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SMJ // Article

Original Article

Externalized Aggressive Behaviors in Patients with Borderline Personality Symptomatology

Authors: Randy A. Sansone, MD, Justin S. Leung, BA, Michael W. Wiederman, PhD

Abstract

Objective: Borderline personality disorder (BPD) is commonly characterized by self-directed aggressive behavior, although the literature indicates that externalized aggressive behavior may be present. The simultaneous examination of multiple types of externalized aggressive behavior in individuals with BPD and the exploration of such relationships in a primary care population have not, to our knowledge, been undertaken; this is the focus of the present study.


Methods: Using a cross-sectional approach in a consecutive sample of 335 internal medicine outpatients, we explored through a self-report survey the relation between 21 externalized aggressive behaviors and BPD symptomatology, using two self-report measures for assessment: the borderline personality disorder scale of the Personality Diagnostic Questionnaire-4 (PDQ-4) and the Self-Harm Inventory (SHI).


Results: Scores on the measure for externalized aggressive behavior correlated strongly with scores on the PDQ-4 (r = 0.60; P < 0.001) and the SHI (r = 0.67; P < 0.001) and were statistically significantly greater among respondents who exceeded the cutoff scores for BPD symptomatology on both the PDQ-4 and the SHI as compared with respondents who did not exceed these scores.


Conclusions: In addition to self-directed aggressive behavior, individuals with BPD symptomatology also exhibit various externalized aggressive behaviors.

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References

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.
 
2. Alden SA. Borderline personality disorder and aggression: exploring mediating and moderating roles of psychophysiological arousal. Dissert Abstr Int 2009; 69: 6397B.
 
3. Fountoulakis KN, Leucht S, Kaprinis GS. Personality disorders and violence. Curr Opin Psychiatry 2008; 21: 84–92.
 
4. Goodman M, New A. Impulsive aggression in borderline personality disorder. Curr Psychiatry Rep 2000; 2: 56–61.
 
5. Dutton DG, Starzomski AJ. Borderline personality in perpetrators of psychological and physical abuse. Violence Vict 1993; 8: 327–337.
 
6. Tweed RG, Dutton DG. A comparison of impulsive and instrumental subgroups of batterers. Violence Vict 1998; 13: 217–230.
 
7. Dutton DG. Personality dynamics of intimate abusiveness. J Psychiatr Pract 2002; 8: 216–228.
 
8. Porcerelli JH, Cogan R, Hibbard S. Personality characteristics of partner violent men: a Q-sort approach. J Pers Disord 2004; 18: 151–162.
 
9. Tong ARWC. A multivariate path model for understanding male spousal violence against women: a Canadian study. Dissert Abstr Int 2004; 64: 5238B.
 
10. Mauricio AM, Lopez FG. A latent classification of male batterers. Violence Vict 2009; 24: 419–438.
 
11. Ross JM, Babcock JC. Proactive and reactive violence among intimate partner violent men diagnosed with antisocial and borderline personality disorder. J Fam Violence 2009; 24: 607–617.
 
12. Hughes FM, Stuart GL, Gordon KC, et al. Predicting the use of aggressive conflict tactics in a sample of women arrested for domestic violence. J Soc Per Relat 2007; 24: 155–176.
 
13. Stuart GL, Moore TM, Gordon KC, et al. Psychopathology in women arrested for domestic violence. J Interpers Violence 2006; 21: 376–389.
 
14. Hines DA. Borderline personality traits and intimate partner aggression: an international multisite, cross-gender analysis. Psychol Women Q 2008; 32: 290–302.
 
15. Sansone RA, Farukhi S, Wiederman MW. Disruptive behaviors in the medical setting and borderline personality. Int J Psychiatry Med 2011; 41: 355–363.
 
16. Sansone RA, Sansone LA. Borderline personality and criminality. Psychiatry 2009; 6: 16–20.
 
17. Gross J. Aggression in hospitalized criminal offenders with mental illness and personality disorders: a psychoanalytic retrospective longitudinal study. Dissert Abstr Int 2007; 68: 621B.
 
18. Lveille S, Lefebvre J, Marleau J-D. Familicide in Quebec: 1986 to 2000. Ann Med Psychol 2009; 167: 591–596.
 
19. Papazian LM. Literature review on the personalities and patterns of serial killers. Dissert Abstr Int 2001; 61: 6144B.
 
20. Ansevics NL, Doweiko HE. Serial murderers: early proposed developmental model and typology. Psychother Priv Pract 1991; 9: 107–122.
 
21. Newhill CE, Eack SM, Mulvey EP. Violent behavior in borderline personality. J Pers Disord 2009; 23: 541–554.
 
22. Hyler SE. Personality Diagnostic Questionnaire-4. New York, New York State Psychiatric Institute, 1994.
 
23. Sansone RA, Wiederman MW, Sansone LA. The Self-Harm Inventory (SHI): development of a scale for identifying self-destructive behaviors and borderline personality disorder. J Clin Psychol 1998; 54: 973–983.
 
24. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC, American Psychiatric Association, 1994.
 
25. Dubro AF, Wetzler S, Kahn MW. A comparison of three self-report questionnaires for the diagnosis of DSM-III personality disorders. J Personal Disord 1988; 2: 256–266.
 
26. Hyler SE, Lyons M, Rieder RO, et al. The factor structure of self-report DSM-III axis II symptoms and their relationship to clinicians’ ratings. Am J Psychiatry 1990; 147: 751–757.
 
27. Johnson JG, Bornstein RF. Utility of the Personality Diagnostic Questionnaire-Revised in a nonclinical sample. J Personal Disord 1992; 6: 450–457.
 
28. Patrick J, Links P, Van Reekum R, et al. Using the PDQ-R BPD scale as a brief screening measure in the differential diagnosis of personality disorder. J Personal Disord 1995; 9: 266–274.
 
29. Kolb JE, Gunderson JG. Diagnosing borderlines with a semi-structured interview. Arch Gen Psychiatry 1980; 37: 37–41.
 
30. Sen S. Socioeconomic status and mental health: what is the causal relationship? Acta Psychiatr Scand 2012; 125: 187–188.
 
31. Zanarini MC, Frankenburg FR, Dubo ED, et al. Axis II comorbidity of borderline personality disorder. Compr Psychiatry 1998; 39: 296–302.