Resting cardiac function in adolescent non-suicidal self-injury: The impact of borderline personality disorder symptoms and psychosocial functioning

Emotion dysregulation in nonsuicidal self-injury: Dissociations between global self-reports and real-time responses to emotional challenge

INTRODUCTION

Prominent theories of nonsuicidal self-injury (NSSI) propose that the behaviour is characterised by amplified emotional responses. However, little is known about how people who self-injure respond during emotional challenge.

METHODS

We measured subjective and physiological responding (heart rate, heart rate variability, and electrodermal responding) among young adults with past-year NSSI (n = 51) and those with no lifetime NSSI (n = 50) during a resting baseline, a stress induction, and a post-stress resting phase. Participants reported the extent to which they spontaneously used cognitive reappraisal and expressive suppression during the post-stress phase. Two weeks later, a subset of the sample (n = 42) reported how they remembered feeling during the laboratory session.

RESULTS

Although the NSSI group reported considerably greater emotion dysregulation than Controls, both groups showed similar subjective and psychological reactivity to, and recovery from, emotional challenge. Both groups used reappraisal and suppression regulation strategies following acute stress to a similar extent, and later came to remember the emotional challenge in a similar manner.

LIMITATIONS

Within the NSSI group, past-year self-injury tended to be infrequent and sporadic. Only 43.6% of the sample participated in the follow-up survey assessing memory of emotional challenge.

CONCLUSIONS

Findings demonstrate that the role of emotion in NSSI is more complex than prominent theories can account for, raising substantial questions regarding the nature of emotion in NSSI. A more comprehensive understanding of the role of emotion in NSSI is needed to inform intervention strategies to better support people who self-injure.

The relationship between depression severity and heart rate variability in children and adolescents: A meta-analysis

OBJECTIVE

Depression in children and adolescents has gradually attracted social attention. Heart rate variability (HRV) has been found to be influenced by depression severity, but results have not been uniformed in children and adolescents. This study investigated the relationship between depression severity and heart rate variability in children and adolescents, aiming to provide additional evidence for an objective, effective, and convenient depression screening tool in this population.

METHODS

Literature searching was conducted in China National Knowledge Infrastructure (CNKI), Wanfang Data, Web of Science, PubMed, ScienceDirect, and EBSCO. Relevant studies investigating the relationship between depression severity and HRV in children and adolescents were selected for meta-analysis.

RESULTS

31 articles were included in this meta-analysis, involving 4534 participants. Depression severity in children and adolescents was significantly negatively correlated with high frequency (HF) and root mean square of successive differences (RMSSD) in HRV (HF: r = -0.10, 95% CI: -0.17 to -0.04, p = 0.001; RMSSD: r = -0.18, 95% CI: -0.30 to -0.05, p = 0.01). The relationship between HF and depression severity was moderated by age, higher among those aged >12 than among those aged <12 (r = -0.17, -0.02, Q = 7.32, p = 0.007).

CONCLUSION

Heart rate variability is associated with depression severity in children and adolescents.

Facial emotion processing in patients with borderline personality disorder as compared with healthy controls: an fMRI and ECG study

BACKGROUND

Maladaptive behaviors and interpersonal difficulties in patients with borderline personality disorder (BPD) seem connected to biased facial emotion processing. This bias is often accompanied by heightened amygdala activity in patients with BPD as compared to healthy controls. However, functional magnetic resonance imaging (fMRI) studies exploring differences between patients and healthy controls in facial emotion processing have produced divergent results. The current study explored fMRI and heart rate variability (HRV) correlates of negative facial emotion processing in patients with BPD and healthy controls.

METHODS

The study included 30 patients with BPD (29 females; age: M = 24.22, SD = 5.22) and 30 healthy controls (29 females; M = 24.66, SD = 5.28). All participants underwent the "faces" task, an emotional face perception task, in an fMRI session simultaneously with ECG. In this task, participants are presented with emotional expressions of disgust, sadness, and fear (as a negative condition) and with the same pictures in a scrambled version (as a neutral condition).

RESULTS

We found no differences in brain activity between patients with BPD and healthy controls when processing negative facial expressions as compared to neutral condition. We observed activation in large-scale brain areas in both groups when presented with negative facial expressions as compared to neutral condition. Patients with BPD displayed lower HRV than healthy controls in both conditions. However, there were no significant associations between HRV and amygdala activity and BPD symptoms.

CONCLUSION

The results of this study indicate no abnormal brain activity during emotional facial processing in patients with BPD. This result contrasts with previous studies and more studies are needed to clarify the relationship between facial emotion processing and brain activity in patients with BPD. Possible reasons for the absence of brain activity differences are discussed in the study. Consistent with previous findings, patients showed lower HRV than healthy controls. However, HRV was not associated with amygdala activity and BPD symptoms.

Self- and co-regulation of physiological activity during mother-daughter interactions: The role of adolescent non-suicidal self-injury

BACKGROUND

Non-suicidal self-injury (NSSI) is a significant public health concern that is thought to increase risk for future self-injurious behaviors, including suicide attempts. Notably, NSSI is especially prevalent among adolescents, which underscores a critical need to identify modifiable risk factors that could be targeted to reduce future risk. The current study examined self- and co-regulation of physiological responses during mother-daughter interactions in adolescent girls with and without a history of NSSI.

METHODS

Participants were 60 girls aged 13-17 with (n = 27) and without (n = 33) a history of NSSI and their mothers. Adolescents and their mothers completed positive and negative interaction tasks during which physiological reactivity was assessed via respiratory sinus arrhythmia (RSA).

RESULTS

Using Actor-Partner Interdependence Modeling (APIM), we found that adolescents with an NSSI history demonstrated a higher RSA setpoint than adolescents without this history during the negative, but not positive, interaction task. In addition, there were differences in co-regulation during the negatively valenced interaction, such that mothers of daughters with NSSI were more reactive to fluctuations in their daughters' RSA than mothers of daughters without an NSSI history.

CONCLUSIONS

These findings highlight intra- and interpersonal aspects of physiological dysregulation associated with NSSI that could provide promising targets of intervention to reduce future risk in adolescent girls.

Autonomic dysregulation and self-injurious thoughts and behaviours in children and young people: A systematic review and meta-analysis

Background

Self-injurious thoughts and behaviours (SITBs) have been associated with dysfunction of the Autonomic Nervous System (ANS) in children and young people, suggesting that objective ANS measures may aid assessment of suicide risk, but a systematic synthesis of this literature is currently lacking.

Methods

Following a pre-registered protocol (PROSPERO CRD42022327605), we conducted a systematic search of PubMed, Medline, Embase, PsycINFO, and Web of Science, for empirical studies published until 10th May 2022 that compared indices of ANS functioning in individuals aged 0-25 years with versus without SITBs, or reported continuous associations between ANS measures and SITBs. Study quality was assessed with the Newcastle-Ottawa Scales. Pooled effect sizes (Hedge's g) were estimated with random-effects meta-analytic models.

Results

Twenty studies (1979 participants) were included in our systematic review, with 16 included in meta-analyses. Results suggested that SITBs were associated with altered cardiac indices of arousal (g = -0.328, p < 0.001), which was driven by lower heart rate variability in individuals with SITBs (g = -0.375, p = 0.025). Overall results for electrodermal activity were not significant (g = 0.026, p = 0.857), but subgroup analyses showed increased activity in studies of individuals who engaged specifically in non-suicidal self-harm (g = 0.249, p = 0.014) but decreased activity in the remaining studies (g = -0.567, p = 0.004).

Conclusions

Our systematic review and meta-analysis found evidence of reduced parasympathetic regulation as well as more tentative evidence of altered electrodermal activity in children and young people displaying SITBs. Future longitudinal studies should test the clinical utility of these markers for detecting and monitoring suicide risk.

An RDoC-based approach to adolescent self-injurious thoughts and behaviors: The interactive role of social affiliation and cardiac arousal

Recent theoretical models have posited that increases in self-injurious thoughts and behaviors (SITBs) during adolescence may be linked to failures in biological stress regulation in contexts of social stress. However, there is a lack of data examining this hypothesis during the transition to adolescence, a sensitive period of development characterized by changes across socioaffective and psychophysiological domains. Building on principles from developmental psychopathology and the RDoC framework, the present study used a longitudinal design in a sample of 147 adolescents to test whether interactions among experiences of social (i.e., parent and peer) conflict and cardiac arousal (i.e., resting heart rate) predicted adolescents' engagement in SITBs (i.e., nonsuicidal self-injury, NSSI; and suicidal ideation; SI) across 1-year follow-up. Prospective analyses revealed that adolescents experiencing a combination of greater peer, but not family, conflict and higher cardiac arousal at baseline showed significant longitudinal increases in NSSI. In contrast, social conflict did not interact with cardiac arousal to predict future SI. Findings indicate that greater peer-related interpersonal stress in adolescents may increase risk for future NSSI among youth with physiological vulnerabilities (i.e., higher resting heart rate) that may be markers of maladaptive stress responses. Future research should examine these processes at finer timescales to elucidate whether these factors are proximal predictors of within-day SITBs.

Peripheral and neural correlates of self-harm in children and adolescents: a scoping review

BACKGROUND

Self-harm in children and adolescents is difficult to treat. Peripheral and neural correlates of self-harm could lead to biomarkers to guide precision care. We therefore conducted a scoping review of research on peripheral and neural correlates of self-harm in this age group.

METHODS

PubMed and Embase databases were searched from January 1980-May 2020, seeking English language peer-reviewed studies about peripheral and neural correlates of self-harm, defined as completed suicide, suicide attempts, suicidal ideation, or non-suicidal self-injury (NSSI) in subjects, birth to 19 years of age. Studies were excluded if only investigating self-harm in persons with intellectual or developmental disability syndromes. A blinded multi-stage assessment process by pairs of co-authors selected final studies for review. Risk of bias estimates were done on final studies.

RESULTS

We screened 5537 unduplicated abstracts, leading to the identification of 79 eligible studies in 76 papers. Of these, 48 investigated peripheral correlates and 31 examined neural correlates. Suicidality was the focus in 2/3 of the studies, with NSSI and any type of self-harm (subjects recruited with suicidality, NSSI, or both) investigated in the remaining studies. All studies used observational designs (primarily case-control), most used convenience samples of adolescent patients which were predominately female and half of which were recruited based on a disorder. Over a quarter of the specific correlates were investigated with only one study. Inter-study agreement on findings from specific correlates with more than one study was often low. Estimates of Good for risk of bias were assigned to 37% of the studies and the majority were rated as Fair.

CONCLUSIONS

Research on peripheral and neural correlates of self-harm is not sufficiently mature to identify potential biomarkers. Conflicting findings were reported for many of the correlates studied. Methodological problems may have produced biased findings and results are mainly generalizable to patients and girls. We provide recommendations to improve future peripheral and neural correlate research in children and adolescents, ages 3-19 years, with self-harm.

Reduced vagal activity in borderline personality disorder is unaffected by intranasal oxytocin administration, but predicted by the interaction between childhood trauma and attachment insecurity

Individuals with borderline personality disorder (BPD) show self-regulatory deficits, associated with reduced heart-rate variability (HRV). However, results on reduced HRV in BPD remain heterogeneous, thus encouraging the search for developmental constructs explaining this heterogeneity. The present study first examined predictors of reduced resting-state HRV in BPD, namely the interaction between self-reported adult attachment insecurity and childhood trauma. Second, we investigated if alterations in resting-state HRV are modified by intranasal oxytocin administration, as oxytocin may enhance HRV and is implicated in the interaction between childhood trauma and disturbed attachment for the pathogenesis of BPD. In a randomized, placebo-controlled trial, 53 unmedicated women with BPD and 60 healthy controls (HC) self-administered either 24 I.U. of oxytocin or placebo and underwent a 4-min electrocardiogram. Our results replicate significantly reduced HRV in women with BPD, explained up to 16% by variations in childhood trauma and attachment insecurity. At high levels of acute attachment insecurity, higher levels of childhood trauma significantly predicted reduced HRV in BPD. However, our results do not support a significant effect of oxytocin on mean HRV, and no interaction effect emerged including childhood trauma and attachment insecurity. Our findings highlight a complex interaction between reduced vagal activity and developmental factors in BPD.

Psychobiological Correlates of Aggression in Female Adolescents with Borderline Personality Disorder

INTRODUCTION

Aggressive behavior in reaction to threats, frustration, or provocation is prevalent in borderline personality disorder (BPD). This study investigated aggressive behavior and its biological correlates in adolescents with BPD.

METHODS

Twenty-one female adolescents with a DSM-IV BPD diagnosis and 25 sex- and age-matched healthy controls participated in the Taylor Aggression Paradigm (TAP), a laboratory-based experiment measuring aggressive behavior in the interpersonal context. Heart rate was measured and saliva samples were taken throughout the experiment.

RESULTS

Multilevel mixed-effects linear regression analyses revealed no significant group difference in aggressive behavior induced by the TAP. Additionally, the two groups did not differ in cortisol, testosterone, and heart rate responses to the aggression induction. The BPD group showed a significant cortisol increase in the time preceding the start of the TAP in contrast to the healthy control group, in whom a significant heart rate increase from baseline to the first block of the TAP was observed.

DISCUSSION

There was no evidence, either at the phenomenological or the biological level, of increased task-induced aggression in adolescents with BPD. The results may indicate that adolescents with BPD experienced fearful stress in anticipation of the experimental task in contrast to healthy controls who showed an adaptive response of the autonomic nervous system necessary to deal with the upcoming demand.

Development of a Wearable Biocueing App (Sense-IT) Among Forensic Psychiatric Outpatients With Aggressive Behavior: Design and Evaluation Study

Background

The ability to regulate anger is often impaired in forensic psychiatric patients, frequently resulting in aggressive behavior. Although some treatment programs are partially successful in enhancing aggression regulation and reducing recidivism among specific subgroups, generalizable conclusions on the effectiveness of these interventions cannot be drawn to date. In forensic outpatient care, low treatment adherence and a predominant focus on cognitive control in most treatment programs may entail some of the factors impeding treatment. Technology-based interventions may address some of these treatment challenges.

Objective

The aim of this study is to explore whether a new technology-based biocueing intervention, the Sense-IT app, can be a valuable addition to aggression regulation treatment programs in forensic outpatient care. The Sense-IT app, which provides the user with real-time physiological feedback and behavioral support, is developed to strengthen emotional awareness and facilitate real-life practice. In this study, we aim to develop and evaluate an updated version of the Sense-IT app that is suitable for forensic outpatients with aggressive behavior.

Methods

First, we conducted a design study to assess the attitudes of forensic professionals and patients toward biocueing and to collect requirements for a biocueing app for this specific population. On the basis of this information, we developed an updated version of the Sense-IT app. In an evaluation study, 10 forensic outpatients used the app for 2 weeks. The app’s acceptability, usability, and clinical outcomes (aggression, anger, and recognition of bodily signals related to anger) were measured before and after the intervention using both quantitative and qualitative measures.

Results

The design study revealed a cautiously positive attitude toward the use of biocueing as an addition to aggression regulation therapy. The evaluation study among forensic outpatients demonstrated moderate acceptability and adequate usability for the new version of the Sense-IT app. Exploratory analysis revealed a significant decrease in trait aggression postintervention; no significant changes were found in other anger-related clinical outcomes. To further increase acceptability and usability, a stable functioning app with self-adjustable settings, the use of smartwatches with a longer battery life, and the use of the patient’s own smartphone devices were recommended.

Conclusions

This study, which is one of the first attempts to enroll and evaluate the real-life use of a biocueing intervention among forensic outpatients, emphasized the importance of involving both patients and therapists throughout the development and implementation process. In the future, experimental studies, including single-case experimental designs using ecological momentary assessment, should be performed to evaluate the effectiveness of the Sense-IT intervention on clinical outcomes. An open attitude toward new technology, allowing exploration of the potential benefits of the Sense-IT app case-by-case, and training of therapists in using the app are expected to facilitate its integration in therapy.

Advancing a temporal framework for understanding the biology of nonsuicidal self- injury: An expert review

Nonsuicidal self-injury (NSSI) is a serious clinical problem, particularly for adolescents and young adults. NSSI is a complex behavior that emerges through the intersecting effects of social, psychological, and biological mechanisms. Although the social and psychological contributions to risk for developing NSSI are relatively well understood and have guided the development of effective psychosocial treatments for self-injury, the biological mechanisms underlying NSSI have just begun to come to light. To evaluate and categorize the biological research conducted on the topic of NSSI, we propose a model that distinguishes between trait and state markers. According to this model, risk factors and mechanisms involved in NSSI can be distinguished into both trait and state factors. We review the existing evidence on distal biological traits (predictors) of NSSI, proximal biological traits (correlates) of NSSI, and biological states directly preceding or following NSSI. We conclude by providing recommendations for future research on the neurobiology of NSSI.

Autonomic nervous system activity and dialectical behavioral therapy outcome in adolescent borderline personality pathology

OBJECTIVES

We aimed to investigate whether pre-treatment cardiac autonomic nervous system (ANS) activity, indexed by heart rate (HR) and heart rate variability (HRV) predicts clinical outcome and therapy drop-outs in adolescents with borderline personality (BPD) pathology receiving dialectical behavioural therapy (DBT-A). We further tested for an association between changes in ANS function and clinical outcome over time. Traumatic experiences were considered as potential confounding factor.

METHODS

N = 43 (95.4% female, M_age = 15.5 years) adolescents fulfilling at least sub-threshold criteria for BPD (≥3) were investigated before and after outpatient DBT-A as well as at follow-up. N = 10 patients dropped out of treatment (<50% of treatment sessions). Latent growth curve models were used for analyses.

RESULTS

Greater pre-treatment resting HRV significantly predicted clinical improvement (decrease in BPD pathology/increase of global functioning) over time. Pre-treatment ANS activity was unrelated to treatment drop-out. Further, changes in ANS activity over treatment were associated with changes in clinical outcome.

CONCLUSION

This study is the first providing evidence that pre-treatment HRV predicts and is related to treatment response in adolescent borderline personality pathology. Implications for the use of ANS measures in clinical practice and directions for future research are discussed.

[Pain perception and nonsuicidal self-injurious behavior]

This review focuses on studies of pain threshold and tolerance in individuals with nonsuicidal self-injurious (NSSI) behavior. The data on methods of pain sensitivity studies are presented, with issues in animal modeling of NSSI discussed separately. The results of neuroimaging studies on pain sensitivity in individuals with NSSI are described, along with contribution of genetic factors, psychological variables, and disturbances in opioid and hypothalamic-pituitary-adrenal systems. A critical methodological analysis of the studies on pain sensitivity in individuals with NSSI was performed.

Psychophysiological concomitants of personality pathology in development

Psychophysiological research methods allow important insights into normative and pathological functioning of the human organism. This position paper briefly reviews existing studies, investigating the psychophysiological concomitants of personality pathology, with an emphasis on developmental aspects. Focussing on measures, indexing autonomic nervous system (ANS) activity at rest, and its reactivity to experimental challenge, the narrative synthesis of the literature highlights current challenges in the field. Findings on the psychophysiological concomitants of personality pathology are mixed. Inconsistencies among studies arise from differences between disorders and heterogeneity within distinct diagnostic categories. The majority of studies addressed borderline personality disorder, illustrating robust alterations in ANS function linked to severe experiences of early maltreatment and trauma, and associated symptoms of dissociation. However, important life-style and secondary health-related factors (i.e. physical activity, smoking) influencing ANS function are frequently neglected. Adapting a dimensional approach to personality pathology and longitudinal research designs seem promising to advance the filed in the years to come.

Biocueing and ambulatory biofeedback to enhance emotion regulation: A review of studies investigating non-psychiatric and psychiatric populations

Over the last years, biofeedback applications are increasingly used to enhance interoceptive awareness and self-regulation, in psychiatry and beyond. These applications are used to strengthen emotion regulation skills by home training (ambulatory biofeedback) and real-time support in everyday life stressful situations (biocueing). Unfortunately, knowledge about the feasibility and effectivity of these applications is still scarce. Therefore, a systematic literature search was performed. In total, 30 studies (4 biocueing, 26 ambulatory biofeedback) were reviewed; 21 of these studies were conducted in non-psychiatric samples and 9 studies in psychiatric samples. Study characteristics, biofeedback characteristics, effectivity and feasibility outcomes were extracted. Despite the rapid advances in wearable technology, only a few biocueing studies were found. In the majority of the studies significant positive effects were found on self-reported (stress-related) psychological measures. Significant improvements on physiological measures were also reported, though these measures were used less frequently. Feasibility of the applications was often reported as sufficient, though not adequately assessed in most studies. Taken into account the small sample sizes and the limited quality of the majority of the studies in this recently emerging field, biocueing and ambulatory biofeedback interventions showed promising results. Future research is expected to be focusing on biocueing as a just-in-time adaptive intervention. To establish this research field, closer cooperation between research groups, use of more rigorous as well as individually tailored research designs and more valid feasibility and effectivity assessment are recommended.

Development and validation of an emotional picture set of self-injury (EPSI) for borderline personality disorder: protocol for a validation study

INTRODUCTION

Borderline personality disorder (BPD) is a severe psychiatric disorder that is characterised by major problems in emotion regulation. Affected persons frequently engage in non-suicidal self-injury (NSSI) to regulate emotions. NSSI is associated with high emotionality in patients with BPD and it can be expected that stimuli depicting scenes of NSSI elicit an emotional response indicative of BPD. The present study protocol describes the development and validation of an emotional picture set of self-injury (EPSI) to advance future research on emotion regulation in BPD.

METHODS AND ANALYSIS

The present validation study aims to develop and validate an emotional picture set relevant for BPD. Emotional responses to EPSI as well as to a neutral picture set will be investigated in a sample of 30 patients with BPD compared with 30 matched, healthy controls and to 30 matched depressive controls. Emotional responses will be assessed by heart rate variability, facial expression and Self-Assessment Manikin.

ETHICS AND DISSEMINATION

Ethics approval was obtained by the medical ethics committee of the Carl-von-Ossietzky University of Oldenburg, Germany (registration: 2017-044). The results of the trial will be submitted for publication in a peer-reviewed journal.

TRIAL REGISTRATION NUMBER

NCT03149926; Pre-results.

A design for process-outcome psychotherapy research in adolescents with Borderline Personality Pathology

Underage patients with Borderline Personality Pathology (BPP) are in need of specialised psychotherapeutic treatment. A handful of these treatments, including Adolescent Identity Treatment (AIT) and Dialectical Behavior Therapy for Adolescents (DBT-A), have been adapted for adolescent patients. Psychotherapy research has shown that the outcome of different psychotherapeutic approaches can be very similar despite conceptual and practical differences between the theoretical models. Therefore, to understand what really works in psychotherapy, it is necessary to investigate the psychotherapeutic process and its effects on the patient. This paper presents a study design for process-outcome research, integrating (1) a classical outcome design, comparing AIT and DBT-A in a non-inferiority trial assessing changes in psychosocial functioning at 12 months after baseline as primary outcome; and (2) a process research design, addressing multiple BPP and psychotherapy relevant factors. These factors include well-studied generic variables such as the psychotherapeutic alliance, more recent approaches such as video-based identification of significant therapeutic events, as well as more experimental approaches such as psychophysiological markers measured during the therapeutic sessions. The use of repeated measures and the methodological pluralism which includes event and micro-process analyses has been recommended for psychotherapy research aiming at a better understanding of the interplay of factors at work to narrow the gap between research and practice in this field.

The physiological orienting response in female adolescents with borderline personality disorder

BACKGROUND

The reflexive startle- and orienting-response have been widely studied in psychiatric disorders. Existing evidence in patients with borderline personality disorder (BPD) is mixed, and limited to adults. The present study addressed clinical correlates of the psychophysiological orienting response in adolescents with BPD.

METHODS

Female adolescents (13-19 years) with BPD (n = 30), healthy controls (HC; n = 34), and psychiatric clinical controls (CC; n = 53) participated in the trial. Orienting response was induced using acoustic startle-probes (sinus tones) while heart rate (HR) and skin conductance (SCR) were continuously recorded. Besides clinical interviews, the assessment included self-reports on depressive symptoms, anxiety, dissociation and psychopathological distress.

RESULTS

On a group level, relative habituation of the HR-response (regression slope) significantly differed between groups (F_(2,114) = 3.74, p = 0.027), with significant contrasts (p = 0.026, Sidak corrected) comparing CC (slope 0.04 ± 0.41) and BPD (slope 0.28 ± 0.40). On a dimensional level, relative HR habituation was significantly correlated with the number of BPD diagnostic criteria endorsed (r₍₁₁₇₎ = 0.183, p = 0.049) and symptoms of dissociation (r₍₁₁₆₎ = 0.193, p = 0.038), indicating that delayed HR habituation across probes was associated with greater BPD symptom severity. Analyses of SCR showed no significant findings.

CONCLUSION

Findings provide preliminary support for altered habituation of the HR orienting response in adolescent BPD, associated with BPD severity - in particular dissociative experiences. Dissociative experiences may alter the automatic defensive response early in the course of BPD, providing a potential pathway to exaggerated emotional responding in BPD.

Longitudinal covariance of resting-state cardiac function and borderline personality disorder symptoms in adolescent non-suicidal self-injury

OBJECTIVES

Cardiac function is altered in borderline personality disorder (BPD). In adolescents with non-suicidal self-injury (NSSI) resting heart rate (HR) and vagally mediated heart rate variability (vmHRV) are associated with BPD symptoms. The study aimed to investigate longitudinal covariance of BPD symptoms and cardiac function in adolescent NSSI.

METHODS

HR and vmHRV were recorded in female adolescents with NSSI (n = 17) completing a baseline and 1-year follow-up assessment. Physiological data, structured clinical interviews and self-reports were obtained at both time points. Predictors of change in clinical outcomes and cardiac function were assessed.

RESULTS

Patients showed a reduction of NSSI (z_(34;17) = -3.79, P < 0.0001), depressive symptoms (z_(34;17) = -3.74, P < 0.0001), and increases in the level of functioning (z_(34;17) = 2.87, P = 0.004). Symptoms of BPD and frequency of BPD diagnosis did not significantly change. No significant differences on HR or vmHRV were observed. Changes in BPD symptoms were associated with changes in HR (r₍₁₇₎= 0.532, P = 0.028) and vmHRV (r₍₁₇₎ = -0.516, P = 0.033).

CONCLUSIONS

Longitudinal changes in BPD symptomatology in adolescents engaging in NSSI are associated with changes in resting cardiac function. Clinical studies are needed to investigate the utility of cardiac markers to track treatment outcome in adolescents with BPD.

A Meta-Analysis on Sex Differences in Resting-State Vagal Activity in Children and Adolescents

Lower vagal activity is associated with psychopathology independent of age. Research suggests that alterations of vagal activity precede the development of psychopathology. The present review aimed to quantify sex differences in vagal activity in children and adolescents. Studies reporting on sex differences on measures of vagally-mediated heart rate variability derived from short-term recordings under resting conditions in boys and girls were included. Drawing on data from more than 5,000 children and adolescents, we provide evidence that healthy young girls display lower vagal activity and greater mean heart rate compared to boys, a finding that may have implications for risk associated with the development of internalizing psychopathology and somatic ill-health.

Prevalence of borderline personality disorder and its risk factors in female prison inmates in China

High prevalence of borderline personality disorder (BPD) has been found in Western prisons but no such data exists in China. The objective of this study was to determine the lifetime prevalence of BPD in Chinese female prison inmates and its associated risk factors. This cross-sectional study was conducted in Hunan Provincial Female Prison. Data on consenting inmates' socio-demographic and clinical characteristics were collected and the diagnosis of lifetime BPD was established using the Structural Clinical Interview for DSM-IV. The prevalence of BPD was 10.6% in the cohort of 2709 participating inmates. Multiple logistic regression analysis revealed that younger age, unmarried marital status, higher education level, fewer major medical conditions, more frequent personal and family members' drug use, more frequent comorbid psychiatric disorders and family history of psychiatric disorders were positively and independently associated with BPD. BPD is common in Chinese female prison inmates. Considering its adverse social consequences and impact on physical and mental well-being, serious attempts should be made to diagnose BPD early and improve access to treatment in women prisons.