Joel Paris

..To examine recent research on the treatment of borderline personality disorder (BPD)...

..DID was based on poorly conceived theories and used potentially damaging treatment methods. The problem continues, given that the DSM-5 includes DID and accords dissociative disorders a separate chapter in its manual...

..As in Part 1 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances...

..The general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances...

..There is good support for well-structured methods of psychotherapy, mainly in borderline personality disorder (BPD), but evidence for the efficacy of pharmacotherapy is weak. Research on other PD categories is sparse...

..This review suggests that BPD needs to be diagnosed with a narrower set of criteria that cover all of its domains. In the long run, the disorder will need to be redefined on the basis of its etiology and pathogenesis...

..Biological reductionism lies behind a concept of mood as the primary driver of psychopathology, a view that may be detrimental to treatment...

..While there are few empirical data on intermittent therapy, it may be common in clinical practice. This approach is illustrated by two cases of patients with personality disorders seen at multiple points in their lives...

..This review examines whether borderline personality disorder (BPD) should be considered part of the bipolar spectrum...

..A population-based strategy may be more effective than a high-risk strategy focusing on patients with suicidal ideas or attempts. Much more research is needed before developing effective suicide prevention programs...

..Outcome research shows that most patients recover with time. A series of clinical trials show that a variety of psychotherapies are effective in BPD and that the effects of medication are unimpressive...

..Until further research clarifies the boundaries of bipolarity, we should be conservative about extending its scope...

..To examine the extent to which neuroscience accounts for mental disorders...

..Successful psychotherapy in individuals with borderline personality disorder should not resemble treatment as usual but should offer a predictable structure and methods to promote emotion regulation and problem solving in current life...

..Overestimation of prevalence negatively affects research, which would benefit from a narrower definition of PDs based on dysfunction in multiple domains...

..There were no differences on Kd. Neither B(max) nor K(d) was related to most trait or symptomatic measures. Paroxetine binding could reflect endophenotypes common to BPD probands and their first-degree relatives...

..However, application of endophenotypes to personality disorders is unlikely for the foreseeable future, given an insufficient knowledge of etiology and pathogenesis...

..However, drug treatment does not produce remission of BPD. Routine prescription of these agents for these patients is not evidence-based...

..These pathways also help account for the life course and outcome of BPD in adulthood...

..Taken together, these findings point to the need for a revision of the classification of personality disorders that would separate enduring traits from reversible symptoms...

..Thus, existing evidence is insufficient to support the concept that BPD falls in the bipolar spectrum...

..Hospitalization is of unproven value for suicide prevention and can often produce negative effects. Day treatment is an evidence-based alternative to full admission. Chronic suicidality can best be managed in an outpatient setting...

..Since there is no evidence that hospitalization prevents completion, an ambulatory approach to the management of chronically suicidal patients may be most useful...

..The chronicity of personality disorders is both a challenge and a frame for treatment planning. Psychotherapy for these patients can focus on rehabilitation and the development of social niches that match their personality profiles...

..The purpose of this review is to examine empirical evidence concerning critiques of the diagnosis of borderline personality disorder (BPD): for uncertain validity, and for overlap with other mental disorders...

..Our current understanding of neurobiology is insufficient to develop a model of personality on this basis. At this point, dimensions of personality should be derived from factor analysis rather than from neurobiological theories...

..There is an evidence base for treatment using both psychotherapy and psychopharmacology. The clinical challenge centres on managing chronic suicidality...

..The chronicity of personality disorders can usefully guide treatment planning, and psychotherapy for personality disorders can focus on rehabilitation...

..Multiple causal factors, including biological, psychological, and social risks, influence thresholds for self-mutilation. Management of this behavior can be informed by understanding its psychological functions...

..There were no differences in cortisol response to m-CPP, or on the cholinergic and noradrenergic challenges. The results suggest that impulsive traits in borderline patients are associated with abnormalities in serotonergic systems...

..These differences are not artifacts, but reflect gender differences in the personality traits that underlie Axis II diagnoses...

..One approach may be to examine whether narrow, i.e., lower-order personality traits may be more useful than their underlying, broad personality trait dimensions...

..In this study, we examined the natural histories of several suicidal behaviors and investigated two conceptual models of suicidality (dimensional and categorical) in the context of adolescent and adult-onset suicide attempts...

..Identification of factors that distinguish between ideators who act on their suicidal thoughts from those who do not is an important clinical and research objective...

..No differences were found between abused and non-abused patients with BPD. These results do not support the hypothesis that CSA is directly related to neurobiological abnormalities in BPD...

..To investigate the association of childhood trajectories of anxiousness and disruptiveness with suicide attempts in early adulthood...

..Sensitivity to adverse experiences, as reflected in the development of psychopathology, appears to be influenced by personality trait profiles...

..Results have implications for the design of therapies for patients with BPD...

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..Subtle differences notwithstanding, our results offer additional evidence for structural stability of broad DAPP-BQ personality traits across sociodemographic and cultural contexts...

..There were no associations with trait dimensions independent of diagnosis. CONCLUSIONS: Reduced platelet paroxetine binding in female BPD patients may reflect presynaptic serotonin dysfunction...

..Although childhood abuse is an important correlate of suicidality, not all individuals who were abused as children attempt suicide...

..With no evidence that full hospitalization prevents suicide completion by patients with borderline personality, suicidal risk is not a contraindication for day hospital treatment...

..Findings indicate the importance of interpersonal perceptions in the affect dysregulation of individuals with BPD...

..All of these findings have clinical implications. Although treatment effects must be assessed in the context of naturalistic improvement, therapy can hasten remission...

..Using a case-control design, this study investigated clinical and behavioral risk factors for suicide completion in borderline personality disorder...

..These findings generally support the principle of multifinality, in which similar histories of adversities can be associated with a variety of outcomes, ranging from psychopathology to resilience...

..Little is known about the prevalence of and factors associated with suicide ideation and suicide attempts among college youth in India...

..In order to further explore their utility as markers of suicide risk and targets of intervention further investigation in clinical samples and other cultural and age groups is necessary...

..The findings document behavioral and affective manifestations of BPD in the context of naturally occurring interpersonal situations...

..Future directions for research are discussed...

..This study examined the outcomes of patients diagnosed with borderline personality disorder (BPD) prior to age 18...

..DIB-R scores and GAF scores at 15 years were significant predictors of all these measures of long-term outcome. In contrast, reports of parenting quality and of childhood abuse or trauma had no relationship to outcome...