Common Characteristics of Personality Disorders
"Personality Disorders are mental illnesses that share several unique qualities. They contain symptoms that are enduring and play a major role in most, if not all, aspects of the person's life. While many disorders vacillate in terms of symptom presence and intensity, personality disorders typically remain relatively constant.
To be diagnosed with a disorder in this category, a psychologist will look for the following criteria:
1. Symptoms have been present for an extended period of time, are inflexible and pervasive, and are not a result of alcohol or drugs or another psychiatric disorder. The history of symptoms can be traced back to adolescence or at least early adulthood.
2. The symptoms have caused and continue to cause significant distress or negative consequences in different aspects of the person's life.
3. Symptoms are seen in at least two of the following areas:
* Thoughts (ways of looking at the world, thinking about self or others, and interacting)
* Emotions (appropriateness, intensity, and range of emotional functioning)
* Interpersonal Functioning (relationships and interpersonal skills)
* Impulse Control"
from: http://allpsych.com/disorders/personality/index.html
"Patients with personality disorders are alloplastic in their defences. In other words: they tend to blame the external world for their mishaps. In stressful situations, they try to pre-empt a (real or imaginary) threat, change the rules of the game, introduce new variables, or otherwise influence the external world to conform to their needs. This is as opposed to autoplastic defences exhibited, for instance, by neurotics (who change their internal psychological processes in stressful situations).
The character problems, behavioural deficits and emotional deficiencies and instability encountered by the patient with personality disorder are, mostly, ego-syntonic. This means that the patient does not, on the whole, find his personality traits or behaviour objectionable, unacceptable, disagreeable, or alien to his self. As opposed to that, neurotics are ego-dystonic: they do not like who they are and how they behave on a constant basis."
Also check out Key BPD-Related Behavioral and Cognitive Patterns
Differential Diagnosis of Borderline Personality
Disorder:
"* major depressive disorder and bipolar disorder, in which there are less affective lability and less impulsivity and often more stable relationships;From: PsychiatryMatters.com
* histrionic personality disorder, in which there is less self-destructiveness and fewer angry disruptions in relationships;
* schizotypal personality disorder, in which psychotic symptoms are less transient and interpersonally driven and in which there is less desire for interpersonal intimacy;
* narcissistic and paranoid personality disorders, in which there is relative stability of self-image and less self-destructiveness and impulsivity and fewer concerns over abandonment;
* antisocial personality disorder, in which the patient is manipulative to gain profit, power, or material gratification;
* dependent personality disorder, in which there are more stable and less intense relationships, and in which the response to the fear of abandonment is characterized by appeasement, submissiveness and the seeking of replacement relationships;
* personality change due to a general medical condition."
To see how professionals go about making differential diagnoses, read these excerpts from the DSM-IV Handbook of Differential Diagnosis provided by amazon.com.
General
The Iron Mask: What do all the Personality Disorders have in Common?
and
How are all the Personality Disorders Interrelated?
by Dr. Sam Vaknin, researcher of NPD ~ Recommended!
Co-morbidity: Personality disorder and mental illness: The Nature of their Relationship
by Jeremy Coid
This is an excellent article detailing the comorbidity of Axis I and Axis II disorders, with emphasis on BPD. ~ Recommended!
Axis I Comorbidity of Borderline Personality Disorder
Abstract of a study by Mary C. Zanarini, et al
This study shows the correlation of BPD with anxiety disorders, PTSD, eating disorders and substance abuse. It was found that male BPs are more likely to have problems with substance abuse and female BPs with eating disorders.
and
Psychological Criminology
From a criminologist's perspective; very interesting categorization of personality disorders.
Dependency, impulsivity, and self-harm: Traits hypothesized to underlie the association between cluster B personality and substance use disorders
by A. Casillas and L.A. Clark, Journal-of-Personality-Disorders, 2002 Oct; Vol 16(5): 424-436.
"Cluster B personality disorders (PDs) (i.e., antisocial, borderline, histrionic, and
narcissistic) typically show a high degree of comorbidity with substance use disorders
(SUDs). Previous research suggests that the broad-based personality domains of
Disinhibition and Negative Temperament/Neuroticism may be common factors to both
types of disorders. Using a 2-phase process (i.e., screening and follow-up), this
study examined 3 lower-order personality traits (i.e., dependency, impulsivity,
and self-harm) that fall within the Disinhibition and Neuroticism domains.
The study evaluated the hypotheses that these traits (1) are related both to
cluster B PDs and to SUDs; and (2) underlie the association between the 2
types of disorders. Results indicate that impulsivity and self-harm play a
significant role in cluster B PDs and SUDs, as well as in their association
with each other. However, dependency was not associated with either type of
disorder. These results indicate that sets of individual traits can be of
significant utility in understanding the comorbidity between PDs and SUDs."
Patterns of Comorbidity among DSM-III-R
Personality DisordersAbstract of research by M.G. Marinangelia, G. Buttib, A. Scintoa, et al, 2000
(full-text article can be purchased)
"The aim of this study was to examine patterns of
comorbidity among personality disorders (PDs) in a sample
of 156 psychiatric inpatients. PDs were assessed with
Semistructured Clinical Interview for DSM-III-R
Personality Disorders. To determine significant
co-occurrence among axis II diagnoses, odds ratio and the
percent of co-occurrence of pairs of disorders were
calculated. Both statistical methods revealed high rates
of comorbidity: significance association was found for 36
pairs of disorders using the percent of co-occurrence,
and for 22 pairs of disorders using the odds ratio. These
results support the concept of 'apparent comorbidity' for
most PDs, deriving from conceptual and definitional
artifacts or from a 'state-biasing effect'. In light of
these observations, a categorical approach to PDs,
resulting in a list of diagnoses, appears useless in
psychiatric practice. A dimensional classification is
probably better suited for PDs, improving the
understanding of personality psychopathology and its
clinical implications."
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 [...]."
Comorbidity of Borderline Personality Disorder With Other Personality Disorders in Hospitalized Adolescents and Adults
by Daniel F. Becker, M.D.
Abstract of research showing that BPD usually shows comorbidity with other Cluster B disorders (NPD, APD, and HPD) in adults.
The comorbidity of borderline personality disorder and other DSM-III-R axis II personality disorders
Abstract of a study by HG Nurnberg, M Raskin, PE Levine, S Pollack, O Siegel and R Prince
Demonstrates the fluid boundaries of Personality Disorders, and the need for more specific diagnostic criteria.
Identifying the unique and common characteristics among the DSM-IV antisocial, borderline, and narcissistic personality disorders
by DJ Holdwick Jr, et al, 1998
Psycheducation.org
Excellent, excellent site on the biology of mental health. Dr. Phelps treats Bipolars, Borderlines, and Schizophrenics, and really knows his brain chemistry.
How does Prozac work? Just what is a seratonin receptor, and why does it need to be inhibited? What do hormones have to do with mood? Is there such a thing as the "primitive brain"?
Don't forget to take the exceedingly cool illustrated brain tours while you're there!
Addiction and Addictive Disorders
Substance Abuse
& Alcoholism, Internet Addiction, Sexual Addiction/Sexual Compulsion, Pornography
Addiction, (Gambling)
Substance Abuse/Alcoholism
Dual Diagnosis: BPD and Addictive Disorders
From the excellent Dual Diagnosis site; after you've read this extremely informative article, you can go to their home page to see lots more on the topic: Dual Diagnosis Home
The Etiology of Addiction
by Luciano Anthony Picchio, M.D.
Excellent overview of the latest behavioral and biochemical theories on the development of addictions.
Personality and Alcoholism: Establishing the Link
by Stanley Peele
Excellent full-length essay; incorporates MMPI research on the "pre-addictive personality", etc.
The Meaning of Addiction
by Stanley Peele
A lengthy online excerpt, from the book of the same name.
COMORBIDITY IN A CLINICAL SAMPLE OF SUBSTANCE ABUSERS
by Anne Helene Skinstad, May, 2001
"Borderline PD has been identified in approximately 13%-18% of alcohol dependent patients, although higher estimates also have been reported from 28% to 34%. Substance abusers with borderline PD tend to be younger, to have made more suicide attempts, to demonstrate more pronounced psychological problems, and to be at great risk to abuse other substances. Elevated rates of other PDs and substance abuse have also been reported."
Axis II comorbidity of substance use disorders among patients referred for treatment of personality disorders
Full-text 1999 study by Skodol AE, Oldham JM, Gallaher PE., which found that:
"Close to 60% of subjects with substance use disorders had personality disorders. Borderline personality disorder was significantly associated with current substance use disorders, excluding alcohol and cannabis, and with lifetime alcohol, stimulant, and other substance use disorders, excluding cannabis."
Landmark study examines relationship between brain chemistry and addiction
Preliminary study results, 2001
Substance-use situations and abstinence predictions in substance abusers with and without personality disorders.
Full-text article by Deborah H.A. Van Horn, American Journal of Drug and Alcohol Abuse, 1998
Great informative article!
Natural course of alcohol use disorders from adolescence to young adulthood
Abstract, 2001
A chart review study of male alcoholics differentiated by personality disorder
Abstract, 1998
The association of personality characteristics with parenting problems among alcoholic couples
Full-text article by William Gallant, 1998
The Family and the Dually Diagnosed Patient
by Kathleen Sciacca, M.A. and Agnes B. Hatfield, Ph.D.
Mentally Ill Alcohol and Substance Abusers
Overview of Dual Diagnosis by Bert Pepper, M.D.
The Role of the Family and Significant Others in the Engagement and Retention of Drug-Dependent Individuals
by M. Duncan Stanton
(pdf file: you need Adobe Acrobat reader to read this file)
American Foundation for Addiction Research
Articles, information and a bibliography database
Dual Recovery Anonymous
Information and contact for dual-diagnosis self-help groups.
Internet Addiction
What Makes the Internet Addictive: Potential Explanations for Pathological Internet Use
by Kimberly S. Young
From netaddiction.com. Read many similar articles here
Is Internet Addiction a Problem For You?
A Cognitive-Behavioral Model of Pathological Internet Use (PIU)
by Richard A. Davis
Computers (and Internet ) pose special danger on "borderline-bipolar" subjects
by Antonio Crudele, M.D.
An article submitted to the Mental Health Sanctuary.
Is the Internet Addictive, or Are Addicts Using the Internet?
by By Storm A. King
Sexual/Pornography Addiction
Sex Addiction Self-Assessment Tests (scroll down a bit)
from the National Counsel on Sexual Addiction and Compulsivity
Cybersex Addiction Test
List of Support Groups for Family/Friends of Sex Addicts
Online and Offline support.
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.
Questions and Answers on Sex Addiction
by Dr. Patrick Carnes, author of numerous books on sexual addiction, including the best-selling Out of the Shadows: Understanding Sexual Addiction and The Betrayal Bond: Breaking Free of Exploitative Relationships (a perennial non-Borderline favorite).
Addictions FAQ: Internet, Sexual and Shopping Addiction
Brief overview.
How to Recognize the Signs of Sexual Addiction
by Jennifer P. Schneider, MD, PhD
Great article (more professional than the title makes it sound) on the signs, symptoms, and dynamics of sexual addiction.
What Sexual Scientists Know About Compulsive Sexual Behavior
Great summary from the Society for the Scientific Study of Sexuality
What Sexual Scientists Know About Pornography
Great summary from the Society for the Scientific Study of Sexuality
Position Papers by the National Council on Sexual Addiction and Compulsivity
Lots of excellent information for family/spouses/friends.
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)
Sexual Addiction: Many Conceptions, Minimal Data
by by Steven N Gold and Christopher L. Heffner, 1998
Full-text article (pdf file: requires Adobe Acrobat to read)
The neurobiology, neuropharmacology, and pharmacological treatment of the paraphilias and compulsive sexual behaviour
Abstract of research by JM Bradford, 2001
Serotonergic medications for sexual obsessions, sexual addictions, and paraphilias
by Stein DJ, Hollander E, 1992
"We retrospectively reviewed outcome in 13 patients who presented with sexual symptoms and were treated with serotonin reuptake blockers. Symptoms were divided into paraphilias, nonparaphilic sexual addictions, and sexual obsessions. RESULTS: Paraphilias had the least improvement, while sexual obsessions had the best response to medication."
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."
Breaking Pornography Addiction: A Plan For Personal Success
Adult Children Of Alcoholics
Comparison of BPD traits with Adult Children Of Alcoholism traits
Relationship of child psychopathology to parental alcoholism and antisocial personality disorder
by Samuel Kuperman, Journal of the American Academy of Child and Adolescent Psychiatry, June, 1999
Full-text article explores the relationship of parental alcoholism and the development of psychiatric disorders in children.
Parental Alcoholism and Co-Occurring Antisocial Behavior: Prospective Relationships to Externalizing Behavior Problems in their Young Sons
Alexandra Loukas, Psychiatry, April, 2001
Full-text article: "Results revealed that child lack of control mediated the relation between paternal alcoholism and the son's subsequent externalizing behavior problems. Family conflict was a significant mediator of maternal and paternal lifetime antisocial behavior effects and father-son conflict mediated paternal lifetime antisocial behavior effects."
AD(H)D: Attention Deficit/Hyperactivity Disorder
The specificity of clinical characteristics in adults with attention-deficit/hyperactivity disorder: a comparison with patients with borderline personality disorder
J. H. Dowson, , a, A. McLeana, E. Bazanis, et al, 2004
³A group of 20 adult patients selected on the basis of a diagnosis of ADHD and 20 patients selected on the basis of a diagnosis of BPD were assessed by the self-report Attention Deficit Scales for Adults (ADSA). The two groups were matched for age, verbal IQ and gender. Of the nine ADSA scales, seven showed significant inter-group differences, in particular involving attention, organisation and persistence. The ŒConsistency/Long-Term' scale, which mainly reflects impaired task and goal persistence, was the best discriminator between the groups.²
Attentional mechanisms of borderline personality disorder
Posner MI, Rothbart MK, Vizueta N, Levy KN, Evans DE, Thomas KM, Clarkin JF., Dec 2002
"We consider whether disruption of a specific neural circuit related to self-regulation is an underlying biological deficit in borderline personality disorder (BPD). Because patients with BPD exhibit a poor ability to regulate negative affect, we hypothesized that brain mechanisms thought to be involved in such self-regulation would function abnormally even in situations that seem remote from the symptoms exhibited by these patients. To test this idea, we compared the efficiency of attentional networks in BPD patients with controls who were matched to the patients in having very low self-reported effortful control and very high negative emotionality and controls who were average in these two temperamental dimensions. We found that the patients exhibited significantly greater difficulty in their ability to resolve conflict among stimulus dimensions in a purely cognitive task than did average controls but displayed no deficit in overall reaction time, errors, or other attentional networks. The temperamentally matched group did not differ significantly from either group. A significant correlation was found between measures of the ability to control conflict in the reaction-time task and self-reported effortful control."
History of childhood attention deficit/hyperactivity disorder symptoms and borderline personality disorder: A controlled studyAbstract of research by Fossati A, Novella L, Donati D, Donini M, Maffei C., Sept. 2002
"BPD subjects showed a significantly higher mean WURS total score compared to all control groups (minimum t = 7.93, maximim t = 11.63, all Ps <.001). These contrasts remained significant even controlling for potential confounders such as antisocial personality disorder (ASPD) diagnosis, gender, inpatient status, and axis I diagnoses. The results of this study seem to support the hypothesis of an association between history of childhood ADHD symptoms and adult BPD diagnosis."
Genetics of Childhood Disorders: Is ADHD Genetically Heterogeneous?
by Stephen V. Faraone, Ph.D., 2000
"This column focuses on evidence suggesting 2 other clinical features that may be useful for parsing the genetic heterogeneity of ADHD: psychiatric comorbidity and long-term outcome.
Epidemiological studies have documented high rates of psychiatric comorbidity among
children with psychiatric disorders. These data confirm the adult epidemiological
literature that suggests that comorbidity is the rule rather than the exception
for psychiatric disorders. Researchers and clinicians have known for decades about ADHD¹s
comorbidity with conduct disorder (CD) and learning disabilities. More recently,
researchers have documented its comorbidity with mood and anxiety disorders."
Comorbidity in Adults
with Attention-Deficit/Hyperactivity Disorderby David J. Marks, Jeffrey H. Newcorn and Jeffrey M. Halperin, 2001
Full-text examination of AD(H)D's 'overlap' with other psychiatric disorders.
Development of the Cerebral Cortex: Stress Impairs Prefrontal Cortical Function
by Amy F.T. Arnsten, Ph.D, 1998
Great article: worth reading!
"A 10-year-old boy has been referred to you at the school¹s insistence.
For the past 6 months, he has had behavioral problems in class. He has difficulty paying
attention, has been easily agitated, and fails to inhibit inappropriate and aggressive
impulses. His parents report that he has always been active but he was never
like this before. Does he suddenly have attention-deficit/hyperactivity disorder
(ADHD)? A little probing reveals that the parents¹ marriage is in trouble and that
their child¹s problems in school coincide with problems at home. Recent advances in
neurobiological research may help us understand reactive behavioral problems in children. Neurochemical changes in the prefrontal cortex (PFC) during periods of stress may take this brain region ³off-line,² making the child less able to govern his behavior.
The PFC is situated anterior to the motor cortices in the frontal lobe.
It is much larger in primates than in other mammals. It continues to develop throughout adolescence. This region of our brains is critical for using ³working memory,² a form of memory that is required to appropriately guide behavior. Working memory has been called ³scratch-pad² memory, because this type of memory must be constantly updated. Memories can be called up from long-term storage or from more recent buffers. The PFC uses these representations to effectively guide behavior, freeing us from responding only to our immediate environment, inhibiting inappropriate responses or distractions, and allowing us to plan and organize. Animals or humans with lesions to the PFC exhibit poor attention regulation, disorganized and impulsive behavior, and hyperactivity.
Recent research in animals indicates that exposure to stress can produce a functional
³lesion² of the PFC."
Neuropsychological and neurophysiological indices of auditory impairment in children with multiple complex development disorder
by Alan J. Lincoln 1998
This interesting study of BPD/ADHD and AHDH children shows findings that suggest:
"children with B[P]D/ MCDD and comorbid ADHD differ from
children with only ADHD in the following ways: (1)
prevalence of internalizing and externalizing behaviors,
(2) neuro-psychological deficits related to auditory
processing, and (3) ERP brain physiology associated with
auditory cognitive target attention tasks."
"The B[P]D/MCDD children also demonstrated evidence of auditory processing abnormalities on both neuropsychological and neurophysiological indices. "
"We believe that such psychosocial factors related to neglect and abuse combine with primary biological deficits in the regulation of anxiety, and particularly auditory and executive processes that should help contain and control the disruptive effects of anxiety. Thus, these children may benefit more from treatment that adds a type of rehabilitation focus for their auditory and executive function deficits. Rehabilitative interventions might include speech therapy, occupational therapy, structured teaching techniques, and training in problem-solving strategies similar to those found to be helpful in assisting children with attention impairments. Highly verbal forms of psychotherapy including individual, family, and/or group work may not be appropriate without such additional rehabilitative work.
These findings lend support to the conclusion that B[P]D/MCDD with comorbid ADHD is distinct from ADHD and distinct from both autistic disorder and developmental language disorder."
"The B[P]D/MCDD children also demonstrated evidence of auditory processing abnormalities on both neuropsychological and neurophysiological indices. "
"We believe that such psychosocial factors related to neglect and abuse combine with primary biological deficits in the regulation of anxiety, and particularly auditory and executive processes that should help contain and control the disruptive effects of anxiety. Thus, these children may benefit more from treatment that adds a type of rehabilitation focus for their auditory and executive function deficits. Rehabilitative interventions might include speech therapy, occupational therapy, structured teaching techniques, and training in problem-solving strategies similar to those found to be helpful in assisting children with attention impairments. Highly verbal forms of psychotherapy including individual, family, and/or group work may not be appropriate without such additional rehabilitative work.
These findings lend support to the conclusion that B[P]D/MCDD with comorbid ADHD is distinct from ADHD and distinct from both autistic disorder and developmental language disorder."
Psychophysiological Responses in ADHD Boys With and Without Conduct Disorder: Implications for Adult Antisocial Behavior
by Sabine C. Herpertz in Psychiatric Times, February 1996
"These findings give further support for a high persistence of antisocial behavior from childhood to adulthood, while no evidence was found that ADHD itself is associated with a predisposition to antisocial behavior."
Neuropsychological Dysfunction In Borderline Children
A great full-text study of BPD and brain dysfunction by Julie A.C. Ellett
Explores and tests comorbidity of BPD with neurological dysfunctions, especially ADHD.
Familial evidence for comorbid ADHD with BPD [BiPolar Disorder] as distinctive syndrome
Study by Stephen Faraone, et al, in: Journal of Affective Disorders, 30 April 2001
Their "results reject the assumption that all ADHD children have some familial risk for BPD. Instead, they suggest that comorbid ADHD with BPD is distinct from other forms of ADHD, and may be related to what others have termed 'childhood onset BPD'. [...] 'Our finding that this subgroup has a distinctive pattern of familial transmission suggests that future work could determine if they also have a characteristic course, outcome, and response to treatment.' "
The amphetamine challenge test in patients with borderline disorder
Results of a study by SC Schulz, J Cornelius, PM Schulz and PH Soloff, 1988, which found (in a small test sample of 16 patients) that those with only BPD/ADD improved overall using amphetamines (Adderall, etc) whereas patients with comorbid psychotic symptomology worsened at first.
Comorbidity of attention deficit hyperactivity disorder with conduct, depressive, anxiety, and other disorders
Abstract of a study by J Biederman, J Newcorn and S Sprich
Antisocial Personality Disorder
Antiosocial Personality Disorder is categorized with BPD,
Narcissistic Personality Disorder and Histrionic
Personality Disorder in Cluster B of the DSM-IV
Personality Disorders: "Dramatic and Emotional Cluster."
It shares many characteristics of all personality
disorders, but appears to differ from BPD in a few major
areas: hypo- rather than hyper-emotionality, deliberate
mistreatment of animals/children, an exaggerated lack of
respect for the law. Antisocial counts as the most
overtly "criminal" of all the personality disorders.
Antisocial Personality Disorder
by Luciano Anthony Picchio, M.D.
Excellent first read! Overview of the symptoms and development of APD.
Psychopath - Sociopath - Antisocial Personality
Good collection of resources!
Antisocial Personality, Sociopathy, and Psychopathy
by Dr. Tom O'Connor, PhD
An excellent introduction to the terminological confusion and diagnostic debates over this disorder, from an online course on criminal profiling, Wesleyan University.
Psychopathy and Antisocial Personality Disorder: A Case of Diagnostic Confusion
by Robert D. Hare, Ph.D.
Hare is one of the top American researchers of APD.
Antisocial Personality Disorder: The Forgotten Patients of Psychiatry
by Donald W. Black, MD
Excellent essay on the history, treatment, etiology and symptomology of APD.
Psychopathic criminals lack fear factor, emotion
10/12/01: Interesting study comparing criminals diagnosed with APD and BPD; differences are elaborated.
Psychopathology and Antisocial Personality Disorder: A Journey Into the Abyss
The Sociobiology Of Sociopathy: An Integrated Evolutionary Model
by Linda Mealey
Contemporary Biological and Integrated Perspectives on the Etiology of Criminal Behavior
by Diana Fishbein
Great article!
The Safety Zone
Supportive message board for friends/family.
Message Board for Family/Friends of "Psychopaths" (APDs)
What Makes Serial Killers Tick?
Very interesting lengthy article by Shirley Lynn Scott
Anxiety Disorders
Generalized Anxiety Disorder (GAD)
Panic Disorders
Agoraphobia
Generalized Anxiety Disorder (GAD)
Panic Disorders
Agoraphobia
Anxiety disorders are very frequently diagnosed together
with BPD. Many non-Borderline partners of long-term intimate
relationships with folks with BPD develop panic and
anxiety symptoms. Please also see my write-up on this
phenomenon under Post-Traumatic Stress Disorder
tAPIr: The Anxiety Panic Internet Resource
tAPIr is "a grass roots project involving thousands of people interested in anxiety disorders such as panic attacks, phobias, shyness, generalized anxiety, obsessive-compulsive behavior and post traumatic stress. is a self-help network dedicated to the overcoming and cure of overwhelming anxiety." Offers an excellent collection of hundreds of articles, resources on treatment options, and support forums for sufferers and friends/family.
Freedom from Fear
"Freedom From Fear is a national not-for-profit mental health advocacy association founded in 1984 by Mary Guardino. Ms. Guardino founded FFF as an outgrowth of her own personal experiences of suffering with anxiety and depressive illnesses for more than 25 years. The mission of FFF is to aid and counsel individuals and their families who suffer from anxiety and depressive illnesses."
All About Panic and Anxiety Disorders
from the tAPir Panic and Anxiety pages, above.
tAPir also hosts online forums for sufferers and family/friends, an online newsjournal and plenty of good links.
Diagnostic Criteria for Panic Disorder
The Panic Disorder Home Page
Panic Disorder and Agoraphobia
Excellent overview of symptoms, etiology & comorbidity.
Healing Panic
by Bert Anderson, M.D.
Panic and Anxiety Disorder Bookstore
What is GAD?
Excellent write-up by Michael F. Gliatto, M.D.
Anxiety Disorders Association of America
Diagnosis & Management of Generalized Anxiety Disorder
ANXIETY DISORDERS - The Caregiver
"Information and support for family and friends of those with anxiety disorders."
Fabulous, affirming and supportive collection of resources for family/friends.
ANXIETY, PANIC ATTACKS AND AGORAPHOBIA - Information For Support People, Family and Friends
by Kenneth V. Strong, 2nd Edition 1997
from the review: "At last! A practical and compassionate book for people who support their partner, family member or friend who has an anxiety disorder. Author Ken Strong writes with an intimate understanding through his own experience of and recovery from Panic Disorder and Agoraphobia. In addition Ken also writes with the intimate experience of being a support person, to not only one person with an Anxiety Disorder but as a support to many thousands of support people world wide through his extensive web site." -- Bronwyn Fox
Anxiety Panic Hub
A really excellent Australian web site with tons of information on GAD, its etiology, and recovery resources.
Grant Me the Serenity Web Site on Social Phobia & Anxiety
Excellent article and resource database!
Anxiety Disorders Association of America Therapist Listings
Searchable database of listings for specialists in anxiety & panic disorders.
Search for current clinical trials of treatment for anxiety disorders here
Attachment Disorder/ Reactive Attachment Disorder
BPD is increasingly seen as an attachment disorder, after
the work of John Bowlby and others, who postulated that
disturbances in the bonding between infant and caretaker
result in lifelong difficulties in the individual's
"attachment organization", or ability to relate
intimately to and to trust others. This leads to the
classic Borderline emotional push-pull with loved ones:
"I hate you -- don't leave me!" This behavior is also
known as the abandonment/engulfment cycle.
For many more articles on attachment theory and the etiology of BPD in particular, see:
BPD as an Attachment Disorder
Reactive Attachment Disorder is a relatively new diagnosis, often given to "problem" children who have spent their formative years in abusive or foster situations.
The symptomatology is very similar to adult BPD, and there is even an Adults with RAD Message Board which reads much like many BPD support boards.
For many more articles on attachment theory and the etiology of BPD in particular, see:
BPD as an Attachment Disorder
Reactive Attachment Disorder is a relatively new diagnosis, often given to "problem" children who have spent their formative years in abusive or foster situations.
The symptomatology is very similar to adult BPD, and there is even an Adults with RAD Message Board which reads much like many BPD support boards.
RADkid.org
Articles, links and texts for parents of RAD children, run by a couple raising a RAD child. Offers an active support forum for parents of kids with RAD.
Attachment Disorder Support Group
Articles, links and texts, mainly for parents of RAD children.
Reactive Attachment Disorder and Related Behaviors
An active support board
See a list of many more parents' support boards
Notes on Attachment
by Arthur Becker-Weidman
Excellent readable essay on recognizing attachment issues in very young children.
Articles from the Institute of Attachment and Child Development
Many topics, all informative.
Correlation between Bipolar Disorder and Reactive Attachment Disorder (BPD is included in analysis)
by John F. Alston, M.D.
Attachment and Borderline Personality Disorder. A Theory and Some Evidence
Abstract of a study by P. Fonagy, et al, 2000
Evidence is presented that suggests that representations
of attachment relationships and attachment behaviors of
patients with this diagnosis are commonly disorganized in
character. It is argued that the capacity to develop
mental representations of mental states in self and other
(reflective function) develops in the context of
attachment relationships and that disorganization of
attachment undermines this process. Such disorganization
can be associated with trauma but may also be linked to
other biological and psychosocial deficits. Many of the
clinical characteristics of patients with borderline
personality disorder may be seen as consequences of
disordered self-organization and a limited rudimentary
capacity to think about behavior in mental state terms."
Attachment and metacognition in borderline patients
by Giovanni Liotti, M.D. 1999
Excellent job of detailing the relationship of BPD to attachment dysfunctions in the first 2 years of life.
Predictive factors for borderline personality disorder: patients' early traumatic experiences and losses suffered by the attachment figure
Very provocative study by G. Liotti, P. Pasquini, R. Cirrincione, 2000
Objective: To test the hypothesis that serious losses in
the life of the attachment figure and patients' early
traumatic experiences are risk factors for the
development of borderline personality disorder.
Method: A multicentric hospitalbased case-control study of 66 cases and 146 controls.
Results: We estimated an odds ratio of 2.5 (95 CI 1.1-5.8) for mothers' serious losses experienced within 2 years of patients' birth and an odds ratio of 5.3 (95 CI 2.1-13) for patients' early traumatic experiences. Both of them are adjusted for the confounding effect of the other as well as for that of age, size of family and type of patient (in or outpatient), using a multiple logistic function.
Conclusion: Mourning process in the mother within 2 years of the patient's birth and patients' early traumatic experiences are predictive factors for the development of borderline personality disorder."
Method: A multicentric hospitalbased case-control study of 66 cases and 146 controls.
Results: We estimated an odds ratio of 2.5 (95 CI 1.1-5.8) for mothers' serious losses experienced within 2 years of patients' birth and an odds ratio of 5.3 (95 CI 2.1-13) for patients' early traumatic experiences. Both of them are adjusted for the confounding effect of the other as well as for that of age, size of family and type of patient (in or outpatient), using a multiple logistic function.
Conclusion: Mourning process in the mother within 2 years of the patient's birth and patients' early traumatic experiences are predictive factors for the development of borderline personality disorder."
Developmental Defect versus Dynamic Conflict
Morris N. Eagle
Another excellent article detailing the relation of personality disorder pathology to insufficient attachment.
Overview of Attachment Theory
and Agression and Attachment
by Juan Carlos Garelli
Great overviews of Bowlby's theories on attachment in parenting and the development of self.
Attachment Disorders
Excellent audio program from the Infinite Mind (requires RealPlayer or similar)
A Review of Adult Attachment Measures: Implications for Theory and Research
Full-text article by Judith A. Crowell and Dominique Treboux
Borderline Disorder and Attachment Pathology
Study by West M, Keller A, Links P, Patrick J.
Child abuse and neglect in infancy: sources of hostility within the parent-infant dyad and disorders of attachment in infancy
Abstract of a study by Call JD. 1984
"The meaning of ordinary distress signals is in instances of child abuse and neglect determined by an unconscious mythology which the parent has about the infant, and also by what the parent finds unacceptable in oneself and projects onto the infant. "
Reactive Attachment Disorder/Bipolar/ADHD Comparative Symptomology
This chart (you need Adobe Acrobat to read it) compares the symptoms of the childhood disorders often associated with BPD in adults
Preliminary Results of Attachment Disorder Subtypes and Related DSM-IV Diagnoses
Learning to Love: Mechanisms and Milestones
Very detailed but fascinating full-length article on the developing self and attachment theory by Everett Waters, Kiyomi Kondo-Ikemura, German Posada and John E. Richters, 1991
Attachment Disorder Resources
from the adoption site with Nancy Ashe at about.com
Attachment and Psychopathology
by Atkinson, L., & Zucker, K. J. (Eds.). 1997
This book discusses the relation of attachment disorder to the later development of personality disorders.
Avoidant Personality Disorder (AvPD)
(not to be confused with APD, or Antisocial Personality
Disorder)
What is Avoidant Personality Disorder?
Excellent overview article.
Avoidant Personality Disorder Home Page
Excellent anonymous site devoted to AvPD.
Includes a message board.
Terry Jone's Great AvPD Home Page
Rhyme of the Ancient Wanderer
Support for Dysthimia and Depression; home page with a personal account by a man with Avoidant Personality Disorder & Dysthymia.
FAQ on social anxiety & avoidant personality disorder
Collection of information from alt.support.social-phobia newsgroup
Helping Your Phobic Partner do In-Vivo Exposure
from the fabulous Grant Me the Serenity site.
Online Guide to Avoidance and Avoidant Personality Disorder
by Martin Kantor
This excellent book was available online until last July, but now due to copyright, one has to order it. If you do, in particular check out Chapter 11, where Kantor discusses comorbidity with BPD.
Distancing by Martin Kantor
The only full-length book on AvPD (summarized on site above).
AvPD Support Group
on MSN.com
The Introvert's Hideaway
"A safe haven for avoidant & schizoid personalities, agoraphobics, those with afflictions such as obsessive compulsive disorder (amongst other disorders/illness) and those whom are over-all very introverted and feeling outcasted and freakish in society."
Bipolar Disorder I (Manic-Depression) and II
(Rapid-Cycling, Hypomania)
Bipolar Spectrum Disorders
Bipolar Spectrum Disorders
There is vast and heated professional debate over the
relation of BPD to Bipolar Disorder.
According to the multiaxial classification system of the Diagnostic and Statistical Manual of Mental Health Disorders IV-TR (the 'bible' of psychology in the USA):
Bipolar Disorder is an Axis I Disorder - a mood or affective disorder - regarded as physiological in origin.
Borderline Personality Disorder is an Axis II Disorder - a personality disorder - regarded as environmental or "learned" in origin.
Some clinicians who believe that BPD is sub-set of Bipolar prefer to diagnose all BPD symptomatology as Bipolar. Some clinicians differentiate between the two (as per the DSM-IV-TR), while some might diagnose both simultaneously. This depends on the training and treatment philosophy of the therapist in question; it is not necessarily a matter of 'right' and 'wrong.'
Dr. Hagop Akiskal has recently called for a revision of the concept of Bipolar Disorder, arranging the proposed symptomatology of Bipolar "subtypes" along an affective spectrum between Bipolar I and "Bipolar IV." BPD would be diagnostically subsumed into Bipolar Disorder in this model.
Search here for Dr. Akiskal's latest research on this conceptualization of "Soft Bipolarity".
Regardless how one decides to label them, the clinically preferred medication for both disorders is virtually identical: a cocktail of mood stabilizers, antidepressants and atypical antipsychotics, all intended to cut down on the worst of the affective symptoms. The only real difference in terms of the most often-prescribed medication appears to be that Bipolars more often receive lithium and less often receive the newer SSRI antidepressants, which may bring on a manic state (mania, by the way, is not a criterion for BPD diagnosis, and its appearance during an initial course of SSRI treatment should alert to possible Bipolarity).
Although combinations of medication and psychotherapy are recommended for both disorders, you may want to locate a BPD specialist in your area who practices forms of therapy developed specifically for BPD, such as Dialectical Behavioral Therapy (DBT).
According to the multiaxial classification system of the Diagnostic and Statistical Manual of Mental Health Disorders IV-TR (the 'bible' of psychology in the USA):
Bipolar Disorder is an Axis I Disorder - a mood or affective disorder - regarded as physiological in origin.
Borderline Personality Disorder is an Axis II Disorder - a personality disorder - regarded as environmental or "learned" in origin.
Some clinicians who believe that BPD is sub-set of Bipolar prefer to diagnose all BPD symptomatology as Bipolar. Some clinicians differentiate between the two (as per the DSM-IV-TR), while some might diagnose both simultaneously. This depends on the training and treatment philosophy of the therapist in question; it is not necessarily a matter of 'right' and 'wrong.'
Dr. Hagop Akiskal has recently called for a revision of the concept of Bipolar Disorder, arranging the proposed symptomatology of Bipolar "subtypes" along an affective spectrum between Bipolar I and "Bipolar IV." BPD would be diagnostically subsumed into Bipolar Disorder in this model.
Search here for Dr. Akiskal's latest research on this conceptualization of "Soft Bipolarity".
Regardless how one decides to label them, the clinically preferred medication for both disorders is virtually identical: a cocktail of mood stabilizers, antidepressants and atypical antipsychotics, all intended to cut down on the worst of the affective symptoms. The only real difference in terms of the most often-prescribed medication appears to be that Bipolars more often receive lithium and less often receive the newer SSRI antidepressants, which may bring on a manic state (mania, by the way, is not a criterion for BPD diagnosis, and its appearance during an initial course of SSRI treatment should alert to possible Bipolarity).
Although combinations of medication and psychotherapy are recommended for both disorders, you may want to locate a BPD specialist in your area who practices forms of therapy developed specifically for BPD, such as Dialectical Behavioral Therapy (DBT).
What's the Difference between Bipolar II (Cyclothymia) and Borderline Personality Disorder?
by Jim Phelps, M.D.
Excellent article, make sure to click on and read the attached essay
and
Bipolar II: Mood Swings without "Manic" Episodes, another article by Jim Phelps. (So many folks ask about Bipolar II that I include this great article for reference.)
Also check out Bipolar World, Dr. Phelps' really excellent web site.
The Lowdown on the Upswing
by Ann Palmer
What does it feel like to have Bipolar Disorder AND Borderline Personality Disorder and go into a manic or depressive phase?
Do patients with borderline personality disorder belong to the bipolar spectrum?
by Deltito J, Martin L, Riefkohl J, Austria B, Kissilenko A, Corless C Morse P., 2001, Anxiety and Mood Disorders Program, The New York Hospital-Cornell Medical Center, Westchester Division
"Background: This report examines clinical indicators for
bipolarity in a cohort of patients suffering from
Borderline Personality Disorder (BPD). Methods: The study
was conducted in the Cornell-Westchester Hospital, famed
for its expertise in BPD. Through the use of both open
clinical interviews and standardized diagnostic
interviews (SCID), borderline patients were examined for
evidence of bipolarity by five indicators: history of
spontaneous mania, history of spontaneous hypomania,
bipolar temperaments, pharmacologic response typical of
bipolar disorder, and a positive bipolar family history.
Results: Depending on the level of bipolar disorder from
the most rigorous (mania) to the most 'soft' (bipolar
family history), between 13 and 81% of borderline
patients showed signs of bipolarity. Based on what the
emerging literature supports as rigorously defined
bipolar spectrum (bipolar I and II), we submit that at
least 44% of BPD belong to this spectrum; adding
hypomanic switches during antidepressant pharmacotherapy,
the rate of bipolarity in BPD reaches 69%. As expected
from this formulation, most responded negatively to
antidepressants (e.g. hostility and agitation) and
positively to mood stabilizers. Limitations: Small sample
size and retrospective gathering of data on treatment
response. Conclusion: Patients with BPD more often than
not exhibit clinically ascertainable evidence for
bipolarity and may benefit from known treatments for
Bipolar Spectrum Disorders. Large scale, systematic
treatment studies with mood stabilizers are indicated."
The soft bipolar spectrum redefined: Focus on the cyclothymic, anxious-sensitive, impulse-dyscontrol, and binge-eating connection in bipolar II and related conditions
Giulio Perugi and Hagop S. Akiskal, Dec. 2002
"Bipolar disorder has been divided into a clinical spectrum including bipolar I,
bipolar II, bipolar III, and beyond. This article focuses on the soft bipolar
spectrum representing bipolar II and its variants and accounting for most bipolar
patients seen in clinical practice. The soft spectrum is typically characterized
by temperamental instability of a cyclothymic nature, which overlaps significantly
with the rejection sensitivity and mood reactivity observed in so-called
"atypical" depressions, and the mood lability and impulsivity of those with
borderline personality disorder. In addition, the soft bipolar spectrum is
characterized by high comorbidity with panic-agoraphobic, obsessive-compulsive,
social phobic, body dysmorphic, bulimic, as well as alcohol and substance
abuse disorders. The authors develop the hypothesis that the cyclothymic-anxious-sensitive
temperamental disposition might represent the mediating underlying characteristic
in the complex pattern of comorbid mood, anxiety and impulse control disorders
that Bipolar II spectrum patients display clinically."
Practice Parameters for the Assessment and Treatment of Children and Adolescents With Bipolar Disorder
Excellent, very informative full-text article by Jon McClellan. M.D., and John Werry, M.D.
Affective instability and impulsivity in borderline personality and bipolar II disorders: similarities and differences
Results of a study by Henry C.; Mitropoulou V.; New A.S.; Koenigsberg H.W.; Silverman J.; Siever L.J,; November 2001
"Conclusions: borderline personality disorder and bipolar II disorder appear to involve affective lability, which may account for the efficacy of mood stabilizers treatments in both disorders. However, our results suggest that borderline personality disorder cannot be viewed as an attenuated group of affective disorders."
Atypical Bipolar II Depression Compared with Atypical Unipolar Depression and Nonatypical Bipolar II Depression
Abstract of a study by Franco Benazzi, 2000
"Aim of the study was to find out whether atypical
bipolar II depression was distinct from both atypical
unipolar depression and nonatypical bipolar II
depression. Seventy-nine consecutive atypical bipolar II
depressed outpatients were compared with 42 consecutive
atypical unipolar depressed outpatients and with 53
consecutive nonatypical bipolar II depressed outpatients.
Among the variables studied (age at intake, age at onset,
female gender, duration of illness, psychosis,
comorbidity, chronicity, recurrences, severity), age at
intake and onset were significantly lower in the atypical
bipolar II group than in the other groups. The other
variables, apart from psychosis, were not significantly
different. Findings suggest that atypical bipolar II
depression may have an age at onset different from that
of atypical unipolar depression and nonatypical bipolar
II depression. As different ages at onset may identify
distinct subtypes of depression, this finding might
suggest that atypical bipolar II depression may be
distinct from both atypical unipolar depression and
nonatypical bipolar II depression."
Rapid-cycling bipolar disorder. An overview of research and clinical experience
by Kilzieh N, Akiskal HS., 1999
Contested boundaries of bipolar disorder and the limits of categorical diagnosis in psychiatry
Abstract of a study by D Blacker and MT Tsuang
The Affective Spectrum of Bipolar Disorder
Excellent page by Joy Ikelman from her Bipolar Disorder web site.
The evolving bipolar spectrum. Prototypes I, II, III, and IV
by Akiskal HS, Pinto O., 1999
Collection of Scholarly Abstracts on the Bipolar/BPD connection
Bipolar II disorder and comorbidity
Abstract of an article by Eduard Vieta
Children and Adolescent Bipolar Foundation
For parents and adults concerned about BPD/Bipolar dual-diagnosed children and adolescents.
Message boards, articles, links, etc.
BPSO.org
For spouses, loved ones, families of those diagnosed with Bipolar Disorder. This is the BPDCENTRAL of Bipolar Disorder.
BPD is often confused with/mistaken for Bipolar, and there are many folks with dual diagnoses.
Bipolar Children and Teens Web Site for Parents
plenty of links, personal stories and articles
Depression
The Difference Between Depression and Sadness
Excellent checklist, explanations and a free online depression screening test.
Depression: An Overview
Another great overview from mentalhealthsource.com
Treatment-resistant depression and Axis II comorbidity
Abstract of a study by T. Petersen et al, 2002
Personality pathology, depression and HPA axis functioning
Schweitzer I, Tuckwell V, Maguire K, Tiller J., 2001
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."
Biological nature of depressive symptoms in borderline personality disorder: endocrine comparison to recurrent brief and major depression
De la Fuente JM, Bobes J, Vizuete C, Mendlewicz J., 2002
More research supporting the authors' proposal in the link above.
"Borderline personality disorder (BPD) often shows depressive symptoms and their biological nature albeit extensively discussed remains controversial. The knowledge of this nature seems essential as it could imply key therapeutic strategies. We have found BPD and major depression (MD) not to share biological abnormalities. We have proposed BPD to frequently display an affective syndrome distinct from the nonborderline MD both in terms of quality and duration of symptoms and of biological substrate. A substantial number of BPD patients can be diagnosed as having clinical Recurrent Brief Depression (RBD) which has been proposed to overlap with BPD. RBD has been found to share perturbed biological substrate with MD but we have previously not found this abnormal substrate in BPD. Our aim was to study the possibility that BPD patients with depressive symptoms and even clinically diagnosed with RBD have a biological substrate distinct from RBD without BPD and from MD, and therefore a specific affective syndrome."
Negativism in evaluative judgments of words among depressed outpatients with borderline personality disorder
Abtract 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."
A current view of the interface between borderline personality disorder and depression
Abstract of a study by JG Gunderson and KA Phillips, 1991, which shows an insignificant correlation between clinical depression and BPD.
Aspects of depression associated with borderline personality disorder
Abstract of a study by JH Rogers, TA Widiger and A Krupp, 1995
Identifying the depressive border of the borderline personality disorder
Abstract of an analysis by S Snyder, C Sajadi, WM Pitts Jr and WA Goodpaster, 1982
Depressive response to physostigmine challenge in borderline personality disorder patients
Steinberg BJ, Trestman R, Mitropoulou V, et al, 1997
The dexamethasone suppression test in borderlines: is it useful?
Abstract of a study by Korzekwa M, Steiner M, Links P, Eppel A. 1991
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
Cognitive and Physiological Aspects of Attention to Personally Relevant Negative Information in Depression
Full-text online dissertation by Greg Jeremy Siegle 1999
Dissociative Disorders, Depersonalization Disorder and
Dissociative Identity Disorder (Multiple Personality)
Dissociation and Depersonalization can include the
following subjective feelings:
erasure of a sense of "self", trouble controlling or feeling one's own body, trouble with speaking, trouble putting memories in the correct time frame, bad short- or long-term memory, extremely selective memory, time loss, somatoform syndromes, recurrent nightmares, visual disturbances, feeling "spaced out", out of body experiences.
Some researchers posit that BPD is a dissociative disorder somewhere along a spectrum between PTSD and Dissociative Identity Disorder (Multiple Personality Disorder). (Some speculate that DID as a separate clinical entity may not even exist, but is the guise presented by those with severely pathological cases of BPD.)
For more details on memory loss, please see: Memory and Trauma in BPD
For a brief, clear overview of how memory, brain chemistry and life experience interact, read: Emotional Memory Management by Joe Carver, PhD.
erasure of a sense of "self", trouble controlling or feeling one's own body, trouble with speaking, trouble putting memories in the correct time frame, bad short- or long-term memory, extremely selective memory, time loss, somatoform syndromes, recurrent nightmares, visual disturbances, feeling "spaced out", out of body experiences.
Some researchers posit that BPD is a dissociative disorder somewhere along a spectrum between PTSD and Dissociative Identity Disorder (Multiple Personality Disorder). (Some speculate that DID as a separate clinical entity may not even exist, but is the guise presented by those with severely pathological cases of BPD.)
For more details on memory loss, please see: Memory and Trauma in BPD
For a brief, clear overview of how memory, brain chemistry and life experience interact, read: Emotional Memory Management by Joe Carver, PhD.
What is the difference between BPD and the spectrum of dissociative disorders?
Great article by Dr. Richard Moskovitz, author of Lost in the Mirror
BPD and dissociation
Excellent article by Alain Tortosa of AAPEL
Understanding Dissociative Disorders Through Dissociative Signs and Symptoms
by Cecilia Pearson, 1991
Childhood Trauma and Dissociation in Adulthood
Full-text article by Barbara Apgar, 1999
Multiple personality disorder and borderline personality disorder. Distinct entities or variations on a common theme?
by Lauer J, Black DW, Keen P. 1993
"We report data from a comparison of 14 subjects with multiple personality disorder (MPD) and 13 subjects with borderline personality disorder (BPD). There were few significant differences between the groups. The authors discuss the concept of MPD as an epiphenomenon of BPD, and argue their fundamental similarity."
The dissociative experiences of borderline patients
Study by Zanarini MC, Ruser T, Frankenburg FR, Hennen J., 2000
"The study objective was to assess the severity and
quality of dissociative experiences reported by
borderline patients. [...] Thirty-two percent of
borderline patients had a low level of dissociation, 42%
a moderate level, and 26% a high level similar to that
reported by patients meeting criteria for posttraumatic
stress disorder (PTSD) or dissociative disorders. [...]
The results of this study suggest that the severity of
dissociation experienced by borderline patients is more
heterogeneous than previously reported. They also suggest
that borderline patients have a wider range of
dissociative experiences than are commonly recognized,
including experiences of absorption and amnesia, as well
as experiences of depersonalization."
Treating personality fragmentation and dissociation in borderline personality disorder: a pilot study of the impact of cognitive analytic therapy
Abstract of a study by Wildgoose A, Clarke S, Waller G., 2001
"Recent findings suggest that personality fragmentation may be a core component of borderline personality disorder (BPD) and that successful treatment of BPD may depend on the extent to which this is addressed. Cognitive analytic therapy (CAT) can increase integration by strengthening awareness, and hence control, of the dissociative processes maintaining fragmentation. This pilot study aimed to conduct a systematic evaluation of the impact of CAT on BPD severity and personality integration."
Psychiatric symptomatology in borderline and other personality disorders: dissociation and fragmentation as mediators
Research by Wildgoose A, Waller G, Clarke S, Reid A., 2000, as to
"why BPD patients have higher levels of other psychiatric
symptomatology than those with other personality
disorders" looked at 2 groups: those with BPD and those
with other PDs.
"The BPD group had higher levels of a number of aspects of psychiatric symptomatology. Those differences were mediated by aspects of dissociation. Personality fragmentation differentiated the two groups but was not related to the higher levels of other aspects of psychiatric disturbance. Treating the syndrome of BPD may depend on addressing both dissociation and personality fragmentation."
"The BPD group had higher levels of a number of aspects of psychiatric symptomatology. Those differences were mediated by aspects of dissociation. Personality fragmentation differentiated the two groups but was not related to the higher levels of other aspects of psychiatric disturbance. Treating the syndrome of BPD may depend on addressing both dissociation and personality fragmentation."
Dissociative Identity Disorder and the Socio-Cognitive Model: Recalling the Lessons of the Past
by Scott O. Lilienfeld, Steven Jay Lynn, Irving Kirsch, John F. Chaves, Theodore R. Sarbin, George K. Ganaway, Russell A. Powell, 1996
A comprehensive examination of the diagnosis of DID and its relation to other disorders such as BPD. Looks at the misuse of differential diagnosis by mental health professionals, and the "possibility that both the history of abuse and PTSD symptoms may be seized upon as evidence of potential DID by therapists who seek to explain many of the puzzling features of BPD, such as identity disturbance, dramatic changes in mood, and marked instability in interpersonal relationships, in terms of DID."
Childhood Trauma and Perceived Parental Dysfunction in the Etiology of Dissociative Symptoms in Psychiatric Inpatients
by Nel Draijer, Ph.D., and Willie Langeland, M.A., 1999
OBJECTIVE: Research on the etiology of dissociation in
adults has focused primarily on childhood sexual abuse.
The role of co-occurring childhood stressors and of more
chronic adverse conditions such as neglect is less clear.
This study examined the level of dissociation in relation
to childhood trauma (sexual/physical abuse, witnessing
interparental violence), early separation from a parent,
and perceived parental dysfunction. METHOD: One hundred
sixty inpatients consecutively admitted to a general
psychiatric hospital were administered the Dissociative
Experiences Scale and the Structured Trauma
Interview.
RESULTS: The mean Dissociative Experiences Scale score was 17.4; 18.0% of the patients scored beyond 30. Early separation was reported by 26.4% of the patients; 30.1% had witnessed interparental violence; 23.6% reported physical abuse; 34.6% reported sexual abuse; 11.7% reported rape before age 16; and 42.1% reported sexual and/or physical abuse. The level of dissociation was primarily related to reported overwhelming childhood experiences (sexual and physical abuse). When sexual abuse was severe (involving penetration, several perpetrators, lasting more than 1 year), dissociative symptoms were even more prominent. Highest dissociation levels were found in patients reporting cumulative sexual trauma (intrafamilial and extrafamilial) or both sexual and physical abuse. In particular, maternal dysfunction was related to the level of dissociation. With control for gender and age, stepwise multiple regression analysis indicated that the severity of dissociative symptoms was best predicted by reported sexual abuse, physical abuse, and maternal dysfunction. CONCLUSIONS: These findings indicate that dissociation, although trauma-related, is neglect-related as well. This implies the importance of object relations and attachment in the diagnosis and treatment of patients with dissociative disorders."
RESULTS: The mean Dissociative Experiences Scale score was 17.4; 18.0% of the patients scored beyond 30. Early separation was reported by 26.4% of the patients; 30.1% had witnessed interparental violence; 23.6% reported physical abuse; 34.6% reported sexual abuse; 11.7% reported rape before age 16; and 42.1% reported sexual and/or physical abuse. The level of dissociation was primarily related to reported overwhelming childhood experiences (sexual and physical abuse). When sexual abuse was severe (involving penetration, several perpetrators, lasting more than 1 year), dissociative symptoms were even more prominent. Highest dissociation levels were found in patients reporting cumulative sexual trauma (intrafamilial and extrafamilial) or both sexual and physical abuse. In particular, maternal dysfunction was related to the level of dissociation. With control for gender and age, stepwise multiple regression analysis indicated that the severity of dissociative symptoms was best predicted by reported sexual abuse, physical abuse, and maternal dysfunction. CONCLUSIONS: These findings indicate that dissociation, although trauma-related, is neglect-related as well. This implies the importance of object relations and attachment in the diagnosis and treatment of patients with dissociative disorders."
Personality factors associated with dissociation: temperament, defenses, and cognitive schemata
Survey by Simeon D, Guralnik O, Knutelska M, Schmeidler J., 2002
"Subjects with depersonalization disorder demonstrated significantly greater harm-avoidant temperament, immature defenses, and over-connection and disconnection cognitive schemata than comparison subjects. Within the group of subjects with depersonalization disorder, dissociation scores significantly correlated with the same variables."
Feeling Unreal: Cognitive Processes in Depersonalization
Orna Guralnik, Psy.D., James Schmeidler, Ph.D., and Daphne Simeon, M.D., 2000
"OBJECTIVE: Depersonalization disorder is characterized
by a detachment from one's sense of self and one's
surroundings that leads to considerable distress and
impairment yet an intact testing of reality.
Depersonalized individuals often report difficulties in
perception, concentration, and memory; however, data on
their cognitive profiles are lacking. METHOD: Fifteen
patients with depersonalization disorder were compared to
15 matched normal comparison subjects on a comprehensive
neuropsychological test battery that assessed cognitive
function. RESULTS: The subjects with depersonalization
disorder showed a distinct cognitive profile. They
performed significantly worse than the comparison
subjects on certain measures of attention, short-term
visual and verbal memory, and spatial reasoning within
the context of comparable intellectual abilities.
CONCLUSIONS: The authors propose that depersonalization
involves alterations in the attentional and perceptual
systems, specifically in the ability to effortfully
control the focus of attention. These early encoding
deficits are hypothesized to have a deleterious effect on
the short-term memory system; they manifest as deficits
in the ability to take in new information but not in the
ability to conceptualize and manipulate previously
encoded information."
Dissociative phenomena in women with borderline personality disorder
Study by SL Shearer, 1994
"Patients with borderline personality disorder seem to be characterized by somewhat different life experiences, treatment histories, and behavioral presentations depending on their level of dissociative experience, even though they meet the same DSM-III-R criteria."
The identification and characteristics of the partially dissociated states of patients with borderline personality disorder
Abstract of a study by Golynkina K, Ryle A., 1999
"Partial dissociation provoked by trauma and deprivation
in childhood is seen to result in the persistence of
separate self states. The characteristics of these and
alternations between them are seen to account for the
main features of the condition.
The states identified [...] are classified into six groups, named abuser rage, victim rage, passive victim, ideal, coping and zombie."
The states identified [...] are classified into six groups, named abuser rage, victim rage, passive victim, ideal, coping and zombie."
Risk factors associated with the dissociative experiences of borderline patients
by Zanarini MC, Ruser TF, Frankenburg FR, Hennen J, Gunderson JG., 2000
Abstract of a survey of 362 BPD inpatients suggests that "both sexual trauma and something intrinsic to the borderline diagnosis itself are risk factors for dissociative phenomena among borderline patients."
Trauma and Dissociation in Delinquent Adolescents
by Victor G. Carrion, March 2000
Full-text study.
Relationship of Dissociation to Temperament and Character in Men and Women
by Hans-Joergen Grabe, M.D., et al, 1999
Directed forgetting of emotional stimuli in borderline personality disorder
Abstract of a study by Korfine, Lauren; Hooley, Jill M., 2000
Memory performance among women with parental abuse histories: Enhanced directed forgetting or directed remembering?
Abstract of a study by Cloitre, Marylene; Cancienne, James, et al, 1996, suggesting that:
"The enhanced selective memory in the abused group was the result of better recall for "remember" and not poorer recall for "forget" information, indicating that abused individuals have an enhanced ability to sustain attention to designated "remember" information."
Autobiographical memory and parasuicide in borderline personality disorder
by Startup M, Heard H, Swales M, Jones B, Williams JM, Jones RS., June 2001
Abstract of a study which suggests that the inability to remember autobiographical specifics is directly tied in to an innate protective mechanism reducing the chance of parasuicidal behavior.
Brain Researchers From UCLA, Johns
Hopkins Discover Role of Key Protein in Converting
Short-term Memories Into Lifelong OnesMay 2001
The prisoners of despair:
right hemisphere deficiency and suicideReview of research by I. Weinberg, 2000
(You may have to register to read; it's free)
"It is suggested that due to functional insufficiency of
the right hemisphere the suicidal person demonstrates a
compensatory shift to left hemisphere functioning. This
shift manifests itself in reversed asymmetry of
neurotransmitters, tendency to dissociation, alienated
and negative perception of the body, lower sensitivity to
pain, disintegration of self-representation, cognitive
constriction, overly general nature of personal memories,
difficulties in affect regulation as well as such
personality traits as low openness to experience and
personal constriction."
Emotion Regulation and Memory: The Cognitive Costs of Keeping One's Cool
by Jane M. Richards and James J. Gross 2000
Multiple Personality Disorder
Great introductory essay by Linda Humphrey
About Multiple Personality Disorder and Dissociation
by A.J. Mahari
The Significant Other's Guide to Dissociative Identity Disorder (Multiple Personality Disorder)
by Jeff Vineburg
Excellent! This has got to be one of the more compelling accounts I've read. Much of it applies to SOs of BPs, too.
You can also join the Significant Others of DIDs email support group. To join, email the moderator at: snuffy
The Effects of DID on Children of Trauma Survivors
By Esther Giller, 1995
Great article detailing the parenting challenges of someone suffering from a dissociative disorder, and the effects on the children
FIVE CONFLICTING VIEWS ABOUT MPD AND DID
Great compilation from the website of a DID
Unwanted Sexual Experiences and Sexual Risks in Gay and Bisexual Men: Associations Among Revictimization, Substance Use, and Psychiatric Symptoms
by Seth C. Kalichman, Feb 2001
"Explanations for the association between child sexual
abuse and unwanted sexual events in adulthood have
emphasized the roles of psychiatric symptoms such as
dissociation, trauma-related anxiety, and borderline
personality characteristics. Dissociation serves as a
cognitive and emotional escape strategy that can be
effective in coping with childhood trauma but becomes
maladaptive in adulthood. Dissociation in response to
fear producing events can translate to ignoring potential
risks, including risks for HIV-AIDS. [...] Trauma,
dissociation, and borderline characteristics may be
important risk factors for substance abuse, unwanted
sexual experiences, and sexual revictimization in women.
However, to our knowledge sexual revictimization,
dissociation, trauma-related anxiety, and borderline
characteristics have not been investigated in relation to
unwanted sexual experiences among gay and bisexual men.
The purpose of the current study was, therefore, to
extend findings reported in studies of women to men who
have sex with men, and to examine revictimization as a
risk factor for HIV and other sexually transmitted
diseases (STDs) in men who have sex with men."