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Brud PP, Cieciuch J. Temperamental underpinnings of borderline personality disorder and its facets. Personal Ment Health 2024; 18:205-215. [PMID: 38476088 DOI: 10.1002/pmh.1610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/11/2023] [Accepted: 02/18/2024] [Indexed: 03/14/2024]
Abstract
Temperament is claimed to be the basis for personality; therefore, discovering the temperamental underpinnings of borderline personality disorder and its facets is crucial for understanding this personality disorder. In this article, we explore these underpinnings by using a new model of temperament, based on the Regulative Theory of Temperament, the Big Two of temperament, and the Circumplex of Personality Metatraits. Two studies were conducted on adults-the first was in a general population sample (N = 315) and the second was in a clinical sample (N = 113) in people with a diagnosis of borderline personality disorder. The following measurements were used: The Screening Instrument for Borderline Personality Disorder (SI-Bord), the Five-Factor Borderline Inventory-Short Form (FFBI-SF), and the Temperament Metadimensions Questionnaire (TMQ). General borderline was explained by Reactivity (high Sensitivity) and Activity (high Dynamism). At the facet level, the Borderline Internalizing Facet was mainly explained by Reactivity (high Sensitivity), while the Borderline Externalizing Facet was explained by Activity (high Dynamism) in addition to Reactivity (high Sensitivity). The results of our study revealed specific temperamental underpinnings of borderline and its facets. Reactivity underlies all borderline facets, while Activity differentiates between the Borderline Externalizing Facet and Borderline Internalizing Facet.
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Affiliation(s)
- Piotr P Brud
- Institute of Psychology, Cardinal Stefan Wyszyński University in Warsaw, Warsaw, Poland
| | - Jan Cieciuch
- Institute of Psychology, Cardinal Stefan Wyszyński University in Warsaw, Warsaw, Poland
- University Research Priority Social Networks, University of Zürich, Zürich, Switzerland
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Yun S, Jo SH, Jeon HJ, Choo B, Seok JH, Shin H, Kim IY, Choi SW, Koo BH. Neurophysiological insights into impaired mentalization in borderline personality disorder an electroencephalography study. Front Psychiatry 2024; 14:1293347. [PMID: 38268560 PMCID: PMC10806161 DOI: 10.3389/fpsyt.2023.1293347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/22/2023] [Indexed: 01/26/2024] Open
Abstract
Introduction Borderline personality disorder (BPD) is characterized by interpersonal and emotional instabilities, recurring suicidal tendencies, and feelings of emptiness. Childhood adverse event is reported in 70%-80% of cases involving BPD. Furthermore, the deficiency in mentalization capacity plays a significant role in emotion dysregulation and social interaction problems within individuals with BPD. This study explored the relationship among childhood adverse experiences, mentalization capacity, and neurophysiological activity in patients with BPD. Methods Resting-state electroencephalography was used to identify the neural correlates associated with childhood adversity and mentalization deficits. The participants included 45 patients with BPD and 15 healthy controls. Results The BPD group exhibited reduced alpha activity during eyes-closed rest, indicating heightened arousal even during relaxation. Correlations were found between the power spectral density (PSD) and mentalization capacity in the delta and theta ranges, suggesting an association between PSD and emotional awareness and expression. Gamma activity negatively correlated with psychic equivalence, implying a blurring of the boundaries between internal mental experiences and the external world. Conclusion These findings offer insights into the pathophysiology of BPD, provide potential diagnostic markers, and suggest personalized treatment approaches based on mentalization traits.
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Affiliation(s)
- Seokho Yun
- Department of Psychiatry, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - So-Hye Jo
- Department of Psychiatry, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Hye-Jin Jeon
- Department of Psychiatry, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Bokyung Choo
- Industry-Academic Cooperations, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Ho Seok
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyunkyung Shin
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - In-Young Kim
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sun-Woo Choi
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Bon-Hoon Koo
- Department of Psychiatry, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Republic of Korea
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Kouros I, Holmberg H, Ekselius L, Ramklint M. Temperament, but not childhood trauma, distinguishes borderline personality disorder from bipolar disorder and ADHD. Nord J Psychiatry 2024; 78:79-86. [PMID: 37870069 DOI: 10.1080/08039488.2023.2267041] [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: 03/20/2022] [Accepted: 10/01/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND The aim of this study was to investigate if temperament and experience of childhood trauma differed between young psychiatric patients with borderline personality disorder (BPD), bipolar disorder (BD) and attention-deficit/hyperactivity disorder (ADHD). METHODS Diagnoses were based on the Structured Clinical Interview for DSM Axis I and Axis II. Temperament was assessed by the Temperament and Character Inventory (TCI) and childhood trauma by the Early Trauma Inventory-Self Report-Short Form (ETI-SR-SF). Temperament and childhood trauma were compared between the BPD group (n = 19) and the non-BPD group (BD/ADHD) (n = 95). Interactions between trauma and temperament were evaluated using a logistic regression model with a BPD diagnosis as outcome variable. RESULTS Participants in the BPD group showed higher novelty seeking (NS) and harm avoidance (HA). Traumatic experiences in childhood were common but the BPD group differed very little from the others in this regard. The interaction between temperament and trauma had low explanatory power for a BPD diagnosis in this sample. CONCLUSION Temperament might be useful to distinguish BPD when symptoms of impulsivity and affective instability are evaluated in psychiatric patients. The results from the interaction analysis support the multifactorial background to BPD.
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Affiliation(s)
- Ioannis Kouros
- Department of Neuroscience, Psychiatry, Uppsala University, Akademiska sjukhuset, Uppsala, Sweden
| | - Håkan Holmberg
- Department of Neuroscience, Psychiatry, Uppsala University, Akademiska sjukhuset, Uppsala, Sweden
| | - Lisa Ekselius
- Department of Neuroscience, Psychiatry, Uppsala University, Akademiska sjukhuset, Uppsala, Sweden
- Department for Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Mia Ramklint
- Department of Neuroscience, Psychiatry, Uppsala University, Akademiska sjukhuset, Uppsala, Sweden
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Yuan Y, Lee H, Eack SM, Newhill CE. A Systematic Review of the Association Between Early Childhood Trauma and Borderline Personality Disorder. J Pers Disord 2023; 37:16-35. [PMID: 36723424 DOI: 10.1521/pedi.2023.37.1.16] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Borderline personality disorder (BPD) is a debilitating clinical disorder associated with adverse impacts on multiple levels. While a high prevalence of childhood trauma has been noted, the ways such trauma impacts the development of BPD symptomatology remain unclear. In this systematic review, the authors examine the literature from 2000 to 2020, focusing on the association between trauma and BPD, and offer a comprehensive synthesis of possible etiological implications related to either one specific or multiple trauma types. In addition, results are analyzed based on commonly tested trauma parameters, including repeated exposure, polytrauma, onset, perpetrators, and gender. The authors also note some limitations in areas of sampling, measurement, causal inference methods, and data analyses. Results of this review point to several parameters of trauma that can be used to inform training for practitioners as well as enhance current interventions.
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Affiliation(s)
- Yan Yuan
- School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Hyunji Lee
- School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Shaun M Eack
- University of Pittsburgh, Pittsburgh, Pennsylvania
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Adverse Childhood Experiences and Neurocognition in Borderline Personality Disorder: A Call-to-Action Perspective Review. Harv Rev Psychiatry 2022; 30:248-260. [PMID: 35849742 DOI: 10.1097/hrp.0000000000000344] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Adverse childhood experiences (ACEs) contribute to the development of personality traits leading to adult borderline personality disorder (BPD). Neurocognitive changes could partly mediate the association between ACEs and BPD. We discuss how exposure to ACEs could induce alterations in neurocognition, which, in turn, would contribute to the development of BPD. We conducted a review of MEDLINE articles through 2021, documenting a link between ACEs, neurocognitive impairments, and BPD, and also focusing on the pairwise associations. ACEs appear to have a strong impact on neurocognition and are a predictive factor for BPD. Maltreated, abused, and emotionally invalidated children are more likely to present BPD traits. Neurocognitive impairments in adults exposed to ACEs and in patients with BPD arise from similar brain alterations in the amygdala, hippocampus, and prefrontal cortex. These impairments seem to be linked with clinical dimensions of BPD: increased impulsivity to altered inhibitory control; dissociative experiences to nonspecific autobiographical memory; and emotionally biased facial recognition to unstable interpersonal relationships. This perspective review highlights the contributory role of neurocognition in the association between ACEs and BPD. Additional research is needed, however, on the interconnections among ACEs, neurocognition, and BPD. Future studies could also focus on developing tools to assess early adversity in BPD specifically and on psychotherapeutic approaches to promptly remedy neurocognitive impairments.
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Bertele N, Talmon A, Gross JJ, Schmahl C, Schmitz M, Niedtfeld I. Childhood Maltreatment and Borderline Personality Disorder: The Mediating Role of Difficulties with Emotion Regulation. J Pers Disord 2022; 36:264-276. [PMID: 35647775 DOI: 10.1521/pedi.2022.36.3.264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Exposure to childhood maltreatment (CM) increases the risk of developing borderline personality disorder (BPD). However, it remains unclear what mechanisms might mediate this link. One candidate of interest is difficulties with emotion regulation. This study aims to examine the pattern of relations among CM, difficulties with emotion regulation, and the risk of developing BPD. A total of 162 individuals diagnosed with current BPD and 162 matched healthy controls completed self-reported questionnaires assessing CM and difficulties with emotion regulation. The authors found high correlations between CM and BPD diagnosis (r = .73, p < .001). Difficulties with emotion regulation were found to mediate the link between CM and BPD diagnosis (p < .001). Results suggest that CM may play a key role in the etiology of BPD and that difficulties with emotion regulation might be a mediating component between CM and BPD.
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Affiliation(s)
- Nina Bertele
- Psychology Department, Stanford University, Stanford, California
| | - Anat Talmon
- Psychology Department, Stanford University, Stanford, California
| | - James J Gross
- Psychology Department, Stanford University, Stanford, California
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Marius Schmitz
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Germany
| | - Inga Niedtfeld
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
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Mu E, Thomas EHX, Kulkarni J. Menstrual Cycle in Trauma-Related Disorders: A Mini-Review. Front Glob Womens Health 2022; 3:910220. [PMID: 35706526 PMCID: PMC9189376 DOI: 10.3389/fgwh.2022.910220] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/12/2022] [Indexed: 11/13/2022] Open
Abstract
Fluctuations of sex hormones across the menstrual cycle have been linked to exacerbation of symptoms of psychiatric disorders. Women diagnosed with trauma-related disorders such as post-traumatic stress disorder (PTSD) and borderline personality disorder (BPD) have reported worsening of mood symptoms at various phases of their menstrual cycle. There is also considerable overlap between PTSD, BPD, and complex-PTSD (cPTSD) symptoms, suggesting similar biological underpinnings. This mini-review examines the influence of sex hormones and the menstrual cycle on PTSD, BPD, and cPTSD symptoms, and discusses the involvement of the hypothalamic-pituitary-adrenal (HPA) axis. We review literature showing that PTSD and BPD symptoms fluctuate with the menstrual cycle, though the effect of the menstrual cycle phase appears to be inconsistent, warranting future research. Based on the reported phasic vulnerability in individuals with PTSD and BPD, it is plausible to assume that women diagnosed with the newly introduced cPTSD may experience similar difficulties. However, no study to date has addressed this. This review highlights the importance of considering an individual's trauma history as it may influence symptom severity and diagnosis, and the phase of the menstrual cycle at the time of diagnosis. This review also highlights that additional work is needed to clarify the influence of estradiol and progesterone fluctuations on trauma-related symptoms, especially in cPTSD. Continued research on menstrual cycle vulnerability and trauma will lead to better informed management and treatment of PTSD, BPD, and cPTSD.
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Wang WL, Hung HY, Chung CH, Hsu JW, Huang KL, Chan YY, Chien WC, Chen MH. Risk of Personality disorders among childhood maltreatment victims: A nation-wide population-based study in Taiwan. J Affect Disord 2022; 305:28-36. [PMID: 34965397 DOI: 10.1016/j.jad.2021.12.109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 12/21/2021] [Accepted: 12/24/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND To date, numerous cohort studies and meta-analyses have shown that childhood maltreatment is associated with a wide range of adverse physiological and psychological symptoms. Although childhood maltreatment has been linked to an increased risk of personality disorders, the direction and magnitude of the association remain uncertain. Therefore, this cohort study aimed to evaluate whether children who have suffered childhood maltreatment have a higher incidence of subsequent personality disorders, using a nationwide database in Taiwan. METHODS We conducted a large retrospective cohort study using data drawn from Taiwan's National Health Insurance Research Database between 2000 and 2015. A total of 10,345 children who experienced childhood maltreatment were identified using International Classification of Disease codes. They were then compared with 41,380 children who never experienced childhood maltreatment in terms of the prevalence rates of personality disorders. RESULTS Childhood maltreatment was associated with an increased risk of personality disorders (considering the control as reference: adjusted hazard ratio, 2.12; 95% confidence interval, 1.90-2.36; p < 0.001). The Kaplan-Meier analysis revealed a significantly higher 15-year cumulative incidence of personality disorders among childhood maltreatment victims than among controls (log-rank test, p < 0.001). CONCLUSIONS The present population-based study showed a positive association between prior childhood maltreatment and subsequent personality disorders in the general Taiwanese population. In order to reduce the risk of personality disorders, interventions should be implemented, identifying and supporting economically disadvantaged families and vulnerable children as early as possible.
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Affiliation(s)
- Wei-Li Wang
- Department of Psychiatry, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Section 2, Taipei 11217, Taiwan; Master of Public Health Degree Program, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Hao-Yuan Hung
- Department of Pharmacology, National Defense Medical Center, Taipei, Taiwan; Department of Pharmacy Practice, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; National Defense Medical Center, Graduate Institute of Medical Sciences, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, 325, Chung-Gung Rd, Sec 2, Nei-Hu District 114, Taipei, Taiwan; School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Ju-Wei Hsu
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Section 2, Taipei 11217, Taiwan; Division of Psychiatry, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kai-Lin Huang
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Section 2, Taipei 11217, Taiwan; Division of Psychiatry, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yuan-Yu Chan
- Department of Psychiatry, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan; Department of Psychology, Chung Yuan Christian University, Taoyuan, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, 325, Chung-Gung Rd, Sec 2, Nei-Hu District 114, Taipei, Taiwan; School of Public Health, National Defense Medical Center, Taipei, Taiwan; National Defense Medical Center, Graduate Institute of Life Sciences, Taipei, Taiwan.
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Section 2, Taipei 11217, Taiwan; Division of Psychiatry, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Migraine and Neuroticism: A Scoping Review. Behav Sci (Basel) 2022; 12:bs12020030. [PMID: 35200282 PMCID: PMC8869701 DOI: 10.3390/bs12020030] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 01/10/2022] [Accepted: 01/26/2022] [Indexed: 02/07/2023] Open
Abstract
Headache is the first cause of consultation in neurology, and one of the most frequent reasons for consultation in general medicine. Migraine is one of the most common, prevalent, and socioeconomically impactful disabling primary headache disorders. Neuroticism can be conceptualized as a disposition to suffer anxiety and emotional disorders in general. Neuroticism has been associated with various mental and physical disorders (e.g., chronic pain, depression), including migraine. With the aim to explore in depth the relationship between migraine and neuroticism, and contribute to the understanding of this relation in order to provide a better treatment for migraine patients based on a personalized and more comprehensive approach, a scoping review was performed using PubMed, Scopus, and Web of Science. Databases were searched independently by the two researchers, reaching a final set of 18 articles to be included. The search terms were: migraine and neuroticism. Neuroticism seems to be highly prevalent in migraine patients. Findings reveal that migraine patients with comorbid depression and anxiety showed higher levels of neuroticism. Depression has been associated with an increased risk of transformation from episodic to chronic migraine whereas neuroticism might be a mediator factor. Neuroticism also might be a mediator factor between childhood maltreatment and migraine. The revision conducted confirms that: (1) Migraine patients usually have a higher level of neuroticism and vulnerability to negative affect, compared to non-migraineurs and tension-type headache patients. (2) Neuroticism is associated with migraine. Nonetheless, more research is needed to clarify potential moderators of this relationship and the role of neuroticism itself in this disease. This knowledge might be useful in order to promote a better management of negative emotions as part of intervention programs in migraine.
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Borderline Personality Disorder: Risk Factors and Early Detection. Diagnostics (Basel) 2021; 11:diagnostics11112142. [PMID: 34829488 PMCID: PMC8620075 DOI: 10.3390/diagnostics11112142] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 12/13/2022] Open
Abstract
Personality disorders (PDs) exert a great toll on health resources, and this is especially true for borderline personality disorder (BPD). As all PDs, BPD arises during adolescence or young adulthood. It is therefore important to detect the presence of this PD in its earlier stages in order to initiate appropriate treatment, thus ameliorating the prognosis of this condition. This review aims to highlight the issues associated with BPD diagnosis in order to promote its early detection and treatment. To do so, we conducted a search on PubMed database of current evidence regarding BPD early diagnosis, focusing on risk factors, which represent important conditions to assess during young patient evaluation, and on diagnostic tools that can help the clinician in the assessment process. Our findings show how several risk factors, both environmental and genetic/neurobiological, can contribute to the onset of BPD and help identify at-risk patients who need careful monitoring. They also highlight the importance of a careful clinical evaluation aided by psychometric tests. Overall, the evidence gathered confirms the complexity of BDP early detection and its crucial importance for the outcome of this condition.
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Link between History of Childhood Maltreatment and Emotion Dysregulation in Adults Suffering from Attention Deficit/Hyperactivity Disorder or Borderline Personality Disorder. Biomedicines 2021; 9:biomedicines9101469. [PMID: 34680586 PMCID: PMC8533068 DOI: 10.3390/biomedicines9101469] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 01/26/2023] Open
Abstract
Childhood maltreatment (CM) may have a long-term effect on emotion regulation. This study aimed to explore the relationship between CM and emotion dysregulation (ED) in a heterogeneous population. Four hundred seventy French-speaking outpatients (N = 279 ADHD, N = 70 BPD, N = 60 ADHD + BPD, N = 61 clinical controls) completed the Emotion Reactivity Scale (ERS), the Cognitive Emotional Regulation Questionnaire (CERQ), the Childhood Trauma Questionnaire (CTQ), and the Relationship Scales Questionnaire (RSQ). Reports of childhood maltreatment experiences were significantly associated with increased levels of emotion reactivity in all our groups and in the whole population, with a greater use of non-adaptive cognitive emotion regulation strategies and insecure attachment patterns. Emotional abuse showed the strongest effect. Further analysis indicated that an anxious attachment style significantly mediated the relationship between CM and the use of non-adaptive cognitive emotion regulation strategies and emotion reactivity. The results of our study suggest an impact of CM on ED and a potentially marked effect of emotional abuse. They also indicate a potentially mediating role of insecure attachment in the relationship between a history of childhood abuse and emotion reactivity and a higher use of non-adaptive cognitive emotion regulation strategies in adulthood.
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Erkoreka L, Zamalloa I, Rodriguez S, Muñoz P, Mendizabal I, Zamalloa MI, Arrue A, Zumarraga M, Gonzalez-Torres MA. Attachment anxiety as mediator of the relationship between childhood trauma and personality dysfunction in borderline personality disorder. Clin Psychol Psychother 2021; 29:501-511. [PMID: 34228846 DOI: 10.1002/cpp.2640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 11/11/2022]
Abstract
Insecure attachment has been described as mediating the relationship between childhood trauma and dysfunctional personality traits in different mental disorders. Despite the role insecure attachment and childhood trauma have independently demonstrated to play as determinants of borderline personality disorder, less is known about the mediating mechanisms explaining these associations. For the first time, we assessed adult attachment, childhood trauma and dimensional personality pathology in a sample of outpatients with borderline personality disorder and tested whether the association between childhood trauma and personality dysfunction was at least partially attributable to insecure attachment. The results showed that attachment anxiety fully mediated the relationship between specific types of trauma (emotional abuse and physical neglect) and emotional dysregulation. Further, emotional abuse was both directly associated with dissocial behaviour and indirectly via attachment anxiety (partial mediation). Emotional abuse has been described as an essential environmental factor for the development of borderline personality disorder and emotional dysregulation, on its part, as the core feature of the condition. Our results indicate that attachment anxiety explains the link between these central aspects of borderline personality disorder. Our findings are consistent with previous research and current etiological understanding of the condition and provide support for recommending a careful assessment of childhood traumatic experiences and adult attachment style to gain a more comprehensive insight into the symptoms and its heterogeneity. As a secondary aim, we assessed the effect parental mental illness may have in these mediation models, but no significant influence on childhood trauma, attachment or personality was found.
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Affiliation(s)
- Leire Erkoreka
- Department of Psychiatry, Galdakao-Usansolo Hospital, Osakidetza Basque Health Service, Galdakao, Spain.,Department of Neurosciences, University of the Basque Country UPV/EHU, Leioa, Spain.,Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Iker Zamalloa
- Department of Neurosciences, University of the Basque Country UPV/EHU, Leioa, Spain
| | | | - Pedro Muñoz
- Eating Disorders Unit, Bizkaia Mental Health Network, Osakidetza Basque Health Service, Barakaldo, Spain
| | - Imanol Mendizabal
- Department of Neurosciences, University of the Basque Country UPV/EHU, Leioa, Spain
| | - M Isabel Zamalloa
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.,Department of Neurochemical Research, Bizkaia Mental Health Network, Osakidetza Basque Health Service, Barakaldo, Spain
| | - Aurora Arrue
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.,Department of Neurochemical Research, Bizkaia Mental Health Network, Osakidetza Basque Health Service, Barakaldo, Spain
| | - Mercedes Zumarraga
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.,Department of Neurochemical Research, Bizkaia Mental Health Network, Osakidetza Basque Health Service, Barakaldo, Spain
| | - Miguel Angel Gonzalez-Torres
- Department of Neurosciences, University of the Basque Country UPV/EHU, Leioa, Spain.,Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.,Department of Psychiatry, Basurto University Hospital, Osakidetza Basque Health Service, Bilbao, Spain
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Kindheitstraumatisierungen bei Patienten mit Borderline-Persönlichkeitsstörung. PSYCHOTHERAPEUT 2020. [DOI: 10.1007/s00278-020-00452-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ZusammenfassungWährend Kindheitstraumatisierungen zentrale psychosoziale Risikofaktoren für die Entwicklung einer Borderline-Persönlichkeitsstörung (BPS) darstellen, ist ihre Relevanz für die Symptomschwere der Erkrankung und das Therapieergebnis bisher unzureichend und mit inkonsistenten Ergebnissen untersucht worden. In dieser naturalistischen Studie an 482 stationären Psychotherapiepatienten mit einer BPS wurde daher der differenzielle Einfluss verschiedener Kindheitstraumatisierungen (gemessen mit dem Childhood Trauma Questionnaire, CTQ) auf die selbstberichtete Psychopathologie hinsichtlich Depressivität (Beck-Depressions-Inventar II [BDI-II], Gesundheitsfragebogen für Patienten [PHQ]), Ängstlichkeit und Somatisierung (PHQ), BPS-spezifischer Symptomatik (Borderline-Symptom-Liste, BSL) sowie gesundheitsbezogener Lebensqualität (Kurzform des Fragebogens zum Gesundheitszustand, SF-12) zu Behandlungsbeginn und bei Abschluss einer Dialektisch-Behavioralen Therapie analysiert. Weil sich Frauen und Männer in Symptomschwere und Häufigkeit verschiedener Kindheitstraumatisierungen unterscheiden, erfolgten geschlechtsdifferenzielle Analysen. Bei Patientinnen trugen Kindheitstraumatisierungen bis maximal knapp 7 % zur Varianzaufklärung der Symptombelastung bei Aufnahme bei; lediglich emotionaler Missbrauch hatte einen signifikanten und unabhängigen Einfluss. Bei Männern fanden sich keine relevanten Zusammenhänge zwischen dem CTQ und den Ergebnismaßen. Weder bei Männern noch bei Frauen wirkten sich Kindheitstraumatisierungen auf das symptombezogene Behandlungsergebnis aus. Die Ergebnisse werden im Kontext der bisherigen Befundlage zum Zusammenhang zwischen Kindheitstraumatisierungen, Symptomschwere und Therapieergebnis bei psychischen Störungen im Allgemeinen und der BPS im Besonderen diskutiert.
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Mainali P, Rai T, Rutkofsky IH. From Child Abuse to Developing Borderline Personality Disorder Into Adulthood: Exploring the Neuromorphological and Epigenetic Pathway. Cureus 2020; 12:e9474. [PMID: 32874803 PMCID: PMC7455386 DOI: 10.7759/cureus.9474] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/30/2020] [Indexed: 01/01/2023] Open
Abstract
Borderline personality disorder (BPD) is one of the most common personality disorders seen in the general population. Among multiple identified risk factors, one of the most influential elements is exposure to an adverse childhood experience in terms of emotional, physical, or sexual abuse. A cascade of neuromorphological and epigenetic changes occurs in response to these childhood stressors, which may have a strong link to the development of BPD. PubMed and Google Scholar were searched for articles relevant to child abuse and the development of BPD. The search was not restricted to any time frame or geographic location. Significant epigenetic and neuromorphological changes are seen with child abuse, contributing to the development of BPD. Chronic stressors lead to hypothalamic-pituitary axis (HPA) activation, releasing cortisol that acts on the prefrontal cortex, amygdala, and hippocampus, producing the behavioral patterns seen in BPD. Overstimulation of gray matter leads to permanent neuromorphological changes, which can be visualized in functional MRI/brain scans. Hypermethylation of messenger ribonucleic acid in various sites suggests the impact of child abuse on the genetic level. Interestingly, the prevalence of BPD is seen equally in both genders but is diagnosed more frequently in females because they tend to be more likely to seek help. Understanding the impact of early age life stressors into adulthood calls for serious focus on early diagnosis and intervention. This implies the need for more studies in patients with BPD with or without any childhood traumatic experience and a better understanding of the changes that occur biopsychologically and genetically in response to trauma.
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Affiliation(s)
- Pranita Mainali
- Psychiatry, Washington DC Veterans Affairs Medical Center, Washington, DC, USA
- Psychiatry, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Tehrima Rai
- Pediatrics, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ian H Rutkofsky
- Psychiatry, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Mertens Y, Yılmaz M, Lobbestael J. Schema modes mediate the effect of emotional abuse in childhood on the differential expression of personality disorders. CHILD ABUSE & NEGLECT 2020; 104:104445. [PMID: 32278927 DOI: 10.1016/j.chiabu.2020.104445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 02/10/2020] [Accepted: 03/01/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND There is sound evidence that childhood maltreatment increases the likelihood of developing personality disorders (PDs). However, research on the possible mechanisms involved in the relationship between childhood maltreatment and PDs is scarce. One potential mediator of the maltreatment-PD relationship are schema modes, reflecting dynamic states of cognition, emotion, and behaviour. AIMS The current study aimed to explore the mediating effect of schema modes on the association between childhood maltreatment and the expression of Cluster B (borderline and antisocial) and C (avoidant and dependent) PDs. METHOD Within a mixed sample of N = 120 clinical PD patients and non-clinical participants, a multivariate path model including interview-assessed childhood maltreatment (emotional abuse, emotional neglect, sexual abuse, and physical abuse), schema modes (child, parent, coping and healthy modes), and borderline, antisocial, avoidant and dependent PDs was explored. RESULTS The path model depicted five significant indirect links from emotional abuse on PDs via distinct schema modes. The impact of emotional abuse on borderline PD was mediated by child and coping modes, while parent modes mediated the link to antisocial PD. Healthy modes acted as a mediator on dependent and avoidant PDs. CONCLUSIONS The results indicate emotional abuse as a main predictor of schema mode clusters and emphasize the mediating role of schema modes on the maltreatment-related pathways towards PDs. Therapeutic implications are discussed with a special focus on healthy modes.
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Affiliation(s)
- Yoki Mertens
- Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
| | - Meltem Yılmaz
- Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
| | - Jill Lobbestael
- Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands.
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16
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Taka-Eilola Nèe Riekki T, Veijola J, Miettunen J, Koskela J, Kantojärvi L, Mäki P. Antisocial and borderline personality disorders in the offspring of antenatally depressed mothers - a follow-up until mid-adulthood in the Northern Finland 1966 birth cohort. Nord J Psychiatry 2020; 74:138-146. [PMID: 31647361 DOI: 10.1080/08039488.2019.1681508] [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] [Indexed: 01/22/2023]
Abstract
Background: Maternal depression is common during pregnancy, affecting 10-15% of mothers. In previous reports, the offspring of antenatally depressed mothers have had an elevated risk for antisocial, criminal and violent behaviour in adolescence, and for borderline personality features in childhood, but long-term outcomes are unknown.Aims: To study whether the adult offspring of antenatally depressed mothers have an elevated risk for antisocial (ASPD) or borderline personality disorder (BPD) when followed until mid-adulthood.Methods: In the general population-based Northern Finland 1966 Birth Cohort, mothers of 12,058 children were asked during mid-gestation if they felt depressed. Of the mothers, 14% reported being depressed. The offspring were followed for 49 years. The diagnoses of in- and outpatient-treated ASPD and BPD in the offspring were detected using the Finnish Care Register for Healthcare. Maternal antenatal smoking, newborn´s low birthweight or short gestational age, father's social class, and family type at birth were considered as confounding variables. Logistic regression analyses on the potential confounders were performed. Maternal postnatal depression and paternal ASPD information was not available.Results: In the male offspring of antenatally depressed mothers, the risk for ASPD was elevated (adjusted odds ratio 5.6; 95% confidence interval 1.8-17.8), but not in female offspring. The risk for BPD was not elevated in the offspring of antenatally depressed mothers in this study.Conclusions: The sons of antenatally depressed mothers had an increased risk for ASPD. Prevention and treatment of antenatal depression might present an opportunity to decrease the risk of antisocial personality in the offspring.
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Affiliation(s)
- Tiina Taka-Eilola Nèe Riekki
- Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland.,Basic Health Care District of Kallio, Finland
| | - Juha Veijola
- Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland.,Department of Psychiatry, Oulu University Hospital, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Jouko Miettunen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Jari Koskela
- Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland
| | - Liisa Kantojärvi
- Department of Psychiatry, Oulu University Hospital, Oulu, Finland
| | - Pirjo Mäki
- Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland.,Department of Psychiatry, Oulu University Hospital, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Department of Psychiatry, Länsi-Pohja Healthcare District, Kemi, Finland.,Department of Psychiatry, The Middle Ostrobothnia Central Hospital, Soite Mental Health Services, Joint Municipal Authority of Wellbeing in Raahe District, Mental Health Services and Basic Health Care District of Kallio, Finland.,Department of Psychiatry, Kainuu Central Hospital, Kainuu Social and Healthcare District, Kainuu, Finland
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17
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Garland J, Miller S. Borderline personality disorder: part 1 – assessment and diagnosis. BJPSYCH ADVANCES 2020. [DOI: 10.1192/bja.2019.76] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
SUMMARYGeneral adult psychiatrists are largely responsible for the care of patients with personality disorders in community and in-patient settings, and this can be associated with diagnostic and management challenges. In the first of two articles focusing specifically on borderline personality disorder (BPD), we summarise the core clinical features of the disorder and discuss appropriate diagnostic practice.
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18
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Calvo N, Lara B, Serrat L, Pérez-Rodríguez V, Andión Ò, Ramos-Quiroga JA, Ferrer M. The role of environmental influences in the complex relationship between borderline personality disorder and attention-deficit/hyperactivity disorder: review of recent findings. Borderline Personal Disord Emot Dysregul 2020; 7:2. [PMID: 31921426 PMCID: PMC6945629 DOI: 10.1186/s40479-019-0118-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 12/05/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In recent years, the existence of possible developmental pathways from childhood Attention-Deficit/Hyperactivity Disorder (ADHD) to adult Borderline Personality Disorder (BPD) has been suggested. The existence of common genetic factors has been described but there is little evidence on the role of environmental factors in the possible transition from one disorder to another throughout life. The main goal of this work is to review the literature about the existing evidence on childhood traumas as factors that mediate the risk of developing BPD in children with ADHD. METHODS A literature search was conducted using PubMed, Science Direct and PsychInfo databases. Criteria included studies of BPD and ADHD relationships and childhood traumas as environmental influences from epidemiological or clinical samples. RESULTS The review only identified 4 studies that matched the search criteria. All studies retrospectively analyzed childhood traumas, and adult patients with BPD, with or without comorbid ADHD, were the most frequently mentioned. The analyzed evidence reinforces the relationship between the number of childhood traumas and higher clinical severity. Three of these analyzed studies describe an increased the risk of children with ADHD who report emotional and sexual traumatic experiences to develop BPD in adulthood. CONCLUSIONS The experience of traumatic childhood events, especially those of an emotional type, may have a mediating effect of an increased risk of developing adult BPD in childhood ADHD patients. However, to consider them as risk factors, more studies, and especially longitudinal studies, are necessary to clarify the probable transactional process between the two disorders. Evidence from these studies may be helpful to develop early intervention programs to reduce the functional impairment associated with the two disorders.
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Affiliation(s)
- Natalia Calvo
- 1BPD Program, Psychiatry Department, Hospital Universitary Vall d'Hebron, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.,2Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,3Psychiatry, Mental Health and Addictions Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Grup TLP Barcelona (BPD Barcelona Group), Barcelona, Spain
| | - Benjamin Lara
- 1BPD Program, Psychiatry Department, Hospital Universitary Vall d'Hebron, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.,3Psychiatry, Mental Health and Addictions Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Laia Serrat
- 1BPD Program, Psychiatry Department, Hospital Universitary Vall d'Hebron, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Violeta Pérez-Rodríguez
- 1BPD Program, Psychiatry Department, Hospital Universitary Vall d'Hebron, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Òscar Andión
- 1BPD Program, Psychiatry Department, Hospital Universitary Vall d'Hebron, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Josep A Ramos-Quiroga
- 1BPD Program, Psychiatry Department, Hospital Universitary Vall d'Hebron, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.,2Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,3Psychiatry, Mental Health and Addictions Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Grup TLP Barcelona (BPD Barcelona Group), Barcelona, Spain
| | - Marc Ferrer
- 1BPD Program, Psychiatry Department, Hospital Universitary Vall d'Hebron, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.,2Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,3Psychiatry, Mental Health and Addictions Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Grup TLP Barcelona (BPD Barcelona Group), Barcelona, Spain
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19
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Kart A, Türkçapar H. The effects of childhood emotional abuse on aggressive obsessions among patients with obsessive compulsive disorder may be mediated by symptoms of depression and anxiety. PSYCHIAT CLIN PSYCH 2019. [DOI: 10.1080/24750573.2019.1636483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Ayşegül Kart
- Pscyhiatry Department, Bakırköy Mazhar Osman Mental Health and Neurological Diseases Education and Research Hospital, Istanbul, Turkey
| | - Hakan Türkçapar
- Psychology Department, Hasan Kalyoncu University, Gaziantep, Turkey
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20
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Hörberg N, Kouros I, Ekselius L, Cunningham J, Willebrand M, Ramklint M. Early Trauma Inventory Self-Report Short Form (ETISR-SF): validation of the Swedish translation in clinical and non-clinical samples. Nord J Psychiatry 2019; 73:81-89. [PMID: 30900487 DOI: 10.1080/08039488.2018.1498127] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE Childhood trauma in an important public health concern, and there is a need for brief and easily administered assessment tools. The Early Trauma Inventory (ETI) is one such instrument. The aim of this paper is to test the psychometric properties of the Swedish translation of the short, self-rated version (ETISR-SF), and to further validate the instrument. MATERIALS AND METHODS In this cross-sectional study, 243 psychiatric patients from an open care unit in Sweden and 56 controls were recruited. Participants were interviewed and thereafter completed the ETISR-SF. Internal consistency was calculated using Cronbach's alpha, a confirmatory factor analysis (CFA) was performed and goodness-of-fit was determined. Intra Class Correlation (ICC) was used to calculate test-retest reliability. Discriminant validity between groups was gauged using the Mann-Whitney U-test. RESULTS Cronbach's alpha varied between 0.55 and 0.76, with higher values in clinical samples than in controls. Of the four domains, general trauma showed a lower alpha than the other domains. The CFA confirmed the four-factor model previously seen and showed good to acceptable fit. The ICC value was 0.93, indicating good test-retest reliability. According to the Mann-Whitney U-test, the non-clinical sample differed significantly from the clinical sample, as did those with PTSD or borderline diagnosis from those without these diagnoses. CONCLUSIONS The Swedish translation of the ETISR-SF was found to have similar psychometric properties as both the original version and translations. ETISR-SF scores could also distinguish between different diagnostic groups associated with various degrees of trauma, which supports its discriminant validity.
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Affiliation(s)
- Niklas Hörberg
- a Department of Neuroscience, Psychiatry , Uppsala University , Uppsala , Sweden
| | - Ioannis Kouros
- a Department of Neuroscience, Psychiatry , Uppsala University , Uppsala , Sweden
| | - Lisa Ekselius
- a Department of Neuroscience, Psychiatry , Uppsala University , Uppsala , Sweden
| | - Janet Cunningham
- a Department of Neuroscience, Psychiatry , Uppsala University , Uppsala , Sweden
| | - Mimmie Willebrand
- a Department of Neuroscience, Psychiatry , Uppsala University , Uppsala , Sweden
| | - Mia Ramklint
- a Department of Neuroscience, Psychiatry , Uppsala University , Uppsala , Sweden
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21
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Dell'Osso L, Cremone IM, Carpita B, Dell'Oste V, Muti D, Massimetti G, Barlati S, Vita A, Fagiolini A, Carmassi C, Gesi C. Rumination, posttraumatic stress disorder, and mood symptoms in borderline personality disorder. Neuropsychiatr Dis Treat 2019; 15:1231-1238. [PMID: 31190829 PMCID: PMC6526028 DOI: 10.2147/ndt.s198616] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/07/2019] [Indexed: 01/18/2023] Open
Abstract
Background: The interrelationship between mood disorders and borderline personality disorder (BPD) has been long debated in the literature. Increasing attention has also been paid to the relationship between posttraumatic stress disorder (PTSD) and BPD, as well as to the role of rumination in the development and severity of BPD. This study aims to evaluate the association of rumination, PTSD, and mood spectrum among patients with BPD with or without comorbid mood disorders. Methods: Fifty patients with BPD and 69 healthy controls were assessed with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders 5, Mood Spectrum Self-Report (MOODS-SR), and Ruminative Response Scale (RRS). Results: The BPD group was split into subjects with BPD+ mood disorder (MD) or BPD only) . PTSD-criteria fulfillment, MOODS, and RRS scores were significantly higher in both BPD subgroups than in controls, while BPD+MD patients scored significantly higher than the BPD-only group. RRS scores and PTSD-criteria fulfillment were significantly related to the presence of both BPD and BPD+MD, with no effect of MOODS-SR scores. Conclusion: Our findings confirm the presence of a relationship between BPD and the PTSD spectrum, highlighting also a possible role of rumination in BPD psychopathology. Rumination and PTSD symptoms seem to prevail in the effect of mood spectrum in predicting BPD.
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Affiliation(s)
- Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ivan M Cremone
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Barbara Carpita
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Valerio Dell'Oste
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Dario Muti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gabriele Massimetti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Stefano Barlati
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Andrea Fagiolini
- Department of Mental Health , University of Siena, Siena, Italy.,Department of Molecular Medicine, University of Siena, Siena, Italy
| | - Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Camilla Gesi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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22
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Bozzatello P, Bellino S, Bosia M, Rocca P. Early Detection and Outcome in Borderline Personality Disorder. Front Psychiatry 2019; 10:710. [PMID: 31649564 PMCID: PMC6794381 DOI: 10.3389/fpsyt.2019.00710] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 09/04/2019] [Indexed: 01/24/2023] Open
Abstract
Borderline personality disorder (BPD) is a severe and heterogeneous mental disorder that is known to have the onset in young age, often in adolescence. For this reason, it is of fundamental importance to identify clinical conditions of childhood and adolescence that present a high risk to evolve in BPD. Investigations indicate that early borderline pathology (before 19 years) predict long-term deficits in functioning, and a higher percentage of these patients continue to present some BPD symptoms up to 20 years. There is a general accordance among investigators that good competence in both childhood and early adulthood is the main predictive factor of excellent recovery in BPD patients. Some authors suggest that specific childhood personality traits can to be considered precursors of adult BPD, as well as some clinical conditions: disruptive behaviours, disturbance in attention and emotional regulation, conduct disorders, substance use disorders, and attention-deficit-hyperactivity disorder. Unfortunately, diagnosis and treatment of BPD is usually delayed, also because some clinicians are reluctant to diagnose BPD in younger individuals. Instead, the early identification of BPD symptoms have important clinical implications in terms of precocious intervention programs, and guarantees that young people with personality disorders obtain appropriate treatments. This review is aimed to collect the current evidences on early risk and protective factors in young people that may predict BPD onset, course, and outcome.
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Affiliation(s)
| | - Silvio Bellino
- Department of Neuroscience, University of Turin, Turin, Italy
| | - Marco Bosia
- Department of Neuroscience, University of Turin, Turin, Italy
| | - Paola Rocca
- Department of Neuroscience, University of Turin, Turin, Italy
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23
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Abstract
PURPOSE OF REVIEW We review the existing literature on gene-environment interactions (G×E) and epigenetic changes primarily in borderline personality disorder (BPD) but also in antisocial, schizotypal, and avoidant personality disorders. RECENT FINDINGS Research supports that susceptibility genes to BPD or its underlying traits may be expressed under certain environmental conditions such as physical or childhood sexual abuse. Epigenetic modifications of neurodevelopment- and stress-related genes are suggested to underlie the relationship between early life adversary and borderline personality disorder. Only limited studies have investigated the role of gene-environment interactions and epigenetic changes in the genesis of antisocial, schizotypal, and avoidant personality disorders. Considering the lack of pharmacological treatment for most personality disorders, the emerging evidence on the critical role of G×E and epigenetic changes in the genesis of personality disorders could help develop more biologically oriented therapeutic approaches. Future studies should explore the potential of this new therapeutic dimension.
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Moran LR, Kaplan C, Aguirre B, Galen G, Stewart JG, Tarlow N, Auerbach RP. Treatment Effects following Residential Dialectical Behavior Therapy for Adolescents with Borderline Personality Disorder. ACTA ACUST UNITED AC 2018; 3:117-128. [PMID: 30778398 DOI: 10.1080/23794925.2018.1476075] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Dialectical behavior therapy (DBT) is an empirically supported treatment for borderline personality disorder (BPD) in adults, however fewer studies have examined outcomes in adolescents. This study tested the effectiveness of an intensive 1-month, residential DBT treatment for adolescent girls meeting criteria for BPD. Additionally, given well-established associations between BPD symptoms and childhood abuse, the impact of abuse on treatment outcomes was assessed. Participants were female youth (n = 53) aged 13-20 years (M = 17.00, SD = 1.89) completing a 1-month residential DBT program. At pre-treatment, participants were administered a diagnostic interview and self-report measures assessing BPD, depression, and anxiety symptom severity. Following one month of treatment, participants were re-administered the self-report instruments. Results showed significant pre- to post-treatment reductions in both BPD and depression symptom severity with large effects. However, there was no significant change in general anxious distress or anxious arousal over time. The experience of childhood abuse (sexual, physical, or both) was tested as moderator of treatment effectiveness. Although experiencing multiple types of abuse was related to symptom severity, abuse did not moderate the effects of treatment. Collectively, results indicate that a 1-month residential DBT treatment with adolescents may result in reductions in BPD and depression severity but is less effective for anxiety. Moreover, while youth reporting abuse benefitted from treatment, they were less likely to achieve a clinically significant reduction in symptoms.
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Affiliation(s)
- Lyndsey R Moran
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Cynthia Kaplan
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Blaise Aguirre
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Gillian Galen
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Jeremy G Stewart
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Naomi Tarlow
- Department of Psychology, University of Miami, FL, USA
| | - Randy P Auerbach
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA.,Department of Psychiatry, Columbia University, New York, NY, USA.,Division of Clinical Developmental Neuroscience, Sackler Institute, New York, NY, USA
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25
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de Aquino Ferreira LF, Queiroz Pereira FH, Neri Benevides AML, Aguiar Melo MC. Borderline personality disorder and sexual abuse: A systematic review. Psychiatry Res 2018; 262:70-77. [PMID: 29407572 DOI: 10.1016/j.psychres.2018.01.043] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 12/21/2017] [Accepted: 01/21/2018] [Indexed: 01/14/2023]
Abstract
Although sexual abuse (SA) is known to be frequent among borderline personality disorder (BPD) patients, few reviews evaluating that relationship have been published. This systematic review aimed to investigate SA (including adulthood) as a predictor of BPD diagnosis, clinical presentation and prognosis. Studies written in English or Portuguese from January 1997 until January 2017 were identified by searching the following keywords in three international databases: "borderline personality disorder" OR "borderline disorder" AND "sexual abuse" OR "sexual violence" OR "sexual victimization" OR "sexual assault" OR "rape". Forty articles met the eligibility criteria. Overall, SA was found to play a major role in BPD, particularly in women. Childhood sexual abuse (CSA) is an important risk factor for BPD. Adult sexual abuse (ASA) rates are significantly higher in BPD patients compared with other personality disorders (PDs). SA history predicts more severe clinical presentation and poorer prognosis. Suicidality has the strongest evidence, followed by self-mutilation, post-traumatic stress disorder (PTSD), dissociation and chronicity of BPD. Future research should study more ASA and include more males, milder BPD patients and documented or corroborated SA cases. The impact of other traumatic experiences (e.g., emotional abuse) on BPD must also be systematically reviewed.
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26
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Tan RY, Grigg J, Kulkarni J. Borderline personality disorder and polycystic ovary syndrome: A review of the literature. Aust N Z J Psychiatry 2018; 52:117-128. [PMID: 28891300 DOI: 10.1177/0004867417730650] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE This review examines the existing evidence for the relationship between borderline personality disorder and polycystic ovary syndrome, and to identify commonalities in etiological mechanisms of borderline personality disorder and polycystic ovary syndrome that might explain the relationship between these seemingly disparate disorders. METHODS A search of Medline, EMBASE and Cochrane Central was undertaken on 5 December 2016 to identify studies investigating women with borderline personality disorder and polycystic ovary syndrome (or symptoms and markers specific to polycystic ovary syndrome). RESULTS Nine studies were identified, including three cross-sectional studies investigating symptoms of polycystic ovary syndrome in women with borderline personality disorder, two cross-sectional and one cohort study examining the prevalence of psychiatric diagnoses in women with polycystic ovary syndrome and three case reports of comorbid borderline personality disorder and polycystic ovary syndrome. CONCLUSION Overall, the literature shows women with borderline personality disorder to have higher than expected serum androgen levels and incidence of polycystic ovaries, which can be key features of polycystic ovary syndrome. However, this research is still in its infancy, which limits our understanding of this potential comorbid phenomenon. Given the emerging anecdotal and empirical evidence to date, a theoretical discussion of the potential psychoneuroendocrinological mechanism underlying the borderline personality disorder and polycystic ovary syndrome comorbidity is provided. Further rigorous studies using standardized diagnostic criteria for polycystic ovary syndrome are warranted. Specifically, the use of prospective controlled cohort studies may be able to determine the causality and temporality of observed comorbid borderline personality disorder and polycystic ovary syndrome.
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Affiliation(s)
- Raelene Ym Tan
- 1 Monash Alfred Psychiatry Research Centre (MAPrc), Melbourne, VIC, Australia.,2 Monash University, Melbourne, VIC, Australia
| | - Jasmin Grigg
- 1 Monash Alfred Psychiatry Research Centre (MAPrc), Melbourne, VIC, Australia
| | - Jayashri Kulkarni
- 1 Monash Alfred Psychiatry Research Centre (MAPrc), Melbourne, VIC, Australia
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27
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Karmakar M, Elhai JD, Amialchuk AA, Tietjen GE. Do Personality Traits Mediate the Relationship Between Childhood Abuse and Migraine? An Exploration of the Relationships in Young Adults Using the Add Health Dataset. Headache 2017; 58:243-259. [DOI: 10.1111/head.13206] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Monita Karmakar
- Department of Neurology; University of Toledo; Toledo OH USA
- School of Population Health; University of Toledo; Toledo, OH USA
| | - Jon D. Elhai
- Department of Psychology; University of Toledo; Toledo OH USA
- Department of Psychiatry; University of Toledo; Toledo OH USA
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Ferrer M, Andión Ó, Calvo N, Ramos-Quiroga JA, Prat M, Corrales M, Casas M. Differences in the association between childhood trauma history and borderline personality disorder or attention deficit/hyperactivity disorder diagnoses in adulthood. Eur Arch Psychiatry Clin Neurosci 2017; 267:541-549. [PMID: 27658669 DOI: 10.1007/s00406-016-0733-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 09/09/2016] [Indexed: 12/01/2022]
Abstract
Common environmental etiological factors between borderline personality disorder (BPD) and attention deficit/hyperactivity disorder (ADHD) have not been fully studied. The main aim of this study was to investigate the relationship between childhood trauma histories, assessed by the Childhood Trauma Questionnaire-Short Form (CTQ-SF), with adult BPD, ADHD or BPD-ADHD diagnoses. Comorbid BPD-ADHD patients exhibited significantly higher clinical severity and higher scores in the Total Neglect Scale, compared to BPD and ADHD patients, and only a marginal difference was observed for Sexual Abuse when BPD and ADHD patients were compared. Physical Trauma Scales were associated with ADHD diagnosis, whereas Emotional Abuse and Sexual Abuse Scales were associated with BPD or BPD-ADHD diagnoses. The study findings support the association between experiencing traumatic events in childhood and a higher clinical severity of BPD in adulthood. Furthermore, physical trauma history in childhood could be associated with the persistence of ADHD in adulthood and emotional or sexual abuse with later development of BPD or comorbid BPD-ADHD. Whereas experiencing childhood traumas is associated with later development of more general psychopathology, our study supports that a specific type of traumatic event could increase the risk for the consolidation of a concrete psychiatric disorder in the trajectory from childhood to adulthood of vulnerable subjects.
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Affiliation(s)
- Marc Ferrer
- BPD Program, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Psychiatry Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain. .,Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain. .,Grup TLP Barcelona (BPD Barcelona Group), Barcelona, Spain.
| | - Óscar Andión
- BPD Program, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Psychiatry Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Natalia Calvo
- BPD Program, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Psychiatry Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain.,Grup TLP Barcelona (BPD Barcelona Group), Barcelona, Spain
| | - Josep A Ramos-Quiroga
- BPD Program, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Psychiatry Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mònica Prat
- BPD Program, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Psychiatry Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain.,Grup TLP Barcelona (BPD Barcelona Group), Barcelona, Spain
| | - Montserrat Corrales
- BPD Program, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Psychiatry Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Miguel Casas
- BPD Program, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Psychiatry Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain.,Grup TLP Barcelona (BPD Barcelona Group), Barcelona, Spain
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Cattane N, Rossi R, Lanfredi M, Cattaneo A. Borderline personality disorder and childhood trauma: exploring the affected biological systems and mechanisms. BMC Psychiatry 2017; 17:221. [PMID: 28619017 PMCID: PMC5472954 DOI: 10.1186/s12888-017-1383-2] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 06/06/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND According to several studies, the onset of the Borderline Personality Disorder (BPD) depends on the combination between genetic and environmental factors (GxE), in particular between biological vulnerabilities and the exposure to traumatic experiences during childhood. We have searched for studies reporting possible alterations in several biological processes and brain morphological features in relation to childhood trauma experiences and to BPD. We have also looked for epigenetic mechanisms as they could be mediators of the effects of childhood trauma in BPD vulnerability. DISCUSSION We prove the role of alterations in Hypothalamic-Pituitary-Adrenal (HPA) axis, in neurotrasmission, in the endogenous opioid system and in neuroplasticity in the childhood trauma-associated vulnerability to develop BPD; we also confirm the presence of morphological changes in several BPD brain areas and in particular in those involved in stress response. Not so many studies are available on epigenetic changes in BPD patients, although these mechanisms are widely investigated in relation to stress-related disorders. A better comprehension of the biological and epigenetic mechanisms, affected by childhood trauma and altered in BPD patients, could allow to identify "at high risk" subjects and to prevent or minimize the development of the disease later in life.
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Affiliation(s)
- Nadia Cattane
- grid.419422.8Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio - Fatebenefratelli, via Pilastroni 4, Brescia, Italy
| | - Roberta Rossi
- grid.419422.8Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio - Fatebenefratelli, via Pilastroni 4, Brescia, Italy
| | - Mariangela Lanfredi
- grid.419422.8Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio - Fatebenefratelli, via Pilastroni 4, Brescia, Italy
| | - Annamaria Cattaneo
- Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio - Fatebenefratelli, via Pilastroni 4, Brescia, Italy. .,Stress, Psychiatry and Immunology Laboratory, Department of Psychological Medicine, Institute of Psychiatry, King's College London, 125 Coldharbour Lane, London, SE5 9NU, UK. .,Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 125 Coldharbour Lane, London, SE5 9NU, UK.
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Relationships between self-reported childhood traumatic experiences, attachment style, neuroticism and features of borderline personality disorders in patients with mood disorders. J Affect Disord 2017; 210:82-89. [PMID: 28024223 DOI: 10.1016/j.jad.2016.12.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 11/17/2016] [Accepted: 12/12/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Co-occurring borderline personality disorder (BPD) features have a marked impact on treatment of patients with mood disorders. Overall, high neuroticism, childhood traumatic experiences (TEs) and insecure attachment are plausible aetiological factors for BPD. However, their relationship with BPD features specifically among patients with mood disorders remains unclear. We investigated these relationships among unipolar and bipolar mood disorder patients. METHODS As part of the Helsinki University Psychiatric Consortium study, the McLean Screening Instrument (MSI), the Experiences in Close Relationships-Revised (ECR-R), the Short Five (S5) and the Trauma and Distress Scale (TADS) were filled in by patients with mood disorders (n=282) in psychiatric care. Correlation coefficients between total scores of scales and their dimensions were estimated, and multivariate regression (MRA) and mediation analyses were conducted. RESULTS Spearman's correlations were strong (rho=0.58; p<0.001) between total scores of MSI and S5 Neuroticism and moderate (rho=0.42; p<0.001) between MSI and TADS as well as between MSI and ECR-R Attachment Anxiety. In MRA, young age, S5 Neuroticism and TADS predicted scores of MSI (p<0.001). ECR-R Attachment Anxiety mediated 33% (CI=17-53%) of the relationships between TADS and MSI. LIMITATIONS Cross-sectional questionnaire study. CONCLUSIONS We found moderately strong correlations between self-reported BPD features and concurrent high neuroticism, reported childhood traumatic experiences and Attachment Anxiety also among patients with mood disorders. Independent predictors for BPD features include young age, frequency of childhood traumatic experiences and high neuroticism. Insecure attachment may partially mediate the relationship between childhood traumatic experiences and borderline features among mood disorder patients.
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31
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Frias A, Palma C, Farriols N, Gonzalez L, Horta A. Anxious adult attachment may mediate the relationship between childhood emotional abuse and borderline personality disorder. Personal Ment Health 2016; 10:274-284. [PMID: 27604841 DOI: 10.1002/pmh.1348] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 05/16/2016] [Accepted: 08/17/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Childhood trauma has been associated with borderline personality disorder (BPD). However, research has not yet provided conclusive evidence concerning the mediating mechanisms. METHODS Seventy women diagnosed with BPD were compared with other 60 women who met DSM-IV criteria for other personality disorders on measures of childhood trauma and attachment. RESULTS Patients with BPD reported higher severity of emotional, physical and sexual abuse than patients with other personality disorders. Moreover, BPD patients also showed greater preoccupied-anxious adult attachment. At model 1, logistic regression analysis revealed that only childhood emotional abuse predicted the occurrence of BPD. At model 2, this association was no longer significant, and the addition of preoccupied-anxious adult attachment was significantly associated with a greater likelihood of BPD diagnosis. CONCLUSIONS These findings support a specific relationship between childhood emotional abuse and the occurrence of BPD, which may be accounted for by preoccupied-anxious adult attachment. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
| | | | | | - Laura Gonzalez
- Consorci Sanitari del Maresme, Centro de Salud Mental de Adultos de Mataro, Mataro, Spain
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32
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Wlodarczyk J, Lawn S. The developmental trajectory of Borderline personality disorder and peer victimisation: Australian family carers’ perspectives. EMOTIONAL AND BEHAVIOURAL DIFFICULTIES 2016. [DOI: 10.1080/13632752.2016.1243360] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Julian Wlodarczyk
- School of Medicine, Faculty of Medicine, Nursing and Allied Health, Flinders University, Adelaide, Australia
| | - Sharon Lawn
- Flinders Human Behaviour and Health Research Unit, Department of Psychiatry, School of Medicine, Nursing and Allied Health, Flinders University, Adelaide, Australia
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Utzinger LM, Haukebo JE, Simonich H, Wonderlich SA, Cao L, Lavender JM, Mitchell JE, Engel SG, Crosby RD. A latent profile analysis of childhood trauma in women with bulimia nervosa: Associations with borderline personality disorder psychopathology. Int J Eat Disord 2016; 49:689-94. [PMID: 27038436 PMCID: PMC5268761 DOI: 10.1002/eat.22532] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 02/10/2016] [Accepted: 02/13/2016] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The aim of this study was to empirically examine naturally occurring groups of individuals with bulimia nervosa (BN) based on their childhood trauma (CT) histories and to compare these groups on a clinically relevant external validator, borderline personality disorder (BPD) psychopathology. METHOD This study examined the relationship between CT and BPD psychopathology among 133 women with BN using latent profile analysis (LPA) to classify participants based on histories of CT. Participants completed the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I/P), the Diagnostic Interview for Borderlines-Revised (DIB-R), and the Childhood Trauma Questionnaire (CTQ). RESULTS The LPA revealed four trauma profiles: low/no trauma, emotional trauma, sexual trauma, and polytrauma. Results indicated that the sexual and polytrauma profiles displayed significantly elevated scores on the DIB-R and that the low/no and emotional trauma profiles did not differ significantly on the DIB-R. Secondary analyses revealed elevated levels of a composite CT score among those with both BN and BPD psychopathology compared to those with BN only. DISCUSSION These findings suggest that both childhood sexual abuse and the additive effects of childhood polytrauma may be linked to BPD psychopathology in BN. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:689-694).
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Affiliation(s)
- Linsey M. Utzinger
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND,Department of Clinical Neuroscience, University of North Dakota School of Medicine and Heath Sciences, Fargo, ND,Correspondence concerning this article should be addressed to Linsey M. Utzinger, Neuropsychiatric Research Institute, 120 South 8th Street, Fargo, ND 58103.
| | - Justine E. Haukebo
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND
| | - Heather Simonich
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND
| | - Stephen A. Wonderlich
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND,Department of Clinical Neuroscience, University of North Dakota School of Medicine and Heath Sciences, Fargo, ND
| | - Li Cao
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND
| | - Jason M. Lavender
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND,Department of Clinical Neuroscience, University of North Dakota School of Medicine and Heath Sciences, Fargo, ND
| | - James E. Mitchell
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND,Department of Clinical Neuroscience, University of North Dakota School of Medicine and Heath Sciences, Fargo, ND
| | - Scott G. Engel
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND,Department of Clinical Neuroscience, University of North Dakota School of Medicine and Heath Sciences, Fargo, ND
| | - Ross D. Crosby
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND,Department of Clinical Neuroscience, University of North Dakota School of Medicine and Heath Sciences, Fargo, ND
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The role of hypothalamus-pituitary-adrenal genes and childhood trauma in borderline personality disorder. Eur Arch Psychiatry Clin Neurosci 2016; 266:307-16. [PMID: 26182893 DOI: 10.1007/s00406-015-0612-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 06/29/2015] [Indexed: 12/22/2022]
Abstract
Current knowledge suggests that borderline personality disorder (BPD) results from the interaction between genetic and environmental factors. Research has mainly focused on monoaminergic genetic variants and their modulation by traumatic events, especially those occurring during childhood. However, to the best of our knowledge, there are no studies on the genetics of hypothalamus-pituitary-adrenal (HPA) axis, despite its vulnerability to early stress and its involvement in BPD pathogenesis. The aim of this study was to investigate the contribution of genetic variants in the HPA axis and to explore the modulating effect of childhood trauma in a large sample of BPD patients and controls. DNA was obtained from a sample of 481 subjects with BPD and 442 controls. Case-control differences in allelic frequencies of 47 polymorphisms in 10 HPA axis genes were analysed. Modulation of genetic associations by the presence of childhood trauma was also investigated by dividing the sample into three groups: BPD with trauma, BPD without trauma and controls. Two FKBP5 polymorphisms (rs4713902-C and rs9470079-A) showed significant associations with BPD. There were also associations between BPD and haplotype combinations of the genes FKBP5 and CRHR1. Two FKBP5 alleles (rs3798347-T and rs10947563-A) were more frequent in BPD subjects with history of physical abuse and emotional neglect and two CRHR2 variants (rs4722999-C and rs12701020-C) in BPD subjects with sexual and physical abuse. Our findings suggest a contribution of HPA axis genetic variants to BPD pathogenesis and reinforce the hypothesis of the modulating effect of childhood trauma in the development of this disorder.
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Feliu-Soler A, Pascual JC, Elices M, Martín-Blanco A, Carmona C, Cebolla A, Simón V, Soler J. Fostering Self-Compassion and Loving-Kindness in Patients With Borderline Personality Disorder: A Randomized Pilot Study. Clin Psychol Psychother 2016; 24:278-286. [DOI: 10.1002/cpp.2000] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 12/03/2015] [Accepted: 12/07/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Albert Feliu-Soler
- Servei de Psiquiatria; Hospital de la Santa Creu i SantPau; Barcelona Spain
- Institut d'Investigació Biomèdica SantPau-IIB SantPau; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM; Spain
- Universitat Autònoma de Barcelona; Barcelona Spain
| | - Juan Carlos Pascual
- Servei de Psiquiatria; Hospital de la Santa Creu i SantPau; Barcelona Spain
- Institut d'Investigació Biomèdica SantPau-IIB SantPau; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM; Spain
- Universitat Autònoma de Barcelona; Barcelona Spain
| | - Matilde Elices
- Servei de Psiquiatria; Hospital de la Santa Creu i SantPau; Barcelona Spain
- Institut d'Investigació Biomèdica SantPau-IIB SantPau; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM; Spain
- Universitat Autònoma de Barcelona; Barcelona Spain
- Programa de Cognición. Instituto de Fundamentos y Métodos en Psicología, Facultad de Psicología; Universidad de la República; Uruguay
| | - Ana Martín-Blanco
- Servei de Psiquiatria; Hospital de la Santa Creu i SantPau; Barcelona Spain
- Institut d'Investigació Biomèdica SantPau-IIB SantPau; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM; Spain
- Universitat Autònoma de Barcelona; Barcelona Spain
| | - Cristina Carmona
- Servei de Psiquiatria; Hospital de la Santa Creu i SantPau; Barcelona Spain
- Institut d'Investigació Biomèdica SantPau-IIB SantPau; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM; Spain
- Universitat Autònoma de Barcelona; Barcelona Spain
| | - Ausiàs Cebolla
- Departament de Personalitat, Avaluació i Tractaments Psicològics; Universitat de València; Spain
- CIBER Fisiopatología de la Obesidad y la Nutrición; CIBEROBN Santiago de Compostela; Spain
| | | | - Joaquim Soler
- Servei de Psiquiatria; Hospital de la Santa Creu i SantPau; Barcelona Spain
- Institut d'Investigació Biomèdica SantPau-IIB SantPau; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM; Spain
- Universitat Autònoma de Barcelona; Barcelona Spain
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36
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Corcos M. Actualités 2015 autour du trouble de la personnalité borderline. Eur Psychiatry 2015. [DOI: 10.1016/j.eurpsy.2015.09.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Le trouble borderline est le plus fréquent des troubles de la personnalité, et sa prise en charge reste un enjeu majeur pour les psychiatres d’adultes, mais aussi pour les psychiatres d’adolescents et d’enfants. Le trouble borderline, même s’il trouve pour partie son étiopathogénie dans certaines anomalies génétiques, est aussi profondément caractérisé par des facteurs environnementaux précoces de l’enfance. Nous commenterons les études les plus récentes qui, via une conception plus dimensionnelle du trouble, retrouvent un continuum entre les adultes borderline et certaines anomalies développementales chez l’enfant. Nous ferons également une description plus précise des profils de ces enfants, illustrant certaines données sur les fondements étiologiques du trouble borderline, et nous discuterons des possibilités de prévention de ce trouble. Les troubles liés à l’utilisation de substances sont une des comorbidités les plus fréquentes chez les adolescents présentant un trouble de la personnalité borderline, compliquant le suivi de ces jeunes patients, et pouvant entraîner retrait social et désinvestissement scolaire. Nous détaillerons la prévalence des différents troubles liés à l’utilisation de substances chez les adolescents borderline de notre étude, en comparant nos résultats à ceux décrits dans la littérature internationale. Les tentatives de suicide constituent une préoccupation constante pour les cliniciens, mais également un problème majeur de santé publique via le surcoût engendré (passages aux urgences, hospitalisations…). Aucun traitement psychotrope n’a prouvé son efficacité dans la prévention des tentatives de suicide chez les patients borderline, et certaines psychothérapies, comme la thérapie dialectique comportementale de M. Linehan, ont été développées spécifiquement diminuer la fréquence des passages à l’acte hétéro-agressifs de ces patients. Nous présenterons un dispositif innovant de prévention reposant sur la mise en place d’une permanence téléphonique spécifiquement dédiée à ces patients borderline adultes.
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Elices M, Pascual JC, Carmona C, Martín-Blanco A, Feliu-Soler A, Ruiz E, Gomà-i-Freixanet M, Pérez V, Soler J. Exploring the relation between childhood trauma, temperamental traits and mindfulness in borderline personality disorder. BMC Psychiatry 2015; 15:180. [PMID: 26220555 PMCID: PMC4518520 DOI: 10.1186/s12888-015-0573-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Deficits in mindfulness-related capacities have been described in borderline personality disorder (BPD). However, little research has been conducted to explore which factors could explain these deficits. This study assesses the relationship between temperamental traits and childhood maltreatment with mindfulness in BPD. METHODS A total of 100 individuals diagnosed with BPD participated in the study. Childhood maltreatment was assessed using the Childhood Trauma Questionnaire (CTQ-SF), temperamental traits were assessed using the Zuckerman-Khulman Personality Questionnaire (ZKPQ), and mindfulness capabilities were evaluated with the Five Facet Mindfulness Questionnaire (FFMQ). RESULTS Hierarchical regression analyses were performed including only those CTQ-SF and ZKPQ subscales that showed simultaneous significant correlations with mindfulness facets. Results indicated that neuroticism and sexual abuse were predictors of acting with awareness; and neuroticism, impulsiveness and sexual abuse were significant predictors of non-judging. Temperamental traits did not have a moderator effect on the relationship between childhood sexual abuse and mindfulness facets. CONCLUSIONS These results provide preliminary evidence for the effects of temperamental traits and childhood trauma on mindfulness capabilities in BPD individuals. Further studies are needed to better clarify the impact of childhood traumatic experiences on mindfulness capabilities and to determine the causal relations between these variables.
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Affiliation(s)
- Matilde Elices
- Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. .,Institut d'Investigació Biomèdica - Sant Pau (IIB-Sant Pau), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain. .,Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Barcelona, Spain. .,Programa de Cognición. Instituto de Fundamentos y Métodos en Psicología. Facultad de Psicología, Universidad de la República, Montevideo, Uruguay.
| | - Juan C. Pascual
- Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain ,Institut d’Investigació Biomèdica - Sant Pau (IIB-Sant Pau), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain ,Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Carmona
- Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. .,Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Ana Martín-Blanco
- Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. .,Institut d'Investigació Biomèdica - Sant Pau (IIB-Sant Pau), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain. .,Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Albert Feliu-Soler
- Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. .,Institut d'Investigació Biomèdica - Sant Pau (IIB-Sant Pau), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.
| | - Elisabet Ruiz
- Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | | | - Víctor Pérez
- Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. .,Institut d'Investigació Biomèdica - Sant Pau (IIB-Sant Pau), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain. .,Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Joaquim Soler
- Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. .,Institut d'Investigació Biomèdica - Sant Pau (IIB-Sant Pau), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain. .,Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Guo W, Xue JM, Shao D, Long ZT, Cao FL. Effect of the interplay between trauma severity and trait neuroticism on posttraumatic stress disorder symptoms among adolescents exposed to a pipeline explosion. PLoS One 2015; 10:e0120493. [PMID: 25793606 PMCID: PMC4368575 DOI: 10.1371/journal.pone.0120493] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 01/22/2015] [Indexed: 01/16/2023] Open
Abstract
Background While numerous studies have explored relevant factors of posttraumatic stress disorder (PTSD) symptoms, there have been few joint investigations of trauma severity and trait neuroticism on the development of PTSD symptoms. This study aims to assess the involvement and interrelationship of trauma severity and neuroticism in the expression of PTSD symptoms among adolescents exposed to an accidental explosion. Methods Six hundred and sixty-two adolescents were recruited from a junior middle school closest to the 2013 pipeline explosion site in China and were assessed using the Explosion Exposure Questionnaire, the NEO Five Factor Inventory-Neuroticism Subscale (FFI-N), and the PTSD Checklist-Civilian (PCL-C). A battery of hierarchical multiple regression analyses and two-way ANOVAs were performed to examine the effect of trauma severity and trait neuroticism on adolescent PTSD symptoms. Results Eighty-seven adolescents (13.1%) showed PTSD symptoms after the pipeline explosion. Correlation analysis showed that all the factors of explosion exposure and trait neuroticism were positively associated with adolescent PTSD symptoms. Being male and younger was linked to lower risk for PTSD symptoms. The regression models identified explosion exposure and neuroticism as independent risk factors for PTSD symptoms, and the interactions between trait neuroticism and trauma exposure (personal casualty, degree of influence, total traumatic severity) were related to PTSD symptoms. Conclusions The results highlight the role of trauma exposure and trait neuroticism as risk factors for PTSD symptoms. Therefore, the combination of these two factors should be investigated in clinical settings due to an augmented risk for more severe PTSD symptoms.
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Affiliation(s)
- Wei Guo
- School of Nursing, Shandong University, Jinan, Shandong Province, People’s Republic of China
| | - Jiao-Mei Xue
- School of Nursing, Shandong University, Jinan, Shandong Province, People’s Republic of China
| | - Di Shao
- School of Nursing, Shandong University, Jinan, Shandong Province, People’s Republic of China
| | - Zhou-Ting Long
- School of Nursing, Shandong University, Jinan, Shandong Province, People’s Republic of China
| | - Feng-Lin Cao
- School of Nursing, Shandong University, Jinan, Shandong Province, People’s Republic of China
- * E-mail:
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Bungert M, Liebke L, Thome J, Haeussler K, Bohus M, Lis S. Rejection sensitivity and symptom severity in patients with borderline personality disorder: effects of childhood maltreatment and self-esteem. Borderline Personal Disord Emot Dysregul 2015; 2:4. [PMID: 26401307 PMCID: PMC4579499 DOI: 10.1186/s40479-015-0025-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 12/24/2014] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Interpersonal dysfunction in Borderline Personality Disorder (BPD) is characterized by an 'anxious preoccupation with real or imagined abandonment' (DSM-5). This symptom description bears a close resemblance to that of rejection sensitivity, a cognitive affective disposition that affects perceptions, emotions and behavior in the context of social rejection. The present study investigates the level of rejection sensitivity in acute and remitted BPD patients and its relation to BPD symptom severity, childhood maltreatment, and self-esteem. METHODS Data were obtained from 167 female subjects: 77 with acute BPD, 15 with remitted BPD, and 75 healthy controls who were matched with the patients for age and education. The instruments used for assessment were the Rejection Sensitivity Questionnaire, the short version of the Borderline Symptom List, the Childhood Trauma Questionnaire, and the Rosenberg Self-Esteem Scale. RESULTS Both acute and remitted BPD patients had higher scores on the Rejection Sensitivity Questionnaire than did healthy controls. Lower self-esteem was found to be positively correlated with both increased BPD symptom severity and higher rejection sensitivity, and mediated the relation between the two. History of childhood maltreatment did not correlate with rejection sensitivity, BPD symptom severity, or self-esteem. CONCLUSIONS Our findings support the hypothesis that rejection sensitivity is an important component in BPD, even for remitted BPD patients. Level of self-esteem appears to be a relevant factor in the relationship between rejection sensitivity and BPD symptom severity. Therapeutic interventions for BPD would do well to target rejection sensitivity.
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Affiliation(s)
- Melanie Bungert
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Germany, PO Box 12 21 20, 68072 Mannheim, Germany
| | - Lisa Liebke
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Germany, PO Box 12 21 20, 68072 Mannheim, Germany
| | - Janine Thome
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Germany, PO Box 12 21 20, 68072 Mannheim, Germany
| | - Katrin Haeussler
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Germany, PO Box 12 21 20, 68072 Mannheim, Germany
| | - Martin Bohus
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Germany, PO Box 12 21 20, 68072 Mannheim, Germany
| | - Stefanie Lis
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Germany, PO Box 12 21 20, 68072 Mannheim, Germany
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Martín-Blanco A, Ferrer M, Soler J, Salazar J, Vega D, Andión O, Sanchez-Mora C, Arranz MJ, Ribases M, Feliu-Soler A, Pérez V, Pascual JC. Association between methylation of the glucocorticoid receptor gene, childhood maltreatment, and clinical severity in borderline personality disorder. J Psychiatr Res 2014; 57:34-40. [PMID: 25048180 DOI: 10.1016/j.jpsychires.2014.06.011] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 06/11/2014] [Accepted: 06/18/2014] [Indexed: 10/25/2022]
Abstract
The hypothalamus-pituitary-adrenal axis (HPA) is essential in the regulation of stress responses. Increased methylation of the promoter region of the glucocorticoid receptor gene (NR3C1) has been described both in subjects with history of childhood trauma and in patients with Borderline Personality Disorder (BPD). However, no data on the possible association between a higher methylation of this gene and clinical severity is available. The aim of this study was to evaluate the association between NR3C1 methylation status, the history of childhood trauma, and current clinical severity in subjects with BPD. A sample of 281 subjects with BPD (diagnosed by SCID-II and DIB-R semi-structured diagnostic interviews) was recruited. Clinical variables included previous hospitalizations, self-injurious behavior, and self-reported history of childhood trauma. DNA was extracted from peripheral blood. The results indicated a significant positive correlation between NR3C1 methylation status and childhood maltreatment (specifically physical abuse). In addition, a positive correlation between methylation status and clinical severity (DIB-R total score and hospitalizations) was observed. These findings suggest that NR3C1 methylation in subjects with BPD may be associated not only with childhood trauma but also with clinical severity, adding new evidence to the involvement of gene-environment interactions in this disorder.
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Affiliation(s)
- Ana Martín-Blanco
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d'Investigació Biomèdica - Sant Pau (IIB-Sant Pau), Spain; Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona, Spain
| | - Marc Ferrer
- Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona, Spain; Department of Psychiatry, Hospital Universitari de la Vall d'Hebron, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Joaquim Soler
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d'Investigació Biomèdica - Sant Pau (IIB-Sant Pau), Spain; Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona, Spain
| | - Juliana Salazar
- Department of Genetics, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Daniel Vega
- Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona, Spain; Department of Psychiatry, Hospital de Igualada (Consorci Sanitari de l'Anoia), Spain
| | - Oscar Andión
- Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona, Spain; Department of Psychiatry, Hospital Universitari de la Vall d'Hebron, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Cristina Sanchez-Mora
- Psychiatric Genetics Unit, Vall d'Hebron Research Institut, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Maria Jesús Arranz
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d'Investigació Biomèdica - Sant Pau (IIB-Sant Pau), Spain
| | - Marta Ribases
- Psychiatric Genetics Unit, Vall d'Hebron Research Institut, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Albert Feliu-Soler
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d'Investigació Biomèdica - Sant Pau (IIB-Sant Pau), Spain; Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona, Spain
| | - Víctor Pérez
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d'Investigació Biomèdica - Sant Pau (IIB-Sant Pau), Spain; Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona, Spain
| | - Juan Carlos Pascual
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d'Investigació Biomèdica - Sant Pau (IIB-Sant Pau), Spain; Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona, Spain.
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Rosenbach C, Renneberg B. Rejection sensitivity as a mediator of the relationship between experienced rejection and borderline characteristics. PERSONALITY AND INDIVIDUAL DIFFERENCES 2014. [DOI: 10.1016/j.paid.2014.05.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ducasse D, Courtet P, Olié E. Physical and social pains in borderline disorder and neuroanatomical correlates: a systematic review. Curr Psychiatry Rep 2014; 16:443. [PMID: 24633938 DOI: 10.1007/s11920-014-0443-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Borderline personality disorder (BPD) is a common psychiatric disorder, the core features of which are affective dysregulation, identity disturbances, and problems in social interaction, with an intense fear of loss, abandonment, or rejection by social partners. Self-injurious behaviors (SIB), such as superficial cutting, occur in 70-80 % of BPD patients, which are associated with emotional relief. Intriguingly, the majority of BPD patients report reduced or no pain associated with SIB, whereas BPD patients are over-represented in chronic pain patients. Thus, studying pain perception in such patients may help to understand the pathophysiology of BPD, but also the interaction between affective and physical dimensions of pain. We conducted a systematic review dealing with physical and social pains in BPD patients, with a special focus on neuroimaging data. SIB appear to be an inadequate strategy to regulate negative emotions that may be related to social/psychological pain, by increasing dorsolateral prefrontal cortex activation in order to regulate amygdala activation. In addition, abnormal hyperactivation of the insula is a possible trait marker of BPD, and might contribute to modified pain sensitivity. When considering psychological pain in BPD patients, neuroanatomical studies have shown a hyper-responsive subcortical limbic network and a deficient regulatory control system operating through anterior brain regions. Promising therapeutic strategies should target neuroanatomical and neurobiological dysfunctions, which lead to altered pain perception in BPD patients.
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Affiliation(s)
- Déborah Ducasse
- Department of Psychiatric Emergencies and Post Emergencies, Lapeyronie Hospital, Academic Hospital of Montpellier, UM1 University of Montpellier, INSERM U1061, 191 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France,
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