The quality of depression in borderline personality disorder and the diagnostic process.
ABSTRACT 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.
- SourceAvailable from: Daniela Gremaud-Heitz[Show abstract] [Hide abstract]
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; DOI:10.1016/j.comppsych.2013.11.021 · 2.26 Impact Factor
- [Show abstract] [Hide abstract]
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.
- [Show abstract] [Hide abstract]
ABSTRACT: Alterations of the central serotonergic system are considered to be involved in the pathophysiology of borderline personality disorder (BPD). The loudness dependence of the N1/P2 component of auditory evoked potentials (LD) has been shown to indirectly reflect central serotonergic activity. The aim of this study was to investigate LD in patients with BPD compared to healthy controls, and to evaluate the association between LD and psychopathology such as anxiety, anger or impulsiveness. Female patients with BPD were included and compared to age and sex matched healthy subjects. Self-rating instruments, such as State-Trait Anxiety Inventory (STAI), State-Trait Anger Expression Inventory (STAXI), and the Barratt Impulsiveness Scale (BIS) were used to assess clinical scores of anxiety, anger, and impulsiveness. Evoked potentials were recorded following the application of acoustic stimuli with increasing intensities; the LD was analysed using dipole source analysis. The mean LD was significantly higher in patients with BPD compared to controls. In the entire sample there were significant positive correlations of LD with state anxiety scores and STAXI subscores. The data contribute to the knowledge of neurophysiological alterations in patients with BPD, supporting the hypothesis of serotonergic dysregulation in the pathophysiology of the disorder. The significant clinical correlations suggest monoaminergic modulations of psychopathology on the symptom level.Psychiatry Research 04/2012; 199(3). DOI:10.1016/j.psychres.2012.03.051 · 2.68 Impact Factor