scholarly journals The case for cautious paternalism in the emergency management of patients with borderline personality disorder

2021 ◽  
pp. 1-3
Author(s):  
Giles Newton-Howes
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Sense Of Self ◽  
Well Being ◽  
Modern Medicine ◽  
Medical Intervention ◽  
Borderline Personality ◽  
Emotional Instability ◽  
Potential Threat ◽  
Patient’S Will

Summary Principlism is the dominant ethical theory in modern medicine. Autonomy is ‘king’ of the principles espoused and operationalised in consent. Consent is the mechanism by which all medical interactions occur. In borderline personality disorder (BPD) there is often a diffuse sense of self, emotional instability and impulsivity that can lead to medically dangerous non-suicidal self-injury, acute medical intervention and then a withdrawal of consent while the potential threat to the person's well-being remains high. Claims of lack of capacity lack veracity, and simply acting against the patient's will may be illegal. Understanding the will and preferences of patients is a step forward, but it is not always possible in time-sensitive situations. A cautious paternalism is therefore warranted both to ensure the patient's well-being while being honest as to the reasons for this, and to possibly build epistemic trust between the medical system and the patient with BPD.

scholarly journals The Statistical Specificity of Emotion Dynamics in Borderline Personality Disorder

2021 ◽  
pp. 1-22
Author(s):  
Marlies Houben ◽  
Merijn Mestdagh ◽  
Egon Dejonckheere ◽  
Jasmien Obbels ◽  
Pascal Sienaert ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Major Depressive Episode ◽  
Well Being ◽  
Borderline Personality ◽  
Emotional States ◽  
Emotional Instability ◽  
Control Groups ◽  
Major Depressive ◽  
Emotion Dynamics

Persons with borderline personality disorder (BPD) experience heightened emotional instability. Different components underlie instability, and the relation between instability and well-being could be confounded by average emotionality and within-person standard deviation across emotional states, reflecting variability. Therefore, the goal was to examine which pattern of emotion dynamics parsimoniously captures the emotional trajectories of persons with BPD. Forty persons with BPD, 38 clinical controls in a major depressive episode, and 40 healthy controls rated the intensity of their emotions 10 times a day for 1 week. After correction for differences in average emotionality, persons with BPD showed heightened emotional instability compared to both control groups. When additionally correcting for emotional variability, the authors found that instability indices did not differ between groups anymore. This shows that persons with BPD differ from control groups in the magnitude of emotional deviations from the emotional baseline, and not necessarily in the degree of abruptness of these deviations.

scholarly journals Experiences of Compassion in Adults With a Diagnosis of Borderline Personality Disorder: An Interpretative Phenomenological Analysis

2021 ◽  
pp. 003329412110006
Author(s):  
Stephanie Fagan ◽  
Suzanne Hodge ◽  
Charlotte Morris
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Interpretative Phenomenological Analysis ◽  
Sense Of Self ◽  
Phenomenological Analysis ◽  
Borderline Personality ◽  
Adverse Impact ◽  
Empathic Understanding ◽  
Therapeutic Encounters

The study explored experiences of compassion in adults with a diagnosis of Borderline Personality Disorder (BPD) to further the development of the construct of compassion in relation to BPD. Interpretative Phenomenological Analysis was used to develop themes from the narratives of six adults with a diagnosis of BPD. Five themes emerged: Emotional Connection to Suffering, Empathic Understanding, Prioritisation of Needs, A Model of Genuine Compassion and Developing Acceptance and Worth. Participants described the role of compassion in their difficulties, including the adverse impact of experiences of incompassion upon their sense of self. The themes were integrated into a model that highlighted a process of recovery through therapeutic encounters with others in which genuine compassion was modelled. In addition, barriers to compassion and factors facilitating the development of compassion emerged from the analysis and have implications for clinical practice.

Telehealth Treatment of Patients With Borderline Personality Disorder in a Partial Hospital Setting During the COVID-19 Pandemic: Comparative Safety, Patient Satisfaction, and Effectiveness of In-Person Treatment

2021 ◽  
pp. 1-19
Author(s):  
Mark Zimmerman ◽  
Madeline Ward ◽  
Catherine D'Avanzato ◽  
Julianne Wilner Tirpak
Keyword(s):  
Patient Satisfaction ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Psychiatric Treatment ◽  
Well Being ◽  
Borderline Personality ◽  
Hospital Treatment ◽  
Level Of Care ◽  
Hospital Level ◽  
Partial Hospital

There are no studies of the safety and effectiveness of telehealth psychiatric treatment of partial hospital level of care, in general, and for borderline personality disorder (BPD) in particular. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, the authors compared the effectiveness of their partial hospital treatment program in treating patients with BPD. For both the in-person and telehealth partial hospital level of care, patients with BPD were highly satisfied with treatment and reported a significant reduction in symptoms from admission to discharge. Both groups reported a significant improvement in functioning, coping ability, positive mental health, and general well-being. A large effect size of treatment was found in both treatment groups. No patients attempted suicide. Telehealth partial hospital treatment was as effective as in-person treatment in terms of patient satisfaction, symptom reduction, and improved functioning and well-being for patients with BPD.

scholarly journals Metacognitive Interpersonal Therapy for Borderline Personality Disorder: A Single Case Study

2020 ◽  
Vol 20 (1) ◽  
pp. 56-74
Author(s):  
Giampaolo Salvatore ◽  
Lorena Bianchi ◽  
Luisa Buonocore ◽  
Nadia Disturco ◽  
Angus Macbeth ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Emotion Dysregulation ◽  
Single Case ◽  
Sense Of Self ◽  
Severe Disease ◽  
Borderline Personality ◽  
Interpersonal Therapy ◽  
Metacognitive Interpersonal Therapy

Borderline personality disorder (BPD) is a severe disease, characterized by severe instabilities in identity, affect and relationships. Clinical improvement of BPD can be facilitated by psychotherapy aimed at tackling multiple specific cross-modality impairments and their patterns of interaction: impaired sense of self, maladaptive interpersonal schemas, impaired metacognition, emotion dysregulation and impulsivity. Herein, we describe the steps in the treatment of a young woman meeting the criteria for with BPD with paranoid traits, successfully treated with Metacognitive Interpersonal Therapy, a treatment based on comprehensive assessment of domains. In the initial phase, treatment focused on promoting emotion regulation, integrating opposing patient representations of the therapist, enhancing metacognition, and increasing focus on the maladaptive schema that elicited dysregulated behaviors. Later in therapy, treatment focused on supporting the patient to realize her ideas about self and others were schema-driven; and improving metacognitive capacity to understand others’ minds. General implications for psychotherapy of BPD are discussed.

Having a diagnosis of borderline personality disorder in a forensic setting: a qualitative exploration

2014 ◽  
Vol 16 (3) ◽  
pp. 228-240 ◽  
Author(s):  
Lucy Jade Lovell ◽  
Gillian Hardy
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Lived Experience ◽  
Interpretative Phenomenological Analysis ◽  
Sense Of Self ◽  
Borderline Personality ◽  
Power Dynamics ◽  
Structured Interviews ◽  
Content Type ◽  
Forensic Setting

Purpose – The purpose of this paper is to explore the lived experience of having a diagnosis of Borderline Personality Disorder (BPD) in a forensic setting. Design/methodology/approach – Semi-structured interviews were conducted with eight women with a diagnosis of BPD in private secure units. The interview data were analysed using interpretative phenomenological analysis (IPA). Findings – Four main themes emerged: identity, power, protection and containment, and confusion. The themes of identity, power and protection and containment represented polarised positions which in turn contributed to the theme of confusion. Research limitations/implications – There are limitations to this study mainly the heterogeneous nature of the sample. However, good quality control and the similarities with previous findings indicate that this study makes a valuable contribution to the understanding of BPD in a forensic setting. In addition it has implications for further research; exploring sense of self and the differences between a sample from a community and a sample from a forensic setting with a diagnosis of BPD. Practical implications – For practitioners to acknowledge power dynamics and to be able to formulate and address these with patients with a diagnosis of BPD. Originality/value – This is the first IPA study to ask women with a diagnosis of BPD in a forensic setting what their experience is. It is a qualitative study due to the need to genuinely explore the topic and to provide a basis for others to conduct further research.

Mindfulness and Emotional Well-being in Women with Borderline Personality Disorder

Mindfulness ◽  
2011 ◽  
Vol 3 (2) ◽  
pp. 117-123 ◽  
Author(s):  
Siobhan K. O’Toole ◽  
Eric Diddy ◽  
Mark Kent
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Well Being ◽  
Borderline Personality

scholarly journals Child abuse potential in mothers with early life maltreatment, borderline personality disorder and depression

2018 ◽  
Vol 213 (1) ◽  
pp. 412-418 ◽  
Author(s):  
Katja Dittrich ◽  
Katja Boedeker ◽  
Dorothea Kluczniok ◽  
Charlotte Jaite ◽  
Catherine Hindi Attar ◽  
...  
Keyword(s):  
Child Abuse ◽  
Emotion Regulation ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Early Life ◽  
Child Psychopathology ◽  
Well Being ◽  
Borderline Personality ◽  
Abuse Potential ◽  
History Of

BackgroundEarly life maltreatment (ELM), borderline personality disorder (BPD) and major depressive disorder (MDD) have been shown to increase the potential of abuse. Emotion regulation is an identified mediator for the association of ELM and BPD with abuse potential. Until now, there has been no study to account for the co-occurrence of these risk factors in one analysis, although BPD and MDD are known as common sequelae of ELM. This is paired with a lack of studies investigating the effects of abuse potential on child well-being.AimsOur study aims at (a) disentangling the effects of maternal ELM, MDD and BPD on abuse potential; (b) exploring the role of emotion regulation as a mediator; and (c) testing for intergenerational effects of abuse potential on child psychopathology.MethodThe research design included 114 mothers with/without ELM, BPD and MDD in remission and their children, all of which were between 5 and 12 years of age. A path analysis was conducted to investigate the multiple associations between our variables.ResultsELM, MDD and BPD were all associated with abuse potential, with emotion regulation acting as a mediator for BPD and MDD. Furthermore, an elevated abuse potential was related to higher psychopathology in the child.ConclusionsHistory of ELM as well as the common sequelae, BPD and MDD, pose risks for child abuse. Our findings suggest improvement of emotion regulation as a potential target for intervention programs. These programs should also aim at non-substantiated cases because even an elevated abuse potential affected child mental health.Declaration of interestNone.

Association between 5-HTTLPR and neuroticism in borderline personality disorder

2011 ◽  
Vol 26 (S2) ◽  
pp. 816-816
Author(s):  
H. Silva Ibarra ◽  
J. Villarroel Garrido ◽  
P. Iturra Constant ◽  
S. Jerez Concha ◽  
M.L. Bustamante Calderon ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Promoter Region ◽  
Correlation Method ◽  
Borderline Personality ◽  
Transporter Gene ◽  
Emotional Instability ◽  
Personality Dimension ◽  
Significant Difference ◽  
Axis I

Neuroticism is characterized by emotional instability and the tendency to experience negative emotions such as anger, anxiety and depressed mood. Subjects with borderline personality disorder (BPD) present this personality dimension as a temperamental core trait. There has been proposed that neuroticism can appropriately describe the most important characteristics of BPD. The polymorphism in the promoter region of the serotonin transporter gene (5-HTTLPR) has been implicated in depression, anxiety and suicide. It is estimated that 5-HTTLPR polymorphism account to 7 to 9% of inherited variance of neuroticism in personality. The aim of this study is to evaluate the association between neuroticism and 5-HTTLPR polymorphism in BPD. We evaluate personality with NEO PI R inventory in 104 BPD subjects (76 female/28 male) that did not meet criteria for axis I diagnoses and other personality disorders. The genetic analysis of 5-HTTLPR were performed determining the presence of long and short alleles, subjects were grouped in long/long (LL) and S-carriers (LS+SS). Statistical analysis were tested with parametric and correlation method with Stata10. We found significant difference in neuroticism between the genotype groups (F = 8.57, p = 0.0004) and lower levels of neuroticism in LL than S-carriers. Female have higher neuroticism than male. 5-HTTLPR polymorphism explains 18.02% of inherited variance in neuroticism. The S-carriers had 11.9 times higher risk of presenting elevated neuroticism compared with LL. We conclude that there are relation between 5-HTTLPR polymorphism and neuroticism in BPD. These results should contribute to the genetic study of BPD.

scholarly journals The Role of Impairments in Self–Other Distinction in Borderline Personality Disorder: A Narrative Review of Recent Evidence

2020 ◽  
Author(s):  
Celine De Meulemeester ◽  
Benedicte Lowyck ◽  
Patrick Luyten
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Sense Of Self ◽  
Borderline Personality ◽  
Task Demands ◽  
Narrative Review ◽  
Integrative Model ◽  
Future Research ◽  
Central Feature ◽  
Self And Other

Impairments in maintaining a differentiated sense of “self” and “other” are thought to be a central feature of borderline personality disorder (BPD). However, studies directly focusing on self–other distinction (SOD) in BPD are scarce, and these findings have not yet been integrated with novel insights into the neural mechanism involved in SOD. Here, we present a narrative review of recent behavioral and neuroimaging findings focusing on impairments in SOD in BPD. Behavioral findings of SOD at the embodied level provide preliminary evidence for impairments in multisensory integration in BPD. Furthermore, both behavioral and neuroscientific data converge to suggest that SOD impairments in BPD reflect an inability to shift between self and other representations according to task demands. Research also suggests that disruptions in infant–caregiver synchrony may play a role in the development of these impairments. Based on these findings, we present a new, integrative model linking impairments in SOD to reduced neural and behavioral synchrony in BPD. The implications of these findings for future research and clinical interventions are outlined.

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