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Maladaptive Personality Traits in a Group of Patients with Substance Use Disorder and ADHD. Medicina (B Aires) 2022; 58:medicina58070962. [PMID: 35888680 PMCID: PMC9323800 DOI: 10.3390/medicina58070962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/16/2022] [Accepted: 07/18/2022] [Indexed: 11/25/2022] Open
Abstract
Background and Objectives: the comorbidity of personality disorders in patients who use psychoactive substances is common in psychiatric practice. The epidemiology of disharmonious personality traits in patients with ADHD and addictions in adulthood is still insufficiently researched. The study investigated the typology of personality traits in a group of adult patients consuming psychoactive substances, in whom symptoms of ADHD were identified. Materials and Methods: the study evaluates a group of 104 patients with chronic psychoactive substances abuse, in whom symptoms of ADHD were identified in early adulthood, in terms of comorbid personality traits. Results: statistically significant data have been obtained regarding the presence of clinical traits characteristic for cluster B personality disorders, the patients presenting lower levels of self-control, self-image instability, difficulties in the areas of social relationships and own identity integration. Conclusions: ADHD symptomatology precedes the clinical traits of personality disorders in patients with addictions, negatively influencing chronic evolution and quality of life.
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2
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Parr AC, Calancie OG, Coe BC, Khalid-Khan S, Munoz DP. Impulsivity and Emotional Dysregulation Predict Choice Behavior During a Mixed-Strategy Game in Adolescents With Borderline Personality Disorder. Front Neurosci 2022; 15:667399. [PMID: 35237117 PMCID: PMC8882924 DOI: 10.3389/fnins.2021.667399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 12/28/2021] [Indexed: 11/13/2022] Open
Abstract
Impulsivity and emotional dysregulation are two core features of borderline personality disorder (BPD), and the neural mechanisms recruited during mixed-strategy interactions overlap with frontolimbic networks that have been implicated in BPD. We investigated strategic choice patterns during the classic two-player game, Matching Pennies, where the most efficient strategy is to choose each option randomly from trial-to-trial to avoid exploitation by one’s opponent. Twenty-seven female adolescents with BPD (mean age: 16 years) and twenty-seven age-matched female controls (mean age: 16 years) participated in an experiment that explored the relationship between strategic choice behavior and impulsivity in both groups and emotional dysregulation in BPD. Relative to controls, BPD participants showed marginally fewer reinforcement learning biases, particularly decreased lose-shift biases, increased variability in reaction times (coefficient of variation; CV), and a greater percentage of anticipatory decisions. A subset of BPD participants with high levels of impulsivity showed higher overall reward rates, and greater modulation of reaction times by outcome, particularly following loss trials, relative to control and BPD participants with lower levels of impulsivity. Additionally, BPD participants with higher levels of emotional dysregulation showed marginally increased reward rate and increased entropy in choice patterns. Together, our preliminary results suggest that impulsivity and emotional dysregulation may contribute to variability in mixed-strategy decision-making in female adolescents with BPD.
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Affiliation(s)
- Ashley C. Parr
- Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
- Division of Child and Youth Mental Health, Kingston Health Sciences Centre, Kingston, ON, Canada
- *Correspondence: Ashley C. Parr,
| | - Olivia G. Calancie
- Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
- Division of Child and Youth Mental Health, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Brian C. Coe
- Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
| | - Sarosh Khalid-Khan
- Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
- Division of Child and Youth Mental Health, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Douglas P. Munoz
- Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON, Canada
- Douglas P. Munoz,
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3
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Jenkins CA, Thompson KN, Nicholas CL, Chanen AM. Sleep in Young People With Features of Borderline Personality Disorder: A Scoping Review. J Pers Disord 2022; 36:19-39. [PMID: 34124946 DOI: 10.1521/pedi_2021_35_525] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Sleep disturbance is commonly reported in young people with features of borderline personality disorder (BPD). Examining sleep quality and sleep-wake patterns in young people with features of BPD is essential to inform the development of sleep-improvement interventions. A scoping review was conducted according to the Joanna Briggs Institute methodology. The objectives were to map the literature regarding sleep in young people with features of BPD, highlight areas for further investigation, and provide methodological recommendations for future research. Seven data sets were included in the review. Young people with features of BPD had poorer objective and subjective sleep quality, disturbed sleep architecture (particularly rapid-eye-movement sleep), an increased vulnerability to delayed sleep phase syndrome, and more nightmares and dream anxiety, compared with healthy individuals. Future research should use both objective and subjective sleep measures, include clinical comparison groups, and focus specifically on young people with BPD.
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Affiliation(s)
- Claire A Jenkins
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, Australia.,Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Katherine N Thompson
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Christian L Nicholas
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, Australia.,Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | - Andrew M Chanen
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
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Ceroni M, Rossi S, Zerboni G, Biglia E, Soldini E, Izzo A, Morellini L, Sacco L. Attentive-executive functioning and compensatory strategies in adult ADHD: A retrospective case series study. Front Psychol 2022; 13:1015102. [PMID: 36312151 PMCID: PMC9606327 DOI: 10.3389/fpsyg.2022.1015102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background Adults with ADHD exhibit a neuropsychological profile that may present deficits in many cognitive domains, particularly attention and executive functions (EFs). However, some authors do not consider executive disfunction as an important part of the clinical profile of the syndrome; this could be related to the use of inappropriate neuropsychological tests, probably not adapted and not sufficiently ecological. Moreover, new data are required on specific correlation of attentive-executive symptoms with socio-demographic factors. Therefore, the aim of this study is to analyze the neuropsychological performance of a group of adults with ADHD, also evaluating the influence of gender, age and education level. Methods We retrospectively collected health-related personal data of 40 adult ADHD patients, clinically diagnosed and evaluated via a battery of 4 neuropsychological tests and 1 self-administered questionnaire. Gender, age and years of education differences were assessed. Results Attention and EFs deficits have been highlighted mainly on the d2-R and 5-point neuropsychological tests, which therefore seem to be more sensitive in measuring the attention-executive dysfunction in an adult ADHD population, than TAP Go/No-go and ROCFT. ADHD patients also manifested subjective behavioral impulsivity disorders on BIS-11. There were no statistically significant gender differences in cognitive performance. On the contrary, younger patients performed worse on subscales TAP Go/No-go errors and 5-points number of drawings, while participants with a higher education level performed better on subscales d2-R speed of execution and d2-R errors. This supports a reduction in the number of errors and the execution time as a function of older age and a higher level of education. Finally, patients with higher education also self-reported greater impulsivity in planning. Conclusion Our preliminary findings suggest that adult ADHD is not a lifelong stable disorder, but it may change over time. Moreover, attention-executive deficits may be influenced and partially counterbalanced by experience (i.e., advancing age) and a higher level of education. This could underlie the development of specific psycho-behavioral and cognitive compensatory strategies. The use of self-administered questionnaires is therefore recommended to highlight attentional and executive difficulties that may not result in neuropsychological tests.
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Affiliation(s)
- Martino Ceroni
- Neuropsychological and Speech Therapy Unit, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland
| | - Stefania Rossi
- Neuropsychological and Speech Therapy Unit, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland
| | - Giorgia Zerboni
- Neuropsychological and Speech Therapy Unit, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland
| | - Elena Biglia
- Neuropsychological and Speech Therapy Unit, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland
| | - Emiliano Soldini
- Competence Centre for Healthcare Practices and Policies, Department of Business Economics, Health, and Social Care (DEASS), University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Alessia Izzo
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
| | - Lucia Morellini
- Neuropsychological and Speech Therapy Unit, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
- *Correspondence: Lucia Morellini,
| | - Leonardo Sacco
- Neuropsychological and Speech Therapy Unit, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland
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Guilé JM, Zavaglia E, Berthiaume C, Bergeron L. Prevalence and comorbidity of borderline personality traits in the Quebec general population aged 12-14 years. Soc Psychiatry Psychiatr Epidemiol 2021; 56:2053-2062. [PMID: 33745001 DOI: 10.1007/s00127-021-02067-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The early identification of borderline personality traits (BPT) in adolescents helps to prevent their progression. Data are available for the clinical population, but little has been published on the general population, especially regarding age and sex distribution in adolescence. Even less is known about the comorbidity of BPT with other mental disorders. METHODS We estimated the prevalence of BPT, by sex, age, and comorbidity, in a sample of adolescents aged 12-14 years (n = 799) from the Quebec Mental Health Survey. A complex sampling design was used to ensure representativeness. BPT was assessed with the abbreviated-diagnostic interview for borderlines-revised, with the adolescent as an informant. Reliability coefficients were above 0.80. Several levels of severity were explored using an independent criterion, defined by impairment according to the Columbia impairment scale. RESULTS The overall prevalence of BPT was 6.3%. Prevalence estimates for the most impaired were 3.2% for the entire sample and 1.3% for 12-year-olds. Prevalence increased significantly with age for most impairment levels but did not differ significantly between the sexes. In adolescents, BPT displayed moderate-to-strong comorbidity with anxiety (AD) and insomnia disorders, and very strong comorbidity with depressive (DD), attention deficit hyperactivity (ADHD), and oppositional defiant/conduct disorders (ODD/CD). CONCLUSION We, therefore, make two clinical recommendations for child psychiatry practice: (1) with respect to the lower rate of male adolescents attending BPT Health Programs, increase BPT screening in male adolescents; (2) evaluate BPT when children with ADHD or ODD/CD develop AD or DD during adolescence.
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Affiliation(s)
- Jean Marc Guilé
- Child and Adolescent Psychiatry Services, Amiens-Picardie University Medical Centre , Amiens, France. .,Psychiatry Residency Program, Department of Psychiatry, University of Picardie-Jules Verne, Amiens, France. .,Department of Psychiatry, McGill University, Montreal, QC, Canada.
| | - Elissa Zavaglia
- Department of Psychology, Montreal University, Montreal, QC, Canada.,Research Centre, Hôpital en Santé Mentale Rivières-Des-Prairies, CIUSSS du Nord-de-L'Île-de-Montréal, Montréal, Québec, Canada
| | - Claude Berthiaume
- Research Centre, Hôpital en Santé Mentale Rivières-Des-Prairies, CIUSSS du Nord-de-L'Île-de-Montréal, Montréal, Québec, Canada
| | - Lise Bergeron
- Department of Psychology, Montreal University, Montreal, QC, Canada
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Akça ÖF, Wall K, Sharp C. Divergent mentalization types in adolescent borderline personality disorder and attention deficit/hyperactivity disorder. Nord J Psychiatry 2021; 75:479-486. [PMID: 33635183 DOI: 10.1080/08039488.2021.1887349] [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: 10/22/2022]
Abstract
BACKGROUND Attention deficit/hyperactivity disorder (ADHD) and borderline personality disorder (BPD) have several similarities and it is difficult to distinguish these disorders in adolescents. We aimed to identify the unique correlates of mentalization abilities that may distinguish these two disorders, and to investigate the mentalization abilities of adolescents with ADHD, BPD and ADHD + BPD in an inpatient sample to determine the effect of co-morbidity on mentalization abilities. METHODS We have explored the relationship between Child Eye Test (CET) scores, Movie for the Assessment of Social Cognition (MASC) subscales, and ADHD and BPD symptoms in adolescent inpatients. In addition, we compared ADHD, BPD and ADHD + BPD groups in terms of their mentalization abilities. RESULTS Correct MASC scores were negatively associated with both ADHD and BPD symptoms in girls, and negatively associated with ADHD symptoms in boys. In addition, hypermentalization scores were associated with BPD symptoms in girls, and hypomentalization and no mentalization scores were associated with ADHD symptoms in girls. CET scores were negatively associated with ADHD symptoms in girls, but no relations with BPD were found. Group comparisons revealed no significant difference among groups. LIMITATIONS We included only inpatient sample without considering their medication condition, we did not compare the mentalization scores of the patient groups with healthy controls and we used self-report measures for several assessments. CONCLUSION Mentalization patterns in ADHD and BPD are distinct. ADHD may be related to hypomentalization, instead, BPD may be related to hypermentalization.
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Affiliation(s)
- Ömer Faruk Akça
- Department of Child and Adolescent Psychiatry, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Kiana Wall
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Carla Sharp
- Department of Psychology, University of Houston, Houston, TX, USA
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Krylova ES. [First depressive episode in the dynamics of personality disorders in adolescence]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:35-40. [PMID: 34405655 DOI: 10.17116/jnevro202112105235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine clinical and psychopathological specifics of the first depressive episode (DE) in the context of formation of personality anomalies and their dynamics in adolescence. MATERIAL AND METHODS Two hundred and thirty-seven patients (180 male, 57 female), aged 16 to 25 years, with the first DE and comorbid personality disorder (PD) were clinically observed and psychopathologically evaluated. Later 149 patients from this group participated in the follow-up study. RESULTS The first DE with PD in adolescence is characterized by psychopathological variety due to PD type and age factor. Diagnosis of PD in adolescence is based on pathological traits, while affective impairment is a separate dimension. PD determines the clinical features of the first DE and all spectrum of affective disorders. The high conjugation of the first DE with autoagressive behavior confirms their suicidal risk. Autoagressive behavior is noted in 201 (84.8%) patients, of which 59 (29.4%) had non-suicide self-injury (NSSI) and 14 (70.6%) had suicidal activity. The follow-up study identified variants of further dynamics of PD with comorbid affective spectrum disorders after the first DE developed in youth that had prognostic value: unipolar major depression in schizoid PD (13 (37.1%) patients), cluster C PD (8 (26.7%)); bipolar affective disorders in borderline (42 (28.2%)) and narcissistic (16 (40.0%)) PD; recurrent depressive disorder in PD of cluster C (14 (46.7%)). CONCLUSIONS The revealed clinical and psychopathological features will contribute to the creation of a unified model for predicting affective disorders and the formation of therapy standards.
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Affiliation(s)
- E S Krylova
- Mental Health Research Center, Moscow, Russia
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8
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Aouidad A, Cohen D, Mirkovic B, Pellerin H, Garny de La Rivière S, Consoli A, Gérardin P, Guilé JM. Borderline personality disorder and prior suicide attempts define a severity gradient among hospitalized adolescent suicide attempters. BMC Psychiatry 2020; 20:525. [PMID: 33148207 PMCID: PMC7643473 DOI: 10.1186/s12888-020-02930-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 10/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Borderline personality disorder (BPD) and history of prior suicide attempt (SA) have been shown to be high predictors for subsequent suicide. However, no previous study has examined how both factors interact to modify clinical and suicide severity among adolescents. METHODS This study presents a comprehensive assessment of 302 adolescents (265 girls, mean age = 14.7 years) hospitalized after a SA. To test clinical interactions between BPD and history of prior SA, the sample was divided into single attempters without BPD (non-BPD-SA, N = 80), single attempters with BPD (BPD-SA, N = 127) and multiple attempters with BPD (BPD-MA, N = 95). RESULTS Univariate analyses revealed a severity gradient among the 3 groups with an additive effect of BPD on the clinical and suicide severity already conferred by a history of SA. This gradient encompassed categorical (anxiety and conduct disorders and non-suicidal-self-injury [NSSI]) and dimensional comorbidities (substance use and depression severity) and suicide characteristics (age at first SA). According to regression analyses, the BPD-MA group that was associated with the most severe clinical presentation also showed specific features: the first SA at a younger age and a higher prevalence of non-suicidal self-injury (NSSI) and anxiety disorders. The BPD-MA group was not associated with higher impulsivity or frequency of negative life events. CONCLUSIONS Based on these findings and to improve youth suicide prevention, future studies should systematically consider BPD and the efficacy of reinforcing early interventions for anxiety disorders and NSSI.
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Affiliation(s)
| | - David Cohen
- grid.462015.40000 0004 0617 9849Institut des Systemes Intelligents et de Robotique, Paris, France
| | - Bojan Mirkovic
- grid.417615.00000 0001 2296 5231Hopital Charles Nicolle, Rouen, France
| | - Hugues Pellerin
- grid.411439.a0000 0001 2150 9058Hopital Universitaire Pitie Salpetriere, Paris, France
| | | | - Angèle Consoli
- grid.411439.a0000 0001 2150 9058Hopital Universitaire Pitie Salpetriere, Paris, France
| | | | - Jean-Marc Guilé
- grid.134996.00000 0004 0593 702XCentre Hospitalier Universitaire Amiens-Picardie, Amiens, France
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Sharp C, Vanwoerden S, Jouriles EN, Godfrey DA, Babcock J, McLaren V, McFarlane J, Brashear B, Walton Q, Temple JR. Exposure to interparental intimate partner violence and the development of borderline features in adolescents. CHILD ABUSE & NEGLECT 2020; 103:104448. [PMID: 32171797 PMCID: PMC10176899 DOI: 10.1016/j.chiabu.2020.104448] [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: 10/01/2019] [Revised: 01/27/2020] [Accepted: 03/02/2020] [Indexed: 05/14/2023]
Abstract
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.
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Affiliation(s)
- Carla Sharp
- University of Houston, 4800 Calhoun Rd., Houston, TX, 77004, USA.
| | | | | | | | - Julia Babcock
- University of Houston, 4800 Calhoun Rd., Houston, TX, 77004, USA
| | - Veronica McLaren
- University of Houston, 4800 Calhoun Rd., Houston, TX, 77004, USA
| | - Judith McFarlane
- Texas Woman's University, 6700 Fannin Street, Houston, TX, 77030, USA
| | - Barbie Brashear
- Harris County Domestic Violence Coordinating Council, 2990 Richmond Ave #550, Houston, TX, 77098, USA
| | - Quenette Walton
- University of Houston, 4800 Calhoun Rd., Houston, TX, 77004, USA
| | - Jeff R Temple
- UTMB Health, 301 University Boulevard, Galveston, TX, 77555, USA
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10
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Akça ÖF, Wall K, Sharp C. Borderline personality disorder and attention deficit/hyperactivity disorder in adolescence: overlap and differences in a clinical setting. Borderline Personal Disord Emot Dysregul 2020; 7:7. [PMID: 32313658 PMCID: PMC7158052 DOI: 10.1186/s40479-020-00122-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/24/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND With increased consensus regarding the validity and reliability of diagnosing Borderline Personality Disorder (BPD) in adolescents, clinicians express concern over the distinction between BPD and Attention-Deficit/Hyperactivity Disorder (ADHD), and its co-morbidity in clinical settings. The goal of this study was to evaluate differences between BPD, ADHD and BPD + ADHD in terms of co-morbid psychiatric disorders and a range of self-reported behavioral problems in adolescents. METHODS Our sample consisted of N = 550 inpatient adolescents with behavioral and emotional disorders that have not responded to prior intervention. We took a person-centered approach (for increase clinical relevance) and compared adolescents with ADHD, BPD and ADHD+BPD in terms of co-occurring psychiatric disorders and behavioral problems. We performed a regression analysis to test whether BPD symptoms make an incremental contribution to the prediction of psychiatric symptoms over ADHD symptoms. RESULTS The severity of almost all co-occurring disorders, aggression, self-harm, suicidal thoughts, and substance use, were higher in the ADHD+BPD group. Borderline symptoms made an incremental contribution to the prediction of psychiatric symptoms beyond the contribution of ADHD. CONCLUSION Severity and co-morbidity may be helpful factors in distinguishing between ADHD and BPD in clinical practice and the co-morbidity of these two disorders may indicate a worse clinical outcome.
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Affiliation(s)
- Ömer Faruk Akça
- 1Meram School of Medicine, Department of Child and Adolescent Psychiatry, Necmettin Erbakan University, 42080 Konya, Turkey
| | - Kiana Wall
- 2Department of Psychology, University of Houston, Houston, TX USA
| | - Carla Sharp
- 2Department of Psychology, University of Houston, Houston, TX USA
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11
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[Adult ADHD and borderline personality disorder: A pilot study on differences in attachment and early traumatization]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2019; 64:262-280. [PMID: 30829161 DOI: 10.13109/zptm.2018.64.3.262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Adult ADHD and borderline personality disorder: A pilot study on differences in attachment and early traumatization Objective: Attention-deficit/hyperactivity disorder (ADHD) in adulthood and borderline personality disorder (BPD) share commondiagnostic criteria.The present study examined how ADHD in adulthood can be distinguished from BPDregarding attachment style and traumatic experiences. METHOD The sample consists of N = 30 persons with 50% (n = 15) ADHD patients and 50% (n = 15) BPD patients. The patients were asked to fill out different questionnaires to investigate the criteria for specific symptoms. RESULTS The results show that most of the patients are insecurely attached. In addition, 80% of both the ADHD and BPD sample claimed traumatic experiences in their childhood or adolescence. Most frequently, patients reported traumatisation following emotional neglect and emotional abuse. No group-specific differences concerning traumatic experiences and the individual attachment style were determined. CONCLUSION The etiological factors attachment style and traumatic experiences are not suitable for differentiating ADHD in adulthood and BPD.
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12
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Impulsivity and its association with childhood trauma experiences across bipolar disorder, attention deficit hyperactivity disorder and borderline personality disorder. J Affect Disord 2019; 244:33-41. [PMID: 30336349 DOI: 10.1016/j.jad.2018.07.060] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/22/2018] [Accepted: 07/22/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Impulsivity is a core feature of the attention-deficit/hyperactivity disorder (ADHD) and is one of the DSM-V diagnostic criteria for borderline personality disorder (BPD). Impulsivity is also present in bipolar disorder (BD). Impulsivity has been linked to adverse behavior (suicidality,…) and to traumatic childhood experiences. Our study explored impulsivity in BPD, BD, ADHD and healthy controls (CTRL) and investigated the impact of early trauma on impulsivity. METHODS 744 patients with BD (n = 276), BPD (n = 168), ADHD (n = 173) or a combination (BPD_BD, n = 29; BPD_ADHD, n = 94, BD_BPD_ADHD n = 13) and 47 controls were included. All subjects were completed the Baratt Impulsivity Scale (BIS-10) and the Childhood Trauma Questionnaire (CTQ). RESULTS BD reported the same levels of impulsiveness as CTRL. When BPD and BD are co-morbid, impulsivity increased to reach the level of BPD. Impulsiveness was significantly associated to traumatic childhood event for BD and CTRL, not for BPD and AHDH. LIMITATIONS Impulsivity was assessed on the basis of a self-report questionnaire and not by the mean of an objective measure such as a neuropsychological test. Moreover, we don't know what treatment our pathological subjects were receiving. But, ADHD and BPD, despite the probable treatment, were more impulsive than healthy CTRLs who did not take medications. CONCLUSIONS Impulsivity is probably not a feature of BD but is associated with the presence of traumatic childhood experiences, especially for euthymic patients, unlike BPD and ADHD. So, it seems essential to assess the presence of early trauma to reduce the impulsivity and improve the evolution of BD.
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13
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Weiner L, Perroud N, Weibel S. Attention Deficit Hyperactivity Disorder And Borderline Personality Disorder In Adults: A Review Of Their Links And Risks. Neuropsychiatr Dis Treat 2019; 15:3115-3129. [PMID: 31806978 PMCID: PMC6850677 DOI: 10.2147/ndt.s192871] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 10/23/2019] [Indexed: 12/12/2022] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) and borderline personality disorder (BPD) are particularly common disorders, that are highly comorbid in adult populations. The symptomatic overlap between adult ADHD and BPD includes impulsivity, emotional dysregulation and interpersonal impairment, which makes the differential diagnosis difficult. Our review aims at focusing on recent data on the comorbid ADHD+BPD form, as well as the risk factors involved in the emergence of the two disorders. While adult ADHD and BPD share some genetic and temperamental risk factors, adult ADHD is characterized by more severe trait-impulsivity compared to non-comorbid BPD; BPD patients display more severe trait-emotion regulation symptoms compared to non-comorbid ADHD. Patients with the comorbid ADHD+BPD form have severe symptoms in both dimensions. Early-life exposure to adverse events is a shared risk factor for the development of ADHD and BPD, but type and timing of adversity seem to play a differential role in the development of BPD and ADHD symptoms. Age of onset used to be a discriminative diagnostic criterion between ADHD, an early-onset neurodevelopmental disorder, and BPD, a late-onset psychological disorder. However, this distinction has been recently called into question, increasing the need for more research aiming at delineating the disorders from a developmental and clinical standpoint. Clinicians should carefully consider the comorbidity, and consider ADHD and BPD dimensionally, in order to provide more effective patient management. This might improve early preventive interventions, and treatment for comorbid conditions in adulthood.
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Affiliation(s)
- Luisa Weiner
- Department of Psychiatry, University Hospital of Strasbourg, Strasbourg, France.,Laboratoire De Psychologie Des Cognitions, University of Strasbourg, Strasbourg, France
| | - Nader Perroud
- Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland.,Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sébastien Weibel
- Department of Psychiatry, University Hospital of Strasbourg, Strasbourg, France.,Inserm U1114, Strasbourg, France
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Abstract
Over the last 15 years, controversy over the construct of adolescent personality disorder has largely been laid to rest because of accumulating empirical evidence in support of its construct validity. In this article, four conclusions that can be drawn from recent literature on borderline disorder in adolescents are discussed, with the ultimate goal of building an argument to support the idea that adolescence is a sensitive period for the development of personality disorder.
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15
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Parsing cyclothymic disorder and other specified bipolar spectrum disorders in youth. J Affect Disord 2018; 238:375-382. [PMID: 29909300 PMCID: PMC6322201 DOI: 10.1016/j.jad.2018.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 06/01/2018] [Accepted: 06/04/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Most studies of pediatric bipolar disorder (BP) combine youth who have manic symptoms, but do not meet criteria for BP I/II, into one "not otherwise specified" (NOS) group. Consequently, little is known about how youth with cyclothymic disorder (CycD) differ from youth with BP NOS. The objective of this study was to determine whether youth with a research diagnosis of CycD (RDCyc) differ from youth with operationalized BP NOS. METHOD Participants from the Course and Outcome of Bipolar Youth study were evaluated to determine whether they met RDCyc criteria. Characteristics of RDCyc youth and BP NOS youth were compared at baseline, and over eight-years follow-up. RESULTS Of 154 youth (average age 11.96 (3.3), 42% female), 29 met RDCyc criteria. RDCyc youth were younger (p = .04) at baseline. Over follow-up, RDCyc youth were more likely to have a disruptive behavior disorder (p = .01), and were more likely to experience irritability (p = .03), mood reactivity (p = .02), and rejection sensitivity (p = .03). BP NOS youth were more likely to develop hypomania (p = .02), or depression (p = .02), and tended to have mood episodes earlier in the eight-year follow-up period. LIMITATIONS RDCyc diagnoses were made retrospectively and followed stringent criteria, which may highlight differences that, under typical clinical conditions and more vague criteria, would not be evident. CONCLUSION There were few differences between RDCyc and BP NOS youth. However, the ways in which the groups diverged could have implications; chronic subsyndromal mood symptoms may portend a severe, but ultimately non-bipolar, course. Longer follow-up is necessary to determine the trajectory and outcomes of CycD symptoms.
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Irastorza Eguskiza LJ, Bellón JM, Mora M. Comorbidity of personality disorders and attention-deficit hyperactivity disorder in adults. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2018; 11:151-155. [PMID: 26968498 DOI: 10.1016/j.rpsm.2016.01.009] [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: 12/11/2015] [Revised: 12/18/2015] [Accepted: 01/08/2016] [Indexed: 06/05/2023]
Abstract
INTRODUCTION A high comorbidity has been observed among attention-deficit hyperactivity disorder (ADHD) and categorical personality disorders (PD). A study is conducted on the dimensional traits associated with ADHD and PD, in order to determine whether there are any differences. METHODOLOGY A cross-sectional study was conducted on 78 outpatients attending a Mental Health Clinic in Arganda (Madrid) from January 2013 to June 2015. ADHD diagnosis was evaluated with the CAARS, the CAADID, and the WURS scales, and the PD with the SCID-II-DSM-IV questionnaire. None of the patients were receiving any stimulant or atomoxetine before the study, and all patients signed the informed consent before the study. RESULTS A high comorbidity was found with all PD clusters, especially with hyperactive and combined type ADHD. Depressive PD was associated with inattentive ADHD. CONCLUSIONS In spite of using a questionnaire to evaluate PD, some differences can be observed between specific ADHD types and PD. More studies are needed to investigate dimensional personality traits in order to improve the diagnosis and therapeutics goals.
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Affiliation(s)
| | - Jose M Bellón
- Instituto de Investigación de la Salud, Hospital General Gregorio Marañón, Madrid, España
| | - María Mora
- Hospital General Gregorio Marañón, Madrid, España
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Sharp C, Wall K. Personality pathology grows up: adolescence as a sensitive period. Curr Opin Psychol 2018; 21:111-116. [DOI: 10.1016/j.copsyc.2017.11.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 11/29/2017] [Accepted: 11/30/2017] [Indexed: 01/22/2023]
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18
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Weibel S, Nicastro R, Prada P, Cole P, Rüfenacht E, Pham E, Dayer A, Perroud N. Screening for attention-deficit/hyperactivity disorder in borderline personality disorder. J Affect Disord 2018; 226:85-91. [PMID: 28964997 DOI: 10.1016/j.jad.2017.09.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/21/2017] [Accepted: 09/21/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND A valid screening instrument is needed to detect attention-deficit/hyperactivity disorder (ADHD) in treatment-seeking borderline personality disorder (BPD) patients. We aimed to test the performance of the widely-used Adult ADHD Self-Report Scale v1.1 screener (ASRS-v1.1). METHODS 317 BPD subjects were systematically assessed for comorbid ADHD and completed the ASRS-v1.1. 79 BPD patients also completed the Wender Utah Rating Scale (WURS-25). RESULTS The prevalence of adult ADHD was of 32.4%. The overall positive predictive value of the ASRS-v1.1 was of 38.5%, the negative predictive value 77.0%, the sensitivity 72.8%, and the specificity 43.9%. Combining WURS-25 and ASRS-v1.1 improved sensitivity to 81.8% and specificity to 59.6%. LIMITATIONS Cross-sectional study on treatment-seeking patients. CONCLUSIONS We found a high prevalence of ADHD using structured interviews. The ASRS-v1.1 was not a sensitive screener for identifying possible ADHD cases in a BPD population, with a high number of false positives. When combined with the WURS-25, it offered improved screening.
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Affiliation(s)
- Sébastien Weibel
- Department of Psychiatry, University Hospital of Strasbourg, Strasbourg, France; Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland.
| | - Rosetta Nicastro
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Paco Prada
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Pierre Cole
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Eva Rüfenacht
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Eléonore Pham
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Alexandre Dayer
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Nader Perroud
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland
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LeGris J. Rapid emotional response and disadvantageous Iowa gambling task performance in women with borderline personality disorder. Borderline Personal Disord Emot Dysregul 2018; 5:16. [PMID: 30237891 PMCID: PMC6139153 DOI: 10.1186/s40479-018-0092-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 08/29/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Adults with Borderline Personality Disorder (BPD) manifest poor performance on tasks of decision making which may be congruent with their decisional and interpersonal conflicts in real life. Poor decision making is often assumed to be due to impulsive behaviour or weak inhibitory control despite inconsistent evidences of these relationships, leaving questions about the specific nature of these decisional deficits. Decision making in BPD may be compromised by different domains of impulsivity, affective dysregulatory processes or unknown co-morbid ADHD which is considered a developmental precursor to BPD. FINDINGS Iowa Gambling Task (IGT) decision making, 2 tasks of inhibitory control and a self report of ADHD symptoms consisting of 9 subscales were administered to 41 BPD women and 41 healthy controls. No group differences in inhibitory control were present. Net decision making performance and all ADHD subscale ratings differed significantly among BPD women and healthy controls. BPD women did not meet the threshold indicative of moderate to severe ADHD. Three subscales of attention, behaviour/ disorganized and emotive were significantly associated with poor IGT performance in 26 women with BPD. Of these 3 variables, the emotive subscale, representing a rapid emotional response, was the only significant predictor contributing 49% to the variance in poor DM. CONCLUSIONS This is the 1st evidence of an emotive type of impulsivity, representing a type of affective instability that is linked to poor IGT DM in BPD. Findings support the Somatic Marker Hypothesis of IGT DM and may reflect the affective dysregulation that characterizes the disorder.
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Affiliation(s)
- Jeannette LeGris
- 1Faculty of Health Sciences, School of Nursing, McMaster University, Ontario, Hamilton Canada.,2Deparment of Psychiatry and Behavioural Neuroscience, McMaster University, Ontario, Hamilton Canada
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Moukhtarian TR, Mintah RS, Moran P, Asherson P. Emotion dysregulation in attention-deficit/hyperactivity disorder and borderline personality disorder. Borderline Personal Disord Emot Dysregul 2018; 5:9. [PMID: 29796281 PMCID: PMC5960499 DOI: 10.1186/s40479-018-0086-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 04/12/2018] [Indexed: 01/28/2023] Open
Abstract
There is ongoing debate on the overlap between Attention-Deficit/Hyperactivity Disorder (ADHD) and Borderline Personality Disorder (BPD), particularly regarding emotion dysregulation (ED). In this paper, we present a narrative review of the available evidence on the association of these two disorders from several standpoints. First, we discuss the unique and shared diagnostic criteria for ADHD and BPD, focusing particularly on ED. We consider the methodology of ecological momentary assessment and discuss why this approach could be an alternative and more accurate way to qualitatively distinguish between ADHD and BPD. We summarise key findings on the genetic and environmental risk factors for ADHD and BPD and the extent to which there are shared or unique aetiological and neurobiological risk factors. Finally, we discuss the clinical relevance of considering both disorders in the assessment of patients presenting with trait-like behavioural syndromes, distinguishing the two conditions and implications for treatment.
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Affiliation(s)
- Talar R Moukhtarian
- 1King's College London, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF UK
| | - Ruth S Mintah
- 1King's College London, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF UK
| | - Paul Moran
- 2Centre for Academic Mental Health, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN UK
| | - Philip Asherson
- 1King's College London, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF UK
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Brooker BA, Ostojic D, Miller CJ. Symptom covariance accounts for behavioral approach associations across impulse control disorders. ACTA ACUST UNITED AC 2017; 10:199-208. [PMID: 29168110 DOI: 10.1007/s12402-017-0245-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 11/14/2017] [Indexed: 10/18/2022]
Abstract
Behavioral approach system (BAS) dysfunction has been identified as a correlate of and a potential mechanism for attention-deficit/hyperactivity disorder (ADHD) and comorbid disorders. This study examined the role of symptom covariation in the relations among BAS dysfunction, ADHD symptoms, and comorbid impulsive personality disorder features. Undergraduates (N = 207) completed measures of BAS functioning, ADHD symptoms, and borderline and antisocial personality disorder symptoms, and associated features (i.e., relational aggression). Hierarchical regression suggested that age, impulsive ADHD symptoms, and relational aggression were associated with BAS functioning. Adding other ADHD symptom dimensions (inattention, hyperactivity) and antisocial and borderline scores to the model did not increase variance accounted for beyond that accounted for by ADHD impulsivity scores. Results highlight a role of symptom covariance in the previously demonstrated relation between BAS, impulsive presentations of ADHD, and comorbid impulsive personality pathology. Implications for etiological models of ADHD and its co-occurrence with other disorders are discussed.
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Affiliation(s)
- Brianne A Brooker
- Department of Psychology, University of Windsor, 401 Sunset Avenue, Windsor, ON, N9B 3P4, Canada
| | - Dragana Ostojic
- Department of Psychology, University of Windsor, 401 Sunset Avenue, Windsor, ON, N9B 3P4, Canada
| | - Carlin J Miller
- Department of Psychology, University of Windsor, 401 Sunset Avenue, Windsor, ON, N9B 3P4, Canada.
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Kulacaoglu F, Solmaz M, Ardic FC, Akin E, Kose S. The relationship between childhood traumas, dissociation, and impulsivity in patients with borderline personality disorder comorbid with ADHD. PSYCHIAT CLIN PSYCH 2017. [DOI: 10.1080/24750573.2017.1380347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Filiz Kulacaoglu
- Department of Psychiatry, Health Sciences University Bagcilar Research & Training Hospital, Istanbul, Turkey
| | - Mustafa Solmaz
- Department of Psychiatry, Health Sciences University Bagcilar Research & Training Hospital, Istanbul, Turkey
| | - Ferhat Can Ardic
- Department of Psychiatry, Health Sciences University Bagcilar Research & Training Hospital, Istanbul, Turkey
| | - Ercan Akin
- Department of Psychology, Hasan Kalyoncu University, Gaziantep, Turkey
| | - Samet Kose
- Department of Psychology, Hasan Kalyoncu University, Gaziantep, Turkey
- University of Texas Medical School at Houston, Houston, TX, USA
- Center for Neurobehavioral Research on Addictions, Houston, TX, USA
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Kulacaoglu F, Solmaz M, Belli H, Ardic FC, Akin E, Kose S. The relationship between impulsivity and attention-deficit/hyperactivity symptoms in female patients with borderline personality disorder. PSYCHIAT CLIN PSYCH 2017. [DOI: 10.1080/24750573.2017.1342317] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Filiz Kulacaoglu
- Department of Psychiatry, Bagcilar Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Mustafa Solmaz
- Department of Psychiatry, Bagcilar Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Hasan Belli
- Department of Psychiatry, Bagcilar Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Ferhat Can Ardic
- Department of Psychiatry, Bagcilar Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Ercan Akin
- Department of Psychology, Hasan Kalyoncu University, Gaziantep, Turkey
| | - Samet Kose
- Department of Psychology, Hasan Kalyoncu University, Gaziantep, Turkey
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical School of Houston, Houston, TX, USA
- Center for Neurobehavioral Research on Addictions, Houston, TX, USA
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Liu Y, Zhong M, Xi C, Jin X, Zhu X, Yao S, Yi J. Event-Related Potentials Altered in Patients with Borderline Personality Disorder during Working Memory Tasks. Front Behav Neurosci 2017; 11:67. [PMID: 28458633 PMCID: PMC5394125 DOI: 10.3389/fnbeh.2017.00067] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 04/03/2017] [Indexed: 11/13/2022] Open
Abstract
Whereas some studies have demonstrated impaired working memory (WM) among patients with borderline personality disorder (BPD), these findings have not been consistent. Furthermore, there is a lack of neurophysiological evidence about WM function in patients with BPD. The goal of this study was to examine WM function in patients with BPD by using event-related potentials (ERPs). An additional goal was to explore whether characteristics of BPD (i.e., impulsiveness and emotional instability) are associated with WM impairment. A modified version of the N-back task (0- and 2-back) was used to measure WM. ERPs were recorded in 22 BPD patients and 21 age-, handedness-, and sex-matched healthy controls (HCs) while they performed the WM task. The results revealed that there were no significant group differences for behavioral variables (reaction time and accuracy rate) or for latencies and amplitudes of P1 and N1 (all p > 0.05). BPD patients had lower P3 amplitudes and longer N2 latencies than HC, independent of WM load (low load: 0-back; high load: 2-back). Impulsiveness was not correlated with N2 latency or P3 amplitude, and no correlations were found between N2 latency or P3 amplitude and affect intensity scores in any WM load (all p > 0.05). In conclusion, the lower P3 amplitudes and longer N2 latencies in BPD patients suggested that they might have some dysfunction of neural activities in sub-processing in WM, while impulsiveness and negative affect might not have a close relationship with these deficits.
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Affiliation(s)
- Ying Liu
- Medical Psychological Center, Second Xiangya Hospital, Central South UniversityChangsha, China
| | - Mingtian Zhong
- Center for Studies of Psychological Application, School of Psychology, South China Normal UniversityGuangzhou, China
| | - Chang Xi
- Medical Psychological Center, Second Xiangya Hospital, Central South UniversityChangsha, China
| | - Xinhu Jin
- Medical Psychological Center, Second Xiangya Hospital, Central South UniversityChangsha, China
| | - Xiongzhao Zhu
- Medical Psychological Center, Second Xiangya Hospital, Central South UniversityChangsha, China.,Medical Psychological Institute, Central South UniversityChangsha, China
| | - Shuqiao Yao
- Medical Psychological Center, Second Xiangya Hospital, Central South UniversityChangsha, China.,Medical Psychological Institute, Central South UniversityChangsha, China
| | - Jinyao Yi
- Medical Psychological Center, Second Xiangya Hospital, Central South UniversityChangsha, China.,Medical Psychological Institute, Central South UniversityChangsha, China
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Ibraheim M, Kalpakci A, Sharp C. The specificity of emotion dysregulation in adolescents with borderline personality disorder: comparison with psychiatric and healthy controls. Borderline Personal Disord Emot Dysregul 2017; 4:1. [PMID: 28078089 PMCID: PMC5223469 DOI: 10.1186/s40479-017-0052-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 01/04/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research has supported the notion that emotion dysregulation is a core feature of BPD. However, given that this feature is typical of healthy adolescents as well as adolescents with other psychiatric disorders, the specificity of emotion dysregulation to BPD in this age group has not yet been determined. The overall aim of this study was to examine emotion dysregulation in adolescent inpatients with BPD compared with non-BPD inpatient adolescents and healthy non-clinical adolescents, taking into account both global emotion dysregulation deficits and more specific impairments. METHOD The sample included 185 adolescent inpatients with BPD (M = 15.23, SD = 1.52), 367 non-BPD psychiatric inpatient adolescents (M = 15.37, SD = 1.40), and 146 healthy adolescents (M = 15.23, SD = 1.22), all of whom were between the ages of 12 and 17. Borderline personality features were assessed, along with emotion dysregulation and psychiatric severity. RESULTS After controlling for age, gender, and psychiatric severity, results revealed that adolescents with BPD had higher overall emotional dysregulation compared with non-BPD psychiatric controls and healthy controls. These differences were apparent in only two domains of emotion dysregulation including limited access to emotion regulation strategies perceived as effective and impulse control difficulties when experiencing negative emotions. CONCLUSIONS Findings suggest BPD-specific elevations on emotion dysregulation generally, and subscales related to behavioral regulation specifically.
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Affiliation(s)
- Marina Ibraheim
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, TX 77204 USA
| | - Allison Kalpakci
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, TX 77204 USA
| | - Carla Sharp
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, TX 77204 USA
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Safety of Methylphenidate and Atomoxetine in Children with Attention-Deficit/Hyperactivity Disorder (ADHD): Data from the Italian National ADHD Registry. CNS Drugs 2016; 29:865-77. [PMID: 26293742 DOI: 10.1007/s40263-015-0266-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to assess the type and frequency of adverse events (AEs) in children with attention-deficit/hyperactivity disorder (ADHD) treated with methylphenidate or atomoxetine over a 5-year period in a large naturalistic study. METHODS We draw on data from the Italian ADHD Registry, a national database for postmarketing phase IV pharmacovigilance of ADHD medications across 90 centers. AEs were defined as severe or mild as per the classification of the Italian Medicines Agency. AE frequency in the two treatment groups was compared using incidence rates per 100 person-years (IR100PY) and incidence rate ratios (IRRs). Mantel-Haenszel adjusted IRRs were calculated to control for psychiatric comorbidity. RESULTS A total of 1350 and 753 participants (aged 6-18 years, mean age 10.7 ± 2.8) were treated with methylphenidate and atomoxetine, respectively, from 2007 to 2012. Ninety participants (7 %) were switched from methylphenidate to atomoxetine, and 138 (18 %) from atomoxetine to methylphenidate. Thirty-seven children treated with atomoxetine and 12 with methylphenidate had their medication withdrawn. Overall, 645 patients (26.8 %) experienced at least one mild AE (including decreased appetite and irritability, for both drugs) and 95 patients (3.9 %) experienced at least one severe AE (including severe gastrointestinal events). IR100PY were significantly higher in the atomoxetine-treated group compared with the methylphenidate-treated group for a number of mild and severe AEs and for any severe or mild AEs. After controlling for comorbidities, IRR was still significantly higher in the atomoxetine group compared with the methylphenidate group for a number of mild (decreased appetite, weight loss, abdominal pain, dyspepsia, stomach ache, irritability, mood disorder and dizziness) and severe (gastrointestinal, neuropsychiatric, and cardiovascular) AEs. CONCLUSIONS In this naturalistic study, methylphenidate had a better safety profile than atomoxetine.
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Perroud N, Hasler R, Golay N, Zimmermann J, Prada P, Nicastro R, Aubry JM, Ardu S, Herrmann FR, Giannakopoulos P, Baud P. Personality profiles in adults with attention deficit hyperactivity disorder (ADHD). BMC Psychiatry 2016; 16:199. [PMID: 27301261 PMCID: PMC4908674 DOI: 10.1186/s12888-016-0906-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 04/15/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Previous studies suggested that the presence of ADHD in children and young adolescents may affect the development of personality. Whether or not the persistence of ADHD in adult life is associated with distinct personality patterns is still matter for debate. To address this issue, we compared the profiles of the Temperament and Character Inventory (TCI) that assesses personality dimensions in 119 adults ADHD and 403 controls. METHODS ANCOVA were used to examine group differences (controls vs. ADHD and ADHD inattentive type vs. ADHD combined + hyperactive/impulsive types) in Temperaments and Characters. Partial correlation coefficients were used to assess correlation between TCI and expression and severity of symptoms of ADHD. RESULTS High novelty seeking (NS), harm avoidance (HA) and self-transcendence (ST) scores as well as low self-directedness (SD) and cooperativeness (C) scores were associated with ADHD diagnosis. Low SD was the strongest personality trait associated with adult ADHD. Cases with the ADHD inattentive type showed higher HA and lower SD scores compared to the combined and hyperactive/impulsive types. High HA scores correlated with inattention symptoms whereas high NS and ST scores were related to hyperactive symptoms. Finally low SD and high NS were associated with increased ADHD severity. CONCLUSIONS Distinct temperaments were associated with inattentive versus hyperactive/impulsive symptoms supporting the heterogeneous nature of the disorder.
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Affiliation(s)
- Nader Perroud
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland. .,Department of Psychiatry, University of Geneva, Geneva, Switzerland.
| | - Roland Hasler
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Nicolas Golay
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Julien Zimmermann
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Paco Prada
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Rosetta Nicastro
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Jean-Michel Aubry
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland ,Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Stefano Ardu
- Section of Dental Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - François R Herrmann
- Division of Geriatrics, Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Panteleimon Giannakopoulos
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland ,Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Patrick Baud
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
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Korsgaard HO, Torgersen S, Wentzel-Larsen T, Ulberg R. Personality disorders and Axis I comorbidity in adolescent outpatients with ADHD. BMC Psychiatry 2016; 16:175. [PMID: 27245754 PMCID: PMC4888410 DOI: 10.1186/s12888-016-0871-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 05/16/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is a lifelong condition which carries great cost to society and has an extensive comorbidity. It has been assumed that ADHD is 2 to 5 times more frequent in boys than in girls. Several studies have suggested developmental trajectories that link ADHD and certain personality disorders. The present study investigated the prevalence of ADHD, common Axis I disorders, and their gender differences in a sample of adolescent outpatients. We also wanted to investigate the relationship between ADHD and personality disorders (PDs), as well as how this relationship was influenced by adjustment for Axis I disorders, age and gender. METHODS We used a sample consisting of 153 adolescents, aged 14 to 17 years, who were referred to a non-specialized mental health outpatient clinic with a defined catchment area. ADHD, conduct disorder (CD) and other Axis I conditions were assessed using the Mini International Neuropsychiatric Interview (MINI). PDs were assessed using the Structured Interview for DSM-IV Personality (SIDP-IV). RESULTS 13.7 % of the adolescents met diagnostic criteria for ADHD, with no significant gender difference. 21.6 % had at least one PD, 17.6 % had CD, and 4.6 % had both ADHD and a PD. There was a significantly elevated number of PD symptoms in adolescents with an ADHD diagnosis (p = 0.001), and this relationship was not significantly weakened when adjusted for age, gender and other Axis I disorders (p = 0.026). Antisocial (χ (2) = 21.18, p = 0.002) and borderline (χ (2) = 6.15, p = 0.042) PDs were significantly more frequent in girls than in boys with ADHD. CONCLUSIONS We found no significant gender difference in the prevalence of ADHD in a sample of adolescents referred to a general mental health outpatient clinic. Adolescent girls with ADHD had more PDs than boys, with antisocial and borderline PDs significantly different. The present study suggests that ADHD in girls in a general outpatient population may be more prevalent than previously assumed. It especially highlights the importance of assessing antisocial and borderline personality pathology in adolescent girls presenting with ADHD symptoms.
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Affiliation(s)
- Hans Ole Korsgaard
- Department for Child and Adolescent Mental Health (The Nic Waal Institute), Lovisenberg Diakonale Hospital, P.O. Box 4970, Nydalen, N-0440, Oslo, Norway.
| | - Svenn Torgersen
- Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway ,Department of Psychology, University of Oslo, Oslo, Norway
| | - Tore Wentzel-Larsen
- Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway ,Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Randi Ulberg
- Vestfold Hospital Trust, Tønsberg, Norway ,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Korsgaard HO, Torgersen S, Wentzel-Larsen T, Ulberg R. Substance abuse and personality disorder comorbidity in adolescent outpatients: are girls more severely ill than boys? Child Adolesc Psychiatry Ment Health 2016; 10:8. [PMID: 27069507 PMCID: PMC4827187 DOI: 10.1186/s13034-016-0096-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 03/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Substance use disorders (SUDs) constitute a major health problem and are associated with an extensive psychiatric comorbidity. Personality disorders (PDs) and SUDs commonly co-occur. Comorbid PD is characterized by more severe addiction problems and by an unfavorable clinical outcome. The present study investigated the prevalence of SUDs, PDs and common Axis I disorders in a sample of adolescent outpatients. We also investigated the association between PDs and SUDs, and how this association was influenced by adjustment for other Axis I disorders, age and gender. METHODS The sample consisted of 153 adolescents, aged 14-17 years, who were referred to a non-specialized mental health outpatient clinic with a defined catchment area. SUDs and other Axis I conditions were assessed using the mini international neuropsychiatric interview. PDs were assessed using the structured interview for DSM-IV personality. RESULTS 18.3 % of the adolescents screened positive for a SUD, with no significant gender difference. There was a highly significant association between number of PD symptoms and having one or more SUDs; this relationship was practically unchanged by adjustment for gender, age and presence of Axis I disorders. For boys, no significant associations between SUDs and specific PDs, conduct disorder (CD) or attention deficit hyperactivity disorder (ADHD) were found. For girls, there were significant associations between SUD and BPD, negativistic PD, more than one PD, CD and ADHD. CONCLUSIONS We found no significant gender difference in the prevalence of SUD in a sample of adolescents referred to a general mental health outpatient clinic. The association between number of PD symptoms and having one or more SUDs was practically unchanged by adjustment for gender, age and presence of one or more Axis I disorders, which suggested that having an increased number of PD symptoms in itself may constitute a risk factor for developing SUDs in adolescence. The association in girls between SUDs and PDs, CD and ADHD raises the question if adolescent girls suffering from these conditions may be especially at risk for developing SUDs. In clinical settings, they should therefore be monitored with particular diligence with regard to their use of psychoactive substances. Trial registration The regional committee for medical research ethics for eastern Norway approved the study protocol in October 2004 (REK: 11395). Address correspondence and reprint requests to: Hans Ole Korsgaard, The Nic Waal Institute, Lovisenberg Diakonale Hospital, P.O. Box 2970 Nydalen, N-0440 Oslo, Norway; E-mail hansole.korsgaard@tele5.no.
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Affiliation(s)
- Hans Ole Korsgaard
- Department for Child and Adolescent Mental Health (The Nic Waal Institute), Lovisenberg Diakonale Hospital, Oslo, Norway
| | | | - Tore Wentzel-Larsen
- Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway ,Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Randi Ulberg
- Vestfold Hospital Trust, Tønsberg, Norway ,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Huỳnh C, Guilé JM, Breton JJ, Godbout R. Sleep-Wake Patterns of Adolescents with Borderline Personality Disorder and Bipolar Disorder. Child Psychiatry Hum Dev 2016; 47:202-14. [PMID: 26003420 DOI: 10.1007/s10578-015-0557-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Sleep-wake patterns are rarely examined in adolescents with borderline personality disorder (BPD) or bipolar disorder (BD). Within a developmental perspective, this study explores the sleep-wake cycle of adolescents aged 12-17 years with BPD or BD and healthy controls (HC) during periods with and without entrainment by school/work schedules. Eighteen euthymic BPD, six euthymic BD, and 20 HC adolescents wore wrist actigraphy during nine consecutive days to assess sleep-wake patterns. During school/work days, BPD adolescents spent more time awake when they were in bed compared to HC and BD adolescents (p = 0.039). On schedule-free days, BPD and BD youths spent more time in bed compared to HC adolescents (p = 0.015). BPD adolescents woke up over 1 h later compared to HC (p = 0.003). Total sleep time was more variable between nights in BPD adolescents compared to the HC group (p = 0.031). Future research should explore if sleep-wake pattern disruptions are a cause or a consequence of BPD symptomatology in adolescents. Addressing sleep-wake pattern during clinical assessment and treatment of BPD adolescents may potentially reduce their symptoms; this therapeutic effect still needs to be evaluated.
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Affiliation(s)
- Christophe Huỳnh
- Sleep Laboratory and Clinic, Rivière-des-Prairies Hospital, 7070 Boul. Perras, Montréal, QC, H1E 1A4, Canada
- Mood Disorders Clinic and Research Branch, Rivière-des-Prairies Hospital, Montréal, QC, Canada
- Department of Psychiatry, Université de Montréal, Montréal, QC, Canada
- Research Centre, Rivière-des-Prairies Hospital and Institut Universitaire en Santé Mentale de Montréal, Montréal, QC, Canada
| | - Jean-Marc Guilé
- Mood Disorders Clinic and Research Branch, Rivière-des-Prairies Hospital, Montréal, QC, Canada
- Department of Psychiatry, Université de Montréal, Montréal, QC, Canada
| | - Jean-Jacques Breton
- Mood Disorders Clinic and Research Branch, Rivière-des-Prairies Hospital, Montréal, QC, Canada
- Department of Psychiatry, Université de Montréal, Montréal, QC, Canada
- Research Centre, Rivière-des-Prairies Hospital and Institut Universitaire en Santé Mentale de Montréal, Montréal, QC, Canada
| | - Roger Godbout
- Sleep Laboratory and Clinic, Rivière-des-Prairies Hospital, 7070 Boul. Perras, Montréal, QC, H1E 1A4, Canada.
- Department of Psychiatry, Université de Montréal, Montréal, QC, Canada.
- Research Centre, Rivière-des-Prairies Hospital and Institut Universitaire en Santé Mentale de Montréal, Montréal, QC, Canada.
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Matthies S, Philipsen A. Comorbidity of Personality Disorders and Adult Attention Deficit Hyperactivity Disorder (ADHD)--Review of Recent Findings. Curr Psychiatry Rep 2016; 18:33. [PMID: 26893231 DOI: 10.1007/s11920-016-0675-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Children suffering from attention deficit hyperactivity disorder (ADHD) may remit until adulthood. But, more than 60-80% have persisting ADHD symptoms. ADHD as an early manifesting neurodevelopmental disorder is considered a major risk factor for the development of comorbid psychiatric disorders in later life. Particularly, personality disorders are oftentimes observed in adult patients suffering from ADHD. If ADHD and personality disorders share common etiological mechanisms and/or if ADHD as a severely impairing condition influences psychological functioning and learning and leads to unfavorable learning histories is unclear. The development of inflexible and dysfunctional beliefs on the basis of real and perceived impairments or otherness due to the core symptoms of ADHD is intuitively plausible. Such beliefs are a known cause for the development of personality disorders. But, why some personality disorders are more frequently found in ADHD patients as for example antisocial and borderline personality disorder remains subject of debate. Because of the high prevalence of ADHD and the high impact of personality disorders on daily functioning, it is important to take them into account when treating patients with ADHD. Research on the developmental trajectories leading to personality disorders in adult ADHD patients might open the door for targeted interventions to prevent impairing comorbid clinical pictures.
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Affiliation(s)
- Swantje Matthies
- Department of Psychiatry & Psychotherapy, University Medical Centre Freiburg, Hauptstr. 5, D-79104, Freiburg, Germany.
| | - Alexandra Philipsen
- Medical Campus University of Oldenburg, School of Medicine and Health Sciences, D-26111, Oldenburg, Germany. .,Psychiatry and Psychotherapy - University Hospital, Karl-Jaspers-Klinik, Hermann-Ehlers-Straße 7, D-26160, Bad Zwischenahn, Germany.
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Perroud N, Zewdie S, Stenz L, Adouan W, Bavamian S, Prada P, Nicastro R, Hasler R, Nallet A, Piguet C, Paoloni-Giacobino A, Aubry JM, Dayer A. METHYLATION OF SEROTONIN RECEPTOR 3A IN ADHD, BORDERLINE PERSONALITY, AND BIPOLAR DISORDERS: LINK WITH SEVERITY OF THE DISORDERS AND CHILDHOOD MALTREATMENT. Depress Anxiety 2016; 33:45-55. [PMID: 26350166 DOI: 10.1002/da.22406] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 07/28/2015] [Accepted: 08/02/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Serotonin 3A receptor (5-HT3A R) is associated at the genetic and epigenetic levels with a variety of psychiatric disorders and interacts with early-life stress such as childhood maltreatment. We studied the impact of childhood maltreatment on the methylation status of the 5-HT3A R and its association with clinical severity outcomes in relation with a functional genetic polymorphism. METHODS Clinical severity indexes of 346 bipolar, borderline personality, and adult attention deficit hyperactivity disorders patients were tested for association with the DNA methylation status of eight 5-HT3A R gene CpGs. Relationship between the functional variant rs1062613 (C > T) and methylation status on severity of the disorders were also assessed. RESULTS Childhood maltreatment was associated with higher severity of the disease (higher number of mood episodes, history of suicide attempts, hospitalization, and younger age at onset) across disorders and within each individual disorder. This effect was mediated by two 5-HT3A R CpGs. Compared to T allele carriers, CC carriers had higher methylation status at one CpG located 1 bp upstream of this variant. CONCLUSIONS This study shows that epigenetic modification of the 5-HT3A R is involved in the mechanism underlying the relationship between maltreatment in childhood and the severity of several psychiatric disorders in adulthood.
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Affiliation(s)
- Nader Perroud
- Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, University Hospitals of Geneva, Geneva, Switzerland.,Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | | | - Ludwig Stenz
- Department of Psychiatry, University of Geneva, Geneva, Switzerland.,Department of Basic Neuroscience, University of Geneva, Switzerland
| | - Wafae Adouan
- Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Sabine Bavamian
- Department of Psychiatry, University of Geneva, Geneva, Switzerland.,Department of Basic Neuroscience, University of Geneva, Switzerland
| | - Paco Prada
- Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, University Hospitals of Geneva, Geneva, Switzerland
| | - Rosetta Nicastro
- Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, University Hospitals of Geneva, Geneva, Switzerland
| | - Roland Hasler
- Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Audrey Nallet
- Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, University Hospitals of Geneva, Geneva, Switzerland
| | - Camille Piguet
- Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, University Hospitals of Geneva, Geneva, Switzerland
| | - Ariane Paoloni-Giacobino
- Department of Genetic Medicine and Development, University of Geneva Medical School, Geneva, Switzerland
| | - Jean-Michel Aubry
- Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, University Hospitals of Geneva, Geneva, Switzerland.,Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Alexandre Dayer
- Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, University Hospitals of Geneva, Geneva, Switzerland.,Department of Psychiatry, University of Geneva, Geneva, Switzerland.,Department of Basic Neuroscience, University of Geneva, Switzerland
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O'Malley GK, McHugh L, Mac Giollabhui N, Bramham J. Characterizing adult attention-deficit/hyperactivity-disorder and comorbid borderline personality disorder: ADHD symptoms, psychopathology, cognitive functioning and psychosocial factors. Eur Psychiatry 2015; 31:29-36. [PMID: 26657598 DOI: 10.1016/j.eurpsy.2015.09.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 09/22/2015] [Accepted: 09/25/2015] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To characterize adults with comorbid attention-deficit/hyperactivity-disorder (ADHD) and borderline personality disorder (BPD) with regard to ADHD symptoms, psychopathology, cognitive functioning and psychosocial factors. METHOD A between-group design compared a group of individuals diagnosed with ADHD (n=40) with a group diagnosed with BPD and who also met the criteria for ADHD (ADHD+BPD) (n=20). RESULTS Significant differences were observed for both childhood and current impulsivity symptoms, whereby ADHD+BPD exhibited increased impulsivity; no differences on self-report and cognitive measures of impulsivity were reported. The ADHD+BPD group scored significantly higher on measures of depression, anxiety and numerous other axis I and II conditions. The ADHD+BPD group scored significantly lower on most measures of intellectual functioning and attention, however largely not on those relating to response inhibition. Furthermore, group differences were observed for psychosocial factors, including education, substance use and criminal record. CONCLUSION Comorbid ADHD and BPD is characterized by more symptoms of impulsivity, additional psychopathology, comparatively lower intellectual and attentional functioning and increased psychosocial difficulties.
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Affiliation(s)
- G K O'Malley
- School of Psychology, University College Dublin (UCD), Dublin, Ireland
| | - L McHugh
- School of Psychology, University College Dublin (UCD), Dublin, Ireland
| | - N Mac Giollabhui
- School of Psychology, University College Dublin (UCD), Dublin, Ireland
| | - J Bramham
- School of Psychology, University College Dublin (UCD), Dublin, Ireland.
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Sharp C, Fonagy P. Practitioner Review: Borderline personality disorder in adolescence--recent conceptualization, intervention, and implications for clinical practice. J Child Psychol Psychiatry 2015; 56:1266-88. [PMID: 26251037 DOI: 10.1111/jcpp.12449] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND The past decade has seen an unprecedented increase in research activity on personality disorders (PDs) in adolescents. The increase in research activity, in addition to major nosological systems legitimizing the diagnosis of borderline personality disorder (BPD) in adolescents, highlights the need to communicate new research on adolescent personality problems to practitioners. SCOPE In this review, we provide up-to-date information on the phenomenology, prevalence, associated clinical problems, etiology, and intervention for BPD in adolescents. Our aim was to provide a clinically useful practitioner review and to dispel long-held myths about the validity, diagnostic utility, and treatability of PDs in adolescents. FINDINGS AND CONCLUSION Alongside providing up-to-date information on the phenomenology, prevalence, and etiology, we also report on associated clinical problems and interventions for adolescent BPD. It is only through early active assessment and identification of youngsters with these problems that a lifetime of personal suffering and health system burden can be reduced or altogether avoided. A variety of evidence-based approaches are now available to treat BPD and related clinical problems in young people. Future research should focus on establishing optimal precision in the diagnostic processes in different treatment settings.
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Affiliation(s)
- Carla Sharp
- Department of Psychology, University of Houston, and The Menninger Clinic, Houston, Texas, USA
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, and The Anna Freud Centre, London, UK
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35
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Clinical, neuropsychological and structural convergences and divergences between Attention Deficit/Hyperactivity Disorder and Borderline Personality Disorder: A systematic review. PERSONALITY AND INDIVIDUAL DIFFERENCES 2015. [DOI: 10.1016/j.paid.2015.06.049] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Fonagy P, Speranza M, Luyten P, Kaess M, Hessels C, Bohus M. ESCAP Expert Article: borderline personality disorder in adolescence: an expert research review with implications for clinical practice. Eur Child Adolesc Psychiatry 2015; 24:1307-20. [PMID: 26271454 DOI: 10.1007/s00787-015-0751-z] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 07/17/2015] [Indexed: 12/26/2022]
Abstract
Borderline personality disorder (BPD) has onset in adolescence, but is typically first diagnosed in young adulthood. This paper provides a narrative review of the current evidence on diagnosis, comorbidity, phenomenology and treatment of BPD in adolescence. Instruments available for diagnosis are reviewed and their strengths and limitations discussed. Having confirmed the robustness of the diagnosis and the potential for its reliable clinical assessment, we then explore current understandings of the mechanisms of the disorder and focus on neurobiological underpinnings and research on psychological mechanisms. Findings are accumulating to suggest that adolescent BPD has an underpinning biology that is similar in some ways to adult BPD but differs in some critical features. Evidence for interventions focuses on psychological therapies. Several encouraging research studies suggest that early effective treatment is possible. Treatment development has just begun, and while adolescent-specific interventions are still in the process of evolution, most existing therapies represent adaptations of adult models to this developmental phase. There is also a significant opportunity for prevention, albeit there are few data to date to support such initiatives. This review emphasizes that there can be no justification for failing to make an early diagnosis of this enduring and pervasive problem.
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Affiliation(s)
- Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, WC1E 6BT, UK.
| | - Mario Speranza
- Department of Child and Adolescent Psychiatry, Versailles General Hospital, Faculty of Health Sciences, Research Unit EA4047, University of Versailles Saint-Quentin-en-Yvelines, 177 rue de Versailles, 78157, Le Chesnay, France
| | - Patrick Luyten
- Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, WC1E 6BT, UK
- Faculty of Psychology and Educational Sciences, University of Leuven, Tiensestraat 102, Box 3722, 3000, Leuven, Belgium
| | - Michael Kaess
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Blumenstrasse 8, 69115, Heidelberg, Germany
| | - Christel Hessels
- Expertise Centre for Personality Disorders, GGz Centraal, PO Box 3051, 3800 DB, Amersfoort, The Netherlands
| | - Martin Bohus
- Department of Psychosomatics and Psychotherapy, Central Institute of Mental Health Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany
- Faculty of Health, University of Antwerp, Antwerp, Belgium
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Borderline personality disorder: Prevalence and psychiatric comorbidity among male offenders on probation in Sweden. Compr Psychiatry 2015; 62:63-70. [PMID: 26343468 DOI: 10.1016/j.comppsych.2015.06.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 06/02/2015] [Accepted: 06/24/2015] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Borderline personality disorder (BPD) is a severely disabling condition, associated with substantially increased risk of deliberate self-harm and, particularly in men, also with interpersonal violence and other criminal behavior. Although BPD might be common among prison inmates, little is known about prevalence and psychiatric comorbidity in probationers and parolees. METHOD In 2013, a consecutive sample of 109 newly admitted adult male offenders on probation or parole in all three probation offices of Stockholm, Sweden, completed self-report screening questionnaires for BPD and other psychiatric morbidity. Participants scoring over BPD cut-off participated in a psychiatric diagnostic interview. RESULTS We ascertained a final DSM-5 BPD prevalence rate of 19.8% (95% CI: 12.3-27.3%). The most common current comorbid disorders among subjects with BPD were antisocial personality disorder (91%), major depressive disorder (82%), substance dependence (73%), attention deficit hyperactivity disorder (ADHD) (70%), and alcohol dependence (64%). Individuals diagnosed with BPD had significantly more current psychiatric comorbidity (M=6.2 disorders) than interviewed participants not fulfilling BPD criteria (M=3.6). Participants with BPD also reported substantially more symptoms of ADHD, anxiety and depression compared to all subjects without BPD. CONCLUSIONS BPD affected one fifth of probationers and was related to serious mental ill-health known to affect recidivism risk. The findings suggest further study of possible benefits of improved identification and treatment of BPD in offender populations.
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Ballon N, Brunault P, Cortese S. Sensation seeking and cocaine dependence in adults with reported childhood ADHD. J Atten Disord 2015; 19:335-42. [PMID: 25085652 DOI: 10.1177/1087054714543651] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare measures of sensation seeking in a clinical group of cocaine-dependent (CD) patients with and without a history of probable childhood ADHD and in non-cocaine-dependent (NCD) healthy volunteers. METHOD Patients (n = 75; 42 with and 33 without probable childhood ADHD) and comparisons (n = 84) were assessed with the Diagnostic Interview for Genetic Studies, the Wender Utah Rating Scale for childhood ADHD, and the Zuckerman Seeking Sensation Scale. RESULTS We found significantly higher prevalence rates of probable childhood ADHD in CD versus NCD (p < .001). The mean total scores of sensation seeking were significantly higher in CD versus NCD participants (p < .001) as well as in CD patients with versus those without a probable history of childhood ADHD (p < .001). CONCLUSION Our study sets the basis for longitudinal investigation assessing whether the persistence of high level of sensation seeking in adults with childhood ADHD contributes to the transition to cocaine dependence.
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Affiliation(s)
- Nicolas Ballon
- CHRU de Tours, Clinique Psychiatrique Universitaire, Tours, France CHRU de Tours, Équipe de Liaison et de Soins en Addictologie, Tours, France Université François Rabelais de Tours, Tours, France UMR INSERM U930 ERL, Tours, France
| | - Paul Brunault
- CHRU de Tours, Clinique Psychiatrique Universitaire, Tours, France CHRU de Tours, Équipe de Liaison et de Soins en Addictologie, Tours, France Université François Rabelais de Tours, Département de Psychologie, EA 2114, Psychologie des Ages de la Vie, Tours, France
| | - Samuele Cortese
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK School of Medicine, University of Nottingham, UK
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Knafo A, Guilé JM, Breton JJ, Labelle R, Belloncle V, Bodeau N, Boudailliez B, de la Rivière SG, Kharij B, Mille C, Mirkovic B, Pripis C, Renaud J, Vervel C, Cohen D, Gérardin P. Coping strategies associated with suicidal behaviour in adolescent inpatients with borderline personality disorder. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2015; 60:S46-54. [PMID: 25886671 PMCID: PMC4345850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 12/01/2014] [Indexed: 03/07/2023]
Abstract
OBJECTIVES To compare the coping strategies of adolescents with borderline personality disorder (BPD) to the coping strategies of adolescents without BPD, and to explore the association of coping with suicidal ideation and attempts among adolescents with BPD. METHOD Adolescent inpatients (n = 167) aged 13 to 17 years were admitted after suicide attempts and evaluated within 10 days, using the abbreviated version of the Diagnostic Interview for Borderlines-Revised, the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version supported by a team consensus best estimate method for the primary diagnosis, the Adolescent Coping Scale, and the Columbia-Suicide Severity Rating Scale. RESULTS Firstly, compared with adolescents without BPD, adolescents with BPD relied more on nonproductive coping strategies, mostly avoidant strategies, and less on productive coping strategies. Secondly, coping appeared as a factor associated with suicidal ideation in adolescents with BPD. While while controlling for age, sex, and depression, multivariate analyses showed a significant positive association between the coping strategy to focusing on solving the problem and suicidal ideation. CONCLUSION The use of avoidant strategies by adolescents with BPD could be viewed as attempts to increase emotional regulation. Problem-solving strategies in the immediate aftermath of a suicide attempt may prevent adolescents with BPD from overcoming a crisis and may increase suicidal ideation.
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Affiliation(s)
- Alexandra Knafo
- Psychiatry Resident, Service de Psychopathologie de l’Enfant et de l’Adolescent et Unité de Médecine de l’Adolescent, Centre Hospitalier Universitaire d’Amiens, Université Picardie Jules Verne, Amiens, France
| | - Jean-Marc Guilé
- Professor and Department Head, Service de Psychopathologie de l’Enfant et de l’Adolescent et Unité de Médecine de l’Adolescent, Centre Hospitalier Universitaire d’Amiens, Université Picardie Jules Verne, Amiens, France; Associate Professor, Département de Psychiatrie, Université de Montréal, Montréal, Québec; Assistant Professor, Division of Child Psychiatry, Department of Psychiatry, McGill University, Montréal, Québec; Researcher, Centre de recherche de l’Institut universitaire en santé mentale de Montréal, site de l’Hôpital Rivière-des-Prairies, Montréal, Québec
| | - Jean-Jacques Breton
- Associate Professor, Département de Psychiatrie, Université de Montréal, Montréal, Québec; Researcher, Centre de recherche de l’Institut universitaire en santé mentale de Montréal, l’Hôpital Rivière-des-Prairies, Montréal, Québec
| | - Réal Labelle
- Psychologist and Researcher, Clinique des troubles de l’humeur and Centre de recherche de l’Institut universitaire en santé mentale de Montréal, Hôpital Rivière-des-Prairies, Montréal, Québec; Full Professor, Département de psychologie, Université du Québec à Montréal, Montréal, Québec; Associate Professor, Département de psychiatrie, Université de Montréal, Montréal, Québec
| | - Vincent Belloncle
- Psychiatrist, Département de pédiatrie médicale, Fédération hospitalo–universitaire de psychiatrie de l’enfant et de l’adolescent, Centre hospitalier universitaire de Rouen et Centre hospitalier du Rouvray, Université de Rouen, Rouen, France
| | - Nicolas Bodeau
- Statistics Engineer and Data Manager, Service de Psychiatrie de l’Enfant et de l’Adolescent, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique–Hopitaux de Paris et Université Pierre et Marie Curie, Paris, France
| | - Bernard Boudailliez
- Professor and Department Head, Service de pédiatrie et Unité de Médecine de l’Adolescent, Centre Hospitalier Universitaire d’Amiens, Université Picardie Jules Verne, Amiens, France
| | - Sébastien Garny de la Rivière
- Psychiatry Resident, Service de Psychopathologie de l’Enfant et de l’Adolescent et Unité de Médecine de l’Adolescent, Centre Hospitalier Universitaire d’Amiens, Université Picardie Jules Verne, Amiens, France
| | - Brahim Kharij
- Psychiatry Resident, Service de Psychopathologie de l’Enfant et de l’Adolescent et Unité de Médecine de l’Adolescent, Centre Hospitalier Universitaire d’Amiens, Université Picardie Jules Verne, Amiens, France
| | - Christian Mille
- Professor, Service de Psychopathologie de l’Enfant et de l’Adolescent et Unité de Médecine de l’Adolescent, Centre Hospitalier Universitaire d’Amiens, Université Picardie Jules Verne, Amiens, France
| | - Bojan Mirkovic
- Psychiatrist, Fédération hospitalo–universitaire de psychiatrie de l’enfant et de l’adolescent, Centre hospitalier universitaire de Rouen, Rouen, France; PhD Student, Inserm U1079, Université de Rouen, Rouen, France
| | - Cornelia Pripis
- Senior Psychiatrist, Service de Psychopathologie de l’Enfant et de l’Adolescent et Unité de Médecine de l’Adolescent, Centre Hospitalier Universitaire d’Amiens, Université Picardie Jules Verne, Amiens, France
| | - Johanne Renaud
- Child and Adolescent Psychiatrist, Standard Life Centre for Breakthroughs in Teen Depression and Suicide Prevention, Douglas Mental Health University Institute, Montréal, Québec; Medical Chief, McGill Group for Suicide Studies, McGill University, Montréal, Québec
| | - Christine Vervel
- Head, Service de Pédiatrie, Centre Hospitalier de Compiègne, Compiègne, France
| | - David Cohen
- Professor and Department Head, Service de Psychiatrie de l’Enfant et de l’Adolescent, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique–Hopitaux de Paris et Université Pierre et Marie Curie, Paris, France; Researcher, CNRS UMR 7222 Institut des Systèmes Intelligents et Robotiques, Université Pierre et Marie Curie, Paris, France
| | - Priscille Gérardin
- Professor and Department Head, Département de pédiatrie médicale, Fédération hospitalo–universitaire de psychiatrie de l’enfant et de l’adolescent, Centre Hospitalier universitaire de Rouen et Centre hospitalier du Rouvray, France, Rouen et Rouvray, France; Researcher, Laboratoire Psy-NCA-EA-4700, Université de Rouen, Rouen, France
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Abstract
BACKGROUND Several studies report associations between adults with borderline personality disorder (BPD) and a history of attention-deficit hyperactivity (ADHD) symptoms in childhood. AIMS To explore the association between BPD and a history of ADHD in childhood. METHOD A comprehensive search of EMBASE, PsychInfo and Medline and hand-searching yielded 238 "hits". Fifteen articles were found to have sufficient quality and relevance to be included in the final review. The data were considered in six possible explanatory psychopathological models of the association between ADHD and BPD. RESULTS Most of the 15 articles showed a statistical association between ADHD and BPD. The data, most strongly provided a basis for the hypotheses that ADHD is either an early developmental stage of BPD, or that the two disorders share an environmental and genetic aetiology. Furthermore, one of the disorders seems to give a synergic effect, reinforce the other or complicate the disorders. In one prospective study, the risk factor for children with ADHD to develop BPD was as high as odds ratio 13.16. No studies have looked at treatment of ADHD as a mediator of the risk for BPD. CONCLUSIONS Many studies pointed at shared aetiology or the risk for development of one disorder, when the other disorder is present. The data do not evaluate how treatment factors or other factors mediate the risk or how overlap of diagnostic criteria adds to the statistical association. More research is much needed, in particular studies looking at early intervention and which treatment of ADHD that might prevent later development of BPD.
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Affiliation(s)
- Ole Jakob Storebø
- Ole Jakob Storebø, M.A., Ph.D., Psychiatric Research Unit, Region Zealand, and Child and Adolescent Psychiatric Department , Region Zealand, Holbæk 4300 , Denmark
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Prada P, Hasler R, Baud P, Bednarz G, Ardu S, Krejci I, Nicastro R, Aubry JM, Perroud N. Distinguishing borderline personality disorder from adult attention deficit/hyperactivity disorder: a clinical and dimensional perspective. Psychiatry Res 2014; 217:107-14. [PMID: 24656900 DOI: 10.1016/j.psychres.2014.03.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 02/10/2014] [Accepted: 03/02/2014] [Indexed: 11/25/2022]
Abstract
Adult attention deficit hyperactivity disorder (ADHD) is frequently associated with borderline personality disorder (BPD). As both disorders share some core clinical features they are sometimes difficult to distinguish from one another. The present work aimed to investigate differences in the expression of impulsivity, anger and aggression, quality of life as well as the number and severity of the comorbidities between ADHD, BPD, comorbid BPD-ADHD and control subjects. ADHD and BPD-ADHD patients showed a higher level of impulsivity than BPD and control subjects. BPD-ADHD patients had higher levels of substance abuse/dependence and higher levels of aggression than the other groups. Comorbid BPD-ADHD patients showed high levels of impulsivity and aggression, a characteristic that should draw the attention of clinicians on the necessity of providing an accurate diagnosis. The question also arises as to whether they represent a distinct clinical subgroup with specific clinical characteristics, outcomes and vulnerability factors.
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Affiliation(s)
- Paco Prada
- Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, University Hospitals of Geneva, Switzerland
| | - Roland Hasler
- Department of Medical Genetic and Laboratories, Psychiatric Genetic Unit, University Hospitals of Geneva, Switzerland
| | - Patrick Baud
- Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, University Hospitals of Geneva, Switzerland
| | - Giovanna Bednarz
- Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, University Hospitals of Geneva, Switzerland
| | - Stefano Ardu
- Department of Cardiology and Endodontology, Treatment Plan Unit and Division of Operative Dentistry, Dental School, University of Geneva, Geneva, Switzerland
| | - Ivo Krejci
- Department of Cardiology and Endodontology, Treatment Plan Unit and Division of Operative Dentistry, Dental School, University of Geneva, Geneva, Switzerland
| | - Rosetta Nicastro
- Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, University Hospitals of Geneva, Switzerland
| | - Jean-Michel Aubry
- Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, University Hospitals of Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Nader Perroud
- Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, University Hospitals of Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland.
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42
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Braham S, Hadj Kacem I, Mlika S, Moalla Y, Walha A, Gaddour N, Ayadi H, Ghribi F. [Impulsivity and externalization and internalization problems in adolescents]. Encephale 2014; 41:215-20. [PMID: 24746622 DOI: 10.1016/j.encep.2014.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 12/30/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The multidimensional aspect of the concept of impulsivity is proven by the composite structure of the rating scales of impulsivity. Several studies have already found correlations between trait-impulsivity and externalizing disorders. However, the studies interested in the relationship between trait-impulsivity and internalizing problems are rare. We have tried to explore correlations between impulsivity and externalization and internalization problems, in a population of adolescent outpatients. METHODS We recruited 31 adolescent out-patients in the child and adolescent psychiatry department in the University Hospital of Monastir, Tunisia. The Barratt Impulsivity Scale (BIS) was used to evaluate a multidimensional concept of trait-impulsivity, including the dimensions of "Motor", "Non-planning" and "Attentional" impulsivities. The Strength and Difficulties Scales (SDQ) was used to assess different domains of externalizing and internalizing problems, including "Emotional symptoms", "Conduct problems", "Hyperactivity" and "Peer problems". RESULTS The sex-ratio was 1.21. The mean age was 15.19±1.27 years. All patients but one were attending school. The diagnosis was "Major Depressive Episode" in 32% and "Behavior Disorder" in 38%. The means of the scores of externalizing and internalizing problems were 9.35±4.41 and 9.65±3.26, respectively. The total score of the BIS was significantly related to both scores of externalizing and internalizing problems. The "Motor" impulsivity was specially correlated with the externalizing dimension of the SDQ. The non-planning impulsivity was correlated with both scores of externalizing and internalizing problems, but it was mainly related to internalizing problems. The attentional impulsivity was also correlated with both dimensions of externalizing and internalizing problems. CONCLUSION The dimensions of trait-impulsivity were correlated with various dimensions of the SDQ concerning externalizing and internalizing problems. That confirms the hypothesis that the impulsiveness is associated with wide domains of the psychopathology of the teenager which are not limited to behavior disorders. We can process these problems by influencing the "Motor impulsivity" and "Non-planning impulsivity". The cognitive and behavioral therapy and the selective serotonin reuptake inhibitor may be efficient.
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Affiliation(s)
- S Braham
- Service de psychiatrie, CHU F. Bourguiba, avenue Farhat Hached, 5000 Monastir, Tunisie.
| | - I Hadj Kacem
- Service de pédopsychiatrie, CHU H. Chaker, route El Ain, 3000 Sfax, Tunisie
| | - S Mlika
- Service de psychiatrie, CHU F. Hached, 4002 Sousse Medina, Tunisie
| | - Y Moalla
- Service de pédopsychiatrie, CHU H. Chaker, route El Ain, 3000 Sfax, Tunisie
| | - A Walha
- Service de pédopsychiatrie, CHU H. Chaker, route El Ain, 3000 Sfax, Tunisie
| | - N Gaddour
- Service de psychiatrie, CHU F. Bourguiba, avenue Farhat Hached, 5000 Monastir, Tunisie
| | - H Ayadi
- Service de pédopsychiatrie, CHU H. Chaker, route El Ain, 3000 Sfax, Tunisie
| | - F Ghribi
- Service de pédopsychiatrie, CHU H. Chaker, route El Ain, 3000 Sfax, Tunisie
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Matthies SD, Philipsen A. Common ground in Attention Deficit Hyperactivity Disorder (ADHD) and Borderline Personality Disorder (BPD)-review of recent findings. Borderline Personal Disord Emot Dysregul 2014; 1:3. [PMID: 26843958 PMCID: PMC4739390 DOI: 10.1186/2051-6673-1-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 10/17/2013] [Indexed: 12/29/2022] Open
Abstract
Considerable overlap in diagnostic criteria and shared psychopathologic symptoms in attention deficit hyperactivity disorder (ADHD) and borderline personality disorder (BPD) have stimulated research activities in this field. Longitudinal studies have shown that BPD is frequently diagnosed in adult patients who had been diagnosed with ADHD in childhood. The question of whether ADHD and BPD randomly co-occur as comorbidities, have similar origins or share common pathological mechanisms remains unresolved. Some authors suggest that ADHD contributes to the development of BPD via various mechanisms, and therefore consider it a risk factor for later BPD development. In this article the evidence for the co-occurrence of these disorders will be reviewed as well as studies on their common genetic and environmental influences. Temperamental and developmental issues will be reviewed, and shared features such as impulsivity and emotion dysregulation discussed. From a therapeutic perspective, few studies have investigated psychotherapeutic treatment of the comorbid condition, though the issue is highly important to the management of patients suffering from both disorders. Some thought is given to how therapeutic methods and approaches can be modified to benefit patients, and to their possible succession.
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Affiliation(s)
- Swantje D Matthies
- Department of Psychiatry & Psychotherapy, Clinic of Mental illnesses, University Medical Centre, Hauptstr. 5, D-79104 Freiburg, Germany
| | - Alexandra Philipsen
- Department of Psychiatry & Psychotherapy, Clinic of Mental illnesses, University Medical Centre, Hauptstr. 5, D-79104 Freiburg, Germany
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Spodenkiewicz M, Speranza M, Taïeb O, Pham-Scottez A, Corcos M, Révah-Levy A. Living from day to day - qualitative study on borderline personality disorder in adolescence. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2013; 22:282-289. [PMID: 24223047 PMCID: PMC3825468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Accepted: 02/18/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE The purpose of this study was to assess how far identity and self-image disturbances are features of borderline personality disorder (BPD) in adolescence. METHOD Face-to-face interviews were carried out with a total of 50 adolescents with BPD and 50 controls, with a median age of 16 (SD 1.1; range 13 to 18) years. Data was analysed using a qualitative methodology, interpretative phenomenological analysis (IPA). Thematic statements representative of adolescents' lived experience were extracted from the interviews. RESULTS Four main themes representing the day-to-day experiences of adolescents with BPD were identified: emotional experiences characterised by the feelings of fear, sadness and pessimism; interpersonal relationships characterised by the feelings of solitude and hostility from others; a conformist self-image characterised by a feeling of normality and difficulty in projecting into time; and, a structuring of discourse characterised by discontinuity in the perception of experiences. CONCLUSION This qualitative study suggests that the day-to-day experiences of adolescents with borderline personality disorder is centred on the experience of the present. Discontinuity in self-image, alongside marked dysphoric manifestations, leads to distress and hinders compliance with care. These issues are highly relevant in psychotherapy and could lead to more effective treatment of the disorder in adolescents.
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Affiliation(s)
- Michel Spodenkiewicz
- Inserm U669, Maison de Solenn, Université Paris-Sud and Université Paris Descartes, Paris, France
- Institut mutualiste Montsouris, Département de psychiatrie de l’adolescent et du jeune adulte, Paris, France
- Université Pierre et Marie Curie, Groupe hospitalier Pitié-Salpêtrière, Service de psychiatrie de l’enfant et de l’adolescent, Paris, France
| | - Mario Speranza
- Inserm U669, Maison de Solenn, Université Paris-Sud and Université Paris Descartes, Paris, France
- Université de Versailles Saint-Quentin & Centre hospitalier de Versailles, Service de pédopsychiatrie, Le Chesnay, France
| | - Olivier Taïeb
- Inserm U669, Maison de Solenn, Université Paris-Sud and Université Paris Descartes, Paris, France
- Hôpital Avicenne, Département de psychiatrie de l’enfant et de l’adolescent, Université Paris, Bobigny, France
| | - Alexandra Pham-Scottez
- Inserm U669, Maison de Solenn, Université Paris-Sud and Université Paris Descartes, Paris, France
- Hôpital Sainte-Anne, Clinique des maladies mentales et de l’encéphale, Paris, France
| | - Maurice Corcos
- Inserm U669, Maison de Solenn, Université Paris-Sud and Université Paris Descartes, Paris, France
- Institut mutualiste Montsouris, Département de psychiatrie de l’adolescent et du jeune adulte, Paris, France
| | - Anne Révah-Levy
- Inserm U669, Maison de Solenn, Université Paris-Sud and Université Paris Descartes, Paris, France
- Hôpital Victor Dupouy, Centre de soins psychothérapeutiques de transition pour adolescents, Argenteuil, France
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Abstract
The diagnosis of borderline personality disorder (BPD) in adolescents has been controversial. Thus, few studies have examined BPD in suicidal adolescents, even though it is strongly associated with suicidal behaviours in adults. This study examines differences between suicidal adolescents with (n = 47) and without (n = 72) BPD on history and characteristics of suicidal behaviour, Axis I co-morbidity, affect regulation and aggression. Assessments were completed with both adolescents and parents, and consensus ratings based on best available data were analysed. BPD participants were more likely to have a history of suicide attempts and to have been admitted because of a suicide attempt (vs. suicidal ideation). There were no significant differences in self-injurious behaviours or degree of suicidal ideation. BPD participants also had more psychiatric co-morbidity and higher aggression scores but no significant differences in affective dysregulation compared with suicidal adolescents without BPD. Diagnostic stability over 6 months was modest. Our results demonstrate that, compared with other acutely suicidal adolescents, the clinical profile of BPD participants is unique and suggests an increased risk for suicidal behaviours. This extends upon other studies that support the construct validity of BPD during adolescence and suggests that BPD should be considered in suicide risk assessment for adolescents.
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Affiliation(s)
- Shirley Yen
- Brown University, Department of Psychiatry and Human Behavior, Providence, RI, USA
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Sebastian A, Jacob G, Lieb K, Tüscher O. Impulsivity in borderline personality disorder: a matter of disturbed impulse control or a facet of emotional dysregulation? Curr Psychiatry Rep 2013; 15:339. [PMID: 23424747 DOI: 10.1007/s11920-012-0339-y] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Impulsivity is regarded as a clinical, diagnostic and pathophysiological hallmark of borderline personality disorder (BPD). Self-report measures of impulsivity consistently support the notion of higher impulsive traits in BPD patients as compared to healthy control subjects. Laboratory tests of impulsivity, i.e. neuropsychological tests of impulse control render weak and inconsistent results both across different cognitive components of impulse control and within the same cognitive component of impulse control. One important factor worsening impulsive behaviors and impulse control deficits in BPD is comorbid attention-deficit/hyperactivity disorder (ADHD). In addition, emotional dysregulation interacts with impulse control especially for BPD salient emotions. In sum, although basic mechanisms of impulse control seem not to be disturbed in BPD, clinically well observed impulsive behaviors may be explained by comorbid ADHD or may be the consequence of dysregulation of BPD salient emotions.
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Affiliation(s)
- Alexandra Sebastian
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Untere Zahlbacher Strasse 8, 55131 Mainz, Germany
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47
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Abstract
PURPOSE OF REVIEW This review summarizes recent neurocognitive research to better delineate the nosology, prognostication and cause underlying borderline personality disorder (BPD). RECENT FINDINGS BPD had marked clinical heterogeneity with high comorbidity. Executive dysfunction in this disorder was linked to suicidality and treatment adherence, and may serve as an endophenotype. BPD was also characterized by cognitive distortions such as risky decision-making, deficient feedback processing, dichotomous thinking, jumping to conclusion, monocausal attribution and paranoid cognitive style. Social cognition deficits recently described in BPD include altered social inference and emotional empathy, hypermentalization, poorer facial emotional recognition and facial expressions. In electrophysiological studies, BPD was found to have predominantly right hemispheric deficit in high-order cortical inhibition. Reduced left orbitofrontal activity by visual evoked potential and magnetoencephalography correlated with depressive symptoms and functional deterioration. Brain structures implicated in BPD include the hippocampus, dorsolateral prefrontal cortex and anterior cingulate cortex. Abnormal anatomy and functioning of frontolimbic circuitry appear to correlate with cognitive deficits. SUMMARY Frontolimbic structural and functional abnormalities underlie the broad array of cognitive abnormalities in BPD. Further research should espouse broader considerations of effects of comorbidity and clinical heterogeneity, and include community samples and, possibly, longitudinal designs.
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