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Schurz M, Berenz JP, Maerz J, Perla R, Buchheim A, Labek K. Brain Activation for Social Cognition and Emotion Processing Tasks in Borderline Personality Disorder: A Meta-Analysis of Neuroimaging Studies. Brain Sci 2024; 14:395. [PMID: 38672044 PMCID: PMC11048542 DOI: 10.3390/brainsci14040395] [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: 03/28/2024] [Revised: 04/15/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
The present meta-analysis summarizes brain activation for social cognition and emotion-processing tasks in borderline personality disorder (BPD). We carried out two meta-analyses to elaborate on commonalities and potential differences between the two types of tasks. In the first meta-analysis, we implemented a more liberal strategy for task selection (including social and emotional content). The results confirmed previously reported hyperactivations in patients with BPD in the bilateral amygdala and prefrontal cortex and hypoactivations in bilateral inferior frontal gyri. When applying a stricter approach to task selection, focusing narrowly on social cognition tasks, we only found activation in prefrontal areas, particularly in the anterior cingulate and ventromedial prefrontal cortex. We review the role of these areas in social cognition in healthy adults, suggesting that the observed BPD hyperactivations may reflect an overreliance on self-related thought in social cognition.
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Affiliation(s)
- Matthias Schurz
- Department of Psychology, Faculty of Psychology and Sport Science, and Digital Science Center (DiSC), University of Innsbruck, Universitätsstrasse 15, 6020 Innsbruck, Austria
| | - Jan-Patrick Berenz
- Department of Psychology, Faculty of Psychology and Sport Science, University of Innsbruck, Universitätsstrasse 15, 6020 Innsbruck, Austria
| | - Jeff Maerz
- Department of Psychology, Faculty of Psychology and Sport Science, University of Innsbruck, Universitätsstrasse 15, 6020 Innsbruck, Austria
| | - Raphael Perla
- Department of Psychology, Faculty of Psychology and Sport Science, and Digital Science Center (DiSC), University of Innsbruck, Universitätsstrasse 15, 6020 Innsbruck, Austria
| | - Anna Buchheim
- Department of Psychology, Faculty of Psychology and Sport Science, University of Innsbruck, Universitätsstrasse 15, 6020 Innsbruck, Austria
| | - Karin Labek
- Department of Psychology, Faculty of Psychology and Sport Science, University of Innsbruck, Universitätsstrasse 15, 6020 Innsbruck, Austria
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Mancinelli F, Nolte T, Griem J. Attachment and borderline personality disorder as the dance unfolds: A quantitative analysis of a novel paradigm. J Psychiatr Res 2024; 175:470-478. [PMID: 38823203 DOI: 10.1016/j.jpsychires.2024.03.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 06/03/2024]
Abstract
Current research on personality disorders strives to identify key behavioural and cognitive facets of patient functioning, to unravel the underlying root causes and maintenance mechanisms. This process often involves the application of social paradigms - however, these often only include momentary affective depictions rather than unfolding interactions. This constitutes a limitation in our capacity to probe core symptoms, and leaves potential findings uncovered which could help those who are in close relationships with affected individuals. Here, we deployed a novel task in which subjects interact with four unknown virtual partners in a turn-taking paradigm akin to a dance, and report on their experience with each. The virtual partners embody four combinations of low/high expressivity of positive/negative mood. Higher scores on our symptomatic measures of attachment anxiety, avoidance, and borderline personality disorder (BPD) were all linked to a general negative appraisal of all the interpersonal experiences. Moreover, the negative appraisal of the partner who displayed a high negative/low positive mood was tied with attachment anxiety and BPD symptoms. The extent to which subjects felt responsible for causing partners' distress was most strongly linked to attachment anxiety. Finally, we provide a fully-fledged exploration of move-by-move action latencies and click distances from partners. This analysis underscored slower movement initiation from anxiously attached individuals throughout all virtual interactions. In summary, we describe a novel paradigm for second-person neuroscience, which allowed both the replication of established results and the capture of new behavioural signatures associated with attachment anxiety, and discuss its limitations.
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Affiliation(s)
- Federico Mancinelli
- University of Bonn, Transdisciplinary Research Area "Life and Health", Hertz Chair for Artificial Intelligence and Neuroscience, Bonn, Germany; Scuola Internazionale Superiore di Studi Avanzati, Trieste, Italy.
| | - Tobias Nolte
- Research Department of Clinical, Educational and Health Psychology, University College London, London,UK; Anna Freud National Centre for Children and Families, London, UK
| | - Julia Griem
- Research Department of Clinical, Educational and Health Psychology, University College London, London,UK
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Radimecká M, Látalová A, Lamoš M, Jáni M, Bartys P, Damborská A, Theiner P, Linhartová P. Facial emotion processing in patients with borderline personality disorder as compared with healthy controls: an fMRI and ECG study. Borderline Personal Disord Emot Dysregul 2024; 11:4. [PMID: 38360712 PMCID: PMC10870473 DOI: 10.1186/s40479-024-00245-4] [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: 08/16/2023] [Accepted: 01/08/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Maladaptive behaviors and interpersonal difficulties in patients with borderline personality disorder (BPD) seem connected to biased facial emotion processing. This bias is often accompanied by heightened amygdala activity in patients with BPD as compared to healthy controls. However, functional magnetic resonance imaging (fMRI) studies exploring differences between patients and healthy controls in facial emotion processing have produced divergent results. The current study explored fMRI and heart rate variability (HRV) correlates of negative facial emotion processing in patients with BPD and healthy controls. METHODS The study included 30 patients with BPD (29 females; age: M = 24.22, SD = 5.22) and 30 healthy controls (29 females; M = 24.66, SD = 5.28). All participants underwent the "faces" task, an emotional face perception task, in an fMRI session simultaneously with ECG. In this task, participants are presented with emotional expressions of disgust, sadness, and fear (as a negative condition) and with the same pictures in a scrambled version (as a neutral condition). RESULTS We found no differences in brain activity between patients with BPD and healthy controls when processing negative facial expressions as compared to neutral condition. We observed activation in large-scale brain areas in both groups when presented with negative facial expressions as compared to neutral condition. Patients with BPD displayed lower HRV than healthy controls in both conditions. However, there were no significant associations between HRV and amygdala activity and BPD symptoms. CONCLUSION The results of this study indicate no abnormal brain activity during emotional facial processing in patients with BPD. This result contrasts with previous studies and more studies are needed to clarify the relationship between facial emotion processing and brain activity in patients with BPD. Possible reasons for the absence of brain activity differences are discussed in the study. Consistent with previous findings, patients showed lower HRV than healthy controls. However, HRV was not associated with amygdala activity and BPD symptoms.
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Affiliation(s)
- Monika Radimecká
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Jihlavská 340/20, Brno, 625 00, Czech Republic.
| | - Adéla Látalová
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Jihlavská 340/20, Brno, 625 00, Czech Republic
| | - Martin Lamoš
- Brain and Mind Research Program, Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Martin Jáni
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Jihlavská 340/20, Brno, 625 00, Czech Republic
| | - Patrik Bartys
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Jihlavská 340/20, Brno, 625 00, Czech Republic
| | - Alena Damborská
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Jihlavská 340/20, Brno, 625 00, Czech Republic
| | - Pavel Theiner
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Jihlavská 340/20, Brno, 625 00, Czech Republic
| | - Pavla Linhartová
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Jihlavská 340/20, Brno, 625 00, Czech Republic
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Uzar M, Dmitrzak-Węglarz M, Słopień A. Mentalizing in Adolescents with Borderline Personality Disorder. Brain Sci 2023; 13:1473. [PMID: 37891840 PMCID: PMC10605837 DOI: 10.3390/brainsci13101473] [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: 09/19/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
Mentalizing, recognized as the capacity to understand behaviors in the context of our own mental states and those of other people, is being researched more and more commonly in regard to various mental disorders. The research on mentalization focuses on, among other things, borderline personality disorder, which is at present perceived as an emerging problem in the population of adolescents. In order to summarize the currently accessible knowledge of mentalizing in adolescents with borderline personality disorder, we thoroughly analyzed relevant publications. Based on the available literature, it can be concluded that the mentalizing ability of adolescents with borderline personality disorder can be impaired. The evidence demonstrates that they are prone to hypermentalizing, defined as an overattribution of mental states to other people. However, this tendency has not been proven to be specific to teenagers with this disorder. Moreover, the existing data suggest that young people with borderline personality exhibit a reduced capacity to mentalize their own inner states.
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Affiliation(s)
- Magdalena Uzar
- Department of Child and Adolescent Psychiatry, Karol Jonscher Clinical Hospital, Poznan University of Medical Sciences, Szpitalna 27/33 St., 60-572 Poznan, Poland;
| | - Monika Dmitrzak-Węglarz
- Department of Psychiatric Genetics, Medical Biology Center, Poznan University of Medical Sciences, Rokietnicka St. 8, 60-806 Poznan, Poland;
| | - Agnieszka Słopień
- Department of Child and Adolescent Psychiatry, Karol Jonscher Clinical Hospital, Poznan University of Medical Sciences, Szpitalna 27/33 St., 60-572 Poznan, Poland;
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Schmidt P. On Experiential Loneliness. TOPOI : AN INTERNATIONAL REVIEW OF PHILOSOPHY 2023:1-16. [PMID: 37361722 PMCID: PMC10262127 DOI: 10.1007/s11245-023-09936-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/20/2023] [Indexed: 06/28/2023]
Abstract
Presumably, everyone has, at some point in their lives, felt lonely. Loneliness is, in that particular sense, omnipresent. What it feels like to be lonely can, however, vary significantly. Loneliness is far from being a homogeneous phenomenon. Different kinds of loneliness need to be distinguished, considering its causes, contexts, a person's capacities to cope with it, and many other factors. This paper introduces the notion of a specific kind of loneliness: experiential loneliness. Experiential loneliness, it will be argued, consists in particular ways of experiencing the world, oneself, and others. Although feelings of being lonely in one way or another can emanate from one's experience of the world being structured in a particular manner, such kinds of loneliness need not-at least, not always and the whole time-lead to emotional feelings that are concerned with one's loneliness or the lack of meaningful social relationship. Loneliness can give rise to quite different emotional feelings that sometimes even cover up their provenience from underlying experiential loneliness. The notion of experiential loneliness, it is suggested, helps to tie back certain styles of thinking, desires, feelings, and behaviors to contexts of loneliness. Moreover, it will be argued that the notion can also elucidate the development of feelings of being lonely in contexts in which others are not only around but also available. To develop and enrich the notion of experiential loneliness as well as to exemplify its usefulness, a closer look will be taken at the case of borderline personality disorder, a condition in which sufferers are often plagued by loneliness.
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Affiliation(s)
- Philipp Schmidt
- Institut für Philosophie, Julius-Maximilians-Universität Würzburg, Ehrenhof Südflügel, Residenzplatz 2, 97070 Würzburg, Germany
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Dowker A, Frye D, Tsuji H. Editorial: Theory of mind in relation to other cognitive abilities. Front Psychol 2023; 13:1123321. [PMID: 36743640 PMCID: PMC9891725 DOI: 10.3389/fpsyg.2022.1123321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 12/29/2022] [Indexed: 01/19/2023] Open
Affiliation(s)
- Ann Dowker
- Department of Experimental Psychology, Oxford University, Oxford, United Kingdom,*Correspondence: Ann Dowker ✉
| | - Douglas Frye
- Graduate School of Education, University of Pennsylvania, Philadelphia, PA, United States,Douglas Frye ✉
| | - Hiromi Tsuji
- Department of Psychology, Osaka Shoin Women's University, Higashiosaka, Japan,Hiromi Tsuji ✉
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Kelly Grealy M, Godfrey E, Brady F, Whyte O’Sullivan E, Carroll GA, Burke T. Borderline personality disorder traits and mentalising ability: The self-other social cognition paradox. Front Psychiatry 2022; 13:1023348. [PMID: 36339858 PMCID: PMC9631768 DOI: 10.3389/fpsyt.2022.1023348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/06/2022] [Indexed: 11/21/2022] Open
Abstract
Objective Borderline personality disorder (BPD) is a psychiatric condition characterised by a pervasive pattern of impulsivity, low self-image, and interpersonal conflicts. Previous findings indicate a mixed relationship between BPD and social cognition; little research as investigated whether BPD traits influence performance on specific elements of social cognitive tasks, i.e., positive/negative valence. Method Community-based typical controls (n = 151; 51% female) were recruited through an online survey. Participants completed aspects of the Personality Assessment Inventory pertaining to BPD traits, the Interpersonal Reactivity Index, and measures of both emotion recognition and mentalising. Results Following group stratification into high/low BPD traits, participants with high BPD traits were observed to perform significantly better when identifying negative valence stimuli. Furthermore, high levels of affect instability was found to significantly influence negative valence recognition. Conclusion This research highlights previous research which shows a paradox between higher performance on measures of social cognition, with a group of individuals who report significant interpersonal and relational difficulties. This research supports the assessment of social cognitive processes for people with BPD and/or high BPD traits to support clinical formulation of strengths and difficulties.
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Affiliation(s)
- Molly Kelly Grealy
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Emmet Godfrey
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Finn Brady
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | | | - Grace A. Carroll
- School of Psychology, Queen’s University Belfast, Belfast, United Kingdom
| | - Tom Burke
- School of Psychology, National University of Ireland Galway, Galway, Ireland
- Galway Neuroscience Centre, National University of Ireland Galway, Galway, Ireland
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8
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Schmidt P. Affective Instability and Emotion Dysregulation as a Social Impairment. Front Psychol 2022; 13:666016. [PMID: 35496195 PMCID: PMC9051371 DOI: 10.3389/fpsyg.2022.666016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/25/2022] [Indexed: 11/27/2022] Open
Abstract
Borderline personality disorder is a complex psychopathological phenomenon. It is usually thought to consist in a vast instability of different aspects that are central to our experience of the world, and to manifest as “a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity” [American Psychiatric Association (APA), 2013, p. 663]. Typically, of the instability triad—instability in (1) self, (2) affect and emotion, and (3) interpersonal relationships—only the first two are described, examined, and conceptualized from an experiential point of view. In this context, disorders of self have often motivated analyses of self-experience and the sense of self, affective disorders have been frequently considered in the light of emotional experience and its phenomenological structure. Patterns in the phenomenology of social experience have found comparatively little traction when it comes to the conceptualization of the interpersonal disturbances in borderline. In this paper, I argue that interpersonal instability in borderline consists in much more than fragile and shifting relationships but, most importantly, also involves certain styles in experiencing others. These styles, I suggest, may play an explanatory role for the borderline-typical patterns of interpersonal turmoil and so deserve more attention. To better describe and understand these styles, I explore the phenomenological structure of borderline affective instability and discuss the implications it might have for how a person experiences and relates to other people. Considering core aspects of borderline affective instability, such as alexithymia, emotional contagion, emotion dysregulation, and chronic emptiness, I propose borderline can be interpreted as a disturbance of interaffective exchange, which gives rise to certain ways of experiencing others that imply a social impairment.
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Affiliation(s)
- Philipp Schmidt
- Department of Philosophy, Technical University Darmstadt, Darmstadt, Germany
- Department of Philosophy, Julius Maximilian University of Würzburg, Würzburg, Germany
- Phenomenological Psychopathology and Psychotherapy, Psychiatric Clinic, Heidelberg University, Heidelberg, Germany
- *Correspondence: Philipp Schmidt,
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Robin M, Belbèze J, Pham-Scottez A, Speranza M, Shadili G, Silva J, Corcos M. Adversity, attachment and emotion recognition in BPD adolescents: the distinct roles of disengaged and controlling environment. BMC Psychol 2022; 10:89. [PMID: 35379363 PMCID: PMC8981788 DOI: 10.1186/s40359-022-00788-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 03/17/2022] [Indexed: 11/20/2022] Open
Abstract
Background Literature data about emotion perception in patients with borderline personality disorders (BPD) revealed some discrepancies between some patients that are vigilant and accurate to detect their emotional environment and others that are impaired at identifying emotions of others. Even if some links between childhood adversity and facial affect recognition have been established, there is a need to understand the heterogeneous psychobiological mechanisms underlying this association. The aim is to distinguish in a BPD sample, the links between facial emotion recognition (FER) and adversity types (maltreatment and parental bonding), by evaluating two dimensions of disengaged and controlling environment.
Method The study includes BPD adolescents (n = 45) and healthy controls (HC, n = 44): two scores of disengaged environment (parental low care; emotional and physical neglect) and controlling environment (high level of parenting control; emotional, physical and sexual abuse) were established and correlated to FER, as well as to attachment dimensions. Multiple linear regression analyzes were conducted to evaluate the effect of disengaged and controlling dimensions, on FER scores of sensitivity and accuracy, including anxious and avoidant attachment as covariables. Results Analyzes revealed that a disengaged environment was positively correlated to sensitivity in BPD patients, and the correlation was negative in the HC group. Controlling environment was negatively associated to accuracy of emotion in BPD. Avoidant and anxious attachment did not influence these associations. Conclusions These results suggest that distinct adverse experiences account for the heterogeneity observed in emotion regulation in BPD patients.
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Affiliation(s)
- Marion Robin
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014, Paris, France. .,Paris Descartes University, Paris, France.
| | - Jean Belbèze
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014, Paris, France
| | | | - Mario Speranza
- Versailles General Hospital, Le Chesnay, France.,Paris-Saclay University, UVSQ, CESP, INSERM U1178, Team PsyDev, Gif-sur-Yvette, France
| | - Gérard Shadili
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014, Paris, France
| | - Jerôme Silva
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014, Paris, France
| | - Maurice Corcos
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014, Paris, France.,Paris Descartes University, Paris, France
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Fernando SC, Beblo T, Lamers A, Schlosser N, Woermann FG, Driessen M, Toepper M. Neural correlates of emotion acceptance and suppression in borderline personality disorder. Front Psychiatry 2022; 13:1066218. [PMID: 36704727 PMCID: PMC9871986 DOI: 10.3389/fpsyt.2022.1066218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/14/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Emotion dysregulation is a central feature of borderline personality disorder (BPD). Since impaired emotion regulation contributes to disturbed emotion functioning in BPD, it is crucial to study underlying neural activity. The current study aimed at investigating the neural correlates of two emotion regulation strategies, namely emotion acceptance and suppression, which are both important treatment targets in BPD. METHODS Twenty-one women with BPD and 23 female healthy control participants performed an emotion regulation task during functional magnetic resonance imaging (fMRI). While watching fearful movie clips, participants were instructed to either accept or to suppress upcoming emotions compared to passive viewing. RESULTS Results revealed acceptance-related insular underactivation and suppression-related caudate overactivation in subjects with BPD during the emotion regulation task. CONCLUSION This is a first study on the neural correlates of emotion acceptance and suppression in BPD. Altered insula functioning during emotion acceptance may reflect impairments in emotional awareness in BPD. Increased caudate activity is linked to habitual motor and cognitive processes and therefore may accord to the well-established routine in BPD patients to suppress emotional experiences.
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Affiliation(s)
- Silvia Carvalho Fernando
- Department of Psychiatry and Psychotherapy, Evangelisches Klinikum Bethel, University of Bielefeld, Bielefeld, Germany
| | - Thomas Beblo
- Department of Psychiatry and Psychotherapy, Evangelisches Klinikum Bethel, University of Bielefeld, Bielefeld, Germany
| | - Agnes Lamers
- Department of Psychiatry and Psychotherapy, Evangelisches Klinikum Bethel, University of Bielefeld, Bielefeld, Germany
| | - Nicole Schlosser
- Department of Psychiatry and Psychotherapy, Evangelisches Klinikum Bethel, University of Bielefeld, Bielefeld, Germany
| | - Friedrich G Woermann
- Epilepsy Center Bethel, Mara Hospital, University of Bielefeld, Bielefeld, Germany
| | - Martin Driessen
- Department of Psychiatry and Psychotherapy, Evangelisches Klinikum Bethel, University of Bielefeld, Bielefeld, Germany
| | - Max Toepper
- Department of Psychiatry and Psychotherapy, Evangelisches Klinikum Bethel, University of Bielefeld, Bielefeld, Germany
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Abdo MMM, Mohamed AS, Hammed MAE, Hashem RE, El Nagar ZM. Affective theory of the mind and suicide in women with borderline personality disorder and schizophrenia: a comparative study. MIDDLE EAST CURRENT PSYCHIATRY 2021. [DOI: 10.1186/s43045-021-00142-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Theory of mind (ToM) is one of the essential components of social cognition. Affective ToM enables us to interpret other’s feelings and behaviors. Borderline personality disorder (BPD) and schizophrenia are two distinct mental disorders, yet they have a mutual deficit in interpreting emotions, thoughts, and intentions which may lead to a higher incidence of suicidality. Studies that involved social cognition, particularly ToM in schizophrenia, or BPD have controversial results. Therefore, this study aimed at comparing affective ToM functioning in female patients with BPD, schizophrenia, and healthy controls. In addition, identifying the possible impact and any correlation exists between the affective ToM and liability for suicide in those patients. Sixty individuals were recruited from the Institute of Psychiatry, Ain Shams University, Cairo, Egypt, and assigned into 3 groups where group A involved 20 BPD patients, group B involved 20 schizophrenic patients, and group C were healthy persons as a control. Assessment of affective ToM was done using Reading the Mind in the Eyes Test (RMET), and probability of suicide was measured using Suicide Probability Scale (SPS).
Results
Regarding ToM, the three groups were assessed using RMET and the results revealed a significantly higher mean score (hypermentalization) in BPD patients than both schizophrenic patients and controls. While schizophrenic patients had significantly lower mean scores than the control group (hypomentalization). As well, BPD patients had a significantly higher suicide probability total score than Schizophrenic patients and in all subdomains except for the hostility subdomain that was significantly higher in schizophrenic patients. Interestingly, in BPD, the suicide probability total score was positively correlated with RMET.
Conclusions
BPD patients have enhanced affective ToM and hypermentalization that is significantly associated with increased suicide probability in those patients, while in schizophrenia, hypomentalization could not be linked to increased suicide probability. Rehabilitation and proper management of ToM abnormalities might be a crucial tool in suicide prevention in mental illnesses, particularly, BPD.
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12
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Bora E. A meta-analysis of theory of mind and 'mentalization' in borderline personality disorder: a true neuro-social-cognitive or meta-social-cognitive impairment? Psychol Med 2021; 51:2541-2551. [PMID: 34530941 DOI: 10.1017/s0033291721003718] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND It is widely accepted that borderline personality disorder (BPD) is associated with significant impairments in mentalization and theory of mind (ToM) which are considered as closely related concepts by many authors particularly in psychoanalytical circles. However, for understanding interpersonal difficulties in personality disorders, it is important to distinguish neuro-social cognitive impairment from the abnormal meta-social-cognitive style of patients. METHODS The current systematic review aimed to conduct separate meta-analyses of 'mentalization' [reflective functioning (RF] and different aspects of ToM in BPD. A literature search was conducted to locate relevant articles published between January 1990 to July 2021. Random-effect meta-analyses were conducted in 34 studies involving 1448 individuals with BPD and 2006 healthy controls. RESULTS A very large impairment in RF was evident in BPD [d = 1.68, confidence interval (CI) = 1.17-2.19]. In contrast, ToM impairment was modest (d = 0.36, CI = 0.24-0.48). BPD patients underperformed healthy controls in ToM-reasoning (d = 0.44, CI = 0.32-0.56) but not ToM-decoding. Increased HyperToM (d = 0.60, CI = 0.41-0.79) and faux pas recognition (d = 0.62, CI = 0.35-0.90) errors in BPD compared to healthy controls were most robust ToM findings in this meta-analysis. CONCLUSIONS BPD is characterized by very severe deficits in RF and modest and selective abnormalities in ToM. Interpersonal problems and difficulties in processing social information in BPD can be best explained by patients' maldaptive meta-social cognitive style and top-down effects of these abnormalities rather than having a primary neuro-social cognitive deficit.
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Affiliation(s)
- Emre Bora
- Department of Psychiatry, Dokuz Eylul University Medical School, Izmir35340, Turkey
- Department of Neurosciences, Insitiute of Health, Dokuz Eylul University, Izmir, Turkey
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria3053, Australia
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Hillmann K, Neukel C, Krauch M, Spohn A, Schnell K, Herpertz SC, Bertsch K. Cognitive and Affective Theory of Mind in Female Patients With Borderline Personality Disorder. J Pers Disord 2021; 35:672-690. [PMID: 33107807 DOI: 10.1521/pedi_2020_34_490] [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
Empirical studies have identified deficits in cognitive and affective theory of mind (ToM) in patients with borderline personality disorder (BPD), but results remain heterogeneous and not much is known about the role of childhood trauma. The current study assessed cognitive and affective ToM in 80 patients with BPD and 41 healthy controls in a false-belief cartoon task. Childhood trauma was measured with the Childhood Trauma Questionnaire (CTQ). Patients with BPD responded slower in all experimental conditions in false-belief situations, but not when false beliefs were resolved; made more errors in the cognitive ToM condition; and reported worse affective states more often in and after false-belief situations. No significant correlations between ToM and childhood trauma could be found. The current study revealed deficits in cognitive and affective ToM in patients with BPD that may be related to a more negative affective state raised by the false-belief stories.
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Affiliation(s)
- Karen Hillmann
- Department of General Psychiatry, Heidelberg University, Germany
| | - Corinne Neukel
- Department of General Psychiatry, Heidelberg University, Germany
| | - Marlene Krauch
- Department of General Psychiatry, Heidelberg University, Germany.,Central Institute of Mental Health, Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Angelika Spohn
- Central Institute of Mental Health, Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Knut Schnell
- Asklepios Center for Psychiatry and Psychotherapy Göttingen, Göttingen, Germany
| | | | - Katja Bertsch
- Department of General Psychiatry, Heidelberg University, Germany
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14
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Degasperi G, Cristea IA, Di Rosa E, Costa C, Gentili C. Parsing variability in borderline personality disorder: a meta-analysis of neuroimaging studies. Transl Psychiatry 2021; 11:314. [PMID: 34031363 PMCID: PMC8144551 DOI: 10.1038/s41398-021-01446-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/01/2021] [Accepted: 05/14/2021] [Indexed: 02/04/2023] Open
Abstract
Though a plethora of functional magnetic resonance imaging (fMRI) studies explored the neurobiological underpinnings of borderline personality disorder (BPD), findings across different tasks were divergent. We conducted a systematic review and activation likelihood estimation (ALE) meta-analysis on the fMRI studies conducted in BPD patients compared to healthy controls (HC). We systematically searched PubMed and PsychINFO from inception until July 9th 2020 using combinations of database-specific terms like 'fMRI', 'Neuroimaging', 'borderline'. Eligible studies employed task-based fMRI of the brain in participants of any age diagnosed with BPD compared to HC, during any behavioral task and providing a direct contrast between the groups. From 762 entries, we inspected 92 reports full-texts and included 52 studies (describing 54 experiments). Across all experiments, the HC > BPD and BPD > HC meta-analyses did not yield any cluster of significant convergence of differences. Analyses restricted to studies of emotion processing revealed two significant clusters of activation in the bilateral hippocampal/amygdala complex and anterior cingulate for the BPD > HC meta-analysis. Fail-safe N and single study sensitivity analysis suggested significant findings were not robust. For the subgroup of emotional processing experiments, on a restricted number of experiments providing results for each group separately, another meta-analysis method (difference of convergence) showed a significant cluster in the insula/inferior frontal gyrus for the HC > BPD contrast. No consistent pattern of alteration in brain activity for BPD was evidenced suggesting substantial heterogeneity of processes and populations studied. A pattern of amygdala dysfunction emerged across emotion processing tasks, indicating a potential pathophysiological mechanism that could be transdiagnostic.
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Affiliation(s)
- Giorgia Degasperi
- Department of General Psychology, University of Padova, Padova, Italy
| | - Ioana Alina Cristea
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- IRCCS Mondino Foundation, Pavia, Italy
| | - Elisa Di Rosa
- Department of General Psychology, University of Padova, Padova, Italy
| | - Cristiano Costa
- Department of General Psychology, University of Padova, Padova, Italy
| | - Claudio Gentili
- Department of General Psychology, University of Padova, Padova, Italy.
- Padova Neuroscience Center, University of Padova, Padova, Italy.
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15
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Hanegraaf L, van Baal S, Hohwy J, Verdejo-Garcia A. A systematic review and meta-analysis of 'Systems for Social Processes' in borderline personality and substance use disorders. Neurosci Biobehav Rev 2021; 127:572-592. [PMID: 33865874 DOI: 10.1016/j.neubiorev.2021.04.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 02/10/2021] [Accepted: 04/12/2021] [Indexed: 01/12/2023]
Abstract
Deficits in social processing (SP) have been proposed to underpin interpersonal dysfunction in both Borderline Personality Disorder (BPD) and Substance Use Disorders (SUD). This study aimed to explore potential transdiagnostic cognitive and behavioral phenotypes of these disorders utilizing the NIMH Research Domain Criteria 'Systems for Social Processes'. A systematic review and meta-analysis of the published research was conducted on 134 studies identified through our database searches. Four meta-analyses were conducted, which revealed significant overlapping deficits in the ability to identify facial emotions and infer the mental states of others in both BPD and SUD. Further, people with BPD displayed a higher ostracism effect following perceived social exclusion. Systematically reviewed studies also revealed significant dysfunction amongst individuals with BPD and SUD across both self and other SP constructs, which were broadly similar in magnitude. Taken together, these results support the proposition that SP dysfunction may be considered a core transdiagnostic phenotype of BPD and SUD.
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Affiliation(s)
- Lauren Hanegraaf
- Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia.
| | - Simon van Baal
- Cognition and Philosophy Lab, Philosophy Department, Monash University, Clayton, Australia
| | - Jakob Hohwy
- Cognition and Philosophy Lab, Philosophy Department, Monash University, Clayton, Australia
| | - Antonio Verdejo-Garcia
- Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
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16
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Cyrkot T, Szczepanowski R, Jankowiak-Siuda K, Gawęda Ł, Cichoń E. Mindreading and metacognition patterns in patients with borderline personality disorder: experimental study. Eur Arch Psychiatry Clin Neurosci 2021; 271:1159-1168. [PMID: 33459868 PMCID: PMC8354944 DOI: 10.1007/s00406-020-01227-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/18/2020] [Indexed: 11/30/2022]
Abstract
Current psychopathology attempts to understand personality disorders in relation to deficits in higher cognition such as mindreading and metacognition. Deficits in mindreading are usually related to limitations in or a complete lack of the capacity to understand and attribute mental states to others, while impairments in metacognition concern dysfunctional control and monitoring of one's own processes. The present study investigated dysfunctional higher cognition in the population of patients with borderline personality disorder (BPD) by analyzing the accuracy of metacognitive judgments in a mindreading task [reading the mind in the eyes Test (RMET)] and a subsequent metacognitive task based on self-report scales: a confidence rating scale (CR) versus a post-decision wagering scale (PDW). It turned out that people from the BPD group scored lower in the RMET. However, both groups had the same levels of confidence on the PDW scale when giving incorrect answers in the RMET test. As initially hypothesized, individuals with BPD overestimated their confidence in incorrect answers, regardless of the type of metacognitive scales used. The present findings indicate that BPD individuals show dysfunctional patterns between instances of mindreading and metacognition.
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Affiliation(s)
- Tomasz Cyrkot
- College of Psychological Sciences, Faculty of Education, University of Lower Silesia, Wroclaw, Poland
| | - Remigiusz Szczepanowski
- College of Psychological Sciences, Faculty of Education, University of Lower Silesia, Wroclaw, Poland.
| | - Kamila Jankowiak-Siuda
- Behavioral Neuroscience Lab, SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | - Łukasz Gawęda
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Ewelina Cichoń
- College of Psychological Sciences, Faculty of Education, University of Lower Silesia, Wroclaw, Poland ,WSB University in Toruń, Toruń, Poland
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17
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Vai B, Cazzetta S, Scalisi R, Donati A, Bechi M, Poletti S, Sforzini L, Visintini R, Maffei C, Benedetti F. Neuropsychological deficits correlate with symptoms severity and cortical thickness in Borderline Personality Disorder. J Affect Disord 2021; 278:181-188. [PMID: 32961414 DOI: 10.1016/j.jad.2020.09.060] [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] [Received: 04/07/2020] [Revised: 06/15/2020] [Accepted: 09/11/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Neuropsychological abnormalities have been proposed to contribute to the development and maintenance of Borderline Personality Disorder (BPD). Previous meta-analyses and reviews confirmed deficits in a broad range of cognitive domains, including attention, cognitive flexibility, memory, executive functions, planning, information processing, and visuospatial abilities, often suggested to underlie brain abnormalities. However, no study directly explored the structural neural correlates of these deficits in BPD, also accounting for the possible confounding effect of pharmacological treatments, often used as adjunctive symptom-targeted therapy in clinical setting. METHODS In this study we compared the performance of 24 BPD patients to 24 healthy controls obtained at the neuropsychological battery "Brief Assessment and Cognition in Schizophrenia", exploring the relationship between the cognitive impairments and current symptomatology, brain grey matter volumes and cortical thickness, controlling for medications load. RESULTS Data revealed deficits in verbal memory and fluency, working memory, attention and speed of information processing and psychomotor speed and coordination when medication load was not in the model. Correcting for this variable, only the impairment in psychomotor abilities remained significant. A multiple regression confirmed the effect of this neuropsychological domain on the severity of BPD symptomatology (Borderline Evaluation of Severity Over Time). In BPD, the performance at psychomotor speed and coordination was also directly associated to cortical thickness in postcentral gyrus. LIMITATIONS Relatively small sample size, especially for neuroimaging. CONCLUSIONS Our study highlighted an influence of BPD neuropsychological impairments on symptomatology, and cortical thickness, prompting the potential clinical utility of a cognitive remediation program in BPD.
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Affiliation(s)
- Benedetta Vai
- Division of Neuroscience, Psychiatry and Clinical Psychobiology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; Fondazione Centro San Raffaele, Milan, Italy.
| | - Silvia Cazzetta
- Division of Neuroscience, Psychiatry and Clinical Psychobiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Rosalia Scalisi
- Division of Neuroscience, Psychiatry and Clinical Psychobiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessia Donati
- Division of Neuroscience, Psychiatry and Clinical Psychobiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Margherita Bechi
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sara Poletti
- Division of Neuroscience, Psychiatry and Clinical Psychobiology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Laura Sforzini
- Division of Neuroscience, Psychiatry and Clinical Psychobiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Raffaele Visintini
- Division of Neuroscience, Clinical Psychology and Psychotherapy Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Milan, Italy
| | - Cesare Maffei
- Vita-Salute San Raffaele University, Milan, Italy; Division of Neuroscience, Clinical Psychology and Psychotherapy Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Milan, Italy
| | - Francesco Benedetti
- Division of Neuroscience, Psychiatry and Clinical Psychobiology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
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18
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Nahal P, Hurd PL, Read S, Crespi B. Cognitive Empathy as Imagination: Evidence From Reading the Mind in the Eyes in Autism and Schizotypy. Front Psychiatry 2021; 12:665721. [PMID: 33868063 PMCID: PMC8047060 DOI: 10.3389/fpsyt.2021.665721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/10/2021] [Indexed: 12/01/2022] Open
Abstract
How is cognitive empathy related to sociality, imagination, and other psychological constructs? How is it altered in disorders of human social cognition? We leveraged a large data set (1,168 students, 62% female) on the Reading the Mind in the Eyes test (RMET), the Autism Quotient (AQ), and the Schizotypal Personality Questionnaire (SPQ-BR) to test the hypotheses that the RMET, as a metric of cognitive empathy, reflects mainly social abilities, imagination, or both. RMET showed the expected female bias in performance, though only for eyes that expressed emotions and not for neutral expressions. RMET performance was significantly, and more strongly, associated with the AQ and SPQ subscales that reflect aspects of imagination (AQ-Imagination and SPQ-Magical Ideation) than aspects of social abilities (AQ-Social, AQ-Communication, and SPQ-Interpersonal subscales). These results were confirmed with multiple regression analysis, which also implicated increased attention (AQ-Attention Switching and, marginally non-significantly, AQ-Attention to Detail) in RMET performance. The two imagination-related correlates of RMET performance also show the strongest sex biases for the AQ and SPQ: male biased in AQ-Imagination, and female biased in SPQ-Magical Ideation, with small to medium effect sizes. Taken together, these findings suggest that cognitive empathy, as quantified by the RMET, centrally involves imagination, which is underdeveloped (with a male bias) on the autism spectrum and overdeveloped (with a female bias) on the schizotypy spectrum, with optimal emotion-recognition performance intermediate between the two. The results, in conjunction with previous studies, implicate a combination of optimal imagination and focused attention in enhanced RMET performance.
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Affiliation(s)
- Priya Nahal
- Department of Biological Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Peter L Hurd
- Centre for Neuroscience, Department of Psychology, University of Alberta, Edmonton, AB, Canada
| | - Silven Read
- Department of Biological Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Bernard Crespi
- Department of Biological Sciences, Simon Fraser University, Burnaby, BC, Canada
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19
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Bortolla R, Galli M, Ramella P, Sirtori F, Visintini R, Maffei C. Negative bias and reduced visual information processing of socio-emotional context in borderline Personality Disorder: A support for the hypersensitivity hypothesis. J Behav Ther Exp Psychiatry 2020; 69:101589. [PMID: 32502878 DOI: 10.1016/j.jbtep.2020.101589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 04/30/2020] [Accepted: 05/11/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Current studies on emotional dysregulation in BPD suggest that it might be manifested by altered appraisal and biased attentional mechanisms, rather than by hyperreactivity. The aim of this study was to acquire more evidence on this topic by testing the hypothesis that BPD patients are characterized by a negative evaluation bias and reduced visual exploration in response to socio-emotional content. Moreover, the association between the previous conceptualizations and typical dysfunctional processes in BPD were evaluated. METHODS Fifty-four socio-emotional pictures were administered to 20 female BPD patients and 20 healthy controls (HCs) divided into three blocks characterized by different stimulus durations (500 ms, 3s, 18s). Self-reported and eye-tracking data were collected during the experiment. RESULTS BPD patients showed lower valence ratings and reduced visual exploration of socio-emotional pictures compared to HCs. Visual exploration in BPD was affected by exposure time with reduced exploration in response to prolonged stimuli presentation. Dysfunctional features and pre-task negative affectivity level in BPD were correlated with self-reported evaluations and eye-tracking data. LIMITATIONS Possible effects of gender on emotional responsivity could not be addressed given the female composition of our sample. Moreover, the role of psychiatric symptoms and medications should be addressed in future research. CONCLUSIONS This study presented evidence on dysfunctional mechanisms sustaining emotional dysregulation in BPD. This construct seemed supported by a well-established negative bias towards emotional stimuli together with a reduced processing of social information as manifestations of emotional hypersensitivity.
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Affiliation(s)
- Roberta Bortolla
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Hospital, Milan, Italy.
| | - Marco Galli
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Hospital, Milan, Italy
| | - Pietro Ramella
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Hospital, Milan, Italy
| | - Federica Sirtori
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Hospital, Milan, Italy
| | - Raffaele Visintini
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Hospital, Milan, Italy
| | - Cesare Maffei
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Hospital, Milan, Italy
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20
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Signer S, Estermann Jansen R, Sachse R, Caspar F, Kramer U. Social interaction patterns, therapist responsiveness, and outcome in treatments for borderline personality disorder. Psychol Psychother 2020; 93:705-722. [PMID: 31583805 DOI: 10.1111/papt.12254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Inflexible social interaction patterns are defining features of borderline personality disorder (BPD). Specific beliefs about the self and others may be activated across interaction situations, often leading to instable relationships. It may be pivotal to address these difficulties in early treatment phases, through appropriate therapist responsiveness, which means an adaptation of therapist's activity to their client's behaviours using emerging information in the process (Stiles, 2009, Clinical Psychology: Science and Practice, 16, 86). DESIGN In this process-outcome study, responsiveness is operationalized by the motive-oriented therapeutic relationship (Caspar, 2007, Handbook of psychotherapeutic case formulations, 2nd ed., 251-289, Guilford), based on the Plan analysis case formulation. The present study assesses the interplay between social interaction problems and therapist responsiveness, explaining symptoms at discharge and the therapeutic alliance. METHOD In total, N = 50 clients with BPD entered the study, and standard and responsive treatments were compared. Social interaction patterns were assessed by the newly developed Borderline Interaction Patterns Scale (BIPS), applied to recorded material of three sessions per therapy. Outcome was measured by general symptoms (OQ-45), borderline symptoms (BSL-23), interpersonal problems (IIP), and the therapeutic alliance (WAI). RESULTS Results suggest that in standard treatment, social interaction patterns are neither related to outcome nor the therapeutic alliance. In responsive treatment, more activation of social interaction patterns predicted better outcome on IIP and lower therapist ratings of the alliance. CONCLUSIONS The conclusions seem promising for specific effectiveness of responsive treatments in particular in the interpersonal problem area of BPD. Identifying social interaction patterns early in treatment may be a crucial pathway to change for BPD. PRACTITIONER POINTS Responsive therapy activating social interaction patterns may be crucial for better outcome. Future research should focus on mechanisms of change in early treatment phases for BPD. New scale for assessing social interaction patterns specific to borderline personality disorder.
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Affiliation(s)
- Silja Signer
- Department of Clinical Psychology and Psychotherapy, University of Bern, Switzerland
| | | | - Rainer Sachse
- Institut für Psychologische Psychotherapie, Bochum, Germany
| | - Franz Caspar
- Department of Clinical Psychology and Psychotherapy, University of Bern, Switzerland
| | - Ueli Kramer
- Institute of Psychotherapy and General Psychiatry Service, Department of Psychiatry-CHUV, University of Lausanne, Lausanne, Switzerland.,Department of Psychology, University of Windsor, Ontario, Canada
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21
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Baltazar M, Geoffray MM, Chatham C, Bouvard M, Martinez Teruel A, Monnet D, Scheid I, Murzi E, Couffin-Cadiergues S, Umbricht D, Murtagh L, Delorme R, Ly Le-Moal M, Leboyer M, Amestoy A. "Reading the Mind in the Eyes" in Autistic Adults is Modulated by Valence and Difficulty: An InFoR Study. Autism Res 2020; 14:380-388. [PMID: 32929870 PMCID: PMC7891586 DOI: 10.1002/aur.2390] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/08/2020] [Accepted: 08/22/2020] [Indexed: 12/19/2022]
Abstract
Autism spectrum disorders (ASD) are heterogeneous and complex neurodevelopmental conditions that urgently need reliable and sensitive measures to inform diagnosis properly. The Reading the Mind in the Eyes Task (or Eyes Test from now on) is widely used for this purpose. A recent study showed that subcategories of items of the children version of the Eyes Test could be especially discriminative to distinguish ASD and control children. Here, we analyzed the performance on the Eyes Test of 30 high functioning (IQ > 70) adults with ASD and 29 controls from the InFoR cohort multicentric study, using a Generalized Linear Mixed Model. We found that valence and difficulty modulate the performance on the Eyes Test, with easy and positive items being the most discriminative to distinguish ASD and controls. In particular, we suggest this result might be actionable to discriminate ASD patients from controls in subgroups where their overall scores show less difference with controls. We propose for future research the computation of two additional indexes when using the Eyes Test: the first focusing on the easy and positive items (applying a threshold of 70% of correct responses for these items, above which people are at very low risk of having ASD) and the second focusing on the performance gain from difficult to easy items (with a progression of less than 15% showing high risk of having ASD). Our findings open the possibility for a major change in how the Eyes Test is used to inform diagnosis in ASD. Lay Summary The Eyes Test is used worldwide to inform autism spectrum disorders (ASD) diagnosis. We show here that ASD and neurotypical adults show the most difference in performance on subgroups of items: ASD adults do not improve as expected when comparing easy and difficult items, and they do not show an improvement for items displaying a positive feeling. We advise clinicians to focus on these comparisons to increase the property of the test to distinguish people with ASD from neurotypical adults.
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Affiliation(s)
- Matias Baltazar
- Centre d'Evaluation et Diagnostic de l'Autisme (CEDA), Centre Hospitalier Le Vinatier, Bron, France
| | - Marie-Maude Geoffray
- Centre d'Evaluation et Diagnostic de l'Autisme (CEDA), Centre Hospitalier Le Vinatier, Bron, France
| | | | - Manuel Bouvard
- Université de Bordeaux, Bordeaux, France.,Pôle Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre Hospitalier Charles-Perrens, Bordeaux, France.,Centre National Pour La Recherche Scientifique, INCIA UMR 5287, Bordeaux, France.,Fondation FondaMental, Créteil, France
| | - Axelle Martinez Teruel
- Fondation FondaMental, Créteil, France.,UNIACT, NeuroSpin, CEA, Université Paris-Saclay, Paris, France
| | - David Monnet
- Centre Hospitalier de Versailles CHV, Hôpital Mignot, Pôle de Psychiatrie Adulte et Infanto-Juvénile, Centre Expert TSAsdi, Le Chesnay, France
| | | | | | - Sandrine Couffin-Cadiergues
- INSERM, U955, Institut Mondor de Recherches Biomédicales, IMRB, Laboratoire de Neuro-Psychiatrie translationnelle, Créteil, France
| | - Daniel Umbricht
- Roche Innovation Center, F-Hoffmann La Roche Ldt, Basel, Switzerland
| | - Lorraine Murtagh
- Roche Innovation Center, F-Hoffmann La Roche Ldt, Basel, Switzerland
| | - Richard Delorme
- Fondation FondaMental, Créteil, France.,Institut Pasteur, Paris, France.,Psychiatry and Addictology Department, Université Paris Est Créteil, AP-HP, DMU ADAPT, Mondor University Hospital, Créteil, France
| | | | - Marion Leboyer
- Fondation FondaMental, Créteil, France.,INSERM, U955, Institut Mondor de Recherches Biomédicales, IMRB, Laboratoire de Neuro-Psychiatrie translationnelle, Créteil, France
| | - Anouck Amestoy
- Université de Bordeaux, Bordeaux, France.,Pôle Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre Hospitalier Charles-Perrens, Bordeaux, France.,Centre National Pour La Recherche Scientifique, INCIA UMR 5287, Bordeaux, France.,Fondation FondaMental, Créteil, France
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22
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Abstract
The purpose of this research was to determine the differences in empathy, alexithymia features, and theory of mind between healthy controls and patients with borderline personality disorder (BPD). Thirty-five patients with BPD and 35 healthy controls were included in the study. To measure the clinical variables, the Empathy Quotient (EQ), Reading the Mind in the Eyes Test (RMET), Toronto Alexithymia Scale (TAS-20), Barratt Impulsivity Scale-11 (BIS-11), and Beck Depression Inventory (BDI) were applied. We found that the BPD group had significantly worse total RMET and neutral RMET scores than the control group. There were no differences in the EQ scores between the BPD and control groups. The patients with BPD were more alexithymic than the controls, and alexithymia and depression scores predicted BPD status. Patients with BPD who have difficulty identifying their own emotions tend to display deficits in perceptions of facial emotions, which, in turn, may lead to misperceptions of social signals and thus contribute to excessive emotional intensity and tension in social situations. The study results reveal that alexithymia and depression are important variables in predicting BPD traits.
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23
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Penner F, McLaren V, Leavitt J, Akca OF, Sharp C. Implicit and Explicit Mentalizing Deficits in Adolescent Inpatients: Specificity and Incremental Value of Borderline Pathology. J Pers Disord 2020; 34:64-83. [PMID: 31887101 DOI: 10.1521/pedi_2019_33_463] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Research has demonstrated mentalizing impairment associated with borderline personality disorder (BPD) in adolescents. However, mentalizing performance in adolescents with BPD has never been compared to that of psychiatric control and healthy control adolescents simultaneously. The present study aimed to (a) compare implicit and explicit mentalizing, and hypermentalizing errors in implicit mentalizing, across youth with BPD and psychiatric and healthy controls, and (b) evaluate the association of borderline features with mentalizing deficits over and above internalizing and externalizing. Psychiatric inpatients with BPD (n = 139), inpatient psychiatric controls (n = 310), and healthy adolescents (n = 134) completed two mentalizing tasks, an interview assessing BPD, and measures of psychopathology. Results showed that BPD specificity could be demonstrated only for implicit mentalizing and hypermentalizing. Explicit mentalizing deficits did not differ between BPD and psychiatric control groups. Borderline features had unique associations to implicit mentalizing and hypermentalizing, over and above internalizing and externalizing.
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Affiliation(s)
| | | | - Jacob Leavitt
- Department of Psychology, University of Houston, Houston, Texas
| | - Omer Faruk Akca
- Department of Child and Adolescent Psychiatry, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Carla Sharp
- Department of Psychology, University of Houston, Houston, Texas.,Centre for Development Support, University of the Free State, Bloemfontein, South Africa
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24
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Németh N, Péterfalvi Á, Czéh B, Tényi T, Simon M. Examining the Relationship Between Executive Functions and Mentalizing Abilities of Patients With Borderline Personality Disorder. Front Psychol 2020; 11:1583. [PMID: 32760326 PMCID: PMC7372901 DOI: 10.3389/fpsyg.2020.01583] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 06/12/2020] [Indexed: 11/13/2022] Open
Abstract
Patients with borderline personality disorder (BPD) experience interpersonal dysfunctions; therefore, it is important to understand their social functioning and the confounding factors. We aimed to investigate the mentalizing abilities and executive functioning (EF) of BPD patients and healthy subjects and to determine the relative importance of BPD diagnosis and EF in predicting mentalizing abilities while controlling for general IQ and comorbid symptom severity. Self-oriented mentalizing (operationalized as emotional self-awareness/alexithymia), other-oriented mentalizing [defined as theory of mind (ToM)], and several EF domains were examined in 18 patients with BPD and 18 healthy individuals. Decoding and reasoning subprocesses of ToM were assessed by standard tasks (Reading the Mind in the Eyes Test and Faux Pas Test, respectively). Relative to controls, BPD patients exhibited significant impairments in emotional self-awareness and ToM reasoning; however, their ToM decoding did not differ. Multivariate regression analyses revealed that comorbid psychiatric symptoms were negative predictors of alexithymia and ToM decoding. Remarkably, the diagnosis of BPD was a positive predictor of ToM decoding but negatively influenced reasoning. Moreover, EF had no impact on alexithymia, while better IQ, and EF predicted superior ToM reasoning. Despite the small sample size, our results provide evidence that there is a dissociation between mental state decoding and reasoning in BPD. Comorbid psychiatric symptoms could be considered as significant negative confounds of self-awareness and ToM decoding in BPD patients. Conversely, the impairment of ToM reasoning was closely related to the diagnosis of BPD itself but not to the severity of the psychopathology.
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Affiliation(s)
- Nándor Németh
- Neurobiology of Stress Research Group, János Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Ágnes Péterfalvi
- Department of Laboratory Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Boldizsár Czéh
- Neurobiology of Stress Research Group, János Szentágothai Research Centre, University of Pécs, Pécs, Hungary.,Department of Laboratory Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Tamás Tényi
- Department of Psychiatry and Psychotherapy, Medical School, University of Pécs, Pécs, Hungary
| | - Maria Simon
- Neurobiology of Stress Research Group, János Szentágothai Research Centre, University of Pécs, Pécs, Hungary.,Department of Psychiatry and Psychotherapy, Medical School, University of Pécs, Pécs, Hungary
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25
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Abstract
After participating in this activity, learners should be better able to:• Assess differences between adult patients with the diagnosis of borderline personality disorder (BPD) and healthy control subjects in terms of empathy and related processes• Evaluate the effects of empathy or related processes as factors contributing to abnormal social functioning in BPD ABSTRACT: We reviewed 45 original research studies, published between 2000 and 2019, to assess differences between adult patients with the diagnosis of borderline personality disorder (BPD) and healthy control subjects in terms of empathy and related processes (i.e., theory of mind, mentalizing, social cognition, and emotional intelligence). Thirty-six studies reported deficits of empathy or related processes in patients with BPD. Enhanced emotional empathy in BPD was also reported in eight studies, all of which revealed that patients had increased scores of personal distress on the Interpersonal Reactivity Index self-report questionnaire. Six studies did not find significant differences between patients with BPD and healthy control subjects in terms of empathy or related processes. No study reported enhanced cognitive empathy, social cognition, or emotional intelligence in patients with BPD. We postulate that deficits of empathy or related processes contribute to preempting the formation of stable interpersonal relationships, whereas enhanced emotional empathy might lead to personal (and interpersonal) distress, further contributing to abnormal social functioning in BPD.
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26
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Carlyle D, Green R, Inder M, Porter R, Crowe M, Mulder R, Frampton C. A Randomized-Controlled Trial of Mentalization-Based Treatment Compared With Structured Case Management for Borderline Personality Disorder in a Mainstream Public Health Service. Front Psychiatry 2020; 11:561916. [PMID: 33262710 PMCID: PMC7688510 DOI: 10.3389/fpsyt.2020.561916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 10/20/2020] [Indexed: 12/04/2022] Open
Abstract
Background: Treatment of borderline personality disorder (BPD) in publicly funded mental health services generally use approaches based on medical interventions and generic case management. Specific psychological therapies developed for BPD may be more effective but have rarely been evaluated in routine clinical practice. Aim: To examine the effectiveness of Mentalization Based Treatment (MBT) in adults with an established diagnosis of BPD under the care of a publicly funded Mental Health Service (MHS), on rates of non-suicidal self-harm (NSSH) and attempted suicide (SA). Methods: A randomized, controlled trial (RCT) comparing 18 months of MBT with Enhanced Therapeutic Case Management (ETCM), a form of Structured Clinical Case Management (ICTRP: ACTRN12612000951853). Participants were adults recruited from a patient population under the care of a publicly funded mental health service (MHS) with a confirmed diagnosis of BPD. The primary outcome measures were the incidence of non-suicidal self-harm or suicide attempt over 18 months of treatment. Results: 72 participants (71 females, 1 male) were randomized to MBT (n = 38) or ETCM (n = 34). Both groups showed a significant reduction in the overall incident rate of SA and NSSH. Between groups, SA rates were higher in the MBT group and conversely NSSH rates were higher in the ECTM group. Conclusions: The introduction of a structured service that delivered a structured psychotherapy (MBT) and an effective case management approach (ETCM) both resulted in a reduction in SA and NSSH. The differences in improvements found between groups within this study setting will require further research.
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Affiliation(s)
- Dave Carlyle
- Department Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Robert Green
- Canterbury District Health Board, Mental Health Services, Christchurch, New Zealand
| | - Maree Inder
- Department Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard Porter
- Department Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Marie Crowe
- Department Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Roger Mulder
- Department Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Chris Frampton
- Department Psychological Medicine, University of Otago, Christchurch, New Zealand
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27
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Van Heel M, Luyten P, De Meulemeester C, Vanwalleghem D, Vermote R, Lowyck B. Mentalizing Based on External Features in Borderline Personality Disorder Compared With Healthy Controls: The Role of Attachment Dimensions and Childhood Trauma. J Pers Disord 2019; 33:736-750. [PMID: 30689514 DOI: 10.1521/pedi_2019_33_373] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Extant research suggests that borderline personality disorder (BPD) is associated with impairments in mentalizing, that is, comprehending behavior in terms of underlying mental states. However, the precise nature of these impairments remains unclear. The literature is mixed concerning mental-izing based on external features of others, and specifically facial emotion recognition (FER) in BPD patients. This study investigated FER differences in 79 BPD patients and 79 matched healthy controls using the Reading the Mind in the Eyes Test (RMET). The authors also investigated attachment dimensions and childhood trauma in relation to mentalizing based on external features. Results showed that BPD patients performed worse on positive and negative emotions. Furthermore, avoidant attachment was negatively related to FER for neutral emotions, particularly in the control group. Trauma was negatively related to FER at trend level, particularly in BPD patients. The implications for this understanding of mentalizing based on external features in BPD are discussed.
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Affiliation(s)
- Martijn Van Heel
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Patrick Luyten
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | | | | | - Rudi Vermote
- University Psychiatric Hospital UPC KU Leuven, Campus Kortenberg and Department of Neurosciences, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Benedicte Lowyck
- University Psychiatric Hospital UPC KU Leuven, Campus Kortenberg and Department of Neurosciences, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Research Department of Clinical, Educational and Health Psychology, University College London, UK
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28
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Building blocks of social cognition: Mirror, mentalize, share? Cortex 2019; 118:4-18. [DOI: 10.1016/j.cortex.2018.05.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 11/11/2017] [Accepted: 05/03/2018] [Indexed: 01/10/2023]
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29
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Koudys JW, Traynor JM, Rodrigo AH, Carcone D, Ruocco AC. The NIMH Research Domain Criteria (RDoC) Initiative and Its Implications for Research on Personality Disorder. Curr Psychiatry Rep 2019; 21:37. [PMID: 31030293 DOI: 10.1007/s11920-019-1023-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW We discuss the implications of the Research Domain Criteria (RDoC) initiative for neuroscience research on personality disorder (PD). To organize our review, we construct a preliminary conceptual mapping of PD symptom criteria onto RDoC constructs. We then highlight recent neuroscience research, often built around concepts that correspond to RDoC elements, and discuss the findings in reference to the constructs we consider most pertinent to PD. RECENT FINDINGS PD symptoms were strongly conceptually tied to RDoC constructs within the Social Processes domain, implicating brain systems involved in interpersonal rejection, facial emotion perception, and self-referential processes. Negative and Positive Valence Systems were conceptually associated with many PD symptoms, with particular relevance ascribed to the latter's Reward Valuation construct, which could reflect a more widespread disruption of computational processes involved in estimating the probability and benefits of a future outcome. Within the Cognitive Systems domain, the Cognitive Control construct mainly related to PD symptoms associated with impulse control, suggesting a connection to neural circuits that underlie goal selection and behavioral control. Arousal and Regulatory Systems could only be conceptually mapped onto PD symptoms through the Arousal construct, with different symptoms reflecting either a higher or lower biological sensitivity to internal and external stimuli. The RDoC framework has promise to advance neuroscience research on PD. The Social Processes domain is especially relevant to PD, although constructs falling within the other RDoC domains could also yield important insights into the neurobiology of PD and its connections with other forms of psychopathology. Identifying RDoC constructs (e.g., habit formation) that subserve more fundamental processes relevant to personality functioning warrants further investigation.
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Affiliation(s)
- Jacob W Koudys
- Department of Psychology, University of Toronto Scarborough, Toronto, M1C 1A4, Canada
- Department of Psychological Clinical Science, University of Toronto, Toronto, Canada
| | - Jenna M Traynor
- Department of Psychology, University of Toronto Scarborough, Toronto, M1C 1A4, Canada
| | - Achala H Rodrigo
- Department of Psychology, University of Toronto Scarborough, Toronto, M1C 1A4, Canada
- Department of Psychological Clinical Science, University of Toronto, Toronto, Canada
| | - Dean Carcone
- Department of Psychology, University of Toronto Scarborough, Toronto, M1C 1A4, Canada
- Department of Psychological Clinical Science, University of Toronto, Toronto, Canada
| | - Anthony C Ruocco
- Department of Psychology, University of Toronto Scarborough, Toronto, M1C 1A4, Canada.
- Department of Psychological Clinical Science, University of Toronto, Toronto, Canada.
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30
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Quek J, Melvin GA, Bennett C, Gordon MS, Saeedi N, Newman LK. Mentalization in Adolescents With Borderline Personality Disorder: A Comparison With Healthy Controls. J Pers Disord 2019; 33:145-163. [PMID: 29469664 DOI: 10.1521/pedi_2018_32_336] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Mentalization is proposed to underlie the disturbed interpersonal relatedness that is a hallmark of borderline personality disorder (BPD). Despite growing evidence of BPD in adolescents, studies examining mentalization in relation to adolescent BPD have remained limited. Given contradictory findings of this relationship, particularly with adults, further research of mentalization in adolescents with BPD is warranted. The current study further clarifies the nature of mentalizing impairments, related to BPD, by examining different aspects of mentalization between adolescents with BPD (n = 26) and a group of healthy controls (n = 25). Findings support studies that suggest that mentalization may be an important treatment target, influencing BPD symptoms and interpersonal functioning in adolescents with BPD. They also support the importance of examining mentalizing abilities in relation to varying levels of complexity, interpersonal contexts, and levels of arousal. Limitations and further research are discussed.
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Affiliation(s)
- Jeremy Quek
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Australia
| | - Glenn A Melvin
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Australia
| | - Clair Bennett
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Australia
| | - Michael S Gordon
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Australia.,Early in Life Mental Health Service, Monash Health, Australia
| | - Naysun Saeedi
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Australia.,Early in Life Mental Health Service, Monash Health, Australia
| | - Louise K Newman
- Department of Psychiatry, University of Melbourne, Australia
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31
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Colle L, Gabbatore I, Riberi E, Borroz E, Bosco FM, Keller R. Mindreading abilities and borderline personality disorder: A comprehensive assessment using the Theory of Mind Assessment Scale. Psychiatry Res 2019; 272:609-617. [PMID: 30616131 DOI: 10.1016/j.psychres.2018.12.102] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 12/18/2018] [Accepted: 12/18/2018] [Indexed: 01/25/2023]
Abstract
Numerous studies have examined mindreading in borderline personality disorder (BPD). However, the empirical data obtained to date have not facilitated the development of a clear clinical profile of mindreading impairment in BPD due to a lack of consistency or incongruence across studies. One possible explanation for these inconsistencies and divergences in the current literature may lie in the multidimensional character of the mindreading construct; moreover, the heterogeneity of the experimental measures used to assess individuals with BPD mindreading skills may also need to be taken into account. The aim of the present study is to investigate mindreading skills and impairments in patients with BPD through direct comparison of a wide range of mindreading dimensions using a comprehensive semistructured interview, the Theory of Mind Assessment Scale (Th.o.m.a.s.) (Bosco et al., 2009). Our results show that the performance of patients with BPD differs from that of healthy controls only in certain specific dimensions of mindreading. The difficulties encountered by the patients with BPD typically emerge when mindreading tasks require them to disentangle their own subjective mindreading from that of another person, in other words, when they were required to assume an allocentric perspective.
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Affiliation(s)
- L Colle
- Department of Psychology, University of Turin, Italy; Neuroscience Institute of Turin, Italy
| | - I Gabbatore
- Department of Psychology, University of Turin, Italy; Child Language Research Center, University of Oulu, Finland.
| | - E Riberi
- Local Health Unit ASL City of Turin, Department of Mental Health, Turin, Italy
| | - E Borroz
- Local Health Unit ASL City of Turin, Department of Mental Health, Turin, Italy
| | - F M Bosco
- Department of Psychology, University of Turin, Italy; Neuroscience Institute of Turin, Italy
| | - R Keller
- Local Health Unit ASL City of Turin, Department of Mental Health, Turin, Italy
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32
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Bortolla R, Cavicchioli M, Galli M, Verschure PFMJ, Maffei C. A comprehensive evaluation of emotional responsiveness in borderline personality disorder: a support for hypersensitivity hypothesis. Borderline Personal Disord Emot Dysregul 2019; 6:8. [PMID: 31110772 PMCID: PMC6509832 DOI: 10.1186/s40479-019-0105-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 04/02/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Many experimental studies have evaluated Linehan's biological emotional vulnerability in Borderline Personality Disorder (BPD). However, some inconsistencies were observed in operationalizing and supporting its components. This study aims at clarifying which aspects of Linehan's model are altered in BPD, considering a multimodal evaluation of processes concerned with emotional responsiveness (self-report, psychophysiology and eye-tracking). METHODS Forty-eight socio-emotional pictures were administered to 28 participants (14 BPD, 14 Healthy Controls, HCs), gender- and age-matched, by employing two different lengths of stimuli exposure (5 s and 15 s). RESULTS Our results supported the hypersensitivity hypothesis in terms of faster physiological responses and altered visual processing. Furthermore, hypersensitivity was associated with detailed socio-emotional contents. Hyperreactivity assumption was not experimentally sustained by physiological and self-report data. Ultimately, the slow return to emotional baseline was demonstrated as an impaired emotional modulation. CONCLUSIONS Our data alternatively supported the hypersensitivity and the slow return to emotional baseline hypotheses, postulated by Linehan's Biosocial model, rather than the hyperreactivity assumption. Results have been discussed in light of other BPD core psychopathological processes.
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Affiliation(s)
- Roberta Bortolla
- 1Vita-Salute San Raffaele University, via Stamira d'Ancona, 20, Milan, Italy.,2Clinical Psychology and Psychotherapy Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Marco Cavicchioli
- 1Vita-Salute San Raffaele University, via Stamira d'Ancona, 20, Milan, Italy.,2Clinical Psychology and Psychotherapy Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Marco Galli
- 1Vita-Salute San Raffaele University, via Stamira d'Ancona, 20, Milan, Italy.,2Clinical Psychology and Psychotherapy Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Paul F M J Verschure
- 3Laboratory of Synthetic Perceptive, Emotive and Cognitive Systems, Institute for Bioengineering of Catalonia (IBEC), Barcelona Institute of Science and Technology, Barcelona, Spain.,4ICREA, Institucio Catalana de Recerca IEstudis Avançats, Passeig Lluis Companys, Barcelona, Spain
| | - Cesare Maffei
- 1Vita-Salute San Raffaele University, via Stamira d'Ancona, 20, Milan, Italy.,2Clinical Psychology and Psychotherapy Unit, IRCCS San Raffaele Hospital, Milan, Italy
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33
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Duque-Alarcón X, Alcalá-Lozano R, González-Olvera JJ, Garza-Villarreal EA, Pellicer F. Effects of Childhood Maltreatment on Social Cognition and Brain Functional Connectivity in Borderline Personality Disorder Patients. Front Psychiatry 2019; 10:156. [PMID: 30988667 PMCID: PMC6452291 DOI: 10.3389/fpsyt.2019.00156] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 03/04/2019] [Indexed: 01/09/2023] Open
Abstract
Borderline personality disorder (BPD) is a chronic condition characterized by high levels of impulsivity, affective instability, and difficulty to establish and manage interpersonal relationships. However, little is known about its etiology and neurobiological substrates. In our study, we wanted to investigate the influence of child abuse in the psychopathology of BPD by means of social cognitive paradigms [the Movie for the Assessment of Social Cognition (MASC) and the reading the mind in the eyes test (RMET)], and resting state functional magnetic resonance imaging (rs-fMRI). For this, we recruited 33 participants, 18 BPD patients, and 15 controls. High levels of self-reported childhood maltreatment were reported by BPD patients. For the sexual abuse subdimension, there were no differences between the BPD and the control groups, but there was a negative correlation between MASC scores and total childhood maltreatment levels, as well as between physical abuse, physical negligence, and MASC. Both groups showed that the higher the level of childhood maltreatment, the lower the performance on the MASC social cognitive test. Further, in the BPD group, there was hypoconnectivity between the structures responsible for emotion regulation and social cognitive responses that have been described as part of the frontolimbic circuitry (i.e., amygdala). Differential levels of connectivity, associated with different types and levels of abuse were also observed.
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Affiliation(s)
- Xochitl Duque-Alarcón
- Clínica de Especialidades de Neuropsiquiatría, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico City, Mexico
| | - Ruth Alcalá-Lozano
- Departamento de Investigación Clínica, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Jorge J González-Olvera
- Departamento de Investigación Clínica, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Eduardo A Garza-Villarreal
- Departamento de Investigación Clínica, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico.,MIND Lab, Center of Functionally Integrative Neuroscience, University of Aarhus, Aarhus, Denmark
| | - Francisco Pellicer
- Laboratorio de Neurofisiología Integrativa, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
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34
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Fertuck EA, Grinband J, Mann JJ, Hirsch J, Ochsner K, Pilkonis P, Erbe J, Stanley B. Trustworthiness appraisal deficits in borderline personality disorder are associated with prefrontal cortex, not amygdala, impairment. Neuroimage Clin 2018; 21:101616. [PMID: 30639176 PMCID: PMC6411618 DOI: 10.1016/j.nicl.2018.101616] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 11/05/2018] [Accepted: 11/25/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Borderline Personality Disorder (BPD) is associated with sensitivity to signals of interpersonal threats and misplaced trust in others. The amygdala, an integral part of the threat evaluation and response network, responds to both fear- and trust-related stimuli in non-clinical samples, and is more sensitive to emotional stimuli in BPD compared to controls. However, it is unknown whether the amygdalar response can account for deficits of trust and elevated sensitivity to interpersonal threat in BPD. METHODS Facial stimuli were presented to 16 medication-free women with BPD and 17 demographically-matched healthy controls (total n = 33). Participants appraised fearfulness or trustworthiness of the stimuli while BOLD fMRI was obtained. RESULTS Though BPD participants judged stimuli as less trustworthy compared to controls, trustworthiness did not correlate with amygdalar activity in either group. Trustworthiness correlated with prefrontal regional activity in the insula and lateral prefrontal cortex. Prefrontal BOLD activity while appraising trustworthiness was smaller in BPD compared to controls, and the size of the reduction was proportional to each participant's response bias. CONCLUSIONS Neural substrates of trustworthiness appraisal are associated with the lateral prefrontal cortex and insula, not amygdala, suggesting that untrustworthy stimuli do not elicit a subcortical threat response. Current models of BPD and its treatment may need to include a focus on improving impairments in frontally mediated trustworthiness appraisal in addition to amygdala- driven emotional hyper-reactivity.
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Affiliation(s)
- Eric A Fertuck
- The City College of the City University of New York, Department of Psychology, NY, USA; Department of Psychiatry, Columbia University, New York, USA; New York State Psychiatric Institute, New York, NY, USA.
| | - Jack Grinband
- Department of Psychiatry, Columbia University, New York, USA; New York State Psychiatric Institute, New York, NY, USA; Department of Radiology, Columbia University, New York, NY, USA.
| | - J John Mann
- Department of Psychiatry, Columbia University, New York, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Joy Hirsch
- Department of Radiology, Columbia University, New York, NY, USA; Department of Psychiatry and of Neurobiology, Yale School of Medicine, CT, USA
| | - Kevin Ochsner
- Department of Psychology, Columbia University, New York, NY, USA
| | - Paul Pilkonis
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jeff Erbe
- The City College of the City University of New York, Department of Psychology, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Barbara Stanley
- Department of Psychiatry, Columbia University, New York, USA; New York State Psychiatric Institute, New York, NY, USA
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35
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Németh N, Mátrai P, Hegyi P, Czéh B, Czopf L, Hussain A, Pammer J, Szabó I, Solymár M, Kiss L, Hartmann P, Szilágyi ÁL, Kiss Z, Simon M. Theory of mind disturbances in borderline personality disorder: A meta-analysis. Psychiatry Res 2018; 270:143-153. [PMID: 30248485 DOI: 10.1016/j.psychres.2018.08.049] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 07/30/2018] [Accepted: 08/13/2018] [Indexed: 02/07/2023]
Abstract
Impairments of theory of mind (ToM) are widely accepted underlying factors of disturbed relatedness in borderline personality disorder (BPD). The aim of this meta-analysis a was to assess the weighted mean effect sizes of ToM performances in BPD compared to healthy controls (HC), and to investigate the effect of demographic variables and comorbidities on the variability of effect sizes across the studies. Seventeen studies involving 585 BPD patients and 501 HC were selected after literature search. Effect sizes for overall ToM, mental state decoding and reasoning, cognitive and affective ToM, and for task types were calculated. BPD patients significantly underperformed HC in overall ToM, mental state reasoning, and cognitive ToM, but had no deficits in mental state decoding. Affective ToM performance was largely task dependent in BPD. Comorbid anxiety disorders had a positive moderating effect on overall and affective ToM in BPD. Our results support the notion that BPD patients' have specific ToM impairments. Further research is necessary to evaluate the role of confounding factors, especially those of clinical comorbidities, neurocognitive functions, and adverse childhood life events. Complex ToM tasks with high contextual demands seem to be the most appropriate tests to assess ToM in patients with BPD.
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Affiliation(s)
- Nándor Németh
- Neurobiology of Stress Research Group, Szentágothai János Research Centre, University of Pécs, Pécs, Hungary
| | - Péter Mátrai
- Institute of Bioanalysis, University of Pécs, Medical School, Pécs, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine and 1st Department of Medicine, University of Pécs, Medical School, Pécs, Hungary; Momentum Translational Gastroenterology Research Group, Hungarian Academy of Sciences University of Szeged, Szeged, Hungary
| | - Boldizsár Czéh
- Neurobiology of Stress Research Group, Szentágothai János Research Centre, University of Pécs, Pécs, Hungary; Department of Laboratory Medicine, University of Pécs, Medical School, Pécs, Hungary
| | - László Czopf
- Department of Cardiology, 1st Department of Medicine, University of Pécs, Medical School, Pécs, Hungary
| | - Alizadeh Hussain
- Department of Haematology, 1st Department of Medicine, University of Pécs, Medical School, Pécs, Hungary
| | - Judith Pammer
- Department of Haematology, 1st Department of Medicine, University of Pécs, Medical School, Pécs, Hungary
| | - Imre Szabó
- Department of Gastroenterology, 1st Department of Medicine, University of Pécs, Medical School, Pécs, Hungary
| | - Margit Solymár
- Institute for Translational Medicine, University of Pécs, Medical School, Pécs, Hungary
| | - Loránt Kiss
- Department of Pathophysiology, University of Szeged, Medical School, Szeged, Hungary
| | - Petra Hartmann
- Institute of Surgical Research, University of Szeged, Hungary
| | | | - Zoltán Kiss
- 1st Department of Paediatrics, Semmelweis University, Budapest, Hungary
| | - Maria Simon
- Neurobiology of Stress Research Group, Szentágothai János Research Centre, University of Pécs, Pécs, Hungary; Department of Psychiatry and Psychotherapy, University of Pécs, Medical School, Pécs, Hungary.
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36
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Stanley B, Perez-Rodriguez MM, Labouliere C, Roose S. A Neuroscience-Oriented Research Approach to Borderline Personality Disorder. J Pers Disord 2018; 32:784-822. [PMID: 29469663 DOI: 10.1521/pedi_2017_31_326] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Traditionally, the study of personality disorders had been based on psychoanalytic or behavioral models. Over the past two decades, there has been an emerging neuroscience model of borderline personality disorder (BPD) grounded in the concept of BPD as a condition in which dysfunctional neural circuits underlie its pathological dimensions, some of which include emotion dysregulation (broadly encompassing affective instability, negative affectivity, and hyperarousal), abnormal interpersonal functioning, and impulsive aggression. This article, initiated at a joint Columbia University- Cornell University Think Tank on BPD with representation from the Icahn School of Medicine at Mount Sinai, suggests how to advance research in BPD by studying the dimensions that underlie BPD in addition to studying the disorder as a unitary diagnostic entity. We suggest that linking the underlying neurobiological abnormalities to behavioral symptoms of the disorder can inform a research agenda to better understand BPD with its multiple presentations.
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Affiliation(s)
- Barbara Stanley
- Department of Psychiatry, Columbia University, New York City
| | | | | | - Steven Roose
- Department of Psychiatry, Columbia University, New York City.,New York State Psychiatric Institute, New York City
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37
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Schulze L, Schulze A, Renneberg B, Schmahl C, Niedtfeld I. Neural Correlates of Affective Disturbances: A Comparative Meta-analysis of Negative Affect Processing in Borderline Personality Disorder, Major Depressive Disorder, and Posttraumatic Stress Disorder. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2018; 4:220-232. [PMID: 30581154 DOI: 10.1016/j.bpsc.2018.11.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/17/2018] [Accepted: 11/09/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Borderline personality disorder (BPD), major depressive disorder (MDD), and posttraumatic stress disorder (PTSD) are prominent examples of mental disorders with affective disturbances. Notably, all three disorders share a generally heightened negative affect, which is presumably the result of shared neural abnormalities in affective processing. In this meta-analysis, we aimed to identify transdiagnostic and disorder-specific abnormalities during the processing of negative compared with neutral stimuli. METHODS We synthesized neuroimaging findings of affect processing in BPD, MDD, and PTSD and calculated combined coordinate- and image-based meta-analyses. The analysis comprised 70 distinct study samples with a total of 31 unthresholded statistical parametric maps. Twenty-four studies had a focus on BPD (431 individuals with BPD, 436 healthy control subjects [HCs]), 32 studies on MDD (789 individuals with current MDD, 870 HCs), and 14 studies on PTSD (247 individuals with PTSD, 245 HCs). RESULTS Findings showed limbic hyperactivations in BPD and PTSD compared with limbic activation of HCs. In contrast, patients with MDD showed blunted amygdala activation in comparison with that of HCs. Additionally, the calculation of overlapping brain abnormalities in BPD, MDD, and PTSD highlighted transdiagnostic hyperactivation of the right median cingulate gyri and hypoactivation of the right middle frontal gyrus and the right middle occipital gyrus. Finally, disorder-specific comparisons also illustrate unique abnormalities for each mental disorder. CONCLUSIONS The present results support shared and disorder-specific neural abnormalities in patients with affective disturbances.
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Affiliation(s)
- Lars Schulze
- Department of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany.
| | - Andreas Schulze
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany
| | - Babette Renneberg
- Department of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany
| | - Inga Niedtfeld
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany
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38
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Uscinska M, Bellino S. Treatment-induced brain plasticity in borderline personality disorder: review of functional MRI studies. FUTURE NEUROLOGY 2018. [DOI: 10.2217/fnl-2018-0006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Although neural substrates of symptoms expression in borderline personality disorder (BPD) have been studied extensively, neural mechanisms mediating post treatment amelioration of symptoms remain poorly characterized. Herein present review sheds a critical light on all here-to-date functional MRI findings of brain changes in BPD patients following a treatment with psychotherapy or drugs. Preliminary evidence points to downregulation of neuronal activity within the insula and amygdala, together with differential employment of prefrontal areas, mainly orbitofrontal cortex, anterior cingulate cortex and dorsolateral prefrontal cortex, as well as enhanced functional connectivity between limbic and prefrontal regions induced by dialectical behavioral therapy. Identifying neural circuits behind treatment processes may refine strategies to target specific symptoms, thereby resolving some of the controversies over BPD treatment.
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Affiliation(s)
- Maria Uscinska
- Department of Neurosciences, Centre for Personality Disorders, University of Turin, Via Cherasco 11, 10126, Turin, Italy
| | - Silvio Bellino
- Department of Neurosciences, Centre for Personality Disorders, University of Turin, Via Cherasco 11, 10126, Turin, Italy
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39
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Cucchi A, Hampton JA, Moulton-Perkins A. Using the validated Reflective Functioning Questionnaire to investigate mentalizing in individuals presenting with eating disorders with and without self-harm. PeerJ 2018; 6:e5756. [PMID: 30397541 PMCID: PMC6211265 DOI: 10.7717/peerj.5756] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 09/14/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The present study builds on previous research which explored the relationship between mentalizing and eating disorders (ED) in a subgroup of patients with comorbid self-harm (SH). Whereas previous literature had linked this comorbidity to impulse-control difficulties, more recent advances have suggested that a lack of a mentalizing stance might be responsible for a more treatment-resistant and severe symptomatology in this subgroup of clients. METHODS A cross-sectional, quasi-experimental, questionnaire-based, between-groups design was employed and a measure of mentalizing was compared in individuals presenting with ED only, individuals presenting with ED and concurrent SH and a control group. RESULTS Individuals with ED with concurrent SH reported significantly more mentalizing ability impairment than individuals without concurrent SH. In addition, both groups differed significantly from the control group. Opposite scoring patterns were identified in hypo- and hypermentalizing with the comorbid group reporting the lowest scores in hypermentalizing and the highest scores in hypomentalizing. CONCLUSIONS The current findings confirm that individuals with concurrent ED and SH report more severe impairments in mentalizing ability. Such impairments entail difficulties in symbolic capacity and abstract thinking and a concretisation of inner life, exemplified by a rigid, often inflexible focus on the physical world. The clinical implications that a lack of a mentalizing stance can have on individuals' ability to engage with the therapeutic process and to initiate change are reflected upon.
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Affiliation(s)
- Angie Cucchi
- Department of Psychology, City, University of London, London, England, United Kingdom
| | - James A. Hampton
- Department of Psychology, City, University of London, London, England, United Kingdom
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40
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Shaw DJ, Czekóová K, Pennington CR, Qureshi AW, Špiláková B, Salazar M, Brázdil M, Urbánek T. You ≠ me: individual differences in the structure of social cognition. PSYCHOLOGICAL RESEARCH 2018; 84:1139-1156. [PMID: 30324265 PMCID: PMC7239802 DOI: 10.1007/s00426-018-1107-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 10/04/2018] [Indexed: 01/19/2023]
Abstract
This study investigated the structure of social cognition, and how it is influenced by personality; specifically, how various socio-cognitive capabilities, and the pattern of inter-relationships and co-dependencies among them differ between divergent personality styles. To measure social cognition, a large non-clinical sample (n = 290) undertook an extensive battery of self-report and performance-based measures of visual perspective taking, imitative tendencies, affective empathy, interoceptive accuracy, emotion regulation, and state affectivity. These same individuals then completed the Personality Styles and Disorders Inventory. Latent Profile Analysis revealed two dissociable personality profiles that exhibited contrasting cognitive and affective dispositions, and multivariate analyses indicated further that these profiles differed on measures of social cognition; individuals characterised by a flexible and adaptive personality profile expressed higher action orientation (emotion regulation) compared to those showing more inflexible tendencies, along with better visual perspective taking, superior interoceptive accuracy, less imitative tendencies, and lower personal distress and negativity. These characteristics point towards more efficient self-other distinction, and to higher cognitive control more generally. Moreover, low-level cognitive mechanisms served to mediate other higher level socio-emotional capabilities. Together, these findings elucidate the cognitive and affective underpinnings of individual differences in social behaviour, providing a data-driven model that should guide future research in this area.
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Affiliation(s)
- D J Shaw
- Behavioural and Social Neuroscience Research Group, CEITEC - Central European Institute of Technology, Masaryk University, Kamenice 5, 62500, Brno, Czech Republic. .,Department of Psychology, School of Life and Health Sciences, Aston University, Birmingham, B4 7ET, UK.
| | - K Czekóová
- Behavioural and Social Neuroscience Research Group, CEITEC - Central European Institute of Technology, Masaryk University, Kamenice 5, 62500, Brno, Czech Republic.,Institute of Psychology, Academy of Sciences of the Czech Republic, Veveří 97, 60200, Brno, Czech Republic
| | - C R Pennington
- Department of Health and Social Sciences, Faculty of Health and Applied Sciences, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY, UK
| | - A W Qureshi
- Department of Psychology, Edge Hill University, St Helens Road, Ormskirk, Lancashire, L39 4QP, UK
| | - B Špiláková
- Behavioural and Social Neuroscience Research Group, CEITEC - Central European Institute of Technology, Masaryk University, Kamenice 5, 62500, Brno, Czech Republic
| | - M Salazar
- Behavioural and Social Neuroscience Research Group, CEITEC - Central European Institute of Technology, Masaryk University, Kamenice 5, 62500, Brno, Czech Republic
| | - M Brázdil
- Behavioural and Social Neuroscience Research Group, CEITEC - Central European Institute of Technology, Masaryk University, Kamenice 5, 62500, Brno, Czech Republic
| | - T Urbánek
- Institute of Psychology, Academy of Sciences of the Czech Republic, Veveří 97, 60200, Brno, Czech Republic
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41
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Sato M, Fonagy P, Luyten P. Effects of Social Exclusion on Effortful Control and Mentalizing in relation to Borderline Personality Features. Sci Rep 2018; 8:14400. [PMID: 30258202 PMCID: PMC6158252 DOI: 10.1038/s41598-018-32775-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 08/31/2018] [Indexed: 11/17/2022] Open
Abstract
The current study investigated the effects of social interactions on effortful control (EC) and mentalizing in individuals with borderline personality disorder (BPD) features. 123 nonclinical participants completed the emotional Stroop task to assess EC and the modified Reading the Mind in the Eyes Test (RMET) to assess mentalizing capacities before and after having social interactions. The Cyberball paradigm was used to generate socially inclusive and exclusive interactions. Results indicated the high BPD group made more errors on the Stroop task following exclusive social interactions than the low BPD group. The high BPD group, compared to the low BPD group, associated fewer emotional words with facial cues following inclusive social interactions but overanalysed facial cues (hypermentalizing) following the exclusive social interaction. Exclusive social interactions hindered the inhibitory capacities in individuals with high BPD features, but inclusive social interactions facilitated. Individuals with high BPD features responded to exclusive social interactions by hypermentalizing. Thus, it was found social rejection could activate cognitive-affective processes which led to hypermentalizing and impairments in EC which in combination could explain the disruptive effects on social interactions in people with BPD features.
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Affiliation(s)
- Momoko Sato
- Department of Clinical, Educational, and Health Psychology, University College London, London, UK.
| | - Peter Fonagy
- Department of Clinical, Educational, and Health Psychology, University College London, London, UK
| | - Patrick Luyten
- Department of Clinical, Educational, and Health Psychology, University College London, London, UK.,Faculty of Psychology and Educational Sciences, KU Leuven, Belgium
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Armenti NA, Babcock JC. Psychophysiological Reactivity Profiles of Partner-Violent Men With Borderline or Psychopathic Personality Features: The Role of Empathy. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2018; 62:3337-3354. [PMID: 29117769 DOI: 10.1177/0306624x17740029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Borderline and psychopathic features have been linked to unique psychophysiological reactivity profiles. Studies have suggested that levels of psychophysiological reactivity for partner-violent men cannot be attributed to personality features alone. This study tested cognitive and affective empathy as moderators of relations between borderline personality, Factor 1 psychopathy, and psychophysiological reactivity using a community sample of 135 male participants and their female partners. Cognitive empathy moderated the relation between borderline personality features and heart rate reactivity. Affective empathy moderated the relation between Factor 1 psychopathy features and heart rate reactivity. However, directions of these interactions were contrary to original predictions. Understanding unique empathy deficits may be beneficial for identifying ways to minimize relationship conflict, manage arousal, and decrease violence.
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43
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da Costa HP, Vrabel JK, Zeigler-Hill V, Vonk J. DSM-5 pathological personality traits are associated with the ability to understand the emotional states of others. JOURNAL OF RESEARCH IN PERSONALITY 2018. [DOI: 10.1016/j.jrp.2018.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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44
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Redondo I, Herrero-Fernández D. Validation of the Reading the Mind in the Eyes Test in a healthy Spanish sample and women with anorexia nervosa. Cogn Neuropsychiatry 2018; 23:201-217. [PMID: 29635964 DOI: 10.1080/13546805.2018.1461618] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The aim of this study was to build a Spanish version of the Reading the Mind in the Eyes Test (RMET) including limited time of response and an integrated glossary, and to test its validity. METHODS A total of 433 university students (121 men and 350 women) and 38 anorexic women completed the RMET and other related measures of empathy and alexithymia. The results of the Parallel Analysis suggested a unidimensional structure for 19 items, which was verified through a Confirmatory Factor Analysis. RESULTS Similarly to other research, this factor had a low reliability (α = .56, ρ = .59); however, regarding validity, the total score of the instrument showed positive correlations with empathy and negatives with alexithymia. Furthermore, healthy females were superior to males in RMET, and to anorexic women; but no significant differences appeared between healthy men and the anorexic group. CONCLUSION This study confirms the validity of the test and permits a relatively short and inexpensive means of administration in large samples of adults. Besides, it suggests the necessity of assessing and treating the theory of mind in anorexic women.
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Affiliation(s)
- Iratxe Redondo
- a Development and Educational Psychology , University of the Basque Country , Leioa , Spain
| | - David Herrero-Fernández
- b Department of Psychology, Faculty of Health Sciences , Universidad Europea del Atlántico , Santander , Spain
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45
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Herrmann AS, Beutel ME, Gerzymisch K, Lane RD, Pastore-Molitor J, Wiltink J, Zwerenz R, Banerjee M, Subic-Wrana C. The impact of attachment distress on affect-centered mentalization: An experimental study in psychosomatic patients and healthy adults. PLoS One 2018; 13:e0195430. [PMID: 29672540 PMCID: PMC5908075 DOI: 10.1371/journal.pone.0195430] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 03/23/2018] [Indexed: 11/26/2022] Open
Abstract
Introduction We investigated the impact of attachment distress on affect-centered mentalization in a clinical and a non-clinical sample, comparing mentalization in a baseline condition to mentalization under a condition of attachment distress. Methods The sample consisted of 127 adults who underwent inpatient psychosomatic treatment, and 34 mentally healthy adults. Affect-centered mentalization was assessed by analyzing participants’ narratives on interpersonal situations in a baseline condition with the Levels of Emotional Awareness Scale (LEAS), and an experimental condition inducing attachment distress with the Adult Attachment Projective Picture System (AAP). Unlike the LEAS, the AAP is specifically designed to trigger attachment distress. In both conditions, the narratives were evaluated using the LEAS scoring system. Additionally, we assessed the impact of childhood trauma on affect-centered mentalization with the Childhood Trauma Questionnaire (CTQ). Results While the non-clinical sample displayed the same level of affect-centered mentalization in both conditions, the majority of the clinical sample reached higher scores in the attachment distress condition. There was no strong relationship between reported trauma and mentalization scores. Discussion Our findings lend strong empirical support to the assumption that affect-centered mentalization is modulated by attachment-related distress. Several possible explanations for the differences between and within the clinical and the non-clinical sample are discussed.
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Affiliation(s)
- Anna S Herrmann
- DFG Research Training Group "Life Sciences, Life Writing" (GRK2015/1) / Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Katharina Gerzymisch
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Richard D Lane
- Department of Psychiatry, The University of Arizona College of Medicine, Tucson, Arizona, United States of America
| | - Janine Pastore-Molitor
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Jörg Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Rüdiger Zwerenz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Mita Banerjee
- Department of English and Linguistics, University of Mainz, Mainz, Germany
| | - Claudia Subic-Wrana
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
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46
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Anupama V, Bhola P, Thirthalli J, Mehta UM. Pattern of social cognition deficits in individuals with borderline personality disorder. Asian J Psychiatr 2018; 33:105-112. [PMID: 29554632 DOI: 10.1016/j.ajp.2018.03.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 01/18/2018] [Accepted: 03/01/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Social cognition deficits have been implicated in the affect regulation and interpersonal difficulties seen in borderline personality disorder (BPD). The study examined patterns of social cognition abilities, using self-report and task-based measures, among individuals diagnosed with BPD. METHODS The sample included a clinical group of 20 patients diagnosed with BPD and 20 age and gender-matched control group participants from the community with no psychiatric diagnosis. The measures included the Mentalization Questionnaire, the Reading the Mind in the Eyes Test and the Social Cognition Rating Tool in Indian Setting. RESULTS Results indicated that the clinical group had lower self-reported mentalizing ability. Facial emotion recognition ability was significantly lower for the clinical group, particularly for photographs of the eye region with positive and neutral valences. The clinical group had significantly higher personalizing bias, and greater difficulties in social perception. The two groups did not differ on first and second order theory of mind, recognition of faux pas and externalizing bias. CONCLUSIONS The results point to the links between social cognition deficits and interpersonal difficulties among persons with BPD. Implications include the need for pre-therapy assessment of the magnitude and patterns of social cognition difficulties in BPD, the development of culturally and ecologically valid assessments and the evaluation of interventions for social cognition vulnerabilities among individuals with BPD.
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Affiliation(s)
- Anupama V
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Poornima Bhola
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India.
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India
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47
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Badoud D, Prada P, Nicastro R, Germond C, Luyten P, Perroud N, Debbané M. Attachment and Reflective Functioning in Women With Borderline Personality Disorder. J Pers Disord 2018; 32:17-30. [PMID: 28263091 DOI: 10.1521/pedi_2017_31_283] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Insecure attachment and impairments in reflective functioning (RF) are thought to play a critical role in borderline personality disorder (BPD). In particular, the mentalization-based model argues that insecure attachment indirectly accounts for increased BPD features, notably via disruption of RF capacities. Although the mediation relationship between attachment, RF, and BPD is supported by previous evidence, it remains to be directly tested in adults with BPD. In the current study, a sample of 55 female adult BPD patients and 105 female healthy controls completed a battery of self-report measures to investigate the interplay between attachment, RF capacities, and BPD clinical status. Overall, the results showed that BPD patients pre- dominantly reported insecure attachment, characterized by negative internal working models of the self as unlovable and unimportant to others, and decreased RF abilities. Our findings further indicated that actual RF capacities mediated the relationships between adult insecure attachment and BPD clinical status.
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Affiliation(s)
- Deborah Badoud
- Developmental Clinical Psychology Unit, Faculty of Psychology, University of Geneva, Switzerland, and Office Médico-Pédagogique Research Unit, Department of Psychiatry, University of Geneva School of Medicine
| | - Paco Prada
- Program TRE, Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva
| | - Rosetta Nicastro
- Program TRE, Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva
| | - Charlotte Germond
- Program TRE, Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva
| | - Patrick Luyten
- Department of Clinical, Educational and Health Psychology, University College London
- Faculty of Psychology and Educational Sciences, KU Leuven, Belgium
| | - Nader Perroud
- Program TRE, Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva
- Department of Psychiatry, University of Geneva
| | - Martin Debbané
- Developmental Clinical Psychology Unit, Faculty of Psychology, University of Geneva, Switzerland, and Office Médico-Pédagogique Research Unit, Department of Psychiatry, University of Geneva School of Medicine
- Department of Clinical, Educational and Health Psychology, University College London
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48
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Savage M, Lenzenweger MF. The Impact of Social Exclusion on "Reading the Mind in the Eyes" Performance in Relation to Borderline Personality Disorder Features. J Pers Disord 2018; 32:109-130. [PMID: 28513343 DOI: 10.1521/pedi_2017_31_293] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
In this study we used the Reading the Mind in the Eyes Test (RMET) to explore facial emotion recognition in borderline personality disorder (BPD). We also used Cyberball, a computerized task designed to mimic social ostracism, to examine the response of BPD-feature participants to social exclusion. Seventeen individuals with BPD features were compared to 16 healthy controls on RMET performance pre- and post-exclusion via Cyberball. Our results revealed a significant interaction between BPD-feature status and RMET performance in relation to neutral stimuli following a social exclusion experience. BPD participants' ability to correctly identify neutral faces significantly decreased following exclusion. This finding suggests that once an individual with BPD features experiences a social exclusion event, his or her objectivity decreases and affective valence is ascribed to stimuli previously perceived as neutral. Our results may help to explain, in part, the social instability seen in BPD.
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Affiliation(s)
- Megan Savage
- Department of Psychology, State University of New York at Binghamton
| | - Mark F Lenzenweger
- Department of Psychology, State University of New York at Binghamton.,Department of Psychiatry, Weill Cornell Medical College, New York City
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Schnell K, Herpertz SC. Emotion Regulation and Social Cognition as Functional Targets of Mechanism-Based Psychotherapy in Major Depression With Comorbid Personality Pathology. J Pers Disord 2018; 32:12-35. [PMID: 29388896 DOI: 10.1521/pedi.2018.32.supp.12] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This article characterizes functional systems as targets of integrated modular psychotherapy for episodes of major depression (MD) with a comorbid condition of borderline personality disorder (BPD) or chronic depression (CD). Both types of comorbidities to MD are conceptualized as a trait-like concept dominated by impairments in interpersonal functioning. Despite differences in psychopathology, existing data show significant similarities in impairments of emotion regulation and social cognition in BPD and CD, thought to reflect common disease mechanisms linked to early-life adversity. The preexistence of BPD and CD and related functional impairments inhibits the remission of episodic MD and calls for mechanism-based interventions that complement existing treatments of MD by targeting these dysfunctions. Contemporary methods of psychotherapy already provide interventions to address such complicated states of comorbidity by specifically improving dysfunctions of emotion regulation and social cognition. We suggest a layout of modular interventions that can address identified dysfunctions in comorbid MD.
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Affiliation(s)
- Knut Schnell
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany.,Asklepios Center for Psychiatry and Psychotherapy Göttingen, Göttingen, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, University Hospital Heidelberg, Heidelberg, Germany
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50
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Valdespino A, Antezana L, Ghane M, Richey JA. Alexithymia as a Transdiagnostic Precursor to Empathy Abnormalities: The Functional Role of the Insula. Front Psychol 2017; 8:2234. [PMID: 29312079 PMCID: PMC5742870 DOI: 10.3389/fpsyg.2017.02234] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 12/08/2017] [Indexed: 12/22/2022] Open
Abstract
Distorted empathic processing has been observed across multiple psychiatric disorders. Simulation theory provides a theoretical framework that proposes a mechanism through which empathy difficulties may arise. Specifically, introspection-centric simulation theory (IST) predicts that an inability to accurately interpret and describe internal affective states may lead to empathy difficulties. The purpose of this review is to synthesize and summarize an empirical literature suggesting that simulation theory provides insights into a cognitive and neurobiological mechanism (i.e., alexithymia and insula pathology) that negatively impacts empathic processing, in addition to how disruptions in these processes manifest across psychiatric disorders. Specifically, we review an emerging non-clinical literature suggesting that consistent with IST, alexithymia and associated insula pathology leads to empathy deficits. Subsequently, we highlight clinical research suggesting that a large number of disorders characterized by empathy pathology also feature alexithymia. Collectively, these findings motivate the importance for future work to establish the role of alexithymia in contributing to empathy deficits across clinical symptoms and disorders. The current review suggests that simulation theory provides a tractable conceptual platform for identifying a potential common cognitive and neural marker that is associated with empathy deficits across a wide array of diagnostic classes.
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Affiliation(s)
- Andrew Valdespino
- Social Clinical Affective Neuroscience Laboratory, Department of Psychology, Virginia Tech, Blacksburg, VA, United States
| | - Ligia Antezana
- Social Clinical Affective Neuroscience Laboratory, Department of Psychology, Virginia Tech, Blacksburg, VA, United States
| | - Merage Ghane
- Social Clinical Affective Neuroscience Laboratory, Department of Psychology, Virginia Tech, Blacksburg, VA, United States
| | - John A Richey
- Social Clinical Affective Neuroscience Laboratory, Department of Psychology, Virginia Tech, Blacksburg, VA, United States
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