Structured interviews for borderline personality disorder

The authors compared three instruments used to diagnose borderline personality disorder--the Diagnostic Interview for Borderline Patients (DIB), the Schedule for Interviewing Borderlines, and the Structured Interview for DSM-III Personality Disorders--in 56 patients with personality disorders. A borderline diagnosis was made according to the DIB in 30%, the Structured Interview for DSM-III Personality Disorders in 48%, and the Schedule for Interviewing Borderlines in 55% of the patients. Diagnostic agreement was only 52%, which has implications for the generalizability of results of validation studies of the borderline diagnosis. Improvement in diagnostic agreement requires modification of current criteria sets and/or the use of dimensional models.     

Responses and behaviour of patients with borderline personality disorder during semi-structured interviews

The researchers investigated the behaviour of the Borderline Personality Disorder (BPD) patient, based on observations during structured interviews, to test the hypothesis that these patients are frequently more hostile, aggressive, demanding and manipulative in an interview situation, as has been reported in the literature. These patients were compared to a similar group which had been identified as having BPD traits. The findings suggest that the BPD patients respond with more helplessness and anxiety, that they are more reliable, and that they do not differ significantly in displays of negative behavior during the interview.     

Multiple personality and borderline personality disorder

The authors offer their theory that multiple personality represents a "special instance" of borderline personality disorder, that the introjects are composed of a representation of the self, a representation of the object, and an affective bond.     

Structured interviews and the diagnosis of personality disorders

Structured interviews were developed to improve the reliability of the diagnosis of personality disorders, as it has occurred in other areas of psychopathology. Several such interviews are described in this review, which draws together reports scattered across a wide literature. The appearance of structured interviews in Britain reflected the early interest there in the special problems associated with diagnosing personality disorders, whereas in America their development had to await publication of the DSM-III. Studies using these techniques have illustrated important aspects of clinical diagnosis and can be expected to assign value to the diagnosis of personality disorders in the future.     

Epidemiology of borderline personality disorder

The limited epidemiological data available on borderline personality disorder suggest that the prevalence of the disorder is between .2 and 1.8 percent in the general community, 15 percent among psychiatric inpatients, and 50 percent among psychiatric inpatients with a diagnosis of personality disorder. No data on the incidence--the rate of new cases--of the disorder have been reported, and inferences about incidence based on prevalence rates are complicated by differences in the formal designation of personality disorders before and after DSM-III was issued. Current findings suggest that about 76 percent of borderline patients are female. Epidemiological study of borderline personality disorder has been hindered by the lack of a brief semistructured interview that can be used with large population samples and that does not require substantial clinical expertise. The authors discuss alternative research methods, including use of lay interviewers, recoding of existing data, telephone interviews, and self-report inventories.     

Comorbidity of borderline personality disorder

In a retrospective study of 180 inpatients with DSM-III borderline personality disorder (BPD), the degree and direction of psychiatric comorbidity were used to examine the extent to which BPD is a homogeneous entity with clearly defined boundaries. Ninety-one percent of patients with BPD had one additional diagnosis, and 42% had two or more additional diagnoses. Both patients with BPD and controls with other personality disorders had similar rates and directions of comorbidity. The two groups did not differ significantly in prevalence of affective disorder. The DSM-III BPD appears to constitute a very heterogeneous category with unclear boundaries, overlapping with many different disorders but without a specific association with any one Axis I disorder. Comorbidity in patients with BPD may reflect base rates of psychopathology rather than anything inherent to BPD. Future studies should control for comorbidity to ensure homogeneity of comparison groups.     

Moral responsibility and borderline personality disorder

OBJECTIVE: To examine the concepts of free will and moral responsibility in a psychiatric context, and to consider whether those with borderline personality disorder (BPD) may be considered responsible for their actions. METHOD: A wide, but necessarily incomplete, range of literature was reviewed in the fields of psychiatry and philosophy. I offer a set of criteria for responsible action and examine some features of BPD in the light of these criteria. RESULTS: 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.     

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.     

Neuroimaging in borderline personality disorder

Neuroimaging has become one of the most important methods in the investigation of the neurobiological underpinnings of borderline personality disorder. Structural and functional imaging studies have revealed dysfunction in different brain regions which seem to contribute to borderline symptomatology. This review presents relevant studies using different methodologies: volumetry of limbic and prefrontal regions, investigations of brain metabolism under resting conditions, studies of serotonergic neurotransmission, and challenge studies using emotional, stressful, and sensory stimuli. Dysfunction in a frontolimbic network is suggested to mediate much, if not all of the borderline symptomatology.