Diagnostic Criteria For Borderline Personality Disorder Research Articles

Borderline Personality Features and Self-Injurious Urges: The Roles of Self-Concept Clarity and Bedtime Self-Critical Rumination

ABSTRACT Low self-concept clarity is associated with self-injurious urges among persons with borderline personality disorder (BPD). Self-critical rumination may potentially exacerbate these associations. Yet empirical research on how self-critical rumination and self-concept clarity interact is scarce. We examined near-term associations between bedtime self-critical rumination, self-concept clarity, and self-injurious urges among adolescents who met at least 3 diagnostic criteria for BPD (N = 22; 63.6% girls/women; M age = 16.45). Participants were sent five daily mobile surveys for 20 days (1691 total assessments completed). Bedtime self-critical rumination moderated concurrent associations between self-concept clarity and self-harm wishes, but not suicide desires. Lower self-concept clarity was associated with elevated self-harm wishes only among participants with moderate to high bedtime self-critical rumination. Findings provide a preliminary step toward understanding the link between self-concept clarity and self-injurious urges.

Inner and Outer Circles of Factors Associated with Non-Suicidal Self-Injury (NSSI): A Narrative Review

Abstract: Non-suicidal self-injury (NSSI) is a major concern in the field of public health. In the previous version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), self-injury was only a symptom of borderline personality disorder, but this criterion has recently been seen in people who do not have the diagnostic criteria of borderline personality disorder. The trans-diagnostic approach emphasizes the importance of the factors that precipitate and perpetuate this disorder. The purpose of this research is to review the factors that cause this behavior. Studies were reviewed using Google Scholar, PubMed, Web of Science, and Scopus databases with keywords of NSSI etiology factor and NSSI risk factor. In the present study, factors related to self-injury were studied in two categories: proximal and distal factors. Distal factors include traumatic family and insecure attachment; proximal factors are classified into 4 categories: negative selfrelationship, emotional factors, social factors, and the role of peer groups. Hence, it is better to address risk factors that are related to NSSI for a comprehensive and effective treatment.

Borderline Personality Disorder Symptoms in a Community Sample of Sexually and Gender Diverse Adults.

The current study aimed to identify borderline personality disorder (BPD) symptom disparities in sexually and/or gender diverse adults, determine if BPD symptoms vary across sexual orientation and gender identity, and identify factors related to BPD symptoms in this population. A sample of 218 sexually and gender diverse adults completed measures for BPD symptoms and trauma/stressors. Results suggest that sexually and/or gender diverse adults scored higher on six of the nine diagnostic criteria for BPD and were likely to have a probable BPD diagnosis, although these disparities were not observed across groups. Factors such as age, abuse and neglect and stigmatizing events were associated with more BPD symptoms, although the relationship between stigma and BPD symptoms did not remain when controlling for other factors. Results suggest that sexual orientation and gender identity are important factors when investigating BPD, and stigma may in part account for this disparity, although future research is needed.

Crisis interventions for adults with borderline personality disorder.

People diagnosed with borderline personality disorder (BPD) frequently present to healthcare services in crisis, often with suicidal thoughts or actions. Despite this, little is known about what constitutes effective management of acute crises in this population and what type of interventions are helpful at times of crisis. In this review, we will examine the efficacy of crisis interventions, defined as an immediate response by one or more individuals to the acute distress experienced by another individual, designed to ensure safety and recovery and lasting no longer than one month. This review is an update of a previous Cochrane Review examining the evidence for the effects of crisis interventions in adults diagnosed with BPD. To assess the effects of crisis interventions in adults diagnosed with BPD in any setting. We searched CENTRAL, MEDLINE, Embase, nine other databases and three trials registers up to January 2022. We also checked reference lists, handsearched relevant journal archives andcontacted experts in the field to identify any unpublished or ongoing studies. Randomised controlled trials (RCTs) comparing crisis interventions with usual care, no intervention or waiting list, in adults of any age diagnosed with BPD. We used standard methodological procedures expected by Cochrane. We included two studies with 213 participants. One study (88 participants) was a feasibility RCT conducted in the UK that examined the effects of joint crisis plans (JCPs) plus treatment as usual (TAU) compared to TAU alone in people diagnosed with BPD. The primary outcome was self-harm. Participants had an average age of 36 years, and 81% were women. Government research councils funded the study. Risk of bias was unclear for blinding, but low in the other domains assessed. Evidence from this study suggested that there may be no difference between JCPs and TAU on deaths (risk ratio (RR) 0.91, 95% confidence interval (CI) 0.06 to 14.14; 88 participants; low-certainty evidence); mean number of self-harm episodes (mean difference (MD) 0.30, 95% CI -36.27 to 36.87; 72 participants; low-certainty evidence), number of inpatient mental health nights (MD 1.80, 95% CI -5.06 to 8.66; 73 participants; low-certainty evidence), or quality of life measured using the EuroQol five-dimension questionnaire (EQ-5D; MD -6.10, 95% CI -15.52 to 3.32; 72 participants; very low-certainty evidence). The study authors calculated an Incremental Cost Effectiveness Ratio of GBP -32,358 per quality-adjusted life year (QALY), favouring JCPs, but they described this result as "hypothesis-generating only" and we rated this as very low-certainty evidence. The other study (125 participants) was an RCT conducted in Sweden of brief admission to psychiatric hospital by self-referral (BA) compared to TAU, in people with self-harm or suicidal behaviour and three or more diagnostic criteria for BPD. The primary outcome was use of inpatient mental health services. Participants had an average age of 32 years, and 85% were women. Government research councils and non-profit foundations funded the study. Risk of bias was unclear for blinding and baseline imbalances, but low in the other domains assessed. The evidence suggested that there is no clear difference between BA and TAU on deaths (RR 0.49, 95% CI 0.05 to 5.29; 125 participants; low-certainty evidence), mean number of self-harm episodes (MD -0.03, 95% CI -2.26 to 2.20; 125 participants; low-certainty evidence), violence perpetration (RR 2.95, 95% CI 0.12 to 71.13; 125 participants; low-certainty evidence), or days of inpatient mental health care (MD 0.70, 95% CI -14.32 to 15.72; 125 participants; low-certainty evidence). The study suggested that BA may have little or no effect on the mean number of suicide attempts (MD 0.00, 95% CI -0.06 to 0.06; 125 participants; very low-certainty evidence). We also identified three ongoing RCTs that met our inclusion criteria. The results will be incorporated into future updates of this review. A comprehensive search of the literature revealed very little RCT-based evidence to inform the management of acute crises in people diagnosed with BPD. We included two studies of two very different types of intervention (JCP and BA). We found no clear evidence of a benefit over TAU in any of our main outcomes. We are very uncertain about the true effects of either intervention, as the evidence was judged low- and very low-certainty, and there was only a single study of each intervention. There is an urgent need for high-quality, large-scale, adequately powered RCTs on crisis interventions for people diagnosed with BPD, in addition to development of new crisis interventions.

Predicting Suicidal Behavior Without Asking About Suicidal Ideation: Machine Learning and the Role of Borderline Personality Disorder Criteria.

Identifying predictors contributing to suicide risk could help prevent suicides via targeted interventions. However, using only known risk factors may not yield accurate enough results. Furthermore, risk models typically rely on suicidal ideation, even though people often withhold this information. This study examined the contribution of various predictors to the accuracy of six machine learning models for identifying suicidal behavior in a prison population (n=353), including borderline personality disorder (BPD) and antisocial personality disorder (APD) criteria, and compared how excluding data about suicidal ideation affects accuracy. Results revealed that gradient tree boosting accurately identified individuals with suicidal behavior, even without relying on questions about suicidal ideation (AUC=0.875, F1=0.846). Furthermore, the model maintained this accuracy with only 29 predictors. Meeting five or more diagnostic criteria of BPD was an important risk factor for suicidal behavior. APD criteria, in the presence of other predictors, did not substantially improve accuracy. Additionally, it may be possible to implement a decision tree model to assess individuals at risk of suicide, without focusing upon suicidal ideation. These findings highlight that modern classification algorithms do not necessarily require information about suicidal ideation for modeling suicide and self-harm behavior.

Oriented mentalization-based treatment for borderline personality disorder patients: preliminary results at Camposampiero Mental Health Center.

This contribution presents two brief reports about preliminary results of 18 months of oriented Mentalization-Based Treatment (MBT), with Borderline Personality Disorder patients, recruited at the Camposampiero Mental Health Center. Following in large part Bateman and Fonagy guidelines for MBT in institutional settings, this paper presents preliminary results in two brief reports related to two cohorts of patient underwent to the oriented MBT in Camposampiero Mental Health Center (MHC). In the first study, we analyzed a group of 9 patients: an anamnestic schedule was administered; then, symptoms (SCL-90-R), psychodiagnostic scale and global health functioning (Health of the Nation Outcome Scale, Structured Clinical Interview for DSM-IV Axis II Disorder [SCID-II], Global Assessment of Functioning, [GAF]), data on service impact and service costs (Cassel Community Adjustment Questionnaire, Patient Evaluation Schedule and folder data) were provided at the beginning (T0), at the end of the treatment (T2) and 1 year after the end of the MBT project. The second study showed a micro-analytical change on a second patient cohort (n=6) at T0, 3, 6 and 9 months (T1) were presented considering specifically mentalization (Comparative Psychotherapy Process Scale, Modes of Mentalization Scale, Mentalization Imbalances Scale) and patienttherapist session evaluation trends (Session Evaluation Questionnaire) and patient reflective functioning at T0 and T2 (Reflective Functioning Questionnaire). Aims and hypotheses of the two studies pointed out how the oriented MBT bring to an improvement of the overall functioning of the patients, a reduction of the symptoms, a decrease of the diagnostic criteria for the Borderline Personality Disorder (BPD) and the other Axis II disorders, a reduction of the workload hours for the MHC staff and of the costs of the assistance. The analyses of both the studies were carried out using non-parametric statistics (Friedman test, Spearman correlation, Chi-square). Preliminary results confirmed the improvement in the overall functioning of patients (GAF), the reduction in BPD-related symptoms and in diagnostic criteria for BPD (SCID-II), the improvement of patients’ mentalization skills, and a significant reduction in workload for health staff. Standing the limits and the preliminary results, the two brief reports demonstrate the feasibility of an oriented MBT within an Italian Public Service and the effectiveness of this treatment pathway for patients with BPD, leaving some open questions to stimulate a fruitful clinical discussion.

Awareness of identity alteration and diagnostic preference between borderline personality disorder and dissociative disorders

ABSTRACTAim: This study inquires into identity alteration among college students and its relationship to borderline personality disorder (BPD) and/or dissociative disorders (DDs). Methods: Steinberg Identity Alteration Questionnaire (SIAQ), Childhood Trauma Questionnaire (CTQ), and self-report screening tool of the BPD section of the Structured Clinical Interview for DSM-IV (SCID-BPD) were administered to 1301 college students. Participants who fit the diagnostic criteria of BPD (n = 80) according to the clinician-administered SCID-BPD and 111 non-BPD controls were evaluated using the Structured Clinical Interview for DSM-IV DDs (SCID-D) by two psychiatrists blind to the group membership and scale scores. Results: Test-retest evaluations and internal consistency analyses suggested that SIAQ was a reliable instrument. Of the participants, 11.3% reported a SIAQ score 25 or above alongside some impairment. SIAQ scores differentiated participants who fit the diagnostic criteria for a DD from those who did not. While self-report identity alteration was correlated with all childhood trauma types, clinician-assessed identity alteration was correlated with childhood sexual abuse only. Those who fit criteria for both disorders had the highest identity alteration scores in self-report and clinician-assessment. Although both syndromes had significant effect on self-report identity alteration total scores, in contrast to DD, BPD did not have an effect on the clinician-administered evaluation. Conclusion: An impression of personality disorder rather than a DD may seem more likely when identity alteration remains subtle in clinical assessment, notwithstanding its presence in self-report. Lack of recognition of identity alteration may lead to overdiagnosis of BPD among individuals who have a DD.

Digging out insights and behavioral correlates of false and true femininity in borderline personality disorder patients attending four-step integrative model group psychotherapy

IntroductionThe four-step integrative model of psychotherapy is concerned with individual's needs, wants, rights and decisions in that order. It may carry a promise for deep and changing vision for patients with borderline personality disorder (BPD).ObjectivesThe study of the illuminating and changing effect of dealing with BPD patients in view of their needs, wants, rights and decisions.AimsTo evaluate the effect of group work through the hierarchy of the four-step integrative model with BPD patients and to help them explore false and true elements of their femininity.MethodsForty-three female patients (age range: 19-37) diagnosed according to DSM-IV diagnostic criteria for BPD were enrolled in a dynamic psychotherapy group. Their progress was evaluated using Borderline evaluation of severity over time (BEST) and they wrote down detailed comments about their experience quarterly.ResultsResults of regular attendants for 2 years were included (35 = 81.4%). The results of BEST showed a significant reduction of BPD severity at the end of 1 and 2 years. During psychotherapy sessions and within their quarterly comments, patients expressed their change in terms of moving from a state of cunning, manipulation, aggression, arrogance, envy and rejection (as stemming from their false femininity) into wisdom, confrontation, patience, pride, healthy competition and containment respectively (as stemming from their true femininity).ConclusionsPatients with BPD may gain a better insight and genuine change as they realize what is false and what is true about their femininity in the context of attending four-step integrative model group psychotherapy.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Personality Traits and Borderline Personality Disorder

The people with Borderline Personality Disorder (BPD) show pathological personality traits in three of the five domains (APA 2013). In addition to diagnostic criteria for BPD, described by Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the dimensional model of personality disorder, based on five-factor model of personality, seems to gain interest as it promisses to eliminate problems associated with poor-fit, co-morbidity and unclear diagnosis. The purpose of this study is to identify the personality traits by people who are already diagnosed with BPD using the DSM-5 categorical criteria. Based on the theoretical concepts and existing research findings as well as increased interest in the dimensional personality theory, we assume that people diagnosed with BPD will show high levels of pathology on three trait domains: negative affectivity, disinhibition and antagonism. This study was conducted in Germany in psychiatric clinic. Fifteen participants represented a convenience sample, of patients already diagnosed with BPD. For this study Personality Inventory for DSM-5 (PID-5) was used. The findings supported the assumptions that people with BPD show some degree of anxiousness, emotional lability, hostility, impulsivity, risk taking and separation anxiety. The study also found that traits such as distractibility, withdrawal and submissiveness were also present in this participant group. Even though, study was conducted with small number of participants it has provided contribution to the already existing knowledge and understanding in regards to common personality treats for people diagnosed with BPD.

I-A SPECIAL: A Mnemonic for DSM-5 Borderline Personality Disorder Diagnostic Criteria

I-A SPECIAL: A Mnemonic for DSM-5 Borderline Personality Disorder Diagnostic Criteria A mnemonic is developed to assist clinicians in recalling the diagnostic criteria for patients with borderline personality disorder (BPD). For each letter of the mnemonic a DSM-5 diagnostic criterion is described. The mnemonic statement was designed to portray some of the unique facets of patients who suffer from BPD and to reflect a positive and optimistic view of this difficult disorder. It is hoped that clinicians who treat patients with BPD would find the suggested mnemonic helpful in assisting them in recalling the nine DSM-5 diagnostic criteria of BPD.

Beyond borderline personality disorder: the mindful brain.

Numerous studies have showed an improvement in symptoms characteristic of borderline personality disorder (BPD) when mindfulness-based interventions were integrated into the daily lives of individuals with BPD. Although these studies have examined the etiology and diagnostic prognosis of BPD, and have discussed the use of mindfulness-based treatments, few researchers have attempted to interpret the neuroscientific findings, which have showed an increase in gray matter in key areas of the brain in clients with BPD who engaged in mindfulness practice. Some clients who had originally met a minimum of five of the DSM-IV-TR diagnostic criteria for BPD no longer did so upon engaging in mindfulness-based treatment. This article highlights the efficacy of mindfulness-based interventions with an emphasis on meditation, which leads to overall better psychological functioning in clients with BPD in three key areas: impulsivity, emotional irregularity, and relationship instability.

The addition of STEPPS in the treatment of patients with bipolar disorder and comorbid borderline personality features: a protocol for a randomized controlled trial.

BackgroundBipolar disorder (BD) and borderline personality disorder (BPD) both are severe and chronic psychiatric disorders. Both disorders have overlapping symptoms, and current research shows that the presence of a BPD has an adverse effect on the course of BD. The limited research available shows an unfavorable illness course, a worse prognosis and response to medication, longer treatment duration, more frequent psychiatric admissions, higher drop-out, increased risk of substance abuse, increased risk of suicide, and more impairment of social and occupational functioning. However, there is no research available on the effect of specific psychotherapeutic treatment for this patients.Methods/DesignThis paper presents the protocol of a RCT to investigate the presence of borderline personality features in patients treated for BD (study part 1) and the effectiveness of STEPPS (Systems Training for Emotional Predictability and Problem Solving) added to treatment as usual (TAU) for BD compared to TAU in patients with BD and comorbid borderline personality features (study part 2). STEPPS is a validated and effective intervention for BPD. The study population consists of patients treated for BD at specialized outpatient clinics for BD in the Netherlands. At first the prevalence of comorbid borderline personality features in outpatients with BD is investigated. Inclusion criteria for study part 2 is defined as having three or more of the DSM-IV-TR diagnostic criteria of BPD, including impulsivity and anger bursts. Primary outcomes will be the frequency and severity of manic and depressive recurrences as well as severity, course and burden of borderline personality features. Secondary outcomes will be quality of life, utilizing mental healthcare and psychopathologic symptoms not primarily related to BD or BPD. Assessment will be at baseline, at the end of the intervention, and at 12 and 18 months follow-up.DiscussionThis will be the first randomized controlled trial of a specific intervention in patients with BD and comorbid BPD or borderline personality features. There are no recommendations in the guideline of treatment of bipolar disorders for patients with this complex comorbidity. We expect that a combined treatment aimed at mood disorder and emotion regulation will improve treatment outcomes for these patients.

Convergence between DSM-5 Section II and Section III diagnostic criteria for borderline personality disorder

Borderline personality disorder (BPD) is a common mental health condition in psychiatric settings. The current study examined the overlap between the operationalization of BPD listed in Section II (Diagnostic Criteria and Codes) and the alternative, dimensional personality trait-based operationalization listed in Section III (Emerging Measures and Models) of the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Moreover, the unique contributions of specific personality traits for indexing the traditional BPD operationalization were also evaluated, including conceptually relevant traits not originally proposed for Section III BPD. Participants were 145 consecutive patients from a psychiatric unit in a hospital in the USA. These individuals completed a series of questionnaires that index both traditional (DSM-IV/DSM-5 Section II) and alternative (DSM-5 Section III personality traits) diagnostic criteria for BPD. Structural equation modeling results revealed that latent constructs representing the Section II and Section III operationalizations of BPD, respectively, overlapped substantially (r = 0.86, p < 0.001). Hierarchical latent regression models indicated that at least five of the seven traits proposed to define Section III BPD uniquely accounted for variance (69%) in a latent Section II BPD variable. Finally, at least one other conceptually relevant trait (Perceptual Dysregulation) augmented the prediction of latent BPD scores. The proposed personality traits for Section III BPD are clearly aligned with traditional conceptualizations of this important personality disorder construct. At least five of the seven dimensional traits proposed to define Section III contributed uniquely to the characterization of Section II BPD, and these traits can be augmented by Perceptual Dysregulation. If replicated in other settings, these findings might warrant some modification to the operationalization of DSM-5 Section III BPD.

Nonsuicidal self-injury disorder: Clinician and expert ratings

Nonsuicidal self-injury (NSSI) is a growing clinical and public health problem that affects individuals from all age groups, most prominently young adults. NSSI involves numerous methods and functions. NSSI has long been associated with borderline personality disorder (BPD), and in fact, it is only referenced among the diagnostic criteria of BPD in the DSM-IV-TR. However, recent studies have provided strong evidence that NSSI occurs outside of BPD. For these reasons, a diagnosis of nonsuicidal self-injury is included in DSM-5 Section-III as a condition that requires further study. The primary purpose of the present study was to identify whether the proposed DSM-5 NSSI criteria adequately reflect the symptoms of a prototypic individual who engages in self-injury. Clinicians in private practice and expert NSSI researchers (n=119) were asked to describe their familiarity and agreement with the proposed DSM-5 NSSI criteria, as well as the degree to which each proposed criterion is a prototypic symptom. Overall, most participants reported that the proposed DSM-5 criteria for NSSI accurately captured the behavior of the prototypic self-injurer. The results of this study provide incremental support for the proposed DSM-5 NSSI diagnostic criteria.

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.

Borderline personality disorder and couple dysfunctions

The central characteristics of borderline personality disorder (BPD) are bound to be associated with the development and maintenance of couple dysfunction. Although seven of the nine diagnostic criteria of BPD in the DSM-IV-TR refer directly to interpersonal functioning, very few empiric studies have addressed the exact nature of the relationship between BPD and couple functioning. This article examines recent studies describing couple outcomes--union formation and durability, partner choice, relationship satisfaction, intimate violence, attachment security, and sexual functioning--associated with BPD. The relationship between couple dynamics (including partner personality characteristics) and BPD symptomatology is probably bidirectional or reciprocal. The review concludes with an exploration of diagnostic and treatment implications.

MMPI critical item characteristics of the DSM-III borderline personality disorder.

This study attempted to distinguish the borderline personality disorder (BPD) from other personality disorders (OPD) on the basis of the Lachar and Wrobel critical item list. Seventy-five male psychiatric inpatients with diagnoses fitting DSM-III criteria for BPD and OPD and ranging in age from 24 to 47 years completed the MMPI. Lachar's critical item set, composed of 111 items taken from the MMPI, was then selected from each of the 75 subjects' response items. BPD and OPD patients significantly differed on only the Lachar Substance Abuse subscale. Implications of this study are discussed with regard to the concept that personality structure involves a continuum of psychopathology. The Lachar critical item list provided support for drug abuse as part of the diagnostic criteria for BPD and displayed promise for identifying areas of psychopathology on which treatment may be focused.