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Galvez-Merlin A, López-Villatoro JM, de la Higuera-González P, de la Torre-Luque A, McDowell K, Díaz-Marsá M, Leza JC, Carrasco JL. Decreased oxytocin levels related to social cognition impairment in borderline personality disorder. Acta Psychiatr Scand 2024; 149:458-466. [PMID: 38477064 DOI: 10.1111/acps.13679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/24/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Dysfunctions in the oxytocin system have been reported in patients with borderline personality disorder (BPD). Deficits could be related to interpersonal hypersensitivity, which has been previously associated with failures in social cognition (SC) in this disorder, especially in Theory of Mind (ToM) skills. The aim of this work is to study the links between the oxytocin system and SC impairments in patients with BPD. METHOD Plasma oxytocin levels (OXT) and protein expression of oxytocin receptors in blood mononuclear cells (OXTR) were examined in 33 patients with a diagnosis of BPD (age: M 28.85, DT = 8.83). Social cognition was assessed using the Movie for the Assessment of Social Cognition (MASC). Statistical associations between biochemical factors and different response errors in MASC were analyzed through generalized linear regression controlling for relevant clinical factors. RESULTS Generalized linear regression showed a significant relationship between lower OXTR and overmentalization in BPD patients (OR = 0.90). CONCLUSIONS This work supports the relationship between alterations in the oxytocin system and ToM impairments observed in BPD patients, enhancing the search for endophenotypes related to the phenotypic features of the disorder to improve current clinical knowledge and address more specific therapeutic targets.
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Affiliation(s)
- Alejandra Galvez-Merlin
- Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Department of Legal Medicine, Psychiatry and Pathology, Faculty of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - José M López-Villatoro
- Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Department of Legal Medicine, Psychiatry and Pathology, Faculty of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Pilar de la Higuera-González
- Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Department of Personality, Assessment and Clinical Psychology, Faculty of Psychology, UCM, Madrid, Spain
| | - Alejandro de la Torre-Luque
- Department of Legal Medicine, Psychiatry and Pathology, Faculty of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
| | - Karina McDowell
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- Department of Pharmacology and Toxicology, Faculty of Medicine, UCM, Madrid, Spain
- Institute of Health Research Hospital 12 de Octubre (imas12), Madrid, Spain
- Institute of Research in Neurochemistry, UCM, Madrid, Spain
| | - Marina Díaz-Marsá
- Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Department of Legal Medicine, Psychiatry and Pathology, Faculty of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
| | - Juan C Leza
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- Department of Pharmacology and Toxicology, Faculty of Medicine, UCM, Madrid, Spain
- Institute of Health Research Hospital 12 de Octubre (imas12), Madrid, Spain
- Institute of Research in Neurochemistry, UCM, Madrid, Spain
| | - José L Carrasco
- Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Department of Legal Medicine, Psychiatry and Pathology, Faculty of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
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Chang CH, Drobotenko N, Ruocco AC, Lee ACH, Nestor A. Perception and memory-based representations of facial emotions: Associations with personality functioning, affective states and recognition abilities. Cognition 2024; 245:105724. [PMID: 38266352 DOI: 10.1016/j.cognition.2024.105724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 11/09/2023] [Accepted: 01/15/2024] [Indexed: 01/26/2024]
Abstract
Personality traits and affective states are associated with biases in facial emotion perception. However, the precise personality impairments and affective states that underlie these biases remain largely unknown. To investigate how relevant factors influence facial emotion perception and recollection, Experiment 1 employed an image reconstruction approach in which community-dwelling adults (N = 89) rated the similarity of pairs of facial expressions, including those recalled from memory. Subsequently, perception- and memory-based expression representations derived from such ratings were assessed across participants and related to measures of personality impairment, state affect, and visual recognition abilities. Impairment in self-direction and level of positive affect accounted for the largest components of individual variability in perception and memory representations, respectively. Additionally, individual differences in these representations were impacted by face recognition ability. In Experiment 2, adult participants (N = 81) rated facial image reconstructions derived in Experiment 1, revealing that individual variability was associated with specific visual face properties, such as expressiveness, representation accuracy, and positivity/negativity. These findings highlight and clarify the influence of personality, affective state, and recognition abilities on individual differences in the perception and recollection of facial expressions.
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Affiliation(s)
- Chi-Hsun Chang
- Department of Psychology at Scarborough, University of Toronto, 1265 Military Trail, Scarborough, Ontario M1C 1A4, Canada
| | - Natalia Drobotenko
- Department of Psychology at Scarborough, University of Toronto, 1265 Military Trail, Scarborough, Ontario M1C 1A4, Canada
| | - Anthony C Ruocco
- Department of Psychology at Scarborough, University of Toronto, 1265 Military Trail, Scarborough, Ontario M1C 1A4, Canada; Department of Psychological Clinical Science at Scarborough, University of Toronto, 1265 Military Trail, Scarborough, Ontario M1C 1A4, Canada
| | - Andy C H Lee
- Department of Psychology at Scarborough, University of Toronto, 1265 Military Trail, Scarborough, Ontario M1C 1A4, Canada; Rotman Research Institute, Baycrest Centre, 3560 Bathurst St, North York, Ontario M6A 2E1, Canada
| | - Adrian Nestor
- Department of Psychology at Scarborough, University of Toronto, 1265 Military Trail, Scarborough, Ontario M1C 1A4, Canada.
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Galvez-Merlin A, Lopez-Villatoro JM, de la Higuera-Gonzalez P, de la Torre-Luque A, Reneses-Prieto B, Diaz-Marsa M, Carrasco JL. Social cognition deficits in borderline personality disorder: Clinical relevance. Psychiatry Res 2024; 331:115675. [PMID: 38134528 DOI: 10.1016/j.psychres.2023.115675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/26/2023] [Accepted: 12/10/2023] [Indexed: 12/24/2023]
Abstract
Interpersonal difficulties in borderline personality disorder (BDP) have been suggested to be related to impairments in Social Cognition (SC), mainly due to deficits in Theory of Mind (ToM). However, literature is scarce and ambiguous. This work aims to study the SC impairments in BPD patients, by the specific assessment of ToM deficits, and to investigate the relationship between these SC impairments and clinical variables. 82 BPD patients with BPD and 47 control subjects were assessed with the Movie for the Assessment of Social Cognition (MASC). Clinical variables of severity, chronicity, functionality and anxious-depressive symptomatology were recorded. BPD patients had fewer correct mentalization responses and more overmentalization, undermentalization, and absence of mentalization errors than controls. Chronicity was negatively correlated with overmentalization and positively correlated with undermentalization and absence of mentalization errors. Functionality was indirectly correlated with absence of mentalization. These results confirm previous reports of alterations in SC in BPD patients. Furthermore, this study shows that SC impairments in patients with BPD are dependent on characteristics such as chronicity or degree of functionality. The different ToM profiles in patients with BPD indicate the necessity of developing variants of mentalization therapy depending on the deficits of each patient.
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Affiliation(s)
- Alejandra Galvez-Merlin
- Health Research Institute, Hospital Clinico San Carlos (IdISSC), Madrid, Spain; Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid, Madrid, Spain
| | - Jose Manuel Lopez-Villatoro
- Health Research Institute, Hospital Clinico San Carlos (IdISSC), Madrid, Spain; Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid, Madrid, Spain
| | - Pilar de la Higuera-Gonzalez
- Health Research Institute, Hospital Clinico San Carlos (IdISSC), Madrid, Spain; Department of Personality, Assessment and Clinical Psychology, Universidad Complutense de Madrid, Madrid, Spain.
| | - Alejandro de la Torre-Luque
- Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid, Madrid, Spain; Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
| | - Blanca Reneses-Prieto
- Health Research Institute, Hospital Clinico San Carlos (IdISSC), Madrid, Spain; Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid, Madrid, Spain; Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
| | - Marina Diaz-Marsa
- Health Research Institute, Hospital Clinico San Carlos (IdISSC), Madrid, Spain; Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid, Madrid, Spain; Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
| | - Jose L Carrasco
- Health Research Institute, Hospital Clinico San Carlos (IdISSC), Madrid, Spain; Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid, Madrid, Spain; Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
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Muriel NS, López Resa P, Moraleda Sepúlveda E. Linguistic characteristics in bipolar disorder versus borderline personality disorder. Sci Rep 2023; 13:21715. [PMID: 38065986 PMCID: PMC10709396 DOI: 10.1038/s41598-023-46038-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/26/2023] [Indexed: 12/18/2023] Open
Abstract
Scientific evidence has documented throughout the research carried out in recent years, the neuropsychological, behavioral and adaptive difficulties presented by people with Bipolar Disorder and Borderline Personality Disorder at different stages of their development. However, little importance has been given to other factors such as communication, especially in the adult population. The objective of this research was to know the language characteristics presented by people from both groups and the differences in linguistic development. The sample consisted of 60 participants between the ages of 17 and 42:31 of them with a diagnosis of Borderline Personality Disorder and the remaining 29 with a diagnosis of Bipolar Disorder. The standardized evaluation instruments were: the Social Skills Scale and the Pragmatic Competence Questionnaire completed by three different informants (families, professionals and the own person). The results obtained show that both populations manifest linguistic difficulties in adulthood and that there are differences depending on the perception of the agent involved in the language assessment. These results are highly relevant since they provide up-to-date information about language level, support the need for language intervention in adulthood, and reflect a different communicative profile in Bipolar Disorder and Borderline Personality Disorder.
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Affiliation(s)
- Noelia Santos Muriel
- Department of Psychology, Faculty of Health Sciences, University of Castilla-La-Mancha, Avda Real Fábrica de la Seda s/n, 45600, Talavera de la Reina, Spain
| | - Patricia López Resa
- Department of Psychology, Faculty of Health Sciences, University of Castilla-La-Mancha, Avda Real Fábrica de la Seda s/n, 45600, Talavera de la Reina, Spain
| | - Esther Moraleda Sepúlveda
- Department of Psychology, Faculty of Pychology, University Complutense, Campus de Somosaguas, 28223, Pozuelo de Alarcón, Madrid, Spain.
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Dell'Osso L, Cremone IM, Nardi B, Tognini V, Castellani L, Perrone P, Amatori G, Carpita B. Comorbidity and Overlaps between Autism Spectrum and Borderline Personality Disorder: State of the Art. Brain Sci 2023; 13:862. [PMID: 37371342 DOI: 10.3390/brainsci13060862] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/17/2023] [Accepted: 05/24/2023] [Indexed: 06/29/2023] Open
Abstract
Despite the relationship between Autism spectrum disorder (ASD) and personality disorders (PD) still being scarcely understood, recent investigations increased awareness about significant overlaps between some PD and autism spectrum conditions. In this framework, several studies suggested the presence of similarities between BPD and ASD symptoms and traits, based on the recent literature that increasingly reported increased comorbidity rates and significant symptomatologic overlaps between the two conditions. The aim of this review is to describe the available studies about the prevalence of the association between different forms of autism spectrum (full-fledged clinical conditions as well as subthreshold autistic traits) and BPD. Despite some controversial results and lack of homogeneity in the methods used for the diagnostic assessment, the reviewed literature highlighted how subjects with BPD reported higher scores on tests evaluating the presence of AT compared to a non-clinical population and hypothesized the presence of unrecognized ASD in some BPD patients or vice versa, while also describing a shared vulnerability towards traumatic events, and a greater risk of suicidality in BPD subjects with high autistic traits. However, the specific measure and nature of this association remain to be explored in more depth.
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Affiliation(s)
- Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56127 Pisa, Italy
| | - Ivan Mirko Cremone
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56127 Pisa, Italy
| | - Benedetta Nardi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56127 Pisa, Italy
| | - Valeria Tognini
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56127 Pisa, Italy
| | - Lucrezia Castellani
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56127 Pisa, Italy
| | - Paola Perrone
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56127 Pisa, Italy
| | - Giulia Amatori
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56127 Pisa, Italy
| | - Barbara Carpita
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56127 Pisa, Italy
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Robin M, Surjous L, Belbèze J, Bonnardel L, Lamas C, Silva J, Peres V, Corcos M. Four attachment-based categories of emotion regulation in adolescent psychic troubles. Front Psychol 2023; 14:1133980. [PMID: 37275718 PMCID: PMC10237043 DOI: 10.3389/fpsyg.2023.1133980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/06/2023] [Indexed: 06/07/2023] Open
Abstract
Introduction Emotion regulation is altered in many psychiatric disorders in adolescence, but the understanding of mechanisms that underlie this alteration is still poor. Methods The PERCEPT study explores alexithymia, empathy, facial emotion recognition (FER) and defence mechanisms in a sample of adolescents in psychiatric care (n = 61, 74% of girls, mean age = 15.03 y.o.), in relation with participants' attachment styles. Results Results revealed correlations between attachment dimensions and all of the emotion regulation variables, suggesting that attachment modalities have functional links with emotional regulation at its different levels: FER accuracy was inversely correlated with avoidant attachment, while affective empathy, difficulty in identifying feelings (alexithymia) and immature as well as neurotic defence mechanisms were positively correlated with anxious attachment. Moreover, attachment categories delineated distinct emotional perception profiles. In particular, preoccupied attachment included adolescents with the highest levels of facial emotion perception (sensitivity and accuracy) and of affective empathy, whereas detached attachment included adolescents with the lowest levels of these variables. Neurotic defence mechanisms and difficulty to identify feelings were correlated with preoccupied attachment; immature defence mechanisms and difficulty to describe feelings to others characterized fearful attachment. Discussion These results suggest that attachment categories underlie emotion regulation processes in psychiatric disorders in adolescence. Theoretical and clinical implications are discussed.
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Affiliation(s)
- Marion Robin
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
- CESP, INSERM U1178, Paris-Saclay University, Villejuif, France
| | - Luc Surjous
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
- Paris Cité University, Paris, France
| | - Jean Belbèze
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
- Paris Cité University, Paris, France
| | - Lucile Bonnardel
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
| | - Claire Lamas
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
| | - Jérôme Silva
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
| | - Victoire Peres
- 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 Cité University, Paris, France
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Zouraraki C, Karamaouna P, Giakoumaki SG. Facial emotion recognition and schizotypal traits: A systematic review of behavioural studies. Early Interv Psychiatry 2023; 17:121-140. [PMID: 35840128 DOI: 10.1111/eip.13328] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 03/19/2022] [Accepted: 05/29/2022] [Indexed: 11/27/2022]
Abstract
AIM Previous research has indicated that individuals expressing high schizotypal traits and patients with Schizotypal Personality Disorder (SPD), show deficits in facial emotion recognition, compared to low schizotypal or control groups. On the other hand, non-significant findings also exist and the association of facial emotion recognition deficits with the different schizotypal dimensions is not well defined, thus limiting any conclusive outcomes. Therefore, the aim of this systematic review was to further clarify this relationship. METHODS PsychInfo, Web of Science, Scopus and PubMed were systematically searched, and 23 papers with a cross-sectional design were selected. Nineteen studies examined individuals with high schizotypal traits and four studies evaluated SPD individuals with behavioural facial emotion recognition paradigms and self-report measures or clinical interviews for schizotypal traits. All selected studies were published between 1994 and August 2020. RESULTS According to the evidence of studies, high schizotypal individuals and SPD patients have poorer performance in facial emotion recognition tasks. Negative schizotypy was related to lower accuracy for positive and negative emotions and faster emotion labeling while positive schizotypy was associated with worse accuracy for positive, negative and neutral emotions and more biases. Disorganized schizotypy was associated with poorer accuracy for negative emotions and suspiciousness with higher accuracy for disgust faces but lower total accuracy. CONCLUSIONS These findings are consistent with the vulnerability for schizophrenia spectrum disorders and support the idea that emotion recognition deficits are trait markers for these conditions. Thus, the effectiveness of early-intervention programmes could increase by also targeting this class of deficits.
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Affiliation(s)
- Chrysoula Zouraraki
- Laboratory of Neuropsychology, Department of Psychology, Faculty of Social Sciences, University of Crete, Rethymno, Greece
- University of Crete Research Center for the Humanities, The Social and Educational Sciences (UCRC), University of Crete, Rethymno, Greece
| | - Penny Karamaouna
- Laboratory of Neuropsychology, Department of Psychology, Faculty of Social Sciences, University of Crete, Rethymno, Greece
- University of Crete Research Center for the Humanities, The Social and Educational Sciences (UCRC), University of Crete, Rethymno, Greece
| | - Stella G Giakoumaki
- Laboratory of Neuropsychology, Department of Psychology, Faculty of Social Sciences, University of Crete, Rethymno, Greece
- University of Crete Research Center for the Humanities, The Social and Educational Sciences (UCRC), University of Crete, Rethymno, Greece
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Kelly Grealy M, Godfrey E, Brady F, Whyte O’Sullivan E, Carroll GA, Burke T. Borderline personality disorder traits and mentalising ability: The self-other social cognition paradox. Front Psychiatry 2022; 13:1023348. [PMID: 36339858 PMCID: PMC9631768 DOI: 10.3389/fpsyt.2022.1023348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/06/2022] [Indexed: 11/21/2022] Open
Abstract
Objective Borderline personality disorder (BPD) is a psychiatric condition characterised by a pervasive pattern of impulsivity, low self-image, and interpersonal conflicts. Previous findings indicate a mixed relationship between BPD and social cognition; little research as investigated whether BPD traits influence performance on specific elements of social cognitive tasks, i.e., positive/negative valence. Method Community-based typical controls (n = 151; 51% female) were recruited through an online survey. Participants completed aspects of the Personality Assessment Inventory pertaining to BPD traits, the Interpersonal Reactivity Index, and measures of both emotion recognition and mentalising. Results Following group stratification into high/low BPD traits, participants with high BPD traits were observed to perform significantly better when identifying negative valence stimuli. Furthermore, high levels of affect instability was found to significantly influence negative valence recognition. Conclusion This research highlights previous research which shows a paradox between higher performance on measures of social cognition, with a group of individuals who report significant interpersonal and relational difficulties. This research supports the assessment of social cognitive processes for people with BPD and/or high BPD traits to support clinical formulation of strengths and difficulties.
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Affiliation(s)
- Molly Kelly Grealy
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Emmet Godfrey
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Finn Brady
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | | | - Grace A. Carroll
- School of Psychology, Queen’s University Belfast, Belfast, United Kingdom
| | - Tom Burke
- School of Psychology, National University of Ireland Galway, Galway, Ireland
- Galway Neuroscience Centre, National University of Ireland Galway, Galway, Ireland
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Altered psychobiological reactivity but no impairment of emotion recognition following stress in adolescents with non-suicidal self-injury. Eur Arch Psychiatry Clin Neurosci 2022; 273:379-395. [PMID: 36203100 PMCID: PMC10070238 DOI: 10.1007/s00406-022-01496-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 09/27/2022] [Indexed: 11/03/2022]
Abstract
Impairments in both stress regulation and emotion recognition have been associated with borderline personality disorder (BPD) and non-suicidal self-injury (NSSI). Although it has been proposed that emotion recognition deficits particularly emerge during stress, this hypothesis has not been fully investigated. Adolescents with and without NSSI performed emotion recognition tasks before and after the employment of the Trier Social Stress Test (TSST). The psychobiological stress response was captured with psychological self-reports (affect, stress and dissociation), physiological recordings (heart rate, HR, and heart rate variability, HRV) and endocrinological sampling of saliva (cortisol and alpha-amylase). Mixed-linear models were applied to analyze stress-induced changes in emotion recognition performance and respective stress response measures. The TSST elicited altered psychobiological stress responses in adolescents with NSSI: A more pronounced decrease in positive affect, a more pronounced increase in negative affect, a less pronounced increase in HR, a less pronounced decrease in HRV and a more pronounced increase in alpha-amylase throughout the stress induction than adolescents without NSSI. Stress responses (dissociation, negative affect, cortisol and HR) differed as a function of BPD severity on a continuum, illustrating greater reactivity on self-reports but decreased biological responsiveness in those with greater BPD severity. Stress induction had similar effects on emotion recognition in adolescents with and without NSSI. Recognition sensitivity and recognition speed equally increased, in the absence of any differences in recognition accuracy. In contrast to prominent propositions, psychosocial stress does not appear to account for impaired emotion recognition across the BPD spectrum.
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Felsenheimer AK, Kieckhäfer C, Rapp AM. Irony detection in patients with borderline personality disorder: an experimental study examining schizotypal traits, response biases and empathy. Borderline Personal Disord Emot Dysregul 2022; 9:24. [PMID: 36192806 PMCID: PMC9531442 DOI: 10.1186/s40479-022-00194-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/15/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In verbal irony we often convey meanings that oppose the literal words. To look behind these words, we need to integrate perspectives of ourselves, others, and their beliefs about us. Although patients with borderline personality disorder (BPD) experience problems in social cognition and schizotypal symptoms, research on irony comprehension mainly focused on the schizophrenic spectrum. Accounting for possible negative biases in BPD, the current study examined the detection of praising and critical irony in a text messaging interface. METHODS The cross-sectional study included 30 patients and 30 matched controls, who completed measures of cognitive and affective empathy (Interpersonal Reactivity Index, IRI), schizotypal (Schizotypal Personality Questionnaire; SPQ), and borderline symptoms (Borderline Symptom List; BSL-23) and the irony detection task. The irony task contained critical and praising remarks embedded in text messages. Asking for literality (ironic vs. literal) and intention ratings (critical to praising) of the stimuli, it allowed to analyze the sensitivity of literality detection as well as implicit and explicit response biases in a signal detection framework. RESULTS Borderline symptoms explained lower sensitivity for the detection of literal and ironic statements across groups. Whereas HC showed a negativity bias when implicitly asked about the literalness of the statement, patients with BPD perceived praising utterances as less praising when explicitly asked about their perceived intention. Neither empathy nor schizotypy explained outcomes beyond borderline symptoms. CONCLUSIONS This was the first study to show lower detection of verbal irony in patients with BPD. While patients were less biased when asked about the literality of a statement, they perceived praising remarks as less positive on explicit measurements. The results highlight the importance of congruent, transparent communication in promoting epistemic trust in individuals with BPD.
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Affiliation(s)
- Anne Katrin Felsenheimer
- Department of Psychiatry and Psychotherapy, University of Tübingen, 72076, Tübingen, Germany.
- Max Planck School of Cognition , Max Planck Institut for Human Cognitive and Brain Sciences , Leipzig, Germany.
| | - Carolin Kieckhäfer
- LVR Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Alexander Michael Rapp
- Department of Psychiatry and Psychotherapy, University of Tübingen, 72076, Tübingen, Germany
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Sakdalan J, Maxwell Y. The application of adapted dialectical behaviour therapy concepts and skills in the treatment of adults with autistic spectrum disorder who display challenging or offending behaviours. ADVANCES IN AUTISM 2022. [DOI: 10.1108/aia-01-2022-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Despite some advances in the assessment and treatment of autism spectrum disorder (ASD), there remains a paucity of intervention and research literature in treating adults with ASD. There is growing evidence supporting a relationship between the core features of ASD and emotion dysregulation. There is an overlap between ASD and borderline personality disorder (BPD) characteristics such as emotional dysregulation, sensory issues and social skills deficits. This paper aims to explore the applications of dialectical behaviour therapy (DBT) concepts and skills in treating ASD individuals who display challenging or offending behaviours. The similarities in characteristics between ASD and BPD and the core issue of emotion dysregulation hold promise in the utility of DBT with ASD.
Design/methodology/approach
This is a conceptual paper that includes a case vignette.
Findings
A DBT-informed treatment approach using the adaptations and reconceptualization, i.e. risky mind–wise mind outlined in this paper, can be considered promising in addressing issues for ASD individuals, particularly those with challenging and/or offending behaviours. DBT incorporates different elements of applied behaviour analysis, cognitive behavioural therapy, mindfulness skills, sensory-based treatments, psychosocial interventions and emotion regulation skills, which makes it a more cohesive and integrated approach to treatment. The authors assert that DBT can be considered a more integrated, strengths-based, habilitative and trauma-informed approach which can be promising in its application to address challenging behaviours or offending in ASD individuals.
Research limitations/implications
It is recommended that research be carried out to evaluate the effectiveness of adapted DBT programs in treating ASD individuals presenting with challenging and/or offending behaviours. Future research can focus on evaluating the effectiveness of the different DBT concepts and skills and the different DBT modules to determine which components of the program are particularly useful for this client group.
Practical implications
Treatment manuals have already been developed for clients with intellectual disability and developmental disabilities who exhibit challenging and/or offending behaviour; hence, it is recommended that modifications be made to make it more applicable and appropriate for ASD individuals. Modifications should address ASD-specific issues (e.g. black and white thinking, cognitive rigidity, sensory issues, impaired theory of mind, emotion dysregulation issues, social skills deficits and anxiety issues). The use of DBT has much wider implications regarding addressing comorbid mental health conditions and personality issues in this client group.
Originality/value
There are limited psychological interventions that prove to be useful for individuals with ASD with complex presentations and challenging or offending behaviours. This paper discusses the application of adapted DBT concepts and skills that appear to be promising in the treatment of this client group.
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McLaren V, Gallagher M, Hopwood CJ, Sharp C. Hypermentalizing and Borderline Personality Disorder: A Meta-Analytic Review. Am J Psychother 2022; 75:21-31. [PMID: 35099264 DOI: 10.1176/appi.psychotherapy.20210018] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE A hypermentalizing impairment, or tendency to overattribute mental states to others, has been identified among individuals with borderline personality disorder. However, associations between hypermentalizing and other disorders call into question the specificity of this impairment to borderline personality disorder. This study aimed to evaluate the relative strength of the association between hypermentalizing and borderline personality disorder compared with other disorders and to assess the impact of moderators on the relationship between hypermentalizing and psychopathology. METHODS The authors conducted a meta-analysis of 36 studies (N=4,188 people) to investigate the relative strength of the association between hypermentalizing and borderline personality disorder, compared with other disorders, and to assess the impact of moderators on this relationship. The Movie for the Assessment of Social Cognition, an ecologically valid experimental instrument, was used to measure hypermentalizing. RESULTS Results indicated support for an association between psychopathology and hypermentalizing (r=0.24, 95% confidence interval [CI]=0.17 to 0.31), but the association was not significantly stronger for borderline personality disorder (r=0.26, 95% CI=0.12 to 0.39) than for other disorders (r=0.24, 95% CI=0.14 to 0.33). Neither age nor gender significantly moderated the association between psychopathology and hypermentalizing. CONCLUSIONS Hypermentalizing may be related to psychopathology in general rather than borderline personality disorder in particular. The findings are discussed in view of the possibility that features of borderline personality disorder associated with other psychopathology may explain the overall association between psychopathology and hypermentalizing. Clinical implications for mentalization-based treatment and concerns that the measurement used for hypermentalization may be too narrow and not representative of variations in functioning across cultures and race-ethnicity also are discussed.
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Affiliation(s)
- Veronica McLaren
- Department of Psychology, University of Houston, Houston (McLaren, Gallagher, Sharp); Department of Psychology, University of California, Davis (Hopwood)
| | - Matthew Gallagher
- Department of Psychology, University of Houston, Houston (McLaren, Gallagher, Sharp); Department of Psychology, University of California, Davis (Hopwood)
| | - Chris J Hopwood
- Department of Psychology, University of Houston, Houston (McLaren, Gallagher, Sharp); Department of Psychology, University of California, Davis (Hopwood)
| | - Carla Sharp
- Department of Psychology, University of Houston, Houston (McLaren, Gallagher, Sharp); Department of Psychology, University of California, Davis (Hopwood)
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13
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Hyniewska S, Dąbrowska J, Makowska I, Jankowiak-Siuda K, Rymarczyk K. The Borderline Bias in Explicit Emotion Interpretation. Front Psychol 2021; 12:733742. [PMID: 34975623 PMCID: PMC8715824 DOI: 10.3389/fpsyg.2021.733742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/26/2021] [Indexed: 11/28/2022] Open
Abstract
Atypical emotion interpretation has been widely reported in individuals with borderline personality disorder (iBPD); however, empirical studies reported mixed results so far. We suggest that discrepancies in observations of emotion interpretation by iBPD can be explained by biases related to their fear of rejection and abandonment, i.e., the three moral emotions of anger, disgust, and contempt. In this study, we hypothesized that iBPD would show a higher tendency to correctly interpret these three displays of social rejection and attribute more negative valence. A total of 28 inpatient iBPDs and 28 healthy controls were asked to judge static and dynamic facial expressions in terms of emotions, valence, and self-reported arousal evoked by the observed faces. Our results partially confirmed our expectations. The iBPD correctly interpreted the three unambiguous moral emotions. Contempt, a complex emotion with a difficulty in recognizing facial expressions, was recognized better by iBPD than by healthy controls. All negative emotions were judged more negatively by iBPD than by controls, but no difference was observed in the neutral or positive emotion. Alexithymia and anxiety trait and state levels were controlled in all analyses.
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Affiliation(s)
- Sylwia Hyniewska
- Department of Experimental Psychology, University College London, London, United Kingdom
- *Correspondence: Sylwia Hyniewska,
| | - Joanna Dąbrowska
- Psychiatric Clinic I, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Iwona Makowska
- Child and Adolescent Psychiatric Department, Medical University of Łódź, Łódź, Poland
| | - Kamila Jankowiak-Siuda
- Department of Biological Psychology, Behavioral Neuroscience Lab, SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | - Krystyna Rymarczyk
- Department of Biological Psychology, Behavioral Neuroscience Lab, SWPS University of Social Sciences and Humanities, Warsaw, Poland
- Krystyna Rymarczyk,
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14
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Lévay EE, Bajzát B, Unoka ZS. Expectation of Selfishness From Others in Borderline Personality Disorder. Front Psychol 2021; 12:702227. [PMID: 34489805 PMCID: PMC8416988 DOI: 10.3389/fpsyg.2021.702227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/26/2021] [Indexed: 11/13/2022] Open
Abstract
Social difficulties are apparent in borderline personality disorder (BPD). Behavior in BPD is characterized by mistrust and expectations of malevolence from others. We examined whether there is an asymmetry between their social behavior and their belief about other people’s social motivations. Subjects completed a task where they had to allocate money between themselves and an imagined other they will not meet and interact with. In addition they also had to report their expectations about how the imagined other would solve the task. We hypothesized that even though BPD patients will act in a prosocial way, they will expect selfish behavior from the other. We used the Slider Measure of social value orientation (SVO) and also created a modified version of the measure to examine the discrepancy between the subjects’ own SVO and their expectations from other people. We compared the results of thirty clinically diagnosed BPD patients to a matched sample of healthy participants. Our results show that the BPD group’s selfishness expectations significantly outweigh the expectations of selfishness in the HC group (U = 269, p = 0.007). This result further supports the mistrust and negativity bias observed in various aspects of social interactions in BPD.
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Affiliation(s)
- Erika Evelyn Lévay
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Bettina Bajzát
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Zsolt Szabolcs Unoka
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
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15
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Pedone R, Barbarulo AM, Colle L, Semerari A, Grimaldi P. Metacognition Mediates the Relationship Between Maladaptive Personality Traits and Levels of Personality Functioning: A General Investigation on a Nonclinical Sample. J Nerv Ment Dis 2021; 209:353-361. [PMID: 33600122 DOI: 10.1097/nmd.0000000000001304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT The impaired ability to reflect on one's own state of mind and that of others (called metacognition or mentalization) is a central feature of personality disorders (PDs). Metacognition involves different specific abilities, which can be selectively impaired with different PDs and personality maladaptive traits. Moreover, research in the field of PDs has indicated that personality features and metacognitive abilities are associated with the severity of personality pathologies. In this study, we tested a mediation model of the interactions between these variables on predicting levels of personality functioning in a sample of adults taken from the general population (N = 775). Results showed that the relationship between personality traits and personality functioning is partially mediated by metacognitive abilities. These findings support the hypothesis that metacognition plays a significant role in predicting the levels of impairment in personality functioning. These findings have several clinical implications.
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Affiliation(s)
| | | | - Livia Colle
- Department of Psychology, Center of Cognitive Science, University of Turin, Turin
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16
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Rodríguez-Eguizabal E, Oliván-Blázquez B, Coronado-Vázquez V, Sánchez-Calavera MA, Gil-de-Goméz MJ, Lafita-Mainz S, Garcia-Roy Á, Magallón-Botaya R. Perception of the primary health care response capacity by patients with and without mental health problems, and health professionals: qualitative study. BMC Health Serv Res 2021; 21:285. [PMID: 33784998 PMCID: PMC8011075 DOI: 10.1186/s12913-021-06205-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/12/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The objective of this study is to deepen our understanding of perceptions towards Primary Health Care Response Capacity by specifically using patients with and without mental disorders, as well as family doctors and a manager, in order to compare and endorse perspectives. For it, a qualitative study was performed. In-depth interviews were conducted with 28 patients with and without mental health disorders and focus groups were held with 21 professionals and a manager. An inductive thematic content analysis was performed in order to explore, develop and define the emergent categories of analysis. RESULTS The fundamental domains for patients are dignity, communication, and rapid service. People with mental health problems also highlight the domain of confidentiality as relevant, while patients who do not have a mental health problem prioritize the domain of autonomy. Patients with mental health disorders report a greater number of negative experiences in relation to the domain of dignity. Patients do not consider their negative experiences to be a structural problem of the system. These findings are also endorsed by health care professionals. CONCLUSIONS It is necessary to take these results into account as responsive systems can improve service uptake, ensure adherence to treatment, and ultimately enhance patient welfare.
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Affiliation(s)
- Eva Rodríguez-Eguizabal
- Health Service of La Rioja, Primary Health Center Arnedo, Av de Benidorm, 57, Arnedo, La Rioja 26580 Spain
| | - Bárbara Oliván-Blázquez
- Health Research Institute of Aragon (IIS Aragón), Edificio CIBA, Avda. San Juan Bosco, 13, Zaragoza, 50009 Spain
- Research network on preventive activities and health promotion (Red de Investigación en Actividades Preventivas y Promoción de la Salud) (RedIAPP), Gran Via de les Corts Catalanes, 587, Barcelona, 08007 Spain
- Department of Psychology and Sociology, University of Zaragoza, Violante de Hungría 23, Zaragoza, 50009 Spain
| | - Valle Coronado-Vázquez
- Aragonés Health Science Institute, Avda. San Juan Bosco, 13, Zaragoza, 50009 Spain
- Health Service of Castilla La Mancha. Primary Health Center Illescas, C/ Sandro Pertini S/N. 45.200, Toledo, Illescas Spain
| | - Mª. Antonia Sánchez-Calavera
- Health Research Institute of Aragon (IIS Aragón), Edificio CIBA, Avda. San Juan Bosco, 13, Zaragoza, 50009 Spain
- Research network on preventive activities and health promotion (Red de Investigación en Actividades Preventivas y Promoción de la Salud) (RedIAPP), Gran Via de les Corts Catalanes, 587, Barcelona, 08007 Spain
- Aragones Health Service, Plaza de la Convivencia, 2, Zaragoza, 50017 Spain
- Department of Medicine and Psychiatry. University of Zaragoza, Domingo Miral, S/N, Zaragoza, 50002 Spain
| | - Mª. Josefa Gil-de-Goméz
- Health Services of La Rioja, Teaching Unit of San Pedro Hospital, San Pedro. C/ Piqueras 98, 26006 Logroño, Spain
| | - Sergio Lafita-Mainz
- Health Research Institute of Aragon (IIS Aragón), Edificio CIBA, Avda. San Juan Bosco, 13, Zaragoza, 50009 Spain
- Aragones Health Service, Plaza de la Convivencia, 2, Zaragoza, 50017 Spain
| | - África Garcia-Roy
- Health Research Institute of Aragon (IIS Aragón), Edificio CIBA, Avda. San Juan Bosco, 13, Zaragoza, 50009 Spain
- Aragones Health Service, Plaza de la Convivencia, 2, Zaragoza, 50017 Spain
| | - Rosa Magallón-Botaya
- Health Research Institute of Aragon (IIS Aragón), Edificio CIBA, Avda. San Juan Bosco, 13, Zaragoza, 50009 Spain
- Research network on preventive activities and health promotion (Red de Investigación en Actividades Preventivas y Promoción de la Salud) (RedIAPP), Gran Via de les Corts Catalanes, 587, Barcelona, 08007 Spain
- Aragones Health Service, Plaza de la Convivencia, 2, Zaragoza, 50017 Spain
- Department of Medicine and Psychiatry. University of Zaragoza, Domingo Miral, S/N, Zaragoza, 50002 Spain
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17
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Theory of Mind in Borderline Personality Disorder: A Possible Endophenotypic Factor? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063193. [PMID: 33808735 PMCID: PMC8003401 DOI: 10.3390/ijerph18063193] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/10/2021] [Accepted: 03/16/2021] [Indexed: 11/17/2022]
Abstract
The purpose of this study is to examine whether theory of mind (ToM) is an endophenotypic marker of borderline personality disorder (BPD), thus constituting an etiopathogenic factor of the disease. This would suggest familial vulnerability to BPD. This was a case-control study involving 146 individuals with 57 BPD patients, 32 first-degree relatives, and 57 controls (median age of BPD and control = 33.4 years; relatives = 52.9 years; BPD females and controls = 91.2%; female relatives = 62.5%). All the participants completed the Spanish version of the Movie for the Assessment of Social Cognition test to evaluate the ToM subclassification: interpretation of emotions, thoughts and intentions. BPD patients and their healthy first-degree relatives exhibited significant deficits in the correct interpretation of emotions and intentions compared to healthy controls. Both patients with BPD and their healthy first-degree relatives exhibited significant deficits in ToM, which suggests that it may be an etiopathogenic factor of BPD, and ToM (interpretation of emotions, thoughts and intentions) is a possible endophenotypic marker of BPD, suggesting a genetic predisposition to the disorder. Therefore, ToM could be considered as an indicator for the early detection of the disorder of and intervention for BPD.
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18
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Cyrkot T, Szczepanowski R, Jankowiak-Siuda K, Gawęda Ł, Cichoń E. Mindreading and metacognition patterns in patients with borderline personality disorder: experimental study. Eur Arch Psychiatry Clin Neurosci 2021; 271:1159-1168. [PMID: 33459868 PMCID: PMC8354944 DOI: 10.1007/s00406-020-01227-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/18/2020] [Indexed: 11/30/2022]
Abstract
Current psychopathology attempts to understand personality disorders in relation to deficits in higher cognition such as mindreading and metacognition. Deficits in mindreading are usually related to limitations in or a complete lack of the capacity to understand and attribute mental states to others, while impairments in metacognition concern dysfunctional control and monitoring of one's own processes. The present study investigated dysfunctional higher cognition in the population of patients with borderline personality disorder (BPD) by analyzing the accuracy of metacognitive judgments in a mindreading task [reading the mind in the eyes Test (RMET)] and a subsequent metacognitive task based on self-report scales: a confidence rating scale (CR) versus a post-decision wagering scale (PDW). It turned out that people from the BPD group scored lower in the RMET. However, both groups had the same levels of confidence on the PDW scale when giving incorrect answers in the RMET test. As initially hypothesized, individuals with BPD overestimated their confidence in incorrect answers, regardless of the type of metacognitive scales used. The present findings indicate that BPD individuals show dysfunctional patterns between instances of mindreading and metacognition.
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Affiliation(s)
- Tomasz Cyrkot
- College of Psychological Sciences, Faculty of Education, University of Lower Silesia, Wroclaw, Poland
| | - Remigiusz Szczepanowski
- College of Psychological Sciences, Faculty of Education, University of Lower Silesia, Wroclaw, Poland.
| | - Kamila Jankowiak-Siuda
- Behavioral Neuroscience Lab, SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | - Łukasz Gawęda
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Ewelina Cichoń
- College of Psychological Sciences, Faculty of Education, University of Lower Silesia, Wroclaw, Poland ,WSB University in Toruń, Toruń, Poland
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19
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Villanueva-Valle J, Díaz JL, Jiménez S, Rodríguez-Delgado A, Arango de Montis I, León-Bernal A, Miranda-Terres E, Muñoz-Delgado J. Facial and Vocal Expressions During Clinical Interviews Suggest an Emotional Modulation Paradox in Borderline Personality Disorder: An Explorative Study. Front Psychiatry 2021; 12:628397. [PMID: 33841202 PMCID: PMC8024539 DOI: 10.3389/fpsyt.2021.628397] [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: 11/11/2020] [Accepted: 02/24/2021] [Indexed: 11/20/2022] Open
Abstract
Videotape recordings obtained during an initial and conventional psychiatric interview were used to assess possible emotional differences in facial expressions and acoustic parameters of the voice between Borderline Personality Disorder (BPD) female patients and matched controls. The incidence of seven basic emotion expressions, emotional valence, heart rate, and vocal frequency (f0), and intensity (dB) of the discourse adjectives and interjections were determined through the application of computational software to the visual (FaceReader) and sound (PRAAT) tracks of the videotape recordings. The extensive data obtained were analyzed by three statistical strategies: linear multilevel modeling, correlation matrices, and exploratory network analysis. In comparison with healthy controls, BPD patients express a third less sadness and show a higher number of positive correlations (14 vs. 8) and a cluster of related nodes among the prosodic parameters and the facial expressions of anger, disgust, and contempt. In contrast, control subjects showed negative or null correlations between such facial expressions and prosodic parameters. It seems feasible that BPD patients restrain the facial expression of specific emotions in an attempt to achieve social acceptance. Moreover, the confluence of prosodic and facial expressions of negative emotions reflects a sympathetic activation which is opposed to the social engagement system. Such BPD imbalance reflects an emotional alteration and a dysfunctional behavioral strategy that may constitute a useful biobehavioral indicator of the severity and clinical course of the disorder. This face/voice/heart rate emotional expression assessment (EMEX) may be used in the search for reliable biobehavioral correlates of other psychopathological conditions.
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Affiliation(s)
- Javier Villanueva-Valle
- Facultad de Psicología, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico.,Dirección de Investigaciones en Neurociencias, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (INPRFM), Mexico City, Mexico
| | - José-Luis Díaz
- Facultad de Medicina Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | - Said Jiménez
- Facultad de Psicología, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico.,Dirección de Investigaciones en Neurociencias, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (INPRFM), Mexico City, Mexico
| | - Andrés Rodríguez-Delgado
- Clínica de Trastornos de Personalidad, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (INPRFM), Mexico City, Mexico
| | - Iván Arango de Montis
- Clínica de Trastornos de Personalidad, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (INPRFM), Mexico City, Mexico
| | - Areli León-Bernal
- Facultad de Psicología, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico.,Dirección de Investigaciones en Neurociencias, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (INPRFM), Mexico City, Mexico
| | - Edgar Miranda-Terres
- Clínica de Trastornos de Personalidad, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (INPRFM), Mexico City, Mexico
| | - Jairo Muñoz-Delgado
- Facultad de Psicología, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico.,Dirección de Investigaciones en Neurociencias, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (INPRFM), Mexico City, Mexico
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20
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Cameron AY, Benz M, Reed KP. The Role of Guilt and Shame in Psychosocial Functioning in a Sample of Women With Borderline Personality Disorder. J Nerv Ment Dis 2021; 209:13-16. [PMID: 33323792 DOI: 10.1097/nmd.0000000000001246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Individuals diagnosed with borderline personality disorder (BPD) experience significant and pervasive impairment in interpersonal, social, and vocational functioning, and accumulating evidence suggests that impairments in functioning often persist despite significant decreases in symptom severity. Previous research indicates that shame-proneness and guilt-proneness are associated with symptoms of BPD that can affect functioning (such as aggression toward others), but very few studies have examined the impact of shame-proneness and guilt-proneness on validated measures of psychosocial functioning. Forty women with BPD completed measures of shame-proneness and guilt-proneness, psychosocial functioning, and BPD symptom severity. Results from multiple regression analyses indicate that women with BPD who tend to experience higher levels of shame-proneness and lower levels of guilt-proneness report poor performance in school and work settings and in interpersonal relationships. Strengths of the study include the use of a validated measure of functioning as the primary outcome. Limitations and future directions are discussed.
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Affiliation(s)
- Amy Y Cameron
- Providence VA Medical Center, Providence, Rhode Island
| | - Madeline Benz
- Department of Psychology, Clark University, Worcester, Massachusetts
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21
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Bortolla R, Galli M, Ramella P, Sirtori F, Visintini R, Maffei C. Negative bias and reduced visual information processing of socio-emotional context in borderline Personality Disorder: A support for the hypersensitivity hypothesis. J Behav Ther Exp Psychiatry 2020; 69:101589. [PMID: 32502878 DOI: 10.1016/j.jbtep.2020.101589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 04/30/2020] [Accepted: 05/11/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Current studies on emotional dysregulation in BPD suggest that it might be manifested by altered appraisal and biased attentional mechanisms, rather than by hyperreactivity. The aim of this study was to acquire more evidence on this topic by testing the hypothesis that BPD patients are characterized by a negative evaluation bias and reduced visual exploration in response to socio-emotional content. Moreover, the association between the previous conceptualizations and typical dysfunctional processes in BPD were evaluated. METHODS Fifty-four socio-emotional pictures were administered to 20 female BPD patients and 20 healthy controls (HCs) divided into three blocks characterized by different stimulus durations (500 ms, 3s, 18s). Self-reported and eye-tracking data were collected during the experiment. RESULTS BPD patients showed lower valence ratings and reduced visual exploration of socio-emotional pictures compared to HCs. Visual exploration in BPD was affected by exposure time with reduced exploration in response to prolonged stimuli presentation. Dysfunctional features and pre-task negative affectivity level in BPD were correlated with self-reported evaluations and eye-tracking data. LIMITATIONS Possible effects of gender on emotional responsivity could not be addressed given the female composition of our sample. Moreover, the role of psychiatric symptoms and medications should be addressed in future research. CONCLUSIONS This study presented evidence on dysfunctional mechanisms sustaining emotional dysregulation in BPD. This construct seemed supported by a well-established negative bias towards emotional stimuli together with a reduced processing of social information as manifestations of emotional hypersensitivity.
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Affiliation(s)
- Roberta Bortolla
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Hospital, Milan, Italy.
| | - Marco Galli
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Hospital, Milan, Italy
| | - Pietro Ramella
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Hospital, Milan, Italy
| | - Federica Sirtori
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Hospital, Milan, Italy
| | - Raffaele Visintini
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Hospital, Milan, Italy
| | - Cesare Maffei
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Hospital, Milan, Italy
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22
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Goueli T, Nasreldin M, Madbouly N, Dziobek I, Farouk M. Social cognition in adolescent females with borderline personality traits. Psychol Psychother 2020; 93:739-753. [PMID: 31692159 DOI: 10.1111/papt.12257] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 10/10/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Social cognitive impairment is considered to be a psychopathological cornerstone in adolescent females with borderline personality disorder. The aim is to compare the social cognitive performance in adolescent females with borderline personality traits and healthy adolescent females, and to assess the social cognitive performance in relation to the severity of borderline personality features. DESIGN A case-control study was conducted on 30 adolescent females who fulfilled the diagnostic criteria of DSM-IV of borderline personality traits, compared to 30 matched healthy volunteer adolescent females. METHODS Borderline Personality Questionnaire (BPQ) was used to rate borderline personality features. Reading the Mind in the Eyes test (RMET) and Movie for the Assessment of Social Cognition (MASC) were applied to assess social cognitive abilities. RESULTS The scores of RMET and some domains of MASC showed a highly significant difference between the patient and control groups. Scores of RMET and some domains of MASC showed significant correlation with impulsiveness, emptiness, relationship patterns, and quasi-psychotic states subscales of BPQ. CONCLUSIONS Adolescent females with borderline personality traits had lower social cognitive performance compared to healthy adolescent females. The intensity of this social cognitive deficit was evident to be related to impulsivity, emptiness, pattern of relationships, and quasi-psychotic states.
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Affiliation(s)
- Tamer Goueli
- Department of Psychiatry, Faculty of Medicine, Cairo University, Egypt
| | - Mohamed Nasreldin
- Department of Psychiatry, Faculty of Medicine, Cairo University, Egypt
| | - Nagwan Madbouly
- Department of Psychiatry, Faculty of Medicine, Cairo University, Egypt
| | - Isabel Dziobek
- Faculty of Life Sciences, Institute of Psychology, Humboldt University of Berlin, Germany
| | - Mohamed Farouk
- Department of Psychiatry, Faculty of Medicine, Cairo University, Egypt
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23
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Ortega-Díaz E, García-Campos J, Rico-Gomis JM, Cuesta-Moreno C, Palazón-Bru A, Estañ-Cerezo G, Piqueras-Rodríguez JA, Rodríguez-Marín J. Social cognition and social functioning in people with borderline personality disorder and their first-degree relatives. PeerJ 2020; 8:e10212. [PMID: 33194412 PMCID: PMC7605216 DOI: 10.7717/peerj.10212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/28/2020] [Indexed: 11/20/2022] Open
Abstract
Background A few papers studying healthy, first-degree relatives of people with borderline personality disorder (BPD) have found that this group presents attention and memory problems. However, current research has not analyzed their social cognition. Materials and Methods We designed an age-, gender- and education-level matched case-control study involving 57 people with BPD, 32 of their first-degree relatives, and 57 healthy controls in Spain in 2018–2019. All were assessed for social cognition and functioning using the Movie for Assessment of Social Cognition and the Social Functioning Scale; other potential confounders were also collected (marital status, occupation and household variables). Results There were differences in the social cognition domain of overmentalizing errors, with the BPD group scoring significantly higher than controls; however, there was no significant difference with relatives; in the social functioning domain of family relationships, with the controls showing the highest scores. Social engagement/withdrawal, interpersonal behavior, independence-competence, prosocial activities, full scale and categorization domains showed the same pattern: the BPD group had lower scores than their relatives and the controls. Relatives were significantly different from BPD patients in family relationships, social engagement/withdrawal and interpersonal behavior, as well as on the full Social Functioning Scale (both as a linear and categorical variable). However, only controls showed differences with relatives in family relationships. Conclusions All in all, relatives show similar levels of social cognition and functioning compared with controls, and people with BPD show some alterations in different domains of both social cognition and functioning.
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Affiliation(s)
- Esther Ortega-Díaz
- Department of Psychiatry, General University Hospital of Elche, Elche, Alicante, Spain
| | - Jonatan García-Campos
- Department of Behavioral and Health Sciences, Miguel Hernández University, San Juan de Alicante, Alicante, Spain
| | - José María Rico-Gomis
- Department of Psychiatry, General University Hospital of Elche, Elche, Alicante, Spain.,Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Alicante, Spain
| | - Carlos Cuesta-Moreno
- Department of Psychiatry, General University Hospital of Elche, Elche, Alicante, Spain
| | - Antonio Palazón-Bru
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Alicante, Spain
| | - Gabriel Estañ-Cerezo
- Department of Investigation, General University Hospital of Elche, Elche, Alicante, Spain
| | | | - Jesús Rodríguez-Marín
- Department of Health Psychology, Miguel Hernández University, San Juan de Alicante, Alicante, Spain
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24
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Felsenheimer A, Kieckhaefer C, Rapp AM. Familiarity, empathy and comprehension of metaphors in patients with borderline personality disorder. Psychiatry Res 2020; 291:113152. [PMID: 32540684 DOI: 10.1016/j.psychres.2020.113152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 11/19/2022]
Abstract
Research on figurative language has a long tradition in psychiatry, as it is employed in psychotherapy and its (mis)comprehension plays a substantial role in differential diagnostics of schizophrenic spectrum disorders. Although often associated with empathy and mentalization, it has never been addressed in borderline personality disorder (BPD). Therefore, this study investigated metaphor comprehension and its relationship to cognitive and affective empathy in 20 patients with BPD and 20 matched healthy controls who completed a metaphor task comprising conventional metaphors (CM), novel metaphors (NM), meaningless stimuli (MS), and a rating scale of familiarity, a factor known to influence performance. For cognitive and affective empathy, the interpersonal reactivity index was applied. At first patients with BPD seemed to have significantly more problems in comprehending CM, but not NM or MS, and were less familiar with CM. When familiarity with the stimulus was controlled, this difference disappeared. As for empathy, only fantasy was positively related to familiar CM beyond borderline symptoms. Results indicate that the comprehension of novel metaphorical meaning is preserved in patients with BPD.
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Affiliation(s)
- Anne Felsenheimer
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen 72076, Germany.
| | - Carolin Kieckhaefer
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen 72076, Germany; LVR-Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf 40629, Germany
| | - Alexander Michael Rapp
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen 72076, Germany; Fliedner Klinik Stuttgart, Theodor Fliedner Stiftung, Stuttgart 70378, Germany
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25
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Abstract
The purpose of this research was to determine the differences in empathy, alexithymia features, and theory of mind between healthy controls and patients with borderline personality disorder (BPD). Thirty-five patients with BPD and 35 healthy controls were included in the study. To measure the clinical variables, the Empathy Quotient (EQ), Reading the Mind in the Eyes Test (RMET), Toronto Alexithymia Scale (TAS-20), Barratt Impulsivity Scale-11 (BIS-11), and Beck Depression Inventory (BDI) were applied. We found that the BPD group had significantly worse total RMET and neutral RMET scores than the control group. There were no differences in the EQ scores between the BPD and control groups. The patients with BPD were more alexithymic than the controls, and alexithymia and depression scores predicted BPD status. Patients with BPD who have difficulty identifying their own emotions tend to display deficits in perceptions of facial emotions, which, in turn, may lead to misperceptions of social signals and thus contribute to excessive emotional intensity and tension in social situations. The study results reveal that alexithymia and depression are important variables in predicting BPD traits.
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26
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Effects of intranasal oxytocin administration on empathy and approach motivation in women with borderline personality disorder: a randomized controlled trial. Transl Psychiatry 2019; 9:328. [PMID: 31801937 PMCID: PMC6892895 DOI: 10.1038/s41398-019-0658-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 11/04/2019] [Accepted: 11/06/2019] [Indexed: 12/24/2022] Open
Abstract
Borderline personality disorder (BPD) is characterized by severe interpersonal dysfunction with problems in social cognition, empathy and social approach. Although the neuropeptide oxytocin is known to regulate complex social cognition and behavior in healthy individuals and clinical populations, there is still a lack of evidence for a potential beneficial effect of oxytocin administration on social cognition and social approach in BPD. Fifty-one women with BPD and 51 matched healthy controls were randomized to a double-blind, placebo-controlled, between-subject experimental trial. We administered a single dose of 24 IU oxytocin or placebo intranasally prior to a standardized task measuring affective and cognitive empathy and approach motivation. All participants were free of hormonal contraception and tested in the mid-luteal phase of their menstrual cycle. In the placebo condition, patients with BPD showed reduced cognitive and affective empathy, and less approach behavior motivation than healthy controls. Intranasal oxytocin significantly increased affective empathy and approach motivation in both BPD patients and healthy controls compared to placebo. More importantly, oxytocin administration led to similar scores between BPD and healthy controls. These findings provide the first evidence for a beneficial effect of oxytocin on deficits in affective empathy and approach motivation of BPD. Our results indicate a beneficial effect of a single dose of oxytocin on affective empathy and approach motivation in women with BPD adapting their level of social functioning to healthy controls. Future clinical trials will need to investigate the long-term effects and effectiveness of oxytocin as an add-on treatment for social impairments in BPD.
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27
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Van Heel M, Luyten P, De Meulemeester C, Vanwalleghem D, Vermote R, Lowyck B. Mentalizing Based on External Features in Borderline Personality Disorder Compared With Healthy Controls: The Role of Attachment Dimensions and Childhood Trauma. J Pers Disord 2019; 33:736-750. [PMID: 30689514 DOI: 10.1521/pedi_2019_33_373] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Extant research suggests that borderline personality disorder (BPD) is associated with impairments in mentalizing, that is, comprehending behavior in terms of underlying mental states. However, the precise nature of these impairments remains unclear. The literature is mixed concerning mental-izing based on external features of others, and specifically facial emotion recognition (FER) in BPD patients. This study investigated FER differences in 79 BPD patients and 79 matched healthy controls using the Reading the Mind in the Eyes Test (RMET). The authors also investigated attachment dimensions and childhood trauma in relation to mentalizing based on external features. Results showed that BPD patients performed worse on positive and negative emotions. Furthermore, avoidant attachment was negatively related to FER for neutral emotions, particularly in the control group. Trauma was negatively related to FER at trend level, particularly in BPD patients. The implications for this understanding of mentalizing based on external features in BPD are discussed.
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Affiliation(s)
- Martijn Van Heel
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Patrick Luyten
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | | | | | - Rudi Vermote
- University Psychiatric Hospital UPC KU Leuven, Campus Kortenberg and Department of Neurosciences, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Benedicte Lowyck
- University Psychiatric Hospital UPC KU Leuven, Campus Kortenberg and Department of Neurosciences, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Research Department of Clinical, Educational and Health Psychology, University College London, UK
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28
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Kaiser D, Jacob GA, van Zutphen L, Siep N, Sprenger A, Tuschen-Caffier B, Senft A, Arntz A, Domes G. Biased Attention to Facial Expressions of Ambiguous Emotions in Borderline Personality Disorder: An Eye-Tracking Study. J Pers Disord 2019; 33:671-S8. [PMID: 30689505 DOI: 10.1521/pedi_2019_33_363] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Preliminary evidence suggests that biased attention could be crucial in fostering the emotion recognition abnormalities in borderline personality disorder (BPD). We compared BPD patients to Cluster-C personality disorder (CC) patients and non-patients (NP) regarding emotion recognition in ambiguous faces and their visual attention allocation to the eyes. The role of comorbid posttraumatic stress disorder (PTSD) in BPD regarding emotion recognition and visual attention was explored. BPD patients fixated the eyes of angry/happy, sad/happy, and fearful/sad blends longer than non-patients. This visual attention pattern was mainly driven by BPD patients with PTSD. This subgroup also demonstrated longer fixations than CC patients and a trend towards longer fixations than BPD patients without PTSD for the angry/happy and fearful/sad blends. Emotion recognition was not altered in BPD. Biased visual attention towards the eyes of ambiguous facial expressions in BPD might be due to trauma-related attentional bias rather than to impairments in facial emotion recognition.
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Affiliation(s)
- Deborah Kaiser
- Department of Psychology, University of Freiburg, Germany
| | | | - Linda van Zutphen
- Department of Clinical Psychological Science, University of Maastricht, The Netherlands
| | - Nicolette Siep
- Department of Clinical Psychological Science, University of Maastricht, The Netherlands
| | - Andreas Sprenger
- Department of Neurology and Institute of Psychology II, University of Luebeck, Germany
| | | | - Alena Senft
- Department of Psychiatry and Psychotherapy, University of Luebeck
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, The Netherlands
| | - Gregor Domes
- Department of Biological and Clinical Psychology, University of Trier, Germany
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29
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Quek J, Melvin GA, Bennett C, Gordon MS, Saeedi N, Newman LK. Mentalization in Adolescents With Borderline Personality Disorder: A Comparison With Healthy Controls. J Pers Disord 2019; 33:145-163. [PMID: 29469664 DOI: 10.1521/pedi_2018_32_336] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Mentalization is proposed to underlie the disturbed interpersonal relatedness that is a hallmark of borderline personality disorder (BPD). Despite growing evidence of BPD in adolescents, studies examining mentalization in relation to adolescent BPD have remained limited. Given contradictory findings of this relationship, particularly with adults, further research of mentalization in adolescents with BPD is warranted. The current study further clarifies the nature of mentalizing impairments, related to BPD, by examining different aspects of mentalization between adolescents with BPD (n = 26) and a group of healthy controls (n = 25). Findings support studies that suggest that mentalization may be an important treatment target, influencing BPD symptoms and interpersonal functioning in adolescents with BPD. They also support the importance of examining mentalizing abilities in relation to varying levels of complexity, interpersonal contexts, and levels of arousal. Limitations and further research are discussed.
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Affiliation(s)
- Jeremy Quek
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Australia
| | - Glenn A Melvin
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Australia
| | - Clair Bennett
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Australia
| | - Michael S Gordon
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Australia.,Early in Life Mental Health Service, Monash Health, Australia
| | - Naysun Saeedi
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Australia.,Early in Life Mental Health Service, Monash Health, Australia
| | - Louise K Newman
- Department of Psychiatry, University of Melbourne, Australia
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30
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Peter M, Arntz A, Klimstra T, Vingerhoets AJJM. Crying in borderline personality disorder patients. Psychiatry Res 2019; 273:100-107. [PMID: 30640050 DOI: 10.1016/j.psychres.2019.01.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 01/03/2019] [Accepted: 01/06/2019] [Indexed: 11/28/2022]
Abstract
Emotion dysregulation and hyperreactivity are considered central features of Borderline Personality Disorder (BPD). We assumed that such emotion dysregulation is also reflected in increased crying behavior of these patients and, consequently, hypothesized that BPD patients (N = 62), compared to Cluster C personality disorder patients (Cluster C-PD; N = 25) and non-patients (N = 54), would show higher scores on crying measures. To evaluate crying behavior, we used a set of specially designed tools. Compared to non-patients, BPD patients showed the anticipated higher crying frequency despite a similar crying proneness and ways of dealing with tears. They also reported less awareness of the influence of crying on others. However, Cluster C-PD patients showed a very similar pattern of findings. Overall, our results suggest that the increased crying of BPD patients likely results from environmental factors or the misperception of situations, rather than from stable traits. Remarkable is that the observed discrepancies in crying behavior compared to non-patients seem to be similar for Cluster-C PDs and BPD.
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Affiliation(s)
- Mathell Peter
- Department of Personality Disorders, GGz Breburg, Lage Witsiebaan 4, Tilburg, the Netherlands.
| | - Arnoud Arntz
- Department of Clinical Psychology, Faculty of Social and Behavioral Sciences, University of Amsterdam, Nieuwe Achtergracht 129, Amsterdam, the Netherlands
| | - Theo Klimstra
- Developmental Psychology, Tilburg University, Warandalaan 2, Tilburg, the Netherlands
| | - Ad J J M Vingerhoets
- Department of Medical and Clinical Psychology, Tilburg University, Warandalaan 2, Tilburg, the Netherlands
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31
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Sosic-Vasic Z, Eberhardt J, Bosch JE, Dommes L, Labek K, Buchheim A, Viviani R. Mirror neuron activations in encoding of psychic pain in borderline personality disorder. Neuroimage Clin 2019; 22:101737. [PMID: 30844640 PMCID: PMC6402375 DOI: 10.1016/j.nicl.2019.101737] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 02/05/2019] [Accepted: 02/27/2019] [Indexed: 01/20/2023]
Abstract
Borderline personality disorder (BPD) is characterized by pronounced emotional instability in interpersonal relations. Previous studies have shown increased activity in the amygdala, an imaging phenotype of negative affect. However, clinical accounts of BPD have drawn attention to deficits in social cognition and their likely role in engendering emotional instability. BPD patients show enhanced sensitivity to other people's emotions, while being less proficient in reading motives and reasons. In the present functional imaging study, we exposed BPD participants to stylized scenes of individuals affected by loss or separation, an issue to which these patients are particularly sensitive. Previously shown to activate the mirror neuron system, these mourning scenes were here also used to assess differential amygdala activity in stimuli of negative valence, but low arousal. Relative to controls, BPD patients were found to activate sensorimotor areas, a part of the mirror neuron system thought to encode basic aspects of the perception of motoric activity and pain. This contrasted with the activity of areas related to more complex aspects of social cognition, such as the inferior frontal gyrus. The amygdala was more active in patients when viewing these scenes, but this effect also showed a strong association with levels of depressiveness and neuroticism. After adjusting for these covariates, differences in amygdala activation were no longer significant. These findings are consistent with models of social cognition in BPD that attribute emotional sensitivity to emotional contagion through the mirror neuron system, in contrast to areas associated with more sophisticated forms of social cognition. These effects were accompanied by increased amygdala reactivity, consistently with the common occurrence of affective symptoms in these patients.
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Affiliation(s)
- Zrinka Sosic-Vasic
- Department of Psychiatry and Psychotherapy III, University of Ulm, Ulm, Germany
| | - Julia Eberhardt
- Department of Psychiatry and Psychotherapy III, University of Ulm, Ulm, Germany
| | - Julia E Bosch
- Department of Psychiatry and Psychotherapy III, University of Ulm, Ulm, Germany
| | - Lisa Dommes
- Department of Psychiatry and Psychotherapy III, University of Ulm, Ulm, Germany
| | - Karin Labek
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Anna Buchheim
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Roberto Viviani
- Department of Psychiatry and Psychotherapy III, University of Ulm, Ulm, Germany; Institute of Psychology, University of Innsbruck, Innsbruck, Austria.
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32
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Carcione A, Riccardi I, Bilotta E, Leone L, Pedone R, Conti L, Colle L, Fiore D, Nicolò G, Pellecchia G, Procacci M, Semerari A. Metacognition as a Predictor of Improvements in Personality Disorders. Front Psychol 2019; 10:170. [PMID: 30800084 PMCID: PMC6375846 DOI: 10.3389/fpsyg.2019.00170] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 01/17/2019] [Indexed: 11/13/2022] Open
Abstract
Personality Disorders (PDs) are particularly hard to treat and treatment drop-out rates are high. Several authors have agreed that psychotherapy is more successful when it focuses on the core of personality pathology. For this reason, therapists dealing with PDs need to understand the psychopathological variables that characterize this pathology and exactly what contributes to maintaining psychopathological processes. Moreover, several authors have noted that one key problem that characterizes all PDs is an impairment in understanding mental states - here termed metacognition - which could also be responsible for therapy failures. Unfortunately, a limited number of studies have investigated the role of mentalization in the process of change during psychotherapy. In this paper, we assume that poor metacognition corresponds to a core element of the general pathology of personality, impacts a series of clinical variables, generates symptoms and interpersonal problems, and causes treatment to be slower and less effective. We explored whether changes in metacognition predicted an improvement among different psychopathological variables characterizing PDs; 193 outpatients were treated at the Third Center of Cognitive Psychotherapy in Rome, Italy, and followed a structured path tailored for the different psychopathological variables that emerged from a comprehensive psychodiagnostic assessment that considered patients' symptoms, metacognitive abilities, interpersonal relationships, personality psychopathology, and global functioning. The measurements were repeated after a year of treatment. The results showed that changes in metacognitive abilities predicted improvements in the analyzed variables.
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Affiliation(s)
- Antonino Carcione
- Third Centre of Cognitive Psychotherapy – Italian School of Cognitive Psychotherapy (SICC), Rome, Italy
| | - Ilaria Riccardi
- Third Centre of Cognitive Psychotherapy – Italian School of Cognitive Psychotherapy (SICC), Rome, Italy
| | - Elena Bilotta
- Third Centre of Cognitive Psychotherapy – Italian School of Cognitive Psychotherapy (SICC), Rome, Italy
| | - Luigi Leone
- Department of Social and Developmental Psychology, Sapienza University of Rome, Rome, Italy
| | - Roberto Pedone
- Third Centre of Cognitive Psychotherapy – Italian School of Cognitive Psychotherapy (SICC), Rome, Italy
- Department of Psychology, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Laura Conti
- Third Centre of Cognitive Psychotherapy – Italian School of Cognitive Psychotherapy (SICC), Rome, Italy
| | - Livia Colle
- Third Centre of Cognitive Psychotherapy – Italian School of Cognitive Psychotherapy (SICC), Rome, Italy
- Department of Psychology, University of Turin, Turin, Italy
| | - Donatella Fiore
- Third Centre of Cognitive Psychotherapy – Italian School of Cognitive Psychotherapy (SICC), Rome, Italy
| | - Giuseppe Nicolò
- Third Centre of Cognitive Psychotherapy – Italian School of Cognitive Psychotherapy (SICC), Rome, Italy
| | - Giovanni Pellecchia
- Third Centre of Cognitive Psychotherapy – Italian School of Cognitive Psychotherapy (SICC), Rome, Italy
| | - Michele Procacci
- Third Centre of Cognitive Psychotherapy – Italian School of Cognitive Psychotherapy (SICC), Rome, Italy
| | - Antonio Semerari
- Third Centre of Cognitive Psychotherapy – Italian School of Cognitive Psychotherapy (SICC), Rome, Italy
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33
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Colle L, Gabbatore I, Riberi E, Borroz E, Bosco FM, Keller R. Mindreading abilities and borderline personality disorder: A comprehensive assessment using the Theory of Mind Assessment Scale. Psychiatry Res 2019; 272:609-617. [PMID: 30616131 DOI: 10.1016/j.psychres.2018.12.102] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 12/18/2018] [Accepted: 12/18/2018] [Indexed: 01/25/2023]
Abstract
Numerous studies have examined mindreading in borderline personality disorder (BPD). However, the empirical data obtained to date have not facilitated the development of a clear clinical profile of mindreading impairment in BPD due to a lack of consistency or incongruence across studies. One possible explanation for these inconsistencies and divergences in the current literature may lie in the multidimensional character of the mindreading construct; moreover, the heterogeneity of the experimental measures used to assess individuals with BPD mindreading skills may also need to be taken into account. The aim of the present study is to investigate mindreading skills and impairments in patients with BPD through direct comparison of a wide range of mindreading dimensions using a comprehensive semistructured interview, the Theory of Mind Assessment Scale (Th.o.m.a.s.) (Bosco et al., 2009). Our results show that the performance of patients with BPD differs from that of healthy controls only in certain specific dimensions of mindreading. The difficulties encountered by the patients with BPD typically emerge when mindreading tasks require them to disentangle their own subjective mindreading from that of another person, in other words, when they were required to assume an allocentric perspective.
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Affiliation(s)
- L Colle
- Department of Psychology, University of Turin, Italy; Neuroscience Institute of Turin, Italy
| | - I Gabbatore
- Department of Psychology, University of Turin, Italy; Child Language Research Center, University of Oulu, Finland.
| | - E Riberi
- Local Health Unit ASL City of Turin, Department of Mental Health, Turin, Italy
| | - E Borroz
- Local Health Unit ASL City of Turin, Department of Mental Health, Turin, Italy
| | - F M Bosco
- Department of Psychology, University of Turin, Italy; Neuroscience Institute of Turin, Italy
| | - R Keller
- Local Health Unit ASL City of Turin, Department of Mental Health, Turin, Italy
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34
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Bortolla R, Cavicchioli M, Galli M, Verschure PFMJ, Maffei C. A comprehensive evaluation of emotional responsiveness in borderline personality disorder: a support for hypersensitivity hypothesis. Borderline Personal Disord Emot Dysregul 2019; 6:8. [PMID: 31110772 PMCID: PMC6509832 DOI: 10.1186/s40479-019-0105-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 04/02/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Many experimental studies have evaluated Linehan's biological emotional vulnerability in Borderline Personality Disorder (BPD). However, some inconsistencies were observed in operationalizing and supporting its components. This study aims at clarifying which aspects of Linehan's model are altered in BPD, considering a multimodal evaluation of processes concerned with emotional responsiveness (self-report, psychophysiology and eye-tracking). METHODS Forty-eight socio-emotional pictures were administered to 28 participants (14 BPD, 14 Healthy Controls, HCs), gender- and age-matched, by employing two different lengths of stimuli exposure (5 s and 15 s). RESULTS Our results supported the hypersensitivity hypothesis in terms of faster physiological responses and altered visual processing. Furthermore, hypersensitivity was associated with detailed socio-emotional contents. Hyperreactivity assumption was not experimentally sustained by physiological and self-report data. Ultimately, the slow return to emotional baseline was demonstrated as an impaired emotional modulation. CONCLUSIONS Our data alternatively supported the hypersensitivity and the slow return to emotional baseline hypotheses, postulated by Linehan's Biosocial model, rather than the hyperreactivity assumption. Results have been discussed in light of other BPD core psychopathological processes.
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Affiliation(s)
- Roberta Bortolla
- 1Vita-Salute San Raffaele University, via Stamira d'Ancona, 20, Milan, Italy.,2Clinical Psychology and Psychotherapy Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Marco Cavicchioli
- 1Vita-Salute San Raffaele University, via Stamira d'Ancona, 20, Milan, Italy.,2Clinical Psychology and Psychotherapy Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Marco Galli
- 1Vita-Salute San Raffaele University, via Stamira d'Ancona, 20, Milan, Italy.,2Clinical Psychology and Psychotherapy Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Paul F M J Verschure
- 3Laboratory of Synthetic Perceptive, Emotive and Cognitive Systems, Institute for Bioengineering of Catalonia (IBEC), Barcelona Institute of Science and Technology, Barcelona, Spain.,4ICREA, Institucio Catalana de Recerca IEstudis Avançats, Passeig Lluis Companys, Barcelona, Spain
| | - Cesare Maffei
- 1Vita-Salute San Raffaele University, via Stamira d'Ancona, 20, Milan, Italy.,2Clinical Psychology and Psychotherapy Unit, IRCCS San Raffaele Hospital, Milan, Italy
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35
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Ritzl A, Csukly G, Balázs K, Égerházi A. Facial emotion recognition deficits and alexithymia in borderline, narcissistic, and histrionic personality disorders. Psychiatry Res 2018; 270:154-159. [PMID: 30248486 DOI: 10.1016/j.psychres.2018.09.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 09/03/2018] [Accepted: 09/12/2018] [Indexed: 11/18/2022]
Abstract
Previous studies that aimed to support emotion recognition deficits and alexithymia in B cluster personality disorders have mainly focused on borderline personality disorder (BPD), and resulted in mixed findings. In our study we examine emotion recognition and alexithymia in patients with histrionic (HPD), narcissistic (NPD) and borderline (BPD) personality disorders compared to each other and healthy controls. Furthermore, the possibility is investigated that it is not the type of PD but the severity of psychopathology which predicts the severity of emotion recognition deficits and alexithymia. Patients with HPD, NPD, BPD and healthy controls (N = 20 for each group) were examined by using the Ekman 60 Faces Test (FEEST) and the Toronto Alexithymia Scale (TAS-20). To measure the extent and severity of psychopathology, the Symptom-Checklist-90 Revised (SCL-90-R) was used. Patient groups performed significantly worse compared to healthy controls on the Ekman test and TAS-20, while we found no significant differences among patient groups in emotion recognition and alexithymia. Furthermore, higher scores on the SCL-90-R predicted poorer emotion recognition performance and higher alexithymic features. The empirical data supports the conclusion that the severity of psychopathology plays an important role in predicting emotion recognition deficits and alexithymia in borderline, narcissistic, and histrionic personality disorders.
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Affiliation(s)
- Andrea Ritzl
- Department of Psychiatry, Medical Center, University of Debrecen, Hungary.
| | - Gábor Csukly
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Katalin Balázs
- Institute of Psychology, University of Debrecen, Hungary
| | - Anikó Égerházi
- Department of Psychiatry, Medical Center, University of Debrecen, Hungary
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Németh N, Mátrai P, Hegyi P, Czéh B, Czopf L, Hussain A, Pammer J, Szabó I, Solymár M, Kiss L, Hartmann P, Szilágyi ÁL, Kiss Z, Simon M. Theory of mind disturbances in borderline personality disorder: A meta-analysis. Psychiatry Res 2018; 270:143-153. [PMID: 30248485 DOI: 10.1016/j.psychres.2018.08.049] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 07/30/2018] [Accepted: 08/13/2018] [Indexed: 02/07/2023]
Abstract
Impairments of theory of mind (ToM) are widely accepted underlying factors of disturbed relatedness in borderline personality disorder (BPD). The aim of this meta-analysis a was to assess the weighted mean effect sizes of ToM performances in BPD compared to healthy controls (HC), and to investigate the effect of demographic variables and comorbidities on the variability of effect sizes across the studies. Seventeen studies involving 585 BPD patients and 501 HC were selected after literature search. Effect sizes for overall ToM, mental state decoding and reasoning, cognitive and affective ToM, and for task types were calculated. BPD patients significantly underperformed HC in overall ToM, mental state reasoning, and cognitive ToM, but had no deficits in mental state decoding. Affective ToM performance was largely task dependent in BPD. Comorbid anxiety disorders had a positive moderating effect on overall and affective ToM in BPD. Our results support the notion that BPD patients' have specific ToM impairments. Further research is necessary to evaluate the role of confounding factors, especially those of clinical comorbidities, neurocognitive functions, and adverse childhood life events. Complex ToM tasks with high contextual demands seem to be the most appropriate tests to assess ToM in patients with BPD.
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Affiliation(s)
- Nándor Németh
- Neurobiology of Stress Research Group, Szentágothai János Research Centre, University of Pécs, Pécs, Hungary
| | - Péter Mátrai
- Institute of Bioanalysis, University of Pécs, Medical School, Pécs, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine and 1st Department of Medicine, University of Pécs, Medical School, Pécs, Hungary; Momentum Translational Gastroenterology Research Group, Hungarian Academy of Sciences University of Szeged, Szeged, Hungary
| | - Boldizsár Czéh
- Neurobiology of Stress Research Group, Szentágothai János Research Centre, University of Pécs, Pécs, Hungary; Department of Laboratory Medicine, University of Pécs, Medical School, Pécs, Hungary
| | - László Czopf
- Department of Cardiology, 1st Department of Medicine, University of Pécs, Medical School, Pécs, Hungary
| | - Alizadeh Hussain
- Department of Haematology, 1st Department of Medicine, University of Pécs, Medical School, Pécs, Hungary
| | - Judith Pammer
- Department of Haematology, 1st Department of Medicine, University of Pécs, Medical School, Pécs, Hungary
| | - Imre Szabó
- Department of Gastroenterology, 1st Department of Medicine, University of Pécs, Medical School, Pécs, Hungary
| | - Margit Solymár
- Institute for Translational Medicine, University of Pécs, Medical School, Pécs, Hungary
| | - Loránt Kiss
- Department of Pathophysiology, University of Szeged, Medical School, Szeged, Hungary
| | - Petra Hartmann
- Institute of Surgical Research, University of Szeged, Hungary
| | | | - Zoltán Kiss
- 1st Department of Paediatrics, Semmelweis University, Budapest, Hungary
| | - Maria Simon
- Neurobiology of Stress Research Group, Szentágothai János Research Centre, University of Pécs, Pécs, Hungary; Department of Psychiatry and Psychotherapy, University of Pécs, Medical School, Pécs, Hungary.
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Lin Y, Ding H, Zhang Y. Emotional Prosody Processing in Schizophrenic Patients: A Selective Review and Meta-Analysis. J Clin Med 2018; 7:jcm7100363. [PMID: 30336573 PMCID: PMC6210777 DOI: 10.3390/jcm7100363] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/10/2018] [Accepted: 10/14/2018] [Indexed: 12/11/2022] Open
Abstract
Emotional prosody (EP) has been increasingly recognized as an important area of schizophrenic patients’ dysfunctions in their language use and social communication. The present review aims to provide an updated synopsis on emotional prosody processing (EPP) in schizophrenic disorders, with a specific focus on performance characteristics, the influential factors and underlying neural mechanisms. A literature search up to 2018 was conducted with online databases, and final selections were limited to empirical studies which investigated the prosodic processing of at least one of the six basic emotions in patients with a clear diagnosis of schizophrenia without co-morbid diseases. A narrative synthesis was performed, covering the range of research topics, task paradigms, stimulus presentation, study populations and statistical power with a quantitative meta-analytic approach in Comprehensive Meta-Analysis Version 2.0. Study outcomes indicated that schizophrenic patients’ EPP deficits were consistently observed across studies (d = −0.92, 95% CI = −1.06 < δ < −0.78), with identification tasks (d = −0.95, 95% CI = −1.11 < δ < −0.80) being more difficult to process than discrimination tasks (d = −0.74, 95% CI = −1.03 < δ < −0.44) and emotional stimuli being more difficult than neutral stimuli. Patients’ performance was influenced by both participant- and experiment-related factors. Their social cognitive deficits in EP could be further explained by right-lateralized impairments and abnormalities in primary auditory cortex, medial prefrontal cortex and auditory-insula connectivity. The data pointed to impaired pre-attentive and attentive processes, both of which played important roles in the abnormal EPP in the schizophrenic population. The current selective review and meta-analysis support the clinical advocacy of including EP in early diagnosis and rehabilitation in the general framework of social cognition and neurocognition deficits in schizophrenic disorders. Future cross-sectional and longitudinal studies are further suggested to investigate schizophrenic patients’ perception and production of EP in different languages and cultures, modality forms and neuro-cognitive domains.
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Affiliation(s)
- Yi Lin
- Institute of Cross-Linguistic Processing and Cognition, School of Foreign Languages, Shanghai Jiao Tong University, Shanghai 200240, China.
| | - Hongwei Ding
- Institute of Cross-Linguistic Processing and Cognition, School of Foreign Languages, Shanghai Jiao Tong University, Shanghai 200240, China.
| | - Yang Zhang
- Department of Speech-Language-Hearing Sciences & Center for Neurobehavioral Development, University of Minnesota, Twin Cities, MN 55455, USA.
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Dell'Osso L, Cremone IM, Carpita B, Fagiolini A, Massimetti G, Bossini L, Vita A, Barlati S, Carmassi C, Gesi C. Correlates of autistic traits among patients with borderline personality disorder. Compr Psychiatry 2018; 83:7-11. [PMID: 29500962 DOI: 10.1016/j.comppsych.2018.01.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 01/01/2018] [Accepted: 01/02/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Despite discrete autism-related dimensions, such as deficits in communication, empathy and mentalizing are likely to affect the development of personality and despite they actually frequently occur in borderline patients, no research has so far investigated the relationship between autistic traits and Borderline Personality Disorder (BPD). The objective of this study is to investigate the clinical significance of autistic traits in subjects with BPD. METHODS The sample included 50 patients with a clinical diagnosis of BPD and 69 healthy controls. The Structured Clinical Interview for DSM-5 Clinician Version was used to establish the presence of comorbid mental disorders among BPD subjects and to confirm the absence of lifetime mental disorders in the control group. Participants were also asked to fill three self-report instruments: the Adult Autism Subthreshold Spectrum (AdAS Spectrum), the Autism Spectrum Quotient (AQ) and the Mood Spectrum Self-Report (MOODS-SR). RESULTS Patients with BPD reported higher autistic traits than healthy individuals. Moreover, autistic traits were shown to exert a significant impact on some clinical features and associated manifestation of BPD, such as suicidality and lifetime exposure to physical and/or sexual abuse. CONCLUSIONS Subthreshold autism spectrum may be relevant for subjects suffering from BPD and future research may further address clinical correlates of autistic traits among patients with this disorder.
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Affiliation(s)
- Liliana Dell'Osso
- Dipartimento di Medicina Clinica e Sperimentale, University of Pisa, Italy. liliana.dell'
| | - Ivan Mirko Cremone
- Dipartimento di Medicina Clinica e Sperimentale, University of Pisa, Italy.
| | - Barbara Carpita
- Dipartimento di Medicina Clinica e Sperimentale, University of Pisa, Italy
| | - Andrea Fagiolini
- Dipartimento di Medicina molecolare e dello sviluppo, University of Siena, Italy.
| | | | - Letizia Bossini
- Dipartimento di Medicina molecolare e dello sviluppo, University of Siena, Italy
| | - Antonio Vita
- Dipartiento di Scienze cliniche e sperimentali, Università degli Studi di Brescia, Italy.
| | - Stefano Barlati
- Dipartiento di Scienze cliniche e sperimentali, Università degli Studi di Brescia, Italy.
| | - Claudia Carmassi
- Dipartimento di Medicina Clinica e Sperimentale, University of Pisa, Italy
| | - Camilla Gesi
- Dipartimento di Medicina Clinica e Sperimentale, University of Pisa, Italy
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What Is Going On? The Process of Generating Questions about Emotion and Social Cognition in Bipolar Disorder and Schizophrenia with Cartoon Situations and Faces. Brain Sci 2018; 8:brainsci8040068. [PMID: 29673215 PMCID: PMC5924404 DOI: 10.3390/brainsci8040068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 04/11/2018] [Accepted: 04/12/2018] [Indexed: 11/24/2022] Open
Abstract
Regarding the notion of putative “best” practices in social neuroscience and science in general, we contend that following established procedures has advantages, but prescriptive uniformity in methodology can obscure flaws, bias thinking, stifle creativity, and restrict exploration. Generating hypotheses is at least as important as testing hypotheses. To illustrate this process, we describe the following exploratory study. Psychiatric patients have difficulties with social functioning that affect their quality of life adversely. To investigate these impediments, we compared the performances of patients with schizophrenia and those with bipolar disorder to healthy controls on a task that involved matching photographs of facial expressions to a faceless protagonist in each of a series of drawn cartoon emotion-related situations. These scenarios involved either a single character (Nonsocial) or multiple characters (Social). The Social scenarios were also Congruent, with everyone in the cartoon displaying the same emotion, or Noncongruent (with everyone displaying a different emotion than the protagonist should). In this preliminary study, both patient groups produced lower scores than controls (p < 0.001), but did not perform differently from each other. All groups performed best on the social-congruent items and worst on the social-noncongruent items (p < 0.001). Performance varied inversely with illness duration, but not symptom severity. Complete emotional, social, cognitive, or perceptual inability is unlikely because these patient groups could still do this task. Nevertheless, the differences we saw could be meaningful functionally and clinically significant and deserve further exploration. Therefore, we stress the need to continue developing novel, alternative ways to explore social cognition in patients with psychiatric disorders and to clarify which elements of the multidimensional process contribute to difficulties in daily functioning.
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40
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Sarkar S, Clark BS, Deeley Q. Differences between psychopathy and other personality disorders: evidence from neuroimaging. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.bp.107.004747] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SummaryICD-10 and DSM-IV-TR diagnostic guidelines do not list psychopathy as a distinct psychiatric entity. However, there are significant overlaps between psychopathy and DSM-IV-TR Cluster B personality disorders. Neuroimaging studies implicate deficits in structure and function of frontal and limbic regions in this group of personality disorders, while highlighting both distinctions and overlaps between syndromes. Here, these data are reviewed and implications for diagnosis and clinical practice are discussed.
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41
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Keller S, Stelmaszczyk K, Kolly S, de Roten Y, Despland JN, Caspar F, Drapeau M, Kramer U. Change in Biased Thinking in a Treatment Based on the Motive-Oriented Therapeutic Relationship for Borderline Personality Disorder. J Pers Disord 2018; 32:75-92. [PMID: 29388899 DOI: 10.1521/pedi.2018.32.supp.75] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Biased thinking is a common feature of patients presenting with borderline personality disorder (BPD). For the treatment of BPD, it was shown that the individualizing of the treatment, by using the motive-oriented therapeutic relationship (MOTR), had a beneficial short-term effect on process and outcome. So far, it remains unclear what the role of early change in biased thinking is in these treatments. The present study aims to assess whether there is a link between the MOTR, change in biased thinking, and outcome. The sample (N = 60) is based on a randomized controlled trial with two conditions: (a) 30 patients in a 10-session version of psychiatric management, and (b) 30 patients in a 10-session version of psychiatric management augmented with the MOTR. For each patient, three sessions (intake, middle, late) were selected, transcribed, and rated using the Cognitive Errors Rating Scale (CERS). An overall decrease of negative cognitive errors during 10 sessions of treatment was observed, independently of the treatment condition. No specific effect related to change in biased thinking may be attributed to the individualizing of the treatment. These results are discussed with regard to mechanisms of change in treatments for BPD, in particular with regard to the central role that biased thinking, as well as the MOTR, might play early in treatment.
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Affiliation(s)
- Sabine Keller
- University Institute of Psychotherapy, Department of Psychiatry-CHUV, University of Lausanne, Lausanne, Switzerland
| | - Kelly Stelmaszczyk
- Department of Counselling Psychology and Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Stéphane Kolly
- General Psychiatry Service, Department of Psychiatry-CHUV, University of Lausanne, Lausanne, Switzerland
| | - Yves de Roten
- University Institute of Psychotherapy, Department of Psychiatry-CHUV, University of Lausanne, Lausanne, Switzerland
| | - Jean-Nicolas Despland
- University Institute of Psychotherapy, Department of Psychiatry-CHUV, University of Lausanne, Lausanne, Switzerland
| | - Franz Caspar
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Germany
| | - Martin Drapeau
- Department of Counselling Psychology and Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Ueli Kramer
- University Institute of Psychotherapy, Department of Psychiatry-CHUV, University of Lausanne, Lausanne, Switzerland.,General Psychiatry Service, Department of Psychiatry-CHUV, University of Lausanne, Lausanne, Switzerland.,University of Windsor, Windsor, Ontario, Canada
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42
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Bertsch K, Hillmann K, Herpertz SC. Behavioral and Neurobiological Correlates of Disturbed Emotion Processing in Borderline Personality Disorder. Psychopathology 2018. [PMID: 29539627 DOI: 10.1159/000487363] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
One of the core symptoms of borderline personality disorder (BPD) is emotion dysregulation, which comprises emotion sensitivity, heightened and labile negative affect, deficient appropriate regulation strategies, and a surplus of maladaptive regulation strategies. Although earlier studies provided some evidence for threat hypersensitivity in terms of a negatively biased perception of other people ("negativity bias") and deficits in the recognition of full-blown anger, i.e., higher error rates and slower reaction times, researchers have only recently started studying effects of interindividual differences (e.g., sex, impulsivity, aggressiveness) and stimulus complexity as well as associations with early adversity, developmental aspects, or the specificity for BPD. Recent data also suggest a deficit in the detection of positive emotions, which needs to be addressed in more detail since it may prevent the patients from recognizing safety signals and from making positive interpersonal experiences. Neurobiologically, threat hypersensitivity has been related to increased and prolonged amygdala responses, while deficient emotion regulation was associated with reduced prefrontal inhibition of the amygdala. First results suggest that these neural alterations may be modulated by psychotherapeutic treatment focusing on emotion regulation.
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43
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Aberrant link between empathy and social attribution style in borderline personality disorder. J Psychiatr Res 2017; 94:163-171. [PMID: 28735169 DOI: 10.1016/j.jpsychires.2017.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/25/2017] [Accepted: 07/13/2017] [Indexed: 01/30/2023]
Abstract
In social interactions, we often need to quickly infer why other people do what they do. More often than not, we infer that behavior is a result of personality rather than circumstances. It is unclear how the tendency itself may contribute to psychopathology and interpersonal dysfunction. Borderline personality disorder (BPD) is characterized by severe interpersonal dysfunction. Here, we investigated if this dysfunction is related to the tendency to over-attribute behaviors to personality traits. Healthy controls and patients with BPD judged positive and negative behaviors presented within a situational constraint during functional magnetic resonance imaging. Before the experiment, we measured trait levels of empathy, paranoia, and need for cognition. Behaviorally, we found that empathy levels predicted the tendency to attribute behavior to traits in healthy controls, whereas in patients with BPD this relationship was significantly weakened. Whole brain analysis of group-by-empathy interaction revealed that when participants judged the behavior during the attribution phase, several brain regions implicated in mentalizing distinguished patients from controls: In healthy controls, neural activity scaled negatively with empathy, but this relationship was reversed in BPD patients. Due to the cross-sectional study design we cannot establish a causal link between empathy and social attributions. These findings indicate that the self-reported tendency to feel for others is related to the tendency to integrate situational information beyond personality. In BPD patients, by contrast, the association between empathy and attribution was significantly weaker, rendering empathy less informative in predicting the overall attribution style.
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44
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Meehan KB, De Panfilis C, Cain NM, Antonucci C, Soliani A, Clarkin JF, Sambataro F. Facial emotion recognition and borderline personality pathology. Psychiatry Res 2017; 255:347-354. [PMID: 28605709 DOI: 10.1016/j.psychres.2017.05.042] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 05/23/2017] [Accepted: 05/28/2017] [Indexed: 11/24/2022]
Abstract
The impact of borderline personality pathology on facial emotion recognition has been in dispute; with impaired, comparable, and enhanced accuracy found in high borderline personality groups. Discrepancies are likely driven by variations in facial emotion recognition tasks across studies (stimuli type/intensity) and heterogeneity in borderline personality pathology. This study evaluates facial emotion recognition for neutral and negative emotions (fear/sadness/disgust/anger) presented at varying intensities. Effortful control was evaluated as a moderator of facial emotion recognition in borderline personality. Non-clinical multicultural undergraduates (n = 132) completed a morphed facial emotion recognition task of neutral and negative emotional expressions across different intensities (100% Neutral; 25%/50%/75% Emotion) and self-reported borderline personality features and effortful control. Greater borderline personality features related to decreased accuracy in detecting neutral faces, but increased accuracy in detecting negative emotion faces, particularly at low-intensity thresholds. This pattern was moderated by effortful control; for individuals with low but not high effortful control, greater borderline personality features related to misattributions of emotion to neutral expressions, and enhanced detection of low-intensity emotional expressions. Individuals with high borderline personality features may therefore exhibit a bias toward detecting negative emotions that are not or barely present; however, good self-regulatory skills may protect against this potential social-cognitive vulnerability.
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Affiliation(s)
- Kevin B Meehan
- Department of Psychology, Long Island University, 1 University Plaza, Brooklyn, NY 11201, USA; Department of Psychiatry, Weill Cornell Medical College, 21 Bloomingdale Road, White Plains, NY 10605, USA.
| | - Chiara De Panfilis
- Unit of Psychiatry, Department of Neuroscience, University of Parma, c/o Ospedale Maggiore, pad. 21 Braga, viale Gramsci 14, 43126 Parma, Italy
| | - Nicole M Cain
- Department of Psychology, Long Island University, 1 University Plaza, Brooklyn, NY 11201, USA
| | - Camilla Antonucci
- Service of Hospital-based Psychiatry, Department of Mental Health, Parma Local Health Agency, c/o Ospedale Maggiore, pad. 21 Braga, viale Gramsci 14, 43126 Parma, Italy
| | - Antonio Soliani
- Unit of Psychiatry, Department of Neuroscience, University of Parma, c/o Ospedale Maggiore, pad. 21 Braga, viale Gramsci 14, 43126 Parma, Italy
| | - John F Clarkin
- Department of Psychiatry, Weill Cornell Medical College, 21 Bloomingdale Road, White Plains, NY 10605, USA
| | - Fabio Sambataro
- Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy
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45
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Niedtfeld I. Experimental investigation of cognitive and affective empathy in borderline personality disorder: Effects of ambiguity in multimodal social information processing. Psychiatry Res 2017; 253:58-63. [PMID: 28351003 DOI: 10.1016/j.psychres.2017.03.037] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 03/13/2017] [Accepted: 03/20/2017] [Indexed: 01/13/2023]
Abstract
Borderline personality disorder (BPD) is characterized by affective instability and interpersonal problems. In the context of social interaction, impairments in empathy are proposed to result in inadequate social behavior. In contrast to findings of reduced cognitive empathy, some authors suggested enhanced emotional empathy in BPD. It was investigated whether ambiguity leads to decreased cognitive or emotional empathy in BPD. Thirty-four patients with BPD and thirty-two healthy controls were presented with video clips, which were presented through prosody, facial expression, and speech content. Experimental conditions were designed to induce ambiguity by presenting neutral valence in one of these communication channels. Subjects were asked to indicate the actors' emotional valence, their decision confidence, and their own emotional state. BPD patients showed increased emotional empathy when neutral stories comprised nonverbally expressed emotions. In contrast, when all channels were emotional, patients showed lower emotional empathy than healthy controls. Regarding cognitive empathy, there were no significant differences between BPD patients and healthy control subjects in recognition accuracy, but reduced decision confidence in BPD. These results suggest that patients with BPD show altered emotional empathy, experiencing higher rates of emotional contagion when emotions are expressed nonverbally. The latter may contribute to misunderstandings and inadequate social behavior.
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Affiliation(s)
- Inga Niedtfeld
- Department of Psychosomatic Medicine, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim / Heidelberg University, Germany.
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46
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Niedtfeld I, Defiebre N, Regenbogen C, Mier D, Fenske S, Kirsch P, Lis S, Schmahl C. Facing the Problem: Impaired Emotion Recognition During Multimodal Social Information Processing in Borderline Personality Disorder. J Pers Disord 2017; 31:273-288. [PMID: 27064850 DOI: 10.1521/pedi_2016_30_248] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Previous research has revealed alterations and deficits in facial emotion recognition in patients with borderline personality disorder (BPD). During interpersonal communication in daily life, social signals such as speech content, variation in prosody, and facial expression need to be considered simultaneously. We hypothesized that deficits in higher level integration of social stimuli contribute to difficulties in emotion recognition in BPD, and heightened arousal might explain this effect. Thirty-one patients with BPD and thirty-one healthy controls were asked to identify emotions in short video clips, which were designed to represent different combinations of the three communication channels: facial expression, speech content, and prosody. Skin conductance was recorded as a measure of sympathetic arousal, while controlling for state dissociation. Patients with BPD showed lower mean accuracy scores than healthy control subjects in all conditions comprising emotional facial expressions. This was true for the condition with facial expression only, and for the combination of all three communication channels. Electrodermal responses were enhanced in BPD only in response to auditory stimuli. In line with the major body of facial emotion recognition studies, we conclude that deficits in the interpretation of facial expressions lead to the difficulties observed in multimodal emotion processing in BPD.
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Affiliation(s)
- Inga Niedtfeld
- Department of Psychosomatic Medicine, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Nadine Defiebre
- Department of Psychosomatic Medicine, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Christina Regenbogen
- Department of Clinical Neuroscience, Karolinska Institut, Stockholm, Sweden.,Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany
| | - Daniela Mier
- Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University
| | - Sabrina Fenske
- Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University
| | - Peter Kirsch
- Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University
| | - Stefanie Lis
- Department of Psychosomatic Medicine, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
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47
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Brück C, Derstroff S, Jacob H, Wolf-Arehult M, Wekenmann S, Wildgruber D. Perception of Verbal and Nonverbal Emotional Signals in Women With Borderline Personality Disorder: Evidence of a Negative Bias and an Increased Reliance on Nonverbal Cues. J Pers Disord 2017; 31:221-231. [PMID: 27064854 DOI: 10.1521/pedi_2016_30_245] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Studies conducted in patients diagnosed with borderline personality disorder (BPD) have documented a variety of anomalies concerning patients' abilities to interpret emotional signals. Attempting to clarify the bases of these anomalies, the current literature draws attention to a possible role of dysfunctional expectations, such as the expectation of social rejection. Dysfunctional expectations, however, may not only bias social interpretations, but may also focus attention on social cues most important in conveying emotional messages, such as nonverbal signals. To explore these assumptions, 30 female BPD patients were tasked to judge the valence of emotional states conveyed by combinations of verbal and nonverbal emotional cues. Compared to controls, BPD patients exhibited a negative bias in their interpretations and relied more on available nonverbal cues. Shifts in the relative importance of nonverbal cues appeared to be rooted mainly in a reduced reliance on positive verbal cues presumably deemed less credible by BPD patients.
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Affiliation(s)
- Carolin Brück
- Medical Center of the Eberhard Karls University Tübingen, Department of Psychiatry and Psychotherapy, Tübingen, Germany
| | - Stephanie Derstroff
- Medical Center of the Eberhard Karls University Tübingen, Department of Psychiatry and Psychotherapy, Tübingen, Germany
| | - Heike Jacob
- Medical Center of the Eberhard Karls University Tübingen, Department of Psychiatry and Psychotherapy, Tübingen, Germany
| | - Martina Wolf-Arehult
- Medical Center of the Eberhard Karls University Tübingen, Department of Psychiatry and Psychotherapy, Tübingen, Germany.,Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden.,Department of Psychiatry, Uppsala University Hospital, Uppsala, Sweden
| | - Stefanie Wekenmann
- Medical Center of the Eberhard Karls University Tübingen, Department of Psychiatry and Psychotherapy, Tübingen, Germany
| | - Dirk Wildgruber
- Medical Center of the Eberhard Karls University Tübingen, Department of Psychiatry and Psychotherapy, Tübingen, Germany
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48
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Altered mu-rhythm suppression in Borderline Personality Disorder. Brain Res 2017; 1659:64-70. [DOI: 10.1016/j.brainres.2017.01.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 01/09/2017] [Accepted: 01/18/2017] [Indexed: 11/18/2022]
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Yeh ZT, Lin YC, Liu SI, Fang CK. Social Awareness and its Relationship with Emotion Recognition and Theory of Mind in Patients with Borderline Personality Disorder. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2017. [DOI: 10.1521/jscp.2017.36.1.22] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Beeney JE, Hallquist MN, Clifton AD, Lazarus SA, Pilkonis PA. Social disadvantage and borderline personality disorder: A study of social networks. Personal Disord 2016; 9:62-72. [PMID: 27936840 DOI: 10.1037/per0000234] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Examining differences in social integration, social support, and relationship characteristics in social networks may be critical for understanding the character and costs of the social difficulties experienced of borderline personality disorder (BPD). We conducted an ego-based (self-reported, individual) social network analysis of 142 participants recruited from clinical and community sources. Each participant listed the 30 most significant people (called alters) in their social network, then rated each alter in terms of amount of contact, social support, attachment strength and negative interactions. In addition, measures of social integration were determined using participant's report of the connection between people in their networks. BPD was associated with poorer social support, more frequent negative interactions, and less social integration. Examination of alter-by-BPD interactions indicated that whereas participants with low BPD symptoms had close relationships with people with high centrality within their networks, participants with high BPD symptoms had their closest relationships with people less central to their networks. The results suggest that individuals with BPD are at a social disadvantage: Those with whom they are most closely linked (including romantic partners) are less socially connected (i.e., less central) within their social network. (PsycINFO Database Record
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Affiliation(s)
- Joseph E Beeney
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | | | | | - Sophie A Lazarus
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Paul A Pilkonis
- Department of Psychiatry, University of Pittsburgh School of Medicine
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