The aim of the study is to investigate how clinicians in psychiatric care for adults consider borderline personality disorder to be manifested in men and women, respectively. Could there be a tendency to over-diagnose women and under-diagnose men? In addition, the purpose of the study is to bring clarity to the reasons for gender differences within borderline personality as perceived by the clinicians. The study is based on an inductive approach, in which interviews have been conducted with twelve clinicians working with borderline personality disorders to gain a deeper understanding of how the clinicians consider the manifestations of gender differences. The clinicians described tendencies for women to deliberate self-harm, have mood swings and problems in relations. Men with borderline personality disorders are described as having a higher degree of e.g. aggressiveness, addiction and criminal behaviour than women with the same diagnosis. Half of the informants think men are under- diagnosed for borderline personality disorders. This may indicate that other diagnoses are given to men instead or that men end up in other treatments. Possible explanations to the gender differences are discussed, such as societal factors, gender roles or criteria for diagnosis based on gender.

Borderline Personality Disorder (BPD), as defined by the DSM-IV-TR (APA, 2000), is a multifaceted mental illness characterized by pervasive instability of interpersonal relationships, self-image, affect and behavior. Despite a growing consensus that the etiological basis of BPD stems from a combination of biological vulnerability and an early developmental history characterized by invalidation, abuse and/or neglect (e.g., Clarkin, Marziali, & Munroe-Blum, 1991; Linehan, 1993), the reasons for the diversity of troubling symptoms (e.g., self-injury, suicidality, mood reactivity, relationship difficulties) remain unclear. Psychopathology theorists differ in their conceptualization of the fundamental problems (e.g., impulsivity vs. identity disturbance vs. emotion dysregulation) underlying BPD and further research is needed to clarify which features are central to the maintenance of the difficulties associated with the disorder. In the current research, the some of the tenets of Linehan’s (1993) biosocial theory of BPD and the core constructs implicated in her conceptualization of the disorder were explored empirically in several samples of undergraduate university students. According to the biosocial theory, difficulties regulating emotions represent the core pathology in the disorder and contribute causally to the development and expression of all other BPD features. The emotional dysregulation is proposed to emerge from transactional interactions between individuals with biological vulnerabilities (i.e., a highly arousable temperament, sensitive to both positive and negative emotional stimuli) and specific environmental influences (i.e., a childhood environment that invalidates their emotional experience). The theory asserts that the dysregulation affects all aspects of emotional responding, resulting in (i) heightened emotional sensitivity, (ii) intense and more frequent responses to emotional stimuli, and (iii) slow return to emotional baseline. Furthermore, Linehan proposed that individuals with BPD lack clarity with respect to their emotions, have difficulties tolerating intense affect, and engage in maladaptive and inadequate emotion modulation strategies. As a result of their dysfunctional response patterns during emotionally challenging events , individuals with BPD fail to learn how to solve the problems contributing to these emotional reactions. In accordance with this theory, a number of hypotheses were tested. First, it was hypothesized that the interaction between temperamental sensitivity and an adverse childhood environment would predict BPD features over and above that predicted by either construct independently. Second, it was hypothesized that BPD traits would be predicted by high levels of emotional dysregulation (affect lability), problems across different aspects of emotional experience (e.g., intensity, awareness, clarity), and deficits in emotion regulation skills (e.g., poor distress tolerance, self-soothing). Based on the initial findings of the research, a series of competing hypotheses were tested that addressed the nature of the emotional, cognitive and motivational mechanisms that may underlie maladaptive behavior in BPD more directly. Prior to testing these hypotheses, it was important to select a set of measures that would best represent these constructs within an undergraduate population. The purpose of Studies 1a and 1b (N = 147 and N = 56, respectively) was to determine the reliability and validity of a series of self-report measures that assess BPD features and to select one questionnaire with high sensitivity (percentage of cases correctly identified) and high specificity (percentage of noncases correctly identified) as a screener for BPD within undergraduate students by comparing the results of the questionnaires against a “gold standard” criterion diagnosis of BPD (as assessed by two semi-structured interviews: DIB-R and IPDE-I). The second goal of these studies was to conduct a preliminary exploratory analysis of the association of scores on the BPD measures and constructs that have been hypothesized to be relevant to the development and maintenance of BPD symptoms (e.g., “Big Five” personality factors, emotional experience, impulsivity). Overall, the findings of Studies 1a and 1b indicated that screening for BPD in an undergraduate population is feasible and there are several questionnaires that may help in the identification of participants for future studies. Specifically, the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD; Zanarini et al., 2003), International Personality Disorder Examination DSM-IV Screening Questionnaire (IPDE-S; Loranger, 1999) and Borderline Personality Questionnaire (BPQ; Poreh et al., 2006) were all found to be internally consistent and valid screening measures. Furthermore, the results of correlation and regression analyses between dimensions of the “Big Five” and scores on the BPD measures were consistent with previous findings in the literature that BPD is associated with higher scores on neuroticism, lower scores on agreeableness, and to a lesser degree, lower scores on conscientiousness and extraversion. The similarity in results between the current and past studies suggested that individuals in the present samples showed characteristics consistent with that seen in both clinical and nonclinical populations with BPD traits. The results also provided support for the notion that individuals with BPD have a lower threshold (i.e., greater sensitivity) for both sensory and affective stimuli, as well as higher amplitude of emotional response (i.e., greater reactivity) to such stimuli. Furthermore, the findings suggested that those with BPD traits may lack understanding of their emotional state, may be unable to effectively regulate their emotional state, and that their impulsive behavior may be driven by negative affect. The purpose of Study 2 (N = 225) was to test some of the specific tenets of Linehan’s (1993) biosocial theory. The results suggested that BPD traits are associated with numerous dimensions of temperament [e.g., higher levels of negative affect; lower levels of positive affect; lower levels of effortful control; low sensory threshold (i.e., greater sensitivity) for both sensory and affective stimuli; ease of excitation (i.e., greater reactivity to sensory and affective stimuli)] and childhood environment (e.g., authoritarian parenting style, invalidating parenting, neglect, abuse). An examination of the interactions between dimensions of temperament and childhood environment suggested that interactions between (i) ease of excitation (greater reactivity to sensory and affective stimuli) and environment and (ii) trait negative affect and environment, predicted BPD symptoms over and above the temperament and environment variables alone. The results also suggested that a number of other factors are associated with BPD symptoms, including: increased attention to (or absorption in) emotional states, poor emotional clarity, affect lability (particularly anger), poor distress tolerance, and negative urgency (impulsive behavior in the context of negative affect). The association between BPD symptoms and difficulties identifying feelings seemed to be mediated by affect lability and negative urgency. Self-soothing and self-attacking did not predict BPD traits over and above the other variables. Wagner and Linehan (1999) also proposed that the intense emotions (and emotional dysregulation) experienced by those with BPD interferes with cognitive functioning and effective problem solving, resulting in poor decisions and the observed harmful behaviors. Other researchers have suggested that the repetitive, self-damaging behavior occurring in the context of BPD may reflect impairments in planning and failure to consider future consequences (e.g., van Reekum et al., 1994). Proponents of this view suggest that individuals with BPD show greater intensity and lability in their emotional response to their environment because they are unable to inhibit or moderate their emotional urges (i.e., impulsivity is at the core of the disorder). The purpose of Study 3 (N = 220) was to characterize decision making in an undergraduate sample of individuals with BPD traits and to ascertain the relative contribution of individual differences in the following areas to any deficits identified in decision making: emotional experience (e.g., increased affective reactivity or lability); reinforcement sensitivity (e.g., sensitivity to reward and/or punishment); impulsivity; executive functioning (measured by an analogue version of the Wisconsin Card Sorting Test); and reversal learning. Decision making was assessed using modified versions of two Iowa Gambling Tasks (IGT-ABCD and IGT-EFGH; Bechara, Damasio, Damasio, & Anderson, 1994; Bechara, Tranel, & Damasio, 2000) that included reversal learning components (i.e., Turnbull et al., 2006). The results of Study 3 showed that participants in the BPD group demonstrated deficits in decision-making as measured by the IGT-ABCD but not on the IGT-EFGH. The results [interpreted in the context of reinforcement sensitivity models, the somatic marker hypothesis (Damasio, 1994) and the “frequency of gain” model e.g., Chiu et al. 2008)] suggested that decision making under uncertainty may be guided by gain-loss frequency rather than long-term outcome for individuals with BPD traits. The results failed to show consistent associations between BPD symptoms and performance on either version of the IGT. Individual differences in emotional experience, executive functioning or reversal learning did not account for the decision-making problems of the BPD group on the IGT-ABCD.

Thesis (M.S.W.)--Smith College School for Social Work, Northampton, Mass., 2009. / Includes bibliographical references (p.53-56).

Borderline Personality Disorder (BPD) is a debilitating personality disorder that impacts anywhere between 1% to 5% of Americans. Studies claim that women are significantly more at risk than men to suffer from this disorder and may experience stronger symptoms. Previous research has found that victims of childhood abuse such as sexual abuse, physical abuse, and neglect are more at risk for developing Borderline Personality Disorder as adults, particularly when abuse is paired with genetic susceptibility. Some researchers claim that there are no detectable racial differences in Borderline Personality Disorder, but previous studies often have very small sample sizes taken from clinical patients. To examine the sociological patterns of BPD diagnosis with a representative population sample, data was analyzed from the National Epidemiologic Survey on Alcohol and Related Conditions to examine gender, race, and childhood abuse as predictors. Results show that racial minority status is actually a stronger predictor than gender. Examining intersectional effects shows that black women and Native American men have significantly elevated risks for BPD in adulthood. Overall, a history of sexual and emotional abuse are the most significant driving factors of BPD, regardless of race and gender.

69 Abstract This diploma thesis deals with manifestations of a borderline type of emotionally unstable personality disorder and its influence on family members of people with this type of disease. The aim of this thesis was to present the experience of living with a person with BPD. Qualitative research, using the semi-structured type of interview, was conducted with three respondents, one man and two women. The data was evaluated using interpretative phenomenological analysis. The results show the negative effects of contact with the individual with the BPD and the psychological burden is also evident. The thesis could be beneficial for social and health workers who come into contact with people with the BPD and their loved ones within their practice. At the end of the thesis step are mentioned through which each of us can contribute to the improvement of the situation.

Bakgrund: Borderline personlighetsstörning (BPS) har en bred symtombild som främst karaktäriseras av en känslomässig instabilitet hos individen. Flertalet förklaringar till uppkomsten finns men de allra flesta grundar sig i en otrygg uppväxt. Inom patientgruppen är det vanligt med suicidala handlingar samt ett aktivt självskadebeteende utan avsikt att avlida. Syfte: Denna studie siktade till en ökad insyn och förståelse för hur patientgruppen upplevde det att leva med diagnosen BPS samt hur de upplevde att de blir bemötta inom vården.Metod: Litteraturstudien genomfördes med en kvalitativ ansats. Åtta stycken vetenskapliga artiklar svarade mot underliggande studies syfte. Resultat: Analysen resulterade i följande kategorier: Att få diagnosen BPS, ett liv i utanförskap, att sträva efter hälsa och värdighet, att ha städig kontakt med vården, att uppleva sig stämplad, att ha relationer till specifika andra samt att önska sig specialiserad vård, delaktighet, tid, tillgång och kontinuitet. Slutsats: För att kunna ge patientgruppen adekvat vård samt bygga goda vårdrelationer är det av yttersta vikt att vårdpersonalen har kunskap kring patientgruppens livsvärld. Genom en ökad kunskap och förståelse är förhoppningen att minska missförstånd, bristande kommunikation samt känslan av maktlöshet i relationen mellan vårdpersonalen samt patientgruppen, vilket i sin tur kan reducera patientgruppens upplevelse av att vara stämplad. / Background: Borderline personality disorder (BPD) has a broad symptomatology mainly characterized by emotional instability. There is several explanations for the rise but the vast majority are based in an insecure upbringing. Within the patient group it is common with suicidal acts and active self-injury without the intent to die.Objective: This study aimed to greater transparency and understanding of how the patient group experienced it to live with a diagnosis of BPD and how they felt that they were treated within the care system.Method: The literature review was conducted with a qualitative approach. Eight scientific papers responded to the underlying studies purpose.Results: The analysis resulted in the following categories: Getting diagnosed with BPD, a life of alienation, to strive for health and dignity, to have steady contact with health care, to experience themselves as stamped, to have relationships with specific others and also to wish for specialized care, participation, time, availability and continuity.Conclusion: In order to give the patient group adequate care and build good relationships it is of the utmost importance that health professionals have knowledge of the patient groups life world. Through increased knowledge and understanding, the hope is to reduce misunderstandings, lack of communication and the sense of powerlessness in the relationship between the nursing staff and the patient group, which in turn may reduce the patient group experience of being stamped.

No description available.

No description available.

Bakgrund: Patienter med emotionell instabil personlighetsstörning (EIPS) innebär en stor utmaning för den psykiatriska heldygnsvården. Specialistsjuksköterskorna upplever patienter med EIPS som påfrestande och svårare att vårda än andra patienter. Det innebär en utmaning inte bara för specialistsjuksköterskorna i deras yrke utan också för deras känslomässiga välbefinnande, vilket har en negativ inverkan på kvaliteten på den vård som ges. Syfte: Syftet med studien var att undersöka specialistsjuksköterskors copingstrategier för att vårda patienter med emotionell instabil personlighetsstörning inom psykiatrisk heldygnsvård.    Metod: Kvalitativ metod med induktiv ansats. Data samlades in genom 10 semistrukturerade intervjuer. Intervjuerna analyserades med hjälp av Burnards innehållsanalys. Resultat: Resultatet visar att specialistsjuksköterskorna använder sig av flertalet copingstrategier. Analysen resulterade i två kategorier och fem subkategorier. Kategorierna var: använda kunskap som stöd samt söka stöd hos kollegor. Subkategorierna presenteras under: att avleda, finna acceptans, finna trygghet i sin professionella roll; bekräftelse från kollegor och lämna över till kollegor.   Slutsats: Copingstrategierna hjälpte specialistsjuksköterskorna i vården av patienter med EIPS och visade sig vara viktiga för att bibehålla deras psykiska hälsa och fortsätta vårda patienterna. Resultatet antyder att copingstrategier spelar en viktig roll i specialistsjuksköterskornas yrkesutövning och att ämnet behöver lyftas fram. Mer utbildning om självkännedom och copingstrategier kan ge specialistsjuksköterskorna ytterliga redskap i att applicera fungerande strategier. / Background: Patients suffering from borderline personality disorder constitutes a great challenge to the psychiatric inpatient care. Mental health nurses experience these patients as more difficult to attend to than other patients. This imposes a challenge not only to the nurses in their profession but also to their emotional wellness thus imposing a negative influence on the quality of the care given.         Aim: The aim of this study was to examine the coping strategies used by the mental health nurse to care for patients suffering from borderline personality disorder within the realms of the psychiatric inpatient care. Method: Qualitative method with an inductive approach. Data was collected through 10 semi-structured interviews processed with the aid of Burnards method of content analysis. Result: The result shows a varied set of coping strategies used by the mental health nurses. The analysis resulted in two main categories and five subcategories. The main categories consist of: Seeking support in knowledge and seeking support from colleagues. The subcategories are presented under: to divert, to find acceptance, to find comfort in their professional role, confirmation from colleagues and tox§x     hand over tasks to colleagues.    Conclusion: Coping strategies helped the mental health nurses in their care of patients with borderline personality disorder and proved to be important to maintain their mental health and ability to provide care. The result implies that coping strategies play an important role in the professional practice of mental health nurses and needs to be emphasized. More education on self-awareness can provide mental health nurses with additional tools to apply effective strategies.

[pt] Este artigo examina dois aspectos inter-relacionados do transtorno de personalidade borderline (TPB): sua ligação com a inteligência geral e a eficácia da Terapia Comportamental Dialética (DBT) para indivíduos com dificuldades de aprendizagem. Em comparação com os grupos de controle, os indivíduos com TPB apresentaram pontuações de QI significativamente mais baixas. Além disso, foram identificadas deficiências cognitivas distintas, potencialmente impactando a regulação emocional e comportamental. Os resultados mostraram que os cursos de terapia adaptada de DBT podem trazer melhorias significativas nas habilidades essenciais da DBT, como regulação emocional, eficácia interpessoal e tolerância ao sofrimento. Compreender os aspectos cognitivos do TPB pode informar intervenções mais eficazes, enquanto terapias adaptáveis como a DBT podem atender às necessidades específicas de indivíduos com dificuldades de aprendizagem. Esta dissertação incentiva uma maior exploração da interação entre o funcionamento cognitivo e os resultados terapêuticos, particularmente em populações com transtornos de personalidade. / [en] This paper examines two interrelated aspects of borderline personality disorder it s link to general intelligence and the effectiveness of Dialectical Behaviour Therapy for individuals with learning disabilities. Compared to control groups, individuals with BPD displayed significantly lower IQ scores. Additionally, distinct cognitive impairments were identified, potentially impacting emotional and behavioural regulation. Results showed that adapted therapy courses of DBT can have significant improvements in core DBT skills like emotional regulation, interpersonal effectiveness, and distress tolerance. Understanding the cognitive aspects of BPD can inform more effective interventions, while adaptable therapies like DBT can address the unique needs of individuals with learning disabilities. This dissertation encourages further exploration of the interplay between cognitive functioning and therapeutic outcomes, particularly in populations with personality disorders.