Borderline personality disorder (BPD) is associated with a high risk of suicide. Despite several risk factors being known, identifying vulnerable patients in clinical practice remains a challenge so far. The current study aimed at predicting suicide attempts among BPD patients during disorder-specific psychotherapeutic interventions exploiting machine learning techniques. The study took into account several potential predictors relevant to BPD psychopathology: emotion dysregulation, temperamental and character factors, attachment style, impulsivity, and aggression. The sample included 69 patients with BPD who completed the Temperament and Character Inventory, Attachment Style Questionnaire, Difficulties in Emotion Regulation Scale, Barratt Impulsiveness Scale, and Aggression Questionnaire at baseline and after 6 months of psychotherapy. To detect future suicide attempts, baseline questionnaires were entered as predictors into an elastic net penalized regression, whose predictive performance was assessed through nested fivefold cross-validation. At the same time, 5000 iterations of a non-parametric bootstrap were used to determine predictors' robustness. The elastic net model discriminating BPD suicide attempters from non-attempters reached a balanced accuracy of 64.09% and an area under the receiver operating curve of 70.44%. High preoccupation with relationships, harm avoidance, and reward dependence, along with low motor impulsiveness, verbal aggression, cooperativeness, and self-transcendence were the most contributing predictors. Our findings suggest that interpersonal vulnerability and internalizing factors are the strongest predictors of future suicide attempts in BPD. Machine learning on self-report psychological scales may be helpful to identify individuals at suicidal risk, potentially helping clinical settings to develop individualized preventive strategies.

Borderline personality disorder (BPD) is marked by emotional instability, interpersonal dysfunction, and high comorbidity, posing significant treatment challenges. Metacognitive Interpersonal Therapy (MIT) targets core features of BPD, including metacognitive impairments and emotional dysregulation. This study used Latent Transition Analysis to assess changes in BPD symptoms and psychological factors over a 12-month MIT intervention, hypothesizing that MIT will reduce symptom severity and improve emotional regulation, metacognitive abilities, and interpersonal functioning.

This single-center, retrospective, observational study included 98 patients, all diagnosed with BPD according to DSM-IV-TR criteria, without severe psychiatric comorbidities or concurrent psychotherapy. These patients underwent a 12-month MIT intervention, delivered in five phases, targeting metacognitive and emotional regulation skills. Clinical assessments included the Structured Clinical Interview for DSM Axis II Disorders for BPD diagnosis, Symptom Cecklist-90-Revised for symptom severity, Metacognition Assessment Interview for metacognitive abilities, and IIP for interpersonal difficulties.

Latent Class Analysis identified three baseline profiles: "Affective dysregulation and anger" (14.3%), "Low symptomatic" (7.1%), and "Identity and interpersonal sensitivity" (78.6%). After 12 months of treatment, most participants (58.2%) transitioned to a "Recovered" class, with significant reductions in BPD symptoms. The "Recovered" class showed the greatest improvements in metacognitive abilities, emotional regulation, and interpersonal functioning compared to other groups.

MIT was associated with significant improvements in BPD symptoms, with over half of participants achieving full recovery. These findings suggest that MIT may play a role in enhancing emotional regulation and interpersonal functioning. However, residual symptoms in some participants confirm the complexity of BPD, suggesting the need for further research into long-term outcomes and comorbidities.

More than half of all people with borderline personality disorder will develop alcohol use disorder in their lifetime. These disorders mutually reinforce each other, with a higher risk for treatment failure and poor outcomes, including suicide, yet no widely available treatments have been found to be effective for both diagnoses concurrently, leaving patients and clinicians alike stranded between two clinical domains that rarely overlap despite shared features. In the absence of alternatives, good psychiatric management (GPM) capitalizes on standard-of-care interventions using generic clinical tools that do not require specialization. In an effort to broaden and stabilize the social networks of connections for patients with interpersonal hypersensitivity, GPM relies on a multimodal approach that combines the indicated pharmacological and psychosocial interventions for the treatment of alcohol use disorder with a common-factors approach for borderline personality disorder. This multimodal approach emphasizes psychoeducation, social rehabilitation, management of suicidality, and active management of these frequently comorbid conditions. In this article, the authors describe GPM's strategy of stabilizing and broadening the patient's social network to target the core interpersonal and stress hypersensitivity. To do this, clinicians can use interventions for significant others combined with empirically supported and widely available mutual-help groups, such as Alcoholics Anonymous, that structure and regulate relational instabilities with community norms, standards, roles, and procedures. GPM also promotes family interventions for both conditions to reduce conflict and increase support within existing relationships, thereby strengthening patients' capacity to work on their sobriety and borderline personality disorder by mitigating aloneness and its effects.

Borderline personality disorder and eating disorders frequently co-occur among youths. These disorders emerge in adolescence, during the critical developmental period of building an independent sense of self and the capacity to relate to one's community. Because of core differences in the development and psychopathology of borderline personality disorder and eating disorders, adjustments are required when treating these disorders when they co-occur. Few established treatment approaches can address these disorders simultaneously. Evidence-based psychotherapies for borderline personality disorder, such as dialectical behavior therapy and mentalization-based treatment, have been adapted to accommodate the shared vulnerabilities and features of the two disorders. However, these approaches are specialized, intensive, and lengthy and are therefore poorly suited to implementation in general psychiatric or primary health care, where most frontline mental health care is provided. Generalist approaches can fill this public health gap, guiding nonspecialists in structuring informed clinical management for these impairing and sometimes fatal disorders. In this overview, the authors describe the adjustment of good (or general) psychiatric management (GPM) for adolescents with borderline personality disorder to incorporate the prevailing best practices for eating disorder treatment. The adjusted treatment relies on interventions most clinicians already use (diagnostic disclosure, psychoeducation, focusing on life outside treatment, managing patients' self-destructive behaviors, and conservative psychopharmacology with active management of comorbid conditions). Limitations of the adjusted treatment, as well as guidelines for referring patients to specialized and general medical treatments and for returning them to primary generalist psychiatric care, are discussed.

Good psychiatric management (GPM) for borderline personality disorder is a generalist strategic case management approach used by helping professionals of different training backgrounds to work with patients with borderline personality disorder. GPM includes a flexibly administered once-weekly psychotherapy for which a brief introductory course in GPM alone is considered sufficient preparation. GPM integrates concepts from specialized evidence-based treatments for borderline personality disorder, including transference-focused psychotherapy (TFP). This article describes the TFP elements that John Gunderson acknowledged as influential to his development of GPM. A basic introduction to TFP is provided, and elements in GPM that interweave with TFP's theoretical foundation are elucidated and then illustrated in a clinical vignette that captures the GPM clinician's interventions influenced by these ideas. The vignette is then used to illustrate clinical tools informed by TFP principles and common to both GPM and TFP.

Borderline personality disorder (BPD) is a serious psychiatric condition, especially stigmatized in women. Stigma is a social injustice, as it discredits and reduces the wholeness of a person to one of taint and discount. Psychological scientists play a uniquely powerful role in the stigmatization and destigmatization of BPD by constructing the meaning of BPD at each step of the research process. We discuss this powerful role and how to destigmatize BPD by incorporating an intersectionality framework that includes disability as a category of difference (as with gender, race, and sexuality). This framework centers the role of systems and structures in creating and maintaining stigma, while emphasizing the close interactions between interpersonal and structural stigma. This article illustrates researchers' power to assign meaning to BPD in research and highlights the importance of considering individuals as embedded in intersectional social categories, which are multidimensional and dynamic in nature. We propose that intersectional cultural humility, with its social justice aim and feminist origins, can guide BPD researchers to conduct nonstigmatizing and rigorous research on BPD. To inform clinical practice and advance social justice, we offer action steps for researchers to destigmatize BPD with intersectional cultural humility at multiple steps in the research process.

Empirically-based developmental psychopathology approach identified three domains involved in the emergence of borderline personality disorder (BPD): i) underlying liabilities to develop psychopathology (i.e., early patterns of internalizing and externalizing manifestations); ii) invalidating relational experiences (e.g., childhood traumatic experiences, maladaptive parenting, problematic peer relationships); iii) regulatory mechanisms of emotions and behaviors. Nevertheless, no studies have quantitatively summarized empirical findings concerning how and to what extent these domains might be temporally associated to the emergence of BPD features from adolescence to adulthood.

The current multi-level meta-analysis included 106 studies (N = 86,871 participants) assessing the role of previously mentioned antecedents and risk factors for BPD.

The analysis showed moderate effect sizes capturing temporal associations between early internalizing/externalizing psychopathological manifestations, different invalidating relational experiences, emotion/behavior regulation processes with later BPD features. The effect sizes of these domains were not statistically different from each other.

This evidence supports a transactional developmental model of BPD. Consistently, the emergence of BPD could be viewed in the light of dynamic interplays between an underlying liability to psychopathology and invalidating relational experiences across different stages of development, which are progressively reinforced through increasing alterations of emotion and behavior regulation mechanisms.

This study aimed to quantify the instability of psychotherapy process variables by using a novel data-analytic approach. The study explored instability of the working alliance over 10 treatment sessions and its relationship with self-esteem.

Data were extracted from a randomized controlled trial, conducted in Switzerland, of a short-term intervention for borderline personality disorder. Sixty clients diagnosed as having borderline personality disorder were randomly assigned to receive either 10 sessions of good psychiatric management-brief version (GPM-BV) or GPM-BV combined with a relational principle called motive-oriented therapeutic relationship. Square successive differences were calculated for client and therapist ratings of alliance instability. Multilevel models were used to test within- and between-person associations of alliance instability with self-esteem.

Although some preliminary analyses showed an association between a more stable alliance and higher self-esteem at the start of psychotherapy, the alliance did not become more stable over time. Alliance instability was not associated with self-esteem at either the within- or between-person level.

This study highlights the advantages, procedures, and challenges of applying square successive differences to psychotherapy research data. The results suggest that the working alliance develops in complex ways and indicate the importance of continuing to use novel methods to capture dynamic psychotherapy processes.

The prevalence of borderline personality disorder (BPD) in the general population is estimated to be 1.8 % whereas the rates of BPD among people in prison have been reported between 9 and 30 %. To date, there are no published systematic reviews into the rates of BPD among adults in prison. Understanding the prevalence of BPD in this setting can help to inform prison-staff education, funding and intervention options, and adequate care for an already at-risk population. We aimed to explore the global prevalence of BPD diagnoses and self-reported symptomology among adults in prisons via systematic review and meta-analysis. We also aimed to explore gender differences between women and men in prison. Following the PRISMA guidelines, we conducted a systematic review and meta-analysis of papers where a BPD diagnosis or self-reported symptoms were reported within a prison population of male or female adult offenders (18+ years). Our search yielded 33 studies comprising diagnostic interviews, and 15 studies which included self-reported symptom measures. The results indicated that for women and men in prison, the prevalence of BPD was (27.4 % and 18.8 %, respectively) when assessed via diagnostic interview. Results were similar for both women and men in studies that used a self-report measure to assess a BPD diagnosis (29.1 % and 16.4 %). Findings suggest that the prevalence of BPD in prisons should be considered when making decisions about mental health and criminogenic interventions. Self-report measures could be a resource-efficient method for screening prisoners for personality pathology in prison settings. Contemporary, well-structured, large-scale studies are required to better understand the prevalence of personality disorder in prisons.

Background: The move from inconsistent and problematic autobiographical narrative to a more coherent and reality-based narrative construction of the Self has been discussed as potential mechanism of change in psychotherapies for personality disorders. So far, little empirical evidence exists that demonstrates in a time-dependent design the role of narrative construction in the treatment of borderline personality disorder, in particular when it comes to understanding the integration of body-related information from the affective system with the autobiographical narrative. The present study aims at demonstrating change in emotion-based narrative markers over brief psychiatric treatment and to assess the impact of these changes on subsequent symptom change. Methods: A total of N = 57 clients with borderline personality disorder were assessed at three timepoint over the course of four months of brief psychiatric treatment, within the context of a secondary process-outcome analysis of a randomized controlled trial. Symptom change was assessed using the OQ-45.2 and emotion-narrative change was assessed using the Narrative-Emotion Process Coding System to code client's in-session speech in terms of problem, transition and change markers. Results: All three emotion-based marker categories evidenced significant changes in the assumed direction. The reduction in problem emotion-based narrative markers (e.g., empty story telling) between session 1 and 5 into the treatment predicted the symptom reduction assessed between session 5 and 10. Conclusions: Emotion-based narrative construction may be a suitable method to study the pathway of change toward a more coherent and reality-based narrative construction of the Self-in-interaction-with-the-Other. Reduction of emotion-based problem-marker may be a promising candidate for a mechanism of change in treatments for personality disorders which should be tested in a time-dependent controlled design.

Dialectical Behaviour Therapy (DBT) is an evidence-based treatment for borderline personality disorder (BPD), with findings demonstrating improvements in various BPD features and related behaviours, such as nonsuicidal self-injury (NSSI). Theory and research suggest that reductions in emotion dysregulation and interpersonal dysfunction could account for at least some of the reduction in NSSI observed during the course of DBT. The current research investigated: 1) the trajectory of changes in emotion dysregulation, interpersonal dysfunction, and NSSI over the course of DBT, and 2) whether changes in emotion dysregulation mediate the relationship between changes in interpersonal dysfunction and changes in NSSI over treatment. One hundred and twenty individuals with BPD enrolled in a multi-site randomized-clinical trial were assessed at five timepoints over 12 months of standard DBT. Results indicated that interpersonal dysfunction and NSSI decreased over the course of DBT. Emotion dysregulation decreased in a quadratic manner such that most of the gains in emotion dysregulation occurred in earlier phases of DBT. Although changes in interpersonal dysfunction predicted changes in emotion dysregulation, changes in emotion dysregulation did not mediate the relationship between changes in interpersonal dysfunction and changes in NSSI.

Families and significant others of people with borderline personality disorder (BPD) show increased levels of psychological distress. Family Connections®, a 12-week group intervention based on the principles of Dialectical Behavior Therapy, was designed to provide families with both information about the disorder and emotion regulation skills. It has been progressively implemented in French-speaking European countries.

We conducted an observational, multicenter study in France and Switzerland. In total, 149 participants of the Family Connections program were included among five centers. Burden, depression, coping, and emotion regulation were assessed before and after the intervention.

One-way repeated measures MANOVA showed that the burden, depressive symptoms, emotion regulation and coping all changed significantly after the intervention (p < 0.001, partial η2 = 0.297). T-tests showed that the burden significantly decreased after the intervention (p < 0.0001, d = -0.48), as did depressive symptoms (p < 0.0001, d = -0.36) and difficulties in emotion regulation (p < 0.0001, d =-0.32) whereas coping improved (p < 0.0001, d = 0.53). Two-way mixed ANOVA showed that burden reduction was stronger among female than male participants (p = 0.048, η2 = 0.027). Before the intervention, the burden was higher for female than male participants (p < 0.001). An initial linear regression showed the burden reduction to be associated with a decrease in the resignation of the participants (β = 0.19, p = 0.047). A second linear regression showed the burden reduction to be associated with the intensity of the relatives' symptoms at baseline (β = 0.22, p = 0.008) and improvement of emotional clarity of the participants (β = 0.25, p = 0.006).

This Dialectical Behavior Therapy-Based psychoeducational intervention is an appropriate way to support French-speaking European families of people with BPD.

While we know childhood experiences are influential on a child's later socioemotional awareness and behavior, we are still searching for specific mechanisms that influence the transferability of childhood experiences and adult relationship functioning. In this study, we seek to further this area of investigation by examining the interpretation of ambiguous social interactions and perceptions of emotional invalidation as potential mediators of the relationship between perceptions of childhood emotional invalidation and current relationship quality. Participants completed online measures of hostile intent attributions, perceptions of childhood emotional invalidation, and current relationship quality with a significant other. They read emotionally provocative interpersonal scenarios and then reported likely emotionally invalidating reactions from their significant other to measure current perceptions of emotional invalidation. Results supported our hypotheses that perceptions of current emotional invalidation in a close, personal relationship would mediate the relationship between perceptions of childhood maternal emotional invalidation and both current relationship support and relationship conflict. Furthermore, the strength of this mediational pathway outweighed the influence of a more general hostile attribution bias. These findings have implications for prevention and intervention strategies designed to enhance interpersonal functioning.

Several studies have observed that mentalization-based treatment (MBT) is an effective treatment for borderline personality disorder (BPD), but its effectiveness for other personality disorders (PDs) has hardly been examined. Additionally, the evidence supporting the claim that MBT improves mentalizing capacity is scarce. The present study examined whether (i) patients with a broad range of PDs enrolled in an MBT program would improve on several outcome measures (ii) mentalizing capacity would improve over time; (iii) patients with BPD would improve more than those with non-borderline PDs.

Personality disorders, psychiatric symptoms, social functioning, maladaptive personality functioning and mentalizing capacity were measured in a group of individuals with various PDs (n = 46) that received MBT. Assessments were made at baseline and after 6, 12, and 18 months of treatment. The severity of psychiatric symptoms, measured using the Outcome Questionnaire 45, was the primary outcome variable.

Overall, enrollment in the MBT program was associated with a decrease in psychiatric symptoms and an improvement of personality functioning, social functioning for a mixed group of PDs (all p's ≤ .01). Bigger effect sizes were observed for BPD patients (n = 25) than for patients with non-BPD (n = 21), but the difference failed to reach statistical significance (p = 0.06). A primary analysis showed that the decrease in psychiatric symptoms was significant in BPD patients (p = 0.01), not in non-BPD (p = 0.19) patients. However, a sufficiently powered secondary analysis with imputed data showed that non-BPD patients reported a significant decrease in psychiatric symptoms too (p = 0.01). Mentalizing capacity of the whole group improved over time (d = .68 on the Toronto Alexithymia Scale and 1.46 on the Social Cognition and Object Relations System).

These results suggest that MBT coincides with symptomatic and functional improvement across a broad range of PDs and shows that MBT is associated with improvements in mentalizing capacity. As the study is not experimental in design, we cannot make causal claims.

Mentalization-based treatment may be an effective treatment for patients with a broad range of PDs.

The study design was approved by the Leiden University Ethical Committee.

A significant number of borderline personality disorder (BPD) symptoms are manifested in the interpersonal context. This can be explained by the difficulties in attributing the mental states of oneself and others, which constitutes social cognition. Errors in social cognition are interrelated with the affective, cognitive, impulsive, and interpersonal areas of the person with BPD. The aims of this study was to analyze social cognition in women with BPD compared with a control group and to analyze social cognition in BPD based on BPD symptoms and its severity. To assess social cognition, we used a full range of social cognition categories provided by the Movie for the Assessment of Social Cognition (MASC): correct theory of mind (ToM); attribution of mental states (thoughts, emotions, or intentions); errors of mentalization; types of ToM; and attribution of mental states through perceptive or cognitive cues and through hot or cold emotions. The MASC has high ecological validity and has been validated in Spanish. The sample comprised 79 women, including 47 women with BPD and 32 healthy women. Worse social cognition performance was observed in women with BPD. More severe borderline symptoms were related to worse functioning in the correct ToM and to errors of no mentalization. Involvement of the cognitive area in borderline symptoms was associated with worse functioning in correct ToM and worse social cognition in cognitive areas as well as with hypermentalization. This is the first study that uses all the MASC categories and considers BPD heterogeneity and its severity to study social cognition.

Borderline Personality Disorder (BPD) symptoms include inappropriate control of anger and severe emotional dysregulation after rejection in daily life. Nevertheless, when using the Cyberball paradigm, a tossing game to simulate social exclusion, the seven basic emotions (happiness, sadness, anger, surprise, fear, disgust, and contempt) have not been exhaustively tracked out. It was hypothesized that these patients would show anger, contempt, and disgust during the condition of exclusion versus the condition of inclusion. When facial emotions are automatically detected by Artificial Intelligence, "blending", -or a mixture of at least two emotions- and "masking", -or showing happiness while expressing negative emotions- may be most easily traced expecting higher percentages during exclusion rather than inclusion. Therefore, face videos of fourteen patients diagnosed with BPD (26 ± 6 years old), recorded while playing the tossing game, were analyzed by the FaceReader software. The comparison of conditions highlighted an interaction for anger: it increased during inclusion and decreased during exclusion. During exclusion, the masking of surprise; i.e., displaying happiness while feeling surprised, was significantly more expressed. Furthermore, disgust and contempt were inversely correlated with greater difficulties in emotion regulation and symptomatology, respectively. Therefore, the automatic detection of emotional expressions during both conditions could be useful in rendering diagnostic guidelines in clinical scenarios.

Interpersonal hypersensitivity (IHS) is a core organizing concept of Good Psychiatric Management, a generalist treatment for borderline personality disorder (BPD) that relies on basic tools most clinicians already employ yet is informed by an organized and evidence-based framework, developed for dissemination in various mental health care settings. We work in an inpatient psychiatric unit that specializes in the management of suicidal crises at the University Hospitals of Geneva, Switzerland. Because we see numerous patients with previously undiagnosed BPD during their first hospitalization, we have developed techniques and instruments to promote efficient and easy-to-implement psychoeducation. In this article, we propose a practical and user-friendly measure of IHS that is well-suited for use by multidisciplinary inpatient staff or outpatient nursing-based staff, the IHS Ruler, which is based on a visual analog scale. It is a pragmatic tool for preliminary psychoeducation for patients with BPD and their caregivers. Its ease of use and structured way of presenting the inner experience of these patients in relation to their current interpersonal environment allows caregivers to establish a framework for internal reflection and sharing, discuss the causes of current transactions, and illuminate larger patterns in the causes of the patient's crises. Ultimately, this process can help patients and the clinical staff supporting them anticipate future problems.

People often form polarized beliefs, imbuing objects (e.g., themselves or others) with unambiguously positive or negative qualities. In clinical settings, this is referred to as dichotomous thinking or "splitting" and is a feature of several psychiatric disorders. Here, we introduce a Bayesian model of splitting that parameterizes a tendency to rigidly categorize objects as either entirely "Bad" or "Good," rather than to flexibly learn dispositions along a continuous scale. Distinct from the previous descriptive theories, the model makes quantitative predictions about how dichotomous beliefs emerge and are updated in light of new information. Specifically, the model addresses how splitting is context-dependent, yet exhibits stability across time. A key model feature is that phases of devaluation and/or idealization are consolidated by rationally attributing counter-evidence to external factors. For example, when another person is idealized, their less-than-perfect behavior is attributed to unfavorable external circumstances. However, sufficient counter-evidence can trigger switches of polarity, producing bistable dynamics. We show that the model can be fitted to empirical data, to measure individual susceptibility to relational instability. For example, we find that a latent categorical belief that others are "Good" accounts for less changeable, and more certain, character impressions of benevolent as opposed to malevolent others among healthy participants. By comparison, character impressions made by participants with borderline personality disorder reveal significantly higher and more symmetric splitting. The generative framework proposed invites applications for modeling oscillatory relational and affective dynamics in psychotherapeutic contexts. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Treatment trials for borderline personality disorder (BPD) have consistently demonstrated that approaches that are diagnostically tailored are superior to those which are not. Currently, gold standard treatments for BPD are highly intensive, lengthy, and specialized, leading to a critical gap between the supply and demand of effective, evidence-based treatment for patients who receive a diagnosis of BPD. Psychoeducation, which is a common component of most treatments known to be effective, is a low-cost, low-burden intervention proven to relieve symptoms. The present study builds on psychoeducation research, assessing online video prescriptions as a means of disseminating information patients need to know about their diagnosis and care.

This article presents the study protocol for a safety, feasibility, and preliminary efficacy trial of psychoeducational video prescriptions and online assessment with feedback for newly diagnosed individuals with BPD. We aim to recruit 100 adults recently diagnosed with BPD to be randomly assigned to receive videos about BPD or videos about non-BPD mental health topics that are matched in length in the first step of the study. All participants will complete daily surveys about their emotions, interpersonal interactions, and behaviors, as well as self-report assessments and cognitive tests at 4 different time points. Half of the participants in the intervention group will receive feedback on their symptom ratings and cognitive test performance to assess whether there is incremental value in tailoring this online set of interventions with individualized feedback unique to each participant. This study aims to assess the effects of BPD-focused psychoeducational videos with and without personalized feedback, on BPD and depressive symptom severity as well as core mechanisms of the disorder such as loneliness, rejection sensitivity, cognitive control difficulties, and self-clarity. Results will inform efforts to progress to a larger, more definitive trial.

Clinical trials registration: The protocol is registered with ClinicalTrials.gov NCT05358925.

Compelling evidence supports the role of childhood traumatization in the etiology of psychiatric disorders, including adult attention-deficit hyperactivity disorder (aADHD) and borderline personality disorder (BPD). The aim of this study was to examine the psychometric properties of the Hungarian version of the Childhood Trauma Questionnaire Short Form (H-CTQ-SF) and to investigate the differences between patients diagnosed with aADHD and BPD in terms of early traumatization.

Altogether 765 (mean age = 32.8 years, 67.7% women) patients and control subjects were enrolled from different areas of Hungary. Principal component analysis and confirmatory factor analysis were carried out to explore the factor structure of H-CTQ-SF and test the validity of the five-factor structure. Discriminative validity was assessed by comparing clinical and non-clinical samples. Subsequently, aADHD and BPD subgroups were compared with healthy controls to test for the role of early trauma in aADHD without comorbid BPD. Convergent validity was explored by measuring correlations with subscales of the Personality Inventory for DSM-5 (PID-5).

The five scales of the H-CTQ-SF demonstrated adequate internal consistency and reliability values. The five-factor model fitted the Hungarian version well after exclusion of one item from the physical neglect scale because of its cross-loading onto the emotional neglect subscale. The H-CTQ-SF effectively differentiated between the clinical and non-clinical samples. The BPD, but not the aADHD group showed significant differences in each CTQ domain compared with the healthy control group. All CTQ domains, except for physical abuse, demonstrated medium to high correlations with PID-5 emotional lability, anxiousness, separation insecurity, withdrawal, intimacy avoidance, anhedonia, depressivity, suspiciousness, and hostility subscales.

Our study confirmed the psychometric properties of the H-CTQ-SF, an easy-to-administer, non-invasive, ethically sound questionnaire. In aADHD patients without comorbid BPD, low levels of traumatization in every CTQ domain were comparable to those of healthy control individuals. Thus, the increased level of traumatization found in previous studies of aADHD might be associated with the presence of comorbid BPD. Our findings also support the role of emotional neglect, emotional abuse and sexual abuse in the development of BPD.

Healthcare workers encountered novel job stressors during the late stage of the COVID-19 pandemic. These stressors possessed potential deleterious effects on mental health outcomes, yet the underlying mediating and moderating mechanisms remained relatively unexplored.

The current study aimed to examine the role of cognitive emotion regulation as a mediator in the association between pandemic-related job stressors and the psychological symptoms of healthcare professionals in the late stage of the COVID-19 pandemic, and the role of reflective functioning as a resilience factor moderating both the associations of pandemic-related job stressors and cognitive emotion regulation, as well as psychological symptoms.

This cross-sectional survey conducted in October 2020 included 2393 healthcare professionals working in departments with a high risk of exposure to COVID-19 from 22 hospitals in Beijing, China. Participants were asked to complete questionnaires measuring pandemic-related job stressors, anxiety, depression, reflective functioning, and cognitive emotion regulation strategies. Path analyses were performed to examine the hypothesized model.

Epidemic-related job stressors had significant direct effects on depression (β=0.31, p<0.001) and anxiety symptoms (β=0.29, p<0.001) and the indirect effects through mediation of maladaptive cognitive regulation were also significant (for depression, indirect effect=0.06, SE=0.01, CI=[0.04, 0.07]; for anxiety, indirect effect=0.06, SE=0.01, CI=[0.04, 0.08]). The dimension of certainty about mental states in the reflective functioning questionnaire (RFQc) moderated the direct effect of pandemic-related job stressors on depression (β=-0.05, p<0.001) and moderated the effect of job stressors on maladaptive cognitive regulation (β=0.06, p<0.001).

The results shed light on the roles of cognitive emotion regulation and reflective functioning in coping with pandemic-related job stressors in frontline healthcare workers in periods of dealing with major infectious diseases. The findings have implications for developing interventions for healthcare workers in need.

Individuals suffering from borderline personality disorder (BPD) show a pervasive sense that others cannot be trusted, are vulnerable to negative therapeutic reactions, and can oscillate between idealized and persecutory interactions with others. These trust processing impairments impact both the immediate and wider social milieu of individuals with BPD, including therapist-patient interactions. Recently, research started unraveling the social-cognitive mechanisms of these impairments in BPD. In this Special Issue, we attempt to close the gap between research findings and clinical theories on trust processing impairment in BPD. The first section includes five original studies on trust processing in BPD. The second section includes five articulations of trust processing impairment as a treatment target in evidence-based treatments for BPD and as an indispensable "common factor" in the treatment of BPD. These cutting-edge research and clinical contributions advance a potential integrative, clinical science framework for conceptualizing and intervening effectively with those who struggle with BPD.

Individuals with borderline personality disorder (BPD) struggle to identify whom they can safely trust, and this struggle contributes to profound emotional turmoil in their close relationships. Transference-focused psychotherapy (TFP) is an application of object relations theory (ORT) that posits that polarized mental representations of self and other define the personality organization of BPD. TFP aims to utilize a clear treatment frame coupled with an analysis of the therapeutic relationship (i.e., the transference) to help individuals with BPD integrate their polarized mental representations. Improvement in the capacity to trust others is inherent in the mechanisms of change in TFP. In this article, a social cognitive model of trust processing provides a new lens through which we formulate how TFP may enhance trust processing in BPD. Recent evidence from randomized clinical trials supports the argument that TFP may intervene with BPD in a way that is concordant with uniquely improved trust processing.

Individuals with borderline personality disorder (BPD) have shown a negativity bias, whereas the general population has shown a positivity bias in their trustworthiness appraisal of others. We tested if individuals with BPD are more negative but also more realistic with their appraisals. Trustworthiness was objectified on an external criterion. The influence of childhood trauma was investigated. Facial photographs of peace prize laureates and sentenced murderers were presented. Participants with BPD and healthy controls (HC) rated the trustworthiness of the targets. Bias and sensitivity were measured using signal detection theory. The BPD group was more negatively biased compared to HC, but not more sensitive in discriminating between the two groups. When correcting for experienced childhood abuse and neglect, the authors found that group differences in bias disappeared. Individuals with BPD might not be more sensitive in discriminating between, on average, more or less trustworthy targets, but they have developed a negativity bias to ensure the detection of untrustworthiness.

Unstable trust within social interchange underlies the symptom constellation of borderline personality disorder (BPD), resulting in preoccupation with intense dyadic relationships, limited capacity for social collaboration, and constricted social networks. Good Psychiatric Management (GPM) provides a distilled formulation of how interpersonal hypersensitivities drive the engine of BPD's symptomatic oscillations in both affect and attachment. The authors summarize clinically relevant conclusions from the empirical literature on trust in BPD, synthesize it with selected ideas from other empirically supported interventions, and distill a formulation of how the GPM approach can address problems of trust in BPD with strategies most clinicians can use to improve their work with patients. GPM's clinical management approach utilizes common factors in psychotherapy to structure collaboration with patients to be accountable partners in treatment, rely on themselves more to diminish unrealistic demands on others, and function more effectively in arenas that expand and stabilize their social network.

A large body of evidence linked childhood maltreatment (CM) to juvenile violence and delinquent behavior. However, little is known about the association between CM and homicidal ideation in early adolescents. This study aimed to examine that relationship and to explore the serial mediating role of borderline personality features (BPF) and aggression in that relationship in a large sample of early adolescents. A total of 5724 early adolescents (mean age: 13.5 years) were recruited from three middle schools in Anhui Province, China. The participants were invited to complete self-report questionnaires regarding their history of CM, BPF, aggression, and homicidal ideation. Mediation analyses were evaluated using structural equation modeling. A total of 669 participants (11.7%) reported homicidal ideation in the past 6 months. CM victimization was positively associated with homicidal ideation after adjusting for covariates. Furthermore, the serial mediation analysis showed a significant indirect effect of CM on homicidal ideation through BPF and subsequent aggression. Exposure to maltreatment in childhood is likely to manifest BPF and subsequently higher levels of aggression, which in turn are related to increased homicidal ideation. These findings suggest the need for early intervention for BPF and aggression in early adolescents exposed to CM to prevent the development of homicidal ideation.

Borderline personality disorder (BPD) is often accompanied by a history of high-risk sexual behavior and somatic comorbidities. Yet, these features are most often considered in isolation and little is known about their underlying developmental pathways. Life history theory, a leading framework in evolutionary developmental biology, can help make sense of the wide range of behaviors and health issues found in BPD.

To examine whether the emergence of BPD is associated with the prioritization of immediate reproductive goals over longer-term somatic maintenance goals, a life strategy that can be viewed as a developmental response to adverse early life experiences, providing rapid reproductive benefits despite costs to health and well-being.

This study used cross-sectional data from the second wave of the National Epidemiologic Survey on Alcohol and Related Conditions in 2004-2005 (n = 34 653). Civilian, noninstitutionalized individuals in the US, 18 years or older, and those with and without a DSM-IV diagnosis of BPD were included. Analysis took place between August 2020 and June 2021.

Structural equation models were used to examine whether early life adversity was associated with the likelihood of a BPD diagnosis, either directly or indirectly through a life strategy whereby individuals trade somatic maintenance for immediate reproduction.

Analyses were performed on a sample of 30 149 participants (females: 17 042 [52%]; mean [SE] age, 48.5 [0.09]; males: 12 747 [48%]; mean [SE] age, 47 [0.08]). Of these, 892 (2.7%) had a diagnosis of BPD and 29 257 (97.3%) did not have BPD. Mean early life adversity, metabolic disorder score, and body mass index were significantly higher among participants with a diagnosis of BPD. In an analysis adjusted for age, individuals with BPD reported having significantly more children than those without BPD (b =0.06; SE, 0.01; t = 4.09; P < .001). Having experienced greater levels of adversity in early life was significantly associated with a greater risk of being diagnosed with BPD later in life (direct relative risk = 0.268; SE, 0.067; P < .001). Importantly, this risk was further increased by 56.5% among respondents who prioritized short-term reproductive goals over somatic maintenance (indirect relative risk = 0.565; SE, 0.056; P < .001). Similar patterns of associations were found in male and female individuals.

The hypothesis of a reproduction/maintenance life history trade-off mediating the association between early life adversity and BPD helps make sense of the high dimensionality that characterizes the physiological and behavioral correlates of BPD. Additional studies are needed to confirm these results using longitudinal data.

Borderline personality disorder (BPD) is characterized by an elevated distress response to social exclusion (i.e., rejection distress), the neural mechanisms of which remain unclear. Functional magnetic resonance imaging studies of social exclusion have relied on the classic version of the Cyberball task, which is not optimized for functional magnetic resonance imaging. Our goal was to clarify the neural substrates of rejection distress in BPD using a modified version of Cyberball, which allowed us to dissociate the neural response to exclusion events from its modulation by exclusionary context.

Twenty-three women with BPD and 22 healthy control participants completed a novel functional magnetic resonance imaging modification of Cyberball with 5 runs of varying exclusion probability and rated their rejection distress after each run. We tested group differences in the whole-brain response to exclusion events and in the parametric modulation of that response by rejection distress using mass univariate analysis.

Although rejection distress was higher in participants with BPD (F1,40 = 5.25, p = .027, η2 = 0.12), both groups showed similar neural responses to exclusion events. However, as rejection distress increased, the rostromedial prefrontal cortex response to exclusion events decreased in the BPD group but not in control participants. Stronger modulation of the rostromedial prefrontal cortex response by rejection distress was associated with higher trait rejection expectation, r = -0.30, p = .050.

Heightened rejection distress in BPD might stem from a failure to maintain or upregulate the activity of the rostromedial prefrontal cortex, a key node of the mentalization network. Inverse coupling between rejection distress and mentalization-related brain activity might contribute to heightened rejection expectation in BPD.

Alterations in belief updating are proposed to underpin symptoms of psychiatric illness, including psychosis, depression, and anxiety. Key parameters underlying belief updating can be captured using computational modelling techniques, aiding the identification of unique and shared deficits, and improving diagnosis and treatment. We systematically reviewed research that applied computational modelling to probabilistic tasks measuring belief updating in stable and volatile (changing) environments, across clinical and subclinical psychosis (n = 17), anxiety (n = 9), depression (n = 9) and transdiagnostic samples (n = 9). Depression disorders related to abnormal belief updating in response to the valence of rewards, evidenced in both stable and volatile environments. Whereas psychosis and anxiety disorders were associated with difficulties adapting to changing contingencies specifically, indicating an inflexibility and/or insensitivity to environmental volatility. Higher-order learning models revealed additional difficulties in the estimation of overall environmental volatility across psychosis disorders, showing increased updating to irrelevant information. These findings stress the importance of investigating belief updating in transdiagnostic samples, using homogeneous experimental and computational modelling approaches.

Application of emotion regulation strategies might be susceptible to the context of social rejection for individuals with borderline personality disorder (BPD). This study compared the ability of 27 outpatient youths (15-25 years old) with early-stage BPD and 37 healthy controls (HC) to apply expressive suppression and cognitive reappraisal in standard and socially rejecting laboratory contexts. BPD youths were largely as able as HCs to regulate negative affect across instruction and contexts. However, cognitive reappraisal in the context of social rejection heightened BPD negative facial expression relative to HCs. Thus, while BPD emotion regulation ability was largely normative, cognitive reappraisal might be ineffective in the context of social rejection for this group, with social rejection acting as an accelerant that heightens the expression of negative affect. Given the common experience of perceived and actual social rejection for this group, clinicians should carefully consider treatments that include cognitive reappraisal strategies because they might be contraindicated.

The goal of this study was to examine social feedback processing among emerging adults with borderline personality features (BPF). Participants (N = 118; 66.9% female) completed ratings of BPF and a computerized peer interaction task designed to measure processing of rejection and acceptance cues at the neurophysiological (i.e., electroencephalogram [EEG]), behavioral, and self-report levels. When covarying symptoms of depression and social anxiety, greater BPF were associated with heightened neural processing of social acceptance cues, accounting for reactivity to neutral and rejection cues, as demonstrated by an enhanced reward positivity (RewP) component. Additionally, BPF were associated with less adaptive voting in response to peer acceptance, such that emerging adults with higher BPF made fewer votes to keep peers in the game who had provided acceptance feedback to participants. These neural and behavioral patterns associated with BPF highlight the potential role of social reward processing in borderline personality. Specifically, emerging adults high in BPF show a hyper-responsiveness to social acceptance at the neural level but difficulty modulating behavioral responses in an adaptive way to obtain more social rewards. Future research replicating these effects across development may guide efforts to address and prevent the profound social dysfunction associated with BPF.

Narcissistic personality manifests itself in at least two different forms: grandiose and vulnerable. In the present study, we compared cortisol and emotional responses to psychosocial stress between subjects high in vulnerable and grandiose narcissism scores, and examined possible associations between narcissism, other personality traits, and stress responses. We hypothesized that subjects with higher scores of vulnerable narcissism would show stronger emotional and physiological reactivity than those with high scores of grandiose narcissism.

A final sample of forty-seven participants underwent a Trier Social Stress Test (TSST), provided saliva samples to assess cortisol levels, and completed several personality questionnaires.

Consistent with our hypothesis, subjects with higher scores of vulnerable narcissism had a stronger cortisol and emotional response than those with high scores of grandiose narcissism. Vulnerable narcissism was positively correlated with schizotypal traits, while grandiose narcissism was positively correlated with psychopathic traits. Participants with a mixed-type of narcissism were also discussed.

This study provides the first evidence of differential physiological and emotional reactivity to social evaluation threat according to scores of vulnerable and grandiose narcissism. Since this is an exploratory study, the results must be interpreted with caution. However, the results will be informative for future confirmatory research with larger and more heterogeneous samples.

We present a case illustrating common challenges in the hospital management and treatment of comorbid borderline personality disorder and substance use disorders. Experts in the field of personality disorders and substance use disorders discuss various topics and strategies for patient-centered management. Key learning points include evaluation and diagnosis of borderline personality disorder, good psychiatric management, withdrawal and pharmacologic management, harm reduction, team dynamics, and behavior planning all in the hospital setting. This paper provides actionable considerations with elements common to many clinical encounters that present challenges to the consultation-liaison psychiatrist in the general hospital setting.

The focus of the present research is to investigate the impact of therapist responsiveness at the very first session of therapy on the evaluation of therapeutic alliance from the therapist's perspective and from patient's perspective in the context of guideline-based treatment for borderline personality disorder.

The study has a correlational and longitudinal design applied to a 10-session therapy in a naturalistic setting.

A total of four trained raters evaluated therapist responsiveness during the first session of therapy. After each therapy session, therapists and patients filled out the short form of the Working Alliance Inventory measuring working alliance; the sample included 13 therapists and 47 patients. Correlational analysis as well as hierarchical linear modelling exploring the relationship between first session therapist responsiveness and working alliance were performed.

The global evaluation of responsiveness revealed a significant relationship with the temporal evolution of the alliance rated from the therapists' perspective.

There is the necessity to further explore therapist appropriate responsiveness which could potentially explain several psychotherapy research results. Moreover, it could help in finding alternatives in order to facilitate patients' early engagement in therapy as well as facilitating the building process of therapeutic alliance. Finally, an effort should be made in order to study more individualized operationalization of responsiveness.

Borderline personality disorder (BPD) pathology is common among patients with substance use disorders (SUDs) and associated with a variety of negative outcomes, including worse SUD outcomes. One particularly relevant outcome with links to substance use problems that is likely to be elevated among SUD patients with BPD symptoms is ineffective conflict resolution strategies in romantic relationships. However, no research to date has examined the relation of BPD pathology to strategies for managing conflict in romantic relationships among patients with SUDs, or the factors that may increase the use of ineffective strategies within this population. Thus, this study examined the relations of BPD symptoms to ineffective responses to romantic relationship conflict surrounding substance use among residential patients with SUDs, as well as the explanatory roles of fear of compassion from and for others in these relations.

Patients in a community-based correctional SUD residential treatment facility (N = 93) completed questionnaires, including a measure of BPD symptoms, fear of compassion from and for others, and strategies for responding to conflict surrounding substance use in romantic relationships.

Fear of compassion from others accounted for significant variance in the relations of BPD symptoms to the ineffective conflict resolution strategies of reactivity, domination, and submission, whereas fear of compassion for others only accounted for significant variance in the relation between BPD symptoms and the strategy of separation (which is not always ineffective).

Together, findings suggest that it is fear of compassion from others (vs. fear of compassion for others) that explains the relation between BPD symptoms and ineffective responses to romantic relationship conflict surrounding substance use among SUD patients. Findings highlight the potential utility of interventions aimed at reducing fears of compassion and increasing comfort with and tolerance of compassion from both others and oneself among SUD patients with BPD symptoms in order to strengthen relationships and reduce risk for relapse.

Individuals with borderline personality disorder (BPD) commonly have a favorite person (FP), whom they are heavily emotionally attached to and dependent on. This study aims to identify and illustrate the patterns of destructive FP relationships based on actual experiences described by those with BPD.

A data mining process was conducted using raw data collected from online communities, such as blogs and social networks. An in-depth review of the information to better understand the natural course of the FP relationship was also conducted.

Individuals with BPD form an intense and insecure attachment toward their FP, from which they enormously suffer. FPs can be their friends, romantic or life partners, or family members. As their feelings go beyond their control, being increasingly obsessed with their FP, they make their FP gradually lose hope in continuing the relationship and want to quit trying to fulfill their needs. The relationship finally ends when the FP stops being responsible for meeting their expectations and eventually drifts away.

This study suggests that certain FPs, distinctively named Teddy Bear Person, may behave in a particular manner to increase the likelihood of the FP relationship becoming more destructive. Moreover, the rejection sensitivity model should be discussed to understand their dysfunctional interaction.

Borderline personality disorder is a complex psychiatric disorder with limited treatment options that are associated with large heterogeneity in treatment response and high rates of dropout. New or complementary treatments for borderline personality disorder are needed that may be able to bolster treatment outcomes. In this review, the authors comment on the plausibility for research on 3,4-methylenedioxymethamphetamine (MDMA) used in conjunction with psychotherapy for borderline personality disorder (i.e., MDMA-assisted psychotherapy [MDMA-AP]). On the basis of the promise of MDMA-AP in treating disorders overlapping with borderline personality disorder (e.g., posttraumatic stress disorder), the authors speculate on initial treatment targets and hypothesized mechanisms of change that are grounded in prior literature and theory. Initial considerations for designing MDMA-AP clinical trials to investigate the safety, feasibility, and preliminary effects of MDMA-AP for borderline personality disorder are also presented.

Borderline personality disorder (BPD) is characterized by dysregulated emotion, interpersonal relationships, and impulsivity, and is putatively linked to a known transdiagnostic risk factor, anxiety sensitivity (AS). AS is a dispositional fear of the physical, cognitive, and/or social consequences of arousal-related somatic sensations. Gratz et al. (2008) demonstrated significantly higher AS in outpatients with BPD and a predictive value of AS over and above emotion dysregulation and impulsivity. The present study sought to extend these findings with a larger sample of outpatients with BPD by investigating predictive value of AS dimensions; relations between AS and attachment style; and impact of BPD treatment on AS. Participants completed measures at three time points: pretreatment and 6 and 12 months posttreatment. AS social was the best predictor; attachment anxiety correlated positively with AS global and AS physical. AS levels significantly decreased from pretreatment to 6 months posttreatment. Clinical implications discussed include targeting AS in BPD treatment.

Despite the strong link between borderline personality disorder (BPD) symptoms and suicide risk, little is known about the mechanisms underlying this association. Theory-driven research clarifying the pathways through which BPD symptoms increase suicide risk over time is needed and may highlight relevant treatment targets for decreasing suicide risk among individuals with heightened BPD symptoms. This study examined the prospective relations among BPD symptoms, emotion regulation (ER) difficulties, perceived burdensomeness, thwarted belongingness, and suicide risk across five assessments over a 7-month period. Consistent with the interpersonal theory of suicide, we hypothesized that greater BPD symptoms would predict greater suicide risk over time via greater ER difficulties and, subsequently, greater perceived burdensomeness.

A U.S. nationwide sample of 500 adults (47 % women; mean age = 40.0 ± 11.64) completed a prospective online study, including an initial assessment and four follow-up assessments over the next seven months.

Results revealed a significant indirect relation between BPD symptoms and greater suicide risk over time through greater ER difficulties and later perceived burdensomeness. Results also provided evidence for transactional relations between BPD symptoms and ER difficulties and suicide risk over time.

All constructs were assessed via self-report questionnaire data. Our measure of suicide risk focuses on only suicidal ideation, plans, and impulses, and not suicide attempts or preparatory behaviors.

Results highlight both ER- and interpersonal-related factors as key mechanisms underlying suicide risk among community adults with BPD symptoms.

This longitudinal study examined whether personality traits moderate the link between interpersonal dysfunction and suicidal behavior in a high-risk sample of 458 individuals diagnosed with borderline personality disorder (BPD). Participants were assessed annually for up to 30 years (mean number of follow-ups = 7.82). Using multilevel structural equation modeling, we examined i) longitudinal, within-person relationships among interpersonal dysfunction, suicidal ideation, and suicide attempts; and ii) moderation of these relationships by negative affectivity and disinhibition. Negative affectivity predicted a stronger within-person coupling between interpersonal dysfunction and suicidal ideation. Disinhibition predicted a stronger coupling between ideation and suicide attempts. Assessing negative affectivity and disinhibition in a treatment setting may guide clinician vigilance toward those at highest risk for interpersonally triggered suicidal behaviors.

Suicide is a notable risk for individuals with features of borderline personality disorder. Given the centrality of interpersonal difficulties in this disorder, we proposed that the negative interpersonal cognitions (perceived burdensomeness and thwarted belongingness) identified by the Interpersonal Theory of Suicide (IPTS) may explain the associations between suicidal ideation and borderline personality features.

Participants were 322 suicidal youth (74% girls) aged 11-18 years (M, SD = 14.74, 1.6) in an intensive outpatient program in the southwest United States. Youth completed measures assessing borderline personality features at program entry, and suicidal ideation and IPTS variables at entry and exit.

Borderline personality features did not moderate associations of IPTS variables and suicidal ideation. For the entire sample, changes in suicidal ideation from entry to discharge occurred in tandem with changes in perceived burdensomeness and depressive symptoms, but not thwarted belongingness. Youth with elevated borderline personality features entered with greater suicidal ideation, but improved more from treatment entry to exit. Regardless of level of borderline personality features, changes in negative interpersonal cognitions over treatment were associated with changes in suicidal ideation.

Self-report measures and lack of sample diversity are study limitations.

This research highlights the clinical utility of the IPTS variables and the importance of promoting competence and interpersonal connectedness when treating this population. Findings indicate that the IPTS variables carry the same fundamental information for contributing to suicidal ideation, regardless of level of borderline personality features.