BPD

Q: Borderline personality disorder (BPD) features all of the following dimensions EXCEPT? (select one)

A) Impaired relatedness 

B) Affective dysregulation 

C) Behavior dysregulation 

D) Psychosomatic manifestations

Answer: D

Borderline personality disorder (BPD) has been modeled under three dimensions.

• Impaired relatedness
• Affective dysregulation
• Behavior dysregulation 

Out of the above three, 'affective dysregulation' is considered to be the most sensitive and specific single manifestation of BPD. It is also considered to be a potentially helpful screen. It is featured by affective lability, excessive anger, and efforts to avoid abandonment.

Impaired relatedness is manifested as unstable relationships with others, identity disturbance, and chronic emptiness.

Behavior dysregulation is marked by impulsivity, suicidality, and self-injurious behavior.

Patients with chronic emptiness are prone to have higher morbidity, including suicidality, history of suicide attempts and hospitalizations, social and work dysfunction, axis I (symptom) disorder comorbidity, and global functioning.

Although psychosomatic symptoms (choice D) may occur, they are not the hallmark of BPD.

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References:

1. Sanislow CA, Grilo CM, McGlashan TH. Factor analysis of the DSM-III-R borderline personality disorder criteria in psychiatric inpatients. Am J Psychiatry 2000; 157:1629.

2. Zimmerman M, Multach MD, Dalrymple K, Chelminski I. Clinically useful screen for borderline personality disorder in psychiatric out-patients. Br J Psychiatry 2017; 210:165.

3. Ellison WD, Rosenstein L, Chelminski I, et al. The clinical significance of single features of borderline personality disorder: Anger, affective instability, impulsivity, and chronic emptiness in psychiatric outpatients. J Pers Disord 2016; 30:261.