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Wilson K, Van Doorn G, Dye J. Vulnerable dark traits mediate the association between childhood adversity and suicidal ideation. PERSONALITY AND INDIVIDUAL DIFFERENCES 2023. [DOI: 10.1016/j.paid.2022.111959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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52
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Restek-Petrovic B, Grah M, Ivezic E, Handl H, Milovac Z, Bahun I, Mayer N, Vrbek P. Borderline Personality Disorder: Comparison of Two Treatment Modalities. J Nerv Ment Dis 2023; 211:11-16. [PMID: 36596287 DOI: 10.1097/nmd.0000000000001546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
ABSTRACT The aim of this study was to compare the effectiveness of two treatment modalities for patients diagnosed with borderline personality disorder (BPD). A total of 100 psychiatric patients diagnosed with BPD participated in this study. Among them, 50 patients were outpatients who attended the Reason and Emotion (RIO) program, and the remaining 50 were inpatients who were treated on psychotherapeutic ward at the same hospital. All the participants filled out the following battery of tests when entering the program/psychotherapy ward and 3 months later: Rosenberg's Self-Esteem Scale, Tennessee Self-Concept Scale (2nd ed), Barratt Impulsiveness Scale, The COPE Inventory, and the WHOQOL-BREF scale. The results showed significant positive effects of both treatment modalities on patients' self-esteem, different domains of self-concept, impulsivity, and different domains of subjective quality of life. No significant changes were observed in terms of coping strategies. Thus, the results speak in favor of the outpatient RIO program, which is more cost-effective than the inpatient ward treatment.
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Qian X, Townsend ML, Tan WJ, Grenyer BFS. Sex differences in borderline personality disorder: A scoping review. PLoS One 2022; 17:e0279015. [PMID: 36584029 PMCID: PMC9803119 DOI: 10.1371/journal.pone.0279015] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 11/28/2022] [Indexed: 12/31/2022] Open
Abstract
Borderline Personality Disorder (BPD) is often perceived to be a female-predominant disorder in both research and clinical contexts. Although there is growing recognition of possible sex differences, the current literature remains fragmented and inconclusive. This scoping review aimed to synthesize available research evidence on potential sex differences in BPD. PsycINFO, PubMed, Scopus and Web-of-Science were searched from January 1982 to July 2022 surrounding the key concepts of sex and BPD. Data searching and screening processes followed the Joanna Briggs Institute methodology involving two independent reviewers, and a third reviewer if necessary, and identified 118 papers. Data regarding BPD symptoms, comorbid disorders, developmental factors, biological markers, and treatment were extracted. Data was summarized using the vote counting method or narrative synthesis depending on the availability of literature. Males with BPD were more likely to present externalizing symptoms (e.g., aggressiveness) and comorbid disorders (e.g., substance use), while females with BPD were more likely to present internalizing symptoms (e.g., affective instability) and comorbid disorders (e.g., mood and eating disorders). This review also revealed that substantially more research attention has been given to overall sex differences in baseline BPD symptoms and comorbid disorders. In contrast, there is a dearth of sex-related research pertaining to treatment outcomes, developmental factors, and possible biological markers of BPD. The present scoping review synthesized current studies on sex differences in BPD, with males more likely to present with externalizing symptoms in contrast to females. However, how this might change the prognosis of the disorder or lead to modifications of treatment has not been investigated. Most studies were conducted on western populations, mainly North American (55%) or European (33%), and there is a need for future research to also take into consideration genetic, cultural, and environmental concomitants. As the biological construct of 'sex' was employed in the present review, future research could also investigate the social construct 'gender'. Longitudinal research designs are needed to understand any longer-term sex influence on the course of the disorder.
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Affiliation(s)
- Xinyu Qian
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Michelle L. Townsend
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Wan Jie Tan
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Brin F. S. Grenyer
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
- * E-mail:
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Psychopathological Determinants of Quality of Life in People with Borderline Personality Disorder. J Clin Med 2022; 12:jcm12010030. [PMID: 36614831 PMCID: PMC9820836 DOI: 10.3390/jcm12010030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/16/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Subjective quality of life (SQOL) in people with borderline personality disorder (BPD) is a marker of disease burden; a crucial treatment outcome; an indicator of psychosocial functioning; and a measure of interventions' effectiveness. Given the dearth of consolidated data, the current study examined psychopathological determinants of global and domain-specific SQOL in people with BPD. METHODS Hierarchical regression models were employed to examine in BPD patients (n = 150) the relationships of the number of BPD diagnostic criteria; the co-occurrence of other personality disorders (PDs); depression; state and trait anxiety; suicidality; self-harming; alcohol and substance use disorders with SQOL indices, namely physical health, psychological health, social relationships, environment, overall QOL and overall health. SQOL was estimated using the WHOQOL-BREF instrument. RESULTS Co-existing symptomatology such as depression, state and trait anxiety, and personality pathology, namely the co-occurrence of other PDs, exhibited significant associations with global and domain-specific SQOL, albeit depression was the strongest determinant of the most SQOL domains. In contrast, the number of BPD diagnostic criteria and central illness features such as suicidality, self-harming behaviour, and impulsivity manifested through alcohol and substance use did not exhibit significant associations with any SQOL dimension. CONCLUSIONS Comprehensive assessment of depressive symptoms should be regularly implemented in BPD services to facilitate early detection and treatment, thereby ensuring patients' SQOL. Accordingly, tackling anxiety and other PDs co-occurrence through appropriate interventions can facilitate more effectively SQOL improvement. Our findings can be explained by the hypothesis that co-existing psychopathology such as depression, anxiety and co-occurrence of other PDs in BPD patients represent illness severity indices rather than comorbid disorders, and might fully mediate the effect of BPD traits on SQOL. Future mediation analysis is required to elucidate this hypothesis.
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Common and distinct patterns of gray matter alterations in young adults with borderline personality disorder and major depressive disorder. Eur Arch Psychiatry Clin Neurosci 2022; 272:1569-1582. [PMID: 35419633 DOI: 10.1007/s00406-022-01405-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 03/25/2022] [Indexed: 02/08/2023]
Abstract
Young adults with borderline personality disorder (BPD) and major depressive disorder (MDD) have a relatively high comorbidity rate; however, whether they share a neurobiological basis remains controversial. Although previous studies have reported respective brain alterations, the common and distinct gray matter changes between two disorders are still inconsistent. We conducted a meta-analysis using anisotropic effect size-based algorithms (ASE-SDM) to identify consistent findings from whole-brain voxel-based morphometry (VBM) studies of gray matter volume (GMV) in 274 young adults (< 45 years old) with BPD and 1576 with MDD. Compared with healthy controls, the young adults with BPD showed GMV reduction mainly in the prefrontal cortex including the inferior frontal gyrus and superior frontal gyrus, medial temporal network, and insula, whereas the MDD showed GMV alteration in the visual network (fusiform gyrus and inferior temporal gyrus), sensorimotor network (bilateral postcentral gyrus (PoCG) and right cerebellum) and left caudate nucleus. The GMV differences between these two disorders were concentrated in the left orbitofrontal cortex, cingulate cortex, right insula, and cerebellum. The meta-regression of the MDD group showed a negative association between disease duration and the right middle cingulate gyrus as well as negative associations between depressive symptoms and brain regions of the right cerebellum and the left PoCG. Our results identified common and distinct patterns of GMV alteration between BPD and MDD, which may provide neuroimage evidence for the disorder comorbidity mechanisms and partly indicate the similar and different biological features in emotion regulation of the two disorders. This study was registered with PROSPERO (CRD42020212758).
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Reis T, Gekker M, Land MGP, Mendlowicz MV, Berger W, Luz MP, Vilete L, Figueira I, Araújo AXG. The growth and development of research on personality disorders: A bibliometric study. Personal Ment Health 2022; 16:290-299. [PMID: 35182026 DOI: 10.1002/pmh.1540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/19/2022] [Accepted: 02/08/2022] [Indexed: 01/31/2023]
Abstract
This study objective was to investigate publication trends on personality disorders (PD) and to identify patterns of historical development. Publication rates were determined using the Results by Year Timeline feature of PubMed. Time series autoregressive integrated moving average models were used to analyse the publication rates for PDs in quinquennial periods beginning in 1980 and ending in 2019 and to predict the number of publications in the 2024-2029 period. More than 300 articles on antisocial and borderline PD are being published each year, and the models suggest an accelerating growth rate. Approximately 100 articles are being published on average every year on schizotypal PD, and the regression model indicates linear growth in the near future. The mean number of publications per year for obsessive-compulsive, narcissistic and avoidant PDs is in the range of 10-30 with the corresponding models indicating linear growth. Fewer than 10 articles are being published each year on dependent, paranoid, histrionic and schizoid PD, whereas dependent PD shows modest growth and paranoid PD rates tended to stability, histrionic and schizoid PD exhibit declining rates. Personality disorders are a group of conditions with diverse etiological, prognostic, therapeutic, legal, research, social and cultural implications that influence publication rates.
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Affiliation(s)
- Taylor Reis
- Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), 71 Venceslau Brás Avenue, Rio de Janeiro, Rio de Janeiro, 22290-140, Brazil
| | - Márcio Gekker
- Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), 71 Venceslau Brás Avenue, Rio de Janeiro, Rio de Janeiro, 22290-140, Brazil
| | - Marcelo Gerardin Poirot Land
- Clinical Medicine Graduate Medical Program I Maternal and Child Health Graduate Program, Universidade Federal do Rio de Janeiro (UFRJ), 225 Rodolpho Paulo Rocco Avenue, building F, suite 5. University City, Fundão Island, Rio de Janeiro, Rio de Janeiro, 21941-905, Brazil
| | - Mauro Vitor Mendlowicz
- Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), 71 Venceslau Brás Avenue, Rio de Janeiro, Rio de Janeiro, 22290-140, Brazil.,Department of Psychiatry and Mental Health, Universidade Federal Fluminense (UFF), 303 Marquês de Paraná Street, second floor, Niteroi, Rio de Janeiro, 24220-000, Brazil
| | - William Berger
- Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), 71 Venceslau Brás Avenue, Rio de Janeiro, Rio de Janeiro, 22290-140, Brazil
| | - Mariana Pires Luz
- Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), 71 Venceslau Brás Avenue, Rio de Janeiro, Rio de Janeiro, 22290-140, Brazil
| | - Liliane Vilete
- Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), 71 Venceslau Brás Avenue, Rio de Janeiro, Rio de Janeiro, 22290-140, Brazil
| | - Ivan Figueira
- Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), 71 Venceslau Brás Avenue, Rio de Janeiro, Rio de Janeiro, 22290-140, Brazil
| | - Alexandre Xavier Gomes Araújo
- Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), 71 Venceslau Brás Avenue, Rio de Janeiro, Rio de Janeiro, 22290-140, Brazil.,Department of Psychiatry and Mental Health, Universidade Federal Fluminense (UFF), 303 Marquês de Paraná Street, second floor, Niteroi, Rio de Janeiro, 24220-000, Brazil
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Martin S, Del-Monte J. Just try it: Preliminary results of a six-month therapy for borderline personality disorder. Personal Ment Health 2022; 16:338-349. [PMID: 35751447 PMCID: PMC9787760 DOI: 10.1002/pmh.1555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/28/2022] [Accepted: 06/09/2022] [Indexed: 12/30/2022]
Abstract
Borderline Personality Disorder (BPD) is labeled as a personality disorder with impulsivity issues regarding relationships, risky behavior, and emotional dysregulation. This personality disorder is still considered to be hard-to-treat condition even though responses to treatment have improved significantly. In this field, Dialectical Behavioral Therapy is recognized as one of the most efficient therapeutical approaches, and some versions adapted from this gold-standard treatment proved their effectiveness in clinical settings. We tested the 6-month cognitive behavioral therapy (CBT) protocol ECCCLORE, composed of three modules, respectively, working on emotional regulation, distress tolerance, and relationships-in a French context to compare its effectiveness to Treatment As Usual. We recruited 56 patients with a BPD diagnosis in a day-care unit, 34 receiving ECCCLORE and 22 receiving TAU. We assessed BPD traits, impulsivity, aggressiveness, suicidal risk, and hopelessness. Our results revealed the effectiveness of the 6-month ECCCLORE protocol to decrease BPD symptoms and associated clinical dimensions. We also noted the persistence of its effect after a 1-year follow-up. Shortened CBT treatment protocols tend to prove their efficiency for symptom reduction in BPD. Further research is needed to replicate these results.
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Affiliation(s)
- Sylvia Martin
- Center for Research and Bioethics, Uppsala University, Uppsala, Sweden.,Psycho-TCCE, Private Practice, Nîmes, France
| | - Jonathan Del-Monte
- Center for Research and Bioethics, Uppsala University, Uppsala, Sweden.,Psycho-TCCE, Private Practice, Nîmes, France.,Clinical Psychology Department, Nîmes University, Nîmes, France.,LPS laboratory, Aix-Marseille University, Aix-en-Provence, France
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58
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Machado CDS, Ballester PL, Cao B, Mwangi B, Caldieraro MA, Kapczinski F, Passos IC. Prediction of suicide attempts in a prospective cohort study with a nationally representative sample of the US population. Psychol Med 2022; 52:2985-2996. [PMID: 33441206 DOI: 10.1017/s0033291720004997] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND There is still little knowledge of objective suicide risk stratification. METHODS This study aims to develop models using machine-learning approaches to predict suicide attempt (1) among survey participants in a nationally representative sample and (2) among participants with lifetime major depressive episodes. We used a cohort called the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) that was conducted in two waves and included a nationally representative sample of the adult population in the United States. Wave 1 involved 43 093 respondents and wave 2 involved 34 653 completed face-to-face reinterviews with wave 1 participants. Predictor variables included clinical, stressful life events, and sociodemographic variables from wave 1; outcome included suicide attempt between wave 1 and wave 2. RESULTS The model built with elastic net regularization distinguished individuals who had attempted suicide from those who had not with an area under the ROC curve (AUC) of 0.89, balanced accuracy 81.86%, specificity 89.22%, and sensitivity 74.51% for the general population. For participants with lifetime major depressive episodes, AUC was 0.89, balanced accuracy 81.64%, specificity 85.86%, and sensitivity 77.42%. The most important predictor variables were a diagnosis of borderline personality disorder, post-traumatic stress disorder, and being of Asian descent for the model in all participants; and previous suicide attempt, borderline personality disorder, and overnight stay in hospital because of depressive symptoms for the model in participants with lifetime major depressive episodes. Random forest and artificial neural networks had similar performance. CONCLUSIONS Risk for suicide attempt can be estimated with high accuracy.
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Affiliation(s)
- Cristiane Dos Santos Machado
- Laboratory of Molecular Psychiatry, Centro de Pesquisa Experimental (CPE) e Centro de Pesquisa Clínica (CPC), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
- Department of Psychiatry, Faculty of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Pedro L Ballester
- Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada
| | - Bo Cao
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Benson Mwangi
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Marco Antonio Caldieraro
- Laboratory of Molecular Psychiatry, Centro de Pesquisa Experimental (CPE) e Centro de Pesquisa Clínica (CPC), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
- Department of Psychiatry, Faculty of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Flávio Kapczinski
- Laboratory of Molecular Psychiatry, Centro de Pesquisa Experimental (CPE) e Centro de Pesquisa Clínica (CPC), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
- Department of Psychiatry, Faculty of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Department of Psychiatry and Behavioural Neurosciences, McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Ives Cavalcante Passos
- Laboratory of Molecular Psychiatry, Centro de Pesquisa Experimental (CPE) e Centro de Pesquisa Clínica (CPC), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
- Department of Psychiatry, Faculty of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Chiappini S, Picutti E, Alessi MC, Di Carlo F, D'Andrea G, Miuli A, Pettorruso M, Martinotti G, di Giannantonio M. Efficacy of Noninvasive Brain Stimulation on Borderline Personality Disorder Core Symptoms: A Systematic Review. J Pers Disord 2022; 36:505-526. [PMID: 36181488 DOI: 10.1521/pedi.2022.36.5.505] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Although psychotherapy is the first-line treatment of borderline personality disorder (BPD), psychopharmacological agents have not been approved yet. Modulating brain functions with noninvasive brain stimulation (NIBS) interventions, such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), may have a role in the treatment of BPD. In light of the limited knowledge available and the emerging interest in the possible role of NIBS as a therapeutic tool, the authors' main aim is to systematically review the literature on the effect of both rTMS and tDCS on BPD symptoms, specifically affective dysregulation, impulsive-behavioral dyscontrol, and cognitive-perceptual difficulties. The review process was conducted in accordance with PRISMA guidelines. The research methods were registered on PROSPERO (id code CRD42020209491). Eleven studies were included in the review. Despite the limited number of studies retrieved, preliminary data showed an improvement in all domains. Further studies are needed to understand potential long-term advantages of NIBS.
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Affiliation(s)
- Stefania Chiappini
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, Chieti-Pescara, Italy
| | - Elena Picutti
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, Chieti-Pescara, Italy
| | - Maria Chiara Alessi
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, Chieti-Pescara, Italy
| | - Francesco Di Carlo
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, Chieti-Pescara, Italy
| | - Giacomo D'Andrea
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, Chieti-Pescara, Italy
| | - Andrea Miuli
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, Chieti-Pescara, Italy
| | - Mauro Pettorruso
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, Chieti-Pescara, Italy
| | - Giovanni Martinotti
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, Chieti-Pescara, Italy.,G. Martinotti is also from the department of Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, UK
| | - Massimo di Giannantonio
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, Chieti-Pescara, Italy
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Monk-Cunliffe J, Borschmann R, Monk A, O'Mahoney J, Henderson C, Phillips R, Gibb J, Moran P. Crisis interventions for adults with borderline personality disorder. Cochrane Database Syst Rev 2022; 9:CD009353. [PMID: 36161394 PMCID: PMC9511988 DOI: 10.1002/14651858.cd009353.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND People diagnosed with borderline personality disorder (BPD) frequently present to healthcare services in crisis, often with suicidal thoughts or actions. Despite this, little is known about what constitutes effective management of acute crises in this population and what type of interventions are helpful at times of crisis. In this review, we will examine the efficacy of crisis interventions, defined as an immediate response by one or more individuals to the acute distress experienced by another individual, designed to ensure safety and recovery and lasting no longer than one month. This review is an update of a previous Cochrane Review examining the evidence for the effects of crisis interventions in adults diagnosed with BPD. OBJECTIVES To assess the effects of crisis interventions in adults diagnosed with BPD in any setting. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, nine other databases and three trials registers up to January 2022. We also checked reference lists, handsearched relevant journal archives and contacted experts in the field to identify any unpublished or ongoing studies. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing crisis interventions with usual care, no intervention or waiting list, in adults of any age diagnosed with BPD. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included two studies with 213 participants. One study (88 participants) was a feasibility RCT conducted in the UK that examined the effects of joint crisis plans (JCPs) plus treatment as usual (TAU) compared to TAU alone in people diagnosed with BPD. The primary outcome was self-harm. Participants had an average age of 36 years, and 81% were women. Government research councils funded the study. Risk of bias was unclear for blinding, but low in the other domains assessed. Evidence from this study suggested that there may be no difference between JCPs and TAU on deaths (risk ratio (RR) 0.91, 95% confidence interval (CI) 0.06 to 14.14; 88 participants; low-certainty evidence); mean number of self-harm episodes (mean difference (MD) 0.30, 95% CI -36.27 to 36.87; 72 participants; low-certainty evidence), number of inpatient mental health nights (MD 1.80, 95% CI -5.06 to 8.66; 73 participants; low-certainty evidence), or quality of life measured using the EuroQol five-dimension questionnaire (EQ-5D; MD -6.10, 95% CI -15.52 to 3.32; 72 participants; very low-certainty evidence). The study authors calculated an Incremental Cost Effectiveness Ratio of GBP -32,358 per quality-adjusted life year (QALY), favouring JCPs, but they described this result as "hypothesis-generating only" and we rated this as very low-certainty evidence. The other study (125 participants) was an RCT conducted in Sweden of brief admission to psychiatric hospital by self-referral (BA) compared to TAU, in people with self-harm or suicidal behaviour and three or more diagnostic criteria for BPD. The primary outcome was use of inpatient mental health services. Participants had an average age of 32 years, and 85% were women. Government research councils and non-profit foundations funded the study. Risk of bias was unclear for blinding and baseline imbalances, but low in the other domains assessed. The evidence suggested that there is no clear difference between BA and TAU on deaths (RR 0.49, 95% CI 0.05 to 5.29; 125 participants; low-certainty evidence), mean number of self-harm episodes (MD -0.03, 95% CI -2.26 to 2.20; 125 participants; low-certainty evidence), violence perpetration (RR 2.95, 95% CI 0.12 to 71.13; 125 participants; low-certainty evidence), or days of inpatient mental health care (MD 0.70, 95% CI -14.32 to 15.72; 125 participants; low-certainty evidence). The study suggested that BA may have little or no effect on the mean number of suicide attempts (MD 0.00, 95% CI -0.06 to 0.06; 125 participants; very low-certainty evidence). We also identified three ongoing RCTs that met our inclusion criteria. The results will be incorporated into future updates of this review. AUTHORS' CONCLUSIONS A comprehensive search of the literature revealed very little RCT-based evidence to inform the management of acute crises in people diagnosed with BPD. We included two studies of two very different types of intervention (JCP and BA). We found no clear evidence of a benefit over TAU in any of our main outcomes. We are very uncertain about the true effects of either intervention, as the evidence was judged low- and very low-certainty, and there was only a single study of each intervention. There is an urgent need for high-quality, large-scale, adequately powered RCTs on crisis interventions for people diagnosed with BPD, in addition to development of new crisis interventions.
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Affiliation(s)
- Jonathan Monk-Cunliffe
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rohan Borschmann
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
- Department of Psychiatry, University of Oxford, Oxford, UK
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Alice Monk
- School of Primary Care, Severn Postgraduate Medical Education, Bristol, UK
| | - Joanna O'Mahoney
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Claire Henderson
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rachel Phillips
- Imperial Clinical Trials Unit, Imperial College London, London, UK
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Jonathan Gibb
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Paul Moran
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Moran P, Bick D, Biddle L, Borries B, Kandiyali R, Rigby J, Seume P, Sadhnani V, Smith N, Swales M, Turner N. A feasibility randomised controlled trial with an embedded qualitative evaluation of perinatal emotional skills groups for women with borderline personality disorder: protocol for the EASE study. Pilot Feasibility Stud 2022; 8:215. [PMID: 36151584 PMCID: PMC9503265 DOI: 10.1186/s40814-022-01177-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background Borderline personality disorder (BPD) is a severe mental disorder characterised by emotional instability, impaired interpersonal functioning and an increased risk of suicide. There is no clear evidence about how best to help women with BPD during the perinatal period. Perinatal Emotional Skills Groups (ESGs) consist of 12 group sessions, focussing on core skills in emotion regulation, interpersonal effectiveness, distress tolerance and mindfulness and how these skills can best be utilised during the perinatal period. Prior observational research has shown that perinatal ESGs may help women with BPD. We set out to test the feasibility of conducting a randomised controlled trial to investigate the clinical effectiveness of perinatal ESGs. Methods A two-arm, parallel-group, feasibility randomised controlled trial of Perinatal ESGs in addition to Treatment as Usual (TAU) versus TAU for women aged over 18 years, who are likely to have a diagnosis of BPD and are either pregnant or are within 12 months of having a live birth. We will exclude women who have a co-existing organic, psychotic mental disorder or substance use dependence syndrome; those with cognitive or language difficulties that would preclude them from consenting or participating in study procedures; those judged to pose an acute risk to their baby and those requiring admission to a mother and baby unit. After consenting to participation and completing screening assessments, eligible individuals will be randomly allocated, on a 1:1 ratio, to either ESGs + TAU or to TAU. Randomisation will be stratified according to recruitment centre. Feasibility outcomes will be the proportion of participants: (1) consenting; (2) completing baseline measures and randomised; (3) completing the intervention and (4) completing follow-up assessments. All study participants will complete a battery of self-report measures at 2 and 4 months post-randomisation. A nested qualitative study will examine participants’ and therapists’ experiences of the trial and the intervention. Discussion Evidence is lacking about how to help women with BPD during the perinatal period. Perinatal ESGs are a promising intervention and if they prove to be an effective adjunct to usual care, a large population of vulnerable women and their children could experience substantial health gains. Trial registration ISRCTN80470632.
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Affiliation(s)
- Paul Moran
- Centre for Academic Mental Health, Population Health Sciences Department, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Debra Bick
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Lucy Biddle
- Population Health Sciences Department, Bristol Medical School, University of Bristol, Bristol, UK
| | - Belinda Borries
- Specialist Community Perinatal Mental Health Service, Avon & Wiltshire Mental Health Partnership NHS Trust, Bristol, UK
| | - Rebecca Kandiyali
- Centre for Health Economics, Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Janice Rigby
- Channi Kumar Mother and Baby Unit, Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, London, UK
| | - Penny Seume
- Centre for Academic Mental Health, Population Health Sciences Department, Bristol Medical School, University of Bristol, Bristol, UK
| | - Vaneeta Sadhnani
- Specialist Community Perinatal Mental Health Service, Avon & Wiltshire Mental Health Partnership NHS Trust, Bristol, UK
| | - Nadine Smith
- Patient and Public Involvement and Engagement Lead, London, UK
| | - Michaela Swales
- North Wales Clinical psychology Programme, Bangor University, Bath, UK
| | - Nicholas Turner
- Population Health Sciences Department, Bristol Medical School, University of Bristol, Bristol, UK
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Quevedo Y, Booij L, Herrera L, Hernández C, Jiménez JP. Potential epigenetic mechanisms in psychotherapy: a pilot study on DNA methylation and mentalization change in borderline personality disorder. Front Hum Neurosci 2022; 16:955005. [PMID: 36171872 PMCID: PMC9510615 DOI: 10.3389/fnhum.2022.955005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/18/2022] [Indexed: 11/21/2022] Open
Abstract
Genetic and early environmental factors are interwoven in the etiology of Borderline Personality Disorder (BPD). Epigenetic mechanisms offer the molecular machinery to adapt to environmental conditions. There are gaps in the knowledge about how epigenetic mechanisms are involved in the effects of early affective environment, development of BPD, and psychotherapy response. We reviewed the available evidence of the effects of psychotherapy on changes in DNA methylation and conducted a pilot study in a sample of 11 female adolescents diagnosed with BPD, exploring for changes in peripheral DNA methylation of FKBP5 gene, which encodes for a stress response protein, in relation to psychotherapy, on symptomatology and underlying psychological processes. For this purpose, measures of early trauma, borderline and depressive symptoms, psychotherapy outcome, mentalization, and emotional regulation were studied. A reduction in the average FKBP5 methylation levels was observed over time. Additionally, the decrease in FKBP5 methylation observed occurred only in those individuals who had early trauma and responded to psychotherapy. The results suggest an effect of psychotherapy on epigenetic mechanisms associated with the stress response. The finding that epigenetic changes were only observed in patients with early trauma suggests a specific molecular mechanism of recovery. The results should be taken with caution given the small sample size. Also, further research is needed to adjust for confounding factors and include endocrinological markers and therapeutic process variables.
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Affiliation(s)
- Yamil Quevedo
- Departamento de Psiquiatría y Salud Mental Oriente, Universidad de Chile, Santiago, Chile
- Millenium Institute for Depression and Personality Research, Santiago, Chile
| | - Linda Booij
- Department of Psychology, Concordia University, Montreal, QC, Canada
- Sainte-Justine Hospital Research Centre, Montreal, QC, Canada
| | - Luisa Herrera
- Programa de Genética Humana, Instituto de Ciencias Biomédicas, Universidad de Chile, Santiago, Chile
| | - Cristobal Hernández
- Millenium Institute for Depression and Personality Research, Santiago, Chile
- Escuela de Psicología, Universidad Adolfo Ibañez, Santiago, Chile
| | - Juan Pablo Jiménez
- Departamento de Psiquiatría y Salud Mental Oriente, Universidad de Chile, Santiago, Chile
- Millenium Institute for Depression and Personality Research, Santiago, Chile
- *Correspondence: Juan Pablo Jiménez
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Carmassi C, Conti L, Gravina D, Nardi B, Dell'Osso L. Emotional dysregulation as trans-nosographic psychopathological dimension in adulthood: A systematic review. Front Psychiatry 2022; 13:900277. [PMID: 36104987 PMCID: PMC9464828 DOI: 10.3389/fpsyt.2022.900277] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Emotional dysregulation (ED) is characterized by inappropriate emotional reactions related to environmental or cognitive stimuli. In most recent years, increasing interest has been devoted to its definition and detection across mental disorders for its detrimental role progressively highlighted in both neurodevelopment and adult mental disorders, with implications on the severity of clinical manifestations. The aim of this systematic review was to evaluate and gather the scientific evidence about ED in adult psychiatric population to elucidate the concept of ED as trans-nosographic entity. Methods The electronics databases PubMed, Scopus and Web of Science was reviewed to identify studies in accordance with the PRISMA guidelines; at the end of the selection process a total of 29 studies (N = 709; N = 658; N = 1,425) was included. All studies included assessed the presence of ED symptoms, by means of a validate scale in adult (>18 years of age), in clinically diagnosed patients as well as healthy control participants. Results Our results suggest ED as a trans-diagnostic factor across multiple mental disorders, such as bipolar disorder, attention deficit hyperactivity disorder, autism spectrum disorder, personality disorders; a better definition of this concept could be helpful to interpret and clarify many clinical cases and improve their diagnostic and therapeutic management.
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Affiliation(s)
| | - Lorenzo Conti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Neurocognitive functioning in adolescents with non-suicidal self-injury. J Affect Disord 2022; 311:55-62. [PMID: 35550828 DOI: 10.1016/j.jad.2022.05.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/30/2022] [Accepted: 05/05/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) is a highly prevalent transdiagnostic psychiatric symptom in adolescents. Research in adults has begun to investigate neurocognitive processes associated with NSSI as potential underlying phenotypes. However, research on neurocognitive function in adolescent patients with NSSI is scarce. METHODS In this study, we examined neurocognitive functioning in the domains of processing speed, attention, learning, working memory, and executive function in a relatively large sample of n = 240 adolescent patients engaging in NSSI and n = 49 healthy controls. Further, associations between neurocognitive performance and clinical characteristics in the patient group were examined. RESULTS While conventional regression analyses showed somewhat weaker neurocognition in the NSSI group in several domains, propensity score matching for IQ showed little evidence that patients engaging in NSSI showed worse neurocognition when general intelligence was considered. Further, a random forest machine learning algorithm was not able to classify NSSI vs. control groups based on neurocognitive features. Within the patient group, linear regression and latent class analyses yielded little evidence that neurocognitive performance was related with clinical characteristics or phenotypes. LIMITATIONS As the study did not include a clinical control group, findings might not be specific to NSSI. CONCLUSIONS Our findings challenge the importance of specific neurocognitive measures related to the presence or severity of NSSI in adolescents. Future studies should consider general intelligence as an important confounding factor and should focus on domains of affective cognition. Finally, longitudinal studies are needed to determine whether low neurocognitive performance serves to inform prognosis of NSSI or psychopathology in general.
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The role of sense of coherence and loneliness in borderline personality disorder traits: a longitudinal twin study. Borderline Personal Disord Emot Dysregul 2022; 9:19. [PMID: 35909116 PMCID: PMC9341038 DOI: 10.1186/s40479-022-00190-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/21/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Borderline personality disorder (BPD) implies having problems with identity and relations with other people. However, not much is known about whether these indications of BPD are present in adolescence, i.e., before personality disorders usually are diagnosed. In this study, we examined the prediction of an aspect of identity (i.e., sense of coherence [SOC]) and social relations (i.e., perceived loneliness) throughout adolescence on BPD traits in young adulthood. In addition, we examined to what degree the predictive ability could be attributed to genetic and environmental factors. We also examined whether life events in adolescence were related to BPD traits. METHODS Three thousand three hundred ninety-one twins, consisting of seven national birth cohorts from Norway, participated in the study. SOC, loneliness and life events were measured three times throughout adolescence with self-report questionnaires, with 2 years in between measurements. BPD traits were measured at the end of adolescence around the age of 19 with a structured interview. Regression analyses were performed to examine the prediction of SOC, loneliness and life events on BPD traits. Cholesky decomposition models were then used to determine to what degree the associations were due to genetic and environmental influences. RESULTS The prediction of SOC and loneliness on BPD traits increased from R = .25 (when measured 6 years prior to the assessment of BPD traits) to R = .45 (when measured shortly before the assessment of BPD traits). In addition, negative life events considered dependent on a person's behavior were related to BPD traits. Negative independent and positive dependent life events did not contribute to the prediction of BPD traits. Cholesky decomposition models showed that SOC and loneliness were associated with BPD traits mainly due to shared genetic influences (i.e., the proportion due to genetic influences ranged from 71 to 86%). Adding negative dependent life events to the prediction of BPD traits did not change these percentages. CONCLUSIONS These findings indicate that the weaker SOC, the stronger feelings of loneliness, and the negative life events associated with BPD traits are mainly consequences of the genetic aspects of BPD traits, rather than having direct effects on levels of BPD symptoms.
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van Trigt S, van der Zweerde T, van Someren E, van Straten A, van Marle H. Guided internet-based cognitive behavioral therapy for insomnia in patients with borderline personality disorder: Study protocol for a randomized controlled trial. Internet Interv 2022; 29:100563. [PMID: 35899204 PMCID: PMC9310106 DOI: 10.1016/j.invent.2022.100563] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/12/2022] [Accepted: 07/16/2022] [Indexed: 11/14/2022] Open
Abstract
Borderline personality disorder (BPD) is a highly disabling psychiatric disorder with emotion dysregulation at its core, resulting in affective instability, impulsivity and sometimes self-harming or suicidal behavior. Sleep is increasingly recognized to play a crucial role in emotion regulation. BPD patients often suffer from (severe) insomnia, potentially aggravating symptoms and preventing recovery from BPD. Yet, the effects of insomnia treatments have not been investigated in context of BPD. Guided internet-based cognitive behavioral therapy for insomnia (iCBT-I; i-Sleep) has been proven effective in improving both insomnia and affective symptoms. In this randomized controlled trial among 96 patients with a DSM-5 diagnosis of BPD (or other personality disorder with ≥4 BPD traits) and insomnia symptoms, we will test the effectiveness of iCBT-I before regular BPD treatment starts, during the waitlist period, on BPD symptoms. Patients in the control group monitor their sleep through a sleep diary during the waitlist period and also receive standard BPD treatment after that. Using linear mixed models we will test the hypothesis that the iCBT-I group improves more than the control group on BPD symptoms (primary outcome), insomnia severity, additional subjective and objective sleep variables, emotion regulation, comorbid anxiety and depression complaints, and quality of life. These effects are thought to arise from a direct effect of improved sleep on emotion regulation and a synergistic effect on the consolidation and internalization of the BPD treatment effect. To our knowledge, this is the first trial assessing effectiveness of CBT-I in patients with BPD (traits). The accessibility of the studied intervention greatly facilitates clinical implication in case of positive results.
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Affiliation(s)
- S. van Trigt
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, De Boelelaan 1117, Amsterdam, the Netherlands,Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands,Corresponding author at: Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, De Boelelaan 1117, Amsterdam, the Netherlands.
| | - T. van der Zweerde
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, De Boelelaan 1117, Amsterdam, the Netherlands,GGZ inGeest Mental Health Care, Amsterdam, the Netherlands
| | - E.J.W. van Someren
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, De Boelelaan 1117, Amsterdam, the Netherlands,Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, the Netherlands,Department of Sleep and Cognition, Netherlands Institute for Neuroscience, an Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands,Department of Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, Vrije Universiteit, Amsterdam, the Netherlands
| | - A. van Straten
- Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands,Vrije Universiteit Amsterdam, Clinical, Neuro and Developmental Psychology, Amsterdam, the Netherlands
| | - H.J.F. van Marle
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, De Boelelaan 1117, Amsterdam, the Netherlands,GGZ inGeest Mental Health Care, Amsterdam, the Netherlands,Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, the Netherlands
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67
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Risk-Taking Behavior among Suicide Attempters. J Clin Med 2022; 11:jcm11144177. [PMID: 35887941 PMCID: PMC9320022 DOI: 10.3390/jcm11144177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/15/2022] [Accepted: 07/16/2022] [Indexed: 01/10/2023] Open
Abstract
Background: Suicidal behavior is a major mental health concern both for the individual and for the public health. Among others, suicidal behavior is associated with impulsivity, risk taking, pain tolerance, and a state of overarousal. In the present study, we investigated if suicide attempters (SAs) reported higher scores for risk-taking when compared with healthy controls (HC) of the general population. Methods: A total of 616 individuals (mean age: 27.07 years; 51.5% females) took part in the study; of those, 240 (39%) were individuals with a suicide attempt (SA) within a time lapse of one to three months, and 376 (61%) were healthy controls (HC). Participants completed a series of self-rating questionnaires covering sociodemographic information, risk-taking (Risk-Taking Questionnaire 18; RT-18), and suicidal behavior (Suicide Behaviors Questionnaire-Revised; SBQ-R). Results: Compared with HCs, individuals with SA reported higher risk-taking and suicidal behavior scores. The risk-taking questionnaire yielded a four-factor solution: Thrill and sensation seeking; Cautious procedure; Cautious decision making; Impulsive behavior. Compared with HCs, SAs showed the highest scores for thrill and sensation seeking and impulsive behavior. Conclusions: Compared with healthy controls, individuals reporting a recent suicide attempt also reported a higher propensity to thrill and sensation seeking and impulsive behavior as a proxy of risk-taking behavior. The present results corroborate the notion that, among others, suicide attempts appeared to be less related to premeditation, but rather to impulsive and thus spontaneous behavior.
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Adverse Childhood Experiences and Neurocognition in Borderline Personality Disorder: A Call-to-Action Perspective Review. Harv Rev Psychiatry 2022; 30:248-260. [PMID: 35849742 DOI: 10.1097/hrp.0000000000000344] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Adverse childhood experiences (ACEs) contribute to the development of personality traits leading to adult borderline personality disorder (BPD). Neurocognitive changes could partly mediate the association between ACEs and BPD. We discuss how exposure to ACEs could induce alterations in neurocognition, which, in turn, would contribute to the development of BPD. We conducted a review of MEDLINE articles through 2021, documenting a link between ACEs, neurocognitive impairments, and BPD, and also focusing on the pairwise associations. ACEs appear to have a strong impact on neurocognition and are a predictive factor for BPD. Maltreated, abused, and emotionally invalidated children are more likely to present BPD traits. Neurocognitive impairments in adults exposed to ACEs and in patients with BPD arise from similar brain alterations in the amygdala, hippocampus, and prefrontal cortex. These impairments seem to be linked with clinical dimensions of BPD: increased impulsivity to altered inhibitory control; dissociative experiences to nonspecific autobiographical memory; and emotionally biased facial recognition to unstable interpersonal relationships. This perspective review highlights the contributory role of neurocognition in the association between ACEs and BPD. Additional research is needed, however, on the interconnections among ACEs, neurocognition, and BPD. Future studies could also focus on developing tools to assess early adversity in BPD specifically and on psychotherapeutic approaches to promptly remedy neurocognitive impairments.
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Woodbridge J, Townsend M, Reis S, Singh S, Grenyer BFS. Non-response to psychotherapy for borderline personality disorder: A systematic review. Aust N Z J Psychiatry 2022; 56:771-787. [PMID: 34525867 PMCID: PMC9218414 DOI: 10.1177/00048674211046893] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
HIGHLIGHT This is the first systematic review to investigate non-response to psychotherapy for borderline personality disorder. BACKGROUND Psychotherapy is the recommended treatment for borderline personality disorder. While systematic reviews have demonstrated the effectiveness of psychotherapy for borderline personality disorder, effect sizes remain small and influenced by bias. Furthermore, the proportion of people who do not respond to treatment is seldom reported or analysed. OBJECTIVE To obtain an informed estimate of the proportion of people who do not respond to psychotherapy for borderline personality disorder. METHODS Systematic searches of five databases, PubMed, Web of Science, Scopus, PsycINFO and the Cochrane Library, occurred in November 2020. Inclusion criteria: participants diagnosed with borderline personality disorder, treated with psychotherapy and data reporting either (a) the proportion of the sample that experienced 'reliable change' or (b) the percentage of sample that no longer met criteria for borderline personality disorder at conclusion of therapy. Exclusion criteria: studies published prior to 1980 or not in English. Of the 19,517 studies identified, 28 met inclusion criteria. RESULTS Twenty-eight studies were included in the review comprising a total of 2436 participants. Average treatment duration was 11 months using well-known evidence-based approaches. Approximately half did not respond to treatment; M = 48.80% (SD = 22.77). LIMITATIONS Data regarding within sample variability and non-response are seldom reported. Methods of reporting data on dosage and comorbidities were highly divergent which precluded the ability to conduct predictive analyses. Other limitations include lack of sensitivity analysis, and studies published in English only. CONCLUSION Results of this review suggest that a large proportion of people are not responding to psychotherapy for borderline personality disorder and that factors relating to non-response are both elusive and inconsistently reported. Novel, tailored or enhanced interventions are needed to improve outcomes for individuals not responding to current established treatments.
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Affiliation(s)
| | | | | | | | - Brin FS Grenyer
- Brin F Grenyer, Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Building 22, Wollongong, NSW 2522, Australia.
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The Use of Computer-Driven Technologies in the Treatment of Borderline Personality Disorder: A Systematic Review. J Clin Med 2022; 11:jcm11133685. [PMID: 35806970 PMCID: PMC9267789 DOI: 10.3390/jcm11133685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/20/2022] [Accepted: 06/24/2022] [Indexed: 02/01/2023] Open
Abstract
The objective of this study was to perform a systematic review of the effectiveness of computer-driven technologies for treatment of patients suffering from BPD. A systematic literature review was conducted using the Pubmed, EMBASE, PsycNET (PsycINFO), CINAHL and Google Scholar electronic databases for the period from their inception dates until 2022. Thirty studies were selected for abstract screening. Seven studies were excluded for not meeting inclusion criteria. The remaining 23 studies were fully assessed, and 12 were excluded. Therefore, 11 studies were included in the analysis of the effectiveness of computer-driven technologies, which encompassed mobile applications, telehealth interventions, internet-based interventions, virtual reality MBT and dialogue-based integrated interventions. Computer-driven interventions are showing signs of effectiveness in the treatment of BPD symptoms. The limited number of articles found on the subject demonstrates a need for further exploration of this subject.
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Pan N, Wang S, Qin K, Li L, Chen Y, Zhang X, Lai H, Suo X, Long Y, Yu Y, Ji S, Radua J, Sweeney JA, Gong Q. Common and Distinct Neural Patterns of Attention-Deficit/Hyperactivity Disorder and Borderline Personality Disorder: A Multimodal Functional and Structural Meta-analysis. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2022:S2451-9022(22)00147-1. [PMID: 35714858 DOI: 10.1016/j.bpsc.2022.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/02/2022] [Accepted: 06/03/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) and borderline personality disorder (BPD) have partially overlapping symptom profiles and are highly comorbid in adults. However, whether the behavioral similarities correspond to shared neurobiological substrates is not known. METHODS An overlapping meta-analysis of 58 ADHD and 66 BPD whole-brain articles incorporating observations from 3401 adult patients and 3238 healthy participants was performed by seed-based d mapping. Brain maps were subjected to meta-analytic connectivity modeling and data-driven functional decoding analyses to identify associated neural circuit alterations and relations to behavioral dimensions. RESULTS Both groups exhibited hypoactivated abnormalities in the left inferior parietal lobule, and altered clusters of the bilateral superior temporal gyrus were disjunctive in ADHD and BPD. No overlapping structural abnormalities were found. Multimodal alterations of ADHD were located in the right putamen and of BPD in the left orbitofrontal cortex. CONCLUSIONS The transdiagnostic neural bases of ADHD and BPD in temporoparietal circuitry may underlie overlapping problems of behavioral control, while disorder-specific substrates in frontostriatal circuitry may account for their distinguishing features in motor and emotion domains, respectively.
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Affiliation(s)
- Nanfang Pan
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Song Wang
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China.
| | - Kun Qin
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Lei Li
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Ying Chen
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Xun Zhang
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Han Lai
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Xueling Suo
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Yajing Long
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Yifan Yu
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Shiyu Ji
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Joaquim Radua
- Imaging of Mood- and Anxiety-Related Disorders Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain; Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - John A Sweeney
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China; Department of Psychiatry, University of Cincinnati, Cincinnati, Ohio
| | - Qiyong Gong
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China; Department of Radiology, West China Xiamen Hospital of Sichuan University, Xiamen, China.
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Koudys JW, Ruocco AC. Executive functioning in adults with borderline personality disorder and first-degree biological relatives. World J Biol Psychiatry 2022; 23:387-400. [PMID: 34913833 DOI: 10.1080/15622975.2021.2012396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Behavioural dysregulation is a heritable core symptom domain in borderline personality disorder (BPD) that is likely influenced by the integrity of executive functions (EFs). However, the extent to which familial risk for BPD confers decrement to EFs has yet to be comprehensively studied. METHODS In this family study, probands with BPD (n = 73), first-degree biological relatives (n = 65), and healthy controls without psychiatric diagnoses (n = 77) were assessed in abstraction, attentional vigilance, working memory, cognitive flexibility, interference resolution, planning, problem solving, and response inhibition. RESULTS In univariate analyses, probands demonstrated lower response inhibition than relatives. Comparatively, discriminant function analyses revealed that lower interference resolution and response inhibition jointly discriminated probands from relatives and controls, whereas a combination of less efficient problem solving and difficulty manipulating mental information discriminated probands and relatives from controls. Moreover, the subset of psychiatrically non-affected relatives demonstrated a pattern of resilience to psychiatric morbidity substantiated by stronger response inhibition and abstraction abilities despite less efficient problem solving. CONCLUSIONS Familial risk for BPD is represented predominantly by a pattern of problem-solving and working memory deficits. Resilience to a psychiatric disorder in non-affected relatives reflects both EF weaknesses and strengths, highlighting potential protective factors that should be considered in future neurocognitive research on BPD families.
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Affiliation(s)
- Jacob W Koudys
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, Canada
| | - Anthony C Ruocco
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, Canada.,Department of Psychology, University of Toronto Scarborough, Toronto, Canada
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Trouble de la personnalité borderline: état des connaissances et des représentations auprès de praticiens francophones en santé mentale. Encephale 2022:S0013-7006(22)00099-9. [DOI: 10.1016/j.encep.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 02/09/2022] [Accepted: 02/11/2022] [Indexed: 11/22/2022]
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74
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Calati R, Romano D, Lopez-Castroman J, Turolla F, Zimmermann J, Madeddu F, Courtet P, Preti E. BOrderliNe symptoms and suIcide-related outcomes: proTOcol for a systematic review/meta-analysis and an individual patient data meta-analysis (BONITO study). BMJ Open 2022; 12:e056492. [PMID: 35618328 PMCID: PMC9137335 DOI: 10.1136/bmjopen-2021-056492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Prevalence of suicidal thoughts and behaviours is higher among patients with borderline personality disorder than the general population. However, evidence concerning the role of specific borderline symptoms for predicting suicide-related outcomes is lacking and no systematic review/meta-analysis (SR/MA) investigated this topic. Our aim will be to investigate the relationship between any borderline symptom (except criterion 5) and suicide-related outcomes both through an SR/MA and an individual patient data meta-analysis (IPD-MA). METHODS We will search PubMed/MEDLINE, Scopus, Web of Science, Embase, PsycINFO, CINAHL and Cochrane Library databases from 1974 until September 2021. Both published and unpublished studies showing the association between any borderline symptom (except criterion 5) and suicide-related outcomes (death wish, suicidal ideation, suicidal plan, non-suicidal self-injury, deliberate self-harm, suicide attempt, suicidal behaviour disorder, suicide) will be included. Two team members will independently perform the selection of the studies and data extraction, with the supervision of two other members in case of discrepancies; and assess each study with study quality assessment tools by National Institutes of Health and Grading of Recommendations Assessment, Development and Evaluation. Each author will be contacted. If possible, we will perform both random-effect meta-analyses on the collected data (odds, risk, rate ratios or correlations) and an IPD-MA on collected databases. ETHICS AND DISSEMINATION This study does not require an ethical approval. Results will be publicly disseminated, included in research presentations and published in peer-review journals. PROSPERO REGISTRATION NUMBER CRD42018078696.
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Affiliation(s)
- Raffaella Calati
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
- Department of Adult Psychiatry, Nimes University Hospital, Nimes, France
| | - Daniele Romano
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
- Department of History, Society and Human Studies, University of Salento, Lecce, Italy
| | - Jorge Lopez-Castroman
- Department of Adult Psychiatry, Nimes University Hospital, Nimes, France
- France Institute of Functional Genomics, CNRS, INSERM, University of Montpellier, Montpellier, France
- CIBERSAM, Madrid, Spain
| | - Federica Turolla
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | | | - Fabio Madeddu
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Philippe Courtet
- France Institute of Functional Genomics, CNRS, INSERM, University of Montpellier, Montpellier, France
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, Montpellier, France
| | - Emanuele Preti
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
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Tyrer P, Tyrer H, Yang M. The influence of personality disorder in predicting suicidal behaviour in common mental disorders: A 30-year study. Personal Ment Health 2022; 16:111-119. [PMID: 35362264 PMCID: PMC9285912 DOI: 10.1002/pmh.1543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/31/2022] [Accepted: 03/15/2022] [Indexed: 12/29/2022]
Abstract
Two hundred ten patients with anxiety and depressive disorders were followed up over 30 years. Personality status was assessed at baseline using the Personality Assessment Schedule (PAS), an instrument that classifies personality disorder in a similar way to the new ICD-11 classification. Assessments of suicidal behaviour were made at 5, 12 and 30 years and suicidal thoughts at 12 and 30 years and analysed by personality status, clinical diagnosis and scores on the General Neurotic Syndrome Scale, a combined diagnosis of mixed anxiety depression and personality dysfunction. Suicide attempts were most frequent in the first 5 years of the study and reduced over time. Baseline personality status was the best predictor of suicide attempts at 5 years (no personality disorder 29.3%, personality disorder 51.6%, p = 0.006), and at 12 years (no personality disorder 11.9%, personality disorder 25.7%, p = 0.042), but no important differences were found at 30 years, when comorbid mental state disorder was the strongest predictor (p < 0.001). Similar but less marked findings were found for the general neurotic syndrome. It is concluded that the presence of personality disorder is a robust predictor of suicidal behaviour in the shorter term but in the long-term comorbid pathology is a better predictor.
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Affiliation(s)
- Peter Tyrer
- Division of Psychiatry, Imperial College, London, UK.,Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK
| | - Helen Tyrer
- Division of Psychiatry, Imperial College, London, UK
| | - Min Yang
- West China School of Public Health, Sichuan University, Chengdu, China.,Faculty of Health, Art and Design, Swinburne University of Technology, Melbourne, Australia
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Frontal EEG asymmetry moderates the relation between borderline personality disorder features and feelings of social rejection in adolescents. Dev Psychopathol 2022; 35:876-890. [PMID: 35440357 DOI: 10.1017/s0954579422000128] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Although associations among borderline personality disorder (BPD), social rejection, and frontal EEG alpha asymmetry scores (FAA, a neural correlate of emotion regulation and approach-withdrawal motivations) have been explored in different studies, relatively little work has examined these relations during adolescence in the same study. We examined whether FAA moderated the relation between BPD features and rejection sensitivity following a validated social exclusion paradigm, Cyberball. A mixed, clinical-community sample of 64 adolescents (females = 62.5%; Mage = 14.45 years; SD = 1.6; range = 11-17 years) completed psychodiagnostic interviews and a self-report measure of BPD (Time 1). Approximately two weeks later (Time 2), participants completed a resting EEG recording followed by Cyberball. FAA moderated the relation between BPD features and overall feelings of rejection following Cyberball: individuals with greater relative left FAA had the highest and lowest feelings of social rejection depending on whether they had high and low BPD feature scores, respectively. Results remained after controlling for age, sex, gender, depression, and BPD diagnosis. These results suggest that FAA may moderate the relation between BPD features and social rejection, and that left frontal brain activity at rest may be differentially associated with those feelings in BPD. Findings are discussed in terms of the link between left frontal brain activity in the regulation and dysregulation of social approach behaviors, characteristic of BPD.
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77
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Giurin MS, Trojniak MP, Arbo A, Carrozzi M, Abbracciavento G, Monasta L, Zanus C. Safety of Off-Label Pharmacological Treatment in Pediatric Neuropsychiatric Disorders: A Global Perspective From an Observational Study at an Italian Third Level Children’s Hospital. Front Pharmacol 2022; 13:837692. [PMID: 35496268 PMCID: PMC9039008 DOI: 10.3389/fphar.2022.837692] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background: The acquisition of proper and relevant pediatric clinical data is essential to ensure tolerable and effective pediatric drug therapies. In the field of pharmacological treatment of neuropsychiatric disorders, the lack of sufficient high quality scientific evidence for pediatric age results in the frequent need to prescribe off-label drugs. With the aim of improving knowledge about safety profile of off-label drug prescription in children and adolescent with neurological and/or psychiatric disorders, we realized a multidisciplinary pharmacovigilance study. Materials and methods: An observational retrospective study was conducted to assess the safety of off-label pharmacological therapies in patients aged 0–18 years, admitted to the Neuropsychiatry Unit of the Institute for Maternal and Child Health - IRCCS “Burlo Garofolo” between January 2016 and December 2018. Prescription patterns and adverse drug reactions were evaluated by a multidisciplinary team. Results: Overall, 230 patients were enrolled, 48% boys (N = 111), 52% girls (N = 119), average age of 10 years, and a total of 534 prescriptions was analyzed. 54.5% (N = 125) of patients had epilepsy, 37.5% (N = 86) suffered from psychiatric disorders, 8% (N = 19) had other neurological disorders. The prevalence of off-label prescriptions was 32% and 50% of the study population received at least one off-label drug. A total of 106 ADRs was detected: 57% of ADRs were due to drug-drug interactions, 30% were due to off-label prescriptions, 10% were due to overdose and 3% were due to improper use. No significant association between emerged ADRs and off label prescriptions was found (Fisher’s exact two-tailed test, p = 1.000). There was significant association between increasing number of administrated drugs and risk of ADRs (OR 1.99; IC95% 1.58–2.5; p = 0.000). Psychiatric disorders were associated with at least three times higher risk to be treated with an off-label drug (OR 3.30; IC95% 2.26–4.83; p = 0.000). Conclusions: This study shows that off-label prescribing in neuropsychiatric disorders does not pose a greater risk of ADRs than on-label prescribing and highlights unmet clinical needs in pediatric neuropsychopharmacology. The multidisciplinary approach can provide important contributions to improve therapeutic path of these already complex pathologies by careful monitoring of therapeutic appropriateness and drug interactions.
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Streit F, Witt SH, Awasthi S, Foo JC, Jungkunz M, Frank J, Colodro-Conde L, Hindley G, Smeland OB, Maslahati T, Schwarze CE, Dahmen N, Schott BH, Kleindienst N, Hartmann A, Giegling I, Zillich L, Sirignano L, Poisel E, Chen CH, Nöthen MM, Mobascher A, Rujescu D, Lieb K, Roepke S, Schmahl C, Bohus M, Ripke S, Rietschel M, Andreassen OA. Borderline personality disorder and the big five: molecular genetic analyses indicate shared genetic architecture with neuroticism and openness. Transl Psychiatry 2022; 12:153. [PMID: 35411043 PMCID: PMC9001677 DOI: 10.1038/s41398-022-01912-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/18/2022] [Accepted: 03/22/2022] [Indexed: 02/06/2023] Open
Abstract
Both environmental (e.g. interpersonal traumatization during childhood and adolescence) and genetic factors may contribute to the development of Borderline Personality Disorder (BPD). Twin studies assessing borderline personality symptoms/features in the general population indicate that genetic factors underlying these symptoms/features are shared in part with the personality traits of the Five Factor Model (FFM) of personality-the "Big Five". In the present study, the genetic overlap of BPD with the Big Five -Openness to Experience, Conscientiousness, Extraversion, Agreeableness, and Neuroticism- was assessed. Linkage disequilibrium score regression was used to calculate genetic correlations between a genome-wide association study (GWAS) in central European populations on BPD (N = 2543) and GWAS on the Big Five (N = 76,551-122,886, Neuroticism N = 390,278). Polygenic scores (PGS) were calculated to test the association of the genetic disposition for the personality traits with BPD case-control status. Significant positive genetic correlations of BPD were found with Neuroticism (rg = 0.34, p = 6.3*10-5) and Openness (rg = 0.24, p = 0.036), but not with the other personality traits (all | rg | <0.14, all p > 0.30). A cluster and item-level analysis showed positive genetic correlations of BPD with the Neuroticism clusters "Depressed Affect" and "Worry", and with a broad range of Neuroticism items (N = 348,219-376,352). PGS analyses confirmed the genetic correlations, and found an independent contribution of the personality traits to BPD risk. The observed associations indicate a partially shared genetic background of BPD and the personality traits Neuroticism and Openness. Larger GWAS of BPD and the "Big Five" are needed to further explore the role of personality traits in the etiology of BPD.
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Affiliation(s)
- Fabian Streit
- Central Institute of Mental Health, Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Stephanie H. Witt
- grid.7700.00000 0001 2190 4373Central Institute of Mental Health, Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany ,grid.7700.00000 0001 2190 4373Central Institute of Mental Health, Center for Innovative Psychiatry and Psychotherapy, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Swapnil Awasthi
- grid.6363.00000 0001 2218 4662Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Jerome C. Foo
- grid.7700.00000 0001 2190 4373Central Institute of Mental Health, Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Martin Jungkunz
- grid.7700.00000 0001 2190 4373Central Institute of Mental Health, Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany ,grid.7497.d0000 0004 0492 0584Section for Translational Medical Ethics, National Center for Tumor Diseases, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Josef Frank
- grid.7700.00000 0001 2190 4373Central Institute of Mental Health, Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Lucía Colodro-Conde
- grid.1049.c0000 0001 2294 1395QIMR Berghofer Medical Research Institute Brisbane, Brisbane, QLD Australia ,grid.1003.20000 0000 9320 7537School of Psychology, University of Queensland, Brisbane, QLD Australia ,grid.1024.70000000089150953School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD Australia
| | - Guy Hindley
- grid.55325.340000 0004 0389 8485NORMENT, Centre for Mental Disorders Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway ,grid.13097.3c0000 0001 2322 6764Psychosis Studies, Institute of Psychiatry, Psychology and Neurosciences, King’s College London, 16 De Crespigny Park, London, SE5 8AB United Kingdom
| | - Olav B. Smeland
- grid.55325.340000 0004 0389 8485NORMENT, Centre for Mental Disorders Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway ,grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Tolou Maslahati
- grid.7468.d0000 0001 2248 7639Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Campus Benjamin Franklin, Charité - Medical Faculty Berlin, Berlin, Germany
| | - Cornelia E. Schwarze
- grid.7700.00000 0001 2190 4373Department of Developmental and Biological Psychology, Heidelberg University, Heidelberg, Germany
| | - Norbert Dahmen
- grid.410607.4Department of Psychiatry and Psychotherapy, University Medical Center, Mainz, Germany
| | - Björn H. Schott
- grid.6363.00000 0001 2218 4662Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany ,grid.418723.b0000 0001 2109 6265Leibniz Institute for Neurobiology, Magdeburg, Germany ,grid.411984.10000 0001 0482 5331Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Nikolaus Kleindienst
- grid.7700.00000 0001 2190 4373Central Institute of Mental Health, Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Annette Hartmann
- grid.22937.3d0000 0000 9259 8492Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Ina Giegling
- grid.22937.3d0000 0000 9259 8492Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Lea Zillich
- grid.7700.00000 0001 2190 4373Central Institute of Mental Health, Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Lea Sirignano
- grid.7700.00000 0001 2190 4373Central Institute of Mental Health, Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Eric Poisel
- grid.7700.00000 0001 2190 4373Central Institute of Mental Health, Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Chi-Hua Chen
- grid.266100.30000 0001 2107 4242Department of Radiology, University of California, San Diego, CA USA
| | - Markus M. Nöthen
- grid.15090.3d0000 0000 8786 803XInstitute of Human Genetics, University Hospital Bonn, Bonn, Germany
| | - Arian Mobascher
- Department of Psychiatry and Psychotherapy, St. Elisabeth Krankenhaus Lahnstein, Lahnstein, Germany
| | - Dan Rujescu
- grid.22937.3d0000 0000 9259 8492Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Klaus Lieb
- grid.410607.4Department of Psychiatry and Psychotherapy, University Medical Center, Mainz, Germany
| | - Stefan Roepke
- grid.7468.d0000 0001 2248 7639Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Campus Benjamin Franklin, Charité - Medical Faculty Berlin, Berlin, Germany
| | - Christian Schmahl
- grid.7700.00000 0001 2190 4373Central Institute of Mental Health, Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Martin Bohus
- grid.7700.00000 0001 2190 4373Central Institute of Mental Health, Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany ,grid.5570.70000 0004 0490 981XDepartment of Clinical Psychology and Psychotherapy, Ruhr University Bochum, Bochum, Germany
| | - Stephan Ripke
- grid.6363.00000 0001 2218 4662Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany ,grid.66859.340000 0004 0546 1623Broad Institute of MIT and Harvard, Stanley Center for Psychiatric Research and Medical and Population Genetics Program, Cambridge, MA USA ,grid.38142.3c000000041936754XMassachusetts General Hospital and Department of Medicine, Harvard Medical School, Analytic and Translational Genetics Unit, Boston, MA USA
| | - Marcella Rietschel
- grid.7700.00000 0001 2190 4373Central Institute of Mental Health, Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Ole A. Andreassen
- grid.5510.10000 0004 1936 8921NORMENT Centre and KG Jebsen Centre for Neurodevelopmental disorders, Institute of Clinical Medicine, University of Oslo, Oslo, Norway ,grid.55325.340000 0004 0389 8485Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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The prevalence of borderline personality features and borderline personality disorder during the perinatal period: a systematic review and meta-analysis. Arch Womens Ment Health 2022; 25:277-289. [PMID: 35217928 DOI: 10.1007/s00737-022-01218-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/20/2022] [Indexed: 11/02/2022]
Abstract
Borderline personality disorder (BPD) is a psychiatric disorder marked by severe affective instability and poor interpersonal functioning. Existing literature has highlighted that individuals with BPD are at greater risk for a wide range of adverse physiological and psychosocial outcomes in the perinatal period compared to perinatal individuals without BPD. However, to date, no systematic review has addressed the prevalence of BPD and borderline personality features (BPF) in pregnant and postpartum individuals. A systematic review and meta-analysis was conducted by searching three databases (PubMed, PsycINFO, and Embase) on April 6th, 2021. Research articles and conference abstracts that evaluated BPF or BPD in pregnant, postpartum, or mixed perinatal populations were included. Sixteen publications were included in the systematic review (n = 14 research articles, n = 2 conference abstracts), seven of which were included in the meta-analysis. Among non-clinical samples, prevalence rates of BPF during pregnancy ranged from 6.9 to 26.7%, while rates of BPD across the perinatal period ranged from 0.7 to 1.7%. Among clinical samples, rates of BPF and BPD across the perinatal period spanned 9.7-34% and 2.0-35.2%, respectively. Results from the meta-analysis revealed that the pooled prevalence rate of BPD in clinical samples during the perinatal period is 14.0% (95% CI [7.0, 22.0]). Among clinical perinatal samples, there is a high prevalence of borderline personality pathology. This review highlights the need for appropriate validated screening methods to identify and treat BPD in the perinatal population.
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Chu J, Zheng K, Yi J. Aggression in borderline personality disorder: A systematic review of neuroimaging studies. Prog Neuropsychopharmacol Biol Psychiatry 2022; 113:110472. [PMID: 34742774 DOI: 10.1016/j.pnpbp.2021.110472] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 09/30/2021] [Accepted: 10/31/2021] [Indexed: 01/30/2023]
Abstract
Aggressive behaviors are prevalent among patients with Borderline Personality Disorder (BPD). Neuroimaging studies have linked aggression in BPD patients to neurochemical, structural, functional, and metabolic alterations in various brain regions, especially in frontal-limbic areas. This systematic review summarizes current neuroimaging results on aggression among BPD patients and provides an overview of relevant brain mechanisms. A systematic search of PubMed and Web of Science databases, in addition to manual check of references, identified thirty-two eligible articles, including two magnetic resonance spectrum (MRS), thirteen structural magnetic resonance imaging (sMRI), six functional magnetic resonance imaging (fMRI), and eleven positron emission tomography (PET) studies. The reviewed studies have highlighted the abnormalities in prefrontal cortices and limbic structures including amygdala and hippocampus. Less studies have zoomed in the roles of parietal and temporal regions or taken a network perspective. Connectivity studies have shed light on the importance of the frontal-limbic interactions in regulating aggression. Conflicted findings might be attributed to disparity in controlling gender, anatomical subdivisions, and comorbidities, which shall be considered in future studies.
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Affiliation(s)
- Jun Chu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Medical Psychological Institute, Central South University, Changsha, Hunan, China
| | - Kaili Zheng
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Medical Psychological Institute, Central South University, Changsha, Hunan, China
| | - Jinyao Yi
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Medical Psychological Institute, Central South University, Changsha, Hunan, China; National Clinical Research Center for Mental Disorders, Changsha 410011, China.
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81
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Folmo EJ, Langjord T, Myhrvold NCS, Stänicke E, Lind M, Kvarstein EH. Pedagogical stance in mentalization-based treatment. J Clin Psychol 2022; 78:1764-1784. [PMID: 35263445 PMCID: PMC9543465 DOI: 10.1002/jclp.23335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 01/04/2022] [Accepted: 02/12/2022] [Indexed: 11/17/2022]
Abstract
Background A common aspect of evidence‐based treatments for people with borderline personality disorder (BPD) is pedagogical interventions and formats. In mentalization‐based treatment (MBT) the introductory course has a clear pedagogical format, but a pedagogical stance is not otherwise defined. Methods Treatment integrity was quantitatively assessed in a sample of 346 individual MBT sessions. Nine group sessions and 24 individual MBT sessions were qualitatively subjected to interpretative phenomenological analysis (IPA). Results The dominating intervention type was MBT Item 16—therapist checking own understanding (31% of the interventions). IPA unveiled the following: (1) a pervasive, but hidden/implicit psychopedagogical agenda, (2) psychopedagogical content seemed precious for the patients, and (3) four tentative strategies for pedagogical interventions in MBT (a) independent reasoning; (b) epistemic trust; (c) mental flexibility; and (d) application of verified insights, knowledge, or strategies. Conclusion Development and clarification of the pedagogical stance in MBT could further improve the quality of therapists' interventions.
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Affiliation(s)
- Espen J Folmo
- Department for National and Regional Functions, Division of Mental Health & Addiction, Norwegian National Advisory Unit on Personality Psychiatry, Section for Personality Psychiatry & Specialized Treatments, Oslo University Hospital, Oslo, Norway
| | - Tuva Langjord
- Department for National and Regional Functions, Division of Mental Health & Addiction, Section for Personality Psychiatry & Specialized Treatments, Oslo University Hospital, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | | | - Erik Stänicke
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Majse Lind
- Department of Psychology, University of Florida, Gainesville, Florida, United States
| | - Elfrida H Kvarstein
- Department for National and Regional Functions, Division of Mental Health & Addiction, Section for Personality Psychiatry & Specialized Treatments, Oslo University Hospital, Oslo, Norway.,Adult Psychiatry Unit, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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82
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Hasty MK, Macneil CA, Cotton SM, Berk M, Kader L, Ratheesh A, Ramain J, Chanen AM, Conus P. Personality disorder among youth with first episode psychotic mania: An important target for specific treatment? Early Interv Psychiatry 2022; 16:256-263. [PMID: 33768702 DOI: 10.1111/eip.13150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/16/2021] [Accepted: 03/12/2021] [Indexed: 12/01/2022]
Abstract
AIM Personality disorder is a common co-occurrence ('comorbidity') among patients with bipolar disorder and appears to affect outcome negatively. However, there is little knowledge about the impact of this comorbidity in the early phases of bipolar disorder. We examined the prevalence and effect of personality disorder co-occurrence on outcome in a cohort of youth with first episode mania with psychotic features. METHODS Seventy-one first episode mania patients, aged 15-29, were assessed at baseline, 6, 12, and 18 months as part of a randomized controlled trial of olanzapine and chlorpromazine as add-on to lithium in first episode mania with psychotic features. The current study involved secondary analysis of trial data. RESULTS A co-occurring clinical personality disorder diagnosis was present in 16.9% of patients. Antisocial and narcissistic personality disorders were the most common diagnoses. Patients with co-occurring personality disorder had higher rates of readmission to hospital, lower rates of symptomatic recovery and poorer functional levels at 6 months, but these differences disappeared after 12 and 18 months. CONCLUSIONS In the early phase of bipolar disorder, patients with personality disorder comorbidity display delayed symptomatic and functional recovery and increased likelihood to need hospital readmissions. These observations suggest that routine assessment for personality disorder and specific interventions are important in order to improve short-term treatment efficacy in this subgroup.
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Affiliation(s)
| | | | - Sue M Cotton
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Berk
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Deakin University, IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia.,Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Aswin Ratheesh
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Julie Ramain
- Department of Psychiatry CHUV, Treatment and Early Intervention in Psychosis Program (TIPP), Service of General Psychiatry, Lausanne University, Lausanne, Switzerland
| | - Andrew M Chanen
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Philippe Conus
- Orygen, Melbourne, Victoria, Australia.,Department of Psychiatry CHUV, Treatment and Early Intervention in Psychosis Program (TIPP), Service of General Psychiatry, Lausanne University, Lausanne, Switzerland
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83
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Chang TH, Liu SI, Korslund K, Lin CJ, Lin Y, Huang HC, Chen SC, Chang YH, Sun FJ, Wu SI. Adapting dialectical behavior therapy in Mandarin-speaking Chinese patients with borderline personality disorder: An open pilot trial in Taiwan. Asia Pac Psychiatry 2022; 14:e12451. [PMID: 33686804 DOI: 10.1111/appy.12451] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 02/01/2021] [Accepted: 02/13/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Dialectical behavior therapy (DBT) is the most commonly used treatment for patients suffering from borderline personality disorder (BPD). However, data on its applications in Asian countries remain lacking. This pilot study aims to evaluate the feasibility and effectiveness of applying Mandarin-translated DBT among suicidal Chinese patients with BPD in Taiwan. METHODS An open-label trial design was implemented for the 1-year standard DBT model. Patients from a psychiatric outpatient department in a general hospital in Taiwan with a history of ≥2 episodes of suicidal behavior within the previous year and who scored >40 on the Borderline Symptom List were invited to participate in this trial. Outcomes of suicidal behaviors, severity of BPD and depression symptoms, suicidal ideation, hopelessness, and quality of life were assessed at the beginning of the treatment and every 3 months until 12 months. RESULTS Eighteen patients participated, three of whom (16.7%) dropped out. Significant improvements were found in the frequency and severity of suicidal behaviors and ideations, depressive symptoms, and BPD symptoms beginning as early as the third month after initiating DBT. DISCUSSION This pilot study found that DBT may be an effective and feasible intervention for Mandarin-speaking individuals with a recent history of suicidal behaviors with BPD. Future randomized controlled trials with comparison groups are needed to further determine the efficacy of DBT on this population.
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Affiliation(s)
- Ting-Hsin Chang
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan
| | - Shen-Ing Liu
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | | | - Chen-Ju Lin
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan
| | - Ying Lin
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan
| | - Hui-Chun Huang
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
| | - Shu-Chin Chen
- Suicide Prevention Center, Mackay Memorial Hospital, Taipei, Taiwan
| | - Yi-Hung Chang
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan
| | - Fang-Ju Sun
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
| | - Shu-I Wu
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
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84
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Bernheim D, Buchheim A, Domin M, Mentel R, Lotze M. Neural Correlates of Attachment Representation in Patients With Borderline Personality Disorder Using a Personalized Functional Magnet Resonance Imaging Task. Front Hum Neurosci 2022; 16:810417. [PMID: 35280201 PMCID: PMC8908102 DOI: 10.3389/fnhum.2022.810417] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 02/07/2022] [Indexed: 11/20/2022] Open
Abstract
Background Fear of abandonment and aloneness play a key role in the clinical understanding interpersonal and attachment-specific problems in patients with borderline personality disorder (BPD) and has been investigated in previous functional Magnet Resonance Imaging (fMRI) studies. The aim of the present study was to examine how different aspects of attachment representations are processed in BPD, by using for the first time an fMRI attachment paradigm including personalized core sentences from the participants’ own attachment stories. We hypothesized that BPD patients would show increased functional involvement of limbic brain regions associated with fear and pain (e.g., the amygdala and the anterior cingulate cortex) when presented personalized attachment relevant stimuli representing loneliness compared to healthy controls (HC). Methods We examined the attachment classifications of 26 female BPD patients and 26 female HC using the Adult Attachment Projective Picture System (AAP). We used an fMRI-adapted attachment paradigm to investigate the neural correlates of attachment. All participants were presented three personalized (vs. neutral) sentences extracted from their AAP attachment narrative, combined with standardized AAP pictures representing being alone (monadic) or in interactive (dyadic) attachment situations. Results As expected, the classification of unresolved attachment was significantly greater in BPD compared to HC. BPD patients showed increased fMRI-activation in brain areas associated with fear, pain, and hyperarousal than HC when presented with personalized attachment-relevant alone stimuli. In particular, pictures with monadic attachment situations induced greater anterior medial cingulate cortex, anterior insula, amygdala, thalamus and superior temporal gyrus activation in the patient group. Conclusion The results point to increased fMRI-activation in areas processing emotional distress and painful experiences in BPD patients. In particular, the emotional cascade reflecting attachment distress was evoked by combining monadic pictures, representing abandonment and aloneness, with the patients’ personalized narrative material. Our results confirmed and replicated previous results that illustrate once again the high relevance of aloneness and feelings of abandonment for BPD in the context of attachment trauma. Moreover, our results support the hypothesis of hypermentalization in response to attachment distress as a core feature of social-cognitive impairment in BPD associated with common treatment implications across different therapeutic orientations.
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Affiliation(s)
- Dorothee Bernheim
- Department of Psychiatry and Psychotherapy, University Hospital of Greifswald, Greifswald, Germany
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Ulm, Ulm, Germany
| | - Anna Buchheim
- Department of Psychology, University of Innsbruck, Innsbruck, Austria
- *Correspondence: Anna Buchheim,
| | - Martin Domin
- Functional Imaging Unit, Department of Diagnostic Radiology and Neuroradiology, University of Greifswald, Greifswald, Germany
| | - Renate Mentel
- Department of Psychiatry and Psychotherapy, University Hospital of Greifswald, Greifswald, Germany
| | - Martin Lotze
- Functional Imaging Unit, Department of Diagnostic Radiology and Neuroradiology, University of Greifswald, Greifswald, Germany
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85
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Cluster analysis of personality traits in psychiatric patients with borderline personality disorder. Borderline Personal Disord Emot Dysregul 2022; 9:7. [PMID: 35130981 PMCID: PMC8822819 DOI: 10.1186/s40479-022-00178-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 01/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Though the heterogeneous expression of symptoms of borderline personality disorder (BPD) is well-known, it is far from fully understood. Hybrid models combining dimensional and categorical ways of diagnosing BPD have been suggested to better handle this heterogeneity, but more research is needed. The aim of this study was to identify potential clusters in BPD, and evaluate if these clusters differed in diagnostic composition, severity, psychiatric symptoms, emotion regulation and control, or sociodemographic features. METHODS Clusters were based on personality traits measured with the Swedish universities Scales of Personality (SSP) in 141 psychiatric patients diagnosed with BPD. Hierarchical cluster analysis was performed using Ward's method. We used one-way analysis of variance to explore the different clusters' properties. Effect sizes were calculated using partial eta squared. RESULTS We found three distinct clusters: the lower psychopathology cluster (N = 67), the externalizing cluster (N = 28), and the internalizing cluster (N = 46). The clusters differed regarding trait composition, severity, and emotion regulation and control. CONCLUSIONS Our findings support hybrid models for diagnosing BPD by showing that clusters differed in terms of both severity (lower and higher psychopathology) and personality traits/style (internalizing and externalizing). Assessment of personality traits may be a feasible way to differentiate between clusters. In the future, this knowledge might be used to personalize treatment.
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86
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Wibbelink CJM, Arntz A, Grasman RPPP, Sinnaeve R, Boog M, Bremer OMC, Dek ECP, Alkan SG, James C, Koppeschaar AM, Kramer L, Ploegmakers M, Schaling A, Smits FI, Kamphuis JH. Towards optimal treatment selection for borderline personality disorder patients (BOOTS): a study protocol for a multicenter randomized clinical trial comparing schema therapy and dialectical behavior therapy. BMC Psychiatry 2022; 22:89. [PMID: 35123450 PMCID: PMC8817780 DOI: 10.1186/s12888-021-03670-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/21/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Specialized evidence-based treatments have been developed and evaluated for borderline personality disorder (BPD), including Dialectical Behavior Therapy (DBT) and Schema Therapy (ST). Individual differences in treatment response to both ST and DBT have been observed across studies, but the factors driving these differences are largely unknown. Understanding which treatment works best for whom and why remain central issues in psychotherapy research. The aim of the present study is to improve treatment response of DBT and ST for BPD patients by a) identifying patient characteristics that predict (differential) treatment response (i.e., treatment selection) and b) understanding how both treatments lead to change (i.e., mechanisms of change). Moreover, the clinical effectiveness and cost-effectiveness of DBT and ST will be evaluated. METHODS The BOOTS trial is a multicenter randomized clinical trial conducted in a routine clinical setting in several outpatient clinics in the Netherlands. We aim to recruit 200 participants, to be randomized to DBT or ST. Patients receive a combined program of individual and group sessions for a maximum duration of 25 months. Data are collected at baseline until three-year follow-up. Candidate predictors of (differential) treatment response have been selected based on the literature, a patient representative of the Borderline Foundation of the Netherlands, and semi-structured interviews among 18 expert clinicians. In addition, BPD-treatment-specific (ST: beliefs and schema modes; DBT: emotion regulation and skills use), BPD-treatment-generic (therapeutic environment characterized by genuineness, safety, and equality), and non-specific (attachment and therapeutic alliance) mechanisms of change are assessed. The primary outcome measure is change in BPD manifestations. Secondary outcome measures include functioning, additional self-reported symptoms, and well-being. DISCUSSION The current study contributes to the optimization of treatments for BPD patients by extending our knowledge on "Which treatment - DBT or ST - works the best for which BPD patient, and why?", which is likely to yield important benefits for both BPD patients (e.g., prevention of overtreatment and potential harm of treatments) and society (e.g., increased economic productivity of patients and efficient use of treatments). TRIAL REGISTRATION Netherlands Trial Register, NL7699 , registered 25/04/2019 - retrospectively registered.
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Affiliation(s)
- Carlijn J. M. Wibbelink
- grid.7177.60000000084992262Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, Amsterdam, 1018 WS the Netherlands
| | - Arnoud Arntz
- grid.7177.60000000084992262Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, Amsterdam, 1018 WS the Netherlands
| | - Raoul P. P. P. Grasman
- grid.7177.60000000084992262Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, Amsterdam, 1018 WS the Netherlands
| | - Roland Sinnaeve
- grid.5596.f0000 0001 0668 7884Department of Neurosciences, Mind Body Research, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Michiel Boog
- grid.491189.cDepartment of Addiction and Personality, Antes Mental Health Care, Max Euwelaan 1, Rotterdam, 3062 MA the Netherlands ,grid.6906.90000000092621349Institute of Psychology, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, 3000 DR the Netherlands
| | - Odile M. C. Bremer
- grid.491093.60000 0004 0378 2028Arkin Mental Health, NPI Institute for Personality Disorders, Domselaerstraat 128, Amsterdam, 1093 MB the Netherlands
| | - Eliane C. P. Dek
- grid.491389.ePsyQ Personality Disorders Rotterdam-Kralingen, Max Euwelaan 70, Rotterdam, 3062 MA the Netherlands
| | | | - Chrissy James
- grid.420193.d0000 0004 0546 0540Department of Personality Disorders, Outpatient Clinic De Nieuwe Valerius, GGZ inGeest, Amstelveenseweg 589, Amsterdam, 1082 JC the Netherlands
| | | | - Linda Kramer
- grid.491220.c0000 0004 1771 2151GGZ Noord-Holland-Noord, Stationsplein 138, 1703 WC Heerhugowaard, the Netherlands
| | - Maria Ploegmakers
- grid.491369.00000 0004 0466 1666Pro Persona, Siependaallaan 3, Tiel, 4003 LE the Netherlands
| | - Arita Schaling
- grid.491369.00000 0004 0466 1666Pro Persona, Willy Brandtlaan 20, Ede, 6716 RR the Netherlands
| | - Faye I. Smits
- grid.468622.c0000 0004 0501 8787GGZ Rivierduinen, Sandifortdreef 19, Leiden, 2333 ZZ the Netherlands
| | - Jan H. Kamphuis
- grid.7177.60000000084992262Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, Amsterdam, 1018 WS the Netherlands
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Zajenkowska A, Nowakowska I, Kaźmierczak I, Rajchert J, Bodecka-Zych M, Jakubowska A, Anderson JL, Sellbom M. The interplay between disinhibition and Present-Hedonistic time perspective in the relation between Borderline Personality Organization and depressive symptoms. PERSONALITY AND INDIVIDUAL DIFFERENCES 2022. [DOI: 10.1016/j.paid.2021.111317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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88
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Euler S, Pape E, Matthes O. [Borderline Personality Disorder in the Somatic Hospital Setting]. PRAXIS 2022; 110:76-84. [PMID: 35105215 DOI: 10.1024/1661-8157/a003807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Borderline Personality Disorder in the Somatic Hospital Setting Abstract. The Borderline Personality Disorder is a common mental illness characterized by emotional instability, interactional difficulties, an unstable sense of self and impulsive behaviour which is often self-destructive. Since these problems frequently occur in the doctor-patient relationship, patients might be regarded as "difficult" or even manipulative. This may lead to stigmatization and medical undertreatment when due to common mental and somatic comorbidities the condition requires thorough high-standard medical care. Whereas the core symptoms of BPD are well treatable by specific evidence-based psychotherapy, pharmacological interventions are less effective and should be restricted to crisis management. Through a better understanding of the disorder, proactive communication with all involved care providers and a collaborative doctor-patient relationship providing support and boundaries simultaneously the quality of medical care can be improved with long-lasting effects.
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Affiliation(s)
- Sebastian Euler
- Klinik für Konsiliarpsychiatrie und Psychosomatik, Universitätsspital Zürich
| | - Eva Pape
- Psychiatrische Universitätsklinik Zürich, Konsiliarpsychiatrie Spital Limmattal, Schlieren
| | - Oliver Matthes
- Klinik für Konsiliarpsychiatrie und Psychosomatik, Universitätsspital Zürich
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89
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Kahya Y, Munguldar K. Difficulties in Emotion Regulation Mediated the Relationship Between Reflective Functioning and Borderline Personality Symptoms Among Non-Clinical Adolescents. Psychol Rep 2022; 126:1201-1220. [PMID: 35048764 DOI: 10.1177/00332941211061072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The literature has established the associations between reflective functioning (RF), affect regulation, and the development of borderline personality disorder (BPD) symptoms. We aimed to examine the mediator role of difficulties in emotion regulation on the relationship between RF and BPD symptoms in a non-clinical adolescent sample. The sample was composed of 546 Turkish adolescents with a mean age of 16.18 (SD = 1.67). Of the sample, 62.5% were adolescent girls and 37.5% of boys. In the present cross-sectional research, volunteer adolescents along with parental permission filled out Socio-Demographics Form, Reflective Functioning Questionnaire, Difficulties in Emotion Regulation Scale, and Borderline Personality Inventory on paper during counseling sessions at schools. Process macro was used to conduct mediation analyses. Compromised RF was related to an increase in adolescent borderline personality symptoms, both directly and indirectly via difficulties in emotion regulation. In this non-clinical adolescent sample, a lower degree of certainty, as well as a higher degree of uncertainty about the mental states, were related to a propensity to emotion dysregulation, specifically experiencing emotions less clearly, approaching emotions impulsively, and facing emotions without a modulation strategy. These associations were in turn related to an increase in borderline personality symptoms. The present research results suggest RF and emotion regulation problems as one field of early intervention for adolescents with BPD symptoms.
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Affiliation(s)
- Yasemin Kahya
- Faculty of Social Sciences and Humanities, Department of Psychology, RinggoldID:390121Social Sciences University of Ankara, Ankara, Turkey
| | - Koret Munguldar
- Department of Clinical Psychology, The Center for Attachment Research, RinggoldID:5926The New School for Social Research, New York, NY, USA
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90
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Armour JA, Joussemet M, Mageau GA, Varin R. Perceived Parenting and Borderline Personality Features during Adolescence. Child Psychiatry Hum Dev 2022:10.1007/s10578-021-01295-3. [PMID: 35013846 DOI: 10.1007/s10578-021-01295-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2021] [Indexed: 11/27/2022]
Abstract
This study investigates the associations between perceived parenting and borderline personality disorder (BPD) in adolescents. The relations between components of parenting and BPD features were explored. Participants (N = 270; mean age = 15.3) assessed their own BPD features (Personality Assessment Inventory) and both of their parents' parenting practices (Parents as Social Context Questionnaire; Perceived Parental Autonomy Support Scale). SEM results suggest that controlling, rejecting and chaotic parenting all predicted global BPD, and all these parenting components were significantly associated with at least one BPD feature. Chaotic parenting, a relatively neglected construct in the BPD literature, seems to play an important role in early BPD.
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Affiliation(s)
- Jessie-Ann Armour
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Mireille Joussemet
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada.
| | - Geneviève A Mageau
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Rose Varin
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada
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91
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Antipsychotic Use in Pregnancy: Patient Mental Health Challenges, Teratogenicity, Pregnancy Complications, and Postnatal Risks. Neurol Int 2022; 14:62-74. [PMID: 35076595 PMCID: PMC8788503 DOI: 10.3390/neurolint14010005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/11/2021] [Accepted: 09/15/2021] [Indexed: 02/01/2023] Open
Abstract
Pregnant women constitute a vulnerable population, with 25.3% of pregnant women classified as suffering from a psychiatric disorder. Since childbearing age typically aligns with the onset of mental health disorders, it is of utmost importance to consider the effects that antipsychotic drugs have on pregnant women and their developing fetus. However, the induction of pharmacological treatment during pregnancy may pose significant risks to the developing fetus. Antipsychotics are typically introduced when the nonpharmacologic approaches fail to produce desired effects or when the risks outweigh the benefits from continuing without treatment or the risks from exposing the fetus to medication. Early studies of pregnant women with schizophrenia showed an increase in perinatal malformations and deaths among their newborns. Similar to schizophrenia, women with bipolar disorder have an increased risk of relapse in antepartum and postpartum periods. It is known that antipsychotic medications can readily cross the placenta, and exposure to antipsychotic medication during pregnancy is associated with potential teratogenicity. Potential risks associated with antipsychotic use in pregnant women include congenital abnormalities, preterm birth, and metabolic disturbance, which could potentially lead to abnormal fetal growth. The complex decision-making process for treating psychosis in pregnant women must evaluate the risks and benefits of antipsychotic drugs.
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92
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Yang F, Tong J, Zhang SF, Zhang J, Zhong BL. Prevalence and correlates of suicide attempts in Chinese individuals with borderline personality disorder. Front Psychiatry 2022; 13:942782. [PMID: 36104990 PMCID: PMC9464826 DOI: 10.3389/fpsyt.2022.942782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/11/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To date, few empirical studies have examined the clinical characteristics of suicide attempts (SA) in individuals with borderline personality disorder (BPD) in China. AIMS To examine the prevalence and factors associated with SA in Chinese individuals with BPD. METHODS In this cross-sectional study, 84 patients with BPD were recruited from a large public psychiatric hospital in Wuhan, China, between 2013 and 2015. Trained experienced psychiatrists interviewed participants to collect clinical data, including demographics, axis I and axis II diagnoses of mental disorders according to the DSM-IV-TR, number of hospitalizations, and history of SA. An interview outline was used to identify the existence of lifetime SA. In addition, the Beck Depression Inventory-II, Buss & Perry Aggression Questionnaire, Child Trauma Questionnaire-Short Form, and Beck Hopelessness Scale were administered to assess respondents' depressive symptoms, aggression, childhood traumatic experiences, and hopelessness. RESULTS Fifty-two (61.9%) patients reported attempting suicide during their lifetime. Univariate logistic regression analysis screened 7 factors associated with SA in individuals with BPD into Multiple logistic regression analysis: female sex, unemployment, major depressive disorder (MDD), hostility, self-aggression, depressive symptoms, and emotional neglect. Multiple logistic regression analysis identified 3 significant and independent correlates of SA: MDD [odds ratio (OR) = 26.773, 95% confidence interval (CI) = 3.914-183.132, P = 0.001], hostility (OR = 1.073, CI = 1.019-1.130, P = 0.007), and self-aggression (OR = 1.056, CI = 0.998-1.119, P = 0.060). CONCLUSION Chinese individuals with BPD have a high risk of suicide. Correlates of SA in this population differ to some extent from those in Western populations as reported in the literature. Paying attention to MDD and some types of aggression in Chinese individuals with BPD may help identify their risk of suicide. Future large-sample cohort study may improve the limitations of this study and further confirm the point of view above.
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Affiliation(s)
- Fan Yang
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China.,Department of Psychiatry, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Jun Tong
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China.,Department of Psychiatry, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Shu-Fang Zhang
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China.,Department of Psychiatry, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Juan Zhang
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China.,Department of Psychiatry, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Bao-Liang Zhong
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China.,Department of Psychiatry, Wuhan Hospital for Psychotherapy, Wuhan, China
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De Hert M, Loos S, Sterckx S, Thys E, Van Assche K. Improving control over euthanasia of persons with psychiatric illness: Lessons from the first Belgian criminal court case concerning euthanasia. Front Psychiatry 2022; 13:933748. [PMID: 35928783 PMCID: PMC9343580 DOI: 10.3389/fpsyt.2022.933748] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 06/30/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Belgium is one of very few countries that legally allow euthanasia for suffering caused by psychiatric illness. In the first criminal trial in Belgium of physicians involved in euthanasia, three physicians recently faced the accusation of "murder by poisoning," for allegedly having failed to comply with several requirements of the Belgian Euthanasia Law in granting the euthanasia request a woman suffering from psychiatric illness. Although all three physicians were acquitted, the case generated much debate among policy makers, medical professionals, and the general public. METHOD We use this trial as the starting point for a critical analysis of the adequacy of the three-level control system established in the Euthanasia Law, as it is applied in the evaluation of euthanasia requests from persons who suffer unbearably from a psychiatric illness. This analysis is based on information presented during the criminal trial as well as information on the euthanasia that was published in the press. RESULTS Our analysis highlights substantial problems in the assessment and granting of the euthanasia request. The patient was euthanized without it having been substantiated that her psychiatric illness had no prospect of improvement and that her suffering could not be alleviated. The three-step control system enshrined in the Law and promoted by the Federal Control and Evaluation Commission for Euthanasia appears to have failed at each level. CONCLUSION To evaluate requests for euthanasia for mental suffering caused by psychiatric illness, the requirements of the Belgian Euthanasia Law should be complemented by mandating the advice of two psychiatrists, and face-to-face discussions between all physicians involved. In parallel with the process of evaluating the euthanasia request, a treatment track should be guaranteed where reasonable evidence-based treatments and recovery-oriented options are tried.
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Affiliation(s)
- Marc De Hert
- University Psychiatric Centre, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Neurosciences, Centre for Clinical Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium.,Leuven Brain Institute, Katholieke Universiteit Leuven, Leuven, Belgium.,Antwerp Health Law and Ethics Chair, University of Antwerp, Antwerp, Belgium
| | - Sien Loos
- Research Group Personal Rights and Property Rights, Faculty of Law, University of Antwerp, Antwerp, Belgium.,Leuven Institute for Healthcare Policy, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Sigrid Sterckx
- Bioethics Institute Ghent, Department of Philosophy and Moral Sciences, Ghent University, Ghent, Belgium
| | - Erik Thys
- University Psychiatric Centre, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Neurosciences, Centre for Clinical Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Kristof Van Assche
- Antwerp Health Law and Ethics Chair, University of Antwerp, Antwerp, Belgium.,Research Group Personal Rights and Property Rights, Faculty of Law, University of Antwerp, Antwerp, Belgium
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94
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Auditory event-related electroencephalographic potentials in borderline personality disorder. J Affect Disord 2022; 296:454-464. [PMID: 34600969 DOI: 10.1016/j.jad.2021.09.096] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/31/2021] [Accepted: 09/26/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Borderline Personality Disorder (BPD) is characterized by mood dysregulation, impulsivity, identity disturbances, and a higher risk for suicide. Currently, the diagnosis is solely based on clinical observation of overt symptoms, and this can delay the detection of the disease and the timely start of appropriate treatment. Several candidate clinical tools have been studied to better characterize BPD, including event-related potentials (ERP). This review aimed at summarizing the results of the available ERP studies on BPD to clarify the possible application of this technique in the early diagnosis of BPD. METHODS A bibliographic search on PubMed and PsycInfo was performed in order to identify studies comprising individuals with BPD diagnosis and a control group that evaluated the ERP elicited by auditory stimuli. RESULTS Ten studies that explored various ERP components associated with auditory stimuli in BPD were included. Overall, the results showed that positive ERP (P50, P100, and P300) amplitude and latencies as well as loudness dependance were altered in BPD patients compared to controls, possibly reflecting deficits involving attention, mainly at its early stage, and executive functions. LIMITATIONS The reviewed studies used different ERP approaches and non-homogeneous BPD diagnostic criteria. CONCLUSIONS Auditory ERP appear to be a promising tool for the assessment of BPD patients, especially for early diagnosis and evaluation of cognitive symptoms.
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95
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Unremitting Suicidality in Borderline Personality Disorder: A Single Case Study and Discussion of Technology in Clinical Care. Harv Rev Psychiatry 2022; 30:350-360. [PMID: 36534837 PMCID: PMC9770128 DOI: 10.1097/hrp.0000000000000351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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96
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Sampedro F, Aracil-Bolaños I, Carmona I Farrés C, Soler J, Schmidt C, Elices M, Pomarol-Clotet E, Salvador R, Vega D, Pascual JC. A Functional Connectivity Study to Investigate the Role of the Right Anterior Insula in Modulating Emotional Dysfunction in Borderline Personality Disorder. Psychosom Med 2022; 84:64-73. [PMID: 34611112 DOI: 10.1097/psy.0000000000001019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Previous imaging studies in patients with borderline personality disorder (BPD) have detected functional brain dysfunctions. Mindfulness training may improve the symptoms of BPD, although the neural mechanisms involved remain poorly understood. This study had several key aims: a) to investigate the role of right anterior insula (rAI) functional connectivity in modulating baseline emotional status in BPD, b) to compare differences in connectivity changes after mindfulness training versus interpersonal effectiveness intervention, and c) to explore the correlation between longitudinal changes in imaging data and clinical indicators. METHODS Thirty-eight patients with BPD underwent resting-state functional magnetic resonance imaging. Participants completed self-report clinical scales and participated in a dialectical-behavioral therapy (mindfulness versus interpersonal effectiveness modules). Changes in clinical and imaging variables were evaluated longitudinally after completion of the first 10-week sessions of psychotherapeutic intervention. RESULTS At baseline, the rAI was strongly connected with the other salience network nodes and anticorrelated with most core nodes of the default mode network (p < .05, corrected). The functional connectivity of the rAI correlated with emotional dysregulation and deficits in mindfulness capacities (p < .05, corrected). After completion of psychotherapeutic intervention, both groups (mindfulness and interpersonal effectiveness) showed divergent posttherapy functional connectivity changes, which were in turn associated with the clinical response. CONCLUSIONS The functional connectivity of the rAI seems to play an important role in emotion dysregulation and deficits in mindfulness capacities in individuals with BPD. Psychotherapy seems to modulate this functional connectivity, leading to beneficial changes in clinical variables.
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Affiliation(s)
- Frederic Sampedro
- From the Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED) (Sampedro, Aracil-Bolaños); Movement Disorders Unit, Neurology Department (Aracil-Bolaños), Hospital de la Santa Creu I Sant Pau, IIB-Sant Pau, and Department of Psychiatry (Carmona i Farrés, Soler, Schmidt, Elices, Pascual), Hospital de la Santa Creu I Sant Pau, IIB-Sant Pau, Barcelona; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM (Carmona i Farrés, Soler, Elices, Pomarol-Clotet, Salvador, Pascual), Madrid; Institute Mar of Medical Research (IMIM) (Elices); Department of Psychiatry and Legal Medicine, Autonomous University of Barcelona, UAB (Soler, Vega, Pascual); FIDMAG Germanes Hospitalàries Research Foundation (Pomarol-Clotet, Salvador); and Servicio de Salud Mental, Hospital de Igualada (Vega), Consorci Sanitari de l'Anoia, Igualada, Barcelona, Spain
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97
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Cho GY, Waite EE, Ammerman BA, Dixon-Gordon KL. Testing the Influence of Brooding and Anger Rumination on the Association Between Suicidal Outcomes and BPD Features in Undergraduate Students. Arch Suicide Res 2022; 26:290-303. [PMID: 32329411 DOI: 10.1080/13811118.2020.1755920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Borderline personality disorder (BPD) symptoms and suicidal behaviors are prevalent among undergraduate students. Although rumination contributes to self-destructive behaviors in BPD, less research examines the role of rumination in distinct suicidal outcomes among individuals with BPD features instead focusing more on self-destructive behaviors as a latent variable. The present study examined the main and interactive effects of BPD features and two forms of rumination (brooding and anger) in the prediction of suicide-related outcomes (ideation and attempts) among college students. Participants (N = 181 undergraduate students, overrecruited for BPD features; 55.2% female) reported their lifetime suicide risk, brooding rumination, anger rumination, and BPD features. Brooding rumination and BPD features were associated with suicidal ideation. Anger rumination was not associated with suicide-related outcomes. Findings suggest that brooding rumination is a potential intervention target for suicidal ideation in undergraduate students whereas further research is required to determine the association between anger rumination and suicidal ideation and attempts.
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98
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Crawford MJ, Leeson VC, Evans R, Barrett B, McQuaid A, Cheshire J, Sanatinia R, Lamph G, Sen P, Anagnostakis K, Millard L, Qurashi I, Larkin F, Husain N, Moran P, Barnes TRE, Paton C, Hoare Z, Picchioni M, Gibbon S. The clinical effectiveness and cost effectiveness of clozapine for inpatients with severe borderline personality disorder (CALMED study): a randomised placebo-controlled trial. Ther Adv Psychopharmacol 2022; 12:20451253221090832. [PMID: 35510087 PMCID: PMC9058570 DOI: 10.1177/20451253221090832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/11/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Data from case series suggest that clozapine may benefit inpatients with borderline personality disorder (BPD), but randomised trials have not been conducted. METHODS Multicentre, double-blind, placebo-controlled trial. We aimed to recruit 222 inpatients with severe BPD aged 18 or over, who had failed to respond to other antipsychotic medications. We randomly allocated participants on a 1:1 ratio to receive up to 400 mg of clozapine per day or an inert placebo using a remote web-based randomisation service. The primary outcome was total score on the Zanarini Rating scale for Borderline Personality Disorder (ZAN-BPD) at 6 months. Secondary outcomes included self-harm, aggression, resource use and costs, side effects and adverse events. We used a modified intention to treat analysis (mITT) restricted to those who took one or more dose of trial medication, using a general linear model fitted at 6 months adjusted for baseline score, allocation group and site. RESULTS The study closed early due to poor recruitment and the impact of the COVID-19 pandemic. Of 29 study participants, 24 (83%) were followed up at 6 months, of whom 21 (72%) were included in the mITT analysis. At 6 months, 11 (73%) participants assigned to clozapine and 6 (43%) of those assigned to placebo were still taking trial medication. Adjusted difference in mean total ZAN-BPD score at 6 months was -3.86 (95% Confidence Intervals = -10.04 to 2.32). There were 14 serious adverse events; 6 in the clozapine arm and 8 in the placebo arm of the trial. There was little difference in the cost of care between groups. INTERPRETATION We recruited insufficient participants to test the primary hypothesis. The study findings highlight problems in conducting placebo-controlled trials of clozapine and in using clozapine for people with BPD, outside specialist inpatient mental health units. TRIAL REGISTRATION ISRCTN18352058. https://doi.org/10.1186/ISRCTN18352058.
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Affiliation(s)
- Mike J Crawford
- Division of Psychiatry, Imperial College London, The Commonwealth Building, The Hammersmith Hospital, Du Cane Road, London W12 0NN, UK
| | | | - Rachel Evans
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, UK
| | | | | | - Jack Cheshire
- Department of Forensic Psychiatry, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | | | - Gary Lamph
- School of Nursing, University of Central Lancashire, Preston, UK
| | - Piyal Sen
- Department of Forensic Psychiatry, Elysium Healthcare, Milton Keynes, UK
| | | | - Louise Millard
- St Andrew's Academic Centre, St Andrew's Healthcare, Northampton, UK
| | - Inti Qurashi
- Ashworth Hospital, Mersey Care NHS Foundation Trust, Liverpool, UK
| | - Fintan Larkin
- Acute Mental Health Services, West London NHS Trust, London, UK
| | - Nusrat Husain
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK
| | - Paul Moran
- Centre for Academic Mental Health, University of Bristol, Bristol, UK
| | | | - Carol Paton
- Division of Psychiatry, Imperial College London, London, UK
| | - Zoe Hoare
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, UK
| | - Marco Picchioni
- Department of Forensic and Neurodevelopmental Science, Kings College London, London, UK
| | - Simon Gibbon
- Department of Forensic Psychiatry, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
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99
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Bourvis N, Aouidad A, Spodenkiewicz M, Palestra G, Aigrain J, Baptista A, Benoliel JJ, Chetouani M, Cohen D. Adolescents with borderline personality disorder show a higher response to stress but a lack of self-perception: Evidence through affective computing. Prog Neuropsychopharmacol Biol Psychiatry 2021; 111:110095. [PMID: 32896602 DOI: 10.1016/j.pnpbp.2020.110095] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/18/2020] [Accepted: 08/30/2020] [Indexed: 10/23/2022]
Abstract
Stress reactivity is a complex phenomenon associated with multiple and multimodal expressions and functions. Herein, we hypothesized that compared with healthy controls (HCs), adolescents with borderline personality disorder (BPD) would exhibit a stronger response to stressors and a deficit in self-perception of stress due to their lack of insight. Twenty adolescents with BPD and 20 matched HCs performed a socially evaluated mental arithmetic test to induce stress. We assessed self- and heteroperception using both human ratings and affective computing-based methods for the automatic extraction of 39 behavioral features (2D + 3D video recording) and 62 physiological features (Nexus-10 recording). Predictions were made using machine learning. In addition, salivary cortisol was measured. Human ratings showed that adolescents with BPD experienced more stress than HCs. Human ratings and automated machine learning indicated opposite results regarding self- and heteroperceived stress in adolescents with BPD compared to HCs. Adolescents with BPD had higher levels of heteroperceived stress than self-perceived stress. Similarly, affective computing achieved better classification for heteroperceived stress. HCs had an opposite profile; they had higher levels of self-perceived stress, and affective computing reached a better classification for self-perceived stress. We conclude that adolescents with BPD are more sensitive to stress and show a lack of self-perception (or insight). In terms of clinical implications, our affective computing measures may help distinguish hetero- vs. self-perceptions of stress in natural settings and may offer external feedback during therapeutic interaction.
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Affiliation(s)
- Nadège Bourvis
- Pôle de Psychiatrie Infanto-Juvénile, Centre Hospitalier Intercommunal de Toulon - La Seyne-sur-Mer, France; Institut des Systèmes Intelligents et de Robotique, Sorbonne Université, CNRS UMR, Paris 7222, France
| | - Aveline Aouidad
- Institut des Systèmes Intelligents et de Robotique, Sorbonne Université, CNRS UMR, Paris 7222, France; Département de Psychiatrie de l'Enfant et de l'Adolescent, AP-HP. Sorbonne Université, GH Pitié-Salpêtrière, Paris, France; Inserm-CEA U1000, Imagerie en psychiatrie, Orsay, France
| | - Michel Spodenkiewicz
- Unité de Pédopsychiatrie de Liaison, Pôle de Santé Mentale, CHU Sud Réunion, Université de la Réunion, CEPOI EA 7388, Saint-Pierre, France
| | - Giuseppe Palestra
- Institut des Systèmes Intelligents et de Robotique, Sorbonne Université, CNRS UMR, Paris 7222, France
| | - Jonathan Aigrain
- Institut des Systèmes Intelligents et de Robotique, Sorbonne Université, CNRS UMR, Paris 7222, France
| | - Axel Baptista
- Pôle de Psychiatrie Infanto-Juvénile, Centre Hospitalier Intercommunal de Toulon - La Seyne-sur-Mer, France; Institut Jean Nicot, Ecole Normale Supérieure, Paris, France
| | - Jean-Jacques Benoliel
- Service de Biochimie Endocrinienne et Oncologique, AP-HP. Sorbonne Université, GH Pitié-Salpêtrière, et INSERM UMR_S1130 CNRS UMR8246, Pathophysiology of Psychiatric Disorders, Paris, France
| | - Mohamed Chetouani
- Institut des Systèmes Intelligents et de Robotique, Sorbonne Université, CNRS UMR, Paris 7222, France
| | - David Cohen
- Institut des Systèmes Intelligents et de Robotique, Sorbonne Université, CNRS UMR, Paris 7222, France; Inserm-CEA U1000, Imagerie en psychiatrie, Orsay, France.
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100
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Sigrist C, Reichl C, Schmidt SJ, Brunner R, Kaess M, Koenig J. Cardiac autonomic functioning and clinical outcome in adolescent borderline personality disorder over two years. Prog Neuropsychopharmacol Biol Psychiatry 2021; 111:110336. [PMID: 33915219 DOI: 10.1016/j.pnpbp.2021.110336] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/14/2021] [Accepted: 04/21/2021] [Indexed: 12/11/2022]
Abstract
The present study aimed to expand on previous findings that pre-treatment autonomic nervous system (ANS) functioning serves as a predictor of clinical outcome in adolescent borderline personality disorder (BPD), while examining whether the relationship between ANS functioning and treatment outcome may vary as a function of early life maltreatment (ELM). ANS stress response was examined considering changes in heart rate (HR) and vagally-mediated heart rate variability (vmHRV) over different conditions of the Montreal Imaging Stress Task (MIST) in a clinical sample of N = 27 adolescents across the spectrum of BPD severity. Participants received in- and/or outpatient treatment, while clinical data was assessed at routine follow-ups. Clinical outcome was defined by change in the number of fulfilled BPD criteria (as measured using the SCID-II), severity of psychopathology (CGI-S), and global level of functioning (GAF), measured 12 and 24 months after baseline assessments. Mixed-effects (random-intercept/random slope) linear regression models were calculated to examine markers of ANS function as potential predictors of clinical outcome. Irrespective of the presence of ELM exposure, both vmHRV resting-state and stress recovery measures were identified as significant predictors of clinical outcome over time. This study adds to the existing literature by replicating and expanding on preliminary findings, considering also physiological reactivity and recovery in addition to resting-state measures of ANS functioning. The present results further highlight the potential of markers of ANS functioning to serve as objective measures in the process of monitoring patient progress and to make predictions regarding treatment outcome in psychiatry research.
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Affiliation(s)
- Christine Sigrist
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Corinna Reichl
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Stefanie J Schmidt
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Romuald Brunner
- Clinic of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Julian Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Section for Experimental Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
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