MEDLINE RESEARCH ON THE BORDERLINE PERSONALITY
DISORDER
By Leland M. Heller, M.D.
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.
1980-1985
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)
1986-1989
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.
1990-1992
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.
1993-1995
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.
1996
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.
1997-1998
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.
1998-2000
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.
2000-2002
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 at
http://www.BiologicalUnhappiness.com/abstract.htm, along
with the 1999 update at
http://www.BiologicalUnhappiness.com/update.htm)
2003
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."
2004
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."
2005
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)
2006
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.)
Permission by Leland M. Heller, M.D.
