Externalized Aggressive Behaviors in Borderline Personality
Externalized Aggressive Behaviors in Borderline Personality
Regardless of the type of analytic approach used in this study, participants with BPD symptomatology were significantly more likely to have engaged in various externally directed aggressive behaviors as compared with those without such symptomatology. In addition, the most commonly reported behaviors that demonstrated between-group differences were intentionally breaking things (74.1%), pushing or shoving a partner (61.5%), punching a wall (52.7%), participating in fistfights not in a bar (49.5%), hitting a partner (39.6%), damaging the property of others to exact revenge on them (35.2%), and threatening someone with a weapon (29.7%). These data appear to strongly reinforce the impression that patients with BPD symptomatology engage not only in self-directed aggressive behavior but also various forms of externalized aggressive behavior. Behaviors that are interpersonally aggressive reflect the generally volatile nature of these individuals' relationships with others, which is specified as a diagnostic criterion in the DSM-IV (a pattern of unstable and intense interpersonal relationships). In addition, externalized aggression may be explained by several other DSM diagnostic criteria for BPD (eg, impulsivity, reactivity of mood, intense anger).
Note that throughout the article we have used the term "BPD symptomatology" to describe the corresponding subsample of patients. The study measures, although highly correlated, are best viewed as screening measures for BPD. They are not intended as substitutes for diagnosis, which is best undertaken through interview. Because of this, these measures run the risk of generating false-positives or being overly inclusive, which partially explains the high rates of BPD-positive individuals encountered in this study; however, both measures appear to accurately assess the features of BPD. As a caveat, this study was undertaken in a resident-run clinic, which provides services for a large percentage of uninsured individuals and may partially explain the high rates of personality disorder symptomatology.
An interesting side issue is whether some of these reported aggressive behaviors are a reflection of antisocial behavior. The presence of antisocial personality features does not necessarily exclude the presence of comorbid BPD symptomatology. In a study of axis II comorbidity in BPD, investigators commonly encountered antisocial personality disorder, particularly among male subjects. In addition, some overlap between these disorders is likely, given the overlapping DSM criteria between the two, such as irritability and physical fights.
The findings of this investigation indicate that when treating individuals with BPD, it appears clinically relevant to assess not only self-directed aggressive behavior but also externalized aggressive behaviors. These externalized aggressive behaviors may connect with various medical and legal issues that need to be taken into account during treatment, either medical or psychiatric. They also may be an indirect indication of an individual's ability to tolerate stress in a treatment relationship and thereby may indicate any potential risk of danger to the clinician.
This research has a number of potential limitations. First, all of the data were self-report in nature; thus, endorsement of individual aggression items may have been influenced by a number of psychological variables, including forgetfulness, suppression, denial, repression, and misinterpretation. In addition, the self-report measures used in this study for the assessment of BPD are screening measures and indicate BPD symptomatology, not necessarily bona fide BPD. Second, the exclusion process was informal and some individuals who were excluded at the outset may have influenced findings had they been included, although the overall response rate was reasonable. Third, a percentage of participants may have had antisocial features, but from these data we cannot discern what percentage or level of comorbidity exists between BPD and antisocial personality in this sample. Finally, the ABQ does not have established psychometric properties and it does not quantify the frequency or severity of such behaviors; we can only discern lifetime prevalence.
Discussion
Regardless of the type of analytic approach used in this study, participants with BPD symptomatology were significantly more likely to have engaged in various externally directed aggressive behaviors as compared with those without such symptomatology. In addition, the most commonly reported behaviors that demonstrated between-group differences were intentionally breaking things (74.1%), pushing or shoving a partner (61.5%), punching a wall (52.7%), participating in fistfights not in a bar (49.5%), hitting a partner (39.6%), damaging the property of others to exact revenge on them (35.2%), and threatening someone with a weapon (29.7%). These data appear to strongly reinforce the impression that patients with BPD symptomatology engage not only in self-directed aggressive behavior but also various forms of externalized aggressive behavior. Behaviors that are interpersonally aggressive reflect the generally volatile nature of these individuals' relationships with others, which is specified as a diagnostic criterion in the DSM-IV (a pattern of unstable and intense interpersonal relationships). In addition, externalized aggression may be explained by several other DSM diagnostic criteria for BPD (eg, impulsivity, reactivity of mood, intense anger).
Note that throughout the article we have used the term "BPD symptomatology" to describe the corresponding subsample of patients. The study measures, although highly correlated, are best viewed as screening measures for BPD. They are not intended as substitutes for diagnosis, which is best undertaken through interview. Because of this, these measures run the risk of generating false-positives or being overly inclusive, which partially explains the high rates of BPD-positive individuals encountered in this study; however, both measures appear to accurately assess the features of BPD. As a caveat, this study was undertaken in a resident-run clinic, which provides services for a large percentage of uninsured individuals and may partially explain the high rates of personality disorder symptomatology.
An interesting side issue is whether some of these reported aggressive behaviors are a reflection of antisocial behavior. The presence of antisocial personality features does not necessarily exclude the presence of comorbid BPD symptomatology. In a study of axis II comorbidity in BPD, investigators commonly encountered antisocial personality disorder, particularly among male subjects. In addition, some overlap between these disorders is likely, given the overlapping DSM criteria between the two, such as irritability and physical fights.
The findings of this investigation indicate that when treating individuals with BPD, it appears clinically relevant to assess not only self-directed aggressive behavior but also externalized aggressive behaviors. These externalized aggressive behaviors may connect with various medical and legal issues that need to be taken into account during treatment, either medical or psychiatric. They also may be an indirect indication of an individual's ability to tolerate stress in a treatment relationship and thereby may indicate any potential risk of danger to the clinician.
This research has a number of potential limitations. First, all of the data were self-report in nature; thus, endorsement of individual aggression items may have been influenced by a number of psychological variables, including forgetfulness, suppression, denial, repression, and misinterpretation. In addition, the self-report measures used in this study for the assessment of BPD are screening measures and indicate BPD symptomatology, not necessarily bona fide BPD. Second, the exclusion process was informal and some individuals who were excluded at the outset may have influenced findings had they been included, although the overall response rate was reasonable. Third, a percentage of participants may have had antisocial features, but from these data we cannot discern what percentage or level of comorbidity exists between BPD and antisocial personality in this sample. Finally, the ABQ does not have established psychometric properties and it does not quantify the frequency or severity of such behaviors; we can only discern lifetime prevalence.
Source...