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Fanti E, Di Sarno M, Di Pierro R. In search of hidden threats: A scoping review on paranoid presentations in personality disorders. Clin Psychol Psychother 2023; 30:1215-1233. [PMID: 37727949 DOI: 10.1002/cpp.2913] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/25/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023]
Abstract
Recent diagnostic developments suggest that paranoia is a transdiagnostic characteristic common to several personality disorders rather than a personality disorder per se. Nonetheless, empirical literature fails to provide comprehensive and univocal findings on whether and how paranoid presentations relate to different personality disorders. In the present scoping review, we map the empirical literature on paranoid presentations in personality disorders, considering the entire spectrum of paranoid manifestations (i.e., the paranoia hierarchy). In selecting original quantitative studies on paranoid presentations in personality-disordered patients, we screened 4,433 records in PsycArticles, PsycInfo and PUBMED. We eventually included 47 eligible studies in the review. Our synthesis indicates consistent empirical evidence of a wide range of paranoid presentations in Paranoid, Schizotypal and Borderline personality disorders. Conversely, little empirical literature exists on paranoid presentations in other personality disorders. Preliminary findings suggest broad-severity paranoid presentations, ranging from milder to severe forms, in Paranoid, Schizotypal and Borderline personality disorders. There is also some evidence of milder forms of paranoia in Avoidant, Antisocial and Narcissistic personality disorders. Conversely, there is poor evidence of paranoid presentations in Schizoid, Histrionic, Dependent or Obsessive-compulsive personality disorders. Research gaps and recommendations for improving empirical research on paranoid presentations in personality disorders are discussed.
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Affiliation(s)
- Erika Fanti
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Marco Di Sarno
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
- Personality Disorder Lab (PDLab), Milan-Parma, Italy
| | - Rossella Di Pierro
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
- Personality Disorder Lab (PDLab), Milan-Parma, Italy
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Abstract
AbstractBorderline personality disorder (BPD) is a severe and complex disorder characterized by instability across many life domains, including interpersonal relations, behavior, and emotions. A core feature and contributor to BPD, emotion dysegulation (ED), consists of deficits in the ability to regulate emotions in a manner that allows the individual to pursue important goals or behave effectively in various contexts. Biosocial developmental models of BPD have emphasized a transaction of environmental conditions (e.g., invalidating environments and adverse childhood experiences) with key genetically linked vulnerabilities (e.g., impulsivity and emotional vulnerability) in the development of ED and BPD. Emerging evidence has begun to highlight the complex, heterotypic pathways to the development of BPD, with key heritable vulnerability factors possibly interacting with aspects of the rearing environment to produce worsening ED and an adolescent trajectory consisting of self-damaging behaviors and eventual BPD. Adults with BPD have shown evidence of a variety of cognitive, physiological, and behavioral characteristics of ED. As the precursors to the development of ED and BPD have become clearer, prevention and treatment efforts hold great promise for reducing the long-term suffering, functional impairment, and considerable societal costs associated with BPD.
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Lind M, Thomsen DK, Bøye R, Heinskou T, Simonsen S, Jørgensen CR. Personal and parents' life stories in patients with borderline personality disorder. Scand J Psychol 2019; 60:231-242. [PMID: 30809831 DOI: 10.1111/sjop.12529] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 01/14/2019] [Indexed: 11/29/2022]
Abstract
Patients with borderline personality disorder (BPD) display disturbances in understanding self and others. We examined whether these disturbances extended to how patients described their personal and parents' life stories and to measures of identity, alexithymia, empathy, and emotional intelligence. Thirty BPD patients and 30 matched control participants described personal and parents' life stories and completed measures of identity disturbance, alexithymia, empathy, and emotional intelligence. Compared to the controls, patients with BPD described their personal and their parents' life stories more negatively and with fewer themes of agency and communion fulfillment. Patients and controls showed equally complex reasoning about their personal life stories, but patients displayed less complexity and more self-other confusion, when reasoning about their parents' stories. Patients also differed from controls on identity disturbance, alexithymia, and empathy. The results suggest that patients' storied understanding of themselves and others are disturbed and should be taken into account to better understand BPD.
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Affiliation(s)
- Majse Lind
- Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark.,Center on Autobiographical Memory Research (CON AMORE), Aarhus University, Aarhus, Denmark
| | - Dorthe Kirkegaard Thomsen
- Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark.,Center on Autobiographical Memory Research (CON AMORE), Aarhus University, Aarhus, Denmark
| | - Rikke Bøye
- Unit for personality disorders, Aarhus University Hospital, Risskov, Denmark
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Abstract
Findings from randomized controlled trials and meta-analyses suggest that there are several efficacious treatments for borderline personality disorder, including those based on cognitive behavior theories and psychodynamic theories. In addition, there are generalist and adjunctive approaches. These treatments and the corresponding evidence associated with each are described. It is concluded randomized controlled trials and meta-analyses suggest little to no difference between any active specialty treatments for borderline personality disorder; there are no differences between dialectical behavior therapy and non-dialectical behavior therapy treatments or between cognitive behavior-based and psychodynamic theory-based treatments. Thus, clinicians are justified in using any of these efficacious treatments.
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Affiliation(s)
- Kenneth N Levy
- Department of Psychology, The Pennsylvania State University, State College, PA 16802, USA; Department of Psychiatry, Joan and Sanford I. Weill Medical College of Cornell University, New York, NY 10065, USA.
| | - Shelley McMain
- Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, M5S 2S1, Canada
| | - Anthony Bateman
- Mentalization Training Unit, Saint Ann's Hospital, North London, NW3 5SU, UK
| | - Tracy Clouthier
- Department of Psychology, The Pennsylvania State University, State College, PA 16802, USA; Department of Psychiatry, Upstate Medical University, Syracuse, NY 13210, USA
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De Meulemeester C, Lowyck B, Vermote R, Verhaest Y, Luyten P. Mentalizing and interpersonal problems in borderline personality disorder: The mediating role of identity diffusion. Psychiatry Res 2017; 258:141-144. [PMID: 29024891 DOI: 10.1016/j.psychres.2017.09.061] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 04/28/2017] [Accepted: 09/23/2017] [Indexed: 11/16/2022]
Abstract
Individuals with borderline personality disorder (BPD) are characterized by problems in interpersonal functioning and their long-term social integration often remains problematic. Extant theories have linked identity diffusion to many of the interpersonal problems characteristic of BPD patients. Recent theoretical accounts have suggested that identity diffusion results from problems with mentalizing or reflective functioning, that is, the capacity to understand oneself and others in terms of intentional mental states. In this study we tested these assumptions, i.e., whether identity diffusion plays a mediating role in the relationship between mentalizing difficulties and interpersonal problems, in a sample of 167 BPD patients. Highly significant correlations were found between mentalizing impairments, identity diffusion and interpersonal problems. Mediation analyses showed that identity diffusion fully mediated the relationship between mentalizing difficulties and interpersonal problems. This study provides preliminary evidence that impairments in mentalizing are related to identity diffusion, which in turn is related to interpersonal problems in BPD. Further longitudinal research is needed to further substantiate these conclusions.
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Affiliation(s)
| | - Benedicte Lowyck
- University Psychiatric Hospital UPC KU Leuven, Campus Kortenberg and Department of Neurosciences, Faculty of Medicine, KU Leuven, Leuven, Belgium.
| | - Rudi Vermote
- University Psychiatric Hospital UPC KU Leuven, Campus Kortenberg and Department of Neurosciences, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Yannic Verhaest
- University Psychiatric Hospital UPC KU Leuven, Campus Kortenberg, Belgium
| | - Patrick Luyten
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
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Sollberger D, Gremaud-Heitz D, Riemenschneider A, Agarwalla P, Benecke C, Schwald O, Küchenhoff J, Walter M, Dammann G. Change in Identity Diffusion and Psychopathology in a Specialized Inpatient Treatment for Borderline Personality Disorder. Clin Psychol Psychother 2014; 22:559-69. [DOI: 10.1002/cpp.1915] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 07/07/2014] [Accepted: 07/14/2014] [Indexed: 11/11/2022]
Affiliation(s)
| | - Daniela Gremaud-Heitz
- Psychiatric University Hospital; Basel Switzerland
- Psychiatric Clinic; Münsterlingen Switzerland
| | | | | | - Cord Benecke
- Institute of Psychology; University of Kassel; Kassel Germany
| | - Oliver Schwald
- Outpatient Clinic for Victims of Torture and War; Swiss Red Cross; Bern Switzerland
| | - Joachim Küchenhoff
- Psychiatric University Hospital; Basel Switzerland
- Psychiatric Clinic; Liestal Switzerland
| | - Marc Walter
- Psychiatric University Hospital; Basel Switzerland
| | - Gerhard Dammann
- Psychiatric University Hospital; Basel Switzerland
- Psychiatric Clinic; Münsterlingen Switzerland
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Jørgensen CR, Freund C, Bøye R, Jordet H, Andersen D, Kjølbye M. Outcome of mentalization-based and supportive psychotherapy in patients with borderline personality disorder: a randomized trial. Acta Psychiatr Scand 2013; 127:305-17. [PMID: 22897123 DOI: 10.1111/j.1600-0447.2012.01923.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study presents data from a randomized outcome study comparing mentalization-based and supportive psychotherapy for patients with borderline personality disorder (BPD). METHOD Eighty-five SCID-II diagnosed borderline patients were randomized to either i) 2 years of intensive (twice weekly) combined (individual and group), mentalization-based psychotherapy (MBT) or ii) 2 years of less-intensive (biweekly) supportive group therapy. Treatment outcome was assessed using a battery of self-report questionnaires, SCID-II interviews and therapist-rated global assessment of functioning (GAF). RESULTS Fifty-eight patients completed 2 years of treatment. Significant changes in both treatment groups were identified for several outcome measures, including self-reported measures of general functioning, depression, social functioning and number of diagnostic criteria met for BPD, as outlined by the SCID-II interview. General linear modelling was used to compare treatment outcome in the two groups. Only GAF showed a significantly higher outcome in the MBT group. A trend was found for a higher rate of recovery from BPD in the MBT group. Pre-post effect sizes were high (0.5-2.1) and for the most part highly significant in both groups. CONCLUSION The study indicates that both MBT and supportive treatment are highly effective in treating BPD when conducted by a well-trained and experienced psychodynamic staff in a well-organized clinic.
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Affiliation(s)
- C R Jørgensen
- Department of Psychology, University of Aarhus, Aarhus C, Denmark.
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Slavin-Mulford J, Sinclair SJ, Stein M, Malone J, Bello I, Blais MA. External Validity of the Personality Assessment Inventory (PAI) in a Clinical Sample. J Pers Assess 2012; 94:593-600. [DOI: 10.1080/00223891.2012.681817] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Stoffers JM, Völlm BA, Rücker G, Timmer A, Huband N, Lieb K. Psychological therapies for people with borderline personality disorder. Cochrane Database Syst Rev 2012; 2012:CD005652. [PMID: 22895952 PMCID: PMC6481907 DOI: 10.1002/14651858.cd005652.pub2] [Citation(s) in RCA: 195] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Psychotherapy is regarded as the first-line treatment for people with borderline personality disorder. In recent years, several disorder-specific interventions have been developed. This is an update of a review published in the Cochrane Database of Systematic Reviews in 2006. OBJECTIVES To assess the effects of psychological interventions for borderline personality disorder (BPD). SEARCH METHODS We searched the following databases: CENTRAL 2010(3), MEDLINE (1950 to October 2010), EMBASE (1980 to 2010, week 39), ASSIA (1987 to November 2010), BIOSIS (1985 to October 2010), CINAHL (1982 to October 2010), Dissertation Abstracts International (31 January 2011), National Criminal Justice Reference Service Abstracts (15 October 2010), PsycINFO (1872 to October Week 1 2010), Science Citation Index (1970 to 10 October 2010), Social Science Citation Index (1970 to 10 October 2010), Sociological Abstracts (1963 to October 2010), ZETOC (15 October 2010) and the metaRegister of Controlled Trials (15 October 2010). In addition, we searched Dissertation Abstracts International in January 2011 and ICTRP in August 2011. SELECTION CRITERIA Randomised studies with samples of patients with BPD comparing a specific psychotherapeutic intervention against a control intervention without any specific mode of action or against a comparative specific psychotherapeutic intervention. Outcomes included overall BPD severity, BPD symptoms (DSM-IV criteria), psychopathology associated with but not specific to BPD, attrition and adverse effects. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, assessed the risk of bias in the studies and extracted data. MAIN RESULTS Twenty-eight studies involving a total of 1804 participants with BPD were included. Interventions were classified as comprehensive psychotherapies if they included individual psychotherapy as a substantial part of the treatment programme, or as non-comprehensive if they did not.Among comprehensive psychotherapies, dialectical behaviour therapy (DBT), mentalisation-based treatment in a partial hospitalisation setting (MBT-PH), outpatient MBT (MBT-out), transference-focused therapy (TFP), cognitive behavioural therapy (CBT), dynamic deconstructive psychotherapy (DDP), interpersonal psychotherapy (IPT) and interpersonal therapy for BPD (IPT-BPD) were tested against a control condition. Direct comparisons of comprehensive psychotherapies included DBT versus client-centered therapy (CCT); schema-focused therapy (SFT) versus TFP; SFT versus SFT plus telephone availability of therapist in case of crisis (SFT+TA); cognitive therapy (CT) versus CCT, and CT versus IPT.Non-comprehensive psychotherapeutic interventions comprised DBT-group skills training only (DBT-ST), emotion regulation group therapy (ERG), schema-focused group therapy (SFT-G), systems training for emotional predictability and problem solving for borderline personality disorder (STEPPS), STEPPS plus individual therapy (STEPPS+IT), manual-assisted cognitive treatment (MACT) and psychoeducation (PE). The only direct comparison of an non-comprehensive psychotherapeutic intervention against another was MACT versus MACT plus therapeutic assessment (MACT+). Inpatient treatment was examined in one study where DBT for PTSD (DBT-PTSD) was compared with a waiting list control. No trials were identified for cognitive analytical therapy (CAT).Data were sparse for individual interventions, and allowed for meta-analytic pooling only for DBT compared with treatment as usual (TAU) for four outcomes. There were moderate to large statistically significant effects indicating a beneficial effect of DBT over TAU for anger (n = 46, two RCTs; standardised mean difference (SMD) -0.83, 95% confidence interval (CI) -1.43 to -0.22; I(2) = 0%), parasuicidality (n = 110, three RCTs; SMD -0.54, 95% CI -0.92 to -0.16; I(2) = 0%) and mental health (n = 74, two RCTs; SMD 0.65, 95% CI 0.07 to 1.24 I(2) = 30%). There was no indication of statistical superiority of DBT over TAU in terms of keeping participants in treatment (n = 252, five RCTs; risk ratio 1.25, 95% CI 0.54 to 2.92).All remaining findings were based on single study estimates of effect. Statistically significant between-group differences for comparisons of psychotherapies against controls were observed for BPD core pathology and associated psychopathology for the following interventions: DBT, DBT-PTSD, MBT-PH, MBT-out, TFP and IPT-BPD. IPT was only indicated as being effective in the treatment of associated depression. No statistically significant effects were found for CBT and DDP interventions on either outcome, with the effect sizes moderate for DDP and small for CBT. For comparisons between different comprehensive psychotherapies, statistically significant superiority was demonstrated for DBT over CCT (core and associated pathology) and SFT over TFP (BPD severity and treatment retention). There were also encouraging results for each of the non-comprehensive psychotherapeutic interventions investigated in terms of both core and associated pathology.No data were available for adverse effects of any psychotherapy. AUTHORS' CONCLUSIONS There are indications of beneficial effects for both comprehensive psychotherapies as well as non-comprehensive psychotherapeutic interventions for BPD core pathology and associated general psychopathology. DBT has been studied most intensely, followed by MBT, TFP, SFT and STEPPS. However, none of the treatments has a very robust evidence base, and there are some concerns regarding the quality of individual studies. Overall, the findings support a substantial role for psychotherapy in the treatment of people with BPD but clearly indicate a need for replicatory studies.
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Affiliation(s)
- Jutta M Stoffers
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
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Jørgensen CR, Berntsen D, Bech M, Kjølbye M, Bennedsen BE, Ramsgaard SB. Identity-related autobiographical memories and cultural life scripts in patients with Borderline Personality Disorder. Conscious Cogn 2012; 21:788-98. [PMID: 22356875 DOI: 10.1016/j.concog.2012.01.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 01/15/2012] [Accepted: 01/16/2012] [Indexed: 11/26/2022]
Abstract
Disturbed identity is one of the defining characteristics of Borderline Personality Disorder manifested in a broad spectrum of dysfunctions related to the self, including disturbances in meaning-generating self-narratives. Autobiographical memories are memories of personal events that provide crucial building-blocks in our construction of a life-story, self-concept, and a meaning-generating narrative identity. The cultural life script represents culturally shared expectations as to the order and timing of life events in a prototypical life course within a given culture. It is used to organize one's autobiographical memories. Here, 17 BPD-patients, 14 OCD-patients, and 23 non-clinical controls generated three important autobiographical memories and their conceptions of the cultural life script. BPD-patients reported substantially more negative memories, fewer of their memories were of prototypical life script events, their memory narratives were less coherent and more disoriented, and the overall typicality of their life scripts was lower as compared with the other two groups.
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Sollberger D, Gremaud-Heitz D, Riemenschneider A, Küchenhoff J, Dammann G, Walter M. Associations between identity diffusion, Axis II disorder, and psychopathology in inpatients with borderline personality disorder. Psychopathology 2012; 45:15-21. [PMID: 22123512 DOI: 10.1159/000325104] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Accepted: 01/17/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients with borderline personality disorder (BPD) suffer from instability in their relationships, their affectivity, and their identity. However, the associations between these dimensions are not clear. The purpose of the present study was to investigate the relation between identity diffusion and psychopathology in BPD. METHODS In the second week of inpatient treatment, 52 patients with BPD were assessed with the Inventory of Personality Organization (IPO) and questionnaires measuring general psychiatric symptoms, mood states, and negative affects (SCL-90-R, BDI, STAI, and STAXI). A median split was examined to differentiate BPD patients with high identity diffusion from those with low identity diffusion. RESULTS BPD patients with high identity diffusion did not differ in their social data from BPD patients with low identity diffusion. However, BPD patients with high identity diffusion showed significantly higher levels of psychiatric symptoms, as well as higher anxiety, anger, and depression scores (p < 0.01). Moreover, they suffered more frequently from concurrent personality disorders (p < 0.05). CONCLUSIONS These findings indicate an association of identity diffusion with psychopathological symptoms and features of personality disorder and emphasize the clinical significance of identity diffusion for patients with BPD.
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Singh D, McMain S, Zucker KJ. Gender identity and sexual orientation in women with borderline personality disorder. J Sex Med 2010; 8:447-54. [PMID: 21054794 DOI: 10.1111/j.1743-6109.2010.02086.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION In the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, text revision (DSM-IV-TR) (and earlier editions), a disturbance in "identity" is one of the defining features of borderline personality disorder (BPD). Gender identity, a person's sense of self as a male or a female, constitutes an important aspect of identity formation, but this construct has rarely been examined in patients with BPD. AIMS In the present study, the presence of gender identity disorder or confusion was examined in women diagnosed with BPD. MAIN OUTCOME MEASURES We used a validated dimensional measure of gender dysphoria. Recalled gender identity and gender role behavior from childhood was also assessed with a validated dimensional measure, and current sexual orientation was assessed by two self-report measures. METHODS A consecutive series of 100 clinic-referred women (mean age, 34 years) with BPD participated in the study. The women were diagnosed with BPD using the International Personality Disorder Exam-BPD Section. RESULTS None of the women with BPD met the criterion for caseness on the dimensional measure of gender dysphoria. Women who self-reported either a bisexual or a homosexual sexual orientation had a significantly higher score on the dimensional measure of gender dysphoria than the women who self-reported a heterosexual sexual orientation, and they also recalled significantly more cross-gender behavior during childhood. Results were compared with a previous study on a diagnostically heterogeneous group of women with other clinical problems. CONCLUSION The importance of psychosexual assessment in the clinical evaluation of patients with BPD is discussed.
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Affiliation(s)
- Devita Singh
- Gender Identity Service, Child, Youth, and Family Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
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Nilsson AKK, Jørgensen CR, Straarup KN, Licht RW. Severity of affective temperament and maladaptive self-schemas differentiate borderline patients, bipolar patients, and controls. Compr Psychiatry 2010; 51:486-91. [PMID: 20728005 DOI: 10.1016/j.comppsych.2010.02.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 11/23/2009] [Accepted: 02/08/2010] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES There is an unsettled debate on whether borderline personality disorder and bipolar disorder should be considered related or distinct. This study aimed to further the understanding of the similarities and differences between the 2 disorders by comparing borderline patients, bipolar patients, and controls in terms of various affective temperaments and maladaptive self-schemas. METHODS The sample consisted of 85 participants (31 borderline patients, 25 bipolar patients and 29 student controls) who completed 2 questionnaires: The Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego Autoquestionnaire and the Young Schema Questionnaire. All of the patients were in remission from affective episodes. RESULTS Compared to the bipolar patients and the controls, the borderline patients were characterized by significantly higher mean scores on most of the maladaptive self-schemas and affective temperaments. The bipolar patients differed significantly from controls by higher mean scores on the cyclothymic temperament and insufficient self-control. CONCLUSIONS The study suggests that affective temperaments and maladaptive self-schemas are more severe in borderline patients than in bipolar patients. These findings point to phenomenological differences between the 2 disorders and therefore question their degree of kinship.
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