الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Borderline personality disorder (BPD) is a serious mental disorder which is common in clinical practice. It is among the most functionally disabling of all mental disorders and is associated with high treatment seeking in a variety of contexts. BPD is defined in the DSM-5 as a pervasive pattern of disturbance or instability across multiple domains of functioning, which include behavior, affect, cognition, attention, and relationship interaction. It is usually comorbid with other serious mental health conditions, as major depressive and anxiety disorders. In addition, borderline pathology relates to a number of chronic physical health problems, as heart disease, arthritis, and obesity. Obesity may be one factor that connects BPD and risk for medical conditions among older adults. The present research was conducted aiming at testingthe psychometric properties (validity and reliability) of the Arabic translated version of the borderline symptom list, short form (BSL-23), estimating the prevalence of BPD among obese females andinvestigating the relationship between BPD and obesity.
To fulfill this aim, a cross-sectional study design was conducted on a sample of 303 obese females attending the nutrition clinics of Family Health Units, selected randomly, in Alexandria Governorate. from the eight districts of Alexandria, four districts were chosen at random namely; East, Middle, El-Gomrok, and El-Montaza districts. One Family Health Unit with a nutrition clinic was randomly chosen from each of the selected four districts namely; San Stefano, El-HadaraQibly, El-Amal, and SediBeshr Family Health Units. The predetermined sample was equally allocated from the selected nutrition clinics (i.e. seventy-six cases from each unit).
For the execution of this work, the selected females were subjected to:
I) A pre-designed interviewing questionnaire to collect the following data:
1- Socio-demographic data.
2- Personal history: e.g. smoking, substance abuse and alcohol drinking.
3- History of chronic illness.
4- History of psychiatric disorders: e.g. depression and anxiety.
5- History of obesity.
6- Family data: e.g. family history of obesity and psychiatric disorders.
II) The Arabic version of the rapid eating assessment for participants, short version (REAP-S)
III) Psychometric tools used:
1- The translated Arabic version of borderline symptom list, short form (BSL-23) with its supplement and measure of global wellbeing:
The translation of BSL-23 was done by the researcher. Psychometric properties (validity and reliability) of the Arabic version of BSL-23 were also examined by the researcher. Reliability was tested using Cronbach’s alpha which was considered excellent (0.959). Validity was performed using factorial, discriminant and convergent validity and it was significant.
2- The borderline personality disorder part of the Arabic version of the personality diagnostic questionnaire-4+ (PDQ-4+).
The results of the present study revealed the following:
The study sample included 303 obese females. The age of selected females ranged from 20 to 60 years with a mean age of 36.90 ± 11.68 years. The majority of females were married (64.1%) while 29.0%, 4.3% and 2.6% were single, widowed and divorced respectively. Regarding monthly income, the largest proportion of sampled females had enough monthly income (61.7%) while the least proportion had not enough monthly income and was in need to borrow (5.3%). In order to fulfillthe study’s objectives, the following results were presented:
- Estimating the prevalence of BPD among obese females:
The prevalence of BPD among the study sample was 26.7% while the prevalence of subclinical borderline symptoms was 8.6% using the Arabic version of the BSL-23.
- Investigating the relationship between BPD and obesity:
Obese females diagnosed with BPD were more likely to report low quality of overall personal state on the measure of global wellbeing (24.7%) compared to only 1.5% of non-borderline females.
In addition, using the BSL-23 supplement, many behavioral problems were more common among borderline females. In respect of binge eating episodes, they were more among borderline (71.6%) compared to females with sub-diagnostic borderline symptoms and non-borderline (61.5% and 36.2% respectively).
There were also twoobesogenic eating habits namely;always or usually do not eat breakfast,and always or usually eat less than two portions of high fiber carbohydrates per day,which were found to be more prevalent in obese borderline females compared to non-borderline (33.3% and 58% vs. 19.2% and 36.2% respectively).
Moreover, borderline obese females were significantly more likely to be smokers and to have co-morbid psychiatric illnesses compared to non-borderline (OR=5.2 and 7.5 respectively).
- Determinants of BPD:
According to the stepwise multistage logistic regression analysis, the possible variables proved to be significant determinants of BPD were: history of other psychiatric illness (OR=5.387), history of childhood maltreatment (OR=2.037),family violence (OR=1.320), and age equal to or more than 30 years old (OR=0.959).
Based on the present results, the following was concluded:
The present study highlights BPD as one of the important psychiatric disorders among females suffering from obesity and attending nutrition clinics of family health units in Alexandria.
The current research also concluded that the translated Arabic version of the borderline symptom list-short version (BSL-23) has good psychometric properties and provides a specific assessment of BPD symptomatology in an easy and quick way.
Moreover, it was concluded that age equal to more than 30 years old, having another psychiatric disorder, childhood maltreatment and family violence were the most significantly independent determinants of BPD.
Finally, the following items were recommended:
I. Recommendations concerning community:
• The provision of accessible and accurate health education programs for females through social media campaigns and other media or by organizing events at women’s gathering areas such as clubs and youth centers to encourage them to have a healthy lifestyle including proper dietary habits and adequate physical activity.
• Mental health education programs through different media (video and/or audio) are required to increase community awareness about how to maintain sound mental health as well as about the need for early detection of the precursor symptoms of BPD and the various treatment options available.
II. Recommendations concerning family:(families could be approached at schools and/or family health centers)
• Health education should be provided to families especially mothers and adolescents about obesity, its harmful effects and its relation to psychiatric comorbidities including BPD.
• Possible risk factors for BPD such as childhood maltreatment and family violence should be discussed with parents.
III. Recommendations concerning health professionals:
• Co-operation between nutritionists and mental health professionals would ensure the provision of accurate and up to-date information about obesity and how to change dietary habits and life style of patients.
• The use of the Arabic version of REAP-S in primary care settings as a useful instrument for a quick screening for eating habits and those who have poor scores could be referred for further dietary assessment and/or counseling.
• Timely diagnosis and treatment of BPD by primary care physicians and psychiatrists can be an important factor in reducing failure rate of weight management programs among obese females and subsequently improving their quality of life.
• The use of the Arabic version of BSL-23 in weight management programs as this represents an opportunity for the physicians to a more comprehensive approach towards the care of obese patients.