This thesis examined the borderline personality disorder symptom profiles of teenage girls who were referred to a tertiary child and youth psychiatry clinic. Self-injury and unstable mood are key features of Borderline Personality Disorder (BPD) but are also associated with other disorders such as depression and anxiety disorders. The aim of the larger study was to determine whether BPD can be differentiated from other disorders in a highly comorbid adolescent sample who self-injure. To answer this question, individuals in our sample were grouped based on the pattern of BPD symptom endorsement using a latent class analysis. The subgroups that emerged from our sample were then compared to each other across other clinical measures. Four latent classes were identified. The most impaired class had a high prevalence of BPD (70%). An intermediate class had a significantly higher prevalence of PTSD (41.7%). Another intermediate group had a higher prevalence of anxiety disorders (62%) (Social Phobia and Generalized Anxiety Disorder). The largest class had a low prevalence of all psychiatric disorders. The results indicated that only a small subset of teenage girls who presented with self-injury and unstable mood met criteria for BPD. These girls represented a distinct and severely impaired group with high comorbidity. The subgroups that emerged from our sample provide guidance to clinicians regarding the likelihood of a personality disorder diagnosis in this population and the pattern of emotional difficulties of youth who self-injure. / Thesis / Master of Science (MSc)

Title: Borderline personality disorder: examining trajectories of development among adolescents Background: Borderline personality disorder (BPD) tends to be highly comorbid with other disorders. In adolescence, information about the classification and development of BPD is in its early stages. There is limited empirical research available that investigates predictors of clinically significant symptom trajectories of the disorder using data collected in childhood. Given the enormous personal and societal costs associated with BPD, early detection and prevention is important. Clinical implications of this research include an improved understanding of risk factors and possible mechanisms for development of BPD symptomatology. Objectives: To identify trajectories of BPD symptomatology in a Canadian sample of adolescents (N = 703) assessed at ages 13, 14, 15 and 16, while examining predictors of trajectory group membership assessed at age 12. Methods: Data from the McMaster Teen Study was used to examine trajectories of BPD symptoms using group-based trajectory modeling. The influence of gender, depression, ADHD, family functioning and various sociodemographic variables as predictors of an individual’s group membership was tested. Chi-square, analysis of variance and multinomial logistic regression was used to analyze the data. Results: A four-group trajectory model was most robust at describing BPD symptomatology in this age group. Univariate analyses supported female gender, depression and ADHD at baseline, parental age, marital status, education, and income as significant predictors of group membership. Female gender, depression and ADHD severity at baseline were significant predictors of group membership when adopting a multivariate approach. There is a greater prevalence of girls with higher depression and ADHD scores in the high-increasing features and BPD group. Conclusion: Findings demonstrate four various developmental trajectories of BPD features. Results further the understanding of the factors associated with development of the disorder across time. / Thesis / Master of Science (MSc) / Information about the classification and development of borderline personality disorder (BPD) in adolescence is in its early stages. While evidence for similar construct validity to the adult disorder exists for adolescents, major gaps in knowledge regarding the stability in course of BPD symptoms and predictors of clinically significant symptom trajectories in this age group remain. As most clinicians will assess youth already having significant features of the disorder, early detection requires knowledge of the indicators that precede an unfavourable trajectory. This dissertation will help address these gaps by modeling trajectories of BPD symptoms in youth across ages 13-16, whilst examining factors influencing trajectory group membership.

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Borderline Personality Disorder (BPD) is an enduring personality disorder marked by severe self-damaging behaviors such as self-harm, substance use, and disordered eating behaviors. This study examined the emotional antecedents and consequences of self-damaging behavior (self-harm, binge drinking, substance use, and disordered eating behavior) among individualls who report features of BPD to assess the function of these behaviors. Additionally, this study examined whether self-reported difficulties in emotion regulation mediated the relationship between features of BPD and the presence of self-damaging behavior. Results from this study found support for the use of self-harm, drugs use, and disordered eating behavior to regulate emotional experiences and all forms of self-damaging behavior were found to significantly increase the presence of pleasant emotional experiences. The function of self-damaging behavior remains stable, regardless of whether the behavior occurs in isolation or co-occurs with other self-damaging behaviors. In addition, higher rates of polysubstance use were found for individuals with features of BPD compared to those without. Higher rates of difficulties in emotion regulation were found to be associated with features of BPD and the presence of self-damaging behavior was found to partially mediate the relationship between the two constructs. Findings from this study have substantial implications for the conceptualization and treatment of self-damaging behavior in individuals with BPD. / Psychology

This thesis examines the interaction of the medical and moral in the historical evolution of “personality disorder” starting with the relationship between Prichard’s (1835) diagnosis of “Moral Insanity” and an anti-modern religious text (Hancock, 1824) describing disorder of the moral faculty. Moral insanity is traced through to Psychopathic Personalities and the military’s Medical 203 to Personality Disorder in DSM I (1952) through to DSM 5 (2013). The extent to which DSM medicalises everyday moral categories is examined by building on the works of writers theorising moral orders and moral selves, such as Harré (1993), Bakhtin (1981, 1984, 1986) and Taylor (1989). This thesis moves from macro-level concerns to the micro-level using dialogical narrative methodology (Sullivan, 2012) alongside Bakhtin’s conceptual tools to examine how medical and personal narratives of "Personality Disorder" interact in lived experience by analysing a triangulation of my psychiatric clinical notes, contemporary diary entries and an autobiographical account. An analysis is undertaken of several diverse autobiographical accounts of ‘successful’ recovery from mental health crisis already available in the public sphere. Consideration was given to how concepts developed throughout this study might be used in future work, concepts such as “dialogical search for a new narrative”, the dialogical ethics of “habitual excess and insufficiency” and “authoritative narrators”. This thesis’s originality is in linking DSM 5’s diagnosis of personality disorder to anti-modern moral discourses on disorder of the moral faculty, and in revealing complex genre relationships between literal/medical and literary/moral understandings of emotional and mental crisis and recovery.

Borderline personality disorder (BPD) is a highly stigmatized disorder, including among clinicians. Though research indicates a connection between childhood trauma and BPD, there remains considerable debate about the role trauma plays in the diagnosis and whether the diagnosis is properly categorized as a personality disorder. Additionally, studies about counselor perspectives of the Diagnostic and Statistical Manual of Mental Disorders (DSM) indicate conflicted feelings combined with dependency on its use. Research examining clinician views of the diagnosis of BPD, including the role that trauma plays in the diagnosis and categorization as a personality disorder, have largely neglected to explore the views of counselors, indicating a significant gap in the research. This study took a qualitative approach to increasing understanding of the views and experiences of licensed counselors as they work with clients and encounter trauma and the diagnosis of BPD. A total of 17 themes emerged during data analysis. Each theme is examined and conclusions are discussed. / Doctor of Philosophy / Borderline personality disorder (BPD) is a highly stigmatized disorder, including among clinicians. Though research indicates a connection between childhood trauma and BPD, there remains considerable debate about the role trauma plays in the diagnosis and whether the diagnosis is properly categorized as a personality disorder. Additionally, studies about counselor perspectives of the Diagnostic and Statistical Manual of Mental Disorders (DSM) indicate conflicted feelings combined with dependency on its use. Research examining clinician views of the diagnosis of BPD, including the role that trauma plays in the diagnosis and categorization as a personality disorder, have largely neglected to explore the views of counselors, indicating a significant gap in the research. This study took a qualitative approach to increasing understanding of the views and experiences of licensed counselors as they work with clients and encounter trauma and the diagnosis of BPD. A total of 17 themes emerged during data analysis. Each theme is examined and conclusions are discussed.

Social media has become a popular way of connecting with people, but it has also led to an increase in cyber aggression. Borderline Personality Disorder (BPD) is a condition that is characterized by retaliatory aggression, difficulty in interpersonal relationships, and high impulsivity. Those who endorse BPD symptoms experience unstable interpersonal relationships and struggle to maintain connections with others which can lead to problematic behaviors on social media like retaliatory aggression. Understanding the motivations behind those behaviors can help inform the experiences of the diagnosed population, mitigate problematic behaviors, and facilitate healthy social relationships. This study aims to explore the motivations that BPD symptom endorsers most identify with, such as self-protection, affiliation, and status, and the prevalence of retaliatory aggression on social media. The participants completed a self-report survey that measured their motivations, online revenge behaviors, and BPD symptom endorsement. Retaliatory aggression was also positively related to the status motivation. Results indicated self-protection had a moderating effect on the relationship between borderline symptom endorsement and retaliatory aggression. The findings of this study will help to strengthen existing literature about BPD features of impulsivity and reactivity and inform treatment and therapeutic methods by identifying the motivation behind retaliation for those who exhibit symptoms of BPD. It will also have clinical implications for how social media use is advised and addressed. Future research should seek to identify what other motivations are attributed to retaliatory aggression and expand the population to include more genders and cultures.

The World Health Organization has proposed for the ICD-11 a differentiation of symptoms to distinguish separate disorders of PTSD and complex PTSD (CPTSD), rather than one disorder of PTSD as in the current DSM-5. In addition, the accuracy and usefulness of the borderline personality disorder (BPD) diagnosis has been debated for years due to this history of trauma often associated with the diagnosis. New instruments have been developed to assess CPTSD, allowing needed research to expand our understanding of CPTSD and how it may differ from PTSD. The present study explored the relationships between the three different patterns of symptom expression associated with these disorders and various coping strategies in a sample of trauma survivors. A canonical correlation analysis (CCA) showed a significant relationship between trauma symptoms and coping strategies and suggested that individuals with higher borderline personality disorder symptoms, and subsequently complex PTSD and PTSD symptoms, were more likely to cope using avoidant coping strategies- behavioral disengagement, denial, and substance use. This finding was similar to previous research findings that suggested high rates of negative psychological outcomes for adults cognitive and behavioral avoidant coping strategies. Contributions from other coping techniques, such as restraint and venting, also showed significant, but not as strong relationships to higher psychological symptoms.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.