The dissociative experiences of borderline patients

The study objective was to assess the severity and quality of dissociative experiences reported by borderline patients. Two hundred ninety criteria-defined borderline patients and 72 axis II controls completed the Dissociative Experiences Scale (DES), a 28-item self-report measure with demonstrated reliability and validity. Thirty-two percent of borderline patients had a low level of dissociation, 42% a moderate level, and 26% a high level similar to that reported by patients meeting criteria for posttraumatic stress disorder (PTSD) or dissociative disorders. The controls had a significantly different distribution of overall DES scores: 71% reported a low level of dissociation, 26% reported a moderate level, and only 3% reported a high level. In addition, borderline patients had a significantly higher score than the controls on 21 of 28 DES items and a significantly higher overall DES score, as well as the score on the 3 factors that have been found to underlie the DES, absorption, amnesia, and depersonalization. The results of this study suggest that the severity of dissociation experienced by borderline patients is more heterogeneous than previously reported. They also suggest that borderline patients have a wider range of dissociative experiences than are commonly recognized, including experiences of absorption and amnesia, as well as experiences of depersonalization.     

Treatment impressions and termination experiences with borderline patients

This study investigates the treatment impressions and termination experiences of faculty clinicians treating individuals with borderline personality disorder. Thirty-nine clinicians (28 psychiatrists and 11 psychologists) completed the Treatment of Borderlines Survey. Results indicated that individual psychotherapy was perceived to be the most valuable treatment modality, that the majority of respondents work towards character change but do not expect "normal," the most common reported reasons for patient termination were "patient does not see the purpose of treatment" and "patient terminates through acting-out behaviors," and a slight majority reported that they had "cured" at least some of their borderline patients. The most common concerns experienced during the termination process included regression, acting-out, and self-destructive behavior. There were very few differences in the perceptions and treatment experiences between psychiatrists and psychologists. These results provide empirical support for claims made in the clinical literature on treating borderline patients.     

Risk factors associated with the dissociative experiences of borderline patients

The objective of this study was to identify the risk factors associated with the dissociative symptomatology of borderline patients. The Dissociative Experiences Scale--a 28-item self-report measure that has well documented reliability and validity--was administered to 290 criteria-defined borderline patients and 72 axis II comparison subjects. Semistructured interviews pertaining to difficult childhood experiences and adult experiences of being a victim of violence were administered to these patients blind to diagnostic status. In the sample of borderline patients alone, multiple regression analyses revealed that four risk factors were found to be significantly associated with the level of dissociation reported by these 290 patients: inconsistent treatment by a caretaker, sexual abuse by a caretaker, witnessing sexual violence as a child, and adult rape history. In the combined sample of axis II patients, the borderline diagnosis joined these four "traumatic" factors as a significant predictor of the overall level of dissociation reported by these 362 personality-disordered inpatients. The results of this study suggest that both sexual trauma and something intrinsic to the borderline diagnosis itself are risk factors for dissociative phenomena among borderline patients.     

Childhood trauma in borderline personality disorder

Subjects with borderline personality disorder (N = 21) or borderline traits (N = 11) and nonborderline subjects with closely related diagnoses (N = 23) were interviewed in depth regarding experiences of major childhood trauma. Significantly more borderline subjects (81%) gave histories of such trauma, including physical abuse (71%), sexual abuse (68%), and witnessing serious domestic violence (62%); abuse histories were less common in those with borderline traits and least common in the subjects with no borderline diagnosis. These results demonstrate a strong association between a diagnosis of borderline personality disorder and a history of abuse in childhood.     

童年期创伤与边缘型人格障碍

既往研究认为边缘型人格障碍可能与童年期创伤经历有关,童年期经历的虐待与欺凌事件严重影响疾病的发展和预后.文章就童年期创伤对边缘型人格障碍发生机制、临床特征以及治疗和预后的影响进行阐述,旨在为进一步探索边缘型人格障碍的发生、发展以及早期干预提供依据.     

Childhood sexual and physical abuse in adult patients with borderline personality disorder

Experiences of abuse and neglect were assessed in 24 adults diagnosed as having borderline personality disorder according to the Diagnostic Interview for Borderline Patients and in 18 depressed control subjects without borderline disorder. Significantly more of the borderline patients than depressed patients reported childhood sexual abuse, abuse by more than one person, and both sexual and physical abuse. There were no between-group differences for rates of neglect or physical abuse without sexual abuse. A stepwise logistic regression revealed that derealization, diagnostic group, and chronic dysphoria were the best predictors of childhood sexual abuse in this group of patients.     

Childhood experiences of homeless men

The authors interviewed homeless men in New York City shelters about their childhood experiences. Childhood placement away from the family was frequent, especially among former psychiatric patients. Childhood problem behaviors were also frequent.     

Childhood experiences and personality traits in patients with motor conversion symptoms

A total of 30 patients with newly diagnosed motor conversion disorder were consecutively investigated by means of a Swedish self-rating inventory designed to assess perceived parental rearing practices (EMBU), and the Karolinska Scale of Personality (KSP). DSM Axis I and II psychopathology was assessed using a Structured Clinical Interview (SCID), and comparisons were made with 30 age- and sex-matched in-patients with motor symptoms due to a neurological disorder. Depression, the presence of a personality disorder and also poor schooling proved to be significantly associated with motor conversion disorder. The index patients perceived a high degree of parental rejection as well as low levels of affection and emotional warmth during childhood, but contrary to most previous studies, childhood physical and/or sexual abuse was not found to be associated with motor conversion disorder.     

Quality of depressive experiences in borderline personality disorders: differences between patients with borderline personality disorder and patients with higher levels of personality organization

Clinical observations suggest that depressive experiences in patients with borderline personality disorder have a specific quality. These experiences are characterized by emptiness and anger ("angry depression") and are associated with primitive forms of object relations. In this study, this observation was tested empirically. A sample of borderline inpatients (N=30) was compared with a sample of inpatients with higher levels of personality organization suffering from neurotic disorders (N=30). Depression and other affects were assessed by the Affective Dictionary Ulm (Dahl, H?lzer, & Berry, 1992). The quality of object relations was assessed by a scale developed by Urist (1977), which was applied to responses in the Holtzman Inkblot Technique (Holtzman, Thorpe, Swartz, & Herron, 1961). Correlations were assessed between depression, on the one hand, and anger, anxiety, and the quality of object relations, on the other hand. The clinical observations were confirmed: In the patients with borderline personality disorder, depression showed significant correlations with the affects of anger, anxiety, and fear, and with primitive forms of object relations. In the patients with higher levels of personality organization, no such correlations were found. The results are discussed with regard to the understanding of borderline disorders, diagnosis, and therapy.     

Childhood trauma in the etiology of borderline personality disorder

Serious, prolonged intrafamilial childhood sexual abuse is considered to be the main etiological factor in about half of the patients with borderline personality disorder in the USA. Special features of childhood interpersonal trauma leading to the development of borderline personality disorder are the seriousness of the trauma and the fact that it is sexual in nature. Serious intrafamilial childhood abuse can lead not only to the classic post-traumatic stress syndrome, but can influence all aspects of personality development, including the distortion of the sense of identity, self-regulation, and the patterns of interpersonal relations. Viewed from the perspective of the trauma concept, the entire range of adult borderline symptoms are considered as being the consequences of severe complex traumatic experiences. Other clinicians regard such an abuse as a marker of the severity of familial dysfunction and emphasize the role of other pathogenic factors, such as biparental neglect and biological vulnerability of the pre-borderline child.     

Oligodipsia and dissociative experiences in borderline personality disorder

Objective: To test the frequency of attenuated fluid intake behavior (oligodipsia) in patients with borderline personality disorder (BPD) and to test if there is an inverse correlation between oligodipsia and the intensity of current dissociative experience in a pilot study. Method: Analyses were based on a sample of 15 BPD patients and 15 healthy controls. Fluid intake per diem and intensity of dissociative experience were measured by standardized self‐reports daily for 7 days. Results: The BPD patients ingested a significantly lower fluid volume per diem when compared with healthy controls (P < 0.001). We found a strong correlation between intensity of co‐occurring dissociative experience and fluid intake or urine osmolality (r = 0.762 and 0.665), independently of sleep quality and general BPD symptom severity. Conclusion: The results indicate that oligodipsia may constitute a serious problem at least for a subgroup of BPD patients, and may be correlated with some of the most problematic symptoms of BPD.     

Childhood experiences and repeated suicidal behavior

The aim of this study was to elucidate the influence of various events in childhood on suicidal behavior in adult age. For this purpose, 99 patients admitted to the Department of Psychiatry of Odense University Hospital after making a suicide attempt were followed for 5 years, to register repeated suicidal behavior. The results showed that three fourths of the patients attempted suicide more than once (62% nonfatal and 14% fatal outcome). The sex distribution was about the same among the first-evers as among the repeaters. Most repeaters were younger people in their twenties and thirties, and the first-evers on average were past the age of 40. Somewhat unexpectedly, significantly more repeaters than first-evers had grown up with both their parents. However, the results also showed that significantly more repeaters than first-evers had had an unhappy childhood. This indicates that the psychological climate of the home may be more important than the rupture of early home life. It is noteworthy that the group of repeaters, as against the first-evers, could be characterized by personality disorders and abuse, especially of alcohol: disorders known to be precipitated by a discordant childhood. It is commonly agreed that the experience in childhood of suicidal behavior among family members or other persons in the close environment is of importance in future suicidal risk. The results of this study indicate that the predictive value of this factor mainly applies to attempts with no fatal outcome: the suicidal act is perceived--and learned--as way to solve problems.     

Childhood experiences of endogenous and neurotic depressives

Summary The parent-child relationship, the relationship between the parents, and the contact of the child with the outside world was investigated on the basis of retrospective interview data concerning the childhood of endogenous and neurotic depressives and a nonclinical control group. A number of significant links between childhood experiences and the various forms of depression emerges.     

Comorbid personality disorders and their impact on severe dissociative experiences in Mexican patients with borderline personality disorder

Abstract

Objective: To identify personality disorders comorbid with borderline personality disorder (BPD) that may confer greater risk for the presence of severe dissociative experiences.

Method: Three hundred and one outpatients with a primary diagnosis of BPD were evaluated using the Structured Clinical Interview for DSM-IV Axis II personality disorders, the Borderline Evaluation of Severity Over Time (BEST) and the Dissociative Experiences Scale (DES).

Results: The most frequent personality disorders comorbid to BPD were paranoid (83.2%, n?=?263) and depressive (81.3%, n?=?257). The mean BEST and DES total score were 43.3 (SD?=?11.4, range 15–69) and 28.6 (SD?=?19.8, range 0–98), respectively. We categorized the sample into patients with and without severe dissociative experiences (41% were positive). A logistic regression model revealed that Schizotypal, Obsessive-compulsive and Antisocial personality disorders conferred greater risk for the presence of severe dissociative experiences.

Discussion: Our results suggest that a large proportion of patients with BPD present a high rate of severe dissociative experiences and that some clinical factors such as personality comorbidity confer greater risk for severe dissociation, which is related to greater dysfunction and suffering, as well as a worse progression of the BPD.     

Discriminating features of borderline patients

Borderline patients were compared with schizophrenic patients, neurotic depressed patients, and a group of patients with differing diagnoses. The purpose of this comparison was to find out whether borderline patients could be discriminated from other psychopathological groups and whether a discrete list of recognizable characteristics discriminating borderline patients could be isolated. According to the results of the comparison, borderline patients can be discriminated with high accuracy from matched comparison groups with whom diagnostic confusion is common. Seven criteria provided a clinically sensible and practical means of approaching the diagnosis of borderline disorder.