J Trauma Dissociation. 2009;10(3):346-67.
Dissociation in borderline personality disorder: a detailed look.
Korzekwa MI, Dell PF, Links PS, Thabane L, Fougere P.
Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada. mkorzek@mcmaster.ca
The objective of the present study was to assess in detail the whole spectrum of normal and pathological dissociative experiences and dissociative disorder (DD) diagnoses in borderline personality disorder (BPD) as diagnosed with the Revised Diagnostic Interview for Borderlines. Dissociation was measured comprehensively in 21 BPD outpatients using the Structured Clinical Interview for DSM-IV Dissociative Disorders-Revised, the Multidimensional Inventory of Dissociation (MID), the Dissociative Experiences Scale pathological taxon analysis, and the Somatoform Dissociation Questionnaire. The frequencies of DDs in this BPD sample were as follows: 24% no DD, 29% mild DD (dissociative amnesia and depersonalization disorder), 24% DD Not Otherwise Specified (DDNOS), and 24% dissociative identity disorder. With regard to the dissociative experiences endorsed, almost all patients reported identity confusion, unexplained mood changes, and depersonalization. Even those BPD patients with mild DD reported derealization, depersonalization, and dissociative amnesia. BPD patients with DDNOS reported frequent depersonalization, frequent amnesia, and notable experiences of identity alteration. BPD patients with dissociative identity disorder endorsed severe dissociative symptoms in all categories. Analysis of the MID pathological dissociation items revealed that 32% of the items were endorsed at a clinically significant level of frequency by more than 50% of our BPD patients. In conclusion, the frequencies of Diagnostic and Statistical Manual of Mental Disorders (4th ed.) DDs in these patients with BPD were surprisingly high. Likewise, the "average" BPD patient endorsed a wide variety of recurrent pathological dissociative symptoms.
They confirm what we already know: most people with BPD have dissociative symptoms (in fact, most people with any personality disorder have dissociative symptoms), but beyond that many people with BPD also have a dissociative disorder.
Note that the patients enrolled in this study were diagnosed by a standard protocol using an instrument, the Revised Diagnostic Interview for Borderlines. This instrument distinguishes BPD from other personality disorders, but not from dissociative disorders. Thus, it may produce a false diagnosis of BPD in people with DID and DID-like DDNOS (aka DDNOS Type 1) who exhibit borderline traits in some alters.
Current ISSTD guidelines indicate that when a dissociative disorder is present, it should be regarded as superordinate: treat it as the primary disorder, and subordinate personality disorders will improve with treatment of the dissociative disorder.
The article is not free online, but there is a free online summary article by the same authors: http://www.towson.edu/topddstudy/Korzek ... 202009.pdf
) and therefore you couldn't have both. Now I understand. I guess the whole idea of a "continuum of dissociation" confuses me. What is on and not on the continuum? Therapists have always told me dissociation is on a continuum but I guess I just don't get it. I've been diagnosed with DDNOS, which I think seems to fit my experience, and is that on the continuum? And if so, would it be next to DID?
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