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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 -
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 -
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 -
Upsala Journal of Medical Sciences Dec 2018Personality disorders (PDs) can be described as the manifestation of extreme personality traits that interfere with everyday life and contribute to significant... (Review)
Review
Personality disorders (PDs) can be described as the manifestation of extreme personality traits that interfere with everyday life and contribute to significant suffering, functional limitations, or both. They are common and are frequently encountered in virtually all forms of health care. PDs are associated with an inferior quality of life (QoL), poor health, and premature mortality. The aetiology of PDs is complex and is influenced by genetic and environmental factors. The clinical expression varies between different PD types; the most common and core aspect is related to an inability to build and maintain healthy interpersonal relationships. This aspect has a negative impact on the interaction between health-care professionals and patients with a PD. From being discrete and categorical disease entities in previous classification systems, the current concept of PD, reflected in the newly proposed ICD-11, is a dimensional description based on the severity of the disturbed functioning rather than on the type of clinical presentation. Insight about the characteristics of PDs among medical practitioners is limited, which is partly because persons do not seek health care for their PD, but instead for other medical issues which are obscured by their underlying personality problems. What needs to be emphasized is that PDs affect both the clinical presentation of other medical problems, and the outcome of these, in a negative manner and that the integrated effects of having a PD are a shortened life expectancy. Accordingly, PDs need to be recognized in clinical practice to a greater extent than previously.
Topics: Adult; Comorbidity; Female; History, 20th Century; History, 21st Century; Humans; International Classification of Diseases; Male; Personality; Personality Disorders; Psychiatry; Psychology; Quality of Life; Young Adult
PubMed: 30539674
DOI: 10.1080/03009734.2018.1526235 -
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 -
American Family Physician Dec 2011Personality disorders have been documented in approximately 9 percent of the general U.S. population. Psychotherapy, pharmacotherapy, and brief interventions designed... (Review)
Review
Personality disorders have been documented in approximately 9 percent of the general U.S. population. Psychotherapy, pharmacotherapy, and brief interventions designed for use by family physicians can improve the health of patients with these disorders. Personality disorders are classified into clusters A, B, and C. Cluster A includes schizoid, schizotypal, and paranoid personality disorders. Cluster B includes borderline, histrionic, antisocial, and narcissistic personality disorders. Cluster C disorders are more prevalent and include avoidant, dependent, and obsessive-compulsive personality disorders. Many patients with personality disorders can be treated by family physicians. Patients with borderline personality disorder may benefit from the use of omega-3 fatty acids, second-generation antipsychotics, and mood stabilizers. Patients with antisocial personality disorder may benefit from the use of mood stabilizers, antipsychotics, and antidepressants. Other therapeutic interventions include motivational interviewing and solution-based problem solving.
Topics: Antipsychotic Agents; Combined Modality Therapy; Family Practice; Humans; Motivational Interviewing; Personality Disorders; Primary Health Care; Problem Solving
PubMed: 22150659
DOI: No ID Found -
Revista Brasileira de Psiquiatria (Sao... Oct 2006To illustrate the basic characteristics of several specific personality disorders, focusing mainly in antisocial personality disorder. The differences between antisocial... (Review)
Review
OBJECTIVE
To illustrate the basic characteristics of several specific personality disorders, focusing mainly in antisocial personality disorder. The differences between antisocial personality disorder and psychopathy are highlighted. Serial killers and its psychopathic aspects are also discussed.
METHOD
A bibliographic review was completed in order to outline convergences and divergences among different authors about this controversial issue, especially those concerning the possibility of treatment.
RESULTS
While anti-social personality disorder is a medical diagnosis, the term "psychopathy" (which belongs to the sphere of forensic psychiatry) may be understood as a "legal diagnosis". It is not still possible to identify an effective treatment for serial killers.
CONCLUSION
Personality disorders, especially of the antisocial type, still represent a formidable challenge to forensic psychiatry today. Questions as yet unanswered include the best and most humane place for patients with this condition and the nature of a standardised treatment recommendation.
Topics: Antisocial Personality Disorder; Conduct Disorder; Expert Testimony; Forensic Psychiatry; Homicide; Humans; Mental Competency; Mental Disorders; Sex Offenses
PubMed: 17143448
DOI: 10.1590/s1516-44462006000600005 -
Psychiatria Polska Apr 2017Anorexia nervosa (AN) is a relatively common disorder, especially in adolescent and young adult women. The lifetime prevalence of AN in females ranges from 1.2 to 2.2%.... (Review)
Review
Anorexia nervosa (AN) is a relatively common disorder, especially in adolescent and young adult women. The lifetime prevalence of AN in females ranges from 1.2 to 2.2%. The prevalence in males is 10-times lower. The condition is associated with a high risk of chronic course and poor prognosis in terms of treatment and the risk of death. Longer follow-up periods seemed to correspond with increased improvement rates and increased mortality. Onset of the disorder during adolescence is associated with better prognosis. It is reported that as much as 70% to over 80% of patients in this age group achieve remission. Worse outcomes are observed in patients who required hospitalization and in adults. Recent studies indicate improved prognosis for cure and lower mortality rates than previously reported. However, the recovery can take several years and AN is associated with high risk of developing other psychiatric disorders during the patients' lifetime, even after recovery from AN (mainly: affective disorders, anxiety disorders, obsessive-compulsive disorders, substance abuse disorders). Studies indicate that bulimic symptoms often occur in the course of anorexia nervosa (especially within 2-3 years from the onset of AN). The authors present a review of literature on the course, comorbidity, mortality, and prognostic factors in AN. Better knowledge of the course of anorexia can contribute to more realistic expectations of the pace of symptomatic improvement, as well as to a creation of therapeutic programs which are better adapted to the needs of the patients.
Topics: Adolescent; Age Factors; Anorexia Nervosa; Anxiety Disorders; Chronic Disease; Comorbidity; Compulsive Personality Disorder; Female; Humans; Male; Outcome Assessment, Health Care; Personality Disorders; Prognosis; Risk Factors; Sex Factors; Social Adjustment; Young Adult
PubMed: 28581532
DOI: 10.12740/PP/64580 -
The Australian and New Zealand Journal... Feb 2023Autism spectrum disorders and personality disorders are spectrum conditions with shared clinical features. Despite similarities, previous attempts to synthesise... (Review)
Review
OBJECTIVES
Autism spectrum disorders and personality disorders are spectrum conditions with shared clinical features. Despite similarities, previous attempts to synthesise literature on co-existing prevalence and shared traits have employed a unidirectional focus, assessing personality characteristics of individuals with an autism spectrum disorder diagnosis. Here, we assess the prevalence of autism spectrum disorder diagnosis and/or traits among persons diagnosed with a personality disorder.
METHODS
We systematically reviewed the English-language literature following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, according to a pre-registered protocol (PROSPERO: CRD 42021264106). Peer-reviewed quantitative studies reporting the prevalence of autism spectrum disorder diagnosis or traits in persons with an established personality disorder diagnosis were included. Studies were critically appraised using the Appraisal tool for Cross-Sectional Studies.
RESULTS
Fifteen studies were identified, including 72,902 participants (median: 48, interquartile range: 30-77). Diagnoses included borderline, schizotypal and obsessive-compulsive personality disorders, and cohorts with unspecified personality disorder diagnoses. There was significant heterogeneity in diagnostic methodology and assessment tools used. We identified preliminary evidence of an increased prevalence of co-existing autism spectrum disorder diagnosis and traits among those diagnosed with a personality disorder, although significant limitations of the literature were identified.
CONCLUSION
Our research suggests clinicians should consider conducting a careful developmental assessment when assessing service-users with possible or confirmed personality disorder. Future research directions may include larger studies featuring clinical control groups, an exploration of shared and differentiating behavioural-cognitive features of the two conditions, and investigation into potentially shared aetiological factors. Research investigating demographic factors that may contribute to potential diagnostic overshadowing would also be welcomed.
Topics: Humans; Adult; Adolescent; Autism Spectrum Disorder; Prevalence; Cross-Sectional Studies; Personality Disorders; Obsessive-Compulsive Disorder
PubMed: 35986511
DOI: 10.1177/00048674221114603