OBJECTIVE: Impulsivity is a core feature of borderline personality disorder (BPD) and antisocial personality disorder (ASPD) that likely arises from combined genetic and environmental influences. The interaction of the low activity variant of the monoamine oxidase-A (MAOA-L) gene and early childhood adversity has been shown to predict aggression in clinical and non-clinical populations. Although impulsivity is a risk factor for aggression in BPD and ASPD, little research has investigated potential gene-environment (G×E) influences impacting its expression in these conditions. Moreover, G×E interactions may differ by diagnosis. METHODS: Full factorial analysis of variance was employed to investigate the influence of monoamine oxidase-A (MAO-A) genotype, childhood abuse, and diagnosis on Barratt Impulsiveness Scale-11 (BIS-11) scores in 61 individuals: 20 subjects with BPD, 18 subjects with ASPD, and 23 healthy controls. RESULTS: A group×genotype×abuse interaction was present (F(2,49)=4.4, p=0.018), such that the interaction of MAOA-L and childhood abuse predicted greater BIS-11 motor impulsiveness in BPD. Additionally, BPD subjects reported higher BIS-11 attentional impulsiveness versus ASPD participants (t(1,36)=2.3, p=0.025). CONCLUSION: These preliminary results suggest that MAOA-L may modulate the impact of childhood abuse on impulsivity in BPD. Results additionally indicate that impulsiveness may be expressed differently in BPD and ASPD.
Aggression ; Antisocial Personality Disorder ; Borderline Personality Disorder* ; Diagnosis ; Genotype ; Impulsive Behavior ; Monoamine Oxidase ; Risk Factors

The concept of bipolar spectrum disorder (BSD) has developed to include affective temperaments such as cyclothymia and hyperthymia. This has greatly helped clinicians to differentiate depressed patients, who would potentially benefit from mood stabilizing treatment, from those with unipolar depression. Cyclothymia, however, has significant similarities with personality disorders, especially with borderline personality disorder (BPD). All the diagnostic items for BPD are frequently found in patients with BSD as well, which presents diagnostic challenges. There are no clear guidelines on how to differentiate BSD from BPD. Featuring borderline pathology for clinical purposes, it may be useful to rely on psychodynamic approaches to identify primitive defense mechanisms of splitting and projective identification suggesting borderline personality organization. Based on new findings on common features between BSD and BPD, some authors have proposed a renewal of the classification system of mental disorders. The dichotomy of bipolar and unipolar depression has gestated a new concept of BSD. Currently, the BSD concept forced us to formulate the border of BSD and personality disorders.
Bipolar Disorder* ; Borderline Personality Disorder ; Classification ; Defense Mechanisms ; Depressive Disorder ; Humans ; Mental Disorders ; Pathology ; Personality Disorders* ; Temperament

The purpose of this study was to assess the comorbid axis-II disorders of obsessive compulsive disorder(OCD) patients and to investigate the relationship between symptoms of OCD and the comorbid personality traits. The subjects were 59 patients who met DSM-IV criteria for obsessive-compulsive disorder and 32 normal controls. All subjects completed Personality Disorder Questionnaire-IV(PDQ-IV). The patients completed Beck Depression Inventory(BDI) and Beck Anxiety Inventory(BAI), and were rated with Yale-Brown Obsessive Compulsive Scale(YBOCS). The results were as follows. 1) The OCD patients showed significantly higher prevalence of avoidant, depresssive and borderline personality disorder(p<0.01) compared to controls. 2) The BAI score had significant effect on the avoidant personality score(t=3.23, p<0.003). The BDI score had significant effect on the depressive personality score(t=3.08, p=0.004). The YBOCS(t=2.10, p=0.043) and BAI(t=2.60, p=0.014)scores had significant effects on the borderline personality score. We found that OCD patients had higher prevalence of avoidant, depressive, and borderline personality disorders. We also found that obsessive-compulsive symptoms have significant effect on the severity of borderline personalty traits. We suggest that it would be very helpful to consider Axis-II disorders for managing patients with obsessive-compulsive disorder.
Anxiety ; Borderline Personality Disorder ; Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Obsessive-Compulsive Disorder* ; Personality Disorders ; Prevalence

Dermatitis artefacta lies in a gray zone, between the specialities of psychiatry and dermatology. The condition could mimic a number of other lesions and therefore is a source of much confusion in clinical practice. Here, we describe a case of dermatitis artefacta in an 11-years old girl, which resembled self-harming behavior in Borderline personality disorder. We then discuss how the two could be differentiated and why this becomes imperative while dealing with such cases.
Borderline Personality Disorder* ; Dermatitis* ; Dermatology ; Female ; Humans ; Self-Injurious Behavior ; Skin*

This study examined the clinical features of patients with obsessive-compulsive disorders who had been admitted to the Department of psychiatry, Seoul National Univ. Hospital from 1980 to 1995, using retrospective investigation of medical records. The subjects were 26 patients(male 22, female 4) who were compatible with the criteria of OCD by DSM-III-R. The results were as follows: 1) The most common obsessive thinking was pathologic doubt, followed by contamination, need for symmetry, somatic and sexual obsession, religious and aggressive obsession in descending order. Twenty three percent of patients had multiple obsessions. 2) The most common compulsive ritual was checking, followed by washing, need to ask and confess, symmetry and precision, counting in descending order. Thrity nine percents of patients had multiple rituals. 3) Depression, schizophrenia, Tourette's syndrome and tic disorder were the co-existing disorder with obsessive compulsive disorder. Cormorbid personality disorders in OCD were obsessive personality disorder, borderline personality disorder, schizotypal personality disorder and passive-aggressive personality disorder. 4) The course in OCD with co-existing disorder was worse than that in pure OCD. 5) The verbal IQ was significantly higher than the performance IQ checked by KWIS in obsessive compulsive disorder.
Borderline Personality Disorder ; Ceremonial Behavior ; Compulsive Behavior ; Depression ; Female ; Humans ; Inpatients* ; Medical Records ; Obsessive Behavior ; Obsessive-Compulsive Disorder* ; Passive-Aggressive Personality Disorder ; Personality Disorders ; Retrospective Studies ; Schizophrenia ; Schizotypal Personality Disorder ; Seoul ; Thinking ; Tic Disorders ; Tourette Syndrome

Patients with borderline personality disorder (BPD) show significant impairment in functioning, particularly in the interpersonal and social domains. Prior reports suggest that clozapine may be effective in the management of BPD. We present the case of a patient with BPD who experienced persistent suicidal ideation and was treated with clozapine at a state psychiatric hospital. After treatment failure with other psychotropic medications, clozapine medication was initiated; not only did suicidal ideation cease, but social and professional functioning also greatly improved to the point of no longer requiring intensive levels of observation or restrictive procedures. Clozapine appears to be efficacious in the management of suicide attempts and self-injurious behavior. Moreover, it appears to be promising as a therapeutic measure for ameliorating the global functioning of patients with severe BPD. Larger, randomized, blinded, and controlled prospective studies are needed to confirm these findings and to determine optimal dosage.
Borderline Personality Disorder* ; Clozapine* ; Hospitals, Psychiatric ; Humans ; Prospective Studies ; Self-Injurious Behavior ; Social Adjustment ; Suicidal Ideation ; Suicide ; Treatment Failure

Borderline personality disorder (BPD) is characterized by identity and interpersonal problem, affective dysregulation and pervasive severe impulsivity. Although sleep disturbances are not primary symptoms of BPD, they are important aspects of this disorder. However, clinicians and researchers did not give much attention to the sleep symptoms of BPD yet. Measured by nocturnal polysomnography, increased sleep latency as well as reduced total sleep time and sleep efficiency, and 'depression-like' REM abnormalities (i.e., reduced REM latency and increased REM density) are found in BPD patients. Co-morbid sleep disorders such as chronic insomnia, nightmare disorder or circadian rhythm sleep disorder associated with BPD have been reported. Clinicians should focus on the sleep complaints of BPD patients, and carefully manage such symptoms with sleep hygiene education, cognitive psychotherapy or light therapy.
Borderline Personality Disorder ; Circadian Rhythm ; Cognitive Therapy ; Dreams ; Humans ; Hygiene ; Phototherapy ; Polysomnography ; Sleep Wake Disorders ; Sleep Initiation and Maintenance Disorders

Affective Symptoms ; classification ; Borderline Personality Disorder ; classification ; China ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Mental Disorders ; classification

OBJECTIVES: This study aims to determine the prevalence of ADHD among substance users in selected rehabilitation centers admitted from September 1,2008 to October 31,2008 using the Wender-Utah Rating Scale (WURS) and Adult ADHD Self-Report Scale (ASRS).
METHODOLOGY: A total of 104 recovering adult substance users (CI 95%) from rehabilitation centers were included by purposive sampling. They were then asked to answer an information set and subsequently WURS & ASRS was administered, either self-administered or clinician-assisted.
RESULTS: In this study, the prevalence of childhood ADHD among adult substance users using WURS was 23.1%. Of the 80 (77.1%) who didn't reach the cut-off score of 46, twenty-one subjects (20.2%) had WURS scores between 39-45 may have possible ADHD. About 29 (27.9%) subjects showed adult symptoms of ADHD. However, substance users with atypical depression and borderline personality disorder were not screened out and may account for false positive results.
CONCLUSION: About 1/3 of substance users in the study were positive for ADHD using the WURS while 1/5 of those studied had possible ADHD, needing further investigation.

Human ; Male ; Female ; Middle Aged ; Adult ; Young Adult ; Adolescent ; Attention Deficit Disorder With Hyperactivity ; Borderline Personality Disorder ; Depression ; Prevalence ; Psychiatric Status Rating Scales ; Rehabilitation Centers ; Self Report

We report the case of a 29-year-old mixed-race woman suffering from recurrent major depressive episodes, with suicidal ideation and risk, involving several inpatient admissions. A comorbid diagnosis of borderline personality disorder was also recorded in one of her previous inpatient admissions. During her last inpatient admission, a multidisciplinary case discussion and review of the patient's life highlighted several possible intercultural trigger factors that could have contributed to the exacerbation of her psychiatric illness. We emphasise the need to explore intercultural predisposing and precipitating factors for a more complete psychodynamic understanding of psychiatric illnesses among the multiracial population of Singapore. This also adds to the discussion on the management of such patients with the option of formal in-depth psychotherapy in adjunct to medication. This may prevent recurrent relapses, modify suicide intent and reduce the necessity for inpatient treatment, which will be cost-effective and result in efficacious treatment.
Adult ; Asian Continental Ancestry Group ; Borderline Personality Disorder ; epidemiology ; psychology ; Comorbidity ; Cultural Characteristics ; Depressive Disorder, Major ; epidemiology ; psychology ; Ethnic Groups ; Female ; Humans ; Psychotherapy ; methods ; Race Relations ; Religion ; Risk ; Singapore ; Suicidal Ideation