The Case for Shifting Borderline Personality Disorder to Axis I

Department of Psychiatry, Mount Sinai School of Medicine, New York, New York 10029, USA.
Biological psychiatry (Impact Factor: 9.47). 07/2008; 64(8):653-9. DOI: 10.1016/j.biopsych.2008.04.020
Source: PubMed

ABSTRACT Through reviewing what is known about the nature, course, and heritability of borderline personality disorder (BPD), we argue for a reconceptualization of this disorder that would lead to its placement on Axis I. Borderline personality disorder is a prevalent and disabling condition, and yet the empirical research into its nature and treatment has not been commensurate with the seriousness of the illness. We not only review empirical evidence about the etiology, phenomenology, and course of the disorder in BPD but we also address fundamental misconceptions about BPD that we believe have contributed to misunderstanding and stigmatization of the disease. Finally, we suggest future directions for research that might permit the identification of core features of this disorder, with a focus on the importance of naturalistic assessments and of assessments through the course of development.

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Available from: Antonia S New, Dec 30, 2013
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    • "Borderline personality disorder (BPD) is a severe mental disorder that heavily impairs affected individuals in multiple domains (Skodol et al., 2005; Zanarini et al., 2005) and presents a major burden to public health systems (Soeteman et al., 2008). Up to now, empirical research has mainly focused on affective instability and impulsivity as underlying traits of the disorder (for a review, see New et al., 2008). By contrast , little attention has been paid to the interpersonal dysfunction, which is characterized in the DSM-IV by intense and unstable relational style, abandonment fears and vacillating between idealization and devaluation (American Psychiatric Association, 2000). "
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    ABSTRACT: Interpersonal dysfunction is a key feature of borderline personality disorder (BPD). Distorted perception of participation in social situations and altered emotional responses could contribute to these typical interpersonal problems in BPD. Thirty patients with BPD were compared with a healthy control group (n = 30) in their perceptions and subjective emotional reactions to situations of social inclusion and exclusion. Participants played Cyberball, a virtual ball-tossing paradigm, in which social inclusion and exclusion are experimentally induced. Control participants reacted with an increase in sadness, anger and overall negative affect when excluded. In BPD patients, social exclusion also induced anger, while general participating in the game seemed to reduce levels of sadness. Compared with healthy controls, BPD patients felt more readily excluded independent of the condition of inclusion or exclusion. In conclusion, patients with BPD displayed a negative bias toward perceived participation in social situations. Copyright © 2011 John Wiley & Sons, Ltd. Key Practitioner Message Patients with BPD have a biased perception for exclusion. Virtual ball-tossing games can be used to induce anger in patients with BPD. Participating in a virtual ball-tossing game may reduce levels of sadness in BPD in the short term.
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    • "This heterogeneity has led to a search of the core problems of BPD, now thought to be emotional and behavior dysregulation, and interpersonal problems (New, Triebwasser, & Charney, 2008). These three factors have, however, proven to be too highly intercorrelated to be considered separate factors (New, et al., 2008). Current research and clinical work are focused on understanding the genetic, neurobiological and environmental bases of BPD core symptoms. "
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