The Quality of Depression in Borderline Personality Disorder and the Diagnostic Process

Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109-2700, USA.
Journal of personality disorders (Impact Factor: 3.08). 02/2010; 24(1):25-37. DOI: 10.1521/pedi.2010.24.1.25
Source: PubMed


The quality of the depressive experience in borderline personality disorder has always been perceived to be different from the depression experienced in major depression (MDD). This paper reviews those observations and studies of the particular ways in which this borderline personality disorder (BPD) depression/dysphoria has been described in the literature and makes note of the fact the patients with BPD often score more highly on self-rated scales of depression than on corresponding observer-rated scales. Often patients with BPD without MDD score as highly on depression rating scales as BPD patients with MDD and as highly as patients with MDD without BPD. Clinician-rated scales and operationalized diagnostic interviews do not easily capture the distinction between the depression of BPD and the depression of MDD. A fuller appreciation of the BPD patient's object relations, i.e., the nature of the interpersonal relationships and the person's reactions and affects to and within those relationships holds the key to understanding the nature of the quality of the depression of BPD.

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    • "Research also indicates that patients with BPD features more intensely experience painful depressive feelings, as evidenced by higher scores on self-report, but not observation-based measures of depression (Levy, Edell, & McGlashan, 2007; Silk, 2010; Zanarini et al., 1998). "
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    ABSTRACT: Borderline personality disorder (BPD) frequently co-occurs with mood disorders and each influences the course and response to treatment of the other, potentially reducing beneficial outcome. Mentalizing, the ability to infer one's own and others' mental states, is a key factor in both disorders, being a major component of affect regulation and self-identity as well as a central aspect of interpersonal relationships and social function. In this article, we suggest that using mentalization-based treatment may lead to better outcome by addressing the mentalizing problems arising from the dual pathway that leads from depressed mood and BPD to disruption of mentalizing. Some clinical interventions are described to address the mentalizing problems associated with depression and BPD. © 2015 Wiley Periodicals, Inc.
    Journal of Clinical Psychology 07/2015; 71(8). DOI:10.1002/jclp.22206 · 2.12 Impact Factor
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    • "Compared to melancholia and other depression, atypical depression shows an earlier age of onset and a more chronic course of illness [23]. The quality of the depressive experience in borderline personality disorder has always been perceived to be different from the depression experienced in major depression (MDD) [24]. Perugi and colleagues [25] compared patients who met the DSM-IV criteria for major depressive episode with atypical features in terms of a comorbid BPD. "
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    ABSTRACT: The core features of borderline personality disorder (BPD) are affective instability, unstable relationships and identity disturbance. Axis I comorbidities are frequent, in particular affective disorders. The concept of atypical depression is complex and often underestimated. The purpose of the study was to investigate the comorbidity of atypical depression in borderline patients regarding anxiety-related psychopathology and interpersonal problems. Sixty patients with BPD were assessed with the Structured Clinical Interviews for DSM-IV Axis I and II Disorders (SCID I, SCID II) as well as the Atypical Depression Diagnostic Scale (ADDS). Additionally, patients completed a questionnaire (SCL-90-R, BDI, STAI, STAXI, IIP-C). Forty-five BPD patients (81.8%) had a comorbid affective disorder of which 15 (27.3%) were diagnosed with an atypical depression. In comparison to patients with major depressive disorder or no comorbid depression, patients with atypical depression showed significant higher scores in psychopathological symptoms regarding anxiety and global severity as well as interpersonal problems. The presence of atypical depression in borderline patients is correlated with psychopathology, anxiety, and interpersonal problems and seems to be of clinical importance for personalized treatment decisions.
    Comprehensive psychiatry 12/2013; 55(3). DOI:10.1016/j.comppsych.2013.11.021 · 2.25 Impact Factor
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    • "None of the experiences or emotions described by the patients in our study was specific to adolescence. The question of the interweaving of the depressive experience and the borderline experience, however, is not settled, and remains an important research perspective (Silk, 2010). "
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    ABSTRACT: The purpose of this study was to assess how far identity and self-image disturbances are features of borderline personality disorder (BPD) in adolescence. Face-to-face interviews were carried out with a total of 50 adolescents with BPD and 50 controls, with a median age of 16 (SD 1.1; range 13 to 18) years. Data was analysed using a qualitative methodology, interpretative phenomenological analysis (IPA). Thematic statements representative of adolescents' lived experience were extracted from the interviews. Four main themes representing the day-to-day experiences of adolescents with BPD were identified: emotional experiences characterised by the feelings of fear, sadness and pessimism; interpersonal relationships characterised by the feelings of solitude and hostility from others; a conformist self-image characterised by a feeling of normality and difficulty in projecting into time; and, a structuring of discourse characterised by discontinuity in the perception of experiences. This qualitative study suggests that the day-to-day experiences of adolescents with borderline personality disorder is centred on the experience of the present. Discontinuity in self-image, alongside marked dysphoric manifestations, leads to distress and hinders compliance with care. These issues are highly relevant in psychotherapy and could lead to more effective treatment of the disorder in adolescents.
    Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal de l'Academie canadienne de psychiatrie de l'enfant et de l'adolescent 11/2013; 22(4):282-9.
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