Borderline psychopathology in the first-degree relatives of borderline and axis II comparison probands

The purpose of this study was to assess the prevalence of each of the nine DSM criteria for borderline personality disorder and the prevalence of the disorder itself in the first-degree relatives of borderline probands and Axis II comparison subjects. Four hundred and forty-five inpatients were interviewed about familial borderline psychopathology using the Revised Family History Questionnaire--a semistructured interview of demonstrated reliability. Of these 445 subjects, 341 met both DIB-R and DSM-III-R criteria for BPD and 104 met DSM-III-R criteria for another type of personality disorder (and neither criteria set for BPD). The psychopathology of 1,580 first-degree relatives of borderline probands and 472 relatives of Axis II comparison subjects was assessed. Both DSM-III-R and DSM-IV BPD were found to be more common among the relatives of borderline than Axis II comparison probands. However, five of the criteria for BPD (inappropriate anger, affective instability, paranoia/dissociation, general impulsivity, and intense, unstable relationships) and all four sectors of borderline psychopathology (affect, cognition, impulsivity, and interpersonal relationships) were found to be both more common and discriminating than the BPD diagnosis itself. Taken together, the results of this study suggest that the subsyndromal phenomenology of BPD may be more common than the borderline diagnosis itself.     

Aloneness and borderline psychopathology: the possible relevance of child development issues.

The experience of intense painful aloneness is a common event in the lives of borderline patients, especially those closer to the psychotic spectrum. This experience is defined as an intrinsic aspect of the borderline personality defect and consists of a relative or total inability to remember positive images or fantasies of sustaining people in the patient's present or past life, or being overwhelmed by negative memories and images of these people. The development of borderline aloneness is related to a possible developmental failure, defined by Piaget, Fraiberg, and A.-M. Sandler. These workers describe the child's development of object permanence and evocative memory capacity (Piaget's sensori-motor stage VI). We postulate that a major borderline vulnerability is the tenuous achievement of the capacity for affective object permanence and its regressive loss to recognition memory or earlier when under specific stresses. We relate our hypotheses to possible empathic parental failures during the substages of separation-individuation, especially the rapprochement sub-phase. The treatment implications of our formulations are discussed, with an emphasis on the clarification of the need for the therapist's availability and the use of transitional objects during times of the patient's loss of his affective cognitive capacities. These regressive experiences often emerge as a core transference manifestation during psychoanalytic therapy with borderline patients, and often become the basis of significant therapeutic work.     

The nature of borderline personality disorder: multiple dimensions, multiple symptoms, but one category

Borderline personality disorder (BPD) is a multidimensional syndrome that is not rooted in a single diathesis. Each of its features (affective instability, impulsivity, unstable relationships, and cognitive defects) reflects different diatheses. BPD differs from other Axis II disorders in its high level of symptoms, but is not a variant of an Axis I disorder and is difficult to describe through dimensional traits. This review suggests that BPD needs to be diagnosed with a narrower set of criteria that cover all of its domains. In the long run, the disorder will need to be redefined on the basis of its etiology and pathogenesis.     

The psychopathology of nostalgia

Nostalgia is distinguished from depression, of which it was originally considered a variant. It is described as a pleasurable affect involving warm memories of the past. For nostalgia to be normal, it must contain a depressive component that is related to the recognition that the past is irrevocable. In its pathological form, the mood contains only the elated aspects without the acceptance of loss, or what could be described as bittersweet sentiment. The pathological form serves mainly denial and functions like a screen affect. I have attempted to show how particular developments play a role in pathological nostalgia, namely, screen affects, ego ideal formation, and rescue and family romance fantasies. The patients that were described enlisted their nostalgic pursuits as a way of remaining close to the past. These pursuits served both a defensive function, as a way of avoiding the humiliation of oedipal and later defeats, as well as offering them instinctual gratification through fantasy.     

On the nature of attachment in a borderline population: a preliminary investigation

Analyses of interpersonal behavior within a borderline population usually focus on object relations variables. In contrast, this preliminary research focuses on the nature of attachment styles and its relation to behavioral pathology. 24 hospitalized borderline patients were administered an Attachment Style Inventory and Millon Clinical Multiaxial Inventory. Analysis confirms predicted differences in attachment style between the borderline and normal control samples as well as indicates that a dependent style of attachment within this borderline sample is associated with less pathology than an avoidant, hostile, or resistant/ambivalent style. The implications of this preliminary work for full-scale research are addressed.     

Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD): a continuous measure of DSM-IV borderline psychopathology

The purpose of this study was to assess the psychometric properties of the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD), the first clinician-administered scale for the assessment of change in DSM-IV borderline psychopathology. The questions for the measure were adapted from the BPD module of the Diagnostic Interview for DSM-IV Personality Disorders (DIPD-IV) to reflect a 1-week time frame and each of the nine criteria for BPD is rated on a five-point anchored rating scale of 0 to 4, yielding a total score of 0 to 36. Two diagnostic interviews that assess the presence of BPD were administered to 200 nonpsychotic patients: the BPD module of the DIPD-IV and the Revised Diagnostic Interview for Borderlines (DIB-R). The ZAN-BPD was also administered, blind to diagnostic information. In addition, each patient filled out a self-report measure of general psychopathology that is often used in borderline treatment studies, the Symptom Checklist 90 (SCL-90). The convergent validity of the ZAN-BPD and relevant scales of the SCL-90 and the DIB-R was assessed and found to be highly significant. The discriminant validity of the various scores of the ZAN-BPD was also found to be highly significant, easily discriminating the 139 patients who met the DSM-IV criteria for BPD from the 61 patients who did not. In addition, internal consistency of the ZAN-BPD was found to be high (Cronbach's alpha=0.85). The interrater reliability of the ZAN-BPD was assessed using 32 conjoint interviews, while same day test-retest reliability was assessed in a separate sample of 40 patients. All reliability raters were blind to all previously collected information concerning each subject. All intraclass correlations were in the good to excellent range. Finally, the sensitivity of the ZAN-BPD to change was assessed using a third sample of 41 patients who were reinterviewed by a blind rater 7 to 10 days after the ZAN-BPD was first administered. The SCL-90 was also readministered at this time. The correlations between difference scores of the ZAN-BPD and difference scores of the SCL-90 were found to be significant, indicating that the ZAN-BPD measures change in a clinically meaningful manner. Taken together, the results of this study suggest that the ZAN-BPD is a promising clinician-administered scale for the assessment of change in borderline psychopathology over time.     

The borderline syndrome in adolescents

The borderline adolescent is discussed in terms of diagnostic perspectives, characteristic features based on disturbed object relations, and treatment. The disorder is not fully manifest in adolescence but gradually emerges into a definable personality type, the various features of which express the unsatisfactory outcome of a complex psychodynamic struggle related to developmental arrests in psychic structure. Based on clinical observations, the diagnosis of borderline personality, like the schizoid personality, is considered to be compatible with a past, present or future schizophrenic disorder. Finally, therapeutic approaches in a day-treatment program, and individual therapy is considered from a developmental object relations viewpoint.     

The borderline diagnosis and integration of self

To try to encompass what is meant by borderline with parameters that are too delineating can lead to conceptual difficulties and confusion for several reasons: The human psyche is too complex and probably has too much of the quality of a gestalt to be understood adequately by dichotomizing thinking; an individual does not experience himself as operating in discrete units, but as a unified whole; and the most characteristic manifest quality of the borderline picture is its tendency toward a chaotic functioning that somehow always spills over any defining boundaries which are set up to attain conceptual containment. If we then accept our limitations on the precision and order with which we can comprehend it, the understanding of borderline might be supplemented by seeing it in terms of the subjective experience of an integrated self. This offers a more holistic approach that tends not to be so subject to objectifying compartmentalization. It is more in tune with the subjective experiencing a person has of that which defines and moves him in the world. And it offers a referent axis along which the distance one has traveled in the borderline direction might be gleaned. Finally, the relationship of the borderline diagnosis to character disorder might be looked this way: The diagnosis does not refer to a particular character disorder or to a group of disorders. It emerges in all character pathology to the degree that the experiencing of an integrated and whole sense of self, which is at the heart of character structure, is diminished.     

The difficulty of understanding a borderline patient

SUMMARY

For much of the time during my work with Mr A, a borderline patient whom I saw for twice-weekly psychotherapy over a period of one year. I had difficulty understanding and communicating with him. I felt despairing and impotent and that therapy was not progressing at all. A few weeks prior to termination a shift occurred and I realised that there had been some improvement in Mr A's functioning. Although I was aware that behind the polite façade was an angry, disturbed man, I felt that he was a little more in touch with reality than he had been at the beginning of the treatment.

In this paper I will focus on the factors that contributed to my difficulty in understanding and communicating with Mr A. I will also attempt to account for his apparent improvement.     

道德与自然:"形上之道"与"形而上学"的本质区别

Both thinkings on Dao in Chinese philosophy and metaphysics in Western philosophy investigate things on a spiritual level that transcends experience, but there are incommensurable differences between them. The objective of “metaphysics” is ontological knowledge about nature from the perspective of epistemological “truth-pursuing”. Western metaphysics is thus a “metaphysics of nature”. Dao in Chinese philosophy, on the other hand, more often manifests itself in “good-pursuing” by means of the internal, experiential pursuit of moral stature and spiritual security. Philosophy of Dao is thus a “metaphysics of ethics”. The cause of this difference can be traced back to the differences between the rational tradition of the West, characterized by the dualism of the subject and the object, and the moral tradition of China, characterized by the integration of man and nature. __________ Translated by Zhang Lin from Lunlixue yanjiu 伦理学研究 (Studies in Ethics), 2007, (4): 62–65