Borderline Personality Disorder Scale Research Articles

A Randomized Controlled Study of a Psychoeducation Group Intervention for Patients With Borderline Personality Disorder

The objective of this study was to assess the impact of a 6-session psychoeducational group (PEG) intervention for borderline personality disorder (BPD) in an underserved community-based outpatient setting. The study was conducted between July 2015 and January 2017. Of 96 outpatients who met DSM-IV criteria for BPD, the first 48 received the experimental treatment, whereas the next 48 were assigned to a wait list. All received non-intensive treatment as usual. The primary outcome measure, the Zanarini Rating Scale for DSM-IV Borderline Personality Disorder (ZAN-BPD), was administered at baseline, at the end of treatment, and 2 months after the end of treatment. The PEG intervention was associated with a significant improvement on all sectors of BPD (P < .001). Improvements were greater for the PEG on all sectors except impulsivity. Benefits remained stable during 2-month follow-up. The PEG intervention had a large effect size (Cohen d = -1.16), whereas the wait list effect size was small (Cohen d = -0.18). The between-arms effect size was 0.80 after treatment and 0.90 at follow-up. With full response defined as a decrease of ≥ 50% from baseline in ZAN-BPD total score, 22 patients (46%) in the psychoeducation group and 3 (6%) in the wait list group were considered full responders. This study shows that a PEG intervention can be an effective treatment for patients with BPD. The overall cost benefits of group interventions and the the applicability of a PEG intervention to underserved patients demonstrate its potential to address significant public health needs.

RELATIONSHIPS BETWEEN ANXIETY AND PERSONALITY DISORDER FEATURES IN YOUNGER AND OLDER ADULTS

Introduction: Anxiety is a prevalent problem that has been found to be associated with multiple other mental disorders, functional impairments, and poor quality of life. Specifically, it appears that personality may play a major role in anxiety based on preferred dispositional coping methods and presence of normal and dysfunctional personality traits. The purpose of this study was to examine associations between anxiety and personality disorder (PD) features. It was hypothesized that anxiety would have positive associations with the avoidant, dependent, obsessive-compulsive, schizotypal, paranoid, and borderline PD scales. Method: Community-dwelling older adults (N = 130) and younger adults (N = 243) completed the Geriatric Anxiety Scale (GAS) and the Coolidge Axis Two Inventory (CATI) as part of a larger assessment battery. Correlations were computed between the GAS total score and the 14 PD scales from the CATI. Results: Results showed that anxiety was significantly and positively associated with all 14 PD scales. Specifically, as expected, the schizotypal (.52), paranoid (.55), avoidant (.56), obsessive-compulsive (.60), dependent (.62), and borderline (.69) PD scales were all significantly positively associated with anxiety. The remaining 8 PD scales also showed strong, positive correlations with anxiety: sadistic (.27), antisocial (.28), schizoid (.32), histrionic (.42), narcissistic (.44), passive-aggressive (.59), self-defeating (.64), and depressive (.69). Discussion: These results indicate that anxiety and abnormal personality traits are highly associated, showing a strong comorbidity. An implication is that PDs may play a role in the development of anxiety, or vice versa. Longitudinal studies are needed to clarify temporal and causative relationships.

A short screening tool for borderline personality disorder (Short-Bord): Validated by Rasch analysis.

The study aimed to development a short screening scale for borderline personality disorder (Short-Bord), and to validate its psychometric properties using Rasch analysis. Ninety-eight outpatients undergoing psychotherapy were evaluated using a semistructured diagnostic interview for DSM-IV Personality disorders. Correlational analysis and Rasch analysis were used to identify the best-fitted items for the shorter scale. Rasch analysis identified three underfitted items. The best five items were selected for the Short-Bord using two analyses, resulting in two sets of Short-Bord which included item 1 (becoming frantic when someone left), item 2 (up- and- down relationships), item 3 (sudden change of sense of self), item 8 (self-harm or suicide), item 9 (self-mutilation), item 10 (sudden mood change) and item 11 (feeling empty inside). Each set of the five-item Short-Bord were tested against the original 15-item BPD scale. Results showed that both sets of the Short-Bord yielded minimally lower in area under curve (AUC = 0.95 and 0.96, respectively) compared with the total score of 15 items (AUC = 0.97), but none significantly differed (chi-square = 0.89-2.87, df 1, p >.05). Internal consistency for the set from Rasch analysis was slightly higher than correlation methods (Cronbach's alpha = 0.80, and 0.78, respectively). The Short-Bord presents promising tool to screen for borderline personality disorder. Its diagnostic validity was comparable to the total 15 items despite completing in a shorter time. The Short-Bord derived from Rasch analysis was, however, preferable as all items were shown to have unidimensional construct with good fit statistics and good internal consistency.

Development and validation of an experience of time alone scale for borderline personality disorder.

Background/ObjectiveIntolerance of aloneness is considered a core feature of borderline personality disorder (BPD) that is clinically significant, yet under-researched. This study developed a measure of aloneness for individuals with BPD.MethodInterviews investigating the experience of aloneness for BPD participants (n = 12) formed the basis for the development of the measure. Pilot testing then occurred with BPD participants, control participants and qualified respondents. Validity, reliability and factor analysis of an Experience of Time Alone Scale (ETAS) was conducted with BPD participants (n = 112) and a comparison control group (n = 105).ResultsA three factor structure was revealed: (a) Cannot Cope Alone (α = .92), (b) Need to Escape from Others (α = .90), and (c) Consumed in Intolerable Distress (α = .88). The measure correlated significantly (p < .01) with the Mental Health Inventory, the Aloneness and Evocative Memory Scale, and the Hurvich Experience Inventory- Revised. Comparisons revealed highly significant differences between the BPD sample and control group on all subscales and the total score (U = 75.5, p = < .001, r = -.85).ConclusionsThis study represents one of the first empirical examinations of a construct that has largely only been studied theoretically. This newly developed measure may contribute to diagnosis and therapy.

Reduced mentalizing in patients with bulimia nervosa and features of borderline personality disorder: A case-control study

BackgroundMentalizing, the mental capacity to understand oneself and others in terms of mental states, has been found to be reduced in some mental disorders such as Borderline Personality Disorder (BPD). Some studies have suggested that Eating Disorders (EDs) may also be associated with impairments in mentalizing, but studies have not always yielded consistent results. This is the first study to systematically investigate mentalizing impairments in patients with Bulimia Nervosa (BN) compared with controls. In addition, we investigated whether impairments in mentalizing were related to BPD features, rather than BN per se, given the high comorbidity between BPD and BN.MethodsPatients with BN (n = 53) and healthy controls (HCs; n = 87) completed a battery of measures assessing mentalizing including the Reflective Function Questionnaires (RFQ), the Object Relations Inventory (ORI; Differentiation-Relatedness Scales) and the Reading The Mind in The Eyes Test (RMET).ResultsPatients with BN scored significantly lower than HCs on all tests of mentalizing, with moderate to large between-group effect sizes. These differences were partially accounted for by BPD features as assessed with the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD), and partially by bulimic symptoms measured with the Eating Disorder Examination Questionnaire (EDE-Q).ConclusionsPatients with BN have significantly lower levels of mentalizing as assessed with a broad range of tests compared to HCs. These differences were related to both bulimic symptoms and BPD features. Although further research in larger samples is needed, if replicated, these findings suggest that poor mentalizing may be a significant factor in BN patients and should be addressed in treatment, regardless of the presence of BPD features.

Short-term versus long-term mentalization-based therapy for outpatients with subthreshold or diagnosed borderline personality disorder: a protocol for a randomized clinical trial

BackgroundPsychotherapy for borderline personality disorder is often lengthy and resource-intensive. However, the current length of outpatient treatments is arbitrary and based on trials that never tested if the treatment intensity could be reduced. As a result, there is insufficient evidence to inform the decision between short-term and long-term psychotherapy for borderline personality disorder. Mentalization-based therapy is one treatment option for borderline personality disorder and consists traditionally of an 18-month treatment program.Methods/designThis trial is an investigator-initiated single-center randomized clinical superiority trial of short-term (20 weeks) compared to long-term (14 months) mentalization-based therapy for outpatients with subthreshold or diagnosed borderline personality disorder. Participants will be recruited from the Outpatient Clinic for Personality Disorders at Stolpegaard Psychotherapy Centre, Mental Health Services, Capital Region of Denmark. Participants will be included if they meet a minimum of four DSM-V criteria for borderline personality disorder. Participants will be assessed before randomization, and at 8, 16, and 24 months after randomization. The primary outcome is severity of borderline symptomatology assessed with the Zanarini Rating Scale for borderline personality disorder. Secondary outcomes include self-harm incidents, functional impairment (Work and Social Adjustment Scale, Global Assessment of Functioning) and quality of life (Short-Form Health Survey 36). Severity of psychiatric symptoms (Symptom Checklist 90-R) will be included as an exploratory outcome. Measures of personality functioning, attachment, borderline symptoms, group alliance, and mentalization skills will be included to explore potential predictors and mechanisms of change.DiscussionThis trial will provide evidence of the beneficial and harmful effects of short-term compared to long-term mentalization-based therapy for outpatients with subthreshold or diagnosed borderline personality disorder.Trial registrationClinicalTrials.gov, NCT03677037. Registered on September 19, 2018.

Development of the Emptiness Scale for Borderline Personality Disorder

Development of the Emptiness Scale for Borderline Personality Disorder

Psychometric Properties of the Borderline Personality Features Scale for Children-11 (BPFSC-11) in a Sample of Community Dwelling Italian Adolescents

Abstract. The aims of the current study were to assess the psychometric properties of the Borderline Personality Features Scale for Children-11 (BPFSC-11) in adolescence. In particular, we aim at evaluating: the internal consistency and six-month test-retest reliability of the Italian translation of the BPFSC-11, its factor structure, and its convergent validity. Eight hundred five community dwelling adolescents were administered the Italian translations of the BPFSC-11 and Personality Diagnostic Questionnaire-4+(PDQ-4+) Borderline Personality Disorder (BPD) scale. The BPFSC-11 showed adequate internal consistency (Cronbach’s α = .78) and moderate six-month test-retest stability. Although confirmatory factor analysis did not support a one-factor model of the BPFSC-11 items, a bi-factor model (RMSEA = .04) showed that all BPFSC-11 items loaded significantly onto a general common factor, with two specific factors capturing largely residual variance due to distribution artifacts. In this study, the bivariate correlation between the BPFSC-11 and the PDQ-4+BPD scale was .64 ( p &lt; .001). Finally, the BPFSC-11 showed gender invariance across items. In summary, our findings support the reliability and validity of the BPFSC-11 as a measure of self-reported borderline personality features in community dwelling adolescents.

Assessing borderline personality disorder based on the Hierarchical Taxonomy of Psychopathology (HiTOP): Dimensional Clinical Personality Inventory 2 – BPD

Aim of the studyThe aim of this study was to develop a specific version of the Dimensional Clinical Personality Inventory 2 (IDCP-2), a self-reported measure developed in Brazil to pathological personality traits assessment, focused on the assessment of traits related to BPD in accordance to the HiTOP model.Subject or material and methods. In step 1 we developed new factors to cover all the BPD traits according to HiTOP. In step 2, data were collected from 207 adults from the community (N = 207; Mage = 35.9). Participants completed the developed measure (IDCP Borderline Personality Disorder Scale; IDCP-BPD), and factors from IDCP-2, PID-5, FFBI, and FFHI.ResultsExploratory structural equation modeling (E-SEM) suggested a 3-solution for the grouping of the fifteen factors of the IDCP-BPD. Factors and total score reliability was good. Correlations between IDCP-BPD factors and external measures were coherent, corroborating expectations. The bootstrap two-sample t test comparing healthy and pathological group suggested good discrimination capacity of the IDCP-BPD factors, mainly Fragility and Impotency feelings factors.DiscussionFavorable evidences were find for the use of IDCP-BPD to BPD traits measurement. New factors composing this measure seems to extend the coverage of the IDCP-2 factors in measuring BPD symptoms. Correlations suggest that the factors composing IDCP-BPD measure the traits considered as relevant according to HiTOP.ConclusionsDiscriminant capacity of the factors also indicate the use of the measure, although future studies must to replicate the verifications in samples composed by BPD patients.

STEPPS treatment programme for borderline personality disorder: Which scale items improve? An item-level analysis.

We examined which items on the Borderline Evaluation of Severity Over Time and the Zanarini Rating Scale for Borderline Personality Disorder improved during participation in Systems Training for Emotional Predictability and Problem Solving (STEPPS). Data on 193 subjects from two independent sources were included: (1) a randomized controlled trial at an academic medical centre and (2) uncontrolled data from Iowa's correctional system. STEPPS effect size was estimated by contrasting effect size for those in the randomized controlled trial assigned to STEPPS+treatment as usual to effect size for those assigned to treatment as usual alone. Items from the Borderline Evaluation of Severity Over Time scale showing the greatest improvement assessed affective instability, 'taking steps to avoid/prevent problems', 'choosing to use a positive activity', identity disturbance and abandonment fears. The Zanarini Rating Scale for Borderline Personality Disorder items showing the greatest improvement assessed mood instability, chronic feelings of emptiness and identity disturbance. STEPPS effect size was significant for the Borderline Evaluation of Severity Over Time items rating paranoia and 'taking steps to avoid/prevent problems' and the Zanarini Rating Scale for Borderline Personality Disorder items assessing paranoia, impulsivity, chronic emptiness and unstable relationships. This, and future work, could eventually help in matching patients to particular treatment programmes that target their preponderant symptoms. © 2018 John Wiley & Sons, Ltd.

Lamotrigine for people with borderline personality disorder: a RCT

No drug treatments are currently licensed for the treatment of borderline personality disorder (BPD). Despite this, people with this condition are frequently prescribed psychotropic medications and often with considerable polypharmacy. Preliminary studies have indicated that mood stabilisers may be of benefit to people with BPD. To examine the clinical effectiveness and cost-effectiveness of lamotrigine for people with BPD. A two-arm, double-blind, placebo-controlled individually randomised trial of lamotrigine versus placebo. Participants were randomised via an independent and remote web-based service using permuted blocks and stratified by study centre, the severity of personality disorder and the extent of hypomanic symptoms. Secondary care NHS mental health services in six centres in England. Potential participants had to be aged ≥ 18 years, meet diagnostic criteria for BPD and provide written informed consent. We excluded people with coexisting psychosis or bipolar affective disorder, those already taking a mood stabiliser, those who spoke insufficient English to complete the baseline assessment and women who were pregnant or contemplating becoming pregnant. Up to 200 mg of lamotrigine per day or an inert placebo. Women taking combined oral contraceptives were prescribed up to 400 mg of trial medication per day. Outcomes were assessed at 12, 24 and 52 weeks after randomisation. The primary outcome was the total score on the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD) at 52 weeks. The secondary outcomes were depressive symptoms, deliberate self-harm, social functioning, health-related quality of life, resource use and costs, side effects of treatment and adverse events. Higher scores on all measures indicate poorer outcomes. Between July 2013 and October 2015 we randomised 276 participants, of whom 195 (70.6%) were followed up 52 weeks later. At 52 weeks, 49 (36%) of those participants prescribed lamotrigine and 58 (42%) of those prescribed placebo were taking it. At 52 weeks, the mean total ZAN-BPD score was 11.3 [standard deviation (SD) 6.6] among those participants randomised to lamotrigine and 11.5 (SD 7.7) among those participants randomised to placebo (adjusted mean difference 0.1, 95% CI -1.8 to 2.0; p = 0.91). No statistically significant differences in secondary outcomes were seen at any time. Adjusted costs of direct care for those prescribed lamotrigine were similar to those prescribed placebo. Levels of adherence in this pragmatic trial were low, but greater adherence was not associated with better mental health. The addition of lamotrigine to the usual care of people with BPD was not found to be clinically effective or provide a cost-effective use of resources. Future research into the treatment of BPD should focus on improving the evidence base for the clinical effectiveness and cost-effectiveness of non-pharmacological treatments to help policy-makers make better decisions about investing in specialist treatment services. Current Controlled Trials ISRCTN90916365. Funding for this trial was provided by the Health Technology Assessment programme of the National Institute for Health Research (NIHR) and will be published in full in Health Technology Assessment; Vol. 22, No. 17. See the NIHR Journals Library website for further project information. The Imperial Biomedical Research Centre Facility, which is funded by NIHR, also provided support that has contributed to the research results reported within this paper. Part of Richard Morriss' salary during the project was paid by NIHR Collaboration for Leadership in Applied Health Research and Care East Midlands.

Clinical improvement in patients with borderline personality disorder after treatment with repetitive transcranial magnetic stimulation: preliminary results.

Objective:Current treatment of borderline personality disorder (BPD) consists of psychotherapy and pharmacological interventions. However, the use of repetitive transcranial magnetic stimulation (rTMS) could be beneficial to improve some BPD symptoms. The objective of this study was to evaluate clinical improvement in patients with BPD after application of rTMS over the right or left dorsolateral prefrontal cortex (DLPFC).Method:Twenty-nine patients with BPD from the National Institute of Psychiatry, Mexico, were randomized in two groups to receive 15 sessions of rTMS applied over the right (1 Hz, n=15) or left (5 Hz, n=14) DLPFC. Improvement was measured by the Clinical Global Impression Scale for BPD (CGI-BPD), Borderline Evaluation of Severity Over Time (BEST), Beck Depression Inventory (BDI), Hamilton Anxiety Rating Scale (HAM-A), and Barratt Impulsiveness Scale (BIS).Results:Intragroup comparison showed significant (p < 0.05) reductions in every psychopathologic domain of the CGI-BPD and in the total scores of all scales in both groups.Conclusions:Both protocols produced global improvement in severity and symptoms of BPD, particularly in impulsiveness, affective instability, and anger. Further studies are warranted to explore the therapeutic effect of rTMS in BPD.Clinical trial registration:NCT02273674.

Measurement Invariance Between Genders on Two Measures of Borderline Personality Disorder.

Gender bias in the diagnosis and assessment of borderline personality disorder (BPD) has been the subject of much controversy in the psychological research literature. Evidence regarding differential prevalence rates and diagnostic rates in clinical settings between genders has been mixed, and measurement bias is one potential explanation for these mixed findings. A total of 340 participants were recruited from a Midwestern university and four outpatient community mental health clinics. They were administered two structured clinical interviews for BPD that were then evaluated for measurement invariance. Both the SCID-II BPD scale and the PDI-IV BPD scale were found to be measurement invariant between genders. No significant differences were found on the SCID-II BPD scale in diagnosis or overall number of criteria endorsed. However, in the rates of endorsement of individual criteria, differences were found in the unstable relationships item.

Comparison of Three Questionnaires to Screen for Borderline Personality Disorder in Adolescents and Young Adults

Abstract. One of the most common personality disorders among adolescents and young adults is the Borderline Personality Disorder (BPD). The objective of current study was to assess three questionnaires that can reliably screen for BPD in adolescents and young adults (N = 53): the McLean Screening Instrument for BPD (MSI-BPD; Zanarini et al., 2003 ), the Personality Diagnostic Questionnaire 4th edition – BPD scale (PDQ-4 BPD; Hyler, 1994 ), and the SCID-II Patient Questionnaire – BPD scale (SCID-II-PQ BPD). The nine criteria of BPD according to the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV; APA, 1994 ) were measured with the Structural Clinical Interview for DSM-IV Axis II disorders – BPD scale (SCID-II; First, Spitzer, Gibbon, Williams, &amp; Benjamin, 1995 ). Correlations between the questionnaires and the SCID-II were calculated. In addition, the sensitivity and specificity of the questionnaires were tested. All instruments predicted the BPD diagnosis equally well.

The NOURISHED randomised controlled trial comparing mentalisation-based treatment for eating disorders (MBT-ED) with specialist supportive clinical management (SSCM-ED) for patients with eating disorders and symptoms of borderline personality disorder

BackgroundIn this multi-centre randomized controlled trial (RCT) we compared modified mentalisation-based treatment (MBT-ED) to specialist supportive clinical management (SSCM-ED) in patients with eating disorders (EDs) and borderline personality disorder symptoms (BPD). This group of patients presents complex challenges to clinical services, and a treatment which addresses their multiple problems has the potential to improve outcome. MBT has been shown to be effective in improving outcome in patients with BPD, but its use has not been reported in ED.MethodsSixty-eight eligible participants were randomised to MBT-ED or SSCM-ED. The primary outcome measure was the global score on the Eating Disorder Examination. Secondary outcomes included measures of BPD symptoms (the Zanarini Rating Scale for Borderline Personality Disorder), general psychiatric state, quality of life and service utilisation. Participants were assessed at baseline and at 6, 12 and 18 months after randomisation. Analysis was performed using linear mixed models.ResultsOnly 15 participants (22 %) completed the 18 month follow-up. Early drop-out occurred significantly more in the SSCM-ED group. Drop-out did not vary with treatment model later in therapy and was sometimes attributed to participants moving away. There was higher drop--out amongst smokers and those with higher neuroticism scores. 47.1 % of participants in the MBT-ED arm and 37.1 % in the SSCM-ED arm attended at least 50 % of therapy sessions offered.Amongst those remaining in the trial, at 12 and 18 months MBT-ED was associated with a greater reduction in Shape Concern and Weight Concern in the Eating Disorder Examination compared to SSCM-ED. At 6, 12 and 18 months there was a decline of ED and BPD symptoms in both groups combined.Ten participants were reported as having had adverse events during the trial, mostly self-harm, and there was one death, attributed as ’unexplained’ by the coroner.ConclusionsThe high drop-out rate made interpretation of the results difficult. Greater involvement of research staff in clinical management might have improved compliance with both therapy and research assessment. MBT-ED may have had an impact on core body image psychopathology.Trial registrationCurrent Controlled Trials: ISRCTN51304415. Registered on 19 April 2011.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1606-8) contains supplementary material, which is available to authorized users.

Self-Control Capacity as a Predictor of Borderline Personality Disorder Features, Problematic Drinking, and Their Co-occurrence.

Borderline personality disorder (BPD) and alcohol use disorder (AUD) share impulsivity as an etiological factor. However, impulsivity is ill-defined, often overlapping with self-control capacity. This study attempts to disentangle these constructs and their associations with alcohol use and BPD. Undergraduates (n = 192) completed the Five Factor Model Rating Form, which generated two-dimensional scales of BPD, the Self-Control Scale, the UPPS-P (self-reported impulsivity), and the stop-signal and delay discounting tasks (laboratory-measured impulsivity). Self-control appeared as a major predictor of BPD features and drinking, explaining as much or more variance in outcome than impulsivity. Co-occurrence of elevated BPD features and problem drinking was also best explained by self-control. Laboratory measures of impulsivity were not correlated with BPD scales or alcohol use. Self-regulatory capacity may be an important but overlooked factor in BPD and alcohol use and should be considered alongside impulsivity in future research.

Lamotrigine versus inert placebo in the treatment of borderline personality disorder: study protocol for a randomized controlled trial and economic evaluation.

BackgroundPeople with borderline personality disorder (BPD) experience rapid and distressing changes in mood, poor social functioning and have high rates of suicidal behaviour. Several small scale studies suggest that mood stabilizers may produce short-term reductions in symptoms of BPD, but have not been large enough to fully examine clinical and cost-effectiveness.Methods/DesignA two parallel-arm, placebo controlled randomized trial of usual care plus either lamotrigine or an inert placebo for people aged over 18 who are using mental health services and meet diagnostic criteria for BPD. We will exclude people with comorbid bipolar affective disorder or psychosis, those already taking a mood stabilizer, those who speak insufficient English to complete the baseline assessment and women who are pregnant or contemplating becoming pregnant. Those meeting inclusion criteria and provide written informed consent will be randomized to up to 200mg of lamotrigine per day or an inert placebo (up to 400mg if taking combined oral contraceptives).Participants will be randomized via a remote web-based system using permuted stacked blocks stratified by study centre, severity of personality disorder, and level of bipolarity.Follow-up assessments will be conducted by masked researchers 12, 24 weeks, and 52 weeks after randomization. The primary outcome is the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD). The secondary outcomes are depressive symptoms, deliberate self-harm, social functioning, health-related quality of life, resource use and costs, side effects of treatment, adverse events and withdrawal of trial medication due to adverse effects.The main analyses will use intention to treat without imputation of missing data. The economic evaluation will take an NHS/Personal Social Services perspective. A cost-utility analysis will compare differences in total costs and differences in quality of life using QALYs derived from the EQ-5D.DiscussionThe evidence base for the use of pharmacological treatments for people with borderline personality disorder is poor. In this trial we will examine the clinical and cost-effectiveness of lamotrigine to assess what if any impact offering this has on peoples’ mental health, social functioning, and use of other medication and other resources.Trial registrationCurrent Controlled Trials ISRCTN90916365 (registered 01/08/2012)

Development of the self-report version of the Zanarini Rating Scale for Borderline Personality Disorder.

The purpose of this study was to assess the psychometric properties of the self-report version of the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD). The measure covers a 1-week time frame, and each of the nine criteria for BPD is rated on a five-point anchored rating scale of 0-4. Seventy-five subjects meeting DSM-IV criteria for BPD were recruited from the community. The convergent validity of the interview and self-report versions of the ZAN-BPD was found to be high (with a median value of 0.70). In terms of reliability, the internal consistency of the nine criteria scores of the ZAN-BPD was found to be good (Cronbach's alpha = 0.84). In addition, 13 of 14 intraclass correlations for same-day test-retest reliability were in the excellent range (> 0.75). Finally, the sensitivity of both versions of the ZAN-BPD to change was assessed 7-10 days after they were first administered and found to be adequate (e.g. r = 0.66 for total score of ZAN-BPD). Taken together, the results of this study suggest that the self-report ZAN-BPD is a promising self-report scale for the assessment of change in the severity of borderline psychopathology over time.

Fear conditioning induced by interpersonal conflicts in healthy individuals.

Psychophysiological markers have been focused to investigate the psychopathology of psychiatric disorders and personality subtypes. In order to understand neurobiological mechanisms underlying these conditions, fear-conditioning model has been widely used. However, simple aversive stimuli are too simplistic to understand mechanisms because most patients with psychiatric disorders are affected by social stressors. The objective of this study was to test the feasibility of a newly-designed conditioning experiment using a stimulus to cause interpersonal conflicts and examine associations between personality traits and response to that stimulus. Twenty-nine healthy individuals underwent the fear conditioning and extinction experiments in response to three types of stimuli: a simple aversive sound, disgusting pictures, and pictures of an actors’ face with unpleasant verbal messages that were designed to cause interpersonal conflicts. Conditioned response was quantified by the skin conductance response (SCR). Correlations between the SCR changes, and personality traits measured by the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD) and Revised NEO Personality Inventory were explored. The interpersonal conflict stimulus resulted in successful conditioning, which was subsequently extinguished, in a similar manner as the other two stimuli. Moreover, a greater degree of conditioned response to the interpersonal conflict stimulus correlated with a higher ZAN-BPD total score. Fear conditioning and extinction can be successfully achieved, using interpersonal conflicts as a stimulus. Given that conditioned fear caused by the interpersonal conflicts is likely associated with borderline personality traits, this paradigm could contribute to further understanding of underlying mechanisms of interpersonal fear implicated in borderline personality disorder.

Elaborating on the construct validity of the Minnesota Borderline Personality Disorder Scale (MBPD): a multi-sample, longitudinal examination.

Borderline personality disorder (BPD) is frequently conceptualized as an extreme variant of normal personality traits. A previous study successfully developed and validated a self-report BPD measure, the Minnesota Borderline Personality Disorder Scale (MBPD). We conducted 2 studies aimed at providing further validation for this measure. Results from Study 1 (clinical sample of substance users) indicated that the MBPD exhibited strong positive correlations with measures of convergent validity. In addition, the MBPD showed similar correlations with external correlates as those of the convergent validity measures as well as incremental utility in predicting these external correlates above and beyond negative affect and adult antisocial behavior. Also, a receiver operating characteristic curve analysis indicated that diagnostic accuracy of the MBPD was excellent for differentiation between BPD and non-BPD individuals. Likewise, Study 2 (nonclinical sample of undergraduate students followed over 6 months) showed strong correlations with an index of convergent validity, similar correlations with external correlates as that of the convergent validity index, and incremental predictive utility. Finally, in this study, the MBPD exhibited high rank-order stability. These data provide further evidence that the MBPD is a valid indicator of BPD.