1
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Spitzen TL, Tull MT, Baer MM, Dixon-Gordon KL, Chapman AL, Gratz KL. Predicting engagement in nonsuicidal self-injury (NSSI) over the course of 12 months: the roles of borderline personality disorder pathology and emotional consequences of NSSI. J Affect Disord 2020; 277:631-639. [PMID: 32905915 DOI: 10.1016/j.jad.2020.08.049] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 06/06/2020] [Accepted: 08/20/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Despite theories that negative reinforcement in the form of relief from negative emotions maintains nonsuicidal self-injury (NSSI), no studies have examined the extent to which specific emotional consequences of NSSI predict the maintenance of NSSI over time or explain the greater risk for NSSI found among individuals with borderline personality disorder (BPD) pathology. This study examined whether specific emotional consequences of NSSI relate to the continuance of NSSI behavior over a 12-month period and explain the relation of baseline BPD pathology to future NSSI. METHODS Participants with a history of recent repeated NSSI (N = 84) completed baseline measures of BPD pathology, NSSI, and the emotional antecedents and consequences of NSSI, including self-conscious emotions, undifferentiated negative affect, anger, emptiness, sadness, and anxiety; follow-up data on NSSI were collected every three months for one year. RESULTS Of the emotional consequences of NSSI examined here, only self-conscious emotions significantly predicted the presence and frequency of NSSI during the 12-month follow-up period. Likewise, whereas BPD pathology was not directly associated with later NSSI, both overall BPD pathology and the specific BPD feature of identity problems were indirectly related to the presence of 12-month NSSI through the greater frequency of post-NSSI self-conscious emotions. LIMITATIONS Emotional consequences of NSSI were assessed using a retrospective self-report measure. Only frequency, and not intensity, of emotions before and after NSSI were assessed. CONCLUSIONS Results suggest a distinct role of post-NSSI self-conscious emotions in the maintenance of NSSI among individuals with and without BPD pathology.
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Affiliation(s)
- Tara L Spitzen
- Department of Psychology, University of Toledo, Toledo, OH, USA
| | - Matthew T Tull
- Department of Psychology, University of Toledo, Toledo, OH, USA
| | - Margaret M Baer
- Department of Psychology, University of Toledo, Toledo, OH, USA
| | | | | | - Kim L Gratz
- Department of Psychology, University of Toledo, Toledo, OH, USA.
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2
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Bertschy G, Weibel S, Giersch A, Weiner L. Racing and crowded thoughts in mood disorders: A data-oriented theoretical reappraisal. Encephale 2020; 46:202-208. [DOI: 10.1016/j.encep.2020.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 01/20/2020] [Accepted: 01/23/2020] [Indexed: 10/24/2022]
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3
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López-Villatoro JM, Diaz-Marsá M, Mellor-Marsá B, De la Vega I, Carrasco JL. Executive Dysfunction Associated With the Primary Psychopathic Features of Borderline Personality Disorder. Front Psychiatry 2020; 11:514905. [PMID: 33362588 PMCID: PMC7758395 DOI: 10.3389/fpsyt.2020.514905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/13/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose: The aim of the present study is to investigate whether the presence of psychopathic features in BPD is related to dysfunction in executive functions and other neuropsychological functions in these patients. Methods: 82 patients diagnosed with borderline personality disorder and 54 control subjects were studied through clinical and neuropsychological evaluation protocols and the Levenson Psychopathy Inventory. Results: BPD patients showed significantly higher scores on both primary (F1) and secondary (F2) global rates of psychopathy, than controls. The results for these patients also showed a statistically significant association between high scores in primary psychopathy and deficits in executive functions. However, no associations were found between the scores of secondary psychopathy and executive dysfunction. Conclusion: Primary psychopathic features present in patients with BPD are associated with patterns of executive dysfunction. It would therefore be interesting to investigate the role of cognitive rehabilitation in the empathy dysfunctions within these disorders.
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Affiliation(s)
| | - Marina Diaz-Marsá
- Department of Psychiatry and Medical Psychology, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain.,Biomedical Research Networking Consortium for Mental Health (CIBERSAM), Hospital Gregorio Marañón, Madrid, Spain
| | - Blanca Mellor-Marsá
- Sanitary Research Institute, Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Irene De la Vega
- Sanitary Research Institute, Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - José L Carrasco
- Department of Psychiatry and Medical Psychology, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain.,Biomedical Research Networking Consortium for Mental Health (CIBERSAM), Hospital Gregorio Marañón, Madrid, Spain
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4
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Yu H, Meng YJ, Li XJ, Zhang C, Liang S, Li ML, Li Z, Guo W, Wang Q, Deng W, Ma X, Coid J, Li T. Common and distinct patterns of grey matter alterations in borderline personality disorder and bipolar disorder: voxel-based meta-analysis. Br J Psychiatry 2019; 215:395-403. [PMID: 30846010 DOI: 10.1192/bjp.2019.44] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Whether borderline personality disorder (BPD) and bipolar disorder are the same or different disorders lacks consistency.AimsTo detect whether grey matter volume (GMV) and grey matter density (GMD) alterations show any similarities or differences between BPD and bipolar disorder. METHOD Web-based publication databases were searched to conduct a meta-analysis of all voxel-based studies that compared BPD or bipolar disorder with healthy controls. We included 13 BPD studies (395 patients with BPD and 415 healthy controls) and 47 bipolar disorder studies (2111 patients with bipolar disorder and 3261 healthy controls). Peak coordinates from clusters with significant group differences were extracted. Effect-size signed differential mapping meta-analysis was performed to analyse peak coordinates of clusters and thresholds (P < 0.005, uncorrected). Conjunction analyses identified regions in which disorders showed common patterns of volumetric alteration. Correlation analyses were also performed. RESULTS Patients with BPD showed decreased GMV and GMD in the bilateral medial prefrontal cortex network (mPFC), bilateral amygdala and right parahippocampal gyrus; patients with bipolar disorder showed decreased GMV and GMD in the bilateral medial orbital frontal cortex (mOFC), right insula and right thalamus, and increased GMV and GMD in the right putamen. Multi-modal analysis indicated smaller volumes in both disorders in clusters in the right medial orbital frontal cortex. Decreased bilateral mPFC in BPD was partly mediated by patient age. Increased GMV and GMD of the right putamen was positively correlated with Young Mania Rating Scale scores in bipolar disorder. CONCLUSIONS Our results show different patterns of GMV and GMD alteration and do not support the hypothesis that bipolar disorder and BPD are on the same affective spectrum.Declaration of interestNone.
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Affiliation(s)
- Hua Yu
- Associate Researcher,Mental Health Center,West China Hospital of Sichuan University;Psychiatric Laboratory,State Key Laboratory of Biotherapy,West China Hospital of Sichuan University;and Brain Research Center,West China Hospital of Sichuan University,China
| | - Ya-Jing Meng
- Associate Researcher,Mental Health Center,West China Hospital of Sichuan University;Psychiatric Laboratory,State Key Laboratory of Biotherapy,West China Hospital of Sichuan University;and Brain Research Center,West China Hospital of Sichuan University,China
| | - Xiao-Jing Li
- Associate Researcher,Mental Health Center,West China Hospital of Sichuan University;Psychiatric Laboratory,State Key Laboratory of Biotherapy,West China Hospital of Sichuan University;and Brain Research Center,West China Hospital of Sichuan University,China
| | - Chengcheng Zhang
- Associate Researcher,Mental Health Center,West China Hospital of Sichuan University;Psychiatric Laboratory,State Key Laboratory of Biotherapy,West China Hospital of Sichuan University;and Brain Research Center,West China Hospital of Sichuan University,China
| | - Sugai Liang
- Associate Researcher,Mental Health Center,West China Hospital of Sichuan University;Psychiatric Laboratory,State Key Laboratory of Biotherapy,West China Hospital of Sichuan University;and Brain Research Center,West China Hospital of Sichuan University,China
| | - Ming-Li Li
- Mental Health Center,West China Hospital of Sichuan University;Psychiatric Laboratory,State Key Laboratory of Biotherapy,West China Hospital of Sichuan University;and Brain Research Center,West China Hospital of Sichuan University,China
| | - Zhe Li
- Lecturer,Mental Health Center,West China Hospital of Sichuan University;Psychiatric Laboratory,State Key Laboratory of Biotherapy,West China Hospital of Sichuan University;and Brain Research Center,West China Hospital of Sichuan University,China
| | - Wanjun Guo
- Lecturer,Mental Health Center,West China Hospital of Sichuan University;Psychiatric Laboratory,State Key Laboratory of Biotherapy,West China Hospital of Sichuan University;and Brain Research Center,West China Hospital of Sichuan University,China
| | - Qiang Wang
- Lecturer,Mental Health Center,West China Hospital of Sichuan University;Psychiatric Laboratory,State Key Laboratory of Biotherapy,West China Hospital of Sichuan University;and Brain Research Center,West China Hospital of Sichuan University,China
| | - Wei Deng
- Lecturer,Mental Health Center,West China Hospital of Sichuan University;Psychiatric Laboratory,State Key Laboratory of Biotherapy,West China Hospital of Sichuan University;and Brain Research Center,West China Hospital of Sichuan University,China
| | - Xiaohong Ma
- Researcher,Mental Health Center,West China Hospital of Sichuan University;Psychiatric Laboratory,State Key Laboratory of Biotherapy,West China Hospital of Sichuan University;and Brain Research Center,West China Hospital of Sichuan University,China
| | - Jeremy Coid
- Researcher,Mental Health Center,West China Hospital of Sichuan University;Psychiatric Laboratory,State Key Laboratory of Biotherapy,West China Hospital of Sichuan University;and Brain Research Center,West China Hospital of Sichuan University,China
| | - Tao Li
- Researcher,Mental Health Center,West China Hospital of Sichuan University;Psychiatric Laboratory,State Key Laboratory of Biotherapy,West China Hospital of Sichuan University;and Brain Research Center,West China Hospital of Sichuan University,China
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5
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Tyrer P, Mulder R, Kim YR, Crawford MJ. The Development of the ICD-11 Classification of Personality Disorders: An Amalgam of Science, Pragmatism, and Politics. Annu Rev Clin Psychol 2019; 15:481-502. [PMID: 30601688 DOI: 10.1146/annurev-clinpsy-050718-095736] [Citation(s) in RCA: 129] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The nomenclature of personality disorders in the 11th revision of the International Classification of Diseases and Related Health Problems represents the most radical change in the classification history of personality disorders. A dimensional structure now replaces categorical description. It was argued by the Working Group that only a dimensional system was consistent with the empirical evidence and, in the spirit of clinical utility, the new system is based on two steps. The first step is to assign one of five levels of severity, and the second step is to assign up to five prominent domain traits. There was resistance to this structure from those who feel that categorical diagnosis, particularly of borderline personality disorder, should be retained. After lengthy discussion, described in detail here, there is now an option for a borderline pattern descriptor to be selected as a diagnostic option after severity has been determined.
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Affiliation(s)
- Peter Tyrer
- Centre for Psychiatry, Department of Medicine, Imperial College London, London W12 0NN, United Kingdom; ,
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch 8140, New Zealand;
| | - Youl-Ri Kim
- Department of Psychiatry, Seoul Paik Hospital, Inje University, Seoul 100-032, South Korea;
| | - Mike J Crawford
- Centre for Psychiatry, Department of Medicine, Imperial College London, London W12 0NN, United Kingdom; ,
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6
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Shah R, Zanarini MC. Comorbidity of Borderline Personality Disorder: Current Status and Future Directions. Psychiatr Clin North Am 2018; 41:583-593. [PMID: 30447726 DOI: 10.1016/j.psc.2018.07.009] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Patients with borderline personality disorder have high rates of comorbid mood, anxiety, substance use, and eating disorders. The longitudinal studies conducted on borderline patients over 10 years of prospective follow-up suggest that patients with borderline personality disorder experienced declining rates of Axis I disorders over time, but the rates of these disorders remained high compared with those with other personality disorders. In addition, patients whose borderline personality disorder remitted over time experienced a substantial decline in all comorbid Axis I disorders, but those whose borderline personality disorder did not remit over time, reported stable rates of comorbid disorders.
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Affiliation(s)
- Ravi Shah
- Laboratory for the Study of Adult Development, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02215, USA
| | - Mary C Zanarini
- Laboratory for the Study of Adult Development, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02215, USA.
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7
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Yeh ZT, Lin YC, Liu SI, Fang CK. Social Awareness and its Relationship with Emotion Recognition and Theory of Mind in Patients with Borderline Personality Disorder. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2017. [DOI: 10.1521/jscp.2017.36.1.22] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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8
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Abstract
Recent research has linked identity instability with engagement in nonsuicidal self-injury (NSSI; Claes, Luyckx, & Bijttebier, 2014; Claes et al., 2015). This study examined the relationship between self-concept clarity (SCC), an index of identity stability, and NSSI in a sample of 147 college students, using a cross-sectional survey design. The relationship between SCC and emotion dysregulation in NSSI severity was also examined. SCC was significantly negatively associated with NSSI engagement, as well as NSSI frequency and versatility, above negative affect or age. SCC fully accounted for the variance originally explained by emotion dysregulation in NSSI versatility. NSSI frequency was not significantly predicted by emotion regulation, but self-concept clarity reached marginal significance. These findings provide preliminary support for identity instability as a contributing factor to a relationship between emotion dysregulation and NSSI severity. Possible explanations and future research directions are discussed.
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9
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Gratz KL, Chapman AL, Dixon-Gordon KL, Tull MT. Exploring the association of deliberate self-harm with emotional relief using a novel Implicit Association Test. Personal Disord 2016; 7:91-102. [PMID: 26147069 PMCID: PMC5493474 DOI: 10.1037/per0000138] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite the growing consensus that negative reinforcement in the form of emotional relief plays a key role in the maintenance of deliberate self-harm (DSH), most of the research in this area has relied exclusively on self-report measures of the perceived motives for and emotional consequences of DSH. Thus, the primary aim of this study was to extend extant research on the role of emotional relief in DSH by examining the strength of the association of DSH with emotional relief using a novel version of the Implicit Association Test (IAT). The strength of the DSH-relief association among both participants with (vs. without) DSH and self-harming participants with (vs. without) BPD, as well as its associations with relevant clinical constructs (including DSH characteristics, self-reported motives for DSH, BPD pathology, and emotion dysregulation and avoidance) were examined in a community sample of young adults (113 with recent recurrent DSH; 135 without DSH). As hypothesized, results revealed stronger associations between DSH and relief among participants with versus without DSH, as well as among DSH participants with versus without BPD. Moreover, the strength of the DSH-relief association was positively associated with DSH frequency and versatility (both lifetime and at 6-month follow-up), BPD pathology, emotion dysregulation, experiential avoidance, and self-reported emotion relief motives for DSH. Findings provide support for theories emphasizing the role of emotional relief in DSH (particularly among individuals with BPD), as well as the construct validity, predictive utility, and incremental validity (relative to self-reported emotion relief motives) of this IAT.
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Affiliation(s)
- Kim L Gratz
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center
| | | | | | - Matthew T Tull
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center
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10
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Hunt E, Bornovalova MA, Kimonis ER, Lilienfeld SO, Poythress NG. Psychopathy factor interactions and co-occurring psychopathology: Does measurement approach matter? Psychol Assess 2015; 27:583-95. [PMID: 25580612 DOI: 10.1037/pas0000055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The 2 dimensions of psychopathy as operationalized by various measurement tools show differential associations with psychopathology; however, evidence suggests that the statistical interaction of Factor 1 (F1) and Factor 2 (F2) may be important in understanding associations with psychopathology. Findings regarding the interactive effects of F1 and F2 are mixed, as both potentiating and protective effects have emerged. Moreover, approaches to measuring F1 (e.g., clinical interview vs. self-report) are based on different conceptualizations of F1, which may influence the interactive effects. The current study aims to (a) elucidate the influence of F1 and F2 on psychopathology by using both variable-centered and person-centered approaches and (b) determine whether the measurement of F1 influences the interactive effects of F1 and F2 by comparing the strength of interactive effects across F1 measures in a sample of over 1,500 offenders. Across analytic methods, there were very few cases in which F1 statistically influenced the association between F2 and psychopathology, such that F1 failed to evidence either potentiating or protective effects on F2. Furthermore, the conceptualization of F1 across psychopathy measures did not impact the interactive effects of F1 and F2. These findings suggest that F2 is probably driving the relations between psychopathy and other forms of psychopathology and that F1 may play less of a role in interacting with F2 than previously believed.
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Affiliation(s)
| | | | - Eva R Kimonis
- Mental Health Law and Policy Department, University of South Florida
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11
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Zimmerman M, Morgan TA. The relationship between borderline personality disorder and bipolar disorder. DIALOGUES IN CLINICAL NEUROSCIENCE 2014. [PMID: 24174890 PMCID: PMC3811087 DOI: 10.31887/dcns.2013.15.2/mzimmerman] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It is clinically important to recognize both bipolar disorder and borderline personality disorder (BPD) in patients seeking treatment for depression, and it is important to distinguish between the two. Research considering whether BPD should be considered part of a bipolar spectrum reaches differing conclusions. We reviewed the most studied question on the relationship between BPD and bipolar disorder: their diagnostic concordance. Across studies, approximately 10% of patients with BPD had bipolar I disorder and another 10% had bipolar II disorder. Likewise, approximately 20% of bipolar II patients were diagnosed with BPD, though only 10% of bipolar I patients were diagnosed with BPD. While the comorbidity rates are substantial, each disorder is nontheless diagnosed in the absence of the other in the vast majority of cases (80% to 90%). In studies examining personality disorders broadly, other personality disorders were more commonly diagnosed in bipolar patients than was BPD. Likewise, the converse is also true: other axis I disorders such as major depression, substance abuse, and post-traumatic stress disorder are also more commonly diagnosed in patients with BPD than is bipolar disorder. These findings challenge the notion that BPD is part of the bipolar spectrum.
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Affiliation(s)
- Mark Zimmerman
- Department of Psychiatry and Human Behavior, Brown Medical School, Providence, Rhode Island, USA
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12
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Kolar DR, Bürger A, Hammerle F, Jenetzky E. Aversive tension of adolescents with anorexia nervosa in daily course: a case-controlled and smartphone-based ambulatory monitoring trial. BMJ Open 2014; 4:e004703. [PMID: 24760350 PMCID: PMC4010818 DOI: 10.1136/bmjopen-2013-004703] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Monitoring and reduction of aversive tension is a core issue in dialectical behaviour therapy of patients. It has been shown that aversive tension is increased in adult borderline personality disorder and is linked to low emotion labelling ability. However, until now there is no documented evidence that patients with anorexia nervosa suffer from aversive tension as well. Furthermore the usability of a smartphone application for ambulatory monitoring purposes has not been sufficiently explored. METHODS AND ANALYSIS We compare the mean and maximum self-reported aversive tension in 20 female adolescents (12-19 years) with anorexia nervosa in outpatient treatment with 20 healthy controls. They are required to answer hourly, over a 2-day period, that is, about 30 times, four short questions on their smartphone, which ensures prompt documentation without any recall bias. At the close out, the participants give a structured usability feedback on the application and the procedure. ETHICS AND DISSEMINATION The achieved result of this trial has direct relevance for efficient therapy strategies and is a prerequisite for trials regarding dialectical behaviour therapy in anorexia nervosa. The results will be disseminated through peer-review publications. The ethics committee of the regional medical association in Mainz, Germany approved the study protocol under the reference number 837.177.13. TRIAL REGISTRATION NUMBER The trial is registered at the German clinical trials registration under the reference number DRKS00005228.
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Affiliation(s)
- David Raphael Kolar
- Department for Child and Adolescent Psychiatry and Psychotherapy, Johannes-Gutenberg-University Mainz, Mainz, Germany
| | - Arne Bürger
- Department for Child and Adolescent Psychiatry and Psychotherapy, Johannes-Gutenberg-University Mainz, Mainz, Germany
| | - Florian Hammerle
- Department for Child and Adolescent Psychiatry and Psychotherapy, Johannes-Gutenberg-University Mainz, Mainz, Germany
| | - Ekkehart Jenetzky
- Department for Child and Adolescent Psychiatry and Psychotherapy, Johannes-Gutenberg-University Mainz, Mainz, Germany
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
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13
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Abstract
In this article, the process of mentalizing, its components, and role in self-regulation and attachment are reviewed. An examination is presented of the neurodevelopmental changes affecting the adolescent's capacity to mentalize and the role of such compromised mentalizing in the adolescent's vulnerability to adaptive breakdown and psychopathology, in general, and to emerging personality disorders, in particular. The principles, objectives, and core features of mentalizing-based treatment and its application to adolescents and families are discussed.
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Affiliation(s)
- Efrain Bleiberg
- Child and Adolescence Psychiatry, Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA.
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14
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Moller CI, Tait RJ, Byrne DG. Deliberate Self-Harm, Substance Use, and Negative Affect in Nonclinical Samples: A Systematic Review. Subst Abus 2013; 34:188-207. [DOI: 10.1080/08897077.2012.693462] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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15
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Svaldi J, Dorn C, Matthies S, Philipsen A. Effects of suppression and acceptance of sadness on the urge for non-suicidal self-injury and self-punishment. Psychiatry Res 2012; 200:404-16. [PMID: 22819783 DOI: 10.1016/j.psychres.2012.06.030] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 06/08/2012] [Accepted: 06/10/2012] [Indexed: 11/20/2022]
Abstract
The present study wanted to test the course of the urge for non-suicidal self-injury (UNSSI) and the urge for self-punishment (USP) when suppressing or accepting upcoming emotions in response to a sadness-inducing film clip in female participants with borderline personality disorder (BPD). Thirty-six women with BPD were allocated either to a condition in which they were asked to engage in expressive suppression or acceptance while watching a sadness-inducing film clip. Ratings of UNSSI, USP, and positive and negative emotions were assessed prior to the clip (baseline), immediately after it (t1) and after a 5min waiting period (t2), during which participants viewed landscape pictures. Additionally, physiological measures were obtained. Main results revealed a significant increase in UNSSI from baseline to t2 in the acceptance, but not in the suppression group. Furthermore, USP scores significantly increased from baseline to t2 in the acceptance, but not in the suppression condition. However, there was no differential impact on the sympathetic and parasympathetic branch depending on strategy. The results are in line with recent literature showing that expressive suppression in BPD may also have an adaptive function.
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Affiliation(s)
- Jennifer Svaldi
- University of Freiburg, Department of Clinical Psychology and Psychotherapy, Engelbergerstrasse 41, 79106 Freiburg, Germany.
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16
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Olabi B, Hall J. Borderline personality disorder: current drug treatments and future prospects. Ther Adv Chronic Dis 2012; 1:59-66. [PMID: 23251729 DOI: 10.1177/2040622310368455] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Individuals with borderline personality disorder (BPD) suffer from marked affective disturbance, an unstable sense of self, difficulty in interpersonal relationships and heightened impulsivity, leading to high rates of self-harm and suicide. Patients are often refractory to treatment and are at high risk for acute or dangerous presentations, with a serious impact on mental health services. There has been much debate on the effectiveness of pharmacotherapy in treating different facets of the psychopathology of the disorder. Several guidelines recommend the use of antidepressant agents, mood stabilizers for affective dysregulation and impulsive-behavioural dyscontrol, and antipsychotics for cognitive-perceptual symptoms. However, concerns have recently been raised regarding the strength of evidence for these treatment recommendations in BPD. Here, we review the evidence for efficacy of the main psychotropic medications used in BPD, drawing, in particular, on evidence from randomized controlled trials and meta-analyses. Overall, meta-analysis provides little evidence to support the use of antidepressant medication in BPD outside episodes of major depression. However, there is evidence for the use of both mood stabilizers and antipsychotic medications for the treatment of specific aspects of the disorder. Most existing studies have been conducted on small numbers of patients, and there is a requirement for further large-scale trials to substantiate these findings. In addition, given the limitations of current pharmacological treatment of BPD, there is a pressing need to investigate potential new therapeutic targets, including neuropeptides, such as the opioids and vasopressin, and drugs targeted at ameliorating the biological effects of early life stress.
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Affiliation(s)
- Bayanne Olabi
- Bayanne Olabi Division of Psychiatry, School of Molecular and Clinical Medicine, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, EH10 5HF, UK
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17
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Fairfax H, Gillies F. ‘Being with complexity’; Adaptation-based Process Therapy (APT). COUNSELLING PSYCHOLOGY QUARTERLY 2012. [DOI: 10.1080/09515070.2012.713211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Hamilton Fairfax
- a Devon Partnership Trust – Clinical Psychology, Riversvale Centre , 21 Litchdon Street, Barnstaple EX32 8PJ , UK
| | - Frances Gillies
- a Devon Partnership Trust – Clinical Psychology, Riversvale Centre , 21 Litchdon Street, Barnstaple EX32 8PJ , UK
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18
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Is non-suicidal self-injury an "addiction"? A comparison of craving in substance use and non-suicidal self-injury. Psychiatry Res 2012; 197:73-7. [PMID: 22401975 PMCID: PMC3625678 DOI: 10.1016/j.psychres.2011.12.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Revised: 12/05/2011] [Accepted: 12/11/2011] [Indexed: 01/24/2023]
Abstract
There is debate among researchers regarding the most appropriate conceptual model of non-suicidal self-injury (NSSI). Some argue that NSSI is best viewed within an addictions framework. Because craving of substances is a key concept in the addictions literature, we sought to compare the nature of craving in NSSI and substance use. Measures of NSSI, substance use, and craving were administered to a sample of adolescents (n=58) receiving psychiatric treatment. It was found that total craving scores were significantly lower for NSSI than for substances. Item-level analyses suggested that substances are craved in a variety of contexts, whereas NSSI is typically craved in the context of negative emotions. The pattern of results remained the same when analyses were limited to patients who engaged in both NSSI and substance use. Thus, findings appear to be due to differences in the nature of the behaviors themselves rather than to individual differences between those who engage in NSSI or use substances. We conclude that, while both behaviors have powerful reinforcement contingencies, NSSI appears to be almost exclusively maintained by negative reinforcement (e.g., the reduction of aversive emotions). Findings are more consistent with emotion regulation than addiction models of NSSI.
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Magerl W, Burkart D, Fernandez A, Schmidt LG, Treede RD. Persistent antinociception through repeated self-injury in patients with borderline personality disorder. Pain 2012; 153:575-584. [DOI: 10.1016/j.pain.2011.11.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 11/16/2011] [Accepted: 11/18/2011] [Indexed: 12/21/2022]
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Washburn JJ, Gebhardt M, Styer DM, Juzwin KR, Gottlieb L. Co-Occurring Disorders in the Treatment of Nonsuicidal Self-Injury: An Evidence-Informed Approach. J Cogn Psychother 2012. [DOI: 10.1891/0889-8391.26.4.348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Co-occurring disorders are common among patients who present for treatment with nonsuicidal self-injury (NSSI). Evidence-based approaches specifically designed for the treatment of NSSI are limited, although interest in this area of research is growing. An evidence-informed model for the treatment of NSSI and co-occurring disorders is presented here to stimulate interest in addressing co-occurring disorders in the treatment of NSSI. Case examples are presented to highlight the complexity of treating NSSI and co-occurring disorders and to illustrate a model of treatment at the acute level of care. The case examples also underscore the need for clinical researchers to address co-occurring disorders when developing treatments specifically for NSSI.
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Marissen MAE, Arnold N, Franken IHA. Anhedonia in borderline personality disorder and its relation to symptoms of impulsivity. Psychopathology 2012; 45:179-84. [PMID: 22441143 DOI: 10.1159/000330893] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 07/18/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients with borderline personality disorder (BPD) report strong negative affect and show impulsive, disruptive behaviors. The role of anhedonia, or the inability to experience positive affect, has been less examined in BPD. The present study examined the role of anhedonia in BPD patients and its relation to symptoms of impulsivity. SAMPLING AND METHODS Anhedonia, affect, impulsivity and BPD symptoms were measured in BPD patients and healthy control participants. RESULTS It was found that BPD patients showed abnormally high anhedonia levels. In addition, anhedonia was found to be positively related to dysfunctional impulsivity in the BPD patient group, while in the control group, anhedonia was related to withdrawal behaviors. A strong relation was found between anhedonia and BPD symptoms, emphasizing the relevance of anhedonia as an important symptom of BPD. Finally, anhedonia was found to be an important contributor to the severity of borderline symptoms, independently of other factors such as affect and impulsivity. CONCLUSIONS The results underline that anhedonia might be an important but currently overlooked feature of BPD. The results further suggest that anhedonia is associated with the impulsive behaviors that are typically observed in borderline patients.
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Sprague J, Javdani S, Sadeh N, Newman JP, Verona E. Borderline personality disorder as a female phenotypic expression of psychopathy? Personal Disord 2011; 3:127-39. [PMID: 22452756 DOI: 10.1037/a0024134] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Evidence suggests that the combination of the interpersonal-affective (F1) and impulsive-antisocial (F2) features of psychopathy may be associated with borderline personality disorder (BPD), specifically among women (e.g., Coid, 1993; Hicks, Vaidyanathan, & Patrick, 2010). However, empirical research explicitly examining gendered relationships between BPD and psychopathy factors is lacking. To further inform this area of research, we investigated the hypothesis that the interplay between the two psychopathy factors is associated with BPD among women across two studies. Study 1 consisted of a college sample of 318 adults (51% women), and Study 2 consisted of a large sample of 488 female prisoners. The interpersonal-affective (F1) and impulsive-antisocial psychopathy (F2) scores, measured with self-report and clinician-rated indices, respectively, were entered as explanatory variables in regression analyses to investigate their unique contributions to BPD traits. Across two independent samples, results indicated that the interaction of high F1 and F2 psychopathy scores was associated with BPD in women. This association was found to be specific to women in Study 1. These results suggest that BPD and psychopathy, at least as they are measured by current instruments, overlap in women and, accordingly, may reflect gender-differentiated phenotypic expressions of similar dispositional vulnerabilities.
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Affiliation(s)
- Jenessa Sprague
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA.
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Zanarini MC, Frankenburg FR, Weingeroff JL, Reich DB, Fitzmaurice GM, Weiss RD. The course of substance use disorders in patients with borderline personality disorder and Axis II comparison subjects: a 10-year follow-up study. Addiction 2011; 106:342-8. [PMID: 21083831 PMCID: PMC3222933 DOI: 10.1111/j.1360-0443.2010.03176.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The purpose of this study is to detail the course of substance use disorders (SUDs) over 10 years of prospective follow-up among patients with borderline personality disorder (BPD) and Axis II comparison subjects. DESIGN This study uses data from the McLean Study of Adult Development (MSAD), a multi-faceted study of the longitudinal course of BPD using reliable repeated measures administered every 2 years over a decade of prospective follow-up. SETTING All subjects were initially in-patients at McLean Hospital in Belmont Massachusetts. PARTICIPANTS; A total of 290 patients with BPD and 72 Axis II comparison subjects were assessed at baseline and five waves of follow-up. MEASUREMENTS The Structured Clinical Interview for DSM-III-R Axis I Disorders (SCID-I), the Revised Diagnostic Interview for Borderlines (DIB-R) and the Diagnostic Interview for DSM-III-R Personality Disorders (DIPD-R) were administered six times. Generalized estimating equations were used to assess longitudinal prevalence of SUDs. Kaplan-Meier analyses were used to assess time-to-remission, recurrence and new onsets of SUDs. RESULTS The prevalence of SUDs among borderline patients and Axis II comparison subjects declined significantly over time, while remaining significantly more common among those with BPD. More than 90% of borderline patients meeting criteria for a SUD at baseline experienced a remission by 10-year follow-up. Recurrences and new onsets of SUDs were less common (35-40% and 21-23%). CONCLUSIONS Remissions of alcohol and drug abuse/dependence among borderline patients are both common and relatively stable. Results also suggest that new onsets of these disorders are less common than might be expected.
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Fonagy P, Luyten P, Strathearn L. Borderline personality disorder, mentalization, and the neurobiology of attachment. Infant Ment Health J 2011; 32:47-69. [DOI: 10.1002/imhj.20283] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Zanarini MC, Reichman CA, Frankenburg FR, Reich DB, Fitzmaurice G. The course of eating disorders in patients with borderline personality disorder: a 10-year follow-up study. Int J Eat Disord 2010; 43:226-32. [PMID: 19343799 PMCID: PMC2839025 DOI: 10.1002/eat.20689] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The purpose of this study was to describe the longitudinal course of eating disorders in patients with borderline personality disorder. METHOD The SCID I was administered to 290 borderline inpatients and 72 participants with other axis II disorders during their index admission and at five contiguous 2-year follow-up periods. RESULTS The prevalence of anorexia, bulimia, and eating disorder not otherwise specified (EDNOS) declined significantly over time for those in both study groups but the prevalence of EDNOS remained significantly higher among borderline patients. While over 90% of borderline patients meeting criteria for anorexia, bulimia, or EDNOS at baseline experienced a stable remission by the time of the 10-year follow-up, diagnostic migration was common, particularly for those with anorexia or bulimia. In addition, both recurrences (52%) and new onsets (43%) of EDNOS were more common among borderline patients than recurrences and new onsets of anorexia (28% and 4%) and bulimia (29% and 11%). DISCUSSION The results of this study suggest that the prognosis for both anorexia and bulimia in borderline patients is complicated, with remissions being stable but migrations to other eating disorders being common. The results also suggest that EDNOS may be the most prevalent and enduring of the eating disorders in these patients.
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Affiliation(s)
- Mary C. Zanarini
- McLean Hospital, Belmont, MA, Harvard Medical School, Boston, MA
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Piguet C, Dayer A, Kosel M, Desseilles M, Vuilleumier P, Bertschy G. Phenomenology of racing and crowded thoughts in mood disorders: a theoretical reappraisal. J Affect Disord 2010; 121:189-98. [PMID: 19515428 DOI: 10.1016/j.jad.2009.05.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2009] [Revised: 03/31/2009] [Accepted: 05/07/2009] [Indexed: 12/21/2022]
Abstract
BACKGROUND Racing thoughts is a frequent symptom in mood disorders, particularly mixed depressive states. This paper aims to summarize our current knowledge about its phenomenology and frequency in the spectrum of mood disorders, and to offer a new theoretical framework. METHODS We made a selective review of original and review papers in Medline and PsychInfo database using the keywords "racing thoughts", "crowded thoughts" and "depressive mixed state" in conjunction with "mood disorders". RESULTS In the context of a hypomanic state, "racing thoughts" may appear as a result from an excessive production of thoughts, moving quickly from one to the other, and generating a sense of fluidity and pleasantness. In the context of depression, "racing thoughts" are phenomenologically different and better described as "crowded thoughts": they are not only characterized by too many thoughts occurring at the same time in the field of consciousness, but perceived as unpleasant and induce the feeling that ideas are difficult to catch. DISCUSSION AND CLINICAL RELEVANCE: We suggest that crowded thoughts might result from the mixture of a hypomanic component, with an accelerated production of new thoughts (constituting the main source of this symptom in hypomania), and a depressive component, with a deficit of inhibition of previous thoughts (hence making thoughts crowded rather than truly racing). This distinction could help better identify crowded thoughts, and consequently depressive mixed states, which has important implications for therapeutic management. It might also help to further disentangle the psychobiological processes which contribute to the complexity of mood disorders.
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Affiliation(s)
- Camille Piguet
- Laboratory for Neurology and Imaging of Cognition, Department of Neurosciences and Clinic of Neurology, University Medical Center, 1211 Geneva 4, Switzerland.
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Harty L, Duckworth R, Thompson A, Stuewig J, Tangney JP. Are inmates' subjective sleep problems associated with borderline personality, psychopathy, and antisocial personality independent of depression and substance dependence? THE JOURNAL OF FORENSIC PSYCHIATRY & PSYCHOLOGY 2010; 21:23-39. [PMID: 20198127 PMCID: PMC2830015 DOI: 10.1080/14789940903194095] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Previous research investigating the relationship between Borderline Personality Disorder (BPD) and sleep problems, independent of depression, has been conducted on small atypical samples with mixed results. This study extends the literature by utilizing a much larger sample and by statistically controlling for depression and substance dependence. Subjective reports of sleep problems were obtained from 513 jail inmates (70% male) incarcerated on felony charges. Symptoms of BPD were significantly associated with sleep problems even when controlling for depression. Thus, sleep problems associated with BPD cannot be attributed simply to co-morbid symptoms of depression and substance dependence was ruled out as proximal causes for this relationship. Symptoms of depression, but not Antisocial Personality features, were related to sleep problems independent of substance dependence. Treatment of individuals with BPD may be more effective if sleep problems are explicitly addressed in the treatment plan.
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A developmental, mentalization-based approach to the understanding and treatment of borderline personality disorder. Dev Psychopathol 2009; 21:1355-81. [PMID: 19825272 DOI: 10.1017/s0954579409990198] [Citation(s) in RCA: 485] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractThe precise nature and etiopathogenesis of borderline personality disorder (BPD) continues to elude researchers and clinicians. Yet, increasing evidence from various strands of research converges to suggest that affect dysregulation, impulsivity, and unstable relationships constitute the core features of BPD. Over the last two decades, the mentalization-based approach to BPD has attempted to provide a theoretically consistent way of conceptualizing the interrelationship between these core features of BPD, with the aim of providing clinicians with a conceptually sound and empirically supported approach to BPD and its treatment. This paper presents an extended version of this approach to BPD based on recently accumulated data. In particular, we suggest that the core features of BPD reflect impairments in different facets of mentalization, each related to impairments in relatively distinct neural circuits underlying these facets. Hence, we provide a comprehensive account of BPD by showing how its core features are related to each other in theoretically meaningful ways. More specifically, we argue that BPD is primarily associated with a low threshold for the activation of the attachment system and deactivation of controlled mentalization, linked to impairments in the ability to differentiate mental states of self and other, which lead to hypersensitivity and increased susceptibility to contagion by other people's mental states, and poor integration of cognitive and affective aspects of mentalization. The combination of these impairments may explain BPD patients' propensity for vicious interpersonal cycles, and their high levels of affect dysregulation and impulsivity. Finally, the implications of this expanded mentalization-based approach to BPD for mentalization-based treatment and treatment of BPD more generally are discussed.
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Coid J, Yang M, Bebbington P, Moran P, Brugha T, Jenkins R, Farrell M, Singleton N, Ullrich S. Borderline personality disorder: health service use and social functioning among a national household population. Psychol Med 2009; 39:1721-1731. [PMID: 19250579 DOI: 10.1017/s0033291708004911] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND It is unclear whether Axis II psychopathology or co-morbid clinical syndromes result in the treatment-seeking behaviour and social impairment of patients with borderline personality disorder (BPD). This study examined the independent associations between social functioning and service use and Axis I and Axis II disorders in persons with BPD in the national household population of Britain. METHOD The study was a cross-sectional survey of adults aged 16-74 years in households (n=8397). Data included self-reported consultations with health-care professionals and behavioural problems. Diagnosis was determined by computer-assisted interviews. Analyses included logistic regression adjusting for demography, co-morbid Axis I clinical syndromes and other Axis II disorders. RESULTS Consultation in the past year was reported by 57.5% of persons with BPD but only 13.4% reported lifetime psychiatric admission. BPD was not independently associated with impaired functioning but was associated with co-morbid psychotic, depressive and anxiety disorders. Only general practitioners (GPs) were consulted for problems independently due to BPD. CONCLUSIONS Functional effects of BPD are mediated through co-morbid clinical syndromes, not Axis II psychopathology. A subgroup do not have co-morbid disorders or seek treatment, and are high functioning.
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Affiliation(s)
- J Coid
- University of London, UK.
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Klonsky ED. The functions of self-injury in young adults who cut themselves: clarifying the evidence for affect-regulation. Psychiatry Res 2009; 166:260-8. [PMID: 19275962 PMCID: PMC2723954 DOI: 10.1016/j.psychres.2008.02.008] [Citation(s) in RCA: 288] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2006] [Revised: 02/22/2008] [Accepted: 02/24/2008] [Indexed: 11/27/2022]
Abstract
The functions of non-suicidal self-injury were examined in 39 young adults with a history of skin-cutting and other self-injurious behaviors including banging, burning, and severe scratching. Consequences, affect-states, and reasons associated with self-injury were assessed by a structured interview. Results indicate that self-injury is associated with improvements in affective valence and decreases in affective arousal. Specifically, participants tended to feel overwhelmed, sad, and frustrated before self-injury, and relieved and calm after self-injury. Further, these affective changes predict lifetime frequency of self-injury, suggesting that they reinforce the behavior. Finally, although reasons for self-injury related to both affect-regulation (e.g., to release emotional pressure that builds up inside of me) and self-punishment (e.g., to express anger at myself) were endorsed by a majority of participants, affect-regulation reasons were overwhelmingly rated as primary and self-punishment reasons as secondary.
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Tyrer P. Why borderline personality disorder is neither borderline nor a personality disorder. Personal Ment Health 2009. [DOI: 10.1002/pmh.78] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Lindberg N, Tani P, Putkonen H, Sailas E, Takala P, Eronen M, Virkkunen M. Female impulsive aggression: a sleep research perspective. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2009; 32:39-42. [PMID: 19095304 DOI: 10.1016/j.ijlp.2008.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The rate of violent crimes among girls and women appears to be increasing. One in every five female prisoners has been reported to have antisocial personality disorder. However, it has been quite unclear whether the impulsive, aggressive behaviour among women is affected by the same biological mechanisms as among men. Psychiatric sleep research has attempted to identify diagnostically sensitive and specific sleep patterns associated with particular disorders. Most psychiatric disorders are typically characterized by a severe sleep disturbance associated with decreased amounts of slow wave sleep (SWS), the physiologically significant, refreshing part of sleep. Among men with antisocial behaviour with severe aggression, on the contrary, increased SWS has been reported, reflecting either specific brain pathology or a delay in the normal development of human sleep patterns. In our preliminary study among medication-free, detoxified female homicidal offenders with antisocial personality disorder, the same profound abnormality in sleep architecture was found. From the perspective of sleep research, the biological correlates of severe impulsive aggression seem to share similar features in both sexes.
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Dolan M, Völlm B. Antisocial personality disorder and psychopathy in women: a literature review on the reliability and validity of assessment instruments. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2009; 32:2-9. [PMID: 19042020 DOI: 10.1016/j.ijlp.2008.11.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Crime rates are low in women compared to men. The two disorders most commonly associated with offending behaviour, antisocial personality disorder (ASPD) and psychopathy, are also less prevalent in female samples. However, developments in forensic psychiatry have often ignored gender, and the utility of constructs such as psychopathy and their assessment instruments in female samples remains unclear. This article presents a review of studies looking at rates of ASPD and psychopathy and on the reliability and validity of assessment instruments of these disorders in women. Gender differences in symptom patterns will be considered. The literature seems to suggest that DSM-IV criteria for ASPD may lead to an underestimation of the prevalence of the disorder in women due to the requirement of childhood conduct disorder symptoms. The Psychopathy Checklist-Revised (PCL-R) is a valid and reliable instrument to identify psychopathy in women but there are gender differences in the factor structure and item loadings on this measure. Research to date seems to suggest a three-factor model may be most strongly supported in females. Preliminary evidence suggests the PCL-R may have some value in predicting future offending while the PCL:SV may be useful in predicting institutional violence. Clinical implications are discussed.
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Self-injurious behaviour, traumatic life events and alexithymia among treatment-seeking opiate addicts: prevalence, pattern and correlates. Drug Alcohol Depend 2008; 98:227-34. [PMID: 18639391 DOI: 10.1016/j.drugalcdep.2008.06.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Revised: 05/29/2008] [Accepted: 06/01/2008] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Aim of this study was to determine the prevalence and pattern of self-injurious behaviour (SIB) and identify the predictors of SIB among treatment-seeking opiate addicts. METHODS Participants were 80 consecutively consenting opiate addicts admitted into community and inpatient treatment programmes of a large South London National Health Service (NHS) Mental Health Trust. Substance dependence was diagnosed with ICD-10. The following instruments were administered: self-injurious behaviour questionnaire, traumatic life events questionnaire, Toronto alexithymia scale and substance abuse assessment questionnaire. RESULTS Lifetime SIB prevalence rate was 49% (95% CI=37-60). There was no difference in lifetime SIB rates of male (50%) and female (46%) patients. The predominate function of SIB among opiate addicts was affect-regulation followed by self-punishment. Using a logistic regression, sexual harassment and difficulty identifying feelings were the only independent significant predictors of SIB, with the influence of age of first traumatic event and gender partialled out. CONCLUSION Given these findings, there is strong evidence to suggest that treatment of opiate addiction should involve routine screening for adult sexual trauma, deficits in emotional regulation and SIB. Where these problems are identified, appropriate psychological intervention should be integral to routine care for affected patients.
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STEPPS: Systems Training for Emotional Predictability and Problem Solving in women offenders with borderline personality disorder in prison--a pilot study. CNS Spectr 2008; 13:881-6. [PMID: 18955943 DOI: 10.1017/s1092852900016989] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION An uncontrolled pilot study of Systems Training for Emotional Predictability and Problem Solving (STEPPS) was conducted with incarcerated women offenders. STEPPS is a promising new cognitive-behavioral group treatment for persons with borderline personality disorder (BPD). METHODS Twelve women offenders with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition BPD were enrolled in the 20-week program at an Iowa prison. Efficacy assessments included the Borderline Evaluation of Severity over Time, the Positive and Negative Affectivity Scale, and the Beck Depression Inventory. Data were collected at baseline, and weeks 4, 8, 12, 16, and 20. A prison therapist was trained to deliver the STEPPS program. RESULTS The 12 volunteers had a mean age of 34.8+/-8.5 years. Two women discontinued early because they were released from prison; the others attended all sessions. The analysis showed significant improvements in BPD-related symptoms, negative affectivity, and depression. The Borderline Evaluation of Severity over Time total score was highly significant at week 20 (P=.009), indicating overall improvement in BPD-related symptoms. Effect sizes for the efficacy measures were moderate to large. The prison therapist showed excellent adherence to the model. CONCLUSION This study demonstrated the successful implementation of the STEPPS program in a women's prison. Participants achieved "real-world" benefits, including a reduction in the negative thoughts and behaviors associated with BPD, negative affectivity, and depression. Implications of the findings are discussed.
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Cartwright D. Borderline Personality Disorder: What do We Know? Diagnosis, Course, Co-Morbidity, and Aetiology. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2008. [DOI: 10.1177/008124630803800212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Evidence regarding the diagnostic dilemmas, course, co-morbidity, and aetiology of Borderline Personality Disorder (BPD) is reviewed. After considering problems that the clinician and researcher face in using BPD as a diagnostic category, I argue that current evidence indicates that there is reason to be more optimistic about the course of BPD. Emerging dilemmas in considering co-morbidity in the BPD patient are considered. Aetiological factors are presented in support of a ‘multiple pathways’ model of aetiology where characterological and temperamental characteristics interact in complex idiosyncratic ways.
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Affiliation(s)
- Duncan Cartwright
- Centre for Applied Psychology, School of Psychology, University of KwaZulu-Natal, Howard College Campus, Private Bag X54001, Durban, 4000 South Africa
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Stiglmayr CE, Bischkopf J, Albrecht V, Porzig N, Scheuer S, Lammers CH, Auckenthaler A. The Experience of Tension in Patients with Borderline Personality Disorder Compared to Other Patient Groups and Healthy Controls. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2008. [DOI: 10.1521/jscp.2008.27.5.425] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Efficacy of quetiapine for impulsivity and affective symptoms in borderline personality disorder. J Clin Psychopharmacol 2008; 28:147-55. [PMID: 18344724 DOI: 10.1097/jcp.0b013e318166c4bf] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Data on the efficacy of quetiapine in borderline personality disorder (BPD) are still scarce. We aimed to investigate the efficacy of quetiapine for impulsivity and a broad range of affective symptoms in BPD. In this 12-week open-label study, we included individuals with BPD who presented to psychiatric in- and outpatient services. After a gradual titration of quetiapine, a flexible dose (range, 100-800 mg) was administered. The main outcome measures consisted of the scores on patient-rated questionnaires (Barratt Impulsiveness Scale, Buss-Durkee Hostility Inventory, Affective Lability Scale, Spielberger State and Trait Anxiety Inventory, Spielberger State and Trait Anger Inventory, and Beck Depression Inventory) and on neurocognitive tasks related to impulsivity (Stroop Color Word Task and IOWA Gambling Task). A mixed linear model, correcting for age, sex, antidepressant use, and weeks in psychotherapy, was applied. Forty-one patients (34 females and 7 males; mean [SD] age, 27.0 [9.0] years) were enrolled in the study, 32 of which completed the trial. Patients' scores decreased significantly (mean [SD] difference; P value) on the Barratt Impulsiveness Scale (19.7 [2.0]; P < 0.0001), Buss-Durkee Hostility Inventory (11.5 [1.4]; P < 0.0001), Affective Lability Scale (0.75 [0.08]; P < 0.0001), Beck Depression Inventory (25.0 [1.7]; P < 0.0001), Spielberger State and Trait Anxiety Inventory state (19.9 [1.9]; P < 0.0001) and trait (20.8 [1.7]; P < 0.0001) subscale, and Spielberger State and Trait Anger Inventory state (7.3 [1.1]; P < 0.0001) and trait (10.1 [1.0]; P < 0.0001) subscale. In addition, patients showed significantly less inference on the Stroop Color Word Task and had more 'good choices' on the IOWA Gambling Task. These results suggest that quetiapine may be efficacious in the treatment of impulsivity and affective symptoms in BPD.
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Grant BF, Chou SP, Goldstein RB, Huang B, Stinson FS, Saha TD, Smith SM, Dawson DA, Pulay AJ, Pickering RP, Ruan WJ. Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry 2008; 69:533-45. [PMID: 18426259 PMCID: PMC2676679 DOI: 10.4088/jcp.v69n0404] [Citation(s) in RCA: 856] [Impact Index Per Article: 53.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To present nationally representative findings on prevalence, sociodemographic correlates, disability, and comorbidity of borderline personality disorder (BPD) among men and women. METHOD Face-to-face interviews were conducted with 34,653 adults participating in the 2004-2005 Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. Personality disorder diagnoses were made using the Wave 2 Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version. RESULTS Prevalence of lifetime BPD was 5.9% (99% CI = 5.4 to 6.4). There were no differences in the rates of BPD among men (5.6%, 99% CI = 5.0 to 6.2) and women (6.2%, 99% CI = 5.6 to 6.9). BPD was more prevalent among Native American men, younger and separated/divorced/widowed adults, and those with lower incomes and education and was less prevalent among Hispanic men and women and Asian women. BPD was associated with substantial mental and physical disability, especially among women. High co-occurrence rates of mood and anxiety disorders with BPD were similar. With additional comorbidity controlled for, associations with bipolar disorder and schizotypal and narcissistic personality disorders remained strong and significant (odds ratios > or = 4.3). Associations of BPD with other specific disorders were no longer significant or were considerably weakened. CONCLUSIONS BPD is much more prevalent in the general population than previously recognized, is equally prevalent among men and women, and is associated with considerable mental and physical disability, especially among women. Unique and common factors may differentially contribute to disorder-specific comorbidity with BPD, and some of these associations appear to be sex-specific. There is a need for future epidemiologic, clinical, and genetically informed studies to identify unique and common factors that underlie disorder-specific comorbidity with BPD. Important sex differences observed in rates of BPD and associations with BPD can inform more focused, hypothesis-driven investigations of these factors.
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Affiliation(s)
- Bridget F Grant
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD 20892-9304, USA.
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Abstract
This paper explores the development of BPD as it might emerge in the child's early interpersonal reactions and how such reactions might evolve into the interpersonal pattern that typifies BPD. It begins to bridge the relevant bodies of clinical literature on the borderline's prototypic interpersonal problems with the concurrently expanding relevant literature on early child development. We will start by considering how a psychobiological disposition to BPD is likely to include a constitutional diathesis for relational reactivity, that is, for hypersensitivity to interpersonal stressors. Data relevant to this disposition's manifestations in adult clinical samples and to its heritability and neurobiology will be reviewed. We then consider how such a psychobiological disposition for interpersonal reactivity might contribute to the development of a disorganized-ambivalent form of attachment, noting especially the likely contributions of both the predisposed child and of parents who are themselves predisposed to maladaptive responses, leading to an escalation of problematic transactions. Evidence concerning both the genetics and the developmental pathways associated with disorganized attachments will be considered. Emerging links between such developmental pathways and adult BPD will be described, in particular the potential appearance by early- to middle-childhood of controlling-caregiving or controlling-punitive interpersonal strategies. Some implications from this gene-environment interactional theory for a better developmental understanding of BPD's etiology are discussed.
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Hasking P, Momeni R, Swannell S, Chia S. The nature and extent of non-suicidal self-injury in a non-clinical sample of young adults. Arch Suicide Res 2008; 12:208-18. [PMID: 18576202 DOI: 10.1080/13811110802100957] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study aimed to examine the nature, extent and correlates of non-suicidal self injury (NSSI) in a non-clinical sample of young adults. Two hundred and eleven participants (18-30 years) completed self-report questionnaires assessing history of NSSI, emotional regulation, coping strategies, symptoms of psychopathology, and alcohol use. Of the sample, 43.6% reported engaging in NSSI; approximately 10% engaged in moderate/severe NSSI. Those that reported NSSI reported greater psychopathology, avoidant coping and alcohol use than those who did not self-injure. The extent of these differences was magnified as the severity of NSSI increased. These findings highlight the need to consider any form of NSSI, no matter how mild, as an indication of distress and ineffective coping.
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Affiliation(s)
- Penelope Hasking
- School of Psychology, Psychiatry & Psychological Medicine, Monash University, Melbourne, Australia.
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Testing the emotion regulation hypothesis among self-injuring females: evidence for differences across mood states. J Nerv Ment Dis 2007; 195:912-8. [PMID: 18000453 DOI: 10.1097/nmd.0b013e3181593d89] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Self-injurious behavior (SIB) is frequently motivated to regulate aversive affective states. Research has been limited to group level analyses that often did not adequately differentiate distinct emotions. The present study examined the course of 5 emotional states immediately before, after, and 1 day after SIB among 106 female members of a Dutch support organization. Psychological descriptors suggested that most participants exhibited borderline features. At group level, all negative mood states were highest immediately before, dropped markedly after, and increased again 1 day after SIB, whereas the reverse pattern was observed for vigor. However, at the individual level significant differences between mood states were observed. Effects were most pronounced for tension; two thirds of participants reported a reliable reduction in psychological tension that was still present the next day. SIB should be conceptualized as a maladaptive emotion regulation strategy that is effective in reducing negative affect, in particular psychological tension.
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Abstract
Diatheses confer vulnerability to disorder but are not necessarily manifest overtly or consistently. It is suggested that the main empirical findings of studies with abnormal personality support the notion that they are diatheses rather than disorders. This includes their onset early in life, their variability of expression dependent on setting, their greater association with more severe disorders and their acceptance as intrinsic components of functioning by most suffering from these conditions. It is argued that a separate axis of classification for personality diatheses rather than disorders is justified.
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45
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Ebner-Priemer UW, Welch SS, Grossman P, Reisch T, Linehan MM, Bohus M. Psychophysiological ambulatory assessment of affective dysregulation in borderline personality disorder. Psychiatry Res 2007; 150:265-75. [PMID: 17321599 DOI: 10.1016/j.psychres.2006.04.014] [Citation(s) in RCA: 133] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2005] [Revised: 11/28/2005] [Accepted: 04/21/2006] [Indexed: 11/16/2022]
Abstract
Many experts now believe that pervasive problems in affect regulation constitute the central area of dysfunction in borderline personality disorder (BPD). However, data is sparse and inconclusive. We hypothesized that patients with BPD, in contrast to healthy gender and nationality-matched controls, show a higher frequency and intensity of self-reported emotions, altered physiological indices of emotions, more complex emotions and greater problems in identifying specific emotions. We took a 24-hour psychophysiological ambulatory monitoring approach to investigate affect regulation during everyday life in 50 patients with BPD and in 50 healthy controls. To provide a typical and unmanipulated sample, we included only patients who were currently in treatment and did not alter their medication schedule. BPD patients reported more negative emotions, fewer positive emotions, and a greater intensity of negative emotions. A subgroup of non-medicated BPD patients manifested higher values of additional heart rate. Additional heart rate is that part of a heart rate increase that does not directly result from metabolic activity, and is used as an indicator of emotional reactivity. Borderline participants were more likely to report the concurrent presence of more than one emotion, and those patients who just started treatment in particular had greater problems in identifying specific emotions. Our findings during naturalistic ambulatory assessment support emotional dysregulation in BPD as defined by the biosocial theory of [Linehan, M.M., 1993. Cognitive-Behavioral Treatment of Borderline Personality Disorder. The Guildford Press, New York.] and suggest the potential utility for evaluating treatment outcome.
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Affiliation(s)
- Ulrich W Ebner-Priemer
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Postfach 122120, 68072 Mannheim, Germany.
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Ludäscher P, Bohus M, Lieb K, Philipsen A, Jochims A, Schmahl C. Elevated pain thresholds correlate with dissociation and aversive arousal in patients with borderline personality disorder. Psychiatry Res 2007; 149:291-6. [PMID: 17126914 DOI: 10.1016/j.psychres.2005.04.009] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2004] [Revised: 02/09/2005] [Accepted: 04/09/2005] [Indexed: 10/23/2022]
Abstract
In addition to reduced pain perception, patients with borderline personality disorder (BPD) show higher pain thresholds under subjective stress conditions as compared with non-stress conditions. However, the correlation between symptoms of stress and pain thresholds has not been investigated so far. Using a new and convenient methodology, electric stimulation, we expected higher pain and detection thresholds in patients with BPD than in to healthy controls as well as a positive correlation between pain thresholds and symptoms of stress (aversive arousal and dissociation) in BPD patients. Twelve female patients with BPD and twelve healthy controls were included in the study. Electric stimulation was applied on the right index finger, and detection and pain thresholds were assessed by gradually intensifying the stimuli. We found significantly elevated pain thresholds in patients with BPD as compared with healthy controls, but no difference between patients and controls in detection thresholds. In patients, a significant positive correlation was revealed between pain thresholds and dissociation as well as between pain thresholds and aversive arousal. Besides demonstrating a close correlation between pain thresholds and symptoms of stress in patients with BPD, this study replicated earlier findings of reduced pain perception in patients with BPD. Measuring electric pain thresholds is a valid and reasonable method for larger studies.
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Affiliation(s)
- Petra Ludäscher
- Department of Psychiatry and Psychotherapy, University of Freiburg Medical School, Germany
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Klonsky ED. The functions of deliberate self-injury: a review of the evidence. Clin Psychol Rev 2006; 27:226-39. [PMID: 17014942 DOI: 10.1016/j.cpr.2006.08.002] [Citation(s) in RCA: 939] [Impact Index Per Article: 52.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2005] [Revised: 08/09/2006] [Accepted: 08/24/2006] [Indexed: 11/21/2022]
Abstract
Deliberate self-injury is defined as the intentional, direct injuring of body tissue without suicidal intent. The present article reviews the empirical research on the functions of self-injury. This literature includes self-reports of reasons for self-injuring, descriptions of the phenomenology of self-injury, and laboratory studies examining the effects of self-injury proxies on affect and physiological arousal. Results from 18 studies provide converging evidence for an affect-regulation function. Research indicates that: (a) acute negative affect precedes self-injury, (b) decreased negative affect and relief are present after self-injury, (c) self-injury is most often performed with intent to alleviate negative affect, and (d) negative affect and arousal are reduced by the performance of self-injury proxies in laboratory settings. Studies also provide strong support for a self-punishment function, and modest evidence for anti-dissociation, interpersonal-influence, anti-suicide, sensation-seeking, and interpersonal boundaries functions. The conceptual and empirical relationships among the different functions remain unclear. Future research should address the measurement, co-variation, clinical correlates, and treatment implications of different functions.
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Affiliation(s)
- E David Klonsky
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794-2500, United States.
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Jochims A, Ludäscher P, Bohus M, Treede RD, Schmahl C. Schmerzverarbeitung bei Borderline-Persönlichkeitsstörung, Fibromyalgie und Posttraumatischer Belastungsstörung. Schmerz 2006; 20:140-50. [PMID: 15983783 DOI: 10.1007/s00482-005-0405-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The authors review relevant experimental studies on pain perception and processing in psychiatric disorders with traumatic stress as an etiological factor. In borderline personality disorder, post-traumatic stress disorder, and fibromyalgia neurophysiological and neuropsychological patterns of pain processing appear to be different. Experimental studies in borderline patients show a desensitization of pain thresholds whereas patients with fibromyalgia show an opposite pattern, which could be explained by a central augmentation of pain processing. Furthermore, the authors outline methods to assess pain perception (peripheral and central) and describe the neurobiological mechanisms of pain processing, particularly the distinction between the sensory-discriminative lateral system and the affective-motivational medial system. Finally, suggestions for further research and implications for therapy are proposed.
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Affiliation(s)
- A Jochims
- Klinik für Psychosomatik und Psychotherapeutische Medizin, Zentralinstitut für Seelische Gesundheit Mannheim
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Chapman AL, Gratz KL, Brown MZ. Solving the puzzle of deliberate self-harm: The experiential avoidance model. Behav Res Ther 2006; 44:371-94. [PMID: 16446150 DOI: 10.1016/j.brat.2005.03.005] [Citation(s) in RCA: 692] [Impact Index Per Article: 38.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2004] [Revised: 02/28/2005] [Accepted: 03/16/2005] [Indexed: 11/25/2022]
Abstract
Despite increasing attention to the phenomenon of deliberate self-harm (DSH), the literature currently lacks a unifying, evidence-based, theoretical framework within which to understand the factors that control this behavior. The purpose of the present paper is to outline such a framework-the Experiential Avoidance Model (EAM) of DSH. The EAM poses that DSH is primarily maintained by negative reinforcement in the form of escape from, or avoidance of, unwanted emotional experiences. Literature on factors that may lead to experiential avoidance is reviewed, along with the mounting empirical evidence that DSH functions to help the individual escape from unwanted emotional experiences. The EAM integrates a variety of research on emotions, experiential avoidance, and DSH within a clinically useful framework that sparks novel research directions.
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Affiliation(s)
- Alexander L Chapman
- Department of Psychology, University of Washington, Box 351525, Seattle, WA 98195-1525, USA
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Binks CA, Fenton M, McCarthy L, Lee T, Adams CE, Duggan C. Psychological therapies for people with borderline personality disorder. Cochrane Database Syst Rev 2006:CD005652. [PMID: 16437534 DOI: 10.1002/14651858.cd005652] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Borderline personality disorder (BPD) is a relatively common personality disorder with a major impact on health services as those affected often present in crisis, often self-harming. OBJECTIVES To evaluate the effects of psychological interventions for people with borderline personality disorder. SEARCH STRATEGY We conducted a systematic search of 26 specialist and general bibliographic databases (December 2002) and searched relevant reference lists for further trials. SELECTION CRITERIA All relevant clinical randomised controlled trials involving psychological treatments for people with BPD. The definition of psychological treatments included behavioural, cognitive-behavioural, psychodynamic and psychoanalytic. DATA COLLECTION AND ANALYSIS We independently selected, quality assessed and data extracted studies. For binary outcomes we calculated a standard estimation of the risk ratio (RR), its 95% confidence interval (CI), and where possible the number need to help/harm (NNT/H). For continuous outcomes, endpoint data were preferred to change data. Non-skewed data from valid scales were summated using a weighted mean difference (WMD). MAIN RESULTS We identified seven studies involving 262 people, and five separate comparisons. Comparing dialectical behaviour therapy (DBT) with treatment as usual studies found no difference for the outcome of still meeting SCID-II criteria for the diagnosis of BPD by six months (n=28, 1 RCT, RR 0.69 CI 0.35 to 1.38) or admission to hospital in previous three months (n=28, 1 RCT, RR 0.77 CI 0.28 to 2.14). Self harm or parasuicide may decrease at 6 to 12 months (n=63, 1 RCT, RR 0.81 CI 0.66 to 0.98, NNT 12 CI 7 to 108). One study detected statistical difference in favour of people receiving DBT compared with those allocated to treatment as usual for average scores of suicidal ideation at 6 months (n=20, MD -15.30 CI -25.46 to -5.14). There was no difference for the outcome of leaving the study early (n=155, 3 RCTs, RR 0.74 CI 0.52 to 1.04). For the outcome of interviewer-assessed alcohol free days, skewed data are reported and tend to favour DBT. When a substance abuse focused DBT was compared with comprehensive validation therapy plus 12-step substance misuse programme no clear differences were found for service outcomes (n=23, 1 RCT, RR imprisoned 1.09 CI 0.64 to 1.87) or leaving the study early (n=23, 1 RCT, RR 7.58 CI 0.44 to 132.08). When dialectical behaviour therapy-oriented treatment is compared with client centred therapy no differences were found for service outcomes (n=24, 1 RCT, RR admitted 0.33 CI 0.08 to 1.33). However, fewer people in the DBT group displayed indicators of parasuicidal behaviour (n=24, RR 0.13 CI 0.02 to 0.85, NNT 2 CI 2 to 11). There were no differences for outcomes of anxiety and depression (n=24, 1 RCT, RR anxiety BAI >/=10 0.60 CI 0.32 to 1.12; RR depression HDRS >/=10 0.43 CI 0.14 to 1.28) but people who received DBT had less general psychiatric severity than those in the control (MD BPRS at 6 months -7.41 CI -13.72 to -1.10). Finally this one relevant study reports skewed data for suicidal ideation with considerably lower scores for people allocated to DBT. When psychoanalytically oriented partial hospitalization was compared with general psychiatric care the former tended to come off best. People who received treatment in a psychoanalytic orientated day hospital were less likely to be admitted into inpatient care when measured at different time points (e.g. n=44, RR admitted to inpatient 24 hour care >18 to 24 months 0.05 CI 0.00 to 0.77, NNT 3 CI 3 to 10) Fewer people in psychoanalytically oriented partial hospitalization needed day hospital intervention in the 18 months after discharge (n=44, 1 RCT, RR 0.04 CI 0.00 to 0.59, NNT 2 CI 2 to 8). More people in the control group took psychotropic medication by the 30 to 36 month follow-up, than those receiving psychoanalytic treatment (n=44, 1 RCT, RR 0.44 CI 0.25 to 0.80, NNT 3 CI 2 to 7). Anxiety and depression scores were generally lower in the psychoanalytically oriented partial hospitalization group (n=44, 1 RCT, RR >/=14 on BDI 0.52 CI 0.34 to 0.80, NNT 3 CI 3 to 6), as are global severity scores. People receiving psychoanalytic care in a day hospital had better social improvement in social adjustment using the SAS-SR at 6 to 12 months compared with people in general psychiatric care (MD -0.70 CI -1.08 to -0.32). Rates of attrition were the same (n=44, 1 RCT, RR leaving the study early 1.00 CI 0.23 to 4.42). AUTHORS' CONCLUSIONS This review suggests that some of the problems frequently encountered by people with borderline personality disorder may be amenable to talking/behavioural treatments but all therapies remain experimental and the studies are too few and small to inspire full confidence in their results. These findings require replication in larger 'real-world' studies.
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Affiliation(s)
- C A Binks
- University of Bristol, 8 Priory, Bristol, UK, BS8 1TZ.
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