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Gajwani R, Sim F, McAllister K, Smith H, McIntosh E, Moran P, Ougrin D, Smith M, Gumley AI, Chanen AM, Minnis H. The BRIDGE project: a feasibility randomised controlled trial of brief, intensive assessment and integrated formulation for young people (age 14-24) with features of borderline personality disorder (Protocol). Front Psychiatry 2024; 15:1389578. [PMID: 39381608 PMCID: PMC11458484 DOI: 10.3389/fpsyt.2024.1389578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 08/23/2024] [Indexed: 10/10/2024] Open
Abstract
Background Borderline personality disorder (BPD) is a severe mental disorder that is characterised by a pervasive pattern of instability of interpersonal relationships, self-image, and mood as well as marked impulsivity. BPD has its peak incidence and prevalence from puberty through to emerging adulthood. BPD is a controversial diagnosis in young people. Commonly, young people with BPD are under-diagnosed, untreated, are not in employment or training and are estranged from their families. Yet, they have complex needs and are at high suicide risk. Aim To assess the feasibility of conducting a randomised controlled trial (f-RCT) of a BRIDGE, a brief intervention programme for young people (age 14-24) with BPD symptoms (sub-threshold or threshold) in a community sample from Scotland, UK. Method Forty young people (age 14-24) meeting criteria for BPD symptoms, will be randomised in a 1:1 ratio to receive either a) the BRIDGE intervention plus service-as-usual or b) service-as-usual alone. Follow up will be 12 weeks and 24 weeks post-intervention. The study is carried out between 2021 to 2024. Outcome The two primary outcomes of the MQ funded, BRIDGE project (f-RCT) are i. recruitment rates and ii. retention rates. The study will present the acceptability and appropriateness of our putative outcome measures for a future definitive randomised controlled trial (d-RCT). Impact Young people with BPD benefit from good clinical care and targeted intervention, however are regularly missed or mislabelled. The community based feasibility trial would provide initial evidence of variable needs of young people with complex needs, who maybe missed or excluded from services as they don't "fit" a model/diagnosis. Workable multi-agency service model proposed in the trial would be a major advance in understanding care pathways regardless of trial outcome. Clinical Trial Registration ClinicalTrial.gov, identifier NCT05023447.
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Affiliation(s)
- Ruchika Gajwani
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- National Health Service Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Fiona Sim
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Kirsty McAllister
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Helen Smith
- National Health Service (NHS) A&A, Ayrshire & Arran, Scotland, United Kingdom
| | - Emma McIntosh
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Paul Moran
- Department of Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Dennis Ougrin
- Youth Resilience Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Michael Smith
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- National Health Service Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Andrew Ian Gumley
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- National Health Service Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Andrew M. Chanen
- Orygen, Melbourne, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Helen Minnis
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- National Health Service Greater Glasgow and Clyde, Glasgow, United Kingdom
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Leichsenring F, Fonagy P, Heim N, Kernberg OF, Leweke F, Luyten P, Salzer S, Spitzer C, Steinert C. Borderline personality disorder: a comprehensive review of diagnosis and clinical presentation, etiology, treatment, and current controversies. World Psychiatry 2024; 23:4-25. [PMID: 38214629 PMCID: PMC10786009 DOI: 10.1002/wps.21156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Abstract
Borderline personality disorder (BPD) was introduced in the DSM-III in 1980. From the DSM-III to the DSM-5, no major changes have occurred in its defining criteria. The disorder is characterized by instability of self-image, interpersonal relationships and affects. Further symptoms include impulsivity, intense anger, feelings of emptiness, strong abandonment fears, suicidal or self-mutilation behavior, and transient stress-related paranoid ideation or severe dissociative symptoms. There is evidence that BPD can be reliably diagnosed and differentiated from other mental disorders by semi-structured interviews. The disorder is associated with considerable functional impairment, intensive treatment utilization, and high societal costs. The risk of self-mutilation and suicide is high. In the general adult population, the lifetime prevalence of BPD has been reported to be from 0.7 to 2.7%, while its prevalence is about 12% in outpatient and 22% in inpatient psychiatric services. BPD is significantly associated with other mental disorders, including depressive disorders, substance use disorders, post-traumatic stress disorder, attention-deficit/hyperactivity disorder, bipolar disorder, bulimia nervosa, and other personality disorders. There is convincing evidence to suggest that the interaction between genetic factors and adverse childhood experiences plays a central role in the etiology of BPD. In spite of considerable research, the neurobiological underpinnings of the disorder remain to be clarified. Psychotherapy is the treatment of choice for BPD. Various approaches have been empirically supported in randomized controlled trials, including dialectical behavior therapy, mentalization-based therapy, transference-focused therapy, and schema therapy. No approach has proved to be superior to others. Compared to treatment as usual, psychotherapy has proved to be more efficacious, with effect sizes between 0.50 and 0.65 with regard to core BPD symptom severity. However, almost half of the patients do not respond sufficiently to psychotherapy, and further research in this area is warranted. It is not clear whether some patients may benefit more from one psychotherapeutic approach than from others. No evidence is available consistently showing that any psychoactive medication is efficacious for the core features of BPD. For discrete and severe comorbid anxiety or depressive symptoms or psychotic-like features, pharmacotherapy may be useful. Early diagnosis and treatment of BPD can reduce individual suffering and societal costs. However, more high-quality studies are required, in both adolescents and adults. This review provides a comprehensive update of the BPD diagnosis and clinical characterization, risk factors, neurobiology, cognition, and management. It also discusses the current controversies concerning the disorder, and highlights the areas in which further research is needed.
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Affiliation(s)
- Falk Leichsenring
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
- Department of Psychosomatics and Psychotherapy, University of Rostock, Rostock, Germany
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Nikolas Heim
- International Psychoanalytic University, Berlin, Germany
| | - Otto F Kernberg
- Personality Disorders Institute, Weill Cornell Medical College, New York, NY, USA
| | - Frank Leweke
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
| | - Patrick Luyten
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | - Simone Salzer
- International Psychoanalytic University, Berlin, Germany
| | - Carsten Spitzer
- Department of Psychosomatics and Psychotherapy, University of Rostock, Rostock, Germany
| | - Christiane Steinert
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
- International Psychoanalytic University, Berlin, Germany
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Erdman A, Eldar E. The computational psychopathology of emotion. Psychopharmacology (Berl) 2023; 240:2231-2238. [PMID: 36811651 DOI: 10.1007/s00213-023-06335-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 01/30/2023] [Indexed: 02/24/2023]
Abstract
Mood and anxiety disorders involve recurring, maladaptive patterns of distinct emotions and moods. Here, we argue that understanding these maladaptive patterns first requires understanding how emotions and moods guide adaptive behavior. We thus review recent progress in computational accounts of emotion that aims to explain the adaptive role of distinct emotions and mood. We then highlight how this emerging approach could be used to explain maladaptive emotions in various psychopathologies. In particular, we identify three computational factors that may be responsible for excessive emotions and moods of different types: self-intensifying affective biases, misestimations of predictability, and misestimations of controllability. Finally, we outline how the psychopathological roles of these factors can be tested, and how they may be used to improve psychotherapeutic and psychopharmacological interventions.
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Affiliation(s)
- Alon Erdman
- Department of Psychology, Hebrew University of Jerusalem, 9190501, Jerusalem, Israel.
| | - Eran Eldar
- Department of Psychology, Hebrew University of Jerusalem, 9190501, Jerusalem, Israel.
- Department of Cognitive and Brain Sciences, Hebrew University of Jerusalem, 9190501, Jerusalem, Israel.
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Fung HW, Wong MYC, Lam SKK, Wong ENM, Chien WT, Hung SL, Lee KH, Cui J, Ross CA. Borderline personality disorder features and their relationship with trauma and dissociation in a sample of community health service users. Borderline Personal Disord Emot Dysregul 2023; 10:22. [PMID: 37394448 DOI: 10.1186/s40479-023-00228-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 05/31/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND Previous studies have indicated that borderline personality disorder (BPD) is closely associated with trauma and dissociation. Nevertheless, BPD is a heterogeneous condition, and not all people with BPD have severe dissociation. This study examined whether the relationship of BPD features with trauma and dissociation would remain significant after controlling for some general non-specific mental health distress. We also made the first attempt to explore which specific BPD features would be particularly associated with dissociation. METHODS We analyzed survey data from a sample of community health service users in Hong Kong (N = 376). Hierarchical multiple regression and data-driven network analysis were used. RESULTS The lifetime prevalence of DSM-5 BPD was 16.0% in our sample. Of participants who met criteria for BPD, 43.3% scored above cutoff on the dissociation measures, thus possibly having clinically significant dissociative symptoms. BPD features were associated with adulthood trauma and psychoform dissociation even after controlling for age, depression and self-esteem. Network analysis showed that some BPD features - including impulsivity, identity disturbance and suicidal/self-mutilation behaviors - were particularly associated with dissociation; other BPD features such as interpersonal-related problems had relatively weak to no connection with dissociation. CONCLUSIONS Our results suggested that some particular BPD features might be dissociative in nature, although further longitudinal research is required. We argue that a trauma-informed perspective should be employed when working with clients presenting with BPD features despite these features being commonly stigmatized. Further research on the intervention needs of the people with BPD who suffer from high levels of dissociation is required.
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Affiliation(s)
- Hong Wang Fung
- Department of Social Work, Hong Kong Baptist University, Kowloon, Hong Kong.
| | - Ming Yu Claudia Wong
- Department of Health and Physical Education, The Education University of Hong Kong, Ting Kok, Hong Kong
| | - Stanley Kam Ki Lam
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Emily Nga Man Wong
- Department of Counselling and Psychology, Hong Kong Shue Yan University, North Point, Hong Kong
| | - Wai Tong Chien
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Suet Lin Hung
- Department of Social Work, Hong Kong Baptist University, Kowloon, Hong Kong.
| | - Kun-Hua Lee
- Department of Educational Psychology and Counseling, National Tsing Hua University, 521 Nan-Da Road, Hsinchu City, 30014, Taiwan
| | - Jialiang Cui
- Department of Social Work, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Colin A Ross
- The Colin A. Ross Institute for Psychological Trauma, Richardson, TX, USA
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Cavelti M, Rinnewitz L, Walter M, van der Venne P, Parzer P, Josi J, Bertsch K, Brunner R, Resch F, Koenig J, Kaess M. Psychobiological Correlates of Aggression in Female Adolescents with Borderline Personality Disorder. Psychopathology 2022; 55:37-48. [PMID: 34872101 DOI: 10.1159/000520228] [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: 02/25/2021] [Accepted: 10/07/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Aggressive behavior in reaction to threats, frustration, or provocation is prevalent in borderline personality disorder (BPD). This study investigated aggressive behavior and its biological correlates in adolescents with BPD. METHODS Twenty-one female adolescents with a DSM-IV BPD diagnosis and 25 sex- and age-matched healthy controls participated in the Taylor Aggression Paradigm (TAP), a laboratory-based experiment measuring aggressive behavior in the interpersonal context. Heart rate was measured and saliva samples were taken throughout the experiment. RESULTS Multilevel mixed-effects linear regression analyses revealed no significant group difference in aggressive behavior induced by the TAP. Additionally, the two groups did not differ in cortisol, testosterone, and heart rate responses to the aggression induction. The BPD group showed a significant cortisol increase in the time preceding the start of the TAP in contrast to the healthy control group, in whom a significant heart rate increase from baseline to the first block of the TAP was observed. DISCUSSION There was no evidence, either at the phenomenological or the biological level, of increased task-induced aggression in adolescents with BPD. The results may indicate that adolescents with BPD experienced fearful stress in anticipation of the experimental task in contrast to healthy controls who showed an adaptive response of the autonomic nervous system necessary to deal with the upcoming demand.
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Affiliation(s)
- Marialuisa Cavelti
- University Hospital for Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland,
| | - Lena Rinnewitz
- Department of Child and Adolescent Psychiatry, Section for Translational Psychobiology in Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Moritz Walter
- Department of Child and Adolescent Psychiatry, Section for Translational Psychobiology in Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Patrice van der Venne
- Department of Child and Adolescent Psychiatry, Section for Translational Psychobiology in Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Peter Parzer
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, Medical Faculty, University of Heidelberg, Heidelberg, Germany
| | - Johannes Josi
- University Hospital for Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Katja Bertsch
- Department of Psychology, Ludwig-Maximilans-University Munich, Munich, Germany.,Department of Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Romuald Brunner
- Department of Child and Adolescent Psychiatry, University of Regensburg, Regenbsurg, Germany
| | - Franz Resch
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, Medical Faculty, University of Heidelberg, Heidelberg, Germany
| | - Julian Koenig
- University Hospital for Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Department of Child and Adolescent Psychiatry, Section for Experimental Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- University Hospital for Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Department of Child and Adolescent Psychiatry, Section for Translational Psychobiology in Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
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