Advertisement

Current Psychiatry Reports

, Volume 11, Issue 1, pp 82–88 | Cite as

Dissociation and borderline personality disorder: An update for clinicians

  • Marilyn I. KorzekwaEmail author
  • Paul F. Dell
  • Clare Pain
Article

Abstract

Dissociation occurs in about two thirds of people with borderline personality disorder (BPD) but is still not well understood by clinicians. In the past decade, however, research has used new measures of dissociation that provide some of the detail that clinicians need to understand and treat the dissociative symptoms of patients with BPD. In particular, this review examines BPD’s comorbidity with the dissociative disorders, the neurobiology of dissociation in BPD, the role of trauma and disorganized attachment in the etiology of dissociation in BPD, and the clinical assessment and treatment of dissociation in BPD.

Keywords

Borderline Personality Disorder Childhood Sexual Abuse Naltrexone Borderline Personality Disorder Borderline Personality Disorder Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Sar V, Ross C: Dissociative disorders as a confounding factor in psychiatric research. Psychiatr Clin North Am 2006, 29:129–144.PubMedCrossRefGoogle Scholar
  2. 2.
    Waller NG, Putman FW, Carlson EB: Types of dissociation and dissociative types: a taxometric analysis of dissociative experiences. Psychol Methods 1996, 1:300–321.CrossRefGoogle Scholar
  3. 3.
    Ross CA, Duffy CMM, Ellason JW: Prevalence, reliability and validity of dissociative disorders in an inpatient setting. J Trauma Dissociation 2002, 3:7–17.CrossRefGoogle Scholar
  4. 4.
    Carlson EB, Putnam FW: An update on the Dissociative Experiences Scale. Dissociation 1993, 6:16–27.Google Scholar
  5. 5.
    Dell P: The Multidimensional Inventory of Dissociation (MID): a comprehensive measure of pathological dissociation. J Trauma Dissociation 2006, 7:77–106.PubMedCrossRefGoogle Scholar
  6. 6.
    Ross CA: Dissociative Identity Disorder: Diagnosis, Clinical Features, and Treatment of Multiple Personality, edn 2. New York: Wiley; 1997.Google Scholar
  7. 7.
    Steinberg M: Structured Clinical Interview for DSM-IV Dissociative Disorders, Revised (SCID-D-R). Washington, DC: American Psychiatric Press; 1994.Google Scholar
  8. 8.
    Zanarini MC, Ruser TF, Frankenburg FR, et al.: Risk factors associated with the dissociative experiences of borderline patients. J Nerv Ment Dis 2000, 188:26–30.PubMedCrossRefGoogle Scholar
  9. 9.
    Simeon D, Nelson D, Elias R, et al.: Relationship of personality to dissociation and childhood trauma in borderline personality disorder. CNS Spectr 2003, 8:755–757, 760–762.PubMedGoogle Scholar
  10. 10.
    Stiglmayr CE, Ebner-Priemer UW, Bretz J, et al.: Dissociative symptoms are positively related to stress in borderline personality disorder. Acta Psychiatr Scand 2008, 117:139–147.PubMedGoogle Scholar
  11. 11.
    Shearer SL: Dissociative phenomena in women with borderline personality disorder. Am J Psychiatry 1994, 151:1324–1328.PubMedGoogle Scholar
  12. 12.
    Zanarini MC, Frankenburg FR, Jager-Hyman S, et al.: The course of dissociation for patients with borderline personality disorder and Axis II comparison subjects: a 10-year follow up. Acta Psychiatr Scand 2008, 118:291–296.PubMedCrossRefGoogle Scholar
  13. 13.
    Boon S, Draijer N: Multiple personality disorder in The Netherlands: a clinical investigation of 71 patients. Am J Psychiatry 1993, 150:489–494.PubMedGoogle Scholar
  14. 14.
    Dell PF: Axis II pathology in outpatients with dissociative identity disorder. J Nerv Ment Dis 1998, 186:352–356.PubMedCrossRefGoogle Scholar
  15. 15.
    Laddis A, Dell PF: A comparison of DID with 30 cases of SIDP-IV diagnosed borderline personality disorder. Paper presented at the 19th Annual Meeting of the International Society for the Study of Dissociation. Baltimore, MD; November 11, 2002.Google Scholar
  16. 16.
    Stein DJ, Hollander E, DeCaria CM, et al.: m-Chlorophenylpiperazine challenge in borderline personality disorder: relationship of neuroendocrine response, behavioral response, and clinical measures. Biol Psychiatry 1996, 40:508–513.PubMedCrossRefGoogle Scholar
  17. 17.
    Schmahl C, Bremner JD: Neuroimaging in borderline personality disorder. J Psychiatr Res 2006, 40:419–427.PubMedCrossRefGoogle Scholar
  18. 18.
    Rusch N, Weber M, Il’yasov KA, et al.: Inferior frontal white matter microstructure and patterns of psychopathology in women with borderline personality disorder and comorbid attention-deficit hyperactivity disorder. Neuroimage 2007, 35:738–747.PubMedCrossRefGoogle Scholar
  19. 19.
    Simeon D, Knutelska M, Smith L, et al.: A preliminary study of cortisol and norepinephrine reactivity to psychosocial stress in borderline personality disorder with high and low dissociation. Psychiatr Res 2007, 149:177–184.CrossRefGoogle Scholar
  20. 20.
    Simeon D, Guralnik O, Knutelska M, et al.: Basal norepinephrine in depersonalization disorder. Psychiatry Res 2003, 121:93–97.PubMedCrossRefGoogle Scholar
  21. 21.
    Rinne T, de Kloet ER, Wouters L, et al.: Hyperresponsiveness of hypothalamic-pituitary-adrenal axis to combined dexamethasone/corticotrophin-releasing hormone challenge in female borderline personality disorder subjects with a history of sustained childhood abuse. Biol Psychiatry 2002, 52:1102–1112.PubMedCrossRefGoogle Scholar
  22. 22.
    Grosjean B, Tsai GE: NMDA neurotransmission as a critical mediator of borderline personality disorder. J Psychiatry Neurosci 2007, 32:103–115.PubMedGoogle Scholar
  23. 23.
    Irle E, Lange C, Sachsse U: Reduced size and abnormal asymmetry of parietal cortex in women with borderline personality disorder. Biol Psychiatry 2005, 57:173–182.PubMedCrossRefGoogle Scholar
  24. 24.
    Vermetten E, Schmahl C, Lindner S, et al.: Hippocampal and amygdalar volumes in dissociative identity disorder. Am J Psychiatry 2006, 163:630–636.PubMedCrossRefGoogle Scholar
  25. 25.
    Frewen PA, Lanius RA: Neurobiology of dissociation: unity and disunity in mind-body-brain. Psychiatr Clin North Am 2006, 29:113–128.PubMedCrossRefGoogle Scholar
  26. 26.
    Ebner-Priemer UW, Badeck S, Beckmann C, et al.: Affective dysregulation and dissociative experience in female patients with borderline personality disorder: a startle response study. J Psychiatr Res 2005, 39:85–92.PubMedCrossRefGoogle Scholar
  27. 27.
    Irle E, Lange C, Weniger G, Sachsse U: Size abnormalities of the superior parietal cortices are related to dissociation in borderline personality disorder. Psychiatry Res 2007, 156:139–149.PubMedCrossRefGoogle Scholar
  28. 28.
    Simeon D, Guralnik O, Hazlett E, et al.: Feeling unreal: a PET study of depersonalization disorder. Am J Psychiatry 2000, 157:1782–1788.PubMedCrossRefGoogle Scholar
  29. 29.
    Lange C, Kracht L, Herholz K, et al.: Reduced glucose metabolism in temporo-parietal cortices of women with borderline personality disorder. Psychiatry Res 2005, 139:115–126.PubMedCrossRefGoogle Scholar
  30. 30.
    Bohus MJ, Landwehrmeyer GB, Stiglmayr CE, et al.: Naltrexone in the treatment of dissociative symptoms in patients with borderline personality disorder: an open-label trial. J Clin Psychiatry 1999, 60:598–603.PubMedGoogle Scholar
  31. 31.
    Battle CL, Shea T, Johnson DM, et al.: Childhood maltreatment associated with adult personality disorders: findings from the Collaborative Longitudinal Personality Disorders Study. J Personal Disord 2004, 18:193–211.PubMedCrossRefGoogle Scholar
  32. 32.
    Bradley R, Jenei J, Westen D: Etiology of borderline personality disorder: disentangling the contributions of inter-correlated antecedents. J Nerv Ment Dis 2005, 193:24–31.PubMedCrossRefGoogle Scholar
  33. 33.
    Ogawa JR, Sroufe LA, Weinfield NS, et al.: Development and the fragmented self: longitudinal study of dissociative symptomatology in a nonclinical sample. Dev Psychopathol 1997, 9:855–879.PubMedCrossRefGoogle Scholar
  34. 34.
    Allen JG, Fultz J, Huntoon J, Brethour JR Jr: Pathological dissociative taxon membership, absorption, and reported childhood trauma in women with trauma-related disorders. J Trauma Dissociation 2002, 1:89–110.CrossRefGoogle Scholar
  35. 35.
    Van Den Bosch LMC, Verheul R, Langeland W, Van Den Brink W: Trauma, dissociation, and posttraumatic stress disorder in female borderline patients with and without substance abuse problems. Aust N Z J Psychiatry 2003, 37:549–555.CrossRefGoogle Scholar
  36. 36.
    Fonagy P, Bateman AW: Mechanisms of change in mentalization-based treatment of BPD. J Clin Psychol 2006, 62:411–430.PubMedCrossRefGoogle Scholar
  37. 37.
    Gunderson JG, Lyons-Ruth K: BPD’s interpersonal hypersensitivity phenotype: a gene-environment-developmental model. J Personal Disord 2008, 22:22–41.PubMedCrossRefGoogle Scholar
  38. 38.
    Main M, Hesse E: Parents’ unresolved traumatic experiences are related to infant disorganized attachment status: is frightened and/or frightening parental behavior the linking mechanism? In Attachment in the Preschool Years. Edited by Greenberg MT, Cicchetti D, Cummings EM. Chicago: University Press of Chicago; 1990:161–182.Google Scholar
  39. 39.
    Liotti G: The inner schema of borderline states and its correction during psychotherapy: a cognitive-evolutionary approach. J Cogn Psychother 2002, 16:349–366.CrossRefGoogle Scholar
  40. 40.
    Becker-Blease KA, Deater-Deckard K, Eley T, et al.: A genetic analysis of individual differences in dissociative behaviors in childhood and adolescence. J Child Psychol Psychiatry 2004, 45:522–532.PubMedCrossRefGoogle Scholar
  41. 41.
    Judd PH: Neurocognitive impairment as a moderator in the development of borderline personality disorder. Dev Psychopathol 2005, 17:1173–1196.PubMedCrossRefGoogle Scholar
  42. 42.
    Korzekwa MI, Dell PF, Links PS, et al.: Dissociation in borderline personality disorder: a detailed look. J Trauma Dissociation 2009 (in press).Google Scholar
  43. 43.
    Wildgoose A, Clarke S, Waller G: Treating personality fragmentation and dissociation in borderline personality disorder: a pilot study of the impact of cognitive analytic therapy. Br J Med Psychol 2001, 74:47–55.CrossRefGoogle Scholar
  44. 44.
    Bohus M, Haaf B, Simms T, et al.: Effectiveness of inpatient dialectical behavioral therapy for borderline personality disorder: a controlled trial. Behav Res Ther 2004, 42:487–499.PubMedCrossRefGoogle Scholar
  45. 45.
    Sachsse U, Vogel C, Leichsenring F: Results of psychodynamically oriented trauma-focused inpatient treatment for women with complex posttraumatic stress disorder (PTSD) and borderline personality disorder (BPD). Bull Menninger Clin 2006, 70:125–144.PubMedCrossRefGoogle Scholar
  46. 46.
    International Society for Study of Dissociation: Guidelines for treating dissociative identity disorder in adults. J Trauma Dissociation 2005, 6:69–149.CrossRefGoogle Scholar
  47. 47.
    Turkus JA, Kahler JA: Therapeutic interventions in the treatment of dissociative disorders. Psychiatr Clin North Am 2006, 29:245–262.PubMedCrossRefGoogle Scholar
  48. 48.
    Sar V, Kundakci T, Kiziltan E, et al.: The Axis-I dissociative disorder comorbidity of borderline personality disorder among psychiatric outpatients. J Trauma Dissociation 2003, 4:119–136.CrossRefGoogle Scholar
  49. 49.
    Sar V, Akyuz G, Kugu N, et al.: Axis I dissociative disorder comorbidity in borderline personality disorder and reports of childhood trauma. J Clin Psychiatry 2006, 67:1583–1590.PubMedCrossRefGoogle Scholar
  50. 50.
    Ross CA: Borderline personality disorder and dissociation. J Trauma Dissociation 2007, 8:71–80.PubMedCrossRefGoogle Scholar

Copyright information

© Current Medicine Group LLC 2009

Authors and Affiliations

  1. 1.Department of Psychiatry and Behavioural NeurosciencesMcMaster University, St. Joseph’s HospitalHamiltonCanada

Personalised recommendations