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Hudson CC, Ferguson I, Fan K, Björgvinsson T, Beard C. A general inductive approach to characterize transdiagnostic experiences of emptiness. J Clin Psychol 2024; 80:1726-1735. [PMID: 38579178 DOI: 10.1002/jclp.23689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/29/2024] [Accepted: 03/25/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Despite the pervasiveness of patient-reported emptiness and the high burden it carries, emptiness is poorly understood. In the current study, we used a general inductive approach to examine experiences with emptiness in a diagnostically diverse sample of treatment-seeking patients with severe and acute psychopathology. As a secondary aim, we also examined whether identified themes differed among patients with a primary diagnosis of borderline personality disorder or major depressive disorder. METHOD Participants (n = 150) ranged from 18 to 69 years old (M = 33.15, SD = 12.41; 79.3% non-Hispanic White; 57.3% females). All patients completed the borderline personality disorder module of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Personality Disorders and the Mini International Neuropsychiatric Interview. Interviewers documented patients' responses to follow-up questions. Patients were included in the study if they endorsed chronic feelings of emptiness and elaborations were documented. RESULTS We identified 10 themes associated with patient-reported emptiness: (1) purposeless, (2) lack of connection, (3) numbness, (4) self-deprecation, (5) lack of identity, (6) lack of motivation, (7) hopelessness, (8) lack of pleasure, (9) physical sensation, and (10) dissociation. Themes were consistent across diagnostic status, with one exception: patients with borderline personality disorder were more likely to report that emptiness was associated with dissociation relative to patients with major depressive disorder. CONCLUSION Our results suggest that emptiness may reflect a multifaceted and transdiagnostic construct. Identified themes may help to support the assessment of emptiness and can be used to guide individualized treatments.
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Affiliation(s)
- Chloe C Hudson
- McLean Hospital, Belmont, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| | | | - Kailyn Fan
- McLean Hospital, Belmont, Massachusetts, USA
| | - Thröstur Björgvinsson
- McLean Hospital, Belmont, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Courtney Beard
- McLean Hospital, Belmont, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Culina I, Ranjbar S, Maillard P, Martin-Soelch C, Berney S, Kolly S, André J, Conus P, Kramer U. Symptom domains and psychosocial functioning in borderline personality disorder. Borderline Personal Disord Emot Dysregul 2024; 11:10. [PMID: 38835094 DOI: 10.1186/s40479-024-00255-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 05/28/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Borderline personality disorder (BPD) is often characterized by severe functional impairment, even after a decrease in symptoms. A comprehensive understanding of psychosocial functioning in BPD is necessary to tailor treatment offer, which should address relevant aspects of daily life. The aims of the present study are to (1) conduct a cross-sectional comparison of functioning of a group with BPD and a non-BPD clinical comparison group at service entry, and to (2) assess the relationship between intensity of BPD symptom domains and psychosocial functioning. METHODS The sample consists of N = 65 participants with BPD and N = 57 participants from the clinical comparison group without BPD (non-BPD group). The Revised Borderline Follow-up Interview (BFI-R) was used to evaluate psychosocial functioning and the Revised Diagnostic Interview for Borderlines (DIB-R) to assess BPD symptoms. Linear, logistic, and multinomial regression models were run separately for each aspect of functioning as a function of BPD status or BPD symptom domains. RESULTS Only 23% of participants in the BPD group fulfilled criteria for good overall psychosocial functioning, compared to 53% in the non-BPD group. Furthermore, participants in the BPD group were less likely to have completed a high number of years of education, to work consistently, to be financially independent, to be in a cohabiting relationship and have a good relationship with parents. In addition, various links were identified between BPD symptom domains and functional impairments. CONCLUSIONS Consistent with prior research, the main impairments in functioning in the BPD group are found in the educational and vocational domains. Though some domains show impairment, others, like friendships, may act as potential resources. Further investigation on the relationships with symptom domains is required.
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Affiliation(s)
- Ines Culina
- General Psychiatry Service, Department of Psychiatry, University Hospital Center and University of Lausanne, Lausanne, Switzerland.
- Unit of Clinical and Health Psychology, Department of Psychology, University of Fribourg, Fribourg, Switzerland.
| | - Setareh Ranjbar
- Department of Psychiatry, Psychiatric Epidemiology and Psychopathology Research Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Chantal Martin-Soelch
- Unit of Clinical and Health Psychology, Department of Psychology, University of Fribourg, Fribourg, Switzerland
| | - Sylvie Berney
- General Psychiatry Service, Department of Psychiatry, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - Stéphane Kolly
- General Psychiatry Service, Department of Psychiatry, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - Jérémie André
- General Psychiatry Service, Department of Psychiatry, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - Philippe Conus
- General Psychiatry Service, Department of Psychiatry, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - Ueli Kramer
- General Psychiatry Service, Department of Psychiatry, University Hospital Center and University of Lausanne, Lausanne, Switzerland
- Institute of Psychotherapy, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- Departement of Psychology, University of Windsor, Windsor, Canada
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Tedesco V, Day NJS, Lucas S, Grenyer BFS. Diagnosing borderline personality disorder: Reports and recommendations from people with lived experience. Personal Ment Health 2024; 18:107-121. [PMID: 37997227 DOI: 10.1002/pmh.1599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/17/2023] [Accepted: 10/26/2023] [Indexed: 11/25/2023]
Abstract
Borderline personality disorder (BPD) is a severe mental health condition marked by impairments in self and interpersonal functioning. Stigma from health staff may often result in a reluctance to diagnose, impacting recovery trajectories. Qualitative interviews were conducted with participants (N = 15; M Age = 36.4 years, SD = 7.5; 93.3% female) with lived experience of BPD exploring topics of illness onset, insight, experience of diagnosis and treatment. Qualitative responses were analysed within a co-design framework with a member of the research team who identifies as having a lived experience of BPD. On average, participant symptoms emerged at 12.1 years of age (SD = 6.6 years, range 1.5-27), but diagnoses of BPD were delayed until 30.2 years (SD = 7.8 years, range 18-44) resulting in a 'diagnosis gap' of 18.1 years (SD = 9.6 years, range 3-30). Participant explanations for BPD emergence varied from biological, psychological and social factors. Benefits of diagnosis (e.g., fostering insight, aiding treatment planning and reducing isolation) were contrasted with challenges (e.g., stigma and treatment unavailability). Delay in diagnosis was common, and no participants reported receiving a diagnosis of BPD during their adolescence yet 85% felt they would have benefited from a diagnosis in adolescence. Only a quarter (27%) felt highly supported in the diagnostic process. An ideal four-step diagnosis procedure was outlined based on recommendations from participants with a lived experience; this involved the following: (1) explain the process, (2) assess thoroughly, (3) explore how the features are active in everyday life and (4) link diagnosis to evidence-based treatment planning.
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Affiliation(s)
| | | | - Sophie Lucas
- Psychology, University of Wollongong, Wollongong, Australia
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Natividad A, Huxley E, Townsend ML, Grenyer BFS, Pickard JA. What aspects of mindfulness and emotion regulation underpin self-harm in individuals with borderline personality disorder? J Ment Health 2024; 33:141-149. [PMID: 36916308 DOI: 10.1080/09638237.2023.2182425] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 11/16/2022] [Indexed: 03/16/2023]
Abstract
BACKGROUND Self-harm presents significant risk for individuals with borderline personality disorder (BPD). Both self-harm and BPD are associated with deficits in mindfulness and emotion dysregulation. Previous research suggests that thought suppression and emotional inexpressivity may underpin self-harm in people with BPD, suggesting potential links to self-harm functions common for those with BPD. More research is needed to strengthen our understanding of this relationship. AIMS This study examines how BPD symptoms, mindfulness, emotion dysregulation and self-harm functions are related. METHODS Australian community outpatients diagnosed with BPD (N = 110) completed measures of mindfulness, emotion dysregulation and self-harm functions. Serial mediation analyses were conducted to examine relationships between variables. RESULTS BPD symptoms, chronic emptiness, mindfulness skills, describing and non-reacting, emotion dysregulation areas of emotion regulation strategies and poor emotional clarity were associated with recent self-harm. Various combinations of describing, strategies and clarity mediated the path between emptiness and self-harm functions more likely to be endorsed by individuals with a diagnosis of BPD. Describing was associated with all but anti-suicide function, while strategies was associated with all but anti-dissociation. CONCLUSION The study highlights how individuals with BPD experiencing chronic emptiness may benefit from treatment targeting describing skills and adaptive emotion regulation strategies.
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Affiliation(s)
- Ana Natividad
- School of Psychology, University of Wollongong, Wollongong, Australia
| | - Elizabeth Huxley
- School of Psychology, University of Wollongong, Wollongong, Australia
| | | | - Brin F S Grenyer
- School of Psychology, University of Wollongong, Wollongong, Australia
| | - Judy A Pickard
- School of Psychology, University of Wollongong, Wollongong, Australia
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van Schie CC, Whiting L, Grenyer BFS. How negative self-views may interfere with building positive relationships: An experimental analogue of identity dysfunction in borderline personality disorder. PLoS One 2024; 19:e0301196. [PMID: 38547086 PMCID: PMC10977689 DOI: 10.1371/journal.pone.0301196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/12/2024] [Indexed: 04/02/2024] Open
Abstract
INTRODUCTION A disturbed, negative sense of self is associated with various interpersonal difficulties and is characteristic of disorders such as borderline personality disorder (BPD). Negative self-views may affect an individuals' ability to build positive relationships, including a therapeutic relationship. However, it is not yet well understood how identity disturbances give rise to interpersonal difficulties. Using an experimental analogue design, we tested whether identity disturbances are associated with interpersonal difficulties. METHODS Participants were university students (N = 43, age M = 20.51 (SD = 3.08), women N = 32 (74.4%)) who reported moderate to high levels of BPD features, with 34.9% reporting significant BPD features as measured by the Borderline scale of the Personality Assessment Inventory (PAI-BOR). In a within-subject experimental paradigm using a Social Feedback Task, participants received negative, intermediate, and positive evaluations, supposedly from a panel. Using multilevel models, we tested whether negative self-views were associated with how much the participants liked, trusted, and felt close to each of the three panel members who provided either predominantly negative, intermediate, or positive feedback. RESULTS People with more negative self-views reported lower mood in response to positive feedback. In addition, where people with more positive self-views felt better when receiving feedback that was congruent with their self-views, people with more negative self-views did not report a better mood. Importantly, people with negative self-views felt lower desire to affiliate with the member who provided predominantly positive feedback. Affiliation was not affected when feedback was given by the negative member and intermediate member to those with negative self-views. CONCLUSIONS The findings validated that those with more negative self-views anticipated and expected more negative responses from others. Negative self-views, as relevant for BPD, may explain how people relate differently to those giving different types of feedback. Pervasive negative self-views may interfere with building new relationships including the therapeutic alliance. It may be helpful for clinicians to be aware of the potential challenges around creating a supportive therapeutic relationship for patients with negative self-views. Overly positive affirmations made by clinicians may inadvertently lower the patient's mood and may impede alliance formation.
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Affiliation(s)
| | - Laura Whiting
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Brin F. S. Grenyer
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
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Lee H, Jang J, Kang HS, Lee J, Lee D, Yu H, Ha TH, Park J, Myung W. Understanding of Depressive Symptomatology across Major Depressive Disorder and Bipolar Disorder: A Network Analysis. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:32. [PMID: 38256293 PMCID: PMC10818784 DOI: 10.3390/medicina60010032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024]
Abstract
Background and Objectives: Depressive symptoms are prominent in both major depressive disorder (MDD) and bipolar disorder (BD). However, comparative research on the network structure of depressive symptoms in these two diagnostic groups has been limited. This study aims to compare the network structure of depressive symptoms in MDD and BD, providing a deeper understanding of the depressive symptomatology of each disorder. Materials and Methods: The Zung Self-Rating Depressive Scale, a 20-item questionnaire, was administered to assess the depressive symptoms in individuals with MDD (n = 322) and BD (n = 516). A network analysis was conducted using exploratory graph analysis (EGA), and the network structure was analyzed using regularized partial correlation models. To validate the dimensionality of the Zung SDS, principal component analysis (PCA) was adopted. Centrality measures of the depressive symptoms within each group were assessed, followed by a network comparison test between the two groups. Results: In both diagnostic groups, the network analysis revealed four distinct categories, aligning closely with the PCA results. "Depressed affect" emerged as the most central symptom in both MDD and BD. Furthermore, non-core symptoms, "Personal devaluation" in MDD and "Confusion" in BD, displayed strong centrality. The network comparison test did not reveal significant differences in the network structure between MDD and BD. Conclusions: The absence of significant differences in the network structures between MDD and BD suggests that the underlying mechanisms of depressive symptoms may be similar across these disorders. The identified central symptoms, including "Depressed affect", in both disorders and the distinct non-core symptoms in each highlight the complexity of the depressive symptomatology. Future research should focus on validating these symptoms as therapeutic targets and incorporate various methodologies, including non-metric dimension reduction techniques or canonical analysis.
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Affiliation(s)
- Hyukjun Lee
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (H.L.); (J.J.); (J.L.); (D.L.); (H.Y.); (T.H.H.)
| | - Junwoo Jang
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (H.L.); (J.J.); (J.L.); (D.L.); (H.Y.); (T.H.H.)
| | - Hyo Shin Kang
- Department of Psychology, Kyungpook National University, Daegu 41566, Republic of Korea;
| | - Jakyung Lee
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (H.L.); (J.J.); (J.L.); (D.L.); (H.Y.); (T.H.H.)
| | - Daseul Lee
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (H.L.); (J.J.); (J.L.); (D.L.); (H.Y.); (T.H.H.)
| | - Hyeona Yu
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (H.L.); (J.J.); (J.L.); (D.L.); (H.Y.); (T.H.H.)
| | - Tae Hyon Ha
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (H.L.); (J.J.); (J.L.); (D.L.); (H.Y.); (T.H.H.)
| | - Jungkyu Park
- Department of Psychology, Kyungpook National University, Daegu 41566, Republic of Korea;
| | - Woojae Myung
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (H.L.); (J.J.); (J.L.); (D.L.); (H.Y.); (T.H.H.)
- Department of Psychiatry, Seoul National University College of Medicine, Seoul 03087, Republic of Korea
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7
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Dyson T, Thomas SJ, Townsend ML, Finch A, South A, Barkus E, Walter E, Mendonca C, Grenyer BFS, Pickard JA. Salivary testosterone and cortisol levels in borderline personality disorder before and after a 12-week group dialectical behavior therapy intervention. Front Psychol 2023; 14:1195187. [PMID: 37529315 PMCID: PMC10389657 DOI: 10.3389/fpsyg.2023.1195187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/03/2023] [Indexed: 08/03/2023] Open
Abstract
Background Borderline Personality Disorder (BPD) is a chronic, debilitating, and difficult to treat condition. BPD has recently been linked to steroid hormone dysregulation and medical conditions characterized by disturbed androgen metabolism. This study aimed to investigate cortisol and testosterone levels in BPD, and changes in hormones following psychological treatment. Methods Participants with BPD (n = 33) completed a 12-week Dialectical Behavior Therapy group program. Pre and post salivary testosterone and cortisol were analyzed. Baseline hormones in the BPD group were compared to age-and-sex matched controls (n = 33). Non-parametric tests were utilized to investigate group differences, pre-post treatment hormone and symptom changes, and associations between symptoms and hormone levels. Results Participants with BPD had significantly higher testosterone levels than controls. Mean testosterone levels in females with BPD were double that of female controls. Testosterone and cortisol levels were related, and some BPD symptoms were associated with with hormone levels. BPD symptoms reduced significantly with treatment, however pre to post hormone levels did not change. Conclusions This study supports an association between BPD symptoms and neuroendocrine dysfunction at baseline, however we found no reduction in hormone dysfunction post treatment. Further research into relationships between stress signaling and neuroendocrine disturbances in BPD may inform aetiological and treatment models. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12618000477224. Registered on 3 April 2018.
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Affiliation(s)
- Tori Dyson
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Susan J. Thomas
- School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | | | - Adam Finch
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Alexandra South
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Emma Barkus
- Department of Psychology, Northumbria University, Newcastle upon Tyne, North East England, United Kingdom
| | - Emma Walter
- School of Psychology, Western Sydney University, Penrith, NSW, Australia
| | - Carley Mendonca
- School of Psychology, University of Technology Sydney, Sydney, NSW, Australia
| | - Brin F. S. Grenyer
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Judy A. Pickard
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
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Ahlberg R, Du Rietz E, Ahnemark E, Andersson LM, Werner-Kiechle T, Lichtenstein P, Larsson H, Garcia-Argibay M. Real-life instability in ADHD from young to middle adulthood: a nationwide register-based study of social and occupational problems. BMC Psychiatry 2023; 23:336. [PMID: 37173664 PMCID: PMC10176742 DOI: 10.1186/s12888-023-04713-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 03/23/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Studies using self-reports indicate that individuals with ADHD are at increased risk for functional impairments in social and occupational settings, but evidence around real-life instability remains limited. It is furthermore unclear if these functional impairments in ADHD differ across sex and across the adult lifespan. METHOD A longitudinal observational cohort design of 3,448,440 individuals was used to study the associations between ADHD and residential moves, relational instability and job shifting using data from Swedish national registers. Data were stratified on sex and age (18-29 years, 30-39 years, and 40-52 years at start of follow up). RESULTS 31,081 individuals (17,088 males; 13,993 females) in the total cohort had an ADHD-diagnosis. Individuals with ADHD had an increased incidence rate ratio (IRR) of residential moves (IRR 2.35 [95% CI, 2.32-2.37]), relational instability (IRR = 1.07 [95% CI, 1.06-1.08]) and job shifting (IRR = 1.03 [95% CI, 1.02-1.04]). These associations tended to increase with increasing age. The strongest associations were found in the oldest group (40-52 years at start of follow). Women with ADHD in all three age groups had a higher rate of relational instability compared to men with ADHD. CONCLUSION Both men and women with a diagnosis of ADHD present with an increased risk of real-life instability in different domains and this behavioral pattern was not limited to young adulthood but also existed well into older adulthood. It is therefore important to have a lifespan perspective on ADHD for individuals, relatives, and the health care sector.
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Affiliation(s)
- Rickard Ahlberg
- School of Medical Sciences, Örebro University, Örebro, 701 82, Sweden.
| | - E Du Rietz
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - E Ahnemark
- Department of Neuropsychiatry, Region Stockholm, Stockholm, Sweden
| | | | - T Werner-Kiechle
- Global Medical Affairs, Shire International GmbH, Zug, Switzerland
| | - P Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - H Larsson
- School of Medical Sciences, Örebro University, Örebro, 701 82, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - M Garcia-Argibay
- School of Medical Sciences, Örebro University, Örebro, 701 82, Sweden
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Kvarstein EH, Frøyhaug M, Pettersen MS, Carlsen S, Ekberg A, Fjermestad-Noll J, Ulvestad DA, Gikling EL, Hjermann E, Lindberget K, Omvik S, Eikenæs IUM, Hummelen B, Morken KTE, Wilberg T, Pedersen GAF. Improvement of personality functioning among people treated within personality disorder mental health services. A longitudinal, observational study. Front Psychiatry 2023; 14:1163347. [PMID: 37229394 PMCID: PMC10203961 DOI: 10.3389/fpsyt.2023.1163347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/21/2023] [Indexed: 05/27/2023] Open
Abstract
Objective Evidence-based personality disorder (PD) treatments are dominated by interventions targeting Borderline PD, although clinical populations characteristically include different PD features and severity. Personality functioning is a new concept intended to capture common features across PDs. This study aimed to investigate longitudinal improvement of personality functioning in a clinical sample assigned to PD treatment. Method An observational, large, longitudinal study of patients in PD treatments on specialist mental health service levels (N = 1,051). DSM-5 PDs were systematically assessed on referral. Personality functioning was repeatedly assessed (LPFS-BF-2.0), supplemented by symptom distress (anxiety: PHQ-GAD-7, depression: PHQ-9), and social/occupational activity (WSAS, work/study activity). Statistics were linear mixed models. Results Thirty per cent had personality difficulties below PD threshold. Among PDs, 31% had Borderline (BPD), 39% Avoidant (AvPD), 15% not otherwise specified, 15% other PDs, and 24% > one PD. More severe initial LPFS-BF was associated with younger age, presence of PD and increasing number of total PD criteria. Across PD conditions, LPFS-BF, PHQ-9 and GAD-7 improved significantly (overall effect size 0.9). Mean duration of PD treatment was 15 (SD 9) months. Drop-out rates were low (12%). LPFS-BF improvement-rates were higher for BPD. Younger age was moderately associated with slower PHQ-9 improvement. Work/study activity was initially poor, poorer levels associated with AvPD and younger age, and improvement was non-significant across PD conditions. AvPD was associated with slower WSAS improvement-rates. Conclusion Personality functioning improved across PD conditions. The results highlight BPD improvements. The study points to challenges concerning AvPD treatment, poor occupational activity and age-related differences.
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Affiliation(s)
- Elfrida H. Kvarstein
- Section for Personality Psychiatry and Specialized Treatment, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Mathias Frøyhaug
- Groruddalen District Psychiatric Center, Akershus University Hospital, Akershus, Norway
| | | | - Sara Carlsen
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
| | - Andreas Ekberg
- Section for Personality Psychiatry and Specialized Treatment, Oslo University Hospital, Oslo, Norway
- Department for Adult Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
| | - Jane Fjermestad-Noll
- Section for Personality Psychiatry and Specialized Treatment, Oslo University Hospital, Oslo, Norway
| | - Dag A. Ulvestad
- Section for Personality Psychiatry and Specialized Treatment, Oslo University Hospital, Oslo, Norway
| | | | - Eirik Hjermann
- Kronstad District Psychiatric Center, Haukeland University Hospital, Bergen, Norway
| | - Kenneth Lindberget
- Strømme District Psychiatric Center, Sørlandet Hospital, Kristiansand, Norway
| | - Siri Omvik
- Kronstad District Psychiatric Center, Haukeland University Hospital, Bergen, Norway
| | - Ingeborg U-M. Eikenæs
- Section for Personality Psychiatry and Specialized Treatment, Oslo University Hospital, Oslo, Norway
| | - Benjamin Hummelen
- Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
| | - Katharina T. E. Morken
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Theresa Wilberg
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
| | - Geir A. F. Pedersen
- Section for Personality Psychiatry and Specialized Treatment, Oslo University Hospital, Oslo, Norway
- Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
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10
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Woodbridge J, Townsend ML, Reis SL, Grenyer BFS. Patient perspectives on non-response to psychotherapy for borderline personality disorder: a qualitative study. Borderline Personal Disord Emot Dysregul 2023; 10:13. [PMID: 37072881 PMCID: PMC10114439 DOI: 10.1186/s40479-023-00219-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 03/27/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Despite increasing evidence for the effectiveness of psychotherapy for Borderline Personality Disorder (BPD), estimates show that approximately half of those in treatment do not clinically improve or reach reliable change criteria. There are limited qualitative descriptions of treatment factors associated with non-response from the perspectives of those struggling to improve. METHOD Eighteen people (72.2% female, mean age 29.4 (SD = 8)) with experience of receiving psychotherapeutic treatment for BPD were interviewed to obtain their perspectives on hindering factors in treatment and what may be helpful to reduce non-response. The data in this qualitative study was analysed thematically. RESULTS Four domains were created from the insights patients shared on non-response and what may be needed to mitigate it. The focus of Domain 1 was that therapy cannot be effective until two factors are in place. First, the patient needs sufficient safety and stability in their environment in order to face the challenges of therapy. Second, they need to be able to access therapy. Domain 2 described factors the patients themselves contribute. The themes in this domain were described as phases that need to be progressed through before therapy can be effective. These phases were ceasing denial that help is warranted and deserved, taking responsibility for behaviours that contribute to unwellness, and committing to the hard work that is required for change. Domain 3 described how the lack of a safe alliance and ruptures in the safety of the relationship with the therapist can contribute to non-response. Domain 4 was comprised of factors that patients identified as supportive of moving through the barriers to response. The first theme in this domain was prioritising the safety of the therapy relationship. The second theme was giving a clear diagnosis and taking a collaborative approach in sessions. The final theme described the importance of focusing on practical goals with the patient to create tangible life changes. CONCLUSION This study found that non-response is complex and multifaceted. First, it is clear that systems need to be in place to support access to adequate care and foster life stability. Second, considerable effort may be needed at the engagement phase of therapy to clarify expectations. Third, attention to specific interpersonal challenges between patients and therapists is an important focus. Finally, structured work to improve relationships and vocational outcomes is indicated.
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Affiliation(s)
- Jane Woodbridge
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Building 22, Wollongong, NSW, 2522, Australia
| | - Michelle L Townsend
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Building 22, Wollongong, NSW, 2522, Australia
| | - Samantha L Reis
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Building 22, Wollongong, NSW, 2522, Australia
| | - Brin F S Grenyer
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Building 22, Wollongong, NSW, 2522, Australia.
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11
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Carmel A, Comtois KA. Integrating Dialectical Behavior Therapy-Accepting the Challenges of Employment and Self-Sufficiency (DBT-ACES) Strategies into Cognitive Behavioral Therapy. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2023. [DOI: 10.1007/s10879-023-09580-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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12
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Owczarek M, Karatzias T, McElroy E, Hyland P, Cloitre M, Kratzer L, Knefel M, Grandison G, Ho GWK, Morris D, Shevlin M. Borderline Personality Disorder (BPD) and Complex Posttraumatic Stress Disorder (CPTSD): A Network Analysis in a Highly Traumatized Clinical Sample. J Pers Disord 2023; 37:112-129. [PMID: 36723419 DOI: 10.1521/pedi.2023.37.1.112] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Whether complex posttraumatic stress disorder (CPTSD) and borderline personality disorder (BPD) diagnoses differ substantially enough to warrant separate diagnostic classifications has been a subject of controversy for years. To contribute to the nomological network of cumulative evidence, the main goal of the present study was to explore, using network analysis, how the symptoms of ICD-11 PTSD and disturbances in self-organization (DSO) are interconnected with BPD in a clinical sample of polytraumatized individuals (N = 330). Participants completed measures of life events, CPTSD, and BPD. Overall, our study suggests that BPD and CPTSD are largely separated. The bridges between BPD and CPTSD symptom clusters were scarce, with "Affective Dysregulation" items being the only items related to BPD. The present study contributes to the growing literature on discriminant validity of CPTSD and supports its distinctiveness from BPD. Implications for treatment are discussed.
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Affiliation(s)
- Marcin Owczarek
- School of Psychology, Ulster University, Derry, Northern Ireland
| | - Thanos Karatzias
- Edinburgh Napier University, School of Health & Social Care, Edinburgh, UK.,NHS Lothian, Rivers Centre for Traumatic Stress, Edinburgh, UK
| | - Eoin McElroy
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland
| | - Marylène Cloitre
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, California.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Leonhard Kratzer
- Department of Psychotraumatology, Clinic St. Irmingard, Prien am Chiemsee, Germany
| | | | | | - Grace W K Ho
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong
| | - Deborah Morris
- Centre for Developmental and Complex Trauma St Andrews Healthcare, UK
| | - Mark Shevlin
- School of Psychology, Ulster University, Derry, Northern Ireland
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13
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Improving treatment outcomes for borderline personality disorder: what can we learn from biomarker studies of psychotherapy? Curr Opin Psychiatry 2023; 36:67-74. [PMID: 36017562 DOI: 10.1097/yco.0000000000000820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Borderline personality disorder (BPD) is a severe and common psychiatric disorder and though evidence-based psychotherapies are effective, rates of treatment nonresponse are as high as 50%. Treatment studies may benefit from interdisciplinary approaches from neuroscience and genetics research that could generate novel insights into treatment mechanisms and tailoring interventions to the individual. RECENT FINDINGS We provide a timely update to the small but growing body of literature investigating neurobiological and epigenetic changes and using biomarkers to predict outcomes from evidence-based psychotherapies for BPD. Using a rapid review methodology, we identified eight new studies, updating our earlier 2018 systematic review. Across all studies, neuroimaging ( n = 18) and genetics studies ( n = 4) provide data from 735 participants diagnosed with BPD (mean sample size across studies = 33.4, range 2-115). SUMMARY We report further evidence for psychotherapy-related alterations of neural activation and connectivity in regions and networks relating to executive control, emotion regulation, and self/interpersonal functioning in BPD. Emerging evidence also shows epigenetic changes following treatment. Future large-scale multisite studies may help to delineate multilevel treatment targets to inform intervention design, selection, and monitoring for the individual patient via integration of knowledge generated through clinical, neuroscience, and genetics research.
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14
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Jewell M, Bailey RC, Curran RL, Grenyer BFS. Evaluation of a skills-based peer-led art therapy online-group for people with emotion dysregulation. Borderline Personal Disord Emot Dysregul 2022; 9:33. [PMID: 36447216 PMCID: PMC9708140 DOI: 10.1186/s40479-022-00203-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 07/13/2022] [Accepted: 10/11/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE We developed and piloted a novel art-based online skills program led by a peer mental health professional with lived experience of complex mental health, including Borderline Personality Disorder (BPD). Key challenges of living with BPD and emotion dysregulation were addressed through artmaking informed by a dialectical framework and skills, to evaluate acceptability and efficacy. METHOD A structured, manualised 2-hour weekly arts-based skills program was piloted for people with BPD over 18 weeks. Evaluation included both quantitative and qualitative measures at commencement and completion. RESULTS Thirty-eight participants enrolled in the program (89.5% identified she/her pronouns, average age 33.6 years), and 31 completed (82% retention). Multilevel modelling analysis of the primary outcome variable Difficulties in Emotion Regulation Scale (DERS) demonstrated a large improvement over time (effect size Cohen's d = 1.77). Qualitative thematic analysis found participants had improved capacity to regulate emotions and tolerate distress, improved connection with others, enhanced understanding of the self, and higher hope for living well. We found that artmaking facilitated processes and helped the expression of difficult emotions, symbolise challenging relationships, and facilitate greater self-understanding. Participants reported high levels of satisfaction, and 77.4% reported that the program had increased wellbeing. CONCLUSION This novel artmaking program for emotion dysregulation and BPD was acceptable and potentially effective. Peer facilitation using arts-based skills is a modality of therapy for further investigation.
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Affiliation(s)
- Mahlie Jewell
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, 2522, Sydney, NSW, Australia.,Western Sydney University, Sydney, Australia
| | - Rachel C Bailey
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, 2522, Sydney, NSW, Australia
| | | | - Brin F S Grenyer
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, 2522, Sydney, NSW, Australia.
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15
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Martin JA, Levy KN. Chronic feelings of emptiness in a large undergraduate sample: Starting to fill the void. Personal Ment Health 2022; 16:190-203. [PMID: 34731525 DOI: 10.1002/pmh.1531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 10/13/2021] [Indexed: 11/11/2022]
Abstract
Chronic emptiness in borderline personality disorder (BPD) has received little empirical attention. We sought to examine basic properties of a single chronic emptiness item, including prevalence, reliability, validity, the relation of the emptiness item to other BPD criteria, and measures of personality. Undergraduates enrolled in psychology courses over 12 years' time completed the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) (N = 22,217). Subsets of participants completed the International Personality Disorder Examination-Screening Questionnaire (IPDE-SQ) (N = 2732), The Revised NEO Personality Inventory (Anxiety, Angry Hostility, Depression, Positive Emotions [reversed], and Impulsivity facets) (N = 10,506), and the Depression Anxiety Stress Scales (DASS) (N = 1110) as validity indicators; 10.0% of respondents endorsed emptiness. Reliability indices suggested moderate levels of reliability between two emptiness items (r(2730) = 0.61, p < 0.001). Among BPD criteria, emptiness and identity disturbance correlated most strongly (r(22,215) = 0.81, p < 0.001). MSI emptiness was more correlated with depression on the NEO (r(10,504) = 0.43, p < 0.001) and DASS (r(1108) = 0.51, p < 0.001) than other facets of negative affect. Emptiness was more correlated with greater borderline pathology than any other MSI-BPD item (Sample 1, rtet = 0.87; Sample 2, rtet = 0.86). This criterion warrants further study and attention, especially related to assessment of BPD.
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Affiliation(s)
- Jacob A Martin
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Kenneth N Levy
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania, USA
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16
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Biberdzic M, Grenyer BFS. How Much Training Do We Need? Assessing the Validity and Interrater Reliability of the PDM-2's Psychodiagnostic Chart among Less Experienced Clinicians. J Pers Assess 2022; 105:436-444. [PMID: 35771210 DOI: 10.1080/00223891.2022.2086133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The Psychodynamic Diagnostic Manual - Second Edition (PDM-2) has emerging evidence supporting its clinical utility, yet one of the main limitations remains the conjecture that considerable training and experience is required. It also remains unclear how the PDM-2 framework compares with current DSM measures of personality pathology such as the Level of Personality Functioning Scale (LPFS). The aim of the present study is to examine these issues by testing whether less clinically experienced second year doctoral psychology students are able to reliably assess patients' level of personality pathology using the PDM-2's Psychodiagnostic Chart (PDC-2), and to investigate the convergence between the PDC-2 and the LPFS. Results showed adequate inter-rater reliability for both of the main PDC-2 axes, with 52% of the variance for the overall personality organization (P-Axis) rating, and 29% of the overall M-Axis score being due to rater consensus. Reliability of individual ratings ranged from fair to excellent for the overall scores on both axes (ICC = 0.59 to .90). Results also showed that student evaluations were valid, with the latter's assessment of the patients' level of personality organization converging both with the experts' rating of the PDC-2 as well as the LPFS. Implications for clinical training are discussed.
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Affiliation(s)
- Marko Biberdzic
- School of Psychology Illawarra Health and Medical Research Institute, University of Wollongong
| | - Brin F S Grenyer
- School of Psychology Illawarra Health and Medical Research Institute, University of Wollongong
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17
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Calati R, Romano D, Lopez-Castroman J, Turolla F, Zimmermann J, Madeddu F, Courtet P, Preti E. BOrderliNe symptoms and suIcide-related outcomes: proTOcol for a systematic review/meta-analysis and an individual patient data meta-analysis (BONITO study). BMJ Open 2022; 12:e056492. [PMID: 35618328 PMCID: PMC9137335 DOI: 10.1136/bmjopen-2021-056492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Prevalence of suicidal thoughts and behaviours is higher among patients with borderline personality disorder than the general population. However, evidence concerning the role of specific borderline symptoms for predicting suicide-related outcomes is lacking and no systematic review/meta-analysis (SR/MA) investigated this topic. Our aim will be to investigate the relationship between any borderline symptom (except criterion 5) and suicide-related outcomes both through an SR/MA and an individual patient data meta-analysis (IPD-MA). METHODS We will search PubMed/MEDLINE, Scopus, Web of Science, Embase, PsycINFO, CINAHL and Cochrane Library databases from 1974 until September 2021. Both published and unpublished studies showing the association between any borderline symptom (except criterion 5) and suicide-related outcomes (death wish, suicidal ideation, suicidal plan, non-suicidal self-injury, deliberate self-harm, suicide attempt, suicidal behaviour disorder, suicide) will be included. Two team members will independently perform the selection of the studies and data extraction, with the supervision of two other members in case of discrepancies; and assess each study with study quality assessment tools by National Institutes of Health and Grading of Recommendations Assessment, Development and Evaluation. Each author will be contacted. If possible, we will perform both random-effect meta-analyses on the collected data (odds, risk, rate ratios or correlations) and an IPD-MA on collected databases. ETHICS AND DISSEMINATION This study does not require an ethical approval. Results will be publicly disseminated, included in research presentations and published in peer-review journals. PROSPERO REGISTRATION NUMBER CRD42018078696.
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Affiliation(s)
- Raffaella Calati
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
- Department of Adult Psychiatry, Nimes University Hospital, Nimes, France
| | - Daniele Romano
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
- Department of History, Society and Human Studies, University of Salento, Lecce, Italy
| | - Jorge Lopez-Castroman
- Department of Adult Psychiatry, Nimes University Hospital, Nimes, France
- France Institute of Functional Genomics, CNRS, INSERM, University of Montpellier, Montpellier, France
- CIBERSAM, Madrid, Spain
| | - Federica Turolla
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | | | - Fabio Madeddu
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Philippe Courtet
- France Institute of Functional Genomics, CNRS, INSERM, University of Montpellier, Montpellier, France
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, Montpellier, France
| | - Emanuele Preti
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
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18
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Grenyer BFS, Townsend ML, Lewis K, Day N. To love and work: A longitudinal study of everyday life factors in recovery from borderline personality disorder. Personal Ment Health 2022; 16:138-154. [PMID: 35538561 PMCID: PMC9287094 DOI: 10.1002/pmh.1547] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 04/22/2022] [Accepted: 04/25/2022] [Indexed: 11/25/2022]
Abstract
Although recovery from borderline personality disorder (BPD) is common, not all individuals improve over time. This study sought to examine the features that contribute to response or non-response for individuals at different stages of recovery from BPD over a longitudinal follow-up. Participants were individuals with a diagnosis of BPD that were followed up after 1 year of receiving psychological treatment. There were no significant differences between participants at intake across key indices; however, at 1-year follow-up, two groups were distinguishable as either 'functioning well' (n = 23) or 'functioning poorly' (n = 25) based on symptomatology and functional impairment. Participant qualitative responses were analysed thematically and via Leximancer content analysis. Thematic analysis indicated three key themes: (1) love of self and others, (2) making a contribution through work and study and (3) stability in daily life. Participants who were 'functioning well' described meaningful relationships with others, enjoyment in vocation, and described less frequent or manageable life crises. The 'functioning poorly' group described relationship conflicts, vocational challenges, feelings of aimlessness and purposelessness, instability in daily living and frequent crises. Leximancer content analysis visually depicted these divergent thematic nomological networks. Corroborating quantitative analyses indicated significant differences between these groups for social, occupational and symptom profiles. These findings highlight the centrality of achieving the capacity to 'love and work' in fostering a sense of personal recovery. Treatments may need specific focus on these factors, as they appeared to reinforce symptomatic trajectories of either improvement or poor non-response to therapy.
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Affiliation(s)
- Brin F S Grenyer
- School of Psychology, Building 22, University of Wollongong, Wollongong, New South Wales.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales
| | - Michelle L Townsend
- School of Psychology, Building 22, University of Wollongong, Wollongong, New South Wales.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales
| | - Kate Lewis
- School of Education, University of Wollongong, Wollongong, New South Wales, Australia.,Early Start, University of Wollongong, Wollongong, New South Wales, Australia
| | - Nicholas Day
- School of Psychology, Building 22, University of Wollongong, Wollongong, New South Wales.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales
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19
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Juurlink TT, Betts JK, Nicol K, Lamers F, Beekman ATF, Cotton SM, Chanen AM. Characteristics and Predictors of Educational and Occupational Disengagement Among Outpatient Youth With Borderline Personality Disorder. J Pers Disord 2022; 36:116-128. [PMID: 34427492 DOI: 10.1521/pedi_2021_35_534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study aimed to investigate predictors of vocational disengagement (referred to as Not in Employment, Education, or Training [NEET]) in young people with borderline personality disorder (BPD). The sample comprised 112 outpatients with a BPD diagnosis, aged 15-25 years, who participated in a randomized controlled trial (ANZCTR12610000100099). The proportion of participants who were NEET (39.3%) at study entry did not improve after 18 months and NEET status frequently changed. Therefore, multinomial regression analyses were used to study three groups: Non-NEET, NEET, and Unstable NEET status. NEET status was predicted by not achieving expected age-appropriate educational milestones, greater instability in identity, and emptiness. Greater instability in interpersonal relationships and identity predicted Unstable NEET status. The findings suggest that specific vocational interventions, that also incorporate a focus on interpersonal functioning, emptiness, and identity disturbance, are needed to improve functioning in youth with BPD, especially when educational milestones are not achieved.
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Affiliation(s)
- Trees T Juurlink
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, The Netherlands and GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Jennifer K Betts
- Orygen and Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Katie Nicol
- Orygen and Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Femke Lamers
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, The Netherlands and GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Aartjan T F Beekman
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, The Netherlands and GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Sue M Cotton
- Orygen and Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Andrew M Chanen
- Orygen and Centre for Youth Mental Health, The University of Melbourne, Australia
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20
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Dominiak M, Jażdżyk P, Antosik-Wójcińska AZ, Konopko M, Bieńkowski P, Świȩcicki Ł, Sienkiewicz-Jarosz H. The impact of bipolar spectrum disorders on professional functioning: A systematic review. Front Psychiatry 2022; 13:951008. [PMID: 36090375 PMCID: PMC9448890 DOI: 10.3389/fpsyt.2022.951008] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/28/2022] [Indexed: 11/24/2022] Open
Abstract
AIMS The impact of bipolar spectrum (BS) disorders on professional functioning has not been systematically reviewed yet. Since even subsyndromal symptoms may disturb functioning, the determination of the prognostic value of the spectrum of bipolarity for employment seems extremely relevant. The aim of this study was to assess the impact of BS disorders on professional functioning. MATERIALS AND METHODS A systematic review of the literature (namely, cohort and cross-sectional studies) investigating a link between BS disorders and employment was performed in accordance with PRISMA guidelines. BS was defined based on the concept of two-dimensional BS by Angst. Occupational outcomes and factors affecting employment were evaluated as well. RESULTS Seventy-four studies were included. All disorders comprising BS had a negative impact on occupational status, work performance, work costs, and salary, with the greatest unfavorable effect reported by bipolar disorder (BD), followed by borderline personality disorder (BPD), major depressive disorder (MDD), and dysthymia. Employment rates ranged from 40 to 75% (BD), 33 to 67% (BPD), 61 to 88% (MDD), and 86% (dysthymia). The factors affecting employment most included: cognitive impairments, number/severity of symptoms, namely, subsyndromal symptoms (mainly depressive), older age, education, and comorbidity (substance abuse, personality disorders, anxiety, depression, ADHD, PTSD). CONCLUSION Bipolar spectrum symptoms exert a negative impact on professional functioning. Further evaluation of affecting factors is crucial for preventing occupational disability.
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Affiliation(s)
- Monika Dominiak
- Department of Pharmacology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Piotr Jażdżyk
- Department of Affective Disorders, Institute of Psychiatry and Neurology, Warsaw, Poland.,Chair and Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland
| | | | - Magdalena Konopko
- First Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | | | - Łukasz Świȩcicki
- Department of Affective Disorders, Institute of Psychiatry and Neurology, Warsaw, Poland
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21
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D'Agostino A, Pepi R, Rossi Monti M, Starcevic V, Price A. Measuring emptiness: Validation of the Italian version of the Subjective Emptiness Scale in clinical and non-clinical populations. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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22
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Konjusha A, Hopwood CJ, Price AL, Masuhr O, Zimmermann J. Investigating the Transdiagnostic Value of Subjective Emptiness. J Pers Disord 2021; 35:788-800. [PMID: 33661017 DOI: 10.1521/pedi_2021_35_510] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
It is common for people with mental health problems to report feelings of emptiness. However, the association of subjective emptiness with specific disorders and its unique role within dimensional taxonomies of personality pathology is not well understood. The present study assesses the transdiagnostic value of subjective emptiness using a recently developed self-report measure in a mixed sample of 157 participants. The authors investigated the associations of emptiness with clinically relevant variables, including borderline personality disorder symptoms, depression, anxiety, suicidal ideation, and suicide attempts. Subjective emptiness showed strong positive relationships with all criteria. Regression models controlling for impairments of personality functioning, maladaptive personality traits, and current symptom distress supported the incremental validity of emptiness for specific disorder constructs and suicidality. These findings indicate that emptiness represents a facet of psychopathology that can be particularly useful for the classification of mental disorders, and in particular internalizing disorders involving self-dysfunction and detachment.
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Affiliation(s)
| | | | | | - Oliver Masuhr
- Asklepios Fachklinikum Tiefenbrunn, Rosdorf, Germany
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23
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Vanwoerden S, Hofmans J, De Clercq B. Reciprocal effects between daily situational perceptions and borderline personality symptoms in young adulthood: the role of childhood parenting experiences. Psychol Med 2021; 51:2388-2398. [PMID: 32321603 DOI: 10.1017/s0033291720000987] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Recent research has emphasized the importance of within-person transactions between situational perceptions and borderline symptomatology. The current study extends current evidence by evaluating a broad range of situational perceptions and their transactions with borderline symptomatology across both private and professional contexts. Additionally, it explores whether early experiences of parental harsh punishment and emotional support during childhood, two well-established etiological factors in developmental theories of borderline symptomatology, influence the effect of daily situation perception in adulthood on borderline symptom presentation. METHODS N = 131 young adults (Mage = 20.97, s.d.age = 1.64) completed end-of-day diaries of their borderline symptoms and perceptions of the home and school or work environment for 14 days. During their mid-childhood, reports of maternal strategies of harsh punishment and emotional support were collected. RESULTS Findings revealed that on the same day, borderline symptoms were associated with more negative and stressful, and less positive perceptions of both the private and professional context. Additionally, borderline symptoms predicted more negative and stressful perceptions of school/work on subsequent days. Finally, while early harsh punishment predicted overall increases in daily borderline symptoms 10 years later, emotionally supportive parenting in childhood predicted decreases in borderline symptom expression in less positive and more stressful contexts. CONCLUSIONS The current study points to the importance of managing BPD symptoms to reduce subsequent negative perceptions of the environment, and also indicates the relevance of exploring adult person-situation processes based on early parenting experiences.
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Miller CE, Townsend ML, Grenyer BFS. Understanding chronic feelings of emptiness in borderline personality disorder: a qualitative study. Borderline Personal Disord Emot Dysregul 2021; 8:24. [PMID: 34365966 PMCID: PMC8351135 DOI: 10.1186/s40479-021-00164-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 07/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic feelings of emptiness are significant in the lives of people with Borderline Personality Disorder (BPD). Feelings of emptiness have been linked to impulsivity, self-harm, suicidal behaviour and impaired psychosocial function. This study aimed to understand the experience of chronic emptiness, the cognitions, emotions and behaviours linked to emptiness, and clarify the differences between chronic emptiness and hopelessness, loneliness and depression. METHODS This study interviewed people (n = 15) with BPD and used a template analysis qualitative approach to understand their experiences of chronic feelings of emptiness. RESULTS Chronic feelings of emptiness were experienced as a feeling of disconnection from both self and others, and a sense of numbness and nothingness which was frequent and reduced functional capacity. Feelings of purposelessness and unfulfillment were closely associated with emptiness, and most participants experienced emptiness as distressing. Responses to feelings of emptiness varied, with participants largely engaging in either impulsive strategies to tolerate feelings of emptiness or distracting by using adaptive behaviours. Most participants distinguished chronic feelings of emptiness from loneliness, hopelessness, dissociation, and depression. CONCLUSIONS Feelings of chronic emptiness are an important and challenging symptom of BPD which require clinical intervention. Strengthening identity, sense of purpose and vocational and relationship functioning may reduce the intensity of emptiness.
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Affiliation(s)
- Caitlin E Miller
- School of Psychology, University of Wollongong, Building 22, NSW, 2522, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, NSW, Wollongong, Australia
| | - Michelle L Townsend
- School of Psychology, University of Wollongong, Building 22, NSW, 2522, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, NSW, Wollongong, Australia
| | - Brin F S Grenyer
- School of Psychology, University of Wollongong, Building 22, NSW, 2522, Wollongong, Australia. .,Illawarra Health and Medical Research Institute, University of Wollongong, NSW, Wollongong, Australia.
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Woodbridge J, Reis S, Townsend ML, Hobby L, Grenyer BFS. Searching in the dark: Shining a light on some predictors of non-response to psychotherapy for borderline personality disorder. PLoS One 2021; 16:e0255055. [PMID: 34314461 PMCID: PMC8315515 DOI: 10.1371/journal.pone.0255055] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 07/08/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Borderline Personality Disorder (BPD) is a prevalent and serious mental health condition. People can experience recovery or remission after receiving psychotherapy for BPD; however, it is estimated that about 45% of people in well conducted treatment trials do not respond adequately to current psychological treatments. AIM To further advance psychotherapies for BPD by identifying the factors that contribute to the problem of non-response. METHOD 184 consecutive participants with BPD in community treatment were naturalistically followed up over 12 months and measures of personality and social functioning were examined. Logistic regressions were used to determine which baseline factors were associated with the likelihood of being a non-responder after 12 months of psychotherapy. After 12 months, 48.4% of participants were classed as non-responders due to a lack of reduction in BPD symptoms according to the Reliable Change Index (RCI) method. RESULTS At baseline intake, patients who endorsed an adult preoccupied attachment relationship style and increased anger were more likely to be a non-responder regarding BPD symptoms at 12 months. In addition, those with preoccupied attachment patterns in their adult relationships were more likely to be non-responders regarding general psychological distress at follow up. Higher baseline levels of paranoia and endorsement of a dismissive adult relationship style was associated with being a non-responder in regard to global functioning. CONCLUSIONS Consistent with previous research, almost half of the sample did not achieve reliable change at 12-month follow up. A relationship style characterised by preoccupied insecurity and high anger seemed to be particularly challenging in being able to benefit from psychotherapy. This style may have affected both relationships outside, but also inside therapy, complicating treatment engagement and alliance with the therapist. Early identification and modification of treatment based on challenges from these relationship styles may be one way to improve psychotherapy outcomes for BPD.
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Affiliation(s)
- Jane Woodbridge
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, Australia
| | - Samantha Reis
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, Australia
| | - Michelle L. Townsend
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, Australia
| | - Lucy Hobby
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, Australia
- School of Education, Western Sydney University, Penrith, Australia
| | - Brin F. S. Grenyer
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, Australia
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Pickard JA, Finch A, Huxley E, Townsend ML, Deuchar S, Lewis KL, Pratt J, Grenyer BFS. Assessing the efficacy of a stepped-care group treatment programme for borderline personality disorder: study protocol for a pragmatic trial. Trials 2021; 22:383. [PMID: 34099033 PMCID: PMC8183092 DOI: 10.1186/s13063-021-05327-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 05/17/2021] [Indexed: 11/12/2022] Open
Abstract
Background Borderline personality disorder (BPD) is a high prevalence and serious mental health disorder that has historically challenged the finite resources of health services. Despite empirical evidence supporting structured psychological therapy as the first line of treatment, there remains significant barriers in providing timely access to evidence-based treatment for this population. The primary aim of this study is to evaluate the effectiveness of providing a stepped-care structured psychological group treatment to individuals with BPD within local mental health services. The secondary aims of the study are to identify the variables that predict the need to step up or down in care and the effectiveness of treatment on psychosocial functioning. Methods Participants seeking treatment at two community mental health services will be invited to participate. Randomised controlled trial assignment will be to either (i) group skills treatment or (ii) treatment as usual. Group treatment will be offered via a stepped-care pathway with participants initially attending a 12-week group with the option of a subsequent 16-week group. The criteria for inclusion in continuing treatment includes meeting > 4 BPD diagnostic criteria or severity on GAF (< 65) at the completion of the 12-week group. Data will be collected at baseline and at five follow-up time points over a 12-month period. Discussion This pragmatic trial will provide valuable information regarding the effectiveness of a progressive stepped-care group treatment for individuals with BPD in the real-world setting of a community mental health service. It will further the current understanding of variables that predict treatment dose and duration. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12618000477224. Registered on 3 April 2018
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Affiliation(s)
- Judy A Pickard
- School of Psychology, University of Wollongong, Wollongong, Australia.
| | - Adam Finch
- Illawarra Shoalhaven Local Health District, Wollongong, Australia
| | - Elizabeth Huxley
- School of Psychology, University of Wollongong, Wollongong, Australia
| | | | | | - Kate L Lewis
- School of Psychology, University of Wollongong, Wollongong, Australia
| | - Jason Pratt
- Illawarra Shoalhaven Local Health District, Wollongong, Australia
| | - Brin F S Grenyer
- School of Psychology, University of Wollongong, Wollongong, Australia
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Harp Th TSD, Hepp J, Trull TJ, Bateman AW, Kongerslev MT, Simonsen E. Positive Affect Is Associated With Decreased Symptom Severity in the Daily Lives of Individuals With Borderline Personality Disorder. J Pers Disord 2021; 35:355-372. [PMID: 31682195 DOI: 10.1521/pedi_2019_33_453] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Previous research has repeatedly demonstrated positive associations between negative affect (NA) and borderline personality disorder (BPD) symptoms in daily life, but studies have rarely addressed potential effects of positive affect (PA). Consequently, little is known about how PA in daily life covaries with symptoms of BPD. The authors assessed the effects of both PA and NA levels on BPD symptom severity in a sample of 81 treatment-seeking women diagnosed with BPD over a period of 21 days, employing a daily diary design. Using multivariate multilevel modeling, the authors obtained negative associations between PA levels and daily BPD severity in total and at the level of the individual symptoms inappropriate anger, affective instability, emptiness, identity disturbance, and paranoid ideation/dissociation. Moreover, the authors replicated previously reported positive associations between NA and BPD severity for all nine symptoms. Future research can address whether increasing PA in the treatment of BPD may potentially help reduce symptom burden.
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Affiliation(s)
- Tine S D Harp Th
- Psychiatric Research Unit, Region Zealand, Slagelse, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Johanna Hepp
- Department of Psychosomatic Medicine, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Timothy J Trull
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri
| | - Anthony W Bateman
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mickey T Kongerslev
- Psychiatric Research Unit, Region Zealand, Slagelse, Denmark.,Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Erik Simonsen
- Psychiatric Research Unit, Region Zealand, Slagelse, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Abstract
IMPORTANCE Rates of suicide are increasing. Although borderline personality disorder (BPD) and other psychiatric disorders are associated with suicide, there is a dearth of epidemiological research on associations between BPD and suicide attempts (SAs). Delineating the SA risk associated with BPD and its specific criteria in a nationally representative sample of individuals could inform recognition and intervention efforts for SAs. OBJECTIVE To examine the association of a BPD diagnosis and specific BPD criteria with SAs in US adults. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study analyzed data from the National Epidemiological Survey on Alcohol and Related Conditions-III (NESARC-III), a psychiatric epidemiological survey of noninstitutionalized US adults aged 18 or older conducted from April 2012 to June 2013. Eligible adults were randomly selected from households within census-defined counties or groups of counties. Data were analyzed from December 2020 to January 2021. MAIN OUTCOMES AND MEASURES Prevalence of Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) psychiatric and personality disorders, BPD and its specific criteria, SAs, and adverse childhood experiences (ACEs), as assessed by structured diagnostic or clinical interviews; prevalence is expressed as weighted means. Multivariable-adjusted logistic regression was used to compare the risk of lifetime and past-year SAs by BPD diagnosis and by each specific BPD criterion. Analyses were adjusted for demographic and clinical factors, including psychiatric comorbidity, age at BPD onset, and ACEs. RESULTS Of 36 309 respondents, 20 442 (56.3%) were women and 52.9% were non-Hispanic White; the mean (SD) age was 45.6 (17.5) years. The prevalence (SE) of lifetime and past-year SAs among participants with a lifetime diagnosis of BPD based on original NESARC-III diagnostic codes was 22.7% (0.8%) (adjusted odds ratio [AOR], 8.40; 95% CI, 7.53-9.37) and 2.1% (0.2%) (AOR, 11.77; 95% CI, 7.86-17.62), respectively. With use of diagnostic codes requiring 5 BPD criteria to meet social-occupational dysfunction, prevalence (SE) of lifetime and past-year SAs was 30.4% (1.1%) (AOR, 9.15; 95% CI, 7.99-10.47) and 3.2% (0.4%) (AOR, 11.42; 95% CI, 7.71-16.91), respectively. After excluding the BPD criterion of self-injurious behavior (to eliminate criterion overlap), the prevalence (SE) of lifetime and past-year SAs was 28.1% (1.1%) (AOR, 7.61; 95% CI, 6.67-8.69) and 3.0% (0.4%) (AOR, 9.83; 95% CI, 6.63-14.55), respectively. In analyses adjusting for sociodemographic variables, psychiatric disorders, age at BPD onset, and ACEs, BPD diagnosis and specific BPD criteria of self-injurious behaviors and chronic feelings of emptiness were significantly associated with increased odds of lifetime SAs (BPD diagnosis: AOR, 2.10; 95% CI, 1.79-2.45; self-injurious behaviors: AOR, 24.28; 95 CI, 16.83-32.03; feelings of emptiness: AOR, 1.58; 95% CI, 1.16-2.14) and past-year SAs (BPD diagnosis: AOR, 11.42; 95% CI, 7.71-16.91; self-injurious behaviors: AOR, 19.32; 95% CI, 5.22-71.58; feelings of emptiness: AOR, 1.99; 95% CI, 1.08-3.66). In analysis with BPD criteria simultaneously entered (excluding self-injurious behavior), chronic feelings of emptiness were significantly associated with increased odds of lifetime SAs (AOR, 1.66; 95% CI, 1.23-2.24) and past-year SAs (AOR, 2.45; 95% CI, 1.18-5.08). CONCLUSIONS AND RELEVANCE In a national sample of adults, after adjusting for demographic and clinical variables, a BPD diagnosis and the specific BPD criteria of self-injurious behaviors and chronic emptiness were significantly associated with increased SA risk. Although BPD is a complex heterogeneous diagnosis, the results of this study suggest that the criteria of self-injurious behaviors and chronic feelings of emptiness should be routinely considered in suicide risk assessment.
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Affiliation(s)
- Carlos M. Grilo
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Tomoko Udo
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, State University of New York, Rensselaer
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Price AL, Mahler HIM, Hopwood CJ. Construction and Validation of a Self-report Subjective Emptiness Scale. Assessment 2020; 29:397-409. [PMID: 33291950 DOI: 10.1177/1073191120968275] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Subjective emptiness is a psychiatric symptom that is primarily assessed and studied as a criterion of borderline personality disorder, even though research suggests that it may have clinical importance beyond that diagnosis. The aim of this series of studies was to develop and validate a standalone self-report measure of subjective emptiness. A systematic, multistep approach to identifying test content was used to generate 88 items that were then trimmed to 53 via ratings of interviews with patients and experts. This preliminary scale was administered to a sample of 544 university students, and a trimmed version was given to two samples oversampled for clinical problems (n = 1,067; n = 1,016). A five-item measure fit a unidimensional model well and had satisfactory internal consistency across these samples. External validity analyses suggested that emptiness, as measured by the Subjective Emptiness Scale, is strongly related to a number of clinical constructs, particularly in the internalizing domain, indicating that emptiness is an important construct to consider in its own right, independent of its presence in the borderline criterion set.
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Affiliation(s)
- Adrian L Price
- California State University San Marcos, San Marcos, CA, USA
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30
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Yazdani K, Nikoo M, Sayre EC, Choi F, Jang K, Krausz RM. The impact of employment on recovery among individuals who are homeless with severe mental illness in the Vancouver At Home/Chez Soi trial. Soc Psychiatry Psychiatr Epidemiol 2020; 55:1619-1627. [PMID: 32476057 DOI: 10.1007/s00127-020-01887-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 05/15/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To assess impact of employment on recovery in a sample of adults from Vancouver At Home (VAH) study, who were homeless and were diagnosed with severe mental disorders. METHODS The VAH included two randomized controlled trials investigating the effect of housing first with support intervention in vulnerable population. Employment was assessed at baseline and during the follow-up using Demographics, Housing, Vocational, and Service Use History (DSHH), and Vocational Timeline Follow-Back (VTLFB) self-report questionnaires, respectively. Recovery was examined using Recovery Assessment Scale (RAS) at baseline and at 24-month follow-up visit. Multivariable regression models were built to examine: (1) the effect of current employment at baseline on RAS score at baseline, and RAS score at 24-month follow-up visit; and (2) and to examine the cumulative effect of recent employment over 8 follow-up visits on RAS score at 24-month visit. Cumulative effect of employment over the follow-up visits was weighted by recency using a pre-specified weighting function. RESULTS Employment at baseline was associated with an increase in recovery score at baseline [8.06 (95% CI 1.21, 14.91); p = 0.02], but not with recovery score at 24-month follow-up visit [3.78 (-4.67, 12.24); p = 0.37]. Weighted cumulative effect of employment over 8 follow-up visits was associated with increase in RAS score at 24-month follow-up visit [8.33 (1.68, 14.99) p = 0.01]. CONCLUSION Employment is associated with an increase in recovery. Our result suggests a dual effect of employment on recovery, an immediate effect through current employment, and a long-term effect of cumulative employment.
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Affiliation(s)
- Kiana Yazdani
- Addiction and Concurrent Disorders Group, Department of Psychiatry, Faculty of Medicine, Institute of Mental Health, University of British Columbia, Vancouver, Canada. .,Arthritis Research Canada, Richmond, BC, Canada. .,Experimental Medicine Program, Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
| | - Mohammadali Nikoo
- Addiction and Concurrent Disorders Group, Centre for Health Evaluation Outcome Sciences, Department of Psychiatry, Faculty of Medicine, Institute of Mental Health, University of British Columbia, Vancouver, Canada
| | | | - Fiona Choi
- Addiction and Concurrent Disorders Group, Centre for Health Evaluation Outcome Sciences, Department of Psychiatry, Faculty of Medicine, Institute of Mental Health, University of British Columbia, Vancouver, Canada
| | - Kerry Jang
- Department of Psychiatry, Faculty of Medicine, Institute of Mental Health, University of British Columbia, Vancouver, Canada
| | - Reinhard Michael Krausz
- Addiction and Concurrent Disorders Group, Centre for Health Evaluation Outcome Sciences, Department of Psychiatry, Faculty of Medicine, Institute of Mental Health, University of British Columbia, Vancouver, Canada
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Miller CE, Townsend ML, Day NJS, Grenyer BFS. Measuring the shadows: A systematic review of chronic emptiness in borderline personality disorder. PLoS One 2020; 15:e0233970. [PMID: 32609777 PMCID: PMC7329066 DOI: 10.1371/journal.pone.0233970] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 05/15/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chronic feelings of emptiness is an under-researched symptom of borderline personality disorder (BPD), despite indications it may be central to the conceptualisation, course, and outcome of BPD treatment. This systematic review aimed to provide a comprehensive overview of chronic feelings of emptiness in BPD, identify key findings, and clarify differences between chronic feelings of emptiness and related constructs like depression, hopelessness, and loneliness. METHOD A PRISMA guided systematic search of the literature identified empirical studies with a focus on BPD or BPD symptoms that discussed chronic feelings of emptiness or a related construct. RESULTS Ninety-nine studies met criteria for inclusion in the review. Key findings identified there were significant difficulties in defining and measuring chronic emptiness. However, based on the studies reviewed, chronic emptiness is a sense of disconnection from both self and others. When experienced at frequent and severe levels, it is associated with low remission for people with BPD. Emptiness as a construct can be separated from hopelessness, loneliness and intolerance of aloneness, however more research is needed to explicitly investigate these experiences. Chronic emptiness may be related to depressive experiences unique to people with BPD, and was associated with self-harm, suicidality, and lower social and vocational function. CONCLUSIONS AND IMPLICATIONS We conclude that understanding chronic feelings of emptiness is central to the experience of people with BPD and treatment focusing on connecting with self and others may help alleviate a sense of emptiness. Further research is required to provide a better understanding of the nature of chronic emptiness in BPD in order to develop ways to quantify the experience and target treatment. Systematic review registration number: CRD42018075602.
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Affiliation(s)
- Caitlin E. Miller
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Michelle L. Townsend
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Nicholas J. S. Day
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Brin F. S. Grenyer
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
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The identification of a risk profile for young people with borderline personality pathology: a review of recent literature. Curr Opin Psychol 2020; 37:13-20. [PMID: 32653538 DOI: 10.1016/j.copsyc.2020.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/25/2020] [Accepted: 06/07/2020] [Indexed: 12/28/2022]
Abstract
The shift towards early intervention in borderline personality disorder (BPD) has introduced a clinical staging approach in the treatment for young persons with BPD. Complementary to staging is profiling: the identification of psychological, social and biological risk variables that may predict prognosis. The aim of this paper is to provide a risk profile for BPD by systematically reviewing literature on potential risk markers for poor prognosis for BPD. An extensive literature search revealed evidence for seven categories of risk factors: adverse childhood experiences, BPD symptom profile, associated mental disorders, personality impairments and traits, current interpersonal context, biological disposition and socio-demographics. Including these markers within the current staging approach, to compose individual risk profiles for poor BPD prognosis, may assist in personalizing treatment for young people with BPD and in refining research protocols for treatment outcome studies.
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Huxley E, Lewis KL, Coates AD, Borg WM, Miller CE, Townsend ML, Grenyer BFS. Evaluation of a brief intervention within a stepped care whole of service model for personality disorder. BMC Psychiatry 2019; 19:341. [PMID: 31694681 PMCID: PMC6836372 DOI: 10.1186/s12888-019-2308-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 09/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although there is growing evidence that stepped models of care are useful for providing appropriate, person centered care, there are very few studies applied to personality disorders. A brief, four session, psychological treatment intervention for personality disorder within a whole of service stepped care model was evaluated. The intervention stepped between acute emergency crisis mental health services and longer-term outpatient treatments. METHODS Study 1 used service utilization data from 191 individuals referred to the brief intervention at a single community health site in a metropolitan health service. Proportions of individuals retained across the intervention and the referral pathways accessed following the intervention were examined. Study 2 examined 67 individuals referred to the brief intervention across 4 different sites in metropolitan health services. A range of measures of symptoms and quality of life were administered at the first and last session of the intervention. Effect sizes were calculated to examine mean changes across the course of the intervention. RESULTS Study 1 found that 84.29% of individuals referred to the intervention attended at least 1 session, 60.21% attended 2 sessions or more and 41.89% attended 3 or more sessions. 13.61% of the sample required their care to be "stepped up" within the service, whereas 29.31% were referred to other treatment providers following referral to the intervention. Study 2 found a significant reduction in borderline personality disorder symptom severity and distress following the intervention, and an increase in quality of life. The largest reduction was found for suicidal ideation (d = 1.01). CONCLUSIONS Brief psychological intervention was a useful step between acute services and longer-term treatments in this stepped model of care for personality disorder. Suicide risk and symptom severity reduced and quality of life improved, with only a small proportion of individuals requiring ongoing support from the health service following the intervention.
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Affiliation(s)
- Elizabeth Huxley
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Kate L Lewis
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Adam D Coates
- South East Sydney Local Health District, Sydney, Australia
| | - Wayne M Borg
- South East Sydney Local Health District, Sydney, Australia
| | - Caitlin E Miller
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Michelle L Townsend
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Brin F S Grenyer
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, 2522, Australia.
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Pigot M, Miller CE, Brockman R, Grenyer BFS. Barriers and facilitators to the implementation of a stepped care intervention for personality disorder in mental health services. Personal Ment Health 2019; 13:230-238. [PMID: 31411004 DOI: 10.1002/pmh.1467] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/15/2019] [Accepted: 07/30/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Individuals with personality disorders-particularly borderline personality disorder-are high users of mental health treatment services. Emergency service responses often focus on crisis management, and there are limited opportunities to provide appropriate longer term evidence-based treatment. Many individuals with personality disorders find themselves in a revolving cycle between emergency departments and waiting for community treatment. A stepped care approach may help to triage clients and allow access to interventions with minimal client, clinician and system burden. This study aims to understand the facilitators and barriers to real-world implementation of a stepped care approach to treating personality disorders. METHODS Managers and clinicians of health services engaged in implementation were interviewed to obtain accounts of experiences. Interviews were transcribed and thematically analysed to generate themes describing barriers and facilitators. RESULTS Participants identified personal attitudes, knowledge and skills as important for successful implementation. Existing positive attitudes and beliefs about treating people with a personality disorder contributed to the emergence of clinical champions. Training facilitated positive attitudes by justifying the psychological approach. Management support was found to bi-directionally effect implementation. CONCLUSIONS This study suggests specific organizational and individual factors may increase timely and efficient implementation of interventions for people with personality disorders. © 2019 John Wiley & Sons, Ltd.
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Affiliation(s)
- Melissa Pigot
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Caitlin E Miller
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Robert Brockman
- Institute for Positive Psychology and Education, Australian Catholic University, Sydney, NSW, Australia
| | - Brin F S Grenyer
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
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Basten C, Touyz S. Sense of Self: Its Place in Personality Disturbance, Psychopathology, and Normal Experience. REVIEW OF GENERAL PSYCHOLOGY 2019. [DOI: 10.1177/1089268019880884] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sense of self (SOS) is a cornerstone of psychological inquiry and therapy and is a defining feature of a range of psychological conditions including borderline personality disorder, yet it is poorly understood. SOS is that continuous experience of being a complete and authentic person who feels in control of their own activities. It is a part of normal development of the self and, when weakened by trauma or developmental neglect, is a vulnerability for developing many different disorders, including depression and dissociative, personality, and eating disorders. This review aims to provide a working definition and description of SOS and to summarize its transdiagnostic role in contributing to psychological disorders. To achieve this aim, the article encompasses and unites the literature from various theoretical domains including developmental psychology, identity theory, cognitive psychology, personality disorders, and psychodynamic theories. Implications are raised for psychological therapy and research into psychopathology and its underpinnings.
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Affiliation(s)
| | - Stephen Touyz
- The University of Sydney, Sydney, New South Wales, Australia
- InsideOut Institute, Sydney, New South Wales, Australia
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Personality testing and the Americans With Disabilities Act: An applicant/employee perspective. INDUSTRIAL AND ORGANIZATIONAL PSYCHOLOGY-PERSPECTIVES ON SCIENCE AND PRACTICE 2019. [DOI: 10.1017/iop.2019.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Vardy Y, Day NJS, Grenyer BFS. Development and validation of an experience of time alone scale for borderline personality disorder. PLoS One 2019; 14:e0217350. [PMID: 31120954 PMCID: PMC6532922 DOI: 10.1371/journal.pone.0217350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 05/09/2019] [Indexed: 12/11/2022] Open
Abstract
Background/Objective Intolerance of aloneness is considered a core feature of borderline personality disorder (BPD) that is clinically significant, yet under-researched. This study developed a measure of aloneness for individuals with BPD. Method Interviews investigating the experience of aloneness for BPD participants (n = 12) formed the basis for the development of the measure. Pilot testing then occurred with BPD participants, control participants and qualified respondents. Validity, reliability and factor analysis of an Experience of Time Alone Scale (ETAS) was conducted with BPD participants (n = 112) and a comparison control group (n = 105). Results A three factor structure was revealed: (a) Cannot Cope Alone (α = .92), (b) Need to Escape from Others (α = .90), and (c) Consumed in Intolerable Distress (α = .88). The measure correlated significantly (p < .01) with the Mental Health Inventory, the Aloneness and Evocative Memory Scale, and the Hurvich Experience Inventory- Revised. Comparisons revealed highly significant differences between the BPD sample and control group on all subscales and the total score (U = 75.5, p = < .001, r = -.85). Conclusions This study represents one of the first empirical examinations of a construct that has largely only been studied theoretically. This newly developed measure may contribute to diagnosis and therapy.
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Affiliation(s)
- Yvette Vardy
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Nicholas J. S. Day
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Brin F. S. Grenyer
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
- * E-mail:
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Townsend ML, Gray AS, Lancaster TM, Grenyer BFS. A whole of school intervention for personality disorder and self-harm in youth: a pilot study of changes in teachers' attitudes, knowledge and skills. Borderline Personal Disord Emot Dysregul 2018; 5:17. [PMID: 30305905 PMCID: PMC6167835 DOI: 10.1186/s40479-018-0094-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 09/03/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The school environment offers an ideal opportunity for early identification and intervention for youth with self-harm and complex mental health issues, such as borderline personality disorder (BPD). Yet, class teachers often report minimal knowledge, feeling ill-equipped to respond, and experience high levels of stress when exposed to such challenges. Research is required to understand how training and development activities led by school counsellors may enhance teacher attitudes, confidence and knowledge of self-harm and complex mental health issues, such as BPD. We aimed to explore the extent that a whole of school initiative might enhance capacity for early identification and intervention. METHOD 18 secondary schools implemented a manualised program, Project Air Strategy for Schools. N = 400 class teachers (71.3% female, mean age 42 years) across city and rural locations were evaluated before and after program implementation on attitudes, knowledge and skills. RESULTS Providing class teachers with additional training on complex mental health issues and associated behaviours such as self-harm was well received. Participants reported post-program improvements in their optimism (d = .35), confidence (d = .63), knowledge (d = .73) and skills (d = 0.67) in working with young people with complex mental health issues, such as BPD. CONCLUSIONS Providing school counsellor led structured approaches, to help class teachers identify and respond to youth in distress, closed identified gaps. Results indicated improvements in class teachers' knowledge and attitudes towards self-harm and BPD. The intervention also improved the capacity of schools to plan and implement strategies to reduce the impact of mental health problems on the young person and their peers. A stay-at-school psychological care approach was fostered by enhancing partnerships between class teachers and school counsellors.
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Affiliation(s)
- Michelle L. Townsend
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW Australia
| | - Annaleise S. Gray
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW Australia
| | | | - Brin F. S. Grenyer
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW Australia
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