The course of borderline personality disorder from adolescence to early adulthood: A 5-year follow-up study.

BACKGROUND: Studies of the medium- to long-term clinical and functional course for treatment-seeking adolescents with borderline personality disorder (BPD) are lacking. This study aims to outline the psychopathological and functional status of participants, five years after being diagnosed with BPD during adolescence. METHODS: Participants were originally enrolled in a randomized clinical trial that compared mentalization-based group treatment with treatment as usual for adolescents with BPD. Semi-structured interview assessments at five-year follow-up included the Schedules for Clinical Assessment in Neuropsychiatry and the Structured Clinical Interview for DSM-5 Personality Disorders. Attention deficit hyperactivity disorder (ADHD), alcohol, substance and tobacco use, posttraumatic stress disorder (PTSD), complex PTSD, and general functioning were assessed using self-report instruments. RESULTS: 97 of the original sample of 111 participants (87%) participated. They were aged 19-23 years. The most prevalent disorders were ADHD (59%), any personality disorder (47%) of which half continued to meet criteria for BPD (24%), anxiety disorders (37%), depressive disorders (32%), PTSD or complex PTSD (20%), schizophrenia (16%), and eating disorders (13%). Only 16% did not meet criteria for any mental disorder. Approximately half of the sample were in psychological and/or psychopharmacological treatment at the time of follow-up. Their general functioning remained impaired, with 36% not engaged in education, employment or training (NEET), which is nearly four times the rate of NEET in the same age group in the general population. CONCLUSIONS: Although stability of the categorical BPD diagnosis is modest, adolescents meeting diagnostic criteria for BPD show a broad range of poor outcomes at five-year follow-up. BPD appears to be a marker of general maladjustment during adolescence and a harbinger of severe problems during the transition to young adulthood. Early intervention programs for adolescents diagnosed with BPD should focus upon a broad range of functional and psychopathological outcomes, especially social and vocational support, rather than the narrow BPD diagnosis.

Outcomes for pregnant women with Borderline Personality Disorder who attended a specialist antenatal service.

OBJECTIVE: Our study focussed on the obstetric and psychosocial outcomes of pregnant women with Borderline Personality Disorder (BPD) who received care via a specialist antenatal clinic in Western Australia. METHOD: This study is a retrospective examination of outcomes for 80 women with a confirmed diagnosis of BPD, with findings compared with published population outcome data for the state. RESULTS: Pregnant women with BPD appeared to be at a risk of complications including pre-eclampsia and special care nursery admission for their newborns when compared to population data. Furthermore, the studied women had elevated rates of psychiatric admissions during pregnancy, child protection involvement, and domestic violence. Polypharmacy exposure was frequent, with the likely impact on obstetric and neonatal outcomes requiring further study. CONCLUSION: The findings reinforced the notion that pregnant women with BPD experience complex multifaceted vulnerabilities and require enhanced multidisciplinary care. Our study further calls for the development of clinical practice guidelines for managing BPD in the perinatal period.

Longitudinal Description and Prediction of Smoking Among Borderline Patients: An 18-Year Follow-Up Study.

Objective: The objectives of this study were (1) to compare smoking between recovered and non-recovered patients with borderline personality disorder (BPD) over the course of 18 years and (2) to assess baseline predictors of tobacco use in patients with BPD.Methods: A total of 264 borderline patients were interviewed concerning their smoking history beginning at the 6-year follow-up wave in a longitudinal study of the course of BPD (McLean Study of Adult Development) and re-interviewed at 2-year intervals over the next 18 years. Initial data collection of the larger study happened between June 1992 and December 1995, and the DSM-III-R and the Revised Diagnostic Interview for Borderlines (DIB-R) were used as the diagnostic instruments for BPD.Results: Recovered patients had a 48% lower prevalence of smoking than non-recovered patients at 6-year follow-up (a significant difference; P = .01). Also, the rate of decline in smoking for the recovered group was 68% and was significantly faster (P = .008) than for the non-recovered group over the subsequent 18 years. Alcohol abuse or dependence (relative risk [RR] = 1.22; 95% CI, 1.06-1.40; P = .005), lower levels of education (RR = 1.28; 95% CI, 1.15-1.42; P < .001), and higher levels of the defense mechanism of denial (RR = 1.08; 95% CI, 1.03-1.13; P = .002) were significant predictors of smoking in borderline patients in multivariate analyses.Conclusions: Taken together, the results of this study suggest that recovery status was an important element in the prevalence of smoking among borderline patients over time. They also suggest that smoking was predicted by 3 factors: prior psychopathology, demographics, and psychological maturity.

Factitious disorder comorbid with borderline personality disorder and dysthymia: from medically unexplained physical symptoms to functional neurological disorder.

INTRODUCTION: In this study, we introduce the concept of comorbidity between factitious disorder (FD), borderline personality disorder (BPD), dysthymia (DY), medically unexplained physical symptoms (MUPS) and functional neurological disorder (FND) characterising patients who may tend to exaggerate physical or psychiatric symptoms of presentation to a general or psychiatric hospital with a constellation of signs that do not receive confirmation from further clinical and instrumental assessments. The similarities between these syndromes and the constant presence of borderline personality in the psychopathology make it the possible link between all these syndromes. MATERIALS AND METHODS: The authors captured the typical appearance and characterisation of FD-BPD-DY-MUPS-FND (Com-1) syndrome in adult and non-forensic acute psychiatric hospitals in the United Kingdom (UK) and adjacent liaison psychiatric teams through case vignettes. Each case vignette merged similar clinical cases and was cross-analysed using information from various mental health and medical professionals and bridging primary and secondary carers' records. RESULTS: The findings suggest striking similarities between the syndromes making borderline personality the bridge pathology for FD, MUPS and FND. The complexity of the diagnosis of these cases is discussed in the study, together with prototypical presentations. CONCLUSIONS: Improving the management of these often-occurring diseases requires multidisciplinary coordination across psychiatry, general care, neurology and surgery departments.

In search of hidden threats: A scoping review on paranoid presentations in personality disorders.

Recent diagnostic developments suggest that paranoia is a transdiagnostic characteristic common to several personality disorders rather than a personality disorder per se. Nonetheless, empirical literature fails to provide comprehensive and univocal findings on whether and how paranoid presentations relate to different personality disorders. In the present scoping review, we map the empirical literature on paranoid presentations in personality disorders, considering the entire spectrum of paranoid manifestations (i.e., the paranoia hierarchy). In selecting original quantitative studies on paranoid presentations in personality-disordered patients, we screened 4,433 records in PsycArticles, PsycInfo and PUBMED. We eventually included 47 eligible studies in the review. Our synthesis indicates consistent empirical evidence of a wide range of paranoid presentations in Paranoid, Schizotypal and Borderline personality disorders. Conversely, little empirical literature exists on paranoid presentations in other personality disorders. Preliminary findings suggest broad-severity paranoid presentations, ranging from milder to severe forms, in Paranoid, Schizotypal and Borderline personality disorders. There is also some evidence of milder forms of paranoia in Avoidant, Antisocial and Narcissistic personality disorders. Conversely, there is poor evidence of paranoid presentations in Schizoid, Histrionic, Dependent or Obsessive-compulsive personality disorders. Research gaps and recommendations for improving empirical research on paranoid presentations in personality disorders are discussed.

Investigating gender-based differential item functioning on the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD): An item response theory analysis.

The McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) is a popular screening tool for identifying people who may have borderline personality disorder (BPD). However, because women are more frequently diagnosed with the disorder than men, it is possible that the MSI-BPD differs in its ability to identify BPD as a function of gender identity. Using item response theory (IRT), we sought to determine if components of the MSI-BPD would demonstrate differential item functioning (DIF), such that one gender identity would be more likely to endorse certain items. Twenty-two thousand thirty-five college undergraduates (14,305 women) aged 18-55 years (M = 18.77, SD = 1.75) were assessed using the MSI-BPD as part of a subject pool screening between 2008 and 2019. The MSI-BPD contains 10 items that are measured dichotomously, and the authors recommend a cut-off of 7 of 10 items endorsed to maximize sensitivity and specificity to BPD. Results suggested that a two-parameter model was the best fit to the data and that unidimensionality and local independence assumptions were met. The following items demonstrated DIF: self-harm/suicidality, affective lability, abandonment, impulsivity, and anger. At equal levels of the latent construct of BPD, women were more likely to endorse self-harm/suicidality, affective lability, and abandonment. Women were more likely to endorse impulsivity at higher levels of BPD, and men were more likely to endorse anger at lower levels of BPD. Ultimately, the effect sizes of these differences were small, however, and likely do not impact the individual's overall outcome on the measure. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

[Scars from Nonsuicidal Self-Injury - What Plastic Surgery Can Do]. / Narben aus nichtsuizidalem selbstverletzendem Verhalten ­ therapeutische Möglichkeiten der plastischen Chirurgie.

Scars from Nonsuicidal Self-Injury - What Plastic Surgery Can Do Abstract. Objective: Nonsuicidal self-injury (NSSI) can induce characteristic scar patterns indicating the origin of these scars. This frequently results in the stigmatization of the involved patients with far-reaching consequences for their daily routine and quality of life. Despite patients being highly interested in scar correction, the potential of surgical therapy to alleviate NSSI-prone behavior and its help in destigmatizing surgical corrections and esthetic improvements in these situations are not well-known. Method: Over a period of 5 years, we analyzed 600 patients requesting NSSI scar treatment in our outpatient clinic. We collected data on the motivation for a scar correction, on the maturity of the scars, the involved body parts, and potential prior scar treatments as well as the amount, localization, and type of performed surgical procedures in our institution. Results: Stigmatization (57 %) and limitations in choice of clothing (18 %) were the most frequent reasons given for scar correction. We performed 358 dermabrasions and 55 serial excisions on these patients, nine combinations of both, and 13 other procedures. Conclusions: Plastic surgery offers multiple possibilities to reduce the stigmatization of patients with NSSI scars, who should thus be informed early about their choices.

The McLean Screening Instrument for Borderline Personality Disorder: What, and why in a clinical cohort?

Borderline Personality Disorder is a severe psychiatric disorder with debilitating consequences. Screening for the disorder is problematic as symptoms overlap with other psychiatric disorders. The McLean Screening Instrument (MSI) assesses endorsement (yes/no) of 10 symptoms, with a cut-off of seven indicating potential caseness. Participants were (N = 68) from an established clinical cohort who completed a structured clinical interview, the MSI, the Childhood Trauma Questionnaire, and the Adolescent and Adult Time Attitudes Scale. A proportion (N = 20) also completed a follow-up interview examining their rationale for endorsing MSI items. Total number of MSI items endorsed was meaningfully related to scores on emotional neglect and negative time attitudes. There was substantive overlap between MSI threshold (≥7 items) and lifetime diagnosis of a mental disorder. The stated rationale for endorsing MSI items, was less indicative of personality trait, and was related more to particular developmental periods, one-off episodes, and life-contexts. Additionally, participants conflated constructs such as emptiness with loneliness, and moodiness with general emotionality. Those meeting MSI threshold recalled more childhood emotional neglect, and were more negative about all time periods. It is apparent that scoring of the MSI is driven by prevailing life circumstances as much as enduring personality traits.

Positive Predictive Value: A Clinician's Guide to Avoid Misinterpreting the Results of Screening Tests.

Background: Recent studies have used self-administered screening scales in community and clinical samples to identify individuals who probably or likely had the disorder of interest. A better understanding of the statistics of screening, specifically positive predictive value, would indicate that the conclusions drawn from these studies are not justified.Methods: The principles and statistics of diagnostic screening and how screening is distinguished from case-finding are reviewed, followed by a review of studies that have failed to consider the positive predictive value of the screening scales in the samples studied.Results: Multiple studies of both clinical and general population samples have used screening measures as case-finding instruments. For example, two recent studies of response to electroconvulsive therapy in depressed patients used a screening scale for borderline personality disorder (BPD) and concluded that the patients with and without BPD responded equally well to treatment. However, the positive predictive value of the screening scale in these studies was less than 50%, meaning the majority of patients considered to have BPD would not have been so diagnosed if interviewed. A similar problem has also been observed in studies using screening scales for bipolar disorder in general population and primary care settings.Conclusions: When studying a disorder with a relatively low prevalence, it is near impossible for a screening test to have sufficient positive predictive value to be used to validly compare the individuals who do and do not screen positive. Researchers using screening measures as diagnostic proxies need to discuss the issue of positive predictive value.

Altered Left Ventricular Myocardial Deformation in Young Women With Borderline Personality Disorder: An Echocardiographic Study.

OBJECTIVE: Borderline personality disorder (BPD) is characterized by intense mood swings, impulsivity, self-injurious behavior, poor anger control, fear of abandonment, and unstable interpersonal relationships. BPD is also associated with a heightened risk of cardiovascular disease, whereby the underlying mechanisms are insufficiently understood. Accordingly, the present study set out to examine whether individuals with BPD would show abnormal myocardial deformation and to explore the role of potential risk factors, including maladaptive stress responsivity, childhood trauma, and current stress exposure. METHODS: Fifty female patients diagnosed with BPD and 50 controls matched for sex and age underwent echocardiography to determine the global longitudinal strain (GLS) of the left ventricle. In addition, childhood trauma, chronic stress, and "allostatic load" were determined, as well as borderline symptom severity and common risk factors for cardiovascular disease. RESULTS: Aside from a significantly greater GLS in BPD patients, a multivariable regression analysis revealed that allostatic load (ß = 0.225, p = .048) was significantly associated with GLS, with childhood trauma (ß = 0.279, p = .062) approaching significance. Conversely, smoking (p = .867), chronic stress (p = .193), and borderline symptom severity (p = .342) were not associated with GLS, even though bivariate correlations were significant. CONCLUSIONS: Somatically healthy women with BPD display subtle signs of increased GLS, which is associated with allostatic load as an indicator of the "wear-and-tear" of the body. The association between childhood trauma with GLS was of similar strength but did not reach the threshold for statistical significance. This finding may support the need for primary prevention of somatic consequences of maladaptive stress responsivity in psychiatric patients.

Management strategies for borderline and narcissistic personality disorders in dermatology practice: a review.

Dermatologists are often ill-equipped to promptly identify and manage patients with personality disorders. Patients with borderline personality disorder (BPD) and narcissistic personality disorder (NPD) frequently present to dermatology clinics, particularly those that provide esthetic services. Although dermatologists should ideally utilize specific management strategies when working with these patients, there is a lack of awareness and availability of resources on how to do so. Here, we review the psychiatry, plastic and reconstructive surgery, and dermatology literature to provide recommendations on tangible management strategies for dermatologists to avoid common mistakes that are made while managing patients with BPD and NPD. Additionally, we also discuss common dermatologic manifestations of BPD and NPD to improve providers' ability to identify patients with these conditions in their practices.

[Physical activity, sleep, and substance use in adults reporting a borderline personality disorder in France and Canada: An online study]. / Activité physique, sommeil et consommation de substances chez les adultes déclarant un trouble de personnalité limite en France et au Canada : une étude en ligne.

Introduction Borderline personality disorder (BPD) is associated with many unhealthy behaviors. Psychoactive substance (alcohol and drugs) use is present in 78% of adults with BPD. Moreover, a poor sleep seems linked to the clinical profile of adults with BPD. Finally, some physical comorbid disorders like obesity, cardiovascular diseases, and diabetes are linked to physical inactivity and sedentary behaviors. However, to this day no study analyzed these behaviors in French-speaking individuals with BPD. Objectives This study's goal is to document health behaviors in adults with BPD in Canada and in France. Method This cross-sectional study consists of an online survey on the LimeSurvey platform including validated questionnaires distributed in France and Canada. To measure physical activity, we used the "Global Physical Activity Questionnaire." Insomnia was measured with the "Insomnia Severity Index." Substance use was measured with the "Alcohol, Smoking and Substance Involvement Test." Descriptive statistics (N,% and mean) are used to describe previously mentioned health behaviors. Five regression models have been realized to find the main associated variables (age, perceived social status, education level, household income, body mass index, emotional regulation difficulties, BPD symptoms, depression level, previous suicide attempts and psychotropic medication use) to health behaviors. Results A total of 167 participants (92 Canadians, 75 French; 146 women, 21 men) filled out the online survey. In this sample, 38% of Canadians and 28% of French reported doing less than 150 minutes of physical activity weekly. Insomnia affected 42% of Canadians and 49% of French. Tobacco use disorder affected 50% of Canadians and 60% of French. Alcohol use disorder affected 36% of Canadians and 53% of French. Cannabis use disorder affected 36% of Canadians and 38% of French. All tested variables were linked to physical activity (R² = 0.09). Insomnia was only linked with BPD symptoms (R² = 0.24). Tobacco use disorder was linked to social status and alcohol use disorder (R² = 0.13). Alcohol use disorder was linked to social status, body mass index, tobacco use disorder, and depression (R² = 0.16). Finally, cannabis use disorder was linked to age, body mass index, tobacco use disorder, depression, and past suicide attempts (R² = 0.26). Conclusion These results are essential to design health prevention interventions in French-speaking adults with BPD in Canada and in France. They help identify the main factors associated with these health behaviors.

Anti-NMDA receptor encephalitis and overlapping demyelinating disorder in a 20-year old female with borderline personality disorder: proposal of a diagnostic and therapeutic algorithm for autoimmune encephalitis in psychiatric patients "case report".

BACKGROUND: Anti-NMDA receptor encephalitis (NMDAR-E) is an autoimmune encephalitis (AE) mainly affecting young females. It typically presents with isolated psychiatric symptoms (e.g. depressed mood) at first and neurological abnormalities (e.g. seizures, movement disorders) only develop later. Thus, there is a high risk of overlooking NMDAR-E in patients with preexisting psychiatric illness due to symptom overlap in the prodromal period of the disease when treatment is most effective. Although rare, concomitant or sequential development of a demyelinating disorder is increasingly recognized as an associated disease entity (overlap syndrome), with immediate diagnostic and therapeutic implications. CASE PRESENTATION: We report a patient with a borderline personality disorder (BPD), which developed NMDAR-E and an overlapping demyelinating disorder with anti-Myelin oligodendrocyte glycoprotein (MOG) -IgG positivity. The initial clinical presentation with predominantly affective symptoms (e.g. mood lability, anxiety, depressed mood) lead us to suspect an exacerbation of the BPD at first. However, acute changes in premorbid behavior, newly developed psychotic symptoms and memory deficits lead us to the correct diagnosis of an AE, which was further complicated by the development of a demyelinating disorder. As a result of impaired illness awareness and psychosis, diagnostic and treatment was difficult to carry out. The symptoms completely remitted after treatment with methylprednisolone 1 g daily for 5 days and 5 cycles of plasma exchange. CONCLUSIONS: Continuous awareness for neuropsychiatric clinical warning signs in patients with a pre-diagnosed psychiatric disorder is important for a timely diagnosis. Therefore, we believe that the diagnostic and therapeutic algorithm provided here, for the first time specifically addressing patients with preexisting psychiatric illness and integrating overlap syndromes, can be a useful tool. Moreover, in order to timely perform diagnostics and treatment, judicial approval should be obtained rapidly.

Psychophysiological concomitants of personality pathology in development.

Psychophysiological research methods allow important insights into normative and pathological functioning of the human organism. This position paper briefly reviews existing studies, investigating the psychophysiological concomitants of personality pathology, with an emphasis on developmental aspects. Focussing on measures, indexing autonomic nervous system (ANS) activity at rest, and its reactivity to experimental challenge, the narrative synthesis of the literature highlights current challenges in the field. Findings on the psychophysiological concomitants of personality pathology are mixed. Inconsistencies among studies arise from differences between disorders and heterogeneity within distinct diagnostic categories. The majority of studies addressed borderline personality disorder, illustrating robust alterations in ANS function linked to severe experiences of early maltreatment and trauma, and associated symptoms of dissociation. However, important life-style and secondary health-related factors (i.e. physical activity, smoking) influencing ANS function are frequently neglected. Adapting a dimensional approach to personality pathology and longitudinal research designs seem promising to advance the filed in the years to come.

Specific antisocial and borderline personality disorder criteria and general substance use: A twin study.

Antisocial (ASPD) and borderline (BPD) personality disorders (PDs) are associated with increased risk for substance use. They are "specific" risk factors among PDs in that they withstand adjusting for the other PDs, whereas the reverse does not hold. Specificity is a classic sign of causation. This empirical work addresses 3 further problems that can undermine causal inferences in personality and substance-use research: hierarchical nature of etiologic factors in psychiatry, imperfectly operationalized PD criteria, and possible genetic or environmental confounding, as seen in lack of "etiologic continuity." We used exploratory structural equation bifactor modeling and biometric models to mitigate these problems. The participants were Norwegian adult twins of ages 19-36 years (N = 2,801). Criteria for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), PDs were assessed using a structured interview. General substance-use risk was indicated by World Health Organization Composite International Diagnostic Interviewed alcohol use disorder and illicit drug use, and by self-reported regular smoking. A general risk factor for all criteria of both ASPD and BPD was the strongest individual correlate of general substance use and showed etiologic continuity, though just 3 specific PD criteria could predict substance use to the same extent. The findings indicate that a broad latent factor for both ASPD and BPD may be a specific and a genetically and environmentally unconfounded risk factor for substance use. Substance-use treatment research might benefit from attending to transdiagnostic models of ASPD, BPD, and related behavioral disinhibition. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Screening for Borderline Personality Disorder With the McLean Screening Instrument: A Review and Critique of the Literature.

Borderline personality disorder (BPD) is underdiagnosed in clinical practice. One approach towards improving diagnostic detection is the use of screening questionnaires. It is important for a screening test to have high sensitivity because the more time-intensive/expensive follow-up diagnostic inquiry will presumably only occur in patients who are positive on the initial screen. The most commonly studied self-report scale specific for BPD is the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD). We summarize the performance of the scale across studies, examine the performance of the scale using different cutoff scores, and highlight the approach used by investigators in recommending a cutoff score. Most studies of the scale have taken a case-finding approach in deriving the cutoff score on the scale instead of a screening approach. For the purposes of screening, it may be more appropriate for the cutoff score on the MSI-BPD to be less than the currently recommended cutoff of 7.

Diagnostic accuracy of DSM-5 borderline personality disorder criteria: Toward an optimized criteria set.

OBJECTIVE: The polythetic system used by the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) for diagnosing borderline personality disorders (BPD) is far from optimal; however, accumulated research and clinical data are strong enough to warrant ongoing utilization. This study examined diagnostic efficiency of the nine DSM-IV BPD criteria, then explored the feasibility of an optimized criteria set in classifying BPD. METHODS: Adults (N=1,623) completed the Structured Clinical Interviews for DSM-IV Axis II Disorders resulting in a BPD group (n=352) and an inpatient psychiatric control group (PC) with no personality disorders (n=1,271). Receiver operator characteristics and diagnostic efficiency statistics were calculated to ascertain the relative diagnostic efficiency of each DSM-5 BPD criterion in classifying BPD cases. RESULTS: Affective instability (Criterion 6) evidenced the strongest capacity to differentiate the groups (AUC = .84, SE = .01, p < .0001). Abandonment fears (Criterion 1), unstable relationships (Criterion 2), identity disturbance (Criterion 3), impulsivity (Criterion 4), and chronic emptiness (Criterion 7) yielded good-to-moderate discrimination (AUC range = .75-.79). A composite index of these six criteria yielded excellent accuracy (AUC = .98, SE = .002, p < .0001), sensitivity (SN=.99), and specificity (SP=.90). CONCLUSIONS: The current findings add to evidence that affective instability is a useful gate criterion for screening, and the optimized criteria set evidences equivalent accuracy to the original 9 criteria, with a substantial reduction in estimated heterogeneity (from 256 combinations with the original set to 42 combinations with the optimized set).

Psychiatric Disorders in Facial Plastic Surgery.

Body dysmorphic disorder and borderline personality disorder are common in esthetic practices and occur in up to 15% of patients. Operating on these patients may not only lead to dissatisfaction but may also worsen their premorbid condition and can induce negative behavior toward the practice. Preventing surgery and referring patients for cognitive therapy is essential. An adequate understanding of these conditions and the available screening tools is indispensable for all esthetic practitioners. Unrealistic emotional attribution to a facial shape, multiple procedures, a near-normal nose at the outset, childhood trauma, multiple comorbid mental conditions, and social dysfunction are red-flags to consider.