[Epistemic and historical elucidation of the borderline personality disorder]. / Elucidación epistémica e histórica del trastorno de la personalidad límite o borderline.

INTRODUCTION: The particularities of those that have been considered "hard cases" in the clinical field, and their relationship with personality disorders, are discussed together with their quintessential conceptual and diagnostic model: the borderline personalities. The aim of the study is to historically and epistemologically rebuild their origins within psychiatry and psychoanalysis. METHODS AND RESULTS: From a classical epistemological and historical study, a brief tour is made through the nineteenth century alienism and the postulate of "partial insanity". Next, a passage is spawned through the concepts that emerged from this postulate: "monomania" and "moral insanity", up to mid-century Kraepelin and the "fundamental states" of manic-depressive insanity as pathological constitutional forms or characters, and reaching the twentieth century with characterology and psychopathic personalities. Finally, psychoanalysis is analyzed as the main source of borderline personality disorders arising from the problems encountered in analytical treatments and the development of the notion of "character neurosis". CONCLUSIONS: Borderline personality disorders are the result of the conjunction of a number of factors, heirs of the notion of "partial insanity", of the fundamental states of manic-depression insanity, of characterology, of the idea of constitutions and pathological personalities, together with the emerging concerns of psychoanalysis in the early twentieth century.

[Genius between music and disease: Medical considerations on Ludwig van Beethoven]. / Genie zwischen Kunst und Krankheit: Medizinische Betrachtungen zu Ludwig van Beethoven.

Ludwig van Beethoven is nowadays considered to be one of the greatest composers in the history of music and his myth-like reputation is enhanced by his deafness; however, deafness was not the only condition which affected his genius. Due to the many lamentations contained in his letters about continuously recurring health problems, various attempts at an interpretation of Beethoven's personality have been undertaken. These included psychoanalytical considerations with respect to his father-mother relationship and also diagnostic attempts with reference to the symptoms of a possible borderline personality syndrome. The aim of this article is to comprehensively analyze the diseases of the patient Beethoven from the perspective of specialized medical disciplines based on new research results, to summarize various discipline-specific considerations and to make a contemporary assessment from the viewpoint of current scientific results.

Patient-reported outcomes in borderline personality disorder.

Patient-reported outcome (PRO) refers to measures that emphasize the subjective view of patients about their health-related conditions and behaviors. Typically, PROs include self-report questionnaires and clinical interviews. Defining PROs for borderline personality disorder (BPD) is particularly challenging given the disorder's high symptomatic heterogeneity, high comorbidity with other psychiatric conditions, highly fluctuating symptoms, weak correlations between symptoms and functional outcomes, and lack of valid and reliable experimental measures to complement self-report data. Here, we provide an overview of currently used BPD outcome measures and discuss them from clinical, psychometric, experimental, and patient perspectives. In addition, we review the most promising leads to improve BPD PROs, including the DSM-5 Section III, the Recovery Approach, Ecological Momentary Assessments, and novel experimental measures of social functioning that are associated with functional and social outcomes.

El resultado percibido por el paciente (PRO) se refiere a las medidas que enfatizan la perspectiva subjetiva de los pacientes acerca de sus condiciones y conductas relacionadas con la salud. Típicamente, los PROs incluyen cuestionarios de autoreporte y entrevistas clínicas. Definir los PROs para el trastorno de personalidad borderline (TPB) es especialmente desafiante dada la alta heterogeneidad sintomática del trastorno, la elevada comorbilidad con otras condiciones psiquiátricas, los síntomas muy fluctuantes, las correlaciones débiles entre los síntomas y los resultados funcionales, y la falta de mediciones experimentales válidas y confiables para complementar los datos autoreportados. En este artículo se presenta una panorámica de las mediciones de resultados actualmente utilizadas en el TPB y se discuten desde perspectivas clínicas, psicométricas, experimentales y del paciente. Además se revisan los avances más prometedores para mejorar los PROs en el TPB, incluyendo la sección III del DSM-5, el enfoque de la recuperación, las evoluciones ecológicas momentáneas y las nuevas mediciones experimentales del funcionamiento social que se asocian con los resultados funcionales y sociales.

Les PRO (Patient reported outcomes ou résultats déclarés par les patients) sont des mesures reflétant le point de vue subjectif des patients sur leur état de santé et leurs comportements. Classiquement, les PRO contiennent des auto-questionnaires et des entretiens cliniques. Il est particulièrement difficile de définir des PRO pour le trouble de la personnalité borderline compte tenu de l'hétérogénéité élevée des symptômes dans la maladie, de la forte comorbidité avec les autres affections psychiatriques, de la grande fluctuation des symptômes, des faibles corrélations entre les symptômes et l'évolution fonctionnelle et du manque de mesures expérimentales fiables et valables pour compléter les résultats auto-déclarés. Nous présentons dans cet article une synthèse des résultats des mesures actuelles pour la personnalité borderline et les analysons sur le plan clinique, psychométrique et expérimental et du point de vue du patient. Nous examinons les avancées les plus prometteuses pour améliorer les PRO de la personnalité borderline, dont la section III du DSM-5 (Recovery Approach, Ecological Momentary Assessments), et de nouvelles mesures expérimentales du fonctionnement social associées aux résultats fonctionnels et sociaux.

Can sociocultural and historical mechanisms influence the development of borderline personality disorder?

Borderline personality disorder (BPD) is a common and severe clinical problem. While cross-cultural research suggests that this condition can be identified in different societies, indirect evidence suggests that BPD and some of its associated symptoms (suicidality and self-harm) have a higher prevalence in developed countries. If so, sociocultural and historical mechanisms may have influenced the development of the disorder. While the vulnerabilities underlying BPD are broad and nonspecific, specific symptoms can be shaped by culture. The mechanisms involve the influence of a "symptom bank," as well as the role of social contagion. These trends may be related to a decrease in social cohesion and social capital in modern societies.

The partnership of psychoanalysis and psychiatry in the treatment of psychosis and borderline states: its evolution in North America.

The history of psychiatry is about two hundred years old and that of psychoanalysis more than a hundred, with an important anniversary of the latter in 2011. Freud renewed and humanized psychiatry by enriching its static descriptive method with the new dynamic and interpretive discoveries of psychoanalysis. Freud's innovations, while developed in Europe, were integrated into psychiatry briefly by the Swiss School but mainly in the United States. After many years of fruitful collaboration psychiatry and psychoanalysis seemed to part company in the U.S. in the last few decades. However, the tradition of combining psychiatric care with dynamic principles is still considered valid in the treatment of psychoses and severe personality disorders.

'In good times and in bad': boundary relations of psychoanalysis in post-war USA.

This paper suggests writing the history of psychoanalysis by focusing on the manifold ways in which its practitioners may relate to the boundaries dividing it from its neighbouring professions. This approach is illustrated by two loosely interrelated examples: the 1950s debate among leading US psychoanalysts on whether borderline patients can be analysed, and the 1990s responses of psychoanalysts to psychopharmacological treatments of schizophrenia. A close reading of psychoanalysts' journal publications reveals in each instance multiplicity (of voices), instability (of boundaries), duality (of defence and dialogue) and simultaneity (of internal and external addressees). At the same time, a common rhetorical stance emerged in each period, serving as a shared discursive frame while allowing a plurality of boundary relations.

[Historical background to the development of the concept of the borderline personality]. / Rys historyczny rozwoju pojecia osobowosci z pogranicza.

The history of the development of the concept of borderline personality disorder dates back to the late nineteenth century when in 1884 described the first cases of patients with a clinical picture similar to today's concept of borderline personality disorder, using the first time the concept of borderline. On the current understanding of the borderline personality disorder had a significant impact available and valid diagnostic criteria included in the classifications ICD-10 and DSM-IV-TR and psychological theories such as psychoanalytic theory of "object relations" and cognitive behavioral approaches.

[The Jung model of active style of schema]. / Model aktywnego stylu schematów Junga.

Yung was of an opinion that the borderline personality as a pathology results from the experiences of a frightened and violence-experiencing child who is left to their own devices in the hostile world. In that situation, the child, longing for safety, simultaneously experiences fear of abuse, hurt and rejection and remains distrustful. In order to understand the dramatic changes in the individual's behaviour, in case of the borderline personality disorders, Yung developed the concept, presented by Aaron Beck at the therapeutic workshops in the 1980s. Beck's concept was based upon the assumption that some pathological states expressed strong emotional states, experienced in childhood on the basis of regression. Yung presented them in the form of conceptualization in the categories of the active styles of schema. Apart from the states of regression, he also differentiated less regressive styles of schema. The style of schema should be interpreted as a pattern of experiencing, thinking and behaviour, based upon a determined set of schema, and characterized by independence from other styles.

[The evolution of the borderline personality disorder diagnosis: past, present and future]. / La evolución del diagnóstico Borderline: pasado, presente y futuro.

The purpose of this paper is to go along the different senses and meanings that borderline diagnosis has had across time. On behalf of this, many original papers as well as textbooks and other works are analyzed, to define the way and significant points in the discovery or construction of this critical pathology, that even today still divides the opinions in health world community. From Prichard, to Stern, Deutsch, Grinker and Knight, till Kernberg, Gunderson, Linehan and Fonagy we try to put clear the most important contributions of each author.

Denegación y límite. Acerca de los llamados trastornos límites / Denial and limits. About the so called borderline disorders

El estudio de los trastornos del límite revela que la neurosis y la psicosis sólo cubren un reducido campo de la psicopatología (AU)

Studies regarding disorders of borderline point out that neurosis and psychosis only cover a small field within psychopathology (AU)

Relaciones entre el trastorno límite de personalidad y el espectro bipolar: [revisión] / Relationship between borderline personality disorder and bipolar spectrum: [review]

Existe una controversia respecto a la independencia nosológica del trastorno límite de personalidad. Algunos autores sostienen que es parte del trastorno bipolar, mientras otros afirman que es una entidad independiente. En este trabajo se analiza la evolución histórica de los conceptos de trastorno límite y trastorno bipolar. Se discuten los argumentos a favor y en contra de incluir el trastorno límite dentro del trastorno bipolar. Por último se proponen nuevas estrategias para abordar este problema.

The independent nosological status of borderline personality disorder is a controversial issue. Some authors consider borderline as part of bipolar spectrum, but other sustain that is a independent entity. The historical evolution of borderline personality disorder and bipolar disorder is analyzed in this work. The arguments for include, or not include, borderline personality disorder in bipolar disorder is discussed. Finally, new strategies for study this problem are proposed.

A propósito de los trastornos límite / About borderline disorders

A partir de una reflexión clínica de los trastornos límite se introduce un faro de orientación que permite dilucidar, en su seno, la neurosis y la psicosis (AU)

Starting with a clinical reflection on the limit disorders, a guidance headlight is introduced in order to clear up, in itself, the neurosis and the psychosis (AU)

Borderline histories: psychoanalysis inside and out.

Sociologists and historians have long favored externalist over internalist accounts of practices in the clinical disciplines. This has been particularly true in the case of the so-called new patient or borderline personality, which a range of commentators have located in culturally resonant narratives of decline. I argue here that these narratives, while pleasing, do not hold up as history; most problematic is their assumption that the appearance of the borderline portends the emergence of altogether novel forms of modal personhood. Internalist accounts of the category's consolidation are equally problematic in asserting a coherence and a stable referent that repeatedly proves elusive. In the end, I suggest that a complex account of disciplinary practice that attends to knowledge production in the clinical encounter supports the conclusion that the new patient was new to psychoanalysis. Whether or not he was altogether new cannot be established, undermining the critics' certitude and prophecies of decline.

Disclosure of a diagnosis of borderline personality disorder.

OBJECTIVE: Borderline personality disorder (BPD) is a common psychiatric disorder with a prevalence of 1%-2% in the general population. BPD also has the potential to cause significant distress in the lives of patients with BPD and their families. The diagnosis of BPD, however, is often withheld from patients. The purpose of this article is to explore the history of diagnostic disclosure in medicine and psychiatry and then discuss reasons why clinicians may or may not disclose the diagnosis of BPD. METHODS: The authors review medical literature about diagnostic disclosure and other issues that may affect the decision to disclose a diagnosis of BPD. RESULTS: The authors discuss the historical precedents for diagnostic disclosure and reasons a clinician may not disclose the diagnosis of BPD to a patient: questions regarding the validity of BPD as a diagnosis, worries about the stigma of the diagnosis being harmful to the patient, and transference/countertransference issues common in the treatment of patients with BPD. The authors cite factors promoting disclosure, such as the ideal of patient autonomy, possibilities for psychoeducation and collaboration with the patient toward more specific and effective therapies, and the increasing availability of diagnostic information available to patients from sources other than their clinicians. CONCLUSIONS: There are compelling reasons to make the diagnosis the subject of open examination and discussion between clinician and patient, and reasons to believe that disclosure would serve to advance the patient in his or her recovery.

[Psychiatric case history of Vincent van Gogh]. / De psychiatrische ziektegeschiedenis van Vincent van Gogh.

Much has been written about Vincent van Gogh's pathological condition. Most authors base their various diagnoses on the symptoms he exhibited in the last years of his life. However, Van Gogh during a much longer part of his life displayed symptoms best consistent with a borderline (personality) disorder: impulsivity, variable moods, self-destructive behaviour, fear of abandonment, an unbalanced self-image, authority conflicts and other complicated relationships. The precipitating element disturbing Vincent's psychic balance--delicate in any case due to a positive family history, malnutrition, intoxication and exhaustion and the borderline disorder--may have been his being deserted by his friend Gauguin. He (also) developed an organic psychosyndrome with psychotic and epileptic elements. The stress (due to social isolation, by his being a psychiatric patient, and by poor prospects), the intoxication going on outside the hospitals and especially also the problems relating to his brother Theo caused a downward spiral culminating in suicide.

História e psicopatologia do transtorno borderline: da esquizofrenia latente aos transtornos de personalidade / History and psychopathology of borderline disorder: from latent schizophrenia to personality disorders

No presente trabalho é feita uma revisao histórica e psicopatológica do distúrbio borderline. O autor sugere que a categoria clínica introduzida por Kahlbaum, em 1890, chamada "Heboidophrenie", pode ser considerada como um protoconceito na origem do conceito de transtorno borderline. No final dos anos 70 e anos 80, sob a influência do DSM-III, a esquizofrenia latente ou borderline se transforma em dois subtipos de transtorno de personalidade: esquizotípico e borderline. Alguns aspectos psicopatológicos do distúrbio borderline de personalidade sao revistos, com especial ênfase sobre os sintomas afetivos e as alteraçoes no plano da interaçao social.