Disturbed Relationships As A Phenotype for Borderline Personality Disorder

Back to table of contents Previous article Next article CommentaryFull AccessDisturbed Relationships as a Phenotype for Borderline Personality DisorderJohn G. Gunderson M.D.John G. Gunderson M.D.Published Online:1 Nov 2007https://doi.org/10.1176/appi.ajp.2007.07071125AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Factor analytic studies describe three sectors of borderline personality disorder psychopathology: affective, behavioral, and interpersonal (1) . The first two of these sectors, affective instability and impulsivity , have been conceptualized as major underlying phenotypes (i.e., for dispositions having significant heritability) (2) . Borderline personality disorder's third sector of psychopathology, disturbed relationships , has traditionally been conceptualized as environmentally determined, i.e., as learned behaviors. However, these relationship characteristics are central to the clinical problems (e.g., regressions, psychotic transferences, manipulativeness, boundary problems, and countertransference reactions), as well as to major dynamic (3 , 4) and cognitive (5 , 6) theories and therapies. To reconceptualize these relationship phenomena as reflective of a third major phenotype would represent a paradigm shift that is the thesis of this editorial. Does Borderline Personality Disorder Have a Characteristic Interpersonal Style? The relational style of someone with borderline personality disorder is characterized in the DSM-IV borderline personality disorder criteria as intense and unstable, marked further by abandonment fears and by vacillating between idealization and devaluation. These characteristics have offered the best discriminators for the diagnosis (7) . They mirror two prototypic variations of insecure attachments: the "preoccupied" form of attachment marked by pleas for attention or help, clinging, and checking for proximity alternating with the "unresolved/fearful" ("disorganized" in children) form of attachment, which is marked by denial, confusion, or fearfulness about dependency (8 , 9) . Is Borderline Personality Disorder's Interpersonal Style Familial? Zanarini et al. (10) used family history methods to compare 341 borderline personality disorder probands with 1,580 first-degree relatives to a sample of 104 with other personality disorders and their 472 first-degree relatives. Among relatives with borderline personality disorder, 27.5% had borderline personality disorder's particular style of disturbed interpersonal relationships, compared to 17.2% of the relatives of persons with other personality disorders (p=0.002). This degree of familiality was very similar to that shown for borderline personality disorder's affective instability and impulsivity phenotypes. Is Borderline Personality Disorder's Relationship Style Heritable? To date, the heritability of the specific borderline personality disorder disturbed interpersonal style per se has not been tested in patients with borderline personality disorder. Livesley and colleagues (11 , 12) examined heritability for different forms of attachment as measured by self-report. Although the nonshared environment still accounted for most of the variance, the secure style of attachment had a heritability of 0.37, and the fearful and preoccupied styles of insecure attachment—those which, as noted above, characterize borderline personality disorder—had a heritability of 0.43 and 0.25, respectively. A fourth style, dismissive , showed no evidence for heritability. Of further note, a scale related to the borderline patients' prototypic intolerance of aloneness had a heritability of 0.48. Candidate Psychological Endophenotypes Two psychological endophenotypes (which may be closely related), i.e., mentalization failures and rejection sensitivity , offer bridges from the neurobiology of relationships to the more specific interpersonal handicaps of borderline personality disorder. Mentalization Failure Mentalization refers to the ability to recognize feelings and intentions in one's self and in others. Fonagy et al. (13) postulated, based on observations of early mother-child interactions, that an inability to mentalize and the consequent reemergence of more primitive mental states is the core psychological deficit of patients with borderline personality disorder. This theory has gained widespread clinical influence because it has generated a particular form of psychotherapy, i.e., mentalization-based therapy, which has proven effective for patients with borderline personality disorder (4) . Rejection Sensitivity Rejection sensitivity is a trait closely related to abandonment fears and intolerance of aloneness, which have a long association with borderline personality disorder (14) . This trait has been demonstrated in patients with borderline personality disorder by their hypersensitivity to feeling states in others' faces and by their particularly high sensitivity (and physiological reactivity) to angry faces or to abandonment scripts (15) . Possibly related to the rejection sensitivity trait is evidence that the states of intense aversive tension (i.e., dysphoric negative emotional states) that characterize patients with borderline personality disorder and that frequently prompt dissociation and self-injurious behaviors are often prompted by aversive interpersonal events, such as rejecting criticisms or aloneness (16) . Clinical Implications The "personality-event congruence hypothesis," which posits that people who have an insecure relational phenotype experience stressful interpersonal events more drastically, has been confirmed in that interpersonally preoccupied or needy people are more disposed to respond to interpersonal stressors by becoming depressed (17) . Thus, the proposed interpersonal phenotype for borderline personality disorder might also be a diathesis for some types of depressive disorder that could explain the high rate of major depressive disorder and borderline personality disorder co-occurrence—the occurrence of borderline personality disorder depending on an individual also having a diathesis for affective instability or impulsivity . The existence of a disturbed relational phenotype in patients with borderline personality disorder needs to be reconciled with the etiological significance usually assigned to their dysfunctional families and to familial neglect and abuse. This article's thesis does not exonerate the causal role of such family interactions. Indeed, much—perhaps most—of the cause for the typically disturbed relationships of subjects with borderline personality disorder is still likely to remain in the unshared environment. It does mean that dysfunctional families, as well as abuse and neglect, are neither necessary nor sufficient explanations. Moreover, it reminds clinicians that although any offsprings' reconstruction of their past parenting should not be presumed to be valid, this is especially true for patients with borderline personality disorder, whose typically devaluative accounts of their parents likely are colored by their wish for supportive attention, by their genetically influenced tendency to overgeneralize, and by what we here suggest is a genetically influenced hypersensitivity to—or inability to accurately mentalize—parental interactions (e.g., absence, limits). A phenotype marked by high interpersonal reactivity could be expected to have influenced the actual parenting in ways that accentuated rather than minimized the disposition of subjects with preborderline personality disorder for this particular disorder. The existence of a relational phenotype helps explain the effectiveness of psychosocial treatment interventions for borderline personality disorder (18 , 19) . Insofar as social learning experiences determine whether individuals with this phenotypic disposition do or do not go on to develop borderline personality disorder, the existence of an interpersonal phenotype actually can help explain why psychosocial interventions can have powerful effects. This article's thesis can also help everyone involved with borderline patients—including borderline patients themselves—understand that the recurrent interpersonal problems they have with families, lovers, or treaters are constitutionally ingrained maladaptive habits. Understanding this provides a conceptualization from which families, lovers, and treaters can learn less provocative, more palliative ways of responding. Address correspondence and reprint requests to Dr. Gunderson, McLean Hospital, Harvard Medical School, 210 Administration, 115 Mill St., Belmont, MA 02478; [email protected] (e-mail). Editorial accepted for publication July 2007 (doi:10.1176/appi.ajp.2007.07071125).The author reports no competing interests.Supported by NIMH grant MH400130.The author thanks Peter Fonagy, Ph.D., and Larry Siever, M.D., for their input.References1. Skodol AE, Gunderson JG, Pfohl B, Widiger TA, Livesley WJ, Siever L: The borderline diagnosis I: psychopathology, comorbidity, and personality structure. Biol Psychiatry 2002; 51:936–950Google Scholar2. Siever LJ, Davis KL: A psychobiological perspective on the personality disorders. Am J Psychiatry 1991; 148:1647–1658Google Scholar3. Kernberg O: Borderline personality organization. J Am Psychoanal Assoc 1967; 15:641–685Google Scholar4. Bateman A, Fonagy P: Effectiveness of partial hospitalization in the treatment of borderline personality disorder: a randomized controlled trial. Am J Psychiatry 1999; 156:1563–1569Google Scholar5. Westen D, Klesper J, Ruffins SA, Silvermna M, Lifton N, Boekamp J: Object relations in childhood and adolescence: The development of working representations. J Consult Clin Psychol 1991; 59:400–409Google Scholar6. Young JE, Klosko J, Weishaar ME: Schema therapy: a practitioner's guide. New York, Guilford, 2003Google Scholar7. Gunderson JG, Zanarini MC, Kisiel C: Borderline personality disorder, in DSM-IV Sourcebook. Edited by Widiger T, Frances A, Pincus H, Ross R, First M, Davis W. Washington, DC, American Psychiatric Press, 1995, pp 717–732Google Scholar8. Bowlby J: Attachment and Loss, Vol 1: Attachment. New York, Basic Books, 1969Google Scholar9. Ainsworth MD, Blehar MC, Waters E, Wall S: Patterns of Attachment: A Psychological Study of the Strange Situation. Hillsdale, NJ, Lawrence Erlbaum Associates, 1978Google Scholar10. Zanarini MC, Frankenburg FR, Yong L, Raviola G, Reich DB, Hennen J, Hudson JI, Gunderson JG: Borderline psychopathology in the first-degree relatives of borderline and axis II comparison probands. J Personal Disord 2004; 18:439–447Google Scholar11. Livesley WJ, Jang KL, Jackson DN, Vernon PA: Genetic and environmental contributions to dimensions of personality disorder. Am J Psychiatry 1993; 150:1826–1831Google Scholar12. Brussoni MJ, Jang KL, Livesley WJ, MacBeth T: Genetic and environmental influences on adult attachment styles. Personal Relationships 2000; 7:283–289Google Scholar13. Fonagy P, Leigh T, Steele M, Steele H, Kennedy R, Mattoon G, Target M, Gerber A: The relation of attachment status, psychiatric classifications, and response to psychotherapy. J Consult Clin Psychol 1996; 64:22–31Google Scholar14. Klein D: Psychopharmacological treatment and delineation of borderline disorders, in Borderline Personality Disorders: The Concept, the Syndrome, the Patient. Edited by Hartocollis P. New York, International Universities Press, 1977, pp 365–384Google Scholar15. Schmahl CG, Elzinga BM, Ebner UW, Simms T, Sanislow CM, Vermetten E, McGlashan TH, Bremner JD: Psychophysiological reactivity to traumatic and abandonment scripts in borderline personality and posttraumatic stress disorders: a preliminary report. Psych Res 2004; 126:33–42Google Scholar16. Stiglmayr CE, Grathwol T, Linehan MM, Ihorst G, Fahrenberg J, Bohus M: Aversive tension in patients with borderline personality disorder: a computer-based controlled field study. Acta Psychiatr Scand 2005; 111:372–379Google Scholar17. Little SA, Garber J: The role of social stressors and interpersonal orientation in explaining the longitudinal relation between externalizing and depressive symptoms. J Abnorm Psychol 2005; 114:432–443Google Scholar18. American Psychiatric Association: Practice Guideline for the Treatment of Patients With Borderline Personality Disorder. Am J Psychiatry 2001; 158(suppl):1–52Google Scholar19. Gunderson JG: Borderline Personality Disorder: A Clinical Guide. Washington, DC, American Psychiatric Press, 2001Google Scholar FiguresReferencesCited byDetailsCited ByUnderstanding the development of bipolar disorder and borderline personality disorder in young people: a meta-review of systematic reviews30 September 2022 | Psychological Medicine, Vol. 27Childhood maltreatment, personality vulnerability profiles, and borderline personality disorder symptoms in adolescents26 January 2021 | Development and Psychopathology, Vol. 34, No. 3Experimental Investigation of Social Comparison as an Emotion Regulation Strategy Among Young Women with a Range of Borderline Personality Disorder Symptoms30 July 2022 | Journal of Psychopathology and Behavioral Assessment, Vol. 43A Model of Trust17 May 2022 | Games, Vol. 13, No. 3Item method directed forgetting occurs independently of borderline personality traits, even for borderline-salient items13 April 2022 | Cognition and Emotion, Vol. 36, No. 4Alliance rupture profiles by personality disorder pathology in psychotherapy for depression: Tendencies, development, and timing12 December 2021 | Clinical Psychology & Psychotherapy, Vol. 29, No. 3Frontal EEG asymmetry moderates the relation between borderline personality disorder features and feelings of social rejection in adolescents20 April 2022 | Development and Psychopathology, Vol. 20The impact of COVID-19 lockdown on the well-being of clients of a specialist personality disorder service2 December 2021 | Australasian Psychiatry, Vol. 30, No. 2Borderline Personality Traits and Romantic Relationship DissolutionJournal of Personality Disorders, Vol. 36, No. 2The Clinical Characteristics of Patients With Borderline Personality Disorder in Different Treatment SettingsJournal of Personality Disorders, Vol. 36, No. 2Structural Features Predict Sexual Trauma and Interpersonal Problems in Borderline Personality Disorder but Not in Controls: A Multi-Voxel Pattern Analysis23 February 2022 | Frontiers in Human Neuroscience, Vol. 16Die Borderline-Persönlichkeitsstörung im somatischen BehandlungssettingPraxis, Vol. 111, No. 2Borderline personality disorder symptom networks across adolescent and adult clinical samples: examining symptom centrality and replicability31 January 2022 | Psychological Medicine, Vol. 58Dyadic Emotion Regulation in Women with Borderline Personality Disorder20 February 2021 | Cognitive Therapy and Research, Vol. 45, No. 6Identifying Disease-Specific Neural Reactivity to Psychosocial Stress in Borderline Personality DisorderBiological Psychiatry: Cognitive Neuroscience and Neuroimaging, Vol. 15A daily-life study of interpersonal stressors and alcohol use in individuals with borderline personality disorder and community controlsDrug and Alcohol Dependence, Vol. 228Mindreading and metacognition patterns in patients with borderline personality disorder: experimental study18 January 2021 | European Archives of Psychiatry and Clinical Neuroscience, Vol. 271, No. 6College Students' Adult Attachment and Career Adaptability: Mediation by Maladaptive Perfectionism and Moderation by Gender13 August 2019 | Journal of Career Development, Vol. 48, No. 4Probing commitment in individuals with borderline personality disorderJournal of Psychiatric Research, Vol. 137The Relationship of Mindfulness, Self-Differentiation and Alexithymia With Borderline Personality Traits1 May 2021 | Preventive Care In Nursing and Midwifery Journal, Vol. 11, No. 2Insecure Attachment, Maladaptive Personality Traits, and the Perpetration of In-Person and Cyber Psychological Abuse23 February 2018 | Journal of Interpersonal Violence, Vol. 36, No. 5-6Theory of Mind in Borderline Personality Disorder: A Possible Endophenotypic Factor?19 March 2021 | International Journal of Environmental Research and Public Health, Vol. 18, No. 6Rethinking the relationship between attachment and personality disorderCurrent Opinion in Psychology, Vol. 37Motives for opioid use explain the relation between borderline personality disorder pathology and opioid use problemsPsychiatry Research, Vol. 296Depression and Personality Dysfunction: Moving from Descriptive Comorbidity to the Identification of Common Intermediate Phenotypes1 January 2022Diagnostic accuracy of DSM-5 borderline personality disorder criteria: Toward an optimized criteria setJournal of Affective Disorders, Vol. 279Facial emotion recognition in borderline patients is unaffected by acute psychosocial stressJournal of Psychiatric Research, Vol. 132Exploring the boundaries between borderline personality disorder and suicidal behavior disorder23 January 2019 | European Archives of Psychiatry and Clinical Neuroscience, Vol. 270, No. 8Borderline personality disorder: from understanding ontological addiction to psychotherapeutic revolution4 June 2019 | European Archives of Psychiatry and Clinical Neuroscience, Vol. 270, No. 8Personality Disorders in Time of Pandemic10 November 2020 | Current Psychiatry Reports, Vol. 22, No. 12Impaired memory for cooperative interaction partners in borderline personality disorder1 October 2020 | Borderline Personality Disorder and Emotion Dysregulation, Vol. 7, No. 1Are Impairments in Theory of Mind Specific to Borderline Personality Disorder?Journal of Personality Disorders, Vol. 34, No. 6Approach and Avoidance Behavior in Female Patients With Borderline Personality Disorder1 December 2020 | Frontiers in Behavioral Neuroscience, Vol. 14Needing Too Much: Managing Crises in a Patient with Dependent Personality Traits14 September 2020 | Harvard Review of Psychiatry, Vol. 28, No. 6Drawing the borderline: Predicting treatment outcomes in patients with borderline personality disorderBehaviour Research and Therapy, Vol. 133INTEGRATING SOCIAL COMPARISON INTO THE UNDERSTANDING OF EMOTION REGULATION IN BORDERLINE PERSONALITYJournal of Social and Clinical Psychology, Vol. 39, No. 8Efficacy of a Brief Cognitive-Emotional Group Intervention for Patients with Borderline personality disorderPsychologie Française, Vol. 65, No. 3Borderline patients have difficulties describing feelings: bipolar II patients describe difficult feelings. An alexithymia study27 July 2020 | Acta Psychiatrica Scandinavica, Vol. 6Dysfunction of Empathy and Related Processes in Borderline Personality Disorder: A Systematic ReviewHarvard Review of Psychiatry, Vol. 28, No. 4Characterizing Couple Dysfunction in Borderline Personality DisorderJournal of Personality Disorders, Vol. 34, No. 2Rejection Sensitivity and Borderline Personality Disorder Features: The Mediating Roles of Attachment Anxiety, Need to Belong, and Self-CriticismJournal of Personality Disorders, Vol. 34, No. 2Management of Suicidality with Borderline and Narcissistic FeaturesPsychiatric Annals, Vol. 50, No. 4Stuck in a negative me: fMRI study on the role of disturbed self-views in social feedback processing in borderline personality disorder14 March 2019 | Psychological Medicine, Vol. 50, No. 4Environmental and Sociocultural Influences on Personality DisordersBorderline Personality DisorderEmotional Reactivity in Borderline Personality Disorder: Theoretical Considerations Based on a Meta-Analytic Review of Laboratory StudiesJournal of Personality Disorders, Vol. 34, No. 1Are Borderline Personality Symptoms and Psychopathy Differentially Related to Drinking Motives of Former Jail Inmates?Journal of Personality Disorders, Vol. 33, No. 6Dissociation and its disorders: Competing models, future directions, and a way forwardClinical Psychology Review, Vol. 73Aggression of Individuals with Borderline Personality Disorder Tendency under Conditions of Social ExclusionKorean Journal of Health Psychology, Vol. 24, No. 3Trust and Rejection Sensitivity in Personality Disorders1 July 2019 | Current Psychiatry Reports, Vol. 21, No. 8General psychiatric management: An evidence-based treatment for borderline personality disorder in the college setting10 August 2018 | Journal of College Student Psychotherapy, Vol. 33, No. 2Mentalization in Adolescents With Borderline Personality Disorder: A Comparison With Healthy ControlsJournal of Personality Disorders, Vol. 33, No. 2A Randomized Controlled Trial of Group Psychoeducation for Carers of Persons With Borderline Personality DisorderJournal of Personality Disorders, Vol. 33, No. 2Interpersonal Problems in Borderline Personality Disorder: Associations with Mentalizing, Emotion Regulation, and Impulsiveness28 March 2019 | Journal of Personality Disorders, Vol. 1Collaborative Deprescribing in Borderline Personality Disorder: A Narrative ReviewHarvard Review of Psychiatry, Vol. 27, No. 2Reviewing the clinical significance of 'fear of abandonment' in borderline personality disorder7 November 2018 | Australasian Psychiatry, Vol. 27, No. 1Personality and Mental Health, Vol. 13, No. 2Behavioural Brain Research, Vol. 359NeuroImage: Clinical, Vol. 22Personality and Individual Differences, Vol. 140Development and Psychopathology, Vol. 31, No. 3Psychology and Psychotherapy: Theory, Research and PracticeAssessment, Vol. 26, No. 6Blinded by our emotions: The impact of borderline personality disorder and affect on emotion recognition sensitivity17 January 2019 | Journal of Experimental Psychopathology, Vol. 10, No. 1Clinical Psychological Science, Vol. 7, No. 5Mentalization mediates the relationship between borderline personality features and internalizing and externalizing psychopathology in adolescents12 April 2019 | Scandinavian Journal of Child and Adolescent Psychiatry and Psychology, Vol. 7, No. 1Frontiers in Psychiatry, Vol. 10Frontiers in Psychiatry, Vol. 10Differential Susceptibility to the Environment and Borderline Personality DisorderHarvard Review of Psychiatry, Vol. 26, No. 6Treatment-induced brain plasticity in borderline personality disorder: review of functional MRI studiesFuture Neurology, Vol. 13, No. 4Identifying Core Deficits in a Dimensional Model of Borderline Personality Disorder Features: A Network Analysis18 May 2018 | Clinical Psychological Science, Vol. 6, No. 5Theories and Treatment of Borderline Personality Disorder: Commentary on Gunderson et al.Journal of Personality Disorders, Vol. 32, No. 2Individuals with Borderline Personality Disorder show larger preferred social distance in live dyadic interactionsPsychiatry Research, Vol. 260Patient Personality and Relational Patterns in Psychotherapy: Factor Structure, Reliability, and Validity of the Psychotherapy Relationship Questionnaire1 February 2017 | Journal of Personality Assessment, Vol. 100, No. 1, Vol. 2Behaviour Research and Therapy, Vol. 111Personality and Individual Differences, Vol. 126Psychiatric Clinics of North America, Vol. 41, No. 4Psychiatry Research, Vol. 270Mechanisms of Change in Treatments of Personality Disorders: Commentary on the Special SectionJournal of Personality Disorders, Vol. 32, No. SupplementFrontiers in Behavioral Neuroscience, Vol. 12Frontiers in Psychology, Vol. 9Frontiers in Psychology, Vol. 9Dialectical Behavior Therapy8 September 2017Experimental investigation of cognitive and affective empathy in borderline personality disorder: Effects of ambiguity in multimodal social information processingPsychiatry Research, Vol. 253Interpersonal Problems and Negative Affect in Borderline Personality and Depressive Disorders in Daily Life13 February 2017 | Clinical Psychological Science, Vol. 5, No. 3Prevalence of borderline personality disorder and its risk factors in female prison inmates in ChinaPsychiatry Research, Vol. 250Computational Psychiatry in Borderline Personality Disorder4 February 2017 | Current Behavioral Neuroscience Reports, Vol. 4, No. 1, Vol. 35Journal of Abnormal Child Psychology, Vol. 45, No. 7Archives of Psychiatric Nursing, Vol. 31, No. 1Brain Research, Vol. 1659Computers in Human Behavior, Vol. 70Child Abuse & Neglect, Vol. 72Personality and Individual Differences, Vol. 113Behavioral Medicine, Vol. 43, No. 3Social Cognitive and Affective Neuroscience, Vol. 12, No. 11Borderline Personality Disorder and Emotion Dysregulation, Vol. 4, No. 1Borderline Personality Disorder and Emotion Dysregulation, Vol. 4, No. 1Borderline Personality Disorder and Emotion Dysregulation, Vol. 4, No. 1Journal of Social and Clinical Psychology, Vol. 36, No. 1Journal of Personality Disorders, Vol. 31, No. 2Alcohol Craving and Consumption in Borderline Personality Disorder23 June 2016 | Clinical Psychological Science, Vol. 4, No. 5Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, Vol. 1, No. 4Neuroscience & Biobehavioral Reviews, Vol. 71Personality and Individual Differences, Vol. 94Personality and Individual Differences, Vol. 100Psychiatry Research, Vol. 242Journal of Personality Assessment, Vol. 98, No. 1British Journal of Clinical Psychology, Vol. 55, No. 3F1000Research, Vol. 5Wellcome Open Research, Vol. 1Journal of Personality Disorders, Vol. 30, No. 2Journal of Clinical Psychology, Vol. 71, No. 7Aggression and Violent Behavior, Vol. 24Psychiatry Research, Vol. 229, No. 3Journal of Infant, Child, and Adolescent Psychotherapy, Vol. 14, No. 1Acta Psychiatrica Scandinavica, Vol. 132, No. 4PLOS ONE, Vol. 10, No. 5Journal of Personality Disorders, Vol. 29, No. 2Associations Between Dysfunctional Personality Traits and Intimate Partner Violence in Perpetrators and Victims30 January 2014 | Journal of Interpersonal Violence, Vol. 29, No. 13Current Psychiatry Reports, Vol. 16, No. 3Clinical Psychology Review, Vol. 34, No. 3Psychiatry Research, Vol. 215, No. 3Psychiatry Research, Vol. 220, No. 1-2Impairments of Interpersonal Functioning: Empathy and Intimacy in Borderline Personality Disorder22 February 2014 | Psychopathology, Vol. 47, No. 4Journal of Personality Disorders, Vol. 28, No. 6Psychopharmacologic treatment of borderline personality disorder1 April 2022 | Dialogues in Clinical Neuroscience, Vol. 15, No. 2Is low affect consciousness related to the severity of psychopathology? A cross-sectional study of patients with avoidant and borderline personality disorderComprehensive Psychiatry, Vol. 54, No. 2Altered State and Trait Disgust in Borderline Personality DisorderJournal of Nervous & Mental Disease, Vol. 201, No. 2Comprehensive Psychiatry, Vol. 54, No. 1Psychological Medicine, Vol. 43, No. 9Journal of Personality Disorders, Vol. 27, No. 2Journal of Personality Disorders, Vol. 27, No. 4Borderline personality disorder subtypes: A factor analysis of the DSM-IV criteria24 January 2012 | Personality and Mental Health, Vol. 6, No. 3Emotionale Dysregulation bei der Borderline-PersönlichkeitsstörungZeitschrift für Psychiatrie, Psychologie und Psychotherapie, Vol. 60, No. 3Interpersonal Patterns in Borderline Personality Disorder29 May 2012 | Journal of Personality DisordersA 31-Year-Old Female with Suicidal IntentPsychiatric Annals, Vol. 42, No. 2Neuroimaging and Borderline Personality DisorderPsychiatric Annals, Vol. 42, No. 2Clinical Psychology & Psychotherapy, Vol. 19, No. 6Journal of Abnormal Child Psychology, Vol. 40, No. 1Psychiatric Quarterly, Vol. 83, No. 3Current Opinion in Psychiatry, Vol. 25, No. 1Prospective Associations Among Borderline Personality Disorder Symptoms, Interpersonal Problems, and Aggressive Behaviors22 August 2011 | Journal of Interpersonal Violence, Vol. 27, No. 1Journal of Personality Disorders, Vol. 26, No. 4Journal of Personality Disorders, Vol. 26, No. 5Journal of Personality DisordersNeuronal correlates of altered empathy and social cognition in borderline personality disorderNeuroImage, Vol. 57, No. 2Current Psychiatry Reports, Vol. 13, No. 1Journal of the American Academy of Child & Adolescent Psychiatry, Vol. 50, No. 6Psychiatry Research, Vol. 187, No. 1-2Psychological Medicine, Vol. 41, No. 9An Opioid Deficit in Borderline Personality Disorder: Self-Cutting, Substance Abuse, and Social DysfunctionAntonia S. New, M.D., and Barbara Stanley, Ph.D.1 August 2010 | American Journal of Psychiatry, Vol. 167, No. 8Current Status of the Scientific Study of the Personality Disorders: an Overview of Epidemiological, Longitudinal, Experimental Psychopathology, and Neurobehavioral Perspectives29 November 2010 | Journal of the American Psychoanalytic Association, Vol. 58, No. 4Adaptation of Interpersonal Psychotherapy to Borderline Personality Disorder: A Comparison of Combined Therapy and Single Pharmacotherapy1 February 2010 | The Canadian Journal of Psychiatry, Vol. 55, No. 2The Interpersonal Dimension of Borderline Personality Disorder: Toward a Neuropeptide ModelBarbara Stanley, Ph.D., and Larry J. Siever, M.D.1 January 2010 | American Journal of Psychiatry, Vol. 167, No. 1Neuropsychologia, Vol. 48, No. 6Journal of Personality Assessment, Vol. 92, No. 6Selected Posters From the 2009 Poster Session of the American Psychoanalytic Association12 January 2010 | Journal of the American Psychoanalytic Association, Vol. 57, No. 6The Relationship Between Self-Reported Attachment Styles, Interpersonal Dysfunction, and Borderline Personality DisorderJournal of Nervous & Mental Disease, Vol. 197, No. 11Interpersonal and Emotional Experiences of Social Interactions in Borderline Personality DisorderJournal of Nervous & Mental Disease, Vol. 197, No. 7Borderline Personality Disorder: Ontogeny of a DiagnosisJohn G. Gunderson, M.D.1 May 2009 | American Journal of Psychiatry, Vol. 166, No. 5Biological Psychiatry, Vol. 66, No. 9Development and Psychopathology, Vol. 21, No. 4The Case for Shifting Borderline Personality Disorder to Axis IBiological Psychiatry, Vol. 64, No. 8Progress in Neuro-Psychopharmacology and Biological Psychiatry, Vol. 32, No. 4 Volume 164Issue 11 November, 2007Pages 1637-1640THE AMERICAN JOURNAL OF PSYCHIATRY November 2007 Volume 164 Number 11 Metrics PDF download History Published online 1 November 2007 Published in print 1 November 2007