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Ensink K, Deschênes M, Bégin M, Cimon L, Gosselin T, Wais M, Normandin L, Fonagy P. Dimensional model of adolescent personality pathology, reflective functioning, and emotional maltreatment. Front Psychiatry 2024; 14:1302137. [PMID: 38268556 PMCID: PMC10806145 DOI: 10.3389/fpsyt.2023.1302137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/18/2023] [Indexed: 01/26/2024] Open
Abstract
Introduction Childhood emotional abuse (CEA) is a recognized risk factor for adolescent mentalizing challenges. However, there's limited understanding about how CEA might influence personality development and elevate the risk of adolescent personality pathology. A deeper grasp of these pathways is crucial, given that adolescence is a pivotal developmental phase for identity integration, personality consolidation, and the emergence of personality disorders. As the emphasis shifts to dimensional perspectives on adolescent personality pathology, the spotlight is increasingly on adolescents' evolving personality organization (PO). Within this framework, personality disorder manifestations stem from inherent vulnerabilities in PO. A comprehensive understanding of how CEA leads to these inherent vulnerabilities in PO can inform enhanced interventions for at-risk adolescents. Nonetheless, our comprehension lacks insight into potential pathways to PO, especially those involving external factors like maltreatment and individual traits like mentalizing. This study sought to bridge these gaps by employing latent factor analysis and structural equation modeling to explore connections between emotional maltreatment, adolescent mentalizing, and PO. Methods A community-based cohort of 193 adolescents (aged 12-17) took part in self-report assessments: the Childhood Experience of Care and Abuse Questionnaire (CECA.Q), the Reflective Functioning Questionnaire for Youth (RFQ-Y), and the Inventory for Personality Organization for Adolescents (IPO-A). Results The structural equation model revealed a significant direct influence of CEA on both RFQ-Confusion and PO, and a noteworthy direct effect of RFQ-Confusion on PO. Remarkably, the model accounted for 76.9% of the PO variance. CEA exhibited a significant indirect impact on PO through RFQ-Confusion, which was accountable for 52.3% of the CEA effect on PO, signifying a partial mediation by mentalizing. Discussion These insights carry substantial clinical implications, especially for devising integrated, trauma-informed strategies for adolescents with personality pathologies. This is particularly relevant for enhancing mentalizing and bolstering personality consolidation among adolescent CEA survivors.
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Affiliation(s)
- Karin Ensink
- École de Psychologie, Université Laval, Québec, QC, Canada
| | | | - Michaël Bégin
- Département de Psychologie, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Laurie Cimon
- Département de Médecine Sociale et Préventive, Université Laval, Québec, QC, Canada
| | | | - Marissa Wais
- École de Psychologie, Université Laval, Québec, QC, Canada
| | - Lina Normandin
- École de Psychologie, Université Laval, Québec, QC, Canada
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
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Kanj G, Hallit S, Obeid S. The relationship between childhood emotional abuse and borderline personality disorder: the mediating role of difficulties in emotion regulation among Lebanese adults. Borderline Personal Disord Emot Dysregul 2023; 10:34. [PMID: 37986013 PMCID: PMC10662025 DOI: 10.1186/s40479-023-00241-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 11/09/2023] [Indexed: 11/22/2023] Open
Abstract
OBJECTIVE The present study investigates the mediating effect of difficulties in emotion regulation in the association between childhood emotional abuse and Borderline Personality Disorder (BPD) among Lebanese adults. METHOD This cross-sectional study, involving 411 participants, was conducted between March and August 2022. Lebanese individuals from all governorates of the country were recruited using the Snowball Sampling technique. Three self-report scales were utilized to complete this research; the 'Difficulties in Emotion Regulation Scale-Brief Version (DERS-16)' which evaluates the difficulties in emotion regulation of individuals, the 'Childhood Trauma Questionnaire-Short Form (CTQ-SF)' which grants a subjective evaluation of the general childhood environment of the participants, as well as the 'Borderline Personality Questionnaire (BPQ)' which measures Borderline Personality Disorder traits, that demonstrate significant convergence with the disorder. RESULTS The results indicate that DERS-16 played an indirect effect role between childhood emotional abuse scores and Borderline Personality Disorder. Higher emotional abuse scores were significantly associated with higher DERS-16 scores, which in turn was significantly associated with higher BPQ scores. Moreover, childhood emotional abuse was directly associated with higher BPQ scores. CONCLUSION This work suggests that, among the different forms of childhood abuse, emotional abuse may have a role in the development of Borderline Personality Disorder. Training on emotion regulation strategies would potentially benefit individuals in preventing BPD development and facilitating therapeutic processes.
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Affiliation(s)
- Gaelle Kanj
- School of Arts and Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
| | - Sahar Obeid
- Social and Education Sciences Department, School of Arts and Sciences, Lebanese American University, Jbeil, Lebanon
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Grecucci A, Dadomo H, Salvato G, Lapomarda G, Sorella S, Messina I. Abnormal Brain Circuits Characterize Borderline Personality and Mediate the Relationship between Childhood Traumas and Symptoms: A mCCA+jICA and Random Forest Approach. SENSORS (BASEL, SWITZERLAND) 2023; 23:2862. [PMID: 36905064 PMCID: PMC10006907 DOI: 10.3390/s23052862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 06/18/2023]
Abstract
Borderline personality disorder (BPD) is a severe personality disorder whose neural bases are still unclear. Indeed, previous studies reported inconsistent findings concerning alterations in cortical and subcortical areas. In the present study, we applied for the first time a combination of an unsupervised machine learning approach known as multimodal canonical correlation analysis plus joint independent component analysis (mCCA+jICA), in combination with a supervised machine learning approach known as random forest, to possibly find covarying gray matter and white matter (GM-WM) circuits that separate BPD from controls and that are also predictive of this diagnosis. The first analysis was used to decompose the brain into independent circuits of covarying grey and white matter concentrations. The second method was used to develop a predictive model able to correctly classify new unobserved BPD cases based on one or more circuits derived from the first analysis. To this aim, we analyzed the structural images of patients with BPD and matched healthy controls (HCs). The results showed that two GM-WM covarying circuits, including basal ganglia, amygdala, and portions of the temporal lobes and of the orbitofrontal cortex, correctly classified BPD against HC. Notably, these circuits are affected by specific child traumatic experiences (emotional and physical neglect, and physical abuse) and predict symptoms severity in the interpersonal and impulsivity domains. These results support that BPD is characterized by anomalies in both GM and WM circuits related to early traumatic experiences and specific symptoms.
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Affiliation(s)
- Alessandro Grecucci
- Clinical and Affective Neuroscience Lab (CL.I.A.N. Lab), Department of Psychology and Cognitive Sciences (DiPSCo), University of Trento, 38068 Rovereto, Italy
- Centre for Medical Sciences (CISMed), University of Trento, 38122 Trento, Italy
| | - Harold Dadomo
- Unit of Neuroscience, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Gerardo Salvato
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- Cognitive Neuropsychology Centre, ASST “Grande Ospedale Metropolitano” Niguarda, 20162 Milan, Italy
- Milan Centre for Neuroscience (NeuroMI), 20126 Milan, Italy
| | - Gaia Lapomarda
- Department of Psychology, Science Division, New York University of Abu Dhabi, Abu Dhabi P.O. Box 129188, United Arab Emirates
| | - Sara Sorella
- Clinical and Affective Neuroscience Lab (CL.I.A.N. Lab), Department of Psychology and Cognitive Sciences (DiPSCo), University of Trento, 38068 Rovereto, Italy
| | - Irene Messina
- Clinical and Affective Neuroscience Lab (CL.I.A.N. Lab), Department of Psychology and Cognitive Sciences (DiPSCo), University of Trento, 38068 Rovereto, Italy
- Universitas Mercatorum, 00186 Rome, Italy
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Neuner F. Physical and social trauma: Towards an integrative transdiagnostic perspective on psychological trauma that involves threats to status and belonging. Clin Psychol Rev 2023; 99:102219. [PMID: 36395560 DOI: 10.1016/j.cpr.2022.102219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/10/2022] [Accepted: 11/02/2022] [Indexed: 11/13/2022]
Abstract
Current theories of psychological trauma assume that posttraumatic symptoms originate from stress reactions caused by extremely adverse life experiences. Since the diagnosis of PTSD is restricted to events that involve threats to the physical or sexual integrity of a person, such as accidents and physical and sexual violence, these theories are not well suited to explain the psychopathological consequences of severe violations of one's social integrity, such as emotional abuse and bullying. However, it is evident that social threats contribute to a broad range of mental disorders and increase symptom severity in patients with posttraumatic stress disorder. The aim of the Physical and Social Trauma (PAST) framework is to extend current memory theories of psychological trauma to incorporate threats to a person's social integrity. Within this perspective, the harmful effects of events that involve social threats result from violations of core social motives such as the need for status and belonging that bring about intense affective reactions, including despair and defeat. Within associative threat structures, these emotions are tied to the stimulus characteristics of the experiences and can be re-activated in social situations. The resulting psychopathology transcends PTSD criteria and other current classifications and suggests a transdiagnostic perspective of psychological trauma. Implications for treatment and further directions for research are discussed.
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Affiliation(s)
- Frank Neuner
- Bielefeld University, Department of Psychology, Postbox 100131, 33501 Bielefeld, Germany.
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Low Emotional Complexity as a Transdiagnostic Risk Factor: Comparing Idiographic Markers of Emotional Complexity to Emotional Granularity as Predictors of Anxiety, Depression, and Personality Pathology. COGNITIVE THERAPY AND RESEARCH 2023. [DOI: 10.1007/s10608-022-10347-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Vize CE, Baranger DAA, Finsaas MC, Goldstein BL, Olino TM, Lynam DR. Moderation effects in personality disorder research. Personal Disord 2023; 14:118-126. [PMID: 35737564 PMCID: PMC9990702 DOI: 10.1037/per0000582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Tests of statistical interactions (or tests of moderation effects) in personality disorder research are a common way for researchers to examine nuanced hypotheses relevant to personality pathology. However, the nature of statistical interactions makes them difficult to reliably detect in many research scenarios. The present study used a flexible, simulation-based approach to estimate statistical power to detect trait-by-trait interactions common to psychopathy research using the Triarchic model of Psychopathy and the Psychopathic Personality Inventory. Our results show that even above-average sample sizes in these literatures (e.g., N = 428) provide inadequate power to reliably detect trait-by-trait interactions, and the sample sizes needed to detect interaction effect sizes in realistic scenarios are extremely large, ranging from 1,300 to 5,200. The implications for trait-by-trait interactions in psychopathy are discussed, as well as how the present findings might generalize to other areas of personality disorder research. We provide recommendations for how to design research studies that can provide informative tests of interactions in personality disorder research, but also highlight that a more realistic option is to abandon the traditional approach when testing for interaction effects and adopt alternative approaches that may be more productive. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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You JS, Lee CW, Park JY, Jang Y, Yu H, Yoon J, Kwon SS, Oh S, Park YS, Ryoo HA, Lee JH, Lee D, Lee J, Kim Y, Cho N, Ihm HK, Park CHK, Lee YC, Won HH, Kang HS, Beak JH, Ha TH, Myung W. Borderline Personality Pathology in Major Depressive Disorder, Bipolar I and II Disorder, and Its Relationship With Childhood Trauma. Psychiatry Investig 2022; 19:909-918. [PMID: 36444154 PMCID: PMC9708861 DOI: 10.30773/pi.2022.0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/21/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Mood disorder and borderline personality pathology (BPP) are frequently comorbid and relate to childhood trauma. We investigated the relationship between childhood trauma and BPP features in mood disorder patients versus controls. METHODS A total of 488 mood disorder patients, particularly major depressive disorder (MDD), bipolar I disorder (BD I), and bipolar II disorder (BD II), and 734 controls were included. We examined between-group BPP-related differences and correlated between BPP and childhood trauma using the Childhood Trauma Questionnaire-Short Form (CTQ) and the Personality Assessment Inventory-Borderline Features Scale. RESULTS BD II patients showed significantly higher BPP. Emotional abuse and neglect were prominently associated with BPP, while affective instability and negative relationships exhibited a stronger association with childhood trauma. We also found a positive relationship between childhood trauma and BPP in MDD, BD I, and BD II patients. CONCLUSION The findings of the present study imply that BPP features are more likely to be found in patients with BD II than BD I or MDD. Mood disorder patients with severe childhood trauma may have higher BPP features. Thus, further study of the relationship between childhood trauma and BPP features could improve the therapeutic approaches and help understand patients with mood disorders.
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Affiliation(s)
- Ji Seon You
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Psychiatry, Asan Medical Center, Seoul, Republic of Korea
| | - Chan Woo Lee
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ji Yoon Park
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Yoonjeong Jang
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hyeona Yu
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Joohyun Yoon
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sarah Soonji Kwon
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sunghee Oh
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Yun Seong Park
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hyun A Ryoo
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jong Hun Lee
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Daseul Lee
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jakyung Lee
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Yeoju Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Nayoung Cho
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hong Kyu Ihm
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - C Hyung Keun Park
- Department of Psychiatry, Asan Medical Center, Seoul, Republic of Korea
| | - Yeong Chan Lee
- Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Seoul, Republic of Korea
| | - Hong-Hee Won
- Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Seoul, Republic of Korea
| | - Hyo Shin Kang
- Department of Psychology, Kyungpook National University, Daegu, Republic of Korea
| | - Ji Hyun Beak
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Hyon Ha
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Woojae Myung
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
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Personality Disorders in Childhood: Validity of the Coolidge Personality and Neuropsychological Inventory for Children (CPNI). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074050. [PMID: 35409734 PMCID: PMC8998288 DOI: 10.3390/ijerph19074050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/24/2022] [Accepted: 03/26/2022] [Indexed: 12/10/2022]
Abstract
BACKGROUND A growing body of evidence has shown that maladaptive traits and emerging patterns of personality can be traced to an early stage of development and may be assessed in childhood. The goal of present study was to provide preliminary data on the validity of the Coolidge Personality and Neuropsychological Inventory for Children (CPNI), an instrument designed to assess personality pathologies and other clinical conditions in childhood. METHOD A sample of 146 clinicians completed the CPNI, as well as the Child Behavior Checklist (CBCL) to evaluate the behavioral problems and social competencies, regarding a child (aged 6-11 years) who had been in their care between 2 and 12 months. The clinicians also filled out a clinical questionnaire to provide information on the children, their families, and psychotherapies. RESULTS There were significant and clinically consistent associations between the CPNI and CBCL. They confirmed the good concurrent (convergent and discriminant) validity of the CPNI. CONCLUSIONS The findings seem to support the validity of the CPNI as diagnostic instrument, taking children's PDs and behavioral problems into account. Despite some limitations, the CPNI represents a helpful measure to evaluate the children's personality configurations according to the DSM model. It may be employed along with other tools based on other diagnostic frameworks within the context of a multi-method and multi-informant assessment to provide an accurate and comprehensive formulation of children's overall functioning.
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Guilé JM, Zavaglia E, Berthiaume C, Bergeron L. Prevalence and comorbidity of borderline personality traits in the Quebec general population aged 12-14 years. Soc Psychiatry Psychiatr Epidemiol 2021; 56:2053-2062. [PMID: 33745001 DOI: 10.1007/s00127-021-02067-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The early identification of borderline personality traits (BPT) in adolescents helps to prevent their progression. Data are available for the clinical population, but little has been published on the general population, especially regarding age and sex distribution in adolescence. Even less is known about the comorbidity of BPT with other mental disorders. METHODS We estimated the prevalence of BPT, by sex, age, and comorbidity, in a sample of adolescents aged 12-14 years (n = 799) from the Quebec Mental Health Survey. A complex sampling design was used to ensure representativeness. BPT was assessed with the abbreviated-diagnostic interview for borderlines-revised, with the adolescent as an informant. Reliability coefficients were above 0.80. Several levels of severity were explored using an independent criterion, defined by impairment according to the Columbia impairment scale. RESULTS The overall prevalence of BPT was 6.3%. Prevalence estimates for the most impaired were 3.2% for the entire sample and 1.3% for 12-year-olds. Prevalence increased significantly with age for most impairment levels but did not differ significantly between the sexes. In adolescents, BPT displayed moderate-to-strong comorbidity with anxiety (AD) and insomnia disorders, and very strong comorbidity with depressive (DD), attention deficit hyperactivity (ADHD), and oppositional defiant/conduct disorders (ODD/CD). CONCLUSION We, therefore, make two clinical recommendations for child psychiatry practice: (1) with respect to the lower rate of male adolescents attending BPT Health Programs, increase BPT screening in male adolescents; (2) evaluate BPT when children with ADHD or ODD/CD develop AD or DD during adolescence.
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Affiliation(s)
- Jean Marc Guilé
- Child and Adolescent Psychiatry Services, Amiens-Picardie University Medical Centre , Amiens, France. .,Psychiatry Residency Program, Department of Psychiatry, University of Picardie-Jules Verne, Amiens, France. .,Department of Psychiatry, McGill University, Montreal, QC, Canada.
| | - Elissa Zavaglia
- Department of Psychology, Montreal University, Montreal, QC, Canada.,Research Centre, Hôpital en Santé Mentale Rivières-Des-Prairies, CIUSSS du Nord-de-L'Île-de-Montréal, Montréal, Québec, Canada
| | - Claude Berthiaume
- Research Centre, Hôpital en Santé Mentale Rivières-Des-Prairies, CIUSSS du Nord-de-L'Île-de-Montréal, Montréal, Québec, Canada
| | - Lise Bergeron
- Department of Psychology, Montreal University, Montreal, QC, Canada
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Robin M, Douniol M, Pham-Scottez A, Gicquel L, Delvenne V, Nezelof S, Speranza M, Falissard B, Silva J, Corcos M. Specific Pathways From Adverse Experiences to BPD in Adolescence: A Criteria-Based Approach of Trauma. J Pers Disord 2021; 35:94-110. [PMID: 33999657 DOI: 10.1521/pedi_2021_35_523] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Within the European Research Network on BPD (EURNET-BPD; n = 85 BPD adolescents, n = 84 healthy controls, aged 13-19), this study explored the combination of three types of adversity-maltreatment, stressful life events (early separation from parents, parental suicide attempt, parental chronic disease) and parental bonding-as predictors of BPD, on a criteria-based approach. Results indicated that cumulative traumatic experiences largely characterize borderline adolescent's history; and, in the multivariate regression models, all adversity experiences were likely to contribute to BPD symptoms. The role of emotional abuse, parental suicide attempt, and a decrease in paternal level of care were particularly prominent. Moreover, adversities combinations were different for each criterion, suggesting that specific sets of traumatic experiences are leading to BPD. These findings argue for a further criteria-based exploration of trauma in borderline patients, as well as a more accurate and efficient prevention.
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Affiliation(s)
- Marion Robin
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France.,Paris Descartes University, Paris, France
| | - Marie Douniol
- Medical Psychological Center, Odysseum, EPS Erasme, Sceaux, France
| | | | - Ludovic Gicquel
- Henri Laborit Hospital Center, Poitiers, URC, University of Poitiers, France
| | - Veronique Delvenne
- Queen Fabiola Children's University Hospital, Brussels, Free University of Brussels, Belgium
| | - Sylvie Nezelof
- Department of Child and Adolescent Psychiatry, Besançon University Hospital, Franche Comte University, Besançon, France
| | - Mario Speranza
- Versailles General Hospital, Le Chesnay, France.,Paris-Saclay University, UVSQ, CESP, INSERM U1178, Team PsyDev, Paris, France
| | - Bruno Falissard
- Paris-Saclay University, UVSQ, CESP, INSERM U1178, Team PsyDev, Paris, France.,INSERMU 669, Paris, France
| | - Jerôme Silva
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
| | - Maurice Corcos
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France.,Paris Descartes University, Paris, France
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Franssens R, Abrahams L, Brenning K, Van Leeuwen K, De Clercq B. Unraveling Prospective Reciprocal Effects between Parental Invalidation and Pre-Adolescents' Borderline Traits: Between- and Within-Family Associations and Differences with Common Psychopathology-Parenting Transactions. Res Child Adolesc Psychopathol 2021; 49:1387-1401. [PMID: 34021460 DOI: 10.1007/s10802-021-00825-w] [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] [Accepted: 05/04/2021] [Indexed: 11/29/2022]
Abstract
The etiology of borderline personality pathology has consistently been framed as an interactional process between child vulnerability (i.e. emotional sensitivity and reactivity; Linehan, 1993) and invalidating parenting strategies, which evolves into increased emotion dysregulation and disinhibited behavior of the child and in turn activates more parental invalidation. Despite the strong theoretical base in support of these high-risk parent-child transactions, invalidating parenting behaviors have mostly been explored as a cause of child dysregulation and disinhibition, rather than as a result of child-driven effects. Also, most transactional research in this regard focused at differences between families, thereby not addressing potential changes within families across time. The current study therefore examines bidirectional between- and within-family effects of childhood borderline-related traits and maternal invalidation in the sensitive developmental phase of pre-adolescence (n = 574; 54.4% girls) along three assessment points. Cross-Lagged Panel Models and Random-Intercept Cross-Lagged Panel Models indicated detrimental parenting effects of invalidation on subsequent development in borderline-related traits of the child both between and within families, and additional child-driven effects for subsequent invalidating parenting strategies within families. Beyond these transactions between borderline-related traits and parenting, the current study also indicates significant differences in the direction of effects when exploring transactions between more common dimensions of child internalizing/externalizing symptomatology and parental invalidation, suggesting a more substantial parenting etiology in the developmental process of borderline traits throughout pre-adolescence. Future longitudinal research may explore to what extent the transactional nature of borderline personality traits during important developmental stages indeed holds unique aspects compared to more common manifestations of symptomatology at young age.
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Affiliation(s)
- Raissa Franssens
- Department of Developmental, Personality and Social Psychology, Ghent University. H, Dunantlaan 2, B-9000, Gent, Belgium.
| | - Loes Abrahams
- Department of Developmental, Personality and Social Psychology, Ghent University. H, Dunantlaan 2, B-9000, Gent, Belgium
| | - Katrijn Brenning
- Department of Developmental, Personality and Social Psychology, Ghent University. H, Dunantlaan 2, B-9000, Gent, Belgium
| | | | - Barbara De Clercq
- Department of Developmental, Personality and Social Psychology, Ghent University. H, Dunantlaan 2, B-9000, Gent, Belgium
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Fatimah H, Wiernik BM, Gorey C, McGue M, Iacono WG, Bornovalova MA. Familial factors and the risk of borderline personality pathology: genetic and environmental transmission. Psychol Med 2020; 50:1327-1337. [PMID: 31317840 DOI: 10.1017/s0033291719001260] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Parental characteristics and practices predict borderline personality disorder (BPD) symptoms in children. However, it is difficult to disentangle whether these effects are genetically or environmentally mediated. The present study examines the contributions of genetic and environmental influences by comparing the effects of familial risk factors (i.e. parental psychopathology and borderline traits, maladaptive parenting, marital discord) on child BPD traits in genetically related (biological) and non-related (adoptive) families. METHODS Data are from 409 adoptive and 208 biological families who participated in the Siblings Interaction and Behavior Study (SIBS) and 580 twin families the Minnesota Twin Family Study (MTFS). Parent characteristics and practices included parental psychopathology (measured via structured clinical interviews), parental BPD traits, parenting behaviors, and marital discord. A series of multi-level regression models were estimated to examine the relationship of familial risk factors to child BPD traits and to test whether children's adoptive status moderated the association. RESULTS Symptom counts of parents' conduct disorder, adult antisocial behavior, nicotine, alcohol, and illicit drug dependence, and paternal BPD traits substantially predicted child BPD traits only in biological offspring, implying genetic transmission. Maternal BPD traits and both maternal and paternal conflict, lack of regard, and lack of involvement predicted offspring BPD traits regardless of the adoptive status, implying environmental transmission. CONCLUSIONS Parental externalizing psychopathology and father's BPD traits contribute genetic risk for offspring BPD traits, but mothers' BPD traits and parents' poor parenting constitute environmental risks for the development of these offspring traits.
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Affiliation(s)
| | | | | | - Matt McGue
- University of Minnesota, Minneapolis, MN, USA
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Humphreys KL, LeMoult J, Wear JG, Piersiak HA, Lee A, Gotlib IH. Child maltreatment and depression: A meta-analysis of studies using the Childhood Trauma Questionnaire. CHILD ABUSE & NEGLECT 2020; 102:104361. [PMID: 32062423 PMCID: PMC7081433 DOI: 10.1016/j.chiabu.2020.104361] [Citation(s) in RCA: 230] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/03/2020] [Accepted: 01/08/2020] [Indexed: 05/18/2023]
Abstract
BACKGROUND Researchers have documented that child maltreatment is associated with adverse long-term consequences for mental health, including increased risk for depression. Attempts to conduct meta-analyses of the association between different forms of child maltreatment and depressive symptomatology in adulthood, however, have been limited by the wide range of definitions of child maltreatment in the literature. OBJECTIVE We sought to meta-analyze a single, widely-used dimensional measure of child maltreatment, the Childhood Trauma Questionnaire, with respect to depression diagnosis and symptom scores. PARTICIPANTS AND SETTING 192 unique samples consisting of 68,830 individuals. METHODS We explored the association between total scores and scores from specific forms of child maltreatment (i.e., emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect) and depression using a random-effects meta-analysis. RESULTS We found that higher child maltreatment scores were associated with a diagnosis of depression (g = 1.07; 95 % CI, 0.95-1.19) and with higher depression symptom scores (Z = .35; 95 % CI, .32-.38). Moreover, although each type of child maltreatment was positively associated with depression diagnosis and scores, there was variability in the size of the effects, with emotional abuse and emotional neglect demonstrating the strongest associations. CONCLUSIONS These analyses provide important evidence of the link between child maltreatment and depression, and highlight the particularly larger association with emotional maltreatment in childhood.
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Affiliation(s)
| | | | - John G Wear
- Western University of Health Sciences, United States
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Lakhdir MPA, Nathwani AA, Ali NA, Farooq S, Azam SI, Khaliq A, Kadir MM. Intergenerational transmission of child maltreatment: Predictors of child emotional maltreatment among 11 to 17 years old children residing in communities of Karachi, Pakistan. CHILD ABUSE & NEGLECT 2019; 91:109-115. [PMID: 30856598 DOI: 10.1016/j.chiabu.2019.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 02/07/2019] [Accepted: 03/04/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Families where parents had childhood history of victimization may likely to abuse their children; hence contributing as an important predictor of child emotional maltreatment (CEM). This study aimed to determine the relationship of intergenerational abuse with CEM among 11-17 years old children residing in peri-urban and urban communities of Karachi, Pakistan. METHOD Structured interviews were conducted with 800 children and parents-pair using validated questionnaire "International Child Abuse Screening Tool for Child (ICAST-C)" comprised of 4 domains. Domain of child emotional maltreatment was considered as outcome (CEM-score). The relationship between Parental history of childhood victimization and CEM-Score was measured using linear regression. RESULTS The average CEM-score was came to be 19+5.2 among children whom parental history of childhood victimization was present (P < 0.001). The estimated mean CEM-score increased by 5.59 units (95% CI= {2.61, 8.51}) among children whom parents had a history of childhood victimization (Intergenerational abuse) with severe physical familial abuse. CONCLUSION The current study provided evidence on intergenerational transmission of maltreatment suggesting early prevention to break the cycle of child maltreatment through generations. Preventive measures can be taken, once a parental history of childhood victimization has been identified, by providing appropriate services to those families who belong to lower socioeconomic status, where mothers are young, presence of siblings' rivalry/ bullying and/or violence among family members. However, these factors do not explain a complete causality of the intergenerational transmission therefore additional factors, for instance parenting styles must be taken into consideration.
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Affiliation(s)
| | - Apsara Ali Nathwani
- Aga Khan University, Department of Community Health Sciences, Karachi, Pakistan.
| | - Naureen Akber Ali
- Aga Khan University, School of Nursing and Midwifery, Karachi, Pakistan.
| | - Salima Farooq
- Aga Khan University Hospital, Department of Pediatric and Child Health, Karachi, Pakistan.
| | - Syed Iqbal Azam
- Aga Khan University, Department of Community Health Sciences, Karachi, Pakistan.
| | - Asif Khaliq
- Aga Khan University Hospital, Department of Pediatric and Child Health, Karachi, Pakistan.
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Susceptibility or Resilience to Maltreatment Can Be Explained by Specific Differences in Brain Network Architecture. Biol Psychiatry 2019; 85:690-702. [PMID: 30528381 PMCID: PMC6440838 DOI: 10.1016/j.biopsych.2018.10.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 10/15/2018] [Accepted: 10/26/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Childhood maltreatment is a major risk factor for psychopathology. However, some maltreated individuals appear remarkably resilient to the psychiatric effects while manifesting the same array of brain abnormalities as maltreated individuals with psychopathology. Hence, a critical aim is to identify compensatory brain alterations that enable resilient individuals to maintain mental well-being despite alterations in stress-susceptible regions. METHODS Network models were constructed from diffusion tensor imaging and tractography in physically healthy unmedicated 18- to 25-year-old participants (N = 342, n = 192 maltreated) to develop network-based explanatory models. RESULTS First, we determined that susceptible and resilient individuals had the same alterations in global fiber stream network architecture using two different definitions of resilience: 1) no lifetime history of Axis I or II disorders, and 2) no clinically significant symptoms of anxiety, depression, anger-hostility, or somatization. Second, we confirmed an a priori hypothesis that right amygdala nodal efficiency was lower in asymptomatic resilient than in susceptible participants or control subjects. Third, we identified eight other nodes with reduced nodal efficiency in resilient individuals and showed that nodal efficiency moderated the relationship between maltreatment and psychopathology. Fourth, we found that models based on global network architecture and nodal efficiency could delineate group membership (control, susceptible, resilient) with 75%, 82%, and 80% cross-validated accuracy. CONCLUSIONS Together these findings suggest that sparse fiber networks with increased small-worldness following maltreatment render individuals vulnerable to psychopathology if abnormalities occur in specific nodes, but that decreased ability of certain nodes to propagate information throughout the network mitigates the effects and leads to resilience.
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A systematic review of negative parenting practices predicting borderline personality disorder: Are we measuring biosocial theory's ‘invalidating environment’? Clin Psychol Rev 2018; 65:1-16. [DOI: 10.1016/j.cpr.2018.06.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 01/16/2018] [Accepted: 06/06/2018] [Indexed: 11/19/2022]
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van Dijke A, Hopman JA, Ford JD. Affect dysregulation, adult attachment problems, and dissociation mediate the relationship between childhood trauma and borderline personality disorder symptoms in adulthood. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2018. [DOI: 10.1016/j.ejtd.2017.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Ibrahim J, Cosgrave N, Woolgar M. Childhood maltreatment and its link to borderline personality disorder features in children: A systematic review approach. Clin Child Psychol Psychiatry 2018; 23:57-76. [PMID: 28617046 DOI: 10.1177/1359104517712778] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Borderline personality disorder has repeatedly been associated with a history of maltreatment in childhood; however, research on maltreatment and its link to borderline features in children is limited. METHOD The aim of this review is to synthesise the existing data on the association between maltreatment and borderline features in childhood. In total, 10 studies were included in this systematic review. RESULTS Studies indicated that children with borderline features were more likely to have a history of maltreatment, and that children who had been maltreated were more likely to present with borderline features. Other risk factors such as cognitive and executive functioning deficits, parental dysfunction and genetic vulnerability were also identified across studies. CONCLUSION This review adds to the literature by highlighting maltreatment as a risk factor for borderline features in childhood. Longitudinal research is required to establish the link between childhood borderline features and adult borderline features. Implications for early identification, prevention and intervention services are discussed.
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Affiliation(s)
- Jeyda Ibrahim
- 1 National and Specialist Child and Adolescent Mental Health, South London and Maudsley NHS Foundation Trust, UK.,2 Attachment and Trauma Team, Great Ormond Street Hospital, UK
| | - Nicola Cosgrave
- 3 South London and Maudsley NHS Foundation Trust, UK.,4 National Society for the Prevention of Cruelty to Children (NSPCC), UK
| | - Matthew Woolgar
- 5 King's College London, UK.,6 National Adoption and Fostering Service, South London and Maudsley NHS Foundation Trust, UK
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Keng SL, Wong YY. Association among self-compassion, childhood invalidation, and borderline personality disorder symptomatology in a Singaporean sample. Borderline Personal Disord Emot Dysregul 2017; 4:24. [PMID: 29209501 PMCID: PMC5704523 DOI: 10.1186/s40479-017-0075-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 11/22/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Linehan's biosocial theory posits that parental invalidation during childhood plays a role in the development of borderline personality disorder symptoms later in life. However, little research has examined components of the biosocial model in an Asian context, and variables that may influence the relationship between childhood invalidation and borderline symptoms. Self-compassion is increasingly regarded as an adaptive way to regulate one's emotions and to relate to oneself, and may serve to moderate the association between invalidation and borderline symptoms. The present study investigated the association among childhood invalidation, self-compassion, and borderline personality disorder symptoms in a sample of Singaporean undergraduate students. METHODS Two hundred and ninety undergraduate students from a large Singaporean university were recruited and completed measures assessing childhood invalidation, self-compassion, and borderline personality disorder symptoms. RESULTS Analyses using multiple regression indicated that both childhood invalidation and self-compassion significantly predicted borderline personality disorder symptomatology. Results from moderation analyses indicated that relationship between childhood invalidation and borderline personality disorder symptomatology did not vary as a function of self-compassion. CONCLUSION This study provides evidence in support of aspects of the biosocial model in an Asian context, and demonstrates a strong association between self-compassion and borderline personality disorder symptoms, independent of one's history of parental invalidation during childhood.
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Affiliation(s)
- Shian-Ling Keng
- Division of Social Sciences, Yale-NUS College, Singapore, Singapore
- Elm College Office, 12 College Ave West, #01-201, Singapore, 138610 Singapore
| | - Yun Yi Wong
- Psychological Studies Academic Group, National Institute of Education, Nanyang Technological University, Singapore, Singapore
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Piqueras JA, Martín-Vivar M, Sandin B, San Luis C, Pineda D. The Revised Child Anxiety and Depression Scale: A systematic review and reliability generalization meta-analysis. J Affect Disord 2017; 218:153-169. [PMID: 28475961 DOI: 10.1016/j.jad.2017.04.022] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 02/20/2017] [Accepted: 04/16/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND Anxiety and depression are among the most common mental disorders during childhood and adolescence. Among the instruments for the brief screening assessment of symptoms of anxiety and depression, the Revised Child Anxiety and Depression Scale (RCADS) is one of the more widely used. Previous studies have demonstrated the reliability of the RCADS for different assessment settings and different versions. The aims of this study were to examine the mean reliability of the RCADS and the influence of the moderators on the RCADS reliability. METHODS We searched in EBSCO, PsycINFO, Google Scholar, Web of Science, and NCBI databases and other articles manually from lists of references of extracted articles. RESULTS A total of 146 studies were included in our meta-analysis. The RCADS showed robust internal consistency reliability in different assessment settings, countries, and languages. We only found that reliability of the RCADS was significantly moderated by the version of RCADS. However, these differences in reliability between different versions of the RCADS were slight and can be due to the number of items. LIMITATIONS We did not examine factor structure, factorial invariance across gender, age, or country, and test-retest reliability of the RCADS. CONCLUSIONS The RCADS is a reliable instrument for cross-cultural use, with the advantage of providing more information with a low number of items in the assessment of both anxiety and depression symptoms in children and adolescents.
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Affiliation(s)
| | | | - Bonifacio Sandin
- Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
| | | | - David Pineda
- Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
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Metzner F, Reher C, Kindler H, Pawils S. [Psychotherapeutic treatment of accompanied and unaccompanied minor refugees and asylum seekers with trauma-related disorders in Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 59:642-51. [PMID: 27090242 DOI: 10.1007/s00103-016-2340-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Germany is one of the most important host countries for minor refugees and asylum seekers in Europe. The number of children who leave their home country has significantly risen worldwide in recent years; a further rise is to be expected due to the increasing number of crisis zones. A literature review demonstrates the state of research on traumatization, post-traumatic stress disorders and psychotherapy in minor refugees and asylum seekers. EXPOSURE TO VIOLENCE AND POST-TRAUMATIC STRESS DISORDERS Many minor refugees and asylum seekers have made mainly interpersonal traumatic experiences within their home country or during their flight and develop simple or complex post-traumatic stress disorders. Left untreated, there is a risk of chronification. HEALTH CARE SITUATION The psychotherapeutic treatment of minor refugees and asylum seekers in Germany takes place primarily in specialized psychosocial treatment centers. For an involvement of therapists in private practices, a reduction of organizational barriers as well as evidence-based treatment methods for interpreter-aided psychotherapy of minor refugees and asylum seekers that also consider their developmental state, are still lacking. CONCLUSION In research, as well as in practice, there is further need for an early and systematic identification and treatment of minor refugees and asylum seekers with post-traumatic stress disorders or high risk of disease in Germany.
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Affiliation(s)
- Franka Metzner
- Poliklinik und Institut für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.
| | - Cornelia Reher
- Flüchtlingsambulanz für Kinder und Jugendliche, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Heinz Kindler
- Abteilung Familie und Familienpolitik, Deutsches Jugendinstitut, München, Deutschland
| | - Silke Pawils
- Poliklinik und Institut für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
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Childhood maltreatment is associated with alteration in global network fiber-tract architecture independent of history of depression and anxiety. Neuroimage 2017; 150:50-59. [PMID: 28213111 DOI: 10.1016/j.neuroimage.2017.02.037] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 12/31/2016] [Accepted: 02/13/2017] [Indexed: 11/21/2022] Open
Abstract
Childhood maltreatment is a major risk factor for psychopathology. It is also associated with alterations in the network architecture of the brain, which we hypothesized may play a significant role in the development of psychopathology. In this study, we analyzed the global network architecture of physically healthy unmedicated 18-25 year old subjects (n=262) using diffusion tensor imaging (DTI) MRI and tractography. Anatomical networks were constructed from fiber streams interconnecting 90 cortical or subcortical regions for subjects with no-to-low (n=122) versus moderate-to-high (n=140) exposure to maltreatment. Graph theory analysis revealed lower degree, strength, global efficiency, and maximum Laplacian spectra, higher pathlength, small-worldness and Laplacian skewness, and less deviation from artificial networks in subjects with moderate-to-high exposure to maltreatment. On balance, local clustering was similar in both groups, but the different clusters were more strongly interconnected in the no-to-low exposure group. History of major depression, anxiety and attention deficit hyperactivity disorder did not have a significant impact on global network measures over and above the effect of maltreatment. Maltreatment is an important factor that needs to be taken into account in studies examining the relationship between network differences and psychopathology.
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Abstract
Problem gambling is a significant mental health problem that creates a multitude of intrapersonal, interpersonal, and social difficulties. Recent empirical evidence suggests that personality disorders, and in particular borderline personality disorder (BPD), are commonly co-morbid with problem gambling. Despite this finding there has been very little research examining overlapping factors between these two disorders. The aim of this review is to summarise the literature exploring the relationship between problem gambling and personality disorders. The co-morbidity of personality disorders, particularly BPD, is reviewed and the characteristics of problem gamblers with co-morbid personality disorders are explored. An etiological model from the more advanced BPD literature-the biosocial developmental model of BPD-is used to review the similarities between problem gambling and BPD across four domains: early parent-child interactions, emotion regulation, co-morbid psychopathology and negative outcomes. It was concluded that personality disorders, in particular BPD are commonly co-morbid among problem gamblers and the presence of a personality disorder complicates the clinical picture. Furthermore BPD and problem gambling share similarities across the biosocial developmental model of BPD. Therefore clinicians working with problem gamblers should incorporate routine screening for personality disorders and pay careful attention to the therapeutic alliance, client motivations and therapeutic boundaries. Furthermore adjustments to therapy structure, goals and outcomes may be required. Directions for future research include further research into the applicability of the biosocial developmental model of BPD to problem gambling.
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Winsper C, Lereya ST, Marwaha S, Thompson A, Eyden J, Singh SP. The aetiological and psychopathological validity of borderline personality disorder in youth: A systematic review and meta-analysis. Clin Psychol Rev 2015; 44:13-24. [PMID: 26709502 DOI: 10.1016/j.cpr.2015.12.001] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 09/28/2015] [Accepted: 12/08/2015] [Indexed: 02/06/2023]
Abstract
Controversy surrounds the diagnosis of Borderline Personality Disorder (BPD) in youth. This meta-analysis summarised evidence regarding the aetiological and psychopathological validity of youth BPD (the extent to which youth and adult BPD share common risk factors and psychopathology). We identified 61 studies satisfying predetermined inclusion criteria. Statistically significant pooled associations with youth (19 years of age and under) BPD were observed for sexual abuse (all youth: odds ratio=4.88; 95% confidence interval=3.30, 7.21; children: OR=3.97; 95% CI=1.51, 10.41; adolescents: OR=5.41; 95% CI=3.43, 8.53); physical abuse (all youth: 2.79 [2.03, 3.84]; children: 2.86 [1.98, 4.13]; adolescents: 2.60 [1.38, 4.90]); maternal hostility/verbal abuse (all youth: 3.28 [2.67, 4.03]; children: 3.15 [2.55, 3.88]; adolescents: 4.71 [1.77, 12.53]); and neglect (all youth: 3.40 [2.27, 5.11]; children: 2.87 [1.73, 4.73]; adolescents: 4.87 [2.24, 10.59]). Several psychopathological features were also associated with youth BPD, including comorbid mood (3.21 [2.13, 4.83]), anxiety (2.30 [1.44, 3.70]) and substance use (2.92 [1.60, 5.31]) disorders; self-harm (2.81 [1.61, 4.90]); suicide ideation (all youth: 2.02 [1.23, 3.32]; children: 6.00 [1.81, 19.84]; adolescents: 1.75 [1.20; 2.54]) and suicide attempt (2.10 [1.21, 3.66]). Results demonstrate that adult and youth BPD share common aetiological and psychopathological correlates. This offers some support for the diagnostic validity of youth BPD and indicates the need for clinical recognition in this age group.
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Affiliation(s)
- Catherine Winsper
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK.
| | | | - Steven Marwaha
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Andrew Thompson
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Julie Eyden
- Department of Psychology, University of Warwick, Coventry CV4 7AL, UK
| | - Swaran P Singh
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
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Charak R, Koot HM. Severity of maltreatment and personality pathology in adolescents of Jammu, India: A latent class approach. CHILD ABUSE & NEGLECT 2015; 50:56-66. [PMID: 26056057 DOI: 10.1016/j.chiabu.2015.05.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 05/02/2015] [Accepted: 05/16/2015] [Indexed: 05/12/2023]
Abstract
The aims of the present study were to identify discrete classes of adolescents based on their reporting of emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect of several levels of severity using a person-centered analytic approach (i.e., latent class analysis), and to compare the latent classes on 17 dimensions of personality pathology. It was hypothesized that based on types of maltreatment and severity levels within each type there would be discrete latent classes, and that classes of adolescents exposed to a larger number of maltreatment types with higher severity (i.e., moderate-severe) would report higher levels of personality pathology than adolescents in classes exposed to less types with less severity, after controlling for age and gender. Participants were 702 adolescents from Jammu, India (13-17 years, 41.5% females). The latent classes were based on three levels of severity for each type of maltreatment assessed via the Childhood Trauma Questionnaire (Bernstein et al., 2003). Four distinct classes of adolescents, namely, Moderate-severe abuse and physical neglect (Class 1), Low to moderate-severe abuse (Class 2), Moderate-severe neglect (Class 3), and Minimal abuse or neglect (Class 4) were found. Classes with higher percentages of adolescents reporting abuse and neglect with higher severity (Classes 1 and 2) reported higher levels of personality pathology than the other classes. There are distinct classes of adolescents' identifiable based on levels of severity and types of abuse and neglect, which are differentially associated with specific dimensions of personality pathology. Implications for research and practice are discussed.
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Affiliation(s)
- Ruby Charak
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA; Department of Developmental Psychology, VU University & EMGO Institute of Health and Care Research, Amsterdam, The Netherlands
| | - Hans M Koot
- Department of Developmental Psychology, VU University & EMGO Institute of Health and Care Research, Amsterdam, The Netherlands
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Buckholdt KE, Weiss NH, Young J, Gratz KL. Exposure to Violence, Posttraumatic Stress Symptoms, and Borderline Personality Pathology Among Adolescents in Residential Psychiatric Treatment: The Influence of Emotion Dysregulation. Child Psychiatry Hum Dev 2015; 46:884-92. [PMID: 25500759 PMCID: PMC4466212 DOI: 10.1007/s10578-014-0528-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Exposure to violence during adolescence is a highly prevalent phenomenon associated with a range of deleterious outcomes. Theoretical literature suggests that emotion dysregulation is one consequence of exposure to violence associated with the manifestation of posttraumatic stress symptoms (PTSS) and borderline personality (BP) pathology. Thus, the goal of the present study was to examine the mediating role of emotion dysregulation in the relation between exposure to violence and both PTSS and BP pathology in a sample of 144 adolescents (age 10- to 17-years; 51% male; 55% African American) admitted to a psychiatric residential treatment center. Exposure to violence was associated with greater emotion dysregulation, which, in turn, was associated with greater PTSS and BP pathology. Furthermore, emotion dysregulation mediated the associations between exposure to violence and both PTSS and BP pathology. Findings suggest the importance of assessing and treating emotion dysregulation among violence-exposed adolescents in psychiatric residential treatment.
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Affiliation(s)
- Kelly E Buckholdt
- Department of Psychiatry, University of Mississippi Medical Center, Jackson, MS, USA.
- Psychology Division, G.V. (Sonny) Montgomery VAMC, 1500 E Woodrow Wilson Ave., C-154, Jackson, MS, 39216, USA.
| | - Nicole H Weiss
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
| | - John Young
- Department of Psychology, University of Mississippi, Oxford, MS, USA
| | - Kim L Gratz
- Department of Psychiatry, University of Mississippi Medical Center, Jackson, MS, USA
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Sajadi SF, Zargar Y, Mehrabizade Honarmand M, Arshadi N. Designing and Testing a Model of Some Precedents and Outcomes of Borderline Personality Disorder in High School Students of Shiraz. INTERNATIONAL JOURNAL OF SCHOOL HEALTH 2015. [DOI: 10.17795/intjsh-26742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Sajadi SF, Arshadi N, Zargar Y, Mehrabizade Honarmand M, Hajjari Z. Borderline Personality Features in Students: the Predicting Role of Schema, Emotion Regulation, Dissociative Experience and Suicidal Ideation. INTERNATIONAL JOURNAL OF HIGH RISK BEHAVIORS & ADDICTION 2015; 4:e20021. [PMID: 26401490 PMCID: PMC4578319 DOI: 10.5812/ijhrba.20021v2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 08/06/2014] [Accepted: 08/17/2014] [Indexed: 06/05/2023]
Abstract
BACKGROUND Numerous studies have demonstrated that early maladaptive schemas, emotional dysregulation are supposed to be the defining core of borderline personality disorder. Many studies have also found a strong association between the diagnosis of borderline personality and the occurrence of suicide ideation and dissociative symptoms. OBJECTIVES The present study was designed to investigate the relationship between borderline personality features and schema, emotion regulation, dissociative experiences and suicidal ideation among high school students in Shiraz City, Iran. PATIENTS AND METHODS In this descriptive correlational study, 300 students (150 boys and 150 girls) were selected from the high schools in Shiraz, Iran, using the multi-stage random sampling. Data were collected using some instruments including borderline personality feature scale for children, young schema questionnaire-short form, difficulties in emotion-regulation scale (DERS), dissociative experience scale and beck suicide ideation scale. Data were analyzed using the Pearson correlation coefficient and multivariate regression analysis. RESULTS The results showed a significant positive correlation between schema, emotion regulation, dissociative experiences and suicide ideation with borderline personality features. Moreover, the results of multivariate regression analysis suggested that among the studied variables, schema was the most effective predicting variable of borderline features (P < 0.001). CONCLUSIONS The findings of this study are in accordance with findings from previous studies, and generally show a meaningful association between schema, emotion regulation, dissociative experiences, and suicide ideation with borderline personality features.
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Affiliation(s)
- Seyede Fateme Sajadi
- Department of Psychology, Shahid Chamran University of Ahvaz, Ahvaz, IR Iran
- Young Researchers and Elite Club, Shiraz, IR Iran
| | - Nasrin Arshadi
- Department of Psychology, Shahid Chamran University of Ahvaz, Ahvaz, IR Iran
| | - Yadolla Zargar
- Department of Psychology, Shahid Chamran University of Ahvaz, Ahvaz, IR Iran
| | | | - Zahra Hajjari
- Department of Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Conway CC, Hammen C, Brennan PA. Adolescent precursors of adult borderline personality pathology in a high-risk community sample. J Pers Disord 2015; 29:316-33. [PMID: 25248011 PMCID: PMC5653280 DOI: 10.1521/pedi_2014_28_158] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Longitudinal studies of the exact environmental conditions and personal attributes contributing to the development of borderline personality disorder (BPD) are rare. Furthermore, existing research typically examines risk factors in isolation, limiting our knowledge of the relative effect sizes of different risk factors and how they act in concert to bring about borderline personality pathology. The present study investigated the prospective effects of diverse acute and chronic stressors, proband psychopathology, and maternal psychopathology on BPD features in a high-risk community sample (N = 700) of youth followed from mid-adolescence to young adulthood. Multivariate analyses revealed significant effects of maternal externalizing disorder history, offspring internalizing disorder history, family stressors, and school-related stressors on BPD risk. Contrary to expectations, no interactions between chronically stressful environmental conditions and personal characteristics in predicting borderline personality features were detected. Implications of these findings for etiological theories of BPD and early screening efforts are discussed.
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Affiliation(s)
- Christopher C. Conway
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Constance Hammen
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
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Gratz KL, Kiel EJ, Latzman RD, Moore SA, Elkin TD, Megason GC, Tull MT. Complex Interrelations of Trait Vulnerabilities in Mothers and their Infants. INFANCY 2015. [DOI: 10.1111/infa.12075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Kim L. Gratz
- Department of Psychiatry and Human Behavior; University of Mississippi Medical Center
| | | | | | - Sarah A. Moore
- Department of Psychiatry and Human Behavior; University of Mississippi Medical Center
| | - T. David Elkin
- Department of Psychiatry and Human Behavior; University of Mississippi Medical Center
| | - Gail C. Megason
- Department of Pediatrics; University of Mississippi Medical Center
| | - Matthew T. Tull
- Department of Psychiatry and Human Behavior; University of Mississippi Medical Center
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Bounoua N, Felton JF, Long K, Stadnik RD, Loya JM, MacPherson L, Lejuez CW. Childhood emotional abuse and borderline personality features: The role of anxiety sensitivity among adolescents. Personal Ment Health 2015; 9:87-95. [PMID: 25940514 DOI: 10.1002/pmh.1295] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 02/18/2015] [Accepted: 03/02/2015] [Indexed: 11/06/2022]
Abstract
Borderline personality disorder (BPD) is a pervasive personality disorder that poses a burden for affected individuals, their family members and society as a whole. Current research suggests that early childhood abuse, including emotional abuse, may be an important predictor of later BPD symptomology. Further, an emerging body of literature suggests that anxiety sensitivity (AS) may serve as a form of emotional vulnerability and be a key variable in the relation between abuse and the development of BPD symptomatology. This literature has relied on retrospective recall of abuse and AS in adult samples. As a result, there is a dearth of literature examining these variables in adolescence, which is a developmental period in which personality traits begin to emerge. This study explored the impact of AS in the development of BPD symptoms in a group of 277 adolescents. Results suggest a significant indirect effect of emotional abuse on BPD symptoms via AS, after controlling for sex, grade and prior levels of AS (indirect effect = 0.04, standard error (SE) = 0.02 (95% confidence interval (CI) = 0.001-0.070)). These findings suggest that, among adolescents, AS may serve as an important contributor to the development of BPD symptoms. Implications for interventions and future research are further discussed.
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Affiliation(s)
- Nadia Bounoua
- Center for Addictions, Personality and Emotion Research, Department of Psychology, University of Maryland, College Park, MD, 20742, USA
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Winsper C, Wolke D, Lereya T. Prospective associations between prenatal adversities and borderline personality disorder at 11-12 years. Psychol Med 2015; 45:1025-1037. [PMID: 25171495 DOI: 10.1017/s0033291714002128] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The aetiological pathways to borderline personality disorder (BPD) remain only partly elucidated. Retrospective research indicates that prenatal adversity may be an important early risk factor in the development of BPD. This requires corroboration with prospective longitudinal studies. METHOD A community sample of 6050 mothers and their children (born between April 1991 and December 1992) were assessed. Maternal anxiety and depression and maternal alcohol and tobacco consumption were assessed during pregnancy (18 and 32 weeks gestation). Postnatal risks, including maladaptive parenting (suboptimal parenting and parent conflict), family adversity, maternal anxiety and depression and maternal alcohol and tobacco consumption, were assessed during early childhood. Internalizing and externalizing symptoms were assessed in late childhood. Trained psychologists interviewed children in late childhood to ascertain the presence of BPD (at least five probable/definite symptoms). RESULTS In unadjusted analyses, all prenatal risk factors (i.e., maternal alcohol and tobacco consumption and maternal anxiety and depression) were significantly associated with BPD. Following adjustment for sex, birthweight and postnatal exposure to anxiety and depression respectively, maladaptive parenting, family adversity and child's internalizing and externalizing symptoms, prenatal anxiety at 18 weeks gestation [odds ratio (OR) 1.57, 95% confidence interval (CI) 1.18-2.09] and depression at 18 weeks (OR 1.59, 95% CI 1.08-2.32) and 32 weeks (OR 1.57, 95% CI 1.14-2.18) gestation remained significantly associated with BPD. CONCLUSIONS This study provides prospective evidence of associations between prenatal adversities and BPD at 11-12 years. Prenatal anxiety and depression were independently associated with BPD, suggesting that they may exert direct effects on BPD during the prenatal period. This highlights the importance of programmes to reduce maternal stress during pregnancy.
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Affiliation(s)
- C Winsper
- Division of Mental Health and Wellbeing,Warwick Medical School, University of Warwick,Coventry,UK
| | - D Wolke
- Department of Psychology and Division of Mental Health and Wellbeing,Warwick Medical School, University of Warwick,Coventry,UK
| | - T Lereya
- Department of Psychology,University of Warwick,Coventry,UK
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Abstract
The aim of the current paper was to review the most recent advances in the developmental aspects of borderline personality disorder (BPD) over the last 3 years to highlight the most significant trends in the field. In so doing, we identify and discuss two exciting new trends: (a) an emphasis on the biological basis of adolescent BPD and (b) empirical evidence in support of long-held theories of the development of BPD. Together, these trends suggest that for the first time, empirical findings are beginning to emerge in support of complex and reciprocal biology × environment interactions over time in the development of BPD. We discuss the emerging literature and highlight the translational impact of this work for the assessment and intervention of adolescent BPD.
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Chesin M, Fertuck E, Goodman J, Lichenstein S, Stanley B. The interaction between rejection sensitivity and emotional maltreatment in borderline personality disorder. Psychopathology 2015; 48:31-5. [PMID: 25277634 DOI: 10.1159/000365196] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 05/29/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Borderline personality disorder (BPD) is a prevalent psychiatric disorder associated with significant distress, dysfunction, and treatment utilization. Though, theoretically, BPD is posited to arise from a combination of trait and environmental risk factors, few studies have tested trait-by-environment interactions in BPD. We investigated the roles of rejection sensitivity (RS) and childhood emotional neglect and abuse (ENA) as well as their interaction in BPD. SAMPLING AND METHODS Eighty-five adults with a lifetime mood disorder who were recruited for outpatient studies in a psychiatric clinic were assessed for ENA using the Childhood Trauma Questionnaire and for RS with the Adult Rejection Sensitivity Questionnaire. BPD diagnoses were made by consensus using data collected on the Structured Clinical Interview for DSM-IV. Hierarchical logistic regression was used to test associations between RS, ENA, their interaction and BPD. RESULTS RS and ENA interacted to predict co-occurring BPD in our sample of mood-disordered patients, with the strength of the relationship between RS and BPD depending on the severity of ENA. In the context of little or no ENA, RS and BPD were more strongly related than when ENA was more severe. CONCLUSIONS Our results extend previous findings suggesting RS and ENA are risk factors for BPD. They also provide preliminary support for contemporary theories of BPD positing trait-by-environment interactions in the development of BPD. Prospective studies are needed to confirm these findings.
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Affiliation(s)
- Megan Chesin
- Department of Psychiatry, Molecular Imaging and Neuropathology, Columbia University, New York, N.Y., USA
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Goodman J, Fertuck E, Chesin M, Lichenstein S, Stanley B. The moderating role of rejection sensitivity in the relationship between emotional maltreatment and borderline symptoms. PERSONALITY AND INDIVIDUAL DIFFERENCES 2014; 71:146-150. [DOI: 10.1016/j.paid.2014.07.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ramos V, Canta G, de Castro F, Leal I. Discrete subgroups of adolescents diagnosed with borderline personality disorder: a latent class analysis of personality features. J Pers Disord 2014; 28:463-82. [PMID: 24344843 DOI: 10.1521/pedi_2013_27_126] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Research suggests that borderline personality disorder (BPD) can be diagnosed in adolescents and is marked by considerable heterogeneity. This study aimed to identify personality features characterizing adolescents with BPD and possible meaningful patterns of heterogeneity that could lead to personality subgroups. The authors analyzed data on 60 adolescents, ages 15 to 18 years, who met DSM criteria for a BPD diagnosis. The authors used latent class analysis (LCA) to identify subgroups based on the personality pattern scales from the Millon Adolescent Clinical Inventory (MACI). LCA indicated that the best-fitting solution was a two-class model, identifying two discrete subgroups of BPD adolescents that were described as internalizing and externalizing. The subgroups were then compared on clinical and sociodemographic variables, measures of personality dimensions, DSM BPD criteria, and perception of attachment styles. Adolescents with a BPD diagnosis constitute a heterogeneous group and vary meaningfully on personality features that can have clinical implications for treatment.
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Stepp SD, Whalen DJ, Scott LN, Zalewski M, Loeber R, Hipwell AE. Reciprocal effects of parenting and borderline personality disorder symptoms in adolescent girls. Dev Psychopathol 2014; 26:361-78. [PMID: 24443951 PMCID: PMC4103652 DOI: 10.1017/s0954579413001041] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Theories of borderline personality disorder (BPD) postulate that high-risk transactions between caregiver and child are important for the development and maintenance of the disorder. Little empirical evidence exists regarding the reciprocal effects of parenting on the development of BPD symptoms in adolescence. The impact of child and caregiver characteristics on this reciprocal relationship is also unknown. Thus, the current study examines bidirectional effects of parenting, specifically harsh punishment practices and caregiver low warmth, and BPD symptoms in girls aged 14-17 years based on annual, longitudinal data from the Pittsburgh Girls Study (N = 2,451) in the context of child and caregiver characteristics. We examined these associations through the use of autoregressive latent trajectory models to differentiate time-specific variations in BPD symptoms and parenting from the stable processes that steadily influence repeated measures within an individual. The developmental trajectories of BPD symptoms and parenting were moderately associated, suggesting a reciprocal relationship. There was some support for time-specific elevations in BPD symptoms predicting subsequent increases in harsh punishment and caregiver low warmth. There was little support for increases in harsh punishment and caregiver low warmth predicting subsequent elevations in BPD symptoms. Child impulsivity and negative affectivity, and caregiver psychopathology were related to parenting trajectories, while only child characteristics predicted BPD trajectories. The results highlight the stability of the reciprocal associations between parenting and BPD trajectories in adolescent girls and add to our understanding of the longitudinal course of BPD in youth.
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Martín-Blanco A, Soler J, Villalta L, Feliu-Soler A, Elices M, Pérez V, Arranz MJ, Ferraz L, Alvarez E, Pascual JC. Exploring the interaction between childhood maltreatment and temperamental traits on the severity of borderline personality disorder. Compr Psychiatry 2014; 55:311-8. [PMID: 24262124 DOI: 10.1016/j.comppsych.2013.08.026] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 08/03/2013] [Accepted: 08/08/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Childhood maltreatment and temperamental traits play a role in the development of Borderline Personality Disorder (BPD). The aim of the present study was to assess the involvement and the interrelationship of both factors in the clinical severity of BPD. METHOD The self-reported history of childhood trauma, psychobiological temperamental traits, and severity of BPD symptoms were evaluated in 130 subjects with BPD. RESULTS Approximately 70% of the sample reported some form of abuse or neglect. Childhood maltreatment inversely correlated with sociability, but no correlation was observed with the other temperamental traits. The regression model showed that neuroticism-anxiety and aggression-hostility traits, as well as emotional abuse, were risk factors independently associated with the severity of BPD. Sexual abuse was not associated with the severity of the disorder. Finally, the interaction between high neuroticism-anxiety traits and the presence of severe emotional abuse was associated with BPD severity. CONCLUSION These results suggest that the interaction between temperamental traits and childhood emotional abuse has an influence not only on the development but also on the severity of BPD. Further studies are needed to identify more biological and environmental factors associated with the severity of the disorder.
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Affiliation(s)
- Ana Martín-Blanco
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Barcelona, Spain
| | - Joaquim Soler
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Barcelona, Spain
| | - Laia Villalta
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Barcelona, Spain
| | - Albert Feliu-Soler
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Barcelona, Spain
| | - Matilde Elices
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Barcelona, Spain
| | - Víctor Pérez
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Barcelona, Spain
| | - María Jesús Arranz
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Barcelona, Spain
| | - Liliana Ferraz
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Barcelona, Spain
| | - Enrique Alvarez
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Barcelona, Spain
| | - Juan Carlos Pascual
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Barcelona, Spain.
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Ford JD, Courtois CA. Complex PTSD, affect dysregulation, and borderline personality disorder. Borderline Personal Disord Emot Dysregul 2014; 1:9. [PMID: 26401293 PMCID: PMC4579513 DOI: 10.1186/2051-6673-1-9] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 05/18/2014] [Indexed: 12/23/2022] Open
Abstract
Complex PTSD (cPTSD) was formulated to include, in addition to the core PTSD symptoms, dysregulation in three psychobiological areas: (1) emotion processing, (2) self-organization (including bodily integrity), and (3) relational security. The overlap of diagnostic criteria for cPTSD and borderline personality disorder (BPD) raises questions about the scientific integrity and clinical utility of the cPTSD construct/diagnosis, as well as opportunities to achieve an increasingly nuanced understanding of the role of psychological trauma in BPD. We review clinical and scientific findings regarding comorbidity, clinical phenomenology and neurobiology of BPD, PTSD, and cPTSD, and the role of traumatic victimization (in general and specific to primary caregivers), dissociation, and affect dysregulation. Findings suggest that BPD may involve heterogeneity related to psychological trauma that includes, but extends beyond, comorbidity with PTSD and potentially involves childhood victimization-related dissociation and affect dysregulation consistent with cPTSD. Although BPD and cPTSD overlap substantially, it is unwarranted to conceptualize cPTSD either as a replacement for BPD, or simply as a sub-type of BPD. We conclude with implications for clinical practice and scientific research based on a better differentiated view of cPTSD, BPD and PTSD.
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Affiliation(s)
- Julian D Ford
- University of Connecticut Health Center MC1410, 263 Farmington Avenue, Farmington, CT 06030-1410 USA
| | - Christine A Courtois
- Independent Pactice, Washington, DC, Elements Behavioral Health, Promises, Malibu, CA USA
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Hostility and childhood sexual abuse as predictors of suicidal behaviour in Borderline Personality Disorder. Psychiatry Res 2013; 210:980-5. [PMID: 23993466 DOI: 10.1016/j.psychres.2013.07.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 07/05/2013] [Accepted: 07/08/2013] [Indexed: 11/22/2022]
Abstract
Impulsivity is a multidimensional construct and has been previously associated with suicidal behaviour in borderline personality disorder (BPD). This study examined the associations between suicidal behaviour and impulsivity-related personality traits, as well as history of childhood sexual abuse, in 76 patients diagnosed with BPD using both the Structured Interview for Diagnostic and Statistical Manual of Mental Disorders III (DSM-III) Axis-II diagnoses and the self-personality questionnaire. Impulsivity-related traits were measured using the Barratt Impulsiveness Scale-11 (BIS-11), the Buss-Durkee Hostility Inventory (BDHI) and the Temperament and Character Inventory-Revised (TCI-R). We found that hostility and childhood sexual abuse, but not impulsivity or other temperament traits, significantly predicted the presence, number and severity of previous suicide attempts. Hostility traits and childhood sexual abuse showed an impact on suicide attempts in BPD. Our results support previous findings indicating that high levels of hostility and having suffered sexual abuse during childhood lead to an increased risk for suicidal behaviour in BPD.
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Sansone RA, Farukhi S, Wiederman MW. Perceptions of childhood caretakers and borderline personality symptomatology. CHILD ABUSE & NEGLECT 2013; 37:1030-1033. [PMID: 23890571 DOI: 10.1016/j.chiabu.2013.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 06/18/2013] [Accepted: 06/25/2013] [Indexed: 06/02/2023]
Abstract
Previous studies indicate that individuals with borderline personality disorder come from families marked by high levels of psychopathology as well as dysfunctional parenting styles-themes that tend to engender negative attitudes toward parents. However, we are not aware of any studies that have examined perceptions of parenting quality and borderline personality symptoms in a clinical but non-psychiatric population-the purpose of the present study. Using a cross-sectional self-report survey methodology in a sample of internal medicine outpatients, we examined participants' perceptions of the quality of parental caretaking using a one-item assessment, and examined borderline personality symptomatology using two measures. Ratings of the quality of parental care were statistically significantly inversely correlated with scores on both measures of borderline personality symptomatology. After controlling for the number of caretakers during childhood, the observed statistical relationships remained statistically significant. In this primary care sample, participants with borderline personality symptomatology perceived parents more negatively than those without such symptomatology.
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Affiliation(s)
- Randy A Sansone
- Wright State University School of Medicine in Dayton, OH, United States; Kettering Medical Center in Kettering, OH, United States
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