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Tomasetti C, Autullo G, Ballerini A, de Bartolomeis A, Dell'Osso B, Fiorentini A, Tonioni F, Villari V, De Berardis D. Treating depression in patients with borderline personality disorder: clinical clues on the use of antidepressants. Ann Gen Psychiatry 2024; 23:21. [PMID: 38816843 PMCID: PMC11140967 DOI: 10.1186/s12991-024-00507-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 05/23/2024] [Indexed: 06/01/2024] Open
Abstract
Personality disorders (PD) are described as enduring patterns of markedly deviant and pervasive inner experiences and behaviors, with onset in adolescence, which lead to severe distress or impairment. Patients suffering from major depressive disorder (MDD) display higher rates of comorbidity with personality disorders, often complicating the treatment, and worsening the outcomes. Borderline personality disorder (BPD) is the most common of PD and is frequently associated with MDD, with which shares several features. The most part of research agrees on the fact that comorbid BPD in MDD patients quite doubles the poor response to treatments. Moreover, no treatment strategy stands out currently to emerge as more effective in these cases, thus urging the call for the need of new approaches. Herein, we revise the current literature on BPD, its neurobiology and comorbidity with MDD, as well as the more recent treatment strategies used. Then, based on its pharmacology, we propose a possible role of trazodone as a valuable tool to approach comorbid BPD-MDD.
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Affiliation(s)
- Carmine Tomasetti
- Department of Mental Health, Alzheimer Center of Giulianova, Hospital "Maria SS dello Splendore", ASL Teramo, Giulianova (TE), Italy.
| | - G Autullo
- Psychiatry and Psychology Institute, Catholic University of Sacred Heart of Rome, Rome, Italy
| | - A Ballerini
- Psychiatry Unit, Department of Health Science, University of Florence, Largo Brambilla 3, Florence, 50134, Italy
| | - A de Bartolomeis
- Laboratory of Molecular and Translational Psychiatry and Unit of Treatment Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Science and Dentistry, University of Naples "Federico II", Naples, Italy
| | - B Dell'Osso
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
| | - A Fiorentini
- Department of Neurosciences and Mental Health, Ca' Granda Ospedale Maggiore Policlinico, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), University of Milan, Milan, Italy
| | - F Tonioni
- Psychiatric Emergency Service, Department of Neuroscience and Mental Health, A.O.U. "Città della Salute e della Scienza", Turin, Italy
| | - V Villari
- Psychiatry and Psychology Institute, Catholic University of Sacred Heart of Rome, Rome, Italy
| | - D De Berardis
- Department of Mental Health, Mental Health Center of Giulianova, ASL Teramo, Teramo, Italy
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Ehrenthal JC, Kruse J, Schmalbach B, Dinger U, Werner S, Schauenburg H, Brähler E, Kampling H. Measuring personality functioning with the 12-item version of the OPD-Structure Questionnaire (OPD-SQS): reliability, factor structure, validity, and measurement invariance in the general population. Front Psychol 2023; 14:1248992. [PMID: 37780157 PMCID: PMC10536238 DOI: 10.3389/fpsyg.2023.1248992] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/17/2023] [Indexed: 10/03/2023] Open
Abstract
Background The assessment of personality functioning is at the core of current dimensional models of personality disorders. A variety of measures from different clinical and research traditions aim to assess basic psychological capacities regarding the self and others. While some instruments have shown reliability and validity in clinical or other selected samples, much less is known about their performance in the general population. Methods In three samples representative of the German adult population with a total of 7,256 participants, levels of personality functioning were measured with the short 12-item version of the Operationalized Psychodynamic Diagnosis - Structure Questionnaire (OPD-SQS). We addressed questions of factor structure, reliability, validity, factorial invariance, and provide norm values. Results Confirmatory factor analysis indicated a satisfactory to good model fit. OPD-SQS models were mostly unaffected by variables such as gender, age, or measurement time. As expected, personality functioning was associated with general psychopathology as well as indices of occupational functioning. Conclusion The OPD-SQS is a viable measure to assess personality functioning in the general population.
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Affiliation(s)
| | - Johannes Kruse
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
- Department for Psychosomatic Medicine and Psychotherapy, Medical Center of the Philipps University Marburg, Marburg, Germany
| | - Bjarne Schmalbach
- Department of Medical Psychology and Medical Sociology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Ulrike Dinger
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Samuel Werner
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
| | - Henning Schauenburg
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- Department of Medical Psychology and Medical Sociology, University Hospital Leipzig, Leipzig, Germany
| | - Hanna Kampling
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
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Davanzo A, D Huart D, Seker S, Moessner M, Zimmermann R, Schmeck K, Behn A. Study Features and Response Compliance in Ecological Momentary Assessment Research in Borderline Personality Disorder: Systematic Review and Meta-analysis. J Med Internet Res 2023; 25:e44853. [PMID: 36920466 PMCID: PMC10131785 DOI: 10.2196/44853] [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: 12/06/2022] [Revised: 01/17/2023] [Accepted: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Borderline personality disorder (BPD) is characterized by frequent and intense moment-to-moment changes in affect, behavior, identity, and interpersonal relationships, which typically result in significant and negative deterioration of the person's overall functioning and well-being. Measuring and characterizing the rapidly changing patterns of instability in BPD dysfunction as they occur in a person's daily life can be challenging. Ecological momentary assessment (EMA) is a method that can capture highly dynamic processes in psychopathology research and, thus, is well suited to study intense variability patterns across areas of dysfunction in BPD. EMA studies are characterized by frequent repeated assessments that are delivered to participants in real-life, real-time settings using handheld devices capable of registering responses to short self-report questions in daily life. Compliance in EMA research is defined as the proportion of prompts answered by the participant, considering all planned prompts sent. Low compliance with prompt schedules can compromise the relative advantages of using this method. Despite the growing EMA literature on BPD in recent years, findings regarding study design features that affect compliance with EMA protocols have not been compiled, aggregated, and estimated. OBJECTIVE This systematic meta-analytic review aimed to investigate the relationship between study design features and participant compliance in EMA research of BPD. METHODS A systematic review was conducted on November 12, 2021, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and MOOSE (Meta-analyses of Observational Studies in Epidemiology) guidelines to search for articles featuring EMA studies of BPD that reported compliance rates and included sufficient data to extract relevant design features. For studies with complete data, random-effect models were used to estimate the overall compliance rate and explore its association with design features. RESULTS In total, 28 peer-reviewed EMA studies comprising 2052 participants were included in the study. Design features (sampling strategy, average prompting frequency, number of items, response window, sampling device, financial incentive, and dropout rate) showed a large variability across studies, and many studies did not report design features. The meta-analytic synthesis was restricted to 64% (18/28) of articles and revealed a pooled compliance rate of 79% across studies. We did not find any significant relationship between design features and compliance rates. CONCLUSIONS Our results show wide variability in the design and reporting of EMA studies assessing BPD. Compliance rates appear to be stable across varying setups, and it is likely that standard design features are not directly responsible for improving or diminishing compliance. We discuss possible nonspecific factors of study design that may have an impact on compliance. Given the promise of EMA research in BPD, we also discuss the importance of unifying standards for EMA reporting so that data stemming from this rich literature can be aggregated and interpreted jointly.
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Affiliation(s)
- Antonella Davanzo
- Escuela de Psicología, Pontificia Universidad Católica de Chile, Instituto Milenio para la Investigación en Depresión y Personalidad, Santiago, Chile
| | - Delfine D Huart
- Department of Child and Adolescent Psychiatry Research, University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Süheyla Seker
- Department of Child and Adolescent Psychiatry Research, University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Markus Moessner
- University Hospital Heidelberg, Center for Psychotherapy Research, Heidelberg, Germany
| | - Ronan Zimmermann
- Department of Child and Adolescent Psychiatry Research, University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Klaus Schmeck
- Department of Child and Adolescent Psychiatry Research, University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Alex Behn
- Escuela de Psicología, Pontificia Universidad Católica de Chile, Instituto Milenio para la Investigación en Depresión y Personalidad, Santiago, Chile
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Fitzpatrick S, Varma S, Kuo JR. Is borderline personality disorder really an emotion dysregulation disorder and, if so, how? A comprehensive experimental paradigm. Psychol Med 2022; 52:2319-2331. [PMID: 33198829 DOI: 10.1017/s0033291720004225] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Leading theories suggest that borderline personality disorder (BPD) is an emotion dysregulation disorder involving lower basal vagal tone, higher baseline emotion, heightened emotional reactivity, delayed emotional recovery, and emotion regulation deficits. However, the literature to date lacks a unifying paradigm that tests all of the main emotion dysregulation components and comprehensively examines whether BPD is an emotion dysregulation disorder and, if so, in what ways. This study addresses the empirical gaps with a unified paradigm that assessed whether BPD is characterized by five leading emotion dysregulation components compared to generalized anxiety disorder (GAD) and healthy control (HC) groups. METHODS Emotion was assessed across self-report, sympathetic, and parasympathetic indices. Participants with BPD, GAD, and HCs (N = 120) first underwent baseline periods assessing basal vagal tone and baseline emotional intensity, followed by rejection-themed stressors assessing emotional reactivity. Participants then either reacted normally to assess emotional recovery or attempted to decrease emotion using mindfulness or distraction to assess emotion regulation implementation deficits. RESULTS Individuals with BPD and GAD exhibited higher self-reported and sympathetic baseline emotion compared to HCs. The BPD group also exhibited self-reported emotion regulation deficits using distraction only compared to the GAD group. CONCLUSIONS There is minimal support for several emotion dysregulation components in BPD, and some components that are present appear to be pervasive across high emotion dysregulation groups rather than specific to BPD. However, BPD may be characterized by problems disengaging from emotion using distraction.
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Affiliation(s)
| | - Sonya Varma
- Department of Psychology, York University, Canada
| | - Janice R Kuo
- Department of Psychology, Palo Alto University, USA
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5
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Peters EM, Dong LY, Thomas T, Khalaj S, Balbuena L, Baetz M, Osgood N, Bowen R. Instability of Suicidal Ideation in Patients Hospitalized for Depression: An Exploratory Study Using Smartphone Ecological Momentary Assessment. Arch Suicide Res 2022; 26:56-69. [PMID: 32654657 DOI: 10.1080/13811118.2020.1783410] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
This study used ecological momentary assessment (EMA) to explore the correlates of suicidal ideation (SI) instability in patients hospitalized for depression and SI. Thirty-nine adult inpatients were given smartphones with visual analogue scales to rate current depressed mood, anger/irritability, feeling socially connected, and SI three times a day throughout hospitalization. Affective Lability Scales (ALS) were also completed at baseline. SI instability was correlated with SI intensity, depressed mood instability, and social connection instability. Social connection instability was not associated with SI instability after controlling for depressed mood instability. ALS scores were not associated with EMA-derived SI instability. Participants with multiple past suicide attempts experienced greater SI instability. More research examining the clinical significance of SI instability is warranted.
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6
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Lorenzini N, de la Parra G, Dagnino P, Gomez-Barris E, Crempien C, Ehrenthal JC. Chilean validation of the operationalized psychodynamic diagnosis-structure questionnaire (OPD-SQ) for personality structure. BMC Psychol 2021; 9:139. [PMID: 34517907 PMCID: PMC8436439 DOI: 10.1186/s40359-021-00640-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 08/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background This is the validation of the Operationalized Psychodynamic Diagnosis—Structure Questionnaire (OPD-SQ). Methods A clinical sample of 399 adults and a nonclinical general population sample of 50 healthy adults completed measures of depression, attachment, psychiatric symptomatology and distress. Internal consistency and concurrent validity were assessed. Test–retest and Reliable Change Index were also calculated, as was the ability of the OPD-SQ to distinguish between the clinical and general population groups. Results High internal consistencies were found; significant differences between clinical and nonclinical samples, and significant associations with psychiatric symptomatology, depression and psychological distress. Conclusion The Chilean OPD-SQ has good reliability, and discriminates between clinical and healthy samples.
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Affiliation(s)
- Nicolás Lorenzini
- Psychoanalysis Unit, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - G de la Parra
- Department of Psychiatry, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Chile. .,Millenium Institute for Research on Depression and Personality - MIDAP, Santiago, Chile.
| | - P Dagnino
- Millenium Institute for Research on Depression and Personality - MIDAP, Santiago, Chile.,Faculty of Psychology, Universidad Alberto Hurtado, Santiago, Chile
| | - E Gomez-Barris
- Department of Psychiatry, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Chile.,Millenium Institute for Research on Depression and Personality - MIDAP, Santiago, Chile
| | - C Crempien
- Millenium Institute for Research on Depression and Personality - MIDAP, Santiago, Chile
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Hörz-Sagstetter S, Ohse L, Kampe L. Three Dimensional Approaches to Personality Disorders: a Review on Personality Functioning, Personality Structure, and Personality Organization. Curr Psychiatry Rep 2021; 23:45. [PMID: 34181116 PMCID: PMC8238706 DOI: 10.1007/s11920-021-01250-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW The concept of personality functioning (Alternative DSM-5 Model of Personality Disorders) has led to increased interest in dimensional personality disorder diagnosis. While differing markedly from the current categorical classification, it is closely related to the psychodynamic concepts of personality structure and personality organization. In this review, the three dimensional approaches, their underlying models, and common instruments are introduced, and empirical studies on similarities and differences between the concepts and the categorical classification are summarized. Additionally, a case example illustrates the clinical application. RECENT FINDINGS Numerous studies demonstrate the broad empirical basis, validated assessment instruments and clinical usefulness of the dimensional concepts. Their advantages compared to the categorical approach, but also the respective differences, have been demonstrated empirically, in line with clinical observations. Evidence supports the three dimensional concepts, which share conceptual overlap, but also entail unique aspects of personality pathology, respectively.
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Affiliation(s)
| | - Ludwig Ohse
- Psychologische Hochschule Berlin (PHB), Am Köllnischen Park 2, 10179, Berlin, Germany
| | - Leonie Kampe
- Psychologische Hochschule Berlin (PHB), Am Köllnischen Park 2, 10179, Berlin, Germany
- Zentrum für Psychosoziale Medizin, Klinikum Itzehoe, Germany
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8
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Jauk E, Ehrenthal JC. Self-Reported Levels of Personality Functioning from the Operationalized Psychodynamic Diagnosis (OPD) System and Emotional Intelligence Likely Assess the Same Latent Construct. J Pers Assess 2021; 103:365-379. [PMID: 32631173 PMCID: PMC7611281 DOI: 10.1080/00223891.2020.1775089] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/17/2020] [Indexed: 02/08/2023]
Abstract
We tested the hypothesis that structural integration, as assessed in the Operationalized Psychodynamic Diagnosis (OPD) system, and emotional intelligence (EI), as studied in personality psychology, might be closely related constructs at a general level, as both might assess general personality functioning. In three studies (n1 = 166, n2 = 204, n3 = 349), we used a self-report measure of OPD structural integration and measures of Trait and Ability EI. Structural integration and Trait EI display very high correlation at general factor level (r = .77 - .82) and almost perfect latent correlation (r = .85 - .90). This correlation cannot be explained away by the general positivity of self-views or socially desirable responding. There is also substantial latent correlation between structural integration and Ability EI (r = .20 - .65). Results replicate over different samples from different countries and extend to the DSM-5 self-report personality functioning scale.
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Affiliation(s)
- Emanuel Jauk
- Clinical Psychology and Behavioral Neuroscience, Technische Universität Dresden, Dresden, Germany
- Department of Psychology, University of Graz, Graz, Austria
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9
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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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10
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Sinnaeve R, Vaessen T, van Diest I, Myin-Germeys I, van den Bosch LMC, Vrieze E, Kamphuis JH, Claes S. Investigating the stress-related fluctuations of level of personality functioning: A critical review and agenda for future research. Clin Psychol Psychother 2021; 28:1181-1193. [PMID: 33590556 DOI: 10.1002/cpp.2566] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 01/28/2021] [Indexed: 12/14/2022]
Abstract
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the International Classification of Diseases (ICD-11) proposed a dimensional approach to the assessment of personality disorders (PDs). Both models dictate that the clinician first determines PD severity before assessing maladaptive traits, invoking the level of personality functioning (LPF) construct. We consider LPF a promising dimensional construct for translational research because of its clinical importance and conceptual overlap with the Research Domain Criteria (RDoC) Social Processes. We aim to identify biomarkers that co-vary with fluctuations in LPF in adulthood, ultimately to predict persistent decrease in LPF, associated with suicidality and morbidity. However, a theoretical framework to investigate stress-related oscillations in LPF is currently missing. In this article, we aim to fill this hiatus with a critical review about stress and LPF. First, we discuss acute stress and LPF. We briefly present the basics of the neurophysiological stress response and review the literature on momentary and daily fluctuations in LPF, both at a subjective and physiological level. Second, we review the effects of chronic stress on brain function and social behaviour and recapitulate the main findings from prospective cohort studies. This review underlies our suggestions for multimethod assessment of stress-related oscillations in LPF and our theoretical framework for future longitudinal studies, in particular studies using the experience sampling method (ESM).
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Affiliation(s)
- Roland Sinnaeve
- University Psychiatric Center KU Leuven, Kortenberg, Belgium.,Department of Neurosciences, Mind Body Research, KU Leuven, Leuven, Belgium
| | - Thomas Vaessen
- Department of Neurosciences, Mind Body Research, KU Leuven, Leuven, Belgium.,Department of Neurosciences, Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Ilse van Diest
- Faculty of Psychology and Educational Sciences, Health Psychology Research Group, KU Leuven, Leuven, Belgium
| | - Inez Myin-Germeys
- Department of Neurosciences, Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | | | - Elske Vrieze
- University Psychiatric Center KU Leuven, Kortenberg, Belgium.,Department of Neurosciences, Mind Body Research, KU Leuven, Leuven, Belgium
| | - Jan Henk Kamphuis
- Faculty of Social and Behavioural Sciences, Programme group Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Stephan Claes
- University Psychiatric Center KU Leuven, Kortenberg, Belgium.,Department of Neurosciences, Mind Body Research, KU Leuven, Leuven, Belgium
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11
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Einsatz internetbasierter Verlaufsmessung in der Psychotherapieforschung. PSYCHOTHERAPEUT 2020. [DOI: 10.1007/s00278-020-00461-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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12
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Sperry SH, Walsh MA, Kwapil TR. Emotion dynamics concurrently and prospectively predict mood psychopathology. J Affect Disord 2020; 261:67-75. [PMID: 31600589 DOI: 10.1016/j.jad.2019.09.076] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 09/04/2019] [Accepted: 09/30/2019] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Altered emotion dynamics may represent a transdiagnostic risk factor for mood psychopathology. The present study examined whether altered emotion dynamics were associated with bipolar and depressive psychopathology concurrently and at a three-year follow-up. METHODS At baseline (n = 138), participants completed diagnostic interviews, questionnaires, and seven days of experience sampling assessments. Four emotion dynamics were computed for negative affect (NA) and positive affect (PA) - within-person variance (variability), mean square of successive differences and probability of acute change (instability), and autocorrelation (inertia). At the three-year follow-up, participants (n = 108) were re-assessed via interviews and questionnaires. RESULTS NA variability was associated with bipolar spectrum disorders at baseline and follow-up. NA instability predicted depressive symptoms and hypomanic personality at baseline, and bipolar spectrum disorders at the follow-up. NA inertia did not predict diagnoses or symptoms at either assessment. PA inertia predicted hyperthymic temperament at baseline but not follow-up. Notably, NA variability and instability predicted the development of new bipolar spectrum disorders at the follow-up. LIMITATIONS Consistent with the recruitment strategy and young age of the participants, only 50% had developed diagnosable psychopathology by the time of the follow-up assessment. CONCLUSIONS The present study provided a unique demonstration that altered emotion dynamics differentially predicted bipolar and depressive psychopathology concurrently and prospectively. Emotion dynamics are important to both digital phenotyping and mobile-based interventions as emotional instability offers a measurable risk factor that is identifiable prior to illness onset.
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Affiliation(s)
- Sarah H Sperry
- University of Illinois, Urbana-Champaign, IL, United States.
| | - Molly A Walsh
- University of North Carolina, Greensboro, NC, United States
| | - Thomas R Kwapil
- University of Illinois, Urbana-Champaign, IL, United States; University of North Carolina, Greensboro, NC, United States
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13
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Yaroslavsky I, Napolitano SC, France CM. Ruminative responses to interpersonal precipitants mediate borderline personality disorder features’ effects on distress reactivity and recovery in daily life. J Clin Psychol 2019; 75:2188-2209. [DOI: 10.1002/jclp.22839] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Ilya Yaroslavsky
- Department of PsychologyCleveland State University Cleveland Ohio
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14
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Vardy Y, Day NJS, Grenyer BFS. Development and validation of an experience of time alone scale for borderline personality disorder. PLoS One 2019; 14:e0217350. [PMID: 31120954 PMCID: PMC6532922 DOI: 10.1371/journal.pone.0217350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 05/09/2019] [Indexed: 12/11/2022] Open
Abstract
Background/Objective Intolerance of aloneness is considered a core feature of borderline personality disorder (BPD) that is clinically significant, yet under-researched. This study developed a measure of aloneness for individuals with BPD. Method Interviews investigating the experience of aloneness for BPD participants (n = 12) formed the basis for the development of the measure. Pilot testing then occurred with BPD participants, control participants and qualified respondents. Validity, reliability and factor analysis of an Experience of Time Alone Scale (ETAS) was conducted with BPD participants (n = 112) and a comparison control group (n = 105). Results A three factor structure was revealed: (a) Cannot Cope Alone (α = .92), (b) Need to Escape from Others (α = .90), and (c) Consumed in Intolerable Distress (α = .88). The measure correlated significantly (p < .01) with the Mental Health Inventory, the Aloneness and Evocative Memory Scale, and the Hurvich Experience Inventory- Revised. Comparisons revealed highly significant differences between the BPD sample and control group on all subscales and the total score (U = 75.5, p = < .001, r = -.85). Conclusions This study represents one of the first empirical examinations of a construct that has largely only been studied theoretically. This newly developed measure may contribute to diagnosis and therapy.
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Affiliation(s)
- Yvette Vardy
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Nicholas J. S. Day
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Brin F. S. Grenyer
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
- * E-mail:
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15
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Current State and Future Directions of Technology-Based Ecological Momentary Assessment and Intervention for Major Depressive Disorder: A Systematic Review. J Clin Med 2019; 8:jcm8040465. [PMID: 30959828 PMCID: PMC6518287 DOI: 10.3390/jcm8040465] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 03/26/2019] [Accepted: 04/01/2019] [Indexed: 12/20/2022] Open
Abstract
Ecological momentary assessment (EMA) and ecological momentary intervention (EMI) are alternative approaches to retrospective self-reports and face-to-face treatments, and they make it possible to repeatedly assess patients in naturalistic settings and extend psychological support into real life. The increase in smartphone applications and the availability of low-cost wearable biosensors have further improved the potential of EMA and EMI, which, however, have not yet been applied in clinical practice. Here, we conducted a systematic review, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, to explore the state of the art of technology-based EMA and EMI for major depressive disorder (MDD). A total of 33 articles were included (EMA = 26; EMI = 7). First, we provide a detailed analysis of the included studies from technical (sampling methods, duration, prompts), clinical (fields of application, adherence rates, dropouts, intervention effectiveness), and technological (adopted devices) perspectives. Then, we identify the advantages of using information and communications technologies (ICTs) to extend the potential of these approaches to the understanding, assessment, and intervention in depression. Furthermore, we point out the relevant issues that still need to be addressed within this field, and we discuss how EMA and EMI could benefit from the use of sensors and biosensors, along with recent advances in machine learning for affective modelling.
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Emotion Vulnerability in the Context of Positively Valenced Stimuli: Associations with Borderline Personality Disorder Symptom Severity. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2019. [DOI: 10.1007/s10862-019-09730-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Peters EM, John A, Baetz M, Balbuena L. Examining the role of borderline personality traits in the relationship between major depression and nonsuicidal self-injury. Compr Psychiatry 2018; 86:96-101. [PMID: 30089275 DOI: 10.1016/j.comppsych.2018.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 06/28/2018] [Accepted: 07/23/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Depression and borderline personality disorder (BPD) are highly comorbid conditions that are both associated with nonsuicidal self-injury (NSSI). AIMS The purpose of this study was to determine if depression is associated with NSSI after controlling for BPD traits. A distinction was made between NSSI for emotional regulation and NSSI for interpersonal motives. METHOD Logistic regression analyses were conducted on cross-sectional data from a general population sample of 7370 adults who completed the 2007 Adult Psychiatric Morbidity Survey. Depressive symptoms were assessed with the revised Clinical Interview Schedule. NSSI and motives for NSSI were also assessed during clinical interviews. BPD traits were assessed with the participant-completed Structured Clinical Interview for DSM-IV Axis II Personality Disorders. RESULTS Participants in a major depressive episode were more likely to have engaged in emotional-regulation NSSI and interpersonal NSSI than participants without depression. After controlling for BPD traits depression remained associated with emotional-regulation NSSI, whereas the association with interpersonal NSSI became nonsignificant. There were statistically significant relationships between depression and both types of NSSI occurring indirectly through BPD traits. CONCLUSIONS BPD traits account for a significant portion of the cross-sectional relationship between depression and past NSSI that varies in size depending on the motive for NSSI. People with depression are more likely to have engaged in NSSI for emotional regulation even in the absence of prominent BPD traits. In contrast, BPD traits may be more prominent in people with depression who have engaged in interpersonal NSSI.
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Affiliation(s)
- Evyn M Peters
- Department of Psychiatry, University of Saskatchewan, Saskatoon, Saskatchewan S7N0W8, Canada.
| | - Ann John
- Swansea University Medical School, Swansea University, Swansea, Wales SA28PP, United Kingdom
| | - Marilyn Baetz
- Department of Psychiatry, University of Saskatchewan, Saskatoon, Saskatchewan S7N0W8, Canada
| | - Lloyd Balbuena
- Department of Psychiatry, University of Saskatchewan, Saskatoon, Saskatchewan S7N0W8, Canada
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Kim MK, Kim JS, Park HI, Choi SW, Oh WJ, Seok JH. Early life stress, resilience and emotional dysregulation in major depressive disorder with comorbid borderline personality disorder. J Affect Disord 2018; 236:113-119. [PMID: 29730510 DOI: 10.1016/j.jad.2018.04.119] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 03/17/2018] [Accepted: 04/08/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Borderline personality disorder (BPD) show different course and treatment compared to major depressive disorder (MDD). Early life stress may increase BPD onset; however, resilience may play a protective role against the development of psychopathology. The goal of this study was to compare the early life stress, resilience, and the clinical characteristics of emotional dysregulation in patients with MDD with and without comorbid BPD. METHODS Thirty patients with both BPD and MDD, 25 patients with MDD alone, and 25 age- and sex- matched healthy controls, participated in this study. Analysis of variance was used to compare the early life stress, resilience, and emotional dysregulation among groups. Also, multivariate logistic regression models were used to identify the relationship of the early life stress and resilience domains with BPD comorbidity within MDD patients. RESULTS The domains of emotional abuse and self-regulation ability were significantly associated with BPD comorbidity and BPD severity. In emotional dysregulation, difficulty scores of impulsivity, coping strategies, and emotion clarity domains were significantly increased in patients with both BPD and MDD compared to patients with MDD alone. LIMITATIONS The relatively small sample size may contribute to reduce statistical power of investigation. CONCLUSIONS Emotional abuse experiences in early life, and deficits in self-regulation, are significantly associated with comorbid BPD in patients with MDD. A comprehensive evaluation including early life stress, resilience and emotion regulation ability may help to identify comorbid BPD in patients with MDD and develop treatment strategies.
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Affiliation(s)
- Min-Kyeong Kim
- Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong-Sun Kim
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hae-In Park
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sun-Woo Choi
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Wook-Jin Oh
- Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Ho Seok
- Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Ehrenthal JC, Levy KN, Scott LN, Granger DA. Attachment-Related Regulatory Processes Moderate the Impact of Adverse Childhood Experiences on Stress Reaction in Borderline Personality Disorder. J Pers Disord 2018; 32:93-114. [PMID: 29388902 PMCID: PMC5798009 DOI: 10.1521/pedi.2018.32.supp.93] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In this study, the authors explored whether attachment insecurity moderates the effects of adverse childhood experiences on stress reactivity in the context of borderline personality disorder (BPD). Participants were 113 women (39 with BPD, 15 with some BPD criteria present, 59 without any BPD symptoms) who participated in the Trier Social Stress Test. Saliva samples were collected before and after the stressor and assayed for salivary alpha-amylase (sAA) and cortisol. Adverse childhood experiences were measured using the Childhood Trauma Questionnaire, and attachment by the Experiences in Close Relationships-Revised questionnaire. Results revealed that attachment avoidance and a combination of more adverse childhood experiences and attachment insecurity resulted in higher sAA levels and differences in reactivity to the stressor. Interactions between attachment anxiety and adverse childhood experiences were related to blunted cortisol reactivity. The results suggest that the influence of adverse childhood experiences on stress regulation in BPD may be moderated by attachment-related regulatory processes.
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Affiliation(s)
- Johannes C. Ehrenthal
- Department of Psychology, Pennsylvania State University
- Department of Psychology, Klagenfurt University, Austria
| | | | - Lori N. Scott
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Douglas A. Granger
- Institute for Interdisciplinary Salivary Bioscience Research, University of California at Irvine
- Johns Hopkins University School of Medicine; Johns Hopkins University Bloomberg School of Public Health; Johns Hopkins University School of Nursing
- Department of Psychology and Salivary Bioscience Laboratory, University of Nebraska
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Mneimne M, Fleeson W, Arnold EM, Furr RM. Differentiating the everyday emotion dynamics of borderline personality disorder from major depressive disorder and bipolar disorder. Personal Disord 2017; 9:192-196. [PMID: 28557468 DOI: 10.1037/per0000255] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A major barrier to the understanding of emotion dynamics in borderline personality disorder (BPD) lies in its substantial comorbidity with major depressive disorder (MDD) and bipolar disorder (BD). Whereas BPD has often been characterized in terms of dynamic emotional processes, including instability, reactivity, and inertia, its substantial comorbidity with MDD and BD makes it difficult to discern the specificity of these dynamics. To differentiate the emotion dynamics of BPD from those of MDD and BD, an experience sampling study of 38 participants with BPD, 15 participants with MDD, 14 participants with BD, and 62 healthy controls obtained reports of interpersonal challenges and emotions 5 times daily for 2 weeks. Interpersonal challenges included rejection, betrayal, abandonment, offense, disappointment, and self-image challenge; emotions included anger, excitement, guilt, happiness, irritability, and shame. Multilevel analyses revealed that heightened interpersonal reactivity of guilt and shame and heightened inertia of shame were relatively specific to BPD. These findings could not be accounted for by the presence of current MDD or BD. By contrast, heightened instability of anger and irritability and heightened inertia of irritability appeared to be largely transdiagnostic. Implications for clinical assessment, research, and theory are discussed. (PsycINFO Database Record
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Kockler TD, Tschacher W, Santangelo PS, Limberger MF, Ebner-Priemer UW. Specificity of emotion sequences in borderline personality disorder compared to posttraumatic stress disorder, bulimia nervosa, and healthy controls: an e-diary study. Borderline Personal Disord Emot Dysregul 2017; 4:26. [PMID: 29276606 PMCID: PMC5738798 DOI: 10.1186/s40479-017-0077-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 12/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with borderline personality disorder (BPD) exhibit dysregulated emotion sequences in daily life compared to healthy controls (HC). Empirical evidence regarding the specificity of these findings is currently lacking. METHODS To replicate dysregulated emotion sequences in patients with BPD and to investigate the specificity of the sequences, we used e-diaries of 43 female patients with BPD, 28 patients with posttraumatic stress disorder (PTSD), 20 patients with bulimia nervosa (BN), and 28 HC. To capture the rapid dynamics of emotions, we prompted participants every 15 min over a 24-h period to assess their current perceived emotions. We analyzed group differences in terms of activation, persistence, switches, and down-regulation of emotion sequences. RESULTS By comparing patients with BPD to HC, we replicated five of the seven previously reported dysregulated emotion sequences, as well as 111 out of 113 unaltered sequences. However, none of the previously reported dysregulated emotion sequences exhibited specificity, i.e., none revealed higher frequencies compared to the PTSD group or the BN group. Beyond these findings, we revealed a specific finding for patients with BN, as they most frequently switched from anger to disgust. CONCLUSIONS Replicating previously found dysregulated and unaltered emotional sequences strengthens the significance of emotion sequences. However, the lack of specificity points to emotion sequences as transdiagnostic features.
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Affiliation(s)
- Tobias D Kockler
- Karlsruhe Institute of Technology, Mental mHealth Lab, Karlsruhe, Germany
| | - Wolfgang Tschacher
- University of Bern, University Hospital of Psychiatry, Bern, Switzerland
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Santangelo PS, Koenig J, Funke V, Parzer P, Resch F, Ebner-Priemer UW, Kaess M. Ecological Momentary Assessment of Affective and Interpersonal Instability in Adolescent Non-Suicidal Self-Injury. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2016; 45:1429-1438. [DOI: 10.1007/s10802-016-0249-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Grambal A, Prasko J, Kamaradova D, Latalova K, Holubova M, Sedláčková Z, Hruby R. Quality of life in borderline patients comorbid with anxiety spectrum disorders - a cross-sectional study. Patient Prefer Adherence 2016; 10:1421-33. [PMID: 27536074 PMCID: PMC4975144 DOI: 10.2147/ppa.s108777] [Citation(s) in RCA: 8] [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] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Borderline personality disorder (BPD) significantly reduces the quality of life (QoL) in mental, social, and work domains. Patients with BPD often suffer from depressive anxiety symptoms. The purpose of this cross-sectional study was to compare the QoL and demographic and clinical factors of inpatients diagnosed with BPD and comorbid anxiety spectrum disorders, and healthy controls. METHODS Ninety-two hospitalized patients treated in the psychotherapeutic department and 40 healthy controls were included. Subjects were assessed by the Quality of Life Satisfaction and Enjoyment Questionnaire (Q-LES-Q), Dissociative Experiences Scale, Beck Depression Inventory (BDI)-II, Beck Anxiety Inventory, Clinical Global Impression, demographic questionnaire, Sheehan Disability Scale (SDS), and Sheehan Anxiety Scale. RESULTS BPD patients suffered from comorbid anxiety disorders, panic disorder (18.5%), social phobia (20.7%), generalized anxiety disorder/mixed anxiety depression disorder (17.4%), adjustment disorder (22.8%), and posttraumatic stress disorder (8.7%); 19.6% patients had two or more anxiety disorder comorbidities. Patients score in Q-LES-Q (general) was 36.24±9.21, which was significantly lower in comparison to controls (57.83±10.21) and similar in all domains (physical health, feelings, work, household, school/study, leisure, social activities). The subjective level of depression measured by BDI and SDS (social life and family subscales) negatively correlated with all Q-LES-Q domains. CONCLUSION Patients suffering from BPD and comorbid anxiety disorders have a lower level of QoL compared to healthy controls in all measured domains. Negative correlations of the Q-LES-Q domains with clinical scales (Dissociative Experiences Scale, BDI, Beck Anxiety Inventory, Sheehan Anxiety Scale, Clinical Global Impression, and SDS) are noticeable.
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Affiliation(s)
- Ales Grambal
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital, Olomouc
| | - Jan Prasko
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital, Olomouc
- Correspondence: Jan Prasko, Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital, IP Pavlova 6, 77520 Olomouc, Czech Republic, Tel +420 603 414 930, Email
| | - Dana Kamaradova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital, Olomouc
| | - Klara Latalova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital, Olomouc
| | - Michaela Holubova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital, Olomouc
- Department of Psychiatry, Hospital Liberec, Liberec
| | - Zuzana Sedláčková
- Department of Psychology, Faculty of Arts, Palacky University Olomouc, Olomouc, Czech Republic
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