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Euler S, Babl A, Dommann E, Stalujanis E, Labrish C, Kramer U, McMain S. Maladaptive defense mechanisms moderate treatment outcome in 6 months versus 12 months dialectical-behavior therapy for borderline personality disorder. Psychother Res 2024:1-17. [PMID: 38648578 DOI: 10.1080/10503307.2024.2334053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 03/18/2024] [Indexed: 04/25/2024] Open
Abstract
OBJECTIVE We investigated whether defense mechanisms in patients with borderline personality disorder (BPD) predict treatment response of dialectical behavior therapy (DBT) and whether they moderate outcome in different treatment lengths. METHOD We analyzed a subsample of 60 outpatients with BPD, randomized into either 6 (n = 30) or 12 (n = 30) months of DBT. The average level of defensive adaptiveness, assessed with observer-rated overall defensive functioning (ODF) and "immature" (i.e., maladaptive) defenses were used as predictors and moderators of self-reported frequency of self-harm. We conducted a Generalized Linear Mixed Model (GLMM). RESULTS A lower ODF at treatment onset predicted smaller reductions in self-harm, irrespective of treatment length (IRR = 0.92, 95% CI = [0.86, 0.99], p = .020). Lower order "immature" ("major image distorting") defenses showed significantly smaller (IRR = 1.13, 95% CI = [1.06, 1.21], p < .001) and higher order "immature" ("minor image distorting") defenses showed significantly larger (IRR = .91, 95% CI = [.85, .97], p = .006) reductions in self harm in the 6-month but not in the 12-month treatment. CONCLUSION Even though the results have to be regarded as preliminary due to the small sample size, findings might indicate that patients with BPD and lower average defensive adaptiveness may benefit from individualized treatment plans including specific interventions targeting defense function.
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Affiliation(s)
- Sebastian Euler
- Department of Consultation Psychiatry and Psychosomatics, University Hospital of Zürich, Zürich, Switzerland
| | - Anna Babl
- Department of Clinical Psychology, Leiden University, Leiden, Netherlands
| | - Eliane Dommann
- Clinical Psychology and Psychotherapy Department, University of Bern, Bern, Switzerland
| | - Esther Stalujanis
- Department of Consultation Psychiatry and Psychosomatics, University Hospital of Zürich, Zürich, Switzerland
| | - Cathy Labrish
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Ueli Kramer
- Department of Psychiatry, Institute of Psychotherapy, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Shelley McMain
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Wrege JS, Busmann M, Meyer AH, Euler S, Lang UE, Walter M. Impulsiveness in borderline personality disorder predicts the long-term outcome of a psychodynamic treatment programme. Clin Psychol Psychother 2020; 28:633-641. [PMID: 33119970 DOI: 10.1002/cpp.2526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 11/08/2022]
Abstract
Despite the preponderance of treatment outcome predictors in patients with borderline personality disorder (BPD), the predictive value of measures of impulsiveness is inconclusive. This naturalistic study consecutively included hospitalized patients with BPD (N = 99) who underwent a standardized and structured 12-week inpatient treatment programme, which integrated cognitive-behavioural and psychodynamic elements. The Brief Symptom Checklist (BSCL) was applied as outcome measure over four time points: pretreatment, posttreatment, first follow-up at 6 to 8 weeks and second follow-up at 1 year after discharge. Impulsiveness was measured using the Barratt Impulsiveness Scale (BIS) at the pretreatment time point. The BSCL significantly decreased between pretreatment and posttreatment, followed by an increase after posttreatment without reaching pretreatment extent. The temporal course of the BSCL significantly varied with pretreatment BIS in that patients with higher impulsiveness revealed a stronger re-increase of symptom severity from posttreatment to end of follow-up than those with lower impulsiveness. The least impulsive patients thereby showed no rebound effect. The robustness of the results was examined by cross-validation. The results indicate that irrespective of the level of impulsiveness, patients with BPD profit from a structured inpatient treatment. However, long-term treatment success was impaired in patients with high level of impulsiveness at pretreatment. Thus, self-ratings of impulsiveness in BPD patients can be utilized for treatment planning. After discontinuation of interventions, relapse prevention should be implemented early in high impulsive patients as symptoms recrudesce in the course after discharge.
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Affiliation(s)
- Johannes S Wrege
- Department of Psychosomatic and Psychotherapy, Psychiatric University Hospital Basel, Basel, Switzerland
| | - Mareike Busmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andrea H Meyer
- Department of Psychology, University of Basel, Basel, Switzerland
| | - Sebastian Euler
- Department of Consultation Psychiatry and Psychosomatics, University Hospital Zürich, Zürich, Switzerland
| | - Undine E Lang
- Department of Psychosomatic and Psychotherapy, Psychiatric University Hospital Basel, Basel, Switzerland
| | - Marc Walter
- Department of Psychosomatic and Psychotherapy, Psychiatric University Hospital Basel, Basel, Switzerland
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Euler S, Stalujanis E, Allenbach G, Kolly S, de Roten Y, Despland JN, Kramer U. Dialectical behavior therapy skills training affects defense mechanisms in borderline personality disorder: An integrative approach of mechanisms in psychotherapy. Psychother Res 2018; 29:1074-1085. [DOI: 10.1080/10503307.2018.1497214] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Sebastian Euler
- Psychiatric University Hospital (UPK), University of Basel, Basel, Switzerland
| | - Esther Stalujanis
- Psychiatric University Hospital (UPK), University of Basel, Basel, Switzerland
- Division of Clinical Psychology and Psychiatry, University of Basel, Basel, Switzerland
- Division of Clinical Psychology and Cognitive Behavioral Therapy, International Psychoanalytic University, Berlin, Germany
| | - Gilles Allenbach
- Psychiatric University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Stéphane Kolly
- Psychiatric University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Yves de Roten
- Psychiatric University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Jean-Nicolas Despland
- Psychiatric University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Ueli Kramer
- Psychiatric University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
- Department of Psychology, University of Windsor, Windsor, Canada
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Maraz A, Andó B, Rigó P, Harmatta J, Takách G, Zalka Z, Boncz I, Lackó Z, Urbán R, van den Brink W, Demetrovics Z. The two-faceted nature of impulsivity in patients with borderline personality disorder and substance use disorder. Drug Alcohol Depend 2016; 163:48-54. [PMID: 27107850 DOI: 10.1016/j.drugalcdep.2016.03.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 03/18/2016] [Accepted: 03/18/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Impulsivity, which has been the subject of extensive debate in psychiatric research, is a clinically important concept, especially with respect to Borderline Personality Disorder (BPD) and Substance Use Disorders (SUD). The current study aims to examine the presence of two aspects of impulsivity (self-reported impulsivity and delay discounting) in patients with BPD, SUD (alcohol use=AUD or drug use=DUD) and the combination of both disorders (BPD+SUD). METHODS Patients were recruited from eight different mental health treatment service facilities. A total of 345 participants were assessed and divided into six groups: (1) healthy controls (non-BPD, non-SUD), (2) patients with BPD (non-SUD), (3) DUD (non-BPD), (4) AUD (non-BPD), (5) BPD+AUD and (6) BPD+DUD. RESULTS The behavioural measure of impulsivity is more conservative than the results of self-reported impulsivity. Furthermore, ANOVA indicated that BPD and SUD have significant effects on self-reported impulsivity, even when demographic variables, income, other psychiatric symptoms or depression are considered as covariates. On the other hand, the main effects of BPD and SUD are mediated by psychiatric symptoms and depression when delay discounting is considered as a dependent variable. CONCLUSIONS When self-reported, impulsivity is over-estimated as compared to reports based on behavioural measures. These results provide support for the notion that impulsivity is not a unitary construct, and that it instead has different manifestations in BPD and SUD patients.
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Affiliation(s)
- Aniko Maraz
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary; Doctoral School of Psychology, Eötvös Loránd University, Budapest, Hungary.
| | - Bálint Andó
- Department of Psychiatry, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Péter Rigó
- Department of Psychiatry III., Nyírő Gyula Hospital, Budapest, Hungary
| | - János Harmatta
- Department of Psychosomatic Medicine, Psychotherapy and Rehabilitation, "Tündérhegy", Budapest, Hungary
| | - Gáspár Takách
- Department of Pathological Addictions, Merényi Gusztáv Hospital, Budapest, Hungary
| | - Zsolt Zalka
- Thalassa House Institute for Psychotherapeutic and Psychiatric Rehabilitation, Budapest, Hungary
| | - István Boncz
- Department of Psychiatry, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Zsuzsa Lackó
- Department of Pathological Addictions, Merényi Gusztáv Hospital, Budapest, Hungary
| | - Róbert Urbán
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Wim van den Brink
- Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Zsolt Demetrovics
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
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5
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Abstract
The affective decision making of 41 recently treated outpatient women with borderline personality disorder (BPD) was compared to 41 healthy controls using the Iowa Gambling Task (IGT). Non-affective executive functions (EF) of working memory, interference control, and motor inhibition were also compared. Associations among affective and non-affective EF were examined. Despite normal range intelligence, Stroop interference, motor inhibition, and working memory, women with BPD made significantly more disadvantageous IGT decisions than controls (Cohen's d = .72) that were unrelated to substance abuse history, education, psychotropic use, or attentional deficits. Correlates of EF and IGT performance varied by group. Intellect, BPD, and intact behavioral control explained 35% of the adjusted variance in net IGT performance. Disadvantageous IGT decision making was the only EF to predict BPD. IGT deficits in BPD may be separable from IQ and other EF as supported by the somatic marker hypothesis and suggest a stable, trait-like vulnerability favoring immediate reward over long-term gain in women with the disorder.
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Ghaemi SN, Dalley S, Catania C, Barroilhet S. Bipolar or borderline: a clinical overview. Acta Psychiatr Scand 2014; 130:99-108. [PMID: 24571137 DOI: 10.1111/acps.12257] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2014] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To examine the empirical literature on diagnostic validators in borderline personality and bipolar illness. METHOD Using principles of evidence-based medicine, the highest levels of evidence were emphasized in interpretation of similarities or differences between bipolar illness and borderline personality on the five standard diagnostic validators in psychiatric nosology: symptoms, course, genetics, treatment response, and neurobiology. RESULTS Bipolar illness and borderline personality were found to be similar in the nosological validator of symptoms of mood lability and impulsivity, but differed notably on all other diagnostic validators, especially the course validator of past sexual abuse and the genetic validator of a bipolar family history. They also differ notably in the symptom validator of parasuicidal self-harm. Treatment response and neurobiological differences were also present and consistent. CONCLUSION This review of the literature indicates that these two conditions, bipolar illness and borderline personality, are different and can be distinguished. The much stronger biological and genetic evidence for bipolar illness in particular suggests that the two conditions can be reasonably seen as different kinds of clinical entities, namely a biological disease versus a psychosocially caused clinical picture. If this interpretation is correct, similarities between the two conditions, such as mood lability and impulsivity, are superficial, while differences are profound. Further, true comorbidity may be much less common than often presumed.
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Affiliation(s)
- S N Ghaemi
- Mood Disorders Program, Department of Psychiatry, Tufts Medical Center, Boston, MA, USA; Tufts University School of Medicine, Boston, MA, USA
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Jentsch JD, Ashenhurst JR, Cervantes MC, Groman SM, James AS, Pennington ZT. Dissecting impulsivity and its relationships to drug addictions. Ann N Y Acad Sci 2014; 1327:1-26. [PMID: 24654857 DOI: 10.1111/nyas.12388] [Citation(s) in RCA: 135] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Addictions are often characterized as forms of impulsive behavior. That said, it is often noted that impulsivity is a multidimensional construct, spanning several psychological domains. This review describes the relationship between varieties of impulsivity and addiction-related behaviors, the nature of the causal relationship between the two, and the underlying neurobiological mechanisms that promote impulsive behaviors. We conclude that the available data strongly support the notion that impulsivity is both a risk factor for, and a consequence of, drug and alcohol consumption. While the evidence indicating that subtypes of impulsive behavior are uniquely informative--either biologically or with respect to their relationships to addictions--is convincing, multiple lines of study link distinct subtypes of impulsivity to low dopamine D2 receptor function and perturbed serotonergic transmission, revealing shared mechanisms between the subtypes. Therefore, a common biological framework involving monoaminergic transmitters in key frontostriatal circuits may link multiple forms of impulsivity to drug self-administration and addiction-related behaviors. Further dissection of these relationships is needed before the next phase of genetic and genomic discovery will be able to reveal the biological sources of the vulnerability for addiction indexed by impulsivity.
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Affiliation(s)
- J David Jentsch
- Department of Psychology, University of California Los Angeles, Los Angeles, California
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Zanarini MC, Frankenburg FR, Fitzmaurice G. Defense mechanisms reported by patients with borderline personality disorder and axis II comparison subjects over 16 years of prospective follow-up: description and prediction of recovery. Am J Psychiatry 2013; 170:111-20. [PMID: 23223866 PMCID: PMC3537850 DOI: 10.1176/appi.ajp.2012.12020173] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors assessed the defensive functioning of 290 patients with borderline personality disorder and compared it with that of 72 patients with other forms of axis II psychopathology over 16 years of prospective follow-up. They also assessed the relationship between time-varying defenses and recovery from borderline personality disorder. METHOD The Defense Style Questionnaire, a self-report measure with demonstrated criterion validity and internal consistency, was initially administered at study entry. It was readministered at eight contiguous 2-year follow-up periods. RESULTS Borderline patients had significantly lower scores than axis II comparison subjects on one mature defense mechanism (suppression) and significantly higher scores on seven of the other 18 defenses studied: one neurotic-level defense (undoing), four immature defenses (acting out, emotional hypochondriasis, passive aggression, and projection), and two image-distorting/borderline defenses (projective identification and splitting). Over the follow-up period, borderline patients showed significant improvement on 13 of the 19 defenses studied, with significantly higher scores over time on one mature defense (anticipation) and significantly lower scores on two neurotic defenses (isolation and undoing), all immature defenses, and all image-distorting/borderline defenses except primitive idealization. In addition, four time-varying defense mechanisms were found to predict time to recovery: humor, acting out, emotional hypochondriasis, and projection. CONCLUSIONS Taken together, these results suggest that the longitudinal defensive functioning of borderline patients is distinct and improves substantially over time. They also suggest that immature defenses are the best predictor of time to recovery.
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9
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Lazzaretti M, Morandotti N, Sala M, Isola M, Frangou S, De Vidovich G, Marraffini E, Gambini F, Barale F, Zappoli F, Caverzasi E, Brambilla P. Impaired working memory and normal sustained attention in borderline personality disorder. Acta Neuropsychiatr 2012; 24:349-55. [PMID: 25287177 DOI: 10.1111/j.1601-5215.2011.00630.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Lazzaretti M, Morandotti N, Sala M, Isola M, Frangou S, De Vidovich G, Marraffini E, Gambini F, Barale F, Zappoli F, Caverzasi E, Brambilla P. Impaired working memory and normal sustained attention in borderline personality disorder.Objective: Although reports in the literature describe deficits in working memory in borderline personality disorder (BPD), the evidence is limited and inconsistent. The aim of this study was to evaluate further this cognitive dimension and its clinical correlates in BPD.Method: We compared the performance of 15 BPD patients to 1:1 matched healthy controls on verbal working memory as determined by the sequential letter N-back test and sustained attention as measured using the continuous performance test (CPT).Results: BPD patients performed significantly worse on the N-back test compared to healthy controls (p < 0.05), but not on the CPT. The N-back deficit was more pronounced and significant in the 3-back condition and inversely correlated with impulsivity.Conclusions: These results suggest the presence of working memory deficits in BPD that may be linked to greater impulsivity and sustained by impairment in the dorsolateral prefrontal cortex.
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Affiliation(s)
- Matteo Lazzaretti
- Interdepartmental Centre for research on Personality Disorders. Department of Applied and Behavioural Health Sciences, Section of Psychiatry, University of Pavia, Pavia, Italy
| | - Niccolò Morandotti
- Interdepartmental Centre for research on Personality Disorders. Department of Applied and Behavioural Health Sciences, Section of Psychiatry, University of Pavia, Pavia, Italy
| | - Michela Sala
- Interdepartmental Centre for research on Personality Disorders. Department of Applied and Behavioural Health Sciences, Section of Psychiatry, University of Pavia, Pavia, Italy
| | - Miriam Isola
- Department of Medical and Morphological Research, Section of Statistics, University of Udine, Udine, Italy
| | - Sophia Frangou
- Psychosis Clinical Academic Group, Section of Neurobiology of Psychosis, Institute of Psychiatry, King's College London, London, UK
| | - Giulia De Vidovich
- Interdepartmental Centre for research on Personality Disorders. Department of Applied and Behavioural Health Sciences, Section of Psychiatry, University of Pavia, Pavia, Italy
| | - Elisa Marraffini
- Interdepartmental Centre for research on Personality Disorders. Department of Applied and Behavioural Health Sciences, Section of Psychiatry, University of Pavia, Pavia, Italy
| | - Francesca Gambini
- Interdepartmental Centre for research on Personality Disorders. Department of Applied and Behavioural Health Sciences, Section of Psychiatry, University of Pavia, Pavia, Italy
| | - Francesco Barale
- Interdepartmental Centre for research on Personality Disorders. Department of Applied and Behavioural Health Sciences, Section of Psychiatry, University of Pavia, Pavia, Italy
| | - Federico Zappoli
- Service of Radiology, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Edgardo Caverzasi
- Interdepartmental Centre for research on Personality Disorders. Department of Applied and Behavioural Health Sciences, Section of Psychiatry, University of Pavia, Pavia, Italy
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Abstract
The purpose of the present study was to examine the association between features of borderline personality disorder (BPD) and mate retention tactics as a means of examining an evolutionary perspective on the association between BPD features and interpersonal problems and violence in romantic relationships. Two-hundred twenty-five college student participants completed the Personality Assessment Inventory for Borderlines (PAI-BOR; Morey, 1991) and the Mate Retention Inventory-Short Form (MRI-SF; Buss, Shackelford, & McKibbin, 2008) embedded within other measures. There was a strong association between BPD features and cost-inflicting mate retention tactics, including the specific tactics of vigilance, punishing mate's infidelity threat, intrasexual threats, and sexual inducements for both men and women. There were also gender-specific associations for additional tactics. These results contribute to our understanding of problems in romantic relationships among men and women with BPD features, including violence, and to our understanding of impulsive sexual behavior among individuals with BPD features by showing how these behaviors are used as extreme, maladaptive attempts at mate retention.
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Affiliation(s)
- Sarah L Tragesser
- Department of Psychology, Washington State University, Richmond, WA, USA.
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Tragesser SL, Solhan M, Brown WC, Tomko RL, Bagge C, Trull TJ. Longitudinal associations in borderline personality disorder features: Diagnostic Interview for Borderlines-Revised (DIB-R) scores over time. J Pers Disord 2010; 24:377-91. [PMID: 20545501 PMCID: PMC4157937 DOI: 10.1521/pedi.2010.24.3.377] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The Revised Diagnostic Interview for Borderlines (DIB-R; Zanarini, Gunderson, Frankenburg, & Chauncey, 1989) measures four major aspects of borderline personality disorder (BPD): Affect, Cognition, Impulse Action Patterns, and Interpersonal Relationships. In the present study, 353 young adults completed the DIB-R at age 18 (Wave 1) and again two years later (Wave 2) at age 20. Concerning the prediction of future BPD features, three models were compared: (a) Wave 1 Affect scores predicting all Wave 2 BPD features (NA model); (b) Wave 1 Impulse Action Patterns scores predicting all Wave 2 BPD features (IMP model); and (c) both Wave 1 Affect and Impulse Action Patterns scores predicting all Wave 2 BPD features (NA-IMP model). Each model controlled for stabilities over time and within-time covariances. Results indicated that the NA model provided the best fit to the data, and improved model fit over a baseline stabilities model and the other models tested. However, even within the NA model there was some evidence that the impulsivity scores were not accounted for by other BPD features. These results suggest that although negative affect is predictive of most BPD symptoms, it does not fully predict future impulsive behavior.
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Bornovalova MA, Lejuez CW, Daughters SB, Zachary Rosenthal M, Lynch TR. Impulsivity as a common process across borderline personality and substance use disorders. Clin Psychol Rev 2005; 25:790-812. [PMID: 16005556 DOI: 10.1016/j.cpr.2005.05.005] [Citation(s) in RCA: 130] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Borderline personality disorder (BPD) is a significant public health problem characterized by persistent problems with emotional, behavioral, cognitive, and interpersonal functioning. Research indicates an especially high rate of comorbidity between BPD and Substance Use Disorders (SUD). In trying to better understand, and therefore improve the assessment, prevention, and treatment of these disorders, researchers have considered the role of impulsivity. Indeed, impulsivity consistently has been shown to be a biologically-based, heritable characteristic with emergent psychological properties linked to the development and maintenance of BPD and SUD. Following from a previous review of the comorbidity between BPD and SUD (Trull, T. J., Sher, K. J., Minks-Brown, C., Durbin, J., & Burr, R. (2000). Borderline personality disorder and substance use disorders: A review and integration. Clinical Psychology Review, 20, 235-253), the current manuscript revisits the role of impulsivity as a common process across these disorders with a specific focus on the multidimensional nature of impulsivity and its interaction with trait and state negative affectivity.
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Abstract
Mental health nurses have historically been pessimistic about and often unsympathetic towards clients diagnosed with borderline personality disorder. By the time these clients reach adult mental health services their behaviours are often difficult to manage and they often suffer significant re-victimization by health services. Questions need to be raised about how best to avert the consolidation of the problems associated with the disorder. This paper explores the concept of "borderline pathology" in children and adolescents and examines the best available evidence for utilizing an early identification and intervention model for children and adolescents who exhibit this constellation of symptoms.
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Affiliation(s)
- Charles Meekings
- Western Sydney Area Mental Health Service, Prevention, Early Intervention & Recovery Service (PEIRS), Auburn Community Health Centre, 9 Northumberland Road, Auburn, NSW 2144, Australia.
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Hochhausen NM, Lorenz AR, Newman JP. Specifying the impulsivity of female inmates with borderline personality disorder. JOURNAL OF ABNORMAL PSYCHOLOGY 2002. [DOI: 10.1037/0021-843x.111.3.495] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Zanarini MC, Frankenburg FR, Vujanovic AA. Inter-rater and test-retest reliability of the Revised Diagnostic Interview for Borderlines. J Pers Disord 2002; 16:270-6. [PMID: 12136682 DOI: 10.1521/pedi.16.3.270.22538] [Citation(s) in RCA: 128] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The baseline inter-rater reliability, test-retest reliability, follow-up inter-rater reliability, and follow-up longitudinal reliability (interrater reliability between generations of raters) of borderline symptoms and the diagnosis of borderline personality disorder (BPD) were assessed using the Revised Diagnostic Interview for Borderlines (DIB-R). Excellent kappa s (> .75) were found in each of these reliability substudies for the diagnosis of BPD itself. Excellent kappa s were also found in each of the three inter-rater reliability substudies for the vast majority of borderline symptoms assessed by the DIB-R. Test-retest reliability for these symptoms was somewhat lower but still very good. More specifically, one-third of the BPD symptoms assessed had a kappa in the excellent range and the remaining two-thirds had a kappa in the fair-good range (.57-.73). The dimensional reliability of BPD symptom areas was somewhat higher than for categorical measures of the subsyndromal phenomenology of BPD. More specifically, all five dimensional measures of borderline psychopathology had intraclass correlation coefficients in the excellent range for all four reliability substudies. Taken together, the results of this study suggest that both the borderline diagnosis and the symptoms of BPD can be diagnosed reliably when using the DIB-R. They also suggest that excellent reliability, once achieved, can be maintained over time for both the syndromal and subsyndromal phenomenology of BPD.
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Affiliation(s)
- Mary C Zanarini
- Laboratory for the Study of Adult Development, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA.
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