Borderline Personality Organization Research Articles

The Psychoanalytic Model of the Mindby Elizabeth L. Auchincloss, M.D. Washington, D.C., American Psychiatric Association Publishing, 2015, 332 pp., $59.00 (paperback).

The Psychoanalytic Model of the Mindby Elizabeth L. Auchincloss, M.D. Washington, D.C., American Psychiatric Association Publishing, 2015, 332 pp., $59.00 (paperback).

Dimensions of Personality Organization and Sexual Life in a Community Sample of Women

The aim of this study was to explore the relationship between dimensions of borderline personality organization (as assessed according to Kernberg's model), sexual dysfunctions, and paraphilic interest in a community sample of women. Two hundred and sixty-six healthy women were asked to complete a set of questionnaires including the Inventory of Personality Organization (IPO), the Italian version of the Female Sexual Function Index, and a checklist to assess the prevalence of paraphilic interests. Results showed that women with sexual dysfunctions and paraphilic interests are characterized by higher scores on three out of four IPO subscales: Instability of self/others, Instability of behavior, and Psychosis. The results provide evidence of a possible connection between borderline personality organization and sexual life and support the need for a thorough assessment of personality functioning in patients with sexual problems.

The regulative function of mentalization and mindfulness in borderline personality organization

<b>Background</b><br /> The aim of this study was to broaden the understanding of the emotional difficulties of borderline personality organization (BPO) by reference to a meta-ability named ‘orientation on the internal world’, here conceptualized as mentalization and mindfulness, in the framework of object relation theory. It was assumed that it is not mentalization “in itself”, but mainly its regulatory function, that is important for BPO.<br /> <br /> <b>Participants and procedure</b><br /> The clinical and control groups (30 individuals each) were examined using The Mental States Task, The Difficulties of Emotion Regulation Scale and The Mindful Attention Awareness Scale.<br /> <br /> <b>Results</b><br /> Individuals with BPO functioned worse than the control group in terms of mentalization, mindfulness, and emotion regulation. The relationship between BPO and the meta-abilities was mediated by emotional dysregulation: total mediation was revealed for one mentalization dimension, and partial mediation was observed for mindfulness.<br /> <br /> <b>Conclusions</b><br /> Orientation on emotional experience and emotional dysregulation are not independent predictors of BPO, but they can be treated as levels in the hierarchical model. Mentalization determines and influences emotion regulation in BPO.

The Relationship between Theoretical Orientation and Countertransference Expectations: Implications for Ethical Dilemmas and Risk Management.

Countertransference (CT) awareness is widely considered valuable for differential diagnosis and the proactive management of ethical dilemmas. We predicted that the more practitioners' theoretical orientation (TO) emphasizes insight into the dynamics of subjective mental life, the better they will be at using their CT expectations in differential diagnosis with high-risk patients. To test this hypothesis, we compared psychodynamic therapy (PDT) practitioners who emphasize insight into subjective mental life with practitioners who do not emphasize this epistemology. Results indicated that PDT practitioners expected significantly more CT than practitioners of cognitive-behavioural therapy (CBT) and other practitioners (e.g., family systems, humanistic/existential and eclectic) to patients with borderline personality organization overall. PDT practitioners had significantly more CT expectations to patients with borderline-level pathologies as compared with neurotic-level patients than both CBT and other practitioners. PDT practitioners were significantly more expectant of CT issues than CBT practitioners with respect to the personality disorders most associated with acting out and risk management problems (e.g., paranoid, psychopathic, narcissistic, sadistic, sadomasochistic, masochistic, hypomanic, passive-aggressive, counterdependent and counterphobic). The other practitioners generally had CT expectations between PDT and CBT. These findings suggest that clinical training into CT may be useful in differential diagnoses and in helping to avoid ethical dilemmas regardless of one's theoretical preference. Copyright © 2015 John Wiley & Sons, Ltd. Insight into countertransference can be used to help with differential diagnoses and to help prevent possible management problems with acting out patients. The Psychodynamic Diagnostic Manual is a useful taxonomy in that it includes countertransference as a diagnostic aid.

Borderline Personality Organization predicts Machiavellian interpersonal tactics

Despite the phenomenological (e.g., manipulativeness) and dynamic (i.e., emotion dysregulation) analogies between Machiavellianism and Borderline Personality Organization (BPO), the relationship between these constructs has not yet been investigated. In our study, 225 non-clinical, non-student adults (130 females; 32.33±5.42years of age on average) completed measures of BPO and Machiavellianism. Results showed that Machiavellian personality traits were positively correlated with fear of fusion, diffuse identity, and use of primitive defenses. Machiavellianism, in general, and Machiavellian interpersonal tactics were predicted by fear of fusion and use of primitive defenses. Results are discussed from the perspective of Life History Theory.

Personality Structure Features Associated with Early Dropout in Patients with Substance-Related Disorders and Comorbid Personality Disorders

This study aims at investigating factors associated with early dropout in dual diagnosis patients, considering socio-demographic, diagnostic and personality structure variables. We hypothesized that the personality structure of the patient will show stronger associations with dropout, as compared to descriptive variables. Forty-seven patients consecutively admitted in a dual diagnosis residential treatment unit were administered the Structured Interview of Personality Organization (STIPO), the Structured Clinical Interview for Axis II Disorders (SCID II), the Response Evaluation Measure 71 (REM71), the Symptom Check List 90–R (SCL90-R), and the Borderline Personality Disorder Check List (BPDCL). Significant differences emerged between the dropout and no-dropout group: Investments and self-coherence problems (STIPO) were higher among dropouts; moreover, in the dropout group a significantly higher number of patients showed a borderline personality organization (88.9 %). Results support the use of structural interviews in the assessment of dual diagnosis patients; implications regarding research and clinical practice are discussed.

The diagnostic usability of selected narrativity indices in stories about close relationships in the assessment of personality organization

The aim of this study was to test the usability of selected narrativity indices identified from autobiographical accounts of important relationships in an assessment of neurotic (NPO) and borderline personality organization (BPO). Narrativity indices, both particular and generalized, were used to predict personality organization levels. Indices were derived from two separate layers of analysis: 1) lexical indices were counted with computer assistance; 2) evocative/reception indices dealing with coherence of the story were assessed using the competent judges method. It was found that the lexical narrativity index-the active "I"-was a good predictor of both BPO and NPO, while the human factor was a good predictor of BPO when low. Moreover, a generalized index was used to describe how stories are saturated with the narrativity indices of intentionality, concreteness, and active "I", but simultaneously deprived of human factor, and was found to be the best predictor of BPO. Furthermore, where the coherence of the story and of its subdimension (integration) rise, the probability of BPO diagnosis decreases. This research provides support for the thesis that surface narrativity indices may predict deeper personality structure. Its results are justified in the light of Kernberg's theory, and have the potential to become a useful tool in clinical practice as a supplementary source of information in diagnostic and psychotherapeutic processes.

Do Patients with Somatoform Disorders Present with Illusory Mental Health?

Background: Patients with somatoform disorders tend to report somatic complaints, while denying the influence of psychological factors: a pattern described as “illusory mental health”. The present study investigated if somatoform patients present themselves in this way. In this context we investigated features of personality organization), selfreported personality traits, symptomatology, and coping. Methods: A cross-sectional design was applied to 79 patients with somatoform disorders and 114 psychiatric controls. We compared the two groups regarding prevalence of the several profiles of personality organization, selfreported symptoms, coping and personality traits. Results: Compared to controls, the narcissistic subtype of the borderline personality organization was 2.5 times more prevalent among patients with somatoform disorders. Unexpectedly, the psychotic personality organization was also more prevalent among patients with somatoform disorders. Furthermore, patients with somatoform disorders rated themselves as more socially competent, with higher levels of self-esteem and greater ability to cope with problems. They also reported less anger and less depressive symptoms. However, they seem to recognize feelings of anxiety. Conclusion: Patients with somatoform disorders show a favourable self-presentation and in line with this a relatively high prevalence of the narcissistic personality organization. The favourable self-presentation in patients with somatoform disorders may be related to defensive denial, i.e. illusory mental health. The utility of self-reports may be limited in these patients, given their favourable self-presentation on these instruments. This has also implications for the use of self-reports in the context of assessing treatment outcome among patients with somatoform disorders, for example in the context of routine outcome monitoring. Somatization in patients with somatoform disorders might have an integrating preserving function. Future research should investigate the role of personality organization on treatment outcome for patients with somatoform disorders. Future research should also include observer ratings, complementary to self-reports, given the favourable self-presentation of SFD-patients.

Internal relationship patterns in borderline and neurotic personality organization: An analysis of self-narratives

Abstract The main goals of this study are 1) to explore whether internal relationship patterns are related to personality organization, and 2) to recognize the role that selected relationship patterns play in diagnosing personality organization levels. Internal relationship patterns were assessed according to the core conflictual relationship theme (CCRT) - about wishes (WS), responses from others (RO), and responses of the self (RS) - as identified from participants’ self-narratives about important relationships. Significant differences in the frequencies of patterns were found among participants with borderline personality organization (BPO), neurotic personality organization (NPO), and integrated personality (IPO). For example, the majority of negative RS responses were detected in the BPO sample. The study supports the thesis that relationship patterns might be related to personality organization, and that object representation complexity may be a good predictor of integrated personality organization.

Association between level of personality organization as assessed with theory-driven profiles of the Dutch Short Form of the MMPI and outcome of inpatient treatment for personality disorder

The association between level of personality organization as assessed by theory-driven profile interpretation of the MMPI (Hathaway & McKinley, 1943) Dutch Short Form and treatment outcome was investigated in a naturalistic follow-up study among 121 psychotherapy inpatients who had been treated for their severe personality pathology. Treatment outcome was measured with the Brief Symptom Inventory (De Beurs & Zitman, 2006). Personality organization was associated with severity of psychopathology at baseline, the end of treatment, and 36 months after baseline. At 36 months after baseline, all patients except those with the high-level borderline organization profile and the psychotic borderline profile maintained their improvement. Contrary to expectations, (a) personality organization did not differentiate between patients with successful and unsuccessful out-comes, and (b) patients with a neurotic personality organization did not respond better than those with a borderline personality organization. Because of the small N, conclusions are tentative.

Betrayal Trauma and Dimensions of Borderline Personality Organization

Borderline personality pathology can be conceptualized as one of many conditions within a broader spectrum of borderline personality organization (BPO). This spectrum is composed of several specific dimensions of psychological functioning (primitive psychological defenses, identity diffusion, and reality testing). Although several theories associate trauma with borderline pathology, betrayal trauma theory specifies that trauma with a high degree of betrayal has an especially pernicious influence on borderline pathology. In addition, betrayal trauma theorists propose that constructs related to each BPO dimension are influenced by traumatic betrayal, but this has not yet been tested within the context of borderline pathology specifically. In this article, we examine the relation between trauma with varying levels of betrayal and the specific dimensions of BPO using a Bayesian approach to multiple regression. Results indicated that trauma with a high degree of betrayal was associated with each dimension of BPO, that medium betrayal trauma was associated with problems in reality testing, and that low betrayal trauma was associated with primitive psychological defenses. These effects differed by gender. Limitations of the study and directions for future research are also discussed.

Changes in Treated Incidence of Borderline Personality Disorder in Denmark: 1970–2009

To investigate whether there are any trends in treated incidence of borderline personality disorder (BPD) in Danish psychiatric hospitals based on different diagnostic systems from 1970 to 2009. All patients diagnosed with BPD for the first time as a main or an auxiliary diagnosis treated in in- or outpatient facilities in Danish psychiatric hospitals were identified through the Danish Psychiatric Central Research Register. Age-standardized, sex-specific, and standardized rates were calculated for the International Classification of Diseases (ICD), Eighth Revision, diagnostic period from 1970 to 1993 and the ICD-10 diagnostic period from 1994 to 2009. The incidence for BPD in females as a main or an auxiliary diagnosis increased linearly from 1970 to 2009 (β = 0.69 per 100 000 per year [95% CI 0.66 to 0.73]). The rates for males also increased linearly from 1970 to 1993 (β = 0.37 [95% CI 0.30 to 0.43]) followed by a linearly decrease (β = -0.22 [95% CI -0.29 to -0.15]) in the ICD-10 period from 1994 to 2009. The increase in females with BPD after the mid-1990s is smaller when controlling for outpatients mandatorily registered from 1995. The lack of defined criteria for BPD in ICD-8 may have been interpreted broadly to mean Kernberg's overarching concept of borderline personality organization, resulting in similar rates for males and females. However, in ICD-10, clinicians using the more narrow criteria for emotionally unstable personality disorder (borderline type), tended to diagnose BPD more commonly in women. These results suggest the importance of using specific criteria in diagnosing. They also suggest the importance of stability in the diagnostic criteria for BPD and other disorders.

Psychiatric Comorbidity and Personality Structure in Patients with Polyvalent Addiction

Background: This study focuses on the systematic psychiatric evaluation of polydrug-using opiate-dependent patients, using the standard DSM-IV diagnostic interviews and a new psychodynamic instrument operationalizing personality organization (Structured Interview of Personality Organization, STIPO). Sampling and Method: 50 patients were interviewed with the Structured Clinical Interview for DSM-IV Disorders (SCID) I and II and the STIPO by two independent researchers at a detoxification treatment unit. Results: According to the SCID I and II, all patients had at least one axis I disorder, 90% at least one axis II disorder. A correspondence was found between STIPO and SCID results, in that more pathology in the SCID coincided with more severity in the STIPO. According to the STIPO, 100% of the patients were located at the level of borderline personality organization, indicating identity pathology according to Kernberg's model. Conclusion: Given the fact that comorbid psychiatric disorders compromise the outcome of detoxification and dehabituation treatments, it is highly relevant to diagnose these disorders and to assess underlying personality pathology. While the evidence of psychosocial treatments in addiction therapy is still weak, the integration of syndrome-tailored treatment modules may help improve the treatment of patients with this chronically relapsing condition. Limitation: small sample size.

Similarities and differences in borderline and organic personality disorder

IntroductionPrevious research has shown that brain injury patients with Organic Personality Disorder (OPD) may display “borderline” traits due to prefrontal damage, and their personality structure may be unstable and close to a borderline personality organisation. They may have few general neuropsychological dysfunctions but specific executive deficits. Similar deficits have been found in patients with Borderline Personality Disorder (BPD). The objective of this study was to identify differences and similarities between the neuropsychological and personality profiles of BPD and OPD patients.MethodsTwenty BPD patients and 24 OPD patients were assessed with the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II), the Karolinska Psychodynamic Profile (KAPP), and a comprehensive neuropsychological test battery.ResultsVery few neuropsychological differences were found between the two patient groups. However, the verbal fluency, verbal intelligence, verbal memory, and immediate auditory memory/attention of the BPD patients were significantly poorer than the OPD patients'. The KAPP profiles of the BPD patients showed significantly poorer functioning in three areas: frustration tolerance, the body as a factor of self-esteem, and overall personality organisation.ConclusionsThese results support our clinical experience and expectations concerning the severity of symptoms of both patient groups. We suggest considering in depth assessments of both neuropsychological and personality-related problems for each of these patients in order to inform treatment.

Personality Characteristics and Development of Psychopathology in Bipolar I and Borderline Personality Disorder Patients

The debate whether Bipolar Affective Disorder and Borderline Personality Disorder fall under the same spectrum or they represent separate categories has received much research attention. However, the question of their underlying psychological aetiology as well as their personality correlates has remained largely un-explored. The present study aims at gaining knowledge about and insights into these questions. The sample studied consists of 10 Bipolar I patients and 10 patients with Borderline Personality Disorder. Following a cross-sectional design, after determining the remitted phase of Bipolar I patients using Hamilton Depression Rating Scale and Young’s Mania Rating Scale, the Temperament and Character Inventory, Attachment Style Questionnaire, Defense Style Questionnaire and Rorschach Inkblot Test were administered individually by the researcher. Both group of patients showed features of immaturity and instability. A correlational analysis indicated the probable pathway of development of psychopathology. The parallels of the findings to Kernberg’s concept of borderline personality organization have been discussed.

Two to Tango: A Dyadic Analysis of Links Between Borderline Personality Traits and Intimate Partner Violence

Although research has shown links between borderline personality and intimate partner violence (IPV), few studies have examined how each partner's personality traits may influence the other's behavior (Hines, 2008). This study incorporated dimensional assessments of borderline personality organization (BPO) in both partners into a dyadic model that examined associations with IPV. In a community sample of 109 couples, an Actor-Partner Interdependence Model was used to examine links between BPO traits in each partner and victimization and perpetration of IPV. Men's level of BPO traits was associated with more IPV toward and more victimization by their partners. Women's level of BPO traits was associated with their victimization only. This study is unique in examining links between BPO and IPV in couples using analyses that account for the interdependence of these variables in dyads.

Two to Tango: A Dyadic Analysis of Links Between Borderline Personality Traits and Intimate Partner Violence

Although research has shown links between borderline personality and intimate partner violence (IPV), few studies have examined how each partner's personality traits may influence the other's behavior (Hines, 2008). This study incorporated dimensional assessments of borderline personality organization (BPO) in both partners into a dyadic model that examined associations with IPV. In a community sample of 109 couples, an Actor-Partner Interdependence Model was used to examine links between BPO traits in each partner and victimization and perpetration of IPV. Men's level of BPO traits was associated with more IPV toward and more victimization by their partners. Women's level of BPO traits was associated with their victimization only. This study is unique in examining links between BPO and IPV in couples using analyses that account for the interdependence of these variables in dyads.

Defense Mechanisms in Schizotypal, Borderline, Antisocial, and Narcissistic Personality Disorders

Numerous authors have theorized that defense mechanisms play a role in personality disorders. We reviewed theoretical writings and empirical studies about defenses in schizotypal, borderline, antisocial, and narcissistic personality disorders, developing hypotheses about these differential relationships. We then examined these hypotheses using dynamic interview data rated for defenses in a study of participants (n = 107) diagnosed with these four personality disorder types. Overall, the prevalence of immature defenses was substantial, and all four disorders fit within the broad borderline personality organization construct. Defenses predicted the most variance in borderline and the least variance in schizotypal personality disorder, suggesting that dynamic factors played the largest role in borderline and the least in schizotypal personality. Central to borderline personality were strong associations with major image-distorting defenses, primarily splitting of self and other's images, and the hysterical level defenses, dissociation and repression. Narcissistic and antisocial personality disorders shared minor image-distorting defenses, such as omnipotence or devaluation, while narcissistic also used splitting of self-images and antisocial used disavowal defenses like denial. Overall, differential relationships between specific defenses and personality disorder types were largely consistent with the literature, and consistent with the importance that the treatment literature ascribes to working with defenses.

The Influence of Borderline Personality Organization on Trait Depressive Affects and the Generation of Negative Life Events

The Influence of Borderline Personality Organization on Trait Depressive Affects and the Generation of Negative Life Events This study sought to assess whether borderline personality organization (BPO) influenced trait depressive affect, the generation of negative life events (NLEs), and state depressive affect, which includes the depressive affect component caused by the NLEs. The study population was 350 university students in Japan. They were solicited to complete questionnaires on three occasions over a six-week period. The Inventory of Personality Organization and Self-Rating Depression Scale (SDS) were used to assess BPO and depressive affect, respectively. Structural equation modeling and simultaneous analysis of multi-groups were used for statistical analysis.

1612 – Clinical characteristics and disorder-specific cognitions in treatment-seeking patients with internet addiction and borderline personality organization

Introduction Several epidemiological studies revealed prevalence-rates of Internet Addiction (IA) - which was currently proposed as an independent disorder for DSM-5 - ranging from 0.5 to 1 per cent. Above all, patients with IA show psychopathological patterns (craving, tolerance, withdrawal, mood modification, relapses) comparable to substance-related disorders. Besides, IA is frequently accompanied by various comorbidities, such as anxiety, depression or personality disorders. Objectives The aim of the present study was to assess typical clinical characteristics and disorder-specific cognitive styles in a subgroup of patients with IA and an underlying Borderline Personality Organization (BPO) in a consecutive sample of over 450 treatment-seekers in an Outpatient Clinic for Internet and Computer game Addiction. Methods 20 patients, who fulfilled both: the diagnostic criteria of IA and a Borderline Personality Disorder were compared with a matched control-group of BPO-patients without psychopathological but extensive Internet use. Both groups were assessed with the FGG (Questionnaire on borderline-specific cognitions and feelings, Renneberg et al., 2004) and further psychological features (e.g. global assessment of functioning (GAF), self-efficacy (SWE) and sensation seeking). Results BPO-patients with IA show an increased mean of the total score of the FGG as well as of further clinical measures. The results lead to the assumption, that BPO-patients with IA use more disorder-specific cognitions, show higher mental strains and lower levels of health-related well-being compared to BPO-patients with only an extensive internet use. Conclusions Internet addictive behavior in BPO-patients may serve as avoidance behavior in order to subdue the burden of the primary disease.