Jump to content

Borderline personality disorder

From Wikipedia, the free encyclopedia

This is an old revision of this page, as edited by Reub2000 (talk | contribs) at 08:08, 11 December 2012 (→Notable people: although the source is an interesting read, it is not reliable). The present address (URL) is a permanent link to this revision, which may differ significantly from the current revision.

Borderline personality disorder
SpecialtyPsychiatry, clinical psychology Edit this on Wikidata
Personality disorders
Cluster A (odd)
Cluster B (dramatic)
Cluster C (anxious)
Not otherwise specified
Depressive
Others

Borderline personality disorder (BPD) (called emotionally unstable personality disorder, borderline type in the ICD-10) is a personality disorder marked by a prolonged disturbance of personality function, characterized by unusual variability and depth of moods. These moods may secondarily affect cognition and interpersonal relations.[n 1]

The disorder typically involves an unusual degree of instability in mood and black-and-white thinking, or splitting. BPD often manifests itself in idealization and devaluation episodes and chaotic and unstable interpersonal relationships, issues with self-image, identity, and behavior; as well as a disturbance in the individual's sense of self. Self-harm and suicidal ideation often leads to the need for mental health aid centres. [1] In extreme cases, this disturbance in the sense of self can lead to periods of dissociation.[2] It is only recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) in individuals over the age of 18; however, symptoms necessary to establish the disorder can also be found in adolescents. Splitting in BPD includes a switch between idealizing and demonizing others (absolute good or love versus absolute evil or hate with no middle term). This, combined with mood disturbances, can undermine relationships with family, friends, and co-workers. BPD disturbances may also include harm to oneself.[3] Without treatment, symptoms may worsen, leading (in extreme cases) to suicide attempts.[n 2]

There is an ongoing debate among clinicians and patients worldwide about terminology and the use of the word borderline,[4] and some have suggested that this disorder should be renamed.[5] The ICD-10 manual has an alternative definition and terminology to this disorder, called Emotionally unstable personality disorder. There is related concern that the diagnosis of BPD stigmatizes people and supports discriminatory practices.[6]

Signs and symptoms

The primary features of BPD are unstable interpersonal relationships, affective distress, marked impulsivity, and unstable self-image.[2]

Individuals with BPD tend to experience frequent, strong and long-lasting states of aversive tension, often triggered by perceived rejection, being alone or perceived failure.[n 3] They may show lability (changeability) between anger and anxiety or between depression and anxiety[7] and temperamental sensitivity to emotive stimuli.[8]

The negative emotional states specific to BPD fall into four categories: destructive or self-destructive feelings; extreme feelings in general; feelings of fragmentation or lack of identity; and feelings of victimization.[9]

Behaviour

Individuals with BPD can be very sensitive to the way others treat them, reacting strongly to perceived criticism or hurtfulness. Their feelings about others often shift from positive to negative, generally after a disappointment or perceived threat of abandonment or of losing someone. Self-image can also change rapidly from extremely positive to extremely negative. Impulsive behaviors are common, including alcohol or drug abuse, eating disorders, promiscuous and intense sexuality, gambling and recklessness in general.[10] Attachment studies have revealed a strong association between BPD and insecure attachment style, the most characteristic types being "unresolved", "preoccupied", and "fearful".[11]

Evidence suggests that individuals with BPD, while being high in intimacy- or novelty-seeking, can be hyper-alert[12] to signs of rejection or devaluation and tend toward insecure, avoidant or ambivalent, or fearfully preoccupied patterns in relationships.[13] They tend to view the world as generally dangerous and malevolent.[12] BPD is linked to increased levels of chronic stress and conflict in romantic relationships, decreased satisfaction of romantic partners, abuse and unwanted pregnancy; these links may be general to personality disorder and subsyndromal problems.[14]

Manipulation and deceit are viewed as common features of BPD by many of those who treat the disorder, as well as by the DSM-IV.[15][16] Some mental health professionals, however, caution that an overemphasis on these traits and an overly broad definition of "manipulation" can lead to prejudicial treatment of BPD sufferers, particularly within the health care system.[17]

Suicidal or self-harming behavior is one of the core diagnostic criteria in DSM IV-TR, and management of and recovery from this can be complex and challenging.[18] The suicide rate is approximately 8 to 10 percent.[19][20] Self-injury attempts are highly common among patients and may or may not be carried out with suicidal intent.[21][22] Ongoing family interactions and associated vulnerabilities can lead to self-destructive behavior.[23] Stressful life events related to sexual abuse can be a particular trigger for suicide attempts by adolescents with BPD tendencies.[24]

Diagnosis

Diagnosis is based on a clinical assessment by a qualified mental health professional. The assessment incorporates the patient's self-reported experiences as well as the clinician's observations. The resulting profile may be supported or corroborated by long-term patterns of behavior as reported by family members, friends, or co-workers. The list of criteria that must be met for diagnosis is outlined in the DSM-IV-TR.[2]

Borderline personality disorder was once classified as a subset of schizophrenia (describing patients with borderline schizophrenic tendencies). Today BPD is used more generally to describe individuals who display emotional dysregulation and instability, with paranoid ideation or delusions being only one criterion (criterion #9) of a total of 9 criteria, of which 5 or more must be present for diagnosis.

Diagnostic and Statistical Manual

The Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV-TR), a widely used manual for diagnosing mental disorders, defines borderline personality disorder (in Axis II Cluster B) as:[2][16]

A pervasive pattern of instability of interpersonal relationships, self-image and affects, as well as marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
  1. Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-injuring behavior covered in Criterion 5
  2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
  3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
  4. Impulsivity in at least two areas that are potentially self-damaging (e.g., promiscuous sex, excessive spending, eating disorders, binge eating, substance abuse, reckless driving). Note: Do not include suicidal or self-injuring behavior covered in Criterion 5
  5. Recurrent suicidal behavior, gestures, threats or self-injuring behavior such as cutting, interfering with the healing of scars or picking at oneself (excoriation).
  6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability or anxiety usually lasting a few hours and only rarely more than a few days).
  7. Chronic feelings of emptiness
  8. Inappropriate anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
  9. Transient, stress-related paranoid ideation, delusions or severe dissociative symptoms

It is a requirement of DSM-IV that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.

International Classification of Disease

The World Health Organization's ICD-10 defines a conceptually similar disorder to borderline personality disorder called (F60.3) Emotionally unstable personality disorder. It has two subtypes described below.[25]

F60.30 Impulsive type

At least three of the following must be present, one of which must be (2):

  1. marked tendency to act unexpectedly and without consideration of the consequences;
  2. marked tendency to engage in quarrelsome behavior and to have conflicts with others, especially when impulsive acts are thwarted or criticized;
  3. liability to outbursts of anger or violence, with inability to control the resulting behavioral explosions;
  4. difficulty in maintaining any course of action that offers no immediate reward;
  5. unstable and capricious (impulsive, whimsical) mood.
F60.31 Borderline type

At least three of the symptoms mentioned in F60.30 Impulsive type must be present [see above], with at least two of the following in addition:

  1. disturbances in and uncertainty about self-image, aims, and internal preferences;
  2. liability to become involved in intense and unstable relationships, often leading to emotional crisis;
  3. excessive efforts to avoid abandonment;
  4. recurrent threats or acts of self-harm;
  5. chronic feelings of emptiness.
  6. demonstrates impulsive behavior, e.g., speeding, substance abuse[26]

The ICD-10 also describes some general criteria that define what is considered a personality disorder.

Chinese Society of Psychiatry

The Chinese Society of Psychiatry's CCMD has a comparable diagnosis of Impulsive Personality Disorder (IPD). A patient diagnosed as having IPD must display "affective outbursts" and "marked impulsive behavior," plus at least three out of eight other symptoms. The construct has been described as a hybrid of the impulsive and borderline subtypes of the ICD-10's Emotionally Unstable Personality Disorder, and also incorporates six of the nine DSM BPD criteria.[27]

Millon's subtypes

Theodore Millon, a psychologist noted for popular works on personality disorders, has unofficially proposed four subtypes of borderline.[n 4][n 5] He suggests an individual diagnosed with BPD may exhibit none, one or more of the following:

Family members

It is common for those with borderline personality disorder and their families to feel their problems compounded by a lack of clear diagnoses, effective treatments, and accurate information. This is true especially because of evidence that this disorder originates in the families of those with it[23] and has a lot to do with psychosocial and environmental factors (Axis IV), rather than belonging strictly in the personality disorders and mental retardation section (Axis II) of the DSM-IV construct. Conceptual, as well as therapeutic, relief may be obtained through evidence that BPD is closely related to traumatic events during childhood and to post-traumatic stress disorder (PTSD), about which much more is known.[28]

There has been limited research on family members' understanding of borderline personality disorder and the extent of burden or negative emotion experienced or expressed by family members.[29] Parents of individuals with BPD may show co-existing extremes of over-involvement and under-involvement.[23] BPD is linked to increased levels of chronic stress and conflict in romantic relationships, decreased satisfaction of romantic partners, abuse and unwanted pregnancy; these links may be general to personality disorder and subsyndromal problems.[30]

Adolescence

Onset of symptoms typically occurs during adolescence or young adulthood. While borderline personality disorder can manifest itself in children and teenagers, therapists are discouraged from diagnosing anyone before the age of 18, due to adolescence and a still-developing personality. There are some instances when BPD can be evident and diagnosed before the age of 18. The DSM-IV states: "To diagnose a personality disorder in an individual under 18 years, the features must have been present for at least 1 year."

There is some evidence that BPD diagnosed in adolescence is predictive of the disorder continuing into adulthood. It is possible that the diagnosis, if applicable, would be helpful in creating a more effective treatment plan for the child or teen.[2][31]

Differential diagnosis and comorbidity

Comorbid (co-occurring) conditions are common in BPD. When comparing individuals diagnosed with BPD to those diagnosed with other personality disorders, the former showed a higher rate of also meeting criteria for[32]

Borderline personality disorder and mood disorders often appear concurrently.[3] Some features of borderline personality disorder may overlap with those of mood disorders, complicating the differential diagnostic assessment.[35][36][37] Both diagnoses involve symptoms commonly known as "mood swings." In borderline personality disorder, the term refers to the marked lability and reactivity of mood defined as emotional dysregulation.[citation needed] The behavior is typically in response to external psychosocial and intrapsychic stressors, and may arise or subside, or both, suddenly and dramatically and last for seconds, minutes, hours, days, weeks or months.[38] Bipolar depression is generally more pervasive with sleep and appetite disturbances, as well as a marked non-reactivity of mood, whereas mood with respect to borderline personality and co-occurring dysthymia remains markedly reactive and sleep disturbance not acute.[39]

Some hold that BPD represents a subthreshold form of affective disorder,[40][41] while others maintain the categorical distinction between the disorders while noting they often co-occur.[42][43] Some findings suggest BPD lies on a bipolar spectrum, with a number of points of phenomenological and biological overlap between the affective lability criterion of borderline personality disorder and the extremely rapid cycling bipolar disorders.[44][45] Other findings suggest that the DSM-IV BPD diagnosis mixes up two sets of unrelated items—an affective instability dimension related to Bipolar-II, and an impulsivity dimension not related to Bipolar-II.[46]

General medical conditions can cause behavioral dysfunction resulting in a clinical picture that may resemble to some degree BPD. This may include hormonal dysfunction over a long period, and brain dysfunction (e.g. the encephalopathy caused by Lyme disease).[citation needed] These conditions may isolate the patient socially and emotionally, and/or cause limbic damage to the brain. However, it is not BPD that results, but rather a reaction to the isolating circumstances caused by a medical condition and the possibly coincident struggles of the patient to control his or her mood given damage to the brain's limbic system. Heavy alcohol usage over a long period itself can cause an encephalopathy which may cause limbic damage, and various frontal lobe syndromes can also result in disinhibition and impulsive behavior resembling BPD.[citation needed]

Causes

As with other mental disorders, the causes of BPD are complex and not fully understood.[5] One finding is a history of childhood trauma, abandonment, abuse or neglect,[47] although researchers have suggested diverse possible causes, such as a genetic predisposition, neurobiological factors, environmental factors, or brain abnormalities.[5]

There is evidence that suggests that BPD and post-traumatic stress disorder (PTSD) are closely related.[28] Evidence further suggests that BPD might result from a combination that can involve a traumatic childhood, a vulnerable temperament and stressful maturational events during adolescence or adulthood.[48]

Childhood abuse

Numerous studies have shown a strong correlation between child abuse, especially child sexual abuse, and development of BPD.[47][49][50][51][52] Many individuals with BPD report to have had a history of abuse and neglect as young children.[53] Patients with BPD have been found to be significantly more likely to report having been verbally, emotionally, physically or sexually abused by caregivers of either gender. There has also been a high incidence of reported incest and loss of caregivers in early childhood for people with borderline personality disorder.[54]

They were also much more likely to report having caregivers (of both genders) deny the validity of their thoughts and feelings. They were also reported to have failed to provide needed protection, and neglected their child's physical care. Parents (of both sexes) were typically reported to have withdrawn from the child emotionally, and to have treated the child inconsistently.[54]

Additionally, women with BPD who reported a previous history of neglect by a female caregiver and abuse by a male caregiver were consequently at significantly higher risk of claiming sexual abuse by a noncaregiver (not a parent).[54] It has been suggested that children who experience chronic early maltreatment and attachment difficulties may go on to develop borderline personality disorder.[55]

Other developmental factors

Some findings suggest that BPD is not necessarily a trauma-spectrum disorder, and may be biologically distinct from the post-traumatic stress disorder that could be a precursor to it. The personality symptom clusters seem to be related to specific abuses, but they may also be related to more persistent aspects of interpersonal and family environments in childhood.[56]

Otto Kernberg formulated a theory of borderline personality based on a premise of failure to develop in childhood. Writing in the psychoanalytic tradition, Kernberg argued that failure to achieve the developmental task of psychic clarification of self and other can result in an increased risk to develop varieties of psychosis, while failure to overcome splitting results in an increased risk to develop a borderline personality.[57]

Genetics

An overview of the existing literature suggested that traits related to BPD are influenced by genes.[58] A major twin study found that if one identical twin met criteria for BPD, the other also met criteria in 35 percent of cases. People that have BPD influenced by genes usually have a close relative with the disorder.[59]

Twin, sibling and other family studies indicate a partially heritable basis for impulsive aggression, but studies of serotonin-related genes to date have suggested only modest contributions to behavior.[56]

Research on mediating and moderating factors

Research suggests that, rather than having a single cause, BPD may develop as a result of a number of different factors. Research has found that both physical and sexual abuse appear to be factors in developing BPD symptoms. Other factors including family environment also contribute to the development of the disorder.[60] Bradley et al.[60] found that child sexual abuse (CSA) and childhood physical abuse both directly influence the development of BPD symptoms and are mediated by family environment.[60]

Other research has examined whether the negative affectivity associated with BPD—that is, the tendency to often feel anger, contempt, guilt, nervousness, and other negative feelings—can be helped by the technique of thought suppression, or consciously trying not to think certain thoughts. The results of this study found that thought suppression mediated the relationship between negative affectivity and BPD symptoms.[61] While negative affectivity significantly predicted BPD symptoms, this relationship was greatly reduced when thought suppression was introduced into the model. Thus, the relationship of negative affectivity to BPD symptoms is mediated by thought suppression.

Ayduk, et al., found that rejection sensitivity and executive control are predictors of BPD symptoms; in other words, people who are highly apt to feel rejected, and/or who have poor control of their emotions and behavior, are more likely to develop BPD. Another factor the authors studied, namely a child's ability to tolerate delayed gratification at age 4, did not appear to predict later development of BPD.[62]

Parker, Boldero and Bell examined another facet of BPD, which is instability of the sense of self. Their findings indicated that Self-Discrepancy—the sense of failing to match one's own ideals—was strongly correlated to BPD. Self-complexity, or being aware of one's own mental patterns, was not. Among those high in self-complexity, the relationship between AI self-discrepancy magnitudes and BPD features was lower than among those with less self-complexity. Actual-ought self-discrepancy relationship with BPD features was not significantly moderated by self-complexity.[63]

Management

Main article: Management of borderline personality disorder

Psychotherapy forms the foundation of treatment for borderline personality disorder with medications playing a lesser role.[64] Treatments should be based on individual case presentation, rather than upon the diagnosis of BPD with comorbid conditions determining medications use, if any.[65] Hospitalization has not been found to improve outcomes or prevent suicide over community care in those with BPD.[66]

Psychotherapy

Four comprehensive psychosocial interventions for BPD – two psychodynamic treatments (mentalization-based, and transference-focused) and two cognitive-behavioral treatments (dialectical behavioral, and schema-focused) – were the subject of a 2009 review that found that each therapy reduced the severity of the disorder or some elements of it, especially physical self-harm.[67] A 2010 review found that the highest quality evidence from clinical trials of psychotherapeutic interventions supports dialectical behavior therapy and mentalization-based therapy.[68]

A special problem of psychotherapy with borderline patients is intense projection. It requires the psychotherapist to be flexible in considering negative attributions by the patient rather than quickly interpreting the projection.[69]

Medications

A 2010 review by the Cochrane collaboration found that the total severity of BPD is not significantly affected by any drug. No drugs show promise for "the core BPD symptoms of chronic feelings of emptiness, identity disturbance and abandonment." However, the authors found that some drugs may impact certain associated symptoms or the symptoms of comorbid conditions.[70]

Of the typical antipsychotics studied in relation to BPD, haloperidol may reduce anger, and flupenthixol may reduce the likelihood of suicidal behavior. Among the atypical antipsychotics, aripiprazole may reduce interpersonal problems, impulsivity, anger, psychotic paranoid symptoms, depression, anxiety, and general psychiatric pathology; olanzapine may decrease affective instability, anger, psychotic paranoid symptoms, and anxiety, but placebo had a greater ameliorative impact on suicidal ideation than olanzapine did; and ziprasidone treatment demonstrated no significant therapeutic effect.[70]

Of the mood stabilizers studied, valproate semisodium may ameliorate depression and interpersonal problems, and it may reduce anger; lamotrigine may reduce impulsivity and anger, topiramate may ameliorate interpersonal problems, impulsivity, anxiety, anger and general psychiatric pathology, but carbamazepine treatment demonstrated no significant effect. Among the antidepressants, amitriptyline may reduce depression, but mianserin, fluoxetine, fluvoxamine and phenelzine sulfate showed no effect. Omega-3 fatty acid may ameliorate suicidality and improve depression. The review warned that most trials have not been replicated, so the evidence is not strong, and the effect of long-term use has not been assessed.[70]

Because of the weakness of the evidence and the potential for serious side effects from some drug therapies, the UK National Institute for Health and Clinical Excellence (NICE) 2009 clinical guideline for the treatment and management of BPD recommends: "Drug treatment should not be used specifically for borderline personality disorder or for the individual symptoms or behaviour associated with the disorder" but "drug treatment may be considered in the overall treatment of comorbid conditions," and suggests "review of the treatment of people with borderline personality disorder who do not have a diagnosed comorbid mental or physical illness and who are currently being prescribed drugs, with the aim of reducing and stopping unnecessary drug treatment."[71]

Services

Individuals with BPD sometimes use mental health services extensively. They accounted for about 20 percent of psychiatric hospitalizations in one survey.[72] The majority of BPD patients continue to use outpatient treatment in a sustained manner for several years, but the number using the more restrictive and costly forms of treatment, such as inpatient admission, declines with time.[73] Experience of services varies.[74] Assessing suicide risk can be a challenge for mental health services (and patients themselves tend to underestimate the lethality of self-injurious behaviours) with typically a chronically elevated risk of suicide much above that of the general population and a history of multiple attempts when in crisis. [75] Approximately half the individuals who commit suicide meet criteria for a personality disorder. Borderline personality disorder remains the most commonly associated personality disorder with suicide. [76]

Prognosis

Data indicate that people with BPD often make good progress. Around a third (depending on criteria used) of people diagnosed with BPD achieve remission within a year or two.[77] A longitudinal study found that, six years after being diagnosed with BPD, 56% had good psychosocial functioning compared to 26% at baseline. While vocational achievement was generally more limited even compared to those with other personality disorders, those whose symptoms had remitted were significantly more likely to have a good relationship with a spouse/partner and at least one parent, good work/school performance, a sustained work/school history, good global functioning and good psychosocial functioning.[78]

Another study found that ten years from baseline (during a hospitalization), 86% of patients had sustained remission of symptoms, with around half achieving recovery defined as being free of symptoms and achieving certain levels of both social and vocational functioning.[79]

Particular difficulties have been observed in the relationship between some care providers and some individuals diagnosed with BPD. A majority of psychiatric staff report finding individuals with BPD moderately to extremely difficult to work with, and more difficult than other client groups.[80] Some clients feel a diagnosis is helpful, allowing them to understand they are not alone, and to connect with others who have BPD and who have developed helpful coping mechanisms. On the other hand, some with the diagnosis of BPD have reported that the term "BPD" felt like a pejorative label rather than a helpful diagnosis, that self-destructive behaviour was incorrectly perceived as manipulative, and that they had limited access to care.[81] Attempts are made to improve public and staff attitudes.[82][83]

Epidemiology

The prevalence of BPD in the general population ranges from 1 to 2 percent.[77][84] The diagnosis appears to be several times more common in (especially young) women than in men, by as much as 3:1, according to the DSM-IV-TR,[2] although the reasons for this are not clear.[85]

The prevalence of BPD in the United States has been calculated as 1 percent to 3 percent of the adult population,[5] with approximately 75 percent of those diagnosed being female.[86] It has been found to account for 20 percent of psychiatric hospitalizations.[citation needed]

History

Since the earliest record of medical history, the coexistence of intense, divergent moods within an individual has been recognized by such writers as Homer, Hippocrates and Aretaeus, the last describing the vacillating presence of impulsive anger, melancholia and mania within a single person. After medieval suppression of the concept, it was revived by Swiss physician Théophile Bonet in 1684, who, using the term folie maniaco-mélancolique,[n 6] noted the erratic and unstable moods with periodic highs and lows that rarely followed a regular course. His observations were followed by those of other writers who noted the same pattern, including writers such as the American psychiatrist C. Hughes in 1884 and J.C. Rosse in 1890, who called the disorder "borderline insanity".[87] Kraepelin, in 1921, identified an "excitable personality" that closely parallels the borderline features outlined in the current concept of borderline.[n 1]

Adolf Stern wrote the first significant psychoanalytic work to use the term "borderline" in 1938,[88] referring to a group of patients with what was thought to be a mild form of schizophrenia, on the borderline between neurosis and psychosis. For the next decade the term was in popular and colloquial use, a loosely conceived designation mostly used by theorists of the psychoanalytic and biological schools of thought[citation needed]. Increasingly, theorists who focused on the operation of social forces were recognized as well.

The 1960s and 1970s saw a shift from thinking of the borderline syndrome as borderline schizophrenia to thinking of it as a borderline affective disorder (mood disorder), on the fringes of Bipolar disorder, cyclothymia and dysthymia. In DSM-II, stressing the affective components, it was called cyclothymic personality (affective personality).[2] In parallel to this evolution of the term "borderline" to refer to a distinct category of disorder, psychoanalysts such as Otto Kernberg were using it to refer to a broad spectrum of issues, describing an intermediate level of personality organization[n 1] between neurotic and psychotic processes.[89]

The term "borderline" has been described as uniquely inadequate for suggesting the kinds of signs and symptoms characteristic of BPD.[90]

Standardized criteria were developed[91] to distinguish BPD from affective disorders and other Axis I disorders, and BPD became a personality disorder diagnosis in 1980 with the publication of DSM-III.[77] The diagnosis was formulated predominantly in terms of mood and behavior, distinguished from sub-syndromal schizophrenia which was termed "Schizotypal personality disorder".[89] The final terminology in use by the DSM today was decided by the DSM-IV Axis II Work Group of the American Psychiatric Association.[n 7]

Society and culture

Film and television

Several films portraying characters either explicitly diagnosed or with traits strongly suggestive of mental illness have been the subject of discussion by certain psychiatrists and film experts. The films Play Misty for Me[92] and Fatal Attraction are two examples,[93] as is the memoir Girl, Interrupted by Susanna Kaysen (and the movie based on it, with Winona Ryder as Kaysen). Each of these films suggests the emotional instability of the disorder; however, the first two cases show a person more aggressive to others than to herself, which in fact is less typical.[94] The 1992 film Single White Female suggests different aspects of the disorder: the character Hedy suffers from a markedly disturbed sense of identity and, as with the first two films, abandonment leads to drastic measures.[95]

The character of Anakin Skywalker/Darth Vader in the Star Wars films has been "diagnosed" as having BPD. Psychiatrists Eric Bui and Rachel Rodgers have argued that the character meets six of the nine diagnostic criteria; Bui also found Anakin a useful example to explain BPD to medical students. In particular, Bui points to the character's abandonment issues, uncertainty over his identity and violent dissociative episodes.[96] Other films attempting to depict characters with the disorder include The Crush, Mad Love, Malicious, Interiors, Notes On a Scandal, The Cable Guy, Mr. Nobody, Closer, and Cracks.[93] The film Borderline, based on the book of the same name by Marie-Sissi Labrèche, attempts to explore BPD through its main character, Kiki.

Literature

The memoir Songs of Three Islands by Millicent Monks is a meditation on how BPD affects several generations of the wealthy Carnegie family.

In Lois McMaster Bujold's science fiction novel Komarr, Tien Vorsoisson has BPD; his disorder drives a large part of the story.[97]

Awareness

In early 2008, the United States House of Representatives declared the month of May as Borderline Personality Disorder Awareness Month.[98][99]

Notable people

Controversies

Gender

The diagnosis of BPD has been criticized from a feminist perspective.[110][111]This is because some of the diagnostic criteria/symptoms of the disorder uphold common gender stereotypes about women. For example, the criteria of "a pattern of unstable personal relationships, unstable self-image, and instability of mood," can all be linked to the stereotype that women are "neither decisive nor constant".[112] Some think that people with BPD commonly have a history of sexual abuse in childhood.[113]

One feminist critique suggests that BPD is a stigmatizing diagnosis that can sometimes evoke negative responses from health care providers, and additionally, that women who have survived sexual abuse in childhood are therefore sometimes re-traumatized by any such abusive mental health service.[114] The question has also been raised of why women are three times more likely to be diagnosed with BPD than men.[n 8] However, other stigmatizing diagnoses, such as antisocial personality disorder are diagnosed three times as often in men than women.

Some feminist writers have suggested it would be better to give these women the diagnosis of a post-traumatic disorder as this would acknowledge their abuse, but others have argued that the use of the PTSD diagnosis merely medicalizes abuse rather than addressing the root causes in society.[115] Women may be more likely to receive a personality disorder diagnosis if they reject the female role by being hostile, successful or sexually active; alternatively if a woman presents with psychiatric symptoms but does not conform to a traditional passive sick role, she may be labelled as a "difficult" patient and given the stigmatizing diagnosis of BPD.[116]

Stigma

The features of BPD include emotional instability, intense unstable interpersonal relationships, a need for relatedness and a fear of rejection. As a result, people with BPD often evoke intense emotions in those around them. Pejorative terms to describe persons with BPD such as “difficult,” “treatment resistant,” “manipulative,” “demanding” and “attention seeking" are often used, and may become a self-fulfilling prophecy as the clinician's negative response triggers further self-destructive behaviour.[117]

In psychoanalytic theory, this stigmatization may be thought to reflect countertransference (when a therapist projects their own feelings on to a client), as people with BPD are prone to use defense mechanisms such as splitting and projective identification. Thus the diagnosis "often says more about the clinician's negative reaction to the patient than it does about the patient ... as an expression of counter transference hate, borderline explains away the breakdown in empathy between the therapist and the patient and becomes an institutional epithet in the guise of pseudoscientific jargon".[89]

This inadvertent counter transference can give rise to inappropriate clinical responses including excessive use of medication, inappropriate mothering and punitive use of limit setting and interpretation.[118] People with BPD are seen as among the most challenging groups of patients, requiring a high degree of skill and training in the psychiatrists, therapists and nurses involved in their treatment.[119] While some clinicians agree with the diagnosis under the name "borderline personality disorder", some would like the name to be changed.[120] One critique says that some who are labeled "Borderline Personality Disorder" feel this name is unhelpful, stigmatizing, and/or inaccurate.[120]

The Treatment and Research Advancements National Association for Personality Disorders (TARA-APD) campaigns to change the name and designation of BPD in DSM-5.[121] The paper How Advocacy is Bringing BPD into the Light[122] reports that "the name BPD is confusing, imparts no relevant or descriptive information, and reinforces existing stigma...".

Terminology

Because of the above concerns, and because of a move away from the original theoretical basis for the term (see history), there is ongoing debate about renaming BPD. Alternative suggestions for names include emotional regulation disorder or emotional dysregulation disorder. Impulse disorder and interpersonal regulatory disorder are other valid alternatives, according to John Gunderson of McLean Hospital in the United States.[123]

Another term (for example, by psychiatrist Carolyn Quadrio) is post traumatic personality disorganization (PTPD), reflecting the condition's status as (often) both a form of chronic post traumatic stress disorder (PTSD) and a personality disorder in the belief that it is a common outcome of developmental or attachment trauma.[52] Some people do not report any kind of traumatic event.[n 9]

Notes

  1. ^ {{url=http://journals1.scholarsportal.info.myaccess.library.utoronto.ca/details.xqy?uri=/01406736/v364i9432/453_bpd
  2. ^ a b c d e f g Borderline personality disorder – Diagnostic and Statistical Manual of Mental Disorders Fourth edition Text Revision (DSM-IV-TR) American Psychiatric Association (2000) Cite error: The named reference "DSM-IV-TR" was defined multiple times with different content (see the help page).
  3. ^ a b Robinson, David J. (2005). Disordered Personalities. Rapid Psychler Press. pp. 255–310. ISBN 1-894328-09-4.
  4. ^ "Borderline Personality Disorder: Proposal to include a supplementary name in the DSM-IV text revision". Borderline Personality Today. Retrieved 8 February 2010.
  5. ^ a b c d "Borderline personality disorder". MayoClinic.com. Retrieved 15 May 2008.
  6. ^ "New Theses about the Borderline Personality". wilhelm-griesinger-institut.de. Retrieved 31 January 2009.
  7. ^ Koenigsberg HW, Harvey PD, Mitropoulou V; et al. (2002). "Characterizing affective instability in borderline personality disorder". Am J Psychiatry. 159 (5): 784–8. doi:10.1176/appi.ajp.159.5.784. PMID 11986132. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  8. ^ Meyer B, Ajchenbrenner M, Bowles DP (2005). "Sensory sensitivity, attachment experiences, and rejection responses among adults with borderline and avoidant features". J Personal Disord. 19 (6): 641–58. doi:10.1521/pedi.2005.19.6.641. PMID 16553560. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  9. ^ Zanarini MC, Frankenburg FR, DeLuca CJ, Hennen J, Khera GS, Gunderson JG (1998). "The pain of being borderline: dysphoric states specific to borderline personality disorder". Harvard Review of Psychiatry. 6 (4): 201–7. doi:10.3109/10673229809000330. PMID 10370445.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  10. ^ American Psychiatric Association (2001). "Consumer & family information: borderline personality disorder". Psychiatric Serv. 52 (12): 1569–70. doi:10.1176/appi.ps.52.12.1569. PMID 11726742. {{cite journal}}: Unknown parameter |month= ignored (help)
  11. ^ Attention: This template ({{cite pmid}}) is deprecated. To cite the publication identified by PMID 15204804, please use {{cite journal}} with |pmid=15204804 instead.
  12. ^ a b Arntz A (2005). "Introduction to special issue: cognition and emotion in borderline personality disorder". Behav Ther Exp Psychiatry. 36 (3): 167–72. doi:10.1016/j.jbtep.2005.06.001. PMID 16018875. {{cite journal}}: Unknown parameter |month= ignored (help)
  13. ^ Levy KN, Meehan KB, Weber M, Reynoso J, Clarkin JF (2005). "Attachment and borderline personality disorder: implications for psychotherapy". Psychopathology. 38 (2): 64–74. doi:10.1159/000084813. PMID 15802944.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  14. ^ Daley SE, Burge D, Hammen C (2000). "Borderline personality disorder symptoms as predictors of 4-year romantic relationship dysfunction in young women: addressing issues of specificity". J Abnorm Psychol. 109 (3): 451–60. doi:10.1037/0021-843X.109.3.451. PMID 11016115. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  15. ^ Zanarini, Mary C. "The Subsyndromal Phenomenology of Borderline Personality Disorder: A 10-Year Follow-Up Study." The American Journal of Psychiatry, June 2007.
  16. ^ a b "Borderline Personality Disorder DSM-IV Criteria". BPD Today. Retrieved 21 September 2007.
  17. ^ Potter NN (2006). "What is manipulative behavior, anyway?". J Personal Disord. 20 (2): 139–56, discussion 181–5. doi:10.1521/pedi.2006.20.2.139. PMID 16643118. {{cite journal}}: Unknown parameter |month= ignored (help)
  18. ^ Hawton K, Townsend E, Arensman E; et al. (2000). Hawton, Keith KE (ed.). "Psychosocial versus pharmacological treatments for deliberate self harm". Cochrane Database Syst Rev. (2): CD001764. doi:10.1002/14651858.CD001764. PMID 10796818. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  19. ^ Borderline Personality Disorder Facts. BPD Today. Retrieved 21 September 2007.
  20. ^ Gunderson J, "Borderline Personality Disorder", "The New England Journal of Medicine", 26 May 2011
  21. ^ Soloff P.H., Lis J.A., Kelly T.; et al. (1994). "Self-mutilation and suicidal behavior in borderline personality disorder". Journal of Personality Disorders. 8 (4): 257–67. doi:10.1521/pedi.1994.8.4.257. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  22. ^ Gardner D.L., Cowdry R.W. (1985). "Suicidal and parasuicidal behavior in borderline personality disorder". Psychiatric Clinics of North America. 8 (2): 389–403. PMID 3895199.
  23. ^ a b c Allen DM, Farmer RG (1996). "Family relationships of adults with borderline personality disorder". Compr Psychiatry. 37 (1): 43–51. doi:10.1016/S0010-440X(96)90050-4. PMID 8770526.
  24. ^ Horesh N, Sever J, Apter A (2003). "A comparison of life events between suicidal adolescents with major depression and borderline personality disorder". Compr Psychiatry. 44 (4): 277–83. doi:10.1016/S0010-440X(03)00091-9. PMID 12923705. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  25. ^ Emotionally unstable personality disorder – International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) – World Health Organization
  26. ^ Neil R.Carlson, C.Donald Heth. "Psychology: The Science of Behaviour". Pearson Canada Inc,2010, p.570.
  27. ^ Zhong J, Leung F (2007). "Should borderline personality disorder be included in the fourth edition of the Chinese classification of mental disorders?". Chin Med J. 120 (1): 77–82. PMID 17254494. {{cite journal}}: Unknown parameter |month= ignored (help)
  28. ^ a b Gunderson JG, Sabo AN (1993). "The phenomenological and conceptual interface between borderline personality disorder and PTSD". Am J Psychiatry. 150 (1): 19–27. PMID 8417576.
  29. ^ Hoffman PD, Buteau E, Hooley JM, Fruzzetti AE, Bruce ML (2003). "Family members' knowledge about borderline personality disorder: correspondence with their levels of depression, burden, distress, and expressed emotion". Family Process. 42 (4): 469–78. doi:10.1111/j.1545-5300.2003.00469.x. PMID 14979218.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  30. ^ Daley SE, Burge D, Hammen C (2000). "Borderline personality disorder symptoms as predictors of 4-year romantic relationship dysfunction in young women: addressing issues of specificity". J Abnorm Psychol. 109 (3): 451–60. doi:10.1037/0021-843X.109.3.451. PMID 11016115. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  31. ^ Netherton, S.D., Holmes, D., Walker, C.E. 1999. Child and Adolescent Psychological Disorders: Comprehensive Textbook. New York, NY: Oxford University Press.
  32. ^ Zanarini MC, Frankenburg FR, Dubo ED; et al. (1998). "Axis I comorbidity of borderline personality disorder". Am J Psychiatry. 155 (12): 1733–9. PMID 9842784. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  33. ^ Gregory, R. (2006). Clinical Challenges in Co-occurring Borderline Personality and Substance Use Disorders. Psychiatric Times XXIII (13). Retrieved 23 September 2007.
  34. ^ ADHD, borderline personality disorder and bipolar disorder, JJ Sandra Kooij, MD PhD – psychiatrist, Head Program & Expertise Center Adult ADHD PsyQ, The Hague
  35. ^ Bolton S, Gunderson JG (1996). "Distinguishing borderline personality disorder from bipolar disorder: differential diagnosis and implications". Am J Psychiatry. 153 (9): 1202–7. PMID 8780426. {{cite journal}}: Unknown parameter |month= ignored (help)
  36. ^ (2001). "Treatment of Patients With Borderline Personality Disorder". APA Practice Guidelines. Retrieved 21 September 2007.
  37. ^ "Differential Diagnosis of Borderline Personality Disorder". BPD Today. Retrieved 21 September 2007.
  38. ^ Rosemery O. Nelson- Gray, Christopher M. Lootens, John T. Mitchell, Christopher D. Robertson, Natalie E. Hundt, & Nathan A. Kimbrel (2009). Assessment and Treatment of Personality Disorders: A Behavioral Perspective. The Behavior Analyst Today, 10(1), 7–46 BAO
  39. ^ Jamison, Kay R.; Goodwin, Frederick Joseph (1990). Manic-depressive illness. Oxford [Oxfordshire]: Oxford University Press. ISBN 0-19-503934-3.{{cite book}}: CS1 maint: multiple names: authors list (link)
  40. ^ Akiskal HS, Yerevanian BI, Davis GC, King D, Lemmi H (1985). "The nosologic status of borderline personality: clinical and polysomnographic study". Am J Psychiatry. 142 (2): 192–8. PMID 3970243. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  41. ^ Gunderson JG, Elliott GR (1985). "The interface between borderline personality disorder and affective disorder". Am J Psychiatry. 142 (3): 277–88. PMID 2857532. {{cite journal}}: Unknown parameter |month= ignored (help)
  42. ^ McGlashan TH (1983). "The borderline syndrome. II. Is it a variant of schizophrenia or affective disorder?". Arch Gen Psychiatry. 40 (12): 1319–23. PMID 6651467. {{cite journal}}: Unknown parameter |month= ignored (help)
  43. ^ Pope HG, Jonas JM, Hudson JI, Cohen BM, Gunderson JG (1983). "The validity of DSM-III borderline personality disorder. A phenomenologic, family history, treatment response, and long-term follow-up study". Arch Gen Psychiatry. 40 (1): 23–30. PMID 6849616. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  44. ^ Mackinnon DF, Pies R (2006). "Affective instability as rapid cycling: theoretical and clinical implications for borderline personality and bipolar spectrum disorders". Bipolar Disord. 8 (1): 1–14. doi:10.1111/j.1399-5618.2006.00283.x. PMID 16411976. {{cite journal}}: Unknown parameter |month= ignored (help)
  45. ^ Goldberg, Ivan MD (February 2006). "MMEDLINE Citations on The Borderline-Bipolar Connection". Bipolar disord. 8 (1): 1–14. Retrieved 21 September 2007.
  46. ^ Benazzi F (2006). "Borderline personality-bipolar spectrum relationship". Prog Neuropsychopharmacol Biol Psychiatry. 30 (1): 68–74. doi:10.1016/j.pnpbp.2005.06.010. PMID 16019119. {{cite journal}}: Unknown parameter |month= ignored (help)
  47. ^ a b Kluft, Richard P. (1990). Incest-Related Syndromes of Adult Psychopathology. American Psychiatric Pub, Inc. pp. 83, 89. ISBN 0-88048-160-9.
  48. ^ Zanarini MC, Frankenburg FR (1997). "Pathways to the development of borderline personality disorder". Journal of personality disorders. 11 (1): 93–104. doi:10.1521/pedi.1997.11.1.93. PMID 9113824.
  49. ^ Zanarini MC, Gunderson JG, Marino MF, Schwartz EO, Frankenburg FR (1989). "Childhood experiences of borderline patients". Comprehensive Psychiatry. 30 (1): 18–25. doi:10.1016/0010-440X(89)90114-4. PMID 2924564. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  50. ^ Brown GR, Anderson B (1991). "Psychiatric morbidity in adult inpatients with childhood histories of sexual and physical abuse". Am J Psychiatry. 148 (1): 55–61. PMID 1984707. {{cite journal}}: Unknown parameter |month= ignored (help)
  51. ^ Herman, Judith Lewis; Judith Herman MD (1992). Trauma and recovery. New York: BasicBooks. ISBN 0-465-08730-2.{{cite book}}: CS1 maint: multiple names: authors list (link)
  52. ^ a b Quadrio, C. (December 2005). "Axis One/Axis Two: A disordered borderline". Australian & New Zealand Journal of Psychiatry 39 (Suppl. 1): 141–156.
  53. ^ Zanarini M.C., Frankenburg F.R. (1997). "Pathways to the development of borderline personality disorder". Journal of Personality Disorders. 11 (1): 93–104. doi:10.1521/pedi.1997.11.1.93. PMID 9113824.
  54. ^ a b c Zanarini MC, Frankenburg FR, Reich DB; et al. (2000). "Biparental failure in the childhood experiences of borderline patients". J Personal Disord. 14 (3): 264–73. doi:10.1521/pedi.2000.14.3.264. PMID 11019749. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  55. ^ Dozier, M.; K. C. Stovall, et al. (1999). "Attachment and psychopathology in adulthood" in Cassidy, J.; P. Shaver (Eds.), Handbook of attachment pp. 497–519. New York: Guilford Press.
  56. ^ a b Goodman M, New A, Siever L (2004). "Trauma, genes, and the neurobiology of personality disorders". Ann N Y Acad Sci. 1032: 104–16. doi:10.1196/annals.1314.008. PMID 15677398. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  57. ^ Kernberg, Otto F. Borderline conditions and pathological narcissism. Northvale, N.J.: J. Aronson. ISBN 0-87668-762-1.
  58. ^ Torgersen S (2000). "Genetics of patients with borderline personality disorder". Psychiatr Clin North Am. 23 (1): 1–9. doi:10.1016/S0193-953X(05)70139-8. PMID 10729927. {{cite journal}}: Unknown parameter |month= ignored (help)
  59. ^ Torgersen S, Lygren S, Oien PA; et al. (2000). "A twin study of personality disorders". Compr Psychiatry. 41 (6): 416–25. doi:10.1053/comp.2000.16560. PMID 11086146. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  60. ^ a b c Bradley R., Jenei J., Westen D. (2005). "Etiology of borderline personality disorder: Disentangling the contributions of intercorrelated antecedents". The Journal of Nervous and Mental Disease. 193 (1): 24–31. PMID 15674131.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  61. ^ Rosenthal, M. Z., Cheavens, J. S., Lejuez, C. W., Lynch, T. R. (2005). Thought suppression mediates the relationship between negative affect and borderline personality disorder symptoms. Behavior and Research Therapy, 43(9), 1173–1185.
  62. ^ Ayduk O., Zayas V., Downey G., Cole A. B., Shoda Y., Mischel W. (2008). "Rejection Sensitivity and Executive Control: Joint predictors of Borderline Personality features". Journal of Research in Personality. 42 (1): 151–168. doi:10.1016/j.jrp.2007.04.002. PMC 2390893. PMID 18496604.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  63. ^ Parker, A. G., Boldero, J. M., & Bell, R. C. (2006). Borderline personality disorder features: The role of self-discrepancies & self-complexity. Psychology and Psychotherapy: Theory, Research and Practice, 79, 309–321.
  64. ^ Leichsenring F, Leibing E, Kruse J, New AS, Leweke F (2011). "Borderline personality disorder". Lancet. 377 (9759): 74–84. doi:10.1016/S0140-6736(10)61422-5. PMID 21195251. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  65. ^ "CG78 Borderline personality disorder (BPD): NICE guideline". Nice.org.uk. 28 January 2009. Retrieved 12 August 2009.
  66. ^ Paris, J (June 2004). "Is hospitalization useful for suicidal patients with borderline personality disorder?". Journal of personality disorders. 18 (3): 240–7. doi:10.1521/pedi.18.3.240.35443. PMID 15237044.
  67. ^ Attention: This template ({{cite pmid}}) is deprecated. To cite the publication identified by PMID 19807718, please use {{cite journal}} with |pmid= 19807718 instead.
  68. ^ Attention: This template ({{cite pmid}}) is deprecated. To cite the publication identified by PMID 20425311, please use {{cite journal}} with |pmid= 20425311 instead.
  69. ^ Blechner M (1994). "Projective identification, countertransference, and the "maybe-me."". Contemporary Psychoanalysis. 30: 619–630.
  70. ^ a b c Stoffers J, Völlm BA, Rücker G, Timmer A, Huband N, Lieb K (2010). Lieb, Klaus (ed.). "Pharmacological interventions for borderline personality disorder". Cochrane Database Syst Rev (6): CD005653. doi:10.1002/14651858.CD005653.pub2. PMID 20556762.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  71. ^ "The UK National Institute for Health and Clinical Excellence (NICE) 2009 clinical guideline for the treatment and management of BPD" (PDF). Retrieved 6 September 2011.
  72. ^ Zanarini MC, Frankenburg FR, Khera GS, Bleichmar J (2001). "Treatment histories of borderline inpatients". Compr Psychiatry. 42 (2): 144–50. doi:10.1053/comp.2001.19749. PMID 11244151.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  73. ^ Zanarini MC, Frankenburg FR, Hennen J, Silk KR (2004). "Mental health service utilization by borderline personality disorder patients and Axis II comparison subjects followed prospectively for 6 years". J Clin Psychiatry. 65 (1): 28–36. doi:10.4088/JCP.v65n0105. PMID 14744165. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  74. ^ Fallon P (2003). "Travelling through the system: the lived experience of people with borderline personality disorder in contact with psychiatric services". J Psychiatr Ment Health Nurs. 10 (4): 393–401. doi:10.1046/j.1365-2850.2003.00617.x. PMID 12887630. {{cite journal}}: Unknown parameter |month= ignored (help)
  75. ^ Links, P.; Y. Bergmans, S. Warwar (1 July 2004). "Assessing Suicide Risk in Patients With Borderline Personality Disorder". Psychiatric Times XXI (8). Retrieved 23 September 2007.
  76. ^ Klaus Lieb, Mary C Zanarini, Christian Schmahl, Marsha M Linehan, Martin Bohus, " Borderline personality disorder", The Lancet, 2012-12-02
  77. ^ a b c Oldham, J. (July 2004). "Borderline Personality Disorder: An Overview" Psychiatric Times XXI (8). Retrieved 21 September 2007.
  78. ^ Zanarini, M.C.; F.R. Frankenburg, J. Hennen, et al. (February 2005). "Psychosocial functioning of borderline patients and axis II comparison subjects followed prospectively for six years". J Personal Disord 19 (1): 19–29. Retrieved on 2007-09-23.
  79. ^ American Psychiatric Association, Herold and Velora, Press release 15 April 2010
  80. ^ Cleary, M.; N. Siegfried, G. Walter (September 2002). "Experience, knowledge and attitudes of mental health staff regarding clients with a borderline personality disorder". Australian and New Zealand Journal of Ophthalmology 11 (3): 186–191. Retrieved 23 September 2007.
  81. ^ Nehls, N. (August 1999). "Borderline personality disorder: the voice of patients". Res Nurs Health (22): 285–93. Retrieved 23 September 2007.
  82. ^ Deans, C.; E. Meocevic "Attitudes of registered psychiatric nurses towards patients diagnosed with borderline personality disorder". Contemporary Nurse. Retrieved 23 September 2007.
  83. ^ Krawitz, R. (July 2004). "Borderline personality disorder: attitudinal change following training". Australian and New Zealand Journal of Psychiatry 38 (7): 554. Retrieved 23 September 2007.
  84. ^ Swartz, M.; D. Blazer, L. George, et al. (1990). "Estimating the prevalence of borderline personality disorder in the community". Journal of Personality Disorders 4 (3): 257–72. Retrieved 23 September 2007.
  85. ^ Skodol AE, Bender DS (2003). "Why are women diagnosed borderline more than men?" (PDF). Psychiatr Q. 74 (4): 349–60. doi:10.1023/A:1026087410516. PMID 14686459.
  86. ^ Korzekwa MI, Dell PF, Links PS, Thabane L, Webb SP (2008). "Estimating the prevalence of borderline personality disorder in psychiatric outpatients using a two-phase procedure". Comprehensive Psychiatry. 49 (4): 380–6. doi:10.1016/j.comppsych.2008.01.007. PMID 18555059.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  87. ^ C. Hughes (1884). "Borderline psychiatric records – prodronal symptoms of physical impairments". Alienists & Neurology. 5. {{cite journal}}: Unknown parameter |pates= ignored (help)
  88. ^ Stern, Adolf (1938). "Psychoanalytic investigation of and therapy in the borderline group of neuroses". Psychoanalytic Quarterly. 7: 467–489.
  89. ^ a b c Aronson, T (1985) Historical perspectives on the borderline concept: A review and critique. Psychiatry: Journal for the Study of Interpersonal Processes. Vol 48(3), pp. 209–222
  90. ^ Stone MH. (2005). "Borderline Personality Disorder: History of the Concept". In Zanarini MC (ed.). Borderline personality disorder. Boca Raton, FL.: Taylor & Francis. pp. 1–18. ISBN 0-8247-2928-5.
  91. ^ Gunderson JG, Kolb JE, Austin V (1981). "The diagnostic interview for borderline patients". Am J Psychiatry. 138 (7): 896–903. PMID 7258348. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  92. ^ Robinson, David J. (2003). Reel Psychiatry: Movie Portrayals of Psychiatric Conditions. Port Huron, Michigan: Rapid Psychler Press. p. 234. ISBN 1-894328-07-8.
  93. ^ a b Robinson, David J. (1999). The Field Guide to Personality Disorders. Rapid Psychler Press. p. 113. ISBN 0-9680324-6-X.
  94. ^ Wedding D, Boyd MA, Niemiec RM (2005). Movies and Mental Illness: Using Films to Understand Psychopathology. Cambridge,MA: Hogrefe. p. 59. ISBN 0-88937-292-6.{{cite book}}: CS1 maint: multiple names: authors list (link)
  95. ^ Robinson (Reel Psychiatry: Movie Portrayals of Psychiatric Conditions), p. 235
  96. ^ Hsu, Jeremy (8 June 2010). "The Psychology of Darth Vader Revealed". LiveScience. TopTenReviews. Retrieved 8 June 2010.
  97. ^ "LOIS-BUJOLD Digest 2552". http://lists.herald.co.uk. July 1999. Retrieved 9 September 2011. {{cite web}}: External link in |publisher= (help)
  98. ^ HR 1005, 4/1/08
  99. ^ "BPD Awareness Month – Congressional History". BPD Today. Mental Health Today. Retrieved 1 November 2010.
  100. ^ Was it really murder?
  101. ^ Coleman's appeal
  102. ^ Carey, Benedict (23 June 2011). "Expert on Mental Illness Reveals her own Fight". The New York Times. Retrieved 10 December 2011.
  103. ^ "NFL Star Brandon Marshall Has Borderline Personality Disorder". Retrieved 1 August 2011.
  104. ^ US Court of Appeals
  105. ^ Smith had personality disorder
  106. ^ [1]
  107. ^ Mikey Welsh found dead in Chicago hotel room
  108. ^ Ravens, Texas-ex Ricky Williams agree to deal
  109. ^ Aileen Wuornos profile
  110. ^ Shaw and Proctor (2005). "Women at the Margins: A Critique of the Diagnosis of Borderline Personality Disorder" (PDF). Feminism & Psychology 15: 483–90. Retrieved 21 September 2007
  111. ^ Wirth-Cauchon, J (200). Women and Borderline Personality Disorder: Symptoms and Stories. Rutgers University Press.ISBN-10: 0813528917
  112. ^ Beauvoir, Simone. The Second Sex New York: Vintage, 1989
  113. ^ Zanarini MC, Frankenburg FR (1997). "Pathways to the development of borderline personality disorder". J Personal Disord. 11 (1): 93–104. doi:10.1521/pedi.1997.11.1.93. PMID 9113824.
  114. ^ Nehls N (1998). "Borderline personality disorder: gender stereotypes, stigma, and limited system of care". Issues Ment Health Nurs. 19 (2): 97–112. doi:10.1080/016128498249105. PMID 9601307.
  115. ^ Becker D (2000). "When she was bad: borderline personality disorder in a posttraumatic age". Am J Orthopsychiatry. 70 (4): 422–32. doi:10.1037/h0087769. PMID 11086521. {{cite journal}}: Unknown parameter |month= ignored (help)
  116. ^ Simmons, D (1992) Gender issues and borderline personality disorder: Why do females dominate the diagnosis? Archives of Psychiatric Nursing, 6(4), 219–223
  117. ^ Aviram RB, Brodsky BS, Stanley B (2006). "Borderline personality disorder, stigma, and treatment implications". Harv Rev Psychiatry. 14 (5): 249–56. doi:10.1080/10673220600975121. PMID 16990170.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  118. ^ Vaillant G (1992). "The beginning of wisdom is never calling a patient Borderline". Journal of Psychotherapy Practice and Research. 1 (2): 117–34.
  119. ^ Hinshelwood RD (1999). "The difficult patient". British Journal of Psychiatry. 174: 187–90. PMID 10448440.
  120. ^ a b http://www.borderlinepersonalitytoday.com/main/label.htm
  121. ^ Treatment and Research Advancements National Association for Personality Disorders(TARA-APD)
  122. ^ http://www.tara4bpd.org/dyn/index.php?option=content&task=view&id=32&Itemid=35 How Advocacy is Bringing BPD into the Light
  123. ^ Gunderson, John G. M.D., Hoffman, Perry D., PhD Understanding and Treating Borderline Personality Disorder A Guide for Professionals and Families Arlington, Virginia, American Psychiatric Publishing, Inc., 2005
  1. ^ a b c Millon 1996, pp. 645–690
  2. ^ Linehan et al. 2006, pp. 757–766
  3. ^ Stiglmayr et al. 2005, pp. 372–9
  4. ^ Millon 2004, p. [page needed]
  5. ^ Millon 2006
  6. ^ Millon, Grossman & Meagher 2004, p. 172
  7. ^ Millon 1996, p. viii
  8. ^ American Psychiatric Association 2000, pp. 708
  9. ^ Chapman 2007, p. 52

References

Further reading

  • Bockian, Neil R. et al. New Hope for People with Borderline Personality Disorder: Your Friendly, Authoritative Guide to the Latest in Traditional and Complementary Solutions ISBN 978-0-7615-2572-1
  • Chapman, Alex & Gratz, Kim The Borderline Personality Disorder Survival Guide (2007)
  • Jensen, Joy A. Putting The Pieces Together: A Practical Guide to Recovery from Borderline Personality Disorder ISBN 978-0-9667037-6-4
  • Kreger, Randi The Essential Family Guide to Borderline Personality Disorder: New Tools and Techniques to Stop Walking on Eggshells (2008)
  • Kreisman, Jerold J. and Strauss, Hal. I Hate You, Don't Leave Me: Understanding the Borderline Personality (HPBooks, 1989) ISBN 0895866595
  • Linehan, Marsha M., Skills training manual for treating borderline personality disorder New York ; London : Guilford Press, (1993.) ISBN 978-0-89862-034-4
  • Mason, Paul T. & Kreger, Randi Stop Walking on Eggshells: Taking Your Life Back When Someone You Care About Has Borderline Personality Disorder (1998)
  • Moskovitz, Richard A. Lost in the Mirror: An Inside Look at Borderline Personality Disorder (2001) ISBN 978-0-87833-266-3
  • Petrovic, Nick. The 3D Society (2004)
  • Reiland, Rachel. Get Me Out Of Here: My Recovery from Borderline Personality Disorder (2004) ISBN 978-1-59285-099-0
  • Oakley, Barbara. Evil Genes (2008) PROMETHEUS BOOKS ISBN 978-1-59102-665-5

Template:Link FA

Retrieved from "https://en.wikipedia.org/w/index.php?title=Borderline_personality_disorder&oldid=527489661"