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Bettinger S, Höpfner S, Deest-Gaubatz S, Simon L, Matin-Mann F, Weber C, Schülke R, Bleich S, Frieling H, Neyazi A, Maier HB. Neurological soft signs and olfactory dysfunction in patients with borderline personality disorder. Prog Neuropsychopharmacol Biol Psychiatry 2024; 135:111118. [PMID: 39173992 DOI: 10.1016/j.pnpbp.2024.111118] [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: 03/14/2024] [Revised: 08/05/2024] [Accepted: 08/10/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Borderline personality disorder (BPD) is a serious disorder with a lifetime prevalence of 2.7-5.9% and is thought to correlate with altered neuroplasticity. The aim of the present study is to investigate possible associations of BPD (-severity) and alterations in neurological soft signs (NSS) and olfactory function. METHODS For the monocentric observational study, 39 female subjects with a BPD diagnosis and 19 female healthy control subjects were recruited. The groups were matched by age. Olfactory functions were examined using Sniffin' Sticks. NSS were assessed by a standardized test with 50 items. RESULTS BPD subjects have higher NSS scores in group comparison. By contrast, there are no alterations in the total score of olfactory function, while the BPD subjects scored higher in smell identification. Within the BPD group, the total NSS score was discovered to have a negative correlation with olfactory function. BPD subjects taking antipsychotics show more NSS than those without. We found no significant influence of posttraumatic stress disorder on the NSS or olfactory function. The BPD-severity correlates with NSS. LIMITATIONS Due to the cross-sectional design, we did not have a follow up examination. The sample size was small, and all patients had psychiatric comorbidities. Additionally, we did not perform MRI to connect our findings with possible structural abnormalities. CONCLUSIONS Our study confirmed altered NSS in BPD patients, whereas no impairment in the olfactory function was found. Further research is required to establish NSS and smell tests as clinical screening tools in BPD patients and to uncover the disorder's impact on neuroplasticity.
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Affiliation(s)
- Sören Bettinger
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Sarina Höpfner
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Stephanie Deest-Gaubatz
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Lennart Simon
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | | | | | - Rasmus Schülke
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany; Laboratory for Molecular Neuroscience, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Helge Frieling
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany; Laboratory for Molecular Neuroscience, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Alexandra Neyazi
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke-University, Magdeburg, Germany; Laboratory for Molecular Neuroscience, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Hannah Benedictine Maier
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany.
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Kline EA, Lekkas D, Bryan A, Nemesure MD, Griffin TZ, Collins AC, Price GD, Heinz MV, Nepal S, Pillai A, Campbell AT, Jacobson NC. The role of borderline personality disorder traits in predicting longitudinal variability of major depressive symptoms among a sample of depressed adults. J Affect Disord 2024; 363:492-500. [PMID: 39029689 DOI: 10.1016/j.jad.2024.07.104] [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: 04/09/2024] [Revised: 06/07/2024] [Accepted: 07/16/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND Major depressive disorder (MDD) and borderline personality disorder (BPD) often co-occur, with 20 % of adults with MDD meeting criteria for BPD. While MDD is typically diagnosed by symptoms persisting for several weeks, research suggests a dynamic pattern of symptom changes occurring over shorter durations. Given the diagnostic focus on affective states in MDD and BPD, with BPD characterized by instability, we expected heightened instability of MDD symptoms among depressed adults with BPD traits. The current study examined whether BPD symptoms predicted instability in depression symptoms, measured by ecological momentary assessments (EMAs). METHODS The sample included 207 adults with MDD (76 % White, 82 % women) recruited from across the United States. At the start of the study, participants completed a battery of mental health screens including BPD severity and neuroticism. Participants completed EMAs tracking their depression symptoms three times a day over a 90-day period. RESULTS Using self-report scores assessing borderline personality disorder (BPD) traits along with neuroticism scores and sociodemographic data, Bayesian and frequentist linear regression models consistently indicated that BPD severity was not associated with depression symptom change through time. LIMITATIONS Diagnostic sensitivity and specificity may be restricted by use of a self-report screening tool for capturing BPD severity. Additionally, this clinical sample of depressed adults lacks a comparison group to determine whether subclinical depressive symptoms present differently among individuals with BPD only. CONCLUSIONS The unexpected findings shed light on the interplay between these disorders, emphasizing the need for further research to understand their association.
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Affiliation(s)
- Emily A Kline
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States of America; Department of Psychology, Montclair State University, Montclair, NJ, United States of America; Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States of America.
| | - Damien Lekkas
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States of America; Quantitative Biomedical Sciences Program, Dartmouth College, Hanover, NH, United States of America
| | - Anastasia Bryan
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States of America
| | - Matthew D Nemesure
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States of America; Quantitative Biomedical Sciences Program, Dartmouth College, Hanover, NH, United States of America; Digital Data Design Institute, Harvard Business School, Boston, MA, United States of America
| | - Tess Z Griffin
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States of America
| | - Amanda C Collins
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States of America; Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States of America
| | - George D Price
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States of America; Quantitative Biomedical Sciences Program, Dartmouth College, Hanover, NH, United States of America
| | - Michael V Heinz
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States of America; Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States of America
| | - Subigya Nepal
- Department of Computer Science, Dartmouth College, Hanover, NH, United States of America
| | - Arvind Pillai
- Department of Computer Science, Dartmouth College, Hanover, NH, United States of America
| | - Andrew T Campbell
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States of America; Department of Computer Science, Dartmouth College, Hanover, NH, United States of America
| | - Nicholas C Jacobson
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States of America; Quantitative Biomedical Sciences Program, Dartmouth College, Hanover, NH, United States of America; Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States of America; Department of Computer Science, Dartmouth College, Hanover, NH, United States of America
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Brud PP, Cieciuch J. Temperamental underpinnings of borderline personality disorder and its facets. Personal Ment Health 2024; 18:205-215. [PMID: 38476088 DOI: 10.1002/pmh.1610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/11/2023] [Accepted: 02/18/2024] [Indexed: 03/14/2024]
Abstract
Temperament is claimed to be the basis for personality; therefore, discovering the temperamental underpinnings of borderline personality disorder and its facets is crucial for understanding this personality disorder. In this article, we explore these underpinnings by using a new model of temperament, based on the Regulative Theory of Temperament, the Big Two of temperament, and the Circumplex of Personality Metatraits. Two studies were conducted on adults-the first was in a general population sample (N = 315) and the second was in a clinical sample (N = 113) in people with a diagnosis of borderline personality disorder. The following measurements were used: The Screening Instrument for Borderline Personality Disorder (SI-Bord), the Five-Factor Borderline Inventory-Short Form (FFBI-SF), and the Temperament Metadimensions Questionnaire (TMQ). General borderline was explained by Reactivity (high Sensitivity) and Activity (high Dynamism). At the facet level, the Borderline Internalizing Facet was mainly explained by Reactivity (high Sensitivity), while the Borderline Externalizing Facet was explained by Activity (high Dynamism) in addition to Reactivity (high Sensitivity). The results of our study revealed specific temperamental underpinnings of borderline and its facets. Reactivity underlies all borderline facets, while Activity differentiates between the Borderline Externalizing Facet and Borderline Internalizing Facet.
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Affiliation(s)
- Piotr P Brud
- Institute of Psychology, Cardinal Stefan Wyszyński University in Warsaw, Warsaw, Poland
| | - Jan Cieciuch
- Institute of Psychology, Cardinal Stefan Wyszyński University in Warsaw, Warsaw, Poland
- University Research Priority Social Networks, University of Zürich, Zürich, Switzerland
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Bamouss A, Mungo A, Hein M. [Impact of the diagnostic method for borderline personality disorder on the acute response and the risk of early relapse in major depressed individuals treated with ECT: A systematic literature review]. L'ENCEPHALE 2024; 50:436-445. [PMID: 38311474 DOI: 10.1016/j.encep.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 10/25/2023] [Accepted: 11/08/2023] [Indexed: 02/06/2024]
Abstract
INTRODUCTION Given the contradictory data available in the literature, the aim of this systematic review was to investigate the impact of the diagnostic method for borderline personality disorder (BPD) on the acute response and the risk of early relapse in major depressed individuals treated with electroconvulsive therapy (ECT). METHOD After a systematic literature review performed during March 2023 in the PubMed-Medline database according to the PRISMA criteria, 47 articles were identified using the keyword algorithm ("Electroconvulsive Therapy" [Mesh] or electroconvulsive therapy) and ("Borderline Personality Disorder" [Mesh] or borderline personality disorder). The inclusion criteria applied for the selection of articles in this systematic review were: (1) articles investigating the impact of BPD on the acute response and/or the risk of early relapse in major depressed individuals (> 18 years old) treated with ECT, (2) diagnosis of BPD and major depressive disorder by validated screening tests and/or systematic psychiatric interviews based on diagnostic criteria of international classification, (3) any type of study (cross-sectional, longitudinal, prospective, retrospective, interventional and experimental), (4) articles written in English or French, and (5) articles published after January 2000. After assessment of the 47 articles based on these inclusion criteria by two authors, seven studies investigating the impact of BPD diagnosed by systematic psychiatric interview or screening tests on the acute response and the risk of early relapse in major depressed individuals treated with ECT were included in this systematic review. RESULTS Unlike the three studies diagnosing BPD by screening tests, the four studies diagnosing BPD by systematic psychiatric interview demonstrated a negative impact of this personality disorder on the acute response or the risk of early relapse in major depressed individuals treated with ECT. However, all studies included in this systematic review presented a low level of scientific evidence (cross-sectional epidemiological studies and retrospective cohort studies). CONCLUSION Despite the need for studies of better scientific quality, the results of this systematic review seem to indicate that screening for BPD by systematic psychiatric interview during the pre-ECT assessment and the establishment of adequate therapeutic strategies in case of comorbid BPD could be promising options to allow better acute response and better prevention of early relapses in major depressed individuals treated with ECT.
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Affiliation(s)
- Amine Bamouss
- Service de psychiatrie et laboratoire du sommeil, hôpital universitaire de Bruxelles, université libre de Bruxelles (ULB), Bruxelles, Belgique
| | - Anaïs Mungo
- Service de psychiatrie et laboratoire du sommeil, hôpital universitaire de Bruxelles, université libre de Bruxelles (ULB), Bruxelles, Belgique
| | - Matthieu Hein
- Service de psychiatrie et laboratoire du sommeil, hôpital universitaire de Bruxelles, université libre de Bruxelles (ULB), Bruxelles, Belgique.
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Kaess M, Thomson M, Lerch S, Koenig J, Fischer-Waldschmidt G, Reichl C, Cavelti M. Age dependent effects of early intervention in borderline personality disorder in adolescents. Psychol Med 2024; 54:2033-2041. [PMID: 38343374 DOI: 10.1017/s0033291724000126] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2024]
Abstract
BACKGROUND Psychological treatments for young people with sub-threshold or full-syndrome borderline personality disorder (BPD) are found to be effective. However, little is known about the age at which adolescents benefit from early intervention. This study investigated whether age affects the effectiveness of early intervention for BPD. METHODS N = 626 participants (M age = 15 years, 82.7% female) were consecutively recruited from a specialized outpatient service for early intervention in BPD in adolescents aged 12- to 17-years old. DSM-IV BPD criteria were assessed at baseline, one-year (n = 339) and two-year (n = 279) follow-up. RESULTS Older adolescents presented with more BPD criteria (χ2(1) = 58.23, p < 0.001) and showed a steeper decline of BPD criteria over the 2-year follow-up period compared with younger adolescents (χ2(2) = 13.53, p = 0.001). In an attempt to disentangle effects of early intervention from the natural course of BPD, a parametrized regression model was used. An exponential decrease (b = 0.10, p < 0.001) in BPD criteria was found when starting therapy over the 2-year follow-up. This deviation from the natural course was impacted by age at therapy commencement (b = 0.06, p < 0.001), although significant across all ages: older adolescents showed a clear decrease in BPD criteria, and young adolescents a smaller decrease. CONCLUSIONS Early intervention appears effective across adolescence, but manifests differently: preventing the normative increase of BPD pathology expected in younger adolescents, and significantly decreasing BPD pathology in older adolescents. The question as to whether developmentally adapted therapeutic interventions could lead to an even increased benefit for younger adolescents, should be explored in future studies.
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Affiliation(s)
- 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 of Heidelberg, Heidelberg, Germany
| | - Madelyn Thomson
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Stefan Lerch
- 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, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
- Department of Child and Adolescent Psychiatry, University of Cologne, Faculty of Medicine and University Hospital Cologne, Psychosomatics and Psychotherapy, Cologne, Germany
| | - Gloria Fischer-Waldschmidt
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Corinna Reichl
- 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
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Villet L, Madjlessi A, Revah-Levy A, Speranza M, Younes N, Sibéoni J. The lived experience of French parents concerning the diagnosis of their children with borderline personality disorder. Borderline Personal Disord Emot Dysregul 2024; 11:13. [PMID: 38946002 PMCID: PMC11215819 DOI: 10.1186/s40479-024-00258-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 06/18/2024] [Indexed: 07/02/2024] Open
Abstract
BACKGROUND Psychiatrists often hesitate to diagnose borderline personality disorder (BPD). While individuals with BPD have reported both positive and negative experiences upon receiving their diagnosis, no study has specifically explored this issue among parents. Parents of children diagnosed with BPD can benefit from recently developed family-support interventions such as the Family Connections program. Our study aimed to explore the experiences of parents learning about their child's BPD diagnosis and to investigate the impact of the Family Connections program on their experiences. METHODS This qualitative study, conducted in France following the five-stage IPSE method, involved parents of children with BPD recruited through the Family Connections association in Versailles. We conducted semi-structured interviews and used purposive sampling for data collection until data saturation was reached. Data analysis was performed using a descriptive and structuring approach with NVivo 12 software to elucidate the structure of lived experiences. RESULTS The study included 21 parents. The structure of the lived experiences was characterized by three central axes: (1) the long and difficult road to diagnosis; (2) communicating the BPD diagnosis to parents: a necessary step; (3) the pitfalls of receiving the diagnosis. The Family Connections program provided significant support in these areas, particularly in understanding the diagnosis, enhancing communication with their child, and reducing social isolation. CONCLUSION These findings highlight the challenges parents face when receiving a BPD diagnosis for their child and underscore the need for an early, clear, and detailed explanation of the diagnosis. The specific experiences of receiving the diagnosis are indicative of the broader care experience parents undergo and highlight their need and right to be informed, supported, and guided throughout their child's treatment.
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Affiliation(s)
- Léa Villet
- Service de psychopathologie de l'enfant et de l'adolescent, Hôpitaux de Saint Maurice, 63 rue de la Roquette, Paris, 75011, France.
| | - Abtine Madjlessi
- Service de psychiatrie adulte, Hôpital François Quesnay, Mantes-la-Jolie, 78200, France
| | - Anne Revah-Levy
- Service Universitaire de Psychiatrie de l'Adolescent, Argenteuil Hospital Centre, Argenteuil, 95100, France
- ECSTRRA Team, UMR-1153, Université Paris Cité, Inserm, Paris, 75010, France
| | - Mario Speranza
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre Hospitalier de Versailles, 177 Rue de Versailles, Le Chesnay‑Rocquencourt, 78150, France
- Centre de Recherche en Épidémiologie et Santé des Populations (CESP), INSERM UMR 1018 «Developmental Psychiatry and Trajectories», Université Paris-Saclay, Université Versailles Saint Quentin en Yvelines, 16 Av. Paul Vaillant Couturier, Villejuif, 94800, France
| | - Nadia Younes
- Centre de Recherche en Épidémiologie et Santé des Populations (CESP), INSERM UMR 1018 «Developmental Psychiatry and Trajectories», Université Paris-Saclay, Université Versailles Saint Quentin en Yvelines, 16 Av. Paul Vaillant Couturier, Villejuif, 94800, France
- Service Universitaire de Psychiatrie pour adultes et addictologie, Centre Hospitalier de Versailles, 177 rue de Versailles, Le Chesnay-Rocquencourt, 78150, France
- Université de Versailles, Saint -Quentin en Yvelines, Versailles, France
| | - Jordan Sibéoni
- Service Universitaire de Psychiatrie de l'Adolescent, Argenteuil Hospital Centre, Argenteuil, 95100, France
- ECSTRRA Team, UMR-1153, Université Paris Cité, Inserm, Paris, 75010, France
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Crawford MJ, Leeson VC, Evans R, Goulden N, Weaver T, Trumm A, Barrett BM, Khun-Thompson F, Pandya SP, Saunders KE, Lamph G, Woods D, Smith H, Greenall T, Nicklin V, Barnicot K. Clinical effectiveness and cost-effectiveness of Structured Psychological Support for people with probable personality disorder in mental health services in England: study protocol for a randomised controlled trial. BMJ Open 2024; 14:e086593. [PMID: 38925701 PMCID: PMC11202761 DOI: 10.1136/bmjopen-2024-086593] [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: 03/18/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION Evidence-based psychological treatments for people with personality disorder usually involve attending group-based sessions over many months. Low-intensity psychological interventions of less than 6 months duration have been developed, but their clinical effectiveness and cost-effectiveness are unclear. METHODS AND ANALYSIS This is a multicentre, randomised, parallel-group, researcher-masked, superiority trial. Study participants will be aged 18 and over, have probable personality disorder and be treated by mental health staff in seven centres in England. We will exclude people who are: unwilling or unable to provide written informed consent, have a coexisting organic or psychotic mental disorder, or are already receiving psychological treatment for personality disorder or on a waiting list for such treatment. In the intervention group, participants will be offered up to 10 individual sessions of Structured Psychological Support. In the control group, participants will be offered treatment as usual plus a single session of personalised crisis planning. The primary outcome is social functioning measured over 12 months using total score on the Work and Social Adjustment Scale (WSAS). Secondary outcomes include mental health, suicidal behaviour, health-related quality of life, patient-rated global improvement and satisfaction, and resource use and costs. The primary analysis will compare WSAS scores across the 12-month period using a general linear mixed model adjusting for baseline scores, allocation group and study centre on an intention-to-treat basis. In a parallel process evaluation, we will analyse qualitative data from interviews with study participants, clinical staff and researchers to examine mechanisms of impact and contextual factors. ETHICS AND DISSEMINATION The study complies with the Helsinki Declaration II and is approved by the London-Bromley Research Ethics Committee (IRAS ID 315951). Study findings will be published in an open access peer-reviewed journal; and disseminated at national and international conferences. TRIAL REGISTRATION NUMBER ISRCTN13918289.
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Affiliation(s)
| | | | | | | | - Tim Weaver
- Department of Mental Health & Social Work, Middlesex University, London, UK
| | - Aile Trumm
- Department of Mental Health & Social Work, Middlesex University, London, UK
| | | | | | | | | | - Gary Lamph
- School of Nursing and Midwifery, Keele University, Keele, UK
| | - David Woods
- Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Harriet Smith
- Avon and Wiltshire Mental Health Partnership NHS Trust, Bath, UK
| | - Toby Greenall
- Lincolnshire Community Health Services NHS Trust, Lincoln, UK
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Cavelti M, Blaha Y, Lerch S, Hertel C, Berger T, Reichl C, Koenig J, Kaess M. The evaluation of a stepped care approach for early intervention of borderline personality disorder. Borderline Personal Disord Emot Dysregul 2024; 11:12. [PMID: 38886843 PMCID: PMC11184763 DOI: 10.1186/s40479-024-00256-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 06/05/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND The current study evaluated the stepped care approach applied in AtR!Sk; a specialized outpatient clinic for adolescents with BPD features that offers a brief psychotherapeutic intervention (Cutting Down Program; CDP) to all patients, followed by a more intensive Dialectical Behavioral Therapy for Adolescents (DBT-A) for those whose symptoms persist. METHODS The sample consisted of 127 patients recruited from two AtR!Sk clinics. The number of BPD criteria, psychosocial functioning, severity of overall psychopathology, number of days with non-suicidal self-injury (NSSI; past month), and the number of suicide attempts (last 3 months) were assessed at clinic entry (T0), after CDP (T1), and at 1- and 2-year follow-up (T2, T3). Based on the T1 assessment (decision criteria for DBT-A: ≥ 3 BPD criteria & ZAN-BPD ≥ 6), participants were allocated into three groups; CDP only (n = 74), CDP + DBT-A (eligible and accepted; n = 36), CDP no DBT-A (eligible, but declined; n = 17). RESULTS CDP only showed significantly fewer BPD criteria (T2: β = 3.42, p < 0.001; T3: β = 1.97, p = 0.008), higher levels of psychosocial functioning (T2: β = -1.23, p < 0.001; T3: β = -1.66, p < 0.001), and lower severity of overall psychopathology (T2: β = 1.47, p < 0.001; T3: β = 1.43, p = 0.002) over two years compared with CDP no DBT-A, while no group differences were found with regard to NSSI and suicide attempts. There were no group differences between CDP + DBT-A and CDP no DBT-A, neither at T2 nor at T3. DISCUSSION The findings support the decision criterion for the offer of a more intense therapy after CDP. However, there was no evidence for the efficacy of additional DBT-A, which might be explained by insufficient statistical power in the current analysis.
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Affiliation(s)
- Marialuisa Cavelti
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, Bern 60, 3000, Switzerland
| | - Yasmine Blaha
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, Bern 60, 3000, Switzerland
| | - Stefan Lerch
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, Bern 60, 3000, Switzerland
| | - Christian Hertel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, Bern 60, 3000, Switzerland
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Corinna Reichl
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, Bern 60, 3000, Switzerland
| | - Julian Koenig
- Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Cologne, Cologne, Germany
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, Bern 60, 3000, Switzerland.
- Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany.
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Gescher DM, Schanze D, Vavra P, Wolff P, Zimmer-Bensch G, Zenker M, Frodl T, Schmahl C. Differential methylation of OPRK1 in borderline personality disorder is associated with childhood trauma. Mol Psychiatry 2024:10.1038/s41380-024-02628-z. [PMID: 38862675 DOI: 10.1038/s41380-024-02628-z] [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: 09/19/2023] [Revised: 05/21/2024] [Accepted: 05/28/2024] [Indexed: 06/13/2024]
Abstract
According to a growing body of neurobiological evidence, the core symptoms of borderline personality disorder (BPD) may be linked to an opioidergic imbalance between the hedonic and stimulatory activity of mu opioid receptors (MOR) and the reward system inhibiting effects of kappa opioid receptors (KOR). Childhood trauma (CT), which is etiologically relevant to BPD, is also likely to lead to epigenetic and neurobiological adaptations by extensive activation of the stress and endogenous opioid systems. In this study, we investigated the methylation differences in the promoter of the KOR gene (OPRK1) in subjects with BPD (N = 47) and healthy controls (N = 48). Comparing the average methylation rates of regulatorily relevant subregions (specified regions CGI-1, CGI-2, EH1), we found no differences between BPD and HC. Analyzing individual CG nucleotides (N = 175), we found eight differentially methylated CG sites, all of which were less methylated in BPD, with five showing highly interrelated methylation rates. This differentially methylated region (DMR) was found on the falling slope (5') of the promoter methylation gap, whose effect is enhanced by the DMR hypomethylation in BPD. A dimensional assessment of the correlation between disease severity and DMR methylation rate revealed DMR hypomethylation to be negatively associated with BPD symptom severity (measured by BSL-23). Finally, analyzing the influence of CT on DMR methylation, we found DMR hypomethylation to correlate with physical and emotional neglect in childhood (quantified by CTQ). Thus, the newly identified DMR may be a biomarker of the risks caused by CT, which likely epigenetically contribute to the development of BPD.
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Affiliation(s)
- Dorothee Maria Gescher
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany.
- Department for General Psychiatry, Center of Psychosocial Medicine, Medical Faculty, Heidelberg University, Heidelberg, Germany.
- Department of Psychiatry and Psychotherapy, Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany.
| | - Denny Schanze
- Institute of Human Genetics, Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany
| | - Peter Vavra
- Department of Biological Psychology, Institute of Psychology, Otto-von-Guericke University, Magdeburg, Germany
| | - Philip Wolff
- Division of Neuroepigenetics, Institute of Zoology (Biology II), RWTH Aachen University, Aachen, Germany
| | - Geraldine Zimmer-Bensch
- Division of Neuroepigenetics, Institute of Zoology (Biology II), RWTH Aachen University, Aachen, Germany
| | - Martin Zenker
- Institute of Human Genetics, Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany
| | - Thomas Frodl
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Department of Psychiatry and Psychotherapy, Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany
- German Center for Mental Health (DZPG), Jena-Magdeburg-Halle, Germany
- Center for Intervention and Research on adaptive and maladaptive brain Circuits underlying mental health (C-I-R-C), Jena-Magdeburg-Halle, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Eckerström J, Rosendahl I, Lindkvist RM, Amin R, Carlborg A, Flyckt L, Jayaram-Lindström N. Effects of Patient-Initiated Brief Admissions on Psychiatric Care Consumption in Borderline Personality Disorder: ARegister-Based Study. Int J Ment Health Nurs 2024. [PMID: 38855833 DOI: 10.1111/inm.13371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 05/08/2024] [Accepted: 05/19/2024] [Indexed: 06/11/2024]
Abstract
Previous studies have reported that patients with borderline personality disorder (BPD) often have negative experiences in psychiatric inpatient care. To address this issue, a novel intervention known as patient-initiated brief admission (PIBA) has been developed. PIBA offers a constructive approach to crisis management in situations of heightened anxiety, as well as during instances of self-harm and suicidal ideation. The intervention allows patients to directly contact the psychiatric ward to initiate a brief admission lasting 1-3 days. This easily accessible care option during a crisis has the potential to prevent harm to the patient and reduce the need for prolonged hospital stays. The aim of the present study is to investigate the effects of PIBA on psychiatric care consumption among patients diagnosed with BPD. This retrospective register-based study includes data from both inpatient and outpatient care registries for patients diagnosed with BPD. Data were extracted from the National Board of Health and Welfare in Sweden. The study period encompasses 2013-2020, with the PIBA intervention occurring between 2016 and 2019. The sample included 107 patients in the PIBA group and 5659 matched controls. Data were analysed using a difference-in-differences (DiD) approach through ordinary least squares (OLS) regression and ordinal logistic regression. Throughout the 3-year follow-up, both groups exhibited a reduction in the number of days of utilisation of psychiatric inpatient care services. The DiD analysis indicated an additional decrease of 1.5 days at the 6-month mark for the PIBA group (β = -1.436, SE = 1.531), expanding to 3 days fewer at the 12-month follow-up (β = -3.590, SE = 3.546), although not statistically significant. For outpatient care, the PIBA group displayed an increase in the number of visits, averaging to half a visit more every 6 months (β = 0.503, SE = 0.263) compared with the controls. Statistically significant differences were observed for two out of six measurements at the 12-month (β = 0.960, SE = 0.456) and 18-month follow-up period (β = 0.436, SE = 0.219). The PIBA group had a statistically significant lower odds of experiencing extended lengths of inpatient care days after the index date than the controls (OR 0.56, 95% CI: 0.44-0.72). In conclusion, PIBA was associated with a significant reduction in the length of individual hospital stays, but not in the overall number of inpatient care days. PIBA may be linked to a shift from longer inpatient care utilisation to outpatient care utilisation. These findings suggest that PIBA may reduce the risk of prolonged hospitalisations for patients who have access to the intervention. Future research should explore the impact of PIBA on healthcare costs and cost-effectiveness, both in relation to health care for the individual and cost-effectiveness in relation to recovery and health.
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Affiliation(s)
- Joachim Eckerström
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm, Sweden
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Ingvar Rosendahl
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm, Sweden
| | - Rose-Marie Lindkvist
- Department of Clinical Sciences Malmö, Psychiatry, Lund University, Lund, Sweden
| | - Ridwanul Amin
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Division of Infectious Diseases, Department of Medicine, Karolinska, Stockholm, Sweden
| | - Andreas Carlborg
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm, Sweden
| | - Lena Flyckt
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm, Sweden
| | - Nitya Jayaram-Lindström
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm, Sweden
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11
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Culina I, Ranjbar S, Maillard P, Martin-Soelch C, Berney S, Kolly S, André J, Conus P, Kramer U. Symptom domains and psychosocial functioning in borderline personality disorder. Borderline Personal Disord Emot Dysregul 2024; 11:10. [PMID: 38835094 DOI: 10.1186/s40479-024-00255-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 05/28/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Borderline personality disorder (BPD) is often characterized by severe functional impairment, even after a decrease in symptoms. A comprehensive understanding of psychosocial functioning in BPD is necessary to tailor treatment offer, which should address relevant aspects of daily life. The aims of the present study are to (1) conduct a cross-sectional comparison of functioning of a group with BPD and a non-BPD clinical comparison group at service entry, and to (2) assess the relationship between intensity of BPD symptom domains and psychosocial functioning. METHODS The sample consists of N = 65 participants with BPD and N = 57 participants from the clinical comparison group without BPD (non-BPD group). The Revised Borderline Follow-up Interview (BFI-R) was used to evaluate psychosocial functioning and the Revised Diagnostic Interview for Borderlines (DIB-R) to assess BPD symptoms. Linear, logistic, and multinomial regression models were run separately for each aspect of functioning as a function of BPD status or BPD symptom domains. RESULTS Only 23% of participants in the BPD group fulfilled criteria for good overall psychosocial functioning, compared to 53% in the non-BPD group. Furthermore, participants in the BPD group were less likely to have completed a high number of years of education, to work consistently, to be financially independent, to be in a cohabiting relationship and have a good relationship with parents. In addition, various links were identified between BPD symptom domains and functional impairments. CONCLUSIONS Consistent with prior research, the main impairments in functioning in the BPD group are found in the educational and vocational domains. Though some domains show impairment, others, like friendships, may act as potential resources. Further investigation on the relationships with symptom domains is required.
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Affiliation(s)
- Ines Culina
- General Psychiatry Service, Department of Psychiatry, University Hospital Center and University of Lausanne, Lausanne, Switzerland.
- Unit of Clinical and Health Psychology, Department of Psychology, University of Fribourg, Fribourg, Switzerland.
| | - Setareh Ranjbar
- Department of Psychiatry, Psychiatric Epidemiology and Psychopathology Research Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Chantal Martin-Soelch
- Unit of Clinical and Health Psychology, Department of Psychology, University of Fribourg, Fribourg, Switzerland
| | - Sylvie Berney
- General Psychiatry Service, Department of Psychiatry, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - Stéphane Kolly
- General Psychiatry Service, Department of Psychiatry, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - Jérémie André
- General Psychiatry Service, Department of Psychiatry, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - Philippe Conus
- General Psychiatry Service, Department of Psychiatry, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - Ueli Kramer
- General Psychiatry Service, Department of Psychiatry, University Hospital Center and University of Lausanne, Lausanne, Switzerland
- Institute of Psychotherapy, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- Departement of Psychology, University of Windsor, Windsor, Canada
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12
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Blay M, Verne M, Durpoix A, Benmakhlouf I, Labaume L. Clinical specificities of patients with substance use disorder and comorbid borderline personality disorder compared to patients with substance use disorder only: a retrospective study. J Addict Dis 2024:1-7. [PMID: 38835113 DOI: 10.1080/10550887.2024.2363038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
INTRODUCTION Substance use disorder (SUD) is a common condition often associated with borderline personality disorder (BPD), and patients with both disorders (SUD + BPD) have more complex presentations and poorer outcomes in treatment. Thus, there is a need to identify more clearly the clinical differences between patients with SUD + BPD and those with SUD only to help clinicians in their diagnostic process. METHODS Data from medical files of 92 patients with SUD (SUD only: n = 42; SUD + BPD: n = 50) treated in an outpatient psychiatry and addiction treatment center were extracted to compare the differences in terms of sociodemographic characteristics, substance used, psychopathological dimensions, comorbidity prevalence, and functional impairment. RESULTS Compared to the SUD only group, patients in the SUD + BPD group were younger, more disabled, and less satisfied with their social life. Regarding substance used, the comorbid group had more frequently cannabis use disorder and poly nonalcoholic SUD. Regarding psychopathological dimensions, the comorbid group had higher levels of impulsivity, emotion regulation difficulties and alexithymia. Finally, regarding comorbidities, the comorbid group had a higher risk of comorbid anxiety, obsessive-compulsive, and post-traumatic stress disorders. CONCLUSION While being only exploratory, these results add evidence on the impact of the BPD comorbidity in patients with SUD and underline important dimensions that should be considered by clinicians working with this population.
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Affiliation(s)
- Martin Blay
- ADDIPSY, Outpatient Addictology and Psychiatry Center, Lyon, France
- UVSQ, INSERM, Centre de recherche en Epidémiologie et Santé des Populations Team "DevPsy", Université Paris-Saclay, Villejuif, France
| | - Manon Verne
- Lyon-Est Medical School, Claude Bernard University Lyon 1, Lyon, France
| | - Amaury Durpoix
- Department of psychiatry, University Hospital of Strasbourg, Strasbourg, France
| | - Inès Benmakhlouf
- ADDIPSY, Outpatient Addictology and Psychiatry Center, Lyon, France
| | - Laura Labaume
- ADDIPSY, Outpatient Addictology and Psychiatry Center, Lyon, France
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13
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Thakur B, Pathak M, Strenth C, Wilmoth K, Arnold EM. The relationship between borderline personality disorder and self-injurious/suicidal behaviors in adolescents and young adults: A protocol for systematic review and meta-analysis. Health Sci Rep 2024; 7:e2143. [PMID: 38863733 PMCID: PMC11165399 DOI: 10.1002/hsr2.2143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 04/19/2024] [Accepted: 05/08/2024] [Indexed: 06/13/2024] Open
Abstract
Background & Aims Borderline personality disorder (BPD) is a common psychiatric disorder associated with a high risk of suicide attempts, death by suicide, and non-suicidal self-injury (NSSI). A systematic and comprehensive understanding of the link between BPD and suicide and self-injury in adolescents and young adults is crucial for effective public health prevention strategies. This protocol outlines our approach to summarize the evidence on the association between BPD diagnosis and self-injurious/suicidal behaviors including death by suicide, nonfatal suicide attempts, NSSI, and self-harm behavior through a systematic review and meta-analysis. Methods The protocol is registered (PROSPERO: CRD42022363329) and developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P)-2015 statement. We will conduct a comprehensive literature search using electronic databases including MEDLINE, EMBASE, SCOPUS, Web of Science, CINHAL, and PsycINFO. The review will include studies that meet the specific inclusion criteria and will be searched using multiple databases A meta-analysis will be conducted using a fixed-effects or random-effects approach based on the level of heterogeneity. Subgroup analysis and meta-regression will be performed if necessary. Conclusion This study is unique, as it is the first of its kind to systematically review and analyze the existing literature on this topic. The results of this study will provide important evidence on the magnitude of this relationship overall and in different subgroups, which can be used to inform the development of effective prevention and treatment strategies.
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Affiliation(s)
- Bhaskar Thakur
- Department of Family and Community MedicineUT Southwestern Medical CenterDallasTexasUSA
- Peter O'Donnell Jr. School of Public HealthUT Southwestern Medical CenterDallasTexasUSA
| | - Mona Pathak
- Department of PharmacotherapyUNT System College of PharmacyFort WorthTexasUSA
| | - Chance Strenth
- Department of Family and Community MedicineUT Southwestern Medical CenterDallasTexasUSA
| | - Kristin Wilmoth
- Departments of Psychiatry and Physical Medicine & RehabilitationUT Southwestern Medical CenterDallasTexasUSA
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14
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Blay M, Nicot P, Durpoix A, Leaune E, Poulet E, Ulm J, Perroud N. Evaluation of the level of training of French psychiatrists on borderline personality disorder: An online survey. L'ENCEPHALE 2024; 50:257-264. [PMID: 37604716 DOI: 10.1016/j.encep.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/04/2023] [Accepted: 06/08/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Borderline personality disorder is a common and treatable personality disorder that is often underdiagnosed and untreated, mainly due to a lack of training of psychiatrists and to a lack of accessibility to specialized therapies. However, no study has been conducted in France regarding this issue. Thus, we aimed to evaluate on a national scale the level of training, knowledge, and general attitude toward BPD diagnosis of French psychiatrists. METHODS We conducted an online survey in an unselected population of residents and senior French psychiatrists between January and March 2022, the results of which are presented descriptively. RESULTS 228 psychiatrists fully answered the questionnaire, and 21 more psychiatrists answered it partially. We found that most of the responders were unsatisfied with the residency training or the continuing medical education offered regarding BPD, a lack of training resulting in a low level of self-confidence regarding BPD management, in a low number of evidence-based therapies trained psychiatrists in issues regarding diagnostic disclosure, and in misconceptions regarding some aspects of the disorder. CONCLUSIONS These results underlie a clear lack of training of French psychiatrists, as well as a request from the latter for more opportunities to learn. This calls for a rethinking of the teaching system to incorporate more knowledge and tools related to BPD.
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Affiliation(s)
- Martin Blay
- ADDIPSY, Addictology and Psychiatry Outpatient Center, Santé Basque Development group, Lyon, France.
| | - Pierre Nicot
- Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, PSYR2, 69500 Bron, France
| | - Amaury Durpoix
- University Hospital of Strasbourg, Strasbourg, France; University of Strasbourg, Strasbourg, France
| | - Edouard Leaune
- Suicide Prevention Center, Vinatier Hospital Center, Bron, France; Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, PSYR2, 69500 Bron, France
| | - Emmanuel Poulet
- Psychiatry Crisis Unit, Edouard Herriot Hospital, Lyon, France; Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, PSYR2, 69500 Bron, France
| | - Justin Ulm
- Percy Army Instruction Hospital, Clamart, France; Val de Grâce School, Paris, France
| | - Nader Perroud
- Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland; University of Geneva, Geneva, Switzerland
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15
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Parpart H, Blass J, Meindl T, Blautzik J, Michl P, Beblo T, Engel R, Reiser M, Falkai P, Moeller HJ, Driessen M, Hennig-Fast K. Two Sides of the Same Coin in Female Borderline Personality Disorder: Self-Reported Guilt and Shame and Their Neurofunctional Correlates. Brain Sci 2024; 14:549. [PMID: 38928549 PMCID: PMC11201834 DOI: 10.3390/brainsci14060549] [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: 04/30/2024] [Revised: 05/17/2024] [Accepted: 05/24/2024] [Indexed: 06/28/2024] Open
Abstract
OBJECTIVE Patients with borderline personality disorder (BPD) report to be especially prone to social emotions like shame and guilt. At the same time, these emotions seem to play an important role in BPD pathology. The present study aimed to deepen the knowledge about the processes behind shame and guilt in patients with BPD. METHODS Twenty patients with BPD and twenty healthy controls (HCs) took part in an experiment that induced shame and guilt by imagining scenarios during scanning using functional brain imaging. Participants also filled out self-report questionnaires and took part in diagnostic interviews. RESULTS BPD patients reported more proneness to guilt but not to shame than the HCs. There was no difference in the self-reported intensity rating of experimentally induced emotions between the groups. Between-group contrast of neural signals in the shame condition revealed a stronger activation of cingulate and fusiform gyrus for the BPD patients compared to the controls, and a more pronounced activation in the lingual gyrus and cuneus for the HCs. In the guilt condition, activation in the caudate nucleus, the fusiform gyrus, and the posterior cingulate cortex was stronger in BPD patients, while HC showed stronger activations in cuneus, lingual gyrus, and fronto-temporal regions. CONCLUSIONS Differences in the neuro-functional processes between BPD patients and HC were found, even though the two groups did not differ in their self-report of subjective proneness to guilt and emotional intensity of shame and guilt during the experiment. While the HCs may be engaged more by the emotional scenarios themselves, the BPD patients may be more occupied with cognitive regulatory and self-referential processing.
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Affiliation(s)
- Hella Parpart
- Department of Psychiatry and Psychotherapy, LMU Hospital, 80336 Munich, Germany
| | - Jakob Blass
- Department of Psychiatry and Psychotherapy, Universitätsklinikum OWL, 33617 Bielefeld, Germany
| | - Thomas Meindl
- Institute of Clinical Radiology, LMU Hospital, 80336 Munich, Germany
| | - Janusch Blautzik
- Institute of Clinical Radiology, LMU Hospital, 80336 Munich, Germany
| | - Petra Michl
- Department of Psychiatry and Psychotherapy, LMU Hospital, 80336 Munich, Germany
| | - Thomas Beblo
- Department of Psychiatry and Psychotherapy, Universitätsklinikum OWL, 33617 Bielefeld, Germany
| | - Rolf Engel
- Department of Psychiatry and Psychotherapy, LMU Hospital, 80336 Munich, Germany
| | - Maximilian Reiser
- Institute of Clinical Radiology, LMU Hospital, 80336 Munich, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, LMU Hospital, 80336 Munich, Germany
| | | | - Martin Driessen
- Department of Psychiatry and Psychotherapy, Universitätsklinikum OWL, 33617 Bielefeld, Germany
| | - Kristina Hennig-Fast
- Department of Psychiatry and Psychotherapy, LMU Hospital, 80336 Munich, Germany
- Department of Psychiatry and Psychotherapy, Universitätsklinikum OWL, 33617 Bielefeld, Germany
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16
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Chen W, Yuan T, Pan Y, Ma Y, Sun B, Yu M, Lin X, He H, Zhang J. Borderline personality traits mediate the relationship between negative life events and nonsuicidal self-injury in a clinical sample with youth depression. BMC Psychiatry 2024; 24:370. [PMID: 38755597 PMCID: PMC11100148 DOI: 10.1186/s12888-024-05821-0] [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: 01/05/2024] [Accepted: 05/07/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Borderline personality traits play a significant role in nonsuicidal self-injury (NSSI), particularly in depressed youths. NSSI is also highly correlated with negative life events. This research aimed to explore the connections between negative life events, borderline personality traits, and NSSI. METHODS The study included 338 depressed youth aged 13 to 25 years. Self-reported measures and clinical interviews were utilized to evaluate the depressive symptoms, borderline personality traits, negative life events, and NSSI behaviours of these participants. Identifying variables linked to NSSI was the aim of our analysis, and we also conducted a mediation analysis to look into the influence of borderline traits on the connection between negative life events and NSSI. RESULTS Of the 338 depressed youth, approximately 59.47% (201/338) displayed NSSI, which was associated with greater clinical severity. Borderline traits had an independent influence on NSSI and it partially explained the connection between negative life events and NSSI, even when accounting for depression symptoms. Depressed youth who were more vulnerable to NSSI behaviours often experienced negative life events such as interpersonal relationships, academic pressure, being punished, and loss. CONCLUSIONS Our research suggests that depressed youth who experience more negative life events are more likely to experience NSSI, and negative life events indirectly influence nonsuicidal self-injury through borderline personality traits. Implementing interventions focused on mitigating borderline symptoms could be a promising therapeutic approach for addressing NSSI in young people.
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Affiliation(s)
- Wangni Chen
- Department of Psychosomatic Medicine, The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, Liwan District, Guangzhou, Guangdong, 510370, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
- Guangzhou Medical University, Guangzhou, 510000, China
| | - Ting Yuan
- Department of Psychosomatic Medicine, The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, Liwan District, Guangzhou, Guangdong, 510370, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
- Guangzhou Medical University, Guangzhou, 510000, China
| | - Yuwen Pan
- Department of Psychosomatic Medicine, The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, Liwan District, Guangzhou, Guangdong, 510370, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
- Guangzhou Medical University, Guangzhou, 510000, China
| | - Yarong Ma
- Department of Psychosomatic Medicine, The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, Liwan District, Guangzhou, Guangdong, 510370, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Bin Sun
- Department of Psychosomatic Medicine, The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, Liwan District, Guangzhou, Guangdong, 510370, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Min Yu
- Department of Psychosomatic Medicine, The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, Liwan District, Guangzhou, Guangdong, 510370, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Xiaoming Lin
- Department of Psychosomatic Medicine, The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, Liwan District, Guangzhou, Guangdong, 510370, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Hongbo He
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, 519041, China.
| | - Jie Zhang
- Department of Psychosomatic Medicine, The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, Liwan District, Guangzhou, Guangdong, 510370, China.
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China.
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Deiber MP, Piguet C, Berchio C, Michel CM, Perroud N, Ros T. Resting-State EEG Microstates and Power Spectrum in Borderline Personality Disorder: A High-Density EEG Study. Brain Topogr 2024; 37:397-409. [PMID: 37776472 PMCID: PMC11026215 DOI: 10.1007/s10548-023-01005-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 08/30/2023] [Indexed: 10/02/2023]
Abstract
Borderline personality disorder (BPD) is a debilitating psychiatric condition characterized by emotional dysregulation, unstable sense of self, and impulsive, potentially self-harming behavior. In order to provide new neurophysiological insights on BPD, we complemented resting-state EEG frequency spectrum analysis with EEG microstates (MS) analysis to capture the spatiotemporal dynamics of large-scale neural networks. High-density EEG was recorded at rest in 16 BPD patients and 16 age-matched neurotypical controls. The relative power spectrum and broadband MS spatiotemporal parameters were compared between groups and their inter-correlations were examined. Compared to controls, BPD patients showed similar global spectral power, but exploratory univariate analyses on single channels indicated reduced relative alpha power and enhanced relative delta power at parietal electrodes. In terms of EEG MS, BPD patients displayed similar MS topographies as controls, indicating comparable neural generators. However, the MS temporal dynamics were significantly altered in BPD patients, who demonstrated opposite prevalence of MS C (lower than controls) and MS E (higher than controls). Interestingly, MS C prevalence correlated positively with global alpha power and negatively with global delta power, while MS E did not correlate with any measures of spectral power. Taken together, these observations suggest that BPD patients exhibit a state of cortical hyperactivation, represented by decreased posterior alpha power, together with an elevated presence of MS E, consistent with symptoms of elevated arousal and/or vigilance. This is the first study to investigate resting-state MS patterns in BPD, with findings of elevated MS E and the suggestion of reduced posterior alpha power indicating a disorder-specific neurophysiological signature previously unreported in a psychiatric population.
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Affiliation(s)
- Marie-Pierre Deiber
- Department of Psychiatry, University Hospitals of Geneva, Chemin du Petit-Bel-Air 2, 1226 Thônex, Geneva, Switzerland.
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Camille Piguet
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Pediatrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Cristina Berchio
- Department of Pediatrics, University of Geneva, Geneva, Switzerland
| | - Christoph M Michel
- Functional Brain Mapping Laboratory, Department of Fundamental Neuroscience, University of Geneva, Geneva, Switzerland
- Center for Biomedical Imaging, CIBM, Lausanne, Switzerland
| | - Nader Perroud
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Psychiatric Specialties, Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Tomas Ros
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Center for Biomedical Imaging, CIBM, Lausanne, Switzerland
- Department of Neuroscience, University of Geneva, Geneva, Switzerland
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Malas O, Gómez-Domenech A. Effect of Dialectical Behavior Therapy on Negative Affect, and Symptoms of Depression and Anxiety in Individuals with Borderline Personality Disorder during COVID-19 Pandemic. J Clin Med 2024; 13:2603. [PMID: 38731131 PMCID: PMC11084774 DOI: 10.3390/jcm13092603] [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: 03/24/2024] [Revised: 04/24/2024] [Accepted: 04/27/2024] [Indexed: 05/13/2024] Open
Abstract
Background: This study investigated the effectiveness of dialectical behavior therapy (DBT) in patients with borderline personality disorder (BPD) during the COVID-19 pandemic, assessing negative affect, depression, and anxiety levels as indicators of health. Methods: A total of 287 participants were recruited, including BPD patients at different stages of treatment and the general population without a diagnosis of BPD. Questionnaires were used to assess the fear of COVID-19 and the referenced health indicators. Results: No differences were observed between groups in levels of fear of COVID-19, but there were differences in the health indicators studied. BPD patients in long-term treatment showed levels of negative affect similar to those of the general population, while those in early treatment stages exhibited significantly higher levels. However, no significant improvements were observed in levels of depression and anxiety in the long-term treatment group compared to those who underwent the initial treatment phase. Conclusions: These findings underscore the importance of effectively intervening in BPD, especially in stress-inducing situations such as the pandemic, and suggest the need to explore complementary approaches to addressing depression and anxiety in this clinical context.
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Affiliation(s)
- Olga Malas
- Department of Psychology, Sociology and Social Work, University of Lleida, 25001 Lleida, Spain
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Baryshnikov I, Rosenström T, Isometsä E. Predicting a short-term change of suicidal ideation in inpatients with depression: An ecological momentary assessment. J Affect Disord 2024; 350:1-6. [PMID: 38232774 DOI: 10.1016/j.jad.2023.12.091] [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: 07/04/2023] [Revised: 11/30/2023] [Accepted: 12/31/2023] [Indexed: 01/19/2024]
Abstract
INTRODUCTION Patients with depression often require inpatient treatment due to their high suicide risk. Ecological momentary assessment (EMA) studies have shown that suicidal ideation (SI) fluctuates over time. As affective instability and psychological pain (PP) are common experiences in borderline personality disorder (BPD), often comorbid with depression, we examined factors predicting short-term changes of SI in depressive inpatients with or without BPD. METHODS Psychiatric inpatients with depression with (N = 30) or without (N = 37) comorbid BPD assessed their anxiety, PP, severity of depression, SI, and hopelessness three times daily using visual analogue scales. Multilevel regression models were estimated. RESULTS Altogether 4320 EMA observations, spanning on average 3.4 successive days, were collected. Only severity of depression (β = 0.19; [95 % CI = 0.06, 0.32]) and previous SI (β = 0.32; [95 % CI = 0.23, 0.41]) predicted near-future SI within several hours. PP predicted near-future SI in inpatients with depression and BPD (β = 0.28; [95 % CI = 0.11, 0.46]), but not in patients without BPD. LIMITATIONS The follow-up data represents only the first days of hospitalization. The context of the EMA is the acute psychiatric ward, affecting generalizability to outpatients. CONCLUSIONS Short-terms changes in SI are predicted by changes in severity of depression and previous SI in depressed inpatients without BPD, and also by changes in PP in depressed inpatients with BPD. As SI and its risk factors may oscillate within a time scale of hours, frequent monitoring of momentary severity of depression, PP, and SI may be warranted in inpatient settings.
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Affiliation(s)
- Ilya Baryshnikov
- Department of Psychiatry, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
| | - Tom Rosenström
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland.
| | - Erkki Isometsä
- Department of Psychiatry, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
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Lisoni J, Nibbio G, Baldacci G, Cicale A, Zucchetti A, Bertoni L, Calzavara Pinton I, Necchini N, Deste G, Barlati S, Vita A. What impact can brain stimulation interventions have on borderline personality disorder? Expert Rev Neurother 2024; 24:343-360. [PMID: 38349069 DOI: 10.1080/14737175.2024.2316133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 02/05/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION Borderline personality disorder (BPD) is a severe mental disorder characterized by emotion dysregulation, impulsivity, neuropsychological impairment, and interpersonal instability, presenting with multiple psychiatric comorbidities, functional disability and reduced life expectancy due suicidal behaviors. AREAS COVERED In this perspective, the authors explore the application of noninvasive brain stimulation (NIBS) (rTMS, tDCS, and MST) in BPD individuals by considering a symptom-based approach, focusing on general BPD psychopathology, impulsivity and neuropsychological impairments, suicidality and depressive/anxious symptoms, and emotion dysregulation. EXPERT OPINION According to a symptoms-based approach, NIBS interventions (particularly rTMS and tDCS) are promising treatment options for BPD individuals improving core symptoms such as emotional and behavioral dysregulation, neuropsychological impairments and depressive symptoms. However, the heterogeneity of stimulation protocols and of assessment tools used to detect these changes limits the possibility to provide definitive recommendations according to a symptom-based approach. To implement such armamentarium in clinical practice, future NIIBS studies should further consider a lifespan perspective due to clinical variability over time, the role of psychiatric comorbidities affecting BPD individuals and the need to combine NIBS with specialized psychotherapeutic approaches for BPD patients and with functional neuroimaging studies.
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Affiliation(s)
- Jacopo Lisoni
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Gabriele Nibbio
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Giulia Baldacci
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Andrea Cicale
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Andrea Zucchetti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Lorenzo Bertoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Nicola Necchini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Giacomo Deste
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Stefano Barlati
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Antonio Vita
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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Cavelti M, Seiffert N, Lerch S, Koenig J, Reichl C, Kaess M. Differential outcomes of outpatient only versus combined inpatient/outpatient treatment in early intervention for adolescent borderline personality disorder. Eur Child Adolesc Psychiatry 2024; 33:1005-1016. [PMID: 37166520 PMCID: PMC11032290 DOI: 10.1007/s00787-023-02222-8] [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: 08/22/2022] [Accepted: 05/02/2023] [Indexed: 05/12/2023]
Abstract
Clinical guidelines for adults with borderline personality disorder (BPD) recommend outpatient psychotherapy as first-line treatment. Little is known whether this recommendation is also applicable to adolescents. The current study examined the relationship between treatment setting and the outcome of early intervention for adolescents with BPD pathology. One-hundred and seventy-eight adolescents from a specialized outpatient clinic were assessed at baseline, and at 1- and 2-year follow-up. Sixty-three participants who received inpatient treatment during the first year were assigned to the "combined inpatient/outpatient group", 115 participants to the "outpatient only group". Generalized linear and mixed models with inverted probability weights to adjust for baseline differences were applied to examine the impact of group on clinical changes over time. Both groups demonstrated a significant decrease in BPD features, depressive symptoms, psychopathological distress, non-suicidal self-injury (NSSI), suicidal thoughts, suicide attempts, and overall illness severity, and a significant increase in quality of life and psychosocial functioning from baseline to follow-up 2. The decrease in NSSI and overall illness severity, and the increase in psychosocial functioning from baseline to follow-up 1 were greater in the outpatient only group, with comparable improvements between groups from follow-up 1 to follow-up 2. Both outpatient treatment and combined outpatient/inpatient treatment resulted in clinical improvements over time, with some indication for faster changes in the outpatient only setting. The findings provide preliminary evidence that the recommendation of outpatient psychotherapy as the first-line treatment for BPD also holds true for adolescents.
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Affiliation(s)
- Marialuisa Cavelti
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000, Bern 60, Switzerland
| | - Nora Seiffert
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000, Bern 60, Switzerland
| | - Stefan Lerch
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000, Bern 60, Switzerland
| | - Julian Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000, Bern 60, Switzerland
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Corinna Reichl
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000, Bern 60, Switzerland
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000, Bern 60, Switzerland.
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
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22
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Morales-Alonso A, Iglesias-de-la-Iglesia Á, Alonso-Maza M. A nursing intervention based on the Zentangle® method: Experiences of patients diagnosed with borderline personality disorder. Int J Nurs Sci 2024; 11:205-213. [PMID: 38707684 PMCID: PMC11064625 DOI: 10.1016/j.ijnss.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/29/2024] [Accepted: 03/06/2024] [Indexed: 05/07/2024] Open
Abstract
Objective The application of the Zentangle® Method in relation to relaxation and well-being has not been tested in patients with borderline personality disorder (BPD). This study was to analyze the practising Zentangle® experience in patients with BPD. Methods With a phenomenological interpretative approach, this qualitative study conducted semi-structured interviews with patients who participated in a 6-session Zentangle® program accomplished monthly over six months in a Personality Disorders Unit. A total of 15 patients were interviewed for this study. Smith, Flowers & Larkin method was applied for evaluation in the data analysis. Results Based on our findings, three categories were extracted: As you sow, so shall you reap (participants reported improvements in concentration, relaxation, interpersonal relationships, and interaction with their environment as well as positive experiences toward acceptance and change); Many hands make light work (patients admitted feeling better in a group and developed group membership. They described how a group environment influences individual behavior); Drawing your own path (this method provides a medium for self-expression and self-knowledge through drawing, improving well-being through emotional expression, enhancing creativity, and increasing self-confidence). Conclusions By practicing Zentangle®, patients achieve behavioral responses such as flexibility and adaptability, reaching greater emotional well-being through anxiety management, impulse control, learning to cope with problems, or improving self-esteem or concentration. Mental health nursing plays a critical active role in the comprehensive treatment of BPD, as well as the mobilization and coordination of complementary and diverse interventions.
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Affiliation(s)
- Ana Morales-Alonso
- Dr. Rodríguez Lafora Hospital (Hospital Dr. Rodríguez Lafora), Madrid, Spain
| | | | - Miriam Alonso-Maza
- Dr. Rodríguez Lafora Hospital (Hospital Dr. Rodríguez Lafora), Madrid, Spain
- Department of Nursing and Stomatology, University Rey Juan Carlos, Alcorcón, Madrid, Spain
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23
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Kandeger A, Uygur OF, Ataslar EY, Cınar F, Selvi Y. A pilot study examining hemomania behaviors in psychiatry outpatients engaged with nonsuicidal self-injury. Brain Behav 2024; 14:e3475. [PMID: 38594228 PMCID: PMC11004038 DOI: 10.1002/brb3.3475] [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: 11/02/2023] [Revised: 03/05/2024] [Accepted: 03/20/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND This study aims to conduct the first-ever evaluation of our previously proposed behaviors of "hemomania" in individuals engaged with nonsuicidal self-injury (NSSI). METHODS The study encompassed 130 outpatients engaged with NSSI who applied at the psychiatry outpatient clinic. NSSI behaviors were assessed using the Inventory of Statements About Self-Injury, while psychiatric diagnoses were evaluated using the Structured Clinical Interview for DSM-5 Disorders-Clinician Version. Subsequently, participants completed the Depression Anxiety Stress Scale-21 and Short Form of Barratt Impulsiveness Scale. RESULTS The prevalence of at least one hemomania behavior including seeing blood, tasting blood, bloodletting, and blood-drinking was observed to be 43.1% in individuals with NSSI. When participants were divided into two groups, individuals with hemomania exhibited: (1) a higher incidence of psychiatric comorbidities, increased suicide attempts, and more severe symptoms of depression, anxiety, stress, and impulsivity, (2) higher comorbidity rates of borderline personality disorder, body-focused repetitive behaviors, and dissociative disorders, and (3) elevated frequencies of certain NSSI behaviors, including cutting, biting, needle-ticking, and carving, compared to those without. CONCLUSION Hemomania could be considered a specific impulse control disorder, characterized by heightened impulsivity and a persistent urge to obtain one's own blood. However, further studies are needed to validate this hypothesis.
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Affiliation(s)
- Ali Kandeger
- Department of PsychiatrySelçuk UniversityKonyaTürkiye
| | | | | | - Furkan Cınar
- Department of PsychiatrySelçuk UniversityKonyaTürkiye
| | - Yavuz Selvi
- Department of PsychiatrySelçuk UniversityKonyaTürkiye
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24
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Bud S, Szentágotai-Tătar A. Assessing Measurement Consistency: A Study of the BPFSC Invariance Across Age and Sex in Romanian Adolescents. Psychol Rep 2024:332941241239592. [PMID: 38508200 DOI: 10.1177/00332941241239592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
The Borderline Personality Feature Scale for Children (BPFSC) is a widely used instrument and currently the only dimensional measure to investigate Borderline Personality features in children and adolescents. The present study aimed to investigate the factor structure and measurement invariance across age and sex in a community sample of 634 adolescents (mean age = 16.72, standard deviation = 1.31). To test for measurement invariance, we conducted multi-group confirmatory factor analysis (MG-CFA). Analysis showed residual invariance across age and sex. Based on the results, we conclude that BPFSC is a valid and reliable instrument to assess Borderline Personality features in adolescents. Implications for evidence-based assessment of Borderline Personality features in adolescence are discussed.
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Affiliation(s)
- Samuel Bud
- Evidence-Based Assessment and Psychological Interventions Doctoral School, Babeş-Bolyai University, Cluj-Napoca, Romania
- International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania
| | - Aurora Szentágotai-Tătar
- International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania
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25
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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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Blay M, Duarte M, Dessouli MA, Durpoix A, Rüfenacht E, Weibel S, Speranza M, Perroud N. Proposition of a transdiagnostic processual approach of emotion dysregulation based on core triggers and interpersonal styles. Front Psychiatry 2024; 15:1260138. [PMID: 38384590 PMCID: PMC10879599 DOI: 10.3389/fpsyt.2024.1260138] [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: 07/17/2023] [Accepted: 01/19/2024] [Indexed: 02/23/2024] Open
Abstract
Emotion dysregulation (ED) has primarily been described in patients suffering from borderline personality disorder (BPD) and is an integral part of this diagnosis, but it is also a transdiagnostic construct that can be found in several other psychiatric disorders. The strong relationships between ED and BPD may lead clinicians to underestimate ED associated to other clinical contexts. This can lead to difficulties in diagnostic and treatment orientation, especially in the context of comorbidities. In this article, after reviewing the literature on the development and functioning of emotion dysregulation, and on the evidence for emotion dysregulation in eight disorders (borderline personality disorder, pathological narcissism with/without narcissistic personality disorder, obsessive-compulsive personality disorder, antisocial personality disorder, bipolar disorder, autism spectrum disorder, complex post-traumatic stress disorder, and adult attention deficit hyperactivity disorder), we present a transdiagnostic processual model of emotion dysregulation based on core triggers and interpersonal styles to try to address this issue and to provide a simple but technical tool to help clinicians in their diagnostic assessment and treatment orientation. By focusing more on typical patterns and interpersonal dynamics than only on categories, we believe that this model may contribute to the actual need for improvement of our current psychiatric classifications, alongside other well-studied and under-used dimensional models of psychopathology (e.g., HiTOP, AMPD), and may be useful to build more specific treatment frameworks for patients suffering from ED.
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Affiliation(s)
- Martin Blay
- ADDIPSY, Addictology and Psychiatry Outpatient Center, Santé Basque Développement Group, Lyon, France
- Centre de recherche en Epidemiologie et Sante des Populations Team ‘DevPsy’, INSERM, Universite Paris-Saclay, UVSQ, Villejuif, France
| | - Miguel Duarte
- Psychiatric Specialties Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - Marie-Alix Dessouli
- Department of Emergency Psychiatry, University Hospital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Amaury Durpoix
- Department of Psychiatry, University Hospitals of Strasbourg, Strasbourg, France
| | - Eva Rüfenacht
- Psychiatric Specialties Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - Sébastien Weibel
- Department of Psychiatry, University Hospitals of Strasbourg, Strasbourg, France
- U1114, INSERM, Strasbourg, France
| | - Mario Speranza
- Centre de recherche en Epidemiologie et Sante des Populations Team ‘DevPsy’, INSERM, Universite Paris-Saclay, UVSQ, Villejuif, France
- University Department of Child and Adolescent Psychiatry, Versailles Hospital Center, Le Chesnay-Rocquencourt, France
| | - Nader Perroud
- Psychiatric Specialties Unit, University Hospitals of Geneva, Geneva, Switzerland
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Leichsenring F, Fonagy P, Heim N, Kernberg OF, Leweke F, Luyten P, Salzer S, Spitzer C, Steinert C. Borderline personality disorder: a comprehensive review of diagnosis and clinical presentation, etiology, treatment, and current controversies. World Psychiatry 2024; 23:4-25. [PMID: 38214629 PMCID: PMC10786009 DOI: 10.1002/wps.21156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Abstract
Borderline personality disorder (BPD) was introduced in the DSM-III in 1980. From the DSM-III to the DSM-5, no major changes have occurred in its defining criteria. The disorder is characterized by instability of self-image, interpersonal relationships and affects. Further symptoms include impulsivity, intense anger, feelings of emptiness, strong abandonment fears, suicidal or self-mutilation behavior, and transient stress-related paranoid ideation or severe dissociative symptoms. There is evidence that BPD can be reliably diagnosed and differentiated from other mental disorders by semi-structured interviews. The disorder is associated with considerable functional impairment, intensive treatment utilization, and high societal costs. The risk of self-mutilation and suicide is high. In the general adult population, the lifetime prevalence of BPD has been reported to be from 0.7 to 2.7%, while its prevalence is about 12% in outpatient and 22% in inpatient psychiatric services. BPD is significantly associated with other mental disorders, including depressive disorders, substance use disorders, post-traumatic stress disorder, attention-deficit/hyperactivity disorder, bipolar disorder, bulimia nervosa, and other personality disorders. There is convincing evidence to suggest that the interaction between genetic factors and adverse childhood experiences plays a central role in the etiology of BPD. In spite of considerable research, the neurobiological underpinnings of the disorder remain to be clarified. Psychotherapy is the treatment of choice for BPD. Various approaches have been empirically supported in randomized controlled trials, including dialectical behavior therapy, mentalization-based therapy, transference-focused therapy, and schema therapy. No approach has proved to be superior to others. Compared to treatment as usual, psychotherapy has proved to be more efficacious, with effect sizes between 0.50 and 0.65 with regard to core BPD symptom severity. However, almost half of the patients do not respond sufficiently to psychotherapy, and further research in this area is warranted. It is not clear whether some patients may benefit more from one psychotherapeutic approach than from others. No evidence is available consistently showing that any psychoactive medication is efficacious for the core features of BPD. For discrete and severe comorbid anxiety or depressive symptoms or psychotic-like features, pharmacotherapy may be useful. Early diagnosis and treatment of BPD can reduce individual suffering and societal costs. However, more high-quality studies are required, in both adolescents and adults. This review provides a comprehensive update of the BPD diagnosis and clinical characterization, risk factors, neurobiology, cognition, and management. It also discusses the current controversies concerning the disorder, and highlights the areas in which further research is needed.
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Affiliation(s)
- Falk Leichsenring
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
- Department of Psychosomatics and Psychotherapy, University of Rostock, Rostock, Germany
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Nikolas Heim
- International Psychoanalytic University, Berlin, Germany
| | - Otto F Kernberg
- Personality Disorders Institute, Weill Cornell Medical College, New York, NY, USA
| | - Frank Leweke
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
| | - Patrick Luyten
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | - Simone Salzer
- International Psychoanalytic University, Berlin, Germany
| | - Carsten Spitzer
- Department of Psychosomatics and Psychotherapy, University of Rostock, Rostock, Germany
| | - Christiane Steinert
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
- International Psychoanalytic University, Berlin, Germany
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Sosic-Vasic Z, Schaitz C, Mayer B, Maier A, Connemann B, Kroener J. Treating emotion dysregulation in patients with borderline personality disorder using imagery rescripting: A two-session randomized controlled trial. Behav Res Ther 2024; 173:104454. [PMID: 38194759 DOI: 10.1016/j.brat.2023.104454] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/15/2023] [Accepted: 12/04/2023] [Indexed: 01/11/2024]
Abstract
Studies on Emotionally Dysregulated Behavior (EDB) demonstrated that the conduct thereof is associated with emotion dysregulation and preceded by mental imagery of EDB, which can direct future behavior. These findings are specifically important within the context of Borderline Personality Disorder (BPD), where emotion dysregulation and EDB are at the core of the disorder. The present study aims to evaluate the efficacy of imagery rescripting (IR) in treating emotion dysregulation associated with EDB in patients diagnosed with BPD. Forty-eight females diagnosed with BPD were randomly allocated to the IR intervention or treatment-as-usual group. Assessment took place one week before the first treatment session, as well as one week, and twelve weeks after the last treatment session evaluating emotion regulation strategies, borderline-symptomatology, EDB, depressiveness, impulsivity, mental imagery, and illness severity. Within-, and between subject, intention-to-treat-, and per-protocol analysis were conducted. Results showed decreased maladaptive emotion regulation strategies and increased adaptive emotion regulation strategies within the intervention group. Borderline-symptomatology improved immediately after treatment for the intervention group. Additionally, BPD patients within the intervention group improved regarding their impulsivity, depressiveness, and EDB symptomatology in comparison to patients in the TAU group. The presented intervention has proven to be effective in improving BPD-related symptomatology, such as emotion regulation, EDB, depressiveness, and impulsivity. Imagery rescripting could be routinely applied when EDB related images are present. TRIAL REGISTRATION: German Clinical Trials Registry (DRKS) ID: DRKS00010620.
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Affiliation(s)
- Zrinka Sosic-Vasic
- Christophsbad Goeppingen, Department of Applied Psychotherapy and Psychiatry, Faurndauer Straße 6-28, 73035, Göppingen, Germany; Medical Department, University of Ulm, Albert-Einstein-Allee 11, 89081, Ulm, Germany
| | - Caroline Schaitz
- MSB Medical School Berlin, Psychotherapeutic Outpatient Facility, Rüdesheimer Straße 50, 14197, Berlin, Germany
| | - Benjamin Mayer
- Institute of Epidemiology and Medical Biometry, Ulm University, Schwabstrasse 13, 89075, Ulm, Germany
| | - Anna Maier
- Medical Department, University of Ulm, Albert-Einstein-Allee 11, 89081, Ulm, Germany
| | - Bernhard Connemann
- Medical Department, University of Ulm, Albert-Einstein-Allee 11, 89081, Ulm, Germany
| | - Julia Kroener
- Christophsbad Goeppingen, Department of Applied Psychotherapy and Psychiatry, Faurndauer Straße 6-28, 73035, Göppingen, Germany; Medical Department, University of Ulm, Albert-Einstein-Allee 11, 89081, Ulm, Germany.
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Kulakova E, Graumann L, Cho AB, Deuter CE, Wolf OT, Roepke S, Otte C, Wingenfeld K. Evidence of deviant parasympathetic response to social exclusion in women with borderline personality disorder. Eur Arch Psychiatry Clin Neurosci 2024; 274:129-138. [PMID: 37650962 PMCID: PMC10786993 DOI: 10.1007/s00406-023-01678-8] [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: 02/13/2023] [Accepted: 08/08/2023] [Indexed: 09/01/2023]
Abstract
Stressful social situations like social exclusion are particularly challenging for patients with borderline personality disorder (BPD) and often lead to dysfunctional reactive behaviour of aggression and withdrawal. The autonomous signature of these core symptoms of BPD remains poorly understood. The present study investigated the parasympathetic response to social exclusion in women with BPD (n = 62) and healthy controls (HC; n = 87). In a between-subjects design, participants experienced objective social exclusion or overinclusion in the Cyberball task, a virtual ball-tossing game. Need threat scores served as individual measures of perceived exclusion and the resulting frustration of cognitive-emotional needs. Five-minute measurements of high-frequency heart rate variability (HF-HRV) at three time points (before, during, after Cyberball) indicated parasympathetic tone and regulation. We observed a trend towards lowered baseline HF-HRV in BPD vs. HC in line with previous findings. Interestingly, the parasympathetic response of patients with BPD to objective and perceived social exclusion fundamentally differed from HC: higher exclusion was associated with increased parasympathetic activation in HC, while this autonomic response was reversed and blunted in BPD. Our findings suggest that during social stress, the parasympathetic nervous system fails to display an adaptive regulation in patients with BPD, but not HC. Understanding the autonomous signature of the stress response in BPD allows the formulation of clinically relevant and biologically plausible interventions to counteract parasympathetic dysregulation in this clinical group.
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Affiliation(s)
- Eugenia Kulakova
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.
| | - Livia Graumann
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - An Bin Cho
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Christian Eric Deuter
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Oliver T Wolf
- Department of Cognitive Psychology, Institute of Cognitive Neuroscience, Ruhr University, Bochum, Germany
| | - Stefan Roepke
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Christian Otte
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Katja Wingenfeld
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
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30
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Schneider I, Herpertz SC, Ueltzhöffer K, Neukel C. Stress and reward in the maternal brain of mothers with borderline personality disorder: a script-based fMRI study. Eur Arch Psychiatry Clin Neurosci 2024; 274:117-127. [PMID: 37354380 PMCID: PMC10786970 DOI: 10.1007/s00406-023-01634-6] [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: 09/23/2022] [Accepted: 05/29/2023] [Indexed: 06/26/2023]
Abstract
Borderline personality disorder (BPD) is associated with altered neural activity in regions of salience and emotion regulation. An exaggerated sensitization to emotionally salient situations, increased experience of emotions, and dysfunctional regulative abilities could be reasons for increased distress also during parenting. Mothers with BPD tend to have less reciprocal mother-child interactions (MCI) and reveal altered cortisol and oxytocin reactivity in the interaction with their child, which could indicate altered processing of stress and reward. Here, we studied underlying neural mechanisms of disrupted MCI in BPD. Twenty-five mothers with BPD and 28 healthy mothers participated in a script-driven imagery functional magnetic resonance imaging (fMRI)-paradigm. Scripts described stressful or rewarding MCI with the own child, or situations in which the mother was alone. Mothers with BPD showed larger activities in the bilateral insula and anterior cingulate cortex (ACC) compared to healthy mothers during the imagination of MCI and non-MCI. Already in the precursory phase while listening to the scripts, a similar pattern emerged with stronger activity in the left anterior insula (AINS), but not in the ACC. This AINS activity correlated negatively with the quality of real-life MCI for mothers with BPD. Mothers with BPD reported lower affect and higher arousal. An exaggerated sensitization to different, emotionally salient situations together with dysfunctional emotion regulation abilities, as reflected by increased insula and ACC activity, might hinder sensitive maternal behavior in mothers with BPD. These results underline the importance for psychotherapeutic interventions to improve emotional hyperarousal and emotion regulation in patients with BPD, especially in affected mothers caring for young children.
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Affiliation(s)
- Isabella Schneider
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Voßstr. 4, 69115, Heidelberg, Germany.
| | - Sabine C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Voßstr. 4, 69115, Heidelberg, Germany
| | - Kai Ueltzhöffer
- European Molecular Biology Laboratory, Genome Biology Unit, Meyerhofstr. 1, 69117, Heidelberg, Germany
| | - Corinne Neukel
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Voßstr. 4, 69115, Heidelberg, Germany
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Manavalan M, Song X, Nolte T, Fonagy P, Montague PR, Vilares I. Bayesian Decision-Making Under Uncertainty in Borderline Personality Disorder. J Pers Disord 2024; 38:53-74. [PMID: 38324252 DOI: 10.1521/pedi.2024.38.1.53] [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] [Indexed: 02/08/2024]
Abstract
Bayesian decision theory suggests that optimal decision-making should use and weigh prior beliefs with current information, according to their relative uncertainties. However, some characteristics of borderline personality disorder (BPD) patients, such as fast, drastic changes in the overall perception of themselves and others, suggest they may be underrelying on priors. Here, we investigated if BPD patients have a general deficit in relying on or combining prior with current information. We analyzed this by having BPD patients (n = 23) and healthy controls (n = 18) perform a coin-catching sensorimotor task with varying levels of prior and current information uncertainty. Our results indicate that BPD patients learned and used prior information and combined it with current information in a qualitatively Bayesian-like way. Our results show that, at least in a lower-level, nonsocial sensorimotor task, BPD patients can appropriately use both prior and current information, illustrating that potential deficits using priors may not be widespread or domain-general.
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Affiliation(s)
- Mathi Manavalan
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota
| | - Xin Song
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota
| | - Tobias Nolte
- Wellcome Centre for Human Neuroimaging, University College London, London, U.K
- Anna Freud National Centre for Children and Families, London, U.K
| | - Peter Fonagy
- Wellcome Centre for Human Neuroimaging, University College London, London, U.K
- Anna Freud National Centre for Children and Families, London, U.K
| | - P Read Montague
- Wellcome Centre for Human Neuroimaging, University College London, London, U.K
- Fralin Biomedical Research Institute at VTC, Virginia Polytechnic Institute and State University, Roanoke, Virginia
- Department of Physics, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | - Iris Vilares
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota
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Kujovic M, Benz D, Riesbeck M, Bahr C, Kriegs C, Reinermann D, Jänner M, Neufang S, Margittai Z, Kamp D, Plewnia C, Meisenzahl E. Theta burst stimulation add on to dialectical behavioral therapy in borderline-personality-disorder: methods and design of a randomized, single-blind, placebo-controlled pilot trial. Eur Arch Psychiatry Clin Neurosci 2024; 274:87-96. [PMID: 37710135 PMCID: PMC10787000 DOI: 10.1007/s00406-023-01692-w] [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: 04/24/2023] [Accepted: 08/26/2023] [Indexed: 09/16/2023]
Abstract
Specialized psychotherapeutic treatments like dialectical behavioral therapy (DBT) are recommended as first treatment for borderline personality disorder (BPD). In recent years, studies have emerged that focus on repetitive transcranial magnetic stimulation (rTMS) in BPD. Both have independently demonstrated efficacy in the treatment of BPD. Intermitted theta burst stimulation (iTBS), a modified design of rTMS, is thought to increase the excitability of neurons and could be a supplement to psychotherapy in addition to being a standalone treatment. However, no studies to date have investigated the combination of DBT and rTMS/iTBS. This study protocol describes the methods and design of a randomized, single-blinded, sham-controlled clinical pilot study in which BPD patients will be randomly assigned to either iTBS or sham during four consecutive weeks (20 sessions in total) in addition to standardized DBT treatment. The stimulation will focus on the unilateral stimulation of the left dorsolateral prefrontal cortex (DLPFC), which plays an important role in the control of impulsivity and risk-taking. Primary outcome is the difference in borderline symptomatology, while secondary target criteria are depressive symptoms, general functional level, impulsivity and self-compassion. Statistical analysis of therapy response will be conducted by Mixed Model Repeated Measurement using a 2 × 2-factorial between-subjects design with the between-subject factor stimulation (TMS vs. Sham) and the within-subject factor time (T0 vs. T1). Furthermore, structural magnetic resonance imaging (MRI) will be conducted and analyzed. The study will provide evidence and insight on whether iTBS has an enhancing effect as add-on to DBT in BPD.Trial registration: drks.de (DRKS00020413) registered 13/01/2020.
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Affiliation(s)
- Milenko Kujovic
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
| | - Daniel Benz
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Mathias Riesbeck
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Christian Bahr
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Christian Kriegs
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Dirk Reinermann
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Michaela Jänner
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Susanne Neufang
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Zsofia Margittai
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Daniel Kamp
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Christian Plewnia
- Department of Psychiatry and Psychotherapy, University Hospital of Psychiatry and Psychotherapy, Tübingen, Germany
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
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Benacek J, Lawal N, Ong T, Tomasik J, Martin-Key NA, Funnell EL, Barton-Owen G, Olmert T, Cowell D, Bahn S. Identification of Predictors of Mood Disorder Misdiagnosis and Subsequent Help-Seeking Behavior in Individuals With Depressive Symptoms: Gradient-Boosted Tree Machine Learning Approach. JMIR Ment Health 2024; 11:e50738. [PMID: 38206660 PMCID: PMC10811571 DOI: 10.2196/50738] [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: 07/11/2023] [Revised: 10/27/2023] [Accepted: 12/01/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Misdiagnosis and delayed help-seeking cause significant burden for individuals with mood disorders such as major depressive disorder and bipolar disorder. Misdiagnosis can lead to inappropriate treatment, while delayed help-seeking can result in more severe symptoms, functional impairment, and poor treatment response. Such challenges are common in individuals with major depressive disorder and bipolar disorder due to the overlap of symptoms with other mental and physical health conditions, as well as, stigma and insufficient understanding of these disorders. OBJECTIVE In this study, we aimed to identify factors that may contribute to mood disorder misdiagnosis and delayed help-seeking. METHODS Participants with current depressive symptoms were recruited online and data were collected using an extensive digital mental health questionnaire, with the World Health Organization World Mental Health Composite International Diagnostic Interview delivered via telephone. A series of predictive gradient-boosted tree algorithms were trained and validated to identify the most important predictors of misdiagnosis and subsequent help-seeking in misdiagnosed individuals. RESULTS The analysis included data from 924 symptomatic individuals for predicting misdiagnosis and from a subset of 379 misdiagnosed participants who provided follow-up information when predicting help-seeking. Models achieved good predictive power, with area under the receiver operating characteristic curve of 0.75 and 0.71 for misdiagnosis and help-seeking, respectively. The most predictive features with respect to misdiagnosis were high severity of depressed mood, instability of self-image, the involvement of a psychiatrist in diagnosing depression, higher age at depression diagnosis, and reckless spending. Regarding help-seeking behavior, the strongest predictors included shorter time elapsed since last speaking to a general practitioner about mental health, sleep problems disrupting daily tasks, taking antidepressant medication, and being diagnosed with depression at younger ages. CONCLUSIONS This study provides a novel, machine learning-based approach to understand the interplay of factors that may contribute to the misdiagnosis and subsequent help-seeking in patients experiencing low mood. The present findings can inform the development of targeted interventions to improve early detection and appropriate treatment of individuals with mood disorders.
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Affiliation(s)
- Jiri Benacek
- Department of Chemical Engineering and Biotechnology, Cambridge Centre for Neuropsychiatric Research, University of Cambridge, Cambridge, United Kingdom
| | - Nimotalai Lawal
- Department of Chemical Engineering and Biotechnology, Cambridge Centre for Neuropsychiatric Research, University of Cambridge, Cambridge, United Kingdom
| | - Tommy Ong
- Department of Chemical Engineering and Biotechnology, Cambridge Centre for Neuropsychiatric Research, University of Cambridge, Cambridge, United Kingdom
| | - Jakub Tomasik
- Department of Chemical Engineering and Biotechnology, Cambridge Centre for Neuropsychiatric Research, University of Cambridge, Cambridge, United Kingdom
| | - Nayra A Martin-Key
- Department of Chemical Engineering and Biotechnology, Cambridge Centre for Neuropsychiatric Research, University of Cambridge, Cambridge, United Kingdom
| | - Erin L Funnell
- Department of Chemical Engineering and Biotechnology, Cambridge Centre for Neuropsychiatric Research, University of Cambridge, Cambridge, United Kingdom
- Psyomics Ltd, Cambridge, United Kingdom
| | | | - Tony Olmert
- Department of Chemical Engineering and Biotechnology, Cambridge Centre for Neuropsychiatric Research, University of Cambridge, Cambridge, United Kingdom
| | | | - Sabine Bahn
- Department of Chemical Engineering and Biotechnology, Cambridge Centre for Neuropsychiatric Research, University of Cambridge, Cambridge, United Kingdom
- Psyomics Ltd, Cambridge, United Kingdom
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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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Chizhova OA, Iuzbashian PG. [Alexithymia and self-harm in people with borderline personality disorder]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:102-108. [PMID: 38261291 DOI: 10.17116/jnevro2024124011102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
OBJECTIVE To estimate the prevalence of alexithymia and self-harm in patients with borderline personality disorder (BPD). To assess the role of alexithymia in the emergence of self-harm in patients with BPD. MATERIAL AND METHODS We studied 104 patients (85 women, 19 men aged 21 to 25 years (64.4%)), including 54 patients with and 50 patients without BPD. Most of them had incomplete higher education (55%). We used the Russian version of the 20-item Toronto Alexithymia Scale (TAS-20) to reveal alexithymia and SCID-II to diagnose BPD. The presence of self-harm behavior was confirmed by the subjects' anamnesis data. RESULTS The prevalence of alexithymia in patients with BPD was 83.3%, in the control group it was 52% (p=0.001). The prevalence of self-aggression was 70.3% (n=38) in patients with BPD, and 12% (n=6) in people without BPD. Self-harm among persons with alexithymia was noted in 62.5% (n=45). During the analysis, a connection between auto-aggression and alexithymia was found at the level of a statistical trend (p=0.051). CONCLUSION Alexithymia and self-harm are more common in patients with BPD than in healthy people. This type of emotional dysregulation mediates self-harm in patients with BPD.
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Affiliation(s)
- O A Chizhova
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - P G Iuzbashian
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Johansson BA, Holmström E, Westling S, Eberhard S, Rask O. Implementation of Brief Admission by Self-Referral in Child and Adolescent Psychiatry in Sweden: Insights from Implementers and Staff. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 21:35. [PMID: 38248500 PMCID: PMC10815113 DOI: 10.3390/ijerph21010035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/14/2023] [Accepted: 12/23/2023] [Indexed: 01/23/2024]
Abstract
Brief admission by self-referral, which allows patients to briefly admit themselves to a psychiatric ward, is a crisis intervention designed to reduce suicide and self-harm. This method was introduced in Sweden for adult patients in 2015, achieving high patient satisfaction and good acceptance among staff. In 2018, the method was adapted and implemented in pediatric psychiatry. The present study comprehensively describes the multifaceted strategies for implementing brief admissions, including planning, education, financing, restructuring, quality management, and policy implementation and reform. It also includes staff's opinions of the practice of brief admissions for young people. Neither of these topics has been addressed in the existing literature. During the study period (April 2018-April 2021), 63 brief admission contracts were established. The number of new contracts increased exponentially (12.7%) per quarter (p < 0.05), and staff satisfaction with both the implementation and its benefits for unstable patients was high. Brief admission by self-referral can be successfully implemented in pediatric psychiatry and appears to be a functional crisis management method for adolescents.
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Affiliation(s)
- Björn Axel Johansson
- Region Skåne, Psychiatry, Habilitation & Aid, Child and Adolescent Psychiatry, Regional Inpatient Care, Emergency Unit, 20502 Malmö, Sweden; (E.H.); (S.E.); (O.R.)
- Department of Clinical Sciences Lund, Division of Child & Adolescent Psychiatry, Lund University, 22100 Lund, Sweden
| | - Eva Holmström
- Region Skåne, Psychiatry, Habilitation & Aid, Child and Adolescent Psychiatry, Regional Inpatient Care, Emergency Unit, 20502 Malmö, Sweden; (E.H.); (S.E.); (O.R.)
| | - Sofie Westling
- Department of Clinical Sciences, Malmö, Psychiatry, Lund University, 22100 Lund, Sweden;
- Office for Psychiatry and Habilitation, Psychiatric Clinic Lund, Region Skåne, 22185 Lund, Sweden
| | - Sophia Eberhard
- Region Skåne, Psychiatry, Habilitation & Aid, Child and Adolescent Psychiatry, Regional Inpatient Care, Emergency Unit, 20502 Malmö, Sweden; (E.H.); (S.E.); (O.R.)
- Department of Clinical Sciences Lund, Division of Child & Adolescent Psychiatry, Lund University, 22100 Lund, Sweden
| | - Olof Rask
- Region Skåne, Psychiatry, Habilitation & Aid, Child and Adolescent Psychiatry, Regional Inpatient Care, Emergency Unit, 20502 Malmö, Sweden; (E.H.); (S.E.); (O.R.)
- Department of Clinical Sciences Lund, Division of Child & Adolescent Psychiatry, Lund University, 22100 Lund, Sweden
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Pithon L, Rexand-Galais F. French version of the Inventory of Personality Organization (IPO-fr): psychometric properties in young adults. CURRENT ISSUES IN PERSONALITY PSYCHOLOGY 2023; 12:91-99. [PMID: 38807697 PMCID: PMC11129049 DOI: 10.5114/cipp/174519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 04/12/2023] [Accepted: 10/25/2023] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND The Inventory of Personality Organization (IPO) is a self-assessment instrument designed to measure the level of personality organization. In the present study, we developed and validated a French version (IPO-fr) of this instrument in a population of young adults. Its validity was established on the basis of two studies examining (1) its internal structure, and (2) its convergent validity with the Personality Diagnostic Questionnaire-4+, the Positive and Negative Affect Schedule (PANAS), the Hospital Anxiety and Depression Scale (HADS), and the Aggression Questionnaire (AQ). PARTICIPANTS AND PROCEDURE In the first study, we assessed the reliability of the internal structure of the French form of the IPO (IPO-fr) in a nonclinical population. Our sample comprised 602 first- and second-year psychology students, with a mean age of 19.40 years (SD = 1.95). The second study assessed the convergent validity of the questionnaire in nonclinical samples, with regard to the three clusters (A, B, and C) of personality disorders, positive and negative affect, and aggression and depressive symptoms. The sample for this second study consisted of 305 first-, second- and third-year psychology students, with a mean age of 19.83 years (SD = 2.12). RESULTS The French version of the IPO is shorter than the English: 40 items instead of 57. Its internal clarity and its discriminative capacity make it easier to interpret. CONCLUSIONS This study has established the relevance of the IPO-fr as a reliable and brief instrument for assessing individual personality. It could make a major contribution to the screening of personality pathology in the French population and to the assessment of treatment programs.
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Hultsjö S, Appelfeldt Å, Wärdig R, Cederqvist J. Don´t set us aside!Experiences of families of people with BPD who have access to Brief admission:a phenomenological perspective. Int J Qual Stud Health Well-being 2023; 18:2152943. [PMID: 36476045 PMCID: PMC9733683 DOI: 10.1080/17482631.2022.2152943] [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: 08/11/2022] [Accepted: 10/22/2022] [Indexed: 12/12/2022] Open
Abstract
AIM To highlight the experiences of family members of people with borderline personality disorder (BPD) and self-harming behaviour who have access to brief admission. METHODS To understand the families lived experience a phenomenological lifeworld perspective was adopted to this study. Twelve in-depht interviews were performed in November and December 2021 with family members of people with BPD and self-harming behaviour who have accessed BA. The phenomenological life-world perspective guided the analysis. RESULTS Families' life-world was characterized by anxiety and constant protection of their loved one. They live with constant fear of how their loved ones are feeling and whether they will injure themselves. When access to BA was available this gave hope and provided conditions for families to maintain everyday routines and also enhanced relationships among family members. When families' loved ones were denied BA, they felt betrayed which contributed to negative feelings towards the medical profession, and the families lost confidence in psychiatry. CONCLUSION By interviewing families of people with BPD and self-harming behaviour who had access to BA, it emerged they possess valuable knowledge. BA can be developed if the needs of families are taken into consideration, and if families are given the opportunity to share emotions and the high burden of responsibility with staff or families in similar situations. If health care staff gives family members a more central role in care and makes their shared life-world visible it could thereby hopefully increase well-being and benefits for the whole family.
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Affiliation(s)
- Sally Hultsjö
- Department of Psychiatry, Ryhov County Hospital. Jönköping, Sweden and Department of Health, Medicine and Caring Sciences. Division of Nursing and Reproductive Health, Linköping University, Linköping, Sweden
| | - Åsa Appelfeldt
- Department of Psychiatry, Ryhov County Hospital. Jönköping, Sweden and Department of Health, Medicine and Caring Sciences. Division of Nursing and Reproductive Health, Linköping University, Linköping, Sweden
| | - Rikard Wärdig
- Department of Health, Medicine and Caring Sciences. Division of Nursing and Reproductive Health, Linköping University, Linköping, Sweden
| | - Jessica Cederqvist
- Department of Psychiatry, Ryhov County Hospital. Jönköping, Sweden and Department of Health, Medicine and Caring Sciences. Division of Nursing and Reproductive Health, Linköping University, Linköping, Sweden
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Kernot J, Baker A, Oster C, Petrakis M, Dawson S. Employment interventions to assist people who experience borderline personality disorder: A scoping review. Int J Soc Psychiatry 2023; 69:1845-1855. [PMID: 37497932 PMCID: PMC10685697 DOI: 10.1177/00207640231189424] [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: 07/28/2023]
Abstract
BACKGROUND Employment is an important social determinant of health and is associated with positive health outcomes. However, individuals who have been diagnosed with borderline personality disorder (BPD) are significantly underrepresented in the workforce. Whilst there is an array of evidence based therapeutic interventions, there remains a gap in knowledge regarding the most effective ways to enhance employment outcomes for people with a diagnosis of BPD. AIM To explore employment interventions for people with BPD, map the available evidence and identify key concepts and knowledge gaps. METHODS A scoping review was conducted to identify and map the relevant literature. Findings were summarised using a narrative approach. Consultation was provided by a reference group including peer support workers with lived experience of BPD and mental health clinicians. RESULTS Seven articles met the inclusion criteria, including non-randomised and case study/series designs and a randomised controlled trial protocol, with participant numbers generally low. All programmes combined a psychotherapeutic component with work related goals; however, there were notable differences in relation to the conceptual/theoretical approach of the psychotherapeutic component and delivery of the work-related components. Barriers and enablers to programme participation and success are explored. CONCLUSIONS This review provides important insights into the characteristics of vocational rehabilitation interventions for people diagnosed with BPD. The findings will inform the co-production of approaches to support people with BPD to engage in employment.
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Affiliation(s)
- Jocelyn Kernot
- Allied Health & Human Performance Academic Unit, University of South Australia, Adelaide, Australia
| | - Amy Baker
- Allied Health & Human Performance Academic Unit, University of South Australia, Adelaide, Australia
| | - Candice Oster
- Caring Futures Institute, Flinders University, Bedford Park, SA, Australia
| | - Melissa Petrakis
- Department of Social Work, Monash University, Melbourne, VIC, Australia
| | - Suzanne Dawson
- Caring Futures Institute, Flinders University, Bedford Park, SA, Australia
- Southern Adelaide Local Health Network, Adelaide, SA, Australia
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Boone K, Whalen DJ, Barch DM, Luby JL, Luking KR. Self-Reported Gonadal Pubertal Timing Predicts Adolescent Borderline Personality Symptoms: Two Extended Replications With Prospective and Cross-Sectional Data. J Pers Disord 2023; 37:661-677. [PMID: 38038660 DOI: 10.1521/pedi.2023.37.6.661] [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] [Indexed: 12/02/2023]
Abstract
The current study investigated the understudied relationship between pubertal timing and borderline personality disorder (BPD) symptoms in males and females. We conducted hierarchical linear regressions in a longitudinal Cohort 1 (N = 117) and a cross-sectional Cohort 2 (N = 127). Cohort 1: Pubertal timing was self-reported at age 10; BPD symptoms and covariates were assessed between ages 13 and 19. Cohort 2: All assessments were between ages 8 and 12. Covariates: race, age, internalizing and externalizing symptoms, and income-to-needs ratio. Sex differences were examined post hoc. In Cohort 1, early gonadal timing was associated with more BPD symptoms in females (beta = .46, p = .002), and late gonadal timing was associated with more BPD symptoms in males (beta = -.23, p = .035). In Cohort 2, early gonadal timing was associated with more BPD symptoms (beta = .21, p = .033) without sex moderation. Results indicate that early gonadal development could be a risk indicator for the emergence of BPD in adolescence, particularly in females, which could inform causal mechanisms and intervention targets.
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Affiliation(s)
- Kiran Boone
- Department of Psychology, Washington University in St. Louis
| | - Diana J Whalen
- Department of Psychology, Washington University in St. Louis
| | - Deanna M Barch
- Department of Psychology, Washington University in St. Louis
- Department of Psychiatry, Washington University School of Medicine in St. Louis
| | - Joan L Luby
- Department of Psychology, Washington University in St. Louis
- Department of Psychiatry, Washington University School of Medicine in St. Louis
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Schäfer M, Luck-Sikorski C, Hochrein R, Schomerus G, Gollek S. [Development of a self-report questionnaire for the measurement of stigmatizing attitudes of the psychiatric staff towards patients with borderline personality disorder]. PSYCHIATRISCHE PRAXIS 2023; 50:424-430. [PMID: 37429316 DOI: 10.1055/a-2088-3629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
OBJECTIVE The development of a self-report questionnaire for quantitative measurement of stigmatizing attitudes of the psychiatric staff towards patients with borderline personality disorder. METHOD Online survey with psychiatrists, psychologists and nursing staff (n=94) in the (semi-)stationary psychiatric sector with translated items of an attitude questionnaire, followed by a principal component analysis and correlations between principal components and social distance. RESULTS Analyses revealed a 4-principal component structure (BPD-treatment difficulties, BPD-assessment of suicide risk, BPD-assumption of manipulative tendencies, BPD-negative emotions) with 63,60% explained variance and small to large correlations between principal components and social distance. CONCLUSION Results initially indicate possible validity and reliability of the developed questionnaire. Further analyses with larger sample size and confirmatory factor analysis for continued development are advised.
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Affiliation(s)
- Marvin Schäfer
- Forschungsgruppe COPE, SRH Hochschule für Gesundheit, Gera
| | | | | | - Georg Schomerus
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig
| | - Sabine Gollek
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig
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Goldbach RE, Neukel C, Panizza A, Reinken A, Krause-Utz A. Differentiating between intrapsychic symptoms and behavioral expressions of borderline personality disorder in relation to childhood emotional maltreatment and emotion dysregulation: an exploratory investigation. Eur J Psychotraumatol 2023; 14:2263317. [PMID: 37846822 PMCID: PMC10583625 DOI: 10.1080/20008066.2023.2263317] [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: 03/08/2023] [Accepted: 08/11/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Borderline personality disorder (BPD) is a severe mental disorder, characterized by pronounced instability in emotions, self-image, and interpersonal relationships. Experiences of childhood maltreatment are among the risk factors for BPD. While self-damaging and aggressive acts often occur, not every person with the disorder shows markedly dysregulated behaviour. Internalized symptoms, such as shame, loneliness, and self-disgust tend to be more pervasive and persist after clinical remission. OBJECTIVE Here we investigated associations between BPD symptom severity, childhood maltreatment, and emotion regulation difficulties. We further explored if the Borderline Symptom List (BSL) could potentially be used to differentiate between internalized symptoms (intrapsychic strain) and externalized symptoms (dysregulated behaviours) in future research. METHOD 187 women with at least mild BPD symptoms (65% having a diagnosis of BPD) completed the BSL 23 including its 11-item supplement (BSL-S), the Childhood Trauma Questionnaire (CTQ), and Difficulties in Emotion Regulation Scale (DERS). Participants further underwent a semi-structured clinical interview to assess BPD criteria (International Personality Disorder Examination, IPDE). Multivariate models and regression-based bootstrapping analyses were performed to test direct and indirect effects. RESULTS Childhood trauma severity, especially emotional abuse, positively predicted BPD symptom severity. A significant indirect effect through emotion regulation difficulties was found (k2=.56). When exploring associations with BPD criteria (IPDE), the BSL-23 mean significantly correlated with separation anxiety, identity and mood problems, chronic emptiness, suicidal ideation, and dissociation, while the BSL-S correlated with self-harming impulsive behaviour and anger outbursts. CONCLUSIONS Findings complement previous research, highlighting the role of childhood maltreatment and emotion regulation difficulties in BPD. While our findings need to be seen as preliminary and interpreted with caution, they suggest that the BSL may be used to differentiate between internalized symptoms and behavioural expressions of BPD in future research. Such a distinction might help to deepen the understanding of this complex heterogenous disorder.
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Affiliation(s)
- Roosmarijn E. Goldbach
- Department of Psychology, Faculty of Social and Behavioral Sciences, Leiden University, the Netherlands
| | - Corinne Neukel
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Germany
| | - Angelika Panizza
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Aischa Reinken
- Department of Psychology, Faculty of Social and Behavioral Sciences, Leiden University, the Netherlands
| | - Annegret Krause-Utz
- Department of Psychology, Faculty of Social and Behavioral Sciences, Leiden University, the Netherlands
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Schneider I, Fuchs A, Herpertz SC, Lobo FM. Microsocial analysis of dyadic interactions with toddlers and mothers with borderline personality disorder. Arch Womens Ment Health 2023; 26:589-597. [PMID: 37438620 PMCID: PMC10491556 DOI: 10.1007/s00737-023-01346-9] [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: 03/14/2023] [Accepted: 07/01/2023] [Indexed: 07/14/2023]
Abstract
Borderline personality disorder (BPD) is known for disruptions in mother-child interaction, but possible underlying patterns of micro-behavior are barely understood. This is the first study examining behavioral dyadic synchrony-the coordinated and reciprocal adaptation of behavior-and regulation on a micro-level and relating it to macro-behavior in mothers with BPD and their toddlers. Twenty-five mothers with BPD and 29 healthy mothers participated with their 18- to 36-month-old toddlers in a frustration-inducing paradigm. Mother and toddler behavior was continuously micro-coded for gaze, affect, and vocalization. Synchrony, operationalized as the simultaneous engagement in social gaze and positive affect, and (co-)regulative behaviors and their contingencies were analyzed and associated with borderline symptom severity, the overall quality of interaction, and child internalizing and externalizing behavioral problems. Dyads with mothers with BPD showed significantly less synchrony compared to dyads with healthy mothers. Low synchrony was associated with high BPD symptom severity and low overall interaction quality. Dyads with BPD used the same amount of regulative behaviors as dyads with healthy mothers. Though both groups equally responded to children's negative emotionality, mothers with BPD were less effective in drawing the dyad back into synchrony. For dyads with BPD, regulative behaviors were negatively associated with child externalizing behaviors. BPD symptomology may reduce the effectiveness of mothers' attempts to attune to their child's needs. An emphasis on synchrony and regulative behaviors may be an important therapeutic target for parenting programs in mothers with BPD.
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Affiliation(s)
- Isabella Schneider
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University Hospital, Voßstr. 4, 69115, Heidelberg, Germany.
| | - Anna Fuchs
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, Heidelberg University Hospital, Blumenstr. 8, 69115, Heidelberg, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University Hospital, Voßstr. 4, 69115, Heidelberg, Germany
| | - Frances M Lobo
- Department of Psychology, The University of North Carolina at Greensboro, 294 Eberhart Building, Greensboro, NC, 27402, USA
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Culina I, Maillard P, Loosli J, Martin-Soelch C, Berney S, Kolly S, Kramer U. Validation of the French version of the Revised Diagnostic Interview for Borderlines (DIB-R) for assessing the psychopathology of borderline personality disorder. Borderline Personal Disord Emot Dysregul 2023; 10:27. [PMID: 37718410 PMCID: PMC10506241 DOI: 10.1186/s40479-023-00233-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 08/26/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Borderline personality disorder (BPD) is frequently subject to misdiagnosis or underdiagnosis. As a matter of fact, its evaluation poses several challenges, highlighting the importance of having validated evaluation instruments. The Revised Diagnostic Interview for Borderlines (DIB-R) is widely used and recognized for its validity when it comes to assessing the psychopathology of BPD, but, as for now, no French version of the interview exists. The aim of the current work is to validate a French version of the DIB-R. METHODS The sample consists of N = 65 patients with borderline personality disorder (BPD) and N = 57 treatment seeking patients (non-BPD comparison group). For inter-rater reliability, a subsample of N = 84 interviews will be assessed by two raters, n = 47 for the BPD group and n = 37 for the non-BPD comparison group. RESULTS To assess reliability, we conducted analyses of internal consistency and inter-rater reliability. The results were good for the overall interview as well as for the four domains of the DIB-R. To assess validity, we calculated the receiver operating characteristic (ROC) curve, sensitivity, specificity, predictive values, convergent and discriminative validity. The optimal cutoff was found to be 7. Regarding convergent validity, we found strong convergence between the Borderline Symptom List (BSL-23) and the DIB-R total score. Additionally, the two groups statistically differed on all the DIB-R scores, which indicates that the interview discriminates between the two groups. CONCLUSIONS Our results indicate good psychometric properties of the French version of the DIB-R. This has important implications as the interview is useful both in clinical settings and for research purposes. Additionally, the present paper aims to contribute to the more general effort of demonstrating generalizability and transportability of the scale.
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Affiliation(s)
- Ines Culina
- Department of Psychiatry, General Psychiatry Service, University Hospital Center and University of Lausanne, Lausanne, Switzerland.
- Department of Psychology, Unit of Clinical and Health Psychology, University Fribourg, Fribourg, Switzerland.
| | | | - Janice Loosli
- Institute of Psychotherapy, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Chantal Martin-Soelch
- Department of Psychology, Unit of Clinical and Health Psychology, University Fribourg, Fribourg, Switzerland
| | - Sylvie Berney
- Department of Psychiatry, General Psychiatry Service, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - Stéphane Kolly
- Department of Psychiatry, General Psychiatry Service, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - Ueli Kramer
- Department of Psychiatry, General Psychiatry Service, University Hospital Center and University of Lausanne, Lausanne, Switzerland
- Institute of Psychotherapy, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- Department of Psychology, University of Windsor, Windsor, Canada
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Tsyngauz E, Chiu AK, Faruqui Z. Importance of Longitudinal Assessments in a Case of Comorbid Polysubstance Use Disorder and Borderline Personality Disorder Misdiagnosed As Bipolar I Disorder. Cureus 2023; 15:e45253. [PMID: 37842374 PMCID: PMC10576620 DOI: 10.7759/cureus.45253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 10/17/2023] Open
Abstract
Differentiating between borderline personality disorder (BPD) and bipolar disorder (BD) can be difficult. Both may present with altered mood states, deliberate self-harm, suicidality, impulsivity, unstable relationships, and risky behaviors. A manic episode is characterized by at least one week of elevated or irritated mood and at least three of the following: distractibility, impulsivity, grandiosity, flight of ideas, psychomotor activity, decreased need for sleep, and pressured speech. Borderline personality disorder is characterized by unstable mood and relationships, fear of abandonment, impulsivity, self-mutilation, suicidality, and a feeling of emptiness. In combination with polysubstance use, borderline personality disorder can present similarly to a manic episode and lead to an incorrect diagnosis of bipolar I disorder. In this study, we present a 44-year-old female whose psychiatric history highlights the importance of long-term patient observation in making an accurate diagnosis. Over the course of several years, she was given incorrect psychiatric diagnoses, including attention deficit hyperactivity disorder (ADHD), generalized anxiety disorder, and bipolar I disorder. As a result, her interpersonal relationships remained unstable and significantly affected her quality of life. Over the course of consistent, long-term psychiatric appointments, conversations with family members, and notes from previous psychiatrists, it became evident that substance use had also complicated her psychiatric history, leading to the aforementioned diagnoses. Once this was established, she was diagnosed with borderline personality disorder; subsequent correct medical intervention has been integral in helping her maintain a steady job and improve her interpersonal relationships and quality of life.
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Affiliation(s)
- Esther Tsyngauz
- Psychiatry and Behavioral Sciences, Drexel University College of Medicine, Philadelphia, USA
| | - Andrew K Chiu
- Psychiatry, Drexel University College of Medicine, Philadelphia, USA
| | - Zeeshan Faruqui
- Interventional Psychiatry, Keystone Health, Chambersburg, USA
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Reinsberg C, Schecklmann M, Abdelnaim MA, Weber FC, Langguth B, Hebel T. Treatment of depression and borderline personality disorder with 1 Hz repetitive transcranial magnetic stimulation of the orbitofrontal cortex - A pilot study. World J Biol Psychiatry 2023; 24:595-602. [PMID: 36920303 DOI: 10.1080/15622975.2023.2186484] [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: 12/19/2022] [Revised: 01/28/2023] [Accepted: 02/27/2023] [Indexed: 03/16/2023]
Abstract
Borderline personality disorder (BPD) is characterised by impairments in emotional regulation, impulse control and interpersonal interaction. Comorbid depression is common. The orbitofrontal cortex (OFC) plays a crucial role in the biological substrate of BPD. We investigated the effects of 1 Hz repetitive transcranial magnetic stimulation (rTMS) targeting the OFC on depressive symptoms and symptoms of BPD in 15 patients suffering from both conditions to assess feasibility and effectiveness. Target treatment intensity was 120% of resting motor threshold (RMT) and intended duration four weeks. Treatment improved both symptoms of depression as measured by the Hamilton Depression Rating Scale and of BPD as measured by Borderline Symptom List-23 and Barratt Impulsivity Scale. Drop-out rates were high with 7/15 patients not completing the full course of rTMS, but only two drop-outs were related to treatment. Only a minority of patients tolerated target treatment intensity. Despite the limitations, the results suggest efficacy of treatment and welcome further research.
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Affiliation(s)
- C Reinsberg
- University of Regensburg, Regensburg, Germany
| | - M Schecklmann
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - M A Abdelnaim
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - F C Weber
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - B Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - T Hebel
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
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Robin M, Bellone L, Belbèze J, Kazemian K, Radjack R, Corcos M. Three-level containment model of hospitalized adolescents with borderline pathology: a holistic therapeutic perspective. Front Psychiatry 2023; 14:1110788. [PMID: 37608992 PMCID: PMC10441123 DOI: 10.3389/fpsyt.2023.1110788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 06/16/2023] [Indexed: 08/24/2023] Open
Abstract
Borderline personality disorders account for 50% of adolescent hospitalization cases in psychiatry. The severity and psychopathological complexity of these symptoms indicate the need for inclusive models of understanding. Adopting a holistic approach allows for the consideration of not only the patient's environment, but also their position within that environment and their life history. In this article, a model based on the concept of therapeutic containment at three levels is presented. Global containment refers to the mindset and organization of the institution that provides care, which is itself a part of society at a specific time. Local containment focuses on understanding and therapeutic interventions within the immediate social environment of the individual. Lastly, individual containment encompasses the development of independent processes during the course of care. These three levels are integrated in the hospital treatment of borderline personality disorders, forming a trans-theoretical approach.
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Affiliation(s)
- Marion Robin
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
- Paris-Saclay University, UVSQ, CESP, INSERM U1178, Team PsyDev, Villejuif, France
- Paris Cité University, Paris, France
| | - Laura Bellone
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
- Paris Cité University, Paris, France
| | - Jean Belbèze
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
- Paris Cité University, Paris, France
| | - Koucha Kazemian
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
- Paris Cité University, Paris, France
| | - Rahmeth Radjack
- Paris-Saclay University, UVSQ, CESP, INSERM U1178, Team PsyDev, Villejuif, France
- Paris Cité University, Paris, France
- Maison de Solenn, Department of Adolescent Psychiatry, Cochin Hospital, AP-HP, Paris University, Paris, France
| | - Maurice Corcos
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
- Paris Cité University, Paris, France
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Martin S. Why using “consciousness” in psychotherapy? Insight, metacognition and self-consciousness. NEW IDEAS IN PSYCHOLOGY 2023. [DOI: 10.1016/j.newideapsych.2023.101015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
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Blay M, Benmakhlouf I, Duarte M, Perroud N, Greiner C, Charbon P, Choi-Kain L, Speranza M. Case reports: Using Good Psychiatric Management (GPM) conceptualizations in the dimensional assessment and treatment of personality disorders. Front Psychiatry 2023; 14:1186524. [PMID: 37564248 PMCID: PMC10410145 DOI: 10.3389/fpsyt.2023.1186524] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/06/2023] [Indexed: 08/12/2023] Open
Abstract
Good Psychiatric Management (GPM) is a generalist clinical management approach for borderline personality disorder that incorporates common ingredients of good standard care for any psychiatric diagnosis with what works from prevailing specialist psychotherapies. Similar to all validated therapies for BPD, it relies on a specified formulation of the disorder' symptoms as arising from interpersonal hypersensitivity, to dynamically describe typical patterns of daily self- and interpersonal issues that drive the instability that defines the general personality dysfunction characteristic of the disorder. Recent adaptations of GPM have been proposed for narcissistic personality disorder and obsessive-compulsive personality disorder, with development of similar dynamic models for both (intrapsychic coherence model and model of overcontrol). New dimensional models of personality disorder diagnosis have been developed to address limitations of categorical approach, but the incorporation of these models into usage in the delivery of clinical services (where categorical approach remains the most used) is limited. This paper describes an adaptation of GPM to two cases of personality disorder that illustrate the usefulness of GPM models for dynamic representation of complex daily fluctuations in internal psychic coherence and interpersonal functioning. Specialist psychotherapies will never meet the demands of public health needs to treat personality dysfunction, and incorporation of new dimensional models of diagnosis are needed for treatments that can provide a minimal standard of care for providers and patients.
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Affiliation(s)
- Martin Blay
- ADDIPSY, Outpatient Addictology and Psychiatry Center, Santé Basque Développement Group, Lyon, France
- Lyon Est Faculty of Medicine, Claude Bernard University Lyon 1, Lyon, France
| | - Ines Benmakhlouf
- ADDIPSY, Outpatient Addictology and Psychiatry Center, Santé Basque Développement Group, Lyon, France
| | - Miguel Duarte
- Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, University Hospitals of Geneva, Geneva, Switzerland
| | - Nader Perroud
- Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, University Hospitals of Geneva, Geneva, Switzerland
- Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Christian Greiner
- Consultative Psychiatry and Crisis Intervention Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Patrick Charbon
- Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, University Hospitals of Geneva, Geneva, Switzerland
| | - Lois Choi-Kain
- McLean Hospital, Gunderson Personality Disorders Institute, Belmont, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Mario Speranza
- Versailles Hospital Center, University Department of Child and Adolescent Psychiatry, Le Chesnay, France
- Centre de recherche en Epidémiologie et Santé des Populations Team “DevPsy”, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), INSERM, Université Paris-Saclay, Villejuif, France
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Fung HW, Wong MYC, Lam SKK, Wong ENM, Chien WT, Hung SL, Lee KH, Cui J, Ross CA. Borderline personality disorder features and their relationship with trauma and dissociation in a sample of community health service users. Borderline Personal Disord Emot Dysregul 2023; 10:22. [PMID: 37394448 DOI: 10.1186/s40479-023-00228-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 05/31/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND Previous studies have indicated that borderline personality disorder (BPD) is closely associated with trauma and dissociation. Nevertheless, BPD is a heterogeneous condition, and not all people with BPD have severe dissociation. This study examined whether the relationship of BPD features with trauma and dissociation would remain significant after controlling for some general non-specific mental health distress. We also made the first attempt to explore which specific BPD features would be particularly associated with dissociation. METHODS We analyzed survey data from a sample of community health service users in Hong Kong (N = 376). Hierarchical multiple regression and data-driven network analysis were used. RESULTS The lifetime prevalence of DSM-5 BPD was 16.0% in our sample. Of participants who met criteria for BPD, 43.3% scored above cutoff on the dissociation measures, thus possibly having clinically significant dissociative symptoms. BPD features were associated with adulthood trauma and psychoform dissociation even after controlling for age, depression and self-esteem. Network analysis showed that some BPD features - including impulsivity, identity disturbance and suicidal/self-mutilation behaviors - were particularly associated with dissociation; other BPD features such as interpersonal-related problems had relatively weak to no connection with dissociation. CONCLUSIONS Our results suggested that some particular BPD features might be dissociative in nature, although further longitudinal research is required. We argue that a trauma-informed perspective should be employed when working with clients presenting with BPD features despite these features being commonly stigmatized. Further research on the intervention needs of the people with BPD who suffer from high levels of dissociation is required.
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Affiliation(s)
- Hong Wang Fung
- Department of Social Work, Hong Kong Baptist University, Kowloon, Hong Kong.
| | - Ming Yu Claudia Wong
- Department of Health and Physical Education, The Education University of Hong Kong, Ting Kok, Hong Kong
| | - Stanley Kam Ki Lam
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Emily Nga Man Wong
- Department of Counselling and Psychology, Hong Kong Shue Yan University, North Point, Hong Kong
| | - Wai Tong Chien
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Suet Lin Hung
- Department of Social Work, Hong Kong Baptist University, Kowloon, Hong Kong.
| | - Kun-Hua Lee
- Department of Educational Psychology and Counseling, National Tsing Hua University, 521 Nan-Da Road, Hsinchu City, 30014, Taiwan
| | - Jialiang Cui
- Department of Social Work, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Colin A Ross
- The Colin A. Ross Institute for Psychological Trauma, Richardson, TX, USA
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