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Livingston NR, Stanton K. Compatibility of Linehan's biosocial theory and the DSM-5 Alternative Model of Personality Disorders for borderline personality disorder. Personal Ment Health 2024. [PMID: 39258431 DOI: 10.1002/pmh.1635] [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: 04/06/2024] [Revised: 07/02/2024] [Accepted: 08/25/2024] [Indexed: 09/12/2024]
Abstract
Borderline personality disorder (BPD) is characterized by affective, interpersonal, and identity instability, as well as marked impulsivity. There is evidence that BPD may be best operationalized dimensionally using models such as the Alternative Model for Personality Disorders (AMPD) described in Section III of the Diagnostic and Statistical Manual for Mental Disorders (DSM). Moreover, biosocial theory is a well-known etiological theory of BPD emphasizing emotion dysregulation, inherited impulsivity, and development within invalidating contexts as key etiological mechanisms. Given that current research and clinical efforts for BPD are informed by both nosology and etiology, this narrative review examined how well biosocial theory (a) aligns with AMPD conceptualizations, (b) accounts for psychiatric comorbidity, and (c) accounts for heterogeneity in BPD presentation. Findings suggested that tenets of biosocial theory align well with Criteria A and B of the AMPD; however, biosocial theory focuses narrowly on roles of emotion dysregulation, impulsivity, and invalidating contexts, and empirical support is lacking in some ways for several etiological explanations proposed by biosocial theory. Additionally, although biosocial theory captures empirically supported features of BPD and emphasizes high-risk subgroups, the theory may not account for lower-risk subgroups. Finally, the theory accounts for diagnostic co-occurrence via the central role of emotion dysregulation, but biosocial theory may not be specific to BPD and may broadly apply to a range of psychopathology. Based on the literature reviewed, implications for future research and clinical efforts are highlighted.
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Affiliation(s)
| | - Kasey Stanton
- Department of Psychology, University of Wyoming, Laramie, Wyoming, USA
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2
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Martinez BS, Rowland JA, Shura RD, Magnante AT, Morey RA, Martindale SL. Influence of affective instability on suicidal ideation beyond traumatic brain injury and posttraumatic stress disorder in veterans. J Psychiatr Res 2024; 172:411-419. [PMID: 38458113 DOI: 10.1016/j.jpsychires.2024.02.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 02/02/2024] [Accepted: 02/27/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE Mild traumatic brain injury (TBI) is associated with long-term consequences, including greater risk for posttraumatic stress disorder (PTSD) and suicidal ideation. Affective instability is also independently related to PTSD and suicidality, which may explain why some individuals continue to experience chronic psychiatric complaints following mild TBI. The purpose of the present study was to evaluate affective instability as a key factor for PTSD and suicidal ideation among Veterans with and without TBI. METHOD Participants (N = 299 Veterans; 86.96% male) completed the Personality Assessment Inventory (PAI) and structured clinical interviews for TBI and psychiatric diagnoses. Hierarchical linear regression was used to evaluate main and interaction effects. RESULTS There were no significant differences in affective instability (p = 0.140) or suicidal ideation (p = 0.453) between Veterans with or without TBI. Individuals with TBI were more likely to have a PTSD diagnosis (p = 0.001). Analyses evaluating PTSD diagnosis as an outcome indicated a main effect of affective instability (p < 0.001), but not TBI (p = 0.619). Analyses evaluating suicidal ideation as an outcome demonstrated an interaction effect between PTSD and affective instability beyond the effects of TBI (p = 0.034). CONCLUSIONS Severe Affective instability appears to be a key factor in suicidal ideation among Veterans beyond TBI or PTSD history. PTSD was more strongly associated with suicidality at lower and moderate levels of affective instability. At severe levels of affective instability, however, Veterans with and without PTSD experienced suicidal ideation at similar rates. Findings suggests that high levels of affective instability not better explained by other psychiatric conditions confers similar suicidality risk to that of PTSD in a Veteran population.
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Affiliation(s)
- Brandy S Martinez
- Durham Veteran Affairs (VA) Health Care System, Durham, NC, USA; VA (VISN 6) Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, NC, USA.
| | - Jared A Rowland
- VA (VISN 6) Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Research & Academic Affairs Service Line, W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, USA; Department of Neurobiology & Anatomy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Robert D Shura
- VA (VISN 6) Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Research & Academic Affairs Service Line, W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, USA; Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Anna T Magnante
- VA (VISN 6) Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Research & Academic Affairs Service Line, W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, USA; Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Rajendra A Morey
- Durham Veteran Affairs (VA) Health Care System, Durham, NC, USA; VA (VISN 6) Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, NC, USA
| | - Sarah L Martindale
- VA (VISN 6) Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Research & Academic Affairs Service Line, W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, USA; Department of Physiology & Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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3
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Chang CH, Drobotenko N, Ruocco AC, Lee ACH, Nestor A. Perception and memory-based representations of facial emotions: Associations with personality functioning, affective states and recognition abilities. Cognition 2024; 245:105724. [PMID: 38266352 DOI: 10.1016/j.cognition.2024.105724] [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: 06/03/2023] [Revised: 11/09/2023] [Accepted: 01/15/2024] [Indexed: 01/26/2024]
Abstract
Personality traits and affective states are associated with biases in facial emotion perception. However, the precise personality impairments and affective states that underlie these biases remain largely unknown. To investigate how relevant factors influence facial emotion perception and recollection, Experiment 1 employed an image reconstruction approach in which community-dwelling adults (N = 89) rated the similarity of pairs of facial expressions, including those recalled from memory. Subsequently, perception- and memory-based expression representations derived from such ratings were assessed across participants and related to measures of personality impairment, state affect, and visual recognition abilities. Impairment in self-direction and level of positive affect accounted for the largest components of individual variability in perception and memory representations, respectively. Additionally, individual differences in these representations were impacted by face recognition ability. In Experiment 2, adult participants (N = 81) rated facial image reconstructions derived in Experiment 1, revealing that individual variability was associated with specific visual face properties, such as expressiveness, representation accuracy, and positivity/negativity. These findings highlight and clarify the influence of personality, affective state, and recognition abilities on individual differences in the perception and recollection of facial expressions.
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Affiliation(s)
- Chi-Hsun Chang
- Department of Psychology at Scarborough, University of Toronto, 1265 Military Trail, Scarborough, Ontario M1C 1A4, Canada
| | - Natalia Drobotenko
- Department of Psychology at Scarborough, University of Toronto, 1265 Military Trail, Scarborough, Ontario M1C 1A4, Canada
| | - Anthony C Ruocco
- Department of Psychology at Scarborough, University of Toronto, 1265 Military Trail, Scarborough, Ontario M1C 1A4, Canada; Department of Psychological Clinical Science at Scarborough, University of Toronto, 1265 Military Trail, Scarborough, Ontario M1C 1A4, Canada
| | - Andy C H Lee
- Department of Psychology at Scarborough, University of Toronto, 1265 Military Trail, Scarborough, Ontario M1C 1A4, Canada; Rotman Research Institute, Baycrest Centre, 3560 Bathurst St, North York, Ontario M6A 2E1, Canada
| | - Adrian Nestor
- Department of Psychology at Scarborough, University of Toronto, 1265 Military Trail, Scarborough, Ontario M1C 1A4, Canada.
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Yin Q, Hughes CD, Rizvi SL. Using GIMME to model the emotional context of suicidal ideation based on clinical data: From research to clinical practice. Behav Res Ther 2023; 171:104427. [PMID: 37980875 DOI: 10.1016/j.brat.2023.104427] [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: 01/31/2023] [Revised: 10/15/2023] [Accepted: 11/03/2023] [Indexed: 11/21/2023]
Abstract
Research and clinical experience highlight the variability of suicidal ideation (SI) within and between individuals. Although the idiographic emotional contexts in which SI occurs may offer explanations for its dynamic nature, most statistical methods focus on nomothetic patterns, making it difficult to advance our understanding of SI. Furthermore, the gap between nomothetic methods and a need for idiographic understanding of SI poses challenges to translating empirical knowledge into individualized clinical treatment. Group iterative multiple model estimation (GIMME) is a method that may bridge the idiographic-nomothetic divide by analyzing temporal relationships among a network of variables at both group- and individual-levels. This study explored the feasibility and clinical utility of GIMME applied to examine the relationships between various emotions and SI among individuals with borderline personality disorder who underwent Dialectical Behavior Therapy. We present graphic outputs that emerged throughout treatment and discuss how they could aid clinical assessment and case formulation (ClinicalTrials.gov Identifier: NCT03123198.).
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Affiliation(s)
- Qingqing Yin
- Department of Psychology, Rutgers University, 152 Frelinghuysen Road, Piscataway, NJ, 08854, United States.
| | - Christopher D Hughes
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Box G-BH, Providence, RI, 02912, United States; Department of Psychosocial Research, Butler Hospital, 345 Blackstone Blvd., Providence, RI, 02906, United States
| | - Shireen L Rizvi
- Graduate School of Applied and Professional Psychology, Rutgers University, 152 Frelinghuysen Road, Piscataway, NJ, 08854, United States
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5
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So SHW, Chau AKC, Chung LKH, Leung CM, Chong GH, Chang WC, Mak AD, Chan SS, Lee S, Sommer IE. Moment-to-moment affective dynamics in schizophrenia and bipolar disorder. Eur Psychiatry 2023; 66:e67. [PMID: 37544924 PMCID: PMC10594258 DOI: 10.1192/j.eurpsy.2023.2438] [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: 05/01/2023] [Revised: 06/20/2023] [Accepted: 07/03/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Affective disturbances in schizophrenia and bipolar disorder may represent a transdiagnostic etiological process as well as a target of intervention. Hypotheses on similarities and differences in various parameters of affective dynamics (intensity, successive/acute changes, variability, and reactivity to stress) between the two disorders were tested. METHODS Experience sampling method was used to assess dynamics of positive and negative affect, 10 times a day over 6 consecutive days. Patients with schizophrenia (n = 46) and patients with bipolar disorder (n = 46) were compared against age-matched healthy controls (n = 46). RESULTS Compared to controls, the schizophrenia group had significantly more intense momentary negative affect, a lower likelihood of acute changes in positive affect, and reduced within-person variability of positive affect. The bipolar disorder group was not significantly different from either the schizophrenia group or the healthy control group on any affect indexes. Within the schizophrenia group, level of depression was associated with weaker reactivity to stress for negative affect. Within the bipolar disorder group, level of depression was associated with lower positive affect. CONCLUSIONS Patients with schizophrenia endured a more stable and negative affective state than healthy individuals, and were less likely to be uplifted in response to happenings in daily life. There is little evidence that these affective constructs characterize the psychopathology of bipolar disorder; such investigation may have been limited by the heterogeneity within group. Our findings supported the clinical importance of assessing multiple facets of affective dynamics beyond the mean levels of intensity.
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Affiliation(s)
- Suzanne Ho-wai So
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China
| | - Anson Kai Chun Chau
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China
- Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Chung-ming Leung
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China
| | - George H.C. Chong
- Department of Clinical Psychology, Kwai Chung Hospital, Hong Kong, China
| | - Wing Chung Chang
- Department of Psychiatry, The University of Hong Kong, Hong Kong, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
| | - Arthur D.P. Mak
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China
| | - Sandra S.M. Chan
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China
| | - Sing Lee
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China
| | - Iris E. Sommer
- Department of Psychiatry, University Medical Centre Groningen, The Netherlands
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McGowan AL, Sayed F, Boyd ZM, Jovanova M, Kang Y, Speer ME, Cosme D, Mucha PJ, Ochsner KN, Bassett DS, Falk EB, Lydon-Staley DM. Dense Sampling Approaches for Psychiatry Research: Combining Scanners and Smartphones. Biol Psychiatry 2023; 93:681-689. [PMID: 36797176 PMCID: PMC10038886 DOI: 10.1016/j.biopsych.2022.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 11/22/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
Together, data from brain scanners and smartphones have sufficient coverage of biology, psychology, and environment to articulate between-person differences in the interplay within and across biological, psychological, and environmental systems thought to underlie psychopathology. An important next step is to develop frameworks that combine these two modalities in ways that leverage their coverage across layers of human experience to have maximum impact on our understanding and treatment of psychopathology. We review literature published in the last 3 years highlighting how scanners and smartphones have been combined to date, outline and discuss the strengths and weaknesses of existing approaches, and sketch a network science framework heretofore underrepresented in work combining scanners and smartphones that can push forward our understanding of health and disease.
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Affiliation(s)
- Amanda L McGowan
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Psychology, Concordia University, Montréal, Québec, Canada
| | - Farah Sayed
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Zachary M Boyd
- Department of Mathematics, Brigham Young University, Provo, Utah
| | - Mia Jovanova
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yoona Kang
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Megan E Speer
- Department of Psychology, Columbia University, New York, New York
| | - Danielle Cosme
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Peter J Mucha
- Department of Mathematics, Dartmouth College, Hanover, New Hampshire
| | - Kevin N Ochsner
- Department of Psychology, Columbia University, New York, New York
| | - Dani S Bassett
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Physics & Astronomy, College of Arts and Sciences, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Electrical & Systems Engineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Santa Fe Institute, Santa Fe, New Mexico
| | - Emily B Falk
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania; Marketing Department, Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania; Operations, Information and Decisions, Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David M Lydon-Staley
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.
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Nauphal M, Curreri AJ, Cardona ND, Meyer ER, Southward MW, Sauer-Zavala S. Measuring Emotion Regulation Skill Use During Treatment: A Promising Methodological Approach. Assessment 2023; 30:592-605. [PMID: 34886709 DOI: 10.1177/10731911211063229] [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] [Indexed: 11/15/2022]
Abstract
Emotion regulation has become ubiquitous in the study of psychopathology and a growing number of treatment outcome studies are collecting data on emotion regulation skill use. However, traditional measures of emotion regulation fail to capture important nuances in emotion regulation processes, their relationship to psychopathology, and how individuals use emotion regulation skills over time and across contexts. Novel methodologies are particularly needed for measuring emotion regulation in the context of treatment studies. In this article, we discuss a proposed methodology, the combination of ecological momentary assessment (EMA), and single-case experimental design (SCED), for measuring emotion regulation strategy use in the context of treatment outcome studies. To inform this discussion, we provide a brief overview of common approaches to assessing emotion regulation skill use in the context of treatment outcome research. We then describe the utility of intensive data capture (EMA) in the context of idiographic treatment studies (SCED), present a case study to illustrate the different uses of data collected through EMA in the context of a SCED study, and discuss considerations for implementing this method in clinical practice.
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8
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Bud S, Nechita D, Szentagotai Tatar A. Emotion regulation strategies in borderline personality disorder: a meta-analysis. CLIN PSYCHOL-UK 2023. [DOI: 10.1080/13284207.2022.2152668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Affiliation(s)
- Samuel Bud
- Evidence-Based Assessment and Psychological Interventions Doctoral School, Babeş-Bolyai University, Cluj-Napoca, Romania
- International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania
| | - Diana Nechita
- International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania
| | - Aurora Szentagotai Tatar
- International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania
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Kelly Grealy M, Godfrey E, Brady F, Whyte O’Sullivan E, Carroll GA, Burke T. Borderline personality disorder traits and mentalising ability: The self-other social cognition paradox. Front Psychiatry 2022; 13:1023348. [PMID: 36339858 PMCID: PMC9631768 DOI: 10.3389/fpsyt.2022.1023348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/06/2022] [Indexed: 11/21/2022] Open
Abstract
Objective Borderline personality disorder (BPD) is a psychiatric condition characterised by a pervasive pattern of impulsivity, low self-image, and interpersonal conflicts. Previous findings indicate a mixed relationship between BPD and social cognition; little research as investigated whether BPD traits influence performance on specific elements of social cognitive tasks, i.e., positive/negative valence. Method Community-based typical controls (n = 151; 51% female) were recruited through an online survey. Participants completed aspects of the Personality Assessment Inventory pertaining to BPD traits, the Interpersonal Reactivity Index, and measures of both emotion recognition and mentalising. Results Following group stratification into high/low BPD traits, participants with high BPD traits were observed to perform significantly better when identifying negative valence stimuli. Furthermore, high levels of affect instability was found to significantly influence negative valence recognition. Conclusion This research highlights previous research which shows a paradox between higher performance on measures of social cognition, with a group of individuals who report significant interpersonal and relational difficulties. This research supports the assessment of social cognitive processes for people with BPD and/or high BPD traits to support clinical formulation of strengths and difficulties.
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Affiliation(s)
- Molly Kelly Grealy
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Emmet Godfrey
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Finn Brady
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | | | - Grace A. Carroll
- School of Psychology, Queen’s University Belfast, Belfast, United Kingdom
| | - Tom Burke
- School of Psychology, National University of Ireland Galway, Galway, Ireland
- Galway Neuroscience Centre, National University of Ireland Galway, Galway, Ireland
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Schmidt P. Affective Instability and Emotion Dysregulation as a Social Impairment. Front Psychol 2022; 13:666016. [PMID: 35496195 PMCID: PMC9051371 DOI: 10.3389/fpsyg.2022.666016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/25/2022] [Indexed: 11/27/2022] Open
Abstract
Borderline personality disorder is a complex psychopathological phenomenon. It is usually thought to consist in a vast instability of different aspects that are central to our experience of the world, and to manifest as “a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity” [American Psychiatric Association (APA), 2013, p. 663]. Typically, of the instability triad—instability in (1) self, (2) affect and emotion, and (3) interpersonal relationships—only the first two are described, examined, and conceptualized from an experiential point of view. In this context, disorders of self have often motivated analyses of self-experience and the sense of self, affective disorders have been frequently considered in the light of emotional experience and its phenomenological structure. Patterns in the phenomenology of social experience have found comparatively little traction when it comes to the conceptualization of the interpersonal disturbances in borderline. In this paper, I argue that interpersonal instability in borderline consists in much more than fragile and shifting relationships but, most importantly, also involves certain styles in experiencing others. These styles, I suggest, may play an explanatory role for the borderline-typical patterns of interpersonal turmoil and so deserve more attention. To better describe and understand these styles, I explore the phenomenological structure of borderline affective instability and discuss the implications it might have for how a person experiences and relates to other people. Considering core aspects of borderline affective instability, such as alexithymia, emotional contagion, emotion dysregulation, and chronic emptiness, I propose borderline can be interpreted as a disturbance of interaffective exchange, which gives rise to certain ways of experiencing others that imply a social impairment.
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Affiliation(s)
- Philipp Schmidt
- Department of Philosophy, Technical University Darmstadt, Darmstadt, Germany
- Department of Philosophy, Julius Maximilian University of Würzburg, Würzburg, Germany
- Phenomenological Psychopathology and Psychotherapy, Psychiatric Clinic, Heidelberg University, Heidelberg, Germany
- *Correspondence: Philipp Schmidt,
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Southward MW, Semcho SA, Stumpp NE, MacLean DL, Sauer-Zavala S. A Day in the Life of Borderline Personality Disorder: A Preliminary Analysis of Within-Day Emotion Generation and Regulation. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2021; 42:702-713. [PMID: 33776200 DOI: 10.1007/s10862-020-09836-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
In Linehan's (1993) biosocial theory, borderline personality disorder (BPD) results in part from frequent, intense, negative emotions and maladaptive behavioral responses to those emotions. We conducted a secondary data analysis of an intensive single-case experimental design to explore hourly relations among behavioral responses and emotions in BPD. Eight participants with BPD (M age = 21.57, 63% female; 63% Asian) reported their emotions and behaviors hourly on two days. Participants reported a neutral-to-negative average emotional state with substantial variability each day. This emotional state was characterized most frequently by anxiety and joy. Participants tended to "dig into", or savor, experiences of joy, but problem-solve around, push away, or accept anxiety. Acceptance predicted hour-by-hour increases in negative emotion intensity, and pushing emotions away predicted hour-by-hour increases in positive emotion intensity. These results suggest that anxiety dominates the emotional experiences of people with BPD and co-occurs with a variety of emotion regulation strategies, while joy co-occurs with strategies designed to prolong emotional experiences. Despite its general adaptiveness, acceptance may be less effective, and pushing emotions away may be more effective, than other emotion regulation strategies at improving momentary negative emotions for those with BPD. We discuss the preliminary nature of these findings and encourage future researchers to build on them in larger samples with more severe presentations of BPD.
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12
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Bottesi G, Tesini V, Cerea S, Ghisi M. Are difficulties in emotion regulation and intolerance of uncertainty related to negative affect in borderline personality disorder? CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12163] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Gioia Bottesi
- Department of General Psychology, University of Padova, Padova, Italy,
| | - Veronica Tesini
- Department of General Psychology, University of Padova, Padova, Italy,
| | - Silvia Cerea
- Department of General Psychology, University of Padova, Padova, Italy,
| | - Marta Ghisi
- Department of General Psychology, University of Padova, Padova, Italy,
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13
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Gee BL, Han J, Benassi H, Batterham PJ. Suicidal thoughts, suicidal behaviours and self-harm in daily life: A systematic review of ecological momentary assessment studies. Digit Health 2020; 6:2055207620963958. [PMID: 33224516 PMCID: PMC7649887 DOI: 10.1177/2055207620963958] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 09/11/2020] [Indexed: 12/13/2022] Open
Abstract
Background Ecological Momentary Assessments (EMA) offer an approach to understand the daily risk factors of suicide and self-harm of individuals through the use of self-monitoring techniques using mobile technologies. Objectives This systematic review aimed to examine the results of studies on suicidality risk factors and self-harm that used Ecological Momentary Assessments. Methods Pubmed and PsycINFO databases were searched up to April 2020. Bibliographies of eligible studies were hand-searched, and 744 abstracts were screened and double-coded for inclusion. Results The 49 studies using EMA included in the review found associations between daily affect, rumination and interpersonal interactions and daily non-suicidal self-injury (NSSI). Studies also found associations between daily negative affect and positive affect, social support, sleep, and emotions and a person's history of suicide and self-harm. Associations between daily suicide thoughts and self-harm, and psychopathology factors measured at baseline were also observed. Conclusions Research using EMA has the potential to offer clinicians the ability to understand the daily predictors, or risk factors, of suicide and self-harm. However, there are no clear reporting standards for EMA studies on risk factors for suicide. Further research should utilise longitudinal study designs, harmonise datasets and use machine learning techniques to identify patterns of proximal risk factors for suicide behaviours.
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Affiliation(s)
- Brendan Loo Gee
- Centre for Mental Health Research, Australian National University, Acton, Australia.,Australasian Institute of Digital Health, Level 1, 85 Buckhurst Street, South Melbourne, Australia
| | - Jin Han
- Black Dog Institute, University of New South Wales, New South Wales, Australia
| | - Helen Benassi
- Centre for Mental Health Research, Australian National University, Acton, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, Australian National University, Acton, Australia
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14
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Linhartová P, Látalová A, Barteček R, Širůček J, Theiner P, Ejova A, Hlavatá P, Kóša B, Jeřábková B, Bareš M, Kašpárek T. Impulsivity in patients with borderline personality disorder: a comprehensive profile compared with healthy people and patients with ADHD. Psychol Med 2020; 50:1829-1838. [PMID: 31439062 DOI: 10.1017/s0033291719001892] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Impulsivity is a core symptom of borderline personality disorder (BPD). Impulsivity is a heterogeneous concept, and a comprehensive evaluation of impulsivity dimensions is lacking in the literature. Moreover, it is unclear whether BPD patients manifest impaired cognitive functioning that might be associated with impulsivity in another patient group, such as ADHD, a frequent comorbidity of BPD. METHODS We tested 39 patients with BPD without major psychiatric comorbidities and ADHD, 25 patients with ADHD, and 55 healthy controls (HC) using a test battery consisting of a self-report measure of impulsivity (UPPS-P questionnaire), behavioral measures of impulsivity - impulsive action (Go/NoGo task, stop signal task) and impulsive choice (delay discounting task, Iowa gambling task), and standardized measures of attention (d2 test), working memory (digit span), and executive functioning (Tower of London). RESULTS Patients with BPD and ADHD, as compared with HC, manifested increased self-reported impulsivity except sensation seeking and increased impulsive choice; patients with ADHD but not BPD showed increased impulsive action and deficits in cognitive functioning. Negative urgency was increased in BPD as compared to both HC and ADHD groups and correlated with BPD severity. CONCLUSIONS Patients with BPD without ADHD comorbidity had increased self-reported impulsivity and impulsive choice, but intact impulsive action and cognitive functioning. Controlling for ADHD comorbidity in BPD samples is necessary. Negative urgency is the most diagnostically specific impulsivity dimension in BPD.
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Affiliation(s)
- Pavla Linhartová
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Adéla Látalová
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Richard Barteček
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jan Širůček
- Faculty of Social Studies, Institute for Research on Children, Youth and Family, Masaryk University, Brno, Czech Republic
| | - Pavel Theiner
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Anastasia Ejova
- Faculty of Science, School of Psychology, University of Auckland, Auckland, New Zealand
| | - Pavlína Hlavatá
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Behavioral and Social Neuroscience Research Group, CEITEC - Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Barbora Kóša
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Barbora Jeřábková
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Martin Bareš
- First Department of Neurology, St. Anne's Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Neurology, Faculty of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Tomáš Kašpárek
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
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15
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Mackesy-Amiti ME, Donenberg G. Negative affect and emotion dysregulation among people who inject drugs: An ecological momentary assessment study. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2020; 34:650-659. [PMID: 32271056 DOI: 10.1037/adb0000577] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study used ecological momentary assessment (EMA) to measure positive affect (PA) and negative affect (NA) among people who inject drugs (PWID) and examined associations with borderline personality disorder (BPD) symptoms and difficulties with emotion regulation, in the context of injection drug use. We recruited PWID, ages 18-35 years, through syringe exchange program sites in Chicago, Illinois. After completing a baseline interview including a screener for BPD and the Difficulties in Emotion Regulation Scale (DERS), participants used a mobile phone app to report mood, substance use, and injection behavior for 2 weeks. Participants who completed at least 2 EMA assessments were included in the analysis (N = 161). The mean age was 30, about 1/3 were women, 63% were non-Hispanic White, and 23% were Hispanic. In multivariable mixed-effects regression models, positive BPD screen was associated with greater momentary NA intensity and greater instability of both NA and PA. Independent of BPD screening status, DERS score was associated positively with momentary NA intensity and instability and negatively with PA intensity. This finding suggests that emotion dysregulation is an appropriate target for assessment and intervention. Whereas concurrent withdrawal was associated with both greater NA and less PA, opioid intoxication was associated with only greater PA. We did not find support for our hypothesis that emotion dysregulation would moderate the effect of withdrawal on NA. Findings support the validity of the EMA mood measure and the utility of studying mood and behavior among PWID using EMA on mobile phones. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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16
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Bortolan A. Narratively Shaped Emotions: The Case of Borderline Personality Disorder. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2020; 45:212-230. [PMID: 32073620 DOI: 10.1093/jmp/jhz037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In this article, I provide a phenomenological exploration of the role played by narrativity in shaping affective experience. I start by surveying and identifying different ways in which linguistic and narrative expression contribute to structure and regulate emotions, and I then expand on these insights by taking into consideration the phenomenology of borderline personality disorder. Disruptions of narrative abilities have been shown to be central to the illness, and I argue that these disruptions are at the origin of a number of alterations of affective experience. In particular, I suggest that due to the narrative "fragmentation" characteristic of the disorder, the emotions experienced by borderline patients can be less differentiated and have a predominantly bodily and unregulated character.
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17
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Interaction of emotion and cognitive control along the psychosis continuum: A critical review. Int J Psychophysiol 2020; 147:156-175. [DOI: 10.1016/j.ijpsycho.2019.11.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 10/29/2019] [Accepted: 11/05/2019] [Indexed: 12/11/2022]
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18
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Zaehringer J, Ende G, Santangelo P, Kleindienst N, Ruf M, Bertsch K, Bohus M, Schmahl C, Paret C. Improved emotion regulation after neurofeedback: A single-arm trial in patients with borderline personality disorder. Neuroimage Clin 2019; 24:102032. [PMID: 31795041 PMCID: PMC6978219 DOI: 10.1016/j.nicl.2019.102032] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/25/2019] [Accepted: 10/07/2019] [Indexed: 01/09/2023]
Abstract
Real-time functional magnetic resonance imaging (fMRI) neurofeedback training of amygdala hemodynamic activity directly targets a neurobiological mechanism, which contributes to emotion regulation problems in borderline personality disorder (BPD). However, it remains unknown which outcome measures can assess changes in emotion regulation and affective instability, associated with amygdala downregulation in a clinical trial. The current study directly addresses this question. Twenty-four female patients with a DSM-IV BPD diagnosis underwent four runs of amygdala neurofeedback. Before and after the training, as well as at a six-weeks follow-up assessment, participants completed measures of emotion dysregulation and affective instability at diverse levels of analysis (verbal report, clinical interview, ecological momentary assessment, emotion-modulated startle, heart rate variability, and fMRI). Participants were able to downregulate their amygdala blood oxygen-dependent (BOLD) response with neurofeedback. There was a decrease of BPD symptoms as assessed with the Zanarini rating scale for BPD (ZAN-BPD) and a decrease in emotion-modulated startle to negative pictures after training. Further explorative analyses suggest that patients indicated less affective instability, as seen by lower hour-to-hour variability in negative affect and inner tension in daily life. If replicated by an independent study, our results imply changes in emotion regulation and affective instability for several systems levels, including behavior and verbal report. Conclusions are limited due to the lack of a control group. A randomized controlled trial (RCT) will be needed to confirm effectiveness of the training.
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Affiliation(s)
- Jenny Zaehringer
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/University of Heidelberg, Mannheim, Germany.
| | - Gabriele Ende
- Department Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim / University of Heidelberg, Mannheim, Germany
| | - Philip Santangelo
- Chair of Applied Psychology/Mental Health Lab, Institute of Sport and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Nikolaus Kleindienst
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/University of Heidelberg, Mannheim, Germany
| | - Matthias Ruf
- Department Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim / University of Heidelberg, Mannheim, Germany
| | - Katja Bertsch
- Department for General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany; Department of Psychology, LMU Munich, Munich, Germany
| | - Martin Bohus
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/University of Heidelberg, Mannheim, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/University of Heidelberg, Mannheim, Germany
| | - Christian Paret
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/University of Heidelberg, Mannheim, Germany; Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center and School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel.
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19
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Bodkyn CN, Holroyd CB. Neural mechanisms of affective instability and cognitive control in substance use. Int J Psychophysiol 2019; 146:1-19. [PMID: 31400355 DOI: 10.1016/j.ijpsycho.2019.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 07/22/2019] [Accepted: 08/06/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We explored the impact of affect on cognitive control as this relates to individual differences in affective instability and substance use. Toward this end, we examined how different dimensions of affective instability interact to predict substance misuse and the effect of this on two event-related potential components, the reward positivity and the late positive potential, which are said to reflect the neural mechanisms of reward and emotion processing, respectively. METHODS We recorded the ongoing electroencephalogram from undergraduate students as they navigated two T-maze tasks in search of rewards. One of the tasks included neutral, pleasant, and unpleasant pictures from the International Affective Picture System. Participants also completed several questionnaires pertaining to substance use and personality. RESULTS A principal components analysis revealed a factor related to affective instability, which we named reactivity. This factor significantly predicted increased substance use. Individuals reporting higher levels of affective reactivity also displayed a larger reward positivity following stimuli with emotional content. CONCLUSION The current study uncovered a group of high-risk substance users who were characterized by greater levels of affective reactivity and context-specific increased sensitivity to rewards. SIGNIFICANCE These results help to elucidate the complex factors underlying substance use and may facilitate the creation of individually-tailored treatment programs for those struggling with substance use disorders.
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Affiliation(s)
| | - Clay B Holroyd
- Department of Psychology, University of Victoria, Canada.
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20
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Lydon-Staley DM, Xia M, Mak HW, Fosco GM. Adolescent Emotion Network Dynamics in Daily Life and Implications for Depression. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2019; 47:717-729. [PMID: 30203118 PMCID: PMC6411453 DOI: 10.1007/s10802-018-0474-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Emotion network density describes the degree of interdependence among emotion states across time. Higher density is theorized to reflect rigidity in emotion functioning and has been associated with depression in adult samples. This paper extended research on emotion networks to adolescents and examined associations between emotion network density and: 1) emotion regulation and 2) symptoms of depression. Data from a daily diary study (t = 21 days) of adolescents (N = 151; 61.59% female; mean age = 14.60 years) were used to construct emotion network density scores. Emotion regulation was measured using The Difficulties in Emotion Regulation Scale Short Form (DERS-SF). Depression was measured using the Revised Child Anxiety and Depression Scale-Short Version (RCADS-SV). Associations between emotion network density and DERS-SF were examined through Pearson correlations. Multiple regression analyses examined associations between emotion network density and depression. Emotion network density was not associated with the DERS-SF. Follow-up analyses showed that it was positively associated with non-acceptance of emotions (a subscale of the DERS-SF). Emotion network density was positively associated with RCADS-SV depression. Non-acceptance of emotions may encourage the spread of emotion across time and states given that a feature of non-acceptance is to have secondary emotional responses to one's emotions. Emotion networks that are self-predictive may be a risk factor for adolescent depression.
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Affiliation(s)
- D M Lydon-Staley
- Department of Human Development and Family Studies, The Pennsylvania State University, State College, PA, USA.
- Department of Bioengineering, University of Pennsylvania, 311 Hayden Hall, Philadelphia, PA, 19104, USA.
| | - M Xia
- Department of Human Development and Family Studies, The Pennsylvania State University, State College, PA, USA
| | - H W Mak
- Department of Human Development and Family Studies, The Pennsylvania State University, State College, PA, USA
| | - G M Fosco
- Department of Human Development and Family Studies, The Pennsylvania State University, State College, PA, USA
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21
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Bullis JR, Boettcher H, Sauer‐Zavala S, Farchione TJ, Barlow DH. What is an emotional disorder? A transdiagnostic mechanistic definition with implications for assessment, treatment, and prevention. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2019. [DOI: 10.1111/cpsp.12278] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Jacqueline R. Bullis
- Center for Anxiety and Related Disorders Boston University Boston Massachusetts
- Division of Depression and Anxiety Disorders Harvard Medical School McLean Hospital Belmont Massachusetts
| | - Hannah Boettcher
- Center for Anxiety and Related Disorders Boston University Boston Massachusetts
| | | | - Todd J. Farchione
- Center for Anxiety and Related Disorders Boston University Boston Massachusetts
| | - David H. Barlow
- Center for Anxiety and Related Disorders Boston University Boston Massachusetts
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22
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Hughes CD, Rizvi SL. Biases in Affective Forecasting and Recall as a Function of Borderline Personality Disorder Features. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2019. [DOI: 10.1521/jscp.2019.38.3.200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: The ability to predict emotional experiences, “affective forecasting,” is an essential factor in individuals' decision-making processes. Research has shown that, generally, individuals are inaccurate in their affective forecasts/recollections, and that certain psychological disorders may be related to individual differences in these inaccuracies, or biases. Understanding the role of affective biases in disorders characterized by emotion dysregulation, like Borderline Personality Disorder (BPD), may provide important information regarding the sources of said dysregulation. The present study aimed to identify specific or unique patterns in affective forecasting/recall biases as a function of BPD features. Method: Using a sample of undergraduates (n = 185), we compared predicted and recalled affective states with actual affect following a sadness-evoking film clip. We predicted that higher levels of BPD features would be associated with greater affective forecasting and recall biases. Results: Results indicated that BPD features predicted a specific pattern of forecasting and recall biases regarding the clip. Counter to our hypotheses, as BPD features increased, forecasts/recollections of their affective states following the sadness-evoking film clip were more accurate (less biased). Discussion: Results indicate that BPD features may be related to a specific pattern of bias with negative affective states and warrant further study. Furthermore, this study provides evidence that disorder-specific patterns of forecasting/recall bias can be studied with a laboratory-based paradigm.
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23
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Schulze L, Schulze A, Renneberg B, Schmahl C, Niedtfeld I. Neural Correlates of Affective Disturbances: A Comparative Meta-analysis of Negative Affect Processing in Borderline Personality Disorder, Major Depressive Disorder, and Posttraumatic Stress Disorder. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2018; 4:220-232. [PMID: 30581154 DOI: 10.1016/j.bpsc.2018.11.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/17/2018] [Accepted: 11/09/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Borderline personality disorder (BPD), major depressive disorder (MDD), and posttraumatic stress disorder (PTSD) are prominent examples of mental disorders with affective disturbances. Notably, all three disorders share a generally heightened negative affect, which is presumably the result of shared neural abnormalities in affective processing. In this meta-analysis, we aimed to identify transdiagnostic and disorder-specific abnormalities during the processing of negative compared with neutral stimuli. METHODS We synthesized neuroimaging findings of affect processing in BPD, MDD, and PTSD and calculated combined coordinate- and image-based meta-analyses. The analysis comprised 70 distinct study samples with a total of 31 unthresholded statistical parametric maps. Twenty-four studies had a focus on BPD (431 individuals with BPD, 436 healthy control subjects [HCs]), 32 studies on MDD (789 individuals with current MDD, 870 HCs), and 14 studies on PTSD (247 individuals with PTSD, 245 HCs). RESULTS Findings showed limbic hyperactivations in BPD and PTSD compared with limbic activation of HCs. In contrast, patients with MDD showed blunted amygdala activation in comparison with that of HCs. Additionally, the calculation of overlapping brain abnormalities in BPD, MDD, and PTSD highlighted transdiagnostic hyperactivation of the right median cingulate gyri and hypoactivation of the right middle frontal gyrus and the right middle occipital gyrus. Finally, disorder-specific comparisons also illustrate unique abnormalities for each mental disorder. CONCLUSIONS The present results support shared and disorder-specific neural abnormalities in patients with affective disturbances.
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Affiliation(s)
- Lars Schulze
- Department of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany.
| | - Andreas Schulze
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany
| | - Babette Renneberg
- Department of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany
| | - Inga Niedtfeld
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany
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Abstract
In recent years, significant technological advances have changed our understanding of dynamic processes in clinical psychology. A particularly important agent of change has been ambulatory assessment (AA). AA is the assessment of individuals in their daily lives, combining the twin benefits of increased ecological validity and minimized retrospective biases. These benefits make AA particularly well-suited to the assessment of dynamic processes, and recent advancements in technology are providing exciting new opportunities to understand these processes in new ways. In the current article, we briefly detail the capabilities currently offered by smartphones and mobile physiological devices, as well as some of the practical and ethical challenges of incorporating these new technologies into AA research. We then provide several examples of recent innovative applications of AA methodology in clinical research, assessment, and intervention and provide a case example of AA data generated from a study utilizing multiple mobile devices. In this way, we aim to provide a sense of direction for researchers planning AA studies of their own.
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Abstract
This article aims to review the concept of emotion dysregulation, focusing on issues related to its definition, meanings and role in psychiatric disorders. Articles on emotion dysregulation published until May 2016 were identified through electronic database searches. Although there is no agreement about the definition of emotion dysregulation, the following five overlapping, not mutually exclusive dimensions of emotion dysregulation were identified: decreased emotional awareness, inadequate emotional reactivity, intense experience and expression of emotions, emotional rigidity and cognitive reappraisal difficulty. These dimensions characterise a number of psychiatric disorders in various proportions, with borderline personality disorder and eating disorders seemingly more affected than other conditions. The present review contributes to the literature by identifying the key components of emotion dysregulation and by showing how these permeate various forms of psychopathology. It also makes suggestions for improving research endeavours. Better understanding of the various dimensions of emotion dysregulation will have implications for clinical practice. Future research needs to address emotion dysregulation in all its multifaceted complexity so that it becomes clearer what the concept encompasses.
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26
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Gersh E, Leiman M, Hulbert C, McCutcheon L, Burke E, Valkonen H, Tikkanen S, Chanen AM. Alliance rupture and repair processes in borderline personality disorder: A case study using dialogical sequence analysis. COUNSELLING PSYCHOLOGY QUARTERLY 2017. [DOI: 10.1080/09515070.2017.1331203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Elon Gersh
- School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia
- Orygen Youth Health, Northwestern Mental Health, Melbourne, Australia
| | - Mikael Leiman
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
| | - Carol Hulbert
- School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Louise McCutcheon
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia
- Orygen Youth Health, Northwestern Mental Health, Melbourne, Australia
| | - Emma Burke
- Orygen Youth Health, Northwestern Mental Health, Melbourne, Australia
| | - Harri Valkonen
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
| | - Soile Tikkanen
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
| | - Andrew M Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia
- Orygen Youth Health, Northwestern Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
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27
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Vansteelandt K, Houben M, Claes L, Berens A, Sleuwaegen E, Sienaert P, Kuppens P. The affect stabilization function of nonsuicidal self injury in Borderline Personality Disorder: An Ecological Momentary Assessment study. Behav Res Ther 2017; 92:41-50. [PMID: 28257980 DOI: 10.1016/j.brat.2017.02.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 02/08/2017] [Accepted: 02/15/2017] [Indexed: 10/20/2022]
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28
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Bilderbeck AC, Atkinson LZ, Geddes JR, Goodwin GM, Harmer CJ. The effects of medication and current mood upon facial emotion recognition: findings from a large bipolar disorder cohort study. J Psychopharmacol 2017; 31:320-326. [PMID: 27678089 DOI: 10.1177/0269881116668594] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Emotional processing abnormalities have been implicated in bipolar disorder (BD) but studies are typically small and uncontrolled. Here, facial expression recognition was explored in a large and naturalistically recruited cohort of BD patients. METHODS 271 patients with BD completed the facial expression recognition task. The effects of current medication together with the influence of current mood state and diagnostic subtype were assessed whilst controlling for the effects of demographic variables. RESULTS Patients who were currently receiving treatment with lithium demonstrated significantly poorer accuracy in recognising angry faces, an effect that held in a monotherapy sub-analysis comparing those participants on lithium only and those who were medication-free. Accuracy in recognising angry faces was also lower amongst participants currently taking dopamine antagonists (antipsychotics). Higher levels of current depressive symptoms were linked to poorer accuracy at identifying happy faces. CONCLUSION Use of lithium and possibly dopamine antagonists may be associated with reduced processing of anger cues in BD. Findings support the existence of mood-congruent negative biases associated with depressive symptoms in BD. Observational cohort studies provide opportunities to explore the substantial effects of demographic, psychometric and clinical variables on cognitive performance and emotional processing.
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Affiliation(s)
| | | | - John R Geddes
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Guy M Goodwin
- Department of Psychiatry, University of Oxford, Oxford, UK
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Gersh E, Hulbert CA, McKechnie B, Ramadan R, Worotniuk T, Chanen AM. Alliance rupture and repair processes and therapeutic change in youth with borderline personality disorder. Psychol Psychother 2017; 90:84-104. [PMID: 27240265 DOI: 10.1111/papt.12097] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 03/02/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES This study aimed to investigate alliance rupture and repair processes in psychotherapy for youth with borderline personality disorder. It sought to examine whether alliance processes differ between treatments, across the phases of therapy, and what associations these processes might have with therapeutic outcomes. DESIGN The study involves repeated measurement of both process and outcome measures. Hypotheses were addressed using within- and between-subjects analyses. METHODS Forty-four people, aged 15-24, with a diagnosis of BPD were randomized to receive either 16 sessions of Cognitive Analytic Therapy (CAT) or a supportive treatment known as Befriending. In addition to pre-post outcome assessments, alliance processes were rated using the observer-based Rupture Resolution Rating Scale. RESULTS Results indicated that CAT and Befriending did not differ in terms of number of ruptures, although CAT was associated with more stages of rupture resolution. Examination of alliance processes across time pointed to increasing ruptures, more frequent confrontation ruptures and increasing rupture resolution, suggesting increased volatility, directness and productivity in the therapeutic process across time. Contrary to hypotheses, there was no consistent link between alliance processes and outcome. However, two specific phases were significant. Early treatment ruptures were associated with poor outcome whereas greater late treatment resolution was associated with better outcomes. CONCLUSIONS This study suggests that alliance processes can differ across treatments and the phases of therapy in psychotherapy for youth with BPD. Alliance ruptures are more likely to be problematic early in therapy but later in therapy, they appear to be opportunities for therapeutic growth. PRACTITIONER POINTS Alliance ruptures are more likely than not to occur in any given session with a young person with Borderline Personality Disorder. Early in therapy, withdrawal type ruptures are more frequent, whereas late in therapy, confrontation ruptures are more frequent. Late in therapy, alliance ruptures should be viewed as opportunities for therapeutic change, rather than barriers to good outcomes.
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Affiliation(s)
- Elon Gersh
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Orygen Youth Health, Northwestern Mental Health, Melbourne, Victoria, Australia
| | - Carol A Hulbert
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Ben McKechnie
- Orygen Youth Health, Northwestern Mental Health, Melbourne, Victoria, Australia
| | - Reem Ramadan
- Orygen Youth Health, Northwestern Mental Health, Melbourne, Victoria, Australia
| | - Tamara Worotniuk
- Orygen Youth Health, Northwestern Mental Health, Melbourne, Victoria, Australia
| | - Andrew M Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Orygen Youth Health, Northwestern Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
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Köhling J, Moessner M, Ehrenthal JC, Bauer S, Cierpka M, Kämmerer A, Schauenburg H, Dinger U. Affective Instability and Reactivity in Depressed Patients With and Without Borderline Pathology. J Pers Disord 2016; 30:776-795. [PMID: 26623534 DOI: 10.1521/pedi_2015_29_230] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The quality of depression in borderline personality disorder (BPD) was reported to differ from that in patients with major depressive disorder (MDD) only. However, little is known about affect dynamics in "borderline-depression." The authors assessed affective instability and reactivity in 20 MDD patients with BPD and in 21 MDD patients without BPD by Ambulatory Assessment. Participants reported on current affect, daily events, and attribution of affective states to events five times per day over a 7-day period. The results do not indicate higher affective instability in MDD patients with BPD comorbidity. Depressed patients with BPD reported less subjectively perceived affective reactivity, while observed associations between events and affect were not different between groups, except for one finding: In depressed patients with BPD, overall mood was lower after being alone. These findings suggest impaired attribution of mood changes and less tolerance of being alone as specific for depression in BPD.
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Stange JP, Sylvia LG, da Silva Magalhães PV, Miklowitz DJ, Otto MW, Frank E, Yim C, Berk M, Dougherty DD, Nierenberg AA, Deckersbach T. Affective instability and the course of bipolar depression: results from the STEP-BD randomised controlled trial of psychosocial treatment. Br J Psychiatry 2016; 208:352-8. [PMID: 26795426 PMCID: PMC4816971 DOI: 10.1192/bjp.bp.114.162073] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 03/29/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Little is known about predictors of recovery from bipolar depression. AIMS We investigated affective instability (a pattern of frequent and large mood shifts over time) as a predictor of recovery from episodes of bipolar depression and as a moderator of response to psychosocial treatment for acute depression. METHOD A total of 252 out-patients with DSM-IV bipolar I or II disorder and who were depressed enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) and were randomised to one of three types of intensive psychotherapy for depression (n= 141) or a brief psychoeducational intervention (n= 111). All analyses were by intention-to-treat. RESULTS Degree of instability of symptoms of depression and mania predicted a lower likelihood of recovery and longer time until recovery, independent of the concurrent effects of symptom severity. Affective instability did not moderate the effects of psychosocial treatment on recovery from depression. CONCLUSIONS Affective instability may be a clinically relevant characteristic that influences the course of bipolar depression.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Thilo Deckersbach
- Jonathan P. Stange, MA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Louisa G. Sylvia, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Pedro Vieira da Silva Magalhães, PhD, National Institute for Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil; David J. Miklowitz, PhD, Division of Child and Adolescent Psychiatry, UCLA School of Medicine, Los Angeles, California, USA; Michael W. Otto, PhD, Department of Psychology, Boston University, Boston, Massachusetts, USA; Ellen Frank, PhD, Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Christine Yim, BA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Michael Berk, MD, IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria and Orygen, The National Centre of Excellence in Youth Mental Health, Department of Psychiatry and The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia; Darin D. Dougherty, MD, Andrew A. Nierenberg, MD, Thilo Deckersbach, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Differences and overlap in self-reported symptoms of bipolar disorder and borderline personality disorder. Eur Psychiatry 2015; 30:914-9. [DOI: 10.1016/j.eurpsy.2015.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 08/04/2015] [Accepted: 08/09/2015] [Indexed: 11/23/2022] Open
Abstract
AbstractBackgroundDifferential diagnosis between bipolar disorder (BD) and borderline personality disorder (BPD) is often challenging due to some overlap in symptoms and comorbidity of disorders. We investigated correlations in self-reported symptoms of BD and BPD in screening questionnaires at the levels of both total scores and individual items and explored overlapping dimensions.MethodsThe McLean Screening Instrument (MSI) for BPD and the Mood Disorder Questionnaire (MDQ) for BD were filled in by patients with unipolar and bipolar mood disorders (n = 313) from specialized psychiatric care within a pilot study of the Helsinki University Psychiatric Consortium. Pearson's correlation coefficients between total scores and individual items of the MSI and the MDQ were estimated. Relationships between MDQ and MSI were evaluated by exploratory factor analysis (EFA).ResultsThe correlation between total scores of the MDQ and MSI was moderate (r = 0.431, P < 0.001). Significant correlations were found between the MSI items of “impulsivity” and “mood instability” and all MDQ items (P < 0.01). In the EFA, the MSI “impulsivity” and “mood instability” items had significant cross-loadings (0.348 and 0.298, respectively) with the MDQ factor. The MDQ items of “irritability”, “flight of thoughts” and “distractibility” (0.280, 0.210 and 0.386, respectively) cross-loaded on the MSI factor.ConclusionsThe MDQ and MSI items of “affective instability”, “impulsivity”, “irritability”, “flight of thoughts” and “distractibility” appear to overlap in content. The other scale items are more disorder-specific, and thus, may help to distinguish BD and BPD.
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Yen S, Frazier E, Hower H, Weinstock LM, Topor DR, Hunt J, Goldstein TR, Goldstein BI, Gill MK, Ryan ND, Strober M, Birmaher B, Keller MB. Borderline personality disorder in transition age youth with bipolar disorder. Acta Psychiatr Scand 2015; 132:270-80. [PMID: 25865120 PMCID: PMC4573347 DOI: 10.1111/acps.12415] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2015] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To determine the longitudinal impact of borderline personality disorder (BPD) on the course and outcome of bipolar disorder (BP) in a pediatric BP sample. METHOD Participants (N = 271) and parents from the Course and Outcome of Bipolar Youth (COBY) study were administered structured clinical interviews and self-reports on average every 8.7 months over a mean of 93 months starting at age 13.0 ± 3.1 years. The structured interview for DSM-IV personality disorders (SIDP-IV) was administered at the first follow-up after age 18 to assess for symptoms of BPD. BPD operationalized at the disorder, factor, and symptom level, was examined as a predictor of poor clinical course of BP using all years of follow-up data. RESULTS The number of BPD symptoms was significantly associated with poor clinical course of BP, above and beyond BP characteristics. Affective dysregulation was most strongly associated with poor course at the factor level; the individual symptoms most strongly associated with poor course were dissociation/stress-related paranoid ideation, impulsivity, and affective instability. CONCLUSION BPD severity adds significantly to the burden of BP illness and is significantly associated with a more chronic and severe course and outcome beyond what can be attributable to BP characteristics.
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Affiliation(s)
- Shirley Yen
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University,Butler Hospital, Providence, Rhode Island, United States
| | - Elisabeth Frazier
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University,Emma Pendleton Bradley Hospital, East Providence, Rhode Island, United States
| | - Heather Hower
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Lauren M. Weinstock
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University,Butler Hospital, Providence, Rhode Island, United States
| | - David R. Topor
- VA Boston Healthcare System and Harvard Medical School, Cambridge, Massachusetts, United States
| | - Jeffrey Hunt
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University,Emma Pendleton Bradley Hospital, East Providence, Rhode Island, United States
| | - Tina R. Goldstein
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Benjamin I. Goldstein
- Department of Child Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto Medical Center, Toronto, Ontario, Canada
| | - Mary Kay Gill
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Neal D. Ryan
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Michael Strober
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, CA, United States
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
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Tomko RL, Lane SP, Pronove LM, Treloar HR, Brown WC, Solhan MB, Wood PK, Trull TJ. Undifferentiated negative affect and impulsivity in borderline personality and depressive disorders: A momentary perspective. JOURNAL OF ABNORMAL PSYCHOLOGY 2015; 124:740-753. [PMID: 26147324 PMCID: PMC4573801 DOI: 10.1037/abn0000064] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Individuals with borderline personality disorder (BPD) often report experiencing several negative emotions simultaneously, an indicator of "undifferentiated" negative affect. The current study examined the relationship between undifferentiated negative affect and impulsivity. Participants with a current BPD (n = 67) or depressive disorder (DD; n = 38) diagnosis carried an electronic diary for 28 days, reporting on emotions and impulsivity when randomly prompted (up to 6 times per day). Undifferentiated negative affect was quantified using momentary intraclass correlation coefficients, which indicated how consistently negative emotion items were rated across fear, hostility, and sadness subscales. Undifferentiated negative affect at the occasion-level, day-level, and across 28 days was used to predict occasion-level impulsivity. Multilevel modeling was used to test the hypothesis that undifferentiated negative emotion would be a significant predictor of momentary impulsivity above and beyond levels of overall negative affect. Undifferentiated negative affect at the occasion and day levels were significant predictors of occasion-level impulsivity, but undifferentiated negative affect across the 28-day study period was only marginally significant. Results did not differ depending on BPD or DD status, though individuals with BPD did report significantly greater momentary impulsivity and undifferentiated negative affect. Undifferentiated negative affect may increase risk for impulsivity among individuals with BPD and depressive disorders, and the current data suggest that this process can be relatively immediate as well as cumulative over the course of a day. This research supports the consideration of undifferentiated negative affect as a transdiagnostic construct, but one that may be particularly relevant for those with BPD.
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Affiliation(s)
- Rachel L. Tomko
- University of Missouri-Columbia and Midwest Alcoholism Research Center, Columbia, MO
| | - Sean P. Lane
- University of Missouri-Columbia and Midwest Alcoholism Research Center, Columbia, MO
| | - Lisa M. Pronove
- University of Missouri-Columbia and Midwest Alcoholism Research Center, Columbia, MO
| | - Hayley R. Treloar
- University of Missouri-Columbia and Midwest Alcoholism Research Center, Columbia, MO
- Alpert Medical School of Brown University, Providence, RI
| | - Whitney C. Brown
- University of Missouri-Columbia and Midwest Alcoholism Research Center, Columbia, MO
- Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, MI
| | - Marika B. Solhan
- University of Missouri-Columbia and Midwest Alcoholism Research Center, Columbia, MO
- VA Boston Healthcare System, Boston, MA
| | - Phillip K. Wood
- University of Missouri-Columbia and Midwest Alcoholism Research Center, Columbia, MO
| | - Timothy J. Trull
- University of Missouri-Columbia and Midwest Alcoholism Research Center, Columbia, MO
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Rosenthal MZ, Fang CM, Chapman AL. Ambulatory measurement of emotional dysfunction in borderline personality disorder. Curr Opin Psychol 2015. [DOI: 10.1016/j.copsyc.2015.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Patel R, Lloyd T, Jackson R, Ball M, Shetty H, Broadbent M, Geddes JR, Stewart R, McGuire P, Taylor M. Mood instability is a common feature of mental health disorders and is associated with poor clinical outcomes. BMJ Open 2015; 5:e007504. [PMID: 25998036 PMCID: PMC4452754 DOI: 10.1136/bmjopen-2014-007504] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Mood instability is a clinically important phenomenon but has received relatively little research attention. The objective of this study was to assess the impact of mood instability on clinical outcomes in a large sample of people receiving secondary mental healthcare. DESIGN Observational study using an anonymised electronic health record case register. SETTING South London and Maudsley NHS Trust (SLaM), a large provider of inpatient and community mental healthcare in the UK. PARTICIPANTS 27,704 adults presenting to SLaM between April 2006 and March 2013 with a psychotic, affective or personality disorder. EXPOSURE The presence of mood instability within 1 month of presentation, identified using natural language processing (NLP). MAIN OUTCOME MEASURES The number of days spent in hospital, frequency of hospital admission, compulsory hospital admission and prescription of antipsychotics or non-antipsychotic mood stabilisers over a 5-year follow-up period. RESULTS Mood instability was documented in 12.1% of people presenting to mental healthcare services. It was most frequently documented in people with bipolar disorder (22.6%), but was common in people with personality disorder (17.8%) and schizophrenia (15.5%). It was associated with a greater number of days spent in hospital (β coefficient 18.5, 95% CI 12.1 to 24.8), greater frequency of hospitalisation (incidence rate ratio 1.95, 1.75 to 2.17), greater likelihood of compulsory admission (OR 2.73, 2.34 to 3.19) and an increased likelihood of prescription of antipsychotics (2.03, 1.75 to 2.35) or non-antipsychotic mood stabilisers (2.07, 1.77 to 2.41). CONCLUSIONS Mood instability occurs in a wide range of mental disorders and is not limited to affective disorders. It is generally associated with relatively poor clinical outcomes. These findings suggest that clinicians should screen for mood instability across all common mental health disorders. The data also suggest that targeted interventions for mood instability may be useful in patients who do not have a formal affective disorder.
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Affiliation(s)
- Rashmi Patel
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Theodore Lloyd
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Richard Jackson
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Michael Ball
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Hitesh Shetty
- South London and Maudsley NHS Foundation Trust, Biomedical Research Centre Nucleus, London, UK
| | - Matthew Broadbent
- South London and Maudsley NHS Foundation Trust, Biomedical Research Centre Nucleus, London, UK
| | - John R Geddes
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Robert Stewart
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Philip McGuire
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Matthew Taylor
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
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Scheiderer EM, Wang T, Tomko RL, Wood PK, Trull TJ. Negative Affect Instability among Individuals with Comorbid Borderline Personality Disorder and Posttraumatic Stress Disorder. Clin Psychol Sci 2015; 4:67-81. [PMID: 26904388 DOI: 10.1177/2167702615573214] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ecological momentary assessment (EMA; Stone & Shiffman, 1994) was utilized to examine affective instability (AI) in the daily lives of outpatients with borderline personality disorder (BPD; n=78) with and without posttraumatic stress disorder (PTSD). A psychiatric control group (n=50) composed of outpatients with major depressive disorder/dysthymia (MDD/DYS) was employed to compare across subgroups: BPD-only, BPD+PTSD, MDD/DYS-only, and MDD/DYS+PTSD. Compared to the BPD-only group, the BPD+PTSD group had significantly greater instability of fear and sadness, but did not significantly differ in instability of hostility or aggregate negative affect. This pattern of elevated instability of fear and sadness was not present-and, in fact, was reversed-in the MDD/DYS group. Results emphasize the importance of examining AI within the context of specific comorbidities and affect types. Treatment and research addressing AI in the context of BPD-PTSD comorbidity may benefit from a focus on fear and sadness as separate from hostility or general negative affect.
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Affiliation(s)
| | - Ting Wang
- Department of Psychological Sciences, University of Missouri - Columbia
| | - Rachel L Tomko
- Department of Psychological Sciences, University of Missouri - Columbia
| | - Phillip K Wood
- Department of Psychological Sciences, University of Missouri - Columbia
| | - Timothy J Trull
- Department of Psychological Sciences, University of Missouri - Columbia
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Snir A, Rafaeli E, Gadassi R, Berenson K, Downey G. Explicit and inferred motives for nonsuicidal self-injurious acts and urges in borderline and avoidant personality disorders. Personal Disord 2015; 6:267-77. [PMID: 25867834 DOI: 10.1037/per0000104] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Nonsuicidal self-injury (NSSI) is a perplexing phenomenon that may have differing motives. The present study used experience sampling methods (ESM) which inquired explicitly about the motives for NSSI, but also enabled a temporal examination of the antecedents/consequences of NSSI; these allow us to infer other motives which were not explicitly endorsed. Adults (n = 152, aged 18-65) with borderline personality disorder (BPD), avoidant personality disorder (APD), or no psychopathology participated in a 3-week computerized diary study. We examined 5 classes of explicit motives for engaging in NSSI, finding support primarily for internally directed rather than interpersonally directed ones. We then used multilevel regression to examine changes in affect, cognition, and behavior surrounding moments of NSSI acts/urges compared with control moments (i.e., without NSSI). We examined changes in 5 scales of inferred motives, designed to correspond to the 5 classes of explicit motives. The results highlight differing motives for NSSI among individuals with BPD and APD, with some similarities (mostly in the explicit motives) and some differences (mostly in the inferred motives) between the disorders. Despite their infrequent explicit endorsement, fluctuations in interpersonally oriented scales were found surrounding NSSI acts/urges. This highlights the need to continue attending to interpersonal aspects of NSSI in research and in clinical practice. Additionally, NSSI urges, like acts, were followed by decline in affective/interpersonal distress (although in a delayed manner). Thus, interventions that build distress tolerance and enhance awareness for affective changes, and for antecedent/consequence patterns in NSSI, could help individuals resist the urge to self-injure.
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Abstract
The present study examined relationships among negative affect, borderline personality features, and eating behavior through the experimental manipulation of mood. Undergraduate women (N = 307) completed a baseline mood assessment, viewed a 39-minute sad film either with or without concurrent food presentation, then completed a second mood assessment and questionnaires assessing personality and eating attitudes/behaviors. Women reporting more borderline personality features exhibited greater negative affect across time and were more reactive to the sad film. Food presentation appeared to have a small ameliorative effect on sadness and general negative affect. However, quantity of food consumption was associated with improvements in mood only for women reporting higher levels of borderline personality features. These data suggest that women with borderline personality characteristics may be at elevated risk for developing problems with binge eating, because consuming larger quantities of food appeared to have a tempering effect on their negative mood and feelings of sadness.
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40
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Quality and severity of depression in borderline personality disorder: A systematic review and meta-analysis. Clin Psychol Rev 2015; 37:13-25. [DOI: 10.1016/j.cpr.2015.02.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 01/31/2015] [Accepted: 02/05/2015] [Indexed: 12/21/2022]
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Dissociation of explicit and implicit measures of the behavioral inhibition and activation system in borderline personality disorder. Psychiatry Res 2014; 218:134-42. [PMID: 24798120 DOI: 10.1016/j.psychres.2014.04.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 02/15/2014] [Accepted: 04/09/2014] [Indexed: 01/01/2023]
Abstract
Patients with borderline personality disorder (BPD) suffer from various impairments in emotional functioning such as affective instability, inappropriate anger and unstable relationships. These deficits may influence two fundamental motivational systems, the behavioral inhibition system (BIS) and behavioral activation system (BAS). To investigate behavioral intentions and possible impairments in BPD we applied an implicit joystick task to measure implicit behavioral tendencies in response to facial expressions (happiness, sadness, anger, fear and neutral) in 25 patients with BPD and matched 25 healthy controls (HC). Additionally, we evaluated explicit approach and avoidance reactions to these social stimuli, emotion recognition abilities and subjective behavioral ratings. Our data analysis suggests that, although BPD patients accurately identified facial emotional expressions and reacted to them similarly as HC in the joystick task, they had significantly stronger avoidance tendencies in the rating task, especially for happiness and fear. On top of this they exhibited increased BIS sensitivity and decreased BAS sensitivity in the self-report measures. Possible influences are maladaptive cognitive schemas, high negative affect, insecure attachment style and a negative evaluation bias. The observed dysfunctional avoidance ratings may influence the appraisal of socially relevant stimuli and therefore adds further knowledge on social interaction problems in BPD.
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Santangelo P, Bohus M, Ebner-Priemer UW. Ecological momentary assessment in borderline personality disorder: a review of recent findings and methodological challenges. J Pers Disord 2014; 28:555-76. [PMID: 22984853 DOI: 10.1521/pedi_2012_26_067] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The use of Ecological Momentary Assessment (EMA) has led to increased insight into borderline personality disorder (BPD) symptoms, especially regarding affective instability. EMA is characterized by a series of repeated assessments of current affective, behavioral, and contextual experiences or physiological processes while participants engage in normal daily activities. EMA has several advantages. It enables researchers to avoid biased recollection, to investigate within-person processes, and to enhance real-life generalizability. This review is dedicated to four main objectives: (1) to discuss the characteristics of EMA in studying BPD symptomatology; (2) to provide an extensive overview of EMA findings in BPD structured into findings regarding DSM-IV criteria and findings regarding emotional dysregulation as stated in the biosocial theory of Linehan; (3) to discuss challenges of EMA and to give recommendations for the proper use of it; and (4) to highlight prospects and promising applications that should be addressed.
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Matthies SD, Philipsen A. Common ground in Attention Deficit Hyperactivity Disorder (ADHD) and Borderline Personality Disorder (BPD)-review of recent findings. Borderline Personal Disord Emot Dysregul 2014; 1:3. [PMID: 26843958 PMCID: PMC4739390 DOI: 10.1186/2051-6673-1-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 10/17/2013] [Indexed: 12/29/2022] Open
Abstract
Considerable overlap in diagnostic criteria and shared psychopathologic symptoms in attention deficit hyperactivity disorder (ADHD) and borderline personality disorder (BPD) have stimulated research activities in this field. Longitudinal studies have shown that BPD is frequently diagnosed in adult patients who had been diagnosed with ADHD in childhood. The question of whether ADHD and BPD randomly co-occur as comorbidities, have similar origins or share common pathological mechanisms remains unresolved. Some authors suggest that ADHD contributes to the development of BPD via various mechanisms, and therefore consider it a risk factor for later BPD development. In this article the evidence for the co-occurrence of these disorders will be reviewed as well as studies on their common genetic and environmental influences. Temperamental and developmental issues will be reviewed, and shared features such as impulsivity and emotion dysregulation discussed. From a therapeutic perspective, few studies have investigated psychotherapeutic treatment of the comorbid condition, though the issue is highly important to the management of patients suffering from both disorders. Some thought is given to how therapeutic methods and approaches can be modified to benefit patients, and to their possible succession.
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Affiliation(s)
- Swantje D Matthies
- Department of Psychiatry & Psychotherapy, Clinic of Mental illnesses, University Medical Centre, Hauptstr. 5, D-79104 Freiburg, Germany
| | - Alexandra Philipsen
- Department of Psychiatry & Psychotherapy, Clinic of Mental illnesses, University Medical Centre, Hauptstr. 5, D-79104 Freiburg, Germany
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Courtney-Seidler EA, Klein D, Miller AL. Borderline personality disorder in adolescents. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2013. [DOI: 10.1111/cpsp.12051] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Koval P, Ogrinz B, Kuppens P, Van den Bergh O, Tuerlinckx F, Sütterlin S. Affective instability in daily life is predicted by resting heart rate variability. PLoS One 2013; 8:e81536. [PMID: 24312315 PMCID: PMC3843676 DOI: 10.1371/journal.pone.0081536] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 10/14/2013] [Indexed: 11/19/2022] Open
Abstract
Previous research has shown that being affectively unstable is an indicator of several forms of psychological maladjustment. However, little is known about the mechanisms underlying affective instability. Our research aims to examine the possibility that being prone to extreme fluctuations in one's feelings is related to maladaptive emotion regulation. We investigated this hypothesis by relating affective instability, assessed in daily life using the experience sampling method, to self-reported emotion regulation strategies and to parasympathetically mediated heart rate variability (HRV), a physiological indicator of emotion regulation capacity. Results showed that HRV was negatively related to instability of positive affect (as measured by mean square successive differences), indicating that individuals with lower parasympathetic tone are emotionally less stable, particularly for positive affect.
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Affiliation(s)
- Peter Koval
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Barbara Ogrinz
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Peter Kuppens
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Omer Van den Bergh
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Francis Tuerlinckx
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Stefan Sütterlin
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Department of Psychology, Lillehammer University College, Lillehammer, Norway
- Department of Neuropsychiatry and Psychosomatic Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
- * E-mail:
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Zaki LF, Coifman KG, Rafaeli E, Berenson KR, Downey G. Emotion differentiation as a protective factor against nonsuicidal self-injury in borderline personality disorder. Behav Ther 2013; 44:529-40. [PMID: 23768678 DOI: 10.1016/j.beth.2013.04.008] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 04/03/2013] [Accepted: 04/10/2013] [Indexed: 11/16/2022]
Abstract
Evidence that nonsuicidal self-injury (NSSI) serves a maladaptive emotion regulation function in borderline personality disorder (BPD) has drawn attention to processes that may increase risk for NSSI by exacerbating negative emotion, such as rumination. However, more adaptive forms of emotion processing, including differentiating broad emotional experiences into nuanced emotion categories, might serve as a protective factor against NSSI. Using an experience-sampling diary, the present study tested whether differentiation of negative emotion was associated with lower frequency of NSSI acts and urges in 38 individuals with BPD who reported histories of NSSI. Participants completed a dispositional measure of rumination and a 21-day experience-sampling diary, which yielded an index of negative emotion differentiation and frequency of NSSI acts and urges. A significant rumination by negative emotion differentiation interaction revealed that rumination predicted higher rates of NSSI acts and urges in participants with difficulty differentiating their negative emotions. The results extend research on emotion differentiation into the clinical literature and provide empirical support for clinical theories that suggest emotion identification and labeling underlie strategies for adaptive self-regulation and decreased NSSI risk in BPD.
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Abstract
Following Linehan's biosocial model, we conceptualize emotion dysregulation in borderline personality disorder (BPD) as consisting of four components: emotion sensitivity, heightened and labile negative affect, a deficit of appropriate regulation strategies, and a surplus of maladaptive regulation strategies. We review the evidence supporting each of these components. Given the complexity of the construct of emotion dysregulation and its involvement in many disorders, there is a need for research that specifies which components of emotion dysregulation are under study and also examines the interplay amongst these emotion dysregulation components.
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Abstract
Ambulatory assessment (AA) covers a wide range of assessment methods to study people in their natural environment, including self-report, observational, and biological/physiological/behavioral. AA methods minimize retrospective biases while gathering ecologically valid data from patients' everyday life in real time or near real time. Here, we report on the major characteristics of AA, and we provide examples of applications of AA in clinical psychology (a) to investigate mechanisms and dynamics of symptoms, (b) to predict the future recurrence or onset of symptoms, (c) to monitor treatment effects, (d) to predict treatment success, (e) to prevent relapse, and (f) as interventions. In addition, we present and discuss the most pressing and compelling future AA applications: technological developments (the smartphone), improved ecological validity of laboratory results by combined lab-field studies, and investigating gene-environment interactions. We conclude with a discussion of acceptability, compliance, privacy, and ethical issues.
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Affiliation(s)
- Timothy J Trull
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri 65211-1350, USA.
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Abstract
Affective instability is a psychophysiological symptom observed in some psychopathologies. It is a complex construct that encompasses (1) primary emotions, or affects, and secondary emotions, with each category having its own characteristics, amplitude, and duration, (2) rapid shifting from neutral or valenced affect to intense affect, and (3) dysfunctional modulation of emotions. Affective instability is often confused with mood lability, as in bipolar disorders, as well as with other terms. To clarify the concept, we searched databases for the term affective instability and read related articles on the topic. In this article we situate the term within the current affective nomenclature and human emotional experience, explore its psychophysiological features, and place it within the context of psychopathology. We explain why the term can potentially be confused with mood pathology and then define affective instability as an inherited temperamental trait modulated by developmental experience.
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Affiliation(s)
- Robert S Biskin
- Department of Psychiatry, Sir Mortimer B. Davis Jewish General Hospital, Montréal, Quebec, Canada.
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