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Chanen AM, Kerslake R, Berubé FA, Nicol K, Jovev M, Yuen HP, Betts JK, McDougall E, Nguyen AL, Cavelti M, Kaess M. Psychopathology and psychosocial functioning among young people with first-episode psychosis and/or first-presentation borderline personality disorder. Schizophr Res 2024; 266:12-18. [PMID: 38359514 DOI: 10.1016/j.schres.2024.02.010] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/01/2024] [Accepted: 02/11/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND One in five young people with first-episode psychosis (FEP) also presents with borderline personality disorder (BPD) features. Among people diagnosed with BPD, auditory verbal hallucinations occur in 29-50 % and delusions in 10-100 %. Co-occurrence of psychotic symptoms and BPD is associated with greater clinical severity and greater difficulty accessing evidence based FEP care. This study aimed to investigate psychotic symptoms and psychosocial functioning among young people presenting to an early intervention mental health service. METHOD According to the presence or absence of either FEP or BPD, 141 participants, aged 15-25 years, were assigned to one of four groups: FEP, BPD, combined FEP + BPD, or clinical comparison (CC) participants with neither FEP nor BPD. Participants completed semi-structured diagnostic interviews and interviewer and self-report measures of psychopathology and psychosocial functioning. RESULTS The FEP + BPD group had significantly more severe psychopathology and poorer psychosocial functioning than the FEP group on every measure, apart from intensity of hallucinations. Comparing the FEP or BPD groups, the BPD group had greater psychopathology, apart from intensity of psychotic symptoms, which was significantly greater in the FEP group. These two groups did not significantly differ in their overall psychosocial functioning. Compared with CC young people, both the FEP + BPD and BPD groups differed significantly on every measure, with medium to large effect sizes. CONCLUSIONS Young people with co-occurring FEP and BPD experience more severe difficulties than young people with either diagnosis alone. This combination of psychosis and severe personality pathology has been longitudinally associated with poorer outcomes among adults and requires specific clinical attention.
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Affiliation(s)
- Andrew M Chanen
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
| | - Richard Kerslake
- Sussex Partnership NHS Foundation Trust, Sussex, United Kingdom.
| | - Felix-Antoine Berubé
- Institut Universitaire en Santé Mentale de Montréal, Université de Montréal, Montreal, Canada.
| | - Katie Nicol
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
| | - Martina Jovev
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
| | - Hok Pan Yuen
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
| | - Jennifer K Betts
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
| | - Emma McDougall
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
| | - Ai-Lan Nguyen
- Department of Medicine, The University of Melbourne, Parkville, VIC, Australia.
| | - Marialuisa Cavelti
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany.
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Wilner JG, Ronzio B, Gillen C, Aguirre B. Self-Hatred: The Unaddressed Symptom of Borderline Personality Disorder. J Pers Disord 2024; 38:157-170. [PMID: 38592908 DOI: 10.1521/pedi.2024.38.2.157] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
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.
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Affiliation(s)
- Julianne G Wilner
- From Division of Child and Adolescent Psychiatry, McLean Hospital/Harvard Medical School, Belmont, Massachusetts
| | - Blake Ronzio
- From Division of Child and Adolescent Psychiatry, McLean Hospital/Harvard Medical School, Belmont, Massachusetts
| | - Carly Gillen
- From Division of Child and Adolescent Psychiatry, McLean Hospital/Harvard Medical School, Belmont, Massachusetts
| | - Blaise Aguirre
- From Division of Child and Adolescent Psychiatry, McLean Hospital/Harvard Medical School, Belmont, Massachusetts
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3
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Bailey BC, Novick D, Boyce K, Swartz HA. Dialectical Behavior and Social Rhythm Therapy for Comorbid Bipolar Disorder and Borderline Personality Disorder. Am J Psychother 2024; 77:23-29. [PMID: 37670578 DOI: 10.1176/appi.psychotherapy.20230006] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
Bipolar disorder and borderline personality disorder commonly co-occur. Each disorder is associated with substantial morbidity and mortality, which are worsened by co-occurrence of the disorders. Emotional dysregulation, suicidality, and disrupted circadian rhythm are key aspects of psychopathology associated with both conditions. A novel psychotherapy combining elements of two evidence-based treatments (i.e., dialectical behavior therapy [DBT] for borderline personality disorder and social rhythm therapy [SRT] for bipolar disorder) is described. Unlike either treatment alone, the new therapy, called dialectical behavior and social rhythm therapy (DBSRT), targets all three disease-relevant processes and therefore may represent a promising new approach to treatment for individuals with these two conditions. DBSRT may also have utility for individuals with overlapping characteristics of bipolar disorder and borderline personality disorder or for those whose illness manifestation includes a mix of bipolar and borderline personality disorder traits. Strategies associated with DBSRT are described, and a brief case vignette illustrates its application.
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Affiliation(s)
- Bridget C Bailey
- School of Social Work, Eberly College of Arts and Sciences (Bailey), and Department of Behavioral Medicine and Psychiatry, School of Medicine (Bailey, Boyce), West Virginia University, Morgantown; U.S. Department of Veterans Affairs Pittsburgh Healthcare System, Pittsburgh (Novick); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Swartz)
| | - Danielle Novick
- School of Social Work, Eberly College of Arts and Sciences (Bailey), and Department of Behavioral Medicine and Psychiatry, School of Medicine (Bailey, Boyce), West Virginia University, Morgantown; U.S. Department of Veterans Affairs Pittsburgh Healthcare System, Pittsburgh (Novick); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Swartz)
| | - Kristen Boyce
- School of Social Work, Eberly College of Arts and Sciences (Bailey), and Department of Behavioral Medicine and Psychiatry, School of Medicine (Bailey, Boyce), West Virginia University, Morgantown; U.S. Department of Veterans Affairs Pittsburgh Healthcare System, Pittsburgh (Novick); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Swartz)
| | - Holly A Swartz
- School of Social Work, Eberly College of Arts and Sciences (Bailey), and Department of Behavioral Medicine and Psychiatry, School of Medicine (Bailey, Boyce), West Virginia University, Morgantown; U.S. Department of Veterans Affairs Pittsburgh Healthcare System, Pittsburgh (Novick); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Swartz)
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Denning DM, Ciotti V, Gioia A, Viranda T, Reilly EE, Berner LA, Velkoff EA, Anderson LK, Kaye WH, Wierenga CE, Brown TA. Effects of borderline personality disorder symptoms on dialectical behavior therapy outcomes for eating disorders. Personal Disord 2024; 15:146-156. [PMID: 37589688 PMCID: PMC10873472 DOI: 10.1037/per0000641] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Existing literature on the effects of borderline personality disorder (BPD) and eating disorder (ED) comorbidity in terms of clinical presentation and treatment outcome has been limited and inconclusive. The present study examined whether clients with EDs and varying levels of BPD symptoms presented with more severe ED symptoms at admission, and whether they responded to dialectical behavior therapy (DBT)-based treatment. Participants (N = 176) were adults in a DBT-based partial hospitalization program for EDs at an academic medical center. Participants completed self-report measures at admission, 1-month postadmission, discharge, and 6-month follow-up. Results suggested that patients with elevated BPD symptoms at admission had greater ED symptoms during treatment, evidenced by small to moderate effect sizes. However, patients with high BPD symptoms demonstrated steeper declines in binge eating, fasting, and parasuicidal behavior early during treatment compared to patients with low BPD symptoms. Individuals with high BPD symptoms at admission (i.e., probable BPD diagnosis) were as likely to meet remission criteria and relapse as individuals with low BPD symptoms, though this null finding may be influenced by small cell sizes. Our findings also suggest that DBT skills use does not predict changes in symptoms. In sum, our findings suggest that while clients with higher BPD symptoms may improve during DBT-based partial hospitalization, their ED symptoms may remain more severe. Future studies are needed to determine whether adjunctive treatments improve outcomes for clients with EDs and comorbid BPD symptoms in DBT programs and whether skills use quality is a better predictor of ED symptom changes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Dominic M. Denning
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst
| | | | - Ayla Gioia
- Department of Psychology, Hofstra University
| | - Thalia Viranda
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai
| | - Erin E. Reilly
- Department of Psychiatry, University of California San Francisco
| | - Laura A. Berner
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai
| | | | | | - Walter H. Kaye
- Department of Psychiatry, University of California San Diego
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Maoz H, Grossman-Giron A, Sedoff O, Nitzan U, Kashua H, Yarmishin M, Arad O, Tzur Bitan D. Intranasal oxytocin as an adjunct treatment among patients with severe major depression with and without comorbid borderline personality disorder. J Affect Disord 2024; 347:39-44. [PMID: 37992767 DOI: 10.1016/j.jad.2023.11.053] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/12/2023] [Accepted: 11/17/2023] [Indexed: 11/24/2023]
Abstract
INTRODUCTION Results of studies concerning a possible beneficial effect of Intranasal-Oxytocin (IN-OT) as an add-on treatment for patients with major depression (MDD) have been inconsistent. One possible explanation to account for the difference in the effect of IN-OT is comorbid borderline personality disorder (BPD). This randomized controlled study was aimed to explore the differential effect of IN-OT administration among depressive patients with or without comorbid borderline personality disorder. METHODS A secondary analysis was conducted on a specific subset of patients who participated in an RCT evaluating the impact of IN-OT as add-on treatment for patients with severe mental illness. Patients treated in inpatient settings (N = 58) were randomized and double-blindly allocated to receive twice daily IN-OT (32 IU) or placebo for a period of four weeks. The effect of IN-OT on therapy process and outcome was examined among patients with (n = 35) and without (n = 23) comorbid BPD. RESULTS An interaction effect between diagnosis and group was observed on the Outcome Questionnaire-45 (B = 8.93, p = .007). Further analysis revealed that patients without BPD demonstrated significantly greater improvements following OT administration (B = -8.32, p = .001), whereas patients with BPD did not show significant improvement (B = 0.61, p = .76). The interactive pattern was also observed in the Hopkins Symptom Checklist (B = 0.25, p = .02), where patients without BPD demonstrated significantly larger improvements following OT administration (B = -0.29, p = .0009) as compared to placebo, while patients with BPD demonstrated no significant improvement (B = -0.04, p = .55). We did not find a harmful effect of IN-OT administration among patients with MDD and comorbid BPD. CONCLUSIONS Patients with MDD and comorbid BPD benefit less from IN-OT administration as compared to depressed patients without BPD. Future studies should aim to identify patients who are more likely to benefit from IN-OT administration.
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Affiliation(s)
- Hagai Maoz
- Shalvata Mental Health Center, Affiliated with the School of Medicine, Tel-Aviv University, Tel-Aviv-Jaffa, Israel; School of Medicine, Tel-Aviv University, Tel-Aviv-Jaffa, Israel.
| | - Ariella Grossman-Giron
- Shalvata Mental Health Center, Affiliated with the School of Medicine, Tel-Aviv University, Tel-Aviv-Jaffa, Israel; Department of Behavioral Sciences, Ariel University, Ariel, Israel
| | - Omer Sedoff
- Shalvata Mental Health Center, Affiliated with the School of Medicine, Tel-Aviv University, Tel-Aviv-Jaffa, Israel; Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Uri Nitzan
- Shalvata Mental Health Center, Affiliated with the School of Medicine, Tel-Aviv University, Tel-Aviv-Jaffa, Israel; School of Medicine, Tel-Aviv University, Tel-Aviv-Jaffa, Israel
| | - Halil Kashua
- Shalvata Mental Health Center, Affiliated with the School of Medicine, Tel-Aviv University, Tel-Aviv-Jaffa, Israel
| | - Maya Yarmishin
- Shalvata Mental Health Center, Affiliated with the School of Medicine, Tel-Aviv University, Tel-Aviv-Jaffa, Israel
| | - Olga Arad
- Shalvata Mental Health Center, Affiliated with the School of Medicine, Tel-Aviv University, Tel-Aviv-Jaffa, Israel
| | - Dana Tzur Bitan
- Shalvata Mental Health Center, Affiliated with the School of Medicine, Tel-Aviv University, Tel-Aviv-Jaffa, Israel; Department of Community Mental Health, University of Haifa, Haifa, Israel
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Francis B, Ganasan VA, Sulaiman ARB. Brexpiprazole Attenuates Aggression, Suicidality and Substance Use in Borderline Personality Disorder: A Case Series. Medicina (Kaunas) 2024; 60:283. [PMID: 38399570 PMCID: PMC10890360 DOI: 10.3390/medicina60020283] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/30/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024]
Abstract
Background: Borderline personality disorder (BPD) is a heterogeneous and highly comorbid disorder. Suicidality, aggression and substance abuse are common presentations of BPD. Our case series is the first to highlight the role of brexpiprazole in improving these symptoms in patients with BPD. Case presentation: We describe three cases demonstrating the role of brexpiprazole in improving BPD's prominent features and comorbidities. All cases improved when brexpiprazole was added to their treatment regime. Case 1: A 26-year-old woman who was diagnosed with BPD and cyclothymia, presented to the psychiatric emergency unit with impulsive suicidal behaviour. Case 2: A 43-year-old woman suffering from BPD sought help due to her violent behaviour and emotional dysregulation. Case 3: A 22-year-old woman with underlying attention deficit and hyperactivity disorder, polysubstance use disorder and BPD presented with dysregulated emotions. Conclusions: Our case series provides anecdotal evidence of the potential role of brexpiprazole in attenuating suicidality, aggression and substance abuse in patients with BPD. We postulate that brexpiprazole's high affinity for the 5HT1A/5HT2A receptors, coupled with its low intrinsic effect on the D2/D3 receptor system, is fundamental in its actions to stabilise the aberrant dopaminergic and serotonergic signalling in BPD. Future research should focus on well-designed clinical trials investigating the efficacy of brexpiprazole in patients with BPD.
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Affiliation(s)
- Benedict Francis
- Department of Psychiatry, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Vijay A/L Ganasan
- Department of Psychiatry and Mental Health, Hospital Tuanku Ja’afar, Seremban 70300, Malaysia;
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7
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Danon M, Duriez P, Gorwood P. Three clinical indicators of borderline personality disorder in anorexia nervosa: A pilot study. Encephale 2024; 50:4-10. [PMID: 36411120 DOI: 10.1016/j.encep.2022.09.006] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/22/2022] [Accepted: 09/26/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Co-occurrence of Anorexia Nervosa (AN) and borderline personality disorder (BPD) is frequent (8%-40%) and associated with specificities that impact the treatment process. Lifetime history of suicide attempt (HAS), substance use disorder (SUD) and the binge-purging subtype (B-P) might be good markers of such comorbidity. We made the hypothesis that in patients with AN, the presence of HAS, SUD and B-P have sufficient predictive power to efficiently detect an associated BPD comorbidity. METHODS After a case report analysis on a pilot sample of 119 patients with AN, we performed a cross-sectional analysis on a confirmatory sample of 84 patients with AN in a single center specialized in eating disorders systematically assessing HAS, SUD, B-P and BPD using the Mini International Neuropsychiatric Interview for DSM-5 and the Diagnostic Interview for Borderline (DIB-R). RESULTS B-P had a 100% negative predictive value, and the combination of SUD plus HAS had a 100% positive predictive value. On a quantitative level, B-P, HAS and SUD were independent explanatory factors of the DIB-R total score. CONCLUSIONS The main limitations were the low number of patients, the single center analyses, the potential overlapping of assessments and the fact that data were exclusively declarative. In this study, every patient with B-P, SUD and HAS had been diagnosed with BPD.
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Affiliation(s)
- M Danon
- Université de Paris, Institute of Psychiatry and Neuroscience of Paris (IPNP), Inserm U1266, 75014 Paris, France; GHU Paris psychiatrie et neurosciences, CMME, hôpital Sainte-Anne, 75014 Paris, France.
| | - P Duriez
- Université de Paris, Institute of Psychiatry and Neuroscience of Paris (IPNP), Inserm U1266, 75014 Paris, France; GHU Paris psychiatrie et neurosciences, CMME, hôpital Sainte-Anne, 75014 Paris, France
| | - P Gorwood
- Université de Paris, Institute of Psychiatry and Neuroscience of Paris (IPNP), Inserm U1266, 75014 Paris, France; GHU Paris psychiatrie et neurosciences, CMME, hôpital Sainte-Anne, 75014 Paris, France
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Smith D, Cammell P, Battersby M, Bartsch D, Stevenson J, Bastiampillai T. Recurrent Mental Health Presentations to Public Hospital Services: A Focus on Borderline Personality Disorder. Prim Care Companion CNS Disord 2024; 26:23m03559. [PMID: 38228069 DOI: 10.4088/pcc.23m03559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024] Open
Abstract
Objective: To investigate associations between patients with borderline personality disorder (BPD)-related symptoms and their hospital presentations as well as the effect of inpatient length of stay (LOS) on time to hospital re-presentation. Methods: A retrospective cohort design was used to investigate mental health emergency department (ED) visits and inpatient admissions. The cohort comprised 13,320 men and 12,290 women with a follow-up period between January 1, 2014, and December 31, 2019. Results: Across all presentations in the study period, approximately 4% of mental health patients were discharged from ED or inpatient admission with primary diagnosis of BPD. Both male and female patients with BPD were at higher risk of hospital re-presentation when compared to patients with any other type of mental disorder (P < .01). Patients with BPD who had LOS > 14 days in their first inpatient admission were, on average, more likely to experience a repeat ED or inpatient presentation 58 days sooner than patients who had LOS < 2 days (P = .036). Conclusions: Findings suggest the need for (a) more accurate recording of BPD and related presentations, (b) more in-depth investigations of BPD care pathways, and (c) identifications of subpopulations who may benefit from a specific inpatient length of stay. Prim Care Companion CNS Disord 2024;26(1):23m03559. Author affiliations are listed at the end of this article.
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Affiliation(s)
- David Smith
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Corresponding Author: David Smith, BSc, MNurs, MAppStat, PhD, Senior Researcher, Discipline of Psychiatry, College of Medicine and Public Health, Flinders University, GPO Box 2100, ADELAIDE SA 5001, Australia
| | - Paul Cammell
- Royal Melbourne Hospital Head of Psychotherapy Training, St Vincent's Health, Melbourne, Victoria, Australia
| | - Malcolm Battersby
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Southern Adelaide Local Health Network, Mental Health Division, Adelaide, South Australia, Australia
| | - Dianna Bartsch
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - Jeremy Stevenson
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Tarun Bastiampillai
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Southern Adelaide Local Health Network, Mental Health Division, Adelaide, South Australia, Australia
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Reynolds CJ, Tragesser SL. Borderline personality features are associated with worse perceptions of (but not compliance with) chronic pain treatment. PSYCHOL HEALTH MED 2024; 29:163-173. [PMID: 37822059 DOI: 10.1080/13548506.2023.2268889] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/04/2023] [Indexed: 10/13/2023]
Abstract
Treating chronic illness requires ongoing patient-provider cooperation, but individual differences in patients' negative perceptions of care can undermine this cooperation. Research suggests people high on borderline personality disorder (BPD) features may react negatively to and comply less with mental health and medical treatment. This might be particularly problematic in chronic pain treatment, where BPD features are over-represented and the dysregulation typifying BPD likely undermines consistent care. In a sample of 147 chronic pain patients, we investigated whether higher levels of BPD features - both in general and by specific facets - predicted worse perceptions of treatment and lower patient-reported compliance with treatment recommendations. Participants higher (vs. lower) on borderline features viewed treatment more negatively but did not report complying less with recommendations. We found evidence that this may reflect the unstable relationships facet of BPD. Our results indicate that, consistent with other treatment settings, BPD features may undermine care for chronic pain. Furthermore, our results highlight the importance of collaborative provider-patient relationships and patient agreement with the treatment of chronic pain, particularly among individuals higher on BPD features.
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Affiliation(s)
- Caleb J Reynolds
- Department of Psychology, Wake Forest University, Winston-Salem, NC, USA
| | - Sarah L Tragesser
- Department of Psychology, Washington State University Tri-Cities, Richland, WA, USA
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10
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Tseng ST, Georgiades A. A phenomenological comparison of auditory hallucinations between borderline personality disorder and schizophrenia: A systematic review. Clin Psychol Psychother 2024; 31:e2958. [PMID: 38358078 DOI: 10.1002/cpp.2958] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVE Borderline personality disorder (BPD) with auditory hallucinations (AHs) may inadvertently be misdiagnosed with a primary psychotic disorder, such as schizophrenia (SZ). This misidentification can lead to challenges in providing effective psychological treatment. This review therefore aims to identify the phenomenological characteristics of AHs in BPD in comparison to SZ, as well as psychological interventions that explicitly target AHs in BPD. METHODS A systematic review was conducted to summarise the existing evidence base regarding the phenomenological similarities and differences of AHs in BPD and SZ, along with the identification of psychological interventions for AHs in BPD. RESULTS Eighteen studies were eligible for inclusion. Compared to the SZ group, BPD clients were characterised by more persistent and repetitive AHs, significantly more voice-related distress and appraisals of omnipotence, and an earlier age of onset of AHs. The BPD group also reported more severe depression and anxiety, a higher incidence of childhood trauma, and more negative self-schema. Cognitive Behaviour Therapy Coping Strategy Enhancement (CBT-CSE) might be a promising intervention to reduce AH-related distress in BPD, although further studies are required to determine its effectiveness. CONCLUSION In order to prevent misdiagnosis of AHs in BPD, the DSM-5 may need to acknowledge the broader and more frequent occurrence of psychosis symptoms in BPD clients. Such clarification may enhance diagnostic practices and facilitate more timely access to treatment. There is also a need to develop and trial psychological interventions that explicitly target AHs in BPD.
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Affiliation(s)
- Shih-Ting Tseng
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
- Brent Early Intervention Service, CNWL, NHS Foundation Trust, London, UK
| | - Anna Georgiades
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
- Brent Early Intervention Service, CNWL, NHS Foundation Trust, London, UK
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11
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Galvez-Merlin A, Lopez-Villatoro JM, de la Higuera-Gonzalez P, de la Torre-Luque A, Reneses-Prieto B, Diaz-Marsa M, Carrasco JL. Social cognition deficits in borderline personality disorder: Clinical relevance. Psychiatry Res 2024; 331:115675. [PMID: 38134528 DOI: 10.1016/j.psychres.2023.115675] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/26/2023] [Accepted: 12/10/2023] [Indexed: 12/24/2023]
Abstract
Interpersonal difficulties in borderline personality disorder (BDP) have been suggested to be related to impairments in Social Cognition (SC), mainly due to deficits in Theory of Mind (ToM). However, literature is scarce and ambiguous. This work aims to study the SC impairments in BPD patients, by the specific assessment of ToM deficits, and to investigate the relationship between these SC impairments and clinical variables. 82 BPD patients with BPD and 47 control subjects were assessed with the Movie for the Assessment of Social Cognition (MASC). Clinical variables of severity, chronicity, functionality and anxious-depressive symptomatology were recorded. BPD patients had fewer correct mentalization responses and more overmentalization, undermentalization, and absence of mentalization errors than controls. Chronicity was negatively correlated with overmentalization and positively correlated with undermentalization and absence of mentalization errors. Functionality was indirectly correlated with absence of mentalization. These results confirm previous reports of alterations in SC in BPD patients. Furthermore, this study shows that SC impairments in patients with BPD are dependent on characteristics such as chronicity or degree of functionality. The different ToM profiles in patients with BPD indicate the necessity of developing variants of mentalization therapy depending on the deficits of each patient.
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Affiliation(s)
- Alejandra Galvez-Merlin
- Health Research Institute, Hospital Clinico San Carlos (IdISSC), Madrid, Spain; Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid, Madrid, Spain
| | - Jose Manuel Lopez-Villatoro
- Health Research Institute, Hospital Clinico San Carlos (IdISSC), Madrid, Spain; Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid, Madrid, Spain
| | - Pilar de la Higuera-Gonzalez
- Health Research Institute, Hospital Clinico San Carlos (IdISSC), Madrid, Spain; Department of Personality, Assessment and Clinical Psychology, Universidad Complutense de Madrid, Madrid, Spain.
| | - Alejandro de la Torre-Luque
- Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid, Madrid, Spain; Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
| | - Blanca Reneses-Prieto
- Health Research Institute, Hospital Clinico San Carlos (IdISSC), Madrid, Spain; Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid, Madrid, Spain; Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
| | - Marina Diaz-Marsa
- Health Research Institute, Hospital Clinico San Carlos (IdISSC), Madrid, Spain; Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid, Madrid, Spain; Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
| | - Jose L Carrasco
- Health Research Institute, Hospital Clinico San Carlos (IdISSC), Madrid, Spain; Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid, Madrid, Spain; Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
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12
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Chizhova OA, Iuzbashian PG. [Alexithymia and self-harm in people with borderline personality disorder]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:102-108. [PMID: 38261291 DOI: 10.17116/jnevro2024124011102] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
OBJECTIVE To estimate the prevalence of alexithymia and self-harm in patients with borderline personality disorder (BPD). To assess the role of alexithymia in the emergence of self-harm in patients with BPD. MATERIAL AND METHODS We studied 104 patients (85 women, 19 men aged 21 to 25 years (64.4%)), including 54 patients with and 50 patients without BPD. Most of them had incomplete higher education (55%). We used the Russian version of the 20-item Toronto Alexithymia Scale (TAS-20) to reveal alexithymia and SCID-II to diagnose BPD. The presence of self-harm behavior was confirmed by the subjects' anamnesis data. RESULTS The prevalence of alexithymia in patients with BPD was 83.3%, in the control group it was 52% (p=0.001). The prevalence of self-aggression was 70.3% (n=38) in patients with BPD, and 12% (n=6) in people without BPD. Self-harm among persons with alexithymia was noted in 62.5% (n=45). During the analysis, a connection between auto-aggression and alexithymia was found at the level of a statistical trend (p=0.051). CONCLUSION Alexithymia and self-harm are more common in patients with BPD than in healthy people. This type of emotional dysregulation mediates self-harm in patients with BPD.
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Affiliation(s)
- O A Chizhova
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - P G Iuzbashian
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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13
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Yi X, Xiao Q, Fu Y, Wang X, Shen L, Ding J, Jiang F, Wang J, Zhang Z, Chen BT. Association of white matter microstructural alteration with non-suicidal self-injury behavior and visual working memory in adolescents with borderline personality disorder. Psychiatry Res 2024; 331:115619. [PMID: 38048646 DOI: 10.1016/j.psychres.2023.115619] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/13/2023] [Accepted: 11/18/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Non-suicidal self-injurious behavior (NSSI) is the core characteristic of adolescent borderline personality disorder (BPD) and visual working memory is involved in the pathological processes of BPD. This study aimed to investigate alterations in white matter microstructure and their association with NSSI and visual working memory in adolescents with BPD. METHODS 53 adolescents diagnosed with BPD and 39 healthy controls (HCs) were enrolled. White matter microstructure was assessed with the fractional anisotropy (FA) and mean diffusivity (MD) from diffusion tensor imaging (DTI). Correlation analysis was performed to assess the association between FA/MD and core features of BPD. A mediation analysis was performed to test whether the effects of white matter alterations on NSSI could be mediated by visual working memory. RESULTS Adolescents with BPD showed a reduced FA and an increased MD in the cortical-limbic and cortical-thalamus circuit when compared to the HCs (p < 0.05). Increased MD was positively correlated with NSSI, impulse control and identity disturbance (p < 0.05), and was negatively correlated with the score of visual reproduction. Reserved visual working memory masked the effects of white matter microstructural alterations on NSSI behavior. CONCLUSIONS White matter microstructural deficits in the cortical-limbic and cortical-thalamus circuits may be associated with NSSI and visual working memory in adolescents with BPD. Reserved visual working memory may protect against NSSI.
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Affiliation(s)
- Xiaoping Yi
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China; National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Central South University, Changsha, Hunan 410008, PR China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Xiangya Hospital, Changsha, Hunan 410008, PR China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China; Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China
| | - Qian Xiao
- Mental Health Center of Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, Hunan 410008, PR China.
| | - Yan Fu
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China
| | - Xueying Wang
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China
| | - Liying Shen
- Mental Health Center of Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, Hunan 410008, PR China
| | - Jun Ding
- Department of Public Health, Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, Guangdong, PR China
| | - Furong Jiang
- Mental Health Center of Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, Hunan 410008, PR China
| | - Jing Wang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China
| | - Zhejia Zhang
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China
| | - Bihong T Chen
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA 91010, USA
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14
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Bemmouna D, Lagzouli A, Weiner L. The biosocial correlates and predictors of emotion dysregulation in autistic adults compared to borderline personality disorder and nonclinical controls. Mol Autism 2023; 14:47. [PMID: 38110995 PMCID: PMC10726572 DOI: 10.1186/s13229-023-00580-3] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/12/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Emotion dysregulation (ED) is a core symptom of borderline personality disorder (BPD), whose aetiology has been attributed to biosocial factors. In autism spectrum condition (ASC), although ED is prevalent and is associated with decreased well-being (e.g. self-harm, suicidality), it has been understudied, especially in adults. It is therefore crucial to further understand ED in autistic adults to improve its treatment. Our study investigates ED, its behavioural correlates (e.g. self-harm, suicidality) and biosocial predictors in autistic adults relative to BPD and nonclinical controls (NC). METHODS A total of 724 participants (ASC = 154; BPD = 111; NC = 459) completed 11 self-reported questionnaires assessing ED, ASC and BPD traits, co-occurring disorders, alexithymia, emotional vulnerability and invalidating experiences (e.g. bullying, autistic camouflaging). The occurrence of ED behavioural correlates (i.e. self-harm, history of suicide attempts, and psychiatric hospitalizations) was collected. In addition, between-groups analyses, linear regressions and machine learning (ML) models were used to identify ED predictors in each group. RESULTS ED and its behavioural correlates were higher in ASC compared to NC, but milder than in BPD. While gender did not predict ED scores, autistic women had increased risk factors to ED, including sexual abuse and camouflaging. Interestingly, BPD traits, emotional vulnerability and alexithymia strongly predicted ED scores across the groups. Using ML models, sensory sensitivity and autistic camouflaging were associated with ED in ASC, and ADHD symptoms with ED in BPD. LIMITATIONS ASC and BPD diagnoses were self-reported, which did not allow us to check their accuracy. Additionally, we did not explore the transactional and the moderating/mediating relationships between the different variables. Moreover, our research is cross-sectional and cannot draw conclusions regarding the direction and causality of relationships between ED and other clinical dimensions. CONCLUSIONS ED and its behavioural correlates are heightened in BPD compared to ASC and nonclinical controls. In the ASC group, there were no gender differences in ED, despite the heightened exposure of autistic women to ED risk factors. BPD traits, emotional vulnerability, and alexithymia are core to ED regardless of diagnosis. Although less central, sensory sensitivity and autistic camouflaging seem to be specific predictors of ED in autistic adults.
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Affiliation(s)
- Doha Bemmouna
- Department of Psychology, University of Strasbourg, 12 Rue Goethe, 67000, Strasbourg, France.
| | - Amine Lagzouli
- MSME, CNRS UMR 8208, Paris-Est Créteil University, Gustave Eiffel University, 94010, Créteil, France
- School of Chemistry, Physics and Mechanical Engineering, Queensland University of Technology, Brisbane, QLD, 4001, Australia
| | - Luisa Weiner
- Department of Psychology, University of Strasbourg, 12 Rue Goethe, 67000, Strasbourg, France.
- Psychiatry Department, University Hospitals of Strasbourg, 1 Place de l'Hôpital, 67000, Strasbourg, France.
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15
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Bitran AM, Temes CM, Gecha TC, Glass IV, Frankenburg FR, Fitzmaurice GM, Zanarini MC. The 8-Year Course of Acute Physical Pain Reported by Patients With Borderline Personality Disorder and Comparison Subjects With Other Personality Disorders. J Pers Disord 2023; 37:678-690. [PMID: 38038657 DOI: 10.1521/pedi.2023.37.6.678] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
The present study examines the 8-year course of physical pain and its interference with functioning in patients with borderline personality disorder (BPD) and a comparison group of patients with other personality disorders (other-PD). Participants completed the Brief Pain Inventory (BPI) at five assessments, each separated by 2 years. Results showed that across all 13 domains assessed, participants with BPD reported significantly higher levels of acute physical pain and its functional interference than other-PD comparison subjects. The severity of physical pain and its interference with multiple domains of functioning were relatively stable over 8 years of assessment for both study groups. Within the BPD group, pain was significantly associated with older age, comorbid major depressive disorder (MDD), and history of a physically violent partner. Taken together, these results suggest that physical pain is a serious health issue for individuals with BPD that interferes with functioning across a wide spectrum of areas.
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Affiliation(s)
- Alma M Bitran
- Laboratory for the Study of Adult Development, McLean Hospital, Belmont, Massachusetts
| | - Christina M Temes
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tess C Gecha
- Laboratory for the Study of Adult Development, McLean Hospital, Belmont, Massachusetts
| | - Isabel V Glass
- Laboratory for the Study of Adult Development, McLean Hospital, Belmont, Massachusetts
| | - Frances R Frankenburg
- Edith Nourse Rogers VA Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Garrett M Fitzmaurice
- Laboratory for Psychiatric Biostatistics, McLean Hospital
- Harvard Medical School, Boston, Massachusetts
| | - Mary C Zanarini
- Laboratory for the Study of Adult Development, McLean Hospital, Belmont, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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16
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Gałuszko-Węgielnik M, Jakuszkowiak-Wojten K, Wilkowska A, Cubała WJ. Short term ketamine treatment in patient with bipolar disorder with comorbidity with borderline personality disorder: Focus on impulsivity. World J Biol Psychiatry 2023; 24:849-853. [PMID: 37338035 DOI: 10.1080/15622975.2023.2227901] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/17/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVES Borderline personality disorder (BPD) and bipolar disorder (BD) often co-occur and frequently do not respond adequately to traditional antidepressant treatments. Ketamine has shown rapid antidepressant and anti-suicidal effects. However, there is limited literature on the safety and tolerance of using ketamine to treat patients with comorbid BD and BPD. METHODS This case presents a female patient diagnosed with both Bipolar Disorder (BD) and Borderline Personality Disorder (BPD) who received intravenous ketamine treatment to alleviate acute depressive symptoms. RESULTS Initially, ketamine ameliorated depressed symptoms. However, as the ketamine treatment continued, the patient showed an increase in nonsuicidal self-injury (NSSIs) and impulsive conduct with a aggravation of dissociative symptoms. As a result, intravenous ketamine was discontinued, and the patient received the medication, which proved helpful. CONCLUSIONS Although ketamine presents antidepressant properties, reports on its impact on emotional dysregulation and impulsive conduct are unclear and not alike to its antidepressant effect. Therefore, there is a need for more studies investigating the effectiveness and safety of this rapid-acting medicine in this patient population.
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Affiliation(s)
| | | | - Alina Wilkowska
- Department of Psychiatry, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Wiesław Jerzy Cubała
- Department of Psychiatry, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
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17
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Lopez-Villatoro JM, Diaz-Marsa M, Garcia-Ramos A, Galvez-Merlin A, Carrasco JL. Altered emotional response pattern related to complex trauma in patients with borderline personality disorder. Clin Psychol Psychother 2023; 30:1256-1263. [PMID: 37565308 DOI: 10.1002/cpp.2897] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 06/05/2023] [Revised: 07/21/2023] [Accepted: 07/29/2023] [Indexed: 08/12/2023]
Abstract
INTRODUCTION This work aims to demonstrate, through the International Affective Picture System (IAPS) responses, an altered emotional pattern in borderline personality disorder (BPD) patients and to find a specific emotional response pattern by understanding their relationship with traumatic experiences and attachment bonds towards their primary caregivers. METHOD A total of 50 BPD patients and 39 control patients were evaluated using the IAPS, and its assessment was carried out through the Self-Assessment Manikin (SAM). Paternal and maternal attachment bonds as well as traumatic experiences in BPD patients were evaluated. Statistical associations were analysed in the different variables. RESULTS Significant differences between BPD and control patients were found in all emotional response components for pleasant, unpleasant and neutral images (p < .01), with one exception, the arousal in pleasant images. Patients' experience of traumatic experiences was positively related to scores on the happiness component of pleasant imagery (p = .057) and on the arousal component of unpleasant imagery (p = .058). Poorer maternal bonding in BPD patients was significantly related to lower scores on happiness (p < .01) and dominance (p < .05) components of pleasant imagery and all emotional response components for unpleasant imagery (p < .01). CONCLUSIONS The results of the study confirm an impaired emotional response pattern in patients with borderline personality disorder (BPD), showing an emotional response to pleasant images similar to that of depression, while the pattern found to unpleasant images could be related to the complex trauma observed in these patients, which includes PTSD experiences such as sexual abuse and attachment trauma experiences.
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Affiliation(s)
- Jose M Lopez-Villatoro
- Health Research Institute of the Hospital Clínico San Carlos, Madrid, Spain
- Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense of Madrid, Madrid, Spain
| | - Marina Diaz-Marsa
- Health Research Institute of the Hospital Clínico San Carlos, Madrid, Spain
- Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense of Madrid, Madrid, Spain
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
| | - Adriana Garcia-Ramos
- Department of Personality, Assessment and Clinical Psychology, Universidad Complutense of Madrid, Madrid, Spain
| | - Alejandra Galvez-Merlin
- Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense of Madrid, Madrid, Spain
| | - Jose L Carrasco
- Health Research Institute of the Hospital Clínico San Carlos, Madrid, Spain
- Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense of Madrid, Madrid, Spain
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
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18
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Lazzari C, Shoka A, Rabottini M. Factitious disorder comorbid with borderline personality disorder and dysthymia: from medically unexplained physical symptoms to functional neurological disorder. Riv Psichiatr 2023; 58:205-219. [PMID: 37807866 DOI: 10.1708/4113.41070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
INTRODUCTION In this study, we introduce the concept of comorbidity between factitious disorder (FD), borderline personality disorder (BPD), dysthymia (DY), medically unexplained physical symptoms (MUPS) and functional neurological disorder (FND) characterising patients who may tend to exaggerate physical or psychiatric symptoms of presentation to a general or psychiatric hospital with a constellation of signs that do not receive confirmation from further clinical and instrumental assessments. The similarities between these syndromes and the constant presence of borderline personality in the psychopathology make it the possible link between all these syndromes. MATERIALS AND METHODS The authors captured the typical appearance and characterisation of FD-BPD-DY-MUPS-FND (Com-1) syndrome in adult and non-forensic acute psychiatric hospitals in the United Kingdom (UK) and adjacent liaison psychiatric teams through case vignettes. Each case vignette merged similar clinical cases and was cross-analysed using information from various mental health and medical professionals and bridging primary and secondary carers' records. RESULTS The findings suggest striking similarities between the syndromes making borderline personality the bridge pathology for FD, MUPS and FND. The complexity of the diagnosis of these cases is discussed in the study, together with prototypical presentations. CONCLUSIONS Improving the management of these often-occurring diseases requires multidisciplinary coordination across psychiatry, general care, neurology and surgery departments.
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Affiliation(s)
- Carlo Lazzari
- International Centre for Healthcare and Medical Education, London, UK
| | - Ahmed Shoka
- Essex Partnership University Foundation Trust, Colchester, UK
| | - Marco Rabottini
- International Centre for Healthcare and Medical Education, London, UK
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19
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Jose Manuel LV, Marina DM, Rico-Perez, A, Fernandez-Rodrigues, V, Ayad-Ahmed, W, Galvez-Merlin, A, Carrasco, JL. Neurocognitive profile associated with borderline personality disorder: building specific indices of executive function. Actas Esp Psiquiatr 2023; 51:220-228. [PMID: 38117262 PMCID: PMC10803855] [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] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 09/01/2023] [Indexed: 12/21/2023]
Abstract
The objective of this work is the creation of specific indices of the different executive functions (EF).
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Affiliation(s)
- Lopez-Villatoro, Jose Manuel
- Health Research Institute, Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Department of Legal Medicine, Psychiatry and Pathology, Faculty of Medicine, Universidad Complutense de Madrid (UCM) Madrid, Spain
- Research Group in Psychiatric Epidemiology and Mental Health (EPISAM), Complutense University of Madrid, Spain
| | - Diaz-Marsá, Marina
- Biomedical Research NetworkingConsortium for Mental Health (CIBERSAM), Madrid, Spain
- Department of Legal Medicine, Psychiatry and Pathology, Faculty of Medicine, Universidad Complutense de Madrid (UCM) Madrid, Spain
| | - Ana Rico-Perez,
- Faculty of Psychology, Universidad Complutense de Madrid (UCM) Madrid, Spain
| | - Veronica Fernandez-Rodrigues,
- Health Research Institute, Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Department of Legal Medicine, Psychiatry and Pathology, Faculty of Medicine, Universidad Complutense de Madrid (UCM) Madrid, Spain
- Research Group in Psychiatric Epidemiology and Mental Health (EPISAM), Complutense University of Madrid, Spain
| | - Wala Ayad-Ahmed,
- Health Research Institute, Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Department of Legal Medicine, Psychiatry and Pathology, Faculty of Medicine, Universidad Complutense de Madrid (UCM) Madrid, Spain
- Research Group in Psychiatric Epidemiology and Mental Health (EPISAM), Complutense University of Madrid, Spain
- MIGRASALUD, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Alejandra Galvez-Merlin,
- Health Research Institute, Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Department of Legal Medicine, Psychiatry and Pathology, Faculty of Medicine, Universidad Complutense de Madrid (UCM) Madrid, Spain
- Research Group in Psychiatric Epidemiology and Mental Health (EPISAM), Complutense University of Madrid, Spain
| | - Jose Luis Carrasco,
- Biomedical Research NetworkingConsortium for Mental Health (CIBERSAM), Madrid, Spain
- Department of Legal Medicine, Psychiatry and Pathology, Faculty of Medicine, Universidad Complutense de Madrid (UCM) Madrid, Spain
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de Filippis R, De Fazio P. Esketamine nasal spray in severe bipolar depression with borderline personality disorder and history of multiple substance abuse: A case report. Bipolar Disord 2023; 25:524-526. [PMID: 37563778 DOI: 10.1111/bdi.13375] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Affiliation(s)
- Renato de Filippis
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Pasquale De Fazio
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
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21
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Hernández LM, Kemp KC, Barrantes-Vidal N, Kwapil TR. Replication of the associations of positive, negative, and disorganized schizotypy with interview-assessed symptoms and impairment: Convergence with previous studies. Personal Disord 2023; 14:527-533. [PMID: 36595437 DOI: 10.1037/per0000611] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Schizophrenia-spectrum psychopathology appears best understood as being expressed across a continuum of clinical and subclinical symptoms and impairment referred to as schizotypy. This brief report describes a comprehensive replication study examining the associations of positive, negative, and disorganized schizotypy with interview ratings of impairment, psychopathology, and personality pathology in a sample of 161 young adults. Consistent with past studies, positive, negative, and disorganized schizotypy had distinct and hypothesized associations with symptoms and impairment. Positive schizotypy was associated with prodromal symptoms and schizotypal, paranoid, and borderline personality traits. Negative schizotypy was associated with impaired functioning, negative symptoms, and schizoid, schizotypal, and paranoid traits, as well as any broad personality disorder diagnosis; it was also associated with never having dated. Disorganized schizotypy was associated with impaired functioning, disorganized schizotypic experiences, attentional deficits, and schizotypal, paranoid, borderline, and avoidant personality traits, as well as depression. Overall, we successfully replicated findings from five previous schizotypy interview studies, supporting the construct validity of the multidimensional model of schizotypy and the Multidimensional Schizotypy Scale. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Laura M Hernández
- Department of Psychology, University of Illinois at Urbana-Champaign
| | - Kathryn C Kemp
- Department of Psychology, University of Illinois at Urbana-Champaign
| | - Neus Barrantes-Vidal
- Departament de Psicologia Clinica i de la Salut, Universitat Autonoma de Barcelona
| | - Thomas R Kwapil
- Department of Psychology, University of Illinois at Urbana-Champaign
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22
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Fitzpatrick S, Crenshaw A, Earle EA, Radosavljevic D, Kuo JR. The influence of sleep on emotion dysregulation in borderline personality disorder, generalized anxiety disorder, and healthy controls. Psychiatry Res 2023; 326:115273. [PMID: 37301022 DOI: 10.1016/j.psychres.2023.115273] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 05/25/2023] [Accepted: 05/28/2023] [Indexed: 06/12/2023]
Abstract
Emotion dysregulation is central to borderline personality disorder (BPD) and exacerbated by sleep disruptions. This study investigated whether homeostatic (i.e., sleep efficiency), circadian (i.e., chronotype), and subjective (i.e., sleep quality) sleep elements predict emotion dysregulation in BPD, healthy controls (HCs), and a generalized anxiety disorder (GAD) group. Participants (N = 120) with BPD, GAD, and HCs completed daily sleep measures for seven days prior to an experiment wherein baseline emotion, emotional reactions to stressors (i.e., reactivity), and the extent to which they can decrease their emotion using mindfulness and distraction (i.e., emotion regulation) were measured across self-reported, sympathetic, and parasympathetic emotion. Across groups, earlier chronotypes and higher sleep quality predicted less self-reported baseline negative emotion, and higher sleep quality predicted better parasympathetic emotion regulation. For HCs, higher sleep efficiency and lower sleep quality predicted higher parasympathetic baseline emotion, and higher sleep efficiency predicted more self-reported baseline negative emotion. Also in HCs, earlier chronotype predicted better sympathetic emotion regulation, and there was a quadratic relationship between sleep efficiency and self-reported emotion regulation. Optimizing sleep quality and improving alignment between chronotype and daily living may improve baseline emotion and emotion regulation. Healthy individuals may be particularly vulnerable to high or low sleep efficiency.
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Affiliation(s)
- Skye Fitzpatrick
- Department of Psychology, York University, North York, ON, Canada.
| | - Alexander Crenshaw
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
| | | | | | - Janice R Kuo
- Department of Psychology(,) Stanford-PGSP PsyD Consortium, Palo Alto University, Palo Alto, CA, United States
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23
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Békés V, Szabó D, Lévay EE, Salgó E, Unoka Z. Moral Injury and Shame Mediate the Relationship Between Childhood Trauma and Borderline Personality Disorder, PTSD, and Complex PTSD Symptoms in Psychiatric Inpatients. J Pers Disord 2023; 37:406-423. [PMID: 37721777 DOI: 10.1521/pedi.2023.37.4.406] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Moral injury (MI) has received increased research attention in the past decades. However, despite its detrimental mental health consequences, MI has not been studied in psychiatric patients. We aimed to establish the relationship between childhood trauma, MI, and borderline personality disorder (BPD), posttraumatic stress disorder (PTSD), and disturbances in self-organization symptoms (DSO), a core diagnostic criterion of complex PTSD besides PTSD symptoms, and shame as a moral emotion in an inpatient psychiatric sample (N = 240). We found that the impact of childhood trauma on present BPD, PTSD, and DSO symptoms was mediated by MI and shame; the models accounted for up to 31% of variance in symptomatology. To our knowledge, this study is the first to investigate MI in a psychiatric sample, and our results highlight the importance of considering MI as a critical factor of patient experiences in relation to childhood trauma that potentially contributes to the development of psychiatric symptoms.
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Affiliation(s)
- Vera Békés
- From Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA
| | - Dominik Szabó
- Doctoral School of Mental Health Sciences, Semmelweis University, Budapest, Hungary
| | - Erika Evelyn Lévay
- Doctoral School of Mental Health Sciences, Semmelweis University, Budapest, Hungary
| | - Ella Salgó
- Doctoral School of Mental Health Sciences, Semmelweis University, Budapest, Hungary
| | - Zsolt Unoka
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
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Hamada K, Sagiyama K, Nishi R, Fukumoto T, Kato R, Fuku Y, Amitani H, Asakawa A. Unpredictable refeeding syndrome with severe hypophosphatemia in borderline personality disorder comorbidity: A case report. Medicine (Baltimore) 2023; 102:e34103. [PMID: 37352052 PMCID: PMC10289500 DOI: 10.1097/md.0000000000034103] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/05/2023] [Indexed: 06/25/2023] Open
Abstract
RATIONALE Refeeding syndrome (RS) is a fatal condition caused by rapid calorie intake during starvation. Self-neglected fasting in psychiatric disorders is associated with RS. However, overeating resulting from circumventing the clinician's instructions does not have a reportedly high risk of RS. PATIENT CONCERNS A 47-year-old undernourished woman with borderline personality disorder was hospitalized for nausea, vomiting, and diarrhea. CLINICAL FINDINGS She had not eaten much for 10 days and had lost weight (56.5-51.1 kg) over 3 weeks. No abnormalities were indicated on physical examination and imaging examinations. DIAGNOSES, INTERVENTIONS, AND OUTCOMES Infectious diseases and malignancies were excluded from the differential diagnosis. On the third day of admission, the patient's serum phosphorus level significantly decreased to 0.7 mg/dL, and additional sodium phosphate was administered intravenously. On the fourth day, despite our instructions, the patient was found to be eating nonhospital food from the first day of admission. In conjunction with her history, a final diagnosis of RS was made. After appropriate treatments, the patient was discharged on the 15th day of hospitalization. The patient's nausea, vomiting, and diarrhea were improved. LESSONS When undernourished patients have psychiatric disorders, including borderline personality disorder or schizophrenia, the occurrence of RS should be considered based on the patients' poor adherence to physicians' instructions.
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Affiliation(s)
- Kazumasa Hamada
- Department of Psychosomatic Internal Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragaoka, Kagoshima, Japan
| | - Kenichiro Sagiyama
- Department of Psychosomatic Internal Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragaoka, Kagoshima, Japan
| | - Ryusei Nishi
- Department of Psychosomatic Internal Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragaoka, Kagoshima, Japan
| | - Takamasa Fukumoto
- Department of Psychosomatic Internal Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragaoka, Kagoshima, Japan
| | - Ryuichi Kato
- Department of Psychosomatic Internal Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragaoka, Kagoshima, Japan
| | - Yuuki Fuku
- Department of Psychosomatic Internal Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragaoka, Kagoshima, Japan
| | - Haruka Amitani
- Department of Psychosomatic Internal Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragaoka, Kagoshima, Japan
| | - Akihiro Asakawa
- Department of Psychosomatic Internal Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragaoka, Kagoshima, Japan
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Nicolini AP, Sienaert P. Borderline Personality Disorder and Outcome of Electroconvulsive Therapy in Patients With Depression: A Systematic Review. J ECT 2023; 39:74-80. [PMID: 36821825 DOI: 10.1097/yct.0000000000000900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
ABSTRACT Major depressive disorder (MDD) commonly coincides with borderline personality disorder (BPD), aggravating depressive symptom severity and reducing the odds of responding to antidepressant treatments. In this systematic review, we summarize the available evidence assessing the question whether the presence of BPD reduces the response to electroconvulsive therapy (ECT) in individuals with MDD.We conducted a systematic literature search (up to December 2021) without language restriction, using the PubMed/MEDLINE, Web of Science (Core Collection), Embase, and Cochrane Library databases, for prospective and retrospective studies, which assessed the efficacy of ECT in patients with MDD and comorbid BPD.Of the 2548 records screened, 6 articles were selected, 2 of which were based on the same population, leading to 5 included articles. The included studies are reporting on 3465 patients with MDD, of which 1206 had a comorbid BPD. Five of the 6 studies found a less robust response to ECT in patients with MDD and BPD compared with those without BPD.Our results suggest that, in patients with MDD, the presence of BPD is associated with a less robust acute response to ECT. Patients with BPD, however, showed a significant response to ECT in all of the included studies. More longitudinal studies with higher accuracy in BPD diagnosis are needed. Although a comorbid BPD seems to decrease the efficacy of ECT for MDD, ECT remains an effective treatment option in this severely ill patient group.
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Affiliation(s)
| | - Pascal Sienaert
- Department of Neurosciences, University Psychiatric Center KU Leuven and Research Group Psychiatry, Academic Center for ECT and Neuromodulation, Faculty of Medicine, University of Leuven, Leuven, Belgium
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Díaz-Marsa M, Gálvez-Merlín A, Guillen AI, de la Torre-Luque A, López-Villatoro JM, Beato-Fernández L, Polo-Montes F, León-Velasco M, Gómez-del Barrio A, Santos-Carrasco I, Carrasco-Díaz Á, Carrasco JL. Transdiagnostic Study of Impulsivity and Self-Injurious Behaviour in Unstable and Impulsive Disorders. Actas Esp Psiquiatr 2023; 51:120-128. [PMID: 37489556 PMCID: PMC10803848] [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] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/01/2023] [Indexed: 07/26/2023]
Abstract
High comorbidity between borderline personality disorder (BPD) and eating disorders (ED) shows the necessity of developing transdiagnostic models, where impulsivity could play a relevant role in the manifestations of self-injurious behaviour.
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Affiliation(s)
- Marina Díaz-Marsa
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Departamento de Medicina Legal, Psiquiatría y Patología, Universidad Complutense de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Alejandra Gálvez-Merlín
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Departamento de Medicina Legal, Psiquiatría y Patología, Universidad Complutense de Madrid, Madrid, Spain
| | - Ana I. Guillen
- Departamento de Personalidad, Evaluación y Psicología Clínica, Universidad Complutense de Madrid, Madrid, Spain
| | - Alejandro de la Torre-Luque
- Departamento de Medicina Legal, Psiquiatría y Patología, Universidad Complutense de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - José M. López-Villatoro
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Departamento de Medicina Legal, Psiquiatría y Patología, Universidad Complutense de Madrid, Madrid, Spain
| | | | | | | | - Andrés Gómez-del Barrio
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Unidad de Trastornos de la Conducta Alimentaria, Hospital Universitario Marqués de Valdecilla, Santander, Spain
- Instituto de Investigación Valdecilla (IDIVAL) Santander, Spain
| | - Isabel Santos-Carrasco
- Departamento de Medicina Legal, Psiquiatría y Patología, Universidad Complutense de Madrid, Madrid, Spain
- Hospital Universitario Infanta Cristina, Madrid, Spain
| | | | - José L. Carrasco
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Departamento de Medicina Legal, Psiquiatría y Patología, Universidad Complutense de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
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Abstract
IMPORTANCE Borderline personality disorder (BPD) affects approximately 0.7% to 2.7% of adults in the US. The disorder is associated with considerable social and vocational impairments and greater use of medical services. OBSERVATIONS Borderline personality disorder is characterized by sudden shifts in identity, interpersonal relationships, and affect, as well as by impulsive behavior, periodic intense anger, feelings of emptiness, suicidal behavior, self-mutilation, transient, stress-related paranoid ideation, and severe dissociative symptoms (eg, experience of unreality of one's self or surroundings). Borderline personality disorder is typically diagnosed by a mental health specialist using semistructured interviews. Most people with BPD have coexisting mental disorders such as mood disorders (ie, major depression or bipolar disorder) (83%), anxiety disorders (85%), or substance use disorders (78%). The etiology of BPD is related to both genetic factors and adverse childhood experiences, such as sexual and physical abuse. Psychotherapy is the treatment of choice for BPD. Psychotherapy such as dialectical behavior therapy and psychodynamic therapy reduce symptom severity more than usual care, with medium effect sizes (standardized mean difference) between -0.60 and -0.65. There is no evidence that any psychoactive medication consistently improves core symptoms of BPD. For discrete and severe comorbid mental disorders, eg, major depression, pharmacotherapy such as the selective serotonin reuptake inhibitors escitalopram, sertraline, or fluoxetine may be prescribed. For short-term treatment of acute crisis in BPD, consisting of suicidal behavior or ideation, extreme anxiety, psychotic episodes, or other extreme behavior likely to endanger a patient or others, crisis management is required, which may include prescription of low-potency antipsychotics (eg, quetiapine) or off-label use of sedative antihistamines (eg, promethazine). These drugs are preferred over benzodiazepines such as diazepam or lorazepam. CONCLUSIONS AND RELEVANCE Borderline personality disorder affects approximately 0.7% to 2.7% of adults and is associated with functional impairment and greater use of medical services. Psychotherapy with dialectical behavior therapy and psychodynamic therapy are first-line therapies for BPD, while psychoactive medications do not improve the primary symptoms of BPD.
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Affiliation(s)
- Falk Leichsenring
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
- Department of Psychosomatics and Psychotherapy, University of Rostock, Rostock, Germany
| | - Nikolas Heim
- International Psychoanalytic University, Berlin, Germany
| | - Frank Leweke
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
| | - Carsten Spitzer
- Department of Psychosomatics and Psychotherapy, University of Rostock, Rostock, Germany
| | - Christiane Steinert
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
- International Psychoanalytic University, Berlin, Germany
| | - Otto F Kernberg
- Weill Cornell Medical College, Personality Disorders Institute, New York, New York
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West ML, Guest RM, Carmel A, Madigan R, Yen S. Borderline personality features among individuals at clinical high risk for psychosis (CHR-P): A brief report. Early Interv Psychiatry 2023; 17:223-228. [PMID: 35959808 DOI: 10.1111/eip.13336] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 05/13/2022] [Accepted: 07/05/2022] [Indexed: 11/29/2022]
Abstract
AIM This exploratory study reports on borderline symptomatology within a sample of individuals at clinical high risk for psychosis (CHR-P) through a validated, self-report instrument, the short version of the Borderline Symptom List (BSL-23). METHODS The sample consisted of 44 help-seeking CHR-P youth (ages 14-29 years) who completed an initial evaluation at a specialized clinic for psychosis-risk. RESULTS The mean BSL-23 score was 1.5 (SD = 1.0, range 0.1-4.0). Higher scores were strongly associated with greater reported depressive symptoms (r = 0.84, p < 0.001). Additionally, borderline symptoms associated with attenuated positive symptoms (r = 0.32, p = 0.034) and social anxiety (r = 0.34, p = 0.027). Borderline symptomatology was not associated with role or social functioning. CONCLUSIONS This study is one of the first examinations of borderline symptomatology within a CHR-P sample through a validated self-report measure. Future research replicating these results is required to determine their robustness.
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Affiliation(s)
- Michelle L West
- Center for Early Detection, Assessment, and Response to Psychosis (CEDAR) Clinic at Massachusetts Mental Health Center and Brookline Mental Health Center, Brookline, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Psychiatry, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Ryan M Guest
- Department of Psychology, Emory University, Atlanta, Georgia, USA
| | - Adam Carmel
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Ryan Madigan
- Boston Child Study Center, Boston, Massachusetts, USA
| | - Shirley Yen
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Abstract
OBJECTIVES The aim of the present study was to investigate the risk of nonremission following electroconvulsive therapy (ECT), as associated with borderline personality disorder, in individuals with major depression in the context of the contradictory data available in the literature. METHODS We analyzed demographic and clinical data from 210 individuals with major depression who were treated with ECT. Study participants were recruited from the medical records database of the Psychiatry Department at Erasme Hospital. Only individuals with major depression who were in remission, as demonstrated during the systematic psychiatric interview performed at the end of ECT (ie, with a >60% reduction in their 24-item Hamilton Depression Rating Scale score, combined with a score of <10), were included in the "remission" group. Logistic regression analyses were used to determine the risk of nonremission following ECT. RESULTS Nonremission following ECT occurred frequently (42.9%) in our sample. Moreover, after adjusting for major confounding factors, multivariate logistic regression analyses demonstrated that borderline personality disorder was a risk factor for nonremission following ECT in individuals with major depression. CONCLUSIONS We demonstrated that borderline personality disorder was associated with a higher risk of nonremission following ECT in individuals with major depression. This finding seems to justify more systematic screening as well as more adequate management of this personality disorder in individuals with major depression who are treated with ECT to allow for attaining better remission rates in this subpopulation.
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Affiliation(s)
- Matthieu Hein
- From the Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université Libre de Bruxelles, Brussels, Belgium
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Tsinanis T, Mu E, Kulkarni J. The physical symptoms of polycystic ovarian syndrome exacerbate the mental health symptoms of borderline personality disorder. Aust N Z J Psychiatry 2022; 56:878. [PMID: 34839752 DOI: 10.1177/00048674211062533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Tia Tsinanis
- Monash Alfred Psychiatry Research Centre (MAPrc), Monash University, Melbourne, VIC, Australia
| | - Eveline Mu
- Monash Alfred Psychiatry Research Centre (MAPrc), Monash University, Melbourne, VIC, Australia
| | - Jayashri Kulkarni
- Monash Alfred Psychiatry Research Centre (MAPrc), Monash University, Melbourne, VIC, Australia
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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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Abstract
BACKGROUND Previous studies have suggested that processing of visual contrast information could be altered in major depressive disorder. To clarify the changes at different levels of the visual hierarchy, we behaviourally measured contrast perception in 2 centre-surround conditions, assessing retinal and cortical processing. METHODS As part of a prospective cohort study, our sample consisted of controls (n = 29; 21 female) and patients with unipolar depression, bipolar disorder and borderline personality disorder who had baseline major depressive episodes (n = 111; 74 female). In a brightness induction test that assessed retinal processing, participants compared the perceived luminance of uniform patches (presented on a computer screen) as the luminance of the backgrounds was varied. In a contrast suppression test that assessed cortical processing, participants compared the perceived contrast of gratings, which were presented with collinearly or orthogonally oriented backgrounds. RESULTS Brightness induction was similar for patients with major depressive episodes and controls (p = 0.60, d = 0.115, Bayes factor = 3.9), but contrast suppression was significantly lower for patients than for controls (p < 0.006, d = 0.663, Bayes factor = 35.2). We observed no statistically significant associations between contrast suppression and age, sex, or medication or diagnostic subgroup. At follow-up (n = 74), we observed some normalization of contrast perception. LIMITATIONS We assessed contrast perception using behavioural tests instead of electrophysiology. CONCLUSION The reduced contrast suppression we observed may have been caused by decreased retinal feedforward or cortical feedback signals. Because we observed intact brightness induction, our results suggest normal retinal but altered cortical processing of visual contrast during a major depressive episode. This alteration is likely to be present in multiple types of depression and to partially normalize upon remission.
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Affiliation(s)
- Viljami Salmela
- From the Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland (Salmela, Lahti); and the Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (Socada, Söderholm, Heikkilä, Ekelund, Isometsä)
| | - Lumikukka Socada
- From the Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland (Salmela, Lahti); and the Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (Socada, Söderholm, Heikkilä, Ekelund, Isometsä)
| | - John Söderholm
- From the Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland (Salmela, Lahti); and the Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (Socada, Söderholm, Heikkilä, Ekelund, Isometsä)
| | - Roope Heikkilä
- From the Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland (Salmela, Lahti); and the Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (Socada, Söderholm, Heikkilä, Ekelund, Isometsä)
| | - Jari Lahti
- From the Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland (Salmela, Lahti); and the Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (Socada, Söderholm, Heikkilä, Ekelund, Isometsä)
| | - Jesper Ekelund
- From the Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland (Salmela, Lahti); and the Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (Socada, Söderholm, Heikkilä, Ekelund, Isometsä)
| | - Erkki Isometsä
- From the Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland (Salmela, Lahti); and the Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (Socada, Söderholm, Heikkilä, Ekelund, Isometsä)
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Howard J, De Jesu´s-Romero R, Peipert A, Riley T, Rutter LA, Lorenzo-Luaces L. The significance of anxiety symptoms in predicting psychosocial functioning across borderline personality traits. PLoS One 2021; 16:e0245099. [PMID: 33503038 PMCID: PMC7840050 DOI: 10.1371/journal.pone.0245099] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 12/22/2020] [Indexed: 11/18/2022] Open
Abstract
Emotion regulation is a central task of daily life. Difficulty regulating emotions is a core feature of borderline personality disorder (BPD), one of the most common and impairing personality disorder diagnoses. While anger and symptoms of depression are instantiated in the criteria for BPD, anxiety is not, despite being among the most common psychiatric symptoms. In a sample of online respondents (N = 471), we explored the interactions between anxiety symptoms and BPD traits in predicting well-being (WHO-5) as well as poorer work and social adjustment (WSAS), while controlling for anger and depression. We hypothesized that anxiety would lead to more impairment (i.e., lower well-being and poorer work and more difficulties with work and social adjustment) as BPD traits increased. BPD traits and symptoms of anxiety both contributed to overall lower levels well-being and higher levels of psychosocial dysfunction. However, contrary to our expectations, at higher (vs. lower) levels of BPD traits, symptoms of anxiety were less conducive to lower well-being on the WHO-5. For the WSAS, there was no consistent evidence for an interaction between BPD traits and anxiety in predicting functioning. By and large, our results do not support the idea that anxiety contributes to more impairment at higher levels of BPD traits.
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Affiliation(s)
- Jacqueline Howard
- Department of Psychological and Brain Sciences (PBS), Indiana University-Bloomington, Bloomington, Indiana, United States of America
| | - Robinson De Jesu´s-Romero
- Department of Psychological and Brain Sciences (PBS), Indiana University-Bloomington, Bloomington, Indiana, United States of America
| | - Allison Peipert
- Department of Psychological and Brain Sciences (PBS), Indiana University-Bloomington, Bloomington, Indiana, United States of America
| | - Tennisha Riley
- School of Education, Indiana University-Bloomington, Bloomington, Indiana, United States of America
| | - Lauren A. Rutter
- Department of Psychological and Brain Sciences (PBS), Indiana University-Bloomington, Bloomington, Indiana, United States of America
| | - Lorenzo Lorenzo-Luaces
- Department of Psychological and Brain Sciences (PBS), Indiana University-Bloomington, Bloomington, Indiana, United States of America
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Göttlich M, Westermair AL, Beyer F, Bußmann ML, Schweiger U, Krämer UM. Neural basis of shame and guilt experience in women with borderline personality disorder. Eur Arch Psychiatry Clin Neurosci 2020; 270:979-992. [PMID: 32382793 PMCID: PMC7599192 DOI: 10.1007/s00406-020-01132-z] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 04/27/2020] [Indexed: 11/17/2022]
Abstract
Borderline personality disorder (BPD) is characterized by instability of affect, emotion dysregulation, and interpersonal dysfunction. Especially shame and guilt, so-called self-conscious emotions, are of central clinical relevance to BPD. However, only few experimental studies have focused on shame or guilt in BPD and none investigated their neurobiological underpinnings. In the present functional magnetic resonance imaging study, we took a scenario-based approach to experimentally induce feelings of shame, guilt, and disgust with neutral scenarios as control condition. We included 19 women with BPD (age 26.4 ± 5.8 years; DSM-IV diagnosed; medicated) and 22 healthy female control subjects (age 26.4 ± 4.6 years; matched for age and verbal IQ). Compared to controls, women with BPD reported more intense feelings when being confronted with affective scenarios, especially higher levels of shame, guilt, and fear. We found increased amygdala reactivity in BPD compared to controls for shame and guilt, but not for disgust scenarios (p = 0.05 FWE corrected at the cluster level; p < 0.0001 cluster defining threshold). Exploratory analyses showed that this was caused by a diminished habituation in women with BPD relative to control participants. This effect was specific to guilt and shame scenarios as both groups showed amygdala habituation to disgust scenarios. Our work suggests that heightened shame and guilt experience in BPD is not related to increased amygdala activity per se, but rather to decreased habituation to self-conscious emotions. This provides an explanation for the inconsistencies in previous imaging work on amygdala involvement in BPD as well as the typically slow progress in the psychotherapy of dysfunctional self-conscious emotions in this patient group.
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Affiliation(s)
- Martin Göttlich
- Department of Neurology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Anna Lisa Westermair
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Frederike Beyer
- School of Biological and Chemical Sciences, Queen Mary University of London, London, UK
| | - Marie Luise Bußmann
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Ulrich Schweiger
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Ulrike M Krämer
- Department of Neurology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
- Institute for Psychology II, University of Lübeck, Lübeck, Germany.
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Snoek A, Beekman ATF, Dekker J, Aarts I, van Grootheest G, Blankers M, Vriend C, van den Heuvel O, Thomaes K. A randomized controlled trial comparing the clinical efficacy and cost-effectiveness of eye movement desensitization and reprocessing (EMDR) and integrated EMDR-Dialectical Behavioural Therapy (DBT) in the treatment of patients with post-traumatic stress disorder and comorbid (Sub)clinical borderline personality disorder: study design. BMC Psychiatry 2020; 20:396. [PMID: 32762677 PMCID: PMC7409691 DOI: 10.1186/s12888-020-02713-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 06/04/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Comorbidity between Posttraumatic Stress Disorder (PTSD) and Borderline Personality Disorder (BPD) is high. There is growing motivation among clinicians to offer PTSD treatments - such as Eye Movement Desensitization and Reprocessing (EMDR) - to patients with PTSD and comorbid BPD. However, a large subgroup with comorbid BPD does not sufficiently respond to PTSD treatment and is more likely to be excluded or to dropout from treatment. Dialectical Behaviour Therapy (DBT) for BPD is well established and although there is some evidence that DBT combined with DBT Prolonged Exposure (DBT + DBT PE) is twice as effective in reducing PTSD symptoms than DBT alone, the comparative efficacy of integrated PTSD-DBT and PTSD-only treatment has not been investigated yet. The current study will therefore evaluate the comparative clinical efficacy and cost-effectiveness of EMDR-DBT and EMDR-only in patients with PTSD and comorbid (sub)clinical BPD. Moreover, it is not clear yet what treatment works best for which individual patient. The current study will therefore evaluate neurobiological predictors and mediators of the individual response to treatment. METHOD A randomized controlled trial comparing the clinical efficacy and cost-effectiveness of integrated EMDR-DBT (n = 63) and EMDR-only (n = 63) in treatment-seeking adult patients with PTSD and comorbid (sub)clinical BPD. In addition, neurobiological predictors and mediators of treatment outcome, such as hair cortisol, FKBP5 and BDNF protein levels and FKBP5 and BDNF methylation status, are measured through hair and blood samples. DISCUSSION This is the first study to compare the clinical efficacy and cost-effectiveness of integrated EMDR-DBT and EMDR-only in patients with PTSD and comorbid (sub)clinical BPD, while simultaneously identifying individual predictors and mediators of treatment response. Results will reveal which treatment works best for which individual patient, thereby guiding individual treatment choices and personalizing psychiatry. TRIAL REGISTRATION Clinical Trials, NCT03833453 . Retrospectively registered, 15 March 2019.
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Affiliation(s)
- Aishah Snoek
- Arkin Sinai Centrum, Amstelveen, The Netherlands
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands
| | - Aartjan T. F. Beekman
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Jack Dekker
- Amsterdam UMC, Vrije Universiteit Amsterdam, Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam, the Netherlands
- GGZinGeest, Department of Psychiatry, Amsterdam, the Netherlands
| | - Inga Aarts
- Arkin Sinai Centrum, Amstelveen, The Netherlands
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands
| | - Gerard van Grootheest
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Matthijs Blankers
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam, the Netherlands
- Arkin Mental Health Care, Amsterdam, the Netherlands
| | - Chris Vriend
- Vrije Universiteit Amsterdam, Faculty of Behavioural and Movement Sciences, Amsterdam, the Netherlands
- Trimbos Institute, Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Odile van den Heuvel
- Vrije Universiteit Amsterdam, Faculty of Behavioural and Movement Sciences, Amsterdam, the Netherlands
- Trimbos Institute, Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Kathleen Thomaes
- Arkin Sinai Centrum, Amstelveen, The Netherlands
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam, the Netherlands
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Johnson BN, Lumley MA, Cheavens JS, McKernan LC. Exploring the links among borderline personality disorder symptoms, trauma, and pain in patients with chronic pain disorders. J Psychosom Res 2020; 135:110164. [PMID: 32569851 PMCID: PMC7422088 DOI: 10.1016/j.jpsychores.2020.110164] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/30/2020] [Accepted: 05/31/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Chronic pain and borderline personality disorder (BPD) are commonly comorbid and jointly associated with increased symptoms of both disorders and clinical and functional impairment. Little is known, however, about specific links between these disorders. In a cross-sectional study of patients with chronic pain, we compared participants high or low on BPD symptoms on patterns of pain experience and types of child and adult traumas. METHODS Adults (N = 181) with chronic pain completed self-reports of pain severity, dimensions of pain experiencing, body coverage of pain, and clinical indicators of central sensitization (i.e., chronic hypersensitivity of the central nervous system), as well as measures of child and adult physical abuse, sexual abuse, trauma, and neglect. Participants also completed the McLean Screening Instrument for BPD. RESULTS Participants with clinically significant BPD symptoms (n = 32) reported more childhood sexual trauma, punishment, and neglect, as well as adult physical/sexual trauma, than those without elevated BPD symptoms. Among participants with clinically significant BPD symptoms, affective pain and central sensitization were elevated, potentially explained by heightened negative affect in BPD. CONCLUSION BPD symptoms are associated with increased clinical severity among patients with chronic pain as well as a unique manifestation of pain experiencing (i.e., increased affective pain and central sensitization in particular). Childhood trauma of all types is associated with chronic pain and BPD co-occurrence. Researchers and clinicians should assess for BPD in people with chronic pain to enhance conceptual models of the transaction between these disorders and to improve clinical care.
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Kaiser D, Jacob GA, van Zutphen L, Siep N, Sprenger A, Tuschen-Caffier B, Senft A, Arntz A, Domes G. Patients with borderline personality disorder and comorbid PTSD show biased attention for threat in the facial dot-probe task. J Behav Ther Exp Psychiatry 2020; 67:101437. [PMID: 30563688 DOI: 10.1016/j.jbtep.2018.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/14/2018] [Accepted: 11/22/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Biased attention to threat is likely to play a crucial role in the dysfunctional emotion-related information processing in borderline personality disorder (BPD). However, the role of comorbid posttraumatic stress disorder (PTSD) has not yet been fully disentangled. METHODS BPD patients with (n = 24) and without (n = 46) PTSD, 35 patients with Cluster-C personality disorder and 52 non-patients participated in the facial dot-probe task with angry, happy and neutral faces during automatic (100 ms), controlled (600 ms), and later (1200 ms) stages of information processing. RESULTS BPD patients showed a greater congruency effect to angry faces during the controlled stage of processing than controls. Specifically, in BPD with PTSD compared to controls, this effect was due to difficulties disengaging from threat, indicated by slower reaction times to incongruent angry targets compared to neutral trials. Regarding automatic and later stages of information processing, there was no attentional bias (AB) in BPD. None of the groups revealed biased attention for happy faces at any stages of information processing. LIMITATIONS We did not include a control group of PTSD patients without BPD. Therefore, we cannot rule out that the present AB in BPD is mainly due to PTSD-specific psychopathology. CONCLUSIONS These findings provide first evidence for an AB towards angry faces and difficulties disengaging from these threat-related social cues in adult BPD patients. Although BPD patients in general demonstrated an AB when compared with controls, this effect was especially pronounced for BPD with PTSD, suggesting a significant effect of trauma-related psychopathology on social attention in BPD.
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Affiliation(s)
- Deborah Kaiser
- Department of Biological and Clinical Psychology, University of Trier, Germany; Department of Clinical Psychology and Psychotherapy, University of Freiburg, Germany
| | | | - Linda van Zutphen
- Department of Clinical Psychological Science, University of Maastricht, the Netherlands
| | - Nicolette Siep
- Department of Clinical Psychological Science, University of Maastricht, the Netherlands
| | - Andreas Sprenger
- Department of Neurology and Institute of Psychology II, University of Luebeck, Germany
| | | | - Alena Senft
- Department of Psychiatry and Psychotherapy, University of Luebeck, Germany
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, the Netherlands
| | - Gregor Domes
- Department of Biological and Clinical Psychology, University of Trier, Germany.
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Vest NA, Tragesser S. Coping motives mediate the relationship between borderline personality features and alcohol, cannabis, and prescription opioid use disorder symptomatology in a substance use disorder treatment sample. Personal Disord 2020; 11:230-236. [PMID: 31815505 PMCID: PMC7156315 DOI: 10.1037/per0000385] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Borderline personality disorder and substance use disorder co-occur at a high rate. However, little is known about the mechanisms driving this association. This study examined substance use motives for 3 common substance use disorders among 193 individuals in substance use disorder treatment. We found that the coping motive consistently mediated the relationship between borderline personality and alcohol, cannabis, and prescription opioid use disorders. For this substance use disorder treatment sample, our findings support the self-medication model of substance use, and that interventions aimed at coping-related substance use would be helpful among these patients. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Noel A Vest
- Department of Psychology, Washington State University
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Ferreri MM, Ferrerri MM, Loze JY, Rouillon F, Limosin F. Clozapine treatment of a borderline personality disorder with severe self-mutilating behaviours. Eur Psychiatry 2020; 19:177-8. [PMID: 15158928 DOI: 10.1016/j.eurpsy.2003.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2003] [Accepted: 11/20/2003] [Indexed: 10/26/2022] Open
Affiliation(s)
- Mélanie M Ferreri
- Service de Psychiatrie, Hôpital Albert Chenevier, 40 rue de Mesly, 94010 Créteil cedex, France
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Abstract
This study examined the relationship between borderline personality disorder assessed as self-reported borderline features (Morey, 1991), opioid use, and Hepatitis C virus (HCV) in pregnant women. There were 55 women in the opioid use group and 38 in the comparison group who were at high risk due to medical issues that did not include drug use. Women were in their 2nd or 3rd trimester. All women received Medicaid and were racially representative of the geographic area (84% White). We assessed opioid use severity from medical records based on urine assays and prescriptions for opioids. The results revealed that women who scored in the clinical range of total borderline features, which is associated with a diagnosis of borderline personality disorder (Trull, 1995), had 2.83 greater odds of being opioid users (prescribed and nonprescribed) than had individuals below the cutoff. The borderline features of affective instability, identity disturbance, negative relationships, and self-harm/impulsivity were significantly correlated with opioid use severity. Negative relationships and self-harm/impulsivity contributed significant variance in opioid use severity over and above affective instability and identity disturbance. Women in the clinical range of borderline features were more likely to have HCV than were women below the cutoff, and the borderline feature of negative relationships specifically was associated with HCV. We discuss implications for interventions to address negative relationships and self-harm/impulsivity and interventions to help prevent opioid misuse in women before they become pregnant. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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McDonald S. Understanding the genetics and epigenetics of bulimia nervosa/bulimia spectrum disorder and comorbid borderline personality disorder (BN/BSD-BPD): a systematic review. Eat Weight Disord 2019; 24:799-814. [PMID: 31119586 PMCID: PMC6751148 DOI: 10.1007/s40519-019-00688-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 04/08/2019] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate and understand the genetic and epigenetic basis of bulimia nervosa/bulimia spectrum disorder and comorbid borderline personality disorder (BN/BSD-BPD). METHODS The present systematic review was conducted in accordance to PRISMA guidelines. Advanced systematic searches of Medline, EMBASE, PsychINFO, Web of Science, Scopus, CINHAL plus, and the Cochrane Library were conducted using the search terms 'bulimia nervosa', 'bulimia spectrum disorder', 'borderline personality disorder', 'genes', and 'genetics'. The search strategy garnered seven studies for inclusion in the present review. RESULTS Women with BN/BSD-BPD had significantly lower serotonin and monoamine oxidise activity compared to women with BN/BSD or healthy controls (HC). As well, women with BN/BSD-BPD displayed elevated methylation of the dopamine receptor gene promoter, brain-derived neurotrophic factor, and changes in the methylation of the glucocorticoid receptor gene promoter (NR3C1) compared to women with BN/BSD and HC. The results also demonstrated that rates of childhood sexual abuse and childhood physical abuse are higher in those with BN/BSD-BPD than those with BN/BSD and HC, and that these types of abuse are often correlated with the methylation differences seen in BN/BSD-BPD women. CONCLUSION Due to the differences observed between individuals with BN/BSD-BPD and those with BN/BSD and HC a genetic/epigenetic aetiological model of BN/BSD-BPD was developed and is proposed in this review. This evidence-based model visually illustrates the current state of the field and draws attention to the need for subsequent research.
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Affiliation(s)
- Sydney McDonald
- Division of Medicine, University College London, Gower Street, London, WC1E 6BT, UK.
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Roininen SM, Cheetham M, Mueller BU, Battegay E. Unmet challenges in treating hypertension in patients with borderline personality disorder: A systematic review. Medicine (Baltimore) 2019; 98:e17101. [PMID: 31517840 PMCID: PMC6750323 DOI: 10.1097/md.0000000000017101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/18/2019] [Accepted: 08/16/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Caregivers encounter serious and substantial challenges in managing hypertension in patients with subclinical or clinical borderline personality disorder (BPD). These challenges include therapeutic conflicts resulting from harmful drug-drug, and drug-disease interactions. Current guidelines provide no recommendations for concurrent psychotropic and antihypertensive treatment of hypertensive BPD patients who are at even greater cardiovascular risk. METHODS We conducted a systematic literature review to assess the extent of available evidence on prevalence rates, cardiovascular risk factors, therapeutic conflicts, and evidence-based treatment recommendations for patients with co-occurring hypertension and BPD. Search terms were combined for hypertension and BPD in PubMed, MEDLINE, EMBASE, Cochrane, and PsycINFO databases. RESULTS We included 11 articles for full-text evaluation and found a very high prevalence of hypertension and substantial cardiovascular risk in studies on co-occurring BPD and hypertension. However, we identified neither studies on harmful drug-drug and drug-disease interactions nor studies with treatment recommendations for co-occurring hypertension and BPD. CONCLUSIONS Increased prevalence of hypertension in BPD patients, and therapeutic conflicts of psychotropic agents strongly suggest careful evaluation of treatment strategies in this patient group. However, no studies or guidelines recommend specific therapies or strategies to resolve therapeutic conflicts in patients with hypertension and BPD. This evidence gap needs attention in this population at high risk for cardiovascular disease.
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Affiliation(s)
- Saara M. Roininen
- Department of Internal Medicine, University Hospital Zurich
- Center of Competence Multimorbidity
| | - Marcus Cheetham
- Department of Internal Medicine, University Hospital Zurich
- Center of Competence Multimorbidity
- University Research Priority Program “Dynamics of Healthy Aging”, University of Zurich, Zurich, Switzerland
| | - Beatrice U. Mueller
- Department of Internal Medicine, University Hospital Zurich
- Center of Competence Multimorbidity
| | - Edouard Battegay
- Department of Internal Medicine, University Hospital Zurich
- Center of Competence Multimorbidity
- University Research Priority Program “Dynamics of Healthy Aging”, University of Zurich, Zurich, Switzerland
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Chen TH, Hsiao RC, Liu TL, Yen CF. Predicting effects of borderline personality symptoms and self-concept and identity disturbances on internet addiction, depression, and suicidality in college students: A prospective study. Kaohsiung J Med Sci 2019; 35:508-514. [PMID: 31063227 DOI: 10.1002/kjm2.12082] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 04/22/2019] [Indexed: 11/07/2022] Open
Abstract
The aims of this study were to evaluate the predicting effects of borderline personality symptoms and self-concept and identity disturbances on internet addiction, significant depression, and suicidality among college students at follow-up assessments conducted 1 year later. A sample of 500 college students aged between 20 and 30 years participated in this study. Their levels of borderline personality symptoms, self-concept and identity disturbances, internet addiction, depression, and suicidality at baseline and at follow-up interviews were assessed through the Borderline Symptoms List, Self-concept and Identity Measure, Chen Internet Addiction Scale, Beck Depression Inventory-II, and questions related to suicidality from the Epidemiological version of the Kiddie Schedule for Affective Disorders and Schizophrenia, respectively. A total of 324 college students received follow-up assessments 1 year later. Among them, 15.4%, 27.5%, and 17% had internet addiction, significant depression, and suicidality, respectively. Our result revealed the severity of borderline symptoms, disturbed identity, unconsolidated identity, and lack of identity at initial assessment increased the occurrence of internet addiction, significant depression, and suicidality at follow-up assessment except for the predictive effect of unconsolidated identity on internet addiction. The results indicated that self-concept and identity and borderline symptoms may have a significant role in the risk of mental health problems in college students.
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Affiliation(s)
- Ting-Hsiang Chen
- Department of Psychiatry, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Ray C Hsiao
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
- Department of Psychiatry, Children's Hospital and Regional Medical Center, Seattle, Washington
| | - Tai-Ling Liu
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Cheng-Fang Yen
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Abstract
Borderline personality disorder (BPD) is associated with suicidal behaviors and self-harm. Up to 10% of BPD patients will die by suicide. However, no research data support the effectiveness of suicide prevention in this disorder, and hospitalization has not been shown to be useful. The most evidence-based treatment methods for BPD are specifically designed psychotherapies.
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Affiliation(s)
- Joel Paris
- Institute of Community and Family Psychiatry, McGill University, 4333 Chemin de la Cote Ste. Catherine, Montreal, QC H3T1E4, Canada.
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Sacchetti S, Robinson P, Bogaardt A, Clare A, Ouellet-Courtois C, Luyten P, Bateman A, Fonagy P. Reduced mentalizing in patients with bulimia nervosa and features of borderline personality disorder: A case-control study. BMC Psychiatry 2019; 19:134. [PMID: 31060534 PMCID: PMC6501333 DOI: 10.1186/s12888-019-2112-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 04/10/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Mentalizing, the mental capacity to understand oneself and others in terms of mental states, has been found to be reduced in some mental disorders such as Borderline Personality Disorder (BPD). Some studies have suggested that Eating Disorders (EDs) may also be associated with impairments in mentalizing, but studies have not always yielded consistent results. This is the first study to systematically investigate mentalizing impairments in patients with Bulimia Nervosa (BN) compared with controls. In addition, we investigated whether impairments in mentalizing were related to BPD features, rather than BN per se, given the high comorbidity between BPD and BN. METHODS Patients with BN (n = 53) and healthy controls (HCs; n = 87) completed a battery of measures assessing mentalizing including the Reflective Function Questionnaires (RFQ), the Object Relations Inventory (ORI; Differentiation-Relatedness Scales) and the Reading The Mind in The Eyes Test (RMET). RESULTS Patients with BN scored significantly lower than HCs on all tests of mentalizing, with moderate to large between-group effect sizes. These differences were partially accounted for by BPD features as assessed with the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD), and partially by bulimic symptoms measured with the Eating Disorder Examination Questionnaire (EDE-Q). CONCLUSIONS Patients with BN have significantly lower levels of mentalizing as assessed with a broad range of tests compared to HCs. These differences were related to both bulimic symptoms and BPD features. Although further research in larger samples is needed, if replicated, these findings suggest that poor mentalizing may be a significant factor in BN patients and should be addressed in treatment, regardless of the presence of BPD features.
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Affiliation(s)
- Sofia Sacchetti
- Research Department of Clinical, Education and Health Psychology, University College London, London, UK
| | - Paul Robinson
- Nutrition Science Group, UCL Division of Medicine, University College London, London, UK.
- Barnet Enfield and Haringey Mental Health Trust, London, UK.
| | | | - Ajay Clare
- Barnet Enfield and Haringey Mental Health Trust, London, UK
| | | | - Patrick Luyten
- Research Department of Clinical, Education and Health Psychology, University College London, London, UK
| | - Anthony Bateman
- Research Department of Clinical, Education and Health Psychology, University College London, London, UK
| | - Peter Fonagy
- Research Department of Clinical, Education and Health Psychology, University College London, London, UK
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Acres K, Loughhead M, Procter N. Carer perspectives of people diagnosed with borderline personality disorder: A scoping review of emergency care responses. Australas Emerg Care 2019; 22:34-41. [PMID: 30998870 DOI: 10.1016/j.auec.2018.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/05/2018] [Accepted: 12/05/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Caring for a person with borderline personality disorder remains largely stigmatised and misunderstood. When a crisis arises, carers often seek help with the person they care for in emergency care settings such as the emergency department. The aim of this review was to explore, locate and compile the literature regarding the perspectives of family carers for a person with borderline personality disorder in an emergency care setting with a focus on nursing practices. This review advances understandings of carer perspectives in emergency care settings. METHODS The Joanna Briggs Institute (2015) [1], methodology for scoping reviews guided this review. A search of Emcare, Medline and Ovid Nursing was performed during April 2018, to identify literature where carer views and perspectives on engaging with emergency care services were reported. A grey literature search was also conducted. A total of ten articles and reports were included in this review. Consultation with a carer support group precipitated this review, which assisted in the formulation of the research questions. RESULTS Papers found via the study focused on health professional responses, rather than on nursing practice. Findings indicate that carers often perceive emergency departments as the only option for emergency care in a crisis. Carers require information about how to effectively manage a crisis with their loved one more effectively. CONCLUSION This scoping review identified that carers are often not consulted or engaged with by health professionals. Carers often perceive that nurses and health professionals have a lack understanding about the consumer's conceptualisation of distress and the nature of BPD, which becomes a barrier to effective crisis support and management. The literature often reported that a trusting and collaborative relationship between carers, nurses and health professionals demonstrated improved outcomes for the carer and consumer.
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Affiliation(s)
- Kristy Acres
- School of Nursing and Midwifery, Division of Health Sciences, University of South Australia, Adelaide SA 5000, Australia.
| | - Mark Loughhead
- School of Nursing and Midwifery, Division of Health Sciences, University of South Australia, Adelaide SA 5000, Australia.
| | - Nicholas Procter
- School of Nursing and Midwifery, Division of Health Sciences, University of South Australia, Adelaide SA 5000, Australia.
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Parker JD, Naeem A. Pharmacologic Treatment of Borderline Personality Disorder. Am Fam Physician 2019; 99:Online. [PMID: 30811158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Justin D Parker
- Southern Illinois University Decatur Family Medicine Residency Program, Decatur, IL, USA
| | - Aimen Naeem
- Southern Illinois University Decatur Family Medicine Residency Program, Decatur, IL, USA
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Nguyen DH, Thant TM. Recognizing and Managing "Magic Wand Syndrome" Among Clinical Services. Psychosomatics 2019; 60:223-224. [PMID: 30497688 DOI: 10.1016/j.psym.2018.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 10/26/2018] [Accepted: 10/26/2018] [Indexed: 06/09/2023]
Affiliation(s)
| | - Thida M Thant
- University of Colorado, School of Medicine, Aurora, CO
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49
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Sarkheil P, Goik N, Ibrahim CN, Schneider F. Effect of negative valence on assessment of self-relevance in female patients with borderline personality disorder. PLoS One 2019; 14:e0209989. [PMID: 30629628 PMCID: PMC6328147 DOI: 10.1371/journal.pone.0209989] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 12/14/2018] [Indexed: 11/18/2022] Open
Abstract
Background A disturbed self-image is central to the characteristic symptoms of borderline personality disorder (BPD). Evaluations of self-relevance (SR) are highly important in cognitive and emotional processing of information and adaptive behavior. Method In the current study, we used affective statements to investigate if SR is altered in patients with higher scores on Borderline Symptom List (BSL-95). Forthyfemale adults with BPD and 20 healthy participants assessed a set of stimuli consisting of sentences in third-person for relevance to self. Results BPD patients exhibited a higher SR for negative contents as compared to healthy controls (p < .001). Furthermore, a significant positive correlation coefficient was found between the increased bias in evaluating the SR of stimuli and borderline symptom severity scores, as measured by BSL-95 questionnaire (r = 0.67, p < .001). This effect persisted after controlling for depressive symptoms by a partial correlation analysis. Conclusion Our results revealed an enhanced SR for negative statements, which was related to the severity of individuals’ BPD symptoms. These findings add to the diagnostic information regarding the disturbed organization of self in this clinical population. We suggest the maladaptive evaluation of SR offers an important treatment target for therapeutic approaches to BPD.
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Affiliation(s)
- Pegah Sarkheil
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical school, RWTH Aachen University, Aachen, Germany
- JARA Institute Brain Structure Function Relationship, Research Center Jülich and RWTH Aachen University, Aachen, Germany
- * E-mail:
| | - Niko Goik
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical school, RWTH Aachen University, Aachen, Germany
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Camellia N. Ibrahim
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical school, RWTH Aachen University, Aachen, Germany
| | - Frank Schneider
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical school, RWTH Aachen University, Aachen, Germany
- JARA Institute Brain Structure Function Relationship, Research Center Jülich and RWTH Aachen University, Aachen, Germany
- University Hospital Düsseldorf, Düsseldorf, Germany
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Abstract
Borderline personality disorder (BPD) is often a complicating comorbid factor in alcohol use disorders and substance use disorders. Previous work showed that abstinent alcoholics endorsed lifetime and current symptoms of most of the BPD criteria at much higher rates than controls, with much higher symptom counts for short-term abstinent alcoholic (STAA) women than men, which is consistent with such symptoms negatively affecting female alcoholics' ability to maintain abstinence. Because prior work has also shown that treatment-naïve alcoholics (TNA) are not the same as treated alcoholics observed earlier in their alcohol dependence, but rather are a different population with potentially lower psychiatric comorbidity, in this study we compared BPD symptom criteria between TNA samples of comparable age to the control and STAA samples, including both men and women and individuals dependent on alcohol only or with lifetime dependence on both alcohol and drugs. BPD symptoms were obtained using the SCID-II, and endorsed symptoms were classified as current or lifetime. Logistic regression analyses were used to test for effects of group, sex, presence of a lifetime drug dependence diagnosis, and their interactions for lifetime and current symptom endorsement for each BPD criteria. Groups were compared pairwise (TNA vs. NSAC, and STAA vs. TNA). The effect of a lifetime drug dependence diagnosis was not significant for any BPD symptom variable, consistent with the alcohol groups' BPD symptoms being unaffected by the presence of a comorbid drug dependence. The primary result presented here is that TNA women have borderline symptomatology more similar to that of treated STAA than to NSAC, while TNA men have borderline symptomatology more similar to NSAC than to STAA. A visual examination of co-occurring BPD symptoms showed that while more BPD symptoms are likely to be present in TNA and STAA vs. NSAC, there is no grouping of criteria (i.e., symptom cluster) that is characteristic of TNA or STAA.
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Affiliation(s)
- George Fein
- Neurobehavioral Research, Inc., 77 Ho'okele Street, 3rd Floor, Kahului, Maui, HI 96732, United States; Department of Medicine and Psychology, University of Hawaii, Honolulu, HI 96822, United States.
| | - Mathew Price
- Neurobehavioral Research, Inc., 77 Ho'okele Street, 3rd Floor, Kahului, Maui, HI 96732, United States; Cogency, Cape Town, South Africa.
| | - Valerie A Cardenas
- Neurobehavioral Research, Inc., 77 Ho'okele Street, 3rd Floor, Kahului, Maui, HI 96732, United States.
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