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Marrocu A, Kettner H, Weiss B, Zeifman RJ, Erritzoe D, Carhart-Harris RL. Psychiatric risks for worsened mental health after psychedelic use. J Psychopharmacol 2024; 38:225-235. [PMID: 38491857 PMCID: PMC10944581 DOI: 10.1177/02698811241232548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
Abstract
BACKGROUND Resurgent psychedelic research has largely supported the safety and efficacy of psychedelic therapy for the treatment of various psychiatric disorders. As psychedelic use and therapy increase in prevalence, so does the importance of understanding associated risks. Cases of prolonged negative psychological responses to psychedelic therapy seem to be rare; however, studies are limited by biases and small sample sizes. The current analytical approach was motivated by the question of whether rare but significant adverse effects have been under-sampled in psychedelic research studies. METHODS A "bottom margin analysis" approach was taken to focus on negative responders to psychedelic use in a pool of naturalistic, observational prospective studies (N = 807). We define "negative response" by a clinically meaningful decline in a generic index of mental health, that is, one standard error from the mean decrease in psychological well-being 4 weeks post-psychedelic use (vs pre-use baseline). We then assessed whether a history of diagnosed mental illness can predict negative responses. RESULTS We find that 16% of the cohort falls into the "negative responder" subset. Parsing the sample by self-reported history of psychiatric diagnoses, results revealed a disproportionate prevalence of negative responses among those reporting a prior personality disorder diagnosis (31%). One multivariate regression model indicated a greater than four-fold elevated risk of adverse psychological responses to psychedelics in the personality disorder subsample (b = 1.425, p < 0.05). CONCLUSION We infer that the presence of a personality disorder may represent an elevated risk for psychedelic use and hypothesize that the importance of psychological support and good therapeutic alliance may be increased in this population.
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Affiliation(s)
- Alessia Marrocu
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Hannes Kettner
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Brandon Weiss
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Richard J Zeifman
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
- NYU Langone Center for Psychedelic Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - David Erritzoe
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Robin L Carhart-Harris
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
- Carhart-Harris Lab, Departments of Neurology and Psychiatry, University of California San Francisco, San Francisco, CA, USA
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2
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Remeeus MGA, Smits ML, Bal-Bax AM, Feenstra DJ, Luyten P. Attachment as a predictor of dropout in mentalization-based treatment. Psychol Psychother 2023. [PMID: 37466096 DOI: 10.1111/papt.12478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 06/07/2023] [Accepted: 06/13/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVES Although treatments of patients with borderline personality disorder (BPD) were historically associated with relatively high dropout rates, dropout rates in contemporary evidence-based treatments for BPD are typically substantially lower. However, only a few studies have investigated dropout rates in mentalization-based treatment (MBT), and even fewer have investigated predictors of dropout in this type of treatment. In this study, we investigated dropout rates in two types of MBT (day hospital MBT [MBT-DH] and intensive outpatient MBT [MBT-IOP]) using data from a recent multicenter randomized clinical trial. Given the central importance of attachment considerations in MBT, we also investigated the relationship between dropout in these two treatments and attachment dimensions. DESIGN Within a multicenter randomized clinical trial, 114 BPD patients were randomized to MBT-DH (n = 70) or MBT-IOP (n = 44). METHODS Dropout in both types of MBT was investigated using descriptive analyses, and its association with attachment anxiety and attachment avoidance, as measured by the Experiences in Close Relationships questionnaire at baseline, was investigated using regression analyses. RESULTS Dropout rates were relatively low (10.5% across both types of MBT) and did not significantly differ between groups (11.4% in MBT-DH, 9.1% in MBT-IOP). Attachment avoidance and attachment anxiety did not impact dropout, nor did their interaction or the interaction with the type of MBT. CONCLUSIONS Low dropout rates in both types of MBT indicate a high level of engagement of patients in both programmes. Attachment dimensions were not associated with dropout, consistent with the principle that MBT is tailored to each individual's needs. More research is needed, however, to investigate to what extent attachment is a dynamic context-bound adaptive process rather than a static personality feature.
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Affiliation(s)
- Melissa G A Remeeus
- Viersprong Institute for Studies on Personality Disorders, Bergen op Zoom, The Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Maaike L Smits
- Viersprong Institute for Studies on Personality Disorders, Bergen op Zoom, The Netherlands
- Department of Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam, The Netherlands
| | - Anna M Bal-Bax
- Department of Medical Psychology, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | - Dine J Feenstra
- Viersprong Institute for Studies on Personality Disorders, Bergen op Zoom, The Netherlands
- Department of Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam, 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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3
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Robin M, Surjous L, Belbèze J, Bonnardel L, Lamas C, Silva J, Peres V, Corcos M. Four attachment-based categories of emotion regulation in adolescent psychic troubles. Front Psychol 2023; 14:1133980. [PMID: 37275718 PMCID: PMC10237043 DOI: 10.3389/fpsyg.2023.1133980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/06/2023] [Indexed: 06/07/2023] Open
Abstract
Introduction Emotion regulation is altered in many psychiatric disorders in adolescence, but the understanding of mechanisms that underlie this alteration is still poor. Methods The PERCEPT study explores alexithymia, empathy, facial emotion recognition (FER) and defence mechanisms in a sample of adolescents in psychiatric care (n = 61, 74% of girls, mean age = 15.03 y.o.), in relation with participants' attachment styles. Results Results revealed correlations between attachment dimensions and all of the emotion regulation variables, suggesting that attachment modalities have functional links with emotional regulation at its different levels: FER accuracy was inversely correlated with avoidant attachment, while affective empathy, difficulty in identifying feelings (alexithymia) and immature as well as neurotic defence mechanisms were positively correlated with anxious attachment. Moreover, attachment categories delineated distinct emotional perception profiles. In particular, preoccupied attachment included adolescents with the highest levels of facial emotion perception (sensitivity and accuracy) and of affective empathy, whereas detached attachment included adolescents with the lowest levels of these variables. Neurotic defence mechanisms and difficulty to identify feelings were correlated with preoccupied attachment; immature defence mechanisms and difficulty to describe feelings to others characterized fearful attachment. Discussion These results suggest that attachment categories underlie emotion regulation processes in psychiatric disorders in adolescence. Theoretical and clinical implications are discussed.
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Affiliation(s)
- Marion Robin
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
- CESP, INSERM U1178, Paris-Saclay University, Villejuif, France
| | - Luc Surjous
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
- Paris Cité University, Paris, France
| | - Jean Belbèze
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
- Paris Cité University, Paris, France
| | - Lucile Bonnardel
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
| | - Claire Lamas
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
| | - Jérôme Silva
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
| | - Victoire Peres
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
| | - Maurice Corcos
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
- Paris Cité University, Paris, France
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4
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Meulemeester CD, Lowyck B, Boets B, van der Donck S, Verhaest Y, Luyten P. "Feeling Invisible": Individuals With Borderline Personality Disorder Underestimate the Transparency of Their Emotions. J Pers Disord 2023; 37:213-232. [PMID: 37002937 DOI: 10.1521/pedi.2023.37.2.213] [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: 04/04/2023]
Abstract
The present study investigated transparency estimation, that is, the ability to estimate how observable one's emotions are, in patients diagnosed with borderline personality disorder (BPD) (n = 35) and healthy controls (HCs; n = 35). Participants watched emotionally evocative video clips and estimated the transparency of their own emotional experience while watching the clip. Facial expression coding software (FaceReader) quantified their objective transparency. BPD patients felt significantly less transparent than HCs, but there were no differences in objective transparency. BPD patients tended to underestimate the transparency of their emotions compared to HCs, who in turn overestimated their transparency. This suggests that BPD patients expect that others will not know how they feel, irrespective of how observable their emotions actually are. We link these findings to low emotional awareness and a history of emotional invalidation in BPD, and we discuss their impact on BPD patients' social functioning.
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Affiliation(s)
| | - Benedicte Lowyck
- University Psychiatric Hospital UPC KU Leuven, Campus Kortenberg, and Department of Neurosciences, Faculty of Medicine, KU Leuven, Belgium
| | - Bart Boets
- Center for Developmental Psychiatry, Department of Neurosciences, KU Leuven, Belgium
| | | | - Yannic Verhaest
- University Psychiatric Hospital UPC KU Leuven, Campus Kortenberg, and Department of Neurosciences, Faculty of Medicine, KU Leuven, Belgium
| | - Patrick Luyten
- Faculty of Psychology and Educational Sciences, KU Leuven, Belgium
- Research Department of Clinical, Educational and Health Psychology, University College London, United Kingdom
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Kroener J, Schaitz C, Karabatsiakis A, Maier A, Connemann B, Schmied E, Sosic-Vasic Z. Relationship Dysfunction in Couples When One Partner Is Diagnosed with Borderline Personality Disorder: Findings from a Pilot Study. Behav Sci (Basel) 2023; 13:bs13030253. [PMID: 36975278 PMCID: PMC10045094 DOI: 10.3390/bs13030253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/23/2023] [Accepted: 02/28/2023] [Indexed: 03/14/2023] Open
Abstract
Relationship dysfunction—marked by frequent conflicts—is one of the hallmark features of borderline personality disorder (BPD). However, the BPD couple as a dyad and partner-related features have rarely been taken into account. The aim of the present study was to investigate hormonal, personality, and relationship relevant factors, such as relationship satisfaction, attachment, and trauma in both partners within a dyad where one partner is diagnosed with BPD. The total sample consisted of 26 heterosexual couples. All studies were conducted at 2 p.m. Primary outcomes: Neo-Five-Factor-Inventory, Childhood Trauma Questionnaire, Experiences in Close Relationships Scale. Secondary outcomes: Problem List, Partnership Questionnaire, Questionnaire for Assessing Dyadic Coping. Upon questionnaire completion, one saliva sample was taken via passive drool to assess baseline cortisol and testosterone levels. Results showed that females with BPD have higher scores on childhood maltreatment, dysfunctional attachment styles, and neuroticism than mentally healthy females. Furthermore, they have more relationship-related problems and are less satisfied in their romantic relationship. Male partners of women with BPD showed lower testosterone levels, higher levels of childhood maltreatment, dysfunctional attachment styles, neuroticism, and openness compared with the healthy control partners. Furthermore, childhood trauma, neuroticism as well as dysfunctional attachment styles displayed a significant positive correlation with relationship-related problems. Traumatic childhood experiences, insecure attachment styles as well as neurotic personality characteristics contribute to increased relationship disruptions in couples. Relevant hormonal and psychosocial parameters in BPD partners should be taken into account when treating females with BPD.
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Affiliation(s)
- Julia Kroener
- Christophsbad Goeppingen, Research Division of Applied Psychotherapy and Psychiatry, Faurndauer Straße 6-28, 73035 Goeppingen, Germany
- Department of Psychiatry and Psychotherapy III, University Clinic of Ulm, 89075 Ulm, Germany
- Correspondence: ; Tel.: +49-7161-601-8672
| | - Caroline Schaitz
- MSB Medical School Berlin, Psychotherapeutic Outpatient Facility, Rüdesheimer Straße 50, 14197 Berlin, Germany
| | - Alexander Karabatsiakis
- Department of Psychology, Clinical Psychology II, University of Innsbruck, 6020 Innsbruck, Austria
| | - Anna Maier
- Department of Psychiatry and Psychotherapy III, University Clinic of Ulm, 89075 Ulm, Germany
| | - Bernhard Connemann
- Department of Psychiatry and Psychotherapy III, University Clinic of Ulm, 89075 Ulm, Germany
| | - Elisa Schmied
- Christophsbad Goeppingen, Research Division of Applied Psychotherapy and Psychiatry, Faurndauer Straße 6-28, 73035 Goeppingen, Germany
| | - Zrinka Sosic-Vasic
- Christophsbad Goeppingen, Research Division of Applied Psychotherapy and Psychiatry, Faurndauer Straße 6-28, 73035 Goeppingen, Germany
- Department of Psychiatry and Psychotherapy III, University Clinic of Ulm, 89075 Ulm, Germany
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Wojtynkiewicz E, Sekowski M. Relations between attachment, identity and borderline personality disorder symptom severity in male inpatients with alcohol use disorder. Personal Ment Health 2022; 16:309-318. [PMID: 35475327 DOI: 10.1002/pmh.1545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/25/2022] [Accepted: 04/19/2022] [Indexed: 11/09/2022]
Abstract
Insecure attachment style and borderline personality disorder (BPD) symptoms are related to the severity of alcohol use disorder (AUD) and can also complicate its course and treatment. We propose a theoretical model of relationships between adult attachment style and BPD and AUD symptom severity in which the sense of identity is a mediator. The aim of our study was to test this model in a sample of male inpatients with AUD. Male inpatients with AUD (N = 114) aged 22-72 years (M = 43.05; SD = 9.84) completed the Experiences in Close Relationships-Revised, the Multidimensional Identity Questionnaire, the Alcohol Use Disorders Identification Test and the Borderline Symptom List 23. Results showed that the sense of identity fully mediated the positive relationship between attachment anxiety and BPD symptom severity. There was also a positive indirect effect of attachment avoidance on BPD symptoms via weaker sense of identity. Contrary to hypothesis, AUD symptom severity was not related to attachment, identity or BPD symptoms in our sample. Sense of identity could be a possible target for interventions for insecurely attached men with AUD to reduce BPD symptoms.
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Affiliation(s)
- Ewa Wojtynkiewicz
- Department of Psychology, The Kazimierz Wielki University, Bydgoszcz, Poland
| | - Marcin Sekowski
- Department of Psychology, The Maria Grzegorzewska University, Warsaw, Poland
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7
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Borderline Personality Disorder Symptoms and Its Clinical Correlates among Chinese University Students: A Cross-Sectional Study. Healthcare (Basel) 2022; 10:healthcare10091751. [PMID: 36141363 PMCID: PMC9498450 DOI: 10.3390/healthcare10091751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 11/17/2022] Open
Abstract
Borderline personality disorder (BPD) is common among young adults. Related studies showed a wide range of prevalence among university students. Few studies regarding BPD symptoms and their correlations with different variables have been reported in the Chinese population. A cross-sectional, online survey was conducted on a sample of university students in China between November 2021 and January 2022. Sociodemographic questionnaires, the Screening Instrument for Borderline Personality Disorder (SI-Bord), the 18-item Experience in Close Relationships-Revised (ECR-R-18), the Meaning In Life Questionnaire (MLQ), the 10-item Perceived Stress Scale (PSS-10), the Patient Health Questionnaire (PHQ-9), the Rosenberg Self-Esteem Scale (RSES) and the Resilience Inventory (RI-9) were completed. Data were analyzed using Pearson’s correlation methods. Among 767 participants, mean age was 20.33 ± 1.495 years, and the majority were males (53.5%). According to the SI-Bord’s cut-off score >7, BPD symptoms were found in 17.5% of participants. Attachment anxiety, avoidance, depression, perceived stress, lack of meaning in life, resilience and self-esteem were significantly correlated with BPD symptoms with r’s of 0.473, 0.180, 0.451, 0.481, −0.148, −0.238 and −0.388, respectively (all p’s < 0.01). The prevalence of BPD symptoms is high among Chinese university students and significantly associated with mental health outcomes, suggesting that an early detection of BPD symptoms is necessary for this population.
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Enhancing member engagement in a Tier 3 personality disorder service during COVID-19: evaluation of a virtual group programme. Behav Cogn Psychother 2022; 50:629-643. [PMID: 36082688 DOI: 10.1017/s1352465822000339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Drop-out rates from evidence-based interventions for people with a diagnosis of personality disorder (PD) are high. The COVID-19 pandemic has likely exacerbated barriers to engagement with the introduction of virtual working. Virtual therapy has a good evidence-base for Axis I disorders, but limited research for Axis II disorders. AIMS To investigate facilitators and barriers to engagement in a Tier 3 PD service virtual group programme. METHOD A virtual group programme was developed in collaboration with service members, and analysed members' attendance rates over a 5-month period pre- and post-COVID-19. Thematic analysis of semi-structured telephone interviews with 38 members is reported, describing their experience of the virtual group programme. RESULTS Attendance rates were significantly higher pre-COVID (72%) than post-COVID (50%). Thematic analysis highlighted key barriers to attendance were: practical issues, low motivation, challenges of working in a group online and feeling triggered at home. Main promoters of engagement were: feeling valued, continued sense of connection and maintaining focus on recovery. DISCUSSION The results suggest that the pandemic has exacerbated relational and practical barriers to engagement in a Tier 3 PD service. Ways of enhancing engagement are discussed, as well as preliminary recommendation for services offering virtual therapy to people with a diagnosis of PD.
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Bindung als Prädiktor von Strukturveränderungen im Verlauf von stationärer Psychotherapie. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2022; 68:6-23. [DOI: 10.13109/zptm.2022.68.1.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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10
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Choi-Kain LW, Simonsen S, Euler S. A Mentalizing Approach for Narcissistic Personality Disorder: Moving From "Me-Mode" to "We-Mode". Am J Psychother 2022; 75:38-43. [PMID: 35016552 DOI: 10.1176/appi.psychotherapy.20210017] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Narcissistic personality disorder (NPD) is a prevalent condition that frequently co-occurs with other diagnoses that bring patients into treatment. Narcissistic disturbances are not often the chief complaint, but they complicate the development of an adequate therapeutic alliance. Typical countertransference challenges, combined with stigma related to NPD, result in difficulty for the therapist to relate to these patients empathically. Mentalization-based treatment provides a means for therapists to reach these patients by taking a "not-knowing" stance with interest and curiosity in clarifying and expanding a shared awareness of the patient's emotional experiences. By understanding the attachment functions, mentalizing imbalances, and problems of epistemic disregard among patients with NPD, therapists can break through the self-centered "me-mode" of the therapeutic dyad, where the typical lack of engagement or power struggles prevail, to a "we-mode," where the patient and therapist are joined in attention to what happens in the patient's mind and in interactions with others.
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Affiliation(s)
- Lois W Choi-Kain
- Gunderson Personality Disorders Institute, McLean Hospital, Belmont, Massachusetts, (Choi-Kain); Department of Psychiatry, Harvard Medical School, Boston (Choi-Kain); Stolpegaard Psychotherapy Center, Mental Health Services, Capital Region, Gentofte, Denmark (Simonsen); University Psychiatric Clinics Basel, Basel, Switzerland (Euler)
| | - Sebastian Simonsen
- Gunderson Personality Disorders Institute, McLean Hospital, Belmont, Massachusetts, (Choi-Kain); Department of Psychiatry, Harvard Medical School, Boston (Choi-Kain); Stolpegaard Psychotherapy Center, Mental Health Services, Capital Region, Gentofte, Denmark (Simonsen); University Psychiatric Clinics Basel, Basel, Switzerland (Euler)
| | - Sebastian Euler
- Gunderson Personality Disorders Institute, McLean Hospital, Belmont, Massachusetts, (Choi-Kain); Department of Psychiatry, Harvard Medical School, Boston (Choi-Kain); Stolpegaard Psychotherapy Center, Mental Health Services, Capital Region, Gentofte, Denmark (Simonsen); University Psychiatric Clinics Basel, Basel, Switzerland (Euler)
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11
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Smith MS, South SC. Call to arms: Research directions to substantiate a unified model of attachment and personality pathology. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2021. [DOI: 10.1111/spc3.12644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Madison Shea Smith
- Department of Psychological Sciences Purdue University West Lafayette Indiana USA
| | - Susan C. South
- Department of Psychological Sciences Purdue University West Lafayette Indiana USA
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12
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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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13
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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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14
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Woodbridge J, Reis S, Townsend ML, Hobby L, Grenyer BFS. Searching in the dark: Shining a light on some predictors of non-response to psychotherapy for borderline personality disorder. PLoS One 2021; 16:e0255055. [PMID: 34314461 PMCID: PMC8315515 DOI: 10.1371/journal.pone.0255055] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 07/08/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Borderline Personality Disorder (BPD) is a prevalent and serious mental health condition. People can experience recovery or remission after receiving psychotherapy for BPD; however, it is estimated that about 45% of people in well conducted treatment trials do not respond adequately to current psychological treatments. AIM To further advance psychotherapies for BPD by identifying the factors that contribute to the problem of non-response. METHOD 184 consecutive participants with BPD in community treatment were naturalistically followed up over 12 months and measures of personality and social functioning were examined. Logistic regressions were used to determine which baseline factors were associated with the likelihood of being a non-responder after 12 months of psychotherapy. After 12 months, 48.4% of participants were classed as non-responders due to a lack of reduction in BPD symptoms according to the Reliable Change Index (RCI) method. RESULTS At baseline intake, patients who endorsed an adult preoccupied attachment relationship style and increased anger were more likely to be a non-responder regarding BPD symptoms at 12 months. In addition, those with preoccupied attachment patterns in their adult relationships were more likely to be non-responders regarding general psychological distress at follow up. Higher baseline levels of paranoia and endorsement of a dismissive adult relationship style was associated with being a non-responder in regard to global functioning. CONCLUSIONS Consistent with previous research, almost half of the sample did not achieve reliable change at 12-month follow up. A relationship style characterised by preoccupied insecurity and high anger seemed to be particularly challenging in being able to benefit from psychotherapy. This style may have affected both relationships outside, but also inside therapy, complicating treatment engagement and alliance with the therapist. Early identification and modification of treatment based on challenges from these relationship styles may be one way to improve psychotherapy outcomes for BPD.
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Affiliation(s)
- Jane Woodbridge
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, Australia
| | - Samantha Reis
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, Australia
| | - Michelle L. Townsend
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, Australia
| | - Lucy Hobby
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, Australia
- School of Education, Western Sydney University, Penrith, Australia
| | - Brin F. S. Grenyer
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, Australia
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15
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Hashworth T, Reis S, Grenyer BFS. Personal Agency in Borderline Personality Disorder: The Impact of Adult Attachment Style. Front Psychol 2021; 12:669512. [PMID: 34248763 PMCID: PMC8264284 DOI: 10.3389/fpsyg.2021.669512] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/17/2021] [Indexed: 12/02/2022] Open
Abstract
Background Personal agency- the degree to which one believes they have control over their life- is thought to influence how people understand their interpersonal relationships. Links between adult attachment and personal agency are theoretically relevant to the experience of borderline personality disorder (BPD) but this has yet to be empirically examined. The present research examines the impact of personal agency and adult attachment styles for individuals meeting criteria for BPD. Methods Participants consented to an online community study examining measures of locus of control (as an index of personal agency), BPD, and adult attachment. Participants meeting criteria for BPD (N = 96; mean age = 30.63; 70.5% female) were compared to age-matched healthy controls (N = 96; mean age = M = 31.99; 89.0% female). Results Individuals who met criteria for BPD displayed lower personal agency and higher fearful and preoccupied attachment styles in their close relationships, compared to Controls. Controls reported greater personal agency and were more securely attached in their relationships. Using multiple mediation modeling, the indirect effect of personal agency on BPD was significant for preoccupied, fearful, and secure attachment, but was non-significant for dismissive attachment. Lower personal agency was associated with insecure adult attachment styles. Conclusions Findings highlight the previously unexplored relationship between BPD and personal agency and indicate that adult attachment style plays a significant role. Low personal agency may increase challenges for individuals with symptoms of BPD by exacerbating relationship difficulties. People in treatment for BPD may benefit from focusing on both relationship insecurity and its impact on their perceived personal control.
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Affiliation(s)
- Talia Hashworth
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Samantha Reis
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Brin F S Grenyer
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
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16
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Family relationships and DSM-5 personality domains in adolescence: A person- and variable-based approach. PERSONALITY AND INDIVIDUAL DIFFERENCES 2021. [DOI: 10.1016/j.paid.2020.110582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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17
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Svrakic DM, Zorumski CF. Neuroscience of Object Relations in Health and Disorder: A Proposal for an Integrative Model. Front Psychol 2021; 12:583743. [PMID: 33790822 PMCID: PMC8005655 DOI: 10.3389/fpsyg.2021.583743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 01/08/2021] [Indexed: 11/13/2022] Open
Abstract
Recent advances in the neuroscience of episodic memory provide a framework to integrate object relations theory, a psychoanalytic model of mind development, with potential neural mechanisms. Object relations are primordial cognitive-affective units of the mind derived from survival- and safety-level experiences with caretakers during phase-sensitive periods of infancy and toddlerhood. Because these are learning experiences, their neural substrate likely involves memory, here affect-enhanced episodic memory. Inaugural object relations are encoded by the hippocampus-amygdala synaptic plasticity, and systems-consolidated by medial prefrontal cortex (mPFC). Self- and object-mental representations, extracted from these early experiences, are at first dichotomized by contradictory affects evoked by frustrating and rewarding interactions ("partial object relations"). Such affective dichotomization appears to be genetically hardwired the amygdala. Intrinsic propensity of mPFC to form schematic frameworks for episodic memories may pilot non-conscious integration of dichotomized mental representations in neonates and infants. With the emergence of working memory in toddlers, an activated self- and object-representation of a particular valence can be juxtaposed with its memorized opposites creating a balanced cognitive-affective frame (conscious "integration of object relations"). Specific events of object relations are forgotten but nevertheless profoundly influence the mental future of the individual, acting (i) as implicit schema-affect templates that regulate attentional priorities, relevance, and preferential assimilation of new information based on past experience, and (ii) as basic units of experience that are, under normal circumstances, integrated as attractors or "focal points" for interactive self-organization of functional brain networks that underlie the mind. A failure to achieve integrated object relations is predictive of poor adult emotional and social outcomes, including personality disorder. Cognitive, cellular-, and systems-neuroscience of episodic memory appear to support key postulates of object relations theory and help elucidate neural mechanisms of psychodynamic psychotherapy. Derived through the dual prism of psychoanalysis and neuroscience, the gained insights may offer new directions to enhance mental health and improve treatment of multiple forms of psychopathology.
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Affiliation(s)
- Dragan M. Svrakic
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Charles F. Zorumski
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Department of Psychiatry, Taylor Family Institute for Innovative Psychiatric Research, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
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18
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Clark GI, Rock AJ, Clark LH, Murray‐lyon K. Adult attachment, worry and reassurance seeking: Investigating the role of intolerance of uncertainty. CLIN PSYCHOL-UK 2021. [DOI: 10.1111/cp.12218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Gavin I. Clark
- School of Psychology, Newcastle University, Newcastle upon Tyne, UK,
- School of Psychology, University of New England, Armidale, Australia,
| | - Adam J. Rock
- School of Psychology, University of New England, Armidale, Australia,
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[Psychometric evaluation of the Experiences in Close Relationships Revised German 12-item version (ECR-RD 12) in a sample of psychotherapeutic inpatients]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2021; 67:56-69. [PMID: 33565379 DOI: 10.13109/zptm.2021.67.1.56] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Psychometric evaluation of the Experiences in Close Relationships Revised German 12-item version (ECR-RD 12) in a sample of psychotherapeutic inpatients Objectives: The ECR-R assesses the self-description of adult attachment strategies in romantic relationships. The present study evaluates the psychometric properties of the German 12-item short version ECR-RD 12 in a large sample of patients in psychotherapeutic inpatient treatment. Method: Inpatients in psychotherapeutic treatment (N = 2231) were assessed using the ECR-RD 12 and other clinical questionnaires. Its psychometric properties and factor structure of were evaluated. Results: The psychometric properties of the short form measure were in line with the German full length version (ECR-RD). In contrast to theoretical assumptions, factor analysis suggested a three factor solution in the present sample. Discussion: The ECR-RD 12 can be recommended as a screening measure for assessing attachment styles in inpatient psychotherapeutic settings. Further studies are required to investigate the factor structure of the measure in clinical samples.
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20
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Bottesi G, Tesini V, Cerea S, Ghisi M. Are difficulties in emotion regulation and intolerance of uncertainty related to negative affect in borderline personality disorder? CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12163] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Gioia Bottesi
- Department of General Psychology, University of Padova, Padova, Italy,
| | - Veronica Tesini
- Department of General Psychology, University of Padova, Padova, Italy,
| | - Silvia Cerea
- Department of General Psychology, University of Padova, Padova, Italy,
| | - Marta Ghisi
- Department of General Psychology, University of Padova, Padova, Italy,
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21
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Kaurin A, Beeney JE, Stepp SD, Scott LN, Woods WC, Pilkonis PA, Wright AG. Attachment and Borderline Personality Disorder: Differential Effects on Situational Socio-Affective Processes. AFFECTIVE SCIENCE 2020; 1:117-127. [PMID: 33718882 PMCID: PMC7954219 DOI: 10.1007/s42761-020-00017-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 08/24/2020] [Indexed: 06/12/2023]
Abstract
Insecure attachment and borderline personality disorder (BPD) are defined by similar affective and interpersonal processes. Individuals diagnosed with BPD, however, represent only a subset of those described as insecurely attached, suggesting that attachment may hold broader relevance for socio-affective functioning. Based on a 21-day ecological momentary assessment protocol in a mixed clinical and community sample (N = 207) oversampled for BPD, we evaluate the discriminant validity of each construct as it influences daily interpersonal interactions. We find that insecure attachment is associated with elevated perceptions of interpersonal disaffiliation and maladaptive strategies for affect regulation, whereas enacted interpersonal hostility is more distinctive for BPD. In a series of sensitivity analyses, we further highlight potential caveats to these findings when studying both constructs concurrently. Together, our results suggest that both insecure attachment and BPD contribute to problematic affective and interpersonal processes, but that they do so at different stages of the unfolding social interaction, which has important implications for their maintenance and treatment.
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Affiliation(s)
- Aleksandra Kaurin
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA USA
| | - Joseph E. Beeney
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Stephanie D. Stepp
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Lori N. Scott
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - William C. Woods
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA USA
| | - Paul A. Pilkonis
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Aidan G.C. Wright
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA USA
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22
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Pathogenic beliefs among patients with schizotypal personality disorder. Heliyon 2020; 6:e03870. [PMID: 32382682 PMCID: PMC7200782 DOI: 10.1016/j.heliyon.2020.e03870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/25/2020] [Accepted: 04/23/2020] [Indexed: 11/24/2022] Open
Abstract
This study aimed to explore the differences in pathogenic beliefs (PBs) between patients with schizotypal personality disorder (PD) and those with other PDs or without any PD. The study was conducted among 212 patients treated with psychotherapy at the Psychotherapy and Personality Disorder Clinic, Chiang Mai University between 2007 and 2019. Collected data included sociodemographic information, psychiatric disorders and personality disorder as determined by the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, and the Pathogenic Belief Scale (PBS). An analysis was conducted to compare three groups, i.e., patients with schizotypal PD, patients with other PDs and patients without any PD. The PBS score was compared by two outcomes: a total score and a categorical score of individual items. The entire sample was predominantly female (62.3%) with a mean age of 31.41 years. Most participants had a bachelor's degree (76.9%), lived alone (72.6%) and received diagnoses of major depressive disorder (45.8%). No significant differences were found in participants' characteristics regarding age, sex, educational level, marital status and psychiatric clinical diagnosis among the three groups. The mean PBS total score was highest for schizotypal PD (mean = 58.74, SD = 11.54), compared with non-schizotypal PD (mean = 46.14, SD = 13.15) and non-PD (mean = 46.07, SD = 11.17). Twenty of 27 items were significantly higher in the schizotypal PD group than in other groups, after adjusting for type I error. The number of PBs was significantly prominent for schizotypal PD. Possible explanations were provided.
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23
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The Capacity to End: Termination of Mentalization-Based Therapy for Borderline Personality Disorder. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2020. [DOI: 10.1007/s10879-020-09456-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Davies G, Hayward M, Evans S, Mason O. A systematic review of structural MRI investigations within borderline personality disorder: Identification of key psychological variables of interest going forward. Psychiatry Res 2020; 286:112864. [PMID: 32163818 DOI: 10.1016/j.psychres.2020.112864] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 02/09/2020] [Accepted: 02/09/2020] [Indexed: 12/19/2022]
Abstract
Existing models of Borderline Personality Disorder (BPD) suggest that a combination of genetic vulnerability, childhood trauma, and disrupted attachment can lead to the marked emotional lability, impulsivity and interpersonal difficulties observed clinically. Brain structural differences in frontal, limbic and hippocampal regions have been reported in BPD. Less clear is how specific psychological factors relate to these structural differences, and how consistently this is found across studies. This was the focus of the present review. Eighteen studies published between 2004 and 2018 met inclusion criteria encompassing 990 participants. Study quality was assessed using the Nottingham-Ottawa Scale. We also introduce a newly devised scale to assess MRI reporting quality. The most frequently investigated psychological variable were impulsivity (9 studies), depression (8), trauma (6), aggression (6), severity of symptoms (3), global functioning, abuse and dissociation (2). Study quality varied, however, a trend was observed where newer studies were higher in reporting quality. Impulsivity demonstrated greater association with frontal structures, trauma related to the hypothalamus and limbic systems, and aggression with hippocampal and frontal structures. The present review recommends greater exploration of neurocognitive and psychosis-related features such as delusions, paranoia and voice-hearing in future studies, and to investigate cortical changes in longitudinal designs.
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Affiliation(s)
- Geoff Davies
- Faculty of Health and Medical Science, University of Surrey, Guildford, UK; Surrey & Borders NHS Trust, UK.
| | - Mark Hayward
- School of Psychology, University of Sussex, UK; Sussex Partnership NHS Foundation Trust, UK
| | - Simon Evans
- Faculty of Health and Medical Science, University of Surrey, Guildford, UK
| | - Oliver Mason
- Faculty of Health and Medical Science, University of Surrey, Guildford, UK
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25
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Van Heel M, Luyten P, De Meulemeester C, Vanwalleghem D, Vermote R, Lowyck B. Mentalizing Based on External Features in Borderline Personality Disorder Compared With Healthy Controls: The Role of Attachment Dimensions and Childhood Trauma. J Pers Disord 2019; 33:736-750. [PMID: 30689514 DOI: 10.1521/pedi_2019_33_373] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Extant research suggests that borderline personality disorder (BPD) is associated with impairments in mentalizing, that is, comprehending behavior in terms of underlying mental states. However, the precise nature of these impairments remains unclear. The literature is mixed concerning mental-izing based on external features of others, and specifically facial emotion recognition (FER) in BPD patients. This study investigated FER differences in 79 BPD patients and 79 matched healthy controls using the Reading the Mind in the Eyes Test (RMET). The authors also investigated attachment dimensions and childhood trauma in relation to mentalizing based on external features. Results showed that BPD patients performed worse on positive and negative emotions. Furthermore, avoidant attachment was negatively related to FER for neutral emotions, particularly in the control group. Trauma was negatively related to FER at trend level, particularly in BPD patients. The implications for this understanding of mentalizing based on external features in BPD are discussed.
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Affiliation(s)
- Martijn Van Heel
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Patrick Luyten
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | | | | | - Rudi Vermote
- University Psychiatric Hospital UPC KU Leuven, Campus Kortenberg and Department of Neurosciences, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Benedicte Lowyck
- University Psychiatric Hospital UPC KU Leuven, Campus Kortenberg and Department of Neurosciences, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Research Department of Clinical, Educational and Health Psychology, University College London, UK
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26
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Molaie AM, Chiu CY, Habib Z, Galynker I, Briggs J, Rosenfield PJ, Calati R, Yaseen ZS. Emotional Pain Mediates the Link Between Preoccupied Attachment and Non-suicidal Self-Injury in High Suicide Risk Psychiatric Inpatients. Front Psychol 2019; 10:289. [PMID: 30846949 PMCID: PMC6393353 DOI: 10.3389/fpsyg.2019.00289] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 01/29/2019] [Indexed: 11/16/2022] Open
Abstract
Background: Non-suicidal self-injury (NSSI) is a risk factor for suicide attempts (SA). Both attachment disturbances and cognitive and emotional problems (e.g., emotional pain) have been associated with SA history. This study sought to determine differential contributions of attachment styles and cognitive and emotional states associated with SA to lifetime NSSI occurrence among adults hospitalized for suicide risk. Sampling and Methods: Adult psychiatric inpatients (n = 200) were assessed for attachment style, cognitive and emotional states, and lifetime NSSI within 72 h of hospitalization. Binary logistic regression and mediation analyses were performed. Results: Preoccupied attachment and emotional pain at admission were independently associated with lifetime NSSI. Emotional pain partially mediated the relationship between preoccupied attachment and lifetime NSSI. Limitations: The cross-sectional nature of the study and the use of a dichotomous (yes/no) measure of NSSI, not specifically designed for its assessment. Conclusions: Preoccupied attachment and emotional pain are associated with NSSI and may be useful targets for assessing risk of NSSI.
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Affiliation(s)
- Ali M Molaie
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, United States
| | - Chih-Yun Chiu
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, United States
| | - Zara Habib
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, United States
| | - Igor Galynker
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, United States
| | - Jessica Briggs
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, United States
| | - Paul J Rosenfield
- Department of Psychiatry, Mount Sinai St. Luke's and Mount Sinai West, New York, NY, United States
| | - Raffaella Calati
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, United States
| | - Zimri S Yaseen
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, United States
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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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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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Adshead G, Moore E, Humphrey M, Wilson C, Tapp J. The role of mentalising in the management of violence. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.bp.110.008243] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SummaryViolence between people is a complex social phenomenon involving both social and individual psychological variables. Prevention of violence includes attention to risk factors for violence; but also the provision of interventions for those who have been violent to others. This article explores the evidence that failures of the mentalising process are a risk factor for acts of violence, especially in mental health service users; and describes the implementation of potential therapeutic programmes that seek to improve mentalising in individuals who pose a risk of serious violence to others.
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30
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Mentalization in borderline individuals: an attempt to integrate contradictory research results. CURRENT ISSUES IN PERSONALITY PSYCHOLOGY 2018. [DOI: 10.5114/cipp.2018.80196] [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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31
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Parra F, Miljkovitch R, Persiaux G, Morales M, Scherer S. The Multimodal Assessment of Adult Attachment Security: Developing the Biometric Attachment Test. J Med Internet Res 2017; 19:e100. [PMID: 28385683 PMCID: PMC5399225 DOI: 10.2196/jmir.6898] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/27/2017] [Accepted: 03/05/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Attachment theory has been proven essential for mental health, including psychopathology, development, and interpersonal relationships. Validated psychometric instruments to measure attachment abound but suffer from shortcomings common to traditional psychometrics. Recent developments in multimodal fusion and machine learning pave the way for new automated and objective psychometric instruments for adult attachment that combine psychophysiological, linguistic, and behavioral analyses in the assessment of the construct. OBJECTIVE The aim of this study was to present a new exposure-based, automatic, and objective adult-attachment assessment, the Biometric Attachment Test (BAT), which exposes participants to a short standardized set of visual and music stimuli, whereas their immediate reactions and verbal responses, captured by several computer sense modalities, are automatically analyzed for scoring and classification. We also aimed to empirically validate two of its assumptions: its capacity to measure attachment security and the viability of using themes as placeholders for rotating stimuli. METHODS A total of 59 French participants from the general population were assessed using the Adult Attachment Questionnaire (AAQ), the Adult Attachment Projective Picture System (AAP), and the Attachment Multiple Model Interview (AMMI) as ground truth for attachment security. They were then exposed to three different BAT stimuli sets, whereas their faces, voices, heart rate (HR), and electrodermal activity (EDA) were recorded. Psychophysiological features, such as skin-conductance response (SCR) and Bayevsky stress index; behavioral features, such as gaze and facial expressions; as well as linguistic and paralinguistic features, were automatically extracted. An exploratory analysis was conducted using correlation matrices to uncover the features that are most associated with attachment security. A confirmatory analysis was conducted by creating a single composite effects index and by testing it for correlations with attachment security. The stability of the theory-consistent features across three different stimuli sets was explored using repeated measures analysis of variances (ANOVAs). RESULTS In total, 46 theory-consistent correlations were found during the exploration (out of 65 total significant correlations). For example, attachment security as measured by the AAP was correlated with positive facial expressions (r=.36, P=.01). AMMI's security with the father was inversely correlated with the low frequency (LF) of HRV (r=-.87, P=.03). Attachment security to partners as measured by the AAQ was inversely correlated with anger facial expression (r=-.43, P=.001). The confirmatory analysis showed that the composite effects index was significantly correlated to security in the AAP (r=.26, P=.05) and the AAQ (r=.30, P=.04) but not in the AMMI. Repeated measures ANOVAs conducted individually on each of the theory-consistent features revealed that only 7 of the 46 (15%) features had significantly different values among responses to three different stimuli sets. CONCLUSIONS We were able to validate two of the instrument's core assumptions: its capacity to measure attachment security and the viability of using themes as placeholders for rotating stimuli. Future validation of other of its dimensions, as well as the ongoing development of its scoring and classification algorithms is discussed.
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Affiliation(s)
- Federico Parra
- Institute for Creative Technologies, University of Southern California, Los Angeles, CA, United States.,Paragraphe Laboratory, Paris VIII University, Saint-Denis, France
| | | | | | - Michelle Morales
- Institute for Creative Technologies, University of Southern California, Los Angeles, CA, United States.,The Graduate Center, City University of New York, New York, NY, United States
| | - Stefan Scherer
- Institute for Creative Technologies, University of Southern California, Los Angeles, CA, United States
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Relationships between self-reported childhood traumatic experiences, attachment style, neuroticism and features of borderline personality disorders in patients with mood disorders. J Affect Disord 2017; 210:82-89. [PMID: 28024223 DOI: 10.1016/j.jad.2016.12.004] [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: 07/12/2016] [Revised: 11/17/2016] [Accepted: 12/12/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Co-occurring borderline personality disorder (BPD) features have a marked impact on treatment of patients with mood disorders. Overall, high neuroticism, childhood traumatic experiences (TEs) and insecure attachment are plausible aetiological factors for BPD. However, their relationship with BPD features specifically among patients with mood disorders remains unclear. We investigated these relationships among unipolar and bipolar mood disorder patients. METHODS As part of the Helsinki University Psychiatric Consortium study, the McLean Screening Instrument (MSI), the Experiences in Close Relationships-Revised (ECR-R), the Short Five (S5) and the Trauma and Distress Scale (TADS) were filled in by patients with mood disorders (n=282) in psychiatric care. Correlation coefficients between total scores of scales and their dimensions were estimated, and multivariate regression (MRA) and mediation analyses were conducted. RESULTS Spearman's correlations were strong (rho=0.58; p<0.001) between total scores of MSI and S5 Neuroticism and moderate (rho=0.42; p<0.001) between MSI and TADS as well as between MSI and ECR-R Attachment Anxiety. In MRA, young age, S5 Neuroticism and TADS predicted scores of MSI (p<0.001). ECR-R Attachment Anxiety mediated 33% (CI=17-53%) of the relationships between TADS and MSI. LIMITATIONS Cross-sectional questionnaire study. CONCLUSIONS We found moderately strong correlations between self-reported BPD features and concurrent high neuroticism, reported childhood traumatic experiences and Attachment Anxiety also among patients with mood disorders. Independent predictors for BPD features include young age, frequency of childhood traumatic experiences and high neuroticism. Insecure attachment may partially mediate the relationship between childhood traumatic experiences and borderline features among mood disorder patients.
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Romaniuk L, Pope M, Nicol K, Steele D, Hall J. Neural correlates of fears of abandonment and rejection in borderline personality disorder. Wellcome Open Res 2016. [DOI: 10.12688/wellcomeopenres.10331.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Borderline personality disorder (BPD) is a prevalent and disabling psychiatric condition commonly associated with early life adversity. Social difficulties are a prominent symptom of BPD, particularly a fear of abandonment and rejection. There has recently been a growing interest in the neural basis of these social symptoms and their relationship to early experience. Methods: In the current study, we examined social brain function and learning in BPD using functional MRI. Participants with BPD (n=20) and healthy controls (n=16) completed a computerized parametric social exclusion task (the “Cyberball” task). Brain activation was compared between groups and related to social symptom status and experiences of childhood trauma. Additional analyses were conducted using a reinforcement learning model treating social inclusion as a rewarding event. Results: Participants with BPD demonstrated a group effect of decreased right temporoparietal junction (TPJ) activation (p < 0.013, FWE-corrected). Increased fear of abandonment in BPD was associated with reduced inclusion-related activation of the inferior frontal gyrus (p = 0.003, FWE-corrected). Across all participants, TPJ inclusion-related activation was modified by prior experience of childhood physical neglect (p < 0.001, FWE-corrected). Reinforcement learning modelling revealed decreased midbrain responses to social inclusion in BPD participants (p = 0.028, FWE-corrected within midbrain mask), with decreased anticipatory midbrain activation in anticipation of social inclusion specifically associated with fears of abandonment (p = 0.019, FWE-corrected within a midbrain mask). Conclusions: The findings demonstrate alterations in social brain function and social reinforcement learning in BPD, which are influenced by both early life experience and symptom status.
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Aleknaviciute J, Tulen JHM, Kamperman AM, de Rijke YB, Kooiman CG, Kushner SA. Borderline and cluster C personality disorders manifest distinct physiological responses to psychosocial stress. Psychoneuroendocrinology 2016; 72:131-8. [PMID: 27413994 DOI: 10.1016/j.psyneuen.2016.06.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 05/23/2016] [Accepted: 06/13/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Maladaptive emotional control is a defining feature of personality disorders. Yet little is known about the underlying physiological dynamics of emotional reactivity to psychosocial stress across distinct personality disorders. The current study compared subjective emotional responses with autonomic nervous system and HPA axis physiological responses to psychosocial stress in women with cluster C personality disorder (CPD) and borderline personality disorder (BPD). METHODS Subjective mood ratings, salivary cortisol, heart rate (HR), and skin conductance level (SCL) were assessed before, during, and after exposure to a standardized psychosocial stress paradigm (Trier Social Stress Test, TSST) in 26 women with BPD, 20 women with CPD, and 35 healthy female controls. Subjects were free of any medication including hormonal contraceptives, had a regular menstrual cycle, and were tested during the luteal phase of their menstrual cycle. RESULTS Both CPD and BPD patients reported a similar burden of subjective mood disturbance. However, only BPD patients demonstrated reduced baseline cortisol levels with a blunted cortisol and HR reactivity to the TSST. In addition, BPD patients exhibited a generalized increase of SCL. No significant differences in baseline or TSST reactivity of cortisol, HR, or SCL were observed between CPD patients and healthy controls. CONCLUSION These findings indicate that patients with BPD have significant alterations in their physiological stress reactivity, which is notably distinct from patients with CPD and those of healthy controls.
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Affiliation(s)
| | - Joke H M Tulen
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Astrid M Kamperman
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands; Epidemiological and Social Psychiatric Research Institute, Rotterdam, The Netherlands.
| | - Yolanda B de Rijke
- Department of Clinical Chemistry, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Cornelis G Kooiman
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands; Rivierduinen, Institute of Mental Health Care, Zoetermeer, The Netherlands.
| | - Steven A Kushner
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands.
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Ramos V, Canta G, de Castro F, Leal I. The relation between attachment, personality, internalizing, and externalizing dimensions in adolescents with borderline personality disorder. Bull Menninger Clin 2016; 80:213-33. [PMID: 27583810 DOI: 10.1521/bumc.2016.80.3.213] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The relation between attachment and personality features is an important field to explore in adolescent borderline personality disorder (BPD), and previous research has shown that personality features may be conceptualized within latent internalizing and externalizing dimensions. This cross-sectional study used a structural equation model to examine the association between the BPD participants' perception of attachment and personality features, mediated by the underlying internalizing/externalizing personality dimensions. Data were analyzed for 60 adolescents, ages 15 to 18 years, diagnosed with BPD who completed attachment and personality self-report measures. The authors' results showed a good fit of the model, suggesting a significant association between attachment and the internalizing/externalizing dimensions, which simultaneously congregate and influence personality traits. The perception of attachment anxiety was positively related to the internalizing dimension and at the same time negatively related to the externalizing dimension. However, the perception of attachment avoidance was not related to internalizing or externalizing personality dimensions.
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Affiliation(s)
- Vera Ramos
- William James Center for Research, ISPA - Instituto Universitário, Lisboa, Portugal, and in the Hospital Garcia de Orta, Child and Adolescent Psychiatry Unit, Almada, Portugal
| | | | | | - Isabel Leal
- William James Center for Research, ISPA - Instituto Universitário, Lisboa, Portugal
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Evidence-Based Treatments for Borderline Personality Disorder: Implementation, Integration, and Stepped Care. Harv Rev Psychiatry 2016; 24:342-56. [PMID: 27603742 DOI: 10.1097/hrp.0000000000000113] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
LEARNING OBJECTIVE After participating in this activity, learners should be better able to:• Evaluate evidence-based therapies for borderline personality disorder ABSTRACT Several manualized psychotherapies for treating borderline personality disorder (BPD) have been validated in randomized, controlled trials. Most of these approaches are highly specialized, offering different formulation of BPD and different mechanisms by which recovery is made possible. Mental health clinicians are challenged by the degree of specialization and clinical resources that these approaches require in their empirically validated adherent forms. While these effective treatments have renewed optimism for the treatment of BPD, clinicians may feel limited in their ability to offer any of them or may integrate an eclectic assortment of features from the different treatments. This article will evaluate four major evidence-based treatments for BPD-dialectical behavioral therapy, mentalization-based treatment, transference-focused psychotherapy, and General Psychiatric Management-and possible modes of implementation in adherent and integrative forms. Models of implementing these diverse treatment approaches will be evaluated, and the potential advantages of combining evidence-based treatments will be discussed, along with some cautionary notes. A proposal for providing stepwise care through assessment of clinical severity will be presented as a means of achieving system-wide changes and greater access to care.
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Sharp C, Venta A, Vanwoerden S, Schramm A, Ha C, Newlin E, Reddy R, Fonagy P. First empirical evaluation of the link between attachment, social cognition and borderline features in adolescents. Compr Psychiatry 2016; 64:4-11. [PMID: 26298843 DOI: 10.1016/j.comppsych.2015.07.008] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 07/13/2015] [Accepted: 07/15/2015] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Several developmental models of borderline personality disorder (BPD) emphasize the role of disrupted interpersonal relationships or insecure attachment. As yet, attachment quality and the mechanisms by which insecure attachment relates to borderline features in adolescents have not been investigated. In this study, we used a multiple mediational approach to examine the cross-sectional interplay between attachment, social cognition (in particular hypermentalizing), emotion dysregulation, and borderline features in adolescence, controlling for internalizing and externalizing symptoms. METHODS The sample included 259 consecutive admissions to an adolescent inpatient unit (Mage=15.42, SD=1.43; 63.1% female). The Child Attachment Interview (CAI) was used to obtain a dimensional index of overall coherence of the attachment narrative. An experimental task was used to assess hypermentalizing, alongside self-report measures of emotion dyregulation and BPD. RESULTS Our findings suggested that, in a multiple mediation model, hypermentalizing and emotion dysregulation together mediated the relation between attachment coherence and borderline features, but that this effect was driven by hypermentalizing; that is, emotion dysregulation failed to mediate the link between attachment coherence and borderline features while hypermentalizing demonstrated mediational effects. CONCLUSIONS The study provides the first empirical evidence of well-established theoretical approaches to the development of BPD.
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Affiliation(s)
- Carla Sharp
- University of Houston, Houston, TX, USA; The Menninger Clinic, Houston, TX, USA.
| | - Amanda Venta
- Sam Houston State University, Huntsville, TX, USA
| | - Salome Vanwoerden
- University of Houston, Houston, TX, USA; The Menninger Clinic, Houston, TX, USA
| | | | - Carolyn Ha
- University of Houston, Houston, TX, USA; The Menninger Clinic, Houston, TX, USA
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Sinnaeve R, van den Bosch LMC, van Steenbergen-Weijenburg KM. Change in interpersonal functioning during psychological interventions for borderline personality disorder—a systematic review of measures and efficacy. Personal Ment Health 2015; 9:173-94. [PMID: 26058794 DOI: 10.1002/pmh.1296] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 04/08/2015] [Accepted: 04/23/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To provide a systematic review of measures of interpersonal functioning used in treatments for people diagnosed with borderline personality disorder (BPD) and to report the effectiveness of treatments on these measures of interpersonal functioning. METHOD Literature was reviewed using the online databases and reference lists of previous systematic reviews. Selected studies were randomized controlled trials (RCTs) that examined psychotherapeutic interventions for people with BPD and contained quantitative outcomes on various aspects of interpersonal functioning and reported their results in peer-reviewed journals. Reliability and validity of the results were evaluated. RESULTS Nineteen RCTs met our inclusion criteria. We found 16 different (sub)scales that measured some aspect of interpersonal functioning. Only four instruments were used by more than one research team. There is some evidence that psychotherapeutic interventions have beneficial effects on some aspects of interpersonal functioning in people diagnosed with BPD, both after individual and group therapy. Generalizability of these findings is limited. CONCLUSION There is preliminary evidence that psychotherapeutic interventions have beneficial effects on various aspects of interpersonal reactivity that characterize people diagnosed with BPD. However, none of these effects have a robust evidence base. There are serious concerns about the lack of agreed-upon concepts and instruments.
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Affiliation(s)
| | - Louisa M C van den Bosch
- University Psychiatric Center K.U. Leuven, Leuven, Belgium.,Psychiatric Hospital Pro Persona, Arnhem, The Netherlands.,Pro Persona Centre for Education and Science, Nijmegen, The Netherlands
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Ensink K, Biberdzic M, Normandin L, Clarkin J. A Developmental Psychopathology and Neurobiological Model of Borderline Personality Disorder in Adolescence. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/15289168.2015.1007715] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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40
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Sharp C, Vanwoerden S. Hypermentalizing in Borderline Personality Disorder: A Model and Data. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/15289168.2015.1004890] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Okuda M, Olfson M, Wang S, Rubio JM, Xu Y, Blanco C. Correlates of intimate partner violence perpetration: results from a National Epidemiologic Survey. J Trauma Stress 2015; 28:49-56. [PMID: 25624189 DOI: 10.1002/jts.21986] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study presents data on the association of intimate partner violence (IPV) perpetration and rates of psychiatric disorders, and other correlates. Data were drawn from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative sample of adults in the United States, 18 years and older, residing in households and group quarters. The sample comprised adults who reported being in a relationship within the past 12 months (N = 25,631). Of these, 1,677 individuals reported perpetrating IPV (4.2% in men, 7.0% in women). Compared to non-IPV perpetrators, IPV perpetrators had greater odds of having any psychiatric disorder, 42.0% and 67.7%, respectively, OR = 2.89, 95% CI [2.51, 3.32]. After adjusting for the effects of nuisance variables, being younger, having an alcohol use disorder, a personality disorder, low levels of social support, and low income were associated with perpetration. Across a wide range of factors, IPV victimization itself had the strongest association with perpetration, AOR = 66.12, 95% CI [55.01, 79.48]. Mental health assessments of IPV perpetrators might offer an opportunity to identify and treat psychiatric disorders and improve the clinical course of conditions that can be affected by ongoing acts of violence.
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Affiliation(s)
- Mayumi Okuda
- Department of Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons of Columbia University, New York, USA
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Dissociation of explicit and implicit measures of the behavioral inhibition and activation system in borderline personality disorder. Psychiatry Res 2014; 218:134-42. [PMID: 24798120 DOI: 10.1016/j.psychres.2014.04.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 02/15/2014] [Accepted: 04/09/2014] [Indexed: 01/01/2023]
Abstract
Patients with borderline personality disorder (BPD) suffer from various impairments in emotional functioning such as affective instability, inappropriate anger and unstable relationships. These deficits may influence two fundamental motivational systems, the behavioral inhibition system (BIS) and behavioral activation system (BAS). To investigate behavioral intentions and possible impairments in BPD we applied an implicit joystick task to measure implicit behavioral tendencies in response to facial expressions (happiness, sadness, anger, fear and neutral) in 25 patients with BPD and matched 25 healthy controls (HC). Additionally, we evaluated explicit approach and avoidance reactions to these social stimuli, emotion recognition abilities and subjective behavioral ratings. Our data analysis suggests that, although BPD patients accurately identified facial emotional expressions and reacted to them similarly as HC in the joystick task, they had significantly stronger avoidance tendencies in the rating task, especially for happiness and fear. On top of this they exhibited increased BIS sensitivity and decreased BAS sensitivity in the self-report measures. Possible influences are maladaptive cognitive schemas, high negative affect, insecure attachment style and a negative evaluation bias. The observed dysfunctional avoidance ratings may influence the appraisal of socially relevant stimuli and therefore adds further knowledge on social interaction problems in BPD.
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Elliot RL, Campbell L, Hunter M, Cooper G, Melville J, McCabe K, Newman L, Loughland C. WHEN I LOOK INTO MY BABY'S EYES . . . INFANT EMOTION RECOGNITION BY MOTHERS WITH BORDERLINE PERSONALITY DISORDER. Infant Ment Health J 2013; 35:21-32. [DOI: 10.1002/imhj.21426] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ricki-Leigh Elliot
- Mothers and Babies Unit, Hunter New England Mental Health, Mater Hospital Campus; Newcastle and University of Newcastle; Australia
| | - Linda Campbell
- School of Psychology, Ourimbah Campus, University of Newcastle, Australia; Centre for Translational Neuroscience and Mental Health, University of Newcastle, Australia; and Hunter Medical Research Institute; Newcastle Australia
| | - Mick Hunter
- Centre for Translational Neuroscience and Mental Health, The University of Newcastle
| | - Gavin Cooper
- Centre for Translational Neuroscience and Mental Health, The University of Newcastle
| | - Jessica Melville
- Centre for Translational Neuroscience and Mental Health, The University of Newcastle
| | - Kathryn McCabe
- Brain & Mind Research Institute, University of Sydney, NSW, Australia; Schizophrenia Research Institute, Darlinghurst, NSW, Australia; Centre for Translational Neuroscience and Mental Health, The University of Newcastle
| | | | - Carmel Loughland
- Centre for Translational Neuroscience and Mental Health, University of Newcastle, Australia; Schizophrenia Research Institute, Sydney, Australia; and Hunter Medical Research Institute; Newcastle Australia
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MacDonald K, Berlow R, Thomas ML. Attachment, affective temperament, and personality disorders: a study of their relationships in psychiatric outpatients. J Affect Disord 2013; 151:932-41. [PMID: 24054918 DOI: 10.1016/j.jad.2013.07.040] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Revised: 02/25/2013] [Accepted: 07/31/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND As the result of extensive translational and cross-disciplinary research, attachment theory is now a construct with significant neuropsychiatric traction. The correlation of attachment with other influential conceptual models (i.e. temperament and personality) is therefore of interest. Consequently, we explored how two attachment dimensions (attachment anxiety and attachment avoidance) correlated with measures of temperament and personality in 357 psychiatric outpatients. METHODS We performed a retrospective review of four questionnaires (the Experiences in Close Relationship scale (ECR-R), Temperament and Character inventory (TCI), Temperament Evaluation of the Memphis, Pisa, Paris and San Diego questionnaire (TEMPS-A), and Personality Self-Portrait Questionnaire (PSQ)). Frequency measures and correlations were examined, as was the predictive value of attachment security for a personality disorder (PD). RESULTS Significant, robust correlations were found between attachment anxiety and (1) several negative affective temperaments (dysthymic and cyclothymic); (2) several indices of personality pathology (low self-directedness (TCI), DSM-IV paranoid, borderline, histrionic, avoidant and dependent personality traits). Attachment avoidance had fewer large correlations. In an exploratory model, the negative predictive value of attachment security for a PD was 86%. LIMITATIONS Subjects were a relatively homogeneous subset of ambulatory psychiatric outpatients. PD diagnoses were via self-report. CONCLUSIONS Clinically, these findings highlight the significant overlap between attachment, affective temperament, and personality and support the value of attachment as a screen for PDs. More broadly, given our growing understanding of the neurobiology of attachment (i.e. links with the oxytocin system), these results raise interesting questions about underlying biological systems and psychiatric treatment.
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Affiliation(s)
- Kai MacDonald
- University of California Medical Center, Department of Psychiatry, USA.
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Bernecker SL, Levy KN, Ellison WD. A meta-analysis of the relation between patient adult attachment style and the working alliance. Psychother Res 2013; 24:12-24. [DOI: 10.1080/10503307.2013.809561] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Roma P, Pazzelli F, Pompili M, Girardi P, Ferracuti S. Shibari: double hanging during consensual sexual asphyxia. ARCHIVES OF SEXUAL BEHAVIOR 2013. [PMID: 23187701 DOI: 10.1007/s10508-012-0035-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
We describe a case of shibari, a double hanging sexual asphyxia practice, which ended fatally for one of the two women involved. We present the autopsy findings and a psychiatric and psychometric evaluation of the surviving participant. The survivor had a borderline personality disorder, had suffered sexual abuse as a child, and had a history of illicit substance consumption, self-harm behavior, and sexual dysregulation. This case study raises doubts regarding the safety measures adopted by participants in masochistic practices and the engagement of people with psychiatric disorders in these extremely dangerous games. Further case studies of living participants in such games are likely to shed light on this practice and facilitate treatment.
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Affiliation(s)
- Paolo Roma
- NESMOS Department (Neurosciences Mental Health and Sensory Organs) Sapienza, Faculty of Medicine and Psychology, University of Rome, Level 3, Room 113, Via di Grottarossa, Sant'Andrea Hospital 1035-1039, 00189, Rome, Italy.
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Fossati A, Borroni S, Feeney J, Maffei C. Predicting borderline personality disorder features from personality traits, identity orientation, and attachment styles in Italian nonclinical adults: issues of consistency across age ranges. J Pers Disord 2012; 26:280-97. [PMID: 22486456 DOI: 10.1521/pedi.2012.26.2.280] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aims of this study were to assess whether Borderline Personality Disorder (BPD) features could be predicted by Big Five traits, impulsivity, identity orientation, and adult attachment patterns in a sample of 1,192 adult nonclinical participants, and to evaluate the consistency of these regression models across four age groups (<30 years, 30-39 years, 40-49 years, and >50 years, respectively). In the full sample, measures of neuroticism (N), impulsivity, and anxious insecure attachment were substantial predictors of BPD features (adjusted R(2) = .38, p < .001). Attachment scales were significant predictors of BPD features across all age groups, but different scales were relevant in different age groups. Our results suggest that in nonclinical populations, BPD may represent a complex constellation of personality traits and disturbed attachment patterns.
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Affiliation(s)
- Andrea Fossati
- Servizio di Psicologia Clinica e Psicoterapia, San Raffaele Turro, Vita-Salute San Raffaele University, via Stamira d’Ancona 20, Milan, Italy.
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Berenson KR, Downey G, Rafaeli E, Coifman KG, Paquin NL. The rejection-rage contingency in borderline personality disorder. JOURNAL OF ABNORMAL PSYCHOLOGY 2011; 120:681-90. [PMID: 21500875 DOI: 10.1037/a0023335] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Though long-standing clinical observation reflected in the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) suggests that the rage characteristic of borderline personality disorder (BPD) often appears in response to perceived rejection, the role of perceived rejection in triggering rage in BPD has never been empirically tested. Extending basic personality research on rejection sensitivity to a clinical sample, a priming-pronunciation experiment and a 21-day experience-sampling diary examined the contingent relationship between perceived rejection and rage in participants diagnosed with BPD compared with healthy controls. Despite the differences in these 2 assessment methods, the indices of rejection-contingent rage that they both produced were elevated in the BPD group and were strongly interrelated. They provide corroborating evidence that reactions to perceived rejection significantly explain the rage seen in BPD.
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Affiliation(s)
- Kathy R Berenson
- Department of Psychology, Columbia University, 1190 Amsterdam Avenue, MC 5501, New York, NY 10027, USA.
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49
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Berthoud L, Kramer U, de Roten Y, Despland JN, Caspar F. Using Plan Analysis in Psychotherapeutic Case Formulation of Borderline Personality Disorder. Clin Psychol Psychother 2011; 20:1-9. [DOI: 10.1002/cpp.784] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Revised: 07/22/2011] [Accepted: 07/22/2011] [Indexed: 01/04/2023]
Affiliation(s)
- Laurent Berthoud
- University Institute of Psychotherapy; Department of Psychiatry; University of Lausanne; Switzerland
| | - Ueli Kramer
- University Institute of Psychotherapy; Department of Psychiatry; University of Lausanne; Switzerland
| | - Yves de Roten
- University Institute of Psychotherapy; Department of Psychiatry; University of Lausanne; Switzerland
| | - Jean-Nicolas Despland
- University Institute of Psychotherapy; Department of Psychiatry; University of Lausanne; Switzerland
| | - Franz Caspar
- Department for Clinical Psychology and Psychotherapy; University of Bern; Switzerland
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Troisi A, Frazzetto G, Carola V, Di Lorenzo G, Coviello M, Siracusano A, Gross C. Variation in the μ-opioid receptor gene (OPRM1) moderates the influence of early maternal care on fearful attachment. Soc Cogn Affect Neurosci 2011; 7:542-7. [PMID: 21742765 DOI: 10.1093/scan/nsr037] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
There is evidence that both early experience and genetic variation play a role in influencing sensitivity to social rejection. In this study, we aimed at ascertaining if the A118G polymorphism of the μ-opioid receptor gene (OPRM1) moderates the impact of early maternal care on fearful attachment, a personality trait strongly related to rejection sensitivity. In 112 psychiatric patients, early maternal care and fearful attachment were measured using the Parental Bonding Inventory and the Relationship Questionnaire (RQ), respectively. The pattern emerging from the RQ data was a crossover interaction between genotype and maternal caregiving. Participants expressing the minor 118 G allele had similar and relatively high scores on fearful attachment regardless of the quality of maternal care. By contrast, early experience made a major difference for participants carrying the A/A genotype. Those who recalled higher levels of maternal care reported the lowest levels of fearful attachment whereas those who recalled lower levels of maternal care scored highest on fearful attachment. Our data fit well with the differential susceptibility model which stipulates that plasticity genes would make some individuals more responsive than others to the negative consequences of adversity and to the benefits of environmental support and enrichment.
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Affiliation(s)
- Alfonso Troisi
- Department of Neurosciences, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy.
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