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Heller AS, Fox AS, Davidson RJ. Parsing affective dynamics to identify risk for mood and anxiety disorders. ACTA ACUST UNITED AC 2018; 19:283-291. [PMID: 29863379 DOI: 10.1037/emo0000440] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Emotional dysregulation is thought to underlie risk for both anxiety and depressive disorders. However, despite high rates of comorbidity, anxiety and depression are phenotypically different. Apart from nosological differences (e.g., worry for anxiety, low mood for depression), it remains unclear how the emotional dysregulation inherent in individual differences in trait anxiety and depression severity present on a day-to-day basis. One approach that may facilitate addressing these questions is to utilize Ecological Momentary Assessment (EMA) using mobile phones to parse the temporal dynamics of affective experiences into specific parameters. An emerging literature in affective science suggests that risk for anxiety and depressive disorders may be associated with variation in the mean and instability/variability of emotion. Here we examine the extent to which distinct temporal dynamic parameters uniquely predict risk for anxiety versus depression. Over 10 days, 105 individuals rated their current positive and negative affective state several times each day. Using two distinct approaches to statistically assess mean and instability of positive and negative affect, we found that individual differences in trait anxiety was generally associated with increased instability of positive and negative affect whereas mean levels of positive and negative affect were generally associated with individual differences in depression. These data provide evidence that the emotional dysregulation underlying risk for mood versus anxiety disorders unfolds in distinct ways and highlights the utility in examining affective dynamics to understand psychopathology. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | - Andrew S Fox
- Department of Psychology and California National Primate Research Center, University of California, Davis
| | - Richard J Davidson
- Department of Psychology and Center for Healthy Minds, University of Wisconsin
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Schoenleber M. Ending the Competition to Better Understand Emotional Processes in Borderline Personality Pathology: Commentary on Gunderson et al. J Pers Disord 2018; 32:185-191. [PMID: 29561726 DOI: 10.1521/pedi.2018.32.2.185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In reviewing four prominent theories, Gunderson et al. (2018) incidentally highlight for the reader the need for new collaborative research efforts that draw together scholars representing these various theories o borderline personality pathology. Many avenues for such research exist that have the potential to improve o r overall understanding of the development, maintenance and possible treatment of borderline personality pathology in ways that research grounded in just one theory does not. Herein, the similarities and differences among these theories in their assumptions with regard to emotional baselines and sequences of emotion (i.e., primary and secondary emotional reactions) are discussed as one important direction for cross-theory research collaborations.
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Prospective crowdsensing versus retrospective ratings of tinnitus variability and tinnitus–stress associations based on the TrackYourTinnitus mobile platform. INTERNATIONAL JOURNAL OF DATA SCIENCE AND ANALYTICS 2018. [DOI: 10.1007/s41060-018-0111-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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54
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Koenig J, Weise S, Rinnewitz L, Parzer P, Resch F, Kaess M. Longitudinal covariance of resting-state cardiac function and borderline personality disorder symptoms in adolescent non-suicidal self-injury. World J Biol Psychiatry 2018; 19:152-157. [PMID: 28610467 DOI: 10.1080/15622975.2017.1342046] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Cardiac function is altered in borderline personality disorder (BPD). In adolescents with non-suicidal self-injury (NSSI) resting heart rate (HR) and vagally mediated heart rate variability (vmHRV) are associated with BPD symptoms. The study aimed to investigate longitudinal covariance of BPD symptoms and cardiac function in adolescent NSSI. METHODS HR and vmHRV were recorded in female adolescents with NSSI (n = 17) completing a baseline and 1-year follow-up assessment. Physiological data, structured clinical interviews and self-reports were obtained at both time points. Predictors of change in clinical outcomes and cardiac function were assessed. RESULTS Patients showed a reduction of NSSI (z(34;17) = -3.79, P < 0.0001), depressive symptoms (z(34;17) = -3.74, P < 0.0001), and increases in the level of functioning (z(34;17) = 2.87, P = 0.004). Symptoms of BPD and frequency of BPD diagnosis did not significantly change. No significant differences on HR or vmHRV were observed. Changes in BPD symptoms were associated with changes in HR (r(17)= 0.532, P = 0.028) and vmHRV (r(17) = -0.516, P = 0.033). CONCLUSIONS Longitudinal changes in BPD symptomatology in adolescents engaging in NSSI are associated with changes in resting cardiac function. Clinical studies are needed to investigate the utility of cardiac markers to track treatment outcome in adolescents with BPD.
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Affiliation(s)
- Julian Koenig
- a Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine , University of Heidelberg , Heidelberg , Germany
| | - Sindy Weise
- a Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine , University of Heidelberg , Heidelberg , Germany
| | - Lena Rinnewitz
- a Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine , University of Heidelberg , Heidelberg , Germany
| | - Peter Parzer
- b Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine , University of Heidelberg , Heidelberg , Germany
| | - Franz Resch
- b Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine , University of Heidelberg , Heidelberg , Germany
| | - Michael Kaess
- a Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine , University of Heidelberg , Heidelberg , Germany.,b Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine , University of Heidelberg , Heidelberg , Germany.,c University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern , Bern , Switzerland
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Wright AGC, Hallquist MN, Stepp SD, Scott LN, Beeney JE, Lazarus SA, Pilkonis PA. Modeling Heterogeneity in Momentary Interpersonal and Affective Dynamic Processes in Borderline Personality Disorder. Assessment 2018; 23:484-495. [PMID: 27317561 DOI: 10.1177/1073191116653829] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Borderline personality disorder (BPD) is a diagnosis defined by impairments in several dynamic processes (e.g., interpersonal relating, affect regulation, behavioral control). Theories of BPD emphasize that these impairments appear in specific contexts, and emerging results confirm this view. At the same time, BPD is a complex construct that encompasses individuals with heterogeneous pathology. These features-dynamic processes, situational specificity, and individual heterogeneity-pose significant assessment challenges. In the current study, we demonstrate assessment and analytic methods that capture both between-person differences and within-person changes over time. Twenty-five participants diagnosed with BPD completed event-contingent, ambulatory assessment protocols over 21 days. We used p-technique factor analyses to identify person-specific psychological structures consistent with clinical theories of personality. Five exemplar cases are selected and presented in detail to showcase the potential utility of these methods. The presented cases' factor structures reflect not only heterogeneity but also suggest points of convergence. The factors also demonstrated significant associations with important clinical targets (self-harm, interpersonal violence).
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Affiliation(s)
| | - Michael N Hallquist
- 2 University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA.,3 The Pennsylvania State University, University Park, PA, USA
| | | | - Lori N Scott
- 2 University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
| | - Joseph E Beeney
- 2 University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
| | - Sophie A Lazarus
- 2 University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
| | - Paul A Pilkonis
- 2 University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
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Abstract
In recent years, significant technological advances have changed our understanding of dynamic processes in clinical psychology. A particularly important agent of change has been ambulatory assessment (AA). AA is the assessment of individuals in their daily lives, combining the twin benefits of increased ecological validity and minimized retrospective biases. These benefits make AA particularly well-suited to the assessment of dynamic processes, and recent advancements in technology are providing exciting new opportunities to understand these processes in new ways. In the current article, we briefly detail the capabilities currently offered by smartphones and mobile physiological devices, as well as some of the practical and ethical challenges of incorporating these new technologies into AA research. We then provide several examples of recent innovative applications of AA methodology in clinical research, assessment, and intervention and provide a case example of AA data generated from a study utilizing multiple mobile devices. In this way, we aim to provide a sense of direction for researchers planning AA studies of their own.
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Trull TJ. Ambulatory Assessment of Borderline Personality Disorder. Psychopathology 2018; 51:137-140. [PMID: 29471296 DOI: 10.1159/000486604] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/26/2017] [Indexed: 11/19/2022]
Abstract
Ambulatory assessment (AA) is an important tool that promises to minimize retrospective biases while gathering ecologically valid data, including self-reports, physiological or biological data, and observed behavior, for example, from daily life experiences. AA is well suited for studying borderline personality disorder (BPD) because it can measure moods and emotion (as well as dynamic mood processes, mood changes, and mood instability), problematic behaviors (including interpersonal conflicts, addictive behaviors, binge and purge episodes, and motoric activity), and problematic cognitions/expectancies/urges (e.g., rejection sensitivity, cravings, and self-harm urges) as they occur in daily life. In this article, I review existing AA research on BPD, and I discuss future applications of AA as well as limitations and considerations for future use.
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Scala JW, Levy KN, Johnson BN, Kivity Y, Ellison WD, Pincus AL, Wilson SJ, Newman MG. The Role of Negative Affect and Self-Concept Clarity in Predicting Self-Injurious Urges in Borderline Personality Disorder Using Ecological Momentary Assessment. J Pers Disord 2018; 32:36-57. [PMID: 29388895 DOI: 10.1521/pedi.2018.32.supp.36] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Deficits in identity as well as negative affect have been shown to predict self-injurious and suicidal behaviors in individuals with borderline personality disorder (BPD). However, less is known about the interactive effects of these two predictors. We examined the moderating effect of a particular component of identity, self-concept, on the relationship between negative affect and self-injurious urges utilizing ecological momentary assessments. Outpatients diagnosed with either BPD (n = 36) or any anxiety disorder but no BPD (n = 18) completed surveys throughout the day over a 21-day period. Higher levels of momentary negative affect predicted greater subsequent urges to self-injure, but only when self-concept clarity was low (z = -3.60, p < .01). This effect did not differ between diagnostic groups. The results suggest that self-concept clarity has a protective effect against self-injurious urges in light of high negative affect, and that this effect may be transdiagnostic.
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Affiliation(s)
- J Wesley Scala
- Department of Psychology, Pennsylvania State University, University Park, Pennsylvania
| | - Kenneth N Levy
- Department of Psychology, Pennsylvania State University, University Park, Pennsylvania
| | - Benjamin N Johnson
- Department of Psychology, Pennsylvania State University, University Park, Pennsylvania
| | - Yogev Kivity
- Department of Psychology, Pennsylvania State University, University Park, Pennsylvania
| | | | - Aaron L Pincus
- Department of Psychology, Pennsylvania State University, University Park, Pennsylvania
| | - Stephen J Wilson
- Department of Psychology, Pennsylvania State University, University Park, Pennsylvania
| | - Michelle G Newman
- Department of Psychology, Pennsylvania State University, University Park, Pennsylvania
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Moukhtarian TR, Mintah RS, Moran P, Asherson P. Emotion dysregulation in attention-deficit/hyperactivity disorder and borderline personality disorder. Borderline Personal Disord Emot Dysregul 2018; 5:9. [PMID: 29796281 PMCID: PMC5960499 DOI: 10.1186/s40479-018-0086-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 04/12/2018] [Indexed: 01/28/2023] Open
Abstract
There is ongoing debate on the overlap between Attention-Deficit/Hyperactivity Disorder (ADHD) and Borderline Personality Disorder (BPD), particularly regarding emotion dysregulation (ED). In this paper, we present a narrative review of the available evidence on the association of these two disorders from several standpoints. First, we discuss the unique and shared diagnostic criteria for ADHD and BPD, focusing particularly on ED. We consider the methodology of ecological momentary assessment and discuss why this approach could be an alternative and more accurate way to qualitatively distinguish between ADHD and BPD. We summarise key findings on the genetic and environmental risk factors for ADHD and BPD and the extent to which there are shared or unique aetiological and neurobiological risk factors. Finally, we discuss the clinical relevance of considering both disorders in the assessment of patients presenting with trait-like behavioural syndromes, distinguishing the two conditions and implications for treatment.
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Affiliation(s)
- Talar R Moukhtarian
- 1King's College London, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF UK
| | - Ruth S Mintah
- 1King's College London, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF UK
| | - Paul Moran
- 2Centre for Academic Mental Health, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN UK
| | - Philip Asherson
- 1King's College London, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF UK
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Schoenleber M, Berghoff CR, Tull MT, DiLillo D, Messman-Moore T, Gratz KL. Emotional lability and affective synchrony in borderline personality disorder. Personal Disord 2017; 7:211-20. [PMID: 27362623 DOI: 10.1037/per0000145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Extant research on emotional lability in borderline personality disorder (BPD) has focused almost exclusively on lability of individual emotions or emotion types, with limited research considering how different types of emotions shift together over time. Thus, this study examined the temporal dynamics of emotion in BPD at the level of both individual emotions (i.e., self-conscious emotions [SCE], anger, and anxiety) and mixed emotions (i.e., synchrony between emotions). One hundred forty-four women from the community completed a diagnostic interview and laboratory study involving 5 emotion induction tasks (each of which was preceded and followed by a 5-min resting period or neutral task). State ratings of SCE, anger, and anxiety were provided at 14 time points (before and after each laboratory task and resting period). Hierarchical linear modeling results indicate that women with BPD reported greater mean levels of SCE and Anxiety (but not Anger), and greater lability of Anxiety. Women with BPD also exhibited greater variability in lability of all 3 emotions (suggestive of within-group differences in the relevance of lability to BPD). Results also revealed synchrony (i.e., positive relations) between each possible pair of emotions, regardless of BPD status. Follow-up regression analyses suggest the importance of accounting for lability when examining the role of synchrony in BPD, as the relation of SCE-Anger synchrony to BPD symptom severity was moderated by Anger and SCE lability. Specifically, synchronous changes in SCE and Anger were associated with greater BPD symptom severity when large shifts in SCE were paired with minor shifts in Anger. (PsycINFO Database Record
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Affiliation(s)
- Michelle Schoenleber
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center
| | | | - Matthew T Tull
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center
| | - David DiLillo
- Department of Psychology, University of Nebraska-Lincoln
| | | | - Kim L Gratz
- Department of Psychiatry and Human Behavior, University of Mississippi Medical
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Greiff S, Scherer R, Kirschner PA. Some critical reflections on the special issue: Current innovations in computer-based assessments. COMPUTERS IN HUMAN BEHAVIOR 2017. [DOI: 10.1016/j.chb.2017.08.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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62
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Prada P, Zamberg I, Bouillault G, Jimenez N, Zimmermann J, Hasler R, Aubry JM, Nicastro R, Perroud N. EMOTEO: A Smartphone Application for Monitoring and Reducing Aversive Tension in Borderline Personality Disorder Patients, a Pilot Study. Perspect Psychiatr Care 2017; 53:289-298. [PMID: 27439663 DOI: 10.1111/ppc.12178] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 06/16/2016] [Accepted: 06/17/2016] [Indexed: 11/27/2022] Open
Abstract
PURPOSE We developed a smartphone application (App; EMOTEO: emotion-meteo [weather forecast]) to help borderline personality disorder (BPD) patients to monitor and regulate their inner tension. The App proposes targeted mindfulness-based exercises. DESIGN AND METHODS We assessed the usability and efficiency of this App for monitoring and reduction of aversive tension in 16 BPD participants over a 6-month period. FINDINGS We recorded a mean of 318.1 sessions (SD = 166.7) per participants, with a high level of satisfaction. There was a significant decrease in aversive tension (p < .05) and the App was mainly used around 10 a.m. and 9 p.m. PRACTICE IMPLICATIONS EMOTEO was user-friendly and efficient in reducing aversive tension in BPD patients.
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Affiliation(s)
- Paco Prada
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Ido Zamberg
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Gérald Bouillault
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Naya Jimenez
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Julien Zimmermann
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Roland Hasler
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Jean-Michel Aubry
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Rosetta Nicastro
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Nader Perroud
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
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Abstract
OBJECTIVE The present paper elaborates a process perspective of change in psychotherapy for personality disorders (PDs). Firstly, the paper reviews the literature of mechanisms of change in treatments of PD, with the main focus on emotional processing and socio-cognitive processing. Secondly, it proposes an illustrative case-series analysis of eight cases, drawn from a mediation analysis conducted within the context of a randomized controlled trial for borderline personality disorder (BPD). METHOD As such, cases with good and poor outcomes are compared, as are cases with poor and good intake features and cases with poor and good process markers across treatment. RESULTS The results illustrate possible pathways to healthy change over the course of four months of treatment, and possible pathways of the absence of change. CONCLUSIONS These results are discussed with regard to three main research perspectives: the combination of qualitative and quantitative methodology in psychotherapy research may be applied to case study research, a neurobehavioral perspective on change may incorporate the individualized experience in the laboratory and therapist responsiveness to patient characteristics may be a core feature of fostering change. Clinical or methodological significance of this article: The present paper illustrates individual pathways to change in personality disorders. It illustrates how coping capacities influence the process of psychotherapy and outcome in personality disorders. It demonstrates the relevance of individualizing treatments for personality disorders. It demonstrates several integrative features of psychotherapy research, in particular the use of neurobehavioral paradigms and the integration of single-case research within randomized controlled trials.
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Affiliation(s)
- Ueli Kramer
- a Department of Psychiatry , Institute of Psychotherapy and General Psychiatry, University of Lausanne , Lausanne , Switzerland.,b Department of Psychology , University of Windsor , Windsor , Canada
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Balsis S, Loehle-Conger E, Busch AJ, Ungredda T, Oltmanns TF. Self and informant report across the borderline personality disorder spectrum. Personal Disord 2017; 9:429-436. [PMID: 28857585 DOI: 10.1037/per0000259] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Individuals with borderline personality disorder (BPD) features may be unaware of or unwilling to report their own personality or maladaptive behaviors, which complicates the assessment of BPD. Informants who know the individuals with BPD features may be uniquely suited to aid in the personality assessment of these individuals. The present study analyzed the comparative ability of individuals (targets) and informants to report BPD features across the continuum of BPD severity. The sample consisted of 1387 targets, ages 55 to 65 (56% women), who were recruited for an epidemiological longitudinal study examining the effects of PDs on health and social functioning. Each target nominated an informant who provided information about the target's personality. Results indicated relatively low levels of agreement between perspectives and that informants reported BPD symptoms with more precision and at lower levels of BPD severity than targets. The benefits of including an informant perspective when measuring the BPD continuum are discussed; these benefits may include gains in reliability and improvement in the prediction of outcomes. (PsycINFO Database Record
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Gauthier Mongeon F, Gagnon J. Negativity bias and instability in spontaneous and deliberate evaluations of others: The role of borderline personality features. Behav Res Ther 2017; 97:105-114. [PMID: 28753448 DOI: 10.1016/j.brat.2017.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 07/12/2017] [Accepted: 07/17/2017] [Indexed: 11/19/2022]
Abstract
This study tested the hypotheses that borderline personality (BP) features are characterized by a negativity bias and instability in spontaneous and deliberate evaluations of others. Undergraduate women (N = 204) watched two movie clips depicting either positive or negative conjugal interactions. Spontaneous and deliberate evaluations of the male character were assessed after each clip with an Evaluative Priming Task and a self-report measure, respectively. Participants with high BP features showed unstable spontaneous evaluations. Results revealed a non-significant trend toward more negative spontaneous evaluations after the negative clip and less positive and more negative deliberate evaluations after watching the positive clip first relative to participants with low BP features. These results provide preliminary evidence that impression formation in borderline personality may be characterized by negative and unstable evaluations that are shaped at least in part at earlier processing stages.
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Affiliation(s)
- Félix Gauthier Mongeon
- Department of Psychology, Université de Montréal, 90 Avenue Vincent-D'Indy, Montreal, QC H2V 2S9, Canada.
| | - Jean Gagnon
- Department of Psychology, Université de Montréal, 90 Avenue Vincent-D'Indy, Montreal, QC H2V 2S9, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montréal, Canada; Centre de recherche en neuropsychologie et cognition (CERNEC), Montréal, Canada.
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Borderline personality features, interpersonal correlates, and blood pressure response to social stressors: Implications for cardiovascular risk. PERSONALITY AND INDIVIDUAL DIFFERENCES 2017; 113:38-47. [DOI: 10.1016/j.paid.2017.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Barrigón ML, Berrouiguet S, Carballo JJ, Bonal-Giménez C, Fernández-Navarro P, Pfang B, Delgado-Gómez D, Courtet P, Aroca F, Lopez-Castroman J, Artés-Rodríguez A, Baca-García E. User profiles of an electronic mental health tool for ecological momentary assessment: MEmind. Int J Methods Psychiatr Res 2017; 26:e1554. [PMID: 28276176 PMCID: PMC6877232 DOI: 10.1002/mpr.1554] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 10/19/2016] [Accepted: 12/03/2016] [Indexed: 11/10/2022] Open
Abstract
Ecological momentary assessment (EMA) is gaining importance in psychiatry. This article assesses the characteristics of patients who used a new electronic EMA tool: the MEmind Wellness Tracker. Over one year, 13811 adult outpatients in our Psychiatry Department were asked to use MEmind. We collected information about socio-demographic data, psychiatric diagnoses, illness severity, stressful life events and suicidal thoughts/behavior. We compared active users (N = 2838) and non-active users (N = 10,973) of MEmind and performed a Random Forest analysis to assess which variables could predict its use. Univariate analyses revealed that MEmind-users were younger (42.2 ± 13.5 years versus 48.5 ± 16.3 years; χ2 = 18.85; P < 0.001) and more frequently diagnosed with anxiety related disorders (57.9% versus 46.7%; χ2 = 105.92; P = 0.000) than non-active users. They were more likely to report thoughts about death and suicide (up to 24% of active users expressed wish for death) and had experienced more stressful life events than non-active users (57% versus 48.5%; χ2 = 64.65; P < 0.001). In the Random Forest analysis, 31 variables showed mean decrease accuracy values higher than zero with a 95% confidence interval (CI), including sex, age, suicidal thoughts, life threatening events and several diagnoses. In the light of these results, strategies to improve EMA and e-Mental Health adherence are discussed.
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Affiliation(s)
- María Luisa Barrigón
- Department of Psychiatry, IIS-Jimenez Diaz Foundation, Madrid, Spain.,Autonoma University, Madrid, Spain
| | - Sofian Berrouiguet
- Department of Psychiatry, IIS-Jimenez Diaz Foundation, Madrid, Spain.,Department of Psychiatry, Brest Medical University Hospital at Brest, IMT atlantique UMR CNRS 6285 Lab-STICC, Institut Mines-Telecom, ERCR SPURBO, Université de Bretagne occidentale, France
| | - Juan José Carballo
- Department of Psychiatry, IIS-Jimenez Diaz Foundation, Madrid, Spain.,Autonoma University, Madrid, Spain.,Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Pablo Fernández-Navarro
- Cancer and Environmental Epidemiology Unit, National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Madrid, Spain
| | - Bernadette Pfang
- Department of Internal Medicine, IIS-Jimenez Diaz Foundation, Madrid, Spain
| | | | - Philippe Courtet
- Département d'Urgences & Post-Urgences Psychiatriques, CHU Montpellier, Université Montpellier, France
| | - Fuensanta Aroca
- Instituto de Matemáticas, Universidad Nacional Autónoma de México, México City, Mexico
| | | | - Antonio Artés-Rodríguez
- Department of Signal Theory and Communications, Universidad Carlos III, Madrid, Spain.,Gregorio Marañón Health Research Institute, Madrid, Spain.,CIBERSAM (Centro de Investigación en Salud Mental), Carlos III Institute of Health, Madrid, Spain
| | - Enrique Baca-García
- Department of Psychiatry, IIS-Jimenez Diaz Foundation, Madrid, Spain.,Autonoma University, Madrid, Spain.,CIBERSAM (Centro de Investigación en Salud Mental), Carlos III Institute of Health, Madrid, Spain.,Department of Psychiatry, University Hospital Rey Juan Carlos, Móstoles, Spain.,Department of Psychiatry, General Hospital of Villalba, Madrid, Spain.,Department of Psychiatry, University Hospital Infanta Elena, Valdemoro, Spain
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- Department of Psychiatry, IIS-Jimenez Diaz Foundation, Madrid, Spain.,Department of Psychiatry, University Hospital Rey Juan Carlos, Móstoles, Spain.,Department of Psychiatry, General Hospital of Villalba, Madrid, Spain.,Department of Psychiatry, University Hospital Infanta Elena, Valdemoro, Spain.,AGC Salud Mental, Área Sanitaria 3, Avilés, Asturias, Spain.,Hospital 12 de Octubre, Madrid, Spain
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Ibraheim M, Kalpakci A, Sharp C. The specificity of emotion dysregulation in adolescents with borderline personality disorder: comparison with psychiatric and healthy controls. Borderline Personal Disord Emot Dysregul 2017; 4:1. [PMID: 28078089 PMCID: PMC5223469 DOI: 10.1186/s40479-017-0052-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 01/04/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research has supported the notion that emotion dysregulation is a core feature of BPD. However, given that this feature is typical of healthy adolescents as well as adolescents with other psychiatric disorders, the specificity of emotion dysregulation to BPD in this age group has not yet been determined. The overall aim of this study was to examine emotion dysregulation in adolescent inpatients with BPD compared with non-BPD inpatient adolescents and healthy non-clinical adolescents, taking into account both global emotion dysregulation deficits and more specific impairments. METHOD The sample included 185 adolescent inpatients with BPD (M = 15.23, SD = 1.52), 367 non-BPD psychiatric inpatient adolescents (M = 15.37, SD = 1.40), and 146 healthy adolescents (M = 15.23, SD = 1.22), all of whom were between the ages of 12 and 17. Borderline personality features were assessed, along with emotion dysregulation and psychiatric severity. RESULTS After controlling for age, gender, and psychiatric severity, results revealed that adolescents with BPD had higher overall emotional dysregulation compared with non-BPD psychiatric controls and healthy controls. These differences were apparent in only two domains of emotion dysregulation including limited access to emotion regulation strategies perceived as effective and impulse control difficulties when experiencing negative emotions. CONCLUSIONS Findings suggest BPD-specific elevations on emotion dysregulation generally, and subscales related to behavioral regulation specifically.
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Affiliation(s)
- Marina Ibraheim
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, TX 77204 USA
| | - Allison Kalpakci
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, TX 77204 USA
| | - Carla Sharp
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, TX 77204 USA
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Kockler TD, Tschacher W, Santangelo PS, Limberger MF, Ebner-Priemer UW. Specificity of emotion sequences in borderline personality disorder compared to posttraumatic stress disorder, bulimia nervosa, and healthy controls: an e-diary study. Borderline Personal Disord Emot Dysregul 2017; 4:26. [PMID: 29276606 PMCID: PMC5738798 DOI: 10.1186/s40479-017-0077-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 12/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with borderline personality disorder (BPD) exhibit dysregulated emotion sequences in daily life compared to healthy controls (HC). Empirical evidence regarding the specificity of these findings is currently lacking. METHODS To replicate dysregulated emotion sequences in patients with BPD and to investigate the specificity of the sequences, we used e-diaries of 43 female patients with BPD, 28 patients with posttraumatic stress disorder (PTSD), 20 patients with bulimia nervosa (BN), and 28 HC. To capture the rapid dynamics of emotions, we prompted participants every 15 min over a 24-h period to assess their current perceived emotions. We analyzed group differences in terms of activation, persistence, switches, and down-regulation of emotion sequences. RESULTS By comparing patients with BPD to HC, we replicated five of the seven previously reported dysregulated emotion sequences, as well as 111 out of 113 unaltered sequences. However, none of the previously reported dysregulated emotion sequences exhibited specificity, i.e., none revealed higher frequencies compared to the PTSD group or the BN group. Beyond these findings, we revealed a specific finding for patients with BN, as they most frequently switched from anger to disgust. CONCLUSIONS Replicating previously found dysregulated and unaltered emotional sequences strengthens the significance of emotion sequences. However, the lack of specificity points to emotion sequences as transdiagnostic features.
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Affiliation(s)
- Tobias D Kockler
- Karlsruhe Institute of Technology, Mental mHealth Lab, Karlsruhe, Germany
| | - Wolfgang Tschacher
- University of Bern, University Hospital of Psychiatry, Bern, Switzerland
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Chaudhury SR, Galfalvy H, Biggs E, Choo TH, Mann JJ, Stanley B. Affect in response to stressors and coping strategies: an ecological momentary assessment study of borderline personality disorder. Borderline Personal Disord Emot Dysregul 2017; 4:8. [PMID: 28533905 PMCID: PMC5438851 DOI: 10.1186/s40479-017-0059-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 03/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Affect instability is a core symptom of borderline personality disorder (BPD). Ecological momentary assessment allows for an understanding of real-time changes in affect in response to various daily stressors. The purpose of this study was to explore changes in affect in response to specific stressors and coping strategies in subjects with BPD utilizing ecological momentary assessment (EMA) methodology. METHODS Subjects (n = 50) with BPD were asked to complete real-time assessments about stressors experienced, affect felt, and coping strategies employed six times per day for a 1-week period. Mixed effect regression models were used to measure the effect of stressors and coping strategies on affect change. RESULTS While most stressors led to experiencing more negative affect, only being in a disagreement was independently associated with increased negative affect. Among coping strategies, only doing something good for oneself independently reduced negative affect, controlling for all other coping strategies used. CONCLUSIONS These findings provide valuable insights into affective instability in BPD and can help inform treatment with individuals with the disorder.
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Affiliation(s)
- Sadia R Chaudhury
- New York State Psychiatric Institute/Columbia University, 1051 Riverside Drive, Unit 42, New York, NY 10032 USA
| | - Hanga Galfalvy
- New York State Psychiatric Institute/Columbia University, 1051 Riverside Drive, Unit 42, New York, NY 10032 USA
| | - Emily Biggs
- New York State Psychiatric Institute/Columbia University, 1051 Riverside Drive, Unit 42, New York, NY 10032 USA
| | - Tse-Hwei Choo
- New York State Psychiatric Institute/Columbia University, 1051 Riverside Drive, Unit 42, New York, NY 10032 USA
| | - J John Mann
- New York State Psychiatric Institute/Columbia University, 1051 Riverside Drive, Unit 42, New York, NY 10032 USA
| | - Barbara Stanley
- New York State Psychiatric Institute/Columbia University, 1051 Riverside Drive, Unit 42, New York, NY 10032 USA
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71
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Bowen R, Peters E, Marwaha S, Baetz M, Balbuena L. Moods in Clinical Depression Are More Unstable than Severe Normal Sadness. Front Psychiatry 2017; 8:56. [PMID: 28446884 PMCID: PMC5388683 DOI: 10.3389/fpsyt.2017.00056] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 03/29/2017] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Current descriptions in psychiatry and psychology suggest that depressed mood in clinical depression is similar to mild sadness experienced in everyday life, but more intense and persistent. We evaluated this concept using measures of average mood and mood instability (MI). METHOD We prospectively measured low and high moods using separate visual analog scales twice a day for seven consecutive days in 137 participants from four published studies. Participants were divided into a non-depressed group with a Beck Depression Inventory score of ≤10 (n = 59) and a depressed group with a Beck Depression Inventory score of ≥18 (n = 78). MI was determined by the mean square successive difference statistic. RESULTS Mean low and high moods were not correlated in the non-depressed group but were strongly positively correlated in the depressed group. This difference between correlations was significant. Low MI and high MI were weakly positively correlated in the non-depressed group and strongly positively correlated in the depressed group. This difference in correlations was also significant. CONCLUSION The results show that low and high moods, and low and high MI, are highly correlated in people with depression compared with those who are not depressed. Current psychiatric practice does not assess or treat MI or brief high mood episodes in patients with depression. New models of mood that also focus on MI will need to be developed to address the pattern of mood disturbance in people with depression.
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Affiliation(s)
- Rudy Bowen
- University of Saskatchewan, Saskatoon, SK, Canada
| | - Evyn Peters
- University of Saskatchewan, Saskatoon, SK, Canada
| | - Steven Marwaha
- Division of Mental Health and Wellbeing, Warwick Medical School, Warwick University, Coventry, UK.,Affective Disorder Service (IPU 3-8), Caludon Centre, Coventry, UK
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72
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Dixon-Gordon KL, Peters JR, Fertuck EA, Yen S. Emotional Processes in Borderline Personality Disorder: An Update for Clinical Practice. JOURNAL OF PSYCHOTHERAPY INTEGRATION 2017; 27:425-438. [PMID: 29527105 PMCID: PMC5842953 DOI: 10.1037/int0000044] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite prior assumptions about poor prognosis, the surge in research on borderline personality disorder (BPD) over the past several decades shows that it is treatable and can have a good prognosis. Prominent theories of BPD highlight the importance of emotional dysfunction as core to this disorder. However, recent empirical research suggests a more nuanced view of emotional dysfunction in BPD. This research is reviewed in the present article, with a view towards how these laboratory-based findings can influence clinical work with individuals suffering from BPD.
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Affiliation(s)
- Katherine L Dixon-Gordon
- University of Massachusetts Amherst, Department of Psychological and Brain Science, 135 Hicks Way, Amherst, MA 01002
| | - Jessica R Peters
- Alpert Brown Medical School, Department of Psychiatry and Human Behavior, Box G-BH, Providence, Rhode Island 02912
| | - Eric A Fertuck
- The City College of New York, The City University of New York, 160 Convent Avenue, North Academic Center, Room 7/239, New York, NY 10031
- New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032
| | - Shirley Yen
- Alpert Brown Medical School, Department of Psychiatry and Human Behavior, Box G-BH, Providence, Rhode Island 02912
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73
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Tucker RP, Lengel GJ, Smith CE, Capron DW, Mullins-Sweatt SN, Wingate LR. Maladaptive Five Factor Model personality traits associated with Borderline Personality Disorder indirectly affect susceptibility to suicide ideation through increased anxiety sensitivity cognitive concerns. Psychiatry Res 2016; 246:432-437. [PMID: 27788465 DOI: 10.1016/j.psychres.2016.08.051] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 08/17/2016] [Indexed: 11/18/2022]
Abstract
The current study investigated the relationship between maladaptive Five-Factor Model (FFM) personality traits, anxiety sensitivity cognitive concerns, and suicide ideation in a sample of 131 undergraduate students who were selected based on their scores on a screening questionnaire regarding Borderline Personality Disorder (BPD) symptoms. Those who endorsed elevated BPD symptoms in a pre-screen analyses completed at the beginning of each semester were oversampled in comparison to those with low or moderate symptoms. Indirect effect (mediation) results indicated that the maladaptive personality traits of anxious/uncertainty, dysregulated anger, self-disturbance, behavioral dysregulation, dissociative tendencies, distrust, manipulativeness, oppositional, and rashness had indirect effects on suicide ideation through anxiety sensitivity cognitive concerns. All of these personality traits correlated to suicide ideation as well. The maladaptive personality traits of despondence, affective dysregulation, and fragility were positive correlates of suicide ideation and predicted suicide ideation when all traits were entered in one linear regression model, but were not indirectly related through anxiety sensitivity cognitive concerns. The implication for targeting anxiety sensitivity cognitive concerns in evidence-based practices for reducing suicide risk in those with BPD is discussed.
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Affiliation(s)
- Raymond P Tucker
- Oklahoma State University, 116 North Murray, Stillwater, OK 74078, USA
| | - Greg J Lengel
- Oklahoma State University, 116 North Murray, Stillwater, OK 74078, USA
| | - Caitlin E Smith
- Oklahoma State University, 116 North Murray, Stillwater, OK 74078, USA
| | - Dan W Capron
- University of Southern Mississippi, 118 College Drive #5025, Hattiesburg, MS 39406-5025, USA
| | | | - LaRicka R Wingate
- Oklahoma State University, 116 North Murray, Stillwater, OK 74078, USA.
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74
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Santangelo PS, Koenig J, Funke V, Parzer P, Resch F, Ebner-Priemer UW, Kaess M. Ecological Momentary Assessment of Affective and Interpersonal Instability in Adolescent Non-Suicidal Self-Injury. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2016; 45:1429-1438. [DOI: 10.1007/s10802-016-0249-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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75
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Köhling J, Moessner M, Ehrenthal JC, Bauer S, Cierpka M, Kämmerer A, Schauenburg H, Dinger U. Affective Instability and Reactivity in Depressed Patients With and Without Borderline Pathology. J Pers Disord 2016; 30:776-795. [PMID: 26623534 DOI: 10.1521/pedi_2015_29_230] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The quality of depression in borderline personality disorder (BPD) was reported to differ from that in patients with major depressive disorder (MDD) only. However, little is known about affect dynamics in "borderline-depression." The authors assessed affective instability and reactivity in 20 MDD patients with BPD and in 21 MDD patients without BPD by Ambulatory Assessment. Participants reported on current affect, daily events, and attribution of affective states to events five times per day over a 7-day period. The results do not indicate higher affective instability in MDD patients with BPD comorbidity. Depressed patients with BPD reported less subjectively perceived affective reactivity, while observed associations between events and affect were not different between groups, except for one finding: In depressed patients with BPD, overall mood was lower after being alone. These findings suggest impaired attribution of mood changes and less tolerance of being alone as specific for depression in BPD.
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76
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The wandering mind in borderline personality disorder: Instability in self- and other-related thoughts. Psychiatry Res 2016; 242:302-310. [PMID: 27318635 DOI: 10.1016/j.psychres.2016.05.060] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 05/30/2016] [Accepted: 05/30/2016] [Indexed: 11/21/2022]
Abstract
Diagnostic criteria for borderline personality disorder (BPD) include instability in identity and interpersonal relationships. Here, we probed whether instability is already present in BPD patients' thoughts about themselves and others. We tested BPD patients (N=27) and healthy controls (N=25) with a mind-wandering task that assesses content and variability of stimulus-independent self-generated thoughts. Multi-level modeling revealed that while BPD patients and healthy controls mind-wander to a similar extent, BPD patients' thoughts are colored predominantly negatively. Most importantly, although their thoughts concerned the self and others as much as in controls, they fluctuated more strongly in the degree to which their thoughts concerned themselves and others and also gave more extreme ratings. Self- and other related thoughts that were more extreme were also more negative in valence. The increased variability supports current conceptualizations of BPD and may account for the instability in identity and interpersonal relationships.
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77
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Silvers JA, Hubbard AD, Biggs E, Shu J, Fertuck E, Chaudhury S, Grunebaum MF, Weber J, Kober H, Chesin M, Brodsky BS, Koenigsberg H, Ochsner KN, Stanley B. Affective lability and difficulties with regulation are differentially associated with amygdala and prefrontal response in women with Borderline Personality Disorder. Psychiatry Res 2016; 254:74-82. [PMID: 27379614 PMCID: PMC4992645 DOI: 10.1016/j.pscychresns.2016.06.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 06/18/2016] [Accepted: 06/18/2016] [Indexed: 10/21/2022]
Abstract
The present neuroimaging study investigated two aspects of difficulties with emotion associated with Borderline Personality Disorder (BPD): affective lability and difficulty regulating emotion. While these two characteristics have been previously linked to BPD symptomology, it remains unknown whether individual differences in affective lability and emotion regulation difficulties are subserved by distinct neural substrates within a BPD sample. To address this issue, sixty women diagnosed with BPD were scanned while completing a task that assessed baseline emotional reactivity as well as top-down emotion regulation. More affective instability, as measured by the Affective Lability Scale (ALS), positively correlated with greater amygdala responses on trials assessing emotional reactivity. Greater difficulties with regulating emotion, as measured by the Difficulties with Emotion Regulation Scale (DERS), was negatively correlated with left Inferior Frontal Gyrus (IFG) recruitment on trials assessing regulatory ability. These findings suggest that, within a sample of individuals with BPD, greater bottom-up amygdala activity is associated with heightened affective lability. By contrast, difficulties with emotion regulation are related to reduced IFG recruitment during emotion regulation. These results point to distinct neural mechanisms for different aspects of BPD symptomology.
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Affiliation(s)
- Jennifer A Silvers
- Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095, USA.
| | - Alexa D Hubbard
- Department of Psychology, New York University, 6 Washington Place, New York, NY 10003, USA
| | - Emily Biggs
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, 1051 Riverside Drive, New York, NY 10032, USA
| | - Jocelyn Shu
- Department of Psychology, 1190 Amsterdam Avenue, New York, NY 10027, USA
| | - Eric Fertuck
- The City University of New York, Clinical Psychology Doctoral Program and Graduate Center, New York, NY 10031, USA
| | - Sadia Chaudhury
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, 1051 Riverside Drive, New York, NY 10032, USA
| | - Michael F Grunebaum
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, 1051 Riverside Drive, New York, NY 10032, USA
| | - Jochen Weber
- Department of Psychology, 1190 Amsterdam Avenue, New York, NY 10027, USA
| | - Hedy Kober
- Department of Psychiatry, Yale School of Medicine, One Church Street, New Haven, CT 06510, USA
| | - Megan Chesin
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, 1051 Riverside Drive, New York, NY 10032, USA
| | - Beth S Brodsky
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, 1051 Riverside Drive, New York, NY 10032, USA
| | - Harold Koenigsberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Kevin N Ochsner
- Department of Psychology, 1190 Amsterdam Avenue, New York, NY 10027, USA
| | - Barbara Stanley
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, 1051 Riverside Drive, New York, NY 10032, USA.
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78
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Santangelo PS, Limberger MF, Stiglmayr C, Houben M, Coosemans J, Verleysen G, Kuppens P, Tuerlinckx F, Vanpaemel W, Ebner-Priemer UW. Analyzing subcomponents of affective dysregulation in borderline personality disorder in comparison to other clinical groups using multiple e-diary datasets. Borderline Personal Disord Emot Dysregul 2016; 3:5. [PMID: 27386138 PMCID: PMC4934004 DOI: 10.1186/s40479-016-0039-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 06/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Affective dysregulation is widely regarded as being the core problem in patients with borderline personality disorder (BPD). Moreover, BPD is the disorder mainly associated with affective dysregulation. However, the empirical confirmation of the specificity of affective dysregulation for BPD is still pending. We used a validated approach from basic affective science that allows for simultaneously analyzing three interdependent components of affective dysregulation that are disturbed in patients with BPD: homebase, variability, and attractor strength (return to baseline). METHODS We applied two types of multilevel models on two e-diary datasets to investigate group differences regarding three subcomponents between BPD patients (n = 43; n = 51) and patients with posttraumatic stress disorder (PTSD; n = 28) and those with bulimia nervosa (BN; n = 20) as clinical control groups in dataset 1, and patients with panic disorder (PD; n = 26) and those with major depression (MD; n = 25) as clinical control groups in dataset 2. In addition, healthy controls (n = 28; n = 40) were included in the analyses. In both studies, e-diaries were used to repeatedly collect data about affective experiences during participants' daily lives. In study 1 a high-frequency sampling strategy with assessments in 15 min-intervals over 24 h was applied, whereas the assessments occurred every waking hour over 48 h in study 2. The local ethics committees approved both studies, and all participants provided written informed consent. RESULTS In contradiction to our hypotheses, BPD patients did not consistently show altered affective dysregulation compared to the clinical patient groups. The only differences in affective dynamics in BPD patients emerged with regard to one of three subcomponents, affective homebase. However, these results were not even consistent. Conversely, comparing the patients to healthy controls revealed a pattern of more negative affective homebases, higher levels of affective variability, and (partially) reduced returns to baseline in the patient groups. CONCLUSIONS Our results indicate that affective dysregulation constitutes a transdiagnostic mechanism that manifests in similar ways in several different mental disorders. We point out promising prospects that might help to elucidate the common and distinctive mechanisms that underlie several different disorders and that should be addressed in future studies.
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Affiliation(s)
| | | | - C. Stiglmayr
- />Consortium for Scientific Psychotherapy Berlin (AWP-Berlin), Berlin, Germany
| | - M. Houben
- />KU Leuven – University of Leuven, Leuven, Belgium
| | - J. Coosemans
- />KU Leuven – University of Leuven, Leuven, Belgium
| | - G. Verleysen
- />KU Leuven – University of Leuven, Leuven, Belgium
| | - P. Kuppens
- />KU Leuven – University of Leuven, Leuven, Belgium
| | | | - W. Vanpaemel
- />KU Leuven – University of Leuven, Leuven, Belgium
| | - U. W. Ebner-Priemer
- />Karlsruhe Institute of Technology, Karlsruhe, Germany
- />Central Institute of Mental Health, Mannheim, Germany
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Wright AGC, Simms LJ. Stability and fluctuation of personality disorder features in daily life. JOURNAL OF ABNORMAL PSYCHOLOGY 2016; 125:641-56. [PMID: 27196437 PMCID: PMC4925296 DOI: 10.1037/abn0000169] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Very little is known about the daily stability and fluctuation of personality pathology. To address this gap in knowledge, we investigated the naturalistic manifestation of personality pathology over the course of 100 days. A group of individuals (N = 101) diagnosed with any personality disorder (PD) completed a daily diary study over 100 consecutive days (Mdn = 94 days, range = 33-101 days). Participants completed daily ratings of 30 manifestations of personality pathology. Patterns of stability and variability over the course of the study were then examined. Results indicated that individual PD manifestations and domains of PD manifestations were variable across days and differed widely in their frequency. Additionally, individual averages and level of variability in PD domains were highly stable across months, individual averages of PD domains were predicted by baseline dispositional ratings of PD traits with a high degree of specificity, and daily variability PD domains was associated with elevated levels of PD traits. This pattern of findings suggests that dynamic processes of symptom exacerbation and diminution that are stable in mean level and variability in expression over time characterizes personality pathology. Further, dispositional ratings are significant predictors of average daily expression of PD features. (PsycINFO Database Record
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Affiliation(s)
| | - Leonard J Simms
- Department of Psychology, University at Buffalo, State University of New York
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80
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Schoenleber M, Berghoff CR, Tull MT, DiLillo D, Messman-Moore T, Gratz KL. Emotional lability and affective synchrony in borderline personality disorder. Personal Disord 2016. [PMID: 27362623 DOI: 10.1037/per0000145.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Extant research on emotional lability in borderline personality disorder (BPD) has focused almost exclusively on lability of individual emotions or emotion types, with limited research considering how different types of emotions shift together over time. Thus, this study examined the temporal dynamics of emotion in BPD at the level of both individual emotions (i.e., self-conscious emotions [SCE], anger, and anxiety) and mixed emotions (i.e., synchrony between emotions). One hundred forty-four women from the community completed a diagnostic interview and laboratory study involving 5 emotion induction tasks (each of which was preceded and followed by a 5-min resting period or neutral task). State ratings of SCE, anger, and anxiety were provided at 14 time points (before and after each laboratory task and resting period). Hierarchical linear modeling results indicate that women with BPD reported greater mean levels of SCE and Anxiety (but not Anger), and greater lability of Anxiety. Women with BPD also exhibited greater variability in lability of all 3 emotions (suggestive of within-group differences in the relevance of lability to BPD). Results also revealed synchrony (i.e., positive relations) between each possible pair of emotions, regardless of BPD status. Follow-up regression analyses suggest the importance of accounting for lability when examining the role of synchrony in BPD, as the relation of SCE-Anger synchrony to BPD symptom severity was moderated by Anger and SCE lability. Specifically, synchronous changes in SCE and Anger were associated with greater BPD symptom severity when large shifts in SCE were paired with minor shifts in Anger. (PsycINFO Database Record
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Affiliation(s)
- Michelle Schoenleber
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center
| | | | - Matthew T Tull
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center
| | - David DiLillo
- Department of Psychology, University of Nebraska-Lincoln
| | | | - Kim L Gratz
- Department of Psychiatry and Human Behavior, University of Mississippi Medical
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Houben M, Bohus M, Santangelo P, Ebner-Priemer U, Trull T, Kuppens P. The specificity of emotional switching in borderline personality disorder in comparison to other clinical groups. Personal Disord 2016; 7:198-204. [PMID: 26882282 PMCID: PMC4816671 DOI: 10.1037/per0000172] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In an attempt to better understand the nature of emotion dysregulation in the daily lives of persons with a borderline personality disorder (BPD), Houben et al. (2016) recently identified emotional switching, which refers to the tendency to make large changes between positive and negative emotional states over time, as a possible defining characteristic of the emotion dynamics observed in BPD. The goal of this study was to examine the specificity of these previous findings in 2 samples by comparing BPD patients (N = 43 in sample 1; N = 81 in sample 2) to patients with bulimia nervosa (N = 20), posttraumatic stress disorder (N = 28), or healthy controls (N = 28) in sample 1, and to patients with depressive disorder (N = 50) in sample 2, with respect to measures of emotional switching. Analyses of these 2 experience sampling datasets revealed that contrary to expectations, BPD patients did not differ from the clinical groups regarding their mere tendency to switch between positive and negative emotional states on consecutive moments over time and regarding the magnitude of such changes between positive and negative emotional states over time. However, all clinical groups did differ from healthy controls regarding all switch measures in dataset 1. These results indicate that emotional switching, similar to other more traditional indicators of overall changes in emotional intensity in daily life, might reflect a feature of emotional responding characterizing a range of disorders with mood disturbances.
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Affiliation(s)
| | - Martin Bohus
- Central Institute of Mental Health Mannheim, Germany
| | | | - Ulrich Ebner-Priemer
- Central Institute of Mental Health Mannheim, Germany
- Karlsruhe Institute of Technology, Germany
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82
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Fonagy P, Speranza M, Luyten P, Kaess M, Hessels C, Bohus M. ESCAP Expert Article: borderline personality disorder in adolescence: an expert research review with implications for clinical practice. Eur Child Adolesc Psychiatry 2015; 24:1307-20. [PMID: 26271454 DOI: 10.1007/s00787-015-0751-z] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 07/17/2015] [Indexed: 12/26/2022]
Abstract
Borderline personality disorder (BPD) has onset in adolescence, but is typically first diagnosed in young adulthood. This paper provides a narrative review of the current evidence on diagnosis, comorbidity, phenomenology and treatment of BPD in adolescence. Instruments available for diagnosis are reviewed and their strengths and limitations discussed. Having confirmed the robustness of the diagnosis and the potential for its reliable clinical assessment, we then explore current understandings of the mechanisms of the disorder and focus on neurobiological underpinnings and research on psychological mechanisms. Findings are accumulating to suggest that adolescent BPD has an underpinning biology that is similar in some ways to adult BPD but differs in some critical features. Evidence for interventions focuses on psychological therapies. Several encouraging research studies suggest that early effective treatment is possible. Treatment development has just begun, and while adolescent-specific interventions are still in the process of evolution, most existing therapies represent adaptations of adult models to this developmental phase. There is also a significant opportunity for prevention, albeit there are few data to date to support such initiatives. This review emphasizes that there can be no justification for failing to make an early diagnosis of this enduring and pervasive problem.
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Affiliation(s)
- Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, WC1E 6BT, UK.
| | - Mario Speranza
- Department of Child and Adolescent Psychiatry, Versailles General Hospital, Faculty of Health Sciences, Research Unit EA4047, University of Versailles Saint-Quentin-en-Yvelines, 177 rue de Versailles, 78157, Le Chesnay, France
| | - Patrick Luyten
- Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, WC1E 6BT, UK
- Faculty of Psychology and Educational Sciences, University of Leuven, Tiensestraat 102, Box 3722, 3000, Leuven, Belgium
| | - Michael Kaess
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Blumenstrasse 8, 69115, Heidelberg, Germany
| | - Christel Hessels
- Expertise Centre for Personality Disorders, GGz Centraal, PO Box 3051, 3800 DB, Amersfoort, The Netherlands
| | - Martin Bohus
- Department of Psychosomatics and Psychotherapy, Central Institute of Mental Health Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany
- Faculty of Health, University of Antwerp, Antwerp, Belgium
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83
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Abstract
Personality disorders (PDs) are often described as stable, which ignores the important dynamic processes and shifts that are observed clinically in individuals with PD. The current study examined patterns of variability in problematic interpersonal functioning, a core feature of personality pathology. Participants (N = 150) were assessed for personality pathology at baseline and also completed the Inventory of Interpersonal Problems-Circumplex Scales at baseline and every 3 months over the course of a year. Baseline PD was used to predict individual means and variability parameters in generalized interpersonal distress, agentic problems, and communal problems across repeated assessments. Disorders associated with disinhibition predicted variability in generalized distress and agentic problems, whereas only antagonism-related disorders predicted variability in communal problems. These associations reveal dynamic processes involved in multiple dimensions of personality pathology and suggest that future research on instability is needed that expands beyond the historical focus on borderline PD.
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Affiliation(s)
| | - Lori N Scott
- Department of Psychiatry, University of Pittsburgh
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84
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Marzano L, Bardill A, Fields B, Herd K, Veale D, Grey N, Moran P. The application of mHealth to mental health: opportunities and challenges. Lancet Psychiatry 2015; 2:942-8. [PMID: 26462228 DOI: 10.1016/s2215-0366(15)00268-0] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 05/15/2015] [Accepted: 05/26/2015] [Indexed: 02/04/2023]
Abstract
Advances in smartphones and wearable biosensors enable real-time psychological, behavioural, and physiological data to be gathered in increasingly precise and unobtrusive ways. Thus, moment-to-moment information about an individual's moods, cognitions, and activities can be collected, in addition to automated data about their whereabouts, behaviour, and physiological states. In this report, we discuss the potential of these new mobile digital technologies to transform mental health research and clinical practice. By drawing on results from the INSIGHT research project, we show how traditional boundaries between research and clinical practice are becoming increasingly blurred and how, in turn, this is leading to exciting new developments in the assessment and management of common mental disorders. Furthermore, we discuss the potential risks and key challenges associated with applying mobile technology to mental health.
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Affiliation(s)
- Lisa Marzano
- School of Science and Technology, Middlesex University, London, UK.
| | - Andy Bardill
- School of Science and Technology, Middlesex University, London, UK
| | - Bob Fields
- School of Science and Technology, Middlesex University, London, UK
| | - Kate Herd
- School of Science and Technology, Middlesex University, London, UK
| | - David Veale
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Nick Grey
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Paul Moran
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; University of Bristol, Bristol, UK
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85
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Tomko RL, Lane SP, Pronove LM, Treloar HR, Brown WC, Solhan MB, Wood PK, Trull TJ. Undifferentiated negative affect and impulsivity in borderline personality and depressive disorders: A momentary perspective. JOURNAL OF ABNORMAL PSYCHOLOGY 2015; 124:740-753. [PMID: 26147324 PMCID: PMC4573801 DOI: 10.1037/abn0000064] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Individuals with borderline personality disorder (BPD) often report experiencing several negative emotions simultaneously, an indicator of "undifferentiated" negative affect. The current study examined the relationship between undifferentiated negative affect and impulsivity. Participants with a current BPD (n = 67) or depressive disorder (DD; n = 38) diagnosis carried an electronic diary for 28 days, reporting on emotions and impulsivity when randomly prompted (up to 6 times per day). Undifferentiated negative affect was quantified using momentary intraclass correlation coefficients, which indicated how consistently negative emotion items were rated across fear, hostility, and sadness subscales. Undifferentiated negative affect at the occasion-level, day-level, and across 28 days was used to predict occasion-level impulsivity. Multilevel modeling was used to test the hypothesis that undifferentiated negative emotion would be a significant predictor of momentary impulsivity above and beyond levels of overall negative affect. Undifferentiated negative affect at the occasion and day levels were significant predictors of occasion-level impulsivity, but undifferentiated negative affect across the 28-day study period was only marginally significant. Results did not differ depending on BPD or DD status, though individuals with BPD did report significantly greater momentary impulsivity and undifferentiated negative affect. Undifferentiated negative affect may increase risk for impulsivity among individuals with BPD and depressive disorders, and the current data suggest that this process can be relatively immediate as well as cumulative over the course of a day. This research supports the consideration of undifferentiated negative affect as a transdiagnostic construct, but one that may be particularly relevant for those with BPD.
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Affiliation(s)
- Rachel L. Tomko
- University of Missouri-Columbia and Midwest Alcoholism Research Center, Columbia, MO
| | - Sean P. Lane
- University of Missouri-Columbia and Midwest Alcoholism Research Center, Columbia, MO
| | - Lisa M. Pronove
- University of Missouri-Columbia and Midwest Alcoholism Research Center, Columbia, MO
| | - Hayley R. Treloar
- University of Missouri-Columbia and Midwest Alcoholism Research Center, Columbia, MO
- Alpert Medical School of Brown University, Providence, RI
| | - Whitney C. Brown
- University of Missouri-Columbia and Midwest Alcoholism Research Center, Columbia, MO
- Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, MI
| | - Marika B. Solhan
- University of Missouri-Columbia and Midwest Alcoholism Research Center, Columbia, MO
- VA Boston Healthcare System, Boston, MA
| | - Phillip K. Wood
- University of Missouri-Columbia and Midwest Alcoholism Research Center, Columbia, MO
| | - Timothy J. Trull
- University of Missouri-Columbia and Midwest Alcoholism Research Center, Columbia, MO
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86
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Abstract
We discuss three varieties of affective dynamics (affective instability, emotional inertia, and emotional differentiation). In each case, we suggest how these affective dynamics should be operationalized and measured in daily life using time-intensive methods, like ecological momentary assessment or ambulatory assessment, and recommend time-sensitive analyses that take into account not only the variability but also the temporal dependency of reports. Studies that explore how these affective dynamics are associated with psychological disorders and symptoms are reviewed, and we emphasize that these affective processes are within a nexus of other components of emotion regulation.
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Affiliation(s)
- Timothy J Trull
- Department of Psychological Sciences, University of Missouri, USA
| | - Sean P Lane
- Department of Psychological Sciences, University of Missouri, USA
| | - Peter Koval
- School of Psychology, Australian Catholic University, Australia Research Group of Quantitative Psychology and Individual Differences, KU Leuven, Belgium
| | - Ulrich W Ebner-Priemer
- Department of Sport and Sport Science and House of Competence, Karlsruhe Institute of Technology, Germany
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87
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Santangelo P, Reinhard I, Mussgay L, Steil R, Sawitzki G, Klein C, Trull TJ, Bohus M, Ebner-Priemer UW. Specificity of affective instability in patients with borderline personality disorder compared to posttraumatic stress disorder, bulimia nervosa, and healthy controls. JOURNAL OF ABNORMAL PSYCHOLOGY 2015; 123:258-72. [PMID: 24661176 DOI: 10.1037/a0035619] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Affective instability is a core feature of borderline personality disorder (BPD). The use of advanced assessment methodologies and appropriate statistical analyses has led to consistent findings that indicate a heightened instability in patients with BPD compared with healthy controls. However, few studies have investigated the specificity of affective instability among patients with BPD with regard to relevant clinical control groups. In this study, 43 patients with BPD, 28 patients with posttraumatic stress disorder (PTSD), 20 patients with bulimia nervosa (BN), and 28 healthy controls carried e-diaries for 24 hours and were prompted to rate their momentary affective states approximately every 15 minutes while awake. To quantify instability, we used 3 state-of-the-art indices: multilevel models for squared successive differences (SSDs), multilevel models for probability of acute changes (PACs), and aggregated point-by-point changes (APPCs). Patients with BPD displayed heightened affective instability for emotional valence and distress compared with healthy controls, regardless of the specific instability indices. These results directly replicate earlier studies. However, affective instability did not seem to be specific to patients with BPD. With regard to SSDs, PACs, and APPCs, patients with PTSD or BN showed a similar heightened instability of affect (emotional valence and distress) to that of patients with BPD. Our results give raise to the discussion if affective instability is a transdiagnostic or a disorder-specific mechanism. Current evidence cannot answer this question, but investigating psychopathological mechanisms in everyday life across disorders is a promising approach to enhance validity and specificity of mental health diagnoses.
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Affiliation(s)
- Philip Santangelo
- Department of Sport and Sport Science, Karlsruhe Institute of Technology
| | - Iris Reinhard
- Department of Biostatistics, Central Institute of Mental Health Mannheim
| | | | - Regina Steil
- Department of Psychology and Sports Sciences, Johann Wolfgang Goethe University
| | - Günther Sawitzki
- Statlab, Institute for Applied Mathematics, University of Heidelberg
| | - Christoph Klein
- Klein, Department of Child and Adolescent Psychiatry and Psychotherapy, Freiburg University
| | - Timothy J Trull
- Department of Psychological Sciences, University of Missouri-Columbia
| | - Martin Bohus
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University
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88
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Quality and severity of depression in borderline personality disorder: A systematic review and meta-analysis. Clin Psychol Rev 2015; 37:13-25. [DOI: 10.1016/j.cpr.2015.02.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 01/31/2015] [Accepted: 02/05/2015] [Indexed: 12/21/2022]
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89
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Hasler G, Hopwood CJ, Jacob GA, Brändle LS, Schulte-Vels T. Patient-reported outcomes in borderline personality disorder. DIALOGUES IN CLINICAL NEUROSCIENCE 2014. [PMID: 25152662 PMCID: PMC4140517 DOI: 10.31887/dcns.2014.16.2/ghasler] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Patient-reported outcome (PRO) refers to measures that emphasize the subjective view of patients about their health-related conditions and behaviors. Typically, PROs include self-report questionnaires and clinical interviews. Defining PROs for borderline personality disorder (BPD) is particularly challenging given the disorder's high symptomatic heterogeneity, high comorbidity with other psychiatric conditions, highly fluctuating symptoms, weak correlations between symptoms and functional outcomes, and lack of valid and reliable experimental measures to complement self-report data. Here, we provide an overview of currently used BPD outcome measures and discuss them from clinical, psychometric, experimental, and patient perspectives. In addition, we review the most promising leads to improve BPD PROs, including the DSM-5 Section III, the Recovery Approach, Ecological Momentary Assessments, and novel experimental measures of social functioning that are associated with functional and social outcomes.
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Affiliation(s)
- Gregor Hasler
- Psychiatric University Hospital, University of Bern, Bern, Switzerland
| | | | | | - Laura S Brändle
- Psychiatric University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Schulte-Vels
- Department of Psychiatry and Psychotherapy, University Hospital, Zurich, Switzerland
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90
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Scott LN, Stepp SD, Pilkonis PA. Prospective associations between features of borderline personality disorder, emotion dysregulation, and aggression. Personal Disord 2014; 5:278-88. [PMID: 24635753 DOI: 10.1037/per0000070] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Difficulties with emotion regulation and behavioral instability, including impulsive aggression, are seen as core dimensions underlying borderline personality disorder (BPD). Although both BPD and antisocial personality disorder (ASPD) are associated with impulsivity and aggressive behavior, difficulties regulating emotions may be associated uniquely with BPD and may explain distinctive associations between BPD and aggression. This study was designed to examine the unique prospective associations between BPD symptoms at baseline, difficulties with emotion regulation and trait impulsivity, and psychological and physical aggression (both perpetration and victimization) over the course of a year after controlling for ASPD symptoms in a mixed clinical and community sample of adults (N = 150). Results of a multivariate path analysis demonstrated that associations between BPD symptoms at baseline and later psychological and physical aggression were fully mediated by difficulties with emotion regulation. Although BPD symptoms also predicted trait impulsivity, impulsivity did not predict aggression after controlling for emotion dysregulation. ASPD symptoms were directly associated with physical assault perpetration and victimization but were not associated with emotion dysregulation, impulsivity, or psychological aggression. These findings suggest that although both BPD and ASPD are associated with aggressive behaviors, associations between BPD symptoms and aggression are mediated uniquely by difficulties regulating emotions.
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Affiliation(s)
- Lori N Scott
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Stephanie D Stepp
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Paul A Pilkonis
- Department of Psychiatry, University of Pittsburgh School of Medicine
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91
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Schmahl C, Herpertz SC, Bertsch K, Ende G, Flor H, Kirsch P, Lis S, Meyer-Lindenberg A, Rietschel M, Schneider M, Spanagel R, Treede RD, Bohus M. Mechanisms of disturbed emotion processing and social interaction in borderline personality disorder: state of knowledge and research agenda of the German Clinical Research Unit. Borderline Personal Disord Emot Dysregul 2014; 1:12. [PMID: 26401296 PMCID: PMC4579501 DOI: 10.1186/2051-6673-1-12] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 08/22/2014] [Indexed: 12/15/2022] Open
Abstract
The last two decades have seen a strong rise in empirical research in the mechanisms of emotion dysregulation in borderline personality disorder. Major findings comprise structural as well as functional alterations of brain regions involved in emotion processing, such as amygdala, insula, and prefrontal regions. In addition, more specific mechanisms of disturbed emotion regulation, e.g. related to pain and dissociation, have been identified. Most recently, social interaction problems and their underlying neurobiological mechanisms, e.g. disturbed trust or hypersensitivity to social rejection, have become a major focus of BPD research. This article covers the current state of knowledge and related relevant research goals. The first part presents a review of the literature. The second part delineates important open questions to be addressed in future studies. The third part describes the research agenda for a large German center grant focusing on mechanisms of emotion dysregulation in BPD.
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Affiliation(s)
- Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim / Heidelberg University, J 5, 68159 Mannheim, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Center of Psychosocial Medicine, Medical Faculty Heidelberg / Heidelberg University, Heidelberg, Germany
| | - Katja Bertsch
- Department of General Psychiatry, Center of Psychosocial Medicine, Medical Faculty Heidelberg / Heidelberg University, Heidelberg, Germany
| | - Gabriele Ende
- Department of Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim / Heidelberg University, Mannheim, Germany
| | - Herta Flor
- Institute of Neuropsychology and Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim / Heidelberg University, Mannheim, Germany
| | - Peter Kirsch
- Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim / Heidelberg University, Mannheim, Germany
| | - Stefanie Lis
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim / Heidelberg University, J 5, 68159 Mannheim, Germany
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim / Heidelberg University, Mannheim, Germany
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Miriam Schneider
- Institute of Psychopharmacology, Central Institute of Mental Health, Medical Faculty Mannheim / Heidelberg University, Mannheim, Germany
| | - Rainer Spanagel
- Institute of Psychopharmacology, Central Institute of Mental Health, Medical Faculty Mannheim / Heidelberg University, Mannheim, Germany
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Center for Biomedicine and Medical Technology Mannheim, Medical Faculty Mannheim / Heidelberg University, Mannheim, Germany
| | - Martin Bohus
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim / Heidelberg University, J 5, 68159 Mannheim, Germany
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92
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Abstract
Ambulatory assessment (AA) covers a wide range of assessment methods to study people in their natural environment, including self-report, observational, and biological/physiological/behavioral. AA methods minimize retrospective biases while gathering ecologically valid data from patients' everyday life in real time or near real time. Here, we report on the major characteristics of AA, and we provide examples of applications of AA in clinical psychology (a) to investigate mechanisms and dynamics of symptoms, (b) to predict the future recurrence or onset of symptoms, (c) to monitor treatment effects, (d) to predict treatment success, (e) to prevent relapse, and (f) as interventions. In addition, we present and discuss the most pressing and compelling future AA applications: technological developments (the smartphone), improved ecological validity of laboratory results by combined lab-field studies, and investigating gene-environment interactions. We conclude with a discussion of acceptability, compliance, privacy, and ethical issues.
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Affiliation(s)
- Timothy J Trull
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri 65211-1350, USA.
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