Psychotic symptoms in depression and borderline personality disorder.

The authors investigated the prevalence of psychotic symptoms in depression and borderline personality disorder employing the Diagnostic Interview for Borderlines. Clear-cut delusions and hallucinations were rare among the borderlines. However, derealization and depersonalization symptoms were common and were found to be prevalent as among depressives. The prevalence of these symptoms among patients with both borderline personality disorder and depression was similar to that among patients with only borderline personality disorder or depression. The relationship between depression and borderline personality disorder and the significance of psychotic symptoms in these disorders is discussed.

Eating disorders in Japan: finding the right context.

Eating disorders have traditionally been described as a typically 'Western' illness. Cases that occur outside Western countries are often regarded as atypical. Peculiarities are thus emphasized. However, eating disorders are now prevalent in Japan, among non-Western immigrants in Europe, and in other societies. The author focuses on the universality of the background of eating disorders and looks at them as 'culture change syndromes'. Change in the family and in women's roles are the central themes. The majority of the subjects experienced very little emotional relationship with their parents when they were children. It is misleading to say that eating disorder patients lack femininity and that they should be encouraged to be more feminine, more passive. Gender issues concerning treatment settings such as the doctor-patient relationship, the doctor-nurse relationship influence the treatment process. Typical anorexics described in a 1788 Japanese document are briefly presented in order to challenge further the idea of eating disorders as a Western illness.

Comparison of American and Japanese outpatients with borderline personality disorder.

The borderline psychopathology of 33 American and 19 Japanese female outpatients who met the Revised Diagnostic Interview for Borderlines (DIB-R) criteria for borderline personality disorder (BPD) was compared. There were significant differences between the samples in the DIB-R total score, as well as in the affect/cognition section and scaled section scores. However, only one of the 22 summary statements (SS) of the DIB-R distinguished American borderlines from Japanese borderlines. Most of the differences seemed to reflect differences in inclusion criteria. It is concluded that there are borderline patients in Japan whose psychopathology is basically identical to that of American borderline patients.

Diagnosis and clinical features of borderline personality disorder in the east and west: a preliminary report.

In the first clinical study of the borderline personality disorder (BPD) in Asia, the Diagnostic Interview for Borderlines (DIB) was performed on 85 female outpatients aged 18 to 30 years in Japan. BPD was diagnosed in 32 (38%) of these patients. The International Classification of Diseases-9 (ICD-9) diagnoses made at the initial examination of the DIB-identified BPD patients were, in order of frequency, neurotic disorders, anorexia nervosa and other eating disorders, and manic-depressive psychoses. The DSM-III axis I diagnoses of the DIB-identified BPD patients were affective disorders in 63%, eating disorders in 34%, and substance use disorders in 22%. This study suggests that there are indeed BPD patients in Japan. An exception is made of the low incidence of substance use disorders, and of the fact that most Japanese patients continue to maintain stormy one-to-one or masochistic relationships with their parents because they live at home--their clinical picture is not different from that of American patients.

Object images of eating disorder patients.

The authors investigated images held by eating disorder patients toward selected stimulus words using the semantic differential method. The concept "object image" was introduced here to designate the images which any person has about the mother, the father, etc. A comparison was made between 22 eating disorder patients with concurrent borderline personality disorder, 20 patients without borderline pathology, and 48 controls. The eating disorder patients were found to have a "weaker" image of "motherliness" and "womanliness" compared to the control group. Another characteristic of eating disorder patients was their unfavorable image of children. The authors also studied the images held by fathers and mothers. In the families with borderline patients, the discrepancies between what we term "object images" held by fathers, mothers, and daughters were conspicuous. The importance of a tripartite (daughter-mother-father) relationship in the psychopathology of eating disorder is discussed.