1
|
Guan M, Liu J, Li X, Cai M, Bi J, Zhou P, Wang Z, Wu S, Guo L, Wang H. The impact of depressive and anxious symptoms on non-suicidal self-injury behavior in adolescents: a network analysis. BMC Psychiatry 2024; 24:229. [PMID: 38532354 DOI: 10.1186/s12888-024-05599-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/08/2024] [Indexed: 03/28/2024] Open
Abstract
PURPOSE Conceptualizing adolescent NSSI and emotional symptoms as a system of causal elements could provide valuable insights into the development of non-suicidal self-injury (NSSI) in adolescent. This study aimed to explore the intricate relationship between NSSI, depressive symptoms, and anxious symptoms in adolescents, identifying key symptoms to establish a theoretical foundation for targeted and effective interventions addressing NSSI behaviors in this population. METHODS A total of 412 adolescents with NSSI behaviors were selected from outpatients. Generalized anxious disorder scale (GAD-7) and patient health questionnaire (PHQ-9) were employed to measure anxious symptoms and depressive symptoms, respectively. The adolescent non-suicidal self-injury assessment questionnaire (ANSSIAQ) was used to evaluate NSSI of adolescent. Using network analysis, the NSSI、depressive symptoms and anxious symptoms network were constructed to identify the most central symptoms and the bridge symptoms within the networks. RESULTS The findings revealed that the NSSI functional nodes "coping with sadness and disappointment" and "relieving stress or anxious" exhibited the strongest correlation, with a regularized partial correlation coefficient was 0.401. The symptoms "having a desire to harm oneself and unable to stop" and the node "depressive symptoms" had the highest strength centrality in the network, and their strength centrality indices were 1.267 and 1.263, respectively. The bridge nodes were "having a desire to harm oneself and unable to stop" and "expressing one's despair and hopelessness", with expected impact indices of 0.389 and 0.396, respectively. CONCLUSION In adolescents, the network revealed a closer connection between NSSI and depressive symptoms. "The desire to not stop hurting oneself" is not only broadly connected to other nodes but also could activate other nodes to maintain NSSI behavior. In light of these findings, precise targets for pharmacological treatment, psychotherapy, physical therapy, etc., are identified for adolescents with NSSI. Targeting this specific aspect in interventions may contribute to preventing and reducing NSSI behavior in adolescents.
Collapse
Affiliation(s)
- Muzhen Guan
- Department of Mental Health, Xi'an Medical College, 710021, Xi'an, China
- Department of psychiatry, the first affiliated hospital, Air Force Medical University, 710032, Xi'an, China
| | - Junchang Liu
- Department of psychiatry, the first affiliated hospital, Air Force Medical University, 710032, Xi'an, China
| | - Xinhong Li
- Department of General Practice, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Min Cai
- Department of psychiatry, the first affiliated hospital, Air Force Medical University, 710032, Xi'an, China
| | - Jing Bi
- Department of science, Xi'an Guanmiao primary school, 710086, Xi'an, China
| | - Ping Zhou
- Department of psychiatry, the first affiliated hospital, Air Force Medical University, 710032, Xi'an, China
| | - Zhongheng Wang
- Department of psychiatry, the first affiliated hospital, Air Force Medical University, 710032, Xi'an, China
| | - Songwen Wu
- Department of Mental Health, Xi'an Medical College, 710021, Xi'an, China.
| | - Li Guo
- Department of psychiatry, the first affiliated hospital, Air Force Medical University, 710032, Xi'an, China.
| | - Huaning Wang
- Department of psychiatry, the first affiliated hospital, Air Force Medical University, 710032, Xi'an, China.
| |
Collapse
|
2
|
Kot E, Kostecka B, Radoszewska J, Kucharska K. Self-disgust in patients with borderline personality disorder. The associations with alexithymia, emotion dysregulation, and comorbid psychopathology. Borderline Personal Disord Emot Dysregul 2023; 10:24. [PMID: 37641140 PMCID: PMC10463936 DOI: 10.1186/s40479-023-00232-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/05/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Self-disgust is a negative self-conscious emotion, which has been linked with borderline personality disorder (BPD). However, it has not yet been investigated in relation to both emotion dysregulation and alexithymia, which are recognized as crucial to BPD. Therefore, the aim of our study was to measure these variables and examine the possible mediational role of emotional alterations and comorbid anxiety and depression symptoms in shaping self-disgust in patients with BPD and healthy controls (HCs). METHODS In total, the study included 100 inpatients with BPD and 104 HCs. Participants completed: the Self-Disgust Scale (SDS), Disgust Scale - Revised (DS-R), Toronto Alexithymia Scale (TAS-20), Emotion Dysregulation Scale short version (EDS-short), Borderline Personality Disorder Checklist (BPD Checklist), State-Trait Anxiety Inventory (STAI), and Center for Epidemiologic Studies Depression Scale (CESD-R). RESULTS Inpatients with BPD showed higher self-disgust, alexithymia, emotion dysregulation, core and comorbid symptoms levels, and lower disgust sensitivity. Alexithymia, emotion dysregulation, and trait anxiety partially mediated between BPD diagnosis and self-disgust. The relationship between the severity of BPD symptoms and self-disgust was fully mediated by alexithymia, emotion dysregulation, depressive symptoms, and trait anxiety. CONCLUSIONS The results of our study may imply the contribution of emotion dysregulation, alexithymia, and comorbid psychopathology to self-referenced disgust in BPD.
Collapse
Affiliation(s)
- Emilia Kot
- Department of Neuroses, Personality Disorders, and Eating Disorders, Institute of Psychiatry and Neurology, 9 Sobieskiego Street, Warsaw, 02-957, Poland.
| | - Barbara Kostecka
- II Department of Psychiatry, Medical University of Warsaw, 8 Kondratowicza Street, Warsaw, 03-242, Poland
| | - Joanna Radoszewska
- Faculty of Psychology, University of Warsaw, 5/7 Stawki Street, Warsaw, 00-183, Poland
| | - Katarzyna Kucharska
- Institute of Psychology, Cardinal Stefan Wyszyński University in Warsaw, 1/3 Wóycickiego Street, Warsaw, 01-938, Poland
| |
Collapse
|
3
|
Biermann M, Schulze A, Unterseher F, Hamm M, Atanasova K, Stahlberg D, Lis S. Trustworthiness judgments and Borderline Personality Disorder: an experimental study on the interplay of happiness and trustworthiness appraisals and the effects of wearing face masks during the Covid-19 pandemic in Germany. Borderline Personal Disord Emot Dysregul 2022; 9:27. [PMID: 36324166 PMCID: PMC9629878 DOI: 10.1186/s40479-022-00193-x] [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] [Received: 03/12/2022] [Accepted: 07/13/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Judging positive emotional states or the trustworthiness of others is important for forming and maintaining social affiliations. Past studies have described alterations in these appraisal processes in Borderline Personality Disorder (BPD), which might have been exacerbated during the Covid-19 pandemic by the requirement to wear face masks. In the present study, we investigated in an online-survey a) whether social judgments are particularly strongly affected in individuals with BPD when they have to judge happiness and trustworthiness in facial stimuli covered by a mask, b) whether appraising a positive emotional state affects trustworthiness appraisals differentially in BPD and healthy individuals and c) whether social judgments are related to how individuals with BPD experience wearing masks during the pandemic. METHODS Participants (67 HC, 75 BPD) judged happiness and trustworthiness of faces with calm expression with and without masks. Additionally, data on participants' confidence in their judgments, the experience of the burden induced by wearing masks, the protective benefits of masks, and compliance to wearing masks were collected. RESULTS Happiness and trustworthiness were evaluated less confidently and less intense in the BPD group compared to HC. Masks reduced happiness and trustworthiness ratings in both groups. Lower happiness appraisals contributed to lower trustworthiness appraisals except for those with BPD and low levels of symptom severity. Lower trustworthiness ratings were associated with a higher burden, attributing a lower benefit to masks and lower compliance with wearing masks in BPD. CONCLUSIONS Masks do not exacerbate deficits in social judgments. However, lower trustworthiness appraisals in general were linked with more negative evaluations of wearing masks in the BPD group. TRIAL REGISTRATION The aims and hypotheses were preregistered together with the design and planned analyses ( https://aspredicted.org/f5du7.pdf ). For findings of an additionally preregistered research question on the impact of adverse childhood experiences see supplementary material.
Collapse
Affiliation(s)
- Miriam Biermann
- Department of Psychiatric and Psychosomatic Medicine, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany. .,Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany.
| | - Anna Schulze
- Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany
| | - Franziska Unterseher
- Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany
| | - Marie Hamm
- Department of Psychiatric and Psychosomatic Medicine, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany.,Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany
| | - Konstantina Atanasova
- Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany
| | - Dagmar Stahlberg
- School of Social Sciences, University of Mannheim, A5, 6, 68159, Mannheim, Germany
| | - Stefanie Lis
- Department of Psychiatric and Psychosomatic Medicine, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany.,Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany
| |
Collapse
|
4
|
Tate AE, Sahlin H, Liu S, Lu Y, Lundström S, Larsson H, Lichtenstein P, Kuja-Halkola R. Borderline personality disorder: associations with psychiatric disorders, somatic illnesses, trauma, and adverse behaviors. Mol Psychiatry 2022; 27:2514-2521. [PMID: 35304564 PMCID: PMC9135625 DOI: 10.1038/s41380-022-01503-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 02/01/2022] [Accepted: 02/22/2022] [Indexed: 11/09/2022]
Abstract
In one of the largest, most comprehensive studies on borderline personality disorder (BPD) to date, this article places into context associations between this diagnosis and (1) 16 different psychiatric disorders, (2) eight somatic illnesses, and (3) six trauma and adverse behaviors, e.g., violent crime victimization and self-harm. Second, it examines the sex differences in individuals with BPD and their siblings. A total of 1,969,839 Swedish individuals were identified from national registers. Cumulative incidence with 95% confidence intervals (CI) was evaluated after 5 years of follow-up from BPD diagnosis and compared with a matched cohort. Associations were estimated as hazard ratios (HR) with 95% CIs from Cox regression. 12,175 individuals were diagnosed with BPD (85.3% female). Individuals diagnosed with BPD had higher cumulative incidences and HRs for nearly all analyzed indicators, especially psychiatric disorders. Anxiety disorders were most common (cumulative incidence 95% CI 33.13% [31.48-34.73]). Other notable findings from Cox regressions include psychotic disorders (HR 95% CI 24.48 [23.14-25.90]), epilepsy (3.38 [3.08-3.70]), violent crime victimization (7.65 [7.25-8.06]), and self-harm (17.72 [17.27-18.19]). HRs in males and females with BPD had overlapping CIs for nearly all indicators. This indicates that a BPD diagnosis is a marker of vulnerability for negative events and poor physical and mental health similarly for both males and females. Having a sibling with BPD was associated with an increased risk for psychiatric disorders, trauma, and adverse behaviors but not somatic disorders. Clinical implications include the need for increased support for patients with BPD navigating the health care system.
Collapse
Affiliation(s)
- Ashley E. Tate
- grid.465198.7Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Hanna Sahlin
- grid.4714.60000 0004 1937 0626Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Shengxin Liu
- grid.465198.7Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Yi Lu
- grid.465198.7Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Sebastian Lundström
- grid.8761.80000 0000 9919 9582Centre for Ethics, Law and Mental Health (CELAM), University of Gothenburg, Gothenburg, Sweden ,grid.8761.80000 0000 9919 9582Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden
| | - Henrik Larsson
- grid.465198.7Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden ,grid.15895.300000 0001 0738 8966School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Paul Lichtenstein
- grid.465198.7Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Ralf Kuja-Halkola
- grid.465198.7Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| |
Collapse
|
5
|
Prevolnik Rupel V, Jagger B, Fialho LS, Chadderton LM, Gintner T, Arntz A, Baltzersen ÅL, Blazdell J, van Busschbach J, Cencelli M, Chanen A, Delvaux C, van Gorp F, Langford L, McKenna B, Moran P, Pacheco K, Sharp C, Wang W, Wright K, Crawford MJ. Standard set of patient-reported outcomes for personality disorder. Qual Life Res 2021; 30:3485-3500. [PMID: 34075531 PMCID: PMC8602216 DOI: 10.1007/s11136-021-02870-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE The purpose of the article is to present standard set of outcomes for people with personality disorder (PD), in order to facilitate patient outcome measurement worldwide. METHODS The International Consortium for Health Outcomes Measurement (ICHOM) gathered a multidisciplinary international working group, consisting of 16 experts, including clinicians, nurses, psychologists, methodologists and patient representatives, to develop a standard set of outcome measures for people with PD. The Delphi method was used to reach consensus on the scope of the set, outcome domains, outcome measures, case-mix variables and time points for measuring outcomes in service users. For each phase, a project team prepared materials based on systematic literature reviews and consultations with experts. RESULTS The working group decided to include PD, as defined by International Classification of Diseases 11th revision (ICD-11). Eleven core outcomes and three optional outcomes across four health domains (mental health, behaviour, functioning and recovery) were defined as those relevant for people with PD. Validated measures for the selected outcomes were selected, some covering more than one outcome. Case-mix variables were aligned to other ICHOM mental health standard sets and consisted of demographic factors and those related to the treatment that people received. The group recommended that most outcomes are measured at baseline and annually. CONCLUSION The international minimum standard set of outcomes has the potential to improve clinical decision making through systematic measurement and comparability. This will be key in improving the standard of health care for people with PD across the world.
Collapse
Affiliation(s)
| | - Beth Jagger
- International Consortium for Health Outcomes Measurement, Cambridge, USA
| | - Luz Sousa Fialho
- International Consortium for Health Outcomes Measurement, Cambridge, USA
| | | | - Timea Gintner
- International Consortium for Health Outcomes Measurement, Cambridge, USA
| | - Anroud Arntz
- University of Amsterdam, Amsterdam, The Netherlands
| | - Åse-Line Baltzersen
- Patient Representative, The Norwegian National Advisory Unit On Personality Psychiatry, Oslo, Norway
| | - Julia Blazdell
- The Institute of Mental Health, WLMHT Managed Clinical Network, Southall, UK
| | | | | | - Andrew Chanen
- The University of Melbourne, Melbourne, Australia.,Orygen, Melbourne, Australia
| | | | | | | | - Brian McKenna
- Auckland University of Technology, Auckland, New Zealand.,Swinburne University of Technology, Melbourne, Australia
| | | | | | | | - Wei Wang
- Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | | | | |
Collapse
|
6
|
Mohi S, Deane FP, Mooney-Reh D, Bailey A, Ciaglia D. Experiential avoidance and depression predict values engagement among people in treatment for borderline personality disorder. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2021. [DOI: 10.1016/j.jcbs.2021.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
7
|
Klein P, Fairweather AK, Lawn S, Stallman HM, Cammell P. Structural stigma and its impact on healthcare for consumers with borderline personality disorder: protocol for a scoping review. Syst Rev 2021; 10:23. [PMID: 33423674 PMCID: PMC7798332 DOI: 10.1186/s13643-021-01580-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 01/02/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Structural stigma in health systems experienced by consumers diagnosed with Borderline Personality Disorder (BPD) is a widespread phenomenon that causes major health inequities and harm for this population. Structural stigma in this context relates to institutional policies, cultural norms, and organizational practices that limit consumers' access to health services, quality of care, and capacity to achieve optimal health and well-being. BPD is a serious mental illness with high morbidity and mortality, characterized by instability in interpersonal relationships, self-image, and emotional and behavioral deregulation, which stem from significant traumatic childhood/life events, and/or biological etiologies. The objectives of this scoping review are to explore the international literature on structural stigma in healthcare systems specific to BPD, and to provide an overview of the impact of structural stigma on health services for BPD consumers and their carers/families. METHODS This scoping review will follow the Joanna Briggs Institute (JBI) scoping review guidelines. We will search the following electronic databases (from inception onwards): MEDLINE, CINAHL, PsycINFO, Scopus, Cochrane Library, and JBI-Evidence databases. Grey literature will be identified through the Google search engine. We will include all types of literature in English, published and unpublished, including any study design, reviews, clinical practice guidelines, policy reports, and other documents. No restrictions on publication date of sources of evidence will be applied. International literature should examine structural stigma associated with BPD in any healthcare setting such as, outpatients, inpatients, primary health care, or community-based facilities. Two reviewers will independently screen all titles, abstracts, and full-text citations. Quality appraisal of the included sources of evidence will be assessed using the Mixed Methods Appraisal Tool (MMAT) 2018 version. Data analysis will involve quantitative (e.g., frequencies) and qualitative (e.g., thematic analysis) methods. DISCUSSION This review is anticipated to enhance both identification and understanding of those structures in health systems (i.e., institutional policies, cultural norms, and practices) that manifest and perpetuate stigma experienced by consumers with BPD and their carers/families. The findings can be used to inform future research, policy, and practice relating to stigma reduction strategies that can be adopted to improve the provision of BPD-responsive services and care for this population. SYSTEMATIC REVIEW REGISTRATION Open Science Framework ( https://osf.io/bhpg4 ).
Collapse
Affiliation(s)
- Pauline Klein
- Discipline of Behavioural Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia 5001 Australia
| | - Alicia Kate Fairweather
- Discipline of Behavioural Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia 5001 Australia
| | - Sharon Lawn
- Discipline of Behavioural Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia 5001 Australia
| | - Helen Margaret Stallman
- Thompson Insititute, University of the Sunshine Coast, 12 Innovation Pkwy, Birtinya, Queensland 4575 Australia
| | - Paul Cammell
- The Royal Melbourne Hospital, Parkville, Victoria 3050 Australia
| |
Collapse
|
8
|
Conceptualization, measurement, and effects of pregnancy-specific stress: review of research using the original and revised Prenatal Distress Questionnaire. J Behav Med 2019; 43:16-33. [PMID: 31183596 DOI: 10.1007/s10865-019-00068-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 06/04/2019] [Indexed: 12/26/2022]
Abstract
Pregnancy-specific stress (PSS) arises from the numerous changes that women experience during pregnancy and from their concerns about childbirth and the health of their offspring. Prolonged or elevated maternal stress heightens risk for poor fetal, infant, and child outcomes. The Prenatal Distress Questionnaire (PDQ) and its expanded successor, the revised Prenatal Distress Questionnaire (NuPDQ), were developed to assess PSS, but their psychometric properties and findings are not well-documented. We reviewed research using the PDQ (n = 45) or NuPDQ (n = 37). Results establish that PSS as measured by these instruments is common in pregnancy; PSS is associated with sociodemographic and obstetric characteristics, perceptions of pregnancy, health behaviors, maternal health, and birth outcomes. The NuPDQ is an especially appropriate tool to assess PSS, with demonstrated reliability and convergent, concurrent, and predictive validity. The ability to assess PSS in a reliable and valid manner is critical to advance research and improve maternal and child health.
Collapse
|
9
|
Flasbeck V, Enzi B, Brüne M. Childhood trauma affects processing of social interactions in borderline personality disorder: An event-related potential study investigating empathy for pain. World J Biol Psychiatry 2019; 20:278-288. [PMID: 28532273 DOI: 10.1080/15622975.2017.1333147] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objectives: Patients with borderline personality disorder (BPD) have difficulties in empathising with others and show disturbances in social interactions. Using a 'Social Interaction Empathy Task', we found that BPD patients judged neutral and psychologically painful conditions as more painful than healthy subjects. Here, we present the neural correlates underlying these differences in empathy for pain. Methods: Female BPD patients and healthy controls completed the 'Social Interaction Empathy Task' during EEG recording. Event-related potentials (ERP) were analysed for an early anterior component and a late latency positivity. Empathic abilities were assessed using the Interpersonal Reactivity Index and early aversive experiences were measured by the Childhood Trauma Questionnaire (CTQ). Results: ERPs in the patient group matched the behaviour results and correlated with the level of personal distress and CTQ. In addition, ERPs of patients were predicted by childhood maltreatment and stress. Conclusions: Taken together, our findings indicate that the observed behavioural differences between patients with BPD and controls might be due to modulatory effects of empathic abilities on the evaluation of pain-related social stimuli, which are supposed to be based on childhood maltreatment.
Collapse
Affiliation(s)
- Vera Flasbeck
- a Department of Psychiatry, Psychotherapy and Preventive Medicine, Division of Cognitive Neuropsychiatry and Psychiatric Preventive Medicine, LWL University Hospital , Ruhr-University , Bochum , Germany
| | - Björn Enzi
- a Department of Psychiatry, Psychotherapy and Preventive Medicine, Division of Cognitive Neuropsychiatry and Psychiatric Preventive Medicine, LWL University Hospital , Ruhr-University , Bochum , Germany
| | - Martin Brüne
- a Department of Psychiatry, Psychotherapy and Preventive Medicine, Division of Cognitive Neuropsychiatry and Psychiatric Preventive Medicine, LWL University Hospital , Ruhr-University , Bochum , Germany
| |
Collapse
|
10
|
Kleindienst N, Hauschild S, Liebke L, Thome J, Bertsch K, Hensel S, Lis S. A negative bias in decoding positive social cues characterizes emotion processing in patients with symptom-remitted Borderline Personality Disorder. Borderline Personal Disord Emot Dysregul 2019; 6:17. [PMID: 31788316 PMCID: PMC6858731 DOI: 10.1186/s40479-019-0114-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 10/23/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Impairments in the domain of interpersonal functioning such as the feeling of loneliness and fear of abandonment have been associated with a negative bias during processing of social cues in Borderline Personality Disorder (BPD). Since these symptoms show low rates of remission, high rates of recurrence and are relatively resistant to treatment, in the present study we investigated whether a negative bias during social cognitive processing exists in BPD even after symptomatic remission. We focused on facial emotion recognition since it is one of the basal social-cognitive processes required for successful social interactions and building relationships. METHODS Ninety-eight female participants (46 symptom-remitted BPD [r-BPD]), 52 healthy controls [HC]) rated the intensity of anger and happiness in ambiguous (anger/happiness blends) and unambiguous (emotion/neutral blends) emotional facial expressions. Additionally, participants assessed the confidence they experienced in their own judgments. RESULTS R-BPD participants assessed ambiguous expressions as less happy and as more angry when the faces displayed predominantly happiness. Confidence in these judgments did not differ between groups, but confidence in judging happiness in predominantly happy faces was lower in BPD patients with a higher level of BPD psychopathology. CONCLUSIONS Evaluating social cues that signal the willingness to affiliate is characterized by a negative bias that seems to be a trait-like feature of social cognition in BPD. In contrast, confidence in judging positive social signals seems to be a state-like feature of emotion recognition in BPD that improves with attenuation in the level of acute BPD symptoms.
Collapse
Affiliation(s)
- Nikolaus Kleindienst
- 1Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, PO Box 12 21 20, 68072 Mannheim, Germany
| | - Sophie Hauschild
- 1Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, PO Box 12 21 20, 68072 Mannheim, Germany.,2Institute for Psychosocial Prevention, University Heidelberg, Heidelberg, Germany
| | - Lisa Liebke
- 1Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, PO Box 12 21 20, 68072 Mannheim, Germany
| | - Janine Thome
- 1Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, PO Box 12 21 20, 68072 Mannheim, Germany.,3Department of Psychiatry, Western University, London, Canada.,4Department of Theoretical Neuroscience, Central Institute of Mental Health, Medical Faculty, Heidelberg University, Mannheim, Germany
| | - Katja Bertsch
- 5Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.,6Department of Psychology, LMU Munich, Munich, Germany
| | - Saskia Hensel
- 1Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, PO Box 12 21 20, 68072 Mannheim, Germany
| | - Stefanie Lis
- 1Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, PO Box 12 21 20, 68072 Mannheim, Germany
| |
Collapse
|
11
|
Mancke F, Herpertz SC, Hirjak D, Knies R, Bertsch K. Amygdala structure and aggressiveness in borderline personality disorder. Eur Arch Psychiatry Clin Neurosci 2018; 268:417-427. [PMID: 27878376 DOI: 10.1007/s00406-016-0747-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 11/06/2016] [Indexed: 12/29/2022]
Abstract
Aggressiveness is considered an important clinical feature of borderline personality disorder (BPD) and has been associated with alterations of the amygdala. However, studies that analyzed the exact location of amygdala alterations associated with aggressiveness in BPD or that systematically compared female and male BPD patients are missing. In the current study, we therefore investigated a sex-mixed sample of BPD patients and healthy volunteers and applied an automated segmentation method that allows the study of both, alterations of amygdala volume and localized amygdala shape. Volumetric results revealed no difference in amygdala volume between BPD patients and healthy volunteers, but a trend for a positive association between volume of the right amygdala and aggressiveness in male BPD patients. Analyses of amygdala shape showed a trend for a group by sex interaction effect in the left laterobasal amygdala, without a difference in subgroup analyses. Finally, regions of the left superficial and laterobasal amygdala of male BPD patients were positively associated with aggressiveness. In sum, our results emphasize the need to consider sex-specific effects and demonstrate a link between male BPD patients' aggressiveness and amygdala regions that are particularly related to social information processing and associative emotional learning.
Collapse
Affiliation(s)
- Falk Mancke
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Voßstraße 2, 69115, Heidelberg, Germany.
| | - Sabine C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Voßstraße 2, 69115, Heidelberg, Germany
| | - Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Rebekka Knies
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Katja Bertsch
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Voßstraße 2, 69115, Heidelberg, Germany
| |
Collapse
|
12
|
Capone G, Schroder T, Clarke S, Braham L. Outcomes of therapeutic community treatment for personality disorder. THERAPEUTIC COMMUNITIES 2016. [DOI: 10.1108/tc-12-2015-0025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Purpose
– The purpose of this paper is to review quantitative research since 1999 evaluating the effectiveness of democratic therapeutic community (DTC) treatment for individuals with personality disorders (PD) with reference to interpersonal and offending risk outcomes.
Design/methodology/approach
– A systematic search resulted in the review of ten studies. All of the studies investigated DTCs treating PD in community, inpatient residential and forensic settings. Only peer-reviewed, English-language articles employing a quantitative design were included.
Findings
– The majority of studies were conducted poorly and of low methodological quality, with limitations located in the representativeness of participants, limited use of control and comparison groups, follow up periods and controls for confounders. Heterogeneity remained in use of measures and limited consideration was given to the validity of interpersonal measures used. While improved interpersonal outcomes post DTC treatment were noted in forensic and residential settings, results were mixed in day and mini TC settings. Inconsistent findings in offending risk outcomes were also indicated. A study with increased methodological rigour indicated residential treatment had limited effects on interpersonal outcomes, when compared to combination treatment (residential TC and step-down treatment).
Originality/value
– The study provided an evaluation of the limitations of DTC research across a range of settings and highlighted a combination of residential TC and step-down treatment may achieve superior outcomes to residential TC treatment alone in a community inpatient population. Recommendations are made for future research to contribute to the treatment of PD.
Collapse
|
13
|
Madan A, Oldham JM, Gonzalez S, Fowler JC. Reducing Adverse Polypharmacy in Patients With Borderline Personality Disorder: An Empirical Case Study. Prim Care Companion CNS Disord 2015; 17:14m01760. [PMID: 26693036 PMCID: PMC4664564 DOI: 10.4088/pcc.14m01760] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 03/10/2015] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE Polypharmacy is common and especially challenging in the context of borderline personality disorder in light of impulsivity and self-harm associated with the disorder, risk of adverse drug-drug interactions, and financial burden. Reduction in polypharmacy could be conceptualized as a high priority in the treatment of borderline personality disorder. This case aims to demonstrate that potential. METHOD This case report presents outcomes data for an individual with borderline personality disorder during the course of an extended psychiatric hospitalization. Symptomatic change is based on the Patient Health Questionnaire Somatic, Anxiety, and Depression Symptoms scales and World Health Organization 5-Item Well-Being Index. Change in polypharmacy is presented both in terms of absolute number and complexity of the medication regimen. Clinical outcomes data are provided at 2, 12, and 24 weeks postdischarge. RESULTS During a 56-day hospitalization, the patient demonstrated clinical improvement across clinical domains-all occurred within the context of reduced number (43%) and complexity (40%) of her medication regimen. Symptomatic improvement was sustained up to 6 months postdischarge. CONCLUSIONS Despite good intentions, polypharmacy can be associated with iatrogenic harm and contribute to functional impairment, especially in the context of borderline personality disorder, in which symptomatic fluctuations are part of the illness itself. A reduction in the patient's high-risk polypharmacy during treatment represents a noteworthy treatment outcome in and of itself. Additional measures of medication risk and liability have the potential to become markers of clinical effectiveness.
Collapse
Affiliation(s)
- Alok Madan
- The Menninger Clinic and Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - John M Oldham
- The Menninger Clinic and Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Sylvia Gonzalez
- The Menninger Clinic and Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - J Christopher Fowler
- The Menninger Clinic and Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| |
Collapse
|