AAPEL
Data, Statistics on the borderline personality disorder - Bpd
Myths, lies and realities on a true disease.
.
Introduction:
Many studies were made on the borderline disorder, proving that it is a real disease
There is several way to read the data
- A wrong way: "Borderline people are alcoholics, junkies, violents, etc" (so a stupid way)
- A right way: "Borderline people are trying almost all possible ways to escape from their suffering."
(For example: Acting like a "crazy" way when we are drunk is more "understandable" than when we are sober)
These behaviors have to be seen like self-defensive way to cope with, to calm their suffering or like an warning sign for the close and not to stigmatize them".
And keep in mind that each person is unique !
Meme page en Francais / Same page in french
Statistical data, studies, on the borderline disorder, prevalence, epidemiology, data:
Text Disorder or Disease
WHO (World health organization)
APA
Central BPD
NIMH
Borderlines U.K.
Comparison with other known,diseases
Commit suicide
Children, teenagers,already borderline
Cure (data)
Etiology, causes,(risk factors)(traumatisms, mother-child relationship, family, biology, genetics)
Others disorders and addictions,(Comorbidity, co-occurence, links with alcohol, self-mutilation, bipolar, binge eating, bulimia anorexia, delinquency, depression, dissociative, drug, gender identity, lie, panic disorder, sexuality, somatization, post traumatic stress, violence...)
Therapies, clinical trials studies
Myths

WHO,(World Health Organization) data:
* A person on 4 suffers from a mental disorder at one time of her life.
* Approximately 450 million people currently suffer from mental disorders
* There are treatments but about two third will never be treated
* With an adequate treatment people can live productive lives
* WHO estimates that between 2 and 4% of the general population satisfied the criteria of the borderline disorder (information borderline U.K.)
Read the text the "right to be sick".. and "right to diagnosis"
The American Psychiatric Association,which publishes the DSM,is talking about:
* 2% of the general population
* 10% of the individuals in external consultation (not hospitalized) psychiatric
* 15 to 20% of the individuals hospitalized in psychiatry (inpatients)
* 30 to 60% of the people with a personality disorder have a borderline disorder
* Commit suicide "completed/succeeded" in 8 to 10% of the cases
* It is often difficult to prevent "serious" suicide attempt or self-mutilation, since this behavior can occur impulsively,and without warning.
read the APA text 
The BPD Central (American association that "cannot be ignored" about the disease) is telling us
* The statistic of 2% cannot be accurate (underestimated) for the following reasons:
Clinicians are actively discouraged from putting BPD on a patient's chart because of the stigma and insurance denials and because most clinicians do not have the training to make a diagnostis (AAPEL: To be clear, there is much much more)
* There is 50% more borderline patients than patients suffering from the disease of Alzheimer
* There is as much Borderline than the sum of the patients suffering from Schizophrenia and Bipolar Disorder,(manic-depression)
* 11% of the individuals in external consultation (outpatients, not hospitalized) psychiatric
* 20% of the individuals hospitalized in psychiatry (inpatient)
* BPD has a 10% suicide rate
The NIMH . (American National Institute of Mental Health) is saying to us
* Although less known than Schizophrenie or the bipolar disorder, the borderline disorder is more common, affecting 2% of the population
* The rate of suicide in the United States (all confused populations) is 0.011% (1/10000) 
Borderline U.K. is saying to us
* According to a study of the researcher Anthony Nemo, approximately 1.6 million people in United Kingdom (the U.K.) wouls satisfy with the criteria of the borderline disorder.
(AAPEL 59 million people in the U.K. is thus 2.71% population )
* The major part of these people were not diagnosed and much being unaware of the existence of the disease
* It concluded that at least 29 peoples would die per DAY of causes related to the borderline disorder in the United Kingdom . The majority not being recorded as those having for example a dissociative crisis whereas they are in their car, just as certain overdoses are not allotted to the borderline disorder. 
Comparisons with other known diseases
Why talk about AlDS, of DlABETES or schizophrenia and other?
Just to compare data. The goal not being to minimize the horror of a disease but "to maximize" the problem of the Borderline personality disorder
AlDS
According to UNAlDS (WWW.UNAlDS.ORG) , there was in 2OO2, 42 million people carrier of VlH or having the disease, that is to say 1.2% of the world population (3.5 billion)
DlABETES
According to WHO, there would be 154 million people with DlABETES , that is to say 4.4% of the world population
.
Schizophrenia
1% of the people (1.1% for NlMH) develop a schizophrenia during their life (0.39% to one moment)
* Meltzer HY. - Psychiatric Hospital of Vanderbilt, Nashville, USA
Curr Psychiatry Rep. 2OO2 Aug - Suicidality in schizophrenia: a review of the evidence for risk factors and treatment options.
Approximately one in 10 patients with schizophrenia will commit suicide each year
It is estimated that up to 50% of patients with schizophrenia will attempt suicide at some point during their life
.
The bipolar disorder,(manic-depressive)
1.2% of the population (NlMH)
20% of suicides (nmha)
.
...
* The borderline disorder would touch 105 million people (3%) in the world
- It is between 2.5 and 3 times more than AlDS
- at least 2 times more than schizophrenia
- at least 2 times more than the bipolar disorder .
When we will have more precise data on the disease, it is possible that we will be able to talk about a number comparable between DlABETICS 4.4% and BORDERLINE 2 to 4% 
Studies about suicide and borderline disorder
* Paris J. - McGill University, Montreal, Quebec, Canada.
2OO2 Psychiatr Serv. - Chronic suicidality among patients with borderline personality disorder.
"METHODS: MEDLINE and PsycINFO databases were searched for all English-language articles published between 1984 and 2OOO containing the keywords "borderline personality disorder" and "suicide" or "suicidality." A total of 170 articles located through this search and additional key articles published before 1990 were reviewed. The most relevant articles were selected of review.
RESULTS AND CONCLUSIONS: One in ten patients (10%) with borderline personality disorder completes suicide, but this outcome is not readily preventable and does not necessarily occur during the course of treatment... Hospitalization is of unproven value in preventing suicide by these patients and can sometimes have negative effects..."

AAPEL: About same rate in schizophrenia with 10% of suicide

* Joel Paris MANDELEVIUM Canada
1994 - Commit suicide in borderline personality disorder - 10% of the borderline patients will end up their life making a success of their suicide and dying ,

* Paul R Duberstein Ph.D Department of Psychiatry - University of Medical Rochester Center, New York
1997: 30 to 40% of the suicides are made by people having a personality disorder

* Bronisch T, Wolfersdorf M - max Planck-Institute of Psychiatry, Munich, Germany
1996 Crisis. - Personality disorders and suicidal behavior.
At least a third of the suicides are made by people having a personality disorder

* Brodsky BS, Malone KM, Ellis SP, Dulit RA, Mann JJ. - Department of Neuroscience, New York State Psychiatric Institute
1997 Am J Psychiatry. - Characteristics of borderline personality disorder associated with suicidal behavior.
214 patients DSM III - Since the impulsive behavior is a strong facet of the personality Borderline disorder, this information can help to explain why a so high percentage of the suicides carried out are it by those with a Borderline disorder

* Brent David M.D., Department Child and Adolescent Psychiatry - University of Pittsburgh Pennsylvania
Johnson BA, et al. 1994: Acad Child Adolesc Psychiatry - a study on suicides of American teenagers emphasizes a personality disorder at more than 42%

* Michel Tousignant Pd D - Department of psychology - University from Quebec in Montreal CANADA
More than 57% of the people died by suicide present a personality disorder

* Asberg M., « Biochemical aspects of suicide.”, 1986 Clin Neuropharmacol.
Weak concentrations of serotonin in the cephalo-rachidian liquid of depressed patients made it possible to predict from ten to twenty times more risks of death by suicide in the year following the exit of the hospital
read page Commits suicide,for details and parasuicide 

Children and Adolescent with Borderline disorder BPD
Here is what the DSM IV-TR says about "personnality"
"Personality traits are formed by early adulthood, persist throughout life and affect every aspect of day to day behavior"
APA (Practice Guideline for the Treatment of Patients With Borderline Personality Disorder)
"Because the personality of children and adolescents is still developing, borderline personality 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. "
But... according to DSM IV
DSM-IV (1994) personality disorders may be diagnosed in children and adolescents who have shown stable maladaptive features that have been present for at least 1 year.
* Lofgren DP, Bemporad J, King J, Lindem K,... - Department of Psychiatry, Harvard Medical School, Boston, MA.
1991 Am J Psychiatry - A prospective follow-up study of so-called borderline children.
Follow-up study of 19 of a group of 32 children (ages 6-10) who had been diagnosed as "borderline" 10-20 years earlier.
CONCLUSIONS: The childhood borderline diagnosis appears to be an antecedent of an array of adult personality disorders, but it is not associated with the adult borderline personality disorder per se diagnoses

* Almqvist F, Puura K, Kumpulainen K... Department of Child Psychiatry, University of Helsinki, Finland
1999 Eur Child Adolesc Psychiatry - Population of children aged from 8 to 9 years, 3.1% suffer from a borderline disorder

* Chabrol H, Montovany A, Chouicha K... University of Toulouse it Mirail, Toulouse, France.
2OO1 Edge J Psychiatry - Frequency of the borderline disorder in schoolboys between 13 and 20 years 10% of the boys and 18% of the girls have a borderline disorder

* Chabrol H, Chouicha K, Montovany A...
2OO1 Encephale - Symptoms of DSM IV borderline personality disorder in a nonclinical population of adolescents: study of a series of 35 patients.
Symptoms of the borderline disorder in 107 students between 15 and 18 years 32% have a borderline disorder DSM IV
This study shows that adolescent borderline personality disorder in non-clinical population is a serious disorder characterised by the importance of mental suffering and behavioural disturbances the disorganising power of which may fix the developmental process in a pathological pathway. Adolescent borderline personality disorder appears in this study to be strongly associated with major depressive disorder and at-risk behaviours linked to impulsivity, affective instability, and suicidal ideation

* Reich DB, Zanarini MC. - Laboratory for Study of Adult Development, McLean Hospital, Belmont, MA, USA
Harv Rev Psychiatry. 2OO1 - Developmental aspects of borderline personality disorder.
This study examined whether patients with borderline personality disorder and controls with other personality disorders remember their childhoods differently with respect to separation difficulties, evocative memory, temperamental factors such as frustration tolerance and mood reactivity, and onset of symptoms.
Patients with borderline personality disorder remembered more difficulties with separation between ages 6 and 17 years, more mood reactivity and poorer frustration tolerance between ages 6 and 17, and the onset of more symptoms (most prominently sadness, depression, anxiety, and suicidality) before age 18 than did patients with other personality disorders.
These results indicate that many of the features of adult patients with borderline personality disorder may initially appear during childhood and adolescence and that these features may be used to differentiate borderline from other personality disorders

* Bradley R, Zittel Conklin C, Westen D. - Department of Psychiatry, Emory University, Atlanta, USA
J Child Psychol Psychiatry. 2OO5 - The borderline personality diagnosis in adolescents: gender differences and subtypes.
RESULTS: The symptoms and phenomenology of adolescent girls with BPD are similar to those of adults. Adolescent boys meeting BPD criteria have a more aggressive, disruptive, antisocial presentation...
Q-analysis isolated four clinically coherent subgroups of girls with BPD: high-functioning internalizing, histrionic, depressive internalizing, and angry externalizing.
Empirically derived subgroups are similar to those identified in recent research with adult females.
CONCLUSIONS: BPD in female adolescents resembles DSM-IV BPD as defined for adults. The operating characteristics of the DSM-IV criteria for adolescent boys require further investigation

Etiology, (investigation about the causes) of the borderline disorder,risk factors
Traumas / Past
Mother-child relationship
"pathological" families
Biology - Serotonin receptors - Brain - Thyroid - B12 vitamin - Epilepsy - Hormonal, estrogen, menopause
Genetics

Trauma / Past

* Sansone RA, Sansone, Wiederman M. - Department of Psychiatry, University of Oklahoma College of Medicine, Tulsa, the USA.
1995 Arch Fam Med 1995 - Trauma Prevalence and links with borderline personality disorder and self-destructive behaviors
Traumatic events were reported by 70.7% of the borderline subjects. (aapel: For 30% thus, the cause is different)
Among them 25.8% sexual abuse, 36.4% physical abuses, 43.7% emotional abuses, 9.3% physical negligence and 43.0% witnesses of violence (aapel: Not obligatorily "physical", this violence can be for example the death of a close relation or what the specialists call "early separation")
This provided study of the obviousnesses which the abuse is not an obligatory factor but contributes to the process . Please read the page PTSD

* Ramklint M, von Knorring AL, von Knorring L, Ekselius L. - Child and Adolescent Psychiatry, Department of Neuroscience, University Hospital, Uppsala, Sweden
2OO3 Nord J Psychiatry. - Child and adolescent psychiatric disorders predicting adult personality disorder: a follow-up study.
"The objective of this study was to examine associations between childhood and adolescent psychiatric disorders and adult personality disorders in a group of former child psychiatric inpatients
The odds of adult schizoid, avoidant, dependent,borderline and schizotypal personality disorders increased by almost 10, five, four, three and three times, respectively, soit suite à une précédente dépression majeure
Les résultats illustrent une association entre les troubles mentaux dans l'enfance et l'adolescence et les troubles de la personnalité à l'age adulte. Identification and successful treatment of childhood psychiatric disorders may help to reduce the risk for subsequent development of an adult personality disorder."

* Bandelow B, Krause J, Wedekind D,... - Dept. of Psychiatry and Psychotherapy, University of Gottingen, Gottingen, Germany.
Psychiatry Res. 2OO5  - Early traumatic life events, parental attitudes, family history, and birth risk factors in patients with borderline personality disorder and healthy controls.
Patients with borderline personality disorder (BPD) were compared with a healthy control group with regard to traumatic life events during childhood.
...retrospective interview with 203 questions about childhood traumatic life events, parental attitudes, family history of psychiatric disorders and birth risk factors. The frequency of reports of traumatic childhood experiences was significantly higher in patients than in controls, including sexual abuse, violence, separation from parents, childhood illness, and other factors... Only four (6.1%) of the BPD patients, but 67 (61.5%) of the controls did not report any severe traumatic events at all. Compared with controls, patients described the attitude of their parents as significantly more unfavorable in all aspects. Patients reported significantly higher rates of psychiatric disorders in their families in general, especially anxiety disorders, depression, and suicidality. Among birth risk factors, premature birth was reported more often in BPD subjects... The present data support the hypothesis that the etiology of BPD is multifactorial and that familial psychiatric disorders and sexual abuse are contributing factors.

* BPD and adoption

Mother-child, parental relationship
* Allen DM, Abramson H, Whitson S,... - Dept. of Psychiatry, University of Tennessee Health Science Center, Memphis, USA.
Compr Psychiatry. 2OO5 - Perceptions of contradictory communication from parental figures by adults with borderline personality disorder: a preliminary study.
This study investigated a hypothesized correlation between contradictory responses from parental figures perceived in present-day interactions by adult subjects and the diagnosis of BPD. One hundred subjects were given a questionnaire designed to assess the frequency of perceived parental response patterns divided into appropriate, conflicting, polarized, and neglectful categories. The BPD and a group subthreshold for the disorder endorsed significantly more conflicting and fewer appropriate responses for the first parental figure rated than did both patient control subjects and normal control subjects without BPD; a trend toward similar results was found for the second parental figure also. The frequency of polarized and neglectful responses was not significantly different among the groups...
These results suggest that contradictory family communication patterns might be considered in models of ongoing reinforcement for dysfunctional BPD behavior.

* Crandell LE, Patrick MP, Hobson RP. Developmental Psychopathology Research Unit, Tavistock Clinic, London, UK.
2OO3 Br J Psychiatry. - 'Still-face' interactions between mothers with BPD and their 2-month-old infants.
Eight mothers with borderline personality disorder and twelve mothers without psychiatric disorder were videotaped interacting with their 2-month-old infants in three successive phases of interaction: face-to-face play; an episode when the mother adopted a 'still face' and was unreactive; and a period when play interactions were resumed.
RESULTS: The mothers with borderline personality disorder were more intrusively insensitive towards their infants. During the still-face period, their infants showed increased looking away and dazed looks. Following this, mother-infant interactions were less satisfying and their infants showed dazed looks and lowering of affect.
CONCLUSIONS: The diagnosis of borderline personality disorder is associated with a particular pattern of mother-infant interaction

* Golomb A, Ludolph P, Westen D, Block MJ... Department of Psychology, Marlboro Psychiatric Hospital, NJ
1994 J Am Psychoanal Assoc - Maternal empathy, family chaos and links with the disorder borderline
Conclusion: The problems of the mother-child relationship can play a significant role in the borderline disorder genesis

* Zweig-Frank H, Paris J. - Institute of Community and Family Psychiatry, Jewish Hospital, Montreal, Que, Canada
1991 Am J Psychiatry - Parents' emotional neglect and overprotection according to the recollections of patients with borderline personality disorder.
The findings showed that the patients with borderline personality disorder remembered both their fathers and their mothers as having been significantly less caring and more controlling than did the nonborderline patients
The recollections provide support for a theory of biparental failure in the development of borderline pathology
Please read overprotection and chronic fatigue syndrome in adult

Pathological families
* Goldman SJ, D' Angelo EJ, DeMaso DR.. - Children' S Hospital, Department of Psychiatry, Boston, MA
1993 Am J Psychiatry 1993 - Psychopathology in the families of children and teenagers suffering from a borderline personality.
The families of patients suffering from a borderline disorder have an higher rate of psychopathologies (psychosis) than the families without anybody suffering of a borderline disorder, more particularly in the area of depressive disorders, substance abuse, antisocial disorder.
The conclusion of these more significant rates of psychopathologies within the members of the family of the group of the borderline patients supports the assumption than a significant antecedent of psychopathology has links with the borderline disorder

* Weiss M, Zelkowitz P, Feldman RB, Vogel J, Heyman M, Paris J. - Division of Child Psychiatry, University of British Columbia, Vancouver.
1996 Can J Psychiatry - Psychopathology in offspring of mothers with borderline personality disorder
The children of the borderline mothers, as compared with controls, had more psychiatric diagnoses, more impulse control disorders, a higher frequency of child BPD. The offspring of borderline mothers are at high risk for psychopathology.

* Abela JR, Skitch SA, Auerbach RP,... - Dept. of Psychology, McGill University, Montreal, Canada.
J Personal Disord. 2OO5 - The impact of parental borderline personality disorder on vulnerability to depression in children of affectively ill parents.
Children of parents with major depressive disorder (MDD) are four to six times more likely than other children to develop MDD
This study examines whether children of parents with comorbid MDD and Borderline Personality Disorder (BPD) (1) are at greater risk for experiencing depressive symptoms
Children of parents with comorbid BPD and MDD were 6.84 times more likely to exhibit a current or past diagnosis of MDD

Biology
Serotonin, neurotransmettor, brain activity
* Hansenne M, Pitchot W, Pinto E, Reggers J... - Department of Psychiatry, University of Liege, CHU Sart Tilman, Belgium
2OOO Psychol Med - Influence of the serotoninergic 5-ht1a receptors, dysfunction in the borderline disorder. Our data suggest that the borderline disorder is characterized by a lower sensitivity of the 5-ht1a receivers

* Gurvits IG, Koenigsberg HW, Siever LJ - Mount Sinai School of Medicine, New York, the USA.
2OOO Psychiatr Covering joint North Am - Dysfunction of the neurotransmettors among patients presenting a BPD.
The dysfunction of the neurotransmettor system can contribute to the features of impulsiveness of the borderline disorder and emotional instability .

* Norra C, Mrazek M, Tuchtenhagen F... Department of Psychiatry and Psychotherapy, Medical Faculty of the University of Technology, Aachen, Germany
2OO3 J Psychiatr LMBO - the dysfunction of the serotoninergic central activity was supposed among patients with a borderline disorder characterized by a style of impulsive behaviors.
Our results contribute to another argument in the direction of the assumption of a weak neurotransmission sérotonin in the BPD and seem to indicate the link with impulsive character of this disorder

* Please read the page brain functioning, splitting and borderline disorder

Thyroïd
* Garbutt JC, Loosen PT, Glenn M.
1987 Psychiatry Res - ...TSH response to TRH in borderline personality disorder.
We recently reported that some patients with borderline personality disorder (BPD) exhibit a blunted thyrotropin (thyroid-stimulating hormone; TSH) response to thyrotropin-releasing hormone (TRH).

* Loosen PT, Garbutt JC, Prange AJ.
1987 Pharmacopsychiatry - Evaluation of the diagnostic utility of the TRH-induced TSH response in psychiatric disorders.
To evaluate the diagnostic utility of TSH blunting, the TRH-induced TSH response was measured in 168 normal subjects and 176 psychiatric patients. It was blunted in some acutely depressed, alcoholic, and borderline patients, but not in schizophrenic patients. In both depression and alcoholism the fault also occurred during symptomatic recovery, though with reduced frequency. Although TSH blunting was useful in distinguishing between borderline and schizophrenic patients...

* Heller
Possibly a third (33%) of borderlines may suffer from low thyroid (hypothyroidism) - despite a normal 'TSH' blood test.

* Marco JC, Bondia A, Flecha J,... - Servicio de Anestesia, Hospital de Zaragoza - Spain
1995 Rev Esp Anestesiol Reanim - Psychologic morbidity in thyroidectomized patients
We selected 33 patients who were to undergo thyroidectomy
We detected a 29.6% prevalence of mental illness before surgery; this figure increased to 33.31% after surgery
One in 3 patients shows signs of significant mental illness and could benefit from some type of psychological or psychiatric treatment

B12 
* Please read also the page about BPD, Vitamin B12

Epilepsy
* Gelisse P, Genton P, Samuelian JC, Thomas P, Office M. - Center Saint-Paul, Marseilles
2OO1 Rev Neurol - psychiatric Disorders in the juvenial myoclonic epilepsy
26.5% with psychiatric disorders and 7% with borderline disorder
* Dr Heller
"I suspect both the BPD and bipolar are a form of epilepsy (brain cells firing inappropriately and out of control). That’s why anti-epilepsy medications work so well"

Gluten, Coeliac disease ?
* Lahat E, Broide E, Leshem M, Evans S.... - Unit of Pediatric Neurology, Tel Aviv University Sackler Faculty of Medicine, Zerifin, Israel.
2OOO Pediatr Neurol. - Prevalence of celiac antibodies in children with neurologic disorders.
"Contrary to studies performed in adults, these results did not demonstrate any relationship between common neurologic disorders without a specific diagnosis during childhood and Celiac Disease"

* Pynnonen P, Isometsa E, Aalberg V, ... - Dept of Adolescent Psychiatry, Hospital for Children and Adolescents, Helsinki Finland
2OO2 Acta Paediatr. - Is coeliac disease prevalent among adolescent psychiatric patients?
"Coeliac disease occasionally presents solely with neuropsychiatric symptoms and may predispose to mental and behavioural disorders
The prevalence rate was found to be 1 in 140.
Conclusion: The results do not suggest that undetected CD is markedly overrepresented among adolescent psychiatric outpatients."

Hormonal - Estrogen level - Menopause
* Please read also the page about BPD, hormonal and premenstrual cycle

Genetic
* Skodol AE, Siever LJ, Livesley WJ, Gunderson JG, Pfohl B, Widiger TA. - Department of Psychiatry, Columbia University College of Physicians and Surgeons, and the New York State Psychiatric Institute
2OO2 Biol Psychiatry. - The borderline diagnosis II: biology, genetics, and clinical course.
In Part II, we review the biology, genetics, and clinical course of borderline personality disorder (BPD)...There may be a strong genetic component for the development of BPD, but it seems clear, at least, that there are strong genetic influences on traits that underlie it, such as neuroticism, impulsivity, anxiousness, affective lability, and insecure attachment..."

* Torgersen S - Center for Research in Clinical Psychology, University of Oslo, Norway
2OOO - Psychiatr Clin North Am - Genetics of BPD patients
The effect of genes on the development of the borderline personality disorder is probably left essential.  More small and large studies are necessary to draw the firmer conclusions about the influence of the genetics on the borderline disorder

* Dr Heller
"Genetic factors are important - borderline tends to run in families. The risk of developing borderline is 6 times higher when a close relative has the disorder. In studies of identical twins, researchers have discovered that many personality traits are genetically determined"

Others problems, addictions, risk factors and other disorders with possible relation with borderline disorder(Cormorbidity, co-occurence)
Substance abuse
Alcoholism
Self-mutilation
Other personality disorders
Bipolar disorder
Bulimia nervosa, anorexia, binge-eating
Delinquency
Depression
Dissociative
Dysthymia
Drugs
Lie, memory and vision impairment, false accusation
Miscellaneous: Impulsive.disorders (IED, gambling, kleptomania, spending, road rage, shoplifting, trichotillomania ...)
Panic disorder with agoraphobia
Sexual addictions, identity or gender identity
Parasuicidality
Somatization and diverse physical complaints
Stress post traumatic
Violence

* Without more precise data, we will trust the assumption that the borderline disorder affects 3% of the population,(WHO, Bpd central, Borderline UK, Torgersen,...)
* With 60 million peoples in France, that would make at least 1,8 million people in France

Substance abuse and borderline disorder

* 55% of persons with a substance abuse problem had some type of mental illness(NAMI / Journal of the American Medical Association entitled "The Epidemiological Catchment Study")
* 50 to 67% of people having both substance abuse and mental illness have Borderline disorder (National Alliance for the Mentally ill NewYork State). In those case, treat the substance abuse without taking account of the disorder can only lead to a failure
--> So, in therory 27 to 37% of peoples with substance abuse would be borderline (NAMI)
.
* An estimated 15.9 million Americans aged 12 years old or older were current illicit drug users or alcohol. This estimate represents 7.1 percent of the population (Source SAMHSA - Substance Abuse and Mental Health Services Administration - year 2OO1)
--> 1.9% to 2.59% of the US population would have both substance abuse and borderline disorder
.
* 21 to 67% of borderline peoples have substance abuse (TARA APD)
--> these 21 to 67 % (mean 44%) represent 1.9% to 2.59% (mean 2.25%) of the population so the total BPD population with and without substance abuse would be 5.11% if we believe these data
Alcohol and borderline disorder
* 16 to 23% of Alcohol abuse peoples have a borderline personality disorder

* Zanarini MC, Frankenburg FR, Hennen J,... - McLean Hospital, Belmont, USA.
Am J Psychiatry. 2OO4 - Axis I comorbidity in patients with borderline personality disorder: 6-year follow-up and prediction of time to remission
Follow-Up 2 years: 20.4% of alcohol abuse/dependence experienced by Patients With Borderline Personality Disorder

* Nace EP, Saxon JJ Jr, Shore N, 1983.Arch Gen Psychiatry. "A comparison of borderline and nonborderline alcoholic patients." 94 patients (abstinents) 21.2% borderline
* Nurnberg HG, Rifkin A, Doddi S. - Department of Psychiatry, Queens Hospital Center, 1993 Compr Psychiatry., "A systematic assessment of the comorbidity of DSM-III-R personality disorders in alcoholic outpatients." 50 patients (abstinents) 16.0% borderline
* Morgenstern J, Langenbucher J, Labouvie E, Miller KJ. 1997 J Abnorm Psychol. - The comorbidity of alcoholism and personality disorders in a clinical population: prevalence rates and relation to alcohol typology variables.,  366 patients  22.4% borderline
* Zimmerman & Mattia 142 patients   23.2% borderline

Self-injury, self-harm, self mutilation and borderline disorder
Read self-mutilation and BPD
Read dissociation and self-mutilation
Other personality disorders and borderline disorder, prevalence
* Fyer MR, Frances AJ, Sullivan T,... Department of Psychiatry, New York Hospital-Cornell Medical Center, NY
1988 Arch Gen Psychiatry - "Comorbidity of borderline personality disorder" 180 inpatients with BPD DSM III - 91% of the BPD patients had 1 additional diagnosis, and 42% had two or more additional diagnoses

* Becker DF, Grilo CM, Edell WS, ... - Yale Psychiatric Institute, Yale University, New Haven, Connecticut, USA
2OOO Am J Psychiatry Comorbidity of borderline personality disorder with other personality disorders in hospitalized adolescents and adults - 138 adolescents and 117 adults with personality disorder DSM III R - 68 (49%) of the adolescents and 50 (43%) of the adults have a Borderline disorder
* Widiger TA PhD - Professor Department of Psychology University of Kentucky Lexington
  and Frances AJ 1989: Epidemiology, diagnosis, and comorbidity of borderline personality disorder
  Estimated that 11% of not hospitalized patients et 20% psychiatric inpatients are borderline.
* Svenn Torgersen Ph. D Department of Psychology - University of Oslo, Norway
  BPD Prevalence estimated in general population is 2-3%
* Gross R, Olfson M, Gameroff M, Shea,... Department of Epidemiology - Mailman School of Public Health, Columbia University, New York, USA
2OO2 Arch Intern Med - Borderline personality disorder in primary care - 218 patients from an urban primary care practice (non psy), the BPD prevalence is 6.4%
* Silk KR, Westen D, Lohr NE, Benjamin J, ... - Department of Psychiatry, University of Michigan, Ann Arbor
1990 Compr Psychiatry - schizotypal symptoms in borderline personality disorder. With DSM-III-R 36% borderlines had schizotypal symptoms

Bipolar disorder and borderline disorder
please read bipolar or bpd ?
Bulimia, anorexia, binge-eating and borderline disorder
* According to boulimie .fr,80% of bulimics would have a borderline personality disorder

* Braun DL, Sunday SR, Halmi KA. - Dept. of Psychiatry, New York Hospital, Cornell University
1994 Psychol Med. - Psychiatric comorbidity in patients with eating disorders.
105 eating disorder in-patients DSM III
81.9% of the sample, had Axis I diagnoses in addition to their eating disorder.
69% met criteria for at least one personality disorder diagnosis.

* Zerbe KJ, Marsh SR, Coyne L. - Menninger Memorial Hospital, Topeka, KS
1993 Psychiatr Hosp - Comorbidity in an inpatient eating disordered population
Their Axis I eating disorder diagnoses were as follows: 53 had diagnoses of bulimia; 21 had anorexia nervosa; 2 had both diagnoses; 17 had atypical disorders.
Results: Borderline personality disorder was found in 46% of the sample

* Almost 40% of people who are diagnosed with bulimic anorexia (who lose weight by bingeing and purging) may have borderline personalities (http://www.ucdmc.ucdavis.edu)

* Sansone RA; Fine MA; Seuferer S; Bovenzi J - Psychiatry, Wright State University, Dayton, OH
1989 J Clin Psychol - Prevalence of borderline personality symptomatology among women with eating disorders. Results revealed that 39% were classified as borderline

* Marino MF; Zanarini MC - Laboratory for Study of Adult Development, McLean Hospital, Belmont, MA, USA
2OO1 Int J Eat Disord - Relationship between EDNOS (eating disorders not otherwise specified) and its subtypes and borderline personality disorder.
233 female borderline patients, Thirty-three (33) percent of female borderline patients met DSM-III-R criteria for EDNOS

* Kodama K, Noda S. - Department of Neuropsychiatry, Chiba University School of Medicine - Japan
2OO1 Nippon Rinsho - Binge-eating in simple obesity
Obese binge eaters also exhibit more psychiatric symptomatology suchas distortion of body image, low self-esteem, low self-efficacy, a high level of depression, strong perfectionism, high impulsivity and comorbidity of personality disorders, especially a borderline personality disorder

* "Binge eating is clearly a common activity borderlines pursue to stop dysphoria" (dr heller)

Delinquency and borderline disorder
* Gibbs JT. "Personality patterns of delinquent females"
1982 J Clin Psychol - 48 delinquent females, aged 13-18 - 7 (14.5%) corresponded to a model of borderline personality
* Fazel S, Danesh J. - Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.
2OO2 Lancet - Serious mental disorder in 23000 prisoners (mean age 29 years, men 81%)
42% had a personality disorder
* Gosden NP, Kramp P... Clinic of Forensic Psychiatry, Ministry of Justice, Copenhagen, Denmark
2OO3 Acta Psychiatr - Prevalence of mental disorders among 15-17-year-old male adolescent,remand prisoners in Denmark - 36% would have a personality disorder (Ten per cent had previous registered psychiatric contact)
* Longato-Stadler E, von Knorring L... - Department Neuroscience, Psychiatry, Hospital Uppsala, Sweden
2OO2 - Nord J Psychiatry - Mental and personality disorders in a male criminal population. in a consecutive series of 130 male prisoners in jails sentenced for serious criminality, personality disorders were common, being present in 56% of the subjects

* "The authors compared the characteristics of the actions of 16 borderline violent offenders and those of 18 narcissistic violent offenders. The results of the analyses of all phases of their violent acting out show marked differences between the two groups. In fact, the borderline violent offenders, compared to the narcissistic offenders, are more likely to have negative emotions before, during and after the offence and to encounter more problems of loneliness, lower self esteem, financial problems and difficulties with psychoactive drug intoxication. They use physical violence more often during robberies. Among the borderlines, the motive for the robbery was to obtain money quickly to be able to buy drugs or affection. On the other hand, the narcissistic offenders are more prone to accept "contract" killing for a criminal organization. They seek out power or status; they try to eliminate competitors during their criminal activities. The narcissistic offenders will deny using violence while borderline offenders will explain it away by their loss of control. As well, the narcissistic offenders are more likely to resist arrest" (Criminal violence associated with borderline and non-borderline cases: Characteristics of the acting-out process Guillaume Bernard - École de criminologie - Université de Montréal, Montréal, Québec)

Depression, Atypical Depression and borderline disorder
* Bemi, pizza, lattanzi, perugi , 91 patients DSM-IV depressive with atypical features
46% of people with atypical depression have a borderline personality disorder
* Rossi A, Marinangeli MG, Butti G, Scinto A... - Department of Experimental Medicine, University of L'Aquila, Italy
2OO1 J Affect Disord - 30.8% of patients with depressive disorder have a Borderline personnality disorder DSM III
* Pfohl B, Coryell W, Zimmerman M,... - Dept of Psychiatry, University of Iowa College of Medicine, Iowa
1987 J Clin Psychiatry
Series of 78 inpatients with major depression DSM III, 18 (23%) of depressive met criteria for BPD
* Skodol AE, Stout RL, McGlashan TH,... - Dept of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island, USA
1999 Depress Anxiety - Co-occurrence of mood and personality disorders
571 PD cases, 240 had diagnoses of BPD. Of the BPD cases, 31.3% were diagnosed with major depression
Please read the page depression
Dissociative disorder and borderline disorder
Read the dissociation page
Dysthymia and borderline disorder
* Paris J, Zweig-Frank H. - Department of Psychiatry - McGill University, Montreal, Canada.
2OO1 - Sixty-four patients with borderline personality disorder mean age 27 years(DSM III) , 14 (21.9%) had dysthymia
* Skodol AE, Stout RL, McGlashan TH,... - Dept of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island, USA
1999 Depress Anxiety - Co-occurrence of mood and personality disorders
571 PD cases, 240 had diagnoses of BPD. Of the BPD cases, 16% were diagnosed with dysthymia
Drug and borderline disorder
Read Drugs and BPD
Lies, memory vision loss and impairment, false accusation and borderline disorder
Please read the page
Panic disorder with agoraphobia and Borderline disorder
* Zimmerman M, Mattia JI - .Dep. of Psy. and Human Behavior, Brown University School of Medicine, Rhode Island Hospital, Providence, USA
1999 - Compr Psychiatry - Axis I diagnostic comorbidity and borderline personality disorder.
409 patients, 59 cases who met criteria for borderline personality disorder, 29% had panic disorder with agoraphobia
Sexual addictions, identity or gender identity and Borderline disorder
* Zubenko GS, George AW, Soloff PH, Schulz P.
1987 Am J Psychiatry "Sexual practices among patients with borderline personality disorder" - 80 patients who met standardized criteria for borderline disorder. 21% of these patients were homosexual, 5% were bisexual and 11% had diagnoses of paraphilias
53% of the men were homosexual, 10 times more than in the general population  (aapel means that 50% were not)
11% of the women were homosexual, 6 times more than in the general population
Please read also the page gender identity (transsexualism) and bpd
Please read also the page sexual addictions, paraphilias and bpd
Parasuicidality (attempt)and borderline disorder
* Soderberg S. - Department of Clinical Sciences, Psychiatry, Umea University, SE-901 Umea, Sweden.
2OO1 J Psychiatry "Personality disorders in parasuicide"  64 patients DSM IV - borderline personality disorder (BPD) as principal diagnosis in 55% of the subjects
69% had ongoing outpatient treatment. Only 25% of these outpatients had a borderline personality disorder reported in the hospital records, suggesting that the personality disorder might go undiagnosed
(aapel so 3/4 of patients had bad diagnosis)
* Paul H Soloff MD Department of Psychiatry - University of Pittsburgh Pennsylvania
  1994 - Risk factors for suicidal behavior in borderline personality disorder - 84 patients DSM III - There were 73% of the patients with a lifetime history of suicide attempts, with an average of 3.39 attempts per patient

* Barber ME, Marzuk PM, Leon AC, Portera L. , Payne Whitney Clinic, New York Hospital, NY.
1998 Am J Psychiatry. - Aborted suicide attempts
With the goal of ultimately finding early suicide predictors, the authors undertook a study of aborted suicide attempts. They defined such an attempt as an event in which an individual comes close to attempting suicide but does not complete the act and thus sustains no injury.
Aborted attempts were reported more often in subjects with a diagnosis of borderline personality disorder than in subjects with other diagnoses. Subjects who had made an aborted attempt were nearly twice as likely to have made an actual suicide attempt as subjects with no aborted attempts

Somatization, diverse physical complaints and BPD
Please read the page somatization
Post Traumatic Stress Disorder and borderline disorder
Please read the page PTSD
Impulsive disorders: Impulsive Explosive Disorder, gambling, kleptomania, spending, road rage, shoplifitng, trichotillomania
There is also correlation with impulsive disorders like the Intermittent Explosive Disorder, pathological gambling, kleptomania, trichotillomania (an irrepressible need to pull out one's own body hair), Pyromania

Please read impulsive disorder and bpd

Violence, domestic violence and borderline disorder
1 out of 3 (more than 30%) of  perpetrators of domestic violence (DV) meet criteria for BPD
* Donald Dutton Ph.D Psychology University of British Columbia Vancouver, B.C. Canada
Amy Holtzworth-Munroe  Ph.D., Clinical Psychology Indiana University USA
1 out of 3 perpetrators of DV meet criteria for BPD (info TARA)
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* (http://www.oregoncounseling.org/Handouts/DomesticViolenceMen.htm)
At least 50% of all domestic abuse and violence against men is associated with woman who have a Borderline Personality disorder
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* Raine Adrian - University of Southern California - Departement de Psychologie - Los Angeles CA
1993 Journal of clinical Psychology - Features of borderline personality and violence - It is concluded that borderline personality may predispose toward extreme forms of violence.
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* Edwards DW, Scott CL, Yarvis RM... - University of California at Davis, USA.
2OO3 Violence Vict. - Impulsiveness, impulsive aggression, personality disorder, and spousal violence.
In this study of spouse abusers, the relationship between impulsiveness, impulsive aggression, and physical violence is confirmed.
Impulsiveness and impulsive aggression have significant correlations with physical aggression.
Impulsiveness and impulsive aggression are also correlated with measures of Borderline Personality Disorder and Antisocial Personality Disorder. In addition, the measures of Borderline and Antisocial Personality Disorder (PD) are significantly correlated with physical aggression.

* Guillaume Bernard - Criminology Department, University of Montreal
Criminal violence associated with borderline and non-borderline cases - Characteristics of the acting-out process - "role of situational factors and decisional processes
Subjects: DSM-III-R and DSM-IV, 16 violent borderline personality criminals and 18 violent narcissistic personality criminals
Results :The borderlines appeared to be more sensitive to situational factors than the narcissists, particularly in relation to loneliness, lowered self-esteem, financial problems and problems caused by increased drug use. Also, compared to the narcissists, the borderlines were more likely to experience negative emotions before, during and after the offence the borderlines were more inclined than the narcissists to use physical violence during a robbery.
Among the borderlines, the motive for the robbery was to obtain money quickly to be able to buy drugs or affection. The narcissists were more likely than the borderlines to accept murder "contracts" for a criminal organization. In addition to the resulting financial gratification, executing a "contract" allowed them to fulfil typically narcissistic needs such as the possibility of arousing admiration and envy by living in luxury or by developing an all-powerful self-image, venerated and feared by others
In regard to spousal offences, borderlines seem to react strongly to factors that could produce a loss of love or the feeling of being abandoned. During spousal offences, narcissists are motivated by the importance they attach to their need to reestablish their domination, control and exclusive sexual possession of their spouse

What they say


Text from page
http://www.counselors.com/dispart.cfm?ArtID=152
(all rights reserved)

Myths and Realities about BPD
 
Myth 1: People with BPD never get better. 

Reality: Many people with BPD report success with proper treatment. It is true that ingrained personality traits are not easy for people to change. But BPD behavior that has been learned can be unlearned. And many symptoms of BPD that are biological or chemical in nature can be treated effectively with medication. 

Why is it, then, that this myth persists-in spite of the fact that researchers have demonstrated effective treatments? The problem is the stigma of BPD and the lack of awareness. The research on effective BPD treatment is so new that many seasoned clinicians weren't exposed to it during their training. In addition, clinicians are bombarded with contradictory research on BPD treatment, which may leave them confused about which treatment approaches are most effective. 

Since many mental health professionals find working with borderline patients arduous and exhausting, promising new studies often go unnoticed by clinicians who don't specialize in BPD. It becomes a vicious circle: clinicians don't read studies that could help them work with borderline patients because they believe that borderline patients are always going to be difficult to work with. 

Another problem is that many insurance plans won't cover BPD treatment-again, because of the myth that treatment rarely works. This acts as a barrier for clinicians to learn about state-of-the-art BPD treatments. Clinicians then rely on outdated information, misleading statements, and false information about BPD they've heard from their associates. 

Myth 2: BPD is a "wastebasket definition." That is, clinicians give patients this diagnosis when they can't figure out what's wrong with them.

Reality: BPD should be diagnosed only when patients meet the specific clinical criteria.

Janice Cauwels (1992) wrote: BPD is still a wastebasket diagnosis, a label slapped on patients by therapists trying to pretend that their illness is understood. It is also used to rationalize treatment mistakes or failures, to avoid prescribing drugs or other medical treatments, to defend against sexual issues that may have arisen in therapy, to express hatred of patients, and to justify behavior resulting from such emotional reactions. 

In other words, some clinicians use the word "borderline" like some schoolyard bullies use the word "cooties." But the fact that BPD is used as a wastebasket definition doesn't make it a wastebasket definition, any more than calling grapefruit a fat burner makes it a fat burner. A patient should be diagnosed as borderline only if they meet the clinical criteria and only after a clinician has worked with the patient over time to verify that the BPD symptoms are persistent, extreme, and long standing. 

Myth 3: Women have BPD; men have Antisocial Personality Disorder. 

Reality: Although BPD is diagnosed in women much more frequently, men have it as well. 

According to the DSM-IV, about 75 percent of those diagnosed with BPD are women and that most people diagnosed with Anti-social Personality Disorder (APD) are men. But although the personality disorders have some external similarities (i.e., difficulties with relationships, tendencies to blame others), their internal states are strikingly different. Borderlines feel shame, guilt, emotional distress, and emptiness; people with APD generally do not.

So why are more women diagnosed with BPD than men? No one knows, but several theories have arisen: 

* Sexual abuse, which is common in childhood histories of borderline patients, happens more often to women than men. 
* Women experience more inconsistent and invalidating messages in this society. 
* Women are more vulnerable to BPD because they are socialized to be more dependent on others and more sensitive to rejection. 
* Clinicians are biased. Studies have shown that mental health professionals tend to diagnose BPD more often in women than men, even when patient profiles are identical except for the gender of the patient. 
* Men seek psychiatric help less often. 
* Men are more likely to be treated only for their alcoholism or substance abuse; their borderline symptoms go unnoticed because BPD is assumed to be a woman's disorder.
* Female borderlines are in the mental health system; male borderlines are in jail. 

Myth 4: There is no such thing as BPD. 

Reality: More than three hundred research studies and three thousand clinical papers provide ample evidence that BPD is a valid, diagnosable psychiatric illness. 

Clinicians may claim that BPD doesn't exist for several reasons. They may not have kept up-to-date with the research and are misinformed. They may believe that BPD is not a separate disorder, but part of another illness such as Bipolar Disorder or Post-Traumatic Stress Disorder. They may simply reject the idea of labeling anyone as "borderline" because they think it is too stigmatizing, or they may find nearly all psychiatric diagnoses limiting and misleading. 

(From Stop Walking on Eggshells, Copyright 1998 Randi Kreger and Paul Mason, MS) 

High Functioning, Low Functioning 

People with BPD vary a great deal in their functionality: that is, in their ability to live a normal lifestyle, work inside or outside the home, cope with everyday problems, interact with others, and so on. 

Some people with BPD are so incapacitated by their illness that they are unable to work. They may spend a great deal of time in the hospital because of self-mutilation, severe eating disorders, substance abuse, or suicide attempts. BPD makes it very hard for them to form relationships, so they may have a weak support system. They may be so incapable of dealing with money that they have no cash for food or a place to live. 

People who are close to low-functioning borderlines often find themselves living from crisis to crisis. They often feel manipulated by self-mutilation and suicide attempts. However, because the borderline is obviously ill, non-BPs usually receive understanding and support from family and friends.

High-functioning borderlines act perfectly normal most of the time. Successful, outgoing, and well-liked, they may show their other side only to people they know very well. Although these borderlines may feel the same way inside as their less-functional counterparts, they have covered it up very well-so well, in fact, that they may be strangers unto themselves. 

Non-borderlines involved with this type of BP need to have their perceptions and feelings confirmed. Friends and family members who don't know the borderline as well may not believe stories of rage and verbal abuse. Many non-BPs told us that even their therapists refused to believe them when they described the BP's out-of-control behavior. 

Of course, there's a lot of room in between high-functioning (sometimes referred to as the "borderline" borderline) and low- functioning BPs. Stressful life events are most likely to trigger dysfunctional coping mechanisms. 

Acting In, Acting Out 

Most borderline behavior is about one thing: trying to cope with internal anguish. However, people with BPD may do this in different ways. In our experience, the behavior of people with BPD tends to fall into two general categories: "acting out" and "acting in." These are not official, empirically researched categories. Rather, they are a convenient, real-world way of looking at differences. 

Acting-out behaviors are attempts to alleviate pain by dumping it onto someone else-for example, by raging, blaming, criticizing, making accusations, becoming physically violent, and engaging in verbal abuse. Acting-out behaviors cause direct anguish for friends, family members, and partners. For example, one borderline woman, Kiesha, became very angry when she felt that her husband was ignoring her at an office Christmas party. So she went up to him, threw her drink in his face, and stalked out. 

Acting-in behaviors mostly hurt the person with BPD, although non-BPs are also affected. Someone with BPD who mostly acts in may feel extremely guilty over imagined transgressions. They may mutilate themselves, try to hold in their anger, and blame themselves for problems that are not their fault. Suicide is also a possibility. 

Some BPs seem to mainly act in. Some mainly act out. And some both act in and act out. Take Kiesha, for example; after she embarrassed her husband at the Christmas party, she felt very guilty. She walked home from the party, a distance of several miles. When she arrived home, she grabbed several ornaments from the tree and crushed them with her hands, causing a great deal of bleeding. 

(From Stop Walking on Eggshells, Copyright 1998 Randi Kreger and Paul Mason, MS)

AAPEL - Back to BPD Summary page
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Warning:
All the information in this site is aimed at helping people understand a "rather particular" and puzzling kind of disease
But more especially, to support everyone affected by it, sick or not.  In any case, it is ESSENTIAL to see a therapist who specialises in this field they can confirm or give an alternative diagnosis
The name of what you’ve got doesn’t matter so much, getting the right treatment for the right patient does
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last update  2008
Copyright AAPELTM federation - All rights reserved
Author, Alain Tortosa, psychotherapist, founder president of the Aapel
Non profit organization