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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 -
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 -
Journal of Personality Disorders Jun 2003The purpose of this study was to assess the psychometric properties of the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD), the first...
The purpose of this study was to assess the psychometric properties of the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD), the first clinician-administered scale for the assessment of change in DSM-IV borderline psychopathology. The questions for the measure were adapted from the BPD module of the Diagnostic Interview for DSM-IV Personality Disorders (DIPD-IV) to reflect a 1-week time frame and each of the nine criteria for BPD is rated on a five-point anchored rating scale of 0 to 4, yielding a total score of 0 to 36. Two diagnostic interviews that assess the presence of BPD were administered to 200 nonpsychotic patients: the BPD module of the DIPD-IV and the Revised Diagnostic Interview for Borderlines (DIB-R). The ZAN-BPD was also administered, blind to diagnostic information. In addition, each patient filled out a self-report measure of general psychopathology that is often used in borderline treatment studies, the Symptom Checklist 90 (SCL-90). The convergent validity of the ZAN-BPD and relevant scales of the SCL-90 and the DIB-R was assessed and found to be highly significant. The discriminant validity of the various scores of the ZAN-BPD was also found to be highly significant, easily discriminating the 139 patients who met the DSM-IV criteria for BPD from the 61 patients who did not. In addition, internal consistency of the ZAN-BPD was found to be high (Cronbach's alpha=0.85). The interrater reliability of the ZAN-BPD was assessed using 32 conjoint interviews, while same day test-retest reliability was assessed in a separate sample of 40 patients. All reliability raters were blind to all previously collected information concerning each subject. All intraclass correlations were in the good to excellent range. Finally, the sensitivity of the ZAN-BPD to change was assessed using a third sample of 41 patients who were reinterviewed by a blind rater 7 to 10 days after the ZAN-BPD was first administered. The SCL-90 was also readministered at this time. The correlations between difference scores of the ZAN-BPD and difference scores of the SCL-90 were found to be significant, indicating that the ZAN-BPD measures change in a clinically meaningful manner. Taken together, the results of this study suggest that the ZAN-BPD is a promising clinician-administered scale for the assessment of change in borderline psychopathology over time.
Topics: Adolescent; Adult; Borderline Personality Disorder; Diagnostic and Statistical Manual of Mental Disorders; Female; Humans; Interview, Psychological; Male; Middle Aged; Psychiatric Status Rating Scales; Psychopathology
PubMed: 12839102
DOI: 10.1521/pedi.17.3.233.22147 -
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 -
Journal of the National Cancer Institute Jul 2020Some breast tumors expressing greater than 1% and less than 10% estrogen receptor (ER) positivity (ER-borderline) are clinically aggressive; others exhibit luminal...
BACKGROUND
Some breast tumors expressing greater than 1% and less than 10% estrogen receptor (ER) positivity (ER-borderline) are clinically aggressive; others exhibit luminal biology. Prior ER-borderline studies included few black participants.
METHODS
Using the Carolina Breast Cancer Study (phase I: 1993-1996; 2: 1996-2001; 3: 2008-2013), a population-based study that oversampled black women, we compared ER-borderline (n = 217) to ER-positive (n = 1885) and ER-negative (n = 757) tumors. PAM50 subtype and risk of recurrence score (ROR-PT, incorporates subtype, proliferation, tumor size) were measured. Relative frequency differences (RFD) were estimated using multivariable linear regression. Disease-free interval (DFI) was evaluated by ER category and endocrine therapy receipt, overall and by race, using Kaplan Meier and Cox models. Statistical tests were two-sided.
RESULTS
ER-borderlines were more frequently basal-like (RFD = +37.7%, 95% confidence interval [CI] = 27.1% to 48.4%) and high ROR-PT (RFD = +52.4%, 95% CI = 36.8% to 68.0%) relative to ER-positives. Having a high ROR-PT ER-borderline tumor was statistically significantly associated with black race (RFD = +26.2%, 95% CI = 9.0% to 43.3%). Compared to ER-positives, DFI of ER-borderlines treated with endocrine therapy was poorer but not statistically significantly different (hazard ratio [HR] = 2.03, 95% CI = 0.89% to 4.65%), whereas DFI was statistically significantly worse for ER-borderlines without endocrine therapy (HR = 3.33, 95% CI = 1.84% to 6.02%). However, black women with ER-borderline had worse DFI compared to ER-positives, even when treated with endocrine therapy (HR = 2.77, 95% CI = 1.09% to 7.04%).
CONCLUSIONS
ER-borderline tumors were genomically heterogeneous, with survival outcomes that differed by endocrine therapy receipt and race. Black race predicted high-risk ER-borderlines and may be associated with poorer endocrine therapy response.
Topics: Adult; Aged; Black People; Breast Neoplasms; Female; Humans; Immunohistochemistry; Middle Aged; Neoplasm Staging; North Carolina; Receptors, Estrogen; Transcriptome; White People; Young Adult
PubMed: 31742342
DOI: 10.1093/jnci/djz206 -
American Journal of Psychotherapy Jul 1977"Borderline" has been used to designate conditions intermediate between psychosis and neurosis, analyzability and nonanalyzability; also, for dilute or questionable... (Review)
Review
"Borderline" has been used to designate conditions intermediate between psychosis and neurosis, analyzability and nonanalyzability; also, for dilute or questionable schizophrenia. Contemporary usage inclines toward patients with manic-depressive heredity, although borderlines are still etiologically heterogeneous. Various subtypes are outlined, each responsive to a particular method of psychotherapy or pharmacotherapy. If drug-abuse or antisocial tendencies are absent, prognosis is ofter favorable.
Topics: Adaptation, Psychological; Affective Symptoms; Humans; Intelligence; Neurotic Disorders; Personality Disorders; Prognosis; Psychoanalytic Therapy; Schizotypal Personality Disorder
PubMed: 331970
DOI: 10.1176/appi.psychotherapy.1977.31.3.345 -
Schizophrenia Bulletin 1979Evidence about the genetic determinants for borderline conditions is reviewed. The research data are too limited and the diagnostic practices followed in existing... (Review)
Review
Evidence about the genetic determinants for borderline conditions is reviewed. The research data are too limited and the diagnostic practices followed in existing studies are too varied to allow firm conclusions to be drawn. Thus, the need for new studies starting with well-defined samples of borderline patients is clear. Previous work implicates genetic factors in the etiology of at least some borderlines, but it is unclear that borderlines by any definition will, as a group, have uniformly strong and specific genetic determinants. With further research, partially overlapping subgroups might be defined on the basis of careful examination of borderline patients' clinical characteristics and family histories. Such characterization could have potential clinical value since there may be subgroups of borderlines who respond differently to various psychopharmacologic treatments (Klein 1975) or to exploratory versus ego supportive psychotherapy (Stone 1977). Characterizations based on genetic considerations may have their limitations, since the genetics of these disorders probably involve complex interactions of a variety of factors that may be more or less specifically related to other major diagnostic groups.
Topics: Adoption; Affective Symptoms; Chronic Disease; Diagnosis, Differential; Diseases in Twins; Genotype; Humans; Models, Biological; Personality Disorders; Phenotype; Research; Schizophrenia; Schizotypal Personality Disorder; Terminology as Topic
PubMed: 375383
DOI: 10.1093/schbul/5.1.59 -
The International Journal of Eating... Mar 2022Nonsuicidal self-injury (NSSI) frequently co-occurs with eating disorders, especially bulimia nervosa (BN). Theoretical models and empirical evidence show many...
OBJECTIVE
Nonsuicidal self-injury (NSSI) frequently co-occurs with eating disorders, especially bulimia nervosa (BN). Theoretical models and empirical evidence show many overlapping risk factors for the onset and maintenance of NSSI and BN. However, among those with BN, it remains unclear what distinguishes those who do versus do not engage in NSSI. The primary objective of the present study was to identify factors predicting NSSI among women with BN. Specifically, we tested four domains of borderline personality disorder as mediators between childhood trauma and NSSI.
METHOD
Using structural equation modeling we tested a parallel mediation model to predict NSSI among women with BN (N = 130). Childhood trauma (measured by the Childhood Trauma Questionnaire at baseline) was the independent variable. The four parallel mediators (measured at baseline via the Diagnostic Interview for Borderlines, Revised) were lifetime negative affect, impulsive actions, atypical cognitions (e.g., odd thinking, unusual perceptual experiences, quasi-psychotic thinking), and interpersonal problems. The dependent variable was instances of NSSI during a subsequent two-week ecological momentary assessment protocol.
RESULTS
Childhood trauma was significantly associated with all four mediators (all p values < .01), but only atypical cognitions predicted NSSI (p = .03). The indirect path from childhood trauma to NSSI, through atypical cognitions was significant (path coefficient = .001, SE < .001, p = .01).
DISCUSSION
Among women with BN, childhood trauma was associated with atypical cognitions, which in turn predicted NSSI. Atypical cognitions may be a mechanism for NSSI in this population.
Topics: Adverse Childhood Experiences; Borderline Personality Disorder; Bulimia Nervosa; Ecological Momentary Assessment; Female; Humans; Self-Injurious Behavior
PubMed: 34985154
DOI: 10.1002/eat.23669 -
The Psychiatric Clinics of North America Jun 1990Outlined in the preceding sections are what one could call the ABCDs of treating borderline patients. A = analytically informed psychotherapy; B = behavior therapy; C =... (Review)
Review
Outlined in the preceding sections are what one could call the ABCDs of treating borderline patients. A = analytically informed psychotherapy; B = behavior therapy; C = cognitive therapy; and D = drug therapy. Together they add up to "E": eclectic therapy. In this pragmatic approach, the therapist will assess at the outset (1) amenability to exploratory therapy, but also (2) the need for supportive measures, including education, rehabilitation, and expansion of outside interests, (3) indications for behavioral technics (socially alienating habits, handwashing compulsions, phobias), (4) indications for cognitive measures (conflicts or fears resolvable through rational explanation or logical weighing of alternatives), and (5) indications for pharmacotherapy. All these steps involve the careful weighing of biologic/constitutional, psychodynamic, and, where present, posttraumatic factors, as well as personality assets and habitual problem-solving style. This will help assure against overreliance on a technic that does not fit with the patient's personality and against unwise persistence in a technic that is uncongenial or threatening. Patients already in stable life situations who are seeking help because of life crises may respond well to a brief course of therapy. Borderlines in late adolescence or early adult life, if self-destructive and not yet able to form lasting relationships (or to live contentedly without them), usually require sustained treatment over several years, preferably with the same therapist. Appropriate selection of medications, where indicated, should reduce impulsivity, aggressivity, and psychoticism. This, in turn, will facilitate psychotherapeutic work on maladaptive interpersonal patterns, exaggerated "all-or-none" responses to relatively innocuous stimuli, overpersonalized responses to other people's remarks, and so on. Therapists trained in identical methods will evaluate the same patient in somewhat different ways owing to their differences in personality and perception. This may lead to different sets of priorities and suggests different tactics that are still within the realm of therapeutic efficacy. Those trained primarily in one of the "ABCDs" may have equal success, yet via a different route than the one taken by therapists of a different subspecialty. Borderline patients, perhaps two out of five, often drop out of treatment no matter who the therapist. Yet two out of three patients, if followed long enough, eventually have a good result. One therapist's failure will be his colleague's success, and vice versa. Therapists, to maximize the success of their own efforts, need to be sufficiently steeped in at least one theoretical model of psychopathology/psychotherapy so as not to feel "lost" when confronted by the often bewildering dynamics and symptoms of their borderline patients.(ABSTRACT TRUNCATED AT 400 WORDS)
Topics: Borderline Personality Disorder; Combined Modality Therapy; Follow-Up Studies; Humans; Psychoanalytic Therapy; Psychotropic Drugs
PubMed: 2191281
DOI: No ID Found -
Archives of Psychiatric Nursing Apr 1997Highly suicidal, borderline patients are difficult to treat within the hospital and the community. The institution of managed care necessitates that care for these and... (Review)
Review
Highly suicidal, borderline patients are difficult to treat within the hospital and the community. The institution of managed care necessitates that care for these and other chronically hospitalized populations take place in the community. Psychotherapy has shown moderate success for some borderlines, however, treatment attrition is a significant problem. Without an intervention that successfully maintains suicidal borderline patients in therapy, either more costly methods of treatment must be used or death will result. A form of cognitive-behavioral therapy called dialectical behavior therapy has shown a high rate of effectiveness in reducing inpatient hospital days, suicide attempt frequency, and therapy attrition.
Topics: Borderline Personality Disorder; Cognitive Behavioral Therapy; Humans; Length of Stay; Patient Care Team; Psychiatric Nursing; Suicide, Attempted; Treatment Outcome
PubMed: 9105110
DOI: 10.1016/s0883-9417(97)80058-1