Trastorno límite de la personalidad: actualización clínico-fenomenológica y terapéutica
DOI:
https://doi.org/10.17533/udea.rp.e342752Palabras clave:
trastorno límite de la personalidad, psicoterapia, suicidio, fenomenología, inestabilidad afectivaResumen
El trastorno límite de la personalidad (TLP) representa un reto diagnóstico y terapéutico en los contextos clínicos. Existe una prevalencia variable del trastorno de acuerdo con los diferentes escenarios de observación y se encuentra en un 2% de la población general y en hasta un 15%-28% de los pacientes hospitalizados en unidades psiquiátricas. El trastorno límite de personalidad se caracteriza por cuatro grupos de síntomas: multi-impulsividad, inestabilidad del humor y problemas interpersonales, en asociación con alteraciones de la identidad y conductas suicidas ante situaciones generadoras de frustración. Las dificultades diagnósticas relacionadas con el abordaje de estos pacientes pueden conducir a manejos psicofarmacológicos no exitosos, por lo que la psicoterapia es el eje del tratamiento. En este artículo de revisión se abordan los aspectos históricos, clínico-fenomenológicos y psicoterapéuticos de esta entidad nosológica.
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Aragona, M. y Stanghellini, G. (Eds). (2016). An Experiential Approach to Psychopathology. eBook: Springer. doi: https://doi.org/10.1007/978-3-319-29945-7
APA. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, dc. doi: https://doi.org/10.1176/appi.books.9780890425596.744053
Bartz, J., Simeon, D., Hamilton, H., Kim, S., Crystal, S., Braun, A., Vicens, V. y Hollander, E. (2011). Oxytocin can hinder trust and cooperation in borderline personality disorder. Social Cognitive and Affective Neuroscience, 6(5), 556-563. doi: https://doi.org/10.1093/scan/nsq085
Bateman, A. y Fonagy, P. (2008). The Development of Borderline Personality Disorder A mentalizing model. Journal of Personality Disorders, 22(1), 4-21. doi: https://doi.org/10.1521/pedi.2008.22.1.4
Bateman, A. y Fonagy, P. (2016). Mentalization-Based Treatment for Personality Disorders. New York: Oxford University Press. Recuperado de https://www.oxfordclinicalpsych.com/view/10.1093/med:psych/9780199680375.001.0001/med-9780199680375
Bateman, A. y Fonagy, P. (Eds). (2019). Handbook of mentalizing in mental health practice. Second Edition. Washington: American Psychiatric Association Publishing.
Bayes, A., Parker, G. y Paris, J. (2019). Differential Diagnosis of Bipolar ii Disorder and Borderline Personality Disorder. Current Psychiatry Reports 21, 125. doi: https://doi.org/10.1007/s11920-019-1120-
Beck, A. T., Davis, D. D. y Freeman, A. (Eds.). (2015). Cognitive therapy of personality disorders. Third Edition. New York and London: The Guilford Press.
Berg, J. (1990). Differentiating Ego Functions of Borderline and Narcissistic Personalities. Journal of Personality Assessment, 55(3-4), 537-548. doi: https://doi.org/10.1080/00223891.1990.9674089
Bertsch, K. y Herpertz, S. (2018). Oxytocin and borderline personality disorder. En Current Topics in Behavioral Neurosciences, vol. 35. Cham: Springer. doi: https://doi.org/10.1007/7854_2017_26
Black, G., Murray, J. y Thornicroft, G. (2014). Understanding the phenomenology of borderline personality disorder from the patient’s perspective. Journal of Mental Health, 23(2), 78-82. doi: https://doi.org/10.3109/09638237.2013.869570
Brüne, M. (2016). On the role of oxytocin in borderline personality disorder. The British Journal of Clinical Psychology, 55(3), 287-304. doi: https://doi.org/10.1111/bjc.12100
Buchheim, A. y Diamond, D. (2018). Attachment and Borderline Personality Disorder. Psychiatric Clinics of North America, 41(4), 651-668. doi: https://doi.org/10.1016/j.psc.2018.07.010
Bürgy, M. (2011). Ego disturbances in the sense of Kurt Schneider: Historical and phenomenological aspects. Psychopathology, 44(5), 320-328. doi: https://doi.org/10.1159/000325059
Caballo, V. (Coord.). (2004). Manual de trastornos de la personalidad. Manual de trastornos de la personalidad. Descripción, evaluación y tratamiento. Madrid: Síntesis.
Calati, R., Gressier, F., Balestri, M. y Serretti, A. (2013). Genetic modulation of borderline personality disorder: Systematic review and meta-analysis. Journal of Psychiatric Research, 47(10), 1275-1287. doi: https://doi.org/10.1016/j.jpsychires.2013.06.002
Caligor, E., Kernberg, O. F., Clarkin, J. F. y Yeomans, F. E. (2018). Psychodynamic Therapy for Personality Pathology: Treating Self and Interpersonal Functioning. Washington: American Psychiatric Association Publishing.
Choi-Kain, L. (2012). Handbook of Mentalizing in Mental Health Practice. En Bateman, A. y Fonagy, P. (Eds.). The American Journal of Psychiatry, 169(3), 336-336. Washington, dc: American Psychiatric Publishing. doi: https://doi.org/10.1176/appi.ajp.2011.11101525
Crocq, M. (2013). Milestones in the history of personality disorders. Dialogues in Clinical Neuroscience, 15(2),147-53. doi: https://doi.org/10.31887/dcns.2013.15.2/macrocq
Dimeff, L.A. y Koerner, K. (Eds.). (2007). Dialectical behavior therapy in clinical practice: Applications across disorders and settings. New York and London: The Guilford Press.
Ellison, W., Rosenstein, L., Morgan, T. y Zimmerman, M. (2018). Community and Clinical Epidemiology of Borderline Personality Disorder. Psychiatric Clinics of North America, 41(4), 561-573. doi: https://doi.org/10.1016/j.psc.2018.07.008
Fonagy, P. y Bateman, A. (2007). Mentalizing and borderline personality disorder. Journal of Mental Health, 16(1), 83-101. doi: https://doi.org/10.1080/09638230601182045
Fonagy, P., Target, M., Gergely, G., Allen, J. y Bateman, A. (2003). The developmental roots of borderline personality disorder in early attachment relationships: A theory and some evidence. Psychoanalytic Inquiry, 23(3), 412-459. doi: https://doi.org/10.1080/07351692309349042
Gallagher, S. y Schmicking, D. (2010). Handbook of Phenomenology and Cognitive Science. Dordrecht: Springer. doi: https://doi.org/10.1007/978-90-481-2646-0
Gammelgaard, J. (2018). Betweenity: A discussion of the concept of borderline. Routledge. doi: https://doi.org/10.4324/9780203847626
Ghaemi, S., Dalley, S., Catania, C. y Barroilhet, S. (2014). Bipolar or borderline: A clinical overview. Acta Psychiatrica Scandinavica, 130(2), 99-108. doi: https://doi.org/10.1111/acps.12257
Goodman, M., Tomas, I., Temes, C., Fitzmaurice, G., Aguirre, B. y Zanarini, M. (2017). Suicide attempts and self-injurious behaviours in adolescent and adult patients with borderline personality disorder. Personality and Mental Health, 11(3), 157-163. doi: https://doi.org/10.1002/pmh.1375
Grant, B., Chou, S., Goldstein, R., Huang, B., Stinson, F., Saha, T. y Ruan, W. (2008). Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: Results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry. doi: https://doi.org/10.4088/JCP.v69n0404
Grinker, R. (1978). The borderline syndrome. Adolescent Psychiatry, 35(1), 137-138. doi: https://doi.org/10.1176/appi.psychotherapy.1981.35.1.137
Grotstein, J.S., Solomon, M.F. y Lang, J.A. (Eds.). (1987). The Borderline Patient: Emerging Concepts in Diagnosis, Psychodynamics, and Treatment (1st ed.). New York and London: Routledge.
Gunderson, J., Herpertz, S., Skodol, A., Torgersen, S. y Zanarini, M. (2018). Borderline personality disorder. Nature Reviews Disease Primers 4. doi: https://doi.org/10.1038/nrdp.2018.29
Hennings, J. (2020). Function and Psychotherapy of Chronic Suicidality in Borderline Personality Disorder: Using the Reinforcement Model of Suicidality. Frontiers in Psychiatry 11, pp. 1-8. doi: https://doi.org/10.3389/fpsyt.2020.00199
Hoch, P. y Polatin, P. (1949). Pseudoneurotic forms of schizophrenia. The Psychiatric Quarterly 23, 248-276. doi: https://doi.org/10.1007/BF01563119
Kalin, N., Shelton, S. y Barksdale, C. (1988). Opiate modulation of separationinduced distress in non-human primates. Brain Research, 440(2), 285-292. doi: https://doi.org/10.1016/0006-8993(88)90997-3
Kernberg, O. (1968). The treatment of patients with borderline personality organization. International Journal of Psycho-Analysis, 49(4), 600–619.
Kraepelin, E. (1920). Arbeitspsychologie. Die Naturwissenschaften 8, 855–859. doi: https://doi.org/10.1007/BF02448538
Kraus, A., Esposito, F., Seifritz, E., Di Salle, F., Ruf, M., Valerius, G. y Schmahl, C. (2009). Amygdala Deactivation as a Neural Correlate of Pain Processing in Patients with Borderline Personality Disorder and Co-Occurrent Posttraumatic Stress Disorder. Biological Psychiatry, 65(9), 819-822. doi: https://doi.org/10.1016/j.biopsych.2008.10.028
Levy, K., McMain, S., Bateman, A. y Clouthier, T. (2018). Treatment of Borderline Personality Disorder. Psychiatric Clinics of North America, 41(4), 711-728. doi: https://doi.org/10.1016/j.psc.2018.07.011
Levy, K., Meehan, K., Kelly, K., Reynoso, J., Weber, M., Clarkin, J. y Kernberg, O. (2006). Change in attachment patterns and reflective function in a randomized control trial of transference-focused psychotherapy for borderline personality disorder. Journal of Consulting and Clinical Psychology, 74(6),1027-1040. doi: https://doi.org/10.103/0022-006X.74.6.1027
Linehan, M. (2015). DBT Skills Training Manual, Second Edition. Guilford Press.
Londoño, D. (2015). Elucidación epistémica e histórica del trastorno de la personalidad límite o borderline. Revista Colombiana de Psiquiatría, 44(3), 189-195. doi: https://doi.org/10.1016/j.rcp.2015.04.001
Meehan, K., Clarkin, J. y Lenzenweger, M. (2018). Conceptual Models of Borderline Personality Disorder, Part 1: Overview of Prevailing and Emergent Models. Psychiatric Clinics of North America, 41(4), 535-548. doi: https://doi.org/10.1016/j.psc.2018.08.001
Monti, M. y D’Agostino, A. (2014). Borderline personality disorder from a psychopathological-dynamic perspective. Journal of Psychopathology 20, 451-460.
Nuñez, N., Sancho, M., Granados, B. y Gibert, J. (2019). Trastorno límite de la personalidad (TLP): características, etiología y tratamiento. Psiquiatría Biológica, 26(3), 85-98. doi: https://doi.org/10.1016/j.psiq.2019.10.001
Oud, M., Arntz, A., Hermens, M., Verhoef, R. y Kendall, T. (2018). Specialized psychotherapies for adults with borderline personality disorder: A systematic review and meta-analysis. Australian and New Zealand Journal of Psychiatry, 52(10), 949-961. doi: https://doi.org/10.1177/0004867418791257
Oviedo, G., Gómez-Restrepo, C., Rondón, M., Borda, J. y Tamayo, N. (2016). Tamizaje de rasgos de personalidad en población adulta colombiana. Encuesta Nacional de Salud Mental 2015. Revista Colombiana de Psiquiatría, 45(1), 127-134. doi: https://doi.org/10.1016/j.rcp.2016.08.002
Paris, J. (2018). Differential Diagnosis of Borderline Personality Disorder. Psychiatric Clinics of North America, 41(4), 57-582. doi: https://doi.org/10.1016/j.psc.2018.07.001
Paris, J. (2019). Suicidality in borderline personality disorder. Medicina, 55(6), 223. doi: https://doi.org/10.3390/medicina55060223
Pérez-Rodríguez, M., Bulbena-Cabré, A., Bassir, A., Zipursky, G., Goodman, M. y New, A. (2018). The Neurobiology of Borderline Personality Disorder. Psychiatric Clinics of North America, 41(4), 633-650. doi: https://doi.org/10.1016/j.psc.2018.07.012
Quirk, S., El-Gabalawy, R., Brennan, S., Bolton, J., Sareen, J., Berk, M. y Williams, L. (2015). Personality disorders and physical comorbidities in adults from the United States: data from the National Epidemiologic Survey on Alcohol and Related Conditions. Social Psychiatry and Psychiatric Epidemiology 50, 807–820. doi: https://doi.org/10.1007/s00127-014-0974-1
Ritschel, L., Cowperthwait, C., Stewart, L. y Lim, N. (2018). The Treatment of Borderline Personality Disorder. En David, D., Jay Lynn, S. y Montgomery, G. (Eds.). Evidence-Based Psychotherapy: The State of the Science and Practice. First Edition. John Wiley & Sons, Inc. doi: https://doi.org/10.1002/9781119462996.ch12
Sanches, M. (2019). The Limits between Bipolar Disorder and Borderline Personality Disorder: A Review of the Evidence. Diseases, 7(3), 49. doi: https://doi.org/10.3390/diseases7030049
Skoglund, C., Tiger, A., Rück, C., Petrovic, P., Asherson, P., Hellner, C. y Kuja-Halkola, R. (2019). Familial risk and heritability of diagnosed borderline personality disorder: a register study of the Swedish population. Molecular Psychiatry 26, 999–1008. doi: https://doi.org/10.1038/s41380-019-0442-0
Slavich, G., Tartter, M., Brennan, P. y Hammen, C. (2014). Endogenous opioid system influences depressive reactions to socially painful targeted rejection life events. Psychoneuroendocrinology 49, 141-149. doi: https://doi.org/10.1016/j.psyneuen.2014.07.009
Soloff, P., White, R., Omari, A., Ramaseshan, K. y Diwadkar, V. (2015). Affective context interferes with brain responses during cognitive processing in borderline personality disorder: fmri evidence. Psychiatry Research: Neuroimaging, 233(1), 23-35. doi: https://doi.org/10.1016/j.pscychresns.2015.04.006
Stanghellini, G., Broome, M., Fernández A., Fusar-Poli., P, Raballo A. y Rosfort, R. (2019) The Oxford Handbook of Phenomenological Psychopathology. Oxford University Press. doi: https://doi.org/10.1093/oxfordhb/9780198803157.001.0001
Stanghellini, G, y Mancini, M. (2017). The therapeutic interview in mental health: A values-based and person-centered approach. Cambridge University Press. doi: https://doi.org/10.1017/9781316181973
Stanghellini, G. y Rosfort, R. (2013). Emotions and Personhood. Oxford University Press. doi: https://doi.org/10.1093/med/9780199660575.001.0001
Stern, B. y Yeomans, F. (2018). The Psychodynamic Treatment of Borderline Personality Disorder: An Introduction to Transference-Focused Psychotherapy. Psychiatric Clinics of North America, 41(2), 207-223. doi: https://doi.org/10.1016/j.psc.2018.01.012
Storebø, O., Stoffers-Winterling, J., Völlm, B., Kongerslev, M., Mattivi, J., Jørgensen, M. y Simonsen, E. (2020). Psychological therapies for people with borderline personality disorder. The Cochrane Database of Systematic Reviews, 2012(8). doi: https://doi.org/10.1002/14651858.CD012955.pub2
Winsper, C., Marwaha, S., Lereya, S., Thompson, A., Eyden, J. y Singh, S. (2016). A systematic review of the neurobiological underpinnings of borderline personality disorder (BPD) in childhood and adolescence. Reviews in the Neurosciences, 27(8), 827-847. doi: https://doi.org/10.1515/revneuro-2016-0026
Yeomans, F., Clarkin, J. y Kernberg, O. (2014). Transference-Focused Psychotherapy for Borderline Personality Disorder. Washington: American Psychiatric Association Publishing. doi: https://doi.org/10.1176/appi.books.9781615371006
Yueqin, H., Roman, K., De Girolamo, G., Preti, A., Angermeyer, M., Benjet, C., Demyttenaere, K., De Graaf, R., Gureje, O., Nasser, A., Lee, S., Lépine, J., Matschinger, H., Posada-Villa, J., Suiman, S., Vilagut, G. y Kessler, R. (2009). DSM-IV personality disorders in the who World Mental Health Surveys. British Journal of Psychiatry, 195(1), 46-53. doi: https://doi.org/10.1192/bjp.bp.108.058552
Zanarini, M., Frankenburg, F., Hennen, J. y Silk, K. (2004). Mental health service utilization by borderline personality disorder patients and axis ii comparison subjects followed prospectively for 6 years. Journal of Clinical Psychiatry. doi: https://doi.org/10.4088/JCP.v65n0105
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