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Belvederi Murri M, Folesani F, Costa S, Biancosino B, Zerbinati L, Ounalli H, Rossetto A, Caruso R, Nanni MG, Grassi L. The Relationship Between Cognitive Abilities and Trait Clinical Features in Patients With Borderline Personality Disorder. J Pers Disord 2021; 35:730-749. [PMID: 33779282 DOI: 10.1521/pedi_2020_34_497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Very few studies have focused on the relationship between cognitive functions and clinical features in borderline personality disorder (BPD). Subjects with BPD and healthy controls were administered the Repeatable Battery for the Assessment of Neuropsychological Status, Trail Making Test A and B, and the Wisconsin Card Sorting Test. The Brief Symptom Inventory (BSI-53) was used to assess the severity of current symptoms. Attachment style was assessed with the Experiences in Close Relationship Questionnaire, identity integration with the Personality Structure Questionnaire, and other domains of personality dysfunction with the RUDE Scale for Personality Dysfunction. Patients with BPD performed significantly worse than healthy controls in all cognitive domains. Cognitive functions, particularly delayed memory and visuospatial abilities, displayed meaningful associations with trait-like clinical features, above the effect of global cognition and state psychopathology. These findings highlight the need to evaluate effects of cognitive rehabilitation on trait features among individuals with BPD.
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Affiliation(s)
- Martino Belvederi Murri
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Federica Folesani
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Silvia Costa
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Bruno Biancosino
- Department of Mental Health and Pathological Addiction, Ferrara Health Agency, Ferrara, Italy
| | - Luigi Zerbinati
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Heifa Ounalli
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Agnese Rossetto
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Rosangela Caruso
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Maria Giulia Nanni
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Luigi Grassi
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
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Weiner AS, Ensink K, Normandin L. Psychotherapy for Borderline Personality Disorder in Adolescents. Psychiatr Clin North Am 2018; 41:729-746. [PMID: 30447735 DOI: 10.1016/j.psc.2018.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Research on borderline personality disorder (BPD) in adolescence has helped to clarify the characteristics of BPD in young people. The considerable emotional and economic cost associated with adolescent BPD supports calls for early intervention and requires that the assessment of personality functioning be an essential component in the psychological evaluation of adolescents. Adult treatment models with demonstrated efficacy have been adapted for adolescents. This article describes the implementation of these treatment approaches, factors that frequently complicate the recognition and diagnosis of BPD in young people, and an overview of research on BPD in adolescents that delineates its clinically relevant features.
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Affiliation(s)
- Alan S Weiner
- Weill Cornell Medical College, Personality Disorders Institute, 21 Bloomingdale Road, White Plains, NY 10605, USA.
| | - Karin Ensink
- Université Laval, École de psychologie, 2325 rue des Bibliothèques, Québec, Québec G1V 0A6, Canada
| | - Lina Normandin
- Université Laval, École de psychologie, 2325 rue des Bibliothèques, Québec, Québec G1V 0A6, Canada
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Sato M, Fonagy P, Luyten P. Rejection sensitivity and borderline personality disorder features: A mediation model of effortful control and intolerance of ambiguity. Psychiatry Res 2018; 269:50-55. [PMID: 30145301 DOI: 10.1016/j.psychres.2018.08.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 06/22/2018] [Accepted: 08/11/2018] [Indexed: 11/26/2022]
Abstract
Although past research suggests that borderline personality disorder (BPD) patients' rejection hypersensitivity may be an important factor underlying these patients' interpersonal problems, the role of cognitive factors in this association is still not well understood. The present study examined whether cognitive factors such as effortful control and intolerance of ambiguity mediated the association between rejection sensitivity and BPD features. A sample of 256 young adults completed self-report questionnaires assessing rejection sensitivity, effortful control, intolerance of ambiguity, and BPD features. Results showed that effortful control and intolerance of ambiguity mediated the association between rejection sensitivity and BPD features. The present study showed the role of cognitive aspects including both effortful control and intolerance of ambiguity in the relationship between rejection sensitivity and BPD features. However, there is a need for further research to experimentally investigate how rejection sensitivity may impact cognitive capacities in interpersonal contexts among individuals with BPD features.
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Affiliation(s)
- Momoko Sato
- Department of Clinical, Educational, and Health Psychology, University College London, 1-19 Torrington Place, London WC1E7HB, The United Kingdom.
| | - Peter Fonagy
- Department of Clinical, Educational, and Health Psychology, University College London, 1-19 Torrington Place, London WC1E7HB, The United Kingdom
| | - Patrick Luyten
- Department of Clinical, Educational, and Health Psychology, University College London, 1-19 Torrington Place, London WC1E7HB, The United Kingdom; Faculty of Psychology and Educational Sciences, KU Leuven, Belgium
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Aggressiveness, social support and school experiences as dimensions differentiating negative and positive adaptation among adolescents. CURRENT ISSUES IN PERSONALITY PSYCHOLOGY 2017. [DOI: 10.5114/cipp.2017.70740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
<b>Background</b><br />
The study results presented below lie within a field of study which seeks to identify appropriate risk indicators for risky behaviours in the group of adolescents. The study drew on the tenets of developmental psychopathology. Adaptation assessment was performed on the basis of an objective indicator which comprised adolescents’ problems with social functioning.<br />
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<b>Participants and procedure</b><br />
The main determinants of the observed changes in behaviour and the development of adaptation pathways during the period of adolescence were considered to include bio-psycho-social temperamental factors (Buss & Plomin, 1984), attachment patterns (Armsden & Greenberg, 1987), trait of aggressiveness (Buss & Perry, 1992), conditions created by the environment (support of family members, peers and teachers [Malecki & Demaray, 2002]) as well as previous experiences such as being a victim of violence (Osterman & Bjorqvist, 2008) or the level of school success. The final study group comprised a total of 140 positively and 140 negatively adapted teenagers (N = 280) between the ages of 12 and 19. The study was carried out in Poland.<br />
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<b>Results</b><br />
The study confirmed the gender effect, demonstrating a higher frequency of involvement in risky behaviours among boys. The results from searching for differences between positively and negatively adapted teens showed that in the negatively adapted group there were lower grades at school and more frequent aggressive behaviour.<br />
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<b>Conclusions</b><br />
The main conclusion that can be drawn from the study is that the potential prophylactic and therapeutic interventions require consideration of factors such as age, educational success, aggressiveness and social support.
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Jacob GA, Zvonik K, Kamphausen S, Sebastian A, Maier S, Philipsen A, van Elst LT, Lieb K, Tüscher O. Emotional modulation of motor response inhibition in women with borderline personality disorder: an fMRI study. J Psychiatry Neurosci 2013; 38:164-72. [PMID: 23046830 PMCID: PMC3633709 DOI: 10.1503/jpn.120029] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Both emotion regulation and impulsivity are core aspects of borderline personality disorder (BPD) pathology. Although both problems may be combined specifically in BPD, few studies to date have investigated the emotional modulation of impulsivity in BPD. METHODS Women with BPD and matched healthy controls performed go/no-go tasks after induction of anger, joy or a neutral mood by vocally presented short stories. Dependent variables were the behavioural results and functional magnetic resonance imaging data. RESULTS We included 17 women with BPD and 18 controls in our study. No behavioural group differences were found. However, patients with BPD showed stronger activation of the left amygdala and weaker activation of the subgenual anterior cingulate during anger induction than controls. Inhibition in the go/no-go task after anger induction increased activity in the left inferior frontal cortex in controls, but not in women with BPD, who, in turn, showed increased activation in the subthalamic nucleus. LIMITATIONS Findings cannot be generalized to men, and 4 patients were taking antidepressant medication (selective serotonin reuptake inhibitors). In addition, no patient control group was investigated, thus we do not know whether findings are specific to BPD compared with other disorders. CONCLUSION Our findings are consistent with the view that a disturbed amygdala-prefrontal network in patients with BPD is compensated by a subcortical loop involving the subthalamic nucleus, leading to normal behavioural inhibition in these patients.
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Affiliation(s)
- Gitta A. Jacob
- Correspondence to: G.A. Jacob, Clinical Psychology and Psychotherapy, Institute of Psychology, Engelbergerstraße 41, 79106 Freiburg, Germany;
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Scott LN, Levy KN, Granger DA. Biobehavioral reactivity to social evaluative stress in women with borderline personality disorder. Personal Disord 2012; 4:91-100. [PMID: 23244772 DOI: 10.1037/a0030117] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Several clinical theories propose that borderline personality disorder (BPD) is characterized by a biologically based affective vulnerability to intense affective experiences and impaired modulation of affective states, which might manifest in high emotional intensity, hyperreactivity, and impaired recovery to baseline. However, few studies have tested these theories based on emotional and biological responses of BPD participants in response to psychosocial stressors. This study examined cortisol, alpha-amylase, and subjective emotional reactivity to social evaluative stress among women with BPD compared with two healthy female control groups: a trait-matched (TM) group scoring similarly to the BPD group on trait measures of negative affect and impulsivity, and a non-trait-matched (NTM) group. Results generally suggested high emotional intensity and high baseline psychobiological arousal among individuals with BPD, but not emotional hyperreactivity or impaired recovery specific to the stressor. Relative to both control groups, BPD participants had higher baseline and overall subjective negative affect, higher baseline cortisol levels, and attenuated stress-related cortisol reactivity. In addition, both the BPD and TM groups had attenuated alpha-amylase reactivity in comparison to the NTM group. The differences between BPD and TM groups on most of the dependent measures suggest that emotional dysregulation in BPD is not merely an extreme variant of normative personality traits. These results suggest that women with BPD demonstrate intense and chronic negative affectivity along with high resting psychobiological arousal and attenuated psychobiological reactivity specific to laboratory stressors.
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Affiliation(s)
- Lori N Scott
- Department of Psychology, Pennsylvania State University, University Park, PA 16802, USA.
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Stepp SD, Burke JD, Hipwell AE, Loeber R. Trajectories of attention deficit hyperactivity disorder and oppositional defiant disorder symptoms as precursors of borderline personality disorder symptoms in adolescent girls. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2012; 40:7-20. [PMID: 21671009 DOI: 10.1007/s10802-011-9530-6] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Little empirical evidence exists regarding the developmental links between childhood psychopathology and borderline personality disorder (BPD) in adolescence. The current study addresses this gap by examining symptoms of attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) as potential precursors. ADHD and BPD share clinical features of impulsivity, poor self-regulation, and executive dysfunction, while ODD and BPD share features of anger and interpersonal turmoil. The study is based on annual, longitudinal data from the two oldest cohorts in the Pittsburgh Girls Study (N = 1,233). We used piecewise latent growth curve models of ADHD and ODD scores from age 8 to 10 and 10 to 13 years to examine the prospective associations between dual trajectories of ADHD and ODD symptom severity and later BPD symptoms at age 14 in girls. To examine the specificity of these associations, we also included conduct disorder and depression symptom severity at age 14 as additional outcomes. We found that higher levels of ADHD and ODD scores at age 8 uniquely predicted BPD symptoms at age 14. Additionally, the rate of growth in ADHD scores from age 10 to 13 and the rate of growth in ODD scores from 8 to 10 uniquely predicted higher BPD symptoms at age 14. This study adds to the literature on the early development of BPD by providing the first longitudinal study to examine ADHD and ODD symptom trajectories as specific childhood precursors of BPD symptoms in adolescent girls.
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Affiliation(s)
- Stephanie D Stepp
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, 3811 O'Hara St., Pittsburgh, PA 15213, USA.
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Glenn CR, Blumenthal TD, Klonsky ED, Hajcak G. Emotional reactivity in nonsuicidal self-injury: divergence between self-report and startle measures. Int J Psychophysiol 2011; 80:166-70. [PMID: 21376761 DOI: 10.1016/j.ijpsycho.2011.02.016] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Revised: 02/02/2011] [Accepted: 02/26/2011] [Indexed: 10/18/2022]
Abstract
The current study examined emotional reactivity in nonsuicidal self-injurers and noninjuring controls using self-report (the Emotional Reactivity Scale: ERS) and psychophysiological measures (the startle reflex was measured during and after the presentation of IAPS images). Self-injurers reported greater emotional reactivity on the ERS, but did not exhibit differences in startle modulation during or after picture viewing compared to controls. Results suggest a divergence between self-report and psychophysiological measures of emotion in NSSI.
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Affiliation(s)
- Catherine R Glenn
- Department of Psychology, Stony Brook University, Stony Brook, New York, 11794-2500, United States.
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Critchfield KL, Clarkin JF, Levy KN, Kernberg OF. Organization of co-occurring Axis II features in borderline personality disorder. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2010; 47:185-200. [PMID: 17845740 DOI: 10.1348/014466507x240731] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Considerable heterogeneity exists in the comorbid Axis II features that frequently accompany borderline personality disorder (BPD). These features have potential to be meaningfully organized, relate to specific BPD presentation, and have implications for treatment process and outcome. The present study explored patterns of Axis II comorbidity in order to identify subtypes of BPD. DESIGN A well-defined sample of 90 patients diagnosed with BPD was recruited as part of an RCT study. Participants were administered the International Personality Disorder Examination (Loranger, 1999) to diagnose BPD and assess comorbid Axis II features. Other measures were also administered to assess aspects of current work and relationship functioning, symptomatology, and self-concept. METHODS AND RESULTS Q-factoring was used to develop subtypes based on commonly occurring Axis II profiles, identifying three: Cluster A (elevated paranoid and schizotypal features), Cluster B (elevated narcissistic and histrionic features), and Cluster C (elevated avoidant and obsessive-compulsive features). An additional factor analysis revealed two dimensions underlying the comorbid features identifiable as: extraversion versus introversion and antagonism versus constraint. Validity of these two maps of comorbidity was explored in terms of the BPD criteria themselves, as well as on work and relationship functioning, identity diffusion, views of self and others, positive and negative affect, behavioural dyscontrol, and symptomatic distress. CONCLUSIONS Clinically meaningful subtypes can be identified for BPD based on co-occurring Axis II features. Further research is needed to replicate and further establish base-rates of these subtypes as well as their differential implications for treatment.
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Wagner S, Baskaya O, Anicker NJ, Dahmen N, Lieb K, Tadić A. The catechol o-methyltransferase (COMT) val(158)met polymorphism modulates the association of serious life events (SLE) and impulsive aggression in female patients with borderline personality disorder (BPD). Acta Psychiatr Scand 2010; 122:110-7. [PMID: 19906087 DOI: 10.1111/j.1600-0447.2009.01501.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE We analyzed i) the effects of serious life events (SLE) on impulsive aggression, and ii) modulating effects of the COMT Val(158)Met polymorphism on the association between SLEs and impulsive aggression in borderline personality disorder (BPD). METHOD One hundred and twelve female BPD patients from Germany were included in this study. Impulsive aggression was assessed by the Buss-Durkee-Hostility Inventory (BDHI). RESULTS Childhood sexual abuse was associated with lower BDHI sum score (P = 0.003). In COMT Val(158)Val carriers, but not in Val/Met and Met/Met carriers, childhood sexual abuse and the cumulative number of SLEs were associated with lower BDHI sum scores (P < 0.05). CONCLUSION This study analyzing a specific gene x environment interaction in female BPD patients suggests an association between SLEs and impulsive aggression, as well as a modulating effect of the COMT Val(158)Val genotype on the relation between SLEs and impulsive aggression.
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Affiliation(s)
- S Wagner
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Germany.
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Mensebach C, Wingenfeld K, Driessen M, Rullkoetter N, Schlosser N, Steil C, Schaffrath C, Bulla-Hellwig M, Markowitsch HJ, Woermann FG, Beblo T. Emotion-induced memory dysfunction in borderline personality disorder. Cogn Neuropsychiatry 2009; 14:524-41. [PMID: 19894145 DOI: 10.1080/13546800903049853] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Although emotional dysregulation is a core problem in borderline personality disorder (BPD), few neuropsychological studies have evaluated the impact of emotion. The present study aimed at the comprehensive investigation of verbal memory functions with and without emotionally relevant interference in BPD. BPD patients were expected to perform as well as healthy subjects in standard memory tasks but to show fewer capacities to control for emotionally negative interference. METHODS 47 patients with BPD and 70 healthy control subjects participated. An experimental task assessed verbal memory with respect to standard and emotionally relevant and neutral interference learning conditions. Applied standard tests covered working memory, delayed memory, and word fluency. RESULTS Memory performances of BPD patients were impaired when negatively valenced interference was conducted but normal in all other conditions. These results remained stable after controlling for comorbid major depression and posttraumatic stress disorder. DISCUSSION The present findings suggest no general impairment of verbal memory functions in BPD but control and inhibition of interference by emotionally significant material seem to be disturbed.
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Affiliation(s)
- Christoph Mensebach
- Department of Psychosomatic Medicine and Psychotherapy, LVR University Hospital Duisburg-Essen, Essen, Germany.
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Adolescent attachment and trajectories of hostile-impulsive behavior: implications for the development of personality disorders. Dev Psychopathol 2009; 21:839-51. [PMID: 19583886 DOI: 10.1017/s0954579409000455] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Adolescents' trajectories of impulsive and hostile behaviors provide a dynamic index of risk for the emergence of Cluster B (antisocial and borderline) personality disorders in early adulthood. In the current study, we tested the hypothesis that preoccupied states of mind in the Adult Attachment Interview would increase both the level and rate of growth in adolescents' trajectories of aggressive and sexual risk-taking behaviors measured at ages 13, 15, and 17. Overall, preoccupied states of mind predicted higher levels of sexual risk taking and aggressive behaviors across all three assessments as well as higher rates of growth in sexual-risk taking and caregiver-reported aggression over time. In addition, preoccupied females showed slower rates of decline in self-reported hostile emotions than did preoccupied males. The effects of gender as a moderator of the relations between preoccupied status and risk trajectories for personality disorders are discussed.
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Wagner S, Baskaya O, Dahmen N, Lieb K, Tadić A. Modulatory role of the brain-derived neurotrophic factor Val66Met polymorphism on the effects of serious life events on impulsive aggression in borderline personality disorder. GENES BRAIN AND BEHAVIOR 2009; 9:97-102. [PMID: 19817874 DOI: 10.1111/j.1601-183x.2009.00539.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Impulsive aggression belongs to the key features of borderline personality disorder (BPD). In the development of BPD, serious life events are known to play a major role. Acute and chronic stress has been suggested to inhibit hippocampal brain-derived neurotrophic factor (BDNF) synthesis and to mediate neural plasticity in response to adverse social experiences. Recently it has been reported that the frequency of violent suicide attempts is higher in adult suicide attempters reporting severe childhood sexual abuse and carrying the Val(66)Val genotype of the BDNF Val(66)Met polymorphism. In this study we analysed modulating effects of BDNF Val(66)Met polymorphism on the effects of physical maltreatment, rape and childhood sexual abuse on impulsive aggression. One hundred and fifty-nine BPD patients from Germany and of Caucasian descent were included. Impulsive aggression was assessed by the Buss-Durkee-Hostility Inventory (BDHI). Childhood sexual abuse accounted for 23.6% of the variance of BDHI sum score. Childhood sexual abuse decreased BDHI sum score in BDNF Val/Val carriers but not in Met carriers. In contrast to previous findings this study analysing a specific gene x environment interaction in BPD patients suggests a decreasing effect of childhood sexual abuse on impulsive aggression in BPD patients, particularly in BDNF Val/Val carriers. The interrelations between serious life events, impulsive aggression and the BDNF Val(66)Met polymorphism as well as their implication for BPD are far from understood and require further investigations.
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Affiliation(s)
- S Wagner
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany.
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The 5-HTTLPR polymorphism modulates the association of serious life events (SLE) and impulsivity in patients with Borderline Personality Disorder. J Psychiatr Res 2009; 43:1067-72. [PMID: 19358998 DOI: 10.1016/j.jpsychires.2009.03.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Revised: 02/26/2009] [Accepted: 03/10/2009] [Indexed: 11/17/2022]
Abstract
BACKGROUND Impulsivity belongs to the key features of Borderline Personality Disorder (BPD). It has been linked to altered serotoninergic neurotransmission and, genetically, to an over-representation of the short (S) allele of the serotonin transporter promoter-linked polymorphic region polymorphism (5-HTTLPR). On the other hand, serious life events (SLE) are of major importance in the development of BPD. However, the inter-relations between SLEs, impulsivity, and 5-HTTLPR are not understood. METHOD 159 BPD patients from Germany were included in this study. Impulsivity was assessed by the Barratt Impulsiveness Scale (BIS). We analysed (1) the effects of SLEs on impulsivity; and (2) modulating effects of the 5-HTTLPR polymorphism on the effects of SLEs on impulsivity. RESULTS Regression analyses confirmed a decreasing effect of childhood sexual abuse, the cumulative SLE-related reactions and the impairment by SLEs on BIS sum score. Regarding BIS sum score, all SLEs except for rape were associated with a decrease of impulsivity in SS/SL carriers and an increase of BIS sum score in LL carriers. CONCLUSIONS This study analyzing a specific gene x environment interaction in BPD patients suggests an interaction between SLEs and the 5-HTTLPR S/L polymorphism in the development of impulsivity in BPD patients. Clinical and research implications are discussed.
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Tadić A, Victor A, Başkaya O, von Cube R, Hoch J, Kouti I, Anicker NJ, Höppner W, Lieb K, Dahmen N. Interaction between gene variants of the serotonin transporter promoter region (5-HTTLPR) and catechol O-methyltransferase (COMT) in borderline personality disorder. Am J Med Genet B Neuropsychiatr Genet 2009; 150B:487-95. [PMID: 18756498 DOI: 10.1002/ajmg.b.30843] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Borderline personality disorder (BPD) is characterized by a heterogeneous symptomatology with instability in impulse control, interpersonal relationships and self-image. BPD patients display repeated self-injury, chronic suicidal tendencies and emotional dysregulation, mainly dysregulation of negative affect. In its etiology, genetic and environmental factors have been suggested. Recently, an investigation in male healthy volunteers found gene-gene effects of the catechol-O-methyl-transferase (COMT) low-activity (Met(158)) and the low-expression allele of the deletion/insertion (short/long or S/L, respectively) polymorphism in the serotonin transporter-linked promoter region (5-HTTLPR) on the central processing of aversive stimuli. The purpose of the present study was to test for association between BPD and the COMT Val(158)Met single nucleotide polymorphism (SNP), the 5-HTTLPR S/L variant and the interaction of these two gene variants. One hundred sixty one well-defined Caucasian BPD patients and 156 healthy controls were recruited from central Germany. In BPD patients, the genotype COMT Met(158)Met was over-represented compared to healthy controls (P = 0.0085; adjusted P = 0.034). We observed no differences in 5-HTTLPR genotypes between BPD and controls (P = 0.286). Additionally, the COMT Met(158)Met genotype was significantly over-represented in BPD patients carrying at least one 5-HTTLPR S allele (P = 0.0007; adjusted P = 0.028). Logistic regression analysis confirmed an interaction of the COMT Met(158) and the 5-HTTLPR S allele (P = 0.001). These data suggest an involvement of altered dopaminergic and/or noradrenergic neurotransmission as well as an interactive effect of COMT and 5-HTTLPR gene variants in the etiology of BPD, and underline the usefulness of analyses of gene-gene effects in diseases of complex inheritance with multiple genes involved.
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Affiliation(s)
- André Tadić
- Department of Psychiatry and Psychotherapy, University of Mainz, Germany.
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Stefan DC. Adolescents with cancer: how can we meet their specific needs in developing countries? Int J Adolesc Med Health 2009; 20:389-93. [PMID: 19230439 DOI: 10.1515/ijamh.2008.20.4.389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cancer occurring in adolescents (10 to 19 years) is more than twice as common as cancer in children but has received less attention in South Africa. In the process of becoming adults, adolescents undergo major physical, psychological, and social changes. They manifest specific behaviors and have special emotional needs. Malignant disease and its treatment have the potential to disrupt seriously the processes of adolescence, whereas the emotional instability and the risk-prone behavior characteristic to this age may jeopardize the success of the treatment. A further disruption in the management of these patients, in South Africa, is the need to refer children over the age of 13 to the adult medicine service. Research done worldwide on transferring of adolescents with cancer and other chronic diseases to adult health care underscores the need for a structured and individualized transition. Whilst, in some developed countries, adolescent cancer units already function for years, the extent of the problem has not yet been evaluated in most developing countries, where cancer registers do not even exist. A few simple measures might improve substantially the outcome of cancer in adolescents in the developing world.
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Affiliation(s)
- Daniela Cristina Stefan
- Department of Paediatrics and Child Health, Tygerberg Hospital and Stellenbosch University, Tygerberg, Cape Town, South Africa.
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Ma WF, Shih FJ, Hsiao SM, Shih SN, Hayter M. 'Caring Across Thorns' - Different care outcomes for borderline personality disorder patients in Taiwan. J Clin Nurs 2009; 18:440-50. [DOI: 10.1111/j.1365-2702.2008.02557.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Gratz KL, Tull MT, Baruch DE, Bornovalova MA, Lejuez CW. Factors associated with co-occurring borderline personality disorder among inner-city substance users: the roles of childhood maltreatment, negative affect intensity/reactivity, and emotion dysregulation. Compr Psychiatry 2008; 49:603-15. [PMID: 18970909 DOI: 10.1016/j.comppsych.2008.04.005] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2007] [Revised: 04/21/2008] [Accepted: 04/30/2008] [Indexed: 11/30/2022] Open
Abstract
The co-occurrence of borderline personality disorder (BPD) among individuals with substance use disorders is a common and clinically relevant phenomenon in need of further empirical investigation. The present study adds to the extant literature on the factors associated with co-occurring BPD among substance users, examining the relationships between childhood maltreatment (in the form of sexual, physical, and emotional abuse and emotional and physical neglect), negative affect intensity/reactivity, emotion dysregulation, and BPD pathology (both diagnostic status and symptom count) among a sample of 76 inner-city treatment-seeking substance users. Emotion dysregulation was expected to mediate the relationships between childhood maltreatment and negative affect intensity/reactivity (and their interaction) and BPD pathology. Results indicate that the presence of a BPD diagnosis was associated with higher levels of both childhood maltreatment and negative affect intensity/reactivity. However, only childhood maltreatment emerged as a unique predictor of BPD diagnostic status. Conversely, both childhood maltreatment and negative affect intensity/reactivity accounted for unique variance in the number of endorsed BPD symptoms. Moreover, emotion dysregulation fully mediated the relationships between maltreatment and negative affect intensity/reactivity and BPD symptom count, as well as the relationship between emotional abuse in particular and BPD diagnostic status. Contrary to hypotheses, results provided no support for the interaction between maltreatment and negative affect intensity/reactivity in the prediction of BPD pathology (diagnosis or symptom count), above and beyond the main effects of these factors.
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Affiliation(s)
- Kim L Gratz
- Center for Addictions, Personality, and Emotion Research and the Department of Psychology, University of Maryland, College Park, MD 20742, USA.
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Liotti G, Cortina M, Farina B. Attachment Theory and Multiple Integrated Treatments of Borderline Patients. ACTA ACUST UNITED AC 2008; 36:295-315. [DOI: 10.1521/jaap.2008.36.2.295] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ayduk Ö, Zayas V, Downey G, Cole AB, Shoda Y, Mischel W. Rejection Sensitivity and Executive Control: Joint predictors of Borderline Personality features. JOURNAL OF RESEARCH IN PERSONALITY 2008; 42:151-168. [PMID: 18496604 PMCID: PMC2390893 DOI: 10.1016/j.jrp.2007.04.002] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Two studies tested the hypothesis that rejection sensitivity (RS) and executive control (EC) jointly predict borderline personality (BP) features. We expected high RS to be related to increased vulnerability for BP features specifically in people who also had difficulties in executive control (EC). Study 1 tested this hypothesis using a sample of college students (N = 379) whereas Study 2 (N = 104) was conducted using a community sample of adults. Both studies operationalized EC by a self-report measure. For a subsample in Study 2 (N = 80), ability to delay gratification at age 4 was also used as an early behavioral precursor of EC in adulthood. In both studies, high RS was associated with increased BP features among people low in self-reported EC. Among those high in self-reported EC, the relationship between RS and BP features was attenuated. Study 2 found parallel findings using preschool delay ability as a behavioral index of EC. These findings suggest that EC may protect high RS people against BP features.
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Fuchs T. Fragmented selves: temporality and identity in borderline personality disorder. Psychopathology 2007; 40:379-87. [PMID: 17652950 DOI: 10.1159/000106468] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2006] [Accepted: 10/16/2006] [Indexed: 11/19/2022]
Abstract
The concept of narrative identity implies a continuity of the personal past, present and future. This concept is essentially based on the capacity of persons to integrate contradictory aspects and tendencies into a coherent, overarching sense and view of themselves. In 'mature' neurotic disorders, this is only possible at the price of repression of important wishes and possibilities for personal development. Patients with borderline personality disorder lack the capacity to establish a coherent self-concept. Instead, they adopt what could be called a 'post-modernist' stance towards their life, switching from one present to the next and being totally identified with their present state of affect. Instead of repression, their means of defence consists in a temporal splitting of the self that excludes past and future as dimensions of object constancy, bonding, commitment, responsibility and guilt. The temporal fragmentation of the self avoids the necessity of tolerating the threatening ambiguity and uncertainty of interpersonal relationships. The price, however, consists in a chronic feeling of inner emptiness caused by the inability to integrate past and future into the present and thus to establish a coherent sense of identity. The paper outlines the concept of narrative identity and explores its disturbances in borderline personality disorder. Finally, the increasing prevalence of these disorders is linked to the development of a mainly externally driven, fragmented character in post-modern society.
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Affiliation(s)
- Thomas Fuchs
- Psychiatric Department, University of Heidelberg, Heidelberg, Germany.
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Clarkin JF, Levy KN. Psychotherapy for patients with borderline personality disorder: focusing on the mechanisms of change. J Clin Psychol 2006; 62:405-10. [PMID: 16470611 DOI: 10.1002/jclp.20238] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
A major development in the field of psychotherapy research is the growing recognition of the need for evidence on the mechanisms of change in psychotherapy. The empirical evidence that psychotherapy has a positive and significant effect must be amplified with data on the mechanisms of action in the various psychotherapies. This special issue is devoted to the articulation of putative mechanisms of change in the psychotherapy of patients with borderline personality disorder by leading researchers in this field.
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Affiliation(s)
- John F Clarkin
- Joan and Sanford I. Weill Medical College of Cornell University, NY10605, USA.
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Abstract
Attention is a central theme in cognitive science - it exemplifies the links between the brain and behaviour, and binds psychology to the techniques of neuroscience. A visionary model suggested by Michael Posner described attention as a set of independent control networks. This challenged the previously held view of attention as a uniform concept. The idea that disparate attentional networks correlate with discrete neural circuitry and can be influenced by focal brain injuries, mental state and specific drugs has since been supported by converging data from several modern methodologies. Given the recent explosion in empirical data, attentional typologies provide powerful conceptual tools with which to contextualize and integrate these findings.
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Affiliation(s)
- Amir Raz
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute, New York 10032, USA.
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Zouk H, Tousignant M, Seguin M, Lesage A, Turecki G. Characterization of impulsivity in suicide completers: clinical, behavioral and psychosocial dimensions. J Affect Disord 2006; 92:195-204. [PMID: 16545465 DOI: 10.1016/j.jad.2006.01.016] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2005] [Revised: 12/06/2005] [Accepted: 01/16/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Impulsivity is a personality trait thought to be linked to suicide. Yet, not all suicides are highly impulsive. We aimed to better understand clinical, behavioral and psychosocial correlates of the association between suicide and impulsive behavior. METHODS One hundred sixty four suicide cases with impulsivity scores based on the Barratt Impulsivity Scale (BIS) were investigated. To examine the most extreme phenotypes, one hundred suicide cases, representing subjects with BIS scores above the 70th percentile and below the 30th percentile, were compared on clinical, behavioral and psychosocial suicide risk factors assessed by way of structured psychological autopsy methods with best informants. RESULTS The impulsive suicide cases were significantly younger, exhibited higher measures of aggressive behavior, and were more likely to have a cluster B diagnosis as well as lifetime and 6-month prevalence of alcohol and drug abuse/dependence. They also differed significantly from their non-impulsive counterparts on all subscales of the TCI except for Harm Avoidance and Reward Dependence. Impulsive suicide completers were more likely to have had a history of childhood abuse and to have experienced a triggering life event up to a week preceding their death. A multivariate analysis indicated that 6-month prevalence of substance abuse/dependence and high aggressive behavior remained significant even after controlling for other significant variables. LIMITATIONS This study was carried out using proxy-based interviews. CONCLUSIONS Most of the known clinical and behavioral risk factors commonly associated with suicide are particularly valid for impulsive suicide completers. Further, triggering and adverse life events seem to play a role primarily in impulsive suicide.
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Affiliation(s)
- Hana Zouk
- McGill Group for Suicide Studies, Douglas Hospital Research Center, McGill University, Montreal, QC, Canada
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Fertuck EA, Lenzenweger MF, Clarkin JF, Hoermann S, Stanley B. Executive neurocognition, memory systems, and borderline personality disorder. Clin Psychol Rev 2006; 26:346-75. [PMID: 15992977 DOI: 10.1016/j.cpr.2005.05.008] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2004] [Accepted: 05/09/2005] [Indexed: 11/17/2022]
Abstract
Borderline Personality Disorder (BPD) is a common, disabling, and burdensome psychiatric condition. It is characterized by turbulent fluctuations of negative emotions and moods, unstable and conflictual interpersonal relationships, an incoherent and often contradictory sense of self, and impulsive, potentially lethal self-injurious behaviors. The neurobehavioral facets of BPD have not been extensively studied. However, clinical theoreticians and researchers have proposed that the symptoms and behaviors of BPD are, in part, associated with disruptions in basic neurocognitive processes. This review summarizes and evaluates research that has investigated the relationship between executive neurocognition, memory systems, and BPD. Three historical phases of research are delineated and reviewed, and the methodological and conceptual challenges this body of investigation highlights are discussed. Laboratory-based assessment of executive neurocognition and memory systems is integral to an interdisciplinary approach to research in BPD. Such an approach holds promise in elucidating the neurobehavioral facets, development, diagnostic boundaries, prevention, and optimal interventions for this debilitating and enigmatic disorder.
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Affiliation(s)
- Eric A Fertuck
- New York State Psychiatric Institute, Columbia University, College of Physicians and Surgeons, USA.
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Abstract
Behavior genetics studies in mice demand efficient training protocols for rapid phenotypic screening. However, the capacity of neonatal mice to form and retain associative memories has been difficult to study due to their limited sensorimotor capacities. The present study describes a method for robust, naturalistic associative learning in neonatal mice as young as 3 days old. After removal of the dam from the home cage for 2 h, preweanling CD-1 mice of ages 3, 5, and 10 days postnatal were conditioned to associate an arbitrary odorant with the suckling and milk delivery that ensued upon her return to the home cage. After a second maternal deprivation, neonates were tested on their acquired preference for that odorant. Neonates exhibited a learned preference for the conditioned odorant over a novel control odorant. No learning was observed without deprivation, that is, when the dam was removed only briefly for scenting. One-trial learning sufficed to show clear preferences for the conditioned odorant, although repeated training (three sessions over 8 days) significantly increased the expression of preference. The development of neonatal associative learning protocols requiring minimal human intervention is important for the behavioral phenotyping of mutant and transgenic strains, particularly those modeling developmental disorders.
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Affiliation(s)
- Caren M Armstrong
- Department of Neurobiology and Behavior, Cornell University, Ithaca, NY 14853, USA
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