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Risk of suicide appears to be highest when patients are in their 20s as well as in the presence of co-occurring mood disorders or substance-related disorders (87) discount 50 mg dramamine mastercard medications ocd. Physical handicaps may result from self-inflicted injury or failed suicide attempts. These individuals often have notable diffi- culty with occupational, academic, or role functioning. Their functioning may deteriorate in unstructured work or school situations, and recurrent job loss and interrupted education are com- mon. The social cost for patients with borderline personality disorder and their families is sub- stantial. Longitudinal studies of patients with borderline personality disorder indicate that even though these patients may gradually attain functional roles 10–15 years after admission to psy- chiatric facilities, still only about one-half will have stable, full-time employment or stable mar- riages (40, 134). Recent data indicate that patients with borderline personality disorder show greater lifetime utilization of most major categories of medication and of most types of psycho- therapy than do patients with schizotypal, avoidant, or obsessive-compulsive personality dis- order or patients with major depressive disorder (135). The additional use of assessment instruments can be useful, especially when the diagnosis is unclear. Certain assessment issues relevant to all personality disorders should be considered when di- agnosing borderline personality disorder. For the diagnosis to be made, the personality traits must cause subjective distress or significant impairment in functioning. The traits must also deviate markedly from the culturally expected and accepted range, or norm, and this deviation must be manifested in more than one of the following areas: cognition, affectivity, control over impulses, and ways of relating to others. The clinician should also ascertain that the personality traits are of early onset, pervasive, and enduring; they should not be transient or present in only one situation or in response to only one specific trigger. It is important that borderline personality disorder be assessed as carefully in men as in women. The ego-syntonicity of the personality traits may complicate the assessment process; the use of multiple sources of information (e. Given the high comorbidity of axis I disorders with borderline personality disorder, it is important to do a full axis I evaluation. Useful approaches are to obtain a description of the patient’s personality traits and coping styles when prominent axis I symptoms are absent and to use information provided by people who have known the patient without an axis I disorder. If axis I disorders are present, both the axis I disorders and borderline personality disorder should be diagnosed. Because the personality of children and adolescents is still developing, borderline personal- ity disorder should be diagnosed with care in this age group. Often, the presence of the disorder does not become clear until late adolescence or adulthood. When assessing a patient with borderline personality disorder, the clinician should carefully look for the presence of risk-taking and impulsive behaviors, mood disturbance and reactivity, risk of suicide, risk of violence to persons or property, substance abuse, the patient’s ability to care for himself/herself or others (e. However, some features of borderline personality disorder may overlap with those of mood disorders, complicating the differential diagnostic assessment. However, in borderline per- sonality disorder, the mood swings are often triggered by interpersonal stressors (e. Depressive features may meet criteria for major depressive disorder or may be features of the borderline personality dis- order itself. Depressive features that appear particularly characteristic of borderline personality disorder are emptiness, self-condemnation, abandonment fears, self-destructiveness, and hope- lessness (91, 92). It can be particularly difficult to differentiate dysthymic disorder from bor- derline personality disorder, given that chronic dysphoria is so common in individuals with borderline personality disorder. In other cases, what appear to be features of borderline personality disorder may constitute symptoms of an axis I disorder (e. A more in-depth consideration of the differential diag- nosis or treatment of the presumed axis I condition may help clarify such questions. Although borderline personality disorder may be comorbid with dissociative identity disorder, the latter (unlike borderline personality disorder) is characterized by the presence of two or more distinct identities or personality states that alternate, manifesting different patterns of behavior. It is present in 10% of individuals seen in outpatient mental health clinics, 15%–20% of psychi- atric inpatients, and 30%–60% of clinical populations with a personality disorder. Borderline personality disorder is diagnosed predominantly in women, with an estimated gender ratio of 3:1. It is approximately five times more common among first-degree biological relatives of those with the disorder than Treatment of Patients With Borderline Personality Disorder 43 Copyright 2010, American Psychiatric Association.
Computerized Universal Primary Care N = 771 Primary care At 1-year follow-up generic dramamine 50 mg amex symptoms diabetes type 2, Fink, et al. Project Share Selective Primary Care N = 1,186 Primary At 1-year follow-up, Ettner, et al. Six-year growth curve effects lower for marijuana, amphetamine use, and drunkenness. Project Star Universal School and N = 42 urban At 1-year follow-up, lower Report 1: (Midwestern Community/ public middle proportion of students Pentz, et al. Prevention Multicomponent and junior high reporting past-week and (1989)83 Project) schools in Kansas past-month use of alcohol. Report 2: City, Missouri Secondary prevention Pentz & and Indianapolis, effects on baseline users Valente Indiana; 3,412 were observed up to 1. Report 2: N = Report 2: At posttest, a Wagenaar, et 1,721-3,095 reduction in the number of al. Long-term effects of prenatal and infancy nurse home visitation on the life course of youths: 19-year follow-up of a randomized trial. Enduring effects of prenatal and infancy home visiting by nurses on children: follow- up of a randomized trial among children at age 12 years. Promoting positive adult functioning through social development intervention in childhood: Long-term effects from the Seattle Social Development Project. Effects of a universal classroom behavior management program in frst and second grades on young adult behavioral, psychiatric, and social outcomes. The distal impact of two frst-grade preventive interventions on conduct problems and disorder in early adolescence. Developmentally inspired drug prevention: Middle school outcomes in a school-based randomized prevention trial. Outcomes during middle school for an elementary school-based preventive intervention for conduct problems: Follow-up results from a randomized trial. Impact of early intervention on psychopathology, crime, and well- being at age 25. From childhood physical aggression to adolescent maladjustment: The Montreal Prevention Experiment. Preventing binge drinking during early adolescence: One-and two-year follow-up of a school-based preventive intervention. Effectiveness of a universal drug abuse prevention approach for youth at high risk for substance use initiation. Evaluation of Life Skills Training and Infused-Life Skills Training in a rural setting: Outcomes at two years. Randomized study of combined universal family and school preventive interventions: Patterns of long-term effects on initiation, regular use, and weekly drunkenness. Substance use outcomes 5½ years past baseline for partnership-based, family-school preventive interventions. Effectiveness of a selective, personality-targeted prevention program for adolescent alcohol use and misuse: A cluster randomized controlled trial. Effectiveness of a selective intervention program targeting personality risk factors for alcohol misuse among young adolescents: Results of a cluster randomized controlled trial. Beyond primary prevention of alcohol use: A culturally specifc secondary prevention program for Mexican heritage adolescents. The adolescents training and learning to avoid steroids program: Preventing drug use and promoting health behaviors. Randomized trial of brief family interventions for general populations: Adolescent substance use outcomes 4 years following baseline. Brief family intervention effects on adolescent substance initiation: School-level growth curve analyses 6 years following baseline. Longitudinal substance initiation outcomes for a universal preventive intervention combining family and school programs.
