Article1998

The Pain of Being Borderline: Dysphoric States Specific to Borderline Personality Disorder

Mary C. Zanarini · Frances Rachel Frankenburg · Christine J. DeLuca · John A. Hennen · Gagan S. Khera · John G. Gunderson

197 citations0/0 files storedHarvard Review of Psychiatry

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Abstract

The objective of this study was to identify the dysphoric states that best characterize patients meeting criteria for borderline personality disorder and distinguish them from those in patients with other forms of personality disorder. One hundred forty-six patients with criteria-defined borderline personality disorder and 34 Axis II controls filled out the Dysphoric Affect Scale, a 50-item self-report measure that was designed for this purpose and has good internal consistency and test-retest reliability. Twenty-five dysphoric states (mostly affects) were found to be significantly more common among borderline patients than controls but nonspecific to borderline personality disorder. Twenty-five other dysphoric states (mostly cognitions) were found to be both significantly more common among borderline patients than controls and highly specific to borderline personality disorder. These states tended to fall into one of four clusters: (1) extreme feelings, (2) destructiveness or self-destructiveness, (3) fragmentation or "identitylessness," and (4) victimization. In addition, three of the 25 more-specific states (feeling betrayed, like hurting myself, and completely out of control), when occurring together, were particularly strongly associated with the borderline diagnosis. Equally important, overall mean Dysphoric Affect Scale scores correctly distinguished borderline personality disorder from other personality disorders in 84% of the subjects. Taken together, the results of this study suggest that the subjective pain of borderline patients may be both more pervasive and more multifaceted than previously recognized, and that the overall "amplitude" of this pain may be a particularly good marker for the borderline diagnosis.

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References

1957Two Factor Index of Social Position 1997Reported pathological childhood experiences associated with the development of borderline personality disorder 1979Crossing the Border Into Borderline Personality and Borderline Schizophrenia 1989The Revised Diagnostic Interview for Borderlines: Discriminating BPD from other Axis II Disorders 1974Countertransference Hate in the Treatment of Suicidal Patients 1990Estimating the Prevalence of Borderline Personality Disorder in the Community 1978Discriminating features of borderline patients

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