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BORDERLINE PERSONALITY; TRAIT AND DISORDER

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					BORDERLINE PERSONALITY;
  TRAIT AND DISORDER

     Morey and Zanarini
                        BPD?
• Distinct personality disorder beginning in childhood and
  characterised by pervasive pattern of impulsivity and
  unstable personal relationships, self-image and affect.
• Includes;
 frantic attempts to avoid real or imagined abandonment
 intense and unstable personal relationships
 fluctuating self image
 impulsivity and recurrent suicidal or self mutilating
  gestures or behaviour
 emotional instability
 transient stress–related paranoia or dissociation

• Clinical diagnosis; must meet minimum of five of the
  DSM-IV criteria
    TWO REPRESENTATIONS BP;
    FFM and Categorical Diagnosis

• Global level BPM characterized by very
  high N, low A and low C, explaining
  features such as identity problems and
  fears of abandonment
• BUT other feature’s not associated with
  FFM
             PRESENT STUDY
Goal One:
 Relationship FFM in a clinical sample

Goal Two:
 Highlight aspects of categorical diagnostic
 concept not captured by the FFM representation

Does FFM miss essential aspects of the BP
 diagnosis?
Do the residual elements of the categorical
 diagnosis add to a diagnostic understanding of
 BP?
 CONTRIBUTION OF RESIDUAL TO
     DIAGNOSTIC VALIDITY
• Antecedent validity; etiological factors
  (family history of psychiatric disorders,
  childhood abuse and neglect)
• Concurrent validity; symptoms of
  dysphoric inner states and dissociative
  experiences
• Predictive validity; intermediate –term
  outcomes at two follow-up intervals –
  temporal patterns of functional behaviour.
                Method
Participants
•Inpatients at a hospital in Massachusetts
• Aged 18-35
•Normal or better intelligence
•No history or current symptoms of serious
organic condition
•Had been assigned a definite or probable
Axis II diagnosis by a physician
•This resulted in 378 subjects available for
testing
                  Instruments
• 3 semi-structured interviews
• Structured Clinical Interview for DSM-III-R Axis I
  Disorders
• Revised Diagnostic Interview for Borderlines (DIB-R)
• Diagnostic Interview for DSM-III-R Personality Disorders
  (DIPD-R)
• Five Factor Model
• Self-reported version of the NEO Five-Factor Inventory
• Difficult Childhood Experiences
• Revised Childhood Experiences Questionnaire, which is
  a semi-structured interview
• Family History
• Revised Family History Questionniare
• Symptomatology Associated with BPD
• Dissociative Experiences Scale and the Dysphoric Affect
  Scale
• Global Outcome At Follow-up (2 and 4
  years)
• The Global Assessment of functioning scale
• Psychosocial functioning assessed with the Revised
  Borderline Follow-up Interview
                     Results
• Participants: 290 BPD, 72 at least one other Axis
  2 disorder (control).
            Nonborderline    Borderline
    Trait   Mean     SD     Mean    SD     Sig
     N      26.33    7.9    35.07   7.0   p<.001
     E      25.66    6.7    22.59   6.9   p<.001
     O      30.51    6.6    29.80   6.6    ns
     A      32.68    6.5    30.35   6.7   p<.01
     C      28.59    7.4    28.56   7.7    ns
         Regression analysis
• N seemed to be the largest differentiation
  between borderline and non-borderline patients.
• C was the only other sig. factor but suggests that
  it is a suppressor, in that high levels of C
  removes an unwanted portion of the variance in
  the N variable.
• FFM captures a sizable proportion of the
  variance associated with a borderline diagnosis.
• But what about the rest of the diagnostic
  variance?
       More than personality?
• There were aspects within the 4 sections of the DIB-
  R that weren’t fully captured by the NEO-FFI.
  Impulse action patterns were the least represented.
• But correlation with measures of BPD showed that
  the NEO-FFI representation explained a sig.
  proportion of the historical and outcome variables.
• But also history of sexual abuse was related to BPD
  diagnosis in a way not fully captured by the NEO-
  FFI.
• FFM factors were more highly associated with long
  term outcome than elements of BPD that were
  independent of these factors.
                     IN CONCLUSION
1.    Diagnosis BP related to FFM
•     N scores elevated compared other patients PD’s.
•     C discriminated BPD from other PD’s but limited effect.
2.    FFM did NOT capture all definitional aspects of BPD
•     DBI-R four section – all included aspects not represented by FFM. Affect
      section best explained (N) but impulsive actions least explained.
3.   Diagnostic elements independent FFM are valid elements of the disorder
      and are associated with theoretically important correlates (antecedent,
      concurrent and predictive) of the disorder not error variance.

       “N as a characteristic level of personality dysfunction... is almost
                     ubiquitous within clinical populations”
                                      BUT
      Residual elements represent theoretically viable aspects of BPD

               DISTINCTION DISORDER (BPD) AND TRAIT (N)
 BPD disorder that changes in severity over time whereas N reflects a stable trait.
•    N represents estimate of LT outcome
•    Disorder representing meaningful predictors within certain sectors in
     response to the situation e.g. symptom severity.

				
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posted:4/10/2012
language:English
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