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Psychobiology and treatment of borderline personality disorder

Published online by Cambridge University Press:  24 June 2014

C. Robert Cloninger
C. Robert Cloninger*
Affiliation:
Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
*
Department of Psychiatry, Washington University School of Medicine, Campus Box 8134, 660 South Euclid, St Louis, MO 63110. USA. Tel.: 314 362 7005; E-mail: clon@tci.wustl.edu
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Abstract

Borderline personality disorder can be characterized in terms of a profile of abnormal deviations on multiple personality dimensions using the temperament and character inventory (TCI). Borderline patients show poor character development, including low TCI self-directedness (irresponsible, blaming) and low TCI cooperativeness (hostile, intolerant). Their temperament is explosive or unstable due to a combination of high TCI harm avoidance (anxious, shy), high TCI novelty seeking (impulsive, quick-tempered), and low reward dependence (cold, aloof). Consequently they are usually dysthymic with an admixture of anxiety and anger, and regulate their social problems and intense emotions in immature ways. Genetic and psychobiological studies have led to identification of biological correlates of each of the TCI dimensions of personality, including individual differences in regional brain activity, psychophysiological variables, neuroendocrine abnormalities and specific gene polymorphisms. Each dimension of personality involves complex non-linear interaction of multiple genetic and environmental factors and, in turn, each personality dimension interacts with the others in influencing the way an individual directs and adapts to his or her life experiences. Systematic clinical trials have shown that these personality variables predict the response to pharmacological and psychotherapeutic treatments. For example, high harm avoidance and low self-directedness predict slower response and more rapid relapse with both antidepressants and cognitive-behavioral therapy. Treatment with drugs and/or psychotherapy can be individually matched to the patient's profile of temperament and character traits, rather than treating a heterogeneous group of patients as if they had a discrete, homogeneous illness. Fundamental change in cognitive schemas depends on attention to all aspects of character, especially self-transcendence, which has previously been neglected in cognitive-behavioral therapy. Personality integration requires non-resistance to our natural intuitive awareness, rather than intensified intellectual and emotional defenses.

Keywords

borderlinebiologygeneticsimpulsivity
Type
Research Article
Information
Acta Neuropsychiatrica , Volume 14 , Issue 2 , April 2002 , pp. 60 - 65
Copyright
Copyright © Acta Neuropsychiatrica 2002

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References

Cloninger, CR, Svrakic, DM. Personality disorders. In: Sadock, BJ, Sadock, VA, eds. Comprehensive textbook of psychiatry, 7th edn, Vol. I. Philadelphia: Lippincott, Williams & Wilkins, 2000: 1723–1765. Google Scholar
American Psychiatric Association. Diagnostic and statistical manual (DSM-IV), 4th edn. Washington DC: American Psychiatric Press, 1994: 650–654. Google ScholarPubMed
Stone, MH. Clinical guidelines for psychotherapy for patients with borderline personality disorder. Psychiatr Clin N Am 2000;23: 193–210. CrossRefGoogle ScholarPubMed
Cloninger, CR, Svrakic, DM, Przybeck, TR. A psychobiological model of temperament and character. Arch Gen Psychiatry 1993;50: 975–990.CrossRefGoogle ScholarPubMed
Svrakic, DM, Whitehead, C, Przybeck, TR, Cloninger, CR. Differential diagnosis of personality disorders by the seven-factor model of temperament and character. Arch Gen Psychiatry 1993;50: 991–999.CrossRefGoogle ScholarPubMed
Cloninger, CR, Przybeck, TR, Svrakic, DM, Wetzel, RD. The temperament and character inventory (TCI): a guide to its development and use. St Louis: Washington University Center for Psychobiology of Personality, 1994. Google Scholar
Cloninger, CR, Svrakic, DM. Integrative psychobiological approach to psychiatric assessment and treatment. Psychiatry 1997;60: 120–141.CrossRefGoogle Scholar
Cloninger, CR, Van Eerdewegh, P, Goate, Aet al. Anxiety proneness linked to epistatic loci in genome scan of human personality traits. Am J Med Genet 1998;81: 313–317.DOI: 10.1002/(SICI)1096-8628(19980710)81:4<313::AID-AJMG7>3.3.CO;2-V3.0.CO;2-U>CrossRefGoogle ScholarPubMed
Comings, DE, Gade-Andavolu, R, Gonzalez, Net al. A multivariate analysis of 59 candidate genes in personality traits: the temperament and character inventory. Clin Gen 2002; 6065in pressGoogle ScholarPubMed
Cloninger, CR. The genetics and psychobiology of the seven-factor model of personality. In: Silk, KR, ed. Biology of personality disorders. Washington, DC: American Psychiatric Press, 1998: 63–92. Google Scholar
Cloninger, CR. Biology of personality dimensions. Curr Opin Psychiatry 2000;13: 611–616.DOI: 10.1097/00001504-200011000-00024CrossRefGoogle Scholar
Cloninger, CR, Svrakic, NM, Svrakic, DM. Role of personality self-organization in development of mental order and disorder. Dev Psychopathol 1997;9: 881–906.CrossRefGoogle ScholarPubMed
Mulder, RT, Joyce, PR, Sellman, JD, Sullivan, PR, Cloninger, CR. Towards an understanding of defense style in terms of temperament and character. Acta Psychiatr Scand 1996;93: 99–104.CrossRefGoogle ScholarPubMed
Beck, JS. Cognitive therapy of personality disorders. In: Salkovskis, PM, ed. Frontiers of cognitive therapy. New York: Guilford Press, 1996: 165–181. Google Scholar
Beck, AT. Cognitive aspects of personality disorders and their relation to syndromal disorders: A psychoevolutionary approach. In: Cloninger, CR. Personality and psychopathology. Washington, DC: American Psychiatric Press, 1999: 411–429. Google Scholar
Joffee, RT, Bagby, RM, Levitt, AJ, Regan, JJ, Parker, JDA. The tridimensional personality questionnaire in major depression. Am J Psychiatry 1993;150: 959–960.Google Scholar
Joyce, PR, Mulder, RT, Cloninger, CR. Temperament predicts clomipramine and desipramine response in major depression. J Affect Disord 1994;30: 35–46.CrossRefGoogle ScholarPubMed
Tome, MB, Cloninger, CR, Watson, J, Isaac, MT. Serotonergic autoreceptor blockade in the reduction of antidepressant latency: personality variables and response to paroxetine and pindolol. J Affect Disord 1997;44: 101–109.CrossRefGoogle ScholarPubMed
Markovitz, PJ. Pharmacotherapy of impulsivity, aggression and related disorders. In: Hollander, E, Stein, D, eds. Impulsivity and aggression. Surrey, UK: Wiley, 1995: 263–287. Google Scholar
Salzman, C, Wolfson, AN, Schatzberg, Aet al. Effect of fluoxetine on anger in symptomatic volunteers with borderline personality disorder. J Clin Psychopharmacol 1995;15: 23–29.DOI: 10.1097/00004714-199502000-00005CrossRefGoogle ScholarPubMed
Coccaro, EF, Kavoussi, RJ. Fluoxetine and impulsive-aggressive behavior in personality disordered subjects. Arch Gen Psychiatry 1997;54: 1081–1088.CrossRefGoogle ScholarPubMed
Links, P. Lithium therapy for borderline patients. J Personal Disord 1990;4: 173–181. CrossRefGoogle Scholar
Cowdry, RW, Gardner, DL. Pharmacotherapy of borderline personality disorder. Alprazolam, carbamazepine, trifluoperazine and tranylcypromine. Arch Gen Psychiatry 1988;45: 111–119.CrossRefGoogle ScholarPubMed
De La Fuenta, JM, Lotstra, F. A trial of carbamazepine in borderline personality disorder. Eur Neuropsychopharmacol 1994;4: 479–486.CrossRefGoogle Scholar
Bulik, CM, Sullivan, PF, Joyce, PR, Carter, FA, McIntosh, VV. Predictors of one-year treatment outcome in bulimea nervosa. Comp Psychiatry 1998;39: 206–214. CrossRefGoogle Scholar
Sotsky, SM, Glass, DR, Shea, MTet al. Patient predictors of response to psychotherapy and pharmacotherapy. Findings in the NIMH Treatment of Depression Collaborative Research Program. Am J Psychiatry 1991;148: 997–1008.Google ScholarPubMed
Cloninger, CR, Bayon, C, Svrakic, DM. Measurement of temperament and character in mood disorders: a model of fundamental states as personality types. J Affect Disord 1998;51: 21–32.CrossRefGoogle ScholarPubMed
Cloninger, CR, Svrakic, DM, Bayon, C, Przybeck, TR. Measurement of psychopathology as variants of personality. In: Cloninger, CR, ed. Personality and psychopathology. Washington, DC: American Psychiatric Press, 1999: 33–66. Google Scholar
Cloninger, CR. A new conceptual paradigm from genetics and psychobiology for the science of mental health. Aust NZ J Psychiatry 1999;33: 174–186. CrossRefGoogle Scholar
Cloninger, CR. A practical way to diagnosis of personality disorders: a proposal. J Pers Disord 2000;14: 99–108. CrossRefGoogle Scholar