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Kempe S, Köpp W, Wittmann L. Personality Functioning Improvement during Psychotherapy Is Associated with an Enhanced Capacity for Affect Regulation in Dreams: A Preliminary Study. Brain Sci 2024; 14:489. [PMID: 38790467 PMCID: PMC11118223 DOI: 10.3390/brainsci14050489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/04/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Clinical case illustrations of patients with an impairment of personality functioning (IPF) have repeatedly reported that progress during psychotherapy is reflected by alterations in dream content. However, quantitative studies based on samples of psychotherapy patients are scarce. As a core component of both personality functioning and contemporary psychodynamic dream theory, the construct of affect regulation is of specific significance in this context. AIMS To test if improvement in personality functioning in the course of psychotherapy is associated with an increasing ability to regulate affects in dreams. METHOD In a longitudinal design, affect regulation was compared in N = 94 unsolicited dream reports from the first vs. last third of long term psychotherapy of ten patients with initial IPF. Dream reports were transcribed from recordings of the sessions. Expert ratings of the level of personality functioning were obtained using the Scales of Psychological Capacities. The capacity for affect regulation was assessed using the Zurich Dream Process Coding System. Group differences were assessed using linear mixed models, controlling for dream length as well as the nested structure of this data set. RESULTS Patients demonstrated an increased capacity for affect regulation in dreams that was primarily evident in three core features: the complexity of dream elements (cf., e.g., parameter attributes, p = 0.024); the extent of affective involvement in the dream ego (cf., e.g., parameter subject feeling, p = 0.014); and the flexibility to regulate the dynamics of safety/involvement processes (p ≤ 0.001). This pattern was especially prominent in a subgroup (n = 7) of patients with more pronounced improvements in personality functioning. CONCLUSION These findings support the hypotheses that decreasing IPF during psychotherapy is associated with increases in the capacity for affect regulation in dreams. Thus, researchers and therapists can utilize dream reports to illuminate the important aspects of treatment progress in clinical practice.
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Affiliation(s)
- Simon Kempe
- Department of Psychology, International Psychoanalytic University, Stromstraße 1, 10555 Berlin, Germany
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2
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Lopez-Villatoro JM, Diaz-Marsa M, Garcia-Ramos A, Galvez-Merlin A, Carrasco JL. Altered emotional response pattern related to complex trauma in patients with borderline personality disorder. Clin Psychol Psychother 2023; 30:1256-1263. [PMID: 37565308 DOI: 10.1002/cpp.2897] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/21/2023] [Accepted: 07/29/2023] [Indexed: 08/12/2023]
Abstract
INTRODUCTION This work aims to demonstrate, through the International Affective Picture System (IAPS) responses, an altered emotional pattern in borderline personality disorder (BPD) patients and to find a specific emotional response pattern by understanding their relationship with traumatic experiences and attachment bonds towards their primary caregivers. METHOD A total of 50 BPD patients and 39 control patients were evaluated using the IAPS, and its assessment was carried out through the Self-Assessment Manikin (SAM). Paternal and maternal attachment bonds as well as traumatic experiences in BPD patients were evaluated. Statistical associations were analysed in the different variables. RESULTS Significant differences between BPD and control patients were found in all emotional response components for pleasant, unpleasant and neutral images (p < .01), with one exception, the arousal in pleasant images. Patients' experience of traumatic experiences was positively related to scores on the happiness component of pleasant imagery (p = .057) and on the arousal component of unpleasant imagery (p = .058). Poorer maternal bonding in BPD patients was significantly related to lower scores on happiness (p < .01) and dominance (p < .05) components of pleasant imagery and all emotional response components for unpleasant imagery (p < .01). CONCLUSIONS The results of the study confirm an impaired emotional response pattern in patients with borderline personality disorder (BPD), showing an emotional response to pleasant images similar to that of depression, while the pattern found to unpleasant images could be related to the complex trauma observed in these patients, which includes PTSD experiences such as sexual abuse and attachment trauma experiences.
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Affiliation(s)
- Jose M Lopez-Villatoro
- Health Research Institute of the Hospital Clínico San Carlos, Madrid, Spain
- Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense of Madrid, Madrid, Spain
| | - Marina Diaz-Marsa
- Health Research Institute of the Hospital Clínico San Carlos, Madrid, Spain
- Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense of Madrid, Madrid, Spain
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
| | - Adriana Garcia-Ramos
- Department of Personality, Assessment and Clinical Psychology, Universidad Complutense of Madrid, Madrid, Spain
| | - Alejandra Galvez-Merlin
- Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense of Madrid, Madrid, Spain
| | - Jose L Carrasco
- Health Research Institute of the Hospital Clínico San Carlos, Madrid, Spain
- Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense of Madrid, Madrid, Spain
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
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3
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Amerio A, Natale A, Gnecco GB, Lechiara A, Verrina E, Bianchi D, Fusar-Poli L, Costanza A, Serafini G, Amore M, Aguglia A. The Role of Gender in Patients with Borderline Personality Disorder: Differences Related to Hopelessness, Alexithymia, Coping Strategies, and Sensory Profile. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050950. [PMID: 37241182 DOI: 10.3390/medicina59050950] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/08/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: Gender differences are poorly investigated in patients with borderline personality disorder (BPD), although they could be useful in determining the most appropriate pharmacological and non-pharmacological treatment. The aim of the present study was to compare sociodemographic and clinical characteristics and the emotional and behavioral dimensions (such as coping, alexithymia, and sensory profile) between males and females with BPD. Material and Methods: Two hundred seven participants were recruited. Sociodemographic and clinical variables were collected through a self-administered questionnaire. The Adolescent/Adult Sensory Profile (AASP), Beck Hopelessness Scale (BHS), Coping Orientation to Problems Experienced (COPE), and Toronto Alexithymia Scale (TAS-20) were administered. Results: Male patients with BPD showed more involuntary hospitalizations and greater use of alcohol and illicit substances compared to females. Conversely, females with BPD reported more frequent medication abuse than males. Furthermore, females had high levels of alexithymia and hopelessness. Regarding coping strategies, females with BPD reported higher levels of "restraint coping" and "use of instrumental social support" at COPE. Finally, females with BPD had higher scores in the Sensory Sensitivity and Sensation Avoiding categories at the AASP. Conclusions: Our study highlights gender differences in substance use, emotion expression, future vision, sensory perception, and coping strategies in patients with BPD. Further gender studies may clarify these differences and guide the development of specific and differential treatments in males and females with BPD.
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Affiliation(s)
- Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, 16132 Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Antimo Natale
- Department of Psychiatry, Adult Psychiatry Service (APS), University Hospitals of Geneva (HUG), 1205 Geneva, Switzerland
| | - Giovanni Battista Gnecco
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, 16132 Genoa, Italy
| | - Alessio Lechiara
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, 16132 Genoa, Italy
| | - Edoardo Verrina
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, 16132 Genoa, Italy
| | - Davide Bianchi
- Department of Mental Health and Pathological Addictions, Lavagna Local Health Authority, 16033 Lavagna, Italy
| | - Laura Fusar-Poli
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Alessandra Costanza
- Department of Psychiatry, Adult Psychiatry Service (APS), University Hospitals of Geneva (HUG), 1205 Geneva, Switzerland
- Department of Psychiatry, Faculty of Medicine, Geneva University (UNIGE), 1211 Geneva, Switzerland
- Department of Psychiatry, Faculty of Biomedical Sciences, University of Italian Switzerland (USI), 6900 Lugano, Switzerland
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, 16132 Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, 16132 Genoa, Italy
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, 16132 Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
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4
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Masland SR, Victor SE, Peters JR, Fitzpatrick S, Dixon-Gordon KL, Bettis AH, Navarre KM, Rizvi SL. Destigmatizing Borderline Personality Disorder: A Call to Action for Psychological Science. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2023; 18:445-460. [PMID: 36054911 DOI: 10.1177/17456916221100464] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite recognition that borderline personality disorder (BPD) is one of the most stigmatized psychological disorders, destigmatization efforts have thus far focused on the views and actions of clinicians and the general public, neglecting the critical role that psychological science plays in perpetuating or mitigating stigma. This article was catalyzed by recent concerns about how research and editorial processes propagate stigma and thereby fail people with BPD and the scientists who study BPD. We provide a brief overview of the BPD diagnosis and its history. We then review how BPD has been stigmatized in psychological science, the gendered nature of BPD stigma, and the consequences of this stigmatization. Finally, we offer specific recommendations for researchers, reviewers, and editors who wish to use science to advance our understanding of BPD without perpetuating pejorative views of the disorder. These recommendations constitute a call to action to use psychological science in the service of the public good.
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Affiliation(s)
| | - Sarah E Victor
- Department of Psychological Sciences, Texas Tech University
| | - Jessica R Peters
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | | | | | - Alexandra H Bettis
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center
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5
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Richman Czégel MJ, Unoka Z, Dudas RB, Demetrovics Z. Rumination in Borderline Personality Disorder: A Meta-analytic Review. J Pers Disord 2022; 36:399-412. [PMID: 35913769 DOI: 10.1521/pedi.2022.36.4.399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Borderline personality disorder (BPD) is characterized by deficits in emotion regulation and affective liability, specifically rumination. Despite this, inconsistencies have existed in the literature regarding which rumination type is most prominent in BPD. Taking this into consideration, a meta-analysis was performed to look at how BPD symptoms correlate with rumination, while also considering clinical moderator variables (i.e., BPD symptom domain, comorbidities, GAF score) and demographic moderator variables (i.e., age, gender, sample type, and education level). Analysis of rumination domains for the entire sample revealed a medium correlation between BPD symptoms and rumination. When types of rumination were assessed, the largest correlation was among pain rumination followed by anger, depressive, and anxious rumination. Among BPD symptom domain, affective instability had the strongest correlation with increased rumination, followed by unstable relationships, identity disturbance, and self-harm/impulsivity. Demographic variables showed no significance. Clinical implications and further therapeutic interventions are discussed considering rumination.
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Affiliation(s)
- Mara J Richman Czégel
- Endeavor Psychology, Boston, Massachusetts.,Institute of Psychology, Eötvös Loránd University, Budapest, Hungary.,Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary and Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Zsolt Unoka
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary and Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Robert B Dudas
- Older People's Mental Health Service, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK; University of East Anglia, Norwich, UK
| | - Zsolt Demetrovics
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary.,Centre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar
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6
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Powers A, Petri JM, Sleep C, Mekawi Y, Lathan EC, Shebuski K, Bradley B, Fani N. Distinguishing PTSD, complex PTSD, and borderline personality disorder using exploratory structural equation modeling in a trauma-exposed urban sample. J Anxiety Disord 2022; 88:102558. [PMID: 35378368 PMCID: PMC9107503 DOI: 10.1016/j.janxdis.2022.102558] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/04/2022] [Accepted: 03/19/2022] [Indexed: 11/19/2022]
Abstract
There is debate about the validity of the complex posttraumatic stress disorder (CPTSD) diagnosis and whether disturbances in self-organization (DSO) in CPTSD can be differentiated from borderline personality disorder (BPD). How PTSD is defined may matter. The present study used exploratory structural equation modeling (ESEM) to replicate and extend prior work by including two models to examine how PTSD (ICD-11, DSM-5), DSO, and BPD symptoms relate. Participants (N = 470; 98.1% women; 97.7% Black) were recruited from medical clinics within an urban hospital. PTSD, CPTSD, and BPD were assessed using semi-structured interviews and trauma-related avoidance, aggressive behavior, and anxious attachment were assessed using self-report measures. ESEM models of PTSD, DSO, and BPD symptoms were run. We found a three-factor ESEM model of CPTSD (ICD-11 PTSD and DSO symptoms) and BPD symptoms best fit the data and found support for discriminant validity between factors across trauma-related avoidance, aggressive behavior, and anxious attachment. For DSM-5 PTSD, a two-factor ESEM model was best-fitting (PTSD and DSO/BPD). The findings demonstrate clear distinguishing and overlapping features of ICD-11 PTSD, CPTSD, and BPD and the necessity to consider the diagnostic structure of PTSD in determining the additive value of CPTSD as a distinct construct.
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Affiliation(s)
- Abigail Powers
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
| | - Jessica M Petri
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Yara Mekawi
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Emma C Lathan
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Karen Shebuski
- Department of Counseling and Psychological Services, Georgia State University, Atlanta, GA, USA
| | - Bekh Bradley
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA; Atlanta VA Medical Center, Atlanta, GA, USA
| | - Negar Fani
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
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7
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Sorgi-Wilson KM, McCloskey MS. Emotion regulation strategies among individuals with borderline personality disorder relative to other groups: A review. Clin Psychol Psychother 2022; 29:1655-1678. [PMID: 35366040 DOI: 10.1002/cpp.2738] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 01/28/2022] [Accepted: 03/29/2022] [Indexed: 11/11/2022]
Abstract
Borderline personality disorder (BPD) is associated with difficulties in emotion regulation (ER) abilities. Investigations of ER strategies in BPD have been less robust. This systematic review identified 55 studies comparing ER strategy use between individuals diagnosed with BPD versus psychiatric and non-psychiatric comparison groups. Individuals with BPD reported more frequent maladaptive and less frequent adaptive ER strategy use than non-psychiatric controls. Results were less consistent relative to psychiatric comparison groups, though individuals with BPD reported greater self-criticism and avoidance. Groups responded comparably to instructed use of adaptive (but not maladaptive) ER strategies. This body of research would benefit from further examination of the roles of psychiatric comorbidity and problematic behaviours in the relationship between BPD and ER strategies.
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Affiliation(s)
- Kristen M Sorgi-Wilson
- Department of Psychology and Neuroscience, Temple University, Philadelphia, Pennsylvania, USA
| | - Michael S McCloskey
- Department of Psychology and Neuroscience, Temple University, Philadelphia, Pennsylvania, USA
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8
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Jenkins CA, Thompson KN, Nicholas CL, Hartmann JA, Chanen AM. Potential mechanisms underlying sleep disturbance in young people with borderline personality disorder features: an exploratory study. Borderline Personal Disord Emot Dysregul 2022; 9:10. [PMID: 35264240 PMCID: PMC8908552 DOI: 10.1186/s40479-022-00180-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/11/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Sleep disturbance is common among young people (15-25 years) with features of borderline personality disorder (BPD). However, the mechanisms underlying sleep disturbance in BPD remain unknown. Understanding these underlying processes is essential to guide the development of sleep-improvement interventions and to optimise their efficacy through identifying beneficial treatment targets. This exploratory study aimed to investigate potential underlying mechanisms to inform future hypotheses, research development, and provide insight into potential treatment targets to improve sleep in young people with BPD. This study explored the indirect roles of emotion regulation difficulties, depression, anxiety and stress in the relationship between BPD features and sleep disturbance in young people. METHODS Sleep was measured subjectively (self-report questionnaires) and objectively (10 days wrist actigraphy) in 40 young people with BPD features and 38 healthy young people. Participants also completed the Difficulties in Emotion Regulation Scale and the Depression, Anxiety and Stress Scale. RESULTS Mediation analyses revealed that impulse control difficulties, limited emotion regulation strategies and anxiety indirectly affected the relationship between group (BPD vs. healthy) and subjective sleep disturbance in young people. Lack of emotional awareness and anxiety contributed to associations between group and objectively longer time in bed and bedtime variability, respectively. CONCLUSIONS These preliminary findings suggest that targeting emotional dysregulation (impulse control, strategies, emotional awareness) and anxiety might be beneficial for improving sleep in this population.
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Affiliation(s)
- Claire A. Jenkins
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Katherine N. Thompson
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Christian L. Nicholas
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
- Institute for Breathing and Sleep, Melbourne, Australia
| | - Jessica A. Hartmann
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Andrew M. Chanen
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
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9
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[Reduction of Non-Suicidal Self-Injury (NSSI) in Adolescents with Borderline Personality Organization Treated with TFP-A]. Prax Kinderpsychol Kinderpsychiatr 2021; 70:728-747. [PMID: 34898409 DOI: 10.13109/prkk.2021.70.8.728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study examines whether transference-focused psychotherapy for adolescents (TFP-A) in a dayclinic setting increases the capability to regulate affects and decreases self-destructive behavior in adolescents with borderline personality organization in comparison to treatment as usual (TAU). A total of 120 adolescents consecutively presenting to the dayclinic were allocated to either TFP-A or TAU. They were assessed for aggression, irritability, depression, self-harm, internalizing behavior and pathological personality traits at baseline and after twelve weeks. TFP-A was more effective than TAU in reducing self-harm. Aggression and irritability was improved within the treatment group. These results can be explained by an improvement in affect regulation through a treatment with TFP-A in a dayclinic setting. Further research is necessary in order to assess whether TFP-A reduces self-harm, aggressive behavior and irritability from a long-term perspective and whether these exploratory results can be replicated in independent samples.
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10
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Dyadic Emotion Regulation in Women with Borderline Personality Disorder. COGNITIVE THERAPY AND RESEARCH 2021. [DOI: 10.1007/s10608-021-10206-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Abstract
Background
Emotion regulation (ER) and interpersonal dysfunction constitute key features of borderline personality disorder (BPD). Here, we tested if females with BPD show impairments in dyadic ER, that is in their support seeking and creation of closeness. We investigated if women with BPD might over-rely on their male partner by excessive support seeking and establishing of closeness, during conversations with personally and relationship-threatening topics.
Methods
Thirty couples in which the women were diagnosed with BPD and 34 healthy control (HC) couples were videotaped while discussing neutral, personally threatening, and relationship-threatening topics. Support seeking was rated by three independent raters, using a naïve observer method. The creation of closeness was rated using a continuous video-rating. Perceived emotions were assessed using self-report after each conversation.
Results
Women with BPD engaged in more support seeking than HC women, especially in more negative behaviors to elicit support, they created less closeness to their partner than HCs and reported a greater decline of positive emotions in both threatening conditions. Women with BPD displayed more fluctuations than controls between creating closeness and distance in the personally-threatening situation. They reported a larger increase in negative emotions after the relationship threatening conversation compared to female HC.
Conclusions
The present study indicates an increased demand of dyadic ER in BPD. Increased negative support seeking and less creation of closeness to the partner might reflect ineffective strategies to actually receive support from the partner.
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Cost Borne by the Counselor: Comparing Burnout Between Dialectical Behavior Therapy (DBT) Counselors and Non‐DBT Counselors. JOURNAL OF COUNSELING AND DEVELOPMENT 2021. [DOI: 10.1002/jcad.12376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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12
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Emotion regulation, mindfulness, and self-compassion among patients with borderline personality disorder, compared to healthy control subjects. PLoS One 2021; 16:e0248409. [PMID: 33730065 PMCID: PMC7968662 DOI: 10.1371/journal.pone.0248409] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 02/26/2021] [Indexed: 12/27/2022] Open
Abstract
Objectives Emotion regulation difficulties are a major characteristic of personality disorders. Our study investigated emotion regulation difficulties that are characteristic of borderline personality disorder (BPD), compared to a healthy control group. Methods Patients with BPD (N = 59) and healthy participants (N = 70) filled out four self-report questionnaires (Cognitive Emotion Regulation Questionnaire, Difficulties in Emotion Regulation Scale, Five Facet Mindfulness Questionnaire, Self-Compassion Scale) that measured the presence or lack of different emotion-regulation strategies. Differences between the BPD and the healthy control group were investigated by Multivariate Analysis of Variance (MANOVA) and univariate post-hoc F-test statistics. Results People suffering from BPD had statistically significantly (p<0.05) higher levels of emotional dysregulation and used more maladaptive emotion-regulation strategies, as well as lower levels of mindfulness and self-compassion compared to the HC group. Conclusion In comparison to a healthy control group, BPD patients show deficits in the following areas: mindfulness, self-compassion and adaptive emotion-regulation strategies. Based on these results, we suggest that teaching emotion-regulation, mindfulness, and self-compassion skills to patients can be crucial in the treatment of borderline personality disorder.
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13
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Vegni N, D'Ardia C, Torregiani G. Empathy, Mentalization, and Theory of Mind in Borderline Personality Disorder: Possible Overlap With Autism Spectrum Disorders. Front Psychol 2021; 12:626353. [PMID: 33643157 PMCID: PMC7909009 DOI: 10.3389/fpsyg.2021.626353] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/15/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nicoletta Vegni
- Faculty of Psychology, Niccolò Cusano University, Rome, Italy
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14
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Gamache D, Savard C, Leclerc P, Payant M, Côté A, Faucher J, Lampron M, Tremblay M. Latent profiles of patients with borderline pathology based on the alternative DSM-5 model for personality disorders. Borderline Personal Disord Emot Dysregul 2021; 8:4. [PMID: 33568234 PMCID: PMC7876791 DOI: 10.1186/s40479-021-00146-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There have been multiple attempts to try to parse out heterogeneity within borderline pathology by identifying patient subtypes; thus far, these works have yielded few consistent results. Recent developments in the operationalization of borderline pathology may provide new opportunities to identify clinically and conceptually meaningful subgroups of patients. The Alternative DSM-5 Model for Personality Disorders (AMPD) offers a categorical-dimensional operationalization of Borderline personality disorder (BPD) that has yet to be tested for identification of patient subgroups. The purpose of the present study is to test whether the combination of the Criterion A elements (pertaining to level of severity) and the seven pathological facets from Criterion B that define BPD in the AMPD can yield meaningful patient profiles. METHODS A total of 211 outpatients from a specialized PD treatment program (133 women, Mage = 33.66, SD = 10.97) were selected based on the presence of at least moderate borderline pathology according to cutoffs recently proposed for the Borderline Symptom List-23. Valid Criterion A (Self and Interpersonal Functioning Scale) and B (Personality Inventory for DSM-5 Faceted Brief Form) self-reports were administered to measure elements and facets that define BPD in the AMPD model; these variables were used as indicators in a latent profile analysis (LPA). RESULTS The optimal solution generated by LPA yielded four distinct profiles: (a) Borderline traits; (b) Moderate pathology with Impulsivity; (c) Moderate pathology with Identity problems and Depressivity; and (d) Severe pathology. Clinically meaningful distinctions emerged among profiles on AMPD indicators and external variables relevant to PD, especially aggression and impulsivity. CONCLUSIONS Profiles reflected both the "severity" and "style" components imbedded within Criterion A and B of the AMPD, as they were mainly distinguished by a continuum of severity but also by some meaningful qualitative differences that may have important clinical implications for treatment planning and contracting. Results also suggest that the four Criterion A elements have independent value to identify important differences in patients with borderline pathology. They also highlight that some Criterion B facets that define BPD in the AMPD may be especially important to identify subgroups of patients, mainly Impulsivity and Depressivity.
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Affiliation(s)
- Dominick Gamache
- Department of Psychology, Université du Québec à Trois-Rivières, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada.
- CERVO Brain Research Centre, Quebec City, QC, Canada.
- Interdisciplinary Research Centre on Intimate Relationship Problems and Sexual Abuse, Montreal, QC, Canada.
| | - Claudia Savard
- CERVO Brain Research Centre, Quebec City, QC, Canada
- Interdisciplinary Research Centre on Intimate Relationship Problems and Sexual Abuse, Montreal, QC, Canada
- Department of Educational Fundamentals and Practices, Université Laval, Quebec City, QC, Canada
| | - Philippe Leclerc
- Department of Psychology, Université du Québec à Trois-Rivières, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada
| | - Maude Payant
- Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada
| | - Alexandre Côté
- Department of Psychology, Université du Québec à Trois-Rivières, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada
| | - Jonathan Faucher
- Department of Psychology, Université du Québec à Trois-Rivières, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada
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15
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Ferber SG, Hazani R, Shoval G, Weller A. Targeting the Endocannabinoid System in Borderline Personality Disorder: Corticolimbic and Hypothalamic Perspectives. Curr Neuropharmacol 2021; 19:360-371. [PMID: 32351183 PMCID: PMC8033970 DOI: 10.2174/1570159x18666200429234430] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/09/2020] [Accepted: 04/24/2020] [Indexed: 12/15/2022] Open
Abstract
Borderline Personality Disorder (BPD) is a chronic debilitating psychiatric disorder characterized mainly by emotional instability, chaotic interpersonal relationships, cognitive disturbance (e.g., dissociation and suicidal thoughts) and maladaptive behaviors. BPD has a high rate of comorbidity with other mental disorders and a high burden on society. In this review, we focused on two compromised brain regions in BPD - the hypothalamus and the corticolimbic system, emphasizing the involvement and potential contribution of the endocannabinoid system (ECS) to improvement in symptoms and coping. The hypothalamus-regulated endocrine axes (hypothalamic pituitary - gonadal, thyroid & adrenal) have been found to be dysregulated in BPD. There is also substantial evidence for limbic system structural and functional changes in BPD, especially in the amygdala and hippocampus, including cortical regions within the corticolimbic system. Extensive expression of CB1 and CB2 receptors of the ECS has been found in limbic regions and the hypothalamus. This opens new windows of opportunity for treatment with cannabinoids such as cannabidiol (CBD) as no other pharmacological treatment has shown long-lasting improvement in the BPD population to date. This review aims to show the potential role of the ECS in BPD patients through their most affected brain regions, the hypothalamus and the corticolimbic system. The literature reviewed does not allow for general indications of treatment with CBD in BPD. However, there is enough knowledge to indicate a treatment ratio of a high level of CBD to a low level of THC. A randomized controlled trial investigating the efficacy of cannabinoid based treatments in BPD is warranted.
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Affiliation(s)
| | | | - Gal Shoval
- Address correspondence to this author at the Geha Mental Health Center, Petah Tiqva, Israel; Tel: 972-3-925-8440; Fax: 972-3-925-8276;, E-mail:
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16
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Peng W, Liu Z, Liu Q, Chu J, Zheng K, Wang J, Wei H, Zhong M, Ling Y, Yi J. Insecure attachment and maladaptive emotion regulation mediating the relationship between childhood trauma and borderline personality features. Depress Anxiety 2021; 38:28-39. [PMID: 32720464 DOI: 10.1002/da.23082] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 07/02/2020] [Accepted: 07/12/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Previous studies suggested that childhood trauma is an important etiologic factor for the development of borderline personality disorder (BPD). Moreover, insecure attachment and maladaptive emotion regulation (ER) might be related to childhood trauma and BPD. This study was aimed to explore the relationships among childhood trauma, insecure attachment, maladaptive ER, and BPD features. METHODS A cohort of 637 patients with psychological disorders completed a series of psychometric instruments such as the Personality Diagnostic Questionnaire-4+ (PDQ-4+), the 23-Item Borderline Symptom List, the Childhood Trauma Questionnaire, the Attachment Style Questionnaire, and the Cognitive Emotion Regulation Questionnaire. The path analyses were conducted to investigate the experience-driven model that whether insecure attachment and maladaptive ER could mediate the relationship between childhood trauma and BPD features. The random forest regression was performed to select variables that contribute significantly to BPD features, which variables would be incorporated into the data-driven model to further confirm the experience-driven model. RESULTS Both the experience-driven model and the data-driven model verified that there were three significant mediation pathways (childhood trauma → insecure attachment/maladaptive ER → BPD features, childhood trauma → insecure attachment → maladaptive ER → BPD features; all p < .05), and the most weighted mediation pathway by which childhood trauma influencing the BPD features was through insecure attachment and then through maladaptive ER (weighted 53.16%). CONCLUSION The influence of childhood trauma on BPD features was mainly mediated by the combination of insecure attachment and maladaptive emotion regulation.
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Affiliation(s)
- Wanrong Peng
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China.,Medical Psychological Institute, Central South University, Changsha, China
| | - Zhaoxia Liu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China.,Medical Psychological Institute, Central South University, Changsha, China
| | - Qian Liu
- Guangdong Key Laboratory of Mental Health and Cognitive Science, School of Psychology, Center for Studies of Psychological Application, South China Normal University, Guangzhou, China
| | - Jun Chu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China.,Medical Psychological Institute, Central South University, Changsha, China
| | - Kaili Zheng
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China.,Medical Psychological Institute, Central South University, Changsha, China
| | - Jingwei Wang
- Guangdong Key Laboratory of Mental Health and Cognitive Science, School of Psychology, Center for Studies of Psychological Application, South China Normal University, Guangzhou, China
| | - Hao Wei
- School of Computer Science and Engineering, Central South University, Changsha, China
| | - Mingtian Zhong
- Guangdong Key Laboratory of Mental Health and Cognitive Science, School of Psychology, Center for Studies of Psychological Application, South China Normal University, Guangzhou, China
| | - Yu Ling
- School of Educational Science, Hunan Normal University, Changsha, China
| | - Jinyao Yi
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China.,Medical Psychological Institute, Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, Changsha, China
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17
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Emotion regulation in adolescents: Influences of internal representations of relationships - An ERP study. Int J Psychophysiol 2020; 160:1-9. [PMID: 33278467 DOI: 10.1016/j.ijpsycho.2020.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/17/2020] [Accepted: 11/19/2020] [Indexed: 01/10/2023]
Abstract
Emotion regulation (ER) strategies can decrease the intensity or modify the experience of emotions. Deficits in emotion regulation are implicated in a wide range of psychopathologies. It is argued that interpersonal, socio-cognitive, and developmental variables play an important role in ER. This is the first study to explore the contribution of individual differences in internal representations of relationships (IRR) to neural correlates of ER in a sample of adolescents. Event related potentials of 53 adolescents (12 to 17 years old) were collected while performing an ER task. IRR was assessed with the social cognition and object relations scale (SCORS-G; Westen, 1995) coding of narratives from interviews. Results show that individual differences in IRR significantly predicted the modulation of emotional responses by expressive suppression in adolescents, accounting for 48% of the variance of changes in occipital late positive potentials (LPP). Thus, it appears that IRR are implicated in an individual's ability to regulate emotions. The clinical implications of the findings are discussed.
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18
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Pylypow J, Quinn D, Duncan D, Balbuena L. A Measure of Emotional Regulation and Irritability in Children and Adolescents: The Clinical Evaluation of Emotional Regulation-9. J Atten Disord 2020; 24:2002-2011. [PMID: 29094639 PMCID: PMC7549285 DOI: 10.1177/1087054717737162] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To develop a scale for emotional regulation using item response theory. Method: Eighteen Swanson Nolan and Pelham (SNAP-IV) items that loaded on an emotional dysregulation factor were submitted to Rasch analysis. After eliminating the items that violated Rasch criteria, the remaining items were examined for reliability and validated against the Conners' emotional lability index. Results: A nine-item scale for emotional regulation was developed that satisfies the Rasch model and reliably distinguishes emotionally dysregulated/irritable children and adolescents. A score of 4 or higher in this scale has optimal accuracy for identifying children and adolescents with current significant dysfunction in emotional regulation. Among youth with ADHD inattentive, hyperactive-impulsive, and combined types, 42%, 56%, and 71% met the Clinical Evaluation of Emotional Regulation-9 (CEER-9) threshold for emotional lability, respectively. Conclusion: A nine-item scale whose sum total is a measure of emotional regulation is proposed as a tool for clinical and research purposes.
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Affiliation(s)
| | - Declan Quinn
- University of Saskatchewan, Saskatoon,
Canada,Declan Quinn, Child and Adolescent
Psychiatry, Department of Psychiatry, University of Saskatchewan, Royal
University Hospital, Saskatoon, Saskatchewan, Canada S7N 0W8.
| | - Don Duncan
- BC Interior ADHD Clinic, Kelowna,
British Columbia, Canada
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19
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Abstract
The purpose of this research was to determine the differences in empathy, alexithymia features, and theory of mind between healthy controls and patients with borderline personality disorder (BPD). Thirty-five patients with BPD and 35 healthy controls were included in the study. To measure the clinical variables, the Empathy Quotient (EQ), Reading the Mind in the Eyes Test (RMET), Toronto Alexithymia Scale (TAS-20), Barratt Impulsivity Scale-11 (BIS-11), and Beck Depression Inventory (BDI) were applied. We found that the BPD group had significantly worse total RMET and neutral RMET scores than the control group. There were no differences in the EQ scores between the BPD and control groups. The patients with BPD were more alexithymic than the controls, and alexithymia and depression scores predicted BPD status. Patients with BPD who have difficulty identifying their own emotions tend to display deficits in perceptions of facial emotions, which, in turn, may lead to misperceptions of social signals and thus contribute to excessive emotional intensity and tension in social situations. The study results reveal that alexithymia and depression are important variables in predicting BPD traits.
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20
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Beeney JE, Hallquist MN, Scott LN, Ringwald WR, Stepp SD, Lazarus SA, Mattia AA, Pilkonis PA. The Emotional Bank Account and the Four Horsemen of the Apocalypse in Romantic Relationships of People with Borderline Personality Disorder: A Dyadic Observational Study. Clin Psychol Sci 2020; 7:1063-1077. [PMID: 32670673 DOI: 10.1177/2167702619830647] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Few studies have examined behaviors in romantic relationships associated with borderline personality disorder (BPD). We assessed critical variables from marital research: the "emotional bank account" (positive-to-negative behaviors; Gottman, 1993) and the "four horsemen of the apocalypse" (criticism, defensiveness, contempt, and stonewalling; Gottman & Silver, 1999; Gottman & Krokoff, 1989). Couples (N = 130, or 260 participants) engaged in a conflict task and reported relationship satisfaction at intake and 12-months. Clinician-rated BPD and avoidant PD (APD) criteria were examined. People with more BPD symptoms and their partners were less satisfied, which worsened by follow-up. Conflict behaviors partially explained these associations. Partners of people with more BPD symptoms had a worse emotional bank account, which then predicted (a) poorer satisfaction for both members and (b) worsening partner satisfaction. People with more BPD symptoms criticized more; their partners defended and stonewalled more. APD predicted worsening satisfaction. BPD appears to link specifically with relationship dysfunction, partly through associations with partner behavior.
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Affiliation(s)
- J E Beeney
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - M N Hallquist
- Department of Psychology, Pennsylvania State University
| | - L N Scott
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - W R Ringwald
- Department of Psychology, University of Pittsburgh
| | - S D Stepp
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - S A Lazarus
- The Ohio State University Wexner Medical Center, Department of Psychiatry and Behavioral Health
| | - A A Mattia
- Department of Psychology, University of Pittsburgh
| | - P A Pilkonis
- Department of Psychiatry, University of Pittsburgh School of Medicine
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21
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Seow LLY, Page AC, Hooke GR. Severity of borderline personality disorder symptoms as a moderator of the association between the use of dialectical behaviour therapy skills and treatment outcomes. Psychother Res 2020; 30:920-933. [PMID: 32013808 DOI: 10.1080/10503307.2020.1720931] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
A core aspect of Dialectical Behaviour Therapy (DBT) is the acquisition and use of DBT skills to replace maladaptive behaviours. However, it is unclear whether DBT skill use is associated with differential reductions in psychological distress across individuals with varying severities of borderline personality disorder (BPD) symptoms. In the current study, moderated mediation analyses were conducted to examine the relationships among DBT skill use and attitudes towards skill use, pre-treatment BPD symptom severity and changes in psychological distress over the course of a 12-week DBT-informed program in a sample of outpatients with mixed psychopathology (N = 102), including a minority with BPD (N = 16). It was predicted that (i) self-reported use of the four types of DBT skills (mindfulness, emotion regulation, distress tolerance and interpersonal effectiveness) and (ii) patient attitudes towards these skills (confidence and perceived effectiveness) would be associated with greater improvements in psychological distress in individuals with higher levels of BPD symptoms compared to individuals with lower levels of BPD symptoms. Results supported this hypothesis, indicating that self-reported DBT skill use and attitudes towards DBT skills are associated with differential patterns of reductions in psychological distress.
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Affiliation(s)
- Lillian L Y Seow
- School of Psychological Science, The University of Western Australia, Crawley, Australia
| | - Andrew C Page
- School of Psychological Science, The University of Western Australia, Crawley, Australia
| | - Geoff R Hooke
- School of Psychological Science, The University of Western Australia, Crawley, Australia.,Perth Clinic, West Perth, Australia
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22
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Bortolla R, Cavicchioli M, Fossati A, Maffei C. Emotional Reactivity in Borderline Personality Disorder: Theoretical Considerations Based on a Meta-Analytic Review of Laboratory Studies. J Pers Disord 2020; 34:64-87. [PMID: 30355020 DOI: 10.1521/pedi_2018_32_382] [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] [Indexed: 12/15/2022]
Abstract
Emotional hyperreactivity (Linehan, 1993) is the most investigated construct in borderline personality disorder (BPD). However, experimental studies revealed mixed results on the topic. Our main objective is to comprehensively summarize the results on emotional reactivity in BPD compared to healthy controls (HCs), using a meta-analytic approach, considering different emotional response systems (physiology, behavior, self-report). We included 31 experimental studies (1,675 subjects). We observed null to small effect sizes for several physiological and behavioral outcomes. Conversely, BPD subjects revealed a moderate to large difference in valence attributed to emotional stimuli and a small difference in self-reported arousal. Significant differences in pooled effect sizes were found between self-report and physiological outcomes. Several sources of heterogeneity were explored. In general, the hyperreactivity hypothesis was not supported. Additional dysfunctional processes should be taken into consideration to understand BPD emotional responsiveness.
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Affiliation(s)
| | | | | | - Cesare Maffei
- Vita-Salute San Raffaele University, Milan, Italy.,San Raffaele Hospital, Milan
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23
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Håkansson U, Watten RG, Söderström K, Øie MG. The association between executive functioning and parental stress and psychological distress is mediated by parental reflective functioning in mothers with substance use disorder. Stress Health 2019; 35:407-420. [PMID: 30977584 PMCID: PMC9328653 DOI: 10.1002/smi.2868] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/02/2019] [Accepted: 04/07/2019] [Indexed: 12/05/2022]
Abstract
Mothers with a substance use disorder (SUD) have been found to exhibit heightened experience of stress and deficits in executive functioning (EF) and in parental reflective functioning (PRF). Although experiences of stress, EF and PRF are important for caregiving capacities; no studies have explored associations between the phenomena in mothers with SUD. This study aimed to examine the association between EF (working memory, inhibition, and cognitive flexibility) and different forms of stress (parental stress, general life stress, and psychological distress) in 43 mothers with SUD with infants. We further aimed to investigate whether PRF had a mediating function between EF and the experience of stress. The mothers completed self-report questionnaires regarding experiences of different types of stress, and we also used neuropsychological tests to assess EF and a semistructured interview to assess PRF. Results identified problems in EF were associated with higher parental stress and psychological distress but not with general life stress. Cognitive flexibility contributed uniquely to variance in parental stress, whereas working memory was a unique contributor to variance in psychological distress. PRF had a mediating function between EF and parental stress and between EF and psychological distress. Findings highlight the importance of considering individual differences in PRF when targeting EF in interventions trying to reduce the experience of parental stress and psychological distress in mothers with SUD.
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Affiliation(s)
- Ulrika Håkansson
- Department of PsychologyInnland Norway University of Applied SciencesLillehammerNorway
| | - Reidulf G. Watten
- Department of PsychologyInnland Norway University of Applied SciencesLillehammerNorway
| | - Kerstin Söderström
- Department of PsychologyInnland Norway University of Applied SciencesLillehammerNorway,Division of Mental Health CareInnlandet Hospital TrustLillehammerNorway
| | - Merete Glenne Øie
- Department of PsychologyUniversity of OsloOsloNorway,Research DivisionInnlandet Hospital TrustLillehammerNorway
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24
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Franken K, Lamers SM, Ten Klooster PM, Bohlmeijer ET, Westerhof GJ. Validation of the Mental Health Continuum-Short Form and the dual continua model of well-being and psychopathology in an adult mental health setting. J Clin Psychol 2018; 74:2187-2202. [PMID: 29978482 PMCID: PMC6282789 DOI: 10.1002/jclp.22659] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 05/30/2018] [Accepted: 06/05/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The growing evidence for the dual continua model of psychopathology and well-being has important implications for measuring outcomes in mental health care. The aim of the current study is to validate a measure of well-being as well as the dual continua model in adults with mood, anxiety, personality, and developmental disorders. METHODS 472 adult psychiatric outpatients filled out the Mental Health Continuum-Short Form (MHC-SF) and the Outcome Questionnaire before start of treatment. RESULTS Confirmatory factor analyses (CFA) confirmed the three-factor structure of emotional, psychological, and social well-being of the MHC-SF. The dual continua model had the best fit in the complete sample and the different diagnostic groups. CONCLUSION The MHC-SF is a reliable and valid instrument to measure well-being in the psychiatric population. Although relatively high correlations between psychopathology and well-being exist, the results underline the importance to measure well-being in addition to psychopathology in mental health care.
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Affiliation(s)
- Katinka Franken
- University of TwenteEnschedeThe Netherlands
- GGNetWarnsveldThe Netherlands
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25
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Sato M, Fonagy P, Luyten P. Effects of Social Exclusion on Effortful Control and Mentalizing in relation to Borderline Personality Features. Sci Rep 2018; 8:14400. [PMID: 30258202 PMCID: PMC6158252 DOI: 10.1038/s41598-018-32775-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 08/31/2018] [Indexed: 11/17/2022] Open
Abstract
The current study investigated the effects of social interactions on effortful control (EC) and mentalizing in individuals with borderline personality disorder (BPD) features. 123 nonclinical participants completed the emotional Stroop task to assess EC and the modified Reading the Mind in the Eyes Test (RMET) to assess mentalizing capacities before and after having social interactions. The Cyberball paradigm was used to generate socially inclusive and exclusive interactions. Results indicated the high BPD group made more errors on the Stroop task following exclusive social interactions than the low BPD group. The high BPD group, compared to the low BPD group, associated fewer emotional words with facial cues following inclusive social interactions but overanalysed facial cues (hypermentalizing) following the exclusive social interaction. Exclusive social interactions hindered the inhibitory capacities in individuals with high BPD features, but inclusive social interactions facilitated. Individuals with high BPD features responded to exclusive social interactions by hypermentalizing. Thus, it was found social rejection could activate cognitive-affective processes which led to hypermentalizing and impairments in EC which in combination could explain the disruptive effects on social interactions in people with BPD features.
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Affiliation(s)
- Momoko Sato
- Department of Clinical, Educational, and Health Psychology, University College London, London, UK.
| | - Peter Fonagy
- Department of Clinical, Educational, and Health Psychology, University College London, London, UK
| | - Patrick Luyten
- Department of Clinical, Educational, and Health Psychology, University College London, London, UK.,Faculty of Psychology and Educational Sciences, KU Leuven, Belgium
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26
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Kim MK, Kim JS, Park HI, Choi SW, Oh WJ, Seok JH. Early life stress, resilience and emotional dysregulation in major depressive disorder with comorbid borderline personality disorder. J Affect Disord 2018; 236:113-119. [PMID: 29730510 DOI: 10.1016/j.jad.2018.04.119] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 03/17/2018] [Accepted: 04/08/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Borderline personality disorder (BPD) show different course and treatment compared to major depressive disorder (MDD). Early life stress may increase BPD onset; however, resilience may play a protective role against the development of psychopathology. The goal of this study was to compare the early life stress, resilience, and the clinical characteristics of emotional dysregulation in patients with MDD with and without comorbid BPD. METHODS Thirty patients with both BPD and MDD, 25 patients with MDD alone, and 25 age- and sex- matched healthy controls, participated in this study. Analysis of variance was used to compare the early life stress, resilience, and emotional dysregulation among groups. Also, multivariate logistic regression models were used to identify the relationship of the early life stress and resilience domains with BPD comorbidity within MDD patients. RESULTS The domains of emotional abuse and self-regulation ability were significantly associated with BPD comorbidity and BPD severity. In emotional dysregulation, difficulty scores of impulsivity, coping strategies, and emotion clarity domains were significantly increased in patients with both BPD and MDD compared to patients with MDD alone. LIMITATIONS The relatively small sample size may contribute to reduce statistical power of investigation. CONCLUSIONS Emotional abuse experiences in early life, and deficits in self-regulation, are significantly associated with comorbid BPD in patients with MDD. A comprehensive evaluation including early life stress, resilience and emotion regulation ability may help to identify comorbid BPD in patients with MDD and develop treatment strategies.
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Affiliation(s)
- Min-Kyeong Kim
- Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong-Sun Kim
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hae-In Park
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sun-Woo Choi
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Wook-Jin Oh
- Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Ho Seok
- Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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27
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Southward MW, Altenburger EM, Moss SA, Cregg DR, Cheavens JS. Flexible, yet firm: A model of healthy emotion regulation. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2018; 37:231-251. [PMID: 30337772 DOI: 10.1521/jscp.2018.37.4.231] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We propose a model of healthy intentional emotion regulation that includes (1) a large repertoire of (2) adaptive strategies that (3) one persists with despite initial negative feedback. One hundred forty-four undergraduates (average age = 19.20 years; 68% female, 79% Caucasian) completed a novel performance task indicating what they would think or do to feel better in response to eleven stressful vignettes. After their initial response, participants indicated four more times how they would respond if their previous strategy was not working. Raters categorized each response as an emotion regulation strategy and coded the adaptiveness of each strategy. Participants self-reported Neuroticism, Extraversion, Conscientiousness, Borderline Personality Disorder (BPD) symptoms, and depressive symptoms. We regressed each personality dimension and psychopathology symptom on our model of healthy emotion regulation. Neuroticism was negatively associated with adaptiveness and persistence. Extraversion was positively associated with adaptiveness. Conscientiousness was positively associated with repertoire, adaptiveness, and persistence, while BPD symptoms were negatively associated with all three variables. Depressive symptoms were negatively associated with persistence. These preliminary findings suggest that people with larger repertoires of more adaptive emotion regulation strategies who persist with these strategies despite initial negative feedback report less personality pathology and psychological distress.
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Affiliation(s)
| | | | - Sara A Moss
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - David R Cregg
- Department of Psychology, The Ohio State University, Columbus, OH, USA
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28
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Servan A, Brunelin J, Poulet E. The effects of oxytocin on social cognition in borderline personality disorder. L'ENCEPHALE 2018; 44:46-51. [DOI: 10.1016/j.encep.2017.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 05/16/2017] [Accepted: 11/14/2017] [Indexed: 10/18/2022]
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29
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Dunn EC, Nishimi K, Gomez SH, Lott AP, Bradley B. Developmental timing of trauma exposure and emotion dysregulation in adulthood: Are there sensitive periods when trauma is most harmful? J Affect Disord 2018; 227:869-877. [PMID: 29254068 PMCID: PMC5805641 DOI: 10.1016/j.jad.2017.10.045] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/18/2017] [Accepted: 10/27/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND This study aimed to determine whether there were sensitive periods when a first exposure to trauma was most associated with emotion dysregulation symptoms in adulthood. METHODS Adult participants came from a public urban hospital in Atlanta, GA (n = 1944). Lifetime trauma exposure was assessed using the Traumatic Events Inventory (TEI). Multiple linear regression models were used to assess the association between the developmental timing of first trauma exposure, classified as early childhood (ages 0-5), middle childhood (ages 6-10), adolescence (ages 11-18), and adulthood (ages 19+), on adult emotion dysregulation symptoms, measured using the abbreviated Emotion Dysregulation Scale. RESULTS Participants exposed to trauma at any age had higher emotion dysregulation scores than their unexposed peers. However, participants first exposed to child maltreatment or interpersonal violence during middle childhood had higher emotion dysregulation scores relative to those first exposed during other developmental stages; these developmental timing differences were detected even after controlling for sociodemographic factors, exposure to other trauma, and frequency of exposure to trauma. Further, after controlling for current psychiatric symptoms, the effect of other interpersonal trauma exposure in middle childhood was diminished and first exposure to other interpersonal violence in early childhood was associated with significantly lower emotion dysregulation symptoms. LIMITATIONS Limitations of this study include the use of retrospective reports and absence of complete information about trauma severity or duration. CONCLUSION These findings should be replicated in other population-based samples with prospective designs to confirm the importance of developmental timing of trauma on later emotion dysregulation.
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Affiliation(s)
- Erin C. Dunn
- Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA,Stanley Center for Psychiatric Research, The Broad Institute of Harvard and MIT, Cambridge, MA,Correspondence: Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, 185 Cambridge Street, Simches Research Building 6th Floor (room 6.252), Boston, MA 02114. Phone: 617 726 9387; Fax: 617 726 0830.
| | - Kristen Nishimi
- Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA,Harvard T.H. Chan School of Public Health, Boston, MA
| | - Stephanie H. Gomez
- Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA
| | - Abigail Powers Lott
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Bekh Bradley
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA,Atlanta VA Medical Center, Atlanta, GA
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Schoenleber M, Berghoff CR, Tull MT, DiLillo D, Messman-Moore T, Gratz KL. Emotional lability and affective synchrony in borderline personality disorder. Personal Disord 2017; 7:211-20. [PMID: 27362623 DOI: 10.1037/per0000145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Extant research on emotional lability in borderline personality disorder (BPD) has focused almost exclusively on lability of individual emotions or emotion types, with limited research considering how different types of emotions shift together over time. Thus, this study examined the temporal dynamics of emotion in BPD at the level of both individual emotions (i.e., self-conscious emotions [SCE], anger, and anxiety) and mixed emotions (i.e., synchrony between emotions). One hundred forty-four women from the community completed a diagnostic interview and laboratory study involving 5 emotion induction tasks (each of which was preceded and followed by a 5-min resting period or neutral task). State ratings of SCE, anger, and anxiety were provided at 14 time points (before and after each laboratory task and resting period). Hierarchical linear modeling results indicate that women with BPD reported greater mean levels of SCE and Anxiety (but not Anger), and greater lability of Anxiety. Women with BPD also exhibited greater variability in lability of all 3 emotions (suggestive of within-group differences in the relevance of lability to BPD). Results also revealed synchrony (i.e., positive relations) between each possible pair of emotions, regardless of BPD status. Follow-up regression analyses suggest the importance of accounting for lability when examining the role of synchrony in BPD, as the relation of SCE-Anger synchrony to BPD symptom severity was moderated by Anger and SCE lability. Specifically, synchronous changes in SCE and Anger were associated with greater BPD symptom severity when large shifts in SCE were paired with minor shifts in Anger. (PsycINFO Database Record
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Affiliation(s)
- Michelle Schoenleber
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center
| | | | - Matthew T Tull
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center
| | - David DiLillo
- Department of Psychology, University of Nebraska-Lincoln
| | | | - Kim L Gratz
- Department of Psychiatry and Human Behavior, University of Mississippi Medical
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Håkansson U, Söderström K, Watten R, Skårderud F, Øie MG. Parental reflective functioning and executive functioning in mothers with substance use disorder. Attach Hum Dev 2017; 20:181-207. [PMID: 29105598 DOI: 10.1080/14616734.2017.1398764] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Having a substance use disorder (SUD) may adversely affect caregiving capacities. Reflective functioning (RF) and executive functioning (EF) are both important capacities for sensitive parenting, and are often impaired in a SUD. Only a few studies have explored the possible association between the two phenomena. In this study, we used a neuropsychological test battery to assess EF, and the Parent Development Interview to assess RF in a sample of mothers with a SUD (N = 43). Although parental RF (PRF) was associated with EF, when controlled for intelligence (IQ) and mental health, there was no significant association between EF and PRF. Mental health, however, showed a significant negative association with PRF. Splitting the group in two based on PRF level, mothers with a negative to low PRF exhibited more severe difficulties in SUD-related aspects, as well as in several EF components, compared to mothers with an adequate to high PRF, highlighting the association between EF and PRF. The results from this study contribute to enhance our understanding of the dynamics underlying vulnerability in PRF that mothers with small children may experience. We suggest EF to be a prerequisite for adequate PRF, and for interventions to be customized accordingly regarding parents with a SUD.
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Affiliation(s)
- Ulrika Håkansson
- a The Research Centre for Child and Youth Competence and Development , Innland Norway University of Applied Sciences , Lillehammer , Norway
| | - Kerstin Söderström
- a The Research Centre for Child and Youth Competence and Development , Innland Norway University of Applied Sciences , Lillehammer , Norway.,b Division Mental Health Care , Innlandet Hospital Trust , Lillehammer , Norway
| | - Reidulf Watten
- a The Research Centre for Child and Youth Competence and Development , Innland Norway University of Applied Sciences , Lillehammer , Norway
| | - Finn Skårderud
- c Norwegian School of Sport Science , University of Oslo , Oslo , Norway
| | - Merete Glenne Øie
- d Department of Psychology , University of Oslo , Oslo , Norway.,e Research Division , Innlandet Hospital Trust , Lillehammer , Norway
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Andrewes HE, Hulbert C, Cotton SM, Betts J, Chanen AM. An ecological momentary assessment investigation of complex and conflicting emotions in youth with borderline personality disorder. Psychiatry Res 2017; 252:102-110. [PMID: 28259033 DOI: 10.1016/j.psychres.2017.01.100] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 12/18/2016] [Accepted: 01/12/2017] [Indexed: 10/20/2022]
Abstract
Non-suicidal self-injury (NSSI) is a prevalent behaviour among people with borderline personality disorder (BPD) but many aspects of the emotional changes that trigger and maintain this behaviour are unknown. This study examines the relationships between NSSI and the number of negative ('negative complex') and opposing valence ('conflicting') emotions. One hundred and seven youth (aged 15-25 years) with first-presentation BPD were assessed using a combination of self-report and ecological momentary assessment to investigate trait levels of emotional acceptance and in vivo changes in the number of negative complex and conflicting emotions before and after self-injurious thoughts and behaviours. Multilevel modelling revealed that changes in the number of negative complex emotions mirrored distress levels before and after self-injurious thoughts and behaviours, approximating a quadratic curve. Increases in the number of negative complex emotions reported prior to self-injurious thoughts and behaviours were associated with lower acceptance of negative emotions. These findings indicate that the number of negative emotions experienced contributes to distress prior to engagement in NSSI. The relationship between non-acceptance of negative emotions and negative complex emotions prior to NSSI suggests that improved emotional awareness and acceptance should be a focus for early interventions aimed at reducing self-injury.
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Affiliation(s)
- Holly E Andrewes
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
| | - Carol Hulbert
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Susan M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Jennifer Betts
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Andrew M Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia; Orygen Youth Health, NorthWestern Mental Health, Melbourne, Australia.
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Sleuwaegen E, Claes L, Luyckx K, Berens A, Vogels C, Sabbe B. Subtypes in borderline patients based on reactive and regulative temperament. PERSONALITY AND INDIVIDUAL DIFFERENCES 2017. [DOI: 10.1016/j.paid.2016.11.065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Smits ML, Feenstra DJ, Bales DL, de Vos J, Lucas Z, Verheul R, Luyten P. Subtypes of borderline personality disorder patients: a cluster-analytic approach. Borderline Personal Disord Emot Dysregul 2017; 4:16. [PMID: 28680639 PMCID: PMC5494904 DOI: 10.1186/s40479-017-0066-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 06/08/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The borderline personality disorder (BPD) population is notably heterogeneous, and this has potentially important implications for intervention. Identifying distinct subtypes of patients may represent a first step in identifying which treatments work best for which individuals. METHODS A cluster-analysis on dimensional personality disorder (PD) features, as assessed with the SCID-II, was performed on a sample of carefully screened BPD patients (N = 187) referred for mentalization-based treatment. The optimal cluster solution was determined using multiple indices of fit. The validity of the clusters was explored by investigating their relationship with borderline pathology, symptom severity, interpersonal problems, quality of life, personality functioning, attachment, and trauma history, in addition to demographic and clinical features. RESULTS A three-cluster solution was retained, which identified three clusters of BPD patients with distinct profiles. The largest cluster (n = 145) consisted of patients characterized by "core BPD" features, without marked elevations on other PD dimensions. A second "Extravert/externalizing" cluster of patients (n = 27) was characterized by high levels of histrionic, narcissistic, and antisocial features. A third, smaller "Schizotypal/paranoid" cluster (n = 15) consisted of patients with marked schizotypal and paranoid features. Patients in these clusters showed theoretically meaningful differences in terms of demographic and clinical features. CONCLUSIONS Three meaningful subtypes of BPD patients were identified with distinct profiles. Differences were small, even when controlling for severity of PD pathology, suggesting a strong common factor underlying BPD. These results may represent a stepping stone toward research with larger samples aimed at replicating the findings and investigating differential trajectories of change, treatment outcomes, and treatment approaches for these subtypes. TRIAL REGISTRATION The study was retrospectively registered 16 April 2010 in the Nederlands Trial Register, no. NTR2292.
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Affiliation(s)
- Maaike L Smits
- Viersprong Institute for Studies on Personality Disorders, Halsteren, The Netherlands
| | - Dine J Feenstra
- Viersprong Institute for Studies on Personality Disorders, Halsteren, The Netherlands
| | - Dawn L Bales
- Viersprong Institute for Studies on Personality Disorders, Halsteren, The Netherlands.,Expertisecentrum MBT-NL, Bergen op Zoom, The Netherlands
| | - Jasmijn de Vos
- Netherlands Psychoanalytic Institute, Amsterdam, The Netherlands
| | | | - Roel Verheul
- Viersprong Institute for Studies on Personality Disorders, Halsteren, The Netherlands.,Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Patrick Luyten
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium.,Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Kogan-Goloborodko O, Brügmann E, Repple J, Habel U, Clemens B. Experimentally Assessed Reactive Aggression in Borderline Personality Disorder. PLoS One 2016; 11:e0166737. [PMID: 27851804 PMCID: PMC5112922 DOI: 10.1371/journal.pone.0166737] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 11/02/2016] [Indexed: 11/24/2022] Open
Abstract
Approximately 73% of patients suffering from Borderline personality disorder (BPD) exhibit aggressive behaviour, which severely hinders therapeutic work and clinical improvement. Because the underlying mechanisms of aggression in BPD are not yet completely understood, additional research in this domain has a high clinical and scientific relevance. We employed a modified version of the Taylor Aggression Paradigm (mTAP), in order to examine for the first time whether this task can be used to differentiate between BPD patients and healthy controls with regard to reactive aggression. In the mTAP, the amount of money subtracted by a virtual opponent was categorized into 'low' (10-20 cents) and 'high' (80-100 cents) provocations, enabling us to compare how much money BPD patients and healthy controls subtracted (i.e., how aggressively participants responded) following high and low provocation trials. Our results showed that, compared to healthy controls, BPD patients showed higher overall aggression, higher aggression after high provocation trials, as well as a larger difference between high and low provocation trials. This finding was corroborated by a neuropsychological assessment, demonstrating higher levels of aggression and impulsivity in BPD patients. Interestingly, reactive aggression in the mTAP was positively correlated with symptom severity and impulsivity in BPD patients. We suggest that the mTAP provides a valuable tool allowing psychiatrists to quantify reactive aggression in BPD. Therefore, clinicians and researchers might consider this task, as a short experimental measure of reactive aggression, either in future studies or to aid diagnostic assessment during clinical practice.
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Affiliation(s)
- Olga Kogan-Goloborodko
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany
| | - Elisabeth Brügmann
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany
| | - Jonathan Repple
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Ute Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany
- JARA – BRAIN Institute I, Aachen, Germany
| | - Benjamin Clemens
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany
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Bayes A, Parker G, McClure G. Emotional dysregulation in those with bipolar disorder, borderline personality disorder and their comorbid expression. J Affect Disord 2016; 204:103-11. [PMID: 27344618 DOI: 10.1016/j.jad.2016.06.027] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/06/2016] [Accepted: 06/11/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND Differentiation of the bipolar disorders (BP) from a borderline personality disorder (BPD) can be challenging owing to shared features, with emotional dysregulation being the likely principal one. AIM To assess differences in emotion regulation strategies in those with BP alone, BPD alone and those comorbid for both. METHODS We interviewed participants previously receiving a BP or BPD diagnosis, studying those who met DSM criteria for one or both conditions. RESULTS The sample comprised 83 with bipolar disorder, 53 with BPD and 54 comorbid for both. Analyses established linear trends, with the greatest impairment in emotion regulation strategies in the comorbid group followed by the BPD group, and with the lowest in the BP group. Specific deficits in the comorbid group included impulsivity, difficulties with goal directed behaviour, and accessing strategies. A similar linear profile was quantified for maladaptive cognitive emotion regulation strategies, weighted to catastrophizing and rumination. Adaptive emotion regulation strategies were superior in the bipolar group, without significant differences observed between the comorbid and BPD groups. LIMITATIONS Reliance on self-report measures; combined BP I and II participants limits generalisability of results to each bipolar sub-type; use of DSM diagnoses risking artefactual comorbidity; while there was an over-representation of females in all groups. CONCLUSIONS Differences in emotion regulation strategies advance differentiation of those with either BP or BPD, while we identify the specificity of differing strategies to each condition and their synergic effect in those comorbid for both conditions. Study findings should assist the development and application of targeted strategies for those with either or both conditions.
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Affiliation(s)
- Adam Bayes
- School of Psychiatry, University of New South Wales, NSW, Australia.
| | - Gordon Parker
- School of Psychiatry, University of New South Wales, NSW, Australia; Black Dog Institute, Hospital Rd, Randwick, NSW 2031, Australia
| | - Georgia McClure
- School of Psychiatry, University of New South Wales, NSW, Australia; Black Dog Institute, Hospital Rd, Randwick, NSW 2031, Australia
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Silvers JA, Hubbard AD, Biggs E, Shu J, Fertuck E, Chaudhury S, Grunebaum MF, Weber J, Kober H, Chesin M, Brodsky BS, Koenigsberg H, Ochsner KN, Stanley B. Affective lability and difficulties with regulation are differentially associated with amygdala and prefrontal response in women with Borderline Personality Disorder. Psychiatry Res 2016; 254:74-82. [PMID: 27379614 PMCID: PMC4992645 DOI: 10.1016/j.pscychresns.2016.06.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 06/18/2016] [Accepted: 06/18/2016] [Indexed: 10/21/2022]
Abstract
The present neuroimaging study investigated two aspects of difficulties with emotion associated with Borderline Personality Disorder (BPD): affective lability and difficulty regulating emotion. While these two characteristics have been previously linked to BPD symptomology, it remains unknown whether individual differences in affective lability and emotion regulation difficulties are subserved by distinct neural substrates within a BPD sample. To address this issue, sixty women diagnosed with BPD were scanned while completing a task that assessed baseline emotional reactivity as well as top-down emotion regulation. More affective instability, as measured by the Affective Lability Scale (ALS), positively correlated with greater amygdala responses on trials assessing emotional reactivity. Greater difficulties with regulating emotion, as measured by the Difficulties with Emotion Regulation Scale (DERS), was negatively correlated with left Inferior Frontal Gyrus (IFG) recruitment on trials assessing regulatory ability. These findings suggest that, within a sample of individuals with BPD, greater bottom-up amygdala activity is associated with heightened affective lability. By contrast, difficulties with emotion regulation are related to reduced IFG recruitment during emotion regulation. These results point to distinct neural mechanisms for different aspects of BPD symptomology.
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Affiliation(s)
- Jennifer A Silvers
- Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095, USA.
| | - Alexa D Hubbard
- Department of Psychology, New York University, 6 Washington Place, New York, NY 10003, USA
| | - Emily Biggs
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, 1051 Riverside Drive, New York, NY 10032, USA
| | - Jocelyn Shu
- Department of Psychology, 1190 Amsterdam Avenue, New York, NY 10027, USA
| | - Eric Fertuck
- The City University of New York, Clinical Psychology Doctoral Program and Graduate Center, New York, NY 10031, USA
| | - Sadia Chaudhury
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, 1051 Riverside Drive, New York, NY 10032, USA
| | - Michael F Grunebaum
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, 1051 Riverside Drive, New York, NY 10032, USA
| | - Jochen Weber
- Department of Psychology, 1190 Amsterdam Avenue, New York, NY 10027, USA
| | - Hedy Kober
- Department of Psychiatry, Yale School of Medicine, One Church Street, New Haven, CT 06510, USA
| | - Megan Chesin
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, 1051 Riverside Drive, New York, NY 10032, USA
| | - Beth S Brodsky
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, 1051 Riverside Drive, New York, NY 10032, USA
| | - Harold Koenigsberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Kevin N Ochsner
- Department of Psychology, 1190 Amsterdam Avenue, New York, NY 10027, USA
| | - Barbara Stanley
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, 1051 Riverside Drive, New York, NY 10032, USA.
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Buchheim A, Erk S, George C, Kächele H, Martius P, Pokorny D, Spitzer M, Walter H. Neural Response during the Activation of the Attachment System in Patients with Borderline Personality Disorder: An fMRI Study. Front Hum Neurosci 2016; 10:389. [PMID: 27531977 PMCID: PMC4969290 DOI: 10.3389/fnhum.2016.00389] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 07/19/2016] [Indexed: 11/13/2022] Open
Abstract
Individuals with borderline personality disorder (BPD) are characterized by emotional instability, impaired emotion regulation and unresolved attachment patterns associated with abusive childhood experiences. We investigated the neural response during the activation of the attachment system in BPD patients compared to healthy controls using functional magnetic resonance imaging (fMRI). Eleven female patients with BPD without posttraumatic stress disorder (PTSD) and 17 healthy female controls matched for age and education were telling stories in the scanner in response to the Adult Attachment Projective Picture System (AAP), an eight-picture set assessment of adult attachment. The picture set includes theoretically-derived attachment scenes, such as separation, death, threat and potential abuse. The picture presentation order is designed to gradually increase the activation of the attachment system. Each picture stimulus was presented for 2 min. Analyses examine group differences in attachment classifications and neural activation patterns over the course of the task. Unresolved attachment was associated with increasing amygdala activation over the course of the attachment task in patients as well as controls. Unresolved controls, but not patients, showed activation in the right dorsolateral prefrontal cortex (DLPFC) and the rostral cingulate zone (RCZ). We interpret this as a neural signature of BPD patients’ inability to exert top-down control under conditions of attachment distress. These findings point to possible neural mechanisms for underlying affective dysregulation in BPD in the context of attachment trauma and fear.
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Affiliation(s)
- Anna Buchheim
- Institute of Psychology, University of Innsbruck Innsbruck, Austria
| | - Susanne Erk
- Department of Psychiatry and Psychotherapy, Division of Mind and Brain Research, University Hospital Charité Berlin, Germany
| | - Carol George
- Department of Psychology, Mills College Oakland, CA, USA
| | - Horst Kächele
- International Psychoanalytic University Berlin Berlin, Germany
| | | | - Dan Pokorny
- Department of Psychosomatic Medicine and Psychotherapy, University of Ulm Ulm, Germany
| | - Manfred Spitzer
- Department of Psychiatry III, University of Ulm Ulm, Germany
| | - Henrik Walter
- Department of Psychiatry and Psychotherapy, Division of Mind and Brain Research, University Hospital Charité Berlin, Germany
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Santangelo PS, Limberger MF, Stiglmayr C, Houben M, Coosemans J, Verleysen G, Kuppens P, Tuerlinckx F, Vanpaemel W, Ebner-Priemer UW. Analyzing subcomponents of affective dysregulation in borderline personality disorder in comparison to other clinical groups using multiple e-diary datasets. Borderline Personal Disord Emot Dysregul 2016; 3:5. [PMID: 27386138 PMCID: PMC4934004 DOI: 10.1186/s40479-016-0039-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 06/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Affective dysregulation is widely regarded as being the core problem in patients with borderline personality disorder (BPD). Moreover, BPD is the disorder mainly associated with affective dysregulation. However, the empirical confirmation of the specificity of affective dysregulation for BPD is still pending. We used a validated approach from basic affective science that allows for simultaneously analyzing three interdependent components of affective dysregulation that are disturbed in patients with BPD: homebase, variability, and attractor strength (return to baseline). METHODS We applied two types of multilevel models on two e-diary datasets to investigate group differences regarding three subcomponents between BPD patients (n = 43; n = 51) and patients with posttraumatic stress disorder (PTSD; n = 28) and those with bulimia nervosa (BN; n = 20) as clinical control groups in dataset 1, and patients with panic disorder (PD; n = 26) and those with major depression (MD; n = 25) as clinical control groups in dataset 2. In addition, healthy controls (n = 28; n = 40) were included in the analyses. In both studies, e-diaries were used to repeatedly collect data about affective experiences during participants' daily lives. In study 1 a high-frequency sampling strategy with assessments in 15 min-intervals over 24 h was applied, whereas the assessments occurred every waking hour over 48 h in study 2. The local ethics committees approved both studies, and all participants provided written informed consent. RESULTS In contradiction to our hypotheses, BPD patients did not consistently show altered affective dysregulation compared to the clinical patient groups. The only differences in affective dynamics in BPD patients emerged with regard to one of three subcomponents, affective homebase. However, these results were not even consistent. Conversely, comparing the patients to healthy controls revealed a pattern of more negative affective homebases, higher levels of affective variability, and (partially) reduced returns to baseline in the patient groups. CONCLUSIONS Our results indicate that affective dysregulation constitutes a transdiagnostic mechanism that manifests in similar ways in several different mental disorders. We point out promising prospects that might help to elucidate the common and distinctive mechanisms that underlie several different disorders and that should be addressed in future studies.
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Affiliation(s)
| | | | - C. Stiglmayr
- />Consortium for Scientific Psychotherapy Berlin (AWP-Berlin), Berlin, Germany
| | - M. Houben
- />KU Leuven – University of Leuven, Leuven, Belgium
| | - J. Coosemans
- />KU Leuven – University of Leuven, Leuven, Belgium
| | - G. Verleysen
- />KU Leuven – University of Leuven, Leuven, Belgium
| | - P. Kuppens
- />KU Leuven – University of Leuven, Leuven, Belgium
| | | | - W. Vanpaemel
- />KU Leuven – University of Leuven, Leuven, Belgium
| | - U. W. Ebner-Priemer
- />Karlsruhe Institute of Technology, Karlsruhe, Germany
- />Central Institute of Mental Health, Mannheim, Germany
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40
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Schoenleber M, Berghoff CR, Tull MT, DiLillo D, Messman-Moore T, Gratz KL. Emotional lability and affective synchrony in borderline personality disorder. Personal Disord 2016. [PMID: 27362623 DOI: 10.1037/per0000145.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Extant research on emotional lability in borderline personality disorder (BPD) has focused almost exclusively on lability of individual emotions or emotion types, with limited research considering how different types of emotions shift together over time. Thus, this study examined the temporal dynamics of emotion in BPD at the level of both individual emotions (i.e., self-conscious emotions [SCE], anger, and anxiety) and mixed emotions (i.e., synchrony between emotions). One hundred forty-four women from the community completed a diagnostic interview and laboratory study involving 5 emotion induction tasks (each of which was preceded and followed by a 5-min resting period or neutral task). State ratings of SCE, anger, and anxiety were provided at 14 time points (before and after each laboratory task and resting period). Hierarchical linear modeling results indicate that women with BPD reported greater mean levels of SCE and Anxiety (but not Anger), and greater lability of Anxiety. Women with BPD also exhibited greater variability in lability of all 3 emotions (suggestive of within-group differences in the relevance of lability to BPD). Results also revealed synchrony (i.e., positive relations) between each possible pair of emotions, regardless of BPD status. Follow-up regression analyses suggest the importance of accounting for lability when examining the role of synchrony in BPD, as the relation of SCE-Anger synchrony to BPD symptom severity was moderated by Anger and SCE lability. Specifically, synchronous changes in SCE and Anger were associated with greater BPD symptom severity when large shifts in SCE were paired with minor shifts in Anger. (PsycINFO Database Record
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Affiliation(s)
- Michelle Schoenleber
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center
| | | | - Matthew T Tull
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center
| | - David DiLillo
- Department of Psychology, University of Nebraska-Lincoln
| | | | - Kim L Gratz
- Department of Psychiatry and Human Behavior, University of Mississippi Medical
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Witting AB, Jensen J, Brown M. Evaluating the Utility of MFT Models in the Treatment of Trauma: Implications for Affect Regulation. CONTEMPORARY FAMILY THERAPY 2016. [DOI: 10.1007/s10591-016-9387-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Kramer U. The Role of Coping Change in Borderline Personality Disorder: A Process-Outcome Analysis on Dialectical-Behaviour Skills Training. Clin Psychol Psychother 2016; 24:302-311. [PMID: 27098296 DOI: 10.1002/cpp.2017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 03/11/2016] [Accepted: 03/22/2016] [Indexed: 11/06/2022]
Abstract
Difficulty in emotion regulation is a hallmark feature of patients with borderline personality disorder (BPD). Skills training concepts based on dialectical-behaviour therapy (DBT) are common and effective treatment options for specifically addressing lacking skills in emotion regulation. However, so far it is unclear which aspects of coping change over the course of DBT skills training and if these coping strategies predict symptom change. The present process-outcome analysis, based on a randomized controlled study, aims at investigating these questions, by referring to a general conception of coping and by using an observer-rated approach to assess coping strategies directly in the therapy sessions. In total, n = 31 patients with BPD underwent two individual clinical interview assessments (pre- and post-study intervention; half of the patients underwent DBT skills training, half were in a wait-list control). All individual assessment sessions were transcribed and analysed using the Coping Action Pattern Rating Scale. Outcome was assessed pre- and post-intervention using the Outcome Questionnaire-45.2 and the Borderline Symptom List 23. The results showed increase in overall coping functioning in patients who underwent the DBT skills training, compared with the controls, and specific increases in relatedness coping where the stress is appraised as challenge, along with specific decreases in autonomy coping where the stress is appraised as threat. These changes predicted changes in general distress and borderline symptomatology. The results are interpreted within a general framework aiming at understanding the psychological effects of treatments for BPD, in particular effects related to coping. Effective emotion regulation strategies may therefore be important candidates as potential change mechanisms in treatments for BPD. Copyright © 2016 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE It seems important for clinicians to assess the quality of coping strategies as they occur within the session facing a patient with borderline personality disorder. Clinicians may foster the emergence of support-seeking and self-reliance coping strategies in order to increase the effectiveness of therapy. Clinicians may monitor closely the patient's use of ineffective emotion regulation strategies, in particular opposition and submission, with the aim of reducing them early in therapy.
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Affiliation(s)
- Ueli Kramer
- Institute of Psychotherapy, Department of Psychiatry-CHUV, University of Lausanne, Lausanne, Switzerland.,General Psychiatry Service, Department of Psychiatry-CHUV, University of Lausanne, Lausanne, Switzerland.,Department of Psychology, University of Windsor, Windsor, Canada
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Fertuck EA, Karan E, Stanley B. The specificity of mental pain in borderline personality disorder compared to depressive disorders and healthy controls. Borderline Personal Disord Emot Dysregul 2016; 3:2. [PMID: 26918191 PMCID: PMC4766740 DOI: 10.1186/s40479-016-0036-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 02/10/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Individuals with Borderline Personality Disorder (BPD) may experience a qualitatively distinct depression which includes "mental pain." Mental pain includes chronic, aversive emotions, negative self-concept, and a sense of pervasive helplessness. The present study investigated whether mental pain is elevated in BPD compared to Depressive Disorders (DD) without BPD. METHODS The Orbach and Mikulincer Mental Pain Scale (OMMP) was administered to BPD (N = 57), DD (N = 22), and healthy controls (N = 31). The OMMP assesses total mental pain, comprised of nine subtypes: irreversibility, loss of control, narcissistic wounds, emotional flooding, freezing, self-estrangement, confusion, social distancing, and emptiness. Co-occurring psychiatric diagnoses, depression severity, and other potentially confounding clinical and demographic variables were also assessed. RESULTS The total Mental Pain score did not differentiate BPD from DD. Moreover, most of the subscales of the OMMP were not significantly different in BPD compared to DD. However, the elevation of mental pain subscale "narcissistic wounds," characterized by feeling rejected and having low self-worth, was a specific predictor of BPD status and the severity of BPD symptoms. CONCLUSION On OMMP total score, mental pain was similarly elevated in BPD and DD. However, the narcissistic wounds sub-type of mental pain was a sensitive and specific diagnostic indicator of BPD and, therefore, may be an important aspect of BPD in need of increased focus in assessment and theoretical models.
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Affiliation(s)
- Eric A. Fertuck
- />Department of Psychology, Clinical Psychology Doctoral Program, The City College of the City University of New York, New York, USA
- />New York State Psychiatric Institute, New York, NY USA
| | - Esen Karan
- />Department of Psychology, Clinical Psychology Doctoral Program, The City College of the City University of New York, New York, USA
| | - Barbara Stanley
- />Department of Psychiatry, Columbia University, New York, USA
- />New York State Psychiatric Institute, New York, NY USA
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Emotion regulation, depression and self-harming behaviours in people with borderline personality disorder: the moderating role of action vs. state orientation. CURRENT ISSUES IN PERSONALITY PSYCHOLOGY 2016. [DOI: 10.5114/cipp.2016.56326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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45
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Porter CM, Ireland CA, Gardner KJ, Eslea M. Exploration of emotion regulation experiences associated with borderline personality features in a non-clinical sample. Borderline Personal Disord Emot Dysregul 2016; 3:8. [PMID: 27529025 PMCID: PMC4983780 DOI: 10.1186/s40479-016-0040-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 07/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emotion dysregulation is a core feature associated with borderline personality features (BPF). Little research has explored how individuals with high levels of BPF regulate their emotions. This study aimed to explore how individuals with high versus low levels of BPF compare on the strategies they use to regulate emotions and in their experiences of emotion regulation. METHODS Twenty-nine university students were recruited and assessed for the presence of BPF using self-report questionnaires. Each participant took part in a semi-structured interview about their experiences of emotion regulation. All interview transcripts then underwent thematic analysis. In addition chi square analyses were conducted to explore the association between level of BPF (High vs Low) and each qualitative theme identified. RESULTS Findings indicated similarities in the types of emotion regulation strategies used by the high and low-BPF groups. However, the groups differed in their experiences and thought processes surrounding emotion regulation. High-BPF participants were found to describe a need to communicate negative emotions with others and demonstrated difficulty maintaining attention on positive experiences. In addition there was a trend towards High-BPF participants demonstrating less forward-planning in emotion regulation. CONCLUSIONS This study provides insights into some of the unique aspects of emotion regulation in individuals with high BPF that may make emotion regulation attempts less successful.
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Affiliation(s)
- Carly M Porter
- School of Psychology, University of Central Lancashire, Preston, UK ; ClinPsyD, The University of Manchester, Second Floor Zochonis Building, Brunswick Street, Manchester, M13 9PL UK
| | - Carol A Ireland
- Ashworth Research Centre, Mersey Care NHS Trust, School of Psychology, University of Central Lancashire, Preston, UK ; CCATS: Coastal Child and Adult Therapeutic Services, Preston, UK
| | | | - Mike Eslea
- School of Psychology, University of Central Lancashire, Preston, UK
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Personality Disorder and Changes in Affect Consciousness: A 3-Year Follow-Up Study of Patients with Avoidant and Borderline Personality Disorder. PLoS One 2015; 10:e0145625. [PMID: 26699730 PMCID: PMC4689515 DOI: 10.1371/journal.pone.0145625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 12/07/2015] [Indexed: 11/19/2022] Open
Abstract
Personality disorders (PDs) are highly prevalent in patients receiving psychiatric services, and are associated with significant personal and social costs. Over the past two decades, an increasing number of treatment studies have documented the effectiveness of treatment for patients with PDs, especially when it comes to reduction of symptom distress, risk taking behavior, self-harm, or suicide attempts. However, less is known about the more complex aims of improving the personality structure itself, such as identity- and interpersonal disturbances. Emotional dysfunction is closely associated with PD pathology. The present study investigated changes in affect consciousness (AC) in patients with avoidant or borderline PD, and how these changes were associated with clinical status after 3 years of follow-up. The study included 52 individuals; 79 percent were females, and mean age was 30 years. The evaluations included the Affect Consciousness Interview, Symptom Checklist-90-R, Circumplex of Interpersonal Problems, the Index of Self-Esteem, and three domains (Identity Integration, Relational Capacities, and Self-Control) of the Severity Indices of Personality Problems (SIPP-118). There was a significant increase in the Global AC and AC scores for most of the specific affects from baseline to follow-up. As the present study did not include a control group, it cannot be concluded that changes in AC are effects of psychotherapy, and the possibility of age-related maturation processes cannot be excluded. The change in Global AC contributed significantly to explained variance in the follow-up levels of Circumplex of Interpersonal Problems, and the two SIPP-118 domains Relational Capacities and Identity Integration. Improved AC was not associated with change in the Self-Control domain or the Global Severity Index of Symptom Checklist-90-R. The results suggest that AC may be altered for patients with borderline and avoidant PDs, and this is the first study to report that improvement in AC contribute significantly to the variance in the self- and interpersonal domains of personality functioning.
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Dixon-Gordon KL, Weiss NH, Tull MT, DiLillo D, Messman-Moore T, Gratz KL. Characterizing emotional dysfunction in borderline personality, major depression, and their co-occurrence. Compr Psychiatry 2015; 62:187-203. [PMID: 26343484 PMCID: PMC4561853 DOI: 10.1016/j.comppsych.2015.07.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 07/14/2015] [Accepted: 07/22/2015] [Indexed: 12/21/2022] Open
Abstract
This research aimed to characterize patterns of emotional reactivity and dysregulation in borderline personality, depression, and their co-occurrence. In study 1, 488 young adult women from the community were categorized into four groups based on self-reported major depressive disorder (MDD) and borderline personality disorder (BPD) symptoms (Low BPD/Low MDD; Low BPD/High MDD; High BPD/Low MDD; High BPD/High MDD). Immediate and prolonged subjective emotional reactivity to a laboratory stressor were assessed, and participants completed self-report and behavioral measures of emotion dysregulation. Study 2 extended these findings, examining emotional reactivity and dysregulation in a clinical population of 176 substance dependent patients with diagnoses of BPD and MDD and including a biological index of emotional reactivity. Results revealed greater prolonged fear reactivity in the High BPD/High MDD (vs. Low BPD/Low MDD) group in study 1, and greater prolonged anxiety and negative affect reactivity in both High BPD groups (vs. Low BPD/Low MDD and Low BPD/High MDD groups) in study 2 (but no differences in cortisol reactivity). Results also demonstrated greater subjective (but not behavioral) emotion dysregulation in the High BPD/High MDD (vs. Low BPD/Low MDD) group in study 1 and both High BPD groups (vs. both Low BPD groups) in study 2. Finally, the High BPD/High MDD group reported greater difficulties controlling impulsive behaviors compared with all other groups in study 1 and the Low BPD groups in study 2. Findings suggest that BPD pathology (but not MDD pathology alone) is characterized by greater prolonged emotional (especially anxiety/fear-related) reactivity and heightened emotion dysregulation.
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Affiliation(s)
- Katherine L. Dixon-Gordon
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Nicole H. Weiss
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Matthew T. Tull
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA
| | - David DiLillo
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | | | - Kim L. Gratz
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA,Correspondence concerning this article should be addressed to Kim L. Gratz, Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS 39216; Phone: (601) 815-6450;
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Winter D, Krause-Utz A, Lis S, Chiu CD, Lanius RA, Schriner F, Bohus M, Schmahl C. Dissociation in borderline personality disorder: Disturbed cognitive and emotional inhibition and its neural correlates. Psychiatry Res 2015; 233:339-51. [PMID: 26254542 DOI: 10.1016/j.pscychresns.2015.05.018] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 02/07/2015] [Accepted: 05/29/2015] [Indexed: 11/29/2022]
Abstract
Evidence is heterogeneous regarding whether patients with borderline personality disorder (BPD) display disturbed emotional inhibition in the emotional Stroop task. Previous findings suggest that state dissociation may influence cognitive inhibition of task-irrelevant material, particularly with negative content. Our aim was to examine performance in an emotional Stroop task including negative, neutral, and positive words in BPD patients and healthy controls during functional magnetic resonance imaging. In advance, half of the BPD patients underwent a dissociation induction using script-driven imagery. BPD patients without dissociation induction showed behavioural performance comparable to that of healthy controls but displayed stronger neural responses, especially to positive stimuli, in the superior temporal gyrus, dorsomedial prefrontal cortex, and anterior cingulate cortex. BPD patients with dissociation induction showed overall slower and less accurate responses as well as increased reaction times for negative versus neutral words compared with BPD patients without dissociation induction. Moreover, they showed comparatively decreased neuronal activity in the fusiform gyrus and parietal cortices independent of valence, but elevated activity in the left inferior frontal gyrus in response to negative versus neutral words. In conclusion, experimentally induced dissociation in BPD was associated with inefficient cognitive inhibition, particularly of negative stimuli, in the emotional Stroop task.
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Affiliation(s)
- Dorina Winter
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany.
| | - Annegret Krause-Utz
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany; Institute of Psychology, Leiden University; Institute of Brain and Cognition, Leiden, the Netherlands
| | - Stefanie Lis
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Chui-De Chiu
- Department of Psychology, Clinical and Health Psychology Centre, and Centre for Cognition and Brain Studies, The Chinese University of Hong Kong, Hong Kong
| | - Ruth A Lanius
- Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Friederike Schriner
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Martin Bohus
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany; Faculty of Health, University of Antwerp, Belgium
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany
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Inoue A, Oshita H, Maruyama Y, Tanaka Y, Ishitobi Y, Kawano A, Ikeda R, Ando T, Aizawa S, Masuda K, Higuma H, Kanehisa M, Ninomiya T, Akiyoshi J. Gender determines cortisol and alpha-amylase responses to acute physical and psychosocial stress in patients with borderline personality disorder. Psychiatry Res 2015; 228:46-52. [PMID: 25979467 DOI: 10.1016/j.psychres.2015.04.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 01/10/2015] [Accepted: 04/05/2015] [Indexed: 11/30/2022]
Abstract
Borderline personality disorder (BPD) is characterized by affective instability, unstable relationships, and identity disturbance. We measured salivary alpha-amylase (sAA) and salivary cortisol levels in all participants during exposure to the Trier Social Stress Test (TSST) and an electric stimulation stress. Seventy-two BPD patients were compared with 377 age- and gender- matched controls. The State and Trait versions of the Spielberger Anxiety Inventory test (STAI-S and STAI-T, respectively), the Profile of Mood State (POMS) tests, and the Beck Depression Inventory (BDI), the Depression and Anxiety Cognition Scale (DACS) were administered to participants before electrical stimulation. Following TSST exposure, salivary cortisol levels significantly decreased in female patients and significantly increased in male patients compared with controls. POMS tension-anxiety, depression-dejection, anger-hostility, fatigue, and confusion scores were significantly increased in BPD patients compared with controls. In contrast, vigor scores were significantly decreased in BPD patients relative to controls. Furthermore, STAI-T and STAI-S anxiety scores and BDI scores were significantly increased in BPD patient compared with controls. DACS scores were significantly increased in BPD patient compared with controls. Different stressors (e.g., psychological or physical) induced different responses in the HPA and SAM systems in female or male BPD patients.
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Affiliation(s)
- Ayako Inoue
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Harumi Oshita
- Department of Applied Linguistics, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Yoshihiro Maruyama
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Yoshihiro Tanaka
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Yoshinobu Ishitobi
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Aimi Kawano
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Rie Ikeda
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Tomoko Ando
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Saeko Aizawa
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Koji Masuda
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Haruka Higuma
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Masayuki Kanehisa
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Taiga Ninomiya
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Jotaro Akiyoshi
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan.
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Santangelo P, Reinhard I, Mussgay L, Steil R, Sawitzki G, Klein C, Trull TJ, Bohus M, Ebner-Priemer UW. Specificity of affective instability in patients with borderline personality disorder compared to posttraumatic stress disorder, bulimia nervosa, and healthy controls. JOURNAL OF ABNORMAL PSYCHOLOGY 2015; 123:258-72. [PMID: 24661176 DOI: 10.1037/a0035619] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Affective instability is a core feature of borderline personality disorder (BPD). The use of advanced assessment methodologies and appropriate statistical analyses has led to consistent findings that indicate a heightened instability in patients with BPD compared with healthy controls. However, few studies have investigated the specificity of affective instability among patients with BPD with regard to relevant clinical control groups. In this study, 43 patients with BPD, 28 patients with posttraumatic stress disorder (PTSD), 20 patients with bulimia nervosa (BN), and 28 healthy controls carried e-diaries for 24 hours and were prompted to rate their momentary affective states approximately every 15 minutes while awake. To quantify instability, we used 3 state-of-the-art indices: multilevel models for squared successive differences (SSDs), multilevel models for probability of acute changes (PACs), and aggregated point-by-point changes (APPCs). Patients with BPD displayed heightened affective instability for emotional valence and distress compared with healthy controls, regardless of the specific instability indices. These results directly replicate earlier studies. However, affective instability did not seem to be specific to patients with BPD. With regard to SSDs, PACs, and APPCs, patients with PTSD or BN showed a similar heightened instability of affect (emotional valence and distress) to that of patients with BPD. Our results give raise to the discussion if affective instability is a transdiagnostic or a disorder-specific mechanism. Current evidence cannot answer this question, but investigating psychopathological mechanisms in everyday life across disorders is a promising approach to enhance validity and specificity of mental health diagnoses.
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Affiliation(s)
- Philip Santangelo
- Department of Sport and Sport Science, Karlsruhe Institute of Technology
| | - Iris Reinhard
- Department of Biostatistics, Central Institute of Mental Health Mannheim
| | | | - Regina Steil
- Department of Psychology and Sports Sciences, Johann Wolfgang Goethe University
| | - Günther Sawitzki
- Statlab, Institute for Applied Mathematics, University of Heidelberg
| | - Christoph Klein
- Klein, Department of Child and Adolescent Psychiatry and Psychotherapy, Freiburg University
| | - Timothy J Trull
- Department of Psychological Sciences, University of Missouri-Columbia
| | - Martin Bohus
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University
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