Borderline personality disorder in major depression: Symptomatology, temperament, character, differential drug response, and 6-month outcome

doi:10.1053/comp.2003.50001

Comprehensive Psychiatry

Volume 44, Issue 1, January 2003, Pages 35-43

https://doi.org/10.1053/comp.2003.50001 Get rights and content

Abstract

Among 183 depressed patients participating in a randomized long-term treatment trial of fluoxetine and nortriptyline, 30 patients had borderline personality disorder (BPD), 53 had other personality disorders (OPD), and 100 had no personality disorders (NPD). The borderline depressed patients had earlier age of onset of their depressions, more chronic depressions, more alcohol and cannabis comorbidity, and were more likely to have histories of suicide attempts and of self-mutilation. On self-report, patients with BPD and OPD reported more phobic symptoms, greater interpersonal sensitivity, and more paranoid ideation. Uniquely, BPD patients were more angry than OPD patients. BPD patients had high novelty seeking, high harm avoidance, low self-directedness, and low cooperativeness. Depressed patients with BPD did poorly in the short term if treated with nortriptyline rather than fluoxetine. After 6 months, those with BPD had a favorable outcome in regard to depressive symptoms, social adjustment, and even improvement in the character measure of self-directedness. Those with the poorest outcome were those with OPD.

References (0)

Cited by (114)

Systematic review and meta-analysis of the role of personality disorder in randomised controlled trials of pharmacological interventions for adults with mood disorders
2021, Journal of Affective Disorders
Citation Excerpt :
The other 11 studies were only included in the narrative analysis. Fifteen studies reported no significant difference in treatment outcome between those with PD (categorised as ‘overall’ or ‘any’ PD) and without PD (Davidson et al., 1985; Dean et al., 2017; Ekselius, 1998; Grunebaum et al., 2018; Joyce et al., 2003; Kocsis et al., 1989; Kool et al., 2003; Moradveisi et al., 2013; Mynors-Wallis and Gath, 1997; Prisciandaro et al., 2011); Russell et al. (2003); (Ryder et al., 2010; Shea et al., 1990; Sullivan et al., 1994; Tyrer et al., 1990). Of this, seven studies reported sufficient data to be included in the meta-analysis (Davidson et al., 1985; Dean et al., 2017; Ekselius, 1998; Joyce et al., 2003; Kool et al., 2003; Shea et al., 1990; Sullivan et al., 1994), which comprised entirety of the pooled data of the continuous outcome.
Personality disorder (PD) may affect the efficacy of pharmacological interventions for mood disorders, but the extent to which this occurs is uncertain. We aimed to examine the available published evidence concerning the role of PD in pharmacological treatment outcomes of randomised controlled trials (RCTs) for adults with mood disorders (i.e. depressive and bipolar spectrum disorders).
A systematic search of Cochrane Central Register of Controlled Clinical Trials, PubMed, EMBASE, PsycINFO, CINAHL Complete, and Google Scholar databases was undertaken to identify studies of interest. Data were independently extracted by two reviewers. The Cochrane Risk of Bias tool was used to assess methodological quality and risk of bias. A random effects model was utilised and statistical heterogeneity was assessed using the I² statistic. This systematic review was registered with PROSPERO (CRD42018089279) and the protocol is published.
The search yielded 11,640 studies. Subsequent to removing duplicates, 9657 studies were screened at title and abstract stage and 1456 were assessed at full-text stage. Eighteen studies met criteria for inclusion in this review. Meta-analysis did not reveal a significant difference between groups for treatment outcome (standardised mean difference 0.22 [-0.09, 0.54]; I²: 69%, p=0.17) and remission (risk ratio 0.84 [0.64, 1.11]; I²: 51%, p=0.22).
This review was limited by lack of studies on bipolar disorder.
PD comorbidity does not appear to affect treatment efficacy of pharmacological interventions for adults with mood disorders.
Global functioning and suicide risk in patients with depression and comorbid borderline personality disorder
2019, Neurology Psychiatry and Brain Research
Borderline personality disorder (BPD) and depression are common disabling mental illnesses that are frequently comorbid. There’s limited research investigating specific predictors of suicide in patients with borderline personality disorder and comorbid depression.
This is a comparative study where 150 patients with depressive disorders and 150 patients with bipolar depression were assessed for the prevalence of BPD. In each group, patients with BPD versus without BPD were evaluated for suicide risk and global functioning. Patients with BPD in the whole sample were also assessed for factors correlated with suicide risk.
23.3% of patients with DD and 21.3% of patients with bipolar depression had BPD. Among patients with depressive disorders, BPD was associated with higher suicide risk (p < 0.001). Among patients with bipolar depression, BPD was associated with lower global functioning (p = 0.025) and higher suicide risk (p = 0.020). Among the total number of patients with BPD, suicide risk was significantly correlated with higher DSH (r = 0.331, p = 0.006) and lower global functioning (r= -0.368, p = 0.002), but only global functioning predicted suicide (beta= -0.280, p = 0.023, adjusted R² = 64%, F = 5.433).
Convenience sampling and not excluding patients with other personality disorders.
This study suggests that BPD is associated with higher risk of suicide in patients with different types of depression. Lower global functioning might predict suicide in patients with BPD and depression. This particular finding points to the importance of the assessment and support of global functioning in patients with BPD and depression.
Borderline personality features in depressed or anxious patients
2016, Psychiatry Research
Citation Excerpt :
Although previous studies often reported a lower age of onset for anxiety and depression in the presence of BPD (e.g. Ozkan and Altindag, 2005; Amore et al., 2014), we only found this association for affective instability and negative relationships. In addition, in line with more chronic depression and anxiety in BPD (Joyce et al., 2003; Skodol et al., 2014), we found that a longer duration of symptoms of depression and anxiety was associated with more borderline personality features in general. This association is most likely driven by affective instability and identity problems specifically but not by negative relationships and self-harm.
Anxiety and depression frequently co-occur with borderline personality disorder. Relatively little research examined the presence of borderline personality features and its main domains (affective instability, identity problems, negative relationships and self-harm) in individuals with remitted and current anxiety and depression. Participants with current (n=597) or remitted (n=1115) anxiety and/or depression and healthy controls (n=431) were selected from the Netherlands Study of Depression and Anxiety. Assessments included the Personality Assessment Inventory – Borderline Features Scale and several clinical characteristics of anxiety and depression.
Borderline personality features were more common in depression than in anxiety. Current comorbid anxiety and depression was associated with most borderline personality features. Anxiety and depression status explained 29.7% of the variance in borderline personality features and 3.8% (self-harm) to 31% (identity problems) of the variance in the four domains. A large part of the variance was shared between anxiety and depression but both disorders also explained a significant amount of unique variance. The severity of anxiety and depression and the level of daily dysfunctioning was positively associated with borderline personality features. Individuals with a longer duration of anxiety and depression showed more affective instability and identity problems. These findings suggest that patients with anxiety and depression may benefit from an assessment of personality pathology as it may have implications for psychological and pharmacological treatment.
Temperament and character personality profile and affective temperaments in self-poisoning nonlethal suicide attempters
2015, Psychiatry Research
Involvement of personality traits in susceptibility to suicidal behaviour has attracted considerable research interest over the past decades. This study was motivated by reports that emotionality may play a potentially confounding role in the association between the personality profile and suicidal behaviour. We assessed the association between personality traits, as measured using the Temperament and Character Inventory (TCI), and suicidal behaviour, while controlling for the effects of Affective Temperaments, measured using the Temperament Evaluation of the Memphis, Pisa, Paris and San Diego auto-questionnaire (TEMPS-A) in a sample of 140 consecutive self-poisoning nonlethal suicide (SNS) attempters admitted to the Emergency Toxicology Clinic, comparing them with a sample of 140 age and sex matched healthy controls. After controlling for Affective Temperaments, the temperament dimension of Novelty Seeking (NS) and the character dimensions of Self-directedness and Self-transcendence remained significantly associated with SNS attempts. NS, in particular, was most consistently and uniquely associated with suicidal behaviour. The present study conveys the difficulty in disentangling the personality profile of SNS attempters from their emotionality. We conclude that the risk associated with certain personality traits is often entirely mediated by Affective Temperaments and few dimensions independently contribute to the risk of self-poisoning nonlethal suicidal behaviour.
Quality and severity of depression in borderline personality disorder: A systematic review and meta-analysis
2015, Clinical Psychology Review
Depression in borderline personality disorder (BPD) is hypothesized to be distinct in quality and severity. This paper provides a systematic review of depression quality, and a meta-analysis of depression severity in BPD patients compared to those with depressive disorders (DeDs) only. Based on a systematic literature search, 26 studies were identified for systematic review and 35 studies (3425 participants) were included for meta-analysis. The review focused on different forms of depressive symptoms, affective impairment, self-evaluation, and negative interpersonal experiences. The meta-analysis examined age, gender, presence of comorbid DeDs in BPD patients, and type of depression scale as moderators of effect sizes. Findings indicate that depression quality in BPD is characterized by higher anger/hostility and self-criticism. There was no significant difference in depression severity between BPD and DeD groups, and a high level of heterogeneity. Moderator analyses revealed lower depression severity in BPD patients without comorbid DeDs, but higher severity in BPD patients with comorbid DeDs compared to depressed controls. Our results suggest high variability in depression severity across BPD patients, point toward the consideration of comorbid DeDs, and lend partial support to a BPD-specific depression quality. We discuss difficulties in research on depression in BPD, and offer directions for future studies.
The relationship between temperament and character in conversion disorder and comorbid depression
2013, Comprehensive Psychiatry
The aim of this study was to compare conversion disorder patients with healthy controls in terms of temperament and character, and to determine the effect of these characteristics on comorbid depression, based on the idea that conversion disorder patients may have distinctive temperament and character qualities.
The study involved 58 patients diagnosed with conversion disorder, based on the DSM-IV diagnostic criteria, under observation at the Bakırköy Psychiatric and Neurological Disorders Outpatient Center, Istanbul. The patients were interviewed with a Structured Clinical Interview (SCID-I) and 57 healthy volunteers, matched for age, sex and education level, were interviewed with a Structured Clinical Interview for people without a psychiatric disorder (SCID-I/NP). All the participants completed a sociodemographic form, the Hamilton Depression Rating Scale, the Hamilton Anxiety Scale and the Temperament and Character Inventory.
The conversion disorder patients displayed more harm avoidance (P < .001), more impulsivity (P < .01) and more sentimentality (P < .01) than the healthy controls, but were less persistent (P < .05). In terms of character qualities, conversion disorder patients had high self-transcendence (P < .05), but were inadequate in terms of self-directedness (P < .001) and took on less responsibility (P < .05) than the healthy controls.
Conversion disorder patients are significantly different from healthy controls on temperament and character measures of harm avoidance, persistence, self-transcendence and self-directedness.

View all citing articles on Scopus

^☆: Supported in part by a grant from the Health Research Council of New Zealand, and by an unrestricted grant from Eli Lilly (New Zealand) Ltd.

View full text

Borderline personality disorder in major depression: Symptomatology, temperament, character, differential drug response, and 6-month outcome☆

Abstract