Impulsività e aggressività nel disturbo borderline di personalità: un’indagine clinica

Objectives Several investigators used the expression “impulsive-aggression” to describe a nuclear feature of Borderline Personality Disorder. Nevertheless recent studies did not confirm the existence of a single phenotypic trait and consider aggressiveness and reduced self-control of impulsive behaviour as separate and not related constructs. In BPD patients non-planning, motor impulsivity is considered a factor that distinguishes this from other cluster B personality disorders, while aggressive behaviours can be viewed as a secondary manifestation of lack of behavioural control. The aim of the present study is to identify, in a group of BPD patients, demographic and clinical features that are significantly related to two factors: impulsivity and aggressiveness (outbursts of anger) and to examine if these traits can be considered distinct psychopathological elements. Methods 68 consecutive outpatients who received a DSM-IV-TR diagnosis of BPD (23 males and 45 females) were recruited for the study. Patients included were between 18 and 60 years old; all subjects were tested with a semistructured interview for demographic and clinical variables, the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID II), the Clinical Global Impression-Severity (CGI-S), the Hamilton Scales for Depression and Anxiety (HDR-S, HAR-S), the Social Occupational Functioning Assessment Scales (SOFAS), and the Borderline Personality Disorder Severity Index (BPDSI) (Tables I and II). Pearson’s correlation and Student’s t-test were used for statistical analysis. Significant variables were inserted in two models of stepwise logistic regression with the items “impulsivity” and “outbursts of anger” of BPDSI as dependent variables. Results The continuous variables that were found significantly related to the item “impulsivity” of BPDSI were age of the first psychiatric visit, CGI-S and total score of BPDSI. CGI-S, age and HDR-S were related to the item “outbursts of anger” Comparison of mean values of impulsivity for categorical variables showed a significant difference for substance abuse, while no differences were found when considering mean values of outbursts of anger. Logistic regression showed that impulsivity was directly related to CGI-S score (p=0.002) and inversely related to the age of the first psychiatric visit (p=0.035) (Table III). Outbursts of anger was found inversely related to age (p=0.019) and to HDR-S score (p=0.028) (Table IV). Discussion According to our results, impulsivity and aggressiveness are related to different clinical characteristics and can be considered distinct psychopathological factors. BPD patients with high level of impulsivity express a higher severity of global symptomatology. This condition conduces to an early functional impairment and requires a psychiatric intervention at younger age. Our results suggest that a high degree of outbursts of anger is related to younger age and lower level of depressive symptoms. These characteristics are not core features of BPD, but represent situations that can make easier hetero-directed aggressive conducts. Maybe older subjects manifest more frequently depressive symptoms secondary to personality disorder and to social-functional consequences. Older patients are also less likely to perform aggressive behaviour and sometimes they don’t satisfy diagnostic criteria for BPD any longer. These data need to be replicated in larger samples, using both clinician-rated interviews and self-report questionnaires.