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Objective: Several promising studies investigated marine omega-3 fatty acids (ie, fish oil) in borderline personality disorder (BPD), but overall effects remain unclear. The aim of this study was to obtain estimates of effectiveness of omega-3 fatty acids in BPD using meta-analysis, with a priori differentiation of affective, impulsive, and cognitive-perceptual symptom domains., Data Sources: We performed a literature search in PubMed, EMBASE, PsycINFO, and MEDLINE, using terms related to BPD and omega-3 fatty acids. Publication date was not a restriction., Study Selection: We included randomized controlled trials (RCTs) that compared omega-3 fatty acids to placebo or any active comparator and pooled data using meta-analysis. Five studies were included in the meta-analysis, describing 4 RCTs testing effects of omega-3 fatty acids in 137 patients with BPD or BPD-related behavior., Data Extraction: Using a pre-piloted data extraction form, we obtained data including intervention dose, duration, and BPD symptom scale scores, differentiating affective, impulsive, and cognitive-perceptual symptom domains., Results: Random effects meta-analysis showed an overall significant decreasing effect of omega-3 fatty acids on overall BPD symptom severity (0.54 standardized difference in means [SDM]; 95% CI = 0.91 to 0.17; Z = 2.87; P = .0041), without heterogeneity (I 2  = 0.00; Q = 2.63; P = .45). A priori differentiation of relevant symptom domains showed significant effects on affect dysregulation (0.74 SDM; 95% CI = 1.21 to 0.27; Z = 3.11; P = .002) and impulsive behavior (0.45 SDM; 95% CI = 0.84 to 0.059; Z = 2.26; P = .024). However, effects on cognitive-perceptual symptoms did not reach the significance threshold., Conclusions: Available data indicate that marine omega-3 fatty acids improve symptoms of BPD, particularly impulsive behavioral dyscontrol and affective dysregulation. Marine omega-3 fatty acids could be considered as add-on therapy., (© Copyright 2021 Physicians Postgraduate Press, Inc.)

Background: Electroconvulsive therapy (ECT) is the gold-standard treatment for refractory depression. Borderline personality disorder (BPD) is generally considered a poor predictor of treatment response. We sought to assess symptom-severity outcomes among depressed patients with (BPD+) and without (BPD-) comorbid BPD undergoing acute phase ECT., Methods: The study sample consisted of at least moderately depressed patients who received an acute course of ECT from January 2011 to December 2016 at an academic, freestanding psychiatric hospital. Participants completed a DSM-IV-validated BPD screening instrument at baseline. Measures of DSM-IV depressive symptom severity from the Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR) were taken serially on 4 occasions. Outcomes of interest comprised total QIDS-SR score trajectory, QIDS-SR suicidality subscore, and symptom cluster subscores posited to differentiate response among antidepressant treatments., Results: Of the 693 individuals who met study inclusion criteria, 145 (20.9%) screened positive for BPD. Overall, ECT was associated with significant improvement of depressive symptoms (χ²₁ = 504.8, P < .0001). Despite differing from BPD- individuals on key baseline features, BPD+ individuals responded to ECT with similar improvement in overall depression severity (χ²₁ = 0.22, P = .64), suicidality (χ²₁ = 1.63, P = .20), and core emotional (χ²₁ = 0.63, P = .43), sleep (χ²₁ = 0.20, P = .65), and atypical (χ²₁ = 1.30, P = .25) symptoms after 15 treatments. Post hoc analysis indicated a slightly less robust overall response among the BPD+ group by the 15th treatment., Conclusions: Acute course ECT benefits depressed patients with or without comorbid BPD, although patients with BPD may exhibit less pronounced improvement over time., (© Copyright 2021 Physicians Postgraduate Press, Inc.)

Objective: This report examines the relationship of DSM-IV borderline personality disorder (BPD) to anxiety disorders using data on the reciprocal effects of improvement or worsening of BPD and anxiety disorders over the course of 10 years., Method: We reliably and prospectively assessed borderline patients (n = 164) with DSM-IV-defined co-occurring generalized anxiety disorder (GAD; n = 42), panic disorder with agoraphobia (n = 39), panic disorder without agoraphobia (n= 36), social phobia (n = 48), obsessive-compulsive disorder (OCD; n = 36), and posttraumatic stress disorder (PTSD; n = 88) annually over a period of 10 years between 1997 and 2009. We used proportional hazards regression analyses to assess the effects of monthly improvement or worsening of BPD and anxiety disorders on each other's remission and relapse the following month., Results: BPD improvement significantly predicted remission of GAD (hazard ratio [HR] = 0.65, P <.05) and PTSD (HR = 0.57, P < .05), whereas BPD worsening significantly predicted social phobia relapse (HR = 1.87, P < .05). The course of anxiety disorders did not predict BPD remission or relapse, except that worsening PTSD significantly predicted BPD relapse (HR = 1.90, P < .05)., Conclusion: BPD negatively affects the course of GAD, social phobia, and PTSD. In contrast, the anxiety disorders, aside from PTSD, had little effect on BPD course. For GAD and social phobia, whose course BPD unidirectionally influences, we suggest prioritizing treatment for BPD, whereas BPD should be treated concurrently with panic disorders, OCD, or PTSD. We discuss state/trait issues in the context of our findings., (© Copyright 2015 Physicians Postgraduate Press, Inc.)

Objective: To examine the relationship of borderline personality disorder (BPD) to mood disorders by using data from the Collaborative Longitudinal Personality Disorders Study on the reciprocal interactions of BPD with both depressive and bipolar disorders over the course of 10 years., Method: The study included 223 BPD patients with DSM-IV-defined co-occurring major depressive disorder (MDD) (n = 161), bipolar I disorder (n = 34), and bipolar II disorder (n = 28) who were reliably and prospectively assessed over a period of 10 years between 1997 and 2009. Proportional hazards regression analyses were used to assess the effects of improvement or worsening of BPD and mood disorders on each disorder's time to remission and time to relapse., Results: Borderline personality disorder and MDD had strong and statistically significant reciprocal effects, delaying each disorder's time to remission (BPD's effect on MDD, P = .0004; MDD's effect on BPD, P = .0002) and accelerating time to relapse (BPD's effect on MDD, P = .0410; MDD's effect on BPD, P = .0011), whereas BPD and the bipolar disorders were largely independent disorders except that bipolar II lengthened BPD's time to remission (P = .0085)., Conclusions: Borderline personality disorder and MDD interactions suggest overlap in their psychopathologies and argue for prioritizing the treatment of BPD. Borderline personality disorder and bipolar disorders appear to be independent disorders, underscoring the need to provide appropriate treatment for each., (© Copyright 2014 Physicians Postgraduate Press, Inc.)

Objective: The first purpose was to determine the rate of use of prescription opioid medication reported by patients with borderline personality disorder and to compare that to the rate reported by Axis II comparison subjects during a 10-year period of prospective follow-up. The second purpose was to determine the most clinically relevant predictors of prescription opioid use among borderline patients., Method: The medical conditions and Axis I disorders of 264 borderline patients and 63 Axis II comparison subjects were assessed at 6-year follow-up and 5 contiguous follow-up waves that were 2 years apart. These assessments were conducted between July 1998 and December 2010. Family history of psychiatric disorder was assessed at baseline by interviewers blind to the diagnostic status of the subjects. All 3 areas were assessed using semistructured interviews with proven psychometric properties: the Medical History and Services Utilization Interview (MHSUI), the Structured Clinical Interview for DSM-III-R Axis I Disorders (SCID-I), and the Revised Family History Questionnaire., Results: Borderline patients were significantly more likely to report the use of prescription opioid medication over time than Axis II comparison subjects (OR = 1.79; 95% CI, 1.01-3.17). The best predictors of opioid use among borderline patients were the time-varying presence of back pain (OR = 1.95; 95% CI, 1.41-2.70), fibromyalgia (OR = 3.29; 95% CI, 1.70-6.36), and osteoarthritis (OR =3.32; 95% CI, 2.08-5.29) as well as a baseline history of drug abuse (OR= 1.89; 95% CI, 1.27-2.81)., Conclusions: The sustained use of prescription opioids is common among and discriminating for patients with borderline personality disorder. The results also suggest that these borderline patients may be particularly sensitive to physical pain-mirroring their well-known heightened sensitivity to emotional pain., (© Copyright 2014 Physicians Postgraduate Press, Inc.)

Objective: Because of the potential treatment implications, it is clinically important to distinguish between bipolar II depression and major depressive disorder with comorbid borderline personality disorder. The high frequency of diagnostic co-occurrence and resemblance of phenomenological features has led some authors to suggest that borderline personality disorder is part of the bipolar spectrum. Few studies have directly compared patients with bipolar disorder and borderline personality disorder. In the present study from the Rhode Island Methods to Improve Diagnostic Assessment and Services project, we compared these 2 groups of patients on demographic, clinical, and family history variables., Method: From December 1995 to May 2012, 3,600 psychiatric patients presenting to the outpatient practice at Rhode Island Hospital (Providence, Rhode Island) were evaluated with semistructured diagnostic interviews for DSM-IV Axis I and Axis II disorders. The focus of the present study is the 206 patients with DSM-IV major depressive disorder and borderline personality disorder (MDD-BPD) and 62 patients with DSM-IV bipolar II depression without borderline personality disorder., Results: The patients with MDD-BPD were significantly more often diagnosed with posttraumatic stress disorder (P < .001), a current substance use disorder (P < .01), somatoform disorder (P < .05), and other nonborderline personality disorder (P < .05). Clinical ratings of anger, anxiety, paranoid ideation, and somatization were significantly higher in the MDD-BPD group (all P < .01). The MDD-BPD patients were rated significantly lower on the Global Assessment of Functioning (P < .001), their current social functioning was poorer (P < .01), and they made significantly more suicide attempts (P < .01). The patients with bipolar II depression had a significantly higher morbid risk for bipolar disorder in their first-degree relatives than the MDD-BPD patients (P < .05)., Conclusions: Patients diagnosed with bipolar II depression and major depressive disorder with comorbid borderline personality disorder differed on a number of clinical and family history variables, thereby supporting the validity of this distinction., (© Copyright 2013 Physicians Postgraduate Press, Inc.)

Background: In view of reports of a high incidence of Axis II disorders among patients with bulimia nervosa, we assessed personality diagnoses and traits in a sample of bulimic patients both preceding and following treatment for the eating disorder., Method: The Personality Disorder Examination, a structured interview to assess DSM-III-R personality disorders, was administered to 34 in-patients and 49 outpatients with bulimia nervosa entering treatment. Thirty of 49 outpatients were reassessed after 6 weeks of treatment with desipramine or placebo., Results: At initial assessment, 38% of inpatients (N = 13) and 29% of outpatients (N = 14) fulfilled criteria for at least one personality disorder, most frequently borderline personality disorder. There were significant correlations between Personality Disorder Examination trait scores and clinical measures of eating disorder and depressive symptoms. Of 30 outpatients who were reinterviewed following treatment, 3 of 9 patients lost one or more personality diagnoses at post-treatment assessment, and 2 of 21 patients without initial Personality Disorder Examination diagnoses received one or more diagnoses at the second interview. Changes in Personality Disorder Examination trait scores, but not diagnoses, were correlated with changes in some clinical measures., Conclusion: These data suggest that the assessment of Axis II disorders in patients with bulimia nervosa is problematic and raise the possibility that personality features in this group may be influenced by the course of their Axis I disorder.

Sixty patients with personality disorders were evaluated by several different diagnostic instruments to determine the prevalence of cyclothymia in borderline personality disorder (BPD) and in other personality disorders (OPD). Cyclothymia occurred more frequently in BPD than in OPD, regardless of which diagnostic system was used. In contrast, the prevalence of major, minor, and intermittent depression, hypomania, and bipolar disorder was not significantly different in BPD as compared with OPD. Cyclothymic borderlines and noncyclothymic borderlines could not be distinguished on behavioral or functional measures. These results have implications for the diagnostic validity of both BPD and cyclothymia.

A case is reported of a young woman with attention deficit disorder and concomitant borderline personality disorder who was successfully treated with methylphenidate. The overlapping criteria for these disorders are discussed and recommendations for treatment with psychostimulants are suggested.

Ninety-four consecutive patients seeking treatment for eating disorders were evaluated for eating attitudes and behaviors, weight history, psychiatric symptoms, psychosocial stressors, social adaptation, family environment, and the presence of borderline personality organization. The patients were divided into borderline and nonborderline groups and were compared on the above dimensions, with 46% of the patients showing borderline personality features. The borderline patients and the nonborderline patients had relatively few differences in the severity of their symptomatic eating behaviors and attitudes. The borderline patients, however, were significantly more disturbed on a number of relevant dimensions, including general psychiatric symptoms, psychosocial adaptation, family environment, self-destructive behavior, and treatment history. The authors suggest, on the basis of their findings and the findings of previous studies, that about one third of eating-disordered patients have marked borderline characteristics. They recommend that research studies in the future control for the eating-disordered patients' character pathologies. They also recommend that clinicians use a combination of long-term relationship-oriented treatment and psychopharmacological treatment with eating-disordered patients who have borderline personality disorder.

Thirty patients meeting DSM-III-R criteria for bulimia nervosa with at least three bingeing episodes a week were compared with 30 age- and sex-matched controls on DSM-III personality measures. The bulimic patients were more likely to display cluster B (histrionic, narcissistic, antisocial, and borderline) personality abnormalities (odds ratio 15.0) and cluster C (avoidant, dependent, compulsive, and passive-aggressive) personality abnormalities (odds ratio 4.3) than were the community controls. This study supports the finding that personality disorder is a possible risk factor for bulimia.

The comorbidity of depression and borderline disorder was studied in 39 symptomatic borderline inpatients defined by the Diagnostic Interview for Borderlines using three independent methods for assessing depression and three definitions of depression. Evaluations were conducted by the Schedule for Affective Disorders and Schizophrenia interviews for Research Diagnostic Criteria (RDC) depressive disorders, by clinical ratings for atypical depressive disorder, and by self-rated questionnaires for hysteroid dysphoria. Diagnoses of an RDC depression were made in 25 (64.1%), atypical depressive disorder in 16 (41%), and hysteroid dysphoria in 25 (64.1%) of the borderline patients. Two depressive diagnoses were present in 64.1% of patients, while 17.9% of patients met criteria for all three depressive disorders. No one method accurately characterized depression in borderline patients.

To test the hypothesis that bulimia may be associated with borderline personality traits or frank borderline personality disorder, the authors administered the Diagnostic Interview for Borderlines (DIB) under blind conditions to 52 bulimic subjects, 22 outpatient controls with a history of major depression but no history of an eating disorder, and 13 nonpsychiatric controls. Only 1.9% of bulimic subjects met revised DIB criteria for borderline personality disorder, and mean DIB scores were almost identical in bulimic subjects and controls with major depression. These results argue against a relationship between bulimia per se and borderline personality disorder or traits.