Childhood maltreatment and its link to borderline personality disorder features in children: A systematic review approach

The well-being of young adults: The implications of multi-type child maltreatment and the mediating role of betrayal trauma

BACKGROUND

Research indicates that the nature of the relationship between a victim-survivor and perpetrator of child maltreatment can influence well-being experienced during young adulthood. However, further research is required to substantiate the possible mediating role of betrayal trauma following child maltreatment.

OBJECTIVE

To explore the relationship between child maltreatment and psychological well-being experienced during young adulthood by examining the extent of maltreatment, the importance of the type of perpetrator, and the potential mediating role of betrayal trauma following child maltreatment.

PARTICIPANTS AND SETTING

The self-selected sample comprised 468 young adults (aged 18-25 years; M = 21.74 years, SD = 2.47) from Australia and internationally.

METHOD

Information regarding participants' current well-being, the extent of enduring five types of maltreatment (witnessing family violence, neglect, physical abuse, psychological abuse, and sexual abuse) by their mother, father and other adults during childhood, multi-type maltreatment, and severity of betrayal trauma were obtained via an online survey.

RESULTS

Using multiple regression analysis, it was found that higher levels of multi-type maltreatment were associated with poorer current well-being. Maltreatment by one's mother or father predicted poorer well-being, maltreatment by another adult did not. Hierarchical regressions revealed young adults' sense of betrayal trauma in close relationships partially mediated the relationship between current well-being and child maltreatment by one's mother, father, and another adult.

CONCLUSION

Findings show that the extent of child maltreatment experienced, one's sense of betrayal, and the relationship of the child/adolescent to the perpetrator can influence well-being experienced during young adulthood. These findings highlight the therapeutic benefit of clinicians supporting young adults who have endured child maltreatment to process betrayal trauma, to improve their well-being.

Social cognition in women with borderline personality disorder based on an exhaustive analysis of the Movie for Assessment of Social Cognition (MASC) categories

A significant number of borderline personality disorder (BPD) symptoms are manifested in the interpersonal context. This can be explained by the difficulties in attributing the mental states of oneself and others, which constitutes social cognition. Errors in social cognition are interrelated with the affective, cognitive, impulsive, and interpersonal areas of the person with BPD. The aims of this study was to analyze social cognition in women with BPD compared with a control group and to analyze social cognition in BPD based on BPD symptoms and its severity. To assess social cognition, we used a full range of social cognition categories provided by the Movie for the Assessment of Social Cognition (MASC): correct theory of mind (ToM); attribution of mental states (thoughts, emotions, or intentions); errors of mentalization; types of ToM; and attribution of mental states through perceptive or cognitive cues and through hot or cold emotions. The MASC has high ecological validity and has been validated in Spanish. The sample comprised 79 women, including 47 women with BPD and 32 healthy women. Worse social cognition performance was observed in women with BPD. More severe borderline symptoms were related to worse functioning in the correct ToM and to errors of no mentalization. Involvement of the cognitive area in borderline symptoms was associated with worse functioning in correct ToM and worse social cognition in cognitive areas as well as with hypermentalization. This is the first study that uses all the MASC categories and considers BPD heterogeneity and its severity to study social cognition.

Personality Disorders and Attachment Trauma in Adolescent Patients with Psychiatric Disorders

This study examined how personality disorders (PD) differ with respect to gender, attachment status and traumatic childhood experiences in adolescent psychiatric inpatients. In particular, we investigated attachment-related traumatic material underlying adolescent PD. Our sample consisted of 175 inpatient adolescents aged 14 to 18 years (77% female, Mage = 15.13, SD = 1.35; 23% male, Mage =14.85, SD = 1.41). Thirty-nine patients (22%) fulfilled the diagnostic criteria for a PD according to the SCID-II PD: 51% avoidant, 13% obsessive-compulsive, 13% antisocial, 19% borderline, 2% paranoid and 2% histrionic. In the total sample, eighty-three (47%) of our inpatients were classified with an unresolved attachment status using the Adult Attachment Projective Picture System (AAP). We did not find any significant gender differences for patients with and without a PD. Our results revealed a higher percentage of unresolved attachment status in patients with a PD. The in-depth analysis of the total sample showed that patients with a PD demonstrated more traumatic material in their attachment interviews indicating a greater severity of attachment trauma. Furthermore, patients with a PD reported higher scores on emotional and physical neglect. Intervention strategies targeting traumatic attachment-related themes might be useful to treat adolescents with PD.

Unresolved attachment and identity diffusion in adolescence

This study examined the severity of unresolved attachment underlying adolescent identity diffusion. Our sample consisted of 180 inpatient adolescents aged 14 to 18 years (77% female, M age = 15.13, SD = 1.35; 23% male, M age = 14.85, SD = 1.41) and 84 age-matched non-clinical adolescents (52% female, M age = 16.14, SD = 1.21; 48% males, M age = 15.98, SD = 1.07). We used the Adult Attachment Projective Picture System (AAP) interview to assess attachment representations and the Assessment of Identity Development in Adolescence (AIDA) questionnaire to evaluate the severity of identity diffusion. Our results demonstrate a higher amount of unresolved attachment and identity diffusion in the patient sample than in the control sample. Furthermore, patients with an unresolved attachment status scored higher on identity diffusion than those with no unresolved attachment pattern. Interestingly, this was not found in the control group. Furthermore, patients with a greater severity of unresolved attachment showed the highest maladaptive identity development scores. Psychotherapeutic interventions integrating attachment-related aspects might be useful to treat young people with identity diffusion.

ICD-11 complex posttraumatic stress disorder and subclasses of borderline personality disorder in a South Korean adult population with childhood abuse experiences: a latent class analysis

BACKGROUND

Complex posttraumatic stress disorder (CPTSD) and borderline personality disorder (BPD), which are distinctive diagnoses, share the common risk factor of childhood abuse experiences. However, additional evidence is needed to determine which factors contribute to the manifestation of different symptoms.

METHOD

Participants were 499 South Korean early and midlife adults with primarily college level education who reported experiences of childhood abuse. They were enrolled from an online panel using a stratified sampling considering gender, age, and residence information. A latent class analysis (LCA) was conducted to identify the patterns of CPTSD and BPD symptoms. We adopted a three-step LCA to compare types of childhood abuse, invalidating environments, attachment styles, and pathological personality traits among different classes.

RESULTS

The LCA revealed four classes. Class 1 showed the highest scores in all symptoms and risk factors. Class 2 was distinguished from Class 3 by the externalizing versus internalizing associated pathological personality traits. Class 3 experienced high emotional neglect in addition to other types of abuse and it also showed an additional avoidant attachment style. Class 4 showed low symptomatology.

CONCLUSION

Class 1 was named as a CPTSD and BPD "comorbid" class, Class 2 as an "externalizing BPD" class, Class 3 as an "avoidant BPD" class, and Class 4 as a "low symptom" class. Childhood abuse may heighten the risk for high comorbidity of CPTSD and BPD as well as externalizing-internalizing subgroups of BPD. Beyond the identification of CPTSD and BPD, assessing attachment styles and pathological personality traits based on dimensional approaches would benefit the tailoring of effective treatment.

Attachment and Mindfulness as Mediators in the Relationship Between Childhood Adversity and Personality Outcomes

Past research has shown that those with greater experiences of adversity (abuse and neglect) tend to exhibit insecure attachments, more borderline symptoms, higher psychopathic traits, and are lower in mindfulness. Similarly, there have been positive relationships between insecure attachment styles and borderline and psychopathic traits as well as lower mindfulness and borderline and psychopathic traits. Further, adversity can have a detrimental effect on physical and mental health, including attachment and personality, which necessitate examining this further. The purpose of this study was to examine the indirect relationships between childhood adversity and borderline traits, Factor 1, and Factor 2 of psychopathy all through lower mindfulness, anxious attachment, and avoidant attachment respectively. In this study, using youth retrospective data (N = 395, age range = 12-18, M = 14.64, SD = 1.52), 3 separate mediation models are examined. As expected, the relationship between adversity and borderline traits was indirect through anxious attachment (β = 0.075, p < .01) and lower mindfulness (β = 0.069, p < .01). For psychopathic traits, the relationship was indirect through avoidant attachment (Factor 1: β = 0.078, p < .05; Factor 2: β = 0.071, p < .05) and lower mindfulness (Factor 1: β = 0.074, p < .01: Factor 2: β = 0.076, p < .01). The results suggest that lower mindfulness and insecure attachment are important factors in the expression of disordered personality. Therefore, both mindfulness and attachment-focused interventions could mitigate the harmful effects of adversity and the subsequent expression of disordered personality symptoms.

Focusing the Clinical Supervision on the Therapist's Developmental Trauma: A Single Case Study

The term developmental trauma (DT) refers to the impact of stressful events which occur cumulatively within the child's relevant relationships and contexts, and usually early in life. According to several authors, DT depends on the caregiver's inadequate intersubjective recognition of one or more aspects of the evolving individual's identity. In the clinical and empirical literature, the study of therapists' developmental trauma, and how it might constitute a relevant variable in the clinical exchange, seem to be underrepresented. In this paper, through the analysis of the supervision process of a clinical case, we show how the therapeutic relationship may implicitly take the form of a "dance" between the patient's and therapist's DT, that prevents the therapist from intersubjectively attuning with the patient; and how a supervision process peculiarly focused on the therapist's DT can effectively promote this attunement and a good clinical outcome.

Childhood maltreatment and homicidal ideation among Chinese early adolescents: The serial mediating role of borderline personality features and aggression

A large body of evidence linked childhood maltreatment (CM) to juvenile violence and delinquent behavior. However, little is known about the association between CM and homicidal ideation in early adolescents. This study aimed to examine that relationship and to explore the serial mediating role of borderline personality features (BPF) and aggression in that relationship in a large sample of early adolescents. A total of 5724 early adolescents (mean age: 13.5 years) were recruited from three middle schools in Anhui Province, China. The participants were invited to complete self-report questionnaires regarding their history of CM, BPF, aggression, and homicidal ideation. Mediation analyses were evaluated using structural equation modeling. A total of 669 participants (11.7%) reported homicidal ideation in the past 6 months. CM victimization was positively associated with homicidal ideation after adjusting for covariates. Furthermore, the serial mediation analysis showed a significant indirect effect of CM on homicidal ideation through BPF and subsequent aggression. Exposure to maltreatment in childhood is likely to manifest BPF and subsequently higher levels of aggression, which in turn are related to increased homicidal ideation. These findings suggest the need for early intervention for BPF and aggression in early adolescents exposed to CM to prevent the development of homicidal ideation.

Mother-child interactions in adolescents with borderline personality disorder traits and the impact of early life maltreatment

BACKGROUND

Early detection and intervention of borderline personality disorder (BPD) in adolescence has become a public health priority. Theoretical models emphasize the role of social interactions and transgenerational mechanisms in the development of the disorder suggesting a closer look at caregiver-child relationships.

METHODS

The current study investigated mother-adolescent interactions and their association with adolescent BPD traits by using a case-control design. Thirty-eight adolescent patients with ≥ 3 BPD traits and their mothers (BPD-G) were investigated in contrast to 35 healthy control dyads (HC-G). Maternal, adolescent and dyadic behavior was coded using the Coding Interactive Behavior Manual (CIB) during two interactions: a fun day planning and a stress paradigm. Additional effects of maternal and/or adolescent early life maltreatment (ELM) on behavior were also explored.

RESULTS

BPD-G displayed a significantly lower quality of maternal, adolescent and dyadic behavior than the HC-G during both interactions. Maternal and adolescent behavior was predicted by BPD traits alone, whilst dyadic behavior was also influenced by general adolescent psychopathology. Exploratory analyses of CIB subscales showed that whilst HC-G increased their reciprocal behavior during stress compared to the fun day planning, BPD-G dyads decreased it. Maternal ELM did not differ between groups or have any effect on behavior. Adolescent ELM was correlated with behavioral outcome variables, but did not explain behavioral outcomes above and beyond the effect of clinical status.

DISCUSSION/CONCLUSION

Our data suggest a stronger focus on parent-child interactions in BPD-specific therapies to enhance long-term treatment outcomes in adolescent BPD patients. Further research employing study designs that allow the analyses of bidirectional transactions (e.g. longitudinal design, behavioral microcoding) is needed.

Psychometric properties of the Chinese Mandarin version of the Borderline Symptom List, short form (BSL-23) in suicidal adolescents

BACKGROUND

The short form of the Borderline Symptom List (BSL-23) is a self-rated instrument developed from the initial 95-item German version of the Borderline Symptom List (BSL-95). It is widely used among Chinese adults, but its applicability, factor structure and validity remain uncertain in adolescents. This study aimed to evaluate the psychometric properties of the Chinese Mandarin version of the BSL-23 in a sample of suicidal adolescents.

METHODS

The Chinese Mandarin BSL-23 was given to 279 outpatient adolescents with self-injurious thoughts or behaviors. The factor structure, reliability, convergent validity, criterion-related validity and cut-off value were investigated.

RESULTS

The Chinese Mandarin version of the BSL-23 demonstrated a one-factor structure and replicated the original version. The scale had high reliability and good test-retest stability. The Chinese Mandarin BSL-23 was correlated with depression, hopelessness, impulsivity, emotional dysregulation, self-esteem, loneliness, childhood trauma and parental bonding patterns evaluated with a variety of scales. The measure showed good criterion-related validity and predictive accuracy (AUC = 0.87) for self-injurious and suicidal adolescents with borderline personality disorder (BPD) at a cut-off point of 60/61 (mean score 2.60/2.65), with a sensitivity of 0.76 and specificity of 0.83.

CONCLUSIONS

The Chinese Mandarin version of the BSL-23 is a reliable and valid self-reported instrument to assess BPD symptomatology among suicidal adolescents.

Three-level containment model of hospitalized adolescents with borderline pathology: a holistic therapeutic perspective

Borderline personality disorders account for 50% of adolescent hospitalization cases in psychiatry. The severity and psychopathological complexity of these symptoms indicate the need for inclusive models of understanding. Adopting a holistic approach allows for the consideration of not only the patient's environment, but also their position within that environment and their life history. In this article, a model based on the concept of therapeutic containment at three levels is presented. Global containment refers to the mindset and organization of the institution that provides care, which is itself a part of society at a specific time. Local containment focuses on understanding and therapeutic interventions within the immediate social environment of the individual. Lastly, individual containment encompasses the development of independent processes during the course of care. These three levels are integrated in the hospital treatment of borderline personality disorders, forming a trans-theoretical approach.

Relationship Dysfunction in Couples When One Partner Is Diagnosed with Borderline Personality Disorder: Findings from a Pilot Study

Relationship dysfunction—marked by frequent conflicts—is one of the hallmark features of borderline personality disorder (BPD). However, the BPD couple as a dyad and partner-related features have rarely been taken into account. The aim of the present study was to investigate hormonal, personality, and relationship relevant factors, such as relationship satisfaction, attachment, and trauma in both partners within a dyad where one partner is diagnosed with BPD. The total sample consisted of 26 heterosexual couples. All studies were conducted at 2 p.m. Primary outcomes: Neo-Five-Factor-Inventory, Childhood Trauma Questionnaire, Experiences in Close Relationships Scale. Secondary outcomes: Problem List, Partnership Questionnaire, Questionnaire for Assessing Dyadic Coping. Upon questionnaire completion, one saliva sample was taken via passive drool to assess baseline cortisol and testosterone levels. Results showed that females with BPD have higher scores on childhood maltreatment, dysfunctional attachment styles, and neuroticism than mentally healthy females. Furthermore, they have more relationship-related problems and are less satisfied in their romantic relationship. Male partners of women with BPD showed lower testosterone levels, higher levels of childhood maltreatment, dysfunctional attachment styles, neuroticism, and openness compared with the healthy control partners. Furthermore, childhood trauma, neuroticism as well as dysfunctional attachment styles displayed a significant positive correlation with relationship-related problems. Traumatic childhood experiences, insecure attachment styles as well as neurotic personality characteristics contribute to increased relationship disruptions in couples. Relevant hormonal and psychosocial parameters in BPD partners should be taken into account when treating females with BPD.

Early life stress, depression and epigenetics

Different factors are essential in increasing the vulnerability to psychiatric disorders, such as genetics. Among these factors, early life stress (ELS), including sexual, physical, emotional abuse, and emotional and physical neglect, enhances the odds of having menial conditions throughout life. Exhaustive research has shown that ELS leads to physiological changes, such as alteration in the HPA axis. During the most critical development period (childhood and adolescence), these changes increase the risk of having child-onset psychiatric disorders. Furthermore, research has suggested a relationship between early life stress and depression, particularly more prolonged episodes of depression with treatment-resistant outcomes. Molecular studies indicate that, in general, the hereditary character of psychiatric disorders is polygenic, multifactorial and highly complex, with innumerable low-effect genetic variants interacting with each other. However, whether there are independent effects among subtypes of ELS remains unclear. This article provides an overview of the interplay of epigenetics, the HPA axis, early life stress and the development of depression. Advances in our knowledge of epigenetics in the context of early life stress and depression provide a new understanding of the genetic influence on psychopathology. Furthermore, they could lead to identifying new targets for clinical intervention.

Bullying Perpetration and Victimization as Social Mechanisms in the Development of Borderline Personality Traits during Adolescence: A Longitudinal Study

INTRODUCTION

Borderline personality features are often associated with toxic social relationships and problematic peer functioning. Less is known, however, about the extent to which bullying experiences may shape the development and maintenance of borderline-related traits during crucial periods of rapid normative developments in impulse and emotion regulation skills. Given the core interpersonal character of borderline personality pathology (BPP), such research focus may be relevant to better understand possible causal social mechanisms in the development of personality difficulties within the borderline trait spectrum.

METHOD

The current longitudinal study examined whether experiences of both bullying perpetration and victimization in pre-adolescence mediated the developmental course of BPP traits between childhood and adolescence. To examine these associations, a sample of children (N = 242; 57% girls; Mage = 10.87 years) was recruited and followed up 1 and 4 years later.

RESULTS

Mediation analysis indicated that the prospective link between child and adolescent BPP trait vulnerability was shaped by pre-adolescent experiences of bullying victimization, but not by bullying perpetration.

DISCUSSION

These results indicate that the continuity between child and adolescent borderline trait features are partly explained by exposure to bullying victimization, indicating that the impact of environmental invalidation on BPP development also extends to the peer context.

Emotional working memory training improves cognitive inhibitory abilities in individuals with borderline personality trait: A randomized parallel-group trial

BACKGROUND

Cognitive inhibition impairment is one of the causes of impulsive behaviors in individuals with borderline personality disorder (BPD). This study aimed to investigate the effect of emotional working memory training (EWMT) on cognitive inhibition in individuals with a clinically significant borderline personality trait.

METHODS

In a randomized, parallel-group trial, 40 individuals with borderline personality trait, were selected out of 1000 screened individuals and were randomly assigned to the experimental (N = 20) and waiting-list control (N = 20) groups based on the score on the Borderline Personality Scale and the follow-up Structured Clinical Interview for DSM-IV Personality Disorders. The experimental group underwent 10 sessions of EWMT and the control group did not receive any intervention (waiting list). Participants completed the Stroop Color and Word Test (SCWT) and Go/No-Go task Before and after the intervention.

RESULTS

EWMT significantly reduced reaction time of incongruent trials in the SCWT and commission errors in the Go/No-Go task after the intervention only in the experimental group. Furthermore, the interference score in SCWT and commission error rate at the post-intervention time were significantly lower for the experimental vs the waitlist group.

LIMITATIONS

The single-blind design and absence of follow-up measures.

CONCLUSIONS

EWMT can improve cognitive inhibition in individuals with borderline personality trait and could be used for therapeutic purposes of impulsivity behavior in BPD.

Examining the Construct Validity of Borderline Personality Traits Using Familial Aggregation and Other External Validators

Numerous studies have questioned the reliability and validity of borderline personality disorder's (BPD) categorical conceptualization. DSM-5 Section III's alternative trait-based model of BPD may better capture borderline pathology, but aspects of its validity should be further established. Thus, the authors examined whether a latent BPD factor derived from Section III traits exhibits (1) familial aggregation among siblings and (2) association with constructs related to borderline pathology. The authors also tested whether gender moderated associations. A total of 498 community-recruited adults completed the Personality Inventory for DSM-5, a behavioral assessment of risk-taking, and reported their history of childhood maltreatment, substance use, nonsuicidal self-injury, and suicidal ideation. Familial aggregation was assessed among 232 sibling pairs. Siblings' BPD scores were significantly correlated and most external validators were significantly associated with BPD, with the exception of risk-taking. Results did not vary by gender. Findings further support the construct validity of Section III's BPD trait profile.

Personality functioning and the pathogenic effect of childhood maltreatment in a high-risk sample

BACKGROUND

While the psychopathological sequalae of childhood maltreatment are widely acknowledged, less is known about the underlying pathways by which childhood maltreatment might lead to an increased risk for mental health problems. Recent studies indicated that impaired personality functioning might mediate this relationship. The aim of the present paper was to extend the current literature by investigating the mediating effect of impaired personality functioning between different types of childhood maltreatment and self-reported mental health problems in a high-risk sample.

METHODS

Overall, 173 young adults (mean age = of 26.61 years; SD = 3.27) with a history of residential child welfare and juvenile justice placements in Switzerland were included in the current study. The Childhood Trauma Questionnaire (CTQ-SF), Semi-structured Interview for Personality Functioning DSM-5 (STiP-5.1) and the self-report questionnaires of the Achenbach System of Empirically Based Assessment scales (ASEBA) were used. Mediation analyses were conducted through structural equation modeling.

RESULTS

Overall, 76.3% (N = 132) participants indicated at least one type of childhood maltreatment, with emotional neglect being most commonly reported (60.7%). A total of 30.6% (N = 53) participants self-reported mental health problems. Emotional abuse (r = 0.34; p < .001) and neglect (r = 0.28; p < .001) were found to be most strongly associated with mental health problems. In addition, impaired personality functioning was fond to be a significant mediator for overall childhood maltreatment (β = 0.089; p = 0.008) and emotional neglect (β = 0.077; p = 0.016). Finally, impaired self-functioning was found to be a significant mediator when both self-functioning and interpersonal functioning were included as potential mediators in the relationship between overall childhood maltreatment (β1 = 0.177, p1 = 0.007) and emotional neglect (β1 = 0.173, p1 = 0.003).

CONCLUSION

Emotional neglect may be particularly important in the context of childhood maltreatment, personality functioning, and mental health problems and, therefore, should not be overlooked next to the more "obvious" forms of childhood maltreatment. Combining interventions designed for personality functioning with trauma-informed practices in standard mental health services might counteract the psychopathological outcomes of maltreated children and adolescents.

Borderline Personality Pathology in Major Depressive Disorder, Bipolar I and II Disorder, and Its Relationship With Childhood Trauma

OBJECTIVE

Mood disorder and borderline personality pathology (BPP) are frequently comorbid and relate to childhood trauma. We investigated the relationship between childhood trauma and BPP features in mood disorder patients versus controls.

METHODS

A total of 488 mood disorder patients, particularly major depressive disorder (MDD), bipolar I disorder (BD I), and bipolar II disorder (BD II), and 734 controls were included. We examined between-group BPP-related differences and correlated between BPP and childhood trauma using the Childhood Trauma Questionnaire-Short Form (CTQ) and the Personality Assessment Inventory-Borderline Features Scale.

RESULTS

BD II patients showed significantly higher BPP. Emotional abuse and neglect were prominently associated with BPP, while affective instability and negative relationships exhibited a stronger association with childhood trauma. We also found a positive relationship between childhood trauma and BPP in MDD, BD I, and BD II patients.

CONCLUSION

The findings of the present study imply that BPP features are more likely to be found in patients with BD II than BD I or MDD. Mood disorder patients with severe childhood trauma may have higher BPP features. Thus, further study of the relationship between childhood trauma and BPP features could improve the therapeutic approaches and help understand patients with mood disorders.

Psychological adjustment mediating the relationship between childhood maltreatment and borderline personality features among Chinese early adolescents

BACKGROUND

A strong link between childhood maltreatment (CM) and borderline personality features (BPF) has been consistently demonstrated. However, little is known about the role of psychological adjustment (PA) as a mediator of this relationship. The purpose of the study was to explore the mediating role of PA in the CM-BPF linkage in a large sample of early adolescents.

METHODS

A total of 5724 students (mean age = 13.5, SD = 1.0) were recruited from three middle schools by using the multistage random cluster sampling method in Anhui Province, China. Participants were required to complete self-report questionnaires regarding CM experience, self-perceived PA and BPF. Mediation analyses were computed via structural equation modelling.

RESULTS

CM victimization was positively associated with BPF, and individuals with lower levels of PA were more likely to present with BPF. Mediation analysis showed a significant indirect effect of CM on BPF via PA (effect = 0.047, 95 % CI: 0.035, 0.058).

LIMITATION

The cross-sectional design of this study did not allow testing causality. The retrospective investigation of CM history could cause recall bias.

CONCLUSIONS

PA partially mediates the relationship between CM and BPF. These findings have important implications for considering PA as a protective factor in this relationship.

How childhood maltreatment alters perception and cognition - the predictive processing account of borderline personality disorder

Borderline personality disorder (BPD) is a severe mental disorder, comprised of heterogeneous psychological and neurobiological pathologies. Here, we propose a predictive processing (PP) account of BPD to integrate these seemingly unrelated pathologies. In particular, we argue that the experience of childhood maltreatment, which is highly prevalent in BPD, leaves a developmental legacy with two facets: first, a coarse-grained, alexithymic model of self and others - leading to a rigidity and inflexibility concerning beliefs about self and others. Second, this developmental legacy leads to a loss of confidence or precision afforded beliefs about the consequences of social behavior. This results in an over reliance on sensory evidence and social feedback, with concomitant lability, impulsivity and hypersensitivity. In terms of PP, people with BPD show a distorted belief updating in response to new information with two opposing manifestations: rapid changes in beliefs and a lack of belief updating despite disconfirmatory evidence. This account of distorted information processing has the potential to explain both the instability (of affect, self-image, and interpersonal relationships) and the rigidity (of beliefs about self and others) which is typical of BPD. At the neurobiological level, we propose that enhanced levels of dopamine are associated with the increased integration of negative social feedback, and we also discuss the hypothesis of an impaired inhibitory control of the prefrontal cortex in the processing of negative social information. Our account may provide a new understanding not only of the clinical aspects of BPD, but also a unifying theory of the corresponding neurobiological pathologies. We conclude by outlining some directions for future research on the behavioral, neurobiological, and computational underpinnings of this model, and point to some clinical implications of it.

Specific type of childhood trauma and borderline personality disorder in Chinese patients

Background

Childhood maltreatment (CM) is a known risk factor for the development of mental disorders. An extensive body of literature about CM and mental health has been developed in wealthy countries, but information about this connection is lacking in developing countries including China.

Aims

To explore the possible relationship between specific types of CM and borderline personality disorder (BPD) in patients with mental disorders in China.

Methods

A survey was conducted in 2006, involving over 3,402 Chinese individuals aged 18-60 years who were randomly selected from the outpatients in the Shanghai Mental Health Center. The patients were screened with the Personality Diagnostic Questionnaire and CM was assessed using the Childhood Trauma Questionnaire. The final sample comprised 178 patients with BPD, 178 patients with other personality disorders (PDs), and 178 patients without PDs.

Results

In Chinese patients, compared to other PDs, patients with BPDs are more likely to have experienced CM. Emotional maltreatment (emotional abuse and neglect) was the strongest predictor of BPD. Female gender and sexual abuse are significant predictors of the self-harm/suicidal risk of BPD patients.

Conclusion

This is a pioneering study conducted on a large set of Chinese clinical samples with paired controls to establish and compare the associations between specific CM and BPD. Further studies in this field are necessary to elucidate the mechanism of how various types of childhood trauma have influenced PDs.

Adverse Childhood Experiences and Neurocognition in Borderline Personality Disorder: A Call-to-Action Perspective Review

Adverse childhood experiences (ACEs) contribute to the development of personality traits leading to adult borderline personality disorder (BPD). Neurocognitive changes could partly mediate the association between ACEs and BPD. We discuss how exposure to ACEs could induce alterations in neurocognition, which, in turn, would contribute to the development of BPD. We conducted a review of MEDLINE articles through 2021, documenting a link between ACEs, neurocognitive impairments, and BPD, and also focusing on the pairwise associations. ACEs appear to have a strong impact on neurocognition and are a predictive factor for BPD. Maltreated, abused, and emotionally invalidated children are more likely to present BPD traits. Neurocognitive impairments in adults exposed to ACEs and in patients with BPD arise from similar brain alterations in the amygdala, hippocampus, and prefrontal cortex. These impairments seem to be linked with clinical dimensions of BPD: increased impulsivity to altered inhibitory control; dissociative experiences to nonspecific autobiographical memory; and emotionally biased facial recognition to unstable interpersonal relationships. This perspective review highlights the contributory role of neurocognition in the association between ACEs and BPD. Additional research is needed, however, on the interconnections among ACEs, neurocognition, and BPD. Future studies could also focus on developing tools to assess early adversity in BPD specifically and on psychotherapeutic approaches to promptly remedy neurocognitive impairments.

Judging Personality Disorder: A Systematic Review of Clinician Attitudes and Responses to Borderline Personality Disorder

BACKGROUND

It has been suggested that the diagnosis of borderline personality disorder (BPD) is associated with particularly stigmatizing connotations, particularly among mental health professionals. The goal of this study was to synthesize quantitative studies investigating the attitudes and responses of clinicians to BPD and to appraise the methodological quality of these studies.

METHODS

A systematic search was carried out using MEDLINE Complete, CINAHL Complete, PsychoINFO, PsychARTICLES, Scopus, Social Sciences Citation Index, and Academic Search Complete. Study quality was rated using an adapted tool.

RESULTS

This review included 37 papers involving an estimated 8196 participants: 21 cross-sectional survey studies, 5 studies assessing training workshops, 5 studies assessing countertransference, and 6 experimental studies. The methodological quality of the studies was mixed, with many differing measures with questionable validity used.

CONCLUSIONS

Negative attitudes toward BPD continue to be a problem to differing degrees among clinical staff. Although this issue is most prominent among psychiatric nurses, the results of this review highlight evidence of negative attitudes across all mental health professions as well as potentially in professionals working in physical health settings. Various clinician-level factors may play a role in the development and maintenance of such attitudes. Greater exposure to patients with BPD and attendance at training programs have been found to be associated with improved attitudes. Professionals require regular training concerning BPD that is sufficiently evidence-based.

Risk of Personality disorders among childhood maltreatment victims: A nation-wide population-based study in Taiwan

BACKGROUND

To date, numerous cohort studies and meta-analyses have shown that childhood maltreatment is associated with a wide range of adverse physiological and psychological symptoms. Although childhood maltreatment has been linked to an increased risk of personality disorders, the direction and magnitude of the association remain uncertain. Therefore, this cohort study aimed to evaluate whether children who have suffered childhood maltreatment have a higher incidence of subsequent personality disorders, using a nationwide database in Taiwan.

METHODS

We conducted a large retrospective cohort study using data drawn from Taiwan's National Health Insurance Research Database between 2000 and 2015. A total of 10,345 children who experienced childhood maltreatment were identified using International Classification of Disease codes. They were then compared with 41,380 children who never experienced childhood maltreatment in terms of the prevalence rates of personality disorders.

RESULTS

Childhood maltreatment was associated with an increased risk of personality disorders (considering the control as reference: adjusted hazard ratio, 2.12; 95% confidence interval, 1.90-2.36; p < 0.001). The Kaplan-Meier analysis revealed a significantly higher 15-year cumulative incidence of personality disorders among childhood maltreatment victims than among controls (log-rank test, p < 0.001).

CONCLUSIONS

The present population-based study showed a positive association between prior childhood maltreatment and subsequent personality disorders in the general Taiwanese population. In order to reduce the risk of personality disorders, interventions should be implemented, identifying and supporting economically disadvantaged families and vulnerable children as early as possible.

Childhood neglect and trajectories of affective symptoms throughout adulthood: A British birth cohort study

BACKGROUND

Childhood maltreatment, including neglect, can affect an individual's mental health. However, there is a gap in current literature investigating the long-term, dynamic effects of childhood neglect on adult affective symptoms (AS).

METHOD

Data were used from the National Child Development Study (a British 1958 birth cohort). Childhood neglect was prospectively measured at ages 7 and 11. Five distinct trajectories of AS have been derived previously, using data from the Malaise Inventory Scale (at ages 23, 33, 42 and 50): 'no symptoms', 'persistent mild/moderate symptoms', 'low and increasing symptoms', 'high and increasing symptoms' and 'high and decreasing symptoms' (John et al., 2019). Multinomial logistic regressions were used to explore whether childhood neglect was associated with AS trajectory membership, while adjusting for a number of covariates.

RESULTS

Results revealed that childhood neglect was significantly associated with 'high and decreasing', 'high and increasing' and 'persistent mild/moderate' AS trajectories from young adulthood through midlife. There was no association with the 'low and increasing' AS trajectory. When testing for at age specific effects, neglect experienced at age 7 only, or at age 11 only, was predictive of 'high and decreasing symptoms' trajectory, whereas neglect experienced at both ages was predictive of 'persistent mild/moderate symptoms' trajectory.

CONCLUSIONS

Childhood neglect has negative long-lasting effects on trajectories of adult mental health. This finding has important implications for early intervention for individuals who have experienced childhood neglect.

Borderline Personality Disorder: Risk Factors and Early Detection

Personality disorders (PDs) exert a great toll on health resources, and this is especially true for borderline personality disorder (BPD). As all PDs, BPD arises during adolescence or young adulthood. It is therefore important to detect the presence of this PD in its earlier stages in order to initiate appropriate treatment, thus ameliorating the prognosis of this condition. This review aims to highlight the issues associated with BPD diagnosis in order to promote its early detection and treatment. To do so, we conducted a search on PubMed database of current evidence regarding BPD early diagnosis, focusing on risk factors, which represent important conditions to assess during young patient evaluation, and on diagnostic tools that can help the clinician in the assessment process. Our findings show how several risk factors, both environmental and genetic/neurobiological, can contribute to the onset of BPD and help identify at-risk patients who need careful monitoring. They also highlight the importance of a careful clinical evaluation aided by psychometric tests. Overall, the evidence gathered confirms the complexity of BDP early detection and its crucial importance for the outcome of this condition.

Childhood abuse and borderline personality disorder features in Chinese undergraduates: the role of self-esteem and resilience

BACKGROUND

Although childhood abuse is considered to be related to borderline personality disorder (BPD), few studies have elaborated on the mediating role of self-esteem and resilience in it. Thus, the present study aimed to explore the potential mediating role of resilience and self-esteem between childhood abuse and BPD.

METHODS

This cross-sectional study was conducted with 4034 college students in Anhui Province, China. Participants were asked to complete Chinese versions of the following instruments: Childhood Trauma Questionnaire-Short Form (CTQ-SF), Mclean Screening Instrument for Borderline Personality Disorder (MSI-BPD), Connor-Davidson Resilience Scale (CD-RISC), and Rosenberg Self-Esteem Scale (RSES). Structural equation modeling (SEM) was used to test the mediation effects.

RESULTS

Resilience and self-esteem were found to be mediators of all three types of childhood abuse (emotional abuse, physical abuse and sexual abuse) when the types were examined separately; however, when all three types of childhood abuse were entered into the model simultaneously, neither the indirect effects nor direct effects of physical abuse or sexual abuse were found to be significant, only the association between emotional abuse and BPD features was partially mediated by resilience and self-esteem.

CONCLUSIONS

Self-esteem and resilience mediate the links between childhood abuse and BPD features, and emotional abuse is uniquely associated with BPD features.

Specific Pathways From Adverse Experiences to BPD in Adolescence: A Criteria-Based Approach of Trauma

Within the European Research Network on BPD (EURNET-BPD; n = 85 BPD adolescents, n = 84 healthy controls, aged 13-19), this study explored the combination of three types of adversity-maltreatment, stressful life events (early separation from parents, parental suicide attempt, parental chronic disease) and parental bonding-as predictors of BPD, on a criteria-based approach. Results indicated that cumulative traumatic experiences largely characterize borderline adolescent's history; and, in the multivariate regression models, all adversity experiences were likely to contribute to BPD symptoms. The role of emotional abuse, parental suicide attempt, and a decrease in paternal level of care were particularly prominent. Moreover, adversities combinations were different for each criterion, suggesting that specific sets of traumatic experiences are leading to BPD. These findings argue for a further criteria-based exploration of trauma in borderline patients, as well as a more accurate and efficient prevention.

Childhood maltreatment, personality vulnerability profiles, and borderline personality disorder symptoms in adolescents

Adverse childhood experiences are significant risk factors in the development of adolescent borderline personality disorder symptoms (BPDs). Theorists have posited that two personality vulnerabilities factors, self-criticism and dependency, may inform our understanding of this relationship. However, no research has examined the associations between early negative experiences, personality vulnerabilities, and adolescent BPDs. The current study aimed to identify profiles of dependency and self-criticism to examine the associations of these profiles with cumulative forms of childhood maltreatment (CM) and BPDs as well as to explore the mediating and moderating role of vulnerable personality profiles in the relationship between cumulative CM and BPDs. Two hundred and forty-one nonclinical and clinical adolescents participated in the study (Mage = 16.37, SD = 1.84). The findings indicated three different profiles: average dependent profile, dependent and self-critical profile, and self-critical profile. Individuals in the average dependent profile presented lower levels of CM and BPDs. Mediation analyses showed that relative to the average dependent profile, a higher cumulative CM history predicted a higher probability of belonging in the dependent and self-critical profile or the self-critical profile and, in turn, this was associated with higher levels of BPDs. No moderating effects of profiles of dependency and self-criticism were found.

Associations Between Childhood Trauma and the Age of First-Time Drug Use in Methamphetamine-Dependent Patients

Childhood trauma is related to substance use disorder; however, few studies have examined the relationship between childhood trauma and the age at which the drug was first used. The aim of this study was to investigate the relationship between childhood trauma and the age of first-time drug use among methamphetamine-dependent patients. Moreover, we analyzed the characteristics of adverse family environment associated with severe childhood trauma and the risk factors for starting drugs in minors. A baseline interview was conducted with 110 participants who were in detoxification, including demographic information, past substance use, and age of first-time drug use. The participants' childhood trauma experience before 18 years of age was evaluated using the simplified version of the Childhood Trauma Questionnaire (CTQ-SF). The Chinese version of the Family Environment Scale (FES-CV) was used to assess the family environment of methamphetamine-dependent patients. Among 110 non-injecting methamphetamine-dependent patients, nearly half (n = 48, 43.6%) had moderate and severe childhood trauma. Correlation analysis showed that the age of first-time drug use negatively correlated with emotional abuse (r = -0.32, p < 0.01) and physical abuse (r = -0.27, p < 0.01). The age of first-time drug use negatively correlated with conflict (r = -0.20, p < 0.05) and independence (r = -0.22, p < 0.05) of family environment, but positively correlated with intellectual-cultural orientation (r = 0.28, p < 0.01). Additionally, childhood trauma factors significantly correlated with many indexes of family environment, especially cohesion (r = -0.45, p < 0.01), conflict (r = 0.49, p < 0.01), and independence (r = 0.33, p < 0.01). Additionally, the regression model showed that when emotional abuse increased by one point, the age of first-time drug use was 0.69 years earlier. These findings suggest that a detrimental family environment can aggravate childhood trauma, and the experience of childhood emotional or physical abuse may be an effective predictor of early drug use among methamphetamine-dependent patients.

The Role of Trauma in Early Onset Borderline Personality Disorder: A Biopsychosocial Perspective

The role of childhood trauma in the development of borderline personality disorder (BPD) in young age has long been studied. The most accurate theoretical models are multifactorial, taking into account a range of factors, including early trauma, to explain evolutionary pathways of BPD. We reviewed studies published on PubMed in the last 20 years to evaluate whether different types of childhood trauma, like sexual and physical abuse and neglect, increase the risk and shape the clinical picture of BPD. BPD as a sequela of childhood traumas often occurs with multiple comorbidities (e.g. mood, anxiety, obsessive-compulsive, eating, dissociative, addictive, psychotic, and somatoform disorders). In such cases it tends to have a prolonged course, to be severe, and treatment-refractory. In comparison with subjects who suffer from other personality disorders, patients with BPD experience childhood abuse more frequently. Adverse childhood experiences affect different biological systems (HPA axis, neurotransmission mechanisms, endogenous opioid systems, gray matter volume, white matter connectivity), with changes persisting into adulthood. A growing body of evidence is emerging about interaction between genes (e.g. FKBP5 polymorphisms and CRHR2 variants) and environment (physical and sexual abuse, emotional neglect).

Understanding the Relationship Between Sleep Problems in Early Childhood and Borderline Personality Disorder: A Narrative Review

OBJECTIVE

Recent research indicates that sleep problems in childhood precede the development of borderline personality disorder (BPD) symptoms, but the mechanisms by which sleep problems associate with BPD are still unknown. This narrative review aims to provide some potential explanations for how early sleep problems might associate with BPD.

METHODS

We used the biosocial developmental model of BPD as a framework to discuss how sleep problems may associate with BPD. Articles were identified via PubMed and Embase, and papers published between January 1991 and April 2021 were extracted. Authors made a series of literature searches using the following keywords: Sleep problems, Insomnia, Nightmares, Hypothalamic-Pituitary-Adrenal Axis (HPA), Prefrontal Cortex, Family Psychopathology, Disrupted Attachment, Child Maltreatment, Impulsivity, Emotion Regulation, Internalizing, Externalizing, Rumination, Childhood, Adolescence, Young people. The inclusion criteria were published in peer-reviewed journals; human studies or reviews; published in English. The exclusion criteria were commentaries; abstracts from conferences; studies with animal samples. A total of 96 articles were included for the purpose of this review.

RESULTS

The evidence from this review suggests that some biological factors and core features of BPD act as potential mechanisms mediating the associations between early sleep and subsequent BPD, while some family-related factors might constitute common risk factors for sleep problems and BPD.

CONCLUSION

The biosocial developmental model of BPD provides a plausible characterization of how sleep disruption might lead to subsequent BPD. Further research on new developmental and early intervention approaches to understand how sleep in early stages associates with BPD could have significant clinical impact on these patients and could inform targeted therapeutic interventions.

The mediating effect of difficulties in emotion regulation on the association between childhood maltreatment and borderline personality disorder

BACKGROUND

Childhood maltreatment and difficulties in emotion regulation are common in patients with Borderline Personality Disorder (BPD) and Depressive Disorders (DD).

OBJECTIVE

This study examines differences between patients with BPD and patients with DD, regarding childhood maltreatment and difficulties in emotion regulation as well as the mediating effect of different aspects of emotion regulation deficits on the association between childhood maltreatment and BPD-symptoms.

METHOD

A total of 305 participants, 177 with BPD and 128 with DD completed an assessment including the Childhood Trauma Questionnaire (CTQ), the Emotion Regulation Scale (DERS), the Brief Symptom Inventory (BSI), and the Structured Clinical Interview for DSM-IV (SCID). Data was analyzed using multiple analyses of variances and mediation analyses.

RESULTS

Patients with BPD reported more childhood maltreatment and more difficulties in emotion regulation than patients with DD. When general symptom severity, age, and gender were included in the analysis as covariates only group differences regarding 'impulse control difficulties' (F(1,299) = 38.97, p < .001, η_p² = .115), 'limited access to emotion regulation strategies' (F(1,299) = 4.66, p = .032, η_p² = .015), and 'lack of emotional clarity' (F(1,299) = 9.38, p = .002, η_p² = .030) remained statistically significant. A mediation analysis, including above-mentioned covariates, indicated an association between emotional abuse and BPD-symptoms, which was mediated by difficulties in emotion regulation (indirect effect B = .012, 95% CI [.001; .031], R² = .429). Subscale analyses revealed 'impulse control difficulties' as the aspect of difficulties in emotion regulation that has the greatest impact on this association (B = .021, 95% CI [.003; .045]).

CONCLUSIONS

Patients with BPD display more childhood maltreatment and difficulties in emotion regulation than patients with DD. Difficulties in emotion regulation, especially difficulties in impulse control, seem to play an important role in the association between childhood emotional abuse and BPD-symptoms.

Differential effect of childhood emotional abuse on present social support in borderline disorder and depression: a cross-sectional study

BACKGROUND

Perceived social support (PSS) is a crucial factor in physical and mental health. Previous studies found a negative association between childhood maltreatment (CM) and current PSS.

OBJECTIVE

In this paper, we investigate whether psychopathology moderates this association in a sample of patients with Depressive Disorder (DD) and Borderline Personality Disorder (BPD).

METHOD

Sixty-nine patients with DD and 110 patients with BPD were recruited to inpatient/day clinic treatment programmes for either DD or BPD. All participants completed the Childhood Trauma Questionnaire (CTQ) and the Social Support Questionnaire (F-SozU). Our hypothesis was tested with a moderator analysis in a multiple linear regression model.

RESULTS

We found a significant interaction between diagnosis and CM for the CTQ total score and the emotional abuse subscale. Post hoc analyses revealed a significant negative correlation between CM and PSS only for patients suffering from BPD and not for patients with DD.

CONCLUSION

Our results suggest that the negative association between CM and PSS might be more pronounced in certain patient groups, particularly patients with BPD.

Insecure attachment and maladaptive emotion regulation mediating the relationship between childhood trauma and borderline personality features

BACKGROUND

Previous studies suggested that childhood trauma is an important etiologic factor for the development of borderline personality disorder (BPD). Moreover, insecure attachment and maladaptive emotion regulation (ER) might be related to childhood trauma and BPD. This study was aimed to explore the relationships among childhood trauma, insecure attachment, maladaptive ER, and BPD features.

METHODS

A cohort of 637 patients with psychological disorders completed a series of psychometric instruments such as the Personality Diagnostic Questionnaire-4+ (PDQ-4+), the 23-Item Borderline Symptom List, the Childhood Trauma Questionnaire, the Attachment Style Questionnaire, and the Cognitive Emotion Regulation Questionnaire. The path analyses were conducted to investigate the experience-driven model that whether insecure attachment and maladaptive ER could mediate the relationship between childhood trauma and BPD features. The random forest regression was performed to select variables that contribute significantly to BPD features, which variables would be incorporated into the data-driven model to further confirm the experience-driven model.

RESULTS

Both the experience-driven model and the data-driven model verified that there were three significant mediation pathways (childhood trauma → insecure attachment/maladaptive ER → BPD features, childhood trauma → insecure attachment → maladaptive ER → BPD features; all p < .05), and the most weighted mediation pathway by which childhood trauma influencing the BPD features was through insecure attachment and then through maladaptive ER (weighted 53.16%).

CONCLUSION

The influence of childhood trauma on BPD features was mainly mediated by the combination of insecure attachment and maladaptive emotion regulation.

Comparing the Self-Reported Personality Disorder Traits and Childhood Traumatic Experiences Between Patients With Schizophrenia Vs. Major Depressive Disorder

Introduction: Personality disorder (PD) and childhood traumatic experience (CTE) are well- recognized risk factors for the development of schizophrenia (SZ) and major depressive disorder (MDD). The relationship between CTE and PD is extremely close, and both conditions can affect subsequent psychiatric disorders. Little is known about the differences of these factors in patients with SZ and those with MDD. Materials and Methods: A total of 1,026 outpatients participated in the study, including 533 (51.9%) with SZ and 493 (48.1%) with MDD who were sequentially sampled. The PD traits were assessed using the Personality Diagnostic Questionnaire Fourth Edition Plus (PDQ-4+). The Child Trauma Questionnaire Short Form (CTQ-SF) was used to assess childhood adversities. The scores and associations of PDQ-4+ and CTQ-SF between patients with SZ and those with MDD were compared. Results: The MDD group exhibited more PD traits and more childhood emotional neglect than the SZ group. In patients with MDD, the correlation between PD traits and CTE was significantly higher than that in patients with SZ. Patients with SZ vs. those with MDD showed different PD traits and CTE. The schizotypal and antisocial PD traits, as well as sexual abuse and physical neglect CTE, were significantly related to SZ. In contrast, the borderline, narcissistic and avoidant PD traits, and emotional abuse/neglect CTE were significantly associated with MDD. Discussion: These findings indicated a robust relationship between CTE and PD traits. Moreover, patients with SZ or MDD, have different interactive patterns. Both CTE and PD traits have the potential to be premorbid risk factors that could be targeted for preventative interventions.

Childhood Adversities and Salivary Cortisol Responses to the Trier Social Stress Test: A Systematic Review of Studies Using the Children Trauma Questionnaire (CTQ)

Alteration in cortisol response to acute social stressors has been hypothesized to mediate childhood adversities (CA) and increased morbidity in adulthood. However, the evidence supporting an association between CA and cortisol response to social stressors is inconclusive. The present review addressed this issue by reviewing the literature on CA and cortisol response to acute social stressors, with a focus on studies with adolescents or adults, using the Childhood Trauma Questionnaire (CTQ) to assess CA, and examining salivary cortisol response to the Trier Social Stress Test (TSST). Systematic searches of relevant articles in PsycINFO, PubMed, Web of Science and ScienceDirect in February and March 2020 identified 12 articles including 1196 participants with mean ages ranging from 15.3 to 52.3 yrs. across studies. CTQ scores were significantly associated with cortisol response in 2 studies. In addition, the physical abuse and emotional neglect subscales were associated with cortisol response respectively in 2 separate studies. The lack of association between CA and cortisol response calls for more longitudinal studies, and the use of formal records of maltreatment or informant reports in future research to complement information collected by retrospective measures. In addition, increased attention to biological mechanisms other than that associated with the regulation of cortisol in explaining the connection between CA and psychiatry morbidity is warranted.

Childhood trauma, alexithymia, and mental states recognition among individuals with alcohol use disorder and healthy controls

BACKGROUND

Although prior work indicates a link between childhood trauma, alexithymia, and mental states recognition, empirical support is limited. Moreover, findings based on adult samples are mixed. Previous studies demonstrate that childhood trauma might either enhance, preserve, or reduce mental states recognition in selected at-risk populations. The current study investigates whether alcohol use disorder (AUD) status moderates the association between childhood trauma, alexithymia, and mental states recognition in a treatment-seeking AUD sample and non-AUD healthy adults.

METHODS

Data comes from 255 individuals participating in an ongoing project that compares emotional and behavioral functioning of patients treated in an inpatient setting for AUD and a comparison sample of 172 healthy controls (HCs). Mental states recognition was measured using a computerized version of the Reading the Mind in the Eyes Task (RMET). The presence of childhood trauma was assessed with the Childhood Trauma Questionnaire. Alexithymia was measured with the Toronto Alexithymia Scale (TAS-20). Demographic information, as well as alcohol drinking and psychopathological symptoms were assessed. A moderated mediation model was estimated whereby alexithymia was included as a mediator in the association between childhood trauma and RMET performance, with AUD diagnosis status moderating the link between alexithymia and RMET performance.

RESULTS

Findings provide support for moderated mediation. Childhood emotional trauma impacted negative mental states recognition performance via difficulty describing feelings, but only among HCs (p < 0.01).

CONCLUSIONS

Findings highlight the impact that AUD status has on the association between early life emotional trauma and difficulty describing feelings on individual differences in mental states recognition.

Unresolved Attachment Mediates the Relationship Between Childhood Trauma and Impaired Personality Functioning in Adolescence

The present study investigates the mediating effect of attachment trauma on the relationship between childhood maltreatment and personality functioning in 199 adolescents (12-18 years) using a novel approach of an in-depth analysis of attachment-related traumatic contents during an attachment interview (AAP). Our findings demonstrate that adolescents with a high amount of traumatic attachment-related material show a lower resilience when facing traumatic childhood experiences, resulting in a greater severity of personality dysfunction. In particular, the associations between emotional abuse and neglect and the domains of identity, empathy, self-direction, and intimacy were mediated by the severity of attachment trauma. These results advance our understanding of the different nuances of attachment-related traumatic material and how they might shape personality structure in an adolescent age group.

Oxytocin receptor gene, childhood maltreatment and borderline personality disorder features among male inmates in China

BACKGROUND

Borderline personality disorder (BPD) is caused by a variety of biological and environmental factors. Accumulating evidence suggests that childhood maltreatment is a risk environmental factor in the development of BPD, but research on the genetic pathology of BPD is still in its early stages, and very little is known about the oxytocin receptor (OXTR) gene. The purpose of this study is to further explore the interactive effects between OXTR gene polymorphisms and childhood maltreatment on BPD risk.

METHODS

Among the 1804 Chinese Han male inmates, 765 inmates who had BPD or antisocial personality disorder (ASPD) or highly impulsive or violent crime were considered as high-risk inmates and included in this study. Childhood maltreatment, BPD, antisocial personality disorder (ASPD) and impulsivity were measured by self-reported questionnaires. Peripheral venous blood was collected for the genotype test.

RESULTS

Analyses revealed that the BP group (inmates with BPD features) had higher rs53576 AA genotype frequency and rs237987 AA genotype frequency than the non-BP group, while the statistical significances were lost after Bonferroni correction. Total childhood maltreatment score, emotional abuse and neglect could positively predict BPD risk. Among the high-risk samples, rs53576 GG genotype carriers had higher BPD scores at higher levels of physical abuse and sexual abuse and had lower BPD scores at lower levels of physical abuse and sexual abuse.

CONCLUSIONS

The findings suggest that the interaction between OXTR gene variations and childhood maltreatment is an important mechanism for the development of BPD. The moderating role of the OXTR gene provides evidence for gene plasticity.

Schema modes mediate the effect of emotional abuse in childhood on the differential expression of personality disorders

BACKGROUND

There is sound evidence that childhood maltreatment increases the likelihood of developing personality disorders (PDs). However, research on the possible mechanisms involved in the relationship between childhood maltreatment and PDs is scarce. One potential mediator of the maltreatment-PD relationship are schema modes, reflecting dynamic states of cognition, emotion, and behaviour.

AIMS

The current study aimed to explore the mediating effect of schema modes on the association between childhood maltreatment and the expression of Cluster B (borderline and antisocial) and C (avoidant and dependent) PDs.

METHOD

Within a mixed sample of N = 120 clinical PD patients and non-clinical participants, a multivariate path model including interview-assessed childhood maltreatment (emotional abuse, emotional neglect, sexual abuse, and physical abuse), schema modes (child, parent, coping and healthy modes), and borderline, antisocial, avoidant and dependent PDs was explored.

RESULTS

The path model depicted five significant indirect links from emotional abuse on PDs via distinct schema modes. The impact of emotional abuse on borderline PD was mediated by child and coping modes, while parent modes mediated the link to antisocial PD. Healthy modes acted as a mediator on dependent and avoidant PDs.

CONCLUSIONS

The results indicate emotional abuse as a main predictor of schema mode clusters and emphasize the mediating role of schema modes on the maltreatment-related pathways towards PDs. Therapeutic implications are discussed with a special focus on healthy modes.

Relationship Between Alcohol-related Family Adversity, Alcohol Use Across Adolescence, and Mental States Recognition in Young Adulthood

OBJECTIVES

Although a theoretical link between childhood adversity and mental states recognition has been established, empirical findings are mixed. Some prior work indicates that childhood adversity might enhance, preserve, or reduce mentalization skills in selected at-risk populations. In the current study, we examine whether the presence of risky alcohol use during adolescence moderates the association between childhood alcohol-related family adversity and mental states recognition in young adulthood.

METHODS

Secondary data analysis was conducted on 266 young adults who participated in the Michigan Longitudinal Study-a multiwave prospective study on at-risk youth. Children were assessed after initial recruitment (wave 1, target child age range 3-5 years), with assessments repeated every 3 years using parallel measures. The current study focuses on data spanning wave 2 (age range 7-9 years) through wave 6 (target child age range 18-21 years). A family adversity index was derived reflecting exposure to a maladaptive family environment during childhood as assessed at wave 1. An alcohol use risk factor was established reflecting early problem alcohol use during adolescence (target child age range 12-17 years). Mental states recognition was measured with a computerized version of the Reading the Mind in the Eyes Task (RMET) at wave 6. Information about demographics, psychopathological symptoms, and IQ was obtained. The alcohol use risk factor was tested as a potential moderator of the association between childhood family adversity on RMET performance during young adulthood.

RESULTS

Alcohol use risk moderated the relationship between childhood alcohol-related family adversity, and negative and neutral mental states recognition. Specifically, childhood family adversity was positively associated with neutral mental states recognition among participants high in alcohol risk (P = 0.03) and positively associated with negative mental states recognition among participants at average (P = 0.02) and high (P = 0.002) levels of alcohol risk.

CONCLUSIONS

Findings indicate that history of childhood adversity may actually improve young adult negative and neutral mental states recognition among those demonstrating high levels of risky alcohol use, as substance use may serve as an external self-regulatory tool. Clinical interventions that target enhancing metacognitive competence and emotion regulation could ultimately help to break the cycle of alcohol-related family adversity.

Exposure to interparental intimate partner violence and the development of borderline features in adolescents

BACKGROUND

Due to associated trauma, exposure to intimate partner violence (IPV) is considered a form of child maltreatment, and is associated with heightened risk for mental health problems.

OBJECTIVE

To evaluate associations between exposure to interparental IPV and the prospective development of borderline features in adolescents.

PARTICIPANTS AND SETTING

A diverse sample of 1,042 adolescents were recruited from public high schools throughout southeastern United States and followed annually for 5 years. Baseline mean age was 15.09 (SD = .79; range 13-18), and 56 % of the sample was female; 31.4 % (n = 327) were Hispanic, 29.4 % (n = 306) were White/not Hispanic, 27.9 % (n = 291) were African American, 3.6 % (n = 38) were Asian or Pacific Islander, and 7.7 % (n = 80) were mixed or another race.

METHODS

Exposure to interparental IPV and the quality of the parent-child relationship were assessed at baseline. Borderline features were assessed annually for the each of the five follow-up timepoints. Latent growth curve modeling was used to estimate the course of change of BPD features over time.

RESULTS

Consistent with expectations, and controlling for quality of parent-child relationships and sociodemographic confounds, findings demonstrated that IPV exposure related to both cross-sectional association between interparental IPV and adolescents' borderline features and change in borderline features over a 5-year period.

CONCLUSION

Adolescents who had witnessed interparental IPV were more likely to have higher levels of BPD features at baseline and to deviate from the typically observed normative decline in BPD features over the 4-year follow-up period.

Childhood maltreatment, anxiety disorders and outcome in borderline personality disorder

INTRODUCTION

Anxiety disorders are a frequent in borderline personality disorder (BPD) and are associated with more severe symptomatology and poorer functional outcomes. Their presence in BPD is also believed to be the consequence of early life adversities. The aim of our study was to examine the relationship between comorbid anxiety disorders, childhood maltreatment and severity of BPD.

METHODS

388 BPD outpatients were assessed for lifetime anxiety disorders and history of childhood maltreatment. Severity of BPD was measured by the number of DSM-IV BPD criteria, history of suicide attempts, hospitalizations, psychotic symptoms, comorbid substance use disorder, other comorbid disorders, level of depression, hopelessness, impulsivity and trait anger. We used logistic regressions to test the association between childhood maltreatment and anxiety disorders and the effect of those factors on severity indicators RESULTS: More than half of the participants suffered from two or more anxiety disorders. The most common comorbidity was social phobia. Childhood maltreatment was associated with an increased number of anxiety disorders. Both anxiety disorders and childhood maltreatment had, independently from one another, an effect on severity indicators. Anxiety disorders were significantly associated with the number of DSM-IV BPD criteria, suicide attempts and psychotic symptoms. Anxiety disorders had an impact on the level of depression and hopelessness, whereas childhood maltreatment impacted impulsivity and anger trait.

CONCLUSION

Our results show the importance of comorbid anxiety disorders in BPD, as well as their impact on severity. Anxiety disorders and childhood maltreatment should be considered by healthcare professionals to ensure optimal care. Furthermore, interventions targeting those issues need to be developed.

Parenting and personality disorder: An overview and meta-synthesis of systematic reviews

BACKGROUND/OBJECTIVES

Maladaptive parenting (including childhood maltreatment, abuse and neglect) has been implicated in the scientific literature exploring the aetiology of personality disorder, particularly borderline personality disorder (BPD). Our primary objective was to summarise the evidence on the relationship between parenting and personality disorder, assisting clinical decision-makers to translate this research into clinical policy and practice.

METHODS

We conducted an overview of systematic reviews that assessed individuals with personality disorder pathology for experiences of maladaptive parenting, compared to psychiatric or healthy comparisons/controls, and the impact on psychopathological and relational outcomes. Systematic literature searches were conducted in Scopus, Web of Science, MEDLINE, PsycINFO, and by hand in August 2018. Methodological quality was assessed using the CASP systematic review checklist, and results were qualitatively synthesised. A pre-determined protocol was registered in Prospective Register of Systematic Reviews (PROSPERO 2019:CRD42018096177).

RESULTS

Of the 312 identified records, 293 abstracts were screened, 36 full-text articles were retrieved and eight systematic reviews met pre-determined criteria for qualitative synthesises. The majority of studies reported outcomes related to BPD (n = 7), and study design, methodology and quality varied. Within the eight systematic reviews there were 211 primary studies, of which 140 (66.35%) met eligibility criteria for inclusion in this overview. Eligible primary studies reported on 121,895 adult, child/adolescent and parent-offspring participants, with most studies focused on borderline personality pathology (n = 100, 71.43%). Study design and methodology also varied for these studies. Overall, five systematic reviews overwhelming found that maladaptive parenting was a psychosocial risk factor for the development of borderline personality pathology, and three studies found that borderline personality pathology was associated with maladaptive parenting, and negative offspring and parenting-offspring outcomes.

CONCLUSIONS

In light of these findings, we recommend greater emphasis on parenting in clinical practice and the development of parenting interventions for individuals with personality disorder. However, our understanding is limited by the heterogeneity and varying quality of the evidence, and as such, future research utilising more rigorous research methodology is needed.

Autism and psychosis as diametrical disorders of embodiment

Humans have evolved an elaborate system of self-consciousness, self-identity, self-agency, and self-embodiment that is grounded in specific neurological structures including an expanded insula. Instantiation of the bodily self has been most-extensively studied via the 'rubber hand illusion', whereby parallel stimulation of a hidden true hand, and a viewed false hand, leads to the felt belief that the false hand is one's own. Autism and schizophrenia have both long been regarded as conditions centrally involving altered development of the self, but they have yet to be compared directly with regard to the self and embodiment. Here, we synthesize the embodied cognition literature for these and related conditions, and describe evidence that these two sets of disorders exhibit opposite susceptibilities from typical individuals to the rubber hand illusion: reduced on the autism spectrum and increased in schizophrenia and other psychotic-affective conditions. Moreover, the opposite illusion effects are mediated by a consilient set of associated phenomena, including empathy, interoception, anorexia risk and phenotypes, and patterns of genetic correlation. Taken together, these findings: (i) support the diametric model of autism and psychotic-affective disorders, (ii) implicate the adaptive human system of self-embodiment, and its neural bases, in neurodevelopmental disorders, and suggest new therapies and (iii) experimentally ground Bayesian predictive coding models with regard to autism compared with psychosis. Lay summary: Humans have evolved a highly developed sense of self and perception of one's own body. The 'rubber hand illusion' can be used to test individual variation in sense of self, relative to connection with others. We show that this illusion is reduced in autism spectrum disorders, and increased in psychotic and mood disorders. These findings have important implications for understanding and treatment of mental disorders.

The intergenerational transmission of childhood maltreatment: Nonspecificity of maltreatment type and associations with borderline personality pathology

One generation's experience of childhood maltreatment is associated with that of the next. However, whether this intergenerational transmission is specific to distinct forms of maltreatment and what factors may contribute to its continuity remains unclear. Borderline personality pathology is predicted by childhood maltreatment and characterized by features (e.g., dysregulated emotion, relationship instability, impulsivity, and inconsistent appraisals of others) that may contribute to its propagation. Among 364 older adults and 573 of their adult children (total n = 937), self-reported exposure to distinct forms of childhood maltreatment (i.e., emotional, physical, and sexual abuse, and emotional and physical neglect as assessed by the Childhood Trauma Questionnaire) showed homotypic and heterotypic associations across generations with little evidence that latent factors unique to specific forms of maltreatment show generational continuity. General nonspecific indices of childhood maltreatment showed evidence of intergenerational transmission after accounting for demographic factors and parent socioeconomic status (b = 0.126, p = 9.21 × 10−4). This continuity was partially mediated by parental borderline personality pathology (assessed longitudinally through a variety of measures and sources, indirect effect: b = 0.031, 95% confidence interval [0.003, 0.060]). The intergenerational continuity of childhood maltreatment may largely represent general risk for nonspecific maltreatment that may, in part, be propagated by borderline personality pathology and/or shared risk factors.

Neural processing of the own child's facial emotions in mothers with a history of early life maltreatment

Early life maltreatment (ELM) has long-lasting effects on social interaction. When interacting with their own child, women with ELM often report difficulties in parenting and show reduced maternal sensitivity. Sensitive maternal behavior requires the recognition of the child's emotional state depicted in its facial emotions. Based on previous studies, it can be expected that ELM affects the neural processing of facial emotions by altering activation patterns in parts of the brain's empathy and mentalizing networks. However, so far studies have focused on the processing of standardized, adult facial emotions. Therefore, the current study investigated the impact of ELM on the processing of one's own child's facial emotions using functional magnetic resonance imaging. To achieve this, 27 mothers with and 26 mothers without a history of ELM (all without current mental disorders and psychopharmacological treatment) took part in an emotional face recognition paradigm with happy, sad, and neutral faces of their own and an unknown primary school-aged child of the same age and sex. We found elevated activations in regions of the mentalizing (superior temporal sulcus, precuneus) and mirror neuron (inferior parietal lobule) networks as well as in the visual face processing network (cuneus, middle temporal gyrus) in mothers with ELM compared to the non-maltreated mothers in response to happy faces of their own child. This suggests a more effortful processing and cognitive empathic mentalizing of the own child's facial happiness in mothers with ELM. Future research should address whether this might indicate a compensatory recruitment of mentalizing capacities to maintain maternal sensitivity.