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American Family Physician Feb 2022Borderline personality disorder is a psychological disorder characterized by a pervasive pattern of instability in affect regulation, impulse control, interpersonal...
Borderline personality disorder is a psychological disorder characterized by a pervasive pattern of instability in affect regulation, impulse control, interpersonal relationships, and self-image. Borderline personality disorder may be present in up to 6.4% of adult primary care visits, which is fourfold higher than in the general population. Borderline personality disorder is underdiagnosed and most patients who have it also have additional psychiatric conditions. Individuals with borderline personality disorder have an underlying vulnerability to emotional hyperarousal states and social and interpersonal stressors. Clinically these patients may have high health care utilization, health-sabotaging behaviors, chronic or vague somatic concerns, aggressive outbursts, high-risk sexual behaviors, and substance use. Obesity and binge-eating disorders are common comorbidities in those diagnosed with borderline personality disorder. There is an established correlation between borderline personality disorder and increased suicide risk. Structured interview assessments that are designed specifically for borderline personality disorder include the Revised Diagnostic Interview for Borderlines and the Structured Clinical Interview for the DSM-5 Alternative Model for Personality Disorders. As general guidelines for practice, family physicians should avoid excessive familiarity, schedule regular visits, set appropriate limits, and maintain awareness of personal feelings. Use of effective communication strategies such as motivational interviewing and problem-solving techniques can help navigate addressing problematic behaviors in patients who have borderline personality disorder. Multiple behavior treatments are useful, the most effective of which are dialectical behavior therapy and mentalization-based therapy. No medications have been approved by the U.S. Food and Drug Administration specifically for the treatment of borderline personality disorder.
Topics: Adult; Borderline Personality Disorder; Comorbidity; Diagnostic and Statistical Manual of Mental Disorders; Humans; Psychiatric Status Rating Scales; Suicide
PubMed: 35166488
DOI: No ID Found -
Medicina (Kaunas, Lithuania) May 2019Borderline personality disorder (BPD) is associated with suicidal behaviors and self-harm. Up to 10% of BPD patients will die by suicide. However, no research data... (Review)
Review
Borderline personality disorder (BPD) is associated with suicidal behaviors and self-harm. Up to 10% of BPD patients will die by suicide. However, no research data support the effectiveness of suicide prevention in this disorder, and hospitalization has not been shown to be useful. The most evidence-based treatment methods for BPD are specifically designed psychotherapies.
Topics: Borderline Personality Disorder; Hospitalization; Humans; Suicidal Ideation; Suicide
PubMed: 31142033
DOI: 10.3390/medicina55060223 -
Journal of the American Academy of... Mar 1991This pilot study compared mothers of boys with gender identity disorder (GID) with mothers of normal boys to determine whether differences in psychopathology and... (Comparative Study)
Comparative Study
This pilot study compared mothers of boys with gender identity disorder (GID) with mothers of normal boys to determine whether differences in psychopathology and child-rearing attitudes and practices could be identified. Results of the Diagnostic Interview for Borderlines and the Beck Depression Inventory revealed that mothers of boys with GID had more symptoms of depression and more often met the criteria for Borderline Personality Disorder than the controls. Fifty-three percent of the mothers of boys with GID compared with only 6% of controls met the diagnosis for Borderline Personality Disorder on the Diagnostic Interview for Borderlines or had symptoms of depression on the Beck Depression Inventory. Results of the Summers and Walsh Symbiosis Scale suggested that mothers of probands had child-rearing attitudes and practices that encouraged symbiosis and discouraged the development of autonomy.
Topics: Anxiety, Separation; Borderline Personality Disorder; Child Rearing; Child, Preschool; Depression; Female; Gender Identity; Humans; Male; Mother-Child Relations; Mothers; Personality Inventory; Psychiatric Status Rating Scales; Sexual Dysfunctions, Psychological
PubMed: 2016237
DOI: 10.1097/00004583-199103000-00022 -
Revista Medica de Chile Feb 2014Borderline personality disorder (BPD) is highly prevalent and associated with significant dysfunctional behavior and suicide risk. The association with psychosocial... (Review)
Review
Borderline personality disorder (BPD) is highly prevalent and associated with significant dysfunctional behavior and suicide risk. The association with psychosocial factors is well established, however its neurobiology is not fully unraveled. According with the revised studies, subjects with BPD have structural and functional brain alterations, particularly in areas involved in affective and cognitive regulation and control of impulses. These alterations allow us to understand the psychopathology of this disorder and partly explain its pathogenesis.
Topics: Borderline Personality Disorder; Brain; Cognitive Behavioral Therapy; Empathy; Humans
PubMed: 24953109
DOI: 10.4067/S0034-98872014000200009 -
Current Psychiatry Reports Jun 2019To provide an update of a life span perspective on borderline personality disorder (BPD). We address the life span course of BPD, and discuss possible implications for... (Review)
Review
PURPOSE OF REVIEW
To provide an update of a life span perspective on borderline personality disorder (BPD). We address the life span course of BPD, and discuss possible implications for assessment, treatment, and research.
RECENT FINDINGS
BPD first manifests itself in adolescence and can be distinguished reliably from normal adolescent development. The course of BPD from adolescence to late life is characterized by a symptomatic switch from affective dysregulation, impulsivity, and suicidality to maladaptive interpersonal functioning and enduring functional impairments, with subsequent remission and relapse. Dimensional models of BPD appear more age neutral and more useful across the entire life span. There is a need for age-specific interventions across the life span. BPD symptoms and impairments tend to wax and wane from adolescence up to old age, and presentation depends on contextual factors. Our understanding of the onset and early course of BPD is growing, but knowledge of BPD in late life is limited. Although the categorical criteria of DSM allow for reliable diagnosis of BPD in adolescence, dimensional models appear both more age neutral, and useful up to late life. To account for the fluctuating expression of BPD, and to guide development and selection of treatment across the life span, a clinical staging model for BPD holds promise.
Topics: Adolescent; Borderline Personality Disorder; Diagnostic and Statistical Manual of Mental Disorders; Disease Progression; Humans; Impulsive Behavior; Longevity; Personality Inventory; Psychiatric Status Rating Scales; Psychopathology; Recurrence; Suicide, Attempted; Temperament
PubMed: 31161404
DOI: 10.1007/s11920-019-1040-1 -
Dialogues in Clinical Neuroscience Jun 2013It is clinically important to recognize both bipolar disorder and borderline personality disorder (BPD) in patients seeking treatment for depression, and it is important... (Review)
Review
It is clinically important to recognize both bipolar disorder and borderline personality disorder (BPD) in patients seeking treatment for depression, and it is important to distinguish between the two. Research considering whether BPD should be considered part of a bipolar spectrum reaches differing conclusions. We reviewed the most studied question on the relationship between BPD and bipolar disorder: their diagnostic concordance. Across studies, approximately 10% of patients with BPD had bipolar I disorder and another 10% had bipolar II disorder. Likewise, approximately 20% of bipolar II patients were diagnosed with BPD, though only 10% of bipolar I patients were diagnosed with BPD. While the comorbidity rates are substantial, each disorder is nontheless diagnosed in the absence of the other in the vast majority of cases (80% to 90%). In studies examining personality disorders broadly, other personality disorders were more commonly diagnosed in bipolar patients than was BPD. Likewise, the converse is also true: other axis I disorders such as major depression, substance abuse, and post-traumatic stress disorder are also more commonly diagnosed in patients with BPD than is bipolar disorder. These findings challenge the notion that BPD is part of the bipolar spectrum.
Topics: Bipolar Disorder; Borderline Personality Disorder; Comorbidity; Humans; Prevalence
PubMed: 24174890
DOI: 10.31887/DCNS.2013.15.2/mzimmerman -
Current Opinion in Psychology Feb 2021The present article gives a selective overview of recent studies on the role of nonsuicidal self-injury (NSSI) and suicidal behavior in the context of borderline... (Review)
Review
The present article gives a selective overview of recent studies on the role of nonsuicidal self-injury (NSSI) and suicidal behavior in the context of borderline personality disorder (BPD). Previous research found self-harming behavior, particularly NSSI, to constitute an easily accessible marker in the early detection of individuals at risk of development of BPD. The review further summarizes studies that investigated inter-relations between BPD features and self-harming behavior over time. Mainly, affective instability has been shown to play a role in the maintenance of NSSI and the increased risk of suicidal behavior among individuals with BPD. Finally, results about the effectiveness of treatment programs on the reduction of self-harming behavior among individuals with BPD are presented.
Topics: Borderline Personality Disorder; Humans; Self-Injurious Behavior; Suicidal Ideation
PubMed: 33548678
DOI: 10.1016/j.copsyc.2020.12.007 -
Adolescent Health, Medicine and... 2018Using the same Diagnostic and Statistical Manual of Mental Disorders, fifth version () criteria as in adults, borderline personality disorder (BPD) in adolescents is... (Review)
Review
Using the same Diagnostic and Statistical Manual of Mental Disorders, fifth version () criteria as in adults, borderline personality disorder (BPD) in adolescents is defined as a 1-year pattern of immature personality development with disturbances in at least five of the following domains: efforts to avoid abandonment, unstable interpersonal relationships, identity disturbance, impulsivity, suicidal and self-mutilating behaviors, affective instability, chronic feelings of emptiness, inappropriate intense anger, and stress-related paranoid ideation. BPD can be reliably diagnosed in adolescents as young as 11 years. The available epidemiological studies suggest that the prevalence of BPD in the general population of adolescents is around 3%. The clinical prevalence of BPD ranges from 11% in adolescents consulting at an outpatient clinic to 78% in suicidal adolescents attending an emergency department. The diagnostic procedure is based on a clinical assessment with respect to developmental milestones and the interpersonal context. The key diagnostic criterion is the 1-year duration of symptoms. Standardized, clinician-rated instruments are available for guiding this assessment (eg, the Diagnostic Interview for Borderlines-Revised and the Childhood Interview for DSM-IV-TR BPD). The assessment should include an evaluation of the suicidal risk. Differential diagnosis is a particular challenge, given the high frequency of mixed presentations and comorbidities. With respect to clinical and epidemiological studies, externalizing disorders in childhood constitute a risk factor for developing BPD in early adolescence, whereas adolescent depressive disorders are predictive of BPD in adulthood. The treatment of adolescents with BPD requires commitment from the parents, a cohesive medical team, and a coherent treatment schedule. With regard to evidence-based medicine, psychopharmacological treatment is not recommended and, if ultimately required, should be limited to second-generation antipsychotics. Supportive psychotherapy is the most commonly available first-line treatment. Randomized controlled trials have provided evidence in favor of the use of specific, manualized psychotherapies (dialectic-behavioral therapy, cognitive analytic therapy, and mentalization-based therapy).
PubMed: 30538595
DOI: 10.2147/AHMT.S156565