Borderline Personality Disorder Outline

Lena Roberts

Introduction/ Description of Disorder- DSM criterion, Can we trust the DSM/ room for
improvement? traits of disorder, life experiences in contrast to those without disorder

Theme: What traits distinguish BPD from others? Where are there overlaps? Is there a
possibility for misdiagnosis?

DSM-5 Criterion:
1. Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or
self-mutilating behaviour covered in Criterion 5.
2. A pattern of unstable and intense interpersonal relationship characterized by alternating
between extremes of idealization and devaluation.
3. Identity disturbance: markedly and persistently unstable self-image or sense of self
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex,
substance abuse, reckless driving, binge eating). Note: Do not include suicidal or selfmutilating
behaviour covered in Criterion 5.
5. Recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour
6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria,
irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
7. Chronic feelings of emptiness
8. Inappropriate, intense anger or difficulty controlling anger (e.g. frequent displays of temper,
constant anger, recurrent physical fights).
9. Transient, stress-related paranoid ideation or severe dissociative symptoms.

CANNOT USE THIS SOURCE- MORE THAN 10 YEARS/ JUST FOR MORE INFORMATION
Diagnostic efficiency and hierarchical functioning of the DSM-IV borderline personality disorder
criteria.
https://web.s.ebscohost.com/ehost/detail/detail?vid=53&sid=443d739f-27d9-4e4d-b477-452d36
283344%40redis&bdata=JkF1dGhUeXBlPWlwLHNzbyZzaXRlPWVob3N0LWxpdmUmc2NvcGU
9c2l0ZQ%3d%3d#AN=1999-10812-005&db=psyh
- Are certain criteria more determinant of BPD than others?
- Hierarchy in criteria/traits?
- What does this say about how physicians refer to DSM in diagnosis

Emotion regulation, mindfulness, and self-compassion among patients with borderline

personality disorder, compared to healthy control subjects.
https://web.s.ebscohost.com/ehost/detail/detail?vid=31&sid=443d739f-27d9-4e4d-b477-452d36
283344%40redis&bdata=JkF1dGhUeXBlPWlwLHNzbyZzaXRlPWVob3N0LWxpdmUmc2NvcGU
9c2l0ZQ%3d%3d#AN=2021-29009-001&db=psyh
- Questionnaire
 - People with BPD had higher levels of emotional dysregulation and maladaptive
strategies
- Lower levels of mindfulness and self-compassion

Cognitive Factors- Argumentative! Are there brain abnormalities that are linked to the
disorder? How does age affect? Explain the link between brain functions and BPD traits.

Theme: Is the disorder caused by genetic brain abnormalities or developed abnormalities? How
do these occur? Can they be reversed?

Structural brain abnormalities in borderline personality disorder correlate with clinical severity
and predict psychotherapy response
https://web.s.ebscohost.com/ehost/detail/detail?vid=3&sid=443d739f-27d9-4e4d-b477-452d362
83344%40redis&bdata=JkF1dGhUeXBlPWlwLHNzbyZzaXRlPWVob3N0LWxpdmUmc2NvcGU9
c2l0ZQ%3d%3d#AN=2021-22516-001&db=psyh
- Study on individuals with BPD using VBM and Cth to analyze prefrontal cortex and
increased GMV in parahippocampal area
- Theory: could explain increased impulsivity and emotional dysregulation

REPETITIVE- MAY NOT USE

https://web.s.ebscohost.com/ehost/detail/detail?vid=16&sid=443d739f-27d9-4e4d-b477-452d36
283344%40redis&bdata=JkF1dGhUeXBlPWlwLHNzbyZzaXRlPWVob3N0LWxpdmUmc2NvcGU
9c2l0ZQ%3d%3d#AN=2021-76894-001&db=psyh
- Relationship btw BPD and CARs levels
- Factor of age in women- how CARs change
- What that means for BPD people

Associations between age and cortisol awakening response in patients with borderline
personality disorder.
https://web.s.ebscohost.com/ehost/detail/detail?vid=17&sid=443d739f-27d9-4e4d-b477-452d36
283344%40redis&bdata=JkF1dGhUeXBlPWlwLHNzbyZzaXRlPWVob3N0LWxpdmUmc2NvcGU
9c2l0ZQ%3d%3d#AN=2021-76894-001&db=psyh
- Corresponding deviations of the cortisol awakening response (CAR) are presumed to
mirror maladaptive neuroendocrine processes
- How does BPD influence CAR?
- What does age have to do with CAR
- -elevated levels of CAR with age in females

Diagnosis/ Clinical Approaches- What factors play into the development of BPD that
physicians look for- genetics and family history, Differences in diagnosis from other personality
disorders. How does age play into this? Why are people younger than 18 less likely to be
diagnosed?

Theme: Nature vs Nurture/ Biological vs Environmental- What factors can be evidence for BPD?
BPD: Clinical Guidelines for Treatment
https://pubmed.ncbi.nlm.nih.gov/30840560/
- Comparisons to bipolar disorder and schizophrenia
- Genetic links and post-natal factors like family environment
- Initial evaluations of family history

Differential Diagnosis of Borderline Personality Disorder

https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S0193953X18311304?returnurl=null&
referrer=null
- Importance of diagnosis in relation to different treatments
- Distinguishing BPD from bipolar spectrum, ADHD, PTSD, other personality disorders

Nature and nurture? A review of the literature on childhood maltreatment and genetic factors in
the pathogenesis of borderline personality disorder.
https://web.s.ebscohost.com/ehost/detail/detail?vid=19&sid=443d739f-27d9-4e4d-b477-452d36
283344%40redis&bdata=JkF1dGhUeXBlPWlwLHNzbyZzaXRlPWVob3N0LWxpdmUmc2NvcGU
9c2l0ZQ%3d%3d#AN=2021-41671-020&db=psyh
- Genes involved in HPA axis regulation may be altered w child abuse
- Cause or correlation?
- Screened many articles- 16 used in review
- I definitely want to expand on the nature vs nurture debate when revolving this topic,
may have to find an additional source for contrasting opinions

Treatment Approaches- How do treatments vary? different age groups- adolescent vs adult,
differences in cross cultural approaches, gender influences, physician biases
Different treatment methods-psychotherapy, treatment models
Is treatment necessary/helpful? Can it be “cured”?

Theme: Physician Biases and Differences in Treatment Approaches

Psychotherapy for Borderline Personality Disorder in Adolescents

https://pubmed.ncbi.nlm.nih.gov/30447735/
- Early intervention and psychological evaluation
- Implementation of treatment approaches
- Basic explanation of approaching psychotherapy in adolescents

What works for adolescents with borderline personality disorder: Towards a developmentally
informed understanding and structured treatment model
https://web.s.ebscohost.com/ehost/detail/detail?vid=43&sid=443d739f-27d9-4e4d-b477-452d36
283344%40redis&bdata=JkF1dGhUeXBlPWlwLHNzbyZzaXRlPWVob3N0LWxpdmUmc2NvcGU
9c2l0ZQ%3d%3d#AN=2020-97210-002&db=psyh
 - Most effective treatments for adolescents
- Developmental obstacles in psychotherapy for adolescents

Dynamic deconstructive psychotherapy in Iran: A randomized controlled trial with follow-up for
borderline personality disorder.
https://web.s.ebscohost.com/ehost/detail/detail?vid=4&sid=443d739f-27d9-4e4d-b477-452d362
83344%40redis&bdata=JkF1dGhUeXBlPWlwLHNzbyZzaXRlPWVob3N0LWxpdmUmc2NvcGU9
c2l0ZQ%3d%3d#AN=2021-32201-001&db=psyh
- non-Western psychotherapy models- DDP
- Analyze western vs non western approaches

Gender differences in the treatment of patients with borderline personality disorder.

https://web.s.ebscohost.com/ehost/detail/detail?vid=7&sid=443d739f-27d9-4e4d-b477-452d362
83344%40redis&bdata=JkF1dGhUeXBlPWlwLHNzbyZzaXRlPWVob3N0LWxpdmUmc2NvcGU9
c2l0ZQ%3d%3d#AN=2022-00430-001&db=psyh
- men are less treated than women for disorder
- Men are diagnosed later
- Less psychiatric medications and therapy

Gender bias and diagnosing: An examination of clinician gender bias in borderline and
antisocial personality disorders.
https://web.s.ebscohost.com/ehost/detail/detail?vid=51&sid=443d739f-27d9-4e4d-b477-452d36
283344%40redis&bdata=JkF1dGhUeXBlPWlwLHNzbyZzaXRlPWVob3N0LWxpdmUmc2NvcGU
9c2l0ZQ%3d%3d#AN=2010-99060-452&db=psyh
- surveys
- Study concluded no gender differences in diagnosis BPD by clinicians
- Contradicts other study

Is there a bias in the diagnosis of borderline personality disorder among lesbian, gay, and
bisexual patients?
https://web.s.ebscohost.com/ehost/detail/detail?vid=20&sid=443d739f-27d9-4e4d-b477-452d36
283344%40redis&bdata=JkF1dGhUeXBlPWlwLHNzbyZzaXRlPWVob3N0LWxpdmUmc2NvcGU
9c2l0ZQ%3d%3d#AN=2021-27583-003&db=psyh
- Physician bias in treating and diagnosing?
- Disparity highest for bisexual vs hetero people
- Hetero less likely to be diagnosed

NOT SURE IF I WANT TO ADDRESS STIGMAS

Borderline personality disorder: To diagnose or not to diagnose? That is the question.
https://web.s.ebscohost.com/ehost/detail/detail?vid=39&sid=443d739f-27d9-4e4d-b477-452d36
283344%40redis&bdata=JkF1dGhUeXBlPWlwLHNzbyZzaXRlPWVob3N0LWxpdmUmc2NvcGU
9c2l0ZQ%3d%3d#AN=2020-35415-001&db=psyh
 - Is it effective to diagnose? Effect of stigma associated with disorder
- Treatment may lead to full recovery

Reference Section:

Bo, S., Vilmar, J. W., Jensen, S. L., Jorgensen, M. S., Kongerslev, M., Lind, M., & Fonagy, P.

(2021). What works for adolescents with borderline personality disorder: Towards a
developmentally informed understanding and structured treatment model. Current
Opinion in Psychology, 37, 7–12. https://doi.org/10.1016/j.copsyc.2020.06.008

Campbell, K., Clarke, K. A., Massey, D., & Lakeman, R. (2020). Borderline personality disorder:

To diagnose or not to diagnose? that is the question. International Journal of Mental

Health Nursing, 29(5), 972–981. https://doi.org/10.1111/inm.12737

Davis, S. (2010). Gender bias and diagnosing: An examination of clinician gender bias in

borderline and antisocial personality disorders. Dissertation Abstracts International:

Section B: The Sciences and Engineering, 70(9-B), 5813.
https://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,sso&db=psyh&AN=2
010-99060-452&site=ehost-live&scope=site

Dehlbom, P., Wetterborg, D., Lundqvist, D., Maurex, L., Dal, H., Dalman, C., & Kosidou, K.

(2021). Gender differences in the treatment of patients with borderline personality

disorder. Personality Disorders: Theory, Research, and Treatment.
https://doi.org/10.1037/per0000507

Majdara, E., Rahimian-Boogar, I., Talepasand, S., & Gregory, R. J. (2021). Dynamic

deconstructive psychotherapy in Iran: A randomized controlled trial with follow-up for

borderline personality disorder. Psychoanalytic Psychology, 38(4), 328–335.
https://doi.org/10.1037/pap0000338

Paris, J. (2018). Differential Diagnosis of Borderline Personality Disorder. Psychiatric Clinics of

 North America, 41(4), 575-582.
https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S0193953X18311304?returnu
rl=null&referrer=null

Rausch, J., Flach, E., Panizza, A., Brunner, R., Herpertz, S. C., Kaess, M., & Bertsch, K. (2021).

Associations between age and cortisol awakening response in patients with borderline
personality disorder. Journal of Neural Transmission, 128(9), 1425–1432.
https://doi.org/10.1007/s00702-021-02402-3

Rodriguez-Seijas, C., Morgan, T. A., & Zimmerman, M. (2020). Is there a bias in the diagnosis of

borderline personality disorder among lesbian, gay, and bisexual patients? Assessment,
28(3), 724–738. https://doi.org/10.1177/1073191120961833

Salgó, E., Szeghalmi, L., Bajzát, B., Berán, E., & Unoka, Z. (2021). Emotion regulation,

mindfulness, and self-compassion among patients with borderline personality disorder,

compared to healthy control subjects. PLOS ONE, 16(3).
https://doi.org/10.1371/journal.pone.0248409

Sampedro, F., Farrés, C. C., Soler, J., Elices, M., Schmidt, C., Corripio, I., Domínguez-Clavé, E.,

Pomarol-Clotet, E., Salvador, R., & Pascual, J. C. (2021). Structural brain abnormalities
in borderline personality disorder correlate with clinical severity and predict
psychotherapy response. Brain Imaging and Behavior, 15(5), 2502–2512.
https://doi.org/10.1007/s11682-021-00451-6

Stone, M. H. (2019). Borderline personality disorder: Clinical guidelines for treatment.

Psychodynamic Psychiatry, 47(1), 5–26. https://doi.org/10.1521/pdps.2019.47.1.5

Weiner, A., Ensink, K., Normandin, L. (2018). Psychotherapy for Borderline Personality Disorder

in Adolescents. Psychiatr Clin North Am., 41(4), 729-746.

https://doi:10.1016/j.psc.2018.07.005

Wilson, N., Robb, E., Gajwani, R., & Minnis, H. (2021). Nature and nurture? A review of the

literature on childhood maltreatment and genetic factors in the pathogenesis of

borderline personality disorder. Journal of Psychiatric Research, 137, 131–146.
https://doi.org/10.1016/j.jpsychires.2020.12.025