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Etain B, Lajnef M, Henry C, Aubin V, Azorin JM, Bellivier F, Bougerol T, Courtet P, Gard S, Kahn JP, Passerieux C, Leboyer M. Childhood trauma, dimensions of psychopathology and the clinical expression of bipolar disorders: A pathway analysis. J Psychiatr Res 2017; 95:37-45. [PMID: 28777981 DOI: 10.1016/j.jpsychires.2017.07.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 05/23/2017] [Accepted: 07/17/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND This study aims at testing for paths from childhood abuse to clinical indicators of complexity in bipolar disorder (BD), through dimensions of affective dysregulation, impulsivity and hostility. METHOD 485 euthymic patients with BD from the FACE-BD cohort were included from 2009 to 2014. We collect clinical indicators of complexity/severity: age and polarity at onset, suicide attempt, rapid cycling and substance misuse. Patients completed questionnaires to assess childhood emotional, sexual and physical abuses, affective lability, affect intensity, impulsivity, motor and attitudinal hostility. RESULTS The path-analysis demonstrated significant associations between emotional abuse and all the affective/impulsive dimensions (p < 0.001). Sexual abuse was moderately associated with emotion-related dimensions but not with impulsivity nor motor hostility. In turn, affect intensity and attitudinal hostility were associated with high risk for lifetime presence of suicide attempts (p < 0.001), whereas impulsivity was associated with a higher risk of lifetime presence of substance misuse (p < 0.001). No major additional paths were identified when including Emotional and Physical Neglect in the model. CONCLUSIONS This study provides refinement of the links between early adversity, dimensions of psychopathology and the complexity/severity of BD. Mainly, dimensions of affective dysregulation, impulsivity/hostility partially mediate the links between childhood emotional to suicide attempts and substance misuse in BD.
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Affiliation(s)
- B Etain
- AP-HP, GH Saint-Louis - Lariboisière - Fernand Widal, Pôle Neurosciences, Paris, France; Université Paris Diderot, UMR-S 1144, Paris, France; Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Fondation Fondamental, Créteil, France.
| | - M Lajnef
- Inserm, U955, Equipe Psychiatrie Translationnelle, Créteil, France
| | - C Henry
- Fondation Fondamental, Créteil, France; Inserm, U955, Equipe Psychiatrie Translationnelle, Créteil, France; Université Paris Est, Faculté de Médecine, Créteil, France; AP-HP, Hôpitaux Universitaires Henri Mondor, DHU Pepsy, Pôle de Psychiatrie et d'Addictologie, Créteil, France; Institut Pasteur, Unité Perception et Mémoire, Paris, France
| | - V Aubin
- Fondation Fondamental, Créteil, France; Service de Psychiatrie, Centre Hospitalier Princesse-Grace, Avenue Pasteur, Monaco
| | - J M Azorin
- Fondation Fondamental, Créteil, France; Pôle de Psychiatrie, Hôpital Sainte Marguerite, Assistance Publique Hôpitaux de Marseille, France; Aix-Marseille Université, CNRS, CRN2M UMR 7286, Marseille, France
| | - F Bellivier
- AP-HP, GH Saint-Louis - Lariboisière - Fernand Widal, Pôle Neurosciences, Paris, France; Université Paris Diderot, UMR-S 1144, Paris, France; Fondation Fondamental, Créteil, France
| | - T Bougerol
- Fondation Fondamental, Créteil, France; Clinique Universitaire de Psychiatrie, CHU de Grenoble, Grenoble, France
| | - P Courtet
- Fondation Fondamental, Créteil, France; Département d'Urgence et Post Urgence Psychiatrique, CHRU Montpellier, INSERM U1061, Université Montpellier 1, Montpellier, France
| | - S Gard
- Fondation Fondamental, Créteil, France; Centre Expert Trouble Bipolaire, Pôle de Psychiatrie Générale Universitaire, Centre Hospitalier Charles Perrens, Bordeaux, France
| | - J P Kahn
- Fondation Fondamental, Créteil, France; Université de Lorraine, CHU de Nancy et Pôle 6 de Psychiatrie et Psychologie Clinique, Centre Psychothérapique de Nancy, 1 rue du Docteur Archambault, Laxou Cedex, France
| | - C Passerieux
- Fondation Fondamental, Créteil, France; Université de Versailles Saint-Quentin, Centre Hospitalier de Versailles, Service de Psychiatrie Adulte, Le Chesnay, France
| | - M Leboyer
- Fondation Fondamental, Créteil, France; Inserm, U955, Equipe Psychiatrie Translationnelle, Créteil, France; Université Paris Est, Faculté de Médecine, Créteil, France; AP-HP, Hôpitaux Universitaires Henri Mondor, DHU Pepsy, Pôle de Psychiatrie et d'Addictologie, Créteil, France
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Aas M, Henry C, Bellivier F, Lajnef M, Gard S, Kahn JP, Lagerberg TV, Aminoff SR, Bjella T, Leboyer M, Andreassen OA, Melle I, Etain B. Affective lability mediates the association between childhood trauma and suicide attempts, mixed episodes and co-morbid anxiety disorders in bipolar disorders. Psychol Med 2017; 47:902-912. [PMID: 27894372 DOI: 10.1017/s0033291716003081] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Many studies have shown associations between a history of childhood trauma and more severe or complex clinical features of bipolar disorders (BD), including suicide attempts and earlier illness onset. However, the psychopathological mechanisms underlying these associations are still unknown. Here, we investigated whether affective lability mediates the relationship between childhood trauma and the severe clinical features of BD. METHOD A total of 342 participants with BD were recruited from France and Norway. Diagnosis and clinical characteristics were assessed using the Diagnostic Interview for Genetic Studies (DIGS) or the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I). Affective lability was measured using the short form of the Affective Lability Scale (ALS-SF). A history of childhood trauma was assessed using the Childhood Trauma Questionnaire (CTQ). Mediation analyses were performed using the SPSS process macro. RESULTS Using the mediation model and covariation for the lifetime number of major mood episodes, affective lability was found to statistically mediate the relationship between childhood trauma experiences and several clinical variables, including suicide attempts, mixed episodes and anxiety disorders. No significant mediation effects were found for rapid cycling or age at onset. CONCLUSIONS Our data suggest that affective lability may represent a psychological dimension that mediates the association between childhood traumatic experiences and the risk of a more severe or complex clinical expression of BD.
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Affiliation(s)
- M Aas
- NORMENT,KG Jebsen Centre for Psychosis Research,Institute of Clinical Medicine,University of Oslo,Norway
| | - C Henry
- AP-HP,Hôpitaux Universitaires Henri Mondor,Pôle de Psychiatry,DHU Pepsy,Créteil,France
| | | | - M Lajnef
- Inserm,U955,Equipe Psychiatrie Translationnelle,Créteil,France
| | - S Gard
- Fondation Fondamental,Créteil,France
| | - J-P Kahn
- Fondation Fondamental,Créteil,France
| | - T V Lagerberg
- NORMENT,KG Jebsen Centre for Psychosis Research,Institute of Clinical Medicine,University of Oslo,Norway
| | - S R Aminoff
- NORMENT,KG Jebsen Centre for Psychosis Research,Institute of Clinical Medicine,University of Oslo,Norway
| | - T Bjella
- NORMENT,KG Jebsen Centre for Psychosis Research,Institute of Clinical Medicine,University of Oslo,Norway
| | - M Leboyer
- AP-HP,Hôpitaux Universitaires Henri Mondor,Pôle de Psychiatry,DHU Pepsy,Créteil,France
| | - O A Andreassen
- NORMENT,KG Jebsen Centre for Psychosis Research,Institute of Clinical Medicine,University of Oslo,Norway
| | - I Melle
- NORMENT,KG Jebsen Centre for Psychosis Research,Institute of Clinical Medicine,University of Oslo,Norway
| | - B Etain
- Fondation Fondamental,Créteil,France
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Links PS, Eynan R, Heisel MJ, Nisenbaum R. Elements of affective instability associated with suicidal behaviour in patients with borderline personality disorder. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2008; 53:112-6. [PMID: 18357929 DOI: 10.1177/070674370805300206] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To identify elements of affective instability associated with an increased likelihood of impulsivity and then to determine whether these elements characterize patients with borderline personality disorder (BPD) and suicidal behaviour. METHOD We prospectively followed 82 individuals with BPD and a history of recurrent suicidal behaviour who recorded their current mood states, impulsivity, suicide ideation, and environmental stressors (triggers) 6 times daily over 3 weeks. RESULTS Our results suggested that mood amplitude was correlated with impulsivity and that 4 subgroups defined by mean scores on mood amplitude and negative mood intensity significantly differed in the number of suicidal behaviours reported in the last year. CONCLUSIONS A subgroup of BPD patients appears to be at elevated risk for suicidal behaviour based on high mood amplitude and mean negative mood intensity. Clinicians might target this group for monitoring and interventions to reduce the likelihood of suicidal behaviour.
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Affiliation(s)
- Paul S Links
- Suicide Studies Unit, St Michael's Hospital, Toronto, Ontario.
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McGlashan TH, Grilo CM, Sanislow CA, Ralevski E, Morey LC, Gunderson JG, Skodol AE, Shea MT, Zanarini MC, Bender D, Stout RL, Yen S, Pagano M. Two-year prevalence and stability of individual DSM-IV criteria for schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders: toward a hybrid model of axis II disorders. Am J Psychiatry 2005; 162:883-9. [PMID: 15863789 PMCID: PMC3272783 DOI: 10.1176/appi.ajp.162.5.883] [Citation(s) in RCA: 260] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study tracked the individual criteria of four DSM-IV personality disorders-borderline, schizotypal, avoidant, and obsessive-compulsive personality disorders-and how they change over 2 years. METHOD This clinical sample of patients with personality disorders was derived from the Collaborative Longitudinal Personality Disorders Study and included all participants with borderline, schizotypal, avoidant, or obsessive-compulsive personality disorder for whom complete 24-month blind follow-up assessments were obtained (N=474). The authors identified and rank-ordered criteria for each of the four personality disorders by their variation in prevalence and changeability (remission) over time. RESULTS The most prevalent and least changeable criteria over 2 years were paranoid ideation and unusual experiences for schizotypal personality disorder, affective instability and anger for borderline personality disorder, feeling inadequate and feeling socially inept for avoidant personality disorder, and rigidity and problems delegating for obsessive-compulsive personality disorder. The least prevalent and most changeable criteria were odd behavior and constricted affect for schizotypal personality disorder, self-injury and behaviors defending against abandonment for borderline personality disorder, avoiding jobs that are interpersonal and avoiding potentially embarrassing situations for avoidant personality disorder, and miserly behaviors and strict moral behaviors for obsessive-compulsive personality disorder. CONCLUSIONS These patterns highlight that within personality disorders the relatively fixed criteria are more trait-like and attitudinal, whereas the relatively intermittent criteria are more behavioral and reactive. These patterns suggest that personality disorders are hybrids of traits and symptomatic behaviors and that the interaction of these elements over time helps determine diagnostic stability. These patterns may also inform criterion selection for DSM-V.
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Affiliation(s)
- Thomas H McGlashan
- Collaborative Longitudinal Personality Disorder Study, Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA.
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