Nonborderline Personality Disorders Research Articles

Metacognitive Interpersonal Therapy for Personality Disorders: A Case Study Series

The study aimed to assess the effectiveness of metacognitive interpersonal therapy (MIT) as a psychological treatment for presentations consistent with non-borderline personality disorders (PD). We conducted a single-case series of three patients with personality disorders meeting inclusion criteria. Clients received 2 years of weekly individual MIT. Outcomes were assessed every 3 months for the first year at the end of treatment and at 3-months follow-up. Co-primary outcomes were reduction in the number of SCID-II PD criteria met and reduction in self-reported global distress (SCL-90-R GSI). Secondary outcomes were reduction in self-reported interpersonal problems (IIP-32), anxiety (STAI-Y), depression (BDI-II) and emotional dysregulation (DERS). Reliable Change Indices were calculated for all outcomes. All three patients completed treatment, achieving reliable change at the end of treatment for reduction in total number of personality disorder criteria and in overall symptoms. For secondary outcomes, two patients improved in emotion regulation, one in depression. There was no evidence of reliable change on self-reported anxiety or interpersonal problems. At 3-months post treatment improvements in overall symptoms and emotional regulation were observed for all patients. Plot analyses of the results showed a trend towards reduction for all outcomes. MIT is a new manualized treatment for non-borderline PD’s. We demonstrate preliminary evidence of acceptability and effectiveness in this understudied population. Future studies are required to establish the effectiveness of MIT in larger PD samples, including patients with lower socio-economic status.

Distinguishing Bipolar II Depression From Major Depressive Disorder With Comorbid Borderline Personality Disorder

Article Abstract Objective: Because of the potential treatment implications, it is clinically important to distinguish between bipolar II depression and major depressive disorder with comorbid borderline personality disorder. The high frequency of diagnostic co-occurrence and resemblance of phenomenological features has led some authors to suggest that borderline personality disorder is part of the bipolar spectrum. Few studies have directly compared patients with bipolar disorder and borderline personality disorder. In the present study from the Rhode Island Methods to Improve Diagnostic Assessment and Services project, we compared these 2 groups of patients on demographic, clinical, and family history variables. Method: From December 1995 to May 2012, 3,600 psychiatric patients presenting to the outpatient practice at Rhode Island Hospital (Providence, Rhode Island) were evaluated with semistructured diagnostic interviews for DSM-IV Axis I and Axis II disorders. The focus of the present study is the 206 patients with DSM-IV major depressive disorder and borderline personality disorder (MDD-BPD) and 62 patients with DSM-IV bipolar II depression without borderline personality disorder. Results: The patients with MDD-BPD were significantly more often diagnosed with posttraumatic stress disorder (P < .001), a current substance use disorder (P < .01), somatoform disorder (P < .05), and other nonborderline personality disorder (P < .05). Clinical ratings of anger, anxiety, paranoid ideation, and somatization were significantly higher in the MDD-BPD group (all P < .01). The MDD-BPD patients were rated significantly lower on the Global Assessment of Functioning (P < .001), their current social functioning was poorer (P < .01), and they made significantly more suicide attempts (P < .01). The patients with bipolar II depression had a significantly higher morbid risk for bipolar disorder in their first-degree relatives than the MDD-BPD patients (P < .05). Conclusions: Patients diagnosed with bipolar II depression and major depressive disorder with comorbid borderline personality disorder differed on a number of clinical and family history variables, thereby supporting the validity of this distinction. J Clin Psychiatry 2013;74(9):880-886 © Copyright 2013 Physicians Postgraduate Press, Inc. Submitted: February 15, 2013; accepted April 22, 2013 (doi:10.4088/JCP.13m08428). Corresponding author: Mark Zimmerman, MD, 146 West River St, Providence, RI 02904 (mzimmerman@lifespan.org).

A description of an audit cycle of early dropouts from an inpatient psychotherapy unit

This paper describes the results and implications of an 8-year audit cycle concerning premature termination of treatment in a population with severe personality disorder treated within a specialist residential setting. The results of the first audit showed (a) a high early dropout rate, (b) a significant difference in early dropout rates between the two clinical programmes (one-stage and step-down) offered by the unit, and (c) a higher attrition of non-borderline personality disorders compared to borderline type disorder. Qualitative analysis of interviews with early dropout patients helped to identify deficiencies in practice, which may have contributed to dropout. Discussion of results amongst the team led to corrective measures that allowed reduction of early dropout in the one-stage programme over the subsequent years. The implications of the results are discussed.

Serum cholesterol and impulsivity in personality disorders

Decreased serum cholesterol has been associated with impulsive aggressive behaviors. This study was designed to explore the relationship between serum cholesterol levels and measures of impulsive aggression in personality disordered patients. Forty-two personality disordered patients (14 borderline personality disorder, 28 other personality disorders) were included. Fasting serum cholesterol was measured by standard enzymatic assay. An ANOVA was performed with factors of gender and diagnosis, looking at two-way interactions between the factors and serum cholesterol. Patients with borderline personality disorder were found to have significantly lower serum cholesterol than non-borderline personality disorders. A significant interaction effect was also seen between gender and diagnosis with the male patients having lower cholesterol levels. This study suggests there may be a relationship between borderline personality disorder and low serum cholesterol.

Psychopathology in offspring of mothers with borderline personality disorder: a pilot study.

Children of mothers with borderline personality disorder (BPD) were hypothesized to be at greater risk for psychopathology, particularly impulse spectrum disorders, than children of mothers with other personality disorders. Twenty-one index children were compared with 23 children of mothers with a nonborderline personality disorder. Diagnoses were obtained using the Kiddie Schedule for Affective Disorders and Schizophrenia-Episodic Version (KSADS-E) and the Child Diagnostic Interview for BPD (CDIB), and functioning was rated with the Child Global Assessment Schedule (CGAS). Physical, sexual, and verbal abuse, as well as family violence and placements, were also assessed. The children of the borderline mothers, as compared with controls, had more psychiatric diagnoses, more impulse control disorders, a higher frequency of child BPD, and lower CGAS scores. There were no differences between the groups for trauma. The offspring of borderline mothers are at high risk for psychopathology.

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.

A comparison of the families of mothers with borderline and nonborderline personality disorders

The purpose of this study was to evaluate the families of procreation of mothers with borderline personality disorder (BPD) on measures of family stability, family satisfaction, and family environment. Families of nine BPD mothers were compared with families of 14 mothers with other personality disorders using a semi-structured interview to evaluate family history, the Family Environment Scale (FES), and the Family Satisfaction Scale (FSS). Families of procreation of BPD mothers were more unstable than comparison group families. FES scores of BPD mothers were significantly lower than controls in cohesion and organization, but not in conflict. Instability and low family cohesion are common in families of BPD mothers, and may place their children at increased risk for development of psychopathology.

Dissociation in Male Patients With Borderline and Non-Borderline Personality Disorders

The purpose of this study was to examine dissociation in males with borderline and nonborderline personality disorders, in relation both to diagnosis and to psychological risk factors. A sample of 121 men with personality disorders was divided into a borderline group from a clinic (n = 32), a borderline group obtained by advertisement (n = 29), and a nonborderline group (n = 60). Dissociation was measured by scores on the Dissociative Experiences Scale (DES) and by scores on three factors derived from the DES. The psychological risk factors that were examined included childhood sexual abuse and its parameters, physical abuse and its parameters, separation or loss, and abnormal parental bonding. The results showed that DES scores were higher in both borderline groups. Sexual and physical abuse were not related to any form of dissociation, and none of the other psychological risk factors was related to either DES or the DES factors above and beyond diagnosis. The findings therefore do not support theories that trauma accounts for the dissociative phenomena associated with BPD.

Dissociation in Female Patients With Borderline and Non-Borderline Personality Disorders

Dissociation in Female Patients With Borderline and Non-Borderline Personality DisordersHallie Zweig-Frank, Joel Paris and Jaswant GuzderHallie Zweig-FrankSearch for more papers by this author, Joel ParisDirect reprint requests to Dr. J. Paris at this address.Search for more papers by this author and Jaswant GuzderInstitute of Community and Family Psychiatry, 4333 Chemin de la Cote Ste, Catherine, Montreal QC H3T 1E4, Canada.Search for more papers by this authorPublished Online:February 2011https://doi.org/10.1521/pedi.1994.8.3.203PDFPDF PLUS ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations About Previous article Next article FiguresReferencesRelatedDetails Cited byCited by1. Child maltreatment-related dissociation and its core mediation schemas in patients with borderline personality disorderOnline publication date: 12 August 2020. Go to citation Crossref Google Scholar2. The So‐Called Borderline Patient: Aetiology, Diagnosis, and TreatmentOnline publication date: 10 September 2020. Go to citation Crossref Google Scholar3. ReferencesOnline publication date: 24 March 2020. Go to citation Crossref Google Scholar4. The extent of dissociation in borderline personality disorder: A meta-analytic reviewOnline publication date: 21 November 2016. Go to citation Crossref Google Scholar5. 32. État limiteOnline publication date: Go to citation Crossref Google Scholar6. Online publication date: Go to citation Crossref 7. The course of dissociation for patients with borderline personality disorder and axis II comparison subjects: a 10-year follow-up studyOnline publication date: Go to citation Crossref Google Scholar8. Fatal Distraction: The Impact of Mortality Salience on Dissociative Responses to 9/11 and Subsequent Anxiety SensitivityOnline publication date: 7 June 2010. Go to citation Crossref Google Scholar9. Childhood sexual abuse in relation to neurobiological challenge tests in patients with borderline personality disorder and normal controlsOnline publication date: Go to citation Crossref Google Scholar10. Neurocognitive impairment as a moderator in the development of borderline personality disorderOnline publication date: 12 December 2005. Go to citation Crossref Google Scholar11. The worm at the core: A terror management perspective on the roots of psychological dysfunctionOnline publication date: Go to citation Crossref Google Scholar12. Online publication date: Go to citation Crossref 13. Dissociative disorders in turkish inpatients with conversion disorderOnline publication date: Go to citation Crossref Google Scholar14. The Relationship Between Pathological Dissociation, Self-Injury and Childhood Trauma in Patients with Personality Disorders Using Taxometric AnalysesOnline publication date: Go to citation Crossref Google ScholarGlenn N. Saxe, Neharika Chawla and Bessel Van der Kolk15. Self-Destructive Behavior in Patients with Dissociative DisordersOnline publication date: 2 June 2005. Go to citation Crossref 16. Wie entwickelt sich die kindliche Persönlichkeit? Beiträge zur Diskussion um Vererbung und UmweltOnline publication date: Go to citation Crossref Google Scholar17. The dissociative experiences of borderline patientsOnline publication date: Go to citation Crossref Google Scholar18. NEUROPSYCHOLOGICAL TESTING RESULTSOnline publication date: Go to citation Crossref Google Scholar19. Risk Factors Associated with the Dissociative Experiences of Borderline PatientsOnline publication date: Go to citation Crossref Google Scholar20. The relationship between dissociation and personalityOnline publication date: Go to citation Crossref Google Scholar21. Childhood experiences and personality traits in patients with motor conversion symptomsOnline publication date: Go to citation Crossref Google Scholar22. Twin Study of Dissociative ExperienceOnline publication date: Go to citation Crossref Google Scholar23. Dissociative experiences and dissociative disorders in acute psychiatric inpatientsOnline publication date: Go to citation Crossref Google Scholar24. A Critical Review of Recovered Memories in Psychotherapy: Part I—Trauma and MemoryOnline publication date: 1 May 1996. Go to citation Crossref Google Scholar25. Defense Styles, Hostility, and Psychological Risk Factors in Male Patients with Personality DisordersOnline publication date: Go to citation Crossref Google Scholar26. Online publication date: Go to citation Crossref Volume 8Issue 3Sep 1994 Information© 1994 The Guilford PressPDF download

Psychological risk factors and self-mutilation in male patients with BPD.

The purpose of this study was to determine whether or not self-mutilation in patients with personality disorders is related to other psychological risk factors, dissociation or diagnosis. The sample included 61 subjects with borderline personality disorder and 60 subjects with nonborderline personality disorder; 32 subjects with borderline personality disorder reported self-mutilation. Psychological risk factors were measured through histories of childhood sexual abuse, physical abuse and separation or loss as well as through scores on the Parental Bonding Index. Dissociation was measured by the Dissociative Experiences Scale. There were no relationships between any of the psychological risk factors and self-mutilation. Subjects who mutilated themselves had higher scores on the Dissociative Experiences Scale in univariate analysis but the scores in multivariate analyses dissociation did not discriminate between subjects who mutilated themselves and those who did not. The results do not support the theory that abuse and dissociation account for self-mutilation in the personality disorders.

Psychological risk factors for dissociation and self-mutilation in female patients with borderline personality disorder.

The purposes of this study were to determine whether or not dissociation in female patients suffering from personality disorder is related to sexual and physical abuse or to abuse parameters and whether or not self-mutilation in the personality disorders is related to psychological risk factors or to dissociation. The sample was divided into 78 borderline and 72 nonborderline personality disorders. Psychological risk factors were measured through histories of childhood sexual abuse, physical abuse and separation or loss as well as scores on the Parental Bonding Index. Dissociation was measured by the Dissociative Experiences Scale. On the diagnostic interview, 48 subjects scored positive for self-mutilation. Dissociative Experiences Scale scores were associated with a borderline diagnosis but not with childhood sexual abuse or physical abuse. The parameters of abuse were not related to dissociation. Subjects who mutilated themselves had higher rates of both childhood sexual abuse and dissociation in univariate analyses. However, in multivariate analyses only diagnosis was significant. None of the other psychological risk factors were significantly linked to self-mutilation. The findings do not support theories that dissociation and self-mutilation in borderline personality disorder are associated with childhood trauma.

Follow-up study on borderline versus nonborderline personality disorders

Using a semi-structured interview, 18 DSM-III borderline personality disorder (BPD) patients and 17 other (nonborderline) personality disorder (OPD) patients were compared blind 4 1 2 years after their index discharge. Although significantly younger and mostly single, BPD patients did not differ from OPD patients in the degree of overall psychopathology or in the level of psychosocial functioning and adjustment. They do not seem to represent a particularly severe personality disorder group. Those characteristics differentiating BPD patients from affective disorders and schizophrenia may be nonspecific regarding other personality disorder types. As such, more attention should be paid to cases of OPD in the future.

The nosologic status of borderline personality: clinical and polysomnographic study.

The REM latencies of 24 nonschizotypal borderline outpatients--who were not in the midst of a major depressive episode--were in the range of those of 30 patients with primary major depression but were significantly shorter than those of 16 patients with nonborderline personality disorders and 14 nonpsychiatric controls. Also, more of the borderline subjects had lifetime diagnoses of affective disorder, such as dysthymic, cyclothymic, and bipolar II disorder, and of a spectrum of anxiety and somatization disorders. The authors conclude that contemporary operational criteria for borderline disorder identify a wide net of temperamental disorders with strong affective coloring rather than a unitary nosologic entity.

A comparative study of borderline patients in a psychiatric outpatient clinic.

The authors applied a list of operational criteria to all new patients in a large psychiatric outpatient department over a one-year period. A randomly selected group of patients clinically diagnosed as having borderline personality disorder was compared with groups with the diagnoses of schizophrenia, neurosis, and nonborderline personality disorder. The group with borderline personality disorder was significantly different from the other groups according to the criteria, especially on items reflecting impulsivity, affectivity, and overvaluation/derogation of others. Impaired reality testing proved a useful distinguishing criterion as well and should be retained as part of the borderline concept.