Characterologic subtypes of the borderline personality disorder. With a note on prognostic factors

Borderline personality disorder (BPD), as defined by DSM, is heterogeneous with respect to the array of the personality traits patients may exhibit. Thus, the characterology of BPD admits of many subtypes. From the standpoint of DSM-Axis II, BPD is almost always associated with a complex personality pattern that meets criteria for several other Axis II disorders--which may then be viewed as characterologic subtypes. Usually these will be from the same "dramatic cluster" to which BPD itself belongs; namely, histrionic, narcissistic, or antisocial. But any of the Axis II disorders may be found in conjunction with BPD, "schizoid" being the rarest accompaniment. The Kraepelinian temperaments (depressive, manic, irritable, cyclothymic) constitute another set of subtypes. There is prognostic significance to these diagnostic subdivisions. Irritable and antisocial types predict poor outcome. The poorest prognosis results when antisociality is admixed with psychopathy. Obsessive-compulsive traits, especially self-discipline and orderliness, are associated with good outcome. A number of individual personality traits are found with especial frequency in BPD and may be viewed as finer-scale subtypes. Their presence influences the direction in which therapeutic efforts must be directed and also affects long-term outcome. These traits include mercurial, unreasonable, infantile, volatile, demanding, and going-to-extremes. In general, the nature and intensity of all the traits relevant to each BPD patient (especially those that are "offensive" or socially alienating), and the balance between negative and positive traits, account for much of the variance in ultimate response to treatment and in eventual outcome.