Abbasyia Journal Club

1. ‫‪BORDE RLINE‬‬
‫‪PE RS ONA LITY: DIS ORDE R‬‬
‫‪?What‘s new‬‬
‫د/ نشأت عبد ربه ملك‬
‫استشاري الطب النفسي بمستشفى الصحة النفسية‬
‫بالعبـــــــــــاسية‬

2. Let‘s remember:
DSM-IV-TR diagnostic criteria for borderline
personality disorder
A pervasive pattern of instability of interpersonal
relationships, self-image, and affects:
(1) frantic efforts to avoid real or imagined
abandonment.
(2) a pattern of unstable and intense interpersonal
relationships characterized by alternating
between extremes of idealization and devaluation
(3)markedly and persistently unstable self-image or
sense of self

3. :Diagnostic criteria
(4) impulsivity (e.g., spending, sex, substance
abuse, reckless driving, binge eating).
(5) recurrent suicidal behavior, gestures, or threats,
or self-mutilating behavior
(6) affective instability due to a marked reactivity of
mood (e.g., intense episodic dysphoria,
irritability, or anxiety)
(7) chronic feelings of emptiness
(8) inappropriate, intense anger or difficulty
controlling anger
(9) transient, stress-related paranoid ideation or
severe dissociative symptoms

4. Treatment of borderline pers onality
dis order
 Psychodynamic individual psychotherapy.
 Supportive individual psychotherapy.
 Cognitive-behavioral or schema-focused psychotherapy
 Dialectical behavior therapy.
 Interpersonal psychotherapy.
 Family psychoeducation.
 Antidepressant medications SSRIs (for affective
dysregulation & impulsivity)
 Atypical antipsychotic medications (psychotic-
like features)
 Anticonvulsant medications
(APA Textbook of Psychiatry, 5th ed., 2008)

5. B orderline Pers onality Dis order:
Ontogeny of a Diagnos is
 Before 1970unders on, 2009) colloquialism
( G : psychoanalytic
for untreatable neurotics.
 1970–1980: From Personality
Organization to Syndrome: “An Adjective
in Search of a Noun”
 1980–1990:From Syndrome to
Personality Disorder: “Wisdom Is Never
Calling a Patient Borderline”
 1990–2000: From Unwanted Personality
Disorder to Disorder-Specific Treatability:
“Would the Patient Be Borderline If She
Remitted From a Medication?”
 2000–2009: Borderline Personality
Disorder: “A Good-Prognosis Brain
Disease”?

6. Conclusions
 Bo. Per. D is a valid diagnosis with
significant heritability and with
specific and effective
psychotherapeutic treatments.
 Increased awareness involving much
more education and research is still
needed.
 Psychiatric institutions, professional
organizations, public policies, and
reimbursement agencies need to
prioritize this need.

7. Prospective Predictors of Suicidal
Behavior in Borderline Personality
Disorder at 6-Year F-U
(Soloff & Chiappetta, 2012).
Most patients achieve remission of suicidal
behavior over time, as many as 10% die by
suicide, raising the question of whether
there is a high-risk suicidal subtype??

8. Prospective Predictors of Suicidal
Behavior in Borderline Personality
Disorder at 6-Year F-U
(Soloff & Chiappetta, 2012).
Results:
Among 90 participants, 25 (27.8%) made at least
one suicide attempt in the interval, and most
attempts occurred in the first 2 years. The risk of
suicide attempt was increased by:
3. low socioeconomic status,
4. poor psychosocial adjustment,
5. family history of suicide,
6. previous psychiatric hospitalization.

9. Prospective Predictors of Suicidal
Behavior in Borderline Personality
Disorder at 6-Year F/U
(Soloff & Chiappetta, 2012).
Conclusions:
 Risk factors predictive of suicide attempt change
over time.
 Acute stressors such as major depressive
disorder were predictive only in the short term
(12 months).
 Poor psychosocial functioning had persistent and
long-term effects on suicide risk.
 Half of borderline patients have poor psychosocial
outcomes despite symptomatic improvement.
 A social and vocational rehabilitation model of
treatment is needed to decrease suicide risk and
optimize long-term outcomes.

10. Attainment and Stability of Sustained
Symptomatic Remission and Recovery Among
Patients With Borderline Personality Disorder
and Axis II Comparison Subjects: A 16-Year
Prospective Follow-Up Study ( Zanarini et al,
2012 )
OBJECTIVE:
To determine time to attainment of
symptom remission and to recovery
lasting 2, 4, 6, or 8 years among patients
with borderline personality disorder and
comparison subjects with other
personality disorders and to determine
the stability of these outcomes.

11. Attainment and Stability of Sustained
Symptomatic Remission and Recovery Among
Patients With Borderline Personality Disorder
and Axis II Comparison Subjects
 METHOD:
 A total of 290 inpatients with borderline
personality disorder and 72 comparison
subjects with other axis II disorders were
assessed during their index admission using a
series of semi-structured interviews, which
were administered again at eight successive 2-
year follow-up sessions.

12. Conclusion:
 Borderline patients were significantly slower to
achieve remission or recovery (which involved
good social and vocational functioning as well
as symptomatic remission) than axis II
comparison subjects.
 Sustained symptomatic remission is
substantially more common than sustained
recovery from borderline personality disorder
and that sustained remissions and recoveries
are substantially more difficult for individuals
with borderline personality disorder to attain
and maintain than for individuals with other
forms of personality disorder.