Self-Hatred: The Unaddressed Symptom of Borderline Personality Disorder

Individuals with borderline personality disorder (BPD) often report chronic, severe self-hatred. It is frequently experienced as immutable, seen as a barrier to recovery, and is associated with risk for self-injury and suicide attempts. Yet self-hatred remains a poorly understood, underdiagnosed, and undertreated presentation of BPD. In this concept article and review, we describe the nature of self-hatred in BPD and related disorders, propose a theory as to the development of self-hatred in BPD, review the assessments of and interventions for self-hatred, and consider next steps in the research, assessment, and treatment of self-hatred in BPD. Through increased awareness, understanding, and measures of self-hatred in BPD, new treatment paradigms can be developed to ensure more comprehensive recovery.

An x-ray penumbral imager for measurements of electron-temperature profiles in inertial confinement fusion implosions at OMEGA

Hot-spot shape and electron temperature (T_e) are key performance metrics used to assess the efficiency of converting shell kinetic energy into hot-spot thermal energy in inertial confinement fusion implosions. X-ray penumbral imaging offers a means to diagnose hot-spot shape and T_e, where the latter can be used as a surrogate measure of the ion temperature (T_i) in sufficiently equilibrated hot spots. We have implemented a new x-ray penumbral imager on OMEGA. We demonstrate minimal line-of-sight variations in the inferred T_e for a set of implosions. Furthermore, we demonstrate spatially resolved T_e measurements with an average uncertainty of 10% with 6 μm spatial resolution.

Using millimeter-sized carbon-deuterium foils for high-precision deuterium-tritium neutron spectrum measurements in direct-drive inertial confinement fusion at the OMEGA laser facility

Millimeter-sized CD foils fielded close (order mm) to inertial confinement fusion (ICF) implosions have been proposed as a game-changer for improving energy resolution and allowing time-resolution in neutron spectrum measurements using the magnetic recoil technique. This paper presents results from initial experiments testing this concept for direct drive ICF at the OMEGA Laser Facility. While the foils are shown to produce reasonable signals, inferred spectral broadening is seen to be high (∼5 keV) and signal levels are low (by ∼20%) compared to expectation. Before this type of foil is used for precision experiments, the foil mount must be improved, oxygen uptake in the foils must be better characterized, and impact of uncontrolled foil motion prior to detection must be investigated.

A qualitative research of adolescents with behavioral problems about their experience in a dialectical behavior therapy skills training group

BACKGROUND

Several quantitative studies support the effectiveness of the Dialectical Behavior Therapy (DBT) psychosocial skills training group component for adolescents with impulse-control disorder and/or emotional dysregulation. However, qualitative research to assess this psychotherapeutic tool in the adolescent population is sparse. This study aims to examine the subjective experience of adolescents with behavioral issues who have completed DBT skills training group, as well as using this experience to extract hypotheses regarding its usefulness which can then be verified at a later time by means of quantitative instruments.

METHODS

We developed a qualitative study by using focus groups with adolescents (N = 20) whose diagnosis includes symptoms such as behavior disorder, impulse-control disorder and/or emotional dysregulation, and good informants, who have completed DBT skills training. Three focus groups were created.

RESULTS

The subjective experience of adolescents who have completed a DBT skills training group is collected in four main categories: experience of illness, motivation for therapy, experience of therapy and results of the therapy.

CONCLUSIONS

Adolescents with behavioral problems assess their participation in the DBT skills training group positively, even recommending its usefulness to healthy population. Beyond learning skills, they emphasize the intrapsychic changes (as improvement in reflective activity) that they objectify after the group experience.

Neurophysiological activity following rewards and losses among female adolescents and young adults with borderline personality disorder

Borderline personality disorder (BPD) is a complex and debilitating psychiatric illness. Prior research in adults has shown that neurophysiological deficits in feedback processing and learning from rewards may be central to the development of BPD; however, little research has examined these markers in adolescents and young adults with BPD. The present study used event-related potentials and time-frequency decomposition analysis to probe neural responses to wins and losses in a guessing task among 68 females (13 to 23 years old) either with BPD (n = 35) or no history of mental disorders (healthy control [HC]; n = 33). Participants completed a guessing task wherein they won and lost money at equal frequencies while electroencephalogram (EEG) data were acquired. Adolescents and young adults with BPD showed a smaller differentiation between wins and losses in the reward positivity (RewP) relative to HCs. Using time-frequency decomposition, we isolated distinct frequency bands sensitive to wins (delta = < 3Hz) and losses (theta = 4 Hz to 7 Hz). Compared with BPD participants, HCs showed significantly larger delta power to wins, specifically. The groups did not differ in delta power to losses, nor theta power to wins or losses. Collectively, findings implicate altered reward processing in the pathophysiology of BPD and may inform early identification and targeted intervention. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Frontoinsular Network Markers of Current and Future Adolescent Mood Health

BACKGROUND

Adolescence is a developmental period in which depression and related mood syndromes often emerge, but few objective markers exist to guide diagnosis or predict symptoms. One potential mood marker is the functioning of frontoinsular networks, which undergo substantial development in adolescence and have been implicated in adult depression. To test this hypothesis, we used task-based neuroimaging to evaluate whether frontoinsular network dysfunction was linked to current and prospective mood health in adolescents.

METHODS

Adolescents (n = 40, 13-19 years of age) reporting varying levels of depressive symptom severity performed an emotional working memory task with neuroimaging. Next, teens completed a 2-week follow-up consisting of a daily diary report of negative affect and final report of depressive symptoms (n = 28 adherent). Analyses tested associations between task-related functional connectivity in frontoinsular networks and baseline or prospective measures of mood health over 2-week follow-up.

RESULTS

Frontoinsular task response was associated with higher current depression severity (p = .049, η_p² = .12), increases in future depression severity (p = .018, η_p² = .23), and more intense and labile negative affect in daily life (ps = .015 to .040, η_p² = .22 to .30). In particular, hypoconnectivity between insula and lateral prefrontal regions of the frontoparietal network was related to both baseline and prospective mood health, and hyperconnectivity between insula and midline or temporal regions of the default network was related to prospective mood health.

CONCLUSIONS

These findings indicate that frontoinsular imbalances are related to both current depression and changes in mood health in the near future and suggest that frontoinsular markers may hold promise as translational tools for risk prediction.

Treatment Effects following Residential Dialectical Behavior Therapy for Adolescents with Borderline Personality Disorder

Dialectical behavior therapy (DBT) is an empirically supported treatment for borderline personality disorder (BPD) in adults, however fewer studies have examined outcomes in adolescents. This study tested the effectiveness of an intensive 1-month, residential DBT treatment for adolescent girls meeting criteria for BPD. Additionally, given well-established associations between BPD symptoms and childhood abuse, the impact of abuse on treatment outcomes was assessed. Participants were female youth (n = 53) aged 13-20 years (M = 17.00, SD = 1.89) completing a 1-month residential DBT program. At pre-treatment, participants were administered a diagnostic interview and self-report measures assessing BPD, depression, and anxiety symptom severity. Following one month of treatment, participants were re-administered the self-report instruments. Results showed significant pre- to post-treatment reductions in both BPD and depression symptom severity with large effects. However, there was no significant change in general anxious distress or anxious arousal over time. The experience of childhood abuse (sexual, physical, or both) was tested as moderator of treatment effectiveness. Although experiencing multiple types of abuse was related to symptom severity, abuse did not moderate the effects of treatment. Collectively, results indicate that a 1-month residential DBT treatment with adolescents may result in reductions in BPD and depression severity but is less effective for anxiety. Moreover, while youth reporting abuse benefitted from treatment, they were less likely to achieve a clinically significant reduction in symptoms.

Electrocortical Reactivity During Self-referential Processing in Female Youth With Borderline Personality Disorder

BACKGROUND

Borderline personality disorder (BPD) is debilitating, and theoretical models have postulated that cognitive-affective biases contribute to the onset and maintenance of BPD symptoms. Despite advances, our understanding of BPD pathophysiology in youth is limited. The present study used event-related potentials (ERPs) to identify cognitive-affective processes that underlie negative self-referential processing in BPD youth.

METHODS

Healthy females (n = 33) and females with BPD (n = 26) 13 to 22 years of age completed a self-referential encoding task while 128-channel electroencephalography data were recorded to examine early (i.e., P1 and P2) and late (late positive potential [LPP]) ERP components. Whole-brain standardized low-resolution electromagnetic tomography explored intracortical sources underlying significant scalp ERP effects.

RESULTS

Compared to healthy females, participants with BPD endorsed, recalled, and recognized fewer positive and more negative words. Moreover, unlike the healthy group, females with BPD had faster reaction times to endorse negative versus positive words. In the scalp ERP analyses, the BPD group had greater P2 and late LPP positivity to negative as opposed to positive words. For P2 and late LPP, whole-brain standardized low-resolution electromagnetic tomography analyses suggested that females with BPD overrecruit frontolimbic circuitry in response to negative stimuli.

CONCLUSIONS

Collectively, these findings show that females with BPD process negative self-relevant information differently than healthy females. Clinical implications and future directions are discussed.

[Breast MRI--histologic correlation for ductal carcinoma in situ]

OBJECTIVE

To evaluate the concordance between the breast MRI findings and the histologic findings for the size and extension of pure ductal carcinoma in situ (DCIS) and to compare this concordance with that of conventional techniques (mammography and ultrasonography).

MATERIAL AND METHODS

This is a retrospective study of consecutive patients diagnosed with DCIS after percutaneous biopsy. We estimated Lin's coefficient of concordance for the histologic findings with each of the three techniques. We also assessed concordance using Bland-Altman graphs. Finally, we determined the impact of the MRI findings on the surgical management of patients with DCIS.

RESULTS

A total of 32 patients were included in the study. Concordance between imaging and histology on tumor size was higher for MRI (0.78; 95%CI, 0.62-0.87) than for mammography (0.43; 95%CI, 0.19-0.62) or for ultrasonography (0.27; 95%CI, 0.09-0.43). MRI overestimated the size of DCIS by a mean of 3 mm, whereas mammography and ultrasonography underestimated it by 9 mm and 18 mm, respectively. MRI detected multifocality and multicentricity (7 cases) better than mammography (3) or ultrasonography (0). The MRI findings correctly changed the surgical management in six patients.

CONCLUSION

Breast MRI is better than conventional techniques for the evaluation of the size of DCIS. Breast MRI also detects more cases of multifocality and multicentricity. We recommend that all patients diagnosed with DCIS (especially those with dense breasts) undergo breast MRI prior to surgery.

Prevalencia de la microalbuminuria en una población hipertensa de Navarra septentrional y su relación con otros factores de riesgo cardiovascular

AIM

To determine the prevalence of microalbuminuria in a hypertense population in northern Navarre and its relationship to other cardiovascular risk factors.

PATIENTS AND METHODS

All the known hypertensive patients in our area of work were included, and a transversal study was designed that also evaluated the presence of other cardiovascular risk factors, including diabetes mellitus, hypercholesterolemia, obesity, smoking and alcohol drinking.

RESULTS

A total of 106 hypertensive patients (54.7% women) were studied. The presence of microalbuminuria was found in 19 patients (18%), and a significant percentage showed other cardiovascular risk factors - diabetes mellitus (24.5%), hypercholesterolemia (61.3%), and obesity (49%). In 12.2% there was a concurrence of arterial hypertension, diabetes mellitus, hypercholesterolemia and obesity. Eighty-four percent of the diabetics were type 2. The highest percentage of cardiovascular risk factors corresponded to the group of hypertensive patients with positive microalbuminuria, and the most significant differences were found in the group of diabetics.

CONCLUSIONS

The frequency of microalbuminuria in our hypertensive population was similar to that reported in other papers. A high prevalence of cardiovascular risk factors was found, especially in the group of hypertensive patients with positive microalbuminuria.

[Life-styles determining the oral health of adolescents in Vitoria (Gasteiz):and evaluation]

OBJECTIVE

To assess the factors determining oral health in adolescents in school at Vitoria (Gasteiz).Design. Descriptive epidemiological study.

PARTICIPANTS

Randomised representative sample of 1,380 students from public and private schools. Setting. Vitoria (Gasteiz). MAIN MASUREMENTS AND RESULTS: A questionnaire on bucco-dental health was self-administered. 41.9% of the adolescents brushed their teeth three times or more a day (2.2 ( 0.98 times a day), with greater frequency in girls. 64% never used dental floss, and 30% did so only at times. 88.1% did not complement their oral hygiene with mouth-washes. Consumption of commercial cakes and pastries was 0.74 ( 1.12 times a day; and of sweets, 1.58 ( 3.15 times a day. 81.9% of the adolescents valued their mouth and dental health the same as the health of other organs of their bodies. 63.5% did not know whether any compound was added to the water as a preventive measure against dental disease; and 83.2% of those who thought something was added did not know what compound it was. 66.7% had been to the dentist during the previous year; 28.2% had not been for over a year.

CONCLUSION

The oral health habits of adolescents in Vitoria (Gasteiz) show deficiencies that could be corrected through Health Education Programmes and promotion of the use of preventive dental services.

[Radiosurgical labeling of non-palpable mammary lesions]

BACKGROUND

The frequency of breast cancer is increasing worldwide and mammography allows the diagnosis of concealed lesions.

AIM

To assess the diagnostic yield for carcinoma of non palpable lesions detected by mammography.

PATIENTS AND METHODS

We studied 46 patients, aged 24 to 67 years old, in whom a radiosurgical labeling of non palpable mammary lesions was performed. In all patients, a surgical biopsy was obtained, but the pathological study was available in only 40 patients.

RESULTS

The mammographic appearance of lesions were microcalcifications in 40% of women, stellate images in 27.5%, asymmetry in density in 5% and the association of microcalcifications and other signs in 20%. Seventy seven percent of lesions were benign. Four patients had an in situ ductal carcinoma, two had a predominantly in situ carcinoma and 4 had an invasive ductal carcinoma.

CONCLUSIONS

Our results are similar to those reported abroad. The finding of 5 minimal carcinomas underscores the effectiveness of mammography as a screening method for breast cancer.

Anticardiolipin antibodies in chronic hepatitis C: implication of hepatitis C virus as the cause of the antiphospholipid syndrome

Antiphospholipid antibodies are a type of autoantibodies that have been implicated in the occurrence of thrombocytopenia and thrombotic events and have been described in autoimmune disorders and diverse viral diseases. In this study anticardiolipin antibodies (immunoglobulin G [IgG] isotype) were determined in serum from 100 patients with chronic hepatitis C and 52 healthy controls. In addition, hepatitis C virus (HCV) markers (anti-HCV and HCV RNA) were investigated in 73 patients with thrombotic disorders and no clinical evidence of liver disease; of these patients 37 cases tested negatively for anticardiolipin antibodies and 36 positively. Anticardiolipin test was positive more frequently (22%) in the group of patients with chronic hepatitis C than in healthy controls (1.9%; P < .001). Using conditional logistic-regression analysis we found that in hepatitis C patients the presence of thrombocytopenia, portal hypertension and the existence of prior thrombotic episodes were significantly related to positivity for anticardiolipin antibodies (P < .05 in all cases). In patients with no evidence of liver disease and a history of thrombotic events, hepatitis C markers were absent in all cases who tested negatively for anticardiolipin antibodies (n = 37), but were present in 16.7% of those positive for anticardiolipin (n = 36) (P = .01). In conclusion, anticardiolipin antibodies are frequently found in patients with chronic hepatitis C and in these patients they may be implicated in the occurrence of thrombosis and in the development of thrombocytopenia. Occult HCV infection is present in a significant proportion of patients with thrombotic disorders and positive for anticardiolipin (the antiphospholipid syndrome).

Protective effect of a platelet-activating factor antagonist (WEB-2086) in postischemic renal failure

The purpose of this study was to evaluate the renoprotective effect of a specific platelet-activating factor antagonist (WEB-2086) in an experimental model of normothermic renal ischemia. Twenty New Zealand white rabbits were studied for 2 days before and 24 hours after a 60-minute period of renal ischemia induced by bilateral clamping of the renal arteries. The animals were divided into two groups: a control group (group A; n = 10) and a treated group (group B; n = 10). In group A the urinary flow rate decreased significantly (from 0.098 +/- 0.008 ml/min to 0.029 +/- 0.005 ml/min) (p < 0.001) and there was a significant reduction in creatinine clearance (from 11.4 +/- 1.2 ml/min to 3.4 +/- 1.1 ml/min) (p < 0.001). In group B no significant changes were observed, although the urinary flow rate increased even in the postischemic period (from 0.09 +/- 0.008 ml/min to 0.11 +/- 0.02 ml/min). Microcirculatory cortical flow showed a postischemic reduction in both groups, although it was most significant in the control group (group A = 43.7%, group B = 71.5%; p < 0.001). Histologic study showed mild damage with patchy tubular necrosis in both groups, although this injury was less severe in the treated group. The results suggest that the preoperative administration of WEB-2086 produces a potent diuretic effect with significant attenuation of postischemic acute renal failure.