Bakgrund: Borderline personlighetsstörning karaktäriseras av stark impulsivitet, långvariga känslor av tomhet, självskadebeteende och destruktiva relationer. Suicidrisken uppskattas till 8-10%. Orsaken till borderline personlighetsstörning är ej helt känd men studier har visat att barndomstrauma och negativa händelser i livet kan vara en bidragande faktor till insjuknade. Majoriteten, 75%, av de som utvecklar borderline personlighetsstörning är kvinnor. Syfte: Syftet med litteraturstudien var att beskriva kvinnors upplevelser av att leva med borderline personlighetsstörning. Metod: En litteraturstudie genomfördes där kvalitativa och kvantitativa artiklar granskades. Resultat: Författarna hittade ett samband mellan barndomstrauma och kvinnornas upplevelse av låg självkänlsa, skam och identitetsförvirring. Ångest var något som vanligen präglade kvinnornas liv och detta var ofta grunden till självskadebeteende och självmordstankar. Samtidigt som kvinnorna längtade efter närhet och att bli älskade fanns ändå en rädsla för att bli utnyttjade och svikna. I mötet med vårdpersonal upplevde kvinnorna att de ofta inte blev tagna på allvar och kände sig mest till besvär. Slutsats: Kvinnor med borderline personlighetsstörning lever på gränsen mellan liv och död och har ett starkt behov av stabila relationer och omgivningar. För att kunna bemöta dessa kvinnor på rätt sätt krävs det större kunskap om sjukdomen hos vårdpersonal. / Background: Borderline personality disorder is characterized by high impulsivity, long-lasting feelings of emptiness, self-injury and destructive relationships. The disease has a high suicide risk, estimated to 8-10%. The cause of borderline personality disorder is yet unknown, but studies have shown that childhood trauma and negative life events may be a contributing factor to illness. The majority of those who develop borderline personality disorder are women. Aim: The aim of the literature review was to describe women’s experience of living with borderline personality disorder. Method: A literature review was conducted in which qualitative and quantitative articles were examined. Results: The authors found a correlation between childhood trauma and women's experience of low self-esteem, shame, and identity confusion. Anxiety was something that usually characterized the lives of women and this was often the basis for self-harm and suicidal thoughts. While women were longing for closeness and to be loved, there was still a fear of being exploited and betrayed. In the meeting with the nursing staff the women felt they often were not taken seriously and felt mostly a nuisance. Conclusion: Women with borderline personality are living on the edge between life and death and have a strong need for stable relationships and surroundings. To respond to these women correctly it requires more knowledge of the disease among health professionals.

Syftet med föreliggande systematiska litteraturstudie var att belysa brister i omvårdnaden av patienter med borderline personlighetsstörning (BPS) och vad bristerna beror på. Vid Högskolan Dalarnas fulltextdatabas Elin och PsycInfo söktes vetenskapliga fulltextartiklar som omfattade BPS och omvårdnad. Av 35 artiklar valdes 14 ut varav 9 kvalitativa och 5 kvantitativa. Dessa artiklar kvalitetsprövades med 28 kriterier från granskningsmallar modifierade efter Forsberg och Wengström (2003), Willman, Stoltz och Bahtsevani (2006). Av artiklarna framkom att den viktigaste aspekten i omvårdnaden utgjordes av personalens patientbemötande. Faktorer av betydelse var personalens bristfälliga bemötande, avsaknad av kunskap och empati samt uppfattningen att patienter med BPS är svåra att behandla. Denna studie siktade till att öka omvårdnadspersonalens förståelse för gott bemötande och bibringa en vidare syn på patienter med BPS så att de inte förbises och går förlorade på grund av brister i vården.

Borderline Personality Disorder (BPD) has been previously conceptualized as an extreme variant of normal personality traits, captured by continuous indices. A previous study successfully developed and validated a self-report BPD measure, the Minnesota Borderline Personality Disorder Scale (MBPD). I conducted two studies aimed at providing further validation for this measure. Results from Study 1 (clinical sample of substance users) indicated that MBPD exhibited strong positive correlations with measures of convergent validity (self-report and diagnostic measures). Additionally, the MBPD showed similar correlations with external correlates as those of the convergent validity measures, in addition to incremental utility in predicting these external correlates above and beyond negative affect. Third, a Receiver Operating Characteristic (ROC) curve analysis indicated that diagnostic accuracy of the MBPD was excellent for differentiation between BPD and non-BPD individuals. Likewise, Study 2 (non-clinical sample of undergraduate students followed over 6 months) showed strong correlations with an index of convergent validity (self-report measure), similar correlations with external correlates as that of the convergent validity index, and incremental predictive utility. Finally, in this study, the MBPD exhibited high rank-order stability, but significant mean-level and individual-level change over time. These data suggests that these scales are measuring the same latent construct of BPD, providing further evidence for the construct validity of the MBPD.

Syftet med denna studie var att undersöka grundutbildade sjuksköterskors upplevelser av sin kunskap för att bemöta och vårda patienter med borderline personlighetsstörning samt undersöka vilka kunskaper de önskade att grundutbildningen skulle ge. Sju legitimerade sjuksköterskor utan specialisering inom psykiatri som arbetar i Mellansverige deltog i studien. Studien hade en deskriptiv design med kvalitativ ansats. Det insamlade materialet analyserades med kvalitativ innehållsanalys. Studiens huvudresultat visade att sjuksköterskorna tyckte att psykiatriutbildningen gav en bra teoretisk grund men att den inte alltid överensstämmer med praktiken. De saknade fördjupning och några av dem uttryckte att kursen kändes föråldrad. Det fanns en önskan från sjuksköterskorna att förlänga psykiatrikursen samt möjlighet att fördjupa sig inom vissa områden. De upplevde att psykiatrikursen inte förberett dem tillräckligt för att bemöta och vårda patienter med borderline personlighetsstörning och då patienter med personlighetsstörning utgör en stor patientgrupp är det viktigt att de finns med i utbildningen. Sjuksköterskorna tyckte att det borde vara obligatoriskt att ha verksamhetsförlagd utbildning i sjuksköterskeutbildningen då det var den som förberett dem bäst inför att arbeta med psykiskt sjuka. Slutsatsen av denna studie var att den nuvarande psykiatrikursen inte är tillräcklig vid bemötandet av patienter med borderline personlighetsstörning. / The aim of this study was to investigate the basic trained nurses’ perceptions of their knowledge to respond to and care for patients with borderline personality disorder and explore what skills they wanted the undergraduate education to provide. Seven registered nurses without specialization in psychiatry and working in central Sweden participated in the study. The study had a descriptive design with qualitative approach. The collected material was analyzed by qualitative content analysis. The main result of the study revealed that the nurses felt that psychiatric training provided a good theoretical basis but that it does not always match reality. It lacked depth and some of them expressed that the course was outdated. There was a desire from the nurses to extend the psychiatry course and the opportunity to immerse themselves in certain areas. They felt that the psychiatry course did not prepare them adequately to face and care for patients with borderline personality disorder and because patients with personality disorders are a large patient population, it is important that they are represented in the education. The nurses thought there should be mandatory to have clinical training in nursing as it was the one who prepared them better for working with the mentally ill. The conclusion of this study was that the psychiatry course is not sufficient for treatment of patients with borderline personality disorder.

No description available.

Anger rumination, or persistently dwelling on feelings of anger, is associated with borderline personality disorder (BPD) and related features, such as aggressive behavior and cognitive distortions. To develop more effective treatments, it is crucial to understand why individuals with BPD engage in anger rumination despite its negative outcomes. The activation of energy associated with anger, as well as feelings of justification and validation, may be experienced in the short-term as rewarding. This may prevent individuals with BPD from attempting to reduce their rumination. Functional magnetic resonance imaging (fMRI) and behavioral methods were utilized to examine this theory in a sample of women diagnosed with BPD (n=13) and healthy controls (n=15). In an initial session, all participants were an administered a diagnostic interview for BPD, as well a series of self-report measures. In a second session, all participants completed an essay-writing task prior to the fMRI scan. All participants were provided with identical, highly critical feedback about their essays from a supposed essay evaluator. In response to this interpersonal provocation, participants with BPD demonstrated higher activation in brain regions associated with self-conscious reactivity to errors (insula, ventrolateral prefrontal cortex). Subsequent directed provocation-focused thought, compared to neutral-focused thought, produced greater activation in regions previously associated with anger rumination (dorsomedial prefrontal cortex, lateral orbitofrontal cortex) across groups. As hypothesized, anger rumination, relative to neutral-focused thought, produced greater activation in brain regions associated with reward and pleasure (nucleus accumbens) for the BPD group only. No significant differences were observed for self-focused thought. Following the directed rumination task, participants completed a competitive reaction time task that provides an opportunity for participants to act aggressively, supposedly against their essay evaluator. The BPD group demonstrated significantly higher levels of aggressive behavior; however, no significant group differences emerged in neural functioning during the task. These findings suggest that anger rumination may be positively reinforcing for individuals with BPD, which has implications for treatment approaches.

Borderline personality disorder (BPD) is characterized by patterns of intense negative affect, interpersonal difficulties, and maladaptive impulsive behaviors, and is associated with impairments in social and occupational functioning. Rumination is a maladaptive form of repetitive thought that maintains and intensifies emotional disturbance and is associated with behavioral dysregulation. This study tested several hypotheses about relationships between rumination and borderline personality features. This study included 117 college student participants, 88 female students and 29 male students, most of whom (84%) identified themselves as Caucasian. Participants completed a series of measures which included a writing sample to sample repetitive thought. Findings consistently suggested that rumination accounts for significant incremental variance in BPD features after controlling for various facets of neuroticism, which suggests that individuals with BPD features are probably engaging in high levels of multiple types of rumination. However, scores derived from the On Your Mind writing sample did not predict severity of borderline features after controlling for the NEO-neuroticism domain. Implications for these findings and limitations to this study are also discussed.

Cognitive bias and thought suppression are two maladaptive patterns of thinking that have been associated with borderline personality disorder (BPD). Negative cognitive biases related to BPD include thoughts that they are bad, powerless, or vulnerable and that the world is dangerous. Thought suppression is a maladaptive emotion regulation strategy where unwanted thoughts are intentionally pushed out of one’s consciousness. However, previous research has connected thought suppression and cognitive biases to BPD only via self-report measures. The present study examined whether a laboratory task meant to measure cognitive bias and thought suppression (Scrambled Sentences Test) would predict BPD features over and above self report measures of cognitive bias and thought suppression. A sample of 153 undergraduates completed self-report measures of BPD features, thought suppression, and negative cognitive biases, as well as the Scrambled Sentences Test (SST). Results showed that while the SST was a good predictor of cognitive biases, it did not predict thought suppression when self report measures were included. Recognizing the importance of negative cognitive bias in BPD may be useful in continued treatment development. Further research into other ways of measuring thought suppression and cognitive biases in the lab may be warranted.

Two prominent emotions in borderline personality disorder (BPD) are anger and shame. Rumination has been demonstrated to occur in response to shame and to escalate anger, and rumination, particularly anger rumination, has been shown to predict BPD symptoms. The present study examined whether one way that shame leads to the features of BPD is via increased anger and anger rumination. A sample of 823 undergraduates completed self-report measures of global and situational shame, trait- level anger, anger'rumination, and BPD features. A structural equation model was constructed using these measures. The hypothesized model of shame to anger and anger rumination to BPD features was largely supported. Bootstrapping was used to establish significant indirect effects from both forms of shame via anger rumination to BPD features, and from global shame via anger to BPD features. Recognizing this function of anger rumination may be important in developing and practicing interventions to reduce it. Further research into other ways individuals maladaptively respond to shame and functions of anger rumination is recommended.

Det övergripande syftet med studien var att undersöka hur personalen på en psykiatrisk mottagning upplevde den behandling som de ger för borderline personlighetsstörning, mentaliseringsbaserad terapi. Genom en kvalitativ metod och fokusgrupper söktes svar på frågeställningarna. Det empiriska materialet analyserades med hjälp av tematisk analys och resultatet visade att behandlingen generellt upplevdes ha förbättrat patienternas livskvalitet. De flesta av patienterna gjorde helt andra livsval efter avslutad behandling och en del uppfyllde inte längre de diagnostiska kriterierna för borderline personlighetsstörning. De som hade fullföljt behandlingen eller nästan fullföljt den var de som hade dragit mest nytta av den. De faktorer som ansågs som viktiga för förändringsprocessen rörde individvariabler, strukturella faktorer, gruppterapi, medicinering med psykofarmaka och personalvariabler. De berörde med andra ord behandlingens form snarare än de specifika interventionerna för mentaliseringsbaserad terapi. De fynd som gjorts inom ramen för denna studie skulle därmed kunna betraktas som viktiga komponenter för psykoterapeutisk behandling av borderline personlighetsstörning oavsett tillhörighet av psykoterapeutisk skolbildning. Resultatet skulle kunna indikera att de specifika behandlingsinterventionerna inte har någon nämnvärd effekt samtidigt som det skulle kunna tyda på att en behandling som ges i samma form som MBT, men med andra interventioner, skulle kunna åstadkomma ett än bättre resultat. / The overall purpose of this study was to examine how the professionals on a psychiatric clinic experienced the treatment they are using for borderline personality disorder, mentalization-based treatment. Through a qualitative approach and focus groups, answers to the questions were sought. The empirical material was analyzed by using thematic analysis and the results showed that the treatment generally had improved the patients’ quality of life, as perceived by the professionals. Most of the patients did completely different choices in life after the treatment was finished and some of them did no longer fulfill the diagnostic criteria’s for borderline personality disorder. Those who almost or fully completed the treatment where the ones who have had the most use of it. Important factors for the process of change were individual variables, structural factors, group therapy, medication with psychopharmacological drugs and personnel variables. In other words factors related to the structure of the treatment rather than the specific interventions for mentalization-based treatment. The findings within the scope of this study could hence be considered as vital components for psychotherapeutic treatment of borderline personality disorder independent of psychotherapeutic doctrine. The result could indicate that the specific treatment interventions do not have any significant effect but at the same time it could indicate that a treatment given in the same form as mentalization-based treatment, but with other interventions, could give an even better result.