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Yetim O, Yalçın Ö. Etiopathogenesis in the Development of Borderline Personality Characteristics in Children and Adolescents. TURK PSIKIYATRI DERGISI = TURKISH JOURNAL OF PSYCHIATRY 2024; 35:137-149. [PMID: 38842155 PMCID: PMC11164069 DOI: 10.5080/u26852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 04/25/2022] [Indexed: 06/07/2024]
Abstract
The validity and clinical significance of the characteristics of borderline personality disorder (BPD) in adolescents are increasingly being recognized. The persistence of BPD characteristics in adolescence is high and is associated with negative interpersonal, academic, professional, and financial outcomes. In the literature, BPD characteristics observed in children and adolescents are explained with psychodynamic theories, developmental models, and evolutionary approaches. Emotional dysregulation, interpersonal dysfunction, impulsivity, and self-harming behavior, negative life events, temperament characteristics, neuropsychological dysfunctions, neuroanatomical, genetic, hormonal, and immunological factors may play a role in BPD etiopathogenesis. This review aims to address different approaches and relevant factors for the development of BPD. The articles published between 1968-2021 in the PubMed database were reviewed, and prominent studies were selected for evaluation. The importance of invalidating environment, epistemic freezing and hypermentalization, complex or attachment trauma is emphasized in psychodynamic and developmental literature. In the evolutionary approach, on the other hand, romantic relationships and the onset of reproduction are emphasized as the reason for the emergence of symptoms during adolescence, and it is argued that BPD is related to the rapid life history strategy. It is stated that a decrease in volume in the orbitofrontal cortex and anterior cingulate cortex, which are involved in top-down emotional processing, and an increase in the activity of thalamus and hippocampus regions, which are involved in bottom-up emotional processing are observed in adolescents with BPD characteristics when compared to healthy controls. It is thought that the increase in activation in the superior temporal gyrus and precuneus observed in adolescents with BPD features is a neural indicator of hypermentalization, and the increase in activation in the insula is a neural indicator of social pain. It has been reported that the decrease in resting heart rate and the increase in heart rate variability observed in adolescents with BPD symptoms are associated with the activation of the parasympathetic system. BPD in adolescents is a disorder that challenges clinicians in terms of diagnosis, differential diagnosis, and treatment. It is crucial to evaluate the factors related to etiopathogenesis in BPD in a multifaceted and detailed manner. Keywords: Borderline Personality Disorder, Difficulty in Emotion Regulation, Mentalization, Trauma, Self-harming Behavior, Temperamental Characteristics.
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Affiliation(s)
- Onat Yetim
- Psychiatrist, Ersin Arslan Research and Educational Hospital, Child and Adolescent Mental Health, Gaziantep
| | - Özhan Yalçın
- Assoc. Prof., Private Practice, Child and Adolescent Psychiatrist Antalya, Turkey
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Matthies S, Schiele MA, Koentges C, Pini S, Schmahl C, Domschke K. Please Don't Leave Me-Separation Anxiety and Related Traits in Borderline Personality Disorder. Curr Psychiatry Rep 2018; 20:83. [PMID: 30155649 DOI: 10.1007/s11920-018-0951-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW In light of the apparent symptomatic resemblance of separation anxiety disorder (SAD) symptoms on the one hand and abandonment fears, anxiousness, and separation insecurity central to borderline personality disorder (BPD) on the other hand, a comprehensive overview of separation anxiety and related traits in BPD is provided. RECENT FINDINGS Epidemiological, environmental, psychological, and neurobiological data connecting BPD to separation events, feelings of loneliness, insecure attachment styles, dimensional separation anxiety as well as SAD per se suggest a partly shared etiological pathway model underlying BPD and SAD. Differential diagnostic aspects and implications for treatment are discussed, highlighting separation anxiety as a promising transdiagnostic target for specific psychotherapeutic and pharmacological treatment approaches in BPD. This innovative angle on cross-disorder symptomatology might carry potential for novel preventive and therapeutic avenues in clinical practice by guiding the development of interventions specifically targeting separation anxiety and attachment-related issues in BPD.
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Affiliation(s)
- Swantje Matthies
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hauptstrasse 5, D-79104, Freiburg, Germany
| | - Miriam A Schiele
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hauptstrasse 5, D-79104, Freiburg, Germany
| | - Christa Koentges
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hauptstrasse 5, D-79104, Freiburg, Germany
| | - Stefano Pini
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hauptstrasse 5, D-79104, Freiburg, Germany.
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Wang CH, Ning QF, Liu C, Lv TT, Cong EZ, Gu JY, Zhang YL, Nie HY, Zhang XL, Li Y, Zhang XY, Su LY. Associations of serotonin transporter gene promoter polymorphisms and monoamine oxidase A gene polymorphisms with oppositional defiant disorder in a Chinese Han population. Behav Brain Funct 2018; 14:15. [PMID: 30126429 PMCID: PMC6102835 DOI: 10.1186/s12993-018-0147-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 08/11/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Oppositional defiant disorder (ODD) is a behavioral disorder that mainly refers to a recurrent pattern of disobedient, defiant, negativistic and hostile behaviors toward authority figures. Previous studies have showed associations of serotonin transporter (5-HTT) and monoamine oxidase A (MAOA) with behavioral and psychiatric disorders. The purposes of this study were to investigate the potential association of 5-HTT gene promoter polymorphism (5-HTTLPR) and MAOA gene polymorphism with susceptibility to ODD in a Han Chinese school population. METHODS The 5-HTTLPR gene polymorphism and the MAOA gene polymorphism were genotyped in a case-control study of 257 Han Chinese children (123 ODD and 134 healthy controls). RESULTS There was significant difference in the allele distribution of 5-HTTLPR (χ2 = 7.849, P = 0.005) between the ODD and control groups. Further, there were significant differences in genotype (χ2 = 5.168, P = 0.023) and allele distributions (χ2 = 10.336, P = 0.001) of the MAOA gene polymorphism that is variable-number tandem repeat (MAOA-uVNTR) between two groups. Moreover, there were significant differences in genotype (χ2 = 4.624, P = 0.032) and allele distributions (χ2 = 9.248, P = 0.002) of MAOA-uVNTR only in the male ODD and healthy groups. CONCLUSIONS Our results suggest that 5-HTTLPR and MAOA-uVNTR gene variants may contribute to susceptibility to ODD. Further, MAOA-uVNTR gene polymorphism may play a role in susceptibility to ODD only in male children.
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Affiliation(s)
- Chang-Hong Wang
- Department of Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University (Psychiatric Hospital of Henan Province China), Jianshe Road 388, Xinxiang, 453002, Henan, China.
| | - Qiu-Fen Ning
- Department of Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University (Psychiatric Hospital of Henan Province China), Jianshe Road 388, Xinxiang, 453002, Henan, China
| | - Cong Liu
- Department of Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University (Psychiatric Hospital of Henan Province China), Jianshe Road 388, Xinxiang, 453002, Henan, China
| | - Ting-Ting Lv
- Department of Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University (Psychiatric Hospital of Henan Province China), Jianshe Road 388, Xinxiang, 453002, Henan, China
| | - En-Zhao Cong
- Department of Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University (Psychiatric Hospital of Henan Province China), Jianshe Road 388, Xinxiang, 453002, Henan, China
| | - Jing-Yang Gu
- Department of Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University (Psychiatric Hospital of Henan Province China), Jianshe Road 388, Xinxiang, 453002, Henan, China
| | - Ying-Li Zhang
- Department of Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University (Psychiatric Hospital of Henan Province China), Jianshe Road 388, Xinxiang, 453002, Henan, China
| | - Hui-Yao Nie
- Department of Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University (Psychiatric Hospital of Henan Province China), Jianshe Road 388, Xinxiang, 453002, Henan, China
| | - Xiao-Li Zhang
- Department of Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University (Psychiatric Hospital of Henan Province China), Jianshe Road 388, Xinxiang, 453002, Henan, China
| | - Yan Li
- Department of Child and Adolescent, Public Health College, Zhengzhou University, Kexue Road 100, Zhengzhou, 450001, Henan, China
| | - Xiang-Yang Zhang
- Department of Psychiatry and Behavioral Sciences, UT Houston Medical School, The University of Texas Health Science Center at Houston, 1941 East Road, Houston, TX, 77054, USA
| | - Lin-Yan Su
- Department of Psychiatry, Mental Health Institute, Second Xiangya Hospital of Central South University, Changsha, 410011, China.
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Aleknaviciute J, Tulen JHM, de Rijke YB, van der Kroeg M, Kooiman CG, Kushner SA. The 5-HTTLPR genotype, early life adversity and cortisol responsivity to psychosocial stress in women. BJPsych Open 2018; 4:180-185. [PMID: 29988976 PMCID: PMC6034461 DOI: 10.1192/bjo.2018.23] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 04/16/2018] [Accepted: 05/02/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The serotonin transporter gene-linked polymorphic region (5-HTTLPR) has previously been associated with hypothalamus-pituitary-adrenal axis function. Moreover, it has been suggested that this association is moderated by an interaction with stressful life experiences. AIMS To investigate the moderation of cortisol response to psychosocial stress by 5-HTTLPR genotype, either directly or through an interaction with early life stress. METHOD A total of 151 women, 85 of which had personality psychopathology, performed the Trier Social Stress Test while cortisol responsivity was assessed. RESULTS The results demonstrate a main effect of genotype on cortisol responsivity. Women carrying two copies of the long version of 5-HTTLPR exhibited stronger cortisol responses to psychosocial stress than women with at least one copy of the short allele (P = 0.03). However, the proportion of the variance of stress-induced cortisol responsivity explained by 5-HTTLPR genotype was not further strengthened by including early life adversity as a moderating factor (P = 0.52). CONCLUSIONS Our results highlight the need to clarify gender-specific biological factors influencing the serotonergic system. Furthermore, our results suggest that childhood maltreatment, specifically during the first 15 years of life, is unlikely to exert a moderating influence of large effect on the relationship between the 5-HTTLPR genotype and cortisol responsivity to psychosocial stress. DECLARATION OF INTEREST None.
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Affiliation(s)
- Jurate Aleknaviciute
- Department of Psychiatry, Erasmus University Medical Center Rotterdam, The Netherlands
| | - Joke H. M. Tulen
- Department of Psychiatry, Erasmus University Medical Center Rotterdam, The Netherlands
| | - Yolanda B. de Rijke
- Department of Clinical Chemistry, Erasmus University Medical Center Rotterdam, The Netherlands
| | - Mark van der Kroeg
- Department of Psychiatry, Erasmus University Medical Center Rotterdam, The Netherlands
| | - Cornelis G. Kooiman
- Department of Psychiatry, Erasmus University Medical Center Rotterdam, The Netherlands and Mental Health Clinic De Viersprong, The Netherlands
| | - Steven A. Kushner
- Department of Psychiatry, Erasmus University Medical Center Rotterdam, The Netherlands
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Sharp C, Fonagy P. Practitioner Review: Borderline personality disorder in adolescence--recent conceptualization, intervention, and implications for clinical practice. J Child Psychol Psychiatry 2015; 56:1266-88. [PMID: 26251037 DOI: 10.1111/jcpp.12449] [Citation(s) in RCA: 129] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND The past decade has seen an unprecedented increase in research activity on personality disorders (PDs) in adolescents. The increase in research activity, in addition to major nosological systems legitimizing the diagnosis of borderline personality disorder (BPD) in adolescents, highlights the need to communicate new research on adolescent personality problems to practitioners. SCOPE In this review, we provide up-to-date information on the phenomenology, prevalence, associated clinical problems, etiology, and intervention for BPD in adolescents. Our aim was to provide a clinically useful practitioner review and to dispel long-held myths about the validity, diagnostic utility, and treatability of PDs in adolescents. FINDINGS AND CONCLUSION Alongside providing up-to-date information on the phenomenology, prevalence, and etiology, we also report on associated clinical problems and interventions for adolescent BPD. It is only through early active assessment and identification of youngsters with these problems that a lifetime of personal suffering and health system burden can be reduced or altogether avoided. A variety of evidence-based approaches are now available to treat BPD and related clinical problems in young people. Future research should focus on establishing optimal precision in the diagnostic processes in different treatment settings.
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Affiliation(s)
- Carla Sharp
- Department of Psychology, University of Houston, and The Menninger Clinic, Houston, Texas, USA
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, and The Anna Freud Centre, London, UK
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Fonagy P, Speranza M, Luyten P, Kaess M, Hessels C, Bohus M. ESCAP Expert Article: borderline personality disorder in adolescence: an expert research review with implications for clinical practice. Eur Child Adolesc Psychiatry 2015; 24:1307-20. [PMID: 26271454 DOI: 10.1007/s00787-015-0751-z] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 07/17/2015] [Indexed: 12/26/2022]
Abstract
Borderline personality disorder (BPD) has onset in adolescence, but is typically first diagnosed in young adulthood. This paper provides a narrative review of the current evidence on diagnosis, comorbidity, phenomenology and treatment of BPD in adolescence. Instruments available for diagnosis are reviewed and their strengths and limitations discussed. Having confirmed the robustness of the diagnosis and the potential for its reliable clinical assessment, we then explore current understandings of the mechanisms of the disorder and focus on neurobiological underpinnings and research on psychological mechanisms. Findings are accumulating to suggest that adolescent BPD has an underpinning biology that is similar in some ways to adult BPD but differs in some critical features. Evidence for interventions focuses on psychological therapies. Several encouraging research studies suggest that early effective treatment is possible. Treatment development has just begun, and while adolescent-specific interventions are still in the process of evolution, most existing therapies represent adaptations of adult models to this developmental phase. There is also a significant opportunity for prevention, albeit there are few data to date to support such initiatives. This review emphasizes that there can be no justification for failing to make an early diagnosis of this enduring and pervasive problem.
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Affiliation(s)
- Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, WC1E 6BT, UK.
| | - Mario Speranza
- Department of Child and Adolescent Psychiatry, Versailles General Hospital, Faculty of Health Sciences, Research Unit EA4047, University of Versailles Saint-Quentin-en-Yvelines, 177 rue de Versailles, 78157, Le Chesnay, France
| | - Patrick Luyten
- Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, WC1E 6BT, UK
- Faculty of Psychology and Educational Sciences, University of Leuven, Tiensestraat 102, Box 3722, 3000, Leuven, Belgium
| | - Michael Kaess
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Blumenstrasse 8, 69115, Heidelberg, Germany
| | - Christel Hessels
- Expertise Centre for Personality Disorders, GGz Centraal, PO Box 3051, 3800 DB, Amersfoort, The Netherlands
| | - Martin Bohus
- Department of Psychosomatics and Psychotherapy, Central Institute of Mental Health Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany
- Faculty of Health, University of Antwerp, Antwerp, Belgium
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Winsper C, Wolke D, Lereya T. Prospective associations between prenatal adversities and borderline personality disorder at 11-12 years. Psychol Med 2015; 45:1025-1037. [PMID: 25171495 DOI: 10.1017/s0033291714002128] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The aetiological pathways to borderline personality disorder (BPD) remain only partly elucidated. Retrospective research indicates that prenatal adversity may be an important early risk factor in the development of BPD. This requires corroboration with prospective longitudinal studies. METHOD A community sample of 6050 mothers and their children (born between April 1991 and December 1992) were assessed. Maternal anxiety and depression and maternal alcohol and tobacco consumption were assessed during pregnancy (18 and 32 weeks gestation). Postnatal risks, including maladaptive parenting (suboptimal parenting and parent conflict), family adversity, maternal anxiety and depression and maternal alcohol and tobacco consumption, were assessed during early childhood. Internalizing and externalizing symptoms were assessed in late childhood. Trained psychologists interviewed children in late childhood to ascertain the presence of BPD (at least five probable/definite symptoms). RESULTS In unadjusted analyses, all prenatal risk factors (i.e., maternal alcohol and tobacco consumption and maternal anxiety and depression) were significantly associated with BPD. Following adjustment for sex, birthweight and postnatal exposure to anxiety and depression respectively, maladaptive parenting, family adversity and child's internalizing and externalizing symptoms, prenatal anxiety at 18 weeks gestation [odds ratio (OR) 1.57, 95% confidence interval (CI) 1.18-2.09] and depression at 18 weeks (OR 1.59, 95% CI 1.08-2.32) and 32 weeks (OR 1.57, 95% CI 1.14-2.18) gestation remained significantly associated with BPD. CONCLUSIONS This study provides prospective evidence of associations between prenatal adversities and BPD at 11-12 years. Prenatal anxiety and depression were independently associated with BPD, suggesting that they may exert direct effects on BPD during the prenatal period. This highlights the importance of programmes to reduce maternal stress during pregnancy.
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Affiliation(s)
- C Winsper
- Division of Mental Health and Wellbeing,Warwick Medical School, University of Warwick,Coventry,UK
| | - D Wolke
- Department of Psychology and Division of Mental Health and Wellbeing,Warwick Medical School, University of Warwick,Coventry,UK
| | - T Lereya
- Department of Psychology,University of Warwick,Coventry,UK
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Abstract
The aim of the current paper was to review the most recent advances in the developmental aspects of borderline personality disorder (BPD) over the last 3 years to highlight the most significant trends in the field. In so doing, we identify and discuss two exciting new trends: (a) an emphasis on the biological basis of adolescent BPD and (b) empirical evidence in support of long-held theories of the development of BPD. Together, these trends suggest that for the first time, empirical findings are beginning to emerge in support of complex and reciprocal biology × environment interactions over time in the development of BPD. We discuss the emerging literature and highlight the translational impact of this work for the assessment and intervention of adolescent BPD.
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Barzman D, Geise C, Lin PI. Review of the genetic basis of emotion dysregulation in children and adolescents. World J Psychiatry 2015; 5:112-117. [PMID: 25815260 PMCID: PMC4369540 DOI: 10.5498/wjp.v5.i1.112] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 11/21/2014] [Accepted: 02/09/2015] [Indexed: 02/05/2023] Open
Abstract
Previous evidence suggests that emotion dysregulation may have different biological correlates between adults and children/adolescents. Although the role of genetic factors has been extensively studied in adult-onset emotion dysregulation, the genetic basis for pediatric-onset emotion dysregulation remains elusive. The current review article presents a summary of previous studies that have suggested a few genetic variants associated with pediatric emotion dysregulation. Among these candidate loci, many prior studies have been focused on serotonin transporter promoter gene polymorphism 5-HTTLPR. Certain alleles of the 5-HTTLPR gene polymorphism have been found to be associated with traits associated with emotion dysregulation, such as aggression, affect reactivity, and insecure attachment. Additionally, genetic variants involving dopamine and neurophysiological biomarkers like the COMT Val158Met (rs460) and dopamine receptor D2/ ankyrin repeat and kinase domain containing one polymorphisms may play a role in emotion dysregulation. Inconsistent findings have been noted, possibly due to the heterogeneity in study designs and characteristics of different populations. Further research on the role of genetic predetermination of emotion dysregulation in children and adolescents is warranted.
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Ensink K, Biberdzic M, Normandin L, Clarkin J. A Developmental Psychopathology and Neurobiological Model of Borderline Personality Disorder in Adolescence. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/15289168.2015.1007715] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Hankin BL, Barrocas AL, Young JF, Haberstick B, Smolen A. 5-HTTLPR × interpersonal stress interaction and nonsuicidal self-injury in general community sample of youth. Psychiatry Res 2015; 225:609-12. [PMID: 25500344 PMCID: PMC4314334 DOI: 10.1016/j.psychres.2014.11.037] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 11/09/2014] [Accepted: 11/15/2014] [Indexed: 01/12/2023]
Abstract
No research with youth has investigated whether measured genetic risk interacts with stressful environment (G⁎E) to explain engagement in non-suicidal self-injury (NSSI). Two independent samples of youth were used to test the a priori hypothesis that the Transporter-Linked Polymorphic Region (5-HTTLPR) would interact with chronic interpersonal stress to predict NSSI. We tested this hypothesis with children and adolescents from United States public schools in two independent samples (N׳s=300 and 271) using identical procedures and methods. They were interviewed in person with the Self-Injurious Thoughts and Behaviors Interview to assess NSSI engagement and with the UCLA Chronic Stress Interview to assess interpersonal stress. Buccal cells were collected for genotyping of 5-HTTLPR. For both samples, ANOVAs revealed the hypothesized G*E. Specifically, short carriers who experienced severe interpersonal stress exhibited the highest level of NSSI engagement. Replicated across two independent samples, results provide the first demonstration that youth at high genetic susceptibility (5-HTTLPR) and high environmental exposure (chronic interpersonal stress) are at heightened risk for NSSI.
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Affiliation(s)
- Benjamin L. Hankin
- Department of Psychology, University of Denver. 2155 South Race Street, Denver CO 80208
,Correspondence concerning this article should be addressed to Benjamin L. Hankin, Department of Psychology, University of Denver, 2155 South Race Street, Denver CO 80208. Internet correspondence can be addressed to . Phone: 303-871-7468
| | - Andrea L. Barrocas
- Department of Psychology, University of Denver. 2155 South Race Street, Denver CO 80208
| | | | - Brett Haberstick
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO 80309-0447
| | - Andrew Smolen
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO 80309-0447
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Brunner R, Henze R, Richter J, Kaess M. Neurobiological Findings in Youth with Borderline Personality Disorder. Scand J Child Adolesc Psychiatr Psychol 2014. [DOI: 10.21307/sjcapp-2015-003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Abstract
This review summarizes recent neurobiological research into youth with borderline personality disorder (BPD) to better delineate the biological factors involved in the development of this disorder. Psychobiological studies when BPD first becomes manifest are of particular interest, because there are fewer confounding factors (e.g., duration of illness, drug abuse, medication, other therapeutic interventions) at this time. This article focuses on recent findings in the field of neuroimaging, neuropsychology, neuroendocrinology, genetics, and pain perception, and it aims to integrate these findings in a developmental psychopathology model of BPD. In studies of clinical samples of adults with BPD, structural imaging studies revealed abnormalities predominantly in the frontolimbic areas. Disturbances in emotional information processing—particularly involving negative stimuli—may mediate affective dysregulation as a core feature of BPD. Genetic studies could reveal that the stability of BPD traits in youth is largely influenced by a combination of genetic and non-shared environmental factors. Hyporesponsiveness to a laboratory stressor indicates an enduring alteration of the hypothalamic–pituitary–adrenal axis. Findings of a higher pain threshold indicate that pain processing is already disturbed during the early stages of BPD, which could contribute to the initiation or maintenance of self-injurious behavior. All biological factors, together with environmental risk factors, may contribute to the core symptoms of BPD: severe emotional and behavioral dysregulation. Further research should investigate the development of BPD in youth by using longitudinal designs to determine whether the neurobiological factors are a cause, an effect, or an epiphenomenon of BPD.
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Affiliation(s)
- Romuald Brunner
- Section for Disorders of Personality Development, Clinic for Child and Adolescent Psychiatry, University of Heidelberg , Heidelberg , Germany
| | - Romy Henze
- Section for Disorders of Personality Development, Clinic for Child and Adolescent Psychiatry, University of Heidelberg , Heidelberg , Germany
- Department of Radiology, German Cancer Research Center , Heidelberg , Germany
| | - Julia Richter
- Section for Disorders of Personality Development, Clinic for Child and Adolescent Psychiatry, University of Heidelberg , Heidelberg , Germany
- Department of Radiology, German Cancer Research Center , Heidelberg , Germany
| | - Michael Kaess
- Section for Disorders of Personality Development, Clinic for Child and Adolescent Psychiatry, University of Heidelberg , Heidelberg , Germany
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Sharp C, Kalpakci A. If It Looks Like a Duck and Quacks Like a Duck: Evaluating the Validity of Borderline Personality Disorder in Adolescents. Scand J Child Adolesc Psychiatr Psychol 2014. [DOI: 10.21307/sjcapp-2015-005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Abstract
Background:
The validity of borderline personality disorder (BPD) has been a topic of much controversy in psychiatry. Over the last two decades, a wealth of empirical work has challenged long-held concerns regarding the validity of adolescent BPD. However, this research has been conducted within a traditional approach to psychiatric nosology.
Objective:
In this article, we aim to evaluate the validity of adolescent BPD as guided by both the Robins and Guze criteria for the validity of psychiatric constructs and the new National Institute of Mental Health Research Domain Criteria (NIMH RDoC).
Method:
We used the five principles of the Robins and Guze approach to evaluate selected research from our own and other groups regarding the validity of adolescent BPD. These principles include clinical description studies, laboratory studies, studies that delimitate the disorder from other related syndromes, follow-up studies, and family studies.
Results:
Within the Robins and Guze criteria framework, evidence to date supports the validity of adolescent BPD to some extent. However, limitations of the research about the construct validity of adolescent BPD have also been identified, most notably regarding the delimitation of adolescent BPD from other disorders as well as a lack of longitudinal and family studies.
Conclusions:
Given these limitations and the limitations of the Robins and Guze approach to psychiatric nosology, we recommend exploring the potential of the National Institute of Mental Health Research Domain Criteria as a complement to previous work.
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Affiliation(s)
- Carla Sharp
- 1 University of Houston, The Menninger Clinic, Baylor College of Medicine , Texas , United States
| | - Allison Kalpakci
- 2 Developmental Psychopathology Lab, Dep. of Psychology, University of Houston , Texas , United States
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Abstract
Borderline personality disorder (BPD) is a common and severe mental disorder that is associated with severe functional impairment and a high suicide rate. BPD is usually associated with other psychiatric and personality disorders, high burden on families and carers, continuing resource utilization, and high treatment costs. BPD has been a controversial diagnosis in adolescents, but this is no longer justified. Recent evidence demonstrates that BPD is as reliable and valid among adolescents as it is in adults and that adolescents with BPD can benefit from early intervention. Consequently, adolescent BPD is now recognized in psychiatric classification systems and in national treatment guidelines. This review aims to inform practitioners in the field of adolescent health about the nature of BPD in adolescence and the benefits of early detection and intervention. BPD diagnosis and treatment should be considered part of routine practice in adolescent mental health to improve these individuals' well-being and long-term prognosis.
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Affiliation(s)
- Michael Kaess
- Section for Disorders of Personality Development, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany;
| | - Romuald Brunner
- Section for Disorders of Personality Development, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Andrew Chanen
- Orygen Youth Health Research Centre & Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia; and Orygen Youth Health Clinical Program, Northwestern Mental Health, Melbourne, Australia
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15
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Abstract
Borderline personality disorder (BPD) and major depressive disorder (MDD) commonly co-occur, but the relationship between these disorders remains unclear. While BPD patients often suffer from depression, their subjective experience and treatment response are different from that experienced by MDD patients without BPD. Surveying the current literature on the interface of these two pathologies, we find that depression in BPD has distinct symptoms, treatment responses, remission predictors, and suicide risks. It tends to be subjectively more severe, more interpersonally fueled, and more persistent than MDD without BPD. BPD depression responds less well to biological treatments and may be fueled by the neurobiology of BPD. These findings suggest that clinicians should recognize the unique features of BPD depression and anticipate a clinical trajectory that may be different from MDD without BPD, keeping in mind that BPD depression tends not to improve until BPD improves.
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16
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Bukh JD, Bock C, Kessing LV. Association between genetic polymorphisms in the serotonergic system and comorbid personality disorders among patients with first-episode depression. J Pers Disord 2014; 28:365-78. [PMID: 24344840 DOI: 10.1521/pedi_2013_27_123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Studies on the association between genetic polymorphisms and personality disorders have provided inconsistent results. Using the "enriched sample method," the authors of the present study aimed to assess the association between polymorphisms in the serotonergic transmitter system and comorbid personality disorders in patients recently diagnosed with first-episode depression. A total of 290 participants were systematically recruited via the Danish Psychiatric Central Research Register. Diagnoses of personality disorders were assessed by a SCID-II interview, and polymorphisms in the genes encoding the serotonin transporter, serotonin receptors 1A, 2A, 2C, and tryptophan hydroxylase 1 were genotyped. The authors found a significant effect of the length polymorphism in the serotonin transporter gene (5-HTTLPR) on cluster B personality disorder (mainly borderline disorder), but no influence on cluster C personality disorder, and no associations between other polymorphisms and personality disorders. The study adds evidence to the effect of the serotonin transporter gene specifically on cluster B personality disorders.
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17
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Hafizi S. Sleep and borderline personality disorder: a review. Asian J Psychiatr 2013; 6:452-9. [PMID: 24309854 DOI: 10.1016/j.ajp.2013.06.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 06/24/2013] [Accepted: 06/28/2013] [Indexed: 12/17/2022]
Abstract
Sleep problems are very common among psychiatric patients. Borderline personality disorder, as a common and severe mental disorder, is associated with different types of sleep disturbances, such as disturbances of sleep continuity, altered REM sleep regulation and nightmares. These disturbances are the result of interaction of the personality traits, concomitant and comorbid diseases and environmental factors. Despite the high prevalence of sleep related disorders in BPD patients, this aspect of BPD is still neglected in clinical and research settings. To date there has been little agreement on sleep characteristics of BPD among different studies, and presence of some uncontrolled confounding factors, make interpretation of the results difficult. However, it seems that appropriate diagnosis and treatment of sleep disorders in BPD patients might lead to better outcome. This article aimed to review the current literature of sleep studies in BPD. Some recommendations and suggestions were made for future researches in this field.
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Affiliation(s)
- Sina Hafizi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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18
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Papousek I, Reiser EM, Schulter G, Fink A, Holmes EA, Niederstätter H, Nagl S, Parson W, Weiss EM. Serotonin transporter genotype (5-HTTLPR) and electrocortical responses indicating the sensitivity to negative emotional cues. Emotion 2013; 13:1173-81. [PMID: 24040881 PMCID: PMC3948098 DOI: 10.1037/a0033997] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 06/27/2013] [Accepted: 07/02/2013] [Indexed: 12/24/2022]
Abstract
Growing literature indicates that emotional reactivity and regulation are strongly linked to genetic modulation of serotonergic neurotransmission. However, until now, most studies have focused on the relationship between genotypic markers, in particular the serotonin transporter-linked polymorphic region (5-HTTLPR), and neural structures using MRI. The current study aimed to bridge the gap between the relevant MRI literature on the effects of the 5-HTTLPR genotype and the research tradition focusing on transient lateralized changes of electrocortical activity in the prefrontal cortex using electroencephalography (EEG). Lateral shifts of EEG alpha asymmetry in response to an aversive film consisting of scenes of real injury and death were assessed in healthy participants (n = 165). To evaluate the specificity of the 5-HTTLPR effect, participants were also tested for the COMT Val158Met polymorphism which is linked to dopamine inactivation. While viewing the film, individuals homozygous for the 5-HTTLPR short allele displayed a clear lateral shift of dorsolateral frontal activity to the right, which was virtually absent in participants carrying the long allele. The heightened electrocortical response to the aversive stimulation and its direction indicates a greater propensity of s/s homozygotes to experience withdrawal oriented affect in response to negative emotion cues in the environment. Moreover, together with previous research the findings support the notion of a link between the serotonergic system and self-regulation related to avoidance motivation, and a link between the dopaminergic system and self-regulation related to approach motivation.
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19
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Goodman M, Mascitelli K, Triebwasser J. The Neurobiological Basis of Adolescent-onset Borderline Personality Disorder. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2013; 22:212-219. [PMID: 23970910 PMCID: PMC3749895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 05/09/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Over the past two decades, neurobiological studies in adult onset borderline personality disorder have made important strides, but inquiry into adolescent-onset BPD is still in its infancy and our understanding of the neurobiology of adolescent BPD remains highly tentative. METHODS This paper highlights recent findings in genetics, neuroendocrinology and neuroimaging for adult and adolescent-onset BPD. RESULTS Neurobiological studies of adolescent-onset BPD to date have focused mainly on volumetric studies of various brain regions and measurements of HPA axis components, with comparatively few publications on brain functioning. CONCLUSION Such information is essential to developing more effective screening, treatment and preventive strategies.
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Affiliation(s)
- Marianne Goodman
- James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
- Mount Sinai School of Medicine, New York, New York, USA
| | | | - Joseph Triebwasser
- James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
- Mount Sinai School of Medicine, New York, New York, USA
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20
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Abstract
This paper reviews recent studies of biological and environmental risk and protective factors and patterns of continuity leading to borderline personality disorder (BPD). It focuses on prospective studies of children and adolescents and studies of young people with borderline pathology, reporting findings from genetics, neurobiology, experimental psychopathology, environmental risk, and precursor signs and symptoms. Studies of individuals earlier in the course of BPD demonstrate relatively consistent environmental risk factors, but neurobiological and experimental psychopathology findings are still inconsistent. Also, temperamental and mental state abnormalities that resemble aspects of the BPD phenotype emerge in childhood and adolescence and presage the BPD syndrome in adolescence or adulthood. Further work is required to better understand the roles that all these factors play in the developmental pathways to BPD and to increase their specificity for BPD in order to facilitate prevention and early intervention.
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Affiliation(s)
- Andrew M Chanen
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, The University of Melbourne, Locked Bag 10, Parkville, Victoria, Australia.
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