1
|
Yetim O, Yalçın Ö. Etiopathogenesis in the Development of Borderline Personality Characteristics in Children and Adolescents. TURK PSIKIYATRI DERGISI = TURKISH JOURNAL OF PSYCHIATRY 2024; 35:137-149. [PMID: 38842155 PMCID: PMC11164069 DOI: 10.5080/u26852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 04/25/2022] [Indexed: 06/07/2024]
Abstract
The validity and clinical significance of the characteristics of borderline personality disorder (BPD) in adolescents are increasingly being recognized. The persistence of BPD characteristics in adolescence is high and is associated with negative interpersonal, academic, professional, and financial outcomes. In the literature, BPD characteristics observed in children and adolescents are explained with psychodynamic theories, developmental models, and evolutionary approaches. Emotional dysregulation, interpersonal dysfunction, impulsivity, and self-harming behavior, negative life events, temperament characteristics, neuropsychological dysfunctions, neuroanatomical, genetic, hormonal, and immunological factors may play a role in BPD etiopathogenesis. This review aims to address different approaches and relevant factors for the development of BPD. The articles published between 1968-2021 in the PubMed database were reviewed, and prominent studies were selected for evaluation. The importance of invalidating environment, epistemic freezing and hypermentalization, complex or attachment trauma is emphasized in psychodynamic and developmental literature. In the evolutionary approach, on the other hand, romantic relationships and the onset of reproduction are emphasized as the reason for the emergence of symptoms during adolescence, and it is argued that BPD is related to the rapid life history strategy. It is stated that a decrease in volume in the orbitofrontal cortex and anterior cingulate cortex, which are involved in top-down emotional processing, and an increase in the activity of thalamus and hippocampus regions, which are involved in bottom-up emotional processing are observed in adolescents with BPD characteristics when compared to healthy controls. It is thought that the increase in activation in the superior temporal gyrus and precuneus observed in adolescents with BPD features is a neural indicator of hypermentalization, and the increase in activation in the insula is a neural indicator of social pain. It has been reported that the decrease in resting heart rate and the increase in heart rate variability observed in adolescents with BPD symptoms are associated with the activation of the parasympathetic system. BPD in adolescents is a disorder that challenges clinicians in terms of diagnosis, differential diagnosis, and treatment. It is crucial to evaluate the factors related to etiopathogenesis in BPD in a multifaceted and detailed manner. Keywords: Borderline Personality Disorder, Difficulty in Emotion Regulation, Mentalization, Trauma, Self-harming Behavior, Temperamental Characteristics.
Collapse
Affiliation(s)
- Onat Yetim
- Psychiatrist, Ersin Arslan Research and Educational Hospital, Child and Adolescent Mental Health, Gaziantep
| | - Özhan Yalçın
- Assoc. Prof., Private Practice, Child and Adolescent Psychiatrist Antalya, Turkey
| |
Collapse
|
2
|
Preti E, Richetin J, Poggi A, Fertuck E. A Model of Trust Processes in Borderline Personality Disorder: A Systematic Review. Curr Psychiatry Rep 2023; 25:555-567. [PMID: 37889465 PMCID: PMC10654201 DOI: 10.1007/s11920-023-01468-y] [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] [Accepted: 10/04/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE OF REVIEW Unstable relationships are a core feature of borderline personality disorder (BPD). Impairments in trust processes (i.e., appraisal and learning regarding others' trustworthiness) can subserve interpersonal problems associated with BPD, but the determinants, mechanisms, consequences, and variations in trust impairments among individuals with BPD remain poorly characterized. Thus, a better understanding of such impairments could help target interventions that address the interpersonal problems of individuals with BPD beyond emotion dysregulation, impulsivity, and aggression. RECENT FINDINGS We conducted a pre-registered systematic review of empirical studies on trust processes and BPD features (k = 29). Results are organized around a heuristic model of trust processes in BPD comprising the following stages: developmental factors, prior beliefs and dispositions, situation perception, emotional states, trust appraisal, behavioral manifestations, and trust learning. Based on the synthesis of the findings, we recommended directions for future research and clinical assessment and intervention, such as managing trust during the early stages of therapy and considering improvements in trust processes as a central mechanism of change in treating individuals with BPD.
Collapse
Affiliation(s)
- Emanuele Preti
- Department of Psychology, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126, Milan, Italy.
| | - Juliette Richetin
- Department of Psychology, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126, Milan, Italy
| | - Anita Poggi
- Department of Psychology, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126, Milan, Italy
| | - Eric Fertuck
- City College of the City University of New York, New York, USA
| |
Collapse
|
3
|
Uzar M, Dmitrzak-Węglarz M, Słopień A. Mentalizing in Adolescents with Borderline Personality Disorder. Brain Sci 2023; 13:1473. [PMID: 37891840 PMCID: PMC10605837 DOI: 10.3390/brainsci13101473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
Mentalizing, recognized as the capacity to understand behaviors in the context of our own mental states and those of other people, is being researched more and more commonly in regard to various mental disorders. The research on mentalization focuses on, among other things, borderline personality disorder, which is at present perceived as an emerging problem in the population of adolescents. In order to summarize the currently accessible knowledge of mentalizing in adolescents with borderline personality disorder, we thoroughly analyzed relevant publications. Based on the available literature, it can be concluded that the mentalizing ability of adolescents with borderline personality disorder can be impaired. The evidence demonstrates that they are prone to hypermentalizing, defined as an overattribution of mental states to other people. However, this tendency has not been proven to be specific to teenagers with this disorder. Moreover, the existing data suggest that young people with borderline personality exhibit a reduced capacity to mentalize their own inner states.
Collapse
Affiliation(s)
- Magdalena Uzar
- Department of Child and Adolescent Psychiatry, Karol Jonscher Clinical Hospital, Poznan University of Medical Sciences, Szpitalna 27/33 St., 60-572 Poznan, Poland;
| | - Monika Dmitrzak-Węglarz
- Department of Psychiatric Genetics, Medical Biology Center, Poznan University of Medical Sciences, Rokietnicka St. 8, 60-806 Poznan, Poland;
| | - Agnieszka Słopień
- Department of Child and Adolescent Psychiatry, Karol Jonscher Clinical Hospital, Poznan University of Medical Sciences, Szpitalna 27/33 St., 60-572 Poznan, Poland;
| |
Collapse
|
4
|
Meehan KB, Cain NM, Roche MJ, Fertuck EA, Sowislo JF, Clarkin JF. Evaluating Change in Transference, Interpersonal Functioning, and Trust Processes in the Treatment of Borderline Personality Disorder: A Single-Case Study Using Ecological Momentary Assessment. J Pers Disord 2023; 37:490-507. [PMID: 37903025 DOI: 10.1521/pedi.2023.37.5.490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
Transference-focused psychotherapy (TFP) is an empirically supported treatment for borderline personality disorder (BPD) that improves functioning via targeting representations of self affectively relating to others, particularly as evoked in the therapeutic relationship. If change in TFP operates as theorized, then shifts in patterns of "self affectively relating to others" should be observed in the transference prior to shifts in daily relationships. Using ecological momentary assessment (EMA), a patient with BPD rated daily interpersonal events for 2-week periods during 18 months of TFP; at 9 and 18 months these ratings included interactions with the therapist. Results suggest that positive perceptions of her therapist that ran counter to her negatively biased perception in other relationships preceded changes in her perceptions of others. EMA shifts corresponded to improvements in self-reported symptoms, interview-based personality functioning, and therapist assessments. Implications for assimilation of a trusting experience with the therapist as a mechanism of change in TFP are discussed.
Collapse
Affiliation(s)
- Kevin B Meehan
- Long Island University - Brooklyn, NY
- Weill Medical College of Cornell University, New York, New York
| | | | | | - Eric A Fertuck
- The City College and Graduate Center of CUNY, New York, New York
| | - Julia F Sowislo
- Weill Medical College of Cornell University, New York, New York
| | - John F Clarkin
- Weill Medical College of Cornell University, New York, New York
| |
Collapse
|
5
|
Rückert KK, Ernst M, Zwerenz R, Michal M, Beutel ME, Krakau L. [The relationship of functional and symptomatic changes after multimodal psychodynamic treatment]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2023; 69:261-277. [PMID: 37815587 DOI: 10.13109/zptm.2023.69.3.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
Objectives: Personality organization or functioning describes biographically acquired characteristics for the regulation of psychological processes. Limitations correlate with symptom load. This study examines whether significant improvement in personality functioning can be achieved in the framework of a multimodal psychodynamic treatment and its influence on the psychological symptoms. Methods: In this naturalistic study design (N = 318) personality organization was measured with the OPD-SQS and the symptoms were obtained using PHQ-9, GAD-7, SCL-9 and mini- Spin. Changes in the functioning levels were calculated using a t-test. The associations between the functional and symptom improvements were calculated using hierarchical regressionmodels. ANOVAs for dependent samples were used to calculate the association of the personality organization changes on symptom reduction Results: Treatment resulted in significant improvement in personality structure.The greater the changes, the lower the symptom burden at the end of treatment. Patients with lower personality structure benefited equally well from treatment. Conclusions: Personality functioning improves with multimodal psychodynamic therapy and is accompanied by reduction of psychological symptoms. Structural changes proceed equally in high and low structured patients.
Collapse
Affiliation(s)
- Kamiar Kersten Rückert
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie Universitätsmedizin der Johannes Gutenberg-Universität Mainz Untere Zahlbacher Str. 8 55131 Mainz Deutschland
| | - Mareike Ernst
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie Universitätsmedizin der Johannes Gutenberg-Universität Mainz Untere Zahlbacher Str. 8 55131 Mainz Deutschland
| | - Rüdiger Zwerenz
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie Universitätsmedizin der Johannes Gutenberg-Universität Mainz Untere Zahlbacher Str. 8 55131 Mainz Deutschland
| | - Matthias Michal
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie Universitätsmedizin der Johannes Gutenberg-Universität Mainz Untere Zahlbacher Str. 8 55131 Mainz Deutschland
| | - Manfred E Beutel
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie Universitätsmedizin der Johannes Gutenberg-Universität Mainz Untere Zahlbacher Str. 8 55131 Mainz Deutschland
| | - Lina Krakau
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie Universitätsmedizin der Johannes Gutenberg-Universität Mainz Untere Zahlbacher Str. 8 55131 Mainz Deutschland
| |
Collapse
|
6
|
Fertuck EA, Stanley B, Kleshchova O, Mann JJ, Hirsch J, Ochsner K, Pilkonis P, Erbe J, Grinband J. Rejection Distress Suppresses Medial Prefrontal Cortex in Borderline Personality Disorder. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2023; 8:651-659. [PMID: 36868964 PMCID: PMC10388534 DOI: 10.1016/j.bpsc.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/25/2022] [Accepted: 11/17/2022] [Indexed: 12/10/2022]
Abstract
BACKGROUND Borderline personality disorder (BPD) is characterized by an elevated distress response to social exclusion (i.e., rejection distress), the neural mechanisms of which remain unclear. Functional magnetic resonance imaging studies of social exclusion have relied on the classic version of the Cyberball task, which is not optimized for functional magnetic resonance imaging. Our goal was to clarify the neural substrates of rejection distress in BPD using a modified version of Cyberball, which allowed us to dissociate the neural response to exclusion events from its modulation by exclusionary context. METHODS Twenty-three women with BPD and 22 healthy control participants completed a novel functional magnetic resonance imaging modification of Cyberball with 5 runs of varying exclusion probability and rated their rejection distress after each run. We tested group differences in the whole-brain response to exclusion events and in the parametric modulation of that response by rejection distress using mass univariate analysis. RESULTS Although rejection distress was higher in participants with BPD (F1,40 = 5.25, p = .027, η2 = 0.12), both groups showed similar neural responses to exclusion events. However, as rejection distress increased, the rostromedial prefrontal cortex response to exclusion events decreased in the BPD group but not in control participants. Stronger modulation of the rostromedial prefrontal cortex response by rejection distress was associated with higher trait rejection expectation, r = -0.30, p = .050. CONCLUSIONS Heightened rejection distress in BPD might stem from a failure to maintain or upregulate the activity of the rostromedial prefrontal cortex, a key node of the mentalization network. Inverse coupling between rejection distress and mentalization-related brain activity might contribute to heightened rejection expectation in BPD.
Collapse
Affiliation(s)
- Eric A Fertuck
- Department of Psychology, Clinical Psychology Doctoral Program, The City College of the City University of New York, New York, New York; Department of Psychiatry, Columbia University, New York, New York; Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, New York.
| | - Barbara Stanley
- Department of Psychiatry, Columbia University, New York, New York; Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, New York
| | - Olena Kleshchova
- Department of Psychology, University of Nevada Reno, Reno, Nevada
| | - J John Mann
- Department of Psychiatry, Columbia University, New York, New York; Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, New York
| | - Joy Hirsch
- Departments of Psychiatry, Neuroscience and Comparative Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Kevin Ochsner
- Department of Psychology, Columbia University, New York, New York
| | - Paul Pilkonis
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jeff Erbe
- Department of Psychology, Clinical Psychology Doctoral Program, The City College of the City University of New York, New York, New York; Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, New York
| | - Jack Grinband
- Department of Psychiatry, Columbia University, New York, New York
| |
Collapse
|
7
|
Blay M, Cohen S, Jan M, Perroud N, Speranza M, Charbon P. [Towards a pragmatic cohabitation of theoretical and clinical models: The example of "Good Psychiatric Management" in the treatment of borderline personality disorder]. L'ENCEPHALE 2023:S0013-7006(23)00042-8. [PMID: 37088579 DOI: 10.1016/j.encep.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/16/2023] [Accepted: 01/31/2023] [Indexed: 04/25/2023]
Abstract
Borderline personality disorder (BPD) is a common disorder in general and clinical populations and is related to potentially severe medical and socio-professional consequences. Treatment of BPD is based on evidence-based psychotherapies (such as Dialectical Behavioral Therapy, Mentalization-Based Therapy, Schema-Focused Therapy or Transference Focused Psychotherapy), which have been shown effective but are poorly available in France. Pharmacological treatments, which are more easily available, are not effective in treating symptoms of the disorder but can be useful in management of comorbidities. In this context, recently called "generalist" models have been developed, which every well-trained psychiatrist can implement in their daily practice, combining practical elements from evidence-based psychotherapies and elements of pharmacological management of symptoms and comorbidities. The purpose of this article is to present one of these models, the Good Psychiatric Management (GPM) and its basic principles and its applications, and to provide one of the first French-speaking resources about this model. In addition, beyond the practical elements proposed by the GPM, we discuss the deeper question that it raises, namely the question of a pragmatic integration of different theoretical and clinical models. Indeed, the treatment of BPD patients is at the junction of different conceptualizations of mental pathology (psychopathological, neurobiological) and different modalities of practice (psychotherapy, biological psychiatry). In a French context, that sometimes separates these two models, and in our opinion GPM constitutes an example of clinical collaboration which shows the interest of the combined role of psychiatrist-psychotherapist.
Collapse
Affiliation(s)
- Martin Blay
- ADDIPSY, Centre ambulatoire d'addictologie et de psychiatrie, Groupe santé basque développement, 164, avenue Jean-Jaurès, 69007 Lyon, France; Université Claude-Bernard Lyon 1, Lyon, France.
| | - Satchel Cohen
- Centre hospitalier de Versailles, Service universitaire de psychiatrie de l'enfant et de l'adolescent, Le Chesnay, France
| | - Marlène Jan
- Centre hospitalier de Versailles, Service universitaire de psychiatrie de l'enfant et de l'adolescent, Le Chesnay, France
| | - Nader Perroud
- Service des spécialités psychiatriques, Département de psychiatrie, Hôpitaux universitaires de Genève, Genève, Suisse; Département de psychiatrie, Université de Genève, Genève, Suisse
| | - Mario Speranza
- Centre hospitalier de Versailles, Service universitaire de psychiatrie de l'enfant et de l'adolescent, Le Chesnay, France; Université Paris-Saclay, UVSQ, Inserm, Centre de recherche en épidémiologie et santé des populations Team "DevPsy", 94807 Villejuif, France
| | - Patrick Charbon
- Service des spécialités psychiatriques, Département de psychiatrie, Hôpitaux universitaires de Genève, Genève, Suisse; Cabinet de groupe « D'un Monde à l'Autre », Lausanne, Suisse
| |
Collapse
|
8
|
Jackson M, Foret BL, Fontenot J, Hasselschwert D, Smith J, Romero E, Smith KM. Molecular examination of the endogenous opioid system in rhesus macaque monkeys with self-injurious behavior. J Neurosci Res 2023; 101:70-85. [PMID: 36131680 DOI: 10.1002/jnr.25128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/30/2022] [Accepted: 09/10/2022] [Indexed: 11/10/2022]
Abstract
Self-injurious behavior (SIB) can lead to serious injury and occurs in approximately 1%-4% of the adult population, with higher incidences in adolescent and institutionalized populations, as well as in children with developmental disorders such as Autism. SIB also spontaneously occurs in a low percentage of captive monkeys. Rhesus macaque (Macaca mulatta) monkeys are evolutionarily and physiologically similar to humans, share 93% genetic sequence similarity to humans, and have long been used as testing subjects for vaccine and clinical trials. Previous studies hypothesized that altered endogenous opioid expression occurs in the brains of individuals and animals that self-injure. We examined the regional mRNA expression of opioid signaling genes in sixteen rhesus macaques that exhibited SIB and eight sex- and age- matched controls. The brain regions examined are linked to reward reinforcement and stress adaptation including the hypothalamus, orbital frontal cortex, nucleus accumbens, hippocampus, caudate, and the amygdala. We found decreased μ-opioid receptor (OPRM1) in the amygdala of monkeys with SIB, and reduced prodynorphin (PDYN) in the hypothalamus. Our data suggest dysfunction in the regulation of opioid peptide precursors and calls for further investigation of the endogenous opioid system in SIB.
Collapse
Affiliation(s)
- Marques Jackson
- Department of Biology, University of Louisiana at Lafayette, Lafayette, Louisiana, USA
| | - Brittany L Foret
- Department of Biology, University of Louisiana at Lafayette, Lafayette, Louisiana, USA
| | - Jane Fontenot
- New Iberia Research Center, University of Louisiana at Lafayette, New Iberia, Louisiana, USA
| | - Dana Hasselschwert
- New Iberia Research Center, University of Louisiana at Lafayette, New Iberia, Louisiana, USA
| | - Josh Smith
- New Iberia Research Center, University of Louisiana at Lafayette, New Iberia, Louisiana, USA
| | - Emily Romero
- New Iberia Research Center, University of Louisiana at Lafayette, New Iberia, Louisiana, USA
| | - Karen Müller Smith
- Department of Biology, University of Louisiana at Lafayette, Lafayette, Louisiana, USA
| |
Collapse
|
9
|
Marazziti D, Diep PT, Carter S, Carbone MG. Oxytocin: An Old Hormone, A Novel Psychotropic Drug And Possible Use In Treating Psychiatric Disorders. Curr Med Chem 2022; 29:5615-5687. [PMID: 35894453 DOI: 10.2174/0929867329666220727120646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/17/2022] [Accepted: 04/19/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Oxytocin is a nonapeptide synthesized in the paraventricular and supraoptic nuclei of the hypothalamus. Historically, this molecule has been involved as a key factor in the formation of infant attachment, maternal behavior and pair bonding and, more generally, in linking social signals with cognition, behaviors and reward. In the last decades, the whole oxytocin system has gained a growing interest as it was proposed to be implicated in etiopathogenesis of several neurodevelopmental and neuropsychiatric disorders. METHODS With the main goal of an in-depth understanding of the oxytocin role in the regulation of different functions and complex behaviors as well as its intriguing implications in different neuropsychiatric disorders, we performed a critical review of the current state of art. We carried out this work through PubMed database up to June 2021 with the search terms: 1) "oxytocin and neuropsychiatric disorders"; 2) "oxytocin and neurodevelopmental disorders"; 3) "oxytocin and anorexia"; 4) "oxytocin and eating disorders"; 5) "oxytocin and obsessive-compulsive disorder"; 6) "oxytocin and schizophrenia"; 7) "oxytocin and depression"; 8) "oxytocin and bipolar disorder"; 9) "oxytocin and psychosis"; 10) "oxytocin and anxiety"; 11) "oxytocin and personality disorder"; 12) "oxytocin and PTSD". RESULTS Biological, genetic, and epigenetic studies highlighted quality and quantity modifications in the expression of oxytocin peptide or in oxytocin receptor isoforms. These alterations would seem to be correlated with a higher risk of presenting several neuropsychiatric disorders belonging to different psychopathological spectra. Collaterally, the exogenous oxytocin administration has shown to ameliorate many neuropsychiatric clinical conditions. CONCLUSION Finally, we briefly analyzed the potential pharmacological use of oxytocin in patient with severe symptomatic SARS-CoV-2 infection due to its anti-inflammatory, anti-oxidative and immunoregulatory properties.
Collapse
Affiliation(s)
- Donatella Marazziti
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Italy.,Saint Camillus International University of Health and Medical Sciences, Rome, Italy
| | - Phuoc-Tan Diep
- Department of Histopathology, Royal Lancaster Infirmary, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, United Kingdom
| | - Sue Carter
- Director Kinsey Institute, Indiana University, Bloomington, IN, USA
| | - Manuel G Carbone
- Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, 21100 Varese, Italy
| |
Collapse
|
10
|
Cakin Memik N, Hunc F, Kalayci S, Demir N, Senturk E, Yildiz Gundogdu O, Ozlen Dillioglugil M. Assessment of Plasma-Endogenous Opioid Neuropeptide Levels and Psychometric Properties of Non-Suicidal Self-Injury in Adolescents. Arch Suicide Res 2022; 27:749-768. [PMID: 35499526 DOI: 10.1080/13811118.2022.2066494] [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: 11/02/2022]
Abstract
OBJECTIVE Non-suicidal self-injury (NSSI) is one of the most common mental health problems and growing public-health issues, coupled with a significant population-level burden among adolescents in both developed and developing countries. We aimed to assess the role of endogenous opioid system-emotion regulation circuitry in NSSI through measurement of plasma beta-endorphin (β-EP), met-enkephalin (MENK) levels, and determination of psychometric features of Turkish adolescent subjects. METHOD In this research, we measured plasma β-EP and MENK levels of 49 adolescents with NSSI and 39 control subjects without NSSI between the ages of 12-18 years. All adolescent subjects were observed in the outpatient clinic, and their clinical and sociodemographic characteristics were examined. All subjects were assessed using the Brief Symptom Inventory (BSI) and Inventory of Statements About Self Injury (ISAS). RESULTS Plasma β-EP levels were statistically lower in adolescents with NSSI than control group, whereas there was no statistically significant difference in MENK levels. β-EP levels showed a negative correlation with depression severity. The data obtained from BSI and ISAS were not found to be associated with both β-EP and MENK levels, while subscale scores exhibited versatile correlations. CONCLUSION Our findings supported the salient role of β-EP in NSSI behavior. Also, decreased plasma β-EP could be assessed as a reliable indicator for NSSI. However, it is possible that measurement of basal plasma levels of neuropeptides might also bring many confounders and could cause bias. Therefore, repeated measurements of plasma-endogenous opioid neuropeptides in a time-dependent manner-concomitant to engage of NSSI behavior-might give more reliable results.
Collapse
|
11
|
Kartal F, Uğur K, Mete B, Demirkol ME, Tamam L. The Relationship Between the Oxytocin Level and Rejection Sensitivity, Childhood Traumas, and Attachment Styles in Borderline Personality Disorder. Psychiatry Investig 2022; 19:239-246. [PMID: 35330564 PMCID: PMC8958212 DOI: 10.30773/pi.2021.0358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/19/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE In this study, it is aimed to investigate the relationship between the oxytocin level and the rejection sensitivity, childhood mental traumas, and attachment styles in patients diagnosed with borderline personality disorder (BPD). METHODS Participants between the ages of 18-30 were included in the study. The patient group consists of 31 participants and the healthy control group consists of 31 participants. Sociodemographic/Clinical Variables Questionnaire, Relationship Scales Questionnaire, Rejection Sensitivity Questionnaire and Childhood Trauma Questionnaire were administered to the participants included in the study. Serum oxytocin levels of the participants were measured using the Elisa method. RESULTS The oxytocin levels were found to be significantly lower in patients with BPD than in healthy control subjects, whereas the rejection sensitivity and childhood traumas were found to be significantly higher. No difference was found between the patient and control groups in terms of attachment styles, yet it was determined that there may be differences between the oxytocin levels of the BPD patients according to the attachment styles the patients have. CONCLUSION In conclusion, the findings of this study revealed that the rejection sensitivity in BPD patients is not associated with oxytocin levels and childhood traumas, indicating the need to assess the BPD patients in terms of other biopsychosocial factors related to the etiopathogenesis of BPD.
Collapse
Affiliation(s)
- Fatma Kartal
- Department of Psychiatry, Malatya Training and Research Hospital, Malatya, Turkey
| | - Kerim Uğur
- Department of Psychiatry, Malatya Turgut Ozal University, Malatya, Turkey
| | - Burak Mete
- Department of Public Health, Cukurova University, Adana, Turkey
| | | | - Lut Tamam
- Department of Psychiatry, Cukurova University, Adana, Turkey
| |
Collapse
|
12
|
Suchak V, Sathyanath S, Kakunje A. Neuropeptides in psychiatry. ARCHIVES OF MEDICINE AND HEALTH SCIENCES 2022. [DOI: 10.4103/amhs.amhs_91_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
13
|
Baryshnikov I, Isometsä E. Psychological pain and suicidal behavior: A review. Front Psychiatry 2022; 13:981353. [PMID: 36203837 PMCID: PMC9531162 DOI: 10.3389/fpsyt.2022.981353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/05/2022] [Indexed: 11/29/2022] Open
Abstract
Despite accumulation of clinical research on risk factors for suicidal process, understanding of the mechanisms and pathways underlying the emergence of suicidal thoughts and their progression to acts is insufficient. The suicidal process has been conceptualized in multiple psychological theories that have aimed to shed light on the interplay of contributing factors. One of the central concepts included in both the cubic model of suicide and the three-step theory of suicide is psychological pain (mental pain or psychache). Over the two last decades, interest in psychological pain has increased considerably, particularly since the discovery of the complex link between the pain processing system and the neurobiology of suicide, and the putative antisuicidal effect of buprenorphine. Growing evidence supports the association between experiencing psychological pain and suicidal ideation and acts in both clinical and non-clinical samples. However, many questions related to the concept of psychological pain and its role in prediction of suicidal behavior remain to be answered in future research. In this narrative review, we have outlined the history of the concept, the definition of psychological pain, and the tools developed for its measurement, summarized the empirical research on psychological pain in relation to suicidal behavior, and suggested future directions for clinical research on psychological pain and suicidal behavior.
Collapse
Affiliation(s)
- Ilya Baryshnikov
- Department of Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | - Erkki Isometsä
- Department of Psychiatry, University of Helsinki, Helsinki, Finland
| |
Collapse
|
14
|
Schwarz SM, Feike M, Stangier U. Mental Imagery and Social Pain in Adolescents-Analysis of Imagery Characteristics and Perspective-A Pilot Study. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8121160. [PMID: 34943356 PMCID: PMC8700563 DOI: 10.3390/children8121160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/15/2021] [Accepted: 12/07/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Mental imagery (MI) may play a key role in the development of various mental disorders in adolescents. Adolescence is known to be a fragile life period, in which acceptance by one's favored peer group is extremely important, and social rejection is particularly painful. This is the first pilot study investigating MI and its relationship to social pain (SP). METHOD A sample of 80 adolescents (14-20 years; 75.3% female) completed a web-based quasi-experimental design about the contents and characteristics of their spontaneous positive and negative MI and associated emotions, and were asked to complete the Social Pain Questionnaire, the Becks Depression Inventory and the Social Phobia Inventory. RESULTS A higher score of SP was significantly associated with increased fear, sadness, and feelings of guilt, and less control over negative MI. Characteristics of negative MI were more precisely predicted by SP scores than depression- and social anxiety scores. Adolescents with higher SP-scores more often reported negative images including social situations and were more likely to perceive negative images in a combination of field-and observer perspectives than adolescents with lower SP scores. CONCLUSION SP-sensitivity seems to be linked to unique characteristics of negative MI, which reveals the strong emotional impact of social exclusion in youths. The results do not allow causal conclusions to be drawn, but raise questions about previous studies comparing each imagery perspective individually.
Collapse
|
15
|
Dyadic Emotion Regulation in Women with Borderline Personality Disorder. COGNITIVE THERAPY AND RESEARCH 2021. [DOI: 10.1007/s10608-021-10206-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Abstract
Background
Emotion regulation (ER) and interpersonal dysfunction constitute key features of borderline personality disorder (BPD). Here, we tested if females with BPD show impairments in dyadic ER, that is in their support seeking and creation of closeness. We investigated if women with BPD might over-rely on their male partner by excessive support seeking and establishing of closeness, during conversations with personally and relationship-threatening topics.
Methods
Thirty couples in which the women were diagnosed with BPD and 34 healthy control (HC) couples were videotaped while discussing neutral, personally threatening, and relationship-threatening topics. Support seeking was rated by three independent raters, using a naïve observer method. The creation of closeness was rated using a continuous video-rating. Perceived emotions were assessed using self-report after each conversation.
Results
Women with BPD engaged in more support seeking than HC women, especially in more negative behaviors to elicit support, they created less closeness to their partner than HCs and reported a greater decline of positive emotions in both threatening conditions. Women with BPD displayed more fluctuations than controls between creating closeness and distance in the personally-threatening situation. They reported a larger increase in negative emotions after the relationship threatening conversation compared to female HC.
Conclusions
The present study indicates an increased demand of dyadic ER in BPD. Increased negative support seeking and less creation of closeness to the partner might reflect ineffective strategies to actually receive support from the partner.
Collapse
|
16
|
Timäus C, Meiser M, Wiltfang J, Bandelow B, Wedekind D. Efficacy of naltrexone in borderline personality disorder, a retrospective analysis in inpatients. Hum Psychopharmacol 2021; 36:e2800. [PMID: 34029405 DOI: 10.1002/hup.2800] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The endogenous opioid system is assumed to be involved in the pathophysiology of borderline personality disorder (BPD), and opioid antagonists may improve core features of BPD. The aim of this retrospective chart analysis was to evaluate the relative contribution of the opioid antagonist naltrexone and other psychotropic drugs in the improvement of overall symptomatology in BPD. METHODS One hundred sixty-one inpatients with BPD treated between January 2010 and October 2013 were classified as either treatment responders or non-responders. Treatment responders were defined as subjects with significant improvements in four or more symptoms from a defined symptom list. The relative contribution of all psychotropic drugs to improvement of BPD symptomatology was assessed by means of a stepwise logistic regression. RESULTS None of the drugs applied contributed significantly to improvement, with the exception of naltrexone (odds ratio [OR] 43.2, p ≤ 0.0001). Patients treated with naltrexone (N = 55, 34%) recovered significantly more often. Higher doses of naltrexone were more effective (OR 791.8, p ≤ 0.0001) than lower doses (OR 26.6, p ≤ 0.0001); however, even low-dose treatment was better than any other pharmacological treatment. CONCLUSIONS Naltrexone was associated with improvement in BPD in a dose-dependent manner. The present study provides additional evidence that dysregulation of the endogenous opioid system is implicated in the pathophysiology of BPD symptoms.
Collapse
Affiliation(s)
- Charles Timäus
- Department of Psychiatry and Psychotherapy, University of Göttingen, Göttingen, Germany
| | - Miriam Meiser
- Department of Psychiatry and Psychotherapy, University of Göttingen, Göttingen, Germany
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University of Göttingen, Göttingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany.,Neurosciences and Signaling Group, Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Borwin Bandelow
- Department of Psychiatry and Psychotherapy, University of Göttingen, Göttingen, Germany
| | - Dirk Wedekind
- Department of Psychiatry and Psychotherapy, University of Göttingen, Göttingen, Germany
| |
Collapse
|
17
|
Trofimova I. Functional Constructivism Approach to Multilevel Nature of Bio-Behavioral Diversity. Front Psychiatry 2021; 12:641286. [PMID: 34777031 PMCID: PMC8578849 DOI: 10.3389/fpsyt.2021.641286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 09/07/2021] [Indexed: 12/20/2022] Open
Abstract
Attempts to revise the existing classifications of psychiatric disorders (DSM and ICD) continue and highlight a crucial need for the identification of biomarkers underlying symptoms of psychopathology. The present review highlights the benefits of using a Functional Constructivism approach in the analysis of the functionality of the main neurotransmitters. This approach explores the idea that behavior is neither reactive nor pro-active, but constructive and generative, being a transient selection of multiple degrees of freedom in perception and actions. This review briefly describes main consensus points in neuroscience related to the functionality of eight neurochemical ensembles, summarized as a part of the neurochemical model Functional Ensemble of Temperament (FET). None of the FET components is represented by a single neurotransmitter; all neurochemical teams have specific functionality in selection of behavioral degrees of freedom and stages of action construction. The review demonstrates the possibility of unifying taxonomies of temperament and classifications of psychiatric disorders and presenting these taxonomies formally and systematically. The paper also highlights the multi-level nature of regulation of consistent bio-behavioral individual differences, in line with the concepts of diagonal evolution (proposed earlier) and Specialized Extended Phenotype.
Collapse
Affiliation(s)
- Irina Trofimova
- Laboratory of Collective Intelligence, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
18
|
Bohus M, Stoffers-Winterling J, Sharp C, Krause-Utz A, Schmahl C, Lieb K. Borderline personality disorder. Lancet 2021; 398:1528-1540. [PMID: 34688371 DOI: 10.1016/s0140-6736(21)00476-1] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/18/2021] [Accepted: 02/18/2021] [Indexed: 12/15/2022]
Abstract
Borderline personality disorder (BPD) is a mental disorder with a high burden on patients, family members, and health-care systems. The condition was previously regarded as untreatable, but progress in understanding and management has resulted in earlier diagnosis and better treatment outcomes. A coherent syndrome of BPD typically onsets during adolescence (after age 12 years). BPD is often preceded by or co-develops with symptoms of internalising disorders (depression and anxiety), externalising disorders (conduct problems, hyperactivity, and substance use), or both. BPD is associated with various poor outcomes, including low occupational and educational attainment, lack of long-term relationships, increased partner conflict, sexual risk-taking, low levels of social support, low life satisfaction, and increased service use. Psychotherapy is the main treatment for BPD; drug treatment is only indicated for comorbid conditions that require medication, or during a crisis if psychosocial interventions are insufficient. Awareness of BPD by non-specialists, as well as specialists, is key to appropriate early intervention.
Collapse
Affiliation(s)
- Martin Bohus
- Institute for Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Harvard Medical School, Boston, MA, USA
| | - Jutta Stoffers-Winterling
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany; Leibniz Institute for Resilience Research, Mainz, Germany
| | - Carla Sharp
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Annegret Krause-Utz
- Department of Clinical Psychology, Leiden University, Leiden Institute of Brain and Cognition, Leiden, Netherlands
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Klaus Lieb
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany; Leibniz Institute for Resilience Research, Mainz, Germany.
| |
Collapse
|
19
|
Maiß C, Engemann L, Kern K, Flasbeck V, Mügge A, Lücke T, Brüne M. Cardiac parasympathetic activity in female patients with borderline personality disorder predicts approach/avoidance behavior towards angry faces. Biol Psychol 2021; 163:108146. [PMID: 34252482 DOI: 10.1016/j.biopsycho.2021.108146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 07/07/2021] [Accepted: 07/07/2021] [Indexed: 12/21/2022]
Abstract
Among other features, Borderline Personality Disorder (BPD) is characterized by difficulties in regulating affiliative behavior. Here, we examined the association of heart rate variability (HRV) with approach/avoidance behavior in BPD. Accordingly, HRV parameters (RMSSD and HF-HRV) were measured in 42 female patients with BPD and 50 controls before performing an Approach Avoidance Task (AAT). Half of participants were previously exposed to social exclusion in a virtual ball-tossing game. Overall, HRV was lower in patients with BPD compared to controls. Moreover, low HRV was associated with attenuated approach for angry faces with an averted gaze. Following social exclusion, the BPD group showed the largest approach to happy faces and the least approach for angry faces, a pattern which differed from controls and patients in the control condition. Our findings indicate an association of cardiac parasympathetic activity with social behavior. Moreover, social exclusion may foster avoidance of angry faces in BPD patients.
Collapse
Affiliation(s)
- Clara Maiß
- LWL University Hospital Bochum, Division of Social Neuropsychiatry and Evolutionary Medicine, Ruhr University, 44791, Bochum, NRW, Germany
| | - Luisa Engemann
- LWL University Hospital Bochum, Division of Social Neuropsychiatry and Evolutionary Medicine, Ruhr University, 44791, Bochum, NRW, Germany
| | - Katharina Kern
- LWL University Hospital Bochum, Division of Social Neuropsychiatry and Evolutionary Medicine, Ruhr University, 44791, Bochum, NRW, Germany
| | - Vera Flasbeck
- LWL University Hospital Bochum, Division of Social Neuropsychiatry and Evolutionary Medicine, Ruhr University, 44791, Bochum, NRW, Germany
| | - Andreas Mügge
- Bergmannsheil Bochum, Medical Clinic II, Department of Cardiology and Angiology, Ruhr University, Bochum, Germany
| | - Thomas Lücke
- St. Josef-Hospital, University Hospital of Pediatrics and Adolescent Medicine, Department of Neuropediatrics and Social Pediatrics, Ruhr University Bochum, Germany
| | - Martin Brüne
- LWL University Hospital Bochum, Division of Social Neuropsychiatry and Evolutionary Medicine, Ruhr University, 44791, Bochum, NRW, Germany.
| |
Collapse
|
20
|
Störkel LM, Karabatsiakis A, Hepp J, Kolassa IT, Schmahl C, Niedtfeld I. Salivary beta-endorphin in nonsuicidal self-injury: an ambulatory assessment study. Neuropsychopharmacology 2021; 46:1357-1363. [PMID: 33398083 PMCID: PMC8134499 DOI: 10.1038/s41386-020-00914-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/29/2020] [Accepted: 11/09/2020] [Indexed: 01/19/2023]
Abstract
Nonsuicidal self-injury (NSSI) is a prevalent and impairing behavior, affecting individuals with and without additional psychopathology. To shed further light on biological processes that precede and result from NSSI acts, we built on previous cross-sectional evidence suggesting that the endogenous opioid system, and especially β-endorphin, is involved in the psychopathology of NSSI. This is the first study assessing salivary β-endorphin in daily life in the context of NSSI acts. Fifty-one female adults with repetitive NSSI participated over a period of 15 days in an ambulatory assessment study. Salivary β-endorphin was assessed before and after engagement in NSSI, during high urge for NSSI, and on a non-NSSI day. Furthermore, NSSI specific variables such as pain ratings, as well as method, severity, and function of NSSI were assessed. We found that β-endorphin levels immediately before an NSSI act were significantly lower than directly after NSSI. However, there was no difference between β-endorphin during high urge for NSSI and post NSSI measures. We found a positive association between severity of the self-inflicted injury and β-endorphin levels, but no significant association between β-endorphin levels and subjectively experienced pain. The results of the present study indicate that it is possible to assess salivary β-endorphin in daily life in the context of NSSI. Furthermore, our results provide a first indication that NSSI acts could be associated with a momentary increase of β-endorphin, and this might reinforce NSSI engagement. More research is needed to replicate and extend our findings on peripheral β-endorphin in daily life.
Collapse
Affiliation(s)
- Lisa M Störkel
- Department of Psychosomatic Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Johanna Hepp
- Department of Psychosomatic Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Christian Schmahl
- Department of Psychosomatic Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Inga Niedtfeld
- Department of Psychosomatic Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| |
Collapse
|
21
|
Fitzpatrick S, Liebman RE, Monson CM. The borderline interpersonal-affective systems (BIAS) model: Extending understanding of the interpersonal context of borderline personality disorder. Clin Psychol Rev 2021; 84:101983. [PMID: 33517245 DOI: 10.1016/j.cpr.2021.101983] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 12/16/2020] [Accepted: 01/19/2021] [Indexed: 01/10/2023]
Abstract
Prominent explanatory models for borderline personality disorder (BPD) are intrapersonal in nature and hold that it is an emotional disorder. However, the empirical support for emotional models of BPD is mixed. Refinements to BPD explanatory models are needed to increase the precision with which BPD can be understood and treated. Drawing on existing theoretical and empirical research in BPD, this manuscript presents the Borderline Interpersonal-Affective Systems (BIAS) model. The BIAS model purports that harmful early life relationships and subsequent conflictual relationships lead individuals with BPD to develop a sensitivity to interpersonal threat in the form of attentional and appraisal biases. Individuals with BPD are posited to 1) experience heightened emotional reactivity specifically to perceived interpersonal threat and 2) engage in destructive behaviors both to regulate increasing emotion and to meet interpersonal needs. We review the empirical support for each component of the BIAS model, along with the role of the cognitions, emotions, and behaviors of significant others in influencing BIAS model processes in individuals with BPD over time. The BIAS model highlights a novel way of understanding and integrating interpersonal and emotional components of the disorder. Key directives for future research and clinical implications are discussed.
Collapse
Affiliation(s)
- Skye Fitzpatrick
- Department of Psychology, York University, Behavioural Science Building, 4700 Keele Street, Toronto, ON M3J 1P3, Canada.
| | - Rachel E Liebman
- Department of Psychology, York University, Behavioural Science Building, 4700 Keele Street, Toronto, ON M3J 1P3, Canada; Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3, Canada
| | - Candice M Monson
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3, Canada
| |
Collapse
|
22
|
Vancova Z. Potential Therapeutic Possibility of Oxytocin for Borderline Personality Disorder. Psychiatr Ann 2021. [DOI: 10.3928/00485713-20210208-01] [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: 11/20/2022]
|
23
|
Facial emotion recognition in borderline patients is unaffected by acute psychosocial stress. J Psychiatr Res 2021; 132:131-135. [PMID: 33091687 DOI: 10.1016/j.jpsychires.2020.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/30/2020] [Accepted: 10/12/2020] [Indexed: 01/01/2023]
Abstract
Borderline Personality Disorder (BPD) is characterized by difficulties in social cognition and social interactions, which exacerbate under stress. A previous study found better facial emotion recognition (FER) in patients with personality disorders and healthy controls (HC) after stress. We recently reported that emotional empathy scores, i.e. the emotional response to another person's emotional state, were significantly lower in BPD patients than in HC after psychosocial stress. Cognitive empathy scores remained unaltered. The present study aims to further investigate the effect of psychosocial stress induced by the Trier Social Stress Test (TSST) on FER as part of social cognition in patients with BPD. We randomized 43 women with BPD and 46 female HC to either the TSST or a placebo condition. Afterwards, participants were asked in an emotion recognition test to identify emotions in faces showing anger or sadness at low and high intensity. Both groups recognized emotions better at high intensity compared with low intensity. There was no effect of stress on FER performance and we found no difference between groups. This is in line with prior research on social cognition in BPD patients demonstrating that the ability to understand another person's perspective might be unaffected by acute stress.
Collapse
|
24
|
Borderline personality disorder: from understanding ontological addiction to psychotherapeutic revolution. Eur Arch Psychiatry Clin Neurosci 2020; 270:941-945. [PMID: 31165236 DOI: 10.1007/s00406-019-01029-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 05/30/2019] [Indexed: 12/25/2022]
Abstract
Bypassing a reductionist view of existing diagnostic categories, ontological addiction theory (OAT) is a new psychological model of human functioning. Borderline Personality Disorder (BPD), defined as "a pattern of instability in interpersonal relationships, self-image and affects, and marked impulsivity", is not only common (up to 20% of psychiatric inpatients), but also strongly associated with suicide attempts and death by suicide. Therefore, BPD constitutes a major public health concern. As a consequence of an underlying condition of ontological addiction, self-harming behaviors can be conceptualized as addictions, suicidal acts reflecting an experiential avoidance strategy against unbearable psychological pain. The present paper aims at: (1) understanding BPD daily life experiences from the perspective of OAT; (2) offering psychotherapeutic perspectives for this mental disorder. The diagnostic category of BDP may be understood as a simple label reflecting several extreme types of manifestations resulting from the Self-grasping ignorance that underpins ontological addiction. Therefore, development of psychotherapeutic interventions targeting ontological addiction appears to be a promising future direction.
Collapse
|
25
|
Exploring the boundaries between borderline personality disorder and suicidal behavior disorder. Eur Arch Psychiatry Clin Neurosci 2020; 270:959-967. [PMID: 30673835 DOI: 10.1007/s00406-019-00980-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 01/03/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To compare clinical traits of suicidal vulnerability among in-patients with suicidal behavior disorder (SBD) with and without borderline personality disorder (BPD). METHOD we recruited adult patients with SBD, consecutively and voluntarily hospitalized in a specialized unit for affective disorders and suicidal behavior between July and October 2016. Ninety-two inpatients having attempted suicide within the past 2 years were divided into two subgroups according to the presence or absence of BPD. Clinical vulnerability traits for suicidal behavior were assessed. RESULTS Half of the patients with SBD also had BPD. Patients with BPD were nine times more likely to be major suicide repeaters compared to those without. They were also more likely to display clinical and psychological vulnerability traits for suicidal behavior, even after considering potential confounders. Emotional dysregulation, shame-proneness, impulsiveness, preoccupied attachment pattern, and childhood trauma were high in both groups, but significantly increased in those with (vs. without) BPD status. Psychological traits remained stable in SBD-BPD patients, regardless of the time since the last suicide attempt (i.e. SBD in recent vs. early remission). CONCLUSIONS Clinical and psychological traits associated with suicidal vulnerability are present in all SBD patients compared to non-suicidal populations, but comorbidity with BPD is associated with particularly high scores. BPD could be considered as a specifier for SBD diagnoses.
Collapse
|
26
|
Sato M, Fonagy P, Luyten P. Rejection Sensitivity and Borderline Personality Disorder Features: The Mediating Roles of Attachment Anxiety, Need to Belong, and Self-Criticism. J Pers Disord 2020; 34:273-288. [PMID: 30650007 DOI: 10.1521/pedi_2019_33_397] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Rejection hypersensitivity has been considered the core feature of patients with borderline personality disorder (BPD). However, little is known about the possible developmental mechanisms that might explain the association between rejection sensitivity and BPD features. The current study investigated the mediating roles of adult attachment, need to belong, and self-criticism in the association between rejection sensitivity and BPD features in 256 healthy adults. Results indicated that attachment anxiety, need to belong, and self-criticism mediated the association between rejection sensitivity and BPD features. However, attachment anxiety and self-criticism did not moderate the mediated association between rejection sensitivity and BPD features. The findings suggest that individuals with high rejection sensitivity are more likely to be anxiously attached to significant others, which might increase the desire to be accepted by others. To satisfy this elevated need to affiliate with others, these individuals might become more self-critical, which may contribute to high BPD features.
Collapse
Affiliation(s)
- Momoko Sato
- Department of Clinical, Educational, and Health Psychology, University College London
| | - Peter Fonagy
- Department of Clinical, Educational, and Health Psychology, University College London
| | - Patrick Luyten
- Faculty of Psychology and Educational Sciences, KU Leuven, Belgium
| |
Collapse
|
27
|
Abstract
Relationship dysfunction is a key criterion of borderline personality disorder (BPD). Nevertheless, little is known about the characteristics of romantic relationship functioning in BPD. In this study, couples in which the women were diagnosed with BPD (BPD couples) and healthy control couples (HC) were compared in their perceived relationship characteristics (e.g., relationship quality) and interpersonal experience variables (e.g., attachment). The hypothesis was tested that insecure attachment styles account for group differences in relationship characteristics. Variables were measured by self-report. Romantic relationships were appraised as more negative and conflictual by both members of BPD couples compared to HC. The perception of women with BPD was often more negative than that of their male partners, indicating potential biases in BPD patients' relationship evaluation. Insecure attachment styles only partially explained group differences in relationship characteristics, showing that attachment style is one, but not the only predictor of decreased relationship functioning in BPD couples.
Collapse
Affiliation(s)
- Annemarie Miano
- Research Cluster Languages of Emotion, Freie Universität Berlin, Berlin, Germany.,Department of Clinical Psychology and Psychotherapy, Heidelberg University, Heidelberg, Germany
| | - Isabel Dziobek
- Research Cluster Languages of Emotion, Freie Universität Berlin, Berlin, Germany.,Berlin School of Mind and Brain and Institute of Psychology, Humboldt Universität zu Berlin
| | - Stefan Roepke
- Research Cluster Languages of Emotion, Freie Universität Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Department of Psychiatry, Berlin
| |
Collapse
|
28
|
Richmond JR, Tull MT, Gratz KL. The Roles of Emotion Regulation Difficulties and Impulsivity in the Associations between Borderline Personality Disorder Symptoms and Frequency of Nonprescription Sedative Use and Prescription Sedative/Opioid Misuse. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020; 16:62-70. [PMID: 32368442 DOI: 10.1016/j.jcbs.2020.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Despite evidence of a strong relationship between BPD and substance use problems in general, little research has examined the associations of BPD symptoms with the misuse of sedatives or opioids, and no studies have explored possible factors that may underlie these associations. Thus, this study examined the relationships of BPD symptoms (i.e., the number of BPD criteria with threshold ratings on a diagnostic interview) to nonprescription sedative use, nonprescription opioid use, and prescription sedative/opioid misuse among 194 patients with alcohol and/or cocaine dependence in a residential substance use disorder treatment facility, as well as the roles of two theoretically-relevant factors in these relationships: emotion regulation (ER) difficulties and impulsivity facets. We found significant positive associations between BPD symptoms and nonprescription sedative use, nonprescription opioid use, and prescription sedative/opioid misuse. We also found significant positive indirect relationships of BPD symptoms to nonprescription sedative use through ER difficulties, ab = .04, 95% CI [.003, .09], and to prescription sedative/opioid misuse through two facets of impulsivity: lack of perseverance, ab = .05, 95% CI [.01, .11], and negative urgency, ab = .03, 95% CI [.002, .07]. Findings highlight the differential relevance of ER difficulties and impulsivity dimensions to the relationships of BPD symptoms to nonprescription sedative use and prescription sedative/opioid misuse, respectively, among patients with alcohol and/or cocaine dependence.
Collapse
Affiliation(s)
| | - Matthew T Tull
- Department of Psychology, University of Toledo, Toledo, OH, USA
| | - Kim L Gratz
- Department of Psychology, University of Toledo, Toledo, OH, USA
| |
Collapse
|
29
|
Anderson G. Pathoetiology and pathophysiology of borderline personality: Role of prenatal factors, gut microbiome, mu- and kappa-opioid receptors in amygdala-PFC interactions. Prog Neuropsychopharmacol Biol Psychiatry 2020; 98:109782. [PMID: 31689444 DOI: 10.1016/j.pnpbp.2019.109782] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 10/05/2019] [Accepted: 10/06/2019] [Indexed: 02/07/2023]
Abstract
The pathoetiology and pathophysiology of borderline personality disorder (BPD) have been relatively under-explored. Consequently, no targetted pharmaceutical treatments or preventative interventions are available. The current article reviews the available data on the biological underpinnings of BPD, highlighting a role for early developmental processes, including prenatal stress and maternal dysbiosis, in BPD pathoetiology. Such factors are proposed to drive alterations in the infant's gut microbiome, in turn modulating amygdala development and the amygdala's two-way interactions with other brain regions. Alterations in opioidergic activity, including variations in the ratio of the mu-and kappa-opioid receptors seem a significant aspect of BPD pathophysiology, contributing to its comorbidities with depression, anxiety, impulsivity and addiction. Stress and dysphoria are commonly experienced in people classed with BPD. A growing body of data, across a host of medical conditions, indicate that stress and mood dysregulation may be intimately associated with gut dysbiosis and increased gut permeability, coupled to heightened levels of oxidative stress and immune-inflammatory activity. It urgently requires investigation as to the relevance of such gut changes in the course of BPD symptomatology. Accumulating data indicates that BPD symptom exacerbations may be linked to cyclical variations in estrogen, in turn decreasing serotonin and local melatonin synthesis, and thereby overlapping with the pathophysiology of migraine and endometriosis, which also have a heightened association with BPD. Future research directions and treatment implications are indicated.
Collapse
|
30
|
Garland J, Miller S. Borderline personality disorder: part 1 – assessment and diagnosis. BJPSYCH ADVANCES 2020. [DOI: 10.1192/bja.2019.76] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
SUMMARYGeneral adult psychiatrists are largely responsible for the care of patients with personality disorders in community and in-patient settings, and this can be associated with diagnostic and management challenges. In the first of two articles focusing specifically on borderline personality disorder (BPD), we summarise the core clinical features of the disorder and discuss appropriate diagnostic practice.
Collapse
|
31
|
Baharikhoob P, Kolla NJ. Microglial Dysregulation and Suicidality: A Stress-Diathesis Perspective. Front Psychiatry 2020; 11:781. [PMID: 32848946 PMCID: PMC7432264 DOI: 10.3389/fpsyt.2020.00781] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/22/2020] [Indexed: 12/11/2022] Open
Abstract
According to the stress-diathesis model of suicidal behavior, completed suicide depends on the interaction between psychosocial stressors and a trait-like susceptibility. While there are likely multiple biological processes at play in suicidal behavior, recent findings point to over-activation of microglia, the resident macrophages of the central nervous system, as implicated in stress-induced suicidal behavior. However, it remains unclear how microglial dysregulation can be integrated into a clinical model of suicidal behavior. Therefore, this narrative review aims to (1) examine the findings from human post-mortem and neuroimaging studies that report a relationship between microglial activation and suicidal behavior, and (2) update the clinical model of suicidal behavior to integrate the role of microglia. A systematic search of SCOPUS, PubMed, PsycINFO, and Embase databases revealed evidence of morphological alterations in microglia and increased translocator protein density in the brains of individuals with suicidality, pointing to a positive relationship between microglial dysregulation and suicidal behavior. The studies also suggested several pathological mechanisms leading to suicidal behavior that may involve microglial dysregulation, namely (1) enhanced metabolism of tryptophan to quinolinic acid through the kynurenine pathway and associated serotonin depletion; (2) increased quinolinic acid leading to excessive N-methyl-D-aspartate-signaling, resulting in potential disruption of the blood brain barrier; (3) increased quinolinic acid resulting in higher neurotoxicity, and; (4) elevated interleukin 6 contributing to loss of inhibition of glutamatergic neurons, causing heightened glutamate release and excitotoxicity. Based on these pathways, we reconceptualized the stress-diathesis theory of suicidal behavior to incorporate the role of microglial activity.
Collapse
Affiliation(s)
- Paria Baharikhoob
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health (CAMH) Research Imaging Centre and Campbell Family Mental Health Research Institute, Toronto, ON, Canada.,Violence Prevention Neurobiological Research Unit, CAMH, Toronto, ON, Canada
| | - Nathan J Kolla
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health (CAMH) Research Imaging Centre and Campbell Family Mental Health Research Institute, Toronto, ON, Canada.,Violence Prevention Neurobiological Research Unit, CAMH, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Waypoint Centre for Mental Health Care, Waypoint Research Institute, Penetanguishene, ON, Canada
| |
Collapse
|
32
|
Effects of intranasal oxytocin administration on empathy and approach motivation in women with borderline personality disorder: a randomized controlled trial. Transl Psychiatry 2019; 9:328. [PMID: 31801937 PMCID: PMC6892895 DOI: 10.1038/s41398-019-0658-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 11/04/2019] [Accepted: 11/06/2019] [Indexed: 12/24/2022] Open
Abstract
Borderline personality disorder (BPD) is characterized by severe interpersonal dysfunction with problems in social cognition, empathy and social approach. Although the neuropeptide oxytocin is known to regulate complex social cognition and behavior in healthy individuals and clinical populations, there is still a lack of evidence for a potential beneficial effect of oxytocin administration on social cognition and social approach in BPD. Fifty-one women with BPD and 51 matched healthy controls were randomized to a double-blind, placebo-controlled, between-subject experimental trial. We administered a single dose of 24 IU oxytocin or placebo intranasally prior to a standardized task measuring affective and cognitive empathy and approach motivation. All participants were free of hormonal contraception and tested in the mid-luteal phase of their menstrual cycle. In the placebo condition, patients with BPD showed reduced cognitive and affective empathy, and less approach behavior motivation than healthy controls. Intranasal oxytocin significantly increased affective empathy and approach motivation in both BPD patients and healthy controls compared to placebo. More importantly, oxytocin administration led to similar scores between BPD and healthy controls. These findings provide the first evidence for a beneficial effect of oxytocin on deficits in affective empathy and approach motivation of BPD. Our results indicate a beneficial effect of a single dose of oxytocin on affective empathy and approach motivation in women with BPD adapting their level of social functioning to healthy controls. Future clinical trials will need to investigate the long-term effects and effectiveness of oxytocin as an add-on treatment for social impairments in BPD.
Collapse
|
33
|
Ramseyer F, Ebert A, Roser P, Edel M, Tschacher W, Brüne M. Exploring nonverbal synchrony in borderline personality disorder: A double‐blind placebo‐controlled study using oxytocin. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2019; 59:186-207. [DOI: 10.1111/bjc.12240] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 06/27/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Fabian Ramseyer
- Department of Clinical Psychology and Psychotherapy Institute of Psychology University of Bern Switzerland
| | - Andreas Ebert
- Division of Social Neuropsychiatry and Evolutionary Medicine Department of Psychiatry, Psychotherapy and Preventive Medicine LWL University Hospital BochumRuhr‐University Bochum Germany
| | - Patrik Roser
- Centre for Addiction Disorders Psychiatric Hospital Königsfelden Psychiatric Services Aargau Academic Hospital of the University of Zurich Switzerland
| | | | - Wolfgang Tschacher
- Department of Experimental Psychology University Hospital of Psychiatry and Psychotherapy University of Bern Switzerland
| | - Martin Brüne
- Division of Social Neuropsychiatry and Evolutionary Medicine Department of Psychiatry, Psychotherapy and Preventive Medicine LWL University Hospital BochumRuhr‐University Bochum Germany
| |
Collapse
|
34
|
Fareri DS. Neurobehavioral Mechanisms Supporting Trust and Reciprocity. Front Hum Neurosci 2019; 13:271. [PMID: 31474843 PMCID: PMC6705214 DOI: 10.3389/fnhum.2019.00271] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 07/22/2019] [Indexed: 01/10/2023] Open
Abstract
Trust and reciprocity are cornerstones of human nature, both at the levels of close interpersonal relationships and economic/societal structures. Being able to both place trust in others and decide whether to reciprocate trust placed in us is rooted in implicit and explicit processes that guide expectations of others, help reduce social uncertainty, and build relationships. This review will highlight neurobehavioral mechanisms supporting trust and reciprocity, through the lens of implicit and explicit social appraisal and learning processes. Significant consideration will be given to the neural underpinnings of these implicit and explicit processes, and special focus will center on the underlying neurocomputational mechanisms facilitating the integration of implicit and explicit signals supporting trust and reciprocity. Finally, this review will conclude with a discussion of how we can leverage findings regarding the neurobehavioral mechanisms supporting trust and reciprocity to better inform our understanding of mental health disorders characterized by social dysfunction.
Collapse
Affiliation(s)
- Dominic S Fareri
- Gordon F. Derner School of Psychology, Adelphi University, Garden City, NY, United States
| |
Collapse
|
35
|
Abstract
Research concerning psychiatric issues relating to opioid drugs currently focuses primarily on their role in reinforcing addictive behaviors, given the recent proliferation of lethal abuse of illicit opiates in the United States and around the world. In contrast, this article will review the mechanism of action of opioids in affective disorders and the available evidence and potential for their use, especially in the treatment of resistant major depression. Buprenorphine is the opioid derivative of special interest; we review this and other opioid derivatives, highlighting the growing role of opioids in treating depressive illnesses and other related psychopathologies.
Collapse
Affiliation(s)
- Parnika P Saxena
- Brockton Neighborhood Health Center, 63 Main St, Brockton, MA, 02301, USA.
| | - J Alexander Bodkin
- McLean Hospital, 115 Mill St, North Belknap, Belmont, MA, 02478, USA.,Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| |
Collapse
|
36
|
Vest N, Tragesser S. Borderline Features and Prescription Opioid Misuse in a Substance Use Disorder Treatment Sample. Subst Use Misuse 2019; 54:166-175. [PMID: 30375912 DOI: 10.1080/10826084.2018.1512626] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND An association between borderline personality disorder (BPD) and substance use disorders has been well established. However, very little is known about the relationship between BPD and prescription opioid misuse, specifically. OBJECTIVES The relationship between borderline personality disorder features and prescription opioid misuse was examined in a sample of 208 substance use disorder treatment patients in the outpatient level of care. RESULTS Controlling for use of alcohol and cannabis, as well as other relevant covariates, we found that BPD features were associated with age of first use of prescription opioids, prescription opioid use disorder symptom count, lifetime use, past 12-month use, problem use, and cravings. Additionally, we found that BPD features were not associated with greater use of medically necessary opioid pain killers as prescribed by a physician; rather the association with BPD was in the greater likelihood of misuse (non-prescribed) of prescription opioid pain killers. The self-harm/impulsivity facet of BPD was most strongly associated with prescription opioid-related variables. Conclusions/Importance: These findings suggest that BPD is related to prescription opioid misuse, above and beyond the tendency to use other drugs of abuse, and that the self-harm impulsivity facet appears to be driving this relationship.
Collapse
Affiliation(s)
- Noel Vest
- a Experimental Psychology , Washington State University College of Arts and Sciences , Pullman , USA
| | - Sarah Tragesser
- b Department of Psychology , Washington State University College of Arts and Sciences , Richland , USA
| |
Collapse
|
37
|
Peciña M, Karp JF, Mathew S, Todtenkopf MS, Ehrich EW, Zubieta JK. Endogenous opioid system dysregulation in depression: implications for new therapeutic approaches. Mol Psychiatry 2019; 24:576-587. [PMID: 29955162 PMCID: PMC6310672 DOI: 10.1038/s41380-018-0117-2] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/11/2018] [Accepted: 05/25/2018] [Indexed: 12/12/2022]
Abstract
The United States is in the midst of an opioid addiction and overdose crisis precipitated and exacerbated by use of prescription opioid medicines. The majority of opioid prescriptions are dispensed to patients with comorbid mood disorders including major depressive disorder (MDD). A growing body of research indicates that the endogenous opioid system is directly involved in the regulation of mood and is dysregulated in MDD. This involvement of the endogenous opioid system may underlie the disproportionate use of opioids among patients with mood disorders. Emerging approaches to address endogenous opioid dysregulation in MDD may yield novel therapeutics that have a low or absent risk of abuse and addiction relative to µ-opioid agonists. Moreover, agents targeting the endogenous opioid system would be expected to yield clinical benefits qualitatively different from conventional monaminergic antidepressants. The development of safe and effective agents to treat MDD-associated endogenous opioid dysregulation may represent a distinct and currently underappreciated means of addressing treatment resistant depression with the potential to attenuate the on-going opioid crisis.
Collapse
Affiliation(s)
- Marta Peciña
- 0000 0004 1936 9000grid.21925.3dDepartment of Psychiatry, University of Pittsburgh, Pittsburgh, PA USA
| | - Jordan F. Karp
- 0000 0004 1936 9000grid.21925.3dDepartment of Psychiatry, University of Pittsburgh, Pittsburgh, PA USA
| | - Sanjay Mathew
- 0000 0001 2160 926Xgrid.39382.33Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX USA
| | | | | | - Jon-Kar Zubieta
- Department of Psychiatry, University of Utah Health Sciences Center, Salt Lake City, UT, USA.
| |
Collapse
|
38
|
Abstract
This article reviews the most salient neurobiological information available about borderline personality disorder (BPD) and presents a theoretic model for what lies at the heart of BPD that is grounded in those findings. It reviews the heritability, genetics, and the biological models of BPD, including the neurobiology of affective instability, impaired interoception, oxytocin and opiate models of poor attachment or interpersonal dysfunction, and structural brain imaging over the course of development in BPD; and posits that the core characteristic of BPD may be an impairment in emotional interoception or alexithymia.
Collapse
|
39
|
Stanley B, Perez-Rodriguez MM, Labouliere C, Roose S. A Neuroscience-Oriented Research Approach to Borderline Personality Disorder. J Pers Disord 2018; 32:784-822. [PMID: 29469663 DOI: 10.1521/pedi_2017_31_326] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Traditionally, the study of personality disorders had been based on psychoanalytic or behavioral models. Over the past two decades, there has been an emerging neuroscience model of borderline personality disorder (BPD) grounded in the concept of BPD as a condition in which dysfunctional neural circuits underlie its pathological dimensions, some of which include emotion dysregulation (broadly encompassing affective instability, negative affectivity, and hyperarousal), abnormal interpersonal functioning, and impulsive aggression. This article, initiated at a joint Columbia University- Cornell University Think Tank on BPD with representation from the Icahn School of Medicine at Mount Sinai, suggests how to advance research in BPD by studying the dimensions that underlie BPD in addition to studying the disorder as a unitary diagnostic entity. We suggest that linking the underlying neurobiological abnormalities to behavioral symptoms of the disorder can inform a research agenda to better understand BPD with its multiple presentations.
Collapse
Affiliation(s)
- Barbara Stanley
- Department of Psychiatry, Columbia University, New York City
| | | | | | - Steven Roose
- Department of Psychiatry, Columbia University, New York City.,New York State Psychiatric Institute, New York City
| |
Collapse
|
40
|
Kulacaoglu F, Kose S. Borderline Personality Disorder (BPD): In the Midst of Vulnerability, Chaos, and Awe. Brain Sci 2018; 8:E201. [PMID: 30453675 PMCID: PMC6266914 DOI: 10.3390/brainsci8110201] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 11/07/2018] [Accepted: 11/07/2018] [Indexed: 01/23/2023] Open
Abstract
Borderline personality disorder (BPD) is a chronic psychiatric disorder characterized by pervasive affective instability, self-image disturbances, impulsivity, marked suicidality, and unstable interpersonal relationships as the core dimensions of psychopathology underlying the disorder. Across a wide range of situations, BPD causes significant impairments. Patients with BPD suffer considerable morbidity and mortality compared with other populations. Although BPD is more widely studied than any other personality disorder, it is not understood sufficiently. This paper briefly reviews the recent evidence on the prevalence, etiology, comorbidity, and treatment approaches of borderline personality disorder (BPD) by examining published studies, and aims to offer a more coherent framework for the understanding and management of borderline personality disorder.
Collapse
Affiliation(s)
- Filiz Kulacaoglu
- Department of Psychiatry, Cerkezkoy State Hospital, Tekirdag 59500, Turkey.
| | - Samet Kose
- Department of Psychology, Hasan Kalyoncu University, Gaziantep 27000, Turkey.
- University of Texas Medical School of Houston, Houston, TX 77065, USA.
- Center for Neurobehavioral Research on Addictions, Houston, TX 77054, USA.
| |
Collapse
|
41
|
Sato M, Fonagy P, Luyten P. Rejection sensitivity and borderline personality disorder features: A mediation model of effortful control and intolerance of ambiguity. Psychiatry Res 2018; 269:50-55. [PMID: 30145301 DOI: 10.1016/j.psychres.2018.08.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 06/22/2018] [Accepted: 08/11/2018] [Indexed: 11/26/2022]
Abstract
Although past research suggests that borderline personality disorder (BPD) patients' rejection hypersensitivity may be an important factor underlying these patients' interpersonal problems, the role of cognitive factors in this association is still not well understood. The present study examined whether cognitive factors such as effortful control and intolerance of ambiguity mediated the association between rejection sensitivity and BPD features. A sample of 256 young adults completed self-report questionnaires assessing rejection sensitivity, effortful control, intolerance of ambiguity, and BPD features. Results showed that effortful control and intolerance of ambiguity mediated the association between rejection sensitivity and BPD features. The present study showed the role of cognitive aspects including both effortful control and intolerance of ambiguity in the relationship between rejection sensitivity and BPD features. However, there is a need for further research to experimentally investigate how rejection sensitivity may impact cognitive capacities in interpersonal contexts among individuals with BPD features.
Collapse
Affiliation(s)
- Momoko Sato
- Department of Clinical, Educational, and Health Psychology, University College London, 1-19 Torrington Place, London WC1E7HB, The United Kingdom.
| | - Peter Fonagy
- Department of Clinical, Educational, and Health Psychology, University College London, 1-19 Torrington Place, London WC1E7HB, The United Kingdom
| | - Patrick Luyten
- Department of Clinical, Educational, and Health Psychology, University College London, 1-19 Torrington Place, London WC1E7HB, The United Kingdom; Faculty of Psychology and Educational Sciences, KU Leuven, Belgium
| |
Collapse
|
42
|
Uscinska M, Bellino S. Treatment-induced brain plasticity in borderline personality disorder: review of functional MRI studies. FUTURE NEUROLOGY 2018. [DOI: 10.2217/fnl-2018-0006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Although neural substrates of symptoms expression in borderline personality disorder (BPD) have been studied extensively, neural mechanisms mediating post treatment amelioration of symptoms remain poorly characterized. Herein present review sheds a critical light on all here-to-date functional MRI findings of brain changes in BPD patients following a treatment with psychotherapy or drugs. Preliminary evidence points to downregulation of neuronal activity within the insula and amygdala, together with differential employment of prefrontal areas, mainly orbitofrontal cortex, anterior cingulate cortex and dorsolateral prefrontal cortex, as well as enhanced functional connectivity between limbic and prefrontal regions induced by dialectical behavioral therapy. Identifying neural circuits behind treatment processes may refine strategies to target specific symptoms, thereby resolving some of the controversies over BPD treatment.
Collapse
Affiliation(s)
- Maria Uscinska
- Department of Neurosciences, Centre for Personality Disorders, University of Turin, Via Cherasco 11, 10126, Turin, Italy
| | - Silvio Bellino
- Department of Neurosciences, Centre for Personality Disorders, University of Turin, Via Cherasco 11, 10126, Turin, Italy
| |
Collapse
|
43
|
Cataldo I, Azhari A, Lepri B, Esposito G. Oxytocin receptors (OXTR) and early parental care: An interaction that modulates psychiatric disorders. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 82:27-38. [PMID: 29033100 DOI: 10.1016/j.ridd.2017.10.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 09/21/2017] [Accepted: 10/05/2017] [Indexed: 05/12/2023]
Abstract
Oxytocin plays an important role in the modulation of social behavior in both typical and atypical contexts. Also, the quality of early parental care sets the foundation for long-term psychosocial development. Here, we review studies that investigated how oxytocin receptor (OXTR) interacts with early parental care experiences to influence the development of psychiatric disorders. Using Pubmed, Scopus and PsycInfo databases, we utilized the keyword "OXTR" before subsequently searching for specific OXTR single nucleotide polymorphisms (SNPs), generating a list of 598 studies in total. The papers were catalogued in a database and filtered for gene-environment interaction, psychiatric disorders and involvement of parental care. In particular, rs53576 and rs2254298 were found to be significantly involved in gene-environment interactions that modulated risk for psychopathology and the following psychiatric disorders: disruptive behavior, depression, anxiety, eating disorder and borderline personality disorder. These results illustrate the importance of OXTR in mediating the impact of parental care on the emergence of psychopathology.
Collapse
Affiliation(s)
- Ilaria Cataldo
- Department of Psychology and Cognitive Science, University of Trento, Italy; Mobile and Social Computing Lab, Fondazione Bruno Kessler, Trento, Italy
| | - Atiqah Azhari
- Division of Psychology, School of Social Sciences, Nanyang Technological University, Singapore
| | - Bruno Lepri
- Mobile and Social Computing Lab, Fondazione Bruno Kessler, Trento, Italy
| | - Gianluca Esposito
- Department of Psychology and Cognitive Science, University of Trento, Italy; Division of Psychology, School of Social Sciences, Nanyang Technological University, Singapore.
| |
Collapse
|
44
|
Olié E, Doell KC, Corradi-Dell’Acqua C, Courtet P, Perroud N, Schwartz S. Physical pain recruits the nucleus accumbens during social distress in borderline personality disorder. Soc Cogn Affect Neurosci 2018; 13:1071-1080. [PMID: 30204911 PMCID: PMC6204482 DOI: 10.1093/scan/nsy078] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 07/18/2018] [Accepted: 09/04/2018] [Indexed: 01/16/2023] Open
Abstract
Patients with borderline personality disorder (BPD) often engage in dangerous self-injurious behaviors (SIBs) as a maladaptive technique to decrease heightened feelings of distress (e.g. negative feelings caused by social exclusion). The reward system has recently been proposed as a plausible neural substrate, which may influence the interaction between social distress and physical pain processing in patients that engage in SIBs. Using functional magnetic resonance imaging (fMRI) in 20 adult BPD patients with a history of SIBs and 23 healthy controls (HCs), we found a hyper-activation of the nucleus accumbens (NAcc) and amygdala when painful stimuli were presented to BPD patients (but not HCs) in a state of heightened distress, induced via social exclusion. This differential NAcc activity was mediated by anxious attachment style, which is a key developmental feature of the disorder. Altogether, these results suggest a neural mechanism underlying the pathophysiology of SIBs in these patients, which is likely reinforced via the reward system.
Collapse
Affiliation(s)
- Emilie Olié
- Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHU Montpellier - Inserm U1061 -University of Montpellier, Montpellier, France
| | - Kimberly C Doell
- Department of Neuroscience, University of Geneva, Geneva, Switzerland
- Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
- Geneva Neuroscience Center, University of Geneva, Geneva, Switzerland
- Department of Psychology, FPSE, University of Geneva, Geneva, Switzerland
| | - Corrado Corradi-Dell’Acqua
- Geneva Neuroscience Center, University of Geneva, Geneva, Switzerland
- Department of Psychology, FPSE, University of Geneva, Geneva, Switzerland
| | - Philippe Courtet
- Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHU Montpellier - Inserm U1061 -University of Montpellier, Montpellier, France
| | - Nader Perroud
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
- Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Sophie Schwartz
- Department of Neuroscience, University of Geneva, Geneva, Switzerland
- Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
- Geneva Neuroscience Center, University of Geneva, Geneva, Switzerland
| |
Collapse
|
45
|
Orbitofrontal overactivation in reward processing in borderline personality disorder: the role of non-suicidal self-injury. Brain Imaging Behav 2018; 12:217-228. [PMID: 28247156 DOI: 10.1007/s11682-017-9687-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Borderline Personality Disorder (BPD) is a disabling and difficult-to-treat mental disease. One of its core features is a significant difficulty in affect regulation, which is often accompanied by Non-Suicidal Self-Injury (NSSI). It is suggested that this type of behavior elicits positive emotions and mitigates emotional distress, and therefore can ultimately be reinforced and promoted. In spite of the high prevalence of NSSI behaviors (also in non-BPD samples), their role in modulating reward-related processes has not yet been investigated in BPD patients. In the present study, this lack of research was addressed. A large sample of BPD patients (N = 40), divided into two groups depending on the presence of NSSI, and a group of matched healthy controls underwent functional Magnetic Resonance Imaging (fMRI) while performing a gambling task. Patients who committed NSSI acts exhibited enhanced activation of the orbitofrontal cortex following an unexpected reward, when compared with controls and BPD patients with no NSSI behavior. In addition, the NSSI group showed diminished functional connectivity between the left orbitofrontal cortex and the right parahippocampal gyrus. These findings might suggest impaired ability to update reward associations of potential choices when both BPD and NSSI are present. We propose that the presence of NSSI involves alterations in the reward system independently of BPD, and thus can be considered as a possible phenotype for reward-related alterations.
Collapse
|
46
|
Lischke A, Herpertz SC, Berger C, Domes G, Gamer M. Divergent effects of oxytocin on (para-)limbic reactivity to emotional and neutral scenes in females with and without borderline personality disorder. Soc Cogn Affect Neurosci 2018; 12:1783-1792. [PMID: 29036358 PMCID: PMC5714167 DOI: 10.1093/scan/nsx107] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 09/11/2017] [Indexed: 12/31/2022] Open
Abstract
Borderline personality disorder (BPD) patients’ hypersensitivity for emotionally relevant stimuli has been suggested be due to abnormal activity and connectivity in (para-)limbic and prefrontal brain regions during stimulus processing. The neuropeptide oxytocin has been shown to modulate activity and functional connectivity in these brain regions, thereby optimizing the processing of emotional and neutral stimuli. To investigate whether oxytocin would be capable of attenuating BPD patients’ hypersensitivity for such stimuli, we recorded brain activity and gaze behavior during the processing of complex scenes in 51 females with and 48 without BPD after intranasal application of either oxytocin or placebo. We found divergent effects of oxytocin on BPD and healthy control (HC) participants’ (para-)limbic reactivity to emotional and neutral scenes: Oxytocin decreased amygdala and insula reactivity in BPD participants but increased it in HC participants, indicating an oxytocin-induced normalization of amygdala and insula activity during scene processing. In addition, oxytocin normalized the abnormal coupling between amygdala activity and gaze behavior across all scenes in BPD participants. Overall, these findings suggest that oxytocin may be capable of attenuating BPD patients’ hypersensitivity for complex scenes, irrespective of their valence.
Collapse
Affiliation(s)
- Alexander Lischke
- Department of Psychology, University of Greifswald, Greifswald, Germany.,Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany.,Department of Psychiatry and Psychotherapy, University of Rostock, Rostock, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Christoph Berger
- Department of Psychiatry and Psychotherapy, University of Rostock, Rostock, Germany.,Department of Child and Adolescent Psychiatry, Neurology, Psychosomatics and Psychotherapy, University of Rostock, Rostock, Germany
| | - Gregor Domes
- Department of Psychology, University of Trier, Trier, Germany
| | - Matthias Gamer
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Psychology, University of Würzburg, Würzburg, Germany
| |
Collapse
|
47
|
Abstract
Anger and low self-esteem characterize borderline individuals, yet little is known about their role and impact in the presence or absence of self-injury behavior. The present study aimed to investigate the impact of anger and self-esteem in borderline patients and whether these variables distinguish these patients with and without self-injury. Patients were recruited from a psychiatric service and were evaluated for self-esteem and anger. Additionally, impulsivity and symptoms were assessed. Two groups were compared, one with self-injurious behavior (n = 18) and another one without it (n = 23). Those who injure themselves seem to have a lower self-esteem (p < 0.001), yet the strengthening of self-esteem seems to have different outcomes, according to the presence or absence of self-injury. Anger and self-esteem seem to influence the severity of diagnosis, but only in patients who self-injure. Anger and self-esteem may influence borderline patients differently according to the presence or absence of self-injury.
Collapse
|
48
|
Ibáñez A, García AM, Esteves S, Yoris A, Muñoz E, Reynaldo L, Pietto ML, Adolfi F, Manes F. Social neuroscience: undoing the schism between neurology and psychiatry. Soc Neurosci 2018; 13:1-39. [PMID: 27707008 PMCID: PMC11177280 DOI: 10.1080/17470919.2016.1245214] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Multiple disorders once jointly conceived as "nervous diseases" became segregated by the distinct institutional traditions forged in neurology and psychiatry. As a result, each field specialized in the study and treatment of a subset of such conditions. Here we propose new avenues for interdisciplinary interaction through a triangulation of both fields with social neuroscience. To this end, we review evidence from five relevant domains (facial emotion recognition, empathy, theory of mind, moral cognition, and social context assessment), highlighting their common disturbances across neurological and psychiatric conditions and discussing their multiple pathophysiological mechanisms. Our proposal is anchored in multidimensional evidence, including behavioral, neurocognitive, and genetic findings. From a clinical perspective, this work paves the way for dimensional and transdiagnostic approaches, new pharmacological treatments, and educational innovations rooted in a combined neuropsychiatric training. Research-wise, it fosters new models of the social brain and a novel platform to explore the interplay of cognitive and social functions. Finally, we identify new challenges for this synergistic framework.
Collapse
Affiliation(s)
- Agustín Ibáñez
- a Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation , Favaloro University , Buenos Aires , Argentina
- b National Scientific and Technical Research Council (CONICET) , Buenos Aires , Argentina
- c Center for Social and Cognitive Neuroscience (CSCN), School of Psychology , Universidad Adolfo Ibáñez , Santiago de Chile , Chile
- d Universidad Autónoma del Caribe , Barranquilla , Colombia
- e Centre of Excellence in Cognition and its Disorders , Australian Research Council (ACR) , Sydney , Australia
| | - Adolfo M García
- a Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation , Favaloro University , Buenos Aires , Argentina
- b National Scientific and Technical Research Council (CONICET) , Buenos Aires , Argentina
- f Faculty of Elementary and Special Education (FEEyE) , National University of Cuyo (UNCuyo) , Mendoza , Argentina
| | - Sol Esteves
- a Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation , Favaloro University , Buenos Aires , Argentina
| | - Adrián Yoris
- a Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation , Favaloro University , Buenos Aires , Argentina
- b National Scientific and Technical Research Council (CONICET) , Buenos Aires , Argentina
| | - Edinson Muñoz
- g Departamento de Lingüística y Literatura, Facultad de Humanidades , Universidad de Santiago de Chile , Santiago , Chile
| | - Lucila Reynaldo
- a Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation , Favaloro University , Buenos Aires , Argentina
| | | | - Federico Adolfi
- a Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation , Favaloro University , Buenos Aires , Argentina
| | - Facundo Manes
- a Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation , Favaloro University , Buenos Aires , Argentina
- b National Scientific and Technical Research Council (CONICET) , Buenos Aires , Argentina
- e Centre of Excellence in Cognition and its Disorders , Australian Research Council (ACR) , Sydney , Australia
- i Department of Experimental Psychology , University of South Carolina , Columbia , SC , USA
| |
Collapse
|
49
|
Servan A, Brunelin J, Poulet E. The effects of oxytocin on social cognition in borderline personality disorder. L'ENCEPHALE 2018; 44:46-51. [DOI: 10.1016/j.encep.2017.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 05/16/2017] [Accepted: 11/14/2017] [Indexed: 10/18/2022]
|
50
|
Boritz T, Barnhart R, Eubanks CF, McMain S. Alliance Rupture and Resolution in Dialectical Behavior Therapy for Borderline Personality Disorder. J Pers Disord 2018; 32:115-128. [PMID: 29388901 DOI: 10.1521/pedi.2018.32.supp.115] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The aim of this exploratory study was to investigate alliance rupture and resolution processes in the early sessions of a sample of clients who underwent 1 year of standard dialectical behavior therapy (DBT) for borderline personality disorder (BPD). Participants were three recovered and three unrecovered clients drawn from the DBT arm of a randomized controlled trial that compared the clinical and cost-effectiveness of DBT and general psychiatric management. Alliance rupture and resolution processes were coded using the observer-based Rupture Resolution Rating Scale. Unrecovered clients evidenced a higher frequency of withdrawal ruptures than recovered clients. Withdrawal ruptures tended to persist for unrecovered clients despite the degree of resolution in the prior session, unlike for recovered clients, for whom the probability of withdrawal ruptures decreased as the degree of resolution increased. This study suggests that alliance rupture and resolution processes in early treatment differ between recovered and unrecovered clients in DBT for BPD.
Collapse
Affiliation(s)
- Tali Boritz
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Ryan Barnhart
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | | | - Shelley McMain
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Ontario, Canada
| |
Collapse
|