Clinical Aspects of Borderline Personality Disorder

Deborah Daniels Carver, MD

Disclosures

Medscape Psychiatry & Mental Health eJournal. 1997;2(5) 

In This Article

Abstract & Introduction

The majority of patients with borderline personality disorder (BPD) can improve in time if given appropriate treatment. In a study known as PI-500--one of the largest studies with the best follow-up--two thirds of the patients were "clinically well" at follow-up. Results of this study suggest that factors associated with the best outcomes for patients with BPD include high intelligence (IQ >130); unusual artistic talent; physical attractiveness (women only); and obsessive-compulsive features that enhance self-discipline, work-orientation, and the ability to structure leisure time. Regarding treatment, psychobiologic principles suggest the impulsive behavior should be ameliorated by enhancing serotonergic activity with selective serotonin reuptake inhibitors. Because there may be a relationship between affective instability and hyperresponsiveness of the noradrenergic and cholinergic systems, agents that stabilize catecholaminergic function, such as monoamine oxidase inhibitors, lithium, or carbamazepine, may be helpful in treating labile BPD patients. Antipsychotics, mood stabilizers, anxiolytics, and antidepressants can also play a role in the pharmacologic management of BPD. Depression is a frequent chief complaint in patients with BPD. It can be a positive sign of growth during treatment, or it can foreshadow a suicide attempt. Understanding of the etiology of a patient's depressive symptoms is crucial to providing the appropriate treatment. Although there appears to be an association between BPD and bipolar disorder, the exact nature of this relationship is unclear. It has been observed, however, that while not every adolescent with BPD develops bipolar disorder, most adolescents with bipolar disorder also have features of BPD.

Impulsive and frequently self-destructive acts of patients with borderline personality disorder (BPD) can pose a tremendous challenge for clinicians treating them. Advances in the understanding of BPD and its management, however, are improving the prognosis and outcome. During a symposium entitled "Clinical Aspects of Borderline Personality Disorder," presented at the 150th Annual Meeting of the American Psychiatric Association in San Diego, California, 4 leading clinicians highlighted major developments in BPD: Michael H. Stone, MD, of the New York State Psychiatric Institute, discussed new insights into the course of the illness and outcomes identified in long-term, follow-up studies. Larry J. Siever, MD, of the Bronx VA Medical Center, reviewed the current understanding of the biologic correlates of BPD and their implications for pharmacotherapy. Harold W. Koenigsberg, MD, of New York Hospital-Cornell Medical Center, presented a systematic approach to the psychotherapy of patients with BPD and depression. Finally, Clarice J. Kestenbaum, MD, of the New York State Psychiatric Institute, looked at the relationship between BPD in adolescence and bipolar disorder in adulthood.

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