Discriminating Borderline from Neurotic Patients

Leichsenring, Falk

doi:10.1159/000284633

Cited by 8 publications

(9 citation statements)

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“…hysterical or compulsive personality disorder. A relatively high interrater agreement with a blind rater concerning the DIB total score could be demonstrated (r = 0.90) [8]. A more detailed description of the sam ple and the procedures is given in a previous paper [ 8],…”

Section: Methods: Patient Sample Procedures and Instrumentsmentioning

confidence: 91%

“…Having scored the HIT records, the author applied the "Diagnostic Interview for BLs" (DIB) of Gunderson and Kolb [12,13] to the same patients. The German translation of the DIB was used [14], A total score of at least 7 in the DIB was used as a criterion for diagnostic classification: patients with a total score of >: 7 in the DIB were classified as BL, patients scoring below 7 as neurotic [8], In the sample of the 30 neurotic patients the following disorders according to their clinical diagnoses were included: anxiety neuroses (7), neurotic depression (4), obses sive-compulsive neuroses (3), hysteria (4), phobia (3), different types of (neurotic) personality disorders (9), e.g. hysterical or compulsive personality disorder.…”

Section: Methods: Patient Sample Procedures and Instrumentsmentioning

confidence: 99%

“…As the sum of all categories of DVs of the levels 3 and 4 differentiates best and with a highly discrimina tive power between the two groups [8], this sum 'V34' is used in the present paper as an indicator of severe forms of primary process thinking.…”

Section: The Holtzman Inkblot Techniquementioning

confidence: 99%

“…being devoured, swallowed up). The Urist scale differentiates significantly between BL and neurotic patients [7], A sufficient interrater agreement with blind raters concerning the scoring of DVs, primitive interper sonal modes and defensive operations could be dem onstrated [7][8][9], Thus, an influence of the different diagnostic sources on each other can be ruled out to a great extent.…”

Section: Aspects O F Internalized Object Relationshipsmentioning

confidence: 99%

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Primary Process Thinking, Primitive Defensive Operations and Object Relationships in Borderline and Neurotic Patients

Leichsenring¹

1991

Psychopathology

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In the present paper Kernberg’s hypothesis concerning the connection between primary process thinking on the one hand and primitive defense mechanisms and modes of object relationships on the other hand were tested empirically in a sample of 30 hospitalized borderline and 30 hospitalized neurotic patients. The diagnoses of the patients were given according to the ‘Diagnostic Interview for Borderlines’ of Gunderson and Kolb, the functions mentioned above were assessed on the basis of the Holtzman Inkblot Technique applying scoring systems of Lerner and coworkers for primitive defense mechanisms and of Urist for the scoring of object relationships to the Holtzman Inkblot Technique. According to the results the hypothesis derived from assumptions of Kernberg could be corroborated. Primary process thinking in borderline patients seems to be closely connected with high levels of anxiety and hostility, projective identification/projection, primitive denial and sadomasochistic relationships. A model for the coming about of primary process thinking in borderline patients is proposed.

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Section: Methods: Patient Sample Procedures and Instrumentsmentioning

confidence: 91%

Section: Methods: Patient Sample Procedures and Instrumentsmentioning

confidence: 99%

Section: The Holtzman Inkblot Techniquementioning

confidence: 99%

Section: Aspects O F Internalized Object Relationshipsmentioning

confidence: 99%

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Primary Process Thinking, Primitive Defensive Operations and Object Relationships in Borderline and Neurotic Patients

Leichsenring¹

1991

Psychopathology

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“…However, the author thought it was important to discriminate the psychopathology of BPD from hysterical disease by comparative study in our clinical psychiatry in order to treat these patients exactly. Previous findings suggested that not a few neurotic symptoms were admitted in BPD 13,14 . In psychopathology there were some descriptive studies about BPD and hysteria 15–17 .…”

Section: Introductionmentioning

confidence: 99%

Borderline personality traits in hysterical neurosis

Ohshima

2001

Psychiatry Clin Neurosci

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The objective of the present study is to demonstrate the traits of the psychopathology of Borderline Personality Disorder (BPD) compared with hysterical neurosis. A total of 48 subjects with BPD and 40 subjects with hysterical neurosis both defined by DSM-III-R were assessed by Diagnostic Interview for Borderlines (DIB). Statistical analysis was done by quantification of the second type, a multivariate data analysis. The total scores of DIB were BPD group, 6.13 ± 1.52; hysterical neurosis group, 4.9 ± 2.12 (t = 3.05, P = 0.0016). The correlation ratio (index of to what extent the two groups are discriminated) was 0.2442. Among the four parameters of: (i) affect, (ii) cognition, (iii) impulse-action pattern, (iv), and interpersonal relationships, the partial coefficient correlations of (iii) and (iv) were significantly high (0.342, 0.287, P < 0.01). The question items with high independent coefficients were manipulation (0.4416), intolerance of aloneness (0.3797), demanding nature (0.3768), self-mutilation (0.3609), visual hallucination (0.3395). Those with low score of independent coefficients were counterdependency (0.0533), identity disturbance (0.1010), depression (0.1551), loneliness (0.1752), hypomanic episode (0.1936). Both of BPD and hysterical neurosis groups were not so fairly well discriminated. However, these results suggested that impulse-action pattern and disorder of interpersonal relationships were traits of borderline personality disorder. We could admit manipulation, intolerance of aloneness as its symptoms. In addition, counterdependency, identity disturbance were comparatively common to both. There were some borderline personality traits symptomatically in hysterical neurosis.

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Borderline Personality Disorder

Leichsenring

Heim

Leweke

et al. 2023

JAMA

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ImportanceBorderline personality disorder (BPD) affects approximately 0.7% to 2.7% of adults in the US. The disorder is associated with considerable social and vocational impairments and greater use of medical services.ObservationsBorderline personality disorder is characterized by sudden shifts in identity, interpersonal relationships, and affect, as well as by impulsive behavior, periodic intense anger, feelings of emptiness, suicidal behavior, self-mutilation, transient, stress-related paranoid ideation, and severe dissociative symptoms (eg, experience of unreality of one’s self or surroundings). Borderline personality disorder is typically diagnosed by a mental health specialist using semistructured interviews. Most people with BPD have coexisting mental disorders such as mood disorders (ie, major depression or bipolar disorder) (83%), anxiety disorders (85%), or substance use disorders (78%). The etiology of BPD is related to both genetic factors and adverse childhood experiences, such as sexual and physical abuse. Psychotherapy is the treatment of choice for BPD. Psychotherapy such as dialectical behavior therapy and psychodynamic therapy reduce symptom severity more than usual care, with medium effect sizes (standardized mean difference) between −0.60 and −0.65. There is no evidence that any psychoactive medication consistently improves core symptoms of BPD. For discrete and severe comorbid mental disorders, eg, major depression, pharmacotherapy such as the selective serotonin reuptake inhibitors escitalopram, sertraline, or fluoxetine may be prescribed. For short-term treatment of acute crisis in BPD, consisting of suicidal behavior or ideation, extreme anxiety, psychotic episodes, or other extreme behavior likely to endanger a patient or others, crisis management is required, which may include prescription of low-potency antipsychotics (eg, quetiapine) or off-label use of sedative antihistamines (eg, promethazine). These drugs are preferred over benzodiazepines such as diazepam or lorazepam.Conclusions and RelevanceBorderline personality disorder affects approximately 0.7% to 2.7% of adults and is associated with functional impairment and greater use of medical services. Psychotherapy with dialectical behavior therapy and psychodynamic therapy are first-line therapies for BPD, while psychoactive medications do not improve the primary symptoms of BPD.

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Discriminating Borderline from Neurotic Patients

Cited by 8 publications

References 4 publications

Primary Process Thinking, Primitive Defensive Operations and Object Relationships in Borderline and Neurotic Patients

Primary Process Thinking, Primitive Defensive Operations and Object Relationships in Borderline and Neurotic Patients

Borderline personality traits in hysterical neurosis

Borderline Personality Disorder

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