Diagnosing borderline personality disorder

Biskin, Robert; Paris, Joel

doi:10.1503/cmaj.090618

Cited by 71 publications

(70 citation statements)

References 61 publications

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“…chronic neurological or medical disorders. The diagnosis of BPD is often delayed and the patients are frequently misdiagnosed with other primary psychiatric conditions and receive psychiatric and psychotherapeutic treatment for several years prior to being diagnosed with BPD . This corroborate our results, which showed increased use of mental health care services before initial diagnosis of BPD, including up to seven times higher costs of prescription medication both before and after diagnosis.…”

Section: Discussionsupporting

confidence: 90%

Societal costs of Borderline Personality Disorders: a matched‐controlled nationwide study of patients and spouses

Hastrup

Jennum

Ibsen

et al. 2019

Acta Psychiatr Scand

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Objective Information on societal cost of patients with Borderline Personality Disorder (BPD) and spouses is limited. The aim was to investigate factual societal costs before and after initial BPD diagnosis. Method A register‐based cohort study of 2756 patients with incident BPD (ICD F60.3) with spouses and 11 024 matched controls, during 2002–2016. Results Total direct healthcare costs and lost productivity costs amounted €40 441 for patients with BPD, which was more than 16 times higher than the matched controls. Somatic and psychiatric health care costs and costs of lost productivity were increased during 5 years before initial diagnosis of BPD. Before and after initial diagnosis, health care costs and lost productivity were increased among spouses of patients with BPD. Conclusion Patients with BPD differed substantially from the general population with respect to all included costs. The study documented a significant burden on their spouses. Besides the early onset of BPD, which implies that patients are affected before they finish school and enter labor market, the neurocognitive impairment and fundamental symptoms of BPD, e.g. unstable, intense relationships, impulsivity, and lack of stable sense of self together with psychiatric and somatic comorbidity are part of explanation of the excess costs of BPD.

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Section: Discussionsupporting

confidence: 90%

Societal costs of Borderline Personality Disorders: a matched‐controlled nationwide study of patients and spouses

Hastrup

Jennum

Ibsen

et al. 2019

Acta Psychiatr Scand

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“…We did not include personality disorders (PD) in our de nition of MD, although PD commonly co-occurs with SUD (50); this is because SUD is considered a diagnostic criterion for borderline personality disorder (51). We grouped together use of alcohol and drugs, and did not consider the impact of speci c substances, the severity of usage or the impact of using speci c combinations of substances.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Incidence, mortality and survival in children and young people aged 11-25 in Wales with co-occurring mental disorders and problem, hazardous or harmful substance use: estimates derived from linked routine data

Rees

Watkins

Keauffling³

et al. 2020

Preprint

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Background Mental disorder (MD) and problem, hazardous or harmful substance use (SUD) are associated with poorer than average health and greater mortality. We analysed routine data to estimate incidence of co-occurring (CC) MD and SUD, and to estimate all-cause mortality and survival with CC, a single MD or SUD diagnosis or neither condition (NC), in young people aged 11-25 in Wales, UK. Methods A retrospective population-based electronic cohort study using data from the Secure Anonymised Information Linkage (SAIL) Databank. Participants were 958,603 individuals aged 11-25 between 2008 and 2017, with a subset for mortality and survival analysis of 465,242 individuals born between 1983 and 1997 and present in the data on 1st January 2008. Incidence was defined as date of first recorded occurrence of a CC code. Incidence and observed unadjusted mortality were reported as rates per 1,000 person-years at risk (PYAR). We plotted Kaplan-Meier survival curves and carried out Cox regression to estimate hazard ratios for risk of death by condition group (CC; MD or SUD only; NC). Results CC incidence in primary care significantly decreased, from 2.5/1,000 PYAR (95% CI 2.3-2.6) in 2008 to 2.1/1,000 (95% CI 2.0-2.2) in 2017 (Incidence rate ratio (IRR) = 0.9, 95% CI 0.8-1.0, p=0.01), and in hospital admissions remained stable, from 2.3/1,000 (95% CI 2.1-2.4) in 2008 to 2.2/1,000 (95% CI 2.0-2.3) in 2017 (IRR = 1.0, 95% CI 0.9-1.1). Higher incidence was associated with male sex, older age and greater deprivation.Observed unadjusted mortality rates for CC (1.4/1,000 PYAR, 95% CI 1.2-1.5) and SUD only (1.1/1,000, 95% CI 0.9-1.4) were significantly higher than for MD only (0.4/1,000, 95% CI 0.3-0.4) and no condition (NC) (0.3/1,000, 95% CI 0.2-0.3). Risk of death was significantly higher for CC (HR = 8.7, 95% CI 7.5-10.0, p<0.001), SUD only (HR = 4.5, 95% CI 3.4-5.9, p<0.001) and MD only (HR = 2.7, 95% CI 2.4-3.1, p<0.001), compared with NC.Conclusions Male sex, older age and greater deprivation were associated with significantly higher CC incidence. CC, and also SUD or MD only, were associated with greater risk of death, compared with individuals with NC.

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“…Borderline personality is characterized as an ongoing pattern of instability regarding interpersonal relationships, self-image and affect, typically marked by episodes of impulsivity (APA, 2013). In their everyday life, individuals with BP shift between extreme and easily triggered feelings of depression and anger (Biskin & Paris, 2012). They often engage in potentially dangerous behaviours (e.g., substance abuse, reckless driving) and various forms of selfaggression (e.g., self-mutilation, suicide attempts, gestures or threats; APA, 2013).…”

Section: Categorical Versus Dimensional Assessment Of Borderline Persmentioning

confidence: 99%

“…As a result, they often establish dysfunctional and debilitating relationships, alternating between over-involvement and withdrawal (APA, 2013). Finally, BP is associated with the lack of a coherent and stable sense of self which manifests primarily in chronic feelings of emptiness and uncertainty regarding one's actions, beliefs, values systems and goals (Biskin & Paris, 2012).…”

Section: Categorical Versus Dimensional Assessment Of Borderline Persmentioning

confidence: 99%

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From categorical diagnosis to dimensional assessment of borderline personality

Huczewska¹,

Didyk²,

Rogoza³

2019

Current Issues in Personality Psychology

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Recent research suggested that personality disorders could be diagnosed as a continuous phenomenon. Therefore, in our study we examined whether the dimensional model of pathological personality traits could be applied to the assessment of borderline personality 1. For this purpose, we modified an existing measure of borderline personality, the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD), and scrutinized its psychometric properties (i.e., reliability, factorial structure, criterion validity). To assess criterion validity we calculated correlations with pathological personality traits. Our sample comprised 354 participants (67.8% women). Confirmatory factor analysis revealed that the modified MSI-BPD measures borderline personality as a global construct, giving one-factor structure. The reliability of the measurement was excellent (α = .90). Moreover, we found positive associations between borderline personality and all five pathological personality traits, which supports the validity of the continuous assessment of borderline personality. Our findings suggest that the DSM-5 dimensional model may be applied in the assessment of borderline personality.

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Diagnosing borderline personality disorder

Cited by 71 publications

References 61 publications

Societal costs of Borderline Personality Disorders: a matched‐controlled nationwide study of patients and spouses

Societal costs of Borderline Personality Disorders: a matched‐controlled nationwide study of patients and spouses

Incidence, mortality and survival in children and young people aged 11-25 in Wales with co-occurring mental disorders and problem, hazardous or harmful substance use: estimates derived from linked routine data

From categorical diagnosis to dimensional assessment of borderline personality

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