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Thakur B, Pathak M, Strenth C, Wilmoth K, Arnold EM. The relationship between borderline personality disorder and self-injurious/suicidal behaviors in adolescents and young adults: A protocol for systematic review and meta-analysis. Health Sci Rep 2024; 7:e2143. [PMID: 38863733 PMCID: PMC11165399 DOI: 10.1002/hsr2.2143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 04/19/2024] [Accepted: 05/08/2024] [Indexed: 06/13/2024] Open
Abstract
Background & Aims Borderline personality disorder (BPD) is a common psychiatric disorder associated with a high risk of suicide attempts, death by suicide, and non-suicidal self-injury (NSSI). A systematic and comprehensive understanding of the link between BPD and suicide and self-injury in adolescents and young adults is crucial for effective public health prevention strategies. This protocol outlines our approach to summarize the evidence on the association between BPD diagnosis and self-injurious/suicidal behaviors including death by suicide, nonfatal suicide attempts, NSSI, and self-harm behavior through a systematic review and meta-analysis. Methods The protocol is registered (PROSPERO: CRD42022363329) and developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P)-2015 statement. We will conduct a comprehensive literature search using electronic databases including MEDLINE, EMBASE, SCOPUS, Web of Science, CINHAL, and PsycINFO. The review will include studies that meet the specific inclusion criteria and will be searched using multiple databases A meta-analysis will be conducted using a fixed-effects or random-effects approach based on the level of heterogeneity. Subgroup analysis and meta-regression will be performed if necessary. Conclusion This study is unique, as it is the first of its kind to systematically review and analyze the existing literature on this topic. The results of this study will provide important evidence on the magnitude of this relationship overall and in different subgroups, which can be used to inform the development of effective prevention and treatment strategies.
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Affiliation(s)
- Bhaskar Thakur
- Department of Family and Community MedicineUT Southwestern Medical CenterDallasTexasUSA
- Peter O'Donnell Jr. School of Public HealthUT Southwestern Medical CenterDallasTexasUSA
| | - Mona Pathak
- Department of PharmacotherapyUNT System College of PharmacyFort WorthTexasUSA
| | - Chance Strenth
- Department of Family and Community MedicineUT Southwestern Medical CenterDallasTexasUSA
| | - Kristin Wilmoth
- Departments of Psychiatry and Physical Medicine & RehabilitationUT Southwestern Medical CenterDallasTexasUSA
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Garikana S, Jain P, Megna JL, Leontieva L. Borderline Personality Disorder With Atypical Traits in a 30-Year-Old Female: A Case Report. Cureus 2024; 16:e55166. [PMID: 38558669 PMCID: PMC10980538 DOI: 10.7759/cureus.55166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 04/04/2024] Open
Abstract
In this paper, we report an atypical presentation of borderline personality disorder (BPD) in a 30-year-old female with a history of childhood molestation and trauma and a prior diagnosis of post-traumatic stress disorder (PTSD). The patient was hospitalized due to anxiety, depression, and guilt over her relapse into alcohol use disorder. During her hospital stay, we diagnosed her with BPD based on psychiatric examination, clinical interviews, and patient history. While the patient exhibited some of the typical characteristics of BPD, such as an instability of interpersonal and romantic relationships, there were numerous findings that were atypical of BPD. These include a demonstration of mature defense mechanisms such as sublimation and altruism, high levels of occupational functioning, strong maternal caregiving behavior, and no history of self-harm. Further analysis of the patient's personality traits helped us identify that this presentation could be best characterized as a high-functioning internalizing subtype of BPD as identified in prior literature.
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Affiliation(s)
- Sarah Garikana
- Psychiatry, State University of New York Upstate Medical University, Syracuse, USA
| | - Pratik Jain
- Psychiatry, State University of New York Upstate Medical University, Syracuse, USA
| | - James L Megna
- Psychiatry and Behavioral Sciences, State University of New York Upstate Medical University, Syracuse, USA
| | - Luba Leontieva
- Psychiatry, State University of New York Upstate Medical University, Syracuse, USA
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Hill J, Fonagy P, Osel T, Dziobek I, Sharp C. The social domains organization of mentalizing processes in adolescents: a contribution to the conceptualization of personality function and dysfunction in young people. J Child Psychol Psychiatry 2023; 64:1470-1479. [PMID: 37259851 DOI: 10.1111/jcpp.13838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND We propose and evaluate a contribution to the conceptualization and assessment of personality functioning based on social domains and mentalizing hypotheses. Social domains are distinct social contexts, such as with acquaintances and friends, with differentiated expectations regarding participants' behaviours and social attributions. The capacity to organize social participation according to these expectations requires the ability, we suggest, to modulate mentalizing processes domain by domain. Drawing on evidence that social domain organization is impaired in borderline personality disorder (BPD) and that hypermentalizing, a heightened interpretation of others' motives, thoughts or emotions, is elevated in adolescent BPD, we hypothesized that hypermentalizing levels in adolescents will vary by social domain and that elevated BPD features will be associated with impairment of this domain organization of hypermentalizing. METHODS Measures including the borderline personality features scale for children (BPFSC) and the movie for the assessment of social cognition (MASC) were administered to 171 adolescents aged 12-17 recruited from public schools and community organizations in a large metropolitan area in southwestern United States. Mean hypermentalizing scores were computed for adolescent interpretations of sequences in the MASC focusing on the social domains of acquaintance, friends and romantic interactions. RESULTS There was a progressive increase in hypermentalizing scores across the acquaintance, friends and romantic interactions (repeated measures ANOVA, p < .001, all pairwise comparisons, p ≤ .02), which was markedly reduced in the presence of elevated BPD features (interaction term, p = .007). CONCLUSIONS Hypermentalizing is organized according to social domain and this organization is impaired in the presence of elevated BPD features. The findings are consistent with the proposal that personality functioning entails a social domains organization of hypermentalizing, which is impaired in personality dysfunction. Identifying mentalizing processes domain by domain has the potential to create a personalized focus for the treatment of adolescents with personality difficulties.
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Affiliation(s)
- Jonathan Hill
- School for Psychology and Clinical Language Sciences, University of Reading, Reading, UK
- Department of Philosophy, University of Reading, Reading, UK
| | - Peter Fonagy
- Psychoanalysis Unit, University College London, London, UK
- Anna Freud National Centre for Children and Families, London, UK
| | - Tiziana Osel
- School for Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Isabel Dziobek
- Institut fur Psychologie, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Carla Sharp
- Department of Psychology, University of Houston, Houston, TX, USA
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Smith MM, McCabe GA, Widiger TA. Experimental Manipulation of the BFI-2, IPIP-NEO-120, and the IPC-5. Assessment 2022:10731911221107622. [PMID: 35815395 DOI: 10.1177/10731911221107622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Research assessing the relationship of the five-factor model (FFM) to personality disorder symptomatology has generally been confirmatory, with three exceptions. The exceptions have been failures to confirm associations of conscientiousness with the obsessive-compulsive personality disorder, agreeableness with dependent, and openness with schizotypal. Haigler and Widiger demonstrated empirically years ago that this was occurring because the predominant FFM measure at that time, the NEO Personality Inventory-Revised, does not include a sufficient representation of maladaptive variants of the respective FFM personality trait domains. Research since their study has continued to fail to confirm the FFM hypotheses, using other measures of the FFM. The current study extended the work of Haigler and Widiger by considering three additional FFM measures, the Big Five Inventory-2 (BFI-2), the International Item Pool-NEO-120 (IPIP-NEO-120), and the Inventory of Personal Characteristics-5 (IPC-5). Data were obtained from a community sample of adults with experience of mental health treatment. The results confirmed an improvement in the FFM-personality disorder relationships when the experimentally manipulated versions of the BFI-2, IPIP-NEO-120, and IPC-5 were used. The implications of the findings for existing and future FFM-personality disorder research are discussed.
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Prunetti E, Magrin C, Zavagnin M, Bodini L, Bateni M, Dimaggio G. Short-Term Inpatient DBT Combined with Metacognitive Interventions for Personality Disorders: A Pilot Acceptability and Effectiveness Study. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2022. [DOI: 10.1007/s10879-022-09536-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Gerra ML, Ardizzi M, Martorana S, Leoni V, Riva P, Preti E, Marino BFM, Ossola P, Marchesi C, Gallese V, De Panfilis C. Autonomic vulnerability to biased perception of social inclusion in borderline personality disorder. Borderline Personal Disord Emot Dysregul 2021; 8:28. [PMID: 34794518 PMCID: PMC8600701 DOI: 10.1186/s40479-021-00169-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 10/20/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Individuals with Borderline Personality Disorder (BPD) feel rejected even when socially included. The pathophysiological mechanisms of this rejection bias are still unknown. Using the Cyberball paradigm, we investigated whether patients with BPD, display altered physiological responses to social inclusion and ostracism, as assessed by changes in Respiratory Sinus Arrhythmia (RSA). METHODS The sample comprised 30 patients with BPD, 30 with remitted Major Depressive Disorder (rMDD) and 30 Healthy Controls (HC). Self-report ratings of threats toward one's fundamental need to belong and RSA reactivity were measured immediately after each Cyberball condition. RESULTS Participants with BPD showed lower RSA at rest than HC. Only patients with BPD, reported higher threats to fundamental needs and exhibited a further decline in RSA after the Inclusion condition. CONCLUSIONS Individuals with BPD experience a biased appraisal of social inclusion both at the subjective and physiological level, showing higher feelings of ostracism and a breakdown of autonomic regulation to including social scenarios.
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Affiliation(s)
| | - Martina Ardizzi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Silvia Martorana
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Veronica Leoni
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Paolo Riva
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Emanuele Preti
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | | | - Paolo Ossola
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Carlo Marchesi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Vittorio Gallese
- Department of Medicine and Surgery, University of Parma, Parma, Italy
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Henriques-Calado J, Gonçalves B, Marques C, Paulino M, Gama Marques J, Grácio J, Pires R. In light of the DSM-5 dimensional model of personality: Borderline personality disorder at the crossroads with the bipolar spectrum. J Affect Disord 2021; 294:897-907. [PMID: 34375218 DOI: 10.1016/j.jad.2021.07.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/22/2021] [Accepted: 07/10/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND State-of-the-art research highlights that borderline personality disorder (PD) and bipolar spectrum disorders have clinical characteristics in common, which imply uncertainty in differential diagnoses. Although there is a growing body of literature on the DSM-5 dimensional model of personality disorder, its discriminative features between these clinical samples are still understudied. In this study, we seek to identify the best set of predictors that differentiate between borderline PD and bipolar spectrum, based on pathological and normative personality traits and symptoms. METHODS A cross-sectional study of three clinical samples: 1) Borderline PD group of 63 participants; 2) Major depressive disorder group of 89 participants; 3) Bipolar disorder group of 65 participants. Self-reported assessment: Personality Inventory for DSM-5; Brief Symptom Inventory; FFM Inventory. A series of one-way ANOVAs and logistic regression analyses were computed. RESULTS The major set of data emerging as common discriminants of borderline PD across the bipolar spectrum are unusual beliefs & experiences, paranoid ideation, obsession-compulsion and extraversion. Depressivity (OR: 34.95) and impulsivity (OR: 22.35) pathological traits displayed the greatest predictive values in the differential diagnosis. LIMITATIONS The small size of the samples; a lack of data from participants' previous clinical history. CONCLUSIONS Findings support the DSM-5 pathological traits as differentiating borderline PD through bipolar spectrum, and reinforcing the joint use of symptom-related pathological functioning and normal-range personality traits. Alongside the bipolar spectrum, borderline pathology sheds light upon a hypothetical overlap along the depressive and schizoaffective/schizophrenia spectra, representing a borderland space at a crossroads with the psychopathology of a meta-spectrum.
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Affiliation(s)
- Joana Henriques-Calado
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013 Lisboa, Portugal; CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013 Lisboa, Portugal.
| | - Bruno Gonçalves
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013 Lisboa, Portugal; CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013 Lisboa, Portugal
| | - Catarina Marques
- Instituto Universitário de Lisboa (ISCTE-IUL), Business Research Unit, Av. das Forças Armadas, 1649-026 Lisboa, Portugal
| | - Marco Paulino
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013 Lisboa, Portugal; Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - João Gama Marques
- Clínica de Psiquiatria Geral e Transcultural, Hospital Júlio de Matos, Centro Hospitalar Psiquiátrico de Lisboa, Avenida do Brasil, 53, 1749-002 Lisboa, Portugal; Clínica Universitária de Psiquiatra e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Jaime Grácio
- Champalimaud Clinical Centre, Champalimaud Centre for the Unknown, Champalimaud Foundation, Lisbon, Portugal; Champalimaud Research, Champalimaud Centre for the Unknown, Champalimaud Foundation, Lisbon, Portugal; NOVA Medical School/ Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Rute Pires
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013 Lisboa, Portugal; CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013 Lisboa, Portugal
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Edershile EA. Leveraging economic games to integrate and differentiate personality and psychopathology. J Pers 2021; 90:103-114. [PMID: 34053069 DOI: 10.1111/jopy.12653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 10/26/2020] [Accepted: 05/24/2021] [Indexed: 11/26/2022]
Abstract
A comprehensive model that integrates, yet differentiates, between personality and psychopathology is needed. Emerging empirical models of psychopathology are aligned structurally with trait models of personality, suggesting clear points of convergence. However, traits, themselves, are not sufficient to quantify consequential adaptivity and maladaptivity. Rather, as multiple theoretical accounts argue, unsuccessful pursuit of goals and needs, and the inability to flexibly adapt goals to fit the situation, is how maladaptivity is understood to emerge. Thus far, though, the empirical literature has suffered from an unsatisfactory connection between structural (or trait-based personality) models and our understanding of dysfunctional processes (psychopathology). Economic games, which elicit intensive repeated behavior suitable for studying dynamic processes, have been leveraged to explore how personality and pathology are associated with behavior across a variety of tasks. When coupled with computational modeling, economic games offer a promising method for integrating and differentiating personality and psychopathology. Ultimately, a fully formed model of psychopathology will be achieved when structural models of personality and psychopathology can be merged with a better understanding of the underlying functional processes of each. This will likely only be achieved by leveraging a number of available tools across disciplines.
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Johnson ML. Neuroqueer Feminism: Turning with Tenderness toward Borderline Personality Disorder. SIGNS 2021. [DOI: 10.1086/712081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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10
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Davies G, Hayward M, Evans S, Mason O. A systematic review of structural MRI investigations within borderline personality disorder: Identification of key psychological variables of interest going forward. Psychiatry Res 2020; 286:112864. [PMID: 32163818 DOI: 10.1016/j.psychres.2020.112864] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 02/09/2020] [Accepted: 02/09/2020] [Indexed: 12/19/2022]
Abstract
Existing models of Borderline Personality Disorder (BPD) suggest that a combination of genetic vulnerability, childhood trauma, and disrupted attachment can lead to the marked emotional lability, impulsivity and interpersonal difficulties observed clinically. Brain structural differences in frontal, limbic and hippocampal regions have been reported in BPD. Less clear is how specific psychological factors relate to these structural differences, and how consistently this is found across studies. This was the focus of the present review. Eighteen studies published between 2004 and 2018 met inclusion criteria encompassing 990 participants. Study quality was assessed using the Nottingham-Ottawa Scale. We also introduce a newly devised scale to assess MRI reporting quality. The most frequently investigated psychological variable were impulsivity (9 studies), depression (8), trauma (6), aggression (6), severity of symptoms (3), global functioning, abuse and dissociation (2). Study quality varied, however, a trend was observed where newer studies were higher in reporting quality. Impulsivity demonstrated greater association with frontal structures, trauma related to the hypothalamus and limbic systems, and aggression with hippocampal and frontal structures. The present review recommends greater exploration of neurocognitive and psychosis-related features such as delusions, paranoia and voice-hearing in future studies, and to investigate cortical changes in longitudinal designs.
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Affiliation(s)
- Geoff Davies
- Faculty of Health and Medical Science, University of Surrey, Guildford, UK; Surrey & Borders NHS Trust, UK.
| | - Mark Hayward
- School of Psychology, University of Sussex, UK; Sussex Partnership NHS Foundation Trust, UK
| | - Simon Evans
- Faculty of Health and Medical Science, University of Surrey, Guildford, UK
| | - Oliver Mason
- Faculty of Health and Medical Science, University of Surrey, Guildford, UK
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Bayes AJ, Parker GB. Differentiating borderline personality disorder (BPD) from bipolar disorder: diagnostic efficiency of DSM BPD criteria. Acta Psychiatr Scand 2020; 141:142-148. [PMID: 31758547 DOI: 10.1111/acps.13133] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE We sought to determine the differential diagnostic efficiency of all DSM-IV borderline personality disorder (BPD) criteria by studying a sample of those with BPD and a contrast group with a bipolar disorder (BP). METHOD Participants were clinically assessed and assigned diagnoses based on DSM criteria - with prevalence rates and diagnostic efficiency values calculated. RESULTS Fifty-three participants were assigned a BPD diagnosis, 83 a BP diagnosis, with comorbid participants excluded. The mean number of DSM BPD criteria assigned was 6.6 (SD = 1.0) in the BPD group and 1.9 (SD = 1.3) in the BP group. The most prevalent criterion in the BPD group was 'affective instability' (AI) (92.5%), with 'inappropriate anger' least endorsed (49%). The highest specificity criterion was 'abandonment fears', which displayed the greatest positive predictive value (PPV) = 0.9, and with AI offering the lowest specificity. 'Unstable relationships' had the highest overall negative predictive value (NPV) = 0.91. The highest percentage accuracy of classification was provided by 'identity disturbance' and 'abandonment fears' criteria, both 85%. CONCLUSION The transdiagnostic nature of 'affective instability' means it is less useful for diagnostic decisions, whereas 'abandonment fears' and 'identity disturbance' offer superior diagnostic efficiency in distinguishing BPD from BP.
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Affiliation(s)
- A J Bayes
- School of Psychiatry, UNSW, Sydney, NSW, Australia.,Black Dog Institute, Sydney, NSW, Australia
| | - G B Parker
- School of Psychiatry, UNSW, Sydney, NSW, Australia.,Black Dog Institute, Sydney, NSW, Australia
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Mulay AL, Waugh MH, Fillauer JP, Bender DS, Bram A, Cain NM, Caligor E, Forbes MK, Goodrich LB, Kamphuis JH, Keeley JW, Krueger RF, Kurtz JE, Jacobsson P, Lewis KC, Rossi GMP, Ridenour JM, Roche M, Sellbom M, Sharp C, Skodol AE. Borderline personality disorder diagnosis in a new key. Borderline Personal Disord Emot Dysregul 2019; 6:18. [PMID: 31827801 PMCID: PMC6886204 DOI: 10.1186/s40479-019-0116-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 11/07/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Conceptualizations of personality disorders (PD) are increasingly moving towards dimensional approaches. The definition and assessment of borderline personality disorder (BPD) in regard to changes in nosology are of great importance to theory and practice as well as consumers. We studied empirical connections between the traditional DSM-5 diagnostic criteria for BPD and Criteria A and B of the Alternative Model for Personality Disorders (AMPD). METHOD Raters of varied professional backgrounds possessing substantial knowledge of PDs (N = 20) characterized BPD criteria with the four domains of the Level of Personality Functioning Scale (LPFS) and 25 pathological personality trait facets. Mean AMPD values of each BPD criterion were used to support a nosological cross-walk of the individual BPD criteria and study various combinations of BPD criteria in their AMPD translation. The grand mean AMPD profile generated from the experts was compared to published BPD prototypes that used AMPD trait ratings and the DSM-5-III hybrid categorical-dimensional algorithm for BPD. Divergent comparisons with DSM-5-III algorithms for other PDs and other published PD prototypes were also examined. RESULTS Inter-rater reliability analyses showed generally robust agreement. The AMPD profile for BPD criteria rated by individual BPD criteria was not isomorphic with whole-person ratings of BPD, although they were highly correlated. Various AMPD profiles for BPD were generated from theoretically relevant but differing configurations of BPD criteria. These AMPD profiles were highly correlated and showed meaningful divergence from non-BPD DSM-5-III algorithms and other PD prototypes. CONCLUSIONS Results show that traditional DSM BPD diagnosis reflects a common core of PD severity, largely composed of LPFS and the pathological traits of anxiousness, depressively, emotional lability, and impulsivity. Results confirm the traditional DSM criterion-based BPD diagnosis can be reliably cross-walked with the full AMPD scheme, and both approaches share substantial construct overlap. This relative equivalence suggests the vast clinical and research literatures associated with BPD may be brought forward with DSM-5-III diagnosis of BPD.
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Affiliation(s)
- Abby L Mulay
- 1Medical University of South Carolina, 29C Leinbach Drive, Charleston, SC 29407 USA
| | - Mark H Waugh
- 2Oak Ridge National Laboratory (ORNL) & University of Tennessee Knoxville, Knoxville, TN 37996 USA
| | | | - Donna S Bender
- 4Tulane University, 6823 St. Charles Ave., Bldg. 92, New Orleans, LA 70118 USA
| | | | - Nicole M Cain
- 6Rutgers University, Graduate School of Applied and Professional Psychology, 152 Frelinghuysen Rd, Piscataway, NJ 08854-8020 USA
| | - Eve Caligor
- 7Columbia University, 1501 Riverside Drive, New York, NY 10032 USA
| | - Miriam K Forbes
- 8Macquarie University, Balaclava Rd., Macquarie Park, NSW 2109 Australia
| | | | - Jan H Kamphuis
- 10University of Amsterdam (UvA), Nieuwe Achtergracht, 129B, 1001 NK Amsterdam, Netherlands
| | - Jared W Keeley
- 11Virginia Commonwealth University, 806 West Franklin Street, Box 842018, Richmond, VA 23284-2018 USA
| | - Robert F Krueger
- 12University of Minnesota, 101 Pleasant St SE, Minneapolis, MN 55455 USA
| | - John E Kurtz
- 13Villanova University, 800 Lancaster Avenue, Villanova, PA 19085 USA
| | - Peter Jacobsson
- 14Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Katie C Lewis
- 15Austen Riggs Center, 25 Main Street, P.O. Box 962, Stockbridge, MA 01262 USA
| | - Gina M P Rossi
- 16Department of Psychology, Personality and Psychopathology Research group Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Jeremy M Ridenour
- 15Austen Riggs Center, 25 Main Street, P.O. Box 962, Stockbridge, MA 01262 USA
| | - Michael Roche
- 17Penn State Altoona, 3000 Ivyside Park, Altoona, PA 16601 USA
| | - Martin Sellbom
- 18University of Otago, PO Box 56, Dunedin, 9054 New Zealand
| | - Carla Sharp
- 19University of Houston, 3695 Cullen Boulevard Room 126, Houston, TX 77204-5022 USA
| | - Andrew E Skodol
- 20University of Arizona, 1501 N. Campbell Avenue, PO Box 245017, Tucson, AZ 85724 USA
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Bertsch K, Krauch M, Roelofs K, Cackowski S, Herpertz SC, Volman I. Out of control? Acting out anger is associated with deficient prefrontal emotional action control in male patients with borderline personality disorder. Neuropharmacology 2018; 156:107463. [PMID: 30553826 DOI: 10.1016/j.neuropharm.2018.12.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/08/2018] [Accepted: 12/09/2018] [Indexed: 12/18/2022]
Abstract
Difficulty in anger control and anger-related aggressive outbursts against others are frequently reported by patients with borderline personality disorder (BPD). Although male sex is a known predictor for aggression, hardly any study has addressed the neural correlates of deficient anger control in male patients with BPD. Building on previous reports in female BPD, we investigated the involvement of lateral antero- and dorsal prefrontal cortex in the control of fast emotional actions and its relation to self-reported tendencies to act out anger. 15 medication-free male patients with BPD and 25 age- and intelligence-matched healthy men took part in a social Approach-Avoidance task in the MR-scanner. This task allows the measurement of neural correlates underlying the control of fast behavioral tendencies to approach happy and avoid angry faces. Hypothesis-driven region-of-interest and exploratory whole brain analyses were used to test for activations of antero- and dorsolateral prefrontal regions and their relation with the amygdala during emotional action control as well as their association with self-reported anger out in male patients with BPD and healthy volunteers. Male patients with BPD showed reduced anterolateral prefrontal activations during emotional action control compared to healthy volunteers. Furthermore, anger out was negatively related to antero- and dorsolateral prefrontal activations, while it was positively related to amygdala activity in male patients with BPD. The current results suggest the involvement of antero- and dorsolateral prefrontal regions in controlling and overriding fast emotional actions. Deficits in lateral prefrontal emotion control seem to be a common neural mechanism underlying anger-related aggression. This article is part of the Special Issue entitled 'Current status of the neurobiology of aggression and impulsivity'.
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Affiliation(s)
- Katja Bertsch
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
| | - Marlene Krauch
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Karin Roelofs
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | - Sylvia Cackowski
- Department of Psychosomatic Medicine, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Heidelberg, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Inge Volman
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Sleep CE, Wygant DB, Miller JD. Examining the Incremental Utility of DSM-5 Section III Traits and Impairment in Relation to Traditional Personality Disorder Scores in a Female Correctional Sample. J Pers Disord 2018; 32:738-752. [PMID: 28972814 DOI: 10.1521/pedi_2017_31_320] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Personality disorders (PDs) are challenging to assess and are associated with great individual and societal costs. In response to the limitations of categorical models, the DSM-5 included an alternative model (i.e., Section III), which uses impairment (Criterion A) and pathological traits (Criterion B) to diagnose PDs. Although numerous studies have illustrated dimensional trait models' ability to capture personality psychopathology, less attention has been paid to personality impairment. The present investigation sought to examine Criterion A's ability to contribute incrementally to the prediction of antisocial (ASPD), borderline (BPD), and narcissistic personality disorders (NPD), and Interpersonal-Affective (F1) and Impulsive-Antisocial (F2) features of psychopathy. The current study used 200 female inmates and found that impairment contributed to the prediction of BPD, NPD, and psychopathy F1 scores and did not add to the prediction of ASPD and psychopathy F2 scores. Difficulties in distinguishing between personality impairment and personality disordered traits are discussed.
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Affiliation(s)
| | - Dustin B Wygant
- Department of Psychology, Eastern Kentucky University, Richmond, Kentucky
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15
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Combination of Omega-3 Fatty Acids and Valproic Acid in Treatment of Borderline Personality Disorder: A Follow-Up Study. Clin Drug Investig 2018; 38:367-372. [PMID: 29302857 DOI: 10.1007/s40261-017-0617-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Some evidence of efficacy has been found for omega-3 fatty acids in patients with borderline personality disorder (BPD). In a previous 12-week randomized trial we assessed the efficacy of the combination of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) with valproic acid, in comparison with valproic acid monotherapy, in 43 BPD outpatients. Combined therapy was superior to valproic acid monotherapy (the control group) in the treatment of some BPD symptoms: impulsive-behavioral dyscontrol, outbursts of anger, and self-harm. The present study is a 24-week follow-up aimed at evaluating whether the differences in efficacy between the two subgroups were maintained after discontinuation of omega-3 fatty acids. METHODS Thirty-four patients who completed the 12-week trial entered the follow-up study. Participants were evaluated at the beginning and at the end of the follow-up period using the rating scales that showed a significant difference between the groups after the 12-week trial with fatty acids supplementation: the Borderline Personality Disorder Severity Index (BPDSI) (items 'impulsivity' and 'outbursts of anger'), Barratt Impulsiveness Scale-Version 11 (BIS-11), and Self Harm Inventory (SHI). Statistical analysis was performed with analysis of variance (ANOVA) for repeated measures. RESULTS At the end of the follow-up a significant difference within groups was maintained for all four variables examined, while a significant difference between groups was maintained for outbursts of anger. Concerning tolerability, no clinically significant adverse effects were registered during the follow-up period. CONCLUSIONS Combined therapy with omega-3 fatty acids showed long-lasting effects after discontinuation in terms of anger control. TRIAL REGISTRATION The trial was registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) and allocated the code: ACTRN12612001150831.
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Esguevillas Á, Díaz-Caneja CM, Arango C, Rey-Mejías ÁLD, Bernardo EG, Delgado C, Clarkin JF, Carrasco JL. Personality organization and its association with clinical and functional features in borderline personality disorder. Psychiatry Res 2018; 262:393-399. [PMID: 28923434 DOI: 10.1016/j.psychres.2017.09.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/25/2017] [Accepted: 09/08/2017] [Indexed: 10/18/2022]
Abstract
Patients with borderline personality disorder (BPD) show poor psychosocial functioning over the course of their lives. To date, predictors of functionality in BPD patients have remained mostly unexplored. In this study, we aimed to assess the association between personality organization and clinical and functional features in a sample of 50 patients with BPD referred to a specialized outpatient clinic. We used the Structured Interview of Personality Organization (STIPO) to assess personality organization and the Global Assessment of Functioning (GAF) scale to measure functionality. Clinical and demographic associations with personality organization were also explored. STIPO scores were negatively correlated with GAF scores (i.e. higher scores in the STIPO dimensions, which reflected greater personality pathology, were significantly associated with lower psychosocial functioning). After controlling for potential confounders, the STIPO domain "identity" significantly accounted for 26.7% of the variance in the GAF, while the STIPO subscale "sense of self" significantly accounted for 31.2% of the variance in the GAF. These findings suggest that identity and its pathological correlate, identity diffusion, may play a key role in the functional prognosis of BPD patients.
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Affiliation(s)
- Álvaro Esguevillas
- Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Covadonga M Díaz-Caneja
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Ángel Luis Del Rey-Mejías
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain; Innovation Unit, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC). Department of Methodology, School of Psychology, Universidad Complutense, Madrid, Spain
| | - Enrique G Bernardo
- Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Carlos Delgado
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | | | - José Luis Carrasco
- Department of Psychiatry, Hospital Clínico San Carlos, Universidad Complutense, CIBERSAM, Madrid, Spain
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17
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Bertsch K, Roelofs K, Roch PJ, Ma B, Hensel S, Herpertz SC, Volman I. Neural correlates of emotional action control in anger-prone women with borderline personality disorder. J Psychiatry Neurosci 2018; 43:170102. [PMID: 29336775 PMCID: PMC5915237 DOI: 10.1503/jpn.170102] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 08/24/2017] [Accepted: 09/06/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Difficulty in controlling emotional impulses is a crucial component of borderline personality disorder (BPD) that often leads to destructive, impulsive behaviours against others. In line with recent findings in aggressive individuals, deficits in prefrontal amygdala coupling during emotional action control may account for these symptoms. METHODS To study the neurobiological correlates of altered emotional action control in individuals with BPD, we asked medication-free, anger-prone, female patients with BPD and age- and intelligence-matched healthy women to take part in an approach-avoidance task while lying in an MRI scanner. The task required controlling fast behavioural tendencies to approach happy and avoid angry faces. Additionally, before the task we collected saliva testosterone and self-reported information on tendencies to act out anger and correlated this with behavioural and functional MRI (fMRI) data. RESULTS We included 30 patients and 28 controls in our analysis. Patients with BPD reported increased tendencies to act out anger and were faster in approaching than avoiding angry faces than with healthy women, suggesting deficits in emotional action control in women with BPD. On a neural level, controlling fast emotional action tendencies was associated with enhanced activation in the antero- and dorsolateral prefrontal cortex across groups. Healthy women showed a negative coupling between the left dorsolateral prefrontal cortex and right amygdala, whereas this was absent in patients with BPD. LIMITATIONS Specificity of results to BPD and sex differences remain unknown owing to the lack of clinical control groups and male participants. CONCLUSION The results indicate reduced lateral prefrontal-amygdala communication during emotional action control in anger-prone women with BPD. The findings provide a possible neural mechanism underlying difficulties with controlling emotional impulses in patients with BPD.
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Affiliation(s)
- Katja Bertsch
- From the Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany (Bertsch, Herpertz); the Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands (Roelofs); Division of Experimental Radiology, University of Heidelberg, Heidelberg, Germany (Ma); the Department of Psychosomatic Medicine, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Heidelberg, Germany (Hensel); and the Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK (Volman)
| | - Karin Roelofs
- From the Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany (Bertsch, Herpertz); the Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands (Roelofs); Division of Experimental Radiology, University of Heidelberg, Heidelberg, Germany (Ma); the Department of Psychosomatic Medicine, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Heidelberg, Germany (Hensel); and the Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK (Volman)
| | - Paul Jonathan Roch
- From the Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany (Bertsch, Herpertz); the Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands (Roelofs); Division of Experimental Radiology, University of Heidelberg, Heidelberg, Germany (Ma); the Department of Psychosomatic Medicine, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Heidelberg, Germany (Hensel); and the Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK (Volman)
| | - Bo Ma
- From the Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany (Bertsch, Herpertz); the Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands (Roelofs); Division of Experimental Radiology, University of Heidelberg, Heidelberg, Germany (Ma); the Department of Psychosomatic Medicine, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Heidelberg, Germany (Hensel); and the Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK (Volman)
| | - Saskia Hensel
- From the Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany (Bertsch, Herpertz); the Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands (Roelofs); Division of Experimental Radiology, University of Heidelberg, Heidelberg, Germany (Ma); the Department of Psychosomatic Medicine, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Heidelberg, Germany (Hensel); and the Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK (Volman)
| | - Sabine C Herpertz
- From the Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany (Bertsch, Herpertz); the Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands (Roelofs); Division of Experimental Radiology, University of Heidelberg, Heidelberg, Germany (Ma); the Department of Psychosomatic Medicine, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Heidelberg, Germany (Hensel); and the Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK (Volman)
| | - Inge Volman
- From the Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany (Bertsch, Herpertz); the Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands (Roelofs); Division of Experimental Radiology, University of Heidelberg, Heidelberg, Germany (Ma); the Department of Psychosomatic Medicine, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Heidelberg, Germany (Hensel); and the Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK (Volman)
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18
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Sellbom M, Waugh MH, Hopwood CJ. Development and Validation of Personality Disorder Spectra Scales for the MMPI–2–RF. J Pers Assess 2018; 100:406-420. [DOI: 10.1080/00223891.2017.1407327] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Martin Sellbom
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Mark H. Waugh
- Department of Psychology, University of Tennessee & Oak Ridge National Laboratory
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19
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Williams R. Anger as a Basic Emotion and Its Role in Personality Building and Pathological Growth: The Neuroscientific, Developmental and Clinical Perspectives. Front Psychol 2017; 8:1950. [PMID: 29163318 PMCID: PMC5681963 DOI: 10.3389/fpsyg.2017.01950] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 10/23/2017] [Indexed: 11/21/2022] Open
Abstract
Anger is probably one of the mostly debated basic emotions, owing to difficulties in detecting its appearance during development, its functional and affective meaning (is it a positive or a negative emotion?), especially in human beings. Behaviors accompanied by anger and rage serve many different purposes and the nuances of aggressive behaviors are often defined by the symbolic and cultural framework and social contexts. Nonetheless, recent advances in neuroscientific and developmental research, as well as clinical psychodynamic investigation, afford a new view on the role of anger in informing and guiding many aspects of human conducts. Developmental studies have confirmed the psychophysiological, cognitive and social acquisition that hesitate in the pre-determined sequence appearance of anger and rage in the first 2 years of life. The so-called affective neurosciences have shown the phylogenetic origin of the two circuits underlying the emergence of anger along with its evolutionary role for promoting survival. This view has been integrated by the psychodynamic theory of motivational systems that attribute a double role to anger: on the one hand, this affect works as an inwardly directed signal concerning a pressure to overcome an obstacle or an aversive situation; on the other hand, anger is also an outwardly directed communicative signal establishing differentiation and conflict within interpersonal relationships and affective bonds. Of course, human peculiar mental functioning requires the appraisal of such signals by higher cortical functions and, there is little doubt that the meaning that orientates individual behaviors is, eventually, construed on a social and cultural level. At the same time, everyday life experiences as well as clinical insights into psychopathic, narcissistic and borderline personality pathology clearly illustrate the necessity to correctly interpret and give answers to the basic questions raised around the topic of anger as a basic emotion.
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Affiliation(s)
- Riccardo Williams
- Dipartimento di Psicologia Dinamica e Clinica, Sapienza Università di Roma, Rome, Italy
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20
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Borges LM, Naugle AE. The role of emotion regulation in predicting personality dimensions. Personal Ment Health 2017; 11:314-334. [PMID: 28856850 DOI: 10.1002/pmh.1390] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 07/05/2017] [Accepted: 07/09/2017] [Indexed: 11/10/2022]
Abstract
Dimensional models of personality have been widely acknowledged in the field as alternatives to a trait-based system of nomenclature. While the importance of dimensional models has been established, less is known about the constructs underlying these personality dimensions. Emotion regulation is one such potential construct. The goal of the current study was to examine the relationship between personality dimensions and emotion regulation. More specifically, the predictive capacity of emotion regulation in accounting for personality dimensions and symptoms on the Schedule for Nonadaptive and Adaptive Personality-2 above and beyond a measure of general distress was evaluated. Emotion regulation was found to be predictive of most personality dimensions and symptoms of most personality disorders. Consistent with hypotheses, emotion regulation variables associated with undercontrol of emotions were most predictive of traits associated with Cluster B personality disorders whereas Cluster A and C traits were most associated with emotion regulation related to overcontrol of emotions. These findings provide preliminary evidence that some personality dimensions never assessed in relation to emotion regulation are strongly predicted by emotion regulation variables. Thus, the present study facilitates an initial step in understanding the relationship between personality dimensions and a multidimensional model of emotion regulation. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Lauren M Borges
- Rocky Mountain MIRECC, 1055 Clermont St., Denver, CO, 80220, USA
| | - Amy E Naugle
- Department of Clinical Psychology, Western Michigan University, 3524 Wood Hall, Mail Stop 5439, Kalamazoo, MI, 49008, USA
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21
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Herpertz SC, Huprich SK, Bohus M, Chanen A, Goodman M, Mehlum L, Moran P, Newton-Howes G, Scott L, Sharp C. The Challenge of Transforming the Diagnostic System of Personality Disorders. J Pers Disord 2017; 31:577-589. [PMID: 28910213 PMCID: PMC5735999 DOI: 10.1521/pedi_2017_31_338] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
While the DSM-5 alternative model of personality disorder (PD) diagnosis allows the field to systematically compare categorical and dimensional classifications, the ICD-11 proposal suggests a radical change by restricting the classification of PDs to one category, deleting all specific types, basing clinical service provision exclusively upon a severity dimension, and restricting trait domains to secondary qualifiers without defining cutoff points. This article reflects broad international agreement about the state of PD diagnosis. It is argued that diagnosis according to the ICD-11 proposal is based on broad, potentially stigmatizing descriptions of impaired functioning and ignores much of the impressive body of research and treatment guidelines that have advanced the care of adults and adolescents with borderline and other PDs. Before radically changing classification, which highly impacts the provision of health care, head-to-head field trials coupled with the views of patients as well as thorough debate among scientists are urgently needed.
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Affiliation(s)
| | | | - Martin Bohus
- Institute of Psychiataric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
| | - Andrew Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
| | | | - Lars Mehlum
- National Centre for Suicide Research and Prevention, Oslo, Norway
| | - Paul Moran
- Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, United Kingdom
| | | | | | - Carla Sharp
- Department of Psychology, University of Houston, Texas
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22
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Rojas SL, Widiger TA. Coverage of the DSM-IV-TR/DSM-5 Section II Personality Disorders With the DSM-5 Dimensional Trait Model. J Pers Disord 2017; 31:462-482. [PMID: 27617654 DOI: 10.1521/pedi_2016_30_262] [Citation(s) in RCA: 19] [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
Section III of DSM-5, for emerging measures and models, includes a five-domain, 25-trait model, assessed by the Personality Inventory for DSM-5. A primary concern with respect to the trait model is its coverage of the DSM-IV-TR personality disorder syndromes (all of which were retained in DSM-5). The current study considered not only total scale scores of three independent measures of DSM-IV-TR personality disorders but also the coverage of each diagnostic criterion included within six personality disorders: antisocial, borderline, avoidant, dependent, narcissistic, and obsessive-compulsive. Participants were 425 community adults, all of whom had received mental health treatment (36% currently; 75% within the past year). Results provided support for the coverage of the diagnostic criteria for the antisocial, borderline, avoidant, dependent, and narcissistic personality disorders. Coverage could perhaps be improved for a few of the criteria for obsessive-compulsive personality disorder.
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23
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Perez-Rodriguez MM, New AS, Goldstein KE, Rosell D, Yuan Q, Zhou Z, Hodgkinson C, Goldman D, Siever LJ, Hazlett EA. Brain-derived neurotrophic factor Val66Met genotype modulates amygdala habituation. Psychiatry Res 2017; 263:85-92. [PMID: 28371657 PMCID: PMC5856456 DOI: 10.1016/j.pscychresns.2017.03.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 02/04/2017] [Accepted: 03/20/2017] [Indexed: 12/14/2022]
Abstract
A deficit in amygdala habituation to repeated emotional stimuli may be an endophenotype of disorders characterized by emotion dysregulation, such as borderline personality disorder (BPD). Amygdala reactivity to emotional stimuli is genetically modulated by brain-derived neurotrophic factor (BDNF) variants. Whether amygdala habituation itself is also modulated by BDNF genotypes remains unknown. We used imaging-genetics to examine the effect of BDNF Val66Met genotypes on amygdala habituation to repeated emotional stimuli. We used functional magnetic resonance imaging (fMRI) in 57 subjects (19 BPD patients, 18 patients with schizotypal personality disorder [SPD] and 20 healthy controls [HC]) during a task involving viewing of unpleasant, neutral, and pleasant pictures, each presented twice to measure habituation. Amygdala responses across genotypes (Val66Met SNP Met allele-carriers vs. Non-Met carriers) and diagnoses (HC, BPD, SPD) were examined with ANOVA. The BDNF 66Met allele was significantly associated with a deficit in amygdala habituation, particularly for emotional pictures. The association of the 66Met allele with a deficit in habituation to unpleasant emotional pictures remained significant in the subsample of BPD patients. Using imaging-genetics, we found preliminary evidence that deficient amygdala habituation may be modulated by BDNF genotype.
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Affiliation(s)
- M Mercedes Perez-Rodriguez
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; The Mental Illness Research Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY 10468, USA; CIBERSAM, Autonoma University, Fundacion Jimenez Diaz and Ramon y Cajal Hospital, Madrid, Spain.
| | - Antonia S New
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; The Mental Illness Research Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY 10468, USA
| | - Kim E Goldstein
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Daniel Rosell
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; The Mental Illness Research Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY 10468, USA
| | - Qiaoping Yuan
- Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD 20892-9412, USA
| | - Zhifeng Zhou
- Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD 20892-9412, USA
| | - Colin Hodgkinson
- Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD 20892-9412, USA
| | - David Goldman
- Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD 20892-9412, USA
| | - Larry J Siever
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; The Mental Illness Research Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY 10468, USA
| | - Erin A Hazlett
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; The Mental Illness Research Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY 10468, USA
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24
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Sleuwaegen E, Claes L, Luyckx K, Berens A, Vogels C, Sabbe B. Subtypes in borderline patients based on reactive and regulative temperament. PERSONALITY AND INDIVIDUAL DIFFERENCES 2017. [DOI: 10.1016/j.paid.2016.11.065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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25
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Evans CM, Simms LJ. Assessing inter-model continuity between the Section II and Section III conceptualizations of borderline personality disorder in DSM-5. Personal Disord 2017; 9:290-296. [PMID: 28252983 DOI: 10.1037/per0000243] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
DSM-5 includes 2 competing models of borderline personality disorder (BPD) in Sections II and III. Empirical comparisons between these models are required to understand and improve intermodel continuity. We compared Section III BPD traits to Section II BPD criteria assessed via semistructured interviews in 455 current/recent psychiatric patients using correlation and regression analyses, and also evaluated the incremental predictive power of other Section III traits. In addition, we tested the hypothesis that self-harm would incrementally predict BPD Criterion 5 over the Section III traits. Results supported Section III BPD traits as an adequate representation of traditional BPD symptomatology, although modifications that would increase intermodel continuity were identified. Finally, we found support for the incremental validity of suspiciousness, anhedonia, perceptual dysregulation, and self-harm, suggesting possible gaps in the Section III PD trait definitions. (PsycINFO Database Record
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Affiliation(s)
- Chloe M Evans
- Department of Psychology, University at Buffalo, The State University of New York
| | - Leonard J Simms
- Department of Psychology, University at Buffalo, The State University of New York
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26
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De Panfilis C, Meehan KB, Cain NM, Clarkin JF. Effortful Control, Rejection Sensitivity, and Borderline Personality Disorder Features in Adulthood. J Pers Disord 2016; 30:595-612. [PMID: 26623540 DOI: 10.1521/pedi_2015_29_226] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This investigation examined the moderating role of effortful control (EC) in the association between rejection sensitivity (RS) and its subsequent interpersonal distress (IP-distress) on borderline personality disorder (BPD) features. In total, 625 multicultural undergraduates (Study 1) and 562 community international adults (Study 2) completed scales evaluating EC, RS, IP-distress, and BPD features; Study 2 participants also self-reported both anxious and angry expectations of rejection. In both samples, EC moderated the mediating effect of IP-distress in the link between RS and BPD-related psychopathology. The extent to which RS was associated with BPD symptoms through increased IP-distress was greater for individuals with low EC and less so for those with high EC. Thus, low self-regulatory abilities may foster the association between RS and BPD by magnifying interpersonal distress. The implications and limitations of findings are discussed.
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Affiliation(s)
- Chiara De Panfilis
- Department of Neuroscience, Unit of Psychiatry, University of Parma, Italy.,Personality Disorders Lab, Parma, Italy
| | - Kevin B Meehan
- Department of Psychology, PhD Program in Clinical Psychology, Long Island University Brooklyn Campus, Brooklyn, New York, USA.,Department of Psychiatry, Weill Medical College of Cornell University, White Plains, New York, USA
| | - Nicole M Cain
- Department of Psychology, PhD Program in Clinical Psychology, Long Island University Brooklyn Campus, Brooklyn, New York, USA
| | - John F Clarkin
- Department of Psychiatry, Weill Medical College of Cornell University, White Plains, New York, USA
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27
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Lane SP, Carpenter RW, Sher KJ, Trull TJ. Alcohol Craving and Consumption in Borderline Personality Disorder: When, Where, and with Whom. Clin Psychol Sci 2016; 4:775-792. [PMID: 28042520 PMCID: PMC5199026 DOI: 10.1177/2167702615616132] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Substance use is highly prevalent in our society, and substance use disorders are comorbid with most psychiatric disorders, including borderline personality disorder (BPD; Grant et al., 2006, 2008). Craving is a fundamental feature of addiction and disorder, yet the contexts in which craving occurs and is associated with substance use is still under-researched. We examined alcohol craving and consumption in a sample of 56 BPD individuals and a comparison group of community drinkers (COM; n = 60) who carried electronic diaries for approximately 21 days. BPD individuals reported more craving than COM individuals in most contexts. Compared to COM individuals, elevated craving in BPD individuals was paralleled by more drinking when at work, at home, and with romantic partners, coworkers, and children. These findings identify contexts of particular relevance to those with BPD and other mood/anxiety disorders in which craving may lead to risky and maladaptive alcohol use.
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Affiliation(s)
- Sean P Lane
- University of Missouri-Columbia and Alcoholism Research Center, Columbia, MO
| | - Ryan W Carpenter
- University of Missouri-Columbia and Alcoholism Research Center, Columbia, MO
| | - Kenneth J Sher
- University of Missouri-Columbia and Alcoholism Research Center, Columbia, MO
| | - Timothy J Trull
- University of Missouri-Columbia and Alcoholism Research Center, Columbia, MO
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Dinsdale N, Mokkonen M, Crespi B. The ‘extreme female brain’: increased cognitive empathy as a dimension of psychopathology. EVOL HUM BEHAV 2016. [DOI: 10.1016/j.evolhumbehav.2016.02.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Daros AR, Ruocco AC, Rule NO. Identifying Mental Disorder from the Faces of Women with Borderline Personality Disorder. JOURNAL OF NONVERBAL BEHAVIOR 2016. [DOI: 10.1007/s10919-016-0237-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Widiger TA, Crego C, Oltmanns JR. The Validation of a Classification of Psychopathology. PSYCHOLOGICAL INQUIRY 2015. [DOI: 10.1080/1047840x.2015.1038211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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31
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Tomko RL, Lane SP, Pronove LM, Treloar HR, Brown WC, Solhan MB, Wood PK, Trull TJ. Undifferentiated negative affect and impulsivity in borderline personality and depressive disorders: A momentary perspective. JOURNAL OF ABNORMAL PSYCHOLOGY 2015; 124:740-753. [PMID: 26147324 PMCID: PMC4573801 DOI: 10.1037/abn0000064] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Individuals with borderline personality disorder (BPD) often report experiencing several negative emotions simultaneously, an indicator of "undifferentiated" negative affect. The current study examined the relationship between undifferentiated negative affect and impulsivity. Participants with a current BPD (n = 67) or depressive disorder (DD; n = 38) diagnosis carried an electronic diary for 28 days, reporting on emotions and impulsivity when randomly prompted (up to 6 times per day). Undifferentiated negative affect was quantified using momentary intraclass correlation coefficients, which indicated how consistently negative emotion items were rated across fear, hostility, and sadness subscales. Undifferentiated negative affect at the occasion-level, day-level, and across 28 days was used to predict occasion-level impulsivity. Multilevel modeling was used to test the hypothesis that undifferentiated negative emotion would be a significant predictor of momentary impulsivity above and beyond levels of overall negative affect. Undifferentiated negative affect at the occasion and day levels were significant predictors of occasion-level impulsivity, but undifferentiated negative affect across the 28-day study period was only marginally significant. Results did not differ depending on BPD or DD status, though individuals with BPD did report significantly greater momentary impulsivity and undifferentiated negative affect. Undifferentiated negative affect may increase risk for impulsivity among individuals with BPD and depressive disorders, and the current data suggest that this process can be relatively immediate as well as cumulative over the course of a day. This research supports the consideration of undifferentiated negative affect as a transdiagnostic construct, but one that may be particularly relevant for those with BPD.
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Affiliation(s)
- Rachel L. Tomko
- University of Missouri-Columbia and Midwest Alcoholism Research Center, Columbia, MO
| | - Sean P. Lane
- University of Missouri-Columbia and Midwest Alcoholism Research Center, Columbia, MO
| | - Lisa M. Pronove
- University of Missouri-Columbia and Midwest Alcoholism Research Center, Columbia, MO
| | - Hayley R. Treloar
- University of Missouri-Columbia and Midwest Alcoholism Research Center, Columbia, MO
- Alpert Medical School of Brown University, Providence, RI
| | - Whitney C. Brown
- University of Missouri-Columbia and Midwest Alcoholism Research Center, Columbia, MO
- Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, MI
| | - Marika B. Solhan
- University of Missouri-Columbia and Midwest Alcoholism Research Center, Columbia, MO
- VA Boston Healthcare System, Boston, MA
| | - Phillip K. Wood
- University of Missouri-Columbia and Midwest Alcoholism Research Center, Columbia, MO
| | - Timothy J. Trull
- University of Missouri-Columbia and Midwest Alcoholism Research Center, Columbia, MO
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Quality and severity of depression in borderline personality disorder: A systematic review and meta-analysis. Clin Psychol Rev 2015; 37:13-25. [DOI: 10.1016/j.cpr.2015.02.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 01/31/2015] [Accepted: 02/05/2015] [Indexed: 12/21/2022]
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Borges LM, Naugle AE. An Experimental Examination of the Interaction between Mood Induction Task and Personality Psychopathology on State Emotion Dysregulation. Behav Sci (Basel) 2015; 5:70-92. [PMID: 25760929 PMCID: PMC4384064 DOI: 10.3390/bs5010070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 02/17/2015] [Accepted: 02/27/2015] [Indexed: 11/16/2022] Open
Abstract
While emotion dysregulation has been investigated as a key variable in the development and persistence of personality psychopathology, few studies have explored state emotion dysregulation among individuals with personality disorders (PDs). The current study addresses this void in the literature through a laboratory investigation of state emotion dysregulation among participants with and without PDs. To facilitate this goal, participants were matched to pairs based on similar personality features and were randomized to one of two behavioral analogues; either the Paced Auditory Serial Addition Task-Computerized (PASAT-C) or an interpersonally based mood induction. As hypothesized, PD participants in the PASAT-C reported significantly more difficulty with impulsivity and emotion regulation strategies. Contrary to expectations, the PD group in the interpersonal task demonstrated significantly less difficulty with non-acceptance of emotion and emotional clarity and significantly greater positive affect compared to non-PD participants. Implications for these findings and directions for future research are discussed.
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Affiliation(s)
- Lauren M Borges
- Department of Clinical Psychology, Western Michigan University, 3700 Wood Hall, Kalamazoo, MI 49008, USA.
| | - Amy E Naugle
- Department of Clinical Psychology, Western Michigan University, 3700 Wood Hall, Kalamazoo, MI 49008, USA.
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Borderline personality disorder and aesthetic plastic surgery. Aesthetic Plast Surg 2014; 38:1169-76. [PMID: 25209530 DOI: 10.1007/s00266-014-0396-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 08/01/2014] [Indexed: 10/24/2022]
Abstract
UNLABELLED Borderline personality disorder (BPD) is a common axis II disorder associated with a high risk of impulsivity and self-injury. Several authors have suggested that individuals with BPD are poor candidates for plastic surgery. Recent changes in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for BPD may be confusing to surgeons. This article reviews the literature on BPD and discusses how important it is to recognize this condition and how difficult it is to treat patients, highlighting features and signs of this condition in plastic surgery settings. Illustrative case examples from our experience are also described. Our careful search of the literature revealed that individuals with BPD may seek treatment from plastic surgeons in two different patterns: as treatment for self-injury or as insatiable requests for aesthetic procedures. Individuals with BPD tend to request corrections of multiple body parts to avoid abandonment by the surgeon or due to their impulsivity, but such preoccupation with appearance is less profound and shifts from one body part to another over time. While flexible and individualized psychological approaches are required to minimize the patient's impulsivity and abandonment fears, surgeons should be inflexible to any unrealistic requests. It is best to avoid surgery on patients with BPD. Surgeons should be aware of the nuances of this condition so as not to miss the proper timing for a psychiatric referral. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Yam WH, Simms LJ. Comparing criterion- and trait-based personality disorder diagnoses in DSM-5. JOURNAL OF ABNORMAL PSYCHOLOGY 2014; 123:802-8. [PMID: 25111090 DOI: 10.1037/a0037633] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In the recent Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the official personality disorder (PD) classification system remains unchanged. However, DSM-5 also includes an alternative hybrid categorical-dimensional PD system in Section III to spur additional research. One defining feature of the alternative system is the incorporation of a trait model with PD-specific trait configurations, but relatively little work has evaluated how these traits map onto official PD diagnoses or their implications for diagnosis rates. To that end, we compared official PD criteria to Section III PD traits in a sample of current or recent psychiatric patients. We (a) evaluated the extent to which PD traits predicted traditional PD criterion counts, and (b) computed trait-based diagnosis rates and compared them to those reported in several published outpatient and epidemiological samples. Overall, PD traits generally predicted PD criterion counts, but with less than ideal specificity. In addition, we identified differences in diagnosis rates across approaches. These results provide some support for the Section III approach, but they also identify important areas in need of refinement and future study before the field could reasonably switch to a hybrid PD classification approach like that in Section III.
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Affiliation(s)
- Wern How Yam
- Department of Psychology, University at Buffalo, The State University of New York
| | - Leonard J Simms
- Department of Psychology, University at Buffalo, The State University of New York
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Soler J, Vega D, Elices M, Feliu-Soler A, Soto À, Martín-Blanco A, Marco-Pallarés J, Torrubia R, Pascual JC. Testing the reinforcement sensitivity theory in borderline personality disorder compared with major depression and healthy controls. PERSONALITY AND INDIVIDUAL DIFFERENCES 2014. [DOI: 10.1016/j.paid.2014.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Reinelt E, Stopsack M, Aldinger M, Ulrich I, Grabe HJ, Barnow S. Longitudinal transmission pathways of borderline personality disorder symptoms: from mother to child? Psychopathology 2014; 47:10-6. [PMID: 23713057 DOI: 10.1159/000345857] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 11/11/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND There is evidence that the borderline symptomatology of the mother longitudinally predicts the number of borderline criteria met by the children. However, possible underlying mechanisms have rarely been examined. In line with transactional models of borderline personality disorder (BPD), we analyzed a broad concept of maladaptive mother-child interactions of mothers with BPD symptoms towards their children, including insensitive parenting and mother-child discrepancies, in reporting the child's psychopathological behavior. SAMPLING/METHODS: The sample was drawn from the population-based Greifswald Family Study and consisted of 295 children and their biological mothers. Both were examined at two points in time, first when the children were about 15 years old (T0) and again 5 years later (T1), using path analyses. RESULTS Maladaptive mother-child interactions (especially an overprotective and rejecting parenting style and high discrepancies regarding internalizing problems) mediate the longitudinal transmission of borderline symptoms from mother to child. Furthermore, our data revealed that this result is consistent for various youth symptoms which are associated with BPD such as impulsivity or dissociation. CONCLUSION The data of the current study imply that the transmission of borderline symptoms from mother to child is mediated by maladaptive mother-child interactions. For this reason early and professional support may be useful to prevent these children from developing severe psychopathology.
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Affiliation(s)
- Eva Reinelt
- Department of Clinical Psychology and Psychotherapy, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
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Schulz SC, Camchong J, Romine A, Schlesinger A, Kuskowski M, Pardo JV, Cullen KR, Lim KO. An exploratory study of the relationship of symptom domains and diagnostic severity to PET scan imaging in borderline personality disorder. Psychiatry Res 2013; 214:161-8. [PMID: 24011393 PMCID: PMC8291759 DOI: 10.1016/j.pscychresns.2013.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 04/05/2013] [Accepted: 05/17/2013] [Indexed: 01/18/2023]
Abstract
The purpose of this report is to describe the relationship between clinical rating assessments of borderline personality disorder (BPD) and regional brain metabolism as measured by positron emission tomography with fluorodeoxyglucuse-F18 (PET-FDG). Fourteen women with BPD underwent PET-FDG scanning in a medication-free state. Correlations were performed on a voxel-by-voxel basis with Buss-Durkee Hostility Index (BDHI) and the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD) which provides a score for BPD severity. There was a significant negative correlation between glucose metabolism in frontal brain areas and the BDHI. Correlations of brain metabolic changes and diagnostic behavioral rating scale scores (ZAN-BPD) were small and seen mostly in posterior areas. The assessment of the statistical relationship of the BDHI to brain regions was substantially more robust than the correlations of the total ZAN-BPD. This exploratory study illustrates regional metabolic values that are highly related to hostile behavior. Our findings replicate some prior studies that have identified a negative relationship between frontal metabolism and aggression in personality disorders. We have also identified a range of other areas that relate to both positive (representing increased drive) and negative (representing impaired control) hostility scores. The substantially greater correlations of the BDHI compared with the ZAN-BPD provide information about the neural underpinnings of BPD.
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Affiliation(s)
- S. Charles Schulz
- University of Minnesota, Department of Psychiatry, P2S2/2A West, 2450 Riverside Avenue, Minneapolis, MN 55454, USA,Corresponding author. Tel.: +612 273 9820; fax: +612 273 9779. (S. Charles Schulz)
| | - Jazmin Camchong
- University of Minnesota, Department of Psychiatry, P2S2/2A West, 2450 Riverside Avenue, Minneapolis, MN 55454, USA
| | - Ann Romine
- University of Minnesota, Department of Psychiatry, P2S2/2A West, 2450 Riverside Avenue, Minneapolis, MN 55454, USA
| | - Amanda Schlesinger
- University of Minnesota, Department of Psychiatry, P2S2/2A West, 2450 Riverside Avenue, Minneapolis, MN 55454, USA
| | - Michael Kuskowski
- University of Minnesota, Department of Psychiatry, P2S2/2A West, 2450 Riverside Avenue, Minneapolis, MN 55454, USA,VA Medical Center, One Veterans Dr, Minneapolis, MN 55417, USA
| | - Jose V. Pardo
- University of Minnesota, Department of Psychiatry, P2S2/2A West, 2450 Riverside Avenue, Minneapolis, MN 55454, USA,VA Medical Center, One Veterans Dr, Minneapolis, MN 55417, USA
| | - Kathryn R. Cullen
- University of Minnesota, Department of Psychiatry, P2S2/2A West, 2450 Riverside Avenue, Minneapolis, MN 55454, USA
| | - Kelvin O. Lim
- University of Minnesota, Department of Psychiatry, P2S2/2A West, 2450 Riverside Avenue, Minneapolis, MN 55454, USA
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Zanarini MC, Frankenburg FR, Wedig MM, Fitzmaurice GM. Cognitive experiences reported by patients with borderline personality disorder and axis II comparison subjects: a 16-year prospective follow-up study. Am J Psychiatry 2013; 170:671-9. [PMID: 23558452 PMCID: PMC3674122 DOI: 10.1176/appi.ajp.2013.13010055] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors assessed three main types of disturbed cognition: nonpsychotic thought (odd thinking, unusual perceptual experiences, and nondelusional paranoia), quasi-psychotic thought, and true psychotic thought in patients with borderline personality disorder followed prospectively for 16 years. They also compared the rates of these disturbed cognitions with those reported by axis II comparison subjects. METHOD The cognitive experiences of 362 inpatients (290 borderline patients and 72 axis II comparison subjects) were assessed at study entry using the cognitive section of the Revised Diagnostic Interview for Borderlines. Participants' cognitive experiences were reassessed every 2 years using the same interview. RESULTS Each of the five main types of thought studied was reported by a significantly higher percentage of patients in the borderline group than in the axis II comparison group over time. Each of these types of thought, except true psychotic thought, declined significantly over time for participants in both groups. Eleven of the 17 more specific forms of thought studied were also reported by a significantly higher percentage of patients in the borderline group over the follow-up period: magical thinking, overvalued ideas, recurrent illusions, depersonalization, derealization, undue suspiciousness, ideas of reference, other paranoid ideation, quasi-psychotic delusions, quasi-psychotic hallucinations, and true psychotic hallucinations. Fourteen specific forms of thought were found to decline significantly over time for participants in both groups: all forms of thought mentioned above except true psychotic hallucinations plus marked superstitiousness, sixth sense, telepathy, and clairvoyance. CONCLUSIONS Disturbed cognitions are common in patients with borderline personality disorder and are distinguishing for the disorder. They also decline substantially over time but remain a problem, particularly those of a nonpsychotic nature.
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Schafer T, McGrath M, Kent L, Nightingale M. Evaluation of personality disorder workshops in Essex, England: reported impacts on clinical practice. JOURNAL OF FORENSIC NURSING 2013; 9:92-100. [PMID: 24158130 DOI: 10.1097/jfn.0b013e31827a5b0e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In this paper we examine the background and context for training related to working with people with personality disorders in England. People with a diagnosis of personality disorder often feel excluded from mainstream health, social and employment contexts, and sometimes experience negative and stigmatizing attitudes from people, including health and social care workers. An evaluation of a program of workshops for forensic nurses and other practitioners was carried out to ascertain how effective the workshops were in challenging attitudes and also in potentially promoting better practice in working with this client group. The evaluation was designed utilizing the principles of illuminative evaluation and involved an analysis of workshop evaluation forms and telephone interviews with course participants. The course received very positive evaluations and participants described how it challenged their beliefs, promoting therapeutic optimism, understanding, and more positive partnerships. Key factors in achieving this were adopting a team approach to the training and service user participation in the workshops. Drawing on our experiences and a wide range of literature, we illustrate the importance of service user involvement in teaching and promoting more positive attitudes, and we outline further areas for investigation.
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Affiliation(s)
- Tim Schafer
- Author Affiliations: 1Senior Lecturer, Anglia Ruskin University, Chelmsford, UK, 2Service User Researcher, South Essex Service User Research Group (SE-SURG), Anglia Ruskin University, Chelmsford, UK. The authors declare no conflict of interest
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Andión O, Ferrer M, Calvo N, Gancedo B, Barral C, Di Genova A, Arbos MA, Torrubia R, Casas M. Exploring the clinical validity of borderline personality disorder components. Compr Psychiatry 2013; 54:34-40. [PMID: 22794943 DOI: 10.1016/j.comppsych.2012.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 05/14/2012] [Accepted: 06/04/2012] [Indexed: 11/17/2022] Open
Abstract
Borderline personality disorder (BPD) is recognized as a complex syndrome, resulting in a heterogeneous diagnostic category. Besides the characteristics of the disorder itself, comorbid disorders play an important role in this complexity. The aim of the study is to analyze the clinical validity of 3 components for BPD Diagnostic and Statistical Manual of Mental Disorders criteria--called affective dysregulation, behavioral dysregulation, and disturbed relatedness--investigating differences in patterns of comorbidity. For this purpose, 365 patients with suspected BPD were included in the study. To test our hypothesis, patients were classified into 5 clusters using a K-cluster analysis to study the clinical validity of the 3 components based on the 3-factor model of BPD. Differences in comorbidity, previous suicide attempts, and self-harm behaviors among the defined clusters were analyzed. Between-cluster differences were observed for Axis I and Axis II disorders as well as in the frequency of suicide attempts and in self-harm behaviors. The study of BPD based on the 3 components seems to be more useful than the study of BPD as a unitary construct to help further our understanding of this complex disorder. In the present study, the 3 BPD components have allowed us to analyze the complex comorbidity of BPD patients. This solution could be considered an interesting way to clarify BPD etiology, diagnosis, and treatment efficacy.
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Affiliation(s)
- Oscar Andión
- Psychiatry Department, Hospital Universitari Vall d'Hebron, Barcelona, CIBERSAM 08035, Spain.
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Zimmerman M, Dalrymple K, Young D, Chelminski I, Martinez J. An empirical examination of Gunderson's proposed revision of the diagnostic algorithm for borderline personality disorder. J Pers Disord 2012; 26:880-9. [PMID: 23281673 DOI: 10.1521/pedi.2012.26.6.880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Gunderson (2010) recently offered a sharp criticism of the draft proposal for diagnosing personality disorders in DSM-5. Based on a review of phenomenological, factor analytic, social psychology, family, neurobiological, and treatment studies of borderline personality disorder (BPD), he proposed an alternative revision of the BPD criteria. One of the suggested changes was a modification of the DSM-IV diagnostic algorithm. Gunderson did not, however, provide any data on the impact this new diagnostic algorithm would have on the prevalence of BPD, or the validity of this alternative approach compared to the DSM-IV algorithm. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project we administered semi-structured diagnostic interviews to 3,081 psychiatric outpatients and examined diagnostic concordance between DSM-IV and Gunderson's proposal, and whether there is incremental validity in Gunderson's diagnostic approach. The results did not indicate that the alternative diagnostic algorithm improved validity, and, depending on the threshold used, could result in false negative diagnoses.
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Affiliation(s)
- Mark Zimmerman
- Brown Medical School, Rhode Island Hospital, Providence, Rhode Island, USA.
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Links PS, Eynan R. The relationship between personality disorders and Axis I psychopathology: deconstructing comorbidity. Annu Rev Clin Psychol 2012; 9:529-54. [PMID: 23157449 DOI: 10.1146/annurev-clinpsy-050212-185624] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The purpose of this review is (a) to study and systematically review the recent literature examining the co-occurrence and relationships between Axis I psychiatric disorders and Axis II personality disorders, specifically the six originally proposed for the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5, and (b) to consider the clinical utility of the current Axis I and Axis II approach in the DSM-IV-TR and apply findings to state a position on the issue of collapsing together Axis I and Axis II. Community surveys or prospective cohort studies were reviewed as a priority. Our review indicates that the associations between clinical disorders and personality disorders clearly varied within each disorder and across the six personality disorders. Our understanding has advanced, particularly related to the clinical utility of comorbidity, and there may be sufficient evidence to support moving borderline personality disorder to Axis I. However, it seems premature to conclude that comorbidity is best conceptualized by having all disorders in a single category or by deleting disorders so that comorbidity is reduced. Our review suggests some priorities for future research into comorbidity, such as including personality disorders in future multivariate comorbidity models.
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Affiliation(s)
- Paul S Links
- Department of Psychiatry, The University of Western Ontario, London, ON N6A 5W9 Canada.
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Conway C, Hammen C, Brennan PA. A comparison of latent class, latent trait, and factor mixture models of DSM-IV borderline personality disorder criteria in a community setting: implications for DSM-5. J Pers Disord 2012; 26:793-803. [PMID: 23013346 PMCID: PMC3460547 DOI: 10.1521/pedi.2012.26.5.793] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
With the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) scheduled for publication in 2013, researchers continue to debate the optimal classification of borderline personality disorder (BPD). Much of the discussion has focused on the relative merits of dimensional versus categorical classification schemes for BPD. Advances in statistical technologies have made it possible to adjudicate between continuous and categorical models of BPD using quantitative methods, yet no prior studies have attempted such a comparison. The current study directly compares the fit of dimensional, categorical, and hybrid models of BPD in a large community sample (N = 700) of young adults at risk for psychopathology due to elevated rates of maternal depression. BPD symptoms were assessed using the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). Latent class, latent trait, and factor mixture models of SCID-II symptoms were estimated, and a latent trait model provided superior fit to the data, supporting a dimensional conceptualization of borderline pathology. The nosological implications of these results are discussed with respect to a "hybrid" model of BPD diagnosis currently under consideration for DSM-5.
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Affiliation(s)
- Christopher Conway
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA 90095, USA.
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Affiliation(s)
- Robert S Biskin
- Department of Psychiatry, Sir Mortimer B. Davis Jewish General Hospital, Montréal, Quebec, Canada.
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Abstract
This article provides a brief history of the development of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association, and how it relates to the proposed fifth edition to be published in 2013. Of particular emphasis is Axis II and how this axis is likely to be restructured. The reconceptualization of the nosology for personality disorders has been controversial since the publication of the DSM-III-R (Wilson, 1993). In both the clinical and academic communities, ongoing debate about diagnostic classification of personality disorders has been common. One recurrent theme among the deliberations on diagnosis and personality disorder focuses on the question of whether distinct (categorical) diagnoses exist or whether diagnoses are dimensionally related to each other in some empirically determined way. The proposed changes for Axis II in the DSM-5 are likely to bridge the gap between these two arguments by revamping the overall criteria and discarding the three currently used diagnostic clusters. The resulting nosology proposes six personality disorders with common factors in Criteria A and Criteria B. However, a major concern and a continuing problem not likely to be resolved in this edition is the symptom resemblance of borderline personality disorder and bipolar disorder. This article suggests some ways the revised DSM might affect mental health nursing practice.
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Walter M, Dammann G. Abhängigkeitserkrankungen und Persönlichkeitsstörungen. PSYCHOTHERAPEUT 2012. [DOI: 10.1007/s00278-012-0917-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Furnham A, Dadabhoy H. Beliefs about causes, behavioural manifestations and treatment of borderline personality disorder in a community sample. Psychiatry Res 2012; 197:307-13. [PMID: 22401971 DOI: 10.1016/j.psychres.2011.12.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Revised: 12/16/2011] [Accepted: 12/19/2011] [Indexed: 11/30/2022]
Abstract
This study was part of a programmatic series into mental health literacy, specifically lay people's knowledge of causes, manifestations and cures of borderline personality disorder (BPD). The aim was to determine to what extent non-experts understood BDP and to what extent they held erroneous beliefs about specific aspects of the causes and cures for the disorder. A convenience sample of 102 participants completed a vignette-identification task that required them to answer open-ended questions about hypothetical people with four psychological problems, one of which was BPD and a 50-item questionnaire divided into three sections about BDP. Analysis of the vignette-identification task revealed very low rates of recognition for BPD, with participants significantly more likely to identify depression, schizophrenia or psychopathy. Participants generally favoured psychological and sociological treatments, as well as rating early trauma and stress as possible causes of the symptoms of the person described in the BDP vignette. There were logical relationships between perceptions of cause and cure. The results suggest that participants hold certain coherent beliefs (psychological, sociological, biological or theological) regarding aetiology and treatments of BPD. Further, the findings suggest the need for greater awareness and educational programmes to inform the general public accurately regarding BPD and to improve mental health literacy.
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Affiliation(s)
- Adrian Furnham
- Research Department of Clinical, Educational and Health Psychology, University College, London, UK.
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Samuel DB, Miller JD, Widiger TA, Lynam DR, Pilkonis PA, Ball SA. Conceptual changes to the definition of borderline personality disorder proposed for DSM-5. JOURNAL OF ABNORMAL PSYCHOLOGY 2012; 121:467-76. [PMID: 21875165 PMCID: PMC3706458 DOI: 10.1037/a0025285] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 Personality and Personality Disorders Work Group proposed the elimination of diagnostic criterion sets in favor of a prototype matching system that defines personality disorders using narrative descriptions. Although some research supports this general approach, no empirical studies have yet examined the specific definitions proposed for DSM-5. Given the wide interest in borderline personality disorder (BPD), it is crucial to determine how this methodological shift might affect the content and conceptualization of the diagnosis. Eighty-two experts on BPD provided ratings of the DSM-IV-TR or DSM-5 version of BPD in terms of 37 traits proposed for DSM-5. Analyses revealed significant and meaningful differences among the two constructs, with the DSM-5 version evincing increased interpersonal dependency but a decreased emphasis on antagonism and disinhibition. A second study within a clinical sample demonstrated that both antagonism and disinhibition mediated the relationships between DSM-IV BPD and impairment, suggesting that the proposed changes might have important consequences for BPD's coverage, prevalence, and nomological network. More globally, our results illustrate that unanticipated shifts in diagnostic constructs can stem from seemingly minor revisions and suggest that research is needed to understand how these, or other changes, might affect our conceptualization, diagnosis, and treatment of BPD.
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Affiliation(s)
- Douglas B Samuel
- Department of Psychiatry, Yale University School of Medicine, USA.
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Miller JD, Morse JQ, Nolf K, Stepp SD, Pilkonis PA. Can DSM-IV borderline personality disorder be diagnosed via dimensional personality traits? Implications for the DSM-5 personality disorder proposal. JOURNAL OF ABNORMAL PSYCHOLOGY 2012; 121:944-950. [PMID: 22428791 DOI: 10.1037/a0027410] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The proposal for the diagnosis of personality disorders (PDs) in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5;American Psychiatric Association, in preparation) involves, in part, the use of elevated scores on dimensional personality traits. For instance, the diagnosis of borderline personality disorder (BPD) in the DSM-5 will require evidence of self- and interpersonal impairment as well as elevated scores on traits of emotional lability, anxiousness, separation insecurity, depressivity, impulsivity, risk taking, and hostility. Using a sample of individuals from the community (N = 134), half of whom were receiving psychiatric treatment, we tested whether the summation of relevant personality trait scores, using data derived from a measure of the Five-Factor Model of personality (FFM), would result in a construct that corresponds to the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV, American Psychiatric Association, 2000) BPD construct as scored by expert consensus ratings. The DSM-IV and FFM BPD scores were significantly correlated (r = .60) and generated highly similar patterns of relations (ricc = .84) with key constructs from BPD's nomological network. These data should serve to allay concerns that the DSM-5's new diagnostic approach will be detrimental to the identification of BPD.
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Affiliation(s)
| | - Jennifer Q Morse
- Department of Psychiatry, University of Pittsburgh Medical Center
| | - Kimberly Nolf
- Department of Psychiatry, University of Pittsburgh Medical Center
| | | | - Paul A Pilkonis
- Department of Psychiatry, University of Pittsburgh Medical Center
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