Experiential avoidance in adolescents with borderline personality disorder: comparison with a non-BPD psychiatric group and healthy controls

Prediction of borderline personality disorder based on childhood trauma with the mediating role of experiential avoidance

Introduction

Traits of borderline personality disorder are important for the determination of the prognosis of mental illnesses and in evaluating risks of negativity as well as impulsivity. But, there is a lack of information about the distribution characteristics of borderline personality disorder traits and symptoms within clinical groups. The goal of the current study was to predict borderline personality disorder based on childhood trauma, using experiential avoidance as a mediator.

Methods

All male patients hospitalized in local psychiatric health centers with a diagnosis of borderline personality disorder comprised the statistical population of the current study. The number of 60 patients were selected by the purposeful sampling method. The questionnaire included the Childhood Trauma Questionnaire (CTQ), the Experiential Avoidance Questionnaire (AAQ-II), and the Borderline Personality Disorder Symptoms (BSL-23).

Results and discussion

The results demonstrated that there is a considerable and positive relationship between childhood trauma and experiential avoidance (r = 0.711, p< 0.01). In the mediating model, childhood trauma had significant direct predictive effects on borderline personality disorder (β = 0.546, p< 0.01). Also, between childhood trauma and BPD, experienced avoidance acts as a moderating factor. (β = 0.304, p< 0.01).

Experiential avoidance in participants with borderline personality disorder and other personality disorders

BACKGROUND

The present study has descriptive and predictive aims. The descriptive aims were to determine if participants with borderline personality disorder (BPD) reported higher levels of experiential avoidance (EA) than participants with other personality disorders (OPD) as well as determine if non-recovered participants with BPD reported higher levels of EA than participants with BPD who have recovered symptomatically and psychosocially. The predictive aim was to determine if the level of EA reported by participants with BPD was predicted by the severity of aspects of childhood or adult adversity and/or aspects of temperament.

METHODS

The Overall Anxiety Severity and Impairment Scale (OASIS) was administered to 248 participants at 24-year follow-up in the McLean Study of Adult Development (MSAD). Adversity and temperament were assessed during index admission using interviews (Revised Childhood Experience Questionnaire [CEQ-R], Adult History Interview [AHI], and the NEO-FFI self-report measure).

RESULTS

Participants with BPD reported significantly higher levels of EA than those with OPD. Within the BPD group, non-recovered participants reported significantly higher levels of EA than recovered participants. Severity of childhood sexual abuse and lower levels of extraversion were found to be significant multivariate predictors of levels of EA in those with BPD.

CONCLUSIONS

Taken together, these results suggest that EA is a serious problem for participants with BPD, particularly those who have not recovered. They also suggest that both the severity of childhood adversity and a temperament marked by lower levels of extroversion are significantly related to levels of EA reported by participants with BPD.

Enhancing the capacity for optimal social and personality function through the mediational intervention for sensitizing caregivers: A case illustration

OBJECTIVE

Based on the well-known principle that the ability to meaningfully relate to others starts in the context of early attachment relationships, the current case illustration uses a recent extension of mentalization-based theory and practice to demonstrate how caregivers can enhance the capacity for optimal social and personality function through the mediational intervention for sensitizing caregivers (MISC).

METHODS

Case material is presented to demonstrate the implementation of the MISC affective and cognitive components with a mother of an adopted 10-year-old girl who shows signs of affect avoidance, social isolation within and outside the family, and maladaptive personality development.

RESULTS

The case illustration shows how video feedback sessions facilitate the gradual use of affective and cognitive components in the daily interactions between mother and daughter, thereby scaffolding optimal social and personality development.

CONCLUSIONS

Affective and cognitive components of the Mediational Intervention for Sensitizing Caregiving can be effectively integrated to enhance mentalizing capacity in caregiver-child interactions.

Adolescent Personality Pathology and the Alternative Model for Personality Disorders: Self Development as Nexus

This paper reviews maladaptive trait development (DSM-5 Section III Criterion B), the development of DSM-5 Section II borderline personality disorder, and research on the development of identity, self-direction, empathy/mentalizing, and intimacy (DSM-5 Section III Criterion A). Combined, these previously disparate literatures begin to point to an integrated developmental theory of personality pathology, which suggests that Criterion A concepts (identity, self-direction, empathy, and intimacy) coalesce around the development of self, marking a discontinuous (qualitative) developmental shift. This developmental shift is a function of the demands placed on individuals to take on independent adult role function, combined with biologically-based maturational cognitive and emotional advances during adolescence. Section II personality disorder ensues when an integrated and coherent sense of self fails to develop, resulting in nonfulfilment of adult role function. In this sense, Criterion A self function can account for the onset of Section II personality disorder in adolescence, while Criterion B provides a useful descriptive account of continuous aspects of personality function over time.