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Coma Gonzalez AA, Vilella E, Gutiérrez-Zotes A. Social cognition in women with borderline personality disorder based on an exhaustive analysis of the Movie for Assessment of Social Cognition (MASC) categories. J Clin Psychol 2024; 80:1231-1242. [PMID: 38363876 DOI: 10.1002/jclp.23661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 12/21/2023] [Accepted: 01/31/2024] [Indexed: 02/18/2024]
Abstract
A significant number of borderline personality disorder (BPD) symptoms are manifested in the interpersonal context. This can be explained by the difficulties in attributing the mental states of oneself and others, which constitutes social cognition. Errors in social cognition are interrelated with the affective, cognitive, impulsive, and interpersonal areas of the person with BPD. The aims of this study was to analyze social cognition in women with BPD compared with a control group and to analyze social cognition in BPD based on BPD symptoms and its severity. To assess social cognition, we used a full range of social cognition categories provided by the Movie for the Assessment of Social Cognition (MASC): correct theory of mind (ToM); attribution of mental states (thoughts, emotions, or intentions); errors of mentalization; types of ToM; and attribution of mental states through perceptive or cognitive cues and through hot or cold emotions. The MASC has high ecological validity and has been validated in Spanish. The sample comprised 79 women, including 47 women with BPD and 32 healthy women. Worse social cognition performance was observed in women with BPD. More severe borderline symptoms were related to worse functioning in the correct ToM and to errors of no mentalization. Involvement of the cognitive area in borderline symptoms was associated with worse functioning in correct ToM and worse social cognition in cognitive areas as well as with hypermentalization. This is the first study that uses all the MASC categories and considers BPD heterogeneity and its severity to study social cognition.
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Affiliation(s)
| | - Elisabet Vilella
- Hospital Universitari Institut Pere Mata, Reus, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV)-CERCA, Tarragona, Spain
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili (URV), Tarragona, Spain
- Centro deinvestigación biomédica en red en salud mental (CIBERSAM), Salamanca, Spain
| | - Alfonso Gutiérrez-Zotes
- Hospital Universitari Institut Pere Mata, Reus, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV)-CERCA, Tarragona, Spain
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili (URV), Tarragona, Spain
- Centro deinvestigación biomédica en red en salud mental (CIBERSAM), Salamanca, Spain
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Li Y, Yuan M, Zhang C, Zhang X, Hao J, Tao F, Wang G, Su P. Bisphenol AF exposure synergistically increases the risk for suicidality among early adolescents with child maltreatment: A prospective cohort study. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 279:116511. [PMID: 38810289 DOI: 10.1016/j.ecoenv.2024.116511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/20/2024] [Accepted: 05/23/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Child maltreatment (CM) is correlated with suicidality risk among adolescents. Additionally, exposure to bisphenol AF (BPAF) may increase this risk. However, the combined effect of CM and BPAF exposure remains unknown and should be further investigated. METHODS In this study, 1,475 early adolescents (mean age = 12.48 years) from the Chinese Early Adolescents Cohort were enrolled. Data were collected at three time points with an interval of 12 months between 2019 and 2021. Participants' history of CM and suicidality (including suicidal ideation and suicidal attempts) were evaluated using a self-report questionnaire. Blood samples were obtained from participants to measure serum BPAF concentrations at baseline. Group-based trajectory modeling was employed to identify different developmental trajectories of suicidality across the three waves. After adjusting for potential confounders, the association between CM and BPAF exposure on suicidal ideation and suicidal attempts was assessed using logistic regression and Poisson regression analyses. RESULTS Participants with CM were associated with a risk of one- and two-year incident suicidality (all ps < 0.05), and BPAF levels were positively associated with two-year incident suicidal ideation (adjusted OR = 1.68, 95% CI: 1.13-2.50). Additionally, middle and high levels of BPAF exposure synergistically increase the risk for one- and two-year incident suicidal ideation among participants with CM (adjusted ORs = 2.00-3.83). Similarly, participants exposed to high-level BPAF as well as CM were at a greater risk of one- and two-year incident suicidal attempts than those with low-level BPAF exposure and no CM (adjusted incidence rate ratio [IRRs] = 2.82-4.34). Moreover, compared with participants with a low developmental trajectory of suicidality across the three waves, high BPAF exposure exhibited a significant synergistic effect on participants with CM in the persistently high suicidal ideation trajectory and the increasing suicidal attempts trajectory (all ps < 0.05). Sex subgroup analysis revealed that females were more susceptible to the synergistic effect of BPAF and CM exposure on suicidality than males. CONCLUSIONS Environmental factors and the psychological status of individuals may synergistically increase their susceptibility to suicidality. These results offer novel insights into enhancing our understanding of suicidality among adolescents.
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Affiliation(s)
- Yonghan Li
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, Anhui 230032, China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No. 81 Meishan Road, Hefei, Anhui 230032, China
| | - Mengyuan Yuan
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, Anhui 230032, China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No. 81 Meishan Road, Hefei, Anhui 230032, China
| | - Chao Zhang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, Anhui 230032, China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No. 81 Meishan Road, Hefei, Anhui 230032, China
| | - Xueying Zhang
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Jiahu Hao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, Anhui 230032, China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No. 81 Meishan Road, Hefei, Anhui 230032, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, No. 81 Meishan Road, Hefei, Anhui 230032, China
| | - Fangbiao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, Anhui 230032, China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No. 81 Meishan Road, Hefei, Anhui 230032, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, No. 81 Meishan Road, Hefei, Anhui 230032, China
| | - Gengfu Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, Anhui 230032, China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No. 81 Meishan Road, Hefei, Anhui 230032, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, No. 81 Meishan Road, Hefei, Anhui 230032, China.
| | - Puyu Su
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, Anhui 230032, China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No. 81 Meishan Road, Hefei, Anhui 230032, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, No. 81 Meishan Road, Hefei, Anhui 230032, China.
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3
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Seguí-Grivé M, Jurado N, Navarrete A, Morelló C, Ortega E, Boluda M, Muntané G, Llaurador-Coll M, Vilella E, Gutiérrez-Zotes A. Influence of the typology and timing of childhood trauma in psychoticism. Arch Womens Ment Health 2024:10.1007/s00737-024-01459-9. [PMID: 38656388 DOI: 10.1007/s00737-024-01459-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/14/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE Child maltreatment (CM) is associated with psychosis; however little is known about the frequency, type, and timing of abuse in the personality pathology domain of psychoticism (PSY) in the DSM-5. The purpose of this study was to analyze childhood trauma typology and frequency according to gender and to identify sensitive periods of susceptibility to CM in women with high PSY. METHODS The Maltreatment and Abuse Chronology Exposure (MACE) scale was used to evaluate the frequency, severity and timing of each type of maltreatment. The full sample consisted of 83 participants with different psychiatric diagnoses. Psychoticism was assessed with the DSM-5 Personality Inventory (PID-5). To identify the differences in CM exposure between the PSY+ (high psychoticism) and PSY- (low psychoticism) groups, the Mann-Whitney U test, the chi square test and random forest (RF) test were used. RESULTS Comparing PSY + and PSY-, revealed gender differences in the impact of abuse, with highly frequent and severe types of abuse, in women. In women, PSY + and PSY-, were differentiated especially in non-verbal emotional abuse, peer physical bullying and parental verbal abuse. Several periods with a major peak at age seven followed by peaks at age 17 and 12 years old were identified. CONCLUSION Increased exposure to CM occurs in women with PSY+. A sensitivity to CM exposure during early childhood and late adolescence could be a risk factor for psychoticism in women.
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Affiliation(s)
- M Seguí-Grivé
- Hospital Universitari Institut Pere Mata, Ctra de l'Institut Pere Mata, s/n. 43206, Reus, Spain
| | - N Jurado
- Hospital Universitari Institut Pere Mata, Ctra de l'Institut Pere Mata, s/n. 43206, Reus, Spain
| | - A Navarrete
- Hospital Universitari Institut Pere Mata, Ctra de l'Institut Pere Mata, s/n. 43206, Reus, Spain
| | - C Morelló
- Hospital Universitari Institut Pere Mata, Ctra de l'Institut Pere Mata, s/n. 43206, Reus, Spain
| | - E Ortega
- Hospital Universitari Institut Pere Mata, Ctra de l'Institut Pere Mata, s/n. 43206, Reus, Spain
| | - M Boluda
- Hospital Universitari Institut Pere Mata, Ctra de l'Institut Pere Mata, s/n. 43206, Reus, Spain
| | - G Muntané
- Hospital Universitari Institut Pere Mata, Ctra de l'Institut Pere Mata, s/n. 43206, Reus, Spain
- Institut d'Investigació Sanitària Pere Virgili-CERCA, Reus, Spain
- Universitat Rovira i Virgili, Reus, Spain
- Centro de Investigación Biomédica en Red en Salud Mental, CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain
| | - M Llaurador-Coll
- Hospital Universitari Institut Pere Mata, Ctra de l'Institut Pere Mata, s/n. 43206, Reus, Spain
- Institut d'Investigació Sanitària Pere Virgili-CERCA, Reus, Spain
- Universitat Rovira i Virgili, Reus, Spain
| | - E Vilella
- Hospital Universitari Institut Pere Mata, Ctra de l'Institut Pere Mata, s/n. 43206, Reus, Spain
- Institut d'Investigació Sanitària Pere Virgili-CERCA, Reus, Spain
- Universitat Rovira i Virgili, Reus, Spain
- Centro de Investigación Biomédica en Red en Salud Mental, CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain
| | - A Gutiérrez-Zotes
- Hospital Universitari Institut Pere Mata, Ctra de l'Institut Pere Mata, s/n. 43206, Reus, Spain.
- Institut d'Investigació Sanitària Pere Virgili-CERCA, Reus, Spain.
- Universitat Rovira i Virgili, Reus, Spain.
- Centro de Investigación Biomédica en Red en Salud Mental, CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain.
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Deng F, Bueber MA, Cao Y, Tang J, Bai X, Cho Y, Lee J, Lin Z, Yang Q, Keshavan MS, Stone WS, Qian M, Yang LH, Phillips MR. Assessing social cognition in patients with schizophrenia and healthy controls using the reading the mind in the eyes test (RMET): a systematic review and meta-regression. Psychol Med 2024; 54:847-873. [PMID: 38173096 DOI: 10.1017/s0033291723003501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
The reading the mind in the eyes test (RMET) - which assesses the theory of mind component of social cognition - is often used to compare social cognition between patients with schizophrenia and healthy controls. There is, however, no systematic review integrating the results of these studies. We identified 198 studies published before July 2020 that administered RMET to patients with schizophrenia or healthy controls from three English-language and two Chinese-language databases. These studies included 41 separate samples of patients with schizophrenia (total n = 1836) and 197 separate samples of healthy controls (total n = 23 675). The pooled RMET score was 19.76 (95% CI 18.91-20.60) in patients and 25.53 (95% CI 25.19-25.87) in controls (z = 12.41, p < 0.001). After excluding small-sample outlier studies, this difference in RMET performance was greater in studies using non-English v. English versions of RMET (Chi [Q] = 8.54, p < 0.001). Meta-regression analyses found a negative association of age with RMET score and a positive association of years of schooling with RMET score in both patients and controls. A secondary meta-analysis using a spline construction of 180 healthy control samples identified a non-monotonic relationship between age and RMET score - RMET scores increased with age before 31 and decreased with age after 31. These results indicate that patients with schizophrenia have substantial deficits in theory of mind compared with healthy controls, supporting the construct validity of RMET as a measure of social cognition. The different results for English versus non-English versions of RMET and the non-monotonic relationship between age and RMET score highlight the importance of the language of administration of RMET and the possibility that the relationship of aging with theory of mind is different from the relationship of aging with other types of cognitive functioning.
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Affiliation(s)
- Fei Deng
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- University of Nottingham School of Economics (Ningbo China), Zhejiang, China
| | - Marlys A Bueber
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yourong Cao
- Guangxi Medical University School of Public Health, Guangxi, China
- The Reproductive Hospital of Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Jeff Tang
- New York University, New York, NY, USA
| | - Xinyu Bai
- Guangxi Medical University School of Public Health, Guangxi, China
- Guangxi Academy of Medical Sciences & The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Young Cho
- New York State Psychiatric Institute, New York, NY, USA
| | - Jiwon Lee
- Teachers College, Columbia University, New York, NY, USA
| | - Zhuozhi Lin
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Qi Yang
- Ningxia Medical University School of Public Health, Ningxia, China
| | - Matcheri S Keshavan
- Harvard Medical School Department of Psychiatry at Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - William S Stone
- Harvard Medical School Department of Psychiatry at Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Min Qian
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Lawrence H Yang
- New York University, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Michael R Phillips
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- Department of Psychiatry, Columbia University, New York, NY, USA
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Li Y, Huang X, Yuan M, Chang J, Zhang T, Wang G, Su P. Childhood maltreatment and homicidal ideation among Chinese early adolescents: The serial mediating role of borderline personality features and aggression. Aggress Behav 2023; 49:536-546. [PMID: 37243977 DOI: 10.1002/ab.22091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 05/29/2023]
Abstract
A large body of evidence linked childhood maltreatment (CM) to juvenile violence and delinquent behavior. However, little is known about the association between CM and homicidal ideation in early adolescents. This study aimed to examine that relationship and to explore the serial mediating role of borderline personality features (BPF) and aggression in that relationship in a large sample of early adolescents. A total of 5724 early adolescents (mean age: 13.5 years) were recruited from three middle schools in Anhui Province, China. The participants were invited to complete self-report questionnaires regarding their history of CM, BPF, aggression, and homicidal ideation. Mediation analyses were evaluated using structural equation modeling. A total of 669 participants (11.7%) reported homicidal ideation in the past 6 months. CM victimization was positively associated with homicidal ideation after adjusting for covariates. Furthermore, the serial mediation analysis showed a significant indirect effect of CM on homicidal ideation through BPF and subsequent aggression. Exposure to maltreatment in childhood is likely to manifest BPF and subsequently higher levels of aggression, which in turn are related to increased homicidal ideation. These findings suggest the need for early intervention for BPF and aggression in early adolescents exposed to CM to prevent the development of homicidal ideation.
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Affiliation(s)
- Yonghan Li
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Xiaoman Huang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, People's Republic of China
- Hefei City Maternal and Child Health & Family Planning Service Center, Hefei, People's Republic of China
| | - Mengyuan Yuan
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Junjie Chang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Tingting Zhang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Gengfu Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, People's Republic of China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, Hefei, Anhui, People's Republic of China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, Anhui, People's Republic of China
| | - Puyu Su
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, People's Republic of China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, Hefei, Anhui, People's Republic of China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, Anhui, People's Republic of China
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Xu B, Wei S, Yin X, Jin X, Yan S, Jia L. The relationship between childhood emotional neglect experience and depressive symptoms and prefrontal resting functional connections in college students: The mediating role of reappraisal strategy. Front Behav Neurosci 2023; 17:927389. [PMID: 36969801 PMCID: PMC10037214 DOI: 10.3389/fnbeh.2023.927389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 02/01/2023] [Indexed: 03/12/2023] Open
Abstract
Childhood emotional neglect (CEN) has a relatively high incidence rate and substantially adverse effects. Many studies have found that CEN is closely related to emotion regulation and depression symptoms. Besides, the functional activity of the prefrontal lobe may also be related to them. However, the relationships between the above variables have not been thoroughly studied. This study recruited two groups of college students, namely, those with primary CEN (neglect group) and those without childhood trauma (control group), to explore the relationships among CEN, adulthood emotion regulation, depressive symptoms, and prefrontal resting functional connections. The methods used in this study included the Childhood Trauma Questionnaire (CTQ), Emotion Regulation Questionnaire (ERQ), Beck Depression Inventory-II (BDI-II) and resting-state functional magnetic resonance imaging (rs-fMRI). The results showed that compared with the control group, the neglect group utilized the reappraisal strategy less frequently and displayed more depressive symptoms. The prefrontal functional connections with other brain regions in the neglect group were more robust than those in the control group using less stringent multiple correction standards. Across the two groups, the functional connection strength between the right orbitofrontal gyrus and the right middle frontal gyrus significantly negatively correlated with the ERQ reappraisal score and positively correlated with the BDI-II total score; the ERQ reappraisal score wholly mediated the relationship between the functional connection strength and the BDI-II total score. It suggests that primary CEN may closely correlate with more depressive symptoms in adulthood. Furthermore, the more robust spontaneous activity of the prefrontal lobe may also be closely associated with more depressive symptoms by utilizing a reappraisal strategy less frequently.
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Affiliation(s)
- Bin Xu
- *Correspondence: Bin Xu ✉
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Williams R, Andreassi S, Moselli M, Fantini F, Tanzilli A, Lingiardi V, Laghi F. Relationship between Executive Functions, Social Cognition, and Attachment State of Mind in Adolescence: An Explorative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2836. [PMID: 36833531 PMCID: PMC9957111 DOI: 10.3390/ijerph20042836] [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: 12/19/2022] [Revised: 01/30/2023] [Accepted: 02/03/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The passage from pre-adolescence to adolescence is presented as a turning point for the achievement of those abilities in social understanding as they commonly appear in adulthood. Developmental perspectives point to the possible role of neuro-cognitive maturation and social experiences to facilitate this growth. This paper has the goal to goalsto propose a valid and reliable measure of the new quantitative and qualitative advancements in social understanding occurring in the adolescent passage; relying on this, the research has two main objectives (a) to establish the associations between the advancements in social understanding and the executive functions held responsible for the neuro-cognitive rearrangements of adolescence; (c) to evidence the significant associations between attachment models and the development of social understanding in this phase of life. METHODS 100 subjects (50 boys and 50 girls, aged 11-15) were administered with AICA, SCORS, CNT, Stroop Color-Word Test, and WISC-III. RESULTS Advancements in the complexity of self-other representations and mentalization of interpersonal exchanges significantly occurs in the passage from pre-adolescence to adolescence and seem to be promoted by increased performances in executive control and cognitive shifting. Dismissing state of mind with respect to attachment is associated with lower development of social understanding in adolescence. The neurocognitive reorganization that underlies the passage from pre-adolescence to adolescence seems to provide the scaffolding for more sophisticated interpretations of the social world. Past and current affective experience can boost or hinder the full deployment of such human maturational potential. Given the importance of social cognition for adjustment and psychopathology, clinical intervention should target the amelioration of individual and family abilities in social reasoning and mentalization.
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Affiliation(s)
- Riccardo Williams
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza—University of Rome, Via degli Apuli 1, 00185 Rome, Italy
| | - Silvia Andreassi
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza—University of Rome, Via degli Apuli 1, 00185 Rome, Italy
| | - Marta Moselli
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza—University of Rome, Via degli Apuli 1, 00185 Rome, Italy
| | - Fiorella Fantini
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza—University of Rome, Via degli Apuli 1, 00185 Rome, Italy
| | - Annalisa Tanzilli
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza—University of Rome, Via degli Apuli 1, 00185 Rome, Italy
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza—University of Rome, Via degli Apuli 1, 00185 Rome, Italy
| | - Fiorenzo Laghi
- Department of Developmental and Social Psychology, Faculty of Medicine and Psychology, Sapienza—University of Rome, Via dei Marsi 78, 00185 Rome, Italy
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8
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Li YH, Wang GF, Yuan MY, Chang JJ, Wang SJ, Cao LL, Li Y, Su PY. Psychological adjustment mediating the relationship between childhood maltreatment and borderline personality features among Chinese early adolescents. J Affect Disord 2022; 314:249-252. [PMID: 35878835 DOI: 10.1016/j.jad.2022.07.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/19/2022] [Accepted: 07/17/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND A strong link between childhood maltreatment (CM) and borderline personality features (BPF) has been consistently demonstrated. However, little is known about the role of psychological adjustment (PA) as a mediator of this relationship. The purpose of the study was to explore the mediating role of PA in the CM-BPF linkage in a large sample of early adolescents. METHODS A total of 5724 students (mean age = 13.5, SD = 1.0) were recruited from three middle schools by using the multistage random cluster sampling method in Anhui Province, China. Participants were required to complete self-report questionnaires regarding CM experience, self-perceived PA and BPF. Mediation analyses were computed via structural equation modelling. RESULTS CM victimization was positively associated with BPF, and individuals with lower levels of PA were more likely to present with BPF. Mediation analysis showed a significant indirect effect of CM on BPF via PA (effect = 0.047, 95 % CI: 0.035, 0.058). LIMITATION The cross-sectional design of this study did not allow testing causality. The retrospective investigation of CM history could cause recall bias. CONCLUSIONS PA partially mediates the relationship between CM and BPF. These findings have important implications for considering PA as a protective factor in this relationship.
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Affiliation(s)
- Yong-Han Li
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei 230032, Anhui, China
| | - Geng-Fu Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei 230032, Anhui, China
| | - Meng-Yuan Yuan
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei 230032, Anhui, China
| | - Jun-Jie Chang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei 230032, Anhui, China
| | - Shao-Jie Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei 230032, Anhui, China
| | - Lei-Lei Cao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei 230032, Anhui, China
| | - Yuan Li
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei 230032, Anhui, China
| | - Pu-Yu Su
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei 230032, Anhui, China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, Hefei, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei 230032, Anhui, China.
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9
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Herzog P, Kube T, Fassbinder E. How childhood maltreatment alters perception and cognition - the predictive processing account of borderline personality disorder. Psychol Med 2022; 52:2899-2916. [PMID: 35979924 PMCID: PMC9693729 DOI: 10.1017/s0033291722002458] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/24/2022] [Accepted: 07/18/2022] [Indexed: 01/05/2023]
Abstract
Borderline personality disorder (BPD) is a severe mental disorder, comprised of heterogeneous psychological and neurobiological pathologies. Here, we propose a predictive processing (PP) account of BPD to integrate these seemingly unrelated pathologies. In particular, we argue that the experience of childhood maltreatment, which is highly prevalent in BPD, leaves a developmental legacy with two facets: first, a coarse-grained, alexithymic model of self and others - leading to a rigidity and inflexibility concerning beliefs about self and others. Second, this developmental legacy leads to a loss of confidence or precision afforded beliefs about the consequences of social behavior. This results in an over reliance on sensory evidence and social feedback, with concomitant lability, impulsivity and hypersensitivity. In terms of PP, people with BPD show a distorted belief updating in response to new information with two opposing manifestations: rapid changes in beliefs and a lack of belief updating despite disconfirmatory evidence. This account of distorted information processing has the potential to explain both the instability (of affect, self-image, and interpersonal relationships) and the rigidity (of beliefs about self and others) which is typical of BPD. At the neurobiological level, we propose that enhanced levels of dopamine are associated with the increased integration of negative social feedback, and we also discuss the hypothesis of an impaired inhibitory control of the prefrontal cortex in the processing of negative social information. Our account may provide a new understanding not only of the clinical aspects of BPD, but also a unifying theory of the corresponding neurobiological pathologies. We conclude by outlining some directions for future research on the behavioral, neurobiological, and computational underpinnings of this model, and point to some clinical implications of it.
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Affiliation(s)
- Philipp Herzog
- Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, D-23562 Lübeck, Germany
- Department of Psychiatry and Psychotherapy, Christian-Albrechts-University of Kiel, Niemannsweg 147, D-24105 Kiel, Germany
- Department of Psychology, University of Koblenz-Landau, Ostbahnstr. 10, 76829 Landau, Germany
| | - Tobias Kube
- Department of Psychology, University of Koblenz-Landau, Ostbahnstr. 10, 76829 Landau, Germany
| | - Eva Fassbinder
- Department of Psychiatry and Psychotherapy, Christian-Albrechts-University of Kiel, Niemannsweg 147, D-24105 Kiel, Germany
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10
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Waters RC, Gould E. Early Life Adversity and Neuropsychiatric Disease: Differential Outcomes and Translational Relevance of Rodent Models. Front Syst Neurosci 2022; 16:860847. [PMID: 35813268 PMCID: PMC9259886 DOI: 10.3389/fnsys.2022.860847] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/19/2022] [Indexed: 12/02/2022] Open
Abstract
It is now well-established that early life adversity (ELA) predisposes individuals to develop several neuropsychiatric conditions, including anxiety disorders, and major depressive disorder. However, ELA is a very broad term, encompassing multiple types of negative childhood experiences, including physical, sexual and emotional abuse, physical and emotional neglect, as well as trauma associated with chronic illness, family separation, natural disasters, accidents, and witnessing a violent crime. Emerging literature suggests that in humans, different types of adverse experiences are more or less likely to produce susceptibilities to certain conditions that involve affective dysfunction. To investigate the driving mechanisms underlying the connection between experience and subsequent disease, neuroscientists have developed several rodent models of ELA, including pain exposure, maternal deprivation, and limited resources. These studies have also shown that different types of ELA paradigms produce different but somewhat overlapping behavioral phenotypes. In this review, we first investigate the types of ELA that may be driving different neuropsychiatric outcomes and brain changes in humans. We next evaluate whether rodent models of ELA can provide translationally relevant information regarding links between specific types of experience and changes in neural circuits underlying dysfunction.
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11
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The Mexican magnetic resonance imaging dataset of patients with cocaine use disorder: SUDMEX CONN. Sci Data 2022; 9:133. [PMID: 35361781 PMCID: PMC8971535 DOI: 10.1038/s41597-022-01251-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 03/10/2022] [Indexed: 01/16/2023] Open
Abstract
Cocaine use disorder (CUD) is a substance use disorder (SUD) characterized by compulsion to seek, use and abuse of cocaine, with severe health and economic consequences for the patients, their families and society. Due to the lack of successful treatments and high relapse rate, more research is needed to understand this and other SUD. Here, we present the SUDMEX CONN dataset, a Mexican open dataset of 74 CUD patients (9 female) and matched 64 healthy controls (6 female) that includes demographic, cognitive, clinical, and magnetic resonance imaging (MRI) data. MRI data includes: 1) structural (T1-weighted), 2) multishell high-angular resolution diffusion-weighted (DWI-HARDI) and 3) functional (resting state fMRI) sequences. The repository contains unprocessed MRI data available in brain imaging data structure (BIDS) format with corresponding metadata available at the OpenNeuro data sharing platform. Researchers can pursue brain variability between these groups or use a single group for a larger population sample. Measurement(s) | functional brain measurement • Diffusion Weighted Imaging • Abnormality of brain morphology • Alteration Of Cognitive Function • Clinical Study | Technology Type(s) | Functional Magnetic Resonance Imaging • Diffusion Weighted Imaging • Turbo Field Echo MRI • neuropsychological test • Clinical Evaluation | Factor Type(s) | Cocaine Dependence | Sample Characteristic - Organism | Homo | Sample Characteristic - Location | Mexico City |
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12
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Seitz KI, Ehler N, Schmitz M, Schmitz SE, Dziobek I, Herpertz SC, Bertsch K. Affective and cognitive theory of mind in posttraumatic stress, major depressive, and somatic symptom disorders: Association with childhood trauma. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2022; 61:680-700. [PMID: 35102575 DOI: 10.1111/bjc.12357] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 01/12/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Childhood trauma constitutes a major risk factor for adult psychopathology, including posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and somatic symptom disorder (SSD). One potential mechanism linking childhood trauma to adult psychopathology may be alterations in theory of mind (ToM). Given the lack of transdiagnostic studies on the association between childhood trauma and ToM, further research is needed to elucidate whether and how childhood trauma relates to ToM impairments across and within diagnostic boundaries. DESIGN A cross-sectional study design was applied. METHODS A total of 137 individuals with varying levels of childhood trauma took part in this study, encompassing individuals with PTSD (n = 33), MDD (n = 33), SSD (n = 36), and healthy volunteers (HVs; n = 35). To assess ToM performance and childhood trauma, the Movie for the Assessment of Social Cognition was administered along with the Childhood Trauma Questionnaire. RESULTS Only individuals with PTSD, but not individuals with MDD or SSD, showed a worse ToM performance compared to HVs. In the whole sample, childhood trauma correlated negatively with ToM performance. Exploratory group-specific analyses revealed higher levels of childhood trauma to be associated with more excessive ToM errors in individuals with SSD, and notably with an enhanced ToM performance in individuals with MDD. CONCLUSIONS Our results indicate associations between childhood trauma and ToM impairments in a large, transdiagnostic sample. Provided replication in future studies, our findings suggest ToM capacities as a promising treatment target for individuals exposed to severe childhood trauma, at least or particularly with a diagnosis of PTSD. PRACTITIONER POINTS Our results suggest that individuals with a history of severe childhood trauma, at least or particularly with a clinical diagnosis of posttraumatic stress disorder, may benefit from therapeutic approaches targeting theory of mind capacities. Our findings indicate that higher levels of childhood trauma may be linked to a specific 'hypermentalizing' bias in somatic symptom disorder. Our findings further point towards an association between higher levels of childhood trauma and a heightened - rather than a diminished - sensitivity towards interpersonal cues in major depressive disorder. Provided further confirmatory evidence, our findings may support diagnosis-specific approaches in ameliorating theory of mind abilities in individuals with different mental disorders and a history of severe childhood trauma.
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Affiliation(s)
- Katja I Seitz
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Germany
| | - Nicola Ehler
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Germany
| | - Marius Schmitz
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Germany.,Department of Psychology, Ludwig-Maximilians-University Munich, Germany
| | - Sara E Schmitz
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Isabel Dziobek
- Berlin School of Mind and Brain, Humboldt Universität zu Berlin, Germany.,Department of Psychology, Humboldt Universität zu Berlin, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Germany
| | - Katja Bertsch
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Germany.,Department of Psychology, Ludwig-Maximilians-University Munich, Germany
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13
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Bora E. A meta-analysis of theory of mind and 'mentalization' in borderline personality disorder: a true neuro-social-cognitive or meta-social-cognitive impairment? Psychol Med 2021; 51:2541-2551. [PMID: 34530941 DOI: 10.1017/s0033291721003718] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND It is widely accepted that borderline personality disorder (BPD) is associated with significant impairments in mentalization and theory of mind (ToM) which are considered as closely related concepts by many authors particularly in psychoanalytical circles. However, for understanding interpersonal difficulties in personality disorders, it is important to distinguish neuro-social cognitive impairment from the abnormal meta-social-cognitive style of patients. METHODS The current systematic review aimed to conduct separate meta-analyses of 'mentalization' [reflective functioning (RF] and different aspects of ToM in BPD. A literature search was conducted to locate relevant articles published between January 1990 to July 2021. Random-effect meta-analyses were conducted in 34 studies involving 1448 individuals with BPD and 2006 healthy controls. RESULTS A very large impairment in RF was evident in BPD [d = 1.68, confidence interval (CI) = 1.17-2.19]. In contrast, ToM impairment was modest (d = 0.36, CI = 0.24-0.48). BPD patients underperformed healthy controls in ToM-reasoning (d = 0.44, CI = 0.32-0.56) but not ToM-decoding. Increased HyperToM (d = 0.60, CI = 0.41-0.79) and faux pas recognition (d = 0.62, CI = 0.35-0.90) errors in BPD compared to healthy controls were most robust ToM findings in this meta-analysis. CONCLUSIONS BPD is characterized by very severe deficits in RF and modest and selective abnormalities in ToM. Interpersonal problems and difficulties in processing social information in BPD can be best explained by patients' maldaptive meta-social cognitive style and top-down effects of these abnormalities rather than having a primary neuro-social cognitive deficit.
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Affiliation(s)
- Emre Bora
- Department of Psychiatry, Dokuz Eylul University Medical School, Izmir35340, Turkey
- Department of Neurosciences, Insitiute of Health, Dokuz Eylul University, Izmir, Turkey
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria3053, Australia
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14
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Zarnowski O, Ziton S, Holmberg R, Musto S, Riegle S, Van Antwerp E, Santos-Nunez G. Functional MRI findings in personality disorders: A review. J Neuroimaging 2021; 31:1049-1066. [PMID: 34468063 DOI: 10.1111/jon.12924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 11/28/2022] Open
Abstract
Personality disorders (PDs) have a prevalence of approximately 10% in the United States, translating to over 30 million people affected in just one country. The true prevalence of these disorders may be even higher, as the paucity of objective diagnostic criteria could be leading to underdiagnosis. Because little is known about the underlying neuropathologies of these disorders, patients are diagnosed using subjective criteria and treated nonspecifically. To better understand the neural aberrancies responsible for these patients' symptoms, a review of functional MRI literature was performed. The findings reveal that each PD is characterized by a unique set of activation changes corresponding to individual structures or specific neural networks. While unique patterns of neural activity are distinguishable within each PD, aberrations of the limbic/paralimbic structures and default mode network are noted across several of them. In addition to identifying valuable activation patterns, this review reveals a void in research pertaining to paranoid, schizoid, histrionic, narcissistic, and dependent PDs. By delineating patterns in PD neuropathology, we can more effectively direct future research efforts toward enhancing objective diagnostic techniques and developing targeted treatment modalities. Furthermore, understanding why patients are manifesting certain symptoms can advance clinical awareness and improve patient outcomes.
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Affiliation(s)
- Oskar Zarnowski
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Shirley Ziton
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Rylan Holmberg
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Sarafina Musto
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Sean Riegle
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Emily Van Antwerp
- West Virginia School of Osteopathic Medicine, Lewisburg, West Virginia, USA
| | - Gabriela Santos-Nunez
- University of Massachusetts Memorial Medical Center, Radiology Department, Worcester, Massachusetts, USA
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15
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[Neurobiological principles of borderline personality disorder: integration into the ICD-11 model of personality disorders]. DER NERVENARZT 2021; 92:653-659. [PMID: 34019118 DOI: 10.1007/s00115-021-01133-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/18/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Borderline personality disorder (BPD) is a severe mental disorder associated with far-reaching impairments in the self and interpersonal functioning. The broad database has contributed to the fact that BPD remains the only categorical personality diagnosis in ICD-11, even if coupled to the determination of the severity of impairments. Nevertheless, we need to deal with a dimensional conceptualization of personality disorders-which is also supported by neuroscientific findings-at the latest in 2022 when the ICD-11 comes into effect . OBJECTIVE This narrative review provides an overview of neuroscientific findings regarding impairments in self and interpersonal functioning in patients with BPD. RESULTS Alterations in the medial prefrontal cortex, temporoparietal junction and precuneus mediate deficits in self-referential thought processes and the mentalization of emotions and intentions of others. Enhanced connectivity between the amygdala and midline structures is associated with hypermentalization. At the same time, elevated insula activation seems to underlie the strengthened nonreflective parts of feelings of other people. Frontolimbic alterations are transdiagnostically associated with deficient emotional regulation and negative affectivity and alterations in reward and cognitive control regions are related to impulsivity. CONCLUSION Neuroscientific findings help to have a better understanding of the underlying mechanisms of central functional impairments in BPD and can support the transition to ICD-11 as well as the implementation of new interventions.
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16
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Szczepaniak M, Chowdury A, Soloff PH, Diwadkar VA. Stimulus valence, episodic memory, and the priming of brain activation profiles in borderline personality disorder. Psychol Med 2021; 52:1-11. [PMID: 33858552 PMCID: PMC9275123 DOI: 10.1017/s0033291721001136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 02/12/2021] [Accepted: 03/12/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Borderline personality disorder (BPD) is characterized by instability in affective regulation that can result in a loss of cognitive control. Triggers may be neuronal responses to emotionally valenced context and/or stimuli. 'Neuronal priming' indexes the familiarity of stimuli, and may capture the obligatory effects of affective valence on the brain's processing system, and how such valence mediates responses to the repeated presentation of stimuli. We investigated the effects of affective valence of stimuli on neuronal priming (i.e. changes in activation to repeated presentation of stimuli), and if these effects distinguished BPD patients from controls. METHODS Forty BPD subjects and 25 control subjects (age range: 18-44) participated in an episodic memory task during fMRI. Stimuli were presented in alternating epochs of encoding (six images of positive, negative, and neutral valence) and recognition (six images for 'old' v. 'new' recognition). Analyses focused on inter-group differences in the change in activation to repeated stimuli (presented during Encoding and Recognition). RESULTS Relative to controls, BPD showed greater priming (generally greater decrease from encoding to recognition) for negatively valenced stimuli. Conversely, BPD showed less priming for positively valenced stimuli (generally greater increase from encoding to recognition). CONCLUSION Plausibly, the relative familiarity of negative valence to patients with BPD exerts an influence on obligatory responses to repeated stimuli leading to repetition priming of neuronal profiles. The specific effects of valence on memory and/or attention, and consequently on priming can inform the understanding of mechanisms of altered salience for affective stimuli in BPD.
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Affiliation(s)
- Morgan Szczepaniak
- Department of Psychiatry & Behavioral Neurosciences, Wayne State University, Detroit, USA
| | - Asadur Chowdury
- Department of Psychiatry & Behavioral Neurosciences, Wayne State University, Detroit, USA
| | - Paul H. Soloff
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, USA
| | - Vaibhav A. Diwadkar
- Department of Psychiatry & Behavioral Neurosciences, Wayne State University, Detroit, USA
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17
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Ferber SG, Hazani R, Shoval G, Weller A. Targeting the Endocannabinoid System in Borderline Personality Disorder: Corticolimbic and Hypothalamic Perspectives. Curr Neuropharmacol 2021; 19:360-371. [PMID: 32351183 PMCID: PMC8033970 DOI: 10.2174/1570159x18666200429234430] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/09/2020] [Accepted: 04/24/2020] [Indexed: 12/15/2022] Open
Abstract
Borderline Personality Disorder (BPD) is a chronic debilitating psychiatric disorder characterized mainly by emotional instability, chaotic interpersonal relationships, cognitive disturbance (e.g., dissociation and suicidal thoughts) and maladaptive behaviors. BPD has a high rate of comorbidity with other mental disorders and a high burden on society. In this review, we focused on two compromised brain regions in BPD - the hypothalamus and the corticolimbic system, emphasizing the involvement and potential contribution of the endocannabinoid system (ECS) to improvement in symptoms and coping. The hypothalamus-regulated endocrine axes (hypothalamic pituitary - gonadal, thyroid & adrenal) have been found to be dysregulated in BPD. There is also substantial evidence for limbic system structural and functional changes in BPD, especially in the amygdala and hippocampus, including cortical regions within the corticolimbic system. Extensive expression of CB1 and CB2 receptors of the ECS has been found in limbic regions and the hypothalamus. This opens new windows of opportunity for treatment with cannabinoids such as cannabidiol (CBD) as no other pharmacological treatment has shown long-lasting improvement in the BPD population to date. This review aims to show the potential role of the ECS in BPD patients through their most affected brain regions, the hypothalamus and the corticolimbic system. The literature reviewed does not allow for general indications of treatment with CBD in BPD. However, there is enough knowledge to indicate a treatment ratio of a high level of CBD to a low level of THC. A randomized controlled trial investigating the efficacy of cannabinoid based treatments in BPD is warranted.
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Affiliation(s)
| | | | - Gal Shoval
- Address correspondence to this author at the Geha Mental Health Center, Petah Tiqva, Israel; Tel: 972-3-925-8440; Fax: 972-3-925-8276;, E-mail:
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18
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Trimboli F, Marshall RL. The So‐Called Borderline Patient: Aetiology, Diagnosis, and Treatment. BRITISH JOURNAL OF PSYCHOTHERAPY 2020. [DOI: 10.1111/bjp.12596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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19
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Anderson G. Pathoetiology and pathophysiology of borderline personality: Role of prenatal factors, gut microbiome, mu- and kappa-opioid receptors in amygdala-PFC interactions. Prog Neuropsychopharmacol Biol Psychiatry 2020; 98:109782. [PMID: 31689444 DOI: 10.1016/j.pnpbp.2019.109782] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 10/05/2019] [Accepted: 10/06/2019] [Indexed: 02/07/2023]
Abstract
The pathoetiology and pathophysiology of borderline personality disorder (BPD) have been relatively under-explored. Consequently, no targetted pharmaceutical treatments or preventative interventions are available. The current article reviews the available data on the biological underpinnings of BPD, highlighting a role for early developmental processes, including prenatal stress and maternal dysbiosis, in BPD pathoetiology. Such factors are proposed to drive alterations in the infant's gut microbiome, in turn modulating amygdala development and the amygdala's two-way interactions with other brain regions. Alterations in opioidergic activity, including variations in the ratio of the mu-and kappa-opioid receptors seem a significant aspect of BPD pathophysiology, contributing to its comorbidities with depression, anxiety, impulsivity and addiction. Stress and dysphoria are commonly experienced in people classed with BPD. A growing body of data, across a host of medical conditions, indicate that stress and mood dysregulation may be intimately associated with gut dysbiosis and increased gut permeability, coupled to heightened levels of oxidative stress and immune-inflammatory activity. It urgently requires investigation as to the relevance of such gut changes in the course of BPD symptomatology. Accumulating data indicates that BPD symptom exacerbations may be linked to cyclical variations in estrogen, in turn decreasing serotonin and local melatonin synthesis, and thereby overlapping with the pathophysiology of migraine and endometriosis, which also have a heightened association with BPD. Future research directions and treatment implications are indicated.
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20
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Abstract
After participating in this activity, learners should be better able to:• Assess differences between adult patients with the diagnosis of borderline personality disorder (BPD) and healthy control subjects in terms of empathy and related processes• Evaluate the effects of empathy or related processes as factors contributing to abnormal social functioning in BPD ABSTRACT: We reviewed 45 original research studies, published between 2000 and 2019, to assess differences between adult patients with the diagnosis of borderline personality disorder (BPD) and healthy control subjects in terms of empathy and related processes (i.e., theory of mind, mentalizing, social cognition, and emotional intelligence). Thirty-six studies reported deficits of empathy or related processes in patients with BPD. Enhanced emotional empathy in BPD was also reported in eight studies, all of which revealed that patients had increased scores of personal distress on the Interpersonal Reactivity Index self-report questionnaire. Six studies did not find significant differences between patients with BPD and healthy control subjects in terms of empathy or related processes. No study reported enhanced cognitive empathy, social cognition, or emotional intelligence in patients with BPD. We postulate that deficits of empathy or related processes contribute to preempting the formation of stable interpersonal relationships, whereas enhanced emotional empathy might lead to personal (and interpersonal) distress, further contributing to abnormal social functioning in BPD.
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21
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Porter C, Palmier-Claus J, Branitsky A, Mansell W, Warwick H, Varese F. Childhood adversity and borderline personality disorder: a meta-analysis. Acta Psychiatr Scand 2020; 141:6-20. [PMID: 31630389 DOI: 10.1111/acps.13118] [Citation(s) in RCA: 158] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/15/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The aim of this meta-analysis was to better understand the magnitude and consistency of the association between childhood adversity and borderline personality disorder (BPD) across case-control, epidemiological and prospective cohort studies. METHOD Following the review protocol (reference: CRD42017075179), search terms pertaining to adversity and BPD were entered into three search engines. Random-effects meta-analysis synthesised the size and consistency of the effects. RESULTS A total of 97 studies compared BPD to non-clinical (k = 40) and clinical (k = 70) controls. Meta-analysis of case-control studies indicated that individuals with BPD are 13.91 (95% CI 11.11-17.43) times more likely to report childhood adversity than non-clinical controls. This effect was smaller when considering retrospective cohort (OR: 2.59; 95% CI 0.93-7.30) and epidemiological (OR: 2.56, 95% CI 1.24-5.30) studies. Findings were significant across adversity subtypes with emotional abuse (OR: 38.11, 95% CI: 25.99-55.88) and neglect (OR: 17.73, 95% CI = 13.01-24.17) demonstrating the largest effects. Individuals with BPD were 3.15 (95% CI 2.62-3.79) times more likely to report childhood adversity than other psychiatric groups. CONCLUSIONS This meta-analysis corroborates theoretical proposals that exposure to adverse life experiences is associated with BPD. It highlights the importance of considering childhood adversity when treating people diagnosed with BPD.
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Affiliation(s)
- C Porter
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - J Palmier-Claus
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, UK.,Lancashire Care NHS Foundation Trust, Lancashire, UK
| | - A Branitsky
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - W Mansell
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - H Warwick
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - F Varese
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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22
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Connolly P. The Gravity of Objects: How Affectively Organized Generative Models Influence Perception and Social Behavior. Front Psychol 2019; 10:2599. [PMID: 31824382 PMCID: PMC6881275 DOI: 10.3389/fpsyg.2019.02599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/01/2019] [Indexed: 11/13/2022] Open
Abstract
Friston's (2010) free energy principle (FEP) offers an opportunity to rethink what is meant by the psychoanalytic concept of an object or discrete mental representation (Ogden, 1992). The significance of such objects in psychoanalysis is that they may be superimposed on current experience so that perceptions are partly composed of projected fantasy and partly of more realistic perception. From a free energy perspective, the psychoanalytic (person) object may be understood as a bounded set of prior beliefs about a "platonic" sort of person that provides a free energy minimizing, evidence maximizing, hypothesis to explain inference about - or dyadic interactions with - another. The degree to which realistic perception supervenes - relative to a platonic person object - will depend upon the precision assigned to the sensory evidence (concerning the person) relative to the prior beliefs about a platonic form. This provides a basis for not only explaining projection and transference phenomena but also conceptualizing a central assumption within the object relations psychoanalysis. As an example, the paper examines the Kleinian theory of split good or bad part objects as affectively organized generative models (or platonic part-object models) formed in early infancy. This also provides a basis for building on work by Kernberg (1984, 1996) by conceptualizing the role of the part object(s) in a continuum of reality testing, from mild errors in perception that are relatively easily corrected, through borderline affective instability and frequent shifts between part-object experience, to psychotic failures of reality testing, where Friston et al. (2016) proposed that aberrant precisions bias perception to high precision false beliefs (here cast as platonic part objects), such as stable perceptions of others (and possibly oneself) as persecutory agents of some sort. The paper demonstrates the value that the history of clinical insights into psychoanalysis (including object relations) and a system-based approach to the brain (including the free energy principle) can have for one another. This is offered as a demonstration of the potential value of an "Integrative Clinical Systems Psychology" proposed by Tretter and Lo¨ffler-Stastka (2018), which has the potential to integrate the major theoretical frameworks in the field today.
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Affiliation(s)
- Patrick Connolly
- Counselling and Psychology Department, Hong Kong Shue Yan University, North Point, Hong Kong
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