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Voestermans D, Eikelenboom M, Rullmann J, Wolters-Geerdink M, Draijer N, Smit JH, Thomaes K, van Marle HJF. The Association Between Childhood Trauma and Attachment Functioning in Patients With Personality Disorders. J Pers Disord 2021; 35:554-572. [PMID: 32163027 DOI: 10.1521/pedi_2020_34_474] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Attachment (mal)functioning and a history of childhood trauma (CT) are both considered psychological determinants of personality disorders (PDs). Their interaction, however, remains largely uninvestigated. In this study, the authors assessed adult and childhood attachment style in a sample of patients with diverse PDs (N = 75) and determined the relation with both occurrence and severity of CT. The authors found that the sample was characterized by severe attachment malfunctioning and high levels of CT. Using cross-tabulations and analysis of variance, the authors showed that patients with a fearful or dismissive attachment style experienced more severe CT than patients with a preoccupied attachment style. Patients reporting an affectionless control bonding style to either parent suffered frequent and severe CT. Although temporal causality cannot be determined, these findings stress the necessity to screen for CT in PDs and suggest that attachment-centered psychotherapy for these patients may benefit from preceding or concurrent trauma treatment.
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Affiliation(s)
| | - Merijn Eikelenboom
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | | | | | - Nel Draijer
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam, The Netherlands
| | - Jan H Smit
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Kathleen Thomaes
- Arkin Institute for Mental Health, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam, The Netherlands
| | - Hein J F van Marle
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam, The Netherlands.,GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands.,Amsterdam UMC, Amsterdam Neuroscience, Amsterdam, The Netherlands
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2
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Hanley C, Saleem F, Graffeo I, McCarthy G, Gavin B, McNicholas F, Adamis D. Association of Wender Utah Rating Scale (WURS)-61 items with clinical psychiatric diagnosis in adulthood. Ir J Med Sci 2021; 191:327-335. [PMID: 33665779 DOI: 10.1007/s11845-021-02574-7] [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: 02/13/2021] [Accepted: 02/26/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The Wender Utah Rating Scale (WURS) is a widely used retrospective scale in adults presenting for ADHD evaluations which features items relating to childhood symptoms. AIMS The aim of this study is to establish if certain childhood symptoms (including ADHD) as identified by the WURS-61 are associated with specific mental health disorders in adulthood. METHODS Case-control study of N=630 attending Adult Mental Health Services (AMHS) and a control group without mental disorders (N=96). RESULTS The mean age of the participants was 39.81 (SD 12.94) of which 387 (53.3%) were females. There were no significant differences between cases and controls in terms of age (t= 1.829, df 724, p=.068) and gender (x2=1.123, df 1, p=.289). Exploratory factor analysis of WURS-61 reveals 5 factors. Using factor scores and after cross-tabulation, we found that: The presence of childhood impulsivity, emotional lability and distress in addition to inattention/disorganisation were significantly associated with adult ADHD diagnosis (F90). WURS items which suggests childhood conduct problems were associated with a number of adult diagnoses, when present either on its own (psychoactive substance use, or when present in combination with childhood impulsivity, emotional lability and distress (personality disorders). CONCLUSION There is an association between certain childhood behaviours and risk for later development of personality disorders, and psychoactive substance use. There is overlap of childhood symptoms to those who later diagnosed in adulthood with ADHD, personality disorders, and substance abuse.
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Affiliation(s)
- Cliodhna Hanley
- Sligo Mental Health Services, Clarion Rd, Sligo, Ireland.,University College Dublin, Dublin, Ireland
| | - Faisal Saleem
- Sligo Mental Health Services, Clarion Rd, Sligo, Ireland
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3
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Stanley B, Perez-Rodriguez MM, Labouliere C, Roose S. A Neuroscience-Oriented Research Approach to Borderline Personality Disorder. J Pers Disord 2018; 32:784-822. [PMID: 29469663 DOI: 10.1521/pedi_2017_31_326] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Traditionally, the study of personality disorders had been based on psychoanalytic or behavioral models. Over the past two decades, there has been an emerging neuroscience model of borderline personality disorder (BPD) grounded in the concept of BPD as a condition in which dysfunctional neural circuits underlie its pathological dimensions, some of which include emotion dysregulation (broadly encompassing affective instability, negative affectivity, and hyperarousal), abnormal interpersonal functioning, and impulsive aggression. This article, initiated at a joint Columbia University- Cornell University Think Tank on BPD with representation from the Icahn School of Medicine at Mount Sinai, suggests how to advance research in BPD by studying the dimensions that underlie BPD in addition to studying the disorder as a unitary diagnostic entity. We suggest that linking the underlying neurobiological abnormalities to behavioral symptoms of the disorder can inform a research agenda to better understand BPD with its multiple presentations.
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Affiliation(s)
- Barbara Stanley
- Department of Psychiatry, Columbia University, New York City
| | | | | | - Steven Roose
- Department of Psychiatry, Columbia University, New York City.,New York State Psychiatric Institute, New York City
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4
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Matthies S, Schiele MA, Koentges C, Pini S, Schmahl C, Domschke K. Please Don't Leave Me-Separation Anxiety and Related Traits in Borderline Personality Disorder. Curr Psychiatry Rep 2018; 20:83. [PMID: 30155649 DOI: 10.1007/s11920-018-0951-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW In light of the apparent symptomatic resemblance of separation anxiety disorder (SAD) symptoms on the one hand and abandonment fears, anxiousness, and separation insecurity central to borderline personality disorder (BPD) on the other hand, a comprehensive overview of separation anxiety and related traits in BPD is provided. RECENT FINDINGS Epidemiological, environmental, psychological, and neurobiological data connecting BPD to separation events, feelings of loneliness, insecure attachment styles, dimensional separation anxiety as well as SAD per se suggest a partly shared etiological pathway model underlying BPD and SAD. Differential diagnostic aspects and implications for treatment are discussed, highlighting separation anxiety as a promising transdiagnostic target for specific psychotherapeutic and pharmacological treatment approaches in BPD. This innovative angle on cross-disorder symptomatology might carry potential for novel preventive and therapeutic avenues in clinical practice by guiding the development of interventions specifically targeting separation anxiety and attachment-related issues in BPD.
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Affiliation(s)
- Swantje Matthies
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hauptstrasse 5, D-79104, Freiburg, Germany
| | - Miriam A Schiele
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hauptstrasse 5, D-79104, Freiburg, Germany
| | - Christa Koentges
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hauptstrasse 5, D-79104, Freiburg, Germany
| | - Stefano Pini
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hauptstrasse 5, D-79104, Freiburg, Germany.
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5
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Frias A, Palma C, Farriols N, Gonzalez L, Horta A. Anxious adult attachment may mediate the relationship between childhood emotional abuse and borderline personality disorder. Personal Ment Health 2016; 10:274-284. [PMID: 27604841 DOI: 10.1002/pmh.1348] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 05/16/2016] [Accepted: 08/17/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Childhood trauma has been associated with borderline personality disorder (BPD). However, research has not yet provided conclusive evidence concerning the mediating mechanisms. METHODS Seventy women diagnosed with BPD were compared with other 60 women who met DSM-IV criteria for other personality disorders on measures of childhood trauma and attachment. RESULTS Patients with BPD reported higher severity of emotional, physical and sexual abuse than patients with other personality disorders. Moreover, BPD patients also showed greater preoccupied-anxious adult attachment. At model 1, logistic regression analysis revealed that only childhood emotional abuse predicted the occurrence of BPD. At model 2, this association was no longer significant, and the addition of preoccupied-anxious adult attachment was significantly associated with a greater likelihood of BPD diagnosis. CONCLUSIONS These findings support a specific relationship between childhood emotional abuse and the occurrence of BPD, which may be accounted for by preoccupied-anxious adult attachment. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
| | | | | | - Laura Gonzalez
- Consorci Sanitari del Maresme, Centro de Salud Mental de Adultos de Mataro, Mataro, Spain
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6
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Fossati A, Gratz KL, Somma A, Maffei C, Borroni S. The Mediating Role of Emotion Dysregulation in the Relations Between Childhood Trauma History and Adult Attachment and Borderline Personality Disorder Features: A Study of Italian Nonclinical Participants. J Pers Disord 2016; 30:653-676. [PMID: 26583588 DOI: 10.1521/pedi_2015_29_222] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In order to evaluate if emotion dysregulation significantly mediates the relationships between childhood abuse and adult attachment and borderline personality disorder features, 354 community Italian adults were administered the Borderline Personality Inventory (Leichsenring, 1999a), the Difficulties in Emotion Regulation Scale (Gratz & Roemer, 2004), the Child Abuse and Trauma Scale (Sanders & Becker-Lausen, 1995), and the Attachment Style Questionnaire (Feeney, Noller, & Hanrahan, 1994). Hierarchical regression analyses showed that both childhood abuse and adult attachment were positively associated with emotion dysregulation and borderline personality features; however, only emotional abuse and the attachment dimension of need for approval were common predictors of both dependent variables. No significant interaction effects were detected in regression analyses. Mediation analyses provided support for partial mediation, revealing a significant mediating role of emotion dysregulation in the relationships between both emotional abuse and need for approval and borderline personality features in this community sample.
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Affiliation(s)
- Andrea Fossati
- Department of Human Studies, LUMSA University, Rome, Italy
| | - Kim L Gratz
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson
| | | | - Cesare Maffei
- Faculty of Psychology, Vita Salute San Raffaele University, Milan, Italy
| | - Serena Borroni
- Faculty of Psychology, Vita Salute San Raffaele University, Milan, Italy
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7
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Kealy D, Sierra-Hernandez CA, Ogrodniczuk JS. Childhood emotional support and borderline personality features in a sample of Canadian psychiatric outpatients. Int J Soc Psychiatry 2016; 62:452-4. [PMID: 27220722 DOI: 10.1177/0020764016650214] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite links between early relational experiences and psychopathology, data regarding childhood emotional neglect among Canadian mental health services users are scarce. AIMS To explore the absence of emotional support experiences reported by Canadian psychiatric outpatients, and to examine the relationship between childhood emotional support and borderline personality disorder (BPD) features. METHODS A survey regarding childhood emotional support was completed by consecutively admitted adult outpatients, along with self-report assessments of symptom distress and BPD features. RESULTS A substantial proportion of outpatients reported absent emotional support experiences. After controlling for the effects of age and symptom distress, childhood emotional support was found to be significantly negatively associated with BPD features. CONCLUSION The findings add further support to the need for clinical attention to the early relational experiences of mental health service users.
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Affiliation(s)
- David Kealy
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | | | - John S Ogrodniczuk
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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8
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Bellino S, Bozzatello P, Bogetto F. Combined treatment of borderline personality disorder with interpersonal psychotherapy and pharmacotherapy: predictors of response. Psychiatry Res 2015; 226:284-8. [PMID: 25677397 DOI: 10.1016/j.psychres.2014.12.064] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 08/13/2014] [Accepted: 12/21/2014] [Indexed: 11/17/2022]
Abstract
Borderline personality disorder (BPD) is characterized by affective instability, impulsive behaviors, and disturbed interpersonal relationships. A previous study of our group found that combined therapy with interpersonal psychotherapy adapted to BPD (IPT-BPD) and fluoxetine was superior to single pharmacotherapy in BPD patients. The aim of the present study was to examine what clinical factors predicted response to combined therapy in patients evaluated in the previous efficacy study. The subgroup of 27 patients allocated to combined therapy was analyzed. Patients were treated for 32 weeks with fluoxetine 20-40 mg/day plus IPT-BPD. Patients were assessed at baseline and week 32 with an interview for demographic and clinical variables, CGI-S, HDRS, HARS, SOFAS, BPDSI, and SAT-P. Statistical analysis was performed with multiple regression. The difference of CGI-S score between baseline and week 32 (∆CGI-S) was the dependent variable. Factors significantly and independently related to ∆CGI-S were the BPDSI total score and the items abandonment, affective instability, and identity. Patients with more severe BPD psychopathology and with a higher degree of core symptoms such as fear of abandonment, affective instability, and identity disturbance have a better chance to improve with combined therapy with fluoxetine and IPT-BPD.
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Affiliation(s)
- Silvio Bellino
- Center for Personality Disorders, Psychiatric Clinic, Department of Neuroscience, University of Turin, Italy.
| | - Paola Bozzatello
- Center for Personality Disorders, Psychiatric Clinic, Department of Neuroscience, University of Turin, Italy
| | - Filippo Bogetto
- Center for Personality Disorders, Psychiatric Clinic, Department of Neuroscience, University of Turin, Italy
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9
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Fossati A, Gratz KL, Borroni S, Maffei C, Somma A, Carlotta D. The relationship between childhood history of ADHD symptoms and DSM-IV borderline personality disorder features among personality disordered outpatients: the moderating role of gender and the mediating roles of emotion dysregulation and impulsivity. Compr Psychiatry 2015; 56:121-7. [PMID: 25446725 DOI: 10.1016/j.comppsych.2014.09.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 09/28/2014] [Accepted: 09/30/2014] [Indexed: 10/24/2022] Open
Abstract
A number of studies have reported data suggestive of a significant association between attention-deficit/hyperactivity disorder (ADHD) and borderline personality disorder (BPD). However, the nature of this relation is not fully understood. This study aimed to evaluate if the relation between retrospectively assessed ADHD symptoms and adult BPD features is moderated by participants' gender and mediated by emotion dysregulation and impulsivity. Two hundred seventeen outpatients meeting DSM-IV criteria for at least one personality disorder (PD) consecutively admitted to the Clinical Psychology and Psychotherapy Unit of the Scientific Institute H San Raffaele of Milan, Italy, were administered Italian versions of the following instruments: Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II), Wender Utah Rating Scale (WURS), Difficulties in Emotion Regulation Scale (DERS), and the Barratt Impulsiveness Scale-11 (BIS-11). Moderation analyses revealed a significant association between ADHD and BPD symptoms among only female (vs. male) outpatients. Furthermore, in the female subsample, mediation analyses revealed that both impulsivity and emotion dysregulation fully mediated the relationship between retrospectively assessed ADHD symptoms and current BPD features.
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Affiliation(s)
- Andrea Fossati
- Department of Human Studies, LUMSA University, Rome, Italy; Clinical Psychology and Psychotherapy Unit, San Raffaele Turro Hospital, Milano, Italy
| | - Kim L Gratz
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Serena Borroni
- Clinical Psychology and Psychotherapy Unit, San Raffaele Turro Hospital, Milano, Italy; Faculty of Psychology, Vita-Salute San Raffaele University, Milano, Italy
| | - Cesare Maffei
- Clinical Psychology and Psychotherapy Unit, San Raffaele Turro Hospital, Milano, Italy; Faculty of Psychology, Vita-Salute San Raffaele University, Milano, Italy
| | - Antonella Somma
- Department of Human Studies, LUMSA University, Rome, Italy; Clinical Psychology and Psychotherapy Unit, San Raffaele Turro Hospital, Milano, Italy
| | - Davide Carlotta
- Clinical Psychology and Psychotherapy Unit, San Raffaele Turro Hospital, Milano, Italy.
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