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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 -
Alcohol Research : Current Reviews 2019Alcohol use disorder (AUD) frequently co-occurs with other psychiatric disorders, including personality disorders, which are pervasive, persistent, and impairing.... (Review)
Review
Alcohol use disorder (AUD) frequently co-occurs with other psychiatric disorders, including personality disorders, which are pervasive, persistent, and impairing. Personality disorders are associated with myriad serious outcomes, have a high degree of co-occurrence with substance use disorders, including AUD, and incur significant health care costs. This literature review focuses on co-occurring AUD and personality disorders characterized by impulsivity and affective dysregulation, specifically antisocial personality disorders and borderline personality disorders. Prevalence rates, potential explanations and causal models of co-occurrence, prognoses, and the status of existing treatment research are summarized. Several important future research considerations are relevant to these complex, co-occurring conditions. Research assessing mechanisms responsible for co-occurring AUD and antisocial personality disorder or borderline personality disorder will further delineate the underlying developmental processes and improve understanding of onset and courses. In addition, increased focus on the efficacy and effectiveness of treatments targeting underlying traits or common factors in these disorders will inform future prevention and treatment efforts, as interventions targeting these co-occurring conditions have relatively little empirical support.
Topics: Alcoholism; Anticonvulsants; Antidepressive Agents; Antipsychotic Agents; Antisocial Personality Disorder; Behavior Therapy; Borderline Personality Disorder; Comorbidity; Humans; Impulsive Behavior; Personality Disorders; Prognosis
PubMed: 31886107
DOI: 10.35946/arcr.v40.1.05 -
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 -
Eating and Weight Disorders : EWD Feb 2022Childhood abuse is associated with an increased risk of developing eating disorders (EDs) as well as personality disorders (PDs). However, their interaction is still...
PURPOSE
Childhood abuse is associated with an increased risk of developing eating disorders (EDs) as well as personality disorders (PDs). However, their interaction is still uncertain, particularly in adolescents. This study investigates the correlations between childhood emotional neglect (CEN), childhood emotional abuse (CEA), and obsessive-compulsive and borderline personality styles in female adolescent inpatients with eating disorders (EDs).
METHODS
One hundred and twenty-eight inpatients (ages 14-18) were assessed, 54 were diagnosed with restricting-type anorexia nervosa (AN-R) and 33 with a binge-purging ED [BP-ED; comprising patients with binge-purging type anorexia nervosa (AN-BP), n = 15, and bulimia nervosa (BN), n = 18]. Fifty healthy participants made up the control group (CG). CEN and CEA were assessed with the Childhood Trauma Questionnaire, while the Personality Style and Disorder Inventory was implemented to determine personality styles.
RESULTS
A MANOVA revealed a significant main effect of CEA on spontaneous-borderline personality style [F(8,119) = 17.1, p < 0.001, η = 0.126], as well as a main effect of ED group on spontaneous-borderline [F(2,119) = 3.1, p = 0.048, η = 0.050]. A significant interaction between ED group, CEA, and spontaneous-borderline was found [F(2,119) = 3.5, p = 0.034, η = 0.055] with BP-ED showing significantly higher scores in CEA (9.3 ± 4.0) and in spontaneous-borderline (14.2 ± 6.2).
CONCLUSIONS
Considering CEA and borderline personality style in adolescent inpatients with BN or AN-BP may help improve the understanding of the etiology and maintenance of BP-ED and provide more effective treatment targets.
LEVEL OF EVIDENCE
Level III, case-control analytic study.
Topics: Adolescent; Anorexia Nervosa; Bulimia Nervosa; Child; Emotional Abuse; Feeding and Eating Disorders; Female; Humans; Inpatients; Personality
PubMed: 33677816
DOI: 10.1007/s40519-021-01142-3 -
Psychological Medicine Sep 2019Dialectical behaviour therapy (DBT) and mentalisation-based therapy (MBT) are both widely used evidence-based treatments for borderline personality disorder (BPD), yet a... (Comparative Study)
Comparative Study
BACKGROUND
Dialectical behaviour therapy (DBT) and mentalisation-based therapy (MBT) are both widely used evidence-based treatments for borderline personality disorder (BPD), yet a head-to-head comparison of outcomes has never been conducted. The present study therefore aimed to compare the clinical outcomes of DBT v. MBT in patients with BPD.
METHODS
A non-randomised comparison of clinical outcomes in N = 90 patients with BPD receiving either DBT or MBT over a 12-month period.
RESULTS
After adjusting for potentially confounding differences between participants, participants receiving DBT reported a significantly steeper decline over time in incidents of self-harm (adjusted IRR = 0.93, 95% CI 0.87-0.99, p = 0.02) and in emotional dysregulation (adjusted β = -1.94, 95% CI -3.37 to -0.51, p < 0.01) than participants receiving MBT. Differences in treatment dropout and use of crisis services were no longer significant after adjusting for confounding, and there were no significant differences in BPD symptoms or interpersonal problems.
CONCLUSIONS
Within this sample of people using specialist personality disorder treatment services, reductions in self-harm and improvements in emotional regulation at 12 months were greater amongst those receiving DBT than amongst those receiving MBT. Experimental studies assessing outcomes beyond 12 months are needed to examine whether these findings represent differences in the clinical effectiveness of these therapies.
Topics: Adolescent; Adult; Behavior Control; Borderline Personality Disorder; Dialectical Behavior Therapy; Emotional Regulation; Female; Humans; Linear Models; Male; Mentalization; Middle Aged; Psychotherapy, Group; Self-Injurious Behavior; Treatment Outcome; United Kingdom; Young Adult
PubMed: 30303061
DOI: 10.1017/S0033291718002878 -
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 -
CNS Drugs Jun 2023Comorbidity between borderline personality disorder (BPD) and other mental disorders is common. Although no specific pharmacological treatments have been approved for... (Review)
Review
Comorbidity between borderline personality disorder (BPD) and other mental disorders is common. Although no specific pharmacological treatments have been approved for the treatment of BPD, many drugs, including antidepressants such as selective serotonin reuptake inhibitors (SSRIs), mood stabilizers, second-generation antipsychotics, and even benzodiazepines, are routinely prescribed off label. Nonetheless, recommendations for off-label drugs in these patients are highly varied, with a notable lack of agreement among clinical guidelines. The most common reason for pharmacological treatment and polypharmacy in these patients is comorbidity with other psychiatric disorders. In this context, we reviewed major clinical guidelines and the available data on pharmacotherapy in patients with BPD to develop practical recommendations to facilitate decision-making in routine clinical practice, thus helping clinicians to select the optimal therapeutic approach in patients with BPD who have comorbid disorders. This review confirmed that no clear recommendations for the pharmacological treatment are available in clinical guidelines. Therefore, based on the available evidence, we have developed a series of recommendations for pharmacotherapy in patients with BPD who present the four most common comorbidities (affective, anxiety, eating, and drug use disorders). Here, we discuss the recommended treatment approach for each of these comorbid disorders. The prescription of medications should be considered only as an adjunct to BPD-specific psychotherapy. Polypharmacy and the use of unsafe drugs (i.e., with a risk of overdose) should be avoided. Our review highlights the need for more research to provide more definitive guidance and to develop treatment algorithms.
Topics: Humans; Borderline Personality Disorder; Antipsychotic Agents; Antidepressive Agents; Antimanic Agents; Comorbidity
PubMed: 37256484
DOI: 10.1007/s40263-023-01015-6 -
Expert Opinion on Pharmacotherapy Jan 2020: The treatment of borderline personality disorder (BPD) remains an open question for clinicians. There is scarce evidence available and the guidelines' conclusions... (Review)
Review
: The treatment of borderline personality disorder (BPD) remains an open question for clinicians. There is scarce evidence available and the guidelines' conclusions diverge. Together with these factors, the complexity of BPD generates uncertainty in day-to-day practice. This narrative review aims to provide an overview of advances in BPD treatment and posit a critical opinion based on clinical evidence and practice.: The authors review the clinical trials concerning the efficacy of the main classes of drugs in BPD: antidepressants, mood stabilizers, first-, second-, and third-generation antipsychotics, and other agents (opiate antagonists, clonidine, oxytocin, omega-3 fatty acids). They also include in this review studies on combinations of drugs and psychotherapies.: An individualized, tailored pharmacotherapy for BPD that targets the prominent symptom clusters can improve relevant aspects of the clinical picture. However, no medication is indicated to treat the global psychopathology of BPD. Polypharmacy should be avoided or strictly limited. To date, pharmacotherapy alone does not suffice to manage the complexity of BPD. Combining medication with psychotherapy may improve specific BPD symptom dimensions. In particular, it may help those aspects that respond slowly or not at all to monotherapy.
Topics: Anticonvulsants; Antidepressive Agents; Antimanic Agents; Antipsychotic Agents; Borderline Personality Disorder; Fatty Acids, Omega-3; Humans; Polypharmacy; Psychotherapy
PubMed: 31693423
DOI: 10.1080/14656566.2019.1686482 -
PloS One 2019Maladaptive parenting (including childhood maltreatment, abuse and neglect) has been implicated in the scientific literature exploring the aetiology of personality... (Meta-Analysis)
Meta-Analysis
BACKGROUND/OBJECTIVES
Maladaptive parenting (including childhood maltreatment, abuse and neglect) has been implicated in the scientific literature exploring the aetiology of personality disorder, particularly borderline personality disorder (BPD). Our primary objective was to summarise the evidence on the relationship between parenting and personality disorder, assisting clinical decision-makers to translate this research into clinical policy and practice.
METHODS
We conducted an overview of systematic reviews that assessed individuals with personality disorder pathology for experiences of maladaptive parenting, compared to psychiatric or healthy comparisons/controls, and the impact on psychopathological and relational outcomes. Systematic literature searches were conducted in Scopus, Web of Science, MEDLINE, PsycINFO, and by hand in August 2018. Methodological quality was assessed using the CASP systematic review checklist, and results were qualitatively synthesised. A pre-determined protocol was registered in Prospective Register of Systematic Reviews (PROSPERO 2019:CRD42018096177).
RESULTS
Of the 312 identified records, 293 abstracts were screened, 36 full-text articles were retrieved and eight systematic reviews met pre-determined criteria for qualitative synthesises. The majority of studies reported outcomes related to BPD (n = 7), and study design, methodology and quality varied. Within the eight systematic reviews there were 211 primary studies, of which 140 (66.35%) met eligibility criteria for inclusion in this overview. Eligible primary studies reported on 121,895 adult, child/adolescent and parent-offspring participants, with most studies focused on borderline personality pathology (n = 100, 71.43%). Study design and methodology also varied for these studies. Overall, five systematic reviews overwhelming found that maladaptive parenting was a psychosocial risk factor for the development of borderline personality pathology, and three studies found that borderline personality pathology was associated with maladaptive parenting, and negative offspring and parenting-offspring outcomes.
CONCLUSIONS
In light of these findings, we recommend greater emphasis on parenting in clinical practice and the development of parenting interventions for individuals with personality disorder. However, our understanding is limited by the heterogeneity and varying quality of the evidence, and as such, future research utilising more rigorous research methodology is needed.
Topics: Adolescent; Adult; Borderline Personality Disorder; Child; Child Abuse; Emotions; Female; Humans; Mental Health; Parenting; Personality Disorders; Risk Factors
PubMed: 31574104
DOI: 10.1371/journal.pone.0223038