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de Andrade D, Davidson L, Robertson C, Williams P, Leung J, Walter Z, Allan J, Hides L. Randomized effectiveness-implementation trial of dialectical behavior therapy interventions for young people with borderline personality disorder symptoms. J Clin Psychol 2024. [PMID: 38874116 DOI: 10.1002/jclp.23725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 04/16/2024] [Accepted: 05/22/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVES Dialectical behavior therapy (DBT) is an evidence-based treatment for people with emerging borderline personality disorder (BPD). In "real world" clinical settings, standard DBT is resource intensive. Emerging evidence suggests that group-based DBT skills training alone can lead to promising outcomes. This hybrid type 1 effectiveness-implementation trial directly compared the effectiveness of an 8-week group DBT-skills training program and a 16-week DBT-informed program including individual treatment and group-based skills training. METHODS This pragmatic trial employed a staggered, parallel-groups design. We recruited 104 participants, aged 16-25 years, with emotion dysregulation or emerging BPD symptoms. Participants were randomized to receive either program at a youth mental health service located in the Gold Coast, Australia. Data was collected via online surveys at baseline, 8-week, 16-week, and 24-week follow-up. Mixed effect linear models compared groups on the primary outcomes of emotion dysregulation and BPD symptoms, and secondary outcomes of suicidal ideation, coping skills, depression, anxiety, and stress. RESULTS Across groups there were significant and sustained improvements relating to emotion dysregulation, BPD symptoms, stress, depression, and emotion-focused coping; but not suicide risk, anxiety, or task-focused coping. There was no significant time by group differences between the 8-week and 16-week interventions on any primary or secondary outcome. CONCLUSION The more intensive mode of delivering DBT was not more effective than the brief group-based skills training. Both interventions resulted in significant improvements across both primary and most secondary outcomes. These results have implications for clinical practice regarding length and intensity of DBT treatment in young people.
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Affiliation(s)
- Dominique de Andrade
- National Centre for Youth Substance Use Research, University of Queensland, Brisbane, Queensland, Australia
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Griffith Criminology Institute, Griffith University, Brisbane, Queensland, Australia
| | - Lily Davidson
- National Centre for Youth Substance Use Research, University of Queensland, Brisbane, Queensland, Australia
| | - Carlie Robertson
- Headspace Southport, Gold Coast, Queensland, Australia
- Lives Lived Well, Brisbane, Queensland, Australia
| | - Philip Williams
- Headspace Southport, Gold Coast, Queensland, Australia
- Lives Lived Well, Brisbane, Queensland, Australia
| | - Janni Leung
- National Centre for Youth Substance Use Research, University of Queensland, Brisbane, Queensland, Australia
| | - Zoe Walter
- National Centre for Youth Substance Use Research, University of Queensland, Brisbane, Queensland, Australia
| | | | - Leanne Hides
- National Centre for Youth Substance Use Research, University of Queensland, Brisbane, Queensland, Australia
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Thomson M, Cavelti M, Lerch S, Koenig J, Reichl C, Mürner-Lavanchy I, Wyssen A, Kaess M. Clinical profiles of adolescent personality pathology: a latent structure examination of the Semi-Structured Interview for Personality Functioning DSM-5 (STiP-5.1) in a help-seeking sample. Borderline Personal Disord Emot Dysregul 2024; 11:9. [PMID: 38589974 PMCID: PMC11003081 DOI: 10.1186/s40479-024-00252-5] [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: 11/10/2023] [Accepted: 03/25/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Despite the introduction of dimensional conceptualisations of personality functioning in the latest classification systems, such as Criterion A of the Alternative Model of Personality Disorders in the DSM-5, heterogeneous clinical presentation of personality pathology remains a challenge. Relatedly, the latent structure of personality pathology as assessed by the Semi-Structured Interview for Personality Functioning DSM-5 (STiP-5.1) has not yet been comprehensively examined in adolescents. Therefore, this study aimed to examine the latent structure of the STiP-5.1, and, based on those findings, to describe any unique clinical profiles that might emerge. METHODS The final sample comprised 502 participants aged 11-18 years consecutively recruited from a specialised personality disorder outpatient service, as well as general day clinic and inpatient wards at the University Hospital University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Bern, Switzerland. Participants were assessed using the STiP-5.1, as well as a battery of other psychological measures by clinical psychologists or trained doctoral students. Variations of Factor Analysis, Latent Class Analysis and Factor Mixture Models (FMM) were applied to the STiP-5.1 to determine the most appropriate structure. RESULTS The best fitting model was an FMM comprising four-classes and two factors (corresponding to self- and interpersonal-functioning). The classes differed in both overall severity of personality functioning impairment, and in their scores and clinical relevance on each element of the STiP-5.1. When compared to the overall sample, classes differed in their unique clinical presentation: class 1 had low impairment, class 2 had impairments primarily in self-functioning with high depressivity, class 3 had mixed levels of impairment with emerging problems in identity and empathy, and class 4 had severe overall personality functioning impairment. CONCLUSIONS A complex model incorporating both dimensional and categorical components most adequately describes the latent structure of the STiP-5.1 in our adolescent sample. We conclude that Criterion A provides clinically useful information beyond severity (as a dimensional continuum) alone, and that the hybrid model found for personality functioning in our sample warrants further attention. Findings can help to parse out clinical heterogeneity in personality pathology in adolescents, and help to inform early identification and intervention efforts.
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Affiliation(s)
- Madelyn Thomson
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Marialuisa Cavelti
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Stefan Lerch
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Julian Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Corinna Reichl
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Ines Mürner-Lavanchy
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Andrea Wyssen
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
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Li J, Gao Y, Liu J, Liu X, Wang H. Impacts of difficulties with emotion regulation on the longitudinal relationship between peer victimization and changes in adolescent nonsuicidal self-injury. J Adolesc 2024; 96:350-359. [PMID: 38017669 DOI: 10.1002/jad.12279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/30/2023] [Accepted: 11/19/2023] [Indexed: 11/30/2023]
Abstract
INTRODUCTION Research has found that peer victimization is associated with adolescent nonsuicidal self-injury (NSSI) behavior; however, most of these studies ignored the association between these constructs at the within-person level. Additionally, the association between peer victimization and NSSI may vary among adolescents with different personal characteristics. With a longitudinal design, this study investigated whether and how emotion regulation (ER) difficulties moderate the relationship between peer victimization and changes in NSSI, with particular attention given to the unique moderating role of different dimensions of ER difficulties. METHODS The study sample comprised 3,561 adolescents aged between 10 and 17 years old (Mage = 13.22, SD = 0.85; 56.9% males). Self-report assessments were administered in December 2021 and June 2022 in Shanxi province, China. RESULTS The latent change score model showed that the adolescent NSSI increased during our assessments, with peer victimization as a significant predictor. ER difficulties moderated the association between peer victimization and NSSI changes, but interestingly, in an unexpected pattern. Specifically, peer victimization significantly predicted NSSI changes among adolescents with low ER difficulties but not for those with high ER difficulties. Moreover, among the multiple dimensions of ER difficulties, only nonacceptance of emotional responses and limited access to emotion regulation strategies interacted with peer victimization to predict NSSI changes and showed interaction patterns similar to those at the overall level of ER difficulties. CONCLUSIONS The current study revealed the moderating role of ER difficulties in the relationship between peer victimization and changes in NSSI. These findings provide intervention implications for adolescents who engage in NSSI.
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Affiliation(s)
- Jinwen Li
- Institute of Developmental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Yemiao Gao
- Institute of Developmental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Jinmeng Liu
- Institute of Developmental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Xia Liu
- Institute of Developmental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Hui Wang
- Institute of Developmental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, China
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Altered cortical thickness and emotional dysregulation in adolescents with borderline personality disorder. Eur J Psychotraumatol 2023; 14:2163768. [PMID: 37052085 PMCID: PMC9848334 DOI: 10.1080/20008066.2022.2163768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background: Emotional dysregulation is a core feature of borderline personality disorder (BPD). Previous studies have reported that abnormal grey matter volume is associated with the limbic-cortical circuit and default mode network (DMN) in patients with BPD. However, alterations of cortical thickness in adolescents with BPD have not been well evaluated.Objective: The aim of this study was to assess cortical thickness and its association with emotional dysregulation in adolescents with BPD.Method: This prospective study enrolled 52 adolescents with BPD and 39 age- and sex-matched healthy controls (HCs). Assessments included brain magnetic resonance imaging (MRI) acquisition with structural and resting-state functional MRI data, and clinical assessment for emotional dysregulation using the Difficulties in Emotion Regulation Scale (DERS). Cortical thickness and seed-based functional connectivity were analysed with FreeSurfer 7.2 software. Correlation analysis between cortical thickness and the scores from emotional assessment was performed with Spearman analysis.Results: Compared to HCs, there was altered cortical thickness in the DMN and limbic-cortical circuit in adolescents with BPD (Monte Carlo correction, all p < .05). These regions with altered cortical thickness were significantly associated with emotional dysregulation (all p < .05). There were also alterations of functional connectivity, i.e. with increased connectivity of the right prefrontal cortex with bilateral occipital lobes, or with the limbic system, and with decreased connectivity among the DMN regions (voxel p < .001, cluster p < .05, family-wise error corrected).Conclusions: Our results suggest that the altered cortical thickness and altered functional connectivity in the limbic-cortical circuit and DMN may be involved in emotional dysregulation in adolescents with BPD.
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Reiter AMF, Hula A, Vanes L, Hauser TU, Kokorikou D, Goodyer IM, Fonagy P, Moutoussis M, Dolan RJ. Self-reported childhood family adversity is linked to an attenuated gain of trust during adolescence. Nat Commun 2023; 14:6920. [PMID: 37903767 PMCID: PMC10616102 DOI: 10.1038/s41467-023-41531-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 09/07/2023] [Indexed: 11/01/2023] Open
Abstract
A longstanding proposal in developmental research is that childhood family experiences provide a template that shapes a capacity for trust-based social relationships. We leveraged longitudinal data from a cohort of healthy adolescents (n = 570, aged 14-25), which included decision-making and psychometric data, to characterise normative developmental trajectories of trust behaviour and inter-individual differences therein. Extending on previous cross-sectional findings from the same cohort, we show that a task-based measure of trust increases longitudinally from adolescence into young adulthood. Computational modelling suggests this is due to a decrease in social risk aversion. Self-reported family adversity attenuates this developmental gain in trust behaviour, and within our computational model, this relates to a higher 'irritability' parameter in those reporting greater adversity. Unconditional trust at measurement time point T1 predicts the longitudinal trajectory of self-reported peer relation quality, particularly so for those with higher family adversity, consistent with trust acting as a resilience factor.
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Affiliation(s)
- Andrea M F Reiter
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, London, UK.
- Wellcome Centre for Human Neuroimaging, University College London, London, UK.
- Department of Child and Adolescence Psychiatry, Psychosomatics and Psychotherapy, Centre of Mental Health, University Hospital Würzburg, Würzburg, Germany.
- Department of Psychology, Julius-Maximilians-Universität Würzburg, Würzburg, Germany.
- CRC Cognitive Control, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany.
| | - Andreas Hula
- Austrian Institute of Technology, Vienna, Austria
| | - Lucy Vanes
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Tobias U Hauser
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, London, UK
- Wellcome Centre for Human Neuroimaging, University College London, London, UK
- Department of Psychiatry and Psychotherapy, Medical School and University Hospital, Eberhard Karls University of Tübingen, Tübingen, Germany
- German Center for Mental Health (DZPG), Tübingen, Germany
| | - Danae Kokorikou
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Ian M Goodyer
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Peter Fonagy
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Michael Moutoussis
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, London, UK
- Wellcome Centre for Human Neuroimaging, University College London, London, UK
| | - Raymond J Dolan
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, London, UK
- Wellcome Centre for Human Neuroimaging, University College London, London, UK
- State Key Laboratory of Cognitive Neuroscience and Learning, IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
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Kolla NJ, Tully J, Bertsch K. Neural correlates of aggression in personality disorders from the perspective of DSM-5 maladaptive traits: a systematic review. Transl Psychiatry 2023; 13:330. [PMID: 37884552 PMCID: PMC10603082 DOI: 10.1038/s41398-023-02612-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 09/17/2023] [Accepted: 09/21/2023] [Indexed: 10/28/2023] Open
Abstract
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published in 2013, includes an alternative model of personality disorders (AMPD) focusing on a maladaptive trait model utilized to diagnose several personality disorders. Borderline personality disorder (BPD) and antisocial personality disorder (ASPD) are two conditions categorized by AMPD that exhibit high rates of violence and aggression. Several of the traits outlined in the AMPD, including hostility, impulsivity, risk-taking, and callousness, have been previously linked to aggression in BPD and ASPD. However, to the best of our knowledge, there has never been a synthesis of neuroimaging studies that have investigated links between these traits and aggression in BPD and ASPD. To overcome this gap, we conducted a systematic review under the PRISMA framework to locate neuroimaging articles published since the release of AMPD linking trait anger/hostility, impulsivity, risk-taking, and callousness to aggression in BPD and ASPD. Key findings included the following: i) anger/hostility, associated with alterations in the interplay between prefrontal and subcortical regions (primarily the amygdala), may be a common factor explaining aggressive reactions to response to interpersonal threat or provocation; ii) alterations of fronto-temporal-limbic regions and serotonergic and endocannabinoid signaling systems may link impulsivity to aggression in BPD and ASPD; iii) weaker cortico-striatal connectivity could relate to greater risk taking and greater proclivity for violence. Insufficient evidence from neuroimaging articles was discerned to describe a relationship between callousness and aggression. Overall, results of this review reveal a relative paucity of neuroimaging studies examining AMPD traits relevant to aggression in BPD and ASPD. In addition to encouraging further investigation of neuroimaging markers of AMPD traits linked to aggression, we recommend multi-methodological designs, including the incorporation of other biomarkers, such as hormones and indices of physiological arousal, to fully expand our understanding of aggression in BPD and ASPD.
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Affiliation(s)
- Nathan J Kolla
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
- Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Department of Psychiatry, University of Saskatchewan, Saskatoon, SK, Canada.
| | - John Tully
- Academic Unit of Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Katja Bertsch
- Department of Psychology, Ludwig-Maximilians-University, Munich, Germany
- NeuroImagine Core Unit Munich (NICUM), University Hospital LMU, Munich, Germany
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
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Keller PS, Widiger TA, El-Sheikh M. Parental Problem Drinking and Maladaptive Personality Features in Children: The Role of Marital Conflict. Child Psychiatry Hum Dev 2023; 54:1336-1346. [PMID: 35278171 DOI: 10.1007/s10578-022-01340-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/21/2022] [Indexed: 11/03/2022]
Abstract
The personality characteristics of children of exposed to parental problem drinking have been of interest to clinicians and researchers for several decades, but personality research on this population often focuses on identifying a unique cluster of adult personality traits. The current study adopts a cutting-edge dimensional approach to understanding personality pathology as extreme variants of the five factor model, and examines pathways of risk to personality pathology through marital conflict and emotional insecurity. Participants were 199 two-parent families with a child between the ages of 6 and 12 years. Parents completed questionnaire measures of their problem drinking, marital conflict, child emotional insecurity (i.e., emotional reactivity to conflict), and child maladaptive personality traits. Structural equation models found an indirect pathway from mother and father problem drinking to pathological child disagreeableness, introversion, emotional instability, and compulsivity via greater mother destructive marital conflict behavior and child emotional reactivity to conflict. There was also some evidence that this pathway of effects was stronger for girls than for boys. Findings support the use of a dimensional approach to understanding maladaptive personality among individuals exposed to parental problem drinking.
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Affiliation(s)
- Peggy S Keller
- Department of Psychology, University of Kentucky, Lexington, KY, 40506, USA.
| | - Thomas A Widiger
- Department of Psychology, University of Kentucky, Lexington, KY, 40506, USA
| | - Mona El-Sheikh
- Department of Human Development and Family Studies, Auburn University, Auburn, AL, 36849, USA
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Sharp C, Venta A, McLaren V. Interpersonal Trust in Adolescents With Borderline Personality Disorder: Comparisons With Healthy and Psychiatric Controls. J Pers Disord 2023; 37:475-489. [PMID: 37903026 DOI: 10.1521/pedi.2023.37.5.475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
The aim of the current study was to utilize a well-known trust versus lottery paradigm to evaluate interpersonal trust in adolescents with borderline personality disorder (BPD). The study included 126 healthy controls, 59 inpatient adolescents with a diagnosis of BPD, and 137 inpatient adolescents without BPD. Alongside diagnostic measures, a questionnaire-based measure for assessing trust beliefs was administered to probe group differences in trust beliefs and associations between game behavior and trust beliefs. No main effect for group or condition was found. A significant interaction of trial and group was noted, suggesting that across games, psychiatric controls demonstrated the steepest increase in trust over time, followed by the BPD and healthy control groups. Healthy controls evidenced significantly higher levels of trust beliefs compared to BPD and psychiatric controls. Reasons for nonreplication of previously demonstrated anomalous game behavior in adults in this adolescent sample are discussed.
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Penner F, Steinberg L, Sharp C. The Development and Validation of the Difficulties in Emotion Regulation Scale-8: Providing Respondents with a Uniform Context That Elicits Thinking About Situations Requiring Emotion Regulation. J Pers Assess 2023; 105:657-666. [PMID: 36306434 DOI: 10.1080/00223891.2022.2133722] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/17/2022] [Accepted: 09/27/2022] [Indexed: 10/31/2022]
Abstract
Emotion regulation difficulties are associated with a range of psychological disorders. A widely used measure of emotion regulation is the Difficulties in Emotion Regulation Scale (DERS-36). There are also three shortened DERS versions. Consistent with current efforts to build very brief versions of measures, the aim of this research is to develop a briefer DERS and evaluate its construct validity. Study 1 uses IRT methods coupled with content considerations to develop a briefer unidimensional DERS. Previous attempts to shorten the DERS have not considered how frame of reference may influence responses to items. The new DERS-8 includes only items prefaced with the phrase "When I'm upset," to provide respondents with a uniform context that elicits thinking about situations requiring regulation of negative emotion; answers to items are more likely to represent affect, thought, and actions in response to such situations. Study 2 showed that the DERS-8 performed well in an IRT analysis among adolescents with psychiatric disorders and showed similar group differences, sensitivity to change, and correlations with other variables compared to existing DERS versions, in both healthy adult and clinical adolescent samples. The DERS-8 offers a very brief unidimensional measure of difficulties in emotion regulation for adolescents and adults.
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Affiliation(s)
| | | | - Carla Sharp
- Department of Psychology, University of Houston
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Limberger MF, Schmiedek F, Santangelo PS, Reichert M, Wieland LM, Berhe O, Meyer-Lindenberg A, Tost H, Ebner-Priemer UW. Assessing affect in adolescents with e-diaries: multilevel confirmatory factor analyses of different factor models. Front Psychol 2023; 14:1061229. [PMID: 37425158 PMCID: PMC10328383 DOI: 10.3389/fpsyg.2023.1061229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 05/23/2023] [Indexed: 07/11/2023] Open
Abstract
In the last two decades, e-diary studies have gained increasing interest, with a dominant focus on mood and affect. Although requested in current guidelines, psychometric properties are rarely reported, and methodological investigations of factor structure, model fit, and the reliability of mood and affect assessment are limited. We used a seven-day e-diary dataset of 189 adolescent participants (12-17 years). The e-diary affect assessments revealed a considerable portion of within-person variance. The six-factor model showed the best model fit compared to the less complex models. Factor loadings also improved with the complexity of the models. Accordingly, we recommend that future e-diary studies of adolescents use the six-factor model of affect as well as reporting psychometric properties and model fit. For future e-diary scale development, we recommend using a minimum of three items per scale to enable the use of confirmatory multilevel factor analyses.
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Affiliation(s)
- Matthias F. Limberger
- Mental mHealth Lab, Institute for Sport and Sport Science, Faculty for Humanities and Social Sciences, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Florian Schmiedek
- Leibniz Institute for Research and Information in Education (DIPF), Frankfurt, Germany
- IDeA Research Center for Individual Development and Adaptive Education of Children at Risk, Frankfurt, Germany
- Department of Educational Psychology, Goethe University Frankfurt, Frankfurt, Germany
| | - Philip S. Santangelo
- Mental mHealth Lab, Institute for Sport and Sport Science, Faculty for Humanities and Social Sciences, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
- Behavioural Health Technology Interventions, Department of Behavioural and Cognitive Sciences, Faculty of Humanities, Education and Social Sciences, Université du Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Markus Reichert
- Mental mHealth Lab, Institute for Sport and Sport Science, Faculty for Humanities and Social Sciences, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of eHealth and Sports Analytics, Faculty of Sports Science, Ruhr University Bochum, Bochum, Germany
| | - Lena M. Wieland
- Mental mHealth Lab, Institute for Sport and Sport Science, Faculty for Humanities and Social Sciences, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
- Leibniz Institute for Research and Information in Education (DIPF), Frankfurt, Germany
- IDeA Research Center for Individual Development and Adaptive Education of Children at Risk, Frankfurt, Germany
| | - Oksana Berhe
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Heike Tost
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ulrich W. Ebner-Priemer
- Mental mHealth Lab, Institute for Sport and Sport Science, Faculty for Humanities and Social Sciences, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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Gupta N, Gupta M, Madabushi JS, Zubiar F. Integrating Psychosocial Risks With Emerging Evidence for Borderline Personality Disorders in Adolescence: An Update for Clinicians. Cureus 2023; 15:e40295. [PMID: 37448386 PMCID: PMC10337505 DOI: 10.7759/cureus.40295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 07/15/2023] Open
Abstract
Borderline personality disorder (BPD) has seen significant advances in the knowledge of its developmental phenomenology during late childhood and adolescence. Various genetic, neurobiological, psychological, and social factors are implicated in the etiology of BPD. With emerging evidence on BPD development in adolescence, the review focused on recent literature to understand the role of psychosocial risk factors. The effects of adverse familial environment, physical, emotional, verbal, and sexual abuse, intergenerational transmission of psychopathological traits, maternal neglect and rejection, low socioeconomic status, bullying victimization, and dating violence were reviewed to understand their role in the development of BPD. BPD is a highly complex, serious, and enduring mental illness that has now been widely accepted to have symptoms that onset in early adolescence and could be diagnosed as early as age 12. BPD symptoms are stable, phenomenologically distinct from externalizing and internalizing disorders, and often present with co-occurring disorders, which during assessment could not explain impairments associated with BPD. New measures like the Difficulties in Emotion Regulation Scale (DERS), detailed developmental histories, understanding of psychosocial risks, shared decision-making, and psychoeducation could assist in early diagnosis and improvement of long-term outcomes. The implementation of evidence-based treatments is a challenge given higher costs and access to services; therefore, modifications in the treatment based on the core principles of these strategies should be considered. It is imperative to screen for psychosocial factors early in higher-risk groups. The assessment of familial factors, parental histories of psychopathologies, and histories of childhood abuse is important in context with impairing symptoms of clinical presentation and dimensional aspects of self-functioning. The role of family therapies, parental psychoeducation, and the integration of trauma-informed care approaches are important for clinical outcomes. Also, coordinated efforts with multiple stakeholders like school awareness programs, anti-bullying policies, legislation, and enforcement of existing laws might be instrumental in addressing issues related to victimization by peers.
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Affiliation(s)
- Nihit Gupta
- Psychiatry, University of West Virginia, Glen Dale, USA
| | - Mayank Gupta
- Psychiatry and Behavioral Sciences, Southwood Psychiatric Hospital, Pittsburgh , USA
| | | | - Faiza Zubiar
- Psychiatry, The Trenton Psychiatric Hospital, Trenton, USA
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Himmerich H, Lewis YD, Conti C, Mutwalli H, Karwautz A, Sjögren JM, Uribe Isaza MM, Tyszkiewicz-Nwafor M, Aigner M, McElroy SL, Treasure J, Kasper S. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines update 2023 on the pharmacological treatment of eating disorders. World J Biol Psychiatry 2023:1-64. [PMID: 37350265 DOI: 10.1080/15622975.2023.2179663] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 02/08/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVES This 2023 update of the WFSBP guidelines for the pharmacological treatment of eating disorders (EDs) reflects the latest diagnostic and psychopharmacological progress and the improved WFSBP recommendations for the assessment of the level of evidence (LoE) and the grade of recommendation (GoR). METHODS The WFSBP Task Force EDs reviewed the relevant literature and provided a timely grading of the LoE and the GoR. RESULTS In anorexia nervosa (AN), only a limited recommendation (LoE: A; GoR: 2) for olanzapine can be given, because the available evidence is restricted to weight gain, and its effect on psychopathology is less clear. In bulimia nervosa (BN), the current literature prompts a recommendation for fluoxetine (LoE: A; GoR: 1) or topiramate (LoE: A; GoR: 1). In binge-eating disorder (BED), lisdexamfetamine (LDX; LoE: A; GoR: 1) or topiramate (LoE: A; GoR: 1) can be recommended. There is only sparse evidence for the drug treatment of avoidant restrictive food intake disorder (ARFID), pica, and rumination disorder (RD). CONCLUSION In BN, fluoxetine, and topiramate, and in BED, LDX and topiramate can be recommended. Despite the published evidence, olanzapine and topiramate have not received marketing authorisation for use in EDs from any medicine regulatory agency.
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Affiliation(s)
- Hubertus Himmerich
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK
| | - Yael Doreen Lewis
- Hadarim Eating Disorders Unit, Shalvata Mental Health Center, Hod HaSharon, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Chiara Conti
- Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Hiba Mutwalli
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Clinical Nutrition, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Andreas Karwautz
- Eating Disorders Care & Research Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | | | | | - Marta Tyszkiewicz-Nwafor
- Department of Child and Adolescent Psychiatry, Poznan University of Medical Sciences, Poznań, Poland
| | - Martin Aigner
- Universitätsklinikum Tulln, Tulln an der Donau, Austria
| | - Susan L McElroy
- Lindner Center of HOPE, Mason, OH, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Janet Treasure
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK
| | - Siegfried Kasper
- Center for Brain Research, Medical University of Vienna, Vienna, Austria
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13
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Xiao Q, Wang X, Yi X, Fu Y, Ding J, Jiang F, Wang J, Han Z, Chen BT. Alteration of surface morphology and core features in adolescents with borderline personality disorder. J Affect Disord 2023; 333:86-93. [PMID: 37080498 DOI: 10.1016/j.jad.2023.04.055] [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: 11/27/2022] [Revised: 04/03/2023] [Accepted: 04/14/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Accurate early diagnosis of adolescent borderline personality disorder (BPD) is critical for prompt treatment. The aim of this study was to assess the alteration of brain surface morphology and to evaluate its relationship with core features in adolescent BPD. METHODS A total of 52 adolescents with BPD aged 12-17 years and 39 age- and sex-matched healthy controls (HCs) were prospectively enrolled into the study. Brain magnetic resonance imaging (MRI) was obtained with both 3D-T1 weighted structural sequence and resting-state functional data. The structural data was analyzed for surface morphology parameters including the local gyrification index (LGI), mean curvature and surface area. The functional MRI data was analyzed for seed-based functional connectivity (FC). Correlative analysis of surface morphology and core features of adolescent BPD was performed. RESULTS Adolescents with BPD showed the following altered surface morphology in the limbic-cortical circuit when compared to the HCs: (1) reduced LGI in the left fusiform and right superior temporal gyrus; (2) reduced mean curvature in the left precentral gyrus and right rostral anterior cingulate cortex, and increased mean curvature in the bilateral pericalcarine; and (3) reduced surface area in the left paracentral gyrus, left pars triangularis, right insula and right lateral orbitofrontal gyrus (P < 0.05, FWE correction). In addition, these brain regions with altered surface morphology were significantly correlated with several core features including the mood instability, self-identity problems, and non-suicidal self-injury behavior in adolescents with BPD (P < 0.05). Furthermore, there was enhanced functional connectivity among these altered brain regions within the limbic-cortical circuit (voxel P < 0.001, cluster P < 0.05, FWE corrected). CONCLUSIONS Adolescents with BPD had significant alterations of brain surface morphology in the limbic-cortical circuit, which was correlated with core BPD features. These results implicated the surface morphology parameters and FC alterations may potentially serve as neuroimaging biomarkers for adolescents with BPD.
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Affiliation(s)
- Qian Xiao
- Mental Health Center of Xiangya Hospital, Central South University, Changsha 410008, Hunan, PR China; National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Central South University, Changsha 410008, Hunan, PR China
| | - Xueying Wang
- National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Central South University, Changsha 410008, Hunan, PR China; Department of Radiology, Xiangya Hospital, Central South University, Changsha 410008, Hunan, PR China
| | - Xiaoping Yi
- Department of Radiology, Xiangya Hospital, Central South University, Changsha 410008, Hunan, PR China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Xiangya Hospital, Changsha 410008, Hunan, PR China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha 410008, Hunan, PR China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha 410008, Hunan, PR China; Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008, Hunan, PR China.
| | - Yan Fu
- National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Central South University, Changsha 410008, Hunan, PR China; Department of Radiology, Xiangya Hospital, Central South University, Changsha 410008, Hunan, PR China
| | - Jun Ding
- Department of Public Health, Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, Guangdong, PR China
| | - Furong Jiang
- Mental Health Center of Xiangya Hospital, Central South University, Changsha 410008, Hunan, PR China
| | - Jing Wang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, Hunan, PR China
| | - Zaide Han
- Department of Radiology, Xiangya Hospital, Central South University, Changsha 410008, Hunan, PR China
| | - Bihong T Chen
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA 91010, USA
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14
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Yaqoob N, Ahsan S. Impact of mood disorders and personality disorders on suicide intent among self-harm patients. Pak J Med Sci 2023; 39:491-496. [PMID: 36950393 PMCID: PMC10025743 DOI: 10.12669/pjms.39.2.6140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 11/22/2022] [Accepted: 11/30/2022] [Indexed: 01/26/2023] Open
Abstract
Objectives The present research examined the impact of mood disorder and personality disorders on suicide intent among self-harm patients using cross sectional research design. Methods A clinical sample of 220 self-harm inpatients with age of 18 to 35 years was collected through purposive sampling technique from different mental health departments of Rawalpindi, Jhelum and Multan hospitals. Study was conducted from June 2019 till November, 2021. Data was compiled in three steps. In step-I, rapport was established with patients and identification of intent was carried out by administering Beck Suicide Intent Scale. In step-II, mental illness was identified by administering Mood Disorder Questionnaire, Personality Diagnostic Questionnaire and subscale of Depression from Depression Anxiety and Stress Scale. In step-III, in order to confirm his / her responses and diagnosis, a detailed semi-structured clinical interview was carried out with each participant who responded positively to Personality Diagnostic Questionnaire. Result Results revealed that bipolar spectrum disorder, depression and antisocial personality disorder were significantly positive predictors of suicide intent among self-harm patients. On the other hand, narcissistic personality disorder and borderline personality disorder were found to be significantly negative predictors of suicide intent among self-harm patients. Conclusion Results of current research highlighted those predisposing factors that discriminate self-harm from attempted suicide. The study has important implications for identification of intent of self-harm patients, which could help in devising a proper treatment plan for the management of such challenging patients.
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Affiliation(s)
- Naila Yaqoob
- Major Dr. Naila Yaqoob, Clinical Psychologist, CMH Multan, Pakistan
| | - Sadaf Ahsan
- Dr. Sadaf Ahsan Associate Professor, Foundation University, Islamabad, Pakistan
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15
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McQuade JD. ADHD Symptoms, Peer Problems, and Emotion Dysregulation as Longitudinal and Concurrent Predictors of Adolescent Borderline Personality Features. J Atten Disord 2022; 26:1711-1724. [PMID: 35535649 DOI: 10.1177/10870547221098174] [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: 11/16/2022]
Abstract
OBJECTIVE ADHD and borderline personality (BP) disorder are highly comorbid and characterized by emotion dysregulation and peer problems. However, limited research has examined social and emotional predictors of BP features in samples that include youth with ADHD. METHOD Using a sample of 124 youth with and without ADHD (52% female), ADHD symptoms, peer problems, and emotion dysregulation were assessed in childhood (8-13 years) and in adolescence, along with BP features (13-18 years). RESULTS In addition to the significant effect of ADHD symptoms, teacher-rated child peer victimization and adolescent-reported peer victimization, poorer close friendships, and emotion dysregulation domains significantly predicted adolescent BP features. Greater parent-rated child and adolescent emotion dysregulation domains also significantly predicted adolescent BP features, with ADHD symptoms no longer significant. CONCLUSION Even for youth with ADHD, peer and emotional vulnerabilities in childhood and adolescence may serve as important markers of risk for adolescent BP features.
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16
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Yang C, Wang J, Shao Y, Liu M, Geng F. Antisocial and borderline personality traits and childhood trauma in male prisoners: Mediating effects of difficulties in emotional regulation. CHILD ABUSE & NEGLECT 2022; 132:105822. [PMID: 35944450 DOI: 10.1016/j.chiabu.2022.105822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 12/10/2021] [Accepted: 07/27/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To investigate the prevalence of probable antisocial personality disorder (ASPD) and borderline personality disorder (BPD) among prisoners, and further examine the mediating effect of difficulties in emotional regulation (ER) between childhood trauma and symptoms of ASPD and BPD. METHODS A total of 1491 male participants (35.4 ± 9.69 years) were recruited from a prison in Guangdong, China. The symptoms of ASPD and BPD, childhood trauma, difficulties in ER, and suicidal behaviors were measured by self-administered structured questionnaires. Logistic regressions were performed to investigate the associations of ASPD and BPD with suicidal behaviors. Path analysis was used to examine the mediating effects of difficulties in ER between childhood trauma and symptoms of ASPD and BPD. RESULT Approximately, 21.2 % and 11.2 % of the participants were screened as ASPD and BPD, respectively. Probable ASPD and BPD were associated with higher risk of suicidal behaviors. Childhood trauma and difficulties in ER were significantly associated with suicidal behaviors in prisoners with probable ASPD and BPD. Path analyses showed that partial mediating effects of difficulties in ER were significant in the dimensions of clarity and strategies on ASPD, and in the dimensions of clarity, impulse, and strategies on BPD. CONCLUSION ASPD and BPD are two of the common personality disorders in prisoners. Difficulties in ER are key to understanding the relationships between childhood trauma and personality disorders.
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Affiliation(s)
- Chenxiao Yang
- School of Psychology, Jiangxi Normal University, Nanchang, China
| | - Jian Wang
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, China
| | - Yuan Shao
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, China
| | - Mingfan Liu
- School of Psychology, Jiangxi Normal University, Nanchang, China
| | - Fulei Geng
- School of Psychology, Jiangxi Normal University, Nanchang, China.
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17
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Borderline and Other Personality Disorders: New Directions in 2022. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2022; 20:420-421. [PMID: 37200881 PMCID: PMC10187389 DOI: 10.1176/appi.focus.22020013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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18
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Ledden S, Rains LS, Schlief M, Barnett P, Ching BCF, Hallam B, Günak MM, Steare T, Parker J, Labovitch S, Oram S, Pilling S, Johnson S. Current state of the evidence on community treatments for people with complex emotional needs: a scoping review. BMC Psychiatry 2022; 22:589. [PMID: 36064337 PMCID: PMC9442944 DOI: 10.1186/s12888-022-04171-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improving the quality of care in community settings for people with 'Complex Emotional Needs' (CEN-our preferred working term for services for people with a "personality disorder" diagnosis or comparable needs) is recognised internationally as a priority. Plans to improve care should be rooted as far as possible in evidence. We aimed to take stock of the current state of such evidence, and identify significant gaps through a scoping review of published investigations of outcomes of community-based psychosocial interventions designed for CEN. METHODS We conducted a scoping review with systematic searches. We searched six bibliographic databases, including forward and backward citation searching, and reference searching of relevant systematic reviews. We included studies using quantitative methods to test for effects on any clinical, social, and functioning outcomes from community-based interventions for people with CEN. The final search was conducted in November 2020. RESULTS We included 226 papers in all (210 studies). Little relevant literature was published before 2000. Since then, publications per year and sample sizes have gradually increased, but most studies are relatively small, including many pilot or uncontrolled studies. Most studies focus on symptom and self-harm outcomes of various forms of specialist psychotherapy: most result in outcomes better than from inactive controls and similar to other specialist psychotherapies. We found large evidence gaps. Adaptation and testing of therapies for significant groups (e.g. people with comorbid psychosis, bipolar disorder, post-traumatic stress disorder, or substance misuse; older and younger groups; parents) have for the most part only reached a feasibility testing stage. We found little evidence regarding interventions to improve social aspects of people's lives, peer support, or ways of designing effective services. CONCLUSIONS Compared with other longer term mental health problems that significantly impair functioning, the evidence base on how to provide high quality care for people with CEN is very limited. There is good evidence that people with CEN can be helped when specialist therapies are available and when they are able to engage with them. However, a much more methodologically robust and substantial literature addressing a much wider range of research questions is urgently needed to optimise treatment and support across this group.
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Affiliation(s)
- Sarah Ledden
- Division of Psychiatry, University College London, London, UK
| | - Luke Sheridan Rains
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Merle Schlief
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK.
| | - Phoebe Barnett
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Brian Chi Fung Ching
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Brendan Hallam
- Division of Psychiatry, University College London, London, UK
- Research Department of Primary Care & Population Health, University College London, London, UK
| | - Mia Maria Günak
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
- Department of Psychology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Thomas Steare
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Jennie Parker
- NIHR Mental Health Policy Research Unit Co-Production Group, University College London, London, UK
| | - Sarah Labovitch
- NIHR Mental Health Policy Research Unit Co-Production Group, University College London, London, UK
- West London NHS Trust, London, UK
| | - Sian Oram
- NIHR Mental Health Policy Research Unit, Department of Health Service and Population Research, King's College London, London, UK
| | - Steve Pilling
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
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19
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Das Mentalisieren des Körpers braucht den Gegenwartsmoment der Gruppe. GRUPPENPSYCHOTHERAPIE UND GRUPPENDYNAMIK 2022. [DOI: 10.13109/grup.2022.58.3.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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He S, Yang F, Zhang H, Zhang S. Affective well-being of Chinese urban postpartum women: predictive effect of spousal support and maternal role adaptation. Arch Womens Ment Health 2022; 25:781-788. [PMID: 35652947 DOI: 10.1007/s00737-022-01240-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 05/26/2022] [Indexed: 11/25/2022]
Abstract
Due to shortage of childcare facilities while high social expectations for mothering, becoming a mother is a big life challenge for most women in urban China. The understandings on Chinese postpartum women's affective well-being and its relation with spousal support and maternal role adaptation remain limited. This study aims to investigate the affective well-being (including both positive and negative affect) of Chinese urban postpartum women and how it is associated with spousal support and maternal role adaptation. A cross-sectional survey was conducted in Shanghai, China, between June and July 2019. A total of 498 urban mothers whose babies were 0 to 1 year old participated in this survey. They completed the Postpartum Social Support Questionnaire (PSSQ), the Maternal Role Adaptation Scale, and the Positive and Negative Affect Scale (PANAS), and reported socio-demographic information. Results showed that positive and negative affect of postpartum women were not significantly associated with each other. Positive affect had a positive correlation with spousal support and maternal role adaptation. Negative affect was negatively associated with maternal role adaptation, while not significantly associated with spousal support. Maternal role adaptation partially mediated the relationship between spousal support and positive affect of the participants, controlling for age, household income, education, birth order, and inter-generational support. The findings indicate that intervention programs towards mental health of postpartum women should focus more on positive affect cultivation; moreover, clinical services should help postpartum women to adapt to maternal role by encouraging new fathers' or partners' involvement in daily childcare-giving.
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Affiliation(s)
- Shanshan He
- School of Social Development, East China Normal University, Shanghai, 200062, China
| | - Fan Yang
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, 200030, China. .,Institute of Healthy Yangtze River Delta, Shanghai Jiao Tong University, Room 335, Xinjian Building, 1954 Huashan Road, Shanghai, 200030, China.
| | - Huimin Zhang
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, 200030, China.,Institute of Healthy Yangtze River Delta, Shanghai Jiao Tong University, Room 335, Xinjian Building, 1954 Huashan Road, Shanghai, 200030, China
| | - Shumiao Zhang
- School of Social Development, East China Normal University, Shanghai, 200062, China
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21
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Maffly-Kipp J, McCredie MN, Morey LC. The self-reference effect as a behavioral indicator of identity disturbances associated with borderline personality features in a non-clinical sample. Borderline Personal Disord Emot Dysregul 2022; 9:20. [PMID: 35854373 PMCID: PMC9297558 DOI: 10.1186/s40479-022-00189-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 06/22/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Identity disturbances are a common feature of personality pathology and BPD. The Self-Reference Effect paradigm is a method used to measure the impact of self-relevant processing on encoding/memory, whereby self-relevant information is typically advantaged in cognitive processes. We postulated that difficulties with identity might impede the process by which one encodes self-relevant information. Based on this reasoning, we predicted that high levels of identity disturbance could be associated with atypical impact of the SRE. METHODS Undergraduate participants were randomized into one of three groups where they were exposed to 60 trait adjectives for seven seconds each. Depending on condition, participants either indicated whether a word was/wasn't capitalized (Capitalization condition), whether it was a good synonym for "openness" (Synonyms condition), or whether it described them as a person (Self-reference condition). After a brief delay, all participants were asked to recall as many of the 60 words as possible. Finally, we measured identity disturbance using the Borderline Features-Identity Problems (BOR-I) scale from the Personality Assessment Inventory. RESULTS We found significant but modest correlations between Recall and scores on the BOR-I subscale in the Self-Reference condition, but not the two control conditions. Contrary to expectations, the interaction between BOR-I and Condition was not a significant predictor of Recall, suggesting that identity disturbance did not significantly moderate the SRE. CONCLUSIONS While our primary hypothesis was not supported, there is a need for multimethod approaches to studying personality pathology. Future research should continue to examine the extent to which behavioral paradigms like the SRE might be useful indicators of identity disturbance/personality pathology, with an emphasis on the use of clinical populations.
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Affiliation(s)
- Joseph Maffly-Kipp
- Department of Psychological and Brain Sciences, Texas A&M University, 4235 TAMU, College Station, TX, 77843, USA.
| | - Morgan N McCredie
- Department of Psychological and Brain Sciences, Texas A&M University, 4235 TAMU, College Station, TX, 77843, USA
| | - Leslie C Morey
- Department of Psychological and Brain Sciences, Texas A&M University, 4235 TAMU, College Station, TX, 77843, USA
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22
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Nöstlinger C, Van Landeghem E, Vanhamel J, Rotsaert A, Manirankunda L, Ddungu C, Reyniers T, Katsuva D, Vercruyssen J, Dielen S, Meudec M. COVID-19 as a social disease: qualitative analysis of COVID-19 prevention needs, impact of control measures and community responses among racialized/ethnic minorities in Antwerp, Belgium. Int J Equity Health 2022; 21:67. [PMID: 35578292 PMCID: PMC9108705 DOI: 10.1186/s12939-022-01672-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 04/27/2022] [Indexed: 12/25/2022] Open
Abstract
Background In high income countries, racialized/ethnic minorities are disproportionally affected by COVID-19. Despite the established importance of community involvement in epidemic preparedness, we lack in-depth understanding of these communities’ experiences with and responses to COVID-19. We explored information and prevention needs, coping mechanisms with COVID-19 control measures and their impact on lived experiences among selected racialized/ethnic minority communities. Methods This qualitative rapid assessment conducted in Antwerp/Belgium used an interpretative and participatory approach. We included migrant communities with geographic origins ranging from Sub-Saharan Africa, North-Africa to the Middle East, Orthodox Jewish communities and professional community workers. Data were collected between May 2020–May 2021 through key informant-, in-depth interviews and group discussions (N = 71). Transcripts were analyzed inductively, adopting a reflexive thematic approach. A community advisory board provided feedback throughout the research process. Results Participants indicated the need for tailored information in terms of language and timing. At the start of the epidemic, they perceived official public health messages as insufficient to reach all community members. Information sources included non-mainstream (social) media and media from home countries, hampering a nuanced understanding of virus transmission mechanisms and local and national protection measures. Participants felt the measures’ most negative impact on their livelihoods (e.g. loss of income, disruption of social and immigration support). Economic insecurity triggered chronic stress and fears at individual and family level. High degrees of distrust in authorities and anticipated stigma were grounded in previously experienced racial and ethnic discrimination. Community-based initiatives mitigated this impact, ranging from disseminating translated and tailored information, providing individual support, and successfully reaching community members with complex needs (e.g. the elderly, digitally illiterate people, those with small social networks or irregular legal status). Conclusion Study participants’ narratives showed how coping with and responding to COVID-19 was strongly intertwined with socio-economic and ethnic/racial characteristics. This justifies conceptualizing COVID-19 a social disease. At the same time, communities demonstrated resilience in responding to these structural vulnerabilities. From a health equity perspective, we provide concrete policy recommendations grounded in insights into communities’ structural vulnerabilities and resilience.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Stef Dielen
- Department of Public Health, Antwerp, Belgium
| | - Marie Meudec
- Department of Public Health, Antwerp, Belgium.,Outbreak Research Team, Institute of Tropical Medicine, Antwerp, Belgium
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23
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Wagner-Skacel J, Riedl D, Kampling H, Lampe A. Mentalization and dissociation after adverse childhood experiences. Sci Rep 2022; 12:6809. [PMID: 35474233 PMCID: PMC9043194 DOI: 10.1038/s41598-022-10787-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 04/12/2022] [Indexed: 11/09/2022] Open
Abstract
.Impairment of mentalization may impact coping strategies, regulation of affect and stress. The influence of impaired mentalization on dissociation in patients with adverse childhood experiences (ACEs) could be important for treatment strategies. The aim of this study is to assess the relationship between ACEs, mentalizing and dissociation in adult individuals. Sixty-seven patients with ACEs completed the Mentalization Questionnaire (MZQ), the Essener Trauma Inventory (ETI) and the Brief Symptom Inventory-18 (BSI-18). The SPSS PROCESS macro tool was applied to test if mentalization mediated the relationship of ACEs and dissociation. ACEs were significantly associated with higher dissociation (β = 0.42, p < 0.001) and lower mentalization (β = - 0.49, p < 0.001). When mentalization was added to the model as a predictor, the association of ACEs with dissociation was no longer significant (β = 0.11, p = 0.31) and a statistically significant indirect effect was found (β = 0.32, 95% CI 0.16-0.47). The overall explained variance of dissociation notably improved after inclusion of mentalization (17.5% to 49.1%). Thus, the results indicated that the association of ACEs on dissociation was fully mediated by mentalization. Our results suggest that ACEs are associated with lower mentalization and higher dissociation. Lower mentalization was also associated with worse depression, anxiety, somatization and PTSD symptoms. These findings underline the increasing importance of early treatment of individuals affected by ACEs with a focus to foster the development of mentalization.
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Affiliation(s)
- J Wagner-Skacel
- Department of Medical Psychology and Psychotherapy, Medical University Graz, Graz, Austria
| | - D Riedl
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University Innsbruck, Innsbruck, Austria.
| | - H Kampling
- Department of Psychosomatic and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
| | - A Lampe
- VAMED Rehabilitation Center, Schruns, Austria.,Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
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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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Sprecher EA, Li E, Sleed M, Midgley N. ‘Trust me, we can sort this out’: a theory-testing case study of the role of epistemic trust in fostering relationships. QUALITATIVE RESEARCH IN PSYCHOLOGY 2022. [DOI: 10.1080/14780887.2022.2033898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Eva A. Sprecher
- The Anna Freud National Centre for Children and Families, Child Attachment and Psychological Therapies Research Unit (ChAPTRe), London, UK
- Department of Clinical, University College London (UCL), Educational and Health Psychology, London, UK
| | - Elizabeth Li
- The Anna Freud National Centre for Children and Families, Child Attachment and Psychological Therapies Research Unit (ChAPTRe), London, UK
- Department of Clinical, University College London (UCL), Educational and Health Psychology, London, UK
| | - Michelle Sleed
- The Anna Freud National Centre for Children and Families, Child Attachment and Psychological Therapies Research Unit (ChAPTRe), London, UK
| | - Nick Midgley
- The Anna Freud National Centre for Children and Families, Child Attachment and Psychological Therapies Research Unit (ChAPTRe), London, UK
- Department of Clinical, University College London (UCL), Educational and Health Psychology, London, UK
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Bock MM, Graf T, Woeber V, Kothgassner OD, Buerger A, Plener PL. Radical Acceptance of Reality: Putting DBT®-A Skill Groups Online During the COVID-19 Pandemic: A Qualitative Study. Front Psychiatry 2022; 13:617941. [PMID: 35546945 PMCID: PMC9082632 DOI: 10.3389/fpsyt.2022.617941] [Citation(s) in RCA: 3] [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: 10/15/2020] [Accepted: 02/23/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Emotion dysregulation is a common challenge pertaining to numerous psychiatric disorders in adolescence and is associated with increased morbidity and mortality. Dialectical Behavior Therapy for Adolescents (DBT®-A) has been shown to be an effective treatment, especially in the reduction of self-harm and suicidality. Measures in relation to the COVID-19 pandemic set strict limits on physical contacts with patients. In order to continuously provide evidence-based specialized care to patients suffering from emotion dysregulation, we offered two online DBT®-A skill groups in a video-group-call format. OBJECTIVE We aimed at assessing our online DBT®-A skills groups, collect according up- and downsides, and form a basis for advancement of this form of treatment provision. Also, the impact of the COVID-19 pandemic on patients was assessed. METHODS A physical DBT®-A skill group was switched to a video-group-call format and a second group was initiated de novo online. After five sessions, patients engaged in structured group discussions to reflect experiences. Discussion content was analyzed via Inductive Category Formation within the Framework of Qualitative Content Analysis. RESULTS Patients unanimously found the COVID-19 pandemic challenging, but also reported differentially on its impact. Downsides were balanced by subjective "gains" in time and a perceived reduction in stress. Technical problems of the online format were discussed, but did not limit the positive experience of still receiving treatment. Patients of both online DBT®-A skill groups valued the offer, felt connected, and reported benefits from the treatment. The transition group additionally discussed changes in structure and content of the group sessions after the switch to online meetings and reflected differential functions of the group. DISCUSSION Although the sample size is small, and conclusions are drawn from Inductive Qualitative Content Analysis, the presented results are of interest. In our investigation, video-group-calls were both safe and beneficial for patients. This alternative to physical meetings is not only interesting for further waves of the current pandemic but also for service provision in remote areas with limited access to specialized care. Further research is needed to challenge and refine our results and to explore extensions to "basic" video-group-calls, such as "break-out sessions," blended therapy, or real-time supervision within an online session.
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Affiliation(s)
- Mercedes M Bock
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria.,Psychosocial Services, Vienna, Austria
| | - Theres Graf
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Verena Woeber
- Department of Clinical Psychology and Psychotherapy, Wiener Gesundheitsverbund, University Clinic AKH, Vienna, Austria.,Department of Child and Adolescent Psychiatry, Wiener Gesundheitsverbund, University Clinic AKH, Vienna, Austria
| | - Oswald D Kothgassner
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Arne Buerger
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Wuerzburg, Würzburg, Germany
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria.,Department of Child- and Adolescent Psychiatry and Psychotherapy, Medical University of Ulm, Ulm, Germany
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27
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Nester MS, Brand BL, Schielke HJ, Kumar S. An examination of the relations between emotion dysregulation, dissociation, and self-injury among dissociative disorder patients. Eur J Psychotraumatol 2022; 13:2031592. [PMID: 35145611 PMCID: PMC8823688 DOI: 10.1080/20008198.2022.2031592] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Dissociative disorder (DD) patients report high rates of self-injury. Previous studies have found dissociation and self-injury to be related to emotional distress. To the best of our knowledge, however, the link between emotion dysregulation and self-injury has not yet been examined within a DD population. OBJECTIVE The present study investigated relations between emotion dysregulation, dissociation, and self-injury in DD patients, and explored patterns of emotion dysregulation difficulties among DD patients with and without recent histories of self-injury. METHOD We utilized linear and logistic regressions and t-test statistical methods to examine data from 235 patient-clinician dyads enrolled in the TOP DD Network Study. RESULTS Analyses revealed emotion dysregulation was associated with heightened dissociative symptoms and greater endorsement of self-injury in the past six months. Further, patients with a history of self-injury in the past six months reported more severe emotion dysregulation and dissociation than those without recent self-injury. As a group, DD patients reported the greatest difficulty engaging in goal-directed activities when distressed, followed by lack of emotional awareness and nonacceptance of emotional experiences. DD patients demonstrated similar patterns of emotion dysregulation difficulties irrespective of recent self-injury status. CONCLUSIONS Results support recommendations to strengthen emotion regulation skills as a means to decrease symptoms of dissociation and self-injury in DD patients.
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Affiliation(s)
- M Shae Nester
- Department of Psychology, Towson University, Towson, MD, USA
| | - Bethany L Brand
- Department of Psychology, Towson University, Towson, MD, USA
| | - Hugo J Schielke
- Traumatic Stress Injury & Concurrent Program, Homewood Health Centre, Guelph, Ontario, Canada
| | - Shaina Kumar
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
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28
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Vukojević J, Mulc D, Kinder I, Jovičić E, Friganović K, Savić A, Cifrek M, Vidović D. Borderline and Depression: A Thin EEG Line. Clin EEG Neurosci 2021; 54:224-227. [PMID: 34779273 DOI: 10.1177/15500594211060830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In everyday clinical practice, there is an ongoing debate about the nature of major depressive disorder (MDD) in patients with borderline personality disorder (BPD). The underlying research does not give us a clear distinction between those 2 entities, although depression is among the most frequent comorbid diagnosis in borderline personality patients. The notion that depression can be a distinct disorder but also a symptom in other psychopathologies led our team to try and delineate those 2 entities using 146 EEG recordings and machine learning. The utilized algorithms, developed solely for this purpose, could not differentiate those 2 entities, meaning that patients suffering from MDD did not have significantly different EEG in terms of patients diagnosed with MDD and BPD respecting the given data and methods used. By increasing the data set and the spatiotemporal specificity, one could have a more sensitive diagnostic approach when using EEG recordings. To our knowledge, this is the first study that used EEG recordings and advanced machine learning techniques and further confirmed the close interrelationship between those 2 entities.
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Affiliation(s)
- Jakša Vukojević
- 87137University Psychiatric Hospital Vrapče, University of Zagreb, Zagreb, Croatia
| | - Damir Mulc
- 87137University Psychiatric Hospital Vrapče, University of Zagreb, Zagreb, Croatia
| | - Ivana Kinder
- 112586University of Zagreb, Faculty of Electrical Engineering and Computing, Zagreb, Croatia
| | - Eda Jovičić
- 112586University of Zagreb, Faculty of Electrical Engineering and Computing, Zagreb, Croatia
| | - Krešimir Friganović
- 112586University of Zagreb, Faculty of Electrical Engineering and Computing, Zagreb, Croatia
| | - Aleksandar Savić
- 87137University Psychiatric Hospital Vrapče, University of Zagreb, Zagreb, Croatia
| | - Mario Cifrek
- 112586University of Zagreb, Faculty of Electrical Engineering and Computing, Zagreb, Croatia
| | - Domagoj Vidović
- 87137University Psychiatric Hospital Vrapče, University of Zagreb, Zagreb, Croatia
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29
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Volkert J, Taubner S, Byrne G, Rossouw T, Midgley N. Introduction to Mentalization-Based Approaches for Parents, Children, Youths, and Families. Am J Psychother 2021; 75:4-11. [PMID: 34724808 DOI: 10.1176/appi.psychotherapy.20210020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Family members mentalize when they try to understand each other's behavior on the basis of intentional mental states. This article aims to introduce and briefly describe how the concept of mentalization can provide a useful framework for clinicians to understand psychopathology of children, youths, and families. The authors further outline how mentalization-based techniques and interventions can be applied to build epistemic trust and to reestablish mentalizing in families by presenting clinical vignettes of initial sessions from various clinical settings in the United Kingdom and Germany. The article concludes with a brief summary about the current evidence for mentalization-based interventions with children, adolescents, and families and provides an outlook for future clinical and research work.
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Affiliation(s)
- Jana Volkert
- Department of Psychology, MSB Medical School Berlin, Berlin (Volkert); Institute for Psychosocial Prevention, University of Heidelberg, Heidelberg, Germany (Volkert, Taubner); Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom (Byrne); North East London National Health Service Foundation Trust, London (Rossouw); Anna Freud Centre and University College London, London (Midgley)
| | - Svenja Taubner
- Department of Psychology, MSB Medical School Berlin, Berlin (Volkert); Institute for Psychosocial Prevention, University of Heidelberg, Heidelberg, Germany (Volkert, Taubner); Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom (Byrne); North East London National Health Service Foundation Trust, London (Rossouw); Anna Freud Centre and University College London, London (Midgley)
| | - Gerry Byrne
- Department of Psychology, MSB Medical School Berlin, Berlin (Volkert); Institute for Psychosocial Prevention, University of Heidelberg, Heidelberg, Germany (Volkert, Taubner); Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom (Byrne); North East London National Health Service Foundation Trust, London (Rossouw); Anna Freud Centre and University College London, London (Midgley)
| | - Trudie Rossouw
- Department of Psychology, MSB Medical School Berlin, Berlin (Volkert); Institute for Psychosocial Prevention, University of Heidelberg, Heidelberg, Germany (Volkert, Taubner); Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom (Byrne); North East London National Health Service Foundation Trust, London (Rossouw); Anna Freud Centre and University College London, London (Midgley)
| | - Nick Midgley
- Department of Psychology, MSB Medical School Berlin, Berlin (Volkert); Institute for Psychosocial Prevention, University of Heidelberg, Heidelberg, Germany (Volkert, Taubner); Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom (Byrne); North East London National Health Service Foundation Trust, London (Rossouw); Anna Freud Centre and University College London, London (Midgley)
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30
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Back SN, Flechsenhar A, Bertsch K, Zettl M. Childhood Traumatic Experiences and Dimensional Models of Personality Disorder in DSM-5 and ICD-11: Opportunities and Challenges. Curr Psychiatry Rep 2021; 23:60. [PMID: 34279729 PMCID: PMC8289775 DOI: 10.1007/s11920-021-01265-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE OF REVIEW Childhood trauma is an important risk factor for the development of personality disorders (PDs), yet most research has been devoted to categorical models of personality pathology. Considering the introduction of a dimensional PD model with ICD-11, we review current findings related to various forms of childhood trauma, and PDs, operationalized in the form of personality functioning and maladaptive traits. We focus on the magnitude of associations and examine specific relationships between emotional and physical trauma with areas of personality functioning and single traits. RECENT FINDINGS Two studies showed a strong association between childhood trauma and personality dysfunction. Seven studies, including clinical and forensic samples, demonstrated heterogeneous associations between various forms of childhood trauma and maladaptive traits. Overall, four studies indicated a slightly stronger association between personality dysfunction, maladaptive trait expression, and higher levels of emotional trauma than for physical or sexual trauma. Regarding specific trait domains and childhood trauma, most studies yielded the strongest associations for either psychoticism or detachment. Research on childhood trauma and dimensional PD models (i.e., personality functioning and traits) has the potential to contribute to a better understanding of their complex relationship. However, high intercorrelations among different types of childhood trauma, areas of personality functioning, and trait domains increase the difficulty of disentangling single effects. More research is needed including clinical and non-Western samples, especially considering the upcoming ICD-11 classification.
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Affiliation(s)
- Sarah N Back
- Department of Psychology, Faculty of Psychology and Education, Ludwig-Maximilians-University Munich, Leopoldstraße 13, 80802, Munich, Germany.
| | - Aleya Flechsenhar
- Department of Psychology, Faculty of Psychology and Education, Ludwig-Maximilians-University Munich, Leopoldstraße 13, 80802, Munich, Germany
| | - Katja Bertsch
- Department of Psychology, Faculty of Psychology and Education, Ludwig-Maximilians-University Munich, Leopoldstraße 13, 80802, Munich, Germany
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, University of Heidelberg, Heidelberg, Germany
| | - Max Zettl
- Institute for Psychosocial Prevention, Center for Psychosocial Medicine, Medical Faculty, University of Heidelberg, Heidelberg, Germany
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31
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de Carvalho Braule Pinto AL, R Pasian S, F Malloy-Diniz L. Identifying and validating emotion regulation latent profiles and their relationship with affective variables. J Clin Psychol 2021; 78:249-265. [PMID: 34252980 DOI: 10.1002/jclp.23213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 05/04/2021] [Accepted: 06/15/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE We investigated and validated the presence of emotion regulation profiles in an adult sample. METHOD In a cross-sectional study, 1165 individuals completed the Emotion Regulation Questionnaire (ERQ), Difficulties in Emotion Regulation Scale (DERS), Positive and Negative Affect Scale (PANAS), and Following Affective States Test (FAST). Sample was divided into three to establish and validate emotion regulation profiles using a latent profile analysis. RESULTS Sample 1 (n = 375) showed three different profiles: dysregulated, adapted, and unaware regulator. Sample 2 (n = 390) shows a consistent pattern with the same number of profiles that remained stable over time. In Sample 3 (n = 400), we validate and find that cognitive reappraisal and lack of awareness were essential to differentiating profiles. CONCLUSIONS Three emotional regulation profiles differ due to the levels of positive/negative affect and the propensity to avoid/follow emotions, increasing the understanding of how different regulatory strategies interact and explain different outcomes with mental health.
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Affiliation(s)
- André L de Carvalho Braule Pinto
- Psychodiagnostic Research Center, Graduate Program in Psychology, Faculty of Philosophy, Sciences and Letters, University of São Paulo at Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Sonia R Pasian
- Psychodiagnostic Research Center, Graduate Program in Psychology, Faculty of Philosophy, Sciences and Letters, University of São Paulo at Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Leandro F Malloy-Diniz
- Neuropsychological Research Laboratory, National Institute of Science and Technology of Molecular Medicine, Faculty of Medicine-Federal University of Minas Gerais, Belo Horizonte, Brazil
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32
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Harp Th TSD, Hepp J, Trull TJ, Bateman AW, Kongerslev MT, Simonsen E. Positive Affect Is Associated With Decreased Symptom Severity in the Daily Lives of Individuals With Borderline Personality Disorder. J Pers Disord 2021; 35:355-372. [PMID: 31682195 DOI: 10.1521/pedi_2019_33_453] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Previous research has repeatedly demonstrated positive associations between negative affect (NA) and borderline personality disorder (BPD) symptoms in daily life, but studies have rarely addressed potential effects of positive affect (PA). Consequently, little is known about how PA in daily life covaries with symptoms of BPD. The authors assessed the effects of both PA and NA levels on BPD symptom severity in a sample of 81 treatment-seeking women diagnosed with BPD over a period of 21 days, employing a daily diary design. Using multivariate multilevel modeling, the authors obtained negative associations between PA levels and daily BPD severity in total and at the level of the individual symptoms inappropriate anger, affective instability, emptiness, identity disturbance, and paranoid ideation/dissociation. Moreover, the authors replicated previously reported positive associations between NA and BPD severity for all nine symptoms. Future research can address whether increasing PA in the treatment of BPD may potentially help reduce symptom burden.
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Affiliation(s)
- Tine S D Harp Th
- Psychiatric Research Unit, Region Zealand, Slagelse, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Johanna Hepp
- Department of Psychosomatic Medicine, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Timothy J Trull
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri
| | - Anthony W Bateman
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mickey T Kongerslev
- Psychiatric Research Unit, Region Zealand, Slagelse, Denmark.,Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Erik Simonsen
- Psychiatric Research Unit, Region Zealand, Slagelse, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Vahidi E, Ghanbari S, Behzadpoor S. The relationship between mentalization and borderline personality features in adolescents: mediating role of emotion regulation. INTERNATIONAL JOURNAL OF ADOLESCENCE AND YOUTH 2021. [DOI: 10.1080/02673843.2021.1931376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Elahe Vahidi
- Department of Psychology, Faculty of Education and Psychology, Shahid Beheshti University, Tehran, Iran
| | - Saeed Ghanbari
- Department of Psychology, Faculty of Education and Psychology, Shahid Beheshti University, Tehran, Iran
| | - Samaneh Behzadpoor
- Department of Psychology, Faculty of Humanities, The University of Science and Culture, Tehran, Iran
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34
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Marchini F, Langher V, Napoli A, Balonan JT, Fedele F, Martino G, Amorosi FR, Caputo A. Unconscious loss processing in diabetes: associations with medication adherence and quality of care. PSYCHOANALYTIC PSYCHOTHERAPY 2021. [DOI: 10.1080/02668734.2021.1922492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Francesco Marchini
- Department of Dynamic and Clinical Psychology, “Sapienza” University of Rome, Rome, Italy
| | - Viviana Langher
- Department of Dynamic and Clinical Psychology, “Sapienza” University of Rome, Rome, Italy
| | - Angela Napoli
- Department of Clinical and Molecular Medicine, “Sapienza” University of Rome A.O. Sant’Andrea, Rome, Italy
| | - Jerilyn Tan Balonan
- Department of Dynamic and Clinical Psychology, “Sapienza” University of Rome, Rome, Italy
| | - Fabiola Fedele
- Department of Dynamic and Clinical Psychology, “Sapienza” University of Rome, Rome, Italy
| | - Gabriella Martino
- Department of Dynamic and Clinical Psychology, “Sapienza” University of Rome, Rome, Italy
| | | | - Andrea Caputo
- Department of Dynamic and Clinical Psychology, “Sapienza” University of Rome, Rome, Italy
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35
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Emotion regulation, mindfulness, and self-compassion among patients with borderline personality disorder, compared to healthy control subjects. PLoS One 2021; 16:e0248409. [PMID: 33730065 PMCID: PMC7968662 DOI: 10.1371/journal.pone.0248409] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 02/26/2021] [Indexed: 12/27/2022] Open
Abstract
Objectives Emotion regulation difficulties are a major characteristic of personality disorders. Our study investigated emotion regulation difficulties that are characteristic of borderline personality disorder (BPD), compared to a healthy control group. Methods Patients with BPD (N = 59) and healthy participants (N = 70) filled out four self-report questionnaires (Cognitive Emotion Regulation Questionnaire, Difficulties in Emotion Regulation Scale, Five Facet Mindfulness Questionnaire, Self-Compassion Scale) that measured the presence or lack of different emotion-regulation strategies. Differences between the BPD and the healthy control group were investigated by Multivariate Analysis of Variance (MANOVA) and univariate post-hoc F-test statistics. Results People suffering from BPD had statistically significantly (p<0.05) higher levels of emotional dysregulation and used more maladaptive emotion-regulation strategies, as well as lower levels of mindfulness and self-compassion compared to the HC group. Conclusion In comparison to a healthy control group, BPD patients show deficits in the following areas: mindfulness, self-compassion and adaptive emotion-regulation strategies. Based on these results, we suggest that teaching emotion-regulation, mindfulness, and self-compassion skills to patients can be crucial in the treatment of borderline personality disorder.
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Abstract
The main aim of this study was to examine the associations between emotion dysregulation and psychopathology in adolescence. A representative sample of 1,500 adolescent students (50% female) aged 12 to 19 years (M = 15.08, SD = 1.44) was recruited from schools and colleges located in the province of district Punjab, Pakistan, using a stratified sampling technique. Structural equation modeling (SEM) was used to test associations between five dimensions of emotion regulation difficulties and five forms of psychopathology by gender (male/female). The model provided an adequate fit to the data among girls and boys. In the model tested among boys, seven positive associations between emotion regulation difficulties and psychopathology variables were found. The model tested with girls included one negative and 13 positive associations between the study variables. Findings can be used for designing universal prevention programs to prevent the development of psychopathology.
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Affiliation(s)
- Huma Zafar
- Viqar un Nisa College for Women, Rawalpindi, Pakistan
- The University of Sheffield, Sheffield, UK
| | - Agata Debowska
- The University of Sheffield, Sheffield, UK
- SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | - Daniel Boduszek
- SWPS University of Social Sciences and Humanities, Warsaw, Poland
- University of Huddersfield, Huddersfield, UK
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Signer S, Estermann Jansen R, Sachse R, Caspar F, Kramer U. Social interaction patterns, therapist responsiveness, and outcome in treatments for borderline personality disorder. Psychol Psychother 2020; 93:705-722. [PMID: 31583805 DOI: 10.1111/papt.12254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Inflexible social interaction patterns are defining features of borderline personality disorder (BPD). Specific beliefs about the self and others may be activated across interaction situations, often leading to instable relationships. It may be pivotal to address these difficulties in early treatment phases, through appropriate therapist responsiveness, which means an adaptation of therapist's activity to their client's behaviours using emerging information in the process (Stiles, 2009, Clinical Psychology: Science and Practice, 16, 86). DESIGN In this process-outcome study, responsiveness is operationalized by the motive-oriented therapeutic relationship (Caspar, 2007, Handbook of psychotherapeutic case formulations, 2nd ed., 251-289, Guilford), based on the Plan analysis case formulation. The present study assesses the interplay between social interaction problems and therapist responsiveness, explaining symptoms at discharge and the therapeutic alliance. METHOD In total, N = 50 clients with BPD entered the study, and standard and responsive treatments were compared. Social interaction patterns were assessed by the newly developed Borderline Interaction Patterns Scale (BIPS), applied to recorded material of three sessions per therapy. Outcome was measured by general symptoms (OQ-45), borderline symptoms (BSL-23), interpersonal problems (IIP), and the therapeutic alliance (WAI). RESULTS Results suggest that in standard treatment, social interaction patterns are neither related to outcome nor the therapeutic alliance. In responsive treatment, more activation of social interaction patterns predicted better outcome on IIP and lower therapist ratings of the alliance. CONCLUSIONS The conclusions seem promising for specific effectiveness of responsive treatments in particular in the interpersonal problem area of BPD. Identifying social interaction patterns early in treatment may be a crucial pathway to change for BPD. PRACTITIONER POINTS Responsive therapy activating social interaction patterns may be crucial for better outcome. Future research should focus on mechanisms of change in early treatment phases for BPD. New scale for assessing social interaction patterns specific to borderline personality disorder.
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Affiliation(s)
- Silja Signer
- Department of Clinical Psychology and Psychotherapy, University of Bern, Switzerland
| | | | - Rainer Sachse
- Institut für Psychologische Psychotherapie, Bochum, Germany
| | - Franz Caspar
- Department of Clinical Psychology and Psychotherapy, University of Bern, Switzerland
| | - Ueli Kramer
- Institute of Psychotherapy and General Psychiatry Service, Department of Psychiatry-CHUV, University of Lausanne, Lausanne, Switzerland.,Department of Psychology, University of Windsor, Ontario, Canada
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Wall K, Vanwoerden S, Penner F, Patriquin M, Alfano CA, Sharp C. Adolescent Sleep Disturbance, Emotion Regulation and Borderline Features in an Inpatient Setting. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2020; 51:892-906. [PMID: 32603239 DOI: 10.1080/15374416.2020.1772081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The current study aimed to examine the relation between sleep disturbance, emotion dysregulation and borderline personality features in adolescent inpatients. METHOD N = 217 adolescents (67.1% female; ages 12-17) with the following racial/ethnic breakdown: 67.4% White, 3.7% Hispanic, 2.8% Asian, 1.8% African American, and 6.4% multiracial) completed self-report measures of sleep disturbance, emotion dysregulation and borderline personality symptoms at admission to, discharge from, and at 6-months-post discharge from an inpatient psychiatric hospital. Group comparison and path analyses were conducted to examine differences in sleep disturbance between those with and without borderline personality disorder and the mediating role of emotion dysregulation in the relation between sleep disturbance and borderline personality features. RESULTS Borderline personality features and emotion dysregulation were significantly related to indices of sleep disturbance. Path models revealed that some sleep disturbance indices at admission directly predicted levels of borderline features at discharge and at 6-months-post-discharge. However, none of the indirect pathways between sleep disturbance at admission, emotion dysregulation at discharge, and borderline features at discharge or 6-months post-discharge were significant. CONCLUSIONS Findings are consistent with prior literature which suggest that a unique relation exists between sleep disturbance and BPD, beyond comorbid depression symptoms. However, contrary to our hypotheses, the current study did not provide empirical support for the mediating role of emotion regulation in this relation. These findings have implications for existing personality disorder and sleep interventions and suggest further research into the mechanisms underlying the relation between sleep disturbance and borderline personality pathology is necessary.
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Affiliation(s)
- Kiana Wall
- Department of Psychology, University of Houston
| | | | | | - Michelle Patriquin
- Psychiatry and Behavioral Sciences, Baylor College of Medicine.,Psychiatry and Behavioral Sciences, The Menninger Clinic
| | | | - Carla Sharp
- Department of Psychology, University of Houston
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Sharp C. Adolescent Personality Pathology and the Alternative Model for Personality Disorders: Self Development as Nexus. Psychopathology 2020; 53:198-204. [PMID: 32464626 DOI: 10.1159/000507588] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/27/2020] [Indexed: 11/19/2022]
Abstract
This paper reviews maladaptive trait development (DSM-5 Section III Criterion B), the development of DSM-5 Section II borderline personality disorder, and research on the development of identity, self-direction, empathy/mentalizing, and intimacy (DSM-5 Section III Criterion A). Combined, these previously disparate literatures begin to point to an integrated developmental theory of personality pathology, which suggests that Criterion A concepts (identity, self-direction, empathy, and intimacy) coalesce around the development of self, marking a discontinuous (qualitative) developmental shift. This developmental shift is a function of the demands placed on individuals to take on independent adult role function, combined with biologically-based maturational cognitive and emotional advances during adolescence. Section II personality disorder ensues when an integrated and coherent sense of self fails to develop, resulting in nonfulfilment of adult role function. In this sense, Criterion A self function can account for the onset of Section II personality disorder in adolescence, while Criterion B provides a useful descriptive account of continuous aspects of personality function over time.
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Affiliation(s)
- Carla Sharp
- Department of Psychology, University of Houston, Houston, Texas, USA,
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40
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Effectiveness of a 5-Week Inpatient Dialectical Behavior Therapy for Borderline Personality Disorder. J Psychiatr Pract 2019; 25:192-198. [PMID: 31083031 DOI: 10.1097/pra.0000000000000383] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The goal of this study was to evaluate whether symptoms are reduced and emotion regulation improves when patients with borderline personality disorder (BPD) receive a 5-week course of inpatient dialectical behavioral therapy (DBT) and if changes in emotion regulation are associated with changes in symptoms. METHODS Forty-four patients with BPD receiving a 5-week course of DBT in a German psychiatry clinic participated. The short version of the "Borderline Symptom List" (BSL-23) was the patient-reported outcome. To measure emotion regulation, the "Self-Report Measure for the Assessment of Emotion Regulation Skills" (SEK-27) was administered. Wilcoxon tests were performed to evaluate whether pre-post changes in the BSL-23 and SEK-27 reached statistical significance. Effect sizes (d) were calculated and correlations between the pre-post differences for both measures were computed to test associations between changes in emotion regulation and changes in symptoms. Completer (n=33) and intention-to-treat (n=43) analyses were performed. RESULTS Symptoms (BSL-23) were reduced and emotion regulation (SEK-27) improved during the 5-week inpatient DBT treatment (completer and intention-to-treat analysis: P<0.001). Effect sizes reached d=0.47 for the BSL-23 and d=0.84 for the SEK-27 in the completer analysis, and d=0.38 for the BSL-23 and d=0.68 for the SEK-27 in the intention-to-treat analysis. Improvements in emotion regulation (SEK-27) were correlated with reductions in symptoms (BSL-23) in both the completer (r=0.54; P=0.001) and the intention-to-treat (r=0.59; P<0.001) analyses. CONCLUSIONS These findings indicate that a 5-week course of inpatient DBT can effectively reduce symptoms in patients with BPD and that the more patients' emotion regulation improves, the more the patients benefit from the therapy.
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Santangelo PS, Koenig J, Kockler TD, Eid M, Holtmann J, Koudela-Hamila S, Parzer P, Resch F, Bohus M, Kaess M, Ebner-Priemer UW. Affective instability across the lifespan in borderline personality disorder - a cross-sectional e-diary study. Acta Psychiatr Scand 2018; 138:409-419. [PMID: 30146733 DOI: 10.1111/acps.12950] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Longitudinal and cross-sectional studies suggest that affective instability is inversely related to greater age in borderline personality disorder (BPD). However, existing studies relied on retrospective self-reports of perceived instability. We examined affective instability in everyday life in patients with BPD and healthy controls (HCs) by age in a cross-sectional e-diary study. METHODS Two hundred and sixty female participants between 14 and 53 years of age (130 patients with BPD and 130 HCs) carried an e-diary over 4 days. The e-diaries emitted a prompting signal in approximately hourly intervals asking participants to rate their current affective state, that is valence (ranging from pleasant to unpleasant) and tense arousal (ranging from calm/relaxed to restless/under tension). RESULTS Multilevel analyses revealed a significant interaction of age and group predicting affective instability (valence: F(1,255.6) = 7.59; P < 0.01; tense arousal: F(1,252) = 6.08; P < 0.01), suggesting that affective instability significantly declines with greater age in patients with BPD. Controlling for the number of comorbid disorders and BPD severity did not change the results, illustrating an inverse relationship between age and affective instability in BPD (significant interaction of age*group for valence: F(1,238.7) = 5.74; P < 0.02 and tense arousal: F(1,235.2) = 5.28; P < 0.02). CONCLUSION Affective instability during daily life declines with greater age in BPD. This decline is irrespective of comorbidity and BPD severity.
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Affiliation(s)
- P S Santangelo
- Chair of Applied Psychology/Mental mHealth Lab, Institute of Sport and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany.,Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - J Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - T D Kockler
- Chair of Applied Psychology/Mental mHealth Lab, Institute of Sport and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - M Eid
- Department of Educational Science and Psychology, Freie Universität Berlin, Berlin, Germany
| | - J Holtmann
- Department of Educational Science and Psychology, Freie Universität Berlin, Berlin, Germany
| | - S Koudela-Hamila
- Chair of Applied Psychology/Mental mHealth Lab, Institute of Sport and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - P Parzer
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - F Resch
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - M Bohus
- Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - M Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - U W Ebner-Priemer
- Chair of Applied Psychology/Mental mHealth Lab, Institute of Sport and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany.,Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
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42
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García-Alandete J, Gallego Hernández de Tejada B, Pérez Rodríguez S, Marco-Salvador JH. Meaning in life among adolescents: Factorial invariance of the purpose in life test and buffering effect on the relationship between emotional dysregulation and hopelessness. Clin Psychol Psychother 2018; 26:24-34. [PMID: 30203883 DOI: 10.1002/cpp.2327] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/16/2018] [Accepted: 06/28/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The purpose of the present study was threefold: first, to analyse the psychometric properties of a 10-item Spanish version of the Purpose in Life Test, which assesses meaning in life (MiL), in a sample of community adolescents; second, to analyse the differences between the age and gender groups; and third, to analyse whether MiL buffers the relationship between emotional dysregulation and hopelessness. METHOD Participants were 1,599 adolescents from 12 to 19 years old, M = 15.69, SD = 2.14. The Purpose in Life Test-10 Items, the Beck Hopelessness Scale, and the Difficulties in Emotional Regulation Scale were used. RESULTS A nine-item version showed good fit, psychometric properties (internal consistency, construct, and concurrent validity), and factorial invariance across gender and age (12-15 years/16-19 years). Difference in MiL between boys and girls was not significant, whereas between age groups was significant. MiL had a strong buffering effect on the relationship between emotional dysregulation and hopelessness. DISCUSSION It is desirable to promote the sense of MiL in adolescents. MiL plays a significant and strong mediator role in the relationship between emotional dysregulation and hopelessness, reinforcing the positive role of MiL in mental health and as a resource for facing adversity.
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Affiliation(s)
- Joaquín García-Alandete
- Dpto. de Metodología, Neuropsicobiología y Psicología Básica y Social, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain
| | | | - Sandra Pérez Rodríguez
- Dpto. de Personalidad, Evaluación y Tratamientos Psicológicos, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain
| | - José H Marco-Salvador
- Dpto. de Personalidad, Evaluación y Tratamientos Psicológicos, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain
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43
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Kim MK, Kim JS, Park HI, Choi SW, Oh WJ, Seok JH. Early life stress, resilience and emotional dysregulation in major depressive disorder with comorbid borderline personality disorder. J Affect Disord 2018; 236:113-119. [PMID: 29730510 DOI: 10.1016/j.jad.2018.04.119] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 03/17/2018] [Accepted: 04/08/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Borderline personality disorder (BPD) show different course and treatment compared to major depressive disorder (MDD). Early life stress may increase BPD onset; however, resilience may play a protective role against the development of psychopathology. The goal of this study was to compare the early life stress, resilience, and the clinical characteristics of emotional dysregulation in patients with MDD with and without comorbid BPD. METHODS Thirty patients with both BPD and MDD, 25 patients with MDD alone, and 25 age- and sex- matched healthy controls, participated in this study. Analysis of variance was used to compare the early life stress, resilience, and emotional dysregulation among groups. Also, multivariate logistic regression models were used to identify the relationship of the early life stress and resilience domains with BPD comorbidity within MDD patients. RESULTS The domains of emotional abuse and self-regulation ability were significantly associated with BPD comorbidity and BPD severity. In emotional dysregulation, difficulty scores of impulsivity, coping strategies, and emotion clarity domains were significantly increased in patients with both BPD and MDD compared to patients with MDD alone. LIMITATIONS The relatively small sample size may contribute to reduce statistical power of investigation. CONCLUSIONS Emotional abuse experiences in early life, and deficits in self-regulation, are significantly associated with comorbid BPD in patients with MDD. A comprehensive evaluation including early life stress, resilience and emotion regulation ability may help to identify comorbid BPD in patients with MDD and develop treatment strategies.
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Affiliation(s)
- Min-Kyeong Kim
- Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong-Sun Kim
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hae-In Park
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sun-Woo Choi
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Wook-Jin Oh
- Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Ho Seok
- Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Krauch M, Ueltzhöffer K, Brunner R, Kaess M, Hensel S, Herpertz SC, Bertsch K. Heightened Salience of Anger and Aggression in Female Adolescents With Borderline Personality Disorder-A Script-Based fMRI Study. Front Behav Neurosci 2018; 12:57. [PMID: 29632476 PMCID: PMC5879116 DOI: 10.3389/fnbeh.2018.00057] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 03/09/2018] [Indexed: 01/27/2023] Open
Abstract
Background: Anger and aggression belong to the core symptoms of borderline personality disorder. Although an early and specific treatment of BPD is highly relevant to prevent chronification, still little is known about anger and aggression and their neural underpinnings in adolescents with BPD. Method: Twenty female adolescents with BPD (age 15–17 years) and 20 female healthy adolescents (age 15–17 years) took part in this functional magnetic resonance imaging (fMRI) study. A script-driven imagery paradigm was used to induce rejection-based feelings of anger, which was followed by descriptions of self-directed and other-directed aggressive reactions. To investigate the specificity of the neural activation patterns for adolescent patients, results were compared with data from 34 female adults with BPD (age 18–50 years) and 32 female healthy adults (age 18–50 years). Results: Adolescents with BPD showed increased activations in the left posterior insula and left dorsal striatum as well as in the left inferior frontal cortex and parts of the mentalizing network during the rejection-based anger induction and the imagination of aggressive reactions compared to healthy adolescents. For the other-directed aggression phase, a significant diagnosis by age interaction confirmed that these results were specific for adolescents. Discussion: The results of this very first fMRI study on anger and aggression in adolescents with BPD suggest an enhanced emotional reactivity to and higher effort in controlling anger and aggression evoked by social rejection at an early developmental stage of the disorder. Since emotion dysregulation is a known mediator for aggression in BPD, the results point to the need of appropriate early interventions for adolescents with BPD.
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Affiliation(s)
- Marlene Krauch
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Kai Ueltzhöffer
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.,Department of Psychology, Goethe University Frankfurt, Frankfurt am Main, Germany.,Bernstein Center for Computational Neuroscience, University of Heidelberg, Mannheim, Germany
| | - Romuald Brunner
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Saskia Hensel
- Department of Psychosomatic Medicine, Central Institute of Mental Health, Mannheim, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Katja Bertsch
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
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45
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Bo S, Kongerslev M. Self-reported patterns of impairments in mentalization, attachment, and psychopathology among clinically referred adolescents with and without borderline personality pathology. Borderline Personal Disord Emot Dysregul 2017; 4:4. [PMID: 28228967 PMCID: PMC5310093 DOI: 10.1186/s40479-017-0055-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 02/09/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous research, which primarily focused on adult samples, suggests that individuals with borderline personality disorder (BPD) display high levels of psychopathology, dysfunctional mentalization and problematic attachment to others. The current study investigated whether impairments in mentalization, attachment, and psychopathology are more severe in outpatient adolescents with BPD than in a clinical comparison group. METHODS Consecutive referrals to a child and adolescent psychiatric clinic were clinically assessed with a battery of self-report instruments to assess mentalization, attachment, and psychopathology. Specifically, in regard to BPD a self-report questionnaire was employed to decide if patients were classified into the BPD or the clinical comparison group. The main outcome variables of adolescents with a primary diagnosis of BPD were then compared with those of a clinical comparison group comprising patients receiving psychiatric diagnoses other than BPD. RESULTS Relative to the clinical group without BPD, and after controlling for sociodemographic variables, the BPD group displayed poorer mentalizing abilities, more problematic attachments to parents and peers, and higher self-reported levels of psychopathology. CONCLUSIONS The results of this study suggest that BPD is a severe mental condition in adolescents and is characterized by poor mentalizing abilities, attachment problems and high levels of psychopathology compared to adolescents with psychiatric disorders other than BPD. Hence, clinicians should consider BPD when conducting diagnostic assessments, and evidence-based treatments for this vulnerable group should be developed.
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Affiliation(s)
- Sune Bo
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Department of Child and Adolescent Psychiatry, Region Zealand Psychiatry, Roskilde, Denmark
| | - Mickey Kongerslev
- Centre of Excellence on Personality Disorder, Region Zealand Psychiatry, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
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