Maladaptive interpersonal schemas as sensitive and specific markers of borderline personality disorder among psychiatric inpatients

The Relationship of Rejection Sensitivity to Depressive Symptoms in Adolescence: The Indirect Effect of Perceived Social Acceptance by Peers

Rejection sensitivity (RS), the tendency to expect, perceive and overreact to rejection from others, has been linked to children's and adolescents' increased vulnerability to depressive symptoms, negatively affecting their perceptions of the quality of their relationship with their peers. The aim of this study is to examine (a) the indirect effect of perceived peer social acceptance in the relationship between RS and depressive symptoms in a sample of Greek adolescents, (b) the differential effect of the different components of rejection sensitivity (angry and anxious RS) on the model, and (c) possible gender differences. The sample of the study consists of 295 adolescents (139 boys, 156 girls, Mage = 14.20, SD = 1.60) residing in the greater Heraklion Prefecture area. Data collection was carried out using self-report questionnaires that measured demographic characteristics, self-perceptions about their peer relationships (self-perception profile for adolescents/SPPA), susceptibility to rejection (children's rejection sensitivity questionnaire/CRSQ), and depressive symptoms (children's depression inventory/CDI). Results showed that (a) RS was positively related to depressive symptoms and negatively related to adolescents' perceptions of their relationships, (b) relationship perceptions were negatively related to depressive symptoms, and gender differences were also found, (c) perceived social acceptance by peers was found to have an indirect effect in the relationship between RS and depressive symptoms, with girls showing a greater effect, and (d) differences were observed in the mediating model between the components of RS, with the mediating effect of perceptions being higher in the model with anxious RS, which appears to confirm previous theoretical postulations. The results of this study highlight the importance of adolescents' perceptions of their peer relationships in the occurrence of depressive symptoms during this developmental period, especially in youths with anxious rejection sensitivity.

Are the schema modes suitable for explaining borderline and narcissistic behaviours?

Jeffrey Young assumes that people suffering from personality disorders differ from healthy ones in schema modes intensity but not diversity. Besides, healthy people also present behaviours typical for personality disorders, but to a lesser extent. However, research lacks the interrelationships between modes, especially in healthy individuals. The presented study aimed to investigate the mutual relations between the schema modes using path analysis to understand better problematic behaviour in borderline and narcissistic types in a non-clinical sample and to verify Young assumption about the continuum of the schema modes. A sample of 467 healthy adults aged 18–50 (M = 32.87, SD = 10.56), 52.9% of whom were women, completed SMI 1.1 and SCID-II. Descriptive statistics, matrix of correlation and structural equation modelling were used. Results confirmed the significance of the theoretically assumed and previously empirically proved schema modes also for healthy people. The most important modes for both borderline and narcissistic behaviours are the Punitive Parent, the Angry Child and the Enraged Child modes. For borderline behaviour, the Detached Protector coping mode, connected to a sense of emptiness, is significant. Narcissistic behaviour relates to Bully and Attack, and Self-Aggrandiser modes and is connected to aggressive and dominant behaviour. The obtained models explain 47% of the variance in borderline and 44% in narcissistic behaviours. The study indicates the validity of analysing the modes among people with lower intensity of behaviours typical for personality disorders and also confirms Young’s assumptions about the universality of schema modes. Results are discussed in the context of their relevance for practitioners.

Childhood maltreatment and suicidal ideation in Chinese children and adolescents: the mediating role of mindfulness

BACKGROUND

Childhood maltreatment (CM) has been associated with suicidal ideation (SI) in children and adolescents, yet the mediating role of mindfulness in this association remains unclear. This study aims to test the mediation of mindfulness in CM-SI association among a large sample of Chinese children and adolescents.

METHODS

A population-based cross-sectional study of 3455 children and adolescents aged 10-17 years from southwest China Yunnan province was conducted. Information from the participants was collected by using a comprehensive self-administered questionnaire. The Chinese version of the Childhood Trauma Questionnaire (CTQ), Five Facet Mindfulness Questionnaire (FFMQ), and the Beck Scale for Suicidal Ideation (BSSI) were used to measure CM, mindfulness and SI. Univariate and multivariate binary logistic regression models were used to estimate the crude and adjusted associations between CM, mindfulness and SI (one-week, one-year, lifetime). Pathway analysis was subsequently performed to test the mediation of mindfulness in CM-SI association.

RESULTS

The findings showed that mindfulness, CM and SI were significantly correlated with each other (p < 0.05). Mindfulness is a significant mediator in CM-SI association, accounted for 7.5, 11.4, and 17.6% of the total associations for one-week SI, one-year SI, and lifetime SI, respectively. For the five types of CM, the highest level of mediation via mindfulness had been found for physical neglect (PN) and one-year SI (34.3%), followed by emotional neglect (EN) and one-year SI (30.2%), sexual abuse (SA) and one-year SI (25.4%).

CONCLUSIONS

Our study findings highlight the intervention potential of mindfulness in preventing CM associated suicidal risk. Future longitudinal studies are warranted to corroborate the effectiveness of mindfulness-based intervention for Chinese children and adolescents.

Impact of Childhood Maltreatment in Borderline Personality Disorder on Treatment Response to Intensive Dialectical Behavior Therapy

Childhood maltreatment (CM), including emotional, physical, and sexual abuse and emotional and physical neglect, is associated with severity of borderline personality disorder (BPD). However, knowledge on the impact of CM on treatment response is scarce. The authors investigated whether self-reported CM or one of its subtypes affected treatment retention, depressive symptoms, and impulsivity throughout short-term intensive dialectical behavior therapy (I-DBT) in 333 patients with BPD. Data were analyzed with linear and logistic regressions and linear mixed models, using a Bayesian approach. Patients who reported childhood emotional abuse had a higher dropout rate, whereas it was lower in patients who reported childhood emotional neglect. Emotional neglect predicted a greater decrease of depressive symptoms, and global CM predicted a greater decrease of impulsivity. The authors concluded that patients with BPD who experienced CM might benefit from I-DBT in specific symptom domains. Nonetheless, the impact of emotional abuse on higher dropout needs to be considered.

Internet addiction and maladaptive schemas: The potential role of disconnection/rejection and impaired autonomy/performance

INTRODUCTION AND OBJECTIVES

Problematic internet use (PIU) has become public health concern, particularly among adolescents and emerging adults. There is growing interest concerning the potential impacts of early maladaptive schemas (EMSs) on PIU and its most severe manifestation internet addiction (IA). However, a deeper understanding of these relationships is needed regarding of effects of schemas on IA. The purpose of the present study was to explore the role of EMSs among adults.

METHODS

The sample comprised 714 Iranian participants who completed a self-report survey comprising sociodemographic variables, the Internet Addiction Test (IAT), and the Young Schema Questionnaire-Short Form (YSQ-SF). The data were analysed using partial least squares structural equation modelling (PLS-SEM).

RESULTS

Findings indicated that there was a positive and significant relationship between EMS domains and IA. The results confirmed that disconnection/rejection schema domains and impaired autonomy/performance schema domains were significantly related with IA. The results of the analysis of convergent validity and discriminant validity were acceptable among the nine reflective constructs.

CONCLUSION

Findings of the present study indicated that existence of underlying EMSs may be a vulnerability factor for developing IA and adds to the growing body of cyberpsychology literature that has examined the relationships between the EMSs and IA.

Mouse-tracking reveals cognitive conflict during negative impression formation in women with Borderline Personality Disorder or Social Anxiety Disorder

Individuals with Borderline Personality Disorder (BPD) or Social Anxiety Disorder (SAD) suffer from substantial interpersonal dysfunction and have difficulties establishing social bonds. A tendency to form negative first impressions of others could contribute to this by way of reducing approach behavior. We tested whether women with BPD or SAD would show negative impression formation compared to healthy women (HCs). We employed the Thin Slices paradigm and showed videos of 52 authentic target participants to 32 women with BPD, 29 women with SAD, and 37 HCs. We asked participants to evaluate whether different positive or negative adjectives described targets and expected BPD raters to provide the most negative ratings, followed by SAD and HC. BPD and SAD raters both agreed with negative adjectives more often than HCs (e.g., ‘Yes, the person is greedy’), and BPD raters rejected positive adjectives more often (e.g., ‘No, the person is not humble.’). However, BPD and SAD raters did not differ significantly from each other. Additionally, we used the novel process tracing method mouse-tracking to assess the cognitive conflict (via trajectory deviations) raters experienced during decision-making. We hypothesized that HCs would experience more conflict when making unfavorable (versus favorable) evaluations and that this pattern would flip in BPD and SAD. We quantified cognitive conflict via maximum absolute deviations (MADs) of the mouse-trajectories. As hypothesized, HCs showed more conflict when rejecting versus agreeing with positive adjectives. The pattern did not flip in BPD and SAD but was substantially reduced, such that BPD and SAD showed similar levels of conflict when rejecting and agreeing with positive adjectives. Contrary to the hypothesis for BPD and SAD, all three groups experienced substantial conflict when agreeing with negative adjectives. We discuss therapeutic implications of the combined choice and mouse-tracking results.

Testing the Interpersonal-Cognitive Model of Auditory Verbal Hallucinations in Youths with Either Early-Stage Borderline Personality Disorder or First-Episode Schizophrenia Spectrum Disorder

This is the first study to explore interpersonal schemata in outpatient youths (age 15-25 years) with early-stage borderline personality disorder (BPD) and auditory verbal hallucinations (AVH). It also aimed to replicate, in a transdiagnostic youth sample, the finding from studies of adults with AVH that negative beliefs about the self and others lead to negative appraisals of voices, which in turn elicits depression. The following 3 groups were compared: youth with BPD+AVH (n = 23), youth with schizophrenia spectrum disorder (SZ) with AVH (SZ+AVH, n = 20), and youths with BPD who did not experience AVH (BPD no AVH, n = 23). The BPD+AVH group reported more negative and fewer positive self schemata than the SZ+AVH group. They also saw themselves as being more socially inferior to others than did the SZ+AVH group, but they did not differ in appraisals of self or others, compared with the BPD no AVH group. In youths with AVH (BPD+AVH, SZ+AVH combined), the indirect effect of beliefs about self or others, via negative appraisals of voices on depression, was not significant. Instead, a significant indirect effect of negative appraisals of voices on depression, via negative beliefs about self, was found. The experience of AVH during adolescence and young adulthood, when the identity is still being formed, might have a more profound effect on the developing self than during later adulthood, when the self is more stable and resilient. Negative self-appraisals might constitute a treatment target for early intervention for youths with distressing voices, including those with BPD.

Comparison of early maladaptive schemas between borderline personality disorder and chronic depression

Borderline personality disorder (BPD) and chronic depression (CD) are common and challenging mental disorders. Maladaptive cognitive schemas have been proposed to increase vulnerability to both disorders. In order to elucidate the role of maladaptive cognitive schemas in BPD and CD, this study compared psychiatric outpatients with BPD (N = 30) and CD (N = 30) in terms of early maladaptive schemas (EMSs). The groups were compared using the Young Schema Questionnaire short form-extended (YSQ-S2-extended) and the 15D health status questionnaire. BPD patients showed higher endorsement on the majority of EMSs, poorer social functioning, and greater concurrent distress than CD patients. However, after controlling for concurrent effects of psychological distress, the groups did not differ in 14 out of the 18 EMSs. These findings point to significant similarities in maladaptive beliefs between the 2 disorders and do not support broad, specific patterns of EMSs associated with either disorder. The results highlight the need for further study of the role of maladaptive schemas in the development and treatment of chronic mental disorders.

Schemas and modes in borderline personality disorder: The mistrustful, shameful, angry, impulsive, and unhappy child

In this study we investigated how early maladaptive schemas and schema modes uniquely characterize Borderline Personality Disorder (BPD) patients versus comparison groups. BPD patients (n = 101) were systematically matched with personality disordered patients without BPD (n = 101) and healthy controls (n = 101). Differences were investigated using one-way ANOVA and multinomial logistic regression analyses. Results indicated that schemas of Mistrust/Abuse and Defectiveness/Shame along with modes of Angry Child, Impulsive Child, and (low) Happy Child uniquely differentiated BPD patients from patients with other personality disorders. Likewise, schemas of Mistrust/Abuse, Defectiveness/Shame, and Insufficient Self-Control along with modes of Vulnerable Child, Enraged Child, and (low) Happy Child, uniquely differentiated BPD patients from healthy controls. The results are overall consistent with propositions in the schema therapy literature as well as previous findings, and suggest that underlying schemas of Mistrust/Abuse and Defectiveness/Shame as well as manifest modes of Angry/Enraged Child, Impulsive Child, and (low) Happy Child comprise key features of BPD. Consequently, these features may be important foci in the conceptualization and treatment of BPD.