51
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Stewart JG, Singleton P, Benau EM, Foti D, Allchurch H, Kaplan CS, Aguirre B, Auerbach RP. Neurophysiological activity following rewards and losses among female adolescents and young adults with borderline personality disorder. JOURNAL OF ABNORMAL PSYCHOLOGY 2019; 128:610-621. [PMID: 31318241 DOI: 10.1037/abn0000439] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Borderline personality disorder (BPD) is a complex and debilitating psychiatric illness. Prior research in adults has shown that neurophysiological deficits in feedback processing and learning from rewards may be central to the development of BPD; however, little research has examined these markers in adolescents and young adults with BPD. The present study used event-related potentials and time-frequency decomposition analysis to probe neural responses to wins and losses in a guessing task among 68 females (13 to 23 years old) either with BPD (n = 35) or no history of mental disorders (healthy control [HC]; n = 33). Participants completed a guessing task wherein they won and lost money at equal frequencies while electroencephalogram (EEG) data were acquired. Adolescents and young adults with BPD showed a smaller differentiation between wins and losses in the reward positivity (RewP) relative to HCs. Using time-frequency decomposition, we isolated distinct frequency bands sensitive to wins (delta = < 3Hz) and losses (theta = 4 Hz to 7 Hz). Compared with BPD participants, HCs showed significantly larger delta power to wins, specifically. The groups did not differ in delta power to losses, nor theta power to wins or losses. Collectively, findings implicate altered reward processing in the pathophysiology of BPD and may inform early identification and targeted intervention. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Dan Foti
- Department of Psychological Sciences
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52
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Bozzatello P, Bellino S, Bosia M, Rocca P. Early Detection and Outcome in Borderline Personality Disorder. Front Psychiatry 2019; 10:710. [PMID: 31649564 PMCID: PMC6794381 DOI: 10.3389/fpsyt.2019.00710] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 09/04/2019] [Indexed: 01/24/2023] Open
Abstract
Borderline personality disorder (BPD) is a severe and heterogeneous mental disorder that is known to have the onset in young age, often in adolescence. For this reason, it is of fundamental importance to identify clinical conditions of childhood and adolescence that present a high risk to evolve in BPD. Investigations indicate that early borderline pathology (before 19 years) predict long-term deficits in functioning, and a higher percentage of these patients continue to present some BPD symptoms up to 20 years. There is a general accordance among investigators that good competence in both childhood and early adulthood is the main predictive factor of excellent recovery in BPD patients. Some authors suggest that specific childhood personality traits can to be considered precursors of adult BPD, as well as some clinical conditions: disruptive behaviours, disturbance in attention and emotional regulation, conduct disorders, substance use disorders, and attention-deficit-hyperactivity disorder. Unfortunately, diagnosis and treatment of BPD is usually delayed, also because some clinicians are reluctant to diagnose BPD in younger individuals. Instead, the early identification of BPD symptoms have important clinical implications in terms of precocious intervention programs, and guarantees that young people with personality disorders obtain appropriate treatments. This review is aimed to collect the current evidences on early risk and protective factors in young people that may predict BPD onset, course, and outcome.
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Affiliation(s)
| | - Silvio Bellino
- Department of Neuroscience, University of Turin, Turin, Italy
| | - Marco Bosia
- Department of Neuroscience, University of Turin, Turin, Italy
| | - Paola Rocca
- Department of Neuroscience, University of Turin, Turin, Italy
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53
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Rohde C, Polcwiartek C, Correll CU, Nielsen J. Real-World Effectiveness of Clozapine for Borderline Personality Disorder: Results From a 2-Year Mirror-Image Study. J Pers Disord 2018; 32:823-837. [PMID: 29120277 DOI: 10.1521/pedi_2017_31_328] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
While some second-generation antipsychotics have shown efficacy on patients with borderline personality disorder (BPD), limited data exist regarding the effect of clozapine. Thus, we aimed to investigate the effects of clozapine on naturalistic outcomes in BPD patients with a 2-year mirror-image model. Among 25,916 patients with BPD, 1,107 redeemed ≥ 1 clozapine prescription. Of these, 18,188 were "specific" BPD patients, and 102 redeemed ≥ 1 clozapine prescription. During a mean observation period of 598.51 days, in all BPD patients, clozapine was associated with a significant reduction in psychiatric admissions from 2.52 (95% CI [2.31, 2.78]) to 2.00 (95% CI [1.77, 2.23]) admissions (p < .001) and a significant reduction in psychiatric bed-days from 190.08 (95% CI [176.84, 203.33]) to 65.95 (95% CI [58.27, 73.66]) bed-days (p < .001). Similar findings were found for "specific" BPD patients. The number of patients with intentional self-harm or overdose decreased significantly from 189 to 114 individuals (p < .001) after clozapine initiation. Randomized trials evaluating the risk- benefit ratio of clozapine in patients with severe BPD are warranted.
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Affiliation(s)
- Christopher Rohde
- Aalborg University, Aalborg, Denmark.,Aalborg University Hospital, Aalborg, Denmark
| | | | - Christoph U Correll
- Hofstra Northwell School of Medicine, Hempstead, New York.,The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York
| | - Jimmi Nielsen
- Aalborg University, Aalborg, Denmark.,Aalborg University Hospital, Aalborg, Denmark.,Mental Health Centre Glostrup, Copenhagen University Hospital
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54
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Stanley B, Perez-Rodriguez MM, Labouliere C, Roose S. A Neuroscience-Oriented Research Approach to Borderline Personality Disorder. J Pers Disord 2018; 32:784-822. [PMID: 29469663 DOI: 10.1521/pedi_2017_31_326] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Traditionally, the study of personality disorders had been based on psychoanalytic or behavioral models. Over the past two decades, there has been an emerging neuroscience model of borderline personality disorder (BPD) grounded in the concept of BPD as a condition in which dysfunctional neural circuits underlie its pathological dimensions, some of which include emotion dysregulation (broadly encompassing affective instability, negative affectivity, and hyperarousal), abnormal interpersonal functioning, and impulsive aggression. This article, initiated at a joint Columbia University- Cornell University Think Tank on BPD with representation from the Icahn School of Medicine at Mount Sinai, suggests how to advance research in BPD by studying the dimensions that underlie BPD in addition to studying the disorder as a unitary diagnostic entity. We suggest that linking the underlying neurobiological abnormalities to behavioral symptoms of the disorder can inform a research agenda to better understand BPD with its multiple presentations.
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Affiliation(s)
- Barbara Stanley
- Department of Psychiatry, Columbia University, New York City
| | | | | | - Steven Roose
- Department of Psychiatry, Columbia University, New York City.,New York State Psychiatric Institute, New York City
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Hessels CJ, Laceulle OM, van Aken MAG, Resch F, Kaess M. Differentiating BPD in adolescents with NSSI disorder: the role of adverse childhood experiences and current social relationships. Borderline Personal Disord Emot Dysregul 2018; 5:20. [PMID: 30555704 PMCID: PMC6286500 DOI: 10.1186/s40479-018-0097-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 11/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As borderline personality disorder (BPD) is increasingly considered a lifespan developmental disorder, we need to focus on risk factors and precursors in the developmental pathways to BPD, in order to enable early detection and intervention. Within this developmental pathway, adolescence is a crucial phase in the light of the manifestation of the disorder. Relational factors such as adverse childhood experiences and current relational problems can be considered important in adolescents who are at-risk for BPD. Nonsuicidal self-injury (NSSI) is a key precursor for adolescent BPD and one of the most promising targets for early detection and intervention of BPD. METHODS In a clinical sample of 152 adolescents engaging in nonsuicidal self-injury (NSSI) disorder referred to mental healthcare in Germany, this study investigated whether we can differentiate who has BPD from 1) adverse childhood experiences; and 2) the quality of current relationships, both with parents and peers. BPD was assessed both categorically as a dichotomized score and dimensionally as a continuous score. RESULTS More adverse childhood experiences, but not low quality of current social relationships, were related to more BPD symptoms and an increased risk for meeting full criteria for BPD. In the dimensional model, current social relationship quality with parents and peers did not show a moderating (protecting or aggravating) effect on the association between adverse childhood experiences and BPD. Using a categorical approach, however, the association between childhood adversity and meeting full criteria for BPD was higher in individuals reporting higher quality of current parent-child relationship. CONCLUSIONS These results highlight adverse childhood experiences as risk factors of BPD, while the role of current social relationships seems more complex.
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Affiliation(s)
| | - Odilia M Laceulle
- 2Department of Developmental Psychology, Utrecht University, Utrecht, Netherlands
| | - Marcel A G van Aken
- 2Department of Developmental Psychology, Utrecht University, Utrecht, Netherlands
| | - Franz Resch
- 3Clinic of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- 4University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,5Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
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56
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Moscoso A, Speranza M, Delvenne V, Corcos M, Pham-Scottez A. Parental Risk for Suicide and Attachment Patterns Among Adolescents With Borderline Personality Disorder. A Clinical-Based Study. Front Psychiatry 2018; 9:771. [PMID: 30687143 PMCID: PMC6336919 DOI: 10.3389/fpsyt.2018.00771] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 12/21/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction: Experiencing adverse life events and early disturbed patterns of interaction are crucial determinants for the development of Borderline Personality Disorder (BPD). Parental suicidal attempts can be considered a major adverse life event and a potentially traumatic experience. The aim of this study was to examine differences in parental suicidal attempts among a BPD adolescent population vs. a matched control group. We also aimed to understand if attachment styles and the number of parental suicidal attempts predicted the severity of borderline symptomatology. Methods: Our study (EURNET BPD) comprised 85 BPD adolescents and 85 matched controls. Axis II disorders were investigated using the French version of SIDP-IV. Parental suicidal behaviors were assessed during a face-to-face interview with the adolescent. Attachment style was assessed with the Relationship Questionnaire (RQ). Results: Parents of BPD adolescents made more suicidal attempts than controls (34 vs. 11%; chi2 = 13.8, p < 0.001). The linear regression showed that the best model explaining the severity of borderline symptomatology (R 2 adjusted = 0.15, F = 4.65, p < 0.001) was a model including the number of suicidal attempts realized by the parent (standardized beta = 0.28, p = 0.009) and the preoccupied attachment style of the adolescents toward their parents (standardized beta = 0.21, p = 0.043). Conclusion: Our results highlight the usefulness of assessing parental suicidal behavior when interviewing patients with BPD traits. This could be useful in clinical practice as an early clue to identify patients with potentially severe clinical profiles and parents needing a specific support. Further research is needed to confirm our findings.
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Affiliation(s)
- Ana Moscoso
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre Hospitalier de Versailles, Versailles, France
| | - Mario Speranza
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre Hospitalier de Versailles, Versailles, France.,"Recherches Cliniques et en Santé Publique sur les Handicaps Psychique, Cognitif et Moteur" (HANDIReSP), Université de Versailles Saint Quentin en Yvelines, Versailles, France
| | - Veronique Delvenne
- Service de Pédopsychiatrie, Hôpital Universitaire des Enfants Reine Fabiola, Brussels, Belgium
| | - Maurice Corcos
- Département de Psychiatrie de l'Adolescent et du Jeune Adulte, Institut Mutualiste Montsouris, Paris, France
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57
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Frías Á, Palma C, Solves L, Martínez B, Salvador A. Differential symptomatology and functioning in borderline personality disorder across age groups. Psychiatry Res 2017; 258:44-50. [PMID: 28985552 DOI: 10.1016/j.psychres.2017.09.081] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 09/24/2017] [Accepted: 09/26/2017] [Indexed: 10/18/2022]
Abstract
There is increasing research aimed at addressing whether patients with borderline personality disorder (BPD) may exhibit variations in symptomatology and functioning according to their chronological age. The current study consisted of 169 outpatients diagnosed with BPD, who were divided into four age groups as follows: 16-25 years (n = 41), 26-35 years (n = 43), 36-45 years (n = 45), and 46 and more years (n = 40). Age groups were compared for symptomatology, normal personality traits, psychiatric comorbidities, functioning, and treatment-related features. The younger group had significantly higher levels of physical/verbal aggression and suicide attempts relative to the older group. Conversely, the older group had significantly greater severity of somatization, depression, and anxiety symptoms. In addition, the older group showed significantly greater functional impairment overall and across physical/psychological domains, specifically when compared to the younger group. Overall, these findings may suggest that age-related symptoms should be considered when diagnosing BPD. Also, functional impairments should be the target interventions for older BPD patients.
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Affiliation(s)
- Álvaro Frías
- Facultad de Psicologia, Ciencias de la Educación y el Deporte Blanquerna, University of Ramon-Llull, Barcelona, Spain; Consorci Sanitari del Maresme, Department of Psychiatry, Hospital of Mataró, Mataró, Spain.
| | - Carol Palma
- Facultad de Psicologia, Ciencias de la Educación y el Deporte Blanquerna, University of Ramon-Llull, Barcelona, Spain; Consorci Sanitari del Maresme, Department of Psychiatry, Hospital of Mataró, Mataró, Spain
| | - Laia Solves
- Consorci Sanitari del Maresme, Department of Psychiatry, Hospital of Mataró, Mataró, Spain
| | - Bárbara Martínez
- Consorci Sanitari del Maresme, Department of Psychiatry, Hospital of Mataró, Mataró, Spain
| | - Ana Salvador
- Facultad de Psicologia, Ciencias de la Educación y el Deporte Blanquerna, University of Ramon-Llull, Barcelona, Spain; Consorci Sanitari del Maresme, Department of Psychiatry, Hospital of Mataró, Mataró, Spain
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58
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Vega D, Torrubia R, Soto À, Ribas J, Soler J, Pascual JC, Rodríguez-Fornells A, Marco-Pallarés J. Exploring the relationship between non suicidal self-injury and borderline personality traits in young adults. Psychiatry Res 2017; 256:403-411. [PMID: 28692921 DOI: 10.1016/j.psychres.2017.07.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 04/30/2017] [Accepted: 07/03/2017] [Indexed: 11/28/2022]
Abstract
Non-suicidal self-injury (NSSI) is highly prevalent during late adolescence and young adulthood. There is some evidence of a link between NSSI and Borderline Personality Disorder (BPD), but little is known about the association between BPD traits and the various functions that maintain NSSI. The main purpose of this study was to explore the association between borderline personality traits and NSSI functions in a sample of college students. We also compared NSSI functions in college students who engaged in NSSI to those in an age-matched sample of BPD patients. This study included a total of 238 college students and 36 BPD patients. Participants were asked to complete a number of clinical measures. In the non-clinical sample, BPD features were more pronounced in the presence of NSSI, and we observed a differential relationship between NSSI functions and psychopathological BPD-traits. The NSSI clinical variables most strongly associated with BPD were frequency, variety of methods and severity, but not age of onset. Our results provide new information on the relationship between BPD and NSSI in young adults, and could be used to improve the early detection of vulnerable BPD-individuals and in planning NSSI treatment.
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Affiliation(s)
- Daniel Vega
- Servei de Psiquiatria i Salut Mental, Hospital d'Igualada (Consorci Sanitari de l'Anoia) Igualada, Barcelona, Spain; Unitat de Psicologia Mèdica, Departament de Psiquiatria i Medicina Legal & Institut de Neurociències, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain; Cognition and Brain Plasticity Group [Bellvitge Biomedical Research Institute-IDIBELL], L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Rafael Torrubia
- Unitat de Psicologia Mèdica, Departament de Psiquiatria i Medicina Legal & Institut de Neurociències, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Àngel Soto
- Servei de Psiquiatria i Salut Mental, Hospital d'Igualada (Consorci Sanitari de l'Anoia) Igualada, Barcelona, Spain
| | - Joan Ribas
- Servei de Psiquiatria i Salut Mental, Hospital d'Igualada (Consorci Sanitari de l'Anoia) Igualada, Barcelona, Spain
| | - Joaquim Soler
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau & Institut d'Investigació Biomèdica - Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Juan Carlos Pascual
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau & Institut d'Investigació Biomèdica - Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Antoni Rodríguez-Fornells
- Cognition and Brain Plasticity Group [Bellvitge Biomedical Research Institute-IDIBELL], L'Hospitalet de Llobregat, Barcelona, Spain; Dept. of Basic Psychology, Campus Bellvitge, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain; Catalan Institution for Research and Advanced Studies, ICREA, Barcelona, Spain
| | - Josep Marco-Pallarés
- Cognition and Brain Plasticity Group [Bellvitge Biomedical Research Institute-IDIBELL], L'Hospitalet de Llobregat, Barcelona, Spain; Dept. of Basic Psychology, Campus Bellvitge, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
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59
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Hopwood CJ, Bleidorn W. Stability and change in personality and personality disorders. Curr Opin Psychol 2017; 21:6-10. [PMID: 28923391 DOI: 10.1016/j.copsyc.2017.08.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/26/2017] [Accepted: 08/29/2017] [Indexed: 10/18/2022]
Abstract
In this paper, we review recent findings related to stability and change in personality and personality disorder. Estimates of stability vary depending on a number of methodological and substantive factors. These factors include the type of stability being examined, the type of construct being assessed, the method being used to assess personality, how participants are sampled, and developmental trends in personality stability and change. We describe current evidence about personality stability with respect to each of these factors. We conclude that current gaps in the literature can be filled by more carefully attending to factors that impact estimates of stability and change, and provide recommendations about how future research can fill those gaps.
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60
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Feenstra DJ, Luyten P, Bales DL. Mentalization-based treatment for borderline personality disorder in adults and adolescents: For whom, when, and how? Bull Menninger Clin 2017; 81:264-280. [DOI: 10.1521/bumc_2017_81_04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Dine J. Feenstra
- Viersprong Institute for Studies on Personality Disorders (VISPD), Bergen op Zoom, The Netherlands
| | - Patrick Luyten
- Viersprong Institute for Studies on Personality Disorders (VISPD), Bergen op Zoom, The Netherlands
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
- Research Department of Clinical, Educational, and Health Psychology, University College London, London, UK
- MBT Netherlands, Bergen op Zoom, The Netherlands
| | - Dawn L. Bales
- Viersprong Institute for Studies on Personality Disorders (VISPD), Bergen op Zoom, The Netherlands
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61
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Fuchs M, Karwautz A. [The epidemiology of mental disorders in youth : A narrative review including Austrian data]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT ÖSTERREICHISCHER NERVENÄRZTE UND PSYCHIATER 2017; 31:96-102. [PMID: 28853032 DOI: 10.1007/s40211-017-0238-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 07/04/2017] [Indexed: 10/19/2022]
Abstract
For decades, epidemiological studies have consistently and impressively demonstrated the frequency of mental illness in childhood and adolescence. Mental health disorders are among the most common causes of diminished quality of life among young people, sometimes casting long shadows into adulthood. This narrative review looks at this phenomenon using a selection of research findings dealing with overall prevalence figures, with the prevalence of individual disorders, and with the progression of mental illness from childhood and adolescence to adulthood. Austrian epidemiological studies supplementing these findings are also presented.
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Affiliation(s)
- Martin Fuchs
- Universitätsklinik für Psychiatrie, Psychotherapie und Psychosomatik im Kindes- und Jugendalter, Medizinische Universität Innsbruck, Christoph-Probst Platz, Innrain 52, 6020, Innsbruck, Österreich.
| | - Andreas Karwautz
- Universitätsklinik für Kinder- und Jugendpsychiatrie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
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62
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Roessner V, Wolff N, Ehrlich S, Waltereit R. Need for a more developmental perspective: QTc prolongation under psychotropic medication. Eur Child Adolesc Psychiatry 2017; 26:871-873. [PMID: 28730428 DOI: 10.1007/s00787-017-1028-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Veit Roessner
- Department of Child and Adolescent Psychiatry, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
| | - Nicole Wolff
- Department of Child and Adolescent Psychiatry, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Stefan Ehrlich
- Department of Child and Adolescent Psychiatry, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Robert Waltereit
- Department of Child and Adolescent Psychiatry, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
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63
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Die Ambulanz für Risikoverhalten und Selbstschädigung (AtR!Sk) – ein Pionierkonzept der ambulanten Früherkennung und Frühintervention von Borderline-Persönlichkeitsstörungen. Prax Kinderpsychol Kinderpsychiatr 2017; 66:404-422. [DOI: 10.13109/prkk.2017.66.6.404] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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64
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Fonagy P, Luyten P, Allison E, Campbell C. What we have changed our minds about: Part 2. Borderline personality disorder, epistemic trust and the developmental significance of social communication. Borderline Personal Disord Emot Dysregul 2017; 4:9. [PMID: 28405338 PMCID: PMC5387344 DOI: 10.1186/s40479-017-0062-8] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 03/21/2017] [Indexed: 12/02/2022] Open
Abstract
In Part 1 of this paper, we discussed emerging evidence suggesting that a general psychopathology or 'p' factor underlying the various forms of psychopathology should be conceptualized in terms of the absence of resilience, that is, the absence of positive reappraisal mechanisms when faced with adversity. These impairments in the capacity for positive reappraisal seem to provide a comprehensive explanation for the association between the p factor and comorbidity, future caseness, and the 'hard-to-reach' character of many patients with severe personality pathology, most notably borderline personality disorder (BPD). In this, the second part of the paper, we trace the development of the absence of resilience to disruptions in the emergence of human social communication, based on recent evolutionary and developmental psychopathology accounts. We argue that BPD and related disorders may be reconceptualized as a form of social understanding in which epistemic hypervigilance, distrust or outright epistemic freezing is an adaptive consequence of the social learning environment. Negative appraisal mechanisms become overriding, particularly in situations of attachment stress. This constitutes a shift towards a more socially oriented perspective on personality psychopathology in which the absence of psychological resilience is seen as a learned response to the transmission of social knowledge. This shift in our views has also forced us to reconsider the role of attachment in BPD. The implications for prevention and intervention of this novel approach are discussed.
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Affiliation(s)
- Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Patrick Luyten
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Elizabeth Allison
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Chloe Campbell
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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65
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Bo S, Kongerslev M. Self-reported patterns of impairments in mentalization, attachment, and psychopathology among clinically referred adolescents with and without borderline personality pathology. Borderline Personal Disord Emot Dysregul 2017; 4:4. [PMID: 28228967 PMCID: PMC5310093 DOI: 10.1186/s40479-017-0055-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 02/09/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous research, which primarily focused on adult samples, suggests that individuals with borderline personality disorder (BPD) display high levels of psychopathology, dysfunctional mentalization and problematic attachment to others. The current study investigated whether impairments in mentalization, attachment, and psychopathology are more severe in outpatient adolescents with BPD than in a clinical comparison group. METHODS Consecutive referrals to a child and adolescent psychiatric clinic were clinically assessed with a battery of self-report instruments to assess mentalization, attachment, and psychopathology. Specifically, in regard to BPD a self-report questionnaire was employed to decide if patients were classified into the BPD or the clinical comparison group. The main outcome variables of adolescents with a primary diagnosis of BPD were then compared with those of a clinical comparison group comprising patients receiving psychiatric diagnoses other than BPD. RESULTS Relative to the clinical group without BPD, and after controlling for sociodemographic variables, the BPD group displayed poorer mentalizing abilities, more problematic attachments to parents and peers, and higher self-reported levels of psychopathology. CONCLUSIONS The results of this study suggest that BPD is a severe mental condition in adolescents and is characterized by poor mentalizing abilities, attachment problems and high levels of psychopathology compared to adolescents with psychiatric disorders other than BPD. Hence, clinicians should consider BPD when conducting diagnostic assessments, and evidence-based treatments for this vulnerable group should be developed.
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Affiliation(s)
- Sune Bo
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Department of Child and Adolescent Psychiatry, Region Zealand Psychiatry, Roskilde, Denmark
| | - Mickey Kongerslev
- Centre of Excellence on Personality Disorder, Region Zealand Psychiatry, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
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Benarous X, Consoli A, Guilé JM, Garny de La Rivière S, Cohen D, Olliac B. Evidence-based treatments for youths with severely dysregulated mood: a qualitative systematic review of trials for SMD and DMDD. Eur Child Adolesc Psychiatry 2017; 26:5-23. [PMID: 27662894 DOI: 10.1007/s00787-016-0907-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 09/16/2016] [Indexed: 01/14/2023]
Abstract
The aim of this literature review was to examine the evidence for psychotherapeutic and pharmacological treatments in subjects with severely dysregulated mood and to identify potential areas for improvements in research designs. A literature search was conducted using several databases for published (PubMed, PsycINFO) and ongoing (clinical trial registries) studies conducted in youths who met NIMH's criteria for Severe Mood Dysregulation (SMD) or the DSM-5 diagnosis of Disruptive Mood Dysregulation Disorder (DMDD). Eight completed studies were identified: three randomized trials, four open pilot studies and one case report. Seven ongoing studies were found in trial registries. The available evidence suggests potential efficacy of psychotherapies which have previously been developed for internalizing and externalizing disorders. The two main pharmacological strategies tested are, first, a monotherapy of psychostimulant or atypical antipsychotic such as risperidone, already used in the treatment of severe irritability in youths with developmental disorders; and second, the use of a serotonergic antidepressant as an add-on therapy in youths treated with psychostimulant. Ongoing studies will further clarify the effectiveness of psychotherapeutic interventions for DMDD individuals and whether they should be given alone or in conjunction with other treatments. The short duration of the trials for a chronic disorder, the low number of studies, the lack of placebo or active comparator arm, and restrictive inclusion criteria in most of the controlled trials dramatically limit the interpretation of the results. Finally, future research should be conducted across multiple sites, with standardized procedures to measure DMDD symptoms reduction, and include a run-in period to limit placebo effect.
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Affiliation(s)
- Xavier Benarous
- Department of Child And Adolescent Psychiatry, Pitié-Salpêtrière Hospital, 47-83 boulevard de l'Hôpital, 75013, Paris, France.
| | - Angèle Consoli
- Department of Child And Adolescent Psychiatry, Pitié-Salpêtrière Hospital, 47-83 boulevard de l'Hôpital, 75013, Paris, France.,INSERM U-669, PSIGIAM, Paris, France
| | - Jean-Marc Guilé
- Department of Child And Adolescent Psychiatry, Pitié-Salpêtrière Hospital, 47-83 boulevard de l'Hôpital, 75013, Paris, France.,Groupe de Recherches sur l'Analyse Multimodale de la Fonction Cérébrale, INSERM U1105, CHU, Université Picardie Jules Verne, Amiens, France.,Department of Psychiatry, McGill University, Montreal, Canada
| | - Sébastien Garny de La Rivière
- Groupe de Recherches sur l'Analyse Multimodale de la Fonction Cérébrale, INSERM U1105, CHU, Université Picardie Jules Verne, Amiens, France
| | - David Cohen
- Department of Child And Adolescent Psychiatry, Pitié-Salpêtrière Hospital, 47-83 boulevard de l'Hôpital, 75013, Paris, France.,CNRS UMR 7222, Institute for Intelligent Systems and Robotics-ISIR, Paris, France
| | - Bertrand Olliac
- Department of Child And Adolescent Psychiatry, Pitié-Salpêtrière Hospital, 47-83 boulevard de l'Hôpital, 75013, Paris, France.,Pôle Hospitalo-Universitaire de psychiatrie de l'enfant et de l'adolescent, Centre Hospitalier Esquirol, Limoges, France
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Kaess M, Fischer-Waldschmidt G, Resch F, Koenig J. Health related quality of life and psychopathological distress in risk taking and self-harming adolescents with full-syndrome, subthreshold and without borderline personality disorder: rethinking the clinical cut-off? Borderline Personal Disord Emot Dysregul 2017; 4:7. [PMID: 28484600 PMCID: PMC5420401 DOI: 10.1186/s40479-017-0058-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 03/14/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Diagnostic standards do not acknowledge developmental specifics and differences in the clinical presentation of adolescents with borderline personality disorder (BPD). BPD is associated with severe impairments in health related quality of life (HRQoL) and increased psychopathological distress. Previously no study addressed differences in HRQoL and psychopathology in adolescents with subthreshold and full-syndrome BPD as well as adolescents at-risk for the development but no current BPD. METHODS Drawing on data from a consecutive sample of N = 264 adolescents (12-17 years) presenting with risk-taking and self-harming behavior at a specialized outpatient clinic, we investigated differences in HRQoL (KIDSCREEN-52) and psychopathological distress (SCL-90-R) comparing adolescents with no BPD (less than 3 criteria fulfilled), to those with subthreshold (3-4 BPD criteria) and full-syndrome BPD (5 or more BPD criteria). Group differences were analyzed using one-way analysis of variance with Sidak corrected contrasts or Chi-Square test for categorical variables. RESULTS Adolescents with subthreshold and full-syndrome BPD presented one year later at our clinic and were more likely female. Adolescents with subthreshold and full-syndrome BPD showed greater Axis-I and Axis-II comorbidity compared to adolescents with no BPD, and reported greater risk-taking behaviour, self-injury and suicidality. Compared to those without BPD, adolescents with subthreshold and full-syndrome BPD reported significantly reduced HRQoL. Adolescents with sub-threshold BPD and those with full-syndrome BPD did not differ on any HRQoL dimension, with the exception of Self-Perception. Similar, groups with sub-threshold and full-syndrome BPD showed no significant differences on any dimension of self-reported psychopathological distress, with the exception of Hostility. CONCLUSIONS Findings highlight that subthreshold BPD in adolescents is associated with impairments in HRQoL and psychopathological distress comparable to full-syndrome BPD. Findings raise awareness on the importance of early detection and question the diagnostic validity and clinical utility of existing cut-offs. Findings support a lower diagnostic cut-off for adolescent BPD, to identify those at-risk at an early stage.
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Affiliation(s)
- Michael Kaess
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Blumenstraße 8, Heidelberg, 69115 Germany.,Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Gloria Fischer-Waldschmidt
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Blumenstraße 8, Heidelberg, 69115 Germany
| | - Franz Resch
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Julian Koenig
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Blumenstraße 8, Heidelberg, 69115 Germany
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Infurna MR, Fuchs A, Fischer-Waldschmidt G, Reichl C, Holz B, Resch F, Brunner R, Kaess M. Parents' childhood experiences of bonding and parental psychopathology predict borderline personality disorder during adolescence in offspring. Psychiatry Res 2016; 246:373-378. [PMID: 27788455 DOI: 10.1016/j.psychres.2016.10.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 07/16/2016] [Accepted: 10/13/2016] [Indexed: 10/20/2022]
Abstract
Previous studies on borderline personality disorder (BPD) development suggest a transgenerational transmission of parent-child relationship quality, which may also be influenced by parents' mental health status. The aim of this study was twofold. First, we aimed to investigate the transgenerational effect of parental bonding experiences on the development of BPD in their offspring. Second, we examined the association between parents' mental health status and BPD in offspring. Ninety-one female adolescent psychiatric inpatients along with 87 mothers and 59 fathers were enrolled in the study. Adolescent BPD was assessed with the Structured Clinical Interview for DSM-IV-II, parental bonding with the Parental Bonding Instrument, and parents´ psychiatric symptoms with the Patient Health Questionnaire. We found that low parental care produced a transgenerational effect from mother to BPD in offspring. Further, significant associations were found between paternal psychiatric symptoms and adolescent BPD. High paternal stress levels mediated the association between maternal affect reported by fathers and BPD in daughters. There is evidence of a transgenerational effect of parental bonding specifically for female adolescents with BPD, compared with other clinical control subjects. Our findings highlight the importance of including both parents in future research and in early clinical treatment in adolescents with BPD.
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Affiliation(s)
- Maria Rita Infurna
- Section for "Translational Psychobiology in Child and Adolescent Psychiatry", Department of Child and Adolescent Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Anna Fuchs
- Section for "Translational Psychobiology in Child and Adolescent Psychiatry", Department of Child and Adolescent Psychiatry, University of Heidelberg, Heidelberg, Germany; Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Gloria Fischer-Waldschmidt
- Section for "Translational Psychobiology in Child and Adolescent Psychiatry", Department of Child and Adolescent Psychiatry, University of Heidelberg, Heidelberg, Germany; Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Corinna Reichl
- Section for "Translational Psychobiology in Child and Adolescent Psychiatry", Department of Child and Adolescent Psychiatry, University of Heidelberg, Heidelberg, Germany; Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Birger Holz
- Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Franz Resch
- Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Romuald Brunner
- Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- Section for "Translational Psychobiology in Child and Adolescent Psychiatry", Department of Child and Adolescent Psychiatry, University of Heidelberg, Heidelberg, Germany; Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany.
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Frías Á, Baltasar I, Birmaher B. Comorbidity between bipolar disorder and borderline personality disorder: Prevalence, explanatory theories, and clinical impact. J Affect Disord 2016; 202:210-9. [PMID: 27267293 DOI: 10.1016/j.jad.2016.05.048] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 05/21/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND The relationship between bipolar disorder (BD) and borderline personality disorder (BPD) has been controversial and widely debated. Specifically, the comorbidity between both disorders has yielded a plethora of research, but there are no comprehensive reviews on this issue. OBJECTIVE To determine the empirical evidence regarding the comorbidity between BD and BPD based on prevalence data, explanatory theories for their co-occurrence, and clinical impact of one disorder in the other. METHOD A comprehensive search of databases (PubMed and PsycINFO) was performed. Published manuscripts between January 1985 and August 2015 were identified. Overall, 70 studies fulfilled inclusion criteria. RESULTS Over a fifth of subjects showed comorbidity between BPD and BD. Empirical evidence from common underlying factors was inconclusive, but BPD appears to be a risk factor for BD. Data also indicated that the negative impact of BPD in BD (e.g., suicidality, worse mood course) was greater than vice verse. CONCLUSIONS Given the high prevalence of comorbidity between BD and BPD and the negative effects of BPD in subjects with BD, further studies are needed to clarify the factor associated with the comorbidity between these two disorders. This information is important to develop appropriate treatments for subjects with both disorders, improve their clinical course, and prevent the increased risk of suicidality commonly found in these subjects.
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Affiliation(s)
- Álvaro Frías
- FPCEE Blanquerna, University of Ramon-Llull, Barcelona, Spain; Adult Outpatient Mental Health Center, Consorci Sanitari del Maresme, Mataró, Spain; Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, United States.
| | - Itziar Baltasar
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, United States
| | - Boris Birmaher
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, United States
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Ramos V, Canta G, de Castro F, Leal I. The relation between attachment, personality, internalizing, and externalizing dimensions in adolescents with borderline personality disorder. Bull Menninger Clin 2016; 80:213-33. [PMID: 27583810 DOI: 10.1521/bumc.2016.80.3.213] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The relation between attachment and personality features is an important field to explore in adolescent borderline personality disorder (BPD), and previous research has shown that personality features may be conceptualized within latent internalizing and externalizing dimensions. This cross-sectional study used a structural equation model to examine the association between the BPD participants' perception of attachment and personality features, mediated by the underlying internalizing/externalizing personality dimensions. Data were analyzed for 60 adolescents, ages 15 to 18 years, diagnosed with BPD who completed attachment and personality self-report measures. The authors' results showed a good fit of the model, suggesting a significant association between attachment and the internalizing/externalizing dimensions, which simultaneously congregate and influence personality traits. The perception of attachment anxiety was positively related to the internalizing dimension and at the same time negatively related to the externalizing dimension. However, the perception of attachment avoidance was not related to internalizing or externalizing personality dimensions.
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Affiliation(s)
- Vera Ramos
- William James Center for Research, ISPA - Instituto Universitário, Lisboa, Portugal, and in the Hospital Garcia de Orta, Child and Adolescent Psychiatry Unit, Almada, Portugal
| | | | | | - Isabel Leal
- William James Center for Research, ISPA - Instituto Universitário, Lisboa, Portugal
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Bohus M, Schmahl C, Herpertz SC, Lieb K, Berger M, Roepke S, Heinz A, Gallinat J, Lyssenko L. Leitliniengerechte stationäre psychiatrisch-psychotherapeutische Behandlung der Borderline-Persönlichkeitsstörung. DER NERVENARZT 2016; 87:739-45. [PMID: 27271516 DOI: 10.1007/s00115-016-0132-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- M Bohus
- Institut für Psychiatrische und Psychosomatische Psychotherapie, Zentralinstitut für Seelische Gesundheit, Universität Heidelberg, J 5, 68156, Mannheim, Deutschland.
- Fakultät für Gesundheit, Universität Antwerpen, Antwerpen, Belgien.
| | - C Schmahl
- Klinik für Psychosomatische Medizin und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Universität Heidelberg, Mannheim, Deutschland
| | - S C Herpertz
- Klinik für Allgemeine Psychiatrie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Heidelberg, Universität Heidelberg, Heidelberg, Deutschland
| | - K Lieb
- Klinik für Psychiatrie und Psychotherapie der Universitätsmedizin Mainz, Mainz, Deutschland
| | - M Berger
- Klinik für Psychiatrie und Psychotherapie, Universität Freiburg, Freiburg, Deutschland
| | - S Roepke
- Klinik für Psychiatrie und Psychotherapie, Charité-Universitätsmedizin Berlin, Berlin, Deutschland
| | - A Heinz
- Klinik für Psychiatrie und Psychotherapie, Charité-Universitätsmedizin Berlin, Berlin, Deutschland
| | - J Gallinat
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - L Lyssenko
- Institut für Psychiatrische und Psychosomatische Psychotherapie, Zentralinstitut für Seelische Gesundheit, Universität Heidelberg, J 5, 68156, Mannheim, Deutschland
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Hessels C, van Aken MAG, Orobio de Castro B, Laceulle OM, van Voorst G. Social Information Processing and Cluster B Personality Pathology among Clinic-Referred Adolescents. Psychopathology 2016; 49:13-23. [PMID: 26756521 DOI: 10.1159/000440812] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 09/01/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND This study investigated relations between personality pathology and mentalizing capacities reflected in social information processing (SIP) of adolescents. SAMPLING AND METHODS 96 adolescent outpatients completed a structured interview regarding SIP. Their clinicians completed a checklist based on DSM-IV, assessing severity of personality pathology. RESULTS Significant relations were found between the severity of personality pathology and SIP: the more severe the personality pathology, the higher the intensity of reported emotions, the more likely adolescents were to choose inadequate coping strategies and aggressive reactions in social situations, and the more positively they evaluated aggressive reactions. Severity of traits of antisocial (ASPD) and borderline personality disorder (BPD) had unique associations with distinctive SIP variables: ASPD being more related to inadequate coping strategies, less reflection on other's motives and aggressive responses, and BPD being more related to avoidant or prosocial responses and in particular to memories of frustrating events. CONCLUSIONS This study provides evidence for difficulties in SIP among adolescents with more severe personality pathology, suggesting that the steps in the SIP model can be used to operationalize mentalizing problems. The results seem to paint a picture of ASPD and BPD having a shared background, but their own specific problems concerning SIP.
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