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Brown RH, Speyer LG, Eisner MP, Ribeaud D, Murray A. Exploring the effect of ADHD traits on the moment-to-moment interplay between provocation and aggression: Evidence from dynamic structural equation modeling. Aggress Behav 2023; 49:469-479. [PMID: 36891623 DOI: 10.1002/ab.22081] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 01/10/2023] [Accepted: 02/23/2023] [Indexed: 03/10/2023]
Abstract
The relation between attention deficit hyperactivity disorder (ADHD) symptoms and aggression is well documented; however, the processes that account for higher levels of aggression associated with ADHD in the course of daily life are little understood. The current study used ecological momentary assessment to explore how ADHD traits relate to individual differences in perceiving provocation from others and the resultant aggressive behaviors; and the strengths of the links between provocation and aggression in the flow of daily life. A dynamic structural equation model was fit using data from a subpopulation of young adults involved in the longitudinal z-proso study (n = 259, median-age 20). Data on provocation and aggression was collected at four quasi-random time periods per day over a 14-day period. Individuals with higher ADHD trait levels reported higher instances of provocation and aggression, with ADHD traits significantly moderating aggression inertia such that those with higher levels of ADHD traits showed greater persistence of aggressive behavior over time. However, ADHD trait levels did not significantly moderate any of the observed cross-lagged effects. Our findings suggest that individuals with higher levels of ADHD traits are at greater risk of exposure to interpersonal interactions involving interpersonal provocation, show higher levels of aggressive behavior in daily life, and find it more difficult to reduce their aggression once triggered. These findings support the importance of targeting factors such as social skills and emotion regulation that may underpin the increased difficulties in interpersonal interactions often experienced by individuals with high levels of ADHD symptoms.
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Affiliation(s)
- Ruth H Brown
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Lydia G Speyer
- Department of Psychology, University of Cambridge, Cambridge, UK
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Manuel P Eisner
- Violence Research Centre, Institute of Criminology, University of Cambridge, Cambridge, UK
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
| | - Denis Ribeaud
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
| | - Aja Murray
- Department of Psychology, University of Cambridge, Cambridge, UK
- Department of Psychology, University of Edinburgh, Edinburgh, UK
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2
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Kouppis E, Gerdin B, Björkenstam C, Björkenstam E, Ekselius L. Effect of comorbid ADHD on mortality in women with borderline personality disorder. Borderline Personal Disord Emot Dysregul 2022; 9:25. [PMID: 36316740 PMCID: PMC9623906 DOI: 10.1186/s40479-022-00196-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 09/02/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Many similarities exist between borderline personality disorder (BPD) and attention-deficit/hyperactivity disorder (ADHD), more so in women than in men. People with comorbid ADHD and BPD represent a subgroup of BPD patients with distinct symptom expression and, consequently, a different prognosis. We used Swedish national high quality registers to assess whether such comorbidity is related to increased mortality risk. The study focused on women with BPD because they are more likely than men to be clinically diagnosed with BPD and present a higher mortality risk, especially for unnatural causes of death, including suicide. FINDINGS In a cohort of 15 847 women diagnosed with BPD a subsequent clinical diagnosis of ADHD did not influence the overall risk of mortality, including suicide. CONCLUSIONS Women with comorbid ADHD and BPD have a similar mortality risk as those only diagnosed with BPD.
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Affiliation(s)
| | - Bengt Gerdin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Emma Björkenstam
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Lisa Ekselius
- Department of Women's and Children's Health, Uppsala University, Akademiska Sjukhuset, 751 85, Uppsala, Sweden.
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3
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Neukel C, Bullenkamp R, Moessner M, Spiess K, Schmahl C, Bertsch K, Herpertz SC. Anger instability and aggression in Borderline Personality Disorder - an ecological momentary assessment study. Borderline Personal Disord Emot Dysregul 2022; 9:29. [PMID: 36244971 PMCID: PMC9575226 DOI: 10.1186/s40479-022-00199-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/09/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Anger and aggression are core features of Borderline Personality Disorder (BPD), contributing strongly to the individual as well as the societal burden caused by the disorder. Across studies, patients with BPD have shown increased, more frequent and prolonged episodes of anger and reported an increased prevalence of reactive aggression. However, only a few studies have investigated anger and aggression in the patients' everyday lives and did not consider anger instability. In order to contribute knowledge about aggression and its association with anger intensity and anger instability in real-life in BPD the aim of the present study was to better characterize days with and without aggressive behaviors with regard to the patients' experienced anger. METHODS Patients with BPD and high aggression as well as healthy participants took part in an ecological momentary assessment (EMA) study assessing state anger and aggression three times per day over two weeks. Multilevel modeling was conducted and anger instability was operationalized by squared successive differences. RESULTS As expected, patients with BPD reported greater instability in their experienced anger compared to healthy participants. Most interestingly, in the BPD group the occurrence of aggressive behavior was significantly associated with anger intensity as well as anger instability. More precisely, on days when patients with BPD acted out aggressively, they reported higher anger intensity as well as greater anger instability than on days when they did not act out aggressively. CONCLUSION Knowledge about what characterizes days with aggressive behaviors may help to improve interventions to reduce aggressive behavior and thus relieve the burden aggression causes for patients with BPD, their surroundings and society.
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Affiliation(s)
- Corinne Neukel
- Department of General Psychiatry, Medical Faculty, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany.
| | - Robin Bullenkamp
- Department of General Psychiatry, Medical Faculty, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Markus Moessner
- Center for Psychotherapy Research, Heidelberg University, Heidelberg, Germany
| | - Karen Spiess
- Department of General Psychiatry, Medical Faculty, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Katja Bertsch
- Department of General Psychiatry, Medical Faculty, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany.,Department of Psychology, LMU Munich, Munich, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Medical Faculty, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
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4
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Akça ÖF, Wall K, Sharp C. Divergent mentalization types in adolescent borderline personality disorder and attention deficit/hyperactivity disorder. Nord J Psychiatry 2021; 75:479-486. [PMID: 33635183 DOI: 10.1080/08039488.2021.1887349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Attention deficit/hyperactivity disorder (ADHD) and borderline personality disorder (BPD) have several similarities and it is difficult to distinguish these disorders in adolescents. We aimed to identify the unique correlates of mentalization abilities that may distinguish these two disorders, and to investigate the mentalization abilities of adolescents with ADHD, BPD and ADHD + BPD in an inpatient sample to determine the effect of co-morbidity on mentalization abilities. METHODS We have explored the relationship between Child Eye Test (CET) scores, Movie for the Assessment of Social Cognition (MASC) subscales, and ADHD and BPD symptoms in adolescent inpatients. In addition, we compared ADHD, BPD and ADHD + BPD groups in terms of their mentalization abilities. RESULTS Correct MASC scores were negatively associated with both ADHD and BPD symptoms in girls, and negatively associated with ADHD symptoms in boys. In addition, hypermentalization scores were associated with BPD symptoms in girls, and hypomentalization and no mentalization scores were associated with ADHD symptoms in girls. CET scores were negatively associated with ADHD symptoms in girls, but no relations with BPD were found. Group comparisons revealed no significant difference among groups. LIMITATIONS We included only inpatient sample without considering their medication condition, we did not compare the mentalization scores of the patient groups with healthy controls and we used self-report measures for several assessments. CONCLUSION Mentalization patterns in ADHD and BPD are distinct. ADHD may be related to hypomentalization, instead, BPD may be related to hypermentalization.
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Affiliation(s)
- Ömer Faruk Akça
- Department of Child and Adolescent Psychiatry, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Kiana Wall
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Carla Sharp
- Department of Psychology, University of Houston, Houston, TX, USA
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5
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Krause-Utz A, Mertens LJ, Renn JB, Lucke P, Wöhlke AZ, van Schie CC, Mouthaan J. Childhood Maltreatment, Borderline Personality Features, and Coping as Predictors of Intimate Partner Violence. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:6693-6721. [PMID: 30596325 PMCID: PMC8202213 DOI: 10.1177/0886260518817782] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Intimate partner violence (IPV) is a serious mental and physical health concern worldwide. Although previous research suggests that childhood maltreatment increases the risk for IPV, the underlying psychological mechanisms of this relationship are not yet entirely understood. Borderline personality (BP) features may play an important role in the cycle of violence, being associated with interpersonal violence in both childhood and adult relationships. The present study investigated whether BP features mediate the relationship between childhood maltreatment and IPV, differentiating between perpetration and victimization, and taking maladaptive stress coping and gender into account. Self-reports on IPV, childhood trauma, BP features, and maladaptive stress coping were collected in a mixed (nonclinical and clinical) sample of 703 adults (n = 537 female, n = 166 male), using an online survey. A serial mediation analysis (PROCESS) was performed to quantify the direct effect of childhood maltreatment on IPV and its indirect effects through BP features and maladaptive coping. Childhood maltreatment severity significantly positively predicted IPV perpetration as well as victimization. BP features, but not coping, partially mediated this relationship. Follow-up analyses suggest that affective instability and interpersonal disturbances (e.g., separation concerns) play an important role in IPV perpetration, while interpersonal and identity disturbances may mediate the effect of childhood maltreatment on IPV victimization. In clinical practice, attention should be paid not only to histories of childhood abuse and neglect but also to BP features, which may be possible risk factors for IPV.
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Affiliation(s)
- Annegret Krause-Utz
- Leiden University, The Netherlands
- Leiden Institute for Brain and Cognition, The Netherlands
- Heidelberg University, Germany
| | | | | | | | | | - Charlotte C. van Schie
- Leiden University, The Netherlands
- Leiden Institute for Brain and Cognition, The Netherlands
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Deuter CE, Duesenberg M, Hellmann-Regen J, Metz S, Roepke S, Wolf OT, Otte C, Wingenfeld K. Psychosocial stress increases testosterone in patients with borderline personality disorder, post-traumatic stress disorder and healthy participants. Borderline Personal Disord Emot Dysregul 2021; 8:3. [PMID: 33517905 PMCID: PMC7849084 DOI: 10.1186/s40479-021-00145-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 01/10/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The gonadal hormone testosterone not only regulates sexual behavior but is also involved in social behavior and cognition in both sexes. Changes in testosterone secretion in response to stress have been reported. In addition, stress associated mental disorders such as borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD) are characterized by alterations in basal testosterone metabolism. However, testosterone changes to stress have not been investigated in mental disorders such as BPD and PTSD so far. METHODS In the study described, we investigated testosterone reactivity to an acute psychosocial stressor, the Trier Social Stress Test (TSST). Our sample consisted of young adult women with BPD (n = 28), PTSD (n = 22) or both disorders (n = 22), and healthy control (n = 51). Based on previous studies on basal testosterone secretion in these disorders, we expected the stress-associated testosterone reactivity to be higher in the BPD group and lower in the PTSD group, when compared to the healthy control group. RESULTS The study could demonstrate an increase in testosterone after acute stress exposure across all groups and independent of BPD or PTSD status. Different possible explanations for the absence of a group effect are discussed. CONCLUSIONS From the results of this study, we conclude that stress-related changes in testosterone release are not affected by BPD or PTSD status in a female patient population. This study expands the knowledge about changes in gonadal hormones and stress reactivity in these disorders.
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Affiliation(s)
- Christian E Deuter
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, 12203, Berlin, Germany.
| | - Moritz Duesenberg
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, 12203, Berlin, Germany
| | - Julian Hellmann-Regen
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, 12203, Berlin, Germany
| | - Sophie Metz
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, 12203, Berlin, Germany
| | - Stefan Roepke
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, 12203, Berlin, Germany
| | - Oliver T Wolf
- Department of Cognitive Psychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Christian Otte
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, 12203, Berlin, Germany
| | - Katja Wingenfeld
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, 12203, Berlin, Germany
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Akça ÖF, Wall K, Sharp C. Borderline personality disorder and attention deficit/hyperactivity disorder in adolescence: overlap and differences in a clinical setting. Borderline Personal Disord Emot Dysregul 2020; 7:7. [PMID: 32313658 PMCID: PMC7158052 DOI: 10.1186/s40479-020-00122-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/24/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND With increased consensus regarding the validity and reliability of diagnosing Borderline Personality Disorder (BPD) in adolescents, clinicians express concern over the distinction between BPD and Attention-Deficit/Hyperactivity Disorder (ADHD), and its co-morbidity in clinical settings. The goal of this study was to evaluate differences between BPD, ADHD and BPD + ADHD in terms of co-morbid psychiatric disorders and a range of self-reported behavioral problems in adolescents. METHODS Our sample consisted of N = 550 inpatient adolescents with behavioral and emotional disorders that have not responded to prior intervention. We took a person-centered approach (for increase clinical relevance) and compared adolescents with ADHD, BPD and ADHD+BPD in terms of co-occurring psychiatric disorders and behavioral problems. We performed a regression analysis to test whether BPD symptoms make an incremental contribution to the prediction of psychiatric symptoms over ADHD symptoms. RESULTS The severity of almost all co-occurring disorders, aggression, self-harm, suicidal thoughts, and substance use, were higher in the ADHD+BPD group. Borderline symptoms made an incremental contribution to the prediction of psychiatric symptoms beyond the contribution of ADHD. CONCLUSION Severity and co-morbidity may be helpful factors in distinguishing between ADHD and BPD in clinical practice and the co-morbidity of these two disorders may indicate a worse clinical outcome.
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Affiliation(s)
- Ömer Faruk Akça
- 1Meram School of Medicine, Department of Child and Adolescent Psychiatry, Necmettin Erbakan University, 42080 Konya, Turkey
| | - Kiana Wall
- 2Department of Psychology, University of Houston, Houston, TX USA
| | - Carla Sharp
- 2Department of Psychology, University of Houston, Houston, TX USA
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8
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Rüfenacht E, Euler S, Prada P, Nicastro R, Dieben K, Hasler R, Pham E, Perroud N, Weibel S. Emotion dysregulation in adults suffering from attention deficit hyperactivity disorder (ADHD), a comparison with borderline personality disorder (BPD). Borderline Personal Disord Emot Dysregul 2019; 6:11. [PMID: 31360522 PMCID: PMC6637623 DOI: 10.1186/s40479-019-0108-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 06/25/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Emotional dysregulation (ED) is now considered as an important symptom of attention deficit hyperactivity disorder (ADHD). It is believed to have a considerable impact on the severity of the disorder, one's global functioning, and the prognosis. Our research aimed to evaluate and compare ED and cognitive emotional regulation strategies between ADHD and borderline personality disorder (BPD) patients. METHODS Four hundred six French-speaking outpatients (N = 279 ADHD, N = 70 BPD, N = 60 BPD + ADHD) were assessed with the Emotion Reactivity Scale (ERS), the Cognitive Emotional Regulation Questionnaire (CERQ), The Basic Empathy Scale (BES-A), the Adult ADHD Self-Report Scale (ARSV-v1.1) and the Beck Depression Inventory II (BDI-II). ADHD, BPD and comorbid patients were compared with each other and with samples of controls extracted from already published data. RESULTS ADHD patients, although having higher ED than samples derived from the general population, had less ED, better control over their emotions with higher use of adaptive cognitive strategies and lesser use of non-adaptive strategies than BPD patients. However, ADHD subjects had similar scores as BPD subjects when looking at difficulties in perceiving self and others. ED generated considerable distress in all groups and was also positively associated with ADHD symptomatology. ADHD patients with comorbid BPD had the highest scores of ED. CONCLUSIONS Our results suggest that there may be similarly inefficient cognitive emotional regulation skills leading to ED in both disorders (ADHD and BPD). However, ADHD patients showed a higher use of adaptive cognitive emotional strategies and a lower level of ED than BPD patients.
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Affiliation(s)
- Eva Rüfenacht
- TRE Unit, Department of Psychiatry, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, 20bis rue de Lausanne, Geneva, Switzerland
| | - Sebastian Euler
- Department of Consultation Psychiatry and Psychosomatics, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Paco Prada
- TRE Unit, Department of Psychiatry, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, 20bis rue de Lausanne, Geneva, Switzerland
| | - Rosetta Nicastro
- TRE Unit, Department of Psychiatry, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, 20bis rue de Lausanne, Geneva, Switzerland
| | - Karen Dieben
- TRE Unit, Department of Psychiatry, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, 20bis rue de Lausanne, Geneva, Switzerland
| | - Roland Hasler
- TRE Unit, Department of Psychiatry, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, 20bis rue de Lausanne, Geneva, Switzerland
| | - Eléonore Pham
- TRE Unit, Department of Psychiatry, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, 20bis rue de Lausanne, Geneva, Switzerland
| | - Nader Perroud
- TRE Unit, Department of Psychiatry, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, 20bis rue de Lausanne, Geneva, Switzerland
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Sébastien Weibel
- Pôle de Psychiatrie, Santé Mentale et Addictologie, University Hospital Strasbourg, Strasbourg, France
- INSERM 1114, Strasbourg, France
- FMTS, University of Strasbourg, Strasbourg, France
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Blair RJR. Traits of empathy and anger: implications for psychopathy and other disorders associated with aggression. Philos Trans R Soc Lond B Biol Sci 2019; 373:rstb.2017.0155. [PMID: 29483341 DOI: 10.1098/rstb.2017.0155] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2017] [Indexed: 12/22/2022] Open
Abstract
Empathy and anger are two social emotions that modulate an individual's risk for aggression. Empathy is an emotional reaction to another individual's emotional state. Anger is an emotional reaction to threat, frustration or social provocation. Reduced empathy, seen in psychopathy, increases the risk for goal-directed aggression. Atypically increased anger (i.e. irritability), seen in conditions like disruptive mood dysregulation disorder and borderline personality disorder, increases the risk for reactive aggression. In this paper, I will outline core neurocognitive functions that correspond to empathy and which are compromised in individuals with psychopathic traits. In addition, I will outline neurocognitive functions involved in either the generation or regulation of anger and which are compromised in psychiatric conditions at increased risk for irritability/reactive aggression. It can be hoped that improved understanding of empathy and anger will lead to better assessment tools and improved interventions to reduce aggression risk.This article is part of the theme issue 'Diverse perspectives on diversity: multi-disciplinary approaches to taxonomies of individual differences'.
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Affiliation(s)
- R J R Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Omaha, NE 68131, USA
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Weiner L, Perroud N, Weibel S. Attention Deficit Hyperactivity Disorder And Borderline Personality Disorder In Adults: A Review Of Their Links And Risks. Neuropsychiatr Dis Treat 2019; 15:3115-3129. [PMID: 31806978 PMCID: PMC6850677 DOI: 10.2147/ndt.s192871] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 10/23/2019] [Indexed: 12/12/2022] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) and borderline personality disorder (BPD) are particularly common disorders, that are highly comorbid in adult populations. The symptomatic overlap between adult ADHD and BPD includes impulsivity, emotional dysregulation and interpersonal impairment, which makes the differential diagnosis difficult. Our review aims at focusing on recent data on the comorbid ADHD+BPD form, as well as the risk factors involved in the emergence of the two disorders. While adult ADHD and BPD share some genetic and temperamental risk factors, adult ADHD is characterized by more severe trait-impulsivity compared to non-comorbid BPD; BPD patients display more severe trait-emotion regulation symptoms compared to non-comorbid ADHD. Patients with the comorbid ADHD+BPD form have severe symptoms in both dimensions. Early-life exposure to adverse events is a shared risk factor for the development of ADHD and BPD, but type and timing of adversity seem to play a differential role in the development of BPD and ADHD symptoms. Age of onset used to be a discriminative diagnostic criterion between ADHD, an early-onset neurodevelopmental disorder, and BPD, a late-onset psychological disorder. However, this distinction has been recently called into question, increasing the need for more research aiming at delineating the disorders from a developmental and clinical standpoint. Clinicians should carefully consider the comorbidity, and consider ADHD and BPD dimensionally, in order to provide more effective patient management. This might improve early preventive interventions, and treatment for comorbid conditions in adulthood.
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Affiliation(s)
- Luisa Weiner
- Department of Psychiatry, University Hospital of Strasbourg, Strasbourg, France.,Laboratoire De Psychologie Des Cognitions, University of Strasbourg, Strasbourg, France
| | - Nader Perroud
- Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland.,Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sébastien Weibel
- Department of Psychiatry, University Hospital of Strasbourg, Strasbourg, France.,Inserm U1114, Strasbourg, France
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11
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Krause-Utz A, Erol E, Brousianou AV, Cackowski S, Paret C, Ende G, Elzinga B. Self-reported impulsivity in women with borderline personality disorder: the role of childhood maltreatment severity and emotion regulation difficulties. Borderline Personal Disord Emot Dysregul 2019; 6:6. [PMID: 30873282 PMCID: PMC6399941 DOI: 10.1186/s40479-019-0101-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 02/05/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Childhood maltreatment, such as severe emotional, physical, and sexual abuse and neglect, has been linked to impulse control problems and dysfunctional emotional coping. In borderline personality disorder (BPD), a history of childhood maltreatment may worsen difficulties in emotion regulation, which may in turn give rise to impulsive behaviours. The aim of this self-report study was to investigate associations between childhood maltreatment severity, emotion regulation difficulties, and impulsivity in women with BPD compared to healthy and clinical controls. METHODS Sixty-one female patients with BPD, 57 clinical controls (CC, women with Attention Deficit Hyperactivity Disorder and/or Substance Use Disorder, without BPD), and 60 female healthy controls (HC) completed self-report scales on childhood trauma (Childhood Trauma Questionnaire, CTQ), difficulties in emotion regulation (Difficulties in Emotion Regulation Scale, DERS), and impulsivity (UPPS Impulsive Behaviour Scale). A conditional process analysis was performed to investigate whether emotion dysregulation statistically mediated the effect of childhood maltreatment severity on impulsivity depending on group (BPD vs. CC vs. HC). RESULTS Childhood maltreatment, particularly emotional maltreatment, was positively associated with impulsivity and emotion regulation difficulties across all groups. Difficulties in emotion regulation statistically mediated the effect of childhood maltreatment on impulsivity in BPD, but not in the other groups. CONCLUSION In the context of current conceptualizations of BPD and previous research, findings suggest that problems with emotion regulation may be related to a history of childhood maltreatment, which may in turn enhance impulsivity. Targeting emotion dysregulation in psychotherapy and discussing it in relation to childhood maltreatment can help decreasing impulsive behaviors in individuals with BPD. Given the correlational design of our study which does not allow causal conclusions, future studies have to employ prospective, experimental designs and include larger sample sizes to corroborate associations between childhood maltreatment, emotion dysregulation, and impulsivity.
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Affiliation(s)
- Annegret Krause-Utz
- Department of Clinical Psychology, Institute of Psychology, Leiden, The Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden, the Netherlands
| | - Ezgi Erol
- Department of Clinical Psychology, Institute of Psychology, Leiden, The Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden, the Netherlands.,3Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim, Germany.,4Medical Faculty, University of Heidelberg, Mannheim, Germany
| | - Athina V Brousianou
- Department of Clinical Psychology, Institute of Psychology, Leiden, The Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden, the Netherlands
| | - Sylvia Cackowski
- 4Medical Faculty, University of Heidelberg, Mannheim, Germany.,5Department of Psychosomatic Medicine and Psychtherapy, Central Institute of Mental Health (CIMH), Mannheim, Germany
| | - Christian Paret
- 4Medical Faculty, University of Heidelberg, Mannheim, Germany.,5Department of Psychosomatic Medicine and Psychtherapy, Central Institute of Mental Health (CIMH), Mannheim, Germany
| | - Gabriele Ende
- 4Medical Faculty, University of Heidelberg, Mannheim, Germany.,6Department Neuoimaging, Central Institute of Mental Health (CIMH), Mannheim, Germany
| | - Bernet Elzinga
- Department of Clinical Psychology, Institute of Psychology, Leiden, The Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden, the Netherlands
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Mechanism underlying NMDA blockade-induced inhibition of aggression in post-weaning socially isolated mice. Neuropharmacology 2018; 143:95-105. [DOI: 10.1016/j.neuropharm.2018.09.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 08/22/2018] [Accepted: 09/11/2018] [Indexed: 11/18/2022]
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