Is There a Bias in the Diagnosis of Borderline Personality Disorder Among Lesbian, Gay, and Bisexual Patients?

Assessment ◽  
2020 ◽  
pp. 107319112096183
Author(s):  
Craig Rodriguez-Seijas ◽  
Theresa A. Morgan ◽  
Mark Zimmerman
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Sexual Minority ◽  
Borderline Personality ◽  
Future Research ◽  
Clinician Bias ◽  
Partial Hospital ◽  
High Prevalence ◽  
Hospital Patients ◽  
And Bisexual

High prevalence of borderline personality disorder (BPD) diagnosis is observed among sexual minority samples. It is unclear if sexual minority individuals are systematically diagnosed with BPD at higher rates than heterosexual individuals, and if potential diagnostic disparity can be explained by differences in maladaptive personality domains. Utilizing data from partial hospital patients ( N = 1,099) the current study explored (a) differences in the frequency of diagnosis of BPD based on sexual orientation, (b) whether disparities explained differences in psychopathology across groups, and (c) the congruence between traditional methods of BPD diagnosis (i.e., clinical assessment) versus diagnosis based on elevations in self-reported maladaptive personality domains consistent with the alternative model for personality disorders. Sexual minority individuals were more likely to be diagnosed with BPD than heterosexual individuals (odds ratio [ OR] = 2.43, p < .001), even after controlling for differences in clinical correlates of BPD diagnosis (age, gender, comorbid posttraumatic stress disorder, maladaptive personality domains; OR = 1.59, p < .05). Diagnostic disparity was highest for bisexual compared with heterosexual patients. These results suggest that clinicians may be predisposed to provide a BPD diagnosis to sexual minority patients that is independent of presenting psychopathology and bear important implications for future research aimed at discerning whether such predisposition is due to measure or clinician bias.

Failures to Imagine

2016 ◽  
Vol 36 (3) ◽  
pp. 270-300 ◽  
Author(s):  
Reed Maxwell ◽  
Steven Jay Lynn ◽  
Scott Lilienfeld
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Mental Imagery ◽  
Emotional Regulation ◽  
Preliminary Evidence ◽  
Borderline Personality ◽  
Self Report ◽  
Future Research ◽  
Cross Sectional ◽  
Visual Mental Imagery

Although interest in the relationship between mental imagery and psychopathology has increased greatly over the last decade, few publications to date have examined relationships between personality-related psychopathology and mental imagery use, abilities, or both. However, we have reason to expect that substantive relationships may exist. For example, studies have consistently linked psychopathy and borderline personality disorder to problems in emotion experience and emotion regulation, and a growing number of studies indicate that deficits in visual mental imagery use and ability in particular may contribute to such problems. Using correlational data from multiple self-report measures of normal and pathological personality functioning and visual mental imagery, our study presents preliminary evidence for lower levels of self-reported visual mental imagery use, abilities, or both among noncriminal individuals with higher levels of self-reported psychopathy and individuals with greater emotional regulation difficulties, a core feature of borderline personality disorder. We also found significant relationships among self-reported visual mental imagery use, ability, or both, and personality variables shown to strongly predict psychopathy and emotional regulation difficulties. Limitations of the study, especially its reliance on a correlational, cross-sectional design, are discussed, and implications for future research are explored.

Telehealth Treatment of Patients With Borderline Personality Disorder in a Partial Hospital Setting During the COVID-19 Pandemic: Comparative Safety, Patient Satisfaction, and Effectiveness of In-Person Treatment

2021 ◽  
pp. 1-19
Author(s):  
Mark Zimmerman ◽  
Madeline Ward ◽  
Catherine D'Avanzato ◽  
Julianne Wilner Tirpak
Keyword(s):  
Patient Satisfaction ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Psychiatric Treatment ◽  
Well Being ◽  
Borderline Personality ◽  
Hospital Treatment ◽  
Level Of Care ◽  
Hospital Level ◽  
Partial Hospital

There are no studies of the safety and effectiveness of telehealth psychiatric treatment of partial hospital level of care, in general, and for borderline personality disorder (BPD) in particular. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, the authors compared the effectiveness of their partial hospital treatment program in treating patients with BPD. For both the in-person and telehealth partial hospital level of care, patients with BPD were highly satisfied with treatment and reported a significant reduction in symptoms from admission to discharge. Both groups reported a significant improvement in functioning, coping ability, positive mental health, and general well-being. A large effect size of treatment was found in both treatment groups. No patients attempted suicide. Telehealth partial hospital treatment was as effective as in-person treatment in terms of patient satisfaction, symptom reduction, and improved functioning and well-being for patients with BPD.

Access to Evidence-Based Services for Individuals With Borderline Personality Disorder

2019 ◽  
pp. 155-176
Author(s):  
Peter King ◽  
Jennifer M. Martin
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Sexual Assault ◽  
Treatment Outcomes ◽  
Psychological Factors ◽  
Borderline Personality ◽  
Evidence Based ◽  
International Literature ◽  
High Prevalence ◽  
Key Features

This chapter outlines the key features of the diagnosis of borderline personality disorder. This is a diagnosis that has attracted significant levels of stigma and has generally been viewed as difficult to treat. This has resulted in often inadequate service responses for people experiencing high levels of distress. Increased understanding is facilitated by exploring precipitating factors leading to this diagnosis, including invalidating and often traumatizing environments. Available evidence from Australian and international literature is considered, with main treatments identified to inform improved treatment outcomes. The need for attention to biological, psychological factors is highlighted and in particular acknowledgment of the high prevalence of trauma, particularly childhood sexual assault, amongst the mostly women who are given this diagnosis.

scholarly journals Borderline personality disorder classification based on brain network measures during emotion regulation

2020 ◽  
Author(s):  
Henk Cremers ◽  
Linda van Zutphen ◽  
Sascha Duken ◽  
Gregor Domes ◽  
Andreas Sprenger ◽  
...  
Keyword(s):  
Emotion Regulation ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Brain Network ◽  
Borderline Personality ◽  
Future Research ◽  
Support Vector ◽  
Classification Analysis ◽  
Network Analyses ◽  
Network Measures

AbstractBorderline Personality Disorder (BPD) is characterized by an increased emotional sensitivity and dysfunctional capacity to regulate emotions. While amygdala and prefrontal cortex interactions are regarded as the critical neural mechanisms underlying these problems, the empirical evidence hereof is inconsistent. In the current study, we aimed to systematically test different properties of brain connectivity and evaluate the predictive power to detect borderline personality disorder. Patients with borderline personality disorder (n = 51), cluster C personality disorder (n = 26) and non-patient controls (n = 44), performed an fMRI emotion regulation task. Brain network analyses focused on two properties of task-related connectivity: phasic refers to task-event dependent changes in connectivity, while tonic was defined as task-stable background connectivity. Three different network measures were estimated (strength, local efficiency, and participation coefficient) and entered as separate models in a nested cross-validated linear support vector machine classification analysis. Borderline personality disorder vs. non-patient controls classification showed a balanced accuracy of 55%, which was not significant under a permutation null-model, p = 0.23. Exploratory analyses did indicate that the tonic strength model was the highest performing model (balanced accuracy 62%), and the amygdala was one of the most important features. Despite being one of the largest data-sets in the field of BPD fMRI research, the sample size may have been limited for this type of classification analysis. The results and analytic procedures do provide starting points for future research, focusing on network measures of tonic connectivity, and potentially focusing on subgroups of BPD.

scholarly journals Identifying Core Deficits in a Dimensional Model of Borderline Personality Disorder Features: A Network Analysis

2018 ◽  
Vol 6 (5) ◽  
pp. 685-703 ◽  
Author(s):  
Matthew W. Southward ◽  
Jennifer S. Cheavens
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Network Analysis ◽  
Emotion Dysregulation ◽  
Interpersonal Problems ◽  
Borderline Personality ◽  
Future Research ◽  
Self Identity ◽  
Affective Intensity ◽  
Core Deficits

Researchers have proposed three core deficits of Borderline Personality Disorder (BPD): emotion dysregulation, interpersonal problems, and self-identity disturbance. Previous methods for testing these deficits rest on problematic assumptions (e.g., the assumption that observable/measured features of BPD, such as chaotic relationships and affective intensity, occur independently). A network model of psychopathology assumes that observable features of disorders directly interact, and network analytic methods quantify how central each feature is. We conducted a network analysis of core deficits of BPD features using a large ( N = 4,386) sample of participants with a range of BPD features. The most central features of participants in the High BPD group were loneliness, recklessness/impulsivity, and intense moods, supporting models of emotion dysregulation and interpersonal problems. The networks of BPD features did not differ between men and women. We provide directions for future research to enhance our understanding of how networks of BPD features change over time.

scholarly journals Reviewing the clinical significance of ‘fear of abandonment’ in borderline personality disorder

2018 ◽  
Vol 27 (1) ◽  
pp. 60-63 ◽  
Author(s):  
Venura Palihawadana ◽  
Jillian H Broadbear ◽  
Sathya Rao
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Clinical Significance ◽  
English Language ◽  
Borderline Personality ◽  
Future Research ◽  
Treatment Interventions ◽  
Therapeutic Engagement ◽  
Therapy Target ◽  
Fear Of Abandonment

Objectives: To review and highlight the clinical significance of the symptom ‘fear of abandonment’ in borderline personality disorder (BPD). Methods: A systematic search of the literature was conducted using MEDLINE and PubMed, employing search terms including ‘fear of abandonment’, ‘borderline personality disorder’ and ‘rejection’. The most relevant English-language articles and books were selected for this review. Results: Fear of abandonment is widely recognised as a core symptom in BPD; a biopsychosocial explanation for the occurrence of the symptom is presented. While fear of abandonment may differ in its clinical presentation, it has a significant impact on therapeutic engagement, suicidal behaviour and non-suicidal self-injury, clinical management and prognosis. Most evidence based psychotherapies for BPD address the phenomenon of fear of abandonment; however, the lack of specifically targeted treatment interventions is disproportionate to its prominence and clinical significance. Conclusions: Given its defining role in BPD, we recommend fear of abandonment as an important subject of future research and a specific therapy target.

Affective Processing in Young Adults with Borderline Personality Disorder

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
S. Herpertz
Keyword(s):  
Young Adults ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Young Adulthood ◽  
Affect Regulation ◽  
Young Patients ◽  
Borderline Personality ◽  
Brain Maturation ◽  
Affective Processing ◽  
Future Research

Individuals diagnosed with borderline personality disorder usually seek for treatment as adolescents or young adults. As age progresses, longitudinal studies suggest that borderline patients improve psychosocially, suggesting that they may somewhat belatedly achieve the milestones of young adulthood. Affect regulation may be particularly subject to major changes in young adulthood, as the prefrontal brain areas involved in affective processing underlie maturation processes up into the late third decade. From studies in healthy volunteers we know that that the capacity to process positive affects improves with age. Young adults with borderline personality disorder, however, display a negativity bias in emotion recognition and they have difficulties in inhibiting the recall of negative information. Neuroimaging data suggest that they suffer from deficient implicit affect regulation but they are able to profit from explicit strategies to suppress negative emotions, an observation which could have interesting implications for treatment. Regarding future research more efforts on developmental psychopathology on the one hand, brain maturation on the other will help to further understand the nature of borderline personality disorder. Regarding clinical issues early treatment designed to foster affect regulating competencies and self-esteem and to develop interpersonal skills might benefit young patients diagnosed with borderline personality disorder.

Pharmacotherapy of the Borderline Patient: A Critical Review and Clinical Guidelines

1989 ◽  
Vol 34 (4) ◽  
pp. 347-353 ◽  
Author(s):  
S.P. Kutcher ◽  
D.H.R. Blackwood
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Critical Review ◽  
Clinical Guidelines ◽  
Borderline Personality ◽  
Future Research ◽  
Clinical Use ◽  
Borderline Patient ◽  
Psychotropic Agents

The literature on the pharmacotherapy of Borderline Personality Disorder (BPD) is critically reviewed, and suggestions for the appropriate clinical use of psychotropic agents and directions for future research are made.

scholarly journals Service user experiences of mentalisation-based treatment for borderline personality disorder

2017 ◽  
Vol 22 (1) ◽  
pp. 16-27 ◽  
Author(s):  
Diarmaid Ó. Lonargáin ◽  
Suzanne Hodge ◽  
Rachael Line
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Interpretative Phenomenological Analysis ◽  
Service User ◽  
Borderline Personality ◽  
Individual Therapy ◽  
Future Research ◽  
User Experiences ◽  
Content Type ◽  
The Uk

Purpose Previous research indicates that mentalisation-based treatment (MBT) is an effective therapeutic programme for difficulties associated with borderline personality disorder (BPD). The purpose of this paper is to explore service user experiences of the therapy. Design/methodology/approach Seven adults (five female and two male), recruited via three NHS trusts, were interviewed. Participants were attending intensive out-patient MBT for BPD between 3 and 14 months. Data were analysed using interpretative phenomenological analysis. Findings Participants experienced the group component of MBT as challenging and unpredictable. They highlighted developing trust as key to benefitting from MBT. This was much more difficult to achieve in group sessions than in individual therapy, particularly for those attending MBT for less than five or six months. The structure of MBT generally worked well for participants but they identified individual therapy as the core component in achieving change. All participants learned to view the world more positively due to MBT. Practical implications Enhanced mentalisation capacity may help address specific challenges associated with BPD, namely, impulsivity and interpersonal difficulties. MBT therapists are confronted with the ongoing task of creating a balance between sufficient safety and adequate challenge during MBT. Potential benefits and drawbacks of differing structural arrangements of MBT programmes within the UK are considered. Originality/value Learning about service user perspectives has facilitated an enhanced understanding of experiences of change during MBT in addition to specific factors that may impact mentalisation capacity throughout the programme. These factors, in addition to implications for MBT and suggestions for future research, are discussed.

scholarly journals Body Image in Borderline Personality Disorder: A Systematic Review of the Emerging Empirical Literature

2021 ◽  
Vol 10 (18) ◽  
pp. 4264
Author(s):  
Magdalena Wayda-Zalewska ◽  
Barbara Kostecka ◽  
Katarzyna Kucharska
Keyword(s):  
Systematic Review ◽  
Body Image ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Borderline Personality ◽  
Empirical Literature ◽  
Psychotic Symptoms ◽  
Future Research ◽  
Eligibility Criteria ◽  
Body Image Disturbances

As an element of distorted self-image, body image disturbances may be relevant to borderline personality disorder (BPD). Therefore, this systematic review aims to critically discuss and summarize empirical findings in this matter. Based on the available theoretical models, three body image components were identified: (a) perception, (b) affect and cognition, and (c) general body dissatisfaction. We conducted a systematic search of the empirical literature published in English in the MEDLINE, PsycINFO, and Scopus databases until June 2021 using a priori eligibility criteria (BPD; BPD symptoms or features in nonclinical groups; quasipsychotic or psychotic symptoms were not considered). We included k = 10 records meeting the criteria. Compared with other analyzed groups, individuals diagnosed with BPD obtained higher scores in the three components of body image disturbances. The issue of body image in BPD is relatively understudied, although current research findings clearly indicate disturbances in all of the abovementioned body image components in individuals with BPD or significant relationships of these components with BPD traits or symptoms both in clinical and nonclinical samples. Eventually, possible practical implications and future research directions are also discussed.

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