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Williams K, Fleck L, Fuchs A, Koenig J, Kaess M. Mother-child interactions in adolescents with borderline personality disorder traits and the impact of early life maltreatment. Child Adolesc Psychiatry Ment Health 2023; 17:96. [PMID: 37563641 PMCID: PMC10416495 DOI: 10.1186/s13034-023-00645-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/24/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Early detection and intervention of borderline personality disorder (BPD) in adolescence has become a public health priority. Theoretical models emphasize the role of social interactions and transgenerational mechanisms in the development of the disorder suggesting a closer look at caregiver-child relationships. METHODS The current study investigated mother-adolescent interactions and their association with adolescent BPD traits by using a case-control design. Thirty-eight adolescent patients with ≥ 3 BPD traits and their mothers (BPD-G) were investigated in contrast to 35 healthy control dyads (HC-G). Maternal, adolescent and dyadic behavior was coded using the Coding Interactive Behavior Manual (CIB) during two interactions: a fun day planning and a stress paradigm. Additional effects of maternal and/or adolescent early life maltreatment (ELM) on behavior were also explored. RESULTS BPD-G displayed a significantly lower quality of maternal, adolescent and dyadic behavior than the HC-G during both interactions. Maternal and adolescent behavior was predicted by BPD traits alone, whilst dyadic behavior was also influenced by general adolescent psychopathology. Exploratory analyses of CIB subscales showed that whilst HC-G increased their reciprocal behavior during stress compared to the fun day planning, BPD-G dyads decreased it. Maternal ELM did not differ between groups or have any effect on behavior. Adolescent ELM was correlated with behavioral outcome variables, but did not explain behavioral outcomes above and beyond the effect of clinical status. DISCUSSION/CONCLUSION Our data suggest a stronger focus on parent-child interactions in BPD-specific therapies to enhance long-term treatment outcomes in adolescent BPD patients. Further research employing study designs that allow the analyses of bidirectional transactions (e.g. longitudinal design, behavioral microcoding) is needed.
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Affiliation(s)
- Katharina Williams
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Medical Faculty, University of Heidelberg, Blumenstr. 8, Heidelberg, Germany.
- Institute of Psychology, University of Heidelberg, Heidelberg, Germany.
| | - Leonie Fleck
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Medical Faculty, University of Heidelberg, Blumenstr. 8, Heidelberg, Germany
| | - Anna Fuchs
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Medical Faculty, University of Heidelberg, Blumenstr. 8, Heidelberg, Germany
| | - Julian Koenig
- Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Cologne, Cologne, Germany
| | - Michael Kaess
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Medical Faculty, University of Heidelberg, Blumenstr. 8, Heidelberg, Germany
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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Neukel C, Bullenkamp R, Moessner M, Spiess K, Schmahl C, Bertsch K, Herpertz SC. Anger instability and aggression in Borderline Personality Disorder - an ecological momentary assessment study. Borderline Personal Disord Emot Dysregul 2022; 9:29. [PMID: 36244971 PMCID: PMC9575226 DOI: 10.1186/s40479-022-00199-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/09/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Anger and aggression are core features of Borderline Personality Disorder (BPD), contributing strongly to the individual as well as the societal burden caused by the disorder. Across studies, patients with BPD have shown increased, more frequent and prolonged episodes of anger and reported an increased prevalence of reactive aggression. However, only a few studies have investigated anger and aggression in the patients' everyday lives and did not consider anger instability. In order to contribute knowledge about aggression and its association with anger intensity and anger instability in real-life in BPD the aim of the present study was to better characterize days with and without aggressive behaviors with regard to the patients' experienced anger. METHODS Patients with BPD and high aggression as well as healthy participants took part in an ecological momentary assessment (EMA) study assessing state anger and aggression three times per day over two weeks. Multilevel modeling was conducted and anger instability was operationalized by squared successive differences. RESULTS As expected, patients with BPD reported greater instability in their experienced anger compared to healthy participants. Most interestingly, in the BPD group the occurrence of aggressive behavior was significantly associated with anger intensity as well as anger instability. More precisely, on days when patients with BPD acted out aggressively, they reported higher anger intensity as well as greater anger instability than on days when they did not act out aggressively. CONCLUSION Knowledge about what characterizes days with aggressive behaviors may help to improve interventions to reduce aggressive behavior and thus relieve the burden aggression causes for patients with BPD, their surroundings and society.
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Affiliation(s)
- Corinne Neukel
- Department of General Psychiatry, Medical Faculty, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany.
| | - Robin Bullenkamp
- Department of General Psychiatry, Medical Faculty, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Markus Moessner
- Center for Psychotherapy Research, Heidelberg University, Heidelberg, Germany
| | - Karen Spiess
- Department of General Psychiatry, Medical Faculty, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Katja Bertsch
- Department of General Psychiatry, Medical Faculty, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany.,Department of Psychology, LMU Munich, Munich, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Medical Faculty, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
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Malivoire BL, Mutschler C, Monson CM. Interpersonal dysfunction and treatment outcome in GAD: A systematic review. J Anxiety Disord 2020; 76:102310. [PMID: 33002755 DOI: 10.1016/j.janxdis.2020.102310] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 07/01/2020] [Accepted: 09/08/2020] [Indexed: 01/06/2023]
Abstract
Interpersonal dysfunction is posited to maintain worry and generalized anxiety disorder (GAD). It has been suggested that the low remission rates in psychotherapy for GAD may be attributable, in part, to inadequately addressing interpersonal dysfunction. This paper systematically reviewed the literature examining the moderating role of interpersonal dysfunction on GAD psychotherapy outcomes and change in interpersonal dysfunction over the course of GAD treatment. Thirteen studies were identified, seven of which examined the relationship between interpersonal dysfunction or distress and treatment outcome and nine investigated change in interpersonal dysfunction over the course of psychotherapy. The majority of studies indicated that interpersonal dysfunction improves following psychotherapy. However, there is preliminary evidence that not all subscales of interpersonal dysfunction improve, including subscales relevant to GAD pathology such as overly-nurturant dysfunction. Further, greater interpersonal dysfunction predicted worse treatment outcomes. As such, interpersonal dysfunction may hinder treatment success and further research is needed to delineate for whom additional or integrated interpersonal interventions may be needed. Approaches to target interpersonal dysfunction in GAD are discussed.
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Affiliation(s)
- Bailee L Malivoire
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, Ontario, M5B 2K3, Canada.
| | - Christina Mutschler
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, Ontario, M5B 2K3, Canada
| | - Candice M Monson
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, Ontario, M5B 2K3, Canada
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Wilks CR, Korslund KE, Harned MS, Linehan MM. Dialectical behavior therapy and domains of functioning over two years. Behav Res Ther 2015; 77:162-9. [PMID: 26764586 DOI: 10.1016/j.brat.2015.12.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 12/16/2015] [Accepted: 12/20/2015] [Indexed: 11/17/2022]
Abstract
Individuals diagnosed with borderline personality disorder (BPD) tend to have a significant degree of functional impairment across a range of social and occupational spheres including difficulty finding and maintaining satisfying employment, housing, or relationships. Understanding what factors are associated with functional impairment will enable treatment providers to move those diagnosed with BPD beyond symptomatic recovery and toward a life worth living. This paper investigated the trajectories and predictors of functional outcomes for suicidal women with BPD (N = 99) during a treatment outcome study of Dialectical Behavior Therapy (DBT). Results revealed that participants had statistical and clinical improvements in functioning. Individuals with high emotion dysregulation displayed poorer psychosocial functioning at the subsequent assessment period and slower rates of change, which was also seen in reverse for one psychosocial functioning variable. Skills use was not related to individual trajectories in functioning. This study highlights the relationship of emotion dysregulation to functioning within a sample of suicidal women with BPD as well as the importance researching multiple domains in functioning.
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Affiliation(s)
- Chelsey R Wilks
- Behavioral Research and Therapy Clinics, Department of Clinical Psychology, University of Washington, USA.
| | - Kathryn E Korslund
- Behavioral Research and Therapy Clinics, Department of Clinical Psychology, University of Washington, USA
| | - Melanie S Harned
- Behavioral Research and Therapy Clinics, Department of Clinical Psychology, University of Washington, USA
| | - Marsha M Linehan
- Behavioral Research and Therapy Clinics, Department of Clinical Psychology, University of Washington, USA
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Sadeh N, Londahl-Shaller EA, Piatigorsky A, Fordwood S, Stuart BK, McNiel DE, Klonsky ED, Ozer EM, Yaeger AM. Functions of non-suicidal self-injury in adolescents and young adults with Borderline Personality Disorder symptoms. Psychiatry Res 2014; 216:217-22. [PMID: 24594204 DOI: 10.1016/j.psychres.2014.02.018] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 02/03/2014] [Accepted: 02/09/2014] [Indexed: 12/28/2022]
Abstract
Rates of deliberate non-suicidal self-injury (NSSI) increase during adolescence and young adulthood, particularly in clinical samples, making these important developmental stages for understanding the functions of NSSI. Borderline Personality Disorder (BPD) symptoms also begin to emerge in adolescence, though little research has examined relationships between BPD symptoms and the functions of NSSI in youth, the primary goal of the present study. Adolescents and young adults recruited from an outpatient psychotherapy clinic (N=36) endorsed a range of NSSI functions on the Inventory of Statements about Self-Injury (Klonsky and Glenn, 2009). Participants engaged in NSSI to serve intrapersonal functions (e.g., regulate affect, punish oneself) more frequently than interpersonal functions (e.g., bond with peers, establish autonomy). As predicted, linear regression analyses indicated that BPD affective dysregulation symptoms were associated with the intrapersonal but not the interpersonal functions of NSSI. In contrast, BPD interpersonal dysfunction symptoms were differentially associated with the interpersonal rather than intrapersonal functions of NSSI. These preliminary data indicate that clusters of BPD symptoms show unique relationships with functions of NSSI in treatment-seeking adolescents and young adults, relationships that can be used to target specific functions of NSSI in treatment planning.
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Affiliation(s)
- Naomi Sadeh
- Department of Psychiatry, University of California, San Francisco, CA, USA.
| | | | - Auran Piatigorsky
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Samantha Fordwood
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Barbara K Stuart
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Dale E McNiel
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - E David Klonsky
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Elizabeth M Ozer
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, CA, USA; Office of Diversity and Outreach, University of California, San Francisco, CA, USA
| | - Alison M Yaeger
- Department of Psychiatry, University of California, San Francisco, CA, USA
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