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Boog M, Dugonjic H, Arntz A, Goudriaan AE, Wetering BJMVD, Franken IHA. Borderline Personality Disorder With Versus Without Alcohol Use Disorder: Comparing Impulsivity and Schema Modes. J Pers Disord 2022; 36:1-18. [PMID: 33999655 DOI: 10.1521/pedi_2021_35_521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Substance use disorders (SUDs) and borderline personality disorder (BPD) are highly comorbid. In the present study, an attempt was made to understand the differences between BPD and BPD with comorbid SUD (BPD + alcohol use disorder [AUD]), by studying impulsivity and schema modes (i.e., maladaptive moment-to-moment emotional states and coping responses). BPD patients, BPD+AUD patients, and nonpatients (NP) were compared regarding behavioral impulsivity (motor impulsivity, risk taking, delay discounting), and schema modes. The two patient groups displayed greater delay discounting than the NP group. Further, BPD and BPD+AUD groups were different from the NP group regarding all schema modes investigated. However, no differences were found on any of the dependent variables between the two patient groups. It is suggested that although BPD patients are in general more impulsive and have more maladaptive moment-to-moment emotional states and coping responses, BPD patients with and without AUD seem not to be different in this respect.
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Affiliation(s)
- Michiel Boog
- Antes Mental Health Care, Rotterdam, the Netherlands.,Institute of Psychology, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | | | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, the Netherlands
| | - Anna E Goudriaan
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Arkin Mental Health Care, Amsterdam, the Netherlands
| | | | - Ingmar H A Franken
- Institute of Psychology, Erasmus University Rotterdam, Rotterdam, the Netherlands
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Schag K, Rauch-Schmidt M, Wernz F, Zipfel S, Batra A, Giel KE. Transdiagnostic Investigation of Impulsivity in Alcohol Use Disorder and Binge Eating Disorder With Eye-Tracking Methodology-A Pilot Study. Front Psychiatry 2019; 10:724. [PMID: 31681036 PMCID: PMC6813717 DOI: 10.3389/fpsyt.2019.00724] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 09/09/2019] [Indexed: 01/01/2023] Open
Abstract
Objective: Patients with alcohol use disorder (AUD) and patients with binge eating disorder (BED) are characterized by increased impulsivity, i.e. increased reward sensitivity and diminished response inhibition. In this pilot study, we compare both disorders directly concerning impulsivity using disorder-specific stimuli to gain insight into the relationship of both disorders and underlying mechanisms. Methods: We compared eye movements of 23 women with BED (age M = 40.9), 21 participants with AUD (13 females, 8 males, age M = 46.6), and age- and sex-matched control groups (BED-CG and AUD-CG, respectively). We measured reward sensitivity with the free exploration paradigm and response inhibition with the modified antisaccade paradigm. We presented disorder-specific stimuli vs. neutral stimuli, i.e. food stimuli in the BED and BED-CG and alcohol stimuli in the AUD and AUD-CG. Results: BED and BED-CG initially fixated more often on food stimuli vs. neutral stimuli, whereas AUD and AUD-CG initially fixated more often on neutral stimuli vs. alcohol stimuli. AUD showed shorter dwell times on both stimulus categories in comparison with the other groups. When saccades towards stimuli should be inhibited, BED made more errors in first saccades for both stimulus categories in comparison with AUD-CG and in second saccades particularly for food stimuli in comparison with all other groups, whereas AUD did not differ from the control groups. Conclusions: This pilot study indicates that food and alcohol stimuli are at the first sight differently processed. Moreover, patients with BED and with AUD seem to process disorder-specific stimuli differently. Whereas patients with AUD avoid stimuli generally, patients with BED predominantly show deficits in inhibitory control.
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Affiliation(s)
- Kathrin Schag
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Competence Center for Eating Disorders Tübingen (KOMET), Tübingen, Germany
| | - Magdalena Rauch-Schmidt
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Competence Center for Eating Disorders Tübingen (KOMET), Tübingen, Germany
| | - Friederike Wernz
- Department of Psychiatry and Psychotherapy, Section Addiction Medicine and Addiction Research, University Hospital Tübingen, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Competence Center for Eating Disorders Tübingen (KOMET), Tübingen, Germany
| | - Anil Batra
- Department of Psychiatry and Psychotherapy, Section Addiction Medicine and Addiction Research, University Hospital Tübingen, Tübingen, Germany
| | - Katrin E Giel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Competence Center for Eating Disorders Tübingen (KOMET), Tübingen, Germany
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Jiménez-Murcia S, Fernández-Aranda F, Mestre-Bach G, Granero R, Tárrega S, Torrubia R, Aymamí N, Gómez-Peña M, Soriano-Mas C, Steward T, Moragas L, Baño M, Del Pino-Gutiérrez A, Menchón JM. Exploring the Relationship between Reward and Punishment Sensitivity and Gambling Disorder in a Clinical Sample: A Path Modeling Analysis. J Gambl Stud 2017; 33:579-597. [PMID: 27447184 DOI: 10.1007/s10899-016-9631-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Most individuals will gamble during their lifetime, yet only a select few will develop gambling disorder. Gray's Reinforcement Sensitivity Theory holds promise for providing insight into gambling disorder etiology and symptomatology as it ascertains that neurobiological differences in reward and punishment sensitivity play a crucial role in determining an individual's affect and motives. The aim of the study was to assess a mediational pathway, which included patients' sex, personality traits, reward and punishment sensitivity, and gambling-severity variables. The Sensitivity to Punishment and Sensitivity to Reward Questionnaire, the South Oaks Gambling Screen, the Symptom Checklist-Revised, and the Temperament and Character Inventory-Revised were administered to a sample of gambling disorder outpatients (N = 831), diagnosed according to DSM-5 criteria, attending a specialized outpatient unit. Sociodemographic variables were also recorded. A structural equation model found that both reward and punishment sensitivity were positively and directly associated with increased gambling severity, sociodemographic variables, and certain personality traits while also revealing a complex mediational role for these dimensions. To this end, our findings suggest that the Sensitivity to Punishment and Sensitivity to Reward Questionnaire could be a useful tool for gaining a better understanding of different gambling disorder phenotypes and developing tailored interventions.
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Affiliation(s)
- Susana Jiménez-Murcia
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain. .,Ciber Fisiopatología Obesidad y Nutrición (CB 06/03), Instituto Salud Carlos III, C/Monforte de Lemos, 3-5. Pabellón 11-Planta 0, 28029, Madrid, Spain. .,Department of Clinical Sciences, School of Medicine, University of Barcelona, Campus de Bellvitge - Pavelló de Govern, Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain.
| | - Fernando Fernández-Aranda
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain.,Ciber Fisiopatología Obesidad y Nutrición (CB 06/03), Instituto Salud Carlos III, C/Monforte de Lemos, 3-5. Pabellón 11-Planta 0, 28029, Madrid, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Campus de Bellvitge - Pavelló de Govern, Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Gemma Mestre-Bach
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain.,Ciber Fisiopatología Obesidad y Nutrición (CB 06/03), Instituto Salud Carlos III, C/Monforte de Lemos, 3-5. Pabellón 11-Planta 0, 28029, Madrid, Spain
| | - Roser Granero
- Ciber Fisiopatología Obesidad y Nutrición (CB 06/03), Instituto Salud Carlos III, C/Monforte de Lemos, 3-5. Pabellón 11-Planta 0, 28029, Madrid, Spain.,Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, C/Fortuna Edifici B, Bellaterra, Cerdanyola del Vallès, 08193, Barcelona, Spain
| | - Salomé Tárrega
- Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, C/Fortuna Edifici B, Bellaterra, Cerdanyola del Vallès, 08193, Barcelona, Spain
| | - Rafael Torrubia
- Department of Psychiatry and Forensic Medicine, Institute of Neurosciences, School of Medicine, Autonomous University of Barcelona, Av. de Can Domènech, 737, 08193, Cerdanyola, Barcelona, Spain
| | - Neus Aymamí
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Mónica Gómez-Peña
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Carles Soriano-Mas
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain.,Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, C/Fortuna Edifici B, Bellaterra, Cerdanyola del Vallès, 08193, Barcelona, Spain.,Ciber de Salud Mental (CIBERSAM), Instituto Salud Carlos III, C/Monforte de Lemos 3-5. Pabellón 11-Planta 0, 28029, Madrid, Spain
| | - Trevor Steward
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain.,Ciber Fisiopatología Obesidad y Nutrición (CB 06/03), Instituto Salud Carlos III, C/Monforte de Lemos, 3-5. Pabellón 11-Planta 0, 28029, Madrid, Spain
| | - Laura Moragas
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Marta Baño
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Amparo Del Pino-Gutiérrez
- Nursing Department of Mental Health, Public Health, Maternal and Child Health, Nursing School, University of Barcelona, Campus de Bellvitge - Pavelló de Govern, Feixa Llarga s/n, Hospitalet del Llobregat, 08907, Barcelona, Spain
| | - José M Menchón
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain.,Ciber Fisiopatología Obesidad y Nutrición (CB 06/03), Instituto Salud Carlos III, C/Monforte de Lemos, 3-5. Pabellón 11-Planta 0, 28029, Madrid, Spain.,Ciber de Salud Mental (CIBERSAM), Instituto Salud Carlos III, C/Monforte de Lemos 3-5. Pabellón 11-Planta 0, 28029, Madrid, Spain
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Boog M, Höppener P, V D Wetering BJM, Goudriaan AE, Boog MC, Franken IHA. Cognitive Inflexibility in Gamblers is Primarily Present in Reward-Related Decision Making. Front Hum Neurosci 2014; 8:569. [PMID: 25165438 PMCID: PMC4131672 DOI: 10.3389/fnhum.2014.00569] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 07/13/2014] [Indexed: 11/17/2022] Open
Abstract
One hallmark of gambling disorder (GD) is the observation that gamblers have problems stopping their gambling behavior once it is initiated. On a neuropsychological level, it has been hypothesized that this is the result of a cognitive inflexibility. The present study investigated cognitive inflexibility in patients with GD using a task involving cognitive inflexibility with a reward element (i.e., reversal learning) and a task measuring general cognitive inflexibility without such a component (i.e., response perseveration). For this purpose, scores of a reward-based reversal learning task (probabilistic reversal learning task) and the Wisconsin card sorting task were compared between a group of treatment seeking patients with GD and a gender and age matched control group. The results show that pathological gamblers have impaired performance on the neurocognitive task measuring reward-based cognitive inflexibility. However, no difference between the groups is observed regarding non-reward-based cognitive inflexibility. This suggests that cognitive inflexibility in GD is the result of an aberrant reward-based learning, and not based on a more general problem with cognitive flexibility. The pattern of observed problems is suggestive of a dysfunction of the orbitofrontal cortex, the ventrolateral prefrontal cortex, and the ventral regions of the striatum in gamblers. Relevance for the neurocognition of problematic gambling is discussed.
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Affiliation(s)
- Michiel Boog
- Bouman Mental Health Care , Rotterdam , Netherlands ; Institute of Psychology, Erasmus University Rotterdam , Rotterdam , Netherlands
| | - Paul Höppener
- Bouman Mental Health Care , Rotterdam , Netherlands ; Reinier van Arkel Groep , 's-Hertogenbosch , Netherlands
| | | | - Anna E Goudriaan
- Department of Psychiatry, Academic Medical Center, Amsterdam Institute for Addiction Research, University of Amsterdam , Amsterdam , Netherlands ; Arkin Mental Health Care , Amsterdam , Netherlands
| | - Matthijs C Boog
- Department of Public Health, Erasmus MC , Rotterdam , Netherlands
| | - Ingmar H A Franken
- Institute of Psychology, Erasmus University Rotterdam , Rotterdam , Netherlands
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