Pharmacotherapy for patients with borderline personality disorder is directed against the psychobiology of cognitive-perceptual, affective, and impulsive-behavioral symptoms. A symptom-specific method using current empiric evidence for drug efficacy in each symptom domain is proposed. Drugs in each medication class have some potential utility against specific symptoms in patients with borderline personality disorder.
"Psychopharmacologically experienced psychiatrists on every unit prescribed the medication. All patients in both groups were on medication deemed appropriate by the psychiatrists and in accordance with the recommended APA guidelines (Soloff, 2000). "
[Show abstract][Hide abstract] ABSTRACT: Patients with borderline personality disorder (BPD) show various psychopathological symptoms and suffer especially from disturbance in their identity. The purpose of the study was to investigate changes—particularly in affective BPD symptoms and identity diffusion—during a structured, disorder-specific inpatient treatment (DST) that combined a psychodynamic transference-focused psychotherapy approach with modules of dialectical behavioural skills training. In a prospective, two-group comparison trial, 44 patients with BPD were assessed with questionnaires addressing identity diffusion and state, as well as trait affective psychopathology, before and after 12 weeks of inpatient treatment. Thirty-two patients received DST, whereas 12 patients were given inpatient treatment-as-usual (TAU). The patients were allocated in a non-random procedure for two groups, in order of admission and availability of treatment options in the DST unit. In the pre-post-comparison, the DST group showed a significant decrease in identity diffusion (p < 0.001) and improvements in instability of the image of self and others (p < 0.008), as well as in pathological (trait and state) symptoms. However, there was no significant improvement in the TAU group. After a 12-week inpatient treatment, the findings indicate significant improvements in the DST group in typical affective borderline symptomatology and in the personality structure feature of identity diffusion. This highlights the significance of a short-term specific inpatient therapy for BPD. Copyright
"Several direct tests of 5-HT functioning in individuals with BPD support an association between the disorder and deficits of the 5-HT system. Pharmacologic challenge tests designed to assess central 5-HT activity (e.g., fenfluramine, m-chlorophenylpiperazine, buspirone, ipsapirone) have been conducted in several samples with personality disorders, including individuals with BPD, with findings suggestive of reduced central 5-HT activity (Coccaro, Astill, Herbert, & Schut, 1990; Coccaro & Kavoussi, 1997; Moss, Yao, & Panzak, 1990; Soloff, 2000). These results reveal that the relation between aggressive, mooddependent behavior and 5-HT activity is common to many personality disorders and may not be specific to BPD (Gurvits, Koenigsberg, & Siever, 2000). "
[Show abstract][Hide abstract] ABSTRACT: Over the past several decades, research has focused increasingly on developmental precursors to psychological disorders that were previously assumed to emerge only in adulthood. This change in focus follows from the recognition that complex transactions between biological vulnerabilities and psychosocial risk factors shape emotional and behavioral development beginning at conception. To date, however, empirical research on the development of borderline personality is extremely limited. Indeed, in the decade since M. M. Linehan initially proposed a biosocial model of the development of borderline personality disorder, there have been few attempts to test the model among at-risk youth. In this review, diverse literatures are reviewed that can inform understanding of the ontogenesis of borderline pathology, and testable hypotheses are proposed to guide future research with at-risk children and adolescents. One probable pathway is identified that leads to borderline personality disorder; it begins with early vulnerability, expressed initially as impulsivity and followed by heightened emotional sensitivity. These vulnerabilities are potentiated across development by environmental risk factors that give rise to more extreme emotional, behavioral, and cognitive dysregulation. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
"Pharmacologic interventions that address the balance of 5HT and DA may serve a distress tolerance function. For example, SSRIs have been recommended as a first-line treatment for both the affective dysregulation and behavioral dyscontrol symptoms of BPD (Grossman, 2002; Soloff, 2000). Because 5HT and DA interact, it is likely that SSRIs are effective at treating emotion-based risky behavior because as the levels of 5HT in the brain are regulated, the DA levels are also stabilized. "
[Show abstract][Hide abstract] ABSTRACT: Under heightened emotional states, individuals are more inclined to engage in ill-considered or rash actions than at other times. The authors present evidence for the existence of 2 related traits called positive and negative urgency. The traits refer to individual differences in the disposition to engage in rash action when experiencing extreme positive and negative affect, respectively. The authors provide evidence that these traits are distinct from other dispositions toward rash action and that they play distinct roles in predicting problem levels of involvement in behaviors such as alcohol consumption, binge eating, drug use, and risky sexual behavior. The authors identify facilitative conditions for the emergence of the urgency traits from neuroscience. Certain gene polymorphisms are associated with low levels of serotonin and high levels of dopamine; that pattern of neurotransmitter activity in a brain system linking the orbitofrontal cortex and the amygdala appears to facilitate the development of positive and negative urgency. The authors discuss the implications of this theory.
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