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Leichsenring F, Fonagy P, Heim N, Kernberg OF, Leweke F, Luyten P, Salzer S, Spitzer C, Steinert C. Borderline personality disorder: a comprehensive review of diagnosis and clinical presentation, etiology, treatment, and current controversies. World Psychiatry 2024; 23:4-25. [PMID: 38214629 PMCID: PMC10786009 DOI: 10.1002/wps.21156] [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: 01/13/2024] Open
Abstract
Borderline personality disorder (BPD) was introduced in the DSM-III in 1980. From the DSM-III to the DSM-5, no major changes have occurred in its defining criteria. The disorder is characterized by instability of self-image, interpersonal relationships and affects. Further symptoms include impulsivity, intense anger, feelings of emptiness, strong abandonment fears, suicidal or self-mutilation behavior, and transient stress-related paranoid ideation or severe dissociative symptoms. There is evidence that BPD can be reliably diagnosed and differentiated from other mental disorders by semi-structured interviews. The disorder is associated with considerable functional impairment, intensive treatment utilization, and high societal costs. The risk of self-mutilation and suicide is high. In the general adult population, the lifetime prevalence of BPD has been reported to be from 0.7 to 2.7%, while its prevalence is about 12% in outpatient and 22% in inpatient psychiatric services. BPD is significantly associated with other mental disorders, including depressive disorders, substance use disorders, post-traumatic stress disorder, attention-deficit/hyperactivity disorder, bipolar disorder, bulimia nervosa, and other personality disorders. There is convincing evidence to suggest that the interaction between genetic factors and adverse childhood experiences plays a central role in the etiology of BPD. In spite of considerable research, the neurobiological underpinnings of the disorder remain to be clarified. Psychotherapy is the treatment of choice for BPD. Various approaches have been empirically supported in randomized controlled trials, including dialectical behavior therapy, mentalization-based therapy, transference-focused therapy, and schema therapy. No approach has proved to be superior to others. Compared to treatment as usual, psychotherapy has proved to be more efficacious, with effect sizes between 0.50 and 0.65 with regard to core BPD symptom severity. However, almost half of the patients do not respond sufficiently to psychotherapy, and further research in this area is warranted. It is not clear whether some patients may benefit more from one psychotherapeutic approach than from others. No evidence is available consistently showing that any psychoactive medication is efficacious for the core features of BPD. For discrete and severe comorbid anxiety or depressive symptoms or psychotic-like features, pharmacotherapy may be useful. Early diagnosis and treatment of BPD can reduce individual suffering and societal costs. However, more high-quality studies are required, in both adolescents and adults. This review provides a comprehensive update of the BPD diagnosis and clinical characterization, risk factors, neurobiology, cognition, and management. It also discusses the current controversies concerning the disorder, and highlights the areas in which further research is needed.
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Affiliation(s)
- Falk Leichsenring
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
- Department of Psychosomatics and Psychotherapy, University of Rostock, Rostock, Germany
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Nikolas Heim
- International Psychoanalytic University, Berlin, Germany
| | - Otto F Kernberg
- Personality Disorders Institute, Weill Cornell Medical College, New York, NY, USA
| | - Frank Leweke
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
| | - Patrick Luyten
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | - Simone Salzer
- International Psychoanalytic University, Berlin, Germany
| | - Carsten Spitzer
- Department of Psychosomatics and Psychotherapy, University of Rostock, Rostock, Germany
| | - Christiane Steinert
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
- International Psychoanalytic University, Berlin, Germany
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Galvez-Merlin A, Lopez-Villatoro JM, de la Higuera-Gonzalez P, de la Torre-Luque A, Reneses-Prieto B, Diaz-Marsa M, Carrasco JL. Social cognition deficits in borderline personality disorder: Clinical relevance. Psychiatry Res 2024; 331:115675. [PMID: 38134528 DOI: 10.1016/j.psychres.2023.115675] [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: 07/06/2023] [Revised: 11/26/2023] [Accepted: 12/10/2023] [Indexed: 12/24/2023]
Abstract
Interpersonal difficulties in borderline personality disorder (BDP) have been suggested to be related to impairments in Social Cognition (SC), mainly due to deficits in Theory of Mind (ToM). However, literature is scarce and ambiguous. This work aims to study the SC impairments in BPD patients, by the specific assessment of ToM deficits, and to investigate the relationship between these SC impairments and clinical variables. 82 BPD patients with BPD and 47 control subjects were assessed with the Movie for the Assessment of Social Cognition (MASC). Clinical variables of severity, chronicity, functionality and anxious-depressive symptomatology were recorded. BPD patients had fewer correct mentalization responses and more overmentalization, undermentalization, and absence of mentalization errors than controls. Chronicity was negatively correlated with overmentalization and positively correlated with undermentalization and absence of mentalization errors. Functionality was indirectly correlated with absence of mentalization. These results confirm previous reports of alterations in SC in BPD patients. Furthermore, this study shows that SC impairments in patients with BPD are dependent on characteristics such as chronicity or degree of functionality. The different ToM profiles in patients with BPD indicate the necessity of developing variants of mentalization therapy depending on the deficits of each patient.
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Affiliation(s)
- Alejandra Galvez-Merlin
- Health Research Institute, Hospital Clinico San Carlos (IdISSC), Madrid, Spain; Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid, Madrid, Spain
| | - Jose Manuel Lopez-Villatoro
- Health Research Institute, Hospital Clinico San Carlos (IdISSC), Madrid, Spain; Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid, Madrid, Spain
| | - Pilar de la Higuera-Gonzalez
- Health Research Institute, Hospital Clinico San Carlos (IdISSC), Madrid, Spain; Department of Personality, Assessment and Clinical Psychology, Universidad Complutense de Madrid, Madrid, Spain.
| | - Alejandro de la Torre-Luque
- Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid, Madrid, Spain; Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
| | - Blanca Reneses-Prieto
- Health Research Institute, Hospital Clinico San Carlos (IdISSC), Madrid, Spain; Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid, Madrid, Spain; Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
| | - Marina Diaz-Marsa
- Health Research Institute, Hospital Clinico San Carlos (IdISSC), Madrid, Spain; Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid, Madrid, Spain; Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
| | - Jose L Carrasco
- Health Research Institute, Hospital Clinico San Carlos (IdISSC), Madrid, Spain; Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid, Madrid, Spain; Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
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Muriel NS, López Resa P, Moraleda Sepúlveda E. Linguistic characteristics in bipolar disorder versus borderline personality disorder. Sci Rep 2023; 13:21715. [PMID: 38065986 PMCID: PMC10709396 DOI: 10.1038/s41598-023-46038-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/26/2023] [Indexed: 12/18/2023] Open
Abstract
Scientific evidence has documented throughout the research carried out in recent years, the neuropsychological, behavioral and adaptive difficulties presented by people with Bipolar Disorder and Borderline Personality Disorder at different stages of their development. However, little importance has been given to other factors such as communication, especially in the adult population. The objective of this research was to know the language characteristics presented by people from both groups and the differences in linguistic development. The sample consisted of 60 participants between the ages of 17 and 42:31 of them with a diagnosis of Borderline Personality Disorder and the remaining 29 with a diagnosis of Bipolar Disorder. The standardized evaluation instruments were: the Social Skills Scale and the Pragmatic Competence Questionnaire completed by three different informants (families, professionals and the own person). The results obtained show that both populations manifest linguistic difficulties in adulthood and that there are differences depending on the perception of the agent involved in the language assessment. These results are highly relevant since they provide up-to-date information about language level, support the need for language intervention in adulthood, and reflect a different communicative profile in Bipolar Disorder and Borderline Personality Disorder.
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Affiliation(s)
- Noelia Santos Muriel
- Department of Psychology, Faculty of Health Sciences, University of Castilla-La-Mancha, Avda Real Fábrica de la Seda s/n, 45600, Talavera de la Reina, Spain
| | - Patricia López Resa
- Department of Psychology, Faculty of Health Sciences, University of Castilla-La-Mancha, Avda Real Fábrica de la Seda s/n, 45600, Talavera de la Reina, Spain
| | - Esther Moraleda Sepúlveda
- Department of Psychology, Faculty of Pychology, University Complutense, Campus de Somosaguas, 28223, Pozuelo de Alarcón, Madrid, Spain.
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Weijers JG, van Kaam F, Selten JP, de Winter RFP, ten Kate C. Diverging effects of mentalization based treatment for patients with borderline personality disorder and schizophrenia: an explorative comparison. Front Psychiatry 2023; 14:1226507. [PMID: 37692309 PMCID: PMC10485774 DOI: 10.3389/fpsyt.2023.1226507] [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: 05/21/2023] [Accepted: 08/01/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction There is robust evidence that both patients with schizophrenia (SCZ) and borderline personality disorder (BPD) display mentalizing difficulties. Less is known however about differences in the way mentalization based treatment (MBT) impacts mentalizing capacity in SCZ and BPD patients. This study compares the impact of MBT on mentalizing capacity in individuals with SCZ and BPD. Method The thematic apperception test was used to measure mentalizing capacity. It was administered at the beginning and end of treatment to 26 patients with SCZ and 28 patients with BPD who enrolled in an 18-month long MBT program. For comparison a sample of 28 SCZ patients who did not receive MBT was also included. Using the social cognition and object-relations system, these narratives were analyzed and scored. Missing data was imputed and analyzed using intention-to-treat ANCOVAs with post-treatment measures of mentalizing capacity as dependent variables, group type as independent variable and baseline mentalizing capacities as covariates. Results Results showed that patients with BPD showed significantly more improvement on several measures of mentalizing, including complexity of representation (ηp2 = 0.50, ppooled < 0.001), understanding of social causality (ηp2 = 0.41, ppooled < 0.001) and emotional investment in relationships (ηp2 = 0.41, ppooled < 0.001) compared to patients with SCZ who received MBT. No differences were found regarding affect-tone of relationships (ηp2 = 0.04, ppooled = 0.36). SCZ patients who received MBT showed greater performance on understanding of social causality (ηp2 = 0.12, ppooled = 0.01) compared to SCZ patients who did not receive MBT, but no differences were observed on complexity of representations, capacity for emotional investment or affect-tone of relationships. Discussion Patients with BPD performed better after receiving MBT on three dimensions of mentalizing capacity than SCZ patients who received MBT. Remarkably, SCZ patients who received MBT performed better on one dimension of mentalizing capacity compared to SCZ patients who did not receive MBT. Whereas MBT for BPD clearly involves improvement on most aspects of mentalizing, MBT for SCZ seems to thwart a further decline of other-oriented, cognitive mentalizing. Treatment goals should be adapted toward these disorder-specific characteristics.
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Affiliation(s)
- Jonas G. Weijers
- GGZ Rivierduinen, Institute for Mental Health Care, Leiden, Netherlands
| | - Fleur van Kaam
- GGZ Rivierduinen, Institute for Mental Health Care, Leiden, Netherlands
| | - Jean-Paul Selten
- GGZ Rivierduinen, Institute for Mental Health Care, Leiden, Netherlands
- MHeNs School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Remco F. P. de Winter
- GGZ Rivierduinen, Institute for Mental Health Care, Leiden, Netherlands
- MHeNs School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
- Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Coriene ten Kate
- GGZ Rivierduinen, Institute for Mental Health Care, Leiden, Netherlands
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Burghardt J, Gradl S, Knopp M, Sprung M. Psychopathology and Theory of Mind in patients with personality disorders. Borderline Personal Disord Emot Dysregul 2023; 10:18. [PMID: 37259167 DOI: 10.1186/s40479-023-00224-1] [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: 01/19/2023] [Accepted: 05/09/2023] [Indexed: 06/02/2023] Open
Abstract
OBJECTIVE People with mental disorders frequently suffer from deficits in the ability to infer other's mental states (Theory of Mind; ToM). Individuals with borderline personality disorder (BPD) show ToM deficits characterized by exceeding ToM (over-attributions of mental states). The present study analyzed associations between ToM, BPD severity, and depression severity in patients with BPD and other personality disorders. METHOD We analyzed ToM abilities in 128 patients with BPD and 82 patients with 'mixed and other personality disorders' (MOPD). MOPD are diagnosed if symptoms of multiple personality disorders are present without any set of symptoms being dominant enough to allow a specific diagnosis. We used the movies for the assessment of social cognition (MASC) to measure ToM abilities, the Patient Health Questionnaire (PHQ-9) to assess severity of depression and the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) to assess the severity of BPD symptoms. RESULTS Both symptoms of BPD and depression were associated with exceeding ToM in separate regressions. Using a stepwise regression, only the association of depression severity with exceeding ToM was reliable. Patients with BPD and MOPD did not differ in exceeding ToM. Age was most reliably associated with ToM. CONCLUSION The results imply that exceeding ToM is associated with general psychopathology instead of BPD-symptoms in specific. Patients with MOPD show deficits similar to BPD patients.
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Affiliation(s)
- Juliane Burghardt
- Division of Clinical Psychology, Department of Psychology and Psychodynamics, Karl Landsteiner University of Health Sciences, Dr.-Karl-Dorrek-Straße 30, Krems an Der Donau, 3500, Austria
| | - Silvia Gradl
- Division of Clinical Psychology, Department of Psychology and Psychodynamics, Karl Landsteiner University of Health Sciences, Dr.-Karl-Dorrek-Straße 30, Krems an Der Donau, 3500, Austria.
- University Hospital for Psychosomatic Medicine Eggenburg, Grafenberger Straße 2, Eggenburg, 3730, Austria.
- Faculty of Psychology and Educational Sciences, Department of Psychology, Ludwig-Maximilians-Universität München, Leopoldstraße 13, Munich, 80802, Germany.
| | - Magdalena Knopp
- Division of Clinical Psychology, Department of Psychology and Psychodynamics, Karl Landsteiner University of Health Sciences, Dr.-Karl-Dorrek-Straße 30, Krems an Der Donau, 3500, Austria
- Faculty of Psychology and Educational Sciences, Department of Psychology, Ludwig-Maximilians-Universität München, Leopoldstraße 13, Munich, 80802, Germany
| | - Manuel Sprung
- Division of Clinical Psychology, Department of Psychology and Psychodynamics, Karl Landsteiner University of Health Sciences, Dr.-Karl-Dorrek-Straße 30, Krems an Der Donau, 3500, Austria
- University Hospital for Psychosomatic Medicine Eggenburg, Grafenberger Straße 2, Eggenburg, 3730, Austria
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Yazgeç E, Bora E, İngeç S, Çıray RO, Bağcı B, Alkın T. Social Cognition in Opioid Use Disorder. Subst Use Misuse 2023; 58:996-1003. [PMID: 37096303 DOI: 10.1080/10826084.2023.2201845] [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: 04/26/2023]
Abstract
Background: Opioid use disorder (OUD) is associated with significant functional impairment and neurocognitive dysfunction, but only a handful of studies have investigated social cognitive abilities in this condition. This study aimed to investigate facial emotion recognition accuracy/biases and two different aspects of theory of mind (ToM) (ToM-decoding vs ToM-reasoning) in people with recovered OUD. Methods: The participants included 32 people with recovered OUD who were on Buprenorphine + Naloxone (B/N) maintenance treatment and 32 healthy controls. In addition to neurocognitive tasks, both groups were assessed by a facial emotion recognition task, the faux pas recognition task, and the reading the mind from the eyes task. Results: In comparison to healthy controls, people on B/N maintenance treatment showed deficits in facial emotion recognition (d = 1.32) and both aspects of ToM (d = 0.87-1.21). In analyses of individual emotions, people on B/N maintenance treatment had decreased accuracy in recognition of anger and fear and had a bias to identify other emotions as sad. The duration of opioid use was robustly associated with difficulties in the recognition of anger. Conclusion: People in B/N maintenance treatment have significant difficulties in recognizing the emotions and mental states of others. Deficits in social cognition might be important for understanding the difficulties in interpersonal and social functioning in people with OUD.
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Affiliation(s)
- Emre Yazgeç
- Department of Psychiatry, Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
| | - Emre Bora
- Department of Psychiatry, Dokuz Eylul University Medical School, Izmir, Turkey
- Department of Neuroscience Health Sciences Institute, Dokuz Eylul University, Izmir, Turkey
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia
| | - Seda İngeç
- Department of Psychiatry, Balıkesir State Hospital, Balikesir, Turkey
| | - R Oğulcan Çıray
- Department of Child and Adolescent Psychiatry, Mardin StateHospital, Mardin, Turkey
| | - Başak Bağcı
- Department of Psychiatry, Ataturk Education and Research Hospital, Izmır Kâtip Çelebi University, Izmir, Turkey
| | - Tunç Alkın
- Department of Psychiatry, Dokuz Eylul University Medical School, Izmir, Turkey
- Department of Neuroscience Health Sciences Institute, Dokuz Eylul University, Izmir, Turkey
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Chevalier V, Simard V, Achim J. Meta-analyses of the associations of mentalization and proxy variables with anxiety and internalizing problems. J Anxiety Disord 2023; 95:102694. [PMID: 36905852 DOI: 10.1016/j.janxdis.2023.102694] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 12/15/2022] [Accepted: 02/28/2023] [Indexed: 03/13/2023]
Abstract
Mentalization, the high-order function of detecting and interpreting one's own and others' mental states, has gained interest in the fields of clinical and developmental psychopathology. However, little is known about mentalization's associations with anxiety and broader internalizing problems. Using the framework of the multidimensional model of mentalization, the aim of this meta-analysis was to quantify the strength of the association between mentalization and anxiety/internalizing problems and to identify potential moderators of this association. A systematic review of the literature led to the inclusion of 105 studies (N = 19,529) covering all age groups. The global effect analysis showed a small negative association between mentalization and the overall anxious and internalizing symptomatology (r = -0.095, p = .000). Various effect sizes were found for associations between mentalization and specific outcomes (unspecified anxiety, social anxiety, generalized anxiety, and internalizing problems). The methods of assessment of mentalization and anxiety moderated their association. Findings support the presence of modest impairments in the mentalizing capacities of anxious individuals, likely influenced by their vulnerability to stress and the context in which they mentalize. Further studies are needed to draw a clear profile of mentalizing capacities with regard to specific anxious and internalizing symptomatologies.
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Affiliation(s)
- Valérie Chevalier
- Department of Psychology, Université de Sherbrooke, 150 Place Charles-Le Moyne, Suite 200, Longueuil J4K 0A8, QC, Canada
| | - Valérie Simard
- Department of Psychology, Université de Sherbrooke, 150 Place Charles-Le Moyne, Suite 200, Longueuil J4K 0A8, QC, Canada; Charles-Le Moyne Research Center, 150 Place Charles-Le Moyne, Suite 200, Longueuil J4K 0A8, QC, Canada; Research Center of the Sainte-Justine University Hospital, 3175 Côte-Sainte-Catherine Road, Montréal, QC H3T 1C5, Canada.
| | - Julie Achim
- Department of Psychology, Université de Sherbrooke, 150 Place Charles-Le Moyne, Suite 200, Longueuil J4K 0A8, QC, Canada; Charles-Le Moyne Research Center, 150 Place Charles-Le Moyne, Suite 200, Longueuil J4K 0A8, QC, Canada; Research Center of the Centre intégré universitaire de santé et de services sociaux du Nord-de-l'île-de-Montréal, Montréal Sacré-Coeur Hospital, 5400, Gouin Blvd West, Montreal H4J 1C5, QC, Canada
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Ollinheimo A, Hakkarainen K. Critical thinking as cooperation and its relation to mental health and social welfare. NEW IDEAS IN PSYCHOLOGY 2023. [DOI: 10.1016/j.newideapsych.2022.100988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Biermann M, Schulze A, Unterseher F, Hamm M, Atanasova K, Stahlberg D, Lis S. Trustworthiness judgments and Borderline Personality Disorder: an experimental study on the interplay of happiness and trustworthiness appraisals and the effects of wearing face masks during the Covid-19 pandemic in Germany. Borderline Personal Disord Emot Dysregul 2022; 9:27. [PMID: 36324166 PMCID: PMC9629878 DOI: 10.1186/s40479-022-00193-x] [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: 03/12/2022] [Accepted: 07/13/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Judging positive emotional states or the trustworthiness of others is important for forming and maintaining social affiliations. Past studies have described alterations in these appraisal processes in Borderline Personality Disorder (BPD), which might have been exacerbated during the Covid-19 pandemic by the requirement to wear face masks. In the present study, we investigated in an online-survey a) whether social judgments are particularly strongly affected in individuals with BPD when they have to judge happiness and trustworthiness in facial stimuli covered by a mask, b) whether appraising a positive emotional state affects trustworthiness appraisals differentially in BPD and healthy individuals and c) whether social judgments are related to how individuals with BPD experience wearing masks during the pandemic. METHODS Participants (67 HC, 75 BPD) judged happiness and trustworthiness of faces with calm expression with and without masks. Additionally, data on participants' confidence in their judgments, the experience of the burden induced by wearing masks, the protective benefits of masks, and compliance to wearing masks were collected. RESULTS Happiness and trustworthiness were evaluated less confidently and less intense in the BPD group compared to HC. Masks reduced happiness and trustworthiness ratings in both groups. Lower happiness appraisals contributed to lower trustworthiness appraisals except for those with BPD and low levels of symptom severity. Lower trustworthiness ratings were associated with a higher burden, attributing a lower benefit to masks and lower compliance with wearing masks in BPD. CONCLUSIONS Masks do not exacerbate deficits in social judgments. However, lower trustworthiness appraisals in general were linked with more negative evaluations of wearing masks in the BPD group. TRIAL REGISTRATION The aims and hypotheses were preregistered together with the design and planned analyses ( https://aspredicted.org/f5du7.pdf ). For findings of an additionally preregistered research question on the impact of adverse childhood experiences see supplementary material.
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Affiliation(s)
- Miriam Biermann
- Department of Psychiatric and Psychosomatic Medicine, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany. .,Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany.
| | - Anna Schulze
- Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany
| | - Franziska Unterseher
- Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany
| | - Marie Hamm
- Department of Psychiatric and Psychosomatic Medicine, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany.,Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany
| | - Konstantina Atanasova
- Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany
| | - Dagmar Stahlberg
- School of Social Sciences, University of Mannheim, A5, 6, 68159, Mannheim, Germany
| | - Stefanie Lis
- Department of Psychiatric and Psychosomatic Medicine, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany.,Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany
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Kelly Grealy M, Godfrey E, Brady F, Whyte O’Sullivan E, Carroll GA, Burke T. Borderline personality disorder traits and mentalising ability: The self-other social cognition paradox. Front Psychiatry 2022; 13:1023348. [PMID: 36339858 PMCID: PMC9631768 DOI: 10.3389/fpsyt.2022.1023348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/06/2022] [Indexed: 11/21/2022] Open
Abstract
Objective Borderline personality disorder (BPD) is a psychiatric condition characterised by a pervasive pattern of impulsivity, low self-image, and interpersonal conflicts. Previous findings indicate a mixed relationship between BPD and social cognition; little research as investigated whether BPD traits influence performance on specific elements of social cognitive tasks, i.e., positive/negative valence. Method Community-based typical controls (n = 151; 51% female) were recruited through an online survey. Participants completed aspects of the Personality Assessment Inventory pertaining to BPD traits, the Interpersonal Reactivity Index, and measures of both emotion recognition and mentalising. Results Following group stratification into high/low BPD traits, participants with high BPD traits were observed to perform significantly better when identifying negative valence stimuli. Furthermore, high levels of affect instability was found to significantly influence negative valence recognition. Conclusion This research highlights previous research which shows a paradox between higher performance on measures of social cognition, with a group of individuals who report significant interpersonal and relational difficulties. This research supports the assessment of social cognitive processes for people with BPD and/or high BPD traits to support clinical formulation of strengths and difficulties.
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Affiliation(s)
- Molly Kelly Grealy
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Emmet Godfrey
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Finn Brady
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | | | - Grace A. Carroll
- School of Psychology, Queen’s University Belfast, Belfast, United Kingdom
| | - Tom Burke
- School of Psychology, National University of Ireland Galway, Galway, Ireland
- Galway Neuroscience Centre, National University of Ireland Galway, Galway, Ireland
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Stone BM. The Pathogenesis of Borderline Personality Disorder: Evolution of Evidence and Treatment Implications for Two Prominent Models. Psychol Rep 2022:332941221127618. [PMID: 36112891 DOI: 10.1177/00332941221127618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
Since Stern first started his work in 1938, the field has recognized several empirically supported models of the etiology of borderline personality disorder (BPD). Two such models are the Tripartite Model of the Development of BPD and the Biosocial Development Model of BPD. The Tripartite Model of the Development of BPD suggests that it is a combination of a hyperbolic temperament, traumatic childhood experiences, and an event or series of events that trigger the onset of BPD. Whereas the Biosocial Development Model of BPD elaborates on the work of Linehan's Biosocial Theory. This model suggests a combination of an emotionally vulnerable temperament and an invalidating environment cause BPD. Over 70 years of research support these models. This article covers a detailed description of each of these models, the decades of research supporting these models, similarities, differences, treatment implications, the latest research, and future directions.
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Zheltyakova M, Korotkov A, Masharipov R, Myznikov A, Didur M, Cherednichenko D, Wagels L, Habel U, Kireev M, Votinov M. Social Interaction With an Anonymous Opponent Requires Increased Involvement of the Theory of Mind Neural System: An fMRI Study. Front Behav Neurosci 2022; 16:807599. [PMID: 35645745 PMCID: PMC9136332 DOI: 10.3389/fnbeh.2022.807599] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/07/2022] [Indexed: 11/25/2022] Open
Abstract
An anonymous interaction might facilitate provoking behavior and modify the engagement of theory of mind (TOM) brain mechanisms. However, the effect of anonymity when processing unfair behavior of an opponent remains largely unknown. The current functional magnetic resonance imaging (fMRI) study applied the Taylor aggression paradigm, introducing an anonymous opponent to this task. Thirty-nine healthy right-handed subjects were included in the statistical analysis (13 males/26 females, mean age 24.5 ± 3.6 years). A player winning the reaction-time game could subtract money from the opponent during the task. Participants behaved similarly to both introduced and anonymous opponents. However, when an anonymous opponent (when compared to the introduced opponent) subtracted money, the right inferior frontal gyrus (IFG) demonstrated an increased BOLD signal and increased functional connectivity with the left IFG. Further, increased functional connectivity between the right IFG, the right temporal parietal junction and precuneus was observed during the perception of high provocation (subtracting a large amount of money) from the anonymous compared to the introduced opponent. We speculate that the neural changes may underlie different inferences about the opponents’ mental states. The idea that this reorganization of the TOM network reflects the attempt to understand the opponent by “completing” socially relevant details requires further investigation.
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Affiliation(s)
- Maya Zheltyakova
- N.P. Bechtereva Institute of the Human Brain, Russian Academy of Science, Saint Petersburg, Russia
| | - Alexander Korotkov
- N.P. Bechtereva Institute of the Human Brain, Russian Academy of Science, Saint Petersburg, Russia
- Alexander Korotkov,
| | - Ruslan Masharipov
- N.P. Bechtereva Institute of the Human Brain, Russian Academy of Science, Saint Petersburg, Russia
| | - Artem Myznikov
- N.P. Bechtereva Institute of the Human Brain, Russian Academy of Science, Saint Petersburg, Russia
| | - Michael Didur
- N.P. Bechtereva Institute of the Human Brain, Russian Academy of Science, Saint Petersburg, Russia
| | - Denis Cherednichenko
- N.P. Bechtereva Institute of the Human Brain, Russian Academy of Science, Saint Petersburg, Russia
| | - Lisa Wagels
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Ute Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Maxim Kireev
- N.P. Bechtereva Institute of the Human Brain, Russian Academy of Science, Saint Petersburg, Russia
- Institute for Cognitive Studies, Saint Petersburg State University, Saint Petersburg, Russia
| | - Mikhail Votinov
- N.P. Bechtereva Institute of the Human Brain, Russian Academy of Science, Saint Petersburg, Russia
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany
- *Correspondence: Mikhail Votinov,
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Paul SN, Wingenfeld K, Otte C, Meijer OC. Brain Mineralocorticoid receptor in health and disease: from molecular signaling to cognitive and emotional function. Br J Pharmacol 2022; 179:3205-3219. [PMID: 35297038 PMCID: PMC9323486 DOI: 10.1111/bph.15835] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 02/22/2022] [Accepted: 03/08/2022] [Indexed: 11/27/2022] Open
Abstract
Brain mineralocorticoid receptors (MR) mediate effects of glucocorticoid hormones in stress adaptation, as well as the effects of aldosterone itself in relation to salt homeostasis. Brain stem MRs respond to aldosterone, whereas forebrain MRs mediate rapid and delayed glucocorticoid effects in conjunction with the glucocorticoid receptor (GR). MR‐mediated effects depend on age, gender, genetic variations, and environmental influences. Disturbed MR activity through chronic stress, certain (endocrine) diseases or during glucocorticoid therapy can cause deleterious effects on affective state, cognitive and behavioural function in susceptible individuals. Considering the important role MR plays in cognition and emotional function in health and disease, MR modulation by pharmacological intervention could relieve stress‐ and endocrine‐related symptoms. Here, we discuss recent pharmacological interventions in the clinic and genetic developments in the molecular underpinnings of MR signalling. Further understanding of MR‐dependent pathways may help to improve psychiatric symptoms in a diversity of settings.
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Affiliation(s)
- Susana N Paul
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands.,Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Katja Wingenfeld
- Klinik für Psychiatrie und Psychotherapie, Charité Universitätsmedizin Campus Benjamin Franklin, Berlin, Germany
| | - Christian Otte
- Klinik für Psychiatrie und Psychotherapie, Charité Universitätsmedizin Campus Benjamin Franklin, Berlin, Germany.,NeuroCure Cluster of Excellence, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Onno C Meijer
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands.,Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands
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