Borderline Personality Disorder Research
Borderline Personality Disorder Subtypes
April 2003
 Subtype differentiation of patients with borderline personality disorder
using a circumplex model of interpersonal behavior.
Leihener F, Wagner A, Haaf B, Schmidt C, Lieb K, Stieglitz R, Bohus M.
Department of Psychiatry and Psychotherapy, University of Freiburg Medical
School, Hauptstr. 5, D-79104 Freiburg, Germany.
"The considerable heterogeneity of symptomatology in persons with borderline personality disorder (BPD) has led some to suggest the existence of subtypes within this diagnosis. However, no study to date has examined subtypes according to differences in interpersonal functioning, despite the central role of interpersonal problems in the BPD diagnosis. The interpersonal problems of 95 patients with BPD were investigated using the German version of the Inventory of Interpersonal Problems, a self-report measure based on a circumplex model of interpersonal functioning. Data were analyzed by means of cluster analysis. The results supported the existence of two distinct subtypes of persons with BPD, labeled
'autonomous' and 'dependent.' Four-month longitudinal assessment indicated that these types were stable over time, suggesting the categorization reflected trait, as opposed to state, patterns of interpersonal behavior. Implications of these findings for future research and management of BPD are discussed."
Suicide and Self
Injury
February 2002
Suicidal and self-injurious behavior in personality disorder: controversies and treatment directions.
Curr Psychiatry Rep. 2002 Feb;4(1):30-8.
Gerson J, Stanley B.
New York State Psychiatric Institute, Department of Neuroscience, 1051 Riverside Drive, New York, NY 10032, USA.
"Contrary to common clinical perceptions, individuals with personality disorders attempt and commit suicide at nearly the same rate as individuals with major depression. In particular, those with borderline personality disorder are at high risk for suicidal behavior and nonsuicidal self-injury. Yet there is significant controversy surrounding the diagnosis of borderline personality disorder in terms of its existence, its definition and symptom structure, its Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) axis location, and its importance as a contributing factor to suicidality and nonsuicidal self-injury. Furthermore, both suicidal and nonsuicidal self-harm is prominent in borderline personality disorder. There is often confusion between suicidal and nonsuicidal self-injury with one sometimes mistaken for the other. Nonsuicidal self-injury is sometimes met with hospitalization, because it is viewed as life threatening. Alternately, the potential lethality of suicidal behavior is underestimated, because it occurs in the context of multiple low lethality self-harm behaviors. It is possible to view these behaviors as distinct yet on a spectrum in borderline personality-disordered patients. With respect to treatment of self-injury in personality disorders, some recent pharmacotherapy trials have been conducted, though efficacy is often unclear. Findings with respect to psychotherapy, particularly dialectical behavior therapy, a form of cognitive behavioral treatment, are promising."
February 2002
Reasons for suicide
attempts and nonsuicidal self-injury in women with borderline
personality disorder.
Brown MZ Comtois KA Linehan MM
J Abnorm Psychol 2002 Feb;
111:198-202
People with BPD who are chronically suicidal say
they want to feel better and want to release negative emotions
whereas people who have the BPD and self injure and are not
suicidal do it to express anger, punish oneself, generate normal
feelings, and distract oneself and also to relieve negative
emotions.
April 2002
Stress Regulation and Self Mutilation
Ulrich Sachsse, M.D., Sussanne Von Der Heyde, M.Dl,
Gerald Huether, Ph.D., . Am J
Psychiatry 159:672, April 2002
A 36 year old woman diagnosed with borderline
personality disorder gave 86 nightly urine tests. Her levels of
cortisol excretion was extreme from high to low and it is reported
that during the low cortisol levels, self injury normally followed.
Also it was noted that several days before she self injured she
experienced feelings of "dissociation and
depersonalization, flashbacks, and depressive states."
Important Borderline Personality Disorder Information
January 2002
Borderline personality disorder in primary
care.
Gross R Olfson M Gameroff M Shea S Feder A Fuentes
M Lantigua R Weissman MM
Arch Intern Med 2002 Jan; 162:53-60
"Prevalence of BPD is high in the primary care
community and in spite of the fact that there are available
medications and counseling techniques that will treat the BPD, in
spite of the high suicide rate and psychiatric disorders that
usually accompany this disorder and how disabling the BPD can be,
the borderline personality disorder is largely unrecognized and
untreated."
Borderline Personality Disorder and Bipolar
Disorder
December 2001
Do patients with
borderline personality disorder belong to the bipolar spectrum?
Deltito J Martin L Riefkohl J Austria B Kissilenko
A Corless C Morse P
Anxiety and Mood Disorders Program, The New York Hospital-Cornell
Medical Center, Westchester Division, USA, J
Affect Disord 2001 Dec; 67:221-8
A study was done to determine if the BPD belongs in
the bipolar spectrum. It was determined that patients more often
than not shown signs of bipolarity and would benefit by medications
used for bipolar disorder spectrum disorders.
Older People With BPD
January 2003
Diminished Impulsivity in Older Patients With Borderline
Personality Disorder
Am J Psychiatry. 2003 Jan;160(1):165-6.
Stevenson J, Meares R, Comerford A.
Department of Psychological Medicine, University of Sydney, Westmead Hospital, Darcy Rd., Westmead N.S.W., 2145 Australia.
"OBJECTIVE: The aim of this study was to test, in terms of impulsivity, the hypothesis that borderline personality disorder "burns out" with age...
RESULTS: Older patients with borderline personality disorder showed less impulsivity than younger patients, but there was no difference in terms of affect disturbance, identity disturbance, and interpersonal problems. CONCLUSIONS: The view that borderline personality disorder burns out with age is supported in terms of impulsivity."
BPD and Responsibility for Behavior
June 2003
Moral responsibility and borderline personality disorder.
Are people with BPD responsible for their behavior?
"Impulsivity, acting out and the less severe forms of dissociation
do not vitiate responsibility. Severe dissociative and psychotic
symptoms may well render people with BPD less morally responsible
for their actions. Conclusions: Comorbid conditions in BPD may also
affect the ability to act responsibly."
BPD Mother and Infant
September 2003
'Still-face' interactions between mothers and borderline
personality disorder and their 2-month-old infants
Br J Psychiatry. 2003
Sep;183:239-47.
Crandell LE, Patrick MP, Hobson RP.
Developmental Psychopathology Research Unit, Tavistock Clinic,
London, UK. drlisa@libero.it
"BACKGROUND: There is evidence that psychopathology in mothers may
be associated with dysfunctional mother-infant interactions. AIMS:
To investigate mother-infant relations when mothers have borderline
personality disorder."
BPD mothers and mothers without a psychiatric disorder were videotaped interacting
with their 2 month old infants. During face-to-face play, the
BPD mothers "adopted a 'still face' and was unreactive.." BPD
mothers were more "intrusively insensitive towards their infants.
During the still-face period, their infants showed increased looking
away and dazed looks. Following this, mother-infant interactions were less
satisfying and their infants showed dazed looks and lowering of
affect. CONCLUSIONS: The diagnosis of borderline personality
disorder is associated with a particular pattern of mother-infant
interaction. The infants' responses to the still-face challenge
might suggest dysfunctional self-regulation, but the developmental
significance remains to be assessed."
Borderline Personality Disorder Families
Fall 2000
A family study of outpatients with borderline personality
disorder and no history of mood disorder
J Personal Disord 2000 Fall;14(3):208-17 Riso LP, Klein DN,
Anderson RL, Ouimette PC.
Department of Psychology, Georgia State University, Atlanta 30303,
USA
Relatives of borderline outpatients were studied for mood
disorders and for personality disorders. There were increased rates
of mood disorders and personality disorders in the relatives of
borderlines compared with never psychiatrically ill patients.
"Familial aggregation of psychiatric disorders was generally
similar for borderline personality and the mood disorder comparison
group. The results suggest there may be common etiological factors
between borderline personality disorder and mood disorders."
October 1999
Expressed Emotion and Clinical Outcome in Borderline
Personality Disorder
American Journal of Psychiatry (October 1999): Vol. 156,
pp. 1557–562.
Hooley JM, Hoffman PD.
Department of Psychology, Harvard University, Cambridge, MA 02138, USA. jmh@wjh.harvard.edu
Criticism and hostility from family members had
little effect on the recovery level of those with the BPD "in the year after discharge. Neither did they predict rates of rehospitalization. Clinical outcome was strongly associated with family levels of emotional overinvolvement,
however. Patients whose families scored higher on emotional overinvolvement had better clinical outcomes over the course of the follow-up period. CONCLUSIONS: These findings suggest that the association between expressed emotion and patient outcome may be different for patients with borderline personality disorder than it is for patients with schizophrenia or mood disorders."
REFERENCES:
1 Hooley JM and Hoffman PD., Expressed Emotion
and Clinical Outcome in Borderline Personality Disorder, American
Journal of Psychiatry (October 1999): Vol. 156, pp.
1557–562.
2 Zweig-Frank H Paris J., Predictors of outcome in
a 27-year follow-up of patients with borderline personality
disorder. Compr Psychiatry ; 43:103-7
Material in quotes is from PubMed.
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