Borderline personality disorder : new research

198 Pages·2009·6.729 MB·English

by  Marian H Jackson, Linda F Westbrook

B P D :
ORDERLINE ERSONALITY ISORDER
NEW RESEARCH

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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.

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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