Body image and borderline personality disorder among psychiatric inpatients

Objective

With the exclusion of studies in individuals with eating disorders, few investigators have examined body image issues in patients with borderline personality disorder (BPD). In this study, we examined among psychiatric inpatients relationships between body image and BPD.

Method

In a cross-sectional sample of convenience, we surveyed 126 women in an inpatient psychiatric unit using 5 measures for body image and 2 measures for BPD.

Results

Using standardized cutoffs for BPD diagnosis, participants with BPD demonstrated a number of differentiating features with regard to body image issues. Explicitly, BPD did not seem to be related to being self-conscious about one's appearance, although BPD was related to being more self-conscious, in general. Individuals with BPD were not more invested in their appearance as a source of self-definition but evaluated their own appearance more negatively and were more likely to believe that attractiveness is an important factor for happiness and acceptance. Although BPD was not related to perceptions about the strength and competence of one's own body, those with BPD indicated less comfort and trust in their own bodies. In general, it appeared that body image measures that were more perceptually grounded were more likely to be similar to non-BPD participants, whereas body image measures that were more cognitively grounded were more likely to be statistically significantly different in comparison with non-BPD participants.

Conclusions

Psychiatric inpatients with BPD demonstrate a number of disturbances in body image.     

The frequency of major psychiatric disorder in Chinese inpatients

The authors applied DSM-III criteria to 268 consecutive Chinese inpatients. Nearly a quarter had affective disorder, a third had schizophrenia, and, except for one patient, none had alcoholism or drug abuse. The authors discuss the factors influencing hospitalization in China.     

Concordance between two personality disorder instruments with psychiatric inpatients

Eighty-two psychiatric inpatients received axis II diagnoses on the Millon Clinical Multiaxial Inventory (MCMI-1)--a self-report instrument--and the Structured Interview for DSM-III Personality (SIDP). Those two instruments were then compared in terms of personality disorder categories and trait-scores (dimensions). Essentially, with the exception of the borderline category, concordance between the two instruments was poor on all scales. Bayesian statistics confirmed the obtained results. The adequacy of the MCMI-I as an index of DSM-III personality disorders is questioned.     

Prevalence of multiple personality among inpatients and outpatients

A survey of psychiatric inpatients (N = 50) and outpatients (N = 100) indicated that about 10% had multiple personality and an additional 5%-20% had amnesia for early traumatic experiences.     

Sadistic personality disorder and comorbid mental illness in adolescent psychiatric inpatients

Sadistic personality disorder (SPD) is a controversial diagnosis proposed in the DSM-III-R, but not included in the DSM-IV. Few studies have focused on this disorder in adolescents. This article describes the results of a study that sought to determine the presence of sadistic personality characteristics in psychiatrically hospitalized adolescents and of comorbid Axis I or personality disorder patterns in those youth with SPD or SPD traits. Fifty-six adolescents were assessed for sadistic and other personality disorders with the Structured Interview for DSM-III-R Personality Disorders-Revised (SIDP-R). Axis I disorders were assessed using the Diagnostic Interview for Children and Adolescents, Adolescent Version (DICA-R-A) and portions of the Schedule for Affective Disorders and Schizophrenia for School Age Children, Epidemiologic (K-SADS-E). The youth were divided into those with SPD and SPD traits, the Sadistic Group (n = 18), and the Nonsadistic Group (n = 38). A significant proportion of the adolescents in this study met full DSM criteria for SPD (14%). The Sadistic Group (32%) had significantly more Axis I and personality pathology than did the Nonsadistic Group. However, all but one in the Sadistic Group met criteria for other personality disorders, confounding the interpretation of these findings and consistent with adult literature studies. Subjects with sadistic personality characteristics were identified in this adolescent inpatient sample, and they had more extensive Axis I and II psychopathology than the comparison group. The validity of this disorder in younger populations requires further study. Future studies should also explore the impact that the mandatory use of the pleasure/gratification criterion has on the validity of the SPD diagnosis and whether the requisite presence of this criterion decreases the overlap currently noted between SPD and other Axis II diagnoses.     

Factor analysis of the DSM-III-R borderline personality disorder criteria in psychiatric inpatients

OBJECTIVE: The goal of this study was to examine the factor structure of the DSM-III-R criteria for borderline personality disorder in young adult psychiatric inpatients. METHOD: The authors assessed 141 acutely ill inpatients with the Personality Disorder Examination, a semistructured diagnostic interview for DSM-III-R personality disorders. They used correlational analyses to examine the associations among the different criteria for borderline personality disorder and performed an exploratory factor analysis. RESULTS: Cronbach's coefficient alpha for the borderline personality disorder criteria was 0.69. A principal components factor analysis with a varimax rotation accounted for 57.2% of the variance and revealed three homogeneous factors. These factors were disturbed relatedness (unstable relationships, identity disturbance, and chronic emptiness); behavioral dysregulation (impulsivity and suicidal/self-mutilative behavior); and affective dysregulation (affective instability, inappropriate anger, and efforts to avoid abandonment). CONCLUSIONS: Exploratory factor analysis revealed three homogeneous components of borderline personality disorder that may represent personality, behavioral, and affective features central to the disorder. Recognition of these components may inform treatment plans.     

MAPI personality correlates of comorbid substance abuse among adolescent psychiatric inpatients

This study investigated MAPI scale patterns among adolescent psychiatric inpatients along a dimension of substance abuse deviancy; no substance abuse; alcohol abuse only; alcohol and marijuana abuse only; other substance abuse plus alcohol and/or marijuana abuse. The findings showed the most notable distinction involved the issue of non-alcoholic substance abuse. Psychiatric inpatients who abuse alcohol were little different from patients with no substance abuse diagnosis. Conversely, those patients who abuses the more culturally deviant non-alcoholic substance were markedly different than non-substance abusing or alcohol-only abusing patients in several respects; highly negativistic attitudes toward family, authority and conformity; personality styles marked by aggressiveness and labile negativism and low conscientiousness; behavioral trait of impulsivity; poor sense of academic confidence. Only these non-alcoholic substance abusing psychiatric patients may require a distinctively different treatment plan than the protocol for uncomplicated psychiatric disorder.     

Diagnosing personality disorders in psychiatric inpatients

This study investigated assumptions made by DSM-III and DSM-III-R regarding Axis I-Axis II associations and sex differences for the 11 personality disorders (PD). A total of 112 patients formed 4 Axis I diagnostic groups: recent-onset schizophrenia (n = 35); recent-onset mania (n = 26); unipolar affective disorder (n = 30); and a mixed diagnostic group (n = 21). The prevalence of PD was determined using the Structured Interview for DSM-III Personality Disorders (SIDP). Schizophrenia was associated with antisocial PD and schizotypal PD; manic disorder was associated with histrionic PD; and unipolar affective disorder was associated with borderline, dependent and avoidant PD. Some of these results were consistent with DSM-III/DSM-III-R postulates. However, there was little support for the DSM-III/DSM-III-R statements on sex differences in the prevalence of PD, except for antisocial PD. The implications of the results for DSM-III/DSM-III-R assumptions are discussed.     

Associations of past conduct disorder with personality disorders in 'non-psychotic' psychiatric inpatients.

The aim was to investigate associations of a history of features of DSM-III-R conduct disorder (CD) with features of DSM-III-R personality disorders (PDs) and psychopathy, in inpatient psychiatric practice. Fifty-six psychiatric inpatients, without a history of specified 'psychoses', were assessed by the SCID structured interview for DSM-III-R PDs and the 'Psychopathy Checklist Revised' (PCL-R). In a sample in which 59% had borderline PD, significant associations between a history of CD criteria and the adult features of antisocial PD (APD) were relatively specific compared with other PDs, but were weaker in women. However, significant correlations between the number of positive CD criteria and PCL-R scores were similar in both genders. The relatively specific associations between CD and adult features of APD are likely to be relevant to psychiatric patients who show various presentations of PD, if these include some adult features of APD. The findings inform the understanding of the development and classification of PDs.     

Personality disorder assessment for psychiatric inpatients

The standardised criteria for DSM-III personality disorders encouraged the development of numerous multidimensional instruments to make the diagnosis of such disorders more objective and reliable compared with clinical judgement. Yet, there is no published research on the concordance between these instruments when used with psychiatric inpatients. Two such measures, the Millon Clinical Multiaxial Inventory (MCMI) and the Structured Interview for DSM-III Personality (SIDP), were chosen for this study. The MCMI identified a significantly greater number of personality disorders than the SIDP for each subject. Despite overall high interrater reliability with the SIDP, low agreement was found between the two instruments for most of the 11 DSM-III Axis II (personality disorders) categories. Different normative populations on which the instruments were developed, method variance, and theoretical differences between Millon and DSM-III, were all likely to contribute to the low concordance. Systematic research of possible confounding factors is suggested.     

Violence among psychiatric inpatients.

A considerable body of evidence suggests increasing levels of violence among psychiatric inpatients. The literature on the subject is reviewed, highlighting correlates of violence among psychiatric patients and methodological flaws in the published literature. Improvement in the definition of violence and the methodology as well as future areas of research are discussed.     

Nursing care of inpatients with borderline personality disorder

TOPIC. This paper reviews the current literature on the nursing care of inpatients with borderline personality disorder (BPD). Information is included about the background and various features of BPD, and recent conceptualizations and predicted outcomes for BPD patients are provided. The effect of caring for patients with BPD on the nursing staff is discussed. CONCLUSIONS. With proper education, support, and clinical supervision, the difficulties of caring for patients with BPD for the nursing staff can be reduced, and beneficial outcomes can be achieved for the staff and patients. NURSING IMPLICATIONS. Patients with BPD can impact the entire multidisciplinary team. Understanding the dynamics of patients with BPD helps the staff to develop strategies to avoid splitting, acting-out behaviors, and negative impact on other patients and staff.     

Substance abuse among psychiatric inpatients.

The drug use history was obtained for all patients admitted to the inpatient service of a large municipal hospital during a 1-month period. A total of 104 patients were evaluated. An inverse relationship was found between the frequency of drug use and the diagnosis of schizophrenia. Approximately one third of the patients were found to be polydrug users, that is, individuals who used at least two types of drugs weekly (e.g., alcohol plus cocaine, heroin plus cocaine, etc.) during the 3 months prior to hospitalization. Most of the polydrug users were males. Patients who scored high in drug use tended to be younger, had more seclusions while on the ward, and had less of a history of drug or alcohol treatment. The drug having the highest frequency of daily use was found to be cocaine. It appears that drug use in general and polydrug use in particular is increasing among psychiatric patients.     

Coffee consumption among psychiatric inpatients.

Of 135 patients on an acute psychiatric ward, 34 were "high users" of coffee. The high users tended to be older, single, and have diagnoses of psychosis. They showed significantly more state anxiety than other patients, but there were no differences in trait anxiety or MMPI scores. Further research is suggested to determine whether high caffeine consumption among inpatients may be related to staff coffee-drinking behavior and/or treatment with anticholinergic drugs.     

Dissociative experiences among psychiatric inpatients.

The Dissociative Experiences Scale was administered to 299 inpatients on an acute care general adult psychiatric ward over a 2-year period. The average score was 14.6, which is significantly higher than the mean for the general population. About one in six inpatients reported very high scores above 50 on the seven most common items in the scale, indicating a high level of dissociative psychopathology. Based on the responses to four items which form a scale factor called Activities of Dissociated States, an estimate is made that 6%-8% of general adult inpatients may have multiple personality disorder. Dissociative psychopathology is common on inpatient units.