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.

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

Diss. (sammanfattning) Stockholm : Karol. inst., 2006. / Härtill 4 uppsatser.

Thesis (M.S.)--University of Michigan, 1992.