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Kulakova E, Graumann L, Wingenfeld K. The Hypothalamus-Pituitary-Adrenal Axis and Social Cognition in Borderline Personality Disorder. Curr Neuropharmacol 2024; 22:378-394. [PMID: 37539934 PMCID: PMC10845078 DOI: 10.2174/1570159x21666230804085639] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/28/2023] [Accepted: 05/28/2023] [Indexed: 08/05/2023] Open
Abstract
Borderline personality disorder (BPD) is characterized by emotional instability, impulsivity and unstable interpersonal relationships. Patients experience discomforting levels of distress, inducing symptoms like dissociation, aggression or withdrawal. Social situations are particularly challenging, and acute social stress can reduce patients' cognitive and social functioning. In patients with Major Depressive Disorder or Posttraumatic Stress Disorder, which show high comorbidity with BPD, the endocrine stress response is characterized by Hypothalamus-Pituitary-Adrenal (HPA) axis dysfunction, which affects cognitive functioning. Compared to these clinical groups, research on HPA-axis function in BPD is relatively scarce, but evidence points towards a blunted cortisol reactivity to acute stress. Since BPD patients are particularly prone to social stress and experience high subjective difficulties in these situations, it seems plausible that HPA-axis dysregulation might contribute to decreased social cognition in BPD. The present review summarizes findings on the HPA-axis function in BPD and its association with social cognition following acute social stress. For this purpose, we review literature that employed a widely used social stressor (Trier Social Stress Test, TSST) to study the effects of acute social stress on social cognition and the HPA-axis response. We contrast these findings with studies on social cognition that employed Cyberball, another widely used social stressor that lacks HPA-axis involvement. We conclude that research on social cognition in BPD reveals heterogeneous results with no clear relationship between social functioning and HPA-axis response. More research is needed to better understand the psychophysiological underpinnings of impaired social cognition in BPD.
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Affiliation(s)
- Eugenia Kulakova
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Berlin, Germany
| | - Livia Graumann
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Berlin, Germany
| | - Katja Wingenfeld
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Berlin, Germany
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2
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Roché S, Kearns H, Brindle RC. Testing adverse childhood experiences (ACEs) as a potential moderator of the association between current chronic stress and cardiovascular reactivity. Int J Psychophysiol 2023; 193:112245. [PMID: 37730123 DOI: 10.1016/j.ijpsycho.2023.112245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/13/2023] [Accepted: 09/15/2023] [Indexed: 09/22/2023]
Abstract
Motivated by mixed findings regarding the relationship between chronic stress and cardiovascular reactivity, the current study aimed to investigate whether adverse childhood experiences (ACEs) serve as a potential moderator of the association between current chronic stress and cardiovascular reactivity. Incidence of ACEs, levels of current chronic stress, and heart rate (HR) reactivity to a mental arithmetic stress task were measured in 111 participants (age = 20.83, 76 % female, 66 % White). ACEs were measured using the Childhood Trauma Questionnaire and current chronic stress was measured using the Perceived Stress Scale. Moderation analyses were conducted with HR reactivity as the outcome and ACEs as the moderator. Results indicated that a greater amount of current chronic stress was significantly associated with relatively blunted HR reactivity (β = -0.25, p = 0.03) even after controlling for sociodemographic variables. Exposure to ACEs was not significantly related to HR reactivity, (all p ≥ 0.66), and there was no significant interaction between current chronic stress and ACE exposure in predicting HR reactivity, (all p ≥ 0.44). These results show that current chronic stress is associated with relatively blunted HR reactivity and that exposure to ACEs does not moderate the relationship between chronic stress and cardiac stress reactivity.
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Affiliation(s)
- Sophia Roché
- Department of Biology, Washington and Lee University, USA
| | - Hannah Kearns
- Department of Cognitive and Behavioral Science, Washington and Lee University, USA
| | - Ryan C Brindle
- Department of Cognitive and Behavioral Science, Neuroscience Program, Washington and Lee University, USA.
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3
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Schwarzer NH, Dietrich L, Gingelmaier S, Nolte T, Bolz T, Fonagy P. Mentalizing partially mediates the association between attachment insecurity and global stress in preservice teachers. Front Psychol 2023; 14:1204666. [PMID: 37671112 PMCID: PMC10475550 DOI: 10.3389/fpsyg.2023.1204666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/27/2023] [Indexed: 09/07/2023] Open
Abstract
Objective Considering the fact that the teaching profession is a highly stressful occupation and that teachers' ineffective coping strategies contribute to higher levels of stress, the objective of the present study was to investigate whether insecure attachment is related to global stress experiences in preservice student teachers. Furthermore, it was examined whether this link is mediated by the preservice teachers' mentalizing-the capacity to perceive and consider one's own and others' behavior based on intentional mental states. Methods Data of this cross-sectional study came from 202 preservice student teachers using self-report instruments (attachment: Expectation in Close Relationships; mentalizing: Reflective Functioning Questionnaire; stress: Trier Inventory of Chronic Stress). The hypotheses were tested using structural equation modelling. Results Anxious attachment was positively related to stress and impairments in mentalizing. In addition, the link between attachment-related anxiety and stress was partially mediated by mentalizing. Avoidant attachment was not associated with stress or mentalizing. Discussion Results indicate that anxious attachment is associated with higher perceived stress in preservice student teachers. Consequently, attachment-related anxiety may be a risk factor which, in turn, may foster perceptions of higher global stress experiences. Conclusion Additional research needs to focus on exploring the link between attachment insecurity and global stress experiences among preservice student teachers. An examination of preservice student teachers' own attachment experiences proves to be useful, for example in the context of mentalization-based supervision or reflective practice.
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Affiliation(s)
| | - Lars Dietrich
- Humboldt University of Berlin, Berlin, Baden-Wurttemberg, Germany
| | | | - Tobias Nolte
- Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Tijs Bolz
- University of Oldenburg, Oldenburg, Lower Saxony, Germany
| | - Peter Fonagy
- University College London, London, England, United Kingdom
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Mavrenkova PV, Khlebnikova NN, Alchinova IB, Demorzhi MS, Shoibonov BB, Karganov MY. Effects of Maternal Separation and Subsequent Stress on Behaviors and Brain Monoamines in Rats. Brain Sci 2023; 13:956. [PMID: 37371434 DOI: 10.3390/brainsci13060956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/04/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Childhood adversity can induce maladaptive behaviors and increase risk for affective disorders, post-traumatic stress disorder, personality disorders, and vulnerability to stress in adulthood. Deprivation of maternal care interrupts brain development through the disturbance of various neurotransmitters, however, the details remain unclear. The features of the symptoms of disorders are largely determined by early stress protocol, genetic characteristics (line), and the sex of the animals. The purpose of current study was (1) to assess behavioral changes in adult Wistar rats of both sexes after early life stress; (2) to determine the levels of monoamines in brain structures involved in the motor, emotional, and social reactions in rats aged 1 and 2 months; and (3) to determine the level of monoamines after physical or emotional stress in adult rats. The rat pups were separated from their dams and isolated from siblings in tight boxes at a temperature of 22-23 °C for 6 h during postnatal days 2-18. The data were processed predominantly using two-way analysis of variance and the Newman-Keys test as the post hoc analysis. The adult rats demonstrated an increase in motor activity and aggressiveness and a decrease in levels of anxiety and sociability. Behavioral disturbances were accompanied by region-, sex-, and age-dependent changes in the levels of monoamines and their metabolites. The dopaminergic and noradrenergic systems were found to be sensitive to psycho-emotional stress.
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Affiliation(s)
- Polina V Mavrenkova
- Institute of General Pathology and Pathophysiology, 8 Baltiyskaya St., 125315 Moscow, Russia
| | - Nadezhda N Khlebnikova
- Institute of General Pathology and Pathophysiology, 8 Baltiyskaya St., 125315 Moscow, Russia
| | - Irina B Alchinova
- Institute of General Pathology and Pathophysiology, 8 Baltiyskaya St., 125315 Moscow, Russia
| | - Marina S Demorzhi
- Institute of General Pathology and Pathophysiology, 8 Baltiyskaya St., 125315 Moscow, Russia
| | - Batozhab B Shoibonov
- P. K. Anokhin Institute of Normal Physiology, 8 Baltiyskaya St., 125315 Moscow, Russia
| | - Mikhail Yu Karganov
- Institute of General Pathology and Pathophysiology, 8 Baltiyskaya St., 125315 Moscow, Russia
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Kroener J, Schaitz C, Karabatsiakis A, Maier A, Connemann B, Schmied E, Sosic-Vasic Z. Relationship Dysfunction in Couples When One Partner Is Diagnosed with Borderline Personality Disorder: Findings from a Pilot Study. Behav Sci (Basel) 2023; 13:bs13030253. [PMID: 36975278 PMCID: PMC10045094 DOI: 10.3390/bs13030253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/23/2023] [Accepted: 02/28/2023] [Indexed: 03/14/2023] Open
Abstract
Relationship dysfunction—marked by frequent conflicts—is one of the hallmark features of borderline personality disorder (BPD). However, the BPD couple as a dyad and partner-related features have rarely been taken into account. The aim of the present study was to investigate hormonal, personality, and relationship relevant factors, such as relationship satisfaction, attachment, and trauma in both partners within a dyad where one partner is diagnosed with BPD. The total sample consisted of 26 heterosexual couples. All studies were conducted at 2 p.m. Primary outcomes: Neo-Five-Factor-Inventory, Childhood Trauma Questionnaire, Experiences in Close Relationships Scale. Secondary outcomes: Problem List, Partnership Questionnaire, Questionnaire for Assessing Dyadic Coping. Upon questionnaire completion, one saliva sample was taken via passive drool to assess baseline cortisol and testosterone levels. Results showed that females with BPD have higher scores on childhood maltreatment, dysfunctional attachment styles, and neuroticism than mentally healthy females. Furthermore, they have more relationship-related problems and are less satisfied in their romantic relationship. Male partners of women with BPD showed lower testosterone levels, higher levels of childhood maltreatment, dysfunctional attachment styles, neuroticism, and openness compared with the healthy control partners. Furthermore, childhood trauma, neuroticism as well as dysfunctional attachment styles displayed a significant positive correlation with relationship-related problems. Traumatic childhood experiences, insecure attachment styles as well as neurotic personality characteristics contribute to increased relationship disruptions in couples. Relevant hormonal and psychosocial parameters in BPD partners should be taken into account when treating females with BPD.
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Affiliation(s)
- Julia Kroener
- Christophsbad Goeppingen, Research Division of Applied Psychotherapy and Psychiatry, Faurndauer Straße 6-28, 73035 Goeppingen, Germany
- Department of Psychiatry and Psychotherapy III, University Clinic of Ulm, 89075 Ulm, Germany
- Correspondence: ; Tel.: +49-7161-601-8672
| | - Caroline Schaitz
- MSB Medical School Berlin, Psychotherapeutic Outpatient Facility, Rüdesheimer Straße 50, 14197 Berlin, Germany
| | - Alexander Karabatsiakis
- Department of Psychology, Clinical Psychology II, University of Innsbruck, 6020 Innsbruck, Austria
| | - Anna Maier
- Department of Psychiatry and Psychotherapy III, University Clinic of Ulm, 89075 Ulm, Germany
| | - Bernhard Connemann
- Department of Psychiatry and Psychotherapy III, University Clinic of Ulm, 89075 Ulm, Germany
| | - Elisa Schmied
- Christophsbad Goeppingen, Research Division of Applied Psychotherapy and Psychiatry, Faurndauer Straße 6-28, 73035 Goeppingen, Germany
| | - Zrinka Sosic-Vasic
- Christophsbad Goeppingen, Research Division of Applied Psychotherapy and Psychiatry, Faurndauer Straße 6-28, 73035 Goeppingen, Germany
- Department of Psychiatry and Psychotherapy III, University Clinic of Ulm, 89075 Ulm, Germany
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Bryant RA. Attachment processes in posttraumatic stress disorder: A review of mechanisms to advance theories and treatments. Clin Psychol Rev 2023; 99:102228. [PMID: 36493729 DOI: 10.1016/j.cpr.2022.102228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/31/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022]
Abstract
Current conceptualisations of posttraumatic stress disorder (PTSD) are driven by biological, learning, and cognitive models that have shaped current treatments of the disorder. The strong influence of these models has resulted in a relative neglect of social mechanisms that can influence traumatic stress. There is abundant evidence from experimental, observational, and clinical studies that social factors can moderate many of the mechanisms articulated in prevailing models of PTSD. In this review it is proposed that attachment theory provides a useful framework to complement existing models of PTSD because it provides explanatory value for social factors can interact with biological, learning, and cognitive processes that shape traumatic stress response. The review provides an overview of attachment theory in the context of traumatic stress, outlines the evidence for how attachment factors can moderate stress responses and PTSD, and considers how harnessing attachment processes may augment recovery from and treatment of PTSD. This review emphasizes that rather than conceptualizing attachment theory as an independent theory of traumatic stress, there is much to gain by integrating attachment mechanisms into existing models of PTSD to accommodate the interactions between cognitive, biological, and attachment processes.
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Gong J, Zhou L, Zhao L, Zhang S, Chen Z, Liu J. Epidemiology of Childhood Witnessing Domestic Violence and Exploration of Its Relationships With Affective Lability and Suicide Attempts in Chinese Young Adults. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP22834-NP22863. [PMID: 35229677 DOI: 10.1177/08862605211072221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Childhood witnessing domestic violence (CWDV) exerts short- and long-term negative impacts on emotional and behavioral health. The present study investigated the epidemiological features of CWDV, and its negative impact on psychological outcomes in a sample of Chinese college students. The mediating role of emotion regulation strategies on CWDV associations with psychological outcomes and gender differences in these relationships were examined. A total of 3,126 respondents (1,034 males; 2,086 females; 6 missing data in gender) completed the study questionnaire, which included demographic characteristics, CWDV, and suicide attempt history items as well as the Emotion Regulation Questionnaire (ERQ) and Affect Lability Scale-18 (ALS-18). Overall, 43.03% of the respondents reported CWDV, including 44.87% of males and 42.09% of females. Higher frequencies of CWDV were found to be related to the following factors: unstable marital status of parents; not being an only child; being a left-behind child, family financial difficulties, consumption of alcohol in the past year, and being in relatively poor physical condition. Among males, ERQ suppression scores were significantly higher for those men who experienced "often or every day" CWDV than for men who indicated that they did not have any history of CWDV (Bonferroni-corrected p = 0.047). More frequent CWDV was associated with higher ALS-18 scores and increased risk of suicide attempts in males and females (p < 0.05), and emotion regulation (suppression) was found to mediate the association between CWDV and affective lability among males. This study revealed high rates of CWDV, and serious impacts of CWDV on mental health in male and female Chinese college students. In males, but not females, emotion regulation strategy use, use of suppression, was found to act as a mediator in the association of CWDV with affective lability. Our findings suggest that interventions for individuals with CWDV should focus on the emotional regulation, which may help them improve mental health, especially in males.
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Affiliation(s)
- Jingbo Gong
- Shanghai Changning Mental Health Center, Shanghai 200335, China
- Department of Applied Psychology, Hunan University of Chinese Medicine118393, Changsha, Hunan, China
| | - Lihua Zhou
- College of Education Science, Hengyang Normal University12573, Hengyang, Hunan, China
| | - Lishun Zhao
- Department of Applied Psychology, Hunan University of Chinese Medicine118393, Changsha, Hunan, China
| | - Shujun Zhang
- Department of Applied Psychology, Hunan University of Chinese Medicine118393, Changsha, Hunan, China
| | - Ziyi Chen
- Department of Applied Psychology, Hunan University of Chinese Medicine118393, Changsha, Hunan, China
| | - Jianbo Liu
- Department of Child Psychiatry of Shenzhen Kangning Hospital, Shenzhen Mental Health Center, School of mental health, Shenzhen University504010, Shenzhen, China
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8
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Cruz D, Lichten M, Berg K, George P. Developmental trauma: Conceptual framework, associated risks and comorbidities, and evaluation and treatment. Front Psychiatry 2022; 13:800687. [PMID: 35935425 PMCID: PMC9352895 DOI: 10.3389/fpsyt.2022.800687] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 06/27/2022] [Indexed: 11/17/2022] Open
Abstract
Children exposed to adverse childhood experiences (ACEs) and pervasive interpersonal traumas may go on to develop PTSD and, in most cases, will further undergo a significant shift in their developmental trajectory. This paper examines contemporary research on Developmental Trauma (DT), which is inextricably linked to disruptions in social cognition, physiological and behavioral regulation, and parent-child attachments. Developmental trauma associated with early experiences of abuse or neglect leads to multi-faceted and longstanding consequences and underscores critical periods of development, complex stress-mediated adaptations, and multilevel, trans-theoretical influences in the diagnostic formulation and treatment of traumatized children, adolescents, and adults. Psychological and medical correlates of Developmental Trauma Disorder are considered, and directions for future research are discussed.
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Affiliation(s)
- Daniel Cruz
- Hackensack Meridian Health Mountainside Medical Center, Montclair, NJ, United States
| | | | - Kevin Berg
- Hackensack Meridian Health Mountainside Medical Center, Montclair, NJ, United States
| | - Preethi George
- Hackensack Meridian Health Mountainside Medical Center, Montclair, NJ, United States
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Abstract
The effects of glucocorticoids on aggression can be conceptualized based on its mechanisms of action. These hormones can affect cell function non-genomically within minutes, primarily by affecting the cell membrane. Overall, such effects are activating and promote both metabolic preparations for the fight and aggressive behavior per se. Chronic increases in glucocorticoids activate genomic mechanisms and are depressing overall, including the inhibition of aggressive behavior. Finally, excessive stressors trigger epigenetic phenomena that have a large impact on brain programming and may also induce the reprogramming of neural functions. These induce qualitative changes in aggression that are deemed abnormal in animals, and psychopathological and criminal in humans. This review aims at deciphering the roles of glucocorticoids in aggression control by taking in view the three mechanisms of action often categorized as acute, chronic, and toxic stress based on the duration and the consequences of the stress response. It is argued that the tripartite way of influencing aggression can be recognized in all three animal, psychopathological, and criminal aggression and constitute a framework of mechanisms by which aggressive behavior adapts to short-term and log-term changes in the environment.
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Morán-Kneer J, Ríos U, Costa-Cordella S, Barría C, Carvajal V, Valenzuela K, Wasserman D. Childhood Trauma and Social Cognition in participants with Bipolar Disorder: The Moderating Role of Attachment. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Back SN, Schmitz M, Koenig J, Zettl M, Kleindienst N, Herpertz SC, Bertsch K. Reduced vagal activity in borderline personality disorder is unaffected by intranasal oxytocin administration, but predicted by the interaction between childhood trauma and attachment insecurity. J Neural Transm (Vienna) 2022; 129:409-419. [PMID: 35275249 PMCID: PMC9007810 DOI: 10.1007/s00702-022-02482-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 02/22/2022] [Indexed: 12/31/2022]
Abstract
Individuals with borderline personality disorder (BPD) show self-regulatory deficits, associated with reduced heart-rate variability (HRV). However, results on reduced HRV in BPD remain heterogeneous, thus encouraging the search for developmental constructs explaining this heterogeneity. The present study first examined predictors of reduced resting-state HRV in BPD, namely the interaction between self-reported adult attachment insecurity and childhood trauma. Second, we investigated if alterations in resting-state HRV are modified by intranasal oxytocin administration, as oxytocin may enhance HRV and is implicated in the interaction between childhood trauma and disturbed attachment for the pathogenesis of BPD. In a randomized, placebo-controlled trial, 53 unmedicated women with BPD and 60 healthy controls (HC) self-administered either 24 I.U. of oxytocin or placebo and underwent a 4-min electrocardiogram. Our results replicate significantly reduced HRV in women with BPD, explained up to 16% by variations in childhood trauma and attachment insecurity. At high levels of acute attachment insecurity, higher levels of childhood trauma significantly predicted reduced HRV in BPD. However, our results do not support a significant effect of oxytocin on mean HRV, and no interaction effect emerged including childhood trauma and attachment insecurity. Our findings highlight a complex interaction between reduced vagal activity and developmental factors in BPD.
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Affiliation(s)
- Sarah N Back
- Department of Psychology, Ludwig-Maximilians-University Munich, Leopoldstraße 13, 80802, Munich, Germany.
| | - Marius Schmitz
- Department of Psychology, Ludwig-Maximilians-University Munich, Leopoldstraße 13, 80802, Munich, Germany
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Julian Koenig
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Max Zettl
- Institute of Psychosocial Prevention, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Nikolaus Kleindienst
- Medical Faculty Mannheim, Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Katja Bertsch
- Department of Psychology, Ludwig-Maximilians-University Munich, Leopoldstraße 13, 80802, Munich, Germany
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
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12
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Ehrenthal JC, Zimmermann J, Brenk-Franz K, Dinger U, Schauenburg H, Brähler E, Strauß B. Evaluation of a short version of the Experiences in Close Relationships-Revised questionnaire (ECR-RD8): results from a representative German sample. BMC Psychol 2021; 9:140. [PMID: 34521473 PMCID: PMC8439023 DOI: 10.1186/s40359-021-00637-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 08/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Attachment insecurity is a prominent risk factor for the development and course of psychiatric and psychosomatic disorders. The Experiences in Close Relationships - Revised (ECR-R) questionnaire is a widely used self-report to assess attachment related anxiety and avoidance. However, its length has the potential to restrict its use in large, multi-instrument studies. The aim of this study was to develop and evaluate a brief version of the ECR-R, and provide norm values for the German population. METHODS A screening version of the original ECR-R was developed through principal components analysis of datasets from several previous studies. In a representative sample of 2428 randomly selected individuals from the German population, we compared fit indices of different models by means of confirmatory factor analyses (CFA). We investigated the convergent validity of the screening version in an independent convenience sample of 557 participants. Correlations between the short and the full scale were investigated in a re-analysis of the original German ECR-R evaluation sample. RESULTS CFA indicated a satisfactory model fit for an eight-item version (ECR-RD8). The ECR-RD8 demonstrated adequate reliability. The subscales correlated as expected with another self-report measure of attachment in an independent sample. Individuals with higher levels of attachment anxiety, but especially higher levels of attachment avoidance were significantly more likely to not be in a relationship, across all age groups. Correlations between the short and the full scale were high. CONCLUSIONS The ECR-RD8 appears to be a reliable, valid, and economic questionnaire for assessing attachment insecurity. In addition, the reported population-based norm values will help to contextualize future research findings.
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Affiliation(s)
- Johannes C Ehrenthal
- Department of Psychology, University of Cologne, Bernhard-Feilchenfeld-Str. 11, 50969, Cologne, Germany.
| | | | - Katja Brenk-Franz
- Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Jena, Germany
| | - Ulrike Dinger
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Henning Schauenburg
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Elmar Brähler
- Department of Medical Psychology and Medical Sociology, University Hospital Leipzig, Leipzig, Germany.,Department for Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Bernhard Strauß
- Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Jena, Germany
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Crow TM, Levy KN, Bradley B, Fani N, Powers A. The roles of attachment and emotion dysregulation in the association between childhood maltreatment and PTSD in an inner-city sample. CHILD ABUSE & NEGLECT 2021; 118:105139. [PMID: 34091237 PMCID: PMC8292198 DOI: 10.1016/j.chiabu.2021.105139] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 04/01/2021] [Accepted: 05/23/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Most people will experience a traumatic event in their lifetime, but only a subset (<10%) will develop posttraumatic stress disorder (PTSD). OBJECTIVE To facilitate prevention and intervention of PTSD, it is important to understand how risk and resilience factors interact with one another to explain individual differences in risk for PTSD, especially in underprivileged groups, who often experience greater burden of trauma and PTSD. METHOD The current study utilized multiple and moderated regression to examine the relation between childhood maltreatment and adulthood PTSD risk in the context of various attachment patterns and emotion dysregulation in a sample (n = 856) of mostly low-income, African American participants. RESULTS Moderation analysis indicated that the strongest association between self-reported childhood maltreatment and PTSD symptoms was manifest in participants reporting the highest levels of both attachment anxiety and attachment avoidance (b = 0.22, 95% CI [0.15, 0.29], p < .001), whereas, among those low on both these dimensions (i.e., more securely attached participants), there was no significant association between childhood maltreatment and current PTSD (b = 0.07, 95% CI [-0.01, 0.14], p = .07). Separately, multiple regression predicting current PTSD symptoms revealed an effect size for the two attachment dimensions similar to that of emotion dysregulation, while controlling for childhood maltreatment. CONCLUSIONS These findings suggest more secure attachment may buffer against the deleterious effects of childhood maltreatment, and both attachment difficulties and emotion dysregulation serve as robust correlates of adulthood PTSD.
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Affiliation(s)
- Thomas M Crow
- Department of Psychology, Pennsylvania State University, USA
| | - Kenneth N Levy
- Department of Psychology, Pennsylvania State University, USA
| | - Bekh Bradley
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, USA; Atlanta VA Medical Center, Mental Health Services, USA
| | - Negar Fani
- Emory University School of Medicine, USA
| | - Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, USA.
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Graetz C, Woeste S, Mrowietz U, Ehrenthal JC. The impact of psychological attachment on the relationship between periodontal health and dental fear in patients with versus without psoriasis: a questionnaire-based, cross-sectional study. BMC Oral Health 2021; 21:95. [PMID: 33663457 PMCID: PMC7934537 DOI: 10.1186/s12903-021-01457-8] [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] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 02/23/2021] [Indexed: 11/16/2022] Open
Abstract
Background While there is increasing evidence for the relevance of psychosocial variables such as dental fear or psychological attachment in dentistry, much less is known about the mechanisms that determine the strength of those associations. One potential moderator is the occurrence of a comorbid chronic disease such as psoriasis, which is linked to relevant disease parameters such as periodontal inflammation. The aim of the study was to test a moderation model of the relationship between dental fear, psychological attachment and psoriasis on periodontal health. Methods A total of 201 patients (100 with psoriasis, 101 without psoriasis) were included in a questionnaire-based, cross-sectional study. Dental status was measured with the Community Periodontal Index (CPI), dental fear was measured with the Hierarchical Anxiety Questionnaire (HAQ), and psychological attachment was measured with the Relationship Questionnaire (RQ). In addition to the examination of main effects, bootstrapping-based analyses were conducted to test the moderating influence of psychological attachment on the association between CPI and dental fear, gain moderated by group (with vs. without psoriasis). Results Controlling for several covariates, higher CPI scores were associated with higher levels of dental fear only in individuals without psoriasis under conditions of higher levels of psychological attachment anxiety and lower levels of attachment avoidance. Conclusion In individuals without psoriasis, psychological attachment can moderate the association between periodontal health and dental fear. This may provide a useful framework for reducing dental fear through interventions on the level of the dentist-patient relationship.
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Affiliation(s)
- Christian Graetz
- Clinic of Conservative Dentistry and Periodontology, University of Kiel, Arnold-Heller-Str. 3, Haus B, 24105, Kiel, Germany.
| | - Sirka Woeste
- Clinic of Conservative Dentistry and Periodontology, University of Kiel, Arnold-Heller-Str. 3, Haus B, 24105, Kiel, Germany
| | - Ullrich Mrowietz
- Psoriasis-Center at the Department of Dermatology, University Medical Center Schleswig-Holstein, Campus, Kiel, Germany
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15
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Dinger U, Fuchs M, Köhling J, Schauenburg H, Ehrenthal JC. Change of Emotional Experience in Major Depression and Borderline Personality Disorder During Psychotherapy: Associations With Depression Severity and Personality Functioning. J Pers Disord 2021; 35:1-20. [PMID: 30785864 DOI: 10.1521/pedi_2019_33_420] [Citation(s) in RCA: 9] [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
This study examines emotional experience in major depressive disorder (MDD) with and without comorbid borderline personality disorder (BPD). It investigates if depression severity or personality functioning mediates group differences and which aspects of emotional experience change during psychotherapy. The emotional experience of MDD-BPD patients (n = 44) was compared to MDD-only patients (n = 35) before and after multimodal short-term psychotherapy. Emotions were classified based on valence and an active/passive polarity. MDD-BPD patients exhibited more active-negative emotions. This group difference was mediated by the level of personality functioning, but not by depression severity. Although passive-negative emotions decreased and positive emotions increased during therapy, there was no significant change in active-negative emotions. The two patient groups did not significantly differ in the change of emotional experience. Lower levels of personality functioning in depressed patients with BPD are associated with a broader spectrum of negative emotions, specifically more active-negative emotions.
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16
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Lai CLJ, Lee DYH, Leung MOY. Childhood Adversities and Salivary Cortisol Responses to the Trier Social Stress Test: A Systematic Review of Studies Using the Children Trauma Questionnaire (CTQ). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:ijerph18010029. [PMID: 33374531 PMCID: PMC7793098 DOI: 10.3390/ijerph18010029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/19/2020] [Accepted: 12/20/2020] [Indexed: 12/27/2022]
Abstract
Alteration in cortisol response to acute social stressors has been hypothesized to mediate childhood adversities (CA) and increased morbidity in adulthood. However, the evidence supporting an association between CA and cortisol response to social stressors is inconclusive. The present review addressed this issue by reviewing the literature on CA and cortisol response to acute social stressors, with a focus on studies with adolescents or adults, using the Childhood Trauma Questionnaire (CTQ) to assess CA, and examining salivary cortisol response to the Trier Social Stress Test (TSST). Systematic searches of relevant articles in PsycINFO, PubMed, Web of Science and ScienceDirect in February and March 2020 identified 12 articles including 1196 participants with mean ages ranging from 15.3 to 52.3 yrs. across studies. CTQ scores were significantly associated with cortisol response in 2 studies. In addition, the physical abuse and emotional neglect subscales were associated with cortisol response respectively in 2 separate studies. The lack of association between CA and cortisol response calls for more longitudinal studies, and the use of formal records of maltreatment or informant reports in future research to complement information collected by retrospective measures. In addition, increased attention to biological mechanisms other than that associated with the regulation of cortisol in explaining the connection between CA and psychiatry morbidity is warranted.
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Affiliation(s)
- Chuk Ling Julian Lai
- Psychophysiology Laboratory, Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, China; (D.Y.H.L.); (M.O.Y.L.)
- Correspondence: ; Tel.: +852-34424306; Fax: +852-34420283
| | - Daryl Yu Heng Lee
- Psychophysiology Laboratory, Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, China; (D.Y.H.L.); (M.O.Y.L.)
- Department of Experimental Psychology, Division of Psychology and Language Sciences, University College London, London WC1H 0AP, UK
| | - Monique On Yee Leung
- Psychophysiology Laboratory, Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, China; (D.Y.H.L.); (M.O.Y.L.)
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17
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Ciocca G, Rossi R, Collazzoni A, Gorea F, Vallaj B, Stratta P, Longo L, Limoncin E, Mollaioli D, Gibertoni D, Santarnecchi E, Pacitti F, Niolu C, Siracusano A, Jannini EA, Di Lorenzo G. The impact of attachment styles and defense mechanisms on psychological distress in a non-clinical young adult sample: A path analysis. J Affect Disord 2020; 273:384-390. [PMID: 32560933 DOI: 10.1016/j.jad.2020.05.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 04/21/2020] [Accepted: 05/10/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Insecure attachment styles and immature or neurotic defense mechanisms are related to psychological distress. However, their mutual interaction in influencing psychological distress deserves further investigation. METHODS One-thousand-one-hundred-twenty-nine University students were evaluated using the Global Severity Index of Symptoms Check List 90-Revised for psychological distress, Relationship Questionnaire for attachment styles and Defense Style Questionnaire for defense mechanisms. Following exploratory analyses, a Path Analysis was performed with psychological distress as outcome. RESULTS Fearful and preoccupied attachment styles had a substantial impact on psychological distress. About 30% of their effect was mediated by Immature and Neurotic defenses, with the former having the major effect. Dismissing attachment showed no substantial effect on psychological distress. Secure Attachment and Mature Defenses had a small protective effect on psychological distress, but their inclusion in the path model did not improve overall goodness-of-fit. Attachment style and defense mechanisms accounted for nearly 25% of the variance in psychological distress. CONCLUSIONS The results showed that attachment styles and defense mechanisms have a substantial impact on psychological distress. The effect of attachment style is mediated by defense mechanisms. Individual differences in attachment style and defense mechanisms represent risk factors for psychological distress in young adults.
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Affiliation(s)
- Giacomo Ciocca
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | - Rodolfo Rossi
- Department of Systems Medicine, University of Rome Tor Vergata, Italy
| | - Alberto Collazzoni
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Italy
| | - Fiorela Gorea
- Catholic University of "Our Lady of Good Council", Tirana, Albania
| | - Blerina Vallaj
- Catholic University of "Our Lady of Good Council", Tirana, Albania
| | - Paolo Stratta
- Department of Mental Health, ASL 01 Avezzano-Sulmona-L'Aquila, Italy
| | - Lucia Longo
- Department of Systems Medicine, University of Rome Tor Vergata, Italy; Psychiatry and Clinical Psychology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Erika Limoncin
- Department of Systems Medicine, University of Rome Tor Vergata, Italy
| | - Daniele Mollaioli
- Department of Systems Medicine, University of Rome Tor Vergata, Italy
| | - Dino Gibertoni
- DIBINEM Department of Biomedical And Neuromotor Sciences, Unit of Hygiene, Public Health And Biostatistics, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Emiliano Santarnecchi
- Department of Medicine, Surgery and Neuroscience, University of Siena, Italy; Berenson-Allen Center for Non-Invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Francesca Pacitti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Italy; Catholic University of "Our Lady of Good Council", Tirana, Albania
| | - Cinzia Niolu
- Department of Systems Medicine, University of Rome Tor Vergata, Italy; Psychiatry and Clinical Psychology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Alberto Siracusano
- Department of Systems Medicine, University of Rome Tor Vergata, Italy; Psychiatry and Clinical Psychology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy
| | | | - Giorgio Di Lorenzo
- Department of Systems Medicine, University of Rome Tor Vergata, Italy; Psychiatry and Clinical Psychology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy; IRCCS Fondazione Santa Lucia, Rome, Italy.
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18
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Crow TM, Levy KN. Adult attachment anxiety moderates the relation between self-reported childhood maltreatment and borderline personality disorder features. Personal Ment Health 2019; 13:239-249. [PMID: 31571424 DOI: 10.1002/pmh.1468] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 08/16/2019] [Accepted: 08/23/2019] [Indexed: 12/21/2022]
Abstract
Childhood maltreatment is one of many risk factors for borderline personality disorder (BPD). However, not all individuals with BPD report histories of childhood maltreatment. Therefore, it is necessary to identify factors that contextualize the relation between childhood maltreatment and BPD features. With its emphasis on the developmental origins of emotion regulation, attachment theory provides a useful framework to understand how people are differentially affected by early life stress. The present study examined self-reported adult attachment as a moderator in the relation between childhood maltreatment and BPD features in a large undergraduate sample (n = 1 033). Attachment anxiety, but not attachment avoidance, moderated the relation between childhood maltreatment and BPD features, and this relation was non-significant among participants low (-1 standard deviation) in attachment anxiety. These results support the hypothesis that secure attachment in adulthood may buffer against the otherwise deleterious effects of distal risk factors on personality pathology. Future research should continue to examine this question across risk factors and across disorders. Furthermore, we suggest that researchers who have historically examined attachment as a mediator cross-sectionally should re-examine their data for evidence of a moderation effect. © 2019 John Wiley & Sons, Ltd.
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Affiliation(s)
- Thomas M Crow
- Department of Psychology, Pennsylvania State University, State College, PA, USA
| | - Kenneth N Levy
- Department of Psychology, Pennsylvania State University, State College, PA, USA
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19
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An Attachment Theoretical Perspective on Tend-and-Befriend Stress Reactions. EVOLUTIONARY PSYCHOLOGICAL SCIENCE 2019. [DOI: 10.1007/s40806-019-00197-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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Duesenberg M, Wolf OT, Metz S, Roepke S, Fleischer J, Elias V, Renneberg B, Otte C, Wingenfeld K. Psychophysiological stress response and memory in borderline personality disorder. Eur J Psychotraumatol 2019; 10:1568134. [PMID: 30788063 PMCID: PMC6374976 DOI: 10.1080/20008198.2019.1568134] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/29/2018] [Accepted: 12/29/2018] [Indexed: 10/27/2022] Open
Abstract
Background: Previously, we found that patients with borderline personality disorder (BPD) but not healthy controls (HC) showed improved memory retrieval after hydrocortisone administration. Objective: In this study, we examined whether increases in endogenous cortisol after psychosocial stress are associated with memory function in patients with BPD and in healthy individuals. Methods: We recruited 49 female patients with BPD and 49 female HC. All participants were exposed to a psychosocial stressor, the Trier Social Stress Test (TSST) and a control condition (Placebo (P-)TSST) in randomized order. Salivary cortisol, alpha amylase (sAA) and blood pressure were measured in response to stress. Subsequently, we examined free recall of a previously learned word list, autobiographical memory, and working memory. Results: We found a stress*time*group interaction effect for the cortisol response and for sAA to stress, which is mainly triggered by a slightly different increase in cortisol between groups from pre to post TSST. Furthermore, BPD patients showed a less pronounced increase in diastolic blood pressure compared to HC after stress. There was no effect of stress on memory performance in any tests, either in healthy controls or in patients with BPD. Conclusion: Our results suggest a slightly blunted response of the HPA axis and the sympathetic nervous system to stress in BPD compared to healthy women. In contrast to hydrocortisone administration, psychosocial stress did not improve memory retrieval in BPD patients. This might be explained by lower cortisol concentrations and parallel increases in norepinephrine and negative affect after stress.
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Affiliation(s)
- Moritz Duesenberg
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Berlin, Germany
| | - Oliver T Wolf
- Institute of Cognitive Neuroscience, Department of Cognitive Psychology, Ruhr University Bochum, Bochum, Germany
| | - Sophie Metz
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Berlin, Germany
| | - Stefan Roepke
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Berlin, Germany
| | - Juliane Fleischer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Berlin, Germany
| | - Valentina Elias
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Berlin, Germany
| | | | - Christian Otte
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Berlin, Germany
| | - Katja Wingenfeld
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Berlin, Germany
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21
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Drews E, Fertuck EA, Koenig J, Kaess M, Arntz A. Hypothalamic-pituitary-adrenal axis functioning in borderline personality disorder: A meta-analysis. Neurosci Biobehav Rev 2018; 96:316-334. [PMID: 30500331 DOI: 10.1016/j.neubiorev.2018.11.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/15/2018] [Accepted: 11/18/2018] [Indexed: 12/29/2022]
Abstract
Borderline Personality Disorder (BPD) has been associated with altered hypothalamic-pituitary-adrenal (HPA) axis functioning. However, evidence is inconsistent. Therefore, the present series of meta-analyses aimed to quantify HPA axis functioning in BPD patients based on singular and continuous cortisol assessments and measures of reactivity to pharmacological and psychosocial stress. Case-control studies comparing adult BPD patients and healthy and clinical controls were considered for inclusion. The search resulted in 804 publications, of which 37 studies (k = 81; BPD n = 803, controls n = 1092) were included. Analyses were based on random effect models using standardized mean differences. BPD patients displayed elevated continuous cortisol output and blunted cortisol following psychosocial challenges. Singular cortisol assessments and cortisol after pharmacological challenges were not significantly different. Meta-analyses were limited by inconsistent reporting in individual studies and small samples for some comparisons. Due to the debilitating nature of stress-related symptoms in BPD, more research on elevated continuous cortisol output and blunted cortisol responses to psychosocial stress is warranted.
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Affiliation(s)
- Elisa Drews
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany; Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands; New York State Psychiatric Institute, Columbia University, College of Physicians and Surgeons, New York, United States.
| | - Eric A Fertuck
- The City College and Graduate Center of the City University of New York, New York, United States; New York State Psychiatric Institute, Columbia University, College of Physicians and Surgeons, New York, United States
| | - Julian Koenig
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Michael Kaess
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
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22
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Kramer U. Mechanisms of Change in Treatments of Personality Disorders: Introduction to the Special Section. J Pers Disord 2018; 32:1-11. [PMID: 29388900 DOI: 10.1521/pedi.2018.32.supp.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The present introduction to the Special Section on Mechanisms of Change in Treatments of Personality Disorders explains the value of research focusing on processes of change in psychotherapy by referring to a variety of methodologies. Whereas outcome for these treatments has been repeatedly demonstrated, it remains an open question what the core psychobiological features of change are. Taking a radically empirical perspective, this introduction focuses on patient and therapeutic relationship variables, such as emotional and socio-cognitive processing. The six empirical articles of the Special Section are introduced, as are the three discussions of the Special Section.
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Affiliation(s)
- Ueli Kramer
- Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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23
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Kealy D, Ogrodniczuk JS. Mechanisms of Change in Treatments of Personality Disorders: Commentary on the Special Section. J Pers Disord 2018; 32:134-142. [PMID: 29388897 DOI: 10.1521/pedi.2018.32.supp.134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Considerable progress has been made in the psychotherapeutic treatment of patients with personality disorders (PDs). Once engendering a pervasive therapeutic nihilism, PDs are starting to be viewed as treatable with a much better prognosis than previously thought. Evidence from several randomized controlled trials demonstrating the effectiveness of various forms of psychotherapy, coupled with findings from several longitudinal studies, suggests that such increased clinical optimism is warranted. However, the persistent focus on treatment brands obscures our understanding of the mechanisms through which benefits are actually realized. This article considers emerging trends in PD treatment research, exemplified by the series of articles contained within this special section, that attempt to identify more precisely the mechanisms of therapeutic change. It is only through such work that we will be able to accomplish further refinement of effective strategies, create possibilities for true integration of therapies, and achieve real progress in the field for the betterment of our patients.
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Affiliation(s)
| | - John S Ogrodniczuk
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
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24
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Gunderson JG. Mechanisms of Change in Treatments of Personality Disorders: Commentary on the Special Section. J Pers Disord 2018; 32:129-133. [PMID: 29388893 DOI: 10.1521/pedi.2018.32.supp.129] [Citation(s) in RCA: 1] [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
Ueli Kramer has assembled an eclectic and original set of articles on mechanisms of change in the treatment of borderline personality disorder. They largely focus on patient variables. Several authors make the point that developmentally based variables may have more predictive power than symptom-based variables. Several other articles illustrate that changes occur early in treatments and studying their mechanisms is a promising approach that could have longer term significance. These articles document the variety of research methodologies that can be used to study mechanisms of change and the potential clinical significance of doing this. For showing the field the potential of such research, we owe Dr. Kramer our gratitude.
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Affiliation(s)
- John G Gunderson
- McLean Hospital and Harvard Medical School, Belmont, Massachusetts
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25
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Aafjes-van Doorn K, Barber JP. Mechanisms of Change in Treatments of Personality Disorders: Commentary on the Special Section. J Pers Disord 2018; 32:143-151. [PMID: 29388898 DOI: 10.1521/pedi.2018.32.supp.143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Personality disorders (PDs) come in a large variety of presentations, severely affect the individual's social and emotional functioning, and are notoriously complex to treat. To make treatments for individuals with PDs more potent, there is a need to better understand how and why these treatments work. The articles assembled for this special section propose potential mechanisms of change within PD patients that may be addressed in future process-outcome research. Although the studies are exploratory and were limited by their scope and heterogeneity of their samples, they illustrate the importance of process research as nomothetic and idiographic building blocks toward a multifaceted understanding of change processes in PDs and their treatment. In this discussion, the authors aim to foster interest in the potential mechanisms of change in PD treatments and inspire further research by providing several methodological considerations for future process-outcome research and its potential clinical implications.
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Affiliation(s)
| | - Jacques P Barber
- Gordon F. Derner School of Psychology, Adelphi University, Garden City, New York
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