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: 10.26). 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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    • "The mean age of the mother at the birth of the participant was 28.2 years for Group 1, and 28.8 years for Group 2. Furthermore, results indicated that fewer participants in Group 1 (3.1%) than in Group 2 (13.8%) had mothers who were aged 35-50 years at the time of their birth. A cohort study conducted by Durkin, Maenner, Newschaffer et al (2008) in the US found that the odds of developing ASD were significantly reduced for parental age <20, and increased for maternal age >35. The results of our study suggest that after 2002, mothers were on average older, and might therefore have been at risk of having children with ASD. "
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    ABSTRACT: Limited research has been published about the demographic characteristics of children with Autism Spectrum Disorder (ASD) in South Africa. Describing the profiles of learners from a school for children with ASD may contribute to local knowledge in the field. A retrospective comparative design was utilised to compare the demographic characteristics of learners over two time intervals: 1992-2002 (Group 1, n=32) and 2003-2014 (Group 2, n=109). A total of 141 historical admission records in paper-based files were reviewed. Results indicated that there is a large male gender bias (8.4:1) in learners, which increased over the years. The age of the child when parents first became concerned and the age at diagnosis and assessment at school increased over both time periods. There was also an increase in the diversity of home languages after 2002. Parental qualifications decreased, but social class improved in recent years. The low qualification of a mother was associated with an advanced age of the child at school entry. The data serves as a point of reference for future studies about the characteristics of school children with ASD in South Africa.
    South African Journal of Childhood Education 06/2015; 5(1):42-61.
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    • "Thus far there is no generally accepted notion of how BPD fits with NIMH's Research Domain Criteria (RDoC) that is aimed at developing new ways to identify valid neurobiological data and observable behavioral dimensions across psychiatric disorders.6 A number of reconceptualizations of BPD have been offered based on factors such as treatment recovery patterns, heritability, and underlying neurobiology.7 In this paper we posit that BPD reflects a generalized maladaptive personality. "
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    ABSTRACT: Patient-reported outcome (PRO) refers to measures that emphasize the subjective view of patients about their health-related conditions and behaviors. Typically, PROs include self-report questionnaires and clinical interviews. Defining PROs for borderline personality disorder (BPD) is particularly challenging given the disorder's high symptomatic heterogeneity, high comorbidity with other psychiatric conditions, highly fluctuating symptoms, weak correlations between symptoms and functional outcomes, and lack of valid and reliable experimental measures to complement self-report data. Here, we provide an overview of currently used BPD outcome measures and discuss them from clinical, psychometric, experimental, and patient perspectives. In addition, we review the most promising leads to improve BPD PROs, including the DSM-5 Section III, the Recovery Approach, Ecological Momentary Assessments, and novel experimental measures of social functioning that are associated with functional and social outcomes.
    Dialogues in clinical neuroscience 06/2014; 16(2):255-66. DOI:10.5167/uzh-98461
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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.
    Clinical Psychology & Psychotherapy 11/2012; 19(6). DOI:10.1002/cpp.772 · 2.59 Impact Factor
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