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Mundorf A, Deneke L, Ocklenburg S. Hemispheric asymmetries in borderline personality disorder: a systematic review. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01888-8. [PMID: 39261314 DOI: 10.1007/s00406-024-01888-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 08/23/2024] [Indexed: 09/13/2024]
Abstract
Borderline personality disorder (BPD) is characterized by increased mood reactivity and affective instability. Since core structures involved in emotion processing, such as the amygdala, demonstrate strong lateralization, BPD is an interesting target for laterality research. So far, a systematic integration of findings on lateralization in BPD is missing. Therefore, we systematically reviewed studies published until February 2024 in PubMed, Web of Science, and PsycInfo databases that measured hemispheric asymmetries and behavioral lateralization in patients with BPD. Inclusion criteria were (a) diagnosis of BPD and (b) results on hemispheric or behavioral asymmetries. Specifically for neuroimaging studies, hemispheres need to be assessed separately. Review articles and studies with disorders other than BPD were excluded. Risk of bias was assessed with the Newcastle Ottawa Scale for non-randomized, non-comparative intervention studies. A total of 21 studies met the inclusion criteria. Thirteen studies investigated structural hemispheric asymmetries, five functional hemispheric asymmetries, two examined handedness, and one studied hemispheric asymmetry in visuospatial attention. Overall, studies examining structural asymmetries in BPD report bilateral volume reduction in the amygdala and hippocampus but a right-sided reduction in the orbitofrontal cortex. For functional lateralization, asymmetrical de/activation patterns in the default mode network in BPD and reduced right-frontal asymmetry were evident. Also, studies indicate a trend towards increased non-right-handedness in BPD. Risk factors for BPD, such as childhood abuse, may play a crucial role in the development of structural and functional alterations. However, the generalization of results may be limited by small sample sizes and varying study designs.
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Affiliation(s)
- Annakarina Mundorf
- ISM Institute for Systems Medicine, Department of Human Medicine, MSH Medical School Hamburg, Am Kaiserkai 1, Hamburg, 20457, Germany.
- Department of Neurology, Division of Cognitive Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Lisa Deneke
- Department of Psychology, Medical School Hamburg, Hamburg, Germany
| | - Sebastian Ocklenburg
- Department of Psychology, Medical School Hamburg, Hamburg, Germany
- ICAN Institute for Cognitive and Affective Neuroscience, Medical School Hamburg, Hamburg, Germany
- Institute of Cognitive Neuroscience, Biopsychology, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
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2
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O'Gorman ET, Meyer GJ. Developmental cascades from early childhood attachment security to adolescent level of personality functioning among high-risk youth. Dev Psychopathol 2024:1-14. [PMID: 38934483 DOI: 10.1017/s0954579424001044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
This study examines associations between early childhood attachment security and adolescent personality functioning in a high-risk sample within a developmental psychopathology framework. Data from 2,268 children (1165 male; 1103 female) and caregivers participating in Future of Families and Child Well-Being Study (FFCWS) were used to examine (1) effects of genetic polymorphisms of the serotonin transporter (5-HTTLPR) and dopamine D4 receptor (DRD4) genes and adverse childhood experiences (ACEs) on attachment security and emotional and behavioral dysregulation in early childhood and (2) longitudinal associations and transactional relationships among attachment security, dysregulation, negative parenting attitudes and behaviors, social competence, and adolescent personality functioning. Results revealed that ACEs predicted attachment security over and above sex or the genetic risk, and gene × environment interactions did not increment prediction. Results of cascade models showed that greater early childhood attachment security predicted higher adolescent level of personality functioning via pathways through intermediary variables. Limitations and future research directions are discussed.
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Affiliation(s)
- Emily T O'Gorman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Gregory J Meyer
- Department of Psychology, University of Toledo, Toledo, OH, USA
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3
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Boog M, Goudriaan AE, Wetering BJMVD, Franken IHA, Arntz A. Schema therapy for patients with borderline personality disorder and comorbid alcohol dependence: A multiple-baseline case series design study. Clin Psychol Psychother 2022; 30:373-386. [PMID: 36399433 DOI: 10.1002/cpp.2803] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/10/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022]
Abstract
This study tested the effectiveness of schema therapy (ST) for borderline personality disorder (BPD) and comorbid alcohol dependence (AD). Twenty patients participated in a case series study with multiple baselines. The baseline phase consisted of treatment as usual. It was followed by a case conceptualization phase, an experiential techniques phase and a behavioural change phase. Patients showed a significant decrease in BPD and AD symptoms; change was mainly accomplished in the experiential techniques phase, with medium to large effect sizes. Three months after termination of therapy, 68% of the patients had remitted from BPD, and the number of drinking days decreased clearly. This study shows that, although treatment is challenging in this group of patients, meaningful change can be obtained in patients with BPD and AD using ST.
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Affiliation(s)
- Michiel Boog
- Antes Mental Health Care, Rotterdam, the Netherlands.,Institute of Psychology, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Anna E Goudriaan
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Arkin Mental Health Care, Amsterdam, the Netherlands
| | | | - Ingmar H A Franken
- Institute of Psychology, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
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4
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Dinu B, Dark F. Cognitive remediation therapy: is it a feasible and acceptable psychological treatment for borderline personality disorder? Australas Psychiatry 2022:10398562221136774. [PMID: 36341496 DOI: 10.1177/10398562221136774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Cognitive remediation (CR) is increasingly being used to address the cognitive impairment that can occur in people diagnosed with borderline personality disorder (BPD). This study aimed to understand attitudes towards CR in this service user group from the perspective of the person with the diagnosis and clinicians involved in their care. METHOD Anonymous online surveys were made available to people with a diagnosis of BPD in a public mental health service and clinicians of the same service. RESULTS Thirty-three percent of service users with a diagnosis of BPD responded to the survey. Most respondents (93%) expressed a desire to improve their cognition and were interested in cognitive remediation therapy (83%). Most staff (86%) recognised cognitive impairment can occur in people with a diagnosis of BPD and the same proportion believed cognitive skills impact on patient's emotional and mental health. Seventy percent of respondents believed CR would be useful for this service user group. CONCLUSIONS It is important that interventions to address the cognitive impairment associated with BPD are made available and that they are well integrated into the person's overall care plan.
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Affiliation(s)
- Bianca Dinu
- 157829Metro South Hospital and Health Service, Woolloongabba, QLD, Australia
| | - Frances Dark
- University of Queensland, Brisbane, QLD, Australia
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5
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Cannabis-Based Medicinal Products in the Management of Emotionally Unstable Personality Disorder (EUPD): A Narrative Review and Case Series. Brain Sci 2022; 12:brainsci12111467. [DOI: 10.3390/brainsci12111467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022] Open
Abstract
Emotionally unstable personality disorder (EUPD) is a common mental health disorder, manifesting with a range of chronic and debilitating symptoms, including impaired social functioning, unstable mood, and risky impulsive or self-injurious behaviour. Whilst the exact aetiology has not been fully elucidated, implicated factors seem to include genetic factors, environmental causes such as trauma, and neurotransmitter deficits. The literature suggests that impaired functioning of the endocannabinoid system in key brain regions responsible for emotional processing and stress response may underlie the manifestation of EUPD symptoms. The National Institute for Health and Care Excellence (NICE) 2009 guidelines state that “no drugs have established efficacy in treating or managing EUPD”, and yet, patients are commonly prescribed medication which includes antipsychotics, antidepressants, and mood stabilisers. Here we present a case series of seven participants diagnosed with EUPD and treated with cannabis-based medicinal products (CBMPs). Participants were given an initial assessment and followed up one month after CBMPs prescription. Improvement in symptoms was assessed by the completion of ratified rating scales by the participant and psychiatrist. Our results indicate that CBMPs were effective and well tolerated, as six participants reported a noticeable improvement in their symptoms and functioning. Although promising, further research is needed to ascertain the long-term tolerability, efficacy, and dosing strategy for CBMPs in EUPD.
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Nugent NR, Armey M, Boker S, Brick L, Knopik V, McGeary JE, Spirito A, Mehl MR. Adolescents hospitalised for suicidality: biomarkers, social and affective predictors: a cohort study. BMJ Open 2022; 12:e056063. [PMID: 36192099 PMCID: PMC9535190 DOI: 10.1136/bmjopen-2021-056063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The present research examines genomics and in vivo dynamics of family context and experienced affect following discharge from psychiatric hospitalisation for suicidal thoughts and behaviours (STBs). The purpose of this paper is to provide an overview of a new model, description of model-guided integration of multiple methods, documentation of feasibility of recruitment and retention and a description of baseline sample characteristics. DESIGN The research involved a longitudinal, multimethod observational investigation. SETTING Participants were recruited from an inpatient child and adolescent psychiatric hospital. 194 participants ages 13-18 were recruited following hospitalisation for STB. PRIMARY AND SECONDARY OUTCOME MEASURES Participants underwent a battery of clinical interviews, self-report assessments and venipuncture. On discharge, participants were provided with a phone with (1) the electronically activated recorder (EAR), permitting acoustic capture later coded for social context, and (2) ecological momentary assessment, permitting assessment of in vivo experienced affect and STB. Participants agreed to follow-ups at 3 weeks and 6 months. RESULTS A total of 71.1% of approached patients consented to participation. Participants reported diversity in gender identity (11.6% reported transgender or other gender identity) and sexual orientation (47.6% reported heterosexual or straight sexual orientation). Clinical interviews supported a range of diagnoses with the largest proportion of participants meeting criteria for major depressive disorder (76.9%). History of trauma/maltreatment was prevalent. Enrolment rates and participant characteristics were similar to other observational studies. CONCLUSIONS The research protocol characterises in vivo, real-world experienced affect and observed family context as associated with STB in adolescents during the high-risk weeks post discharge, merging multiple fields of study.
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Affiliation(s)
- Nicole R Nugent
- Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Michael Armey
- Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
- Department of Psychosocial Research, Butler Hospital, Providence, Rhode Island, USA
| | - Steven Boker
- Department of Psychology, University of Virginia, Charlottesville, Virginia, USA
| | - Leslie Brick
- Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Valerie Knopik
- Department of Human Development and Family Studies, Purdue University, West Lafayette, Indiana, USA
| | - John E McGeary
- Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
- Providence VA Medical Center, Providence, Rhode Island, USA
| | - Anthony Spirito
- Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Matthias R Mehl
- Department of Psychology, Arizona State University, Tempe, Arizona, USA
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7
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Rössler H, Flasbeck V, Gatermann S, Brüne M. Alterations of the gut microbiota in borderline personality disorder. J Psychosom Res 2022; 158:110942. [PMID: 35594813 DOI: 10.1016/j.jpsychores.2022.110942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/07/2022] [Accepted: 05/07/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE A growing body of research has shown that people with a wide range of psychiatric disorders, including depression, present with alterations of the gut microbiota, although it is unclear if differences may be caused by the action of psychotropic medication. No data exist for patients with borderline personality disorder (BPD), a psychiatric condition that is frequently comorbidly associated with depression. METHODS Twenty-four unmedicated patients and twenty-one age- and sex-matched healthy controls were recruited. Stool samples were frozen at -80 °C within ten minutes after defecation. The V4 region of bacterial 16S ribosomal RNA (rRNA) gene was sequenced on an Illumina platform. Operational taxonomic units (OTUs) were used for further analysis of community structure, alpha- and beta-diversity. RESULTS There was no significant difference in alpha- and beta-diversity between patients and controls. However, the Bacteroidetes/Firmicutes-ratio was higher in patients, approaching significance (p = 0.06, r = 0.23). Four species were significantly less abundant in BPD patients, namely Pseudoflavonifractor phocaensis (p = 0.003, r = 0.41), Eubacterium coprostanoligenes (p = 0.01, r = 0.34), Anaerotaenia torta (p = 0.01, r = 0.35), and (statistically somewhat weaker) Parabacteroides chongii (p = 0.046, r = 0.26), which correlated with various psychometric scores. CONCLUSION Differences in the taxonomic composition may indicate a potential dysbiosis among SCFA-producing bacteria in BPD. Future research is warranted to replicate these findings in independent and larger samples. If confirmed, the results suggest that microbiota-targeted therapies may be a useful adjunct strategy for BPD.
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Affiliation(s)
- Hannah Rössler
- LWL University Hospital, Department of Psychiatry, Psychotherapy and Preventive Medicine, Division of Social Neuropsychiatry and Evolutionary Medicine, Ruhr University Bochum, Germany; Department of Medical Microbiology; National Reference Centre for Multi-Resistant Gram-Negative Infectious Agents, Ruhr University Bochum, Germany
| | - Vera Flasbeck
- LWL University Hospital, Department of Psychiatry, Psychotherapy and Preventive Medicine, Division of Social Neuropsychiatry and Evolutionary Medicine, Ruhr University Bochum, Germany
| | - Sören Gatermann
- Department of Medical Microbiology; National Reference Centre for Multi-Resistant Gram-Negative Infectious Agents, Ruhr University Bochum, Germany
| | - Martin Brüne
- LWL University Hospital, Department of Psychiatry, Psychotherapy and Preventive Medicine, Division of Social Neuropsychiatry and Evolutionary Medicine, Ruhr University Bochum, Germany.
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8
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Parr AC, Calancie OG, Coe BC, Khalid-Khan S, Munoz DP. Impulsivity and Emotional Dysregulation Predict Choice Behavior During a Mixed-Strategy Game in Adolescents With Borderline Personality Disorder. Front Neurosci 2022; 15:667399. [PMID: 35237117 PMCID: PMC8882924 DOI: 10.3389/fnins.2021.667399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 12/28/2021] [Indexed: 11/13/2022] Open
Abstract
Impulsivity and emotional dysregulation are two core features of borderline personality disorder (BPD), and the neural mechanisms recruited during mixed-strategy interactions overlap with frontolimbic networks that have been implicated in BPD. We investigated strategic choice patterns during the classic two-player game, Matching Pennies, where the most efficient strategy is to choose each option randomly from trial-to-trial to avoid exploitation by one’s opponent. Twenty-seven female adolescents with BPD (mean age: 16 years) and twenty-seven age-matched female controls (mean age: 16 years) participated in an experiment that explored the relationship between strategic choice behavior and impulsivity in both groups and emotional dysregulation in BPD. Relative to controls, BPD participants showed marginally fewer reinforcement learning biases, particularly decreased lose-shift biases, increased variability in reaction times (coefficient of variation; CV), and a greater percentage of anticipatory decisions. A subset of BPD participants with high levels of impulsivity showed higher overall reward rates, and greater modulation of reaction times by outcome, particularly following loss trials, relative to control and BPD participants with lower levels of impulsivity. Additionally, BPD participants with higher levels of emotional dysregulation showed marginally increased reward rate and increased entropy in choice patterns. Together, our preliminary results suggest that impulsivity and emotional dysregulation may contribute to variability in mixed-strategy decision-making in female adolescents with BPD.
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Affiliation(s)
- Ashley C. Parr
- Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
- Division of Child and Youth Mental Health, Kingston Health Sciences Centre, Kingston, ON, Canada
- *Correspondence: Ashley C. Parr,
| | - Olivia G. Calancie
- Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
- Division of Child and Youth Mental Health, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Brian C. Coe
- Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
| | - Sarosh Khalid-Khan
- Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
- Division of Child and Youth Mental Health, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Douglas P. Munoz
- Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON, Canada
- Douglas P. Munoz,
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9
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Boog M, Dugonjic H, Arntz A, Goudriaan AE, Wetering BJMVD, Franken IHA. Borderline Personality Disorder With Versus Without Alcohol Use Disorder: Comparing Impulsivity and Schema Modes. J Pers Disord 2022; 36:1-18. [PMID: 33999655 DOI: 10.1521/pedi_2021_35_521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Substance use disorders (SUDs) and borderline personality disorder (BPD) are highly comorbid. In the present study, an attempt was made to understand the differences between BPD and BPD with comorbid SUD (BPD + alcohol use disorder [AUD]), by studying impulsivity and schema modes (i.e., maladaptive moment-to-moment emotional states and coping responses). BPD patients, BPD+AUD patients, and nonpatients (NP) were compared regarding behavioral impulsivity (motor impulsivity, risk taking, delay discounting), and schema modes. The two patient groups displayed greater delay discounting than the NP group. Further, BPD and BPD+AUD groups were different from the NP group regarding all schema modes investigated. However, no differences were found on any of the dependent variables between the two patient groups. It is suggested that although BPD patients are in general more impulsive and have more maladaptive moment-to-moment emotional states and coping responses, BPD patients with and without AUD seem not to be different in this respect.
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Affiliation(s)
- Michiel Boog
- Antes Mental Health Care, Rotterdam, the Netherlands.,Institute of Psychology, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | | | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, the Netherlands
| | - Anna E Goudriaan
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Arkin Mental Health Care, Amsterdam, the Netherlands
| | | | - Ingmar H A Franken
- Institute of Psychology, Erasmus University Rotterdam, Rotterdam, the Netherlands
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10
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Takahashi T, Sasabayashi D, Velakoulis D, Suzuki M, McGorry PD, Pantelis C, Chanen AM. Heschl's gyrus duplication pattern and clinical characteristics in borderline personality disorder: A preliminary study. Front Psychiatry 2022; 13:1033918. [PMID: 36405909 PMCID: PMC9669378 DOI: 10.3389/fpsyt.2022.1033918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
Inter-individual variations in the sulco-gyral pattern of Heschl's gyrus (HG) might contribute to emotional processing. However, it remains largely unknown whether borderline personality disorder (BPD) patients exhibit an altered HG gyrification pattern, compared with healthy individuals, and whether such a brain morphological feature, if present, might contribute to their clinical characteristics. The present study used magnetic resonance imaging to investigate the distribution of HG gyrification patterns (single or duplicated) and their relationship to clinical characteristics in teenage BPD patients with minimal treatment exposure. No significant difference was noted for the prevalence of HG patterns between 20 BPD and 20 healthy participants. However, the BPD participants with left duplicated HG were characterized by higher prevalence of comorbid disruptive behavior disorders, with higher externalizing score compared with those with left single HG. Our preliminary results suggest that neurodevelopmental pathology associated with gyral formation might be implicated in the neurobiology of early BPD, especially for emotional and behavioral control.
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Affiliation(s)
- Tsutomu Takahashi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan.,Research Center for Idling Brain Science, University of Toyama, Toyama, Japan
| | - Daiki Sasabayashi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan.,Research Center for Idling Brain Science, University of Toyama, Toyama, Japan
| | - Dennis Velakoulis
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Carlton, VIC, Australia.,Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne Health, Melbourne, VIC, Australia
| | - Michio Suzuki
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan.,Research Center for Idling Brain Science, University of Toyama, Toyama, Japan
| | - Patrick D McGorry
- Orygen, Melbourne, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Christos Pantelis
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Carlton, VIC, Australia.,Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia.,North Western Mental Health, Western Hospital Sunshine, St Albans, VIC, Australia
| | - Andrew M Chanen
- Orygen, Melbourne, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
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11
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Fumagalli G, Margola D. Is personality the key in cognitive-behavioural therapy for eating disorders? A review. Clin Psychol Psychother 2021; 29:164-177. [PMID: 34110647 DOI: 10.1002/cpp.2627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/13/2021] [Accepted: 06/03/2021] [Indexed: 11/08/2022]
Abstract
The efficacy of individual cognitive-behavioural therapy (CBT) for eating disorders can be assessed by investigating the potential predictors, mediators and moderators of treatment. The present review focused on personality since its crucial role has been emphasized both by research and practice. Sixteen studies were collected, and data were extracted through a highly operationalized coding system. Overall, personality disorders were the most investigated construct; however, their influence was somewhat contradictory. A more cogent result occurred for borderline personality disorder (BPD) when considered as a moderator (not a predictor nor a mediator). Patients with a more disturbed borderline personality benefited to a greater extent from treatments including booster modules on affects, interpersonal relationships and mood intolerance, rather than symptoms exclusively. Nine additional personality dimensions, beyond BPD, were investigated sparsely, and results regarding them were barely indicative in this review. However, some of these dimensions (e.g., affective lability and stimulus-seeking behaviours) could be traced back to BPD, thereby strengthening evidence of the role of borderline disorder as a moderator. Although research on the relationship between personality and eating disorders needs to be increased and methodologically improved, personality, taken as a whole, emerged as a promising variable for enhancing the efficacy of CBT.
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Affiliation(s)
| | - Davide Margola
- Faculty of Psychology, Catholic University of Milan, Milan, Italy
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12
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Franklin AR, Mathersul DC, Raine A, Ruscio AM. Restlessness in Generalized Anxiety Disorder: Using Actigraphy to Measure Physiological Reactions to Threat. Behav Ther 2021; 52:734-744. [PMID: 33990246 DOI: 10.1016/j.beth.2020.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 08/28/2020] [Accepted: 09/08/2020] [Indexed: 01/22/2023]
Abstract
Generalized anxiety disorder (GAD) is characterized by excessive, uncontrollable worry accompanied by symptoms of physiological arousal. Although individuals with GAD report greater subjective arousal than healthy individuals, they show equivalent or even attenuated physiological reactions to threat. This may result from using physiological measures better suited to fear than anxiety. To test this possibility, 102 adults with and without GAD were assessed for restlessness, a core physiological symptom of GAD. They were exposed to an in vivo threat task designed to elicit anxiety in the laboratory. Throughout the task, restlessness was measured physiologically with actigraphy sensors on both ankles and both wrists, and subjectively with self-report ratings. The GAD group reported higher subjective restlessness than the no-GAD group, and in the subset of cases who had restlessness as a clinically significant symptom, actigraphy scores were reliably elevated as well. However, although actigraphy scores increased with proximity to the threat, the increases did not differ by group. These findings provide initial validation for actigraphy as a novel measure of motor restlessness in GAD. In addition, they underscore the value of measuring restlessness using multiple assessment methods. These methods suggest that, in GAD, restlessness reflects a chronic state of arousal rather than a heightened physiological reaction to threat.
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13
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Nature and nurture? A review of the literature on childhood maltreatment and genetic factors in the pathogenesis of borderline personality disorder. J Psychiatr Res 2021; 137:131-146. [PMID: 33677217 DOI: 10.1016/j.jpsychires.2020.12.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 11/22/2020] [Accepted: 12/09/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Borderline Personality Disorder (BPD) is a psychiatric disorder associated with significant morbidity and mortality. However, the neurobiological alterations underlying the condition remain poorly understood. As a result, existing treatments remain inadequate. One of the main risk factors for the development of BPD is a history of childhood maltreatment. However, it is considered neither causative nor specific to the condition. Current theory is therefore increasingly moving toward a 'Gene x Environment' (GxE) model of the condition. The purpose of the current work was to conduct a systematic literature review, which comprehensively identifies all published molecular level GxE studies that have explored the role of specific genetic loci, in influencing the risk of BPD following exposure to childhood abuse or neglect. METHODS Four electronic databases were used to systematically search for molecular level GxE studies of any design, which focused on the development of BPD following exposure to childhood abuse or neglect, without language or date restrictions. Articles were screened independently by two reviewers and results were synthesized narratively. RESULTS A total of 473 articles were screened of which sixteen were selected for inclusion in our review. Implicated genes were categorised according to their influence on; Neurotransmitter Systems, Neurodevelopment and Neuroendocrine Systems. CONCLUSIONS The identified studies have produced several relevant and statistically significant results. Of particular note, is the repeated finding that genes involved in HPA axis regulation, may be altered by exposure to childhood maltreatment, influencing subsequent susceptibility to BPD. This is both biologically plausible and of potential clinical significance.
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14
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Vai B, Cazzetta S, Scalisi R, Donati A, Bechi M, Poletti S, Sforzini L, Visintini R, Maffei C, Benedetti F. Neuropsychological deficits correlate with symptoms severity and cortical thickness in Borderline Personality Disorder. J Affect Disord 2021; 278:181-188. [PMID: 32961414 DOI: 10.1016/j.jad.2020.09.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/15/2020] [Accepted: 09/11/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Neuropsychological abnormalities have been proposed to contribute to the development and maintenance of Borderline Personality Disorder (BPD). Previous meta-analyses and reviews confirmed deficits in a broad range of cognitive domains, including attention, cognitive flexibility, memory, executive functions, planning, information processing, and visuospatial abilities, often suggested to underlie brain abnormalities. However, no study directly explored the structural neural correlates of these deficits in BPD, also accounting for the possible confounding effect of pharmacological treatments, often used as adjunctive symptom-targeted therapy in clinical setting. METHODS In this study we compared the performance of 24 BPD patients to 24 healthy controls obtained at the neuropsychological battery "Brief Assessment and Cognition in Schizophrenia", exploring the relationship between the cognitive impairments and current symptomatology, brain grey matter volumes and cortical thickness, controlling for medications load. RESULTS Data revealed deficits in verbal memory and fluency, working memory, attention and speed of information processing and psychomotor speed and coordination when medication load was not in the model. Correcting for this variable, only the impairment in psychomotor abilities remained significant. A multiple regression confirmed the effect of this neuropsychological domain on the severity of BPD symptomatology (Borderline Evaluation of Severity Over Time). In BPD, the performance at psychomotor speed and coordination was also directly associated to cortical thickness in postcentral gyrus. LIMITATIONS Relatively small sample size, especially for neuroimaging. CONCLUSIONS Our study highlighted an influence of BPD neuropsychological impairments on symptomatology, and cortical thickness, prompting the potential clinical utility of a cognitive remediation program in BPD.
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Affiliation(s)
- Benedetta Vai
- Division of Neuroscience, Psychiatry and Clinical Psychobiology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; Fondazione Centro San Raffaele, Milan, Italy.
| | - Silvia Cazzetta
- Division of Neuroscience, Psychiatry and Clinical Psychobiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Rosalia Scalisi
- Division of Neuroscience, Psychiatry and Clinical Psychobiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessia Donati
- Division of Neuroscience, Psychiatry and Clinical Psychobiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Margherita Bechi
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sara Poletti
- Division of Neuroscience, Psychiatry and Clinical Psychobiology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Laura Sforzini
- Division of Neuroscience, Psychiatry and Clinical Psychobiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Raffaele Visintini
- Division of Neuroscience, Clinical Psychology and Psychotherapy Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Milan, Italy
| | - Cesare Maffei
- Vita-Salute San Raffaele University, Milan, Italy; Division of Neuroscience, Clinical Psychology and Psychotherapy Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Milan, Italy
| | - Francesco Benedetti
- Division of Neuroscience, Psychiatry and Clinical Psychobiology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
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Wrege JS, Busmann M, Meyer AH, Euler S, Lang UE, Walter M. Impulsiveness in borderline personality disorder predicts the long-term outcome of a psychodynamic treatment programme. Clin Psychol Psychother 2020; 28:633-641. [PMID: 33119970 DOI: 10.1002/cpp.2526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 11/08/2022]
Abstract
Despite the preponderance of treatment outcome predictors in patients with borderline personality disorder (BPD), the predictive value of measures of impulsiveness is inconclusive. This naturalistic study consecutively included hospitalized patients with BPD (N = 99) who underwent a standardized and structured 12-week inpatient treatment programme, which integrated cognitive-behavioural and psychodynamic elements. The Brief Symptom Checklist (BSCL) was applied as outcome measure over four time points: pretreatment, posttreatment, first follow-up at 6 to 8 weeks and second follow-up at 1 year after discharge. Impulsiveness was measured using the Barratt Impulsiveness Scale (BIS) at the pretreatment time point. The BSCL significantly decreased between pretreatment and posttreatment, followed by an increase after posttreatment without reaching pretreatment extent. The temporal course of the BSCL significantly varied with pretreatment BIS in that patients with higher impulsiveness revealed a stronger re-increase of symptom severity from posttreatment to end of follow-up than those with lower impulsiveness. The least impulsive patients thereby showed no rebound effect. The robustness of the results was examined by cross-validation. The results indicate that irrespective of the level of impulsiveness, patients with BPD profit from a structured inpatient treatment. However, long-term treatment success was impaired in patients with high level of impulsiveness at pretreatment. Thus, self-ratings of impulsiveness in BPD patients can be utilized for treatment planning. After discontinuation of interventions, relapse prevention should be implemented early in high impulsive patients as symptoms recrudesce in the course after discharge.
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Affiliation(s)
- Johannes S Wrege
- Department of Psychosomatic and Psychotherapy, Psychiatric University Hospital Basel, Basel, Switzerland
| | - Mareike Busmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andrea H Meyer
- Department of Psychology, University of Basel, Basel, Switzerland
| | - Sebastian Euler
- Department of Consultation Psychiatry and Psychosomatics, University Hospital Zürich, Zürich, Switzerland
| | - Undine E Lang
- Department of Psychosomatic and Psychotherapy, Psychiatric University Hospital Basel, Basel, Switzerland
| | - Marc Walter
- Department of Psychosomatic and Psychotherapy, Psychiatric University Hospital Basel, Basel, Switzerland
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Emotion regulation in adolescents: Influences of internal representations of relationships - An ERP study. Int J Psychophysiol 2020; 160:1-9. [PMID: 33278467 DOI: 10.1016/j.ijpsycho.2020.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/17/2020] [Accepted: 11/19/2020] [Indexed: 01/10/2023]
Abstract
Emotion regulation (ER) strategies can decrease the intensity or modify the experience of emotions. Deficits in emotion regulation are implicated in a wide range of psychopathologies. It is argued that interpersonal, socio-cognitive, and developmental variables play an important role in ER. This is the first study to explore the contribution of individual differences in internal representations of relationships (IRR) to neural correlates of ER in a sample of adolescents. Event related potentials of 53 adolescents (12 to 17 years old) were collected while performing an ER task. IRR was assessed with the social cognition and object relations scale (SCORS-G; Westen, 1995) coding of narratives from interviews. Results show that individual differences in IRR significantly predicted the modulation of emotional responses by expressive suppression in adolescents, accounting for 48% of the variance of changes in occipital late positive potentials (LPP). Thus, it appears that IRR are implicated in an individual's ability to regulate emotions. The clinical implications of the findings are discussed.
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Kaplan B, Yazici Gulec M, Gica S, Gulec H. The association between neurocognitive functioning and clinical features of borderline personality disorder. ACTA ACUST UNITED AC 2020; 42:503-509. [PMID: 32321061 PMCID: PMC7524408 DOI: 10.1590/1516-4446-2019-0752] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/14/2020] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To investigate the relationship between neurocognitive profiles and clinical manifestations of borderline personality disorder (BPD). METHODS Forty-five patients diagnosed with BPD and 35 healthy volunteers were included in the study. The BPD group was evaluated with the Borderline Personality Inventory for dissociative, impulsivity and suicidal dimensions. The Verbal Memory Processes Test and the Cambridge Neurophysiological Assessment Battery were administered to both the BPD and healthy control groups. RESULTS BPD patients differed from controls in sustained attention, facial emotion recognition, and deteriorated verbal memory function. A model consisting of the Dissociative Experiences Scale - Taxon (DES-T), motor impulsivity and Scale for Suicidal Behavior scores explained 52% of the variance in Borderline Personality Inventory scores. It was detected that motor impulsivity, decision-making and recognizing sadness may significantly predict DES-T scores, and response inhibition and facial emotion recognition scores may significantly predict impulsivity. CONCLUSION Our findings demonstrate that the disassociation, impulsivity, and suicidality dimensions are sufficient to represent the clinical manifestations of BPD, that they are related to neurocognitive differences, and that they interact with clinical features.
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Affiliation(s)
- Bahar Kaplan
- Department of Psychiatry, Sivas Numune Hospital, Sivas Provincial Health Directorate, Sivas, Turkey
| | - Medine Yazici Gulec
- Department of Psychiatry, University of Health Sciences Turkey, Erenkoy Mental Health and Neurological Disease Education and Research Hospital, Istanbul, Turkey
| | - Sakir Gica
- Department of Psychiatry, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Huseyin Gulec
- Department of Psychiatry, University of Health Sciences Turkey, Erenkoy Mental Health and Neurological Disease Education and Research Hospital, Istanbul, Turkey
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Khalifa NR, Gibbon S, Völlm BA, Cheung NHY, McCarthy L. Pharmacological interventions for antisocial personality disorder. Cochrane Database Syst Rev 2020; 9:CD007667. [PMID: 32880105 PMCID: PMC8094881 DOI: 10.1002/14651858.cd007667.pub3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Antisocial personality disorder (AsPD) is associated with rule-breaking, criminality, substance use, unemployment, relationship difficulties, and premature death. Certain types of medication (drugs) may help people with AsPD. This review updates a previous Cochrane review, published in 2010. OBJECTIVES To assess the benefits and adverse effects of pharmacological interventions for adults with AsPD. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, 13 other databases and two trials registers up to 5 September 2019. We also checked reference lists and contacted study authors to identify studies. SELECTION CRITERIA Randomised controlled trials in which adults (age 18 years and over) with a diagnosis of AsPD or dissocial personality disorder were allocated to a pharmacological intervention or placebo control condition. DATA COLLECTION AND ANALYSIS Four authors independently selected studies and extracted data. We assessed risk of bias and created 'Summary of findings tables' and assessed the certainty of the evidence using the GRADE framework. The primary outcomes were: aggression; reconviction; global state/global functioning; social functioning; and adverse events. MAIN RESULTS We included 11 studies (three new to this update), involving 416 participants with AsPD. Most studies (10/11) were conducted in North America. Seven studies were conducted exclusively in an outpatient setting, one in an inpatient setting, and one in prison; two studies used multiple settings. The average age of participants ranged from 28.6 years to 45.1 years (overall mean age 39.6 years). Participants were predominantly (90%) male. Study duration ranged from 6 to 24 weeks, with no follow-up period. Data were available from only four studies involving 274 participants with AsPD. All the available data came from unreplicated, single reports, and did not allow independent statistical analysis to be conducted. Many review findings were limited to descriptive summaries based on analyses carried out and reported by the trial investigators. No study set out to recruit participants on the basis of having AsPD; many participants presented primarily with substance abuse problems. The studies reported on four primary outcomes and six secondary outcomes. Primary outcomes were aggression (six studies) global/state functioning (three studies), social functioning (one study), and adverse events (seven studies). Secondary outcomes were leaving the study early (eight studies), substance misuse (five studies), employment status (one study), impulsivity (one study), anger (three studies), and mental state (three studies). No study reported data on the primary outcome of reconviction or the secondary outcomes of quality of life, engagement with services, satisfaction with treatment, housing/accommodation status, economic outcomes or prison/service outcomes. Eleven different drugs were compared with placebo, but data for AsPD participants were only available for five comparisons. Three classes of drug were represented: antiepileptic; antidepressant; and dopamine agonist (anti-Parkinsonian) drugs. We considered selection bias to be unclear in 8/11 studies, attrition bias to be high in 7/11 studies, and performance bias to be low in 7/11 studies. Using GRADE, we rated the certainty of evidence for each outcome in this review as very low, meaning that we have very little confidence in the effect estimates reported. Phenytoin (antiepileptic) versus placebo One study (60 participants) reported very low-certainty evidence that phenytoin (300 mg/day), compared to placebo, may reduce the mean frequency of aggressive acts per week (phenytoin mean = 0.33, no standard deviation (SD) reported; placebo mean = 0.51, no SD reported) in male prisoners with aggression (skewed data) at endpoint (six weeks). The same study (60 participants) reported no evidence of difference between phenytoin and placebo in the number of participants reporting the adverse event of nausea during week one (odds ratio (OR) 1.00, 95% confidence interval (CI) 0.06 to 16.76; very low-certainty evidence). The study authors also reported that no important side effects were detectable via blood cell counts or liver enzyme tests (very low-certainty evidence). The study did not measure reconviction, global/state functioning or social functioning. Desipramine (antidepressant) versus placebo One study (29 participants) reported no evidence of a difference between desipramine (250 to 300 mg/day) and placebo on mean social functioning scores (desipramine = 0.19; placebo = 0.21), assessed with the family-social domain of the Addiction Severity Index (scores range from zero to one, with higher values indicating worse social functioning), at endpoint (12 weeks) (very low-certainty evidence). Neither of the studies included in this comparison measured the other primary outcomes: aggression; reconviction; global/state functioning; or adverse events. Nortriptyline (antidepressant) versus placebo One study (20 participants) reported no evidence of a difference between nortriptyline (25 to 75 mg/day) and placebo on mean global state/functioning scores (nortriptyline = 0.3; placebo = 0.7), assessed with the Symptom Check List-90 (SCL-90) Global Severity Index (GSI; mean of subscale scores, ranging from zero to four, with higher scores indicating greater severity of symptoms), at endpoint (six months) in men with alcohol dependency (very low-certainty evidence). The study measured side effects but did not report data on adverse events for the AsPD subgroup. The study did not measure aggression, reconviction or social functioning. Bromocriptine (dopamine agonist) versus placebo One study (18 participants) reported no evidence of difference between bromocriptine (15 mg/day) and placebo on mean global state/functioning scores (bromocriptine = 0.4; placebo = 0.7), measured with the GSI of the SCL-90 at endpoint (six months) (very low-certainty evidence). The study did not provide data on adverse effects, but reported that 12 patients randomised to the bromocriptine group experienced severe side effects, five of whom dropped out of the study in the first two days due to nausea and severe flu-like symptoms (very low-certainty evidence). The study did not measure aggression, reconviction and social functioning. Amantadine (dopamine agonist) versus placebo The study in this comparison did not measure any of the primary outcomes. AUTHORS' CONCLUSIONS The evidence summarised in this review is insufficient to draw any conclusion about the use of pharmacological interventions in the treatment of antisocial personality disorder. The evidence comes from single, unreplicated studies of mostly older medications. The studies also have methodological issues that severely limit the confidence we can draw from their results. Future studies should recruit participants on the basis of having AsPD, and use relevant outcome measures, including reconviction.
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Affiliation(s)
- Najat R Khalifa
- Department of Psychiatry, Queen's University, Kingston, Canada
| | - Simon Gibbon
- Arnold Lodge, Nottinghamshire Healthcare NHS Foundation Trust, Leicester, UK
| | - Birgit A Völlm
- Department of Forensic Psychiatry, Center for Neurology, University Rostock, Rostock, Germany
| | - Natalie H-Y Cheung
- Forensic Research, Nottinghamshire Healthcare NHS Foundation Trust, Leicester, UK
| | - Lucy McCarthy
- Arnold Lodge, Nottinghamshire Healthcare NHS Foundation Trust, Leicester, UK
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Maurex L, Zaboli G, Öhman A, Åsberg M, Leopardi R. The serotonin transporter gene polymorphism (5-HTTLPR) and affective symptoms among women diagnosed with borderline personality disorder. Eur Psychiatry 2020; 25:19-25. [DOI: 10.1016/j.eurpsy.2009.05.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Revised: 04/27/2009] [Accepted: 05/02/2009] [Indexed: 10/20/2022] Open
Abstract
AbstractGene variants of the serotonin transporter have been associated with vulnerability to affective disorders. In particular, the presence of one or two copies of the short (s) allele of the 5-HTTLPR polymorphism has been associated with reduced serotonin transporter expression and function, and vulnerability to affective disorders. To test for an association between variants of the serotonin transporter gene polymorphism (5-HTTLPR) and relevant clinical features of borderline personality disorder (BPD), a psychiatric disorder with symptoms characteristic for serotonin dysfunction, 77 women with BPD were genotyped in the 5-HTTLPR polymorphism. They rated their subjective experience of borderline-specific, depressive, anxious and obsessive-compulsive symptoms, and were interviewed about lifetime incidence of suicide attempts and self-harming acts. Carriers of two s alleles of the 5-HTTLPR reported more symptoms of borderline, depression, anxiety and obsessive-compulsive behaviours, but not of suicidal and self-injury behaviour, compared to carriers of a long (l) allele. This indicates that the 5-HTTLPR ss homozygous genotype might influence serotonin function affecting susceptibility to both borderline-specific, depressive, anxious and obsessive-compulsive symptoms in BPD, and leading to a more severe symptomatology related to these clinical features. Further, this suggests that 5-HTT gene variants may not be as influential on suicidal and self-injury behaviour in BPD.
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Van Heel M, Luyten P, De Meulemeester C, Vanwalleghem D, Vermote R, Lowyck B. Mentalizing Based on External Features in Borderline Personality Disorder Compared With Healthy Controls: The Role of Attachment Dimensions and Childhood Trauma. J Pers Disord 2019; 33:736-750. [PMID: 30689514 DOI: 10.1521/pedi_2019_33_373] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Extant research suggests that borderline personality disorder (BPD) is associated with impairments in mentalizing, that is, comprehending behavior in terms of underlying mental states. However, the precise nature of these impairments remains unclear. The literature is mixed concerning mental-izing based on external features of others, and specifically facial emotion recognition (FER) in BPD patients. This study investigated FER differences in 79 BPD patients and 79 matched healthy controls using the Reading the Mind in the Eyes Test (RMET). The authors also investigated attachment dimensions and childhood trauma in relation to mentalizing based on external features. Results showed that BPD patients performed worse on positive and negative emotions. Furthermore, avoidant attachment was negatively related to FER for neutral emotions, particularly in the control group. Trauma was negatively related to FER at trend level, particularly in BPD patients. The implications for this understanding of mentalizing based on external features in BPD are discussed.
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Affiliation(s)
- Martijn Van Heel
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Patrick Luyten
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | | | | | - Rudi Vermote
- University Psychiatric Hospital UPC KU Leuven, Campus Kortenberg and Department of Neurosciences, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Benedicte Lowyck
- University Psychiatric Hospital UPC KU Leuven, Campus Kortenberg and Department of Neurosciences, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Research Department of Clinical, Educational and Health Psychology, University College London, UK
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Abstract
AbstractBorderline personality disorder (BPD) is a severe and complex disorder characterized by instability across many life domains, including interpersonal relations, behavior, and emotions. A core feature and contributor to BPD, emotion dysegulation (ED), consists of deficits in the ability to regulate emotions in a manner that allows the individual to pursue important goals or behave effectively in various contexts. Biosocial developmental models of BPD have emphasized a transaction of environmental conditions (e.g., invalidating environments and adverse childhood experiences) with key genetically linked vulnerabilities (e.g., impulsivity and emotional vulnerability) in the development of ED and BPD. Emerging evidence has begun to highlight the complex, heterotypic pathways to the development of BPD, with key heritable vulnerability factors possibly interacting with aspects of the rearing environment to produce worsening ED and an adolescent trajectory consisting of self-damaging behaviors and eventual BPD. Adults with BPD have shown evidence of a variety of cognitive, physiological, and behavioral characteristics of ED. As the precursors to the development of ED and BPD have become clearer, prevention and treatment efforts hold great promise for reducing the long-term suffering, functional impairment, and considerable societal costs associated with BPD.
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Naoum J, Kleindienst N, Baumgärtner U, Willis F, Mancke F, Treede RD, Bohus M, Schmahl C. Effects of a Painful Stimulus on Stress Regulation in Male Patients With Borderline Personality Disorder: A Pilot Study. J Pers Disord 2019; 33:394-412. [PMID: 30036168 DOI: 10.1521/pedi_2018_32_351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pain processing in relation to stress has so far not been investigated in male patients with borderline personality disorder (BPD). This experimental pilot study examined 17 male BPD patients and 20 male healthy controls (HCs) to assess the effects of a pain stimulus on arousal, aggression, pain (ratings), and heart rate. At baseline, BPD patients showed significantly higher arousal and aggression; however, there was no significant difference in heart rate compared to the HC group. Following stress induction, a noninvasive mechanical pain stimulus was applied. No significant differences in pain ratings or heart rates were found between the groups. For arousal, a significantly stronger decrease was revealed in the BPD group compared to the HC group (t = 2.16, p = .038). Concerning aggression, the BPD group showed a significantly greater decrease after the pain stimulus than the HC group (t = 3.25, p = .002). This data showed that nonsuicidal self-injury can reduce arousal and aggression in male BPD.
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Affiliation(s)
- Janina Naoum
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Nikolaus Kleindienst
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim
| | - Ulf Baumgärtner
- Department of Neurophysiology, Center of Biomedicine and Medical Technology Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim
| | - Franziska Willis
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Falk Mancke
- Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Center of Biomedicine and Medical Technology Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim
| | - Martin Bohus
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.,Department of Neurophysiology, Center of Biomedicine and Medical Technology Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim.,Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Repetitive Transcranial Magnetic Stimulation in the Treatment of a Difficult to Treat Condition, Borderline Personality Disorder. J Psychiatr Pract 2019; 25:14-21. [PMID: 30633728 DOI: 10.1097/pra.0000000000000350] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Borderline personality disorder (BPD) is a serious mental disorder characterized by a pervasive pattern of instability in affect regulation and interpersonal relationships, poor self-image and behavioral control, self-injurious behavior, suicidality, and other high-risk behaviors. It is also characterized by a high mortality rate by suicide. METHODS The published literature on repetitive transcranial magnetic stimulation (TMS), theta-burst stimulation (TBS), and deep TMS in the treatment of BPD were reviewed. RESULTS Four clinical studies (2 randomized trials and 2 case studies) with limited sample sizes found that TMS and TBS were safe and potentially effective in the reduction of symptoms of BPD. CONCLUSIONS Given the limited clinical evidence for efficacy on the basis of the results of these studies, future controlled studies involving larger samples and optimal stimulus parameters should be designed to confirm the short-term and long-term safety and efficacy of repetitive TMS and TBS in the treatment of BPD.
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Prada P, Perroud N, Rüfenacht E, Nicastro R. Strategies to Deal With Suicide and Non-suicidal Self-Injury in Borderline Personality Disorder, the Case of DBT. Front Psychol 2018; 9:2595. [PMID: 30619004 PMCID: PMC6304419 DOI: 10.3389/fpsyg.2018.02595] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 12/03/2018] [Indexed: 11/28/2022] Open
Abstract
One of the most problematic aspects of borderline personality disorder resides in repeated non-suicidal self-injury (NSSI) and suicide attempts. These behaviors constitute the prime therapeutic target and a factor that complicates patient care, namely in terms of therapeutic continuity. It has been demonstrated that Dialectical Behavior Therapy (DBT) is efficient in reducing the symptomatology of this disorder, as well as NSSI and suicide. DBT is a multi-component psychotherapeutic treatment, and the effectiveness of its individual constituents is therefore a relevant question. Studies comparing its various components (individual therapy, group therapy, and standard DBT) have not revealed any marked difference between them, other than a tendency toward improved patient retention rates in the standard version of the treatment. The aim of this study is to review the various components of DBT and their constituent parts, in order to highlight the importance of focusing on self-harm behaviors within the therapy as a whole. Although therapeutic strategies may differ and target directly suicide or NSSI, managing the quality of life, and the persistence of the therapeutic alliance (and of the interpersonal alliance) is equally important in terms of treatment efficacy.
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Affiliation(s)
- Paco Prada
- TRE Unit, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Nader Perroud
- TRE Unit, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Eva Rüfenacht
- TRE Unit, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Rosetta Nicastro
- TRE Unit, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, Geneva University Hospitals, Geneva, Switzerland
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Denny BT, Fan J, Fels S, Galitzer H, Schiller D, Siever LJ, Koenigsberg HW. Sensitization of the Neural Salience Network to Repeated Emotional Stimuli Following Initial Habituation in Patients With Borderline Personality Disorder. Am J Psychiatry 2018; 175:657-664. [PMID: 29961363 PMCID: PMC6032521 DOI: 10.1176/appi.ajp.2018.17030367] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Borderline personality disorder is the prototypical disorder of emotion reactivity and dysregulation, yet there remains limited understanding of its neurocognitive correlates. Two mechanisms that may underlie anomalous reactivity in response to negative stimuli among patients with borderline personality disorder are impairment in habituation and exaggerated sensitization of activity in the neural salience network, including the amygdala, anterior insula, and dorsal anterior cingulate cortex. The authors aimed to reveal the most plausible mechanism by examining the effect of repeated exposure to emotional images both within and across study sessions. METHOD A total of 75 participants (patients with borderline personality disorder, N=26; patients with avoidant personality disorder included as a psychopathological control group, N=25; and healthy control subjects, N=24) were included in the study analyses. All participants viewed five presentations of the same set of negative and neutral images at each of two sessions, separated by approximately 3 days, while functional MRI data were acquired. Salience network activity, as measured by blood-oxygen-level-dependent signal in anatomically defined regions of interest across the salience network, was compared across the three groups for each presentation at each of the two study sessions. Self-reported negative affect was measured for each trial. RESULTS Salience network activity showed a main effect of within-session habituation across all groups and sessions. However, a group-by-session interaction was present, such that only patients with borderline personality disorder showed increased salience network activity in response to the images reencountered at the second session, and this increased salience network sensitization predicted greater sensitization in self-reported negative affect. CONCLUSIONS These results elucidate the neural mechanisms by which patients with borderline personality disorder appraise negative social situations as exaggeratedly salient and suggest potential neurocognitive intervention targets.
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Affiliation(s)
- Bryan T. Denny
- Department of Psychology, Rice University, Houston, TX, USA
| | - Jin Fan
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA,Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA,Department of Psychology, Queens College, City University of New York, New York, NY, USA
| | - Samuel Fels
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hayley Galitzer
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniela Schiller
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA,Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Larry J. Siever
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA,James J Peters VA Medical Center, Bronx, NY, USA
| | - Harold W. Koenigsberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA,James J Peters VA Medical Center, Bronx, NY, USA
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Eren Simsek N, Yildiz M. A case of factitious disorder presenting with symptoms of movement disorder. PSYCHIAT CLIN PSYCH 2018. [DOI: 10.1080/24750573.2018.1480003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Affiliation(s)
- Nurcan Eren Simsek
- Department of Child and Adolescent Psychiatry, Bayburt Public Hospital, Bayburt, Turkey
| | - Mustafa Yildiz
- Department of Psychiatry, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
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Gamache D, Savard C, Lemelin S, Côté A, Villeneuve E. Premature psychotherapy termination in an outpatient treatment program for personality disorders: a survival analysis. Compr Psychiatry 2018; 80:14-23. [PMID: 28915423 DOI: 10.1016/j.comppsych.2017.08.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 07/06/2017] [Accepted: 08/04/2017] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE Psychological treatment for patients with personality disorders (PD) is plagued with a high proportion of early dropouts, and attempts to identify risk factors for attrition have generated very few conclusive results. The purpose of the present study is to identify significant predictors of early treatment termination in a long-term psychotherapy program for PD. METHODS Data was retrospectively retrieved from 174 files of patients who began long-term psychotherapy in an outpatient treatment program in Quebec City, Canada. Socio-demographic, initial disturbance, and diagnostic variables were considered for prediction, along with a measure specifically designed to identify PD patients at risk of dropping out early from psychotherapy, the Treatment Attrition-Retention Scale for Personality Disorders (TARS-PD). Survival analysis using Cox proportional hazard regression was performed to identify significant predictors. RESULTS Results using univariate Cox proportional hazards regressions revealed that unemployment, Global Assessment of Functioning scores, and recent hetero-aggressive behavior were significant predictors of early dropout in the first six months of therapy. Adjusting for these three confounders, four of the factor scores from the TARS-PD (Narcissism, Secondary gains, Low distress, and Cluster A features) were significantly associated with dropout in univariate Cox proportional hazards regressions. Secondary gains and Narcissism remained significant predictors after entering all five TARS-PD factors in a multivariate Cox proportional hazards regression adjusting for confounders. CONCLUSIONS Taking into consideration specific treatment prognosis variables, such as those measured by the TARS-PD, might be more useful for dropout prediction in PD patients in comparison with more general demographic and diagnostic variables.
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Affiliation(s)
- Dominick Gamache
- Université du Québec à Trois-Rivières, Département de psychologie, C.P. 500, Trois-Rivières, QC, Canada; CERVO Research Center, 2601 Chemin de la Canardière, Quebec City, QC, Canada.
| | - Claudia Savard
- CERVO Research Center, 2601 Chemin de la Canardière, Quebec City, QC, Canada; Université Laval, Faculté des Sciences de l'éducation, 2325 rue des Bibliothèques, Quebec City, QC, Canada
| | - Sophie Lemelin
- Clinique Focus, 3679, rue de l'Hêtrière, Local 120, Saint-Augustin-de-Desmaures, QC, Canada
| | - Alexandre Côté
- Université du Québec à Trois-Rivières, Département de psychologie, C.P. 500, Trois-Rivières, QC, Canada
| | - Evens Villeneuve
- CERVO Research Center, 2601 Chemin de la Canardière, Quebec City, QC, Canada; Institut universitaire en santé mentale de Québec, Centre de traitement le Faubourg Saint-Jean, 2601 Chemin de la Canardière, Quebec City, QC, Canada
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Frías Á, Palma C, Solves L, Martínez B, Salvador A. Differential symptomatology and functioning in borderline personality disorder across age groups. Psychiatry Res 2017; 258:44-50. [PMID: 28985552 DOI: 10.1016/j.psychres.2017.09.081] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 09/24/2017] [Accepted: 09/26/2017] [Indexed: 10/18/2022]
Abstract
There is increasing research aimed at addressing whether patients with borderline personality disorder (BPD) may exhibit variations in symptomatology and functioning according to their chronological age. The current study consisted of 169 outpatients diagnosed with BPD, who were divided into four age groups as follows: 16-25 years (n = 41), 26-35 years (n = 43), 36-45 years (n = 45), and 46 and more years (n = 40). Age groups were compared for symptomatology, normal personality traits, psychiatric comorbidities, functioning, and treatment-related features. The younger group had significantly higher levels of physical/verbal aggression and suicide attempts relative to the older group. Conversely, the older group had significantly greater severity of somatization, depression, and anxiety symptoms. In addition, the older group showed significantly greater functional impairment overall and across physical/psychological domains, specifically when compared to the younger group. Overall, these findings may suggest that age-related symptoms should be considered when diagnosing BPD. Also, functional impairments should be the target interventions for older BPD patients.
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Affiliation(s)
- Álvaro Frías
- Facultad de Psicologia, Ciencias de la Educación y el Deporte Blanquerna, University of Ramon-Llull, Barcelona, Spain; Consorci Sanitari del Maresme, Department of Psychiatry, Hospital of Mataró, Mataró, Spain.
| | - Carol Palma
- Facultad de Psicologia, Ciencias de la Educación y el Deporte Blanquerna, University of Ramon-Llull, Barcelona, Spain; Consorci Sanitari del Maresme, Department of Psychiatry, Hospital of Mataró, Mataró, Spain
| | - Laia Solves
- Consorci Sanitari del Maresme, Department of Psychiatry, Hospital of Mataró, Mataró, Spain
| | - Bárbara Martínez
- Consorci Sanitari del Maresme, Department of Psychiatry, Hospital of Mataró, Mataró, Spain
| | - Ana Salvador
- Facultad de Psicologia, Ciencias de la Educación y el Deporte Blanquerna, University of Ramon-Llull, Barcelona, Spain; Consorci Sanitari del Maresme, Department of Psychiatry, Hospital of Mataró, Mataró, Spain
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Schoenleber M, Berghoff CR, Tull MT, DiLillo D, Messman-Moore T, Gratz KL. Emotional lability and affective synchrony in borderline personality disorder. Personal Disord 2017; 7:211-20. [PMID: 27362623 DOI: 10.1037/per0000145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Extant research on emotional lability in borderline personality disorder (BPD) has focused almost exclusively on lability of individual emotions or emotion types, with limited research considering how different types of emotions shift together over time. Thus, this study examined the temporal dynamics of emotion in BPD at the level of both individual emotions (i.e., self-conscious emotions [SCE], anger, and anxiety) and mixed emotions (i.e., synchrony between emotions). One hundred forty-four women from the community completed a diagnostic interview and laboratory study involving 5 emotion induction tasks (each of which was preceded and followed by a 5-min resting period or neutral task). State ratings of SCE, anger, and anxiety were provided at 14 time points (before and after each laboratory task and resting period). Hierarchical linear modeling results indicate that women with BPD reported greater mean levels of SCE and Anxiety (but not Anger), and greater lability of Anxiety. Women with BPD also exhibited greater variability in lability of all 3 emotions (suggestive of within-group differences in the relevance of lability to BPD). Results also revealed synchrony (i.e., positive relations) between each possible pair of emotions, regardless of BPD status. Follow-up regression analyses suggest the importance of accounting for lability when examining the role of synchrony in BPD, as the relation of SCE-Anger synchrony to BPD symptom severity was moderated by Anger and SCE lability. Specifically, synchronous changes in SCE and Anger were associated with greater BPD symptom severity when large shifts in SCE were paired with minor shifts in Anger. (PsycINFO Database Record
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Affiliation(s)
- Michelle Schoenleber
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center
| | | | - Matthew T Tull
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center
| | - David DiLillo
- Department of Psychology, University of Nebraska-Lincoln
| | | | - Kim L Gratz
- Department of Psychiatry and Human Behavior, University of Mississippi Medical
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30
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Vega D, Torrubia R, Soto À, Ribas J, Soler J, Pascual JC, Rodríguez-Fornells A, Marco-Pallarés J. Exploring the relationship between non suicidal self-injury and borderline personality traits in young adults. Psychiatry Res 2017; 256:403-411. [PMID: 28692921 DOI: 10.1016/j.psychres.2017.07.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 04/30/2017] [Accepted: 07/03/2017] [Indexed: 11/28/2022]
Abstract
Non-suicidal self-injury (NSSI) is highly prevalent during late adolescence and young adulthood. There is some evidence of a link between NSSI and Borderline Personality Disorder (BPD), but little is known about the association between BPD traits and the various functions that maintain NSSI. The main purpose of this study was to explore the association between borderline personality traits and NSSI functions in a sample of college students. We also compared NSSI functions in college students who engaged in NSSI to those in an age-matched sample of BPD patients. This study included a total of 238 college students and 36 BPD patients. Participants were asked to complete a number of clinical measures. In the non-clinical sample, BPD features were more pronounced in the presence of NSSI, and we observed a differential relationship between NSSI functions and psychopathological BPD-traits. The NSSI clinical variables most strongly associated with BPD were frequency, variety of methods and severity, but not age of onset. Our results provide new information on the relationship between BPD and NSSI in young adults, and could be used to improve the early detection of vulnerable BPD-individuals and in planning NSSI treatment.
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Affiliation(s)
- Daniel Vega
- Servei de Psiquiatria i Salut Mental, Hospital d'Igualada (Consorci Sanitari de l'Anoia) Igualada, Barcelona, Spain; Unitat de Psicologia Mèdica, Departament de Psiquiatria i Medicina Legal & Institut de Neurociències, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain; Cognition and Brain Plasticity Group [Bellvitge Biomedical Research Institute-IDIBELL], L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Rafael Torrubia
- Unitat de Psicologia Mèdica, Departament de Psiquiatria i Medicina Legal & Institut de Neurociències, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Àngel Soto
- Servei de Psiquiatria i Salut Mental, Hospital d'Igualada (Consorci Sanitari de l'Anoia) Igualada, Barcelona, Spain
| | - Joan Ribas
- Servei de Psiquiatria i Salut Mental, Hospital d'Igualada (Consorci Sanitari de l'Anoia) Igualada, Barcelona, Spain
| | - Joaquim Soler
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau & Institut d'Investigació Biomèdica - Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Juan Carlos Pascual
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau & Institut d'Investigació Biomèdica - Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Antoni Rodríguez-Fornells
- Cognition and Brain Plasticity Group [Bellvitge Biomedical Research Institute-IDIBELL], L'Hospitalet de Llobregat, Barcelona, Spain; Dept. of Basic Psychology, Campus Bellvitge, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain; Catalan Institution for Research and Advanced Studies, ICREA, Barcelona, Spain
| | - Josep Marco-Pallarés
- Cognition and Brain Plasticity Group [Bellvitge Biomedical Research Institute-IDIBELL], L'Hospitalet de Llobregat, Barcelona, Spain; Dept. of Basic Psychology, Campus Bellvitge, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
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Lu WH, Lee KH, Ko CH, Hsiao RC, Hu HF, Yen CF. Relationship between borderline personality symptoms and Internet addiction: The mediating effects of mental health problems. J Behav Addict 2017; 6:434-441. [PMID: 28849668 PMCID: PMC5700727 DOI: 10.1556/2006.6.2017.053] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Aim To examine the relationship between borderline personality symptoms and Internet addiction as well as the mediating role of mental health problems between them. Methods A total of 500 college students from Taiwan were recruited and assessed for symptoms of Internet addiction using the Chen Internet Addiction Scale, borderline personality symptoms using the Taiwanese version of the Borderline Symptom List and mental health problems using four subscales from the Symptom Checklist-90-Revised Scale (interpersonal sensitivity, depression, anxiety, and hostility). Structural equation modeling (SEM) was used to test our hypothesis that borderline personality symptoms are associated with the severity of Internet addiction directly and also through the mediation of mental health problems. Results SEM analysis revealed that all paths in the hypothesized model were significant, indicating that borderline personality symptoms were directly related to the severity of Internet addiction as well as indirectly related to the severity of Internet addiction by increasing the severity of mental health problems. Conclusion Borderline personality symptoms and mental health problems should be taken into consideration when designing intervention programs for Internet addiction.
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Affiliation(s)
- Wei-Hsin Lu
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan,Department of Psychiatry, School of Medicine, and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan,Department of Psychiatry, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City, Taiwan
| | - Kun-Hua Lee
- Department of Clinical Psychology, Yuli Hospital, Ministry of Health and Welfare, Hualien, Taiwan,Department of Counseling and Clinical Psychology, National Dong Hwa University, Hualien, Taiwan
| | - Chih-Hung Ko
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan,Department of Psychiatry, School of Medicine, and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan,Department of Psychiatry, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
| | - Ray C. Hsiao
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA,Department of Psychiatry, Seattle Children’s Hospital, Seattle, WA, USA
| | - Huei-Fan Hu
- Department of Psychiatry, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan, Taiwan,Corresponding authors: Cheng-Fang Yen, MD, PhD; Department of Psychiatry, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Road, Kaohsiung 807, Taiwan; Phone: +886 7 312 4941; Fax: +886 7 313 4761; E-mail: ; Huei-Fan Hu, MD; Department of Psychiatry, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), No. 670, Chongde Road, East District, Tainan 701, Taiwan; Phone: +886 6 260 9926-886; Fax: +886 6 260 6351; E-mail:
| | - Cheng-Fang Yen
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan,Department of Psychiatry, School of Medicine, and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan,Corresponding authors: Cheng-Fang Yen, MD, PhD; Department of Psychiatry, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Road, Kaohsiung 807, Taiwan; Phone: +886 7 312 4941; Fax: +886 7 313 4761; E-mail: ; Huei-Fan Hu, MD; Department of Psychiatry, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), No. 670, Chongde Road, East District, Tainan 701, Taiwan; Phone: +886 6 260 9926-886; Fax: +886 6 260 6351; E-mail:
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Goorden M, Willemsen EMC, Bouwmans-Frijters CAM, Busschbach JJV, Noomx MJ, van der Feltz-Cornelis CM, Uyl-de Groot CA, Hakkaart-van Roijen L. Developing a decision tool to identify patients with personality disorders in need of highly specialized care. BMC Psychiatry 2017; 17:317. [PMID: 28859629 PMCID: PMC5580206 DOI: 10.1186/s12888-017-1460-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 08/11/2017] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Current guidelines recommend referral to highly specialized care for patients with severe personality disorders. However, criteria for allocation to highly specialized care are not clearly defined. The aim of the present study was to develop a decision tool that can support clinicians to identify patients with a personality disorder in need of highly specialized care. METHODS Steps taken to develop a decision tool were a literature search, concept mapping, a meeting with experts and a validation study. RESULTS The concept mapping method resulted in six criteria for the decision tool. The model used in concept mapping provided a good fit (stress value = 0.30) and reasonable reliability (ρ = 0.49). The bridging values were low, indicating homogeneity. The decision tool was subsequently validated by enrolling 368 patients from seven centers. A multilevel model with a Receiver Operating Characteristic Curve (ROC) was applied. In this way, an easily implementable decision tool with relatively high sensitivity (0.74) and specificity (0.69) was developed. CONCLUSIONS A decision tool to identify patients with personality disorders for highly specialized care was developed using advanced methods to combine the input of experts with currently available scientific knowledge. The tool appeared to be able to accurately identify this group of patients. Clinicians can use this decision tool to identify patients who are in need of highly specialized treatment.
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Affiliation(s)
- M. Goorden
- 0000000092621349grid.6906.9Erasmus University Rotterdam, Institute for Medical Technology Assessment, Institute of Health Policy & Management, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | | | - C. A. M. Bouwmans-Frijters
- 0000000092621349grid.6906.9Erasmus University Rotterdam, Institute for Medical Technology Assessment, Institute of Health Policy & Management, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - J. J. V. Busschbach
- Viersprong, Institute for Studies on Personality Disorders (VISPD), Halsteren, The Netherlands ,000000040459992Xgrid.5645.2Erasmus Medical Centre, Department of Psychiatry, Rotterdam, The Netherlands
| | - M. J. Noomx
- Zaanstad Medical Centre, Department of Psychiatry, Zaandam, The Netherlands ,Department of Child Development and Education, University of Amseterdam, Amsterdam, The Netherlands
| | - C. M. van der Feltz-Cornelis
- 0000 0001 0943 3265grid.12295.3dDepartment of Tranzo, University of Tilburg, Tilburg, The Netherlands ,Clinical Center for Body, Mind and Health, Academic Psychiatry Department, GGZBreburg, Tilburg, The Netherlands
| | - C. A. Uyl-de Groot
- 0000000092621349grid.6906.9Erasmus University Rotterdam, Institute for Medical Technology Assessment, Institute of Health Policy & Management, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - L. Hakkaart-van Roijen
- 0000000092621349grid.6906.9Erasmus University Rotterdam, Institute for Medical Technology Assessment, Institute of Health Policy & Management, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
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Lindberg N, Miettunen J, Heiskala A, Kaltiala-Heino R. Mortality of young offenders: a national register-based follow-up study of 15- to 19-year-old Finnish delinquents referred for forensic psychiatric examination between 1980 and 2010. Child Adolesc Psychiatry Ment Health 2017; 11:37. [PMID: 28794798 PMCID: PMC5547467 DOI: 10.1186/s13034-017-0174-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 06/27/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The mortality rate of young offenders is high. Furthermore, mortality in young offenders is associated with psychiatric and substance use disorders. The primary aim of this national register-based follow-up study was to investigate the mortality rate of Finnish delinquents who underwent a forensic psychiatric examination between 1980 and 2010. As delinquency is not a solid entity, we further aimed to compare the risk of premature death among different subgroups of the delinquents; violent versus non-violent offenders, offenders with alcohol use disorders versus those with no such diagnoses, offenders with schizophrenia spectrum disorders versus conduct- and personality-disordered offenders, under-aged versus young adult offenders, and, finally, boys versus girls. METHODS We collected the forensic psychiatric examination reports of all 15- to 19-year-old offenders who were born in Finland and had undergone the examination between 1.1.1980 and 31.12.2010 (n = 606) from the archives of the National Institute of Health and Welfare and retrospectively reviewed them. For each delinquent, four age-, gender- and place of birth-matched controls were randomly selected from the Central Population Register (n = 2424). The delinquents and their controls were followed until the end of 2015. The median follow-up time was 23.9 years (interquartile range 15.3-29.5). We obtained the mortality data from the causes of death register. Deaths attributable to a disease or an occupational disease were considered natural, and those attributable to an accident, suicide or homicide were considered unnatural. RESULTS By the end of the follow-up period, 22.1% (n = 134) of the delinquents and 3.4% (n = 82) of their controls had died (OR 8.11, 95% CI 6.05-10.86, p < 0.001). Among boys, 22.0% (n = 121) of the delinquents and 3.7% (n = 81) of the controls had died (OR 7.38, 95% CI 5.46-9.95, p < 0.001). Male delinquents' risk of unnatural death was almost 11-fold, of natural death more than twofold, and of unclear death more than fourfold compared to that of their controls. No girls had natural or unclear deaths, but 23.6% (n = 13) of the delinquents and 0.5% (n = 1) of the controls had died due to unnatural causes (OR 67.79, 95% CI 8.63-532.00, p < 0.001). The violent delinquents' risk of premature death was twice that of the non-violent delinquents. The other comparisons demonstrated no statistically significant differences between subgroups. CONCLUSIONS Even though the Finnish correction system prefers psychiatric treatment and rehabilitation over criminal sanctions, and the national health care system offers developmental-phase-specific psychiatric care, the mortality rate of delinquents, especially of those with a history of violent offences, is high. The excess mortality of offenders can be regarded as a specific public-health inequity that calls for more effective intervention procedures than those used thus far.
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Affiliation(s)
- Nina Lindberg
- 0000 0000 9950 5666grid.15485.3dForensic Psychiatry, Helsinki University and Helsinki University Hospital, PO Box 590, 00029 HUS Helsinki, Finland
| | - Jouko Miettunen
- 0000 0001 0941 4873grid.10858.34Center for Life Course Health Research, University of Oulu, Oulu, Finland ,0000 0004 4685 4917grid.412326.0Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Anni Heiskala
- 0000 0001 0941 4873grid.10858.34Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Riittakerttu Kaltiala-Heino
- 0000 0001 2314 6254grid.5509.9School of Medicine, Tampere University, Tampere, Finland ,0000 0004 0628 2985grid.412330.7Department of Adolescent Psychiatry, Tampere University Hospital, Tampere, Finland ,0000 0004 0628 2766grid.417253.6Vanha Vaasa Hospital, Vaasa, Finland
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Thompson RG, Eaton NR, Hu MC, Hasin DS. Borderline personality disorder and regularly drinking alcohol before sex. Drug Alcohol Rev 2017; 36:540-545. [PMID: 28321919 DOI: 10.1111/dar.12476] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 07/26/2016] [Accepted: 07/29/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND AIMS Drinking alcohol before sex increases the likelihood of engaging in unprotected intercourse, having multiple sexual partners and becoming infected with sexually transmitted infections. Borderline personality disorder (BPD), a complex psychiatric disorder characterised by pervasive instability in emotional regulation, self-image, interpersonal relationships and impulse control, is associated with substance use disorders and sexual risk behaviours. However, no study has examined the relationship between BPD and drinking alcohol before sex in the USA. This study examined the association between BPD and regularly drinking before sex in a nationally representative adult sample. DESIGN AND METHODS Participants were 17 491 sexually active drinkers from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Logistic regression models estimated effects of BPD diagnosis, specific borderline diagnostic criteria and BPD criterion count on the likelihood of regularly (mostly or always) drinking alcohol before sex, adjusted for controls. RESULTS Borderline personality disorder diagnosis doubled the odds of regularly drinking before sex [adjusted odds ratio (AOR) = 2.26; confidence interval (CI) = 1.63, 3.14]. Of nine diagnostic criteria, impulsivity in areas that are self-damaging remained a significant predictor of regularly drinking before sex (AOR = 1.82; CI = 1.42, 2.35). The odds of regularly drinking before sex increased by 20% for each endorsed criterion (AOR = 1.20; CI = 1.14, 1.27) DISCUSSION AND CONCLUSIONS: This is the first study to examine the relationship between BPD and regularly drinking alcohol before sex in the USA. Substance misuse treatment should assess regularly drinking before sex, particularly among patients with BPD, and BPD treatment should assess risk at the intersection of impulsivity, sexual behaviour and substance use. [Thompson Jr RG, Eaton NR, Hu M-C, Hasin DS Borderline personality disorder and regularly drinking alcohol before sex Drug Alcohol Rev 2017;36:540-545].
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Affiliation(s)
- Ronald G Thompson
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, USA
| | | | - Mei-Chen Hu
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, USA
| | - Deborah S Hasin
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, USA.,New York State Psychiatric Institute, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
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35
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Scheiderer E, Carlile JA, Aosved AC, Barlow A. Concurrent Dialectical Behavior Therapy and Prolonged Exposure Reduces Symptoms and Improves Overall Quality of Life for a Veteran With Posttraumatic Stress Disorder and Borderline Personality Disorder. Clin Case Stud 2017. [DOI: 10.1177/1534650116688557] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article presents a case study illustration of integrated, concurrent dialectical behavior therapy (DBT) and prolonged exposure (PE), conducted within a Veterans Affairs health care system. Treatment in this case effectively reduced symptoms and improved overall quality of life. Based on clinical complexities encountered (e.g., substance use, nonsuicidal self-harm, treatment setting constraints), recommendations are provided for concurrent treatment of posttraumatic stress disorder and borderline personality disorder in veterans. Recommendations include consideration of flexibility in duration of pre-PE stabilization, modification of DBT phone coaching protocol, management of structural barriers to treatment access, full use of consultation, and coordination of clinician roles.
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Affiliation(s)
| | | | | | - Alycia Barlow
- VA Puget Sound, American Lake Division, Tacoma, WA, USA
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36
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De Vidovich GZ, Muffatti R, Monaco J, Caramia N, Broglia D, Caverzasi E, Barale F, D'Angelo E. Repetitive TMS on Left Cerebellum Affects Impulsivity in Borderline Personality Disorder: A Pilot Study. Front Hum Neurosci 2016; 10:582. [PMID: 27994543 PMCID: PMC5136542 DOI: 10.3389/fnhum.2016.00582] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 11/02/2016] [Indexed: 12/13/2022] Open
Abstract
The borderline personality disorder (BPD) is characterized by a severe pattern of instability in emotional regulation, interpersonal relationships, identity and impulse control. These functions are related to the prefrontal cortex (PFC), and since PFC shows a rich anatomical connectivity with the cerebellum, the functionality of the cerebellar-PFC axis may impact on BPD. In this study, we investigated the potential involvement of cerebello-thalamo-cortical connections in impulsive reactions through a pre/post stimulation design. BPD patients (n = 8) and healthy controls (HC; n = 9) performed an Affective Go/No-Go task (AGN) assessing information processing biases for positive and negative stimuli before and after repetitive transcranial magnetic stimulation (rTMS; 1 Hz/10 min, 80% resting motor threshold (RMT) over the left lateral cerebellum. The AGN task consisted of four blocks requiring associative capacities of increasing complexity. BPD patients performed significantly worse than the HC, especially when cognitive demands were high (third and fourth block), but their performance approached that of HC after rTMS (rTMS was almost ineffective in HC). The more evident effect of rTMS in complex associative tasks might have occurred since the cerebellum is deeply involved in integration and coordination of different stimuli. We hypothesize that in BPD patients, cerebello-thalamo-cortical communication is altered, resulting in emotional dysregulation and disturbed impulse control. The rTMS over the left cerebellum might have interfered with existing functional connections exerting a facilitating effect on PFC control.
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Affiliation(s)
- Giulia Zelda De Vidovich
- Department of Brain and Behavioral Sciences, University of PaviaPavia, Italy; Psychiatry Unit, Santi Paolo e Carlo Hospital of MilanMilan, Italy; Interdepartmental Center for Research on Personality Disorders, University of PaviaPavia, Italy
| | | | - Jessica Monaco
- Department of Brain and Behavioral Sciences, University of PaviaPavia, Italy; Brain Connectivity Center, C. Mondino National Neurological InstitutePavia, Italy
| | - Nicoletta Caramia
- Department of Brain and Behavioral Sciences, University of PaviaPavia, Italy; Brain Connectivity Center, C. Mondino National Neurological InstitutePavia, Italy
| | - Davide Broglia
- Interdepartmental Center for Research on Personality Disorders, University of Pavia Pavia, Italy
| | - Edgardo Caverzasi
- Interdepartmental Center for Research on Personality Disorders, University of Pavia Pavia, Italy
| | - Francesco Barale
- Interdepartmental Center for Research on Personality Disorders, University of Pavia Pavia, Italy
| | - Egidio D'Angelo
- Department of Brain and Behavioral Sciences, University of PaviaPavia, Italy; Brain Connectivity Center, C. Mondino National Neurological InstitutePavia, Italy
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37
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Langdon KJ, Rubin A, Brief DJ, Enggasser JL, Roy M, Solhan M, Helmuth E, Rosenbloom D, Keane TM. Sexual Traumatic Event Exposure, Posttraumatic Stress Symptomatology, and Alcohol Misuse Among Women: A Critical Review of the Empirical Literature. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2016. [DOI: 10.1111/cpsp.12167] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Kirsten J. Langdon
- National Center for PTSD; Women's Health Sciences Division; VA Boston Healthcare System; Boston University School of Medicine
| | - Amy Rubin
- National Center for PTSD; VA Boston Healthcare System; Boston University School of Medicine
| | - Deborah J. Brief
- National Center for PTSD; VA Boston Healthcare System; Boston University School of Medicine
| | | | - Monica Roy
- VA Boston Healthcare System; Boston University School of Medicine
| | - Marika Solhan
- VA Boston Healthcare System; Boston University School of Medicine
| | - Eric Helmuth
- National Center for PTSD; Boston University School of Public Health
| | - David Rosenbloom
- National Center for PTSD; Boston University School of Public Health
| | - Terence M. Keane
- National Center for PTSD; VA Boston Healthcare System; Boston University School of Medicine
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38
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Fossati A, Gratz KL, Somma A, Maffei C, Borroni S. The Mediating Role of Emotion Dysregulation in the Relations Between Childhood Trauma History and Adult Attachment and Borderline Personality Disorder Features: A Study of Italian Nonclinical Participants. J Pers Disord 2016; 30:653-676. [PMID: 26583588 DOI: 10.1521/pedi_2015_29_222] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In order to evaluate if emotion dysregulation significantly mediates the relationships between childhood abuse and adult attachment and borderline personality disorder features, 354 community Italian adults were administered the Borderline Personality Inventory (Leichsenring, 1999a), the Difficulties in Emotion Regulation Scale (Gratz & Roemer, 2004), the Child Abuse and Trauma Scale (Sanders & Becker-Lausen, 1995), and the Attachment Style Questionnaire (Feeney, Noller, & Hanrahan, 1994). Hierarchical regression analyses showed that both childhood abuse and adult attachment were positively associated with emotion dysregulation and borderline personality features; however, only emotional abuse and the attachment dimension of need for approval were common predictors of both dependent variables. No significant interaction effects were detected in regression analyses. Mediation analyses provided support for partial mediation, revealing a significant mediating role of emotion dysregulation in the relationships between both emotional abuse and need for approval and borderline personality features in this community sample.
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Affiliation(s)
- Andrea Fossati
- Department of Human Studies, LUMSA University, Rome, Italy
| | - Kim L Gratz
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson
| | | | - Cesare Maffei
- Faculty of Psychology, Vita Salute San Raffaele University, Milan, Italy
| | - Serena Borroni
- Faculty of Psychology, Vita Salute San Raffaele University, Milan, Italy
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39
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Reuter TR, Sharp C, Kalpakci AH, Choi HJ, Temple JR. Sexual Orientation and Borderline Personality Disorder Features in a Community Sample of Adolescents. J Pers Disord 2016; 30:694-707. [PMID: 26583589 DOI: 10.1521/pedi_2015_29_224] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Empirical literature demonstrates that sexual minorities are at an increased risk of developing psychopathology, including borderline personality disorder (BPD). The specific link between sexual orientation and BPD has received significantly less attention in youth, and it remains unclear what drives this relation. Given that there are higher rates of psychopathology in both sexual minorities and individuals with BPD, the present study aimed to determine if sexual orientation uniquely contributes to borderline personality pathology, controlling for other psychopathology. An ethnically diverse sample of 835 adolescents completed self-report measures of borderline features, depression, anxiety, and sexual orientation. Sexual minorities scored higher on borderline features compared to heterosexual adolescents. When controlling for depression and anxiety, sexual orientation remained significantly associated with borderline features. The relation between sexual orientation and BPD cannot fully be explained by other psychopathology. Future research is necessary to understand potential mechanisms underlying this relation.
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Affiliation(s)
| | | | | | - Hye J Choi
- University of Texas Medical Branch, Galveston, Texas
| | - Jeff R Temple
- University of Texas Medical Branch, Galveston, Texas
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40
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Buchheim A, Erk S, George C, Kächele H, Martius P, Pokorny D, Spitzer M, Walter H. Neural Response during the Activation of the Attachment System in Patients with Borderline Personality Disorder: An fMRI Study. Front Hum Neurosci 2016; 10:389. [PMID: 27531977 PMCID: PMC4969290 DOI: 10.3389/fnhum.2016.00389] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 07/19/2016] [Indexed: 11/13/2022] Open
Abstract
Individuals with borderline personality disorder (BPD) are characterized by emotional instability, impaired emotion regulation and unresolved attachment patterns associated with abusive childhood experiences. We investigated the neural response during the activation of the attachment system in BPD patients compared to healthy controls using functional magnetic resonance imaging (fMRI). Eleven female patients with BPD without posttraumatic stress disorder (PTSD) and 17 healthy female controls matched for age and education were telling stories in the scanner in response to the Adult Attachment Projective Picture System (AAP), an eight-picture set assessment of adult attachment. The picture set includes theoretically-derived attachment scenes, such as separation, death, threat and potential abuse. The picture presentation order is designed to gradually increase the activation of the attachment system. Each picture stimulus was presented for 2 min. Analyses examine group differences in attachment classifications and neural activation patterns over the course of the task. Unresolved attachment was associated with increasing amygdala activation over the course of the attachment task in patients as well as controls. Unresolved controls, but not patients, showed activation in the right dorsolateral prefrontal cortex (DLPFC) and the rostral cingulate zone (RCZ). We interpret this as a neural signature of BPD patients’ inability to exert top-down control under conditions of attachment distress. These findings point to possible neural mechanisms for underlying affective dysregulation in BPD in the context of attachment trauma and fear.
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Affiliation(s)
- Anna Buchheim
- Institute of Psychology, University of Innsbruck Innsbruck, Austria
| | - Susanne Erk
- Department of Psychiatry and Psychotherapy, Division of Mind and Brain Research, University Hospital Charité Berlin, Germany
| | - Carol George
- Department of Psychology, Mills College Oakland, CA, USA
| | - Horst Kächele
- International Psychoanalytic University Berlin Berlin, Germany
| | | | - Dan Pokorny
- Department of Psychosomatic Medicine and Psychotherapy, University of Ulm Ulm, Germany
| | - Manfred Spitzer
- Department of Psychiatry III, University of Ulm Ulm, Germany
| | - Henrik Walter
- Department of Psychiatry and Psychotherapy, Division of Mind and Brain Research, University Hospital Charité Berlin, Germany
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41
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Denny BT, Fan J, Liu X, Guerreri S, Mayson SJ, Rimsky L, McMaster A, Alexander H, New AS, Goodman M, Perez-Rodriguez M, Siever LJ, Koenigsberg HW. Brain structural anomalies in borderline and avoidant personality disorder patients and their associations with disorder-specific symptoms. J Affect Disord 2016; 200:266-74. [PMID: 27155069 PMCID: PMC5841761 DOI: 10.1016/j.jad.2016.04.053] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 03/22/2016] [Accepted: 04/23/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Borderline personality disorder (BPD) and avoidant personality disorder (AvPD) are characterized by hyper-reactivity to negatively-perceived interpersonal cues, yet they differ in degree of affective instability. Recent work has begun to elucidate the neural (structural and functional) and cognitive-behavioral underpinnings of BPD, although some initial studies of brain structure have reached divergent conclusions. AvPD, however, has been almost unexamined in the cognitive neuroscience literature. METHODS In the present study we investigated group differences among 29 BPD patients, 27 AvPD patients, and 29 healthy controls (HC) in structural brain volumes using voxel-based morphometry (VBM) in five anatomically-defined regions of interest: amygdala, hippocampus, medial prefrontal cortex (MPFC), dorsolateral prefrontal cortex (DLPFC), and anterior cingulate cortex (ACC). We also examined the relationship between individual differences in brain structure and self-reported anxiety and affective instability in each group. RESULTS We observed reductions in MPFC and ACC volume in BPD relative to HC, with no significant difference among patient groups. No group differences in amygdala volume were found. However, BPD and AvPD patients each showed a positive relationship between right amygdala volume and state-related anxiety. By contrast, in HC there was an inverse relationship between MPFC volume and state and trait-related anxiety as well as between bilateral DLPFC volume and affective instability. LIMITATIONS Current sample sizes did not permit examination of gender effects upon structure-symptom correlations. CONCLUSIONS These results shed light on potentially protective, or compensatory, aspects of brain structure in these populations-namely, relatively reduced amygdala volume or relatively enhanced MPFC and DLPFC volume.
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Affiliation(s)
- Bryan T. Denny
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Jin Fan
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA,Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA,Department of Psychology, Queens College, City University of New York, New York, NY, 11367, USA
| | - Xun Liu
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Stephanie Guerreri
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Sarah Jo Mayson
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Liza Rimsky
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Antonia McMaster
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Heather Alexander
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Antonia S. New
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA,James J Peters VA Medical Center, Bronx, NY, 10468, USA
| | - Marianne Goodman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA,James J Peters VA Medical Center, Bronx, NY, 10468, USA
| | | | - Larry J. Siever
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA,James J Peters VA Medical Center, Bronx, NY, 10468, USA
| | - Harold W. Koenigsberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA,James J Peters VA Medical Center, Bronx, NY, 10468, USA,Corresponding author. Mental Health Patient Care Center, James J Peters VA Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468, Tel.: 212 241 4459; fax: 212 241 7930.
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42
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Schoenleber M, Berghoff CR, Tull MT, DiLillo D, Messman-Moore T, Gratz KL. Emotional lability and affective synchrony in borderline personality disorder. Personal Disord 2016. [PMID: 27362623 DOI: 10.1037/per0000145.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Extant research on emotional lability in borderline personality disorder (BPD) has focused almost exclusively on lability of individual emotions or emotion types, with limited research considering how different types of emotions shift together over time. Thus, this study examined the temporal dynamics of emotion in BPD at the level of both individual emotions (i.e., self-conscious emotions [SCE], anger, and anxiety) and mixed emotions (i.e., synchrony between emotions). One hundred forty-four women from the community completed a diagnostic interview and laboratory study involving 5 emotion induction tasks (each of which was preceded and followed by a 5-min resting period or neutral task). State ratings of SCE, anger, and anxiety were provided at 14 time points (before and after each laboratory task and resting period). Hierarchical linear modeling results indicate that women with BPD reported greater mean levels of SCE and Anxiety (but not Anger), and greater lability of Anxiety. Women with BPD also exhibited greater variability in lability of all 3 emotions (suggestive of within-group differences in the relevance of lability to BPD). Results also revealed synchrony (i.e., positive relations) between each possible pair of emotions, regardless of BPD status. Follow-up regression analyses suggest the importance of accounting for lability when examining the role of synchrony in BPD, as the relation of SCE-Anger synchrony to BPD symptom severity was moderated by Anger and SCE lability. Specifically, synchronous changes in SCE and Anger were associated with greater BPD symptom severity when large shifts in SCE were paired with minor shifts in Anger. (PsycINFO Database Record
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Affiliation(s)
- Michelle Schoenleber
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center
| | | | - Matthew T Tull
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center
| | - David DiLillo
- Department of Psychology, University of Nebraska-Lincoln
| | | | - Kim L Gratz
- Department of Psychiatry and Human Behavior, University of Mississippi Medical
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43
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The role of hypothalamus-pituitary-adrenal genes and childhood trauma in borderline personality disorder. Eur Arch Psychiatry Clin Neurosci 2016; 266:307-16. [PMID: 26182893 DOI: 10.1007/s00406-015-0612-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 06/29/2015] [Indexed: 12/22/2022]
Abstract
Current knowledge suggests that borderline personality disorder (BPD) results from the interaction between genetic and environmental factors. Research has mainly focused on monoaminergic genetic variants and their modulation by traumatic events, especially those occurring during childhood. However, to the best of our knowledge, there are no studies on the genetics of hypothalamus-pituitary-adrenal (HPA) axis, despite its vulnerability to early stress and its involvement in BPD pathogenesis. The aim of this study was to investigate the contribution of genetic variants in the HPA axis and to explore the modulating effect of childhood trauma in a large sample of BPD patients and controls. DNA was obtained from a sample of 481 subjects with BPD and 442 controls. Case-control differences in allelic frequencies of 47 polymorphisms in 10 HPA axis genes were analysed. Modulation of genetic associations by the presence of childhood trauma was also investigated by dividing the sample into three groups: BPD with trauma, BPD without trauma and controls. Two FKBP5 polymorphisms (rs4713902-C and rs9470079-A) showed significant associations with BPD. There were also associations between BPD and haplotype combinations of the genes FKBP5 and CRHR1. Two FKBP5 alleles (rs3798347-T and rs10947563-A) were more frequent in BPD subjects with history of physical abuse and emotional neglect and two CRHR2 variants (rs4722999-C and rs12701020-C) in BPD subjects with sexual and physical abuse. Our findings suggest a contribution of HPA axis genetic variants to BPD pathogenesis and reinforce the hypothesis of the modulating effect of childhood trauma in the development of this disorder.
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44
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Leppänen V, Hakko H, Sintonen H, Lindeman S. Comparing Effectiveness of Treatments for Borderline Personality Disorder in Communal Mental Health Care: The Oulu BPD Study. Community Ment Health J 2016; 52:216-27. [PMID: 25824852 DOI: 10.1007/s10597-015-9866-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 03/24/2015] [Indexed: 11/29/2022]
Abstract
The implementation of effective psychotherapies in community mental health care is challenging. This study aimed to create a well-structured and easily applicable treatment model for patients with severe borderline personality disorder (BPD). We integrated a schema therapy based psycho-educational group into an available individual therapy. Two groups were formed: (1) community treatment by experts (CTBE) patients (n = 24) receiving new treatment and (2) treatment as usual (TAU) patients (n = 47). Changes in symptoms were measured by Borderline Personality Disorder Severity Index-IV interview and quality of life by the 15D health-related quality of life questionnaire. After 1 year the CTBE patients showed a significant reduction in a wider range of BPD symptoms and better quality of life than TAU patients. The results of this study are encouraging. A well-structured treatment model was successfully implemented into community mental health care with improved patient adherence to treatment and superior treatment outcomes compared to TAU patients.
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Affiliation(s)
- V Leppänen
- Social and Health Services, Mental Health Services, P.O. Box 13, 90015, Oulu City, Finland.
| | - H Hakko
- Department of Psychiatry, Oulu University Hospital, P.O. Box 26, 90029, Oulu City, Finland.
| | - H Sintonen
- Health Economics, Department of Public Health, University of Helsinki, P.O. Box 41, 00014, Helsinki, Finland.
| | - S Lindeman
- Institute of Clinical Medicine, Department of Psychiatry, Central Finland Health Care District, Jyväskylä Central Hospital, University of Eastern Finland, Matarankatu 6 B, 40100, Jyväskylä, Finland.
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45
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Teschler S, Gotthardt J, Dammann G, Dammann RH. Aberrant DNA Methylation of rDNA and PRIMA1 in Borderline Personality Disorder. Int J Mol Sci 2016; 17:ijms17010067. [PMID: 26742039 PMCID: PMC4730312 DOI: 10.3390/ijms17010067] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 12/28/2015] [Accepted: 12/29/2015] [Indexed: 12/17/2022] Open
Abstract
Borderline personality disorder (BPD) is a serious psychic disease with a high risk for suicide. DNA methylation is a hallmark for aberrant epigenetic regulation and could be involved in the etiology of BPD. Previously, it has been reported that increased DNA methylation of neuropsychiatric genes is found in the blood of patients with BPD compared to healthy controls. Here, we analyzed DNA methylation patterns of the ribosomal RNA gene (rDNA promoter region and 5′-external transcribed spacer/5′ETS) and the promoter of the proline rich membrane anchor 1 gene (PRIMA1) in peripheral blood samples of 24 female patients (mean age (33 ± 11) years) diagnosed with DSM-IV BPD and in 11 female controls (mean age (32 ± 7) years). A significant aberrant methylation of rDNA and PRIMA1 was revealed for BPD patients using pyrosequencing. For the promoter of PRIMA1, the average methylation of six CpG sites was 1.6-fold higher in BPD patients compared to controls. In contrast, the methylation levels of the rDNA promoter region and the 5′ETS were significantly lower (0.9-fold) in patients with BPD compared to controls. Thus, for nine CpGs located in the rDNA promoter region and for four CpGs at the 5′ETS decreased methylation was found in peripheral blood of patients compared to controls. Our results suggest that aberrant methylation of rDNA and PRIMA1 is associated with the pathogenesis of BPD.
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Affiliation(s)
- Stefanie Teschler
- Institute for Genetics, Justus-Liebig-University Giessen, D-35392 Giessen, Germany.
| | - Julia Gotthardt
- Institute for Genetics, Justus-Liebig-University Giessen, D-35392 Giessen, Germany.
| | - Gerhard Dammann
- Psychiatric Hospital, Psychiatric Services of Thurgovia, CH-8596 Münsterlingen, Switzerland and Department of Psychiatry, Paracelsus Medical University, A-5020 Salzburg, Austria.
| | - Reinhard H Dammann
- Institute for Genetics, Justus-Liebig-University Giessen, D-35392 Giessen, Germany.
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46
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Dixon-Gordon KL, Weiss NH, Tull MT, DiLillo D, Messman-Moore T, Gratz KL. Characterizing emotional dysfunction in borderline personality, major depression, and their co-occurrence. Compr Psychiatry 2015; 62:187-203. [PMID: 26343484 PMCID: PMC4561853 DOI: 10.1016/j.comppsych.2015.07.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 07/14/2015] [Accepted: 07/22/2015] [Indexed: 12/21/2022] Open
Abstract
This research aimed to characterize patterns of emotional reactivity and dysregulation in borderline personality, depression, and their co-occurrence. In study 1, 488 young adult women from the community were categorized into four groups based on self-reported major depressive disorder (MDD) and borderline personality disorder (BPD) symptoms (Low BPD/Low MDD; Low BPD/High MDD; High BPD/Low MDD; High BPD/High MDD). Immediate and prolonged subjective emotional reactivity to a laboratory stressor were assessed, and participants completed self-report and behavioral measures of emotion dysregulation. Study 2 extended these findings, examining emotional reactivity and dysregulation in a clinical population of 176 substance dependent patients with diagnoses of BPD and MDD and including a biological index of emotional reactivity. Results revealed greater prolonged fear reactivity in the High BPD/High MDD (vs. Low BPD/Low MDD) group in study 1, and greater prolonged anxiety and negative affect reactivity in both High BPD groups (vs. Low BPD/Low MDD and Low BPD/High MDD groups) in study 2 (but no differences in cortisol reactivity). Results also demonstrated greater subjective (but not behavioral) emotion dysregulation in the High BPD/High MDD (vs. Low BPD/Low MDD) group in study 1 and both High BPD groups (vs. both Low BPD groups) in study 2. Finally, the High BPD/High MDD group reported greater difficulties controlling impulsive behaviors compared with all other groups in study 1 and the Low BPD groups in study 2. Findings suggest that BPD pathology (but not MDD pathology alone) is characterized by greater prolonged emotional (especially anxiety/fear-related) reactivity and heightened emotion dysregulation.
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Affiliation(s)
- Katherine L. Dixon-Gordon
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Nicole H. Weiss
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Matthew T. Tull
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA
| | - David DiLillo
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | | | - Kim L. Gratz
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA,Correspondence concerning this article should be addressed to Kim L. Gratz, Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS 39216; Phone: (601) 815-6450;
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47
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Martín-Blanco A, Ferrer M, Soler J, Arranz MJ, Vega D, Bauzà J, Calvo N, Elices M, Sanchez-Mora C, García-Martinez I, Salazar J, Ribases M, Carmona C, Prat M, Pascual JC. An exploratory association study of the influence of noradrenergic genes and childhood trauma in Borderline Personality Disorder. Psychiatry Res 2015. [PMID: 26216165 DOI: 10.1016/j.psychres.2015.07.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This study investigated the possible association of 40 polymorphisms within 4 noradrenergic genes with BPD risk and the modulating effect of childhood trauma on these associations in 481 BPD subjects and 442 controls. COMT rs5993882, DBH rs77905 and SLC6A2 rs1814270 showed associations with BPD, which were modulated by childhood trauma. However, none of these findings survived Bonferroni correction. Further investigation is needed to clarify the involvement of these genes in BPD pathogenesis.
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Affiliation(s)
- Ana Martín-Blanco
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Av. Sant Antoni Mª Claret 167, 08025 Barcelona Spain; Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona, Spain
| | - Marc Ferrer
- Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona, Spain; Department of Psychiatry, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Joaquim Soler
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Av. Sant Antoni Mª Claret 167, 08025 Barcelona Spain; Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona, Spain
| | - Maria Jesús Arranz
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Av. Sant Antoni Mª Claret 167, 08025 Barcelona Spain; Fundació Docència i Recerca Mútua Terrassa, Terrassa, Spain
| | - Daniel Vega
- Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona, Spain; Department of Psychiatry and Mental Health, Consorci Sanitari de l'Anoia, Spain; Institut of Neurosciences, Universitat Autònoma de Barcelona, Spain
| | - Joana Bauzà
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Av. Sant Antoni Mª Claret 167, 08025 Barcelona Spain; Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona, Spain
| | - Natalia Calvo
- Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona, Spain; Department of Psychiatry, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Matilde Elices
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Av. Sant Antoni Mª Claret 167, 08025 Barcelona Spain; Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona, Spain
| | - Cristina Sanchez-Mora
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institut (VHIR), Universitat Autònoma de Barcelona, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Iris García-Martinez
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institut (VHIR), Universitat Autònoma de Barcelona, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Juliana Salazar
- Department of Genetics, Hospital de la Santa Creu i Sant Pau, U705 CIBERER, Barcelona, Spain
| | - Marta Ribases
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institut (VHIR), Universitat Autònoma de Barcelona, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Cristina Carmona
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Av. Sant Antoni Mª Claret 167, 08025 Barcelona Spain; Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona, Spain
| | - Mónica Prat
- Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona, Spain; Department of Psychiatry, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Juan C Pascual
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Av. Sant Antoni Mª Claret 167, 08025 Barcelona Spain; Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona, Spain.
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Abstract
BACKGROUND Impulsivity is a core feature of borderline personality disorder (BPD) and is most frequently measured using self-rating scales. There is a need to find objective, valid and reliable measures of impulsivity. This study aimed to examine performance of participants with BPD compared with healthy controls on delay and probabilistic discounting tasks and the stop-signal task (SST), which are objective measures of choice and motor impulsivity, respectively. METHOD A total of 20 participants with BPD and 21 healthy control participants completed delay and probabilistic discounting tasks and the SST. They also completed the Barratt Impulsiveness Scale (BIS), a self-rating measure of impulsivity. RESULTS Participants with BPD showed significantly greater delay discounting than controls, manifest as a greater tendency to accept the immediately available lesser reward rather than waiting longer for a greater reward. Similarly they showed significantly greater discounting of rewards by the probability of payout, which correlated with past childhood trauma. Participants with BPD were found to choose the more certain and/or immediate rewards, irrespective of the value. On the SST the BPD and control groups did not differ significantly, demonstrating no difference in motor impulsivity. There was no significant difference between groups on self-reported impulsivity as measured by the BIS. CONCLUSIONS Measures of impulsivity show that while motor impulsivity was not significantly different in participants with BPD compared with controls, choice or reward-related impulsivity was significantly affected in those with BPD. This suggests that choice impulsivity but not motor impulsivity is a core feature of BPD.
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Affiliation(s)
- V Barker
- Division of Psychiatry,Centre for Brain Sciences,School of Clinical Sciences, University of Edinburgh, Royal Edinburgh Hospital,Morningside Park,Edinburgh EH10 5HF,UK
| | - L Romaniuk
- Division of Psychiatry,Centre for Brain Sciences,School of Clinical Sciences, University of Edinburgh, Royal Edinburgh Hospital,Morningside Park,Edinburgh EH10 5HF,UK
| | - R N Cardinal
- Department of Psychiatry,Behavioural & Clinical Neuroscience Institute, University of Cambridge,Downing Street,Cambridge CB2 3EB,UK
| | - M Pope
- Royal Edinburgh Hospital,Morningside Park,Edinburgh EH10 5HF,UK
| | - K Nicol
- Division of Psychiatry,Centre for Brain Sciences,School of Clinical Sciences, University of Edinburgh, Royal Edinburgh Hospital,Morningside Park,Edinburgh EH10 5HF,UK
| | - J Hall
- Division of Psychiatry,Centre for Brain Sciences,School of Clinical Sciences, University of Edinburgh, Royal Edinburgh Hospital,Morningside Park,Edinburgh EH10 5HF,UK
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49
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Bech M, Elklit A, Simonsen E. Autobiographical memory in borderline personality disorder-A systematic review. Personal Ment Health 2015; 9:162-71. [PMID: 25940516 DOI: 10.1002/pmh.1294] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 02/13/2015] [Accepted: 02/16/2015] [Indexed: 11/11/2022]
Abstract
Borderline personality disorder is a severe psychiatric illness. A key feature of the disorder is a disorganized sense of self often referred to as identity diffusion. Autobiographical memory is memory for personal life events. One of the main functions of these memories is to enable us to understand who we are by connecting past, present and future experiences. It seems that autobiographical memory is in some way disrupted in individuals with borderline personality disorder. A systematic review is conducted looking at studies that focus on the potential connections. We find that although a number of studies have been published results remain inconsistent. Furthermore, we find that many of the studies suffer from inadequate designs particularly regarding the reported measures of autobiographical memory. We discuss potential links between personality functioning, identity diffusion, autobiographical memory and borderline personality disorder.
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Affiliation(s)
- Morten Bech
- Department of Psychology, Faculty of Health, University of Southern Denmark, Odense, Denmark
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50
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Bounoua N, Felton JF, Long K, Stadnik RD, Loya JM, MacPherson L, Lejuez CW. Childhood emotional abuse and borderline personality features: The role of anxiety sensitivity among adolescents. Personal Ment Health 2015; 9:87-95. [PMID: 25940514 DOI: 10.1002/pmh.1295] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 02/18/2015] [Accepted: 03/02/2015] [Indexed: 11/06/2022]
Abstract
Borderline personality disorder (BPD) is a pervasive personality disorder that poses a burden for affected individuals, their family members and society as a whole. Current research suggests that early childhood abuse, including emotional abuse, may be an important predictor of later BPD symptomology. Further, an emerging body of literature suggests that anxiety sensitivity (AS) may serve as a form of emotional vulnerability and be a key variable in the relation between abuse and the development of BPD symptomatology. This literature has relied on retrospective recall of abuse and AS in adult samples. As a result, there is a dearth of literature examining these variables in adolescence, which is a developmental period in which personality traits begin to emerge. This study explored the impact of AS in the development of BPD symptoms in a group of 277 adolescents. Results suggest a significant indirect effect of emotional abuse on BPD symptoms via AS, after controlling for sex, grade and prior levels of AS (indirect effect = 0.04, standard error (SE) = 0.02 (95% confidence interval (CI) = 0.001-0.070)). These findings suggest that, among adolescents, AS may serve as an important contributor to the development of BPD symptoms. Implications for interventions and future research are further discussed.
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Affiliation(s)
- Nadia Bounoua
- Center for Addictions, Personality and Emotion Research, Department of Psychology, University of Maryland, College Park, MD, 20742, USA
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