Faculty Bibliography

BACKGROUND: Offensive language (spoken by medical staff and by patients and their families) is often heard in the general hospital, but its manifestations and clinical implications have not been previously examined. OBJECTIVE: The authors sought to facilitate an understanding of the effects and treatment of offensive utterances and their downstream consequences. METHOD: The authors present a sampling of clinical vignettes that illustrate a variety of examples of hospital-based events in which offensive language was used and discuss differential diagnoses and management strategies. RESULTS: Swearing can also be used as a psychological tool in the service of helping. Swearing may provide a channel of catharsis for aggressive drives and affects that have been building in either the doctor or the patient. DISCUSSION: Placing offensive behaviors, for example, use of profane language, in a biopsychosocial context can facilitate an understanding of the causes, effects, and treatment of these events.

BACKGROUND: borderline personality disorder (BPD) is a psychiatric diagnosis characterized by high exposure, reactivity, and vulnerability to stress. Given these abnormalities in stress reactivity in BPD, there is a question of whether the hypothalamic-pituitary-adrenal (HPA) axis functions normally in BPD, since the activation of the HPA axis normally occurs to coordinate both behavioral and physiologic responses to stress. Several studies have investigated the functioning of the HPA axis in BPD and have shown varied results. This review seeks to summarize and interpret the findings of this growing literature. METHODS: Pubmed search for English language articles on borderline personality disorder and hypothalamic-pituitary-adrenal axis. RESULTS: findings are mixed but suggest that important variables relevant to between-group differences include comorbid depression, comorbid posttraumatic stress disorder, dissociative symptoms, and history of childhood abuse. DISCUSSION: comorbid diagnoses and clinical features such as trauma history and symptom severity may have variable, interacting influences on the psychoneuroendocrine profile in BPD. Also explored here are the implications of these findings for developing possible models of HPA-axis dysfunction in BPD, for identifying potential targets for treatment, and for improving the methodology of future studies.