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Cavicchioli M, Scalabrini A, Vai B, Palumbo I, Benedetti F, Galli F, Maffei C. Antecedents and risk factors for borderline personality disorder: Etiopathogenic models based on a multi-level meta-analysis. J Affect Disord 2024; 367:442-452. [PMID: 39243819 DOI: 10.1016/j.jad.2024.08.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 07/22/2024] [Accepted: 08/31/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND Empirically-based developmental psychopathology approach identified three domains involved in the emergence of borderline personality disorder (BPD): i) underlying liabilities to develop psychopathology (i.e., early patterns of internalizing and externalizing manifestations); ii) invalidating relational experiences (e.g., childhood traumatic experiences, maladaptive parenting, problematic peer relationships); iii) regulatory mechanisms of emotions and behaviors. Nevertheless, no studies have quantitatively summarized empirical findings concerning how and to what extent these domains might be temporally associated to the emergence of BPD features from adolescence to adulthood. METHODS The current multi-level meta-analysis included 106 studies (N = 86,871 participants) assessing the role of previously mentioned antecedents and risk factors for BPD. RESULTS The analysis showed moderate effect sizes capturing temporal associations between early internalizing/externalizing psychopathological manifestations, different invalidating relational experiences, emotion/behavior regulation processes with later BPD features. The effect sizes of these domains were not statistically different from each other. CONCLUSION This evidence supports a transactional developmental model of BPD. Consistently, the emergence of BPD could be viewed in the light of dynamic interplays between an underlying liability to psychopathology and invalidating relational experiences across different stages of development, which are progressively reinforced through increasing alterations of emotion and behavior regulation mechanisms.
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Affiliation(s)
- Marco Cavicchioli
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology SAPIENZA University of Rome, Italy; Faculty of Psychology, Sigmund Freud University, Ripa di Porta Ticinese 77, Milan, Italy.
| | - Andrea Scalabrini
- Department of Human and Social Science, University of Bergamo, Italy Mental Health, Bergamo, Italy
| | - Benedetta Vai
- Psychiatry and Clinical Psychobiology Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | | | - Francesco Benedetti
- Psychiatry and Clinical Psychobiology Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Federica Galli
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology SAPIENZA University of Rome, Italy
| | - Cesare Maffei
- Faculty of Psychology, Sigmund Freud University, Ripa di Porta Ticinese 77, Milan, Italy
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Cavicchioli M, Santoni A, Chiappetta F, Deodato M, Di Dona G, Scalabrini A, Galli F, Ronconi L. Psychological dissociation and temporal integration/segregation across the senses: An experimental study. Conscious Cogn 2024; 124:103731. [PMID: 39096823 DOI: 10.1016/j.concog.2024.103731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/19/2024] [Accepted: 07/23/2024] [Indexed: 08/05/2024]
Abstract
There are no studies that have experimentally tested how temporal integration/segregation of sensory inputs might be linked to the emergence of dissociative experiences and alterations of emotional functioning. Thirty-six participants completed 3 sensory integration tasks. Psychometric thresholds were estimated as indexes of temporal integration/segregation processes. We collected self-report measures of pre-task trait levels of dissociation, as well as pre- post-task changes in both dissociation and emotionality. An independent sample of 21 subjects completed a control experiment administering the Attention Network Test. Results showed: (i) a significant increase of dissociative experiences after the completion of sensory integration tasks, but not after the ANT task; (ii) that subjective thresholds predicted the emergence of dissociative states; (iii) temporal integration efforts affected positive emotionality, which was explained by the extent of task-dependent dissociative states. The present findings reveal that dissociation could be understood in terms of an imbalance between "hyper-segregation" and "hyper-integration" processes.
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Affiliation(s)
- Marco Cavicchioli
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, SAPIENZA University of Rome, Italy; Faculty of Psychology, Sigmund Freud University, Ripa di Porta Ticinese 77, Milan, Italy.
| | - Alessia Santoni
- School of Psychology, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Michele Deodato
- Psychology Program, Division of Science, New York University Abu Dhabi, United Arab Emirates
| | - Giuseppe Di Dona
- School of Psychology, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Scalabrini
- Department of Human and Social Science, University of Bergamo, Mental Health, Bergamo, Italy
| | - Federica Galli
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, SAPIENZA University of Rome, Italy
| | - Luca Ronconi
- School of Psychology, Vita-Salute San Raffaele University, Milan, Italy
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3
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Pugliese E, Visco-Comandini F, Papa C, Ciringione L, Cornacchia L, Gino F, Cannito L, Fadda S, Mancini F. Understanding Trauma in IPV: Distinguishing Complex PTSD, PTSD, and BPD in Victims and Offenders. Brain Sci 2024; 14:856. [PMID: 39335352 PMCID: PMC11430181 DOI: 10.3390/brainsci14090856] [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: 06/23/2024] [Revised: 08/16/2024] [Accepted: 08/22/2024] [Indexed: 09/30/2024] Open
Abstract
This work aims to shed light on the differential diagnosis of complex post-traumatic stress disorder (cPTSD), post-traumatic stress disorder (PTSD), and borderline personality disorder (BPD) within the context of intimate partner violence (IPV), which represents a highly innovative field of clinical research. To this end, a critical review of the literature was conducted to identify and compare the clinical patterns and symptomatic overlaps among cPTSD, PTSD, and BPD, with an emphasis on their manifestation in both IPV victims and offenders. The results show that despite some symptomatic similarities, cPTSD, PTSD, and BPD have distinct clinical patterns of interpersonal violence. Specifically, disturbances in self-organization (DSO) are more commonly found in offenders, while the diagnosis of cPTSD seems more aligned with the psychological functioning of victims. In addition, cPTSD and specific characteristics of BPD, such as fear of rejection and instability of identity, constitute risk factors for IPV victimization. cPTSD is shown as a predisposing factor not only for IPV victims but also for offenders, while PTSD emerges as a consequential factor. The specific pathways linking PTSD, cPTSD, and BPD with IPV have significant implications for clinical practice. Further research is needed to understand these profiles and the mechanisms linking trauma-related features to IPV, which is crucial for implementing effective violence prevention programs.
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Affiliation(s)
- Erica Pugliese
- Associazione di Psicologia Cognitiva APC e Scuola di Psicoterapia Cognitiva SPC, 00185 Roma, Italy; (F.V.-C.); (C.P.)
| | - Federica Visco-Comandini
- Associazione di Psicologia Cognitiva APC e Scuola di Psicoterapia Cognitiva SPC, 00185 Roma, Italy; (F.V.-C.); (C.P.)
| | - Carolina Papa
- Associazione di Psicologia Cognitiva APC e Scuola di Psicoterapia Cognitiva SPC, 00185 Roma, Italy; (F.V.-C.); (C.P.)
- Department of Psychology, Sapienza University of Rome, 00185 Roma, Italy
| | - Luciana Ciringione
- Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy
- Scuola di Psicoterapia Cognitiva, 37122 Verona, Italy
| | | | - Fabiana Gino
- Associazione Scuola di Psicoterapia Cognitiva, 58100 Grosseto, Italy
| | - Loreta Cannito
- Department of Social Sciences, University of Foggia, 71122 Foggia, Italy
| | - Stefania Fadda
- Associazione di Psicologia Cognitiva APC e Scuola di Psicoterapia Cognitiva SPC, 00185 Roma, Italy; (F.V.-C.); (C.P.)
| | - Francesco Mancini
- Associazione di Psicologia Cognitiva APC e Scuola di Psicoterapia Cognitiva SPC, 00185 Roma, Italy; (F.V.-C.); (C.P.)
- Department of Human Sciences, Guglielmo Marconi University, 00193 Roma, Italy
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4
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Niesten IJM, Glass IV, Zanarini MC. Course and Prediction of Dissociation in Patients with Borderline Personality Disorder and Personality-Disordered Comparison Subjects: A 24-Year Follow-Up Study. J Trauma Dissociation 2024:1-15. [PMID: 39093625 DOI: 10.1080/15299732.2024.2383192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 07/08/2024] [Indexed: 08/04/2024]
Abstract
The first purpose of this study was to determine the course of dissociation among patients with borderline personality disorder (BPD) and personality-disordered comparison subjects (OPD) over 24 years of prospective follow-up. The second purpose was to determine clinically meaningful predictors of dissociation among patients with BPD. The Dissociative Experiences Scale (DES) was administered to 290 patients with BPD and 72 personality-disordered comparison subjects at baseline, and then once every two years over 24 years of prospective follow-up. Baseline predictors were assessed with the Revised Childhood Experiences Questionnaire (CEQ-R), the SCID-I, and the Shipley Institute of Living Scale. Time-varying predictors were assessed at baseline and every subsequent two years by means of the Abuse History Interview (AHI). Patients with BPD had higher baseline dissociation scores than personality-disordered comparison subjects. Whilst dissociation decreased significantly over time for both patient groups, the BPD group showed a steeper decline. Severity of childhood sexual abuse, adult history of rape, adult history of partner violence, and IQ were multivariate predictors of dissociation among patients with BPD. Taken together, the present findings suggest that a combination of interpersonal trauma exposure and cognitive abilities may contribute to the severity of dissociation in adult patients with BPD.
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Affiliation(s)
| | - Isabel V Glass
- Laboratory for the Study of Adult Development, McLean Hospital, Belmont, Massachusetts, USA
| | - Mary C Zanarini
- Laboratory for the Study of Adult Development, McLean Hospital, Belmont, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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5
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Lam SKK, Cheung CTY, Chien WT, Ross CA, Po BSK, Lee VWP, Fung HW. Trauma, Emotional Regulation, and Coping Styles in Individuals with and without Probable Dissociative Disorders in Hong Kong. J Trauma Dissociation 2024:1-19. [PMID: 38549465 DOI: 10.1080/15299732.2024.2326511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 02/02/2024] [Indexed: 04/25/2024]
Abstract
Previous studies showed that dissociation and dissociative disorders (DDs) are prevalent and are associated with considerable individual and social consequences. There are ongoing debates regarding whether dissociation is a response to betrayal trauma across cultures and whether dissociation can be explained by maladaptive coping. Additionally, little is known about the clinical features of individuals with DDs in the Chinese context. This study aimed to investigate the relationship between trauma, emotional regulation, coping, and dissociation. We analyzed baseline data from a randomized controlled trial (N = 101). Participants with dissociative symptoms in Hong Kong completed self-report assessments. Structured interviews were also conducted subsequently. Participants with probable DDs reported more traumatic events (p = .009 to .017) and exhibited significantly higher levels of dysfunctional coping (p < .001) compared to those who reported dissociative symptoms but did not have a DD. Dissociative symptoms were more strongly associated with betrayal trauma than with non-betrayal trauma. Among different emotion regulation and coping strategies, dysfunctional coping was the only significant factor associated with dissociative symptoms (β = .309, p = .003). Dysfunctional coping was a statistically significant mediator that may explain the relationship between betrayal trauma and dissociative symptoms. Although other mediation paths are also possible and further longitudinal studies are required, our findings highlight the strong link between dysfunctional coping and dissociative symptoms and suggest that coping skills training should be incorporated into interventions for betrayal trauma survivors with dissociative symptoms. Additionally, this study provides evidence for the cross-cultural validity of the betrayal trauma theory. Further studies, however, are required.
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Affiliation(s)
- Stanley Kam Ki Lam
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | | | - Wai Tong Chien
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Colin A Ross
- The Colin A. Ross Institute for Psychological Trauma, Richardson, Texas, USA
| | | | | | - Hong Wang Fung
- Department of Social Work, Hong Kong Baptist University, Hong Kong
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Cavicchioli M, Ogliari A, Maffei C, Mucci C, Scalabrini A. Dissociative Dimensions and Their Implications for Emotional Dysregulation Underlying Borderline Personality Disorder Features. J Nerv Ment Dis 2023; 211:742-751. [PMID: 37734116 DOI: 10.1097/nmd.0000000000001707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
ABSTRACT Emotion dysregulation is considered a core feature of borderline personality disorder (BPD). The role of dissociation in BPD has been discussed from different perspectives. Nevertheless, implications of dissociation for BPD features are not clear. The current study estimated mediation effects of dissociative dimensions on the relationships between several emotion regulation strategies (ERSs) and BPD features among 281 adults recruited from the general population. The online survey administered a comprehensive self-report battery for the assessment of maladaptive and adaptive ERSs together with dissociative dimensions. Borderline personality disorder features were also self-report screened. Results showed significant indirect effects of dissociation on the relationships between ERSs and BPD features. Dissociation was a full mediator of the relationship between deficits with problem-solving skills and BPD criteria. The study confirmed that emotion dysregulation is a core feature of BPD and that the dissociative dimensions should be included as relevant maladaptive mechanisms sustaining BPD emotional difficulties.
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Affiliation(s)
- Marco Cavicchioli
- Department of Psychology, University "Vita-Salute San Raffaele", Milan, Italy
| | | | - Cesare Maffei
- Department of Psychology, University "Vita-Salute San Raffaele", Milan, Italy
| | - Clara Mucci
- Department of Human and Social Science, University of Bergamo, Bergamo, Italy
| | - Andrea Scalabrini
- Department of Human and Social Science, University of Bergamo, Bergamo, Italy
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Macia KS, Carlson EB, Palmieri PA, Smith SR, Anglin DM, Ghosh Ippen C, Lieberman AF, Wong EC, Schell TL, Waelde LC. Development of a Brief Version of the Dissociative Symptoms Scale and the Reliability and Validity of DSS-B Scores in Diverse Clinical and Community Samples. Assessment 2023; 30:2058-2073. [PMID: 37653563 PMCID: PMC10478338 DOI: 10.1177/10731911221133317] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
The Dissociative Symptoms Scale (DSS) was developed to assess moderately severe types of dissociation (depersonalization, derealization, gaps in awareness and memory, and dissociative reexperiencing) that would be relevant to a range of clinical populations, including those experiencing trauma-related dissociation. The current study used data from 10 ethnically and racially diverse clinical and community samples (N = 3,879) to develop a brief version of the DSS (DSS-B). Item information curves were examined to identify items with the most precision in measuring above average levels of the latent trait within each subscale. Analyses revealed that the DSS-B preserved the factor structure and content domains of the full scale, and its scores had strong reliability and validity that were comparable to those of scores on the full measure. DSS-B scores showed high levels of measurement invariance across ethnoracial groups. Results indicate that DSS-B scores are reliable and valid in the populations studied.
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Affiliation(s)
- Kathryn S. Macia
- National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, CA, USA
- Stanford University School of Medicine, Palo Alto, CA, USA
| | - Eve B. Carlson
- National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, CA, USA
- Stanford University School of Medicine, Palo Alto, CA, USA
| | | | | | | | | | | | | | | | - Lynn C. Waelde
- Stanford University School of Medicine, Palo Alto, CA, USA
- Palo Alto University, CA, USA
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Fung HW, Wong MYC, Lam SKK, Wong ENM, Chien WT, Hung SL, Lee KH, Cui J, Ross CA. Borderline personality disorder features and their relationship with trauma and dissociation in a sample of community health service users. Borderline Personal Disord Emot Dysregul 2023; 10:22. [PMID: 37394448 DOI: 10.1186/s40479-023-00228-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 05/31/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND Previous studies have indicated that borderline personality disorder (BPD) is closely associated with trauma and dissociation. Nevertheless, BPD is a heterogeneous condition, and not all people with BPD have severe dissociation. This study examined whether the relationship of BPD features with trauma and dissociation would remain significant after controlling for some general non-specific mental health distress. We also made the first attempt to explore which specific BPD features would be particularly associated with dissociation. METHODS We analyzed survey data from a sample of community health service users in Hong Kong (N = 376). Hierarchical multiple regression and data-driven network analysis were used. RESULTS The lifetime prevalence of DSM-5 BPD was 16.0% in our sample. Of participants who met criteria for BPD, 43.3% scored above cutoff on the dissociation measures, thus possibly having clinically significant dissociative symptoms. BPD features were associated with adulthood trauma and psychoform dissociation even after controlling for age, depression and self-esteem. Network analysis showed that some BPD features - including impulsivity, identity disturbance and suicidal/self-mutilation behaviors - were particularly associated with dissociation; other BPD features such as interpersonal-related problems had relatively weak to no connection with dissociation. CONCLUSIONS Our results suggested that some particular BPD features might be dissociative in nature, although further longitudinal research is required. We argue that a trauma-informed perspective should be employed when working with clients presenting with BPD features despite these features being commonly stigmatized. Further research on the intervention needs of the people with BPD who suffer from high levels of dissociation is required.
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Affiliation(s)
- Hong Wang Fung
- Department of Social Work, Hong Kong Baptist University, Kowloon, Hong Kong.
| | - Ming Yu Claudia Wong
- Department of Health and Physical Education, The Education University of Hong Kong, Ting Kok, Hong Kong
| | - Stanley Kam Ki Lam
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Emily Nga Man Wong
- Department of Counselling and Psychology, Hong Kong Shue Yan University, North Point, Hong Kong
| | - Wai Tong Chien
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Suet Lin Hung
- Department of Social Work, Hong Kong Baptist University, Kowloon, Hong Kong.
| | - Kun-Hua Lee
- Department of Educational Psychology and Counseling, National Tsing Hua University, 521 Nan-Da Road, Hsinchu City, 30014, Taiwan
| | - Jialiang Cui
- Department of Social Work, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Colin A Ross
- The Colin A. Ross Institute for Psychological Trauma, Richardson, TX, USA
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Salmon AP, Nicol K, Kaess M, Jovev M, Betts JK, Chanen AM. Associations of state or trait dissociation with severity of psychopathology in young people with borderline personality disorder. Borderline Personal Disord Emot Dysregul 2023; 10:20. [PMID: 37303050 DOI: 10.1186/s40479-023-00226-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 05/22/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND State and trait dissociation are associated with borderline personality disorder (BPD) severity and severity of commonly co-occurring mental health symptoms. Although these distinct constructs do not consistently co-occur in experimental settings, they are frequently reported as the same construct, namely dissociation. This study aimed to investigate the co-occurrence of state and trait dissociation among young people with BPD and to examine whether state or trait dissociation were associated with symptom severity in this population. METHODS State dissociation was induced using a stressful behavioural task in a clinical sample of 51 young people (aged 15-25 years) with three or more BPD features. Diagnoses, state and trait dissociation, BPD severity and severity of posttraumatic stress disorder (PTSD), depressive, and stress symptoms were assessed by self-report or research interview. RESULTS A chi-square test of independence showed a strong association between state and trait dissociation. Bonferroni corrected t-tests showed that state dissociation was significantly associated with PTSD symptom severity and likely associated with BPD severity and severity of depressive and stress symptoms. Trait dissociation was not associated with symptom severity or severity of BPD features. CONCLUSIONS These findings highlight the need to distinguish between state and trait dissociation in personality disorder research. They suggest that state dissociation might be an indicator of higher severity of psychopathology in young people with BPD.
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Affiliation(s)
- Ashleigh P Salmon
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Katie Nicol
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Jennifer K Betts
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Andrew M Chanen
- Orygen, Melbourne, Australia.
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia.
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Zanarini MC, Martinho E, Temes CM, Glass IV, Aguirre BA, Goodman M, Fitzmaurice GM. Dissociative experiences of adolescents with borderline personality disorder: description and prediction. Borderline Personal Disord Emot Dysregul 2023; 10:9. [PMID: 36895048 PMCID: PMC9999594 DOI: 10.1186/s40479-023-00217-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/02/2023] [Indexed: 03/11/2023] Open
Abstract
AIMS The first purpose of this study was to assess the severity of dissociative experiences reported by adolescent inpatients with borderline personality disorder (BPD). The second purpose was to compare the severity of their dissociative symptoms to those reported by a sample of adult inpatients with BPD. The third purpose of this study was to assess a range of clinically meaningful predictors of the severity of dissociation in adolescents and adults with BPD. METHODS The Dissociative Experiences Scale (DES) was administered to a total of 89 hospitalized girls and boys aged 13-17 with BPD and 290 adult inpatients with BPD. Predictors of the severity of dissociation in adolescents and adults with BPD were assessed using the Revised Childhood Experiences Questionnaire (a semi-structured interview), the NEO, and the SCID I. RESULTS Borderline adolescents and adults had non-significant differences on their overall DES scores and subscale scores. They also had a non-significant distribution of low, moderate, and high scores. In terms of multivariate predictors, neither temperament nor childhood adversity was a significant predictor of the severity of dissociative symptoms in adolescents. However, co-occurring eating disorders were found in multivariate analyses to be the only bivariate predictor to significantly predict this outcome. In adults with BPD, however, both the severity of childhood sexual abuse and co-occurring PTSD were significantly related to the severity of dissociative symptoms in multivariate analyses. CONCLUSIONS Taken together, the results of this study suggest that the severity of dissociation is not significantly different in adolescents and adults with BPD. However, the etiological factors differ substantially.
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Affiliation(s)
- Mary C Zanarini
- McLean Hospital, McLean Hospital, 115 Mill Street, Belmont, MA, 02478, USA. .,Harvard Medical School, Boston, MA, USA.
| | | | - Christina M Temes
- Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital, Boston, MA, USA
| | - Isabel V Glass
- McLean Hospital, McLean Hospital, 115 Mill Street, Belmont, MA, 02478, USA
| | - Blaise A Aguirre
- McLean Hospital, McLean Hospital, 115 Mill Street, Belmont, MA, 02478, USA.,Harvard Medical School, Boston, MA, USA
| | - Marianne Goodman
- James J. Peters Veteran Affairs Medical Center, Bronx, USA.,Icahn School of Medicine, Mt. Sinai, New York, NY, USA
| | - Garrett M Fitzmaurice
- McLean Hospital, McLean Hospital, 115 Mill Street, Belmont, MA, 02478, USA.,Harvard Medical School, Boston, MA, USA
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11
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Mellado A, Martínez C, Tomicic A, Krause M. Identification of Dynamic Patterns of Personal Positions in a Patient Diagnosed With Borderline Personality Disorder and the Therapist During Change Episodes of the Psychotherapy. Front Psychol 2022; 13:716012. [PMID: 35992464 PMCID: PMC9384848 DOI: 10.3389/fpsyg.2022.716012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 05/18/2022] [Indexed: 11/24/2022] Open
Abstract
Personal positions and voices of a patient diagnosed with borderline personality disorder (BPD) and the therapist during long-term psychotherapy were studied aiming to find differences in the patterns formed in these aspects of subjectivity according to the level of elaboration of the change episodes achieved by the patient. This case study considered a stage of qualitative analysis where change episodes of the patient were traced through the Change Episodes Model. Later, through the Model of Analysis of Discursive Positioning in Psychotherapy (MAPP), the voices and personal positions of the patient and her therapist were identified in each of the change episodes. In the stage of quantitative analysis, dynamic patterns in the voices and personal positions were established, accounting for hypothetical attractors using the Space State Grid (SSG) technique in each of the three different levels of subjective elaboration that constitute the change episodes. The results established differentiated dynamic patterns in the change episodes, coherent with the patient’s change process, and formation of propositive/reflective specific patterns as the patient evolved in the three different levels of subjective elaboration. The above suggests that a subjective transformation process is displayed, and this is manifested in the different voices and personal positions that emerged as the change episodes evolve. The identified dynamic patterns can be considered nonlinear and emergent subjective exchanges between the patient and the therapist throughout the psychotherapy.
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Affiliation(s)
- Augusto Mellado
- Doctoral Program in Psychotherapy, Department of Psychology, Pontificia Universidad Católica de Chile, Santiago, Chile
- *Correspondence: Augusto Mellado,
| | - Claudio Martínez
- Faculty of Psychology, Universidad Diego Portales, Santiago, Chile
| | - Alemka Tomicic
- Faculty of Psychology, Universidad Diego Portales, Santiago, Chile
| | - Mariane Krause
- Department of Psychology, Faculty of Social Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
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12
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Krause-Utz A. Dissociation, trauma, and borderline personality disorder. Borderline Personal Disord Emot Dysregul 2022; 9:14. [PMID: 35440020 PMCID: PMC9020027 DOI: 10.1186/s40479-022-00184-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/01/2022] [Indexed: 11/10/2022] Open
Abstract
Dissociation is a complex phenomenon, which occurs in various clinical conditions, including dissociative disorders, (complex) post-traumatic stress disorder (CPTSD, PTSD), and borderline personality disorder (BPD). Traumatic stress is considered an important risk factor, while the etiology of dissociation is still debated. Next to traumatic experiences, temperamental and neurobiological vulnerabilities seem to contribute to the development of dissociation. Stress-related dissociation is a prevalent symptom of BPD, which may interfere with psychosocial functioning and treatment outcome. More research in the field is strongly needed to improve the understanding and management of this complex phenomenon. This article collection brings together research on dissociation and trauma, with a special focus on BPD or sub-clinical expressions of BPD. In this editorial, recent conceptualizations of dissociation and relevant previous research are introduced in order to provide a framework for this novel research.
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Affiliation(s)
- Annegret Krause-Utz
- Department of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands. .,Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands.
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13
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Cyr G, Godbout N, Cloitre M, Bélanger C. Distinguishing Among Symptoms of Posttraumatic Stress Disorder, Complex Posttraumatic Stress Disorder, and Borderline Personality Disorder in a Community Sample of Women. J Trauma Stress 2022; 35:186-196. [PMID: 34374135 DOI: 10.1002/jts.22719] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 11/05/2022]
Abstract
The diagnosis of complex posttraumatic stress disorder (CPTSD) was included in the ICD-11 in 2018. Debates are still ongoing in the scientific community regarding the conceptual distinction between CPTSD symptoms and those of comorbid PTSD and borderline personality disorder (BPD). The present study aimed to determine whether (a) patterns of symptoms reported by women in a community sample would reveal a CPTSD profile distinct from PTSD and BPD profiles and (b) the resulting profiles could be compared on measures of cumulative childhood trauma exposure, dissociation, and life satisfaction. Women who reported at least one potentially traumatic experience (N = 438) completed questionnaires assessing PTSD, CPTSD, and BPD symptoms. We performed latent profile analyses testing seven models, with the five-profile model emerging as the most appropriate solution. The profiles were characterized as "high PTSD symptoms" (12.0%), "high CPTSD symptoms" (7.6%), "high BPD symptoms" (9.9%), "high CPTSD and BPD symptoms" (3.8%), and "low symptoms" (66.7%). Group comparisons revealed that the profiles characterized by high CPTSD symptoms, high BPD symptoms, and high CPTSD and BPD symptoms tended to include participants with higher levels of cumulative childhood trauma exposure and symptoms of dissociation and lower ratings of life satisfaction compared to the profiles characterized by high PTSD symptoms and low symptoms, ds = 0.55-1.06. These findings support the distinction between ICD-11 CPTSD symptoms and those of PTSD and BPD, promoting an integrative approach to understanding trauma sequelae, diagnosis, and treatment.
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Affiliation(s)
- Gaëlle Cyr
- Department of Psychology, University of Quebec in Montreal, Montreal, Canada
| | - Natacha Godbout
- Department of Sexology, University of Quebec in Montreal, Montreal, Canada
| | - Marylene Cloitre
- Dissemination and Training Division, National Center for PTSD, Menlo Park, California, USA
| | - Claude Bélanger
- Department of Psychology, University of Quebec in Montreal, Montreal, Canada
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14
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Martins HADL, Ribas VR, Dos Santos Ribas KH, da Fonseca Lins L, Mainieri AG. Case Report: Anomalous Experience in a Dissociative Identity and Borderline Personality Disorder. Front Psychiatry 2022; 13:662290. [PMID: 35923455 PMCID: PMC9339793 DOI: 10.3389/fpsyt.2022.662290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 06/03/2022] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Dissociative identity disorder, formerly called multiple personality disorder, is a rupture of identity characterized by the presence of two or more distinct personality states, described in some cultures as an experience of possession. OBJECTIVE The case of a 30-year-old woman with dissociative identity disorder and borderline personality disorder associated with a previous history of anomalous experience was reported. CASE REPORT A 30-year-old woman who fulfilled the DSM-5 criteria for dissociative identity disorder and borderline personality disorder reported the presence of unusual sensory experiences (clairvoyance, premonitory dreams, clairaudience) since she was 5 years old. The patient told that for 12 months she presented episodes in which a "second self" took charge of her actions: she would then speak with a male voice, become aggressive, and require several people to contain her desire for destruction. After 3 months of religious follow-up, and accepting her unusual experiences and trance possessions as normal and natural, she had significant improvement. CONCLUSION When approaching DID and BPD patients, it is necessary to observe the anomalous phenomena (in the light of) closer to their cultural and religious contexts, to promote better results in the treatment of their disorders, which has not been explored in the treatment guide.
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15
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Schmitz M, Bertsch K, Löffler A, Steinmann S, Herpertz SC, Bekrater-Bodmann R. Body connection mediates the relationship between traumatic childhood experiences and impaired emotion regulation in borderline personality disorder. Borderline Personal Disord Emot Dysregul 2021; 8:17. [PMID: 34001243 PMCID: PMC8127297 DOI: 10.1186/s40479-021-00157-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 04/12/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Previous studies revealed an association between traumatic childhood experiences and emotional dysregulation in patients with borderline personality disorder (BPD). However, possible mediating pathways are still not fully understood. The aim of the present study was to investigate the potential mediating role of body connection, describing the awareness of the relationship of bodily and mental states, for the association between a history of traumatic childhood experiences and BPD core symptomatology. METHODS One-hundred-twelve adult female individuals with BPD and 96 healthy female controls (HC) were included. Impaired emotion regulation, traumatic childhood experiences, and BPD symptomatology were assessed with self-report questionnaires. The Scale of Body Connection was used to assess two dimensions of body connection, that is body awareness, describing attendance to bodily information in daily life and noticing bodily responses to emotions and/or environment and body dissociation, describing a sense of separation from one's own body, due to avoidance or emotional disconnection. Mann-Whitney U tests were employed to test for group differences (BPD vs. HC) on the two SBC subscales and associations with clinical symptoms were analyzed with Spearman correlations. We performed mediation analyses in the BPD group to test the assumption that body connection could act as a mediator between a history of traumatic childhood experiences and emotion dysregulation. RESULTS Individuals with BPD reported significantly lower levels of body awareness and significantly higher levels of body dissociation compared to HC. Body dissociation, traumatic childhood experiences, and emotion dysregulation were significantly positively associated. Further analyses revealed that body dissociation, but not body awareness, significantly and fully mediated the positive relationship between traumatic childhood experiences and impaired emotion regulation in the BPD sample. This mediation survived when trait dissociation, i.e., general dissociative experiences not necessarily related to the body, was statistically controlled for. CONCLUSION Certain dimensions of body connection seem to be disturbed in BPD patients, with body dissociation being an important feature linking a history of traumatic childhood experiences to current deficits in emotion regulation.
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Affiliation(s)
- Marius Schmitz
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Katja Bertsch
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
- Department of Psychology, LMU Munich, Munich, Germany
| | - Annette Löffler
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sylvia Steinmann
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Robin Bekrater-Bodmann
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
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16
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Ford JD, Courtois CA. Complex PTSD and borderline personality disorder. Borderline Personal Disord Emot Dysregul 2021; 8:16. [PMID: 33958001 PMCID: PMC8103648 DOI: 10.1186/s40479-021-00155-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 04/09/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND This article builds on a previous review (Ford and Courtois, Borderline Personal Disord Emot Dysregul 1:9, 2014) which concluded that complex posttraumatic stress disorder (cPTSD) could not be conceptualized as a sub-type of either PTSD or BPD. Recent research is reviewed that extends and clarifies the still nascent understanding of the relationship between cPTSD and BPD. MAIN BODY The circumscribed formulation of adult cPTSD that has been developed, validated, and included in the 11th Edition of the International Classification of Diseases has spurred research aimed at differentiating cPTSD and BPD both descriptively and empirically. A newly validated Developmental Trauma Disorder (DTD) syndrome for children and adolescents provides a basis for systematic research on the developmental course and origins of adult cPTSD and BPD. This review summarizes recent empirical findings regarding BPD, PTSD, and cPTSD in terms of: (1) prevalence and comorbidity; (2) clinical phenomenology; (3) traumatic antecedents; (4) psychobiology; (5) emotion dysregulation; (6) dissociation; and (7) empirically supported approaches to clinical assessment and psychotherapeutic treatment. CONCLUSION The evidence suggests that PTSD, cPTSD, and BPD are potentially comorbid but distinct syndromes. A hypothesis is advanced to stimulate scientific research and clinical innovation defining and differentiating the disorders, positing that they may represent a continuum paralleling the classic conceptualization of the stress response, with dissociation potentially involved in each disorder.
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Affiliation(s)
- Julian D Ford
- University of Connecticut Health Center MC1410, 263 Farmington Avenue, Farmington, CT, 06030-1410, USA.
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17
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Emotion regulation, mindfulness, and self-compassion among patients with borderline personality disorder, compared to healthy control subjects. PLoS One 2021; 16:e0248409. [PMID: 33730065 PMCID: PMC7968662 DOI: 10.1371/journal.pone.0248409] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 02/26/2021] [Indexed: 12/27/2022] Open
Abstract
Objectives Emotion regulation difficulties are a major characteristic of personality disorders. Our study investigated emotion regulation difficulties that are characteristic of borderline personality disorder (BPD), compared to a healthy control group. Methods Patients with BPD (N = 59) and healthy participants (N = 70) filled out four self-report questionnaires (Cognitive Emotion Regulation Questionnaire, Difficulties in Emotion Regulation Scale, Five Facet Mindfulness Questionnaire, Self-Compassion Scale) that measured the presence or lack of different emotion-regulation strategies. Differences between the BPD and the healthy control group were investigated by Multivariate Analysis of Variance (MANOVA) and univariate post-hoc F-test statistics. Results People suffering from BPD had statistically significantly (p<0.05) higher levels of emotional dysregulation and used more maladaptive emotion-regulation strategies, as well as lower levels of mindfulness and self-compassion compared to the HC group. Conclusion In comparison to a healthy control group, BPD patients show deficits in the following areas: mindfulness, self-compassion and adaptive emotion-regulation strategies. Based on these results, we suggest that teaching emotion-regulation, mindfulness, and self-compassion skills to patients can be crucial in the treatment of borderline personality disorder.
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18
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Cavicchioli M, Barone L, Fiore D, Marchini M, Pazzano P, Ramella P, Riccardi I, Sanza M, Maffei C. Emotion Regulation, Physical Diseases, and Borderline Personality Disorders: Conceptual and Clinical Considerations. Front Psychol 2021; 12:567671. [PMID: 33597906 PMCID: PMC7882545 DOI: 10.3389/fpsyg.2021.567671] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 01/08/2021] [Indexed: 11/13/2022] Open
Abstract
This perspective paper aims at discussing theoretical principles that could explain how emotion regulation and physical diseases mutually influence each other in the context of borderline personality disorder (BPD). Furthermore, this paper discusses the clinical implications of the functional relationships between emotion regulation, BPD and medical conditions considering dialectical behavior therapy (DBT) as a well-validated therapeutic intervention, which encompasses these issues. The inflexible use of maladaptive emotion regulation strategies (e.g., suppression, experiential avoidance, and rumination) might directly increase the probability of developing physical diseases through a physiological pathway, or indirectly through a behavioral pathway. Some metabolic and chronic medical conditions could significantly impact emotional functioning through biological alterations involved in emotion regulation. Several empirical studies have shown high co-occurrence rates between BPD and several chronic physical diseases, especially ones linked to emotion-based maladaptive behaviors. DBT addresses physical diseases reported by individuals with BPD reducing problematic behaviors functionally associated to emotion dysregulation and identifying physical health as a goal for Building a Life Worth Living.
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Affiliation(s)
- Marco Cavicchioli
- Department of Psychology, University "Vita-Salute San Raffaele", Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Milan, Italy.,Italian Society for Dialectical Behavior Therapy, Milan, Italy
| | - Lavinia Barone
- Italian Society for Dialectical Behavior Therapy, Milan, Italy.,Department of Psychology, University of Pavia, Pavia, Italy
| | - Donatella Fiore
- Italian Society for Dialectical Behavior Therapy, Milan, Italy.,Third Center of Cognitive Psychotherapy - Italian School of Clinical Cognitivism, Rome, Italy
| | - Monica Marchini
- Italian Society for Dialectical Behavior Therapy, Milan, Italy.,Villa Azzurra - Psychiatric Specialist Clinic - Neomesia, Riolo Terme, Italy
| | - Paola Pazzano
- Italian Society for Dialectical Behavior Therapy, Milan, Italy.,Ecopoiesis Centre of Cognitive Psychotherapy of Reggio Calabria, Reggio Calabria, Italy
| | - Pietro Ramella
- Department of Psychology, University "Vita-Salute San Raffaele", Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Milan, Italy.,Italian Society for Dialectical Behavior Therapy, Milan, Italy
| | - Ilaria Riccardi
- Italian Society for Dialectical Behavior Therapy, Milan, Italy.,Third Center of Cognitive Psychotherapy - Italian School of Clinical Cognitivism, Rome, Italy
| | - Michele Sanza
- Italian Society for Dialectical Behavior Therapy, Milan, Italy.,Department of Addictions ASL Romagna, Cesena, Italy
| | - Cesare Maffei
- Department of Psychology, University "Vita-Salute San Raffaele", Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Milan, Italy.,Italian Society for Dialectical Behavior Therapy, Milan, Italy
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19
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Khosravi M. Child maltreatment-related dissociation and its core mediation schemas in patients with borderline personality disorder. BMC Psychiatry 2020; 20:405. [PMID: 32787823 PMCID: PMC7425596 DOI: 10.1186/s12888-020-02797-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/29/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND From a developmental and pathogenic perspective, child maltreatment is strongly linked to later dissociative symptoms, as ultimate forms of human response to chronic stress. The present study aimed to investigate the mediating role of early maladaptive schemas (EMSs) in the relationship between child maltreatment and dissociation among patients with borderline personality disorder (BPD). METHODS In this cross-sectional study, a total of 152 BPD patients (men: 52%; women: 48%) with an average age of 29.64 years (standard deviation (SD) = 7.29, range = 18-47) were selected by systematic random sampling from the patients who referred to Baharan psychiatric hospital in Zahedan, Iran, with the sampling interval of 3. The Childhood Trauma Questionnaire-Short Form, Dissociative Experiences Scale, and Young Schema Questionnaire-Short Form 3 were used to assess the patients. Data were analyzed using SPSS v25 software, and the statistical significance level was set at p < 0.05. RESULTS four main findings were obtained from the present study: (1) Heterogeneity of the levels of dissociation (LOD) in BPD patients; (2) The predicting roles of emotional neglect (EN), vulnerability to harm, and defectiveness/shame schemas in the total DES scores; (3) The vague role of childhood sexual abuse (SA) in developing dissociative symptoms; and (4) The mediating role of the core schemas of vulnerability to harm (β = 0.28, 95% confidence interval (CI): 0.04, 0.61) and defectiveness/shame (β = 0.21, 95% CI: 0.008, 0.45) in the relationship between EN and dissociation. CONCLUSIONS Regarding the heterogeneity of LOD and its crucial role in the successful treatment of BPD patients, it is highly essential to evaluate the present-state dissociation of the patient during the diagnosis process and provide effective interventions to reduce it. The obtained results highlighted the potential role of schema therapy in reducing dissociative responses to emotional stimuli (based on EN), vulnerability to harm, and defectiveness/shame. Nevertheless, psychopathology of dissociation among BPD patients should be further investigated in depth.
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Affiliation(s)
- Mohsen Khosravi
- Department of Psychiatry and Clinical Psychology, Baharan Psychiatric Hospital, Zahedan University of Medical Sciences, Zahedan, Postal Code: 9813913777, Iran.
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20
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Lee JS. Borderline Personality Disorder in the Courtroom. PSYCHIATRY, PSYCHOLOGY, AND LAW : AN INTERDISCIPLINARY JOURNAL OF THE AUSTRALIAN AND NEW ZEALAND ASSOCIATION OF PSYCHIATRY, PSYCHOLOGY AND LAW 2020; 28:206-217. [PMID: 34712092 PMCID: PMC8547869 DOI: 10.1080/13218719.2020.1767718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The insanity defense has been criticized with consequences for individuals with real mental illness. In the United States, several states have redefined the insanity defense by excluding antisocial personality disorder from consideration for the not guilty by reason of insanity plea. Four states have eliminated the insanity defense completely. The purpose of this article is to analyze the diagnosis of borderline personality disorder, its relevance in the courtroom setting, and how this speaks to the approach of the insanity defense in general. The history of the insanity defense, impulsive nature of borderline personality disorder, and the reasons that make personality disorders controversial are reviewed. The impulsive nature, and the association to childhood trauma, dissociation, and frontolimbic abnormalities support the continued protection of borderline personality disorder under the insanity defense. Knowledge of these facts will assist the forensic psychiatrist in effectively educating the courtroom about borderline personality disorder.
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Affiliation(s)
- Jin S. Lee
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA, USA
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21
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Vine V, Victor SE, Mohr H, Byrd AL, Stepp SD. Adolescent suicide risk and experiences of dissociation in daily life. Psychiatry Res 2020; 287:112870. [PMID: 32171125 PMCID: PMC7983062 DOI: 10.1016/j.psychres.2020.112870] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/11/2020] [Accepted: 02/17/2020] [Indexed: 11/28/2022]
Abstract
Dissociation is associated with risk for suicide in adults, but this link is not well studied in adolescents, in spite of their marked suicide risk. This study assessed adolescents' dissociative experiences in daily life and evaluated the association between dissociative experiences and suicide risk, including the independence of this relationship from related affective and clinical states and demographic characteristics. Clinically referred early adolescents (N = 162; aged 11-13) were assessed via multi-informant clinical interview, questionnaires, and 4-day ecological momentary assessment protocol. Adolescents were classified as being at elevated suicide risk using multi-informant, multi-method reports of suicide risk behavior and/or at elevated proximal risk using the 4-day EMA only. Suicide risk was associated with daily dissociative experiences, and this relationship was independent of daily negative and positive affect and co-occurring borderline personality symptoms. Gender differences emerged, such that the relationship between daily dissociative experiences and suicide risk was only significant in adolescent girls. Overall, findings suggest dissociation may be independently relevant to adolescent suicide risk, above and beyond effects of psychopathology and affective disturbance, and especially in girls. Daily dissociative experiences may help understand and detect suicide risk among early adolescents and warrant further research.
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Affiliation(s)
- Vera Vine
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA.
| | - Sarah E Victor
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Harmony Mohr
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| | - Amy L Byrd
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| | - Stephanie D Stepp
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA
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22
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Scalabrini A, Mucci C, Angeletti LL, Northoff G. The Self and its World: A Neuro-Ecological and Temporo-Spatial Account of Existential Fear. CLINICAL NEUROPSYCHIATRY 2020; 17:46-58. [PMID: 34908967 PMCID: PMC8629082 DOI: 10.36131/clinicalnpsych20200203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 04/05/2020] [Indexed: 11/25/2022]
Abstract
The current international crisis situation caused by the COVID-19 pandemic is having a strong psychological impact on our subjectivities. We are constantly threatened by the danger of i) being infected, ii) infecting other people, and (iii) by the loss of social relation. Departing from these premises, we here aim to investigate the psychological and neurodynamics of this complex phenomenon. First, we discuss about recent psychological and neuronal findings on fear and its disorders, related to an unbalanced intero-exteroceptive processing and emotional regulation. Secondly we move to the psychological and neuronal dynamics of self and others characterized by a temporo-spatial alignment with the world. Due to the neural overlap of emotion and self and the deep-reaching neuro-ecological layers of self, emotional feelings like fear and anxiety cannot be detached and dissociated from the world; they signify the world–brain relation, and, more specifically, our self-other relation. The deepest neuro-ecological and neuro-social layers of self are threatened by the loss of subjectivity, which is manifest in our loss of body and thus the fear of dying, and the loss of intersubjectivity that surfaces in our fear of infecting others, which reflect the intimate anchorage of the self with the world. In our opinion the pandemic of COVID-19 deeply affect our sense of self and its spatio-temporal neuronal dynamics providing the prerequisites for the manifestation of fear and existential anxiety, thus disrupting the brain-world relation with significant repercussions on our psyche and on our daily lives.
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Affiliation(s)
- Andrea Scalabrini
- Department of Psychological, Health and Territorial Sciences (DiSPuTer), G. d'Annunzio University of Chieti-Pescara, Via dei Vestini 33, 66100 Chieti (CH), Italy
| | - Clara Mucci
- Department of Psychological, Health and Territorial Sciences (DiSPuTer), G. d'Annunzio University of Chieti-Pescara, Via dei Vestini 33, 66100 Chieti (CH), Italy
| | - Lorenzo Lucherini Angeletti
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo G. Alessandro Brambilla 3, 50134, Florence, Italy
| | - Georg Northoff
- The Royal's Institute of Mental Health Research & University of Ottawa. Brain and Mind Research Institute, Centre for Neural Dynamics, Faculty of Medicine, University of Ottawa, Ottawa, 145 Carling Avenue, Rm. 6435, Ottawa, Ontario, Canada K1Z 7K4.,Mental Health Centre, Zhejiang University School of Medicine, Tianmu Road 305, Hangzhou, Zhejiang Province, 310013, China.,Centre for Cognition and Brain Disorders, Hangzhou Normal University, Tianmu Road 305, Hangzhou, Zhejiang Province, 310013, China.,TMU Research Centre for Brain and Consciousness, Shuang Hospital, Taipei Medical University, No. 250 Wu-Xing Street, 11031 Taipei, Taiwan.,Graduate Institute of Humanities in Medicine, Taipei Medical University, No. 250 Wu-Xing Street, 11031 Taipei, Taiwan
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23
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Golshani S, Ghanbari S, Firoozabadi A, Shakeri J, Hookari S, Rahami B, Sadeghi Bahmani D, Brand S. Dissociative Symptoms and Self-Reported Childhood and Current Trauma in Male Incarcerated People with Borderline Personality Disorder - Results from a Small Cross-Sectional Study in Iran. Neuropsychiatr Dis Treat 2020; 16:2407-2417. [PMID: 33116540 PMCID: PMC7586052 DOI: 10.2147/ndt.s266016] [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: 06/04/2020] [Accepted: 08/28/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND There is evidence that incarcerated people show higher rates of symptoms of psychopathology. In the present study, we assessed male Iranian incarcerated people with borderline personality disorders (BPD) and investigated the occurrence of past and current trauma and their associations with dissociative experiences. METHODS A total of 69 male Iranian incarcerated people (mean age: 33.76 years) diagnosed with PBD completed questionnaires covering sociodemographic information, dissociative experiences, and past and current traumatic events. RESULTS Participants reporting the occurrence of childhood trauma also reported the occurrence of adulthood trauma. Dissociation and adulthood trauma were associated in a U-shaped, non-linear fashion: Low and high adulthood trauma were associated with higher dissociation. Younger age, the presence of childhood trauma, and being single or divorced predicted adulthood trauma. CONCLUSION The pattern of results suggests that both childhood and adulthood trauma are highly prevalent among male incarcerated people, while the association between adulthood trauma and dissociation appeared to be more complex. When treating male incarcerated people, a complex interplay between past and current traumas and dissociation should be considered.
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Affiliation(s)
- Sanobar Golshani
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sahel Ghanbari
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ali Firoozabadi
- Research Center for Psychiatry and Behavioral Sciences, Department of Psychiatry, Hafez Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Jalal Shakeri
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sarah Hookari
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Bahareh Rahami
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Dena Sadeghi Bahmani
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.,University of Basel, Psychiatric Clinics (UPK), Center for Affective-, Stress- and Sleep Disorders (ZASS), Basel 4002, Switzerland
| | - Serge Brand
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.,University of Basel, Psychiatric Clinics (UPK), Center for Affective-, Stress- and Sleep Disorders (ZASS), Basel 4002, Switzerland.,Department of Sport, Exercise, and Health, Division of Sport Science and Psychosocial Health, University of Basel, Basel, Switzerland.,Department of Psychiatry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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24
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Abstract
OBJECTIVE Auditory verbal hallucinations (AVH) frequently co-occur with borderline personality disorder (BPD) and can lead to misdiagnosis with schizophrenia (SCZ) or other primary psychotic disorders. Misdiagnosis is more common when AVH meet criteria for Schneiderian first rank symptoms (FRS). This paper's objective is to improve diagnostic accuracy by outlining particular clinical features that can assist the distinction between BPD and psychotic disorders in these cases. CONCLUSION The overall clinical presentation when AVH occur in BPD can assist in determining a primary diagnosis of BPD when frank psychotic disorder is absent. AVH in BPD cannot be distinguished phenomenologically from AVH in SCZ. Clinical experience and increasing research suggest that AVH in BPD are often dissociative in origin and highly correlated with the presence of FRS, elevated levels of dissociation and a history of childhood trauma. When AVH occur in BPD in the absence of co-occurring psychotic disorder, formal thought disorder is usually absent, negative symptoms minimal or absent, bizarre symptoms absent, affect reactive and the patient retains sociability. Psychotropic medication may be less effective for the AVH in these cases, while they may improve or remit during psychotherapy for BPD.
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Affiliation(s)
- Josephine Beatson
- Spectrum, Statewide Service for Personality Disorder, Eastern Health, Richmond, VIC, Australia
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25
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Rodríguez-Delgado A, Fresán A, Miranda E, Garza-Villarreal E, Alcalá-Lozano R, Duque-Alarcón X, Balducci T, Arango de Montis I. Comorbid personality disorders and their impact on severe dissociative experiences in Mexican patients with borderline personality disorder. Nord J Psychiatry 2019; 73:509-514. [PMID: 31453750 DOI: 10.1080/08039488.2019.1658127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To identify personality disorders comorbid with borderline personality disorder (BPD) that may confer greater risk for the presence of severe dissociative experiences. Method: Three hundred and one outpatients with a primary diagnosis of BPD were evaluated using the Structured Clinical Interview for DSM-IV Axis II personality disorders, the Borderline Evaluation of Severity Over Time (BEST) and the Dissociative Experiences Scale (DES). Results: The most frequent personality disorders comorbid to BPD were paranoid (83.2%, n = 263) and depressive (81.3%, n = 257). The mean BEST and DES total score were 43.3 (SD = 11.4, range 15-69) and 28.6 (SD = 19.8, range 0-98), respectively. We categorized the sample into patients with and without severe dissociative experiences (41% were positive). A logistic regression model revealed that Schizotypal, Obsessive-compulsive and Antisocial personality disorders conferred greater risk for the presence of severe dissociative experiences. Discussion: Our results suggest that a large proportion of patients with BPD present a high rate of severe dissociative experiences and that some clinical factors such as personality comorbidity confer greater risk for severe dissociation, which is related to greater dysfunction and suffering, as well as a worse progression of the BPD.
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Affiliation(s)
- Andrés Rodríguez-Delgado
- Clínica de Trastorno Límite de la Personalidad, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñíz , Mexico City , Mexico
| | - Ana Fresán
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñíz , Mexico City , Mexico
| | - Edgar Miranda
- Clínica de Trastorno Límite de la Personalidad, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñíz , Mexico City , Mexico
| | - Eduardo Garza-Villarreal
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñíz , Mexico City , Mexico.,Center of Functionally Integrative Neuroscience, University of Aarhus , Aarhus , Denmark
| | - Ruth Alcalá-Lozano
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñíz , Mexico City , Mexico
| | - Xóchitl Duque-Alarcón
- Clínica de Especialidades en Neuropsiquiatría, Instituto de Seguridad y Servicios Sociales de Los Trabajadores Del Estado (ISSSTE) , Mexico City , Mexico
| | - Thania Balducci
- Facultad de Medicina, Universidad Nacional Autónoma de México , Mexico City , Mexico
| | - Iván Arango de Montis
- Clínica de Trastorno Límite de la Personalidad, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñíz , Mexico City , Mexico
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26
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Fung HW, Chan C. A preliminary study of the clinical differences between dissociative and nondissociative depression in Hong Kong: implications for mental health practice. SOCIAL WORK IN HEALTH CARE 2019; 58:564-578. [PMID: 30958123 DOI: 10.1080/00981389.2019.1597006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 02/12/2019] [Accepted: 03/13/2019] [Indexed: 06/09/2023]
Abstract
Depression is a serious public health issue, but not all patients with depression respond well to pharmaceutical treatments. Some scholars suggested that dissociation could be a marker indicating the types of patients with depression that may benefit more from psychosocial interventions than from pharmaceutical treatments. This study explored the possibility to differentiate dissociative depression and nondissociative depression in a clinical sample (N = 68) in the Chinese context, and discusses the potential implications for treatment considerations. Compared with the nondissociative group, the dissociative group reported higher occurrences of psychosocial etiological risk factors (e.g., childhood physical abuse, lack of help from family) and psychosocial-related symptoms (e.g., unstable relations, fear of abandonment, trauma-related flashbacks, somatization symptoms). Our initial findings revealed that patients with dissociative depression appeared to have distinct clinical features and might require more psychosocial interventions. Implications for health care research and practice are discussed.
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Affiliation(s)
- Hong Wang Fung
- a Department of Applied Social Sciences , The Hong Kong Polytechnic University , Hung Hom , Hong Kong
| | - Chitat Chan
- a Department of Applied Social Sciences , The Hong Kong Polytechnic University , Hung Hom , Hong Kong
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27
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Mahoney CT, Benight CC. The Temporal Relationship Between Coping Self-Efficacy and Dissociation in Undergraduate Students. J Trauma Dissociation 2019; 20:471-487. [PMID: 30924408 DOI: 10.1080/15299732.2019.1597805] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Dissociation is a lack of information integration resulting from a process that ranges on a continuum from normative experiences (e.g., daydreaming) to a pervasive traumatic response involving alterations and/or fragmentation in mental processes such as memory, emotion, and perception. Perceived coping self-efficacy (CSE) is a cognitive appraisal ability utilized to regulate internal and external stressors that arise from traumatic events, and is crucial for effective adaptation after extreme stress or trauma. Thus, CSE may be a critical component in decreasing dissociative experiences following a traumatic event. In the present study, 136 undergraduate students (M age = 22.36 years, SD = 6.27; 81% female, 69.1% Caucasian, 77.2% attended some college) completed self-report measures of trauma, dissociation, and coping self-efficacy. All measures were completed by the same participants at two different time points (Time 1 and Time 2) two months apart; all participants reported a history of exposure to at least one Criterion A traumatic event (according to the DSM-5) at Time 1. We hypothesized that CSE for posttraumatic coping demands at Time 2 would mediate the relationship between dissociation at Time 1 and dissociation at Time 2, and subsequently found evidence of significant mediation, 95% CI [.02, .18]. These findings suggest that initial levels of persistent dissociation negatively predict CSE, which in turn directly and negatively influence persistent dissociation at a later time point. This highlights how CSE may serve as a protective factor against persistent dissociation.
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Affiliation(s)
- Colin T Mahoney
- a Department of Psychology , Idaho State University , Pocatello , ID , USA
| | - Charles C Benight
- b Department of Psychology , University of Colorado at Colorado Springs , Colorado Springs , CO , USA
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28
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Luyten P, Campbell C, Fonagy P. Borderline personality disorder, complex trauma, and problems with self and identity: A social‐communicative approach. J Pers 2019; 88:88-105. [DOI: 10.1111/jopy.12483] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 04/05/2019] [Accepted: 04/24/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Patrick Luyten
- Faculty of Psychology and Educational Sciences University of Leuven Leuven Belgium
- Research Department of Clinical, Educational and Health Psychology University College London London UK
| | - Chloe Campbell
- Research Department of Clinical, Educational and Health Psychology University College London London UK
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology University College London London UK
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29
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Didonna F, Rossi R, Ferrari C, Iani L, Pedrini L, Rossi N, Xodo E, Lanfredi M. Relations of mindfulness facets with psychological symptoms among individuals with a diagnosis of obsessive-compulsive disorder, major depressive disorder, or borderline personality disorder. Psychol Psychother 2019; 92:112-130. [PMID: 29575447 DOI: 10.1111/papt.12180] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 12/26/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To explore differences in mindfulness facets among patients with a diagnosis of either obsessive-compulsive disorder (OCD), major depressive disorder (MDD), or borderline personality disorder (BPD), and healthy controls (HC), and their associations with clinical features. DESIGN AND METHOD One hundred and fifty-three patients and 50 HC underwent a clinical assessment including measures of mindfulness (Five Facets Mindfulness Questionnaire - FFMQ), psychopathological symptoms (Symptom Check List-90-R), dissociation (Dissociative Experience Scale), alexithymia (Alexithymia Scale 20), and depression (Beck Depression Inventory-II). Analysis of variance (ANOVA) and analysis of covariance (ANCOVA) were performed to assess differences in mindfulness scores and their associations with clinical features. RESULTS The three diagnostic groups scored lower on all mindfulness facets (apart from FFMQobserving) compared to the HC group. OCD group had a significant higher FFMQ total score (FFMQ-TS) and FFMQacting with awareness compared to the BPD group, and scored higher on FFMQdescribing compared to BPD and MDD groups. The scores in non-judging facet were significantly lower in all the three diagnostic groups compared to the HC group. Interestingly, higher FFMQ-TS was inversely related to all psychological measures, regardless of diagnostic group. CONCLUSIONS Deficits in mindfulness skills were present in all diagnostic groups. Furthermore, we found disease-specific relationships between some mindfulness facets and specific psychological variables. Clinical implications are discussed. PRACTITIONER POINTS The study showed deficits in mindfulness scores in all diagnostic groups compared to a healthy control group. Overall, mindfulness construct has a significantly negative association with indexes of global distress, dissociative symptoms, alexithymia, and depression. Mindfulness-based interventions in clinical settings should take into account different patterns of mindfulness skills and their impact on disease-specific maladaptive cognitive strategies or symptomatology.
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Affiliation(s)
- Fabrizio Didonna
- Unit for OCD, Department of Psychiatry, Villa Margherita Private Hospital, Vicenza, Italy.,Italian Institute for Mindfulness, Vicenza, Italy
| | - Roberta Rossi
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Clarissa Ferrari
- Service of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Luca Iani
- Department of Human Sciences, European University of Rome, Italy
| | - Laura Pedrini
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Nicoletta Rossi
- Unit for OCD, Department of Psychiatry, Villa Margherita Private Hospital, Vicenza, Italy
| | - Erica Xodo
- Italian Institute for Mindfulness, Vicenza, Italy
| | - Mariangela Lanfredi
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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30
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Iyengar U, Rajhans P, Fonagy P, Strathearn L, Kim S. Unresolved Trauma and Reorganization in Mothers: Attachment and Neuroscience Perspectives. Front Psychol 2019; 10:110. [PMID: 30761051 PMCID: PMC6363675 DOI: 10.3389/fpsyg.2019.00110] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 01/14/2019] [Indexed: 11/13/2022] Open
Abstract
The onset of motherhood is characterized by significant psychological and neurobiological changes. These changes equip the mother to care for her new child. Although rewarding, motherhood is also an inherently stressful period, more so for mothers with unresolved trauma. Past research has looked at how unresolved trauma can hamper a mother’s caregiving response toward her infant, which further affects the development of secure attachment in her own infant. The Dynamic Maturational Model of Attachment and Adaptation (DMM) has introduced a unique concept of “attachment reorganization” which can be described as a process whereby individuals with unresolved trauma are transitioning toward attachment security based on their enhanced understanding of past and present experiences. Preliminary results from one of our previous studies have shown that, among mothers with unresolved trauma, mothers who themselves demonstrated “reorganizing attachment” toward security, had infants with secure attachment, thereby indicating the potential to halt the intergenerational transmission of insecure attachment. While this concept is of great clinical relevance, further research is required to assess the benefits of attachment reorganization as a protective factor and its positive implications for child development. Thus, the aim of the current review is to expand on the concept of attachment reorganization in mothers with unresolved trauma from both attachment and neuroscience perspectives. To that effect, we will first review the literature on the transition to motherhood from attachment and neuroscience perspectives. Second, we will use attachment and neuroscience approaches to address deviations from normative experiences during motherhood with a specific focus on the role of a mother’s unresolved trauma. Lastly, we will expand on the concept of reorganization and the promise this concept holds in resolving or halting the intergenerational transmission of trauma from mothers to their children.
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Affiliation(s)
- Udita Iyengar
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Purva Rajhans
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States.,Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, United States
| | - Peter Fonagy
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States.,Anna Freud National Centre for Children and Families, London, United Kingdom.,Research Department of Clinical, Educational, and Health Psychology, University College London, London, United Kingdom
| | - Lane Strathearn
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, United States.,Center for Disabilities and Development, University of Iowa Stead Family Children's Hospital, Iowa City, IA, United States
| | - Sohye Kim
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States.,Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, United States.,Center for Reproductive Psychiatry, Pavilion for Women, Texas Children's Hospital, Houston, TX, United States
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31
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Scalabrini A, Mucci C, Northoff G. Is Our Self Related to Personality? A Neuropsychodynamic Model. Front Hum Neurosci 2018; 12:346. [PMID: 30337862 PMCID: PMC6180150 DOI: 10.3389/fnhum.2018.00346] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 08/13/2018] [Indexed: 12/16/2022] Open
Abstract
The concept and the assessment of personality have been extensively discussed in psychoanalysis and in clinical psychology over the years. Nowadays there is large consensus in considering the constructs of the self and relatedness as central criterions to assess the personality and its disturbances. However, the relation between the psychological organization of personality, the construct of the self, and its neuronal correlates remain unclear. Based on the recent empirical data on the neural correlates of the self (and others), on the importance of early relational and attachment experiences, and on the relation with the brain's spontaneous/resting state activity (rest-self overlap/containment), we propose here a multilayered model of the self with: (i) relational alignment; (ii) self-constitution; (iii) self-manifestation; and (iv) self-expansion. Importantly, these different layers of the self can be characterized by different neuronal correlates-this results in different neuronally grounded configurations or organizations of personality. These layers correspond to different levels of personality organization, such as psychotic (as related to the layer of self-constitution), borderline (as related to the layer of self-manifestation) and neurotic (as related to the layer of self-expansion). Taken together, we provide here for the first time a neurobiologically and clinically grounded model of personality organization, which carries major psychodynamic and neuroscientific implications. The study of the spontaneous activity of the brain, intrinsically related to the self (rest-self overlap/containment) and the interaction with stimuli (rest-stimulus interaction) may represent a further advance in understanding how our default state plays a crucial role in navigating through the internal world and the external reality.
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Affiliation(s)
- Andrea Scalabrini
- Department of Psychological, Health and Territorial Sciences (DiSPuTer), G. d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Clara Mucci
- Department of Psychological, Health and Territorial Sciences (DiSPuTer), G. d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Georg Northoff
- University of Ottawa Institute of Mental Health Research and University of Ottawa Brain and Mind Research Institute, Ottawa, ON, Canada
- Mental Health Centre, Zhejiang University School of Medicine, Hangzhou, China
- Centre for Cognition and Brain Disorders, Hangzhou Normal University, Hangzhou, China
- TMU Research Centre for Brain and Consciousness, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Humanities in Medicine, Taipei Medical University, Taipei, Taiwan
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32
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Krause-Utz A, Elzinga B. Current Understanding of the Neural Mechanisms of Dissociation in Borderline Personality Disorder. Curr Behav Neurosci Rep 2018; 5:113-123. [PMID: 29577011 PMCID: PMC5857558 DOI: 10.1007/s40473-018-0146-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Purpose of Review In this article, we aim to give an overview over recent neuroimaging research on dissociation in borderline personality disorder (BPD). Stress-related dissociation is highly prevalent in BPD, while so far only little is known about its neural underpinnings. Recent Findings Based on research in depersonalization and the dissociative subtype of posttraumatic stress disorder, it has been proposed that dissociation involves alterations in a cortico-limbic network. In BPD, neuroimaging research explicitly focusing on dissociation is still scarce. Summary Functional neuroimaging studies have provided preliminary evidence for an altered recruitment and interplay of fronto-limbic regions (amygdala, anterior cingulate, inferior frontal gyrus, medial and dorsolateral prefrontal cortices) and temporoparietal areas (superior temporal gyrus, inferior parietal lobule, fusiform gyrus), which may underlie disrupted affective-cognitive processing during dissociation in BPD. More neuroimaging research with larger samples, clinical control groups, and repeated measurements is needed to deepen the understanding of dissociation in BPD.
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Affiliation(s)
- Annegret Krause-Utz
- Institute of Psychology, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition (LIBC), Leiden, The Netherlands
| | - Bernet Elzinga
- Institute of Psychology, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition (LIBC), Leiden, The Netherlands
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