Die Skala zur Erfassung der Impulsivität der Borderline-Persönlichkeitsstörung (IS-27)

[Eating Disorder-Related Symptom Reduction, Suicidal/Self-Injurious Behavior, Emotional Dysregulation and Interpersonal Difficulties in an Eating Disorder-Specific Treatment - A Clinical Study]

This study exploratively investigated a possible relationship between suicidal/self-injurious behavior and the change in self-reported eating disorder symptoms as well as emotional dysregulation and interpersonal difficulties during eating disorder-specific treatment. For this purpose, the symptom index of the Eating Disorder Inventory-2 (EDI-SI) and the scale for the assessment of impulsivity and emotional dysregulation of borderline personality disorder (IES-27) with its subscales suicidal and self-injurious behavior (SVV/SEV), emotional dysregulation (EmotDys) and interpersonal difficulties (BezSchw) were collected from 167 female patients at a psychosomatic clinic. The participants were divided into four groups depending on the occurrence of SVV/SEV before the start and/or end of treatment. A one-way multivariate analysis of variance (MANOVA) with repeated measures showed an interaction of time and SVV/SEV group with regard to EDI-SI, EmotDys and BezSchw. The effect sizes of the pre-post comparison of the EDI-SI were very different in the groups divided according to the occurrence of SVV/SEV (0.27 Collapse

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Affiliation(s)

Brigitte Dippold Klinische Psychologie und Psychotherapie, Institut für Psychologie, Universität Hildesheim
Kathrin Dreyße Psychotherapie, Schön Klinik Bad Bramstedt
Christoph Kröger Klinische Psychologie und Psychotherapie, Institut für Psychologie, Universität Hildesheim

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[Factorial and Convergent Validity of the Short Form of the "Questionnaire of Thoughts and Feelings" (QTF-14) for Borderline Personality Disorder]

The "Questionnaire of Thoughts and Feelings" (QTF) is being used as screening instrument as well as tool for treatment planning and treatment evaluation for patients with borderline personality disorder (BPD). The primary goal of this study was the validation of the dimensional structure of the short version with 14 items, QTF-14. Additionally, item characteristics, reliability and evidence of convergent validity were examined. A diagnostically homogenous sample of patients with BPD (N=3035) of a psychosomatic clinic was presented with several self-assessment inventories, including the QTF-14. The expected single-factor model of the structure of the FGG showed unacceptable model fit indices (CFI=0.751; TLI=0.706; RMSEA=0.115; SRMR=0.073). Exploratory factor analysis showed evidence of two or three specific factors. In a subsequent confirmatory factor analysis, a bifactor model with two specific factors proved to be preferable (CFI=0.956; TLI=0.936; RMSEA=0.054; SRMR=0.034). The internal consistency of the total scale as well as the suggested subscales "Relationship Difficulties and Emotional Dysregulation" and "Autoaggression" was acceptable to good (ω=.81-.84; α=.79-.85). Associations with similar scales were as expected. Good psychometric properties of the QTF-14 can be confirmed in this study. Using the suggested subscales could support treatment planning.

[Convergent and Factorial Validity of the Impulsivity and Emotion Dysregulation Scale (IED-27) for Borderline Personality Disorder]

There is a growing consensus that emotion dysregulation is the defining feature of borderline personality disorder, but there are also persisting competing views on the pathology and dimensional structure of the disorder. The "Impulsivity and Emotion Dysregulation Scale" (IED-27) is already being used for assessing patients with borderline personality disorder. The particular aim of this study was to gain evidence of the dimensional structure of the disorder by confirmatory factorial analysis. A heterogeneous sample of patients with borderline personality disorder (n=484), attention deficit (hyperactivity) disorder (n=191) and eating disorders (n=197) of a psychosomatic clinic were given general and specific self-assessment inventories via computer-assisted testing system, including the IED-27. Results showed a bifactor model with a general factor and three specific factors: "emotional dysregulation", "relationship difficulties" and "self-injuries and suicidal behaviours", to be the model with the best fit (ΔCFI=0,032). The internal consistency of the sample seems to be good (ω=0,83-0,93) and expected correlations to similar subscales could be proved. Good psychometric criteria of the IED-27 were replicated in this study. Prospectively, the subscales allow a more detailed representation and specific treatment planning.

A hierarchical analysis of the latent trait of borderline personality disorder and its possible clinical implications

Borderline personality disorder (BPD) is a severe mental disorder which is accompanied by impaired functioning, complex psychosocial problems and incurs large costs. However, it rarely has been examined whether BPD symptoms form a hierarchical (Mokken) scale, which would imply that symptoms are ordered along a latent dimension of borderline severity. In this study the data from 1,198 inpatients of a psychosomatic clinic were examined. A non-parametric Mokken analysis was employed to investigate if the BPD symptoms measured by the impulsivity and emotion dysregulation scale (IES-27) formed a hierarchical scale. 16 of the 27 items, mainly regarding emotion dysregulation, formed a monotonous Mokken scale with a very strong hierarchy of BPD symptoms. These results imply that single BPD symptoms provide information about BPD severity, suggesting several important consequences regarding escalation of BPD, diagnosis and treatment, e.g. how to optimize treatment planning.

Understanding the genetics and epigenetics of bulimia nervosa/bulimia spectrum disorder and comorbid borderline personality disorder (BN/BSD-BPD): a systematic review

PURPOSE

To evaluate and understand the genetic and epigenetic basis of bulimia nervosa/bulimia spectrum disorder and comorbid borderline personality disorder (BN/BSD-BPD).

METHODS

The present systematic review was conducted in accordance to PRISMA guidelines. Advanced systematic searches of Medline, EMBASE, PsychINFO, Web of Science, Scopus, CINHAL plus, and the Cochrane Library were conducted using the search terms 'bulimia nervosa', 'bulimia spectrum disorder', 'borderline personality disorder', 'genes', and 'genetics'. The search strategy garnered seven studies for inclusion in the present review.

RESULTS

Women with BN/BSD-BPD had significantly lower serotonin and monoamine oxidise activity compared to women with BN/BSD or healthy controls (HC). As well, women with BN/BSD-BPD displayed elevated methylation of the dopamine receptor gene promoter, brain-derived neurotrophic factor, and changes in the methylation of the glucocorticoid receptor gene promoter (NR3C1) compared to women with BN/BSD and HC. The results also demonstrated that rates of childhood sexual abuse and childhood physical abuse are higher in those with BN/BSD-BPD than those with BN/BSD and HC, and that these types of abuse are often correlated with the methylation differences seen in BN/BSD-BPD women.

CONCLUSION

Due to the differences observed between individuals with BN/BSD-BPD and those with BN/BSD and HC a genetic/epigenetic aetiological model of BN/BSD-BPD was developed and is proposed in this review. This evidence-based model visually illustrates the current state of the field and draws attention to the need for subsequent research.

Erfassung von Impulsivität und emotionaler Dysregulation bei Jugendlichen mit Borderline-Persönlichkeitsstörung

Zusammenfassung. Die Skala zur Erfassung der Impulsivität und emotionalen Dysregulation (IES-27) bei der Borderline-Persönlichkeitsstörung (BPS) hat sich in Forschung und Praxis bei Erwachsenen bewährt. In adaptierter Form soll das Instrument auch bei Jugendlichen (IES-27-J) sowie deren Angehörigen (IES-27-A) eingesetzt werden können. Ziel der vorliegenden Studie war die Evaluation dieser Selbst- und Fremdbeurteilungsskalen. Die psychometrischen Kennwerte der IES-27-J wurden anhand von zwei unabhängigen psychiatrischen Stichproben (n = 109 und n = 170) und die der IES-27-A von Angehörigen (n = 31) überprüft. Die Itemanalyse zeigt für beide Instrumente gute Ergebnisse. Die interne Konsistenz beträgt für die IES-27-J in beiden Stichproben α = .95 sowie α = .92 für die IES-27-A. Die Test-Retest-Reliabilität fiel sehr gut aus (ρ = .97). Für die IES-27-J ergaben sich in der exploratorischen Hauptkomponentenanalyse Hinweise auf eine einfaktorielle Struktur. Jugendliche mit einer BPS erzielten signifikant höhere Summenwerte als Patientinnen und Patienten mit depressiver Störung und Störung des Sozialverhaltens, was als Hinweis auf die diskriminative Validität der IES-27-J gewertet werden kann. Die IES-27-J weist einen moderaten Zusammenhang zur IES-27-A auf. Beide Instrumente können für die Forschung und Praxis eingesetzt werden. Zukünftig sollte eine Normierung mithilfe einer Stichprobe von gesunden Jugendlichen erfolgen.

Validation and psychometric properties of the German Capability for Suicide Questionnaire

OBJECTIVE

Our study aimed at the validation of the newly developed German Capability for Suicide Questionnaire, the GCSQ. It is supposed to assess both fearlessness of death and pain tolerance, both facets of the acquired capability to commit suicide as postulated by the interpersonal theory of suicide.

METHODS

This cross-sectional study was conducted on two clinical (n=424) and an online sample (n=532). Factor structure, convergent and discriminant validity, predictive validity as well as test-retest reliability were investigated.

RESULTS

Two factors-"Fearlessness of Death" and "Pain Tolerance"-were derived. One item, the "perceived capability" item, assesses the subject's self-perception of acquired capability. Both subscales and the "perceived capability"-item demonstrate good construct validity and a high test-retest reliability. Fearlessness of death proves to be predictive for the occurrence of suicidal behaviors, whereas the importance of pain tolerance for suicidal behaviors was not confirmed. The subject's perception of his own capability is of high predictive value for both attempt status and suicidal behaviors.

CONCLUSION

The GCSQ seems to be a useful measure of pain tolerance, fearlessness of death and the self-perception of acquired capability of suicide.

How is affective instability defined and measured? A systematic review

BACKGROUND

Affective instability (AI) is poorly defined but considered clinically important. The aim of this study was to examine definitions and measures of AI employed in clinical populations.

METHOD

This study was a systematic review using the PRISMA guidelines. MEDLINE, Embase, PsycINFO, PsycArticles and Web of Science databases were searched. Also five journals were hand searched. Primary empirical studies involving randomized controlled trials (RCTs), non-RCTs, controlled before and after, and observational investigations were included. Studies were selected, data extracted and quality appraised. A narrative synthesis was completed.

RESULTS

A total of 11 443 abstracts were screened and 37 studies selected for final analysis on the basis that they provided a definition and measure of AI. Numbers of definitions for each of the terms employed in included studies were: AI (n = 7), affective lability (n = 6), affective dysregulation (n = 1), emotional dysregulation (n = 4), emotion regulation (n = 2), emotional lability (n = 1), mood instability (n = 2), mood lability (n = 1) and mood swings (n = 1); however, these concepts showed considerable overlap in features. A total of 24 distinct measures were identified that could be categorized as primarily measuring one of four facets of AI (oscillation, intensity, ability to regulate and affect change triggered by environment) or as measuring general emotional regulation.

CONCLUSIONS

A clearer definition of AI is required. We propose AI be defined as 'rapid oscillations of intense affect, with a difficulty in regulating these oscillations or their behavioural consequences'. No single measure comprehensively assesses AI and a combination of current measures is required for assessment. A new short measure of AI that is reliable and validated against external criteria is needed.

Effectiveness, response, and dropout of dialectical behavior therapy for borderline personality disorder in an inpatient setting

To examine the effectiveness of dialectical behavior therapy for inpatients with borderline personality disorder (BPD), small sample sizes and, predominantly, tests of statistical significance have been used so far. We studied 1423 consecutively admitted individuals with BPD, who were seeking a 3-month inpatient treatment. They completed the Borderline Symptom List (BSL) as the main outcome measure, and other self-rating measures at pre- and post-treatment. Therapy outcome was defined in three ways: effect size (ES), response based on the reliable change index, and remission compared to the general population symptom level. Non-parametric conditional inference trees were used to predict dropouts. In the pre-post comparison of the BSL, the ES was 0.54 (95% CI: 0.49-0.59). The response rate was 45%; 31% remained unchanged, and 11% deteriorated. Approximately 15% showed a symptom level equivalent to that of the general population. A further 10% of participants dropped out. A predictive impact on dropout was demonstrated by substance use disorders and a younger age at pre-treatment. In future research, follow-up assessments should be conducted to investigate the extent to which response and remission rates at post-treatment remain stable over time. A consistent definition of response appears to be essential for cross-study and cross-methodological comparisons.

Remission, Response und deren Prädiktion nach einer Dialektisch-Behavioralen Therapie der Borderline-Persönlichkeitsstörung im stationären Setting

Theoretischer Hintergrund: Bislang wurde die Wirksamkeit der Dialektisch-Behavioralen Therapie (DBT) für die Borderline-Persönlichkeitsstörung (BPS) im stationären Bereich überwiegend anhand von gruppenstatistischen Kennwerten aufgezeigt. Fragestellung: Wie hoch fallen die Remissions- und Responseraten aus? Lassen sich Prädiktoren hinsichtlich der Responserate finden? Methode. Soziodemographische und klinische Merkmale von 366 stationären, konsekutiven Patienten mit einer BPS wurden erhoben. Der Therapieerfolg wurde durch den Global Severity Index (GSI) des Brief Symptom Inventory erfasst und auf vier verschiedene Arten (Effektstärke [ES], Remission, Response anhand des Reliable Change Index [RCI] bzw. der prozentualen Symptomverbesserung [PSV]) definiert. Ergebnisse: Es ergab sich im Prä-Post-Vergleich des GSI eine ES von 0.52 (95 %-KI: 0.48 – 0.56). Die Responseraten betrug 42 % nach dem Kriterium des RCIs bzw. 33 % nach der PSV. Etwa 33 % erreichten ein Belastungsniveau, das dem einer ambulanten Stichprobe entspricht. Unverändert blieben 47 %, verschlechtert haben sich 11 %. Einen prädiktiven Einfluss auf die Response zeigten eine höhere Ausprägung der allgemeinen Symptombelastung und Depressivität zu Therapiebeginn und eine höhere Schulbildung. Schlussfolgerungen: Zukünftig sollten Nachbefragungen durchgeführt werden, um zu untersuchen, inwiefern die Response- bzw. Remissionsraten nach der Behandlung über die Zeit hinweg stabil bleiben. Um studien- und verfahrensübergreifende Vergleiche durchführen zu können, erscheinen einheitliche Definitionen notwendig.

Emotion dysregulation as a core feature of borderline personality disorder: comparison of the discriminatory ability of two self-rating measures

BACKGROUND/AIMS

There is growing evidence that emotion dysregulation (ED) is a core feature of borderline personality disorder (BPD). The present study examines whether a self-rating measure, the ED Scale, lets us distinguish between individuals with BPD and those diagnosed with other mental disorders in a way similar to that of a borderline-related screening measure, the German version of the McLean Screening Instrument for Borderline Personality Disorders (MSI-BPD).

METHOD

Based on the signal detection theory, receiver operating characteristics as well as reliability and validity indicators are determined in a heterogeneous outpatient sample (n = 168).

RESULTS

The values of internal consistency and the validity indicators turned out to be in the expected range. The area under the curve (AUC) for the ED Scale was 0.86, and therefore emerged on a par with the AUC = 0.90 of the MSI-BPD. As required, analyses for both measures revealed equal and high values for sensitivity, as well as corresponding low negative predictive values. There was, however, a lower degree of specificity on the ED Scale as compared to the MSI-BPD.

CONCLUSION

The results support the assumption that ED is a core feature of BPD, but should also be taken into account in the assessment and treatment of other mental disorders.