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Conjaerts JAP, Videler AC, Schepman R, Elfeddali I, Rosowsky E, van Alphen SPJ. Clinical Staging for Personality Disorders in Older Adults. J Geriatr Psychiatry Neurol 2024:8919887241254467. [PMID: 38809516 DOI: 10.1177/08919887241254467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
OBJECTIVE This scientific research aimed to investigate the feasibility of implementing a clinical staging (CS) model for personality disorders (PDs) in older adults. The CS model could provide valuable insights into the life course of personality pathology, prognosis, and treatment decisions for PDs in older adults. METHODS/DESIGN The study employed an international Delphi methodology with three rounds and involved 21 experts. RESULTS Consensus was achieved on 12 out of 17 statements, confirming the viability of a CS model for PDs in older adults. The proposed model incorporates the Alternative Model for PDs, criterion A, and integrates life course information, distinguishing between chronic PD, re-emergent PD, late-onset PD, and past PD. CONCLUSION The findings suggest that international experts support the implementation of a CS model for PDs in older adults, considering both the severity of personality functioning and the retrospective life course of PD expression.
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Affiliation(s)
- Jeroen A P Conjaerts
- Clinical Center of Excellence for Personality Disorders in Older Adults, Mondriaan Mental Health Center, Heerlen-Maastricht, The Netherlands
| | - Arjan C Videler
- Clinical Center of Excellence of Personality Disorders and Developmental Disorders in Older Adults, GGz Breburg Mental Health Center, PersonaCura, Tilburg, The Netherlands
- Tranzo department, Tilburg University, Tilburg, The Netherlands
- Clinical Centre of Excellence Body Mind and Health, GGz Breburg Mental Health Center, Tilburg, The Netherlands
| | - Roel Schepman
- Clinical Center of Excellence of Personality Disorders and Developmental Disorders in Older Adults, GGz Breburg Mental Health Center, PersonaCura, Tilburg, The Netherlands
| | - Iman Elfeddali
- Clinical Center of Excellence of Personality Disorders and Developmental Disorders in Older Adults, GGz Breburg Mental Health Center, PersonaCura, Tilburg, The Netherlands
- Tranzo department, Tilburg University, Tilburg, The Netherlands
- Clinical Centre of Excellence Body Mind and Health, GGz Breburg Mental Health Center, Tilburg, The Netherlands
| | - Erlene Rosowsky
- Department of Clinical Psychology William James College, Newton, MA, USA
| | - Sebastiaan P J van Alphen
- Clinical Center of Excellence for Personality Disorders in Older Adults, Mondriaan Mental Health Center, Heerlen-Maastricht, The Netherlands
- Personality and Psychopathology Research Group (PEPS), Department of Psychology (PE), Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Khasho DA, van Alphen SPJ, Ouwens MA, Arntz A, Heijnen-Kohl SMJ, Videler AC. The effectiveness of individual schema therapy in older adults with borderline personality disorder: A multiple-baseline case series design. Clin Psychol Psychother 2023; 30:1313-1323. [PMID: 37641578 DOI: 10.1002/cpp.2900] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/30/2023] [Accepted: 08/14/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE The aim of this study was to explore the effectiveness of schema therapy (ST) in older adults with borderline personality disorder (BPD). METHODS Multiple baseline case series design with five BPD patients, with a mean age of 66. After a baseline phase with random length, patients received weekly ST sessions for a year, followed by follow-up sessions during 6 months. Participants rated the credibility of negative core beliefs weekly; various secondary outcome measures were assessed every 6 months (severity of BPD, early maladaptive schemas, schema modes, personality functioning, maladaptive personality traits, psychological distress and quality of life), and BPD diagnosis was assessed before baseline and after follow-up. Data were analysed with mixed regression analyses and paired t-tests. RESULTS Results revealed that ST led to a significant decrease in credibility of negative core beliefs, with high effect sizes. All participants remitted from their BPD diagnosis. CONCLUSION This is the first study exploring the effectiveness of ST for BPD in older adults, and it suggests that ST can be a powerful intervention for this group of patients.
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Affiliation(s)
- David A Khasho
- GGz Breburg, PersonaCura, Clinical Centre of Excellence for Personality Disorders and Autism in Older Adults, Tilburg, The Netherlands
| | - Sebastiaan P J van Alphen
- GGz Breburg, PersonaCura, Clinical Centre of Excellence for Personality Disorders and Autism in Older Adults, Tilburg, The Netherlands
- Department of Clinical and Life Span Psychology, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Mondriaan, Clinical Centre of Excellence for Older Adults with Personality Disorders, Heerlen-Maastricht, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Machteld A Ouwens
- GGz Breburg, PersonaCura, Clinical Centre of Excellence for Personality Disorders and Autism in Older Adults, Tilburg, The Netherlands
- Tranzo Department, Tilburg University, Tilburg, The Netherlands
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Sylvia M J Heijnen-Kohl
- Mondriaan, Clinical Centre of Excellence for Older Adults with Personality Disorders, Heerlen-Maastricht, The Netherlands
| | - Arjan C Videler
- GGz Breburg, PersonaCura, Clinical Centre of Excellence for Personality Disorders and Autism in Older Adults, Tilburg, The Netherlands
- Tranzo Department, Tilburg University, Tilburg, The Netherlands
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Baptista A, Chambon V, Hoertel N, Olfson M, Blanco C, Cohen D, Jacquet PO. Associations Between Early Life Adversity, Reproduction-Oriented Life Strategy, and Borderline Personality Disorder. JAMA Psychiatry 2023; 80:558-566. [PMID: 37099311 PMCID: PMC10134045 DOI: 10.1001/jamapsychiatry.2023.0694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 02/06/2023] [Indexed: 04/27/2023]
Abstract
Importance Borderline personality disorder (BPD) is often accompanied by a history of high-risk sexual behavior and somatic comorbidities. Yet, these features are most often considered in isolation and little is known about their underlying developmental pathways. Life history theory, a leading framework in evolutionary developmental biology, can help make sense of the wide range of behaviors and health issues found in BPD. Objective To examine whether the emergence of BPD is associated with the prioritization of immediate reproductive goals over longer-term somatic maintenance goals, a life strategy that can be viewed as a developmental response to adverse early life experiences, providing rapid reproductive benefits despite costs to health and well-being. Design, Setting, and Participants This study used cross-sectional data from the second wave of the National Epidemiologic Survey on Alcohol and Related Conditions in 2004-2005 (n = 34 653). Civilian, noninstitutionalized individuals in the US, 18 years or older, and those with and without a DSM-IV diagnosis of BPD were included. Analysis took place between August 2020 and June 2021. Main Outcomes and Measures Structural equation models were used to examine whether early life adversity was associated with the likelihood of a BPD diagnosis, either directly or indirectly through a life strategy whereby individuals trade somatic maintenance for immediate reproduction. Results Analyses were performed on a sample of 30 149 participants (females: 17 042 [52%]; mean [SE] age, 48.5 [0.09]; males: 12 747 [48%]; mean [SE] age, 47 [0.08]). Of these, 892 (2.7%) had a diagnosis of BPD and 29 257 (97.3%) did not have BPD. Mean early life adversity, metabolic disorder score, and body mass index were significantly higher among participants with a diagnosis of BPD. In an analysis adjusted for age, individuals with BPD reported having significantly more children than those without BPD (b =0.06; SE, 0.01; t = 4.09; P < .001). Having experienced greater levels of adversity in early life was significantly associated with a greater risk of being diagnosed with BPD later in life (direct relative risk = 0.268; SE, 0.067; P < .001). Importantly, this risk was further increased by 56.5% among respondents who prioritized short-term reproductive goals over somatic maintenance (indirect relative risk = 0.565; SE, 0.056; P < .001). Similar patterns of associations were found in male and female individuals. Conclusions and Relevance The hypothesis of a reproduction/maintenance life history trade-off mediating the association between early life adversity and BPD helps make sense of the high dimensionality that characterizes the physiological and behavioral correlates of BPD. Additional studies are needed to confirm these results using longitudinal data.
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Affiliation(s)
- Axel Baptista
- Institut Jean Nicod, Département d’Études Cognitives, ENS, EHESS, CNRS, PSL University, Paris, France
- Université Paris Cité, Paris, France
- Service de Psychiatrie de l’Enfant et de l’Adolescent, GH Pitié-Salpêtrière Charles Foix, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Centre de Recherche en Épidémiologie et en Santé des Populations, INSERM U1018, UVSQ, Université Paris-Saclay, Paris, France
| | - Valérian Chambon
- Institut Jean Nicod, Département d’Études Cognitives, ENS, EHESS, CNRS, PSL University, Paris, France
| | - Nicolas Hoertel
- Université Paris Cité, Paris, France
- Département Médico-Universitaire Psychiatrie et Addictologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Issy-les-Moulineaux, France
- INSERM UMR 894, Psychiatry and Neurosciences Center; Paris University, Paris, France
| | - Mark Olfson
- Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, Maryland
| | - David Cohen
- Service de Psychiatrie de l’Enfant et de l’Adolescent, GH Pitié-Salpêtrière Charles Foix, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Institut des Systèmes Intelligents et de Robotique, Sorbonne Université, ISIR CNRS UMR, Paris, France
| | - Pierre O. Jacquet
- Centre de Recherche en Épidémiologie et en Santé des Populations, INSERM U1018, UVSQ, Université Paris-Saclay, Paris, France
- Institut du Psychotraumatisme de l’Enfant et de l’Adolescent, Conseil Départemental Yvelines et Hauts-de-Seine et Centre Hospitalier de Versailles, Versailles, France
- Département d’études Cognitives, LNC2, INSERM U960, École Normale Supérieure, PSL Research University, Paris, France
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Approximating defense mechanisms in a national study of adults: prevalence and correlates with functioning. Transl Psychiatry 2023; 13:21. [PMID: 36690611 PMCID: PMC9870881 DOI: 10.1038/s41398-022-02303-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/30/2022] [Accepted: 12/30/2022] [Indexed: 01/25/2023] Open
Abstract
Despite the clinical relevance of defense mechanisms, there are no published studies in nationally representative samples of their prevalence, correlates, and association with psychosocial functioning. We sought to estimate the prevalence and correlates of 12 defense mechanisms in the general adult population by approximating from items used to assess personality traits in the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), a representative sample of US adults (N = 36,653). We examined the associations between sociodemographic characteristics and prevalence of 3 types of defenses mechanisms (pathological, immature, and neurotic). For each defense mechanism, we used the Short-Form 12 to compare psychosocial functioning among 3 groups: those who (1) endorsed the mechanism with self-recognized impairment, (2) endorsed the mechanism without self-recognized impairment, and (3) did not endorse the defense mechanism. The prevalence of defense mechanisms ranged from 13.2% (splitting) to 44.5% (obsessive/controlling behavior). Pathological defenses were more strongly associated with immature defenses (OR = 5.4, 95% CI = 5.2-5.6) than with neurotic defenses (OR = 2.0, 95% CI = 1.9-2.0), whereas the association between immature and neurotic defenses had an intermediate value between the other two (OR = 2.2, 95% CI = 2.1-2.2). Pathological and immature defenses were associated with younger age, having been never married, lower educational attainment, and lower income. After adjusting the crude results for age and sex, individuals who did not endorse a given defense generally had higher scores on the mental health component of the SF-12 than those who endorsed the defense without self-recognized impairment who, in turn, had on average higher scores than those with self-recognized impairment. These results suggest that neurotic, immature, and pathological defense mechanisms are prevalent in the general population and associated with psychosocial impairment. Recognizing defense mechanisms may be important in clinical practice regardless of treatment modality.
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Lee RK, Harms CA, Jeffery SE. The contribution of skills to the effectiveness of dialectical behavioral therapy. J Clin Psychol 2022; 78:2396-2409. [PMID: 35333407 DOI: 10.1002/jclp.23349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 01/07/2022] [Accepted: 02/25/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The present study investigated the effectiveness of dialectical behavioral therapy (DBT) and the effect of improvement in DBT skills on clinical outcomes. METHOD Participants included 57 adults who attended a community mental health service and underwent one of two modes of DBT. Twenty-six adults had been diagnosed with borderline personality disorder (BPD) and participated in comprehensive DBT (DBT-C; including group skills training, individual therapy, and phone coaching). Thirty-one adults had BPD traits and participated in DBT skills training (DBT-S; group skills training only). In the present study, the DBT skills examined were mindfulness, emotion regulation, and interpersonal effectiveness; the clinical outcomes examined were borderline symptoms, psychological distress, and quality of life. RESULTS Six 2 × 2 analysis of covariances indicated significant improvements in psychological distress, quality of life, mindfulness, and interpersonal effectiveness (but not borderline symptoms and emotion regulation), over a 6-month period. Mode of delivery of DBT did not impact on the improvement in DBT skills and clinical outcomes over the 6-month period. Hierarchical multiple regression results indicated that improvement in DBT skills (mindfulness, emotion regulation, and interpersonal effectiveness) were associated with reductions in borderline symptoms and psychological distress, with emotion regulation the only skill uniquely associated with improvements in clinical outcomes. CONCLUSIONS The results of the present study support the effectiveness of DBT and the specific role of emotion regulation for favorable clinical outcomes over a 6-month period, independent of the mode of delivery of DBT.
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Affiliation(s)
- Rachael K Lee
- Psychology and Criminology, School of Arts and Humanities, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Craig A Harms
- Psychology and Criminology, School of Arts and Humanities, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Sian E Jeffery
- Fremantle Mental Health Service, Fremantle, Western Australia, Australia
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Ouwens MA, Videler AC, van Alphen SPJ. Clinical Staging as a Novel Approach for Selecting Psychological Treatment Levels for Older Adults with Borderline Personality Disorder. Clin Gerontol 2022:1-7. [PMID: 35189784 DOI: 10.1080/07317115.2022.2041143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES In this paper, a novel approach is presented for selecting psychological treatment levels for older adults with borderline personality disorder (BPD). BPD tends to be a lifelong disorder persisting into old age, with a specific presentation of BPD symptoms in later life, which is illustrated by three different clinical cases. METHODS Recently, a clinical staging and health management model for BPD was presented to assist in selecting appropriate treatment approaches. RESULTS We combined this clinical staging model for BPD across the lifespan with psychotherapeutic treatment levels for older adults with personality disorders. CONCLUSIONS This may allow for a more accurate treatment selection for older adults with BPD and was applied to the three clinical cases. Finally, implications for research and clinical practice are discussed.
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Affiliation(s)
- Machteld A Ouwens
- PersonaCura, GGz Breburg, Clinical Center of Excellence for Personality Disorders and Autism Spectrum Disorders in Older Adults, Tilburg, The Netherlands
- Tranzo, Scientific Center for Care and Wellbeing of the Tilburg School of Social and Behavioral Sciences of Tilburg University, Tilburg, The Netherlands
| | - Arjan C Videler
- PersonaCura, GGz Breburg, Clinical Center of Excellence for Personality Disorders and Autism Spectrum Disorders in Older Adults, Tilburg, The Netherlands
- Tranzo, Scientific Center for Care and Wellbeing of the Tilburg School of Social and Behavioral Sciences of Tilburg University, Tilburg, The Netherlands
| | - Sebastiaan P J van Alphen
- PersonaCura, GGz Breburg, Clinical Center of Excellence for Personality Disorders and Autism Spectrum Disorders in Older Adults, Tilburg, The Netherlands
- Mondriaan Mental Health Center, Clinical Center of Excellence for Personality Disorders in Older Adults, Heerlen-Maastricht, The Netherlands
- Department Psychology (PE), Personality and Psychopathology Research Group (PEPS), Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Department of Medical and Clinical Psychology of the Tilburg School of Social and Behavioral Sciences of Tilburg University, Tilburg University, Tilburg, The Netherlands
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Remission of Suicidal Ideation in Emotionally Unstable Personality Disorder with Flupenthixol. Case Rep Psychiatry 2022; 2022:7097189. [PMID: 35070463 PMCID: PMC8776478 DOI: 10.1155/2022/7097189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 12/17/2021] [Indexed: 12/01/2022] Open
Abstract
There are currently no licensed pharmacological treatments for Emotionally Unstable Personality Disorder. This case report describes a 50-year-old male who two years previously had been brought to the attention of psychiatric services following an overdose with intention to end his life. He was subsequently diagnosed with Emotionally Unstable Personality Disorder (EUPD) and, following further suicide attempts and trials of mainstream pharmacological treatments, responded to flupenthixol IM 20 mg fortnightly, experiencing complete remission from his suicidal ideation. Clinicians should be aware of EUPD presenting in later life and should consider the role of typical antipsychotics, including flupenthixol, in the treatment of suicidal ideation in patients with EUPD. Age-specific guidance on EUPD management would be of use to clinicians, especially in the management of older patients, as current guidance is based on findings within a narrow age group.
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Abstract
PURPOSE OF REVIEW Although mental health issues in ageing individuals have been receiving more attention, borderline personality disorder (BPD) in older adults and the elderly has been relatively neglected. This article aims to review the current state of knowledge about BPD in these age groups. RECENT FINDINGS Studies have consistently reported decreasing prevalence rates of BPD among ageing individuals. This may be attributed to the ageing process itself and/or different clinical features due to which meeting the diagnostic criteria for BPD becomes more difficult. Ageing individuals with BPD often present in a way that makes them look 'atypical' compared to younger individuals with the same condition. In particular, this pertains to somewhat attenuated and less overt manifestations of impulsivity. However, the basic pattern of overall symptoms instability continues to characterize ageing individuals with BPD, in addition to depressive symptoms, feeling of emptiness, anger, unstable interpersonal relationships, turbulent responses when needs are not met, various somatic complaints and other symptoms. SUMMARY Clinicians should be aware of different clinical features of BPD as patients get older. Diagnostic criteria for BPD may need to be revised to reflect this reality, allow accurate diagnosis and minimize the risk of overlooking BPD in ageing individuals.
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Affiliation(s)
| | - Raffaele Pepi
- Department of Humanities, University of Urbino 'Carlo Bo', Urbino, Italy
| | - Vladan Starcevic
- University of Sydney, Faculty of Medicine and Health, Sydney Medical School, Nepean Clinical School, Sydney, Australia
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Cavelti M, Lerch S, Ghinea D, Fischer-Waldschmidt G, Resch F, Koenig J, Kaess M. Heterogeneity of borderline personality disorder symptoms in help-seeking adolescents. Borderline Personal Disord Emot Dysregul 2021; 8:9. [PMID: 33722308 PMCID: PMC7958409 DOI: 10.1186/s40479-021-00147-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 01/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The heterogeneous presentation of borderline personality disorder (BPD) represents a clinical challenge. There is an ongoing scientific debate whether the heterogeneity can best be understood in terms of qualitative (categorical) or quantitative (dimensional) differences between individuals. The present study examined the latent structure of BPD in adolescents. METHODS Five-hundred and six outpatients aged 12 to 17 years with risk-taking and/or self-harming behavior were assessed at baseline and one-year follow-up. Latent class analysis (corresponding with the categorical approach), factor analysis (corresponding with the dimensional approach), and factor mixture models (allowing for both categorical and dimensional aspects) were applied to the DSM-IV BPD criteria. RESULTS The best fitting model distinguished between a majority class with high probabilities for all BPD criteria ("borderline group") and a minority class with high probabilities for the impulsivity and anger criteria only ("impulsive group"). Sex significantly affected latent class membership, and both a latent factor and age explained within-class variability. The borderline group primarily consisted of females, frequently reported adverse childhood experiences, scored high on the emotion dysregulation and inhibitedness personality traits, and was associated with internalizing psychopathology. In contrast, the impulsive group primarily consisted of males, scored high on the dissocial behavior personality trait, and was associated with externalizing psychopathology. After one year, the two groups showed similar clinical improvement. CONCLUSIONS The study provides evidence for two distinct subgroups of adolescents with BPD features that resemble the subtypes of the ICD-10 emotionally unstable personality disorder. More research is needed to further investigate the diagnostic stability of the two groups over time and potential differential treatment indications.
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Affiliation(s)
- Marialuisa Cavelti
- University Hospital for Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000, Bern 60, Switzerland
| | - Stefan Lerch
- University Hospital for Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000, Bern 60, Switzerland
| | - Denisa Ghinea
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
- Clinic for Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Gloria Fischer-Waldschmidt
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
- Clinic for Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Franz Resch
- Clinic for Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Julian Koenig
- University Hospital for Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000, Bern 60, Switzerland
- Section for Experimental Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- University Hospital for Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000, Bern 60, Switzerland.
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
- Clinic for Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
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Lohanan T, Leesawat T, Wongpakaran T, Wongpakaran N, Karawekpanyawong N, Oon-Arom A, Kuntawong P. Development and validation of a screening instrument for borderline personality disorder (SI-Bord) for use among university students. BMC Psychiatry 2020; 20:479. [PMID: 32998759 PMCID: PMC7526163 DOI: 10.1186/s12888-020-02807-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/03/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The screening instrument for borderline personality disorder (SI-Bord) consists of a 5-item self-reported questionnaire on the key features of BPD from the DSM-5 using a 5-point Likert scale. This study investigated its validity and reliability in screening for BPD in university students. METHODS A cross-sectional study was conducted on a sample of university students in Thailand between November and December 2019. An online assessment gathered demographic data and results from the SI-Bord, the Perceived Stress Scale-10 (PSS-10) and the Patient Health Questionnaire-9 (PHQ-9). Participants whose SI-Bord scores were ≥ 1 were randomly selected to be interviewed and assessed for a BPD diagnosis by four psychiatrists using the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II) as a reference point. An intraclass correlation coefficient (ICC) of 0.925 (95% CI, 0.805-0.979) ensured inter-rater reliability between the four psychiatrists. The diagnostic sensitivity and specificity of the SI-Bord, as compared to that of the SCID-II, were determined to indicate the cut-off score. The Receiver Operating Characteristics (ROC) was analyzed to evaluate its diagnostic accuracy. RESULTS The study included 342 students aged 18-25 years (the mean age was 20.25 ± 1.4 years), 80.4% of whom were female. Among the 68 participants selected for an online interview, 16 were diagnosed with BPD. The cut-off score of the SI-Bord was > 9, as suggested by the Youden index, yielding a sensitivity of 56.3% and a specificity of 92.3%. It had a positive predictive value of 69.2% and negative predictive value of 87.3%. The SI-Bord had adequate discriminative power between cases and non-cases of BPD, with the area under the ROC curve being 0.83. Cronbach's alpha for the SI-Bord was 0.76, indicating acceptable internal consistency. The SI-Bord score was positively correlated to PHQ-9 and PSS-10 scores (r = 0.67 and r = 0.69, p < 0.001, respectively) and negatively correlated to MSPSS (r = - 0.50, p < 0.001). The prevalence of BPD in the sample was 6.4%, according to the cut-off score > 9. CONCLUSION The SI-Bord demonstrated good reliability and validity for screening BPD in university students. However, a study in non-Thai and other population groups should be warranted.
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Affiliation(s)
- Trustsavin Lohanan
- grid.7132.70000 0000 9039 7662Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Thanakorn Leesawat
- grid.7132.70000 0000 9039 7662Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Tinakon Wongpakaran
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Rd., T. Sriphum, A. Muang, Chiang Mai, 50200, Thailand.
| | - Nahathai Wongpakaran
- grid.7132.70000 0000 9039 7662Department of Psychiatry, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Rd., T. Sriphum, A. Muang, Chiang Mai, 50200 Thailand
| | - Nuntaporn Karawekpanyawong
- grid.7132.70000 0000 9039 7662Department of Psychiatry, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Rd., T. Sriphum, A. Muang, Chiang Mai, 50200 Thailand
| | - Awirut Oon-Arom
- grid.7132.70000 0000 9039 7662Department of Psychiatry, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Rd., T. Sriphum, A. Muang, Chiang Mai, 50200 Thailand
| | - Pimolpun Kuntawong
- grid.7132.70000 0000 9039 7662Department of Psychiatry, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Rd., T. Sriphum, A. Muang, Chiang Mai, 50200 Thailand
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Dong Y, Dumas D. Are personality measures valid for different populations? A systematic review of measurement invariance across cultures, gender, and age. PERSONALITY AND INDIVIDUAL DIFFERENCES 2020. [DOI: 10.1016/j.paid.2020.109956] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
PURPOSE OF REVIEW To provide an update of a life span perspective on borderline personality disorder (BPD). We address the life span course of BPD, and discuss possible implications for assessment, treatment, and research. RECENT FINDINGS BPD first manifests itself in adolescence and can be distinguished reliably from normal adolescent development. The course of BPD from adolescence to late life is characterized by a symptomatic switch from affective dysregulation, impulsivity, and suicidality to maladaptive interpersonal functioning and enduring functional impairments, with subsequent remission and relapse. Dimensional models of BPD appear more age neutral and more useful across the entire life span. There is a need for age-specific interventions across the life span. BPD symptoms and impairments tend to wax and wane from adolescence up to old age, and presentation depends on contextual factors. Our understanding of the onset and early course of BPD is growing, but knowledge of BPD in late life is limited. Although the categorical criteria of DSM allow for reliable diagnosis of BPD in adolescence, dimensional models appear both more age neutral, and useful up to late life. To account for the fluctuating expression of BPD, and to guide development and selection of treatment across the life span, a clinical staging model for BPD holds promise.
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