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Rosén Rasmussen A, Handest P, Vollmer-Larsen A, Parnas J. Pseudoneurotic Symptoms in the Schizophrenia Spectrum: A Longitudinal Study of Their Relation to Psychopathology and Clinical Outcomes. Schizophr Bull 2024; 50:871-880. [PMID: 38227579 PMCID: PMC11283190 DOI: 10.1093/schbul/sbad185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
BACKGROUND AND HYPOTHESIS Nonpsychotic symptoms (depression, anxiety, obsessions, etc.) are frequent in schizophrenia-spectrum disorders and are usually conceptualized as comorbidity or transdiagnostic symptoms. However, in twentieth century foundational psychopathological literature, many nonpsychotic symptoms with specific phenomenology (here termed pseudoneurotic symptoms) were considered relatively typical of schizophrenia. In this prospective study, we investigated potential associations of pseudoneurotic symptoms with diagnostic status, functional outcome as well as psychopathological dimensions of schizophrenia. STUDY DESIGN First-admitted patients (N = 121) diagnosed with non-affective psychosis, schizotypal disorder, or other mental illness were examined at initial hospitalization and 5 years later with a comprehensive assessment of psychopathology. Informed by the literature, we constructed scales targeting pseudoneurotic symptoms and other, more general, nonpsychotic symptoms. STUDY RESULTS Pseudoneurotic symptoms aggregated in schizophrenia-spectrum groups compared to other mental illnesses and occurred at similar levels at baseline and follow-up. They longitudinally predicted poorer social and occupational functioning in schizophrenia-spectrum patients over a 5-year-period but not transition to schizophrenia-spectrum disorders from other mental illnesses. Finally, the level of pseudoneurotic symptoms correlated with disorder of basic self at both assessments and with positive and negative symptoms at follow-up. The scale targeting general nonpsychotic symptoms did not show this pattern of associations. CONCLUSIONS The study supports that a group of nonpsychotic symptoms, ie, pseudoneurotic symptoms, are associated with schizophrenia-spectrum disorders and linked with temporally stable psychopathology, particularly disorder of the basic self. Their prospective association with social and occupational functioning needs replication.
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Affiliation(s)
- Andreas Rosén Rasmussen
- Mental Health Center Amager, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Center for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | | | | | - Josef Parnas
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Communication, Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark
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Lo Buglio G, Boldrini T, Polari A, Fiorentino F, Nelson B, Solmi M, Lingiardi V, Tanzilli A. Harmonizing early intervention strategies: scoping review of clinical high risk for psychosis and borderline personality disorder. Front Psychol 2024; 15:1381864. [PMID: 38966724 PMCID: PMC11223645 DOI: 10.3389/fpsyg.2024.1381864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 04/29/2024] [Indexed: 07/06/2024] Open
Abstract
Aims To map studies assessing both clinical high risk for psychosis (CHR-P) and borderline personality disorder (BPD) in clinical samples, focusing on clinical/research/preventive paradigms and proposing informed research recommendations. Methods We conducted a PRISMA-ScR/JBI-compliant scoping review (protocol: https://osf.io/8mz7a) of primary research studies (cross-sectional/longitudinal designs) using valid measures/criteria to assess CHR-P and BPD (threshold/subthreshold) in clinical samples, reporting on CHR-P/psychotic symptoms and personality disorder(s) in the title/abstract/keywords, identified in Web of Science/PubMed/(EBSCO)PsycINFO until 23/08/2023. Results 33 studies were included and categorized into four themes reflecting their respective clinical/research/preventive paradigm: (i) BPD as a comorbidity in CHR-P youth (k = 20), emphasizing early detection and intervention in psychosis; (ii) attenuated psychosis syndrome (APS) as a comorbidity among BPD inpatients (k = 2), with a focus on hospitalized adolescents/young adults admitted for non-psychotic mental disorders; (iii) mixed samples (k = 7), including descriptions of early intervention services and referral pathways; (iv) transdiagnostic approaches (k = 4) highlighting "clinical high at risk mental state" (CHARMS) criteria to identify a pluripotent risk state for severe mental disorders. Conclusion The scoping review reveals diverse approaches to clinical care for CHR-P and BPD, with no unified treatment strategies. Recommendations for future research should focus on: (i) exploring referral pathways across early intervention clinics to promote timely intervention; (ii) enhancing early detection strategies in innovative settings such as emergency departments; (iii) improving mental health literacy to facilitate help-seeking behaviors; (iv) analysing comorbid disorders as complex systems to better understand and target early psychopathology; (v) investigating prospective risk for BPD; (vi) developing transdiagnostic interventions; (vii) engaging youth with lived experience of comorbidity to gain insight on their subjective experience; (viii) understanding caregiver burden to craft family-focused interventions; (ix) expanding research in underrepresented regions such as Africa and Asia, and; (x) evaluating the cost-effectiveness of early interventions to determine scalability across different countries. Systematic Review Registration https://osf.io/8mz7a.
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Affiliation(s)
- Gabriele Lo Buglio
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Tommaso Boldrini
- Department of Psychology and Educational Science, Pegaso Telematic University, Naples, Italy
| | - Andrea Polari
- Orygen Specialist Programs, Melbourne, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Flavia Fiorentino
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Barnaby Nelson
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- On Track: The Champlain First Episode Psychosis Program, Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Department of Child and Adolescent Psychiatry, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Annalisa Tanzilli
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
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Petersen LS, Vestergaard M, Meisner MW, Foldager M, Simonsen E. Atypical semantic cognition in schizotypal personality disorder and borderline personality disorder. J Clin Exp Neuropsychol 2024; 46:218-232. [PMID: 38704611 DOI: 10.1080/13803395.2024.2340813] [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: 09/17/2023] [Accepted: 04/02/2024] [Indexed: 05/06/2024]
Abstract
Increased schizotypal traits have previously been associated with atypical semantic cognition in community samples. However, no study has yet examined whether adults diagnosed with schizotypal personality disorder (SPD) display atypical semantic fluency and memory. We hypothesized that 24 adults diagnosed with SPD would name more idiosyncratic words on the semantic fluency task and show decreased semantic recall for animal and fruit category words compared with 29 participants with borderline personality disorder (BPD) and a community sample of 96 age-matched controls. We examined whether atypical semantic cognition was specifically associated with disorganized and eccentric speech and thinking, or more broadly with pathological personality traits and personality functioning. Our main hypothesis was confirmed, as the SPD participants named more idiosyncratic words and recalled fewer semantically related words compared with controls. Surprisingly, participants with BPD likewise named more atypical words compared with controls. More idiosyncratic semantic fluency was associated with more eccentric speech and thinking. Increased idiosyncratic semantic fluency and reduced semantic recall were both coupled to increased detachment and lowered personality functioning, while reduced semantic recall further was related to increased interpersonal problems. Our findings suggest that persons with SPD, and to a lesser degree BPD, show atypical semantic cognition, which is associated with eccentric speech and thinking, and more broadly with impaired personality function, social withdrawal, and emotional flatness. The idiosyncratic semantic cognition may worsen difficulties with social reciprocity seen in SPD and BPD.
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Affiliation(s)
- Lea S Petersen
- Psychiatric Research Unit, Psychiatry Region Zealand, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Martin Vestergaard
- Psychiatric Research Unit, Psychiatry Region Zealand, Denmark
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital - Psychiatry Region Zealand, Roskilde, Denmark
| | - Maria W Meisner
- Psychiatric Research Unit, Psychiatry Region Zealand, Denmark
| | - Malene Foldager
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital - Psychiatry Region Zealand, Roskilde, Denmark
| | - Erik Simonsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Mental Health Services East, Copenhagen University Hospital, Psychiatry Region Zealand, Denmark
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Feyaerts J, Sass L. Self-Disorder in Schizophrenia: A Revised View (1. Comprehensive Review-Dualities of Self- and World-Experience). Schizophr Bull 2024; 50:460-471. [PMID: 38069912 PMCID: PMC10919772 DOI: 10.1093/schbul/sbad169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
A growing body of research supports the role of self-disorders as core phenotypic features of schizophrenia-spectrum disorders. Self-disorders comprise various alterations of conscious experience whose theoretical understanding continues to present a challenge. The following 2 articles aim to provide further clarification of the nature of self-disorders in schizophrenia by offering a comprehensive review (article 1) and theoretical revision (article 2) of the currently most influential model of altered selfhood in schizophrenia: the basic-self-disturbance or ipseity-disorder model (IDM). This article presents a state-of-the-art overview of the current self-disturbance model and critically assesses its descriptive adequacy with respect to the clinical variability and heterogeneity of the alterations in self- and world-awareness characteristic of schizophrenia. Special attention is paid to experiences of exaggerated basic self, increased "grip" or "hold" on the world, and paradoxical combinations. The next article proposes a theoretical revision of the self-disturbance model by considering how hyperreflexivity might form the crucial common thread or generating factor that unifies the phenomenologically heterogeneous, and sometimes even contradictory features of schizophrenic self-disorders. We outline the implications of our revised model for explanatory research, therapeutic practice, and our general understanding of the abnormalities in question.
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Affiliation(s)
- Jasper Feyaerts
- Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Louis Sass
- Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
- Graduate School of Applied and Professional Psychology, Rutgers, The State University of New Jersey, USA
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Gruber M, Alexopoulos J, Doering S, Feichtinger K, Friedrich F, Klauser M, Hinterbuchinger B, Litvan Z, Mossaheb N, Parth K, Wininger A, Blüml V. Personality functioning and self-disorders in individuals at ultra-high risk for psychosis, with first-episode psychosis and with borderline personality disorder. BJPsych Open 2023; 9:e150. [PMID: 37563768 PMCID: PMC10594090 DOI: 10.1192/bjo.2023.530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 04/21/2023] [Accepted: 06/01/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Assessment of personality functioning in different stages of psychotic disorders could provide valuable information on psychopathology, course of illness and treatment planning, but empirical data are sparse. AIMS To investigate personality functioning and sense of self in individuals at ultra-high risk (UHR) for psychosis and with first-episode psychosis (FEP) in comparison with a clinical control group of individuals with borderline personality disorder (BPD) and healthy controls. METHOD In a cross-sectional design, we investigated personality functioning (Structured Interview of Personality Organization, STIPO; Level of Personality Functioning Scale, LPFS) and disturbances of the basic self (Examination of Anomalous Self-Experience, EASE) in 107 participants, comprising 24 individuals at UHR, 29 individuals with FEP, 27 individuals with BPD and 27 healthy controls. RESULTS The UHR, FEP and BPD groups had moderate to severe deficits in personality organisation (STIPO) compared with the healthy control group. Self-functioning with its subdomain (facet) 'self-direction' (LPFS) was significantly worse in participants with manifest psychosis (FEP) compared with those at-risk for psychosis (UHR). The FEP group showed significantly worse overall personality functioning than the UHR group and significantly higher levels of self-disturbance (EASE) than the BPD group, with the UHR group lying between these diagnostic groups. Hierarchical cluster analysis based on the seven STIPO domains yielded three clusters differing in level of personality functioning and self-disturbances. CONCLUSIONS Our data demonstrate that psychotic disorders are associated with impaired personality functioning and self-disturbances. Assessment of personality functioning can inform treatment planning for patients at different stages of psychotic disorder.
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Affiliation(s)
- Maria Gruber
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria; and Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Johanna Alexopoulos
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Stephan Doering
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Karin Feichtinger
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Fabian Friedrich
- Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Miriam Klauser
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Barbara Hinterbuchinger
- Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Zsuzsa Litvan
- Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Nilufar Mossaheb
- Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Karoline Parth
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Antonia Wininger
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Victor Blüml
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
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de With J, de Haan L, Schirmbeck F. Attachment Style and Self-Experience: The Association Between Attachment Style and Self-Reported Altered Self-Experience in Patients With Psychotic Disorders, Unaffected Siblings, and Healthy Controls. J Nerv Ment Dis 2023; 211:440-447. [PMID: 36971431 DOI: 10.1097/nmd.0000000000001634] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
ABSTRACT The present study aimed to examine the cross-sectional association between attachment style and self-reported disturbed self-awareness (disturbed sense of mineness of experiences) and depersonalization (disturbed sense of first-person perspective) in patients with psychotic disorders, unaffected siblings, and healthy controls. Data pertain to a subsample of the GROUP (Genetic Risk and Outcome of Psychosis) study. We found positive associations between anxious attachment and disturbed self-awareness and depersonalization across participants with different psychosis vulnerability. We also found a positive association between avoidant attachment and depersonalization, although on a trend level. Findings indicate that attachment style is associated with self-reported disturbed self-awareness and depersonalization over and above the influence of psychotic or depressive experiences in people across the vulnerability spectrum of psychosis. This supports the importance of attachment style, self-awareness, and depersonalization as potential targets in prevention and treatment interventions in patients with psychotic disorders or those with increased vulnerability.
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Affiliation(s)
- Justine de With
- Early Psychosis Department, Amsterdam UMC (location AMC), Department of Psychiatry; and
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Cheng P, Wang L, Zhou Y, Ma W, Zhao G, Zhang L, Li W. Post-traumatic stress disorder and depressive symptoms among firefighters: a network analysis. Front Public Health 2023; 11:1096771. [PMID: 37213609 PMCID: PMC10193951 DOI: 10.3389/fpubh.2023.1096771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 04/04/2023] [Indexed: 05/23/2023] Open
Abstract
Background Firefighters, as first responders with a high risk of occupational exposure to traumatic events and heavy working stress, have a high prevalence of PTSD symptoms and depressive symptoms. But no previous studies analyzed the relationships and hierarchies of PTSD and depressive symptoms among firefighters. Network analysis is a novel and effective method for investigating the complex interactions of mental disorders at the symptom level and providing a new understanding of psychopathology. The current study was designed to characterize the PTSD and depressive symptoms network structure in the Chinese firefighters. Method The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) and the Self-Rating Depression Scale (SDS) were applied to assess PTSD and depressive symptoms, respectively. The network structure of PTSD and depressive symptoms was characterized using "expected influence (EI)" and "bridge EI" as centrality indices. The Walktrap algorithm was conducted to identify communities in the PTSD and depressive symptoms network. Finally, Network accuracy and stability were examined using the Bootstrapped test and the case-dropping procedure. Results A total of 1,768 firefighters were enrolled in our research. Network analysis revealed that the relationship between PTSD symptoms, "Flashback" and "Avoidance," was the strongest. "Life emptiness" was the most central symptom with the highest EI in the PTSD and depression network model. Followed by "Fatigue" and "Interest loss." Bridge symptoms connecting PTSD and depressive symptoms in our study were "Numb," "High alertness," "Sad mood," and "Compunction and blame," successively. The data-driven community detection suggested the differences in PTSD symptoms in the clustering process. The reliability of the network was approved by both stability and accuracy tests. Conclusion To the best of our knowledge, the current study first demonstrated the network structure of PTSD and depressive symptoms among Chinese firefighters, identifying the central and bridge symptoms. Targeting interventions to the symptoms mentioned above may effectively treat firefighters suffering from PTSD and depressive symptoms.
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Affiliation(s)
- Peng Cheng
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Lirong Wang
- Xiangya School of Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Ying Zhou
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Wenjing Ma
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Guangju Zhao
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Li Zhang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Weihui Li
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- *Correspondence: Weihui Li,
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Bogaerts A, Claes L, Raymaekers K, Buelens T, Bastiaens T, Luyckx K. Trajectories of adaptive and disturbed identity dimensions in adolescence: developmental associations with self-esteem, resilience, symptoms of depression, and borderline personality disorder features. Front Psychiatry 2023; 14:1125812. [PMID: 37168080 PMCID: PMC10165116 DOI: 10.3389/fpsyt.2023.1125812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/06/2023] [Indexed: 05/13/2023] Open
Abstract
To advance our understanding of adolescents' identity formation and how it may play into their psychological functioning, this study investigated developmental trajectory classes of adaptive and disturbed dimensions of identity formation, and whether adolescents belonging to different trajectory classes develop differently on self-esteem, resilience, symptoms of depression, and borderline personality disorder (BPD) features. Three-wave longitudinal data from 2,123 Flemish adolescents was used (54.2% girls; Mage = 14.64, range = 12-18 at T1). Results pointed to four trajectory classes of identity formation: adaptive identity, identity progression, identity regression, and diffused identity. The adaptive identity class presented with stable high levels of self-esteem and resilience, and stable low levels of symptoms of depression and BPD, whereas opposite results were obtained for the diffused identity class. The identity progression class reported an increase in self-esteem and resilience as well as a decrease in symptoms of depression and BPD, whereas opposite results were obtained for the identity regression class. These results emphasize that adaptive and disturbed dimensions of identity formation are closely related to markers of well-being and psychopathology among adolescents, and could help identify adolescents with an increased risk for negative psychological functioning or increased opportunity for positive psychological functioning.
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Affiliation(s)
- Annabel Bogaerts
- Department of Clinical Developmental Psychology, University of Amsterdam, Amsterdam, Netherlands
- *Correspondence: Annabel Bogaerts,
| | - Laurence Claes
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Faculty of Medicine and Health Sciences, University Antwerp, Antwerp, Belgium
| | - Koen Raymaekers
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Fonds Wetenschappelijk Onderzoek, Brussels, Belgium
| | - Tinne Buelens
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Tim Bastiaens
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- University Psychiatric Centre, KU Leuven, Kortenberg, Belgium
| | - Koen Luyckx
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- UNIBS, University of the Free State, Bloemfontein, South Africa
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Rasmussen AR, Zandersen M, Nordgaard J, Sandsten KE, Parnas J. Pseudoneurotic symptoms in the schizophrenia spectrum: An empirical study. Schizophr Res 2022; 250:164-171. [PMID: 36423441 DOI: 10.1016/j.schres.2022.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/13/2022] [Accepted: 11/08/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Nonpsychotic symptoms (depression, anxiety, obsessions etc.) are frequent in schizophrenia-spectrum disorders. Twentieth century foundational psychopathological literature claimed that certain nonpsychotic symptoms (here termed pseudoneurotic symptoms) are relatively closely linked with the schizophrenia-spectrum, despite descriptive overlap with symptoms of other diagnoses. In this study, we investigated the association of pseudoneurotic and other nonpsychotic symptoms with the schizophrenia-spectrum as well as a hypothesis about an association of pseudoneurotic symptoms with disorder of basic self. METHODS The sample (N = 226) comprised patients with non-affective psychosis (N = 119), schizotypal personality disorder (N = 51) and other mental illness (N = 56), who were examined with a comprehensive assessment of lifetime psychopathology. Informed by the literature, we constructed scales targeting pseudoneurotic symptoms and other, more general, nonpsychotic symptoms. RESULTS Pseudoneurotic symptoms aggregated significantly in schizophrenia-spectrum disorders with an Area under the receiver operating characteristic curve of 0.84 (SE 0.03) for classifying patients with schizophrenia-spectrum disorders versus other mental illness. Patients with non-affective psychosis scored slightly, but significantly, higher on the scale targeting general nonpsychotic symptomatology than the other groups. In multiple regression analysis, pseudoneurotic symptoms were predicted by general nonpsychotic symptoms, disorders of basic self, and negative symptoms but not positive symptoms. CONCLUSION The study supports that certain neurotic-like symptoms with specific descriptive features (pseudoneurotic symptoms) are associated with schizophrenia-spectrum disorders. It suggests that pseudoneurotic symptoms are linked with temporally stable schizophrenia psychopathology (disorder of basic self and negative symptoms).
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Affiliation(s)
- Andreas Rosén Rasmussen
- Mental Health Center Amager, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Maja Zandersen
- Mental Health Center Glostrup, Broendbyoestervej, University of Copenhagen, Broendby, Denmark; Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark
| | - Julie Nordgaard
- Mental Health Center Amager, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Karl Erik Sandsten
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
| | - Josef Parnas
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark
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Boberg M, Felding S, Jansson L, Nordgaard J. Differential diagnosis: Schizophrenia and personality disorder. Schizophr Res 2022; 248:171-172. [PMID: 36063609 DOI: 10.1016/j.schres.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 07/08/2022] [Accepted: 08/20/2022] [Indexed: 10/14/2022]
Affiliation(s)
- Mateo Boberg
- Mental Health Centre Glostrup, University of Copenhagen, Copenhagen, Denmark.
| | - Simon Felding
- Mental Health Center Glostrup, University of Southern Denmark, Odense, Denmark
| | - Lennart Jansson
- Mental Health Centre Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Julie Nordgaard
- Mental Health Centre Amager, University of Copenhagen, Copenhagen, Denmark
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Ramos BRM, Sousa AED, Osório ESL, Guerra CSPS. From depression to śūnyatā perspectives on the concept of emptiness. Int J Soc Psychiatry 2022; 68:1151-1152. [PMID: 35411808 DOI: 10.1177/00207640221089532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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12
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Martin JA, Levy KN. Chronic feelings of emptiness in a large undergraduate sample: Starting to fill the void. Personal Ment Health 2022; 16:190-203. [PMID: 34731525 DOI: 10.1002/pmh.1531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 10/13/2021] [Indexed: 11/11/2022]
Abstract
Chronic emptiness in borderline personality disorder (BPD) has received little empirical attention. We sought to examine basic properties of a single chronic emptiness item, including prevalence, reliability, validity, the relation of the emptiness item to other BPD criteria, and measures of personality. Undergraduates enrolled in psychology courses over 12 years' time completed the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) (N = 22,217). Subsets of participants completed the International Personality Disorder Examination-Screening Questionnaire (IPDE-SQ) (N = 2732), The Revised NEO Personality Inventory (Anxiety, Angry Hostility, Depression, Positive Emotions [reversed], and Impulsivity facets) (N = 10,506), and the Depression Anxiety Stress Scales (DASS) (N = 1110) as validity indicators; 10.0% of respondents endorsed emptiness. Reliability indices suggested moderate levels of reliability between two emptiness items (r(2730) = 0.61, p < 0.001). Among BPD criteria, emptiness and identity disturbance correlated most strongly (r(22,215) = 0.81, p < 0.001). MSI emptiness was more correlated with depression on the NEO (r(10,504) = 0.43, p < 0.001) and DASS (r(1108) = 0.51, p < 0.001) than other facets of negative affect. Emptiness was more correlated with greater borderline pathology than any other MSI-BPD item (Sample 1, rtet = 0.87; Sample 2, rtet = 0.86). This criterion warrants further study and attention, especially related to assessment of BPD.
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Affiliation(s)
- Jacob A Martin
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Kenneth N Levy
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania, USA
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Sekowski M, Gambin M, Sumlin E, Sharp C. Associations between symptoms of borderline personality disorder and suicidality in inpatient adolescents: The significance of identity disturbance. Psychiatry Res 2022; 312:114558. [PMID: 35483136 DOI: 10.1016/j.psychres.2022.114558] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 04/14/2022] [Accepted: 04/16/2022] [Indexed: 11/19/2022]
Abstract
Several studies report that borderline personality disorder (BPD) is a risk factor for suicidality in adults. However, this issue requires further research in adolescents, as it is not clear which individual BPD symptoms are significant correlates of suicidality in this age group. The main aim of the current study was to test which symptoms of BPD are associated with suicidality in adolescent inpatients, even when controlling for age, gender, and depressive symptoms. Inpatient adolescents (N = 339) aged 12-17 years completed the Childhood Interview for DSM-IV Borderline Personality Disorder, the Beck Depression Inventory-II, the Modified Scale for Suicidal Ideation, and reported their number of lifetime suicide attempts. Multivariable regression analyses showed that, after controlling for confounding variables, overall BPD symptom severity was positively related to suicidal ideation and suicide attempts. Of the individual BPD symptoms, identity disturbance, chronic emptiness, avoid abandonment, and transient paranoia were the most robust correlates of suicidal ideation intensity, and only identity disturbance was associated with the number of lifetime suicide attempts. To assess the risk of suicidality in youth, it is essential to assess for BPD symptoms; it is important to focus on adolescents' subjective feelings to assess the severity of identity disturbance and chronic emptiness.
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Affiliation(s)
- Marcin Sekowski
- Department of Psychology, The Maria Grzegorzewska University, ul. Szczesliwicka 40, 02-353 Warsaw, Poland.
| | - Malgorzata Gambin
- Department of Psychology, University of Warsaw, ul Stawki 5/7, 00-183 Warsaw, Poland
| | - Eric Sumlin
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, TX, 77204, USA
| | - Carla Sharp
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, TX, 77204, USA
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14
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Schmidt P. Affective Instability and Emotion Dysregulation as a Social Impairment. Front Psychol 2022; 13:666016. [PMID: 35496195 PMCID: PMC9051371 DOI: 10.3389/fpsyg.2022.666016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/25/2022] [Indexed: 11/27/2022] Open
Abstract
Borderline personality disorder is a complex psychopathological phenomenon. It is usually thought to consist in a vast instability of different aspects that are central to our experience of the world, and to manifest as “a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity” [American Psychiatric Association (APA), 2013, p. 663]. Typically, of the instability triad—instability in (1) self, (2) affect and emotion, and (3) interpersonal relationships—only the first two are described, examined, and conceptualized from an experiential point of view. In this context, disorders of self have often motivated analyses of self-experience and the sense of self, affective disorders have been frequently considered in the light of emotional experience and its phenomenological structure. Patterns in the phenomenology of social experience have found comparatively little traction when it comes to the conceptualization of the interpersonal disturbances in borderline. In this paper, I argue that interpersonal instability in borderline consists in much more than fragile and shifting relationships but, most importantly, also involves certain styles in experiencing others. These styles, I suggest, may play an explanatory role for the borderline-typical patterns of interpersonal turmoil and so deserve more attention. To better describe and understand these styles, I explore the phenomenological structure of borderline affective instability and discuss the implications it might have for how a person experiences and relates to other people. Considering core aspects of borderline affective instability, such as alexithymia, emotional contagion, emotion dysregulation, and chronic emptiness, I propose borderline can be interpreted as a disturbance of interaffective exchange, which gives rise to certain ways of experiencing others that imply a social impairment.
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Affiliation(s)
- Philipp Schmidt
- Department of Philosophy, Technical University Darmstadt, Darmstadt, Germany
- Department of Philosophy, Julius Maximilian University of Würzburg, Würzburg, Germany
- Phenomenological Psychopathology and Psychotherapy, Psychiatric Clinic, Heidelberg University, Heidelberg, Germany
- *Correspondence: Philipp Schmidt,
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15
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The Dynamic Boundaries of the Self:Serial Dependence in the Sense of Agency. Cortex 2022; 152:109-121. [DOI: 10.1016/j.cortex.2022.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 01/17/2022] [Accepted: 03/19/2022] [Indexed: 11/23/2022]
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16
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Bioinformatics and Network-based Approaches for Determining Pathways, Signature Molecules, and Drug Substances connected to Genetic Basis of Schizophrenia etiology. Brain Res 2022; 1785:147889. [PMID: 35339428 DOI: 10.1016/j.brainres.2022.147889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/28/2022] [Accepted: 03/21/2022] [Indexed: 12/12/2022]
Abstract
Knowledge of heterogeneous etiology and pathophysiology of schizophrenia (SZP) is reasonably inadequate and non-deterministic due to its inherent complexity and underlying vast dynamics related to genetic mechanisms. The evolution of large-scale transcriptome-wide datasets and subsequent development of relevant, robust technologies for their analyses show promises toward elucidating the genetic basis of disease pathogenesis, its early risk prediction, and predicting drug molecule targets for therapeutic intervention. In this research, we have scrutinized the genetic basis of SZP through functional annotation and network-based system biology approaches. We have determined 96 overlapping differentially expressed genes (DEGs) from 2 microarray datasets and subsequently identified their interconnecting networks to reveal transcriptome signatures like hub proteins (FYN, RAD51, SOCS3, XIAP, AKAP13, PIK3C2A, CBX5, GATA3, EIF3K, and CDKN2B), transcription factors and miRNAs. In addition, we have employed gene set enrichment to highlight significant gene ontology (e.g., positive regulation of microglial cell activation) and relevant pathways (such as axon guidance and focal adhesion) interconnected to the genes associated with SZP. Finally, we have suggested candidate drug substances like Luteolin HL60 UP as a possible therapeutic target based on these key molecular signatures.
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17
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Anomalous self-experience, body image disturbance, and eating disorder symptomatology in first-onset anorexia nervosa. Eat Weight Disord 2022; 27:101-108. [PMID: 33661516 PMCID: PMC8860951 DOI: 10.1007/s40519-021-01145-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/01/2021] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Anorexia nervosa-restrictive subtype (AN-R) is a life-threatening disorder relying on behavioural abnormalities, such as excessive food restriction or exercise. Such abnormalities may be secondary to an "objectified" attitude toward body image and self. This is the first study exploring the impact of anomalous self-experience (ASEs) on abnormal body image attitude and eating disorder (ED) symptomatology in individuals with AN-R at onset. METHODS We recruited Italian female participants, 40 with AN-R (mean age 18.3 ± 2.3) and 45 age and educational level-matched healthy controls (HCs) (mean age 18.2 ± 2.6). ASEs, body image attitude, and ED symptom severity were assessed through the examination of anomalous self-experience (EASE), the body uneasiness test (BUT), and the eating disorder examination questionnaire (EDE-Q), respectively. We conducted multivariate analysis of variance to investigate distribution patterns of variables of interest, and mediation analysis to test the effect of ASEs and body image on ED symptomatology. RESULTS Individuals with AN-R scored higher than HCs on the EASE (p < .0001). A direct effect of ASEs on ED severity (p = 0.009; bootstrapped LLCI = 0.067, ULCI = 0.240) was found in AN-R. After modelling the effect of abnormal body image attitude, the relationship between EASE total score and ED symptomatology was significantly mediated by BUT (p = 0.002; bootstrapped LLCI = 0.001, ULCI = 0.172). CONCLUSION Although the exact pathways linking AN-R to self-disorder remain to be identified, a broader exploration of transdiagnostic features in AN, including explorations of different dimensions of self-experience and intersubjectivity, may shed further light on the clinical phenomenology of the disorder. LEVEL OF EVIDENCE Level III, case-control analytic study.
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18
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Burgin S, Reniers R, Humpston C. Prevalence and assessment of self-disorders in the schizophrenia spectrum: a systematic review and meta-analysis. Sci Rep 2022; 12:1165. [PMID: 35064201 PMCID: PMC8782935 DOI: 10.1038/s41598-022-05232-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
Self-disorders have been proposed as the "clinical core" of the schizophrenia spectrum. This has been explored in recent studies using self-disorder assessment tools. However, there are few systematic discussions of their quality and utility. Therefore, a literature search was performed on Medline, Embase, PsychINFO, PubMed and the Web of Science. Studies using these assessment tools to explore self-disorders within schizophrenia spectrum disorders (SSDs) were included. A meta-analysis was performed on the outcomes of total self-disorder score and odds ratios of self-disorders, using Comprehensive Meta-Analysis software. Weighted pooled effect sizes in Hedge's g were calculated using a random-effects model. 15 studies were included, giving a sample of 810 participants on the schizophrenia spectrum. Self-disorders showed a greater aggregation within schizophrenia spectrum groups compared to non-schizophrenia spectrum groups, as measured with the Bonn Scale for the Assessment of Basic Symptoms (Hedge's g = 0.774, p < 0.01) and Examination of Anomalous Self-Experiences (Hedge's g = 1.604, p < 0.01). Also, self-disorders had a greater likelihood of occurring within SSDs (odds ratio = 5.435, p < 0.01). These findings help to validate self-disorders as a core clinical feature of the broad schizophrenia spectrum.
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Affiliation(s)
- Sam Burgin
- University of Birmingham Medical School, University of Birmingham, Birmingham, B15 2TT, UK
| | - Renate Reniers
- Institute of Clinical Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Institute for Mental Health, University of Birmingham, Birmingham, B15 2TT, UK
| | - Clara Humpston
- Institute for Mental Health, University of Birmingham, Birmingham, B15 2TT, UK.
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19
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Kovács A, Ladányi B, Farkas N, Stempel L, Kiss D, Bittermann É, Rácz J. The recovery of homicidal people diagnosed with schizophrenia and schizoaffective disorder-An interpretative phenomenological analysis. Front Psychiatry 2022; 13:951678. [PMID: 36741576 PMCID: PMC9892903 DOI: 10.3389/fpsyt.2022.951678] [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: 05/24/2022] [Accepted: 12/28/2022] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Identity recovery in people diagnosed with schizophrenia who have committed homicide poses several difficulties. Premorbid mental illnesses, the experience of psychosis, and the absence of cohesive ego functions may result in the inability to integrate the homicidal act into self-identity. Problems with integration increase the risk of recidivism and further mental problems. The aim of the present research was to explore how homicidal people diagnosed with schizophrenia make sense of their actions, and how they identify with the homicide. METHOD Six semi-structured interviews were conducted at a long-term psychiatric home with people who had committed homicide and who had been diagnosed with schizophrenia. The interviews were transcribed verbatim and analysed using interpretative phenomenological analysis (IPA), an idiographic method rooted in phenomenologist traditions that focuses on how participants experience and make sense of events in their lives, and how those events affect their identity and sense of self. RESULTS Three personal experiential themes were established as a result of the analysis: (1) homicide and responsibility; (2) homicide and self; and (3) control over threats to self and self-evaluation. (1) Homicide was often reported to have been committed in a non-conscious, delusional state that may have led to the loss of self-determination. (2) Our interviewees struggled to integrate their acts into their identities. They distanced themselves from the crime or held multiple, parallel interpretations of the act. (3) Recovering patients experienced the constant threat of entering into a delusional reality and losing control. The importance of control was central to their self-evaluation. The patients appeared to distance themselves from the homicidal act and to regard their delusional selves as a threat to their lives. CONCLUSION Therapy aimed at bolstering self-control, supporting the integration of the fragmented self, and raising awareness of the connections between delusional reality and standard, intersubjective reality may be helpful in reducing the instability of the self. Therapy aimed at processing complex grief and loss of family is also needed.
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Affiliation(s)
- Asztrik Kovács
- Doctoral School of Psychology, Eötvös Loránd University, Budapest, Hungary.,Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Bence Ladányi
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary.,Department of Criminal Investigation, Hungarian National Police Headquarters, Budapest, Hungary
| | - Noémi Farkas
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Laura Stempel
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Dániel Kiss
- Doctoral School of Psychology, Eötvös Loránd University, Budapest, Hungary
| | | | - József Rácz
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary.,Department of Addictology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
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20
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Belohradova Minarikova K, Prasko J, Holubova M, Vanek J, Kantor K, Slepecky M, Latalova K, Ociskova M. Hallucinations and Other Psychotic Symptoms in Patients with Borderline Personality Disorder. Neuropsychiatr Dis Treat 2022; 18:787-799. [PMID: 35422622 PMCID: PMC9005124 DOI: 10.2147/ndt.s360013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/18/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Psychotic symptoms in BPD are not uncommon, and they are diverse and phenomenologically similar to those in schizophrenia spectrum disorders. Despite their prevalence in BPD patients, knowledge about the characteristics and severity of hallucinations is limited, especially in modalities other than auditory. AIM This review summarises the causes, phenomenology, severity, and treatment options of hallucinations and other psychotic symptoms in BPD. METHODS The PubMed database was used with the following key terms: "borderline personality disorder" and 'hallucinations' and "psychotic symptoms". Articles were selected between January 1990 and May 2021. The primary keyword search yielded a total of 545 papers, of which 102 articles met the inclusion criteria and were fully screened. Papers from the primary source reference lists were also screened, assessed for eligibility, and then added to the primary documents where appropriate (n = 143). After the relevance assessment, 102 papers were included in the review. We included adult and adolescent studies to gather more recent reviews on this topic. RESULTS Hallucinations are significantly prevalent in BPD, mainly auditory, similar to schizophrenia spectrum disorders. The relationship between hallucinations and depression, anxiety, suicidality, schizotypy, and loneliness in BPD has been discovered but requires more research. Studies for treatment options for hallucinations in BPD are lacking. CONCLUSION Recognition of psychotic symptoms in patients with BPD as distinguished psychopathological phenomena instead of diminishing and overlooking them is essential in the clinical assessment and can be useful in predicting complications during treatment. More focused research in this area is needed.
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Affiliation(s)
- Kamila Belohradova Minarikova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University, University Hospital, Olomouc, The Czech Republic
| | - Jan Prasko
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University, University Hospital, Olomouc, The Czech Republic.,Institute for Postgraduate Education in Health Care, Prague, The Czech Republic.,Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University, Nitra, The Slovak Republic.,Jessenia, a.s., Rehabilitation Hospital Beroun, AKESO Holding, Beroun, The Czech Republic
| | - Michaela Holubova
- Department of Psychiatry, Hospital Liberec, Liberec, The Czech Republic.,Department of Pedagogy and Psychology, Faculty of Science, Humanities and education, Technical University, Liberec, The Czech Republic
| | - Jakub Vanek
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University, University Hospital, Olomouc, The Czech Republic
| | - Krystof Kantor
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University, University Hospital, Olomouc, The Czech Republic
| | - Milos Slepecky
- Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University, Nitra, The Slovak Republic
| | - Klara Latalova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University, University Hospital, Olomouc, The Czech Republic
| | - Marie Ociskova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University, University Hospital, Olomouc, The Czech Republic
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21
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Zvereva N, Zvereva M, Pyatnitskaya L. Temperament Profiles of Children and Adolescents with Psychotic and Mood Disorders. Neuropsychobiology 2021; 80:176-184. [PMID: 33130675 DOI: 10.1159/000511108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 08/20/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Psychiatric disorders are often linked to dysfunctions within neurotransmitter systems, and the same systems play a role in healthy temperaments. Development of a common bio-behavioural taxonomy based on functionality of neurotransmitter systems suggests examining temperament profiles in patients with various psychiatric disorders. OBJECTIVE (1) To investigate temperament profiles in two age groups of children with delusional disorders; (2) to investigate temperament profiles in adolescents with mood disorders; (3) to investigate temperament profiles in in vitro fertilisation (IVF) children. METHODS Sample: in total 171 participants (M/F = 91/80), healthy children and teenagers (volunteers); two age groups of children with psychotic disorders; teens with mood disorders (clients of the Federal Mental Health Center) and healthy IVF. Parents of participants completed a test based on the neurochemical model Functional Ensemble of Temperament (FET). RESULTS AND CONCLUSIONS (1) Both age groups of children with psychotic disorders had significantly lower scores on the scales of physical endurance, tempo, plasticity, and self-satisfaction, in comparison to healthy controls; the psychotic group aged 5-11 had also lower scores on the impulsivity scale, whereas the psychotic group 12-17 had lower scores on the social endurance and social tempo scales and higher neuroticism. (2) Teens with mood disorders had lower scores on the self-confidence-satisfaction scale and higher scores on the impulsivity scale, in comparison to controls. (3) No difference between IVF and naturally conceived children were found. The results show the benefits of using the FET framework for structuring the correspondence between psychiatric disorders and temperament as it differentiates between social versus physical aspects of behaviour and orientational versus executive aspects.
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Affiliation(s)
- Natalia Zvereva
- Federal State Budgetary Scientific Institution, Mental Health Research Center, Moscow, Russian Federation, .,Federal State Budgetary Institution of Higher Education, Moscow State University of Psychology and Education, Moscow, Russian Federation,
| | - Mariia Zvereva
- Federal State Budgetary Scientific Institution, Mental Health Research Center, Moscow, Russian Federation
| | - Luydmila Pyatnitskaya
- Federal State Budgetary Scientific Institution, Mental Health Research Center, Moscow, Russian Federation
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22
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Henriksen MG, Raballo A, Nordgaard J. Self-disorders and psychopathology: a systematic review. Lancet Psychiatry 2021; 8:1001-1012. [PMID: 34688345 DOI: 10.1016/s2215-0366(21)00097-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 02/28/2021] [Accepted: 03/02/2021] [Indexed: 01/01/2023]
Abstract
In foundational texts on schizophrenia, the mental disorder was constitutively linked to a specific disintegration of subjectivity (often termed a self-disorder). Apart from Scharfetter's work on ego-pathology, research on self-disorders generally faded into oblivion, and self-disorders were only rediscovered as notable psychopathological features of the schizophrenia spectrum nearly two decades ago. Subsequently, the Examination of Anomalous Self-Experience (EASE) scale was constructed to allow systematic assessment of non-psychotic self-disorders. This Review is the first systematic review of empirical studies on self-disorders based on the EASE or other related scales. The results consistently show that self-disorders hyper-aggregate in schizophrenia spectrum disorders but not in other mental disorders; that self-disorders are found in individuals at a clinical risk of developing psychosis; that self-disorders show a high degree of temporal stability; that self-disorders predict the later development of schizophrenia spectrum disorders; and that self-disorders correlate with the canonical dimensions of the psychopathology of schizophrenia, impaired social functioning, and suicidality. Issues with the methods of the reviewed literature are critically discussed and the role of self-disorders in clinical psychiatry and future research is outlined.
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Affiliation(s)
- Mads Gram Henriksen
- Centre for Subjectivity Research, Department of Communication, University of Copenhagen, Copenhagen, Denmark; Mental Health Centre Amager, University Hospital of Copenhagen, Copenhagen, Denmark; Mental Health Centre Glostrup, University Hospital of Copenhagen, Copenhagen, Denmark.
| | - Andrea Raballo
- Section of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Perugia, Italy; Centre for Translational, Phenomenological and Developmental Psychopathology, Perugia University Hospital, Perugia, Italy
| | - Julie Nordgaard
- Mental Health Centre Amager, University Hospital of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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23
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Abstract
A feeling of emptiness is commonly encountered in clinical practice, but it is poorly understood, with incongruent approaches to its definition and possible role in various disorders. This review examines the conceptualization of the feeling of emptiness and its place in psychopathology. We found an imbalance between theoretical approaches to this phenomenon and empirical research, and argue that more studies using adequate assessment tools are needed. Based on our literature review, we propose that a feeling of emptiness is a complex, negative emotional state that is experienced in different ways by different individuals. This feeling includes a physical or bodily component, a component of aloneness or social disconnectedness, and a component of a deep sense of personal unfulfillment or lack of purpose. The feeling of emptiness is related to other emotional states (dysphoria, boredom, loneliness, and numbness) and overlaps to some extent with them. Although the feeling of emptiness is most often considered in the context of borderline personality disorder, it is also encountered in depression, narcissistic personality disorder, and schizophrenia spectrum disorders, with its features potentially varying between different conditions. The feeling of emptiness may lead to nonsuicidal self-injury and may also have an important relationship with suicidality. We conclude by offering suggestions for further research, emphasizing a need to refine the multidimensional conceptualization of the feeling of emptiness and to better understand its manifestations and relationships with other emotions within various forms of psychopathology.
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Konjusha A, Hopwood CJ, Price AL, Masuhr O, Zimmermann J. Investigating the Transdiagnostic Value of Subjective Emptiness. J Pers Disord 2021; 35:788-800. [PMID: 33661017 DOI: 10.1521/pedi_2021_35_510] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
It is common for people with mental health problems to report feelings of emptiness. However, the association of subjective emptiness with specific disorders and its unique role within dimensional taxonomies of personality pathology is not well understood. The present study assesses the transdiagnostic value of subjective emptiness using a recently developed self-report measure in a mixed sample of 157 participants. The authors investigated the associations of emptiness with clinically relevant variables, including borderline personality disorder symptoms, depression, anxiety, suicidal ideation, and suicide attempts. Subjective emptiness showed strong positive relationships with all criteria. Regression models controlling for impairments of personality functioning, maladaptive personality traits, and current symptom distress supported the incremental validity of emptiness for specific disorder constructs and suicidality. These findings indicate that emptiness represents a facet of psychopathology that can be particularly useful for the classification of mental disorders, and in particular internalizing disorders involving self-dysfunction and detachment.
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Affiliation(s)
| | | | | | - Oliver Masuhr
- Asklepios Fachklinikum Tiefenbrunn, Rosdorf, Germany
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25
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Nordgaard J, Henriksen MG, Jansson L, Handest P, Møller P, Rasmussen AR, Sandsten KE, Nilsson LS, Zandersen M, Zahavi D, Parnas J. Disordered Selfhood in Schizophrenia and the Examination of Anomalous Self-Experience: Accumulated Evidence and Experience. Psychopathology 2021; 54:275-281. [PMID: 34384082 PMCID: PMC8686724 DOI: 10.1159/000517672] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/24/2021] [Indexed: 11/19/2022]
Abstract
Disordered selfhood in schizophrenia was rediscovered at the turn of the millennium. In 2005, Psychopathology published the psychometric instrument, the Examination of Anomalous Self-Experience (EASE). In this article, we summarize the historical background of the creation of the EASE, explicate the notion of the disorder of basic or minimal self with the help of phenomenological philosophy, and provide a brief description of clinical manifestations targeted by the EASE. We also present our personal experience using and teaching the EASE and summarize the empirical evidence obtained so far. We conclude that the basic self-disorder represents a crucial phenotype of schizophrenia spectrum disorders and that this phenotype offers a potential avenue to empirical pathogenetic research and psychotherapeutic treatment.
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Affiliation(s)
- Julie Nordgaard
- Mental Health Center Amager, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mads Gram Henriksen
- Mental Health Center Amager, Copenhagen, Denmark
- Mental Health Center Glostrup, Broendby, Denmark
- Department of Communication, Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark
| | - Lennart Jansson
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Mental Health Center Glostrup, Broendby, Denmark
| | | | - Paul Møller
- Division of Mental Health and Addicition, Department of Mental Health Research and Development, Vestre Viken Hospital Trust, Drammen, Norway
| | - Andreas Rosen Rasmussen
- Mental Health Center Amager, Copenhagen, Denmark
- Mental Health Center Glostrup, Broendby, Denmark
| | | | - Lars Siersbæk Nilsson
- Mental Health Center Glostrup, Broendby, Denmark
- Department of Communication, Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark
| | - Maja Zandersen
- Mental Health Center Glostrup, Broendby, Denmark
- Department of Communication, Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark
| | - Dan Zahavi
- Department of Communication, Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark
| | - Josef Parnas
- Department of Communication, Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark
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26
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Herron SJ, Sani F. Understanding the typical presentation of emptiness: a study of lived-experience. J Ment Health 2021; 31:188-195. [PMID: 34008477 DOI: 10.1080/09638237.2021.1922645] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Persistent feelings of emptiness, while poorly understood, characterise a range of mental health difficulties. AIMS To investigate the meaning of emptiness from the perspective of those with lived experience. METHOD 240 participants detailed their experiences of emptiness in a survey. Inductive thematic analysis was performed to produce a detailed description of emptiness and a definition of its typical manifestation. In a follow up survey, 178 individuals with lived experience of emptiness rated the accuracy of this definition. RESULTS Nine components of emptiness were identified. These were used to produce a definition of the typical manifestation of emptiness, which highlighted a sense of going through life mechanically, purposelessly and numbly, with a psychological and bodily felt inner void, together with a sense of disconnectedness from others, and of not contributing to an unchanged but distant and remote world. Participants in the second survey judged this definition as highly accurate. CONCLUSIONS First person accounts of emptiness point to an integrated experience concerning the relationship between the self, others, and the external world more generally. Therefore, emptiness can be conceptualised as an existential feeling; a background orientation structuring the way in which the self relates to the interpersonal and impersonal world.
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Affiliation(s)
- Shona Joyce Herron
- Department of Clinical Psychology, University College London, London, UK
| | - Fabio Sani
- School of Social Sciences (Psychology), University of Dundee, Dundee, UK
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Abstract
The few studies that examined the association between narcissism and problematic smartphone use found mixed results. Moreover, the empirical examination of psychological mechanisms for this link is lacking. This study investigated the relationships between pathological narcissism, emptiness and problematic smartphone use. Participants included 278 young Israeli adults (159 males; Mage = 26.21) who completed a battery of self-report questionnaires. Our results show that narcissistic grandiosity, vulnerability and emptiness were positively related to problematic smartphone use. Importantly, emptiness mediated the relationships between pathological narcissism and problematic smartphone use. These findings highlight the mediating role of emptiness experience in the associations between pathological narcissism and problematic smartphone use and lend empirical support to the importance of the emptiness experience for compensatory behaviors such as heavy and compulsive smartphone usage by the pathological narcissist.
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Affiliation(s)
- Gadi Zerach
- Department of Behavioral Sciences and Psychology, Ariel University, 40700, Ariel, Israel.
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28
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Integrating clinical staging and phenomenological psychopathology to add depth, nuance, and utility to clinical phenotyping: a heuristic challenge. Lancet Psychiatry 2021; 8:162-168. [PMID: 33220779 DOI: 10.1016/s2215-0366(20)30316-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/17/2020] [Accepted: 06/30/2020] [Indexed: 11/23/2022]
Abstract
Psychiatry has witnessed a new wave of approaches to clinical phenotyping and the study of psychopathology, including the US National Institute of Mental Health's Research Domain Criteria, clinical staging, network approaches, the Hierarchical Taxonomy of Psychopathology, the general psychopathology factor, and a revival of interest in phenomenological psychopathology. The question naturally emerges about what the relationship between these new approaches is. Are they mutually exclusive and competing approaches, or can they be integrated in some way and be used to enrich each other? In this Personal View, we propose a possible integration between clinical staging and phenomenological psychopathology. Domains identified in phenomenological psychopathology (eg, selfhood, embodiment, and affectivity) can be overlaid on clinical stages to enrich and deepen the phenotypes captured in clinical staging (creating high-resolution clinical phenotypes). This approach might be useful both ideographically and nomothetically, to complement diagnosis, enrich clinical formulation, inform treatment of individual patients, and help to guide aetiology research, prediction of clinical trajectory and treatment. Overlaying phenomenological domains on clinical stages might require reformulating these domains in dimensional rather than categorial terms. This integrative project requires assessment tools (some of which are already available) that are sufficiently sensitive and thorough to pick up on the range of relevant psychopathology. The proposed approach offers opportunities for mutual enrichment: clinical staging might be enriched by introducing greater depth to phenotypes; phenomenological psychopathology might be enriched by introducing stages of severity and disorder progression to phenomenological analysis.
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29
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Cavelti M, Thompson K, Chanen AM, Kaess M. Psychotic symptoms in borderline personality disorder: developmental aspects. Curr Opin Psychol 2021; 37:26-31. [DOI: 10.1016/j.copsyc.2020.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/02/2020] [Indexed: 12/14/2022]
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30
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Raballo A, Poletti M, Preti A, Parnas J. The Self in the Spectrum: A Meta-analysis of the Evidence Linking Basic Self-Disorders and Schizophrenia. Schizophr Bull 2021; 47:1007-1017. [PMID: 33479736 PMCID: PMC8266610 DOI: 10.1093/schbul/sbaa201] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Disturbed self-experience has been reported as a characteristic feature of schizophrenia since the first formulation of its diagnostic concept; however, only in the last 2 decades an explicit notion of basic Self-disturbance, or Self-Disorders (SD), has emerged as target for a systematic research program. We conducted systematic searches in bibliographical databases to identify cross-sectional studies that explored SD across different diagnostic groups and explored diagnostic ascription within or outside schizophrenia spectrum disorders (SSD) as main outcome. Data were pooled using fixed- and random-effects meta-analysis models. Heterogeneity was assessed using stratified meta-analyses and meta-regression. Of 218 identified studies, 32 were included in the systematic review and 27 in the meta-analysis. Patients diagnosed with SSD scored higher on measures of SD than healthy controls (HC) (Hedges' g = 1.8; 95% CI = 1.5 to 2.0), individuals diagnosed with other mental illness (OMI) (1.9; 1.6 to 2.2), bipolar or affective disorders (1.8; 1.4 to 2.2), and clinical high risk for psychosis (CHR) (1.6; 0.9 to 2.4). Patients with schizotypy or schizotypal personality disorder scored higher on measures of SD than OMI (1.5; 1.3 to 1.8) and HC (1.4; 1.1 to 1.7). Patients with first-episode psychosis scored higher on measures of SD than HC (2.5; 2.1 to 2.9) and OMI (1.6; 1.2 to 2.1). Subjects at CHR scored higher on measures of SD than HC (2.0; 1.7 to 2.2) and OMI (19; 1.6 to 2.2). Overall, heterogeneity ranged from negligible to high, especially in comparisons of the target group with OMI, probably as a reflection of the immanent diagnostic heterogeneity of this group. The findings suggest that SD selectively aggregate within schizophrenia spectrum disorders as compared to other mental disorders and that they could be a central phenotypic marker of vulnerability to schizophrenia across the different shades of severity of its spectrum of disorders.
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Affiliation(s)
- Andrea Raballo
- Section of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Perugia, Italy,Center for Translational, Phenomenological and Developmental Psychopathology (CTPDP), Perugia University Hospital, Perugia, Italy,To whom correspondence should be addressed; Section of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia Piazzale Lucio Severi 1, 06132, Perugia, Italy; tel: +39 075 5783194, fax: +39 075 5783183, e-mail:
| | - Michele Poletti
- Department of Mental Health and Pathological Addiction, Child and Adolescent Neuropsychiatry Service, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Antonio Preti
- Department of Neuroscience, University of Turin, Turin, Italy
| | - Josef Parnas
- Center for Subjectivity Research, University of Copenhagen, 2300, Copenhagen, Denmark,Mental Health Centre Glostrup, University Hospital of Copenhagen, 2605, Brøndby, Denmark,Faculty of Health and Medical Sciences, University of Copenhagen, 2200, Copenhagen, Denmark
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31
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Meisner MW, Lenzenweger MF, Bach B, Vestergaard M, Petersen LS, Haahr UH, Kongerslev M, Simonsen E. Exploring Identity Disturbance and Psychotic Spectrum Symptoms as Predictors of Borderline and Schizotypal Personality Disorders. Psychopathology 2021; 54:193-202. [PMID: 34058737 DOI: 10.1159/000516209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 03/28/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Borderline personality disorder (BPD) and schizotypal personality disorder (SPD) were introduced in DSM-III and retained in DSM-5 Section II. They often co-occur and some aspects of the clinical differentiation between the 2 diagnoses remain unclear (e.g., psychotic-like features and identity disturbance). METHODS The present study explored if self-reported identity disturbance and psychosis proneness could discriminate between the BPD and SPD DSM-5 diagnoses. All patients were interviewed with the Schedules for Clinical Assessment in Neuropsychiatry and the Structured Clinical Interview for DSM-5 Personality Disorders, and administered the Inventory of Personality Organization, Self-Concept and Identity Measure, Schizotypal Personality Questionnaire, Perceptual Aberration Scale, and the Magical Ideation Scale. RESULTS A total of 105 patients were initially assessed, 26 were excluded, and the final sample (N = 79) was composed of 34 BPD patients, 25 SPD patients, and 20 patients with co-occurring SPD and BPD. The BPD group (n = 34) was first compared with the pure SPD group (n = 25), and secondly with the total group of patients diagnosed with SPD (n = 25 + 20). Logistic regression analyses indicated that primitive defenses and disorganization best differentiated the BPD and the pure SPD group, while primitive defenses and interpersonal factor along with perceptual aberrations best differentiated the BPD and the total SPD group. CONCLUSION Identity disturbance did not predict the diagnostic groups, but BPD patients were characterized by primitive defenses, which are closely related to identity disturbance. Pure SPD was characterized by oddness/eccentricity, while the lack of specificity for cognitive-perceptual symptoms suggests that the positive symptoms do not differentiate BPD from SPD.
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Affiliation(s)
- Maria W Meisner
- Psychiatric Research Unit, Region Zealand, Slagelse, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mark F Lenzenweger
- Department of Psychology, The State University of New York at Binghamton, Binghamton, New York, USA.,Department of Psychiatry, Weill Cornell Medical College, New York, New York, USA
| | - Bo Bach
- Psychiatric Research Unit, Region Zealand, Slagelse, Denmark.,Mental Health Services West, Psychiatry Region Zealand, Slagelse, Denmark
| | | | - Lea S Petersen
- Psychiatric Research Unit, Region Zealand, Slagelse, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ulrik H Haahr
- Psychiatric Research Unit, Region Zealand, Slagelse, Denmark
| | - Mickey Kongerslev
- Mental Health Services East, Psychiatry Region Zealand, Roskilde, Denmark.,Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Erik Simonsen
- Psychiatric Research Unit, Region Zealand, Slagelse, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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32
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Price AL, Mahler HIM, Hopwood CJ. Construction and Validation of a Self-report Subjective Emptiness Scale. Assessment 2020; 29:397-409. [PMID: 33291950 DOI: 10.1177/1073191120968275] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Subjective emptiness is a psychiatric symptom that is primarily assessed and studied as a criterion of borderline personality disorder, even though research suggests that it may have clinical importance beyond that diagnosis. The aim of this series of studies was to develop and validate a standalone self-report measure of subjective emptiness. A systematic, multistep approach to identifying test content was used to generate 88 items that were then trimmed to 53 via ratings of interviews with patients and experts. This preliminary scale was administered to a sample of 544 university students, and a trimmed version was given to two samples oversampled for clinical problems (n = 1,067; n = 1,016). A five-item measure fit a unidimensional model well and had satisfactory internal consistency across these samples. External validity analyses suggested that emptiness, as measured by the Subjective Emptiness Scale, is strongly related to a number of clinical constructs, particularly in the internalizing domain, indicating that emptiness is an important construct to consider in its own right, independent of its presence in the borderline criterion set.
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Affiliation(s)
- Adrian L Price
- California State University San Marcos, San Marcos, CA, USA
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33
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Zandersen M, Parnas J. Exploring schizophrenia spectrum psychopathology in borderline personality disorder. Eur Arch Psychiatry Clin Neurosci 2020; 270:969-978. [PMID: 31289925 PMCID: PMC7599140 DOI: 10.1007/s00406-019-01039-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 07/03/2019] [Indexed: 12/15/2022]
Abstract
We have previously argued that the current borderline personality disorder (BPD) diagnosis is over-inclusive and clinically and conceptually impossible to distinguish from the schizophrenia spectrum disorders. This study involves 30 patients clinically diagnosed with BPD as their main diagnosis by three BPD dedicated outpatient treatment facilities in Denmark. The patients underwent a careful and time-consuming psychiatric evaluation involving several senior level clinical psychiatrists and researchers and a comprehensive battery of psychopathological scales. The study found that the vast majority of patients (67% in DSM-5 and 77% in ICD-10) in fact met the criteria for a schizophrenia spectrum disorder, i.e., schizophrenia (20%) or schizotypal (personality) disorder (SPD). The schizophrenia spectrum group scored significantly higher on the level of disorders of core self as measured by the Examination of Anomalous Self-Experiences Scale (EASE). The BPD criterion of "identity disturbance" was significantly correlated with the mean total score of EASE. These findings are discussed in the light of changes from prototypical to polythetic diagnostic systems. We argue that the original prototypes/gestalts informing the creation of BPD and SPD have gone into oblivion during the evolution of polythetic criteria.
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Affiliation(s)
- Maja Zandersen
- Mental Health Centre Glostrup, University Hospital of Copenhagen, Broendbyoestervej 160, 2605, Broendby, Denmark.
| | - Josef Parnas
- Mental Health Centre Glostrup, University Hospital of Copenhagen, Broendbyoestervej 160, 2605, Broendby, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark
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34
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Jansson L, Parnas J. 'The schizophrenic basic mood (self-disorder)', by Hans W Gruhle (1929). HISTORY OF PSYCHIATRY 2020; 31:364-375. [PMID: 32308031 DOI: 10.1177/0957154x20915147] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
During the first half of the twentieth century, German psychiatry came to consider 'Ich-Störungen', best translated as self-disorders, to be important features of schizophrenia. The present text is a translation of a chapter by the German psychiatrist Hans Gruhle, which is extraordinarily clear and emblematic for this research line. Published in 1929, it was part of a book co-written with Josef Berze, The Psychology of Schizophrenia (concerning its subjectivity). Gruhle claims that the essential core of schizophrenia is of an affective nature, a 'mood' manifesting itself as self-disorder, an unstable, incomplete pre-reflective self-awareness. His impact on contemporary psychiatry was probably limited due to his confrontational style, but this text has great significance for the modern revival of phenomenological research in schizophrenia.
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Affiliation(s)
| | - Josef Parnas
- University Hospital of Copenhagen, and University of Copenhagen, Denmark
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35
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Rasmussen AR, Reich D, Lavoie S, Li E, Hartmann JA, McHugh M, Whitford TJ, Nelson B. The relation of basic self-disturbance to self-harm, eating disorder symptomatology and other clinical features: Exploration in an early psychosis sample. Early Interv Psychiatry 2020; 14:275-282. [PMID: 31264785 DOI: 10.1111/eip.12850] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/30/2019] [Accepted: 06/09/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIMS The notion of basic self-disturbance has been proposed as a core feature of schizophrenia-spectrum disorders and as an indicator of future transition to psychosis in high-risk populations. However, the relation of this notion to many clinical characteristics has not been explored. The aim of this study was: (a) to investigate the distribution of self-disturbance and other symptoms dimensions in ultra-high risk (UHR), first-episode psychosis (FEP) and healthy control groups; and (b) to explore the association of self-disturbance with a history of self-harm, suicidal attempt, eating disorder symptomatology, school bullying victimization and sexual or physical abuse. METHODS Patients with UHR status (n = 38) or FEP (n = 26) and healthy controls (n = 33) were assessed with the Examination of Anomalous Self-Experience (EASE) and the Comprehensive Assessment of at Risk Mental States (CAARMS). The clinical-historical variables were assessed through medical records. RESULTS The FEP group scored significantly higher on the EASE than the UHR group, which scored significantly higher than the healthy control group, which had a very low score. Multivariate logistic regression analyses revealed that higher EASE score was significantly associated with a history of self-harm, disordered eating and bullying victimization (but not with suicide attempts or sexual/physical abuse) after controlling for positive, negative and depressive symptoms. CONCLUSION These novel findings suggest that self-disturbance may be related to a history of school bullying victimization, self-harm and eating disorder symptomatology in patients with or at-risk of psychosis. If further confirmed, these findings are potentially relevant to clinical risk assessment and therapy.
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Affiliation(s)
- Andreas R Rasmussen
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Mental Health Center Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Daniel Reich
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
| | - Suzie Lavoie
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Emily Li
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Jessica A Hartmann
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Meredith McHugh
- Health Care for the Homeless, Baltimore, Maryland.,Youth Empowered Society, Baltimore, Maryland
| | - Thomas J Whitford
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
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36
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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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37
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Rasmussen AR, Nordgaard J, Parnas J. Schizophrenia-spectrum psychopathology in obsessive-compulsive disorder: an empirical study. Eur Arch Psychiatry Clin Neurosci 2020; 270:993-1002. [PMID: 31129700 PMCID: PMC7599137 DOI: 10.1007/s00406-019-01022-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/15/2019] [Indexed: 12/29/2022]
Abstract
The differential diagnosis of obsessive-compulsive disorder (OCD) and schizophrenia-spectrum disorders can be difficult. In the current diagnostic criteria, basic concepts such as obsession and delusion overlap. This study examined lifetime schizophrenia-spectrum psychopathology, including subtle schizotypal symptomatology and subjective anomalies such as self-disorders, in a sample diagnosed with OCD in a specialized setting. The study also examined the differential diagnostic potential of the classic psychopathological notions of true obsession ('with resistance') and pseudo-obsession. The study involved 42 outpatients diagnosed with OCD at two clinics specialized in the treatment of OCD. The patients underwent semi-structured, narrative interviews assessing a comprehensive battery of psychopathological instruments. The final lifetime research-diagnosis was based on a consensus between a senior clinical psychiatrist and an experienced research clinician. The study found that 29% of the patients fulfilled criteria of schizophrenia or another non-affective psychosis as main, lifetime DSM-5 research-diagnosis. Another 33% received a research-diagnosis of schizotypal personality disorder, 10% a research-diagnosis of major depression and 29% a main research-diagnosis of OCD. Self-disorders aggregated in the schizophrenia-spectrum groups. True obsessions had a specificity of 93% and a sensitivity of 58% for a main diagnosis of OCD. In conclusion, a high proportion of clinically diagnosed OCD patients fulfilled diagnostic criteria of a schizophrenia-spectrum disorder. The conspicuous obsessive-compulsive symptomatology may have resulted in a disregard of psychotic symptoms and other psychopathology. Furthermore, the differentiation of obsessions from related psychopathological phenomena is insufficient and a conceptual and empirical effort in this domain is required in the future.
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Affiliation(s)
- Andreas Rosén Rasmussen
- Mental Health Center Glostrup, University of Copenhagen, Broendbyostervej 160, 2605, Broendby, Denmark.
| | - Julie Nordgaard
- grid.5254.60000 0001 0674 042XMental Health Center Amager, University of Copenhagen, Gl. Kongevej 33, 1610 Copenhagen V, Denmark
| | - Josef Parnas
- grid.5254.60000 0001 0674 042XMental Health Center Glostrup, University of Copenhagen, Broendbyostervej 160, 2605 Broendby, Denmark ,grid.5254.60000 0001 0674 042XCenter for Subjectivity Research, University of Copenhagen, Karen Blixens Plads 8, 2300 Copenhagen S, Denmark
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38
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Crespi B, Dinsdale N. Autism and psychosis as diametrical disorders of embodiment. Evol Med Public Health 2019; 2019:121-138. [PMID: 31402979 PMCID: PMC6682708 DOI: 10.1093/emph/eoz021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/11/2019] [Indexed: 12/12/2022] Open
Abstract
Humans have evolved an elaborate system of self-consciousness, self-identity, self-agency, and self-embodiment that is grounded in specific neurological structures including an expanded insula. Instantiation of the bodily self has been most-extensively studied via the 'rubber hand illusion', whereby parallel stimulation of a hidden true hand, and a viewed false hand, leads to the felt belief that the false hand is one's own. Autism and schizophrenia have both long been regarded as conditions centrally involving altered development of the self, but they have yet to be compared directly with regard to the self and embodiment. Here, we synthesize the embodied cognition literature for these and related conditions, and describe evidence that these two sets of disorders exhibit opposite susceptibilities from typical individuals to the rubber hand illusion: reduced on the autism spectrum and increased in schizophrenia and other psychotic-affective conditions. Moreover, the opposite illusion effects are mediated by a consilient set of associated phenomena, including empathy, interoception, anorexia risk and phenotypes, and patterns of genetic correlation. Taken together, these findings: (i) support the diametric model of autism and psychotic-affective disorders, (ii) implicate the adaptive human system of self-embodiment, and its neural bases, in neurodevelopmental disorders, and suggest new therapies and (iii) experimentally ground Bayesian predictive coding models with regard to autism compared with psychosis. Lay summary: Humans have evolved a highly developed sense of self and perception of one's own body. The 'rubber hand illusion' can be used to test individual variation in sense of self, relative to connection with others. We show that this illusion is reduced in autism spectrum disorders, and increased in psychotic and mood disorders. These findings have important implications for understanding and treatment of mental disorders.
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Affiliation(s)
- Bernard Crespi
- Department of Biological Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - Natalie Dinsdale
- Department of Biological Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
- Department of Psychology, University of Saskatchewan, Saskatoon, SK, Canada
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39
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Durmaz YÇ, Ünsal G. Study of validity, reliability in accordance with Turkey conditions in ego functions assessment scale. Perspect Psychiatr Care 2019; 55:509-516. [PMID: 30767235 DOI: 10.1111/ppc.12357] [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: 09/05/2018] [Revised: 11/27/2018] [Accepted: 01/07/2019] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The aim of the study is to conduct a reliability and validity study of the Ego Function Assessment (EFA) scale. DESIGN AND METHODS The study was conducted with a total of 426 participants, which included 213 patients with schizophrenia and a control group of 213 normal individuals. The Individual Information Form, EFA Scale, Wonderlic Personnel Test, Adjective Check List, and Symptom Check List were used for data collection. FINDING All the statistical procedures performed in the validity and reliability stages of the study show that the scale is a valid, reliable measurement tool for the Turkish culture. PRACTICE IMPLICATIONS In psychiatric nursing, the use of the EFA scale can be recommended for planning individual patient care, which involves the assessment of a patient's functional adjustment on the basis of their own ego profile.
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Affiliation(s)
- Yadigar Çevik Durmaz
- Psychiatric Nursing Department, School of Health Sciences, Munzur University, Tunceli, Turkey
| | - Gül Ünsal
- Psychiatric Nursing Department, Health Sciences Faculty, Marmara University, İstanbul, Turkey
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40
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Abstract
The term "pseudoneurotic schizophrenia" was introduced in 1949 by Hoch and Polatin to describe apparently neurotic patients showing formal thought disorders, emotional dysregulation, and transient psychotic symptoms. Even if this diagnostic entity is no longer included in modern diagnostic systems, its evolution is intertwined with the history of schizophrenia in the 20th century. This article retraces the development of pseudoneurotic (or "borderline") schizophrenia in modern psychiatry, finding it a pioneering concept in psychopathology. In particular, we demonstrate that recent findings about the positive syndrome, good-outcome, type I "distress" subtype of schizophrenia (associated with high emotionality, including anxiety, depression, and sensitivity to stress) show surprising consistency with the clinical concept of pseudoneurotic schizophrenia. Finally, we discuss the historical development of pseudoneurotic schizophrenia in modern psychiatry as a meaningful example of the difficulty of confining severe psychological disturbances lying at the edge of full-blown schizophrenia within a widely accepted diagnostic category.
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41
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Yang Q, Li B, Tang J, Cui X, Wang Y, Li X, Hu J, Chen Y, Xue W, Lou Y, Qiu Y, Zhu F. Consistent gene signature of schizophrenia identified by a novel feature selection strategy from comprehensive sets of transcriptomic data. Brief Bioinform 2019; 21:1058-1068. [DOI: 10.1093/bib/bbz049] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/11/2019] [Accepted: 03/30/2019] [Indexed: 12/16/2022] Open
Abstract
Abstract
The etiology of schizophrenia (SCZ) is regarded as one of the most fundamental puzzles in current medical research, and its diagnosis is limited by the lack of objective molecular criteria. Although plenty of studies were conducted, SCZ gene signatures identified by these independent studies are found highly inconsistent. As one of the most important factors contributing to this inconsistency, the feature selection methods used currently do not fully consider the reproducibility among the signatures discovered from different datasets. Therefore, it is crucial to develop new bioinformatics tools of novel strategy for ensuring a stable discovery of gene signature for SCZ. In this study, a novel feature selection strategy (1) integrating repeated random sampling with consensus scoring and (2) evaluating the consistency of gene rank among different datasets was constructed. By systematically assessing the identified SCZ signature comprising 135 differentially expressed genes, this newly constructed strategy demonstrated significantly enhanced stability and better differentiating ability compared with the feature selection methods popular in current SCZ research. Based on a first-ever assessment on methods’ reproducibility cross-validated by independent datasets from three representative studies, the new strategy stood out among the popular methods by showing superior stability and differentiating ability. Finally, 2 novel and 17 previously reported transcription factors were identified and showed great potential in revealing the etiology of SCZ. In sum, the SCZ signature identified in this study would provide valuable clues for discovering diagnostic molecules and potential targets for SCZ.
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Affiliation(s)
- Qingxia Yang
- Innovative Drug Research and Bioinformatics Group, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
- Innovative Drug Research and Bioinformatics Group, School of Pharmaceutical Sciences and Collaborative Innovation Center for Brain Science, Chongqing University, Chongqing, China
| | - Bo Li
- Innovative Drug Research and Bioinformatics Group, School of Pharmaceutical Sciences and Collaborative Innovation Center for Brain Science, Chongqing University, Chongqing, China
| | - Jing Tang
- Innovative Drug Research and Bioinformatics Group, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
- Innovative Drug Research and Bioinformatics Group, School of Pharmaceutical Sciences and Collaborative Innovation Center for Brain Science, Chongqing University, Chongqing, China
| | - Xuejiao Cui
- Innovative Drug Research and Bioinformatics Group, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
- Innovative Drug Research and Bioinformatics Group, School of Pharmaceutical Sciences and Collaborative Innovation Center for Brain Science, Chongqing University, Chongqing, China
| | - Yunxia Wang
- Innovative Drug Research and Bioinformatics Group, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
- Innovative Drug Research and Bioinformatics Group, School of Pharmaceutical Sciences and Collaborative Innovation Center for Brain Science, Chongqing University, Chongqing, China
| | - Xiaofeng Li
- Innovative Drug Research and Bioinformatics Group, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
- Innovative Drug Research and Bioinformatics Group, School of Pharmaceutical Sciences and Collaborative Innovation Center for Brain Science, Chongqing University, Chongqing, China
| | - Jie Hu
- Innovative Drug Research and Bioinformatics Group, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Yuzong Chen
- Bioinformatics and Drug Design Group, Department of Pharmacy, and Center for Computational Science and Engineering, National University of Singapore, Singapore, Singapore
| | - Weiwei Xue
- Innovative Drug Research and Bioinformatics Group, School of Pharmaceutical Sciences and Collaborative Innovation Center for Brain Science, Chongqing University, Chongqing, China
| | - Yan Lou
- Zhejiang Provincial Key Laboratory for Drug Clinical Research and Evaluation, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yunqing Qiu
- Zhejiang Provincial Key Laboratory for Drug Clinical Research and Evaluation, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Feng Zhu
- Innovative Drug Research and Bioinformatics Group, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
- Innovative Drug Research and Bioinformatics Group, School of Pharmaceutical Sciences and Collaborative Innovation Center for Brain Science, Chongqing University, Chongqing, China
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Karterud SW, Kongerslev MT. A Temperament-Attachment-Mentalization-Based (TAM) Theory of Personality and Its Disorders. Front Psychol 2019; 10:518. [PMID: 30967807 PMCID: PMC6439347 DOI: 10.3389/fpsyg.2019.00518] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 02/21/2019] [Indexed: 12/18/2022] Open
Abstract
Theories of personality and its disorders need, from time to time, to be revised and updated according to new empirical and conceptual developments. Such development has taken place in the realms of affective neuroscience, evolution, and social cognition. In this article, we outline a new personality theory, which claims that phenomena we usually ascribe to the concept personality are best understood by postulating a web consisting of three major constituents: temperament (mainly primary emotions), attachment, and self-consciousness (mentalizing). We describe these constituents, their neurobiological underpinnings, the subjective experiences they evoke, and their behavioral implications. We discuss the relevance of the espoused theory in the field of personality disorders with references to borderline, narcissistic, and avoidant personality disorders as well as the DSM-5 alternative model. Implications for social psychology, psychotherapy, and common sense self-understanding are outlined. The theory aims to bridge previous contradictions between natural sciences and hermeneutics by its propositions of the evolution of self-consciousness.
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Affiliation(s)
| | - Mickey T. Kongerslev
- Centre of Excellence on Personality Disorder, Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
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