Memory of childhood trauma before and after long-term psychological treatment of borderline personality disorder

Examining childhood experiences and personality functioning as potential predictors for the speed of recovery during psychotherapy of patients with anxiety disorders

Background

Adverse childhood experiences were previously identified as relevant risk factors for the development of anxiety disorders. Furthermore, anxiety disorders were shown to be associated with impairments of personality functioning. The objective of this study was to investigate adverse and protective childhood experiences as well as personality functioning, as defined by the Operationalized Psychodynamic Diagnosis system, as potential predictors for the speed of recovery during psychotherapy for patients with anxiety disorders.

Methods

The sample consisted of n = 312 completed psychotherapies. The speed of recovery, defined as symptom abatement over time, was calculated using a two-stage hierarchical linear model. The effects of adverse and protective childhood experiences as well as personality functioning on the speed of recovery during psychotherapy were then examined using a structural equation model.

Results

The presence of adverse childhood experiences predicted a lower speed of recovery during psychotherapy. In addition, a higher number of adverse childhood experiences was associated with greater impairments in the abilities of perception and regulation as dimensions of personality functioning. A higher number of protective childhood experiences was associated with fewer impairments in the communication and attachment dimensions. Impairments in personality functioning in patients with anxiety disorders did not predict the speed of recovery during psychotherapy.

Conclusions

Among patients with anxiety disorders, adverse childhood experiences lead to a lower speed of recovery during psychotherapy. Therefore, childhood adversity should be routinely assessed before and thoroughly addressed during psychotherapy in patients with anxiety disorders.

Seeing the past in a new light: change in reports of childhood abuse and neglect before and after inpatient psychotherapy and its relevance for change in depression symptoms

OBJECTIVE

As changes in mental representations have been discussed as mechanisms of change in psychotherapy, the question arises whether recollections of childhood abuse and neglect are altered as well and how they relate to symptom changes.

METHOD

Individuals in psychosomatic inpatient treatment (N = 488, 60.5% women) filled out the Childhood Trauma Questionnaire (CTQ) and Patient Health Questionnaire (PHQ-9). Changes in both were investigated with correlations and t-tests. Linear regression analysis was used to test whether CTQ changes predicted symptom changes. Network analysis was performed to ascertain structural connections between somatic and emotional-cognitive depression symptoms and CTQ subscales before and after treatment.

RESULTS

After treatment (duration in days: M = 52.83, SD = 20.94), patients reported fewer depression symptoms (d = 0.84), while CTQ scores increased slightly (d = 0.11). Changes in the CTQ predicted recovery from depression symptoms in a statistically significant way (β = .133, p = .001). We did not observe changes in the overall network structure between baseline assessment and discharge.

CONCLUSION

The findings suggest that the evaluation of past experiences can change over multiple weeks of psychotherapy. Further, these updated mental representations, indicating a greater recognition of past adversity, may contribute to symptom relief.

The relationship between childhood adversity and adult personality revealed by network analysis

BACKGROUND

Childhood adversity is known to influence personality development. Studies suggest that distinct types of childhood adversities have differential effects on personality dimensions. However, different types of adversity often co-occur, and personality dimensions are strongly interconnected.

OBJECTIVE

The aim of this study was to use a network approach to analyze the interrelationships between different types of childhood adversity and diverse personality dimensions integratively.

PARTICIPANTS AND SETTING

We used previously collected data on 142 alcohol dependent patients and 102 healthy controls.

METHODS

The participants completed the Interview for Traumatic Events in Childhood, the Parental Acceptance and Rejection Questionnaire and the Temperament and Character Inventory. Outcomes on the subscales of these instruments were included in the network analysis.

RESULTS

The resulting network showed strong connections between different types of childhood adversity, and between the different temperaments and characters of personality. Childhood adversity, mainly physical abuse and maternal rejection, was connected to most personality dimensions, except for reward dependence. Physical abuse showed the highest centrality measures, indicating a central, important role in the network.

CONCLUSIONS

These findings confirm that different types of childhood adverse experiences often co-occur, and suggest that specifically physical and emotional abuse, and maternal rejection might play a prominent role in shaping personality.

Emerging Adulthood and Prospective Depression: A Simultaneous Test of Cumulative Risk Theories

Past research indicates that a history of depression and exposure to abuse and neglect represent some of the most robust predictors of depression in emerging adults. However, studies rarely test the additive or interactive risk associated with these distinct risk factors. In response, the present study explored how these three risk factors (prior depression, abuse, and neglect) synergistically predicted prospective depressive symptoms in a sample of 214 emerging adults (M_age = 21.4 years; SD_age = 2.4; 78% females). Subtypes of maltreatment and lifetime history of depression were assessed through semi-structured interviews, and depressive symptoms were assessed annually for three years via self-report measures. The results indicated that for both males and females, a lifetime history of depression, abuse, and neglect-exposure uniquely conferred risk for elevated depressive symptoms. Furthermore, the interaction between neglect and prior depression forecasted increasing depressive symptoms, and a history of abuse also predicted increasing depressive symptoms, but only in females. These findings are contextualized within extant developmental psychopathology theories, and translational implications for trauma-informed depression prevention efforts are discussed.

We cannot change the past, but we can change its meaning. A randomized controlled trial on the effects of self-help imagery rescripting on depression

BACKGROUND

Imagery rescripting is a psychotherapeutic technique that aims to ameliorate negative emotions by altering (i.e., rescripting) inner representations of negative memories and images. Although the treatment was initially developed for traumatized individuals, face-to-face interventions have yielded promising results for patients with other diagnoses as well. The present study explored the feasibility and efficacy of the approach when used as a self-help intervention for depression.

METHOD

A total of 127 individuals with diagnosed depression were randomly allocated to either a wait-list control condition or received a brief or long version of a manual teaching imagery rescripting. Six weeks after inclusion, patients were invited to participate in the post assessment. The Beck Depression Inventory (BDI-II) served as the primary outcome (registered at ClinicalTrials.gov (NCT03299127).

RESULTS

The long version was superior to the wait-list control condition on the BDI-II, self-esteem, and quality of life at a medium effect size. No effects emerged for anxiety. No significant between-group differences were found for the brief version. Moderation analyses indicated that the self-help approach seems particularly beneficial for those scoring high on symptoms, willingness to change, and expectancy (baseline). Most patients indicated they would use the technique in the future.

DISCUSSION

The efficacy of imagery rescripting was confirmed when applied via self-help. Use of the long form of the manual is recommended. Future studies are needed to ascertain whether treatment effects are sustained over time.

Autobiographical memory in borderline personality disorder-A systematic review

Borderline personality disorder is a severe psychiatric illness. A key feature of the disorder is a disorganized sense of self often referred to as identity diffusion. Autobiographical memory is memory for personal life events. One of the main functions of these memories is to enable us to understand who we are by connecting past, present and future experiences. It seems that autobiographical memory is in some way disrupted in individuals with borderline personality disorder. A systematic review is conducted looking at studies that focus on the potential connections. We find that although a number of studies have been published results remain inconsistent. Furthermore, we find that many of the studies suffer from inadequate designs particularly regarding the reported measures of autobiographical memory. We discuss potential links between personality functioning, identity diffusion, autobiographical memory and borderline personality disorder.

Inconsistent retrospective self-reports of childhood sexual abuse and their correlates in the general population

PURPOSE

Epidemiological research on childhood sexual abuse (CSA) and its consequences in adult life mainly relies on retrospective reports. This study explores their consistency and the correlates of inconsistent CSA self-reports in a random population sample.

METHOD

A stratified subsample of 2,462 subjects (selected from a large-scale (N = 34,267) representative sample of Dutch adults aged 40 and beyond) participated in a two-phase online questionnaire survey on extra-familial CSA which was conducted on a four- to six-week interval. Subjects reporting CSA were overrepresented. Participants with consistent and inconsistent responses were compared with regard to demographics, family background, abuse severity, and clinical characteristics. Potential correlates of inconsistency were identified using logistic regression analysis. An additional questionnaire (Phase III) administered to inconsistent respondents explored possible reasons for their inconsistency.

RESULTS

Of the 1,992 respondents who had reported extra-familial CSA during Phase I, 707 (35.5%) denied this in Phase II. Of the 2,462 respondents in Phase II, 727 (29.5%; 9.2% when considering sample stratification) gave a discrepant answer to the extra-familial sexual abuse item compared to their answers given in Phase I. Reports of less severe abuse, intra-familial CSA, and early parental separation predicted inconsistency. Reasons provided for inconsistency varied from misunderstanding (e.g., reporting intra-familial CSA rather than extra-familial CSA) to emotional motives (e.g., embarrassment, being overwhelmed) or practical considerations (e.g., lack of privacy while filling out the questionnaire).

CONCLUSIONS

Inconsistent self-reports of extra-familial sexual abuse occur on a substantial scale and are associated with less severe forms of abuse (lack of salience) or classification difficulties (perpetrator being a family member or not). Consistency tests and probing for clarifications or corrections should be routinely conducted in order to increase the quality of CSA epidemiological research.

Schema therapy for borderline personality disorder: a comprehensive review of its empirical foundations, effectiveness and implementation possibilities

Borderline personality disorder is a serious psychiatric disorder for which the effectiveness of the current pharmacotherapeutical and psychotherapeutic approaches has shown to be limited. In the last decades, schema therapy has increased in popularity as a treatment of borderline personality disorder; however, systematic evaluation of both effectiveness and empirical evidence for the theoretical background of the therapy is limited. This literature review comprehensively evaluates the current empirical status of schema therapy for borderline personality disorder. We first described the theoretical framework and reviewed its empirical foundations. Next, we examined the evidence regarding effectiveness and implementability. We found evidence for a considerable number of elements of Young's schema model; however, the strength of the results varies and there are also mixed results and some empirical blanks in the theory. The number of studies on effectiveness is small, but reviewed findings suggest that schema therapy is a promising treatment. In Western-European societies, the therapy could be readily implemented as a cost-effective strategy with positive economic consequences.

Consistency of reporting sexual and physical abuse during psychological treatment of personality disorder: an explorative study

The objective of this study was to assess the prevalence of decreasing, consistent and increasing reports of sexual and physical abuse after 12 months of long-term psychological treatment of personality disorders, to investigate demographic and clinical characteristics predictive of inconsistency of reporting abuse, and to explore whether autobiographical memory may account for this inconsistency. In 229 clinical participants with an SCID II diagnosed personality disorder, 180 (78.6%) reported the same instances of invasive sexual and/or physical abuse on a trauma questionnaire (SPAQ) at baseline and follow-up, 25 (10.9%) decreased and 24 (10.4%) increased their abuse reports. Consistency of reporting abuse did not differ between schema-focused therapy, clarification-oriented psychotherapy and treatment-as-usual. Current depressive episode (SCID-I) and decreased capacity to produce specific negative memories on the Autobiographical Memory Test were characteristic of decreasing abuse reporters, while increasing abuse reporters showed higher levels of Cluster A personality pathology (in particular schizotypal traits) on the Assessment of DSM-IV Personality Disorders (ADP-IV). These results suggest that even in treatment procedures directed at exploring someone's personal past with abuse-related imagery consistency of reporting abuse is quite stable. However, certain clinical characteristics may make some persons more likely to change their trauma reports. Moreover, reduced negative memory specificity may represent an avoidant strategy associated with no longer reporting instances of abuse.

Effects of child abuse history on borderline personality traits, negative life events, and depression: a study among a university student population in Japan

To simultaneously examine the impact of childhood abuse history on borderline personality traits, negative life events, and depression, undergraduate students (N=243) were studied by questionnaire surveys with one week intervals. Neglect and emotional abuse as well as sexual maltreatment predicted borderline personality traits and baseline depression. Baseline depression as well as the impact of negative life events occurring the week prior predicted depression a week later. However, after considering the baseline depression level, child abuse history failed to predict the follow-up depression level. Borderline personality traits did not moderate these findings. Childhood emotional and sexual abuse history may influence depression and borderline personality traits.

Development and psychometric evaluation of a new assessment method for childhood maltreatment experiences: the interview for traumatic events in childhood (ITEC)

OBJECTIVE

We conducted a comprehensive assessment of the reliability and validity of the Interview for Traumatic Events in Childhood (ITEC, Lobbestael, Arntz, Kremers, & Sieswerda, 2006), a retrospective, semi-structured interview for childhood maltreatment. The ITEC aims to yield dimensional scores for severity of experiences of different childhood maltreatment dimensions.

METHODS

Initial psychometric properties were tested with the pilot version of the ITEC in 362 participants. A second study assessed the revised ITEC in 217 participants, patients and non-patients.

RESULTS

Factor analyses produced the best fit for a five-factor model (sexual, physical and emotional abuse, physical and emotional neglect). The scales had good internal consistency, except for the physical neglect subscale, and excellent inter-rater reliability. The scales were highly associated with equivalent scales of the Childhood Trauma Questionnaire (i.e., good convergent validity), and showed good correspondence with patient file information (i.e., good criterion validity).

CONCLUSION

These results support the reliability and validity of the ITEC, making it a potentially useful tool for assessing a broad range of traumatic events in childhood.

PRACTICE IMPLICATION

The first step in therapy for dealing with childhood maltreatment is to map abusive experiences and assess their severity and impact. Since maltreatment is a sensitive topic that is not reported on easily, trauma interviews are promising assessment instruments since they provide the opportunity to probe and clarify. There are hardly any well-validated trauma interviews available that assess the extent of maltreatment in and outside the family in various dimensions. The current study tries to fill this gap by presenting a new trauma interview; the Interview for Traumatic Events in Childhood.