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Fanti E, Di Sarno M, Di Pierro R. In search of hidden threats: A scoping review on paranoid presentations in personality disorders. Clin Psychol Psychother 2023; 30:1215-1233. [PMID: 37727949 DOI: 10.1002/cpp.2913] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/25/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023]
Abstract
Recent diagnostic developments suggest that paranoia is a transdiagnostic characteristic common to several personality disorders rather than a personality disorder per se. Nonetheless, empirical literature fails to provide comprehensive and univocal findings on whether and how paranoid presentations relate to different personality disorders. In the present scoping review, we map the empirical literature on paranoid presentations in personality disorders, considering the entire spectrum of paranoid manifestations (i.e., the paranoia hierarchy). In selecting original quantitative studies on paranoid presentations in personality-disordered patients, we screened 4,433 records in PsycArticles, PsycInfo and PUBMED. We eventually included 47 eligible studies in the review. Our synthesis indicates consistent empirical evidence of a wide range of paranoid presentations in Paranoid, Schizotypal and Borderline personality disorders. Conversely, little empirical literature exists on paranoid presentations in other personality disorders. Preliminary findings suggest broad-severity paranoid presentations, ranging from milder to severe forms, in Paranoid, Schizotypal and Borderline personality disorders. There is also some evidence of milder forms of paranoia in Avoidant, Antisocial and Narcissistic personality disorders. Conversely, there is poor evidence of paranoid presentations in Schizoid, Histrionic, Dependent or Obsessive-compulsive personality disorders. Research gaps and recommendations for improving empirical research on paranoid presentations in personality disorders are discussed.
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Affiliation(s)
- Erika Fanti
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Marco Di Sarno
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
- Personality Disorder Lab (PDLab), Milan-Parma, Italy
| | - Rossella Di Pierro
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
- Personality Disorder Lab (PDLab), Milan-Parma, Italy
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2
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Evans CM, Simms LJ. Do self and interpersonal dysfunction cross-sectionally mediate the association between adverse childhood experiences and personality pathology? Personal Ment Health 2023; 17:259-271. [PMID: 37395060 DOI: 10.1002/pmh.1588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 01/19/2023] [Accepted: 02/13/2023] [Indexed: 07/04/2023]
Abstract
Two primary limitations of research on the association between adverse childhood experiences (ACEs) and personality disorder (PD) are (1) failure to consider mechanisms of association and (2) inconsistent results due, in part, to inconsistent approaches to quantifying ACE exposure. The current study will address these limitations by examining the cross-sectional mediating role of self- and interpersonal dysfunction on the association between ACE and three PDs (antisocial, schizotypal, and borderline) using three quantifications of ACE exposure (cumulative, individual, and unique risk). Participants were 149 current or recent psychiatric patients, and data analyses were performed through estimation of a series of cross-sectional mediation models. Taken together, results suggest that (1) the association between ACE and PD is moderate, (2) self- and interpersonal dysfunction cross-sectionally mediate this association, (3) after accounting for variance shared among ACEs, associations between specific ACE subtypes and PD were negligible, (4) much of the association between ACE and PD is accounted for by general processes impacted by all forms of ACE and implicated in all forms of PD, and (5) emotional neglect may uniquely contribute to self- and interpersonal dysfunction and thereby, PD risk.
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Affiliation(s)
- Chloe M Evans
- Department of Psychology, University at Buffalo, Buffalo, New York, USA
| | - Leonard J Simms
- Department of Psychology, University at Buffalo, Buffalo, New York, USA
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3
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Messina I, Spataro P, Sorella S, Grecucci A. "Holding in Anger" as a Mediator in the Relationship between Attachment Orientations and Borderline Personality Features. Brain Sci 2023; 13:878. [PMID: 37371358 DOI: 10.3390/brainsci13060878] [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: 04/26/2023] [Revised: 05/19/2023] [Accepted: 05/20/2023] [Indexed: 06/29/2023] Open
Abstract
Insecure attachment and difficulties in regulating anger have both been put forward as possible explanations for emotional dysfunction in borderline personality (BP). This study aimed to test a model according to which the influence of attachment on BP features in a subclinical population is mediated by anger regulation. In a sample of 302 participants, BP features were assessed with the Borderline features scale of the Personality Assessment Inventory (PAI-BOR), attachment was measured with the Experiences in Close Relationships-12 (ECR-12), and trait anger and anger regulation were assessed with the State and Trait Anger Expression Inventory-2 (STAXI-2). The results indicated that anger suppression emerged as a significant mediator of the associations between both anxious and avoidant attachment and BP traits, while anger control resulted as a marginal mediator in the association between attachment avoidance and BP. Suppressing anger may reflect different forms of cognitive or behavioural avoidance of anger, which may differ on the basis of attachment orientations. We argue that these results may have important clinical implications: the promotion of anger regulation in BP should be considered a critical treatment goal.
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Affiliation(s)
- Irene Messina
- Department of Economics, Mercatorum University, Piazza Mattei 10, 00186 Rome, Italy
- Department of Psychology and Cognitive Sciences, DipSCo, University of Trento and Centre for Medical Sciences, University of Trento, Bettini, 84, 38068 Rovereto, Italy
| | - Pietro Spataro
- Department of Economics, Mercatorum University, Piazza Mattei 10, 00186 Rome, Italy
| | - Sara Sorella
- Department of Psychology and Cognitive Sciences, DipSCo, University of Trento and Centre for Medical Sciences, University of Trento, Bettini, 84, 38068 Rovereto, Italy
| | - Alessandro Grecucci
- Department of Psychology and Cognitive Sciences, DipSCo, University of Trento and Centre for Medical Sciences, University of Trento, Bettini, 84, 38068 Rovereto, Italy
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Herzog P, Kube T, Fassbinder E. How childhood maltreatment alters perception and cognition - the predictive processing account of borderline personality disorder. Psychol Med 2022; 52:2899-2916. [PMID: 35979924 PMCID: PMC9693729 DOI: 10.1017/s0033291722002458] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/24/2022] [Accepted: 07/18/2022] [Indexed: 01/05/2023]
Abstract
Borderline personality disorder (BPD) is a severe mental disorder, comprised of heterogeneous psychological and neurobiological pathologies. Here, we propose a predictive processing (PP) account of BPD to integrate these seemingly unrelated pathologies. In particular, we argue that the experience of childhood maltreatment, which is highly prevalent in BPD, leaves a developmental legacy with two facets: first, a coarse-grained, alexithymic model of self and others - leading to a rigidity and inflexibility concerning beliefs about self and others. Second, this developmental legacy leads to a loss of confidence or precision afforded beliefs about the consequences of social behavior. This results in an over reliance on sensory evidence and social feedback, with concomitant lability, impulsivity and hypersensitivity. In terms of PP, people with BPD show a distorted belief updating in response to new information with two opposing manifestations: rapid changes in beliefs and a lack of belief updating despite disconfirmatory evidence. This account of distorted information processing has the potential to explain both the instability (of affect, self-image, and interpersonal relationships) and the rigidity (of beliefs about self and others) which is typical of BPD. At the neurobiological level, we propose that enhanced levels of dopamine are associated with the increased integration of negative social feedback, and we also discuss the hypothesis of an impaired inhibitory control of the prefrontal cortex in the processing of negative social information. Our account may provide a new understanding not only of the clinical aspects of BPD, but also a unifying theory of the corresponding neurobiological pathologies. We conclude by outlining some directions for future research on the behavioral, neurobiological, and computational underpinnings of this model, and point to some clinical implications of it.
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Affiliation(s)
- Philipp Herzog
- Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, D-23562 Lübeck, Germany
- Department of Psychiatry and Psychotherapy, Christian-Albrechts-University of Kiel, Niemannsweg 147, D-24105 Kiel, Germany
- Department of Psychology, University of Koblenz-Landau, Ostbahnstr. 10, 76829 Landau, Germany
| | - Tobias Kube
- Department of Psychology, University of Koblenz-Landau, Ostbahnstr. 10, 76829 Landau, Germany
| | - Eva Fassbinder
- Department of Psychiatry and Psychotherapy, Christian-Albrechts-University of Kiel, Niemannsweg 147, D-24105 Kiel, Germany
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5
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Extending the two-component model of delusion to substance use disorder etiology and recovery. NEW IDEAS IN PSYCHOLOGY 2022. [DOI: 10.1016/j.newideapsych.2022.100935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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6
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Masland SR, Schnell SE, Shah TV. Trust Beliefs, Biases, and Behaviors in Borderline Personality Disorder: Empirical Findings and Relevance to Epistemic Trust. Curr Behav Neurosci Rep 2020. [DOI: 10.1007/s40473-020-00220-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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7
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Jenkins M, Obhi SS. Neurophysiological and Psychological Consequences of Social Exclusion: The Effects of Cueing In-Group and Out-Group Status. Cereb Cortex Commun 2020; 1:tgaa057. [PMID: 34296120 PMCID: PMC8152886 DOI: 10.1093/texcom/tgaa057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 11/24/2022] Open
Abstract
Exclusion by outgroups is often attributed to external factors such as prejudice. Recently, event-related potential studies have demonstrated that subtle cues influence expectations of exclusion, altering the P3b response to inclusion or exclusion. We investigated whether a visual difference between participants and interaction partners could activate expectations of exclusion, indexed by P3b activity, and whether this difference would influence psychological responses to inclusion and exclusion. Participants played a ball-tossing game with two computer-controlled coplayers who were believed to be real. One period involved fair play inclusion while the other involved partial exclusion. Avatars represented participants, with their color matching participant skin tone, and either matching or differing from the color of coplayer avatars. This created the impression that the participant was an ingroup or outgroup member. While ingroup members elicited enhanced P3b activation when receiving the ball during exclusion, outgroup members showed this pattern for both inclusion and exclusion, suggesting that they formed robust a-priori expectations of exclusion. Self-reports indicated that while these expectations were psychologically protective during exclusion, they were detrimental during inclusion. Ultimately, this study reveals that expectations of exclusion can be formed purely based on visual group differences, regardless of the actual minority or majority status of individuals.
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Affiliation(s)
- Michael Jenkins
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Ontario L8S4L8, Canada
| | - Sukhvinder S Obhi
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Ontario L8S4L8, Canada
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8
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Sato M, Fonagy P, Luyten P. Rejection Sensitivity and Borderline Personality Disorder Features: The Mediating Roles of Attachment Anxiety, Need to Belong, and Self-Criticism. J Pers Disord 2020; 34:273-288. [PMID: 30650007 DOI: 10.1521/pedi_2019_33_397] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Rejection hypersensitivity has been considered the core feature of patients with borderline personality disorder (BPD). However, little is known about the possible developmental mechanisms that might explain the association between rejection sensitivity and BPD features. The current study investigated the mediating roles of adult attachment, need to belong, and self-criticism in the association between rejection sensitivity and BPD features in 256 healthy adults. Results indicated that attachment anxiety, need to belong, and self-criticism mediated the association between rejection sensitivity and BPD features. However, attachment anxiety and self-criticism did not moderate the mediated association between rejection sensitivity and BPD features. The findings suggest that individuals with high rejection sensitivity are more likely to be anxiously attached to significant others, which might increase the desire to be accepted by others. To satisfy this elevated need to affiliate with others, these individuals might become more self-critical, which may contribute to high BPD features.
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Affiliation(s)
- Momoko Sato
- Department of Clinical, Educational, and Health Psychology, University College London
| | - Peter Fonagy
- Department of Clinical, Educational, and Health Psychology, University College London
| | - Patrick Luyten
- Faculty of Psychology and Educational Sciences, KU Leuven, Belgium
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9
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Schouw JEMC, Verkes RJ, Schene AH, Schellekens AFA. The relationship between childhood adversity and adult personality revealed by network analysis. CHILD ABUSE & NEGLECT 2020; 99:104254. [PMID: 31765851 DOI: 10.1016/j.chiabu.2019.104254] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 10/21/2019] [Accepted: 10/28/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Childhood adversity is known to influence personality development. Studies suggest that distinct types of childhood adversities have differential effects on personality dimensions. However, different types of adversity often co-occur, and personality dimensions are strongly interconnected. OBJECTIVE The aim of this study was to use a network approach to analyze the interrelationships between different types of childhood adversity and diverse personality dimensions integratively. PARTICIPANTS AND SETTING We used previously collected data on 142 alcohol dependent patients and 102 healthy controls. METHODS The participants completed the Interview for Traumatic Events in Childhood, the Parental Acceptance and Rejection Questionnaire and the Temperament and Character Inventory. Outcomes on the subscales of these instruments were included in the network analysis. RESULTS The resulting network showed strong connections between different types of childhood adversity, and between the different temperaments and characters of personality. Childhood adversity, mainly physical abuse and maternal rejection, was connected to most personality dimensions, except for reward dependence. Physical abuse showed the highest centrality measures, indicating a central, important role in the network. CONCLUSIONS These findings confirm that different types of childhood adverse experiences often co-occur, and suggest that specifically physical and emotional abuse, and maternal rejection might play a prominent role in shaping personality.
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Affiliation(s)
- Jessica E M C Schouw
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, the Netherlands.
| | - Robbert J Verkes
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Aart H Schene
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, the Netherlands
| | - Arnt F A Schellekens
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, the Netherlands; Nijmegen Institute for Science Practitioners in Addiction, Radboud University Nijmegen, the Netherlands
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10
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Lischke A, Herpertz SC, Berger C, Domes G, Gamer M. Divergent effects of oxytocin on (para-)limbic reactivity to emotional and neutral scenes in females with and without borderline personality disorder. Soc Cogn Affect Neurosci 2018; 12:1783-1792. [PMID: 29036358 PMCID: PMC5714167 DOI: 10.1093/scan/nsx107] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 09/11/2017] [Indexed: 12/31/2022] Open
Abstract
Borderline personality disorder (BPD) patients’ hypersensitivity for emotionally relevant stimuli has been suggested be due to abnormal activity and connectivity in (para-)limbic and prefrontal brain regions during stimulus processing. The neuropeptide oxytocin has been shown to modulate activity and functional connectivity in these brain regions, thereby optimizing the processing of emotional and neutral stimuli. To investigate whether oxytocin would be capable of attenuating BPD patients’ hypersensitivity for such stimuli, we recorded brain activity and gaze behavior during the processing of complex scenes in 51 females with and 48 without BPD after intranasal application of either oxytocin or placebo. We found divergent effects of oxytocin on BPD and healthy control (HC) participants’ (para-)limbic reactivity to emotional and neutral scenes: Oxytocin decreased amygdala and insula reactivity in BPD participants but increased it in HC participants, indicating an oxytocin-induced normalization of amygdala and insula activity during scene processing. In addition, oxytocin normalized the abnormal coupling between amygdala activity and gaze behavior across all scenes in BPD participants. Overall, these findings suggest that oxytocin may be capable of attenuating BPD patients’ hypersensitivity for complex scenes, irrespective of their valence.
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Affiliation(s)
- Alexander Lischke
- Department of Psychology, University of Greifswald, Greifswald, Germany.,Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany.,Department of Psychiatry and Psychotherapy, University of Rostock, Rostock, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Christoph Berger
- Department of Psychiatry and Psychotherapy, University of Rostock, Rostock, Germany.,Department of Child and Adolescent Psychiatry, Neurology, Psychosomatics and Psychotherapy, University of Rostock, Rostock, Germany
| | - Gregor Domes
- Department of Psychology, University of Trier, Trier, Germany
| | - Matthias Gamer
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Psychology, University of Würzburg, Würzburg, Germany
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11
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Unoka Z, Vizin G. To see in a mirror dimly. The looking glass self is self-shaming in borderline personality disorder. Psychiatry Res 2017; 258:322-329. [PMID: 28865721 DOI: 10.1016/j.psychres.2017.08.055] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 08/21/2017] [Accepted: 08/21/2017] [Indexed: 11/17/2022]
Abstract
Symptoms of borderline personality disorder (BPD) can be conceptualized as the expression of and defenses against or response to the painful emotion of chronic shame, which may relate to early maladaptive schemas (EMS). The goal of this research is to examine levels of early maladaptive schemas, self-reported shame, and anxious or angry reactions to social put-downs as well as their associations. We also looked to assess the association of shame with BPD symptoms. Fifty-six patients with BPD completed self-report measures of EMSs, chronic shame, and reactions to put-downs. Comparison groups consisted of 24 patients without personality disorder (non-PD) and 80 healthy controls (HC). Those with BPD reported higher levels of EMSs, characterological, behavioral and bodily shame, and were more prone to react with anxiety and anger than non-PD patients and HC subjects. EMSs domains had specific associations with chronic shame and reaction types to social put-downs. Identity disturbances were associated with characterological, behavioral and bodily shame. Stormy relationships were associated with bodily shame. Chronic shame and anxious and angry reactions to social put-downs are prominent in patients with borderline personality disorder and are associated with specific EMS domains and with the symptoms of identity disturbance and stormy relationships.
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Affiliation(s)
- Zsolt Unoka
- Semmelweis University, Faculty of General Medicine, Department of Psychiatry and Psychotherapy, Balassa utca 6, 1083 Budapest, Hungary.
| | - Gabriella Vizin
- Eötvös Loránd University, Faculty of Education and Psychology, Department of Clinical Psychology and Addictology, Izabella utca 46, 1064 Budapest, Hungary
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12
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Gutz L, Roepke S, Renneberg B. Cognitive and affective processing of social exclusion in borderline personality disorder and social anxiety disorder. Behav Res Ther 2016; 87:70-75. [DOI: 10.1016/j.brat.2016.08.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 08/26/2016] [Accepted: 08/29/2016] [Indexed: 12/01/2022]
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13
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Barnicot K, Gonzalez R, McCabe R, Priebe S. Skills use and common treatment processes in dialectical behaviour therapy for borderline personality disorder. J Behav Ther Exp Psychiatry 2016; 52:147-156. [PMID: 27132175 DOI: 10.1016/j.jbtep.2016.04.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 03/30/2016] [Accepted: 04/19/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Dialectical behaviour therapy (DBT) trains participants to use behavioural skills for managing their emotions. The study aimed to evaluate whether skills use is associated with positive treatment outcomes independently of treatment processes that are common across different therapeutic models. METHOD Use of the DBT skills and three common treatment processes (therapeutic alliance, treatment credibility and self-efficacy) were assessed every 2 months for a year in 70 individuals with borderline personality disorder receiving DBT. Mixed-multilevel modelling was used to determine the association of these factors with frequency of self-harm and with treatment dropout. RESULTS Participants who used the skills less often at any timepoint were more likely to drop out of DBT in the subsequent two months, independently of their self-efficacy, therapeutic alliance or perceived treatment credibility. More frequent use of the DBT skills and higher self-efficacy were each independently associated with less frequent concurrent self-harm. Treatment credibility and the alliance were not independently associated with self-harm or treatment dropout. LIMITATIONS The skills use measure could not be applied to a control group who did not receive DBT. The sample size was insufficient for structural equation modelling. CONCLUSION Practising the DBT skills and building an increased sense of self-efficacy may be important and partially independent treatment processes in dialectical behaviour therapy. However, the direction of the association between these variables and self-harm requires further evaluation.
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Affiliation(s)
- Kirsten Barnicot
- Unit for Social and Community Psychiatry, Queen Mary University of London, Cherry Tree Way, Glen Road, London, E13 8SP, United Kingdom.
| | - Rafael Gonzalez
- Centre for Mental Health, Imperial College London, Commonwealth Building, Du Cane Road, London, W12 0NN, United Kingdom.
| | - Rosemarie McCabe
- Unit for Social and Community Psychiatry, Queen Mary University of London, Cherry Tree Way, Glen Road, London, E13 8SP, United Kingdom.
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, Queen Mary University of London, Cherry Tree Way, Glen Road, London, E13 8SP, United Kingdom.
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14
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Examining the Shared and Unique Features of Self-Concept Content and Structure in Borderline Personality Disorder and Depression. COGNITIVE THERAPY AND RESEARCH 2015. [DOI: 10.1007/s10608-015-9695-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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15
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Geiger PJ, Peters JR, Baer RA. Using a measure of cognitive distortion to examine the relationship between thought suppression and borderline personality features: A multi-method investigation. PERSONALITY AND INDIVIDUAL DIFFERENCES 2014. [DOI: 10.1016/j.paid.2013.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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16
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Dèttore D, Pozza A, Coradeschi D. Does time-intensive ERP attenuate the negative impact of comorbid personality disorders on the outcome of treatment-resistant OCD? J Behav Ther Exp Psychiatry 2013; 44:411-7. [PMID: 23770674 DOI: 10.1016/j.jbtep.2013.04.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 04/20/2013] [Accepted: 04/29/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVES There is growing interest regarding patients with obsessive-compulsive disorder (OCD) who do not fully respond to cognitive-behavioural therapy (CBT). Limited data are available on the role of Comorbid Personality Disorders (CPDs) in the outcome of treatment-resistant obsessive-compulsive disorder (OCD), despite the fact that CPDs are considered a predictor of a poorer outcome. This study investigated whether a time-intensive scheduling of treatment could be an effective strategy aimed at attenuating the negative influence of CPDs on outcome in a sample of 49 inpatients with a primary diagnosis of treatment-resistant OCD. METHOD 38 inpatients completed the five-week individual treatment consisting of daily and prolonged sessions of exposure with response prevention (ERP) delivered for 2 h in the morning and 2 h in the afternoon. 44% of the sample received a full diagnosis of one or more CPDs. Following a pre-post-test design, outcome measures included the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Beck Depression Inventory-II (BDI-II) and Beck Anxiety Inventory (BAI). RESULTS Data showed that the treatment was effective and indicated that CPDs were not a significant predictor of treatment failure. LIMITATIONS Future larger studies should evaluate the role of specific clusters of CPDs on the outcome of resistant OCD. CONCLUSIONS These findings suggest that an intensive treatment could be effective for severely ill patients who have not responded to weekly outpatient sessions and could also attenuate the negative impact of CPDs on outcome, evidencing the importance of a tailored therapeutic approach for patients who need a rapid reduction in OCD-related impairment.
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Affiliation(s)
- Davide Dèttore
- Department of Health Sciences, University of Florence, Via di San Salvi 12, Building 26, 50135 Florence, Italy.
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17
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Kramer U, Caspar F, Drapeau M. Change in biased thinking in a 10-session treatment for borderline personality disorder: Further evidence of the motive-oriented therapeutic relationship. Psychother Res 2013; 23:633-45. [DOI: 10.1080/10503307.2013.791404] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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18
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Miano A, Fertuck EA, Arntz A, Stanley B. Rejection sensitivity is a mediator between borderline personality disorder features and facial trust appraisal. J Pers Disord 2013; 27:442-56. [PMID: 23586933 DOI: 10.1521/pedi_2013_27_096] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Individuals with borderline personality disorder (BPD) fear abandonment and exhibit instability in their close relationships. These interpersonal difficulties may be influenced by the propensity to interpret neutral social stimuli (e.g., nonemotional faces) as untrustworthy. This study evaluated the hypothesis that BPD features are associated with attributions of untrustworthiness to neutral faces. Additionally, the authors hypothesized that the trait of rejection sensitivity (RS) is also associated with BPD features and mediates the relationship between BPD features and untrustworthy facial trait appraisal. An undergraduate, nonclinical sample (N = 95) was assessed for BPD features, RS, and trust appraisal of neutral faces. Higher BPD features were associated with lower ratings of trustworthiness of the faces and higher scores on RS. Furthermore, as hypothesized, the association between BPD features and trust appraisal was mediated by RS. Results are discussed in the context of a proposed model of the social cognitive mechanisms of interpersonal hypersensitivity in BPD.
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Affiliation(s)
- Annemarie Miano
- Department of Clinical Psychological Science, Maastricht University, The Netherlands
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19
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Kramer U, Vaudroz C, Ruggeri O, Drapeau M. Biased thinking assessed by external observers in borderline personality disorder. Psychol Psychother 2013; 86:183-96. [PMID: 23674468 DOI: 10.1111/j.2044-8341.2011.02056.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Biased thinking (to some extent overlapping with the concepts of cognitive distortions and cognitive errors) is a key concept in cognitive therapy of borderline personality disorder (BPD). Specific contents and cognitive processes related to BPD functioning are known. However, most studies are based on self-report measures which present a number of important limitations, in particular the difficulty in assessing non-conscious processes infused by affect. So far, no studies were conducted using valid observer-rated methodology addressing the question of biased thinking in BPD as it unfolds spontaneously in session. DESIGN This is a controlled interview study comparing two matched groups, BPD patients and healthy controls. METHODS A total of N= 25 clinical dynamic interviews with patients presenting with BPD were transcribed and rated using the Cognitive Errors Rating Scale (Drapeau, Perry, & Dunkley, 2008); their cognitive profiles were compared to those of N= 25 healthy controls who underwent the same procedure. RESULTS Overall, results indicated that no between-group difference in the frequency of specific biases was found. However, heightened levels of negative cognitive biases, in particular over-generalizing and fortune-telling, were associated with BPD. Furthermore, negative over-generalizing was associated with the number of BPD symptoms. CONCLUSIONS These results have high levels of ecological validity and are promising for the refinement of cognitive theory of BPD. Clinical implications for assessment and intervention are discussed.
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Affiliation(s)
- Ueli Kramer
- Institute of Psychotherapy, Department of Psychiatry-CHUV, University of Lausanne, Switzerland.
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Sempértegui GA, Karreman A, Arntz A, Bekker MHJ. Schema therapy for borderline personality disorder: a comprehensive review of its empirical foundations, effectiveness and implementation possibilities. Clin Psychol Rev 2012; 33:426-47. [PMID: 23422036 DOI: 10.1016/j.cpr.2012.11.006] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 11/23/2012] [Accepted: 11/26/2012] [Indexed: 11/19/2022]
Abstract
Borderline personality disorder is a serious psychiatric disorder for which the effectiveness of the current pharmacotherapeutical and psychotherapeutic approaches has shown to be limited. In the last decades, schema therapy has increased in popularity as a treatment of borderline personality disorder; however, systematic evaluation of both effectiveness and empirical evidence for the theoretical background of the therapy is limited. This literature review comprehensively evaluates the current empirical status of schema therapy for borderline personality disorder. We first described the theoretical framework and reviewed its empirical foundations. Next, we examined the evidence regarding effectiveness and implementability. We found evidence for a considerable number of elements of Young's schema model; however, the strength of the results varies and there are also mixed results and some empirical blanks in the theory. The number of studies on effectiveness is small, but reviewed findings suggest that schema therapy is a promising treatment. In Western-European societies, the therapy could be readily implemented as a cost-effective strategy with positive economic consequences.
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Spinhoven P, Bamelis L, Haringsma R, Molendijk M, Arntz A. Consistency of reporting sexual and physical abuse during psychological treatment of personality disorder: an explorative study. J Behav Ther Exp Psychiatry 2012. [PMID: 23200431 DOI: 10.1016/j.jbtep.2011.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The objective of this study was to assess the prevalence of decreasing, consistent and increasing reports of sexual and physical abuse after 12 months of long-term psychological treatment of personality disorders, to investigate demographic and clinical characteristics predictive of inconsistency of reporting abuse, and to explore whether autobiographical memory may account for this inconsistency. In 229 clinical participants with an SCID II diagnosed personality disorder, 180 (78.6%) reported the same instances of invasive sexual and/or physical abuse on a trauma questionnaire (SPAQ) at baseline and follow-up, 25 (10.9%) decreased and 24 (10.4%) increased their abuse reports. Consistency of reporting abuse did not differ between schema-focused therapy, clarification-oriented psychotherapy and treatment-as-usual. Current depressive episode (SCID-I) and decreased capacity to produce specific negative memories on the Autobiographical Memory Test were characteristic of decreasing abuse reporters, while increasing abuse reporters showed higher levels of Cluster A personality pathology (in particular schizotypal traits) on the Assessment of DSM-IV Personality Disorders (ADP-IV). These results suggest that even in treatment procedures directed at exploring someone's personal past with abuse-related imagery consistency of reporting abuse is quite stable. However, certain clinical characteristics may make some persons more likely to change their trauma reports. Moreover, reduced negative memory specificity may represent an avoidant strategy associated with no longer reporting instances of abuse.
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Affiliation(s)
- Philip Spinhoven
- Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands.
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22
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Hernandez A, Arntz A, Gaviria AM, Labad A, Gutiérrez-Zotes JA. Relationships between childhood maltreatment, parenting style, and borderline personality disorder criteria. J Pers Disord 2012; 26:727-36. [PMID: 23013341 DOI: 10.1521/pedi.2012.26.5.727] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study examines the relationship of different types of childhood maltreatment and the perceived parenting style with borderline personality disorder (BPD) criteria. Kendall's Tau partial correlations were performed controlling for the effect of simultaneous adverse experiences and Axis I and II symptoms in a sample of 109 female patients (32 BPD, 43 other personality disorder, and 34 non-personality disorder). BPD criteria were associated with higher scores on emotional and sexual abuse, whereas parenting style did not show a specific association with BPD. Findings of the present study help clarify the effects of overlapping environmental factors that are associated with BPD.
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Affiliation(s)
- Ana Hernandez
- Hospital Psiquiàtric Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, Reus, Spain.
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Scott LN, Levy KN, Adams RB, Stevenson MT. Mental state decoding abilities in young adults with borderline personality disorder traits. Personal Disord 2012; 2:98-112. [PMID: 22247796 DOI: 10.1037/a0020011] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Previous studies have demonstrated that patients with borderline personality disorder (BPD) tend to misattribute malevolence to benign social stimuli, including facial expressions. Yet, facial emotion recognition studies examining those with BPD have yielded mixed results, with some studies showing impaired accuracy and others demonstrating enhanced accuracy in the recognition of emotions or mental states. The current study examined the ability to decode mental states from photographs of just the eye region of faces in a nonclinical sample of young adults who exhibited BPD traits (high BPD) compared with those who did not (low BPD). Group differences in mental state decoding ability depended on the valence of the stimuli. The high-BPD group performed better for negative stimuli compared with the low-BPD group, but did not perform significantly different from the low-BPD group for stimuli of neutral or positive valence. The high-BPD group also demonstrated a response bias for attributing negative mental states to facial stimuli. In addition, findings suggested that the group difference in accuracy for negative stimuli could not be explained by response bias, because the group difference in response bias for negative stimuli did not reach significance. These findings suggest that BPD traits may be associated with enhanced ability to detect negative emotions and a bias for attributing negative emotions to nonnegative social stimuli.
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Affiliation(s)
- Lori N Scott
- Department of Psychology, Penn State University, University Park, PA 16802, USA.
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24
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Baer RA, Peters JR, Eisenlohr-Moul TA, Geiger PJ, Sauer SE. Emotion-related cognitive processes in borderline personality disorder: A review of the empirical literature. Clin Psychol Rev 2012; 32:359-69. [DOI: 10.1016/j.cpr.2012.03.002] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 01/02/2012] [Accepted: 03/17/2012] [Indexed: 10/28/2022]
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Keinänen MT, Johnson JG, Richards ES, Courtney EA. A systematic review of the evidence-based psychosocial risk factors for understanding of borderline personality disorder. PSYCHOANALYTIC PSYCHOTHERAPY 2012. [DOI: 10.1080/02668734.2011.652659] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Abstract
The aim of the current study was to compliment previous studies identifying negative states present in borderline personality disorder (BPD) by investigating the presence of positive affective and cognitive states. Ninety-six patients with criteria-defined borderline personality disorder and 24 axis II comparison participants completed the Positive Affect Scale, a 50-item self-report measure designed to assess positive states thought to be characteristic of and discriminating for BPD. Seventeen positive states (4 affective, 10 cognitive, and 3 mixed) were found to be significantly more common among axis II comparison participants than borderline patients. Twelve of these states were common to both borderline patients and axis II comparison participants. Furthermore, four positive states, when co-occurring together, were particularly strongly associated with borderline personality disorder (three negatively and one positively): (a) Fond of myself, (b) That things around me are real, (c) That I've forgiven others, and (d) Assertive. Finally, the overall mean score on the PAS significantly distinguished patients with borderline personality disorder from axis II comparison participants. Taken together, these results suggest that borderline patients are far less likely to report experiencing positive states of an affective, cognitive, and mixed nature than axis II comparison participants. They also suggest that being assertive is a positive state particularly discriminating for borderline personality disorder.
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27
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Haaland AT, Vogel PA, Launes G, Haaland VØ, Hansen B, Solem S, Himle JA. The role of early maladaptive schemas in predicting exposure and response prevention outcome for obsessive-compulsive disorder. Behav Res Ther 2011; 49:781-8. [DOI: 10.1016/j.brat.2011.08.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 08/19/2011] [Accepted: 08/30/2011] [Indexed: 10/17/2022]
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Staebler K, Renneberg B, Stopsack M, Fiedler P, Weiler M, Roepke S. Facial emotional expression in reaction to social exclusion in borderline personality disorder. Psychol Med 2011; 41:1929-1938. [PMID: 21306661 DOI: 10.1017/s0033291711000080] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Disturbances in social interaction are a defining feature of patients with borderline personality disorder (BPD). In this study, facial emotional expressions, which are crucial for adaptive interactions in social contexts, were assessed in patients with BPD in response to social exclusion. METHOD We examined facial emotional reactions of 35 patients with BPD and 33 healthy controls when playing Cyberball, a virtual ball-tossing game that reliably induces social exclusion. Besides self-reported emotional responses, facial emotional expressions were analyzed by applying the Emotional Facial Action Coding System (EMFACS). RESULTS Patients with BPD showed a biased perception of participation. They more readily reported feeling excluded compared to controls even when they were included. In BPD, social exclusion led to an increase in self-reported other-focused negative emotions. Overall, EMFACS analyses revealed that BPD patients reacted with fewer positive expressions and with significantly more mixed emotional expressions (two emotional facial expressions at the same time) compared to the healthy control group when excluded. CONCLUSIONS Besides a negative bias for perceived social participation, ambiguous facial emotional expressions may play an important role in the disturbed relatedness in patients with BPD.
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Affiliation(s)
- K Staebler
- Department of Psychology, Freie Universität Berlin, Germany
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29
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Berthoud L, Kramer U, de Roten Y, Despland JN, Caspar F. Using Plan Analysis in Psychotherapeutic Case Formulation of Borderline Personality Disorder. Clin Psychol Psychother 2011; 20:1-9. [DOI: 10.1002/cpp.784] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Revised: 07/22/2011] [Accepted: 07/22/2011] [Indexed: 01/04/2023]
Affiliation(s)
- Laurent Berthoud
- University Institute of Psychotherapy; Department of Psychiatry; University of Lausanne; Switzerland
| | - Ueli Kramer
- University Institute of Psychotherapy; Department of Psychiatry; University of Lausanne; Switzerland
| | - Yves de Roten
- University Institute of Psychotherapy; Department of Psychiatry; University of Lausanne; Switzerland
| | - Jean-Nicolas Despland
- University Institute of Psychotherapy; Department of Psychiatry; University of Lausanne; Switzerland
| | - Franz Caspar
- Department for Clinical Psychology and Psychotherapy; University of Bern; Switzerland
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Renneberg B, Herm K, Hahn A, Staebler K, Lammers CH, Roepke S. Perception of Social Participation in Borderline Personality Disorder. Clin Psychol Psychother 2011; 19:473-80. [DOI: 10.1002/cpp.772] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Kerstin Herm
- Department of Psychology; Freie Universität Berlin; Berlin; Germany
| | | | - Katja Staebler
- Department of Psychology; University of Heidelberg; Heidelberg; Germany
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Arntz A, Weertman A, Salet S. Interpretation bias in Cluster-C and borderline personality disorders. Behav Res Ther 2011; 49:472-81. [DOI: 10.1016/j.brat.2011.05.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Revised: 04/13/2011] [Accepted: 05/04/2011] [Indexed: 10/18/2022]
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Effects of child abuse history on borderline personality traits, negative life events, and depression: a study among a university student population in Japan. Psychiatry Res 2010; 180:120-5. [PMID: 20488554 DOI: 10.1016/j.psychres.2010.04.029] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Revised: 10/10/2009] [Accepted: 04/19/2010] [Indexed: 11/20/2022]
Abstract
To simultaneously examine the impact of childhood abuse history on borderline personality traits, negative life events, and depression, undergraduate students (N=243) were studied by questionnaire surveys with one week intervals. Neglect and emotional abuse as well as sexual maltreatment predicted borderline personality traits and baseline depression. Baseline depression as well as the impact of negative life events occurring the week prior predicted depression a week later. However, after considering the baseline depression level, child abuse history failed to predict the follow-up depression level. Borderline personality traits did not moderate these findings. Childhood emotional and sexual abuse history may influence depression and borderline personality traits.
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Giesen-Bloo JH, Wachters LM, Schouten E, Arntz A. The Borderline Personality Disorder Severity Index-IV: Psychometric evaluation and dimensional structure. PERSONALITY AND INDIVIDUAL DIFFERENCES 2010. [DOI: 10.1016/j.paid.2010.03.023] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Renneberg B, Seehausen A. Fragebogen zu Gedanken und Gefühlen (FGG). ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2010. [DOI: 10.1026/1616-3443/a000031] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Basierend auf kognitiven Ansätzen sowie dem bio-sozialen Modell von Linehan zur Borderline Störung wurden eine Kurz- (14 Items) und eine Langversion (37 Items) des Fragebogens zu Gedanken und Gefühlen (FGG; Renneberg et al., 2005 ) entwickelt. Fragestellung: Die psychometrischen Kennwerte beider Versionen sowie die Eignung der Kurzversion als Screening Verfahren sollten überprüft werden. Methode: Itemkennwerte, Reliabilität und konvergente sowie diskriminante Validität werden an verschiedenen klinischen und nicht-klinischen Stichproben für den FGG-37 (insgesamt n = 530) und den FGG-14 (insgesamt n = 378) ermittelt. Mit der Langversion des FGG wurde zusätzlich zum Mittelwert ein Index zur Erfassung widerspruchsvollen Denkens (IWD) gebildet. Ergebnisse: Die Ergebnisse zeigen eine gute interne Konsistenz und Test-Retest-Reliabilität, eine hohe konvergente Validität und sehr gute diskriminante Validität des FGG-37 und der Kurzversion des FGG mit 14 Items. Schlussfolgerungen: Mit dem Index für widerspruchsvolles Denken (IWD) des FGG-37 ist es möglich, das Ausmaß festzustellen, in dem das Denken durch sich widersprechende handlungsleitende Kognitionen geprägt ist. Die Kurzform des FGG kann als Screening Instrument bei Verdacht auf BPS empfohlen werden.
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Kröger C, Theysohn S, Hartung D, Vonau M, Lammers CH, Kosfelder J. Die Skala zur Erfassung der Impulsivität der Borderline-Persönlichkeitsstörung (IS-27). DIAGNOSTICA 2010. [DOI: 10.1026/0012-1924/a000022] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Um im Bereich von Psychotherapie eingesetzt zu werden, sollte die Skala zur Erfassung der Impulsivität (IS-27) bei der Borderline-Persönlichkeitsstörung (BPS) veränderungssensitiv sein und Personen mit BPS identifizieren können. Das Instrument wurde mit anderen Selbstbeurteilungsinstrumenten einer ambulanten Stichprobe (n = 147), einer gesunden Kontrollgruppe (n = 43) sowie einer Stichprobe von stationären Patienten mit BPS vor und nach einer dreimonatigen dialektisch behavioralen Behandlung (n = 62) vorgelegt. Das reliable und valide Instrument diskriminierte Patienten mit BPS von anderen Diagnosegruppen und konnte die Symptomreduktion infolge der Behandlung abbilden. Die „Receiver-Operating-Characteristic” (ROC)-Kurve zeigte eine hohe diskriminatorische Fähigkeit. Unterschiedliche Cut-Off-Werte wurden hinsichtlich ihrer diagnostischen Effizienz bewertet. Aufgrund der Kosten, die die BPD verursacht, wird ein Cut-off-Wert von ≥ 27 bei fast optimalem Youden-Index und hoher Sensitivität favorisiert. Mit der IS-27 liegt ein Verfahren mit guten teststatischen Kennwerten vor, das einen Beitrag zu einer störungsspezifischen Qualitätssicherung leisten kann.
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36
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Lawrence KA, Allen JS, Chanen AM. A Study of Maladaptive Schemas and Borderline Personality Disorder in Young People. COGNITIVE THERAPY AND RESEARCH 2010. [DOI: 10.1007/s10608-009-9292-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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37
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Lobbestael J, Arntz A, Harkema-Schouten P, Bernstein D. Development and psychometric evaluation of a new assessment method for childhood maltreatment experiences: the interview for traumatic events in childhood (ITEC). CHILD ABUSE & NEGLECT 2009; 33:505-17. [PMID: 19758701 DOI: 10.1016/j.chiabu.2009.03.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2007] [Revised: 02/03/2009] [Accepted: 03/26/2009] [Indexed: 05/14/2023]
Abstract
OBJECTIVE We conducted a comprehensive assessment of the reliability and validity of the Interview for Traumatic Events in Childhood (ITEC, Lobbestael, Arntz, Kremers, & Sieswerda, 2006), a retrospective, semi-structured interview for childhood maltreatment. The ITEC aims to yield dimensional scores for severity of experiences of different childhood maltreatment dimensions. METHODS Initial psychometric properties were tested with the pilot version of the ITEC in 362 participants. A second study assessed the revised ITEC in 217 participants, patients and non-patients. RESULTS Factor analyses produced the best fit for a five-factor model (sexual, physical and emotional abuse, physical and emotional neglect). The scales had good internal consistency, except for the physical neglect subscale, and excellent inter-rater reliability. The scales were highly associated with equivalent scales of the Childhood Trauma Questionnaire (i.e., good convergent validity), and showed good correspondence with patient file information (i.e., good criterion validity). CONCLUSION These results support the reliability and validity of the ITEC, making it a potentially useful tool for assessing a broad range of traumatic events in childhood. PRACTICE IMPLICATION The first step in therapy for dealing with childhood maltreatment is to map abusive experiences and assess their severity and impact. Since maltreatment is a sensitive topic that is not reported on easily, trauma interviews are promising assessment instruments since they provide the opportunity to probe and clarify. There are hardly any well-validated trauma interviews available that assess the extent of maltreatment in and outside the family in various dimensions. The current study tries to fill this gap by presenting a new trauma interview; the Interview for Traumatic Events in Childhood.
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Affiliation(s)
- Jill Lobbestael
- Department of Clinical Psychological Science, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
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38
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Thombs BD, Bernstein DP, Lobbestael J, Arntz A. A validation study of the Dutch Childhood Trauma Questionnaire-Short Form: factor structure, reliability, and known-groups validity. CHILD ABUSE & NEGLECT 2009; 33:518-23. [PMID: 19758699 DOI: 10.1016/j.chiabu.2009.03.001] [Citation(s) in RCA: 190] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Revised: 03/10/2009] [Accepted: 03/10/2009] [Indexed: 05/16/2023]
Affiliation(s)
- Brett D Thombs
- Department of Psychiatry, McGill University - Jewish General Hospital, Montreal, Quebec, Canada
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39
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Scott LN, Levy KN, Pincus AL. Adult attachment, personality traits, and borderline personality disorder features in young adults. J Pers Disord 2009; 23:258-80. [PMID: 19538081 PMCID: PMC3195524 DOI: 10.1521/pedi.2009.23.3.258] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Previous studies have demonstrated that insecure attachment patterns and a trait disposition toward negative affect and impulsivity are both associated with borderline personality disorder (BPD) features. According to attachment theory, insecure attachment patterns impart greater risk for the maladaptive personality traits underlying BPD. Hence, insecure attachment might be indirectly related to BPD through its association with these traits. The current cross-sectional study used structural equation modeling to compare two competing models of the relationship between adult attachment patterns, trait negative affect and impulsivity, and BPD features in a large nonclinical sample of young adults: (M1) attachment anxiety and avoidance are positively related to trait negative affect and impulsivity, which in turn, are directly associated with BPD features; and (M2) trait negative affect and impulsivity are positively related to attachment anxiety and avoidance, which in turn, are directly associated with BPD features. Consistent with attachment theory, M1 provided a better fit to the data than M2. However, only attachment anxiety, and not attachment avoidance, was significantly associated with negative affect and impulsivity. The results favored a model in which the relationship between adult attachment anxiety and BPD features is fully mediated by trait negative affect and impulsivity.
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Affiliation(s)
- Lori N Scott
- Department of Psychology, Pennsylvania State University, 545 Moore Building, University Park, PA 16802, USA.
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40
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Schemas and Borderline Personality Disorder symptoms in incarcerated women. J Behav Ther Exp Psychiatry 2009; 40:256-64. [PMID: 19159865 DOI: 10.1016/j.jbtep.2008.12.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Revised: 12/15/2008] [Accepted: 12/16/2008] [Indexed: 11/21/2022]
Abstract
There is increasing interest regarding the role of maladaptive cognition in Borderline Personality Disorder (BPD). The current study examined the relationship between early maladaptive schema (EMS) domains and BPD symptoms as well as whether schema domains account for the relationship between childhood maltreatment and BPD severity. Incarcerated women (N=105) were assessed for BPD symptoms via semi-structured diagnostic interview. Disconnection/Rejection and Impaired Limits were associated with BPD pathology although these domains shared variance with depression and antisocial personality disorder pathology, respectively. In addition, the relationship between childhood abuse and BPD severity was non-significant after controlling for schema domains. Related findings and the implications for cognitive treatment of BPD are discussed.
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Do Early Maladaptive Schemas Mediate the Relationship Between Childhood Experiences and Avoidant Personality Disorder Features? A Preliminary Investigation in a Non-Clinical Sample. COGNITIVE THERAPY AND RESEARCH 2009. [DOI: 10.1007/s10608-009-9250-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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42
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Barnow S, Stopsack M, Grabe HJ, Meinke C, Spitzer C, Kronmüller K, Sieswerda S. Interpersonal evaluation bias in borderline personality disorder. Behav Res Ther 2009; 47:359-65. [DOI: 10.1016/j.brat.2009.02.003] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2008] [Revised: 01/30/2009] [Accepted: 02/04/2009] [Indexed: 11/29/2022]
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43
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Carr S, Francis A. Childhood familial environment, maltreatment and borderline personality disorder symptoms in a non-clinical sample: A cognitive behavioural perspective. CLIN PSYCHOL-UK 2009. [DOI: 10.1080/13284200802680476] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Steven Carr
- Department of Psychology, RMIT University , Bundoora
- Primary Mental Health Service , Mildura, Victoria, Australia
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Selby EA, Joiner TE. Ethnic variations in the structure of borderline personality disorder symptomatology. J Psychiatr Res 2008; 43:115-23. [PMID: 18433775 DOI: 10.1016/j.jpsychires.2008.03.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2007] [Revised: 02/29/2008] [Accepted: 03/04/2008] [Indexed: 11/30/2022]
Abstract
The goal of this study was to examine differences in the factor structure of borderline personality disorder symptoms among different ethnic groups. The authors obtained information regarding ethnic identity and endorsement of borderline personality disorder criteria for an ethnically diverse community sample of 1140 young adult subjects from south Florida. Using this information the authors conducted an exploratory factor analysis examining differences between Caucasian, Hispanic and African American groups. A principal-components factor analysis (PCA) with Varimax rotation for each ethnic group revealed a reasonably generalizable four-factor structure: affective dysregulation, cognitive disturbance, disturbed relatedness and behavioral dysregulation. The emergence of a four-factor structure across three separate, relatively large samples suggests that the factors obtained have merit. However, the loadings of some BPD symptoms, such as impulsivity, varied for each ethnic group. The results of this study indicate that ethnic variations in borderline personality disorder should be considered during assessment and treatment of this disorder. Also, future research should examine if this same factor structure holds for ethnic minorities with BPD diagnoses, examine ethnic differences in the etiology and maintenance of BPD symptomatology, and explore the effects that these differences might have in treatment settings.
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Affiliation(s)
- Edward A Selby
- Florida State University, Tallahassee, FL 32306-1270, USA
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Slee N, Garnefski N, van der Leeden R, Arensman E, Spinhoven P. Cognitive-behavioural intervention for self-harm: randomised controlled trial. Br J Psychiatry 2008; 192:202-11. [PMID: 18310581 DOI: 10.1192/bjp.bp.107.037564] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Self-harm by young people is occurring with increasing frequency. Conventional in-patient and out-patient treatment has yet to be proved efficacious. AIMS To investigate the efficacy of a short cognitive-behavioural therapy intervention with 90 adolescents and adults who had recently engaged in self-harm. METHOD Participants (aged 15-35 years) were randomly assigned to treatment as usual plus the intervention, or treatment as usual only. Assessments were completed at baseline and at 3 months, 6 months and 9 months follow-up. RESULTS Patients who received cognitive-behavioural therapy in addition to treatment as usual were found to have significantly greater reductions in self-harm, suicidal cognitions and symptoms of depression and anxiety, and significantly greater improvements in self-esteem and problem-solving ability, compared with the control group. CONCLUSIONS These findings extend the evidence that a time-limited cognitive-behavioural intervention is effective for patients with recurrent and chronic self-harm.
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Affiliation(s)
- Nadja Slee
- Department of Clinical, Health and Neuropsychology, Wassenaarseweg 52, PO Box 9555, 2300 RB Leiden, The Netherlands.
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Kröger C, Holdstein D, Lombe A, Schweiger U, Kosfelder J. Konstruktion eines störungsspezifischen Instruments zur Erfassung der Impulsivität der Borderline-Persönlichkeitsstörung. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2007. [DOI: 10.1026/1616-3443.36.4.290] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Impulsivität ist eines der zentralen Merkmale der Borderline-Persönlichkeitsstörung (BPS), das in der Behandlung als eines der ersten Ziele fokussiert wird. Bislang fehlt ein störungsorientiertes Selbstbeurteilungsinstrument, das impulsives Verhalten reliabel, valide und ökonomisch erfasst. Fragestellung: Welche Gütekriterien weist die Skala zur Erfassung der Impulsivität (IS-27) auf? Methode: Nach Voranalysen wurden 27 Items ausgewählt, die einer diagnostisch heterogenen Stichprobe (n1 = 115) und einer Stichprobe mit Patienten mit BPS (n2 = 149) zusammen mit anderen Selbstbeurteilungsinstrumenten vorgelegt wurden. Ergebnisse: Nach der Hauptkomponentenanalyse wird eine Ein-Faktor-Lösung favorisiert. Die Interne Konsistenz wie die Guttmans Split-Half-Koeffizienten betrugen über 0,92. Die IS-27 korreliert mit den Validierungsinstrumenten und diskriminiert zwischen Diagnosegruppen. Schlussfolgerungen: Mit der IS-27 liegt ein Verfahren mit guten teststatischen Kennwerten vor, das Impulsivität als verhaltensnahes Merkmal der BPS erheben kann. Das Verfahren sollte bezüglich seiner Veränderungssensitivität zukünftig untersucht werden.
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Kremers IP, Van Giezen AE, Van der Does AJW, Van Dyck R, Spinhoven P. Memory of childhood trauma before and after long-term psychological treatment of borderline personality disorder. J Behav Ther Exp Psychiatry 2007; 38:1-10. [PMID: 16712781 DOI: 10.1016/j.jbtep.2005.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2004] [Revised: 08/30/2005] [Accepted: 12/20/2005] [Indexed: 11/16/2022]
Abstract
The present study investigated the consistency of self-reports of childhood traumatic events in a sample of 50 patients with a borderline personality disorder (BPD) before and after 27 months of intensive treatment with schema focused therapy or transference focused psychotherapy. The mean number of reported sexual, physical and emotional traumatic events did not change following treatment. Test-retest correlations of the trauma-interview also indicated high stability of the total number of sexual, physical and emotional events reported. The majority of the patients, however, did no longer report at least one of the 33 listed events after psychotherapy, and the majority reported at least one event that they had not mentioned before the start of treatment. These findings were not related to type of treatment or changes in suppression, intrusions, avoidance of intrusions, dissociative symptoms, depressive symptoms, and borderline symptoms.
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Affiliation(s)
- I P Kremers
- Department of Psychology, Leiden University, Leiden, The Netherlands
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Cognitive disturbance in borderline personality disorder: Phenomenologic, social cognitive, and neurocognitive findings. ACTA ACUST UNITED AC 2006. [DOI: 10.1007/bf02629331] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Wenzel A, Chapman JE, Newman CF, Beck AT, Brown GK. Hypothesized mechanisms of change in cognitive therapy for borderline personality disorder. J Clin Psychol 2006; 62:503-16. [PMID: 16470716 DOI: 10.1002/jclp.20244] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Preliminary evidence suggests that cognitive therapy (CT) is effective in treating borderline personality disorder (BPD). According to cognitive theory, BPD patients are characterized by dysfunctional beliefs that are relatively enduring and inflexible and that lead to cognitive distortions such as dichotomous thinking. When these beliefs are activated, they lead to extreme emotional and behavioral reactions, which provide additional confirmation for the beliefs. It is hypothesized that a change in dysfunctional beliefs is the primary mechanism of change associated with CT. However, additional mechanisms of change are likely also at work in CT, including enhancement of skills, reduction in hopelessness, and improvement in attitude toward treatment. Each of these mechanisms is discussed in light of cognitive theory, data from an open clinical CT trial, relevant literature, and therapeutic interventions. Findings from the CT trial support the role of cognitive change during therapy and its continuation after termination.
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Affiliation(s)
- Amy Wenzel
- University of Pennsylvania, Philadelphia, PA 19103, USA
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