Turkiye Klinikleri Journal of Health Sciences

.: REVIEW
Borderline Kişilik Bozukluğunun Gelişimi
Development of Borderline Personality Disorder
Zeynep SETa
aTekirdağ Namık Kemal Üniversitesi Fen Edebiyat Fakültesi, Psikoloji Bölümü, Tekirdağ, TÜRKİYE
Turkiye Klinikleri J Health Sci. 2020;5(2):323-37
doi: 10.5336/healthsci.2019-71741
Article Language: TR
Full Text
ÖZET
 Sınır (borderline) kişilik bozukluğu genellikle erken erişkinlik döneminde ortaya çıkan; dürtüsellik, duygusal dengesizlik ve kişiler arası ilişkilerde bozulma ile kendini gösteren, hem bireyin kendisi hem de toplumun geneli için olumsuz sonuçları olan ciddi bir psikolojik bozukluktur. Bu çalışmanın amacı, çocukluk ve ergenlik dönemine ilişkin faktörlerden hangilerinin erişkinlik yaşamındaki sınır kişilik bozukluğunun gelişimine öncül olduğunu yapılan araştırmalar temelinde ortaya koymaktır. Bu nedenle öncelikle sınır kişilik bozukluğu açıklanmış, toplumda görülme sıklığı ile ilgili araştırmalar incelenmiş ve ergenlerde sınır kişilik bozukluğunun nedenleri ile ilgili etiyolojik teoriler aktarılmıştır. Etiyolojik teoriler içinde Linehan'ın biyososyal teorisi ile sosyal bilişsel teori üzerinde durularak yapılan genetik ve nörobiyolojik araştırmaların sonuçlarına yer verilmiştir. Mizaç ve kişilik özelliklerinin, erken dönem olumsuz çocukluk yaşantılarının, çocukluk ve ergenlik döneminde görülen psikiyatrik bozuklukların ve intihar amacı taşımayan kendine zarar verme davranışlarının sınır kişilik bozukluğunun ortaya çıkmasında risk faktörleri olabileceği belirtilmiş, bahsedilen alanlarda yapılan araştırmalar aktarılmıştır. Son olarak, çocuk ve ergenlerde sınır kişilik bozukluğu için tanı koymada yardımcı olarak geliştirilen geçerli-güvenilir ölçme araçları ve tedavi seçeneklerinden bahsedilmiş; alan yazın ışığında, ergenlik döneminde görülen sınır kişilik bozukluğu belirtilerinin sonuçları tartışılmış ve önerilerde bulunulmuştur.

Anahtar Kelimeler: Sınır kişilik bozukluğu; çocukluk; ergenlik; erişkinlik; epidemiyoloji; risk faktör
ABSTRACT
 Borderline personality disorder usually occurs in early adulthood; it is a serious psychological disorder characterized by impulsivity, emotional imbalance and deterioration in interpersonal relationships, with negative consequences for both the individual and the general population. The aim of this study is to determine which factors related to childhood and adolescence are leading to the development of borderline personality disorder in adulthood on the basis of existing researches. For this reason, firstly borderline personality disorder was explained, researches about the incidence in the community were examined and etiological theories about the causes of borderline personality disorder in adolescents were stated. Linehan's Biosocial Theory and Social Cognitive Theory have been emphasized among the etiological theories and the results of genetic and neurobiological researches have been included. It has been reported that temperament and personality traits, early childhood negative experiences, psychiatric disorders seen during childhood and adolescence and self-injurious behaviors that are not suicidal purposes may be risk factors for the emergence of borderline personality disorder and the studies conducted in the mentioned fields. Finally, valid and reliable measurement tools and treatment options developed to help diagnose borderline personality disorder in children and adolescents are mentioned; in the light of the literature, the results of borderline personality disorder symptoms in adolescence were discussed and recommendations were made.

Keywords: Borderline personality disorder; childhood; adolescence; adulthood; epidemiology; risk factors
REFERENCES:
  1. Stern A. Psychoanalytic investigation of and therapy in the border line group of neuroses. The Psychoanalytic Quarterly. 1938;7(4):467-89. [Crossref] 
  2. Chanen AM, Jovev M, Jackson HJ. Adaptive functioning and psychiatric symptoms in adolescents with borderline personality disorder. J Clin Psychiatry. 2007;68(2):297-306. [Crossref]  [PubMed] 
  3. Winograd G, Cohen P, Chen H. Adolescent borderline symptoms in the community: prognosis for functioning over 20 years. J Child Psychol Psychiatry. 2008;49(9):933-41. [Crossref]  [PubMed] 
  4. Zanarini MC, Frankenburg FR, Hennen J, Reich DB, Silk KR. Axis I comorbidity inpatients with borderline personality disorder: 6-year follow-up and prediction of time to remission. Am J Psychiatry. 2004;161(11):2108-14. [Crossref]  [PubMed] 
  5. Pompili M, Girardi P, Ruberto A, Tatarelli R. Suicide in borderline personality disorder: a metaanalysis. Nord J Psychiatry. 2005;59(5):319-24. [Crossref]  [PubMed] 
  6. Gunderson JG, Stout RL, McGlashan TH, Shea MT, Morey LC, Grilo CM, et al. Ten-year course of borderline personality disorder: psychopathology and function from the collaborative longitudinal personality disorders study. Arch Gen Psychiatry. 2011;68(8):827-37. [Crossref]  [PubMed]  [PMC] 
  7. Zanarini MC, Frankenburg FR, Hennen J, Reich DB, Silk KR. Prediction of the 10-year course of borderline personality disorder. Am J Psychiatry. 2006;163(5):827-32. [Crossref]  [PubMed] 
  8. Zanarini MC, Frankenburg FR, Reich DB, Fitzmaurice G. The 10-year course of psychosocial functioning among patients with borderline personality disorder and axis II comparison subjects. Acta Psychiatr Scand. 2010;122(2):103-9. [Crossref]  [PubMed]  [PMC] 
  9. Kernberg O. Borderline personality organization. J Am Psychoanal Assoc. 1967;15(3):641-85. [Crossref]  [PubMed] 
  10. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013. p.663. [Crossref] 
  11. Nica EI, Links PS. Affective instability in borderline personality disorder: experience sampling findings. Curr Psychiatry Rep. 2009;11(1):74-81. [Crossref]  [PubMed] 
  12. Miller AL, Muehlenkamp JJ, Jacobson CM. Fact or fiction: diagnosing borderline personality disorder in adolescents. Clin Psychol Rev. 2008;28(6):969-81. [Crossref]  [PubMed] 
  13. Laurenssen EMP, Hutsebaut J, Feenstra DJ, Van Busschbach JJ, Luyten P. Diagnosis of personality disorders in adolescents: a study among psychologists. Child Adolesc Psychiatry Ment Health. 2013;7(1):3. [Crossref]  [PubMed]  [PMC] 
  14. Sharp C, Romero C. Borderline personality disorder: a comparison between children and adults. Bull Menninger Clin. 2007;71(2):85-114. [Crossref]  [PubMed] 
  15. Gunderson JG. Borderline personality disorder: ontogeny of a diagnosis. Am J Psychiatry. 2009;166(5):530-9. [Crossref]  [PubMed]  [PMC] 
  16. Bornovalova MA, Hicks BM, Iacono WG, McGue M. Stability, change, and heritability of borderline personality disorder traits from adolescence to adulthood: a longitudinal twin study. Dev Psychopathol. 2009;21(4):1335-53. [Crossref]  [PubMed]  [PMC] 
  17. Bernstein DP, Cohen P, Velez CN, Schwab-Stone M, Siever LJ, Shinsato L. Prevalence and stability of the DSM-III-R personality disorders in a community-based survey of adolescents. Am J Psychiatry. 1993;150(8):1237-43. [Crossref]  [PubMed] 
  18. Johnson JG, Cohen P, Kasen S, Skodol AE, Oldham JM. Cumulative prevalence of personality disorders between adolescence and adulthood. Acta Psychiatr Scand. 2008;118(5):410-3. [Crossref]  [PubMed] 
  19. Chabrol H, Montovany A, Chouicha K, Callahan S, Mullet E. Frequency of borderline personality disorder in a sample of French high school students. Can J Psychiatry. 2001;46(9):847-9. [Crossref]  [PubMed] 
  20. Zanarini MC, Horwood J, Wolke D, Waylen A, Fitzmaurice G, Grant BF. Prevalence of DSM-IV borderline personality disorder in two community samples: 6,330 English 11-year-olds and 34,653 American adults. J Pers Disord. 2011; 25(5):607-19. [Crossref]  [PubMed]  [PMC] 
  21. Biskin RS, Paris J, Renaud J, Raz A, Zelkowitz P. Outcomes in women diagnosed with borderline personality disorder in adolescence. J Can Acad Child Adolesc Psychiatry. 2011;20(3):168-74. [PubMed] 
  22. Cohen P, Crawford TN, Johnson JG, Kasen S. The children in the community study of developmental course of personality disorder. J Pers Disord. 2005;19(5):466-86. [Crossref]  [PubMed] 
  23. Stepp SD, Pilkonis PA, Hipwell AE, Loeber R, Stouthamer-Loeber M. Stability of borderline personality disorder features in girls. J Pers Disord. 2010;24(4):460-72. [Crossref]  [PubMed]  [PMC] 
  24. Adler G. Borderline Psychopathology and Its Treatment. New York: Aronson; 1985. p.44-56.
  25. Bowlby J. Attachment and Loss. Vol. II. Separation: Anxiety and Anger. 1st ed. New York: Basic Books; 1973. p.456.
  26. Fonagy P, Leigh T, Steele M, Steele H, Kennedy R, Mattoon G, et al. The relation of attachment status, psychiatric classification, and response to psychotherapy. J Consult Clin Psychol. 1996;64(1):22-31. [Crossref]  [PubMed] 
  27. Lyons-Ruth K. Rapprochement or approchement: Mahler's theory reconsidered from the vantage point of recent research on early attachment relationships. Psychoanalytic Psychology. 1991;8(1):1-23. [Crossref] 
  28. Ainsworth MDS, Blehar MC, Waters E, Wall SN. Patterns of Attachment: A Psychological Study of the Strange Situation. 1st ed. New York: Psychology Press; 2015. p.418.
  29. Main M, Solomon J. Procedures for identifying infants as disorganized/disoriented during the Ainsworth Strange Situation. In: Greenberg MT, Cicchetti D, Cummings EM eds. Attachment in the Preschool Years: Theory, Research, and Intervention. 1st ed. Chicago, London: University of Chicago Press; 1990. p.121-60.
  30. Crowell JA, Treboux D. A review of adult attachment measures: implications for theory and research. Social Development. 1995;4(3):294-327. [Crossref] 
  31. Bartholomew K, Horowitz LM. Attachment styles among young adults: a test of a four-category model. J Pers Soc Psychol. 1991;61(2):226-44. [Crossref]  [PubMed] 
  32. Fraley RC, Davis KE, Shaver PR. Dismissing-avoidance and the defensive organization of emotion, cognition, and behavior. In: Simpson JA, Rholes WS, ed. Attachment Theory and Close Relationships. 1st ed. New York: Guilford Press; 1998. p.249-79.
  33. Hazan C, Shaver P. Romantic love conceptualized as an attachment process. J Pers Soc Psychol. 1987;52(3):511-24. [Crossref]  [PubMed] 
  34. Trull TJ. Structural relations between borderline personality disorder features and putative etiological correlates. J Abnorm Psychol. 2001;110(3):471-81. [Crossref]  [PubMed] 
  35. Belsky DW, Caspi A, Arseneault L, Bleidorn W, Fonagy P, Goodman M, et al. Etiological features of borderline personality related characteristics in a birth cohort of 12-year-old children. Dev Psychopathol. 2012;24(1):251-65. [Crossref]  [PubMed]  [PMC] 
  36. Johnson JG, Cohen P, Kasen S, Skodol AE, Hamagami F, Brook JS. Age-related change in personality disorder trait levels between early adolescence and adulthood: a community-based longitudinal investigation. Acta Psychiatrica Scand. 2000;102(4):265-75. [Crossref]  [PubMed] 
  37. Zanarini MC, Williams AA, Lewis RE, Reich RB, Vera SC, Marino MF, et al. Reported pathological childhood experiences associated with the development of borderline personality disorder. Am J Psychiatry.1997;154(8):1101-06. [Crossref]  [PubMed] 
  38. Paris J. The development of impulsivity and suicidality in borderline personality disorder. Dev Psychopathol. 2005;17(4):1091-104. [Crossref]  [PubMed] 
  39. Linehan M. Skills Training Manual for Treating Borderline Personality Disorder. 1st ed. New York: Guilford Press; 1993. p.180.
  40. Crick NR, Murray-Close D, Woods K. Borderline personality features in childhood: a short-term longitudinal study. Dev Psychopathol. 2005;17(4):1051-70. [Crossref]  [PubMed] 
  41. Domes G, Schulze L, Herpertz SC. Emotion recognition in borderline personality disorder-a review of the literature. J Pers Disord. 2009;23(1):6-19. [Crossref]  [PubMed] 
  42. Yen S, Zlotnick C, Costello E. Affect regulation in women with borderline personality disorder traits. J Nerv Ment Dis. 2002;190(10):693-6. [Crossref]  [PubMed] 
  43. Gurvits IG, Koenigsberg HW, Siever LJ. Neurotransmitter dysfunction in patients with borderline personality disorder. Psychiatr Clin North Am. 2000;23(1):27-40. [Crossref]  [PubMed] 
  44. Hegerl U, Stein M, Mulert C, Mergl R, Olbrich S, Dichgans E, et al. EEG-vigilance differences between patients with borderline personality disorder, patients with obsessive-compulsive disorder and healthy controls. Eur Arch Psychiatry Clin Neurosci. 2008;258(3):137-43. [Crossref]  [PubMed] 
  45. Battaglia M, Ferini-Strambi L, Smirne S, Bernardeschi L, Bellodi L. Ambulatory polysomnography of never-depressed borderline subjects: a high-risk approach to rapid eye movement latency. Biol Psychiatry. 1993;33(5):326-34. [Crossref]  [PubMed] 
  46. Battaglia M, Strambi LF, Bertella S, Bajo S, Bellodi L. First-cycle REM density in never-depressed subjects with borderline personality disorder. Biol Psychiatry. 1999;45(8):1056-8. [Crossref]  [PubMed] 
  47. Lis E, Greenfield B, Henry M, Guilé JM, Dougherty G. Neuroimaging and genetics of borderline personality disorder: a review. J Psychiatry Neurosci. 2007;32(3):162-73. [PubMed] 
  48. Kuo JR, Linehan MM. Disentangling emotion processes in borderline personality disorder: physiological and self-reported assessment of biological vulnerability, baseline intensity, and reactivity to emotionally evocative stimuli. J Abnorm Psychol. 2009;118(3):531-44. [Crossref]  [PubMed]  [PMC] 
  49. Bateman AW, Fonagy P. Mentalization-based treatment of BPD. J Pers Disord. 2004;18(1):36-51. [Crossref]  [PubMed] 
  50. Bender DS, Skodol AE. Borderline personality as a self-other representational disturbance. J Pers Disord. 2007;21(5):500-17. [Crossref]  [PubMed] 
  51. Fonagy P, Steele H, Steele M, Moran GS, Higgitt AC. The capacity for understanding mental states: the reflective self in parent and child and its significance for security of attachment. Infant Mental Health Journal. 1991;12(3):201-18. [Crossref] 
  52. Fonagy P, Target M. Playing with reality: III. The persistence of dual psychic reality in borderline patients. Int J Psychoanal. 2000;81(Pt 5):853-73. [Crossref]  [PubMed] 
  53. Levy KN. The implications of attachment theory and research for understanding borderline personality disorder. Dev Psychopathol. 2005;17(4):959-86. [Crossref]  [PubMed] 
  54. Levy KN, Clarkin JF, Yeomans FE, Scott LN, Wasserman RH, Kernberg OF. The mechanisms of change in the treatment of borderline personality disorder with transference focused psychotherapy. J Clin Psychol. 2006;62(4):481-501. [Crossref]  [PubMed] 
  55. Westen D. Cognitive-behavioral interventions in the psychoanalytic psychotherapy of borderline personality disorders. Clinical Psychology Review. 1991;11(3):211-30. [Crossref] 
  56. Premack D, Woodruff G. Does the chimpanzee have a theory of mind? Behav Brain Sci. 1978; 4(4), 515-629. [Crossref] 
  57. Sharp C. The social-cognitive basis of BPD: a theory of hypermentalizing. In: Sharp C, Tackett JL, eds. Handbook of Borderline Personality Disorder in Children and Adolescents. 1st ed. New York: Springer Science & Business; 2014. p.211-25. [Crossref] 
  58. Agrawal HS, Gunderson J, Holmes BM, Lyons-Ruth K. Attachment studies with borderline patients: a review. Harv Rev Psychiatry. 2004;12(2):94-104. [Crossref]  [PubMed]  [PMC] 
  59. Miller AL, Rathus JH, Linehan MM. Dialectical Behavior Therapy with Suicidal Adolescents. 1st ed. New York: Guilford Press; 2006. p.346.
  60. Wekerle C, Miller AL, Wolfe DA, Spindel CB. Childhood Maltreatment. Advances in Psychotherapy-Evidence-Based Practice. 1st ed. Cambridge, MA: Hogrefe and Huber Publishers; 2006. p.79.
  61. Battle CL, Shea MT, Johnson DM, Yen S, Zlotnick C, Zanarini MC, et al. Childhood maltreatment associated with adult personality disorders: findings from the Collaborative Longitudinal Personality Disorders Study. J Pers Disord. 2004;18(2):193-211. [Crossref]  [PubMed] 
  62. Belsky DW, Caspi A, Arseneault L, Bleidorn W, Fonagy P, Goodman M, et al. Etiological features of borderline personality related characteristics in a birth cohort of 12-year-old children. Dev Psychopathol. 2012;24(1):251-65. [Crossref]  [PubMed]  [PMC] 
  63. Bradley R, Conklin CZ, Westen D. The borderline personality diagnosis in adolescents: gender differences and subtypes. J Child Psychol Psychiatry. 2005;46(9):1006-19. [Crossref]  [PubMed] 
  64. Herman JL, Perry JC, van der Kolk BA. Childhood trauma in borderline personality disorder. Am J Psychiatry. 1989;146(4):490-5. [Crossref]  [PubMed] 
  65. Zanarini MC, Williams AA, Lewis RE, Reich RB, Vera SC, Marino MR, et al. Reported pathological childhood experiences associated with the development of borderline personality disorder. Am J Psychiatry.1997;154(8):1101-6. [Crossref]  [PubMed] 
  66. Johnson JG, Cohen P, Gould MS, Kasen S, Brown J, Brook JS. Childhood adversities, interpersonal difficulties, and risk for suicide attempts during late adolescence and early adulthood. Arch Gen Psychiatry. 2002;59(8):741-9. [Crossref]  [PubMed] 
  67. Baron M, Gruen R, Asnis L, Lord S. Familial transmission of schizotypal and borderline personality disorders. Am J Psychiatry. 1985;142(8):927-34. [Crossref]  [PubMed] 
  68. Johnson JG, Hyler SE, Skodol AE, Bornstein RF, Sherman M. Personality disorder symptomatology associated with adolescent depression and substance abuse. J Pers Disord. 1995; 9(4):318-29. [Crossref] 
  69. Distel MA, Trull TJ, Derom CA, Thiery EW, Grimmer MA, Martin NG, et al. Heritability of borderline personality disorder features is similar across three countries. Psychol Med. 2008;38(9):1219-29. [Crossref]  [PubMed] 
  70. Distel MA, Carlier A, Middeldorp CM, Derom CA, Lubke GH, Boomsma DI. Borderline personality traits and adult attention-deficit hyperactivity disorder symptoms: a genetic analysis of comorbidity. Am J Med Genet B Neuropsychiatr Genet. 2001;156B(7):817-25. [Crossref]  [PubMed]  [PMC] 
  71. Kendler KS, Aggen SH, Czajkowski N, Røysamb E, Tambs K, Torgerson S, et al. The structure of genetic and environmental risk factors for DSM-IV personality disorders: a multivariate twin study. Arch Gen Psychiatry. 2008; 65(12):1438-46. [Crossref]  [PubMed]  [PMC] 
  72. Bellivier F, Chaste P, Malafosse A. Association between the TPH gene A218C polymorphism and suicidal behavior: a meta-analysis. Am J Med Genet B Neuropsychiatr Genet. 2004;124B(1):87-91. [Crossref]  [PubMed] 
  73. Pooley EC, Houston K, Hawton K, Harrison PJ. Deliberate self-harm is associated with allelic variation in the tryptophan hydroxylase gene (TPH A779C), but not with polymorphisms in five other serotonergic genes. Psychol Med. 2003;33(5):775-83. [Crossref]  [PubMed] 
  74. Leichsenring F, Leibing E, Kruse J, New AS, Leweke F. Borderline personality disorder. Lancet. 2001;377(9759):74- 84. [Crossref]  [PubMed] 
  75. Mauchnik J, Schmahl C. The latest neuroimaging findings in borderline personality disorder. Curr Psychiatry Rep. 2010;12(1):46-55. [Crossref]  [PubMed] 
  76. Goodman M, Hazlett EA, Avedon JB, Siever DR, Chu KW, New AS. Anterior cingulate volume reduction in adolescents with borderline personality disorder and co-morbid major depression. J Psychiatric Res. 2001;45(6):803-7. [Crossref]  [PubMed] 
  77. Hazlett EA, New AS, Newmark R, Haznedar MM, Lo JN, Speiser LJ, et al. Reduced anterior and posterior cingulate gray matter in borderline personality disorder. Biol Psychiatry. 2005;58(8):614-23. [Crossref]  [PubMed] 
  78. Mizenberg MJ, Fan J, New AS, Tang CY, Siever LJ. Frontolimbic structural changes in borderline personality disorder. J Psychiatric Res. 2008;42(9):727-33. [Crossref]  [PubMed]  [PMC] 
  79. van Elst LT, Hesslinger B, Thiel T, Geiger E, Haegele K, Lemieux L, et al. Frontolimbic brain abnormalities in patients with borderline personality disorder: a volumetric magnetic resonance imaging study. Biol Psychiatry. 2003;54(2):163-71. [Crossref]  [PubMed] 
  80. Schmahl CG, Elzinga BM, Vermetten E, Sanislow C, McGlashan TH, Bremner JD. Neural correlates of memories of abandonment in women with and without borderline personality disorder. Biol Psychiatry. 2003;54(2):142-51. [Crossref]  [PubMed] 
  81. Nunes PM, Wenzel A, Borges KT, Porto CR, Caminha RM, de Oliveira IR. Volumes of the hippocampus and amygdala in patients with borderline personality disorder: a meta-analysis. J Personality Disord. 2009; 23(4):333-45. [Crossref]  [PubMed] 
  82. Brambilla P, Soloff PH, Sala M, Nicoletti MA, Keshavan MS, Soares JC. Anatomical MRI study of borderline personality disorder patients. Psychiatry Res. 2004;131(2):125-33. [Crossref]  [PubMed] 
  83. Irle E, Lange C, Sachsse U. Reduced size and abnormal asymmetry of parietal cortex in women with borderline personality disorder. Biol Psychiatry. 2005;57(2):173-82. [Crossref]  [PubMed] 
  84. Chanen AM, Jovev M, Djaja D, McDougall E, Yuen HP, Rawlsings D, et al. Screening for borderline personality disorder in outpatient youth. J Pers Disord. 2008;22(4):353-64. [Crossref]  [PubMed] 
  85. Chanen AM, Velakoulis D, Carison K, Gaunson K, Wood SJ, Yuen HP, et al. Orbitofrontal, amygdala and hippocampal volumes in teenagers with first-presentation borderline personality disorder. Psychiatry Res. 2008;163(2):116-25. [Crossref]  [PubMed] 
  86. Brunner R, Henze R, Parzer P, Kramer J, Feigl N, Lutz K, et al. Reduced prefrontal and orbitofrontal gray matter in female adolescents with borderline personality disorder: is it disorder specific? Neuroimage. 2010;49(1):114-20. [Crossref]  [PubMed] 
  87. New AS, Goodman M, Triebwasser J, Siever LJ. Recent advances in the biological study of personality disorders. Psychiatr Clin North Am. 2008;31(3):441-61. [Crossref]  [PubMed] 
  88. Mervielde I, De Clercq B, De Fruyt F, van Leeuwen K. Temperament, personality, and developmental psychopathology as childhood antecedents of personality disorders. J Pers Disord. 2005;19(2):171-201. [Crossref]  [PubMed] 
  89. Kim-Cohen J, Caspi A, Moffitt TE, Harrington H, Milne BJ, Poulton R. Prior juvenile diagnoses in adults with mental disorder: developmental follow-back of a prospective-longitudinal cohort. Arch Gen Psychiatry. 2003;60(7):709-17. [Crossref]  [PubMed] 
  90. Carlson EA, Egeland B, Sroufe LA. A prospective investigation of the development of borderline personality symptoms. Dev Psychopathol. 2009; 21(4):1311-34. [Crossref]  [PubMed] 
  91. Crawford TN, Cohen PR, Chen H, Anglin DM, Ehrensaft M. Early maternal separation and the trajectory of borderline personality disorder symptoms. Dev Psychopathol. 2009;21(3):1013-30. [Crossref]  [PubMed] 
  92. Dowson J, Bazanis E, Rogers R, Prevost A, Taylor P, Meux C, et al. Impulsivity in patients with borderline personality disorder. Compr Psychiatry. 2004;45(1):29-36. [Crossref]  [PubMed] 
  93. Kaess M, von Ceumern-Lindenstjerna IA, Parzer P, Chanen A, Mundt C, Resch F, et al. Axis I and II comorbidity and psychosocial functioning in female adolescents with borderline personality disorder. Psychopathology. 2013;46(1):55-62. [Crossref]  [PubMed] 
  94. Gratz KL, Tull MT, Reynolds EK, Bagge CL, Latzman RD, Daughters SB, et al. Extending extant models of the pathogenesis of borderline personality disorder to childhood borderline personality symptoms: the roles of affective dysfunction, disinhibition, and self and emotion-regulation deficits. Dev Psychopathol. 2009;21(4):1263-91. [Crossref]  [PubMed]  [PMC] 
  95. Kasen S, Cohen P, Skodol AE, Johnson JG, Brook JS. Influence of child and adolescent psychiatric disorders on young adult personality disorder. Am J Psychiatry. 1999;156(10):1529-35. [Crossref]  [PubMed] 
  96. Stepp SD, Olino TM, Klein DN, Seeley JR, Lewinsohn PM. Unique influences of adolescent antecedents on adult borderline personality disorder features. Personal Disord. 2013;4(3):223-9. [Crossref]  [PubMed]  [PMC] 
  97. Helgeland MI, Kjelsberg E, Torgersen S. Continuities between emotional and disruptive behavior disorders in adolescence and personality disorders in adulthood. Am J Psychiatry. 2005;162(10):1941-7. [Crossref]  [PubMed] 
  98. Barkley RA, Fischer M, Smallish L, Fletcher K. The persistence of attention-deficit/hyperactivity disorder into young adulthood as a function of reporting source and definition of disorder. J Abnormal Psychol. 2002;111(2):279 -89. [Crossref]  [PubMed] 
  99. Rey JM, Morris-Yates A, Singh M, Andrews G, Stewart GW. Continuities between psychiatric disorders in adolescents and personality disorders in young adults. Am J Psychiatry. 1995;152(6):895-900. [Crossref]  [PubMed] 
  100. Zoccolillo M, Pickles A, Quinton D, Rutter M. The outcome of conduct disorder: implications for defining adult personality disorder and conduct disorder. Psychol Med. 1992;22(4):971-86. [Crossref]  [PubMed] 
  101. Burke JD, Stepp SD. Adolescent disruptive behavior and borderline personality disorder symptoms in young adult men. J Abnorm Child Psychol. 2012;40(1):35-44. [Crossref]  [PubMed]  [PMC] 
  102. Coolidge FL, Segal DL, Stewart SE, Ellett JAC. Neuropsychological dysfunction in children with borderline personality disorder features: a preliminary investigation. J Res Pers. 2000;34(4):554-61. [Crossref] 
  103. Fossati A, Novella L, Donati D, Donini M, Maffei C. History of childhood attention deficit/ hyperactivity disorder symptoms and borderline personality disorder: a controlled study. Compr Psychiatry. 2002;43(5):369-77. [Crossref]  [PubMed] 
  104. Philipsen A, Limberger MF, Lieb K, Feige B, Kleindienst N, Ebner-Priemer U, et al. Attention-deficit hyperactivity disorder as a potentially aggravating factor in borderline personality disorder. Br J Psychiatry. 2008;192(2):118-23. [Crossref]  [PubMed] 
  105. Crowell SE, Beauchaine T, Linehan MM. A biosocial developmental model of borderline personality: elaborating and extending Linehan's theory. Psychol Bull. 2009;135(3):495-510. [Crossref]  [PubMed]  [PMC] 
  106. Beauchaine TP, Klein DN, Crowell SE, Derbidge C, Gatzke-Kopp L. Multifinality in the development of personality disorders: a biology x sex x environment interaction model of antisocial and borderline traits. Dev Psychopathol. 2009;21(3):735-70. [Crossref]  [PubMed]  [PMC] 
  107. Nock MK, Joiner Jr TE, Gordon KH, Lloyd-Richardson E, Prinstein MJ. Non-suicidal self-injury among adolescents: diagnostic correlates and relation to suicide attempts. Psychiatry Res. 2006;144(1):65-72. [Crossref]  [PubMed] 
  108. Muehlenkamp JJ, Ertelt TW, Miller AL, Claes L. Borderline personality symptoms differentiate non-suicidal and suicidal self-injury in ethnically diverse adolescent outpatients. J Child Psychol Psychiatry. 2011;52(2):148-55. [Crossref]  [PubMed] 
  109. Hughes AE, Crowell SE, Uyeji L, Coan JA. A developmental neuroscience of borderline pathology: emotion dysregulation and social baseline theory. J Abnormal Child Psychol. 2012;40(1):21-33. [Crossref]  [PubMed]  [PMC] 
  110. Becker DF, McGlashan TH, Grilo CM. Exploratory factor analysis of borderline personality disorder criteria in hospitalized adolescents. Compr Psychiatry. 2006;47(2):99-105. [Crossref]  [PubMed] 
  111. Sharp C, Ha C, Michonski J, Venta A, Carbone C. Borderline personality disorder in adolescents: evidence in support of the Childhood Interview for DSM-IV Borderline Personality Disorder in a sample of adolescent inpatients. Compr Psychiatry. 2012;53(6):765-74. [Crossref]  [PubMed] 
  112. Becker DF, Grilo CM, Morey LC, Walker ML, Edell WS, McGlashan TH. Applicability of personality disorder criteria to hospitalized adolescents: evaluation of internal consistency and criterion overlap. J Am Acad Child Adolesc Psychiatry. 1999;38(2):200-5. [Crossref]  [PubMed] 
  113. Becker DF, Grilo CM, Edell WS, McGlashan TH. Diagnostic efficiency of borderline personality disorder criteria in hospitalized adolescents: Comparison with hospitalized adults. Am J Psychiatry. 2002;159(12):2042-7. [Crossref]  [PubMed] 
  114. Segal-Trivitz Y, Bloch Y, Goldburt Y, Sobol-Havia D, Levkovitch Y, Ratzoni G. Comparison of symptoms and treatments of adults and adolescents with borderline personality disorder. Int J Adolesc Med Health. 2006;18(2):215-20. [Crossref]  [PubMed] 
  115. Michonski JD, Sharp C, Steinberg L, Zanarini MC. An item response theory analysis of the DSM-IV borderline personality disorder criteria in a population-based sample of 11-to 12-year-old children. Personal Disord. 2013;4(1):15-22. [Crossref]  [PubMed] 
  116. Mehlum L, Tørmoen AJ, Ramberg M, Haga E, Diep LM, Laberg S, et al. Dialectical behavior therapy for adolescents with repeated suicidal and self-harming behavior: a randomized trial. J Am Acad Child Adolesc Psychiatry. 2014;53(10):1082-91. [Crossref]  [PubMed] 
  117. Rossouw TI, Fonagy P. Mentalization-based treatment for self-harm in adolescents: a randomized controlledtrial. J Am Acad Child Adolesc Psychiatry. 2012;51(12):1304-13.e3. [Crossref]  [PubMed] 
  118. Kernberg PF, Weiner AS, Bardenstein KK. Personality Disorders in Children and Adolescents. 1st ed. New York: Basic Books; 2000. p.304.
  119. Chanen AM, Jackson HJ, McCutcheon LK, Jovev M, Dudgeon P, Yuen HP, et al. Early intervention for adolescents with borderline personality disorder: quasi-experimental comparison with treatment as usual. Aust N Z J Psychiatry. 2009;43(5):397-408. [Crossref]  [PubMed] 
  120. Mazza JJ, Dexter-Mazza ET, Miller AL, Rathus JH, Murphy HE. DBT Skills in Schools: Skills Training for Emotional Problem Solving for Adolescents (DBT STEPS-A). 1st ed. New York: The Guilford Press; 2016. p.490. [Crossref] 

.: Up To Date

Login

 Forgot your password?

 New Registration  

Contact

Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com