Medline is run by the National Medical Library, and summarized (via abstracts) what are felt to be the most important articles on most medical subjects for the medical profession. These abstracts from Medline are about the BPD.
Am J Psychiatry 1982 Jun;139(6):741-6
“Aggression, suicide, and serotonin: relationships to CSF amine metabolites”
Low levels of the serotonin metabolite (5-HIAA) are associated with aggression and suicidal behavior. (metabolite means a breakdown product)
Arch Gen Psychiatry 1982 Jul;39(7):765-9
“Familial transmission of DSM-III borderline personality disorder”
No increased risk of schizophrenia in relatives with BPD. A relative of a BPD patient had ten times greater risk of developing the BPD compared to those whose relatives had bipolar or schizophrenia.
J Autism Dev Disord 1983 Mar;13(1):67-72
“‘Borderline’ children”
Sixteen children diagnosed with the BPD on comprehensive evaluation did not meet BPD criteria. The BPD diagnosis had a negative impact on some of the children.
J Clin Psychol 1983 Sep,39(5):722-6
“Screening for borderline personality disorders with the MMPI-168”
On this test the BPD pattern was clearly distinguishable from the majority of college students. (Note: severity of the BPD was not selected out for)
Psychiatry Res 1983 Jun;9(2):107-13
“The TRH test in patients with borderline personality disorder”
7/15 BPD patients had a blunted TSH response to TRH infusion (note: the thyroid stimulating hormone – TSH – should have gone up normally).
J Nerv Ment Dis 1984 Feb;172(2):98-104
“Multiple personality as a borderline disorder”
This study suggests the multiple personality should be viewed as a borderline disorder.
Psychiatr Clin North Am 1984 Mar;7(1):69-87
“Are multiple personalities borderline? An analysis of 33 cases.”
BPD is very prevalent in patients with multiple personality disorder, but it is not universal and is a separate and distinct disorder.
J Clin Psychol 1984 Mar;40(2):410-3
“Borderline personality disorder and the MMPI”
14 patients showed considerable variability, but some categories were higher for BPD patients, offering partial support for it’s validity. (Note: severity of the BPD was not selected out for)
Arch Gen Psychiatry 1984 Jun;41(6):565-8
“Structured interviews and borderline personality disorder”
The DIB – Diagnostic Interview for Borderlines – was only 70% sensitive for diagnosing the BPD, and 10% diagnosed with the BPD did not fit BPD criteria.
J Clin Psychiatry 1984 Oct;45(10):441-2
“Treatment of attention deficit and borderline personality disorders with psychostimulants: case report”
A young woman with attention deficit disorder and BPD was successfully treated with methylphenidate (Ritalin).
Psychoneuroendocrinology 1984;9(3):311-4
“A dramatic behavioral response to thyrotropin-releasing hormone following low-dose neuroleptics”
The administration of TRH (thyrotropin-releasing hormone – stimulates thyroid hormone production) dramatically improved mood and behavior after treatment with low dose neuroleptics. Neither high dose neuroleptics nor TRH alone had this effect. (Note: neuroleptics include medications like Haldol and Navane)
J Pers Assess 1985 Feb,49(1):47-55
“MMPI characteristics of borderline psychopathology in adolescent inpatients”
MMPI test was 82.1% successful in correctly classifying borderline patients and 78.0% accurate in identifying non-borderline patients. (Note: this means approximately 20% are misdiagnosed)
Arch Gen Psychiatry 1986 Jan;43(1):20-30
“The Chestnut Lodge follow up study. III. Long-term outcome of borderline personalities”
Outcome varied over time, BPD patients did best in the second decade after discharge.
Am J Psychiatry 1986 Feb;143(2):212-5
“Schizotypal symptoms in patients with borderline personality disorders”
Schizotypal disorder symptoms were very common in those with the BPD.
J Clin Psychiatry 1986 Apr;47(4):196-8
“The demographic profile of the borderline personality disorder”
A survey of 23 patients showed that most were young, white and female. The source of information was considered suspect by the authors, who recommended that their findings be confirmed by other studies.
Suicide Life Threat Behav 1986 Spring;16(1):28-39
“Selected behavioral features of patients with borderline personality traits”
Irregular hospital discharges, frequent suicide attempts, first suicide attempt before age 40, violence inside and outside the hospital, and gradual deterioration in social and occupational functioning were found more often in patients with “high levels of borderline personality traits.”
J Nerv Men Dis 1986 Jun;174(6):328-31
“An empirical study of borderline personality disorder and psychiatric suicides”
In this study of 134 consecutive psychiatric suicides from 1961-1980 only 12% had the BPD.
Psychopathology 1986;19(1-2):68-79
“Prognosis of the borderline disorders”
Wide variability, but in general better than in individuals with schizophrenia.
Acta Psychiatr Scand 1986 Mar;73(3):307-14
“Characterizing somatization, hypochondriasis, and hysteria and the borderline personality disorder”
These symptoms are more common in individuals with dysthymia (low level depression) than in the BPD.
J Stud Alcohol 1986 May;47(3):196-200
“Borderline personality disorder and alcoholism treatment: a one year follow-up study”
This study documents that short term treatment of alcoholics with “severe character pathology” can help them. (I strongly disagree – the BPD is not a character disorder, it’s a medical one.)
Am J Psychiatry 1986 Aug;143(8):998-1003
“An examination of the borderline diagnosis in children”
A study of 86 children aged 6-12 psychiatrically hospitalized showed some features of these symptoms when they went on to develop the BPD as an adult. Further research needed to draw any conclusions.
Psychopathology 1986;19(3):131-7
“Challenges of research with the borderline patient”
“Clinical research of the borderline personality disorder can be difficult and challenging for investigator” due to the “core psychopathology and characteristic defense mechanisms,” difficulty of completing studies, and ‘classical’ and ‘total’ counter transference.
Am J Psychiatry 1986 Oct;143(10):1287-9
“Pseudologia fantastica in the borderline patient”
“An infrequently described clinical feature sometimes associated with borderline personality disorder is pseudologia fantastica” (pathological lying).
Am J Psychiatry 1986 Dec;143(12):1605-7
“Psychotic symptoms of borderline personality disorder”
A study of 13 BPD patients showed “derealization” and “depersonalization” were common symptoms, but drug free hallucinations were also observed.
Can J Psychiatry 1986 Dec;31(9):859-60
“Borderline personality disorder in the elderly: a case study”
“The case suggests that features of BPD persist throughout life and may worsen with the stresses associated with aging.”
J Pers Assess 1986 Winter;50(4):540-53
“The MMPI, prototypal topology and borderline personality disorder”
Unstructured interviews were more reliable than the MMPI.
Percept Mot Skills 1986 Apr;62(2):579-85
“On the consistency of the MMPI in borderline personality disorder”
14 patients showed consistent results, but variability between patients. “A note of caution is advised for those investigators who assume that a prototypical borderline MMPI profile exists” (note: I had a patient who had a mildly abnormal MMPI when doing well, and the next day when dysphoric had one interpreted as ‘strong antisocial features’)”
J Clin Psychopharmacol 1986 Aug;6(4):236-9
“Development of melancholia during carbamazepine treatment in borderline personality disorder”
During carbamazepine (Tegretol) treatment 18% developed melancholia, which went away on discontinuation of carbamazepine. (Note: in my experience many of my patients with this pattern developed low thyroid – hypothyroidism – and the depression remitted with the addition of thyroid replacement hormone)
Acta Psychiatr Scand 1986 May;73(5):500-5
“Characterizing paranoia in the DSM-III borderline personality disorder”
“Paranoia was both more prevalent and severe in borderline patients.”
J Clin Psychiatry 1987 May;48(5):181-4
“Is bulimia associated with borderline personality disorder? A controlled study”
Only 1.9% of bulimic patients in this study using the DIB instead of DSM criteria had the BPD. (The DIB in a previous study was felt to be relatively inaccurate in diagnosing the BPD)
Am J Psychiatry 1987 Jun;144(6);748-52
“Sexual practices among patients borderline personality disorder”
“Homosexuality was 10 times more common among the men and six times more common among the women and borderline personality disorder than in the general population or in a depressed control group.” Bisexuality and paraphilias were also relatively common.
Arch Gen Psychiatry 1987 Jul;44(7):645-50
Auditory P300 in borderline personality disorder and schizophrenia
Those with BPD had different results on EEG, particularly in the P300 location, sharing a dysfunction of auditory neurointegration with schizophrenia.
Psychiatry Res 1987 Aug;21(4):307-11
“Lack of effect of dopamine receptor blockade on the TSH response to TRH in borderline personality disorder”
The reduction in TSH response to TRH is not due to dopamine function.
J Clin Psychiatry 1987 Aug;48 Suppl:15-25
“Psychopharmacology of borderline personality disorder: a review”
“The frequent presence of comorbid disorders and the occurrence of a wide array of possible target symptoms complicate clinical assessment. “Neuroleptics, MAO inhibitors and carbamazepine (Tegretol) were helpful.
Am J Psychiatry 1988 Jun;145(6):737-9
“Suicide attempts in patients with borderline personality disorder”
BPD patients with both depression and substance abuse are at a higher risk of suicide.
Am J Psychiatry 1988 Jul;145(7):809-14
“The amphetamine challenge test in patients with borderline disorder”
Amphetamine administration helped those with BPD unless they also had the schizotypal personality disorder. (How much of the effect was on borderlines who had attention deficit disorder wasn’t addressed)
Can J Psychiatry 1988 Jun;33(5):336-40
“Characteristics of borderline personality disorder: A Canadian study”
Inpatients with the BPD have a chronic severe disorder, which begins in adolescence and probably were neglected or abused as children.
Am J Psychiatry 1988 Nov;145(11):1453-4
“A comparison of three measures for the diagnosis of borderline personality disorder”
Three testing systems showed were not good for making the diagnosis, and more than half those studied had at least three personality disorder diagnoses.
Arch Gen Psychiatry 1988 Feb;45(2):111-9
“Pharmacotherapy of borderline personality disorder. Alprazolam, carbamazepine, trifluoperazine, and tranylcypromine.”
16 female BPD outpatients with severe behavior control problems but without major depression at the time of the study received the above medications. All but alprazolam improved the patient’s condition. Alprazolam(Xanax) worsened behavioral dyscontrol (losing control of behavior). Patients taking carbamazepine (Tegretol) had a “marked decrease in the severity of behavioral dyscontrol.” (Note: this landmark study by Dr. Cowdry and Dr. Gardner at NIMH has been invaluable to me for treating the BPD – it’s one of the most important, informative and useful BPD studies ever performed)
Biol Psychiatry 1988 Sep;24(5):587-94
“Changes in EEG mean frequency associated with anxiety and with amphetamine challenge in BPD”
EEG is often abnormal in the BPD, further study with a stimulant showed minimal change, except in anxiety.
(Note: to me this reflects on attention deficit disorder and the generalized anxiety disorder in borderlines. The EEG is more often abnormal during dysphoric spells. The EEG measures surface readings, whereas deep brain structures are most likely involved in the BPD)
Can J Psychiatry 1988 Jun,33(5):350-4
“Biological markers in borderline personality disorders: an overview”
A summary of what is known, including REM latency (an indicator of sleep and brain function).
J Nerv Ment Dis 1988 Jan;176(1):40-4
“Factors associated with completed suicide in borderline personality disorder”
Highest risks included multiple hospitalizations, more suicide attempts, and severe suicidal behavior at admission. Expecting to go home frequently resulted in suicide.
Can J Psychiatry 1989 Feb;34(1):8-9
“Predictors of suicide in borderline personality disorder”
The most significant predictors of completed suicide were previous attempts and higher education.
Am J Psychiatry 1989 Apr;146(4):490-5
“Childhood trauma in borderline personality disorder”
81% had major childhood trauma. 71% had physical abuse. 68% had sexual abuse. 62% witnessed serious domestic violence. (Note: 1/5 statistically were NOT victims of childhood trauma)
Psychiatry Res 1989 Feb;27(2):111-5
“Cerebral structure in borderline personality disorder”
No evidence of structural brain pathology using CT scans.
Biol Psychiatry 1990 Aug 1;28(3):247-54
“CSF metabolites in borderline personality disorder compared with normal controls”
No different from non BPD. However, those with genuine suicide attempts had low levels.
Am J Psychiatry 1990 Apr;147(4):470-6
“The borderline diagnosis in adolescents: symptoms developmental history”
The following predict BPD in adolescents: disrupted attachments, maternal neglect, maternal rejection, grossly inappropriate parental behavior, number of mother and father surrogates, physical abuse, sexual abuse, and their families were chronically disrupted – particularly during early childhood.
Am Fam Physician 1990 May;41(5):1481-6
“Psychiatric implications of tattoos
Psychiatric disorders, such as antisocial personality disorder, drug or alcohol abuse and BPD, are frequently associated with tattoos. Finding a tatoo on physical examination should alert the physician to the possibility of an underlying psychiatric condition.
Am J Psychiatry 1990 Aug;147(8):1002-7
“Substance use in BPD”
67% of BPD inpatients also had substance use problems, particularly alcohol and hypnotics. When substance abuse was removed as a diagnostic criteria, 23% no longer met BPD criteria. The combination of BPD and substance use changes the severity and course of their illness. Substance use may play a role in BPD development.
Can J Psychiatry 1990 Oct;35(7):590-5
“A comparison of borderline and schizophrenic patients for childhood life events and parent-child relationships”
Borderlines had more childhood sexual and physical abuse, more early separation from their mothers, more paternal criminality, less maternal care, and were more overprotected.
Am J Psychiatry 1990 Aug;147(8):1014-7
“Altered platelet alpha 2-adrenergic receptor binding sites in BPD”
Fewer alpha 2-adrenergic receptor binding sites compared with borderlines on low doses of benzodiazepines. Non medicated BPD’s were more anxious than medicated patients, raising the possibility that lower alpha 2-adrenergic receptor binding in BPD is related to anxiety.
Am J Psychiatry 1991 Jan;148(1):106-11 (from NIMH)
“Neuropsychological testing of patients with BPD”
“…significantly impaired with that of the normal group on memory tests requiring uncued recall of complex, recently learned material. Cues given on an auditory memory task partially corrected that deficit.” “…Also significantly impaired on several visual perceptual tests.” These abnormal findings did not appear to be due to attention problems, depression, alcohol use or “psychomotor impairment.”
J Nerv Ment Dis 1991 Mar;179(3):157-61 (from NIMH)
“Self-ratings of anger and hostility in BPD”
Patients with BPD had significantly higher anger and hostility scores than volunteers, not related to gender, treatment or research setting, the degree of acute distress, or the presence of major depression. “…Anger and depression may represent independent clinical conditions with independent biological mechanisms regulating these two affective states.”
Am J Psychiatry 1991 May;148(5):648-51
“Parents’ emotional neglect and overprotection according to the recollections of patients with BPD”
“…patients with BPD remembered both their fathers and their mothers as having been significantly less caring and more controlling than did the nonborderline patients.” (How much of it is a true phenomenon and how much was splitting is unclear and was not addressed in this study – L. Heller, M.D.)
J Nerv Ment Dis 1991 Jun;179(6):329-37
“A comparison of four measures to diagnose DSM-III-R BPD in outpatients”
Four tests were evaluated to determine how accurate they were at predicting the actual criteria. The DIB (diagnostic interview schedule for borderlines) was the best, and others better than chance levels. (Previous studies showed 70% accuracy for the best test, the DIB – L. Heller, M.D.)
J Clin Psychopharmacol 1991 Apr;11(2):116-20
“A preliminary trial of fluoxetine in refractory borderline patients”
5 BPD patients with severe symptoms resistant to phenelzine and neuroleptics were treated with fluoxetine 20mg to 40mg for 8 weeks. The findings suggested effectiveness for the depressive and impulsive symptoms of refractory BPD patients.
Int Psychogeriatr 1991 Spring;3(1):39-52
“BPD in late life”
A record review of 8 elderly patients shows the individuals didn’t fit criteria later in life. (Note: in my experience – and subsequent data – most crippling symptoms remain including the mood swings, emptiness, anger and social function problems – L. Heller, M.D.)
J Nerv Ment Dis 1991 Jul,179(7):428-31
“Post Traumatic Stress Disorder among children clinically diagnosed as BPD”
“These findings raise the possibility that a diagnosis of borderline personality in childhood can often represent posttraumatic stress disorder.”
Clin Electroencephalogr 1991 Jul;22(3):188-92
“Auditory evoked potentials in BPD”
“Paroxysmal (without warning) changes in affect (mood) and behavior, high incidence of soft neurologic signs and frequent EEG alterations, and evidence of clinical response to antiepileptic drugs have suggested cerebral dysfunction, particularly involving the limbic system or reticular activating system.” (After doing their research on brain waves they remarked…) “These findings may suggest differences from normals in attention maintenance and limbic system function.”(Since many borderlines also have attention deficit disorder, their findings may represent limbic system malfunction in borderlines, and attention maintenance problems in those with ADD – L Heller, MD)
Am J Psychiatry 1991 Oct;148(10):1371-7
“The comorbidity of BPD and other DSM-III-R axis II personality disorders”
80% of those with BPD had at least one additional personality disorder. The authors wonder if there is a “general personality disorder concept” rather than a true BPD diagnosis.
Acta Psychiatr Scand 1991 Jul;84(1):72-7
“Personality disorders 2-5 years after treatment: a prospective follow-up study”
79 patients followed for 3 years had a “moderate symptom reduction,” a “fair global outcome,” and the “overall suicide are was low.”
Am J Psychiatry 1991 Nov;148(11):1541-7
“A prospective follow-up study of so-called borderline children”
The childhood borderline diagnosis appears to be an antecedent of an array of adult personality disorders, but it is not associated with the adult BPD per se, nor with axis I diagnoses (such as depression).
Arch Gen Psychiatry 1991 Dec;48(12):1060-4
“Cognitive-behavioral treatment of chronically parasuicidal borderline patients: (by Marsha Linehan and her group at the U of Washington in Seattle)”
A trial of DBT (dialectical behavior therapy) for chronically parasuicidal women studied for one year showed fewer incidences of parasuicide and less medically severe parasuicides, they were more likely to stay in individual therapy, and had fewer inpatient psychiatric days. No change in measures of depression, hopelessness, suicide ideation, or reasons for living although they did diminish in both the DBT and control groups over the study year.
Am J Psychiatry 1993 Dec;150(12):1836-42
“The impact of mother-child interaction on the development of BPD”
Maternal over-involvement and mismanagement and inappropriateness of maternal guidance and support were shown to only be a problem when the coexisted.
Am J Psychiatry 1993 Dec;150(12):1843-8
“Continuation pharmacotherapy of BPD with haloperidol and phenelzine”
Continuous treatment with haloperidol (Haldol) was ineffective except for irritability. Phenelzine offered modest improvement in irritability. (Note: my experience is Haldol works best on an “as needed” basis only – L Heller, MD)
J Clin Psychol 1993 Mar;49(2):277-81
“Features of borderline personality and violence” (from U of Southern California)
“It is concluded that borderline personality may predispose towards extreme forms of violence”
Am J Psychiatry 1993 Aug;150(8):1233-6
“Comorbidity of conduct disorder and personality disorders in an incarcerated juvenile population”
Conduct disorder in children and adolescents leads to antisocial personality disorder, not the borderline disorder.
Arch Psychiatr Nurs 1993 Jun;7(3):163-73
“Long-term consequences of childhood physical and sexual abuse”
“Physical and sexual abuse is associated with acute psychiatric symptomatology in children and may progress to a spectrum of psychiatric and medical disorders in adults, ranging from the extreme adaptive reactions seen in multiple personality disorder and refractory psychosis to intermediate adaptive reactions present in BPD to more delimited reactions manifest in chronic headaches and unremitting pelvic pain.”
Am J Psychiatry 1993 Dec;150(12):1835-5
“Psychopathology in the families of children and adolescents with BPD”
“…significant family psychopathology is associated with the disorder.”
Arch Gen Psychiatry 1993 Dec;50(12):971-4 (from Marsha Linehan)
“Naturalistic follow-up of a behavioral treatment for chronically parasuicidal borderline patients”
“In general, the superiority of DBT over treatment-as-usual, found in previous studies at the completion of 1 year of treatment, was retained during a 1-year follow-up.”
Am J Drug Alcohol Abuse 1993;19(4):491-7
“Substance abuse in BPD”
“Substance abuse appears to be a devastating complication in the patient with BPD.”
Int J Eat Disord 1993 Dec;14(4):403-16
“Comorbidity of DSM-III-R eating disorders and personality disorders”
Bulimia nervosa with BPD, anorexia nervosa with Avoidant PD. “Eating disorders with personality disorders are characterized by chronicity and low levels of functioning compared with eating disorders with personality disorders.”
J Psychol 1993 Nov;127(6):657-76
“Relationship of childhood sexual abuse to BPD, posttraumatic stress disorder, and multiple personality disorder”
A convincing relationship exists between childhood sexual abuse and BPD, posttraumatic stress disorder and multiple personality disorder.
Comp Psychiatry 1993 Nov-Dec;34(6):402-5
“Clozapine treatment of borderline patients: a preliminary study.”
Clozapine is effective for atypical psychotic symptoms in some BPD patients.
Compr Psychiatry 1993 Nov-Dec;34(6):418-23
“Diagnosis and clinical features of BPD in the east and west: a preliminary report”
BPD is present in Japan and is the same basic disorder. Differences include a low incidence of substance use disorders, and the maintenance of a “stormy one-to-one or masochistic relationships with their parents because they live at home.”
J Behav Ther Exp Psychiatry 1993 Sep;24(3):261-7
“The behavioral treatment of self-starvation and severe self-injury in a patient with BPD”
Self-starvation can be a form of self-injury.
Jpn J Psychiatry Neurol 1993 Mar;47(1):37-46
“Relationship between clinical symptoms and EEG findings in BPD”
No specific diagnostic EEG findings, however abnormalities were found.
Eur Neuropsychopharmacol 1994 Dec;4(4):479-86
“A trial of carbamazepine (Tegretol) in BPD”
No significant positive results were found as a first choice pharmacological treatment. (Note: that has been my experience as well. It only works for those who need it when they’ve been on an SSRI for at least a week – Prozac has been the most consistently successful medication to combine with Tegretol. L Heller, MD)
Psychiatry Res
“Temporal glucose metabolism in BPD”
“Underlying organic factors such as epilepsy are suspected because clinical characteristics of the syndrome are similar to some manifestations of patients with complex partial seizures.” No PET scan data to show temporal lobe epilepsy. (Note: This study does not preclude small areas in the limbic system that are having seizures that extend at times to the temporal lobes during severe dysphoria (anxiety, rage, depression and despair). L. Heller, MD)
Sante Ment Que 1994 Fall;19(2):117-29
“Suicide in patients with BPD”
Long term research shows about 10% will eventually complete suicide. The authors suggest that suicide prevention should not be the major priority of therapy.
Am J Psychiatry 1994 Feb;151(2):277-80
“Serotonergic sensitivity in BPD: preliminary findings”
Malfunction in the serotonin system is found in the BPD. (Note: low levels are not necessarily the same thing as a malfunction. L Heller, MD)
Child Abuse Negl 1994 Jan;18(1):97-101
“Childhood sexual abuse and BPD in eating disorders”
Childhood sexual abuse at less than 14 years old is associated with BPD patients with eating disorders.
Neuropsychopharmacology 1994 Feb;10(1):21-8
“Positron-emission tomography and personality disorders”
A significant decrease in frontal cortex metabolism was seen in the BPD. (Note: this finding is further evidence of physical abnormalities, although the significance of this particular finding is unclear. It may be related to the frequent complication of head injuries. L Heller, MD)
J Nerv Ment Dis 1994 Jul;182(7):375-80
“Risk factors for borderline personality in male outpatients”
Childhood sexual abuse, separation or loss, and problems with their fathers are important for BPD development in males.
Am J Psychiatry 1994 Sep;151(9):1305-11
“Clinical correlates of self-mutilation in BPD”
Self-mutilators are at a higher risk for suicidal behavior, major depression and eating disorders.
Ann Clin Psychiatry 1994 Mar;6(1):17-20
“Divalproex sodium in the treatment of aggressive behavior”
A.k.a. Depakote: effective to reduce agitation in many psychiatric conditions, especially with bipolar or BPD.”
J Clin Psychopharmacol 1995 Feb;15(1):23-9
“Effect of fluoxetine on anger in symptomatic volunteers with BPD”
Fluoxetine (Prozac) reduced anger independent of changes in depression in mild to moderately severe BPD patients.
Am J Psychiatry 1995 May;152(5):789-91
“Psychological dimensions of depression in BPD”
Self-criticism is an underemphasized characteristic of depression in BPD.
Am J Psychiatry 1996 Jun;153(6):752-8
“The borderline patient’s intolerance of aloneness: insecure attachments and therapist availability”
“Intolerance of aloneness is a core deficit in BPD.” (Note: while usually true, it’s not an absolute. Many borderlines enjoy being alone when doing better. LHeller, M.D.)
Am J Psychiatry 1996 Oct;153(10):1329-33
“Structured interview data on 35 cases of dissociative identity disorder in Turkey”
DID (f.k.a. multiple personality disorder) is a world wide disorder, with a consistent set of features throughout North America, the Netherlands, and in Turkey.
Psychiatr Serv 1996 Apr;47(4):426-9
“Comorbidity of DSM-III-R axis I and II disorders among female inpatients with eating disorders”
Social phobia, substance use disorders, BPD, and Avoidant personality disorder were more frequently diagnosed in eating disorder patients.
J Am Acad Child Adolesc Psychiatry 1996 Oct;35(10):1338-43
“BPD in adolescents: affective and cognitive features”
Adolescents with BPD have significant impairments in self-concept, suggestive of pervasive emptiness and identity disturbances associated with the BPD.”
Can J Psychiatry 1996 Jun;41(5):285-90
“Psychopathology in offspring of mothers with BPD: a pilot study”
The offspring of mothers with the BPD are at a higher risk for psychiatric problems, particularly impulse control problems.
Psychiatr Q 1996 Winter;67(4):287-95
“Relationship of borderline symptoms to histories of abuse and neglect: a pilot study”
Mood swings (affective instability), intense anger, and identity disturbances were not correlated with abuse or neglect. (Note: childhood abuse was correlated in an earlier study with derealization and chronic dysphoria (anxiety, rage, depression and despair). LHeller, MD)
Clin Electroencephalogr 1996 Jan;27(1):35-9
“A review of the usefulness of the standard EEG in psychiatry”
Positive spikes have again been associated with impulsivity and 6/sec spike and wave complexes with interpersonal problems.
J Affect Disord 1996 Apr 12;37(2-3):157-70 (from France)
“Comorbidity of personality disorders and unipolar major depression: a review”
20-50% of inpatients and 50-85% of outpatients have a personality disorder.
Am J Psychiatry 1997 Aug;154(8):1101-6
“Reported pathological childhood experiences associated with the development of BPD”
Sexual abuse is neither necessary nor sufficient for the development of BPD. Other childhood experiences, particularly neglect by caretakers of both genders, are also significant risk factors.
J Clin Psychiatry 1998 Mar;59(3):103-7
“Low-dose Clozapine in acute and continuation treatment of severe BPD”
“Psychotic-like symptoms in patients affected by BPD are usually treated with low-dose neuroleptics, which show controversial acute effects and lead to a worsening of affective-related symptoms and to severe neurologic side effects after prolonged administration. …Low-dose Clozapine for acute and continuation treatment led to improvement in overall symptomatology in a small sample of severe BPD patients.”
Compr Psychiatry 1998 Mar-Apr;39(2):72-4
“Comorbidity of personality disorders with bipolar mood disorders”
BPD was more prevalent in those with bipolar illness.
Gen Hosp Psychiatry 1997 May;19(3):209-15
“Serious overdosers admitted to a general hospital: comparison with nonoverdose self-injuries and medically ill patients with suicidal ideation”
Female borderline patients are particularly associated with an overdose method of attempting suicide.
Psychiatry Res 1997 May 30;70(3):175-83
“Pain assessment in a self-injurious patients with BPD using signal detection theory”
‘Analgesia’ during self-injury in patients with BPD is related to both neurosensory and attitudinal/psychological abnormalities.
Psychiatry Res 1998 Feb 9;77(2):131-8
“Electroencephalographic abnormalities in BPD”
Including only definitely abnormal tracings, 40% of borderlines had an abnormality (diffuse slow activity) but no true epileptiform features. Carbamazepine did not change the EEG. (Note: this is consistent with deep brain structures having the seizure like activity. L Heller, MD)
Biol Psychiatry 1998 May 15;43(10):740-6
“Platelet serotonin, monoamine oxidase activity, and [3H] paroxetine binding related to impulsive suicide attempts and BPD”
The serotonin system affects impulsiveness, suicidal behavior, and chronic feelings of emptiness. When platelet serotonin measurements were low, chronic emptiness resulted.
Neuropsychopharmacology 1997 Oct;17(4):264-73
“Depressive response to physostigmine challenge in BPD patients”
The cholinergic system may be involved in mood regulation in patients with personality disorders.
J Clin Psychiatry 1997;58 Suppl 14():48-52;discussion 53
Pharmacotherapy of BPD
The MAOI’s, SSRI’s, and newer antidepressants such as venflaxine (Effexor) have the greatest effect on BPD symptoms.
Flashbacks and dissociative symptoms respond to naltrexone. J Clin Psychiatry 1999 Sep
The opiate blocker naltrexone (ReVia) taken 25-100mg four times daily for two weeks showed a “highly significant” reduction in dissociative symptoms and the number of flashbacks for 6 of the 9 patients studied.
Partial hospitalization treatment of BPD: Am J Psychiatry 1999 Oct
Psychoanalytically oriented partial hospitalization for BPD was more successful than “standard psychiatric care.” The improvement began after 6 months, and were continued for 18 months. There was a decrease in suicidal and self-mutilatory acts, reduced inpatient hospitalization days, and better social and interpersonal function.
Childhood sexual abuse as a BPD risk factor: J Personal Disord 1999 Fall
This “meta-analysis” disputes some literature findings and the experience of clinicians treating individuals with BPD by stating that there was no increased risk of BPD with childhood sexual abuse.
Psychotherapy with BPD patients: Aust N Z J Psychiatry 1999 Aug
Psychotherapy can help patients with the BPD.
Clozapine in BPD: Clin Psychol Rev 1999 Aug
Clozapine helped with severe self-mutilation, aggression and violence. (unfortunately clozapine is a very dangerous medication that requires very close follow up)
Substance abuse in hospitalized BPD patients: Compr Psychiatry 1999 Jul-Aug
This study from Greece showed that 76% of hospitalized BPD patients had a substance abuse problem.
Lamotrigine for treating BPD: J Affect Disorder 1998 Dec
75% of those with BPD showed improvement with lamotrigine (Lamictil). The authors argue that depression in BPD dysphoria is a different phenomenon than “unipolar depression.”
Abnormal frontal brain lobes in BPD: J Affect Disord 1998 Sept
This study from South Korea showed smaller frontal lobe volume on brain MRI’s.
Spinal fluid chemicals in BPD: Neuropsychobiology 1998 Nov
This study from Sweden showed no difference from controls in some neurotransmitter metabolites.
Behav Res Ther 2000 Sep Dept of Psychiatry, University of Freiburg, Germany
“Evaluation of inpatient dialectical-behavioral therapy for borderline personality disorder – a prospective study.”
Three month inpatient DBT treatment of 24 women with BPD were compared at admission and one month after discharge. Significant improvements in ratings of depression, dissociation, anxiety and overall stress. Significant reduction in parasuicidal acts (primarily cutting).
Br J Med Psychol 2000 Jun Kings College, London, UK
“Effectiveness of time-limited cognitive analytic therapy of borderline personality disorder: factors associated with outcome.”
This study showed psychotherapy can help and could cease fitting DSM BPD criteria. Poorer outcome associated with stronger BPD symptoms, cutting, alcohol abuse and unemployment.
J Clin Psychiatry 2000 Jun Eating Disorders Clinic, Douglas Hospital, Verdun, Quebec, Canada
“Childhood abuse and platelet tritiated-paroxetine binding in bulimia nervosa – implications of borderline personality disorder.”
Strong similar causes of bulimia and BPD, which frequently are comorbid. Serotonin function, including transporter malfunction, may be a part of both disorders.
Med Hypotheses 2000 Apr Argyll and Bute Hospital, Lochgilphead, UK
“The role of dysregulated amygdalic emotion in borderline personality disorder.”
The authors propose that the disorder arises from impaired modulation of subcortical inputs to consciousness. “We hypothesize that the amygdaloid complex, and it’s connections with thalamus, cingulate cortex and insular cortex are critical in the development and maintenance of the disorder. If this is the case, peptides such as galanin, somatostatin and cholecystokinin will be the most important neurotransmitters…”
Am J Psychiatry 2000 Apr Western Psychiatric Institute, U of Pittsburgh, PA (Soloff PH, Lynch KG)
“Characteristics of suicide attempts of patients with major depressive episode and borderline personality disorder: a comparative study.”
“Hopelessness and impulsive aggression independently increase the risk of suicidal behavior in patients with borderline personality disorder and in patients with major depressive episode.”
J Personal Disord 2000 Winter Western Psychiatric Institute and Clinic, U of Pittsburgh, Pittsburgh, PA
“Recent life events, social adjustment, and suicide attempts in patients with major depression and borderline personality disorder”
“Borderline disordered patients low on overall social adjustment were over 16 times more likely to have attempted suicide than patients diagnosed with major depression only. Recent life events may elevate suicide risk in groups already at high risk for suicide completion, whereas high levels of social adjustment may be protective against stress-related suicidal behavior.”
Arch Gen Psychiatry 2000 Dec (from Germany).
“Magnetic resonance imaging volumes of the hippocampus and the amygdala in women with borderline personality disorder and early traumatization.”
Individuals with BPD had approximately 16% smaller hippocampus volumes and 8% smaller amygdala volumes. The reason and significance are not clear.
Biol Psychiatry 2000 Mar (Soloff PH) Dept of Psychiatry, U of Pittsburgh, PA
“A fenfluramine activated FDG-PET study of borderline personality disorder”
“Patients with BPD have diminished response to serotonergic stimulation in areas of prefrontal cortex associated with regulation of impulsive behavior.”
J Clin Psychol 2000 Dec Indiana State University Psychology Dept.
“Neuropsychological functioning in patients with borderline personality disorder.”
“The BPD group performance did not differ from the normal group on most tasks of executive functioning or memory, and the introduction of emotional stimuli did not impair performance.”
J Personal Disord 2000 Fall (Zanarini MC) Laboratory for the Study of Adult Development, McLean Hospital, Belmont, MA
“Biparental failure in the childhood experiences of borderline patients”
55% reported a childhood history of biparental abuse; 77% reported a childhood history of biparental neglect.
J Neuropsychiatry Clin Neurosci 2001 Fall Freiberg, Germany.
“Subtle prefrontal neuropathology in a pilot magnetic resonance spectroscopy study in patients with borderline personality disorder.”
“The authors…found a significant 19% reduction of absolute N-acetylaspartate concentrations in the dorsolateral prefrontal cortex in BPD…”
Am J Psychiatry May 2001 McGill University, Montreal, Canada
“Brain regional alpha-[11C]methyl-L-tryptophan trapping in impulsive subjects with borderline personality disorder.”
“Low 5-HT (serotonin) synthesis capacity in corticostriatal pathways may contribute to the development of impulsive behaviors in persons with BPD.”
J Clin Psychiatry 2001 Mar Mount Sinai School of medicine, NY
“A preliminary double-blind, placebo-controlled trial of divalproex sodium in borderline personality disorder”
16 patients with BPD were treated with Depakote (divalproex sodium). “Treatment with divalproex sodium may be more effective than placebo for global symptomatology, level of functioning, aggression and depression. Controlled trials with larger sample sizes are warranted to confirm these preliminary findings.”
Can J Psychiatry 2001 Nov Universite de Toulouse-Le Mirail, Toulouse France
“Frequency of borderline personality disorder in a sample of French high school students Based on a screening test.”
“We estimated the overall frequency of BPD to be 10% for boys and 18% for girls.”
J ECT 2001 Jun Stanford University
“Is electroconvulsive therapy (ECT) effective for the depressed patient with comorbid borderline personality disorder?”
“The depressed, borderline patient appears to have two distinct disorders, one which is responsive to ECT and the other which is not.”
Compr Psychiatry 2001 Nov-Dec from McGill University Montreal Canada
“A 27 year follow-up of patients with borderline personality disorder.”
64 BPD patients followed for an average of 27 years. Most showed improvement over time, with only a small percentage still meeting criteria. The total percentage of suicides was 10.3%. (Note: symptoms tend to change over time, but the underlying neurological symptoms rarely go away)
Biol Psychiatry 2001 Aug (from Germany)
“Evidence of abnormal amygdala functioning in borderline personality disorder: a functional MRI study.”
“Our main finding was that dependent functional MRI signal in the amygdala on both sides.” This was seen in BPD subjects but not the controls.
Gen Hosp Psychiatry 2001 Jul-Aug Wright State University School of Medicine, Dayton, OH
” The prevalence of borderline personality among primary care patients with chronic pain.”
“In this sample, the prevalence of BPD was substantial. Chronic pain may be a manifestation of a self-regulatory disturbance among some patients with BPD.”
Int J Eat Disord 2001 Jan Wright State University School of Medicine, Dayton, OH
“Obesity, borderline personality symptomatology, and body image among women in a psychiatric outpatient setting.”
“In a psychiatric outpatient setting, borderline personality symptomatology is associated with higher body weight as well as body-image issues that are not necessarily due to larger body size.”
J Forensic Sci West Virginia University
“An investigation of the psychological characteristics of stalkers: empathy, problem-solving, attachment and borderline personality features”
“Stalkers scored significantly higher than controls on measures of insecure attachment and borderline personality features, suggesting that the stalking group demonstrates a general pattern of inadequate interpersonal attachment, has limited abilities to form and maintain appropriate relationships, is emotionally labile and unstable, and experiences ambivalence regarding their interpersonal relationships.”
Am J Psychiatry 2002 Dec
“SSRI treatment of borderline personality disorder: an randomized, placebo-controlled clinical trial for female patients with borderline personality disorder.”
“In this study, Luvox (fluvoxamine) significantly improved rapid mood shifts in female borderline patients, but not impulsivity and aggression.”
Harv Rev Psychiatry 2002 Nov
“Implications of long-term outcome research for the management of patients with borderline personality disorder.”
“Fifteen and 27 year follow-up studies of patients with borderline personality disorder show that most of them no longer meet full criteria for the disorder by age 40, and that even more show improvement by age 50. The mechanisms behind remission could include maturation, social learning and the avoidance of conflictual intimacy. Affective instability (mood swings) is slower to change than impulsivity. Suicide rates in patients with this disorder are close to 10%, with most completions occurring late in the course of illness; early mortality from all causes exceeds 18%.”
(Note: the symptoms change over time, but usually the biologically based symptoms remain: unprovoked mood swings, chronic anger – including self directed, emptiness, boredom and stress induced dysphoria (anxiety, rage, depression and despair). Instability in the brain’s limbic system during adolescence and early adulthood improves over time. Avoidance of intimate relationships, while understandable, keeps borderlines from fully enjoying the human experience. Having a successful love relationship is one of my goals for a BPD patient. – L. Heller, M.D.)
J Clin Psychiatry 2002 May
“Divalproex sodium treatment of women with borderline personality disorder and bipolar II disorder: a double-blind placebo-controlled pilot study.”
30 women aged 18-40. “The results of this study suggest that divalproex sodium (Depakote) may be a safe and effective agent in the treatment of women with criteria defined borderline personality disorder and comorbid bipolar II disorder, significantly decreasing their irritability and anger, the tempestuousness of their relationships, and their impulsive aggressiveness.”
Am J Psychiatry 2002 May
“Characterizing affective instability in borderline personality disorder”
“Greater lability in terms of anger and anxiety and oscillation between depression and anxiety, but not in terms of oscillation between depression and elation, was associated with borderline personality disorder.” (Note: this is an important distinction between bipolar and BPD)
Am J Psychiatry 2002 Feb
“Confirmatory factor analysis of DSM-IV criteria for borderline personality disorder: findings from the collaborative longitudinal personality disorders study”
“The diagnostic criteria for borderline personality disorder appear to reflect a statistically coherent construct.”
Neuropsychobiology 2002
“Serum cholesterol and leptin levels in patients with borderline personality disorder”
“In conclusion, the present study demonstrates that the patients with borderline personality disorder have lower cholesterol and leptin levels than healthy controls. Low serum cholesterol and leptin levels are associated with all dimensions of the disorder – impulsivity, aggression and suicidality – but are not associated with the presence and the severity of comorbid depression.”
Compr Psychiatry 2002 Sep-Oct (from Milano, Italy)
“History of childhood attention deficit/hyperactivity disorder symptoms and borderline personality disorder: a controlled study.”
“The results of this study seem to support the hypothesis of an association between history of childhood ADHD symptoms and adult BPD diagnosis.”
Biol Psychiatry 2002 Dec (Dept of Psychiatry, Free University Amsterdam, The Netherlands)
“Hyperresponsiveness of hypothalamic-pituitary-adrenal axis to combined dexamethasone/corticotropin-releasing hormone challenge in female borderline personality disorder subjects with a history of sustained childhood abuse.”
“Chronically abused BPD patients had a significantly enhanced corticotropin (ACTH) and cortisol response to the DEX/CRH challenge compared with nonabused subjects. Cormorbid PTSD significantly attenuated the ACTH response.”
Am J Psychiatry 2002 Dec
“Short-term diagnostic stability of schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders”
“Individual differences in personality disorder features appear to be highly stable, although the number of criteria present decreases over time.”
Psychol Med 2002 Nov
“Neurocognitive deficits in decision-making and planning of patients with DSM-III-R borderline personality disorder”
“The performance of the BPD patients on the decision-making task was characterized by a pattern of delayed and maladaptive choices when choosing between competing actions, and by impulsive, disinhibited responding when gambling on the outcome of their decisions. BPD patients also showed impairments on the planning task. There was no evidence of impaired visual recognition memory.”
Arch Intern Med 2002 Jan
“Borderline personality disorder in primary care.”
“The prevalence of BPD in primary care is high, about 4-fold higher than that found in general community studies. Despite availability of various pharmacological and psychological interventions that are helpful in treating symptoms of BPD, and despite the association of this disorder with suicidal ideation, comorbid psychiatric disorders, and functional impairment, BPD is largely unrecognized and untreated. These findings are also important for the primary care physician, because unrecognized BPD may underlie difficult patient-physician relationships and complicate medical treatment.” (See my 1991 article for primary care physicians athttp://pks.947.myftpupload.com/abstract.htm, along with the 1999 update at http://pks.947.myftpupload.com/update.htm)
Am J Psychiatry 2003 Jan;160(1):165-6 “Diminished impulsivity in older patients with borderline personality disorder”
“Older patients with borderline personality disorder showed less impulsivity than younger patients, but there was no difference in terms of affect (mood) disturbance, identity disturbance, and interpersonal problems.”
Am J Psychiatry 2003 Jan;160(1):167-9 (Harvard University) “Omega-3 fatty acid treatment of women with borderline personality disorder: a double-blind, placebo-controlled pilot study”
For 8 weeks10 were given placebo (sugar pills), 20 were given 1 gm (1000mg) of E-EPA (ethyl-eicosapentaenoic acid). “E-EPA was superior to placebo in diminishing aggression as well as the severity of depressive symptoms.” (Omega 3 oils have previously been shown to help bipolar disorder as well as many medical problems including heart disease).
Harv Rev Psychiatry 2003 Jan-Feb;11(1):8-19 “Family studies of borderline personality disorder: a review”
The most significant finding from this study shows no link between BPD and schizophrenia.”
Am J Psychiatry 2003 Feb;160(2):274-83 (Harvard University) “The longitudinal course of borderline psychopathology: 6-year prospective follow-up of the phenomenology of borderline personality disorder”
362 inpatients followed for 6 years. Only 290 met DSM-III-R BPD criteria initially. These individuals received “multiple treatments” both before the admission and during the study. There were “criteria for remission” that were followed. 34.5% met these criteria at 2 years, 49.4% at 4 years, 68.6% at 6 years, and 73.5% through the entire followup period. Impulsive symptoms improved the most. Mood symptoms were the most chronic. (This study shows improvement for most BPD patients with treatment over time, although mood symptoms remained a significant problem. Specific medication regimens such as Prozac (fluoxetine) with Tegretol (carbamazepine) deserve a similar study).
Aust N Z J Psychiatry 2003 Jun;37:270-6 “Moral Responsibility and borderline personality disorder”
“Impulsivity, acting out and the less severe forms of dissociation to not vitiate responsibility. Severe dissociative and psychotic symptoms may well render people with BPD less morally responsible for their actions. Comorbid conditions in BPD may also affect the ability to act responsibly.”
Biol Psychiatry 2003 Jul 15;54(2):163-71 “Frontolimbic brain abnormalities in patients with borderline personality disorder: a volumetric magnetic resonance imaging study.”
“We found a significant reduction of hippocampal and amydgala volumes in borderline personality disorder. There was a significant 24% reduction of the left orbitofrontal and a 26% reduction of the right anterior cingulate gyrus.” This is an “unspecific finding in neuropsychiatry.”
Am J Psychiatry 2003 Nov;160(11):2018-24 “The relationship of borderline personality disorder to posttraumatic stress disorder and traumatic events.”
“The results do not appear (to single out the) borderline personality disorder from other personality disorders as a trauma-spectrum disorder or variant of PTSD.”
Biol Psychiatry 2003 Dec 1;54(11):1284-93 (Yale University) “Amygdala hyperreactivity in borderline personality disorder: implications for emotional dysregulation”
“Borderline patients showed significantly greater left amygdala activation to the facial expressions of emotion compared with normal control subjects.” (The amygdala is a part of the limbic system, particularly associated with anger and emotions)
J Personal Disord 2003 Dec;17(6):568-73 (Harvard University) “A screening measure for BPD: the McLean Screening Instrument for borderline personality disorder (MSI-BPD)”
The MSI-BPD can be useful as a screening test looking for the BPD.
J Personal Disord 2003 Dec;17(6):497-509 “Frontal Lobe dysfunctions in borderline personality disorder? Neuropsychological findings.”
“Borderline personality patients show no indications of frontal cognitive dysfunction.”
J Clin Psychiatry 2004 Dec;65(12):1660-5
“The association between borderline personality disorder and chronic medical illnesses, poor health-related lifestyle choices, and costly forms of health care utilization.”
If not successfully treated individuals with BPD have a significantly increased risk of health problems and higher health care costs. ‘
J Clin Psychiatry 2004 Nov;65(11):1515-9
“Topiramate treatment of aggression in female BPD patients: a double blind, placebo controlled study.”
This study on 11 BPD patients showed an improvement in anger and mild weight loss. In my experience a high percentage of individuals on Topamax (topiramate) see their underlying BPD get worse.
Am J Psychiatry 2004 Nov;161(11):2108-14
“Axis I comorbidity in patients with BPD: 6 year follow-up and prediction of time to remission.”
Some anxiety and depression problems that co-exist with the BPD improve over time, however those with substance use disorders failed to show significant improvement in the BPD and other symptoms over time.
Am J Psychiatry Nov,162(11):2073-80
“Clinical outcome of ECT in patient with major depression and comorbid BPD”
ECT (electro shock therapy) does not work well for the BPD.
J Clin Psychiatry 2004 Oct:65(10):1414-9
“Clonidine in acute aversive inner tension and self-injurious behavior in female patients with BPD”
There was some improvement in dissociation and urge to commit self-injurious behaviors in 14 females with BPD. (Clonidine is an anti-hypertension medication with many side effects. In my opinion there are better options, although this may help a few individuals).
J Clin Psychiatry 2004 Jul;65(7):903-7
“A preliminary, randomized trial of fluoxetine, olanzapine and the olanzapine-fluoxetine combination in women with BPD”
The combination of Zyprexa (olanzapine) with Prozac (fluoxetine) was more effective than either alone. (While this is true, olanzapine’s weight gain and diabetes limit it’s use. Many patients complain that they have no feelings on olanzapine as well. In my experience the combination of Tegretol (carbamazepine) with Prozac (fluoxetine) is far more effective.)
J Personal Disord 2004 Jun;18(3):240-7
“Is hospitalization useful for suicidal patients with BPD?”
10% of BPD patients eventually complete suicide. For chronic suicidal thoughts, hospitalization is not more effective than outpatient treatment.
Curr Psychiatry Rep 2004 Jun;6(3):225-31
“Psychopharmacology of BPD”
Omega 3 fatty acids can be helpful in the treatment of BPD.
Harv Rev Psychiatry 2004 May-Jun;12(3):140-5
“Borderline or bipolar? Distinguishing BPD from bipolar spectrum disorders”
“There are major differences in phenomenology, family history, longitudinal course, and treatment response between BPD and bipolar disorder, and the findings of comorbidity studies are equivocal. Thus, existing evidence is insufficient to support the concept that BPD falls in the bipolar spectrum.” (Bipolar and BPD are clearly separate disorders, although it’s not uncommon to have both diagnoses).
J Affect Disord 2004 Apr;79(1-3):297-303
“BPD in patients with bipolar disorder and response to lamotrigine”
In some individuals with both disorders, Lamictil (lamotrigine) improved some BPD symptoms.
Psychiatry Res 2004 Mar 15;125(3):257-67
“BPD: impaired visual perception and working memory”
“It is concluded that perceptional speed and working memory are impaired in BPD, but that the deficits are not augmented by increasing cognitive load.”
J Clin Psychiatry 2004 Mar;65(3):379-85
“Combined dialectical behavior therapy and fluoxetine in the treatment of BPD”
A small study (20 patients) showed no added benefit when Prozac (fluoxetine) was added to DBT. (The issue in this study is what do the findings actually mean. Fluoxetine has consistently been shown in studies to be effective with anger, although many patients require higher doses before any benefits are seen. Individuals with the BPD experiencing chronic dysphoria (anxiety, rage, depression and despair) rarely experience benefit from fluoxetine unless Tegretol (carbamazepine) is added a week later. Effective counseling (including DBT) with medication is the optimal treatment).
Curr Psychiatry Rep 2004 Feb;6(1):43-50 (from Germany)
“New developments in the neurobiology of BPD”
“Most of the neuropsychologic, physiologic, endocrinologic, and neuroimaging data support the theory that a dual brain pathology, affecting prefrontal and limbic circuits, may underlie this hyperarousal-dyscontrol syndrome.”
J Clin Psychiatry 2004 Jan;65(1):104-9
“Olanzapine versus placebo in the treatment of BPD”
After 4 weeks there was a definite benefit for both men and women with BPD treated with Zyprexa (olanzapine). Most patients were on 5-10mg daily. Weight gain was a significant problem.
Acta Psychiatr Scand 2004 Jul;110(1):45-54 (from England)
“Impaired spatial working memory in adults with ADHD: comparisons with performance in adults with BPD and in control subjects.”
“The results are consistent with the claim that aspects of working memory are particularly impaired in adult ADHD. Also, the BPD group had a longer deliberation time for one of the additional tasks, compared with the ADHD group, which indicated that the patient groups may have different patterns of neuropsychological impairments.”
Int J Psychophysiol 2004 Jun;53(1):57-70
“Effects of BPD features and a family history of alcohol or drug dependence on P300 in adolescents.”
The “P300 amplitude” (a measurement found on a brain wave test – EEG) is associated with BPD symptoms during adolescence.
Biol Psychiatry 2004 Mar 15;55(6):603-11
“Posttraumatic stress disorder and functional MRI activation patterns of traumatic memory in patients with BPD”
“Dependent on absence or presence of additional PTSD different neural networks seem to be involved in the traumatic memory of patients with BPD.”
J Personal Disord 2004 Oct;18(5):439-47
“Borderline psychopathology in the first-degree relatives of borderline and axis II comparison probands”
Five of the criteria were more common among the relatives: inappropriate anger, mood swings, paranoia/dissociation, general impulsivity and intense, unstable relationships.
Pharmacopsychiatry 2004 Sep;37(5):196-9
“Naloxone in the treatment of acute dissociative states in female patients with BPD”
“..this study does not support the assumption that naloxone in a single dose of 0.4mg IV is superior to placebo in acute dissociative states in patients with BPD.” (only 9 patients were studied)
J Clin Psychiatry 2004 Aug;65(8):1049-56
“Major depressive disorder and BPD revisited: longitudinal interactions”
“When BPD and major depressive disorder (MDD) co-occur, they can sometimes have independent courses, but more often improvements in MDD are predicted by prior improvements in BPD. Clinicians should not ignore BPD in hopes that treatment of MDD will be followed by improvement of BPD.” (Three of the most important long term BPD researchers and clinicians were a part of this Harvard study – Drs. Gunderson, McGlashan and Zanarini. Their findings are consistent with what I’ve seen in a private primary care practice with a strong depression and BPD emphasis. The most severe borderlines get the most attention, but the majority of individuals with BPD are not that severe and are primarily treated for depression and/or anxiety problems.)
Psychiatry Res 2004 Jul 30;131(2):125-33
“Anatomical MRI study of BPD patients”
This study also found diminished hippocampal volumes. Putamen enlargement seems to be due to substance use disorders.
Behav Res Ther 2004 May;42(5):487-99
“Effectiveness of inpatient dialectical behavioral therapy for BPD: a controlled trial.”
A 3 month inpatient DBT treatment was more effective than outpatient treatment. No follow up was done, however.
Prog Neuropsychopharmacol Biol Psychiatry 2004 Mar;28(2):329-41
“Neurocognitive function in BPD.”
Neuropsychological testing implied a dysfunction in the right hemisphere frontotemporal region in BPD individuals.
Psychiatry Res 2004 Jan 1;121(3):239-52
“Neurobiological correlates of diagnosis and underlying traits in patients with BPD compared with normal controls.”
Psychological and neurotransmitter testing suggest that serotonin system abnormalities are associated with impulsive traits.
Biol Psychiatry 2004 Apr 1;55(7):759-65 (from Germany)
“A positron emission tomography study of memories of childhood abuse in BPD”
“Dysfunction of dorsolateral and medial prefrontal cortex, including anterior cingulate, seems to be correlated with the recall of traumatic memories in women with BPD. These brain areas might mediate trauma-related symptoms, such as dissociation or affective instability, in patients with BPD.”
Acta Psychiatr Scand 2004 Dec;110(6):416-20
“Axis II comorbidity of BPD: description of 6 year course and prediction to time-to-remission”
“The results of this study suggest that axis II disorders co-occur less commonly with BPD over time, particularly for remitted borderline patients. They also suggest that anxious cluster disorders are the axis II disorders which most impede symptomatic remission from BPD.”
Prostaglandins Leikot Essent Fatty Acids 2004 Oct;71(4):211-6
“Essential fatty acids and their role in the treatment of impulsive disorders”
Both ADHD and the BPD can improve with the addition of essential fatty acids, which have also been shown to improve depression, schizophrenia and dementia.
J Child Adolesc Psychopharmacol 2004 Winter;14(4):531-8
“Psychosurgery for Self-injurious Behavior in Tourette’s Disorder”
An adolescent male with severe Tourette’s and self injurious behavior underwent two surgical procedures for cingulotomy and subsequent limbic leucotomy. “After the second surgery the severity and frequency of his self injurious behavior were reduced.”
J Personal Disord 2004 APr;18(2):193-211
“Childhood maltreatment with adult personality disorders: findings from the Collaborative Longitudinal Personality Disorders Study.”
“Results indicate that rates of childhood maltreatment among individuals with personality disorders are generally high {73% reporting abuse; 82% reporting neglect}. As expected, BPD was more consistently associated with childhood abuse and neglect than other personality disorder diagnoses.”
Curr Psychiatry Rep. 2005; 7(1):65-72
“Neuroimaging and personality disorders”
“Functional and structural studies provide support for dysfunction in fronto-limbic circuits in BPD and APD, whereas temporal lobe and basal striatal-thalamic compromise is evident in schizotypal personality disorder.
Neuroreport 2005; 16(3):289-93
“Distinct pattern of P3a event-related potential in BPD”
“…distinctive disturbances in P3a in (unmedicated) BPD patients were found: abnormally enhanced amplitude, failure to habituate and a loss of temporal locking with P3b.”
Dev Psychopathol. 2005; 17(4):1197-206
“Defining the neurocircuitry of BPD: functional neuroimaging approaches”
“Functional neuroimaging…is beginning to identify abnormal frontolimbic circuitry…”
Clin Neurophysiol. 2005; 116(6):1424=32
“BPD features in adolescent girls: P300 evidence of altered brain maturation.”
“The present findings suggest abnormal brain maturation among adolescent girls exhibiting features of BPD.”
J Psychiatr Res. 2005; 39(5);489-98
“Increased delta power and discrepancies in objective and subjective sleep measurements in BPD”
“BPD patients showed a tendency for shortened REM latency and significantly decreased NonREM sleep (stage 2)…There was a marked discrepancy between objective and subjective sleep measurements, which indicates an altered perception of sleep in BPD.”
Am J Psychiatry 2005; 162(12):2360-73
“BPD, impulsivity, and the orbitofrontal cortex”
“The patients with orbitofrontal cortex lesions and the patients with BPD performed similarly on several measures. Both groups were more impulsive and reported more inappropriate behaviors.”
(Note: the orbitofrontal cortex is considered part of the limbic system)
Am J psychiatry. 2005; 162(3):621-4
“Impact of trait impulsivity and state aggression on divalproex versus placebo response in BPD”
Depakote (divalproex, valproic acid or valproate) was superior to placebo for impulsive aggressiveness.
Psychiatr Serv. 2005; 56 (2): 193-7
“Intensive dialectical behavior therapy for outpatients with BPD who are in crisis”
“The three-week, intensive version of dialectical behavior therapy was found to be an effective treatment. Treatment completion was high, and patients showed statistically significant improvements in depression and hopelessness measures.”
J Clin Psychiatry 2005; 66(9):1111-5
“Oxcarbazepine in the treatment of BPD: a pilot study”
Trileptal (oxcarbazepine), a variation of the Tegretol (carbamazepine) molecule, is an option for treating the BPD. 25% of those with significant side effects from Tegretol (carbamazepine) can have the same side effects from Trileptal (oxcarbazepine). (low sodium, low magnesium and allergic reactions are concerns).
Am J Psychiatry. 2005; 162(5):883-9
“Two-year prevalence and stability of individual DSM-IV criteria for schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders: toward a hybrid model of axis II disorders.”
“The most prevalent and least changeable criteria over 2 years were mood swings (affective instability) and anger for BPD. The least prevalent and most changeable criteria were self-injury and behaviors defending against abandonment for BPD.”
Am J Psychiatry 2006; 163(5);827-32
“Prediction of the 10-year course of BPD”
88% of 290 inpatients studied achieved remission over 10 years. The best predictors of remission were younger age, absence of childhood sexual abuse, no family history of substance use disorder, good vocational record, absence of an anxious cluster personality disorder, low neuroticism, and high agreeableness.
(“Remission” is a challenging concept in dealing with the BPD. Some authorities base it on prevalence of DSM criteria, some the absence of suicide attempts or self mutilation, others on interviews, sometimes it’s based on the severity of symptoms. Mood swings, anger (which can be self directed) and episodes of dysphoria (anxiety, rage, depression and despair) generally persist. In my experience, the medical BPD symptoms persist for most patients throughout life unless medically treated, although they can be expressed differently. Stress can bring on symptoms that are under control without that stress. The 88% statistic may be based to a large degree on preadmission substance problems, especially alcohol. Alcohol alone can cause BPD symptoms, can markedly worsen the BPD, and frequently leads to hospital admission. In the 18 years I’ve been treating BPD patients, I’ve found psychiatric hospitalization to be a rare phenomenon. The patients studied in this group may represent a skewed population).
Am J Psychiatry 2005; 162(1):168-74
“Bone mineral density, markers of bone turnover, and cytokines in young women with BPD with and without comorbid major depressive disorder”
“The bone mineral density of 10 patients with BPD plus current major depressive episode was significantly lower than that of the healthy subjects and the patients with BPD without depression. Values of crosslaps, osteocalcin, serum cortisol, tumor necrosis factor-alpha (TNF-alpha), and interleukin-6 were significantly higher in the patients with BPD plus current major depressive episode than in the healthy subjects.”
Am J Psychiatry 2005; 162(6):1221-4
“Double-blind, placebo-controlled study of dialectical behavior therapy plus olanzapine for BPD”
“A combined psychotherapeutic plus pharmacological approach appears to lower dropout rates and constitutes an effective treatment for BPD.”
(The mean dose for Zyprexa (olanzapine) was 8.83mg/day. The problem with this medication is risk of massive weight gain and diabetes)
Curr Opin Psychiatry. 2006; 19(4):428031
“Personality disorders and medical comorbidity”
Individuals with personality disorders don’t feel as well medically and are more likely to have medical problems when their psychiatric problems are more symptomatic.
J Personal Disord 2006; 20(1):9-15 (Drs. Zanarini and Gunderson at Harvard)
“Reported childhood onset of self-mutilation among borderline patients”
32.8% of self mutilators started mutilating prior to age 13. These individuals problems with self mutilation were much worse. (Since the BPD appears to start at puberty when the brain’s limbic system revs up, it would be significant to determine if these self mutilators had already started puberty or if the self mutilation considerably predated puberty – possibly as a symptom of childhood onset bipolar disorder).
Brain Inj 2006; 20(1):67-81
“Inhibition and object relations in borderline personality traits after traumatic brain injury (TBI)”
This study of 30 individuals with moderate to severe TBI compared to 30 normals showed post injury BPD traits to be rare and to be more significant regarding moods and pre-injury BPD trains rather than problems with inhibition control. (Note: in the 3.5 years of doing weekly BPD support groups I frequently asked about serious head injuries – approximately 50% had experienced at least one serious head injury.)
Int Clin Psychopharmacol 2006: 21(6):345-53
“Efficacy of pharmacotherapy against core traits of borderline personality disorder: meta-analysis of randomized controlled trials.”
“Pharmacotherapy can exert a modest beneficial effect on some core traits of BPD.” (Dose and combinations of medications are crucial, there is no “borderline drug.”)
Psychol Med 2006; 36(8):1163-72
“The influence of emotions on inhibitory functioning in BPD”
“Our data suggest that individuals with BPD have difficulties in actively suppressing irrelevant information when it is of an aversive nature.”
Emotion 2006; 6(4):647-55
“Heightened sensitivity to facial expressions of emotion in BPD”
“Overall, results appear to support the contention that heightened emotional sensitivity may be a core feature of BPD.”
J Clin Psychiatry 2006; 67(7):1042-6
“Efficacy and tolerability of quetiapine in the treatment of BPD: A pilot study”
Seroquel (quetiapine) is effective and well tolerated for the BPD, particularly when impulsive / aggressive symptoms are prominent. (Note: I have found Seroquel (quetiapine) to be disappointing overall. Zyprexa (olanzapine), Risperdal, and Abilify (aripiprazole) have been more useful in my practice).
Am J Psychiatry 2006; 163(5):833-8
“Aripiprazole in the treatment of patients with BPD: a double-blind, placebo-controlled study.”
“Abilify (aripiprazole) appears to be a safe and effective agent in the treatment of patients with BPD.” (Note: while not as effective as Risperdal (risperidone) or Zyprexa (olanzapine), Abilify (aripiprazole) doesn’t cause the weight gain and is my antipsychotic of choice for chronic use when long term antipsychotic medication is necessary.)
Encephale 2007 Jun:34(3):270-273
“Influence of cannabis use on suicidal ideations among 491 high school students”
An association was found between cannabis (marijuana) use and suicidal thoughts in the BPD.
Behav Ther 2007 Mar;39(1):72-8
“Borderline personality characteristics and treatment outcome in cognitive-behavioral treatments for PTSD in female rape victims”
“Findings suggest that women with borderline pathology may be able to benefit significantly from cognitive-behavioral treatment for PTSD.”
Vertex 2007 Nov-Dec;18(76);418-22 (from Spain)
“Efficacy and safety of gabapentin in BPD: a six-month, open-label study”
“A global improvement, especially in anxious and depressive symptomatology was observed; no adverse events were reported. Gabapentin showed to be efficacious and safe in BPD’s treatment.”
(Note: Neurontin (gabapentin) is rarely significantly effective for most BPD symptoms, a randomized, controlled study comparing the effectiveness of the Prozac (fluoxetine) / Tegretol (carbamazepine) combination with as needed Haldol with any other medication or medication combination needs to be performed.)
J Behav Ther Exp Psychiatry 2007 Nov 24;39(3);391-402
“Time course of anger and other emotions in women with BPD: A preliminary study.”
An experiment was devised comparing women with BPD to those without induced by a short story. In this experiment women with BPD demonstrated a prolonged anger reaction, although it was not more intense.
Z Kinder Jugendpsychiatr Psychother, 2007 Sep;35(5):333-40
“Perception of emotional facial expressions in female adolescents with BPD”
“…female adolescents with BPD rated the pleasantness and intensity of positive facial expressions lower, and the negativity of positive facial expressions higher than did either the clinical or the healthy control group.”
J Personal Disord 2007 Dec;21(6):657-63
“Dimensions of DSM-IV personality disorders and life-success” (from UK)
Avoidant, obsessive compulsive and narcissistic personality disorders can improve lifetime “status and wealth.” The opposite was true for dependent, schizotypal, schizoid and antisocial personality disorders. Individuals with avoidant, schizoid and borderline personality disorders were less likely to achieve “successful intimate relationships.”
J Personal Disord 2007 Dec;21(6):615-25
“Heterogeneity of BPD: do the number of criteria met make a difference?”
There is a wide variety of potential differences among those with BPD. This study showed that grouping borderlines based on the number of DSM criteria does not explain the differences (“heterogeneity”) between those with the BPD.
J Personal Disord 2007 Dec;21(6):603-14
“The role of affective instability and impulsivity in predicting future BPD features.”
This study showed that emotional dysregulation drives the other BPD symptoms.
J Neuropsychiatry Clin Neurosci 2007 Fall;19(4):383-90
“Frontal white matter integrity in BPD with self-injurious behavior”
“Women with BPD self-injurious behavior exhibit decreased white matter microstructural integrity in inferior frontal brain regions that may include components of orbito-frontal circuitry.”
(Another study showing BPD neurological abnormalities. The orbito-frontal cortex is part of the limbic system.)
Am J Addict 2007 Nov-Dec;16(6):443-9
“The impact of personality disorders on alcohol-use outcomes in pharmacotherapy trial for alcohol dependence and comorbid Axis I disorders.”
“The findings suggest that naltrexone and Antabuse (disulfiram) can be safely and effectively used with patients who have comorbid diagnoses of Axis I and Axis II disorders.” (Note: Axis II disorders includes personality disorders such as BPD and mental retardation. Axis I is virtually any other pure psychiatric disorder including depression, anxiety, bipolar, insomnia and alcoholism)
Lipids Health Dis 2007 Sep 18;6:21
“Omega-3 fatty acids as treatments for mental illness: which disorder and which fatty acid?”
“While it is not currently possible to recommend omega-3 polyunsaturated fatty acids as either a mono- or adjunctive-therapy in any mental illness, the available evidence is strong enough to justify continued study, especially with regard to attentional, anxiety and mood disorders.”
World J Biol Psychiatry 2007 Sep 12:1-3
“Bispectral index monitoring during dissociative pseudo-seizure.”
“…BPD is a clinical condition which is often accompanied by a high susceptibility to dissociation and dissociative states are characterized by memory disturbance and perceptual alterations.”
Psychiatry Res 2007 Nov 15;156(2):139-49 (from Germany)
“Size abnormalities of the superior parietal cortices are related to dissociation in BPD”
“Recent evidence suggests that BPD is related to reduced size of the parietal lobe. Dissociative symptoms occur in the majority of individuals with BPD. …Compared with control subjects, BPD subjects had significantly smaller right-sided precuneus (-9%) volumes. The left postcentral gyrus of BPD subjects with the comorbid diagnosis of dissociative amnesia or dissociative identity disorder (DID) was significantly increased compared with controls (+13%) and compared with BPD subjects without these disorders (+11%). In BPD subjects, stronger depersonalization was significantly related to larger right precuneus size. Possibly, larger precuneus size in BPD is related to symptoms of depersonalization. Increased postcentral gyrus size in BPD may be related to the development of dissociative amnesia or dissociative identity disorder (DID) in the presence of severe childhood abuse.”
(Note: most borderlines do not have dissociative symptoms or dissociative amnesia, and DID is extremely rare, although everyone I’ve treated for DID also had the BPD. None-the-less this is an important study furthering the biological basis of the BPD. The “precuneus” is a portion of the brain’s parietal lobe, believed by many to be part of the limbic system.)
J Psychiatr Res 2007 Sep 7 (e-published, published in July 2008)
“Frontolimbic structural changes in BPD”
“Frontolimbic dysfunction is observed in BPD, with responses to emotional stimuli that are exaggerated in the amygdala and impaired in the anterior cingulate cortex (ACC).” CONCLUSIONS: “This sample of BPD patients exhibits gross structural changes in gray matter in cortical and subcortical limbic regions that parallel the regional distribution of altered functional activation to emotional stimuli among these same subjects.”
Can J Psychiatry 2007 Jun;52(6 Suppl 1):115S-127S
“Psychopharmacologic management of suicidality in personality disorders.”
“Modest efficacy of pharmacologic treatments adjuvant to psychosocial treatments can be shown for clusters of symptoms related to BPD.”
(Note: I would love to see a study with the Prozac (fluoxetine) / Tegretol (carbamazepine) combination with the as needed regimen that I prescribe www.biologicalunhappiness.com/dysphori.htm) by itself or compared to any other regimen)
Br J Clin Psychol 2007 Sep;46(Pt 3):273-81
“Subtypes of BPD, associated clinical disorders and stressful life-events, a latent class analysis based on the British Psychiatric Morbidity Survey.”
“A 4-class solution provided the best fit, ranging from a class with a low probability of showing any BPD symptoms to a class whose members had a relatively high probability of endorsing all criteria. Severity of BPD was associated with higher co-morbidity and higher stressful life-events.
Prog Neuropsychopharmacol Biol Psychiatry Epub 2007 Aug 8 (from Japan)
“Yi-gan san (YGS) for the treatment of BPD: an open-label study.”
“Patients treated with YGS showed statistically significant reduction on self-rated and clinical rated scales. The present findings suggest that Yi-gan san (YGS) might be effective for the treatment of a number of BPD symptoms, including low mood, impulsivity and aggression.”
(Note: YGS is a “serotonin modulator” – has been shown to be effective and probably safe for dementia, BPD and tardive dyskinesia. A comparison with standard medications, particularly fluoxetine and carbamazepine would be a terrific research study opportunity)
Compr Psychiatry 2007 Sep-Oct;48(5):406-12
“Relationship of sex to symptom severity, psychiatric comorbidity, and health care utilization in 163 subjects with BPD.”
“Men and women with BPD show important differences in their pattern of psychiatric comorbidity, dimensional symptom ratings, and in quality of life variables. Women have more negative views of themselves, and worse overall emotional and social role functioning.”
Compr Psychiatry 2007 Sep-Oct;48(5):400-5
“BPD in male and female offenders newly committed to prison”
220 offenders entering Iowa’s prison system were evaluated. 29.5% had BPD, the percentage of women was twice that of men.
J Psychiatr Res Epub 2007 Aug 15 (from Germany)
“Declarative and procedural memory consolidation during sleep in patients with bpd”
“BPD is characterized by changes in subjective and objective measures of sleep quality.”
Actas Esp Psiquiatr 2007 Aug 13 (from Spain)
“Association between the serotonin transporter gene and personality traits in BPD patients evaluated with Zuckerman-Kuhlman Personality Questionnaire (ZKPQ)”
“The results suggest a significant association between the 5-HTT (serotonin transporter) gene and some personality traits in BPD.”
Encephale 2007 Mar-Apr;33(2):156-9 (from Switzerland)
“Predictive factors of suicidal behavior recurrence in BPD patients”
36% were readmitted for suicidal behavior within a year of a psychiatric admission for suicidal behavior.
J Clin Psychol 2007 Sep;63(9):843-50 (from Germany)
“Stability of the dexamethasone suppression test in BPD with and without comorbid PTSD (post traumatic stress disorder): a one-year follow-up study”
“Alterations in hypothalamic-pituitary-adrenal axis feedback regulation have been repeatedly reported in patients with BPD.” “Patients with comorbid PTSD showed more pronounced cortisol suppression compared to those without PTSD.”
(Note: hypothalamic-pituitary-thyroid axis is also impaired in approximately 1/3 of individuals with BPD as well).
Psychiatr Prax Epublished Aug 2 2007 2008 Apr;35(3):135-41 (from Germany)
“BPD and transsexualism”
“The data obtained refute the often-assumed increased relationship between BPD and transsexuality. It should be assumed that a BPD is primarily a psychiatric illness, while transsexuality is a disorder of gender identity in which secondary borderline symptoms may arise in some cases.”
J Psychiatry Neurosci 2007 Jul;32(4):234-40 (from Germany)
“[I-123] ADAM and SPECT in patients with BPD and healthy control subjects”
“The study provides evidence of a serotonergic dysfunction in patients with BPD and suggests a serotonergic component in the pathophysiology of the disorder SERT (serotonin transporter) binding reflected the level of impulsiveness as a common feature in BPD.”
(Note: low spinal fluid serotonin metabolite levels are strongly associated with suicidal and impulsive homicidal behavior with or without the BPD, and borderlines without strong suicidal ideation have normal levels)
Psychiatry Res 2007 Aug 15;155(3);231-43
“Fronto-limbic dysfunction in response to facial emotion in BPD: an event-related fMRI study”
“We conclude that adults with BPD exhibit changes in fronto-limbic activity in the processing of fear stimuli, with exaggerated amygdala response and impaired emotion-modulation of anterior cingulate cortex activity.
Actas Esp Psiquiatr 2007 Nov-Dec;35(6):387-92 (from Spain)
“Serotonin transporter polymorphism and fluoxetine effect on impulsiveness and aggression in BPD”
“L-allele carriers responded better to fluoxetine than S carriers, in a way as in depression.”
(Note: this study compared the “short allele {S}” to the {L} allele for the serotonin transporter gene. In my experience Prozac (fluoxetine) is extraordinarily important for BPD treatment, although sometimes high doses are needed. Some individuals with BPD need Tegretol (carbamazepine) in combination with Prozac (fluoxetine), and a genetic study of this combination with the S allele should be interesting. A similar study with high doses of Effexor (venlafaxine) warrants investigation).
J Nerv Ment Dis 2007 Jun;195(6);537-9 (from Germany)
“The impact of PTSD (post traumatic stress disorder) on dysfunctional implicit and explicit emotions among women with BPD.”
“Self reported guilt proneness and general psychopathology, but not shame proneness or trait anxiety, were significantly higher in women with BPD and PTSD than in women with BPD alone.
Compr Psychiatry 2007 Jul-Aug;48(4):329-36
“Psychosocial impairment and treatment utilization by patient with BPD, other personality disorders, mood and anxiety disorders and a healthy comparison group.”
“The BPD group was characterized by significantly greater psychiatric and non psychiatric treatment utilization than the other groups.”
Aust N Z J Psychiatry 2007 Jul;41(7):598-605 (from Australia)
“BPD, mother-infant interaction and parenting perceptions: preliminary findings”
“Mothers with BPD were found to be less sensitive and demonstrated less structuring in their interaction with their infants, and their infants were found to be less attentive, less interested and less eager to interact with their mother. … mothers with BPD reported being less satisfied, less competent and more distressed.” “Early intervention needs to be provided to mothers with BPD to promote maternal sensitivity and maternal perceptions of competence.”
CNS Spectr 2007 Jun;12(6):439-43
“An open-label trial of divalproex (Depakote) extended release in the treatment of BPD.”
70% responded for some symptoms, but mood swings and dissociation (deja vu, unreality) did not improve.
Am J Psychiatry 2007 Jun;164(6);929-35
“The subsyndromal phenomenology of BPD: a 10-year follow-up study.”
Impulsive symptoms (such as self-mutilation and suicide attempts) declined over time, as did demandingness/entitlement and serious treatment regression. Mood swings, anger, loneliness, emptiness, and abandonment/dependency issues were stable over time.
Br J Clin Psychol 2007 Sep;46(Pt 3):347-60 (from Germany)
“Emotion identification and tension in female patients with BPD.”
“Results indicate that the inability to identify different emotions is a problem that characterizes borderline patients in real-life situations.”
(Note: feelings such as weakness, vulnerability, powerlessness, hurt and fear are usually “defended” with anger, to the point where untreated borderlines don’t recognize these feelings, all that’s felt is anger – which frequently goes on to rage. I emphasize teaching borderlines that feelings come from beliefs, and that their beliefs are often faulty and need to be challenged.)
Psychol Med 2007 Dec;37(12):1717-29 (from Germany)
“Neuropsychological and behavioural disinhibition in adult ADHD compared to BPD.”
“ADHD and BPD share some symptoms of behavioural dysregulation without common cognitive deficits, at least in the attentional realm.”
J Clin Psychiatry 2007 May;68(5):721-9 (from Canada)
“Risk factors for suicide completion in BPD: a case-control study of cluster B comorbidity and impulsive aggression.”
Completed BPD suicides were more likely to:
• have fewer hospitalizations and suicide attempts compared to control groups
• to meet criteria for current and lifetime substance dependence disorders
• have Axis I comorbidity
• have novelty seeking and impulsivity
• have hostility
• have comorbid personality disorders
• have lower levels of harm avoidance
Br J Psychiatry Suppl 2007 May;49:s20-6 (from the UK)
“Altered memory and affective instability in prisoners assessed for dangerous and severe personality disorder.”
“Previous studies of BPD report neuropsychological impairments in several domains, including memory.” “Prisoners with BPD exhibited a pattern of multi-modal impairments in the immediate and delayed recall of verbal and visual information, with some association with affective instability. These deficits were not associated with the severity of personality disturbance.”
Biol Psychiatry 2007 Sep 15;62(6):580-7
“5HT2A receptor binding is increased in BPD”
“Postmortem studies in suicide victims demonstrate an increase in the number of post synaptic 5-HT(2A) receptor binding sites in ventral lateral and orbital frontal cortex. Diminished metabolic responses to serotonergic activation are noted in these areas in impulsive subjects with BPD, a group at high risk for suicidal behavior.” Conclusions: “5HT(2A) receptor binding is increased in the hippocampus of BPD subjects independent of depressed mood, impulsivity, aggression, suicidality or childhood abuse.”
Tijdschr Psychiatr 2007;49(4):233-40 (from Holland)
“Helping to integrate love and sexuality with a suitable partner seems to be an important development assignment for persons assisting borderline patients.”
(Note: I couldn’t possibly agree more, and I discuss this with my BPD patients. Controlling BPD symptoms, especially dysphoric episodes, is necessary for intimacy. I usually recommend the following four books: “His Needs, Her Needs” by Willard Harley, “The Five Love Languages” by Gary Chapman, “Men are from Mars, Women are from Venus” by John Gray, “Mars and Venus in the Bedroom” by John Grey. For those not in a relationship, I also highly recommend “Are You the One for Me?” by Barbara DeAngelis and “Mars & Venus on a Date” by John Gray)
Psychother Psychosom Med Psychol 2007 Mar-Apr;57(3-4): 161-9 (from Germany)
“Effectiveness of dialectical behavior therapy for patients with BPD in the long-term course – a 30 month follow-up after inpatient treatment”
“Our findings support the efficacy of DBT in an inpatient setting and show that the achieved success of therapy is stable for a prolonged period of time. Patients with high comorbidity seem to profit from DBT as well.”
Psychiatr Genet 2007 Jun 17(3):153-7 (from Canada)
“Monoamine oxidase a gene is associated with BPD”
“We found that the BPD patients had a high frequency of the high activity VNTR alleles and a low frequency of the low activity haplotype.”
Br J Psychiatry 2007 Apr; 190:357-8 (from Spain)
“Hypothalamic-pituitary-adrenal axis response in BPD without post-traumatic features.”
“Baseline cortisol levels in the patients were … lower than in the controls. The 0.25mg dexamethasone suppression test reveals increased feedback inhibition of the HPA in BPD.”
Neurosci Lett 2007 Apr 24;417(1):36-41 (from Germany)
“Evidence of disturbed amygdalar energy metabolism in patients with BPD”
“Confirming earlier reports we found a significant 11-17% reduction of amygdalar volumes in patients with BPD. In addition there was a significant 17% increase in left amygdalar creatine concentrations in BPD patients.”
J Personal Disord 2007 Feb;21(1):72-86 (from Canada)
“Affective instability and suicidal ideation and behavior in patients with BPD”
“…only negative mood intensity was significantly related to intensity of self-reported suicide ideation and to number of suicidal behaviors over the past year. Other elements of affective instability examined (e.g., mood amplitude, dyscontrol, and reactivity) were not associated with future suicide ideation or with recent suicidal behavior.”
Psychother Psychosom Med Psychol 2007 Jan;57(1):19-24 (from Germany)
“Skill training and the post-treatment efficacy of DBT six months after discharge from the hospital”
“Signs of the efficacy of DBT are mainly reduction of self-injurious behavior and suicidality as well as reduction of clinical parameters such as depression and general symptom stress. … These skills are (a) central part of DBT-treatment and are especially useful for managing high-tension, suicidality and self-injurious behavior. Therefore, the use of skills is possibly the reason for the continuous effect of DBT after the end of inpatient treatment.”
Headache 2007 Jan;47(1):22-6
“BPD and migraine”
“Migraine patients with coexisting BPD are clinically distinct from the migraine population as a whole, they are more severely affected by their headache disorder and more treatment refractory.”
J Psychiatry Neurosci 2007 Mar;32(2):103-15
“NMDA neurotransmission as a critical mediator of BPD”
“Studies of the neurobehavioral components of BPD have shown than symptoms and behaviors of BPD are partly associated with disruptions in basic neurocognitive processes, in particular, in the executive neurocognition and memory systems. A growing body of data indicates that the glutamatergic system, in particular, the N-methyl-D-aspartate (NMDA) subtype receptor, plays a major role in neuronal plasticity, cognition and memory and may underlie the pathophysiology of multiple psychiatric disorders. … We propose that multiple cognitive dysfunctions and symptoms presented by BPD patients, like dissociation, psychosis and impaired nociception, may result from the dysregulation of the NMDA neurotransmission. This impairment may be the results of biological vulnerability and environmental influences mediated by the NMDA neurotransmission.”
J Clin Psychiatry 2007 Feb;68(2):296 (from Australia)
“Adaptive functioning and psychiatric symptoms in adolescents with BPD”
“BPD was a significant predictor over and above Axis I disorders and other personality disorder diagnoses for psychopathology, general functioning, peer relationships, self-care, and family and relationship functioning. CONCLUSIONS: The BPD diagnosis should not be ignored or substituted by Axis I disorders in adolescent clinical practice, and early intervention strategies need to be developed for this disorder.”
CNS Spectr 2007 Mar;12(3):207-10
“Retrospective case review of lamotrigine use for affective instability of BPD.”
“Lamotrigine (Lamictal) seems to be a safe and effective option for the treatment of patients with symptoms of affective instability associated with BPD.”
Am J Psychiatry 2007 Mar;164(3):500-8 (from Germany)
“Shame and implicit self-concept in women with BPD”
“Shame, an emotion that is prominent in women with BPD, is associated with the implicit self-concept as well as with poorer quality of life and self-esteem and greater anger-hostility.”
Psychopharmacology (Berl). 2007 May; 191(4):1023-6 (from Austria)
“Aripiprazole in treatment of borderline patients, part II: an 18 month follow up”
“Abilify (aripiprazole) appears to be an effective and relatively safe agent in the long-term treatment of patients with BPD.”
(Note: if my BPD patients need a long term antipsychotic medication I try to prescribe Abilify (aripiprazole) because of the low incidence of weight gain. Zyprexa (olanzapine) is the most effective antipsychotic for long term use. With rare exception, Risperdal (risperidone) works best only when used occasionally.)
Psychiatry Res 2007 Feb 28;154(157-70) (from Germany)
“Hippocampal volume reduction and history of aggressive behavior in patients with BPD”
“Hippocampal grey matter volume was significantly decreased in BPD patient: the reduction was more pronounced in patients with multiple hospitalizations.”
J Nerv Ment Dis 2007 Feb;195(2):125-9
“Sexually transmitted disease rates and high-risk sexual behaviors in BPD versus BPD with substance use disorder.”
The risk of sexually transmitted diseases was significantly higher when borderlines also have substance use disorder, particularly gonorrhea, Trichomonas, and human papilloma virus. The risk is worsened by poverty, unprotected sex with two or more partners, greater than 20 lifetime partners, and especially prostitution.
Compr Psychiatry 2007 Mar-Apr; 48(2):145-54 (from Canada)
“The interface between BPD and bipolar spectrum disorders.”
“Existing data fail to support the conclusion that BPD and bipolar disorders exist on a spectrum but allows for the possibility of partially overlapping etiologies.”
Neuroimage 2007 Apr 1;35(2):738-47 (from Germany)
“Inferior frontal white matter microstructure and patterns of psychopathology in women with BPD and comorbid ADHD”
“Inferior frontal white matter microstructural abnormalities may be linked to key aspects of psychopathology in women with BPD and comorbid ADHD and add to alternations in orbitofrontal and limbic areas. The relationship between neuropsychological functioning and white matter structure remains unclear.”
Presse Med 2007 Feb;36(2 Pt1):235-7 (from France)
“Self-mutilation induced by cocaine abuse: the pleasure of bleeding”
“Amphetamine use, but not cocaine use, has previously been associated with severe self-injurious behavior. … The complex behavior associated with cocaine abuse may be one cause of self-mutilation.”
Biol Psychiatry 2007 Aug 1:62(3):250-5
“Exaggerated affect-modulated startle during unpleasant stimuli in BPD”
“The BPD patients exhibited larger startle eyeblink during unpleasant but not neutral words, indicating exaggerated physiological affect. This finding remained significant when we controlled for comorbid diagnoses, including generalized anxiety disorder and PTSD (post traumatic stress disorder). Greater symptom severity was associated with greater affective-startle difference scores. CONCLUSIONS: Consistent with the symptom of affective dysregulation, these results suggest an abnormality in the processing of unpleasant emotional stimuli by BPD patients.”
Psychol Med 2007 Jul;37:971-81 (from Germany)
“Enhanced emotion-induced amnesia in BPD”
“BPD patients displayed enhanced retrograde and anterograde amnesia in response to presentation of negative stimuli, while positive stimuli elicited no episodic memory-modulating effects.
Neuropsychopharmacology 2007 Jul, 32 (7):1629-40
“Amygdala-prefrontal disconnection in BPD”
“We demonstrated a tight coupling of metabolic activity between right orbitofrontal cortex and ventral amygdala in healthy subjects with dorsoventral differences in amygdala circuitry, not present in impulsive aggressive BPD. We demonstrated no significant differences in amygdala volumes or metabolism between BPD patients and controls.”
Psychiatry Res 2007 Jan 15;149(1-3):291-6 (from Germany)
“Elevated pain thresholds correlate with dissociation and aversive arousal in patients with BPD”
“…patients with BPD show higher pain thresholds under subjective stress conditions as compared with non-stress conditions.”
Psychiatry Res 2007 Jan 15;149(1-3):139-45
“Early visual information processing deficit in depression with and without BPD”
“Poor early information processing appears to be a feature of BPD, and may play a role in the impulsive behavior that is characteristic of the disorder”
J Psychiatr Res 2007 Nov;41(10):837-47 (from Germany)
“Effects of DBT on the neural correlates of affective hyperarousal in BPD”
“In our pilot study DBT treatment was accompanies by neural changes in limbic and cortical regions resembling those reported on psychotherapy effects in other mental disorders.”
Prog Neuropsychopharmacol Biol Psychiatry 2007 Jan 30,31 (from Italy)
“Quetiapine for the treatment of BPD; an open-label study”
“Present findings would suggest that quetiapine may be effective for the treatment of a number of BPD features, including low mood and aggression. However, monitoring blood counts in patients receiving quetiapine seems to be justified.”
(Note: in my experience Seroquel (quetiapine) has had minimal benefit for BPD patients, with the exception of refractory insomnia. Seroquel (quetiapine) taken on an empty stomach for at least 6-8 hours will cause almost all refractory insomniacs to fall asleep”)
J Psychiatr Res 2007 Dec;41(12):1019-26 (from the Netherlands)
“Basal cortisol and DHEA levels in women with BPD”
“Previous research suggests that in BPD normal stress regulation, with a main role for cortisol, is disturbed.” DHEA can antagonize the effects of cortisol, and is lower in the evening in BPD patients…”significantly related to a stronger tendency to avoid active problem solving and a lowered inclination to seek social support.”
(Note: DHEA is sometimes referred to as the “anti-aging hormone” and supplements can help individuals with lupus).
Prog Neuropsychopharmacol Biol Psychiatry 2008;32(4):1022-9
“A relationship between bipolar II disorder and BPD?”
“The core feature of bipolar II (i.e. hypomania) does not seem to have a close relationship with BPD traits in the study setting, partly running against a strong association between BPD and bipolar II and a bipolar spectrum nature of BPD.”
Actas Esp Psiquiatr 2008;36:46-62
“Anticonvulsants in the treatment of impulsivity”
“…oxcarbazepine shows efficacy in the treatment of acute mania, impulsive/aggressive behaviors associated to personality disorders, eating behavior disorders and dementia associated agitation.”
J Pers Disord 2008; 22(2):191-207
“Personality disorders and pathological gambling: a review and re-examination of prevalence rates.”
“…pathological gamblers consistently displayed significantly higher levels of BPD than non pathological gamblers…”
J Psychiatr Res 2008;42(9):727-33
“Frontolimbic structural changes in BPD”
“This sample of BPD patients exhibits gross structural changes in gray matter in cortical and subcortical limbic regions that parallel the regional distribution of altered functional activation to emotional stimuli among these same subjects.”
J Clin Psychiatry 2008;69(4):603-8
“Ziprasidone (Geodon) in the treatment of BPD: a double-blind, placebo-controlled, randomized study.”
“This trial failed to show a significant effect of ziprasidone in patients with BPD.”
J Pers Disord 2008;22(2):165-77
“Dysfunctional beliefs and psychopathology in BPD”
“Distrust was the sole factor that correlated significantly with suicide ideation.
Eur Psychiatry 2008;23(3);201-4
“Cortisol response to interpersonal stress in young adults with BPD: a pilot study”
“BPD subjects showed a delayed cortisol response after psychosocial stress.”
J Clin Psychopharmacol 2008; 28(2):147-55
“Efficacy of Seroquel (quetiapine) for impulsivity and affective symptoms in BPD.”
“These results suggest that Seroquel (quetiapine) may be efficacious in the treatment of impulsivity and affective symptoms in BPD.”
(Note: in my experience Seroquel (quetiapine) is very effective for severe sleep disorders, but is minimally effective for impulsivity and mood symptoms compared to other medications, particularly Prozac (fluoxetine), Tegretol (carbamazepine) and Zyprexa (olanzapine)).
Behav Ther 2008; 39(1):72-8
“Borderline personality characteristics and treatment outcome in cognitive-behavioral treatments for PTSD in female rape victims”
“Findings suggest that women with borderline pathology may be able to benefit significantly from cognitive-behavioral treatment for PTSD.”
Acta Psychatr Scand 2008; 117(3):177-84 (by Zanarini, M from Harvard)
“The 10-year course of physically self-destructive acts reported by borderline patients and axis II comparison subjects.”
“The course of self-mutilation and suicide attempts among borderline patients is initially more serious and ultimately more benign than previously recognized.”
Actas Esp Psiquiatr 2008; 36(2):70-4
“Long acting injectable Risperdal (risperidone) in treatment resistant BPD. A small series report.”
“Treatment with (intramuscular) long acting Risperdal (risperidone) during six months was associated with significant clinical and functional improvement and excellent tolerability in a group of BPD patients refractory to previous treatment.”
(Note: for those few patients who don’t respond to typical treatment the long term use of Risperdal has been effective, but usually results in significant weight gain.)
Psychiatry Clin Neurosci 2008; 62(1):48-55
“Nightmare disorder, dream anxiety, and subjective sleep quality in patients with BPD”
“The… study provides support for a strong association between BPD, distressing nightmares, and subjective sleep quality. Recognition and management of dream and sleep disturbances in BPD patients might lead to improvements in their global clinical picture.”
Psychopathology 2008;41(1):50-7
“Response inhibition in BPD: performance in a Go/No Go task”
“…BPD patients have inadequately fast reaction times and a speed accuracy tradeoff. …they show a genuine deficit of response inhibition.”
Prog Neuropsychopharmacol Biol Psychiatry 2008; 32(1):150-4
“Yi-gan san for the treatment of BPD: an open-label study”
“…might be effective for a number of BPD symptoms, including low mood, impulsivity, and aggression.”
Acta Psychiatr Scand 2008 Jul;118(1):42-8 (from Switzerland)
“Sequences of emotions in patients with borderline personality disorder”
“Persistence of sadness and anxiety, as well as emotional oscillating between anxiety, sadness and anger are important aspects of the emotional dysregulation in BPD patients.”
J Pers Disord 2008 Jun;22(3):284-90 (by Mary Zanarini from Harvard)
“A preliminary, randomized trial of psychoeducation for women with borderline personality disorder”
“Taken together, the results of the study suggest that informing patients about BPD soon after diagnostic disclosure may help to alleviate the severity of two of the core elements of borderline psychopathology – general impulsivity and unstable relationships. They also suggest that such instruction may prove to be a useful and cost-efficient form of pre-treatment.”
(Note: I fully agree. That’s one of the reasons I did the DVD.)
J Psychosom Res 2010 (Mar;68(3):285-92 (from England)
“The Beliefs about Emotions Scale: validity, reliability and sensitivity to change”
“The new Beliefs about Emotions Scale showed good internal reliability, validity and sensitivity to change.”
J Pers Disord 2009 Dec;23(6):555-62 (from Hungary)
“The neuropsychology of BPD (borderline personality disorder): relationship with clinical dimensions and comparison with other personality disorders.”
“Borderline patients showed deficient attention, immediate and delayed memory, and relatively spared visuospatial and language functions compared with controls. … The neuropsychological deficit significantly correlated with the impulsivity sector score of the Zanarini Rating Scale for Borderline Personality Disorder. … These results suggest the borderline patients are impaired in neuropsychological domains sensitive for frontal and temporal lobe functioning, and this deficit is related to impulsivity.”
J Nerv Ment Dis 2009;197(11):808-15 (from Germany)
“Emotional reactions to standardized stimuli in women with borderline personality disorder: stronger negative affect, but no differences in reactivity.”
“Extreme negative affectivity may be a more appropriate description of BPD-related emotional problems than emotional hyperreactivity.”
Cogn Neuropsychiatry 2009 Nov;14(6):524-41 (from Germany)
“Emotion-induced memory dysfunction in borderline personality disorder”
“The present findings suggest no general impairment of verbal memory functions in BPD but control and inhibition of interference by emotionally significant material seem to be disturbed.”
Am J Psychiatry 2009 Dec;166(12):1355-64 (from England)
“Randomized controlled trial of outpatient mentalization-based treatment versus structured clinical management for borderline personality disorder”
“Structured treatments improve outcomes for individuals with borderline personality disorder.”
J Marital Fam Ther 2009 Oct;35(4):446-55 (from Canada)
“Relationship quality and stability in couples when one partner suffers from borderline personality disorder”
“A majority of couples in which the woman suffered from BPD (68.7%) evidenced frequent episodes of breakups and reconciliations and, over an 18 month period, nearly 30% of these couples dissolved their relationship. Nearly half of the men involved in a romantic relationship with a woman suffering from BPD met criteria for one personality disorder or more. As compared with nonclinical couples, clinical couples showed lower marital satisfaction, higher attachment insecurity, more demand/withdraw communication problems, and higher level of violence.”
Am J Psychiatry 2009 Dec;166(12):1365-74 (from Canada)
“A randomized trial of dialectical behavior therapy (DBT) versus general psychiatric management for borderline personality disorder”
“These results suggest that individuals with borderline personality disorder benefitted equally from DBT and a well-specified treatment delivered by psychiatrists with expertise in the treatment of borderline personality disorder.”
J Sex Med 2009 Dec;6(12):3356-63 (from Germany)
“Impaired sexual function in patients with borderline personality disorder is determined by history of sexual abuse.”
“Not BPD alone, but concomitant sexual traumatization, predicts significantly impaired sexual function. This may have a therapeutic impact on BPD patients reporting sexual traumization.”
J Pers Disord 2009 Aug;23(4):369-409 (from Hungary)
“Trust game reveals restricted interpersonal transactions in patient with borderline personality disorder”
“These results suggest the patients with BPD exhibit less trust during interpersonal interactions, which may be related to stress-related paranoia, dissociation, identity disturbance, and problems in interpersonal relationships.”
J Neural Transm 2009 Sep;1185-8 (from Germany)
“Association analysis of serotonin receptor 1B (HTR1B) and brain-derived neurotrophic factor gene polymorphisms in borderline personality disorder.”
“Logistical regression analyses revealed an over-representation of the BDNF 196A allele in HTR1B A-161 allele carrying BPD patients.”
J Psychiatry Neurosci 2009 Jul;34(4):289-95 (from
Germany)
“Hippocampus and amygdala volumes in patients with borderline personality disorder with or without posttraumatic stress disorder.”
“Comorbid PTSD may be related to volumetric alterations in brain regions that are of central importance to our understanding of borderline psychopathology.”
J Psychiatr Pract 2009 May;15(3): 173-82
“A 5-day dialectical behavior therapy partial hospital program for women with borderline personality disorder: predictors of outcome from a 3-month follow-up study.”
“…that BPD is a complex, heterogeneous disorder for which there is no single pathognomonic criterion, so that each criterion should be considered individually in determining its potential effect on treatment outcomes.”
J Psychiatry Neurosci 2009 May;34(3):214-22 (from Germany)
“Emotional learning during dissociative states in borderline personality disorder”
“Emotional, amygdala-based learning processes seem to be inhibited during state dissociative experience.”
Am J Psychother 2009;63(1):41-51 (from Japan)
“How repeated 15-minute assertiveness training sessions reduce wrist cutting in patients with borderline personality disorder,”
“At the conclusion of psychotherapeutic treatment, 69% of outpatients showed a statistically significant reduction in wrist-cutting behavior.”
J Pers Disord 2009 Apr:23(2):156-74 (from Canada)
“Meta-analyses of mood stabilizers, antidepressants and antipsychotics in the treatment of borderline personality disorder: effectiveness for depression and anger symptoms.”
“Divalproic acid and carbamazepine had a moderate effect on depression. Antidepressants had a moderate effect on anger reduction, but a small effect on depression. Antipsychotics had a moderate effect on anger, however aripiprazole had a much larger effect-size than other antipsychotics. Antipsychotics did not have an effect for depression.”
(Note: the key for most BPD patients is medication combination, which were not reviewed by this statistical analysis of previous studies.”
Psychiatry Res 2009 Feb 28;171(2):94-105 (from Germany)
“Neural correlates of episodic and semantic memory retrieval in borderline personality disorder: an fMRI study.”
“Our findings suggest that BPD patients may need to engage larger brain areas to reach a level of performance in episodic and semantic retrieval tasks that is comparable to that of healthy controls.”
Psychoneuroendocrinology 2009 Apr;34(3):353-7
“Angiogenic factors in patients with current major depressive disorder comorbid with borderline personality disorder”
“Depressive episodes in the context of borderline personality disorder may be accompanied by increased serum concentrations of VEGF (vascular endothelial growth factor) and FGF-2 (fibroblast growth factor-2). Similar findings have been observed in patients with major depression without a borderline personality disorder. A dysregulation of angiogenic factors may be another facet of the endocrine and immunologic disturbances frequently seen in patients with depressive episodes.”
Biol Psychiatry 2009 May 1;65(9):819-22 (from Germany)
“Amygdala deactivation as a neural correlate of pain processing in patients with borderline personality disorder and co-occurrent post traumatic stress disorder”
“Amygdala deactivation seems to differentiate patients who meet criteria for both BPD and PTSD from BPD patients without co-occurrent PTSD.”
Psychoneuroendocrinology 2009 May;34(4):571-86 (from Germany)
“Neural correlates of the individual emotional Stroop in borderline personality disorder”
“These results provide further evidence for a dysfunctional network of brain areas in BPD, including the anterior cingulate cortex and frontal brain regions.”
Am J Med Genet B Neuropsychiatr Genet 2009 Jun 5;150B(4):487-95 (from Germany)
“Interaction between gene variants of the serotonin transporter promoter region (5-HTTLPR) and catechol O-methyltransferase (COMT) in borderline personality disorder.”
“These data suggest an involvement of altered dopaminergic and/or noradrenergic neurotransmission as well as an interactive effect of COMT and 5-HTTLPR gene variants in the etiology of BPD, and underline the usefulness of analyses of gene-gene effects in disease of complex inheritance with multiple genes involved.”
Psychol Med 2009 May;39(5):855-64 (from Germany)
“Negative bias in fast emotion discrimination in borderline personality disorder”
“Our data suggest a selective deficit in BPD patients in rapid and direct discrimination of negative and neutral emotional expressions that may underlie difficulties in social interactions.”
Pain Res Manag 2010 Nov-Dec;15(6):369-70
“Disability and borderline personality disorder in chronic pain patients”
“Findings suggest that among chronic pain patients, there may be no meaningful relationship between having every been on medical disability and borderline personality symptomatology”
J Nerv Ment Dis. 2010 Dec;198(12):914-5
“Self-harm behaviors in borderline personality: an analysis by gender”
Head banging and losing a job on purpose were more common in men, otherwise there were no gender differences.
Am J Psychiatry 2010 Oct;167(10:1210-7
“Impact of co-occurring posttraumatic stress disorder on suicidal women with borderline personality disorder”
The results indicate greater impairment among individuals with both disorders.
J Pers Disord 2010 Dec:24 (6):812-22
“Co-morbid ADHD in borderline patients defines an impulsive subtype of borderline personality disorder”
In this study from Spain they found ADHD was comorbid with BPD 38% of the time (I suspect that number is higher). The combination had a 55% higher risk of substance abuse. Interestingly they found that those with the combination didn’t have the avoidant personality disorder.
Biol Psychiatry 2010 Dec 20 (From Germany)
“Neuronal correlates of cognitive reappraisal in borderline patients with affective instability.”
“Patients demonstrated enhanced activation of left amygdala and right insula during the initial viewing of aversive stimuli.” While attempting to diminish the excessive reaction, the left orbitofrontal cortex didn’t respond as well as normal and there was increased activation of the insula on both sides.
J Clin Psychiatry (Primary Care Companion) 2010; 12(5)
“Sleep quality in borderline personality disorder: a cross sectional study”
“Individuals with borderline personality symptomatology demonstrate a poorer overall quality of sleep…”
Am J Psychiatry 2010 Aug;167(8): 925-33
“Dysregulation of regional endogenous opioid function in borderline personality disorder”
“Differences exist between patients with borderline personality disorder and comparison subjects in baseline in vivo mu-opioid receptor concentrations and in the endogenous opioid system response to a negative emotional challenge…”
J Psychiatr Res 2010 Nov;44 (15): 1075-81
“Tryptophan-hyroxylase 2 haplotype (TPH2) association with borderline personality disorder and aggression in a sample of patients with personality disorders and healthy controls.”
This gene is associated with increased risk of borderline personality disorder, impulsive aggression, mood swings, suicidal behavior, and self-mutilation.
Psychiatr Genet 2010 Feb;20(1):25-30
“Fluoxetine response in impulsive-aggressive behavior and serotonin transporter polymorphism in personality disorder”
Some types of serotonin genes are more responsible for impulsive and aggressive behavior than others, particularly the response to Prozac (fluoxetine).
Biol Psychiatry 2010 Mar 1;67(5):399-405
“Metabolic alterations in the amygdala in borderline personality disorder: a proton magnetic resonance spectroscopy study”
“Decreased tNAA (N-acetylaspartate) and tCr (total creatine) might indicate disturbed affect regulation and emotional information processing in the amygdala of BPD patients.”
Eur Psychiatry 2010 Oct 6
“Hippocampal volume in borderline personality disorder with and without comorbid posttraumatic stress disorder: A meta-analysis”
“…hippocampal volumes are reduced in patients with BPD, relative to healthy controls, but particularly in cases in which patients are diagnosed with comorbid PTSD.”
Int J Psychophysiol 2010 Dec;78:257-64
“Processing of visual stimuli in borderline personality disorder: a combined hehavioral and magnetoencephalographic (MEG) study.
“This MEG study provides evidence for disturbances in cortical visual perception in BPD patients regardless of emotional salience of the stimulus. In line with previous studies, subtle deficits in visual perception might be related to impairment in interpersonal communication in BPD.”
Psychiatry Res 2010 Apr 30;182(1):73-6
“Superior temporal gyrus volume in teenagers with first-presentation borderline personality disorder”
Individual with violent episodes had smaller left STG (superior temporal gyrus) volumes compared to those without violent episodes.
World J Biol Psychiatry 2010 Mar;11:372-81
“Neurochemical alterations in women with borderline personality disorder and comorbid attention deficit hyperactive disorder”
“Glutamatergic changes in the anterior cingulate may be associated with BPD and comorbid ADHD. Increased anterior cingulate tNAA (total N-acetylaspartate) may indicate disturbed energy metabolism or impaired frontal maturation.”
World J Biol Psychiatry 2010 Mar;11(:364-71
“Pain sensitivity is reduced in borderline personality disorder, but not in PTSD (post traumatic stress disorder) and bulimia nervosa.”
These findings “may differentiate the BPD from other stress-related psychiatric conditions.”
Psychiatry Res 2010 Feb 28;181(2):151-4
“Reduced interhemispheric structural connectivity between anterior cingulate cortices in borderline personality disorder”
Decreased communication between both sides of the brain was discovered in those with BPD.
J Clin Psychiatry 2010 Jan;71 (1): 26-31
“Psychiatric diagnoses in patients previously overdiagnosed with bipolar disorder”
“Psychiatric outpatients overdiagnosed with bipolar disorder were characterized by more Axis I and Axis II diagnostic comorbidity in general, and borderline personality disorder in particular.”
J Psychopharmacol 2010 Mar;24 (3): 333-9
“Efficacy and tolerability of duloxetine (Cymbalta) in the treatment of patients with borderline personality disorder: a pilot study”
There was improvement in impulsivity, anger outbursts, mood instability and physical symptoms. (This is an expensive medication, very similar to Effexor (venlafaxine). I’ve switched many patients from Cymbalta (duloxetine) to Prozac (fluoxetine) and seen significant improvement by this change.)
J Pers Disord 2010 Dec;24(6): 785-99
“Impulsivity in borderline personality disorder: reward-based decision-making and its relationship to emotional distress”
“…the BPD is characterized by a preference for immediate gratification and tendency to discount longer-term rewards.”
J Pers Disord 2010 Dec;24(6): 763-72
“A comparison of depressed patients with and without borderline personality disorder: implications for interpreting studies of the validity of the bipolar spectrum”
“Our results do NOT support inclusion of borderline personality disorder as part of the bipolar spectrum.”
J Psychiatr Res 2010 Dec 1 (Mary Zanarini from Harvard)
“Predictors of self-mutilation in patients with borderline personality disorder: a 10 year follow up study.”
Female gender, severity of dysphoric ideas, severity of dissociation (deja vu, unreality), major depression, history of childhood sexual abuse and sexual assaults as an adult were significant risk factors.
Personal Disord 2010 Oct 1;1 (4): 239-249
“Does comorbid substance use disorder exacerbate borderline personality features?: a comparison of borderline personality disorder individuals with versus without current substance dependence.”
“Our results do not support the notion that BPD individuals with substance use disorder display more severe BPD features than individuals with BPD alone.”
Compr Psychiatry 2010 Sep-Oct; 51(5):458-61
“Being bullied in childhood: correlations with borderline personality in adulthood.”
“A history of being bullied in childhood demonstrates a positive correlation with BPD in adulthood…”
Int J Psychiatry Med 2010;40(1):21-9
“Road rage: relationships with borderline personality and driving citations”
Individuals with BPD have a 250% higher risk of road rage and a significantly higher risk of driving citations.
J Pers Disord 2010 Jun;24(3): 365-76 (Mary Zanarini)
“A Longitudinal study of the 10 year course of interpersonal features in borderline personality disorder”
“The interpersonal features slowest to remit were affective responses to being alone, active caretaking, discomfort with care and dependency.”
Psychiatr Serv 2010 Jun;61(6): 612-6 (Mary Zanarini)
“Ten-year use of mental health services by patients with borderline personality disorder and other axis II disorders.”
“…patients with borderline personality disorder tend to use outpatients treatments without interruption over prolonged periods. They also suggest that inpatient treatment is used far more intermittently by patients with borderline personality disorder.”
Ann Clin Psychiatry 2010 May;22(2): 121-8
“Impact on suicidality of borderline personality traits impulsivity and affective instability.”
Impulsivity rather than mood instability is more strongly associated with suicidality.
Am J Psychiatry 2010 Jun;167(6):618-9 (Mary Zanarini)
“Time to attainment of recovery from borderline personality disorder and stability of recovery: A 10-year prospective follow-up study.”
“…the results of this study suggest that recovery from borderline personality disorder, with both symptomatic remission and good psychosocial functioning, seems difficult for many patients to attain. The results also suggest that once attained, such a recovery is relatively stable over time.”
Clin J Pain 2010 May;26(4):348-53
“Borderline personality disorder features and pain: the mediating role of negative affect in a pain patient sample.”
“…individuals with higher levels of BPD features reported greater severity of pain and somatic complaints…this association was no longer significant after controlling for affect scales. In particular, depression was strongest in accounting for this association.”
J Clin Psychiatry 2010 Sep;71(9):1212-7
“Screening for bipolar disorder and finding borderline personality disorder”
“Positive results on the MDQ (mood disorder questionnaire) were as likely to indicate that a patient has borderline personality disorder as bipolar disorder.”
Clin Psychol Psychother 2010 Feb 25
“Dialectic behavioural therapy has an impact on self-concept clarity and facets of self-esteem in women with borderline personality disorder”
“…in BPD patients, self-esteem and the diagnostic criteria identity disturbance…can be influenced with short-term psychotherapy.”
Psychiatry Res 2010 Mar 30;181(3):233-6
“Medial prefrontal cortex hyperactivation during social exclusion in borderline personality disorder”
“BPD subjects showed left medial prefrontal cortex hyperactivation during social exclusion suggesting potential dysfunction of frontolimbic circuitry.”
J Psychiatry Res 2010 Oct;44(13):847-52
“Incidence of polycystic ovaries and androgen serum levels in women with BPD.”
Polycystic ovaries and excessive testosterone have been found in a number of women with BPD compared to depressed patients.”
J Clin Psychopharmacol 2010 Feb;30(1):44-7
“olanzapine (Zyprexa) versus haloperidol (Haldol) in the management of borderline personality disorder: a randomized double-blind trial.”
Chronic use of both medications showed no difference in effectiveness regarding anxiety, tension, depressive mood, and hostility. (Note: there are pluses and minuses for chronic use of both medications. In my experience, Haldol (haloperidol) works much more quickly, Zyprexa is better for severe acute stresses)
Br J Psychiatry 2010 Jan;196(1):4-12
“Pharmacotherapy for borderline personality disorder: Cochrane systematic review of randomized trials.”
There is limited scientific data for medical treatment of BPD. (Even more limited are medication combination studies such as Prozac with Tegretol, Prozac with as needed Haldol, etc. This report confirms the lack of good medication trials, which makes current treatment of the BPD more art than science. There are some studies confirming medication effectiveness, therefore backing up most treatment approaches to some degree. Lack of scientific studies does not prove lack of effectiveness.)
J Psychiatr Res. 2010 Apr;44(6):405-8
“Borderline personality disorder and misdiagnosis of bipolar disorder”
“Patients with borderline personality disorder, regardless of how they meet criteria, may be at increased risk of being misdiagnosed with bipolar disorder.”
Permission by Leland M. Heller, M.D.
