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Yuan Y, Lee H, Newhill CE, Eack SM, Fusco R, Scott LN. Differential associations between childhood maltreatment types and borderline personality disorder from the perspective of emotion dysregulation. Borderline Personal Disord Emot Dysregul 2023; 10:4. [PMID: 36747278 PMCID: PMC9903452 DOI: 10.1186/s40479-023-00210-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/17/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Borderline Personality Disorder (BPD) is characterized by pervasive instability in a range of areas including interpersonal relationships, self-image, and affect. Extant studies have consistently identified significant correlations between childhood maltreatment (CM) and BPD. While exploring this CM-BPD link, a number of cross-sectional studies commonly emphasize the role of emotion dysregulation (ED). A better understanding of the associations between BPD and (1) CM and (2) ED are essential in formulating early, effective intervention approaches, and in addressing varied adverse impacts. METHODS This cross-sectional study analyzed a subset of baseline data collected for a larger community-based longitudinal study. Given that our current focus on CM and ED, only those participants who completed the baseline CM assessment and ED measure (N = 144) were included for the primary analyses. We conducted stepwise multivariate linear models to examine the differential relationships between BPD features, ED, and multiple CM types. A path analysis with latent factors using the structural equation modeling (SEM) method was performed to test the indirect effect from CM to BPD features via ED. RESULTS Linear regression models revealed that only emotional abuse (relative to other trauma types) was significantly associated with high BPD features. The SEM, by constructing direct and indirect effects simultaneously, showed that (1) ED partially mediated the path from CM to BPD features; and (2) CM played an important role in which the direct effect remained significant even after accounting for the indirect effect through ED. CONCLUSIONS Our results highlight a most consistent association between emotional abuse and BPD, indicating its unique role in understanding BPD features in the context of CM. Further, shame-related negative appraisal and ED were found critical when examining the association between CM and BPD, possibly providing promising treatment targets for future practices.
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Affiliation(s)
- Yan Yuan
- School of Social Work, University of Pittsburgh, 2203 Cathedral of Learning, 4200 Fifth Ave, Pittsburgh, PA, 15260, USA.
| | - Hyunji Lee
- College of Social Work, Florida State University, Tallahassee, USA
| | - Christina E Newhill
- School of Social Work, University of Pittsburgh, 2203 Cathedral of Learning, 4200 Fifth Ave, Pittsburgh, PA, 15260, USA
| | - Shaun M Eack
- School of Social Work, University of Pittsburgh, 2203 Cathedral of Learning, 4200 Fifth Ave, Pittsburgh, PA, 15260, USA
| | - Rachel Fusco
- School of Social Work, University of Georgia, Athens, USA
| | - Lori N Scott
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, USA
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Wu T, Hu J, Davydow D, Huang H, Spottswood M, Huang H. Demystifying borderline personality disorder in primary care. Front Med (Lausanne) 2022; 9:1024022. [PMID: 36405597 PMCID: PMC9668888 DOI: 10.3389/fmed.2022.1024022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 10/12/2022] [Indexed: 11/05/2022] Open
Abstract
Borderline personality disorder (BPD) is a common mental health diagnosis observed in the primary care population and is associated with a variety of psychological and physical symptoms. BPD is a challenging disorder to recognize due to the limitations of accurate diagnosis and identification in primary care settings. It is also difficult to treat due to its complexity (e.g., interpersonal difficulties and patterns of unsafe behaviors, perceived stigma) and healthcare professionals often feel overwhelmed when treating this population. The aim of this article is to describe the impact of BPD in primary care, review current state of knowledge, and provide practical, evidence-based treatment approaches for these patients within this setting. Due to the lack of evidence-based pharmacological treatments, emphasis is placed on describing the framework for treatment, identifying psychotherapeutic opportunities, and managing responses to difficult clinical scenarios. Furthermore, we discuss BPD treatment as it relates to populations of special interest, including individuals facing societal discrimination and adolescents. Through this review, we aim to highlight gaps in current knowledge around managing BPD in primary care and provide direction for future study.
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Affiliation(s)
- Tina Wu
- Warren Alpert Medical School, Brown University, Providence, RI, United States
- Butler Hospital, Providence, RI, United States
- *Correspondence: Tina Wu,
| | - Jennifer Hu
- Duke University Hospital, Durham, NC, United States
- Jennifer Hu,
| | | | - Heather Huang
- University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Margaret Spottswood
- Community Health Centers of Burlington, Burlington, VT, United States
- Department of Psychiatry, University of Vermont College of Medicine, Burlington, VT, United States
| | - Hsiang Huang
- Cambridge Health Alliance, Cambridge, MA, United States
- Harvard Medical School, Boston, MA, United States
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Native Hawaiian wellbeing and transdiagnostic trauma symptoms: The protective role of physical activity in dissociation. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2022. [DOI: 10.1016/j.ejtd.2022.100296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Hermosilla S, Choi KW, Askari MS, Marks T, Denckla C, Axinn W, Smoller JW, Ghimire D, Benjet C. What can we learn about polytrauma typologies by comparing population-representative to trauma-exposed samples: A Nepali example. J Affect Disord 2022; 314:201-210. [PMID: 35810829 PMCID: PMC9869468 DOI: 10.1016/j.jad.2022.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 06/14/2022] [Accepted: 07/03/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Potentially traumatic events (PTEs) are common and associated with detrimental outcomes over the life-course. Previous studies exploring the causes and consequences of PTE-exposure profiles are often from high-income settings and fail to explore the implications of sample selection (i.e., population-representative versus PTE-restricted). METHODS Among individuals in the Nepal Chitwan Valley Family Study, latent class analyses (LCA) were performed on 11 self-reported PTEs collected by the Nepali version of the World Mental Health Consortium's Composite International Diagnostic Interview 3.0 from 2016 to 2018, in a population-representative sample (N = 10,714), including a PTE-restricted subsample (N = 9183). Multinomial logistic regressions explored relationships between sociodemographic factors and class membership. Logistic regressions assessed relationships between class membership and psychiatric outcomes. RESULTS On average, individuals were exposed to 2 PTEs in their lifetime. A five-class solution showed optimal fit for both samples; however, specific classes were distinct. No single sociodemographic factor was universally associated with PTE class membership in the population-representative sample; while several factors (e.g., age, age at incident PTE, education, marital status, and migration) were consistently associated with class membership in the PTE-subsample. PTE class membership differentiated psychiatric outcomes in the population-representative sample more than the PTE-subsample. LIMITATIONS Primary limitations are related to the generalizability to high-income settings, debate on LCA model fit statistic usage for final class selection, and cross-sectional nature of data collection. CONCLUSIONS Although population-representative samples provide information applicable to large-scale, population-based programming and policy, PTE-subsample analyses may provide additional nuance in PTE profiles and their consequences, important for specialized prevention efforts.
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Affiliation(s)
- Sabrina Hermosilla
- Population Studies Center, Institute for Social Research, University of Michigan, Ann Arbor, USA.
| | - Karmel W Choi
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA; Stanley Center for Psychiatric Research, Broad Institute, Boston, MA, USA
| | - Melanie S Askari
- Population Studies Center, Institute for Social Research, University of Michigan, Ann Arbor, USA
| | - Taylor Marks
- Population Studies Center, Institute for Social Research, University of Michigan, Ann Arbor, USA
| | - Christy Denckla
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - William Axinn
- Population Studies Center, Institute for Social Research, University of Michigan, Ann Arbor, USA
| | - Jordan W Smoller
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA; Stanley Center for Psychiatric Research, Broad Institute, Boston, MA, USA
| | - Dirgha Ghimire
- Population Studies Center, Institute for Social Research, University of Michigan, Ann Arbor, USA; Institute for Social and Environmental Research-Nepal, Chitwan, Nepal
| | - Corina Benjet
- Department of Epidemiology and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
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Schleyer W, Zona K, Quigley D, Spottswood M. Group therapy in primary care settings for the treatment of posttraumatic stress disorder: A systematic literature review. Gen Hosp Psychiatry 2022; 77:1-10. [PMID: 35390567 DOI: 10.1016/j.genhosppsych.2022.03.010] [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: 09/12/2021] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE This systematic review aims to summarize existing literature on group therapy for the treatment of post-traumatic stress disorder (PTSD) in primary care. METHOD A PRISMA systematic literature review was performed through February 26, 2022 identifying existing studies of group trauma therapy in primary care. Articles were included if they discussed group trauma therapy for primary care patients. Bias was assessed based on sample sizes and presence of control groups. Results are presented as a weighted average of the engagement rate and a qualitative description of overlapping study traits. RESULTS Four studies of group PTSD treatment within primary care were identified with 70 total patients completing group treatment. The weighted treatment engagement rate was 65%. Each utilized distinct group trauma treatment models and reported significant patient improvements in PTSD symptoms on standardized trauma symptom scales. DISCUSSION Group trauma therapy models are available and can be disseminated within primary care settings. Limitations include both the small number of studies and participants. CONCLUSION There have been few studies of group therapy for PTSD in primary care, but these could represent a promising and scalable approach to meet the high need for trauma treatment. Further research is needed regarding implementation feasibility and impact.
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Affiliation(s)
- William Schleyer
- Cambridge Health Alliance/Harvard Medical School, Department of Psychiatry, 1493 Cambridge Street, Cambridge, MA 02139, USA
| | - Kate Zona
- Cambridge Health Alliance/Harvard Medical School, Department of Psychiatry, 1493 Cambridge Street, Cambridge, MA 02139, USA
| | - Dan Quigley
- Smith College School for Social Work Lilly Hall, 23 West St, Northampton, MA 01063, United States of America
| | - Margaret Spottswood
- Community Health Centers of Burlington, 617 Riverside Ave., Burlington, VT 05401, United States of America; University of Vermont, Department of Psychiatry, 1 South Prospect Street, Burlington, VT 05401, United States of America.
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Ibrahim P, Almeida D, Nagy C, Turecki G. Molecular impacts of childhood abuse on the human brain. Neurobiol Stress 2021; 15:100343. [PMID: 34141833 PMCID: PMC8187840 DOI: 10.1016/j.ynstr.2021.100343] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/24/2021] [Accepted: 05/13/2021] [Indexed: 12/17/2022] Open
Abstract
Childhood abuse (CA) is a prevalent global health concern, increasing the risk of negative mental health outcomes later in life. In the literature, CA is commonly defined as physical, sexual, and emotional abuse, as well as neglect. Several mental disorders have been associated with CA, including depression, bipolar disorder, schizophrenia, and post-traumatic stress disorder, along with an increased risk of suicide. It is thought that traumatic life events occurring during childhood and adolescence may have a significant impact on essential brain functions, which may persist throughout adulthood. The interaction between the brain and the external environment can be mediated by epigenetic alterations in gene expression, and there is a growing body of evidence to show that such changes occur as a function of CA. Disruptions in the HPA axis, myelination, plasticity, and signaling have been identified in individuals with a history of CA. Understanding the molecular impact of CA on the brain is essential for the development of treatment and prevention measures. In this review, we will summarize studies that highlight the molecular changes associated with CA in the human brain, along with supporting evidence from peripheral studies and animal models. We will also discuss some of the limitations surrounding the study of CA and propose extracellular vesicles as a promising future approach in the field.
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Affiliation(s)
- Pascal Ibrahim
- Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Verdun, Quebec, Canada
| | - Daniel Almeida
- Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Verdun, Quebec, Canada
| | - Corina Nagy
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Verdun, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Gustavo Turecki
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Verdun, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
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Wang Y, Chung MC, Fang S. Post-Traumatic Distress and Burnout Among Chinese School Teachers: The Mediating Role of Forgiveness. Front Psychol 2021; 12:642926. [PMID: 34393882 PMCID: PMC8362850 DOI: 10.3389/fpsyg.2021.642926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 06/25/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose Teachers’ mental health is concerning due to high stress at work. Its association with job-related stressors has been well-documented. Little is known; however, about how traumatic life events and trauma reactions might contribute to their psychological distress. This paper is to explore whether Post-traumatic Stress Disorder (PTSD) following past traumatic event would predict burnout and psychiatric co-morbidity among Chinese k-12 school teachers and whether this prediction would be mediated by forgiveness after controlling for work-related factors. Methods Two hundred and seventy-nine Chinese teachers (F = 223, M = 56) from primary and secondary schools completed demographic information, Post-traumatic Stress Disorder Checklist for DSM-5 (PCL-5), Heartland Forgiveness Scale (HFS), General Health Questionnaire-28 (GHQ-28), Maslach Burnout Inventory-Educator’s Survey (MBI-ES), and a series of measures assessing work-related factors. Results Structured equation modeling (SEM) showed that after controlling for work-related factors, PTSD following past trauma was positively associated with burnout and general psychological problems but negatively associated with levels of forgiveness. Forgiveness carried the impact of PTSD onto burnout rather than general psychological distress. Conclusion To conclude, regardless of the level of stress experienced from working in school, primary and secondary teachers with PTSD from past trauma found it more difficult forgiving which in turn could affect their levels of burnout.
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Affiliation(s)
- Yabing Wang
- School of English Education, Guangdong University of Foreign Studies, Guangzhou, China
| | - Man Cheung Chung
- Faculty of Education, The Chinese University of Hong Kong, Hong Kong, China
| | - Siqi Fang
- Department of Social and Behavioral Sciences, City University of Hong Kong, Hong Kong, China
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Dixon-Gordon KL, Fitzpatrick S, Haliczer LA. Emotion regulation and borderline personality features in daily life: The role of social context. J Affect Disord 2021; 282:677-685. [PMID: 33445091 DOI: 10.1016/j.jad.2020.12.125] [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: 08/10/2020] [Revised: 11/27/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Borderline personality disorder (BPD) is associated with emotional dysfunction and interpersonal sensitivity. Yet, little work has characterized how BPD features predicts emotional reactivity and emotion regulation behaviors in response to interpersonal stress relative to other forms of stress. METHODS Participants were 152 university students who completed baseline measures of BPD features and complied with two-week daily diary procedures assessing daily emotion regulation strategy use in response to social and non-social stressors. RESULTS Generalized estimating equations revealed that BPD features predicted greater negative and positive emotions in response to daily stressors, and interacted with type of stressor in predicting urges and behaviors. Elevated BPD features was associated with greater urges for dysfunctional emotion regulatory behaviors and fewer functional emotion regulatory behaviors to a greater extent in response to social (versus non-social) stressors. LIMITATIONS This study was limited by its focus on past-day retrospective recall. Further, the student sample limits the generalizability of these findings. CONCLUSIONS These findings suggest that individuals with elevated BPD features may have less functional emotion regulation in social contexts.
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Affiliation(s)
- Katherine L Dixon-Gordon
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, 135 Hicks Way, Amherst, MA 01002, USA.
| | | | - Lauren A Haliczer
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, 135 Hicks Way, Amherst, MA 01002, USA
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9
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Exploring the boundaries between borderline personality disorder and suicidal behavior disorder. Eur Arch Psychiatry Clin Neurosci 2020; 270:959-967. [PMID: 30673835 DOI: 10.1007/s00406-019-00980-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 01/03/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To compare clinical traits of suicidal vulnerability among in-patients with suicidal behavior disorder (SBD) with and without borderline personality disorder (BPD). METHOD we recruited adult patients with SBD, consecutively and voluntarily hospitalized in a specialized unit for affective disorders and suicidal behavior between July and October 2016. Ninety-two inpatients having attempted suicide within the past 2 years were divided into two subgroups according to the presence or absence of BPD. Clinical vulnerability traits for suicidal behavior were assessed. RESULTS Half of the patients with SBD also had BPD. Patients with BPD were nine times more likely to be major suicide repeaters compared to those without. They were also more likely to display clinical and psychological vulnerability traits for suicidal behavior, even after considering potential confounders. Emotional dysregulation, shame-proneness, impulsiveness, preoccupied attachment pattern, and childhood trauma were high in both groups, but significantly increased in those with (vs. without) BPD status. Psychological traits remained stable in SBD-BPD patients, regardless of the time since the last suicide attempt (i.e. SBD in recent vs. early remission). CONCLUSIONS Clinical and psychological traits associated with suicidal vulnerability are present in all SBD patients compared to non-suicidal populations, but comorbidity with BPD is associated with particularly high scores. BPD could be considered as a specifier for SBD diagnoses.
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Wang Y, Chung MC. Linking Rejection Sensitivity, Shyness and Unsociability with Posttraumatic Stress Disorder and Psychiatric Co-Morbidity among Chinese Adolescents. Psychiatr Q 2020; 91:309-319. [PMID: 31898211 DOI: 10.1007/s11126-019-09701-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study investigated whether rejection sensitivity (RS), shyness and unsociability would positively correlate with Posttraumatic Stress Disorder (PTSD) and psychiatric co-morbidity and whether shyness and unsociability would mediate the impact of RS on distress outcomes. Four hundred and one adolescents from three middle schools in China completed a demographic questionnaire, Children's Rejection Sensitivity Questionnaire, Children's Shyness Questionnaire, Child Social Preference Scale, Posttraumatic Stress Disorder Checklist for DSM-5, and the General Health Questionnaire-28. The results showed that RS and shyness were mostly correlated with PTSD and psychiatric co-morbidity whereas unsociability was not and therefore not a mediator. Shyness, on the other hand, mediated the impact of angry RS and anxious RS on PTSD, as well as anxious RS on psychiatric co-morbidity. To conclude, the severity of PTSD along with other psychological difficulties tends to increase for those who are shy and sensitive to rejection.
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Affiliation(s)
- Yabing Wang
- Department of Educational Psychology, Faculty of Education, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Man Cheung Chung
- Department of Educational Psychology, Faculty of Education, The Chinese University of Hong Kong, Shatin, Hong Kong.
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Abstract
After participating in this activity, learners should be better able to:• Assess medication management in patients with borderline personality disorder (BPD)• Evaluate the role of deprescribing as an active intervention in patients with BPD treated with polypharmacy ABSTRACT: Psychopharmacology in borderline personality disorder (BPD) is complicated by comorbid disorders, substance use, sensitivity to side effects, risk of self-harm through medication misuse, and intense but transient symptoms. Patients' relationships with medications may range from tenuous to highly enmeshed, and may profoundly influence the response to treatment. For these reasons, awareness of current evidence and flexible approaches are particularly relevant to prescribing in BPD. In this narrative review, we illustrate the current status of medication management in BPD by focusing on polypharmacy. We use a single vignette to explore the limitations of prescribing multiple medications and the factors contributing to polypharmacy. With the same vignette, and using the framework of deprescribing, we describe how medication regimens can be reduced to a necessary minimum. Deprescribing, originally developed in geriatric medicine, is an active intervention that involves a risk-benefit analysis for each medication, keeping in mind the patient's medical and psychiatric status and his or her preferences and values. Deprescribing lends itself well to use in psychiatry and especially in BPD because of its emphasis on the patient's preferences and on repeated conversations to revisit and update decisions. In addition to elaborating on the deprescribing framework, we provide recommendations for conducting these critical discussions about medications in BPD, with particular attention to the patient's relationship to the medication. Finally, we summarize our recommendations and strategies for implementing flexible and responsive medication management for patients with BPD. We suggest areas of future research, including testing the efficacy of targeted intermittent medication treatments.
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Butter S, Shevlin M, Murphy J. Negative self-evaluation and the genesis of internal threat: beyond a continuum of suicidal thought and behaviour. Psychol Med 2019; 49:2591-2599. [PMID: 30501680 DOI: 10.1017/s0033291718003562] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Death by suicide is often preceded by attempted suicide, suicidal ideation and non-suicidal self-injury. These extreme thoughts and behaviours have been considered in terms of a continuum of suicidality. Little known research, however, has considered a suicide continuum that extends beyond these extreme thoughts and behaviours and incorporates a much wider array of phenomena that may vary in severity and may constitute a broader negative self-evaluation (NSE) continuum. METHOD Harvesting key indicators of NSE from a British epidemiological survey (N = 8580), the current study used exploratory factor analysis, confirmatory factor analysis and factor mixture modelling to (i) identify the dimensional structure of NSE in the general population and (ii) profile the distribution of the resultant NSE dimensions. Multinomial logistic regression was then used to differentiate between classes using an array of risk variables, psychopathology outcome variables and a suicide attempt indicator. RESULTS A 4-factor model that reflected graded levels of NSE was identified; (F1) Low self-worth & subordination (F2) depression, (F3) suicidal thoughts, (F4) self-harm (SH). Seven classes suggested a clear pattern of NSE severity. Classes characterised by higher levels across the dimensions exhibited greater risk and poorer outcomes. The greatest risk for suicide attempt was associated with a class characterised by engagement in SH behaviour. CONCLUSIONS Low self-worth, subordination and depression, while representative of distinct groups in the population are also highly prevalent in those who entertain suicidal thoughts and engage in SH behaviour. The findings promote further investigation into the genesis and evolution of suicidality and internal threat.
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Affiliation(s)
- Sarah Butter
- School of Psychology, Ulster University, Coleraine, Northern Ireland
| | - Mark Shevlin
- School of Psychology, Ulster University, Coleraine, Northern Ireland
| | - Jamie Murphy
- School of Psychology, Ulster University, Coleraine, Northern Ireland
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13
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O'Brien KH. Social determinants of health: the how, who, and where screenings are occurring; a systematic review. SOCIAL WORK IN HEALTH CARE 2019; 58:719-745. [PMID: 31431190 DOI: 10.1080/00981389.2019.1645795] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Screening for social determinants of health allows health care teams to assess and address social factors that influence one's health, mental health, and access to care. These social factors include poverty, health literacy, social support, exposure to trauma, food insecurity, and housing instability. The objective of this study was to examine what screening tools for social determinants of health are being used, in what contexts, and with what populations. Findings suggest that health literacy is the most commonly screened for, followed by trauma history, social support, food insecurity and housing across diverse contexts and populations. Results from this study can be used to inform providers of available screening tools and resources that can be readily utilized in practice.
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Affiliation(s)
- Kyle H O'Brien
- School of Health and Human Services, Department of Social Work, Southern Connecticut State University , New Haven , CT , USA
- Department of Health and Movement Sciences, Southern Connecticut State University , New Haven , CT , USA
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Krause-Utz A, Walther JC, Lis S, Schmahl C, Bohus M. Heart rate variability during a cognitive reappraisal task in female patients with borderline personality disorder: the role of comorbid posttraumatic stress disorder and dissociation. Psychol Med 2019; 49:1810-1821. [PMID: 30198447 PMCID: PMC6650777 DOI: 10.1017/s0033291718002489] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 08/04/2018] [Accepted: 08/10/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Emotion dysregulation is a core feature of borderline personality disorder (BPD), which often co-occurs with posttraumatic stress disorder (PTSD). Difficulties in emotion regulation (ER) have been linked to lower high-frequency heart rate variability (HF-HRV), a measure of autonomous nervous system functioning. However, previous research on vagally-mediated heart rate in BPD revealed heterogeneous findings and the effects of comorbid PTSD and dissociation on HF-HRV are not yet completely understood. This study aim to investigate HF-HRV during resting-state and an ER task in female BPD patients with comorbid PTSD (BPD + PTSD), patients without this comorbidity (BPD), and healthy controls (HC). METHODS 57 BPD patients (BPD: n = 37, BPD + PTSD: n = 20) and 27 HC performed an ER task with neutral, positive, and negative images. Participants were instructed to either attend these pictures or to down-regulate their upcoming emotions using cognitive reappraisal. Subjective arousal and wellbeing, self-reported dissociation, and electrocardiogram data were assessed. RESULTS Independent of ER instruction and picture valence, both patient groups (BPD and BPD + PTSD) reported higher subjective arousal and lower wellbeing; patients with BPD + PTSD further exhibited significantly lower HF-HRV compared with the other groups. Higher self-reported state dissociation predicted higher HF-HRV during down-regulating v. attending negative pictures in BPD + PTSD. CONCLUSIONS Findings suggest increased emotional reactivity to negative, positive, and neutral pictures, but do not provide evidence for deficits in instructed ER in BPD. Reduced HF-HRV appears to be particularly linked to comorbid PTSD, while dissociation may underlie attempts to increase ER and HF-HRV in BPD patients with this comorbidity.
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Affiliation(s)
- Annegret Krause-Utz
- Institute of Clinical Psychology, Leiden University; Leiden Institute for Brain and Cognition; Leiden, The Netherlands
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim; Medical Faculty, University of Heidelberg, Mannheim, Germany
| | - Julia-Caroline Walther
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim; Medical Faculty, University of Heidelberg, Mannheim, Germany
| | - Stefanie Lis
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim; Medical Faculty, University of Heidelberg, Mannheim, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Mannheim; Medical Faculty, University of Heidelberg, Mannheim, Germany
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Martin Bohus
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim; Medical Faculty, University of Heidelberg, Mannheim, Germany
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Slanbekova GK, Chung MC, Karipbaev BI, Sabirova RS, Alimbayeva RT. Posttraumatic Stress and Interpersonal Sensitivity: Alexithymia as Mediator and Emotional Expressivity as Moderator. Psychiatr Q 2019; 90:249-261. [PMID: 30515699 DOI: 10.1007/s11126-018-9612-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study examined 1) the link between PTSD from past trauma, interpersonal sensitivity and psychiatric co-morbidity, 2) mediational effects of alexithymia on 1), and 3) moderated mediational effects with emotional expressivity as the moderator. Five hundred and fifteen Kazakh students completed the Posttraumatic Stress Diagnostic Scale, General Health Questionnaire-28, Toronto Alexithymia Scale-20, Berkeley Expressivity Questionnaire and Interpersonal Sensitivity Measure. The results showed that 28% met the criteria for full-PTSD. Controlling for academic year, age and university major, PTSD from past trauma was significantly correlated with interpersonal sensitivity and psychiatric co-morbidity. Alexithymia mediated the impact of PTSD on interpersonal sensitivity and psychiatric co-morbidity. Alexithymia, however, did not interact with type of emotional expressivity to influence outcomes. Moderated mediational effects were not found. To conclude, following trauma, Kazakh students can experience heightened levels of interpersonal sensitivity and psychological symptoms. These problems are particularly severe for those who have difficulty getting in touch with their emotions.
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Affiliation(s)
| | - Man Cheung Chung
- Department of Educational Psychology, Faculty of Education, The Chinese University of Hong Kong, Ho Tim Building, Shatin, NT, Hong Kong.
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16
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Abstract
The World Health Organization (WHO) has included complex post-traumatic stress disorder (C-PTSD) in the final draft of the 11th edition of the International Statistical Classification of Diseases and Related Health Problems (ICD-11), which was published in June, 2018 and is scheduled to be submitted to WHO's World Health Assembly for official endorsement in 2019. Mental health providers will want to be informed about this diagnosis in order to provide effective treatment. Complex PTSD, or developmental PTSD as it is also called, refers to the constellation of symptoms that may result from prolonged, chronic exposure to traumatic experiences, especially in childhood, as opposed to PTSD which is more typically associated with a discrete traumatic incident or set of traumatic events. Although it has been a controversial diagnosis and is not included in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), lines of evidence support its distinct profile and utility. In this case study, we elucidate and discuss some aspects of the diagnosis and its treatment.
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Shen CC, Hu LY, Tsai SJ, Yang AC, Chen PM, Hu YH. Risk stratification for the early diagnosis of borderline personality disorder using psychiatric co-morbidities. Early Interv Psychiatry 2018; 12:605-612. [PMID: 27587229 DOI: 10.1111/eip.12364] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 02/08/2016] [Accepted: 06/28/2016] [Indexed: 11/30/2022]
Abstract
AIM To develop a risk stratification model for the early diagnosis of borderline personality disorder (BPD) using Taiwan National Health Insurance Research Database. METHODS We conducted a retrospective case-control study of 6132 patients (292 BPD patients and 5840 control subjects) who were selected from the National Health Insurance Research Database. Psychiatric co-morbidities including depressive disorder, bipolar disorder, anxiety disorder, substance-use disorder, personality disorders other than BPD, sleep disorder, eating disorder, autistic spectrum disorder, mental retardation and attention-deficit hyperactivity disorder, which were diagnosed within 3 years before enrolment, were collected. A logistic regression was used to calculate the odds ratio of psychiatric co-morbidities between subjects with and without BPD. The classification and regression tree method was used to generate a risk stratification model. RESULTS The odds ratios for depressive disorder, bipolar disorder, anxiety disorder, substance-use disorder, personality disorders other than BPD, sleep disorder, eating disorder, mental retardation and attention-deficit hyperactivity disorder were greater for BPD patients than for the control subjects. Furthermore, the risk of BPD can be reliably estimated using age and psychiatric co-morbidities including bipolar disorder, substance-use disorder and depressive disorder. CONCLUSIONS Most psychiatric disorders were more common in BPD patients than in the control subjects. Using psychiatric co-morbidities, we identified four variables as significant risk predictors of BPD and permitted identification of subjects with low, intermediate or high risk for BPD. The accuracy of the risk stratification model is high and can be easily applied in clinical practice.
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Affiliation(s)
- Cheng-Che Shen
- Department of Information Management and Institute of Healthcare Information Management, National Chung Cheng University, Chiayi, Taiwan.,Department of Psychiatry, Taichung Veterans General Hospital, Chiayi, Taiwan
| | - Li-Yu Hu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Jen Tsai
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Albert C Yang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,Center for Dynamical Biomarkers and Translational Medicine, National Central University, Chungli, Taiwan
| | - Pan-Ming Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Yilan, Taiwan
| | - Ya-Han Hu
- Department of Information Management and Institute of Healthcare Information Management, National Chung Cheng University, Chiayi, Taiwan.,Department of Psychiatry, Taichung Veterans General Hospital, Chiayi, Taiwan
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Moore KE, Gobin RL, McCauley HL, Kao CW, Anthony SM, Kubiak S, Zlotnick C, Johnson JE. The relation of borderline personality disorder to aggression, victimization, and institutional misconduct among prisoners. Compr Psychiatry 2018; 84:15-21. [PMID: 29660674 PMCID: PMC6002930 DOI: 10.1016/j.comppsych.2018.03.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 03/07/2018] [Accepted: 03/15/2018] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE Borderline personality disorder (BPD) is highly prevalent among incarcerated populations; however, research has yet to examine whether prisoners diagnosed with BPD experience greater interpersonal dysfunction and institutional misconduct while incarcerated. PROCEDURE This study drew from a sample of 184 male and female prisoners diagnosed with major depressive disorder (MDD) in a randomized trial of depression treatment. The presence of a BPD diagnosis (n = 69) was analyzed as a predictor of disciplinary incidents/infractions (i.e., fights, arguments with staff, disciplinary infractions, isolation), time spent in isolation, and types of aggression and victimization experiences during incarceration. RESULTS There was a trend suggesting prisoners with BPD were about twice as likely as those without BPD to report disciplinary incidents/infractions (OR = 1.76 [0.93, 3.32], p = 0.075). Having a BPD diagnosis was unrelated to time in isolation and overall aggression and victimization. However, prisoners with BPD were more likely than those without BPD to perpetrate and be victimized by psychological aggression. Due to high rates of antisocial personality disorder (ASPD) in the sample as a whole (72%), additional analyses compared outcomes across prisoners with no BPD or ASPD diagnosis, BPD diagnosis only, ASPD diagnosis only, and comorbid BPD and ASPD. Prisoners with comorbid BPD and ASPD were no more likely than prisoners with ASPD only to report disciplinary incidents/infractions, but were significantly more likely than those with ASPD only to report perpetrating and being victimized by psychological aggression. CONCLUSIONS Among prisoners with MDD, those with a BPD diagnosis have increased risk of psychological aggression and disciplinary infractions during incarceration.
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Affiliation(s)
- Kelly E. Moore
- Yale University School of Medicine, Department of Psychiatry, 389 Whitney Ave, New Haven, CT 06511,Correspondence concerning this article should be addressed to Kelly E. Moore [Address: 389 Whitney Avenue, New Haven, CT 06511; ; Cell: 203-785-3225]
| | - Robyn L. Gobin
- University of Illinois Urbana-Champaign, Department of Kinesiology and Community Health, 1206 South Fourth Street, Champaign, IL 61820
| | - Heather L. McCauley
- Michigan State University, Department of Human Development & Family Studies, 552 W. Circle Drive, 13E Human Ecology, East Lansing, MI 48824
| | - Chien-Wen Kao
- Columbia University, Department of Counseling and Clinical Psychology, 525 West 120th St., New York, NY 10027
| | - Stephanie M. Anthony
- Michigan State University, College of Human Medicine, Division of Public Health, 200 E. 1st Street, Flint, MI 48502
| | - Sheryl Kubiak
- Michigan State University, School of Social Work and Consortium on Gender-based Violence, 655 Auditorium Rd., East Lansing, MI 48824
| | - Caron Zlotnick
- Brown University Medical School and Butler Hospital, Department of Psychiatry and Human Behavior, 345 Blackstone Boulevard, Providence, RI 02906
| | - Jennifer E. Johnson
- Michigan State University, College of Human Medicine, Division of Public Health, 200 E. 1st Street, Flint, MI 48502
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Chung MC, Symons C, Gilliam J, Kaminski ER. Posttraumatic stress disorder, emotional suppression and psychiatric co-morbidity in patients with chronic idiopathic urticaria: a moderated mediation analysis. J Ment Health 2018; 27:442-449. [PMID: 29431522 DOI: 10.1080/09638237.2018.1437601] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND There is evidence suggesting that posttraumatic stress disorder (PTSD) symptom severity and CIU severity are linked and partially mediated by the high-anxious defense mechanism. What is unclear is whether emotional suppression, as a defense serving the opposite purpose for high-anxious defense, can also act as a mediator and whether this mediational effect is partly influenced by time since trauma and trauma type. AIMS To investigate whether emotional suppression mediated the links between PTSD and CIU symptom severities, and PTSD and psychiatric co-morbid symptom severities. It then examined whether the mediating effect would be moderated by how long ago the trauma occurred and trauma type. METHODS One hundred CIU patients were compared with 60 allergy patients. They completed questionnaires measuring PTSD, psychiatric co-morbidity and emotional suppression. RESULTS Suppressing depression mediated the relationship between PTSD and psychiatric co-morbidity. How long ago the trauma occurred and trauma type moderated the mediational effect of suppressing depression. CONCLUSIONS Following a past trauma, CIU patients may develop PTSD symptoms which influence their psychological well-being through using different levels of emotional suppression, especially suppressing depression. The levels depend on the severity of PTSD symptoms, trauma history and whether they experienced interpersonal traumas.
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Affiliation(s)
- Man Cheung Chung
- a Department of Educational Psychology, Faculty of Education , The Chinese University of Hong Kong , Shatin NT , Hong Kong , and
| | - Christine Symons
- b Department of Clinical Immunology & Allergy , Derriford Hospital , Plymouth , UK
| | - Jane Gilliam
- b Department of Clinical Immunology & Allergy , Derriford Hospital , Plymouth , UK
| | - Edward R Kaminski
- a Department of Educational Psychology, Faculty of Education , The Chinese University of Hong Kong , Shatin NT , Hong Kong , and
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20
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Personality Pathology in Primary Care: Ongoing Needs for Detection and Intervention. J Clin Psychol Med Settings 2018; 25:43-54. [DOI: 10.1007/s10880-017-9525-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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21
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O'Donnell ML, Schaefer I, Varker T, Kartal D, Forbes D, Bryant RA, Silove D, Creamer M, McFarlane A, Malhi G, Felmingham K, Van Hoof M, Hadzi-Pavlovic D, Nickerson A, Steel Z. A systematic review of person-centered approaches to investigating patterns of trauma exposure. Clin Psychol Rev 2017; 57:208-225. [DOI: 10.1016/j.cpr.2017.08.009] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 08/29/2017] [Accepted: 08/29/2017] [Indexed: 10/18/2022]
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22
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Stanković M, Dimov I, Stojanović A, Stevanović J, Kostić J, Mitić N. PO ST -TRAUMATIC STRESS DIS ORDER IN CHILDREN AND ADOLESCENTS - CLINICAL PRESENTATIO N, DIAGNOSIS AND THERAPY. ACTA MEDICA MEDIANAE 2017. [DOI: 10.5633/amm.2017.0310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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23
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Child Abuse and Psychiatric Co-morbidity Among Chinese Adolescents: Emotional Processing as Mediator and PTSD from Past Trauma as Moderator. Child Psychiatry Hum Dev 2017; 48:610-618. [PMID: 27704299 DOI: 10.1007/s10578-016-0687-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This study investigated whether child abuse was associated with psychiatric co-morbidity in a group of Chinese adolescents, and whether this association would be mediated by emotional processing difficulties and moderated by the severity of PTSD from other traumas in the past. Four hundred seventy-four adolescents participated in the study. They completed the Childhood Trauma Questionnaire-Short Form, General Health Questionnaire-28, the Posttraumatic Stress Diagnostic Scale, and Emotional processing scale-25. The results showed that after adjusting for the total number of traumatic events and how long ago the most traumatic event occurred, child abuse was associated with psychiatric co-morbidity. This association was not moderated by the severity of PTSD from past traumas but mediated by emotion processing difficulties. To conclude, adolescents who experience child abuse can develop emotional processing difficulties which in turn impact on psychiatric symptoms. Experience of past trauma does not influence these psychological processes.
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24
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Wilson S, Stroud CB, Durbin CE. Interpersonal dysfunction in personality disorders: A meta-analytic review. Psychol Bull 2017; 143:677-734. [PMID: 28447827 DOI: 10.1037/bul0000101] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Personality disorders are defined in the current psychiatric diagnostic system as pervasive, inflexible, and stable patterns of thinking, feeling, behaving, and interacting with others. Questions regarding the validity and reliability of the current personality disorder diagnoses prompted a reconceptualization of personality pathology in the most recent edition of the psychiatric diagnostic manual, in an appendix of emerging models for future study. To evaluate the construct and discriminant validity of the current personality disorder diagnoses, we conducted a quantitative synthesis of the existing empirical research on associations between personality disorders and interpersonal functioning, defined using the interpersonal circumplex model (comprising orthogonal dimensions of agency and communion), as well as functioning in specific relationship domains (parent-child, family, peer, romantic). A comprehensive literature search yielded 127 published and unpublished studies, comprising 2,579 effect sizes. Average effect sizes from 120 separate meta-analyses, corrected for sampling error and measurement unreliability, and aggregated using a random-effects model, indicated that each personality disorder showed a distinct profile of interpersonal style consistent with its characteristic pattern of symptomatic dysfunction; specific relationship domains affected and strength of associations varied for each personality disorder. Overall, results support the construct and discriminant validity of the personality disorders in the current diagnostic manual, as well as the proposed conceptualization that disturbances in self and interpersonal functioning constitute the core of personality pathology. Importantly, however, contradicting both the current and proposed conceptualizations, there was not evidence for pervasive dysfunction across interpersonal situations and relationships. (PsycINFO Database Record
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Affiliation(s)
- Sylia Wilson
- Department of Psychology, University of Minnesota
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25
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Shen CC, Hu LY, Hu YH. Comorbidity study of borderline personality disorder: applying association rule mining to the Taiwan national health insurance research database. BMC Med Inform Decis Mak 2017; 17:8. [PMID: 28077135 PMCID: PMC5225571 DOI: 10.1186/s12911-016-0405-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 12/26/2016] [Indexed: 11/17/2022] Open
Abstract
Background Borderline personality disorder (BPD) is a complex clinical state with highly polymorphic symptoms and signs. Studies have demonstrated that people with a BPD diagnosis are likely to have numerous co-occurring psychiatric disorders and physical comorbidities. The aim of our study was to obtain further insight about the associations among comorbidities of BPD and to demonstrate the practicality of using association rule mining (ARM) technique in clinical databases. Methods A retrospective case–control study was conducted on information of 1460 patients (292 BPD patients and 1168 control patients) selected from the Taiwan National Health Insurance Research Database. Information on physical and psychiatric comorbidities, which were diagnosed within 3 years before and after enrollment, was collected. A logistic regression model was used to calculate the odds ratios of comorbidities between patients with and without BPD. ARM technique was used to study the associations of BPD and two or more psychiatric comorbidities. Results We classified physical comorbidities into 13 categories according to the International Classification of Diseases, Ninth Revision, Clinical Modification system, and the results indicated that the 12 categories were more common in the BPD patients than in the control patients (except congenital anomalies). However, psychiatric comorbidities, including depressive disorder, bipolar disorder, anxiety disorder, sleep disorder, substance use disorder, and mental retardation were more common in the BPD patients than in the control patients. Furthermore, the associations of BPD and two or more comorbidities were evaluated. Conclusion Most physical and psychiatric disorders were more common in the BPD patients than in the control patients. Because the failure to remit from BPD is associated with suffering from chronic physical conditions and because psychiatric comorbidities may lead to delays in diagnosis of BPD, clinicians caring for people with BPD should be aware of possible comorbidities.
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Affiliation(s)
- Cheng-Che Shen
- Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan.,Department of Information Management and Institute of Healthcare Information Management, National Chung Cheng University, Chiayi, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Li-Yu Hu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ya-Han Hu
- Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan. .,Department of Information Management and Institute of Healthcare Information Management, National Chung Cheng University, Chiayi, Taiwan.
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26
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Berenson KR, Dochat C, Martin CG, Yang X, Rafaeli E, Downey G. Identification of mental states and interpersonal functioning in borderline personality disorder. Personal Disord 2016; 9:172-181. [PMID: 27831693 DOI: 10.1037/per0000228] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Atypical identification of mental states in the self and others has been proposed to underlie interpersonal difficulties in borderline personality disorder (BPD), yet no previous empirical research has directly examined associations between these constructs. We examine 3 mental state identification measures and their associations with experience-sampling measures of interpersonal functioning in participants with BPD relative to a healthy comparison (HC) group. We also included a clinical comparison group diagnosed with avoidant personality disorder (APD) to test the specificity of this constellation of difficulties to BPD. When categorizing blended emotional expressions, the BPD group identified anger at a lower threshold than did the HC and APD groups, but no group differences emerged in the threshold for identifying happiness. These results are consistent with enhanced social threat identification and not general negativity biases in BPD. The Reading the Mind in the Eyes Test (RMET) showed no group differences in general mental state identification abilities. Alexithymia scores were higher in both BPD and APD relative to the HC group, and difficulty identifying one's own emotions was higher in BPD compared to APD and HC. Within the BPD group, lower RMET scores were associated with lower anger identification thresholds and higher alexithymia scores. Moreover, lower anger identification thresholds, lower RMET scores, and higher alexithymia scores were all associated with greater levels of interpersonal difficulties in daily life. Research linking measures of mental state identification with experience-sampling measures of interpersonal functioning can help clarify the role of mental state identification in BPD symptoms. (PsycINFO Database Record
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Affiliation(s)
| | | | | | - Xiao Yang
- Department of Human Development and Family Studies, Pennsylvania State University
| | - Eshkol Rafaeli
- Department of Psychology and Gonda Multidisciplinary Brain Research Center, Bar-Ilan University
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27
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Karamanolaki H, Spyropoulou AC, Iliadou A, Vousoura E, Vondikaki S, Pantazis N, Vaslamatzis G. Birth order and memories of traumatic and family experiences in Greek patients with borderline personality disorder versus patients with other personality disorders. Bull Menninger Clin 2016; 80:234-54. [DOI: 10.1521/bumc.2016.80.3.234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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28
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Frías Á, Palma C, Farriols N, González L. Sexuality-related issues in borderline personality disorder: A comprehensive review. Personal Ment Health 2016; 10:216-31. [PMID: 26840032 DOI: 10.1002/pmh.1330] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 08/28/2015] [Accepted: 12/20/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Sexuality is somewhat neglected in clinical research on borderline personality disorder (BPD). METHOD We performed a systematic review from 1980 to November 2014 through PubMed and PsycINFO. RESULTS Empirical evidence underscores that childhood sexual trauma may be considered a non-specific risk factor for BPD. Furthermore, individuals with BPD also display higher sexual identity disturbances and homosexual relationships than non-BPD individuals. Moreover, patients with BPD also exhibit higher sexual impulsivity than non-BPD. In addition, sexual risk behaviours among individuals with BPD are related to increased rates of sexually transmitted diseases, unwanted pregnancies, rape and commercial sexual relationships, especially among drug abusers. Although psychotherapy is widely recommended for BPD, there has been little systematic research on the effect of these treatments with respect to co-morbid post-traumatic symptoms related to childhood sexual trauma. CONCLUSIONS Sexuality-related issues represent a major clinical topic within this population. Findings are discussed concerning their methodological limitations and clinical implications. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Álvaro Frías
- FPCEE Blanquerna, Ramon-Llull University, Barcelona, Spain.,Consorci Sanitari del Maresme, Adult Outpatient Mental Health Center, Mataró, Spain
| | - Carol Palma
- FPCEE Blanquerna, Ramon-Llull University, Barcelona, Spain.,Consorci Sanitari del Maresme, Adult Outpatient Mental Health Center, Mataró, Spain
| | - Núria Farriols
- FPCEE Blanquerna, Ramon-Llull University, Barcelona, Spain.,Consorci Sanitari del Maresme, Adult Outpatient Mental Health Center, Mataró, Spain
| | - Laura González
- Consorci Sanitari del Maresme, Adult Outpatient Mental Health Center, Mataró, Spain
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29
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Prevalence, Detection and Correlates of PTSD in the Primary Care Setting: A Systematic Review. J Clin Psychol Med Settings 2016; 23:160-80. [DOI: 10.1007/s10880-016-9449-8] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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30
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Cackowski S, Neubauer T, Kleindienst N. The impact of posttraumatic stress disorder on the symptomatology of borderline personality disorder. Borderline Personal Disord Emot Dysregul 2016; 3:7. [PMID: 27482383 PMCID: PMC4968021 DOI: 10.1186/s40479-016-0042-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 07/12/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Previous findings on the impact of co-occurring posttraumatic stress disorder (PTSD) in patients with borderline personality disorder (BPD) have revealed inconsistencies, which may have been related to small sample sizes or differences in the presence of childhood sexual abuse (CSA). In this study, the potentially aggravating impact of PTSD and the role of CSA were examined in a large cohort of BPD patients. METHODS BPD patients with current PTSD (n = 142) were compared to BPD patients without PTSD (n = 225) regarding different BPD features such as non-suicidal self-injury. Further, we examined the potentially confounding role of CSA. RESULTS BPD patients with PTSD showed elevated affect dysregulation, intrusions, dissociation, history of suicide attempts and self-mutilation compared to those with only BPD. The effects of PTSD on BPD patients regarding dissociation and the history of suicide attempts were at least partially related to CSA. CONCLUSIONS The additional diagnosis of PTSD in BPD patients can aggravate some, but not all BPD features. With respect to dissociation and suicide attempts, at least some of the impact seems to relate to CSA.
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Affiliation(s)
- Sylvia Cackowski
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Tamar Neubauer
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Nikolaus Kleindienst
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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31
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Markowitz JC, Petkova E, Biyanova T, Ding K, Suh EJ, Neria Y. EXPLORING PERSONALITY DIAGNOSIS STABILITY FOLLOWING ACUTE PSYCHOTHERAPY FOR CHRONIC POSTTRAUMATIC STRESS DISORDER. Depress Anxiety 2015; 32:919-26. [PMID: 26439430 PMCID: PMC4674381 DOI: 10.1002/da.22436] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 09/10/2015] [Accepted: 09/19/2015] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Axis I comorbidity complicates diagnosing axis II personality disorders (PDs). PDs might influence Axis I outcome. No research has examined psychotherapy effects on PDs of treating Axis I comorbidity. Secondary analysis of a randomized controlled trial examined PD diagnostic stability after brief psychotherapy of chronic posttraumatic stress disorder (PTSD). METHODS Patients with chronic PTSD were randomly assigned to 14 weeks of prolonged exposure, interpersonal psychotherapy, or relaxation therapy. Assessments included the Structured Clinical Interview for DSM-IV, Patient Version (SCID-P) and Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II) at baseline, week 14, and for treatment responders (≥30% clinician-administered PTSD scale improvement, defined a priori) at week 26 follow-up. We hypothesized patients whose PTSD improved would retain fewer baseline PD diagnoses posttreatment, particularly with personality traits PTSD mimics, e.g. paranoid and avoidant. RESULTS Forty-seven (47%) of 99 SCID-II patients evaluated at baseline received a SCID-II diagnosis: paranoid (28%), obsessive-compulsive (27%), and avoidant (23%) PDs were most prevalent. Among 78 patients who repeated SCID-II evaluations posttreatment, 45% (N = 35) had baseline PD diagnoses, of which 43% (N = 15/35) lost at week 14. Three (7%) patients without baseline PDs acquired diagnoses at week 14; 10 others shifted diagnoses. Treatment modality and PTSD response were unrelated to PD improvement. Of treatment responders reevaluated at follow-up (N = 44), 56% with any baseline Axis II diagnosis had none at week 26. CONCLUSION This first evaluation of Axis I psychotherapy effects on personality disorder stability found that acutely treating a chronic state decreased apparent trait-across most PDs observed. These exploratory findings suggest personality diagnoses may have limited prognostic meaning in treating chronic PTSD.
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Affiliation(s)
- John C. Markowitz
- New York State Psychiatric Institute and Columbia University College of Physicians & Surgeons; New York New York
| | - Eva Petkova
- New York State Psychiatric Institute and Columbia University College of Physicians & Surgeons; New York New York
| | - Tatyana Biyanova
- New York State Psychiatric Institute and Columbia University College of Physicians & Surgeons; New York New York
| | - Ke Ding
- New York State Psychiatric Institute and Columbia University College of Physicians & Surgeons; New York New York
| | - Eun Jung Suh
- New York State Psychiatric Institute and Columbia University College of Physicians & Surgeons; New York New York
| | - Yuval Neria
- New York State Psychiatric Institute and Columbia University College of Physicians & Surgeons; New York New York
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32
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Dixon-Gordon KL, Weiss NH, Tull MT, DiLillo D, Messman-Moore T, Gratz KL. Characterizing emotional dysfunction in borderline personality, major depression, and their co-occurrence. Compr Psychiatry 2015; 62:187-203. [PMID: 26343484 PMCID: PMC4561853 DOI: 10.1016/j.comppsych.2015.07.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 07/14/2015] [Accepted: 07/22/2015] [Indexed: 12/21/2022] Open
Abstract
This research aimed to characterize patterns of emotional reactivity and dysregulation in borderline personality, depression, and their co-occurrence. In study 1, 488 young adult women from the community were categorized into four groups based on self-reported major depressive disorder (MDD) and borderline personality disorder (BPD) symptoms (Low BPD/Low MDD; Low BPD/High MDD; High BPD/Low MDD; High BPD/High MDD). Immediate and prolonged subjective emotional reactivity to a laboratory stressor were assessed, and participants completed self-report and behavioral measures of emotion dysregulation. Study 2 extended these findings, examining emotional reactivity and dysregulation in a clinical population of 176 substance dependent patients with diagnoses of BPD and MDD and including a biological index of emotional reactivity. Results revealed greater prolonged fear reactivity in the High BPD/High MDD (vs. Low BPD/Low MDD) group in study 1, and greater prolonged anxiety and negative affect reactivity in both High BPD groups (vs. Low BPD/Low MDD and Low BPD/High MDD groups) in study 2 (but no differences in cortisol reactivity). Results also demonstrated greater subjective (but not behavioral) emotion dysregulation in the High BPD/High MDD (vs. Low BPD/Low MDD) group in study 1 and both High BPD groups (vs. both Low BPD groups) in study 2. Finally, the High BPD/High MDD group reported greater difficulties controlling impulsive behaviors compared with all other groups in study 1 and the Low BPD groups in study 2. Findings suggest that BPD pathology (but not MDD pathology alone) is characterized by greater prolonged emotional (especially anxiety/fear-related) reactivity and heightened emotion dysregulation.
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Affiliation(s)
- Katherine L. Dixon-Gordon
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Nicole H. Weiss
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Matthew T. Tull
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA
| | - David DiLillo
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | | | - Kim L. Gratz
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA,Correspondence concerning this article should be addressed to Kim L. Gratz, Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS 39216; Phone: (601) 815-6450;
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Schilling C, Weidner K, Schellong J, Joraschky P, Pöhlmann K. Patterns of childhood abuse and neglect as predictors of treatment outcome in inpatient psychotherapy: a typological approach. Psychopathology 2015; 48:91-100. [PMID: 25501445 DOI: 10.1159/000368121] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 09/04/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Childhood maltreatment is associated with the development and maintenance of mental disorders. The purpose of this naturalistic study was (a) to identify different patterns of childhood maltreatment, (b) to examine how these patterns are linked to the severity of mental disorders and (c) whether they are predictive of treatment outcome. METHODS 742 adult patients of a university hospital for psychotherapy and psychosomatics were assessed at intake and discharge by standardized questionnaires assessing depression (Beck Depression Inventory, BDI) and general mental distress (Symptom Check List-90-R, SCL-90-R). Traumatic childhood experience (using the Childhood Trauma Questionnaire, CTQ) and ICD-10 diagnoses were assessed at intake. RESULTS The patients could be allocated to three different patterns of early childhood trauma experience: mild traumatization, multiple traumatization without sexual abuse and multiple traumatization with sexual abuse. The three patterns showed highly significant differences in BDI, General Severity Index (GSI) and in the number of comorbidity at intake. For both BDI and GSI a general decrease in depression and general mental distress from intake to discharge could be shown. The three patterns differed in BDI and GSI at intake and discharge, indicating lowest values for mild traumatization and highest values for multiple traumatization with sexual abuse. Patients with multiple traumatization with sexual abuse showed the least favourable outcome. CONCLUSION The results provide evidence that the severity of childhood traumatization is linked to the severity of mental disorders and also to the treatment outcome in inpatient psychotherapy. In the study, three different patterns of childhood traumatization (mild traumatization, multiple traumatization without sexual abuse, multiple traumatization with sexual abuse) showed differences in the severity of mental disorder and in the course of treatment within the same therapy setting.
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Affiliation(s)
- Christoph Schilling
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
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Powers A, Etkin A, Gyurak A, Bradley B, Jovanovic T. Associations Between Childhood Abuse, Posttraumatic Stress Disorder, and implicit Emotion Regulation Deficits: Evidence From a Low-Income Inner City Population. Psychiatry 2015; 78:251-64. [PMID: 26391833 PMCID: PMC4705548 DOI: 10.1080/00332747.2015.1069656] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Childhood abuse is associated with a wide range of negative outcomes, including increased risk for development of emotion dysregulation and psychopathology, such as posttraumatic stress disorder (PTSD). The goal of the present study was to examine associations between child abuse, PTSD symptoms, and performance on an emotional conflict regulation task that assesses implicit emotion regulation abilities. METHOD The sample consisted of 67 (94% African American) females recruited from a public, urban hospital. Childhood abuse was measured using the Childhood Trauma Questionnaire, and PTSD was measured using the modified PTSD Symptom Scale. Task accuracy and implicit emotion regulation were measured through an emotional conflict regulation behavioral task. RESULTS A multivariate analysis of covariance showed that exposure to moderate to severe childhood abuse was significantly related to worse emotional conflict regulation scores independent of current PTSD symptoms, depressive symptoms, and adult trauma exposure, suggesting a deficit in implicit emotion regulation. We also found an interaction between PTSD symptoms and abuse exposure in predicting accuracy on the behavioral task; high levels of PTSD symptoms were associated with poorer task accuracy among individuals who reported moderate to severe exposure to childhood abuse. However, no relationship between implicit emotion regulation abilities and overall PTSD symptom severity was found. CONCLUSIONS This study provides preliminary evidence of an implicit emotion regulation deficit for individuals exposed to significant childhood abuse and further supports the growing evidence that addressing various aspects of emotion dysregulation, such as awareness of emotions and strategies to manage strong emotions, in the context of treatment would be valuable.
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Affiliation(s)
- Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | | | | | - Bekh Bradley
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta VA Medical Center
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
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Ford JD, Courtois CA. Complex PTSD, affect dysregulation, and borderline personality disorder. Borderline Personal Disord Emot Dysregul 2014; 1:9. [PMID: 26401293 PMCID: PMC4579513 DOI: 10.1186/2051-6673-1-9] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 05/18/2014] [Indexed: 12/23/2022] Open
Abstract
Complex PTSD (cPTSD) was formulated to include, in addition to the core PTSD symptoms, dysregulation in three psychobiological areas: (1) emotion processing, (2) self-organization (including bodily integrity), and (3) relational security. The overlap of diagnostic criteria for cPTSD and borderline personality disorder (BPD) raises questions about the scientific integrity and clinical utility of the cPTSD construct/diagnosis, as well as opportunities to achieve an increasingly nuanced understanding of the role of psychological trauma in BPD. We review clinical and scientific findings regarding comorbidity, clinical phenomenology and neurobiology of BPD, PTSD, and cPTSD, and the role of traumatic victimization (in general and specific to primary caregivers), dissociation, and affect dysregulation. Findings suggest that BPD may involve heterogeneity related to psychological trauma that includes, but extends beyond, comorbidity with PTSD and potentially involves childhood victimization-related dissociation and affect dysregulation consistent with cPTSD. Although BPD and cPTSD overlap substantially, it is unwarranted to conceptualize cPTSD either as a replacement for BPD, or simply as a sub-type of BPD. We conclude with implications for clinical practice and scientific research based on a better differentiated view of cPTSD, BPD and PTSD.
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Affiliation(s)
- Julian D Ford
- University of Connecticut Health Center MC1410, 263 Farmington Avenue, Farmington, CT 06030-1410 USA
| | - Christine A Courtois
- Independent Pactice, Washington, DC, Elements Behavioral Health, Promises, Malibu, CA USA
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