The Collaborative Longitudinal Personality Disorders Study: baseline Axis I/II and II/II diagnostic co-occurrence.

Objective: To describe baseline diagnostic co-occurrence in the Collaborative Longitudinal Personality Disorders Study.

Method: Six hundred and sixty-eight patients were reliably assessed with diagnostic interviews for DSM-IV Axis I and II disorders to create five groups: Schizotypal (STPD), Borderline (BPD), Avoidant (AVPD), Obsessive-Compulsive (OCPD) and Major Depressive Disorder (MDD) without personality disorder (PD).

Results: Mean number of Axis I lifetime diagnoses was 3.

Biparental failure in the childhood experiences of borderline patients.

The purpose of this study was to assess the role of biparental abuse and neglect in the development of borderline personality disorder (BPD). A semistructured research interview was used to blindly assess the childhood experiences of biparental abuse and neglect reported by 358 borderline inpatients and 109 axis II controls. Eighty-four percent of borderline patients reported having experienced some type of biparental abuse or neglect before the age of 18; 55% reported a childhood history of biparental abuse; 77% reported a childhood history of biparental neglect.

The dissociative experiences of borderline patients.

The study objective was to assess the severity and quality of dissociative experiences reported by borderline patients. Two hundred ninety criteria-defined borderline patients and 72 axis II controls completed the Dissociative Experiences Scale (DES), a 28-item self-report measure with demonstrated reliability and validity. Thirty-two percent of borderline patients had a low level of dissociation, 42% a moderate level, and 26% a high level similar to that reported by patients meeting criteria for posttraumatic stress disorder (PTSD) or dissociative disorders.

Childhood experiences associated with the development of borderline personality disorder.

In time, mental health professionals will understand the etiology of BPD more fully. Although enormous strides have been made in the past decade, research into the multifactorial basis of BPD is still in its infancy. In particular, studies of children at high risk for developing BPD are needed.

Co-occurrence of mood and personality disorders: a report from the Collaborative Longitudinal Personality Disorders Study (CLPS).

The purpose of this study was to examine the relationship of subtypes and particular clinical features of mood disorders to co-occurrence with specific personality disorders. Five hundred and seventy-one subjects recruited for the Collaborative Longitudinal Personality Disorders Study (CLPS) were assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and the Diagnostic Interview for DSM-IV Personality Disorders (DIPD-IV). Percent co-occurrence rates for current and lifetime mood disorders with personality disorders were calculated.

Risk factors associated with the dissociative experiences of borderline patients.

The objective of this study was to identify the risk factors associated with the dissociative symptomatology of borderline patients. The Dissociative Experiences Scale--a 28-item self-report measure that has well documented reliability and validity--was administered to 290 criteria-defined borderline patients and 72 axis II comparison subjects. Semistructured interviews pertaining to difficult childhood experiences and adult experiences of being a victim of violence were administered to these patients blind to diagnostic status.

The pain of being borderline: dysphoric states specific to borderline personality disorder.

The objective of this study was to identify the dysphoric states that best characterize patients meeting criteria for borderline personality disorder and distinguish them from those in patients with other forms of personality disorder. One hundred forty-six patients with criteria-defined borderline personality disorder and 34 Axis II controls filled out the Dysphoric Affect Scale, a 50-item self-report measure that was designed for this purpose and has good internal consistency and test-retest reliability. Twenty-five dysphoric states (mostly affects) were found to be significantly more common among borderline patients than controls but nonspecific to borderline personality disorder.

Violence in the lives of adult borderline patients.

The purpose of this study was to assess the experiences of adult violence reported by a sample of criteria-defined borderline patients and axis II controls. The experiences of having had a physically abusive partner and/or having been raped reported by 362 personality-disordered inpatients were assessed blind to diagnostic status using a semistructured research interview. Forty-six percent of borderline patients reported having been a victim of violence since the age of 18.

Axis I comorbidity of borderline personality disorder.

Objective: The purpose of this study was to assess the lifetime rates of occurrence of a full range of DSM-III-R axis I disorders in a group of patients with criteria-defined borderline personality disorder and comparison subjects with other personality disorders.

Method: The axis I comorbidity of 504 inpatients with personality disorders was assessed by interviewers who were blind to clinical diagnosis and who used a semistructured research interview of demonstrated reliability.

Results: Four new findings emerged from this study.

Axis II comorbidity of borderline personality disorder.

The purpose of this study was to assess the prevalence of a full range of DSM-III-R axis II disorders in a sample of criteria-defined borderline patients and axis II controls. The axis II comorbidity of 504 personality-disordered inpatients was assessed blind to clinical diagnosis using a semistructured research interview. Odd, anxious, and dramatic cluster disorders were each common among borderline patients.

Clozapine and body mass change.

Background: Patients treated with clozapine have been reported to gain weight. We hypothesized that patients would also experience an increase in body mass, which can be more directly related to cardiovascular morbidity.

Methods: Forty-two patients who had been treated with clozapine for at least 1 year were weighed and measured, and waist-hip ratios (WHR) and body mass index (BMI), measured as kg/m2, were calculated.

Reported pathological childhood experiences associated with the development of borderline personality disorder.

Objective: The purpose of this study was to assess a full range of pathological childhood experiences reported by patients with criteria-defined borderline personality disorder and comparison patients with other personality disorders.

Method: The pathological childhood experiences reported by 467 inpatients with personality disorders were assessed by interviewers who used a semistructured research interview and were blind to clinical diagnosis.

Results: Of the 358 patients with borderline personality disorder, 91% reported having been abused, and 92% reported having been neglected, before the age of 18.

Pathways to the development of borderline personality disorder.

The available empirical evidence concerning the etiology of borderline personality disorder is reviewed. A tripartite model of the development of BPD is then presented. This model has three elements: a traumatic childhood (broadly defined), a vulnerable (hyperbolic) temperament, and a triggering event or series of events.

Childhood antecedents of self-destructiveness in borderline personality disorder.

Objective: To assess the relationship between lifetime patterns of self-destructive behaviour and various parameters of childhood abuse and neglect in patients with borderline personality disorder (BPD) compared with other personality disorder (OPD) controls.

Method: The subjects were 42 inpatients with the diagnosis of BPD and 17 OPD controls. Lifetime patterns of self-destructive behaviour were assessed using the Lifetime Borderline Symptom Index.

DSM-IV antisocial personality disorder field trial.

The development of the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) included 12 field trials to assess proposed revisions. This article provides results from the antisocial personality disorder (APD) field trial that was conducted to obtain data of relevance to the proposals for simplification and for the inclusion of more traditional traits of psychopathy. Provided herein are the results from 4 sites that had sampled from populations of particular relevance to the diagnosis of APD (i.

Uses of clozapine in nonschizophrenic patients.

Clozapine is a novel antipsychotic agent used in the treatment of schizophrenic patients who have not responded to or have been unable to tolerate conventional neuroleptic therapy. In this paper, the literature surveying the uses of clozapine in the treatment of patients with nonschizophrenic illnesses, in particular psychotic affective disorders (bipolar disorder and schizoaffective disorder), will be reviewed. (A Medline search was done for all papers concerning clozapine; those that represented major contributions to the literature were used.

Comparison of American and Japanese outpatients with borderline personality disorder.

The borderline psychopathology of 33 American and 19 Japanese female outpatients who met the Revised Diagnostic Interview for Borderlines (DIB-R) criteria for borderline personality disorder (BPD) was compared. There were significant differences between the samples in the DIB-R total score, as well as in the affect/cognition section and scaled section scores. However, only one of the 22 summary statements (SS) of the DIB-R distinguished American borderlines from Japanese borderlines.

Emotional hypochondriasis, hyperbole, and the borderline patient.

The authors define a new defense mechanism, emotional hypochondriasis, that is hypothesized to be central to borderline psychopathology. The behavioral manifestation of this defense-the hyperbolic stance of the borderline patient-is also defined and related to the complex phenomenology of borderline personality disorder. Borderline patients are seen as making an active attempt to maintain a tolerable, if tenuous, adaptation in the face of tremendous subjective emotional pain that has been shaped in large measure by traumatic childhood events that have never been validated.

Clozapine treatment of borderline patients: a preliminary study.

Clinicians frequently encounter patients who present with borderline personality disorder (BPD) and prolonged and/or pronounced psychotic symptoms of an atypical nature. Fifteen such patients were treated with clozapine and rerated blind to baseline symptomatology and functional level from 2 to 9 months after beginning treatment (mean = 4.2 +/- 2.

The face validity of the DSM-III and DSM-III-R criteria sets for borderline personality disorder.

Objective: The main objective of this study was to determine the congruence between DSM-III and DSM-III-R diagnoses of borderline personality disorder derived through the use of semistructured research interviews or given by experienced clinicians after lengthy consultations with an interdisciplinary team.

Method: The presence of the DSM-III and DSM-III-R criteria sets for borderline personality disorder was assessed in a study group of 253 patients with personality disorders (148 inpatients and 105 outpatients) by raters who were blind to clinical diagnoses and who used information from two semistructured interviews of proven reliability. These diagnoses were then compared with "longitudinal expert all data" (LEAD) standard clinical diagnoses provided by therapists specifically asked to base their diagnoses on DSM criteria.

Discriminating borderline personality disorder from other axis II disorders.

The authors used the Revised Diagnostic Interview for Borderline Patients to assess 22 clinical features of 120 patients with borderline personality disorder and 103 control subjects with other axis II disorders. Four of the 22 features were common in but nondiscriminating for borderline disorder, 11 were discriminating for but nonspecific to borderline disorder, and seven were more specific to borderline disorder. The authors conclude that many clinical features thought to be indicative of borderline disorder are better viewed as personality disorder traits and that the seven more specific features, alone or in conjunction with one another, may be particularly useful markers for borderline personality disorder.

Axis II comorbidity of normal-weight bulimia.

The axis II comorbidity of 34 women with active bulimia, 18 women with remitted bulimia, and 20 women with a history of major depression was assessed blind to axis I diagnosis using the Diagnostic Interview for Personality Disorders (DIPD), a semistructured interview of demonstrated reliability. Fifty percent of the active bulimic subjects, 44% of the remitted bulimic subjects, and 35% of the depressed controls met DSM-III criteria for at least one axis II disorder. Despite the generally higher prevalence of axis II pathology in both bulimic groups than depressed controls, these between-group differences did not reach significance.

Cognitive features of borderline personality disorder.

Of 50 patients with borderline personality disorder, 100% reported disturbed but nonpsychotic thought, 40% (N = 20) reported quasi-psychotic thought, and none reported true psychotic thought during the past 2 years; only 14% (N = 7) reported ever experiencing true psychotic thought. Disturbed and quasi-psychotic thought was significantly more common among these patients than among patients with other axis II disorders or schizophrenia and normal control subjects; however, true psychotic thought was significantly more common among schizophrenic patients. While disturbed thought was also common among axis II disorder and schizophrenic patients, quasi-psychotic thought was reported by only one of these subjects, suggesting that quasi-psychotic thought may be a marker for borderline personality disorder.

Axis I phenomenology of borderline personality disorder.

The Axis I phenomenology of 50 outpatients meeting both Diagnostic Interview for Borderlines (DIB) and DSM-III criteria for Borderline Personality Disorder (BPD), 29 outpatients meeting DSM-III criteria for Antisocial Personality Disorder (APD), and 26 outpatients meeting DSM-III criteria for Dsythymic Disorder as well as DSM-III criteria for some other type of Axis II disorder (dysthymic OPD) was assessed blind to clinical diagnosis using the Structured Clinical Interview for DSM-III (SCID). Borderlines were significantly more likely than antisocial controls to have met DSM-III criteria for an affective disorder, particularly Dysthymic Disorder, and an anxiety disorder. They were also significantly more likely than dysthymic OPD controls but significantly less likely than antisocial controls to have met DSM-III criteria for alcohol abuse/dependence and drug abuse/dependence.