Clinical studies on the borderline concept with special reference to suicidal behavior

Abstract: The diagnostic concept of borderline personality has had various meanings throughout the last decades. From current clinical practice and research two principally different concepts have emerged: The syndrome concept of borderline personality disorder ( BPD ) as identified by the DSM-III or the Diagnostic Interview for Borderline (DIB) and the psychodynamic concept of borderline personality organization (BPO) as defined from the structural Interview (SI) by Otto Kernberg.In the first part of the present study, the DIB, the SI and a percept-genetic test called Defense Mechanism test (DMT) have been utilized in a clinical study on psychiatric inpatients. In the second part completed suicides are studied among patients with borderline personality disorder.Inter-rater reliability was satisfactory for the DIB both when utilized as a clinical interview and as a chart scoring instrument. Previous research findings concerning descriptive validity of the BPD concept were further supported. Fairly reliable scorings of personality organization could be made from the SI. BPO turned out to be a very inclusive concept and a subgroup (46%) also met criteria for BPD. By means of the DMT specific psychodynamic features were identified among patients with BPD which discriminated them from patients with other personality disorders or schizophrenic disorder. It is concluded, that there is empirical support to consider BPD a valid diagnostic entity. BPO should be conceptualized as a level of personality functioning rather than a diagnostic category and its validity remains to be proven.Patients with BPD were not seriously overrepresented in a material of 145 psychiatric patients, suicided during inpatient care or shortly after discharge 1961 to 1980. The number and proportion of borderline patients, however, increased for every five- years-period. In an analysis of cases suicided during inpatient treatment, repressive/rejective behavior from staff was frequently observed. Risk factors were identified in comparative studies. Male sex, extensive earlier hospitalization, repressive/rejective staff behavior and frequent previous suicide attempts were associated with completed suicides. A specific pattern of psychological variables was identified among suicided borderline patients including antisocial traits, drug abuse and a less intense interpersonal attachment.