Borderline Personality Disorder Research

Psychological Trauma

October 2003

    Abuse and neglect in childhood: relationship to personality disorder diagnoses.

Bierer LM, Yehuda R, Schmeidler J, Mitropoulou V, New AS, Silverman JM, Siever LJ.
Department of Psychiatry, Mount Sinai School of Medicine, New York, New York, USA. linda.bierer@med.va.gov

"BACKGROUND: Childhood history of abuse and neglect has been associated with personality disorders and has been observed in subjects with lifetime histories of suicidality and self-injury. Most of these findings have been generated from inpatient clinical samples... RESULTS: Seventy-eight percent of subjects met dichotomous criteria for some form of childhood trauma; a majority reported emotional abuse and neglect. The dichotomized criterion for global trauma severity was predictive of cluster B, borderline, and antisocial personality disorder diagnoses. Trauma scores were positively associated with cluster A, negatively with cluster C, but were not significantly associated with cluster B diagnoses. Among the specific diagnoses comprising cluster A, paranoid disorder alone was predicted by sexual, physical, and emotional abuse. Within cluster B, only antisocial personality disorder showed significant associations with trauma scores, with specific prediction by sexual and physical abuse. For borderline personality disorder, there were gender interactions for individual predictors, with emotional abuse being the only significant trauma predictor, and only in men. History of suicide gestures was associated with emotional abuse in the entire sample and in women only; self-mutilatory behavior was associated with emotional abuse in men. CONCLUSION: These results suggest that childhood emotional abuse and neglect are broadly represented among personality disorders, and associated with indices of clinical severity among patients with borderline personality disorder. Childhood sexual and physical abuse are highlighted as predictors of both paranoid and antisocial personality disorders. These results help qualify prior observations of the association of childhood sexual abuse with borderline personality disorder."

March - April 2002

  The differential relevance of attachment classification for psychological disorders

Psychother Psychosom Med Psychol. 2002 Mar-Apr;52(3-4):128-33. 
Buchheim A, Strauss B, Kachele H.
Abteilung Psychotherapie und Psychosomatische Medizin, Universitat Ulm, Germany. buchheim@sip.medizin.uni-ulm.de

"...This article reviews findings of clinical attachment research...the findings related to anxiety and Borderline Personality Disorders clearly indicate a predominance of preoccupied attachment patterns combined unresolved traumatic experiences."

January 2001

  Diatheses and stressors in borderline pathology of childhood: the role of neuropsychological risk and trauma.

J Am Acad Child Adolesc Psychiatry 2001 Jan;40(1):100-5
Zelkowitz P, Paris J, Guzder J, Feldman R.
Department of Psychiatry, Sir Mortimer B. Davis-Jewish General Hospital, 4333 Cote Ste. Catherine Road, Montreal, Quebec, Canada H3T 1E4.

"OBJECTIVE: To determine the relative contributions of neuropsychological deficits and psychosocial stressors to the presence of borderline pathology in children." Results:
"Both environmental risks and neurobiological vulnerability should be taken into account to understand the etiology of borderline pathology in children."

Spring 1997

  Pathways to the development of borderline personality disorder.

J Personal Disord 1997 Spring;11(1):93-104 
Zanarini MC, Frankenburg FR.
Laboratory for the Study of Adult Development, McLean Hospital, Belmont, Massachusetts 02178, USA.

"The available empirical evidence concerning the etiology of borderline personality disorder is reviewed. A tripartite model of the development of BPD is then presented. This model has three elements: a traumatic childhood (broadly defined), a vulnerable (hyperbolic) temperament, and a triggering event or series of events. The authors conclude that each borderline patient has a unique pathway to the development of BPD that is a painful variation on an unfortunate but familiar theme."

Pharmacological Treatment for Borderline Personality Disorder

Antidepressants

  SSRI (selective serotonin reuptake inhibitor)

December 2002

  SSRI treatment of borderline personality disorder: a randomized, placebo-controlled clinical trial for female patients with borderline personality disorder.

Am J Psychiatry. 2002 Dec;159(12):2048-54. 
Rinne T, van den Brink W, Wouters L, van Dyck R.
Department of Psychiatry, Leiden University Medical Center, University of Leiden, PO Box 9600, 2300 RC Leiden, The Netherlands. t.rinne@lumc.nl

OBJECTIVE: Selective serotonin reuptake inhibitors (SSRIs) are recommended for treatment of affect lability, impulsivity, and aggression in patients with borderline personality disorder... The outcome measures were the rapid mood shift, impulsivity, and aggression subscales from the Borderline Personality Disorder Severity Index. RESULTS: Fluvoxamine but not placebo produced a robust and long-lasting reduction in the scores on the subscale for rapid mood shifts. In contrast, no difference between the fluvoxamine and placebo groups was observed in the effect on the impulsivity and aggression scores. CONCLUSIONS: In this study, fluvoxamine significantly improved rapid mood shifts in female borderline patients, but not impulsivity and aggression. This latter finding may be due to gender-specific differences in impulsivity and aggression.

Fluvoxamine (Luvox)

January 2003

  Fluvoxamine reduces responsiveness of HPA axis in adult female BPD patients with a history of sustained childhood abuse.

Neuropsychopharmacology. 2003 Jan;28(1):126-32.
Rinne T, de Kloet ER, Wouters L, Goekoop JG, de Rijk RH, van den Brink W.
Leiden University Medical Center, Department of Psychiatry, Netherlands. rinne@euronet.nl

"Fluvoxamine treatment reduces the hyperresponsiveness of the HPA axis in BPD patients with a history of sustained childhood abuse. This effect is likely to be obtained in the first 6 weeks of treatment."

Winter 2003

  Pharmacokinetics and drug interactions of the sedative hypnotics.

Psychopharmacol Bull. 2003 Winter;37(1):30-46. 
Gagliardi JP, Krishnan RR.
Departments of Internal Medicine and Psychiatry, Duke University Medical Center, Durham, North Carolina, USA.

"The treatment of patients with borderline personality disorder (BPD) is notoriously difficult. Psychotherapeutic and pharmacological strategies have been investigated, and a few have shown promise... Although there are a variety of studies investigating a number of different medications for the treatment of BPD, there are few randomized, double-blind, placebo-controlled trials. Furthermore, the evidence base is limited by small sample size and variability in inclusion criteria and outcome measures among the different studies. Further study is needed with larger, randomized, placebo-controlled trials to clearly demonstrate benefit of any pharmacotherapy. To date, there is suggestion from some studies that neuroleptics, carbamazepine, monoamine oxidase inhibitors, and selective serotonin reuptake inhibitors may be effective, and there is evidence that benzodiazepines are detrimental. The role of electroconvulsive therapy remains unclear."

October 2003

  Pharmacotherapy for personality disorders

Expert Opin Pharmacother. 2003 Oct;4(10):1643-9. 
Newton-Howes G, Tyrer P.
Department of Psychological Medicine, Imperial College London, Charing Cross Campus, St. Dunstan's Road, London, W6 8RP, UK. p.tyrer@imperial.ac.uk

"...Borderline personality disorder is a condition in which treatment evidence is the most promising" of the personality disorders... there is reasonable evidence that antidepressants, particularly serotonin re-uptake inhibitors and monoamine oxidase inhibitors, have beneficial effects independent of their antidepressive ones and albeit, less favourable, evidence that antipsychotic drugs and mood stabilisers may also be of value. None of this evidence is yet sufficient to point to any specific drug treatment indications.

August 2000

  Treatment with Psychotropic Medication

Tidsskr Nor Laegeforen 2000 Aug 10;120(18):2135-41
Nissen T. Psykiatrisk senter for Tromso og Karlsoy Regionsykehuset i Tromso.  (Article in Norwegian)

"Neuroleptics have a modest, but broad therapeutic effect on symptoms in all domains. Doses are lower than those used for treating schizophrenia. Antidepressants have a more inconsistent effect. Tricyclics have been the least successful, whereas irreversible MAO inhibitors and selective serotonin reuptake inhibitors (SSRIs) have been effective in treating mood symptoms and impulsivity. Lithium has a possible effect in diminishing anger and suicidal symptoms.

As there is no "drug of choice" for the treatment of borderline personality disorder, a more rational clinical approach might be to treat different symptom clusters (cognitive/schizotypal, affective, impulsive) rather than the disorder itself."

Anticonvulsants - Mood Stabilizers

Depakote (divalproex)

May 2002

  Divalproex sodium treatment of women with borderline personality disorder and bipolar II disorder: a double-blind placebo-controlled pilot study.

J Clin Psychiatry. 2002 May;63(5):442-6.
Frankenburg FR, Zanarini MC.
Laboratory for the Study of Adult Development, McLean Hospital, Belmont, MA 02478, USA. ffrankenburg@mclean.harvard.edu

"BACKGROUND: The intent of this study was to compare the efficacy and safety of divalproex sodium and placebo in the treatment of women with borderline personality disorder and comorbid bipolar II disorder...CONCLUSION: The results of this study suggest that divalproex sodium may be a safe and effective agent in the treatment of women with criteria-defined borderline personality disorder and comorbid bipolar II disorder, significantly decreasing their irritability and anger, the tempestuousness of their relationships, and their impulsive aggressiveness."

March 2001

  A preliminary double-blind, placebo-controlled trial of divalproex sodium in borderline personality disorder.

J Clin Psychiatry 2001 Mar;62(3):199-203
Hollander E, Allen A, Lopez RP, Bienstock CA, Grossman R, Siever LJ, Merkatz L, Stein DJ.
Department of Psychiatry, Mount Sinai School of Medicine, New York, NY 10029-6574, USA.

Depakote was compared to placebo in 16 borderline patients. 12 were given Depakote and 4 were given a placebo. "Treatment with divalproex sodium may be more effective than placebo for global symptomatology, level of functioning, aggression, and depression."

Neurontin (gabapentin)

June 2002

    Gabapentin treatment of impulsive-aggressive behaviour. 

"Accession Number 
Peer Reviewed Journal: 2003-05541-015. 
Author 
Biancosino, Bruno; Facchi, Anna; Marmai, Luciana; Grassi, Luigi. 
Title 
Gabapentin treatment of impulsive-aggressive behaviour. 
Source 
Canadian Journal of Psychiatry - Revue Canadienne de Psychiatrie. Vol 
47(5) Jun 2002, [np]. 
Canadian Psychiatric Assn, Canada 

Full text is available online for recent years. Link to the journal title from 
http://www.rfmh.org/library, or click the WebLink button., Older volumes are available in the NKI Library. Please check the stacks. 

Abstract 
Gabapentin is a relatively new antiepileptic agent structurally similar to 
gamma-aminobutyric acid (GABA) with unclear mechanisms of action and a good safety profile. The present article reports the case of successful gabapentin treatment of chronic impulsive-aggressive behavior in a 30-yr-old male patient with severe borderline personality disorder (BPD). The patient started a trial with gabapentin 900 mg daily, and within 48 hrs of gabapentin initiation, a quick and dramatic improvement in the impulsive-aggressive behavior was observed, and a complete remission of 
symptoms was reported in the following 2 wks. Gabapentin was well tolerated by the patient, and the S did not show any side effects. 45 days after gabapentin initiation, the clinical benefit was unchanged, and it was possible to refer the patient to the rehabilitation program for supported employment. (PsycINFO Database Record (c) 2003)."

Tegretol

December 1994

Eur Neuropsychopharmacol 1994 Dec;4(4):479-86
de la Fuente JM, Lotstra F.
Department of Psychiatry, Erasme Hospital, Free University of Brussels (ULB), Belgium.

"Borderline personality disorder does not have a first choice pharmacological treatment. We studied 20 borderline inpatients in a double-blind parallel placebo-controlled trial with carbamazepine for a mean of 30.9 days. No significant positive effects of the drug were found."

Antipsychotics/Neuroleptics

Risperdal (Risperidone)

March 2002

  Treatment of borderline personality disorder with risperidone.

J Clin Psychiatry. 2002 Mar;63(3):241-4. 
Rocca P, Marchiaro L, Cocuzza E, Bogetto F.
Department of Neuroscience, University of Turin, Italy. bogetto@molinette.unito.it

"BACKGROUND: Of the various Axis II disorders, borderline personality disorder (BPD) is among the more critical to treat. There are at present few results in terms of clinical outcome with the psychotropic agents available. Possible targets for pharmacotherapy are affective symptoms, cognitive disturbances, and impulsive, self-injurious behaviors. In previous studies, atypical antipsychotics at low-to-moderate doses provided symptom reduction with good tolerability. Our purpose was to assess the efficacy of risperidone in BPD, focusing on its effects on impulsive-aggressive behavior...CONCLUSION: Risperidone at low-to-moderate doses can improve BPD symptomatology. Further studies are needed to explore the efficacy of risperidone versus placebo as well as in comparison to other potential treatments for BPD."

Zyprexa (Olanzapine)

January 2004

    Olanzapine versus placebo in the treatment of borderline personality
disorder.

J Clin Psychiatry. 2004 Jan; 65(1): 104-9
Department of Psychiatry, University of New Mexico School of Medicine,
Albuquerque.
Bogenschutz MP, George Nurnberg H

"BACKGROUND: ... .Data were collected from July 2000 to April 2002. RESULTS: Olanzapine was found to be significantly (p <.05) superior to placebo on the CGI-BPD at endpoint, with separation occurring as early as 4 weeks. Similar results were found for the single-item Clinical Global Impressions scale. Weight gain was significantly (p =.027) greater in the olanzapine group.
CONCLUSIONS: This study supports the efficacy of olanzapine for symptoms of
BPD in a mixed sample of women and men. Further studies with olanzapine and
other atypical antipsychotics are needed."

November 2001

    Olanzapine treatment of female borderline personality disorder patients: a
double-blind, placebo-controlled pilot study.

J Clin Psychiatry. 2001 Nov; 62(11): 849-54.
McLean Hospital, Belmont, MA 02478, USA. zanarini@mclean.harvard.edu
Zanarini MC, Frankenburg FR

"...CONCLUSION: Olanzapine appears to be a safe and effective agent in
the treatment of women with criteria-defined BPD, significantly affecting
all 4 core areas of borderline psychopathology (i.e., affect, cognition,
impulsivity, and interpersonal relationships)."

November 1999

    Olanzapine safety and efficacy in patients with borderline personality
disorder and comorbid dysthymia

Biol Psychiatry 1999 Nov 15;46(10):1429-35
Schulz SC, Camlin KL, Berry SA, Jesberger JA.
Department of Psychiatry, University of Minnesota Medical School, Minneapolis 55454-1495, USA.

"Open-label pilot study where borderlines treated with Zyprexa "showed statistically significant reduction in self-rated and clinician-rated scales. Symptoms associated with BPD and dysthymia were among those to be substantially reduced. Further studies to explore olanzapine's efficacy versus placebo, as well as comparison to other potential treatments for BPD, are important next steps."

Naltrexone

September 1999

  Naltrexone in the treatment of dissociative symptoms in patients with borderline personality disorder: an open-label trial.

J Clin Psychiatry 1999 Sep;60(9):598-603
Bohus MJ, Landwehrmeyer GB, Stiglmayr CE, Limberger MF, Bohme R, Schmahl CG.
Department of Psychiatry, University of Freiburg, Freiburg im Breisgau, Germany.

BPD and PTSD consumers many times experience dissociative symptoms, including flashbacks. Female BPD patients were treated with naltrexone, an opiate antagonist; 25 to 100 mg three times a day., for at least 2 weeks. The "scores reflected a highly significant reduction of the duration and the intensity of dissociative phenomena and tonic immobility as well as a marked reduction in analgesia during treatment with naltrexone. Six of 9 patients reported a decrease in the mean number of flashbacks per day.

CONCLUSION: These observations support the hypothesis that an increased activity of the opioid system contributes to dissociative symptoms, including flashbacks, in borderline personality disorder and suggest that these symptoms may respond to treatment with opiate antagonists."