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Deriu V, Altavilla D, Adornetti I, Chiera A, Ferretti F. Narrative identity in addictive disorders: a conceptual review. Front Psychol 2024; 15:1409217. [PMID: 38952822 PMCID: PMC11215194 DOI: 10.3389/fpsyg.2024.1409217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 06/03/2024] [Indexed: 07/03/2024] Open
Abstract
Narrative identity allows individuals to integrate their personal experiences into a coherent and meaningful life story. Addictive disorders appear to be associated with a disturbed sense of self, reflected in problematic and disorganized self-narratives. In recent literature, a growing body of research has highlighted how narrative approaches can make a dual contribution to the understanding of addiction: on the one hand, by revealing crucial aspects of self structure, and, on the other, by supporting the idea that addiction is a disorder related to unintegrated self-states in which dissociative phenomena and the resulting sense of 'loss of self' are maladaptive strategies for coping with distress. This conceptual review identified the main measures of narrative identity, i.e., narrative coherence and complexity, agency, and emotions, and critically examines 9 quantitative and qualitative studies (out of 18 identified in literature), that have investigated the narrative dimension in people with an addictive disorder in order to provide a synthesis of the relationship between self, narrative and addiction. These studies revealed a difficulty in the organization of narrative identity of people with an addictive disorder, which is reflected in less coherent and less complex autobiographical narratives, in a prevalence of passivity and negative emotions, and in a widespread presence of themes related to a lack of self-efficacy. This review points out important conceptual, methodological and clinical implications encouraging further investigation of narrative dimension in addiction.
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Affiliation(s)
| | - Daniela Altavilla
- Cosmic Lab, Department of Philosophy, Communication and Performing Arts, Roma Tre University, Rome, Italy
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2
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Liu Y, Chen C, Zhou Y, Zhang N, Liu S. Twenty years of research on borderline personality disorder: a scientometric analysis of hotspots, bursts, and research trends. Front Psychiatry 2024; 15:1361535. [PMID: 38495902 PMCID: PMC10941281 DOI: 10.3389/fpsyt.2024.1361535] [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: 01/12/2024] [Accepted: 02/19/2024] [Indexed: 03/19/2024] Open
Abstract
Borderline personality disorder (BPD), a complex and severe psychiatric disorder, has become a topic of considerable interest to current researchers due to its high incidence and severity of consequences. There is a lack of a bibliometric analysis to visualize the history and developmental trends of researches in BPD. We retrieved 7919 relevant publications on the Web of Science platform and analyzed them using software CiteSpace (6.2.R4). The results showed that there has been an overall upward trend in research interest in BPD over the past two decades. Current research trends in BPD include neuroimaging, biological mechanisms, and cognitive, behavioral, and pathological studies. Recent trends have been identified as "prevention and early intervention", "non-pharmacological treatment" and "pathogenesis". The results are like a reference program that will help determine future research directions and priorities.
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Affiliation(s)
- Yuanli Liu
- Department of Psychology, School of Humanities and Social Sciences, Anhui Agricultural University, Hefei, China
| | - Chaomei Chen
- College of Computing & Informatics, Drexel University, Philadelphia, PA, United States
| | - Ying Zhou
- Department of Psychology, School of Education, China University of Geosciences, Wuhan, China
| | - Na Zhang
- Department of Information Management, Anhui Vocational College of Police Officers, Hefei, China
| | - Shen Liu
- Department of Psychology, School of Humanities and Social Sciences, Anhui Agricultural University, Hefei, China
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3
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Moccia L, di Luzio M, Conte E, Modica M, Ambrosecchia M, Ardizzi M, Lanzotti P, Kotzalidis GD, Janiri D, Di Nicola M, Janiri L, Gallese V, Sani G. Sense of agency and its disturbances: A systematic review targeting the intentional binding effect in neuropsychiatric disorders. Psychiatry Clin Neurosci 2024; 78:3-18. [PMID: 37755315 DOI: 10.1111/pcn.13601] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/12/2023] [Accepted: 09/19/2023] [Indexed: 09/28/2023]
Abstract
Sense of agency (SoA) indicates a person's ability to perceive her/his own motor acts as actually being her/his and, through them, to exert control over the course of external events. Disruptions in SoA may profoundly affect the individual's functioning, as observed in several neuropsychiatric disorders. This is the first article to systematically review studies that investigated intentional binding (IB), a quantitative proxy for SoA measurement, in neurological and psychiatric patients. Eligible were studies of IB involving patients with neurological and/or psychiatric disorders. We included 15 studies involving 692 individuals. Risk of bias was low throughout studies. Abnormally increased action-outcome binding was found in schizophrenia and in patients with Parkinson's disease taking dopaminergic medications or reporting impulsive-compulsive behaviors. A decreased IB effect was observed in Tourette's disorder and functional movement disorders, whereas increased action-outcome binding was found in patients with the cortico-basal syndrome. The extent of IB deviation from healthy control values correlated with the severity of symptoms in several disorders. Inconsistent effects were found for autism spectrum disorders, anorexia nervosa, and borderline personality disorder. Findings pave the way for treatments specifically targeting SoA in neuropsychiatric disorders where IB is altered.
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Affiliation(s)
- Lorenzo Moccia
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Michelangelo di Luzio
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Eliana Conte
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Modica
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marianna Ambrosecchia
- Department of Medicine and Surgery, Unit of Neuroscience, University of Parma, Parma, Italy
| | - Martina Ardizzi
- Department of Medicine and Surgery, Unit of Neuroscience, University of Parma, Parma, Italy
| | - Pierluigi Lanzotti
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Georgios D Kotzalidis
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
- NESMOS Department, University of Rome La Sapienza, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Rome, Italy
| | - Delfina Janiri
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Marco Di Nicola
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luigi Janiri
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Vittorio Gallese
- Department of Medicine and Surgery, Unit of Neuroscience, University of Parma, Parma, Italy
- Italian Academy for Advanced Studies in America at Columbia University, New York, New York, USA
| | - Gabriele Sani
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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4
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Søndergaard AA, Juul S, Poulsen S, Simonsen S. Mentalizing the therapist – Therapist experiences with short-term mentalization-based therapy for borderline personality disorder: A qualitative study. Front Psychiatry 2023; 14:1088865. [PMID: 37009129 PMCID: PMC10061093 DOI: 10.3389/fpsyt.2023.1088865] [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] [Received: 11/03/2022] [Accepted: 03/01/2023] [Indexed: 03/18/2023] Open
Abstract
BackgroundMentalization-Based Therapy (MBT) was originally developed as a structured psychotherapy approach developed to treat borderline personality disorder (BPD) lasting up to 18 months in outpatient settings. However, a short-term (5 months) MBT program has recently been developed. No studies have investigated how MBT therapists experience the shift towards conducting short-term MBT for BPD.ObjectiveThe objective of this study was to explore therapist experiences with conducting short-term MBT for outpatients with BPD in the Danish mental health services.MethodsSemi-structured qualitative interviews were conducted with seven therapists about their experiences with short-term MBT after a one-year pilot phase. The interviews were verbatim transcribed and analyzed using thematic analysis.ResultsThe following four major themes from the therapists’ experiences with short-term MBT were found in the qualitative analysis: (1) The longer the better, (2) Change processes can be intellectual or experiential, (3) Short-term therapy is hard work, and (4) Termination is more challenging in short-term MBT.ConclusionMost therapists were overall reluctant towards changing from long-term to short-term MBT. These therapist experiences could inform implementation of short-term MBT in mental health settings in the future.
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Affiliation(s)
- Amanda Ark Søndergaard
- Stolpegaard Psychotherapy Centre, Mental Health Services in the Capital Region of Denmark, Gentofte, Denmark
- Copenhagen Trial Unit, Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Copenhagen, Denmark
- *Correspondence: Amanda Ark Søndergaard,
| | - Sophie Juul
- Stolpegaard Psychotherapy Centre, Mental Health Services in the Capital Region of Denmark, Gentofte, Denmark
- Copenhagen Trial Unit, Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Copenhagen, Denmark
| | - Stig Poulsen
- Department of Psychology, Faculty of Social Sciences, University of Copenhagen, Copenhagen, Capital Region of Denmark, Denmark
| | - Sebastian Simonsen
- Stolpegaard Psychotherapy Centre, Mental Health Services in the Capital Region of Denmark, Gentofte, Denmark
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Fitzpatrick S, Liebman RE, Traynor J, Varma S, Norouzian N, Chafe D, Goss S, Earle E, Di Bartolomeo A, Latham M, Courey L, Monson CM. Protocol Development of Sage: A Novel Conjoint Intervention for Suicidal and Self-Injuring People With Borderline Personality Disorder and Their Significant Others. COGNITIVE AND BEHAVIORAL PRACTICE 2023. [DOI: 10.1016/j.cbpra.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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6
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Yiu J, Kealy D, Cox DW. Borderline personality features and presence of meaning in life: Mediating role of interpersonal problems. COGENT PSYCHOLOGY 2022. [DOI: 10.1080/23311908.2022.2032913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Jeffrey Yiu
- Department of Psychiatry, University of British Columbia Vancouver Canada
| | - David Kealy
- Counselling Psychology Program, University of British Columbia Vancouver Canada
| | - Daniel W. Cox
- Counselling Psychology Program, University of British Columbia Vancouver Canada
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Adams BE, Porcerelli JH, Abell S, Huprich SK. Malevolent object relations: A multimethod study of female survivors of childhood abuse. Personal Ment Health 2021; 15:252-260. [PMID: 33871184 DOI: 10.1002/pmh.1512] [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] [Received: 06/11/2020] [Accepted: 04/09/2021] [Indexed: 11/09/2022]
Abstract
Although childhood victimization is associated with impairments in object relations, it is not clear how different measures comparatively perform in assessing this relationship. This study examined the connection between emotional, physical, and sexual abuse in childhood and three methods of assessing malevolent object representations. Sixty adult women, recruited from an urban primary-care clinic, were administered the Thematic Apperception Test (TAT), the Object Relations Inventory (ORI) interview, and a version of the Early Memories Test (EMT)/interview. Ratings of malevolent object relations were obtained using the affect-tone dimension from the Social Cognition and Object Relations (SCORS-G) scale with both TAT and early memory narratives and through Malevolence ratings from the ORI interview. It was found that, outside of emotional abuse, ORI interview ratings of malevolence consistently differentiated adult childhood abuse groups and nonabuse groups, whereas early memory ratings of malevolence differentiated groups in two of four analyses. Malevolence ratings based upon TAT ratings failed to differentiate any type of abuse from nonabuse. These findings suggest that the use of malevolence ratings from the ORI and early memory narratives are preferred methods for assessing malevolent object relations in urban-dwelling women who have been victimized as children.
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Affiliation(s)
- Brett E Adams
- Psychology Department, University of Detroit Mercy, Detroit, Michigan, USA
| | - John H Porcerelli
- Psychology Department, University of Detroit Mercy, Detroit, Michigan, USA
| | - Steven Abell
- Psychology Department, University of Detroit Mercy, Detroit, Michigan, USA
| | - Steven K Huprich
- Psychology Department, University of Detroit Mercy, Detroit, Michigan, USA
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8
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Luyten P, Campbell C, Fonagy P. Rethinking the relationship between attachment and personality disorder. Curr Opin Psychol 2021; 37:109-113. [DOI: 10.1016/j.copsyc.2020.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 11/19/2020] [Indexed: 10/22/2022]
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9
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Sommerfeld E, Shechory Bitton M. Rejection Sensitivity, Self-Compassion, and Aggressive Behavior: The Role of Borderline Features as a Mediator. Front Psychol 2020; 11:44. [PMID: 32038443 PMCID: PMC6992554 DOI: 10.3389/fpsyg.2020.00044] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 01/08/2020] [Indexed: 11/23/2022] Open
Abstract
This study used mediation analyses to examine the assumption that the presence of borderline personality features mediates the relationship between rejection sensitivity (RS), self-compassion, and aggressive behavior. Sixty adults consisting of 31 participants diagnosed with borderline personality disorder and 29 participants with no diagnosis of borderline personality disorder were assessed for RS, self-compassion, aggressive behavior, and borderline personality features. Mediation was found for the total aggression score, anger score, and hostility score regarding both self-compassion and RS. Mediation was also found regarding RS and verbal and physical aggression, and regarding self-compassion and verbal and physical aggression. These findings provide evidence that the presence of borderline personality features is an important factor in explaining the associations linking RS and self-compassion to aggressive behavior. High RS and low self-compassion are associated with greater borderline personality features, which in turn relate to increased aggressive behavior.
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10
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Porter C, Palmier-Claus J, Branitsky A, Mansell W, Warwick H, Varese F. Childhood adversity and borderline personality disorder: a meta-analysis. Acta Psychiatr Scand 2020; 141:6-20. [PMID: 31630389 DOI: 10.1111/acps.13118] [Citation(s) in RCA: 167] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/15/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The aim of this meta-analysis was to better understand the magnitude and consistency of the association between childhood adversity and borderline personality disorder (BPD) across case-control, epidemiological and prospective cohort studies. METHOD Following the review protocol (reference: CRD42017075179), search terms pertaining to adversity and BPD were entered into three search engines. Random-effects meta-analysis synthesised the size and consistency of the effects. RESULTS A total of 97 studies compared BPD to non-clinical (k = 40) and clinical (k = 70) controls. Meta-analysis of case-control studies indicated that individuals with BPD are 13.91 (95% CI 11.11-17.43) times more likely to report childhood adversity than non-clinical controls. This effect was smaller when considering retrospective cohort (OR: 2.59; 95% CI 0.93-7.30) and epidemiological (OR: 2.56, 95% CI 1.24-5.30) studies. Findings were significant across adversity subtypes with emotional abuse (OR: 38.11, 95% CI: 25.99-55.88) and neglect (OR: 17.73, 95% CI = 13.01-24.17) demonstrating the largest effects. Individuals with BPD were 3.15 (95% CI 2.62-3.79) times more likely to report childhood adversity than other psychiatric groups. CONCLUSIONS This meta-analysis corroborates theoretical proposals that exposure to adverse life experiences is associated with BPD. It highlights the importance of considering childhood adversity when treating people diagnosed with BPD.
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Affiliation(s)
- C Porter
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - J Palmier-Claus
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, UK.,Lancashire Care NHS Foundation Trust, Lancashire, UK
| | - A Branitsky
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - W Mansell
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - H Warwick
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - F Varese
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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11
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Möller TJ, Braun N, Thöne AK, Herrmann CS, Philipsen A. The Senses of Agency and Ownership in Patients With Borderline Personality Disorder. Front Psychiatry 2020; 11:474. [PMID: 32581864 PMCID: PMC7296131 DOI: 10.3389/fpsyt.2020.00474] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 05/08/2020] [Indexed: 12/19/2022] Open
Abstract
Patients with borderline personality disorder (BPD) not only experience a strong instability in their affect and interpersonal relations but also disturbances in their self-experience, including dissociation and body-alienation symptoms. It is not yet understood whether an altered sense of ownership (SoO) or sense of agency (SoA) may contribute to these disturbances. One recent hypothesis is that patients with BPD have a reduced sense of self and are therefore more likely to misattribute external objects or actions to their own self than healthy individuals. The present study followed up this hypothesis by investigating whether BPD patients have a more flexible body representation than healthy participants. More specifically, the active rubber hand illusion (aRHI) was applied to 21 patients with BPD and the same number of healthy participants. Using established subjective, electrodermal, and behavioral measures, the participants' SoO and SoA were assessed during the aRHI. The findings show self-reported evidence for higher SoO under anatomical hand congruency as compared to anatomical incongruency, but no evidence for group differences between BPD patients and healthy participants. This finding is inconsistent with previous findings of an enhanced SoO-related body plasticity in BPD patients. Regarding SoA, the findings show self-report evidence of higher SoA in BPD patients versus healthy participants, although this group difference was not evident in the implicit SoA measure (intentional binding). In summary, the present study only reveals partial evidence for a higher body plasticity in BPD patients. Instead, the observed variability in results appears better explainable by some generally elevated perceptual suggestibility of BPD individuals.
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Affiliation(s)
- Tim Julian Möller
- Berlin School of Mind and Brain, Humboldt University of Berlin, Berlin, Germany.,Experimental Psychology Lab, Department for Psychology, Faculty for Medicine and Health Sciences, Carl von Ossietzky University, Oldenburg, Germany
| | - Niclas Braun
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany.,Department of Psychiatry, Faculty for Medicine & Health Sciences, University of Oldenburg, Oldenburg, Germany
| | - Ann-Kathrin Thöne
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christoph S Herrmann
- Experimental Psychology Lab, Department for Psychology, Faculty for Medicine and Health Sciences, Carl von Ossietzky University, Oldenburg, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
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12
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Luyten P, Campbell C, Fonagy P. Borderline personality disorder, complex trauma, and problems with self and identity: A social‐communicative approach. J Pers 2019; 88:88-105. [DOI: 10.1111/jopy.12483] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 04/05/2019] [Accepted: 04/24/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Patrick Luyten
- Faculty of Psychology and Educational Sciences University of Leuven Leuven Belgium
- Research Department of Clinical, Educational and Health Psychology University College London London UK
| | - Chloe Campbell
- Research Department of Clinical, Educational and Health Psychology University College London London UK
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology University College London London UK
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13
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Goodlad K, Ioannou M, Hunter M. The Criminal Narrative Experience of Psychopathic and Personality Disordered Offenders. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2019; 63:523-542. [PMID: 30362851 DOI: 10.1177/0306624x18808433] [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: 06/08/2023]
Abstract
Given the challenges associated with psychopathic and personality disordered offenders, further insight is needed. One way of doing this is by looking at offending from the first-person perspective. The study investigated the criminal narrative experience (CNE) of this population during the commissioning of crimes. Twenty-two high-risk male offenders were recruited and a questionnaire design was used. The data were analysed using Smallest Space Analysis which revealed four themes consistent with Ioannou, Canter, and Youngs's CNE framework: depressed victim, distressed revenger, calm professional, and elated hero. Independent samples t tests explored whether personality disorders related to CNE themes, and Pearson's product-moment correlation was used to explore the relationship between psychopathy and the CNE themes. Borderline personality disorder identified with the depressed victim. Paranoid and schizoid personality disorders did not identify with the calm professional. There was no significant relationship between psychopathy and the CNE themes. The theoretical and practical implications are discussed.
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Affiliation(s)
- Katie Goodlad
- University of Huddersfield, UK
- HM Prison Frankland, Durham, UK
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14
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Johansen AB, Tavakoli S, Bjelland I, Lumley M. Constructivist Simultaneous Treatment of Borderline Personality Disorder, Trauma, and Addiction Comorbidity: A Qualitative Case Study. QUALITATIVE HEALTH RESEARCH 2017; 27:236-248. [PMID: 26701963 DOI: 10.1177/1049732315618659] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This qualitative case study explored one client's recovery from borderline personality disorder, trauma, and problem gambling. The client attended 18 months of integrative treatment and was followed for 5 years. The study included 106 data points of both client and therapist data. We identified three phases to treatment. First, alliance formation and normalization appeared as mechanisms, and the client experienced dependence. Second, working alliance and countertransference appeared as mechanisms, and the client experienced reduced gambling and suicidal ideation. Third, external controls and increased opportunity appeared as mechanisms, and "moving into the world" was the client experience. The findings give preliminary support to a phase-based constructivist treatment including trauma assessment to normalize self-feelings, countertransference work to support motivation for restraint, and case management principles to support continuity of change efforts.
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Affiliation(s)
- Ayna B Johansen
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
- Centre for Study of Mind in Nature, University of Oslo, Oslo, Norway
| | | | - Ingerid Bjelland
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
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15
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Badoud D, Billieux J, Eliez S, Imhof A, Heller P, Eytan A, Debbané M. Covariance and specificity in adolescent schizotypal and borderline trait expression. Early Interv Psychiatry 2015; 9:378-87. [PMID: 24428891 DOI: 10.1111/eip.12120] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 12/07/2013] [Indexed: 10/25/2022]
Abstract
AIMS The first aim of the present study is to assess the overlap between borderline and schizotypal traits during adolescence. The second objective is to examine whether some psychological factors (i.e. cognitive coping mechanisms, impulsivity and encoding style) are differentially related to borderline and schizotypal traits and may therefore improve the efficiency of clinical assessments. METHODS One hundred nineteen community adolescents (57 male) aged from 12 to 19 years completed a set of questionnaires evaluating the expression of borderline and schizotypal traits as well as cognitive emotion regulation (CER), impulsivity and encoding style. RESULTS Our data first yielded a strong correlation between borderline and schizotypal scores (r = 0.70, P < 0.001). Secondly, linear regression models indicated that the 'catastrophizing' CER strategy and the 'lack of premeditation' impulsivity facet accounted for the level of borderline traits, whereas an internal encoding style predominantly explained schizotypal traits. CONCLUSIONS Our results support the abundant literature showing that borderline and schizotypal traits frequently co-occur. Moreover, we provide original data indicating that borderline and schizotypal traits during adolescence are linked to different specific psychological mechanisms. Thus, we underline the importance of considering these mechanisms in clinical assessments, in particular to help disentangle personality disorder traits in youths.
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Affiliation(s)
- Deborah Badoud
- Adolescence Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland.,Office Médico-Pédagogique Research Unit, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland
| | - Joël Billieux
- Psychological Sciences Research Institute, Catholic University of Louvain, Louvain-la-Neuve, Belgium
| | - Stephan Eliez
- Office Médico-Pédagogique Research Unit, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland.,Department of Genetic Medicine and Development, University of Geneva School of Medicine, Geneva, Switzerland
| | - Anouk Imhof
- Office Médico-Pédagogique, Clinical Outpatient Service of Geneva State, Geneva, Switzerland
| | - Patrick Heller
- Department of Mental Health and Psychiatry, University Hospital of Geneva, Chêne-Bourg, Switzerland
| | - Ariel Eytan
- Office Médico-Pédagogique, Clinical Outpatient Service of Geneva State, Geneva, Switzerland
| | - Martin Debbané
- Adolescence Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland.,Office Médico-Pédagogique Research Unit, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland
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16
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A comprehensive examination of delayed emotional recovery in borderline personality disorder. J Behav Ther Exp Psychiatry 2015; 47:51-9. [PMID: 25482953 PMCID: PMC4324164 DOI: 10.1016/j.jbtep.2014.11.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 10/21/2014] [Accepted: 11/09/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Despite growing attention to emotion processes in borderline personality disorder (BPD), little research has examined delayed emotional recovery (i.e., long-lasting emotions after the termination of an emotionally evocative stimulus) in this population. The extant data on delayed emotional recovery in BPD are limited by a lack of assessment across a range of indices and emotions. The present study addresses these gaps by comparing emotional recovery between individuals with BPD, social anxiety disorder (SAD), and healthy controls (HCs) using a multi-modal assessment approach. METHODS Participants underwent fear, anger, and sadness inductions followed by a 5-min "washout" phase wherein emotional recovery was assessed via self-report, respiratory sinus arrhythmia (RSA), and skin conductance responses (SCR). RESULTS After controlling for state dissociation, the BPD and SAD group exhibited decreases in RSA, while the HC group showed no changes in RSA after the anger induction only. Groups did not differ in rate of emotional recovery across self-report, RSA, or SCR after fear and sadness inductions. LIMITATIONS The present study is limited by a solely female and small sample, and the short time frame in which emotional recovery was assessed. CONCLUSIONS Findings indicate that individuals with BPD generally do not exhibit delayed emotional recovery, but may show decreases in parasympathetic activity during the recovery period after experiencing anger. However, this pattern may not be specific to this disorder.
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Hecht KF, Cicchetti D, Rogosch FA, Crick N. Borderline personality features in childhood: the role of subtype, developmental timing, and chronicity of child maltreatment. Dev Psychopathol 2014; 26:805-15. [PMID: 25047300 PMCID: PMC4141853 DOI: 10.1017/s0954579414000406] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Child maltreatment has been established as a risk factor for borderline personality disorder (BPD), yet few studies consider how maltreatment influences the development of BPD features through childhood and adolescence. Subtype, developmental timing, and chronicity of child maltreatment were examined as factors in the development of borderline personality features in childhood. Children (M age = 11.30, SD = 0.94), including 314 maltreated and 285 nonmaltreated children from comparable low socioeconomic backgrounds, provided self-reports of developmentally salient borderline personality traits. Maltreated children had higher overall borderline feature scores, had higher scores on each individual subscale, and were more likely to be identified as at high risk for development of BPD through raised scores on all four subscales. Chronicity of maltreatment predicted higher overall borderline feature scores, and patterns of onset and recency of maltreatment significantly predicted whether a participant would meet criteria for the high-risk group. Implications of findings and recommendations for intervention are discussed.
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Affiliation(s)
| | - Dante Cicchetti
- Institute of Child Development, University of Minnesota
- Mt. Hope Family Center, University of Rochester
| | | | - Nicki Crick
- Institute of Child Development, University of Minnesota
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Gadassi R, Snir A, Berenson K, Downey G, Rafaeli E. Out of the frying pan, into the fire: mixed affective reactions to social proximity in borderline and avoidant personality disorders in daily life. JOURNAL OF ABNORMAL PSYCHOLOGY 2014; 123:613-22. [PMID: 24933280 DOI: 10.1037/a0036929] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Social proximity typically helps individuals meet their belongingness needs, but several forms of psychopathology, including borderline and avoidant personality disorders (BPD and APD, respectively) are characterized by social difficulties. This experience-sampling study is one of the first to directly investigate the affective reactions of individuals with BPD and APD (compared with healthy controls [HC]) to social proximity in daily life. We examined both person-level and day-level reactions. At the person level, the rate of social proximity across the diary period was associated with diminished feelings of rejection, isolation, shame, and dissociation in the HC group. In contrast, it was not associated with any affective reaction in the BPD group, and was associated with decreased rejection and isolation on the one hand, but also with increased anxiety in the APD group. At the day level, we used multilevel regression to examine affective reactions when in social proximity. The HC group showed a consistent benefit when in social proximity. In contrast, both PD groups exhibited mixed affective reactions to social proximity; specifically, benefits (increased positive affect, decreased rejection, isolation, and dissociation) were interspersed with costs (increased shame for both PD groups; increased anger for BPD; increased anxiety for APD). The mixed reactions found in both PDs may contribute to the disturbed relationships of individuals with these disorders.
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Affiliation(s)
| | - Avigal Snir
- Department of Psychology, Bar-Ilan University
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19
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Liotti G. Overcoming Powerlessness in the Clinical Exchange With Traumatized Patients. PSYCHOANALYTIC INQUIRY 2014. [DOI: 10.1080/07351690.2014.899783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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20
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Association between childhood maltreatment and adult emotional dysregulation in a low-income, urban, African American sample: moderation by oxytocin receptor gene. Dev Psychopathol 2014; 23:439-52. [PMID: 23786688 DOI: 10.1017/s0954579411000162] [Citation(s) in RCA: 139] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The ability to effectively regulate emotions and a secure attachment style are critical for maintaining mental health across the life span. The experience of childhood maltreatment interferes with normal development of emotional regulation and dramatically increases risk for a wide range of psychiatric disorders in adulthood. The central nervous system oxytocin systems are critically involved in mediating social attachment and buffering psychophysiological responses to stress. We therefore investigated the impact of childhood maltreatment and an oxytocin receptor (OXTR) single nucleotide polymorphism (rs53576) and their interaction on emotional dysregulation and attachment style in adulthood in a sample of low-income, African American men and women recruited from primary care clinics of an urban, public hospital. Consistent with prior research, we found that the severity of childhood maltreatment was associated with increased levels of emotional dysregulation in adulthood. Childhood maltreatment was also positively associated with ratings of disorganized/unresolved adult attachment style and negatively associated with ratings of secure adult attachment style. There was no direct association between rs53576 and emotional dysregulation or ratings of adult attachment style. However, there were significant interactions between rs53576 and childhood maltreatment in predicting level of adult emotional dysregulation and attachment style. Specifically, G/G genotype carriers were at risk for increased emotional dysregulation when exposed to three or more categories of childhood abuse. In addition, G/G genotype carriers exhibited enhanced disorganized adult attachment style when exposed to severe childhood abuse compared to A/A and A/G carriers. Our findings suggest that A allele carriers of OXTR rs53576 are resilient against the effects of severe childhood adversity, by protection against emotional dysregulation and disorganized attachment.
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Genet MC, Golse B, Devouche E, Apter G. Psychopathologie, attachement et devenir des enfants de mères présentant un trouble de personnalité borderline/état-limite : une revue de la littérature. PSYCHIATRIE DE L ENFANT 2014. [DOI: 10.3917/psye.571.0259] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Kuo JR, Neacsiu AD, Fitzpatrick S, MacDonald DE. A Methodological Examination of Emotion Inductions in Borderline Personality Disorder: A Comparison of Standardized Versus Idiographic Stimuli. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2013. [DOI: 10.1007/s10862-013-9378-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Miano A, Fertuck EA, Arntz A, Stanley B. Rejection sensitivity is a mediator between borderline personality disorder features and facial trust appraisal. J Pers Disord 2013; 27:442-56. [PMID: 23586933 DOI: 10.1521/pedi_2013_27_096] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Individuals with borderline personality disorder (BPD) fear abandonment and exhibit instability in their close relationships. These interpersonal difficulties may be influenced by the propensity to interpret neutral social stimuli (e.g., nonemotional faces) as untrustworthy. This study evaluated the hypothesis that BPD features are associated with attributions of untrustworthiness to neutral faces. Additionally, the authors hypothesized that the trait of rejection sensitivity (RS) is also associated with BPD features and mediates the relationship between BPD features and untrustworthy facial trait appraisal. An undergraduate, nonclinical sample (N = 95) was assessed for BPD features, RS, and trust appraisal of neutral faces. Higher BPD features were associated with lower ratings of trustworthiness of the faces and higher scores on RS. Furthermore, as hypothesized, the association between BPD features and trust appraisal was mediated by RS. Results are discussed in the context of a proposed model of the social cognitive mechanisms of interpersonal hypersensitivity in BPD.
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Affiliation(s)
- Annemarie Miano
- Department of Clinical Psychological Science, Maastricht University, The Netherlands
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Sieswerda S, Barnow S, Verheul R, Arntz A. Neither dichotomous nor split, but schema-related negative interpersonal evaluations characterize borderline patients. J Pers Disord 2013; 27:36-52. [PMID: 23342956 DOI: 10.1521/pedi.2013.27.1.36] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cognitive models explain extreme thoughts, affects, and behaviors of patients with Borderline Personality Disorder (BPD) by specific mal-adaptive schemas and dichotomous thinking. Psychodynamic theories ascribe these to splitting. This study expanded the study of Veen and Arntz (2000) and investigated whether extreme evaluations in BPD are (1) dichotomous, negativistic, or split; (2) limited to specific (schema-related) interpersonal situations; and (3) related to traumatic childhood experiences. BPD (n = 18), cluster C personality disorder (n = 16), and nonpatient (n = 17) groups were asked to judge 16 characters portrayed in film fragments in a specific or nonspecific context and with negative, positive, or neutral roles on visual analogue scales. These scales were divided in negative-positive trait opposites related to BPD schemas, negative-positive trait opposites unrelated to BPD schemas, and neutral trait opposites. Interpersonal evaluations of patients with BPD were (1) negativistic; (2) schema related; and (3) partially related to traumatic childhood experiences. Negative evaluations of caring characters in an intimate context particularly characterized BPD. No evidence was found for dichotomous thinking or splitting in BPD.
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Affiliation(s)
- Simkje Sieswerda
- Department of Clinical Psychology and Psychotherapy, Heidelberg University, Hauptstrasse 47-51, 69117 Heidelberg, Germany.
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Liebman RE, Burnette M. It's not you, it's me: an examination of clinician- and client-level influences on countertransference toward borderline personality disorder. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2013; 83:115-25. [PMID: 23330629 DOI: 10.1111/ajop.12002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Individuals with borderline personality disorder (BPD) appear more likely than individuals with other mental disorders to evoke negative countertransference reactions. The current study examined countertransference toward BPD across client- (e.g., client age and gender) and clinician-level (e.g., age, discipline, clinical experience, training) factors. Participants (N = 560) completed an anonymous online survey in which they read case information describing a client with BPD and answered questions to assess their reactions toward the client. The study used a 2 × 2 between-subjects design in which client age and gender were experimentally manipulated. Despite receiving the same vignette, clinicians were more accurate in diagnosing the female client with BPD than the male client, and clinician reactions differed as a function of client age and clinician experience. Specifically, clinicians viewed adolescent clients with BPD as less ill, less trustworthy, and more dangerous than adults with BPD; more clinical experience among clinicians was associated with more positive reactions to clients. Findings help to better understand countertransference reactions and the ways they may impact diagnostic choices and treatment decisions. The implications of these findings for facilitating better clinician-client matching, reducing clinician burnout, and improving treatment experiences for individuals with BPD are discussed.
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Abstract
Affective instability is a psychophysiological symptom observed in some psychopathologies. It is a complex construct that encompasses (1) primary emotions, or affects, and secondary emotions, with each category having its own characteristics, amplitude, and duration, (2) rapid shifting from neutral or valenced affect to intense affect, and (3) dysfunctional modulation of emotions. Affective instability is often confused with mood lability, as in bipolar disorders, as well as with other terms. To clarify the concept, we searched databases for the term affective instability and read related articles on the topic. In this article we situate the term within the current affective nomenclature and human emotional experience, explore its psychophysiological features, and place it within the context of psychopathology. We explain why the term can potentially be confused with mood pathology and then define affective instability as an inherited temperamental trait modulated by developmental experience.
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Differential diagnosis of bipolar affective disorder type II and borderline personality disorder: analysis of the affective dimension. Compr Psychiatry 2012; 53:952-61. [PMID: 22560773 DOI: 10.1016/j.comppsych.2012.03.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 03/05/2012] [Accepted: 03/12/2012] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Differential diagnosis between bipolar affective disorder type II and borderline personality disorder can be problematic yet a priority for effective treatment planning. Diagnosis is problematic when symptoms do not present enough intensity or duration to clear the issue but also when there is a relative overlap of criteria between both disorders. If for many patients, the diagnosis is more easily differentiated, confounding conditions are found in 20% of cases for which it becomes a significant issue. METHOD A research with the key words affective instability, borderline personality disorder, and bipolar disorder on Medline and Psych-Info was done. Other references were found through this review in related articles. Comparison of data about the affective dimensions concerning bipolar disorder and borderline personality disorder was noted. RESULTS Affective instability is a confounding factor: quality and intensity of affects, speed of fluctuations, affective response to social stress, and its modulation are core elements of affective instability that need to be analyzed to clarify a proper diagnosis. LIMITATIONS There is further necessity for research about affective instability in the 2 diagnoses. CONCLUSIONS Making a valid differential diagnosis has an important clinical value in order for the clinician to plan proper treatment. Analysis of the affective experience and its qualitative and quantitative facets can help establish it.
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Adler JM, Chin ED, Kolisetty AP, Oltmanns TF. The distinguishing characteristics of narrative identity in adults with features of borderline personality disorder: an empirical investigation. J Pers Disord 2012; 26:498-512. [PMID: 22867502 PMCID: PMC3434277 DOI: 10.1521/pedi.2012.26.4.498] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
While identity disturbance has long been considered one of the defining features of Borderline Personality Disorder (BPD), the present study marks only the third empirical investigation to assess it and the first to do so from the perspective of research on narrative identity. Drawing on the rich tradition of studying narrative identity, the present study examined identity disturbance in a group of 40 mid-life adults, 20 with features of BPD and a matched sample of 20 without BPD. Extensive life story interviews were analyzed for a variety of narrative elements and the themes of agency, communion fulfillment (but not communion), and narrative coherence significantly distinguished the stories of those people with features of BPD from those without the disorder. In addition, associations between the theme of agency and psychopathology were evident six and twelve months following the life story interview. This study seeks to bridge the mutually-informative fields of research on personality disorders and normal identity processes.
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Schacht R, Hammond L, Marks M, Wood B, Conroy S. The Relation between Mind-mindedness in Mothers with Borderline Personality Disorder and Mental State Understanding in their Children. INFANT AND CHILD DEVELOPMENT 2012. [DOI: 10.1002/icd.1766] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Robin Schacht
- South London and Maudsley NHS Foundation Trust; London UK
| | - Linda Hammond
- Canterbury Christ Church University; Tunbridge Wells UK
| | - Maureen Marks
- Institute of Psychiatry; Kings College London; London UK
| | - Barbara Wood
- South London and Maudsley NHS Foundation Trust; London UK
| | - Susan Conroy
- Institute of Psychiatry; Kings College London; London UK
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Berenson KR, Downey G, Rafaeli E, Coifman KG, Paquin NL. The rejection-rage contingency in borderline personality disorder. JOURNAL OF ABNORMAL PSYCHOLOGY 2011; 120:681-90. [PMID: 21500875 DOI: 10.1037/a0023335] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Though long-standing clinical observation reflected in the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) suggests that the rage characteristic of borderline personality disorder (BPD) often appears in response to perceived rejection, the role of perceived rejection in triggering rage in BPD has never been empirically tested. Extending basic personality research on rejection sensitivity to a clinical sample, a priming-pronunciation experiment and a 21-day experience-sampling diary examined the contingent relationship between perceived rejection and rage in participants diagnosed with BPD compared with healthy controls. Despite the differences in these 2 assessment methods, the indices of rejection-contingent rage that they both produced were elevated in the BPD group and were strongly interrelated. They provide corroborating evidence that reactions to perceived rejection significantly explain the rage seen in BPD.
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Affiliation(s)
- Kathy R Berenson
- Department of Psychology, Columbia University, 1190 Amsterdam Avenue, MC 5501, New York, NY 10027, USA.
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31
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Fairfax H. Re-conceiving personality disorders: Adaptations on a dimension? COUNSELLING PSYCHOLOGY QUARTERLY 2011. [DOI: 10.1080/09515070.2011.630589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Bradley B, DeFife JA, Guarnaccia C, Phifer J, Fani N, Ressler KJ, Westen D. Emotion dysregulation and negative affect: association with psychiatric symptoms. J Clin Psychiatry 2011; 72:685-91. [PMID: 21658350 PMCID: PMC4605672 DOI: 10.4088/jcp.10m06409blu] [Citation(s) in RCA: 184] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Accepted: 08/20/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE A growing body of research focuses on the development and correlates of emotion dysregulation, or deficits in the ability to regulate intense and shifting emotional states. Current models of psychopathology have incorporated the construct of emotion dysregulation, suggesting its unique and interactive contributions, along with childhood disruptive experiences and negative affect, in producing symptomatic distress. Some researchers have suggested that emotion dysregulation is simply a variant of high negative affect. The aim of this study was to assess the construct and incremental validity of self-reported emotion dysregulation over and above childhood trauma and negative affect in predicting a range of psychopathology. METHOD Five hundred thirty individuals aged 18 to 77 years (62% female) were recruited from the waiting areas of the general medical and obstetric/gynecologic clinics in an urban public hospital in Atlanta, Georgia. Participants completed a battery of self-report measures obtained by interview, including the Childhood Trauma Questionnaire, the Positive and Negative Affect Schedule, and the Emotion Dysregulation Scale. Regression analyses examined the unique and incremental associations of these self-report measurements of childhood traumatic experiences, negative affect, and emotion dysregulation with concurrent structured interview-based measurements of psychiatric distress and history of self-destructive behaviors. These measures included the Clinician-Administered PTSD Scale, the Alcohol Use Disorders Identification Test, the Short Drug Abuse Screening Test, the Beck Depression Inventory, and the Global Adaptive Functioning Scale from the Longitudinal Interval Follow-Up Evaluation. The presented data were collected between 2005 and 2009. RESULTS Regression models including age, gender, childhood trauma, negative affect, and emotion dysregulation were significantly (P ≤ .001) associated with each of the study's criterion variables, accounting for large portions of the variance in posttraumatic stress symptoms (R² = 0.21), alcohol and drug abuse (R² = 0.28 and 0.21, respectively), depression (R² = 0.55), adaptive functioning (R² = 0.14), and suicide history (omnibus χ² = 74.80, P < .001). Emotion dysregulation added statistically significant (P < .01) incremental validity to each regression model (β = 0.25, 0.34, 0.35, 0.34, and -0.18, and Wald = 24.43, respectively). CONCLUSIONS Results support the conceptualization of emotion dysregulation as a distinct and clinically meaningful construct associated with psychiatric distress that is not reducible to negative affect. Emotion dysregulation is a key component in a range of psychiatric symptoms and disorders and a core target for psychopharmacologic and psychosocial treatment interventions.
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Affiliation(s)
- Bekh Bradley
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, and Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
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Manser R, Cooper M, Trefusis J. Beliefs about emotions as a metacognitive construct: initial development of a self-report questionnaire measure and preliminary investigation in relation to emotion regulation. Clin Psychol Psychother 2011; 19:235-46. [PMID: 21374759 DOI: 10.1002/cpp.745] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Metacognitive theory, amongst other theories, gives an important role to beliefs about mental states, including beliefs about emotions, in the maintenance of distress. Mentalization theory as well as the dialectical behaviour therapy and emotion-focused therapy literature specifies particular beliefs thought to be related to emotion dysregulation and therefore to a label of borderline personality disorder. The current study aimed to develop a questionnaire to measure the beliefs about emotions as specified by this literature and to test the relationship of this new measure to various aspects of emotion regulation in a non-clinical sample of 289 participants. A factor analysis extracted six factors, which described beliefs about emotions as (a) overwhelming and uncontrollable; (b) shameful and irrational; (c) invalid and meaningless; (d) useless; (e) damaging; and (f) contagious. The final measure showed some promising psychometric properties. All of the questionnaire subscales were related to aspects of emotion dysregulation including distress, borderline personality disorder symptoms and behaviours associated with dysregulation of emotion, suggesting that beliefs about emotions could be an important metacognitive construct involved in the ability to regulate emotions. Beliefs about emotions may be a useful direct or indirect target for treatment of difficulties regulating emotions, and this could be achieved through the use of various therapeutic modalities.
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Affiliation(s)
- Rachel Manser
- Oxford Doctoral Course in Clinical Psychology, University of Oxford, Oxford, UK.
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Fowler KA, Westen D. Subtyping male perpetrators of intimate partner violence. JOURNAL OF INTERPERSONAL VIOLENCE 2011; 26:607-639. [PMID: 20498380 DOI: 10.1177/0886260510365853] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Domestic violence is a serious problem with far-reaching consequences. This study applies a new methodology to derive subtypes of male perpetrators of intimate partner violence. As part of a larger National Institute of Mental Health (NIMH)-funded study, a national sample of randomly selected psychologists and psychiatrists describe 188 adult male patients (59 with a history of partner violence, 97 with a history of arrests but not partner violence, and 57 with neither partner violence nor arrests), using the Shedler-Westen Assessment Procedure-II (SWAP-II), a Q-sort procedure for assessing personality pathology. Using Q-factor analysis, the authors identify three personality constellations among the partner-violent men, two of which strongly resembled subtypes identified using different methods in prior research: psychopathic, hostile/controlling, and borderline/dependent. The authors compare these subtypes with each other and with nonarrested/ nonviolent men and men with arrests but no partner violence on Axis I and II diagnoses, adaptive functioning, etiological variables, and response to treatment, providing initial validity data.
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Fonagy P, Luyten P, Strathearn L. Borderline personality disorder, mentalization, and the neurobiology of attachment. Infant Ment Health J 2011; 32:47-69. [DOI: 10.1002/imhj.20283] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Jordão AB, Ramires VRR. Vínculos afetivos de adolescentes borderline e seus pais. PSICOLOGIA: TEORIA E PESQUISA 2010. [DOI: 10.1590/s0102-37722010000100011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Este estudo investigou as características dos vínculos afetivos entre adolescentes com indicadores de organização de personalidade borderline e seus pais. Esses adolescentes foram avaliados por meio do procedimento de estudo de casos múltiplos. Além de entrevistas, foram aplicados o Teste Projetivo Rorschach, o Teste do Desenho da Família e o Inventário de Vínculos Parentais. Os resultados apontaram para vinculações afetivas fragilizadas, permeadas por representações de negligências, abandonos, falta de amparo e proteção. Foram identificadas histórias de vida com vivências traumáticas e violências de diversas ordens. A dimensão transgeracional apareceu em destaque na compreensão dos casos avaliados. Ressaltou-se a necessidade de estudos sobre a adolescência borderline e da ampliação de pesquisas qualitativas sobre o assunto.
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A unifying perspective on personality pathology across the life span: developmental considerations for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. Dev Psychopathol 2009; 21:687-713. [PMID: 19583880 DOI: 10.1017/s095457940900039x] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Proposed changes in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) include replacing current personality disorder (PD) categories on Axis II with a taxonomy of dimensional maladaptive personality traits. Most of the work on dimensional models of personality pathology, and on personality disorders per se, has been conducted on young and middle-aged adult populations. Numerous questions remain regarding the applicability and limitations of applying various PD models to early and later life. In the present paper, we provide an overview of such dimensional models and review current proposals for conceptualizing PDs in DSM-V. Next, we extensively review existing evidence on the development, measurement, and manifestation of personality pathology in early and later life focusing on those issues deemed most relevant for informing DSM-V. Finally, we present overall conclusions regarding the need to incorporate developmental issues in conceptualizing PDs in DSM-V and highlight the advantages of a dimensional model in unifying PD perspectives across the life span.
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A developmental, mentalization-based approach to the understanding and treatment of borderline personality disorder. Dev Psychopathol 2009; 21:1355-81. [PMID: 19825272 DOI: 10.1017/s0954579409990198] [Citation(s) in RCA: 485] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractThe precise nature and etiopathogenesis of borderline personality disorder (BPD) continues to elude researchers and clinicians. Yet, increasing evidence from various strands of research converges to suggest that affect dysregulation, impulsivity, and unstable relationships constitute the core features of BPD. Over the last two decades, the mentalization-based approach to BPD has attempted to provide a theoretically consistent way of conceptualizing the interrelationship between these core features of BPD, with the aim of providing clinicians with a conceptually sound and empirically supported approach to BPD and its treatment. This paper presents an extended version of this approach to BPD based on recently accumulated data. In particular, we suggest that the core features of BPD reflect impairments in different facets of mentalization, each related to impairments in relatively distinct neural circuits underlying these facets. Hence, we provide a comprehensive account of BPD by showing how its core features are related to each other in theoretically meaningful ways. More specifically, we argue that BPD is primarily associated with a low threshold for the activation of the attachment system and deactivation of controlled mentalization, linked to impairments in the ability to differentiate mental states of self and other, which lead to hypersensitivity and increased susceptibility to contagion by other people's mental states, and poor integration of cognitive and affective aspects of mentalization. The combination of these impairments may explain BPD patients' propensity for vicious interpersonal cycles, and their high levels of affect dysregulation and impulsivity. Finally, the implications of this expanded mentalization-based approach to BPD for mentalization-based treatment and treatment of BPD more generally are discussed.
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Morse JQ, Hill J, Pilkonis PA, Yaggi K, Broyden N, Stepp S, Reed LI, Feske U. Anger, preoccupied attachment, and domain disorganization in borderline personality disorder. J Pers Disord 2009; 23:240-57. [PMID: 19538080 PMCID: PMC2821703 DOI: 10.1521/pedi.2009.23.3.240] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Emotional dysregulation and attachment insecurity have been reported in borderline personality disorder (BPD). Domain disorganization, evidenced in poor regulation of emotions and behaviors in relation to the demands of different social domains, may be a distinguishing feature of BPD. Understanding the interplay between these factors may be critical for identifying interacting processes in BPD and potential subtypes of BPD. Therefore, we examined the joint and interactive effects of anger, preoccupied attachment, and domain disorganization on BPD traits in a clinical sample of 128 psychiatric patients. The results suggest that these factors contribute to BPD both independently and in interaction, even when controlling for other personality disorder traits and Axis I symptoms. In regression analyses, the interaction between anger and domain disorganization predicted BPD traits. In recursive partitioning analyses, two possible paths to BPD were identified: high anger combined with high domain disorganization and low anger combined with preoccupied attachment. These results may suggest possible subtypes of BPD or possible mechanisms by which BPD traits are established and maintained.
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Macfie J, Swan SA. Representations of the caregiver-child relationship and of the self, and emotion regulation in the narratives of young children whose mothers have borderline personality disorder. Dev Psychopathol 2009; 21:993-1011. [PMID: 19583894 PMCID: PMC2825084 DOI: 10.1017/s0954579409000534] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Borderline personality disorder (BPD) represents a severe distortion in the development of attachment, self, and emotion regulation. Study of children at high risk of developing BPD may inform precursors to BPD. In a low socioeconomic status sample of 30 children aged 4-7 whose mothers have BPD and 30 normative comparisons, representations of the caregiver-child relationship and of the self, and emotion regulation were assessed with a story-stem completion measure. In contrast to comparisons and controlling for major depressive disorder, children whose mothers have BPD told stories with the following: (a) more parent-child role reversal, more fear of abandonment, and more negative mother-child and father-child relationship expectations; (b) more incongruent and shameful representations of the self; and (c) poorer emotion regulation indicated by more confusion of boundaries between fantasy and reality and between self and fantasy, more fantasy proneness, less narrative coherence, and marginally more intrusion of traumatic themes. In the sample as a whole, (a) a maladaptive caregiver-child relationship composite was associated with maternal identity disturbance and self-harm; (b) a maladaptive self-composite was associated with maternal self-harm; and (c) a maladaptive emotion regulation composite was associated with maternal identity disturbance, negative relationships, and self-harm. Results are discussed in terms of putative precursors to BPD and preventive interventions.
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Affiliation(s)
- Jenny Macfie
- University of Tennessee, Knoxville, TN 37996-0900, USA.
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Hill J, Pilkonis P, Morse J, Feske U, Reynolds S, Hope H, Charest C, Broyden N. Social domain dysfunction and disorganization in borderline personality disorder. Psychol Med 2008; 38:135-146. [PMID: 17892627 PMCID: PMC2828321 DOI: 10.1017/s0033291707001626] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Social dysfunction in personality disorder is commonly ascribed to abnormal temperamental traits but may also reflect deficits in social processing. In this study, we examined whether borderline and avoidant personality disorders (BPD, APD) may be differentiated by deficits in different social domains and whether disorganization of social domain functioning uniquely characterizes BPD. METHOD Patients were recruited from psychiatric clinics in Pittsburgh, USA, to provide a sample with BPD, APD and a no-personality disorder (no-PD) comparison group. Standardized assessments of Axis I and Axis II disorders and social domain dysfunction were conducted, including a new scale of 'domain disorganization' (DD). RESULTS Pervasive social dysfunction was associated with a 16-fold increase in the odds of an Axis II disorder. Both APD and BPD were associated with elevated social dysfunction. Romantic relationship dysfunction was associated specifically with BPD symptoms and diagnosis. DD was associated specifically with a categorical BPD diagnosis and with a dimensional BPD symptom count. CONCLUSIONS A focus on the inherently interpersonal properties of personality disorders suggests specific mechanisms (within and across interpersonal domains) that may help to account for the origins and maintenance of some disorders. In particular, BPD reflects disturbances in romantic relationships, consistent with a role for attachment processes, and in the organization of functioning across social domains.
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Affiliation(s)
- J Hill
- University of Manchester, Manchester, UK.
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