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Moningka H, Mason L. Misperceiving Momentum: Computational Mechanisms of Biased Striatal Reward Prediction Errors in Bipolar Disorder. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2024; 4:100330. [PMID: 39132577 PMCID: PMC11313182 DOI: 10.1016/j.bpsgos.2024.100330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 04/10/2024] [Accepted: 04/16/2024] [Indexed: 08/13/2024] Open
Abstract
Background Dysregulated reward processing and mood instability are core features of bipolar disorder that have largely been considered separately, with contradictory findings. We sought to test a mechanistic account that emphasizes an excessive tendency in bipolar disorder to enter recursive cycles in which reward perception is biased by signals that the environment may be changing for the better or worse. Methods Participants completed a probabilistic reward task with functional magnetic resonance imaging. Using an influential computational model, we ascertained whether participants with bipolar disorder (n = 21) showed greater striatal tracking of momentum-biased reward prediction errors (RPEs) than matched control participants (n = 21). We conducted psychophysiological interaction analyses to quantify the degree to which each group modulated functional connectivity between the ventral striatum and left anterior insula in response to fluctuations in momentum. Results In participants with bipolar disorder, but not control participants, the momentum-biased RPE model accounted for significant additional variance in striatal activity beyond a standard model of veridical RPEs. Compared with control participants, participants with bipolar disorder exhibited lower insular-striatal functional connectivity modulated by momentum-biased RPEs, an effect that was more pronounced as a function of current manic symptoms. Conclusions Consistent with existing theory, we found evidence that bipolar disorder is associated with a tendency for momentum to excessively bias striatal tracking of RPEs. We identified impaired insular-striatal connectivity as a possible locus for this propensity. We argue that computational psychiatric approaches that examine momentary shifts in reward and mood dynamics have strong potential for yielding new mechanistic insights and intervention targets.
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Affiliation(s)
- Hestia Moningka
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
- Max Planck University College London Centre for Computational Psychiatry and Ageing Research, University College London, London, United Kingdom
- Wellcome Trust Centre for Human Neuroimaging, University College London, London, United Kingdom
| | - Liam Mason
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
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Teh WL, Si SY, Liu J, Subramaniam M, Ho R. The clinical significance of emotional urgency in bipolar disorder: a scoping review. BMC Psychol 2024; 12:273. [PMID: 38750587 PMCID: PMC11097479 DOI: 10.1186/s40359-024-01700-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 04/02/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Emotional urgency, defined as a trait concept of emotion-based impulsivity, is at least moderately associated with general psychopathology. However, its clinical significance and associations with clinically relevant features of bipolar disorder remain unclear. This scoping review aims address this gap by determining the extent of evidence in this niche scope of study. METHODS Evidence of between-group differences of positive and negative urgency, its associations with mood severity, and all peripheral associations related to illness and psychosocial outcomes were synthesized based on PRISMA checklists and guidelines for scoping reviews (PRISMA-ScR). DESIGN Electronic databases were searched for articles published between January 2001 and January 2024. A total of 1013 entries were gathered, and a total of 10 articles were included in the final selection after the removal of duplicates and ineligible articles. RESULTS Differences in urgency scores between bipolar disorder and healthy controls were large (Cohen's d ranged from 1.77 to 2.20). Negative urgency was at least moderately associated with overall trauma, emotional abuse, neglect, suicide ideation, neuroticism, and irritable/cyclothymic temperament, whereas positive urgency was at least moderately associated with various aspects of aggression and quality of life. Positive but not negative urgency was associated with quality of life in bipolar disorder. CONCLUSION Large between-group differences found for emotional urgency in bipolar disorder imply large clinical significance. Emotional urgency was associated with worse clinical features and outcomes. Given the high clinical heterogeneity of the disorder, emotional urgency may be an important phenotype indicative of greater disorder severity.
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Affiliation(s)
- Wen Lin Teh
- Institute of Mental Health, 10 Buangkok View, Buangkok Green, Medical Park, Singapore, S539747, Singapore.
- Yong Loo Lin School of Medicine, National University of Singapore, 21 Lower Kent Ridge Rd, Singapore, S119077, Singapore.
| | - Sheng Yeow Si
- MOH Holdings, 1 Maritime Square, #11-25, Singapore, S099253, Singapore
| | - Jianlin Liu
- Institute of Mental Health, 10 Buangkok View, Buangkok Green, Medical Park, Singapore, S539747, Singapore
| | - Mythily Subramaniam
- Institute of Mental Health, 10 Buangkok View, Buangkok Green, Medical Park, Singapore, S539747, Singapore
| | - Roger Ho
- Yong Loo Lin School of Medicine, National University of Singapore, 21 Lower Kent Ridge Rd, Singapore, S119077, Singapore
- Institute of Health Innovation and Technology (iHealthtech), National University of Singapore, 14 Medical Dr, #14-01 MD6, Singapore, S117599, Singapore
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3
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Lisoni J, Nibbio G, Baldacci G, Cicale A, Zucchetti A, Bertoni L, Calzavara Pinton I, Necchini N, Deste G, Barlati S, Vita A. What impact can brain stimulation interventions have on borderline personality disorder? Expert Rev Neurother 2024; 24:343-360. [PMID: 38349069 DOI: 10.1080/14737175.2024.2316133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 02/05/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION Borderline personality disorder (BPD) is a severe mental disorder characterized by emotion dysregulation, impulsivity, neuropsychological impairment, and interpersonal instability, presenting with multiple psychiatric comorbidities, functional disability and reduced life expectancy due suicidal behaviors. AREAS COVERED In this perspective, the authors explore the application of noninvasive brain stimulation (NIBS) (rTMS, tDCS, and MST) in BPD individuals by considering a symptom-based approach, focusing on general BPD psychopathology, impulsivity and neuropsychological impairments, suicidality and depressive/anxious symptoms, and emotion dysregulation. EXPERT OPINION According to a symptoms-based approach, NIBS interventions (particularly rTMS and tDCS) are promising treatment options for BPD individuals improving core symptoms such as emotional and behavioral dysregulation, neuropsychological impairments and depressive symptoms. However, the heterogeneity of stimulation protocols and of assessment tools used to detect these changes limits the possibility to provide definitive recommendations according to a symptom-based approach. To implement such armamentarium in clinical practice, future NIIBS studies should further consider a lifespan perspective due to clinical variability over time, the role of psychiatric comorbidities affecting BPD individuals and the need to combine NIBS with specialized psychotherapeutic approaches for BPD patients and with functional neuroimaging studies.
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Affiliation(s)
- Jacopo Lisoni
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Gabriele Nibbio
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Giulia Baldacci
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Andrea Cicale
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Andrea Zucchetti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Lorenzo Bertoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Nicola Necchini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Giacomo Deste
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Stefano Barlati
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Antonio Vita
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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4
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De Prisco M, Oliva V, Fico G, Radua J, Grande I, Roberto N, Anmella G, Hidalgo-Mazzei D, Fornaro M, de Bartolomeis A, Serretti A, Vieta E, Murru A. Emotion dysregulation in bipolar disorder compared to other mental illnesses: a systematic review and meta-analysis. Psychol Med 2023; 53:7484-7503. [PMID: 37842774 PMCID: PMC10951413 DOI: 10.1017/s003329172300243x] [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: 11/24/2022] [Revised: 05/24/2023] [Accepted: 07/27/2023] [Indexed: 10/17/2023]
Abstract
People with bipolar disorder (BD) often present emotion dysregulation (ED), a pattern of emotional expression interfering with goal-directed behavior. ED is a transdiagnostic construct, and it is unclear whether it manifests itself similarly in other conditions, such as major depressive disorder (MDD) or borderline personality disorder (BPD), or has specific features in BD. The present systematic review and meta-analysis explored ED and adopted emotion regulation (ER) strategies in BD compared with other psychiatric conditions. PubMed/MEDLINE, EMBASE, Scopus, and PsycINFO databases were systematically searched from inception to April 28th, 2022. Studies implementing validated instruments assessing ED or ER strategies in BD and other psychiatric disorders were reviewed, and meta-analyses were conducted. Twenty-nine studies yielding multiple comparisons were included. BD was compared to MDD in 20 studies (n = 2451), to BPD in six studies (n = 1001), to attention deficit hyperactivity disorder in three studies (n = 232), to anxiety disorders in two studies (n = 320), to schizophrenia in one study (n = 223), and to post-traumatic stress disorder in one study (n = 31). BD patients did not differ from MDD patients in adopting most adaptive and maladaptive ER strategies. However, small-to-moderate differences in positive rumination and risk-taking behaviors were observed. In contrast, patients with BPD presented an overall higher degree of ED and more maladaptive ER strategies. There were insufficient data for a meta-analytic comparison with other psychiatric disorders. The present report further supports the idea that ED is a transdiagnostic construct spanning a continuum across different psychiatric disorders, outlining specific clinical features that could represent potential therapeutic targets.
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Affiliation(s)
- Michele De Prisco
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036 Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona. c. Villarroel, 170, 08036 Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036 Barcelona, Spain
- Institute of Neurosciences (UBNeuro), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Section of Psychiatry, Department of Neuroscience, Reproductive Science and Odontostomatology Federico II University of Naples, Naples, Italy
| | - Vincenzo Oliva
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036 Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona. c. Villarroel, 170, 08036 Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036 Barcelona, Spain
- Institute of Neurosciences (UBNeuro), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giovanna Fico
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036 Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona. c. Villarroel, 170, 08036 Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036 Barcelona, Spain
- Institute of Neurosciences (UBNeuro), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Joaquim Radua
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036 Barcelona, Spain
- Institute of Neurosciences (UBNeuro), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, IDIBAPS, Barcelona, Spain
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Iria Grande
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036 Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona. c. Villarroel, 170, 08036 Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036 Barcelona, Spain
- Institute of Neurosciences (UBNeuro), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Natalia Roberto
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036 Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona. c. Villarroel, 170, 08036 Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036 Barcelona, Spain
- Institute of Neurosciences (UBNeuro), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Gerard Anmella
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036 Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona. c. Villarroel, 170, 08036 Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036 Barcelona, Spain
- Institute of Neurosciences (UBNeuro), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Diego Hidalgo-Mazzei
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036 Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona. c. Villarroel, 170, 08036 Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036 Barcelona, Spain
- Institute of Neurosciences (UBNeuro), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Michele Fornaro
- Section of Psychiatry, Department of Neuroscience, Reproductive Science and Odontostomatology Federico II University of Naples, Naples, Italy
| | - Andrea de Bartolomeis
- Section of Psychiatry, Department of Neuroscience, Reproductive Science and Odontostomatology Federico II University of Naples, Naples, Italy
| | - Alessandro Serretti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Eduard Vieta
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036 Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona. c. Villarroel, 170, 08036 Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036 Barcelona, Spain
- Institute of Neurosciences (UBNeuro), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Andrea Murru
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036 Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona. c. Villarroel, 170, 08036 Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036 Barcelona, Spain
- Institute of Neurosciences (UBNeuro), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
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5
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Samiefard M, Fadardi JS, Kareshki H, Stacy AW. Validity and Reliability of a Revised S-UPPS-P Impulsive Behavior Scale: The Interplay between Impulsivity and Working Memory. J Pers Assess 2023; 105:174-186. [PMID: 35703735 DOI: 10.1080/00223891.2022.2081922] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Impulsivity is a multidimensional construct. The UPPS-P model of impulsivity differentiates five distinct dimensions: negative urgency, positive urgency, lack of premeditation, lack of perseverance, and sensation seeking. The present study, reports the first translation and validation of the recently revised short form of the UPPS-P scale (S-UPPS-P) on a Persian-speaking sample, examining the relationship between impulsivity and working memory. who also completed the Positive and Negative Affect Scale (PANAS), the Buss and Perry Aggression Questionnaire, the Behavioral Inhibition and Activation Scales (BIS/BAS), and the Wechsler Digit Span Task (WDST). A series of confirmatory factor analyses, and Cronbach's alpha results supported the factor structure of the scale. The findings supported the S-UPPS-P model's hypothesized correlations with PANAS, aggressiveness, and the construct validity of the model. The results of hierarchical regression analysis showed that backward and forward digit span scores of the WDST predicted the S-UPPS-P impulsivity scores over the portion explained by BIS/BAS, PANAS, and aggression scores. To conclude, the revised S-UPPS-P Impulsive Behavior Scale was well supported even in a very different population than usually sampled, adding to growing evidence that it assesses distinct but interrelated aspects of the impulsivity construct. Our findings also suggest that attentional capacities and working memory play important roles in the prediction of impulsivity.
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Affiliation(s)
| | - Javad Salehi Fadardi
- Ferdowsi University of Mashhad, Mashhad, Iran.,Bangor University, Bangor, United Kingdom.,Claremont Graduate University, Claremont, USA
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6
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Chanen AM, Betts JK, Jackson H, Cotton SM, Gleeson J, Davey CG, Thompson K, Perera S, Rayner V, Chong SY, McCutcheon L. A Comparison of Adolescent versus Young Adult Outpatients with First-Presentation Borderline Personality Disorder: Findings from the MOBY Randomized Controlled Trial. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:26-38. [PMID: 33576244 PMCID: PMC8811246 DOI: 10.1177/0706743721992677] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The increasing focus on adolescent personality disorder has tended to ignore evidence of the developmental continuity of the period from puberty to young adulthood. This study aims to: (1) describe the characteristics of a sample of young people with borderline personality disorder (BPD) who had no previous history of evidence-based treatment for the disorder and (2) compare their characteristics by participant age group. METHODS One hundred and thirty-nine young people (15 to 25 years) with BPD, newly enrolled in the Monitoring Outcomes of BPD in Youth randomized controlled trial, completed semi-structured interview and self-report measures assessing demographic, clinical, and functional characteristics. Younger (aged 15 to 17 years; n = 64) and older (aged 18 to 25 years; n = 75) participants were compared on these same variables using t-tests, chi-square tests, and logistic regression. RESULTS Young outpatients with BPD had extensive and severe psychopathology and were functioning poorly. Adolescents and young adults with BPD showed substantial similarities on 20 key aspects of their presentation. Significant between-groups differences were observed in household makeup, treatment history, antisocial personality disorder, emotion dysregulation, substance use, age of commencement and extent of self-harm, and achievement of age-appropriate educational milestones. Adolescent BPD group membership was predicted by family composition and self-harm, whereas young adult BPD group membership was predicted by not achieving age-appropriate milestones, vocational disengagement, and emotion dysregulation. The final model explained 54% of the variance and correctly classified 80.2% of the sample by age. CONCLUSIONS Both adolescents and young adults with early stage BPD present with severe and often similar problems to one another, supporting developmental continuity across this age range. However, there are also meaningful differences in presentation, suggesting that pathways to care might differ by age and/or developmental stage. Detection and intervention for personality disorder should not be delayed until individuals reach 18 years of age.
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Affiliation(s)
- Andrew M Chanen
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Jennifer K Betts
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Henry Jackson
- Melbourne School of Psychological Sciences, The University of Melbourne, Australia
| | - Sue M Cotton
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Australia
| | - John Gleeson
- Healthy Brain and Mind Research Centre and School of Behavioural and Health Sciences, Australian Catholic University, Melbourne Campus, Australia
| | - Christopher G Davey
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Australia.,Department of Psychiatry, The University of Melbourne, Australia
| | - Katherine Thompson
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Sharnel Perera
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Victoria Rayner
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Sinn Yuin Chong
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Australia
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7
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Impaired impulse inhibition of emotional stimuli in patients with borderline personality disorder. Sci Rep 2021; 11:16628. [PMID: 34404887 PMCID: PMC8371102 DOI: 10.1038/s41598-021-96166-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 07/26/2021] [Indexed: 02/07/2023] Open
Abstract
This study was aimed to investigate whether BPD patients showed impaired impulse inhibition of emotional and non-emotional stimuli and to explore relevant neuroelectrophysiological mechanisms. A total of 32 BPD patients and 32 matched healthy controls were recruited. Self-reported scales were used to measure psychiatric symptoms. The event-related potentials (ERPs) were recorded when subjects were performing neutral and emotional Stop Signal Task (SST). Group differences in self-reported scores, behavioral variables and ERPs were compared. The BPD group scored significantly higher on impulsivity, severity of BPD symptoms, levels of depression and anxiety than the control group. In neutral SST, no significant group differences were detected in the amplitude and latency of ERPs components induced. In emotional SST, the P2 amplitude of negative emotion was significantly larger than that of neutral emotion in Go trials. In Stop trials, the P2 amplitude of BPD group was significantly smaller than that of control group, and the N2 amplitude of BPD group was significantly greater than that of control group. BPD patients showed impaired inhibition of emotional stimuli rather than non-emotional stimuli. The deficits of emotional impulse control mainly exhibit at the early attention, stimulus evaluation and conflict detection stages.
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8
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Martin S, Graziani P, Del-Monte J. Comparing impulsivity in borderline personality, schizophrenia and obsessional-compulsive disorders: Who is ahead? J Clin Psychol 2021; 77:1732-1744. [PMID: 33822353 DOI: 10.1002/jclp.23129] [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: 12/15/2020] [Revised: 02/18/2021] [Accepted: 03/03/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Impulsivity impacts life domains and in a psychiatric context is often associated with disorders severity and stigmatization. Borderline personality disorder's (BPD), Schizophrenic disorder's (SZD), and obsessional compulsive disorder's (OCD) impulsivity issues relate to worse prognosis. This study aims to compare these disorders assessing their proneness to impulsivity and urgency. METHODS We recruited 90 patients among them OCD (n = 25), SZD (n = 23), and BPD (n = 50), and 24 healthy control participants (HC). We assessed the diagnosis according and measured the impulsivity level. RESULTS Our results showed that BPD was significantly more impulsive than HC, SZD, and OCD. HC, SZD, and OCD being equivalent on their global Urgency-Premeditation-Perseverance-Sensation seeking scores. For urgency, BPD was also superior to others, OCD was superior to HC, but SZD and HC were equivalent. The urgency was correlated to SZD's scale for SZD, no link appeared between borderline personality questionnaire and Yale-Brown Obsessive-Compulsive Scale's score. CONCLUSION These results question the existent literature relating impulsivity and SZD.
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Affiliation(s)
- Sylvia Martin
- Psychosocial Laboratory, Aix-Marseille and Nîmes Universities, Nîmes, France.,Nîmes University, Nîmes, France
| | - Pierluigi Graziani
- Psychosocial Laboratory, Aix-Marseille and Nîmes Universities, Nîmes, France
| | - Jonathan Del-Monte
- Psychosocial Laboratory, Aix-Marseille and Nîmes Universities, Nîmes, France
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9
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Linhartová P, Širůček J, Ejova A, Barteček R, Theiner P, Kašpárek T. Dimensions of Impulsivity in Healthy People, Patients with Borderline Personality Disorder, and Patients with Attention-Deficit/Hyperactivity Disorder. J Atten Disord 2021; 25:584-595. [PMID: 30628513 DOI: 10.1177/1087054718822121] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective: Impulsivity, observed in patients with various psychiatric disorders, is a heterogeneous construct with different behavioral manifestations. Through confirmatory factor analysis (CFA), this study tests hypotheses about relationships between dimensions of impulsivity measured using personality questionnaires and behavioral tests. Method: The study included 200 healthy people, 40 patients with borderline personality disorder, and 26 patients with attention-deficit/hyperactivity disorder (ADHD) who underwent a comprehensive impulsivity test battery including the Barratt Impulsiveness Scale (BIS), UPPS-P Impulsive Behavior Scale, a Go-NoGo task, a stop-signal task, and a delay discounting task. Results: A CFA model comprising three self-reported and three behavioral latent variables reached a good fit. Both patient groups scored higher in the self-reported dimensions and impulsive choice; only the ADHD patients displayed impaired waiting and stopping impulsivity. Conclusions: Using the developed CFA model, it is possible to describe relations between impulsivity dimensions and show different impulsivity patterns in patient populations.
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Affiliation(s)
- Pavla Linhartová
- Masaryk University, Brno, Czech Republic.,University Hospital Brno, Czech Republic
| | | | | | - Richard Barteček
- Masaryk University, Brno, Czech Republic.,University Hospital Brno, Czech Republic
| | - Pavel Theiner
- Masaryk University, Brno, Czech Republic.,University Hospital Brno, Czech Republic
| | - Tomáš Kašpárek
- Masaryk University, Brno, Czech Republic.,University Hospital Brno, Czech Republic
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10
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Schaich A, Assmann N, Köhne S, Alvarez-Fischer D, Borgwardt S, Schweiger U, Klein JP, Faßbinder E. The mediating effect of difficulties in emotion regulation on the association between childhood maltreatment and borderline personality disorder. Eur J Psychotraumatol 2021; 12:1934300. [PMID: 34408815 PMCID: PMC8366657 DOI: 10.1080/20008198.2021.1934300] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Childhood maltreatment and difficulties in emotion regulation are common in patients with Borderline Personality Disorder (BPD) and Depressive Disorders (DD). OBJECTIVE This study examines differences between patients with BPD and patients with DD, regarding childhood maltreatment and difficulties in emotion regulation as well as the mediating effect of different aspects of emotion regulation deficits on the association between childhood maltreatment and BPD-symptoms. METHOD A total of 305 participants, 177 with BPD and 128 with DD completed an assessment including the Childhood Trauma Questionnaire (CTQ), the Emotion Regulation Scale (DERS), the Brief Symptom Inventory (BSI), and the Structured Clinical Interview for DSM-IV (SCID). Data was analyzed using multiple analyses of variances and mediation analyses. RESULTS Patients with BPD reported more childhood maltreatment and more difficulties in emotion regulation than patients with DD. When general symptom severity, age, and gender were included in the analysis as covariates only group differences regarding 'impulse control difficulties' (F(1,299) = 38.97, p < .001, ηp2 = .115), 'limited access to emotion regulation strategies' (F(1,299) = 4.66, p = .032, ηp2 = .015), and 'lack of emotional clarity' (F(1,299) = 9.38, p = .002, ηp2 = .030) remained statistically significant. A mediation analysis, including above-mentioned covariates, indicated an association between emotional abuse and BPD-symptoms, which was mediated by difficulties in emotion regulation (indirect effect B = .012, 95% CI [.001; .031], R2 = .429). Subscale analyses revealed 'impulse control difficulties' as the aspect of difficulties in emotion regulation that has the greatest impact on this association (B = .021, 95% CI [.003; .045]). CONCLUSIONS Patients with BPD display more childhood maltreatment and difficulties in emotion regulation than patients with DD. Difficulties in emotion regulation, especially difficulties in impulse control, seem to play an important role in the association between childhood emotional abuse and BPD-symptoms.
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Affiliation(s)
- Anja Schaich
- Department of Psychiatry and Psychotherapy, University of Lübeck, LübeckGermany.,Department of Psychiatry and Psychotherapy, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Nele Assmann
- Department of Psychiatry and Psychotherapy, University of Lübeck, LübeckGermany
| | - Sandra Köhne
- Department of Psychiatry and Psychotherapy, University of Lübeck, LübeckGermany
| | | | - Stefan Borgwardt
- Department of Psychiatry and Psychotherapy, University of Lübeck, LübeckGermany
| | - Ulrich Schweiger
- Department of Psychiatry and Psychotherapy, University of Lübeck, LübeckGermany
| | - Jan Philipp Klein
- Department of Psychiatry and Psychotherapy, University of Lübeck, LübeckGermany
| | - Eva Faßbinder
- Department of Psychiatry and Psychotherapy, University of Lübeck, LübeckGermany.,Department of Psychiatry and Psychotherapy, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
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11
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Massó Rodriguez A, Hogg B, Gardoki-Souto I, Valiente-Gómez A, Trabsa A, Mosquera D, García-Estela A, Colom F, Pérez V, Padberg F, Moreno-Alcázar A, Amann BL. Clinical Features, Neuropsychology and Neuroimaging in Bipolar and Borderline Personality Disorder: A Systematic Review of Cross-Diagnostic Studies. Front Psychiatry 2021; 12:681876. [PMID: 34177664 PMCID: PMC8220090 DOI: 10.3389/fpsyt.2021.681876] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/14/2021] [Indexed: 12/28/2022] Open
Abstract
Background: Bipolar Disorder (BD) and Borderline Personality Disorder (BPD) have clinically been evolving as separate disorders, though there is still debate on the nosological valence of both conditions, their interaction in terms of co-morbidity or disorder spectrum and their distinct pathophysiology. Objective: The objective of this review is to summarize evidence regarding clinical features, neuropsychological performance and neuroimaging findings from cross-diagnostic studies comparing BD and BPD, to further caracterize their complex interplay. Methods: Using PubMed, PsycINFO and TripDataBase, we conducted a systematic literature search based on PRISMA guidelines of studies published from January 1980 to September 2019 which directly compared BD and BPD. Results: A total of 28 studies comparing BD and BPD were included: 19 compared clinical features, 6 neuropsychological performance and three neuroimaging abnormalities. Depressive symptoms have an earlier onset in BPD than BD. BD patients present more mixed or manic symptoms, with BD-I differing from BPD in manic phases. BPD patients show more negative attitudes toward others and self, more conflictive interpersonal relationships, and more maladaptive regulation strategies in affective instability with separate pathways. Impulsivity seems more a trait in BPD rather than a state as in BD. Otherwise, BD and BPD overlap in depressive and anxious symptoms, dysphoria, various abnormal temperamental traits, suicidal ideation, and childhood trauma. Both disorders differ and share deficits in neuropsychological and neuroimaging findings. Conclusion: Clinical data provide evidence of overlapping features in both disorders, with most of those shared symptoms being more persistent and intense in BPD. Thus, categorical classifications should be compared to dimensional approaches in transdiagnostic studies investigating BPD features in BD regarding their respective explanatory power for individual trajectories. Systematic Review Registration: The search strategy was pre-registered in PROSPERO: CRD42018100268.
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Affiliation(s)
- Anna Massó Rodriguez
- Institute of Neuropsychiatry and Addiction, Parc de Salut Mar, Barcelona, Spain
- Centro Salud Mental Infanto-Juvenil, Parc de Salut Mar, Barcelona, Spain
| | - Bridget Hogg
- Centre Fòrum Research Unit, Institute of Neuropsychiatry and Addiction, Parc de Salut Mar, Barcelona, Spain
- Mental Health Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- PhD Progamme, Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Itxaso Gardoki-Souto
- Centre Fòrum Research Unit, Institute of Neuropsychiatry and Addiction, Parc de Salut Mar, Barcelona, Spain
- Mental Health Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- PhD Progamme, Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alicia Valiente-Gómez
- Institute of Neuropsychiatry and Addiction, Parc de Salut Mar, Barcelona, Spain
- Centre Fòrum Research Unit, Institute of Neuropsychiatry and Addiction, Parc de Salut Mar, Barcelona, Spain
- Mental Health Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Amira Trabsa
- Institute of Neuropsychiatry and Addiction, Parc de Salut Mar, Barcelona, Spain
- Centre Fòrum Research Unit, Institute of Neuropsychiatry and Addiction, Parc de Salut Mar, Barcelona, Spain
- PhD Progamme, Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Dolores Mosquera
- Instituto de Investigación y Tratamiento del Trauma y los Trastornos de la Personalidad (INTRA-TP) Center, A Coruña, Spain
| | - Aitana García-Estela
- Mental Health Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Francesc Colom
- Institute of Neuropsychiatry and Addiction, Parc de Salut Mar, Barcelona, Spain
- Mental Health Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
- Departament of Basic, Evolutive and Education Psychology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Victor Pérez
- Institute of Neuropsychiatry and Addiction, Parc de Salut Mar, Barcelona, Spain
- Mental Health Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Munich, Germany
| | - Ana Moreno-Alcázar
- Centre Fòrum Research Unit, Institute of Neuropsychiatry and Addiction, Parc de Salut Mar, Barcelona, Spain
- Mental Health Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Benedikt Lorenz Amann
- Institute of Neuropsychiatry and Addiction, Parc de Salut Mar, Barcelona, Spain
- Centre Fòrum Research Unit, Institute of Neuropsychiatry and Addiction, Parc de Salut Mar, Barcelona, Spain
- Mental Health Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- *Correspondence: Benedikt Lorenz Amann
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12
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Hasegawa T, Kawahashi I, Fukuda K, Imada S, Tomita Y. Reliability and validity of a short Japanese version of the UPPS-P Impulsive Behavior Scale. Addict Behav Rep 2020; 12:100305. [PMID: 33364314 PMCID: PMC7752707 DOI: 10.1016/j.abrep.2020.100305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 09/09/2020] [Accepted: 09/25/2020] [Indexed: 12/26/2022] Open
Abstract
A Japanese version of the S-UPPS-P Impulsive Behavior Scale is needed. The original five-factor model had the best conformity index in all models. The five scales’ α coefficient and the test-retest reliability were high. The convergent validity of the five scales with personality scales was supported.
Objective This study aimed to verify the reliability and validity of a Japanese version of the S-UPPS-P Impulsive Behavior Scale. This is expected to facilitate comparisons of findings between international and Japanese samples in studies of impulsivity. Methods Two surveys were conducted. In the first survey, 632 participants, aged 20–44 years old, completed a translated version of the Japanese S-UPPS-P Impulsive Behavior Scale, the Motor Impulsiveness Scale, a short form of the Big-Five scale, the short Grit scale, and the brief version of the self-control scale. Two weeks later, the second survey containing the S-UPPS-P and the motor impulsiveness scale were completed by 450 participants who had completed the first survey to examine test-retest reliability. Results In the first survey, an exploratory factor analysis was performed on the S-UPPS-P responses. A four-factor solution was the most suitable solution, with the factors of “Lack of Perseverance,” “Lack of Premeditation,” “Sensation Seeking,” and “Negative-Positive Urgency.” Then, a confirmatory factor analysis was performed. The conformity index of the original five-factor model was slightly better than that of the four-factor model. We also compared the five-factor model’s conformity index with three other models that had been examined in the original and other foreign language versions of the S-UPPS-P. The five-interrelated factor model had the best model fit. The reliability of the five scales was confirmed. The scales exhibited internal consistency with α coefficients ranging from 0.65 to 0.79, in addition to the test-retest reliability ranging from 0.74 to 0.80. The convergent validity of each S-UPPS-P scale was supported by high relationships with the four personality scales, with the highest correlation coefficients ranging from 0.37 to −0.67. Conclusion The reliability and validity of the Japanese version of the S-UPPS-P were confirmed, despite the minor limitations of the exploratory factor analysis providing a four-factor solution instead of a five-factor solution, and the α reliability coefficients of two scales being acceptable but rather low. Thus, comparisons of findings between international and Japanese studies on impulsivity could be facilitated.
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Affiliation(s)
- Tomoko Hasegawa
- Department of Human Sciences, Faculty of Psychology and Sociology, Taisho University, Tokyo, Japan
| | - Ikko Kawahashi
- Department of Psychology, Faculty of Psychology, Meiji Gakuin University, Tokyo, Japan
| | - Kazuhiko Fukuda
- Department of Psychology and Humanities, College of Sociology, Edogawa University, Chiba, Japan
| | - Sumio Imada
- Department of Psychology, Faculty of Health Sciences, Hiroshima Shudo University, Hiroshima, Japan
| | - Yuichi Tomita
- Department of English Language and Cultures, Faculty of Letters, Gakushuin University, Tokyo, Japan
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13
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Exploring the boundaries between borderline personality disorder and suicidal behavior disorder. Eur Arch Psychiatry Clin Neurosci 2020; 270:959-967. [PMID: 30673835 DOI: 10.1007/s00406-019-00980-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 01/03/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To compare clinical traits of suicidal vulnerability among in-patients with suicidal behavior disorder (SBD) with and without borderline personality disorder (BPD). METHOD we recruited adult patients with SBD, consecutively and voluntarily hospitalized in a specialized unit for affective disorders and suicidal behavior between July and October 2016. Ninety-two inpatients having attempted suicide within the past 2 years were divided into two subgroups according to the presence or absence of BPD. Clinical vulnerability traits for suicidal behavior were assessed. RESULTS Half of the patients with SBD also had BPD. Patients with BPD were nine times more likely to be major suicide repeaters compared to those without. They were also more likely to display clinical and psychological vulnerability traits for suicidal behavior, even after considering potential confounders. Emotional dysregulation, shame-proneness, impulsiveness, preoccupied attachment pattern, and childhood trauma were high in both groups, but significantly increased in those with (vs. without) BPD status. Psychological traits remained stable in SBD-BPD patients, regardless of the time since the last suicide attempt (i.e. SBD in recent vs. early remission). CONCLUSIONS Clinical and psychological traits associated with suicidal vulnerability are present in all SBD patients compared to non-suicidal populations, but comorbidity with BPD is associated with particularly high scores. BPD could be considered as a specifier for SBD diagnoses.
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14
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Bøen E, Hummelen B, Boye B, Elvsåshagen T, Malt UF. Borderline patients have difficulties describing feelings; bipolar II patients describe difficult feelings. An alexithymia study. Acta Psychiatr Scand 2020; 142:203-214. [PMID: 32594515 DOI: 10.1111/acps.13204] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Apparent similarities between borderline personality disorder (BPD) and bipolar II disorder (BIP-II) contribute to clinical difficulties in distinguishing between the disorders. Here, we aimed to explore how subjective Difficulties with the Identification and Description of Feelings (DIDF), a major constituent of the alexithymia construct and assessed as a part of the Toronto Alexithymia Scale (TAS), are related to relationship problems and health complaints in these groups. METHODS Twenty-two patients with BPD; 22 patients with BIP-II; and 23 healthy controls (HC) completed TAS. Health complaints, including symptoms associated with mood swings, were assessed with the Giessener Subjective Complaints List (Giessener Beschwerdebogen-GBB), and relationship problems with the Health of the Nation Outcome scale, Relationship item (HoNOSR). Bivariate correlations were run. RESULTS Both patient groups had high DIDF and GBB scores. In BPD only, there was a significant positive correlation between DIDF and HoNOSR. In BIP-II only, there was a significant positive correlation between DIDF and GBB total score. In BIP-II, DIDF correlated highly with those GBB subscales assessing symptoms typically occurring during bipolar mood swings (cardiovascular and gastrointestinal symptoms, exhaustion). CONCLUSION Our results suggest that in BPD, high DIDF scores represent genuine problems with identifying and describing emotions which are expected to correlate with relationship problems. In BIP-II, high DIDF scores could potentially represent difficulties with understanding the unpredictable symptoms of bipolar mood swings. The findings suggest that difficulties with identifying and describing feelings in patients should be carefully explored to increase the validity of the diagnostic evaluation.
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Affiliation(s)
- E Bøen
- Psychosomatic and CL Psychiatry, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - B Hummelen
- Department of Research and Development, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - B Boye
- Psychosomatic and CL Psychiatry, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Department of Behavioural Medicine, University of Oslo, Oslo, Norway
| | - T Elvsåshagen
- Norwegian Centre for Mental Disorders Research (NORMENT), KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - U F Malt
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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15
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Kim JH, Choi JY. Influence of childhood trauma and post-traumatic stress symptoms on impulsivity: focusing on differences according to the dimensions of impulsivity. Eur J Psychotraumatol 2020; 11:1796276. [PMID: 33029332 PMCID: PMC7473132 DOI: 10.1080/20008198.2020.1796276] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Impulsivity, a trait and multidimensional construct, is associated with a wide range of impulsive behaviours. Although it is well documented that childhood trauma (CT) affects impulsivity, few studies examine whether its effects depend on particular dimensions of impulsivity and the role post-traumatic stress symptoms play in the relationship between childhood trauma and different dimensions of impulsivity. OBJECTIVE This research aims to explore the relationships between CT, PTSD, and impulsivity in a heterogeneous clinical sample. We also sought to examine whether the influence of CT on impulsivity differs across the dimensions of impulsivity. METHOD We investigated the relationships between CT, symptoms of post-traumatic stress disorder (PTSD), and five dimensions of impulsivity using a sample of 162 non-psychotic psychiatric patients without neurocognitive diagnoses. Participants completed the Childhood Trauma Questionnaire (CTQ), Impact of Event Scale - Revised (IES), and the UPPS-P Impulsive Behaviour Scale (UPPS-P). RESULTS The results of structural equation modelling showed that CT is associated with PTSD symptoms, in addition to four of the five dimensions of impulsivity in the UPPS-P:positive urgency, negative urgency, lack of premeditation, and lack of perseverance. The indirect effect of CT through PTSD symptoms was significant only for the two types of urgency. CONCLUSIONS The results of this study suggest that interventions that aim to alleviate impulsive behaviour derived from high urgency should pay particular attention to the presence of CT and PTSD symptoms.
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Affiliation(s)
- Ji Hye Kim
- Department of Psychiatry, Sanggye Paik Hospital, Inje University, Seoul, South Korea
| | - Ji Young Choi
- Department of Child Studies, Inha University, Incheon, South Korea
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16
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Linhartová P, Látalová A, Barteček R, Širůček J, Theiner P, Ejova A, Hlavatá P, Kóša B, Jeřábková B, Bareš M, Kašpárek T. Impulsivity in patients with borderline personality disorder: a comprehensive profile compared with healthy people and patients with ADHD. Psychol Med 2020; 50:1829-1838. [PMID: 31439062 DOI: 10.1017/s0033291719001892] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Impulsivity is a core symptom of borderline personality disorder (BPD). Impulsivity is a heterogeneous concept, and a comprehensive evaluation of impulsivity dimensions is lacking in the literature. Moreover, it is unclear whether BPD patients manifest impaired cognitive functioning that might be associated with impulsivity in another patient group, such as ADHD, a frequent comorbidity of BPD. METHODS We tested 39 patients with BPD without major psychiatric comorbidities and ADHD, 25 patients with ADHD, and 55 healthy controls (HC) using a test battery consisting of a self-report measure of impulsivity (UPPS-P questionnaire), behavioral measures of impulsivity - impulsive action (Go/NoGo task, stop signal task) and impulsive choice (delay discounting task, Iowa gambling task), and standardized measures of attention (d2 test), working memory (digit span), and executive functioning (Tower of London). RESULTS Patients with BPD and ADHD, as compared with HC, manifested increased self-reported impulsivity except sensation seeking and increased impulsive choice; patients with ADHD but not BPD showed increased impulsive action and deficits in cognitive functioning. Negative urgency was increased in BPD as compared to both HC and ADHD groups and correlated with BPD severity. CONCLUSIONS Patients with BPD without ADHD comorbidity had increased self-reported impulsivity and impulsive choice, but intact impulsive action and cognitive functioning. Controlling for ADHD comorbidity in BPD samples is necessary. Negative urgency is the most diagnostically specific impulsivity dimension in BPD.
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Affiliation(s)
- Pavla Linhartová
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Adéla Látalová
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Richard Barteček
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jan Širůček
- Faculty of Social Studies, Institute for Research on Children, Youth and Family, Masaryk University, Brno, Czech Republic
| | - Pavel Theiner
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Anastasia Ejova
- Faculty of Science, School of Psychology, University of Auckland, Auckland, New Zealand
| | - Pavlína Hlavatá
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Behavioral and Social Neuroscience Research Group, CEITEC - Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Barbora Kóša
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Barbora Jeřábková
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Martin Bareš
- First Department of Neurology, St. Anne's Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Neurology, Faculty of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Tomáš Kašpárek
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
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17
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Richmond JR, Tull MT, Gratz KL. The Roles of Emotion Regulation Difficulties and Impulsivity in the Associations between Borderline Personality Disorder Symptoms and Frequency of Nonprescription Sedative Use and Prescription Sedative/Opioid Misuse. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020; 16:62-70. [PMID: 32368442 DOI: 10.1016/j.jcbs.2020.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Despite evidence of a strong relationship between BPD and substance use problems in general, little research has examined the associations of BPD symptoms with the misuse of sedatives or opioids, and no studies have explored possible factors that may underlie these associations. Thus, this study examined the relationships of BPD symptoms (i.e., the number of BPD criteria with threshold ratings on a diagnostic interview) to nonprescription sedative use, nonprescription opioid use, and prescription sedative/opioid misuse among 194 patients with alcohol and/or cocaine dependence in a residential substance use disorder treatment facility, as well as the roles of two theoretically-relevant factors in these relationships: emotion regulation (ER) difficulties and impulsivity facets. We found significant positive associations between BPD symptoms and nonprescription sedative use, nonprescription opioid use, and prescription sedative/opioid misuse. We also found significant positive indirect relationships of BPD symptoms to nonprescription sedative use through ER difficulties, ab = .04, 95% CI [.003, .09], and to prescription sedative/opioid misuse through two facets of impulsivity: lack of perseverance, ab = .05, 95% CI [.01, .11], and negative urgency, ab = .03, 95% CI [.002, .07]. Findings highlight the differential relevance of ER difficulties and impulsivity dimensions to the relationships of BPD symptoms to nonprescription sedative use and prescription sedative/opioid misuse, respectively, among patients with alcohol and/or cocaine dependence.
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Affiliation(s)
| | - Matthew T Tull
- Department of Psychology, University of Toledo, Toledo, OH, USA
| | - Kim L Gratz
- Department of Psychology, University of Toledo, Toledo, OH, USA
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18
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Villarroel J, Salinas V, Silva H, Herrera L, Montes C, Jerez S, Vöhringer PA, Bustamante ML. Beyond the Categorical Distinction Between Borderline Personality Disorder and Bipolar II Disorder Through the Identification of Personality Traits Profiles. Front Psychiatry 2020; 11:552. [PMID: 32922312 PMCID: PMC7456877 DOI: 10.3389/fpsyt.2020.00552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/29/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The relationship between borderline personality disorder (BPD) and type-II bipolar disorder (BDII) is not clearly understood. Nevertheless, in clinical practice and research, most efforts focus on establishing a categorical distinction between the two. We propose using personality traits as a more informative strategy to describe them. METHODS Five-Factor Model personality traits were measured in 73 individuals with either BPD or BDII. Latent class cluster analysis was applied to the sample. RESULTS A three-cluster model resulted the best fit to the data, where all clusters had high neuroticism and low extraversion scores but differed widely on the other traits. The clusters' boundaries did not match the categorical diagnosis. CONCLUSIONS Our sample showed significant heterogeneity on personality traits, which can have a relevant effect on the outcome of each disorder and that was not captured by the categorical diagnosis. Thus, we advocate for a multivariate approach as a better way to understand the relationship between BPD and BDII.
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Affiliation(s)
- Juana Villarroel
- University Psychiatric Clinic, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Valeria Salinas
- Neurogenetics Outpatient Clinic and Laboratory, University Neurology Center and Neurology Section, J.M. Ramos Mejía Hospital, Faculty of Medicine, Universidad de Buenos Aires, Buenos Aires, Argentina.,Precision Medicine and Clinical Genomics Program, Faculty of Biomedical Sciences, Translational Medicine Research Institute, Universidad Austral-CONICET, Buenos Aires, Argentina
| | - Hernán Silva
- University Psychiatric Clinic, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Luisa Herrera
- Human Genetics Program, Faculty of Medicine, Biomedical Sciences Institute, Universidad de Chile, Santiago, Chile
| | - Cristián Montes
- University Psychiatric Clinic, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Sonia Jerez
- University Psychiatric Clinic, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Paul A Vöhringer
- University Psychiatric Clinic, Faculty of Medicine, Universidad de Chile, Santiago, Chile.,Mood Disorders Program, Tufts Medical Center, Tufts University, Boston, MA, United States
| | - Maria Leonor Bustamante
- University Psychiatric Clinic, Faculty of Medicine, Universidad de Chile, Santiago, Chile.,Human Genetics Program, Faculty of Medicine, Biomedical Sciences Institute, Universidad de Chile, Santiago, Chile
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19
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Porter C, Palmier-Claus J, Branitsky A, Mansell W, Warwick H, Varese F. Childhood adversity and borderline personality disorder: a meta-analysis. Acta Psychiatr Scand 2020; 141:6-20. [PMID: 31630389 DOI: 10.1111/acps.13118] [Citation(s) in RCA: 158] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/15/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The aim of this meta-analysis was to better understand the magnitude and consistency of the association between childhood adversity and borderline personality disorder (BPD) across case-control, epidemiological and prospective cohort studies. METHOD Following the review protocol (reference: CRD42017075179), search terms pertaining to adversity and BPD were entered into three search engines. Random-effects meta-analysis synthesised the size and consistency of the effects. RESULTS A total of 97 studies compared BPD to non-clinical (k = 40) and clinical (k = 70) controls. Meta-analysis of case-control studies indicated that individuals with BPD are 13.91 (95% CI 11.11-17.43) times more likely to report childhood adversity than non-clinical controls. This effect was smaller when considering retrospective cohort (OR: 2.59; 95% CI 0.93-7.30) and epidemiological (OR: 2.56, 95% CI 1.24-5.30) studies. Findings were significant across adversity subtypes with emotional abuse (OR: 38.11, 95% CI: 25.99-55.88) and neglect (OR: 17.73, 95% CI = 13.01-24.17) demonstrating the largest effects. Individuals with BPD were 3.15 (95% CI 2.62-3.79) times more likely to report childhood adversity than other psychiatric groups. CONCLUSIONS This meta-analysis corroborates theoretical proposals that exposure to adverse life experiences is associated with BPD. It highlights the importance of considering childhood adversity when treating people diagnosed with BPD.
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Affiliation(s)
- C Porter
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - J Palmier-Claus
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, UK.,Lancashire Care NHS Foundation Trust, Lancashire, UK
| | - A Branitsky
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - W Mansell
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - H Warwick
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - F Varese
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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20
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Bayes A, Parker G, Paris J. Differential Diagnosis of Bipolar II Disorder and Borderline Personality Disorder. Curr Psychiatry Rep 2019; 21:125. [PMID: 31749106 DOI: 10.1007/s11920-019-1120-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE OF REVIEW Differentiating bipolar (BP) disorders (in particular BP II) from borderline personality disorder (BPD) is a common diagnostic dilemma. We sought to critically examine recent studies that considered clinical differences between BP II and BPD, which might advance their delineation. RECENT FINDINGS Recent studies focused on differentiating biological parameters-genetics, epigenetics, diurnal rhythms, structural and functional neuroimaging-with indicative differences not yet sufficient to guide diagnosis. Key differentiating factors include family history, developmental antecedents, illness course, phenomenological differences in mood states, personality style and relationship factors. Less differentiating factors include impulsivity, neuropsychological profiles, gender distribution, comorbidity and treatment response. This review details parameters offering differentiation of BP II from BPD and should assist in resolving a frequent diagnostic dilemma. Future studies should specifically examine the BP II subtype directly with BPD, which would aid in sharpening the distinction between the disorders.
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Affiliation(s)
- Adam Bayes
- School of Psychiatry, University of New South Wales (UNSW), Sydney, Australia. .,Black Dog Institute, Sydney, NSW, Australia.
| | - Gordon Parker
- School of Psychiatry, University of New South Wales (UNSW), Sydney, Australia.,Black Dog Institute, Sydney, NSW, Australia
| | - Joel Paris
- Institute of Community and Family Psychiatry, SMBD-Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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21
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Reich DB, Belleau EL, Temes CM, Gonenc A, Pizzagalli DA, Gruber SA. Amygdala Resting State Connectivity Differences between Bipolar II and Borderline Personality Disorders. Neuropsychobiology 2019; 78:229-237. [PMID: 31553999 PMCID: PMC7968721 DOI: 10.1159/000502440] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 07/22/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Borderline personality disorder (BPD) and bipolar II disorder (BD II) have significant clinical overlap, leaving the potential for diagnostic inaccuracies and inadequate treatment recommendations. However, few studies have probed for clinical and neurobiological differences between the two disorders. Clinically, some prior studies have linked BPD with greater impulsivity and more frequent negative affective shifts than BD II, whereas previous neuroimaging studies have highlighted both similar and distinct neural abnormalities in BPD and BD II. Notably, no prior study has specifically targeted cortico-limbic neural differences, which have been hypothesized to underlie these core clinical differences. METHODS Individuals with BPD (n = 14) and BD II (n = 15) completed various clinical measures and a resting state functional imaging scan at 3T. Whole-brain amygdala resting state functional connectivity (RSFC) was compared between the two groups. RESULTS Relative to the BD II group, BPD participants reported significantly higher levels of impulsivity, trait anxiety, more frequent negative affective shifts, greater interpersonally reactive affective instability, lower overall functioning, and were characterized by lower amygdala-middle frontal gyrus RSFC. Lower amygdala-middle frontal gyrus RSFC was associated with greater impulsivity, trait anxiety, affective shifts, interpersonal affective reactivity, and functional impairment. LIMITATIONS The current study consisted of small sample sizes and lacked a control group. CONCLUSIONS This preliminary study suggests that amygdala-frontal RSFC may distinguish BPD from BD II. These results may guide future work aimed at identifying neural markers that can help disentangle these two disorders, leading to greater diagnostic accuracy and appropriate treatment implementation.
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Affiliation(s)
- D Bradford Reich
- Laboratory for the Study of Adult Development, McLean Hospital, Belmont, Massachusetts, USA,
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA,
| | - Emily L Belleau
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts, USA
| | - Christina M Temes
- Laboratory for the Study of Adult Development, McLean Hospital, Belmont, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Atilla Gonenc
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- McLean Imaging Center, McLean Hospital, Belmont, Massachusetts, USA
| | - Diego A Pizzagalli
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts, USA
- McLean Imaging Center, McLean Hospital, Belmont, Massachusetts, USA
| | - Staci A Gruber
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- McLean Imaging Center, McLean Hospital, Belmont, Massachusetts, USA
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22
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Impulsivity and its association with childhood trauma experiences across bipolar disorder, attention deficit hyperactivity disorder and borderline personality disorder. J Affect Disord 2019; 244:33-41. [PMID: 30336349 DOI: 10.1016/j.jad.2018.07.060] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/22/2018] [Accepted: 07/22/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Impulsivity is a core feature of the attention-deficit/hyperactivity disorder (ADHD) and is one of the DSM-V diagnostic criteria for borderline personality disorder (BPD). Impulsivity is also present in bipolar disorder (BD). Impulsivity has been linked to adverse behavior (suicidality,…) and to traumatic childhood experiences. Our study explored impulsivity in BPD, BD, ADHD and healthy controls (CTRL) and investigated the impact of early trauma on impulsivity. METHODS 744 patients with BD (n = 276), BPD (n = 168), ADHD (n = 173) or a combination (BPD_BD, n = 29; BPD_ADHD, n = 94, BD_BPD_ADHD n = 13) and 47 controls were included. All subjects were completed the Baratt Impulsivity Scale (BIS-10) and the Childhood Trauma Questionnaire (CTQ). RESULTS BD reported the same levels of impulsiveness as CTRL. When BPD and BD are co-morbid, impulsivity increased to reach the level of BPD. Impulsiveness was significantly associated to traumatic childhood event for BD and CTRL, not for BPD and AHDH. LIMITATIONS Impulsivity was assessed on the basis of a self-report questionnaire and not by the mean of an objective measure such as a neuropsychological test. Moreover, we don't know what treatment our pathological subjects were receiving. But, ADHD and BPD, despite the probable treatment, were more impulsive than healthy CTRLs who did not take medications. CONCLUSIONS Impulsivity is probably not a feature of BD but is associated with the presence of traumatic childhood experiences, especially for euthymic patients, unlike BPD and ADHD. So, it seems essential to assess the presence of early trauma to reduce the impulsivity and improve the evolution of BD.
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23
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A Comparison of Self-Reported Impulsivity in Gambling Disorder and Bipolar Disorder. J Gambl Stud 2018; 35:339-350. [DOI: 10.1007/s10899-018-9808-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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24
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Ruiz de Lara CM, Navas JF, Soriano-Mas C, Sescousse G, Perales JC. Regional grey matter volume correlates of gambling disorder, gambling-related cognitive distortions, and emotion-driven impulsivity. INTERNATIONAL GAMBLING STUDIES 2018. [DOI: 10.1080/14459795.2018.1448427] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Cristian M. Ruiz de Lara
- Department of Experimental Psychology, University of Granada , Granada, Spain
- Mind, Brain, and Behaviour Research Centre (CIMCYC), University of Granada , Granada, Spain
| | - Juan F. Navas
- Department of Experimental Psychology, University of Granada , Granada, Spain
- Mind, Brain, and Behaviour Research Centre (CIMCYC), University of Granada , Granada, Spain
| | - Carles Soriano-Mas
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL , Barcelona, Spain
- CIBERSAM, Carlos III Health Institute , Barcelona, Spain
- Department of Psychobiology and Methodology in Health Sciences, Universitat Autònoma de Barcelona , Barcelona, Spain
| | - Guillaume Sescousse
- Donders Institute for Brain, Cognition and Behaviour, Radboud University , Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Centre , Nijmegen, The Netherlands
| | - José C. Perales
- Department of Experimental Psychology, University of Granada , Granada, Spain
- Mind, Brain, and Behaviour Research Centre (CIMCYC), University of Granada , Granada, Spain
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25
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Marín-Navarrete R, Toledo-Fernández A, Villalobos-Gallegos L, Roncero C, Szerman N, Medina-Mora ME. Latent Impulsivity Subtypes in Substance Use Disorders and Interactions with Internalizing and Externalizing Co-Occurring Disorders. Front Psychiatry 2018; 9:27. [PMID: 29479323 PMCID: PMC5811514 DOI: 10.3389/fpsyt.2018.00027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 01/23/2018] [Indexed: 01/03/2023] Open
Abstract
This study explored the clinical importance of latent impulsivity subtypes within a sample of individuals with substance use disorders (SUDs) and high rates of co-occurring disorders (CODs) receiving residential treatment, aiming to assess the heterogeneity of the associations between SUDs and CODs across such impulsivity subtypes. The abbreviated Barratt impulsiveness scale was used to assess motor and cognitive (attentional and nonplanning) impulsivity, a structured interview for diagnosis of SUD and CODs, and other clinimetric measures for severity of substance use. Latent class analysis was conducted to extract subgroups of impulsivity subtypes and Poisson regression to analyze effects of interactions of classes by CODs on severity of substance use. 568 participants were evaluated. Results featured a four-class model as the best-fitted solution: overall high impulsivity (OHI); overall low impulsivity; high cognitive-low motor impulsivity; and moderate cognitive-low motor impulsivity (MC-LMI). OHI and MC-LMI concentrated on most of the individuals with CODs, and individuals within OHI and MC-LMI showed more severity of substance use. The expression of this severity relative to the impulsivity subtypes was modified by their interaction with internalizing and externalizing CODs in very heterogeneous ways. Our findings suggest that knowing either the presence of trait-based subtypes or CODs in individuals with SUDs is not enough to characterize clinical outcomes, and that the analysis of interactions between psychiatric categories and behavioral traits is necessary to better understand the expressions of psychiatric disorders.
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Affiliation(s)
- Rodrigo Marín-Navarrete
- National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico.,Clinical Trials Unit on Addiction and Mental Health, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Aldebarán Toledo-Fernández
- Clinical Trials Unit on Addiction and Mental Health, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Luis Villalobos-Gallegos
- Clinical Trials Unit on Addiction and Mental Health, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Carlos Roncero
- Psychiatric Service, University of Salamanca Health Care Complex, Institute of Biomedicine of Salamanca (IBSAL), University of Salamanca, Salamanca, Spain.,Spanish Society on Dual Disorders (SEPD), Madrid, Spain
| | - Nestor Szerman
- Spanish Society on Dual Disorders (SEPD), Madrid, Spain.,Gregorio Marañón University Hospital, Madrid, Spain
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26
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Riemann G, Weisscher N, Post RM, Altshuler L, McElroy S, Frye MA, Keck PE, Leverich GS, Suppes T, Grunze H, Nolen WA, Kupka RW. The relationship between self-reported borderline personality features and prospective illness course in bipolar disorder. Int J Bipolar Disord 2017; 5:31. [PMID: 28944443 PMCID: PMC5610955 DOI: 10.1186/s40345-017-0100-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/04/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Although bipolar disorder (BD) and borderline personality disorder (BPD) share clinical characteristics and frequently co-occur, their interrelationship is controversial. Especially, the differentiation of rapid cycling BD and BPD can be troublesome. This study investigates the relationship between borderline personality features (BPF) and prospective illness course in patients with BD, and explores the effects of current mood state on self-reported BPF profiles. METHODS The study included 375 patients who participated in the former Stanley Foundation Bipolar Network. All patients met DSM-IV criteria for bipolar-I disorder (n = 294), bipolar-II disorder (n = 72) or bipolar disorder NOS (n = 9). BPF were assessed with the self-rated Personality Diagnostic Questionnaire. Illness course was based on 1-year clinician rated prospective daily mood ratings with the life chart methodology. Regression analyses were used to estimate the relationships among these variables. RESULTS Although correlations were weak, results showed that having more BPF at baseline is associated with a higher episode frequency during subsequent 1-year follow-up. Of the nine BPF, affective instability, impulsivity, and self-mutilation/suicidality showed a relationship to full-duration as well as brief episode frequency. In contrast all other BPF were not related to episode frequency. CONCLUSIONS Having more BPF was associated with an unfavorable illness course of BD. Affective instability, impulsivity, and self-mutilation/suicidality are associated with both rapid cycling BD and BPD. Still, many core features of BPD show no relationship to rapid cycling BD and can help in the differential diagnosis.
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Affiliation(s)
- Georg Riemann
- Saxion, University of Applied Science, Handelskade 75, 7417 DH Deventer, The Netherlands
- Dimence Mental Health, Center for Bipolar Disorders, Deventer, The Netherlands
| | - Nadine Weisscher
- GGZ Centraal, Center for Mental Health, Hilversum, The Netherlands
| | - Robert M. Post
- Bipolar Collaborative Network, 5415 W. Cedar Ln, Suite 201-B, Bethesda, MD 20814 USA
- 0000 0004 1936 9510grid.253615.6Psychiatry and Behavioral Sciences, George Washington University, Washington, DC USA
| | - Lori Altshuler
- grid.416792.fFormer Head UCLA Mood Disorders Research Program, VA Medical Center, Los Angeles, CA USA
| | - Susan McElroy
- Lindner Center of HOPE, Mason, OH USA
- 0000 0001 2179 9593grid.24827.3bBiological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, OH USA
| | - Marc A. Frye
- 0000 0004 0459 167Xgrid.66875.3aPsychiatry, Mayo Clinic, Rochester, MI USA
| | - Paul E. Keck
- Lindner Center of HOPE, Mason, OH USA
- 0000 0001 2179 9593grid.24827.3bPsychiatry & Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Gabriele S. Leverich
- Bipolar Collaborative Network, 5415 W. Cedar Ln, Suite 201-B, Bethesda, MD 20814 USA
| | - Trisha Suppes
- 0000000419368956grid.168010.eDepartment of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA USA
| | - Heinz Grunze
- 0000 0004 0523 5263grid.21604.31Paracelsus Medical University, Salzburg, Austria
| | - Willem A. Nolen
- 0000 0004 0407 1981grid.4830.fUniversity Medical Center, University of Groningen, Groningen, The Netherlands
| | - Ralph W. Kupka
- 0000 0004 0435 165Xgrid.16872.3aDepartment of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
- 0000 0004 0546 0540grid.420193.dGGZ inGeest, Center for Mental Health Care, Amsterdam, The Netherlands
- grid.413664.2Altrecht Institute for Mental Health Care, Utrecht, The Netherlands
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27
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Moore KE, Tull MT, Gratz KL. Borderline personality disorder symptoms and criminal justice system involvement: The roles of emotion-driven difficulties controlling impulsive behaviors and physical Aggression. Compr Psychiatry 2017; 76:26-35. [PMID: 28402839 DOI: 10.1016/j.comppsych.2017.03.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 03/10/2017] [Accepted: 03/10/2017] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE Borderline personality disorder (BPD) is associated with elevated risk for a variety of risky behaviors, including criminal behaviors. Yet, limited research has examined the relation of BPD to criminal justice (CJ) involvement, or the mechanisms underlying this relation. PROCEDURES This study examined the role of two mechanisms, emotion-driven difficulties controlling impulsive behaviors and physical aggression, in the relation between BPD symptom severity and CJ involvement among 118 patients in residential substance abuse treatment (76% male; 62% African-American). Participants completed measures of BPD symptom severity, CJ contact, diversity of CJ charges, emotion-driven impulse control difficulties, physical aggression, and covariates (substance use severity and antisocial personality disorder symptoms). RESULTS BPD symptom severity was associated with CJ contact through emotion-driven difficulties controlling impulsive behaviors, and with diversity of CJ charges through emotion-driven difficulties controlling impulsive behaviors and physical aggression; however, the indirect relations to diversity of CJ charges became non-significant when covariates were included. CONCLUSIONS Results highlight the important role of emotion-driven difficulties controlling impulsive behaviors in criminal behaviors among individuals with BPD symptoms, as well as the potential clinical utility of targeting this mechanism to prevent CJ involvement and/or recidivism.
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Affiliation(s)
- Kelly E Moore
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, 2500 N. State St., Jackson, MS 39216, United States.
| | - Matthew T Tull
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, 2500 N. State St., Jackson, MS 39216, United States
| | - Kim L Gratz
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, 2500 N. State St., Jackson, MS 39216, United States
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28
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Abstract
PURPOSE OF REVIEW Impulsivity is a multifaceted construct and an important personality trait in various mental health conditions. Among personality disorders (PDs), especially cluster B PDs are affected. The aims of this review are to summarize the relevant findings of the past 3 years concerning impulsivity in cluster B PDs and to identify those subcomponents of self-reported impulsivity and experimentally measured impulse control that are most affected in these disorders. RECENT FINDINGS All studies referred to antisocial (ASPD) or borderline PD (BPD), and none were found for narcissistic or histrionic PD. In ASPD as well as BPD, self-report scales primarily revealed heightened impulsivity compared to healthy controls. In experimental tasks, ASPD patients showed impairments in response inhibition, while fewer deficits were found in delay discounting. BPD patients showed specific impairments in delay discounting and proactive interference, while response inhibition was less affected. However, after inducing high levels of stress, deficits in response inhibition could also be observed in BPD patients. Furthermore, negative affect led to altered brain activation patterns in BPD patients during impulse control tasks, but no behavioral impairments were found. As proposed by the DSM-5 alternative model for personality disorders, heightened impulsivity is a core personality trait in BPD and ASPD, which is in line with current research findings. However, different components of experimentally measured impulse control are affected in BPD and ASPD, and impulsivity occurring in negative emotional states or increased distress seems to be specific for BPD. Future research could be focused on measures that assess impulsive behaviors on a momentary basis as this is a promising approach especially for further ecological validation and transfer into clinical practice.
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29
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Bayes A, Parker G, McClure G. Emotional dysregulation in those with bipolar disorder, borderline personality disorder and their comorbid expression. J Affect Disord 2016; 204:103-11. [PMID: 27344618 DOI: 10.1016/j.jad.2016.06.027] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/06/2016] [Accepted: 06/11/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND Differentiation of the bipolar disorders (BP) from a borderline personality disorder (BPD) can be challenging owing to shared features, with emotional dysregulation being the likely principal one. AIM To assess differences in emotion regulation strategies in those with BP alone, BPD alone and those comorbid for both. METHODS We interviewed participants previously receiving a BP or BPD diagnosis, studying those who met DSM criteria for one or both conditions. RESULTS The sample comprised 83 with bipolar disorder, 53 with BPD and 54 comorbid for both. Analyses established linear trends, with the greatest impairment in emotion regulation strategies in the comorbid group followed by the BPD group, and with the lowest in the BP group. Specific deficits in the comorbid group included impulsivity, difficulties with goal directed behaviour, and accessing strategies. A similar linear profile was quantified for maladaptive cognitive emotion regulation strategies, weighted to catastrophizing and rumination. Adaptive emotion regulation strategies were superior in the bipolar group, without significant differences observed between the comorbid and BPD groups. LIMITATIONS Reliance on self-report measures; combined BP I and II participants limits generalisability of results to each bipolar sub-type; use of DSM diagnoses risking artefactual comorbidity; while there was an over-representation of females in all groups. CONCLUSIONS Differences in emotion regulation strategies advance differentiation of those with either BP or BPD, while we identify the specificity of differing strategies to each condition and their synergic effect in those comorbid for both conditions. Study findings should assist the development and application of targeted strategies for those with either or both conditions.
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Affiliation(s)
- Adam Bayes
- School of Psychiatry, University of New South Wales, NSW, Australia.
| | - Gordon Parker
- School of Psychiatry, University of New South Wales, NSW, Australia; Black Dog Institute, Hospital Rd, Randwick, NSW 2031, Australia
| | - Georgia McClure
- School of Psychiatry, University of New South Wales, NSW, Australia; Black Dog Institute, Hospital Rd, Randwick, NSW 2031, Australia
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30
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Frías Á, Baltasar I, Birmaher B. Comorbidity between bipolar disorder and borderline personality disorder: Prevalence, explanatory theories, and clinical impact. J Affect Disord 2016; 202:210-9. [PMID: 27267293 DOI: 10.1016/j.jad.2016.05.048] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 05/21/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND The relationship between bipolar disorder (BD) and borderline personality disorder (BPD) has been controversial and widely debated. Specifically, the comorbidity between both disorders has yielded a plethora of research, but there are no comprehensive reviews on this issue. OBJECTIVE To determine the empirical evidence regarding the comorbidity between BD and BPD based on prevalence data, explanatory theories for their co-occurrence, and clinical impact of one disorder in the other. METHOD A comprehensive search of databases (PubMed and PsycINFO) was performed. Published manuscripts between January 1985 and August 2015 were identified. Overall, 70 studies fulfilled inclusion criteria. RESULTS Over a fifth of subjects showed comorbidity between BPD and BD. Empirical evidence from common underlying factors was inconclusive, but BPD appears to be a risk factor for BD. Data also indicated that the negative impact of BPD in BD (e.g., suicidality, worse mood course) was greater than vice verse. CONCLUSIONS Given the high prevalence of comorbidity between BD and BPD and the negative effects of BPD in subjects with BD, further studies are needed to clarify the factor associated with the comorbidity between these two disorders. This information is important to develop appropriate treatments for subjects with both disorders, improve their clinical course, and prevent the increased risk of suicidality commonly found in these subjects.
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Affiliation(s)
- Álvaro Frías
- FPCEE Blanquerna, University of Ramon-Llull, Barcelona, Spain; Adult Outpatient Mental Health Center, Consorci Sanitari del Maresme, Mataró, Spain; Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, United States.
| | - Itziar Baltasar
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, United States
| | - Boris Birmaher
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, United States
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31
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Herbort MC, Soch J, Wüstenberg T, Krauel K, Pujara M, Koenigs M, Gallinat J, Walter H, Roepke S, Schott BH. A negative relationship between ventral striatal loss anticipation response and impulsivity in borderline personality disorder. NEUROIMAGE-CLINICAL 2016; 12:724-736. [PMID: 27766203 PMCID: PMC5067102 DOI: 10.1016/j.nicl.2016.08.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 08/08/2016] [Accepted: 08/10/2016] [Indexed: 11/18/2022]
Abstract
Patients with borderline personality disorder (BPD) frequently exhibit impulsive behavior, and self-reported impulsivity is typically higher in BPD patients when compared to healthy controls. Previous functional neuroimaging studies have suggested a link between impulsivity, the ventral striatal response to reward anticipation, and prediction errors. Here we investigated the striatal neural response to monetary gain and loss anticipation and their relationship with impulsivity in 21 female BPD patients and 23 age-matched female healthy controls using functional magnetic resonance imaging (fMRI). Participants performed a delayed monetary incentive task in which three categories of objects predicted a potential gain, loss, or neutral outcome. Impulsivity was assessed using the Barratt Impulsiveness Scale (BIS-11). Compared to healthy controls, BPD patients exhibited significantly reduced fMRI responses of the ventral striatum/nucleus accumbens (VS/NAcc) to both reward-predicting and loss-predicting cues. BIS-11 scores showed a significant positive correlation with the VS/NAcc reward anticipation responses in healthy controls, and this correlation, while also nominally positive, failed to reach significance in BPD patients. BPD patients, on the other hand, exhibited a significantly negative correlation between ventral striatal loss anticipation responses and BIS-11 scores, whereas this correlation was significantly positive in healthy controls. Our results suggest that patients with BPD show attenuated anticipation responses in the VS/NAcc and, furthermore, that higher impulsivity in BPD patients might be related to impaired prediction of aversive outcomes. We investigated striatal reward and loss anticipation in patients with Borderline Personality Disorder (BPD) and controls BPD patients relative to controls exhibited reduced ventral striatal / nucleus accumbens (VS/NAcc) anticipation responses In healthy controls, VS responses to gains and losses correlated positively with impulsivity BPD patients exhibited a negative correlation between loss responses and impulsivity. Our results suggest that impulsivity in BPD patients may in part result from impaired anticipation of aversive outcomes.
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Affiliation(s)
- Maike C. Herbort
- Leibniz Institute for Neurobiology, Magdeburg, Germany
- Department of Psychiatry and Psychotherapy, Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychology, Humboldt University, Berlin, Germany
| | - Joram Soch
- Leibniz Institute for Neurobiology, Magdeburg, Germany
- Bernstein Center for Computational Neuroscience, Humboldt University, Berlin, Germany
| | - Torsten Wüstenberg
- Department of Psychiatry and Psychotherapy, Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Kerstin Krauel
- Department of Child and Adolescent Psychiatry and Psychotherapy, Otto von Guericke University, Magdeburg, Germany
- Center for Behavioral Brain Sciences, Magdeburg, Germany
| | - Maia Pujara
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA
| | - Michael Koenigs
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychiatry and Psychotherapy, University Hospital Eppendorf, Hamburg, Germany
| | - Henrik Walter
- Department of Psychiatry and Psychotherapy, Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan Roepke
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Björn H. Schott
- Leibniz Institute for Neurobiology, Magdeburg, Germany
- Department of Psychiatry and Psychotherapy, Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Center for Behavioral Brain Sciences, Magdeburg, Germany
- Corresponding author at: Leibniz-Institut für Neurobiologie, Brenneckestr. 6, 39118 Magdeburg, Germany.Leibniz-Institut für NeurobiologieBrenneckestr. 6Magdeburg39118Germany
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Behavior Rating Inventory of Executive Function Adult Version in Patients with Neurological and Neuropsychiatric Conditions: Symptom Levels and Relationship to Emotional Distress. J Int Neuropsychol Soc 2016; 22:682-94. [PMID: 27126218 DOI: 10.1017/s135561771600031x] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The present study explored the level of self-and informant reported executive functioning in daily living using the Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A) in a large sample comprising healthy adults and patient cohorts with neurological and neuropsychiatric disorders. The relationship to neuropsychological test performance and self-reported emotional distress was explored, as well as the applicability of U.S. normative data. METHODS Scores on the self- and informant reported BRIEF-A are presented, along with scores on standardized cognitive tests, and on rating scales of self-reported emotional distress in a Norwegian healthy comparison group (n=115), patients with severe traumatic brain injury (n=125), focal frontal lobe damage (n=29), focal cerebellar lesion (n=24), Parkinson's disease (n=42), attention deficit hyperactivity disorder (n=34), type II bipolar disorder (n=21), and borderline personality disorder (n=18). RESULTS Strong associations were observed between the BRIEF-A and emotional distress in both the healthy group and in neurological groups, while no or weak relationships with IQ and performance-based tests of executive function were seen. The relationship between BRIEF-A and emotional distress was weaker in the neuropsychiatric patient groups, despite high symptom load in both domains. Healthy participants tended to have BRIEF-A scores 1/2-3/4 SD below the U.S. normative mean of T score=50. CONCLUSIONS The study demonstrates the need to interpret BRIEF-A results within a broad differential diagnostic context, where measures of psychological distress are included in addition to neuropsychological tests. Uncertainty about the appropriateness of U.S. normative data in non-U.S. countries adds to the need for interpretive caution. (JINS, 2016, 22, 682-694).
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Bayes AJ, McClure G, Fletcher K, Román Ruiz Del Moral YE, Hadzi-Pavlovic D, Stevenson JL, Manicavasagar VL, Parker GB. Differentiating the bipolar disorders from borderline personality disorder. Acta Psychiatr Scand 2016; 133:187-95. [PMID: 26432099 DOI: 10.1111/acps.12509] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To identify features differentiating bipolar disorder (BP) from borderline personality disorder (BPD) and with each condition variably defined. METHOD Participants were assigned a BP or BPD diagnosis on the basis of DSM criteria and, separately, by clinical judgment, and undertook a diagnostic interview and completed self-report measures. RESULTS Predictors of BPD status varied according to diagnostic decisions, but with the most consistent items being childhood sexual abuse, childhood depersonalization, personality variables relating to relationship difficulties and sensitivity to criticism, and the absence of any BP family history. Across diagnostic groups, personality measure items alone predicted diagnostic allocation with an accuracy of 81-84%, the refined study variables other than hypo/manic features improved the classification rates to 88%, and when the presence or absence of hypo/manic features was added, classification rates increased to 92-95%. CONCLUSION Study findings indicate that BPD can be differentiated from BP with a high degree of accuracy.
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Affiliation(s)
- A J Bayes
- School of Psychiatry, The University of New South Wales, Sydney, NSW, Australia
| | - G McClure
- School of Psychiatry, The University of New South Wales, Sydney, NSW, Australia.,The Black Dog Institute, Sydney, NSW, Australia
| | - K Fletcher
- School of Psychiatry, The University of New South Wales, Sydney, NSW, Australia.,The Black Dog Institute, Sydney, NSW, Australia
| | | | - D Hadzi-Pavlovic
- School of Psychiatry, The University of New South Wales, Sydney, NSW, Australia.,The Black Dog Institute, Sydney, NSW, Australia
| | | | | | - G B Parker
- School of Psychiatry, The University of New South Wales, Sydney, NSW, Australia.,The Black Dog Institute, Sydney, NSW, Australia
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Abstract
PURPOSE OF REVIEW The purpose of this article is to review recent findings regarding the comorbidity of bipolar disorder with borderline personality disorder (BPD). The conceptualization of the comorbid condition is explored in the context of complexity theory. RECENT FINDINGS Recent studies highlight distinguishing features between the two disorders. The course of illness of the comorbid condition is generally considered to be more debilitating than bipolar disorder alone. SUMMARY Some of the differentiating features of bipolar disorder and BPD are highlighted. It is also crucial to consider a co-morbid diagnosis as worse outcomes may be anticipated than for bipolar disorder alone. The concept of 'emotional frailty' is introduced and the comorbid bipolar disorder-BPD condition is considered an expression of this syndrome.
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van Eijk J, Sebastian A, Krause-Utz A, Cackowski S, Demirakca T, Biedermann SV, Lieb K, Bohus M, Schmahl C, Ende G, Tüscher O. Women with borderline personality disorder do not show altered BOLD responses during response inhibition. Psychiatry Res 2015; 234:378-89. [PMID: 26483213 DOI: 10.1016/j.pscychresns.2015.09.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 07/29/2015] [Accepted: 09/24/2015] [Indexed: 01/18/2023]
Abstract
Impulsivity is central to borderline personality disorder (BPD). Response inhibition, addressing the ability to suppress or stop actions, is one aspect of behavioral impulse control which is frequently used to assess impulsivity. BPD patients display deficits in response inhibition under stress condition or negative emotions. We assessed whether response inhibition and its neural underpinnings are impaired in BPD when tested in an emotionally neutral setting and when co-morbid attention-deficit/hyperactivity disorder (ADHD) is excluded. To this end, we studied response inhibition in unmedicated BPD patients and healthy controls (HC) in two independent samples using functional magnetic resonance imaging during Simon-, Go/nogo-, and Stopsignal tasks. BPD patients and HC did not differ significantly in their performance in the Go/nogo and the Stopsignal tasks. Response interference in the Simon task was increased in BPD patients in one sample, but this could not be replicated in the second sample. In both samples, no significant differences in brain activation patterns during any of the tasks were present while the neural impulse control network was robustly activated during the inhibition tasks in both groups. Our results provide evidence that under emotionally neutral conditions response inhibition is not impaired in patients with BPD without co-occurring ADHD.
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Affiliation(s)
- Julia van Eijk
- Department of Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Alexandra Sebastian
- Emotion Regulation and Impulse Control Group, Focus Program Translational Neuroscience, Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University, Mainz Germany.
| | - Annegret Krause-Utz
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany; Clinical Psychology, Institute of Psychology, Faculty of Social and Behavioral Science, Leiden University, Leiden, The Netherlands
| | - Sylvia Cackowski
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Traute Demirakca
- Department of Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Sarah V Biedermann
- Department of Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Klaus Lieb
- Emotion Regulation and Impulse Control Group, Focus Program Translational Neuroscience, Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University, Mainz Germany
| | - Martin Bohus
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Gabriele Ende
- Department of Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Oliver Tüscher
- Emotion Regulation and Impulse Control Group, Focus Program Translational Neuroscience, Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University, Mainz Germany; Departments of Neurology and Psychiatry, Albert-Ludwigs-University Medical Center, Freiburg, Germany
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Differences and overlap in self-reported symptoms of bipolar disorder and borderline personality disorder. Eur Psychiatry 2015; 30:914-9. [DOI: 10.1016/j.eurpsy.2015.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 08/04/2015] [Accepted: 08/09/2015] [Indexed: 11/23/2022] Open
Abstract
AbstractBackgroundDifferential diagnosis between bipolar disorder (BD) and borderline personality disorder (BPD) is often challenging due to some overlap in symptoms and comorbidity of disorders. We investigated correlations in self-reported symptoms of BD and BPD in screening questionnaires at the levels of both total scores and individual items and explored overlapping dimensions.MethodsThe McLean Screening Instrument (MSI) for BPD and the Mood Disorder Questionnaire (MDQ) for BD were filled in by patients with unipolar and bipolar mood disorders (n = 313) from specialized psychiatric care within a pilot study of the Helsinki University Psychiatric Consortium. Pearson's correlation coefficients between total scores and individual items of the MSI and the MDQ were estimated. Relationships between MDQ and MSI were evaluated by exploratory factor analysis (EFA).ResultsThe correlation between total scores of the MDQ and MSI was moderate (r = 0.431, P < 0.001). Significant correlations were found between the MSI items of “impulsivity” and “mood instability” and all MDQ items (P < 0.01). In the EFA, the MSI “impulsivity” and “mood instability” items had significant cross-loadings (0.348 and 0.298, respectively) with the MDQ factor. The MDQ items of “irritability”, “flight of thoughts” and “distractibility” (0.280, 0.210 and 0.386, respectively) cross-loaded on the MSI factor.ConclusionsThe MDQ and MSI items of “affective instability”, “impulsivity”, “irritability”, “flight of thoughts” and “distractibility” appear to overlap in content. The other scale items are more disorder-specific, and thus, may help to distinguish BD and BPD.
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Muhlert N, Lawrence AD. Brain structure correlates of emotion-based rash impulsivity. Neuroimage 2015; 115:138-46. [PMID: 25957991 PMCID: PMC4463859 DOI: 10.1016/j.neuroimage.2015.04.061] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 04/28/2015] [Accepted: 04/29/2015] [Indexed: 01/12/2023] Open
Abstract
Negative urgency (the tendency to engage in rash, ill-considered action in response to intense negative emotions), is a personality trait that has been linked to problematic involvement in several risky and impulsive behaviours, and to various forms of disinhibitory psychopathology, but its neurobiological correlates are poorly understood. Here, we explored whether inter-individual variation in levels of trait negative urgency was associated with inter-individual variation in regional grey matter volumes. Using voxel-based morphometry (VBM) in a sample (n=152) of healthy participants, we found that smaller volumes of the dorsomedial prefrontal cortex and right temporal pole, regions previously linked to emotion appraisal, emotion regulation and emotion-based decision-making, were associated with higher levels of trait negative urgency. When controlling for other impulsivity linked personality traits (sensation seeking, lack of planning/perseverance) and negative emotionality per se (neuroticism), these associations remained, and an additional relationship was found between higher levels of trait negative urgency and smaller volumes of the left ventral striatum. This latter finding mirrors recent VBM findings in an animal model of impulsivity. Our findings offer novel insight into the brain structure correlates of one key source of inter-individual differences in impulsivity.
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Affiliation(s)
- N Muhlert
- School of Psychology and Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff University, Cardiff, UK.
| | - A D Lawrence
- School of Psychology and Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff University, Cardiff, UK
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