Borderline Personality Disorder Research

Borderline Personality Disorder Traits

July 2003

Affect regulation in women with borderline personality disorder traits

Biol Psychiatry. 2003 Jul 15;54(2):142-51.
Department of Psychiatry and Human Behavior, Brown University Medical School, 700 Butler Drive, Providence, Rhode Island 02906, USA.

"... The present study examined the relationship between specific dimensions of affect regulation and borderline traits... Results from hierarchical regression analyses indicated that level of affect intensity and affect control were significantly associated with number of BPD traits, even after controlling for level of depression. Findings for affect control remained significant even after controlling for affect intensity. These results, consistent with biosocial theory of BPD, suggest that persons with BPD experience emotions more intensely and have greater difficulty in controlling their affective responses."

Borderline Personality Disorder Improvement

Summer 2003

Plausibility and possible determinants of sudden "remissions" in borderline patients.

Psychiatry. 2003 Summer;66(2):111-9.
Gunderson JG, Bender D, Sanislow C, Yen S, Rettew JB, Dolan-Sewell R, Dyck I, Morey LC, McGlashan TH, Shea MT, Skodol AE.
McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA.

"THIS STUDY documents dramatic improvements in patients with borderline personality disorder (BPD) and explores their possible determinants. From a sample of the 160 carefully diagnosed borderline patients on whom prospective follow-along data was collected, a subsample of 18 was identified whose DSM-IV criteria count fell to two or fewer during the course of the first 6 months of the study and retained that improvement for the next 6 months. Follow-along data including month-by-month ratings of BPD criteria; week-by-week ratings of Axis I disorders, medication changes, and life events were then used to establish concensus ratings on four hypothesized causes: Axis I remissions, situational change, misdiagnosis, and treatment effects. Follow-up data collected at 2 years was examined to see whether the improvements persisted. The results were that 18 BPD patients underwent dramatic improvements in the first 6 months. Only one had relapsed by 2 years. Though one was judged to have been misdiagnosed at baseline, the most important determinants were judged to be situational changes (n = 10) and remissions of co-occurring Axis I disorders (n = 7). In 10 patients treatment appeared to have facilitated these situational or Axis I resolutions. In conclusion, patients with BPD can make significant improvements that are rapid and of sufficient duration to be considered remissions. Determinants were identified that warrant further prospective evaluation."

Gender

July - August 2003

Gender differences in borderline personality disorder: finding from the Collaborative longitudinal Personality Disorders Study

Compr Psychiatry. 2003 Jul-Aug;44(4):284-92.
Johnson DM, Shea MT, Yen S, Battle CL, Zlotnick C, Sanislow CA, Grilo CM, Skodol AE, Bender DS, McGlashan TH, Gunderson JG, Zanarini MC.
Summa Health System, St Thomas Hospital, Akron, OH 44310, USA.

"...Some studies report that men with BPD may be more likely to be diagnosed with substance use disorders, as well as paranoid, passive-aggressive, narcissistic, sadistic, and antisocial personality disorders (PDs). Additionally, women with BPD appear to be more likely to report histories of adult physical and sexual abuse and to meet diagnostic criteria for post-traumatic stress disorder (PTSD) and eating disorders. The purpose of the present study was to further examine gender differences in BPD. Using baseline data from the Collaborative Longitudinal Personality Disorders Study (CLPS), men and women who met criteria for BPD were compared on current axis I and II disorders, BPD diagnostic criteria, childhood trauma histories, psychosocial functioning, temperament, and personality traits. Men with BPD were more likely to present with substance use disorders, and with schizotypal, narcissistic, and antisocial PDs, while women with BPD were more likely to present with PTSD, eating disorders, and the BPD criterion of identity disturbance. Generally speaking, women and men with BPD displayed more similarities than differences in clinical presentations. The differences that did emerge are consistent with those found in epidemiological studies of psychopathology and therefore do not appear unique to BPD...no difference was found in rates of major depressive disorder, a condition that is more prevalent in females. Thus, BPD pathology may be a prevailing characterization that can attenuate usual gender-based distinctions."

July 2003

Impulsivity, gender, and response to fenfluramine challenge in borderline personality disorder.

Psychiatry Res. 2003 Jul 15;119(1-2):11-24.
Soloff PH, Kelly TM, Strotmeyer SJ, Malone KM, Mann JJ.
Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA, USA

"Behavioral impulsivity in borderline personality disorder (BPD) is associated with indices of diminished central serotonergic function, independent of suicidal behavior, depression or alcohol use disorder. Many of these studies have been conducted among males in specialized settings. Studies of BPD females, who constitute the majority of BPD patients, are generally conducted in community settings and report inconsistent findings. We studied gender differences in behavioral impulsivity and the prolactin response to D,L-fenfluramine (FEN) in BPD subjects in a community setting... Male, but not female, BPD subjects had significantly diminished prolactin responses compared to controls. Impulsivity and aggression each predicted prolactin responses. A significant effect of BPD diagnosis on prolactin response was eliminated when impulsivity was co-varied. Impulsivity and aggression were inversely related to delta-prolactin and peak-prolactin responses among male but not female subjects. Gender differences in central serotonergic function may contribute to variations in impulsivity in BPD."

Female Hormones

August 2003

Estrogen Fluctuations, oral contraceptives and borderline personality

Psychoneuroendocrinology. 2003 Aug;28(6):751-66.
DeSoto MC, Geary DC, Hoard MK, Sheldon MS, Cooper L.
Department of Psychology, University of Northern Iowa, Cedar Falls, IA 50614-0505, USA. cathy.desoto@uni.edu

"Results from three studies suggest fluctuation in estrogen level may influence the expression of borderline personality disorder (BPD) symptoms. In the first study, 226 women were administered the Personality Assessment Inventory, borderline scales (PAI-BOR; L.C. Morey, The Personality Assessment Inventory, Professional Manual, 1991) and a questionnaire that assessed time in menstrual cycle and use of oral contraceptives, that is synthetic estrogens. BPD symptoms were most common in women using oral contraceptives and during times in the menstrual cycle when estrogen level is rising. In Study 2, 52 women were measured four times across one menstrual cycle and provided salivary samples at each test session. The samples were assayed and estrogen levels were obtained. The principle finding was that variation in estrogen levels predicted the presence of BPD symptoms (r=0.4, p<0.01). This relationship remained significant when a general increase in negative affect was statistically controlled. Study 3 employed a pre-post Oral Contraceptive (OC) design with a control group. It was found that for women with high pre-existing levels of BPD, symptoms became significantly worse after starting pill use (F (3,42)=4.7; p<0.01). Research findings that link the serotonin system and estrogen are reviewed and theoretical and practical implications are discussed."

BPD and Other Disorders

November 2003

The relationship of borderline personality disorder to posttraumatic stress disorder and traumatic events.

Am J Psychiatry. 2003 Nov;160(11):2018-24.
Golier JA, Yehuda R, Bierer LM, Mitropoulou V, New AS, Schmeidler J, Silverman JM, Siever LJ.
Department of Psychiatry, Veterans Affairs Medical Center (116-A), 130 West Kingsbridge Road, Bronx, NY 10468, USA. julia.golier@med.va.gov

"OBJECTIVE: The authors examined the relationship of borderline personality disorder to posttraumatic stress disorder (PTSD) with respect to the role of trauma and its timing...RESULTS: High rates of early and lifetime trauma were found for the subject group as a whole. Compared to subjects without borderline personality disorder, subjects with borderline personality disorder had significantly higher rates of childhood/adolescent physical abuse (52.8% versus 34.3%) and were twice as likely to develop PTSD. In the path analysis of the relationship between borderline personality disorder and PTSD, none of the different types of paths (direct path, indirect paths through adulthood traumas, paths sharing the antecedent of childhood abuse) was significant. The associations with both trauma and PTSD were not unique to borderline personality disorder; paranoid personality disorder subjects had an even higher rate of comorbid PTSD than subjects without paranoid personality disorder, as well as elevated rates of physical abuse and assault in childhood/adolescence and adulthood. CONCLUSIONS: The associations of personality disorder with early trauma and PTSD were evident, but modest, in borderline personality disorder and were not unique to this type of personality disorder. The results do not appear substantial or distinct enough to support singling out borderline personality disorder from the other personality disorders as a trauma-spectrum disorder or variant of PTSD."

November 2003

Clinical Features and Impairment in Women with Borderline Personality
Disorder (BPD) with Posttraumatic Stress Disorder (PTSD), BPD Without PTSD,
and Other Personality Disorders with PTSD.

J Nerv Ment Dis. 2003 Nov;191(11):706-713.
Zlotnick C, Johnson DM, Yen S, Battle CL, Sanislow CA, Skodol AE, Grilo CM, McGlashan TH, Gunderson JG, Bender DS, Zanarini MC, Tracie Shea M.
Brown University School of Medicine, Department of Psychiatry and Human Behavior, Butler Hospital, Providence, RI; double dagger Women and Infant's Hospital, Providence, RI; section sign Department of Psychiatry, Yale University School of Medicine, New Haven, CT; paragraph sign New York State Psychiatric Institute/Columbia University, New York, NY; parallel McLean Hospital/Harvard Medical School, Belmont, MA. Brown University School of Medicine, Department of Psychiatry and Human Behavior, Butler Hospital, Providence, RI; double dagger Women and Infant's Hospital, Providence, RI; section sign Department of Psychiatry, Yale University School of Medicine, New Haven, CT; paragraph sign New York State Psychiatric Institute/Columbia University, New York, NY; parallel McLean Hospital/Harvard Medical School, Belmont, MA.

"SUMMARY: The aims of this study were to examine differences in clinical features, impairment, and types of childhood traumas among women with borderline personality disorder (BPD), women with BPD and posttraumatic stress disorder (PTSD), and those with other personality disorders and PTSD...The additional diagnosis of PTSD in borderline women did not significantly increase the degree of borderline pathology and psychiatric morbidity but did significantly increase general dysfunction and the occurrence of hospitalization. The additional diagnosis of BPD in women with PTSD significantly increased the features of suicide proneness and impulsiveness. Both groups of women with PTSD reported significantly more types of childhood traumas relative to borderline women without PTSD. Consistent with other research, the findings suggest that PTSD does not appear to alter the central features of BPD. The clinical implications of our findings are considered."

September - October 2002

History of childhood attention deficit/hyperactivity disorder symptoms and borderline personality disorder: a controlled study.

Compr Psychiatry. 2002 Sep-Oct;43(5):369-77.
Fossati A, Novella L, Donati D, Donini M, Maffei C.
San Raffaele Vita-Salute University, Faculty of Psychology, Milano, Italy.

The results of this study seem to support the hypothesis of an association between history of childhood ADHD symptoms and adult BPD diagnosis.

July - August 1997

Antisocial and borderline personality disorders: two separate diagnoses or two aspects of the same psychopathology?

Compr Psychiatry. 1997 Jul-Aug;38(4):237-42.
Paris J.
Department of Psychiatry, McGill University, Sir Mortimer B. Davis-Jewish General Hospital, Catherine, Montreal Quebec, Canada.

Antisocial personality disorder (ASPD) and borderline personality disorder (BPD) have a number of points of overlap: in symptoms, in personality dimensions that underlie their phenomenology, in community prevalence, in risk factors, and in outcome and response to treatment. Both disorders have a common base in impulsive personality traits, but the behavioral differences between them are shaped by gender. Further research is suggested to explore the commonalities and differences between ASPD and BPD.

Material in quotes is from PubMed.
This material is for educational purposes.

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