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Kwak S, Kwon J. General and distinct correspondence between personality disorder and interpersonal functioning. Acta Psychol (Amst) 2024; 249:104454. [PMID: 39153317 DOI: 10.1016/j.actpsy.2024.104454] [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: 02/20/2024] [Revised: 06/27/2024] [Accepted: 08/06/2024] [Indexed: 08/19/2024] Open
Abstract
The alternative model of personality disorders (AMPD) in DSM-5 includes interpersonal dysfunction as a core construct as a global severity dimension. However, it is less known how various interpersonal characteristics contribute to both general and distinct dimensions of personality dysfunction. In participants from community sources, we obtained responses to Levels of Personality Functioning Scale-Self Report (LPFS-SR), maladaptive traits (PID-5-BF), and social relationship patterns, including those related to close relationships and quantitative measures of network size. Canonical correlation analysis mapped conjoint associations between two sets of variables (personality scales and social relationship) and identified three distinct modes of correlation as significant. The first canonical pattern represented global dysfunction and was associated with utilitarianism, short-termed, weaker strengths, and smaller network sizes. The second canonical correlation represented externalizing traits and was associated with a larger number of relationships, higher utilitarianism, and short-term relationships with a close significant other. The third canonical correlation represented a detached, unemotional, and callous personality which corresponded with weaker relationship strength with both the mother and a close significant other. Our findings suggest that interpersonal functioning corresponding to personality dysfunction can be distinguished into both common and specific characteristics and further highlight the importance of characterizing distinct patterns within close relationships.
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Affiliation(s)
- Seyul Kwak
- Department of Psychology, Pusan National University, Busan, Republic of Korea.
| | - Jieun Kwon
- Department of Psychology, Pusan National University, Busan, Republic of Korea
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Luo L, Xu R, Mu F, Li H, Liu Y, Gao J, Wu Y, Wang K, Liu Y, Zhang Y, Wang J, Liu Y. The interaction between TMEM161B (rs768705) and paranoid personality traits in relation to the risk of major depressive disorder: Results form a longitudinal study of 7642 Chinese freshmen. J Affect Disord 2024; 365:171-177. [PMID: 39147160 DOI: 10.1016/j.jad.2024.08.065] [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] [Received: 05/17/2023] [Revised: 06/26/2024] [Accepted: 08/12/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND Rs768705 (TMEM161B) is one of the identified single nucleotide polymorphisms related to major depressive disorder (MDD). Paranoid personality traits are independently associated with the risk of MDD. This study aimed to investigate the interaction effect between rs768705 (TMEM161B) and paranoid personality traits on the new-onset risk of MDD in Chinese freshmen. METHODS A longitudinal study was conducted among 7642 Chinese freshmen without lifetime MDD at baseline in 2018. 158 new-onset MDD cases were ascertained in 2019. DNA samples were extracted to detect the genotype of rs768705. The diagnostic and statistical manual of mental disorders-IV criteria were used to determine MDD and personality disorder traits. Multiplicative interaction was assessed by logistic regression models. Tomas Andersson's method for calculating biological interactions was used to estimate the additive interaction. RESULTS Rs768705(AG) (OR = 1.88, 95 % CI: 1.24-2.83) and paranoid personality traits (OR = 3.68, 95 % CI: 2.57-5.26) were significantly associated with the risk of MDD. The multiplicative interaction model with the product term of rs768705 and paranoid personality trait traits had a significant interaction effect (OR = 4.20, 95 % CI:1.62-10.91). There was also a significant additive interaction effect (RR = 7.08, 95 % CI:4.31-11.65) for the incidence of MDD. Seventy seven percent patients among new MDD cases were attributed to the additive interaction effect between rs768705 and paranoid personality traits. CONCLUSIONS Rs768705 (AG) may interact with paranoid personality traits to increase the incidence of MDD among Chinese college students. Schools and psychosocial health organizations should pay more attention to individuals with paranoid personality traits for MDD intervention and prevention.
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Affiliation(s)
- Linlin Luo
- School of Public Health, Jining Medical University, Jining, Shandong, China; Department of Hematology, The Affiliated Tai'an City Central Hospital of Qingdao University, Tai'an, Shandong, China
| | - Ruixue Xu
- School of Public Health, Jining Medical University, Jining, Shandong, China; School of Public Health, Binzhou Medical University, Yantai, Shandong, China
| | - Fuqin Mu
- School of Mental Health, Jining Medical University, Jining, Shandong, China
| | - Hanyun Li
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China; School of Clinical Medicine, Jining Medical University, Jining, Shandong, China
| | - Yujia Liu
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jianhua Gao
- School of Mental Health, Jining Medical University, Jining, Shandong, China
| | - Yilin Wu
- School of Mental Health, Jining Medical University, Jining, Shandong, China
| | - Kejin Wang
- The First Senior Middle School of Jining City, Jining, Shandong, China
| | - Yanzhi Liu
- School of Clinical Medicine, Jining Medical University, Jining, Shandong, China
| | - Ying Zhang
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
| | - Jianli Wang
- School of Mental Health, Jining Medical University, Jining, Shandong, China; Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Yan Liu
- School of Public Health, Jining Medical University, Jining, Shandong, China; Center of Evidence-Based Medicine, Jining Medical University, Jining, Shandong, China.
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Khazaie H, Rezaei F, Zakiei A, Faridmarandi B, Komasi S. How are poor sleepers with other clinical conditions affected by maladaptive personality traits? A neural network-based analysis. Front Psychiatry 2024; 15:1392525. [PMID: 39071228 PMCID: PMC11272455 DOI: 10.3389/fpsyt.2024.1392525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 06/28/2024] [Indexed: 07/30/2024] Open
Abstract
Background Psychopathology research mainly focused on the cross-sectional and longitudinal associations between personality and psychiatric disorders without considering the moment-to-moment dynamics of personality in response to environmental situations. The present study aimed to both cluster a young sample according to three mixed clinical conditions (poor sleep quality, depression, and somatization) and to predict the derived clusters by maladaptive personality traits and sex differences using a deep machine learning approach. Methods A sample of 839 adults aged 18-40 years (64% female) from the west of Iran were clustered according to the mixed clinical conditions using the cluster analysis techniques. An Artificial Neural Network (ANN) modeling is used to predict the derived clusters by maladaptive personality traits and biological gender. A receiver operating characteristic (ROC) curve was used to identify independent variables with high sensitivity specific to the derived clusters. Results The cluster analysis techniques suggested a fully stable and acceptable four-cluster solution for Depressed Poor Sleepers, Nonclinical Good Sleepers, Subclinical Poor Sleepers, and Clinical Poor Sleepers. The ANN model led to the identification of one hidden layer with two hidden units. The results of Area under the ROC Curve were relatively to completely acceptable, ranging from.726 to.855. Anhedonia, perceptual dysregulation, depressivity, anxiousness, and unusual beliefs are the most valuable traits with importance higher than 70%. Conclusion The machine learning approach can be well used to predict mixed clinical conditions by maladaptive personality traits. Future research can test the complexity of normal personality traits connected to mixed clinical conditions.
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Affiliation(s)
- Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Farzin Rezaei
- Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Zakiei
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Behrooz Faridmarandi
- Department of Neuroscience and Psychopathology Research, Mind GPS Institute, Kermanshah, Iran
| | - Saeid Komasi
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Department of Neuroscience and Psychopathology Research, Mind GPS Institute, Kermanshah, Iran
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Blay M, Nicot P, Durpoix A, Leaune E, Poulet E, Ulm J, Perroud N. Evaluation of the level of training of French psychiatrists on borderline personality disorder: An online survey. L'ENCEPHALE 2024; 50:257-264. [PMID: 37604716 DOI: 10.1016/j.encep.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/04/2023] [Accepted: 06/08/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Borderline personality disorder is a common and treatable personality disorder that is often underdiagnosed and untreated, mainly due to a lack of training of psychiatrists and to a lack of accessibility to specialized therapies. However, no study has been conducted in France regarding this issue. Thus, we aimed to evaluate on a national scale the level of training, knowledge, and general attitude toward BPD diagnosis of French psychiatrists. METHODS We conducted an online survey in an unselected population of residents and senior French psychiatrists between January and March 2022, the results of which are presented descriptively. RESULTS 228 psychiatrists fully answered the questionnaire, and 21 more psychiatrists answered it partially. We found that most of the responders were unsatisfied with the residency training or the continuing medical education offered regarding BPD, a lack of training resulting in a low level of self-confidence regarding BPD management, in a low number of evidence-based therapies trained psychiatrists in issues regarding diagnostic disclosure, and in misconceptions regarding some aspects of the disorder. CONCLUSIONS These results underlie a clear lack of training of French psychiatrists, as well as a request from the latter for more opportunities to learn. This calls for a rethinking of the teaching system to incorporate more knowledge and tools related to BPD.
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Affiliation(s)
- Martin Blay
- ADDIPSY, Addictology and Psychiatry Outpatient Center, Santé Basque Development group, Lyon, France.
| | - Pierre Nicot
- Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, PSYR2, 69500 Bron, France
| | - Amaury Durpoix
- University Hospital of Strasbourg, Strasbourg, France; University of Strasbourg, Strasbourg, France
| | - Edouard Leaune
- Suicide Prevention Center, Vinatier Hospital Center, Bron, France; Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, PSYR2, 69500 Bron, France
| | - Emmanuel Poulet
- Psychiatry Crisis Unit, Edouard Herriot Hospital, Lyon, France; Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, PSYR2, 69500 Bron, France
| | - Justin Ulm
- Percy Army Instruction Hospital, Clamart, France; Val de Grâce School, Paris, France
| | - Nader Perroud
- Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland; University of Geneva, Geneva, Switzerland
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Greiner C, Charbon P, De Néris M, El Rassi L, Prada P, Choi-Kain L. The Interpersonal Hypersensitivity Formulation of Good Psychiatric Management as a Psychoeducational Intervention for Borderline Personality Disorder. J Psychiatr Pract 2024; 30:220-226. [PMID: 38819246 DOI: 10.1097/pra.0000000000000778] [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] [Indexed: 06/01/2024]
Abstract
Interpersonal hypersensitivity (IHS) is a core organizing concept of Good Psychiatric Management, a generalist treatment for borderline personality disorder (BPD) that relies on basic tools most clinicians already employ yet is informed by an organized and evidence-based framework, developed for dissemination in various mental health care settings. We work in an inpatient psychiatric unit that specializes in the management of suicidal crises at the University Hospitals of Geneva, Switzerland. Because we see numerous patients with previously undiagnosed BPD during their first hospitalization, we have developed techniques and instruments to promote efficient and easy-to-implement psychoeducation. In this article, we propose a practical and user-friendly measure of IHS that is well-suited for use by multidisciplinary inpatient staff or outpatient nursing-based staff, the IHS Ruler, which is based on a visual analog scale. It is a pragmatic tool for preliminary psychoeducation for patients with BPD and their caregivers. Its ease of use and structured way of presenting the inner experience of these patients in relation to their current interpersonal environment allows caregivers to establish a framework for internal reflection and sharing, discuss the causes of current transactions, and illuminate larger patterns in the causes of the patient's crises. Ultimately, this process can help patients and the clinical staff supporting them anticipate future problems.
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Affiliation(s)
- Christian Greiner
- Department of Psychiatry, Crisis Intervention Unit, Consultative Psychiatry and Crisis Intervention, Geneva University Hospital, Geneva, Switzerland
| | - Patrick Charbon
- Department of Psychiatry, Crisis Intervention Unit, Consultative Psychiatry and Crisis Intervention, Geneva University Hospital, Geneva, Switzerland
| | - Mélanie De Néris
- Department of Psychiatry, Psychiatric Emergency Unit, Geneva University Hospital, Geneva, Switzerland
| | - Layla El Rassi
- Department of Pediatrics, Youth Health Unit, Geneva University Hospital, Geneva, Switzerland
| | - Paco Prada
- Department of Psychiatry, Crisis Intervention Unit, Consultative Psychiatry and Crisis Intervention, Geneva University Hospital, Geneva, Switzerland
| | - Lois Choi-Kain
- Gunderson Personality Disorders Institute, McLean Hospital, Belmont, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
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Mušálková D, Přistoupilová A, Jedličková I, Hartmannová H, Trešlová H, Nosková L, Hodaňová K, Bittmanová P, Stránecký V, Jiřička V, Langmajerová M, Woodbury‐Smith M, Zarrei M, Trost B, Scherer SW, Bleyer AJ, Vevera J, Kmoch S. Increased burden of rare protein-truncating variants in constrained, brain-specific and synaptic genes in extremely impulsively violent males with antisocial personality disorder. GENES, BRAIN, AND BEHAVIOR 2024; 23:e12882. [PMID: 38359179 PMCID: PMC10869132 DOI: 10.1111/gbb.12882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 12/11/2023] [Accepted: 01/03/2024] [Indexed: 02/17/2024]
Abstract
The genetic correlates of extreme impulsive violence are poorly understood, and there have been few studies that have characterized a large group of affected individuals both clinically and genetically. We performed whole exome sequencing (WES) in 290 males with the life-course-persistent, extremely impulsively violent form of antisocial personality disorder (APD) and analyzed the spectrum of rare protein-truncating variants (rPTVs). Comparisons were made with 314 male controls and publicly available genotype data. Functional annotation tools were used for biological interpretation. Participants were significantly more likely to harbor rPTVs in genes that are intolerant to loss-of-function variants (odds ratio [OR] 2.06; p < 0.001), specifically expressed in brain (OR 2.80; p = 0.036) and enriched for those involved in neurotransmitter transport and synaptic processes. In 60 individuals (20%), we identified rPTVs that we classified as clinically relevant based on their clinical associations, biological function and gene expression patterns. Of these, 37 individuals harbored rPTVs in 23 genes that are associated with a monogenic neurological disorder, and 23 individuals harbored rPTVs in 20 genes reportedly intolerant to loss-of-function variants. The analysis presents evidence in support of a model where presence of either one or several private, functionally relevant mutations contribute significantly to individual risk of life-course-persistent APD and reveals multiple individuals who could be affected by clinically unrecognized neuropsychiatric Mendelian disease. Thus, Mendelian diseases and increased rPTV burden may represent important factors for the development of extremely impulsive violent life-course-persistent forms of APD irrespective of their clinical presentation.
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Affiliation(s)
- Dita Mušálková
- Research Unit for Rare Diseases, Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of MedicineCharles University in Prague and General University Hospital in PraguePragueCzech Republic
| | - Anna Přistoupilová
- Research Unit for Rare Diseases, Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of MedicineCharles University in Prague and General University Hospital in PraguePragueCzech Republic
| | - Ivana Jedličková
- Research Unit for Rare Diseases, Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of MedicineCharles University in Prague and General University Hospital in PraguePragueCzech Republic
| | - Hana Hartmannová
- Research Unit for Rare Diseases, Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of MedicineCharles University in Prague and General University Hospital in PraguePragueCzech Republic
| | - Helena Trešlová
- Research Unit for Rare Diseases, Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of MedicineCharles University in Prague and General University Hospital in PraguePragueCzech Republic
| | - Lenka Nosková
- Research Unit for Rare Diseases, Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of MedicineCharles University in Prague and General University Hospital in PraguePragueCzech Republic
| | - Kateřina Hodaňová
- Research Unit for Rare Diseases, Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of MedicineCharles University in Prague and General University Hospital in PraguePragueCzech Republic
| | - Petra Bittmanová
- Research Unit for Rare Diseases, Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of MedicineCharles University in Prague and General University Hospital in PraguePragueCzech Republic
| | - Viktor Stránecký
- Research Unit for Rare Diseases, Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of MedicineCharles University in Prague and General University Hospital in PraguePragueCzech Republic
| | - Václav Jiřička
- Department of PsychologyPrison Service of the Czech RepublicPragueCzech Republic
- Department of Psychiatry, Faculty of Medicine in PilsenCharles UniversityPilsenCzech Republic
| | - Michaela Langmajerová
- Department of Psychiatry, Faculty of Medicine in PilsenCharles UniversityPilsenCzech Republic
| | - Marc Woodbury‐Smith
- The Centre for Applied Genomics and Program in Genetics and Genome Biology, The Hospital for Sick ChildrenTorontoOntarioCanada
- Faculty of Medical Sciences, Biosciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Mehdi Zarrei
- The Centre for Applied Genomics and Program in Genetics and Genome Biology, The Hospital for Sick ChildrenTorontoOntarioCanada
| | - Brett Trost
- The Centre for Applied Genomics and Program in Genetics and Genome Biology, The Hospital for Sick ChildrenTorontoOntarioCanada
| | - Stephen W. Scherer
- The Centre for Applied Genomics and Program in Genetics and Genome Biology, The Hospital for Sick ChildrenTorontoOntarioCanada
- Department of Molecular Genetics and McLaughlin CentreUniversity of TorontoTorontoOntarioCanada
| | - Anthony J. Bleyer
- Research Unit for Rare Diseases, Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of MedicineCharles University in Prague and General University Hospital in PraguePragueCzech Republic
- Section on Nephrology, Wake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Jan Vevera
- Department of Psychiatry, Faculty of Medicine in PilsenCharles UniversityPilsenCzech Republic
- Department of PsychiatryUniversity Hospital PilsenPilsenCzech Republic
| | - Stanislav Kmoch
- Research Unit for Rare Diseases, Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of MedicineCharles University in Prague and General University Hospital in PraguePragueCzech Republic
- Department of Psychiatry, Faculty of Medicine in PilsenCharles UniversityPilsenCzech Republic
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Pape VR, Braun S, Peters S, Stingl M, Tucha O, Sammer G. The riddle of deliberate self-harm: Physiological and subjective effects of self-cutting cues in patients with borderline personality disorder and healthy controls. Personal Ment Health 2023; 17:328-351. [PMID: 37042027 DOI: 10.1002/pmh.1583] [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: 09/29/2022] [Revised: 02/15/2023] [Accepted: 02/19/2023] [Indexed: 04/13/2023]
Abstract
Self-harming behavior is a core symptom of borderline personality disorder. Self-report studies show a correlation between a lack of self-reported negative feelings toward self-cutting cues and the likelihood of future self-destructive behavior. Despite these findings, there has so far been insufficient investigation into the implicit emotional processes evoked by this stimulus type. Forty patients with borderline personality disorder and 35 healthy controls between 20 and 50 years of age were confronted with pictures of self-cutting cues and affective reference pictures. A startle reflex paradigm was used for measuring implicit emotional responses, and the Self-Assessment Manikin was used for subjective responses. In line with previous studies, the patients rated the self-cutting pictures significantly less negatively than healthy individuals. On the physiological level, a significant startle inhibition was observed, indicating an activation of the behavioral approach system. A more detailed analysis showed that this startle inhibition effect was specific to scary pictures, whereas no such effect was observed for bloody wounds and self-cutting instruments. For pleasant standard pictures, in contrast, no startle reflex inhibition and no increase in emotional arousal parameters were found. The data replicate the findings of previous studies, demonstrating a generally diminished emotional reactivity to pleasant stimuli in patients with borderline personality disorder. In addition, a physiological approach reaction to self-cutting pictures was found, especially for the scary pictures. These results might indicate a positive identification with the long-lasting consequences of self-cutting behavior in the patients. Implications for therapy are discussed.
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Affiliation(s)
- Valeska Reichel Pape
- Institute of Psychiatry and Psychotherapy, University Medicine Rostock, Gehlsheimer Straße 20, 18147, Rostock, Germany
| | - Silke Braun
- Institute of Psychiatry and Psychotherapy, University Medicine Giessen, Klinikstraße 36, 35392, Giessen, Germany
| | - Svenja Peters
- Institute of Psychiatry and Psychotherapy, University Medicine Giessen, Klinikstraße 36, 35392, Giessen, Germany
| | - Markus Stingl
- Institute of Psychiatry and Psychotherapy, University Medicine Giessen, Klinikstraße 36, 35392, Giessen, Germany
| | - Oliver Tucha
- Institute of Psychiatry and Psychotherapy, University Medicine Rostock, Gehlsheimer Straße 20, 18147, Rostock, Germany
| | - Gebhard Sammer
- Institute of Psychiatry and Psychotherapy, University Medicine Giessen, Klinikstraße 36, 35392, Giessen, Germany
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Scanlon F, Morgan RD, Mitchell SM, Bolaños AD, Bartholomew NR. Criminal risk and mental illness in psychiatric inpatient units: An opportunity to provide psychological services for unmet criminogenic needs. Psychol Serv 2023; 20:565-575. [PMID: 34968121 PMCID: PMC9243185 DOI: 10.1037/ser0000612] [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] [Indexed: 11/08/2022]
Abstract
Although the overrepresentation of people with mental illness in the criminal justice system is known, research is needed to identify the frequency of criminal justice involvement and criminogenic treatment needs in inpatient populations to improve continuity of care and access to appropriate treatments. The purpose of this study is to document the frequency of criminal justice involvement among people receiving inpatient community care, as has been done for persons with mental illness in correctional institutions, and to test the association between criminogenic risk and psychiatric symptomatology. The present study uses two samples (n = 94 and n = 142) of adults from two separate acute psychiatric inpatient hospitals in Texas. Data on psychiatric symptoms, mental health history, criminal risk, and criminal justice history were gathered from file review and self-report. Linear and negative binomial regressions were used to test associations of interest. In both samples, the frequency of prior criminal justice involvement was over 50%. The current results indicate there is a significant, positive association between measures of criminal risk and psychiatric symptoms. These findings highlight the need to address the reciprocal association between mental illness and criminal risk among people receiving inpatient psychiatric treatment with appropriate assessment and treatment. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Faith Scanlon
- Department of Psychological Sciences, Texas Tech University
| | - Robert D. Morgan
- College of Health and Human Sciences, Southern Illinois University Carbondale
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Jacob K, Gatchell J. Biofeedback and Treatment for Borderline Personality Disorder. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:63-69. [PMID: 37205031 PMCID: PMC10172541 DOI: 10.1176/appi.focus.20220070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Empirically validated treatments for borderline personality disorder rely on fostering self-awareness of one's internal experience for treatment success, yet these treatments do not include objective tools to assess self-awareness. Integrating biofeedback into empirically supported treatments provides a way to objectively measure physiological correlates of emotional states, thereby enhancing accurate self-assessment. By using biofeedback, individuals with borderline personality disorder may gain skills to increase self-awareness, improve emotion regulation, and enhance behavioral control. The authors propose that biofeedback can be used to objectively measure fluctuating emotional intensity, thereby facilitating structured self-assessment of emotions and enabling more effective use of interventions for emotion regulation; can be delivered by trained mental health professionals; and may even be considered as a stand-alone intervention replacing alternative, more costly, treatments.
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Affiliation(s)
- Karen Jacob
- Gunderson Residence, Mclean Hospital, Cambridge, Massachusetts (both authors); Department of Psychiatry, Harvard Medical School, Boston (Jacob)
| | - Jaya Gatchell
- Gunderson Residence, Mclean Hospital, Cambridge, Massachusetts (both authors); Department of Psychiatry, Harvard Medical School, Boston (Jacob)
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Forte ARCC, Lessa PHC, Chaves Filho AJM, Aquino PEAD, Brito LM, Pinheiro LC, Juruena MF, Lucena DFD, de Rezende PHF, de Vasconcelos SMM. Oxidative stress and inflammatory process in borderline personality disorder (BPD): a narrative review. Braz J Med Biol Res 2023; 56:e12484. [PMID: 36946840 PMCID: PMC10021502 DOI: 10.1590/1414-431x2023e12484] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/13/2023] [Indexed: 03/23/2023] Open
Abstract
Borderline personality disorder (BPD) is a severe psychiatric condition that affects up to 2.7% of the population and is highly linked to functional impairment and suicide. Despite its severity, there is a lack of knowledge about its pathophysiology. Studies show genetic influence and childhood violence as factors that may contribute to the development of BPD; however, the involvement of neuroinflammation in BPD remains poorly investigated. This article aimed to explore the pathophysiology of BPD according to the levels of brain-derived neurotrophic factor (BDNF), inflammatory cytokines, and oxidative stress substances that exacerbate neuronal damage. Few articles have been published on this theme. They show that patients with BPD have a lower level of BDNF and a higher level of tumor necrosis factor (TNF)-α and interleukin (IL)-6 in peripheral blood, associated with increased plasma levels of oxidative stress markers, such as malondialdehyde and 8-hydroxy-2-deoxyguanosine. Therefore, more research on the topic is needed, mainly with a pre-clinical and clinical focus.
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Affiliation(s)
- A R C C Forte
- Laboratório de Neuropsicofarmacologia, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - P H C Lessa
- Curso de Medicina, Departamento de Ciências Biológicas e da Saúde (DCBS), Universidade Federal do Amapá, Macapá, AP, Brasil
| | - A J M Chaves Filho
- Laboratório de Neuropsicofarmacologia, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - P E A de Aquino
- Laboratório de Neuropsicofarmacologia, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - L M Brito
- Laboratório de Neuropsicofarmacologia, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - L C Pinheiro
- Laboratório de Neuropsicofarmacologia, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - M F Juruena
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - D F de Lucena
- Laboratório de Neuropsicofarmacologia, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - P H F de Rezende
- Laboratório de Neuropsicofarmacologia, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - S M M de Vasconcelos
- Laboratório de Neuropsicofarmacologia, Universidade Federal do Ceará, Fortaleza, CE, Brasil
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11
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Choi-Kain LW, Sahin Z, Traynor J. Borderline Personality Disorder: Updates in a Postpandemic World. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2022; 20:337-352. [PMID: 37200886 PMCID: PMC10187392 DOI: 10.1176/appi.focus.20220057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Progress in understanding borderline personality disorder has unfolded in the last decade, landing in a new COVID-19-influenced world. Borderline personality disorder is now firmly established as a valid diagnosis, distinct from its co-occurring mood, anxiety, trauma-related, and behavioral disorders. Further, it is also understood as a reflection of general personality dysfunction, capturing essential features shared among all personality disorders. Neuroimaging research, representing the vast neurobiological advances made in the last decade, illustrates that the disorder shares frontolimbic dysfunction with many psychiatric diagnoses but has a distinct signature of interpersonal and emotional hypersensitivity. This signature is the conceptual basis of the psychotherapies and clinical management approaches proven effective for the disorder. Medications remain adjunctive and are contraindicated by some guidelines internationally. Less invasive brain-based therapeutics show promise. The most significant change in the treatment landscape is a focus on briefer, less intensive formats of generalist management. Shorter variants of therapies, such as dialectical behavior therapy and mentalization-based treatment, are in the process of being shown to be adequately effective. Earlier intervention and greater emphasis on functional improvement are needed to more effectively curb the disabilities and risks of borderline personality disorder for patients and their families. Remote interventions show promise in broadening access to care.
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Affiliation(s)
- Lois W Choi-Kain
- Gunderson Personality Research Institute, McLean Hospital, Belmont, Massachusetts, and Faculty of Medicine, Harvard Medical School, Boston
| | - Zeynep Sahin
- Gunderson Personality Research Institute, McLean Hospital, Belmont, Massachusetts, and Faculty of Medicine, Harvard Medical School, Boston
| | - Jenna Traynor
- Gunderson Personality Research Institute, McLean Hospital, Belmont, Massachusetts, and Faculty of Medicine, Harvard Medical School, Boston
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12
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Affiliation(s)
- Carla Sharp
- From the Department of Psychology, University of Houston, Houston
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13
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Zahl KE, Pedersen G, Eikenaes IUM, Stänicke LI, Wilberg T, Baltzersen ÅL, Pettersen MS, Hummelen B, Arnevik E, Johansen MS, Hartveit Kvarstein E. Avoidant and borderline personality disorder patients during the first Covid-19 wave in Norway - a survey-based comparison of therapy changes and patients' accommodations. Nord J Psychiatry 2022; 77:336-344. [PMID: 35984379 DOI: 10.1080/08039488.2022.2110614] [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: 10/15/2022]
Abstract
BACKGROUND Patients with personality disorders (PDs) often have insecure attachment patterns and may be especially vulnerable to abrupt treatment changes. Patients with borderline PD (BPD) are often considered vulnerable to treatment interruption due to chronic fear of abandonment. Nonetheless, other PDs are poorly investigated. In the first Covid-19 wave in Norway, in-person treatment facilities and group treatments were strongly restricted from March 12th until May/June 2020. OBJECTIVES To examine and compare changes in outpatient treatment for patients with avoidant (AvPD) and BPD during the first Covid-19 wave in Norway, and patients' reactions to these changes. METHODS The study is based on a cross-sectional survey distributed to 1120 patients referred to 12 different PD treatment units on a specialist mental health service level within the Norwegian Network for Personality Disorders. The survey included questions on treatment situation, immediate reactions, and changes during the crisis. From 133 responders (response rate 12%), 40 patients reported BPD and 30 AvPD as diagnosis. RESULTS All patients were followed up from their therapist after March 12th. Almost all patients in both groups expressed satisfaction under the new circumstances. Both groups experienced the same regularity as before, but more AvPD patients reported less than weekly consultations. AvPD patients reported more negative feelings about changes in therapy, and missed the therapy and group members more than the BPD group. CONCLUSION After the lockdown, BPD patients received a closer follow-up than AvPD patients, and the latter reported more negative feelings related to change in their treatment situation.
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Affiliation(s)
- Kjell-Einar Zahl
- District Psychiatric Center Follo, Group Therapy Section, Akershus University Hospital, Lørenskog, Norway
| | - Geir Pedersen
- Department for National and Regional Functions, Division of Mental Health and Addiction, NETWORK for Personality Disorders, Section for Personality Psychiatry and Specialized Treatments, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingeborg Ulltveit-Moe Eikenaes
- Department for National and Regional Functions, Division of Mental Health and Addiction, National Advisory Unit for Personality Psychiatry, Section for Personality Psychiatry and Specialized Treatments, Oslo University Hospital, Oslo, Norway
| | - Line Indrevoll Stänicke
- Department of Psychology, University of Oslo, Oslo, Norway.,Nic Waals Institute, Lovisenberg Deacon Hospital, Oslo, Norway
| | - Theresa Wilberg
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department for Research and Innovation, Division of Mental Health and Addiction, Section for Treatment Research, Oslo University Hospital, Oslo, Norway
| | - Åse-Line Baltzersen
- Department for National and Regional Functions, Division of Mental Health and Addiction, National Advisory Unit for Personality Psychiatry, Section for Personality Psychiatry and Specialized Treatments, Oslo University Hospital, Oslo, Norway.,Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Mona Skjeklesaether Pettersen
- Department for National and Regional Functions, Division of Mental Health and Addiction, NETWORK for Personality Disorders, Section for Personality Psychiatry and Specialized Treatments, Oslo University Hospital, Oslo, Norway.,Norwegian Centre for E-health Research, Troms, Norway
| | - Benjamin Hummelen
- Department for Research and Innovation, Division of Mental Health and Addiction, Section for Treatment Research, Oslo University Hospital, Oslo, Norway
| | - Espen Arnevik
- Department for Research and Innovation, Division of Mental Health and Addiction, Section for Clinical Addiction Research, Oslo University Hospital, Oslo, Norway
| | - Merete Selsbakk Johansen
- Department for National and Regional Functions, Division of Mental Health and Addiction, Outpatient Clinic for Specialized Treatment of Personality Disorders, Section for Personality Psychiatry and Specialized Treatments, Oslo University Hospital, Oslo, Norway
| | - Elfrida Hartveit Kvarstein
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department for National and Regional Functions, Division of Mental Health and Addiction, Section for Personality Psychiatry and Specialized Treatments, Oslo University Hospital, Oslo, Norway
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14
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Maladaptive Personality Traits in a Group of Patients with Substance Use Disorder and ADHD. Medicina (B Aires) 2022; 58:medicina58070962. [PMID: 35888680 PMCID: PMC9323800 DOI: 10.3390/medicina58070962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/16/2022] [Accepted: 07/18/2022] [Indexed: 11/25/2022] Open
Abstract
Background and Objectives: the comorbidity of personality disorders in patients who use psychoactive substances is common in psychiatric practice. The epidemiology of disharmonious personality traits in patients with ADHD and addictions in adulthood is still insufficiently researched. The study investigated the typology of personality traits in a group of adult patients consuming psychoactive substances, in whom symptoms of ADHD were identified. Materials and Methods: the study evaluates a group of 104 patients with chronic psychoactive substances abuse, in whom symptoms of ADHD were identified in early adulthood, in terms of comorbid personality traits. Results: statistically significant data have been obtained regarding the presence of clinical traits characteristic for cluster B personality disorders, the patients presenting lower levels of self-control, self-image instability, difficulties in the areas of social relationships and own identity integration. Conclusions: ADHD symptomatology precedes the clinical traits of personality disorders in patients with addictions, negatively influencing chronic evolution and quality of life.
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15
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Levy SR, Hilsenroth MJ, Conway F, Owen J. Patient personality characteristics and therapeutic integration: treating borderline personality and emotionally dysregulated-dysphoric personality features. RESEARCH IN PSYCHOTHERAPY: PSYCHOPATHOLOGY, PROCESS AND OUTCOME 2022; 25. [PMID: 35796595 PMCID: PMC9422319 DOI: 10.4081/ripppo.2022.611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/12/2022] [Indexed: 11/23/2022]
Abstract
This study examines the relationship between patient personality characteristics and therapeutic integration. Within a sample of patients (N=93) receiving outpatient psychodynamically- oriented psychotherapy, we assessed patient Borderline and Emotionally Dysregulated personality features through the Shedler-Westen Assessment Procedure (SWAP-200), and therapeutic technique using the Comparative Psychotherapy Process Scale (CPPS) during an early treatment session. We examined personality dimensionally, psychotherapy interventions across different theoretical orientations, as well as psychotherapy integration. These analyses revealed an overlap between the Borderline Clinical Prototype and the Emotionally Dysregulated-Dysphoric Q-factor, with the former associated with higher use of integration and the latter associated with higher use of either psychodynamicinterpersonal or cognitive-behavioural interventions. Secondary analyses also indicated the greater presence of interventions oriented towards emotional exploration and to the didactic instruction of effective symptom coping techniques across both of these personality subtypes early in treatment. The key differences between these personality types, as well as the theoretical, empirical, and clinical implications of these findings are discussed.
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16
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Sex and gender in treatment response to dialectical behaviour therapy: current knowledge, gaps, and future directions. COGNITIVE BEHAVIOUR THERAPIST 2022. [DOI: 10.1017/s1754470x22000253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Borderline personality disorder (BPD) is a mental health condition characterized by emotion dysregulation, interpersonal impairment, and high suicidality. Dialectical behaviour therapy (DBT) is the most widely studied psychotherapeutic treatment for BPD. To date, the vast majority of DBT research has focused on cisgender women, with a notable lack of systematic investigation of sex and/or gender differences in treatment response. In order to encourage effective, equitable treatment of BPD, further investigation into treatment targets in this population is critical. Here, we employed a systematic strategy to delineate gaps in the DBT literature pertaining to sex and gender differences and propose directions for future research. Findings demonstrate a significant discrepancy in measurement of sex and gender, particularly among gender-diverse individuals. Exploring DBT treatment response across the full spectrum of genders will facilitate the provision of more tailored, impactful care to all individuals who suffer from BPD.
Key learning aims
(1)
To date, DBT treatment literature has focused almost exclusively on cisgender women, with only two of 253 DBT studies in current literature accounting for transgender and gender diverse (TGD) individuals.
(2)
Recognize how gender minority stress may impact the prevalence of BPD among TGD individuals.
(3)
Learn how future research initiatives can be employed to rectify this gap in the DBT literature.
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17
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Beale EE, Overholser J, Gomez S, Brannam S, Stockmeier CA. The path not taken: Distinguishing individuals who die by suicide from those who die by natural causes despite a shared history of suicide attempt. J Clin Psychol 2022; 78:526-543. [PMID: 34331770 PMCID: PMC8801545 DOI: 10.1002/jclp.23231] [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: 01/21/2021] [Revised: 06/21/2021] [Accepted: 07/17/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES This study aimed to identify variables that distinguish suicide risk among individuals with previous suicide attempts. METHOD Using psychological autopsy procedures, we evaluated 86 decedents who had at least one lifetime suicide attempt before eventual death by suicide (n = 65) or natural causes (n = 21). RESULTS The Suicide Death group was more likely to be male, to have alcohol in the toxicology report at time of death, and to have a depression diagnosis, while the Natural Cause Death group was more likely to have personality disorder traits, a polysubstance use disorder, higher reported health stress, and an antidepressant in the toxicology report at time of death. Hopelessness and ambivalence were found to distinguish between groups during the 6 months before death. CONCLUSIONS These findings suggest important differences between individuals with a shared history of a suicide attempt who die by suicide versus natural causes.
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Affiliation(s)
- Eleanor E. Beale
- Case Western Reserve University Cleveland, OH, Department of Psychological Sciences, Case Western Reserve University, 11220 Bellflower Road, Cleveland, OH, USA 44106-7123
| | - James Overholser
- Case Western Reserve University Cleveland, OH, Department of Psychological Sciences, Case Western Reserve University, 11220 Bellflower Road, Cleveland, OH, USA 44106-7123
| | - Stephanie Gomez
- Case Western Reserve University Cleveland, OH, Department of Psychological Sciences, Case Western Reserve University, 11220 Bellflower Road, Cleveland, OH, USA 44106-7123
| | - Sidney Brannam
- Case Western Reserve University Cleveland, OH, Department of Psychological Sciences, Case Western Reserve University, 11220 Bellflower Road, Cleveland, OH, USA 44106-7123
| | - Craig A. Stockmeier
- Case Western Reserve University Cleveland, OH, Department of Psychiatry, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH, USA 44106-7123
- University of Mississippi Medical Center Jackson, MS, Department of Psychiatry and Human Behavior, Division of Neurobiology and Behavior Research, Translational Research Center (TR415), University of Mississippi Medical Center, 2500 N. State Street Jackson, MS, USA 39216
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18
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Bliton CF, Rosenstein LK, Pincus AL. Trading Patients: Applying the Alternative Model for Personality Disorders to Two Cases of DSM-5 Borderline Personality Disorder Over Time and Across Therapists. Front Psychol 2022; 13:794624. [PMID: 35237208 PMCID: PMC8884405 DOI: 10.3389/fpsyg.2022.794624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/03/2022] [Indexed: 11/16/2022] Open
Abstract
The DSM-5 Alternative Model for Personality Disorders (AMPD) dimensionally defines personality pathology using severity of dysfunction and maladaptive style. As the empirical literature on the clinical utility of the AMPD grows, there is a need to examine changes in diagnostic profiles and personality expression in treatment over time. Assessing these changes in individuals diagnosed with borderline personality disorder (BPD) is complicated by the tendency for patients to cycle through multiple therapists over the course of treatment leaving the potential for muddled diagnostic clarity and disjointed case conceptualizations. Following patient trajectories across therapists offers a unique opportunity to examine the AMPD’s sensitivity to and utility for capturing personality stability and change over time for patients with BPD. This article demonstrates the utility of the AMPD for two clinical cases in three distinct ways: (i) highlighting heterogeneity in BPD between patients, (ii) comparing improvements in personality severity and style over time, and (iii) elucidating profile change across therapist ratings. We present two patients diagnosed with DSM-5 Section II BPD, crossing between two therapists over the course of 3 years of psychodynamic psychotherapy. Treating clinicians rated patients for their respective treatment phases using the Level of Personality Functioning Scale (LPFS), capturing severity, and the Personality Inventory for the DSM-5 (PID-5), capturing style. AMPD diagnostic profiles differentiated patients with BPD in both severity and style, and captured within-patient change beyond within-therapist response bias. Results indicated greater improvements in personality severity while personality style remained more stable. Implications for the patients’ treatment progress and associated challenges are discussed, as are considerations for the utility of the AMPD in therapy.
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Affiliation(s)
- Chloe F Bliton
- Department of Psychology, The Pennsylvania State University, University Park, PA, United States
| | - Lia K Rosenstein
- Department of Psychology, The Pennsylvania State University, University Park, PA, United States
| | - Aaron L Pincus
- Department of Psychology, The Pennsylvania State University, University Park, PA, United States
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19
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Rush K, Fok M, Moran P, Dorrington S, Shetty H, Stewart R, Chang CK. Risk of First General Hospital Admissions for Self-Harm Among People With Personality Disorder: A Retrospective Cohort Study. J Pers Disord 2021; 35:657-671. [PMID: 33107805 DOI: 10.1521/pedi_2020_34_489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
For individuals with a personality disorder (PD), it is unknown whether additional psychiatric conditions increase their risk of self-harm. The authors therefore conducted a retrospective cohort study, using data from secondary mental health care, to identify self-harm admissions. Adults with diagnosed PD, followed up over a 6-year period, were involved (N = 7,475). Cox regression was used to model the risk of self-harm admissions, with comorbid depression, substance use disorders (SUD), severe mental illness (SMI), anorexia nervosa (AN), and bulimia nervosa (BN) as primary exposures; sociodemographics were considered as confounders. In multivariable analyses, comorbid SUD (adjusted HR = 1.66; 95% CI [1.45, 1.90]), depressive disorder (1.25; [1.09, 1.44]), AN (1.63; [1.10, 2.39]), and BN (1.65; [1.09, 2.51]) were positively associated with increased risks of hospitalization due to self-harm. However, a negative association was found for comorbid SMI. The findings highlight the importance of assessing and treating comorbid psychiatric disorders in PD.
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Affiliation(s)
- Kelsey Rush
- Department of Psychological Medicine (King's College London), Institute of Psychiatry, Psychology, and Neuroscience, London, UK
| | - Marcella Fok
- Department of Psychological Medicine (King's College London), Institute of Psychiatry, Psychology, and Neuroscience, London, UK
| | - Paul Moran
- Centre for Academic Mental Health, Department of Population Health Sciences, University of Bristol, UK
| | - Sarah Dorrington
- Department of Psychological Medicine (King's College London), Institute of Psychiatry, Psychology, and Neuroscience, London, UK
| | - Hitesh Shetty
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Robert Stewart
- Department of Psychological Medicine (King's College London), Institute of Psychiatry, Psychology, and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Chin-Kuo Chang
- Department of Psychological Medicine (King's College London), Institute of Psychiatry, Psychology, and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- Global Health Program, College of Public Health, and Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan
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20
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Heltne A, Bode C, Hummelen B, Falkum E, Selvik SG, Paap MCS. Norwegian Clinicians' Experiences of Learnability and Usability of SCID-II, SCID-5-PD and SCID-5-AMPD-I Interviews: A Sequential Multi-Group Qualitative Approach. J Pers Assess 2021; 104:599-612. [PMID: 34546142 DOI: 10.1080/00223891.2021.1975726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The DSM-5 presents two competing diagnostic frameworks for personality disorders: the standard categorical model and the Alternative Model of Personality Disorders (AMPD). The AMPD was initially criticized for being too complex and theory laden for clinical implementation. Though inter-rater reliability studies have contested initial claims of the model's complexity, little attention has been paid to how clinicians experience the usability and learnability of either model. We interviewed twenty Norwegian clinicians about their experiences with either the SCID-II/5-PD (n = 9), SCID-5-AMPD-I (n = 8), or both (n = 3). Separate thematic analyses were conducted for SCID-II/5-PD and SCID-5-AMPD-I groups, and group themes were compared. We identified four themes for each group, relating to required skills, training, challenges and information gained through the interview. We found that training and clinical experience were considered to be important for both interviews. Moreover, the SCID-5-AMPD-I was considered to rely more explicitly on theory specific to the development and content of the AMPD model in general and the LPFS specifically We also identified shared and unique challenges and shortcomings of each interview. We comment on how our findings relate to the debate surrounding the AMPD, and recommend development of clear training guidelines for both interviews.
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Affiliation(s)
- Aleksander Heltne
- Department of Research and Innovation, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Christina Bode
- Department of Psychology, Health & Technology, Faculty of Behavioural Management and Social Sciences, University of Twente, Enschede, The Netherlands
| | - Benjamin Hummelen
- Department of Research and Innovation, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Erik Falkum
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sara Germans Selvik
- Department of Psychiatry, Helse Nord-Trønderlag, Namsos Hospital, Namsos, Norway.,Department of Mental Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Muirne C S Paap
- Department of Research and Innovation, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Department of Child and Family Welfare, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
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21
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Olssøn I, Dahl AA. Long-term changes in attachment patterns after psychotherapy in outpatients with Axis I and personality disorders vs. Axis I disorders only. Personal Ment Health 2021; 15:136-146. [PMID: 33300299 DOI: 10.1002/pmh.1500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/13/2020] [Accepted: 11/20/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Adult attachment can be self-reported by rating anxiety of deception and avoidance of emotional closeness. There are few studies of changes in adult attachment patterns after psychotherapy. AIM This study investigated how attachment anxiety and avoidance mean scores changed from pre-treatment to follow-up in patients with Axis I disorders only vs. patients with Axis I and comorbid personality disorders (comorbid group) after outpatients psychotherapy. METHOD Of 156 patients with pre-treatment evaluation, 64 (41%) participated in follow-up 6 years later. Axis I and personality disorder interviews were performed at pre-treatment and follow-up, and the participants self-reported attachment patterns at both time points. RESULTS At both pre-treatment and follow-up, the Axis I group had significantly lower attachment avoidance scores than the comorbid group, while no significant between-group differences were observed for attachment anxiety. After adjustment, neither the Axis I nor the comorbid group showed any significant reductions in attachment anxiety or avoidance over time. The pre-treatment attachment scores were the only significant predictors of the follow-up scores. CONCLUSION Neither attachment anxiety nor avoidance were amenable to change over time. These findings may be associated with the psychotherapy given. Pre-treatment attachment scores were the only significant predictors of these scores at follow-up. © 2020 John Wiley & Sons, Ltd.
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Affiliation(s)
- Ingrid Olssøn
- Department of Psychiatry, Innlandet Hospital Trust, Hamar, N-2318, Norway
| | - Alv A Dahl
- National Advisory Unit on Late Effects after Cancer Treatment, Radiumhospitalet, Oslo University Hospital, Oslo, N-0310, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, N-0318, Norway
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22
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Hilden HM, Rosenström T, Karila I, Elokorpi A, Torpo M, Arajärvi R, Isometsä E. Effectiveness of brief schema group therapy for borderline personality disorder symptoms: a randomized pilot study. Nord J Psychiatry 2021; 75:176-185. [PMID: 33103925 DOI: 10.1080/08039488.2020.1826050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Schema group therapy is a potentially cost-effective treatment for borderline personality disorder (BPD). We piloted the feasibility and effectiveness of a 20-session schema group therapy without individual therapy among psychiatric BPD outpatients in a randomized pilot study registered as a clinical trial (ISRCTN76381242). METHODS Altogether 42 psychiatric outpatients diagnosed with BPD were randomized 2:1 to a 20-session weekly schema group therapy plus treatment as usual (TAU) (n = 28) vs. a control group with TAU alone (n = 14). The primary outcome was decline of BPD symptoms in the short Borderline Symptom List (BSL-23) score. Secondary outcomes were decline in symptoms of anxiety, depression, alcohol use, and improvement in functioning and schema modes. Two external experts evaluated validity of the intervention based on videotaped sessions. RESULTS Overall, 23 schema group therapy patients (82%) and 12 controls (86%) completed their treatment. Treatment validity good or very good. However, no significant differences emerged in the primary outcome mean BSL-23 decline (6.95 [SE 5.91] in group schema therapy vs. 12.55 [4.85] in TAU) or in any of the secondary outcome measures. LIMITATIONS Despite randomization, the TAU subgroup had non-significantly higher baseline scores in most measures. Small sample size predisposing to type II errors; reliance on self-reported outcomes. CONCLUSIONS Schema group therapy was feasible for psychiatric outpatients with BPD. However, in this small pilot study we did not find it more effective than TAU. Effectiveness of this short intervention remains open.
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Affiliation(s)
- Hanna-Mari Hilden
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tom Rosenström
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | | | - Aila Elokorpi
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mirka Torpo
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ritva Arajärvi
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Erkki Isometsä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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23
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Vanek J, Prasko J, Ociskova M, Hodny F, Holubova M, Minarikova K, Slepecky M, Nesnidal V. Insomnia in Patients with Borderline Personality Disorder. Nat Sci Sleep 2021; 13:239-250. [PMID: 33654445 PMCID: PMC7910080 DOI: 10.2147/nss.s295030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/20/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Both sleep disorders and BPD are prevalent in the population, and one is often a comorbidity of the other. This narrative review aims to assess contemporary literature and scientific databases to provide the current state of knowledge about sleep disorders in patients with borderline personality disorder (BPD) and clinical suggestions for managing sleep disorders in BPD patients and future research direction. METHODS Articles were acquired via PubMed and Web of Science, and papers published between January 1980 and October 2020 were extracted. Authors made a series of literature searches using the keywords: Sleep problems, Insomnia, Nightmares, Obstructive sleep apnea, Borderline personality disorder. The inclusion criteria were: published in peer-reviewed journals; studies in humans; or reviews on the related topic; English language. The exclusion criteria were: abstracts from conferences; commentaries; subjects younger than 18 years. After an inspection of the full texts, 42 papers from 101 were selected. Secondary documents from the reference lists of the primary designated papers were searched, assessed for suitability, and included. In total, 71 papers were included in the review process. RESULTS Sleep disturbance is common among patients with BPD. Nevertheless, the number of investigations is limited, and the prevalence differs between 5-45%. Studies assessing objective changes in sleep architecture in BPD show inconsistent results. Some of them identify REM sleep changes and a decrease in slow-wave sleep, while other studies found no objective sleep architecture changes. There is also a higher prevalence of nightmares in patients with BPD. Untreated insomnia can worsen BPD symptoms via interference with emotional regulation. BPD itself seems to influence the subjective quality of sleep significantly. Proper diagnosis and treatment of sleep disorders in patients with BPD could lead to better results in therapy. Psychotherapeutic approaches can improve both sleep disorders and BPD symptoms. CONCLUSION Recognising and managing sleep disorders in patients with BPD may help alleviate the disorder's symptoms. Treatment of people with BPD may be more effective if the treatment plan explicitly addresses sleep problems. Further research is needed to reach reliable conclusions.
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Affiliation(s)
- Jakub Vanek
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital, Olomouc, 77520, The Czech Republic
| | - Jan Prasko
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital, Olomouc, 77520, The Czech Republic.,Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, The Slovak Republic.,Institute for Postgraduate Education in Health Care, Prague, The Czech Republic
| | - Marie Ociskova
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital, Olomouc, 77520, The Czech Republic
| | - Frantisek Hodny
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital, Olomouc, 77520, The Czech Republic
| | - Michaela Holubova
- Department of Psychiatry, Hospital Liberec, Liberec, The Czech Republic
| | - Kamila Minarikova
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital, Olomouc, 77520, The Czech Republic
| | - Milos Slepecky
- Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, The Slovak Republic
| | - Vlastimil Nesnidal
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital, Olomouc, 77520, The Czech Republic
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Kopf-Beck J, Zimmermann P, Egli S, Rein M, Kappelmann N, Fietz J, Tamm J, Rek K, Lucae S, Brem AK, Sämann P, Schilbach L, Keck ME. Schema therapy versus cognitive behavioral therapy versus individual supportive therapy for depression in an inpatient and day clinic setting: study protocol of the OPTIMA-RCT. BMC Psychiatry 2020; 20:506. [PMID: 33054737 PMCID: PMC7557007 DOI: 10.1186/s12888-020-02880-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/19/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Major depressive disorder represents (MDD) a major cause of disability and disease burden. Beside antidepressant medication, psychotherapy is a key approach of treatment. Schema therapy has been shown to be effective in the treatment of psychiatric disorders, especially personality disorders, in a variety of settings and patient groups. Nevertheless, there is no evidence on its effectiveness for MDD in an inpatient nor day clinic setting and little is known about the factors that drive treatment response in such a target group. METHODS In the current protocol, we outline OPTIMA (OPtimized Treatment Identification at the MAx Planck Institute): a single-center randomized controlled trial of schema therapy as a treatment approach for MDD in an inpatient and day clinic setting. Over the course of 7 weeks, we compare schema therapy with cognitive behavioral therapy and individual supportive therapy, conducted in individual and group sessions and with no restrictions regarding concurrent antidepressant medication, thus approximating real-life treatment conditions. N = 300 depressed patients are included. All study therapists undergo a specific training and supervision and therapy adherence is assessed. Primary outcome is depressive symptom severity as self-assessment (Beck Depression Inventory-II) and secondary outcomes are clinical ratings of MDD (Montgomery-Asberg Depression Rating Scale), recovery rates after 7 weeks according to the Munich-Composite International Diagnostic Interview, general psychopathology (Brief Symptom Inventory), global functioning (World Health Organization Disability Assessment Schedule), and clinical parameters such as dropout rates. Further parameters on a behavioral, cognitive, psychophysiological, and biological level are measured before, during and after treatment and in 2 follow-up assessments after 6 and 24 months after end of treatment. DISCUSSION To our knowledge, the OPTIMA-Trial is the first to investigate the effectiveness of schema therapy as a treatment approach of MDD, to investigate mechanisms of change, and explore predictors of treatment response in an inpatient and day clinic setting by using such a wide range of parameters. Insights from OPTIMA will allow more integrative approaches of psychotherapy of MDD. Especially, the identification of intervention-specific markers of treatment response can improve evidence-based clinical decision for individualizing treatment. TRIAL REGISTRATION Identifier on clinicaltrials.gov : NCT03287362 ; September, 12, 2017.
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Affiliation(s)
- Johannes Kopf-Beck
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany.
| | - Petra Zimmermann
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
| | - Samy Egli
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
| | - Martin Rein
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
| | - Nils Kappelmann
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
- International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
| | - Julia Fietz
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
- International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
| | - Jeanette Tamm
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
| | - Katharina Rek
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
- University of Kassel, Kassel, Germany
| | - Susanne Lucae
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
| | - Anna-Katharine Brem
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- University Hospital of Old Age Psychiatry, University of Bern, Bern, Switzerland
- Department of Neuropsychology, Lucerne Psychiatry, Lucerne, Switzerland
| | - Philipp Sämann
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
| | - Leonhard Schilbach
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
- Independent Max Planck Research Group for Social Neuroscience, München, Germany
- Ludwig-Maximilians-Universität, Munich, Germany
| | - Martin E Keck
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
- Schmieder Hospital in Gailingen, Gailingen, Germany
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Barroilhet SA, Pellegrini AM, McCoy TH, Perlis RH. Characterizing DSM-5 and ICD-11 personality disorder features in psychiatric inpatients at scale using electronic health records. Psychol Med 2020; 50:2221-2229. [PMID: 31544723 PMCID: PMC9980721 DOI: 10.1017/s0033291719002320] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Investigation of personality traits and pathology in large, generalizable clinical cohorts has been hindered by inconsistent assessment and failure to consider a range of personality disorders (PDs) simultaneously. METHODS We applied natural language processing (NLP) of electronic health record notes to characterize a psychiatric inpatient cohort. A set of terms reflecting personality trait domains were derived, expanded, and then refined based on expert consensus. Latent Dirichlet allocation was used to score notes to estimate the extent to which any given note reflected PD topics. Regression models were used to examine the relationship of these estimates with sociodemographic features and length of stay. RESULTS Among 3623 patients with 4702 admissions, being male, non-white, having a low burden of medical comorbidity, being admitted through the emergency department, and having public insurance were independently associated with greater levels of disinhibition, detachment, and psychoticism. Being female, white, and having private insurance were independently associated with greater levels of negative affectivity. The presence of disinhibition, psychoticism, and negative affectivity were each significantly associated with a longer stay, while detachment was associated with a shorter stay. CONCLUSIONS Personality features can be systematically and scalably measured using NLP in the inpatient setting, and some of these features associate with length of stay. Developing treatment strategies for patients scoring high in certain personality dimensions may facilitate more efficient, targeted interventions, and may help reduce the impact of personality features on mental health service utilization.
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Affiliation(s)
- Sergio A. Barroilhet
- Center for Quantitative Health, Division of Clinical Research and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Tufts University School of Medicine, Boston, MA, USA
- University Psychiatric Clinic, University of Chile Clinical Hospital, Santiago, Chile
| | - Amelia M. Pellegrini
- Center for Quantitative Health, Division of Clinical Research and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Thomas H. McCoy
- Center for Quantitative Health, Division of Clinical Research and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Roy H. Perlis
- Center for Quantitative Health, Division of Clinical Research and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
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Kouppis E, Björkenstam C, Gerdin B, Ekselius L, Björkenstam E. Childbearing and mortality among women with personality disorders: nationwide registered-based cohort study. BJPsych Open 2020; 6:e95. [PMID: 32838831 PMCID: PMC7488311 DOI: 10.1192/bjo.2020.77] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND People with a personality disorder have a higher mortality and reduced life expectancy than the general population. Childbearing is thought to have a protective effect on morbidity and mortality. Yet, there are no studies on whether childbearing is related to a lower mortality among women with personality disorder. AIMS This study examined associations between childbearing and mortality among women with personality disorder. Our hypothesis was that parity would be associated with lower mortality. METHOD This register-based cohort study included 27 412 women treated for personality disorder in in-patient or specialised out-patient care between 1990 and 2015. We used nationwide population-based registers to obtain information on sociodemographics, child delivery, healthcare use and mortality. Mortality risk estimates were calculated as hazard ratios (HRs) with 95% CIs using Cox regression. Adjustments were made for year of birth, educational level, age at diagnosis, comorbidity and severity of personality disorder. RESULTS Nulliparous women had a nearly twofold increased mortality risk (adjusted HR = 1.78, 95% CI 1.50-2.12) compared with parous women and over twofold mortality risk (adjusted HR = 2.29, 95% CI 1.72-3.04) compared with those giving birth after their first personality disorder diagnosis. Those giving birth before their first personality disorder diagnosis had a 1.5-fold higher risk of mortality than those giving birth after their first personality disorder diagnosis (adjusted HR = 1.48, 95% CI 1.06-2.07). There was a threefold risk of suicide in nulliparous women compared with those giving birth after their first personality disorder diagnosis (adjusted HR = 2.90, 95% CI 1.97-4.26). CONCLUSIONS Childbearing history should be an integral part of the clinical evaluation of women with personality disorder.
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Affiliation(s)
| | | | - Bengt Gerdin
- Department of Surgical Sciences, Uppsala University, Sweden
| | - Lisa Ekselius
- Department of Neuroscience, Uppsala University, Sweden
| | - Emma Björkenstam
- Department of Neuroscience, Uppsala University, Sweden; and Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
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Munro OE, Sellbom M. Elucidating the relationship between borderline personality disorder and intimate partner violence. Personal Ment Health 2020; 14:284-303. [PMID: 32162499 DOI: 10.1002/pmh.1480] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/18/2020] [Accepted: 02/22/2020] [Indexed: 11/11/2022]
Abstract
This study examined the established association between borderline personality disorder (BPD) and intimate partner violence (IPV). More specifically, it compared the DSM-5 traditional categorical personality disorder (PD) model with the DSM-5 Alternative Model of PD (AMPD) operationalizations of BPD in their relative associations with IPV. The effects of gender, as well as the associations between BPD and different forms of IPV were also considered. Additionally, we investigated the specific BPD-relevant AMPD personality traits that influence the BPD-IPV association. The study sample were 250 community-dwelling men and women recruited through an established crowdsourcing platform. Results revealed that both the 'traditional' and AMPD operationalizations of BPD were approximately equally associated with IPV perpetration, although the traditional BPD operationalization demonstrated some minor advantages in this regard. The AMPD trait facets of hostility (negative affectivity), suspiciousness (negative affectivity) and risk taking (disinhibition) were most strongly associated with IPV perpetration for the total sample, and additional negative affectivity trait facets were also associated with IPV for men only. Implications for these findings are discussed. © 2020 John Wiley & Sons, Ltd.
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Affiliation(s)
- Olivia E Munro
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Martin Sellbom
- Department of Psychology, University of Otago, Dunedin, New Zealand
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Laliberté V, Giguère CE, Potvin S, Lesage A. Berkson's bias in biobank sampling in a specialised mental health care setting: a comparative cross-sectional study. BMJ Open 2020; 10:e035088. [PMID: 32709640 PMCID: PMC7380858 DOI: 10.1136/bmjopen-2019-035088] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES To determine whether studying aetiological pathways of depression, in particular the well-established determinant of childhood trauma, only in a specialised mental healthcare setting can yield biased estimates of the aetiological association, given that the majority of individuals are treated in primary care settings. DESIGN AND SETTING Two databanks were used in this study. The Canadian Community Health Survey (CCHS) on Mental Health and Well-Being 2012 is a national survey about mental health of adult Canadians. It measured common mental disorders and utilisation of services. The Signature mental health biobank includes adults from the Island of Montreal recruited at the emergency department of a major university mental health centre. After consent, participants filled standardised psychosocial questionnaires, gave blood samples, and their clinical diagnosis was recorded. We compared the cohort of depressed individuals from CCHS and Signature in contact with specialised services with those in contact with primary care or not in treatment. PARTICIPANTS There were 860 participants with depression in the CCHS and 207 participants with depression in the Signature Bank. PRIMARY AND SECONDARY OUTCOMES The Childhood Experiences of Violence Questionnaire was used to measure childhood trauma in both settings. Childhood trauma is associated with depression as with other common mental and physical disorders. RESULTS Individuals with depression in the CCHS who reported having been hospitalised for psychiatric treatment or having seen a psychiatrist or those from Signature were found to be more strongly associated with childhood abuse than individuals with depression who were treated in primary care settings or did not seek mental healthcare in the preceding year. CONCLUSIONS Berkson's bias limits the generalisability of aetiological associations observed in such university-hospital-based biobanks, but the problem can be remedied by broadening recruitment to primary care settings and the general population.
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Affiliation(s)
- Vincent Laliberté
- Department of Psychiatry, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Charles-Edouard Giguère
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada
| | - Stéphane Potvin
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada
- Département de Psychiatrie, Faculté de médecine, Université de Montréal, Montréal, Québec, Canada
| | - Alain Lesage
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada
- Département de Psychiatrie, Faculté de médecine, Université de Montréal, Montréal, Québec, Canada
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Kouppis E, Ekselius L. Validity of the personality disorder diagnosis in the Swedish National Patient Register. Acta Psychiatr Scand 2020; 141:432-438. [PMID: 32092153 DOI: 10.1111/acps.13166] [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: 11/11/2019] [Revised: 02/11/2020] [Accepted: 02/19/2020] [Indexed: 12/28/2022]
Abstract
AIMS The Swedish National Patient Register (NPR) is an exceptional source of information in clinical epidemiological research. The register is, however, not validated for the diagnosis of personality disorder (PD). We therefore assessed its validity in this patient group, and the group with emotionally unstable PD (EUPD)/borderline personality disorder (BPD). METHODS Records from 100 random adult patients (aged 15-65 years) diagnosed with any PD in the NPR between 1987 and 2015 were analysed using a protocol based on general diagnostic criteria for PD, as well as specific criteria for EUPD/BPD in both ICD and DSM classification systems. RESULTS Of the 100 patients, 27 had been given a diagnosis of EUPD, 23 another specific PD and 50 an unspecified PD. Using ICD criteria, 88 of 95 evaluable patients could be confirmed to have a PD, that is an agreement rate of 93%. Using DSM criteria, the agreement was lower (77 patients or 81%). Of 26 evaluable patients with a diagnosis of EUPD/BPD, the diagnosis was confirmed in all cases when using the ICD criteria, but in only 20 when using the DSM criteria. CONCLUSIONS The NPR is a valid source of data for the diagnosis of PD per se and also of EUPD in women.
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Affiliation(s)
- E Kouppis
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - L Ekselius
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
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McDonagh T, Higgins A, Archer J, Galavan E, Sheaf G, Doyle L. Lived experiences of adults with borderline personality disorder: a qualitative systematic review protocol. JBI Evid Synth 2020; 18:583-591. [PMID: 32197018 DOI: 10.11124/jbisrir-2017-004010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objectives of this review are: to explore the lived experiences of individuals with a diagnosis of borderline personality disorder (BPD) and to present recommendations for policy, practice, education and research. INTRODUCTION Borderline personality disorder is a mental disorder characterized by poor capacity to engage in effective relationships, intense and sudden mood changes, poor self-image and emotion regulation, significant impulsivity and severe functional impairment. Studies estimate the prevalence of BPD at 15% to 22% and identify a predominantly negative attitude among health professionals towards individuals with BPD. This review will examine the lived experiences of people with a diagnosis of BPD in order to better understand this condition. INCLUSION CRITERIA This review will include peer-reviewed qualitative studies on adults with a diagnosis of BPD in all settings and from any geographical location. METHODS A three-step search strategy will be used. A search strategy has been developed for MEDLINE. A second search using all identified keywords and index terms will be conducted across MEDLINE, CINAHL, PsycINFO and Embase. Studies will be screened by title and abstract by two independent reviewers against the review inclusion criteria. The full text of selected citations will be assessed against the inclusion criteria and for methodological quality. Qualitative data will be extracted from included papers using a standardized data extraction tool. Qualitative research findings will be pooled using the meta-aggregation approach. The final synthesized findings will be graded according to the ConQual approach and presented in a Summary of Findings. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42019141098.
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Affiliation(s)
- Teresa McDonagh
- School of Nursing and Midwifery, Faculty of Health Sciences, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Agnes Higgins
- School of Nursing and Midwifery, Faculty of Health Sciences, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | | | - Eoin Galavan
- School of Psychology, Faculty of Arts, Humanities and Social Sciences, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Greg Sheaf
- The Library of Trinity College Dublin, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Louise Doyle
- School of Nursing and Midwifery, Faculty of Health Sciences, Trinity College Dublin, The University of Dublin, Dublin, Ireland.,The Trinity Centre for Practice and Healthcare Innovation: a Joanna Briggs Institute Affiliated Group
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Abstract
This article identifies guiding principles in effective psychotherapies of patients with narcissistic personality disorder (NPD) and cautions against some common pitfalls. Individual psychotherapies of NPD patients were examined by both authors, who tested whether or not some principles, recommended in the literature, effectively promote these therapies and help these patients in moving forward with their lives and with effective therapy use. The authors identify a number of principles that were associated with more positive therapy development: helping patients identify goals and direction of their therapies, promoting a sense of agency, promoting a shift of focus to sense of vulnerability, and anticipating difficulty in developing and maintaining the treatment alliance. Common mistakes in these treatments are engaging in a power struggle with the patient, overindulging the grandiosity of the patient, directly challenging the grandiosity of the patient, and ignoring treatment-interfering behaviors. Identification of principles of effective therapies with NPD patients can help with the development of more effective treatment approaches for NPD.
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Kells M, Joyce M, Flynn D, Spillane A, Hayes A. Dialectical behaviour therapy skills reconsidered: applying skills training to emotionally dysregulated individuals who do not engage in suicidal and self-harming behaviours. Borderline Personal Disord Emot Dysregul 2020; 7:3. [PMID: 32021690 PMCID: PMC6993331 DOI: 10.1186/s40479-020-0119-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 01/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dialectical behaviour therapy (DBT) is an evidence-based intervention for borderline personality disorder (BPD) but is an intensive treatment with significant health service costs. Access to DBT can sometimes be restricted due to limited resources. Positive results have been reported for the use of DBT skills training (DBT-ST), one of the four modes of standard DBT, in the treatment of individuals with BPD who self-harm. This study evaluates DBT-ST for a subgroup of individuals attending community mental health services who may have a diagnosis of BPD (or emerging BPD traits) but who are not actively self-harming. METHODS Participants in this study were 100 adults attending community mental health services with a diagnosis of BPD, emerging BPD traits or emotion dysregulation who were not actively self-harming. The majority of participants were female (71%), aged 25-34 years (32%), single (48%) and unemployed (34%). Participants partook in a 24-week DBT-ST intervention delivered by DBT therapists. Outcome measures included the Difficulties in Emotion Regulation Scale (DERS), the DBT Ways of Coping Checklist (DBT-WCCL) and the Five Facet Mindfulness Questionnaire (FFMQ). Measures were administered at pre-intervention, at the end of each skills module, and at post-intervention. RESULTS Significant reductions in emotion dysregulation (DERS) and dysfunctional coping (DBT-WCCL) scores were reported from pre- to post-intervention (p < .001). A significant increase in mindfulness scores (FFMQ) and DBT skill use (DBT-WCCL) was also observed (p < .001). However, the drop-out rate was high (49% at post-intervention). DISCUSSION The results of this uncontrolled study suggest that a standalone 24-week DBT-ST intervention may have a beneficial impact in terms of a reduction in emotion dysregulation and dysfunctional coping, and an increase in mindfulness and DBT skills use in patients with BPD/ emerging BPD traits who are not currently engaging in self-harm. Adequately powered randomised controlled trials are required to determine treatment efficacy in comparison to standard DBT for this population.
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Affiliation(s)
- Mary Kells
- 1Cork Mental Health Services, Cork Kerry Community Healthcare, Health Service Executive, Inniscarraig House, Western Road, Cork, Ireland
| | - Mary Joyce
- 2National Suicide Research Foundation, Western Gateway Building, University College Cork, Cork, Ireland
| | - Daniel Flynn
- 3Mental Health Services, Cork Kerry Community Healthcare, Health Service Executive, St Finbarr's Hospital, Cork, Ireland
| | - Ailbhe Spillane
- 2National Suicide Research Foundation, Western Gateway Building, University College Cork, Cork, Ireland
| | - Aoife Hayes
- 2National Suicide Research Foundation, Western Gateway Building, University College Cork, Cork, Ireland
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Chanen AM, Betts J, Jackson H, McGorry P, Nelson B, Cotton SM, Bartholomeusz C, Jovev M, Ratheesh A, Davey C, Pantelis C, McCutcheon L, Francey S, Bhaduri A, Lowe D, Rayner V, Thompson K. Aripiprazole compared with placebo for auditory verbal hallucinations in youth with borderline personality disorder: Protocol for the VERBATIM randomized controlled trial. Early Interv Psychiatry 2019; 13:1373-1381. [PMID: 30689305 DOI: 10.1111/eip.12774] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 06/15/2018] [Accepted: 12/06/2018] [Indexed: 01/11/2023]
Abstract
AIM Up to half of patients with borderline personality disorder report auditory verbal hallucinations that are phenomenologically indistinguishable from those in schizophrenia, occur early in the course of the disorder, and are enduring, distressing and disabling. In clinical practice, this symptom is widely assumed to be unresponsive to treatment with antipsychotic medication and early intervention is rarely offered. The Verbal Experiences Response in Borderline personality disorder to Aripiprazole TrIal Medication (VERBATIM) study aims to be the first controlled trial to investigate the effectiveness of conventional pharmacotherapy for this symptom in this patient group. METHOD VERBATIM is a 12-week, triple-blind, single-centre, parallel groups randomised controlled trial, with a 27-week follow-up period. Participants between the ages of 15 and 25 years receive either aripiprazole or placebo daily, commencing at 2 mg and increasing to 10 mg by day 15. Further dose escalations (up to 30 mg) may occur, as clinically indicated. This trial was prospectively registered with the Australian and New Zealand Clinical Trials Registry ACTRN12616001192471 on 30/08/2016. RESULTS The primary outcome is severity of auditory verbal hallucinations assessed using the Psychotic Symptom Rating Scale. Secondary outcomes include the severity of general psychopathology, borderline personality pathology, social and occupational functioning and change in brain resting state connectivity. The primary endpoint is week 12 and secondary endpoint is week 39. CONCLUSION The results will inform treatment decisions for individuals with borderline personality disorder who present with auditory verbal hallucinations.
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Affiliation(s)
- Andrew M Chanen
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen Youth Health, Northwestern Mental Health, Melbourne, Victoria, Australia
| | - Jennifer Betts
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Henry Jackson
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Patrick McGorry
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Barnaby Nelson
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sue M Cotton
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Cali Bartholomeusz
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Martina Jovev
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen Youth Health, Northwestern Mental Health, Melbourne, Victoria, Australia
| | - Aswin Ratheesh
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen Youth Health, Northwestern Mental Health, Melbourne, Victoria, Australia
| | - Christopher Davey
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen Youth Health, Northwestern Mental Health, Melbourne, Victoria, Australia
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia
| | - Louise McCutcheon
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Orygen Youth Health, Northwestern Mental Health, Melbourne, Victoria, Australia
| | - Shona Francey
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen Youth Health, Northwestern Mental Health, Melbourne, Victoria, Australia
| | - Amit Bhaduri
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen Youth Health, Northwestern Mental Health, Melbourne, Victoria, Australia
| | - Danielle Lowe
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Victoria Rayner
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Katherine Thompson
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
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Iliakis EA, Sonley AKI, Ilagan GS, Choi-Kain LW. Treatment of Borderline Personality Disorder: Is Supply Adequate to Meet Public Health Needs? Psychiatr Serv 2019; 70:772-781. [PMID: 31138059 DOI: 10.1176/appi.ps.201900073] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study aimed to assess the supply of and demand for treatment of borderline personality disorder (BPD) to inform current standards of care and training in the context of available resources worldwide. METHODS The total supply of mental health professionals and mental health professionals certified in specialist evidence-based treatments for BPD was estimated for 22 countries by using data from publicly available sources and training programs. BPD prevalence and treatment-seeking rates were drawn from large-scale national epidemiological studies. Ratios of treatment-seeking patients to available providers were computed to assess whether current systems are able to meet demand. Training and certification requirements were summarized. RESULTS The ratio of treatment-seeking patients with BPD to mental health professionals (irrespective of professionals' interest or training in treating BPD) ranged from approximately 4:1 in Australia, the Netherlands, and Norway to 192:1 in Singapore. The ratio of treatment-seeking patients to clinicians certified in providing evidence-based care ranged from 49:1 in Norway to 148,215:1 in Mexico. Certification requirements differed by treatment and by country. CONCLUSIONS Shortages of both providers available to treat BPD and providers certified in specialist treatments of BPD exist in most of the 22 countries studied. In well-resourced countries, training clinicians to provide generalist or abbreviated treatments for BPD, in addition to specialist treatments, could help address the current implementation gap. More resource-efficient alternatives must be considered in countries with insufficient staff to implement even generalist treatments. Consideration of realistic allocation of care may shape future guidelines and standards of BPD treatments, beyond intensive evidence-based psychotherapies.
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Affiliation(s)
- Evan A Iliakis
- Adult Borderline Center and Training Institute, McLean Hospital, Belmont, Massachusetts (Iliakis, Ilagan, Choi-Kain); Center for Addiction and Mental Health, University of Toronto, Toronto (Sonley); Department of Psychiatry, Harvard Medical School, Boston (Choi-Kain)
| | - Anne K I Sonley
- Adult Borderline Center and Training Institute, McLean Hospital, Belmont, Massachusetts (Iliakis, Ilagan, Choi-Kain); Center for Addiction and Mental Health, University of Toronto, Toronto (Sonley); Department of Psychiatry, Harvard Medical School, Boston (Choi-Kain)
| | - Gabrielle S Ilagan
- Adult Borderline Center and Training Institute, McLean Hospital, Belmont, Massachusetts (Iliakis, Ilagan, Choi-Kain); Center for Addiction and Mental Health, University of Toronto, Toronto (Sonley); Department of Psychiatry, Harvard Medical School, Boston (Choi-Kain)
| | - Lois W Choi-Kain
- Adult Borderline Center and Training Institute, McLean Hospital, Belmont, Massachusetts (Iliakis, Ilagan, Choi-Kain); Center for Addiction and Mental Health, University of Toronto, Toronto (Sonley); Department of Psychiatry, Harvard Medical School, Boston (Choi-Kain)
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Räisänen T, Hakko H, Riipinen P, Räty E, Kantojärvi L. Personality disorders of drivers killed in fatal motor vehicle accidents in Finland during 1990-2011. Acta Psychiatr Scand 2019; 140:39-49. [PMID: 31087642 DOI: 10.1111/acps.13039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/09/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine the association of personality disorders (PDs) to deaths of drivers in fatal motor vehicle accidents (FMVAs) and analyze gender differences in lifetime psychiatric disorders and medico-legal findings at the time of accident. METHOD The study sample consisted of 4810 Finnish drivers killed in FMVAs in Finland between 1990 and 2011. Doctor-diagnosed PD was found in 146 drivers (118 men and 28 women). The information of psychiatric morbidity was obtained from the Finnish Care Register for Health Care. RESULTS The proportion of deceased drivers with PDs had increased significantly over the study period, particularly among females and those with PD not otherwise specified (NOS). Suicidality and use of medication affecting driving ability were more common among females with PD compared to males with PD. 88% of all deceased drivers with PD had comorbid psychiatric disorders. CONCLUSION Our findings indicate that PDs may predispose drivers to FMVAs, particularly females. This study emphasizes the importance of evaluating the fitness-to-drive of subjects with PD and especially comorbid substance use disorders, which may relate to an increased risk of fatal motor accidents.
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Affiliation(s)
- T Räisänen
- Department of Psychiatry, Oulu University Hospital, Oulu, Finland
| | - H Hakko
- Department of Psychiatry, Oulu University Hospital, Oulu, Finland
| | - P Riipinen
- Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland
| | - E Räty
- The Finnish Crash Data Institute, Helsinki, Finland
| | - L Kantojärvi
- Department of Psychiatry, Oulu University Hospital, Oulu, Finland
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Thompson KN, Betts J, Jovev M, Nyathi Y, McDougall E, Chanen AM. Sexuality and sexual health among female youth with borderline personality disorder pathology. Early Interv Psychiatry 2019; 13:502-508. [PMID: 29076247 DOI: 10.1111/eip.12510] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 06/12/2017] [Accepted: 08/20/2017] [Indexed: 11/26/2022]
Abstract
AIM Borderline personality disorder (BPD) is a severe mental disorder that is characterized by unstable relationships, impulsive behaviours and identity disturbance. BPD usually has its onset between puberty and young adulthood and presents disproportionately among females in clinical settings. Taken together, this makes young women with BPD a particularly vulnerable group with regard to healthy psychosexual development. It was hypothesized that female youth with BPD pathology would be more likely to score worse on measures of sexual health and safety, and to show greater uncertainty in sexual identity formation. METHODS Fifty 15 to 24 yr-old females with 3 or more Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-IV) BPD criteria were compared with 204 females from a nationally representative sample. Both groups were interviewed using a comprehensive interview for sexual health and relationships. The patient group completed a structured diagnostic interview. RESULTS Young women with borderline personality pathology engaged in sexual relationships at a younger age, with more sexual partners in the previous year, in more casual relationships. They were more likely to practice unsafe sex for their first sexual experience, to be coerced into unwanted sexual activity, to be unclear about their sexual identity or their sexual attraction, and to report worse overall health status. CONCLUSIONS BPD pathology in youth is associated with poor sexual health and safety, and uncertainty in sexual identity formation. These findings support the need for assessment of the sexuality and sexual health of youth with BPD, along with the need for routine screening in sexual health services for BPD features among high-risk youth.
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Affiliation(s)
- Katherine N Thompson
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Jennifer Betts
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Martina Jovev
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia.,Orygen Youth Health, Parkville, Victoria, Australia
| | - Yolanda Nyathi
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
| | - Emma McDougall
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
| | - Andrew M Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia.,Orygen Youth Health, Parkville, Victoria, Australia
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Abstract
Several studies of the prevalence of borderline personality disorder in community and clinical settings have been carried out to date. Although results vary according to sampling method and assessment method, median point prevalence is roughly 1%, with higher or lower rates in certain community subpopulations. In clinical settings, the prevalence is around 10% to 12% in outpatient psychiatric clinics and 20% to 22% among inpatient clinics. Further research is needed to identify the prevalence and correlates of borderline personality disorder in other clinical settings (eg, primary care) and to investigate the impact of demographic variables on borderline personality disorder prevalence.
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Abstract
Caretakers are often intimidated or alienated by patients with borderline personality disorder (BPD), compounding the clinical challenges posed by the severe morbidity, high social costs and substantial prevalence of this disorder in many health-care settings. BPD is found in ∼1.7% of the general population but in 15-28% of patients in psychiatric clinics or hospitals and in a large proportion of individuals seeking help for psychological problems in general health facilities. BPD is characterized by extreme sensitivity to perceived interpersonal slights, an unstable sense of self, intense and volatile emotionality and impulsive behaviours that are often self-destructive. Most patients gradually enter symptomatic remission, and their rate of remission can be accelerated by evidence-based psychosocial treatments. Although self-harming behaviours and proneness to crisis can decrease over time, the natural course and otherwise effective treatments of BPD usually leave many patients with persistent and severe social disabilities related to depression or self-harming behaviours. Thus, clinicians need to actively enquire about the central issues of interpersonal relations and unstable identity. Failure to correctly diagnose patients with BPD leads to misleading pharmacological interventions that rarely succeed. Whether the definition of BPD should change is under debate that is linked to not fully knowing the nature of this disorder.
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Nakash O, Cohen M, Nagar M. "Why Come for Treatment?" Clients' and Therapists' Accounts of the Presenting Problems When Seeking Mental Health Care. QUALITATIVE HEALTH RESEARCH 2018; 28:916-926. [PMID: 29415635 DOI: 10.1177/1049732318756302] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Although identification of main problems is the foundation for treatment planning, limited research has examined reasons for seeking mental health care. We identified reasons for seeking mental health care as reported by clients and therapists upon initial contact with mental health services. We conducted in-depth interviews with clients and their therapists immediately following the intake. We analyzed 117 therapist and 112 client interviews using thematic analysis. Overall interrater reliability among three raters who coded the interviews was high (kappa = 0.72). Our findings suggest that, overall, clients and therapists report similar main area problems that bring clients to care. Emotional distress and other psychiatric symptoms as well as interpersonal problems were most prevalent. Therapists tended to ignore some problem areas that clients highlighted, including physical problems and socioeconomic strains. Raising awareness to potential gaps in perception of main problems that bring clients to care will promote a shared understanding and improve quality of care.
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Affiliation(s)
- Ora Nakash
- 1 Interdisciplinary Center Herzliya, Herzliya, Israel
| | - Michal Cohen
- 1 Interdisciplinary Center Herzliya, Herzliya, Israel
| | - Maayan Nagar
- 1 Interdisciplinary Center Herzliya, Herzliya, Israel
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Laporte L, Paris J, Zelkowitz P. Estimating the prevalence of borderline personality disorder in mothers involved in youth protection services. Personal Ment Health 2018; 12:49-58. [PMID: 28944592 DOI: 10.1002/pmh.1398] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 07/28/2017] [Accepted: 08/18/2017] [Indexed: 11/05/2022]
Abstract
Characteristics of borderline personality disorder (BPD) can undermine maternal capacity and in some cases lead to involvement with youth protection services (YPS). Yet, few studies exist on the prevalence of maternal BPD in this context and on the comparison of these families with families with other maternal psychiatric disorders or families with no mental illness within YPS. The current study surveyed 291 caseworkers working with mothers whose children and adolescents are followed by YPS. After reported prevalence was adjusted with validation procedures, the prevalence of maternal BPD in a sample of 1875 mothers was 34.3%. Comparison of three groups of families suggest that some risk factors, including substance abuse and severe conjugal conflicts, were more frequent in mothers with BPD than in mothers with other psychiatric illness or none. Furthermore, results revealed that 48.9% of mothers with BPD had a history of being followed by YPS in their childhood. Finally, children of mothers with BPD were placed at a younger age than the other children and were less often reported for conduct disorder. These results call for more attention to these highly vulnerable parents and children in both research and in adult and child mental health services. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Lise Laporte
- Department of Psychiatry, McGill University Health Centre, Montreal, Quebec, Canada.,Centre de recherche Jeunes en difficulté CIUSS Centre sud de l'île de Montréal, Quebec, Canada
| | - Joel Paris
- Department of Psychiatry, Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada
| | - Phyllis Zelkowitz
- Department of Psychiatry, Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada
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Innocent S, Podder P, Ram JR, Barnicot K, Sen P. Using the SAPAS to identify risk for personality disorders among psychiatric outpatients in India: A feasibility study. Personal Ment Health 2018; 12:15-24. [PMID: 29052355 DOI: 10.1002/pmh.1394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 06/22/2017] [Accepted: 07/30/2017] [Indexed: 11/09/2022]
Abstract
Personality disorders (PDs) are common among psychiatric outpatients and are associated with increased morbidity and worse treatment outcomes. Epidemiological research conducted among this population in Asian countries is limited, reflecting a significant gap in the current literature. One barrier to this research is the lack of appropriate screening tools. The current research assessed the feasibility of using the SAPAS (Standardized Assessment of Personality-Abbreviated Scale) screening tool to identify individuals at high risk of PD in an Indian psychiatric outpatient population and provides an initial estimate of PD prevalence by using a validated diagnostic interview, the ICD-10 International Personality Disorder Examination. The findings suggest that whilst use of the SAPAS was feasible, acceptable to patients and led to clinically useful findings, when using the recommended cut-off score of 4, the SAPAS largely overdiagnoses the risk for PD in psychiatric outpatients in India (positive predictive value = 26.3%). The estimated prevalence of personality disorder in the sample was 11.1%, based on administering the International Personality Disorder Examination diagnostic interview to high-risk patients scoring 4 and above on the SAPAS, which is higher than previous estimates for this population and still likely to be an underestimation. Future studies should translate the measure into Bengali and evaluate its sensitivity and specificity at different cut-off points in order to optimize its use in Indian populations. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
| | - Priyanka Podder
- Mental Health Foundation, University of Calcutta, Kolkata, India
| | | | | | - Piyal Sen
- Elysium Healthcare, King's College London, London, UK
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Carmel A, Torres NI, Chalker S, Comtois KA. Interpersonal barriers to recovery from borderline personality disorder: A qualitative analysis of patient perspectives. Personal Ment Health 2018; 12:38-48. [PMID: 29024577 DOI: 10.1002/pmh.1397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 07/11/2017] [Accepted: 08/09/2017] [Indexed: 11/06/2022]
Abstract
Social-environmental factors have been found to be an integral part in the recovery process for individuals with psychiatric disabilities. There are few studies that have obtained patient perspectives of how their social and treatment environments help facilitate or impede the recovery process. The following study examined the self-reported interpersonal barriers to recovery among a sample of individuals (N = 31) with borderline personality disorder who were receiving dialectical behaviour therapy. The goal of study was to identify self-reported problematic behaviour that interferes with recovery goals and identify types of family, friend and/or provider behaviours that increased the likelihood of patients engaging in these problematic behaviours. A content analysis yielded three themes of problematic behaviour, and how these behaviours were reinforced by others, including (1) avoidance behaviours, (2) encouragement of negative coping and (3) communication of low behavioural expectations. Implications for the impact of these patterns of reinforcement within behavioural health settings are discussed. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Adam Carmel
- Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, 325 9th Ave, Box 359911, Seattle, WA, 98104, USA
| | - Nicole I Torres
- Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, 325 9th Ave, Box 359911, Seattle, WA, 98104, USA
| | - Samantha Chalker
- Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, 325 9th Ave, Box 359911, Seattle, WA, 98104, USA.,Department of Psychology, Catholic University of America, 620 Michigan Ave NE, Washington, DC, 20064, USA
| | - Katherine Anne Comtois
- Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, 325 9th Ave, Box 359911, Seattle, WA, 98104, USA
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Bertsch K, Herpertz SC. Personality Disorders, Functioning and Health. Psychopathology 2018; 51:69-70. [PMID: 29642070 DOI: 10.1159/000487971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Mehlum L, Bateman A, Dalewijk HJ, Doering S, Kaera A, Moran PA, Renneberg B, Ribaudi JS, Simonsen S, Wilberg T, Bohus M. Building a strong European alliance for personality disorder research and intervention. Borderline Personal Disord Emot Dysregul 2018; 5:7. [PMID: 29619226 PMCID: PMC5879813 DOI: 10.1186/s40479-018-0082-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 03/06/2018] [Indexed: 11/11/2022] Open
Abstract
People with personality disorders frequently face stigma, ignorance and pessimism regarding the treatability of their disorders. This is despite substantial progress that has been made in developing a number of effective evidence based psychotherapeutic treatments. However, expertise in how to systematically deliver these treatments in a sustainable way throughout Europe is largely lacking. To bridge the gap between evidence based treatments and their implementation in health services, the European Society for the Study of Personality Disorders is currently building a new alliance of experts to promote personality disorder scholarship, and to support the development of clinical expertise and systematic treatment implementation throughout Europe. The aim of this paper is to describe how the Society is currently using its interdisciplinary and international roster of experts to address the specific treatment and research needs of the European personality disorder field, particularly to countries in which expertise in the field is less developed.
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Affiliation(s)
- Lars Mehlum
- 1National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anthony Bateman
- 2University College, London, University of Copenhagen, London, UK.,Anna Freud National Centre for Children and Families, London, UK
| | | | - Stephan Doering
- 5Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Andres Kaera
- 6Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | - Paul Anthony Moran
- 7Centre for Academic Mental Health, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | | | | | - Theresa Wilberg
- Department of Research and Development, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Martin Bohus
- 12Institute of Psychiatric and Psychosomatic Psychotherapy; Central Institute of Mental Health, Mannheim, Heidelberg University, Mannheim, Germany
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Carvalho LDF, Pianowski G, Reis AM. Development and Diagnostic Accuracy of the Screening of the Dimensional Clinical Personality Inventory. PSICOLOGIA: CIÊNCIA E PROFISSÃO 2017. [DOI: 10.1590/1982-3703003082016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract: The assessment of personality disorders assumes unquestioned clinical relevance when considering the prevalence rates in the general population. Tests assessing the typical pathological traits of these disorders has been adapted to and developed in Brazil. However, there is a gap in the country of screening tools for personality disorders. Screening tools are designed to allow a fast and informative application on the likelihood of a positive diagnosis, where the consequence should be conveyed to a diagnostic assessment. Using as a base the Dimensional Clinical Personality Inventory (IDCP), developed at the national level, the objective of this research was to develop a screening tool for personality disorders, as well as investigate its diagnostic accuracy. The study included 1,196 people, aging between 18 and 73 years (M = 26.32, SD = 8.69), and 64.1% female. The sample was divided into clinical and non-clinical group. We used an empirical approach based on criteria for selection of items similar to those adopted in the development of Minnesota Multiphasic Personality Inventory was used (MMPI). The logistic regression analysis and also the calculation of Cohen's d indicated the items that best discriminate against people with personality disorders and those without this diagnosis. We achieved a final set of 15 items with satisfactory sensitivity and specificity for screening test. We discusses the strengths and limitations of screening version of the IDCP and guidelines for further study.
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46
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Feenstra DJ, Luyten P, Bales DL. Mentalization-based treatment for borderline personality disorder in adults and adolescents: For whom, when, and how? Bull Menninger Clin 2017; 81:264-280. [DOI: 10.1521/bumc_2017_81_04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Dine J. Feenstra
- Viersprong Institute for Studies on Personality Disorders (VISPD), Bergen op Zoom, The Netherlands
| | - Patrick Luyten
- Viersprong Institute for Studies on Personality Disorders (VISPD), Bergen op Zoom, The Netherlands
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
- Research Department of Clinical, Educational, and Health Psychology, University College London, London, UK
- MBT Netherlands, Bergen op Zoom, The Netherlands
| | - Dawn L. Bales
- Viersprong Institute for Studies on Personality Disorders (VISPD), Bergen op Zoom, The Netherlands
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Zahn N, Sellbom M, Pymont C, Schenk PW. Associations between MMPI-2-RF Scale Scores and Self-Reported Personality Disorder Criteria in a Private Practice Sample. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2017. [DOI: 10.1007/s10862-017-9616-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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48
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Scott LN, Wright AGC, Beeney JE, Lazarus SA, Pilkonis PA, Stepp SD. Borderline personality disorder symptoms and aggression: A within-person process model. JOURNAL OF ABNORMAL PSYCHOLOGY 2017; 126:429-440. [PMID: 28383936 PMCID: PMC5480678 DOI: 10.1037/abn0000272] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Theoretical and empirical work suggests that aggression in those with borderline personality disorder (BPD) occurs primarily in the context of emotional reactivity, especially anger and shame, in response to perceived rejection. Using intensive repeated measures, we examined a within-person process model in which perceived rejection predicts increases in aggressive urges and behaviors via increases in negative affect (indirect effect) and in which BPD symptoms exacerbate this process (moderated mediation). Participants were 117 emerging adult women (ages 18-24) with recent histories of aggressive behavior who were recruited from a community-based longitudinal study of at-risk youth. Personality disorder symptoms were assessed by semistructured clinical interview, and aggressive urges, threats, and behaviors were measured in daily life during a 3-week ecological momentary assessment protocol. Multilevel path models revealed that within-person increases in perceived rejection predicted increases in negative affect, especially in women with greater BPD symptoms. In turn, increases in negative affect predicted increased likelihood of aggressive urges or behaviors. Further analysis revealed that BPD symptoms predicted greater anger and shame reactivity to perceived rejection, but not to criticism or insult. Additionally, only anger was associated with increases in aggression after controlling for other negative emotions. Whereas BPD symptoms exacerbated the link between perceived rejection and aggression via increases in negative affect (particularly anger), this process was attenuated in women with greater antisocial personality disorder symptoms. These findings suggest that anger reactivity to perceived rejection is one unique pathway, distinct from antisocial personality disorder, by which BPD symptoms increase risk for aggression. (PsycINFO Database Record
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49
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Personality traits and psychotic symptoms in recent onset of psychosis patients. Compr Psychiatry 2017; 74:109-117. [PMID: 28147290 DOI: 10.1016/j.comppsych.2017.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 11/29/2016] [Accepted: 01/10/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Personality in patients with psychosis, and particularly its relation to psychotic symptoms in recent onset of psychosis (ROP) patients, is understudied. The aims of this research were to study the relation between dimensional and categorical clinical personality traits and symptoms, as well as the effects that symptoms, sex and age have on clinically significant personality traits. METHODS Data for these analyses were obtained from 94 ROP patients. The Millon Clinical Multiaxial Inventory and the Positive and Negative Syndrome Scale were used to assess personality and symptoms. Correlational Analysis, Mann-Whitney test, and, finally, logistic regression were carried out. RESULTS The negative dimension was higher in patients with schizoid traits. The excited dimension was lower for those with avoidant and depressive traits. The anxiety and depression dimension was higher for patients with dependent traits. The positive dimension was lower for patients with histrionic and higher for patients with compulsive traits. Logistic regression demonstrated that gender and the positive and negative dimensions explained 35.9% of the variance of the schizoid trait. The excited dimension explained 9.1% of the variance of avoidant trait. The anxiety and depression dimension and age explained 31.3% of the dependent trait. Gender explained 11.6% of the histrionic trait, 14.5% of the narcissistic trait and 11.6% of the paranoid trait. Finally gender and positive dimension explained 16.1% of the compulsive trait. CONCLUSIONS The study highlights the importance of studying personality in patients with psychosis as it broadens understating of the patients themselves and the symptoms suffered.
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50
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Nakash O, Nagar M. Assessment of diagnostic information and quality of working alliance with clients diagnosed with personality disorders during the mental health intake. J Ment Health 2017. [DOI: 10.1080/09638237.2017.1294740] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Ora Nakash
- Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya, Israel
| | - Maayan Nagar
- Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya, Israel
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