Clonidine in acute aversive inner tension and self-injurious behavior in female patients with borderline personality disorder.
BACKGROUND
States of strong aversive inner tension and dissociative symptoms are clinical hallmarks of borderline personality disorder and major reasons for self-injurious behavior, a severe clinical condition for which there are no established pharmacologic treatment options.


METHODS
The acute effect of 75 and 150 microg of clonidine administered orally in acute states of strong aversive inner tension and urge to commit self-injurious behavior was examined in 14 female patients meeting DSM-IV criteria for borderline personality disorder. Before and 30, 60, and 120 minutes after administration of clonidine, aversive inner tension and dissociative symptoms were assessed using a self-rating instrument for aversive inner tension and dissociation (Dissociation-Tension-Scale acute), and the urge to commit self-injurious behavior and suicidal ideations were assessed using self-rating Likert scales. Blood pressure and heart rate were monitored during the trial.


RESULTS
Aversive inner tension and urge to commit self-injurious behavior before administration of clonidine were strong. After administration of clonidine in both doses, aversive inner tension, dissociative symptoms, urge to commit self-injurious behavior, and suicidal ideations significantly decreased. The strongest effects were seen between 30 and 60 minutes after drug intake and correspond to the pharmacokinetics of clonidine with maximum plasma concentrations after 1 hour. Blood pressure and aversive inner tension and dissociative symptoms were positively correlated before and after administration of clonidine.


CONCLUSIONS
Orally given clonidine may be effective for treatment of acute states of aversive inner tension, dissociative symptoms, and urge to commit self-injurious behavior in female patients with borderline personality disorder. Further placebo-controlled studies with larger populations are needed to confirm this finding.
Philipsen
Alexandra
A
Department of Psychiatry and Psychotherapy, University of Freiburg Medical School, Freiburg, Germany.
Richter
Harald
H
Schmahl
Christian
C
Peters
Julia
J
Rüsch
Nicolas
N
Bohus
Martin
M
Lieb
Klaus
K
D000208:Acute Disease; D000284:Administration, Oral; D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D000553:Ambulatory Care; D001883:Borderline Personality Disorder / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D003000:Clonidine / Q000008:administration & dosage / Q000627:therapeutic use*; D015897:Comorbidity; D004213:Dissociative Disorders / Q000188:drug therapy; D005260:Female; D006760:Hospitalization; D006801:Humans; D010555:Personality Inventory; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D016728:Self-Injurious Behavior / Q000188:drug therapy* / Q000523:psychology; D016037:Single-Blind Method; D013315:Stress, Psychological / Q000188:drug therapy*; D013405:Suicide / Q000523:psychology; D016896:Treatment Outcome
D000316:Adrenergic alpha-Agonists; D003000:Clonidine