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Muzi L, Tieghi L, Franco A, Rugo M, Lingiardi V. The Mediator Effect of Personality on the Relationship Between Symptomatic Impairment and Treatment Outcome in Eating Disorders. Front Psychol 2021; 12:688924. [PMID: 34276515 PMCID: PMC8282821 DOI: 10.3389/fpsyg.2021.688924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/01/2021] [Indexed: 11/13/2022] Open
Abstract
Features of personality disorders (PDs) have been found to explain meaningful variance in the onset, maintenance, and symptomatic presentation of eating disorders (EDs), and a co-occurent personality pathology is commonly associated with poorer response to ED treatment. The "pathoplasty model" of the relationship between personality and EDs implies that, once both conditions are established, they are likely to interact in ways that modify therapy outcome; however, to date, no studies have explored overall personality functioning, and especially PD clusters, as a mediator of treatment outcome. The present study aimed at conjointly exploring the associations between personality functioning and PDs, respectively, with pre-treatment ED symptomatic impairment and therapy outcome; and the mediating role of personality variables. At treatment onset, a sample of 107 women with ED problems were evaluated using both the Structured Clinical Interview for DSM-5 (SCID-5-CV) and the Shedler-Westen Assessment Procedure-200 (SWAP-200)-a clinician-rated procedure to dimensionally assess personality. Participants were also asked to complete self-report questionnaires on overall ED symptomatology, symptoms of binge eating and purging behaviors, and therapy outcome. The findings showed that, over and above the categorical ED diagnosis, the SWAP-200 healthy personality functioning score mediated the relationship between baseline ED symptom severity and therapy outcome, as well as the association between baseline bulimic symptoms and treatment outcome; furthermore, SWAP-200 Cluster B PD scores mediated the link between baseline binge eating and purging symptoms and therapy outcome, whereas scores in Clusters A and C showed no significant effects. The findings suggest that personality-based outcome research may improve treatment effectiveness in this difficult-to-treat population.
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Affiliation(s)
- Laura Muzi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Laura Tieghi
- Eating Disorder Clinic "Residenza Gruber," Bologna, Italy
| | - Anna Franco
- Eating Disorder Clinic "Residenza Gruber," Bologna, Italy
| | - Michele Rugo
- Eating Disorder Clinic "Residenza Gruber," Bologna, Italy
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
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The Course of Borderline Psychopathology in Adolescents with Complex Mental Health Problems: An 18 Month Longitudinal Follow-up Study. Res Child Adolesc Psychopathol 2021; 49:545-557. [PMID: 33439418 DOI: 10.1007/s10802-020-00756-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2020] [Indexed: 10/22/2022]
Abstract
A persistent and significant barrier to the diagnosis and treatment of borderline personality disorder (BPD) in adolescents is clinician reluctance to label an adolescent with a stigmatized, intractable, treatment-resistant diagnosis. The goal of the current study was to evaluate this claim by examining the 18-month longitudinal course of borderline pathology in adolescents after discharge from inpatient treatment. 556 adolescent consecutive admissions (64.6% female; ages 12-17, M = 15.29, SD = 1.46) were assessed during admission to an inpatient treatment facility. They were followed up at discharge, 6 months, 12 months and 18 months after discharge with validated self-and parent report measures of adolescent BPD features. Latent growth modeling was used to evaluate outcomes. BPD features showed a significant decline over the follow-up period with very large effect sizes (> .80) for both parent and adolescent self-report. Rates of change were steeper for adolescent report although adolescent report fell below clinical cut-off 6 months later than parent-report. However, when internalizing and externalizing psychopathology were included in latent growth models, youth-reported BPD features did not show the same level of decline, while parent-reported BPD features maintained the same level of decline. The rate of decline between parents and adolescents was correlated, and baseline levels of BPD features were predictive of rate of change. This is the first study to show that adolescent borderline pathology follows a similar course after discharge from inpatient treatment previously demonstrated for adults. Like adult BPD, adolescent BPD appears to be not as intractable and treatment resistant as previously thought, mitigating against therapeutic nihilism.
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Kirtley J, Chiocchi J, Cole J, Sampson M. Stigma, Emotion Appraisal, and the Family Environment as Predictors of Carer Burden for Relatives of Individuals Who Meet the Diagnostic Criteria for Borderline Personality Disorder. J Pers Disord 2019; 33:497-514. [PMID: 30307828 DOI: 10.1521/pedi_2018_32_355] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
There is some research exploring carers' experiences within the National Health Service in the UK, but only one has focused on carers of individuals with borderline personality disorder (BPD). Ninety-eight carers completed a questionnaire-based study; 57 carers of individuals who meet the diagnostic criteria for BPD were compared to 41 carers of individuals with other mental health problems. The study aimed to investigate whether perceived stigma, perceived threat of strong emotions, and expressed emotion (EE) within the family environment predicted carer burden. The results showed that carers of those who met the diagnosis for BPD experienced higher levels of carer burden, stigma, EE, emotional over involvement (EOI), criticism (CC), and perceived threat of strong emotions than carers of individuals with other mental health difficulties. EOI, CC, carer group (BPD and mental health), and gender of participant were predictors of carer burden, with EOI explaining the most variance of burden.
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Affiliation(s)
| | - John Chiocchi
- North West Boroughs Healthcare, Equality Diversity and Inclusion Department, Winwick, Warrington, United Kingdom
| | - Jon Cole
- University of Liverpool, Liverpool, United Kingdom
| | - Mark Sampson
- North West Boroughs Healthcare, St Helens, United Kingdom
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Barnicot K, Crawford M. Posttraumatic Stress Disorder in Patients With Borderline Personality Disorder: Treatment Outcomes and Mediators. J Trauma Stress 2018; 31:899-908. [PMID: 30398678 DOI: 10.1002/jts.22340] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 08/13/2018] [Accepted: 08/20/2018] [Indexed: 11/07/2022]
Abstract
Posttraumatic stress disorder (PTSD) is highly comorbid with personality disorder (PD). We evaluated whether comorbid PTSD has a negative effect on patients' ability to benefit from evidence-based psychological treatments for PD and tested potential mediators of any effect. The effect of PTSD on self-harm and borderline PD symptoms was evaluated in 90 patients with borderline PD who were receiving dialectical behavior therapy or mentalization-based therapy. Self-report and interview measures were administered every 3 months over a 12-month period. Three-quarters of participants met criteria for PTSD. In the 12 months after beginning treatment, participants with PTSD did not engage in self-harm more often or present with more severe borderline PD symptoms. However, a higher level of PTSD symptom severity at baseline was associated with more frequent self-harm during follow-up, incidence rate ratio = 1.03, 95% CI [1.01, 1.06], p = .005. Participants whose PTSD did not improve or worsened were more likely to still self-harm, odds ratio (OR) = 0.91, 95 % CI [0.85, 0.97], p = .004, and report more severe borderline PD symptoms, b = 0.53, 95% CI [0.34, 0.73], p < .001, at the end of 12 months. The negative effects of PTSD symptoms remained significant after adjusting for potential confounders and were partially mediated by high ongoing levels of emotional dysregulation, indirect effect b = 0.32, 95% CI [0.19, 0.50]. These findings identify subgroups at risk of poorer outcomes from evidence-based psychological treatments for PD and support the idea that treating PTSD may improve outcomes.
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Affiliation(s)
- Kirsten Barnicot
- Centre for Psychiatry, Department of Medicine, Imperial College London, London, UK
| | - Mike Crawford
- Centre for Psychiatry, Department of Medicine, Imperial College London, London, UK
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Giourou E, Skokou M, Andrew SP, Alexopoulou K, Gourzis P, Jelastopulu E. Complex posttraumatic stress disorder: The need to consolidate a distinct clinical syndrome or to reevaluate features of psychiatric disorders following interpersonal trauma? World J Psychiatry 2018; 8:12-19. [PMID: 29568727 PMCID: PMC5862650 DOI: 10.5498/wjp.v8.i1.12] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 12/29/2017] [Accepted: 02/05/2018] [Indexed: 02/05/2023] Open
Abstract
Complex posttraumatic stress disorder (Complex PTSD) has been recently proposed as a distinct clinical entity in the WHO International Classification of Diseases, 11th version, due to be published, two decades after its first initiation. It is described as an enhanced version of the current definition of PTSD, with clinical features of PTSD plus three additional clusters of symptoms namely emotional dysregulation, negative self-cognitions and interpersonal hardship, thus resembling the clinical features commonly encountered in borderline personality disorder (BPD). Complex PTSD is related to complex trauma which is defined by its threatening and entrapping context, generally interpersonal in nature. In this manuscript, we review the current findings related to traumatic events predisposing the above-mentioned disorders as well as the biological correlates surrounding them, along with their clinical features. Furthermore, we suggest that besides the present distinct clinical diagnoses (PTSD; Complex PTSD; BPD), there is a cluster of these comorbid disorders, that follow a continuum of trauma and biological severity on a spectrum of common or similar clinical features and should be treated as such. More studies are needed to confirm or reject this hypothesis, particularly in clinical terms and how they correlate to clinical entities’ biological background, endorsing a shift from the phenomenologically only classification of psychiatric disorders towards a more biologically validated classification.
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Affiliation(s)
- Evangelia Giourou
- Department of Psychiatry, School of Medicine, University of Patras, Rio Patras 26500, Greece
- Department of Public Health, School of Medicine, University of Patras, Rio Patras 26500, Greece
| | - Maria Skokou
- Department of Psychiatry, School of Medicine, University of Patras, Rio Patras 26500, Greece
| | - Stuart P Andrew
- Specialist Care Team Limited, Lancashire LA4 4AY, United Kingdom
| | | | - Philippos Gourzis
- Department of Psychiatry, School of Medicine, University of Patras, Rio Patras 26500, Greece
| | - Eleni Jelastopulu
- Department of Public Health, School of Medicine, University of Patras, Rio Patras 26500, Greece
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Fossati A, Gratz KL, Somma A, Maffei C, Borroni S. The Mediating Role of Emotion Dysregulation in the Relations Between Childhood Trauma History and Adult Attachment and Borderline Personality Disorder Features: A Study of Italian Nonclinical Participants. J Pers Disord 2016; 30:653-676. [PMID: 26583588 DOI: 10.1521/pedi_2015_29_222] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In order to evaluate if emotion dysregulation significantly mediates the relationships between childhood abuse and adult attachment and borderline personality disorder features, 354 community Italian adults were administered the Borderline Personality Inventory (Leichsenring, 1999a), the Difficulties in Emotion Regulation Scale (Gratz & Roemer, 2004), the Child Abuse and Trauma Scale (Sanders & Becker-Lausen, 1995), and the Attachment Style Questionnaire (Feeney, Noller, & Hanrahan, 1994). Hierarchical regression analyses showed that both childhood abuse and adult attachment were positively associated with emotion dysregulation and borderline personality features; however, only emotional abuse and the attachment dimension of need for approval were common predictors of both dependent variables. No significant interaction effects were detected in regression analyses. Mediation analyses provided support for partial mediation, revealing a significant mediating role of emotion dysregulation in the relationships between both emotional abuse and need for approval and borderline personality features in this community sample.
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Affiliation(s)
- Andrea Fossati
- Department of Human Studies, LUMSA University, Rome, Italy
| | - Kim L Gratz
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson
| | | | - Cesare Maffei
- Faculty of Psychology, Vita Salute San Raffaele University, Milan, Italy
| | - Serena Borroni
- Faculty of Psychology, Vita Salute San Raffaele University, Milan, Italy
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Buchheim A, Erk S, George C, Kächele H, Martius P, Pokorny D, Spitzer M, Walter H. Neural Response during the Activation of the Attachment System in Patients with Borderline Personality Disorder: An fMRI Study. Front Hum Neurosci 2016; 10:389. [PMID: 27531977 PMCID: PMC4969290 DOI: 10.3389/fnhum.2016.00389] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 07/19/2016] [Indexed: 11/13/2022] Open
Abstract
Individuals with borderline personality disorder (BPD) are characterized by emotional instability, impaired emotion regulation and unresolved attachment patterns associated with abusive childhood experiences. We investigated the neural response during the activation of the attachment system in BPD patients compared to healthy controls using functional magnetic resonance imaging (fMRI). Eleven female patients with BPD without posttraumatic stress disorder (PTSD) and 17 healthy female controls matched for age and education were telling stories in the scanner in response to the Adult Attachment Projective Picture System (AAP), an eight-picture set assessment of adult attachment. The picture set includes theoretically-derived attachment scenes, such as separation, death, threat and potential abuse. The picture presentation order is designed to gradually increase the activation of the attachment system. Each picture stimulus was presented for 2 min. Analyses examine group differences in attachment classifications and neural activation patterns over the course of the task. Unresolved attachment was associated with increasing amygdala activation over the course of the attachment task in patients as well as controls. Unresolved controls, but not patients, showed activation in the right dorsolateral prefrontal cortex (DLPFC) and the rostral cingulate zone (RCZ). We interpret this as a neural signature of BPD patients’ inability to exert top-down control under conditions of attachment distress. These findings point to possible neural mechanisms for underlying affective dysregulation in BPD in the context of attachment trauma and fear.
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Affiliation(s)
- Anna Buchheim
- Institute of Psychology, University of Innsbruck Innsbruck, Austria
| | - Susanne Erk
- Department of Psychiatry and Psychotherapy, Division of Mind and Brain Research, University Hospital Charité Berlin, Germany
| | - Carol George
- Department of Psychology, Mills College Oakland, CA, USA
| | - Horst Kächele
- International Psychoanalytic University Berlin Berlin, Germany
| | | | - Dan Pokorny
- Department of Psychosomatic Medicine and Psychotherapy, University of Ulm Ulm, Germany
| | - Manfred Spitzer
- Department of Psychiatry III, University of Ulm Ulm, Germany
| | - Henrik Walter
- Department of Psychiatry and Psychotherapy, Division of Mind and Brain Research, University Hospital Charité Berlin, Germany
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Gao Q, Ma G, Zhu Q, Fan H, Wang W. Predicting Personality Disorder Functioning Styles by the Five-Factor Nonverbal Personality Questionnaire in Healthy Volunteers and Personality Disorder Patients. Psychopathology 2016; 49:5-12. [PMID: 26905579 DOI: 10.1159/000443838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 01/07/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Detecting personality disorders in the illiterate population is a challenge, but nonverbal tools measuring personality traits such as the Five-Factor Nonverbal Personality Questionnaire (FFNPQ) might help. We hypothesized that FFNPQ traits are associated with personality disorder functioning styles in a predictable way, especially in a sample of personality disorder patients. METHODS We therefore invited 106 personality disorder patients and 205 healthy volunteers to answer the FFNPQ and the Parker Personality Measure (PERM) which measures 11 personality disorder functioning styles. RESULTS Patients scored significantly higher on the FFNPQ neuroticism and conscientiousness traits and all 11 PERM styles. In both groups, the 5 FFNPQ traits displayed extensive associations with the 11 PERM styles, respectively, and the associations were more specific in patients. Associations between neuroticism, extraversion and agreeableness traits and most PERM styles were less exclusive, but conscientiousness was associated with antisocial (-) and obsessive-compulsive styles, and openness to experience with schizotypal and dependent (-) styles. CONCLUSIONS Our study has demonstrated correlations between FFNPQ traits and PERM styles, and implies the nonverbal measure of personality traits is capable of aiding the diagnoses of personality disorders in the illiterate population. Enlarging sample size and including the illiterate might make for more stable results.
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Affiliation(s)
- Qianqian Gao
- Department of Clinical Psychology and Psychiatry, School of Public Health, Zhejiang University College of Medicine, Hangzhou, China
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Levy KN, Ehrenthal JC, Yeomans FE, Caligor E. The efficacy of psychotherapy: focus on psychodynamic psychotherapy as an example. Psychodyn Psychiatry 2015; 42:377-421. [PMID: 25211431 DOI: 10.1521/pdps.2014.42.3.377] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The growing number of individuals seeking treatment for mental disorders calls for intelligent and responsible decisions in health care politics. However, the current relative decrease in reimbursement of effective psychotherapy approaches occurring in the context of an increase in prescription of psychotropic medication lacks a scientific base. Using psychodynamic psychotherapy as an example, we review the literature on meta-analyses and recent outcome studies of effective treatment approaches. Psychodynamic psychotherapy is an effective treatment for a wide variety of mental disorders. Adding to the known effectiveness of other shorter treatments, the results indicate lasting change in many cases, especially for complex and difficult to treat patients, ultimately reducing health-care utilization. Research-informed health care decisions that take into account the solid evidence for the effectiveness of psychotherapy, including psychodynamic psychotherapy, have the potential to promote choice, increase mental health, and reduce society's burden of disease in the long run.
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Sajadi SF, Riyahi H, Sahraeeyan Z, Sadeghi R, Tajikzadeh F, Mahmoudi T, Zargar Y. A Comparative Study of the Prevalence and Intensity of Borderline Personality Features in Male and Female High School Students in Fars Province. INTERNATIONAL JOURNAL OF SCHOOL HEALTH 2015. [DOI: 10.17795/intjsh-25625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Ammaniti M, Fontana A, Nicolais G. Borderline Personality Disorder in Adolescence Through the Lens of the Interview of Personality Organization Processes in Adolescence (IPOP-A): Clinical Use and Implications. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/15289168.2015.1003722] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Dalbudak E, Evren C. The impact of childhood traumas, depressive and anxiety symptoms on the relationship between borderline personality features and symptoms of adult attention deficit hyperactivity disorder in Turkish university students. Nord J Psychiatry 2015; 69:42-7. [PMID: 24865122 DOI: 10.3109/08039488.2014.922612] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Previous studies reported that there is a significant association between attention deficit hyperactivity disorder (ADHD) in childhood and borderline personality disorder (BPD) in adulthood. AIM The aim of this study is to investigate the relationship of borderline personality features (BPF) and ADHD symptoms while controlling the effect of childhood traumas, symptoms of depression and anxiety in adulthood on this relationship in Turkish university students. METHODS A total of 271 Turkish university students participated in this study. The students were assessed through the Turkish version of the Borderline Personality Inventory (BPI), the Adult ADHD Self-Report Scale (ASRS), the Childhood Trauma Questionnaire (CTQ-28), the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI). RESULTS Correlation analyses have revealed that severity of BPF is related with adult ADHD symptoms, emotional, physical abuse and depression scores. Hierarchical regression analysis has indicated that depressive symptoms, emotional and physical abuse and the severity of ADHD symptoms are the predictors for severity of BPF. CONCLUSIONS Findings of the present study suggests that clinicians must carefully evaluate these variables and the relationship between them to understand BPF and ADHD symptoms in university students better. Together with depressive symptoms, emotional and physical abuse may play a mediator role on this relationship. Further studies are needed to evaluate causal relationship between these variables in both clinical and non-clinical populations.
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Affiliation(s)
- Ercan Dalbudak
- Ercan Dalbudak, Turgut Ozal University, Department of Psychiatry, Faculty of Medicine , Ankara , Turkey
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13
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Abstract
By the current state of knowledge adolescent personality disorders should be taken seriously due to their high prevalence and severe symptomatology. Personality disorders are characterized by a stable pattern of deviation concerning cognition, affectivity, impulse control, and interpersonal relationships and have negative repercussions in psychosocial functioning and subsequent development. There is emerging evidence that personality disorder diagnosis is reliable and valid during adolescence. It is essential to detect youth with personality pathology in order to refer them to specific psychotherapeutic interventions and consequently avoid further chronification and life-long functional impairment. This selective review will give an overview over personality disorders in adolescents as well as according psychotherapeutic interventions.
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15
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Abstract
Borderline personality disorder is estimated to be present in approximately 6% of outpatient primary care settings. However, the time and energy spent on this population can greatly exceed what primary care doctors are able to spend. This article gives an overview of borderline personality disorder, including the clinical characteristics, epidemiology, and comorbidities, as well as pharmacologic and most important behavioral management. It is our hope that, with improved understanding of the disorder and skills for managing this population, caring for patients with the disorder can be more satisfying and less taxing for both primary care doctors and their patients.
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Affiliation(s)
- Amelia N Dubovsky
- Department of Psychiatry and Behavioral Sciences, Harborview Medical Center, University of Washington School of Medicine, 325 9th Avenue, Box 359896, Seattle, WA 98104, USA.
| | - Meghan M Kiefer
- Division of General Internal Medicine, University of Washington General Internal Medicine Center, University of Washington School of Medicine, Box 354760, Seattle, WA 98195-4750, USA
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Zanarini MC, Frankenburg FR, Reich DB, Wedig MM, Conkey LC, Fitzmaurice GM. Prediction of time-to-attainment of recovery for borderline patients followed prospectively for 16 years. Acta Psychiatr Scand 2014; 130:205-13. [PMID: 24588583 PMCID: PMC4138279 DOI: 10.1111/acps.12255] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the most clinically relevant baseline predictors of time-to-recovery from borderline personality disorder. METHOD Two hundred and ninety in-patients meeting rigorous criteria for borderline personality disorder were assessed during their index admission using a series of semistructured interviews and self-report measures. Recovery status, which was defined as concurrent symptomatic remission and good social and full-time vocational functioning, was reassessed at eight contiguous 2-year time periods. Survival analytic methods (Cox regression), which controlled for overall baseline severity, were used to estimate hazard ratios and their confidence intervals. RESULTS All told, 60% of the borderline patients studied achieved a 2-year recovery. In bivariate analyses, seventeen variables were found to be significant predictors of earlier time-to-recovery. Six of these predictors remained significant in multivariate analyses: no prior psychiatric hospitalizations, higher IQ, good full-time vocational record in 2 years prior to index admission, absence of an anxious cluster personality disorder, high extraversion, and high agreeableness. CONCLUSION Taken together, the results of this study suggest that prediction of time-to-recovery for borderline patients is multifactorial in nature, involving factors related to lack of chronicity, competence, and more adaptive aspects of temperament.
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Affiliation(s)
- M. C. Zanarini
- Laboratory for the Study for Adult Development; McLean Hospital and the Department of Psychiatry; Harvard Medical School; Belmont MA USA
| | - F. R. Frankenburg
- Laboratory for the Study for Adult Development; McLean Hospital and the Department of Psychiatry; Harvard Medical School; Belmont MA USA
| | - D. B. Reich
- Laboratory for the Study for Adult Development; McLean Hospital and the Department of Psychiatry; Harvard Medical School; Belmont MA USA
| | - M. M. Wedig
- Laboratory for the Study for Adult Development; McLean Hospital and the Department of Psychiatry; Harvard Medical School; Belmont MA USA
| | - L. C. Conkey
- Laboratory for the Study for Adult Development; McLean Hospital and the Department of Psychiatry; Harvard Medical School; Belmont MA USA
| | - G. M. Fitzmaurice
- Laboratory for the Study for Adult Development; McLean Hospital and the Department of Psychiatry; Harvard Medical School; Belmont MA USA
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Scholte WR, Eurelings-Bontekoe EHM, Tiemens BG, Verheul R, Meerman A, Hutschemaekers GJM. Association between level of personality organization as assessed with theory-driven profiles of the Dutch Short Form of the MMPI and outcome of inpatient treatment for personality disorder. Bull Menninger Clin 2014; 78:160-76. [PMID: 24870848 DOI: 10.1521/bumc.2014.78.2.160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The association between level of personality organization as assessed by theory-driven profile interpretation of the MMPI (Hathaway & McKinley, 1943) Dutch Short Form and treatment outcome was investigated in a naturalistic follow-up study among 121 psychotherapy inpatients who had been treated for their severe personality pathology. Treatment outcome was measured with the Brief Symptom Inventory (De Beurs & Zitman, 2006). Personality organization was associated with severity of psychopathology at baseline, the end of treatment, and 36 months after baseline. At 36 months after baseline, all patients except those with the high-level borderline organization profile and the psychotic borderline profile maintained their improvement. Contrary to expectations, (a) personality organization did not differentiate between patients with successful and unsuccessful out-comes, and (b) patients with a neurotic personality organization did not respond better than those with a borderline personality organization. Because of the small N, conclusions are tentative.
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Fossati A, Gratz KL, Maffei C, Borroni S. Impulsivity dimensions, emotion dysregulation, and borderline personality disorder features among Italian nonclinical adolescents. Borderline Personal Disord Emot Dysregul 2014; 1:5. [PMID: 26401289 PMCID: PMC4574387 DOI: 10.1186/2051-6673-1-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 03/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Contemporary theorists have suggested that impulsivity and emotion dysregulation are two of the core features of BPD. The aim of this study was to evaluate the relationships between Borderline Personality Disorder (BPD) features, impulsivity, and emotion dysregulation in adolescence. METHODS 1,157 nonclinical adolescents were administered the Borderline Personality Inventory, following which three groups of adolescents with high (high-BPD; n = 29), average (average-BPD; n = 31), and low (low-BPD; n = 31) levels of BPD features were selected. Participants in these three groups were administered the UPPS-P Impulsive Behavior Scale (UPPS-P) and the Difficulties in Emotion Regulation Scale (DERS). RESULTS UPPS-P Negative and Positive Urgency scales, as well as the DERS total score, significantly discriminated high-BPD adolescents from both other groups. The differences in UPPS-P Negative and Positive Urgency between high-BPD adolescents and both control groups remained significant when partialing out the variance associated with the DERS; However, when partialing out the variance associated with Positive and Negative Urgency, high-BPD adolescents reported significantly higher DERS scores than only the low-BPD control group (and not the average-BPD group). Finally, although the differences in Positive Urgency between high-BPD adolescents and both control groups remained significant when partialing out the variance associated with Negative Urgency, the between group differences in Negative Urgency did not remain significant when controlling for the variance associated with Positive Urgency. CONCLUSIONS These findings highlight the relevance of both emotion dysregulation and two dimensions of impulsivity (negative and positive urgency) to BPD features in adolescence, providing evidence for a unique association between BPD features and Positive Urgency in particular. These findings add to the literature in this area, suggesting that the tendency to act rashly in the context of intense positive affect may have unique relevance to BPD features in adolescence.
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Affiliation(s)
- Andrea Fossati
- />Department of Human Studies, LUMSA University, Rome, Italy
- />Servizio di Psicologia Clinica e Psicoterapia, San Raffaele Turro, via Stamira d’Ancona, 20, 20127 Milano, Italy
| | - Kim L Gratz
- />Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS USA
| | - Cesare Maffei
- />Faculty of Psychology, Vita-Salute San Raffaele University, Milano, Italy
| | - Serena Borroni
- />Faculty of Psychology, Vita-Salute San Raffaele University, Milano, Italy
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Borderline personality disorder and chronic pain: a practical approach to evaluation and treatment. Curr Pain Headache Rep 2014; 17:350. [PMID: 23801003 DOI: 10.1007/s11916-013-0350-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Patients with chronic pain present a spectrum of complexity that can be overwhelming for the individual practitioner. These patients require thoughtful care and a comprehensive treatment plan. This complexity should be acknowledged, not avoided, and the patient should be engaged, not shunned. A practical approach will assist in developing expertise and proceeding empathically. The presence of a superimposed personality disorder significantly increases the difficulty of caring for these patients. Studies investigating the prevalence of borderline personality disorder in patients with chronic pain averaged 30 %, highlighting the importance of being able to effectively treat this patient population. Appropriate management of these patients should focus on a collaboration to practice productive behaviors despite intense emotional distress. Longitudinal research provides a foundation for an optimistic prognosis that can be enhanced with this rehabilitative approach.
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Harned MS, Korslund KE, Linehan MM. A pilot randomized controlled trial of Dialectical Behavior Therapy with and without the Dialectical Behavior Therapy Prolonged Exposure protocol for suicidal and self-injuring women with borderline personality disorder and PTSD. Behav Res Ther 2014; 55:7-17. [PMID: 24562087 DOI: 10.1016/j.brat.2014.01.008] [Citation(s) in RCA: 190] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 01/27/2014] [Accepted: 01/30/2014] [Indexed: 01/18/2023]
Abstract
OBJECTIVE This study evaluates the efficacy of integrating PTSD treatment into Dialectical Behavior Therapy (DBT) for women with borderline personality disorder, PTSD, and intentional self-injury. METHODS Participants were randomized to DBT (n=9) or DBT with the DBT Prolonged Exposure (DBT PE) protocol (n=17) and assessed at 4-month intervals during the treatment year and 3-months post-treatment. RESULTS Treatment expectancies, satisfaction, and completion did not differ by condition. In DBT+DBT PE, the DBT PE protocol was feasible to implement for a majority of treatment completers. Compared to DBT, DBT+DBT PE led to larger and more stable improvements in PTSD and doubled the remission rate among treatment completers (80% vs. 40%). Patients who completed the DBT PE protocol were 2.4 times less likely to attempt suicide and 1.5 times less likely to self-injure than those in DBT. Among treatment completers, moderate to large effect sizes favored DBT+DBT PE for dissociation, trauma-related guilt cognitions, shame, anxiety, depression, and global functioning. CONCLUSIONS DBT with the DBT PE protocol is feasible, acceptable, and safe to administer, and may lead to larger improvements in PTSD, intentional self-injury, and other outcomes than DBT alone. The findings require replication in a larger sample.
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Affiliation(s)
- Melanie S Harned
- Behavioral Research and Therapy Clinics, Box 355915, University of Washington, Seattle, WA 98195-5915, USA.
| | - Kathryn E Korslund
- Behavioral Research and Therapy Clinics, Box 355915, University of Washington, Seattle, WA 98195-5915, USA
| | - Marsha M Linehan
- Behavioral Research and Therapy Clinics, Box 355915, University of Washington, Seattle, WA 98195-5915, USA
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Sack M, Sachsse U, Overkamp B, Dulz B. [Trauma-related disorders in patients with borderline personality disorders. Results of a multicenter study]. DER NERVENARZT 2014; 84:608-14. [PMID: 22743835 DOI: 10.1007/s00115-012-3489-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is current controversy about the diagnostic overlap between personality disorders and trauma-related disorders. PATIENTS AND METHODS Applying a multicenter study design, trauma-related disorders were investigated via interview assessment in 136 patients with borderline personality disorder (BPD) in 5 specialized treatment centers. Additionally a spectrum of psychological symptoms and prevalence of lifetime traumatic experiences were assessed by questionnaire measures. RESULTS Diagnostic overlap between BPD and PTSD was found to be high (79%) as well as the overlap of BPD with complex PTSD (55%) and severe dissociative disorders (41%). Including neglect and emotional violence as trauma categories, an extremely high prevalence of lifetime traumatic experiences was reported (96%). Experiences of sexual violence were reported by 48% of all female and 28% of all male patients. Severe forms of physical violence were reported by 65% of all patients. CONCLUSIONS BPD patients with severe psychopathology show a high comorbidity with trauma-related disorders including dissociative disorders. This association has to be taken into account when planning psychological treatment.
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Affiliation(s)
- M Sack
- Klinik für Psychosomatische Medizin und Psychotherapie, Klinikum rechts der Isar, Technische Universität München, Langerstrasse 3, Munich, Germany.
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A Case Study Approach to Mental Health Recovery: Understanding the Importance of Trauma-Informed Care. ACTA ACUST UNITED AC 2014. [DOI: 10.1891/1559-4343.16.3.167] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article documents one woman’s experience of mental health recovery using a case study approach. Specifically, qualitative data collected through a semistructured interview were triangulated with the medical record to understand more about how this woman experienced a transition from a period of her life marked by severe psychological and emotional impairment to an extended period of time during which she was thriving and did not experience symptoms consistent with her former diagnosis of severe mental illness. This case study offers important implications regarding the importance of trauma-informed care in the field of mental health.
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23
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Courtney-Seidler EA, Klein D, Miller AL. Borderline personality disorder in adolescents. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2013. [DOI: 10.1111/cpsp.12051] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hersh RG. Assessment and Treatment of Patients with Borderline Personality Disorder in the College and University Population. JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY 2013. [DOI: 10.1080/87568225.2013.824326] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Gescher DM, Will B, Malevani J. [Psychosocial integration of inpatients with borderline personality disorder: reflection of a health care system focused on symptom remission]. DER NERVENARZT 2013; 84:326-33. [PMID: 22318361 DOI: 10.1007/s00115-011-3462-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Borderline personality disorder (BPD) is characterized by a profound instability of identity, by stress and affect dysregulation and impulsivity, and by cognitive-perceptual disturbances. These deficits seriously impair interpersonal experiences and social interaction. The typical impulsive style and psychosocial malfunctioning of these patients lead to grave disturbances in their everyday areas of life with numerous break-ups in all relevant areas of life and entail inadequate vocational placement. Despite vast demands on the health care system, BPD attracts little attention of care process research and reintegration measures as, for instance, exist for schizophrenia. At the LVR-Klinikum Düsseldorf as representative of a large clinic in North Rhein-Westphalia, we analysed socio-demographic characteristics of BPD inpatients. The aims of the study were to substantiate the high impact of the disease on patient's social and vocational integration and to sensitize for significant aspects of disease-specific therapy and care. METHODS A retrospective analysis of DGPPN-BADO of all patients (n = 9,425) who were admitted between January 2004 and December 2009 to the LVR-Klinikum Düsseldorf, department of psychiatry and psychotherapy, Heinrich Heine University Hospital, Germany. Data analysis involved the divisions general psychiatry and addictive disorders and covered 999 patients with BPD (ICD-10: F60.3) and 1,937 patients with schizophrenia (ICD-10: F20). The defined characteristics of DGPPN-BADO that depict psychosocial integration were "living situation at admission", "highest academic/professional degree achieved", "working situation" und "livelihood". Besides descriptive statistics of the elected variables, comparative analysis of the diagnoses BPD and schizophrenia involved calculating group differences after adjusting the groups for sex and age. Statistical analysis was performed by the χ2-test. RESULTS The comparative analysis of psychosocially relevant BADO characteristics reveals a significantly stronger impairment of patients with BPD concerning their academic and professional qualification than patients with schizophrenia. Nevertheless they more often hold a job or cover their living expenses without subsidy, respectively. CONCLUSION The data suggest a lack of general awareness in the significance of social and vocational disturbances in BPD. The interactional deficits of patients with BPD affect all areas of life but their illness-related nature seems to be disregarded in relevant life areas, such as educational processes and the vocational situation. Furthermore, the impact of BPD on earning capacity is not given adequate consideration in the assessment of pensions or subsidies. Consistent with the recent literature, our socio-demographic data indicate significant deficits of the present health system in handling BPD.
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Affiliation(s)
- D M Gescher
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, LVR-Klinikum Düsseldorf, Heinrich-Heine-Universität, Bergische Landstr. 2, 40629 Düsseldorf, Deutschland.
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Harned MS, Tkachuck MA, Youngberg KA. Treatment preference among suicidal and self-injuring women with borderline personality disorder and PTSD. J Clin Psychol 2013; 69:749-61. [PMID: 23444147 PMCID: PMC4075754 DOI: 10.1002/jclp.21943] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES This study examined treatment preferences among suicidal and self-injuring women with borderline personality disorder (BPD) and PTSD. METHOD Women (N = 42, M(age) = 34) with BPD, PTSD and recent intentional self-injury were evaluated upon entry into a psychotherapy outcome study. RESULTS The majority preferred a combined dialectical behavior therapy (DBT) and prolonged exposure (PE) treatment (73.8%), followed by DBT alone (26.2%), and PE alone (0%). Women who preferred the combined treatment were more likely to report a desire to obtain relief from PTSD and to receive specific DBT and PE treatment components as reasons underlying this preference. Few women (21.4%) reported concerns about PE, but those who did were more likely to prefer DBT alone. More severe PTSD re-experiencing symptoms, a childhood index trauma, and less reduction in positive affect after a trauma interview predicted a preference for the combined treatment. CONCLUSIONS These results may help to inform treatment for these complex patients.
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Affiliation(s)
- Melanie S Harned
- Behavioral Research and Therapy Clinics, University of Washington, Seattle, WA, 98195-5915, USA.
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Loas G, Pham-Scottez A, Cailhol L, Perez-Diaz F, Corcos M, Speranza M. Axis II comorbidity of borderline personality disorder in adolescents. Psychopathology 2013; 46:172-5. [PMID: 23006475 DOI: 10.1159/000339530] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 05/17/2012] [Indexed: 11/19/2022]
Abstract
AIMS The objective of the present study was to explore the comorbidity of borderline personality disorder (BPD) with other personality disorders in adolescents and compare these comorbidities in male and female subjects. METHODS The sample was drawn from a European research project investigating the phenomenology of BPD in adolescence (EURNET BPD). A total of 85 BPD patients (11 boys and 74 girls) with a mean age of 16.3 years were included in the study. RESULTS According to the results of the Structured Interview for DSM-IV Disorders of Personality, obsessive-compulsive (35.3%), antisocial (22.4%), avoidant (21.2%), dependent (11.8%) and paranoid (9.4%) personality disorders had significant co-occurrences with BPD. Although none of the gender differences was statistically significant, we observed a trend towards higher rates of antisocial personality disorders in men (45.5%) than in women (19%). CONCLUSION The study results confirmed the frequency of Axis II comorbidity in adolescents with BPD and, for the first time, evidenced a differential pattern of comorbidity in males and females. This differential pattern must be taken into account when developing treatment strategies for adolescents with BPD.
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Affiliation(s)
- Gwenolé Loas
- Antenne de Psychiatrie, CHU d'Amiens, University of Picardie, Amiens, France.
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Rossouw TI, Fonagy P. Mentalization-based treatment for self-harm in adolescents: a randomized controlled trial. J Am Acad Child Adolesc Psychiatry 2012. [PMID: 23200287 DOI: 10.1016/j.jaac.2012.09.018] [Citation(s) in RCA: 374] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We examined whether mentalization-based treatment for adolescents (MBT-A) is more effective than treatment as usual (TAU) for adolescents who self-harm. METHOD A total of 80 adolescents (85% female) consecutively presenting to mental health services with self-harm and comorbid depression were randomly allocated to either MBT-A or TAU. Adolescents were assessed for self-harm, risk-taking and mood at baseline and at 3-monthly intervals until 12 months. Their attachment style, mentalization ability and borderline personality disorder (BPD) features were also assessed at baseline and at the end of the 12-month treatment. RESULTS MBT-A was more effective than TAU in reducing self-harm and depression. This superiority was explained by improved mentalization and reduced attachment avoidance and reflected improvement in emergent BPD symptoms and traits. CONCLUSIONS MBT-A may be an effective intervention to reduce self-harm in adolescents.
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Affiliation(s)
- Trudie I Rossouw
- North East London National Health Service (NHS) Foundation Trust, London, UK.
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Schuppert HM, Bloo J, Minderaa RB, Emmelkamp PMG, Nauta MH. Psychometric evaluation of the Borderline Personality Disorder Severity Index-IV--adolescent version and parent version. J Pers Disord 2012; 26:628-40. [PMID: 22867512 DOI: 10.1521/pedi.2012.26.4.628] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The Borderline Personality Disorder Severity Index-IV-adolescent and parent versions (BPDSI-IV-ado/p) are DSM-IV based semi-structured interviews for the assessment of the severity of symptoms of borderline personality disorder (BPD) in adolescents. The present study evaluates the psychometric properties of the BPDSI-IV-ado/p. The interviews were administered to 122 adolescents, aged 14-19 years and their parents/caretakers who were referred to mental health centres for emotion regulation problems, and to 45 healthy controls. The interrater reliability and internal consistency of all nine subscales (following the nine BPD symptoms in DSM-IV) proved to be good to excellent. Discriminant, concurrent, and construct validity were satisfactory. Cut-off scores that optimize sensitivity and specificity were derived. Informant agreement between adolescents and parents/caretakers was modest. The results of this study suggest that the BPDSI-IV adolescent and parent versions are valid and reliable instruments for the assessment of BPD symptom severity in adolescents.
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Goth K, Foelsch P, Schlüter-Müller S, Birkhölzer M, Jung E, Pick O, Schmeck K. Assessment of identity development and identity diffusion in adolescence - Theoretical basis and psychometric properties of the self-report questionnaire AIDA. Child Adolesc Psychiatry Ment Health 2012; 6:27. [PMID: 22812911 PMCID: PMC3485126 DOI: 10.1186/1753-2000-6-27] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 06/27/2012] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND In the continuing revision of Diagnostic and Statistical Manual (DSM-V) "identity" is integrated as a central diagnostic criterion for personality disorders (self-related personality functioning). According to Kernberg, identity diffusion is one of the core elements of borderline personality organization. As there is no elaborated self-rating inventory to assess identity development in healthy and disturbed adolescents, we developed the AIDA (Assessment of Identity Development in Adolescence) questionnaire to assess this complex dimension, varying from "Identity Integration" to "Identity Diffusion", in a broad and substructured way and evaluated its psychometric properties in a mixed school and clinical sample. METHODS Test construction was deductive, referring to psychodynamic as well as social-cognitive theories, and led to a special item pool, with consideration for clarity and ease of comprehension. Participants were 305 students aged 12-18 attending a public school and 52 adolescent psychiatric inpatients and outpatients with diagnoses of personality disorders (N = 20) or other mental disorders (N = 32). Convergent validity was evaluated by covariations with personality development (JTCI 12-18 R scales), criterion validity by differences in identity development (AIDA scales) between patients and controls. RESULTS AIDA showed excellent total score (Diffusion: α = .94), scale (Discontinuity: α = .86; Incoherence: α = .92) and subscale (α = .73-.86) reliabilities. High levels of Discontinuity and Incoherence were associated with low levels in Self Directedness, an indicator of maladaptive personality functioning. Both AIDA scales were significantly different between PD-patients and controls with remarkable effect sizes (d) of 2.17 and 1.94 standard deviations. CONCLUSION AIDA is a reliable and valid instrument to assess normal and disturbed identity in adolescents. Studies for further validation and for obtaining population norms are in progress and may provide insight in the relevant aspects of identity development in differentiating specific psychopathology and therapeutic focus and outcome.
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Affiliation(s)
- Kirstin Goth
- Child and Adolescent Psychiatric Hospital, Psychiatric University Hospitals Basel, Basel, Switzerland
| | - Pamela Foelsch
- Weill Medical College of Cornell University, New York, USA
| | - Susanne Schlüter-Müller
- Practice for Child and Adolescent Psychiatry, Frankfurt/Germany, and University of Applied Sciences FHNW, Basel, Switzerland
| | - Marc Birkhölzer
- Faculty of Medicine, Justus Liebig University, Giessen, Germany
| | - Emanuel Jung
- Child and Adolescent Psychiatric Hospital, Psychiatric University Hospitals Basel, Basel, Switzerland
| | - Oliver Pick
- Child and Adolescent Psychiatric Hospital, Psychiatric University Hospitals Basel, Basel, Switzerland
| | - Klaus Schmeck
- Child and Adolescent Psychiatric Hospital, Psychiatric University Hospitals Basel, Basel, Switzerland
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Barnicot K, Katsakou C, Bhatti N, Savill M, Fearns N, Priebe S. Factors predicting the outcome of psychotherapy for borderline personality disorder: a systematic review. Clin Psychol Rev 2012; 32:400-12. [PMID: 22681913 DOI: 10.1016/j.cpr.2012.04.004] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 04/13/2012] [Accepted: 04/23/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND There is substantial variation between individuals with borderline personality disorder (BPD) in the degree of benefit gained from psychotherapy. Information on factors predicting the outcome of therapy for this group could facilitate identification of those at risk for poor outcome, and could enable helpful therapy processes to be identified. METHOD A systematic search of PsycInfo, EMBASE, CINHAL and Medline identified research on factors predicting symptom change during therapy for patients with a BPD diagnosis. Non-English language papers and dissertations were included. RESULTS Two consistent positive predictors of symptom change were identified: pre-treatment symptom severity and patient-rated therapeutic alliance. Contrary to theories predicting increasing immutability with age, there was no evidence that age predicted poorer outcome. CONCLUSION More severely ill patients may have greater potential to achieve change during therapy, and should remain a focus for psychotherapy services. The therapeutic alliance is an important common factor predicting outcome in patients with BPD, even in highly disorder-specific treatments. Outcomes may be improved by further clinical and research focus on forming strong therapeutic alliances. The advancement of the field requires identification and testing of new predictors of outcome, especially those related to specific theories of therapeutic change in BPD.
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Affiliation(s)
- Kirsten Barnicot
- Unit for Social and Community Psychiatry, Queen Mary University of London, UK.
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Kvarstein EH, Karterud S. Large variations of global functioning over five years in treated patients with personality traits and disorders. J Pers Disord 2012; 26:141-61. [PMID: 22486446 DOI: 10.1521/pedi.2012.26.2.141] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of this study was to examine the long-term course of global functioning in patients with personality disorders (PD) and investigate predictors of variation. The Global Assessment of Functioning (GAF) was repeated over five years in 352 patients with PDs of varying severity, all treated in psychotherapeutic day hospitals. Growth models were used for statistical analysis. Large variations in the long-term course of global functioning were evident in this clinical sample. At five-year follow-up, 46% reached a GAF-score above 60 with a mean GAF-score of 71. Their linear change-rate over the five years was estimated to be 4.4 GAF points per year. The average five-year GAF-score for the remaining subgroup (54%) was 50 and their linear yearly change-rate was 0.8 GAF points. Greater relief of symptom distress and interpersonal problems was typical of patients with functional improvement. The number of avoidant PD criteria was associated with slower functional change.
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Stepp SD. Development of borderline personality disorder in adolescence and young adulthood: introduction to the special section. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2012; 40:1-5. [PMID: 22116635 DOI: 10.1007/s10802-011-9594-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Recognizable symptoms and features of borderline personality disorder (BPD) appear during adolescence. However, there has been resistance to diagnose or research this disorder prior to adulthood because of clinical lore that BPD is a long-standing illness and that personality traits are not stable until adulthood. This has resulted in little information regarding the development of and risk factors for BPD in youth. The goal of this special section is to examine the development of BPD in adolescence and young adulthood using a broad collection of approaches, including a theoretical review paper, two prospective studies, and a multi-method cross-sectional study. This body of work provides new insights into vulnerabilities that may transact with early attachment relationships and experiences to predict the emergence of BPD in adolescence and young adulthood. These papers also point to future research that is needed to better understand the etiology, development, and course of BPD.
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Affiliation(s)
- Stephanie D Stepp
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, 3811 O'Hara St., Pittsburgh, PA 15213, USA.
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Sanislow CA, Marcus KL, Reagan EM. Long-term outcomes in borderline psychopathology: old assumptions, current findings, and new directions. Curr Psychiatry Rep 2012; 14:54-61. [PMID: 22139609 DOI: 10.1007/s11920-011-0250-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Borderline personality disorder (BPD) and historical variants of the diagnosis were long held to represent an intractable syndrome of psychopathology consisting of interpersonal, intrapsychic, and affective disturbances. For years, patients labeled "borderline" were regarded pejoratively due at least in part to the lack of effective treatments. Prospective data from recent naturalistic follow-along studies along with the development of treatments with empirically demonstrated efficacy have changed how BPD is viewed. It is now less common to hide the diagnosis from the patient, and BPD has become a useful label to guide the treatment process and help the patient make sense of his or her suffering. Although it is now accepted that BPD is a treatment-responsive disorder and that remission is the norm, more work is needed to help patients achieve a higher level of functioning, and targeting persistent trait-like features suggests new directions for future efforts in treatment development.
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Affiliation(s)
- Charles A Sanislow
- Department of Psychology, Wesleyan University, 207 High Street/Judd Hall, Middletown, CT 06459, USA.
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Gabbard GO, Schmahl C, Siever LJ, Iskander EG. Personality disorders. HANDBOOK OF CLINICAL NEUROLOGY 2012; 106:463-475. [PMID: 22608638 DOI: 10.1016/b978-0-444-52002-9.00027-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Glen O Gabbard
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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Barrachina J, Pascual JC, Ferrer M, Soler J, Rufat MJ, Andión O, Tiana T, Martín-Blanco A, Casas M, Pérez V. Axis II comorbidity in borderline personality disorder is influenced by sex, age, and clinical severity. Compr Psychiatry 2011; 52:725-30. [PMID: 21349508 DOI: 10.1016/j.comppsych.2010.11.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 11/24/2010] [Accepted: 11/29/2010] [Indexed: 11/18/2022] Open
Abstract
Borderline personality disorder (BPD) is a severe psychiatric disorder that has a high clinical heterogeneity and frequent co-occurrence with other personality disorders (PDs). Although several studies have been performed to assess axis II comorbidity in BPD, more research is needed to clarify associated factors. The aim of this study was to determine the prevalence of co-occurrent axis II disorders in a large sample of patients with BPD and to investigate the influence of sex, age, and severity on this comorbidity. Data were collected from 484 patients with BPD through 2 semistructured interviews. We analyzed the frequency of axis II comorbidity and assessed differences regarding sex, age, and severity of BPD. About 74% of patients with BPD had at least 1 co-occurrent axis II disorder. The most common were paranoid, passive-aggressive, avoidant, and dependent PDs. Significant sex differences were found. Women presented more comorbidity with dependent PD, whereas men showed higher rates of comorbidity with antisocial PD. We also observed a significant positive correlation between age and the number of co-occurrent axis II disorders in women with BPD. Another finding was the positive correlation between BPD severity and the number of co-occurrent axis II disorders. These findings suggest that comorbidity with other axis II disorders and sex, age, and severity should be taken into account when developing treatment strategies and determining the prognosis of BPD.
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Affiliation(s)
- Judith Barrachina
- Centre de Psicoterapia de Barcelona Serveis Salut Mental (CPB-SSM), Universitat Autònoma de Barcelona, Barcelona, Spain.
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Fossati A, Feeney J, Maffei C, Borroni S. Does mindfulness mediate the association between attachment dimensions and Borderline Personality Disorder features? A study of Italian non-clinical adolescents. Attach Hum Dev 2011; 13:563-78. [DOI: 10.1080/14616734.2011.608993] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Lyons-Ruth K, Choi-Kain L, Pechtel P, Bertha E, Gunderson J. Perceived parental protection and cortisol responses among young females with borderline personality disorder and controls. Psychiatry Res 2011; 189:426-32. [PMID: 21872341 DOI: 10.1016/j.psychres.2011.07.038] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Revised: 06/25/2011] [Accepted: 07/31/2011] [Indexed: 12/16/2022]
Abstract
Borderline personality disorder (BPD) has been associated with deviations in cortisol in response to interpersonal stressors. Identifying mechanisms contributing to such deviations may help to address emotional dysregulation and the increased risk of self-destructive behavior. While dysfunctional relationships to caregivers have been widely reported among individuals with BPD, their contribution to cortisol hyperresponsiveness has yet to be investigated. Fifty-one females (aged 18-24years) participated to assess the impact of BPD and the quality of protective care in mother-daughter relationships on stress responsiveness. Seventeen females with BPD and twenty females without BPD participated with their mothers in a videotaped parent-young adult conflict discussion. Fourteen non-BPD females without their mothers were assessed for cortisol levels without stress exposure. Salivary cortisol samples were collected at lab entry and 20 and 40min after the onset of the discussion. Results revealed a higher overall cortisol response in the BPD group upon lab entry. BPD participants reported less experienced protection in the mother-daughter relationship which was associated with higher cortisol levels on lab entry and higher distress at study end. Results point to the perceived quality of parental protection as likely to modulate the activity of the stress response system among BPD patients.
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Affiliation(s)
- Karlen Lyons-Ruth
- Cambridge Health Alliance, Harvard Medical School, MA 02139-1407, USA.
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Baker C, Sambhi R, Wright L, Chesterman LP. Treatment terminable and interminable: implications of the mental health act 2007 in England and Wales for the treatment of borderline personality disorder. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2011; 21:227-232. [PMID: 21928366 DOI: 10.1002/cbm.797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Bos EH, van Wel EB, Appelo MT, Verbraak MJPM. Effectiveness of Systems Training for Emotional Predictability and Problem Solving (STEPPS) for borderline personality problems in a 'real-world' sample: moderation by diagnosis or severity? PSYCHOTHERAPY AND PSYCHOSOMATICS 2011; 80:173-81. [PMID: 21389754 DOI: 10.1159/000321793] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Accepted: 10/03/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a group treatment for borderline personality disorder (BPD). Two prior randomized controlled trials (RCTs) have shown the efficacy of this training. In both RCTs, patients with borderline features who did not meet the DSM-IV criteria for BPD were excluded, which were many. We investigated the effectiveness of STEPPS in a sample representative of routine clinical practice and examined whether DSM-IV diagnosis and/or baseline severity were related to differential effectiveness. METHODS Patients whom their practicing clinician diagnosed with BPD were randomized to STEPPS plus adjunctive individual therapy (STEPPS, n = 84) or to treatment as usual (TAU, n = 84). RESULTS STEPPS recipients showed more improvement on measures of general and BPD-specific psychopathology as well as quality of life than TAU recipients, both at the end of treatment and at a 6-month follow-up. Presence of DSM-IV-diagnosed BPD was not related to differential treatment effectiveness, but dimensional measures of symptom severity were; STEPPS was superior to TAU particularly in patients with higher baseline severity scores. CONCLUSIONS The findings show the effectiveness of STEPPS in a 'real-world' sample, and underscore the importance of dimensional versus categorical measures of personality disturbance.
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Affiliation(s)
- Elisabeth H Bos
- Lentis, University Medical Center Groningen, Groningen, The Netherlands.
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Borderline personality disorder: considerations for inclusion in the Massachusetts parity list of "biologically-based" disorders. Psychiatr Q 2011; 82:95-112. [PMID: 20882344 DOI: 10.1007/s11126-010-9154-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Borderline Personality Disorder (BPD) is a common and severe mental illness that is infrequently included under state mental health parity statutes. This review considers BPD parity, using the Massachusetts mental health parity statute as a model. While BPD can co-occur with other disorders, studies of its heritability, diagnostic validity/reliability, and response to specific treatments indicate it is best considered an independent disorder, one that negatively impacts the patient's treatment response to comorbid disorders, particularly mood disorders. Persons with BPD are high utilizers of treatment, especially emergency departments and inpatient hospitalizations-the most expensive forms of psychiatric treatment. While some patients remain chronically symptomatic, the majority improve. The findings from psychopharmacologic and other biologic treatment data, coupled with associated brain functioning findings, indicate BPD is a biologically-based disorder. Clinical data indicate that accurately diagnosing and treating BPD conserves resources and improves outcomes. Based on this analysis, insuring BPD in the same manner as other serious mental illnesses is well-founded and recommended.
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42
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Cailhol L, Bui E, Rouillon L, Bruno N, Lemoalle A, Faure K, Klein R, Lamy P, Guelfi JD, Schmitt L. [Differential indications for psychotherapies in borderline personality disorder]. Encephale 2011; 37 Suppl 1:S77-82. [PMID: 21600337 DOI: 10.1016/j.encep.2010.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Accepted: 02/11/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Borderline personality disorder (BPD) accounts for 10% of outpatient psychiatric practice. The risk of suicide attempts is high and the psychosocial impairment significant. Different theoretical streams have suggested psychotherapeutical approaches for BPD. OBJECTIVE to examine the efficacy of psychotherapy for BPD patients on affective symptoms, behavioural outcomes, interpersonal and social functioning, as well as BPD criteria. METHODS We reviewed the medical literature from 1990 to 2008 on Medline by combining the following keywords "borderline personality disorder" and "psychotherapy" (inclusion criteria). We restricted the analysis to "randomised control trial" or "meta analysis". RESULTS Of the 39 abstracts that came out from the search, we selected 17 (44%) after applying the exclusion criteria. According to our review, different types of psychotherapies have shown some efficacy on reducing affective symptoms and BPD criteria, as well as improving behavioural outcomes and psychosocial functioning. Dialectical behavioural therapy presents the best-documented efficacy, notably on reducing self-mutilating and suicidal behaviours (five randomized controlled trials [RCT]). Mentalization based treatment seems to be efficient on the four types of outcomes, but has been the object of only one RCT. Finally, some evidence suggests that Manual Assisted Cognitive Treatment and Systems Training for Emotional Predictability and Problem Solving are the most cost-effective and easiest to be implemented. CONCLUSION According to our review, some evidence supports an efficiency of psychotherapies in the management of several features of BPD. It is likely that, depending on the target symptoms, one type of therapy might be more efficient than another. The acceptability of these long-term treatments is however unknown.
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Affiliation(s)
- L Cailhol
- Inserm CIC 9302 Toulouse, hôpital Purpan, CHU de Toulouse, pavillon Riser, TSA 40031, 31059 Toulouse cedex 09, France.
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43
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Berrino A, Ohlendorf P, Duriaux S, Burnand Y, Lorillard S, Andreoli A. Crisis intervention at the general hospital: an appropriate treatment choice for acutely suicidal borderline patients. Psychiatry Res 2011; 186:287-92. [PMID: 20667602 DOI: 10.1016/j.psychres.2010.06.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Revised: 06/10/2010] [Accepted: 06/22/2010] [Indexed: 11/30/2022]
Abstract
This study investigated whether crisis intervention (CI) at the General Hospital is a suitable management strategy among borderline patients referred to the emergency room (ER) for deliberate self-harm. Two patient cohorts (n=200) meeting DSM-IV Borderline Personality Disorder criteria, were prospectively assessed for repeated deliberate self-harm and service consumption. At ER discharge, 100 subjects received CI, while 100 comparison subjects (recruited before the implementation of CI) were assigned to treatment as usual (TAU). At 3-month follow-up, a high proportion of repeated deliberate self-harm and hospitalization in the global study sample was found. However rates were lower in the CI group: 8% repeated deliberate self-harm and 8% psychiatric hospitalization, versus 17% and 56% in the TAU group. The global expenditure for psychiatric hospitalization was 728,840 Swiss Francs (CHF) for CI and 914,340 for TAU. This study indicates that associated with mean hospitalization/relapse rates, CI may be a suitable management strategy for acutely suicidal borderline patients.
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Affiliation(s)
- Annamaria Berrino
- Service de psychiatrie de liaison et d'intervention de crise, Geneva, Switzerland
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44
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De la Fuente JM, Bengoetxea E, Navarro F, Bobes J, Alarcón RD. Interconnection between biological abnormalities in borderline personality disorder: use of the Bayesian networks model. Psychiatry Res 2011; 186:315-9. [PMID: 20858567 DOI: 10.1016/j.psychres.2010.08.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 08/24/2010] [Accepted: 08/26/2010] [Indexed: 11/26/2022]
Abstract
There is agreement in that strengthening the sets of neurobiological data would reinforce the diagnostic objectivity of many psychiatric entities. This article attempts to use this approach in borderline personality disorder (BPD). Assuming that most of the biological findings in BPD reflect common underlying pathophysiological processes we hypothesized that most of the data involved in the findings would be statistically interconnected and interdependent, indicating biological consistency for this diagnosis. Prospectively obtained data on scalp and sleep electroencephalography (EEG), clinical neurologic soft signs, the dexamethasone suppression and thyrotropin-releasing hormone stimulation tests of 20 consecutive BPD patients were used to generate a Bayesian network model, an artificial intelligence paradigm that visually illustrates eventual associations (or inter-dependencies) between otherwise seemingly unrelated variables. The Bayesian network model identified relationships among most of the variables. EEG and TSH were the variables that influence most of the others, especially sleep parameters. Neurological soft signs were linked with EEG, TSH, and sleep parameters. The results suggest the possibility of using objective neurobiological variables to strengthen the validity of future diagnostic criteria and nosological characterization of BPD.
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Abstract
Recent research findings have contributed to an improved understanding and treatment of borderline personality disorder. This disorder is characterised by severe functional impairments, a high risk of suicide, a negative effect on the course of depressive disorders, extensive use of treatment, and high costs to society. The course of this disorder is less stable than expected for personality disorders. The causes are not yet clear, but genetic factors and adverse life events seem to interact to lead to the disorder. Neurobiological research suggests that abnormalities in the frontolimbic networks are associated with many of the symptoms. Data for the effectiveness of pharmacotherapy vary and evidence is not yet robust. Specific forms of psychotherapy seem to be beneficial for at least some of the problems frequently reported in patients with borderline personality disorder. At present, there is no evidence to suggest that one specific form of psychotherapy is more effective than another. Further research is needed on the diagnosis, neurobiology, and treatment of borderline personality disorder.
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Affiliation(s)
- Falk Leichsenring
- Department of Psychosomatics and Psychotherapy, University of Giessen, Germany.
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46
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Wright AGC, Pincus AL, Lenzenweger MF. Modeling stability and change in borderline personality disorder symptoms using the revised Interpersonal Adjective Scales-Big Five (IASR-B5). J Pers Assess 2010; 92:501-13. [PMID: 20954052 PMCID: PMC3928984 DOI: 10.1080/00223891.2010.513288] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Personality disorders have been defined as "stable over time." However, research now supports marked change in the symptoms of these disorders and significant individual variability in the trajectories across time. Using the Longitudinal Study of Personality Disorders (Lenzenweger, 2006), we explore the ability of the Revised Interpersonal Adjective Scales--Big Five (IASR-B5; Trapnell & Wiggins, 1990) to predict individual variation in initial value and rate of change in borderline personality disorder symptoms. The dimensions of the IASR-B5 predict variability in initial symptoms and rates of change. Interaction effects emerged between Dominance and Conscientiousness, Love and Neuroticism, and Conscientiousness and Neuroticism in predicting initial symptoms; and between Dominance and Love and Love and Neuroticism in predicting rates of change, suggesting that the effects of broad domains of personality are not merely additive but conditional on each other.
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Affiliation(s)
- Aidan G C Wright
- Department of Psychology, The Pennsylvania State University, USA
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47
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[Cognitive behavioral therapy for adolescents suffering from complex trauma disorder]. Prax Kinderpsychol Kinderpsychiatr 2010; 59:453-76. [PMID: 20795522 DOI: 10.13109/prkk.2010.59.6.453] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Complex Posttraumatic Stress Disorder and Developmental Trauma Disorder are discussed as new diagnostic entities representing the broad spectrum of trauma-related symptoms of children and adolescents. However, the psychotherapy of severe and complex trauma during adolescence is challenging because trauma-associated symptoms like attachment problems, the expectation of self-inefficacy and dissociation may complicate therapeutic work and limit treatment outcome. Therefore it is necessary to develop evidence-based treatment approaches for these mental disorders. Trauma-focused cognitive-behavioral therapy has been successfully evaluated for the treatment of posttraumatic stress disorder. Actual treatment approaches combine strategies from Dialectal Behavioral Therapy (DBT) with cognitive behavioral techniques of trauma therapy for the treatment of complex trauma disorder. This article gives a practical overview about cognitive-behavioral treatment approaches and discusses problems of their implementation in the clinical routine of child and adolescent psychiatrists/psychotherapists.
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48
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Wingenfeld K, Spitzer C, Rullkötter N, Löwe B. Borderline personality disorder: hypothalamus pituitary adrenal axis and findings from neuroimaging studies. Psychoneuroendocrinology 2010; 35:154-70. [PMID: 19837517 DOI: 10.1016/j.psyneuen.2009.09.014] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Revised: 08/31/2009] [Accepted: 09/14/2009] [Indexed: 01/24/2023]
Abstract
Borderline personality disorder (BPD) is a complex and serious mental disorder that is commonly seen psychiatric practice. Although stress, especially early life stress, seems to be associated with the development of the disorder, there has been far less research on the function of the hypothalamic-pituitary-adrenal (HPA) axis in BPD, compared to other psychiatric disorders, such as major depressive disorder and post-traumatic stress disorder. Stress has been suggested to exert damaging effects on the brain, particularly the hippocampus; therefore, neuroimaging studies yield important insight into the neurobiology of BPD. This article reviews research on the HPA axis and neuroimaging studies in BPD and aims to integrate these findings.
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Affiliation(s)
- Katja Wingenfeld
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf & Schön Klinik Hamburg-Eilbek, 20246 Hamburg, Germany.
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49
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Coid J, Yang M, Bebbington P, Moran P, Brugha T, Jenkins R, Farrell M, Singleton N, Ullrich S. Borderline personality disorder: health service use and social functioning among a national household population. Psychol Med 2009; 39:1721-1731. [PMID: 19250579 DOI: 10.1017/s0033291708004911] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND It is unclear whether Axis II psychopathology or co-morbid clinical syndromes result in the treatment-seeking behaviour and social impairment of patients with borderline personality disorder (BPD). This study examined the independent associations between social functioning and service use and Axis I and Axis II disorders in persons with BPD in the national household population of Britain. METHOD The study was a cross-sectional survey of adults aged 16-74 years in households (n=8397). Data included self-reported consultations with health-care professionals and behavioural problems. Diagnosis was determined by computer-assisted interviews. Analyses included logistic regression adjusting for demography, co-morbid Axis I clinical syndromes and other Axis II disorders. RESULTS Consultation in the past year was reported by 57.5% of persons with BPD but only 13.4% reported lifetime psychiatric admission. BPD was not independently associated with impaired functioning but was associated with co-morbid psychotic, depressive and anxiety disorders. Only general practitioners (GPs) were consulted for problems independently due to BPD. CONCLUSIONS Functional effects of BPD are mediated through co-morbid clinical syndromes, not Axis II psychopathology. A subgroup do not have co-morbid disorders or seek treatment, and are high functioning.
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Affiliation(s)
- J Coid
- University of London, UK.
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50
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Wingenfeld K, Rullkoetter N, Mensebach C, Beblo T, Mertens M, Kreisel S, Toepper M, Driessen M, Woermann FG. Neural correlates of the individual emotional Stroop in borderline personality disorder. Psychoneuroendocrinology 2009; 34:571-86. [PMID: 19042093 DOI: 10.1016/j.psyneuen.2008.10.024] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Revised: 10/22/2008] [Accepted: 10/22/2008] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Emotional dysregulation is a key feature of borderline personality disorder (BPD) with altered inhibitory functions having suggested as being crucial. The anterior cingulate cortex and further prefrontal brain regions are crucial for response inhibition. The regulation of emotions is ensured via inhibitory control over the amygdala. The present study aimed to investigate neural correlates of response inhibition in BPD by using an emotional Stroop paradigm extending the task to word stimuli which were related to stressful life events. METHODS Twenty BPD patients and 20 healthy controls underwent functional magnetic resonance imaging (fMRI) while performing the individual emotional Stroop task. A block design was used with the following word type conditions: neutral words, general negative words, and individual negative words. The individual negative words were recruited from a prior interview conducted with each participant. RESULTS While BPD patients had overall slower reaction times in the Stroop task compared to healthy controls, there was no increased slowing with emotional interference. Controls exhibited significant fMRI blood oxygenation level-dependent signal increases in the anterior cingulate cortex as well as in frontal cortex contrasting generally negative vs. neutral and individual negative vs. neutral conditions, respectively. BPD patients did not show equivalent signal changes. CONCLUSIONS These results provide further evidence for a dysfunctional network of brain areas in BPD, including the ACC and frontal brain regions. These areas are crucial for the regulation of stress and emotions, the core problems of BPD patients.
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Affiliation(s)
- Katja Wingenfeld
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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