Borderline Personality Disorder Group Research Articles

The impact of borderline personality disorder on 12‐month outcomes for the treatment of heroin dependence

To determine the effects of borderline personality disorder (BPD) on 12-month treatment retention and outcomes for the treatment of heroin dependence. Longitudinal cohort study. Setting Sydney, Australia. A cohort of 495 heroin users enrolled in the Australian Treatment Outcome Study. Criteria for BPD were met by 45% of the cohort. At baseline there were no differences in heroin use, but the BPD group had higher levels of polydrug use, crime, needle risk-taking, more injection-related health problems, higher levels of overdose, poorer psychological health and more extensive suicide histories. At 12 months there was no group difference in the cumulative number of treatment days received, but the BPD group had enrolled in more different treatment episodes. Within both groups reductions had occurred in drug use and drug-related problems, with no differences in heroin use, polydrug use or global physical health at 12 months. After taking into account the effects of treatment on outcome, however, BPD was associated independently with a higher level of needle sharing [odds ratio (OR) 3.21], more injection-related health problems (OR 1.90), a higher likelihood of heroin overdose (OR 1.92), poorer global psychological health (OR 2.43), higher levels of current major depression (OR 3.19) and a higher likelihood of attempted suicide (OR 3.89). While BPD participants showed similar reductions in heroin and other drug use to other patients at 12 months, they continued to exhibit higher levels of risk and harm across a range of outcomes. Screening would appear to be warranted to identify a group who may overtly respond to treatment in terms of drug use per se, but remain at substantially greater risk.

Dexamethasone suppression test in borderline personality disorder—effects of posttraumatic stress disorder

Divergent findings of hypothalamic-pituitary-adrenal (HPA) axis functioning in borderline personality disorder (BPD) may be caused by a different degree of comorbid posttraumatic stress disorder (PTSD), in which alterations of the HPA axis are well known. Here we investigate alterations of the HPA axis in BPD patients with and without comorbid PTSD compared to healthy controls. Considering previous findings current major depression (MDD) was taken into account as a confounding variable. Apart from clinical assessment the 0.5 mg dexamethasone suppression test (DST) was performed in 21 female borderline patients and 23 healthy controls. Twelve BPD patients suffered from comorbid PTSD. Relative suppression (%) did not differ between healthy controls and the total BPD group, but BPD patients with comorbid PTSD showed increased suppression compared to those without. Comorbid MDD was not associated with suppression. Our results do not indicate a dysfunction of the HPA axis in BPD. However, comorbid PTSD seems to be associated with a relative hypersuppression in the 0.5 mg DST.

Affective dysregulation and dissociative experience in female patients with borderline personality disorder: a startle response study

Affective dysregulation and dissociation are currently discussed as core features of borderline personality disorder (BPD). Affective dysregulation is hypothesized to be correlated with increased amygdala functioning and dissociation is linked to inhibited processing on the amygdala and dampened autonomic output, according to the corticolimbic disconnection model of dissociation from Sierra and Berrios [Biological Psychiatry 44 (1998) 898]. We assessed startle response, which is mainly mediated by the amygdala, to investigate the relationship between affective dysregulation and dissociation. We hypothesized that patients with BPD would reveal enhanced responses to startling tones, but that these would be lessened by the presence of state dissociative experiences. 21 unmedicated female patients with BPD and 21 healthy female controls listened to 15 startling tones (95-dB, 500-ms, 1000-Hz) while heart rate, skin conductance and orbicularis oculi electromyogram responses were measured. Covariance analysis showed that the BPD group had a significantly higher startle response in the electromyogram as compared to controls. Furthermore, present-state dissociative experiences significantly influenced the startle response. Patients with low dissociative experiences revealed enhanced startle responses whereas patients with high dissociative experiences showed reduced responses. Our data support affective dysregulation in BPD as well as the corticolimbic disconnection model of dissociation, at least for EMG. Furthermore, it highlights the importance of assessing present-state dissociation in basic research as well as psychotherapy.

Relationship of personality to dissociation and childhood trauma in borderline personality disorder.

Dissociation is a prominent feature in some individuals with borderline personality disorder (BPD), yet our understanding of the meanings and implications of prominent dissociation in BPD remains limited. The purpose of this study was to investigate the relationship between dissociation and childhood trauma in BPD and to explore the relationships of dissociation and trauma to various personality features of BPD. Twenty BPD subjects and 24 healthy comparison subjects of similar age and gender were administered the Dissociative Experiences Scale, the Childhood Trauma Questionnaire-short form, the Tridimensional Personality Questionnaire, the Defense Style Questionnaire, the Relationship Style Questionnaire, and the Schema Questionnaire. The BPD group exhibited greater dissociation and childhood trauma, as well as greater pathology in most personality variables, compared with the healthy group. Dissociation in BPD was not significantly related to total childhood trauma, but only to emotional neglect, which accounted for 23% of the variance in dissociation scores. Within the BPD group, dissociation was associated with fearful attachment and immature defenses, while total childhood trauma and emotional neglect were associated with overconnection and disconnection schemata. This is a preliminary study with a small sample size, yet the correlates of dissociation in BPD merit further investigation.

Borderline personality disorder in primary care.

Borderline personality disorder (BPD) is a severe and chronic psychiatric disorder characterized by marked impulsivity, instability of affect and interpersonal relationships, and suicidal behavior that can complicate medical care. Few data are available on its prevalence or clinical presentation outside of specialty mental health care settings. We examined data from a survey conducted on a systematic sample (N = 218) from an urban primary care practice to study the prevalence, clinical features, comorbidity, associated impairment, and rate of treatment of BPD. Psychiatric assessments were conducted by mental health professionals using structured clinical interviews. Lifetime prevalence of BPD was 6.4% (14/218 patients). The BPD group had a high rate of current suicidal ideation (3 patients [21.4%]), bipolar disorder (3 [21.4%]), and major depressive (5 [35.7%]) and anxiety (8 [57.1%]) disorders. Half of the BPD patients reported not receiving mental health treatment in the past year and nearly as many (6 [42.9%]) were not recognized by their primary care physicians as having an ongoing emotional or mental health problem. The prevalence of BPD in primary care is high, about 4-fold higher than that found in general community studies. Despite availability of various pharmacological and psychological interventions that are helpful in treating symptoms of BPD, and despite the association of this disorder with suicidal ideation, comorbid psychiatric disorders, and functional impairment, BPD is largely unrecognized and untreated. These findings are also important for the primary care physician, because unrecognized BPD may underlie difficult patient-physician relationships and complicate medical treatment.

Borderline personality traits in hysterical neurosis.

The objective of the present study is to demonstrate the traits of the psychopathology of Borderline Personality Disorder (BPD) compared with hysterical neurosis. A total of 48 subjects with BPD and 40 subjects with hysterical neurosis both defined by DSM-III-R were assessed by Diagnostic Interview for Borderlines (DIB). Statistical analysis was done by quantification of the second type, a multivariate data analysis. The total scores of DIB were BPD group, 6.13 +/- 1.52; hysterical neurosis group, 4.9 +/- 2.12 (t = 3.05, P = 0.0016). The correlation ratio (index of to what extent the two groups are discriminated) was 0.2442. Among the four parameters of: (i) affect, (ii) cognition, (iii) impulse-action pattern, (iv), and interpersonal relationships, the partial coefficient correlations of (iii) and (iv) were significantly high (0.342, 0.287, P < 0.01). The question items with high independent coefficients were manipulation (0.4416), intolerance of aloneness (0.3797), demanding nature (0.3768), self-mutilation (0.3609), visual hallucination (0.3395). Those with low score of independent coefficients were counterdependency (0.0533), identity disturbance (0.1010), depression (0.1551), loneliness (0.1752), hypomanic episode (0.1936). Both of BPD and hysterical neurosis groups were not so fairly well discriminated. However, these results suggested that impulse-action pattern and disorder of interpersonal relationships were traits of borderline personality disorder. We could admit manipulation, intolerance of aloneness as its symptoms. In addition, counterdependency, identity disturbance were comparatively common to both. There were some borderline personality traits symptomatically in hysterical neurosis.

Personality disorders in parasuicide

To examine the prevalence of personality disorders in a representative sample of patients admitted to inpatient care after a parasuicide, 64 consecutive patients were investigated with structured interviews for DSM-IV personality disorders and clinical interviews for Axis I disorders and suicidal behaviour. We found a borderline personality disorder (BPD) as principal diagnosis in 55% of the subjects and some other personality disorder (OPD) in an additional 23%. Multiple Axis II disorders were significantly more common in the BPD group, in which 71% met criteria for three or more personality disorders, compared with 7% in the OPD group. In the BPD group 20% did not have a concomitant Axis I disorder, whereas this was very uncommon in the other groups. A relatively large proportion (34%) in the BPD group used other parasuicide methods than drug intoxication, whereas in the other groups this was rare. The mean number of previous parasuicidal acts was significantly higher in the BPD group, in which 57% had three or more previous parasuicides, and a high proportion (60%) also had repeated a parasuicidal act within the last year. In the BPD group 69% had ongoing outpatient treatment. Only 25% of these outpatients had a borderline personality disorder reported in the hospital records, suggesting that the personality disorder might go undiagnosed. The study gives support to the importance of a focused and structured personality disorder diagnosis in customizing treatment for the person with a recent parasuicide.

Neuropsychological Dysfunction in Children with Borderline Personality Disorder Features: A Preliminary Investigation

Borderline personality disorder (BPD) is often linked to neuropsychological deficits, yet few studies have examined BPD or its features and concomitant neuropsychological dysfunction in childhood. This study examined children with borderline features (n = 21) using the Coolidge Personality and Neuropsychological Inventory for Children and compared them to controls (n = 21) with features of at least one personality disorder, but not BPD. As hypothesized, the BPD group scored significantly higher than the control group on the Attention Deficit/Hyperactivity Disorder, Executive Functions Deficits, Mild Neurocognitive Disorder, Conduct Disorder, and Oppositional Defiant Disorder scales. It appears that behavioral disturbances associated with BPD are linked strongly with neuropsychological dysfunction. Because none of the children with BPD features in the present sample had a history of traumatic brain injury (TBI), it appears likely that TBI in the histories of adult BPD patients may not be the cause of BPD, but traits such as anger and impulsivity in BPD may cause TBI. Clinical implications and future research directions are discussed.

Neuropsychological functioning in patients with borderline personality disorder

Although results have been variable, studies suggest that individuals with borderline personality disorder (BPD) exhibit cognitive deficits suggestive of frontal- and temporal-lobe dysfunction. Patients diagnosed with BPD (n = 18) using two structured interviews, and who were carefully screened for neurological and substance-use disorders, were compared to depressed patients (n = 18) and a nonpsychiatric control group (n = 18) on a series of neuropsychological tasks. The role of emotion on cognitive functioning was assessed by including emotional stimuli and interference on several of the tasks. Little support was found for the neurobehavioral hypothesis of BPD. The BPD group performance did not differ from the normal group on most tasks of executive functioning or memory, and the introduction of emotional stimuli did not impair performance. The depressed group performed less effectively than the other groups. Reasons for variable findings and factors affecting the cognitive functioning of patients with BPD are discussed. There may be considerable heterogeneity in the cognitive functioning of BPD patients, with those exhibiting significant cognitive deficits comprising only a subgroup.

The clinical utility of the MMPI-2 Antisocial Practices Content Scale.

This study explored the ability of the MMPI-2 Antisocial Practices Content Scale (ASP) to correctly classify DSM-IV Antisocial Personality Disorder (APD). ASP scores and scores on the MMPI-2 Psychopathic Deviate (Pd) scale were compared in an APD group (n = 10), a Borderline Personality Disorder group (n = 16), a Narcissistic Personality Disorder group (n = 9), an Other Personality Disorder group (representing personality disorders from Clusters A and C; n = 14), and a nonclinical population (NC; n = 67). The ASP exhibited an ability to differentiate APD from other personality disorders and was significantly correlated to DSM-IV diagnostic criteria for APD while the Pd was not. Diagnostic efficiency statistics (sensitivity, specificity, positive predictive power, negative predictive power, overall correct classification rate, and kappa) were calculated under four different conditions in a clinically relevant manner (Kessel & Zimmerman, 1993. Psychological Assessment, 53, 395-399). The results of this study illustrate the usefulness of the ASP as a tool for the assessment of antisocial attitudes, beliefs, and behaviors in individuals suspected of having APD. This information may be valuable to clinicians who are planning treatment or assessing treatment outcome for clients with APD.

A behavioral comparison of female adolescent inpatients with and without borderline personality disorder

Patients with borderline personality disorder (BPD) are thought to have problematic hospitalizations. This study seeks to examine this phenomenon in adolescence by documenting the specific problem behaviors exhibited by patients, and the staff interventions in response to these behaviors in patients with and without BPD. Data were collected from the charts of 81 hospitalized adolescent girls regarding restraints, seclusions, incidents of self-abuse and aggression, incidents of signing the intent-to-leave form, nonroutine drug and/or alcohol screens, and discharges against medical advice. The two groups were compared using the analysis of variance (ANOVA) statistic for continuous variables and the chi-square statistic for the categorical variable. A follow-up multivariate ANOVA (MANOVA) was performed using the length of stay as a covariate. The BPD group displayed significantly higher rates of certain behaviors per day, but not of others. The length of stay was significantly higher in the BPD group. Further analysis indicated that some of the behavioral differences between the two groups may be due to the effect of the difference in length of stay. The data also suggest that while most BPD patients behave similarly to other patients, there may be a subset of BPD patients who behave in an extreme manner while hospitalized. BPD patients may display more of certain problematic behaviors than non-BPD patients in the hospital. However, it is hypothesized that these differences in hospital behavior may be largely due to the different lengths of stay between the two groups or to an acting-out subgroup of BPD patients.

Autobiographical memory and dissociation in borderline personality disorder.

This study investigated whether individuals with borderline personality disorder (BPD) tend to be overgeneral in their autobiographical recall and whether the extent of their overgeneral recall covaries with their susceptibilities to dissociative experiences, as expected on theoretical grounds. Twenty-three patients with BPD and 23 matched controls completed the Autobiographical Memory Test (AMT) and self-report measures of depression, anxiety, trait anger and dissociative experiences. Participants with BPD scored significantly higher than the control group on the measures of depression, anxiety, trait anger, and dissociative experiences and also retrieved significantly more general memories on the AMT. The number of general memories retrieved by the BPD group correlated significantly with their dissociation scores but not with their scores on mood measures. Patients with BPD have difficulties in recalling specific autobiographical memories. These difficulties are related to their tendency to dissociate and may help them to avoid episodic information that would evoke acutely negative affect.

Rheumatoid arthritis, personality, stress response style, and coping with illness. A preliminary survey.

Rheumatoid arthritis (RA) is an inflammatory chronic disease with an autoimmune pathogenesis and a complex multifactorial etiology. Various factors such as immunogenetic determinants, sex, age, and stress play an important role. The relationship between stress and RA is still unclear and undefined; however, various lines of research are developing in order to evaluate environmental, psychologic, and biologic stressors as predisposing factors. The aim of our study was to evaluate whether stress-related psychologic factors and personality disorders might be involved in the development of RA, by using a psychometric investigation-methodology in a series of patients. Fifteen in- and outpatients underwent a clinical interview and other specific psychometric tests. Macro- and microstressful life-events preceded RA onset in 86% of the cases. Sixty percent of the patients showed a correlation between flare-ups of the disease and appearance of microevents. Forty percent of the patients showed an obsessive-compulsive personality disorder (OCPD), 40% showed a borderline personality disorder (BPD), 7% showed a schizoid and a dependent disorder. Only 13% of the patients showed no personality disorders. Among the BPD group we also detected alexithymia. Our results should be considered as preliminary; on the other hand, the high prevalence of major life-events preceding the onset of RA and the presence of personality disorders support the role of the altered stress response system as an important pathogenetic factor and will be a matter of further studies.

Rorschach Responses in Borderline Personality Disorder with Alcohol Dependence

Summary: The purpose of this exploratory study was to analyze differences in Rorschach responses between two groups of alcoholics, one of which was diagnosed Borderline Personality Disorder (BPD) and the other Mixed Personality Disorder (MXPD). Forty-three male alcohol dependent inpatients participated in the study. The subjects were diagnosed by two independent clinical psychologists and divided into three groups. Group 1 consisted of 19 alcoholic patients also diagnosed BPD(BPD19); Group 2 consisted of 14 alcoholic patients also diagnosed MXPD; Group 3 comprised 10 alcoholic patients also diagnosed BPD as well as a secondary personality disorder diagnosis in addition (BPD10). The Rorschach was administered once 14 to 20 days after admission and scored according to Exner's Comprehensive System. BPD patients produced more responses than the MXPD group and revealed more interest in other people than MXPD. However, their interest in other people was marked by ambivalence, feelings of aggression, and withdrawal or isolation from social interaction. Both BPD groups revealed a significantly greater tendency to distorted perception of reality than the MXPD group and a greater tendency to pathological thinking and confusion.

Diagnostic efficiency and hierarchical functioning of the DSM-IV borderline personality disorder criteria.

This study presents information regarding the diagnostic efficiency and hierarchical functioning of the newly revised DSM-IV borderline personality disorder (BPD) criteria. Past research using the DSM-III-R version of BPD showed that the individual BPD criteria differ greatly in their diagnostic utility and that in some clinical situations, fewer than five of eight criteria could efficiently make the diagnosis. Two groups of inpatients, a BPD group (N = 33) and a non-BPD group (N = 43), were rated on the DSM-IV BPD criteria. Acceptable interrater reliability (Kappa estimates) was obtained for the presence or absence of the nine individual BPD criteria. Diagnostic efficiency statistics, sensitivity, specificity, false positive and false negative rates, positive predictive power, negative predictive power, overall classification rate and Kappa with the clinical diagnosis were obtained for all nine BPD criteria. The diagnostic efficiency data indicated that BPD criteria 1 (abandonment) and 2 (unstable relationships) functioned best in our inpatient sample, whereas criterion 9 (stress-related paranoia) performed the poorest. A stepwise logistic regression showed that the combination of BPD criteria 2, 1, 6 (unstable affect), and 3 (identity) (presented in their order of entry into the regression equation) provided the best prediction of group membership (BPD or non-BPD). The results suggest that a further refinement of both the BPD criteria set and the diagnostic decision rules may be needed.

A chart review study of male alcoholics differentiated by personality disorder

The goal of this study was to compare a group of alcoholics with a diagnosis of borderline personality disorder (BPD) with alcoholics with a diagnosis of mixed personality disorder (MXPD). From a sample of 46 inpatients in a substance abuse treatment center, rediagnosed in accordance with Axes I and II of DSM-III, three groups were formed. Group 1 consisted of 22 patients diagnosed as having borderline personality disorder (BPD22); group 2 consisted of 14 patients with a diagnosis of MXPD, and group 3 included 10 BPDs with a secondary personality disorder diagnosis (BPD10). All three groups were also diagnosed as being alcohol-dependent. The BPD groups did not differ from the MXPD in drinking history or family history of alcohol dependence. However, BPD22 and BPD10 were more likely to be polydrug abusers and had experienced a greater number of medical consequences of drinking than MXPD. BPD22 and BPD10 were also less able than MXPD to live in committed relationships and maintain stable employment. Both BPD22 and BPD10 had experienced significantly more distress in childhood than MXPD, with BPD10 reporting the most distress. The same two groups had had the greatest number of emotional problems in childhood, were the least likely to live in a relationship and keep stable employment, and had the greater number of treatment experiences.

Defense styles, hostility, and psychological risk factors in male patients with personality disorders.

The purpose of this study was to compare ratings of defense styles and hostility in male patients with personality disorders, to determine whether either of these is related to a borderline diagnosis, or to specific psychological risk factors. Subjects with personality disorders were divided into borderline personality disorder (BPD) (N = 61) and non-BPD (N = 60) groups were given both the Defense Style Questionnaire (DSQ) and the Buss-Durkee Guilt-Hostility Inventory (BDHI). Risk factors were measured by a developmental interview and the the Parental Bonding Index. The BPD group reported more maladaptive and image distorting defenses on the DSQ, as well as higher ratings on the BDHI. Ratings on both dependent measures were strongly related to diagnosis, and more weakly to measures of psychological risk factors. Thus, in men with personality disorders, immature defense styles and high levels of hostility are strongly associated with a borderline diagnosis.

The Five-Factor Model of Personality in Borderline and Nonborderline Personality Disorders

The purpose of this study was to examine to what extent the phenomena associated with a diagnosis of borderline personality disorder (BPD) can be described by the five-factor model of personality. The sample consisted of female patients with BPD (n = 29) and a control group with a mixture of nonborderline personality disorders (n = 30). All subjects were given the NEO-PI-R. Borderline patients differed from community norms on all five factors, and were particularly high on Neuroticism, and particularly low on Agreeableness. The scores on the five factors did not differ significantly between the 2 clinical groups. Two facets of the conscientiousness scale (competence and deliberation) were significantly lower in the BPD group. Dimensional profiles only partially account for the clinical symptomatology seen in formally diagnosed cases of BPD.

Object relation and defensive operations in transsexuals and borderline patients as measured by the Defense Mechanism Test

The aim of the present study was to discern discriminating patterns in the perceptual responses in accordance with the Defense Mechanism Test (DMT), a projective perceptgenetic method, among 41 subjects with the diagnoses transsexualism (TS) or borderline personality disorder (BPD) and a non-patient group (NP). The overall results showed that, by means of a pattern analysis of 130 DMT variables and partial least squares (PLS) discriminant analysis, it was possible to separate these diagnostic groups. A two-dimensional model seemed to be powerful. The quality and the complexity of the self and object representations have to be considered both from a structural/reality-oriented and from an affective perspective. The most characteristic properties of the TS group were high threshold values for perception, including difficulty in perceiving the threat in the stimulus picture, lack of emotional manifestations, and some projection and introjection responses. With regard to the BPD group, a discontinuity of the ...

Psychological risk factors for borderline personality disorder in female patients

The purpose of this study was to examine the role of several psychological risk factors, i.e., childhood sexual abuse (CSA) and its parameters, childhood physical abuse (PA), early separation or loss, and abnormal parental bonding, in borderline personality disorder (BPD). Women with personality disorders were divided into BPD (n = 78) and non-BPD (n = 72) groups. Risk factors were measured by a developmental interview and the Parental Bonding Index (PBI). The BPD group had a greater frequency of CSA, more severe CSA, as well as more PA, and a lower maternal affection score on the PBI. Only CSA was significant in the multivariate analysis. CSA is the risk factor that most strongly discriminates between BPD and non-BPD. However, CSA has low specificity to BPD, and only a subgroup reported severe abuse experiences.