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TitleBorderline Personality Disorder: New Findings and Current
LanguageEnglish
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Total Pages89
Table of Contents
                            Slide Number 1
Precursors of BPD Concept
The Borderline Syndrome
Concepts of Borderline Disorders
Borderline Personality Disorder (BPD)APA DSM-IV Criteria(At least 5 must be present)
Heterogeneity of BPD
BPD Causes and Risk Factors
Prevalence of PDs in a Community Sample(N=2053)
Slide Number 9
Slide Number 10
Comorbidity
QuestionDo the personality disorders, defined by DSM-IV-TR, have construct validity?
Classification of PDs
“…borderline personality disorder is neither borderline nor a personality disorder.”
Borderline Personality Disorder (BPD)APA DSM-IV Criteria(At least 5 must be present)
Latent Structure Analysis of DSM-IV BPD Criteria
Construct Validity of BPD
Evidence for a Single Latent Class of Borderline Pathology
Robins and Guze (1970)
BPD and Axis I
Revising the DSM-5 BPD Proposal
Revising the DSM-5 BPD Proposal- Gunderson, JPD, 2010
Neurobiology of BPD
BPD as a Personality Disorder Emerging from the Interaction of Underlying Genetically-Based Traits
Slide Number 25
Slide Number 26
Normal
Borderline
Stimulus Response to Facial Viewing
Slide Number 30
Slide Number 31
Slide Number 32
The Genetic Epidemiology of Personality Disorders: Results from the Norwegian Institute of Public Health Twin Registry
Highlights
Highlights
Slide Number 36
Dysregulation of Endogenous Opioids in BPD
A Neuropeptide Model of BPD
Slide Number 39
The Rupture and Repair of Cooperation in BPD
Attachment in BPD Patients
Sequential Theoretical Model of BPD Pathogenesis
Longitudinal course
Collaborative Longitudinal Personality Disorders Study (CLPS)
Remission (12 month) From Personality Disorder Over 4 Years
Slide Number 46
Slide Number 47
Slide Number 48
Treatment Studies
Slide Number 50
APA Treatment Recommendations for Patients with Borderline Personality Disorder
Types of Psychotherapy for BPD(published RCTs)
Overview of Psychotherapy for BPD
Behavioral 			PSA
Pharmacotherapy for BPDCochrane review of RCTs
Four Essentials of Effective BPD Treatment
Greatest Stressors for Professionals
Slide Number 58
What about DSM-5?
Should the Name be Changed?
DSM-5Proposed Self-Report System for All Patients (not just PDs)
Patient-Rated Cross-Cutting Measures
Patient-Rated Level 1 Cross-Cutting Measure
Patient-Rated Level 1 Scale of Personality
World Health Organization Disability Assessment Schedule II (WHO-DAS II)36-item Self-administered Version
DSM-5Proposed PD Diagnostic System
Levels of Personality Functioning
Self and Interpersonal Functioning Continuum
Proposed Personality Types for DSM-5
Borderline Personality Disorder Type(overall prototype description)
Borderline Personality Disorder Type
Borderline Personality Disorder Type (continued)
Borderline Personality Disorder Type (continued)
Borderline Personality Disorder Type (continued)
Borderline Personality Disorder Type (continued)
BPD Type Matching Scale
If no specific PD type judged to be present, then consider Personality Disorder, Trait-Specified
Personality Trait Domains
Personality Trait Facets for Trait Domain of Emotionality
Personality Trait Domain or Facet Rating Scale
Adaptive Personality Traits (Draft)
General Diagnostic Criteria for Personality Disorder
Overall Personality Assessment
Diagnostic Criteria for BPD
Diagnostic Criteria for BPD (continued)
Diagnostic Criteria for BPD (continued)
Diagnostic Criteria for BPD (continued)
DSM-5 Recap
Thank you for your interest!
                        
Document Text Contents
Page 1

Borderline Personality Disorder:
New Findings and Current Controversies
Ohio State University Psychiatry Grand Rounds
Columbus, OH – April 20, 2011

John M. Oldham, M.D.
Senior Vice President and Chief of Staff
The Menninger Clinic
Professor and Executive Vice Chair
Menninger Department of Psychiatry and Behavioral Sciences
Baylor College of Medicine
Immediate Past President, American College of Psychiatrists
President-Elect, American Psychiatric Association

Page 2

Precursors of BPD Concept

• Latent schizophrenia (E Bleuler, 1924)
• The borderline group of neuroses (A Stern, 1938)
• Ambulatory schizophrenia (G Zillborg, 1941)
• “As if” personality (H Deutsch, 1942)
• Pseudoneurotic schizophrenia (P Hoch, P Polatin, 1949)
• Borderline states (R Knight, 1953)
• Psychotic character (J Frosch, 1964)
• The borderline syndrome (R Grinker, B Werble,R Drye,

1968)

Page 44

Collaborative Longitudinal Personality
Disorders Study (CLPS)

• 5 Collaborative Sites
Brown (Shea), Columbia (Skodol), Harvard (Gunderson),
Yale (McGlashan), Texas A&M (Morey)

• 668 Patients Recruited Originally (+65)
STPD (N= 86), BPD (N=175), AVPD (N= 158),
OCPD (N= 154), MDD and no PD (N= 95)

• Followed Longitudinally for >14 Years
To determine the stability of symptoms, diagnoses,
dimensions, and functioning and to determine the predictors
of clinical course

Page 45

Remission (12 month) From
Personality Disorder Over 4 Years

Page 88

DSM-5 Recap

• Evidence-based medicine involves both rigorous
research and extensive clinical experience and
wisdom

• Personality is a dimensional construct
• Personality disorders are clinical syndromes
• Published research supports either a categorical

system (e.g., DSM-IV) or a dimensional system
(e.g., FFM) as a framework

• The DSM-5 Work Group has proposed a hybrid
model, but it is still a “work in progress”

• The DSM-5 Field Trials will inform us about the
clinical utility of the model

• Your continued suggestions are welcome

Page 89

Thank you for your interest!

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