The Clinical Characteristics of Patients With Borderline Personality Disorder in Different Treatment Settings

2021 ◽  
pp. 1-13
Author(s):  
Madeline Ward ◽  
Isabel Benjamin ◽  
Mark Zimmerman
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Rhode Island ◽  
Suicide Attempts ◽  
Present Report ◽  
Hospital Setting ◽  
Borderline Personality ◽  
Partial Hospital ◽  
Outpatient Practice ◽  
Psychosocial Morbidity

The present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) Project compares patients with borderline personality disorder (BPD) in an outpatient practice (n = 390) and a partial hospital setting (n = 358) on diagnostic comorbidities, symptoms experienced, suicidality, and occupational impairment. The patients in the partial program were diagnosed with significantly more psychiatric disorders and were more frequently diagnosed with dysthymia, generalized anxiety disorder, alcohol and substance use disorders, adjustment disorders, and posttraumatic stress disorder. Those at the partial hospital had significantly higher levels of suicidal ideation than those in the outpatient practice. The samples did not differ on utilization of disability or suicide attempts. Treatment setting may have implications in the recognition of the disorder in clinical practice, the development and support of etiological theories, identification of core deficits, and evaluation of psychosocial morbidity associated with BPD.

Patients with borderline personality disorder and bipolar disorder: a descriptive and comparative study

2020 ◽  
pp. 1-12
Author(s):  
Mark Zimmerman ◽  
Caroline Balling ◽  
Iwona Chelminski ◽  
Kristy Dalrymple
Keyword(s):  
Bipolar Disorder ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Rhode Island ◽  
Childhood Trauma ◽  
Suicide Attempts ◽  
Borderline Personality ◽  
Psychiatric Outpatients ◽  
Structured Interviews ◽  
Psychosocial Morbidity

Abstract Background Bipolar disorder and borderline personality disorder (BPD) are each significant public health problems. It has been frequently noted that distinguishing BPD from bipolar disorder is challenging. Consequently, reviews and commentaries have focused on differential diagnosis and identifying clinical features to distinguish the two disorders. While there is a burgeoning literature comparing patients with BPD and bipolar disorder, much less research has characterized patients with both disorders. In the current report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we compare psychiatric outpatients with both BPD and bipolar disorder to patients with BPD without bipolar disorder and patients with bipolar disorder without BPD. Methods Psychiatric outpatients presenting for treatment were evaluated with semi-structured interviews. The focus of the current study is the 517 patients with both BPD and bipolar disorder (n = 59), BPD without bipolar disorder (n = 330), and bipolar disorder without BPD (n = 128). Results Compared to patients with bipolar disorder, the patients with bipolar disorder and BPD had more comorbid disorders, psychopathology in their first-degree relatives, childhood trauma, suicidality, hospitalizations, time unemployed, and likelihood of receiving disability payments. The added presence of bipolar disorder in patients with BPD was associated with more posttraumatic stress disorder in the patients as well as their family, more bipolar disorder and substance use disorders in their relatives, more childhood trauma, unemployment, disability, suicide attempts, and hospitalizations. Conclusions Patients with both bipolar disorder and BPD have more severe psychosocial morbidity than patients with only one of these disorders.

Screening for Bipolar Disorder and Finding Borderline Personality Disorder: A Replication and Extension

2019 ◽  
Vol 33 (4) ◽  
pp. 533-543 ◽  
Author(s):  
Mark Zimmerman ◽  
Iwona Chelminski ◽  
Kristy Dalrymple ◽  
Jacob Martin
Keyword(s):  
Bipolar Disorder ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Rhode Island ◽  
Present Report ◽  
Borderline Personality ◽  
Diagnostic Assessment ◽  
Depressed Patients ◽  
Original Report ◽  
Screening Scale

The authors’ group previously reported that patients who screened positive on the Mood Disorders Questionnaire (MDQ), the most frequently studied screening scale for bipolar disorder, were as likely to be diagnosed with borderline personality disorder (BPD) as with bipolar disorder. A limitation of that study was that the authors examined the performance of the MDQ in patients presenting for various psychiatric disorders, including depression. The recognition of bipolar disorder and its differential diagnosis with BPD is of greatest clinical relevance in depressed patients. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, the authors attempted to replicate their initial findings in a new sample of psychiatric outpatients, and they also examined the performance of the MDQ in depressed patients. The results of the present study were consistent with the original report, thereby indicating that the MDQ is not effective in helping distinguish bipolar disorder from BPD.

Progression from interpersonal problems to suicidal ideation and suicidal behavior in borderline personality disorder

2020 ◽  
Author(s):  
Timothy Allen ◽  
Michael Hallquist ◽  
Aidan G.C. Wright ◽  
Alexandre Dombrovski
Keyword(s):  
Borderline Personality Disorder ◽  
Suicidal Ideation ◽  
Personality Disorder ◽  
Negative Affect ◽  
Structural Equation ◽  
Suicide Attempts ◽  
Borderline Personality ◽  
Equation Modeling ◽  
Interpersonal Dysfunction ◽  
Suicidal Crisis

Importance: Clinicians treating borderline personality disorder (BPD) are often faced with the difficult challenge of assessing when, and for whom, risk for suicide is greatest. Addressing this dilemma requires longitudinal, prospective data from high-risk samples with an elevated base rate of suicide attempts.Objective: To test whether dispositional characteristics modulate the pathway from interpersonal dysfunction to suicide in BPD. Design: This longitudinal, observational study was conducted between 1990 and 2020. Data were analyzed between April and July 2020. Participants were assessed annually for up to 30 years (mean number of follow-ups = 7.82). Setting: Participants were recruited from inpatient, outpatient, and community referral sources.Participants: 458 individuals (Mean age = 28.59, 77% female) diagnosed with BPD.Main Outcomes and Measures: Presence or absence of a suicide attempt within one year of each follow-up assessment. Multilevel structural equation modeling was used to 1) examine longitudinal, within-person transitions from interpersonal dysfunction to suicidal ideation to suicide attempts (i.e., the [I]nterpersonal-[I]deation-[A]ttempt pathway); and 2) evaluate whether two maladaptive personality dimensions, negative affect and disinhibition, moderated these transitions.Results: At the within-person level, there was support for the I-I-A pathway: suicidal ideation accounted for the association between interpersonal dysfunction and suicide attempts. Personality further moderated each component of the I-I-A pathway: negative affect was associated with a stronger coupling between interpersonal dysfunction and ideation; and disinhibition was associated with a stronger coupling between ideation and attempts. Conclusions and Relevance: The escalation from interpersonal difficulties to a suicidal crisis in BPD involves two psychologically distinct process. An internalizing process links interpersonal dysfunction to suicidal ideation and is facilitated by trait negative. An additional externalizing process links suicidal ideation to suicide attempts, and is facilitated by trait disinhibition. Assessment of these intra- and interindividual risk factors may inform clinical decisions about when, and for whom, crisis intervention is necessary.

scholarly journals Mediating role of borderline personality disorder traits in the effects of childhood maltreatment on suicidal behaviour among mood disorder patients

2017 ◽  
Vol 44 ◽  
pp. 53-60 ◽  
Author(s):  
K.I. Aaltonen ◽  
T. Rosenström ◽  
I. Baryshnikov ◽  
B. Karpov ◽  
T. Melartin ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Suicidal Ideation ◽  
Personality Disorder ◽  
Childhood Maltreatment ◽  
Suicidal Behaviour ◽  
Suicide Attempts ◽  
Borderline Personality ◽  
Mediation Effect ◽  
Mediation Analyses ◽  
Borderline Personality Disorder Traits

AbstractBackground:Substantial evidence supports an association between childhood maltreatment and suicidal behaviour. However, few studies have examined factors mediating this relationship among patients with unipolar or bipolar mood disorders.Methods:Depressive disorder and bipolar disorder (ICD-10-DCR) patients (n = 287) from the Helsinki University Psychiatric Consortium (HUPC) Study were surveyed on self-reported childhood experiences, current depressive symptoms, borderline personality disorder traits, and lifetime suicidal behaviour. Psychiatric records served to complement the information on suicide attempts. We examined by formal mediation analyses whether (1) the effect of childhood maltreatment on suicidal behaviour is mediated through borderline personality disorder traits and (2) the mediation effect differs between lifetime suicidal ideation and lifetime suicide attempts.Results:The impact of childhood maltreatment in multivariate models on either lifetime suicidal ideation or lifetime suicide attempts showed comparable total effects. In formal mediation analyses, borderline personality disorder traits mediated all of the total effect of childhood maltreatment on lifetime suicide attempts, but only one fifth of the total effect on lifetime suicidal ideation. The mediation effect was stronger for lifetime suicide attempts than for lifetime suicidal ideation (P = 0.002) and independent of current depressive symptoms.Conclusions:The mechanisms of the effect of childhood maltreatment on suicidal ideation versus suicide attempts may diverge among psychiatric patients with mood disorders. Borderline personality disorder traits may contribute to these mechanisms, although the influence appears considerably stronger for suicide attempts than for suicidal ideation.

Differential Change of Borderline Personality Disorder Traits During Dialectical Behavior Therapy for Adolescents

2019 ◽  
Vol 33 (1) ◽  
pp. 119-134 ◽  
Author(s):  
Arne Buerger ◽  
Gloria Fischer-Waldschmidt ◽  
Florian Hammerle ◽  
Kristin von Auer ◽  
Peter Parzer ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Behavior Therapy ◽  
Dialectical Behavior Therapy ◽  
Suicide Attempts ◽  
Treatment Options ◽  
Skills Training ◽  
Borderline Personality ◽  
Secondary Outcomes ◽  
The Impact

Despite the expansion of treatment options for adults with borderline personality disorder (BPD), research on treatment options for adolescent BPD is scarce. The aim of this study was to investigate the impact of dialectical behavior therapy for adolescents (DBT-A) on the individual trait level as primary outcome; and the frequency of suicide attempts and nonsuicidal self-injury, self-reported BPD core pathology, and general psychopathology as secondary outcomes. Seventy-two adolescents (aged 12–17 years) with full- or subsyndromal BPD were treated with DBT-A (25 single sessions, 20 sessions of skills training), and 13 patients (18.1%) withdrew during treatment. From baseline to post-treatment, the number of BPD traits decreased significantly (p ≤ .001). All secondary outcomes decreased significantly as well (p ≤ .001). Results of this uncontrolled study suggest that beside self-harm, DBT-A may also have a beneficial impact on other features of BPD.

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.

Comorbid Bipolar Disorder and Borderline Personality Disorder and History of Suicide Attempts

2014 ◽  
Vol 28 (3) ◽  
pp. 358-364 ◽  
Author(s):  
Mark Zimmerman ◽  
Jennifer Martinez ◽  
Diane Young ◽  
Iwona Chelminski ◽  
Theresa A. Morgan ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Suicide Attempts ◽  
Borderline Personality ◽  
History Of

scholarly journals Psychotherapies for Adolescents with Subclinical and Borderline Personality Disorder: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 65 (1) ◽  
pp. 5-15 ◽  
Author(s):  
Jennifer Wong ◽  
Anees Bahji ◽  
Sarosh Khalid-Khan
Keyword(s):  
Systematic Review ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Suicide Attempts ◽  
Meta Analysis ◽  
Borderline Personality ◽  
Treatment Retention ◽  
Short Term ◽  
Self Injury

Background: Evidence regarding the efficacy of psychotherapy in adolescents with borderline personality disorder (BPD) symptomatology has not been previously synthesized. Objective: To conduct a systematic review and meta-analysis of the randomized controlled trials (RCTs) in order to assess the efficacy of psychotherapies in adolescents with BPD symptomatology. Methods: Seven electronic databases were systematically searched using the search terms BPD, adolescent, and psychotherapy from database inception to July 2019. Titles/abstracts and full-texts were screened by one reviewer; discrepancies were resolved via consensus. We extracted data on BPD symptomatology, including BPD symptoms, suicide attempts, nonsuicidal self-injury, general psychopathology, functional recovery, and treatment retention. Data were pooled using random-effects models. Results: Of 536 papers, seven trials (643 participants) were eligible. Psychotherapy led to significant short-term improvements in BPD symptomatology posttreatment ( g = −0.89 [−1.75, −0.02]) but not in follow-up ( g = 0.06 [−0.26, 0.39]). There was no significant difference in treatment retention between the experimental and control groups overall (odds ratio [ OR] 1.02, 95% confidence interval [CI], 0.92 to 1.12, I 2 = 52%). Psychotherapy reduced the frequency of nonsuicidal self-injury ( OR = 0.34, 95% CI, 0.16 to 0.74) but not suicide attempts ( OR = 1.03, 95% CI, 0.46 to 2.30). Conclusions: There is a growing variety of psychotherapeutic interventions for adolescents with BPD symptomatology that appears feasible and effective in the short term, but efficacy is not retained in follow-up—particularly for frequency of suicide attempts.

scholarly journals Psychosocial morbidity associated with bipolar disorder and borderline personality disorder in psychiatric out-patients: Comparative study

2015 ◽  
Vol 207 (4) ◽  
pp. 334-338 ◽  
Author(s):  
Mark Zimmerman ◽  
William Ellison ◽  
Theresa A. Morgan ◽  
Diane Young ◽  
Iwona Chelminski ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
College Graduates ◽  
Borderline Personality ◽  
Structured Interviews ◽  
Public Health Perspective ◽  
Repeated Calls ◽  
History Of ◽  
Psychosocial Morbidity

BackgroundThe morbidity associated with bipolar disorder is, in part, responsible for repeated calls for improved detection and recognition. No such commentary exists for the improved detection of borderline personality disorder. Clinical experience suggests that it is as disabling as bipolar disorder, but no study has directly compared the two disorders.AimsTo compare the levels of psychosocial morbidity in patients with bipolar disorder and borderline personality disorder.MethodPatients were assessed with semi-structured interviews. We compared 307 patients with DSM-IV borderline personality disorder but without bipolar disorder and 236 patients with bipolar disorder but without borderline personality disorder.ResultsThe patients with borderline personality disorder less frequently were college graduates, were diagnosed with more comorbid disorders, more frequently had a history of substance use disorder, reported more suicidal ideation at the time of the evaluation, more frequently had attempted suicide, reported poorer social functioning and were rated lower on the Global Assessment of Functioning. There was no difference between the two patient groups in history of admission to psychiatric hospital or time missed from work during the past 5 years.ConclusionsThe level of psychosocial morbidity associated with borderline personality disorder was as great as (or greater than) that experienced by patients with bipolar disorder. From a public health perspective, efforts to improve the detection and treatment of borderline personality disorder might be as important as efforts to improve the recognition and treatment of bipolar disorder.

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