Understanding Of Borderline Personality Disorder Research Articles

Etiology of Borderline Personality Disorder

Back to table of contents Previous article Next article Letter to the EditorFull AccessEtiology of Borderline Personality DisorderJUDITH P. SALZMAN, ED.D., JUDITH P. SALZMANSearch for more papers by this author, ED.D., Watertown, Mass.Published Online:1 Nov 1998https://doi.org/10.1176/ajp.155.11.1626aaAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: I agree with Mary C. Zanarini, Ed.D., and her colleagues (1) that borderline personality disorder will ultimately be understood as an illness with a multifactorial etiology. In our own work, cited by Zanarini and elaborated in a series of reports (2–4), we have similarly emphasized that childhood sexual abuse is neither necessary nor sufficient for the development of borderline personality disorder but that the patient with this diagnosis has almost invariably emerged from an environment characterized by disordered attachments and histories of affective illness in one or more close relatives.Earlier studies by Zanarini et al. (5) and others (6–8) support this etiological perspective. Still others (9–14) further note that a history of sexual abuse, along with a cluster of severely self-destructive behaviors, most accurately characterizes those borderline patients who require hospitalization. Therefore, it is not surprising that for the majority (61.5%) of “severely impaired” inpatients in the study of Zanarini et al. (1), childhood sexual abuse would emerge as a predisposing factor in their illness. Unfortunately, the authors make no comment on the skewed nature of their study group and its possible relation to this finding.Eagle (15) has issued a general warning regarding the use of this class of restrospective data to establish the etiology of borderline personality disorder. Following Eagle’s logic, if researchers were to sample only hospitalized borderline patients, “they would likely develop an etiological theory seriously distorting and exaggerating the nature and strength of the relationship between childhood sexual abuse and adult personality disorder” (p. 134). Such distortion, if unquestioned, can have serious consequences for both research and clinical practice.Zanarini and colleagues themselves call for a more complex, nuanced understanding of borderline personality disorder. In the absence of prospective developmental studies, a next step might be a careful comparison between predisposing factors in “severely impaired” inpatients like those in the Zanarini group and an equally large sample of outpatients who carry a borderline diagnosis but have not needed hospitalization. Such a comparison would help clarify those factors common to the majority of individuals suffering from borderline personality disorder, and would document the extent to which sexual abuse may be correlated with symptom severity, as opposed to diagnosis per se.

The structure and development of borderline personality disorder: a proposed model.

The theory of cognitive analytic therapy is extended to offer an understanding of borderline personality disorder (BPD). A structural model (the multiple self states model) and a classification of different levels of developmental damage are proposed. The model offers an explanation of the phenomenology of BPD. The multiple self states model provides insights that will be useful for clinicians involved in the psychotherapy and management of BPD patients.

Borderline personality disorder: Diagnosis, etiology, and treatment

Abstract Diagnostic, etiological, and treatment factors which contribute to the understanding of borderline personality disorder are examined from an empirical perspective. Studies of the disorder over the last decade show that there is considerable confusion as to the salient diagnostic and etiological factors which are relevant for predicting treatment type, duration, and outcome. This paper presents a review of studies which have addressed the multiple diagnostic features and early life developmental experiences of the disorder. In addition, three models of treatment currently being investigated for their effects with borderline patients are summarized. Specific emphasis is placed on the clinical implications of the research findings.

Borderline personlighedsforstyrrelse—en oversigt

Langagergaard, A. (1991). Borderline personality disorder—an overview. Nordisk Psykologi, 43, 122–140. The concept of borderline personality disorder is a most controversial issue within clinical psychiatry. The American DSM-III-R's (1988) circumscribed, descriptive definition seems to correlate with the future European ICD-10. However, the most vigorous contributors to a dynamic and structural understanding of borderline personality disorder as well as the ‘treatment of choice’ are Kernberg, Gunderson and Masterson. They agree on these patients' lack of consistency, being ‘stable in their instability’. The dilemma is how to integrate their findings in a more uniform concept that makes research and clinical practice comparable, reliable and valid on a national as well as on an international basis.