1
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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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2
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Dippold B, Beller J, Kröger C, Dreyße K. [Factorial and Convergent Validity of the Short Form of the "Questionnaire of Thoughts and Feelings" (QTF-14) for Borderline Personality Disorder]. Psychother Psychosom Med Psychol 2024; 74:43-48. [PMID: 37931650 DOI: 10.1055/a-2177-1676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
The "Questionnaire of Thoughts and Feelings" (QTF) is being used as screening instrument as well as tool for treatment planning and treatment evaluation for patients with borderline personality disorder (BPD). The primary goal of this study was the validation of the dimensional structure of the short version with 14 items, QTF-14. Additionally, item characteristics, reliability and evidence of convergent validity were examined. A diagnostically homogenous sample of patients with BPD (N=3035) of a psychosomatic clinic was presented with several self-assessment inventories, including the QTF-14. The expected single-factor model of the structure of the FGG showed unacceptable model fit indices (CFI=0.751; TLI=0.706; RMSEA=0.115; SRMR=0.073). Exploratory factor analysis showed evidence of two or three specific factors. In a subsequent confirmatory factor analysis, a bifactor model with two specific factors proved to be preferable (CFI=0.956; TLI=0.936; RMSEA=0.054; SRMR=0.034). The internal consistency of the total scale as well as the suggested subscales "Relationship Difficulties and Emotional Dysregulation" and "Autoaggression" was acceptable to good (ω=.81-.84; α=.79-.85). Associations with similar scales were as expected. Good psychometric properties of the QTF-14 can be confirmed in this study. Using the suggested subscales could support treatment planning.
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Affiliation(s)
- Brigitte Dippold
- Klinische Psychologie und Psychotherapie, Institut für Psychologie, Universität Hildesheim
| | | | - Christoph Kröger
- Klinische Psychologie und Psychotherapie, Institut für Psychologie, Universität Hildesheim
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3
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Choi-Kain LW, Masland SR, Finch EF. Corrective Experiences to Enhance Trust: Clinical Wisdom From Good (Enough) Psychiatric Management. J Pers Disord 2023; 37:559-579. [PMID: 37903019 DOI: 10.1521/pedi.2023.37.5.559] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
Unstable trust within social interchange underlies the symptom constellation of borderline personality disorder (BPD), resulting in preoccupation with intense dyadic relationships, limited capacity for social collaboration, and constricted social networks. Good Psychiatric Management (GPM) provides a distilled formulation of how interpersonal hypersensitivities drive the engine of BPD's symptomatic oscillations in both affect and attachment. The authors summarize clinically relevant conclusions from the empirical literature on trust in BPD, synthesize it with selected ideas from other empirically supported interventions, and distill a formulation of how the GPM approach can address problems of trust in BPD with strategies most clinicians can use to improve their work with patients. GPM's clinical management approach utilizes common factors in psychotherapy to structure collaboration with patients to be accountable partners in treatment, rely on themselves more to diminish unrealistic demands on others, and function more effectively in arenas that expand and stabilize their social network.
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Affiliation(s)
- Lois W Choi-Kain
- McLean Hospital, Belmont, Massachusetts, and Harvard Medical School, Boston Massachusetts
| | - Sara R Masland
- Psychology Department, Pomona College, Claremont, California
| | - Ellen F Finch
- Psychology Department, Graduate School of Arts and Sciences, Harvard University, Cambridge, Massachusetts
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4
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Davanzo A, D Huart D, Seker S, Moessner M, Zimmermann R, Schmeck K, Behn A. Study Features and Response Compliance in Ecological Momentary Assessment Research in Borderline Personality Disorder: Systematic Review and Meta-analysis. J Med Internet Res 2023; 25:e44853. [PMID: 36920466 PMCID: PMC10131785 DOI: 10.2196/44853] [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: 12/06/2022] [Revised: 01/17/2023] [Accepted: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Borderline personality disorder (BPD) is characterized by frequent and intense moment-to-moment changes in affect, behavior, identity, and interpersonal relationships, which typically result in significant and negative deterioration of the person's overall functioning and well-being. Measuring and characterizing the rapidly changing patterns of instability in BPD dysfunction as they occur in a person's daily life can be challenging. Ecological momentary assessment (EMA) is a method that can capture highly dynamic processes in psychopathology research and, thus, is well suited to study intense variability patterns across areas of dysfunction in BPD. EMA studies are characterized by frequent repeated assessments that are delivered to participants in real-life, real-time settings using handheld devices capable of registering responses to short self-report questions in daily life. Compliance in EMA research is defined as the proportion of prompts answered by the participant, considering all planned prompts sent. Low compliance with prompt schedules can compromise the relative advantages of using this method. Despite the growing EMA literature on BPD in recent years, findings regarding study design features that affect compliance with EMA protocols have not been compiled, aggregated, and estimated. OBJECTIVE This systematic meta-analytic review aimed to investigate the relationship between study design features and participant compliance in EMA research of BPD. METHODS A systematic review was conducted on November 12, 2021, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and MOOSE (Meta-analyses of Observational Studies in Epidemiology) guidelines to search for articles featuring EMA studies of BPD that reported compliance rates and included sufficient data to extract relevant design features. For studies with complete data, random-effect models were used to estimate the overall compliance rate and explore its association with design features. RESULTS In total, 28 peer-reviewed EMA studies comprising 2052 participants were included in the study. Design features (sampling strategy, average prompting frequency, number of items, response window, sampling device, financial incentive, and dropout rate) showed a large variability across studies, and many studies did not report design features. The meta-analytic synthesis was restricted to 64% (18/28) of articles and revealed a pooled compliance rate of 79% across studies. We did not find any significant relationship between design features and compliance rates. CONCLUSIONS Our results show wide variability in the design and reporting of EMA studies assessing BPD. Compliance rates appear to be stable across varying setups, and it is likely that standard design features are not directly responsible for improving or diminishing compliance. We discuss possible nonspecific factors of study design that may have an impact on compliance. Given the promise of EMA research in BPD, we also discuss the importance of unifying standards for EMA reporting so that data stemming from this rich literature can be aggregated and interpreted jointly.
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Affiliation(s)
- Antonella Davanzo
- Escuela de Psicología, Pontificia Universidad Católica de Chile, Instituto Milenio para la Investigación en Depresión y Personalidad, Santiago, Chile
| | - Delfine D Huart
- Department of Child and Adolescent Psychiatry Research, University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Süheyla Seker
- Department of Child and Adolescent Psychiatry Research, University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Markus Moessner
- University Hospital Heidelberg, Center for Psychotherapy Research, Heidelberg, Germany
| | - Ronan Zimmermann
- Department of Child and Adolescent Psychiatry Research, University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Klaus Schmeck
- Department of Child and Adolescent Psychiatry Research, University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Alex Behn
- Escuela de Psicología, Pontificia Universidad Católica de Chile, Instituto Milenio para la Investigación en Depresión y Personalidad, Santiago, Chile
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5
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Kaurin A, Dombrovski AY, Hallquist MN, Wright AG. Momentary interpersonal processes of suicidal surges in borderline personality disorder. Psychol Med 2022; 52:2702-2712. [PMID: 33298227 PMCID: PMC8190164 DOI: 10.1017/s0033291720004791] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Suicide rates are high in borderline personality disorder (BPD) where interpersonal problems trigger intense affective dysregulation and impulses to act on suicidal thoughts. To date, however, no study has examined how interpersonal stressors contribute to momentary within-person links among affect and impulsivity with suicidal ideation (SI), and how those links vary over time in people's daily lives. METHODS A total of 153 individuals diagnosed with BPD and 52 healthy controls completed a 21-day ecological momentary assessment protocol. Of these 153 individuals with BPD, 105 had a history of suicide attempts. Multilevel structural equation modeling was used to examine dynamic links among interpersonal perceptions, affect, state impulsivity, and suicidal intent. RESULTS Aggregated across interactions, lower perceived warmth in others was associated with SI. This direct relationship, however, did not extend to momentary within-person associations. Instead, interpersonal conflicts were linked to SI indirectly via greater negative affect and lower positive affect. While a robust within-person link between interpersonal perceptions and impulsivity emerged, impulsivity did not account for the relationship between interpersonal perceptions and SI. CONCLUSION This intensive longitudinal study illustrates momentary interpersonal signatures of an emerging suicidal crisis. Among people with BPD at high risk for suicide, interpersonal triggers initiate a cascade of affective dysregulation, which in turn gives rise to SI.
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Affiliation(s)
| | | | - Michael N. Hallquist
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill
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6
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Krause-Utz A, Walther JC, Kyrgiou AI, Hoogenboom W, Alampanou M, Bohus M, Schmahl C, Lis S. Severity of childhood maltreatment predicts reaction times and heart rate variability during an emotional working memory task in borderline personality disorder. Eur J Psychotraumatol 2022; 13:2093037. [PMID: 35816658 PMCID: PMC9262367 DOI: 10.1080/20008198.2022.2093037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
UNLABELLED Background: Difficulties in emotion regulation are a core symptom of borderline personality disorder (BPD) and often interfere with cognitive functions, such as working memory (WM). Traumatic childhood experiences, including severe maltreatment, can contribute to emotion dysregulation, possibly mediated by changes in high-frequency heart rate variability (HF-HRV). However, it is not yet entirely understood if HF-HRV alterations underlie impaired WM during emotional distraction in BPD and if this is related to traumatic childhood experiences and to comorbid post-traumatic stress disorder (PTSD). Objective: Our aim was to investigate performance (reaction times, RTs) and HF-HRV during an emotional working memory task (EWMT) in relation to childhood maltreatment severity and comorbid PTSD in BPD. Method: Eighty-one women (n = 28 healthy controls (HC) and n = 53 BPD patients of which n = 18 had comorbid PTSD) performed an adapted Sternberg item recognition WM task with neutral and negative social cues (interpersonal scenes from the International Affective Picture System (IAPS), and neutral, fearful, and angry faces) as distractors. Dependent variables were RTs of correct trials and HF-HRV. Childhood maltreatment was assessed with the Childhood Trauma Questionnaire. Results: Compared to healthy participants, patients with BPD showed prolonged RTs across all distractor conditions with social cues, regardless of their emotional valence. Patients with BPD, especially those with PTSD, demonstrated reduced HF-HRV both at rest and during EWMT. Severity of childhood maltreatment predicted longer RTs and lower HF-HRV during the EWMT. Conclusions: Findings suggest that adverse childhood experiences accelerate difficulties in shifting attention away from social information and that these are more pronounced in individuals with BPD. Reduced HF-HRV (low parasympathetic-tonus) may be an important psychophysiological mechanism underlying impaired WM in the presence of distracting social cues in patients with BPD, especially in those with comorbid PTSD. HIGHLIGHTS This study provides evidence that childhood maltreatment experiences are associated with hypersensitivity to social information and reduced high-frequency heart rate variability during a working memory task in borderline personality disorder.
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Affiliation(s)
- Annegret Krause-Utz
- Institute of Psychology, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden, Netherlands
| | - Julia-Caroline Walther
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim, Germany.,Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Akrivi I Kyrgiou
- Institute of Psychology, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden, Netherlands
| | - William Hoogenboom
- Institute of Psychology, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden, Netherlands
| | - Myrto Alampanou
- Institute of Psychology, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden, Netherlands
| | - Martin Bohus
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim, Germany.,Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Harvard Medical School and McLean Hospital, Belmont, MA, USA
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefanie Lis
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim, Germany.,Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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7
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Vanwoerden S, Hofmans J, De Clercq B. Reciprocal effects between daily situational perceptions and borderline personality symptoms in young adulthood: the role of childhood parenting experiences. Psychol Med 2021; 51:2388-2398. [PMID: 32321603 DOI: 10.1017/s0033291720000987] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Recent research has emphasized the importance of within-person transactions between situational perceptions and borderline symptomatology. The current study extends current evidence by evaluating a broad range of situational perceptions and their transactions with borderline symptomatology across both private and professional contexts. Additionally, it explores whether early experiences of parental harsh punishment and emotional support during childhood, two well-established etiological factors in developmental theories of borderline symptomatology, influence the effect of daily situation perception in adulthood on borderline symptom presentation. METHODS N = 131 young adults (Mage = 20.97, s.d.age = 1.64) completed end-of-day diaries of their borderline symptoms and perceptions of the home and school or work environment for 14 days. During their mid-childhood, reports of maternal strategies of harsh punishment and emotional support were collected. RESULTS Findings revealed that on the same day, borderline symptoms were associated with more negative and stressful, and less positive perceptions of both the private and professional context. Additionally, borderline symptoms predicted more negative and stressful perceptions of school/work on subsequent days. Finally, while early harsh punishment predicted overall increases in daily borderline symptoms 10 years later, emotionally supportive parenting in childhood predicted decreases in borderline symptom expression in less positive and more stressful contexts. CONCLUSIONS The current study points to the importance of managing BPD symptoms to reduce subsequent negative perceptions of the environment, and also indicates the relevance of exploring adult person-situation processes based on early parenting experiences.
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8
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Harp Th TSD, Hepp J, Trull TJ, Bateman AW, Kongerslev MT, Simonsen E. Positive Affect Is Associated With Decreased Symptom Severity in the Daily Lives of Individuals With Borderline Personality Disorder. J Pers Disord 2021; 35:355-372. [PMID: 31682195 DOI: 10.1521/pedi_2019_33_453] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Previous research has repeatedly demonstrated positive associations between negative affect (NA) and borderline personality disorder (BPD) symptoms in daily life, but studies have rarely addressed potential effects of positive affect (PA). Consequently, little is known about how PA in daily life covaries with symptoms of BPD. The authors assessed the effects of both PA and NA levels on BPD symptom severity in a sample of 81 treatment-seeking women diagnosed with BPD over a period of 21 days, employing a daily diary design. Using multivariate multilevel modeling, the authors obtained negative associations between PA levels and daily BPD severity in total and at the level of the individual symptoms inappropriate anger, affective instability, emptiness, identity disturbance, and paranoid ideation/dissociation. Moreover, the authors replicated previously reported positive associations between NA and BPD severity for all nine symptoms. Future research can address whether increasing PA in the treatment of BPD may potentially help reduce symptom burden.
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Affiliation(s)
- Tine S D Harp Th
- Psychiatric Research Unit, Region Zealand, Slagelse, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Johanna Hepp
- Department of Psychosomatic Medicine, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Timothy J Trull
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri
| | - Anthony W Bateman
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mickey T Kongerslev
- Psychiatric Research Unit, Region Zealand, Slagelse, Denmark.,Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Erik Simonsen
- Psychiatric Research Unit, Region Zealand, Slagelse, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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9
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Six assumptions of contemporary integrative interpersonal theory of personality and psychopathology. Curr Opin Psychol 2021; 41:65-70. [PMID: 33901924 DOI: 10.1016/j.copsyc.2021.03.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 02/08/2021] [Accepted: 03/22/2021] [Indexed: 11/20/2022]
Abstract
Contemporary integrative interpersonal theory is an evidence-based model of personality, psychopathology, and intervention. In this article, we review six assumptions of contemporary integrative interpersonal theory that distinguish it from other frameworks and suggest five particularly promising and important areas for future research.
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10
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Comparing Signal-Contingent and Event-Contingent Experience Sampling Ratings of Affect in a Sample of Psychotherapy Outpatients. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2021; 42:13-24. [PMID: 33664551 DOI: 10.1007/s10862-019-09766-7] [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: 10/25/2022]
Abstract
Experience sampling methods are widely used in clinical psychology to study affective dynamics in psychopathology. The present study examined whether affect ratings (valence and arousal) differed as a function of assessment schedule (signal- versus event-contingent) in a clinical sample and considered various approaches to modeling these ratings. A total of 40 community mental health center outpatients completed ratings of their affective experiences over a 21-day period using both signal-contingent schedules (random prompts) and event-contingent schedules (ratings following social interactions). We tested whether assessment schedules impacted 1) the central tendency (mean) and variability (standard deviation) of valence or arousal considered individually, 2) the joint variability in valence and arousal via the entropy metric, and 3) the between-person differences in configuration of valence-arousal landscapes via the Earth Mover's Distance (EMD) metric. We found that event-contingent schedules, relative to signal-contingent schedules, captured higher average levels of pleasant valence and emotional arousal ratings. Moreover, signal-contingent schedules captured greater variability within and between individuals on arousal-valence landscapes compared to event-contingent schedules. Altogether, findings suggest that the two assessment schedules should not be treated interchangeably in the assessment of affect over time. Researchers must be cautious in generalizing results across studies utilizing different experience sampling assessment schedules.
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11
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Dixon-Gordon KL, Fitzpatrick S, Haliczer LA. Emotion regulation and borderline personality features in daily life: The role of social context. J Affect Disord 2021; 282:677-685. [PMID: 33445091 DOI: 10.1016/j.jad.2020.12.125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/27/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Borderline personality disorder (BPD) is associated with emotional dysfunction and interpersonal sensitivity. Yet, little work has characterized how BPD features predicts emotional reactivity and emotion regulation behaviors in response to interpersonal stress relative to other forms of stress. METHODS Participants were 152 university students who completed baseline measures of BPD features and complied with two-week daily diary procedures assessing daily emotion regulation strategy use in response to social and non-social stressors. RESULTS Generalized estimating equations revealed that BPD features predicted greater negative and positive emotions in response to daily stressors, and interacted with type of stressor in predicting urges and behaviors. Elevated BPD features was associated with greater urges for dysfunctional emotion regulatory behaviors and fewer functional emotion regulatory behaviors to a greater extent in response to social (versus non-social) stressors. LIMITATIONS This study was limited by its focus on past-day retrospective recall. Further, the student sample limits the generalizability of these findings. CONCLUSIONS These findings suggest that individuals with elevated BPD features may have less functional emotion regulation in social contexts.
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Affiliation(s)
- Katherine L Dixon-Gordon
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, 135 Hicks Way, Amherst, MA 01002, USA.
| | | | - Lauren A Haliczer
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, 135 Hicks Way, Amherst, MA 01002, USA
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12
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Moukhtarian TR, Reinhard I, Moran P, Ryckaert C, Skirrow C, Ebner-Priemer U, Asherson P. Comparable emotional dynamics in women with ADHD and borderline personality disorder. Borderline Personal Disord Emot Dysregul 2021; 8:6. [PMID: 33579385 PMCID: PMC7879647 DOI: 10.1186/s40479-021-00144-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emotional dysregulation (ED) is a core diagnostic symptom in borderline personality disorder (BPD) and an associated feature of attention-deficit/hyperactivity disorder (ADHD). We aimed to investigate differences in dynamical indices of ED in daily life in ADHD and BPD. METHODS We used experience sampling method (ESM) and multilevel modelling to assess momentary changes in reports of affective symptoms, and retrospective questionnaire measures of ED in a sample of 98 adult females with ADHD, BPD, comorbid ADHD+BPD and healthy controls. RESULTS We found marked differences between the clinical groups and healthy controls. However, the ESM assessments did not show differences in the intensity of feeling angry and irritable, and the instability of feeling sad, irritable and angry, findings paralleled by data from retrospective questionnaires. The heightened intensity in negative emotions in the clinical groups compared to controls was only partially explained by bad events at the time of reporting negative emotions, suggesting both reactive and endogenous influences on ED in both ADHD and BPD. CONCLUSIONS This study supports the view that ED is a valuable trans-diagnostic aspect of psychopathology in both ADHD and BPD, with similar levels of intensity and instability. These findings suggest that the presence or severity of ED should not be used in clinical practice to distinguish between the two disorders.
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Affiliation(s)
- Talar R Moukhtarian
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
| | - Iris Reinhard
- Central Institute of Mental Health, Division of Biostatistics, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Paul Moran
- Centre for Academic Mental Health, School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - Celine Ryckaert
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Caroline Skirrow
- Cambridge Cognition, Cambridge, UK.,School of Psychological Science, University of Bristol, Bristol, UK
| | - Ulrich Ebner-Priemer
- Mental m-health lab, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany. .,Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany.
| | - Philip Asherson
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, London, UK
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13
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Scamaldo KM, Tull MT, Gratz KL. Motives for opioid use explain the relation between borderline personality disorder pathology and opioid use problems. Psychiatry Res 2021; 296:113609. [PMID: 33418458 DOI: 10.1016/j.psychres.2020.113609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 11/25/2020] [Indexed: 12/31/2022]
Abstract
Despite the established relations between borderline personality disorder (BPD) and substance use problems in general, there is a dearth of research on the relation between BPD pathology and opioid use problems, as well as factors that may explain this relation. Therefore, this study examined the indirect relations of BPD pathology to opioid use problems (i.e., prescription opioid misuse, apprehension about prescription opioid use, and opioid cravings) through motives for opioid use (i.e., coping, enhancement, social, and conformity motives) among 68 patients endorsing prescription opioid misuse in a residential correctional substance use disorder (SUD) treatment facility. Participants completed measures of BPD pathology, motives for opioid use, and opioid use problems. Findings revealed significant indirect relations of BPD pathology to opioid misuse through coping and enhancement motives, apprehension about opioid use through coping, enhancement, and social motives, and opioid cravings through coping motives within this SUD sample. Results illustrate the relevance of both emotion- and interpersonal-related motives for opioid use to opioid use problems among patients with BPD pathology in SUD treatment.
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Affiliation(s)
| | - Matthew T Tull
- Department of Psychology, University of Toledo, Toledo, OH, USA
| | - Kim L Gratz
- Department of Psychology, University of Toledo, Toledo, OH, USA..
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14
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Boritz T, Varma S, Macaulay C, McMain SF. Alliance rupture and repair in early sessions of dialectical behavior therapy: The case of Rachel. J Clin Psychol 2020; 77:441-456. [DOI: 10.1002/jclp.23101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/10/2020] [Accepted: 12/05/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Tali Boritz
- Borderline Personality Disorder Clinic Centre for Addiction and Mental Health Toronto Canada
- Department of Psychiatry University of Toronto Toronto Canada
| | - Sonya Varma
- Department of Psychology York University Toronto Canada
| | | | - Shelley F. McMain
- Borderline Personality Disorder Clinic Centre for Addiction and Mental Health Toronto Canada
- Department of Psychiatry University of Toronto Toronto Canada
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15
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Normann-Eide E, Antonsen BRT, Kvarstein EH, Pedersen G, Vaskinn A, Wilberg T. Are Impairments in Theory of Mind Specific to Borderline Personality Disorder? J Pers Disord 2020; 34:827-841. [PMID: 30785865 DOI: 10.1521/pedi_2019_33_417] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Impaired theory of mind (ToM) is an assumed feature of borderline personality disorder (BPD). Yet, no studies have compared ToM abilities in patients with BPD, other personality disorders, and healthy controls, or investigated the relationship between ToM and severity of psychopathology and interpersonal problems. In this study, ToM was investigated by the Movie for the Assessment of Social Cognition. No differences were found between the three groups in overall ToM abilities. The BPD group was, however, characterized by more excessive ToM (interpreted as hypermentalization). Yet, when differentiating between BPD and further severity indicators, excessive ToM was not specifically associated with a BPD diagnosis per se. Finally, there was a moderate association between hypermentalization and interpersonal problems in the BPD group. This study suggests that BPD patients tend to hypermentalize when they misinterpret social information, and that this tendency is related to the severity of their psychopathology.
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Affiliation(s)
- Eivind Normann-Eide
- Section for Personality Psychiatry, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Research Department, Division of Mental Health and Addiction, Vestfold Hospital Trust, Tonsberg, Norway
| | - Bj Rnar Torske Antonsen
- Section for Personality Psychiatry, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Lovisenberg Diaconal Hospital, Oslo
| | - Elfrida Hartveit Kvarstein
- Section for Personality Psychiatry, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Institute for Clinical Medicine, University of Oslo
| | - Geir Pedersen
- Section for Personality Psychiatry, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital
| | - Anja Vaskinn
- NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital
| | - Theresa Wilberg
- Institute for Clinical Medicine, University of Oslo.,Department of Research and Development, Clinic for Mental Health and Addiction, Oslo University Hospital
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16
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Göttlich M, Westermair AL, Beyer F, Bußmann ML, Schweiger U, Krämer UM. Neural basis of shame and guilt experience in women with borderline personality disorder. Eur Arch Psychiatry Clin Neurosci 2020; 270:979-992. [PMID: 32382793 PMCID: PMC7599192 DOI: 10.1007/s00406-020-01132-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 04/27/2020] [Indexed: 11/17/2022]
Abstract
Borderline personality disorder (BPD) is characterized by instability of affect, emotion dysregulation, and interpersonal dysfunction. Especially shame and guilt, so-called self-conscious emotions, are of central clinical relevance to BPD. However, only few experimental studies have focused on shame or guilt in BPD and none investigated their neurobiological underpinnings. In the present functional magnetic resonance imaging study, we took a scenario-based approach to experimentally induce feelings of shame, guilt, and disgust with neutral scenarios as control condition. We included 19 women with BPD (age 26.4 ± 5.8 years; DSM-IV diagnosed; medicated) and 22 healthy female control subjects (age 26.4 ± 4.6 years; matched for age and verbal IQ). Compared to controls, women with BPD reported more intense feelings when being confronted with affective scenarios, especially higher levels of shame, guilt, and fear. We found increased amygdala reactivity in BPD compared to controls for shame and guilt, but not for disgust scenarios (p = 0.05 FWE corrected at the cluster level; p < 0.0001 cluster defining threshold). Exploratory analyses showed that this was caused by a diminished habituation in women with BPD relative to control participants. This effect was specific to guilt and shame scenarios as both groups showed amygdala habituation to disgust scenarios. Our work suggests that heightened shame and guilt experience in BPD is not related to increased amygdala activity per se, but rather to decreased habituation to self-conscious emotions. This provides an explanation for the inconsistencies in previous imaging work on amygdala involvement in BPD as well as the typically slow progress in the psychotherapy of dysfunctional self-conscious emotions in this patient group.
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Affiliation(s)
- Martin Göttlich
- Department of Neurology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Anna Lisa Westermair
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Frederike Beyer
- School of Biological and Chemical Sciences, Queen Mary University of London, London, UK
| | - Marie Luise Bußmann
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Ulrich Schweiger
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Ulrike M Krämer
- Department of Neurology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
- Institute for Psychology II, University of Lübeck, Lübeck, Germany.
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17
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Foubert K, Sebreghts B, Sutton J, De Backer J. Musical encounters on the borderline. Patterns of mutuality in musical improvisations with Borderline Personality Disorder. ARTS IN PSYCHOTHERAPY 2020. [DOI: 10.1016/j.aip.2019.101599] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Yaroslavsky I, Napolitano SC, France CM. Ruminative responses to interpersonal precipitants mediate borderline personality disorder features’ effects on distress reactivity and recovery in daily life. J Clin Psychol 2019; 75:2188-2209. [DOI: 10.1002/jclp.22839] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Ilya Yaroslavsky
- Department of PsychologyCleveland State University Cleveland Ohio
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19
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Quek J, Melvin GA, Bennett C, Gordon MS, Saeedi N, Newman LK. Mentalization in Adolescents With Borderline Personality Disorder: A Comparison With Healthy Controls. J Pers Disord 2019; 33:145-163. [PMID: 29469664 DOI: 10.1521/pedi_2018_32_336] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Mentalization is proposed to underlie the disturbed interpersonal relatedness that is a hallmark of borderline personality disorder (BPD). Despite growing evidence of BPD in adolescents, studies examining mentalization in relation to adolescent BPD have remained limited. Given contradictory findings of this relationship, particularly with adults, further research of mentalization in adolescents with BPD is warranted. The current study further clarifies the nature of mentalizing impairments, related to BPD, by examining different aspects of mentalization between adolescents with BPD (n = 26) and a group of healthy controls (n = 25). Findings support studies that suggest that mentalization may be an important treatment target, influencing BPD symptoms and interpersonal functioning in adolescents with BPD. They also support the importance of examining mentalizing abilities in relation to varying levels of complexity, interpersonal contexts, and levels of arousal. Limitations and further research are discussed.
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Affiliation(s)
- Jeremy Quek
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Australia
| | - Glenn A Melvin
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Australia
| | - Clair Bennett
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Australia
| | - Michael S Gordon
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Australia.,Early in Life Mental Health Service, Monash Health, Australia
| | - Naysun Saeedi
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Australia.,Early in Life Mental Health Service, Monash Health, Australia
| | - Louise K Newman
- Department of Psychiatry, University of Melbourne, Australia
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20
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Rejection Sensitivity and Self-Regulation of Daily Interpersonal Events. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2019. [DOI: 10.1007/s10879-019-09424-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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21
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Meehan KB, Clarkin JF, Lenzenweger MF. Conceptual Models of Borderline Personality Disorder, Part 1: Overview of Prevailing and Emergent Models. Psychiatr Clin North Am 2018; 41:535-548. [PMID: 30447722 DOI: 10.1016/j.psc.2018.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Borderline personality disorder (BPD) is a debilitating condition with significant personal and societal costs. Throughout the history of the conceptualization of borderline pathology as a form of psychopathology, there has been debate concerning the essential attributes of this disorder, which has significant implications for its assessment and treatment. The first of this 2-part review evaluates the major approaches to conceptualizing BPD, from the traditional DSM diagnosis through the more recent Alternative Model in DSM-5, Section III, and the research domain criteria initiative of the National Institute of Mental Health that was articulated largely in response to limitations of the DSM.
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Affiliation(s)
- Kevin B Meehan
- Long Island University, Brooklyn Campus, 1 University Plaza, Brooklyn, NY 11201, USA; Weill Cornell Medical College, 21 Bloomingdale Road, White Plains, NY 10065, USA.
| | - John F Clarkin
- Weill Cornell Medical College, 21 Bloomingdale Road, White Plains, NY 10065, USA
| | - Mark F Lenzenweger
- Weill Cornell Medical College, 21 Bloomingdale Road, White Plains, NY 10065, USA; State University of New York at Binghamton, Science IV, Binghamton, NY 13902, USA
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22
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Lazarus SA, Scott LN, Beeney JE, Wright AGC, Stepp SD, Pilkonis PA. Borderline personality disorder symptoms and affective responding to perceptions of rejection and acceptance from romantic versus nonromantic partners. Personal Disord 2018; 9:197-206. [PMID: 29745698 DOI: 10.1037/per0000289] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We examined event-contingent recording of daily interpersonal interactions in a diagnostically diverse sample of 101 psychiatric outpatients who were involved in a romantic relationship. We tested whether the unique effect of borderline personality disorder (BPD) symptoms on affective responses (i.e., hostility, sadness, guilt, fear, and positive affect) to perceptions of rejection or acceptance differed with one's romantic partner compared with nonromantic partners. BPD symptoms were associated with more frequent perceptions of rejection and less frequent perceptions of acceptance across the study. For all participants, perceptions of rejecting behavior were associated with higher within-person negative affect and lower within-person positive affect. As predicted, in interactions with romantic partners only, those with high BPD symptoms reported heightened hostility and, to a lesser extent, attenuated sadness in response to perceptions of rejection. BPD symptoms did not moderate associations between perceptions of rejection and guilt, fear, or positive affect across romantic and nonromantic partners. For all participants, perceived acceptance was associated with lower within-person negative affect and higher within-person positive affect. However, BPD symptoms were associated with attenuated positive affect in response to perceptions of accepting behavior in interactions with romantic partners only. BPD symptoms did not moderate associations between perceptions of acceptance and any of the negative affects across romantic and nonromantic partners. This study highlights the specificity of affective responses characteristic of BPD when comparisons are made with patients with other personality and psychiatric disorders. Implications for romantic relationship dysfunction are discussed. (PsycINFO Database Record
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Affiliation(s)
| | - Lori N Scott
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Joseph E Beeney
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | | | - Stephanie D Stepp
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Paul A Pilkonis
- Department of Psychiatry, University of Pittsburgh School of Medicine
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23
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Hopwood CJ, Good EW. Structure and correlates of interpersonal problems and sensitivities. J Pers 2018; 87:843-855. [PMID: 30320881 DOI: 10.1111/jopy.12437] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 01/12/2018] [Accepted: 08/28/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Interpersonal dysfunction is an important marker of individual differences in personality and well-being. Existing research on interpersonal dysfunction focuses primarily on the problematic behaviors of individuals without considering how sensitivity to others' behavior impacts functioning. In this study, we test the structure and correlates of a model of relationship dysfunction that integrates the problems individuals bring to relationships with their sensitivities to others' behavior. We specifically examine the conjoint structure of interpersonal problems and sensitivities using a circumplex framework and associations between dimensions derived from this structure and personality, well-being, attachment, and response style variables. METHOD We evaluated competing measurement models and examined validity correlations of interpersonal problems and sensitivities in two samples (Study 1: N = 955; 79.2% women; Mage = 19.43; Study 2: N = 1,005; 72.1% women; Mage = 19.77). RESULTS Six factors capturing general (nonspecific problems and sensitivities) and stylistic (warmth and dominance for both problems and sensitivities) variation in interpersonal dysfunction were empirically distinguishable and provided incremental information about external criteria. CONCLUSIONS Results support problems and sensitivities as overlapping but distinct sources of information about interpersonal dysfunction, and they specifically suggest an integrative six-factor model with considerable potential for future research.
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Affiliation(s)
| | - Evan W Good
- Department of Psychology, Michigan State University, East Lansing, Michigan
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24
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Everyday social interactions and intra-individual variability in affect: A systematic review and meta-analysis of ecological momentary assessment studies. MOTIVATION AND EMOTION 2018. [DOI: 10.1007/s11031-018-9735-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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25
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Hopwood CJ. Interpersonal Dynamics in Personality and Personality Disorders. EUROPEAN JOURNAL OF PERSONALITY 2018. [DOI: 10.1002/per.2155] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Clinical and basic personality psychologists interact less than they should, given their similar interests. In clinical personality psychology, available evidence supports a transition from the current categorical system to a hierarchical trait scheme for diagnosing the stable features of personality disorder. However, trait models do not capture the dynamic aspects of personality disorders as they have been described in the clinical literature, and thus miss a clinically critical feature of personality pathology. In contrast, basic personality psychologists have coalesced around a consensual structure of individual differences and become increasingly interested in the dynamic processes that underlie and contextualize traits. But trait psychology models are not sufficiently specific to characterize dynamic personality processes. In this paper, I filter clinical descriptions of personality disorders through the lens of interpersonal theory to specify a recursive within–situation interpersonal pattern of motives, affects, behaviours, and perceptions that could contribute to the stable between–situation patterns of maladaptive behaviour of historical interest to both basic and clinical personality psychologists. I suggest that this interpersonal model adds specificity to recent proposals regarding processes in the basic personality literature and has significant potential to advance research on personality dynamics. © 2018 European Association of Personality Psychology
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26
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An interpersonal perspective on Criterion A of the DSM-5 Alternative Model for Personality Disorders. Curr Opin Psychol 2018; 21:11-17. [DOI: 10.1016/j.copsyc.2017.08.035] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/27/2017] [Accepted: 08/29/2017] [Indexed: 11/21/2022]
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27
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Lischke A, Herpertz SC, Berger C, Domes G, Gamer M. Divergent effects of oxytocin on (para-)limbic reactivity to emotional and neutral scenes in females with and without borderline personality disorder. Soc Cogn Affect Neurosci 2018; 12:1783-1792. [PMID: 29036358 PMCID: PMC5714167 DOI: 10.1093/scan/nsx107] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 09/11/2017] [Indexed: 12/31/2022] Open
Abstract
Borderline personality disorder (BPD) patients’ hypersensitivity for emotionally relevant stimuli has been suggested be due to abnormal activity and connectivity in (para-)limbic and prefrontal brain regions during stimulus processing. The neuropeptide oxytocin has been shown to modulate activity and functional connectivity in these brain regions, thereby optimizing the processing of emotional and neutral stimuli. To investigate whether oxytocin would be capable of attenuating BPD patients’ hypersensitivity for such stimuli, we recorded brain activity and gaze behavior during the processing of complex scenes in 51 females with and 48 without BPD after intranasal application of either oxytocin or placebo. We found divergent effects of oxytocin on BPD and healthy control (HC) participants’ (para-)limbic reactivity to emotional and neutral scenes: Oxytocin decreased amygdala and insula reactivity in BPD participants but increased it in HC participants, indicating an oxytocin-induced normalization of amygdala and insula activity during scene processing. In addition, oxytocin normalized the abnormal coupling between amygdala activity and gaze behavior across all scenes in BPD participants. Overall, these findings suggest that oxytocin may be capable of attenuating BPD patients’ hypersensitivity for complex scenes, irrespective of their valence.
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Affiliation(s)
- Alexander Lischke
- Department of Psychology, University of Greifswald, Greifswald, Germany.,Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany.,Department of Psychiatry and Psychotherapy, University of Rostock, Rostock, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Christoph Berger
- Department of Psychiatry and Psychotherapy, University of Rostock, Rostock, Germany.,Department of Child and Adolescent Psychiatry, Neurology, Psychosomatics and Psychotherapy, University of Rostock, Rostock, Germany
| | - Gregor Domes
- Department of Psychology, University of Trier, Trier, Germany
| | - Matthias Gamer
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Psychology, University of Würzburg, Würzburg, Germany
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28
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29
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Abstract
Anger and low self-esteem characterize borderline individuals, yet little is known about their role and impact in the presence or absence of self-injury behavior. The present study aimed to investigate the impact of anger and self-esteem in borderline patients and whether these variables distinguish these patients with and without self-injury. Patients were recruited from a psychiatric service and were evaluated for self-esteem and anger. Additionally, impulsivity and symptoms were assessed. Two groups were compared, one with self-injurious behavior (n = 18) and another one without it (n = 23). Those who injure themselves seem to have a lower self-esteem (p < 0.001), yet the strengthening of self-esteem seems to have different outcomes, according to the presence or absence of self-injury. Anger and self-esteem seem to influence the severity of diagnosis, but only in patients who self-injure. Anger and self-esteem may influence borderline patients differently according to the presence or absence of self-injury.
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30
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Cain NM, Meehan KB, Roche MJ, Clarkin JF, De Panfilis C. Effortful Control and Interpersonal Behavior in Daily Life. J Pers Assess 2018; 101:315-325. [DOI: 10.1080/00223891.2018.1441151] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
| | - Kevin B. Meehan
- Department of Psychology, Long Island University
- Department of Psychiatry, Weill Medical College of Cornell University
| | - Michael J. Roche
- Department of Psychology, The Pennsylvania State University at Altoona
| | - John F. Clarkin
- Department of Psychiatry, Weill Medical College of Cornell University
| | - Chiara De Panfilis
- Department of Neuroscience, Unit of Psychiatry, University of Parma, Parma, Italy
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31
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Hepp J, Lane SP, Wycoff AM, Carpenter RW, Trull TJ. Interpersonal stressors and negative affect in individuals with borderline personality disorder and community adults in daily life: A replication and extension. JOURNAL OF ABNORMAL PSYCHOLOGY 2018; 127:183-189. [PMID: 29528672 PMCID: PMC5851290 DOI: 10.1037/abn0000318] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Affective instability and interpersonal stress are key features of borderline personality disorder (BPD). They were shown to covary in the daily lives of patients in a recent ambulatory assessment study (Hepp et al., 2017) that observed comparatively larger positive associations between interpersonal stressors and negative affect in individuals with BPD than those with depressive disorders. The present study sought to replicate these findings, collecting data on hostility, sadness, fear, and rejection or disagreement events from 56 BPD and 60 community control participants for 21 days, 6 times a day. Using identical statistical procedures, the positive associations between momentary rejection/disagreement and hostility, sadness, and fear were replicated. Again replicating the original study, the rejection-hostility, rejection-sadness, and disagreement-hostility associations were significantly stronger in the BPD group. Time-lagged analyses extended the original study, revealing that rejection was associated with subsequent hostility and sadness more strongly in the BPD group, as was disagreement with subsequent hostility and fear. Though small, we argue that the observed group differences reflect meaningful pervasive responses in a daily life context. Future research should consider these when implementing affect regulation strategies that are applicable in interpersonal contexts for all individuals, but particularly those with BPD. (PsycINFO Database Record
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Affiliation(s)
- Johanna Hepp
- Department of Psychosomatic Medicine, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Sean P. Lane
- Department of Psychological Sciences, Purdue University, West Lafayette, IN, USA
| | - Andrea M. Wycoff
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - Ryan W. Carpenter
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - Timothy J. Trull
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
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32
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Cognitive distortions in anorexia nervosa and borderline personality disorder. Psychiatry Res 2018; 260:164-172. [PMID: 29197752 DOI: 10.1016/j.psychres.2017.11.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 10/23/2017] [Accepted: 11/15/2017] [Indexed: 11/20/2022]
Abstract
Thought-shape fusion (TSF) is a cognitive distortion associated with eating disorders (ED). A similar distortion, thought-abandonment fusion (TAbF), is assumed to occur in borderline personality disorder (BPD). In this study the specificity of TSF in participants with anorexia nervosa (AN) and TAbF in participants with BPD was examined. 63 patients completed questionnaires assessing the manifestation of trait-TAbF and trait-TSF, as well as relevant psychopathology. Nonparametric conditional inference trees were used to test for cognitive disorder-specificity. Participants with AN exhibited higher trait-TSF-scores than those with BPD, when participants with BPD and a co-occurring AN were removed. Trait-TSF in participants with AN seemed to be disorder-specific. Participants with BPD and a co-occurring AN had the highest TAbF-scores. The specificity hypothesis could only be partially confirmed for trait-TAbF: while participants with BPD and a co-occurring AN tended to have the highest trait-TAbF scores, high mean values could also be found in participants with AN. The results indicate that TAbF is not specific to BPD, but may also play a role in AN. Both distortions seem to play a role in the maintenance of the respective disorders.
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33
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Houben M, Claes L, Sleuwaegen E, Berens A, Vansteelandt K. Emotional reactivity to appraisals in patients with a borderline personality disorder: a daily life study. Borderline Personal Disord Emot Dysregul 2018; 5:18. [PMID: 30459949 PMCID: PMC6234606 DOI: 10.1186/s40479-018-0095-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 10/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emotional instability, consisting of patterns of strong emotional changes over time, has consistently been demonstrated in daily life of patients with a borderline personality disorder (BPD). Yet, little empirical work has examined emotional changes that occur specifically in response to emotional triggers in daily life, so-called emotional reactivity. The goal of this study was to examine emotional reactivity in response to general emotional appraisals (i.e. goal congruence or valence, goal relevance or importance, and emotion-focused coping potential) and BPD-specific evaluations (trust and disappointment in self and others) in daily life of inpatients with BPD. METHODS Thirty inpatients with BPD and 28 healthy controls participated in an experience sampling study and repeatedly rated the intensity of their current emotions, emotional appraisals, and evaluations of trust and disappointment in self and others. RESULTS Results showed that the BPD group exhibited stronger emotional reactivity in terms of negative affect than healthy controls, however only in response to disappointment in someone else. BPD patients also showed weaker reactivity in positive affect in response to the appraised importance of a situation; the more a situation was appraised as important, the higher the subsequent positive affect for healthy controls only, not the patient group. CONCLUSIONS These findings show that appraisals can trigger strong emotional reactions in BPD patients, and suggest that altered emotional reactivity might be a potential underlying process of emotional instability in the daily life.
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Affiliation(s)
- Marlies Houben
- 1Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, Box 3713, 3000 Leuven, Belgium
| | - Laurence Claes
- 1Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, Box 3713, 3000 Leuven, Belgium.,2Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Ellen Sleuwaegen
- 2Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.,3University Department of Psychiatry, Campus Psychiatric Hospital Duffel, Stationsstraat 22c, 2570 Duffel, Belgium
| | - Ann Berens
- 3University Department of Psychiatry, Campus Psychiatric Hospital Duffel, Stationsstraat 22c, 2570 Duffel, Belgium
| | - Kristof Vansteelandt
- 4KU Leuven, University Psychiatric Center KU Leuven, Leuvensesteenweg 517, 3070 Kortenberg, Belgium
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34
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Quek J, Newman LK, Bennett C, Gordon MS, Saeedi N, Melvin GA. Reflective function mediates the relationship between emotional maltreatment and borderline pathology in adolescents: A preliminary investigation. CHILD ABUSE & NEGLECT 2017; 72:215-226. [PMID: 28841475 DOI: 10.1016/j.chiabu.2017.08.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 06/10/2017] [Accepted: 08/06/2017] [Indexed: 06/07/2023]
Abstract
Deficits in mentalizing, particularly within the context of attachment relationships i.e., reflective function (RF), are posited to result from childhood maltreatment and to influence the development of borderline personality disorder (BPD). Whilst a mentalization-based model of BPD provides a theoretical explanation, direct empirical support for this model, in linking childhood maltreatment to borderline pathology remains limited. This study examined the interrrelationships between childhood maltreatment, RF, and borderline pathology in a mixed adolescent sample, consisting of adolescents with BPD (n=26) and a group of non-clinical adolescents (n=25). With the aim of directly testing the mentalization-based model of BPD, we additionally investigated the influence of each form of childhood maltreatment within this developmental pathway. Self-report data supported the hypothesized indirect effect of childhood maltreatment on elevated borderline pathology through lowered RF in adolescents. Both emotional abuse and emotional neglect were found to indirectly influence borderline pathology through adolescent RF, however, only emotional abuse indirectly influenced borderline pathology through RF, after all other maltreatment types were controlled for. Findings support the promotion of mentalization, within attachment-related contexts, as an intervention target for adolescents with borderline pathology and as a potential target of prevention for at-risk children and adolescents with histories of childhood maltreatment, especially emotional abuse. Future research should delineate other underlying mechanisms, independent of RF, which may also link the influence of childhood maltreatment, and in particular, emotional abuse, to BPD.
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Affiliation(s)
- Jeremy Quek
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Louise K Newman
- Centre for Women's Mental Health, The Royal Women's Hospital, Melbourne, Australia; Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Clair Bennett
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Michael S Gordon
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; Early in Life Mental Health Service, Monash Health, Melbourne, Australia
| | - Naysun Saeedi
- Early in Life Mental Health Service, Monash Health, Melbourne, Australia
| | - Glenn A Melvin
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia.
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Clarkin JF, Cain NM, Lenzenweger MF. Advances in transference-focused psychotherapy derived from the study of borderline personality disorder: clinical insights with a focus on mechanism. Curr Opin Psychol 2017; 21:80-85. [PMID: 29065381 DOI: 10.1016/j.copsyc.2017.09.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/12/2017] [Accepted: 09/15/2017] [Indexed: 10/18/2022]
Abstract
The most current conceptualization of personality pathology emphasizes the assessment of the severity of selected domains of functioning involving lack of accurate perceptions of self and others that are common across the personality disorder categories. Advances in our understanding of personality pathology have stimulated further development of Transference-Focused Psychotherapy (TFP) for patients with borderline personality disorder, including treatment focus on both behavior and mental representations of self and others, the trajectory of change in TFP, and the extension of TFP principles to the entire domain of personality pathology.
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Affiliation(s)
- John F Clarkin
- Clinical Professor of Psychology in Psychiatry, Weill Cornell Medical College, New York, NY, USA.
| | - Nicole M Cain
- Associate Professor of Psychology, Long Island University-Brooklyn, USA
| | - Mark F Lenzenweger
- Distinguished Professor of Psychology, Binghamton University, The State University of New York, Binghamton, NY, USA
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Hopwood CJ, Bleidorn W. Stability and change in personality and personality disorders. Curr Opin Psychol 2017; 21:6-10. [PMID: 28923391 DOI: 10.1016/j.copsyc.2017.08.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/26/2017] [Accepted: 08/29/2017] [Indexed: 10/18/2022]
Abstract
In this paper, we review recent findings related to stability and change in personality and personality disorder. Estimates of stability vary depending on a number of methodological and substantive factors. These factors include the type of stability being examined, the type of construct being assessed, the method being used to assess personality, how participants are sampled, and developmental trends in personality stability and change. We describe current evidence about personality stability with respect to each of these factors. We conclude that current gaps in the literature can be filled by more carefully attending to factors that impact estimates of stability and change, and provide recommendations about how future research can fill those gaps.
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Unoka Z, Vizin G, Bjelik A, Radics D, Nemeth D, Janacsek K. Intact implicit statistical learning in borderline personality disorder. Psychiatry Res 2017; 255:373-381. [PMID: 28662479 DOI: 10.1016/j.psychres.2017.06.072] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 05/14/2017] [Accepted: 06/21/2017] [Indexed: 10/19/2022]
Abstract
Wide-spread neuropsychological deficits have been identified in borderline personality disorder (BPD). Previous research found impairments in decision making, declarative memory, working memory and executive functions; however, no studies have focused on implicit learning in BPD yet. The aim of our study was to investigate implicit statistical learning by comparing learning performance of 19 BPD patients and 19 healthy, age-, education- and gender-matched controls on a probabilistic sequence learning task. Moreover, we also tested whether participants retain the acquired knowledge after a delay period. To this end, participants were retested on a shorter version of the same task 24h after the learning phase. We found intact implicit statistical learning as well as retention of the acquired knowledge in this personality disorder. BPD patients seem to be able to extract and represent regularities implicitly, which is in line with the notion that implicit learning is less susceptible to illness compared to the more explicit processes.
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Affiliation(s)
- Zsolt Unoka
- Department of Psychotherapy and Psychiatry, Semmelweis University, Budapest, Hungary
| | - Gabriella Vizin
- Department of Psychotherapy and Psychiatry, Semmelweis University, Budapest, Hungary
| | - Anna Bjelik
- Department of Psychotherapy and Psychiatry, Semmelweis University, Budapest, Hungary
| | - Dóra Radics
- Department of Psychotherapy and Psychiatry, Semmelweis University, Budapest, Hungary
| | - Dezso Nemeth
- Institute of Psychology, Eötvös Loránd University, Izabella utca 46., H-1064 Budapest, Hungary; MTA-ELTE NAP B Brain, Memory and Language Research Group, Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, Hungarian Academy of Sciences, Magyar tudósok körútja 2., H-1117 Budapest, Hungary.
| | - Karolina Janacsek
- Institute of Psychology, Eötvös Loránd University, Izabella utca 46., H-1064 Budapest, Hungary; MTA-ELTE NAP B Brain, Memory and Language Research Group, Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, Hungarian Academy of Sciences, Magyar tudósok körútja 2., H-1117 Budapest, Hungary
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Mneimne M, Fleeson W, Arnold EM, Furr RM. Differentiating the everyday emotion dynamics of borderline personality disorder from major depressive disorder and bipolar disorder. Personal Disord 2017; 9:192-196. [PMID: 28557468 DOI: 10.1037/per0000255] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A major barrier to the understanding of emotion dynamics in borderline personality disorder (BPD) lies in its substantial comorbidity with major depressive disorder (MDD) and bipolar disorder (BD). Whereas BPD has often been characterized in terms of dynamic emotional processes, including instability, reactivity, and inertia, its substantial comorbidity with MDD and BD makes it difficult to discern the specificity of these dynamics. To differentiate the emotion dynamics of BPD from those of MDD and BD, an experience sampling study of 38 participants with BPD, 15 participants with MDD, 14 participants with BD, and 62 healthy controls obtained reports of interpersonal challenges and emotions 5 times daily for 2 weeks. Interpersonal challenges included rejection, betrayal, abandonment, offense, disappointment, and self-image challenge; emotions included anger, excitement, guilt, happiness, irritability, and shame. Multilevel analyses revealed that heightened interpersonal reactivity of guilt and shame and heightened inertia of shame were relatively specific to BPD. These findings could not be accounted for by the presence of current MDD or BD. By contrast, heightened instability of anger and irritability and heightened inertia of irritability appeared to be largely transdiagnostic. Implications for clinical assessment, research, and theory are discussed. (PsycINFO Database Record
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40
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Hepp J, Lane SP, Carpenter RW, Niedtfeld I, Brown WC, Trull TJ. Interpersonal problems and negative affect in Borderline Personality and Depressive Disorders in daily life. Clin Psychol Sci 2017; 5:470-484. [PMID: 28529826 PMCID: PMC5436804 DOI: 10.1177/2167702616677312] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Theories of Borderline Personality Disorder (BPD) suggest that interpersonal problems in BPD act as triggers for negative affect and, at the same time, are a possible result of affective dysregulation. Therefore, we assessed the relations between momentary negative affect (hostility, sadness, fear) and interpersonal problems (rejection, disagreement) in a sample of 80 BPD and 51 depressed outpatients at 6 time-points over 28 days. Data were analyzed using multivariate multi-level modeling to separate momentary-, day-, and person-level effects. Results revealed a mutually reinforcing relationship between disagreement and hostility, rejection and hostility, and between rejection and sadness in both groups, at the momentary and day level. The mutual reinforcement between hostility and rejection/disagreement was significantly stronger in the BPD group. Moreover, the link between rejection and sadness was present at all three levels of analysis for the BPD group, while it was localized to the momentary level in the depressed group.
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Affiliation(s)
- Johanna Hepp
- Department of Psychosomatic Medicine, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University; address: C4, 11, 68159 Mannheim, Germany
| | - Sean P Lane
- Department of Psychological Sciences, Purdue University, West Lafayette, IN, USA
| | - Ryan W Carpenter
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - Inga Niedtfeld
- Department of Psychosomatic Medicine, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University; address: C4, 11, 68159 Mannheim, Germany
| | - Whitney C Brown
- Research Institute on Addiction, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Timothy J Trull
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
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Scott LN, Wright AGC, Beeney JE, Lazarus SA, Pilkonis PA, Stepp SD. Borderline personality disorder symptoms and aggression: A within-person process model. JOURNAL OF ABNORMAL PSYCHOLOGY 2017; 126:429-440. [PMID: 28383936 PMCID: PMC5480678 DOI: 10.1037/abn0000272] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Theoretical and empirical work suggests that aggression in those with borderline personality disorder (BPD) occurs primarily in the context of emotional reactivity, especially anger and shame, in response to perceived rejection. Using intensive repeated measures, we examined a within-person process model in which perceived rejection predicts increases in aggressive urges and behaviors via increases in negative affect (indirect effect) and in which BPD symptoms exacerbate this process (moderated mediation). Participants were 117 emerging adult women (ages 18-24) with recent histories of aggressive behavior who were recruited from a community-based longitudinal study of at-risk youth. Personality disorder symptoms were assessed by semistructured clinical interview, and aggressive urges, threats, and behaviors were measured in daily life during a 3-week ecological momentary assessment protocol. Multilevel path models revealed that within-person increases in perceived rejection predicted increases in negative affect, especially in women with greater BPD symptoms. In turn, increases in negative affect predicted increased likelihood of aggressive urges or behaviors. Further analysis revealed that BPD symptoms predicted greater anger and shame reactivity to perceived rejection, but not to criticism or insult. Additionally, only anger was associated with increases in aggression after controlling for other negative emotions. Whereas BPD symptoms exacerbated the link between perceived rejection and aggression via increases in negative affect (particularly anger), this process was attenuated in women with greater antisocial personality disorder symptoms. These findings suggest that anger reactivity to perceived rejection is one unique pathway, distinct from antisocial personality disorder, by which BPD symptoms increase risk for aggression. (PsycINFO Database Record
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Reichenberger J, Eibl JJ, Pfaltz M, Wilhelm FH, Voderholzer U, Hillert A, Blechert J. Don't Praise Me, Don't Chase Me: Emotional Reactivity to Positive and Negative Social-Evaluative Videos in Patients With Borderline Personality Disorder. J Pers Disord 2017; 31:75-89. [PMID: 26845528 DOI: 10.1521/pedi_2016_30_238] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Diagnostic criteria for borderline personality disorder (BPD) include interpersonal problems and high reactivity to negative social interactions. However, experimental studies on these symptoms are scarce, and it remains unclear whether reactivity is also altered in response to positive social interactions. To simulate such situations, the present study used videographic stimuli (E.Vids; Blechert, Schwitalla, & Wilhelm, 2013) in which actors express rejecting, neutral, or appreciating sentences. Twenty BPD patients and 20 healthy controls rated their emotional responses to these on pleasantness, arousal, and 11 specific emotions. In addition to elevated reactivity to negative E.Vids, patients with BPD showed marked reduction in pleasantness responses to positive E.Vids. Furthermore, they exhibited less pride, happiness, feelings of approval, and attraction/love in response to positive videos and more anger, anxiety, embarrassment, contempt, guilt, feelings of disapproval/rejection, and sadness to negative videos. Interestingly, BPD patients also reported negative emotions in response to positive videos. Implications for psychotherapy and research are discussed.
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Affiliation(s)
- Julia Reichenberger
- Centre for Cognitive Neuroscience, University of Salzburg, and Department of Psychology, University of Salzburg
| | | | | | - Frank H Wilhelm
- Department of Psychology, Division of Clinical Psychology, Health Psychology and Psychotherapy, University of Salzburg
| | | | | | - Jens Blechert
- Centre for Cognitive Neuroscience, University of Salzburg, and Department of Psychology, University of Salzburg
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Chaudhury SR, Galfalvy H, Biggs E, Choo TH, Mann JJ, Stanley B. Affect in response to stressors and coping strategies: an ecological momentary assessment study of borderline personality disorder. Borderline Personal Disord Emot Dysregul 2017; 4:8. [PMID: 28533905 PMCID: PMC5438851 DOI: 10.1186/s40479-017-0059-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 03/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Affect instability is a core symptom of borderline personality disorder (BPD). Ecological momentary assessment allows for an understanding of real-time changes in affect in response to various daily stressors. The purpose of this study was to explore changes in affect in response to specific stressors and coping strategies in subjects with BPD utilizing ecological momentary assessment (EMA) methodology. METHODS Subjects (n = 50) with BPD were asked to complete real-time assessments about stressors experienced, affect felt, and coping strategies employed six times per day for a 1-week period. Mixed effect regression models were used to measure the effect of stressors and coping strategies on affect change. RESULTS While most stressors led to experiencing more negative affect, only being in a disagreement was independently associated with increased negative affect. Among coping strategies, only doing something good for oneself independently reduced negative affect, controlling for all other coping strategies used. CONCLUSIONS These findings provide valuable insights into affective instability in BPD and can help inform treatment with individuals with the disorder.
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Affiliation(s)
- Sadia R Chaudhury
- New York State Psychiatric Institute/Columbia University, 1051 Riverside Drive, Unit 42, New York, NY 10032 USA
| | - Hanga Galfalvy
- New York State Psychiatric Institute/Columbia University, 1051 Riverside Drive, Unit 42, New York, NY 10032 USA
| | - Emily Biggs
- New York State Psychiatric Institute/Columbia University, 1051 Riverside Drive, Unit 42, New York, NY 10032 USA
| | - Tse-Hwei Choo
- New York State Psychiatric Institute/Columbia University, 1051 Riverside Drive, Unit 42, New York, NY 10032 USA
| | - J John Mann
- New York State Psychiatric Institute/Columbia University, 1051 Riverside Drive, Unit 42, New York, NY 10032 USA
| | - Barbara Stanley
- New York State Psychiatric Institute/Columbia University, 1051 Riverside Drive, Unit 42, New York, NY 10032 USA
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Dixon-Gordon KL, Peters JR, Fertuck EA, Yen S. Emotional Processes in Borderline Personality Disorder: An Update for Clinical Practice. JOURNAL OF PSYCHOTHERAPY INTEGRATION 2017; 27:425-438. [PMID: 29527105 PMCID: PMC5842953 DOI: 10.1037/int0000044] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite prior assumptions about poor prognosis, the surge in research on borderline personality disorder (BPD) over the past several decades shows that it is treatable and can have a good prognosis. Prominent theories of BPD highlight the importance of emotional dysfunction as core to this disorder. However, recent empirical research suggests a more nuanced view of emotional dysfunction in BPD. This research is reviewed in the present article, with a view towards how these laboratory-based findings can influence clinical work with individuals suffering from BPD.
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Affiliation(s)
- Katherine L Dixon-Gordon
- University of Massachusetts Amherst, Department of Psychological and Brain Science, 135 Hicks Way, Amherst, MA 01002
| | - Jessica R Peters
- Alpert Brown Medical School, Department of Psychiatry and Human Behavior, Box G-BH, Providence, Rhode Island 02912
| | - Eric A Fertuck
- The City College of New York, The City University of New York, 160 Convent Avenue, North Academic Center, Room 7/239, New York, NY 10031
- New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032
| | - Shirley Yen
- Alpert Brown Medical School, Department of Psychiatry and Human Behavior, Box G-BH, Providence, Rhode Island 02912
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Köhling J, Moessner M, Ehrenthal JC, Bauer S, Cierpka M, Kämmerer A, Schauenburg H, Dinger U. Affective Instability and Reactivity in Depressed Patients With and Without Borderline Pathology. J Pers Disord 2016; 30:776-795. [PMID: 26623534 DOI: 10.1521/pedi_2015_29_230] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The quality of depression in borderline personality disorder (BPD) was reported to differ from that in patients with major depressive disorder (MDD) only. However, little is known about affect dynamics in "borderline-depression." The authors assessed affective instability and reactivity in 20 MDD patients with BPD and in 21 MDD patients without BPD by Ambulatory Assessment. Participants reported on current affect, daily events, and attribution of affective states to events five times per day over a 7-day period. The results do not indicate higher affective instability in MDD patients with BPD comorbidity. Depressed patients with BPD reported less subjectively perceived affective reactivity, while observed associations between events and affect were not different between groups, except for one finding: In depressed patients with BPD, overall mood was lower after being alone. These findings suggest impaired attribution of mood changes and less tolerance of being alone as specific for depression in BPD.
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46
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De Panfilis C, Meehan KB, Cain NM, Clarkin JF. Effortful Control, Rejection Sensitivity, and Borderline Personality Disorder Features in Adulthood. J Pers Disord 2016; 30:595-612. [PMID: 26623540 DOI: 10.1521/pedi_2015_29_226] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This investigation examined the moderating role of effortful control (EC) in the association between rejection sensitivity (RS) and its subsequent interpersonal distress (IP-distress) on borderline personality disorder (BPD) features. In total, 625 multicultural undergraduates (Study 1) and 562 community international adults (Study 2) completed scales evaluating EC, RS, IP-distress, and BPD features; Study 2 participants also self-reported both anxious and angry expectations of rejection. In both samples, EC moderated the mediating effect of IP-distress in the link between RS and BPD-related psychopathology. The extent to which RS was associated with BPD symptoms through increased IP-distress was greater for individuals with low EC and less so for those with high EC. Thus, low self-regulatory abilities may foster the association between RS and BPD by magnifying interpersonal distress. The implications and limitations of findings are discussed.
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Affiliation(s)
- Chiara De Panfilis
- Department of Neuroscience, Unit of Psychiatry, University of Parma, Italy.,Personality Disorders Lab, Parma, Italy
| | - Kevin B Meehan
- Department of Psychology, PhD Program in Clinical Psychology, Long Island University Brooklyn Campus, Brooklyn, New York, USA.,Department of Psychiatry, Weill Medical College of Cornell University, White Plains, New York, USA
| | - Nicole M Cain
- Department of Psychology, PhD Program in Clinical Psychology, Long Island University Brooklyn Campus, Brooklyn, New York, USA
| | - John F Clarkin
- Department of Psychiatry, Weill Medical College of Cornell University, White Plains, New York, USA
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Simons JS, Emery NN, Simons RM, Wills TA, Webb MK. Effects of alcohol, rumination, and gender on the time course of negative affect. Cogn Emot 2016; 31:1405-1418. [PMID: 27609298 DOI: 10.1080/02699931.2016.1226162] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This study modelled associations between gender, ruminative cognitive style, alcohol use, and the time course of negative affect over the course of 43,111 random assessments in the natural environment. Participants (N = 263) completed 49 days of experience sampling over 1.3 years. The data indicated that rumination at baseline was positively associated with alcohol dependence symptoms at baseline as well as higher negative affect over the course of the study. Consistent with negative reinforcement models, drinking served to decrease the persistence of negative affect from moment to moment. However, this ameliorative effect of drinking was evident only among women, suggesting an increased risk for negative reinforcement driven drinking behaviour. In addition, rumination appeared to counteract the desired effects of alcohol on mood among women. This suggests that women who ruminate more may be motivated to consume larger amounts of alcohol to achieve the desired effects. Overall, the results indicate that ruminative cognitive style and the persistence of negative affect from moment to moment may reflect an individual vulnerability for the development of alcohol use disorder especially among women.
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Affiliation(s)
- Jeffrey S Simons
- a Department of Psychology , University of South Dakota , Vermilion , SD , USA
| | - Noah N Emery
- a Department of Psychology , University of South Dakota , Vermilion , SD , USA
| | - Raluca M Simons
- a Department of Psychology , University of South Dakota , Vermilion , SD , USA
| | - Thomas A Wills
- b Prevention and Control Program , University of Hawaii Cancer Center , Honolulu , HI , USA
| | - Michael K Webb
- a Department of Psychology , University of South Dakota , Vermilion , SD , USA
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Wright AGC, Simms LJ. Stability and fluctuation of personality disorder features in daily life. JOURNAL OF ABNORMAL PSYCHOLOGY 2016; 125:641-56. [PMID: 27196437 PMCID: PMC4925296 DOI: 10.1037/abn0000169] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Very little is known about the daily stability and fluctuation of personality pathology. To address this gap in knowledge, we investigated the naturalistic manifestation of personality pathology over the course of 100 days. A group of individuals (N = 101) diagnosed with any personality disorder (PD) completed a daily diary study over 100 consecutive days (Mdn = 94 days, range = 33-101 days). Participants completed daily ratings of 30 manifestations of personality pathology. Patterns of stability and variability over the course of the study were then examined. Results indicated that individual PD manifestations and domains of PD manifestations were variable across days and differed widely in their frequency. Additionally, individual averages and level of variability in PD domains were highly stable across months, individual averages of PD domains were predicted by baseline dispositional ratings of PD traits with a high degree of specificity, and daily variability PD domains was associated with elevated levels of PD traits. This pattern of findings suggests that dynamic processes of symptom exacerbation and diminution that are stable in mean level and variability in expression over time characterizes personality pathology. Further, dispositional ratings are significant predictors of average daily expression of PD features. (PsycINFO Database Record
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Affiliation(s)
| | - Leonard J Simms
- Department of Psychology, University at Buffalo, State University of New York
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49
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Law MK, Fleeson W, Arnold EM, Furr RM. Using Negative Emotions to Trace the Experience of Borderline Personality Pathology: Interconnected Relationships Revealed in an Experience Sampling Study. J Pers Disord 2016; 30:52-70. [PMID: 25710731 PMCID: PMC4547903 DOI: 10.1521/pedi_2015_29_180] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
While emotional difficulties are highly implicated in borderline personality disorder (BPD), the dynamic relationships between emotions and BPD symptoms that occur in everyday life are unknown. The current paper examined the function of negative emotions as they relate to BPD symptoms in real time. Experience sampling methodology with 281 participants measured negative emotions and borderline symptoms, expressed as a spectrum of experiences, five times daily for two weeks. Overall, having a BDP diagnosis was associated with experiencing more negative emotions. Multilevel modeling supported positive concurrent relationships between negative emotions and BPD symptoms. Lagged models showed that even after 3 hours negative emotions and several symptoms continued to influence each other. Therefore, results indicated that negative emotions and BPD symptoms are intricately related; some evidenced long-lasting relationships. This research supports emotion-symptom contingencies within BPD and provides insight regarding the reactivity and functionality of negative emotions in borderline pathology.
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Affiliation(s)
- Mary Kate Law
- Department of Psychology, Wake Forest University, Winston-Salem, North Carolina
| | - William Fleeson
- Department of Psychology, Wake Forest University, Winston-Salem, North Carolina
| | | | - R Michael Furr
- Department of Psychology, Wake Forest University, Winston-Salem, North Carolina
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50
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Elevated Monoamine Oxidase-A Distribution Volume in Borderline Personality Disorder Is Associated With Severity Across Mood Symptoms, Suicidality, and Cognition. Biol Psychiatry 2016; 79:117-26. [PMID: 25698585 PMCID: PMC4942262 DOI: 10.1016/j.biopsych.2014.11.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 10/31/2014] [Accepted: 11/21/2014] [Indexed: 01/19/2023]
Abstract
BACKGROUND Monoamine oxidase-A (MAO-A) is a treatment target in neurodegenerative illness and mood disorders that increases oxidative stress and predisposition toward apoptosis. Increased MAO-A levels in prefrontal cortex (PFC) and anterior cingulate cortex (ACC) occur in rodent models of depressive behavior and human studies of depressed moods. Extreme dysphoria is common in borderline personality disorder (BPD), especially when severe, and the molecular underpinnings of severe BPD are largely unknown. We hypothesized that MAO-A levels in PFC and ACC would be highest in severe BPD and would correlate with symptom magnitude. METHODS [(11)C] Harmine positron emission tomography measured MAO-A total distribution volume (MAO-A VT), an index of MAO-A density, in severe BPD subjects (n = 14), moderate BPD subjects (n = 14), subjects with a major depressive episode (MDE) only (n = 14), and healthy control subjects (n = 14). All subjects were female. RESULTS Severe BPD was associated with greater PFC and ACC MAO-A VT compared with moderate BPD, MDE, and healthy control subjects (multivariate analysis of variance group effect: F6,102 = 5.6, p < .001). In BPD, PFC and ACC MAO-A VT were positively correlated with mood symptoms (PFC: r = .52, p = .005; ACC: r = .53, p = .004) and suicidality (PFC: r = .40, p = .037; ACC: r = .38, p = .046), while hippocampus MAO-A VT was negatively correlated with verbal memory (r = -.44, p = .023). CONCLUSIONS These results suggest that elevated MAO-A VT is associated with multiple indicators of BPD severity, including BPD symptomatology, mood symptoms, suicidality, and neurocognitive impairment.
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