Fenomeni dissociativi in un campione di pazienti Borderline

La patologia dissociativa come processo patogenetico nucleare del Disturbo Borderline di Personalità

  • Daniela Cantone
  • Filomena De Falco
  • Tilde Annunziato
  • Alfonso Davide Di Sarno
  • Carmen Giannetti
  • Daniela Iennaco
  • Martina Messina
  • Vincenzo Perrella
  • Barbara Vitulano

Abstract

Aims. This study aims to investigate the relationship between dissociative phenomena and the Borderline Personality Disorder, in order to identify which one of dissociative symptoms factor has a stronger tie with Borderline Personality Disorder. Moreover, this study aims to find out if the presence of dissociative symptoms is linked to the number of Borderline Personality Disorder traits (symptoms), or the Borderline Personality Disorder diagnosis itself. Methods. A representative sample (n = 1033) was selected from patients visiting a private mental health clinical center in Naples. Inclusion criteria provided both Borderline Personality Disorder and non-Borderline Personality Disorder patients. The Dissociative Experiences Scale and the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders IV Axis II Disorders were used in order to collect data. Statistical Analysis involved the Student’s T-test, logistic regression and one-way Analysis of Variance. Continuous variables were standardized before the regression test. In addition, collected data were analyzed by the software Statistical Package of Social Science. Results. The mean of DES-Total scores in Borderline Personality Disorder patients (μ = 17,38) was significantly higher (t = -3,11) than in non-Borderline Personality Disorder patients (μ = 10,72). Logistic regression showed a strong link between dissociative phenomena and Borderline Personality Disorder respect to DES Factor III (depersonalization/derealization). Furthermore, it shows how increasing one standard point in DES Factor III increases by 50% the chance to detect a Borderline Personality Disorder. Lastly, the Analysis of Variance highlighted that more the number of Borderline Personality Disorder traits increase, the higher average are shown on DES-Total scores. Discussion and conclusions. The study has shown that Dissociative phenomena are more frequent in Borderline Personality Disorder patients rather than non-Borderline Personality Disorder patients. Moreover, it shows that the link between dissociative phenomena and Borderline Personality Disorder is stronger in relation to symptom factor depersonalization/derealisation. Finally, results show that DES-Total mean scores increase as Borderline Personality Disorder traits number increases, with higher scores when four specific traits are detected. This evidence confirms that the relationship between dissociative phenomena and Borderline Personality Disorder depends on the number of Borderline Personality Disorder traits detected, but not necessarily on the Borderline Personality Disorder diagnosis.

Keywords: Dissociation, Borderline Personality Disorder, BPD

Abstract in italiano

Obiettivi. Scopi di tale studio sono: indagare il rapporto tra fenomeni dissociativi e Disturbo Borderline di Personalità, indagare rispetto a quale fattore sintomatologico dissociativo sia più forte il legame con il DBP e, infine, indagare se la presenza di fenomeni dissociativi sia legata al numero di tratti (sintomi) di DBP o alla diagnosi dello stesso. Metodi. Al campione (n = 1033), estratto dalla popolazione di pazienti di un ambulatorio di salute mentale privato della provincia di Napoli, sono stati somministrati gli strumenti DES e SCID II. Le valutazioni inferenziali sono state effettuate applicando il test T di Student, la regressione logistica e l’anova ad una via. Le variabili continue sono state standardizzate prima di effettuare il test di regressione. I dati raccolti sono stati trattati statisticamente attraverso l’ausilio del pacchetto SPSS per le analisi statistiche. Risultati. Il punteggio medio alla DES totale è significativamente più alto (t = -3,11) nei soggetti con DBP (μ = 17,38) rispetto a quello dei soggetti senza DBP (μ = 10,72). Dalla regressione logistica emerge che il legame tra fenomeni dissociativi e DBP è forte in relazione al Fattore III della DES (depersonalizzazione/derealizzazione) e che all’aumentare di un punto standard del Fattore III della DES aumenta del 50% la probabilità di riscontrare un DBP. L’analisi della varianza evidenzia che all’aumentare del numero di tratti di DBP si manifestano punteggi medi più alti alla DES totale. Discussione e conclusioni. Si evidenzia che i fenomeni dissociativi sono più frequenti nei pazienti con DBP rispetto ai pazienti senza DBP. Si evidenzia, inoltre, che il legame tra fenomeni dissociativi e DBP è più forte per quanto riguarda il fattore sintomatologico di depersonalizzazione/derealizzazione. Si rileva, infine, che i punteggi medi alla DES TOT aumentano all’aumentare del numero di tratti di DBP ma che, in particolare, tali punteggi sono più alti alla presenza di 4 tratti. Questa evidenza ci consente di concludere che il legame tra fenomeni dissociativi e DBP si collega al numero di tratti di DBP e non necessariamente alla diagnosi dello stesso.

Parole Chiave 

Dissociazione, Disturbo Borderline di Personalità, DBP.

Riferimenti bibliografici

Cantone D., Sperandeo R., Maldonato M N., Cozzolino P. Perris F. (2012). Dissociative phenomena in a sample of outpatients. Rivista di Psichiatria. 47 (3), 246-253. doi: 10.1708/1128.12448.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub. (p.337; p.768)

Spitzer, C., Barnow, S., Freyberger, H. J., & Grabe, H. J. (2006). Recent developments in the theory of dissociation. World Psychiatry, 5(2), 82.

Spitzer, C., Barnow, S., Grabe, H. J., Klauer, T., Schneider, W., Freyberger, H. J., & Stieglitz, R. D. (2006). Frequency, clinical and demographic correlates of pathological dissociation in Europe. Journal of Trauma & Dissociation, 7(1), 51- 62.doi:10.1300/J229v07n01_05.

Modestin, J., & Erni, T. (2004). Testing the dissociative taxon. Psychiatry Research, 126 (1), 77-82.doi:10.1016/j.psychres.2001.12.001.

Maldonato, N. M., Sperandeo, R., Moretto, E., & Dell'Orco, S. (2018). A non-linear predictive model of borderline personality disorder based on multilayer perceptron. Frontiers in psychology, 9, 447.doi:10.3389/fpsyg.2018.00447.

Bernstein, E. M., & Putnam, F. W. (1986). Development, reliability, and validity of a dissociation scale. Journal of nervous and mental disease, 174(12), 727-735.doi: 10.1097/00005053-198612000-00004.

Korzekwa, M. I., Dell, P. F., Links, P. S., Thabane, L., & Fougere, P. (2009). Dissociation in borderline personality disorder: a detailed look. Journal of Trauma & Dissociation, 10(3), 346-367.doi:10.1080/15299730902956838.

Korzekwa, M. I., Dell, P. F., & Pain, C. (2009). Dissociation and borderline personality disorder: an update for clinicians. Current Psychiatry Reports, 11(1), 82-88.

Kernberg, O. (1967). Borderline personality organization. Journal of the American psychoanalytic Association, 15(3), 641-685.doi:10.1177/000306516701500309.

Meares, R. (2012). A Dissociation Model of Borderline Personality Disorder. WW Norton & Company.

Silk, K. R. (2011). Overview of the Pharmacotherapy of Borderline Personality Disorder: Should We Rethink the APA Algorithm?. In JOURNAL OF PERSONALITY DISORDERS (Vol. 25, pp. 6-6). 370 SEVENTH AVE, SUITE 1200, NEW YORK, NY 10001-1020 USA: GUILFORD PUBLICATIONS INC.

Wilkinson-Ryan, T., & Westen, D. (2000). Identity disturbance in borderline personality disorder: An empirical investigation. American Journal of Psychiatry, 157(4), 528-541.

Anderson, G., Yasenik, L., & Ross, C. A. (1993). Dissociative experiences and disorders among women who identify themselves as sexual abuse survivors. Child Abuse & Neglect, 17(5), 677-686.doi:10.1016/0145-2134(93)90088-M.

Chu, J. A., & Dill, D. L. (1990). Dissociation, borderline personality disorder, and childhood trauma. American Journal of Psychiatry, 148(6), 812. doi:10.1176/ajp.148.6.812-a.

Gershuny, B. S., & Thayer, J. F. (1999). Relations among psychological trauma, dissociative phenomena, and trauma-related distress: A review and integration. Clinical psychology review, 19(5), 631-657.doi:10.1016/S0272-7358(98)00103-2.

Stiglmayr, C. E., Shapiro, D. A., Stieglitz, R. D., Limberger, M. F., & Bohus, M. (2001). Experience of aversive tension and dissociation in female patients with borderline personality disorder—a controlled study. Journal of psychiatric research, 35(2), 111- 118.doi:0.1016/S0022-3956(01)00012-7.

Wildgoose, A., Waller, G., Clarke, S., & Reid, A. (2000). Psychiatric symptomatology in borderline and other personality disorders: dissociation and fragmentation as mediators. The Journal of nervous and mental disease, 188(11), 757-763.

Herman, J. L., & van der Kolk, B. A. (1987). Borderline Personality Disorder. Psychological trauma, 111.

Laporte, L., & Guttman, H. (2001). Abusive relationships in families of women with borderline personality disorder, anorexia nervosa, and a control group. Journal of Nervous & Mental Disease, 189, 522–531.

Zanarini, M. C., Ruser, T., Frankenburg, F. R., & Hennen, J. (2000). The dissociative experiences of borderline patients. Comprehensive Psychiatry, 41(3), 223- 227.doi:10.1016/S0010-440X(00)90051-8.

Zanarini, M. C., Ruser, T. F., Frankenburg, F. R., Hennen, J., & Gunderson, J. G. (2000). Risk factors associated with the dissociative experiences of borderline patients. Journal of Nervous & Mental Disorders, 188, 26–30.

Ross-Gower, J., Waller, G., Tyson, M., & Elliott, P. (1998). Reported sexual abuse and subsequent psychopathology among women attending psychology clinics: The mediating role of dissociation. British Journal of Clinical Psychology, 37, 313–326.doi: 10.1111/j.2044-8260.1998.tb01388.x.

Shearer, S. L. (1994). Dissociative phenomena in women with borderline personality disorder. American Journal of Psychiatry, 151, 1324–1328.

Van Den Bosch, L. M. C., Verheul, R., Langeland, W., & Van Den Brink, W. (2003). Trauma, dissociation, and posttraumatic stress disorder in female borderline patients with and without substance abuse problems. Australian & New Zealand Journal of Psychiatry, 37, 549–555.

Allen, J. G., Fultz, J., Huntoon, J., & Brethour, J. R., Jr. (2002). Pathological dissociative taxon membership, absorption, and reported childhood trauma in women with trauma-related disorders. Journal of Trauma & Dissociation, 3(1), 89– 110.doi:10.1300/J229v03n01_07.

Draijer, N., & Langeland, W. (1999). Childhood trauma and perceived parental dysfunction in the etiology of dissociative symptoms in psychiatric inpatients. American Journal of Psychiatry, 156, 379–385.

Carlson, E. B., Dalenberg, C., Armstrong, J., Daniels, J. W., Loewenstein, R., & Roth, D. (2001). Multivariate prediction of posttraumatic symptoms in psychiatric inpatients. Journal of Traumatic Stress, 14, 549–567.

Ogawa, J. R., Sroufe, L. A., Weinfield, N. S., Carlson, E. A., & Egeland, B. (1997). Development and the fragmented self: Longitudinal study of dissociative symptomatology in a nonclinical sample. Development & Psychopathology, 9, 855–879.

Herman, J. L., Perry, C., & Van der Kolk, B. A. (1989). Childhood trauma in borderline personality disorder. The American journal of psychiatry, 146(4), 490-495.

Laporte, L., & Guttman, H. (1996). Traumatic childhood experiences as risk factors for borderline and other personality disorders. Journal of personality Disorders, 10(3), 247- 259.doi:10.1521/pedi.1996.10.3.247.

Links, P. S., Steiner, M., Offord, D. R., & Eppel, A. (1988). Characteristics of borderline personality disorder: A Canadian study. Canadian Journal of Psychiatry, 33, 336– 340.doi:10.1177/070674378803300504.

Paris, J., Zweig-Frank, H., & Guzder, J. (1994). Psychological risk factors for borderline personality disorder in female patients. Comprehensive Psychiatry, 35, 301– 305.doi:10.1016/0010-440X(94)90023-X.

Dell, P. F. (1998). Axis II pathology in outpatients with dissociative identity disorder. The Journal of nervous and mental disease, 186(6), 352-356.

Conklin, C. Z., & Westen, D. (2005). Borderline personality disorder in clinical practice. American Journal of Psychiatry, 162, 867–875.

Laddis, A., & Dell, P. F. (2002). A comparison of DID with 30 cases of SIDP-IV diagnosed borderline personality disorder. Paper presented at the annual meeting of the International Society for the Study of Dissociation, Baltimore, MD.

Sar, V., & Ross, C. (2006). Dissociative disorders as a confounding factor in psychiatric research. Psychiatric Clinics of North America, 29(1), 129–144.doi:10.1016/j.psc.2005.10.008.

Sar, V., Kundakci, T., Kiziltan, E., Yargic, I. L., Tutkun, H., Bakim, B., Bozkurt, O.,Özpulat, T., Keser, V., Özdemir, O. (2003). The Axis-I dissociative disorder comorbidity of borderline personality disorder among psychiatric outpatients. Journal of Trauma & Dissociation, 4(1), 119–136.doi:10.1300/J229v04n01_08.

Pubblicato
2020-05-06
Come citare
Cantone, D., De Falco, F., Annunziato, T., Di Sarno, A. D., Giannetti, C., Iennaco, D., Messina, M., Perrella, V., & Vitulano, B. (2020). Fenomeni dissociativi in un campione di pazienti Borderline. Phenomena Journal - Giornale Internazionale Di Psicopatologia, Neuroscienze E Psicoterapia, 2(1), 26 - 39. https://doi.org/10.32069/pj.2020.1.69
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