Citation

Meares R, Gerull F, Stevenson J, Korner A. Aust. N. Zeal. J. Psychiatry 2011; 45(3): 214-222.

Affiliation

Department of Psychological Medicine, University of Sydney; Director of Mental Health Sciences Centre, Westmead and Cumberland Hospitals, PO Box 7118, Parramatta BC, NSW 2124, Australia.

Copyright

(Copyright © 2011, Royal Australian and New Zealand College of Psychiatrists, Publisher SAGE Publishing)

DOI

10.3109/00048674.2010.551280

PMID

21438747

Abstract

Object: To determine which constellation of clinical features constitutes the core of borderline personality disorder (BPD). Method: The criterion of endurance was used to identify the constellation of features which are most basic, or core, in borderline personality disorder. Two sets of constellations of DSM-III features were tested, each consisting of three groupings. The first set of constellations was constructed according to Clarkin's factor analysis; the second was theoretically derived. Broadly speaking, the three groupings concerned 'self', 'emotional regulation', and 'impulse'. Changes of these constellations were charted over one year in a comparison of the effect of treatment by the Conversational Model (n = 29) with treatment as usual (n = 31). In addition, measures of typical depression (Zung) were scored before and after the treatment period. The changes in the constellations were considered in relation to authoritative opinion. Results: The changes in the two sets of constellations were similar. In the treatment as usual (TAU) group, 'self' endured unchanged, while 'emotional regulation' and 'impulse' improved. In the Conversational Model cohort, 'self' improved, 'emotional regulation' improved more greatly than the TAU group, while 'impulse' improved but not more than the treatment as usual group. Depression scores were not particularly associated with any grouping. Conclusions: A group of features including self/identity disturbance, emptiness and fear of abandonment may be at the core of BPD. Correlations between the three groupings and Zung scores favoured the view that the core affect is not typical depression. Rather, the central state may be 'painful incoherence'. It is suggested that the findings have implications for the refinement and elaboration of treatment methods in borderline personality disorder.

Language: en