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Biomedical subjects

M C Zanarini

Publications and source records attributed to M C Zanarini.

At least 37 records · Page 2Linked to original sources
PubMed1998

Axis I comorbidity of borderline personality disorder.

OBJECTIVE: The purpose of this study was to assess the lifetime rates of occurrence of a full range of DSM-III-R axis I disorders in a group of patients with criteria-defined borderline personality disorder and comparison subjects with other personality disorders. METHOD: The axis I comorbidity of 504 inpatients with personality disorders was assessed by interviewers who were blind to clinical diagnosis and who used a semistructured research interview of demonstrated reliability. RESULTS: Four new findings emerged from this study. First, anxiety disorders were found to be almost as common among borderline patients (N=379) as mood disorders but far more discriminating from axis II comparison subjects (N=125). Second, posttraumatic stress disorder (PTSD) was found to be a common but not universal comorbid disorder among borderline patients, a finding inconsistent with the view that borderline personality disorder is actually a form of chronic PTSD. Third, male and female borderline patients were found to differ in the type of disorder of impulse in which they "specialized." More specifically, substance use disorders were significantly more common among male borderline patients, while eating disorders were significantly more common among female borderline patients. Fourth, a lifetime pattern of complex comorbidity (i.e., met DSM-III-R criteria for both a disorder of affect and a disorder of impulse at some point before the patients' index admission) was found to have strong positive predictive power for the borderline diagnosis as well as a high degree of sensitivity and specificity. CONCLUSIONS: These results suggest that the lifetime pattern of axis I comorbidity characteristic of borderline patients and distinguishing for the disorder is a particularly good marker for borderline personality disorder.

Adolescent↗
PubMed1997

Reported pathological childhood experiences associated with the development of borderline personality disorder.

OBJECTIVE: The purpose of this study was to assess a full range of pathological childhood experiences reported by patients with criteria-defined borderline personality disorder and comparison patients with other personality disorders. METHOD: The pathological childhood experiences reported by 467 inpatients with personality disorders were assessed by interviewers who used a semistructured research interview and were blind to clinical diagnosis. RESULTS: Of the 358 patients with borderline personality disorder, 91% reported having been abused, and 92% reported having been neglected, before the age of 18. The borderline patients were significantly more likely than the 109 patients with other personality disorders to report having been emotionally and physically abused by a caretaker and sexually abused by a noncaretaker. They were also significantly more likely to report having a caretaker withdraw from them emotionally, treat them inconsistently, deny their thoughts and feelings, place them in the role of a parent, and fail to provide them with needed protection. The borderline patients with a childhood history of sexual abuse were significantly more likely than those without such a history to report having experienced all but one of the types of abuse and neglect studied. When all significant risk factors were considered together, four were found to be significant predictors of a borderline diagnosis: female gender, sexual abuse by a male noncaretaker, emotional denial by a male caretaker, and inconsistent treatment by a female caretaker. CONCLUSIONS: The results suggest that sexual abuse is neither necessary nor sufficient for the development of borderline personality disorder and that other childhood experiences, particularly neglect by caretakers of both genders, represent significant risk factors.

Adolescent↗
PubMed1997

Childhood antecedents of self-destructiveness in borderline personality disorder.

OBJECTIVE: To assess the relationship between lifetime patterns of self-destructive behaviour and various parameters of childhood abuse and neglect in patients with borderline personality disorder (BPD) compared with other personality disorder (OPD) controls. METHOD: The subjects were 42 inpatients with the diagnosis of BPD and 17 OPD controls. Lifetime patterns of self-destructive behaviour were assessed using the Lifetime Borderline Symptom Index. Childhood experiences were assessed using a semistructured interview by raters who were blind to diagnosis. RESULTS: Chronic self-destructive behaviour discriminated patients with BPD from OPD controls. In the borderline group, parental sexual abuse was significantly related to suicidal behaviour and both parental sexual abuse and emotional neglect were significantly related to self-mutilation. CONCLUSION: Both parental sexual abuse and emotional neglect appear to play a role in the etiology of self-destructive behaviour in BPD. The results highlight the importance of considering the effects of sexual abuse within its environmental context and suggest that the etiology of borderline symptoms is likely multifactorial.

Adolescent↗
PubMed1997

Pathways to the development of borderline personality disorder.

The available empirical evidence concerning the etiology of borderline personality disorder is reviewed. A tripartite model of the development of BPD is then presented. This model has three elements: a traumatic childhood (broadly defined), a vulnerable (hyperbolic) temperament, and a triggering event or series of events. The authors conclude that each borderline patient has a unique pathway to the development of BPD that is a painful variation on an unfortunate but familiar theme.

Adolescent↗
PubMed1991

The face validity of the DSM-III and DSM-III-R criteria sets for borderline personality disorder.

OBJECTIVE: The main objective of this study was to determine the congruence between DSM-III and DSM-III-R diagnoses of borderline personality disorder derived through the use of semistructured research interviews or given by experienced clinicians after lengthy consultations with an interdisciplinary team. METHOD: The presence of the DSM-III and DSM-III-R criteria sets for borderline personality disorder was assessed in a study group of 253 patients with personality disorders (148 inpatients and 105 outpatients) by raters who were blind to clinical diagnoses and who used information from two semistructured interviews of proven reliability. These diagnoses were then compared with "longitudinal expert all data" (LEAD) standard clinical diagnoses provided by therapists specifically asked to base their diagnoses on DSM criteria. RESULTS: Both criteria sets were found to be overinclusive when compared with the LEAD standard. Most criteria were also found to lack specificity. However, the three DSM-III-R criteria that are new or revisions of DSM-III criteria were found to be more specific, and raising the cutoff on the DSM-III-R criteria from five to six improved specificity. CONCLUSIONS: Both the DSM-III and DSM-III-R criteria sets for borderline personality disorder as assessed by semistructured interview lack face validity because they are nonspecific when compared with a rigorous but representative clinical standard, and the results of studies using these criteria sets may prove misleading to researchers and clinicians because they seem to define a nonspecific type of serious character pathology.

Adolescent↗
PubMed1990

Cognitive features of borderline personality disorder.

Of 50 patients with borderline personality disorder, 100% reported disturbed but nonpsychotic thought, 40% (N = 20) reported quasi-psychotic thought, and none reported true psychotic thought during the past 2 years; only 14% (N = 7) reported ever experiencing true psychotic thought. Disturbed and quasi-psychotic thought was significantly more common among these patients than among patients with other axis II disorders or schizophrenia and normal control subjects; however, true psychotic thought was significantly more common among schizophrenic patients. While disturbed thought was also common among axis II disorder and schizophrenic patients, quasi-psychotic thought was reported by only one of these subjects, suggesting that quasi-psychotic thought may be a marker for borderline personality disorder.

Adult↗
PubMed1990

Discriminating borderline personality disorder from other axis II disorders.

The authors used the Revised Diagnostic Interview for Borderline Patients to assess 22 clinical features of 120 patients with borderline personality disorder and 103 control subjects with other axis II disorders. Four of the 22 features were common in but nondiscriminating for borderline disorder, 11 were discriminating for but nonspecific to borderline disorder, and seven were more specific to borderline disorder. The authors conclude that many clinical features thought to be indicative of borderline disorder are better viewed as personality disorder traits and that the seven more specific features, alone or in conjunction with one another, may be particularly useful markers for borderline personality disorder.

Adult↗
PubMed1987

Current overview of the borderline diagnosis.

The authors review the literature on the diagnosis of borderline personality disorder and describe the core dynamic features that account for its unstable phenomenology and explain in part the complexity of and the controversies associated with the diagnosis. A review of differential diagnosis suggests that the boundary with schizophrenia is well established, that the boundary with affective disorder is becoming clearer, and that the most subtle boundary distinctions lie with other forms of personality disorder. A growing body of evidence about antecedents to and longitudinal aspects of borderline personality disorder confirms its diagnostic validity.

Borderline Personality Disorder↗
PubMed1986

Transitional object use and borderline psychopathology.

The authors examined whether transitional object use distinguishes borderline patients from patients with other personality disorders or schizophrenia and from normal subjects. One hundred five subjects were given a structured interview to assess present and past transitional object use. The borderline group had the highest scores on the interview, and the group with nonborderline axis II diagnoses the lowest. Although transitional object use was not specific to the borderline diagnosis, it did emerge as a potentially useful developmental and psychodynamic marker for borderline persons.

Adolescent↗
PubMedDate not supplied

Pharmacotherapy of borderline outpatients.

The charts of 50 outpatients meeting both Diagnostic Interview for Borderlines (DIB) and DSM-III criteria for Borderline Personality Disorder (BPD), 29 outpatients meeting DSM-III criteria for Antisocial Personality Disorder (APD), and 26 outpatients meeting DSM-III criteria for Dysthymic Disorder, as well as DSM-III criteria for some other type of Axis II disorder (dysthymic other personality disorder [OPD]) were reviewed blind to proband diagnosis to determine both the percentage of those in each group who had adequate medication trials and the efficacy of those trials. Borderlines were significantly more likely than antisocial controls to have received an adequate trial of some form of medication. They were also significantly more likely than antisocial controls to have received an adequate trial of anxiolytics and antidepressants. However, they were distinguished at the trend level or better from both antisocial and dysthymic OPD controls by their greater likelihood of having received an adequate trial of neuroleptics, lithium, and polypharmacy. The percentage of adequately treated borderlines who experienced some degree of symptom relief was not significantly different than that found in either control group. However, adequately treated borderlines were significantly less likely than adequately treated dysthymic OPD controls to have had a definite response to pharmacotherapy (i.e., shown marked improvement of target symptoms).

Adult↗
PubMedDate not supplied

Axis I phenomenology of borderline personality disorder.

The Axis I phenomenology of 50 outpatients meeting both Diagnostic Interview for Borderlines (DIB) and DSM-III criteria for Borderline Personality Disorder (BPD), 29 outpatients meeting DSM-III criteria for Antisocial Personality Disorder (APD), and 26 outpatients meeting DSM-III criteria for Dsythymic Disorder as well as DSM-III criteria for some other type of Axis II disorder (dysthymic OPD) was assessed blind to clinical diagnosis using the Structured Clinical Interview for DSM-III (SCID). Borderlines were significantly more likely than antisocial controls to have met DSM-III criteria for an affective disorder, particularly Dysthymic Disorder, and an anxiety disorder. They were also significantly more likely than dysthymic OPD controls but significantly less likely than antisocial controls to have met DSM-III criteria for alcohol abuse/dependence and drug abuse/dependence. The authors conclude that: (1) the link between BPD and unipolar affective disorders is less specific than previously suggested, and (2) there is a link between BPD and impulse disorders that may be of equal, if not greater, importance.

Adult↗
PubMedDate not supplied

Childhood experiences of borderline patients.

The childhood histories of 50 outpatients meeting both Diagnostic Interview for Borderlines (DIB) and DSM-III criteria for Borderline Personality Disorder, 29 outpatients meeting DSM-III criteria for Antisocial Personality Disorder, and 26 outpatients meeting DSM-III for Dysthymic Disorder as well as DSM-III criteria for some other type of Axis II disorder were assessed, blind to proband diagnosis, using a semistructured interview. Borderlines were significantly more likely than those in either control group to report a history of abuse, particularly verbal and sexual abuse. They were also significantly more likely than antisocial controls to report a history of neglect, particularly emotional withdrawal, and significantly more likely than dysthymic other personality disorder controls to report a history of early separation experiences. The authors conclude that the development of Borderline Personality Disorder is more strongly associated with (1) exposure to chronically disturbed caretakers than prolonged separations from these same adults and (2) a history of abuse than a history of neglect.

Adolescent↗
PubMedDate not supplied

Axis II comorbidity of normal-weight bulimia.

The axis II comorbidity of 34 women with active bulimia, 18 women with remitted bulimia, and 20 women with a history of major depression was assessed blind to axis I diagnosis using the Diagnostic Interview for Personality Disorders (DIPD), a semistructured interview of demonstrated reliability. Fifty percent of the active bulimic subjects, 44% of the remitted bulimic subjects, and 35% of the depressed controls met DSM-III criteria for at least one axis II disorder. Despite the generally higher prevalence of axis II pathology in both bulimic groups than depressed controls, these between-group differences did not reach significance. The clinical implications of these findings are discussed.

Adolescent↗
PubMedDate not supplied

Clozapine treatment of borderline patients: a preliminary study.

Clinicians frequently encounter patients who present with borderline personality disorder (BPD) and prolonged and/or pronounced psychotic symptoms of an atypical nature. Fifteen such patients were treated with clozapine and rerated blind to baseline symptomatology and functional level from 2 to 9 months after beginning treatment (mean = 4.2 +/- 2.1). The overall symptomatology of these patients as rated on the Brief Psychiatric Rating Scale (BPRS) decreased significantly from a mean of 57.0 +/- 10.4 to a mean of 37.8 +/- 7.7 (t = 7.03, df = 14, P = .001). Their positive, negative, and general symptoms as rated by the BPRS also decreased significantly. Additionally, their Global Assessment Scale (GAS) score increased significantly from a mean of 30.8 +/- 4.7 to a mean of 43.1 +/- 8.6 (t = 5.19, df = 14, P = .001). These results suggest that clozapine may be an effective antipsychotic agent for this subset of BPD patients. However, double-blind, placebo-controlled studies are necessary to confirm these preliminary results.

Adolescent↗
PubMedDate not supplied

Comparison of American and Japanese outpatients with borderline personality disorder.

The borderline psychopathology of 33 American and 19 Japanese female outpatients who met the Revised Diagnostic Interview for Borderlines (DIB-R) criteria for borderline personality disorder (BPD) was compared. There were significant differences between the samples in the DIB-R total score, as well as in the affect/cognition section and scaled section scores. However, only one of the 22 summary statements (SS) of the DIB-R distinguished American borderlines from Japanese borderlines. Most of the differences seemed to reflect differences in inclusion criteria. It is concluded that there are borderline patients in Japan whose psychopathology is basically identical to that of American borderline patients.

Adolescent↗
PubMedDate not supplied

The dissociative experiences of borderline patients.

The study objective was to assess the severity and quality of dissociative experiences reported by borderline patients. Two hundred ninety criteria-defined borderline patients and 72 axis II controls completed the Dissociative Experiences Scale (DES), a 28-item self-report measure with demonstrated reliability and validity. Thirty-two percent of borderline patients had a low level of dissociation, 42% a moderate level, and 26% a high level similar to that reported by patients meeting criteria for posttraumatic stress disorder (PTSD) or dissociative disorders. The controls had a significantly different distribution of overall DES scores: 71% reported a low level of dissociation, 26% reported a moderate level, and only 3% reported a high level. In addition, borderline patients had a significantly higher score than the controls on 21 of 28 DES items and a significantly higher overall DES score, as well as the score on the 3 factors that have been found to underlie the DES, absorption, amnesia, and depersonalization. The results of this study suggest that the severity of dissociation experienced by borderline patients is more heterogeneous than previously reported. They also suggest that borderline patients have a wider range of dissociative experiences than are commonly recognized, including experiences of absorption and amnesia, as well as experiences of depersonalization.

Adolescent↗