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Borderline personality disorder : new research PDF

198 Pages·2009·6.729 MB·English
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B P D : ORDERLINE ERSONALITY ISORDER NEW RESEARCH No part of this digital document may be reproduced, stored in a retrieval system or transmitted in any form or by any means. The publisher has taken reasonable care in the preparation of this digital document, but makes no expressed or implied warranty of any kind and assumes no responsibility for any errors or omissions. No liability is assumed for incidental or consequential damages in connection with or arising out of information contained herein. This digital document is sold with the clear understanding that the publisher is not engaged in rendering legal, medical or any other professional services. B P D : ORDERLINE ERSONALITY ISORDER NEW RESEARCH MARIAN H. JACKSON AND LINDA F. WESTBROOK EDITORS Nova Science Publishers, Inc. New York Copyright © 2009 by Nova Science Publishers, Inc. All rights reserved. No part of this book may be reproduced, stored in a retrieval system or transmitted in any form or by any means: electronic, electrostatic, magnetic, tape, mechanical photocopying, recording or otherwise without the written permission of the Publisher. For permission to use material from this book please contact us: Telephone 631-231-7269; Fax 631-231-8175 Web Site: http://www.novapublishers.com NOTICE TO THE READER The Publisher has taken reasonable care in the preparation of this book, but makes no expressed or implied warranty of any kind and assumes no responsibility for any errors or omissions. No liability is assumed for incidental or consequential damages in connection with or arising out of information contained in this book. The Publisher shall not be liable for any special, consequential, or exemplary damages resulting, in whole or in part, from the readers’ use of, or reliance upon, this material. Any parts of this book based on government reports are so indicated and copyright is claimed for those parts to the extent applicable to compilations of such works. Independent verification should be sought for any data, advice or recommendations contained in this book. In addition, no responsibility is assumed by the publisher for any injury and/or damage to persons or property arising from any methods, products, instructions, ideas or otherwise contained in this publication. This publication is designed to provide accurate and authoritative information with regard to the subject matter covered herein. It is sold with the clear understanding that the Publisher is not engaged in rendering legal or any other professional services. If legal or any other expert assistance is required, the services of a competent person should be sought. FROM A DECLARATION OF PARTICIPANTS JOINTLY ADOPTED BY A COMMITTEE OF THE AMERICAN BAR ASSOCIATION AND A COMMITTEE OF PUBLISHERS. LIBRARY OF CONGRESS CATALOGING-IN-PUBLICATION DATA Borderline personality disorder : new research / Marian H. Jackson, Linda F. Westbrook (editors). p. ; cm. Includes bibliographical references and index. ISBN 978-1-60876-540-9 (E-Book) 1. Borderline personality disorder. I. Jackson, Marian H. II. Westbrook, Linda F. [DNLM: 1. Borderline Personality Disorder. WM 190 B728934 2009] RC569.5.B67B6893 2009 616.85'852--dc22 2008041749 Published by Nova Science Publishers, Inc. (cid:30)  New York CONTENTS Preface vii Chapter 1 Genetic Epidemiology of Borderline Personality Disorder 1 Marijn A. Distel, Timothy J. Trull and Dorret I. Boomsma Chapter 2 Correlates and Course of Recovery in Patients with Borderline Personality Disorder – A Review 33 Willem H. J. Martens Chapter 3 Neuropsychobiology, Comorbidity and Dimensional Models in Borderline Personality Disorder: Critical Issues for Treatment 59 Bernardo Dell’Osso, Heather Berlin, Marta Serati and Alfredo Carlo Altamura Chapter 4 Neurobiology of Borderline Personality Disorder: Present State and Future Directions 81 Thomas Zetzsche, Thomas Frodl, Ulrich W. Preuss, Doerthe Seifert, Hans-Jürgen Möller and Eva Maria Meisenzahl Chapter 5 Proving the Efficiency of Music Psychotherapy with Borderline Adolescents By Means of a Quasi-Experimental Design 99 Lony Schiltz Chapter 6 A Dissociative Model of Borderline Personality Disorder 117 Colin A. Ross Chapter 7 Borderline Symptomatology and Empathic Accuracy 127 William Schweinle, Judith M. Flury and William Ickes Chapter 8 Patterns of Interpersonal Behaviors and Borderline Personality Characteristics 137 Glenn Shean and Kimberly Ryan Chapter 9 Borderline Personality and Somatic Symptomatology 147 Randy A. Sansone and Lori A. Sansone vi Contents Chapter 10 Borderline Personality and Sexual Impulsivity 159 Randy A. Sansone and Lori A. Sansone Index 169 PREFACE Borderline personality disorder (BPD) is a serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior. This instability often disrupts family and work life, long-term planning, and the individual's sense of self-identity. Originally thought to be at the "borderline" of psychosis, people with BPD suffer from a disorder of emotion regulation. While less well known than schizophrenia or bipolar disorder (manic-depressive illness), BPD is more common, affecting 2 percent of adults, mostly young women. This new book presents the latest new research in the field Chapter 1 - Borderline personality disorder (BPD) is a severe personality disorder characterized by impulsivity, affective instability, relationship problems and identity problems. BPD affects 1-2% of the general population, 10% of the patients in outpatient settings, 15-20% of the patients in inpatients settings and 30-60% of the patients diagnosed with personality disorders. BPD is most commonly assessed according to the diagnostic and statistical manual of mental disorders (DSM). In addition, assessment of BPD features on a quantitative or dimensional scale is increasingly used. BPD is more often diagnosed in women in clinical samples and in young individuals and is frequently co-morbid with other personality disorders and axis-I disorders. Most studies on BPD have attempted to clarify the etiology in terms of social and environmental determinants (e.g. physical or sexual abuse). These factors are important contributors to risk, but do not explain all variation in BPD risk. Moreover, even if the association is significant, in many instances the direction of causality is unclear. Genetic factors are additional contributors to BPD risk, and there now are some large twin and family studies that suggest significant heritability for the disorder as well as for the quantitative assessment. In this chapter, the authors first discuss the main symptoms of BPD and several assessment methods. Next, the authors consider the association between BPD and demographic characteristics, such as age and sex, and the co-morbidity with other disorders. After the focus on environmental covariates, the authors review family and twin studies into the genetics of BPD and related traits, genetic linkage and candidate gene studies of BPD. The authors end with a discussion of future directions in research in which we will consider multivariate studies, the discordant MZ co-twin design, the children of twins design, genome wide association studies, and genotype-environment interaction. Chapter 2 - In this chapter the correlates and course of remission in patients with borderline personality disorder are studied. For this purpose the data of relevant studies were viii Marian H. Jackson and Linda F. Westbrook analyzed and discussed. It was found that factors like artistic talent; high intelligence; successful and positive relationships; avoidance of destructive conflicting intimacy, but also the healing impact constructive confronting relationships; remission of Axis I and II comorbidity predict recovery. In contrast, factors such as sexual abuse, trauma, parental cruelty and neglect, stigma, destructive overinvolvement of family, affective instability, recurrent suicidality and baseline psychopathology predict poor outcome. Acute symptoms such as self-mutilation, help-seeking suicide threats and attempts, as well as impulsivity seem to resolve quickly, whereas other symptoms as chronic feelings of intense anger, profound abandonment concerns, and affective instability appear to diminish more slowly. Chapter 3 - Borderline Personality Disorder (BPD) affects approximately the 1-2% of the general population in the US, with an incidence up to 20% in psychiatric settings. The pathogenesis of BPD involves complex interactions between genetic, neurobiological and environmental factors, resulting in core dimensional symptoms such as emotional dysregulation, impulse dyscontrol, aggression, cognitive dysfunctions and dissociative states. BPD is often comorbid with other mental disorders such as mood disorders, anxiety disorders, psychotic spectrum disorders, other personality disorders and substance abuse/dependence. Moreover, the comorbidity between bipolar disorder, particularly type II, and BPD has been investigated in several studies, showing interesting results in terms of clinical presentation and outcome. In addition, suicidal ideation is frequently experienced by BPD subjects and almost 10% of affected patients commit suicide by adulthood. As a consequence, BPD patients are high utilizers of health care resources and the correct clinical management of this disorder represents a challenge for psychiatrists. Recently, neurobiological studies showed that symptoms and behaviors of BPD are partly associated with alterations in basic neurocognitive processes, involving glutamatergic, dopaminergic and serotoninergic systems. In addition, neuroimaging studies in BPD patients indicated differences in the volume and activity of specific brain regions related to emotion and impulsivity, such as the prefrontal cortex, cingulate cortex, amygdala and hippocampus. The treatment of BPD, as reported in currently available guidelines, includes both pharmacotherapy and psychotherapy. Pharmacological treatment is generally recommended in the acute treatment of the core symptoms of BPD and in cases with Axis I comorbidity and severe impulse dyscontrol. Over the past decade, antidepressants - SSRIs in particular - have been considered the first pharmacological choice in the treatment of BPD, whereas, more recently, converging evidence indicates the efficacy of other compounds such as mood- stabilizers and atypical antipsychotics. With regard to psychotherapic interventions, long-term approaches including transference-focused psycotherapy, dialectical-behavioural psychoterapy and mentalization-based therapy seem to be particularly useful. In light of the continuing evolution of the BPD diagnosis, of its principal clinical features and of the high incidence of comorbidity, it is very tough to draw a well defined and complete picture of the disorder and future contributions from genetic, neurobiological and neuroimaging studies are warranted. Chapter 4 - Borderline Personality Disorder (BPD) is a severe and frequent psychiatric disorder with prevalence rates of 1-2% reported from community samples. Since the first inclusion of BPD in the diagnostic and statistical manual (DSM) III ongoing research provided evidence for frequent neurobiological alterations in BPD patients. In the 1980s, reductions of serotonin (5-HT) metabolites in the cerebrospinal fluid of male patients with BPD were demonstrated and thereafter numerous studies including neuroendocrine challenge

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