Borderline Personality Disorder

Borderline Personality Disorder

Causes

Bornovalova, M. A., Huibregtse, B. M., Hicks, B. M., Keyes, M., McGue, M., & Iacono, W. (2013). Tests of a direct effect of childhood abuse on adult borderline personality disorder traits: A longitudinal discordant twin design. Journal of Abnormal Psychology, 122(1), 180-194.

This study investigated the association between physical, emotional and sexual childhood abuse and borderline personality disorder (BPD) symptoms at age 24. The study also explored the effects of internalizing and externalizing childhood disorders on the connection between BPD symptoms and childhood abuse. Biometric modeling and discordant twin design are methods used in evaluating the environmental and genetic influences on the connection between childhood abuse and BPD. The results of this study revealed that genetic factors were responsible for the most association between childhood abuse and BPD. These results imply that traumatic events do not causally influence BPD but the association between the two is mostly due to genetic influences.

Distel, M. A., Willemsen, G., Ligthart, L., Derom, C. A., Martin, N. G., Neale, M. C., … & Boomsma, D. I. (2010). Genetic covariance structure of the four main features of borderline personality disorder. Journal of Personality Disorders, 24(4), 427-444.

Some of the causes of BPD are genetics and environmental factors such as traumatic experiences including sexual abuse, illness, parental divorce and physical abuse. The major features of BPD are identity problems, affective instability, self-harm and negative relationships. This study investigated the relationship between genetic and environmental factors and the four main features of BPD. The study revealed that environmental effects and genetic factors influence identity problems, affective instability, self-harm and negative relationships.

Wolke, D., Schreier, A., Zanarini, M. C., & Winsper, C. (2012). Bullied by peers in childhood and borderline personality symptoms at 11 years of age: A prospective study. Journal of Child Psychology and Psychiatry, 53(8), 846-855.

Some of the factors contributing to BPD include sexual and physical abuse by adults, parental hostility, neglect and domestic violence. This study investigates on the impact of bullying by peers on BPD symptoms. The results of the study revealed that victimization of children by peers in primary school led to increased risk of having BPD symptoms. Exposure to both overt and relational victimization by peers further increased the risk of BPD symptoms. Therefore, bullying by peers is one of the causes of BPD symptoms in children.

Symptoms

Crittenden, P. M., & Newman, L. (2010). Comparing models of borderline personality disorder: Mothers’ experience, self-protective strategies, and dispositional representations. Clinical Child Psychology and Psychiatry, 15(3), 433-451.

One of the symptoms of BPD is serious disruptions in psychological processes and self-protective behavior. It is the responsibility of mothers to protect and guide their children in psychological development. This study compares the signs of attachment in mothers suffering from BPD and those without the disorder. Mothers suffering from BPD may have undergone traumatic dangers in childhood, which were never resolved. When mothers feel safe, they can be able to adequately protect their children and themselves. This study is important because if the inability of mothers with BPD to protect their children is as a result of undergoing dangerous situations and being unable to protect themselves, this might help professionals in designing appropriate interventions.

Stanley, B., & Siever, L. J. (2010). The interpersonal dimension of borderline personality disorder: toward a neuropeptide model. American Journal of Psychiatry, 167(1), 24-39. Some of the symptoms of BPD include emotional reactivity, suicidal behavior, aggressive outbursts and self-injury. These behaviors affect interpersonal relationships. Interpersonal sensitivity is believed to be the main factor in BPD and it triggers deregulated affect and impulsivity. The authors suggest that the core component of BPD is interpersonal dysfunction. Therefore, they propose that the neuropeptide function can be altered since it is the causal factor of BPD’s interpersonal susceptibilities. They suggest that the role of oxytocin, opiods and vasopressin in BPD need further investigation as they could provide better treatment approaches to the disorder.

Diagnosis

Conway, C., Hammen, C., & Brennan, P. A. (2012). A comparison of latent class, latent trait, and factor mixture models of DSM-IV borderline personality disorder criteria in a community setting: Implications for DSM-5. Journal of Personality Disorders, 26(5), 793-803.

The DSM is one of the methods of diagnosing borderline personality disorder. This article discusses the debate concerning the best method for BPD diagnosis. This article focuses on the discussion of the benefits of using dimensional classification schemes versus categorical classification for BPD. A wide variety of behaviors is described in the DSM-IV criteria for BPD diagnosis. These include instability in affects, self-image, interpersonal relationships and impulsive behavior. Alternative diagnosis criteria include identification of at least four maladaptive traits. The authors conducted a study comparing the fit of latent class, latent trait and factor mixture models in the BPD criteria in DSM-IV and the results revealed that there was continuous distribution of borderline pathology in the sample. These results support the idea that a dimensional perspective on the assessment of BPD should be incorporated into DSM-V.

Gunderson, J. G. (2009). Borderline personality disorder: ontogeny of a diagnosis. The American Journal of Psychiatry, 166(5), 530-539.

This article explores the development of the BPD diagnosis. The author gives an account of the milestones in the development of the diagnosis from a condition that could not be analyzed and treated to a well defined personality disorder that can be treated. Currently, BPD has been classified as one of the personality disorders in the DSM and has become a subject for study. It is expected that the classification of BPD in DSM-V will clarify its boundaries on whether it belongs to axis I or axis II.

Treatment

Farrell, J. M., Shaw, I. A., & Webber, M. A. (2009). A schema-focused approach to group psychotherapy for outpatients with borderline personality disorder: a randomized controlled trial. Journal of Behavior Therapy and Experimental Psychiatry, 40(2), 317-328.

Psychotherapy is the most common treatment for BPD as there is no conclusive evidence of the effectiveness of any medication on its own. This article explores the use of schema-focused therapy (SFT) as a comprehensive BPD treatment leading to complete recovery. A group of women with BPD went through the SFT program for eight months. After the program, there was a significant decrease in BPD symptoms. The patients also achieved improved overall functioning. The results reveal that unlike other interventions, SFT is very effective in BPD treatment and it improves the overall functioning of patients.

Mercer, D., Douglass, A. B., & Links, P. S. (2009). Meta-analyses of mood stabilizers, antidepressants and antipsychotics in the treatment of borderline personality disorder: effectiveness for depression and anger symptoms. Journal of Personality Disorders, 23(2), 156-174.

Medication and psychotherapy are the main methods used in the treatment of BPD.  This article explores the use of medication in the treatment of BPD. The study investigates the effectiveness of antidepressants, mood stabilizers and antipsychotics in the treatment of BPD’s symptoms such as depression and anger.  The authors reviewed various studies on BDP and found that mood stabilizers were effective in short-term anger management and moderately effective in the treatment of depression. Antipsychotics had a medium effect on short term and medium term anger management and also a medium effect on depression. Antidepressants were also moderately effective in short term anger management and had a small effect on depression.

Soler, J., Valdeperez, A., Feliu-Soler, A., Pascual, J. C., Portella, M. J., Martin-Blanco, A., … & Perez, V. (2012). Effects of the dialectical behavioral therapy-mindfulness module on attention in patients with borderline personality disorder. Behavior Research and Therapy, 50(2), 150-157.

One of the psychosocial interventions used in the treatment of BPD is Dialectical Behavioral Therapy (DBT). Some of the symptoms of BPD are impulsivity and attention deficits. This article explores the impact of Dialectical Behavioral Therapy-Mindfulness (DBT-M) training on BPD patients’ attention variables. The study was conducted on BPD patients and the results showed an improvement in attention and impulsivity after DBT-M. Mindfulness meditation led to reduced confusion and depressive symptoms. Therefore, DBT-M training is an effective intervention for increasing attention and reducing impulsivity in BPD patients.

References

Bornovalova, M. A., Huibregtse, B. M., Hicks, B. M., Keyes, M., McGue, M., & Iacono, W. (2013). Tests of a direct effect of childhood abuse on adult borderline personality disorder traits: A longitudinal discordant twin design. Journal of Abnormal Psychology, 122(1), 180-194.

Conway, C., Hammen, C., & Brennan, P. A. (2012). A comparison of latent class, latent trait, and factor mixture models of DSM-IV borderline personality disorder criteria in a community setting: Implications for DSM-5. Journal of Personality Disorders, 26(5), 793-803.

Crittenden, P. M., & Newman, L. (2010). Comparing models of borderline personality disorder: Mothers’ experience, self-protective strategies, and dispositional representations. Clinical Child Psychology and Psychiatry, 15(3), 433-451.

Distel, M. A., Willemsen, G., Ligthart, L., Derom, C. A., Martin, N. G., Neale, M. C., … & Boomsma, D. I. (2010). Genetic covariance structure of the four main features of borderline personality disorder. Journal of Personality Disorders, 24(4), 427-444.

Farrell, J. M., Shaw, I. A., & Webber, M. A. (2009). A schema-focused approach to group psychotherapy for outpatients with borderline personality disorder: a randomized controlled trial. Journal of Behavior Therapy and Experimental Psychiatry, 40(2), 317-328.

Gunderson, J. G. (2009). Borderline personality disorder: ontogeny of a diagnosis. The American Journal of Psychiatry, 166(5), 530-539.

Mercer, D., Douglass, A. B., & Links, P. S. (2009). Meta-analyses of mood stabilizers, antidepressants and antipsychotics in the treatment of borderline personality disorder: effectiveness for depression and anger symptoms. Journal of Personality Disorders, 23(2), 156-174.

Soler, J., Valdeperez, A., Feliu-Soler, A., Pascual, J. C., Portella, M. J., Martin-Blanco, A., … & Perez, V. (2012). Effects of the dialectical behavioral therapy-mindfulness module on attention in patients with borderline personality disorder. Behavior Research and Therapy, 50(2), 150-157.

Stanley, B., & Siever, L. J. (2010). The interpersonal dimension of borderline personality disorder: toward a neuropeptide model. American Journal of Psychiatry, 167(1), 24-39.

Wolke, D., Schreier, A., Zanarini, M. C., & Winsper, C. (2012). Bullied by peers in childhood and borderline personality symptoms at 11 years of age: A prospective study. Journal of Child Psychology and Psychiatry, 53(8), 846-855.

 

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