Understanding the "Primitive Ego Defense Mechanisms" and
Cognitive Distortions in BPD
Quick clear run-down of the most common psychological defense mechanisms
Understanding the Defense Mechanisms
commonly used by those with BPD
Scroll down for a detailed explanation of the "ego defense
mechanisms" and their origin in (Anna) Freud's work.
Freud and SplittingBrilliant detailed explanations of the theories of splitting, by J.A. Brook.
Splitting and the
Borderline
Very nice summary of the theories behind the how/why
of splitting.
More on Splitting
from bpd411.org
The True Self and the False Self
by Sam Vaknin
Anosognosia Keeps Patients From
Realizing They're Ill
Anosognosia is the inability of someone with mental
illness to perceive that they are ill. This lack of insight,
so often found in BPD, is explained in a review of Dr. Xavier
Amador's excellent volume,
I'm Not Sick: I Don't Need
Help!.
Understanding the Symptoms of Borderline
Personality Disorder
by Richard A. Moskovitz
"Gaslighting" -- when someone with BPD makes
you doubt your own reality perception
Symptoms/Consequences of BPD
An inside perspective by Laura Huizen, a Dutchwoman with
BPD.
Defense Styles in Borderline Personality Disorder
BOND, M.; PARIS, J.; ZWEIG-FRANK, H.,
JOURNAL OF
PERSONALITY DISORDERS, 1994
"Seventy-eight borderline and 72 nonborderline personality
disordered patients were compared on scores on the defense
style questionnaire. The borderline group reported using
maladaptive and image-distorting defense styles more often
and adaptive defense styles less often than the
nonborderline group. These findings empirically validated
clinical observations and theory.
It is striking that, not
only did the borderline group use more splitting and acting
out, but they underused the defenses of suppression,
sublimation, and humor. This suggests that borderlines'
deficit in mastering anxiety, painful emotion, and
threatening impulse is related to an underutilization of
adaptive defenses and not only an overreliance on the
characteristic image-distorting defenses."
Identity Disturbance in Borderline
Personality Disorder: An Empirical Investigation
Abstract of a study by Tess Wilkinson-Ryan, A.B. and Drew
Westen, Ph.D., 2000
"Four identity disturbance factors were identified: role
absorption (in which patients tend to define themselves in
terms of a single role or cause), painful incoherence (a
subjective sense of lack of coherence), inconsistency (an
objective incoherence in thought, feeling, and behavior),
and lack of commitment (e.g., to jobs or values). All four
factors, but particularly painful incoherence,
distinguished patients with borderline personality
disorder. Although sexual abuse was associated with some of
the identity factors, particularly painful incoherence,
borderline pathology contributed unique variance beyond
abuse history to all four identity disturbance factors. The
data also provided further evidence for an emerging
empirical distinction between two borderline personality
disorder types: one defined by emotional dysregulation and
dysphoria, the other by histrionic characteristics."
Primitive defense mechanisms in
schizophrenics and borderline patients
by F. Leichsenring
Borderline Personality Organization
by Steve Cottrell & Peter Jones, 2000
Excellent write-up of Kernberg's original formulation
of BPD and its transformation over the years.
Emotional and cognitive factors in the
borderline profile
by Kretsch R, Goren Y, Wasserman A.
Linguistic characteristics of neurotic,
borderline and psychotic personality organization
by Jeanneau M, Armelius BA.
Real Self-Deception
by Alfred Mele, 1997
Essay on the philosophy and mechanisms of self-deception
(not BPD-specific).
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The Role of Shame and Guilt
The Role of Shame in BPD
by Dr. Richard Moskovitz
Borderline Dysphoria -- The Shame At Its
Core
by A. J. Mahari, 2000
Great insight by a woman with BPD in recovery.
Shame And Guilt: The Masters of
Disguise
by Jane Middelton-Moz
Rage, Shame and the Death of Love
by William Cloke, Ph.D.
Really
fabulous detailed essay on the origins of
shame, empathy, idealization and devaluation, guilt and
anger. Excellent for understanding someone with BPD as well
as understanding one's own emotional reactions to BPD
behaviors.
The role of shame and guilt in
the intergenerational transmission of abusiveness
Abstract of a study of partner-aggressive men, by Donald Dutton et al., 1995
The Relationship Between Shame and
Parasuicide in Borderline Personality Disorder
A full-text study by Milton Brown, Eric R. Levensky, &
Marsha M. Linehan, 1997
This interesting study found that shame is a unique
predictor for parasuicidal behavior.
Healing the Shame That Binds You
by John Bradshaw
Read excerpts of this [i]excellent[/i] book at amazon.com
The Shame of Toxic Shame
by John Bradshaw, author of
Healing the Shame that Binds
Us
Theories about the causes of depression: Guilt,
Shame
Shame
An excellent article by Judith Pierson
Shame and the Social Bond: A Sociological
Theory
by Thomas J. Scheff
Shame and the Resistance to Spirituality
by Thomas Michael Bader, PhD.
Great insights from a practicing therapist.
Shame, Anger and the Social Bond: A Theory of
Sexual Offenders and Treatment
Thomas Scheff and Suzanne Retzinger, 1997
Interesting for its detailed study of how shame erupts into the
breaking of 'social bonds.'
Do the moralistic emotions of shame and
guilt present different responses in thinking, motivation and
feeling?
by Michael S.
Essay on guilt & shame.
Shame Reduction, Affect Regulation, and
Sexual Boundary Development: Essential Building Blocks of
Sexual Addiction Treatment
by Kenneth M. Adams; Donald W. Robinson, 2001
Full-text article (pdf file: requires Adobe Acrobat to
read)
Eye Movement Desensitiztion and Reprocessing
Treatment of Internalized Shame
by Dennis Balcom, MSW. , Elizabeth Call, PsyD., Deborah N.
Pearlman, Ph.D., 2000
Very interesting write-up!
Read lots more about EMDR here.
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Borderline Rage: Impulsive Anger, Temper Tantrums
Rage
by A.J. Mahari, a woman recovered from BPD.
Borderline Rage and Abuse
by Anthony Walker, MD, author of
The Courtship Dance of the
Borderline.
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Borderline "Sensitivity" and "Giftedness"
Facial expression recognition ability among
women with borderline personality disorder: implications for
emotion regulation?
by Wagner AW and Linehan MM., 1999
Results indicated that borderline individuals were
primarily accurate perceivers of others' emotions and
showed a tendency toward heightened sensitivity on
recognition of fear, specifically. Results are discussed in
terms of emotional appraisal ability and emotion
dysregulation among individuals with BPD."
Adult attachment and the perception of
facial expression of emotion
by Niedenthal PM, et al, 2001
Giftedness And Psychological Abuse In Borderline
Personality Disorder: their relevance to genesis and
treatment
by PARK, L.C.; HULSE, S.H., et al,
JOURNAL OF PERSONALITY
DISORDERS, 1992
Abstract:
"This clinical study of 23 borderline outpatients and 38
outpatients with other personality disorders provides
evidence that individuals who become borderline frequently
have a special talent or gift, namely a potential to be
unusually perceptive about the feelings of others. The
authors postulate that this talent is derived from an
innate characteristic rather than simply arising from early
environmental influences. The authors also present evidence
that chronic, severe, pervasive psychological abuse, or
"mind abuse," is the most frequent and significant form of
caretaker abuse (vs. sexual or physical) in the childhood
histories of this disorder. The data support the hypothesis
that the interaction of a child's gifted characteristics
with this abuse creates a tragic drama that is etiology for
bpd in a substantial number of cases. The authors propose
that the abuse markedly perverts not only use of the
perceptual talents (e.g., powerfully compelling projective
identification) but overall psychological development."
Misdiagnosis of the Gifted?
by Lynne Azpeitia, M.A. and Mary Rocamora, M.A
ART AND MENTAL ILLNESS
by Anthony Storr
"Artistic creativity is borne of human dissatisfaction and
consequent "imagination" in the face of adversity. Proneness
to mental illness has some similar origins. This accounts for
the link between them. Under such circumstances the creative
process can be adaptive and therapeutic but, if mental
illness still supervenes, then such creativity is blighted.
Our present stigmatizing diagnostic categorisations of, for
example, "personality disorders", also fails to recognise the
scientific and artistic creative abilities which
significantly often accompany them."
Emotion processing in borderline personality
disorders
by Levine D, Marziali E, Hood J., 1997
The aim of this study was to examine the ways in which
adults with borderline personality disorder (BPD)
experience and manage their feelings. Responses of 30
subjects who met the criteria for BPD on the Structured
Clinical Interview for DSM-III-R were compared with 40
non-BPD controls on the following measures of emotion
processing and affect regulation: 1) level of emotional
awareness, 2) capacity to coordinate mixed valence
feelings, 3) accuracy at identifying facial expressions of
emotion, and 4) intensity of response to negative emotions.
The results showed significant differences between the two
groups on all measures. The borderlines showed
significantly lower levels of emotional awareness, less
capacity to coordinate mixed valence feelings, lower
accuracy at recognizing facial expressions of emotion, and
more intense responses to negative emotions than the
nonborderline controls. The findings corroborate clinical
observations of borderline patients' difficulties in
regulating emotions. The implications of the results for
the therapeutic management of BPD patients are discussed."
Functional Impairment in Patients With
Schizotypal, Borderline, Avoidant, or Obsessive-Compulsive
Personality Disorder
Abstract of a new study by Andrew E. Skodol, M.D., John G.
Gunderson, M.D., Donna S. Bender, Ph.D., Mary C. Zanarini, et
al, Feb. 2002
"Patients with schizotypal personality disorder and
borderline personality disorder were found to have
significantly more impairment at work, in social
relationships, and at leisure than patients with
obsessive-compulsive personality disorder or major
depressive disorder [...]."
Characterizing Affective Instability in
Borderline Personality Disorder
Abstract of a study by Harold W. Koenigsberg, M.D., Philip
D. Harvey, Ph.D., Vivian Mitropoulou, M.A., et al, 2002
"examined the subjective intensity with which moods are
experienced and the association between instability and
intensity of affect. [...] 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.
Contrary to expectation, the experience of an increase in
subjective affective intensity was not more prominent in
patients with borderline personality disorder than in those
with other personality disorders.
Psychopathology and Artistic
Creativity
Examination of Eduard Munch's creativity as springing from
his "Borderline condition."
Outta My Head and Into Your Face
"The poetry and artwork of Mara McWilliams reflects a journey
that led her through the darkest depths of mental illness, to a
place where she more often experiences a peace that is the result
of tremendous hard work and dedication to a better, balanced, life.
This book of selected poems and paintings by Mara McWilliams
chronicles that journey. She hopes to give the reader a view into
the tortured mind of the undiagnosed mentally ill, as well as to
give hope to those whose lives have been touched by mental illness,
that a full and beautiful life is possible."
Second Sightby Judith Orloff, M.D.
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Gender Characteristics, Sexuality, Sexual Orientation
Sex Bias in BPD Diagnosis
The topic of gender bias in the clinical diagnosis of
Borderline Personality Disorder has certainly been debated in the mental health
community. The first three studies cited here represent this debate:
Sex Bias in the Diagnosis of Borderline Personality Disorder and Posttraumatic Stress Disorder
Dana Becker and Sharon Lamb,
Professional Psychology: Research and Practice February 1994 Vol. 25, No. 1, 55-61
"The finding that clinicians rated female clients higher for applicability of the BPD
diagnosis than they rated male clients suggests that sex bias may be influencing the
application of this diagnosis. Some argue that when the base rates for a given disorder
are higher for women than for men, as is the case with BPD, clinicians who diagnose in
accordance with the base rates when judging an ambiguous case are not necessarily showing
bias in clinical judgment (Ford & Widiger, 1989). However, few cases with which
therapists are actually presented are unambiguous; furthermore, some researchers
suggest that the base rates for a given disorder are themselves the result of clinician
diagnoses and that those base rates may be used by therapists to rationalize bias in
decision making (Fernbach et al., 1989).
The overall popularity of BPD as a diagnosis was strongly confirmed in the results of
this study. This finding may speak less to the accuracy of the subjects as diagnosticians
than to the generous and ambiguous parameters of the BPD category as it is currently
conceptualized in the DSM‹III‹R. Ratings
for BPD were consistently high for most subjects at all levels of accuracy, including
those subjects who failed the catch trials. That female cases were seen as more
"borderline" than male cases lends credence to the notion that sex bias is responsible
for the much greater frequency with which this diagnosis is assigned to women than to
men. Even if clinicians are influenced by previously established base rates, if they
overdiagnose a disorder in women and underdiagnose it in men because that disorder is
thought to be more prevalent in women than in men, the result is a further biasing of
the base rates (Fernbach et al., 1989)."
Sex Bias and the Diagnosis of Borderline Personality Disorder
Howard N. Garb, in:
Professional Psychology: Research and Practice, October 1995 Vol. 26, No. 5, 526-5261995
This response to the above study by Becker/Lamb found that:
"results from
previous research indicate that the gender of a
client does not have a statistically significant effect on whether the client
is given a diagnosis of BPD. When clinicians made diagnostic ratings rather than
diagnoses, a statistically significant result was found ( Becker & Lamb, 1994 ),
but the magnitude of the effect was small, and its meaning was difficult to evaluate."
Addressing Criticisms of Sex Bias Research on Borderline Personality Disorder
Dana Becker and Sharon Lamb,
Professional Psychology: Research and Practice October 1995 Vol. 26, No. 5, 526-527
Becker/Lamb respond to Garb's critique of their study (above) with the following letter:
"Dr. Garb [...] suggests that the magnitude of the difference between
clinician ratings of BPD for male versus female clients is "quite small." He goes on
to state that "if one has a large enough sample...one will almost always find a
statistically significant difference." In fact, one of our major hypotheses
(that maleclients would receive a diagnosis of posttraumatic stress disorder
more frequently than female clients) was not borne out statistically in spite of
our large sample. The large size of our sample is one of our study's strengths.
Unlike Henry and Cohen's (1983) study of sex bias in BPD diagnosis, our sample
included psychologists and social workers in addition to psychiatrists. Furthermore,
unlike Henry and Cohen and Adler et al. (1990) , we ensured that our sample consisted
of only practicing clinicians of considerable experience, whereas a good proportion of
the participants in these two other studies comprised psychiatric residents.
Dr. Garb attacks another strength of the study when he suggests that greater accuracy
would have been achieved had we compared diagnoses rather than diagnostic ratings.
We refer him back to the study by Ford and Widiger (1989) , who made strong case for
the scheme of diagnostic rating as a process closer to that used in actual clinical
practice. Although sex bias in the diagnosis of BPD hastwice before been the subject
of study, our study has raised the level of this research through an improved sample
(in terms of size, variety, and experience of clinician), case histories that more
closely approximate typical cases clinicians encounter, and a method of rating that
more closely follows clinicians' own decision making process."
The role of gender in the
clinical presentation of patients with borderline personality
disorder
Zlotnick C, Rothschild L, Zimmerman M., 2002
This more recent study found that:
"This study examined gender differences in the pattern of comorbid disorders and degree of impairment among outpatients with borderline personality disorder (BPD). A total of 130 outpatients with BPD were assessed for various lifetime impulse-related disorders and post-traumatic stress disorder and for indices of impairment. Compared with women with BPD, men with BPD reported significantly more lifetime substance abuse disorders, antisocial personality and met criteria of intermittent explosive disorder that did not overlap with a diagnosis of BPD. Women with BPD reported significantly more lifetime eating disorders than men with BPD. No gender differences were found in degree of overall impairment. These results suggest that male and female patients with BPD, although equally distressed, present with different lifetime patterns of impulse-related disorders."
Gender differences in borderline personality disorder: findings from the collaborative longitudinal personality disorders study
Important data released in July/August 2003
Sex bias in the diagnosis of personality disorders: An evaluation of DSM-IV criteria
by Miriam N. Funtowicz and Thomas A. Widiger, 1999
"This study considered whether the Diagnostic and Statistical Manual of Mental
Disorders (4th ed.; American Psychiatric Association, 1994) is biased against women
by requiring less dysfunction for the personality disorders that are more commonly
diagnosed in women (e.g., histrionic). Clinicians estimated the extent of social
dysfunction, occupational dysfunction, and personal distress suggested by each of
the diagnostic criteria for 6 personality disorders. The results failed to suggest
a bias against women, as there was no difference in the overall level of dysfunction
associated with the female-typed personality disorder diagnostic criteria (fewer
criteria are also required for the male-typed diagnoses). However, the considerable
variation in dysfunction across disorders and criteria, and the minimal degree of
impairment implied by some of the diagnostic criteria, also raise more general
issues that should perhaps be addressed in future editions of the diagnostic manual."
Gender and Violence
Factors in the
Cycle of Violence: Gender Rigidity and Emotional Constriction
by David Lisak, Jim Hopper, and Pat Song
BPD & Sexuality
An empirical examination into
the sexuality of women with borderline personality
disorder
A study by HURLBERT, D.F.,APT, C.,WHITE, L.C.,
Journal of
Sex and Marital Therapy,1992
Abstract:
"In the last decade, a great deal of research has been
accomplished in the study of borderline personality, but
the literature is yet to systematically examine the
intimate relationships of individuals with this particular
personality disorder. In doing so, this study compared a
sample of female borderlines with an adequately matched
sample of non-personality disorders (aged 23-33 years)
using the following measures: the hurlbert index of sexual
assertiveness, the sexual opinion survey, the sexuality
scale and the index of sexual satisfaction. in the
borderline sample about 50% of the women reported a
childhood history of physical or sexual abuse, as compared
to about 15% in the control group. Also, borderline women
were found to have significantly higher sexual
assertiveness, greater erotophilic attitudes, and higher
sexual esteem. Despite these findings, the borderline group
evidenced significantly greater sexual preoccupation,
sexual depression, and sexual dissatisfaction."
Depression and Sex Addiction: The Moment
Between
by Stephen S, Brockway, M.D
Excellent summary of the personality characteristics
of various "types" of sexual addicts.
Sexuality and Violence
by Indira Maya Ganesh, 1999
Examines in particular the interface between childhood
sexual abuse and adult sexual fantasy.
Sexual Fantasies as Antidotes to Guilt and Worry
by Michael Bader, DMH, 2001
Excerpt from the author's book
Arousal, which
examines the psychological underpinnings of adult sexual
behaviors from the perspective of the treating psychologist.
(Some explicit language!)
See especially
A Rape Fantasy: The Case of Jan
Narcissistic Injury and Sexual Victimization
among Women College Students
by Robert E. Billingham, 1999
Problems of female sexuality: the defensive
function of certain phantasies about the body
by LM Squitieri, 1999
Psychoanalytic viewpoint on female Borderline sexuality.
Examination of body concept of female
patients with borderline personality disorder
by Haaf B, Pohl U, Deusinger IM, Bohus M., 2002
Gender and Biochemical Difference
Seeing the Unexpected: How Sex Differences in Stress Responses May Provide a New Perspective on the Manifestation of Psychiatric Disorders
by Laura J Cousino Klein PhD and Elizabeth J Corwin PhD, 2000
"In this report, the authors propose that underlying sex differences in the
biobehavioral response to stress may contribute to the variance in prevalence of
some psychiatric disorders based on sex. The authors begin with a discussion of
stress physiology and review a new theory on sex differences in stress responses
(ie, the 'tend-and-befriend' response), which may provide a recent framework for
considering sex differences in the manifestation of some psychiatric illnesses.
The authors then move to a discussion of major depression and attention deficit
hyperactivity disorder as examples of how sex differences in stress responses
may influence the behavioral symptoms of psychiatric disorders that are more
often diagnosed in one sex compared with another. The authors conclude with
a brief discussion of the implications of this new perspective on treatment
approaches and encourage further inquiry into the importance of sex-based
differences in the behavioral manifestation of some psychiatric illnesses."
Estrogen Fluctuations, Oral Contraceptives and Borderline Personality
New study by M. Catherine DeSoto, David C. Geary, et al, August 2003
"Results from three studies suggest fluctuation in estrogen level may influence the
expression of borderline personality disorder (BPD) symptoms. In the first study, 226
women were administered the Personality Assessment Inventory, borderline scales
(PAI-BOR; L.C. Morey, The Personality Assessment Inventory, Professional Manual, 1991)
and a questionnaire that assessed time in menstrual cycle and use of oral contraceptives,
that is synthetic estrogens. BPD symptoms were most common in women using oral
contraceptives and during times in the menstrual cycle when estrogen level is rising.
In Study 2, 52 women were measured four times across one menstrual cycle and
provided salivary samples at each test session. The samples were assayed and
estrogen levels were obtained. The principle finding was that variation in estrogen
levels predicted the presence of BPD symptoms (r=0.4, p<0.01). This relationship
remained significant when a general increase in negative affect was statistically
controlled.
Study 3 employed a prepost Oral Contraceptive (OC) design with a control
group. It was found that for women with high pre-existing levels of BPD, symptoms
became significantly worse after starting pill use (F (3,42)=4.7; p<0.01).
Research
findings that link the serotonin system and estrogen are reviewed and theoretical and
practical implications are discussed."
Iron Status and Depression in Pre-menopausal
Women: An MMPI Study.(Minnesota Multiphasic Personality
Inventory)
by Janet R. Hunt, 1999
Gender Affects Relationships Between Drug
Abuse and Psychiatric Disorders
by Neil Swan, 1997
Menstrual Cycle Influences on Mood and Behavior in Women
with Borderline Personality Disorder
Abstract of a study by ZIV, B.; HURT, S.; MOLINE, M., et al,
Journal of Personality Disorders,1995
"Patients with borderline personality disorder (BPD) often
report that affective and impulsive symptoms worsen
premenstrually. An association between symptom severity and
phase of menstrual cycle was not found. Despite the finding
that all subjects interviewed following the study reported
having experienced a premenstrual worsening of symptoms,
none of the subjects met criteria for premenstrual
dysphoric disorder."
Effects of the menstrual cycle on measures
of personality in women with premenstrual syndrome: a
preliminary study
by Berlin RE, Raju JD, Schmidt PJ, Adams LF, Rubinow DR.,
2001
"Previous studies suggest that women with premenstrual
syndrome (PMS) differ from those without PMS in measures of
personality. The purpose of this study was to measure the
effect of menstrual cycle phase on personality variables in
women with and without PMS. [...] In this preliminary
study, women with PMS were unique in demonstrating a
menstrual cycle phase effect on PDQ-R score, while their
scores in both phases were closer to symptomatic controls
than asymptomatic controls. These findings suggest that
personality disorder in women with PMS may have both state-
and trait-related components."
BPD & Sexual Orientation
Role of Sexual Orientation and
Gender-Related Traits in Disordered Eating
by Jacqueline Lakkis, 1999
Personality disorder in patients infected
with HIV[note: this study is included for its analysis of homosexual men w/personality disorders as a subject group, not because of an implied or biased homosexuality + HIV linkage]
by Perkins DO, et al, 1993
"The authors present the first controlled study of 1)
personality disorders in HIV-positive and HIV-negative
homosexual men and 2) the impact of personality disorder on
coping, social support, and mood in asymptomatic HIV-positive
homosexual men. [...] There was a significantly higher
prevalence of personality disorder in the HIV-positive (33%)
than in the HIV-negative (15%) subjects."
The borderline personality disorder and gay
people
by C. Silverstein, 1988
"This paper examines the diagnostic category called Borderline Personality
Disorder (BPD) and its relationship to gay people. It discusses the psychoanalytic
definition of borderline personalities, and to it adds a cultural definition.
In the light of these cultural variables, the diagnosis is defined as a metaphor
for the complexities and confusions of modern life. These confusions are important
in the lives of gay people, who, it is suggested, are currently more prone to be
diagnosed as BPD. Through the life study of a gay man, both the psychoanalytic
and cultural variables are identified, then generalized to the problems of gay
people in our transitional society."
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Dysphoria/"Emptiness"
Many researchers, clinicians and loved ones have observed
that Borderline depression has a different "feel" and
"presentation" than classical clinical depression. The
subjective sense of emptiness so often described by
sufferers is more closely associated with an experience of
boredom or numbness than with actual depression. For more,
also see
Depression and
Dissociation.
by Adolfo Pazzaglia, Mario Rossi Montiba, 2001
"A close examination of dysphoria, anger and aloneness
(three main characteristics of the borderline syndrome)
provides a theoretical model of reference for the
therapist. Dysphoria results from the cyclical emotional
oscillation between hope for stability and disappointment
in its inattainability; a dependent-anaclitic depression
arises from the mixture of anger, aloneness and inner
emptiness which is so characteristic of the borderline
syndrome. The tendency to be immersed in the here-and-now,
an intra-festum mentality, exacerbates the sense of
isolation, causing more irritation, mute frustration and,
consequently, anger. The effects and ramifications of
anger, and the resultant precarious cohesion of the self,
are explored in the borderline syndrome; they are
especially illuminated by the application of Kernberg's
pain-anger-hate-vengefulness cycle concept. Meanings of
solitude, in its forms of aloneness and loneliness, are
explored in their pertinence. Aloneness - the constant
needy search for, but condemnation to never finding,
objects to fill an inner sense of emptiness - is especially
germane. Suggestions for assisting subjects with borderline
personality disorder to overcome aloneness and the lack of
historical progression are made."
Full-text article must be purchased.
The depressed borderline: one disorder or two?Soloff PH, Cornelius J, George A., 2001
"A literature review, including studies of comorbidity, longitudinal followup, family history, and laboratory and pharmacotherapy studies, suggests that the borderline patient has both a core biologic affective dysregulation and a pathologic personality organization."
The pain of being borderline: dysphoric
states specific to borderline personality disorder
MC Zanarini, FR Frankenburg, CJ DeLuca, J Hennen, GS Khera
and JG Gunderson, 1998
"Twenty-five [...] dysphoric states (mostly cognitions)
were found to be both significantly more common among
borderline patients than controls and highly specific to
borderline personality disorder. These states tended to
fall into one of four clusters: (1) extreme feelings, (2)
destructiveness or self-destructiveness, (3) fragmentation
or "identitylessness," and (4) victimization. In addition,
three of the 25 more-specific states (feeling betrayed,
like hurting myself, and completely out of control), when
occurring together, were particularly strongly associated
with the borderline diagnosis. Equally important, overall
mean Dysphoric Affect Scale scores correctly distinguished
borderline personality disorder from other personality
disorders in 84% of the subjects."
Sleep-EEG in borderline patients without
concomitant major depression: a comparison with major
depressives and normal control subjects
Abstract of a study by De la Fuente, Bobes et al, 2000
"Although BPD and MD [major depression] may coexist, the
present study offers more arguments favouring the concept
that they are not biologically linked and that BPD patients
with depressive symptoms often experience an affective
syndrome different from that in MD patients without BPD, in
terms of quality and duration of symptoms and of the
biological substrate."
Negativism in evaluative judgments of words
among depressed outpatients with borderline personality
disorder
Abstract of a study by Kurtz JE, Morey LC., 1998
"BPD patients made more "dislike" judgments with neutral
words than MDD (major depressive disorder) patients and
Controls. The performances of the MDD patients were more
similar to the Control group than to the BPD group, despite
negligible differences between the two patient groups in
the severity of depressive symptoms and overall
psychopathology."
Self-concept and mood: a comparative study
between depressed patients with and without borderline
personality disorder
Abstract of a study by de Bonis M, De Boeck P, Lida-Pulik H,
Hourtane M, Feline A, March 1998
Subjective sleep disturbances in depressed
patients with personality disorder
Abstract of a study by F.-S.Kohl, July 2000
Cognitive and Physiological Aspects of
Attention to Personally Relevant Negative Information in
Depression
Full-text online dissertation by Greg Jeremy Siegle
1999
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The Clinician's Viewpoint
"Love Me Or Hate Me: Treating the Impulsive,
Emotionally Labile Borderline Personality-Disordered
Client."
by Cardwell C. Nuckols, Ph.D.
Really fascinating presentation by a psychotherapist, from the
2nd Annual USJ Conference on Anger and Rage.
Treating the Angry Alcoholic
by Raymond DiGiuseppe, Ph.D.
Another very interesting presentation by an experienced clinician -- great insights about anger and boundaries in the therapeutic relationship.
Understanding And Working With Borderline
Personality Disorder
by Luciano Anthony Picchio, M.D.
Another excellent essay from the clinician's standpoint.
3 Levels of Emotion in Borderline Personality
Disorder
by Dr. John Gunderson, leading BPD researcher and
clinician.
Aggression and Transference in Severe Personality
Disorders
by Otto F. Kernberg, M.D. Psychiatric Times, February
1995
Treatment of the I+U? ("I'm OK, You're
Irrelevant") and I-U? ("I'm not-OK, You're Irrelevant") Life
Positions
by Tony White, 1997
Interesting points about treating borderlines with
transactional analysis.
Special Considerations in the Treatment of
Traumatized Patients
by Andrei Novac, M.D.,
Psychiatric Times, February
2002
Dynamically Based Psychotherapy: A Contemporary
Overview
by William N. Goldstein, M.D., 1999
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The Criminologist's Viewpoint
Criminal violence associated with borderline
and non-borderline cases: Characteristics of the acting-out
process
Extracts from a Masters Thesis by Guillaume Bernard,
Criminology Departement, University of Montreal.
Specifying the Impulsivity of Female Inmates With Borderline Personality Disorder
Nicole M. Hochhausen, Amanda R. Lorenz, Joseph P. Newman, 2002
"A potentially important implication of this investigation relates to the
heterogeneity of the impulsivity construct. The diagnostic criteria for BPD emphasize
impulsive behaviors of clinical significance rather than the psychological processes
that may underlie these high-risk behaviors. It is possible that specifying the type of
impulsivity associated with BPD and identifying psychological processes associated with
their disinhibited behavior would facilitate progress in understanding and treating
aspects of this costly syndrome.
Brodsky, Malone, Ellis, Dulit, and Mann (1997) reported that impulsivity was the only
criterion of the Diagnostic and Statistical Manual of Mental Disorders (3rd edition,
revised; American Psychiatric Association, 1987 ) predictive of suicidal behavior in
people with BPD. In times of hopelessness, not pausing to place one's behavior in a broader context may increase a person's risk for acting on suicidal urges. For example, positive aspects of suicide, such as ending the feeling of hopelessness or making others feel guilty, may overwhelm conflicting, inhibitory considerations. To the extent that the results of this study documenting BPD individuals' failure to heed negative consequences are replicable, they may serve to clarify the dysregulatory processes contributing to their clinically significant high-risk behavior. It is also possible that performance on laboratory tasks such as the one used in this study, alone or in conjunction with biological predictors of parasuicidal behaviors (e.g., Coccaro & Astill, 1990 ), could be used to predict such high-risk behaviors. In other words, a tendency to respond in the face of uncertainty might be associated with a tendency to attempt suicide in a situation in which perhaps others would not attempt it because of their uncertainty.
In summary, across both Caucasians and African Americans, incarcerated women
with BPD behaved impulsively on a passive avoidance task, thus identifying
disinhibition as a feature of the impulsivity present in BPD. In addition,
their significantly greater impulsiveness on the IMD inventory suggests that BPD
individuals' impulsivity includes a failure to consider consequences before acting.
Future studies investigating the specific components of impulsivity in BPD are needed
to further differentiate the behavioral deficits underlying this disorder and explore
the association between behavioral and biological correlates of the disorder."
The Narcissistic Exoskeleton: the Defensive
Organization of the Rage-Type Murderer
by D. Cartwright, 2002
"After outlining the characteristics of rage-type murder,
the author reviews possible psychodynamic explanations of
the predisposing personality and the act itself. He argues
that more recent contributions, using an object relations
perspective, best account for the complexity of the
internal world of these offenders. Using a single case to
illustrate observations drawn from his work with nine
offenders, the author sets out to develop an understanding
of the defensive organization present in these apparently
normal murderers. He isolates a defensive system comprising
a set of split object relations that correspond with a
split between internal and external reality, which he calls
the "narcissistic exoskeleton." Projective and introjective
processes that support the defensive organization are
discussed. It is suggested that such a profile typifies a
particular kind of stable borderline personality
organization."
Is
Diminished Responsibility (Diminished Capacity) relevant
today? Are those jurisdictions that have abolished this
defence harsh and unreasonable?
A review of the "not guilty by reason of insanity" clause,
focussing on a man with BPD who committed murder, by Brian
Boettcher.
"Guilty but mentally ill"
Good essay on the topic of insane and accountable vs insane
and inaccountable.
Does the Insanity Defense Have a Legitimate
Role?
by James F. Hooper, M.D., F.A.P.A., and Alix M. McLearen,
M.S.,
Psychiatric Times, April 2002
All Cracked Up and No Place To Go
An article on Borderlines in the penal system by Maureen
O'Hagen.
Understanding borderline personality disorder
and obsessive-compulsiveness
by Dr. Tom O'Connor, PhD
A criminal profiler's view of BPD, from an online course on
justice and profiling, Wesleyan University, 2001.
Aileen Wuornos
A biography of serial killer Aileen Wuornos, diagnosed with
BPD.
My 'funny' malpractice suit was no laughing
matter
by James M. Cummings, 1998
A doctor recounts the story of a personality-disordered man
who sued him for having "shortened his penis by 3 inches"
during a routine circumcision.
Mad or Bad?: Explaining Evil and
Insanity
Bibliography of a number of recent books on the topic, with
critical reviews -- fascinating!
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This Page Last Updated: August 27, 2003
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