Finding the self: A behavioral measure and its clinical implications.

Presents a clinical model of the development of self. The model focuses on the early learning responsible for linguistic self-referents such as "I" and "me." This model offers an account for why some patients, such as those with borderline personality disorder (BPD), feel that they "do not know who they are" or that their sense of self is controlled by other people, while other patients have a sense of a secure, stable self that is not prey to the whims of others. The authors administered the Experiencing of Self Scale, which measures the degree to which other people influence the experience of self, along with the Self-Esteem Scale and the Dissociative Experiences Scale to 284 undergraduate students (mean age 19.2 yrs) and 14 BPD patients (mean age 41.1 yrs). Results show that the degree to which other people influence the experience of self depended on the nature and closeness of the people involved, that those in the BPD sample suffered from excessive influence of other people over the experience of self relative to the undergraduates, and that the degree of influence correlated predictably with high dissociation and low self-esteem. Implications for conceptualizing BPD and narcissistic personality disorder are discussed, and clinical applications are suggested. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rethinking the comparison of borderline personality disorder and multiple personality disorder

This article has made a number of points that assert what is today a minority position within the fields of MPD/DID and BPD. We hope our views will stimulate attempts by others to rethink their positions and test our assertions, so that issues surrounding these two disorders can be sharpened. For the sake of the clarity of future work, we summarize in outline form the essence of our viewpoint. 1. BPD and MPD/DID have similar appearing symptoms, such as identity problems, unstable affect modulation, self-destructive behaviors, chaotic impulse control, and troubled interpersonal relationships, but they have decisive differences in underlying dynamics, process, and structure. 2. DSM tends to blur these two disorders by its emphasis on phenomenology over inner structure, thus fostering misleading conclusions when DSM criteria are used to test for comorbidity or overlap between BPD and MPD/DID. 3. BPD and MPD/DID are both described dynamically as using the defense of splitting, but we contend that the splitting in each disorder is fundamentally different from the splitting in the other. BPD uses a polarization form of splitting, whereas MPD/DID uses ego splitting or identity division. 4. Both disorders partake in the process of dissociation, but the quality of dissociation in BPD is a "low-tech" spaced out type, whereas that of MPD/DID is a "high-tech" waking dream. 5. BPD structure is also "low tech," with polarization of self, object, and relationship. MPD/DID structure is "high tech," with heavily symbolic, highly nuanced variations of self, object, and relationship. 6. Although both conditions have etiologic elements of trauma, BPD has a larger degree of developmental deficiency, with a failure to complete the task of entering a repression hierarchy of defenses. MPD/DID, by use of primary process-linked symbolic dissociation, is able to continue development to the repression hierarchy, although at a profound cost of simultaneous suspension of reality testing. BPD patients suffer from the rigid use of too few defenses; MPD/DID patients suffer from the obsolete use of too many defenses. 7. BPD patients grow up in homes in which overtly expressed aggression is more tolerated, or at least more openly experienced. MPD/DID patients grow up in homes in which the fact of aggression is kept a secret. This has consequences for the formation of psychic structure in each disorder.(ABSTRACT TRUNCATED AT 400 WORDS)     

Depressive response to physostigmine challenge in borderline personality disorder patients

The purpose of this study was to examine the relationship between mood and hormonal responses to cholinergic challenge with physostigmine in order to assess cholinergic system responsiveness in borderline personality disorder (BPD) patients, other non-BPD personality disorder patients, and normal controls. Thirty-four personality disorder patients, 10 of whom met criteria for BPD and 24 of whom met criteria for other, non-borderline, personality disorders, and 11 normal controls participated in a double blind, placebo controlled physostigmine challenge paradigm. The Profile of Mood States depression subscale (POMS-D) self report measure was obtained at baseline and following the physostigmine or placebo infusions. A repeated measures ANOVA of POMS-D scores in placebo and drug conditions indicated a significantly greater depressive response in the total cohort of personality disorder patients than in the normal comparison group (p < 0.05). However, the depressive response to physostigmine was significantly greater in BPD patients, but not other personality disorder patients, compared to normal controls (p < 0.05). There was a correlation between the peak placebo-corrected depressive response to physostigmine and a group of BPD traits related to affective instability but not a group of BPD traits related to impulsivity. There was no correlation in any group between mood response to physostigmine and changes in plasma cortisol, prolactin, or growth hormone, or to nausea or other side effects following physostigmine infusion. These data suggest that there is an association between BPD and acute depressive responses to physostigmine challenge, and that the cholinergic system may be involved in the regulation of affect in Axis II disorders.     

Across civilizations: Psychoanalytic therapy with Asians and Asian Americans.

This article addresses issues of psychoanalytic therapy with Asian North Americans both from their standpoint and the Euro-North American therapist. The latter are often unaware of deeply embedded cultural assumptions of individualism in their psyches and in psychoanalytic and psychological theories and norms. This can result in psychopathologizing Asian North Americans or seeing them as inferior. The most difficult part of doing psychoanalytic therapy with them is first learning a different normality/psychopathology continuum from Euro-North Americans, and then ascertaining where a patient's psychopathology is on this different continuum. The nature of the therapy relationship is related to three psychosocial dimensions of Asian hierarchical relationships. Anger, communication, the bicultural self, the magic-cosmic and spiritual self, and trauma and immigration are then delved into. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality traits as seen by patients, therapists and other group members: The Big Five in personality disorder groups.

Interactional group psychotherapy is based on the assumption that patients bring their problematic personality problems into the group, and that feedback and the ability to test new behaviors leads to change. A corollary of this assumption is that there should be consensual validation among therapists and other group members (OGMs) regarding a patient's personality. The present study tested this corollary. 35 group patients with personality disorders were rated by themselves, their therapists, and OGMs on a measure of the Big Five personality factors. Substantial agreement was found between the therapists and OGMs regarding a target patient's personality, with lesser agreement with the target patient's self ratings. Furthermore, the degree of agreement between self and others was positively related to the number of personality disorder symptoms prior to beginning the group. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Borderline personality disorder symptoms as predictors of 4-year romantic relationship dysfunction in young women: Addresing issues of specificity.

The relationships between romantic relationship dysfunction and symptoms of borderline personality disorder (BPD), other personality disorders, and depression were examined prospectively in a community sample of 142 late adolescent women. Although BPD symptoms predicted 4-year romantic dysfunction (romantic chronic stress, conflicts, partner satisfaction, abuse, and unwanted pregnancy), the associations were not unique to BPD. Instead, relationship dysfunction was better predicted by a cumulative index of non-BPD Axis II pathology. Depression did not predict outcomes uniquely when Axis II symptoms were included, except in the case of unplanned pregnancy. The results suggest that although BPD is associated with relationship dysfunction, the effect is a more general phenomenon applying rather broadly to Axis II pathology. The results also highlight the importance of subclinical psychopathology in the construction of early intimate relationships. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Exploring associations between borderline personality disorder, crack/cocaine dependence, gender, and risky sexual behavior among substance-dependent inpatients.

Engagement in self-destructive and impulsive behaviors is considered to be a cardinal symptom of borderline personality disorder (BPD), and many of the behaviors enumerated in this criterion have been the focus of extensive empirical research. However, very few studies have examined risky sexual behavior (RSB) in particular in BPD. Given evidence that BPD patients with a co-occurring substance use disorder (SUD) may be at increased risk for RSB relative to BPD patients without a SUD, the present study examined the association between BPD and past-year engagement in RSB (particularly, penetrative sex and nonuse of condoms with casual and commercial partners) within a mixed-gender sample of 94 SUD patients in residential treatment, as well as the moderating role of gender in this association. Given past findings of an association between crack/cocaine use and RSB, we also examined the moderating role of lifetime crack/cocaine dependence on the relationship between BPD and RSB. Results demonstrated a significant main effect of BPD on past-year penetrative sex with casual and commercial partners. Significant 3-way interactions between BPD status, lifetime crack/cocaine dependence, and gender were also found for past-year penetrative sex with casual and commercial partners, as well as the likelihood of not using a condom during sex with a casual partner. Post hoc analyses indicated that women with co-occurring BPD and lifetime crack/cocaine dependence were at greatest risk for RSB. Findings replicate extant findings pertaining to the association between BPD and RSB and extend research by identifying relevant factors that may moderate this association. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Object Relations and the Nature of Therapeutic Interventions.

This discussion of a case (see record 2005-02680-005) addresses tailoring a multifaceted therapeutic intervention based on assessing the nature of the patient's object relations. In this case, the patient's ambivalent and confused sense of self and attachment that developed because of the history of abuse suggests an approach that aims to develop a "soft" attachment of the patient to the therapist. The nature of the attachment should be explored using interpersonal therapeutic techniques to understand current relationships rather than to depend on the development and analysis of transference. Cognitive-behavioral interventions will help limit distortions that occur because of an ego that weakens under stress. Though the therapist is thinking and analyzing the therapeutic data in terms of object relations, the interventions can come from a number of theoretical perspectives. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Borderline personality disorder features in nonclinical young adults: 2. Two-year outcome.

Borderline personality disorder (BPD) is thought to develop by early adulthood, and it is characterized by lack of control of anger, intense and frequent mood changes, impulsive acts, disturbed interpersonal relationships, and life-threatening behaviors. We describe data from a 2-year follow-up study of nonclinical young adults who, at study entry, exhibited a significant number of BPD features. Individuals with borderline features were more likely to have academic difficulties over the succeeding 2 years, and these participants were more likely to meet lifetime criteria for a mood disorder and to experience interpersonal dysfunction than their peers at the 2-year follow-up assessment. These findings indicate that BPD features are associated with poorer outcome even within a nonclinical population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment of borderline personality features in population samples: Is the Personality Assessment Inventory–Borderline Features scale measurement invariant across sex and age?

Borderline personality disorder (BPD) is more often diagnosed in women than in men, and symptoms tend to decline with age. Using a large community sample, the authors investigated whether sex and age differences in four main features of BPD, measured with the Personality Assessment Inventory–Borderline Features scale (PAI-BOR; Morey, 1991), are a result of measurement bias or if they represent true differences. The PAI-BOR was completed by four Sex × Age groups (N = 6,838). Multigroup confirmatory factor analysis showed that the PAI-BOR is measurement invariant across sex and age. Compared with men, women reported more borderline characteristics for affective instability, identity problems, and negative relationships but not for self-harm. Younger men had higher scores for identity problems and self-harm than did older men. Younger women had higher scores for identity problems and affective instability than did older women. Results suggest that the PAI-BOR can be used to study the etiology of BPD features in population-based samples and to screen for BPD features in clinical settings in both men and women of varying ages. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Simultaneous determination of urinary catecholamines and 5-hydroxyindoleamines by high-performance liquid chromatography with fluorescence detection

OBJECTIVE: The relationship between bronchopulmonary dysplasia (BPD) and neurodevelopmental outcome after extracorporeal membrane oxygenation (ECMO) has not been extensively reported. We compared the outcomes in a large series of infants with and without BPD after ECMO. STUDY DESIGN: Hospital charts and follow-up records of 145 infants treated with ECMO (1985 through 1990) were reviewed. Complete long-term respiratory and follow-up outcome data were available in 64 infants. BPD occurred in 17 survivors; the remaining 47 did not have BPD. RESULTS: Babies with BPD were more likely to have had respiratory distress syndrome. Mean (+/- SD) age at ECMO initiation was later for the BPD group (127+/-66 vs 53+/-39 hours, p < 0.001), and the duration of ECMO treatment was longer (192+/-68 vs 119+/-53 hours, p < 0.001). Bayley Scales of Infant Development scores at <30 months were lower in infants with BPD (p < 0.001), as were three of four Mullen Scales of Early Learning scores (> or = 30 months, p < 0.001 or p = 0.01). At 57+/-16 months 11 (64%) patients with BPD had mild neurologic disabilities, and 3 (18%) had severe disabilities. At a similar age (53+/-16 months, p = NS) 16 (34%) patients without BPD had mild disabilities, whereas 2 (4%) had severe disabilities (p < 0.01). CONCLUSIONS: The occurrence of BPD after ECMO is associated with adverse neurodevelopmental outcome. Patients with BPD after ECMO merit close long-term follow-up.     

Shame: Countertransference identifications in individual psychotherapy.

Shame is a universal experience felt by patients and therapists alike. Yet, the experience of shame, with its profound sense of inadequacy and worthlessness, is anathema to the competent and compassionate self-image of most therapists. In order to help therapists understand their own shame and their countertransference identifications to patient shame, this article first describes the nature of shame, its developmental progression within interpersonal relationships, and the defenses commonly employed to cope with shame. Because the experience of shame involves the activation of devalued and devaluing internal representations, therapists may develop concordant or complementary countertransference identifications. These countertransference identifications are influenced further by the patient's primary reaction to shame' which includes withdrawal, attacks on self, avoidance, and attacks on others. Each of these reflects a habitual reaction to shame that is displayed in the patient–therapist relationship. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Affective instability: Measuring a core feature of borderline personality disorder with ecological momentary assessment.

Ecological momentary assessment (EMA; Stone & Shiffman, 1994) was used to characterize and quantify a dynamic process--affective instability in borderline personality disorder (BPD). Sixty outpatients (34 with BPD and affective instability; 26 with current depressive disorder but not with BPD or affective instability) carried electronic diaries for approximately 1 month and were randomly prompted to rate their mood state up to 6 times a day. Results indicated that BPD patients (a) did not report significantly different mean levels of positive or negative affect; (b) displayed significantly more variability over time in their positive and negative affect scores; (c) demonstrated significantly more instability on successive scores (i.e., large changes) for hostility, fear, and sadness than did patients with depressive disorders; and (d) were more likely to report extreme changes across successive occasions (≥90th percentile of change scores across participants) for hostility scores. Results illustrate different analytic approaches to quantifying variability and instability of affect based on intensive longitudinal data. Further, results suggest the promise of electronic diaries for collecting data from individuals in their natural environment for purposes of clinical research and assessment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A multimethod investigation of the Behavioral Activation System in bipolar disorder.

Dysregulation in behavioral activation system (BAS) activity has been implicated in the pathogenesis of bipolar disorder (BPD). To characterize BAS activity and related facets in this disorder, the authors compared 59 participants with BPD to 44 controls on multiple measures of BAS activity, including a standardized behavioral task, self-reports, and electroencephalographic indexes of regional cortical activity. Levels of putative BAS activity differed depending on assessment strategy. When a behavioral task indexing reward sensitivity was used, euthymic BPD patients showed evidence of higher BAS activity than either control participants or patients who were in a mood episode. Following a mood induction procedure designed to elicit BAS activity, currently episodic patients showed relatively greater left anterior cortical activity than either euthymic or control participants. Implications of the findings for future research on BPD vulnerability are described. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Group composition and group therapy for complicated grief.

This prospective study investigated the impact of group composition on the outcome of 2 forms of time-limited, short-term group therapy (interpretive, supportive) with 110 outpatients from 18 therapy groups, who presented with complicated grief. The composition variable was based on the patient's level of quality of object relations. The higher the percentage of patients in a therapy group who had a history of relatively mature relationships, the better the outcome for all patients in the group, regardless of the form of therapy or the individual patient's quality of object relations score. The findings have direct clinical implications for composing short-term therapy groups for outpatients with complicated grief and possibly for other types of group therapies and patient problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental state decoding abilities in young adults with borderline personality disorder traits.

Previous studies have demonstrated that patients with borderline personality disorder (BPD) tend to misattribute malevolence to benign social stimuli, including facial expressions. Yet, facial emotion recognition studies examining those with BPD have yielded mixed results, with some studies showing impaired accuracy and others demonstrating enhanced accuracy in the recognition of emotions or mental states. The current study examined the ability to decode mental states from photographs of just the eye region of faces in a nonclinical sample of young adults who exhibited BPD traits (high BPD) compared with those who did not (low BPD). Group differences in mental state decoding ability depended on the valence of the stimuli. The high-BPD group performed better for negative stimuli compared with the low-BPD group, but did not perform significantly different from the low-BPD group for stimuli of neutral or positive valence. The high-BPD group also demonstrated a response bias for attributing negative mental states to facial stimuli. In addition, findings suggested that the group difference in accuracy for negative stimuli could not be explained by response bias, because the group difference in response bias for negative stimuli did not reach significance. These findings suggest that BPD traits may be associated with enhanced ability to detect negative emotions and a bias for attributing negative emotions to nonnegative social stimuli. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The relative roles of bipolar disorder and psychomotor agitation in substance dependence.

Previous studies have shown that both bipolar disorder (BPD) and psychomotor agitation (PMA) are associated with substance dependence. These two findings have yet to be integrated, despite evidence that PMA is closely linked with the bipolar spectrum. Accordingly, the current study examined whether BPD and PMA had unique or overlapping associations with substance dependence disorders. Participants were 2,300 individuals seeking outpatient psychiatric treatment. Before treatment, participants were assessed using structured clinical interviews, which yielded DSM-IV psychiatric diagnoses and clinical ratings of mood symptoms. Current PMA and lifetime BPD were present in 483 and 172 (bipolar I, n = 71; bipolar II, n = 101) participants, respectively. Current PMA and lifetime BPD each were associated with increased prevalence of lifetime nicotine, alcohol, and drug dependence (ORs ≥ 1.52, ps ≤ .0004). These associations remained significant when controlling for demographic characteristics and comorbid psychiatric disorders, except the link between agitation and alcohol dependence, which was reduced to a trend (p = .058). Although BPD and PMA were associated with each other, these two factors demonstrated unique, nonoverlapping relationships to nicotine, alcohol, and drug dependence. Individuals with both PMA and BPD exhibited especially high rates of comorbid substance dependence. The present results replicate and extend previous findings documenting the relations of BPD and PMA to substance dependence. BPD and PMA may represent independent psychopathological correlates of substance dependence. Future research should explore the theoretical and clinical significance of these potentially distinct relations to substance dependence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Borderline personality disorder and personality traits: A comparison of SCID-II BPD and NEO-PI.

62 hospitalized female patients (aged 18–43 yrs) with a clinical diagnosis of borderline personality disorder (BPD) were assessed for Axis II disorders by the SCID-II and for personality traits with the NEO-Personality Inventory (NEO-PI). The predominant personality trait profile for these patients involved a very high Neuroticism score and low Agreeableness score. Five of the 8 BPD criteria had significant correlations with NEO-PI scales. The combination of BPD severity and personality traits as measured on the NEO-PI had a significant relationship to the patients' social adjustment. The utility of gathering information on both borderline personality pathology and personality traits is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)