THE PAIN OF BEING BORDERLINE - DYSPHORIC STATES SPECIFIC TO BORDERLINE PERSONALITY-DISORDER

The objective of this study was to identify the dysphoric states that best characterize patients meeting criteria for borderline personality disorder and distinguish them from those in patients with other forms of personality disorder. One hundred forty-six patients with criteria -defined borderline personality disorder and 34 Axis II controls fille d out the Dysphoric Affect Scale, a 50-item self-report measure that w as designed for this purpose and has good internal consistency and tes t-retest reliability. Twenty-five dysphoric states (mostly affects) we re found to be significantly more common among borderline patients tha n controls but nonspecific to borderline personality disorder. Twenty- five other dysphoric states (mostly cognitions) were found to be both significantly more common among borderline patients than controls and highly specific to borderline personality disorder. These states tende d to fall into one of four clusters: (1) extreme feelings, (2) destruc tiveness or self-destructiveness, (3) fragmentation or ''identitylessn ess,'' and (4) victimization. In addition, three of the 25 more-specif ic states (feeling betrayed, like hurting myself, and completely out o f control), when occurring together, were particularly strongly associ ated with the borderline diagnosis. Equally important, overall mean Dy sphoric Affect Scale scores correctly distinguished borderline persona lity disorder from other personality disorders in 84% of the subjects. Taken together, the results of this study suggest that the subjective pain of borderline patients may be both more pervasive and more multi faceted than previously recognized, and that the overall ''amplitude'' of this pain may be a particularly good marker for the borderline dia gnosis.