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Guillén V, Bolo S, Fonseca-Baeza S, Pérez S, García-Alandete J, Botella C, Marco JH. Psychological assessment of parents of people diagnosed with borderline personality disorder and comparison with parents of people without psychological disorders. Front Psychol 2023; 13:1097959. [PMID: 36710828 PMCID: PMC9880188 DOI: 10.3389/fpsyg.2022.1097959] [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: 11/14/2022] [Accepted: 12/29/2022] [Indexed: 01/15/2023] Open
Abstract
BackgroundTo date, several evidence-based interventions have been created to help relatives of people with Borderline Personality Disorder (BPD), but few studies have analyzed the clinical situation of the family members. The aim of this study was twofold: (1) to explore the clinical symptomatology in a sample of parents of people diagnosed with BPD and compare them with a sample of a sample of people without a relative with a personality disorder, (2) to explore whether the parents of people diagnosed with BPD have psychopathology related to personality disorders (PD) or meet the diagnostic criteria for PD.MethodParticipants were 42 (39.6%) fathers and 64 (60.4%) were mothers and mothers (n = XX, −%) of people diagnosed with BPD, who were selected from a specialized PD unit for treatment. The sample of people without a relative with a PD was obtained from social network announcements. To test for differences between the two groups, Student’s t tests were performed for quantitative variables, and Chi-square tests were performed for categorical variables. Cohen’s d was calculated as a measure of the effect size.ResultsParents of people with BPD showed greater depressive and anxious symptomatology, higher levels of expressed emotion, and worse quality of life than the sample of people without a relative with a personality disorder. In addition, a high percentage of the parents of people diagnosed with BPD (50%) met the diagnostic criteria for different PD.ConclusionParents of people diagnosed with BPD may need psychological help in various aspects. Therapists are therefore advised to bear in mind the importance of carrying out a psychological assessment of family members and, if necessary, to offer psychological intervention. It is crucial to invite the family to be part of the treatment, since they can be part of the solution.Clinical Trial registration: ClinicalTrials.gov ID, NCT04160871 (registered November 15, 2019).
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Affiliation(s)
- Verónica Guillén
- Department of Personality, Evaluation and Psychological Treatments, Universidad de Valencia, Valencia, Spain,Ciber Fisiopatologia Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, Carlos, Spain,*Correspondence: Verónica Guillén,
| | - Sara Bolo
- Department of Personality, Evaluation and Psychological Treatments, Universidad de Valencia, Valencia, Spain
| | - Sara Fonseca-Baeza
- Department of Personality, Evaluation and Psychological Treatments, Universidad de Valencia, Valencia, Spain
| | - Sandra Pérez
- Department of Personality, Evaluation and Psychological Treatments, Universidad de Valencia, Valencia, Spain
| | - Joaquín García-Alandete
- Department of Personality, Evaluation and Psychological Treatments, Universidad de Valencia, Valencia, Spain
| | - Cristina Botella
- Ciber Fisiopatologia Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, Carlos, Spain,Department of Psicología Básica, Clínica y Psicobiología, Universidad Jaime I de Castellón, Plana, Spain
| | - José Heliodoro Marco
- Department of Personality, Evaluation and Psychological Treatments, Universidad de Valencia, Valencia, Spain,Ciber Fisiopatologia Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, Carlos, Spain
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Wrege JS, Busmann M, Meyer AH, Euler S, Lang UE, Walter M. Impulsiveness in borderline personality disorder predicts the long-term outcome of a psychodynamic treatment programme. Clin Psychol Psychother 2020; 28:633-641. [PMID: 33119970 DOI: 10.1002/cpp.2526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 11/08/2022]
Abstract
Despite the preponderance of treatment outcome predictors in patients with borderline personality disorder (BPD), the predictive value of measures of impulsiveness is inconclusive. This naturalistic study consecutively included hospitalized patients with BPD (N = 99) who underwent a standardized and structured 12-week inpatient treatment programme, which integrated cognitive-behavioural and psychodynamic elements. The Brief Symptom Checklist (BSCL) was applied as outcome measure over four time points: pretreatment, posttreatment, first follow-up at 6 to 8 weeks and second follow-up at 1 year after discharge. Impulsiveness was measured using the Barratt Impulsiveness Scale (BIS) at the pretreatment time point. The BSCL significantly decreased between pretreatment and posttreatment, followed by an increase after posttreatment without reaching pretreatment extent. The temporal course of the BSCL significantly varied with pretreatment BIS in that patients with higher impulsiveness revealed a stronger re-increase of symptom severity from posttreatment to end of follow-up than those with lower impulsiveness. The least impulsive patients thereby showed no rebound effect. The robustness of the results was examined by cross-validation. The results indicate that irrespective of the level of impulsiveness, patients with BPD profit from a structured inpatient treatment. However, long-term treatment success was impaired in patients with high level of impulsiveness at pretreatment. Thus, self-ratings of impulsiveness in BPD patients can be utilized for treatment planning. After discontinuation of interventions, relapse prevention should be implemented early in high impulsive patients as symptoms recrudesce in the course after discharge.
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Affiliation(s)
- Johannes S Wrege
- Department of Psychosomatic and Psychotherapy, Psychiatric University Hospital Basel, Basel, Switzerland
| | - Mareike Busmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andrea H Meyer
- Department of Psychology, University of Basel, Basel, Switzerland
| | - Sebastian Euler
- Department of Consultation Psychiatry and Psychosomatics, University Hospital Zürich, Zürich, Switzerland
| | - Undine E Lang
- Department of Psychosomatic and Psychotherapy, Psychiatric University Hospital Basel, Basel, Switzerland
| | - Marc Walter
- Department of Psychosomatic and Psychotherapy, Psychiatric University Hospital Basel, Basel, Switzerland
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Clausen L. Perspectives on Involuntary Treatment of Anorexia Nervosa. Front Psychiatry 2020; 11:533288. [PMID: 33192651 PMCID: PMC7641604 DOI: 10.3389/fpsyt.2020.533288] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 09/16/2020] [Indexed: 01/12/2023] Open
Abstract
Involuntary treatment of anorexia nervosa is an option in cases in which the patient's life or other people's lives are at risk or, in some countries, to prevent the deterioration of the illness. Involuntary treatment is often regarded as controversial and has been intensely debated, although typically with few references to documented knowledge. This paper provides a research perspective of the topic by examine data in the field of the involuntary treatment of anorexia nervosa to pinpoint present knowledge as well as areas demanding clinical action or research attention. The prevalence of involuntary treatment in general as well as specific measures is described and possible early markers of patients at risk of involuntary treatment are discussed. Studies including patients' perspectives of involuntary treatment show the complexity of this treatment, its initiation, and its consequences. To qualify future discussions, improve current practice, and minimize involuntary treatment in general as well as on an individual level, at least four areas need attention: (i) the present specific symptoms of anorexia nervosa and their imminent consequences, (ii) illness history, (iii) overall psychiatric symptoms and general functioning, and (iv) contextual sphere of the patient. In particular, the last two require attention from both clinicians and researchers. Furthermore, critical evaluation of the attitudes of both patients and health care professionals toward each other and the treatment is recommended.
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Affiliation(s)
- Loa Clausen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Esguevillas Á, Díaz-Caneja CM, Arango C, Rey-Mejías ÁLD, Bernardo EG, Delgado C, Clarkin JF, Carrasco JL. Personality organization and its association with clinical and functional features in borderline personality disorder. Psychiatry Res 2018; 262:393-399. [PMID: 28923434 DOI: 10.1016/j.psychres.2017.09.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/25/2017] [Accepted: 09/08/2017] [Indexed: 10/18/2022]
Abstract
Patients with borderline personality disorder (BPD) show poor psychosocial functioning over the course of their lives. To date, predictors of functionality in BPD patients have remained mostly unexplored. In this study, we aimed to assess the association between personality organization and clinical and functional features in a sample of 50 patients with BPD referred to a specialized outpatient clinic. We used the Structured Interview of Personality Organization (STIPO) to assess personality organization and the Global Assessment of Functioning (GAF) scale to measure functionality. Clinical and demographic associations with personality organization were also explored. STIPO scores were negatively correlated with GAF scores (i.e. higher scores in the STIPO dimensions, which reflected greater personality pathology, were significantly associated with lower psychosocial functioning). After controlling for potential confounders, the STIPO domain "identity" significantly accounted for 26.7% of the variance in the GAF, while the STIPO subscale "sense of self" significantly accounted for 31.2% of the variance in the GAF. These findings suggest that identity and its pathological correlate, identity diffusion, may play a key role in the functional prognosis of BPD patients.
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Affiliation(s)
- Álvaro Esguevillas
- Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Covadonga M Díaz-Caneja
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Ángel Luis Del Rey-Mejías
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain; Innovation Unit, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC). Department of Methodology, School of Psychology, Universidad Complutense, Madrid, Spain
| | - Enrique G Bernardo
- Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Carlos Delgado
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | | | - José Luis Carrasco
- Department of Psychiatry, Hospital Clínico San Carlos, Universidad Complutense, CIBERSAM, Madrid, Spain
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Abstract
Borderline personality disorder (BPD) is a severe mental disorder with a multifactorial etiology. The development and maintenance of BPD is sustained by diverse neurobiological factors that contribute to the disorder's complex clinical phenotype. These factors may be identified using a range of techniques to probe alterations in brain systems that underlie BPD. We systematically searched the scientific literature for empirical studies on the neurobiology of BPD, identifying 146 articles in three broad research areas: neuroendocrinology and biological specimens; structural neuroimaging; and functional neuroimaging. We consolidate the results of these studies and provide an integrative model that attempts to incorporate the heterogeneous findings. The model specifies interactions among endogenous stress hormones, neurometabolism, and brain structures and circuits involved in emotion and cognition. The role of the amygdala in BPD is expanded to consider its functions in coordinating the brain's dynamic evaluation of the relevance of emotional stimuli in the context of an individual's goals and motivations. Future directions for neurobiological research on BPD are discussed, including implications for the Research Domain Criteria framework, accelerating genetics research by incorporating endophenotypes and gene × environment interactions, and exploring novel applications of neuroscience findings to treatment research.
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