risk assessment.

Can Epidemiology Translate Into Understanding Major Depression With Borderline Personality Disorder?

Introduction: Borderline personality disorder (BPD) and schizotypal personality disorder (SPD) were introduced in DSM-III and retained in DSM-5 Section II. They often co-occur and some aspects of the clinical differentiation between the 2 diagnoses remain unclear (e.g., psychotic-like features and identity disturbance). Methods: The present study explored if self-reported identity disturbance and psychosis proneness could discriminate between the BPD and SPD DSM-5 diagnoses. All patients were interviewed with the Schedules for Clinical Assessment in Neuropsychiatry and the Structured Clinical Interview for DSM-5 Personality Disorders, and administered the Inventory of Personality Organization, Self-Concept and Identity Measure, Schizotypal Personality Questionnaire, Perceptual Aberration Scale, and the Magical Ideation Scale. Results: A total of 105 patients were initially assessed, 26 were excluded, and the final sample (N = 79) was composed of 34 BPD patients, 25 SPD patients, and 20 patients with co-occurring SPD and BPD. The BPD group (n = 34) was first compared with the pure SPD group (n = 25), and secondly with the total group of patients diagnosed with SPD (n = 25 + 20). Logistic regression analyses indicated that primitive defenses and disorganization best differentiated the BPD and the pure SPD group, while primitive defenses and interpersonal factor along with perceptual aberrations best differentiated the BPD and the total SPD group. Conclusion: Identity disturbance did not predict the diagnostic groups, but BPD patients were characterized by primitive defenses, which are closely related to identity disturbance. Pure SPD was characterized by oddness/eccentricity, while the lack of specificity for cognitive-perceptual symptoms suggests that the positive symptoms do not differentiate BPD from SPD.

Borderline Personality Disorder (BPD) is a mental disorder characterized by significant impairment in intrapersonal and interpersonal functioning, as well as patterns of personality pathology. Memory deficits are not recognized as a core symptom of BPD, but individuals with BPD symptoms have long been suspected to have inaccurate perceptions, disturbed memory processes, and an increased tendency to develop false memories. In the present study, we examined whether there was an association between BPD features and the production of false memories in the Deese-Roediger-McDermott (DRM) paradigm—a laboratory-based procedure that is frequently used to investigate false memory. We also compared the traditional categorical BPD criteria (DSM-5 Section II) with the alternative model of personality disorders BPD criteria (DSM-5 Section III) in predicting memory performance. A total of 298 university students completed the McLean Screening Instrument for Borderline Personality Disorder, SCID-II Personality Questionnaire, Borderline Personality Disorder Impairment Scale, Personality Inventory for DSM-5, Beck Depression Inventory, Dissociative Experiences Scale, and Traumatic Life Events Questionnaire. Participants were also tested using both traditional DRM word lists as well as word lists that were specifically associated with BPD features. Using the traditional diagnosis of BPD, BPD features were correlated with higher false memory for positive information; in the alternative model of BPD, identity impairment and anxiousness were correlated with the overall false memory score. We also found that trauma and dissociation mediated the relation between BPD and false memory. These findings are discussed in terms of how the consequences of trauma, such as dissociation and identity disturbance, are associated with false memory. Whether false memory rates are higher in a clinical population of BPD patients than in non-clinical volunteers remains to be determined.

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessImpaired Social Functioning Lingers After BPD Symptoms RemitMark MoranMark MoranSearch for more papers by this authorPublished Online:7 Oct 2011https://doi.org/10.1176/pn.46.19.psychnews_46_19_19_1AbstractSymptoms of borderline personality disorder (BPD) often remit over a 10-year period, but patients continue to experience severe and persistent impairment in social functioning. That was the finding from a follow-up of patients with BPD in the Collaborative Longitudinal Personality Disorders Study, a report of which appears in the August Archives of General Psychiatry. The analysis found that the 10-year course of BPD is characterized by high rates of remission, low rates of relapse, but severe impairment in social functioning (see Key Findings From BPD Study). The report extends and confirms previous reports about the long-term course of BPD, which have suggested that therapies for the disorder tend to work well for the most acute symptoms—such as self-harm and emotional dysregulation—but do little to address impairments in social functioning. "What this shows is that over time, patients are more quietly dysfunctional than they were likely to have been when originally treated," lead author John Gunderson, M.D., told Psychiatric News. "A minority of patients go on to a reasonably good functional level with a job and a family life, and then another minority remain both functionally and symptomatically ill. But the largest group of patients are not symptomatic but don't have friends or stable relationships." Gunderson is a professor of psychiatry at Harvard Medical School and director of psychosocial and personality research at McLean Hospital in Belmont, Mass. In the study, 75 patients with BPD, 312 with cluster C personality disorder, and 95 with major depressive disorder (MDD) but no personality disorder were followed for a decade. Subjects were drawn from 19 clinical settings (hospital and outpatient) in four northeastern U.S. cities. The Diagnostic Interview for DSM-IV Personality Disorders and its follow-along version were used to diagnose personality disorders and assess changes in the symptoms over time. The Structured Clinical Interview for DSM-IV Axis I Disorders and the Longitudinal Interval Follow-Up Evaluation were used to diagnose MDD and assess changes in MDD and in social function. Eighty-five percent of patients with BPD remitted, but remission was slower than for patients with MDD and minimally slower than for those with other personality disorders. The other notable finding from the study is that once they are in remission, patients rarely relapse: 12 percent of patients with BPD relapsed, a rate less frequent than that for patients with MDD and with other personality disorders. However, social-functioning scores showed severe impairment with only modest (although statistically significant) improvement; patients with BPD remained persistently more dysfunctional than those in the other two groups. Gunderson said that the "most obvious reason" for the discrepancy between symptomatic and functional improvement is that treatments for BPD, as for many psychiatric and other medical disorders, are best for addressing acute symptoms, but do not typically address long-term functional and social deficits. "Another fundamental answer is that even when the symptoms remit, the underlying basis of the disorder—whether it is psychological or genetic—remains," he said. Those with the disorder aren't well "just because they aren't shouting and cutting themselves and being admitted into the hospital. There are fundamental handicaps that these patients have in terms of genetic predispositions." And there is a social learning aspect to the long-term course of BPD. "By the time a patient has BPD, he or she may never have gone through a job interview," he said. "We don't know how much of their dysfunction is genetic and how much is impaired social learning, but they are both important." Gunderson added that at McLean Hospital, social rehabilitation has been made a focus of BPD treatment. "Most of our patients eventually go to school or work, and we expect them to," he said. He added that office-based psychiatrists who work with BPD patients over the long term know "that we in the psychiatric community can and should expect more and give more to our patients in terms of social rehabilitation." "Ten-Year Course of Borderline Personality Disorder: Psychopathology and Function From the Collaborative Longitudinal Personality Disorders Study" is posted at <http://archpsyc.ama-assn.org/cgi/content/abstract/68/8/827>. ISSUES NewArchived