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Więdłocha M, Marcinowicz P, Komarnicki J, Tobiaszewska M, Dębowska W, Dębowska M, Szulc A. Depression with comorbid borderline personality disorder - could ketamine be a treatment catalyst? Front Psychiatry 2024; 15:1398859. [PMID: 38742125 PMCID: PMC11089186 DOI: 10.3389/fpsyt.2024.1398859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 04/15/2024] [Indexed: 05/16/2024] Open
Abstract
Borderline personality disorder (BPD) is diagnosed in 10-30% of patients with major depressive disorder (MDD), and the frequency of MDD among individuals with BPD reaches over 80%. The comorbidity of MDD and BPD is associated with more severe depressive symptoms and functional impairment, higher risk of treatment resistance and increased suicidality. The effectiveness of ketamine usage in treatment resistant depression (TRD) has been demonstrated in numerous studies. In most of these studies, individuals with BPD were not excluded, thus given the high co-occurrence of these disorders, it is possible that the beneficial effects of ketamine also extend to the subpopulation with comorbid TRD and BPD. However, no protocols were developed that would account for comorbidity. Moreover, psychotherapeutic interventions, which may be crucial for achieving a lasting therapeutic effect in TRD and BPD comorbidity, were not included. In the article, we discuss the results of a small number of existing studies and case reports on the use of ketamine in depressive disorders with comorbid BPD. We elucidate how, at the molecular and brain network levels, ketamine can impact the neurobiology and symptoms of BPD. Furthermore, we explore whether ketamine-induced neuroplasticity, augmented by psychotherapy, could be of use in alleviating core BPD-related symptoms such as emotional dysregulation, self-identity disturbances and self-harming behaviors. We also discuss the potential of ketamine-assisted psychotherapy (KAP) in BPD treatment. As there is no standard approach to the application of ketamine or KAP in individuals with comorbid TRD and BPD, we consider further research in the field as imperative. The priorities should include development of dedicated protocols, distinguishing subpopulations that may benefit most from such treatment and investigating factors that may influence its effectiveness and safety.
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Affiliation(s)
- Magdalena Więdłocha
- Department of Psychiatry, Faculty of Health Sciences, Medical University of Warsaw, Pruszkow, Masovian, Poland
| | - Piotr Marcinowicz
- Department of Psychiatry, Faculty of Health Sciences, Medical University of Warsaw, Pruszkow, Masovian, Poland
| | - Jan Komarnicki
- Leszek Giec Upper-Silesian Medical Centre of the Medical University of Silesia, Katowice, Poland
| | | | - Weronika Dębowska
- Department of Psychiatry, Faculty of Health Sciences, Medical University of Warsaw, Pruszkow, Masovian, Poland
| | - Marta Dębowska
- Department of Psychiatry, Faculty of Health Sciences, Medical University of Warsaw, Pruszkow, Masovian, Poland
| | - Agata Szulc
- Department of Psychiatry, Faculty of Health Sciences, Medical University of Warsaw, Pruszkow, Masovian, Poland
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Kulakova E, Graumann L, Cho AB, Deuter CE, Wolf OT, Roepke S, Otte C, Wingenfeld K. Evidence of deviant parasympathetic response to social exclusion in women with borderline personality disorder. Eur Arch Psychiatry Clin Neurosci 2024; 274:129-138. [PMID: 37650962 PMCID: PMC10786993 DOI: 10.1007/s00406-023-01678-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 08/08/2023] [Indexed: 09/01/2023]
Abstract
Stressful social situations like social exclusion are particularly challenging for patients with borderline personality disorder (BPD) and often lead to dysfunctional reactive behaviour of aggression and withdrawal. The autonomous signature of these core symptoms of BPD remains poorly understood. The present study investigated the parasympathetic response to social exclusion in women with BPD (n = 62) and healthy controls (HC; n = 87). In a between-subjects design, participants experienced objective social exclusion or overinclusion in the Cyberball task, a virtual ball-tossing game. Need threat scores served as individual measures of perceived exclusion and the resulting frustration of cognitive-emotional needs. Five-minute measurements of high-frequency heart rate variability (HF-HRV) at three time points (before, during, after Cyberball) indicated parasympathetic tone and regulation. We observed a trend towards lowered baseline HF-HRV in BPD vs. HC in line with previous findings. Interestingly, the parasympathetic response of patients with BPD to objective and perceived social exclusion fundamentally differed from HC: higher exclusion was associated with increased parasympathetic activation in HC, while this autonomic response was reversed and blunted in BPD. Our findings suggest that during social stress, the parasympathetic nervous system fails to display an adaptive regulation in patients with BPD, but not HC. Understanding the autonomous signature of the stress response in BPD allows the formulation of clinically relevant and biologically plausible interventions to counteract parasympathetic dysregulation in this clinical group.
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Affiliation(s)
- Eugenia Kulakova
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.
| | - Livia Graumann
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - An Bin Cho
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Christian Eric Deuter
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Oliver T Wolf
- Department of Cognitive Psychology, Institute of Cognitive Neuroscience, Ruhr University, Bochum, Germany
| | - Stefan Roepke
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Christian Otte
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Katja Wingenfeld
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
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Huang Y, Yan R, Zhang Y, Wang X, Sun H, Zhou H, Zou H, Xia Y, Yao Z, Shi J, Lu Q. Abnormal fractional amplitude of low-frequency fluctuations and regional homogeneity in major depressive disorder with non-suicidal self-injury. Clin Neurophysiol 2024; 157:120-129. [PMID: 38101296 DOI: 10.1016/j.clinph.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/18/2023] [Accepted: 11/25/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE We conducted this resting-state functional magnetic resonance imaging (rsfMRI) study to characterize changes in regional homogeneity (ReHo) or fractional amplitude of low-frequency fluctuations (fALFF) in young adult patients with major depressive disorder (MDD), with or without non-suicidal self-injury (NSSI). METHODS We recruited 54 MDD patients with NSSI (MDD/NSSI), 68 MDD patients without NSSI, which is referred to as simple MDD (sMDD), and 66 matched healthy controls (HCs). A combination of fALFF and ReHo analyses was conducted. The effects of NSSI on the brain and their relationship to clinical variables were examined in this study. RESULTS MDD/NSSI patients have decreased fALFF in the right superior frontal gyrus (SFG) and the right inferior parietal lobe (IPL), decreased ReHo in the right SFG and the right middle temporal gyrus (MTG) and the left middle occipital gyrus (MOG). fALFF and ReHo values of the right SFG are positively correlated. The ReHo values of the right SFG and the number of recent self-injuries are positively correlated; the fALFF values of the right SFG are negatively correlated with NSSI severity. CONCLUSIONS There is a difference in brain activity between MDD/NSSI and sMDD, which may serve as an important physiological marker to determine the risk of self-injury and suicide. SIGNIFICANCE Abnormal brain activity in patients with NSSI may provide new perspectives and significant implications on the severity of MDD patients and the prevention of self-injury and suicide.
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Affiliation(s)
- Yinghong Huang
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China; Nanjing Brain Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Nanjing, China
| | - Rui Yan
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China; Nanjing Brain Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yu Zhang
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China; Department of Clinical Psychology, The Affiliated Hangzhou First People's Hospital of Zhejiang University School of Medicine, Hangzhou 310006, China
| | - Xiaoqin Wang
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Hao Sun
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China; Nanjing Brain Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Nanjing, China
| | - Hongliang Zhou
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Haowen Zou
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China; Nanjing Brain Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yi Xia
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Zhijian Yao
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China; Nanjing Brain Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Nanjing, China; School of Biological Sciences and Medical Engineering, Southeast University, 2 Sipailou, Nanjing 210096, China.
| | - Jiabo Shi
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China.
| | - Qing Lu
- School of Biological Sciences and Medical Engineering, Southeast University, 2 Sipailou, Nanjing 210096, China; Child Development and Learning Science, Key Laboratory of Ministry of Education, Nanjing 210096, China.
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Goreis A, Prillinger K, Bedus C, Lipp R, Mayer A, Nater UM, Koenig J, Plener PL, Kothgassner OD. Physiological stress reactivity and self-harm: A meta-analysis. Psychoneuroendocrinology 2023; 158:106406. [PMID: 37783020 DOI: 10.1016/j.psyneuen.2023.106406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVE Self-harm is associated with alterations in the psychobiological stress response. Specifically, the reactivity of the autonomic nervous system (ANS) and the endocrine hypothalamic-pituitary-adrenal (HPA) axis may differ in individuals who engage in self-harm. However, evidence in this regard is inconsistent. BACKGROUND We conducted a preregistered random-effects meta-analysis of sympathetic ANS, parasympathetic ANS, sympathetic-parasympathetic, i.e., mixed-influence ANS, and HPA axis reactivity following laboratory stress exposure in individuals who engage in self-harm and controls. Stress exposure consisted of paradigms using either social-evaluative (e.g., TSST), emotional (e.g., negatively valenced visual stimuli), or physical (e.g., cold pressor test) challenges. A total of 29 studies (self-harm: n = 954, controls: n = 1122, 74% females) were included in the analysis. RESULTS Regarding ANS reactivity to stress, no differences emerged between the two groups. However, parasympathetic ANS activity was lower before stress (g = -0.30, CI -0.51 to -0.09) and after stressor cessation (g = 0.54, CI -1.07 to -0.01) in the self-harm group compared to controls. Regarding HPA axis reactivity, individuals who engage in self-harm showed significantly lower cortisol responses to stress than did controls (g = -0.26, CI -0.45 to -0.08). After stressor cessation (i.e., during stress recovery), cortisol was also lower in individuals who engage in self-harm compared to controls (g = -0.26, CI -0.43 to -0.08). CONCLUSIONS Lower basal parasympathetic ANS activity and flattened cortisol responses indicate dysregulation of psychobiological stress systems in individuals who engage in self-harm. A better understanding of the psychobiological underpinnings of self-harm may allow for the establishment of biomarkers of risk stratification and treatment monitoring in affected individuals.
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Affiliation(s)
- Andreas Goreis
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Karin Prillinger
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Carolin Bedus
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Ronja Lipp
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Anna Mayer
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Urs M Nater
- Faculty of Psychology, University of Vienna, Vienna, Austria; University Research Platform "The Stress of Life - Processes and Mechanisms Underlying Everyday Life Stress", University of Vienna, Vienna, Austria
| | - Julian Koenig
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Cologne, Germany
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria; Department of Child and Adolescent Psychiatry and Psychotherapy, Medical University of Ulm, Ulm, Germany
| | - Oswald D Kothgassner
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria.
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van der Venne P, Mürner-Lavanchy I, Höper S, Koenig J, Kaess M. Physiological response to pain in female adolescents with nonsuicidal self-injury as a function of severity. J Affect Disord 2023; 339:64-73. [PMID: 37390927 DOI: 10.1016/j.jad.2023.06.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 06/03/2023] [Accepted: 06/20/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Preliminary evidence indicates altered hypothalamic-pituitary-adrenal (HPA) axis and autonomic nervous system (ANS) response to experimental pain in individuals with nonsuicidal self-injury (NSSI). This study investigated effects of NSSI severity and severity of psychopathology on the HPA axis and ANS response to pain. METHODS N = 164 adolescents with NSSI and n = 45 healthy controls received heat pain stimulation. Salivary cortisol, α-amylase and blood pressure were repeatedly assessed before and after painful stimulation. Heart rate (HR) and heart rate variability (HRV) were assessed continuously. NSSI severity and comorbid psychopathology were derived from diagnostic assessments. Main and interaction effects of time of measurement and NSSI severity, adjusted for severity of adverse childhood experiences, borderline personality disorder and depression, on HPA axis and ANS response to pain were examined using regression analyses. RESULTS Increasing NSSI severity predicted an increasing cortisol response (χ2(3) = 12.09, p = .007) to pain. After adjusting for comorbid psychopathology, greater NSSI severity predicted decreased α-amylase levels following pain (χ2(3) = 10.47, p = .015), and decreased HR (χ2(2) = 8.53, p = .014) and increased HRV(χ2(2) = 13.43, p = .001) response to pain. LIMITATIONS Future research should implement several NSSI severity indicators, potentially revealing complex associations with the physiological response to pain. Assessing physiological responses to pain in NSSI in a naturalistic setting presents a promising avenue for future research in NSI. CONCLUSIONS Findings indicate an increased pain-related HPA axis response and an ANS response characterized by reduced sympathetic and increased parasympathetic activity associated with NSSI severity. Results support claims for dimensional approaches to NSSI and its related psychopathology alongside shared, underlying neurobiological correlates.
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Affiliation(s)
- Patrice van der Venne
- Clinic of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany; Institute of Psychology, University of Heidelberg, Heidelberg, Germany
| | - Ines Mürner-Lavanchy
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Saskia Höper
- Clinic of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany; Institute of Psychology, University of Heidelberg, Heidelberg, Germany
| | - Julian Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Cologne, Germany
| | - Michael Kaess
- Clinic of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
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Erol Y, Inozu M. An Investigation of the Mediating Roles of Emotion Regulation Difficulties, Distress Tolerance, Self-Compassion, and Self-Disgust in the Association Between Childhood Trauma and Nonsuicidal Self-Injury. Arch Suicide Res 2023:1-15. [PMID: 37470456 DOI: 10.1080/13811118.2023.2237083] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
OBJECTIVE Childhood maltreatment has been associated as a risk factor with the development of nonsuicidal self-injury (NSSI), with difficulty in emotion regulation explaining the association. However, little is known about the potential factors that make some individuals with maltreatment history more vulnerable to difficulties in emotion regulation and, in turn, engage in NSSI. The current study aimed to examine the roles of distress tolerance, self-compassion, and self-disgust in the association between childhood maltreatment types and emotion regulation difficulty, which was expected to predict NSSI. METHOD The sample included 397 university students between the ages of 18 and 30. Participants completed self-report scales assessing childhood maltreatment, emotion regulation difficulty, distress tolerance, self-compassion, self-disgust, and NSSI using the paper-pencil and online methods. The mediation model suggested for the association between childhood maltreatment types and NSSI was tested using path analysis. RESULTS Low distress tolerance, low self-compassion, high self-disgust, and resulting high emotion regulation difficulty mediated the indirect effect of emotional neglect on NSSI. CONCLUSION The current study sheds light on various factors in the development and maintenance of NSSI and reveals three developmental pathways from emotional neglect in childhood to engaging in NSSI.HIGHLIGHTSEmotional neglect may be a distal risk factor for nonsuicidal self-injury (NSSI).Low distress tolerance and self-compassion and high self-disgust may increase the risk of NSSI.Emotion regulation difficulty may make people engage in NSSI to regulate emotions.
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Pollak OH, Kwon SJ, Jorgensen NA, Lindquist KA, Telzer EH, Prinstein MJ. Neural Reactivity to Social Punishment Predicts Future Engagement in Nonsuicidal Self-injury Among Peer-Rejected Adolescents. Biol Psychiatry 2023; 94:40-49. [PMID: 36411092 DOI: 10.1016/j.biopsych.2022.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Rates of nonsuicidal self-injury (NSSI) increase dramatically in adolescence. Affective reactivity and adverse social experiences have been linked to NSSI, but less is known about whether these factors may separately or interactively predict NSSI, especially longitudinally. This study combined functional magnetic resonance imaging and a sociometric measure to test whether a combination of neural (e.g., amygdala) reactivity to social punishment and peer-nominated peer acceptance/rejection predicts NSSI longitudinally in adolescence. Amygdala reactivity was examined as a potential neural marker of affective reactivity to social punishment, which may heighten NSSI risk in contexts of social adversity. METHODS One hundred twenty-five adolescents (63 female) completed a social incentive delay task during neuroimaging and school-based peer nominations to measure peer acceptance/rejection. NSSI engagement was assessed at baseline and 1-year follow-up. RESULTS Greater amygdala reactivity to social punishment predicted greater NSSI engagement 1 year later among adolescents with high peer rejection. This effect for the amygdala was specific to social punishment (vs. reward) and held when controlling for biological sex and pubertal development. Exploratory analyses found that ventral striatum reactivity to social reward and punishment similarly interacted with peer rejection to predict NSSI but that amygdala connectivity with salience network regions did not. CONCLUSIONS Amygdala reactivity to social punishment, in combination with high peer rejection, may increase NSSI risk in adolescence, possibly via heightened affective reactivity to adverse social experiences. Objective measures of neurobiological and social risk factors may improve prediction of NSSI, while therapeutic approaches that target affective reactivity and increase prosocial skills may protect against NSSI in adolescence.
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Affiliation(s)
- Olivia H Pollak
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Seh-Joo Kwon
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Nathan A Jorgensen
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kristen A Lindquist
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Eva H Telzer
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Mitchell J Prinstein
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Lee SE, Shin H, Kim G, Moon H, Hur JW. Decreased gray matter volume in regions associated with affective pain processing in unmedicated individuals with nonsuicidal self-injury. Psychiatry Res 2023; 326:115314. [PMID: 37406398 DOI: 10.1016/j.psychres.2023.115314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 07/07/2023]
Abstract
Nonsuicidal self-injury (NSSI) has been consistently associated with a reduced aversion to physical pain. Yet, little research has been done to investigate the brain structures related to pain in individuals with NSSI. This study examined gray matter volume patterns of pain processing regions in participants engaging in NSSI (n = 63) and age-, sex-, and handedness-matched healthy controls (n = 63). Voxel-based morphometry was performed to explore gray matter volume in regions of interest (ROIs) and partial correlation analyses were conducted to identify their associations with the frequency, versatility, duration, functions, and pain intensity of self-injury. As a result, significant volume decreases were found in the right anterior insula, bilateral secondary somatosensory cortex (SII), and left inferior frontal gyrus. Moreover, individuals with smaller anterior insula and SII volume showed a higher likelihood of endorsing affect-regulation and sensation-seeking functions of NSSI, as well as engaging in self-injury with a greater perceived intensity of pain. Our results provide the first empirical evidence that individuals with NSSI may exhibit distinct characteristics in brain regions associated with the affective component of pain processing. These neurobiological changes may be associated with their maladaptive response to noxious and painful NSSI experiences.
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Affiliation(s)
- Soo-Eun Lee
- School of Psychology, Korea University, 145 Anam-ro, Seoul, South Korea
| | - Hyemin Shin
- School of Psychology, Korea University, 145 Anam-ro, Seoul, South Korea
| | - Gyumyoung Kim
- School of Psychology, Korea University, 145 Anam-ro, Seoul, South Korea
| | - Hyeri Moon
- School of Psychology, Korea University, 145 Anam-ro, Seoul, South Korea
| | - Ji-Won Hur
- School of Psychology, Korea University, 145 Anam-ro, Seoul, South Korea.
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Liu S, Wu W, Zou H, Chen Y, Xu L, Zhang W, Yu C, Zhen S. Cybervictimization and non-suicidal self-injury among Chinese adolescents: The effect of depression and school connectedness. Front Public Health 2023; 11:1091959. [PMID: 36969626 PMCID: PMC10030997 DOI: 10.3389/fpubh.2023.1091959] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/13/2023] [Indexed: 03/11/2023] Open
Abstract
Cybervictimization has been shown in many studies to be a risk factor for adolescent non-suicidal self-injurious behavior (NSSI). In this study we tested the roles of depression and school connectedness in this association. The Integrative Model of NSSI, Emotion Regulation and Interpersonal Relationship Model of NSSI, and Integrative Model of Social Media and Suicide provided the conceptual framework for the study. A sample of 1106 adolescents (Mage = 13.17; SD = 0.69; 51.78% girls) completed anonymous questionnaires in their classrooms. The results of structural equation modeling showed that the positive association between cybervictimization and adolescent NSSI was mediated by depression. Moreover, this indirect link was stronger for adolescents with low vs. high school connectedness. The results have implications for intervention programs aimed at reducing NSSI among adolescents.
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Affiliation(s)
- Sui Liu
- School of Psychology, South China Normal University, Guangzhou, China
| | - Wanchun Wu
- School of Psychology, South China Normal University, Guangzhou, China
| | - Hongyu Zou
- School of Psychology, South China Normal University, Guangzhou, China
| | - Yanrong Chen
- School of Psychology, South China Normal University, Guangzhou, China
| | - Liling Xu
- School of Foreign Studies, South China Normal University, Guangzhou, China
| | - Wei Zhang
- School of Psychology, South China Normal University, Guangzhou, China
| | - Chenfu Yu
- School of Education, Guangzhou University, Guangzhou, China
- *Correspondence: Chenfu Yu
| | - Shuangju Zhen
- School of Psychology, South China Normal University, Guangzhou, China
- Shuangju Zhen
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Boege I, Schubert N, Scheider N, Fegert JM. Pilot Study: Cut the Cut-A Treatment Program for Adolescent Inpatients with Nonsuicidal Self-Injury. Child Psychiatry Hum Dev 2022; 53:928-940. [PMID: 33939110 DOI: 10.1007/s10578-021-01174-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2021] [Indexed: 11/28/2022]
Abstract
Non-suicidal-self-injury (NSSI) in adolescents needing inpatient treatment is a serious health risk behaviour. NSSI-specific treatment programs for inpatients hardly exist. "Cut the Cut" (CTC) is a new treatment program in intervals, addressing this problem. Aim of this pilot-study was to evaluate acceptability and feasibility of CTC. 23 female inpatients (12 CTC, 11 control, aged 15-17; mean = 16.80, SD.70) engaging in NSSI were evaluated for service user satisfaction, frequency, and severity of NSSI at T1 (admission), T2 (discharge after interval 1, CTC-group) and T3 (discharge). A qualitative interview was performed at T3. Significant improvement in NSSI-frequency was given (T1-T3: CTC p = 0.010; control p = 0.038). Severity of NSSI reduced slightly (mild NSSI: CTC p = 0.022, control p = 0.087; severe NSSI: CTC p = 0.111, control p = 0.066). Satisfaction of parents (T3 mean 28.38) and adolescents (T3 mean 26.11) in CTC was rated high. CTC is a feasible treatment option for inpatients engaging in NSSI. Further studies over time are needed.Trial registration Number DRKS00016762, 05.03.2019, retrospectively registered.
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Affiliation(s)
- Isabel Boege
- Department for Child and Adolescent Psychiatry, ZfP Suedwuerttemberg, CAP, Weingartshoferstrasse 2, 88214, Ravensburg, Germany. .,University of Ulm, CAP, Steinhoevelstrasse 5, 89075, Ulm, Germany.
| | - Nicole Schubert
- University of Ulm, CAP, Steinhoevelstrasse 5, 89075, Ulm, Germany
| | - Nina Scheider
- Department for Child and Adolescent Psychiatry, ZfP Suedwuerttemberg, CAP, Weingartshoferstrasse 2, 88214, Ravensburg, Germany
| | - Joerg M Fegert
- University of Ulm, CAP, Steinhoevelstrasse 5, 89075, Ulm, Germany
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11
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Kuehn KS, Dora J, Harned MS, Foster KT, Song F, Smith MR, King KM. A meta-analysis on the affect regulation function of real-time self-injurious thoughts and behaviours. Nat Hum Behav 2022; 6:964-974. [PMID: 35484208 PMCID: PMC9329197 DOI: 10.1038/s41562-022-01340-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 03/17/2022] [Indexed: 11/09/2022]
Abstract
Prominent theories suggest that self-injurious thoughts and behaviours are negatively reinforced by decreased negative affect. The present meta-analysis quantifies effects from intensive longitudinal studies measuring negative affect and self-injurious thoughts and behaviours. We obtained data from 38 of the 79 studies (48%, 22 unique datasets) involving N = 1,644 participants (80% female, 75% white). Individual-participant data meta-analyses revealed changes in affect pre/post self-injurious thoughts and behaviours. In antecedent models, results supported increased negative affect before nonsuicidal self-injurious behaviour (k = 14, 95% CI 0.09 to 0.31) and suicidal thoughts (k = 14, 95% CI 0.03 to 0.19). For consequence models, negative affect was reduced following nonsuicidal self-injurious thoughts (k = 6, 95% CI -0.79 to -0.44), nonsuicidal self-injurious behaviours (k = 14, 95% CI -0.73 to -0.19) and suicidal thoughts (k = 13, 95% CI -0.79 to -0.23). Findings, which were not moderated by sampling strategies or sample composition, support the affect regulation function of self-injurious thoughts and behaviours.
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Affiliation(s)
- Kevin S Kuehn
- Department of Psychology, University of Washington, Seattle, WA, USA.
| | - Jonas Dora
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Melanie S Harned
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | | | - Frank Song
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Michele R Smith
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Kevin M King
- Department of Psychology, University of Washington, Seattle, WA, USA
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12
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Yan R, Huang Y, Shi J, Zou H, Wang X, Xia Y, Zhao S, Zhou H, Chen Y, Li X, Wu X, Yao Z, Lu Q. Alterations of regional spontaneous neuronal activity and corresponding brain circuits related to non-suicidal self-injury in young adults with major depressive disorder. J Affect Disord 2022; 305:8-18. [PMID: 35181386 DOI: 10.1016/j.jad.2022.02.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 12/24/2021] [Accepted: 02/13/2022] [Indexed: 12/21/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) with non-suicidal self-injury (NSSI)(MDD/NSSI) has been found to differ from simple MDD without NSSI (sMDD). This study analyzes the amplitude of low-frequency fluctuations (ALFF) to explore the NSSI-relevant local neural activity, and uses functional connectivity (FC) analysis to explore the NSSI-relevant circuits corresponding to alterations in local regions in young adult patients with MDD/NSSI. METHODS A total of 54 patients with MDD/NSSI, 68 patients with sMDD, and 66 matched healthy controls (HCs) were recruited. ALFF and seed-based FC analyses were employed. The NSSI-relevant brain alteration and its associations with clinical variables were examined. RESULTS Compared with the sMDD group, the MDD/NSSI group showed higher ALFF in the right lingual gyrus and right middle occipital gyrus; lower ALFF in the right superior frontal gyrus; higher FC values between the right lingual gyrus and left precentral gyrus; and lower FC values between the right middle occipital gyrus and right paracentral gyrus. Within the MDD/NSSI group, ALFF values of the right superior frontal gyrus and right lingual gyrus were positively correlated with the frequency and severity of NSSI. LIMITATIONS The sample size was small, and the potential influence of medicine on brain activity was not excluded. CONCLUSIONS Our preliminary findings indicate that NSSI-relevant ALFF in the right lingual gyrus, right middle occipital gyrus, and right superior frontal gyrus, as well as the alteration FCs in corresponding brain circuits, may play an important role in the neural basis of MDD/NSSI.
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Affiliation(s)
- Rui Yan
- Nanjing Brain Hospital, Medical School, Nanjing University, 22 Hankou Road, Nanjing 210093, China; Department of psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing 210029, China
| | - YingHong Huang
- Nanjing Brain Hospital, Medical School, Nanjing University, 22 Hankou Road, Nanjing 210093, China; Department of psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing 210029, China
| | - JiaBo Shi
- Department of psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing 210029, China
| | - HaoWen Zou
- Nanjing Brain Hospital, Medical School, Nanjing University, 22 Hankou Road, Nanjing 210093, China; Department of psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing 210029, China
| | - XuMiao Wang
- Department of psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing 210029, China
| | - Yi Xia
- Department of psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing 210029, China
| | - Shuai Zhao
- Department of psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing 210029, China
| | - HongLiang Zhou
- Department of psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing 210029, China
| | - Yu Chen
- Department of psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing 210029, China
| | - XueSong Li
- School of Biological Sciences and Medical Engineering, Southeast University, 2 sipailou, Nanjing 210096, China; Child Development and Learning Science, Key Laboratory of Ministry of Education, Nanjing 210096, China
| | - XiaoXiao Wu
- School of Biological Sciences and Medical Engineering, Southeast University, 2 sipailou, Nanjing 210096, China; Child Development and Learning Science, Key Laboratory of Ministry of Education, Nanjing 210096, China
| | - ZhiJian Yao
- Nanjing Brain Hospital, Medical School, Nanjing University, 22 Hankou Road, Nanjing 210093, China; Department of psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing 210029, China; School of Biological Sciences and Medical Engineering, Southeast University, 2 sipailou, Nanjing 210096, China.
| | - Qing Lu
- School of Biological Sciences and Medical Engineering, Southeast University, 2 sipailou, Nanjing 210096, China; Child Development and Learning Science, Key Laboratory of Ministry of Education, Nanjing 210096, China.
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13
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Zhang Y, Lai S, Wu W, Wang Y, Zhao H, He J, Zhu Y, Chen G, Qi Z, Chen P, Lv S, Song Z, Hu Y, Miao H, Yan S, Luo Y, Ran H, Huang X, Lu X, Zhong S, Jia Y. Associations between executive function impairment and biochemical abnormalities in depressed adolescents with non-suicidal self-injury. J Affect Disord 2022; 298:492-499. [PMID: 34737017 DOI: 10.1016/j.jad.2021.10.132] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 10/26/2021] [Accepted: 10/29/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND H protons magnetic resonance spectroscopy (1H-MRS) has been used to detect the biochemical metabolism changes and the mechanism of executive dysfunction in major depressive disorder (MDD). While, finding information associated with non-suicidal self-injury (NSSI) among adolescents with MDD is challenging. The present study aimed to examine the executive function and biochemical metabolism alterations, as well as to elucidate their associations in depressed adolescents with NSSI. METHODS A total of 86 adolescents with MDD (40 with NSSI, and 46 without NSSI) and 28 healthy controls were recruited in the current study. The executive function was assessed by Digital symbol test (DST), Wisconsin Card Sorting Test (WCST), Trail Making Test, part B (TMT-B), and Verbal fluency (VF). Bilateral metabolite levels of the prefrontal cortex (PFC), anterior cingulated cortex (ACC), lenticular nucleus (LN) of basal ganglia and thalamus were obtained by 1H-MRS at 3.0 T, and then the ratios of N-acetyl aspartate (NAA) and choline-containing compounds (Cho) to creatine (Cr) were determined, respectively. Finally, association analysis was conducted to investigate their relationships. RESULTS The depressed adolescents with NSSI showed significantly lower VF scores than those without NSSI and healthy controls. We also found significantly higher NAA/Cr ratios in the right thalamus, while significantly lower Cho/Cr ratios in the right thalamus of NSSI group than the MDD without NSSI group and healthy controls. And NSSI group also showed lower NAA/Cr ratio in the right LN than the MDD without NSSI group. For MDD with NSSI, the NAA/Cr ratios of the left thalamus were positively correlated with the time of TMTB and the Cho/Cr ratios of the left ACC were positively correlated with the VF scores. CONCLUSIONS Depressed adolescents with NSSI may have executive dysfunction and NAA and Cho metabolism abnormalities in the thalamus. And the NAA/Cr ratios of the right LN could distinguish NSSI from depressed adolescents. Further, the executive dysfunction may be associated with the abnormal NAA metabolism in the left thalamus and ACC.
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Affiliation(s)
- Yiliang Zhang
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Shunkai Lai
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Weige Wu
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China; The Department of Child and Adolescent Psychology Xiamen Xianyue hospital, Fujian 361012, China
| | - Ying Wang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Hui Zhao
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Jiali He
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Yunxia Zhu
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Guangmao Chen
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Zhangzhang Qi
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Pan Chen
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Sihui Lv
- School of Management, Jinan University, Guangzhou 510316, China
| | - Zijin Song
- School of Management, Jinan University, Guangzhou 510316, China
| | - Yilei Hu
- School of Management, Jinan University, Guangzhou 510316, China
| | - Haofei Miao
- School of Management, Jinan University, Guangzhou 510316, China
| | - Shuya Yan
- School of Management, Jinan University, Guangzhou 510316, China
| | - Yange Luo
- School of Management, Jinan University, Guangzhou 510316, China
| | - Hanglin Ran
- School of Management, Jinan University, Guangzhou 510316, China
| | - Xiaosi Huang
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Xiaodan Lu
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Shuming Zhong
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China.
| | - Yanbin Jia
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China.
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14
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Geiss L, Beck B, Hitzl W, Hillemacher T, Hösl KM. Cardiovascular Autonomic Modulation during Metronomic Breathing and Stress Exposure in Patients with Borderline Personality Disorder. Neuropsychobiology 2022; 80:359-373. [PMID: 33582662 DOI: 10.1159/000511543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 09/03/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Given the growing evidence of reduced heart rate variability in psychiatric diseases associated with emotional instability, we investigated cardiovascular autonomic modulation in patients with borderline personality disorder (BPD) during resting state, parasympathetic stimulation (metronomic breathing), and sympathetic stimulation (mental arithmetic stress test). METHODS In 29 BPD outpatients and 30 controls, we recorded RR-intervals (RRI), blood pressure, skin conductance levels, and respiratory frequency during resting state, metronomic breathing, stress anticipation, stress exposure, and stress recovery. We calculated baroreflex sensitivity (BRS) and parameters of heart rate variability, including the root mean square of successive differences (RMSSD), an index of cardiovagal modulation. RESULTS During resting state, BPD patients showed higher blood pressure and shorter RRI, as well as lower RMSSD and BRS than controls. Metronomic breathing increased RMSSD and BRS in BPD patients. During the stress exposure, BRS significantly decreased in controls, but not in BPD patients. Furthermore, BPD patients showed less cardioacceleration in response to stress exposure than controls. During stress recovery, we found increases in RMSSD and BRS in controls, but not in BPD patients. CONCLUSION Our data show reduced cardiovascular autonomic modulation in BPD patients during resting state, psychophysiological relaxation, and stress exposure. The results indicate a vagal modulation deficit in this cohort. Breathing techniques, such as metronomic breathing, might be helpful to reduce stress and to increase vagal tone in BPD patients.
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Affiliation(s)
- Lennard Geiss
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany,
| | - Beate Beck
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany
| | - Wolfgang Hitzl
- Research Office (Biostatistics), Paracelsus Medical University, Salzburg, Austria.,Department of Ophthalmology and Optometry, Paracelsus Medical University, Salzburg, Austria.,Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Salzburg, Austria
| | - Thomas Hillemacher
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany.,Department of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Katharina M Hösl
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany
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15
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Oudijn M, Linders J, Mocking R, Lok A, van Elburg A, Denys D. Psychopathological and Neurobiological Overlap Between Anorexia Nervosa and Self-Injurious Behavior: A Narrative Review and Conceptual Hypotheses. Front Psychiatry 2022; 13:756238. [PMID: 35633779 PMCID: PMC9130491 DOI: 10.3389/fpsyt.2022.756238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 04/25/2022] [Indexed: 11/29/2022] Open
Abstract
Empirical evidence and clinical observations suggest a strong -yet under acknowledged-link between anorexia nervosa (AN) and non-suicidal self-injurious behavior (NSSI). By reviewing the literature on the psychopathology and neurobiology of AN and NSSI, we shed light on their relationship. Both AN and NSSI are characterized by disturbances in affect regulation, dysregulation of the reward circuitry and the opioid system. By formulating a reward-centered hypothesis, we explain the overlap between AN and NSSI. We propose three approaches understanding the relationship between AN and NSSI, which integrate psychopathology and neurobiology from the perspective of self-destructiveness: (1) a nosographical approach, (2) a research domain (RDoC) approach and (3) a network analysis approach. These approaches will enhance our knowledge of the underlying neurobiological substrates and may provide groundwork for the development of new treatment options for disorders of self-destructiveness, like AN and NSSI. In conclusion, we hypothesize that self-destructiveness is a new, DSM-5-transcending concept or psychopathological entity that is reward-driven, and that both AN and NSSI could be conceptualized as disorders of self-destructiveness.
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Affiliation(s)
- Marloes Oudijn
- Department of Psychiatry, Amsterdam University Medical Centers (Amsterdam UMC), Academic Medical Center (AMC), University of Amsterdam, Amsterdam, Netherlands
| | - Jara Linders
- Department of Psychiatry, Amsterdam University Medical Centers (Amsterdam UMC), Academic Medical Center (AMC), University of Amsterdam, Amsterdam, Netherlands
| | - Roel Mocking
- Department of Psychiatry, Amsterdam University Medical Centers (Amsterdam UMC), Academic Medical Center (AMC), University of Amsterdam, Amsterdam, Netherlands
| | - Anja Lok
- Department of Psychiatry, Amsterdam University Medical Centers (Amsterdam UMC), Academic Medical Center (AMC), University of Amsterdam, Amsterdam, Netherlands
| | | | - D Denys
- Department of Psychiatry, Amsterdam University Medical Centers (Amsterdam UMC), Academic Medical Center (AMC), University of Amsterdam, Amsterdam, Netherlands
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16
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Dusi N, Bracco L, Bressi C, Delvecchio G, Brambilla P. Imaging associations of self-injurious behaviours amongst patients with Borderline Personality Disorder: A mini-review. J Affect Disord 2021; 295:781-787. [PMID: 34517252 DOI: 10.1016/j.jad.2021.08.074] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 07/07/2021] [Accepted: 08/25/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Borderline Personality Disorder (BPD) is a severe and disabling psychiatric syndrome, frequently associated with self-injurious behaviours (SIB). In recent years, functional magnetic resonance imaging (fMRI) investigations have tried to identify alterations associated with SIB amongst BPD patients, in order to better delineate possible neurobiological underpinnings of these manifestations. In this mini-review, we aimed at summarizing fMRI studies exploring patterns of neural activation associated with SIB in BPD patients. METHODS Literature searches on PubMed, Psych-Info and Embase databases were performed for all fMRI studies including adult patients with BPD and SIB undergoing different tasks, including painful or thermic stimulation, affective stimulation through the presentation of picturesor the recollection of personal memories as well as tasks that evaluate sustained attention and impulsivity, and reward processing. Thirteen relevant papers were considered eligible for the present review. RESULTS Patients with BPD and SIB, compared to HC, showed prefrontal, nucleus accumbens overactivation and amygdala deactivation during pain stimulation. During negative affective stimulation, BPD patients showed a hyperactivation of the amygdala and a hypoactivation of the orbitofrontal cortex (OFC), which was also found to be enhanced during a gambling task and during a recalling of aversive memories. In contrast, during cognitive tasks with negative affective interference, BPD patients showed hypoactivation of OFC, anterior cingulated cortex, and basal ganglia. LIMITATIONS The limited number of studies and the heterogeneity regarding the fMRI tasks employed allowed only suggestive conclusions. CONCLUSIONS The reviewed fMRI studies highlighted that BPD patients with a history of SIB showed altered brain activity, compared to HC, in regions involved in inhibitory cognitive processes and affect regulation, which may in turn, explain the overwhelming emotional experiences eliciting SIB in these patients.
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Affiliation(s)
- N Dusi
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - L Bracco
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - C Bressi
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - G Delvecchio
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy.
| | - P Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
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17
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Kaess M, Hooley JM, Klimes-Dougan B, Koenig J, Plener PL, Reichl C, Robinson K, Schmahl C, Sicorello M, Westlund Schreiner M, Cullen KR. Advancing a temporal framework for understanding the biology of nonsuicidal self- injury: An expert review. Neurosci Biobehav Rev 2021; 130:228-239. [PMID: 34450182 PMCID: PMC8783544 DOI: 10.1016/j.neubiorev.2021.08.022] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 07/17/2021] [Accepted: 08/21/2021] [Indexed: 11/04/2022]
Abstract
Nonsuicidal self-injury (NSSI) is a serious clinical problem, particularly for adolescents and young adults. NSSI is a complex behavior that emerges through the intersecting effects of social, psychological, and biological mechanisms. Although the social and psychological contributions to risk for developing NSSI are relatively well understood and have guided the development of effective psychosocial treatments for self-injury, the biological mechanisms underlying NSSI have just begun to come to light. To evaluate and categorize the biological research conducted on the topic of NSSI, we propose a model that distinguishes between trait and state markers. According to this model, risk factors and mechanisms involved in NSSI can be distinguished into both trait and state factors. We review the existing evidence on distal biological traits (predictors) of NSSI, proximal biological traits (correlates) of NSSI, and biological states directly preceding or following NSSI. We conclude by providing recommendations for future research on the neurobiology of NSSI.
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Affiliation(s)
- Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany.
| | - Jill M Hooley
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Bonnie Klimes-Dougan
- Department of Psychology, College of Liberal Arts, University of Minnesota, Minneapolis, MN, USA
| | - Julian Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Cologne, Germany
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria; Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Corinna Reichl
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Kealagh Robinson
- School of Psychology, Victoria University of Wellington, Wellington, New Zealand
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Maurizio Sicorello
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Germany
| | | | - Kathryn R Cullen
- Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis, MN, USA
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18
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Bohus M, Stoffers-Winterling J, Sharp C, Krause-Utz A, Schmahl C, Lieb K. Borderline personality disorder. Lancet 2021; 398:1528-1540. [PMID: 34688371 DOI: 10.1016/s0140-6736(21)00476-1] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/18/2021] [Accepted: 02/18/2021] [Indexed: 12/15/2022]
Abstract
Borderline personality disorder (BPD) is a mental disorder with a high burden on patients, family members, and health-care systems. The condition was previously regarded as untreatable, but progress in understanding and management has resulted in earlier diagnosis and better treatment outcomes. A coherent syndrome of BPD typically onsets during adolescence (after age 12 years). BPD is often preceded by or co-develops with symptoms of internalising disorders (depression and anxiety), externalising disorders (conduct problems, hyperactivity, and substance use), or both. BPD is associated with various poor outcomes, including low occupational and educational attainment, lack of long-term relationships, increased partner conflict, sexual risk-taking, low levels of social support, low life satisfaction, and increased service use. Psychotherapy is the main treatment for BPD; drug treatment is only indicated for comorbid conditions that require medication, or during a crisis if psychosocial interventions are insufficient. Awareness of BPD by non-specialists, as well as specialists, is key to appropriate early intervention.
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Affiliation(s)
- Martin Bohus
- Institute for Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Harvard Medical School, Boston, MA, USA
| | - Jutta Stoffers-Winterling
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany; Leibniz Institute for Resilience Research, Mainz, Germany
| | - Carla Sharp
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Annegret Krause-Utz
- Department of Clinical Psychology, Leiden University, Leiden Institute of Brain and Cognition, Leiden, Netherlands
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Klaus Lieb
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany; Leibniz Institute for Resilience Research, Mainz, Germany.
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19
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Stacy SE, Pepper CM, Clapp JD, Reyna AH. The effects of blood in self-injurious cutting: Positive and negative affect regulation. J Clin Psychol 2021; 78:926-937. [PMID: 34671976 DOI: 10.1002/jclp.23267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/06/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Seeing one's own blood may be a factor in affect regulation in nonsuicidal self-injury (NSSI). This study examined changes in a negative (NA) and positive affect (PA) in response to a finger prick eliciting a small drop of participants' blood. METHODS Two groups (NSSI; N = 56 and Control; N = 70) of undergraduate students were randomly assigned to receive a finger prick and look at blood, receive a finger prick and not look at blood, or receive a sham finger prick. Following a mood induction, participants completed the PANAS three times: Time 1 (pre mood-induction, baseline), Time 2 (post-mood induction), and Time 3 (post-finger prick condition), and a Pain Severity Scale. RESULTS A significant three-way interaction revealed that the NSSI: Blood Group had an increased positive effect between Time 2 and Time 3. CONCLUSION Blood serves an important function in NSSI and requires additional research to fully understand the relationship.
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Affiliation(s)
- Stephanie E Stacy
- Department of Psychology, University of Wyoming, Laramie, Wyoming, USA
| | - Carolyn M Pepper
- Department of Psychology, University of Wyoming, Laramie, Wyoming, USA
| | - Joshua D Clapp
- Department of Psychology, University of Wyoming, Laramie, Wyoming, USA
| | - Alejandra H Reyna
- Department of Psychology, University of Wyoming, Laramie, Wyoming, USA
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20
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Zarnowski O, Ziton S, Holmberg R, Musto S, Riegle S, Van Antwerp E, Santos-Nunez G. Functional MRI findings in personality disorders: A review. J Neuroimaging 2021; 31:1049-1066. [PMID: 34468063 DOI: 10.1111/jon.12924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 11/28/2022] Open
Abstract
Personality disorders (PDs) have a prevalence of approximately 10% in the United States, translating to over 30 million people affected in just one country. The true prevalence of these disorders may be even higher, as the paucity of objective diagnostic criteria could be leading to underdiagnosis. Because little is known about the underlying neuropathologies of these disorders, patients are diagnosed using subjective criteria and treated nonspecifically. To better understand the neural aberrancies responsible for these patients' symptoms, a review of functional MRI literature was performed. The findings reveal that each PD is characterized by a unique set of activation changes corresponding to individual structures or specific neural networks. While unique patterns of neural activity are distinguishable within each PD, aberrations of the limbic/paralimbic structures and default mode network are noted across several of them. In addition to identifying valuable activation patterns, this review reveals a void in research pertaining to paranoid, schizoid, histrionic, narcissistic, and dependent PDs. By delineating patterns in PD neuropathology, we can more effectively direct future research efforts toward enhancing objective diagnostic techniques and developing targeted treatment modalities. Furthermore, understanding why patients are manifesting certain symptoms can advance clinical awareness and improve patient outcomes.
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Affiliation(s)
- Oskar Zarnowski
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Shirley Ziton
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Rylan Holmberg
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Sarafina Musto
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Sean Riegle
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Emily Van Antwerp
- West Virginia School of Osteopathic Medicine, Lewisburg, West Virginia, USA
| | - Gabriela Santos-Nunez
- University of Massachusetts Memorial Medical Center, Radiology Department, Worcester, Massachusetts, USA
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21
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Predicting Non-Suicidal Self-Injury in Young Adults with and without Borderline Personality Disorder: a Multilevel Approach Combining Ecological Momentary Assessment and Self-Report Measures. Psychiatr Q 2021; 92:1035-1054. [PMID: 33475912 DOI: 10.1007/s11126-020-09875-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2020] [Indexed: 10/22/2022]
Abstract
Non-suicidal self-injury (NSSI) is an increasingly prevalent phenomenon associated with many detrimental outcomes, ranging from poor academic performance to suicide attempts. Research on self-harming behaviors has identified emotion dysregulation, negative affect, and borderline pathology as strong risk factors of NSSI, whereas the potential protective effects of metacognitive skills such as decentering have not yet been explored. The current study combined ecological momentary assessment (EMA) and self-report measures to explore potential risk and protective factors of NSSI in a clinical group of Borderline Personality Disorder (BPD) patients with NSSI (N = 22), a subclinical group of college students with NSSI (N = 19), and a non-clinical healthy control group (N = 23). Participants completed self-report measures of borderline pathology, emotion dysregulation, decentering ability, and negative emotional symptoms, and they used the Sinjur App (EMA instrument) at least three times a day for 15 days to capture negative affect and NSSI in daily life. A multilevel mixed-effect regression analysis with both self-report and EMA measures was conducted to identify predictors of NSSI. The multilevel analysis showed that only momentary frustration directly predicted NSSI. Momentary guilt and anger only predicted NSSI when interacting with more stable traits of borderline pathology and negative emotional symptoms. Most importantly, greater decentering capacity protected against self-injury and attenuated the association between momentary sadness and NSSI. Findings contribute novel knowledge about NSSI, documenting the protective effects of decentering and highlighting the benefit of interventions that target metacognitive emotion regulation skills.
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22
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Goldstein KE, Feinberg A, Corniquel MB, Szeszko JR, New AS, Haznedar MM, Goodman M, Chu KW, Tang CY, Hazlett EA. Anomalous Amygdala Habituation to Unpleasant Stimuli Among Unmedicated Individuals With Borderline Personality Disorder and a History of Self-Harming Behavior. J Pers Disord 2021; 35:618-631. [PMID: 33779281 DOI: 10.1521/pedi_2020_34_495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Self-harming behavior (SB) is one of the diagnostic criteria for borderline personality disorder (BPD). However, it is not exhibited by all individuals with BPD. Furthermore, studies examining the neural correlates of SB in BPD are lacking. Given research showing that BPD patients have difficulty habituating to affective stimuli, this study investigated whether anomalous amygdala activation is specific to BPD patients with SB. The authors used fMRI to compare amygdala activation in BPD patients with SB (n = 15) to BPD patients without SB (n = 18) and healthy controls (n = 32) during a task involving pleasant, neutral, and unpleasant pictures, presented twice. BPD patients with SB demonstrated greater amygdala activity during the second presentation of unpleasant pictures. Results highlight neurobiological differences in BPD patients with and without SB and suggest that anomalous amygdala habituation to unpleasant stimuli may be related to SB.
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Affiliation(s)
- Kim E Goldstein
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.,Mental Illness Research, Education, and Clinical Center (MIRECC VISN 2), James J. Peters VA Medical Center, Bronx, New York
| | - Abigail Feinberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.,Mental Illness Research, Education, and Clinical Center (MIRECC VISN 2), James J. Peters VA Medical Center, Bronx, New York
| | - Morgan B Corniquel
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jake R Szeszko
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.,Mental Illness Research, Education, and Clinical Center (MIRECC VISN 2), James J. Peters VA Medical Center, Bronx, New York
| | - Antonia S New
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - M Mehmet Haznedar
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.,Mental Health Patient Care Center, James J. Peters Veterans Affairs Medical Center
| | - Marianne Goodman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.,Mental Illness Research, Education, and Clinical Center (MIRECC VISN 2), James J. Peters VA Medical Center, Bronx, New York
| | - King-Wai Chu
- Mental Illness Research, Education, and Clinical Center (MIRECC VISN 2), James J. Peters VA Medical Center, Bronx, New York
| | - Cheuk Y Tang
- Translational and Molecular Imaging Institute, Department of Radiology, Icahn School of Medicine at Mount Sinai
| | - Erin A Hazlett
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.,Mental Illness Research, Education, and Clinical Center (MIRECC VISN 2), James J. Peters VA Medical Center, Bronx, New York
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23
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Hennings J. Das Verstärkermodell der Suizidalität: Chronische Suizidalität bei der Borderline-Persönlichkeitsstörung verstehen und behandeln. VERHALTENSTHERAPIE 2021. [DOI: 10.1159/000518239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Trotz großer Fortschritte in der evidenzbasierten Psychotherapie wird unser Versorgungssystem durch chronisch suizidale Patienten mit einer Borderline-Persönlichkeitsstörung (BPS) weiterhin stark herausgefordert. Die BPS ist mit einem hohen Suizidrisiko von 5–10% sowie einem hohen Selbstverletzungsrisiko von bis zu 80% behaftet. Therapeuten wie Angehörige fühlen sich oft überfordert und hilflos, wenn sie mit der Suizidalität der Patienten konfrontiert sind. Immer wieder kommt es so zu Therapieabbrüchen, Vorstellungen in Notaufnahmen oder akut-psychiatrischen Einweisungen. Bei der nichtsuizidalen Selbstverletzung (NSSV) – einem Verhaltensmuster, das gehäuft zusammen mit chronischer Suizidalität bei BPS auftritt – tragen Verstärkermechanismen (z.B. Nachlassen von Anspannung) dazu bei, dass sich Borderline-Patienten trotz längerfristig unangenehmen Folgen immer wieder selbst verletzen. Die Motive für NSSV und suizidales Verhalten können sehr unterschiedlich sein. Es spricht jedoch einiges dafür, dass die zugrunde liegenden Mechanismen ähnlich sind und sich hieraus wichtige therapeutische Interventionsmöglichkeiten ableiten lassen. In dieser Übersichtsarbeit werden die Hintergründe und Unterschiede von NSSV, Suizidideationen sowie Suizidversuchen bei chronisch suizidalen Borderline-Patienten dargestellt. Neuere Erkenntnisse der modernen Neuro- und Verhaltenswissenschaft werden in ein Verstärkermodell der Suizidalität integriert, von dem verhaltenstherapeutische Interventionen abgeleitet werden, die Therapeuten in ihrer Arbeit mit chronisch suizidalen Patienten unterstützen können.
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24
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[Neurobiological principles of borderline personality disorder: integration into the ICD-11 model of personality disorders]. DER NERVENARZT 2021; 92:653-659. [PMID: 34019118 DOI: 10.1007/s00115-021-01133-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/18/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Borderline personality disorder (BPD) is a severe mental disorder associated with far-reaching impairments in the self and interpersonal functioning. The broad database has contributed to the fact that BPD remains the only categorical personality diagnosis in ICD-11, even if coupled to the determination of the severity of impairments. Nevertheless, we need to deal with a dimensional conceptualization of personality disorders-which is also supported by neuroscientific findings-at the latest in 2022 when the ICD-11 comes into effect . OBJECTIVE This narrative review provides an overview of neuroscientific findings regarding impairments in self and interpersonal functioning in patients with BPD. RESULTS Alterations in the medial prefrontal cortex, temporoparietal junction and precuneus mediate deficits in self-referential thought processes and the mentalization of emotions and intentions of others. Enhanced connectivity between the amygdala and midline structures is associated with hypermentalization. At the same time, elevated insula activation seems to underlie the strengthened nonreflective parts of feelings of other people. Frontolimbic alterations are transdiagnostically associated with deficient emotional regulation and negative affectivity and alterations in reward and cognitive control regions are related to impulsivity. CONCLUSION Neuroscientific findings help to have a better understanding of the underlying mechanisms of central functional impairments in BPD and can support the transition to ICD-11 as well as the implementation of new interventions.
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25
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Phelps CE, Navratilova E, Porreca F. Cognition in the Chronic Pain Experience: Preclinical Insights. Trends Cogn Sci 2021; 25:365-376. [PMID: 33509733 PMCID: PMC8035230 DOI: 10.1016/j.tics.2021.01.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 12/24/2020] [Accepted: 01/05/2021] [Indexed: 12/12/2022]
Abstract
Acutely, pain is protective. It promotes escape from, and future avoidance of, noxious stimuli through strong and often lifetime associative memories. However, with persistent acute pain or when pain becomes chronic, these memories can promote negative emotions and poor decisions often associated with deleterious behaviors. In this review, we discuss how preclinical studies can provide insights into the relationship between cognition and chronic pain. We also discuss the concept of pain as a cognitive disorder and new strategies for treating chronic pain that emphasize inhibiting the formation of pain memories or promoting 'forgetting' of established pain memories.
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Affiliation(s)
- Caroline E Phelps
- Department of Pharmacology, Arizona Health Sciences Center, University of Arizona, Tucson, AZ 85724, USA.
| | - Edita Navratilova
- Department of Pharmacology, Arizona Health Sciences Center, University of Arizona, Tucson, AZ 85724, USA
| | - Frank Porreca
- Department of Pharmacology, Arizona Health Sciences Center, University of Arizona, Tucson, AZ 85724, USA.
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26
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Abstract
Self-mutilation and abnormal repetitive behaviors in small mammals are challenging conditions for veterinary practitioners. The etiology may be difficult to identify, and the treatment is often unrewarding unless the specific underlying cause can be found. Reinforcement of the abnormal behavior may also complicate the treatment. However, medical causes, including painful conditions, should be investigated thoroughly. Owing to the small blood volume of many small exotic mammals and the associated risk of hypovolemia in case of hemorrhage, an hospitalization with potent multimodal analgesia and physical barriers to prevent self-mutilation is often warranted. Psychogenic drugs may be useful in some cases.
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27
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Zinchuk MS, Avedisova AS, Voinova NI, Kustov GV, Pashnin EV, Gulyaeva NV, Guekht AB. [Pain perception and nonsuicidal self-injurious behavior]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 120:144-152. [PMID: 33459555 DOI: 10.17116/jnevro2020120121144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This review focuses on studies of pain threshold and tolerance in individuals with nonsuicidal self-injurious (NSSI) behavior. The data on methods of pain sensitivity studies are presented, with issues in animal modeling of NSSI discussed separately. The results of neuroimaging studies on pain sensitivity in individuals with NSSI are described, along with contribution of genetic factors, psychological variables, and disturbances in opioid and hypothalamic-pituitary-adrenal systems. A critical methodological analysis of the studies on pain sensitivity in individuals with NSSI was performed.
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Affiliation(s)
- M S Zinchuk
- Scientific and Practical Psychoneurological Center, Moscow, Russia
| | - A S Avedisova
- Scientific and Practical Psychoneurological Center, Moscow, Russia.,Serbsky National Medical Research Center for Psychiatry and Narcology, Moscow, Russia
| | - N I Voinova
- Scientific and Practical Psychoneurological Center, Moscow, Russia
| | - G V Kustov
- Scientific and Practical Psychoneurological Center, Moscow, Russia
| | - E V Pashnin
- Scientific and Practical Psychoneurological Center, Moscow, Russia
| | - N V Gulyaeva
- Scientific and Practical Psychoneurological Center, Moscow, Russia.,Institute of Higher Nervous Activity and Neurophysiology of RAS, Moscow, Russia
| | - A B Guekht
- Scientific and Practical Psychoneurological Center, Moscow, Russia.,Pirogov Russian National Research Medical University, Moscow, Russia
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28
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Johnson BN, Lumley MA, Cheavens JS, McKernan LC. Exploring the links among borderline personality disorder symptoms, trauma, and pain in patients with chronic pain disorders. J Psychosom Res 2020; 135:110164. [PMID: 32569851 PMCID: PMC7422088 DOI: 10.1016/j.jpsychores.2020.110164] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/30/2020] [Accepted: 05/31/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Chronic pain and borderline personality disorder (BPD) are commonly comorbid and jointly associated with increased symptoms of both disorders and clinical and functional impairment. Little is known, however, about specific links between these disorders. In a cross-sectional study of patients with chronic pain, we compared participants high or low on BPD symptoms on patterns of pain experience and types of child and adult traumas. METHODS Adults (N = 181) with chronic pain completed self-reports of pain severity, dimensions of pain experiencing, body coverage of pain, and clinical indicators of central sensitization (i.e., chronic hypersensitivity of the central nervous system), as well as measures of child and adult physical abuse, sexual abuse, trauma, and neglect. Participants also completed the McLean Screening Instrument for BPD. RESULTS Participants with clinically significant BPD symptoms (n = 32) reported more childhood sexual trauma, punishment, and neglect, as well as adult physical/sexual trauma, than those without elevated BPD symptoms. Among participants with clinically significant BPD symptoms, affective pain and central sensitization were elevated, potentially explained by heightened negative affect in BPD. CONCLUSION BPD symptoms are associated with increased clinical severity among patients with chronic pain as well as a unique manifestation of pain experiencing (i.e., increased affective pain and central sensitization in particular). Childhood trauma of all types is associated with chronic pain and BPD co-occurrence. Researchers and clinicians should assess for BPD in people with chronic pain to enhance conceptual models of the transaction between these disorders and to improve clinical care.
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29
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An Embodied Neurocomputational Framework for Organically Integrating Biopsychosocial Processes: An Application to the Role of Social Support in Health and Disease. Psychosom Med 2020; 81:125-145. [PMID: 30520766 DOI: 10.1097/psy.0000000000000661] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Two distinct perspectives-typically referred to as the biopsychosocial and biomedical models-currently guide clinical practice. Although the role of psychosocial factors in contributing to physical and mental health outcomes is widely recognized, the biomedical model remains dominant. This is due in part to (a) the largely nonmechanistic focus of biopsychosocial research and (b) the lack of specificity it currently offers in guiding clinicians to focus on social, psychological, and/or biological factors in individual cases. In this article, our objective is to provide an evidence-based and theoretically sophisticated mechanistic model capable of organically integrating biopsychosocial processes. METHODS To construct this model, we provide a narrative review of recent advances in embodied cognition and predictive processing within computational neuroscience, which offer mechanisms for understanding individual differences in social perceptions, visceral responses, health-related behaviors, and their interactions. We also review current evidence for bidirectional influences between social support and health as a detailed illustration of the novel conceptual resources offered by our model. RESULTS When integrated, these advances highlight multiple mechanistic causal pathways between psychosocial and biological variables. CONCLUSIONS By highlighting these pathways, the resulting model has important implications motivating a more psychologically sophisticated, person-specific approach to future research and clinical application in the biopsychosocial domain. It also highlights the potential for quantitative computational modeling and the design of novel interventions. Finally, it should aid in guiding future research in a manner capable of addressing the current criticisms/limitations of the biopsychosocial model and may therefore represent an important step in bridging the gap between it and the biomedical perspective.
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30
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Chung BY, Hensel S, Schmidinger I, Bekrater-Bodmann R, Flor H. Dissociation proneness and pain hyposensitivity in current and remitted borderline personality disorder. Eur J Pain 2020; 24:1257-1268. [PMID: 32232961 DOI: 10.1002/ejp.1567] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 03/17/2020] [Accepted: 03/21/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Stress-related dissociation has been shown to negatively co-vary with pain perception in current borderline personality disorder (cBPD). While remission of the disorder (rBPD) is associated with normalized pain perception, it remains unclear whether dissociation proneness is still enhanced in this group and how this feature interacts with pain sensitivity. METHODS Twenty-five cBPD patients, 20 rBPD patients and 24 healthy controls (HC) participated in an experiment using the script-driven imagery approach. We presented a personalized stressful and neutral narrative. After listening to the scripts, dissociation and heat pain thresholds (HPT) were assessed. RESULTS Compared to HC, cBPD patients showed enhanced dissociation and exhibited significantly enhanced HPT in the neutral condition, whereas rBPD participants were in between. After listening to the stress script, both clinical groups exhibited enhanced dissociation scores. Current BPD participants responded with significantly higher HPT, whereas rBPD only showed a trend in the same direction. However, both BPD groups showed significantly increased HPT compared to the HC in the stress condition, but did not differ from each other. Dissociation proneness correlated significantly positively with pain hyposensitivity only in cBPD. CONCLUSION Dissociation proneness is enhanced in both BPD groups. This feature is clearly positively related to pain hyposensitivity in cBPD, but not in rBPD. However, the data indicate that stress causes the pain perception in rBPD to drift away from that obtained in HC. These results highlight the volatile state of BPD remission and might have important implications for the care of BPD patients in the remitted stage. SIGNIFICANCE Both current (cBPD) and remitted borderline personality disorder (rBPD) patients show enhanced proneness to dissociation. This feature is significantly linked with pain hyposensitivity in cBPD in a paradigm that induces stress using a script-driven imagery approach, whereas this connection cannot be observed in rBPD. However, in the stress compared to the neutral condition, rBPD participants also show pain hyposensitivity compared to healthy controls. This study provides new insights into the pain processing mechanisms of BPD and its remission.
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Affiliation(s)
- Boo Young Chung
- Department of Cognitive and Clinical Neuroscience, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany.,Clinic of Anesthesiology and Intensive Care Medicine, Pain Center, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Saskia Hensel
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Ilinca Schmidinger
- Department of General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Robin Bekrater-Bodmann
- Department of Cognitive and Clinical Neuroscience, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany
| | - Herta Flor
- Department of Cognitive and Clinical Neuroscience, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany.,Department of Health Science and Technology, Center for Neuroplasticity and Pain (CNAP), SMI®, Aalborg University, Aalborg, Denmark
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31
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Lince-González AM, Tachak-Duque LC, Parra-García JC, Durán-Florez ME, Estrada-Orozco K. Prevalencia y caracterización de cutting en población pediátrica (0-14 años) en un servicio de urgencias de Bogotá D.C., Colombia. REVISTA DE LA FACULTAD DE MEDICINA 2020. [DOI: 10.15446/revfacmed.v68n2.73583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. El cutting es un comportamiento de autolesión no suicida cada vez más frecuente en menores de 15 años; sin embargo, en Colombia aún no se han realizado estudios que reporten la prevalencia de esta conducta en población pediátrica.Objetivo. Describir las características sociodemográficas y clínicas, y los factores de riesgo de la población pediátrica (0 a 14 años) con diagnóstico de cutting atendida en el servicio de urgencias de una clínica de cuarto nivel en Bogotá D.C., Colombia.Materiales y métodos. Estudio observacional descriptivo de corte transversal en el que se revisaron las historias clínicas de los pacientes menores de 15 años atendidos entre los años 2011 y 2017 con los códigos diagnósticos CIE 10 Z91.5, F32, F33, F99, F19, F41, F43, T742 y X60, con el fin de identificar aquellos casos que cumplieran con los criterios diagnósticos de cutting.Resultados. Se incluyeron 85 historias clínicas de niños entre 10 y 14 años. La prevalencia de cutting fue de 0.15% en el total de la muestra y de 26.7% en el subgrupo con antecedentes de trastorno psiquiátrico. Se encontró una relación mujer a hombre de 3:1. El 62% no tenía un núcleo familiar unificado, el 30.6% presentó un rendimiento escolar bajo y el 80% se lesionó el antebrazo. Respecto a su salud mental, el 22.3% reportó reducción de ansiedad con la lesión y el 72.9% no presentó ideas suicidas. Los factores de riesgo más frecuentes fueron presentar antecedente de enfermedad mental (52.9%), ser víctima de violencia psicológica (25.8%) y, en el caso de los varones, consumir sustancias psicoactivas (22.7%).Conclusiones. La prevalencia de cutting fue inferior en comparación con lo reportado en otros países. Este comportamiento fue tres veces más frecuente en niñas y el antecedente personal psiquiátrico podría aumentar el riesgo de presentarlo. A pesar que las características aquí descritas permitirán identificar fácilmente esta condición en población pediátrica colombiana, es necesario realizar nuevos estudios que determinen la efectividad de medidas terapéuticas dirigidas a esta población.
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32
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Hennings JM. Function and Psychotherapy of Chronic Suicidality in Borderline Personality Disorder: Using the Reinforcement Model of Suicidality. Front Psychiatry 2020; 11:199. [PMID: 32256412 PMCID: PMC7093558 DOI: 10.3389/fpsyt.2020.00199] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/02/2020] [Indexed: 12/12/2022] Open
Abstract
Although great advancements in evidence-based therapies, chronic suicidal patients with borderline personality disorder (BPD) still challenge our mental health system. While BPD patients continue suffering from distress and aversive emotions, therapists and relatives feel often stunned and helpless when confronted with suicidality resulting in interruption of therapies, repeated presentations to emergency rooms and referrals to hospitals. Reviewing the current knowledge of the functions and background of non-suicidal self-injury, we learned that reinforcement mechanisms play an important role to understand why individuals act in deliberate self-mutilation. While individual motives for non-suicidal self-injury and suicidal behavior including suicidal ideations can differ, the principle mechanisms appear to be transferrable. Elucidating the individual motives and function of suicidal behavior is an important therapeutic step, giving us access to very central maladaptive schemes and false believes that we need to address in order to reduce chronic suicidality in BPD patients. This Perspective article aims to give a better idea of what is behind and what are the differences between non-suicidal self-injury, suicidal ideations and suicide attempts. It further integrates recent developments of behavioral science in a reinforcement model of suicidality that can provide therapists a practical armamentarium in their work with chronic suicidal clients.
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Affiliation(s)
- Johannes M. Hennings
- Department of Dialectical Behavioral Therapy, kbo-Isar-Amper-Klinikum Munich-East, Munich, Germany
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33
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Löffler A, Kleindienst N, Cackowski S, Schmidinger I, Bekrater-Bodmann R. Reductions in Whole-body Ownership in Borderline Personality Disorder - A Phenomenological Manifestation of Dissociation. J Trauma Dissociation 2020; 21:264-277. [PMID: 31646957 DOI: 10.1080/15299732.2019.1678213] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Body ownership, i.e., the certainty that own body parts belongs to oneself, is a fundamental feature of self-consciousness. Patients with borderline personality disorder (BPD) often show symptoms of dissociation, describing a state of detachment from reality including their own body. However, up to now, there is no study that a) quantifies body ownership experiences in BPD, b) compares these experiences between the current and the remitted state of the disorder, and c) relates this kind of experience specifically to dissociation. In the present study, we assessed ownership for 25 body areas in current BPD patients (cBPD) and compared their ratings with those of remitted BPD patients (rBPD) and healthy controls (HC). We further related body ownership to dissociation and other relevant BPD markers on body area and subject level by applying multi-level analyses in the cBPD group. We found significantly reduced body ownership experiences in cBPD compared to HC, while there were no significant differences between these groups and rBPD. In cBPD, reduced body ownership was significantly related to dissociation when controlled for other BPD core features. Reduced body ownership might thus constitute a relevant marker for dissociation in current BPD which could further represent a target for therapeutic approaches.
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Affiliation(s)
- Annette Löffler
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Nikolaus Kleindienst
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sylvia Cackowski
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Ilinca Schmidinger
- Department for General Psychiatry, Center of Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Robin Bekrater-Bodmann
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Ammerman BA, Sorgi KM, Berman ME, Coccaro EF, McCloskey MS. Potential Mood Variation Following a Behavioral Analogue of Self-Injurious Behavior. Arch Suicide Res 2020; 24:S113-S125. [PMID: 30300119 PMCID: PMC6531373 DOI: 10.1080/13811118.2018.1527267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Despite increased use of behavioral analogues to identify casual mechanisms of self-injurious behavior (e.g., suicide attempts; non-suicidal self-injury), little is known about the impact on participants. The current study examined the impact of a specific behavior analogue, Self-Aggressive Paradigm (SAP), on participant affect. Community participants (n = 507) reported several affective ratings before and after completing SAP task procedures. Following the SAP, participants reported reductions in nervousness and fear and increases in calmness and anger (d = .21). Participants with a current anxiety disorder reported greater increases in happiness; those with a suicide attempt history reported greater increases in sadness. Findings demonstrate the SAP has no adverse mood effects, supporting its use in experimental research.
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Hooley JM, Dahlgren MK, Best SG, Gonenc A, Gruber SA. Decreased Amygdalar Activation to NSSI-Stimuli in People Who Engage in NSSI: A Neuroimaging Pilot Study. Front Psychiatry 2020; 11:238. [PMID: 32300315 PMCID: PMC7143895 DOI: 10.3389/fpsyt.2020.00238] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 03/11/2020] [Indexed: 01/29/2023] Open
Abstract
In healthy individuals, stimuli associated with injury (such as those depicting blood or wounds) tend to evoke negative responses on both self-report and psychophysiological measures. Such an instinctive aversion makes sense from an evolutionary perspective. However, to engage in nonsuicidal self-injury (NSSI), this natural barrier must be overcome. The Benefits and Barriers model of NSSI predicts that people who engage in NSSI will show diminished aversion to NSSI-related stimuli compared to controls who do not engage in NSSI. We tested this hypothesis in a pilot study assessing 30 adults, 15 of whom reported current skin cutting and 15 of whom had no history of NSSI. Functional magnetic resonance imaging (fMRI) data were collected while participants viewed neutral, positive, and negative images selected from the International Affective Picture System. Participants also viewed NSSI images depicting razors, scalpels, or wounds caused by cutting. Compared to healthy control (HC) participants, the NSSI group showed decreased amygdala and increased cingulate cortex (CC) and orbitofrontal cortex (OFC) activation to NSSI and negative images. They also showed increased amygdalar and OFC activation to positive images. Neither the control group nor the NSSI group demonstrated significant activation within regions more typically associated with reward during any of the conditions; however, positive and negative affect ratings collected throughout the course of the task suggested that none of the affective conditions were viewed as rewarding. Although preliminary, these findings are suggestive of reduced limbic and greater cortical processing of NSSI stimuli in those with a history of this behavior. This has potentially important implications for current models of NSSI as well as for its treatment.
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Affiliation(s)
- Jill M Hooley
- Department of Psychology, Harvard University, Cambridge, MA, United States
| | - Mary Kathryn Dahlgren
- Cognitive and Clinical Neuroimaging Core, McLean Imaging Center, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Stephanie G Best
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States.,McLean Hospital, Boston, MA, United States
| | - Atilla Gonenc
- Cognitive and Clinical Neuroimaging Core, McLean Imaging Center, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Staci A Gruber
- Cognitive and Clinical Neuroimaging Core, McLean Imaging Center, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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Defrin R, Cohen Sagy N, Biran I, Goor-Aryeh I, Shai R, Ginzburg K. Enhanced pain modulation capacity among individuals with borderline personality disorder: A possible mechanism underlying their hypoalgesia. Eur J Pain 2019; 24:544-554. [PMID: 31702076 DOI: 10.1002/ejp.1504] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 10/30/2019] [Accepted: 11/06/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ample evidence suggests that individuals with borderline personality disorder (BPD) exhibit hyposensitivity to pain. Since the underlying mechanism of the pain hyposensitivity is unknown, we tested here for the first time whether this hyposensitivity is pain specific or exists also for innocuous sensation, and whether it is associated with enhanced descending pain modulation capabilities. METHODS Participants were 55 women; 22 patients with BPD and 33 matched healthy controls. Testing included the measurement of warmth sensation threshold (WST), heat-pain threshold (HPT), pain adaptation, conditioned pain modulation (CPM) and temporal summation of heat-pain (TSP). The level of dissociation was also evaluated. RESULTS Women with BPD had higher WST and HPT compared with healthy controls. Moreover, women with BPD had greater magnitude of pain adaptation and CPM as well as higher dissociation level compared to controls. In neither the BPD nor the control group did WST and HPT correlate with pain adaptation, CPM or dissociation. In the BPD group only, HPT inversely correlated with the magnitude of TSP. CONCLUSIONS Women with BPD present generalized hyposensitivity to both innocuous and noxious stimuli. Furthermore, women with BPD exhibit more efficient pain inhibition capabilities than healthy controls. While efficient pain modulation may underlie pain hyposensitivity in BPD, both traits may exist independently from each other, or may be moderated by another factor such as dissociation. SIGNIFICANCE On the basis of testing pronociceptive and antinociceptive components among individuals with BPD and healthy controls, this study reveals enhanced ability to inhibit pain among woman with borderline personality disorder (BPD) which may underlie hyposensitivity to both noxious and innocuous stimuli and perhaps also self-injurious behaviour among these individuals. The study contributes novel information on possible mechanisms involved in BPD manifestations.
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Affiliation(s)
- Ruth Defrin
- Department of Physical Therapy, School of Allied Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neurosciences, Tel Aviv University, Tel Aviv, Israel
| | - Nitzan Cohen Sagy
- School of Psychological Sciences, Gershon H. Gordon Faculty of Social Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Iftah Biran
- Division of Psychiatry, Sheba Medical Center, Ramat-Gan, and The Department of Neurology, Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Itay Goor-Aryeh
- Pain Management Center, Department of Anesthesiology and Intensive Care, Sheba Medical Center, Tel Hashomer, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roni Shai
- The Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Karni Ginzburg
- The Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
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Zaehringer J, Ende G, Santangelo P, Kleindienst N, Ruf M, Bertsch K, Bohus M, Schmahl C, Paret C. Improved emotion regulation after neurofeedback: A single-arm trial in patients with borderline personality disorder. Neuroimage Clin 2019; 24:102032. [PMID: 31795041 PMCID: PMC6978219 DOI: 10.1016/j.nicl.2019.102032] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/25/2019] [Accepted: 10/07/2019] [Indexed: 01/09/2023]
Abstract
Real-time functional magnetic resonance imaging (fMRI) neurofeedback training of amygdala hemodynamic activity directly targets a neurobiological mechanism, which contributes to emotion regulation problems in borderline personality disorder (BPD). However, it remains unknown which outcome measures can assess changes in emotion regulation and affective instability, associated with amygdala downregulation in a clinical trial. The current study directly addresses this question. Twenty-four female patients with a DSM-IV BPD diagnosis underwent four runs of amygdala neurofeedback. Before and after the training, as well as at a six-weeks follow-up assessment, participants completed measures of emotion dysregulation and affective instability at diverse levels of analysis (verbal report, clinical interview, ecological momentary assessment, emotion-modulated startle, heart rate variability, and fMRI). Participants were able to downregulate their amygdala blood oxygen-dependent (BOLD) response with neurofeedback. There was a decrease of BPD symptoms as assessed with the Zanarini rating scale for BPD (ZAN-BPD) and a decrease in emotion-modulated startle to negative pictures after training. Further explorative analyses suggest that patients indicated less affective instability, as seen by lower hour-to-hour variability in negative affect and inner tension in daily life. If replicated by an independent study, our results imply changes in emotion regulation and affective instability for several systems levels, including behavior and verbal report. Conclusions are limited due to the lack of a control group. A randomized controlled trial (RCT) will be needed to confirm effectiveness of the training.
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Affiliation(s)
- Jenny Zaehringer
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/University of Heidelberg, Mannheim, Germany.
| | - Gabriele Ende
- Department Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim / University of Heidelberg, Mannheim, Germany
| | - Philip Santangelo
- Chair of Applied Psychology/Mental Health Lab, Institute of Sport and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Nikolaus Kleindienst
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/University of Heidelberg, Mannheim, Germany
| | - Matthias Ruf
- Department Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim / University of Heidelberg, Mannheim, Germany
| | - Katja Bertsch
- Department for General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany; Department of Psychology, LMU Munich, Munich, Germany
| | - Martin Bohus
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/University of Heidelberg, Mannheim, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/University of Heidelberg, Mannheim, Germany
| | - Christian Paret
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/University of Heidelberg, Mannheim, Germany; Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center and School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel.
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Biased Competition Favoring Physical Over Emotional Pain: A Possible Explanation for the Link Between Early Adversity and Chronic Pain. Psychosom Med 2019; 80:880-890. [PMID: 30222711 DOI: 10.1097/psy.0000000000000640] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Early adversity predisposes to chronic pain, but a mechanistic explanation is lacking. Survivors of early adversity with chronic pain often seem impaired in their ability to be aware of, understand, and express distressing emotions such as anger and fear in social contexts. In this context, it has been proposed that pain may at times serve as a "psychic regulator" by preventing awareness of more intolerable emotions. METHOD This narrative review builds on the premise that physical pain and emotional pain are conscious experiences that can compete for selective attention. We highlight mechanisms whereby the consequences of early adversity may put emotional pain at a competitive disadvantage. A case history, supportive research findings, and an evidence-based neurobiological model are presented. RESULTS Arising from abuse or neglect in childhood, impairments in the adult capacity to attend to and/or conceptualize the emotional meaning of felt distress may be associated with impaired engagement of the default network and impaired top-down modulation of affective response generation processes. Persistent and poorly conceptualized affective distress may be associated with reduced emotion regulation ability, reduced vagal tone, increased inflammation, and amplified nociceptive signals. Attention to physical pain may be reinforced by the temporary reduction in negative emotions that it causes. CONCLUSIONS These processes jointly promote biased competition favoring attention to physical pain and away from one's own emotions. They may constitute an unintentional analog of the phenomenon of self-injury in patients with borderline personality disorder in whom the intentional infliction of physical pain serves to downregulate intense emotional distress. Attending to, expressing, and understanding previously unacknowledged psychological distress unrelated to pain may facilitate recovery from chronic pain after early adversity. Mechanistic studies that can validate this clinically derived neurobiological hypothesis are urgently needed.
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Westlund Schreiner M, Klimes-Dougan B, Parenteau A, Hill D, Cullen KR. A Framework for Identifying Neurobiologically Based Intervention Targets for NSSI. Curr Behav Neurosci Rep 2019. [DOI: 10.1007/s40473-019-00188-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Toward an animal model of borderline personality disorder. Psychopharmacology (Berl) 2019; 236:2485-2500. [PMID: 31201478 PMCID: PMC6697600 DOI: 10.1007/s00213-019-05289-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 05/30/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Borderline personality disorder (BPD) is a pervasive psychiatric disorder characterized by emotion dysregulation, impulsivity, impaired self-perceptions, and interpersonal relationships and currently affects 1-3% of the US population as reported by Torgersen et al. (Arch Gen Psychiatry 58:590-596, Torgersen et al. 2001), Lenzenweger et al. (Biol Psychiatry 62:553-564, Lenzenweger et al. 2007), and Tomko et al. (J Personal Disord 28:734-750, Tomko et al. 2014). One major obstacle to our understanding of the neural underpinnings of BPD is a lack of valid animal models that translate the key known features of the disorder to a system that is amenable to study. OBJECTIVE To summarize the etiology, major symptoms, and symptom triggers of BPD and then propose a blueprint for building an animal model of BPD by choosing key components of the disorder that can be implemented in rodents. RESULTS We identify the role of early life stress and subsequent mild stress in adulthood as contributing etiological factors and the potential use of altered communication between frontal cortices and the amygdala in extinction and habituation, increased impulsivity, dysregulation of the hypothalamic pituitary axis (HPA), and increased neuroinflammation as biological markers of BPD. Building upon these features of BPD, we propose a two-hit animal model that uses maternal abandonment to alter maturation of the HPA axis and mild secondary adult stress to evoke behavioral symptoms such as increased impulsivity and impaired extinction, habituation, and social interactions. CONCLUSION Through exploration of the etiology, symptom presentation, and altered neurological function, we propose an animal model of BPD. We believe that a number of existing animal paradigms that model other mental health disorders should be combined in a unique way to reflect the etiology, symptom presentation, and altered neurological function that is evident in BPD. These model, when compared with available human data, will inform research and treatment in humans for better understanding of systems from the micro-molecular level to more global physiology underlying BPD.
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Krause-Utz A, Walther JC, Lis S, Schmahl C, Bohus M. Heart rate variability during a cognitive reappraisal task in female patients with borderline personality disorder: the role of comorbid posttraumatic stress disorder and dissociation. Psychol Med 2019; 49:1810-1821. [PMID: 30198447 PMCID: PMC6650777 DOI: 10.1017/s0033291718002489] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 08/04/2018] [Accepted: 08/10/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Emotion dysregulation is a core feature of borderline personality disorder (BPD), which often co-occurs with posttraumatic stress disorder (PTSD). Difficulties in emotion regulation (ER) have been linked to lower high-frequency heart rate variability (HF-HRV), a measure of autonomous nervous system functioning. However, previous research on vagally-mediated heart rate in BPD revealed heterogeneous findings and the effects of comorbid PTSD and dissociation on HF-HRV are not yet completely understood. This study aim to investigate HF-HRV during resting-state and an ER task in female BPD patients with comorbid PTSD (BPD + PTSD), patients without this comorbidity (BPD), and healthy controls (HC). METHODS 57 BPD patients (BPD: n = 37, BPD + PTSD: n = 20) and 27 HC performed an ER task with neutral, positive, and negative images. Participants were instructed to either attend these pictures or to down-regulate their upcoming emotions using cognitive reappraisal. Subjective arousal and wellbeing, self-reported dissociation, and electrocardiogram data were assessed. RESULTS Independent of ER instruction and picture valence, both patient groups (BPD and BPD + PTSD) reported higher subjective arousal and lower wellbeing; patients with BPD + PTSD further exhibited significantly lower HF-HRV compared with the other groups. Higher self-reported state dissociation predicted higher HF-HRV during down-regulating v. attending negative pictures in BPD + PTSD. CONCLUSIONS Findings suggest increased emotional reactivity to negative, positive, and neutral pictures, but do not provide evidence for deficits in instructed ER in BPD. Reduced HF-HRV appears to be particularly linked to comorbid PTSD, while dissociation may underlie attempts to increase ER and HF-HRV in BPD patients with this comorbidity.
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Affiliation(s)
- Annegret Krause-Utz
- Institute of Clinical Psychology, Leiden University; Leiden Institute for Brain and Cognition; Leiden, The Netherlands
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim; Medical Faculty, University of Heidelberg, Mannheim, Germany
| | - Julia-Caroline Walther
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim; Medical Faculty, University of Heidelberg, Mannheim, Germany
| | - Stefanie Lis
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim; Medical Faculty, University of Heidelberg, Mannheim, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Mannheim; Medical Faculty, University of Heidelberg, Mannheim, Germany
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Martin Bohus
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim; Medical Faculty, University of Heidelberg, Mannheim, Germany
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Abstract
AbstractBorderline personality disorder (BPD) is a severe and complex disorder characterized by instability across many life domains, including interpersonal relations, behavior, and emotions. A core feature and contributor to BPD, emotion dysegulation (ED), consists of deficits in the ability to regulate emotions in a manner that allows the individual to pursue important goals or behave effectively in various contexts. Biosocial developmental models of BPD have emphasized a transaction of environmental conditions (e.g., invalidating environments and adverse childhood experiences) with key genetically linked vulnerabilities (e.g., impulsivity and emotional vulnerability) in the development of ED and BPD. Emerging evidence has begun to highlight the complex, heterotypic pathways to the development of BPD, with key heritable vulnerability factors possibly interacting with aspects of the rearing environment to produce worsening ED and an adolescent trajectory consisting of self-damaging behaviors and eventual BPD. Adults with BPD have shown evidence of a variety of cognitive, physiological, and behavioral characteristics of ED. As the precursors to the development of ED and BPD have become clearer, prevention and treatment efforts hold great promise for reducing the long-term suffering, functional impairment, and considerable societal costs associated with BPD.
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Naoum J, Kleindienst N, Baumgärtner U, Willis F, Mancke F, Treede RD, Bohus M, Schmahl C. Effects of a Painful Stimulus on Stress Regulation in Male Patients With Borderline Personality Disorder: A Pilot Study. J Pers Disord 2019; 33:394-412. [PMID: 30036168 DOI: 10.1521/pedi_2018_32_351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pain processing in relation to stress has so far not been investigated in male patients with borderline personality disorder (BPD). This experimental pilot study examined 17 male BPD patients and 20 male healthy controls (HCs) to assess the effects of a pain stimulus on arousal, aggression, pain (ratings), and heart rate. At baseline, BPD patients showed significantly higher arousal and aggression; however, there was no significant difference in heart rate compared to the HC group. Following stress induction, a noninvasive mechanical pain stimulus was applied. No significant differences in pain ratings or heart rates were found between the groups. For arousal, a significantly stronger decrease was revealed in the BPD group compared to the HC group (t = 2.16, p = .038). Concerning aggression, the BPD group showed a significantly greater decrease after the pain stimulus than the HC group (t = 3.25, p = .002). This data showed that nonsuicidal self-injury can reduce arousal and aggression in male BPD.
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Affiliation(s)
- Janina Naoum
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Nikolaus Kleindienst
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim
| | - Ulf Baumgärtner
- Department of Neurophysiology, Center of Biomedicine and Medical Technology Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim
| | - Franziska Willis
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Falk Mancke
- Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Center of Biomedicine and Medical Technology Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim
| | - Martin Bohus
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.,Department of Neurophysiology, Center of Biomedicine and Medical Technology Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim.,Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Schloss N, Shabes P, Kuniss S, Willis F, Treede RD, Schmahl C, Baumgärtner U. Differential perception of sharp pain in patients with borderline personality disorder. Eur J Pain 2019; 23:1448-1463. [PMID: 31034113 DOI: 10.1002/ejp.1411] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/16/2019] [Accepted: 04/17/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Cutting is the most common method of non-suicidal self-injury (NSSI) to reduce inner tension in patients with Borderline Personality Disorder (BPD). Aim of this study was to compare pain perception induced by an incision and by application of a surrogate model for sharp mechanical pain (a non-invasive "blade") in BPD. METHODS 22 female patients and 20 healthy controls (HC) received a small incision into the volar forearm, a 7s-blade application on the same side, and non-invasive phasic stimuli (pinprick, blade, laser, tactile). Pain intensity as well as affective versus sensory components were assessed. RESULTS Incision was rated similarly by both groups (BPD: 28.6 ± 5.5 vs. HC: 33.9 ± 6.6; mean maximum pain ± SEM; p > 0.8), without significant difference for "7-s-blade" (BPD: 18.1 ± 3.8 vs. HC: 25.3 ± 3.6; mean maximum pain ± SEM; p > 0.17) or between "7-s-blade" and incision (BPD: p > 0.12; HC: p > 0.84). However, patients' intensity ratings returned significantly faster to baseline after incision (BPD: 38.9 ± 12.6 s vs. HC: 74.52 ± 11.5 s; p < 0.05), and patients evaluated "blade" and incision without any affective and with different sensory descriptors, indicating an altered evaluation of NSSI-like stimulation with qualitative in addition to quantitative differences-especially for the sharp pain component. CONCLUSIONS The reduced perception of suprathreshold nociceptive stimuli is based on a missing affective component and specific loss of the perception of "sharpness" as part of the sensory component of pain. The results further demonstrate the usefulness of the "blade" for the perception of sharpness in patients. SIGNIFICANCE Patients with Borderline Personality Disorder (BPD) who engage in non-suicidal self-injury (NSSI) report less pain in response to phasic nociceptive stimuli. In comparing an invasive pain stimulus to phasic nociceptive stimuli in BPD patients, the "blade" as non-invasive surrogate model for sharp mechanical pain in psychiatric patients is used. In contrast to healthy volunteers, BPD patients do not report significant affective ratings and specifically display a reduced sensory component for sharpness.
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Affiliation(s)
- Natalie Schloss
- Department of Neurophysiology, Center of Biomedicine and Medical Technology Mannheim, Medical Faculty Mannheim, Ruprecht Karls-University Heidelberg, Mannheim, Germany.,Department of Neurology, University of Cologne, Cologne, Germany
| | - Polina Shabes
- Department of Neurophysiology, Center of Biomedicine and Medical Technology Mannheim, Medical Faculty Mannheim, Ruprecht Karls-University Heidelberg, Mannheim, Germany
| | - Sarah Kuniss
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Ruprecht Karls-University Heidelberg, Mannheim, Germany
| | - Franziska Willis
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Ruprecht Karls-University Heidelberg, Mannheim, Germany.,Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Center of Biomedicine and Medical Technology Mannheim, Medical Faculty Mannheim, Ruprecht Karls-University Heidelberg, Mannheim, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Ruprecht Karls-University Heidelberg, Mannheim, Germany
| | - Ulf Baumgärtner
- Department of Neurophysiology, Center of Biomedicine and Medical Technology Mannheim, Medical Faculty Mannheim, Ruprecht Karls-University Heidelberg, Mannheim, Germany
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Bachmann K, Schulze M, Sörös P, Schmahl C, Philipsen A. Development and validation of an emotional picture set of self-injury (EPSI) for borderline personality disorder: protocol for a validation study. BMJ Open 2019; 9:e027063. [PMID: 31122985 PMCID: PMC6538202 DOI: 10.1136/bmjopen-2018-027063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Borderline personality disorder (BPD) is a severe psychiatric disorder that is characterised by major problems in emotion regulation. Affected persons frequently engage in non-suicidal self-injury (NSSI) to regulate emotions. NSSI is associated with high emotionality in patients with BPD and it can be expected that stimuli depicting scenes of NSSI elicit an emotional response indicative of BPD. The present study protocol describes the development and validation of an emotional picture set of self-injury (EPSI) to advance future research on emotion regulation in BPD. METHODS AND ANALYSIS The present validation study aims to develop and validate an emotional picture set relevant for BPD. Emotional responses to EPSI as well as to a neutral picture set will be investigated in a sample of 30 patients with BPD compared with 30 matched, healthy controls and to 30 matched depressive controls. Emotional responses will be assessed by heart rate variability, facial expression and Self-Assessment Manikin. ETHICS AND DISSEMINATION Ethics approval was obtained by the medical ethics committee of the Carl-von-Ossietzky University of Oldenburg, Germany (registration: 2017-044). The results of the trial will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT03149926; Pre-results.
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Affiliation(s)
- Katharina Bachmann
- Medical Campus University of Oldenburg, School of Medicine and Health Sciences, Psychiatry and Psychotherapy, Carl von Ossietzky Universitat Oldenburg, Bad Zwischenahn, Germany
| | - Marcel Schulze
- Department of Psychiatry and Psychotherapy, Rheinische Friedrich-Wilhelms-Universitat Bonn, Bonn, Germany
| | - Peter Sörös
- Department of Neurology, University of Oldenburg, Oldenburg, Germany
| | - Christian Schmahl
- Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, Rheinische Friedrich-Wilhelms-Universitat Bonn, Bonn, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Lewis SP, Heath NL, Hasking PA, Whitlock JL, Wilson MS, Plener PL. Addressing Self‐Injury on College Campuses: Institutional Recommendations. JOURNAL OF COLLEGE COUNSELING 2019. [DOI: 10.1002/jocc.12115] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Stephen P. Lewis
- Department of PsychologyUniversity of Guelph Guelph Ontario Canada
| | - Nancy L. Heath
- Department of Educational and Counselling PsychologyMcGill University Montreal Quebec Canada
| | | | | | - Mark S. Wilson
- School of PsychologyVictoria University Wellington New Zealand
| | - Paul L. Plener
- Department of Child and Adolescent PsychiatryMedical University of Vienna Vienna Austria
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Fitzpatrick S, Khoury JE, Krantz L, Zeifman R, Kuo JR. Next-day effects of dysfunctional and functional emotion regulation and the moderating role of experiential avoidance. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2019. [DOI: 10.1016/j.jcbs.2019.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Tsypes A, Owens M, Hajcak G, Gibb BE. Neural reward responsiveness in children who engage in nonsuicidal self-injury: an ERP study. J Child Psychol Psychiatry 2018; 59:1289-1297. [PMID: 29665047 PMCID: PMC6192869 DOI: 10.1111/jcpp.12919] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND A better understanding of the correlates of nonsuicidal self-injury (NSSI) in children is important for the identification and prevention of future suicide risk. However, although abnormalities in reward responsiveness might constitute one potential transdiagnostic mechanism of risk for NSSI, no studies have examined initial response to reward in children with a history of NSSI. The goal of the present study was to address this important gap in the literature. To objectively assess initial response to reward, we utilized the feedback negativity (FN) event-related potential, a well-established psychophysiological marker of reward responsiveness. METHODS Participants were 57 children (19 with a history of NSSI and 38 demographically matched controls) between the ages of 7 and 11. Diagnostic interviews were used to assess for current and past DSM-IV mood and anxiety diagnoses and NSSI history. Children also completed a guessing task, during which continuous electroencephalography was recorded. RESULTS Children with a history of NSSI exhibited significantly more negative ΔFN (i.e., FN to losses minus FN to gains) than children without NSSI. These findings appeared to be at least partially independent of children's history of psychopathology and current symptoms, suggesting their specificity to NSSI. CONCLUSIONS These results provide initial evidence for heightened neural initial reward responsiveness to losses versus rewards in children with a history of NSSI. Pending replications and longitudinal studies, the ΔFN might represent a psychophysiological marker of risk for self-harm.
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Affiliation(s)
- Aliona Tsypes
- Center for Affective Science, Binghamton University, Binghamton, NY
| | - Max Owens
- University of South Florida, St. Petersburg, FL
| | - Greg Hajcak
- Stony Brook University, Stony Brook, NY, USA
| | - Brandon E. Gibb
- Center for Affective Science, Binghamton University, Binghamton, NY
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Olié E, Doell KC, Corradi-Dell’Acqua C, Courtet P, Perroud N, Schwartz S. Physical pain recruits the nucleus accumbens during social distress in borderline personality disorder. Soc Cogn Affect Neurosci 2018; 13:1071-1080. [PMID: 30204911 PMCID: PMC6204482 DOI: 10.1093/scan/nsy078] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 07/18/2018] [Accepted: 09/04/2018] [Indexed: 01/16/2023] Open
Abstract
Patients with borderline personality disorder (BPD) often engage in dangerous self-injurious behaviors (SIBs) as a maladaptive technique to decrease heightened feelings of distress (e.g. negative feelings caused by social exclusion). The reward system has recently been proposed as a plausible neural substrate, which may influence the interaction between social distress and physical pain processing in patients that engage in SIBs. Using functional magnetic resonance imaging (fMRI) in 20 adult BPD patients with a history of SIBs and 23 healthy controls (HCs), we found a hyper-activation of the nucleus accumbens (NAcc) and amygdala when painful stimuli were presented to BPD patients (but not HCs) in a state of heightened distress, induced via social exclusion. This differential NAcc activity was mediated by anxious attachment style, which is a key developmental feature of the disorder. Altogether, these results suggest a neural mechanism underlying the pathophysiology of SIBs in these patients, which is likely reinforced via the reward system.
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Affiliation(s)
- Emilie Olié
- Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHU Montpellier - Inserm U1061 -University of Montpellier, Montpellier, France
| | - Kimberly C Doell
- Department of Neuroscience, University of Geneva, Geneva, Switzerland
- Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
- Geneva Neuroscience Center, University of Geneva, Geneva, Switzerland
- Department of Psychology, FPSE, University of Geneva, Geneva, Switzerland
| | - Corrado Corradi-Dell’Acqua
- Geneva Neuroscience Center, University of Geneva, Geneva, Switzerland
- Department of Psychology, FPSE, University of Geneva, Geneva, Switzerland
| | - Philippe Courtet
- Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHU Montpellier - Inserm U1061 -University of Montpellier, Montpellier, France
| | - Nader Perroud
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
- Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Sophie Schwartz
- Department of Neuroscience, University of Geneva, Geneva, Switzerland
- Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
- Geneva Neuroscience Center, University of Geneva, Geneva, Switzerland
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