Abstract

Background: There has been close association between borderline personality disorder and dissociative symptoms and disorders (Zanarini et al., 2000; Paris & Zweig-Frank 1997; Spitzer et al., 2006 and Ross, 2007). Dissociation is seen as a coping strategy to deal with strong anxiety states and with painful trauma experiences in BPD (Watson et al., 2006 and Ross, 2007).

Borderline patients have a wider range of dissociative experiences than are commonly recognized, including experiences of absorption and amnesia, as well as experiences of depersonalization (Zanarini et al., 2000).

This study aims at:
I- Examining the role of BPD psychopathology (in the form of child abuse and defensive style) on the form and severity of associated dissociative phenomena.
Hypothesis1(a): Previous psychological trauma specifically child abuse and neglect associated with increased prevalence and severity of dissociation in BPD. Hypothesis1(b):The defensive styleof BPD hasan effect onassociated dissociative phenomena.
II- Examining the effect of BPD illness characteristics and severity variables on form and severity of associated dissociative phenomena.
Hypothesis2 (a): The BPD illness characteristics and severity variableshave an effect on the type of associated dissociation.
Hypothesis2 (b): The BPD illness characteristics and severity variables have an effect on severity of associated dissociation.
EEG status in BPD:

Subjects and Methods: The study was done on (60) participants who have the diagnosis of borderline personality disorder associated with or without dissociation, with age  between 18-50 years. The clinical sample was recruited from different sources as from outpatient psychiatric clinics in minia government area, from patients visiting  the outpatient psychiatric clinic of Elminia university hospital and from patient who attend group psychotherapy settings in Elminia university hospital, scientific building (Group Hall) after informing psychiatrists who follow  these patients regarding the aim and procedure of this study and also from .The patient’s interview was in the outpatient psychiatric clinic of Elminia university hospital.

After diagnosing BPD as previously described, the dissociation was measured using Dissociative Experiences Scale (Bernstein and Putnam, 1986), it is a 28-item self-report questionnaire that surveys the frequency of various experiences of dissociative phenomena in the daily life.

Psychopathology involving child trauma and abuse, defense mechanisms and symptomatology  were assessed according to the following battery of tools:

  1. Childhood Trauma Questionnaire (Bernstein and Fink, 1998),
  2. Questionnaire On Child Sexual Abuse (Halpérin et al, 1996)
  3. Borderline Evaluation of Severity over Time(BEST) (Bruce et al, 1997)
  4. Defens Style questionnaire (D S Q) (Bond , 1992).

In addition  Electroencephalogram (EEG) was done for all selected subjects.

Data were analyzed using the statistical program for sciences-19 (SPSS-19). Frequencies and percentages were calculated for categorical variables while mean and standard deviation were calculated for continuous variables. T-tests were used to compare groups on continuous variables while Chi square tests were used on categorical variables. Cut off value of significance (p value) was considered at less than 0.05.

Results

  • Fifty one (51) of our 60 patients went through EEG assessment. The study of their EEG records showed that13.7% had epileptiform EEG changes while the remaining patients (86.3%) had non epilptiform EEG record (68.6% with normal EEG record, 13.7% with nonspecific EEG changes, and only 3.9% with non-significant EEG changes). Concerning the comparison of BPD with epileptiform EEG changes and BPD with non epilptiform EEG changes regarding variables of DES factors of dissociation, it was found that amnesia factor was lower in patients with epileptiform EEG changes, while absorption, depersonalization and total score of DES were higher in patients with epileptiform EEG changes. However, these results were not statistically significant. Borderline patients with epileptiform EEG changes had higher figures regarding subscale A, B, and total score of DES than those without such changes. The reverse was the case for subscale C (subscale of positive behaviors), but these comparisons were not statistically significant.
  • Dissociative phenomena (including dissociative experiences and dissociative symptoms) are commonly comorbid with BPD.
  • Dissociative phenomena present inBPD vary in presentation and severity from patient to another.
  • Patients with BPD more frequently to have at least another comorbid PD in addition to BPD.
  • Neurotic defenses are the most commonly used defenses by borderline patients, followed by immature defenses and finally the least used are the mature defenses.
  • Defensive style of BPD affects presentation and severity of associated dissociative phenomena.
  • Borderline patients frequently experience exposure to trauma and neglect as children, especially physical and emotional neglect.
  • Reported history of child trauma (especially child abuse) in patients with BPD has a significant effect on presentation and severity of associated dissociation.
  • Severity of BPD (as measured by number of DSM-IV criteria, number of comorbid other personality disorders, and severity of emotional and behavioral disturbance) affect presentation and severity of associated dissociation.

Citation:

Said, H. M., Abd El-Hameed, M. A., Taha, M. and Mahfouz, R. (2017). Doctoral dissertation, Neurology and Psychiatry Dept., Faculty of Medicine, Minia University.

For complete dissertation:

  • Contact Dr. Hussein Mahmoud Said (email: husseinmam47@gmail.com ).
  • Link to Egyptian Universities Library Consortium (here).
  • Visit Minia Faculty of Medicine’s book library.