Assessment of borderline personality disorder: considering a diagnostic strategy

Background:Borderline personality disorder (BPD) represents a highly prevalent, severe and difficult-to-treat mental health problem.Objective:This paper considers methods, instruments and strategies for assessing BPD as described within the frame of the DSM-IV classification.Conclusions:Following the general diagnostic approach introduced by Van Praag in biological psychiatry, a two-tier diagnostic strategy for the descriptive diagnostic assessment of BPD is recommended. Axis one results in a DSM-IV Axis II categorical diagnosis, whereas axis two refers to a symptomatological, dimensional or functional approach, in which the psychological dysfunctions of the nosological syndrome are depicted. Moreover, in a clinical context a basic aim of the diagnostic evaluation is to obtain therapeutically valid information that leads to a constructive conceptual framework, to a case formulation in which therapeutic interventions are understood, selected and implemented. This framework should be based on a biopsychosocial theoretical model and its application in the clinical context involves feedback to the patient, in which the descriptive evaluation is integrated with etiological; and pathogenic elements using an idiographic approach. This therapeutically orientated diagnostic strategy is illustrated by the use of the ADP-IV (Assessment of DSM-IV personality disorders) questionnaire within a cognitive behavioral orientation.

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Borderline personality disorder: does its clinical features show specificity to differing developmental risk factors?

Australasian Psychiatry ◽

10.1177/1039856218760732 ◽

2018 ◽

Vol 26 (4) ◽

pp. 410-413 ◽

Cited By ~ 2

Author(s):

Gordon Parker ◽

Stacey McCraw ◽

Adam Bayes

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

Clinical Sample ◽

Diagnostic Interview ◽

Borderline Personality ◽

Self Report ◽

Therapeutic Interventions ◽

Identity Disturbance ◽

Developmental Factors ◽

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Objectives: To determine if differing developmental factors show specificity to differing manifestations of borderline personality disorder (BPD). Methods: A clinical sample of 73 females diagnosed with BPD undertook a psychiatrist interview and completed self-report questionnaires, including the semi-structured Diagnostic Interview for DSM-IV Personality Disorders (DIPD-IV) assessing for BPD status. A set of negative and potentially traumatic developmental factors were included in the assessment. Results: Childhood sexual abuse, affirmed by 49% of the sample, showed specificity in being linked with DIPD-defined affective instability. DIPD-defined identity disturbance also showed specificity in being associated only with reporting significant non-sexual developmental trauma. DIPD-defined anger and paranoia/dissociation showed minimal specificity and were associated with most antecedent developmental factors in adulthood. Conclusions: Differing manifestations of BPD are likely to be shaped by specific and non-specific developmental events. Clarification of such links has the potential to shape more specific therapeutic interventions.

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Emotion-Oriented Coping Style Predicts Self-Harm in Response to Acute Psychiatric Hospitalization

Crisis ◽

10.1027/0227-5910/a000713 ◽

2020 ◽

pp. 1-7

Author(s):

Jacqueline M. Frei ◽

Vladimir Sazhin ◽

Melissa Fick ◽

Keong Yap

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

Psychiatric Hospitalization ◽

Coping Styles ◽

Psychiatric Inpatients ◽

Borderline Personality ◽

Self Report ◽

Therapeutic Interventions ◽

Coping Behaviors ◽

Self Harm

Abstract. Psychiatric hospitalization can cause significant distress for patients. Research has shown that to cope with the stress, patients sometimes resort to self-harm. Given the paucity of research on self-harm among psychiatric inpatients, a better understanding of transdiagnostic processes as predictors of self-harm during psychiatric hospitalization is needed. The current study examined whether coping styles predicted self-harm after controlling for commonly associated factors, such as age, gender, and borderline personality disorder. Participants were 72 patients (mean age = 39.32 years, SD = 12.29, 64% male) admitted for inpatient treatment at a public psychiatric hospital in Sydney, Australia. Participants completed self-report measures of coping styles and ward-specific coping behaviors, including self-harm, in relation to coping with the stress of acute hospitalization. Results showed that younger age, diagnosis of borderline personality disorder, and higher emotion-oriented coping were associated with self-harm. After controlling for age and borderline personality disorder, higher levels of emotion-oriented coping were found to be a significant predictor of self-harm. Findings were partially consistent with hypotheses; emotion-oriented but not avoidance-oriented coping significantly predicted self-harm. This finding may help to identify and provide psychiatric inpatients who are at risk of self-harm with appropriate therapeutic interventions.

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Comparison of Three Questionnaires to Screen for Borderline Personality Disorder in Adolescents and Young Adults

European Journal of Psychological Assessment ◽

10.1027/1015-5759/a000279 ◽

2017 ◽

Vol 33 (2) ◽

pp. 123-128 ◽

Cited By ~ 5

Author(s):

Anne van Alebeek ◽

Paul T. van der Heijden ◽

Christel Hessels ◽

Melissa S.Y. Thong ◽

Marcel van Aken

Keyword(s):

Young Adults ◽

Borderline Personality Disorder ◽

Personality Disorder ◽

Borderline Personality ◽

Adolescents And Young Adults ◽

Patient Questionnaire ◽

Statistical Manual ◽

Axis Ii ◽

Diagnostic And Statistical Manual ◽

Dsm Iv

Abstract. One of the most common personality disorders among adolescents and young adults is the Borderline Personality Disorder (BPD). The objective of current study was to assess three questionnaires that can reliably screen for BPD in adolescents and young adults (N = 53): the McLean Screening Instrument for BPD (MSI-BPD; Zanarini et al., 2003 ), the Personality Diagnostic Questionnaire 4th edition – BPD scale (PDQ-4 BPD; Hyler, 1994 ), and the SCID-II Patient Questionnaire – BPD scale (SCID-II-PQ BPD). The nine criteria of BPD according to the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV; APA, 1994 ) were measured with the Structural Clinical Interview for DSM-IV Axis II disorders – BPD scale (SCID-II; First, Spitzer, Gibbon, Williams, & Benjamin, 1995 ). Correlations between the questionnaires and the SCID-II were calculated. In addition, the sensitivity and specificity of the questionnaires were tested. All instruments predicted the BPD diagnosis equally well.

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Rumination in Borderline Personality Disorder: Meta-Analysis

10.31234/osf.io/7twf4 ◽

2018 ◽

Author(s):

Mara J. Richman ◽

Zsolt Unoka ◽

Robert Dudas ◽

Zsolt Demetrovics

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

Emotion Dysregulation ◽

Meta Analysis ◽

Borderline Personality ◽

Therapeutic Interventions ◽

Sample Type ◽

Moderator Variables ◽

Analytic Review ◽

Self Harm

Borderline personality disorder (BPD) is characterized by deficits in emotion regulation and affective liability. Of this domain, ruminative behaviors have been considered a core feature of emotion dysregulation difficulties. Despite this, inconsistencies have existed in the literature regarding which rumination type is most prominent in those with BPD symptoms. Moreover, no meta-analytic review has been performed to date on rumination in BPD. Taking this into consideration, a meta-analysis was performed to assess how BPD symptoms correlate with rumination, while also considering clinical moderator variables (i.e., BPD symptom domain, co-morbidities, GAF score) and demographic moderator variables (i.e., age, gender, sample type, and education level). Analysis of correlation across rumination domains for the entire sample revealed a medium overall correlation between BPD symptoms and rumination. When assessing types of rumination, the largest correlation was among pain rumination followed by anger, depressive, and anxious rumination. Among BPD symptom domain, affective instability had the strongest correlation with increased rumination, followed by unstable relationships, identity disturbance, and self-harm/ impulsivity, respectively. Demographic variables showed no significance. Clinical implications are considered and further therapeutic interventions are discussed in the context of rumination.

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Paliperidone ER in the Treatment of Borderline Personality Disorder: A Pilot Study of Efficacy and Tolerability

Depression Research and Treatment ◽

10.1155/2011/680194 ◽

2011 ◽

Vol 2011 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Silvio Bellino ◽

Paola Bozzatello ◽

Camilla Rinaldi ◽

Filippo Bogetto

Keyword(s):

Borderline Personality Disorder ◽

Pilot Study ◽

Personality Disorder ◽

Adverse Events ◽

Mechanism Of Action ◽

Severity Index ◽

Borderline Personality ◽

Controlled Trials ◽

Efficacy And Safety ◽

Dsm Iv

Antipsychotics are recommended for the treatment of impulsive dyscontrol and cognitive perceptual symptoms of borderline personality disorder (BPD). Three reports supported the efficacy of oral risperidone on BPD psychopathology. Paliperidone ER is the metabolite of risperidone with a similar mechanism of action, and its osmotic release reduces plasmatic fluctuations and antidopaminergic effects. The aim of this study is to evaluate efficacy and safety of paliperidone ER in BPD patients. 18 outpatients with a DSM-IV-TR diagnosis of BPD were treated for 12 weeks with paliperidone ER (3–6 mg/day). They were assessed at baseline, week 4, and week 12, using the CGI-Severity item, the BPRS, the HDRS, the HARS, the SOFAS, the BPD Severity Index (BPDSI), and the Barratt Impulsiveness Scale (BIS-11). Adverse events were evaluated with the DOTES. Paliperidone ER was shown to be effective and well tolerated in reducing severity of global symptomatology and specific BPD symptoms, such as impulsive dyscontrol, anger, and cognitive-perceptual disturbances. Results need to be replicated in controlled trials.

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Are DSM-IV-TR Borderline Personality Disorder, ICD-10 Emotionally Unstable Personality Disorder, and CCMD-III Impulsive Personality Disorder Analogous Diagnostic Categories Across Psychiatric Nomenclatures?

Journal of Personality Disorders ◽

10.1521/pedi.2012.26.4.551 ◽

2012 ◽

Vol 26 (4) ◽

pp. 551-567 ◽

Cited By ~ 3

Author(s):

Ching Man Lai ◽

Freedom Leung ◽

Jianing You ◽

Fanny Cheung

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

Borderline Personality ◽

Diagnostic Categories ◽

Icd 10 ◽

Dsm Iv ◽

Emotionally Unstable Personality Disorder

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The neurodevelopmental trajectory of Borderline Personality Disorder: a review

10.7287/peerj.preprints.27414v1 ◽

2018 ◽

Author(s):

Siobhan R Edinboro ◽

Tobias Nolte ◽

Iris Vilares

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

Brain Function ◽

Emotion Dysregulation ◽

Grey Matter ◽

Neural Correlates ◽

Borderline Personality ◽

Therapeutic Interventions ◽

Adult Onset ◽

Neurodevelopmental Model

Borderline Personality Disorder (BPD) is a complex psychological condition characterised by affective instability, cognitive impairment, problematic behaviours and social dysfunction. Due to the variability in symptomatic profiles, efforts have recently been directed towards comprehending the disorder from a neurological standpoint within the aforementioned domains. Although adolescent-onset BPD is now reliably diagnosed as the adult-onset variant, a limited number of studies address the neural correlates of first presentation BPD. Moreover, research investigating the outcomes of therapeutic interventions on brain function and morphology is scarce. Preliminary findings consistently cite the involvement of grey matter deficiencies of the orbitofrontal cortex, hippocampus and amygdala in the neuropathology of BPD. Additionally, frontolimbic white matter deficits are thought to be implicated. Functionally, over-activity in limbic regions such as the cingulate cortices and amygdala are believed to partially account for emotion dysregulation, though the neural correlates of cognitive, social and behavioural impairments are relatively poorly understood. The present review will endeavour to evaluate the existing neurobiological evidence for BPD in adolescence as well as adulthood. Finally, a rudimentary neurodevelopmental model of BPD will be proposed.

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