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1 Electroencephalographic Studies of Borderline Personality Disorder Key words : borderline personality disorder, EEG, 6 Hz spike and wave (phantom spike and wave), Rorschach test, antiepileptic drug Department of Psychiatry, Juntendo University School of Medicine, Tokyo, Japan
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11 J., et al.: Depression in borderline patients: A prospective EEG sleep study. Psychiatry 11)Exner, J. E., McCoy, R.: An experimental score for morbid content (MOR). Workshops Study 269 (unpublished ). Rorschach Workshops, )Snyder, S., Pitts, W. M. Jr.: Electroencephalography of DSM-III borderline personality 1)Hoch, P. H., Polatin, P.: Pseudoneurotic forms of schizophrenia. Psychiatr. Quart., 23 2)Knight, R. P.: Borderline states. Bull Men- 3)Kernberg, O.: Borderline personality organization. J. Am. Psychoanal. Assoc., 15: 641 4)Grinker, R., Werble, B., Drye, R.: The borderline syndrome. Basic Books, New York, )Gunderson, J. G., Singer, M. I.: Defining borderline patients: An overview. Am. J. 6)American Psychiatric Association : Diagnostic and statistical manual of mental disorders, third edition. Washington D. C., )Carroll, B. J., Greden, J. F., Feinberg, M., et al.: Neuroendocrine evaluation of depression in borderline patients. Psychiatr. Clin. 8)Soloff, P. H., George, A., Nathan, R. S.: The dexamethasone suppression test in patients with borderline personality disorders. 9)McNamara, E., Reynolds, C. F., Soloff, P. H., et al.: EEG sleep evaluation of depression in borderline patients. Am. J. Psychiatry, 10)Reynolds, C. F., Soloff, P. H., Kupfer, D. 14)Cowdry, R. W., Picker, D., Davies, R.: Symptoms and EEG findings in the borderline 211, )Cornelius, J. R., Brenner, R. P., Soloff, P. H., et al.: EEG abnormalities in borderline personality disorder: specific or nonspecific. 17)Hill, D.: EEG in episodic psychotic and psychopathic behaviour. A classification of data. 440, )Ellingson, R. J.: The incidence of EEG abnormality among patients with mental disorders of apparently nonorganic origin: A critical review. Am. J. Psychiatry, 111: 20)Matsuda, H., Miura, S., Irie, H., et al.: Epilepsy and borderline personality disorder. Epilepsia, 27: 635, )Andrulonis, P. A., Glueck, B. C., Stroebel, C. F., et al.: Organic brain dysfunction and the borderline syndrome. Rsychiatr. Clin. No 22)Walter, W. G.: Epilepsy. Electroencephalography. a symposium on its various aspects
12 (edited by Hill, J. D. N. and Parr, C.). 246, Mac-Donald, London, )Hughes, J. R., Schlagenhauff, R. E., Magoss, M.: Electroclinical correlations in the six per second spike and wave complex. Electro- 24)Small, J. E.: The six per second spike and )Olson, S. F., Hughes, J. R.: The clinical symptomatology associated with the 6 c/sec spike and wave complex. Epilepsia, 11: )Hughes, J. R.: Two forms of the 6 /sec spike and wave complex. Electroenceph. Clin. 30)Struve, F. A., Klein, D. F., Saraf, F. R.: Electroencephalographic correlates of suicide ideation and attempts. Arch. Gen. Psychiat., 31)Struve, F. A.: Electroencephalographic relationship to suicidal behavior; Qualitative considerations and a report on a series of completed suicides. Clin. Electroenceph., 14: 34)Exner, J. E.: Some Rorschach data comparing schizophrenics with borderline and schizotypal personality disorders. J. Pers. 35)Gardner, D. L., Cowdry, R. W.: Suicidal and parasuicidal behavior in borderline personality disorder. Psychiatr. Clin. North 36)Gardner, D. L., Cowdry, R. W.: Positive effects of Carbamazepine on behavioral dyscontrol in borderline personality disorder.
13 Original paper Summary Electroencephalographic Studies of Borderline Personality Disorder The diagnostic criteria of borderline personality disorder (BPD) were provided by DSM-III and its concept was made clear. However, there has been very little biological or electroencephalographical study of BPD. Most cases of BPD show affective instability and impulsivity as their characteristic symptoms. We have previously reported that cases of attempted suicide had a high rate of EEG abnormalities. Accordingly, we examined the EEGs and Rorschach tests of cases with BPD, in order to investigate the correlation between the biological and psychological characteristics of BPD. The subjects (BPD group) were 32 cases (3 males and 29 females), who satisfied the diagnostic criteria for BPD. They presented to Juntendo Hospital from 1979 to 1985 and their ages ranged from 15 to 37 (average 21.3). We examined the EEGs of all cases and the Rorschach tests of 29 cases. As a age matched control group, 75 schizophrenic patients who were hospitalized during the same period, were selected (schizophrenic group). We also examined their EEGs and then compared the two groups. The BPD group showed 27 (84.4%) definite and 3 (9.4%) marginal EEG abnormalities, characterized by a slowing of the basic rhythm and a 6 Hz spike and wave pattern(phantom spike and wave), which occurred significantly more often in the BPD group than in the schizophrenic group. In the BPD group, the 21 cases with paroxysmal discharges showed a significantly increased tendency to perform" physically self-damaging acts" (e. g. suicidal gestures) compared with the 11 cases without such discharges. In the results of the Rorschach tests, inclinations toward impulsivity (e. g. suicide indicator) were recognized. Twenty four patients in the BPD group with EEG abnormalities were given antiepileptic drugs (e. g. Carbamazepine, Valproic acid, Phenytoin), singly, or together with psychotropic drugs. Sixteen cases showed improvements such as an increased emotional stability and a cessation of suicidal tendencies. It is concluded that BPD subjects show a high rate of EEG abnormalities associated with their affective instability and impulsivity. Therefore, the author emphasizes that the neurophysiological approach is valuable as well as the psychological approach in the diagnosis and treatment of BPD. Key words: borderline personality disorder, EEG, 6 Hz spike and wave (phantom spike and wave), Rorschach test, antiepileptic drug YUTAKA TANAHASHI, M. D. Department of Psychiatry, Juntendo University School of Medicine, Tokyo, Japan
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