Borderline personality organization: Reply to Bauer and Sherry.

Replies to G. P. Bauer and P. Sherry's (see record 1986-25091-001) comments on the present authors' (see record 1984-12361-001) discussion of clinical and theoretical issues in the treatment of borderline patients. It is argued that Bauer and Sherry's reply was inaccurate, overly inferential, and misleading. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A study of personality in eating disorders

Some evidence suggests that temperament and personality traits could influence the development and severity of eating disorders. This study was designed to study these aspects. METHODS: 72 patients with DSM-IV eating disorders including 25 anorexia nervosa restricting type, 17 with anorexia nervosa binge eating-purging type and 30 with bulimia nervosa were studied and compared with thirty healthy controls. Personality disorders and temperament were studied with the Eysenck's EPQ, Cloninger's TCI and SCID-II. Impulsive and clinical features were studied with specific rating scales. RESULTS: 61.8% of patients had at least one personality disorder. Avoidant personality disorder was the most commonly diagnosed in anorexia restricting type (25%). Borderline personality disorder was the most frequent in bulimia nervosa and in the binge eating-purging type of anorexia nervosa. Dimensionally, the group of eating disorders presented high scores in neuroticism and low scores in self-directedness. Higher harm avoidance was found in bulimic patients and higher persistence was associated with anorectic patients. Bulimic patients were significantly more impulsive than anorectic and controls. CONCLUSIONS: Temperament and personality traits differ in anorectic and bulimic patients. Bulimic symptoms are linked to impulsive temperament traits and to impulsive personality features. Anorectic symptoms are linked to persistent temperament traits and anxious personality features.     

Borderline personality: Traits and disorder.

Although the 5-factor model (FFM) has been advocated as an alternative to representing the construct of borderline personality, some argue that this diagnosis carries essential information that is not well captured by the FFM. The present study examined antecedent, concurrent, and predictive markers of construct validity in a sample of 362 patients with personality disorders. The results indicated that neuroticism best distinguished borderline and nonborderline patients, whereas the FFM as a whole captured a sizable proportion of the variance in the borderline diagnosis. However, the residual of the borderline diagnosis that was not explained by the FFM was found to be significantly related to childhood abuse history, family history of mood and substance use disorders, concurrent symptoms, and 2-year and 4-year outcomes. Thus, some elements of the borderline diagnosis may not be fully captured in a 5-factor representation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Borderline personality disorder from the perspective of general personality functioning.

The authors extended previous work on the hypothesis that borderline personality disorder (BPD) can be understood as a maladaptive variant of personality traits included within the 5-factor model (FFM) of personality. In each of 3 samples, an empirically derived prototypic FFM borderline profile was correlated with individuals' FFM profiles to yield a similarity score, an FFM borderline index. Results across all samples indicated that the FFM borderline index correlated as highly with existing borderline measures as they correlated with one another, and the FFM borderline index correlated as highly with measures of dysfunction, history of childhood abuse, and parental psychopathology as did traditional measures of BPD. Findings support the hypothesis that BPD is a maladaptive variant of FFM personality traits. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cardiac response and personality organization.

Level and variability of cardiac response during complex problem-solving and interposed rest periods had different relationships to estimates of personality integration on the Rorschach. Ss were 26 1st and 2nd yr male graduate students. Cardiac variability during problem solving had significant and positive correlations with Holt's defense effectiveness and adaptive regression measures and the amount of Human Movement responses on the Rorschach. Cardiac variability during rests, on the other hand, correlated significantly with only the amount of color responses on the Rorschach. Level of cardiac response both during problems and rests, however, did not correlate significantly with any Rorschach variable. The findings suggest that cardiac variability may be a more differentiated measure than level of cardiac response. Cardiac variability during rest may be an undirected expression of affect while variable cardiac response during a demanding and complex task can serve a signal function, and it is this latter type of cardiac response that is significantly related to higher level personality organization. (11/2 p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality and personality disorders.

Reviews the support for the hypothesis that the personality disorders of the Diagnostic and Statistical Manual of Mental Disorders-III (DSM-III) represent variants of normal personality traits. The focus is, in particular, on the efforts to identify the dimensions of personality that may underlie the personality disorders. The relationship of personality to personality disorders is illustrated using the 5-factor model, conceptual issues in relating normal and abnormal personality traits are discussed, and methodological issues that should be addressed in future research are considered. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Borderline personality characteristics: A betrayal trauma approach.

Borderline Personality Disorder (BPD) has been associated with both trauma and insecure attachment styles. Betrayal Trauma Theory proposes survivors of interpersonal trauma may remain unaware of betrayal in order to maintain a necessary attachment. This preliminary study reports on the relations between self-reports of betrayal trauma experiences and borderline personality characteristics in a college sample. Using multiple regression, betrayal was significantly associated with BPD characteristics. High-betrayal trauma was the largest contributor to borderline traits and medium-betrayal trauma was also a significant predictor. However, traumas of low betrayal were not associated with BPD features. These results stand even after controlling for gender. These findings suggest betrayal may be a key, and yet heretofore unaddressed, feature of borderline personality disorder. (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)     

Borderline personality traits and disorder: Predicting prospective patient functioning.

Objective: Decisions about the composition of personality assessment in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–V) will be heavily influenced by the clinical utility of candidate constructs. In this study, we addressed 1 aspect of clinical utility by testing the incremental validity of 5-factor model (FFM) personality traits and borderline personality disorder (BPD) symptoms for predicting prospective patient functioning. Method: FFM personality traits and BPD features were correlated with one another and predicted 2-, 4-, 6-, 8-, and 10-year psychosocial functioning scores for 362 patients with personality disorders. Results: Traits and symptom domains related significantly and pervasively to one another and to prospective functioning. FFM extraversion and agreeableness tended to be most incrementally predictive of psychosocial functioning across all intervals; cognitive and impulse action features of BPD features incremented FFM traits in some models. Conclusions: These data suggest that BPD symptoms and personality traits are important long-term indicators of clinical functioning that both overlap with and increment one another in clinical predictions. Results support the integration of personality traits and disorders in DSM–V. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Conceptions of personality disorders and dimensions of personality.

Differing conceptions of personality disorders inherent in the Minnesota Multiphasic Personality Inventory Personality Disorder Scales and the Personality Adjective Checklist were evaluated within the context of the circumplex model of interpersonal behavior and the 5-factor model of personality in a sample of 581 university students. Conceptions of personality disorders were strongly and clearly related to dimensions of normal personality traits. Although the circumplex model illuminated conceptions of some of the disorders, the full 5-factor model was required to capture and clarify the entire range of personality disorders. Implications of these findings are discussed with reference to (a) personality disorders and personality traits and (b) suggestions for assessment of personality disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Understanding and treating borderline personality organization.

For many years, clinicians have been puzzled by those nonpsychotic but severely disturbed patients referred to as borderline. Recent work in object-relations theory has suggested that borderline conditions are the result of a failure of integration of the basic personality, leading to a major distortion in the patient's sense of self. Because most of this investigative work is relatively recent, many clinicians are unfamiliar with current theory and clinical observations on the subject. Failure to comprehend these patients' dynamics can lead to treatment catastrophes, whereas understanding of these phenomena may be helpful in dealing with a wide variety of borderline and other clinical problems. The authors present an overview of borderline dynamics and a discussion of 3 major sequelae of these patients' distorted sense of self: "as-if" phenomenon, diffuse sexual identity, and overwhelming aloneness. (37 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Scope and significance of eating disorders.

Anorexia nervosa and bulimia are major health concerns in many industrialized societies. Both disorders appear to be increasing in prevalence, and both (particularly anorexia nervosa) are associated with significant morbidity and mortality. Genetic studies have suggested that there may be a genetic risk for the development of anorexia nervosa. Various treatment strategies have been advocated for these conditions. Both pharmacotherapy and psychotherapy, particularly psychotherapy that incorporates cognitive-behavioral principles, appear to be useful. Recent biological studies on appetite and weight regulation are beginning to yield findings of clinical significance in the treatment of these disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pharmacotherapy of obesity and eating disorders.

Difficulties associated with eating behavior, existing on a broad continuum from uncomplicated overeating to psychopathologically disordered eating, is a growing area of concern within the medical and mental health communities. Psychologists are often called upon to conduct diagnostic assessments in order to identify issues or disorders that may require attention and provide psychotherapeutic interventions ranging from supportive to more intensive therapy. Over the past several years, there have been increased efforts to develop safe and efficacious pharmacologic treatments for obesity and eating disorders. This article provides psychologists with a review of the most currently used pharmacologic interventions for eating dysfunction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological treatment of eating disorders.

Significant progress has been achieved in the development and evaluation of evidence-based psychological treatments for eating disorders over the past 25 years. Cognitive behavioral therapy is currently the treatment of choice for bulimia nervosa and binge-eating disorder, and existing evidence supports the use of a specific form of family therapy for adolescents with anorexia nervosa. Important challenges remain. Even the most effective interventions for bulimia nervosa and binge-eating disorder fail to help a substantial number of patients. A priority must be the extension and adaptation of these treatments to a broader range of eating disorders (eating disorder not otherwise specified), to adolescents, who have been largely overlooked in clinical research, and to chronic, treatment-resistant cases of anorexia nervosa. The article highlights current conceptual and clinical innovations designed to improve on existing therapeutic efficacy. The problems of increasing the dissemination of evidence-based treatments that are unavailable in most clinical service settings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Primary prevention of eating disorders.

Eating disorders have increased dramatically over the past two decades, but the primary prevention of these disorders has received little attention. This article summarizes our current understanding of anorexia nervosa and bulimia and offers some suggestions for the primary prevention of these disorders at the individual, family, and community levels. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk factors for eating disorders.

The authors review research on risk factors for eating disorders, restricting their focus to studies in which clear precedence of the hypothesized risk factor over onset of the disorder is established. They illustrate how studies of sociocultural risk factors and biological factors have progressed on parallel tracks and propose that major advances in understanding the etiology of eating disorders require a new generation of studies that integrate these domains. They discuss how more sophisticated and novel conceptualizations of risk and causal processes may inform both nosology and intervention efforts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Genetic relationships between personality and eating attitudes and behaviors.

Genetic and environmental factors underlying relationships between personality traits and disordered eating were examined in 256 female adolescent twin pairs (166 monozygotic, 90 dizygotic). Eating behaviors were assessed with the Total Score, Body Dissatisfaction, Weight Preoccupation, Binge Eating, and Compensatory Behavior subscales from the Minnesota Eating Disorders Inventory (M-EDI; K. L. Klump, M. McGue, & W. G. Iacono, 2000). Personality characteristics were assessed with the Negative Emotionality, Positive Emotionality, and Constraint scales from the Multidimensional Personality Questionnaire: (MPQ; A. Tellegen, 1982). Model-fitting analyses indicated that although genetic factors were more likely to contribute to MPQ and M-EDI phenotypic associations than environmental factors, shared genetic variance between the 2 phenotypes was limited. MPQ personality characteristics may represent only some of several genetic risk factors for eating pathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive treatments for eating disorders.

Cognitive-behavioral therapy (CBT) is applicable to all eating disorders but has been most intensively studied in the treatment of bulimia nervosa (BN). CBT is designed to alter abnormal attitudes about body shape and weight, replace dysfunctional dieting with normal eating habits, and develop coping skills for resisting binge eating and purging. CBT is effective in reducing all core features of BN and shows good maintenance of therapeutic improvement. Although superior to therapy with antidepressant drugs, CBT has not been shown to be consistently superior to alternative psychological treatments. Different hypotheses about CBT's mechanisms of action are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Subjective organization of personality in adulthood and aging.

Studied self-perceived personality change across 3 phases of adult life (young adulthood, middle age, old age). Drawn from developmental theory, dimensions were identified that were predicted to show self-perceived change during these age periods. Scales were written for the specific dimensions of complexity, generativity, integrity, and interiority. These were administered to 270 Ss divided equally among the 3 ages (young adult mean age 20.6 yrs, middle-aged mean age 47.8 yrs, and old-age mean age 69.3 yrs) and between males and females. Self-perceived change was examined by varying instructional conditions to include concurrent, prospective, and retrospective self-assessments. Four control scales from the Personality Research Form (Abasement, Defendence, Impulsivity, Order) were also administered and were predicted to show no self-perceived change. The predicted pattern of self-perceived change was supported for the generativity scale and partially so for the integrity and interiority scales. In addition, 3 of the 4 scales evidenced no self-perceived change. Sex differences were absent throughout the findings. (26 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Males and eating disorders: Gender-based therapy for eating disorder recovery.

Mental health professionals may wonder how males with eating disorders differ from females with eating disorders and how best to treat males with eating disorders. The eating disorder literature largely focuses on females. Limited research has examined assessment and treatment of eating disorders in males. This article offers a unique view of eating disorder treatment for males by integrating it with the literature on the psychology of men. Mental health professionals are given practical suggestions to guide eating disorder recovery in males. A case example shows treatment considerations for working with males with disordered eating behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)