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Broadbear JH, Bhagwandas MG, Crowley S, Cheney L, Rao S. Exploring the Pathways to Diagnosis for Men With Borderline Personality Disorder: A Qualitative Study. Int J Ment Health Nurs 2024. [PMID: 39225121 DOI: 10.1111/inm.13413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 08/09/2024] [Accepted: 08/18/2024] [Indexed: 09/04/2024]
Abstract
Borderline personality disorder (BPD) is often perceived as being more common in females, since women are more likely to seek help and be diagnosed. However, epidemiological studies have reported no sex differences in community prevalence. The purpose of this study was to learn from the narrative journeys of men who have received a diagnosis of BPD. Eight men participated, mean age 45.9 years (range 27-73 years). Recruitment was through clinician referrals at the study site and via social media and website advertising. Participants consented to a 60-90-min semi-structured interview via an audio-visual digital platform. Audio recordings were transcribed and analysed using Interpretative Phenomenological Analysis (IPA). Three themes were identified: (i) The Emergence of Symptoms, (ii) Reaching Crisis Point and (iii) Receiving a Diagnosis. Participants reported many adverse experiences during childhood and adolescence. Early symptoms were often exacerbated by emotionally invalidating caregiving. Participants reported seeking mental health support only after reaching a crisis point, which often arose following an employment-related stressor. Participants typically initiated help-seeking by consulting a General Practitioner. Long delays were reported from initial help-seeking to being diagnosed with BPD; all expressed relief upon diagnosis. The findings highlight the deleterious consequences of emotional invalidation in participants' mental health and their capacity to access timely support. General Practitioners play a critical role in identifying probable symptoms of BPD in men and are the gateway to referral to psychiatrists and psychologists. It is vital that education is provided to assist their important work.
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Affiliation(s)
- J H Broadbear
- Spectrum, Personality Disorder and Complex Trauma Service, Richmond, Victoria, Australia
- Centre for Personality Disorder & Complex Trauma Research, Richmond, Victoria, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - M G Bhagwandas
- Spectrum, Personality Disorder and Complex Trauma Service, Richmond, Victoria, Australia
- Centre for Personality Disorder & Complex Trauma Research, Richmond, Victoria, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - S Crowley
- Spectrum, Personality Disorder and Complex Trauma Service, Richmond, Victoria, Australia
- Centre for Personality Disorder & Complex Trauma Research, Richmond, Victoria, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - L Cheney
- Spectrum, Personality Disorder and Complex Trauma Service, Richmond, Victoria, Australia
- Centre for Personality Disorder & Complex Trauma Research, Richmond, Victoria, Australia
| | - S Rao
- Spectrum, Personality Disorder and Complex Trauma Service, Richmond, Victoria, Australia
- Centre for Personality Disorder & Complex Trauma Research, Richmond, Victoria, Australia
- School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
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Lin Y, Guo Z, Zhou Y, Wei Y, Xu L, Tang X, Wang Z, Hu Y, Wang J, Mei Y, Wu H, Luo Y, Zhang T. Distribution of self-reported borderline personality disorder traits symptoms in a large-scale clinical population. Front Psychiatry 2024; 15:1424966. [PMID: 38988741 PMCID: PMC11234847 DOI: 10.3389/fpsyt.2024.1424966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 06/06/2024] [Indexed: 07/12/2024] Open
Abstract
Introduction Borderline Personality Disorder (BPD) traits play a crucial role in the prognosis of psychiatric disorders, as well as in assessing risks associated with negativity and impulsivity. However, there is a lack of data regarding the distribution characteristics of BPD traits and symptoms within clinical populations. Methods A total of 3015 participants (1321 males, 1694 females) were consecutively sampled from outpatients at the psychiatric and psycho-counseling clinics at the Shanghai Mental Health Center. BPD symptoms were assessed using a self-reported personality diagnostic questionnaire. Having BPD traits is defined as having five or more positive items in self-reported BPD characteristics. Participants were stratified into male and female groups, age groups, and diagnostic groups (schizophrenia, mood disorders, anxiety disorders). Exploratory factor analysis using principal components analysis was conducted. Three factors were identified: "F1: Affective Instability and Impulsivity", "F2: Interpersonal Unstable and Extreme Reactions", and "F3: Identity Disturbance". Results Among 3015 participants, 45.9% of the patients self-reported BPD traits. Comparing of male and female patients, there was no statistically significant difference in the occurrence rate of BPD traits (χ2 = 1.835, p=0.176). However, in terms of symptoms, female patients reported more symptoms than male patients. Female patients also exhibited more pronounced features on F2 compared to male patients (t =-1.972, p=0.049). There is a general decrease in BPD traits, symptoms, and factors with increasing age. Specifically, the proportion of positive BPD traits is approximately halved before the age of 30 and decreases to around one-third after the age of 30. BPD traits were most common in the Mood Disorders group at 55.7%, followed by the Anxiety Disorders group at 44.4%, and Schizophrenia group at 41.5% (χ2 = 38.084, p<0.001). Discussion Our study revealed the pervasive presence of BPD traits and symptoms among psychiatric outpatients, exhibiting distinctive distributions across gender, age, and diagnostic categories. These findings emphasize the significance of identifying and addressing BPD pathology in the clinical care of psychiatric outpatients.
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Affiliation(s)
- Yong Lin
- Department of Psychiatry, Kangci Hospital of Jiaxing, Tongxiang, Zhejiang, China
| | - ZiLei Guo
- Department of Psychiatry, Kangci Hospital of Jiaxing, Tongxiang, Zhejiang, China
| | - Yong Zhou
- Department of Psychiatry, Kangci Hospital of Jiaxing, Tongxiang, Zhejiang, China
| | - YanYan Wei
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - LiHua Xu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - XiaoChen Tang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - Zixuan Wang
- Department of Psychology, Shanghai Xinlianxin Psychological Counseling Center, Shanghai, China
| | - YeGang Hu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - JiJun Wang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - Yi Mei
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - HaiSu Wu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - YanLi Luo
- Department of Psychological Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - TianHong Zhang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
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Sanchious SN, Zimmerman M, Khoo S. Recognizing Borderline Personality Disorder in Men: Gender Differences in BPD Symptom Presentation. J Pers Disord 2024; 38:195-206. [PMID: 38592913 DOI: 10.1521/pedi.2024.38.2.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
Women are predominantly diagnosed with BPD, with studies estimating a 3:1 female-to-male diagnostic ratio in clinical settings. Previous studies present conflicting findings regarding gender-level criterion differences, with some indicating differences in contradictory criteria. These studies primarily utilize outpatient samples, highlighting gaps in the literature. Thus, the current study investigates gender-level criterion differences, functioning, and impairment within a novel, partial hospital sample. Participants included (a) a sample of 1,153 individuals from the total population of partial hospital patients regardless of BPD diagnosis and (b) 365 BPD-positive patients who were assessed via semistructured clinical interview and provided consent for data collection during the intake process. Results indicated that (a) women endorsed higher relationship instability than men and (b) there were no significant differences in level of functioning across the gender subsamples. Examining gender differences in BPD symptomatology has clinical implications in improving recognition and addressing potential biases associated with men and mental health.
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Affiliation(s)
- Saivone N Sanchious
- From Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Cranston, Rhode Island
| | - Mark Zimmerman
- From Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Cranston, Rhode Island
| | - Shereen Khoo
- From Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Cranston, Rhode Island
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Benzi IMA, Fontana A, Di Pierro R, Parolin L, Ensink K. Unpacking the p-factor. Associations Between Maladaptive Personality Traits and General Psychopathology in Female and Male Adolescents. Res Child Adolesc Psychopathol 2024; 52:473-486. [PMID: 37938410 PMCID: PMC10896943 DOI: 10.1007/s10802-023-01146-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 11/09/2023]
Abstract
Adolescence is a period of rapid physical, psychological, and neural maturation that makes youth vulnerable to emerging psychopathology, highlighting the need for improved identification of psychopathology risk indicators. Recently, a higher-order latent psychopathology factor (p-factor) was identified that explains latent liability for psychopathology beyond internalizing and externalizing difficulties. However, recent proposals suggest reconceptualizing the p-factor model in terms of impairments in personality encompassing difficulties in both self-regulation (borderline features) and self-esteem (narcissistic features), but this remains untested. To address this, this study examined the p-factor structure and the contribution of borderline and narcissistic features using two cross-sectional data collections. In Study 1, 974 cisgender adolescents (63% assigned females at birth; age range: 13-19; Mage = 16.68, SD = 1.40) reported on internalizing and externalizing problems (YSR) to test via structural equation models (SEM) different theoretical models for adolescent psychopathology. In Study 2, 725 cisgender adolescents (64.5% assigned females at birth; age range: 13-19; Mage = 16.22, SD = 1.32) reported internalizing and externalizing problems (YSR), borderline personality features (BPFSC-11), and narcissistic personality traits (PNI), to explore, via SEM, the contribution of borderline and narcissistic traits to the p-factor and accounting for gender differences. Results confirmed the utility of a bi-factor model in adolescence. Furthermore, findings highlighted the contribution of borderline features and narcissistic vulnerability to general psychopathology. The study provides the first evidence supporting a p-factor model reconceptualized in terms of personality impairments encompassing difficulties in self-regulation and self-esteem in adolescents.
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Affiliation(s)
- Ilaria Maria Antonietta Benzi
- Department of Brain and Behavioral Sciences, University of Pavia, Piazza Botta Adorno Antoniotto, 11, 27100, Pavia, Italy.
| | - Andrea Fontana
- Department of Human Science, LUMSA University, Rome, Italy
| | | | - Laura Parolin
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Karin Ensink
- Department of Psychology, Laval University, Quebec, QC, Canada
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Bozzatello P, Blua C, Brandellero D, Baldassarri L, Brasso C, Rocca P, Bellino S. Gender differences in borderline personality disorder: a narrative review. Front Psychiatry 2024; 15:1320546. [PMID: 38283847 PMCID: PMC10811047 DOI: 10.3389/fpsyt.2024.1320546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024] Open
Abstract
Borderline personality disorder (BPD) is a severe and complex mental disorder that traditionally has been found to be more frequent in the female gender in clinical samples. More recently, epidemiological studies have provided conflicting data about the prevalence of borderline disorder in the two genders in community samples. In order to explain this heterogeneity, some authors hypothesized the presence of a bias in the diagnostic criteria thresholds (more prevalent in one gender than another), in the population sampling (community versus clinical), in the instruments of evaluation (clinician versus self-report measures), and in the diagnostic construct of BPD. Beyond the question of the different prevalence of the disorder between genders, the debate remains open as to how personality and clinical characteristics, and attitude toward treatments express themselves in the two genders. This narrative review is aimed to provide an updated overview of the differences among genders in BPD in terms of diagnosis, temperamental and clinical characteristics, comorbidities, findings of neuroimaging, and treatment attitudes. Studies that specifically investigated the gender differences in BPD patients are rather limited. Most of the investigations did not consider gender as a variable or were characterized by a significant imbalance between the two genders (more commonly in favor the female gender). The main results indicated that men were more likely to endorse the criteria "intense and inappropriate anger" and "impulsivity," whereas women endorsed the criteria "chronic feelings of emptiness," "affective instability," and "suicidality/self-harm behaviors." These findings reflect differences in temperament and symptoms of the two genders. Other relevant differences concern pattern of comorbidity, specific neurobiological mechanisms and attitude to treatments. Main limitations were that only one database was searched, time of publications was limited, non-English manuscripts were excluded, and the quality of each paper was not commented.
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Meisner MW, Lenzenweger MF, Storebø OJ, Petersen LS, Bach B, Simonsen E. Co-occurrence of borderline and schizotypal personality disorders: a scoping review. Nord J Psychiatry 2024; 78:1-13. [PMID: 37682696 DOI: 10.1080/08039488.2023.2254299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/19/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND The historical concept of borderline conditions refers to the pathology on the border between neurosis and psychosis. In DSM-III the conditions were divided into specific but also somewhat overlapping diagnostic criteria for Borderline Personality Disorder (BPD) and Schizotypal Personality Disorder (SPD). This phenomenological overlap, which results in co-occurrence of the two diagnoses, remains a clinical challenge to this day. METHODS To address this issue we examined the co-occurrence of SPD and BPD according to the established DSM-IV/-5 diagnostic criteria. A literature search was conducted including studies that employed a structured interview with defined BPD and SPD criteria. RESULTS Studies from 20 samples were included (i.e. 15 patients, 3 community and 2 forensic samples). For patients diagnosed primarily with BPD, 1-27% also met the criteria for SPD and for patients diagnosed primarily with SPD, 5 - 33% showed co-occurrence with BPD. In the forensic samples, co-occurrence for primary BPD was 10% and 67 - 82% for primary SPD. In the community samples, co-occurrence for primary BPD was 29% and 50% for primary SPD. The pattern of co-occurrence across community samples was particularly heterogeneous. CONCLUSION The identified co-occurrences for BPD and SPD were considerably sample-dependent, and samples and measurements were generally too heterogeneous for a precise meta-analysis. Forensic and community samples generally showed higher co-occurrences, but these findings were characterized by potential methodological limitations.
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Affiliation(s)
| | - Mark F Lenzenweger
- Department of Psychology, The State University of New York, Binghamton, NY, USA
- Department of Psychiatry, Weill Cornell Medical College, NY, USA
| | - Ole J Storebø
- Psychiatric Research Unit, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Lea S Petersen
- Psychiatric Research Unit, Slagelse, Denmark
- Division of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Bo Bach
- Psychiatric Research Unit, Slagelse, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Erik Simonsen
- Division of Health and Medical Sciences, University of Copenhagen, Denmark
- Research Unit, Mental Health Services, Roskilde, Denmark
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Qadeer Shah A, Prasad D, Caropreso L, Frey BN, de Azevedo Cardoso T. The comorbidity between Borderline Personality Disorder (BPD) and Generalized Anxiety Disorder (GAD): A systematic review and meta-analysis. J Psychiatr Res 2023; 164:304-314. [PMID: 37392720 DOI: 10.1016/j.jpsychires.2023.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/03/2023] [Accepted: 06/15/2023] [Indexed: 07/03/2023]
Abstract
Borderline personality disorder (BPD) is a psychiatric condition characterized by severe instability in affect, impulse control, and interpersonal functioning. Existing literature has confirmed that BPD is highly comorbid with other psychiatric conditions, including anxiety disorders. Despite this, little research has investigated the nature of the relationship between generalized anxiety disorder (GAD) and BPD. The aim of this systematic review and meta-analysis is to synthesize the literature concerning the prevalence and clinical outcomes of BPD and GAD comorbidity in adults. The following three databases were searched on October 27, 2021: PsycINFO, PubMed, and Embase. Twenty-four studies were included (n = 21 reporting on prevalence of the comorbidity, n = 4 reporting on clinical outcomes associated with the comorbidity), 9 of which were included in a meta-analysis. The meta-analysis showed that the pooled prevalence for current GAD in individuals with BPD was 16.4% (CI 95%: 1.9%; 66.1%) in inpatient samples, and 30.6% (CI 95%: 21.9%; 41.1%) in outpatient or community samples. The pooled lifetime prevalence of GAD in individuals with BPD was 11.3% (CI 95%: 8.9%; 14.3%) in inpatient samples, and 13.7% (CI 95%: 3.4%; 41.4%) in outpatient or community samples. Comorbidity between BPD and GAD was associated with worse outcomes on measures of BPD severity, impulsivity, anger, and hopelessness. In conclusion, this systematic review and meta-analysis indicate that comorbid GAD and BPD is highly prevalent, although the pooled prevalence rates should be interpreted with caution considering the large and overlapping confidence intervals. Further, this comorbidity is associated with worse BPD symptom severity.
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Affiliation(s)
- Aimun Qadeer Shah
- School of Interdisciplinary Science, Life Sciences Program, McMaster University, Hamilton, ON, Canada
| | - Divya Prasad
- Women's Health Concerns Clinic, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada; Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Luisa Caropreso
- Women's Health Concerns Clinic, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Benicio N Frey
- Women's Health Concerns Clinic, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Mood Disorders Program, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Taiane de Azevedo Cardoso
- School of Interdisciplinary Science, Life Sciences Program, McMaster University, Hamilton, ON, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
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8
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Schreiber AM, Cawood CD. Treatment outcomes of Veteran men in a comprehensive dialectical behavior therapy program: Characterizing sex differences in symptom trajectories. J Psychiatr Res 2023; 164:90-97. [PMID: 37331262 DOI: 10.1016/j.jpsychires.2023.05.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/13/2023] [Accepted: 05/18/2023] [Indexed: 06/20/2023]
Abstract
Dialectical Behavior Therapy (DBT) is one of the primary psychosocial treatments for reducing suicidal behaviors and improving psychosocial outcomes among patients with borderline personality disorder (BPD) and has been shown to reduce BPD symptoms when delivered in a Veteran Affairs medical center setting. Despite evidence of similar rates of BPD in both men and women, the vast majority of treatment outcome research in BPD has focused on women. We sought to characterize sex differences in symptom trajectories among Veterans participating in a comprehensive DBT program. We found that Veteran men and women who entered the DBT program were diagnostically and demographically similar. Participants exhibited reductions in BPD symptoms and improvements in emotion regulation over the course of treatment. Moreover, Veteran men reported BPD symptom reductions that were not statistically inferior to those of Veteran women and exhibited a sharper reduction in these symptoms. This research provides support for the use of DBT as a psychosocial treatment for Veteran men with BPD symptoms.
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Affiliation(s)
- Alison M Schreiber
- Ann Arbor VA Medical Center, Ann Arbor, MI, USA; University of North Carolina, Chapel Hill, NC, USA.
| | - Chelsea D Cawood
- Ann Arbor VA Medical Center, Ann Arbor, MI, USA; University of Michigan Medical School, Ann Arbor, MI, USA.
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Qian X, Townsend ML, Tan WJ, Grenyer BFS. Sex differences in borderline personality disorder: A scoping review. PLoS One 2022; 17:e0279015. [PMID: 36584029 PMCID: PMC9803119 DOI: 10.1371/journal.pone.0279015] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 11/28/2022] [Indexed: 12/31/2022] Open
Abstract
Borderline Personality Disorder (BPD) is often perceived to be a female-predominant disorder in both research and clinical contexts. Although there is growing recognition of possible sex differences, the current literature remains fragmented and inconclusive. This scoping review aimed to synthesize available research evidence on potential sex differences in BPD. PsycINFO, PubMed, Scopus and Web-of-Science were searched from January 1982 to July 2022 surrounding the key concepts of sex and BPD. Data searching and screening processes followed the Joanna Briggs Institute methodology involving two independent reviewers, and a third reviewer if necessary, and identified 118 papers. Data regarding BPD symptoms, comorbid disorders, developmental factors, biological markers, and treatment were extracted. Data was summarized using the vote counting method or narrative synthesis depending on the availability of literature. Males with BPD were more likely to present externalizing symptoms (e.g., aggressiveness) and comorbid disorders (e.g., substance use), while females with BPD were more likely to present internalizing symptoms (e.g., affective instability) and comorbid disorders (e.g., mood and eating disorders). This review also revealed that substantially more research attention has been given to overall sex differences in baseline BPD symptoms and comorbid disorders. In contrast, there is a dearth of sex-related research pertaining to treatment outcomes, developmental factors, and possible biological markers of BPD. The present scoping review synthesized current studies on sex differences in BPD, with males more likely to present with externalizing symptoms in contrast to females. However, how this might change the prognosis of the disorder or lead to modifications of treatment has not been investigated. Most studies were conducted on western populations, mainly North American (55%) or European (33%), and there is a need for future research to also take into consideration genetic, cultural, and environmental concomitants. As the biological construct of 'sex' was employed in the present review, future research could also investigate the social construct 'gender'. Longitudinal research designs are needed to understand any longer-term sex influence on the course of the disorder.
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Affiliation(s)
- Xinyu Qian
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Michelle L. Townsend
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Wan Jie Tan
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Brin F. S. Grenyer
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
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Benzi IMA, Fontana A, Barone L, Preti E, Parolin L, Ensink K. Emerging personality in adolescence: developmental trajectories, internalizing and externalizing problems, and the role of mentalizing abilities. J Adolesc 2022; 95:537-552. [PMID: 36564966 DOI: 10.1002/jad.12134] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Identifying longitudinal trajectories of emerging personality (EP) is crucial to highlight developmental patterns that might foster personality pathology in adolescence and early adulthood. Research on the exacerbation of personality pathology in adolescence identifies the significant contribution of internalizing and externalizing problems and suggests the importance of considering aspects such as mentalization, while accounting for gender differences. METHODS In our study, we adopted a mixed-model approach to (1) explore longitudinally EP (Adolescent Personality Structure Questionnaire; APS-Q) over 12 months in a sample of adolescents (N = 178, 62% females, mAGE = 15.04, SD = 1.27), accounting for gender effects. Moreover, (2) we assessed the longitudinal effect of internalizing and externalizing problems (Youth Self-Report; YSR-112) on EP. Finally, (3) we addressed the moderating role of mentalization (Movie Assessment for Social Cognition; MASC) in this developmental pathway. RESULTS Results highlighted a two-way pattern of EP. No changes were found in the level of difficulties in Self-acceptance, Investments and Goals, and Relationships with family dimensions. However, significant changes were found in personality functioning in the dimensions of Sense of Self, Aggression, and Relationships with friends. More, changes in difficulties in Sexuality emerged only in females. Also, gender differences emerged in the level of severity of EP. In addition, Internalizing and Externalizing problems differentially predicted difficulties in personality dimensions. Finally, mentalizing features moderated the relationship between Internalizing problems and Sense of Self and Internalizing problems and Self-acceptance, respectively. CONCLUSIONS Our contribution aligns with recent developmental models of personality pathology, suggesting that different personality dimensions develop at different paces. More, it highlights the predictive power of externalizing and internalizing problems on difficulties in personality dimensions. Finally, it advances the discussion on the contribution of mentalizing abilities to EP.
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Affiliation(s)
| | - Andrea Fontana
- Department of Human Science, LUMSA University, Rome, Italy
| | - Lavinia Barone
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Emanuele Preti
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Laura Parolin
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Karin Ensink
- Department of Psychology, Laval University, Quebec, Canada
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11
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Letkiewicz AM, Spring JD, Carrillo VL, Shankman SA. Examining the Construct Validity of Borderline Personality Traits Using Familial Aggregation and Other External Validators. J Pers Disord 2022; 36:641-661. [PMID: 36454155 PMCID: PMC10074705 DOI: 10.1521/pedi.2022.36.6.641] [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: 12/02/2022]
Abstract
Numerous studies have questioned the reliability and validity of borderline personality disorder's (BPD) categorical conceptualization. DSM-5 Section III's alternative trait-based model of BPD may better capture borderline pathology, but aspects of its validity should be further established. Thus, the authors examined whether a latent BPD factor derived from Section III traits exhibits (1) familial aggregation among siblings and (2) association with constructs related to borderline pathology. The authors also tested whether gender moderated associations. A total of 498 community-recruited adults completed the Personality Inventory for DSM-5, a behavioral assessment of risk-taking, and reported their history of childhood maltreatment, substance use, nonsuicidal self-injury, and suicidal ideation. Familial aggregation was assessed among 232 sibling pairs. Siblings' BPD scores were significantly correlated and most external validators were significantly associated with BPD, with the exception of risk-taking. Results did not vary by gender. Findings further support the construct validity of Section III's BPD trait profile.
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Affiliation(s)
- Allison M Letkiewicz
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois.,Department of Psychology, Northwestern University, Chicago, Illinois
| | - Justin D Spring
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois.,Department of Psychology, Northwestern University, Chicago, Illinois
| | - Vivian L Carrillo
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois
| | - Stewart A Shankman
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois.,Department of Psychology, Northwestern University, Chicago, Illinois
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Krick LC, Berman ME, McCloskey MS, Coccaro EF, Fanning JR. Gender Moderates the Association Between Exposure to Interpersonal Violence and Intermittent Explosive Disorder Diagnosis. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP14746-NP14771. [PMID: 33977809 DOI: 10.1177/08862605211013951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Exposure to interpersonal violence (EIV) is a prevalent risk-factor for aggressive behavior; however, it is unclear whether the effect of EIV on clinically significant aggressive behavior is similar across gender. We examined whether gender moderates the association between experiencing and witnessing interpersonal violence and the diagnosis of intermittent explosive disorder (IED). We also examined potential pathways that might differentially account for the association between EIV and IED in men and women, including emotion regulation and social information processing (SIP). Adult men and women (N = 582), who completed a semistructured clinical interview for syndromal and personality disorders, were classified as healthy controls (HC; n = 118), psychiatric controls (PC; n = 146) or participants with an IED diagnosis (n = 318). Participants also completed the life history of experienced aggression (LHEA) and life history of witnessed aggression (Lhwa) structured interview and self-report measures of emotion regulation and SIP. Men reported more EIV over the lifetime. In multiple logistic regression analysis, experiencing and witnessing aggression within the family and experiencing aggression outside the family were associated with lifetime IED diagnosis. We found that the relationship between EIV and IED was stronger in women than in men. Affective dysregulation mediated certain forms of EIV, and this relation was observed in both men and women. SIP biases did not mediate the relation between EIV and IED. EIV across the lifespan is a robust risk factor for recurrent, clinically significant aggressive behavior (i.e., IED). However, the relationship between EIV and IED appears to be stronger in women. Further, this relation appears partially mediated by affective dysregulation.
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Affiliation(s)
| | | | | | - Emil F Coccaro
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
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13
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Jin MJ, Lee HJ, Hwang KS, Lee JH, Yang CM, Jang SH, Lee SY. A Dimensional Understanding of Borderline Personality Disorder Using MMPI-2 PSY-5 Scales in Clinical Samples. Psychiatry Investig 2021; 18:1164-1170. [PMID: 34872242 PMCID: PMC8721292 DOI: 10.30773/pi.2021.0164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/07/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This study aims to understand borderline personality disorder (BPD) features by employing the Personality Psychopathology Five (PSY-5) scales from the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). METHODS A total of 156 psychiatric patients completed PSY-5 scales of MMPI-2 and Personality Assessment Inventory-Borderline Subscale (PAI-BOR). Pearson's partial correlation analysis was conducted to control the impact of age and gender and to determine the relationship between PSY-5 scales and BOR. A hierarchical multiple regression analysis was implemented to examine whether PSY-5 scales predicted the BOR-total, and a path analysis was performed to determine whether PSY-5 scales predicted each PAI-BOR subscale. RESULTS The BOR-total score had a significant correlation with all PSY-5 scores, even after controlling for age and gender. However, only aggressiveness (AGGR), disconstraint (DISC), negative emotionality/neuroticism (NEGE), and introversion/low positive emotionality (INTR), excluding psychoticism (PSYC), significantly predicted BOR-total. The path analysis indicates that PSYC did not predict any BOR subscale, while NEGE predicted all BOR subscales. CONCLUSION The study findings indicate that NEGE best reflects BPD features, while PSYC is far from the core domain that describes BPD. In addition, the influence of age should be considered when understanding BPD, since age predicted the BOR-total and two BOR subscales.
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Affiliation(s)
- Min Jin Jin
- Faculty of Liberal Arts, Kongju National University, Gongju, Republic of Korea
| | - Hye-Jin Lee
- Department of Public Health, Wonkwang University Graduate School, Iksan, Republic of Korea
| | - Kyu-Sic Hwang
- Department of Psychiatry, School of Medicine, Wonkwang University Hospital, Iksan, Republic of Korea.,Wonkwang Brain-Behavior Mental Health Institute, Iksan, Republic of Korea
| | - Jae-Hee Lee
- Department of Nursing, Sehan University, Yeongam, Republic of Korea
| | - Chan-Mo Yang
- Department of Psychiatry, School of Medicine, Wonkwang University Hospital, Iksan, Republic of Korea.,Wonkwang Brain-Behavior Mental Health Institute, Iksan, Republic of Korea.,Department of Psychiatry, School of Medicine, Wonkwang University, Iksan, Republic of Korea
| | - Seung-Ho Jang
- Department of Psychiatry, School of Medicine, Wonkwang University Hospital, Iksan, Republic of Korea.,Wonkwang Brain-Behavior Mental Health Institute, Iksan, Republic of Korea.,Department of Psychiatry, School of Medicine, Wonkwang University, Iksan, Republic of Korea
| | - Sang-Yeol Lee
- Department of Psychiatry, School of Medicine, Wonkwang University Hospital, Iksan, Republic of Korea.,Wonkwang Brain-Behavior Mental Health Institute, Iksan, Republic of Korea.,Department of Psychiatry, School of Medicine, Wonkwang University, Iksan, Republic of Korea
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14
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De la Peña-Arteaga V, Berruga-Sánchez M, Steward T, Martínez-Zalacaín I, Goldberg X, Wainsztein A, Abulafia C, Cardoner N, Castro MN, Villarreal M, Menchón JM, Guinjoan SM, Soriano-Mas C. An fMRI study of cognitive reappraisal in major depressive disorder and borderline personality disorder. Eur Psychiatry 2021; 64:e56. [PMID: 34465401 PMCID: PMC8516744 DOI: 10.1192/j.eurpsy.2021.2231] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/22/2021] [Accepted: 08/23/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND One common denominator to the clinical phenotypes of borderline personality disorder (BPD) and major depressive disorder (MDD) is emotion regulation impairment. Although these two conditions have been extensively studied separately, it remains unclear whether their emotion regulation impairments are underpinned by shared or distinct neurobiological alterations. METHODS We contrasted the neural correlates of negative emotion regulation across an adult sample of BPD patients (n = 19), MDD patients (n = 20), and healthy controls (HCs; n = 19). Emotion regulation was assessed using an established functional magnetic resonance imaging cognitive reappraisal paradigm. We assessed both task-related activations and modulations of interregional connectivity. RESULTS When compared to HCs, patients with BPD and MDD displayed homologous decreased activation in the right ventrolateral prefrontal cortex (vlPFC) during cognitive reappraisal. In addition, the MDD group presented decreased activations in other prefrontal areas (i.e., left dorsolateral and bilateral orbitofrontal cortices), while the BPD group was characterized by a more extended pattern of alteration in the connectivity between the vlPFC and cortices of the visual ventral stream during reappraisal. CONCLUSIONS This study identified, for the first time, a shared neurobiological contributor to emotion regulation deficits in MDD and BPD characterized by decreased vlPFC activity, although we also observed disorder-specific alterations. In MDD, results suggest a primary deficit in the strength of prefrontal activations, while BPD is better defined by connectivity disruptions between the vlPFC and temporal emotion processing regions. These findings substantiate, in neurobiological terms, the different profiles of emotion regulation alterations observed in these disorders.
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Affiliation(s)
- Víctor De la Peña-Arteaga
- Psychiatry and Mental Health Group, Neuroscience Program, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Spain
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona (UB), L’Hospitalet de Llobregat, Spain
| | - Mercedes Berruga-Sánchez
- Psychiatry and Mental Health Group, Neuroscience Program, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Spain
| | - Trevor Steward
- Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Ignacio Martínez-Zalacaín
- Psychiatry and Mental Health Group, Neuroscience Program, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Spain
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona (UB), L’Hospitalet de Llobregat, Spain
| | - Ximena Goldberg
- Mental Health Department, Unitat de Neurociència Traslacional, Parc Tauli University Hospital, Institut d’Investigació i Innovació Sanitària Parc Taulí (I3PT), Sabadell, Spain
- Network Center for Biomedical Research on Mental Health (CIBERSAM), Carlos III Health Institute (ISCIII), Madrid, Spain
| | - Agustina Wainsztein
- Consejo Nacional de Investigación Científica y Tecnológica (CONICET), Buenos Aires, Argentina
- Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta (Grupo INAAC), Instituto de Neurociencias FLENI-CONICET, Buenos Aires, Argentina
- Departamento de Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
- Instituto de Investigaciones Biomédicas, Facultad de Medicina, Universidad Católica Argentina, Buenos Aires, Argentina
| | - Carolina Abulafia
- Consejo Nacional de Investigación Científica y Tecnológica (CONICET), Buenos Aires, Argentina
- Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta (Grupo INAAC), Instituto de Neurociencias FLENI-CONICET, Buenos Aires, Argentina
| | - Narcís Cardoner
- Mental Health Department, Unitat de Neurociència Traslacional, Parc Tauli University Hospital, Institut d’Investigació i Innovació Sanitària Parc Taulí (I3PT), Sabadell, Spain
- Network Center for Biomedical Research on Mental Health (CIBERSAM), Carlos III Health Institute (ISCIII), Madrid, Spain
- Department of Psychiatry and Forensic Medicine, School of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Mariana N. Castro
- Consejo Nacional de Investigación Científica y Tecnológica (CONICET), Buenos Aires, Argentina
- Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta (Grupo INAAC), Instituto de Neurociencias FLENI-CONICET, Buenos Aires, Argentina
- Department of Physiology and Department of Mental Health, Medicine School, University of Buenos Aires, Buenos Aires, Argentina
| | - Mirta Villarreal
- Consejo Nacional de Investigación Científica y Tecnológica (CONICET), Buenos Aires, Argentina
- Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta (Grupo INAAC), Instituto de Neurociencias FLENI-CONICET, Buenos Aires, Argentina
- Departamento de Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - José M. Menchón
- Psychiatry and Mental Health Group, Neuroscience Program, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Spain
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona (UB), L’Hospitalet de Llobregat, Spain
- Network Center for Biomedical Research on Mental Health (CIBERSAM), Carlos III Health Institute (ISCIII), Madrid, Spain
| | - Salvador M. Guinjoan
- Consejo Nacional de Investigación Científica y Tecnológica (CONICET), Buenos Aires, Argentina
- Neurofisiología I, Facultad de Psicología, Universidad de Buenos Aires, Buenos Aires, Argentina
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
| | - Carles Soriano-Mas
- Psychiatry and Mental Health Group, Neuroscience Program, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Spain
- Network Center for Biomedical Research on Mental Health (CIBERSAM), Carlos III Health Institute (ISCIII), Madrid, Spain
- Department of Psychobiology and Methodology in Health Sciences, Universitat Autònoma de Barcelona, Bellaterra, Spain
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15
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[Disease burden of borderline personality disorder: cost of illness, somatic comorbidity and mortality]. DER NERVENARZT 2021; 92:660-669. [PMID: 34097089 DOI: 10.1007/s00115-021-01139-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 04/30/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Severe mental illnesses (SMI) are characterized by high psychosocial impairment as well as by increased somatic morbidity and mortality. The term SMI commonly includes psychotic, bipolar and severe unipolar depressive disorders but borderline personality disorder (BPD) also shows severe sequelae of the disease. MATERIAL AND METHODS Published reviews and studies since 2010 examining disease burden of BPD, in terms of direct and indirect costs of illness, somatic comorbidity, and mortality were included. Furthermore, administrative data (clinically recorded billing data in Germany), comorbidity and mortality from a comprehensive analysis (n > 59 million, age ≥ 18 years) are reported. RESULTS International studies reveal an increased disease burden, comorbidity, and mortality for BPD. In Germany BPD (administrative 1‑year prevalence 0.34%) is associated with increased rates of somatic sequelae of trauma, hepatitis, HIV, COPD, asthma, and obesity. The estimated reduced life expectancy is 5.0-9.3 years of life lost (depending on age and sex). DISCUSSION The burden of disease in BPD is clearly increased (cost of illness, somatic comorbidity and mortality). The increased mortality can mainly be explained by deaths as a consequence of poor physical health and associated BPD-related health behavior and only to a lesser degree by suicide. These results highlight the importance of classifying BPD as an SMI and the necessity to provide not only psychotherapeutic and psychiatric but also adequate somatic prevention and treatment. Individual improvement of everyday care as well as establishing new interdisciplinary and multiprofessional services could enhance health equality for people with BPD.
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Scamaldo KM, Tull MT, Gratz KL. Motives for opioid use explain the relation between borderline personality disorder pathology and opioid use problems. Psychiatry Res 2021; 296:113609. [PMID: 33418458 DOI: 10.1016/j.psychres.2020.113609] [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: 08/03/2020] [Accepted: 11/25/2020] [Indexed: 12/31/2022]
Abstract
Despite the established relations between borderline personality disorder (BPD) and substance use problems in general, there is a dearth of research on the relation between BPD pathology and opioid use problems, as well as factors that may explain this relation. Therefore, this study examined the indirect relations of BPD pathology to opioid use problems (i.e., prescription opioid misuse, apprehension about prescription opioid use, and opioid cravings) through motives for opioid use (i.e., coping, enhancement, social, and conformity motives) among 68 patients endorsing prescription opioid misuse in a residential correctional substance use disorder (SUD) treatment facility. Participants completed measures of BPD pathology, motives for opioid use, and opioid use problems. Findings revealed significant indirect relations of BPD pathology to opioid misuse through coping and enhancement motives, apprehension about opioid use through coping, enhancement, and social motives, and opioid cravings through coping motives within this SUD sample. Results illustrate the relevance of both emotion- and interpersonal-related motives for opioid use to opioid use problems among patients with BPD pathology in SUD treatment.
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Affiliation(s)
| | - Matthew T Tull
- Department of Psychology, University of Toledo, Toledo, OH, USA
| | - Kim L Gratz
- Department of Psychology, University of Toledo, Toledo, OH, USA..
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17
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Ferber SG, Hazani R, Shoval G, Weller A. Targeting the Endocannabinoid System in Borderline Personality Disorder: Corticolimbic and Hypothalamic Perspectives. Curr Neuropharmacol 2021; 19:360-371. [PMID: 32351183 PMCID: PMC8033970 DOI: 10.2174/1570159x18666200429234430] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/09/2020] [Accepted: 04/24/2020] [Indexed: 12/15/2022] Open
Abstract
Borderline Personality Disorder (BPD) is a chronic debilitating psychiatric disorder characterized mainly by emotional instability, chaotic interpersonal relationships, cognitive disturbance (e.g., dissociation and suicidal thoughts) and maladaptive behaviors. BPD has a high rate of comorbidity with other mental disorders and a high burden on society. In this review, we focused on two compromised brain regions in BPD - the hypothalamus and the corticolimbic system, emphasizing the involvement and potential contribution of the endocannabinoid system (ECS) to improvement in symptoms and coping. The hypothalamus-regulated endocrine axes (hypothalamic pituitary - gonadal, thyroid & adrenal) have been found to be dysregulated in BPD. There is also substantial evidence for limbic system structural and functional changes in BPD, especially in the amygdala and hippocampus, including cortical regions within the corticolimbic system. Extensive expression of CB1 and CB2 receptors of the ECS has been found in limbic regions and the hypothalamus. This opens new windows of opportunity for treatment with cannabinoids such as cannabidiol (CBD) as no other pharmacological treatment has shown long-lasting improvement in the BPD population to date. This review aims to show the potential role of the ECS in BPD patients through their most affected brain regions, the hypothalamus and the corticolimbic system. The literature reviewed does not allow for general indications of treatment with CBD in BPD. However, there is enough knowledge to indicate a treatment ratio of a high level of CBD to a low level of THC. A randomized controlled trial investigating the efficacy of cannabinoid based treatments in BPD is warranted.
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Affiliation(s)
| | | | - Gal Shoval
- Address correspondence to this author at the Geha Mental Health Center, Petah Tiqva, Israel; Tel: 972-3-925-8440; Fax: 972-3-925-8276;, E-mail:
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18
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Gratz KL, Richmond JR, Edmonds KA, Rose JP, Tull MT. INTEGRATING SOCIAL COMPARISON INTO THE UNDERSTANDING OF EMOTION REGULATION IN BORDERLINE PERSONALITY. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2020. [DOI: 10.1521/jscp.2020.39.8.727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Introduction: Theory and research suggest the need to expand research on emotion regulation (ER) within borderline personality disorder (BPD). This research examined the relations of BPD symptoms to interpersonal (venting, reassurance-seeking) and socially-oriented (social comparison) ER strategies (in addition to acceptance and avoidance), and explored the role of trait social comparison orientation (SCO) in these relations. Methods: In Study 1, a nationwide community sample of women completed questionnaires. In Study 2, a university sample of young women completed questionnaires and an online social interaction task (following which they reported on the strategies they used to regulate emotions during the task). Results: Results revealed significant indirect relations of BPD symptoms to venting and reassurance-seeking through trait SCO, reassurance-seeking and social comparison through upward SCO, and the in-vivo use of downward social comparison and avoidance strategies during the social interaction task through upward SCO. Discussion: Results highlight the relevance of trait SCO (particularly upward SCO) to socially-oriented ER strategies among women with heightened BPD symptoms.
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Broadbear JH, Dwyer J, Bugeja L, Rao S. Coroners' investigations of suicide in Australia: The hidden toll of borderline personality disorder. J Psychiatr Res 2020; 129:241-249. [PMID: 32823217 DOI: 10.1016/j.jpsychires.2020.07.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 07/01/2020] [Accepted: 07/10/2020] [Indexed: 10/23/2022]
Abstract
Borderline Personality Disorder (BPD) is associated with a high risk of death by suicide. Our study describes a population-based analysis of Coroners' investigations of suicides where there was evidence of a BPD diagnosis. We utilised the Victorian Suicide Register to identify suicides occurring between 2009 and 2013 where evidence of a BPD diagnosis was recorded. Of the 2870 suicides during this period, 181 (6.3%) had a BPD diagnosis recorded. Evidence of other diagnosed personality disorders was recorded in an additional 14 (0.5%) suicides and BPD was suspected in another 72 (2.5%) suicides. Information coded in the 181 diagnosed BPD suicides was compared with the 2689 suicides without a BPD diagnosis. Compared to the 'no BPD suicide group', the 'BPD suicide group' was younger, comprised a smaller proportion of women, had greater diagnostic complexity, a higher proportion of death by drug overdose, and a higher proportion of social and contextual stressors. 99% of people with a BPD diagnosis who died from suicide had contact with emergency and mental health services within 12 months of death; 88% sought help from these services within 6 weeks of death. These findings demonstrate the magnitude of this most severe outcome of mental illness, confirming that BPD belongs in the same category as schizophrenia, bipolar disorder and depressive disorder with respect to suicide representation. The help-seeking behaviours evident in almost all cases highlight a critical window of opportunity for providing timely support and treatment to help avert future deaths.
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Affiliation(s)
- Jillian H Broadbear
- Spectrum Personality Disorder Service, 110 Church Street, Richmond, Victoria, 3121, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, 27 Rainforest Walk, Clayton, Victoria, 3800, Australia.
| | - Jeremy Dwyer
- Coroners Prevention Unit, Coroners Court of Victoria, 65 Kavanagh St, Southbank, Victoria, 3006, Australia; Department of Forensic Medicine, Monash University, 65 Kavanagh St, Southbank, Victoria, 3006, Australia.
| | - Lyndal Bugeja
- Department of Forensic Medicine, Monash University, 65 Kavanagh St, Southbank, Victoria, 3006, Australia; Monash Nursing and Midwifery, Monash University, Level 1, 10 Chancellors Walk, Wellington Road, Clayton, Victoria, 3800, Australia.
| | - Sathya Rao
- Spectrum Personality Disorder Service, 110 Church Street, Richmond, Victoria, 3121, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, 27 Rainforest Walk, Clayton, Victoria, 3800, Australia.
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20
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Desrosiers L, Saint-Jean M, Laporte L, Lord MM. Engagement complications of adolescents with borderline personality disorder: navigating through a zone of turbulence. Borderline Personal Disord Emot Dysregul 2020; 7:18. [PMID: 32884818 PMCID: PMC7460802 DOI: 10.1186/s40479-020-00134-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 07/21/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Premature treatment discontinuation is a widespread phenomenon in child and adolescent mental health services that impacts treatment benefits and costs of care. Adolescents with borderline personality disorder (BPD) are heavy users of health care services and notoriously difficult to engage in treatment. However, there is hardly any data regarding this phenomenon with these youths. Considering that BPD treatment is associated with intense and chaotic therapeutic processes, exploring barriers emerging in the course of treatment could be relevant. Thus, conceptualizing treatment dropout as a process evolving from engagement to progressive disengagement, and ultimately to dropout, could highlight the mechanisms involved. The aim of this study was to describe the process of treatment disengagement and identify warning signs that foreshadow dropouts of adolescents with BPD. METHOD A constructivist grounded theory method was used. This method has been favoured based on the assumption that the behaviours and decisions leading to disengagement may be better informed by the subjective experience of treatment. Thirty-three interviews were conducted to document 11 treatment trajectories with 3 groups of informants (9 adolescents with BPD 13-17 of age, 11 parents, and 13 clinicians). RESULTS Well before dropout occurs, different phenomena identified as "engagement complications" characterize the disengagement process. These unfold according to a three-step sequence starting with negative emotions associated with the appropriateness of treatment, the therapeutic relationship or the vicissitudes of treatment. These emotions will then generate treatment interfering attitudes that eventually evolve into openly disengaged behaviours. These complications, which may sometimes go unnoticed, punctuate the progression from treatment engagement to disengagement leading the way towards the development of a "zone of turbulence" which creates a vulnerable and unstable therapeutic process presenting risk for late dropout. CONCLUSION Engagement of adolescents with BPD is neither static nor certain, but on the contrary, subject to their fluctuating perceptions. Therefore, it can never be taken for granted. Clinicians must constantly pay attention to emergent signs of engagement complications. Maintaining the engagement of adolescents with BPD should be a therapeutic objective akin to reducing symptomatology or improving psychosocial functioning, and should therefore be given the same attention.
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Affiliation(s)
- Lyne Desrosiers
- Université du Québec à Trois-Rivières, C.P. 500, 3351 Boul. des Forges, Trois-Rivières, Québec G9A 5H7 Canada
- Centre de Recherche et d’Expertise-Jeunes en Difficulté, CIUSS Centre-sud-de-l’île-de-Montréal, Montréal, Québec Canada
| | | | - Lise Laporte
- Centre de Recherche et d’Expertise-Jeunes en Difficulté, CIUSS Centre-sud-de-l’île-de-Montréal, Montréal, Québec Canada
- McGill University Health Centre, Montréal, Québec Canada
| | - Marie-Michèle Lord
- Université du Québec à Trois-Rivières, C.P. 500, 3351 Boul. des Forges, Trois-Rivières, Québec G9A 5H7 Canada
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21
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Jowett S, Karatzias T, Albert I. Multiple and interpersonal trauma are risk factors for both post-traumatic stress disorder and borderline personality disorder: A systematic review on the traumatic backgrounds and clinical characteristics of comorbid post-traumatic stress disorder/borderline personality disorder groups versus single-disorder groups. Psychol Psychother 2020; 93:621-638. [PMID: 31444863 DOI: 10.1111/papt.12248] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/22/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Both borderline personality disorder (BPD) and post-traumatic stress disorder (PTSD) are associated with exposure to traumatic events and are highly comorbid. No review to date has addressed the clinical presentations and traumatic backgrounds associated with these disorders although this work is essential for the development of effective interventions. OBJECTIVES To systematically explore similarities and differences in traumatic history and clinical presentation in comorbid BPD and PTSD as compared to PTSD or BPD alone. METHOD The Web of Science, Cochrane Library, PsycINFO, MEDLINE, and PILOTS databases were searched systematically. Eligible studies included adult populations, compared comorbid BPD/PTSD to a single disorder, and published in English. RESULTS A total of 10,147 cases across 33 studies were included: 2,057 comorbid BPD/PTSD, 2,648 BPD only, and 5,442 PTSD only. The comorbid group overall reported greater exposure to multiple and interpersonal trauma and elevated emotion dysregulation compared to both single-disorder groups. In terms of methodological quality, most papers achieved a Fair rating with improvements required in minimizing bias through recruiting adequate and representative samples, and reporting on traumatic exposure. CONCLUSION Multiple and interpersonal trauma might have a unique role in the development of comorbid BPD/PTSD features, particularly so for emotion dysregulation. Future research is required to unravel the unique characteristics of interpersonal trauma that can generate BPD and PTSD symptoms. PRACTITIONER POINTS Practitioners should routinely assess for interpersonal trauma considering its impact. Tackling emotion regulation difficulties might promote recovery from both PTSD and BPD symptoms. Presence of self -injury might be used to discriminate between PTSD and BPD and offer suitable interventions.
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Affiliation(s)
- Sally Jowett
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Thanos Karatzias
- School of Health and Social Care, Edinburgh Napier University, UK.,Rivers Centre for Traumatic Stress, NHS Lothian, Edinburgh, UK
| | - Idit Albert
- Centre for Anxiety Disorders and Trauma, London, UK
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22
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Zahediabghari S, Boursiquot P, Links P. Impact of Psychotherapy on Psychosocial Functioning in Borderline Personality Disorder Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4610. [PMID: 32604913 PMCID: PMC7344452 DOI: 10.3390/ijerph17124610] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/21/2020] [Accepted: 06/23/2020] [Indexed: 12/23/2022]
Abstract
Borderline Personality Disorder (BPD) significantly impairs functioning. Fortunately, effective treatments are available for borderline symptoms but their effect on functioning should be assessed. The objective of this meta-analysis is to assess the effect of specifically-designed versus non-specifically designed psychotherapies on function in adult patients with BPD. The reference list of Cristea et al. 2017 was used to identify the randomized controlled trials (RCTs) assessing the BPD-specifically-designed psychotherapy versus non-specific psychotherapies in adult BPD patients. Among those, RCTs assessing post-treatment functioning using the Global Assessment of Functioning, Social Adjustment Scale-Self-Report and Inventory of Interpersonal Problems were included. Ten trials (880 participants) were included. Summary effect size was calculated using the measured Hedge's g. The results indicate the BPD patients in the intervention group had a significantly higher (g = 0.41; 95% CI, 0.09-0.73) level of psychosocial functioning after receiving the specifically-designed psychotherapies in comparison with BPD patients in control groups after receiving non-specific psychotherapies. Specifically-designed psychotherapies can improve psychosocial functioning although improvement in measurement of function (i.e., more objective and universal tools) and improvement in psychotherapies (i.e., more focused on general functioning) will be helpful.
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Scott LN, Victor SE, Kaufman EA, Beeney JE, Byrd AL, Vine V, Pilkonis PA, Stepp SD. Affective Dynamics Across Internalizing and Externalizing Dimensions of Psychopathology. Clin Psychol Sci 2020; 8:412-427. [PMID: 32670674 DOI: 10.1177/2167702619898802] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Little is known about pathogenic affective processes that cut across diverse mental disorders. The current study examines how dynamic features of positive and negative affect differ or converge across internalizing and externalizing disorders in a diagnostically diverse urban sample using bivariate dynamic structural equation modeling. One-hundred fifty-six young women completed semi-structured clinical interviews and a 21-day ecological momentary assessment protocol with seven assessments of affective states per day. Internalizing and externalizing dimensions of psychopathology were modeled using confirmatory factor analysis of mental disorders. After controlling for externalizing disorders, internalizing disorders were associated with higher negative affective mean intensity, higher negative affective variability (i.e., unique innovation variance), and lower positive affective variability. Conversely, externalizing disorders were associated with less persistent positive affect (i.e., lower inertia) and more variable positive emotionality. Results suggest internalizing and externalizing disorders have distinct affective dynamic signatures, which have implications for development of tailored interventions.
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Affiliation(s)
- Lori N Scott
- University of Pittsburgh School of Medicine, Department of Psychiatry, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
| | - Sarah E Victor
- Texas Tech University, Department of Psychological Sciences, Box 42051 Lubbock, TX 79409-2051
| | - Erin A Kaufman
- University of Western Ontario, Department of Psychology, 361 Windermere Road, London, ON, Canada, N6A 3K7
| | - Joseph E Beeney
- University of Pittsburgh School of Medicine, Department of Psychiatry, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
| | - Amy L Byrd
- University of Pittsburgh School of Medicine, Department of Psychiatry, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
| | - Vera Vine
- University of Pittsburgh School of Medicine, Department of Psychiatry, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
| | - Paul A Pilkonis
- University of Pittsburgh School of Medicine, Department of Psychiatry, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
| | - Stephanie D Stepp
- University of Pittsburgh School of Medicine, Department of Psychiatry, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
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Koch M, Vyssoki B, Wippel A, Gmeiner A, Pruckner N, Oberndorfer R. [Descriptive examination of inpatient stays of patients with emotionally unstable personality disorder in Austria between 2001 and 2016 with special consideration of age, gender and length of stay]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2019; 33:191-197. [PMID: 30941735 DOI: 10.1007/s40211-019-0308-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 03/16/2019] [Indexed: 06/09/2023]
Abstract
BACKROUND Emotionally unstable personality disorder (EUPD) has a high prevalence worldwide and especially in in-patient psychiatric settings, varying in age and gender. Due to the complex clinical picture, repeated admissions and high costs, health systems are facing great challenges. METHODS For the calculations Statistik Austria data of inpatient stays of patients with mental and behavioral disorders with special regard to EUPD as main discharge diagnosis in Austria in the period 2001-2016 were used. Included were patients with age over 14 years, admission to a psychiatric clinic in acute care and maximum length of stay of 365 days. Age, gender and length of stay were analyzed with SPSS®, evaluated in descriptive form and related to each other. RESULTS The prevalence of EUPD within all mental and behavioral disorders was 4.0%. Of all personality and behavioral disorders, as well as specific personality disorders, EUPD had the highest prevalence (65.3% and 79.3%). About four times more women (79.8%) than men (20.2%) received inpatient treatment. Most patients (23.1%) were admitted at the age of 20-24 years. From 40 years of age the number of admissions clearly decreased. The largest percentage of men was found to be in the age group over 45 years (27.0%) and 183-365 inpatient days (27.0%), those of women aged 15-19 (83.4%) and 0 and 14-182 inpatient days (81.4% each). The average length of stay was 13 days for women and 12 days for men. 11.3% of patients left the clinic on the day of admission, 61.2% were treated for 1-13 days, 27.2% for 14-182 days, and 0.2% for 183-365 days.
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Affiliation(s)
- Marlene Koch
- Klinische Abteilung für Sozialpsychiatrie, Universitätsklinik für Psychiatrie und Psychotherapie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
| | - Benjamin Vyssoki
- Klinische Abteilung für Sozialpsychiatrie, Universitätsklinik für Psychiatrie und Psychotherapie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Andreas Wippel
- Klinische Abteilung für Sozialpsychiatrie, Universitätsklinik für Psychiatrie und Psychotherapie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Andrea Gmeiner
- Klinische Abteilung für Sozialpsychiatrie, Universitätsklinik für Psychiatrie und Psychotherapie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Nathalie Pruckner
- Klinische Abteilung für Sozialpsychiatrie, Universitätsklinik für Psychiatrie und Psychotherapie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Raimund Oberndorfer
- Klinische Abteilung für Sozialpsychiatrie, Universitätsklinik für Psychiatrie und Psychotherapie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
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Edwards BG, Carre JR, Kiehl KA. A review of psychopathy and Cluster B personality traits and their neural correlates in female offenders. Biol Psychol 2019; 148:107740. [PMID: 31415792 DOI: 10.1016/j.biopsycho.2019.107740] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/02/2019] [Accepted: 08/08/2019] [Indexed: 01/24/2023]
Abstract
Although men commit more crime and are incarcerated at higher rates than women, women represent the fastest growing segment of the justice system. Empirical work suggests that psychopathy and Cluster B disorders are implicated in antisocial behavior across gender, and that neurobiological correlates of personality may inform such behavior. This review utilizes a gendered perspective to discuss psychopathy and Cluster B disorders in relation to antisocial behavior and incorporates work on neural correlates of personality disorders. Co-morbidity across these conditions may be partly explained by similar frontal deficits, reflective of disinhibition. Affective processing abnormalities appear to be characterized by distinct deficits in limbic/paralimbic regions, reflecting differential etiological underpinnings and behavioral outcomes. This review underscores the utility in examining personality pathology together with neurobiological and environmental factors. Methodological issues and clinical implications are also discussed.
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Affiliation(s)
- Bethany G Edwards
- The Mind Research Network and Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, United States; University of New Mexico, Albuquerque, New Mexico, United States.
| | - Jessica R Carre
- The Mind Research Network and Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, United States
| | - Kent A Kiehl
- The Mind Research Network and Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, United States; University of New Mexico, Albuquerque, New Mexico, United States
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Soloff PH, Chowdury A, Diwadkar VA. Affective interference in borderline personality disorder: The lethality of suicidal behavior predicts functional brain profiles. J Affect Disord 2019; 252:253-262. [PMID: 30991253 PMCID: PMC6563825 DOI: 10.1016/j.jad.2019.04.050] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 01/11/2019] [Accepted: 04/08/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Negative affective interference with executive cognition is associated with emotion dysregulation and behavioral dyscontrol in BPD, including a diathesis to suicidal and self-injurious behavior. While clinically well described, the neural basis of affective interference with central executive network function, and resulting suicidal behavior is poorly understood. METHOD In an fMRI study, 23 BPD suicide attempters completed an affectively modified Continuous Performance Task(X-CPT), in which targets and distractors were rendered on Negative, Positive and Neutral Ekman faces, with a Distorted image as a behavioral baseline. Responses to targets were contextualized by the affective context of the face. Lethality Rating Scale scores (LRS) were modeled as the primary regressor of interest on activation peaks, with HamD scores covaried. RESULTS In the Negative vs. Neutral contrast, LRS scores were inversely related to activation in the ACC, parietal precuneus, BG and OFC, with no positive relationships. Results were similar in the Negative vs Positive contrast. In the Neutral vs. Positive contrast, activations were much less extensive, with mixed positive and negative relationships. Contextualizing responses based on the effects of valence decreased participant's ability to distinguish between targets and distracters; however, no differences were observed between valence contexts. fMRI-estimated effects were not confounded by differences in behavioral sensitivity across contexts. LIMITATIONS In this female-only sample, possible gender differences were not addressed. CONCLUSIONS With negative affective interference, increased lethality of suicidal behavior in BPD predicted diminished neural activation in areas critical to executive cognitive function. Therapies diminishing affective interference may reduce risk of suicidal behavior.
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Affiliation(s)
- Paul H. Soloff
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Asadur Chowdury
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI
| | - Vaibhav A. Diwadkar
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI
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Vanwoerden S, Leavitt J, Gallagher MW, Temple JR, Sharp C. Dating violence victimization and borderline personality pathology: Temporal associations from late adolescence to early adulthood. Personal Disord 2019; 10:132-142. [PMID: 30829527 DOI: 10.1037/per0000324] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Borderline personality pathology is a serious mental illness characterized by pervasive interpersonal deficits that onset during adolescence. Risk factors for borderline personality pathology include maladaptive interpersonal dynamics within attachment relationships. Given the shift toward emphasizing romantic relationships during adolescence as an important attachment relationship with implications for healthy development, the current study aimed to evaluate the longitudinal and reciprocal relations between victimization in dating relationships and borderline pathology in the transition from late adolescence to early adulthood. A large sample of high school daters (N = 818; 58% female; Mage = 16.10 years, SDage = .78) were recruited to complete annual assessments of borderline personality features and dating violence victimization across 5 years. Results of a cross-lagged panel model revealed that primarily among girls, borderline features predicted increased levels of relational, psychological, and physical violence, whereas psychological and sexual violence predicted greater borderline features. The current findings provide the first evidence of a longitudinal association between victimization and borderline pathology in adolescence and suggest, particularly among girls, that interventions for borderline features have important implications for reducing dating violence victimization among adolescents and young adults. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Jeff R Temple
- Department of Obstetrics and Gynecology, University of Texas Medical Branch
| | - Carla Sharp
- Department of Psychology, University of Houston
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Hoyne JD, Tobia A, Hanna J, Annibali C, Aziz R. Analysis of Fatal Attraction and Gone Girl to Teach Personality Clusters. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2019; 43:218-223. [PMID: 30484142 DOI: 10.1007/s40596-018-1009-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 11/20/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Jake D Hoyne
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
| | - Anthony Tobia
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Jessie Hanna
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | - Rehan Aziz
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Predicting Planned Suicide Attempts With the Columbia-Suicide Severity Rating Scale: A Subanalysis of the 2013 Korea National Suicide Survey on Emergency Department Visitors. J Nerv Ment Dis 2019; 207:59-68. [PMID: 30672875 DOI: 10.1097/nmd.0000000000000921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Identifying predictors of planned suicide attempts (PSA) is critical because these are associated with grave consequences. Using data of suicide attempters visiting emergency departments, we investigated whether the Columbia-Suicide Severity Rating Scale (C-SSRS) subscales, by retrospectively evaluating ideation before an attempt, could predict the occurrence of PSA versus unplanned suicide attempts using logistic regression analyses. The severity subscale was used as a continuous (model A) and a categorical (model B) variable. In model A, higher scores on each subscale were associated with increased risk of PSA. In model B, the highest score on the severity subscale and a higher intensity subscale score predicted PSA. The severity and intensity subscales had areas under receiver operating curves of 0.712 and 0.688 with optimum cutoff points of 4/5 and 15/16, respectively. In addition, being aged 30 to 49 and 50 to 69 years, being male, interpersonal stress, and depressive and adjustment disorders increased PSA risk. The C-SSRS subscales, along with sociodemographic and clinical risk factors, can predict PSA.
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Sher L, Rutter SB, New AS, Siever LJ, Hazlett EA. Gender differences and similarities in aggression, suicidal behaviour, and psychiatric comorbidity in borderline personality disorder. Acta Psychiatr Scand 2019; 139:145-153. [PMID: 30353921 DOI: 10.1111/acps.12981] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/17/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We examined gender differences and similarities in aggression, impulsivity, suicidal behaviour, and psychiatric comorbidity in men and women with borderline personality disorder (BPD) compared with healthy controls. METHOD A community sample of 511 participants (healthy controls: 81 men and 82 women; BPD patients: 145 men and 203 women) were rigorously characterized using structured diagnostic interviews and symptom severity assessments. RESULTS In comparison with women with BPD, men were less educated, had higher total Barratt Impulsivity Scale (BIS), BIS-motoric impulsiveness and BIS-non-planning impulsiveness subscale, total Buss-Perry Aggression Questionnaire (BPAQ), and BPAQ-physical aggression subscale scores. Men with BPD were more likely to have comorbid narcissistic, antisocial, paranoid, and schizotypal personality disorders, alcohol and substance use disorders but less likely to have dependent and obsessive-compulsive personality disorders compared to women with BPD. There was a trend toward higher maximum lethality of suicide attempts in men suicide attempters compared with women suicide attempters but no difference between men and women with regard to the proportion of suicide attempters or the number of suicide attempts. CONCLUSION Men with BPD are more impaired and may be at higher risk of dying by suicide compared to women with BPD.
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Affiliation(s)
- L Sher
- James J. Peters Veterans' Administration Medical Center, Bronx, New York, USA.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - S B Rutter
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - A S New
- James J. Peters Veterans' Administration Medical Center, Bronx, New York, USA.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - L J Siever
- James J. Peters Veterans' Administration Medical Center, Bronx, New York, USA.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - E A Hazlett
- James J. Peters Veterans' Administration Medical Center, Bronx, New York, USA.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Miljkovitch R, Deborde AS, Bernier A, Corcos M, Speranza M, Pham-Scottez A. Borderline Personality Disorder in Adolescence as a Generalization of Disorganized Attachment. Front Psychol 2018; 9:1962. [PMID: 30459673 PMCID: PMC6232672 DOI: 10.3389/fpsyg.2018.01962] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 09/24/2018] [Indexed: 12/25/2022] Open
Abstract
Several researchers point to disorganized attachment as a core feature of borderline personality disorder (BPD). However, recent studies suggest that specific internal working models (IWMs) of each parent combine to account for child outcomes and that a secure relationship with one parent can protect against the deleterious effects of an insecure relationship with the other parent. It was thus hypothesized that adolescents with BPD are more likely to be disorganized with both their parents, whereas non-clinical controls are more secure with at least one of their caregivers. Thirty-six adolescents with BPD and 30 control participants (aged 13-19) were included. Psychiatrist diagnosis was verified with the Structured Interview for DSM-IV Personality Disorders (SIDP-IV) and comorbidity was assessed using the Kiddie-SADS. Reported trauma was assessed with the Childhood Trauma Questionnaire (CTQ). Attachment IWMs of each parent were assessed with the Attachment Multiple Model Interview (AMMI), which enables separate coding for each attachment figure and in which disorganization is conceptualized as conflicting attachment strategies within a specific relationship. Results of a logistic regression analysis suggested that beyond insecure attachment, being disorganized not just with one but with both parents is particularly characteristic of adolescents with BPD. Conversely, belonging to the non-clinical group was predicted by higher security scores with the father and lower deactivation with the mother. Although higher levels of childhood abuse or neglect were reported by adolescents with BPD, the retained attachment dimensions predicted group membership over and above reported trauma. These findings have important implications for clinical intervention and highlight the protective role fathers may have.
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Affiliation(s)
| | | | - Annie Bernier
- Department of Psychology, University of Montreal, Montreal, QC, Canada
| | - Maurice Corcos
- Adolescent Psychiatry Department, Institut Mutualiste Montsouris, Inserm U 669, Faculty of Medecine, University René Descartes-Paris V, Paris, France
| | - Mario Speranza
- Inserm U 669, Faculty of Medecine, University René Descartes-Paris V, Paris, France
- Child Psychiatry Department, Versailles Hospital, Versailles, France
- Unité de Recherche EA4047, Recherches Cliniques et en Santé Publique sur les Handicaps Psychique, Cognitif et Moteur (HANDIReSP), Université de Versailles Saint-Quentin-en-Yvelines, Versailles, France
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van den Brink C, Harte JM, Denzel AD. Men and women with borderline personality disorder resident in Dutch special psychiatric units in prisons: A descriptive and comparative study. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2018; 28:324-334. [PMID: 29971844 DOI: 10.1002/cbm.2084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 01/05/2018] [Accepted: 06/05/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND The overall prevalence of borderline personality disorder is well known, but characteristics of offender patients with the condition are less clear, especially among men. AIM Describe characteristics of men and women with borderline personality disorder in special psychiatric units in Dutch prisons on three domains: prevalence of child abuse, comorbidity of borderline personality disorder with other disorders, and clinical symptoms. METHODS One hundred and sixty-seven people were assigned to this study based on a Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) diagnoses retrieved from records. Other DSM-5 diagnoses were also recorded. Two scales, the Dutch Historisch, Klinisch, Toekomst-Revisie and the international Brief Psychiatric Rating Scale-Expanded (BPRS-E) were used to record child abuse and clinical symptoms, respectively. RESULTS Prevalence rates of child abuse were high, but the men and women did not differ in this respect. The male offender patients were more likely than the women to have a comorbid substance use disorder, whereas the women were more likely to have a comorbid anxiety disorder. Intellectual disability was the most common comorbid Axis II disorder. The women were more likely than the men to have committed a fatal/nearly fatal index offence and showed higher rates of distress or behavioural disturbance on all five BPRS-E factors. CONCLUSIONS This study provides evidence of the importance of in-depth knowledge of presentations with borderline personality disorder specific to setting. Although we were unable to make direct comparisons with other samples, our figures suggest clinically relevant differences among offender patients from the more widely reported general samples. We also shed light on a sometimes underexposed group of men with borderline personality disorder and their clinical needs. More population-specific intervention and follow-up studies are now indicated.
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Affiliation(s)
| | - Joke M Harte
- Vrije Universiteit Amsterdam - Criminal Law and Criminology, Amsterdam, Netherlands
| | - A Dorina Denzel
- Vrije Universiteit Amsterdam - Criminal Law and Criminology, Amsterdam, Netherlands
- Judicial Complex Zaanstad, Westzaan, Netherlands
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Abstract
Borderline personality disorder (BPD) is often a complicating comorbid factor in alcohol use disorders and substance use disorders. Previous work showed that abstinent alcoholics endorsed lifetime and current symptoms of most of the BPD criteria at much higher rates than controls, with much higher symptom counts for short-term abstinent alcoholic (STAA) women than men, which is consistent with such symptoms negatively affecting female alcoholics' ability to maintain abstinence. Because prior work has also shown that treatment-naïve alcoholics (TNA) are not the same as treated alcoholics observed earlier in their alcohol dependence, but rather are a different population with potentially lower psychiatric comorbidity, in this study we compared BPD symptom criteria between TNA samples of comparable age to the control and STAA samples, including both men and women and individuals dependent on alcohol only or with lifetime dependence on both alcohol and drugs. BPD symptoms were obtained using the SCID-II, and endorsed symptoms were classified as current or lifetime. Logistic regression analyses were used to test for effects of group, sex, presence of a lifetime drug dependence diagnosis, and their interactions for lifetime and current symptom endorsement for each BPD criteria. Groups were compared pairwise (TNA vs. NSAC, and STAA vs. TNA). The effect of a lifetime drug dependence diagnosis was not significant for any BPD symptom variable, consistent with the alcohol groups' BPD symptoms being unaffected by the presence of a comorbid drug dependence. The primary result presented here is that TNA women have borderline symptomatology more similar to that of treated STAA than to NSAC, while TNA men have borderline symptomatology more similar to NSAC than to STAA. A visual examination of co-occurring BPD symptoms showed that while more BPD symptoms are likely to be present in TNA and STAA vs. NSAC, there is no grouping of criteria (i.e., symptom cluster) that is characteristic of TNA or STAA.
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Affiliation(s)
- George Fein
- Neurobehavioral Research, Inc., 77 Ho'okele Street, 3rd Floor, Kahului, Maui, HI 96732, United States; Department of Medicine and Psychology, University of Hawaii, Honolulu, HI 96822, United States.
| | - Mathew Price
- Neurobehavioral Research, Inc., 77 Ho'okele Street, 3rd Floor, Kahului, Maui, HI 96732, United States; Cogency, Cape Town, South Africa.
| | - Valerie A Cardenas
- Neurobehavioral Research, Inc., 77 Ho'okele Street, 3rd Floor, Kahului, Maui, HI 96732, United States.
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Wagner G, Krause-Utz A, de la Cruz F, Schumann A, Schmahl C, Bär KJ. Resting-state functional connectivity of neurotransmitter producing sites in female patients with borderline personality disorder. Prog Neuropsychopharmacol Biol Psychiatry 2018; 83:118-126. [PMID: 29355588 DOI: 10.1016/j.pnpbp.2018.01.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 01/11/2018] [Accepted: 01/13/2018] [Indexed: 12/13/2022]
Abstract
Impulsive behavior, difficulties in controlling anger and suicidal behavior are typical patterns of affective/behavioral dysregulation in patients with borderline personality disorder (BPD). Previous functional MRI studies in the resting state condition demonstrated altered functional connectivity (FC) between the anterior cingulate cortex (ACC) and the frontoparietal executive control network (ECN), which was significantly associated with impulsivity in BPD. Impulsivity is often defined as a function of inhibitory control, strongly relying on the proper functioning of the fronto-cingulo-striatal network. Noradrenergic, dopaminergic and serotonergic neurotransmitter systems are assumed to be involved in different forms of impulsive behavior and inhibitory control. In our previous study, we investigated the FC of the main monoamine-producing nuclei within the midbrain and brainstem, which were functionally integrated in specific resting-state networks. In the present study we investigated the resting-state FC of midbrain/brainstem nuclei in 33 unmedicated female patients with BPD and 33 matched healthy controls. We further related altered functional connectivity of these nuclei to the patient's degree of impulsivity. The main finding was that BPD patients showed stronger FC from the noradrenergic locus coeruleus (LC) to the ACC. Functional connectivity between the LC and ACC was positively associated with the degree of motor impulsivity in the total group. Controlling for aggression, a stronger FC was also found between serotonergic nucleus centralis superior (NCS) and the frontopolar cortex (FPC) in patients compared to controls. Furthermore, patients showed a weaker "anti-correlation" from the substantia nigra (SNc) to the left dorsolateral prefrontal cortex (DLPFC). The observed enhanced LC-ACC FC in BPD and its association with the motor impulsivity might be indicative of a noradrenergic dysfunction in the neural inhibitory control network, whereas the significant relationship between NCS-FPC FC and aggression points toward serotonergic contribution to prefrontal control of aggressive reactions.
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Affiliation(s)
- Gerd Wagner
- Psychiatric Brain and Body Research Group Jena, Department of Psychiatry and Psychotherapy, University Hospital Jena, Philosophenweg 3, Jena 07743, Germany
| | - Annegret Krause-Utz
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health (CIMH), Mannheim, Germany; Institute of Clinical Psychology, Leiden University, Leiden, Netherlands; Leiden Institute for Brain and Cognition, Leiden University, Leiden, Netherlands
| | - Feliberto de la Cruz
- Psychiatric Brain and Body Research Group Jena, Department of Psychiatry and Psychotherapy, University Hospital Jena, Philosophenweg 3, Jena 07743, Germany
| | - Andy Schumann
- Psychiatric Brain and Body Research Group Jena, Department of Psychiatry and Psychotherapy, University Hospital Jena, Philosophenweg 3, Jena 07743, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health (CIMH), Mannheim, Germany
| | - Karl-Jürgen Bär
- Psychiatric Brain and Body Research Group Jena, Department of Psychiatry and Psychotherapy, University Hospital Jena, Philosophenweg 3, Jena 07743, Germany.
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Abstract
Information concerning the longitudinal course of Borderline Personality Disorder (BPD) derives mainly from (a) long-term (10 to 25 year) retrospective follow-up studies, primarily those conducted during the 1980s/1990s, (b) brief (1 to 3 year) follow-up studies of recent randomized controlled trials (RCTs) of several different treatment approaches, and (c) prospective follow-up studies. The patients contacted in the retrospective studies had been treated mostly by psychoanalytically informed approaches or supportive. Though there was a significant suicide rate of 3 to 9%, about two-thirds of the BPD patients eventually achieved a global assessment score in the 60s or beyond. BPD represents a heterogeneous group of patients, whose outcome is a function of many variables, including personality traits (paranoid and narcissistic conducing to less favorable outcomes), cultural differences, socio-economic level, intelligence level, gender, and age of onset. The RCT studies focused on amelioration of the symptom components of BPD, especially tendencies to self-injury and suicide. The currently favored treatment methods showed in a large percentage of patients, a lessening of these self-destructive behaviors after a year or two of treatment. The time spans were too brief to allow assessment of improvement in key life areas (attainment of self-sufficiency in work, widening of the circle of friends, and success in forming satisfactory intimate partnerships). The prospective studies are based on reassessments at regular intervals of BPD patients and a control group with other personality disorders. Over the past 16 years the BPD patients, compared with controls, were slower to achieve remission, and more apt to show cognitive peculiarities initially-though they showed appreciable improvement over time. The "recovered" BPD patients, compared with the non-recovered patients, showed twice the likelihood of achieving a successful intimate relationship. At 16 years the McLean study has shown results similar (though scientifically more precise) to those of the old retrospective studies. The studies do not demonstrate the efficacy of one or another treatment approach, since, in long-term follow-up, psychotherapy, albeit essential, becomes one of a myriad of influences affecting outcome. There is general agreement that BPD patients who have experienced severe early trauma (including incest) are at greater risk for a poor outcome-as are those with prominent antisocial traits (more common in BPD males). The personality trait of agreeableness was associated with greater likelihood of favorable outcome.
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Affiliation(s)
- Michael H Stone
- Professor of Clinical Psychiatry, Columbia College of Physicians and Surgeons, New York
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Childhood Trauma and Dissociative Experiences in Female Borderline Disorder With and Without Substance Dependence. ADDICTIVE DISORDERS & THEIR TREATMENT 2018. [DOI: 10.1097/adt.0000000000000121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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37
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Borderline personality disorder and substance use disorders: an updated review. Borderline Personal Disord Emot Dysregul 2018; 5:15. [PMID: 30250740 PMCID: PMC6145127 DOI: 10.1186/s40479-018-0093-9] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 09/03/2018] [Indexed: 12/23/2022] Open
Abstract
For decades, clinicians and researchers have recognized that borderline personality disorder (BPD) and substance use disorders (SUDs) are often diagnosed within the same person (e.g., (Gunderson JG. Borderline personality disorder: A clinical guide. Washington, D.C.: American Psychiatric Press, 2001; Leichsenring et al., Lancet 377:74-84, 2011; Paris J. Borderline personality disorder: A multidimensional approach. American Psychiatric Pub, 1994; Trull et al., Clin Psychol Rev 20:235-53, 2000)). Previously, we documented the extent of this co-occurrence and offered a number of methodological and theoretical explanations for the co-occurrence (Trull et al., Clin Psychol Rev 20:235-53, 2000). Here, we provide an updated review of the literature on the co-occurrence between borderline personality disorder (BPD) and substance use disorders (SUDs) from 70 studies published from 2000 to 2017, and we compare the co-occurrence of these disorders to that documented by a previous review of 36 studies over 15 years ago (Trull et al., Clin Psychol Rev 20:235-53, 2000).
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Euler S, Stöbi D, Sowislo J, Ritzler F, Huber CG, Lang UE, Wrege J, Walter M. Grandiose and Vulnerable Narcissism in Borderline Personality Disorder. Psychopathology 2018; 51:110-121. [PMID: 29466803 DOI: 10.1159/000486601] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 12/16/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Little is known about narcissistic traits in borderline personality disorder (BPD). This exploratory study aimed to illustrate the associations between total, grandiose, and vulnerable narcissism and gender, diagnostic features of BPD and narcissistic personality disorder (NPD), and psychopathology in BPD patients. SAMPLING AND METHODS The Pathological Narcissism Inventory and psychometric measures for impulsivity, anger, borderline symptom severity, personality organization, depression, and rejection sensitivity were completed by 65 BPD patients. Statistical analyses were conducted using the t test, Pearson correlation, and multivariate regression analyses. RESULTS Male BPD patients displayed higher narcissistic scores than females (p < 0.01). Grandiose narcissism showed a stronger association with NPD than with BPD (p < 0.01) while vulnerable narcissism was only associated with BPD (p < 0.01). Rejection sensitivity (p < 0.01) and depression (p < 0.001) predicted vulnerable narcissism. CONCLUSION Vulnerable narcissism is closely associated with BPD and appears to be more dysfunctional than grandiose narcissism. A comprehensive consideration of both traits is recommended. Our results might help to generate hypotheses for further research on pathological narcissism in the spectrum of personality disorders. Future studies are advised to apply complementary measures and take new diagnostic approaches of DSM-5 and ICD-11 into account.
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Brooker BA, Ostojic D, Miller CJ. Symptom covariance accounts for behavioral approach associations across impulse control disorders. ACTA ACUST UNITED AC 2017; 10:199-208. [PMID: 29168110 DOI: 10.1007/s12402-017-0245-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 11/14/2017] [Indexed: 10/18/2022]
Abstract
Behavioral approach system (BAS) dysfunction has been identified as a correlate of and a potential mechanism for attention-deficit/hyperactivity disorder (ADHD) and comorbid disorders. This study examined the role of symptom covariation in the relations among BAS dysfunction, ADHD symptoms, and comorbid impulsive personality disorder features. Undergraduates (N = 207) completed measures of BAS functioning, ADHD symptoms, and borderline and antisocial personality disorder symptoms, and associated features (i.e., relational aggression). Hierarchical regression suggested that age, impulsive ADHD symptoms, and relational aggression were associated with BAS functioning. Adding other ADHD symptom dimensions (inattention, hyperactivity) and antisocial and borderline scores to the model did not increase variance accounted for beyond that accounted for by ADHD impulsivity scores. Results highlight a role of symptom covariance in the previously demonstrated relation between BAS, impulsive presentations of ADHD, and comorbid impulsive personality pathology. Implications for etiological models of ADHD and its co-occurrence with other disorders are discussed.
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Affiliation(s)
- Brianne A Brooker
- Department of Psychology, University of Windsor, 401 Sunset Avenue, Windsor, ON, N9B 3P4, Canada
| | - Dragana Ostojic
- Department of Psychology, University of Windsor, 401 Sunset Avenue, Windsor, ON, N9B 3P4, Canada
| | - Carlin J Miller
- Department of Psychology, University of Windsor, 401 Sunset Avenue, Windsor, ON, N9B 3P4, Canada.
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40
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Bayes A, Parker G. Borderline personality disorder in men: A literature review and illustrative case vignettes. Psychiatry Res 2017; 257:197-202. [PMID: 28768209 DOI: 10.1016/j.psychres.2017.07.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 06/26/2017] [Accepted: 07/25/2017] [Indexed: 10/19/2022]
Abstract
The aim is to review the salient literature on borderline personality disorder (BPD) in men and link those findings with case vignettes. We provide a literature review and then report case examples of those who met DSM and clinical BPD criteria, and consider the extent to which the small male sub-set corresponded developmentally and phenomenologically with prototypic BPD in women. The review considered phenomenological, epidemiological, biological and developmental BPD factors, finding BPD men evidence elevated substance abuse, and 'externalising' patterns of behavior, antisocial personality traits, violent self-harm and interpersonal aggression, whereas women display more 'internalising' strategies. The five male vignettes enriched the literature review providing support for gender differences reported in our review. The literature and case vignette findings should assist clinicians in recognising that BPD in men may not be as rare as generally viewed, and which may reflect BPD being commonly viewed as weighted to women and being misdiagnosed as an antisocial personality disorder (ASPD) in men.
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Affiliation(s)
- Adam Bayes
- School of Psychiatry, University of New South Wales, NSW 2050, Australia.
| | - Gordon Parker
- School of Psychiatry, University of New South Wales, NSW 2050, Australia; Black Dog Institute, Hospital Rd, Randwick, NSW 2031, Australia
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Vanwoerden S, Kalpakci A, Sharp C. The relations between inadequate parent-child boundaries and borderline personality disorder in adolescence. Psychiatry Res 2017; 257:462-471. [PMID: 28837938 DOI: 10.1016/j.psychres.2017.08.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 08/01/2017] [Accepted: 08/09/2017] [Indexed: 11/17/2022]
Abstract
Borderline Personality Disorder (BPD) is a severe mental illness that onsets in adolescence. Research has demonstrated the central role of parent-child relationships for the development and maintenance of BPD although more research is necessary to clarify the specific dynamics that relate to BPD during adolescence. Based on preliminary research establishing the importance of parent-child boundaries for adolescent BPD, this study sought to evaluate the relations between different forms of inadequate boundaries and BPD in adolescence using a multi-method approach. To that end, 301 adolescents (65.1% female; ages 12-17) inpatients were recruited; parents and adolescents completed questionnaire- and interview-based measures of BPD features in adolescent children and a questionnaire-based measure of parent-child boundaries. Relations were found between parental guilt induction and psychological control with children's BPD features above and beyond relations with psychiatric severity and gender. Relations between parent reports of triangulation (when children are recruited to mediate parental marital conflict) and children's BPD were contingent on the level of children's perceptions of triangulation. Findings confirm previous research suggesting the relevance of inadequate parent-child boundaries to children's BPD features and have important implications for understanding the dynamics in families with adolescents with BPD, representing a relevant treatment target.
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Affiliation(s)
| | - Allison Kalpakci
- Department of Psychology, University of Houston, Houston, TX, USA; Department of Psychiatry, Yale College of Medicine, New Haven, CT, USA
| | - Carla Sharp
- Department of Psychology, University of Houston, Houston, TX, USA.
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42
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Gratz KL, Weiss NH, McDermott MJ, Dilillo D, Messman-Moore T, Tull MT. Emotion Dysregulation Mediates the Relation Between Borderline Personality Disorder Symptoms and Later Physical Health Symptoms. J Pers Disord 2017; 31:433-448. [PMID: 27322577 PMCID: PMC5472518 DOI: 10.1521/pedi_2016_30_252] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Despite evidence of a relation between borderline personality disorder (BPD) pathology and physical health problems, the mechanisms underlying this relation remain unclear. Given evidence that emotion dysregulation may affect physical health by altering physiological functioning, one mechanism that warrants examination is emotion dysregulation. This study examined BPD symptoms as a prospective predictor of physical health symptoms 8 months later and the mediating role of emotion dysregulation in this relation. Participants completed three assessments over an 8-month period, including a BPD diagnostic interview. Results of analyses examining baseline predictors of later physical health symptoms revealed a significant unique association between baseline BPD symptom severity and physical health symptoms 8 months later, above and beyond baseline physical health symptoms, depression and anxiety symptoms, and emotion dysregulation. Moreover, structural equation modeling revealed a significant indirect relation of BPD symptoms at Wave 1 to physical health symptoms at Wave 3 through emotion dysregulation at Wave 2.
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Affiliation(s)
- Kim L Gratz
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi
| | - Nicole H Weiss
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Michael J McDermott
- Department of Psychology, University of Louisiana at Lafayette, Lafayette, Louisiana
| | - David Dilillo
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska
| | | | - Matthew T Tull
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi
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43
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Hyper-modulation of brain networks by the amygdala among women with Borderline Personality Disorder: Network signatures of affective interference during cognitive processing. J Psychiatr Res 2017; 88:56-63. [PMID: 28086129 PMCID: PMC5362299 DOI: 10.1016/j.jpsychires.2016.12.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 10/26/2016] [Accepted: 12/20/2016] [Indexed: 01/16/2023]
Abstract
Emotion dysregulation is a core characteristic of patients with Borderline Personality Disorder (BPD), and is often attributed to an imbalance in fronto-limbic network function. Hyperarousal of amygdala, especially in response to negative affective stimuli, results in affective interference with cognitive processing of executive functions. Clinical consequences include the impulsive-aggression, suicidal and self-injurious behaviors which characterize BPD. Dysfunctional interactions between amygdala and its network targets have not been well characterized during cognitive task performance. Using psychophysiological interaction analysis (PPI), we mapped network profiles of amygdala interaction with key regulatory regions during a Go No-Go task, modified to use negative, positive and neutral Ekman faces as targets. Fifty-six female subjects, 31 BPD and 25 healthy controls (HC), completed the affectively valenced Go No-Go task during fMRI scanning. In the negative affective condition, the amygdala exerted greater modulation of its targets in BPD compared to HC subjects in Rt. OFC, Rt. dACC, Rt. Parietal cortex, Rt. Basal Ganglia, and Rt. dlPFC. Across the spectrum of affective contrasts, hypermodulation in BPD subjects observed the following ordering: Negative > Neutral > Positive contrast. The amygdala seed exerted modulatory effects on specific target regions important in processing response inhibition and motor impulsiveness. The vulnerability of BPD subjects to affective interference with impulse control may be due to specific network dysfunction related to amygdala hyper-arousal and its effects on prefrontal regulatory regions such as the OFC and dACC.
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44
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Khan R, Brewer G, Kim S, Centifanti LCM. Students, sex, and psychopathy: Borderline and psychopathy personality traits are differently related to women and men's use of sexual coercion, partner poaching, and promiscuity. PERSONALITY AND INDIVIDUAL DIFFERENCES 2017. [DOI: 10.1016/j.paid.2016.11.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Soloff PH, Abraham K, Burgess A, Ramaseshan K, Chowdury A, Diwadkar VA. Impulsivity and aggression mediate regional brain responses in Borderline Personality Disorder: An fMRI study. Psychiatry Res 2017; 260:76-85. [PMID: 28039797 PMCID: PMC5272782 DOI: 10.1016/j.pscychresns.2016.12.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 12/07/2016] [Accepted: 12/10/2016] [Indexed: 01/24/2023]
Abstract
Fronto-limbic brain networks involved in regulation of impulsivity and aggression are abnormal in Borderline Personality Disorder (BPD). However, it is unclear whether, or to what extent, these personality traits actually modulate brain responses during cognitive processing. Using fMRI, we examined the effects of trait impulsivity, aggression, and depressed mood on regional brain responses in 31 female BPD and 25 control subjects during a Go No-Go task using Ekman faces as targets. First-level contrasts modeled effects of negative emotional context. Second-level regression models used trait impulsivity, aggression and depressed mood as predictor variables of regional brain activations. In BPD, trait impulsivity was positively correlated with activation in the dorsal anterior cingulate cortex, orbital frontal cortex (OFC), basal ganglia (BG), and dorsolateral prefrontal cortex, with no areas of negative correlation. In contrast, aggression was negatively correlated with activation in OFC, hippocampus, and BG, with no areas of positive correlation. Depressed mood had a generally dampening effect on activations. Effects of trait impulsivity on healthy controls differed from effects in BPD, suggesting a disorder-specific response. Negative emotional context and trait impulsivity, but not aggression or depression, diminished task performance across both groups. Negative emotional context may interfere with cognitive functioning in BPD through interaction with the neurobiology of personality traits.
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Affiliation(s)
- Paul H Soloff
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Kristy Abraham
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Ashley Burgess
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Karthik Ramaseshan
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Asadur Chowdury
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Vaibhav A Diwadkar
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
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46
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Drislane LE, Patrick CJ. Integrating Alternative Conceptions of Psychopathic Personality: A Latent Variable Model of Triarchic Psychopathy Constructs. J Pers Disord 2017; 31:110-132. [PMID: 26959963 DOI: 10.1521/pedi_2016_30_240] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study undertook confirmatory factor analyses (CFAs) of data from 567 participants to quantify constructs specified by the triarchic model of psychopathy (Patrick, Fowles, & Krueger, 2009)-boldness, meanness, and disinhibition-as latent variables. Indicators for the CFAs consisted of subscales of the Triarchic Psychopathy Measure along with triarchic scales derived from items of the Psychopathic Personality Inventory, Youth Psychopathic Traits Inventory, and Multidimensional Personality Questionnaire. A modified three-factor model provided good fit to the data and outperformed alternative two- and one-factor models. Multiple-group CFAs demonstrated gender differences (male > female) in factor means and covariances, but not in factor loadings or intercepts. These findings support the idea that the triarchic model dimensions are embedded in differing models and measures of psychopathy and comprise essential building blocks for this clinical condition. Implications for understanding the structure of psychopathy, gender differences in psychopathic traits, and applications of latent variable modeling in future research are discussed.
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47
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Chun S, Harris A, Carrion M, Rojas E, Stark S, Lejuez C, Lechner WV, Bornovalova MA. A psychometric investigation of gender differences and common processes across borderline and antisocial personality disorders. JOURNAL OF ABNORMAL PSYCHOLOGY 2017; 126:76-88. [PMID: 27808543 PMCID: PMC5217473 DOI: 10.1037/abn0000220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The comorbidity between borderline personality disorder (BPD) and antisocial personality disorder (ASPD) is well-established, and the 2 disorders share many similarities. However, there are also differences across disorders: most notably, BPD is diagnosed more frequently in women and ASPD in men. We investigated if (a) comorbidity between BPD and ASPD is attributable to 2 discrete disorders or the expression of common underlying processes, and (b) if the model of comorbidity is true across sex. Using a clinical sample of 1,400 drug users in residential substance abuse treatment, we tested 3 competing models to explore whether the comorbidity of ASPD and BPD should be represented by a single common factor, 2 correlated factors, or a bifactor structure involving a general and disorder-specific factors. Next, we tested whether our resulting model was meaningful by examining its relationship with criterion variables previously reported to be associated with BPD and ASPD. The bifactor model provided the best fit and was invariant across sex. Overall, the general factor of the bifactor model significantly accounted for a large percentage of the variance in criterion variables, whereas the BPD and AAB specific factors added little to the models. The association of the general and specific factor with all criterion variables was equal for men and women. Our results suggest common underlying vulnerability accounts for both the comorbidity between BPD and AAB (across sex), and this common vulnerability drives the association with other psychopathology and maladaptive behavior. This in turn has implications for diagnostic classification systems and treatment. (PsycINFO Database Record
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Affiliation(s)
- Seokjoon Chun
- University of South Florida, Department of Psychology
| | - Alexa Harris
- University of South Florida, Department of Psychology
| | | | | | - Stephen Stark
- University of South Florida, Department of Psychology
| | - Carl Lejuez
- University of Kansas, Department of Psychology
| | - William V. Lechner
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI
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48
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Karamanolaki H, Spyropoulou AC, Iliadou A, Vousoura E, Vondikaki S, Pantazis N, Vaslamatzis G. Birth order and memories of traumatic and family experiences in Greek patients with borderline personality disorder versus patients with other personality disorders. Bull Menninger Clin 2016; 80:234-54. [DOI: 10.1521/bumc.2016.80.3.234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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49
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Auerbach RP, Tarlow N, Bondy E, Stewart JG, Aguirre B, Kaplan C, Yang W, Pizzagalli DA. Electrocortical Reactivity During Self-referential Processing in Female Youth With Borderline Personality Disorder. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2016; 1:335-344. [PMID: 28626812 PMCID: PMC5472065 DOI: 10.1016/j.bpsc.2016.04.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Borderline personality disorder (BPD) is debilitating, and theoretical models have postulated that cognitive-affective biases contribute to the onset and maintenance of BPD symptoms. Despite advances, our understanding of BPD pathophysiology in youth is limited. The present study used event-related potentials (ERPs) to identify cognitive-affective processes that underlie negative self-referential processing in BPD youth. METHODS Healthy females (n = 33) and females with BPD (n = 26) 13 to 22 years of age completed a self-referential encoding task while 128-channel electroencephalography data were recorded to examine early (i.e., P1 and P2) and late (late positive potential [LPP]) ERP components. Whole-brain standardized low-resolution electromagnetic tomography explored intracortical sources underlying significant scalp ERP effects. RESULTS Compared to healthy females, participants with BPD endorsed, recalled, and recognized fewer positive and more negative words. Moreover, unlike the healthy group, females with BPD had faster reaction times to endorse negative versus positive words. In the scalp ERP analyses, the BPD group had greater P2 and late LPP positivity to negative as opposed to positive words. For P2 and late LPP, whole-brain standardized low-resolution electromagnetic tomography analyses suggested that females with BPD overrecruit frontolimbic circuitry in response to negative stimuli. CONCLUSIONS Collectively, these findings show that females with BPD process negative self-relevant information differently than healthy females. Clinical implications and future directions are discussed.
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Affiliation(s)
- Randy P Auerbach
- Department of Psychiatry (RPA, NT, EB, JGS, BA, CK, WY, DAP), McLean Hospital, Center for Depression, Anxiety and Stress Research, Harvard Medical School, Boston, Massachusetts; and Department of Psychology (WY), Hunan Normal University, Hunan, China
| | - Naomi Tarlow
- Department of Psychiatry (RPA, NT, EB, JGS, BA, CK, WY, DAP), McLean Hospital, Center for Depression, Anxiety and Stress Research, Harvard Medical School, Boston, Massachusetts; and Department of Psychology (WY), Hunan Normal University, Hunan, China
| | - Erin Bondy
- Department of Psychiatry (RPA, NT, EB, JGS, BA, CK, WY, DAP), McLean Hospital, Center for Depression, Anxiety and Stress Research, Harvard Medical School, Boston, Massachusetts; and Department of Psychology (WY), Hunan Normal University, Hunan, China
| | - Jeremy G Stewart
- Department of Psychiatry (RPA, NT, EB, JGS, BA, CK, WY, DAP), McLean Hospital, Center for Depression, Anxiety and Stress Research, Harvard Medical School, Boston, Massachusetts; and Department of Psychology (WY), Hunan Normal University, Hunan, China
| | - Blaise Aguirre
- Department of Psychiatry (RPA, NT, EB, JGS, BA, CK, WY, DAP), McLean Hospital, Center for Depression, Anxiety and Stress Research, Harvard Medical School, Boston, Massachusetts; and Department of Psychology (WY), Hunan Normal University, Hunan, China
| | - Cynthia Kaplan
- Department of Psychiatry (RPA, NT, EB, JGS, BA, CK, WY, DAP), McLean Hospital, Center for Depression, Anxiety and Stress Research, Harvard Medical School, Boston, Massachusetts; and Department of Psychology (WY), Hunan Normal University, Hunan, China
| | - Wenhui Yang
- Department of Psychiatry (RPA, NT, EB, JGS, BA, CK, WY, DAP), McLean Hospital, Center for Depression, Anxiety and Stress Research, Harvard Medical School, Boston, Massachusetts; and Department of Psychology (WY), Hunan Normal University, Hunan, China
| | - Diego A Pizzagalli
- Department of Psychiatry (RPA, NT, EB, JGS, BA, CK, WY, DAP), McLean Hospital, Center for Depression, Anxiety and Stress Research, Harvard Medical School, Boston, Massachusetts; and Department of Psychology (WY), Hunan Normal University, Hunan, China
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50
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Meaney R, Hasking P, Reupert A. Borderline Personality Disorder Symptoms in College Students: The Complex Interplay between Alexithymia, Emotional Dysregulation and Rumination. PLoS One 2016; 11:e0157294. [PMID: 27348858 PMCID: PMC4922551 DOI: 10.1371/journal.pone.0157294] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 05/26/2016] [Indexed: 11/17/2022] Open
Abstract
Both Emotional Cascade Theory and Linehan’s Biosocial Theory suggest dysregulated behaviors associated with Borderline Personality Disorder (BPD) emerge, in part, because of cycles of rumination, poor emotional recognition and poor emotion regulation. In this study we examined relationships between rumination, alexithymia, and emotion regulation in predicting dysregulated behaviors associated with BPD (e.g. self-harm, substance use, aggression), and explored both indirect and moderating effects among these variables. The sample comprised 2261 college students who completed self-report measures of the aforementioned constructs. BPD symptoms, stress, family psychological illness, and alexithymia exerted direct effects on behaviors. Symptoms had an indirect effect on behaviors through rumination, alexithymia and emotional dysregulation. In addition, the relationship between symptoms and dysregulated behaviors was conditional on level of rumination and alexithymia. Implications for early identification and treatment of BPD and related behaviors in college settings are discussed.
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Affiliation(s)
- Rebecca Meaney
- Faculty of Education, Monash University, Melbourne, Victoria, Australia
| | - Penelope Hasking
- School of Psychology & Speech Pathology, Curtin University, Perth, Western Australia, Australia.,Department of Psychiatry, Monash University, Clayton, Victoria, Australia
| | - Andrea Reupert
- Faculty of Education, Monash University, Melbourne, Victoria, Australia
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