"I am ashamed that I exist. I feel like apologizing for existing": The phenomenology of shame in patients with borderline personality disorder: A qualitative study.

Shame is an essential affect in many patients with borderline personality disorder (BPD) and can be associated with most of the BPD diagnostic criteria. Severe shame is a highly aversive emotion with concomitant beliefs about the self as deeply inferior, insignificant, disgusting, and unloved. Shame and how it is manifested in the subjective experience and behavior in people diagnosed with BPD is remarkably under-researched, and our knowledge of the phenomenology of shame in BPD needs to be improved. Severe shame is often less accessible and available to conscious awareness, making it difficult to access via questionnaires and self-report measures. Therefore, this study is based on semi-structured interviews with 21 women Structural clinical interview for DSM-5 disorders' diagnosed with BPD. All interviews were analyzed using the interpretive phenomenological approach. Based on the analysis, the participants' descriptions of how severe shame manifests itself in their subjective experience and behavior are classified into 10 themes: the self is deeply flawed and unlovable; self-hatred/self-contempt; eye contact is awkward and shameful; shameful over being mentally ill; shameful identity diffusion; hiding behind façade/social roles; pleasing others/performing to avoid shame; self-destructive behavior to mitigate shame; sex associated with shame; and shame during the therapy session. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

How Does It Feel to Have a Disturbed Identity? The Phenomenology of Identity Diffusion in Patients With Borderline Personality Disorder: A Qualitative Study.

Identity diffusion is one of the defining characteristics of borderline personality disorder (BPD). Given its central importance in the formal diagnostic criteria for personality disorders, identity diffusion is remarkably under-researched. In particular, our knowledge of the phenomenology of identity diffusion needs to be improved. This study is based on semistructured interviews with 16 younger women SCID-5-diagnosed with BPD. All interviews were analyzed using the interpretative phenomenological analysis approach. On the basis of this analysis, the patients' descriptions of how identity diffusion manifests itself in their subjective experience are classified into nine categories: disintegrated self-image; using various façades to stabilize the self; painful feelings of the self as broken; feeling that the self does not fit in; inner emptiness; "I don't know what I want"; great need for attention from others to stabilize identity; feeling unable to handle interpersonal relationships; and using sex to distract the self and regulate painful self-states.

Personal and parents' life stories in patients with borderline personality disorder.

Patients with borderline personality disorder (BPD) display disturbances in understanding self and others. We examined whether these disturbances extended to how patients described their personal and parents' life stories and to measures of identity, alexithymia, empathy, and emotional intelligence. Thirty BPD patients and 30 matched control participants described personal and parents' life stories and completed measures of identity disturbance, alexithymia, empathy, and emotional intelligence. Compared to the controls, patients with BPD described their personal and their parents' life stories more negatively and with fewer themes of agency and communion fulfillment. Patients and controls showed equally complex reasoning about their personal life stories, but patients displayed less complexity and more self-other confusion, when reasoning about their parents' stories. Patients also differed from controls on identity disturbance, alexithymia, and empathy. The results suggest that patients' storied understanding of themselves and others are disturbed and should be taken into account to better understand BPD.

Patients with borderline personality disorder show increased agency in life stories after 12 months of psychotherapy.

Patients with borderline personality disorder (BPD) display disturbances in self and other understanding, which is also evident when they narrate events from their own and significant others' lives. In a recent study, we found that patients described both their own and their parents' life stories as more negative and with fewer themes of agency and communion fulfillment. Hence, we examined whether 12 months of psychotherapy would change how patients described their own and their parents' life stories. At baseline, 30 BPD patients and 30 matched control participants described and answered questions about their personal and their parents' life stories. At follow-up, 23 patients and 23 control participants repeated the same procedure after patients had completed 12 months of psychotherapy. At both baseline and follow-up, the life stories were coded for complexity and themes of agency, communion, communion fulfillment, and self-other confusion. BPD patients' personal life stories increased significantly in agency from baseline to follow-up compared with the control group, whereas other aspects of personal and parents' life stories did not change significantly after therapy. Development of agency through the reconstruction of personal life stories may be a crucial mechanism in psychotherapy with BPD patients. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

[Treatment of borderline personality disorder]. / Behandling af borderline personlighedsforstyrrelser.

Patients with borderline personality disorder entail a considerable strain on mental health services. Previously, the prognosis for these patients was regarded pessimistically, but this perspective has been radically altered during the latest ten years because of the development of structured and evidence-based treatment programs. In this article a short introduction to Mentalisation-Based Treatment of BPD is given.