Borderline personality disorder and mental health care utilization: The role of self-harm.

The current study examined the associations for borderline personality disorder (BPD) and a specific trait of the disorder, self-harm, with mental health care utilization. Our sample consisted of 145 psychiatric inpatients who completed 3 measures of BPD (Personality Diagnostic Questionnaire-4 [PDQ-4], McLean Screening Inventory for borderline personality disorder [MSI-BPD], Structured Clinical Interview for DSM-IV Axis II Disorders-Personality Questionnaire [SCID-II-PQ]) and the Self-Harm Inventory (SHI). In relationship to mental health care utilization, the correlation for the SHI was significantly larger than those for the PDQ-4, MSI-BPD, or SCID-II-PQ. Thus, self-harm was significantly better at detecting mental health care utilization than was the overall BPD construct, which indicates that some of the more severe manifestations of the disorder are the most predictive of impairment in functioning. These findings also call into question whether BPD (and by extension, personality pathology in general) is most useful in these symptom constellations as opposed to focusing on specific maladaptive traits. (PsycINFO Database Record

Elucidating the association between the self-harm inventory and several borderline personality measures in an inpatient psychiatric sample.

OBJECTIVE: The current study evaluated the utility of the self-harm inventory (SHI) as a proxy for and screening measure of borderline personality disorder (BPD) using several diagnostic and statistical manual of mental disorders (DSM)-based BPD measures as criteria. METHODS: We used a sample of 145 psychiatric inpatients, who completed the SHI and a series of well-validated, DSM-based self-report measures of BPD. RESULTS: Using a series of latent trait and latent class analyses, we found that the SHI was substantially associated with a latent construct representing BPD, as well as differentiated latent classes of 'high' vs. 'low' BPD, with good accuracy. CONCLUSIONS: The SHI can serve as proxy for and a good screening measure for BPD, but future research needs to replicate these findings using structured interview-based measurement of BPD.

Comparing External Correlates of DSM-5 Section II and Section III Dimensional Trait Operationalizations of Borderline Personality Disorder.

The current study evaluated the relative associations of the DSM-5 Section II operationalization of Borderline Personality Disorder (BPD) and dimensional traits included in a diagnosis of BPD in DSM-5 Section III with conceptually relevant external criterion variables. It is important to determine whether or not Section II BPD and constellation of Section III BPD traits have similar positions in the nomological network representing the BPD construct. Moreover, it is important to determine whether or not the trait-based Section III BPD diagnosis is an improvement upon the categorical Section II diagnosis in regard to its associations with external criteria. To evaluate this, we used two samples, a patient sample consisting of 145 psychiatric patients and a university sample consisting of 399 undergraduate students. We conducted a series of correlation and regression analyses in order to determine the relative associations of these two diagnostic methodologies with relevant external criteria. Correlation analyses did not favor either model, but indicated that both Section II and Section III BPD have associations with external criterion variables relevant to BPD. The regression analyses tended to favor the trait-based Section III model, supporting the construct validity and use of the trait profile for BPD in DSM-5 Section III. Generally, it was concluded that the Section II and Section III operationalizations have similar positions in a nomological network representing the BPD construct.

Borderline Personality in the Medical Setting.

OBJECTIVE: Individuals with borderline personality disorder in mental health settings tend to present with relationship difficulties, mood instability/dysphoria, and overt self-harm behavior. In contrast, it appears that individuals with borderline personality disorder in medical settings manifest physical symptoms that are medically difficult to substantiate. Through a review of the literature, we examine 2 symptom manifestations among patients with borderline personality in primary care and general medical settings-namely pain sensitivity and multiple somatic complaints. In addition to reviewing the research of others, we also highlight our own investigations into these 2 areas. DATA SOURCES: We conducted a literature search of the PubMed database and a previous version of the PsycINFO search engine (no restrictions). Search terms included borderline personality, borderline personality disorder, personality disorders; chronic pain, pain, pain syndromes; and somatization disorder, Briquet's syndrome, somatic preoccupation, somatic. STUDY SELECTION: Published articles related to borderline personality, pain and somatic symptoms (ie, somatization disorder, somatic preoccupation) were examined. RESULTS: According to our review, the literature indicates higher-than-expected rates of borderline personality disorder among patients in primary care and general medical settings who present with chronic pain conditions and/or somatic preoccupation. CONCLUSIONS: Unlike patients with borderline personality disorder in mental health settings, who tend to present with relationship difficulties, mood instability/dysphoria, and overt self-harm behavior, patients with borderline personality disorder in primary care settings tend to present with unsubstantiated chronic pain of various types as well as somatic preoccupation.

BORDERLINE PERSONALITY DISORDER IN THE MEDICAL SETTING: Suggestive Behaviors, Syndromes, and Diagnoses.

Borderline personality disorder is a personality dysfunction that is characterized by disinhibition and impulsivity, which oftentimes manifest as self-regulation difficulties. Patients with this disorder have always been present in medical settings, but have been described as "difficult patients" rather than patients with borderline personality disorder. According to empirical findings, a number of behaviors and medical syndromes/diagnoses are suggestive of borderline personality disorder. Suggestive behaviors in the medical setting may include aggressive or disruptive behaviors, the intentional sabotage of medical care, and excessive healthcare utilization. Suggestive medical syndromes and diagnoses in the medical setting may include alcohol and substance misuse (including the abuse of prescription medications), multiple somatic complaints, chronic pain, obesity, sexual impulsivity, and hair pulling. While not all-inclusive or diagnostic, these behaviors and syndromes/diagnoses may invite further clinical evaluation of the patient for borderline personality disorder.

The self-harm inventory: A meta-analysis of its relationship to the personality diagnostic questionnaire-4 as a measure of borderline personality disorder.

OBJECTIVE: The purpose of the present study was to further examine the efficacy of the Self-Harm Inventory (SHI) as a proxy measure in diagnosing borderline personality disorder, with the comparison measure being the Personality Diagnostic Questionnaire-4 (PDQ-4). METHODS: We undertook a meta-analysis of data from our previous studies of psychiatric inpatients (N = 270) and internal medicine outpatients (N = 2587), all of whom completed both the SHI and the PDQ-4. RESULTS: Scores on the SHI and PDQ-4 were strongly correlated, especially after correcting for attenuation due to measurement unreliability (0.78 in the compiled inpatient psychiatry sample and 0.83 in the compiled internal medicine sample). Moreover, the SHI demonstrated statistically significantly greater reliability coefficients relative to the PDQ-4. CONCLUSIONS: Based upon comparison with the PDQ-4, the SHI appears to be an efficacious proxy measure of borderline personality symptomatology in both psychiatric inpatient samples and primary care outpatient samples.

The self-harm inventory: A meta-analysis of its relationship to the personality diagnostic questionnaire-4 as a measure of borderline personality disorder.

OBJECTIVE: The purpose of the present study was to further examine the efficacy of the Self-Harm Inventory (SHI) as a proxy measure in diagnosing borderline personality disorder, with the comparison measure being the Personality Diagnostic Questionnaire-4 (PDQ-4). METHODS: We undertook a meta-analysis of data from our previous studies of psychiatric inpatients (N = 270) and internal medicine outpatients (N = 2587), all of whom completed both the SHI and the PDQ-4. RESULTS: Scores on the SHI and PDQ-4 were strongly correlated, especially after correcting for attenuation due to measurement unreliability (0.78 in the compiled inpatient psychiatry sample and 0.83 in the compiled internal medicine sample). Moreover, the SHI demonstrated statistically significantly greater reliability coefficients relative to the PDQ-4. CONCLUSIONS: Based upon comparison with the PDQ-4, the SHI appears to be an efficacious proxy measure of borderline personality symptomatology in both psychiatric inpatient samples and primary care outpatient samples.

Effective Research Strategies for Trainees in Internal Medicine Residency Programs.

For most training programs, the development of research endeavors among trainees is an ongoing challenge. In this article, we review various considerations when attempting to undertake research activities within an internal medicine residency training program, including availability of institutional resources (eg, dedicated research time for trainees and faculty, available faculty mentors, accessible adjunctive personnel), engagement of residents into research, classic project quagmires in training programs, the institutional review board, publication options (eg, letters to the editor, case reports, literature reviews, original research reports), and journal submission strategies. Given that research entails multiple components and distinct skills, the overall program goal should be to make research an educationally understandable process for trainees. Research can be a rewarding activity when nurtured in a facilitating educational environment.

IRRITABLE BOWEL SYNDROME: Relationships with Abuse in Childhood.

Irritable bowel syndrome is allegedly the most common gastrointestinal diagnosis in the United States. The etiology of this syndrome appears to entail the interaction of both genes and the environment. One potential environmental contributory factor to irritable bowel syndrome is abuse in childhood. Of the various forms of abuses previously examined, sexual abuse in childhood appears to be the most patent contributor. However, both emotional and physical abuses may also contribute to irritable bowel syndrome, although less distinctly. Studies examining a combined childhood-abuse variable (i.e., sexual, emotional, and/or physical abuses) in relationship to irritable bowel syndrome also indicate inconsistent results. Given the presence of childhood abuse as a potential factor in the development of irritable bowel syndrome, a number of pathophysiological events are postulated to explain this relationship, including alterations in norepinephrine and serotonin levels as well as dysregulation of the hypothalamic-pituitary-adrenal axis. Only future research will clarify the specific abuse elements (i.e., further clarification of the individual types of abuse, duration of abuse, roles of the perpetrator/victim) and the pathophysiological changes that culminate in irritable bowel syndrome.

Buprenorphine treatment for narcotic addiction: not without risks.

While most clinicians will never prescribe buprenorphine or combined buprenorphine/naloxone, familiarity with the risks of these pharmacological approaches to the treatment of narcotic addiction remains relevant. Overall, medication-assisted treatment has clearly resulted in meaningful gains for a number of individuals who are addicted to narcotics (i.e., opiates and opioids). However, a certain level of risk is inherent with these approaches. For example, both buprenorphine and buprenorphine/naloxone may be diverted and misused (e.g., intravenously injected, intranasally administered), particularly buprenorphine. Likewise, when illicitly injected, both can cause infectious complications as well as result in death from overdose. The risk of death with buprenorphine overdose appears to be heightened with the coadministration of either benzodiazepines or sedative/hypnotics. To conclude, as with all interventions in medicine, buprenorphine treatment for narcotic addiction has a clinically fluctuating risk/benefit equation that must be continually monitored.