Interesting information about BPD

It’s my holidays now and I’d originally planned to borrow a ton of BPD/PD/psychology books from the local library… but as it turns out, the library is crap. There was only one book on anxiety (wedged in between engineering books) although they had a ridiculous amount of self-help and organization books.

So anyway, I ended up searching in my uni’s online catalogue and actually managed to get my hands on some articles and books!

Here are a couple of lesser-known facts about BPD from the article “Borderline and Histrionic Personality Disorders: A Review” by Michael H. Stone:

  1. BPD differs more noticeably across cultures than is the case with, for example, schizoid personality disorder. The aloofness that one encounters in schizoid persons is similar the world over. Yet when BPD is diagnosed in Scandinavia or Japan, for example, the typical patients are less angry or tempestuous than their American counterparts; those diagnosed in Japan, though they engage in suicidal behaviours, show most strikingly the traits of dependent personality disorder.
  2. One of the more robust findings was that about two-thirds of the BPD patients, when evaluated 10 to 25 years later, were functioning at levels compatible with Global Assessment Scores in the mid-60s: ‘‘some mild symptoms . . . but generally functioning pretty well, has some meaningful inter-personal relationships’’. The larger samples yielded large enough subgroups of BPD patients to examine the impact of certain variables.Factors that augured well, prognostically, were high intelligence, selfdiscipline, artistic talent, attractiveness, and (in the case of borderlines who abused alcohol) ability to commit to Alcoholics Anonymous.
  3. At 5-year follow-up, female BPD patients treated with multimodal therapy (that might include group, family, as well as individual supportive and exploratory therapies) at McLean Hospital showed a steady decline in suicidal behaviour, but suicidal ideation and (milder forms of) self-harm did not decline notably; in relation to self-harm, most patients showed a fluctuating course and had higher levels of baseline dysphoria. At 6-year follow-up in the larger group (n ¼ 290) of borderline inpatients at McLean Hospital, 74% no longer met (full) BPD criteria. In this study, it was noted that impulsive symptoms resolved the most quickly; affective symptoms were the most stubborn.
  4. The experience of safety within the context of a close emotional relationship is essential for the development of an autonomous sense of self and anything that undermines the emergent self leads to anxiety and potentially an angry response as the child attempts to stabilize himself. Under conditions of chronic neglect and insensitivity, instability of the self results first in anger and then aggression, which is evoked so frequently because of repeated parental neglect that it becomes incorporated into the self-structure, with the result that self-assertion, demand, wishes, needs have to be accompanied by aggression if the self is to remain intact and stable. Such distortions to the self are not irreversible. The acquisition of the capacity to create a ‘‘narrative’’ of one’s thoughts and feelings, to mentalize, can overcome flaws in the organization of the self that can flow from the disorganization of early attachment. Thus the robustness of the self-structure is dependent on the capacity to mentalize.
  5. PD scores tend to diminish with age. This negative correlation is strongest with the four PDs in Cluster B including BPD. Along with the criterion of physically self-damaging acts, it is the criterion of identity disturbance which is significantly less frequently met in older BPD patients: it was found in 55% of patients aged <35, but in 27% of older patients. Some patients will achieve their identity with a delay due to a later maturation, maybe helped by psychotherapy; some others develop their identity later on in accordance with their social role: role identity would transform into personal identity. Identification or even overidentification with a patient role may help some BPD patients to cope with the stigma of mental disorder and/or to stabilize their own identity. […] The majority of patients maintain some of their symptoms but, generally, are functioning pretty well; we are not sure whether this outcome reflects the impact of treatment or the natural course of the disorder.
  6. When we look at published studies of the relationship between BPD and the five factor model of personality, we find that individuals with BPD are characterized by high neuroticism and relatively low agreeableness and conscientiousness, irrespective of whether BPD is assessed by interview or questionnaire. Extraversion is not related to BPD.
  7. In summary, both treatments show similar effects on suicidal and selfmutilatory acts, but MBT is superior to DBT in terms of the reduction of anxiety and depressive symptoms. Furthermore, the data seem to indicate that the benefits are better maintained in MBT as compared to DBT. Thus I think that it is fair to state that, although the effectiveness of DBT has been documented in more studies than the effectiveness of MBT, the clinical results from the first trial on MBT are more impressive than those published for DBT. What does this mean? As far as I can see, there are three competing explanations: the differential results can result from theoretical and technical differences, or from dosage differences, or from a combination thereof. DBT is 12 months of outpatient treatment without aftercare, whereas MBT is 18 months of day treatment with aftercare. […] Across studies, however, DBT has not shown effectiveness in terms of a reduction of depression, hopelessness, and improvements in survival and coping beliefs or overall life satisfaction. In addition, Verheul et al. showed that DBT was differentially effective in reducing self-harm in chronically parasuicidal borderline patients, whereas the impact of DBT in low-severity patients was similar to treatment as usual. Together, these findings suggest that DBT should—consistent with its original aims —only be a treatment of choice for chronically parasuicidal borderline patients, and should perhaps be extended or followed by another treatment, focusing on other components of BPD, as soon as the high-risk behaviours are sufficiently reduced.

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