1
|
Aguglia A, Cioci D, Meinero M, Placenti V, Verrina E, Bianchi D, Fusar-Poli L, Costanza A, Schiavetti I, Amerio A, Amore M, Serafini G. The Role of Hopelessness in Patients With Borderline Personality Disorder. J Psychiatr Pract 2024; 30:325-332. [PMID: 39357013 PMCID: PMC11451973 DOI: 10.1097/pra.0000000000000813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2024]
Abstract
BACKGROUND The goal of this study was to evaluate specific characteristics associated with hopelessness, potentially correlated with coping strategies, sensory profile, and alexithymia in patients with borderline personality disorder (BPD). MATERIALS AND METHODS Two hundred twenty-four (N=224) inpatients completed a clinical interview with administration of the Beck Hopelessness Scale (BHS), the Adolescent/Adult Sensory Profile (AASP), the Coping Orientation to Problems Experienced Inventory (COPE), and the Toronto Alexithymia Scale (TAS). RESULTS Hopelessness was significantly associated with female gender, more hospitalizations, current suicidal ideation, number of suicide attempts, current and lifetime medication abuse, and alcohol misuse. Furthermore, patients with BHS ≥ 9 had higher scores in low registration, sensory sensitivity and sensation avoiding in AASP, higher rate of alexithymia, and the use of maladaptive coping strategies. CONCLUSIONS Hopelessness in BPD was associated with higher severity of illness, alternative process sensory input from the environment, reduced ability to cope with stressful events, and alexithymia. Therefore, a routine assessment of hopelessness in patients with BPD could lead to better and more specific therapeutic strategies.
Collapse
Affiliation(s)
- Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Daniele Cioci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Matteo Meinero
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Valeria Placenti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Edoardo Verrina
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Davide Bianchi
- Department of Mental Health and Pathological Addictions, Lavagna Local Health Authority, Lavagna, Italy
| | - Laura Fusar-Poli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Alessandra Costanza
- Department of Psychiatry, Adult Psychiatry Service (SPA), University Hospitals of Geneva (HUG), Geneva, Switzerland
- Department of Psychiatry, Faculty of Biomedical Sciences, University of Italian Switzerland (USI), Lugano, Switzerland
- Department of Psychiatry, Faculty of Medicine, Geneva University (UNIGE), Geneva, Switzerland
| | - Irene Schiavetti
- Department of Health Sciences, Section of Biostatistics, University of Genoa, Italy
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| |
Collapse
|
2
|
Leichsenring F, Fonagy P, Heim N, Kernberg OF, Leweke F, Luyten P, Salzer S, Spitzer C, Steinert C. Borderline personality disorder: a comprehensive review of diagnosis and clinical presentation, etiology, treatment, and current controversies. World Psychiatry 2024; 23:4-25. [PMID: 38214629 PMCID: PMC10786009 DOI: 10.1002/wps.21156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Abstract
Borderline personality disorder (BPD) was introduced in the DSM-III in 1980. From the DSM-III to the DSM-5, no major changes have occurred in its defining criteria. The disorder is characterized by instability of self-image, interpersonal relationships and affects. Further symptoms include impulsivity, intense anger, feelings of emptiness, strong abandonment fears, suicidal or self-mutilation behavior, and transient stress-related paranoid ideation or severe dissociative symptoms. There is evidence that BPD can be reliably diagnosed and differentiated from other mental disorders by semi-structured interviews. The disorder is associated with considerable functional impairment, intensive treatment utilization, and high societal costs. The risk of self-mutilation and suicide is high. In the general adult population, the lifetime prevalence of BPD has been reported to be from 0.7 to 2.7%, while its prevalence is about 12% in outpatient and 22% in inpatient psychiatric services. BPD is significantly associated with other mental disorders, including depressive disorders, substance use disorders, post-traumatic stress disorder, attention-deficit/hyperactivity disorder, bipolar disorder, bulimia nervosa, and other personality disorders. There is convincing evidence to suggest that the interaction between genetic factors and adverse childhood experiences plays a central role in the etiology of BPD. In spite of considerable research, the neurobiological underpinnings of the disorder remain to be clarified. Psychotherapy is the treatment of choice for BPD. Various approaches have been empirically supported in randomized controlled trials, including dialectical behavior therapy, mentalization-based therapy, transference-focused therapy, and schema therapy. No approach has proved to be superior to others. Compared to treatment as usual, psychotherapy has proved to be more efficacious, with effect sizes between 0.50 and 0.65 with regard to core BPD symptom severity. However, almost half of the patients do not respond sufficiently to psychotherapy, and further research in this area is warranted. It is not clear whether some patients may benefit more from one psychotherapeutic approach than from others. No evidence is available consistently showing that any psychoactive medication is efficacious for the core features of BPD. For discrete and severe comorbid anxiety or depressive symptoms or psychotic-like features, pharmacotherapy may be useful. Early diagnosis and treatment of BPD can reduce individual suffering and societal costs. However, more high-quality studies are required, in both adolescents and adults. This review provides a comprehensive update of the BPD diagnosis and clinical characterization, risk factors, neurobiology, cognition, and management. It also discusses the current controversies concerning the disorder, and highlights the areas in which further research is needed.
Collapse
Affiliation(s)
- Falk Leichsenring
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
- Department of Psychosomatics and Psychotherapy, University of Rostock, Rostock, Germany
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Nikolas Heim
- International Psychoanalytic University, Berlin, Germany
| | - Otto F Kernberg
- Personality Disorders Institute, Weill Cornell Medical College, New York, NY, USA
| | - Frank Leweke
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
| | - Patrick Luyten
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | - Simone Salzer
- International Psychoanalytic University, Berlin, Germany
| | - Carsten Spitzer
- Department of Psychosomatics and Psychotherapy, University of Rostock, Rostock, Germany
| | - Christiane Steinert
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
- International Psychoanalytic University, Berlin, Germany
| |
Collapse
|
3
|
Chizhova OA, Iuzbashian PG. [Alexithymia and self-harm in people with borderline personality disorder]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:102-108. [PMID: 38261291 DOI: 10.17116/jnevro2024124011102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
OBJECTIVE To estimate the prevalence of alexithymia and self-harm in patients with borderline personality disorder (BPD). To assess the role of alexithymia in the emergence of self-harm in patients with BPD. MATERIAL AND METHODS We studied 104 patients (85 women, 19 men aged 21 to 25 years (64.4%)), including 54 patients with and 50 patients without BPD. Most of them had incomplete higher education (55%). We used the Russian version of the 20-item Toronto Alexithymia Scale (TAS-20) to reveal alexithymia and SCID-II to diagnose BPD. The presence of self-harm behavior was confirmed by the subjects' anamnesis data. RESULTS The prevalence of alexithymia in patients with BPD was 83.3%, in the control group it was 52% (p=0.001). The prevalence of self-aggression was 70.3% (n=38) in patients with BPD, and 12% (n=6) in people without BPD. Self-harm among persons with alexithymia was noted in 62.5% (n=45). During the analysis, a connection between auto-aggression and alexithymia was found at the level of a statistical trend (p=0.051). CONCLUSION Alexithymia and self-harm are more common in patients with BPD than in healthy people. This type of emotional dysregulation mediates self-harm in patients with BPD.
Collapse
Affiliation(s)
- O A Chizhova
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - P G Iuzbashian
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| |
Collapse
|
4
|
Bemmouna D, Lagzouli A, Weiner L. The biosocial correlates and predictors of emotion dysregulation in autistic adults compared to borderline personality disorder and nonclinical controls. Mol Autism 2023; 14:47. [PMID: 38110995 PMCID: PMC10726572 DOI: 10.1186/s13229-023-00580-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/12/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Emotion dysregulation (ED) is a core symptom of borderline personality disorder (BPD), whose aetiology has been attributed to biosocial factors. In autism spectrum condition (ASC), although ED is prevalent and is associated with decreased well-being (e.g. self-harm, suicidality), it has been understudied, especially in adults. It is therefore crucial to further understand ED in autistic adults to improve its treatment. Our study investigates ED, its behavioural correlates (e.g. self-harm, suicidality) and biosocial predictors in autistic adults relative to BPD and nonclinical controls (NC). METHODS A total of 724 participants (ASC = 154; BPD = 111; NC = 459) completed 11 self-reported questionnaires assessing ED, ASC and BPD traits, co-occurring disorders, alexithymia, emotional vulnerability and invalidating experiences (e.g. bullying, autistic camouflaging). The occurrence of ED behavioural correlates (i.e. self-harm, history of suicide attempts, and psychiatric hospitalizations) was collected. In addition, between-groups analyses, linear regressions and machine learning (ML) models were used to identify ED predictors in each group. RESULTS ED and its behavioural correlates were higher in ASC compared to NC, but milder than in BPD. While gender did not predict ED scores, autistic women had increased risk factors to ED, including sexual abuse and camouflaging. Interestingly, BPD traits, emotional vulnerability and alexithymia strongly predicted ED scores across the groups. Using ML models, sensory sensitivity and autistic camouflaging were associated with ED in ASC, and ADHD symptoms with ED in BPD. LIMITATIONS ASC and BPD diagnoses were self-reported, which did not allow us to check their accuracy. Additionally, we did not explore the transactional and the moderating/mediating relationships between the different variables. Moreover, our research is cross-sectional and cannot draw conclusions regarding the direction and causality of relationships between ED and other clinical dimensions. CONCLUSIONS ED and its behavioural correlates are heightened in BPD compared to ASC and nonclinical controls. In the ASC group, there were no gender differences in ED, despite the heightened exposure of autistic women to ED risk factors. BPD traits, emotional vulnerability, and alexithymia are core to ED regardless of diagnosis. Although less central, sensory sensitivity and autistic camouflaging seem to be specific predictors of ED in autistic adults.
Collapse
Affiliation(s)
- Doha Bemmouna
- Department of Psychology, University of Strasbourg, 12 Rue Goethe, 67000, Strasbourg, France.
| | - Amine Lagzouli
- MSME, CNRS UMR 8208, Paris-Est Créteil University, Gustave Eiffel University, 94010, Créteil, France
- School of Chemistry, Physics and Mechanical Engineering, Queensland University of Technology, Brisbane, QLD, 4001, Australia
| | - Luisa Weiner
- Department of Psychology, University of Strasbourg, 12 Rue Goethe, 67000, Strasbourg, France.
- Psychiatry Department, University Hospitals of Strasbourg, 1 Place de l'Hôpital, 67000, Strasbourg, France.
| |
Collapse
|
5
|
Silveira S, Godara M, Faschinger A, Singer T. Reducing alexithymia and increasing interoceptive awareness: A randomized controlled trial comparing mindfulness with dyadic socio-emotional app-based practice. J Affect Disord 2023; 341:162-169. [PMID: 37598721 DOI: 10.1016/j.jad.2023.08.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Emotion processing deficits of alexithymia are a transdiagnostic risk factor. While such deficits are malleable, the differential efficacy of brief scalable digital mental trainings remains understudied. METHODS This randomized controlled trial probed the efficacy of mindfulness-based (MB) and partner-based socio-emotional Affect Dyad (SE) practice, both supported by weekly coaching sessions, in reducing alexithymia in 285 adult participants. We investigated the predictive role of interoceptive awareness assessed a) before and after daily practice, b) in ecological momentary assessment (EMA) before and after the intervention, and c) weekly during the 10-week intervention. RESULTS Both interventions reduced emotion processing difficulties on the Toronto Alexithymia Scale (TAS-20). Similarly, both interventions improved interoceptive awareness immediately after daily practice and after the intervention period, yet SE outperformed MB training in EMA assessments. Further, only Dyad practice led to increases in body listening and self-regulatory aspects of the Multidimensional Assessment of Interoceptive Awareness (MAIA) over time, with the latter explaining a decrease in alexithymia. LIMITATIONS Given the subclinical study sample, findings are limited in their generalizability to clinical samples. CONCLUSIONS Findings suggest that app-based socio-emotional and mindfulness-based practices, supported by online coaching sessions, are effective in reducing emotion processing deficits. Dyad training showed advantages on some measures of body awareness, which predicted observed changes in alexithymia. This highlights the potential of using app-based dyadic approaches in the development of emotion awareness and regulation.
Collapse
Affiliation(s)
- Sarita Silveira
- Social Neuroscience Lab, Max Planck Society, Berlin, Germany.
| | - Malvika Godara
- Social Neuroscience Lab, Max Planck Society, Berlin, Germany
| | - Anna Faschinger
- Social Neuroscience Lab, Max Planck Society, Berlin, Germany
| | - Tania Singer
- Social Neuroscience Lab, Max Planck Society, Berlin, Germany
| |
Collapse
|
6
|
Goldbach RE, Neukel C, Panizza A, Reinken A, Krause-Utz A. Differentiating between intrapsychic symptoms and behavioral expressions of borderline personality disorder in relation to childhood emotional maltreatment and emotion dysregulation: an exploratory investigation. Eur J Psychotraumatol 2023; 14:2263317. [PMID: 37846822 PMCID: PMC10583625 DOI: 10.1080/20008066.2023.2263317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/11/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Borderline personality disorder (BPD) is a severe mental disorder, characterized by pronounced instability in emotions, self-image, and interpersonal relationships. Experiences of childhood maltreatment are among the risk factors for BPD. While self-damaging and aggressive acts often occur, not every person with the disorder shows markedly dysregulated behaviour. Internalized symptoms, such as shame, loneliness, and self-disgust tend to be more pervasive and persist after clinical remission. OBJECTIVE Here we investigated associations between BPD symptom severity, childhood maltreatment, and emotion regulation difficulties. We further explored if the Borderline Symptom List (BSL) could potentially be used to differentiate between internalized symptoms (intrapsychic strain) and externalized symptoms (dysregulated behaviours) in future research. METHOD 187 women with at least mild BPD symptoms (65% having a diagnosis of BPD) completed the BSL 23 including its 11-item supplement (BSL-S), the Childhood Trauma Questionnaire (CTQ), and Difficulties in Emotion Regulation Scale (DERS). Participants further underwent a semi-structured clinical interview to assess BPD criteria (International Personality Disorder Examination, IPDE). Multivariate models and regression-based bootstrapping analyses were performed to test direct and indirect effects. RESULTS Childhood trauma severity, especially emotional abuse, positively predicted BPD symptom severity. A significant indirect effect through emotion regulation difficulties was found (k2=.56). When exploring associations with BPD criteria (IPDE), the BSL-23 mean significantly correlated with separation anxiety, identity and mood problems, chronic emptiness, suicidal ideation, and dissociation, while the BSL-S correlated with self-harming impulsive behaviour and anger outbursts. CONCLUSIONS Findings complement previous research, highlighting the role of childhood maltreatment and emotion regulation difficulties in BPD. While our findings need to be seen as preliminary and interpreted with caution, they suggest that the BSL may be used to differentiate between internalized symptoms and behavioural expressions of BPD in future research. Such a distinction might help to deepen the understanding of this complex heterogenous disorder.
Collapse
Affiliation(s)
- Roosmarijn E. Goldbach
- Department of Psychology, Faculty of Social and Behavioral Sciences, Leiden University, the Netherlands
| | - Corinne Neukel
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Germany
| | - Angelika Panizza
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Aischa Reinken
- Department of Psychology, Faculty of Social and Behavioral Sciences, Leiden University, the Netherlands
| | - Annegret Krause-Utz
- Department of Psychology, Faculty of Social and Behavioral Sciences, Leiden University, the Netherlands
| |
Collapse
|
7
|
Vogel AC, Geselowitz B, Tillman R, Barch DM, Luby JL, Whalen DJ. Developmental trajectories of anger and sadness dysregulation in childhood differentially predict later borderline symptoms. Dev Psychopathol 2023:1-16. [PMID: 37340976 PMCID: PMC10733555 DOI: 10.1017/s0954579423000627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
Difficulties with emotion regulation are integral to borderline personality disorder (BPD) and its hypothesized developmental pathway. Here, we prospectively assess trajectories of emotion processing across childhood, how BPD symptoms impact these trajectories, and whether developmental changes are transdiagnostic or specific to BPD, as major depressive (MDD) and conduct disorders (CD) are also characterized by emotion regulation difficulties. This study included 187 children enriched for those with early symptoms of depression and disruptive behaviors from a longitudinal study. We created multilevel models of multiple components of emotional processing from mean ages 9.05 to 18.55 years, and assessed the effect of late adolescent BPD, MDD, and CD symptoms on these trajectories. Linear trajectories of coping with sadness and anger, and quadratic trajectories of dysregulated expressions of sadness and anger were transdiagnostic, but also exhibited independent relationships with BPD symptoms. Only inhibition of sadness was related to BPD symptoms. The quadratic trajectories of poor emotional awareness and emotional reluctance were also independently related to BPD. Findings support examining separable components of emotion processing across development as potential precursors to BPD, underscoring the importance of understanding these trajectories as not only a marker of potential risk but also potential targets for prevention and intervention.
Collapse
Affiliation(s)
- Alecia C. Vogel
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Ben Geselowitz
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Rebecca Tillman
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Deanna M. Barch
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- Department of Psychological and Brain Sciences, Washington University in St. Louis. St. Louis, MO, USA
- Department of Radiology, Washington University in St. Louis. St. Louis, MO, USA
| | - Joan L. Luby
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Diana J. Whalen
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| |
Collapse
|
8
|
Bach B, Vestergaard M. Differential Diagnosis of ICD-11 Personality Disorder and Autism Spectrum Disorder in Adolescents. CHILDREN (BASEL, SWITZERLAND) 2023; 10:992. [PMID: 37371224 PMCID: PMC10297099 DOI: 10.3390/children10060992] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/17/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023]
Abstract
The International Classification of Diseases 11th Revision (ICD-11) introduces fundamentally new diagnostic descriptions for personality disorder and autism spectrum disorder. Instead of the traditional categorical taxonomies, both personality disorder and autism spectrum disorder are described as being on a continuum. Accumulating research has pointed out that, in some cases, adolescents with autism spectrum disorder are at risk of being confused with having a personality disorder, which particularly applies to female adolescents. Case reports describe how adult autistic women struggled with social and identity roles as children and adolescents, using compensatory strategies such as social imitation and other types of camouflaging. Furthermore, some adolescents with autism display emotion dysregulation and self-injury. The ICD-11 recognizes that features of autism spectrum disorder may resemble features of personality disorder, but the two diagnoses have not yet been formally compared to one another. The present article therefore sought to outline and discuss the overlap and boundaries between the ICD-11 definitions of personality disorder and autism spectrum disorder and propose guiding principles that may assist practitioners in differential diagnosis with female adolescents. We specifically highlight how aspects of the self and interpersonal functioning along with emotional, cognitive, and behavioral manifestations may overlap across the two diagnoses. Restricted, repetitive, and inflexible patterns of behavior, interests, and activities are core features of autism spectrum disorder, which may be masked or less pronounced in female adolescents. Collecting a developmental history of the early presence or absence of autistic features is vital for a conclusive diagnosis, including features that are typically camouflaged in females. A number of future directions for research and clinical practice are proposed.
Collapse
Affiliation(s)
- Bo Bach
- Psychiatric Research Unit, Center for Personality Disorder Research, Mental Health Services, Region Zealand, 4200 Slagelse, Denmark
- Department of Psychology, University of Southern Denmark, 5230 Odense, Denmark
| | - Martin Vestergaard
- Psychiatric Research Unit, Center for Personality Disorder Research, Mental Health Services, Region Zealand, 4200 Slagelse, Denmark
- Department of Child and Adolescence Psychiatry (Copenhagen University Hospital), Mental Health Services, Region Zealand, 4000 Roskilde, Denmark
| |
Collapse
|
9
|
Amerio A, Natale A, Gnecco GB, Lechiara A, Verrina E, Bianchi D, Fusar-Poli L, Costanza A, Serafini G, Amore M, Aguglia A. The Role of Gender in Patients with Borderline Personality Disorder: Differences Related to Hopelessness, Alexithymia, Coping Strategies, and Sensory Profile. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050950. [PMID: 37241182 DOI: 10.3390/medicina59050950] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/08/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: Gender differences are poorly investigated in patients with borderline personality disorder (BPD), although they could be useful in determining the most appropriate pharmacological and non-pharmacological treatment. The aim of the present study was to compare sociodemographic and clinical characteristics and the emotional and behavioral dimensions (such as coping, alexithymia, and sensory profile) between males and females with BPD. Material and Methods: Two hundred seven participants were recruited. Sociodemographic and clinical variables were collected through a self-administered questionnaire. The Adolescent/Adult Sensory Profile (AASP), Beck Hopelessness Scale (BHS), Coping Orientation to Problems Experienced (COPE), and Toronto Alexithymia Scale (TAS-20) were administered. Results: Male patients with BPD showed more involuntary hospitalizations and greater use of alcohol and illicit substances compared to females. Conversely, females with BPD reported more frequent medication abuse than males. Furthermore, females had high levels of alexithymia and hopelessness. Regarding coping strategies, females with BPD reported higher levels of "restraint coping" and "use of instrumental social support" at COPE. Finally, females with BPD had higher scores in the Sensory Sensitivity and Sensation Avoiding categories at the AASP. Conclusions: Our study highlights gender differences in substance use, emotion expression, future vision, sensory perception, and coping strategies in patients with BPD. Further gender studies may clarify these differences and guide the development of specific and differential treatments in males and females with BPD.
Collapse
Affiliation(s)
- Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, 16132 Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Antimo Natale
- Department of Psychiatry, Adult Psychiatry Service (APS), University Hospitals of Geneva (HUG), 1205 Geneva, Switzerland
| | - Giovanni Battista Gnecco
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, 16132 Genoa, Italy
| | - Alessio Lechiara
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, 16132 Genoa, Italy
| | - Edoardo Verrina
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, 16132 Genoa, Italy
| | - Davide Bianchi
- Department of Mental Health and Pathological Addictions, Lavagna Local Health Authority, 16033 Lavagna, Italy
| | - Laura Fusar-Poli
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Alessandra Costanza
- Department of Psychiatry, Adult Psychiatry Service (APS), University Hospitals of Geneva (HUG), 1205 Geneva, Switzerland
- Department of Psychiatry, Faculty of Medicine, Geneva University (UNIGE), 1211 Geneva, Switzerland
- Department of Psychiatry, Faculty of Biomedical Sciences, University of Italian Switzerland (USI), 6900 Lugano, Switzerland
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, 16132 Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, 16132 Genoa, Italy
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, 16132 Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| |
Collapse
|
10
|
Meulemeester CD, Lowyck B, Boets B, van der Donck S, Verhaest Y, Luyten P. "Feeling Invisible": Individuals With Borderline Personality Disorder Underestimate the Transparency of Their Emotions. J Pers Disord 2023; 37:213-232. [PMID: 37002937 DOI: 10.1521/pedi.2023.37.2.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
The present study investigated transparency estimation, that is, the ability to estimate how observable one's emotions are, in patients diagnosed with borderline personality disorder (BPD) (n = 35) and healthy controls (HCs; n = 35). Participants watched emotionally evocative video clips and estimated the transparency of their own emotional experience while watching the clip. Facial expression coding software (FaceReader) quantified their objective transparency. BPD patients felt significantly less transparent than HCs, but there were no differences in objective transparency. BPD patients tended to underestimate the transparency of their emotions compared to HCs, who in turn overestimated their transparency. This suggests that BPD patients expect that others will not know how they feel, irrespective of how observable their emotions actually are. We link these findings to low emotional awareness and a history of emotional invalidation in BPD, and we discuss their impact on BPD patients' social functioning.
Collapse
Affiliation(s)
| | - Benedicte Lowyck
- University Psychiatric Hospital UPC KU Leuven, Campus Kortenberg, and Department of Neurosciences, Faculty of Medicine, KU Leuven, Belgium
| | - Bart Boets
- Center for Developmental Psychiatry, Department of Neurosciences, KU Leuven, Belgium
| | | | - Yannic Verhaest
- University Psychiatric Hospital UPC KU Leuven, Campus Kortenberg, and Department of Neurosciences, Faculty of Medicine, KU Leuven, Belgium
| | - Patrick Luyten
- Faculty of Psychology and Educational Sciences, KU Leuven, Belgium
- Research Department of Clinical, Educational and Health Psychology, University College London, United Kingdom
| |
Collapse
|
11
|
Di Pierro R, Amelio S, Macca M, Madeddu F, Di Sarno M. What If I Feel Rejected? Borderline Personality, Pathological Narcissism, and Social Rejection in Daily Life. J Pers Disord 2022; 36:559-582. [PMID: 36181490 DOI: 10.1521/pedi.2022.36.5.559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The authors investigate whether and how borderline and pathological narcissistic traits differ in their associations with trait and state rejection sensitivity, and with affective reactions to experiences of social rejection occurring in daily life. Community adults (N = 189) completed baseline measures of rejection sensitivity, borderline personality, and pathological narcissism, and daily measures of perceived social rejection and affective states for 7 days. Vulnerable narcissism was the main driver of negative anticipated emotions for social rejection. Borderline personality made people prone to experiencing social rejection in daily life. Moreover, borderline personality traits predicted greater self-directed aggressive impulses when experiencing social rejection. Grandiose narcissism showed only a negative association with anticipatory anxiety for rejection. These findings highlight that sensitivity to social rejection is crucial in both borderline personality and pathological narcissism.
Collapse
Affiliation(s)
- Rossella Di Pierro
- Department of Psychology, University of Milan-Bicocca, Milan, Italy.,Personality Disorder Lab (PDlab), Milan-Parma, Italy
| | - Sara Amelio
- Department of Psychology, University of Milan-Bicocca, Milan, Italy
| | - Martina Macca
- Department of Psychology, University of Milan-Bicocca, Milan, Italy
| | - Fabio Madeddu
- Department of Psychology, University of Milan-Bicocca, Milan, Italy.,Personality Disorder Lab (PDlab), Milan-Parma, Italy
| | - Marco Di Sarno
- Department of Psychology, University of Milan-Bicocca, Milan, Italy.,Personality Disorder Lab (PDlab), Milan-Parma, Italy
| |
Collapse
|
12
|
Hazlett EA, Goldstein KE, Haznedar MM, McClure MM, Perez-Rodriguez MM, New AS, Goodman M, Govindarajulu U, Kapil-Pair KN, Feinberg A, Smith E, Dolgopolskaia ES. Hyperreactivity and Impaired Habituation of Startle Amplitude During Unpleasant Pictures in Borderline but Not Schizotypal Personality Disorder: Quantifying Emotion Dysregulation. Biol Psychiatry 2022; 92:573-582. [PMID: 35717211 DOI: 10.1016/j.biopsych.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/23/2022] [Accepted: 04/11/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Borderline personality disorder (BPD) is characterized by greater intensity of reactions to unpleasant emotional cues and a slower-than-normal return of these responses to baseline. Habituation is defined as decreased response to repeated stimulation. Affect-modulated startle (AMS), a translational psychophysiological approach, is mediated by the amygdala and used to study emotion processing in both humans and animals. This is the first study to examine the specificity of habituation anomalies in BPD during passive emotional and neutral picture processing. METHODS A total of 90 participants were studied: patients with BPD (n = 35), patients with schizotypal personality disorder (n = 26; included as a psychopathological comparison group), and healthy control subjects (n = 29). Participants received rigorous clinical assessments, and patients were unmedicated. AMS was examined during a series of intermixed unpleasant, neutral, and pleasant pictures. RESULTS Compared with the other groups, patients with BPD showed greater overall AMS during unpleasant pictures and prolonged habituation of startle amplitude during unpleasant pictures from early to later trials. The groups did not differ in AMS during neutral or pleasant pictures or self-reported picture valence. Among the patients with BPD, prolonged habituation to unpleasant pictures was associated with greater symptom severity and suicidal/self-harming behavior. CONCLUSIONS These findings 1) indicate that abnormal processing of and habituation to unpleasant pictures is observed in BPD but not schizotypal personality disorder, suggesting that these deficits are not simply characteristics of personality disorders in general; 2) are consistent with studies showing deficient amygdala habituation to unpleasant pictures in BPD; and 3) have significant implications for clinical assessment and treatment of BPD, e.g., alternative therapies for BPD such as gradual exposure to unpleasant emotional stimuli or amygdala neurofeedback may aid habituation deficits.
Collapse
Affiliation(s)
- Erin A Hazlett
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York; Mental Illness Research, Education and Clinical Center (VISN 2), James J. Peters Veterans Affairs Medical Center, Bronx, New York.
| | - Kim E Goldstein
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York; Mental Illness Research, Education and Clinical Center (VISN 2), James J. Peters Veterans Affairs Medical Center, Bronx, New York
| | - M Mehmet Haznedar
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York; Outpatient Psychiatry, James J. Peters Veterans Affairs Medical Center, Bronx, New York
| | - Margaret M McClure
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Antonia S New
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marianne Goodman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York; Mental Illness Research, Education and Clinical Center (VISN 2), James J. Peters Veterans Affairs Medical Center, Bronx, New York
| | - Usha Govindarajulu
- Center for Biostatistics, Department of Population Health & Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Abigail Feinberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Emma Smith
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | | |
Collapse
|
13
|
Herzog P, Kube T, Fassbinder E. How childhood maltreatment alters perception and cognition - the predictive processing account of borderline personality disorder. Psychol Med 2022; 52:2899-2916. [PMID: 35979924 PMCID: PMC9693729 DOI: 10.1017/s0033291722002458] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/24/2022] [Accepted: 07/18/2022] [Indexed: 01/05/2023]
Abstract
Borderline personality disorder (BPD) is a severe mental disorder, comprised of heterogeneous psychological and neurobiological pathologies. Here, we propose a predictive processing (PP) account of BPD to integrate these seemingly unrelated pathologies. In particular, we argue that the experience of childhood maltreatment, which is highly prevalent in BPD, leaves a developmental legacy with two facets: first, a coarse-grained, alexithymic model of self and others - leading to a rigidity and inflexibility concerning beliefs about self and others. Second, this developmental legacy leads to a loss of confidence or precision afforded beliefs about the consequences of social behavior. This results in an over reliance on sensory evidence and social feedback, with concomitant lability, impulsivity and hypersensitivity. In terms of PP, people with BPD show a distorted belief updating in response to new information with two opposing manifestations: rapid changes in beliefs and a lack of belief updating despite disconfirmatory evidence. This account of distorted information processing has the potential to explain both the instability (of affect, self-image, and interpersonal relationships) and the rigidity (of beliefs about self and others) which is typical of BPD. At the neurobiological level, we propose that enhanced levels of dopamine are associated with the increased integration of negative social feedback, and we also discuss the hypothesis of an impaired inhibitory control of the prefrontal cortex in the processing of negative social information. Our account may provide a new understanding not only of the clinical aspects of BPD, but also a unifying theory of the corresponding neurobiological pathologies. We conclude by outlining some directions for future research on the behavioral, neurobiological, and computational underpinnings of this model, and point to some clinical implications of it.
Collapse
Affiliation(s)
- Philipp Herzog
- Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, D-23562 Lübeck, Germany
- Department of Psychiatry and Psychotherapy, Christian-Albrechts-University of Kiel, Niemannsweg 147, D-24105 Kiel, Germany
- Department of Psychology, University of Koblenz-Landau, Ostbahnstr. 10, 76829 Landau, Germany
| | - Tobias Kube
- Department of Psychology, University of Koblenz-Landau, Ostbahnstr. 10, 76829 Landau, Germany
| | - Eva Fassbinder
- Department of Psychiatry and Psychotherapy, Christian-Albrechts-University of Kiel, Niemannsweg 147, D-24105 Kiel, Germany
| |
Collapse
|
14
|
Varma S, Traynor J, Fitzpatrick S. A mixed methods examination of emotional expression and its impact on emotion regulation effectiveness in borderline personality disorder. J Behav Ther Exp Psychiatry 2022; 75:101712. [PMID: 34896881 DOI: 10.1016/j.jbtep.2021.101712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 08/30/2021] [Accepted: 12/01/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Emotional expression (i.e., identifying and labeling emotion using specific words), is theorized to reduce negative emotion and facilitate emotion regulation. However, it remains unclear how individuals with borderline personality disorder express emotion, and whether this influences their emotion regulation. This study examined whether: 1) emotional expression in borderline personality disorder differed from healthy controls based on word valence, emotionality, and vocabulary; and 2) whether such characteristics predict emotion regulation effectiveness across self-reported and physiological emotion domains differentially across these groups. METHODS Individuals with borderline personality disorder (n = 29) and age and sex-matched healthy controls (n = 30) listened to an evocative story, expressed emotion, and regulated emotion by applying Mindfulness or Cognitive Reappraisal. Emotion regulation was measured by changes in self-report, parasympathetic, and sympathetic emotion, while implementing the emotion regulation strategies. The words used to express emotion were coded based on valence, emotionality, and depth of vocabulary. RESULTS Generalized estimating equations revealed no differences between groups in valence, emotionality, and vocabulary. Additionally, using a larger emotional vocabulary predicted more effective sympathetic emotion regulation, and using more negatively valenced words predicted more effective parasympathetic emotion regulation across groups. LIMITATIONS Among other things, this study is limited by its predominantly female sample, and that it does not determine whether valence, emotionality, or vocabulary independently predict emotional expression effectiveness. CONCLUSIONS Emotional expression may not be deficient in borderline personality disorder across the indices studied. Using more negative words and broadening vocabulary while expressing emotion may offer emotion regulation benefits.
Collapse
Affiliation(s)
- Sonya Varma
- Department of Psychology, York University, Canada
| | - Jenna Traynor
- Department of Psychology, University of Toronto Scarborough, Canada; Centre for Addiction and Mental Health, Canada
| | | |
Collapse
|
15
|
Miola A, Cattarinussi G, Antiga G, Caiolo S, Solmi M, Sambataro F. Difficulties in emotion regulation in bipolar disorder: A systematic review and meta-analysis. J Affect Disord 2022; 302:352-360. [PMID: 35093412 DOI: 10.1016/j.jad.2022.01.102] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 01/19/2022] [Accepted: 01/26/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Bipolar disorder (BD) is a severe mental disorder characterized by mood swings and functional impairment. Although alterations in emotional regulation (ER) are a key feature, a comprehensive meta-analysis on abnormalities in emotion regulation in BD is still lacking. METHODS We performed a random-effects meta-analysis on studies comparing the ER measured with the Difficulties in Emotion Regulation Scale (DERS) in BD and healthy controls (HC) or borderline personality disorder (BPD) and calculated the standardized mean difference (SMD) of the total DERS score between those with BD and HC (primary outcome). Secondary outcomes were the SMD of the DERS subscales between BD and HC, as well as the SMD of the total score of DERS and the subscales between BD and BPD. RESULTS Twelve studies (858 BD, 540 BPD, 285 HC) were included. Compared to HC, BD showed significantly higher total DERS score (k=8, SMD 0.962, p<0.001) and subscale scores, including non-acceptance (k=6, SMD=0.85, p<0.001), goal-directed behavior (k=6, SMD=0.894, p<0.001), impulse control (k=6, SMD=1.08, p<0.001), strategies (k=6, SMD=1.25, p<0.001) and emotional clarity (k=6, SMD=0.694, p=0.001). Relative to BPD, BD presented significantly lower scores in all the DERS subscales. Sensitivity analyses confirmed the main analyses. The age of the participants and sample size moderated the primary outcome. LIMITATIONS The small number of studies and the cross-sectional design limit the generalizability of the results. CONCLUSIONS Our findings suggest that alterations of specific ER abilities are present in BD and their magnitude is smaller relative to BPD. Future therapeutic interventions should target ER strategies.
Collapse
Affiliation(s)
- Alessandro Miola
- Department of Neuroscience (DNS), University of Padova, Padua, Italy;; Padua Neuroscience Center, University of Padova, Padua, Italy
| | - Giulia Cattarinussi
- Department of Neuroscience (DNS), University of Padova, Padua, Italy;; Padua Neuroscience Center, University of Padova, Padua, Italy
| | - Gilberto Antiga
- Department of Neuroscience (DNS), University of Padova, Padua, Italy
| | - Stefano Caiolo
- Department of Neuroscience (DNS), University of Padova, Padua, Italy
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ontario, Canada; Department of Mental Health, The Ottawa Hospital, Ontario, Canada
| | - Fabio Sambataro
- Department of Neuroscience (DNS), University of Padova, Padua, Italy;; Padua Neuroscience Center, University of Padova, Padua, Italy.
| |
Collapse
|
16
|
Park J, Zhan X, Gainey KN. Meta-Analysis of the Associations Among Constructs of Intrapersonal Emotion Knowledge. EMOTION REVIEW 2022. [DOI: 10.1177/17540739211068036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To better define the boundaries of conceptually overlapping constructs of intrapersonal emotion knowledge (EK), we examined meta-analytic correlations among five intrapersonal EK-related constructs (affect labelling, alexithymia, emotional awareness, emotional clarity, emotion differentiation) and attention to emotion. Affect labelling, alexithymia, and emotional clarity were strongly associated, and they were moderately associated with attention to emotion. Alexithymia and emotional awareness were weakly associated, and emotion differentiation was unrelated with emotional clarity. Sample characteristics and measures moderated some of the associations. Publication bias was not found, except for the alexithymia-emotional awareness association. This study helped to clarify the extent to which similarly defined constructs overlap or are distinct, which can inform our decision to adequately label important constructs and employ corresponding measures.
Collapse
Affiliation(s)
- Juhyun Park
- Department of Psychology, University at Buffalo, The State University of New York, USA
| | - Xinyi Zhan
- Department of Psychology, University at Buffalo, The State University of New York, USA
| | | |
Collapse
|
17
|
Eddy CM. The Transdiagnostic Relevance of Self-Other Distinction to Psychiatry Spans Emotional, Cognitive and Motor Domains. Front Psychiatry 2022; 13:797952. [PMID: 35360118 PMCID: PMC8960177 DOI: 10.3389/fpsyt.2022.797952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/14/2022] [Indexed: 01/18/2023] Open
Abstract
Self-other distinction refers to the ability to distinguish between our own and other people's physical and mental states (actions, perceptions, emotions etc.). Both the right temporo-parietal junction and brain areas associated with the human mirror neuron system are likely to critically influence self-other distinction, given their respective contributions to theory of mind and embodied empathy. The degree of appropriate self-other distinction will vary according to the exact social situation, and how helpful it is to feel into, or remain detached from, another person's mental state. Indeed, the emotional resonance that we can share with others affords the gift of empathy, but over-sharing may pose a downside, leading to a range of difficulties from personal distress to paranoia, and perhaps even motor tics and compulsions. The aim of this perspective paper is to consider how evidence from behavioral and neurophysiological studies supports a role for problems with self-other distinction in a range of psychiatric symptoms spanning the emotional, cognitive and motor domains. The various signs and symptoms associated with problematic self-other distinction comprise both maladaptive and adaptive (compensatory) responses to dysfunction within a common underlying neuropsychological mechanism, compelling the adoption of more holistic transdiagnostic therapeutic approaches within Psychiatry.
Collapse
Affiliation(s)
- Clare M Eddy
- Birmingham and Solihull Mental Health NHS Foundation Trust, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| |
Collapse
|
18
|
Fernando SC, Beblo T, Lamers A, Schlosser N, Woermann FG, Driessen M, Toepper M. Neural correlates of emotion acceptance and suppression in borderline personality disorder. Front Psychiatry 2022; 13:1066218. [PMID: 36704727 PMCID: PMC9871986 DOI: 10.3389/fpsyt.2022.1066218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/14/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Emotion dysregulation is a central feature of borderline personality disorder (BPD). Since impaired emotion regulation contributes to disturbed emotion functioning in BPD, it is crucial to study underlying neural activity. The current study aimed at investigating the neural correlates of two emotion regulation strategies, namely emotion acceptance and suppression, which are both important treatment targets in BPD. METHODS Twenty-one women with BPD and 23 female healthy control participants performed an emotion regulation task during functional magnetic resonance imaging (fMRI). While watching fearful movie clips, participants were instructed to either accept or to suppress upcoming emotions compared to passive viewing. RESULTS Results revealed acceptance-related insular underactivation and suppression-related caudate overactivation in subjects with BPD during the emotion regulation task. CONCLUSION This is a first study on the neural correlates of emotion acceptance and suppression in BPD. Altered insula functioning during emotion acceptance may reflect impairments in emotional awareness in BPD. Increased caudate activity is linked to habitual motor and cognitive processes and therefore may accord to the well-established routine in BPD patients to suppress emotional experiences.
Collapse
Affiliation(s)
- Silvia Carvalho Fernando
- Department of Psychiatry and Psychotherapy, Evangelisches Klinikum Bethel, University of Bielefeld, Bielefeld, Germany
| | - Thomas Beblo
- Department of Psychiatry and Psychotherapy, Evangelisches Klinikum Bethel, University of Bielefeld, Bielefeld, Germany
| | - Agnes Lamers
- Department of Psychiatry and Psychotherapy, Evangelisches Klinikum Bethel, University of Bielefeld, Bielefeld, Germany
| | - Nicole Schlosser
- Department of Psychiatry and Psychotherapy, Evangelisches Klinikum Bethel, University of Bielefeld, Bielefeld, Germany
| | - Friedrich G Woermann
- Epilepsy Center Bethel, Mara Hospital, University of Bielefeld, Bielefeld, Germany
| | - Martin Driessen
- Department of Psychiatry and Psychotherapy, Evangelisches Klinikum Bethel, University of Bielefeld, Bielefeld, Germany
| | - Max Toepper
- Department of Psychiatry and Psychotherapy, Evangelisches Klinikum Bethel, University of Bielefeld, Bielefeld, Germany
| |
Collapse
|
19
|
[A Multidimensional Assessment of Emotion Regulation in Adolescent Non-Suicidal Self-Injury]. Prax Kinderpsychol Kinderpsychiatr 2021; 70:699-727. [PMID: 34898404 DOI: 10.13109/prkk.2021.70.8.699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The ability to regulate one's emotions (emotion regulation, ER) with regard to individual short- and long-term goals presents one of the most central human skills. A disrupted development of ER skills is associated with psychopathological outcomes. Non-suicidal self-injury (NSSI) presents a frequent and impairing phenomenon among young individuals. Disruptions regarding various aspects of ER are involved in the development and maintenance of NSSI. In the present study, we examined ER from a multidimensional perspective, including a sample of female adolescents meeting DSM-5 criteria for NSSI disorder (N = 30) and a psychologically healthy control group (N = 30). In line with results from previous studies, female adolescents with NSSI exhibited considerable difficulties regarding all aspects of ER investigated. Furthermore, various aspects of ER were distinctly linked with depressive and BPD symptomatology. Differences in NSSI frequency between participants largely went back to difficulties regarding specific aspects of ER, in combination with the self-rated severity of exposure to early life maltreatment. With regard to clinical practice, the use of interventions to improve particular aspects of ER, under simultaneous consideration of the individual developmental history and psychopathological impairment, might provide an efficient approach to mediate long-lasting change in the treatment of deliberate self-harm.
Collapse
|
20
|
Impaired complex theory of mind and low emotional self-awareness in outpatients with borderline personality disorder compared to healthy controls: A cross-sectional study. J Psychiatr Res 2021; 143:445-450. [PMID: 34656877 DOI: 10.1016/j.jpsychires.2021.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 09/02/2021] [Accepted: 10/10/2021] [Indexed: 11/21/2022]
Abstract
Studies on the theory of mind (TOM) and alexithymia in borderline personality disorder (BPD) have yielded inconsistent results. Also, the relationship between TOM abilities and alexithymia facets as two domains of social cognition has not been studied in BPD. This study aimed to fill this gap. Participants were 50 outpatients with BPD and 50 age and gender-matched healthy controls. Assessments performed using Reading the Mind in Eyes Task (RMET), Toronto Alexithymia Scale (TAS-20), Faux Pas Task (FPT), and Digit Span subtest of Wechsler Adult Intelligence Scale. Results showed that BPD patients scored lower on overall FPT (p < .001) and its cognitive (p < .001) and affective TOM (p < .001) subtests but were comparable with healthy controls in emotion recognition ability assessed by RMET (p = .241). The BPD group also scored significantly lower in overall alexithymia (p < .001) and subscales of difficulty identifying feelings (DIF; p < .001) and difficulty describing emotions (DDF; p = .001). However, they performed similarly to the healthy control group in externally oriented thinking (EOT; p = .164). Correlation analysis revealed a significant negative correlation between EOT and RMET in the BPD group (r = -0.33, p < .05). No association, however, was found between FPT and RMET. This study suggests that BPD patients are impaired in the complex TOM abilities and have lower self-awareness of emotions, but their recognition of others' emotions is intact. Also, the results demonstrate that a heightened level of EOT is associated with difficulties in facial emotion recognition in BPD patients.
Collapse
|
21
|
Frederiksen C, Solbakken OA, Licht RW, Jørgensen CR, Rodrigo-Domingo M, Kjaersdam Telléus G. The Relationship between Affect Integration and Psychopathology in Patients with Personality Disorder: A Cross-Sectional Study. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:627. [PMID: 34208658 PMCID: PMC8234290 DOI: 10.3390/medicina57060627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/09/2021] [Accepted: 06/14/2021] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Emotional dysfunction is considered a key component in personality disorders; however, only few studies have examined the relationship between the two. In this study, emotional dysfunction was operationalized through the Affect Integration Inventory, and the aim was to examine the relationships between the level of affect integration and the levels of symptom distress, interpersonal problems, and personality functioning in patients diagnosed with personality disorder according to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition. Materials and Methods: Within a hospital-based psychiatric outpatient setting, 87 patients with personality disorder referred for treatment were identified for assessment with the Affect Integration Inventory and other measures (e.g., the Symptom Checklist-90, Revised, the Inventory of Interpersonal Problems 64 circumplex version, and the Severity Indices of Personality Problems). Results: The analyses revealed that problems with affect integration were strongly and statistically significantly correlated with high levels of symptom distress, interpersonal problems, and maladaptive personality functioning. Additionally, low scores on the Affect Integration Inventory regarding discrete affects were associated with distinct and differentiated patterns of interpersonal problems. Conclusion: Taken together, emotional dysfunction, as measured by the Affect Integration Inventory, appeared to be a central component of the pathological self-organization associated with personality disorder. These findings have several implications for the understanding and psychotherapeutic treatment of personality pathology. Furthermore, they highlight the importance of considering the integration of discrete affects and their specific contributions in the conceptualization and treatment of emotional dysfunction in patients with personality disorders.
Collapse
Affiliation(s)
- Christina Frederiksen
- Psychiatric Clinic North, Brønderslev Psychiatric Hospital, North Denmark Region, 9700 Brønderslev, Denmark
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark;
| | | | - Rasmus Wentzer Licht
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark;
- Psychiatry—Aalborg University Hospital, 9000 Aalborg, Denmark; (M.R.-D.); (G.K.T.)
| | | | | | - Gry Kjaersdam Telléus
- Psychiatry—Aalborg University Hospital, 9000 Aalborg, Denmark; (M.R.-D.); (G.K.T.)
- Psychology, Department of Communication and Psychology, Aalborg University, 9000 Aalborg, Denmark
| |
Collapse
|
22
|
Mohi S, Deane FP, Mooney-Reh D, Bailey A, Ciaglia D. Experiential avoidance and depression predict values engagement among people in treatment for borderline personality disorder. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2021. [DOI: 10.1016/j.jcbs.2021.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
23
|
Edwards ER, Rose NLJ, Gromatsky M, Feinberg A, Kimhy D, Doucette JT, Goodman M, McClure MM, Perez-Rodriguez MM, New AS, Hazlett EA. Alexithymia, Affective Lability, Impulsivity, and Childhood Adversity in Borderline Personality Disorder. J Pers Disord 2021; 35:114-131. [PMID: 33650890 DOI: 10.1521/pedi_2021_35_513] [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: 01/30/2023]
Abstract
Long-standing theories of borderline personality disorder (BPD) suggest that symptoms develop at least in part from childhood adversity. Emotion dysregulation may meaningfully mediate these effects. The current study examined three factors related to emotion dysregulation-alexithymia, affective lability, and impulsivity-as potential mediators of the relation between childhood adversity and BPD diagnosis in 101 individuals with BPD and 95 healthy controls. Path analysis compared three distinct models informed by the literature. Results supported a complex mediation model wherein (a) alexithymia partially mediated the relation of childhood adversity to affective lability and impulsivity; (b) affective lability mediated the relation of childhood adversity to BPD diagnosis; and (c) affective lability and impulsivity mediated the relation of alexithymia to BPD diagnosis. Findings suggest that affective lability and alexithymia are key to understanding the relationship between childhood adversity and BPD. Interventions specifically targeting affective lability, impulsivity, and alexithymia may be particularly useful for this population.
Collapse
Affiliation(s)
- Emily R Edwards
- Mental Health Research, Education, and Clinical Center (MIRECC VISN-2), James J. Peters VA Medical Center, Bronx, New York
| | - Nina L J Rose
- Mental Health Research, Education, and Clinical Center (MIRECC VISN-2), James J. Peters VA Medical Center, Bronx, New York.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Molly Gromatsky
- Mental Health Research, Education, and Clinical Center (MIRECC VISN-2), James J. Peters VA Medical Center, Bronx, New York
| | - Abigail Feinberg
- Mental Health Research, Education, and Clinical Center (MIRECC VISN-2), James J. Peters VA Medical Center, Bronx, New York.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - David Kimhy
- Mental Health Research, Education, and Clinical Center (MIRECC VISN-2), James J. Peters VA Medical Center, Bronx, New York.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - John T Doucette
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai
| | - Marianne Goodman
- Mental Health Research, Education, and Clinical Center (MIRECC VISN-2), James J. Peters VA Medical Center, Bronx, New York.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Margaret M McClure
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Psychology, Fairfield University, Fairfield, Connecticut
| | | | - Antonia S New
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Erin A Hazlett
- Mental Health Research, Education, and Clinical Center (MIRECC VISN-2), James J. Peters VA Medical Center, Bronx, New York.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| |
Collapse
|
24
|
Gillett G, McGowan NM, Palmius N, Bilderbeck AC, Goodwin GM, Saunders KEA. Digital Communication Biomarkers of Mood and Diagnosis in Borderline Personality Disorder, Bipolar Disorder, and Healthy Control Populations. Front Psychiatry 2021; 12:610457. [PMID: 33897487 PMCID: PMC8060643 DOI: 10.3389/fpsyt.2021.610457] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 03/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Remote monitoring and digital phenotyping harbor potential to aid clinical diagnosis, predict episode course and recognize early signs of mental health crises. Digital communication metrics, such as phone call and short message service (SMS) use may represent novel biomarkers of mood and diagnosis in Bipolar Disorder (BD) and Borderline Personality Disorder (BPD). Materials and Methods: BD (n = 17), BPD (n = 17) and Healthy Control (HC, n = 21) participants used a smartphone application which monitored phone calls and SMS messaging, alongside self-reported mood. Linear mixed-effects regression models were used to assess the association between digital communications and mood symptoms, mood state, trait-impulsivity, diagnosis and the interaction effect between mood and diagnosis. Results: Transdiagnostically, self-rated manic symptoms and manic state were positively associated with total and outgoing call frequency and cumulative total, incoming and outgoing call duration. Manic symptoms were also associated with total and outgoing SMS frequency. Transdiagnostic depressive symptoms were associated with increased mean incoming call duration. For the different diagnostic groups, BD was associated with increased total call frequency and BPD with increased total and outgoing SMS frequency and length compared to HC. Depression in BD, but not BPD, was associated with decreased total and outgoing call frequency, mean total and outgoing call duration and total and outgoing SMS frequency. Finally, trait-impulsivity was positively associated with total call frequency, total and outgoing SMS frequency and cumulative total and outgoing SMS length. Conclusion: These results identify a general increase in phone call and SMS communications associated with self-reported manic symptoms and a diagnosis-moderated decrease in communications associated with depression in BD, but not BPD, participants. These findings may inform the development of clinical tools to aid diagnosis and remote symptom monitoring, as well as informing understanding of differential psychopathologies in BD and BPD.
Collapse
Affiliation(s)
- George Gillett
- Oxford University Clinical Academic Graduate School, John Radcliffe Hospital, The Cairns Library IT Corridor Level 3, Oxford, United Kingdom.,Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
| | - Niall M McGowan
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
| | - Niclas Palmius
- Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
| | - Amy C Bilderbeck
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom.,P1vital Products, Manor House, Howbery Business Park, Wallingford, United Kingdom
| | - Guy M Goodwin
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
| | - Kate E A Saunders
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
| |
Collapse
|
25
|
Bottesi G, Tesini V, Cerea S, Ghisi M. Are difficulties in emotion regulation and intolerance of uncertainty related to negative affect in borderline personality disorder? CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12163] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Gioia Bottesi
- Department of General Psychology, University of Padova, Padova, Italy,
| | - Veronica Tesini
- Department of General Psychology, University of Padova, Padova, Italy,
| | - Silvia Cerea
- Department of General Psychology, University of Padova, Padova, Italy,
| | - Marta Ghisi
- Department of General Psychology, University of Padova, Padova, Italy,
| |
Collapse
|
26
|
Németh N, Péterfalvi Á, Czéh B, Tényi T, Simon M. Examining the Relationship Between Executive Functions and Mentalizing Abilities of Patients With Borderline Personality Disorder. Front Psychol 2020; 11:1583. [PMID: 32760326 PMCID: PMC7372901 DOI: 10.3389/fpsyg.2020.01583] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 06/12/2020] [Indexed: 11/13/2022] Open
Abstract
Patients with borderline personality disorder (BPD) experience interpersonal dysfunctions; therefore, it is important to understand their social functioning and the confounding factors. We aimed to investigate the mentalizing abilities and executive functioning (EF) of BPD patients and healthy subjects and to determine the relative importance of BPD diagnosis and EF in predicting mentalizing abilities while controlling for general IQ and comorbid symptom severity. Self-oriented mentalizing (operationalized as emotional self-awareness/alexithymia), other-oriented mentalizing [defined as theory of mind (ToM)], and several EF domains were examined in 18 patients with BPD and 18 healthy individuals. Decoding and reasoning subprocesses of ToM were assessed by standard tasks (Reading the Mind in the Eyes Test and Faux Pas Test, respectively). Relative to controls, BPD patients exhibited significant impairments in emotional self-awareness and ToM reasoning; however, their ToM decoding did not differ. Multivariate regression analyses revealed that comorbid psychiatric symptoms were negative predictors of alexithymia and ToM decoding. Remarkably, the diagnosis of BPD was a positive predictor of ToM decoding but negatively influenced reasoning. Moreover, EF had no impact on alexithymia, while better IQ, and EF predicted superior ToM reasoning. Despite the small sample size, our results provide evidence that there is a dissociation between mental state decoding and reasoning in BPD. Comorbid psychiatric symptoms could be considered as significant negative confounds of self-awareness and ToM decoding in BPD patients. Conversely, the impairment of ToM reasoning was closely related to the diagnosis of BPD itself but not to the severity of the psychopathology.
Collapse
Affiliation(s)
- Nándor Németh
- Neurobiology of Stress Research Group, János Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Ágnes Péterfalvi
- Department of Laboratory Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Boldizsár Czéh
- Neurobiology of Stress Research Group, János Szentágothai Research Centre, University of Pécs, Pécs, Hungary.,Department of Laboratory Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Tamás Tényi
- Department of Psychiatry and Psychotherapy, Medical School, University of Pécs, Pécs, Hungary
| | - Maria Simon
- Neurobiology of Stress Research Group, János Szentágothai Research Centre, University of Pécs, Pécs, Hungary.,Department of Psychiatry and Psychotherapy, Medical School, University of Pécs, Pécs, Hungary
| |
Collapse
|
27
|
Derks YP, Klaassen R, Westerhof GJ, Bohlmeijer ET, Noordzij ML. Development of an Ambulatory Biofeedback App to Enhance Emotional Awareness in Patients with Borderline Personality Disorder: Multicycle Usability Testing Study. JMIR Mhealth Uhealth 2019; 7:e13479. [PMID: 31617851 PMCID: PMC6913718 DOI: 10.2196/13479] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/13/2019] [Accepted: 07/28/2019] [Indexed: 12/20/2022] Open
Abstract
Background Patients with borderline personality disorder experience great difficulties in regulating their emotions. They often are unable to effectively detect their emotional arousal and struggle to timely apply learned techniques for emotion regulation. Although the use of continuous wearable biofeedback has been repeatedly suggested as an option to improve patients’ emotional awareness, this type of app is not yet available for clinical use. Therefore, we developed an ambulatory biofeedback app named Sense-IT that can be integrated in mental health care. Objective The aim of the study was to develop an ambulatory biofeedback app for mental health care that helps with learning to better recognize changes in personal emotional arousal and increases emotional awareness. Methods Using several methods in a tailored User Centred Design (UCD) framework, we tested the app’s usability and user experience (UX) via a cyclic developmental process with multiple user groups (patients, therapists, and UCD experts; 3-5 per group, per cycle). Results The process resulted in a stable prototype of the app that meets most of the identified user requirements. The app was valued as useful and usable by involved patients, therapists, and UCD experts. On the Subjective Usability Scale (SUS), the patients rated the app as “Good” (average score of 78.8), whereas the therapists rated the app as “OK” (average score of 59.4). The UCD experts judged the app’s overall usability as between “OK” and “acceptable” (average score of 0.87 on a cognitive walkthrough). As most critical usability problems were identified and addressed in the first cycle of the prototyping process, subsequent cycles were mainly about implementing new or extending existing functions, and other adjustments to improve UX. Conclusions mHealth development within a clinical mental health setting is challenging, yet feasible and welcomed by targeted users. This paper shows how new mHealth interventions for mental health care can be met with enthusiasm and openness by user groups that are known to be reluctant to embrace technological innovations. The use of the UCD framework, involving multiple user groups, proved to be of added value during design and realization as evidenced by the complementary requirements and perspectives. Future directions on studying clinical effectiveness of the app, appliance of the app in other fields, and the implications of integration of the app for daily practice in mental health are discussed.
Collapse
Affiliation(s)
- Youri Pmj Derks
- Department of Psychology, Health, and Technology, University of Twente, Enschede, Netherlands.,Scelta, Center for Treatment of Personality Disorders, GGNet, Mental Health Institute, Apeldoorn, Netherlands
| | - Randy Klaassen
- Department of Human Media Interaction, University of Twente, Enschede, Netherlands
| | - Gerben J Westerhof
- Department of Psychology, Health, and Technology, University of Twente, Enschede, Netherlands
| | - Ernst T Bohlmeijer
- Department of Psychology, Health, and Technology, University of Twente, Enschede, Netherlands
| | - Matthijs L Noordzij
- Department of Psychology, Health, and Technology, University of Twente, Enschede, Netherlands
| |
Collapse
|
28
|
Martin S, Del-Monte J, Graziani P. Impulsivity issues in borderline personality disorder and it's links with insight: the role of urgency. Heliyon 2019; 5:e02564. [PMID: 31667405 PMCID: PMC6812187 DOI: 10.1016/j.heliyon.2019.e02564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 05/27/2019] [Accepted: 09/30/2019] [Indexed: 12/03/2022] Open
Abstract
Objective Impulsivity plays a major role in a wide range of disorders including Borderline Personality Disorder. Another crucial clinical dimension is insight. This clinical dimension is linked with symptomatology and treatment issue. The present study aims to investigate the impact of positive and negative urgency on insight in Borderline Personality Disorder. Methods We recruited eighty-one women with Borderline Personality Disorder and assessed insight level and impulsivity scores using the Beck Cognitive insight scale and the UPPS-short form scale. Results Our results showed interesting links between positive urgency and insight quality. Conclusion Negative emotions play a fundamental role for the insight quality, but positive emotions are surprisingly related to clinical insight. We discuss the possible therapeutical impact of this results on treatment adaptation.
Collapse
Affiliation(s)
- Sylvia Martin
- Laboratory of Social Psychology (LPS), University of Aix-Marseille & Nîmes, France
| | - Jonathan Del-Monte
- Laboratory of Social Psychology (LPS), University of Aix-Marseille & Nîmes, France
| | - Pierluigi Graziani
- Laboratory of Social Psychology (LPS), University of Aix-Marseille & Nîmes, France
| |
Collapse
|
29
|
Baer MM, LaCroix JM, Browne JC, Hassen HO, Perera KU, Weaver J, Soumoff A, Ghahramanlou-Holloway M. Lack of Emotional Awareness is Associated with Thwarted Belongingness and Acquired Capability for Suicide in a Military Psychiatric Inpatient Sample. Suicide Life Threat Behav 2019; 49:1395-1411. [PMID: 30457162 DOI: 10.1111/sltb.12530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 09/17/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To examine potential links between facets of impulsivity and emotion dysregulation to components of the Interpersonal-Psychological Theory of Suicide (thwarted belongingness, perceived burdensomeness, and acquired capability) among U.S. military personnel. METHOD The current study performed secondary data analysis from a randomized control trial testing the efficacy of a cognitive therapy for 134 service members (71.64% male, 68.66% Caucasian; mean age: 30.14) admitted to a psychiatric inpatient unit for a suicide-related crisis. We utilized the Difficulties in Emotion Regulation Scale, the Barratt Impulsivity Scale, the Acquired Capability for Suicide Scale, and the Interpersonal Needs Questionnaire. RESULTS All emotion dysregulation dimensions and one impulsivity facet (attentional) were positively correlated with perceived burdensomeness and thwarted belongingness. Lack of emotional awareness was positively associated with acquired capability. After controlling for depression, hopelessness, and demographic covariates, lack of emotional awareness was significantly associated with both thwarted belongingness and acquired capability, but not perceived burdensomeness, and impulsivity dimensions did not link to any variable of interest. CONCLUSIONS Findings imply that individuals with reduced emotional awareness may have difficulty cultivating interpersonal bonds and be more vulnerable to elevated acquired capability. Lack of emotional awareness may be a potential contributor to both suicidal desire and capability.
Collapse
Affiliation(s)
- Margaret M Baer
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jessica M LaCroix
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Joy C Browne
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Helena O Hassen
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Kanchana U Perera
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | - Alyssa Soumoff
- Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Marjan Ghahramanlou-Holloway
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| |
Collapse
|
30
|
Antisocial and Borderline Personality Disorders in the Emergency Department: Conceptualizing and Managing “Malingered” or “Exaggerated” Symptoms. Curr Behav Neurosci Rep 2019. [DOI: 10.1007/s40473-019-00183-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
31
|
Use your words: The role of emotion labeling in regulating emotion in borderline personality disorder. Behav Res Ther 2019; 120:103447. [PMID: 31374483 DOI: 10.1016/j.brat.2019.103447] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/13/2019] [Accepted: 07/26/2019] [Indexed: 11/24/2022]
Abstract
Borderline personality disorder (BPD) treatments emphasize emotion labeling to decrease negative emotion and facilitate emotion regulation. However, no studies have examined emotion labeling in BPD or its impact on intentional emotion regulation. The present study examined the impact of emotion labeling on emotion and intentional emotion regulation attempts across self-reported and physiological indices (i.e., skin conductance response [SCR], respiratory sinus arrhythmia [RSA]) in BPD and healthy control (HC) groups. Participants listened to emotionally-evocative scripts and were either instructed to type the emotions that they were experiencing (labeling) or the objects they could imagine seeing in the script (control) into a computer. Following this, they were instructed to use either mindfulness or cognitive reappraisal to decrease their emotion. Self-reported, RSA, and SCR indices of negative emotion were collected throughout and analyzed using generalized estimating equations. Findings indicated that the BPD group experienced higher RSA during emotion labeling compared to the control task, but the HC group did not. HCs reported lower negative emotion after emotion labeling when implementing both emotion regulation strategies compared to the control task, but the BPD group did not. These findings suggest that emotion labeling may activate emotion regulatory systems in BPD and can potentiate intentional emotion regulation in HCs.
Collapse
|
32
|
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.
Collapse
Affiliation(s)
| | - John S Ogrodniczuk
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| |
Collapse
|
33
|
Berthoud L, Pascual-Leone A, Caspar F, Tissot H, Keller S, Rohde KB, de Roten Y, Despland JN, Kramer U. Leaving Distress Behind: A Randomized Controlled Study on Change in Emotional Processing in Borderline Personality Disorder. Psychiatry 2017; 80:139-154. [PMID: 28767333 DOI: 10.1080/00332747.2016.1220230] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The marked impulsivity and instability of clients suffering from borderline personality disorder (BPD) greatly challenge therapists' understanding and responsiveness. This may hinder the development of a constructive therapeutic relationship despite it being of particular importance in their treatment. Recent studies have shown that using motive-oriented therapeutic relationship (MOTR), a possible operationalization of appropriate therapist responsiveness, can enhance treatment outcome for BPD. The overall objective of this study is to examine change in emotional processing in BPD clients following the therapist's use of MOTR. METHOD The present paper focuses on N = 50 cases, n = 25 taken from each of two conditions of a randomized controlled add-on effectiveness design. Clients were either allocated to a manual-based psychiatric-psychodynamic 10-session version of general psychiatric management (GPM), a borderline-specific treatment, or to a 10-session version of GPM augmented with MOTR. Emotional states were assessed using the Classification of Affective-Meaning States (Pascual-Leone & Greenberg, 2005) at intake, midtreatment, and in the penultimate session. RESULTS Across treatment, early expressions of distress, especially the emotion state of global distress, were shown to significantly decrease (p = .00), and adaptive emotions were found to emerge (p < .05). Between-condition differences of change were found, including a significant increase in emotional variability and stronger outcome predictors in the MOTR condition. CONCLUSIONS The findings indicate initial emotional change in BPD clients in a relatively short time frame and suggest the addition of MOTR to psychotherapeutic treatments as promising. Clinical implications are discussed.
Collapse
|
34
|
Flasbeck V, Popkirov S, Brüne M. Frontal EEG asymmetry in borderline personality disorder is associated with alexithymia. Borderline Personal Disord Emot Dysregul 2017; 4:20. [PMID: 28975030 PMCID: PMC5622581 DOI: 10.1186/s40479-017-0071-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 09/20/2017] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Frontal EEG asymmetry is a widely studied correlate of emotion processing and psychopathology. Recent research suggests that frontal EEG asymmetry during resting state is related to approach/withdrawal motivation and is also found in affective disorders such as major depressive disorder. Patients with borderline personality disorder (BPD) show aberrant behavior in relation to both approach and withdrawal motivation, which may arguably be associated with their difficulties in emotion processing. The occurrence and significance of frontal EEG asymmetry in BPD, however, has received little attention. RESULTS Thirty-seven BPD patients and 39 controls underwent resting EEG and completed several psychometric questionnaires. While there were no between-group differences in frontal EEG asymmetry, in BPD frontal EEG asymmetry scores correlated significantly with alexithymia. That is, higher alexithymia scores were associated with relatively lower right-frontal activity. A subsequent analysis corroborated the significant interaction between frontal EEG asymmetry and alexithymia, which was moderated by group. CONCLUSIONS Our findings reveal that lower right frontal EEG asymmetry is associated with alexithymia in patients with BPD. This finding is in accordance with neurophysiological models of alexithymia that implicate a right hemisphere impairment in emotion processing, and could suggest frontal EEG asymmetry as a potential biomarker of relevant psychopathology in these patients.
Collapse
Affiliation(s)
- Vera Flasbeck
- LWL University Hospital Bochum, Department of Psychiatry, Psychotherapy and Preventive Medicine, Division of Cognitive Neuropsychiatry and Psychiatric Preventive Medicine, Ruhr-University, Alexandrinenstr 1, 44791 Bochum, Germany
| | - Stoyan Popkirov
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Martin Brüne
- LWL University Hospital Bochum, Department of Psychiatry, Psychotherapy and Preventive Medicine, Division of Cognitive Neuropsychiatry and Psychiatric Preventive Medicine, Ruhr-University, Alexandrinenstr 1, 44791 Bochum, Germany
| |
Collapse
|