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Euteneuer F, Lass-Hennemann J, Pfundmair M, Salzmann S, Kuehl LK. Childhood emotional maltreatment and sensitivity to social rejection in emerging adults. CHILD ABUSE & NEGLECT 2024; 149:106604. [PMID: 38160496 DOI: 10.1016/j.chiabu.2023.106604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 11/20/2023] [Accepted: 12/12/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Enhanced responsiveness to social rejection may be a transdiagnostic mechanism through which childhood emotional maltreatment predisposes individuals to interpersonal and mental health problems. To investigate this mechanism, as a first step, more detailed investigations are needed regarding the assumed association of childhood emotional maltreatment with rejection sensitivity in later life. OBJECTIVE The present work examines the hypothesis that among different subtypes of childhood maltreatment, in particular forms of emotional maltreatment (emotional abuse and neglect) relate to rejection sensitivity in emerging adults. PARTICIPANTS AND SETTING In study 1, 311 emerging adults (18-25 years) participated in a retrospective cross-sectional assessment. In study 2, 78 emerging adults (18-25 years) were included in an experiment (O-Cam paradigm) which involved the experience of social rejection (vs. inclusion). METHODS Study 1 investigates whether intensities of childhood emotional abuse and neglect have unique associations with trait rejection sensitivity, when considering all maltreatment subtypes (emotional abuse, sexual abuse, physical abuse, emotional neglect, physical neglect) simultaneously. Study 2 examined whether childhood emotional abuse and neglect moderate the experience of social rejection in terms of need depletion, sadness and anger after social rejection (vs. inclusion). RESULTS Study 1 indicates that emotional abuse and neglect have unique associations with rejection sensitivity. Study 2 results show that only a higher intensity of emotional abuse has extensive effects on need depletion and sadness after social rejection (vs. inclusion). CONCLUSIONS In particular, experiences of childhood emotional abuse may relate to rejection sensitivity in young adulthood.
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Affiliation(s)
- Frank Euteneuer
- Clinical Psychology and Psychotherapy, Department of Psychology, Medical School Berlin, Berlin, Germany; Division of Translational Clinical Stress Research, Institute of Neuroscience and Biopsychology for Clinical Application, Medical School Berlin, Berlin, Germany.
| | - Johanna Lass-Hennemann
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany
| | - Michaela Pfundmair
- Faculty of Intelligence, Federal University of Administrative Sciences, Berlin, Germany
| | - Stefan Salzmann
- Medical Psychology, Department of Medicine, Health and Medical University, Erfurt, Germany; Division of Clinical Psychology and Psychotherapy, Department of Psychology, University of Marburg, Marburg, Germany
| | - Linn Kristina Kuehl
- Clinical Psychology and Psychotherapy, Department of Psychology, Medical School Berlin, Berlin, Germany; Division of Translational Clinical Stress Research, Institute of Neuroscience and Biopsychology for Clinical Application, Medical School Berlin, Berlin, Germany
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Broekhof R, Nordahl HM, Eikenæs IUM, Selvik SG. Adverse Childhood Experiences Are Associated With Personality Disorder: A Prospective, Longitudinal Study. J Pers Disord 2024; 38:19-33. [PMID: 38324247 DOI: 10.1521/pedi.2024.38.1.19] [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: 02/08/2024]
Abstract
There is a lack of studies that have prospectively examined adverse childhood experiences (ACEs) in association with a personality disorder (PD). Data from a sample of 8,199 adolescents first assessed for ACEs were linked with subsequent data from the Norwegian Patient Register in order to obtain diagnoses of a PD in adulthood (after a 14-year follow-up). We used logistic regression analysis. Any type of ACE gave a 3.8-fold higher risk of developing a PD. Abuse, more specifically emotional abuse, came out as one of the strongest predictors. Of the adolescents who developed a PD, approximately 90% had a history of ACE. The results of this study support the importance of assessing ACEs, such as abuse, neglect, and household dysfunction, in the diagnostic procedure and treatment for PD.
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Affiliation(s)
| | - Hans M Nordahl
- Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
- St. Olavs University Hospital, Østmarka, Trondheim, Norway
| | - Ingeborg Ulltveit-Moe Eikenæs
- National Advisory Unit for Personality Psychiatry (NAPP), Section for Personality Psychiatry and Specialized Treatment, Oslo University Hospital, Oslo, Norway
| | - Sara G Selvik
- Namsos Hospital, Nord-Trøndelag Hospital Trust, Namsos, Norway
- Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
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Banerjee D, Ray R. Endoxifen in Treatment of Individuals with Borderline Personality Disorder with Predominant Impulsivity: A Case Series. CONSORTIUM PSYCHIATRICUM 2023; 4:66-73. [PMID: 38618630 PMCID: PMC11009975 DOI: 10.17816/cp13622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/14/2023] [Indexed: 04/16/2024] Open
Abstract
Endoxifen, a protein kinase C inhibitor, has been approved for use in manic episodes in India. One of the symptom traits that it predominantly targets is impulsivity. Impulsivity can also be a symptom dimension of other mental health conditions, one of which is Borderline Personality Disorder (BPD). Management of BPD is challenging, with limited pharmacological options that are symptom-directed and psychotherapy sessions that are fraught with early dropouts and lack of compliance. Impulsive behaviors represent a major reason for seeking help in BPD, especially with regard to non-suicidal self-injury, substance abuse, high-risk sexual behavior, aggression, etc. Here, we present a case series comprising five individuals with a diagnosis of BPD whose treatment regimens were changed and endoxifen added at a dose of 8 mg once daily. Clinical improvement was monitored using the Borderline Evaluation of Severity Over Time (BEST). All the subjects improved in the impulsivity domains as well as with regard to attention deficits, mood fluctuations, and overall functioning. Endoxifen is thus potential promising in terms of the management of BPD, but needs more extensive study to fully substantiate its clinical benefits.
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Affiliation(s)
| | - Rajashree Ray
- Gauri Devi Institute of Medical Sciences and Hospital
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Petruso F, Giff A, Milano B, De Rossi M, Saccaro L. Inflammation and emotion regulation: a narrative review of evidence and mechanisms in emotion dysregulation disorders. Neuronal Signal 2023; 7:NS20220077. [PMID: 38026703 PMCID: PMC10653990 DOI: 10.1042/ns20220077] [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] [Received: 03/21/2023] [Revised: 10/25/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Emotion dysregulation (ED) describes a difficulty with the modulation of which emotions are felt, as well as when and how these emotions are experienced or expressed. It is a focal overarching symptom in many severe and prevalent neuropsychiatric diseases, including bipolar disorders (BD), attention deficit/hyperactivity disorder (ADHD), and borderline personality disorder (BPD). In all these disorders, ED can manifest through symptoms of depression, anxiety, or affective lability. Considering the many symptomatic similarities between BD, ADHD, and BPD, a transdiagnostic approach is a promising lens of investigation. Mounting evidence supports the role of peripheral inflammatory markers and stress in the multifactorial aetiology and physiopathology of BD, ADHD, and BPD. Of note, neural circuits that regulate emotions appear particularly vulnerable to inflammatory insults and peripheral inflammation, which can impact the neuroimmune milieu of the central nervous system. Thus far, few studies have examined the link between ED and inflammation in BD, ADHD, and BPD. To our knowledge, no specific work has provided a critical comparison of the results from these disorders. To fill this gap in the literature, we review the known associations and mechanisms linking ED and inflammation in general, and clinically, in BD, ADHD, and BD. Our narrative review begins with an examination of the routes linking ED and inflammation, followed by a discussion of disorder-specific results accounting for methodological limitations and relevant confounding factors. Finally, we critically discuss both correspondences and discrepancies in the results and comment on potential vulnerability markers and promising therapeutic interventions.
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Affiliation(s)
| | - Alexis E. Giff
- Department of Neuroscience, School of Life Sciences, École Polytechnique Fédérale de Lausanne, Switzerland
| | - Beatrice A. Milano
- Sant’Anna School of Advanced Studies, Pisa, Italy
- University of Pisa, Pisa, Italy
| | | | - Luigi Francesco Saccaro
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Switzerland
- Department of Psychiatry, Geneva University Hospital, Switzerland
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Kanj G, Hallit S, Obeid S. The relationship between childhood emotional abuse and borderline personality disorder: the mediating role of difficulties in emotion regulation among Lebanese adults. Borderline Personal Disord Emot Dysregul 2023; 10:34. [PMID: 37986013 PMCID: PMC10662025 DOI: 10.1186/s40479-023-00241-0] [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: 01/15/2023] [Accepted: 11/09/2023] [Indexed: 11/22/2023] Open
Abstract
OBJECTIVE The present study investigates the mediating effect of difficulties in emotion regulation in the association between childhood emotional abuse and Borderline Personality Disorder (BPD) among Lebanese adults. METHOD This cross-sectional study, involving 411 participants, was conducted between March and August 2022. Lebanese individuals from all governorates of the country were recruited using the Snowball Sampling technique. Three self-report scales were utilized to complete this research; the 'Difficulties in Emotion Regulation Scale-Brief Version (DERS-16)' which evaluates the difficulties in emotion regulation of individuals, the 'Childhood Trauma Questionnaire-Short Form (CTQ-SF)' which grants a subjective evaluation of the general childhood environment of the participants, as well as the 'Borderline Personality Questionnaire (BPQ)' which measures Borderline Personality Disorder traits, that demonstrate significant convergence with the disorder. RESULTS The results indicate that DERS-16 played an indirect effect role between childhood emotional abuse scores and Borderline Personality Disorder. Higher emotional abuse scores were significantly associated with higher DERS-16 scores, which in turn was significantly associated with higher BPQ scores. Moreover, childhood emotional abuse was directly associated with higher BPQ scores. CONCLUSION This work suggests that, among the different forms of childhood abuse, emotional abuse may have a role in the development of Borderline Personality Disorder. Training on emotion regulation strategies would potentially benefit individuals in preventing BPD development and facilitating therapeutic processes.
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Affiliation(s)
- Gaelle Kanj
- School of Arts and Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
| | - Sahar Obeid
- Social and Education Sciences Department, School of Arts and Sciences, Lebanese American University, Jbeil, Lebanon
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Goldbach RE, Neukel C, Panizza A, Reinken A, Krause-Utz A. Differentiating between intrapsychic symptoms and behavioral expressions of borderline personality disorder in relation to childhood emotional maltreatment and emotion dysregulation: an exploratory investigation. Eur J Psychotraumatol 2023; 14:2263317. [PMID: 37846822 PMCID: PMC10583625 DOI: 10.1080/20008066.2023.2263317] [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: 03/08/2023] [Accepted: 08/11/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Borderline personality disorder (BPD) is a severe mental disorder, characterized by pronounced instability in emotions, self-image, and interpersonal relationships. Experiences of childhood maltreatment are among the risk factors for BPD. While self-damaging and aggressive acts often occur, not every person with the disorder shows markedly dysregulated behaviour. Internalized symptoms, such as shame, loneliness, and self-disgust tend to be more pervasive and persist after clinical remission. OBJECTIVE Here we investigated associations between BPD symptom severity, childhood maltreatment, and emotion regulation difficulties. We further explored if the Borderline Symptom List (BSL) could potentially be used to differentiate between internalized symptoms (intrapsychic strain) and externalized symptoms (dysregulated behaviours) in future research. METHOD 187 women with at least mild BPD symptoms (65% having a diagnosis of BPD) completed the BSL 23 including its 11-item supplement (BSL-S), the Childhood Trauma Questionnaire (CTQ), and Difficulties in Emotion Regulation Scale (DERS). Participants further underwent a semi-structured clinical interview to assess BPD criteria (International Personality Disorder Examination, IPDE). Multivariate models and regression-based bootstrapping analyses were performed to test direct and indirect effects. RESULTS Childhood trauma severity, especially emotional abuse, positively predicted BPD symptom severity. A significant indirect effect through emotion regulation difficulties was found (k2=.56). When exploring associations with BPD criteria (IPDE), the BSL-23 mean significantly correlated with separation anxiety, identity and mood problems, chronic emptiness, suicidal ideation, and dissociation, while the BSL-S correlated with self-harming impulsive behaviour and anger outbursts. CONCLUSIONS Findings complement previous research, highlighting the role of childhood maltreatment and emotion regulation difficulties in BPD. While our findings need to be seen as preliminary and interpreted with caution, they suggest that the BSL may be used to differentiate between internalized symptoms and behavioural expressions of BPD in future research. Such a distinction might help to deepen the understanding of this complex heterogenous disorder.
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Affiliation(s)
- Roosmarijn E. Goldbach
- Department of Psychology, Faculty of Social and Behavioral Sciences, Leiden University, the Netherlands
| | - Corinne Neukel
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Germany
| | - Angelika Panizza
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Aischa Reinken
- Department of Psychology, Faculty of Social and Behavioral Sciences, Leiden University, the Netherlands
| | - Annegret Krause-Utz
- Department of Psychology, Faculty of Social and Behavioral Sciences, Leiden University, the Netherlands
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González-Ortega I, Diaz-Marsa M, López-Peña P, Fernández-Sevillano J, Andreo-Jover J, Bobes J, Bravo-Ortiz MF, Cebria AI, Crespo-Facorro B, de la Torre-Luque A, Elices M, Fernández-Rodrigues V, Garrido-Torres N, Grande I, Palao-Tarrero Á, Pemau A, Roberto N, Ruiz-Veguilla M, Seijo-Zazo E, Alberich S, González-Pinto A, Pérez V. Clinical predictors and psychosocial risk factors of suicide attempt severity. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2023:S2950-2853(23)00034-0. [PMID: 38591830 DOI: 10.1016/j.sjpmh.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/06/2023] [Accepted: 07/09/2023] [Indexed: 04/10/2024]
Abstract
BACKGROUND Suicide attempts are an important predictor of completed suicide and may differ in terms of severity of medical consequences or medical lethality. There is little evidence on serious suicide attempt (SSA) and very few studies have compared SSA with non-SSA. OBJECTIVE The aim of this multisite, coordinated, cohort study was to analyze the role of clinical variables and the sociodemographic and psychological risk factors of SSA. METHOD In this multisite, coordinated, cohort study, 684 participants (222 for the mild suicide attempt group, 371 for the moderate suicide attempt group and 91 for the SSA group) were included in the study. Ordinal regression models were performed to analyze the predictor variables of SSA. RESULTS Early physical abuse (OR=1.231) and impulsivity (OR=1.036) were predictors of SSA, while depressive symptoms were associated with a lower risk of SSA. CONCLUSION Environmental and psychological factors as physical abuse and impulsivity are related with severe suicide severity. These findings will help to develop strategies to prevent suicide and may be considered for the treatment and management of suicide.
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Affiliation(s)
- Itxaso González-Ortega
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain; Department of Psychiatry, Araba University Hospital, Bioaraba Research Institute, Vitoria, Spain; Department of Personality, Assessment and Psychological Treatment, National University of Distance Education (UNED), Vitoria, Spain
| | - Marina Diaz-Marsa
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain; Hospital Clínico San Carlos, Madrid, Spain; Complutense University of Madrid, Madrid, Spain
| | - Purificación López-Peña
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain; Department of Psychiatry, Araba University Hospital, Bioaraba Research Institute, Vitoria, Spain; Department of Neurosciences, University of the Basque Country, Leioa, Spain
| | - Jessica Fernández-Sevillano
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain; Department of Psychiatry, Araba University Hospital, Bioaraba Research Institute, Vitoria, Spain
| | - Jorge Andreo-Jover
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain; Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
| | - Julio Bobes
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain; Department of Psychiatry, University of Oviedo, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Spain; Instituto de Neurociencias del Principado de Asturias (INEUROPA), Spain; Mental Health Services of the Principality of Asturias (SESPA), Oviedo, Spain
| | - María Fe Bravo-Ortiz
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain; Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain; Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain; Department of Psychiatry, Clinical Psychology and Mental Health, La Paz University Hospital, Madrid, Spain
| | - Ana Isabel Cebria
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain; Mental Health Service, Hospital Universitari Parc Taulí, Unitat Mixta de Neurociència Traslacional I3PT-INc-UAB, Barcelona, Spain; Department of Clinical and Health Psychology, Faculty of Psychology, Universitat Autònoma of Barcelona, Cerdanyola del Vallès, Spain
| | - Benedicto Crespo-Facorro
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain; Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain; Department of Psychiatry, University of Sevilla, Sevilla, Spain
| | - Alejandro de la Torre-Luque
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain; Complutense University of Madrid, Madrid, Spain
| | - Matilde Elices
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain; Mar Institute of Medical Research (IMIM), Parc de Salut Mar, Barcelona, Spain
| | | | - Nathalia Garrido-Torres
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain; Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain
| | - Iria Grande
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain; Bipolar and Depressive Disorders Unit, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Institute of Neurosciences (UBNeuro) P. de la Vall d'Hebron, Barcelona, Spain; Department de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | - Ángela Palao-Tarrero
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain; Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain; Department of Psychiatry, Clinical Psychology and Mental Health, La Paz University Hospital, Madrid, Spain
| | | | - Natalia Roberto
- Bipolar and Depressive Disorders Unit, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Institute of Neurosciences (UBNeuro) P. de la Vall d'Hebron, Barcelona, Spain
| | - Miguel Ruiz-Veguilla
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain; Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain; Department of Psychiatry, University of Sevilla, Sevilla, Spain
| | - Elisa Seijo-Zazo
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Spain; Instituto de Neurociencias del Principado de Asturias (INEUROPA), Spain; Mental Health Services of the Principality of Asturias (SESPA), Oviedo, Spain
| | - Susana Alberich
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain; Department of Psychiatry, Araba University Hospital, Bioaraba Research Institute, Vitoria, Spain; Department of Personality, Assessment and Psychological Treatment, National University of Distance Education (UNED), Vitoria, Spain
| | - Ana González-Pinto
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain; Department of Psychiatry, Araba University Hospital, Bioaraba Research Institute, Vitoria, Spain; Department of Neurosciences, University of the Basque Country, Leioa, Spain; Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy; Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Psychiatry and Forensic Medicine, Faculty of Medicine, Universitat Autònoma de Barcelona, 08193 Cerdanyola del Vallès, Spain.
| | - Víctor Pérez
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain; Mar Institute of Medical Research (IMIM), Parc de Salut Mar, Barcelona, Spain; Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain; Universitat Pompeu Fabra, UPF, Barcelona, Spain
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Martz E, Weiner L, Weibel S. Identifying different patterns of emotion dysregulation in adult ADHD. Borderline Personal Disord Emot Dysregul 2023; 10:28. [PMID: 37743484 PMCID: PMC10519076 DOI: 10.1186/s40479-023-00235-y] [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: 04/03/2023] [Accepted: 08/27/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Emotion dysregulation (ED) is a core intrinsic feature of adult presenting Attention Deficit Hyperactivity Disorder (ADHD). However, the clinical expressions of ED are diverse and several questionnaires have been used to measure ED in adults with ADHD. Thus, to date, the characteristics of ED in adult ADHD remain poorly defined. The objective of this study is to identify the different patterns of ED in adults with ADHD. METHODS A large sample of 460 newly diagnosed adults with ADHD were recruited. Patients completed a total of 20 self-reported questionnaires. Measures consisted in the several facets of ED, but also other clinical features of adult ADHD such as racing thoughts. A factor analysis with the principal component extraction method was performed to define the symptomatic clusters. A mono-dimensional clustering was then conducted to assess whether participants presented or not with each symptomatic cluster. RESULTS The factor analysis yielded a 5 factor-solution, including "emotional instability", "impulsivity", "overactivation", "inattention/disorganization" and "sleep problems". ED was part of two out of five clusters and concerned 67.52% of our sample. Among those patients, the combined ADHD presentation was the most prevalent. Emotional instability and impulsivity were significantly predicted by childhood maltreatment. The ED and the "sleep problems" factors contributed significantly to the patients' functional impairment. CONCLUSIONS ED in ADHD is characterized along emotional instability and emotional impulsivity, and significantly contributes to functional impairment. However, beyond impairing symptoms, adult ADHD may also be characterized by functional strengths such as creativity.
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Affiliation(s)
- Emilie Martz
- INSERM U1114, Strasbourg, France.
- University of Strasbourg, Strasbourg, France.
| | - Luisa Weiner
- University of Strasbourg, Strasbourg, France
- Laboratoire de Psychologie Des Cognitions, University of Strasbourg, Strasbourg, France
- Psychiatry Department, University Hospital of Strasbourg, Strasbourg, France
| | - Sébastien Weibel
- INSERM U1114, Strasbourg, France
- Psychiatry Department, University Hospital of Strasbourg, Strasbourg, France
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Semple SJ, Pines HA, Pitpitan EV, Harvey-Vera A, Martinez G, Rangel MG, Strathdee SA, Patterson TL. Correlates of impulsivity among female sex workers in Mexico. Health Care Women Int 2023; 44:1119-1135. [PMID: 34427544 PMCID: PMC8866522 DOI: 10.1080/07399332.2021.1958816] [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: 05/11/2020] [Accepted: 07/18/2021] [Indexed: 10/20/2022]
Abstract
Impulsivity is a trait characteristic that is associated with sexual risk behavior. We examined correlates of impulsivity among 602 female sex workers (FSWs) enrolled in a sexual risk reduction intervention in Mexico (2016-2020). Impulsivity was positively associated with condomless sex with clients. Higher levels of impulsivity were associated with greater use of alcohol and heavy drugs, use of illicit drugs with clients, sexual/physical abuse history, and clinical depression. Global public health policy that supports free substance abuse treatment in combination with psychotherapeutic treatments (e.g. regulation management skills) and behavioral-focused therapy may help to reduce HIV/STI incidence in this vulnerable population.
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Affiliation(s)
- Shirley J. Semple
- Department of Psychiatry, University of California San Diego, La Jolla, California USA
| | - Heather A. Pines
- Department of Medicine, University of California San Diego, La Jolla, California USA
| | - Eileen V. Pitpitan
- Department of Medicine, University of California San Diego, La Jolla, California USA
- School of Social Work, San Diego State University, San Diego, California USA
| | - Alicia Harvey-Vera
- Department of Medicine, University of California San Diego, La Jolla, California USA
| | - Gustavo Martinez
- Federación Méxicana de Asociaciones Privadas (FEMAP), Ciudad Juarez, Chihuahua, Mexico
| | - M. Gudelia Rangel
- US-Mexico Border Health Commission, Tijuana, Baja California, Mexico
| | | | - Thomas L. Patterson
- Department of Psychiatry, University of California San Diego, La Jolla, California USA
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Jin M, Wang Z, Zhou Y, Zhong J. Exploring the impact of childhood maltreatment and BPD on impulsivity in crimes of passion. Front Psychiatry 2023; 14:1159678. [PMID: 37529070 PMCID: PMC10387528 DOI: 10.3389/fpsyt.2023.1159678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/27/2023] [Indexed: 08/03/2023] Open
Abstract
Background Crimes of passion, characterized as unpremeditated impulsive aggression, have garnered increasing attention in recent years. Impulsivity, a major factor in crimes of passion, is also a common feature of various health conditions, including Borderline Personality Disorder (BPD). Childhood maltreatment is considered a significant precursor to BPD and is closely related to impulsivity. Although prior research has affirmed the relationship between impulsivity, childhood maltreatment, BPD, and criminal behavior, few studies have examined these variables' interconnections within the context of crimes of passion. This study seeks to explore the relationship between childhood maltreatment, BPD, and impulsivity in crimes of passion, assessing the former's impact on the latter. Method Our research examined 133 crimes of passion offenders and 149 other offenders from the Shenzhen male prison in China. All 282 participants completed The Abbreviated Version of The Barratt Impulsiveness Scale (ABIS), The UPPS Impulsivity Scale (Urgency, Premeditation, Perseverance, Sensation Seeking), The McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD), and The Childhood Trauma Questionnaire (CTQ). Results Our findings indicated that (1) crimes of passion offenders scored significantly higher in emotional neglect, physical neglect, and overall childhood maltreatment than did other offenders, and childhood maltreatment scores were notably higher in the high BPD trait group. (2) Crimes of passion offenders demonstrated significantly elevated impulsivity in attention and nonplanning scales compared to other offenders. Impulsivity scores across all scales were also significantly higher in the high BPD trait group. (3) Emotional neglect was found to significantly influence the urgency scale in crimes of passion offenders. An interaction effect was noted between physical abuse and high BPD traits, leading to increased impulsivity in crimes of passion offenders. Conclusion This study underscores the predictive roles of childhood maltreatment and BPD in determining impulsivity within the context of crimes of passion.
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Affiliation(s)
- Michelle Jin
- Beijing Key Laboratory of Behavior and Mental Health, Clinical and Health Psychology Department, School of Psychological and Cognitive Science, Peking University, Beijing, China
| | - Zhongrui Wang
- Center for Psychological Health Education, Xihua University, Chengdu, China
| | | | - Jie Zhong
- Beijing Key Laboratory of Behavior and Mental Health, Clinical and Health Psychology Department, School of Psychological and Cognitive Science, Peking University, Beijing, China
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Warmingham JM, Duprey EB, Handley ED, Rogosch FA, Cicchetti D. Patterns of childhood maltreatment predict emotion processing and regulation in emerging adulthood. Dev Psychopathol 2023; 35:766-781. [PMID: 35287777 PMCID: PMC9474738 DOI: 10.1017/s0954579422000025] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Childhood maltreatment is a potent interpersonal trauma associated with dysregulation of emotional processes relevant to the development of psychopathology. The current study identified prospective links between patterns of maltreatment exposures and dimensions of emotion regulation in emerging adulthood. Participants included 427 individuals (48% Male; 75.9% Black, 10.8% White, 7.5% Hispanic, 6% Other) assessed at two waves. At Wave 1, children (10-12 years) from families eligible for public assistance with and without involvement with Child Protective Services took part in a research summer camp. Patterns of child maltreatment subtype and chronicity (based on coded CPS record data) were used to predict Wave 2 (age 18-24 years) profiles of emotion regulation based on self-report, and affective processing assessed via the Affective Go/No-Go task. Results identified associations between task-based affective processing and self-reported emotion regulation profiles. Further, chronic, multi-subtype childhood maltreatment exposure predicted difficulties with aggregated emotion dysregulation. Exposure to neglect with and without other maltreatment subtypes predicted lower sensitivity to affective words. Nuanced results distinguish multiple patterns of emotion regulation in a sample of emerging adults with high exposure to trauma and socioeconomic stress and suggest that maltreatment disrupts emotional development, resulting in difficulties identifying emotions and coping with emotional distress.
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Affiliation(s)
- Jennifer M Warmingham
- Mt. Hope Family Center, University of Rochester, Rochester, NY, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Erinn B Duprey
- Mt. Hope Family Center, University of Rochester, Rochester, NY, USA
- The Children's Institute, Rochester, NY, USA
| | | | - Fred A Rogosch
- Mt. Hope Family Center, University of Rochester, Rochester, NY, USA
| | - Dante Cicchetti
- Mt. Hope Family Center, University of Rochester, Rochester, NY, USA
- Institute of Child Development, University of Minnesota, Minneapolis, MN, USA
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12
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Kadivari F, Najafi M, Khosravani V. Childhood emotional maltreatment, maladaptive coping and obsessive-compulsive symptoms in patients with obsessive-compulsive disorder. Clin Psychol Psychother 2023. [PMID: 36639957 DOI: 10.1002/cpp.2829] [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: 04/14/2022] [Revised: 12/30/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
Previous studies have reported childhood emotional maltreatment (CEM) to be associated with specific obsessive-compulsive (OC) symptoms, but maladaptive coping, which may be the underlying mechanism in this relationship, has not been evaluated yet. Thus, the present study aimed to examine the effects of CEM on the OC symptoms of responsibility for harm and unacceptable thoughts, as well as obsessive-compulsive disorder (OCD) severity, through maladaptive coping, including cognitive avoidance, experiential avoidance and emotional suppression in OCD patients (n = 360). The results showed that CEM had direct effects, as well as indirect effects via cognitive and experiential avoidance and emotional suppression, on responsibility for harm and unacceptable thoughts. In addition, the indirect effect of CEM on OCD severity was significantly mediated by the roles of cognitive avoidance and experiential avoidance. The present study adds new literature to evidence indicating the role of early childhood events in developing and maintaining OCD in which adverse maladaptive coping related to unpleasant childhood abuse plays an important role in OCD. More precisely, OCD patients who experience a history of CEM may further use maladaptive coping to cope with their distress and subsequently experience responsibility for harm, unacceptable thoughts and severe OCD.
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Affiliation(s)
- Faranak Kadivari
- Department of Clinical Psychology, Faculty of Psychology and Educational Sciences, Semnan University, Semnan, Iran
| | - Mahmoud Najafi
- Department of Clinical Psychology, Faculty of Psychology and Educational Sciences, Semnan University, Semnan, Iran
| | - Vahid Khosravani
- Behavioral Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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13
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Stellern J, Xiao KB, Grennell E, Sanches M, Gowin JL, Sloan ME. Emotion regulation in substance use disorders: a systematic review and meta-analysis. Addiction 2023; 118:30-47. [PMID: 35851975 PMCID: PMC10087816 DOI: 10.1111/add.16001] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 06/19/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS The ability to regulate emotions effectively has been associated with resilience to psychopathology. Individuals with substance use disorders (SUDs) have been shown to have higher levels of negative emotionality, with some evidence suggesting impairment in emotion regulation compared with individuals without SUDs. However, no previous attempt has been made to systematically review the literature to assess the magnitude of this difference. We aimed to assess the association between SUD diagnosis and emotion regulation as measured by the Difficulties in Emotion Regulation Scale (DERS) and Emotion Regulation Questionnaire (ERQ) through a systematic review and meta-analysis of existing findings. METHODS The systematic review was conducted using PubMed, PsycINFO and Embase. We examined cross-sectional studies that compared a SUD group with a control group and measured emotion regulation using the DERS or the ERQ. The primary analysis focused on papers using the DERS, as this was the predominant instrument in the literature. RESULTS Twenty-two studies met our primary analysis criteria, representing 1936 individuals with a SUD and 1567 controls. Individuals with SUDs relative to controls had significantly greater DERS scores, with a mean difference of 21.44 [95% confidence interval (CI) = 16.49-26.40, P < 0.001] and Hedges' g = 1.05 (95% CI = 0.86-1.24, P < 0.001). The difference was robust, remaining significant after removing outliers and studies with high risk of bias. Individuals with SUDs demonstrated poorer emotion regulation on each subscale of the DERS, with the largest deficits in the Strategies and Impulse subscales. The ERQ analysis revealed greater use of expressive suppression in those with SUDs relative to controls (Hedges' g = 0.76, 95% CI = 0.25-1.28, P = 0.004). CONCLUSIONS People with substance use disorders appear to have greater difficulties in emotion regulation than people without substance use disorders.
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Affiliation(s)
- Jordan Stellern
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ke Bin Xiao
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Erin Grennell
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Marcos Sanches
- Biostatistics Core, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Joshua L Gowin
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Matthew E Sloan
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada.,Division of Neurosciences and Clinical Translation, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychological Clinical Science, University of Toronto Scarborough, Toronto, Ontario, Canada
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14
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Zhong H, Li H, Zhang X, Zhang X, Zhang Y, Zhao J. Childhood maltreatment and impulsivity in offenders: Examining the mediating roles of self-compassion and cognitive reappraisal. CHILD ABUSE & NEGLECT 2022; 133:105847. [PMID: 35988478 DOI: 10.1016/j.chiabu.2022.105847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 08/10/2022] [Accepted: 08/14/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The higher impulsivity of offenders in prison is a challenge for prison intervention. Childhood maltreatment, one of the factors closely related to the generation and development of impulsivity, is also prevalent in offenders. Therefore, it is critical to investigate the underlying paths that generate impulsivity in offenders who have experienced childhood abuse. OBJECTIVE Targeting positive protective factors, this study aimed to probe the mediating roles of self-compassion and cognitive reappraisal in the relationship between childhood maltreatment and impulsivity in offenders. METHODS The participants included 2643 offenders, 1534 males and 1109 females. Each participant completed the appropriate questionnaires to measure childhood maltreatment, impulsivity, self-compassion, and cognitive reappraisal. The PROCESS macro was used to perform the mediation analysis and hypothesis testing. RESULTS The findings showed that childhood maltreatment indirectly affected offenders' impulsivity through self-compassion and cognitive reappraisal, and the mediating effect of self-compassion was stronger than that of cognitive reappraisal. Further analyses found that sexual abuse indirectly affected impulsivity through self-compassion, and the remaining types of childhood maltreatment were associated with impulsivity in indirect pathways through self-compassion and cognitive reappraisal. CONCLUSIONS The results suggest that reinforcing practical training in self-compassion and cognitive reappraisal, especially the former, might facilitate the reduction of impulsive symptoms among offenders with backgrounds of childhood maltreatment.
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Affiliation(s)
- Huiqun Zhong
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou 510515, China; Department of Psychiatry, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Huihuang Li
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou 510515, China; Department of Psychiatry, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Xin Zhang
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou 510515, China; Department of Psychiatry, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Xiaoyuan Zhang
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou 510515, China; Department of Psychiatry, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Yan Zhang
- Medical Administration Division, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China.
| | - Jiubo Zhao
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou 510515, China; Department of Psychiatry, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China.
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15
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Herzog P, Kube T, Fassbinder E. How childhood maltreatment alters perception and cognition - the predictive processing account of borderline personality disorder. Psychol Med 2022; 52:2899-2916. [PMID: 35979924 PMCID: PMC9693729 DOI: 10.1017/s0033291722002458] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/24/2022] [Accepted: 07/18/2022] [Indexed: 01/05/2023]
Abstract
Borderline personality disorder (BPD) is a severe mental disorder, comprised of heterogeneous psychological and neurobiological pathologies. Here, we propose a predictive processing (PP) account of BPD to integrate these seemingly unrelated pathologies. In particular, we argue that the experience of childhood maltreatment, which is highly prevalent in BPD, leaves a developmental legacy with two facets: first, a coarse-grained, alexithymic model of self and others - leading to a rigidity and inflexibility concerning beliefs about self and others. Second, this developmental legacy leads to a loss of confidence or precision afforded beliefs about the consequences of social behavior. This results in an over reliance on sensory evidence and social feedback, with concomitant lability, impulsivity and hypersensitivity. In terms of PP, people with BPD show a distorted belief updating in response to new information with two opposing manifestations: rapid changes in beliefs and a lack of belief updating despite disconfirmatory evidence. This account of distorted information processing has the potential to explain both the instability (of affect, self-image, and interpersonal relationships) and the rigidity (of beliefs about self and others) which is typical of BPD. At the neurobiological level, we propose that enhanced levels of dopamine are associated with the increased integration of negative social feedback, and we also discuss the hypothesis of an impaired inhibitory control of the prefrontal cortex in the processing of negative social information. Our account may provide a new understanding not only of the clinical aspects of BPD, but also a unifying theory of the corresponding neurobiological pathologies. We conclude by outlining some directions for future research on the behavioral, neurobiological, and computational underpinnings of this model, and point to some clinical implications of it.
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Affiliation(s)
- Philipp Herzog
- Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, D-23562 Lübeck, Germany
- Department of Psychiatry and Psychotherapy, Christian-Albrechts-University of Kiel, Niemannsweg 147, D-24105 Kiel, Germany
- Department of Psychology, University of Koblenz-Landau, Ostbahnstr. 10, 76829 Landau, Germany
| | - Tobias Kube
- Department of Psychology, University of Koblenz-Landau, Ostbahnstr. 10, 76829 Landau, Germany
| | - Eva Fassbinder
- Department of Psychiatry and Psychotherapy, Christian-Albrechts-University of Kiel, Niemannsweg 147, D-24105 Kiel, Germany
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16
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Adverse Childhood Experiences and Neurocognition in Borderline Personality Disorder: A Call-to-Action Perspective Review. Harv Rev Psychiatry 2022; 30:248-260. [PMID: 35849742 DOI: 10.1097/hrp.0000000000000344] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Adverse childhood experiences (ACEs) contribute to the development of personality traits leading to adult borderline personality disorder (BPD). Neurocognitive changes could partly mediate the association between ACEs and BPD. We discuss how exposure to ACEs could induce alterations in neurocognition, which, in turn, would contribute to the development of BPD. We conducted a review of MEDLINE articles through 2021, documenting a link between ACEs, neurocognitive impairments, and BPD, and also focusing on the pairwise associations. ACEs appear to have a strong impact on neurocognition and are a predictive factor for BPD. Maltreated, abused, and emotionally invalidated children are more likely to present BPD traits. Neurocognitive impairments in adults exposed to ACEs and in patients with BPD arise from similar brain alterations in the amygdala, hippocampus, and prefrontal cortex. These impairments seem to be linked with clinical dimensions of BPD: increased impulsivity to altered inhibitory control; dissociative experiences to nonspecific autobiographical memory; and emotionally biased facial recognition to unstable interpersonal relationships. This perspective review highlights the contributory role of neurocognition in the association between ACEs and BPD. Additional research is needed, however, on the interconnections among ACEs, neurocognition, and BPD. Future studies could also focus on developing tools to assess early adversity in BPD specifically and on psychotherapeutic approaches to promptly remedy neurocognitive impairments.
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17
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Enrico V, Matteo D, Luciano G, Alessandro Z. Markers of emotion regulation processes: a neuroimaging and behavioral study of reappraising abilities. Biol Psychol 2022; 171:108349. [DOI: 10.1016/j.biopsycho.2022.108349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/26/2022] [Accepted: 05/06/2022] [Indexed: 12/11/2022]
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18
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Krause-Utz A, Walther JC, Kyrgiou AI, Hoogenboom W, Alampanou M, Bohus M, Schmahl C, Lis S. Severity of childhood maltreatment predicts reaction times and heart rate variability during an emotional working memory task in borderline personality disorder. Eur J Psychotraumatol 2022; 13:2093037. [PMID: 35816658 PMCID: PMC9262367 DOI: 10.1080/20008198.2022.2093037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
UNLABELLED Background: Difficulties in emotion regulation are a core symptom of borderline personality disorder (BPD) and often interfere with cognitive functions, such as working memory (WM). Traumatic childhood experiences, including severe maltreatment, can contribute to emotion dysregulation, possibly mediated by changes in high-frequency heart rate variability (HF-HRV). However, it is not yet entirely understood if HF-HRV alterations underlie impaired WM during emotional distraction in BPD and if this is related to traumatic childhood experiences and to comorbid post-traumatic stress disorder (PTSD). Objective: Our aim was to investigate performance (reaction times, RTs) and HF-HRV during an emotional working memory task (EWMT) in relation to childhood maltreatment severity and comorbid PTSD in BPD. Method: Eighty-one women (n = 28 healthy controls (HC) and n = 53 BPD patients of which n = 18 had comorbid PTSD) performed an adapted Sternberg item recognition WM task with neutral and negative social cues (interpersonal scenes from the International Affective Picture System (IAPS), and neutral, fearful, and angry faces) as distractors. Dependent variables were RTs of correct trials and HF-HRV. Childhood maltreatment was assessed with the Childhood Trauma Questionnaire. Results: Compared to healthy participants, patients with BPD showed prolonged RTs across all distractor conditions with social cues, regardless of their emotional valence. Patients with BPD, especially those with PTSD, demonstrated reduced HF-HRV both at rest and during EWMT. Severity of childhood maltreatment predicted longer RTs and lower HF-HRV during the EWMT. Conclusions: Findings suggest that adverse childhood experiences accelerate difficulties in shifting attention away from social information and that these are more pronounced in individuals with BPD. Reduced HF-HRV (low parasympathetic-tonus) may be an important psychophysiological mechanism underlying impaired WM in the presence of distracting social cues in patients with BPD, especially in those with comorbid PTSD. HIGHLIGHTS This study provides evidence that childhood maltreatment experiences are associated with hypersensitivity to social information and reduced high-frequency heart rate variability during a working memory task in borderline personality disorder.
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Affiliation(s)
- Annegret Krause-Utz
- Institute of Psychology, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden, Netherlands
| | - Julia-Caroline Walther
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim, Germany.,Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Akrivi I Kyrgiou
- Institute of Psychology, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden, Netherlands
| | - William Hoogenboom
- Institute of Psychology, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden, Netherlands
| | - Myrto Alampanou
- Institute of Psychology, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden, Netherlands
| | - Martin Bohus
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim, Germany.,Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Harvard Medical School and McLean Hospital, Belmont, MA, USA
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefanie Lis
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim, Germany.,Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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19
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Link between History of Childhood Maltreatment and Emotion Dysregulation in Adults Suffering from Attention Deficit/Hyperactivity Disorder or Borderline Personality Disorder. Biomedicines 2021; 9:biomedicines9101469. [PMID: 34680586 PMCID: PMC8533068 DOI: 10.3390/biomedicines9101469] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 01/26/2023] Open
Abstract
Childhood maltreatment (CM) may have a long-term effect on emotion regulation. This study aimed to explore the relationship between CM and emotion dysregulation (ED) in a heterogeneous population. Four hundred seventy French-speaking outpatients (N = 279 ADHD, N = 70 BPD, N = 60 ADHD + BPD, N = 61 clinical controls) completed the Emotion Reactivity Scale (ERS), the Cognitive Emotional Regulation Questionnaire (CERQ), the Childhood Trauma Questionnaire (CTQ), and the Relationship Scales Questionnaire (RSQ). Reports of childhood maltreatment experiences were significantly associated with increased levels of emotion reactivity in all our groups and in the whole population, with a greater use of non-adaptive cognitive emotion regulation strategies and insecure attachment patterns. Emotional abuse showed the strongest effect. Further analysis indicated that an anxious attachment style significantly mediated the relationship between CM and the use of non-adaptive cognitive emotion regulation strategies and emotion reactivity. The results of our study suggest an impact of CM on ED and a potentially marked effect of emotional abuse. They also indicate a potentially mediating role of insecure attachment in the relationship between a history of childhood abuse and emotion reactivity and a higher use of non-adaptive cognitive emotion regulation strategies in adulthood.
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20
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Oquendo MA, Galfalvy HC, Choo TH, Kandlur R, Burke AK, Sublette ME, Miller JM, Mann JJ, Stanley BH. Highly variable suicidal ideation: a phenotypic marker for stress induced suicide risk. Mol Psychiatry 2021; 26:5079-5086. [PMID: 32576966 PMCID: PMC7755748 DOI: 10.1038/s41380-020-0819-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 05/31/2020] [Accepted: 06/10/2020] [Indexed: 11/24/2022]
Abstract
Suicidal behavior (SB) can be impulsive or methodical; violent or not; follow a stressor or no obvious precipitant. This study tested whether childhood trauma, affective lability, and aggressive and impulsive traits predicted greater SI variability. We also assessed whether affective lability, aggressive or impulsive traits explain childhood trauma's effects on SI variability and whether those with highly variable SI respond to stressful events with increases in SI. Finally, we assessed variable SI's trajectory over 2 years. Depressed participants (n = 51) had ecological momentary assessments (EMA) over 7 days at baseline, 3, 6, 12, 18, and 24 months. SI variability was assessed using the square Root of the Mean Square of Successive Deviations. Mixed Effects Models were fit as appropriate. Childhood trauma was associated with subsequent aggression. Physical abuse predicted both aggression and affective lability as well as SI variability, but not impulsivity. In two-predictor models, physical abuse's effect on SI variability was no longer significant, when controlling for the effect of higher aggression and impulsivity. Those with high SI variability exhibited greater increases in SI after stressors compared with those with less variability. We did not find that SI variability changed over time, suggesting it might be trait-like, at least over 2 years. Variable SI predisposes to marked SI increases after stressful events and may be a trait increasing risk for impulsive SB, at least over 2 years.
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Affiliation(s)
- Maria A Oquendo
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.
| | - Hanga C Galfalvy
- Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Tse-Hwei Choo
- Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | | | - Ainsley K Burke
- Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - M Elizabeth Sublette
- Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Jeffrey M Miller
- Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - J John Mann
- Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Barbara H Stanley
- Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA
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21
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Xie GD, Chang JJ, Yuan MY, Wang GF, He Y, Chen SS, Su PY. Childhood abuse and borderline personality disorder features in Chinese undergraduates: the role of self-esteem and resilience. BMC Psychiatry 2021; 21:326. [PMID: 34210279 PMCID: PMC8252225 DOI: 10.1186/s12888-021-03332-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 06/18/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Although childhood abuse is considered to be related to borderline personality disorder (BPD), few studies have elaborated on the mediating role of self-esteem and resilience in it. Thus, the present study aimed to explore the potential mediating role of resilience and self-esteem between childhood abuse and BPD. METHODS This cross-sectional study was conducted with 4034 college students in Anhui Province, China. Participants were asked to complete Chinese versions of the following instruments: Childhood Trauma Questionnaire-Short Form (CTQ-SF), Mclean Screening Instrument for Borderline Personality Disorder (MSI-BPD), Connor-Davidson Resilience Scale (CD-RISC), and Rosenberg Self-Esteem Scale (RSES). Structural equation modeling (SEM) was used to test the mediation effects. RESULTS Resilience and self-esteem were found to be mediators of all three types of childhood abuse (emotional abuse, physical abuse and sexual abuse) when the types were examined separately; however, when all three types of childhood abuse were entered into the model simultaneously, neither the indirect effects nor direct effects of physical abuse or sexual abuse were found to be significant, only the association between emotional abuse and BPD features was partially mediated by resilience and self-esteem. CONCLUSIONS Self-esteem and resilience mediate the links between childhood abuse and BPD features, and emotional abuse is uniquely associated with BPD features.
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Affiliation(s)
- Guo-Die Xie
- grid.186775.a0000 0000 9490 772XDepartment of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei, 230032 Anhui China ,grid.410620.1Anhui Provincial Center for Disease Control and Prevention, No.12560 Fanhua Avenue, Hefei, 230601 Anhui China
| | - Jun-Jie Chang
- grid.186775.a0000 0000 9490 772XDepartment of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei, 230032 Anhui China
| | - Meng-Yuan Yuan
- grid.186775.a0000 0000 9490 772XDepartment of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei, 230032 Anhui China
| | - Geng-Fu Wang
- grid.186775.a0000 0000 9490 772XDepartment of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei, 230032 Anhui China
| | - Yang He
- grid.186775.a0000 0000 9490 772XDepartment of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei, 230032 Anhui China
| | - Shan-Shan Chen
- grid.186775.a0000 0000 9490 772XDepartment of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei, 230032 Anhui China
| | - Pu-Yu Su
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei, 230032, Anhui, China. .,Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China. .,Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei, 230032, Anhui, China.
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22
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Yalvaç EBK, Gaynor K. Emotional dysregulation in adults: The influence of rumination and negative secondary appraisals of emotion. J Affect Disord 2021; 282:656-661. [PMID: 33445088 DOI: 10.1016/j.jad.2020.12.194] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/30/2020] [Accepted: 12/26/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Emotional dysregulation is commonly discussed as a transdiagnostic factor in clinical populations. The present study aims to investigate cognitive factors (rumination and negative appraisals of emotion) in the maintenance of emotional dysregulation in a normative sample in order to partially validate a cognitive model of emotional dysregulation and to examine the potential clinical relevance of addressing cognitive factors in the treatment of emotional dysregulation. METHODS People who were 18 or older were asked to participate via a university research system and social media. Participants (N = 216) were asked to fill out online surveys regarding emotional dysregulation, rumination and negative secondary appraisals of emotion. RESULTS People who had higher emotional dysregulation levels displayed a greater tendency to ruminate and were more prone to negative secondary appraisals of emotion. There was a positive association between rumination and negative secondary appraisals of emotion, and this association was mediated by emotional dysregulation. LIMITATIONS The present study was solely based on self-report measurements and the collected data were cross-sectional. CONCLUSIONS The present study showed that a wide spectrum of experiences of emotional dysregulation occurred in a normative sample. The significant mediation highlighted the maintaining role of rumination and negative appraisals in emotional dysregulation. These data highlight the importance of addressing cognitive factors in emotional dysregulation.
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Affiliation(s)
| | - Keith Gaynor
- School of Psychology, University College Dublin, Ireland.
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Peng W, Liu Z, Liu Q, Chu J, Zheng K, Wang J, Wei H, Zhong M, Ling Y, Yi J. Insecure attachment and maladaptive emotion regulation mediating the relationship between childhood trauma and borderline personality features. Depress Anxiety 2021; 38:28-39. [PMID: 32720464 DOI: 10.1002/da.23082] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 07/02/2020] [Accepted: 07/12/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Previous studies suggested that childhood trauma is an important etiologic factor for the development of borderline personality disorder (BPD). Moreover, insecure attachment and maladaptive emotion regulation (ER) might be related to childhood trauma and BPD. This study was aimed to explore the relationships among childhood trauma, insecure attachment, maladaptive ER, and BPD features. METHODS A cohort of 637 patients with psychological disorders completed a series of psychometric instruments such as the Personality Diagnostic Questionnaire-4+ (PDQ-4+), the 23-Item Borderline Symptom List, the Childhood Trauma Questionnaire, the Attachment Style Questionnaire, and the Cognitive Emotion Regulation Questionnaire. The path analyses were conducted to investigate the experience-driven model that whether insecure attachment and maladaptive ER could mediate the relationship between childhood trauma and BPD features. The random forest regression was performed to select variables that contribute significantly to BPD features, which variables would be incorporated into the data-driven model to further confirm the experience-driven model. RESULTS Both the experience-driven model and the data-driven model verified that there were three significant mediation pathways (childhood trauma → insecure attachment/maladaptive ER → BPD features, childhood trauma → insecure attachment → maladaptive ER → BPD features; all p < .05), and the most weighted mediation pathway by which childhood trauma influencing the BPD features was through insecure attachment and then through maladaptive ER (weighted 53.16%). CONCLUSION The influence of childhood trauma on BPD features was mainly mediated by the combination of insecure attachment and maladaptive emotion regulation.
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Affiliation(s)
- Wanrong Peng
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China.,Medical Psychological Institute, Central South University, Changsha, China
| | - Zhaoxia Liu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China.,Medical Psychological Institute, Central South University, Changsha, China
| | - Qian Liu
- Guangdong Key Laboratory of Mental Health and Cognitive Science, School of Psychology, Center for Studies of Psychological Application, South China Normal University, Guangzhou, China
| | - Jun Chu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China.,Medical Psychological Institute, Central South University, Changsha, China
| | - Kaili Zheng
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China.,Medical Psychological Institute, Central South University, Changsha, China
| | - Jingwei Wang
- Guangdong Key Laboratory of Mental Health and Cognitive Science, School of Psychology, Center for Studies of Psychological Application, South China Normal University, Guangzhou, China
| | - Hao Wei
- School of Computer Science and Engineering, Central South University, Changsha, China
| | - Mingtian Zhong
- Guangdong Key Laboratory of Mental Health and Cognitive Science, School of Psychology, Center for Studies of Psychological Application, South China Normal University, Guangzhou, China
| | - Yu Ling
- School of Educational Science, Hunan Normal University, Changsha, China
| | - Jinyao Yi
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China.,Medical Psychological Institute, Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, Changsha, China
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24
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Vogel M, Meyer F, Frommer J, Walter M, Lohmann CH, Croner R. Unwillingly traumatizing: is there a psycho-traumatologic pathway from general surgery to postoperative maladaptation? Scand J Pain 2020; 21:238-246. [PMID: 34387954 DOI: 10.1515/sjpain-2020-0081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 10/04/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Surgery may possibly be undermined by psychologic, psychiatric and psychosomatic problems, as long as these problems interfere with a patient's capacity to cope with surgery adaptively. Recent studies have shown that interpersonal trauma, e.g. abuse or neglect, and its correlates are involved in the adaptation to surgery. This observation is heuristically coherent, given the respective traumatization is an interpersonal event occurring in a relationship. Notably, surgery inevitably leads to the violation of physical boundaries within a doctor-patient relationship. Based on the principles of psycho-traumatologic thinking, such a constellation is deemed qualified to activate posttraumatic symptoms in the traumatized. METHOD The present topical review summarizes the respective findings which point to a subgroup of patients undergoing surgery, in whom difficulty bearing tension and confiding in others may cause adaptive problems relevant to surgery. Although this theorizing is empirically substantiated primarily with respect to total knee arthroplasty (TKA), a pubmed-research reveals psychopathologic distress to occur prior to surgery beyond TKA. Likewise, posttraumatic distress occurs in large numbers in the context of several operations, including cardiac, cancer and hernia surgery. CONCLUSION Aspects of psychological trauma may be linked to the outcomes of general surgery, as well, e.g. biliary, hernia or appendix surgery. The mechanisms possibly involved in this process are outlined in terms of a hierarchical organization of specific anxiety and negative affect as well as in terms of psychodynamics which imply the unconscious action of psychologic defenses at their core. IMPLICATIONS Not least, we encourage the screening for trauma and its correlates including defenses prior to general surgery in order to identify surgical candidates at risk of, e.g. chronic postoperative pain, before the operation.
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Affiliation(s)
- Matthias Vogel
- Department of Psychosomatic Medicine and Psychotherapy, Otto-von-Guericke University, Magdeburg, Germany
| | - Frank Meyer
- Department of Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Jörg Frommer
- Department of Psychosomatic Medicine and Psychotherapy, Otto-von-Guericke University, Magdeburg, Germany
| | - Martin Walter
- Department of Psychiatry and Psychotherapy, University Hospital Jena Friedrich Schiller University, Jena, Germany
| | - Christoph H Lohmann
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Roland Croner
- Department of Surgery, Otto-von-Guericke University, Magdeburg, Germany
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25
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Kindheitstraumatisierungen bei Patienten mit Borderline-Persönlichkeitsstörung. PSYCHOTHERAPEUT 2020. [DOI: 10.1007/s00278-020-00452-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ZusammenfassungWährend Kindheitstraumatisierungen zentrale psychosoziale Risikofaktoren für die Entwicklung einer Borderline-Persönlichkeitsstörung (BPS) darstellen, ist ihre Relevanz für die Symptomschwere der Erkrankung und das Therapieergebnis bisher unzureichend und mit inkonsistenten Ergebnissen untersucht worden. In dieser naturalistischen Studie an 482 stationären Psychotherapiepatienten mit einer BPS wurde daher der differenzielle Einfluss verschiedener Kindheitstraumatisierungen (gemessen mit dem Childhood Trauma Questionnaire, CTQ) auf die selbstberichtete Psychopathologie hinsichtlich Depressivität (Beck-Depressions-Inventar II [BDI-II], Gesundheitsfragebogen für Patienten [PHQ]), Ängstlichkeit und Somatisierung (PHQ), BPS-spezifischer Symptomatik (Borderline-Symptom-Liste, BSL) sowie gesundheitsbezogener Lebensqualität (Kurzform des Fragebogens zum Gesundheitszustand, SF-12) zu Behandlungsbeginn und bei Abschluss einer Dialektisch-Behavioralen Therapie analysiert. Weil sich Frauen und Männer in Symptomschwere und Häufigkeit verschiedener Kindheitstraumatisierungen unterscheiden, erfolgten geschlechtsdifferenzielle Analysen. Bei Patientinnen trugen Kindheitstraumatisierungen bis maximal knapp 7 % zur Varianzaufklärung der Symptombelastung bei Aufnahme bei; lediglich emotionaler Missbrauch hatte einen signifikanten und unabhängigen Einfluss. Bei Männern fanden sich keine relevanten Zusammenhänge zwischen dem CTQ und den Ergebnismaßen. Weder bei Männern noch bei Frauen wirkten sich Kindheitstraumatisierungen auf das symptombezogene Behandlungsergebnis aus. Die Ergebnisse werden im Kontext der bisherigen Befundlage zum Zusammenhang zwischen Kindheitstraumatisierungen, Symptomschwere und Therapieergebnis bei psychischen Störungen im Allgemeinen und der BPS im Besonderen diskutiert.
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26
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Dal Santo F, Carballo JJ, Velasco A, Jiménez-Treviño L, Rodríguez-Revuelta J, Martínez-Cao C, Caro-Cañizares I, de la Fuente-Tomás L, Menéndez-Miranda I, González-Blanco L, García-Portilla MP, Bobes J, Sáiz PA. The Mediating Role of Impulsivity in the Relationship Between Suicidal Behavior and Early Traumatic Experiences in Depressed Subjects. Front Psychiatry 2020; 11:538172. [PMID: 33240115 PMCID: PMC7683571 DOI: 10.3389/fpsyt.2020.538172] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 10/20/2020] [Indexed: 01/10/2023] Open
Abstract
Background: Depressed patients with early traumatic experiences may represent a clinically and biologically distinct subtype, with worse clinical outcomes and greater risk of suicide. Since early traumatic experiences alter development of systems that regulate the stress response, increasing sensitivity to stress and mood disorders later in life, certain personality features may influence coping strategies, putting individuals with depression and a history of early traumatic experiences at greater risk of suicidal behavior. Objective: To determine whether impulsivity mediates the relationship between early traumatic experiences and suicidal behavior in patients with major depressive disorder (MDD). Methods: The total sample consists of 190 patients [mean age (SD) = 53.71 (10.37); females: 66.3%], with current MDD (DSM-5 criteria). The Childhood Trauma Questionnaire-Short Form (CTQ-SF), the List of Threatening Experiences (LTE), and the Barratt Impulsiveness Scale-11 (BIS-11) were used to assess childhood and adulthood adverse life events and impulsivity, respectively. We developed mediation models by bootstrap sampling methods. Results: Eighty-one (42.6%) patients had a history of previous suicide attempts (SA). CTQ-SF-Total and BIS-11-Total scores were significantly higher in MDD patients with previous SA. Correlation analyses revealed significant correlations between the CTQ-SF-Total and BIS-11-Total, CTQ-SF-Total and HDRS-Total, and BIS-11-Total and HDRS-Total scores. Regression models found that CTQ-SF-Total, BIS-11-Total, and HDRS-Total scores were associated with SA. Mediation analyses further revealed the association between CTQ-SF-Total and SA was mediated by the indirect effect of the BIS-11-Total score (b = 0.007, 95% CI = 0.001, 0.015), after statistically controlling for sex, the HDRS-Total, and the LTE-Total. Discussion: Data suggest that impulsivity could mediate the influence of childhood trauma on suicidal behavior. This will help understand the role of risk factors in suicidal behavior and aid in the development of prevention interventions focused on modifiable mediators when risk factors are non-modifiable.
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Affiliation(s)
- Francesco Dal Santo
- Department of Psychiatry, University of Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Mental Health Services of Principado de Asturias, SESPA, Oviedo, Spain
| | - Juan José Carballo
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, IISGM, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Angela Velasco
- Department of Psychiatry, University of Oviedo, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Oviedo, Spain
| | - Luis Jiménez-Treviño
- Department of Psychiatry, University of Oviedo, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Mental Health Services of Principado de Asturias, SESPA, Oviedo, Spain
| | - Julia Rodríguez-Revuelta
- Department of Psychiatry, University of Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Mental Health Services of Principado de Asturias, SESPA, Oviedo, Spain
| | | | - Irene Caro-Cañizares
- Department of Psychiatry, Fundación Jiménez Díaz Hospital, Universidad a Distancia de Madrid, Madrid, Spain
| | - Lorena de la Fuente-Tomás
- Department of Psychiatry, University of Oviedo, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Oviedo, Spain
| | - Isabel Menéndez-Miranda
- Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Mental Health Services of Principado de Asturias, SESPA, Oviedo, Spain
| | - Leticia González-Blanco
- Department of Psychiatry, University of Oviedo, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Mental Health Services of Principado de Asturias, SESPA, Oviedo, Spain
| | - Mª Paz García-Portilla
- Department of Psychiatry, University of Oviedo, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Mental Health Services of Principado de Asturias, SESPA, Oviedo, Spain
| | - Julio Bobes
- Department of Psychiatry, University of Oviedo, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Mental Health Services of Principado de Asturias, SESPA, Oviedo, Spain
| | - Pilar A Sáiz
- Department of Psychiatry, University of Oviedo, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Mental Health Services of Principado de Asturias, SESPA, Oviedo, Spain
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27
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Porter C, Palmier-Claus J, Branitsky A, Mansell W, Warwick H, Varese F. Childhood adversity and borderline personality disorder: a meta-analysis. Acta Psychiatr Scand 2020; 141:6-20. [PMID: 31630389 DOI: 10.1111/acps.13118] [Citation(s) in RCA: 158] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/15/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The aim of this meta-analysis was to better understand the magnitude and consistency of the association between childhood adversity and borderline personality disorder (BPD) across case-control, epidemiological and prospective cohort studies. METHOD Following the review protocol (reference: CRD42017075179), search terms pertaining to adversity and BPD were entered into three search engines. Random-effects meta-analysis synthesised the size and consistency of the effects. RESULTS A total of 97 studies compared BPD to non-clinical (k = 40) and clinical (k = 70) controls. Meta-analysis of case-control studies indicated that individuals with BPD are 13.91 (95% CI 11.11-17.43) times more likely to report childhood adversity than non-clinical controls. This effect was smaller when considering retrospective cohort (OR: 2.59; 95% CI 0.93-7.30) and epidemiological (OR: 2.56, 95% CI 1.24-5.30) studies. Findings were significant across adversity subtypes with emotional abuse (OR: 38.11, 95% CI: 25.99-55.88) and neglect (OR: 17.73, 95% CI = 13.01-24.17) demonstrating the largest effects. Individuals with BPD were 3.15 (95% CI 2.62-3.79) times more likely to report childhood adversity than other psychiatric groups. CONCLUSIONS This meta-analysis corroborates theoretical proposals that exposure to adverse life experiences is associated with BPD. It highlights the importance of considering childhood adversity when treating people diagnosed with BPD.
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Affiliation(s)
- C Porter
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - J Palmier-Claus
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, UK.,Lancashire Care NHS Foundation Trust, Lancashire, UK
| | - A Branitsky
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - W Mansell
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - H Warwick
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - F Varese
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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28
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Calvo N, Lara B, Serrat L, Pérez-Rodríguez V, Andión Ò, Ramos-Quiroga JA, Ferrer M. The role of environmental influences in the complex relationship between borderline personality disorder and attention-deficit/hyperactivity disorder: review of recent findings. Borderline Personal Disord Emot Dysregul 2020; 7:2. [PMID: 31921426 PMCID: PMC6945629 DOI: 10.1186/s40479-019-0118-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 12/05/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In recent years, the existence of possible developmental pathways from childhood Attention-Deficit/Hyperactivity Disorder (ADHD) to adult Borderline Personality Disorder (BPD) has been suggested. The existence of common genetic factors has been described but there is little evidence on the role of environmental factors in the possible transition from one disorder to another throughout life. The main goal of this work is to review the literature about the existing evidence on childhood traumas as factors that mediate the risk of developing BPD in children with ADHD. METHODS A literature search was conducted using PubMed, Science Direct and PsychInfo databases. Criteria included studies of BPD and ADHD relationships and childhood traumas as environmental influences from epidemiological or clinical samples. RESULTS The review only identified 4 studies that matched the search criteria. All studies retrospectively analyzed childhood traumas, and adult patients with BPD, with or without comorbid ADHD, were the most frequently mentioned. The analyzed evidence reinforces the relationship between the number of childhood traumas and higher clinical severity. Three of these analyzed studies describe an increased the risk of children with ADHD who report emotional and sexual traumatic experiences to develop BPD in adulthood. CONCLUSIONS The experience of traumatic childhood events, especially those of an emotional type, may have a mediating effect of an increased risk of developing adult BPD in childhood ADHD patients. However, to consider them as risk factors, more studies, and especially longitudinal studies, are necessary to clarify the probable transactional process between the two disorders. Evidence from these studies may be helpful to develop early intervention programs to reduce the functional impairment associated with the two disorders.
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Affiliation(s)
- Natalia Calvo
- 1BPD Program, Psychiatry Department, Hospital Universitary Vall d'Hebron, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.,2Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,3Psychiatry, Mental Health and Addictions Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Grup TLP Barcelona (BPD Barcelona Group), Barcelona, Spain
| | - Benjamin Lara
- 1BPD Program, Psychiatry Department, Hospital Universitary Vall d'Hebron, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.,3Psychiatry, Mental Health and Addictions Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Laia Serrat
- 1BPD Program, Psychiatry Department, Hospital Universitary Vall d'Hebron, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Violeta Pérez-Rodríguez
- 1BPD Program, Psychiatry Department, Hospital Universitary Vall d'Hebron, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Òscar Andión
- 1BPD Program, Psychiatry Department, Hospital Universitary Vall d'Hebron, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Josep A Ramos-Quiroga
- 1BPD Program, Psychiatry Department, Hospital Universitary Vall d'Hebron, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.,2Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,3Psychiatry, Mental Health and Addictions Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Grup TLP Barcelona (BPD Barcelona Group), Barcelona, Spain
| | - Marc Ferrer
- 1BPD Program, Psychiatry Department, Hospital Universitary Vall d'Hebron, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.,2Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,3Psychiatry, Mental Health and Addictions Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Grup TLP Barcelona (BPD Barcelona Group), Barcelona, Spain
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