• A systematic method for clinical description and classification of both normal and abnormal personality variants is proposed based on a general biosocial theory of personality. Three dimensions of personality are defined in terms of the basic stimulus-response characteristics of novelty seeking, harm avoidance, and reward dependence. The possible underlying genetic and neuroanatomical bases of observed variation in these dimensions are reviewed and considered in relation to adaptive responses to environmental challenge. The functional interaction of these dimensions leads to integrated patterns of differential response to novelty, punishment, and reward. The possible tridimensional combinations of extreme (high or low) variants on these basic stimulusresponse characteristics correspond closely to traditional descriptions of personality disorders. This reconciles dimensional and categorical approaches to personality description. It also implies that the underlying structure of normal adaptive traits is the same as that of maladaptive personality traits, except for schizotypal and paranoid disorders.

https://jamanetwork.com/journals/PSYCH/articlepdf/494070/archpsyc_44_6_014.pdf

A systematic method for clinical description and classification of personality variants: A proposal.

Contrary to common clinical perceptions, individuals with personality disorders attempt and commit suicide at nearly the same rate as individuals with major depression. In particular, those with borderline personality disorder are at high risk for suicidal behavior and nonsuicidal self-injury. Yet there is significant controversy surrounding the diagnosis of borderline personality disorder in terms of its existence, its definition and symptom structure, its Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) axis location, and its importance as a contributing factor to suicidality and nonsuicidal self-injury. Furthermore, both suicidal and nonsuicidal self-harm is prominent in borderline personality disorder. There is often confusion between suicidal and nonsuicidal self-injury with one sometimes mistaken for the other. Nonsuicidal self-injury is sometimes met with hospitalization, because it is viewed as life threatening. Alternately, the potential lethality of suicidal behavior is underestimated, because it occurs in the context of multiple low lethality self-harm behaviors. It is possible to view these behaviors as distinct yet on a spectrum in borderline personality-disordered patients. With respect to treatment of self-injury in personality disorders, some recent pharmacotherapy trials have been conducted, though efficacy is often unclear. Findings with respect to psychotherapy, particularly dialectical behavior therapy, a form of cognitive behavioral treatment, are promising.

Suicidal and self-injurious behavior in personality disorder: controversies and treatment directions.

Borderline personality has been, for many years, a discredited diagnostic concept. In 1979 a review of the literature concluded that its validity status was very uncertain. The authors have reviewed research conducted since then and discuss it in terms of the Robins & Guze (1970) criteria. In spite of existing unclear issues, the balance is tipping in favour of the validity of borderline personality, as diagnosed with new research criteria. This development is taking place in the context of a growing interest in the area of personality disorders.

Borderline personality. A review of recent research.

The psychoanalytic concept of Personality Organization (PO) may be operationalized by means of a Structural Interview as well as by means of psychological tests. The present study utilized the Stru ...

Personality organization defined by DMT and the Structural Interview.

In Denmark sex and age standardized rates of first-admission diagnosis of the borderline state (301.83; ICD-8), have significantly increased during the 16 year interval 1970-85. There was no increase in the sex and age standardized rates of first-admission diagnosis of the other borderline state schizophrenia latens (295.59; ICD-8), in the same period. There was not sex difference in application of the 301.83 diagnosis, but a generation effect, the age group 15-34 especially contributed to the increase. Analysis of the geographic variation showed a five-fold relative risk of receiving the 301.83 diagnosis in the metropolitan area of Copenhagen compared with a total of three selected counties. Possible causes of the increase are discussed. There is every probability that the increase is due to change in diagnostic habits, but change in population psychiatric morbidity can not be excluded.

Increasing incidence of borderline states in Denmark from 1970-1985.

The diagnosis of borderline disorders poses complex problems of a semantic and methodological nature. The various diagnostic criteria sets published are examined and compared. Gunderson's borderline personality disorder and the DSM-III schizotypal and borderline disorders are recommended, as used with the structured interviews developed for them. Problems concerning the relationship of borderline disorders to the major psychoses, the importance of brief psychotic experiences, diagnostic efficiency of items, and various cut-off levels of criteria are discussed in detail, and proposals for further research are pointed out.

A critical examination of empirical studies of the diagnosis of borderline disorders in adults.

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A critical examination of empirical studies of the diagnosis of borderline disorders in adults.