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Experiential evidence suggests that the main features of spiritual experience are euphoria, and a feeling of the expansion and unification of consciousness. A way towards understanding this state and how it might arise comes from a consideration of a state in which these features are lacking. Such a state is borderline personality disorder, central to which is a "painful incoherence" that is not merely "psychological" but can be demonstrated neurophysiologically. The phenomena of the borderline syndrome can be understood as failure of proper maturation of the experience of "self," conceived as higher order consciousness in a notional hierarchy of consciousness. Spiritual experience is understood as a state "larger than self." Since both the achievement of a sense of the spirit and recovery from borderline personality disorder (BPD) involve an ascent in a hierarchy of consciousness, they may have a common basis. The approach to the development of self is derived from developmental observations which suggest that it depends upon a particular form of conversation, the first form of which is shown in the first months of life as a proto-conversation. It has the characteristics of an analogical relatedness. Symbolic play arising at the second year of life, shows a partial internalization of this relatedness. Symbolic play is accompanied by a quasi-inner conversation with an illusory other who is both self and the mothering figure. It is suggested that this is the embryonic form of the "conversations" of mystics in communion with self and God., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Object: To determine which constellation of clinical features constitutes the core of borderline personality disorder (BPD)., Method: The criterion of endurance was used to identify the constellation of features which are most basic, or core, in borderline personality disorder. Two sets of constellations of DSM-III features were tested, each consisting of three groupings. The first set of constellations was constructed according to Clarkin's factor analysis; the second was theoretically derived. Broadly speaking, the three groupings concerned 'self', 'emotional regulation', and 'impulse'. Changes of these constellations were charted over one year in a comparison of the effect of treatment by the Conversational Model (n = 29) with treatment as usual (n = 31). In addition, measures of typical depression (Zung) were scored before and after the treatment period. The changes in the constellations were considered in relation to authoritative opinion., Results: The changes in the two sets of constellations were similar. In the treatment as usual (TAU) group, 'self' endured unchanged, while 'emotional regulation' and 'impulse' improved. In the Conversational Model cohort, 'self' improved, 'emotional regulation' improved more greatly than the TAU group, while 'impulse' improved but not more than the treatment as usual group. Depression scores were not particularly associated with any grouping., Conclusions: A group of features including self/identity disturbance, emptiness and fear of abandonment may be at the core of BPD. Correlations between the three groupings and Zung scores favoured the view that the core affect is not typical depression. Rather, the central state may be 'painful incoherence'. It is suggested that the findings have implications for the refinement and elaboration of treatment methods in borderline personality disorder.

Objective: To test the hypothesis that borderline personality disorder is a manifestation of a particularly right hemispheric disturbance, involving deficient higher order inhibition, and to consider the therapeutic implications of the findings., Methods: A cohort of 17 medication free borderline patients were compared with 17 age and sex matched controls by means of a study of p3a, which reflects the activity of one of the two main generators of the P300 (P3) of the event-related-potential. P3b reflects the output of the other generator. P3a, an aspect of the attentional system, depends upon prefrontally connected neurocircuitry. P3b is underpinned by a particularly parietally connected neural system. Using an oddball paradigm, P3a was extracted from the responses to targets using a novel single trial analysis., Results: In borderline patients, over homologous electrode sites, p3a amplitudes, but not latencies, were significantly larger in the right hemisphere compared with the left. The differences were most marked fronto-centrally. No such difference was shown in the control subjects. P3a at right hemisphere sites was significantly larger in borderline compared with control patients. There was no significant difference between the groups for the left hemisphere sites., Conclusions: The abnormally large amplitudes of P3a at right hemisphere sites in borderline patients together with the failure of habituation of P3a, are consistent with deficient inhibitory activity. Discussion of the findings suggest that they may reflect impeded maturation of the fronto-medial processing systems which, it is argued, may be a consequence of the typical early environment of those with the borderline condition. This suggestion leads to a consideration of optimal therapeutic behaviour in this condition, in particular for 'matching' or 'analogical' responsiveness.

The harmful effect of borderline patients on their families is an important but relatively neglected aspect of outcome studies. This study concerns changes in perceived quality of relationships with partners and children of 24 patients suffering Borderline Personality Disorder (BPD) after 12 months of treatment with the Conversational Model (CM). They were compared to 21 parents with BPD receiving "Treatment as Usual" (TAU) from their referring clinicians for the same period. Both groups developed naturalistically giving the study a quasi-experimental design. The Social Adjustment Scale (SAS-SR) was administered on intake and again after 12 months. The subscales dealing with relationships with children, with partners and with the family unit were scored and compared between groups. It was found that the perceived relationships with children and partners improved significantly for the CM group but not for the TAU group.

People with borderline personality disorder (BPD) often describe a longstanding depression or dysphoria central to the disorder. The dimension of chronic inner dysphoria is reflected in the DSM criterion of "emptiness" and is demonstrated on self-report measures of depression. In this paper, we report on outcomes for patients with BPD treated with outpatient psychodynamic psychotherapy based on the Conversational Model. Data were collected using the Zung depression scale and the Westmead severity scale at 1 year and at 2 years from two groups of patients. One group had 1 year in psychotherapy, the other had 2 years in therapy. While general symptom scores improved steadily over time in the two-year group, gains for the one-year group tapered off in the second year. Change in depression scores continued at an unchanged rate in the second year for the two-year group compared to a leveling out of gains in the group treated for one year. Gains in general symptom scores were more substantial, suggesting that change in affect occurs more slowly than other symptomatic changes. Drawing upon our findings and those of others in the field, it appears that this slowness of affective change may reflect that patients with BPD have an inner world where predominant negative affectivity became established early in life in the context of disturbances of relatedness. This has implications for the appropriate duration of psychotherapeutic engagement with this group. We argue for more prolonged psychotherapy in this group, which is consistent with current understanding of processes of attachment and development.

This article investigates the pattern of temperament for patients with borderline personality disorder and the impact of psychotherapeutic treatment on temperamental variables. A cohort of patients treated in the Westmead Borderline Personality Disorder Psychotherapy research project completed the Tridimensional Personality Questionnaire. All patients had a diagnosis of borderline personality disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, criteria. This group scored highly on novelty-seeking and harm avoidance scales and moderately on reward dependence. There was a significant reduction in harm avoidance after 12 months of psychotherapy with a further reduction after 2 years in therapy. Although at variance with Cloninger's original prediction of low harm avoidance in histrionic and borderline patients, results are consistent with other studies in this patient group. The paradox of "self-harmers" scoring highly on harm avoidance may be explained by recognition of the intensity of "psychic pain" in this group. Self-harming behaviors may frequently be motivated by avoidance of a "greater harm" in terms of the inner psychic reality for these patients. Reduction in harm avoidance with psychotherapy could suggest an impact of treatment on temperament or may indicate that the harm avoidance construct is influenced by state variables such as mood.

Recent work has lead to a greater degree of optimism in the treatment of borderline personality disorder (BPD). This study looks at a group of patients with BPD treated with outpatient psychotherapy using the conversational model of Hobson and Meares. The study group is compared, first, with the original cohort previously reported by Stevenson and Meares [Stevenson J, Meares R. An outcome study of psychotherapy for patients with borderline personality disorder. Am J Psychiatry 1992;149(3):358-62] and, second, with a wait-list "treatment-as-usual" control group. Patients were recruited well after initiation of the program and, hence, can be seen as a group treated under more usual clinical conditions rather than as a cohort subject to the initial wave of research enthusiasm. Subjects were rated at baseline and 12 months on a range of symptomatic, functional, and objective measures. The rate and degree of improvement in the later cohort are very similar to the original 1992 cohort and significantly greater than what is found in the treatment-as-usual controls. We believe that this is the first replication study demonstrating success in treating patients with BPD using an established form of individual psychodynamic therapy delivered in an outpatient setting.

Objective: Symptoms of borderline personality disorder (BPD) may reflect distinct breakdowns in the integration of posterior and frontal brain networks. We used a high temporal resolution measure (40-Hz gamma phase synchrony) of brain activity to examine the connectivity of brain function in BPD., Methods: Unmedicated patients with BPD (n = 15) and age-and sex-matched healthy control subjects (n = 15) undertook a task requiring discrimination of salient from background tones. In response to salient stimuli, the magnitude and latency of peak gamma phase synchrony for early (0-150 ms post stimulus) and late (250-500 ms post stimulus) phases were calculated for frontal and posterior regions and for left and right hemispheres. We recorded skin conductance responses (SCRs) and reaction time (RT) simultaneously to examine the contribution of arousal and performance., Results: Compared with controls, patients with BPD had a significant delay in early posterior gamma synchrony and a reduction in right hemisphere late gamma synchrony in response to salient stimuli. Both SCR onset and RT were also delayed in BPD, but independently from differences in synchrony. The delay in posterior synchrony was associated with cognitive symptoms, and reduced right hemisphere synchrony was associated with impulsivity., Conclusions: These findings suggest that distinct impairments in the functional connectivity of neural systems for orienting to salient input underlie core dimensions of cognitive disturbance and poor impulse control in BPD.

A case series of 10 patients with a diagnosis of borderline personality disorder (BPD) presenting with auditory hallucinosis is examined. In this series, the hallucinations were persistent, longstanding, and a significant source of distress and disability. Extrapolating from this series to our sample of 171 patients with BPD suggests that a form of auditory hallucinosis may occur in almost 30% of this population. The failure to emphasize this phenomenon in current systems of classification risks misdiagnosis or inappropriate treatment. Use of terms such as pseudohallucination or quasi hallucination dismisses the phenomenon as unimportant or as "not real." There is an emerging literature on the frequency of hallucinosis among nonpatients. A basis for understanding different forms of hallucination is discussed with reference to the concept of "normativity." We propose a nomenclature for hallucinosis that is expressed in positive terms, reflecting the clinical significance of the phenomenon in different contexts: (1) normative hallucinosis, (2) traumatic-intrusive hallucinosis (as in our series), (3) psychotic hallucinosis, and (4) organic hallucinosis.

P3a and P3b event-related brain potentials to auditory stimuli were recorded for 17 unmedicated patients with borderline personality disorder, 17 matched healthy controls and 100 healthy control participants spanning five decades. Using high-resolution fragmentary decomposition for single-trial event-related potential analysis, distinctive disturbances in P3a in borderline personality disorder patients were found: abnormally enhanced amplitude, failure to habituate and a loss of temporal locking with P3b. Normative age dependencies from 100 controls suggest that natural age-related decline in P3a amplitude is reduced in borderline personality disorder patients and is likely to indicate failure of frontal maturation. On the basis of the theories of Hughlings Jackson, this conceptualization of borderline personality disorder is consistent with an aetiological model of borderline personality disorder.

Background: Borderline personality disorder (BPD) is a serious mental illness. Due to scepticism about the effectiveness of its treatment, the care of these patients is neglected. In this study we evaluated the effect of treatment 5 years after its ending, of patients with BPD., Method: Thirty subjects were treated twice weekly for 1 year by psychotherapy based on the 'Conversational Model' of Hobson. Outcome measures included time in hospital, number of episodes of violence and self-harm, number of medical appointments, drug use and work history. A 'morbidity budget' made up of these items was collated for the year before treatment, the year following treatment, and for the year preceding the 5-year follow-up. Additional measures included DSM-III criteria and a self-report of symptoms. These outcomes were compared to a hypothetical natural history of BPD constructed from the DSM scores of 150 borderline patients aged between 18 and 52 years., Results: Except for one measure, the improvements evident 1 year following treatment were maintained 4 years later. This improvement was not predicted by the hypothetical natural history., Conclusion: A particular form of treatment of BPD has relatively long-lasting, beneficial effects.

Objective: The aim of this study was to test, in terms of impulsivity, the hypothesis that borderline personality disorder "burns out" with age., Method: Linear regression analyses, with age as a predictor variable, were conducted on subsection scores of the Revised Diagnostic Interview for Borderlines (DIB-R) for 123 individuals with a diagnosis of borderline personality disorder who were accepted into an outpatient-based psychotherapy program. The subsection scores of the DIB-R allow quantification of the core features of the disorder: affective disturbance, relationship disturbance, cognitive disturbance, and impulsive behavior., Results: Older patients with borderline personality disorder showed less impulsivity than younger patients, but there was no difference in terms of affect disturbance, identity disturbance, and interpersonal problems., Conclusions: The view that borderline personality disorder burns out with age is supported in terms of impulsivity.

The article focuses on the association of analogical relatedness with coherence or personal integration. It says that personal integration is frequently lost on those people seeking medical care. It states that the ideas of William James, one of the few theorists who have studied the subject, have formed the background to the therapeutic approach to the problem of coherence. It suggests that the activity that promotes coherence is a style of conversation that involves analogical responses.

Objective: The aim of this paper is to develop an aetiological model for borderline personality disorder. Method: The postulates of Hughlings Jackson are used to provide a preliminary explanatory framework for borderline phenomena. As a necessary background to this discussion, the findings concerning abuse in the early history of borderline personality disorder (BPD) and other conditions, notably somatisation disorder and dissociative states, are briefly reviewed. Other data, including family studies, which might have significance in the aetiology of BPD are also reviewed. Results: The hypothesis is put forward that the symptoms of BPD are due to the failure of ‘experience-dependent’ maturation of a cascade of neural networks, with prefrontal connections, which become active relatively late in development and which coordinate disparate elements of central nervous system function. These networks subserve higher psychological functions, including attentional focus and affect regulation. They also underpin the reflective function necessary to the emergence of self as the stream of consciousness, which appears at about the age of 4 years. Conclusion: Adverse developmental circumstances may produce an interrelated set of symptom clusters, with associated neural network disturbances that are amenable to investigation with psychometric and brain imaging techniques. Since these disturbances are seen as ‘experience-dependent’, they are considered reversible, at least in part. [ABSTRACT FROM AUTHOR]