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Clinical studies on the borderline concept with special reference to suicidal behavior
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
1987 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The diagnostic concept of borderline personality has had various meanings throughout the last decades. From current clinical practice and research two principally different concepts have emerged: The syndrome concept of borderline personality disorder ( BPD ) as identified by the DSM-III or the Diagnostic Interview for Borderline (DIB) and the psychodynamic concept of borderline personality organization (BPO) as defined from the structural Interview (SI) by Otto Kernberg.

In the first part of the present study, the DIB, the SI and a percept-genetic test called Defense Mechanism test (DMT) have been utilized in a clinical study on psychiatric inpatients. In the second part completed suicides are studied among patients with borderline personality disorder.

Inter-rater reliability was satisfactory for the DIB both when utilized as a clinical interview and as a chart scoring instrument. Previous research findings concerning descriptive validity of the BPD concept were further supported. Fairly reliable scorings of personality organization could be made from the SI. BPO turned out to be a very inclusive concept and a subgroup (46%) also met criteria for BPD. By means of the DMT specific psychodynamic features were identified among patients with BPD which discriminated them from patients with other personality disorders or schizophrenic disorder. It is concluded, that there is empirical support to consider BPD a valid diagnostic entity. BPO should be conceptualized as a level of personality functioning rather than a diagnostic category and its validity remains to be proven.

Patients with BPD were not seriously overrepresented in a material of 145 psychiatric patients, suicided during inpatient care or shortly after discharge 1961 to 1980. The number and proportion of borderline patients, however, increased for every five- years-period. In an analysis of cases suicided during inpatient treatment, repressive/rejective behavior from staff was frequently observed. Risk factors were identified in comparative studies. Male sex, extensive earlier hospitalization, repressive/rejective staff behavior and frequent previous suicide attempts were associated with completed suicides. A specific pattern of psychological variables was identified among suicided borderline patients including antisocial traits, drug abuse and a less intense interpersonal attachment.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 1987. , 51 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 204
Keyword [en]
borderline
National Category
Psychiatry
Identifiers
URN: urn:nbn:se:umu:diva-100571OAI: oai:DiVA.org:umu-100571DiVA: diva2:793363
Public defence
1987-12-18, Psykiatriska klinikens föreläsningssal, KV, Regionsjukhuset i Umeå, Umeå universitet, Umeå, 09:15
Projects
digitalisering@umu
Note

Diss. (sammanfattning) Umeå : Umeå universitet, 1987, härtill 7 uppsatser.

Available from: 2015-03-16 Created: 2015-03-04 Last updated: 2015-04-09Bibliographically approved
List of papers
1. An empirical comparison of three different borderline concepts.
Open this publication in new window or tab >>An empirical comparison of three different borderline concepts.
1987 (English)In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 76, no 3, 246-55 p.Article in journal (Refereed) Published
Abstract [en]

Forty-six inpatients were independently diagnosed according to the DSM-III concept of borderline personality disorder, the diagnostic interview for borderlines (DIB) and the concept of borderline personality organization, which is linked to Kernbergs structural interview. The interviews were videotaped. Satisfactory inter-rater reliability was demonstrated for the DIB, which furthermore showed high sensitivity and specificity in identifying patients with a clinical DSM-III diagnosis of borderline personality disorder from patients with a other personality disorders or schizophrenic disorders. Discriminant features, demographic profile and earlier treatment history for the patients with a borderline personality disorder are described and discussed. The structural interviews were scored according to a specified format. Inter-rater reliability was satisfactory but not too impressive. Borderline personality organization turned out to be a very broad concept and only half of the patients within this concept received a syndrome diagnosis of borderline personality disorder. A general conclusion was that borderline personality organization should not be considered as a diagnostic entity but rather as a different diagnostic dimension representing an intermediate level of personality structure.

Identifiers
urn:nbn:se:umu:diva-36469 (URN)3673651 (PubMedID)
Available from: 2010-09-30 Created: 2010-09-30 Last updated: 2017-12-12
2. Borderline diagnosis from hospital records:  reliability and validity of Gunderson's diagnostic interview for Borderlines (DIB)
Open this publication in new window or tab >>Borderline diagnosis from hospital records:  reliability and validity of Gunderson's diagnostic interview for Borderlines (DIB)
1985 (English)In: Journal of Nervous and Mental Disease, ISSN 0022-3018, E-ISSN 1539-736X, Vol. 173, no 1, 32-4 p.Article in journal (Refereed) Published
Abstract [en]

Two trained and experienced clinical psychologists and two nontrained students rated the sections in Gunderson's Diagnostic Interview for Borderlines (DIB) on the basis of hospital records for 16 patients (DIB-R). The results showed that both reliability and validity, i.e., correlations with an actual interview, were unexpectedly high, around .80 for the trained judges and around .55 for the nontrained judges. The conclusion is that the DIB may be used for retrospective diagnosis of borderline patients from hospital records.

National Category
Psychiatry Psychology
Research subject
Psychiatry; Psychology
Identifiers
urn:nbn:se:umu:diva-43960 (URN)3965609 (PubMedID)
Available from: 2011-05-16 Created: 2011-05-16 Last updated: 2017-12-11Bibliographically approved
3. Psychodynamic features in borderline personality disorder identified by a subliminal test, the Defense Mechanism Test.
Open this publication in new window or tab >>Psychodynamic features in borderline personality disorder identified by a subliminal test, the Defense Mechanism Test.
1989 (English)In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 80, no 1, 101-5 p.Article in journal (Refereed) Published
Abstract [en]

Twenty-seven psychiatric inpatients, diagnosed according to DSM-III and the Diagnostic Interview for Borderline (DIB), and 7 healthy controls were tested with the Defense Mechanism Test (DMT), a test of subliminal perception based on psychoanalytic theory. In the test a specific stimulus is presented subliminally in a tachistoscope and the patient's perceptual distortions are registered. Patients with borderline personality disorder (BPD) were compared with patients with other personality disorders, patients with schizophrenic disorders and healthy controls. Specific perceptual distortions were identified among patients with BPD. Some individual DMT signs correlated with some deviant behaviors as identified by the DIB. The findings supported the psychodynamic validity of the concept of borderline personality disorder. It is concluded that DMT is a promising research instrument that provides an empirical approach to crucial psychodynamic phenomena.

Identifiers
urn:nbn:se:umu:diva-36467 (URN)2669443 (PubMedID)
Available from: 2010-09-30 Created: 2010-09-30 Last updated: 2017-12-12

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