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Traynor JM, Roberts DE, Ross S, Zeifman R, Choi-Kain L. MDMA-Assisted Psychotherapy for Borderline Personality Disorder. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2022; 20:358-367. [PMID: 37200873 PMCID: PMC10187385 DOI: 10.1176/appi.focus.20220056] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Borderline personality disorder is a complex psychiatric disorder with limited treatment options that are associated with large heterogeneity in treatment response and high rates of dropout. New or complementary treatments for borderline personality disorder are needed that may be able to bolster treatment outcomes. In this review, the authors comment on the plausibility for research on 3,4-methylenedioxymethamphetamine (MDMA) used in conjunction with psychotherapy for borderline personality disorder (i.e., MDMA-assisted psychotherapy [MDMA-AP]). On the basis of the promise of MDMA-AP in treating disorders overlapping with borderline personality disorder (e.g., posttraumatic stress disorder), the authors speculate on initial treatment targets and hypothesized mechanisms of change that are grounded in prior literature and theory. Initial considerations for designing MDMA-AP clinical trials to investigate the safety, feasibility, and preliminary effects of MDMA-AP for borderline personality disorder are also presented.
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Affiliation(s)
- Jenna M Traynor
- Gunderson Personality Disorders Research Institute, McLean Hospital, Belmont, Massachusetts (Traynor, Choi-Kain); Faculty of Medicine, Harvard Medical School, Boston (Traynor, Choi-Kain); Langone Center for Psychedelic Medicine, Department of Psychiatry, New York University Grossman School of Medicine, New York (Roberts, Ross); Department of Psychology, Ryerson University, Toronto (Zeifman); Centre for Psychedelic Research, Imperial College London, London (Zeifman)
| | - Daniel E Roberts
- Gunderson Personality Disorders Research Institute, McLean Hospital, Belmont, Massachusetts (Traynor, Choi-Kain); Faculty of Medicine, Harvard Medical School, Boston (Traynor, Choi-Kain); Langone Center for Psychedelic Medicine, Department of Psychiatry, New York University Grossman School of Medicine, New York (Roberts, Ross); Department of Psychology, Ryerson University, Toronto (Zeifman); Centre for Psychedelic Research, Imperial College London, London (Zeifman)
| | - Stephen Ross
- Gunderson Personality Disorders Research Institute, McLean Hospital, Belmont, Massachusetts (Traynor, Choi-Kain); Faculty of Medicine, Harvard Medical School, Boston (Traynor, Choi-Kain); Langone Center for Psychedelic Medicine, Department of Psychiatry, New York University Grossman School of Medicine, New York (Roberts, Ross); Department of Psychology, Ryerson University, Toronto (Zeifman); Centre for Psychedelic Research, Imperial College London, London (Zeifman)
| | - Richard Zeifman
- Gunderson Personality Disorders Research Institute, McLean Hospital, Belmont, Massachusetts (Traynor, Choi-Kain); Faculty of Medicine, Harvard Medical School, Boston (Traynor, Choi-Kain); Langone Center for Psychedelic Medicine, Department of Psychiatry, New York University Grossman School of Medicine, New York (Roberts, Ross); Department of Psychology, Ryerson University, Toronto (Zeifman); Centre for Psychedelic Research, Imperial College London, London (Zeifman)
| | - Lois Choi-Kain
- Gunderson Personality Disorders Research Institute, McLean Hospital, Belmont, Massachusetts (Traynor, Choi-Kain); Faculty of Medicine, Harvard Medical School, Boston (Traynor, Choi-Kain); Langone Center for Psychedelic Medicine, Department of Psychiatry, New York University Grossman School of Medicine, New York (Roberts, Ross); Department of Psychology, Ryerson University, Toronto (Zeifman); Centre for Psychedelic Research, Imperial College London, London (Zeifman)
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Budenz A, Klein A, Prutzman Y. The Relationship Between Trauma Exposure and Adult Tobacco Use: Analysis of the National Epidemiologic Survey on Alcohol and Related Conditions (III). Nicotine Tob Res 2021; 23:1716-1726. [PMID: 33848342 PMCID: PMC8562326 DOI: 10.1093/ntr/ntab057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 04/12/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Previous research has examined cigarette smoking in trauma exposed populations. However, the relationships between trauma exposure and use of other tobacco products (eg, cigars, e-cigarettes) and specific trauma exposure characteristics that may be associated with tobacco use are understudied. AIMS AND METHODS Using the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (N = 36 151 adults), we conducted weighted bivariate analyses of tobacco use among participants with no trauma exposure, trauma exposure, and trauma exposure with post-traumatic stress disorder (trauma + PTSD), stratified by tobacco product use. We also performed weighted logistic regressions testing relationships between trauma exposure and tobacco use, controlling for behavioral health (BH) conditions (mood, anxiety, substance use, personality disorders) and sociodemographics. RESULTS Approximately 44% of participants had experienced trauma; 6% experienced trauma + PTSD. Trauma exposed participants had a higher prevalence of tobacco use (30%--46% vs. 22%) and poly-tobacco use (34%--35% vs. 28%) than unexposed participants. Cigarettes were the most used tobacco product; trauma + PTSD (19%), and trauma (15%) participants had a higher prevalence of e-cigarette use than unexposed participants (11%). Trauma exposure was associated with current tobacco use (AOR = 1.36 trauma + PTSD; 1.23 trauma) (but not former use), particularly among participants exposed to violence/abuse (AOR = 1.23). Personality and substance use disorders were strongly associated with current and former tobacco use. CONCLUSIONS Trauma exposure, PTSD, and experiences of violence/abuse are associated with current tobacco use. BH conditions may also play a role in current and former tobacco use. Recognizing and addressing trauma exposure and BH conditions among tobacco users may improve cessation rates in these populations. IMPLICATIONS This study contributes to research on tobacco use disparities in behavioral health populations by providing a comprehensive examination of tobacco use in trauma exposed individuals. Prior research has examined cigarette smoking, but not other tobacco product use in these populations. This study presents findings on multiple tobacco use behaviors (tobacco product, poly-tobacco use, cessation attempts) in trauma exposed populations and characteristics of trauma exposure (severity, type of traumatic event) associated with tobacco use. These findings underscore the importance of further examining the implications of trauma exposure for tobacco use and of screening and addressing trauma in cessation treatment.
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Affiliation(s)
- Alexandra Budenz
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Amanda Klein
- Center for Chronic Disease Prevention and Control Prevention and Health Promotion Administration, Maryland Department of Health, Timonium, MD, USA
| | - Yvonne Prutzman
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
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Lee DA. A person-centred political critique of current discourses in post-traumatic stress disorder and post-traumatic growth. PSYCHOTHERAPY AND POLITICS INTERNATIONAL 2017. [DOI: 10.1002/ppi.1411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Deborah A. Lee
- Division of Sociology; Nottingham Trent University; Nottingham UK
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Cwik JC, Margraf J. Information order effects in clinical psychological diagnoses. Clin Psychol Psychother 2017; 24:1142-1154. [PMID: 28276173 DOI: 10.1002/cpp.2080] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 02/07/2017] [Accepted: 02/13/2017] [Indexed: 11/06/2022]
Abstract
Despite the wide application and long history of diagnostic systems, several sources of diagnostic errors remain in the criterion-based diagnosing of mental disorders. The aim of this study was to investigate whether the presentational order of diagnosis-relevant information and pretreatment reports predict diagnostic errors. One hundred twenty psychotherapists participated in the present online study. The study employed a 2 (symptom presentation: core symptoms at vignette's beginning vs. core symptoms at the end of the case vignette) × 2 (pretreatment report: receiving a pretreatment report with an incongruent diagnosis to the case vignette vs. receiving no pretreatment report) between-subjects experimental design, with random assignment. Participants were asked to make diagnoses after reading three case vignettes describing patients with different disorder constellations. Additionally, participants rated their confidence in the diagnoses and their estimation of the severity of each diagnosed condition. Results indicated that order of symptom descriptions predicted the correctness of diagnostic decisions, with a recency effect causing more fully correct diagnostic decisions in cases where diagnostic information was presented last. Receiving incongruent pretreatment reports was predictive for diagnostic errors. In conclusion, the results of this study indicate that diagnoses of mental disorders can depend on the way symptoms are presented or reported. KEY PRACTITIONER MESSAGE Therapists' diagnostic decisions are not influenced by pretreatment reports. Diagnostic decisions are affected by information order effects. Diagnostic accuracy of psychotherapists is debatable. High rate of misdiagnoses in case vignette with comorbid disorders.
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Affiliation(s)
- Jan Christopher Cwik
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Bochum, Germany
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Winsper C, Lereya ST, Marwaha S, Thompson A, Eyden J, Singh SP. The aetiological and psychopathological validity of borderline personality disorder in youth: A systematic review and meta-analysis. Clin Psychol Rev 2015; 44:13-24. [PMID: 26709502 DOI: 10.1016/j.cpr.2015.12.001] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 09/28/2015] [Accepted: 12/08/2015] [Indexed: 02/06/2023]
Abstract
Controversy surrounds the diagnosis of Borderline Personality Disorder (BPD) in youth. This meta-analysis summarised evidence regarding the aetiological and psychopathological validity of youth BPD (the extent to which youth and adult BPD share common risk factors and psychopathology). We identified 61 studies satisfying predetermined inclusion criteria. Statistically significant pooled associations with youth (19 years of age and under) BPD were observed for sexual abuse (all youth: odds ratio=4.88; 95% confidence interval=3.30, 7.21; children: OR=3.97; 95% CI=1.51, 10.41; adolescents: OR=5.41; 95% CI=3.43, 8.53); physical abuse (all youth: 2.79 [2.03, 3.84]; children: 2.86 [1.98, 4.13]; adolescents: 2.60 [1.38, 4.90]); maternal hostility/verbal abuse (all youth: 3.28 [2.67, 4.03]; children: 3.15 [2.55, 3.88]; adolescents: 4.71 [1.77, 12.53]); and neglect (all youth: 3.40 [2.27, 5.11]; children: 2.87 [1.73, 4.73]; adolescents: 4.87 [2.24, 10.59]). Several psychopathological features were also associated with youth BPD, including comorbid mood (3.21 [2.13, 4.83]), anxiety (2.30 [1.44, 3.70]) and substance use (2.92 [1.60, 5.31]) disorders; self-harm (2.81 [1.61, 4.90]); suicide ideation (all youth: 2.02 [1.23, 3.32]; children: 6.00 [1.81, 19.84]; adolescents: 1.75 [1.20; 2.54]) and suicide attempt (2.10 [1.21, 3.66]). Results demonstrate that adult and youth BPD share common aetiological and psychopathological correlates. This offers some support for the diagnostic validity of youth BPD and indicates the need for clinical recognition in this age group.
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Affiliation(s)
- Catherine Winsper
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK.
| | | | - Steven Marwaha
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Andrew Thompson
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Julie Eyden
- Department of Psychology, University of Warwick, Coventry CV4 7AL, UK
| | - Swaran P Singh
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
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Bogar CB, Hulse-Killacky D. Resiliency Determinants and Resiliency Processes Among Female Adult Survivors of Childhood Sexual Abuse. JOURNAL OF COUNSELING AND DEVELOPMENT 2011. [DOI: 10.1002/j.1556-6678.2006.tb00411.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Commons Treloar AJ, Lewis AJ. Diagnosing borderline personality disorder: Examination of how clinical indicators are used by professionals in the health setting. CLIN PSYCHOL-UK 2009. [DOI: 10.1080/13284200802392536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - Andrew J. Lewis
- Health, Medicine, Nursing, and Behavioural Sciences, Deakin University , Geelong, Victoria, Australia
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Jones DW. A Psychosocial Understanding of Personality Disorder: The Historical Problem of Moral Insanity. Emotion 2009. [DOI: 10.1057/9780230245136_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Cartwright D. Borderline Personality Disorder: What do We Know? Diagnosis, Course, Co-Morbidity, and Aetiology. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2008. [DOI: 10.1177/008124630803800212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Evidence regarding the diagnostic dilemmas, course, co-morbidity, and aetiology of Borderline Personality Disorder (BPD) is reviewed. After considering problems that the clinician and researcher face in using BPD as a diagnostic category, I argue that current evidence indicates that there is reason to be more optimistic about the course of BPD. Emerging dilemmas in considering co-morbidity in the BPD patient are considered. Aetiological factors are presented in support of a ‘multiple pathways’ model of aetiology where characterological and temperamental characteristics interact in complex idiosyncratic ways.
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Affiliation(s)
- Duncan Cartwright
- Centre for Applied Psychology, School of Psychology, University of KwaZulu-Natal, Howard College Campus, Private Bag X54001, Durban, 4000 South Africa
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Austin MA, Riniolo TC, Porges SW. Borderline personality disorder and emotion regulation: insights from the Polyvagal Theory. Brain Cogn 2007; 65:69-76. [PMID: 17659821 PMCID: PMC2082054 DOI: 10.1016/j.bandc.2006.05.007] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2004] [Revised: 05/07/2006] [Accepted: 05/07/2006] [Indexed: 11/16/2022]
Abstract
The current study provides the first published evidence that the parasympathetic component of the autonomic nervous system differentiates the response profiles between individuals diagnosed with borderline personality disorder (BPD) and controls. Respiratory sinus arrhythmia (RSA), a non-invasive marker of the influence of the myelinated vagal fibers on the heart, and heart period were collected during the presentation of film clips of varying emotional content. The BPD and control groups had similar initial levels of RSA and heart period. However, during the experiment the groups exhibited contrasting trajectories, with the BPD group decreasing RSA and heart period and the control group increasing RSA and heart period. By the end of the experiment, the groups differ significantly on both RSA and heart period. The correlation between the changes in RSA and heart period was significant only for the control group, suggesting that vagal mechanisms mediated the heart period responses only in the control group. The findings were consistent with the Polyvagal Theory [Porges, S. W. (1995). Orienting in a defensive world: Mammalian modifications of our evolutionary heritage: A Polyvagal Theory. Psychophysiology, 32, 301-318; Porges, S. W. (2001). The Polyvagal Theory: Phylogenetic substrates of a social nervous system. International Journal of Psychophysiology, 42, 123-146; Porges, S. W. (2003). Social engagement and attachment: A phylogenetic perspective. Annals of the New York Academy of Sciences, 1008, 31-47.], illustrating different adaptive shifts in autonomic state throughout the course of the experiment. The BPD group ended in a physiological state that supports the mobilization behaviors of fight and flight, while the control group ended in a physiological state that supports social engagement behaviors. These finding are consistent with other published studies demonstrating atypical vagal regulation of the heart with other psychiatric disorders.
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Affiliation(s)
- Marilyn A Austin
- Department of Human Development, University of Maryland, College Park, MD, USA
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