1
|
El-Hourani M, Zadra A, Castellanos-Ryan N, Rioux C, Tremblay RE, Parent S, Séguin JR. Longitudinal Study of Early Adversity and Disturbing Dream Frequency: Moderating Role of Early Negative Emotionality. Res Child Adolesc Psychopathol 2024; 52:277-291. [PMID: 37589805 DOI: 10.1007/s10802-023-01109-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/18/2023]
Abstract
Although disturbing dreams are prevalent in youth and are associated with psychopathology, little is known about their developmental course and risk factors. We aimed to examine the association between early social environment and subsequent disturbing dream frequency across adolescence as moderated by early negative emotionality. Measures of children's early social environment and negative emotionality were collected from the mothers of 410 children (5-42 months old) and measures of disturbing dream frequency directly from the children (13-18 years old). Preliminary steps identified subgroups of families with distinct profiles of social environment using latent variable mixture modeling, and captured changes in disturbing dream frequency using latent growth modeling. Regression and moderation analyses were conducted to test the study objectives. Results showed that the diverse family patterns were best captured by two profiles reflecting adverse and positive social environments and that overall disturbing dream frequency decreased during adolescence. Moderation analyses showed that when early negative emotionality was higher, DD frequency was not only more elevated in an adverse environment, but lower in a positive environment. These results indicate that the development of disturbing dreams is most strongly associated with a combination of individual and environment factors. Our study adds to the literature by refining our conception of individual traits and disturbing dream development and has implications for the prevention of bad dreams, nightmares, and associated psychopathologies.
Collapse
Affiliation(s)
- Mira El-Hourani
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche du CHU Ste-Justine, Bureau B17.107; 3175 Chemin Côte Ste-Catherine, H3T 1C5, Montréal, Québec, Canada
| | - Antonio Zadra
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Natalie Castellanos-Ryan
- Centre de Recherche du CHU Ste-Justine, Bureau B17.107; 3175 Chemin Côte Ste-Catherine, H3T 1C5, Montréal, Québec, Canada
- School of Psychoeducation, Université de Montréal, Montréal, Québec, Canada
| | - Charlie Rioux
- Department of Psychology, University of Oklahoma, Norman, Oklahoma, USA
| | - Richard E Tremblay
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche du CHU Ste-Justine, Bureau B17.107; 3175 Chemin Côte Ste-Catherine, H3T 1C5, Montréal, Québec, Canada
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
- School of Public Health, University College Dublin, Dublin, Ireland
| | - Sophie Parent
- Centre de Recherche du CHU Ste-Justine, Bureau B17.107; 3175 Chemin Côte Ste-Catherine, H3T 1C5, Montréal, Québec, Canada
- School of Psychoeducation, Université de Montréal, Montréal, Québec, Canada
| | - Jean R Séguin
- Centre de Recherche du CHU Ste-Justine, Bureau B17.107; 3175 Chemin Côte Ste-Catherine, H3T 1C5, Montréal, Québec, Canada.
- Department of Psychiatry and Addictology, Université de Montréal, Montréal, Québec, Canada.
| |
Collapse
|
2
|
Solis-Trapala I, Campbell P, Lacey R, Rowlands G, Dunn K, Protheroe J. Are childhood factors predictive of adult health literacy? A longitudinal birth cohort analysis. SSM Popul Health 2023; 23:101426. [PMID: 37252287 PMCID: PMC10220279 DOI: 10.1016/j.ssmph.2023.101426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/05/2023] [Accepted: 05/07/2023] [Indexed: 05/31/2023] Open
Abstract
Health literacy (HL), defined as the ability of an individual to understand and appraise health information to make informed decisions on their health, helps maintain and improve one's health and thus reduce the use of healthcare services. There is a recognised global effort to address insufficient HL in early life and understand how HL develops. This study examined the association of a range of factors including educational, speech and language ability, health and healthcare engagement, sleep problems, mental health, demographic, environmental, and maternal factors at different childhood stages (from 5 years to 11 years) with later adult HL at age 25. HL was measured using a HL ordinal score (insufficient, limited, or sufficient) derived from the European Literacy Survey Questionnaire-short version (HLS-EU-Q16) within a large UK based birth cohort (Avon Longitudinal Study of Parents and Children: ALSPAC study). Univariate proportional odds logistic regression models for the probability of having higher levels of HL were developed. Results of analysis of 4248 participants showed that poorer speech and language ability (aged 9 years, OR 0.18 95% CI 0.04 to 0.78), internalising in child (age 11 years, OR 0.62 95% CI 0.5 to 0.78), child depression (age 9 years, OR 0.67 95% CI 0.52 to 0.86), and the presence of maternal depression (child age 5, OR 0.80 95% CI 0.66 to 0.96), reduced the odds of sufficient HL when adult. Our results suggest some useful markers to identify children at potential risk of low HL that could be targeted for research into future interventions within school settings, for example, child's speech and language capability. In addition, this study identified child and maternal mental health as factors associated with later development of limited HL and future research should consider what potential mechanisms might explain this link.
Collapse
Affiliation(s)
- I. Solis-Trapala
- School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
| | - P. Campbell
- School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
- Midlands Partnership NHS Foundation Trust, St Georges' Hospital, Stafford, ST16 3AG, UK
| | - R.J. Lacey
- School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
| | - G. Rowlands
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, NE1 7RU, UK
| | - K.M. Dunn
- School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
| | - J. Protheroe
- School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
| |
Collapse
|
3
|
Sheaves B, Rek S, Freeman D. Nightmares and psychiatric symptoms: A systematic review of longitudinal, experimental, and clinical trial studies. Clin Psychol Rev 2023; 100:102241. [PMID: 36566699 PMCID: PMC10933816 DOI: 10.1016/j.cpr.2022.102241] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 11/24/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
Nightmares occur across a wide range of psychiatric disorders, but outside of PTSD presentations are infrequently considered a treatment priority. We aimed to assess evidence for a contributory causal role of nightmares to the occurrence of psychiatric disorders, and vice versa. A systematic review was conducted of longitudinal, experimental, and clinical trial studies. Twenty-four longitudinal, sixteen trials, and no experimental studies were identified. Methodological shortcomings were common, especially the use of single-item nightmare assessment. Thirty-five studies assessed the path from nightmares to psychiatric symptoms. Depression (n = 10 studies), PTSD (n = 10) and anxiety (n = 5) were the most commonly assessed outcomes in trials. Most were not designed to assess the effect of nightmare treatment on psychiatric symptoms. Treating nightmares led to moderate reductions in PTSD and depression, small to moderate reductions in anxiety, and potentially moderate reductions in paranoia. Nightmares increased the risk of later suicide outcomes (n = 10), but two small pilot trials indicated that treating nightmares might potentially prevent recovery of suicidal ideation. PTSD treatment led to large reductions in trauma-related nightmares (n = 3). The limited literature suggests that treating nightmares may be one route to lessening threat-based disorders in particular, suggestive of a causal relationship. Overall, however, nightmares in most disorders are greatly understudied.
Collapse
Affiliation(s)
- Bryony Sheaves
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, United Kingdom; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, OX3 7JX, United Kingdom.
| | - Stephanie Rek
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, United Kingdom; Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany; International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, United Kingdom; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, OX3 7JX, United Kingdom
| |
Collapse
|
4
|
Do better nights lead to better days? Guided internet-based cognitive behavioral therapy for insomnia in people suffering from a range of mental health problems: Protocol of a pragmatic randomized clinical trial. Contemp Clin Trials 2023; 127:107122. [PMID: 36813085 DOI: 10.1016/j.cct.2023.107122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/10/2023] [Accepted: 02/14/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND Insomnia is the transdiagnostically shared most common complaint in disorders of anxiety, stress and emotion regulation. Current cognitive behavioral therapies (CBT) for these disorders do not address sleep, while good sleep is essential for regulating emotions and learning new cognitions and behaviours: the core fundaments of CBT. This transdiagnostic randomized control trial (RCT) evaluates whether guided internet-delivered cognitive behavioral therapy for insomnia (iCBT-I) (1) improves sleep, (2) affects the progression of emotional distress and (3) enhances the effectiveness of regular treatment of people with clinically relevant symptoms of emotional disorders across all mental health care (MHC) echelons. METHODS We aim for 576 completers with clinically relevant symptoms of insomnia as well as at least one of the dimensions of generalized anxiety disorder (GAD), social anxiety disorder (SAD), panic disorder (PD), posttraumatic stress disorder (PTSD) or borderline personality disorder (BPD). Participants are either pre-clinical, unattended, or referred to general- or specialized MHC. Using covariate-adaptive randomization, participants will be assigned to a 5 to 8-week iCBT-I (i-Sleep) or a control condition (sleep diary only) and assessed at baseline, and after two and eight months. The primary outcome is insomnia severity. Secondary outcomes address sleep, severity of mental health symptoms, daytime functioning, mental health protective lifestyles, well-being, and process evaluation measures. Analyses use linear mixed-effect regression models. DISCUSSION This study can reveal for whom, and at which stage of disease progression, better nights could mean substantially better days. TRIAL REGISTRATION International Clinical Trial Registry Platform (NL9776). Registered on 2021-10-07.
Collapse
|
5
|
Distressing dreams in childhood and risk of cognitive impairment or Parkinson's disease in adulthood: a national birth cohort study. EClinicalMedicine 2023; 57:101872. [PMID: 37064510 PMCID: PMC10102896 DOI: 10.1016/j.eclinm.2023.101872] [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] [Received: 11/18/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 02/28/2023] Open
Abstract
Background Distressing dreams in middle-aged and older adults have been associated with an increased risk of developing cognitive impairment (including dementia) and Parkinson's disease (PD). Whether distressing dreams in younger people might be associated with an increased risk of developing these conditions is unknown. This study investigated the association between distressing dreams in childhood and the risk of developing cognitive impairment or PD by age 50. Methods Data from the 1958 British Birth Cohort Study - a prospective birth cohort which included all people born in Britain during a single week in 1958, were used in this longitudinal analysis. Information on distressing dreams were obtained prospectively from the children's mothers at ages 7 (1965) and 11 (1969). Cognitive impairment and PD at age 50 (2008) were determined by cognitive assessment and doctor-diagnosis respectively. The association between distressing dreams at ages 7 and 11 (no time point, 1 time point, 2 time points) and cognitive impairment or PD at age 50, was evaluated using multivariable Firth logistic regression, with adjustment for potential confounders. Findings Among 6991 children (50.6% female) with follow-up available at age 50, 267 (3.8%) developed cognitive impairment or PD. After adjustment for all covariates, having more regular distressing dreams during childhood was linearly and statistically significantly associated with higher risk of developing cognitive impairment or PD by age 50 (P for trend = 0.037). Compared with children who never had distressing dreams (no time point), children who had persistent distressing dreams (2 time points) had an 85% increased risk of developing cognitive impairment or PD by age 50 (adjusted odds ratio = 1.85; 95% CI: 1.10, 3.11). Interpretation Having persistent distressing dreams during childhood may be associated with an increased risk of developing cognitive impairment or PD in adulthood. Future studies are needed to confirm these findings and to determine whether treating distressing dreams during early life may lower the risk of dementia and PD. Funding The study received no external funding.
Collapse
|
6
|
Barton J, Mio M, Timmins V, Mitchell RHB, Murray BJ, Goldstein BI. Factors Associated With Sleep Disturbance Amongst Youth With Bipolar Disorder. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2022; 31:165-175. [PMID: 36425019 PMCID: PMC9661909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 07/05/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND While sleep disturbances and their impact on functioning are well-established in adults with bipolar disorder (BD), little is known about this topic in youth. OBJECTIVE This study investigates the prevalence and correlates of sleep disturbance among youth with BD. METHODS The study included 103 youth (72 BD, 31 healthy controls [HC]), ages 14-20 years. Study measures included a semi-structured diagnostic interview and the Pittsburgh Sleep Quality Index (PSQI). PSQI yields a global score and 7 subscale scores. Analyses examined between group differences in PSQI scores, and correlates of PSQI within BD. RESULTS BD youth had significantly higher (worse) global sleep scores, and higher scores on 5/7 subscales (quality, latency, disturbance, sleep medication use, daytime dysfunction). In univariate analyses, poorer sleep quality was associated with higher lifetime and current depression severity, mixed mood state, self-reported affective lability, and borderline personality traits. Lifetime lithium treatment and euthymic mood state were associated with better sleep scores. In multivariate analyses, greater current depression severity and self-reported affective lability were most robustly associated with poor sleep quality. CONCLUSIONS Converging with data from adults, present findings indicate greater sleep disturbance among youth with BD versus HC. Also convergent with adults with BD, mood disturbance, whether depression severity or emotional lability, comprised the predominant correlates of sleep disturbance among youth with BD. Future research is warranted to better understand the temporal association between sleep disturbance and its correlates in youth with BD. Relatedly, interventions that address both mood and sleep disturbances may help improve overall functioning.
Collapse
Affiliation(s)
- Jessica Barton
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario
| | - Megan Mio
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario
- Department of Pharmacology, University of Toronto, Toronto, Ontario
| | - Vanessa Timmins
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario
| | - Rachel H B Mitchell
- Department of Psychiatry, University of Toronto, Toronto, Ontario
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Brian J Murray
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
- Department of Pharmacology, University of Toronto, Toronto, Ontario
| |
Collapse
|
7
|
Chanen AM, Sharp C, Nicol K, Kaess M. Early Intervention for Personality Disorder. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2022; 20:402-408. [PMID: 37200874 PMCID: PMC10187393 DOI: 10.1176/appi.focus.20220062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Both the DSM-5 Section III Alternative Model for Personality Disorders and the ICD-11 have introduced a genuinely developmental approach to personality disorder. Among young people with personality disorder, compelling evidence demonstrates a high burden of disease, substantial morbidity, and premature mortality, as well as response to treatment. Yet, early diagnosis and treatment for the disorder have struggled to emerge from its identity as a controversial diagnosis to a mainstream focus for mental health services. Key reasons for this include stigma and discrimination, lack of knowledge about and failure to identify personality disorder among young people, along with the belief that personality disorder must always be addressed through lengthy and specialized individual psychotherapy programs. In fact, evidence suggests that early intervention for personality disorder should be a focus for all mental health clinicians who see young people and is feasible by using widely available clinical skills.
Collapse
Affiliation(s)
- Andrew M Chanen
- Orygen, and Centre for Youth Mental Health, University of Melbourne, Melbourne (Chanen, Nicol); Department of Psychology, University of Houston, Houston (Sharp); University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland, and Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany (Kaess)
| | - Carla Sharp
- Orygen, and Centre for Youth Mental Health, University of Melbourne, Melbourne (Chanen, Nicol); Department of Psychology, University of Houston, Houston (Sharp); University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland, and Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany (Kaess)
| | - Katie Nicol
- Orygen, and Centre for Youth Mental Health, University of Melbourne, Melbourne (Chanen, Nicol); Department of Psychology, University of Houston, Houston (Sharp); University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland, and Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany (Kaess)
| | - Michael Kaess
- Orygen, and Centre for Youth Mental Health, University of Melbourne, Melbourne (Chanen, Nicol); Department of Psychology, University of Houston, Houston (Sharp); University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland, and Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany (Kaess)
| |
Collapse
|
8
|
Kaurin A, Hisler G, Dombrovski AY, Hallquist MN, Wright AGC. Sleep and next-day negative affect and suicidal ideation in borderline personality disorder. Personal Disord 2022; 13:160-170. [PMID: 34424020 PMCID: PMC9815476 DOI: 10.1037/per0000496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Sleep disturbance is associated with elevated suicidal ideation and negative affect. To date, however, no study has investigated the temporal relationship between sleep and suicidality among those diagnosed with borderline personality disorder (BPD). This preregistered (https://osf.io/4vugk) study tested whether nightly sleep (self-reported sleep duration, sleep onset latency, and subjective sleep quality) represents a (within-person) short-term risk factor for affective dysregulation and increases in suicide risk from day-to-day, as well as whether between-person differences in sleep, negative affect, and suicidality were associated. We used a 21-day ecological momentary assessment protocol in a sample of 153 people diagnosed with BPD, 105 of which had a history of serious suicide attempts, and 52 healthy controls (N = 4076 days). We found a within-person association between worse subjective sleep quality and greater next-day negative affect. At the between-person level, we found positive relationships between sleep latency and suicidal ideation, and a negative association between subjective sleep quality and negative affect. BPD severity did not significantly moderate the strength of any within-person associations, although BPD was positively associated with average levels of suicidal ideation, sleep latency, and negative affect, and negatively related to subjective sleep quality. These findings suggest that the association of sleep with suicidal ideation and BPD exists largely at the between-persons rather than the within-person level. Disturbed sleep, therefore, seems to largely coincide, rather than specifically contribute to, the exacerbation of suicidal crises in BPD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Collapse
Affiliation(s)
| | - Garrett Hisler
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | | | - Michael N. Hallquist
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill
| | | |
Collapse
|
9
|
Symptômes reliés au diagnostic du trouble de personnalité limite à l’adolescence : une recension systématique de la littérature. ANNALES MEDICO-PSYCHOLOGIQUES 2021. [DOI: 10.1016/j.amp.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
10
|
Lam LT, Lam MK. Sleep Disorders in Early Childhood and the Development of Mental Health Problems in Adolescents: A Systematic Review of Longitudinal and Prospective Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211782. [PMID: 34831538 PMCID: PMC8621806 DOI: 10.3390/ijerph182211782] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/08/2021] [Accepted: 11/08/2021] [Indexed: 11/27/2022]
Abstract
The association between sleep problems, particularly sleep disorders, and mental health has long been studied and recognized. However, the causal relationship between sleep disorders, particularly during early childhood, on mental health problems in adolescence are yet to be established. From a preventive perspective, it is important to understand the causality of mental health problems in adolescents so that intervention measures can be derived and implemented as early as possible for maximum effectiveness. To provide more precise information on the effect of early childhood sleep disorders on mental health problems during adolescence, a systematic review was conducted on longitudinal and prospective studies reported in the literature. Following the PRISMA guidelines with an extensive search of the literature 26 studies were identified. Seven of these identified studies satisfied all selection criteria with sufficient data on the effect of early childhood sleep disorders and mental health problems in adolescence. Information was extracted and analyzed systematically from each study and tabulated. The overall results obtained from these studies indicate a significant and possible causal relationship between early childhood sleep disorders and the development of mental health problems, such as anxiety, depression, and ADHD in adolescence. These results are discussed with regards to the theoretical and practical implications as well as preventive strategies.
Collapse
Affiliation(s)
- Lawrence T Lam
- Tung Wah College, Hong Kong, China
- Faculty of Health, University of Technology Sydney, Sydney, NSW 2007, Australia
- Correspondence:
| | - Mary K Lam
- RMIT University, Melbourne, VIC 3083, Australia;
| |
Collapse
|
11
|
Kahn M, Schnabel O, Gradisar M, Rozen GS, Slone M, Atzaba-Poria N, Tikotzky L, Sadeh A. Sleep, screen time and behaviour problems in preschool children: an actigraphy study. Eur Child Adolesc Psychiatry 2021; 30:1793-1802. [PMID: 33006004 DOI: 10.1007/s00787-020-01654-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/21/2020] [Indexed: 11/30/2022]
Abstract
Inadequate sleep and excessive exposure to media screens have both been linked to poorer mental health in youth. However, the ways in which these interact to predict behaviour problems have yet to be examined using objective sleep measurement. The lack of objective evidence for these relationships in young children has recently been defined by the World Health Organization (2019) as a gap in the field. We thus aimed to test the interacting effects of screen exposure and objectively measured sleep on behaviour problems in the preschool age. A total of 145 children aged 3-to-6-years participated in this cross-sectional study. Sleep was assessed objectively using actigraphy for 1-week, and subjectively using parent-reported daily sleep diaries. Parents reported the child's daily duration of screen exposure, and completed the Strengths and Difficulties Questionnaire. Results showed that actigraphic sleep duration, timing and efficiency were associated with screen exposure. The link between screen time and behaviour problems was moderated by sleep duration, as it was significant only for children with sleep duration of 9.88 h or less per night. Sleep duration also moderated the relation between screen time and externalizing-but not internalizing-problems. Hence, the combination of increased screen exposure and decreased sleep duration may be particularly adverse for child mental health. While these key relationships should be further examined in longitudinal and experimental investigations, our findings shed light on their complexity, underscoring the importance of the moderating role of sleep.
Collapse
Affiliation(s)
- Michal Kahn
- School of Psychological Sciences, Tel-Aviv University, Tel Aviv, Israel. .,College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia.
| | - Ortal Schnabel
- School of Psychological Sciences, Tel-Aviv University, Tel Aviv, Israel
| | - Michael Gradisar
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
| | - Geila S Rozen
- Clinical Nutrition Department, Rambam Medical Center, Haifa, Israel
| | - Michelle Slone
- School of Psychological Sciences, Tel-Aviv University, Tel Aviv, Israel
| | - Naama Atzaba-Poria
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Liat Tikotzky
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Avi Sadeh
- School of Psychological Sciences, Tel-Aviv University, Tel Aviv, Israel
| |
Collapse
|
12
|
Guilé JM, Zavaglia E, Berthiaume C, Bergeron L. Prevalence and comorbidity of borderline personality traits in the Quebec general population aged 12-14 years. Soc Psychiatry Psychiatr Epidemiol 2021; 56:2053-2062. [PMID: 33745001 DOI: 10.1007/s00127-021-02067-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The early identification of borderline personality traits (BPT) in adolescents helps to prevent their progression. Data are available for the clinical population, but little has been published on the general population, especially regarding age and sex distribution in adolescence. Even less is known about the comorbidity of BPT with other mental disorders. METHODS We estimated the prevalence of BPT, by sex, age, and comorbidity, in a sample of adolescents aged 12-14 years (n = 799) from the Quebec Mental Health Survey. A complex sampling design was used to ensure representativeness. BPT was assessed with the abbreviated-diagnostic interview for borderlines-revised, with the adolescent as an informant. Reliability coefficients were above 0.80. Several levels of severity were explored using an independent criterion, defined by impairment according to the Columbia impairment scale. RESULTS The overall prevalence of BPT was 6.3%. Prevalence estimates for the most impaired were 3.2% for the entire sample and 1.3% for 12-year-olds. Prevalence increased significantly with age for most impairment levels but did not differ significantly between the sexes. In adolescents, BPT displayed moderate-to-strong comorbidity with anxiety (AD) and insomnia disorders, and very strong comorbidity with depressive (DD), attention deficit hyperactivity (ADHD), and oppositional defiant/conduct disorders (ODD/CD). CONCLUSION We, therefore, make two clinical recommendations for child psychiatry practice: (1) with respect to the lower rate of male adolescents attending BPT Health Programs, increase BPT screening in male adolescents; (2) evaluate BPT when children with ADHD or ODD/CD develop AD or DD during adolescence.
Collapse
Affiliation(s)
- Jean Marc Guilé
- Child and Adolescent Psychiatry Services, Amiens-Picardie University Medical Centre , Amiens, France. .,Psychiatry Residency Program, Department of Psychiatry, University of Picardie-Jules Verne, Amiens, France. .,Department of Psychiatry, McGill University, Montreal, QC, Canada.
| | - Elissa Zavaglia
- Department of Psychology, Montreal University, Montreal, QC, Canada.,Research Centre, Hôpital en Santé Mentale Rivières-Des-Prairies, CIUSSS du Nord-de-L'Île-de-Montréal, Montréal, Québec, Canada
| | - Claude Berthiaume
- Research Centre, Hôpital en Santé Mentale Rivières-Des-Prairies, CIUSSS du Nord-de-L'Île-de-Montréal, Montréal, Québec, Canada
| | - Lise Bergeron
- Department of Psychology, Montreal University, Montreal, QC, Canada
| |
Collapse
|
13
|
Bohus M, Stoffers-Winterling J, Sharp C, Krause-Utz A, Schmahl C, Lieb K. Borderline personality disorder. Lancet 2021; 398:1528-1540. [PMID: 34688371 DOI: 10.1016/s0140-6736(21)00476-1] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/18/2021] [Accepted: 02/18/2021] [Indexed: 12/15/2022]
Abstract
Borderline personality disorder (BPD) is a mental disorder with a high burden on patients, family members, and health-care systems. The condition was previously regarded as untreatable, but progress in understanding and management has resulted in earlier diagnosis and better treatment outcomes. A coherent syndrome of BPD typically onsets during adolescence (after age 12 years). BPD is often preceded by or co-develops with symptoms of internalising disorders (depression and anxiety), externalising disorders (conduct problems, hyperactivity, and substance use), or both. BPD is associated with various poor outcomes, including low occupational and educational attainment, lack of long-term relationships, increased partner conflict, sexual risk-taking, low levels of social support, low life satisfaction, and increased service use. Psychotherapy is the main treatment for BPD; drug treatment is only indicated for comorbid conditions that require medication, or during a crisis if psychosocial interventions are insufficient. Awareness of BPD by non-specialists, as well as specialists, is key to appropriate early intervention.
Collapse
Affiliation(s)
- Martin Bohus
- Institute for Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Harvard Medical School, Boston, MA, USA
| | - Jutta Stoffers-Winterling
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany; Leibniz Institute for Resilience Research, Mainz, Germany
| | - Carla Sharp
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Annegret Krause-Utz
- Department of Clinical Psychology, Leiden University, Leiden Institute of Brain and Cognition, Leiden, Netherlands
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Klaus Lieb
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany; Leibniz Institute for Resilience Research, Mainz, Germany.
| |
Collapse
|
14
|
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.
Collapse
|
15
|
Xie GD, Chang JJ, Yuan MY, Wang GF, He Y, Chen SS, Su PY. Childhood abuse and borderline personality disorder features in Chinese undergraduates: the role of self-esteem and resilience. BMC Psychiatry 2021; 21:326. [PMID: 34210279 PMCID: PMC8252225 DOI: 10.1186/s12888-021-03332-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 06/18/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Although childhood abuse is considered to be related to borderline personality disorder (BPD), few studies have elaborated on the mediating role of self-esteem and resilience in it. Thus, the present study aimed to explore the potential mediating role of resilience and self-esteem between childhood abuse and BPD. METHODS This cross-sectional study was conducted with 4034 college students in Anhui Province, China. Participants were asked to complete Chinese versions of the following instruments: Childhood Trauma Questionnaire-Short Form (CTQ-SF), Mclean Screening Instrument for Borderline Personality Disorder (MSI-BPD), Connor-Davidson Resilience Scale (CD-RISC), and Rosenberg Self-Esteem Scale (RSES). Structural equation modeling (SEM) was used to test the mediation effects. RESULTS Resilience and self-esteem were found to be mediators of all three types of childhood abuse (emotional abuse, physical abuse and sexual abuse) when the types were examined separately; however, when all three types of childhood abuse were entered into the model simultaneously, neither the indirect effects nor direct effects of physical abuse or sexual abuse were found to be significant, only the association between emotional abuse and BPD features was partially mediated by resilience and self-esteem. CONCLUSIONS Self-esteem and resilience mediate the links between childhood abuse and BPD features, and emotional abuse is uniquely associated with BPD features.
Collapse
Affiliation(s)
- Guo-Die Xie
- grid.186775.a0000 0000 9490 772XDepartment of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei, 230032 Anhui China ,grid.410620.1Anhui Provincial Center for Disease Control and Prevention, No.12560 Fanhua Avenue, Hefei, 230601 Anhui China
| | - Jun-Jie Chang
- grid.186775.a0000 0000 9490 772XDepartment of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei, 230032 Anhui China
| | - Meng-Yuan Yuan
- grid.186775.a0000 0000 9490 772XDepartment of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei, 230032 Anhui China
| | - Geng-Fu Wang
- grid.186775.a0000 0000 9490 772XDepartment of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei, 230032 Anhui China
| | - Yang He
- grid.186775.a0000 0000 9490 772XDepartment of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei, 230032 Anhui China
| | - Shan-Shan Chen
- grid.186775.a0000 0000 9490 772XDepartment of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei, 230032 Anhui China
| | - Pu-Yu Su
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei, 230032, Anhui, China. .,Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China. .,Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei, 230032, Anhui, China.
| |
Collapse
|
16
|
Johnson BN, Vanwoerden S. Future directions in personality pathology development research from a trainee perspective: Suggestions for theory, methodology, and practice. Curr Opin Psychol 2021; 37:66-71. [PMID: 32891979 PMCID: PMC7895861 DOI: 10.1016/j.copsyc.2020.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/02/2020] [Accepted: 08/09/2020] [Indexed: 11/28/2022]
Abstract
Research on personality disorder (PD) development has received increased attention in the last two decades, spurring reconceptualization in theoretical models of etiology, use of advanced methods, and development of effective treatments. The current manuscript briefly reviews the state of the field and proposes avenues of new research on the development of personality pathology in theoretical, methodological, and clinical veins. We identify the need to adopt a unifying and comprehensive theory to describe PD development across the lifespan, novel statistical methods to complement traditional methods relied on thus far, and the adoption of developmentally sensitive interventions that are disseminated to professionals and trainees alike. These directions for future research aim to augment prevention efforts to reduce the burden of PDs earlier in life.
Collapse
Affiliation(s)
- Benjamin N Johnson
- The Pennsylvania State University, Mount Sinai Beth Israel, United States
| | - Salome Vanwoerden
- University of Pittsburgh Medical Center, Western Psychiatric Hospital, United States
| |
Collapse
|
17
|
Morales-Muñoz I, Durdurak BB, Bilgin A, Marwaha S, Winsper C. Understanding the Relationship Between Sleep Problems in Early Childhood and Borderline Personality Disorder: A Narrative Review. Nat Sci Sleep 2021; 13:2175-2202. [PMID: 34984039 PMCID: PMC8709557 DOI: 10.2147/nss.s311672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/06/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Recent research indicates that sleep problems in childhood precede the development of borderline personality disorder (BPD) symptoms, but the mechanisms by which sleep problems associate with BPD are still unknown. This narrative review aims to provide some potential explanations for how early sleep problems might associate with BPD. METHODS We used the biosocial developmental model of BPD as a framework to discuss how sleep problems may associate with BPD. Articles were identified via PubMed and Embase, and papers published between January 1991 and April 2021 were extracted. Authors made a series of literature searches using the following keywords: Sleep problems, Insomnia, Nightmares, Hypothalamic-Pituitary-Adrenal Axis (HPA), Prefrontal Cortex, Family Psychopathology, Disrupted Attachment, Child Maltreatment, Impulsivity, Emotion Regulation, Internalizing, Externalizing, Rumination, Childhood, Adolescence, Young people. The inclusion criteria were published in peer-reviewed journals; human studies or reviews; published in English. The exclusion criteria were commentaries; abstracts from conferences; studies with animal samples. A total of 96 articles were included for the purpose of this review. RESULTS The evidence from this review suggests that some biological factors and core features of BPD act as potential mechanisms mediating the associations between early sleep and subsequent BPD, while some family-related factors might constitute common risk factors for sleep problems and BPD. CONCLUSION The biosocial developmental model of BPD provides a plausible characterization of how sleep disruption might lead to subsequent BPD. Further research on new developmental and early intervention approaches to understand how sleep in early stages associates with BPD could have significant clinical impact on these patients and could inform targeted therapeutic interventions.
Collapse
Affiliation(s)
- Isabel Morales-Muñoz
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK.,Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Buse Beril Durdurak
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Ayten Bilgin
- School of Psychology, University of Kent, Canterbury, UK
| | - Steven Marwaha
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK.,The Barberry National Centre for Mental Health, Birmingham and Solihull Mental Health Trust, Birmingham, UK
| | - Catherine Winsper
- Coventry and Warwickshire Partnership NHS Trust, Research and Innovation, Coventry, UK
| |
Collapse
|
18
|
Morales-Muñoz I, Broome MR, Marwaha S. Association of Parent-Reported Sleep Problems in Early Childhood With Psychotic and Borderline Personality Disorder Symptoms in Adolescence. JAMA Psychiatry 2020; 77:1256-1265. [PMID: 32609357 PMCID: PMC7330826 DOI: 10.1001/jamapsychiatry.2020.1875] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
IMPORTANCE Persistent nightmares in childhood have been prospectively associated with psychosis and borderline personality disorder (BPD) in adolescence. However, the extent to which this association is also true for behavioral sleep problems is still unknown, and the potential mechanisms are unexplored. OBJECTIVE To examine the prospective associations between several parent-reported sleep problems in early childhood and psychotic and BPD symptoms at 11 to 13 years of age and the potential mediation of the associations by depression at 10 years of age. DESIGN, SETTING, AND PARTICIPANTS This cohort study assessed 13 488 participants in the Avon Longitudinal Study of Parents and Children birth cohort who were followed up for more than 13 years. Pregnant women from Avon, United Kingdom, with expected dates of delivery from April 1, 1991, to December 31, 1992, were invited to take part in the study. Data analysis was conducted from May 1 to December 31, 2019. MAIN OUTCOMES AND MEASURES Psychotic experiences at 12 to 13 years of age were assessed using the Psychosis-Like Symptom Interview, and BPD symptoms at 11 to 12 years of age were tested using the UK Childhood Interview for DSM-IV Borderline Personality Disorder. Parent-reported nighttime sleep duration, night awakening frequency, bedtime, and regularity of sleep routines were assessed when the child was 6, 18, and 30 months and 3.5, 4.8, and 5.8 years of age. RESULTS Data were available on 7155 participants (3718 girls [52%]) who reported on BPD symptoms and 6333 (3280 boys [52%]) who reported on BPD symptoms. Higher night awakening frequency at 18 months of age (odds ratio [OR], 1.13; 95% CI, 1.01-1.26) and less regular sleep routines at 6 months (OR, 0.68; 95% CI, 0.50-0.93), 30 months (OR, 0.64; 95% CI, 0.44-0.95), and 5.8 years (OR, 0.32; 95% CI, 0.19-0.53) of age were significantly associated with psychotic experiences in adolescence, whereas shorter nighttime sleep duration (OR, 0.78; 95% CI, 0.66-0.92) and later bedtime at 3.5 years of age (OR, 1.32; 95% CI, 1.09-1.60) were significantly associated with BPD symptoms. Results of mediation analysis were consistent with all these associations, except for later bedtime at 3.5 years and BPD in adolescence, which had no association. Depression at 10 years of age mediated the associations between frequent night awakenings at 18 months of age (bias-corrected estimate, -0.005; 95% CI, -0.008 to -0.002; P = .002) and irregular sleep routines at 5.8 years of age (bias-corrected estimate, -0.006; 95% CI, -0.010 to -0.003; P = .003) with psychosis. CONCLUSIONS AND RELEVANCE The findings suggest that some behavioral sleep problems in childhood are distinctively associated with the onset of psychosis and BPD in adolescence, following different pathways. Furthermore, depression at 10 years of age may mediate only the association with psychosis. These findings contribute to the design of more personalized interventions in psychosis and BPD.
Collapse
Affiliation(s)
- Isabel Morales-Muñoz
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland,Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Matthew R. Broome
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Steven Marwaha
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, United Kingdom,The Barberry National Centre for Mental Health, Birmingham, United Kingdom
| |
Collapse
|
19
|
Gauchat A, Zadra A, El-Hourani M, Parent S, Tremblay RE, Séguin JR. Disturbing Dreams and Psychosocial Maladjustment in Children: A Prospective Study of the Moderating Role of Early Negative Emotionality. Front Neurol 2020; 11:762. [PMID: 32849218 PMCID: PMC7427048 DOI: 10.3389/fneur.2020.00762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 06/19/2020] [Indexed: 12/26/2022] Open
Abstract
Although frequent disturbing dreams, including bad dreams and nightmares, have been repeatedly associated with poor psychological well-being in adults, considerably less information exists on their psychosocial correlates in children. Recent empirical and theoretical contributions suggest that the association between disturbing dream frequency and psychosocial adaptation in children may differ as a function of children's negative emotionality. The current study assessed the moderating effect of very early negative emotionality (17 months of age) in the relation between disturbing dream frequency and psychosocial maladjustment (i.e., externalizing + internalizing behaviors) in a sample of 173 11-year-old children. Mixed-model analyses revealed that disturbing dream frequency was associated with some internalizing behaviors but that the association between disturbing dream frequency and most externalizing behaviors was moderated by early negative emotionality. The latter result indicates that the relation between disturbing dream frequency and externalizing behaviors was significant in 11-year-old children showing moderate negative emotionality early in life, but particularly strong in those children with high early negative emotionality. Whereas, a moderating effect of early negative emotionality was not found between disturbing dream frequency and internalizing behaviors, the findings highlight the more specific role of early emotional negativity as a developmental moderator for the link between disturbing dreams and externalizing behaviors in children. The results are discussed in light of recent models of disturbed dreaming production.
Collapse
Affiliation(s)
- Aline Gauchat
- Clinique de Consultation Conjugale et Familiale Poitras-Wright, Côté, Longueuil, QC, Canada.,Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Antonio Zadra
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Mira El-Hourani
- Department of Psychology, Université de Montréal, Montreal, QC, Canada.,CHU Ste-Justine Research Center, Montreal, QC, Canada
| | - Sophie Parent
- School of Psychoeducation, Université de Montréal, Montreal, QC, Canada
| | - Richard E Tremblay
- Department of Psychology, Université de Montréal, Montreal, QC, Canada.,CHU Ste-Justine Research Center, Montreal, QC, Canada.,Department of Pediatrics, Université de Montréal, Montreal, QC, Canada.,School of Public Health, University College Dublin, Dublin, Ireland
| | - Jean R Séguin
- CHU Ste-Justine Research Center, Montreal, QC, Canada.,Department of Psychiatry and Addictology, Université de Montréal, Montreal, QC, Canada
| |
Collapse
|
20
|
Wall K, Vanwoerden S, Penner F, Patriquin M, Alfano CA, Sharp C. Adolescent Sleep Disturbance, Emotion Regulation and Borderline Features in an Inpatient Setting. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2020; 51:892-906. [PMID: 32603239 DOI: 10.1080/15374416.2020.1772081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The current study aimed to examine the relation between sleep disturbance, emotion dysregulation and borderline personality features in adolescent inpatients. METHOD N = 217 adolescents (67.1% female; ages 12-17) with the following racial/ethnic breakdown: 67.4% White, 3.7% Hispanic, 2.8% Asian, 1.8% African American, and 6.4% multiracial) completed self-report measures of sleep disturbance, emotion dysregulation and borderline personality symptoms at admission to, discharge from, and at 6-months-post discharge from an inpatient psychiatric hospital. Group comparison and path analyses were conducted to examine differences in sleep disturbance between those with and without borderline personality disorder and the mediating role of emotion dysregulation in the relation between sleep disturbance and borderline personality features. RESULTS Borderline personality features and emotion dysregulation were significantly related to indices of sleep disturbance. Path models revealed that some sleep disturbance indices at admission directly predicted levels of borderline features at discharge and at 6-months-post-discharge. However, none of the indirect pathways between sleep disturbance at admission, emotion dysregulation at discharge, and borderline features at discharge or 6-months post-discharge were significant. CONCLUSIONS Findings are consistent with prior literature which suggest that a unique relation exists between sleep disturbance and BPD, beyond comorbid depression symptoms. However, contrary to our hypotheses, the current study did not provide empirical support for the mediating role of emotion regulation in this relation. These findings have implications for existing personality disorder and sleep interventions and suggest further research into the mechanisms underlying the relation between sleep disturbance and borderline personality pathology is necessary.
Collapse
Affiliation(s)
- Kiana Wall
- Department of Psychology, University of Houston
| | | | | | - Michelle Patriquin
- Psychiatry and Behavioral Sciences, Baylor College of Medicine.,Psychiatry and Behavioral Sciences, The Menninger Clinic
| | | | - Carla Sharp
- Department of Psychology, University of Houston
| |
Collapse
|
21
|
Abstract
Sleep has been linked to adjustment difficulties in both children and adolescents; yet little is known about the long-term impact of childhood sleep on subsequent development. This study tested whether childhood sleep problems, sleep quantity, and chronotype predicted internalizing and externalizing problems during adolescence. Latent Growth Modeling using the Czech portion of the European Longitudinal Study of Pregnancy and Childhood (N = 4393) was utilized to test the developmental trajectories of sleep characteristics (from 1.5 to 7 years) as predictors of adjustment problems trajectories (from 11 to 18 years). Findings provided evidence that children with higher levels of sleep problems at 1.5 years (and throughout childhood) reported higher levels of internalizing and externalizing problems at age 11. Additionally, greater eveningness at age 1.5 predicted a greater increase in externalizing problems from ages 11 to 18 years. The results emphasize the importance of childhood sleep problems in evaluating the risk of future adjustment difficulties.
Collapse
|
22
|
Winsper C, Bilgin A, Wolke D. Associations between infant and toddler regulatory problems, childhood co-developing internalising and externalising trajectories, and adolescent depression, psychotic and borderline personality disorder symptoms. J Child Psychol Psychiatry 2020; 61:182-194. [PMID: 31469175 DOI: 10.1111/jcpp.13125] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Early regulatory problems (RPs) are associated with childhood internalising and externalising symptoms. Internalising and externalising symptoms, in turn, are associated with adolescent psychopathology (e.g. personality disorders, depression). We examined whether RPs are directly associated with adolescent psychopathology, or whether associations are indirect via childhood internalising and externalising symptoms. METHODS We used data from the Avon Longitudinal Study of Parents and Children. Mothers reported on their child's RPs at 6, 15-18 and 24-30 months, and internalising and externalising symptoms at 4, 7, 8 and 9.5 years. Adolescent psychotic, depression and BPD symptoms were assessed at 11-12 years. Children were grouped by their patterns of co-developing internalising and externalising symptoms using parallel process latent class growth analysis (PP-LCGA). Path analysis was used to examine direct and indirect associations from RPs to the three adolescent outcomes. RESULTS There were four groups of children with distinct patterns of co-developing internalising and externalising (INT/EXT) symptoms. Most children (53%) demonstrated low-moderate and stable levels of INT/EXT symptoms. A small proportion (7.7%) evidenced moderate and increasing INT and high stable EXT symptoms: this pattern was strongly predictive of adolescent psychopathology (e.g. depression at 11 years: unadjusted odds ratio = 5.62; 95% confidence intervals = 3.82, 8.27). The other two groups were differentially associated with adolescent outcomes (i.e. moderate-high increasing INT/moderate decreasing EXT predicted mother-reported depression at 12, while low stable INT/moderate-high stable EXT predicted child-reported depression at 11). In path analysis, RPs at each time-point were significantly indirectly associated with symptoms of BPD and child- and mother-reported depression symptoms via the most severe class of INT/EXT symptoms. CONCLUSIONS Consistent with a cascade model of development, RPs are predictive of higher levels of co-developing INT/EXT symptoms, which in turn increase risk of adolescent psychopathology. Clinicians should be aware of, and treat, early RPs to prevent chronic psychopathology.
Collapse
Affiliation(s)
- Catherine Winsper
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK.,R & I Department, Caludon Centre, Coventry and Warwickshire Partnership Trust, Coventry, UK
| | - Ayten Bilgin
- Department of Psychology, University of Warwick, Coventry, UK.,Berlin Psychological University, Berlin, Germany
| | - Dieter Wolke
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK.,Department of Psychology, University of Warwick, Coventry, UK
| |
Collapse
|
23
|
Lynn SJ, Maxwell R, Merckelbach H, Lilienfeld SO, Kloet DVHVD, Miskovic V. Dissociation and its disorders: Competing models, future directions, and a way forward. Clin Psychol Rev 2019; 73:101755. [DOI: 10.1016/j.cpr.2019.101755] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 06/20/2019] [Accepted: 07/15/2019] [Indexed: 12/18/2022]
|
24
|
Scarpelli S, Bartolacci C, D'Atri A, Gorgoni M, De Gennaro L. Mental Sleep Activity and Disturbing Dreams in the Lifespan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3658. [PMID: 31569467 PMCID: PMC6801786 DOI: 10.3390/ijerph16193658] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/11/2019] [Accepted: 09/27/2019] [Indexed: 02/05/2023]
Abstract
Sleep significantly changes across the lifespan, and several studies underline its crucial role in cognitive functioning. Similarly, mental activity during sleep tends to covary with age. This review aims to analyze the characteristics of dreaming and disturbing dreams at different age brackets. On the one hand, dreams may be considered an expression of brain maturation and cognitive development, showing relations with memory and visuo-spatial abilities. Some investigations reveal that specific electrophysiological patterns, such as frontal theta oscillations, underlie dreams during sleep, as well as episodic memories in the waking state, both in young and older adults. On the other hand, considering the role of dreaming in emotional processing and regulation, the available literature suggests that mental sleep activity could have a beneficial role when stressful events occur at different age ranges. We highlight that nightmares and bad dreams might represent an attempt to cope the adverse events, and the degrees of cognitive-brain maturation could impact on these mechanisms across the lifespan. Future investigations are necessary to clarify these relations. Clinical protocols could be designed to improve cognitive functioning and emotional regulation by modifying the dream contents or the ability to recall/non-recall them.
Collapse
Affiliation(s)
- Serena Scarpelli
- Department of Psychology, "Sapienza" University of Rome, Via dei Marsi, 78, 00185 Rome, Italy.
| | - Chiara Bartolacci
- Department of Psychology, "Sapienza" University of Rome, Via dei Marsi, 78, 00185 Rome, Italy.
| | - Aurora D'Atri
- Department of Psychology, "Sapienza" University of Rome, Via dei Marsi, 78, 00185 Rome, Italy.
| | - Maurizio Gorgoni
- Department of Psychology, "Sapienza" University of Rome, Via dei Marsi, 78, 00185 Rome, Italy.
| | - Luigi De Gennaro
- Department of Psychology, "Sapienza" University of Rome, Via dei Marsi, 78, 00185 Rome, Italy.
- IRCCS Santa Lucia Foundation, 00142 Rome, Italy.
| |
Collapse
|
25
|
Tham EKH, Richmond J, Gooley JJ, Jafar NK, Chong YS, Yap F, Teoh OH, Goh DYT, Broekman BFP, Rifkin-Graboi A. Variations in habitual sleep and relational memory in 6-month-olds. Sleep Health 2019; 5:257-265. [PMID: 31208709 DOI: 10.1016/j.sleh.2018.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 12/10/2018] [Accepted: 12/11/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Adequate sleep duration and good sleep quality are considered essential for development, especially during periods of major neurodevelopmental change. Still, relations between parent-reported habitual sleep and emerging cognitive abilities within the first year of life are not well studied. Here, we examined relations between habitual sleep measures and an aspect of cognitive functioning, relational memory, which emerges as early as 6 months of age, as compared to other abilities (ie, recognition memory and attentional orienting), both of which are considered to emerge earlier in development. PARTICIPANTS Participants were a subset of 267 healthy typically developing 6-month-olds taking part in the Growing Up in Singapore towards Healthy Outcomes cohort study. MEASUREMENTS Sleep duration, sleep latency, and number and duration of night awakenings were derived from the Brief Infant Sleep Questionnaire (BISQ). Short sleep was defined as <10 hours per day, categorized as "not recommended" based on the National Sleep Foundation recommendations. Associations between sleep variables and infants' performance on 2 relational memory tests (deferred imitation and relational binding) were examined independently using hierarchical (blockwise entry) linear regression. Associations between sleep and recognition memory and attentional orienting were also explored. RESULTS Habitual short sleepers had poorer relational memory recall in the deferred imitation task compared with 'typical' sleepers (10-18 hours per day). Shorter sleep latency was related to a greater proportion of correct responses for certain aspects of relational binding. There were no associations between sleep and recognition memory or attention. CONCLUSIONS Our findings suggest that habitual sleep duration and short sleep latency associate with 6-month-olds' relational memory, suggesting a preferential association with memory tasks that are sensitive to development during the second half of the first year.
Collapse
Affiliation(s)
- Elaine K H Tham
- Singapore Institute for Clinical Sciences, Agency for Science and Technology Research (A*STAR), Singapore
| | - Jenny Richmond
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Joshua J Gooley
- Program in Neuroscience and Behavioral Disorders, Duke-NUS Medical School, Singapore
| | - Nur K Jafar
- Singapore Institute for Clinical Sciences, Agency for Science and Technology Research (A*STAR), Singapore
| | - Yap-Seng Chong
- Singapore Institute for Clinical Sciences, Agency for Science and Technology Research (A*STAR), Singapore; Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Fabian Yap
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Daniel Y T Goh
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Birit F P Broekman
- Singapore Institute for Clinical Sciences, Agency for Science and Technology Research (A*STAR), Singapore; Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Anne Rifkin-Graboi
- Singapore Institute for Clinical Sciences, Agency for Science and Technology Research (A*STAR), Singapore.
| |
Collapse
|
26
|
Nielsen T, Carr M, Picard-Deland C, Marquis LP, Saint-Onge K, Blanchette-Carrière C, Paquette T. Early childhood adversity associations with nightmare severity and sleep spindles. Sleep Med 2019; 56:57-65. [DOI: 10.1016/j.sleep.2019.03.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 03/04/2019] [Accepted: 03/06/2019] [Indexed: 12/22/2022]
|
27
|
Borderline personality disorder traits and suicide risk: The mediating role of insomnia and nightmares. J Affect Disord 2019; 244:85-91. [PMID: 30326346 DOI: 10.1016/j.jad.2018.10.097] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/10/2018] [Accepted: 10/08/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Borderline personality disorder (BPD) is associated with high rates of suicide risk and problems related to sleep, including insomnia and nightmares. The purpose of the current study was to assess the potential indirect effect of BPD traits on suicide risk through both/either insomnia and nightmares. METHODS Participants (N = 281) were recruited via Amazon's Mechanical Turk to complete the study remotely online. Participants completed measures of BPD traits and symptoms, suicide risk (history of suicidal thoughts and behaviors), insomnia symptoms, and distress and impairment related to nightmares. RESULTS BPD traits and symptoms were moderately to highly correlated to suicide risk, insomnia, and nightmares. In parallel mediation models, BPD traits had a significant indirect effect on suicide risk through insomnia symptoms but not nightmares. LIMITATIONS The current study assessed problems within the general population and not in a clinical sample. Second, the study relied solely on self-report measures. Futures studies would benefit from investigating these relations in clinical samples utilizing observer-report and interview methods. CONCLUSIONS BPD traits appear to relate to increased risk for suicide through the relation with sleep concerns, particularly insomnia symptoms. Therefore, assessing and treating sleep problems within individuals with BPD may result in a lower risk for suicide.
Collapse
|
28
|
de Almondes KM, Leonardo MEM. Study Protocol of Sleep Education Tool for Children: Serious Game "Perfect Bedroom: Learn to Sleep Well". Front Psychol 2018; 9:1016. [PMID: 29997540 PMCID: PMC6028730 DOI: 10.3389/fpsyg.2018.01016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 05/31/2018] [Indexed: 12/19/2022] Open
Abstract
Promoting a healthy sleep is a big challenge and becomes a strategic priority in public health, due to the severe consequences on children's development and risk to psychiatric diseases. Interventions that promote healthy sleep, such as those that focus on the dissemination of behavioral and environmental recommendations of sleep hygiene with children, are presented as an alternative. Serious game design offers wide-reaching domains in health applications and is increasing in popularity, particularly with children and teens because of it's potential to engage and motivate players differently from other interventions. This study aims to evaluate effects of serious game on sleep hygiene recommendations "Perfect Bedroom: learn to sleep well," on sleep habits and sleep parameters of healthy children. This is an experimental, prospective and quantitative study. We will randomize children in experimental (n = 88) and no intervention groups (n = 88). The experiment has four stages (pre-intervention, intervention, post-intervention, and follow-up), which will count with participation of children and their parents/guardians. In the evaluation stages, the guardians will answer questionnaires and scales to assess sociodemographic and health data, sleep habits and sleep pattern of their child. The children themselves will answer the following: a scale to assess sleepiness levels, a questionnaire to evaluate the serious game and the game itself, will characterize their bedroom and the activities they perform before sleep, with strategies developed by researches. Intervention with experimental group conducted with the serious game "Perfect Bedroom" will happen twice a week, for 3 weeks in a row, resulting in six sessions of 50 min each. Inferential analysis will be conducted for comparisons between groups and intragroups to measure effect of intervention in primary outcomes (sleep habits) and secondary outcomes (sleep parameters). We expect that the intervention with this game can provide valuable evidence to a new approach in promoting healthy sleep habits, with applications in clinical, educational, and familiar settings, which could diminish future health issues and risk at psychiatric diseases, decreasing the social burden of treatments for these conditions in children.
Collapse
Affiliation(s)
- Katie Moraes de Almondes
- Department of Psychology and Postgraduate Program, Postgraduate Program in Psychobiology, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Maria E M Leonardo
- Postgraduate Program in Psychology, Federal University of Rio Grande do Norte, Natal, Brazil
| |
Collapse
|
29
|
Hessels CJ, Laceulle OM, van Aken MAG, Resch F, Kaess M. Differentiating BPD in adolescents with NSSI disorder: the role of adverse childhood experiences and current social relationships. Borderline Personal Disord Emot Dysregul 2018; 5:20. [PMID: 30555704 PMCID: PMC6286500 DOI: 10.1186/s40479-018-0097-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 11/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As borderline personality disorder (BPD) is increasingly considered a lifespan developmental disorder, we need to focus on risk factors and precursors in the developmental pathways to BPD, in order to enable early detection and intervention. Within this developmental pathway, adolescence is a crucial phase in the light of the manifestation of the disorder. Relational factors such as adverse childhood experiences and current relational problems can be considered important in adolescents who are at-risk for BPD. Nonsuicidal self-injury (NSSI) is a key precursor for adolescent BPD and one of the most promising targets for early detection and intervention of BPD. METHODS In a clinical sample of 152 adolescents engaging in nonsuicidal self-injury (NSSI) disorder referred to mental healthcare in Germany, this study investigated whether we can differentiate who has BPD from 1) adverse childhood experiences; and 2) the quality of current relationships, both with parents and peers. BPD was assessed both categorically as a dichotomized score and dimensionally as a continuous score. RESULTS More adverse childhood experiences, but not low quality of current social relationships, were related to more BPD symptoms and an increased risk for meeting full criteria for BPD. In the dimensional model, current social relationship quality with parents and peers did not show a moderating (protecting or aggravating) effect on the association between adverse childhood experiences and BPD. Using a categorical approach, however, the association between childhood adversity and meeting full criteria for BPD was higher in individuals reporting higher quality of current parent-child relationship. CONCLUSIONS These results highlight adverse childhood experiences as risk factors of BPD, while the role of current social relationships seems more complex.
Collapse
Affiliation(s)
| | - Odilia M Laceulle
- 2Department of Developmental Psychology, Utrecht University, Utrecht, Netherlands
| | - Marcel A G van Aken
- 2Department of Developmental Psychology, Utrecht University, Utrecht, Netherlands
| | - Franz Resch
- 3Clinic of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- 4University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,5Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| |
Collapse
|
30
|
The aetiology of borderline personality disorder (BPD): contemporary theories and putative mechanisms. Curr Opin Psychol 2017; 21:105-110. [PMID: 29182951 DOI: 10.1016/j.copsyc.2017.10.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 10/27/2017] [Accepted: 10/31/2017] [Indexed: 12/11/2022]
Abstract
This article presents an overview of current knowledge regarding the aetiology of Borderline Personality Disorder (BPD). It begins with a brief synopsis of early research and theory, and discusses how changing conceptualisations of BPD have impacted on our aetiological knowledge. Contemporary theories are described and presented within a developmental psychopathology framework. Deficient co-regulation and social communication in infancy are purported to underpin emotional dysregulation and social cognition deficits across development. These mechanisms are further potentiated by maladaptive social experiences in a series of positive feedback loops. Prospective research provides preliminary evidence for the reciprocal (or mediating) effects of maladaptive experiences and childhood dysregulation. Moving forward, cohort studies may incorporate neurobiological assessments to examine the biological systems underpinning phenotypic (e.g., impulsivity, disturbed relatedness) covariation.
Collapse
|
31
|
Titus CE, Speed KJ, Cartwright PM, Drapeau CW, Heo Y, Nadorff MR. What role do nightmares play in suicide? A brief exploration. Curr Opin Psychol 2017; 22:59-62. [PMID: 28846873 DOI: 10.1016/j.copsyc.2017.08.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 07/21/2017] [Accepted: 08/08/2017] [Indexed: 01/01/2023]
Abstract
The suicide rate in the United States has climbed each year for more than a decade, highlighting the need for greater understanding of, and prevention strategies for suicidal behavior. Nightmares have been shown to be associated with suicidal behavior independent of several psychiatric risk factors for suicide, such as symptoms of depression, anxiety, and posttraumatic stress disorder (PTSD). The specific role of nightmares in contributing to suicide remains unclear due to the difficulty in delineating causal factors. However, the reporting, screening and treatment of nightmares continues to remain rare making progress difficult. Research is beginning to make some progress in uncovering the mechanisms by which nightmares increase suicide risk providing opportunities for intervention and prediction of suicidal behaviors.
Collapse
Affiliation(s)
- Caitlin E Titus
- Department of Psychology, Mississippi State University, MS, USA.
| | - Katrina J Speed
- Department of Psychology, Mississippi State University, MS, USA
| | | | | | - Yeseul Heo
- Department of Psychology, Mississippi State University, MS, USA
| | | |
Collapse
|
32
|
Abstract
Adverse childhood experiences can deleteriously affect future physical and mental health, increasing risk for many illnesses, including psychiatric problems, sleep disorders, and, according to the present hypothesis, idiopathic nightmares. Much like post-traumatic nightmares, which are triggered by trauma and lead to recurrent emotional dreaming about the trauma, idiopathic nightmares are hypothesized to originate in early adverse experiences that lead in later life to the expression of early memories and emotions in dream content. Accordingly, the objectives of this paper are to (1) review existing literature on sleep, dreaming and nightmares in relation to early adverse experiences, drawing upon both empirical studies of dreaming and nightmares and books and chapters by recognized nightmare experts and (2) propose a new approach to explaining nightmares that is based upon the Stress Acceleration Hypothesis of mental illness. The latter stipulates that susceptibility to mental illness is increased by adversity occurring during a developmentally sensitive window for emotional maturation—the infantile amnesia period—that ends around age 3½. Early adversity accelerates the neural and behavioral maturation of emotional systems governing the expression, learning, and extinction of fear memories and may afford short-term adaptive value. But it also engenders long-term dysfunctional consequences including an increased risk for nightmares. Two mechanisms are proposed: (1) disruption of infantile amnesia allows normally forgotten early childhood memories to influence later emotions, cognitions and behavior, including the common expression of threats in nightmares; (2) alterations of normal emotion regulation processes of both waking and sleep lead to increased fear sensitivity and less effective fear extinction. These changes influence an affect network previously hypothesized to regulate fear extinction during REM sleep, disruption of which leads to nightmares. This network consists of a fear circuit that includes amygdala, hippocampus, and medial prefrontal cortex and whose substantial overlap with the stress acceleration findings allows the latter to be incorporated into a wider, more developmentally coherent framework.
Collapse
Affiliation(s)
- Tore Nielsen
- Dream and Nightmare Laboratory, Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM - Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada.,Department of Psychiatry, Université de Montreal, Montreal, QC, Canada
| |
Collapse
|