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Blaha Y, Cavelti M, Lerch S, Steinhoff A, Koenig J, Kaess M. Risk-taking and self-harm behaviors as markers of adolescent borderline personality disorder. Eur Child Adolesc Psychiatry 2024; 33:2743-2753. [PMID: 38194081 PMCID: PMC11272750 DOI: 10.1007/s00787-023-02353-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 12/05/2023] [Indexed: 01/10/2024]
Abstract
Adolescence is a critical period for early identification and intervention of borderline personality disorder (BPD). Risk-taking and self-harm behaviors (RSB) have been identified as promising early markers of BPD and correlates of depression in school-based samples. The present study aimed, first, to examine the association between RSB and BPD in a clinical sample of adolescents and, second, to examine whether RSB are also linked to depression. N = 405 participants (82.7% female) were recruited from an outpatient clinic for adolescents with RSB. RSB assessed included truancy, excessive media use, alcohol, tobacco, and illicit drug use, sexual risk-taking, and self-harm behavior. Regression analyses and generalized linear models were performed to examine the associations between individual RSB or patterns of RSB (identified using latent class analysis, LCA) and a diagnosis and severity of BPD or depression. All RSB (except excessive media use) were positively associated with BPD diagnosis and severity. In contrast, only non-suicidal self-injury (NSSI) and suicide attempts were positively associated with depression diagnosis and severity, while illicit drug use was negatively associated with depression severity. The LCA yielded two classes differing in the occurrence of RSB. The high RSB class was more likely to have a BPD diagnosis and greater BPD severity than the low RSB class. Classes did not differ regarding depression diagnosis or severity. As NSSI and suicide attempts were associated with both BPD and depression, the presence of additional RSB, besides self-harm behavior, may represent a specific risk marker for BPD in adolescents.
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Affiliation(s)
- Yasmine Blaha
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Marialuisa Cavelti
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Stefan Lerch
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Annekatrin Steinhoff
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Julian Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany.
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Sreenivasulu M., Prathyusha V, Ezhumalai S, Narayanan G, Murthy P. Adverse Childhood Experiences, Coping and Resilience in Persons with Alcohol Use Disorder and Their Non-drinking Siblings in High-density Families: A Case-control Study. Indian J Psychol Med 2024; 46:139-146. [PMID: 38725730 PMCID: PMC11076933 DOI: 10.1177/02537176231219769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024] Open
Abstract
Background Adverse childhood experiences (ACEs) increase the odds of alcohol use disorder (AUD). Aim To study the ACEs, coping, and resilience in persons with AUD and their non-drinking siblings from high-density families. Methods The study used a case-control study design. Using purposive sampling, 135 participants were selected; the sample consists of persons with AUD (n = 45), non-drinking siblings (n = 45), and healthy controls (n = 45), selected from out-patient and in-patient services from a government-run de-addiction centre in Bengaluru. Individuals were administered an ACEs questionnaire, Brief-COPE, and Connor-Davison Resilience scale. Descriptive statistics, Friedman's test, and Bonferroni's post-hoc test, Binary Logistic Regression were used for analysis. Results ACEs, coping, and resilience significantly differ across the three groups. Persons with AUD and their non-drinking siblings are comparable in terms of ACEs and having dysfunctional family members. Non-drinking siblings and healthy controls have similar coping and resilience. None of the healthy controls had dysfunctional family members. Conclusion ACEs are more prevalent and more frequent in persons with AUD. Individuals with AUD showed higher avoidant coping and lower resilience than their non-drinking siblings and healthy controls. Early identification of ACEs and interventions to build resilience and coping strategies could prevent individuals from developing AUD in high-density families.
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Affiliation(s)
- Sreenivasulu M.
- Dept. of Psychiatric Social Work, NIMHANS, Bangalore, Karnataka, India
| | - Vasuki Prathyusha
- Dept of Bio-Statistics, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Sinu Ezhumalai
- Dept. of Psychiatric Social Work, NIMHANS, Bangalore, Karnataka, India
| | | | - Pratima Murthy
- Dept of Psychiatry, NIMHANS, Bangalore, Karnataka, India
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Reynolds CJ, Tragesser SL. Borderline personality features are associated with worse perceptions of (but not compliance with) chronic pain treatment. PSYCHOL HEALTH MED 2024; 29:163-173. [PMID: 37822059 DOI: 10.1080/13548506.2023.2268889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/04/2023] [Indexed: 10/13/2023]
Abstract
Treating chronic illness requires ongoing patient-provider cooperation, but individual differences in patients' negative perceptions of care can undermine this cooperation. Research suggests people high on borderline personality disorder (BPD) features may react negatively to and comply less with mental health and medical treatment. This might be particularly problematic in chronic pain treatment, where BPD features are over-represented and the dysregulation typifying BPD likely undermines consistent care. In a sample of 147 chronic pain patients, we investigated whether higher levels of BPD features - both in general and by specific facets - predicted worse perceptions of treatment and lower patient-reported compliance with treatment recommendations. Participants higher (vs. lower) on borderline features viewed treatment more negatively but did not report complying less with recommendations. We found evidence that this may reflect the unstable relationships facet of BPD. Our results indicate that, consistent with other treatment settings, BPD features may undermine care for chronic pain. Furthermore, our results highlight the importance of collaborative provider-patient relationships and patient agreement with the treatment of chronic pain, particularly among individuals higher on BPD features.
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Affiliation(s)
- Caleb J Reynolds
- Department of Psychology, Wake Forest University, Winston-Salem, NC, USA
| | - Sarah L Tragesser
- Department of Psychology, Washington State University Tri-Cities, Richland, WA, USA
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Stetsiv K, McNamara IA, Nance M, Carpenter RW. The Co-occurrence of Personality Disorders and Substance Use Disorders. Curr Psychiatry Rep 2023; 25:545-554. [PMID: 37787897 PMCID: PMC10798162 DOI: 10.1007/s11920-023-01452-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/03/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE OF REVIEW Despite significant negative outcomes, the co-occurrence of personality disorders (PDs) and substance use disorders (SUDs) continues to be underrecognized, and the mechanisms contributing to this co-occurrence remain unclear. This review summarizes recent work on PD-SUD co-occurrence, with a focus on borderline and antisocial PDs, general substance use patterns among those with PDs, and the association of personality traits with SUDs. RECENT FINDINGS The prevalence of co-occurring PD-SUD is generally high, with estimates ranging depending on the type of PD and SUD, the population assessed, and the sampling methods and measures used. Current theoretical explanations for co-occurrence include shared etiology and predisposition models, with research highlighting the importance of transactional processes. Potential underlying mechanisms include personality traits and transdiagnostic characteristics. Recent research has increased focus on substances besides alcohol, dimensional models of personality pathology, and transactional explanations of co-occurrence, but more research is needed to disentangle the nuanced PD-SUD relationship.
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Affiliation(s)
- Khrystyna Stetsiv
- Department of Psychological Sciences, University of Missouri, St. Louis, USA
| | - Ian A McNamara
- Department of Psychological Sciences, University of Missouri, St. Louis, USA
| | - Melissa Nance
- Department of Psychological Sciences, University of Missouri, St. Louis, USA
| | - Ryan W Carpenter
- Department of Psychological Sciences, University of Missouri, St. Louis, USA.
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Guillot CR, Lucke HR, Ramsey AJ, Kearns NT, Blumenthal H, Berman ME. Cluster-b personality disorder traits and impulsivity: Indirect associations with alcohol use severity through positive alcohol expectancies. Exp Clin Psychopharmacol 2023; 31:423-432. [PMID: 36048108 PMCID: PMC9975115 DOI: 10.1037/pha0000598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Prior theory and research suggest that both Cluster-B personality pathology and trait impulsivity are indirectly associated with alcohol use through positive alcohol expectancies. Yet, no prior study has investigated whether features of each of the Cluster-B personality disorders (PDs) (i.e., antisocial, borderline, histrionic, and narcissistic) and rash impulsiveness are indirectly associated with alcohol use severity through positive alcohol expectancies. In a cross-sectional design, social drinkers (N = 200; 51% female; Mage = 26 years) completed self-report measures of trait (rash) impulsivity, Cluster-B personality disorder (PD) traits, positive alcohol expectancies, and alcohol use severity. Simple and serial mediation analyses were used to test positive alcohol expectancies and the association between trait impulsivity and alcohol expectancies as potential mediators of personality disorder trait relations with alcohol use severity. Simple mediation analyses evidenced that trait impulsivity and traits specific to each of the Cluster-B (PDs) were indirectly associated with alcohol use severity through positive alcohol expectancies. Serial mediation analyses further evidenced that the Cluster-B (PD) traits were indirectly associated with alcohol use severity via positive alcohol expectancies both uniquely from and together with trait impulsivity. Current findings are novel and suggest that positive alcohol expectancies may be important to connecting the rashly impulsive aspects of Cluster-B (PDs) with greater alcohol use severity. However, current findings also suggest that features of the Cluster-B (PDs) probably increase risk for alcohol use disorder due to other reasons (e.g., other aspects of personality or forms of impulsivity). (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Espinosa A, Ruglass LM, Conway FN, Jackson KM, White HR. Motives, Frequency, and Consequences of Cannabis Use Among College Students. JOURNAL OF DRUG ISSUES 2022. [DOI: 10.1177/00220426221093608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We investigated profiles of cannabis use motives among current cannabis-consuming college students. Then we assessed profile differences in demographic characteristics, social contexts of use, regulatory environment, alcohol use, negative affect, negative consequences, and cannabis use. Participants ( N = 1, 213) were from three universities in states with different cannabis legislation. Six profiles emerged: Low Motives, Low to Moderate Enhance, High Enhance, High Enhance & Social + Moderate Expand, High Enhance & Cope, and High Motives. Profiles differed in social contexts of use, sex, alcohol use, negative affect, and regulatory environment. Profiles endorsing high and multiple motives had higher cannabis use and negative consequences, relative to profiles with low or fewer motives. Profiles characterized by high avoidance motives (i.e., coping) had the highest cannabis use and consequences. Interventions targeting types and intensity of motives for cannabis-use may help reduce use and related consequences among college students who use cannabis.
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Affiliation(s)
- Adriana Espinosa
- Department of Psychology, The City College of New York, New York, NY, USA
- Center of Alcohol & Substance Use Studies, Rutgers University, New Brunswick, NJ, USA
| | - Lesia M. Ruglass
- Department of Psychology, The City College of New York, New York, NY, USA
- Center of Alcohol & Substance Use Studies, Rutgers University, New Brunswick, NJ, USA
| | - Fiona N. Conway
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
| | - Kristina M. Jackson
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI USA
| | - Helene R. White
- Center of Alcohol & Substance Use Studies, Rutgers University, New Brunswick, NJ, USA
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Akbari M, Bahadori MH, Mohammadkhani S, Kolubinski DC, Nikčević AV, Spada MM. A discriminant analysis model of psychosocial predictors of problematic Internet use and cannabis use disorder in university students. Addict Behav Rep 2021; 14:100354. [PMID: 34141856 PMCID: PMC8186557 DOI: 10.1016/j.abrep.2021.100354] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/08/2021] [Accepted: 05/20/2021] [Indexed: 12/13/2022] Open
Abstract
Researchers have found similarities and differences between behavioral and drug addictions. The present study was designed to explore which of a series of psychosocial predictors of addictive behaviors could differentiate problematic Internet use (PIU) and Cannabis Use Disorder (CUD) in a sample of University students. A total of 144 participants (76 males, mean age = 23.03 years ± 2.83) were separated into three groups: those presenting with PIU (18 females, Mean age = 22.27 years), those presenting with CUD (22 female, Mean age = 22.73 years), and a control group (28 female, Mean age = 24.04 years). Participants completed the Internet Abusive Use Questionnaire (IAUQ), the Severity of Dependence Scale (SDS), the Multidimensional Scale of Perceived Social Support (MSPSS), the Barratt Impulsiveness Scale-11 (BIS-11), the Multidimensional Distress Tolerance Scale (MDTS), the Emotion Regulation Questionnaire (ERQ), the Metacognitions Questionnaire-30 (MCQ-30), and the Repetitive Thinking Questionnaire-10 (RTQ-10). The classification analysis results showed that 68.8% of the control group, 70.8% of the PIU group, and 81.3% of the CUD group were correctly classified in their respective groups. In addition, the results of the discriminant function analysis showed that there was a significant difference between members of the PIU and CUD groups in the degree of family support (0.45), significant other (0.33), tolerance of physical discomfort (0.30), reappraisal (0.42), and cognitive confidence (0.35). The findings provide evidence that specific psychosocial predictors can discriminate PIU from CUD.
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Affiliation(s)
- Mehdi Akbari
- Department of Clinical Psychology, Faculty of Psychology and Education,
Kharazmi University, Tehran, Iran
| | - Mohammad Hossein Bahadori
- Department of Clinical Psychology, Faculty of Psychology and Education,
Kharazmi University, Tehran, Iran
| | - Shahram Mohammadkhani
- Department of Clinical Psychology, Faculty of Psychology and Education,
Kharazmi University, Tehran, Iran
| | - Daniel C. Kolubinski
- Division of Psychology, School of Applied Sciences, London South Bank
University, London, UK
| | - Ana V. Nikčević
- Department of Psychology, School of Law, Social and Behavioural Sciences,
Kingston University, Kingston-upon- Thames, UK
| | - Marcantonio M. Spada
- Division of Psychology, School of Applied Sciences, London South Bank
University, London, UK
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8
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Rady A, Abdelkarim A, Ivanoff A, Molokhia T. Efficacy of Dialectical Behavioral Therapy for Emotion Dysregulation in Patients with Dual Diagnosis of Borderline Personality Disorder and Substance Use Disorder. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2021. [DOI: 10.2174/2666082217666210716130354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
The published evidence supports the efficacy of dialectical behavioral
therapy (DBT) to treat patients with borderline personality disorder and particular emphasis on
emotion dysregulation as a psychopathological construct.
Aim:
To assess the efficacy of DBT for improving emotion dysregulation among patients with
dual diagnosis of borderline personality disorder and substance use disorder.
Methods:
We recruited 40 patients meeting DSM-5 criteria for borderline personality disorder
and substance use disorder and assigned them to one of two groups of 20 participants each.
One group underwent DBT therapy and the other group followed a treatment-as-usual (TAU)
protocol over one year. We used the scores of the difficulties in emotion regulation scale
(DERS) at baseline, immediately after therapy, and 4 months after therapy to assess emotion
dysregulation.
Results:
We found significant improvements (p<0.05) in the DBT group after therapy that were
maintained at least for 4 months afterwards based on the DERS scores (including subscale
scores). More patients dropped out of the treatment in the TAU group than in the DBT group.
Conclusion:
DBT is a potentially efficacious psychological intervention to treat emotion dysregulation
in patients with borderline personality disorder and substance use disorder.
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Affiliation(s)
- Ahmed Rady
- Department of Psychiatry, Alexandria University School of Medicine, Alexandria,Egypt
| | - Ahmed Abdelkarim
- Department of Psychiatry, Alexandria University School of Medicine, Alexandria,Egypt
| | - Andre Ivanoff
- School of Social Work, Columbia University, New York, NY,United States
| | - Tarek Molokhia
- Department of Psychiatry, Alexandria University School of Medicine, Alexandria,Egypt
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Scamaldo KM, Tull MT, Gratz KL. Motives for opioid use explain the relation between borderline personality disorder pathology and opioid use problems. Psychiatry Res 2021; 296:113609. [PMID: 33418458 DOI: 10.1016/j.psychres.2020.113609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 11/25/2020] [Indexed: 12/31/2022]
Abstract
Despite the established relations between borderline personality disorder (BPD) and substance use problems in general, there is a dearth of research on the relation between BPD pathology and opioid use problems, as well as factors that may explain this relation. Therefore, this study examined the indirect relations of BPD pathology to opioid use problems (i.e., prescription opioid misuse, apprehension about prescription opioid use, and opioid cravings) through motives for opioid use (i.e., coping, enhancement, social, and conformity motives) among 68 patients endorsing prescription opioid misuse in a residential correctional substance use disorder (SUD) treatment facility. Participants completed measures of BPD pathology, motives for opioid use, and opioid use problems. Findings revealed significant indirect relations of BPD pathology to opioid misuse through coping and enhancement motives, apprehension about opioid use through coping, enhancement, and social motives, and opioid cravings through coping motives within this SUD sample. Results illustrate the relevance of both emotion- and interpersonal-related motives for opioid use to opioid use problems among patients with BPD pathology in SUD treatment.
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Affiliation(s)
| | - Matthew T Tull
- Department of Psychology, University of Toledo, Toledo, OH, USA
| | - Kim L Gratz
- Department of Psychology, University of Toledo, Toledo, OH, USA..
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