An open, noncomparative study of amoxapine in borderline disorders

Five patients with borderline personality disorder (BPD) and 5 patients with schizotypal personality disorder (SPD) completed at least 3 weeks of treatment with amoxapine. The patients fulfilled DSM-III criteria for borderline disorders and scored 7 points or more in Gunderson's Diagnostic Interview for Borderlines (DIB). The final median medication in patients with BPD was 200 mg amoxapine/day and 42 mg oxazepam/day. Duration of treatment averaged 28 days. In patients with SPD the corresponding figures were 250 mg amoxapine/day, 36 mg oxazepam/day and 39 days. The study suggests that amoxapine improves schizophrenic-like and depressive symptoms in patients with schizotypal personality disorders (SPD). No effect could be shown in patients with borderline personality disorders (BPD).     

The prediction of healthcare utilization by three self-report measures for borderline personality

Objective. In this study, we explored the ability of three self-report measures for borderline personality disorder (BPD) to predict psychiatric and medical (i.e. non-psychiatric) healthcare utilization. Methods. Using a sample of convenience and survey methodology, we asked participants (N=120) to complete the borderline personality scale of the Personality Diagnostic Questionnaire-4 (PDQ-4), the Self-Harm Inventory (SHI), the McLean Screening Inventory for Borderline Personality Disorder (MSI-BPD), and several variables relating to psychiatric and medical healthcare utilization. Results. The SHI demonstrated the greatest number of correlations with healthcare utilization, particularly with regard to psychiatric care. Conclusions. The SHI provides several functions for clinicians including the identification of self-harm behaviors, confirmation of the diagnosis BPD, and prediction of psychiatric healthcare utilization.     

Psychodynamic features in borderline personality disorder identified by a subliminal test, the Defense Mechanism Test

Twenty-seven psychiatric inpatients, diagnosed according to DSM-III and the Diagnostic Interview for Borderline (DIB), and 7 healthy controls were tested with the Defense Mechanism Test (DMT), a test of subliminal perception based on psychoanalytic theory. In the test a specific stimulus is presented subliminally in a tachistoscope and the patient's perceptual distortions are registered. Patients with borderline personality disorder (BPD) were compared with patients with other personality disorders, patients with schizophrenic disorders and healthy controls. Specific perceptual distortions were identified among patients with BPD. Some individual DMT signs correlated with some deviant behaviors as identified by the DIB. The findings supported the psychodynamic validity of the concept of borderline personality disorder. It is concluded that DMT is a promising research instrument that provides an empirical approach to crucial psychodynamic phenomena.     

Retrospective and prospective design and data

The study of the presentation, symptomatology and family characteristics of an exclusively adolescent sample of patients with borderline personality disorder (BPD) was undertaken. Twenty-four cases of borderline personality disorder, 20 females, 4 males, identified using chart review and meeting the criteria of the Diagnostic Interview for Borderlines (DIB) and DSM III-R, were matched with psychiatric controls. Adolescents with borderline personality disorder were found to have high rates of affective symptomatology with Axis I diagnosis of major depressive disorder - MDD (DSM-III-R), and high rates of interpersonal psychopathology, i.e., manipulation, devaluation, and a pervasive sense of boredom. The latter seem to be characteristic as for adults with borderline personality disorder. The families were particularly angry and volatile.     

Patterns of self-harm behavior among women with borderline personality symptomatology: psychiatric versus primary care samples

The current study investigated differences in self-harm behavior among individuals with borderline personality symptomatology from two different clinical settings. Participants were women, between the ages of 18 and 45, from an outpatient mental health setting or a primary care setting. Each participant completed the Self-Harm Inventory (SHI) and the borderline personality scale of the Personality Diagnostic Questionnaire-Revised (PDQ-R). Using a predetermined cut-off for substantial borderline personality symptomatology on the SHI, group comparisons with chi(2) analyses indicated that "overdosed" and "hit self" were significantly more common in the mental health subsample whereas "abused laxatives" was significantly more common in the primary care subsample. Using a predetermined cut-off for borderline personality on the PDQ-R, chi-square analyses indicated that "overdosed" and "hit self" remained significantly more common in the mental health subsample. Despite these differences, there was remarkable similarity of symptoms between groups. The implications of these findings are discussed.     

The prevalence of borderline personality among buprenorphine patients

OBJECTIVE: In this study, we examined the prevalence of borderline personality disorder (BPD) in a sample of patients seeking outpatient treatment with buprenorphine for opioid addiction. METHOD: To assess for BPD, we used three self-report surveys in a consecutive study sample. RESULTS: Of the 111 participants who completed all three measures of BPD, 49 (44.1%) exceeded the cut-off score indicative of BPD. CONCLUSIONS: Among individuals who are addicted to opioids and seeking treatment with buprenorphine, the prevalence of BPD, as mutually confirmed by three self-report measures, is quite high.     

Is bulimia associated with borderline personality disorder? A controlled study

To test the hypothesis that bulimia may be associated with borderline personality traits or frank borderline personality disorder, the authors administered the Diagnostic Interview for Borderlines (DIB) under blind conditions to 52 bulimic subjects, 22 outpatient controls with a history of major depression but no history of an eating disorder, and 13 nonpsychiatric controls. Only 1.9% of bulimic subjects met revised DIB criteria for borderline personality disorder, and mean DIB scores were almost identical in bulimic subjects and controls with major depression. These results argue against a relationship between bulimia per se and borderline personality disorder or traits.     

Diagnostic approaches to borderline personality and their relationship to self-harm behavior

OBJECT: This study was designed to explore the relationship, if any, between diagnostic approach to borderline personality disorder (BPD) and the extent of self-harm behavior among psychiatric inpatients. METHOD: Newly admitted psychiatric inpatients (N =77) were evaluated for BPD using a self-report measure, clinical diagnosis, and a DSM-IV checklist. All participants were assessed for self-harm behavior using the 22-item Self-Harm Inventory (SHI). RESULTS: Participants with a clinical diagnosis of BPD showed the highest prevalence of, and most potentially lethal, types of self-harm behavior, followed by those diagnosed as BPD by the DSM-IV checklist, and then by self-report measure. Participants diagnosed as BPD on all three measures showed the highest mean number of self-harm and potentially lethal behavior types. Prevalence and potential lethality decreased successively among those who were diagnosed as BPD on two measures versus one measure versus no diagnosis of BPD. CONCLUSION: Self-harm behavior appears to be a clinically concordant behavior type among the diagnostic approaches to BPD used in this study. Clinical diagnosis appears most sensitive to self-harm behavior, compared with self-report and DSM-IV checklist.     

A comparison of four measures to diagnose DSM-III-R borderline personality disorder in outpatients

After three decades of clinical controversy and research, a clinical consensus has formed that borderline personality disorder (BPD) exists as a unique entity which can be defined by DSM-III-R diagnostic criteria. The purpose of this study was to evaluate the relative abilities of four different approaches to the identification of borderlines and to differentiate a DSM-III-R BPD group from a control group of other diagnoses. The approaches were the Kernberg's Structural Interview, the Diagnostic Interview for Borderline Personality Disorders (DIB), the Borderline Syndrome Index (BSI), and the Million Clinical Multiaxial Inventory (MCMI). Sixty outpatient volunteers (27 men and 33 women) from a community mental health center served as subjects. The volunteers included 30 BPDs and 30 other diagnoses, including 11 non-BPD personality disorders. Point biserial correlations indicated that the best method for identifying DSM-III-R BPD was the DIB, and the second best was the Kernberg Structural Interview, although all four identified DSM-III-R BPDs at better than chance levels. Multiple regression results showed that the DIB accounted for 61.5% of the BPD variance, while the Kernberg approach added 4.9% more unique variance prediction. MCMI dimensions and personal history characteristics were used to identify differentiators of BPD from all other diagnoses and from other personality disorders.     

Structured interviews and borderline personality disorder

A study was designed to determine whether the Diagnostic Interview for Borderlines (DIB) might be scored from the Schedule for Affective Disorders and Schizophrenia (SADS), and also whether DIB scores predicted the clinical diagnosis of DSM-III borderline personality disorder. One pair of clinicians interviewed patients with the DIB, and another pair interviewed the same patients with a slightly modified version of the SADS. Both interviews diagnosed virtually the same patients as borderline according to the criteria of Gunderson and Singer. The sensitivity of DIB scores in predicting a DSM-III diagnosis of borderline was 70%, while the specificity was 90%; the intraclass correlation coefficient was .75. Although there is a substantial concordance, the disparity between the DSM-III and DIB systems of diagnosing borderline patients is sufficiently great to preclude the generalization of findings from studies employing one set of criteria to those employing the other.     

The 10‐year course of psychosocial functioning among patients with borderline personality disorder and axis II comparison subjects

Zanarini MC, Frankenburg FR, Bradford Reich D, Fitzmaurice G. The 10‐year course of psychosocial functioning among patients with borderline personality disorder and axis II comparison subjects. Objective: The purpose of this study was to determine the 10‐year course of the psychosocial functioning of patients with borderline personality disorder (BPD). Method: The social and vocational functioning of 290 inpatients meeting both the Revised Diagnostic Interview for Borderlines (DIB‐R) and DSM‐III‐R criteria for BPD and 72 axis II comparison subjects were carefully assessed during their index admission. Psychosocial functioning was reassessed using similar methods at five contiguous 2‐year time periods. Results: Borderline patients without good psychosocial functioning at baseline reported difficulty attaining it for the first time. Those who had such functioning at baseline reported difficulty retaining and then regaining it. In addition, over 90% of their poor psychosocial functioning was due to poor vocational but not social performance. Conclusion: Good psychosocial functioning that involves both social and vocational competence is difficult for borderline patients to achieve and maintain over time. In addition, their vocational functioning is substantially more compromised than their social functioning.     

Borderline personality symptomatology and sexual impulsivity

OBJECTIVE: According to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, borderline personality disorder (BPD) is an Axis II phenomenon that is characterized by impulsivity, including sexual impulsivity. However, little empirical research has been undertaken to confirm and/or define the nature of sexual impulsivity in patients with BPD, which is the focus of the present study. METHOD: Using a cross-sectional approach and sample of convenience, we surveyed 76 women who were being seen as outpatients in an internal medicine clinic regarding: a) borderline personality symptoms using two measures (i.e., the borderline personality scale of the Personality Diagnostic Questionnaire-4, McLean Screening Inventory for Borderline Personality Disorder); and b) their sexual histories. RESULTS: We found two statistically significant differences--those with borderline personality symptomatology were more likely to have an earlier onset of sexual intercourse as well as to report date rape. CONCLUSIONS: Individuals with borderline personality symptomatology report earlier sexual exposure as well as date rape, but not other aspects of sexual impulsivity such a greater number of sexual partners, more frequent treatment for sexually transmitted diseases, etc.     

Characteristics of psychosis in borderline personality disorder

Comparing a sample of 88 inpatients with borderline personality disorder (BPD) to inpatients with borderline traits, this paper addresses four hypotheses regarding the association between BPD and psychotic symptoms: (1) narrowly defined psychotic symptoms are rare in BPD; (2) broadly defined psychotic symptoms are often reported in BPD; (3) narrowly defined psychotic symptoms are due to concomitant disorders, and (4) psychotic symptoms may be factitious. Consecutive admissions to acute inpatient services were screened for borderline features and patients were examined using the Diagnostic Interview for Borderlines and the Schedule for Affective Disorders and Schizophrenia. The results generally supported the proposed explanations for the association between BPD and psychotic symptoms. Factitious psychotic symptoms were found in only 13% of the BPD sample.     

Borderline personality traits in hysterical neurosis

The objective of the present study is to demonstrate the traits of the psychopathology of Borderline Personality Disorder (BPD) compared with hysterical neurosis. A total of 48 subjects with BPD and 40 subjects with hysterical neurosis both defined by DSM-III-R were assessed by Diagnostic Interview for Borderlines (DIB). Statistical analysis was done by quantification of the second type, a multivariate data analysis. The total scores of DIB were BPD group, 6.13 +/- 1.52; hysterical neurosis group, 4.9 +/- 2.12 (t = 3.05, P = 0.0016). The correlation ratio (index of to what extent the two groups are discriminated) was 0.2442. Among the four parameters of: (i) affect, (ii) cognition, (iii) impulse-action pattern, (iv), and interpersonal relationships, the partial coefficient correlations of (iii) and (iv) were significantly high (0.342, 0.287, P < 0.01). The question items with high independent coefficients were manipulation (0.4416), intolerance of aloneness (0.3797), demanding nature (0.3768), self-mutilation (0.3609), visual hallucination (0.3395). Those with low score of independent coefficients were counterdependency (0.0533), identity disturbance (0.1010), depression (0.1551), loneliness (0.1752), hypomanic episode (0.1936). Both of BPD and hysterical neurosis groups were not so fairly well discriminated. However, these results suggested that impulse-action pattern and disorder of interpersonal relationships were traits of borderline personality disorder. We could admit manipulation, intolerance of aloneness as its symptoms. In addition, counterdependency, identity disturbance were comparatively common to both. There were some borderline personality traits symptomatically in hysterical neurosis.     

The effects of loss versus alteration of consciousness on inhibition-related brain activity among individuals with a history of blast-related concussion

Paroxetine binding could be a vulnerability marker for traits associated with borderline personality disorder (BPD). To study this relationship, we examined [³H] paroxetine binding in female patients with BPD and their sisters. The sample consisted of 54 sibling pairs in which a proband met criteria for BPD. All subjects were given the Diagnostic Interview for Borderlines, revised (DIB-R), the Diagnostic Assessment for Personality Pathology: Brief Questionnaire (DAPP-BQ), the Barratt Impulsivity Scale (BIS), the Affective Lability Scale (ALS), the Hamilton Rating Scale for Anxiety (HAM-A), the Hamilton Rating Scale for Depression (HAM-D), and the Symptom Checklist-90, revised (SCL-90-R). All subjects had platelets assayed for [³H] paroxetine binding. There were no significant differences between probands and sisters, but both groups scored significantly lower than a previously studied control group on B_max. There were no differences on Kd. Neither B_max nor K_d was related to most trait or symptomatic measures. Paroxetine binding could reflect endophenotypes common to BPD probands and their first-degree relatives.     

The relationship between illegal behaviors and borderline personality symptoms among internal medicine outpatients

BackgroundIn psychiatric dysfunction, illegal behaviors are frequently associated with the traditional prison personality antisocial personality disorder. However, some empirical data indicate that illegal behaviors may also be associated with borderline personality, which is the focus of the present study.MethodUsing a cross-sectional sample of consecutive internal medicine outpatients from a resident-provider clinic, we examined relationships between 27 illegal behaviors as delineated by the Federal Bureau of Investigation's crime-cataloguing schema and 2 measures of borderline personality disorder (BPD), the BPD scale of the Personality Diagnostic Questionnaire-4 and the Self-Harm Inventory.ResultsThe overall correlations between BPD and the number of the 27 illegal behaviors endorsed were r = 0.32 (P < .001, n = 375) for the Personality Diagnostic Questionnaire-4 and r = 0.47 (P < .001, n = 372) for the Self-Harm Inventory. Six specific illegal behaviors were endorsed by at least 12 participants each, and analyses indicated associations for each of these illegal behaviors with BPD (ie, aggravated and simple assault, disorderly conduct, driving under the influence, drug abuse violations, public drunkenness/intoxication). These 6 behaviors may be interrelated through alcohol/substance use. Participants who were male and younger were more likely to report having engaged in a greater number of different illegal behaviors.ConclusionsThere appear to be associations between illegal behaviors and BPD, particularly in relation to alcohol/substance abuse and in young men.     

An empirical comparison of three different borderline concepts

Forty-six inpatients were independently diagnosed according to the DSM-III concept of borderline personality disorder, the diagnostic interview for borderlines (DIB) and the concept of borderline personality organization, which is linked to Kernbergs structural interview. The interviews were videotaped. Satisfactory inter-rater reliability was demonstrated for the DIB, which furthermore showed high sensitivity and specificity in identifying patients with a clinical DSM-III diagnosis of borderline personality disorder from patients with a other personality disorders or schizophrenic disorders. Discriminant features, demographic profile and earlier treatment history for the patients with a borderline personality disorder are described and discussed. The structural interviews were scored according to a specified format. Inter-rater reliability was satisfactory but not too impressive. Borderline personality organization turned out to be a very broad concept and only half of the patients within this concept received a syndrome diagnosis of borderline personality disorder. A general conclusion was that borderline personality organization should not be considered as a diagnostic entity but rather as a different diagnostic dimension representing an intermediate level of personality structure.     

The prevalence of cyclothymia in borderline personality disorder

Sixty patients with personality disorders were evaluated by several different diagnostic instruments to determine the prevalence of cyclothymia in borderline personality disorder (BPD) and in other personality disorders (OPD). Cyclothymia occurred more frequently in BPD than in OPD, regardless of which diagnostic system was used. In contrast, the prevalence of major, minor, and intermittent depression, hypomania, and bipolar disorder was not significantly different in BPD as compared with OPD. Cyclothymic borderlines and noncyclothymic borderlines could not be distinguished on behavioral or functional measures. These results have implications for the diagnostic validity of both BPD and cyclothymia.     

Depression in borderline patients: a prospective EEG sleep study

The relationship between borderline personality disorder and primary major depression was studied prospectively using Schedule for Affective Disorders and Schizophrenia-Lifetime Version (SADS-L) interviews and electroencephalographic (EEG) sleep studies. Ten consecutively admitted borderline patients (a prospective sample), defined by Gunderson's Diagnostic Interview for Borderlines (DIB), underwent EEG sleep studies on two consecutive nights and were compared to previously reported samples of nonborderline depressed patients (defined by Research Diagnostic Criteria; RDC), normal controls, and DIB-defined borderline patients who had been referred "to rule out major depression" (a retrospective sample). EEG sleep data were analyzed visually and by automated techniques. Rapid eye movement (REM) latency values were similar in depressed and both borderline groups but significantly different from controls. Eighty-five percent of REM latency values in RDC major depressives were less than or equal to 65 minutes, compared to similar rates of 75% in the prospective sample of borderline patients and 65% in the retrospective sample, versus 35% for controls (chi 2 = 10.7, p less than 0.005). The REM latency in borderline patients did not vary with the severity of depression as measured by the Hamilton Rating Scale for Depression. In the prospective borderline sample, the major SADS-L diagnoses were chronic intermittent depression (five), current major depression (four) (two unipolar, two bipolar II), and labile personality (one). A convergence of nosologic and EEG sleep data is suggested, and supports the concept of a close relationship between criteria-defined borderline personality disorder and affective illness.     

Personality disorders in parasuicide

To examine the prevalence of personality disorders in a representative sample of patients admitted to inpatient care after a parasuicide, 64 consecutive patients were investigated with structured interviews for DSM-IV personality disorders and clinical interviews for Axis I disorders and suicidal behaviour. We found a borderline personality disorder (BPD) as principal diagnosis in 55% of the subjects and some other personality disorder (OPD) in an additional 23%. Multiple Axis II disorders were significantly more common in the BPD group, in which 71% met criteria for three or more personality disorders, compared with 7% in the OPD group. In the BPD group 20% did not have a concomitant Axis I disorder, whereas this was very uncommon in the other groups. A relatively large proportion (34%) in the BPD group used other parasuicide methods than drug intoxication, whereas in the other groups this was rare. The mean number of previous parasuicidal acts was significantly higher in the BPD group, in which 57% had three or more previous parasuicides, and a high proportion (60%) also had repeated a parasuicidal act within the last year. In the BPD group 69% had ongoing outpatient treatment. Only 25% of these outpatients had a borderline personality disorder reported in the hospital records, suggesting that the personality disorder might go undiagnosed. The study gives support to the importance of a focused and structured personality disorder diagnosis in customizing treatment for the person with a recent parasuicide.