Pub Date : 2026-02-04DOI: 10.1016/j.comppsych.2026.152670
Eline Eigenhuis, Margreet Ten Have, Marlous Tuithof, Rosa E Boeschoten, Anna D T Muntingh, Patricia C van Oppen, Neeltje M Batelaan
Understanding factors influencing the onset and course of major depressive disorder (MDD) is critical due to its frequently unfavorable prognosis. While Borderline Personality Disorder (BPD) seems to negatively affect the course of MDD, the role of subthreshold BPD symptoms remains unclear. This study investigated the impact of subthreshold BPD symptoms on the onset and persistence of MDD over a three-year follow-up in a general population sample of 4618 participants from the Netherlands Mental Health Survey and Incidence Study. MDD was assessed using the Composite International Diagnostic Interview 3.0 and BPD symptoms via the International Personality Examination. Logistic regression models were used. Respondents with 1-2 BPD symptoms (OR = 2.36, 95% CI = 1.56-3.56) and 3-4 BPD symptoms (OR = 4.36, 95% CI = 2.22-8.58) had significantly higher odds of developing MDD compared to those without BPD symptoms. These results remained robust after adjustment for potential confounders. Sensitivity analyses indicated BPD symptoms were linked to increased risk for both first onset and recurrence of MDD, with a seemingly stronger effect on recurrence. BPD symptoms were not significantly associated with MDD persistence, but limited power may have influenced this result. A significant dose-response relationship was observed for onset and recurrence, but not persistence. These findings suggest individuals with subthreshold BPD symptoms have elevated risk for new and recurrent depressive episodes, while no consistent association was observed with persistence of depression. Targeting BPD symptoms in (relapse) prevention may improve MDD outcomes.
{"title":"Associations between borderline personality disorder symptomatology and major depressive disorder: Insights from a general population study.","authors":"Eline Eigenhuis, Margreet Ten Have, Marlous Tuithof, Rosa E Boeschoten, Anna D T Muntingh, Patricia C van Oppen, Neeltje M Batelaan","doi":"10.1016/j.comppsych.2026.152670","DOIUrl":"https://doi.org/10.1016/j.comppsych.2026.152670","url":null,"abstract":"<p><p>Understanding factors influencing the onset and course of major depressive disorder (MDD) is critical due to its frequently unfavorable prognosis. While Borderline Personality Disorder (BPD) seems to negatively affect the course of MDD, the role of subthreshold BPD symptoms remains unclear. This study investigated the impact of subthreshold BPD symptoms on the onset and persistence of MDD over a three-year follow-up in a general population sample of 4618 participants from the Netherlands Mental Health Survey and Incidence Study. MDD was assessed using the Composite International Diagnostic Interview 3.0 and BPD symptoms via the International Personality Examination. Logistic regression models were used. Respondents with 1-2 BPD symptoms (OR = 2.36, 95% CI = 1.56-3.56) and 3-4 BPD symptoms (OR = 4.36, 95% CI = 2.22-8.58) had significantly higher odds of developing MDD compared to those without BPD symptoms. These results remained robust after adjustment for potential confounders. Sensitivity analyses indicated BPD symptoms were linked to increased risk for both first onset and recurrence of MDD, with a seemingly stronger effect on recurrence. BPD symptoms were not significantly associated with MDD persistence, but limited power may have influenced this result. A significant dose-response relationship was observed for onset and recurrence, but not persistence. These findings suggest individuals with subthreshold BPD symptoms have elevated risk for new and recurrent depressive episodes, while no consistent association was observed with persistence of depression. Targeting BPD symptoms in (relapse) prevention may improve MDD outcomes.</p>","PeriodicalId":10554,"journal":{"name":"Comprehensive psychiatry","volume":"146 ","pages":"152670"},"PeriodicalIF":4.2,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146131445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-02DOI: 10.1016/j.comppsych.2026.152671
Yuan Cao, Gerald S Y Kwan, Yuanwei Yao, Jiajing Chen, Mandy H M Yu, David H K Shum
Difficulties in coping with the unknown, or intolerance of uncertainty (IU), has been established as an important risk factor for anxiety and other mental health problems. However, the conceptualisation so far is primarily based on self-report data from younger populations. Informed by theories on both anxiety and aging, the current study examined self-report IU and behavioural decisions made under uncertainty, across adulthood. A total of 300 participants between the age of 20-79 years were recruited from the community. They completed the self-reported Intolerance of Uncertainty Scale (IUS-12) and the behavioural Balloon Analogue Risk Task (BART). Results suggested that young adults had higher self-report prospective IU than older adults, and there were no differences on IUS-12 scores between middle-aged versus young/older adults. However, older adults had higher certainty-prone behaviours on the BART (less pumps and bursts) than both young and middle-aged adults. Exploratory modelling analysis on the BART responses suggested that young adults had both lower loss aversion and lower sensitivity to risk changes in the environment. The results are discussed in line with previous theories; whilst one's belief about their general ability to manage uncertainty in daily life increases with age, so does one's behavioural conservatism in the context of new (i.e., uncertain) situations. The results have practical implications for working with adults of various ages, in terms of needing to tailor uncertainty management and emotion regulation to the developmental stage of the person.
{"title":"Prospective and inhibitory intolerance of uncertainty, and certainty-seeking behaviours across adulthood in a Chinese sample.","authors":"Yuan Cao, Gerald S Y Kwan, Yuanwei Yao, Jiajing Chen, Mandy H M Yu, David H K Shum","doi":"10.1016/j.comppsych.2026.152671","DOIUrl":"https://doi.org/10.1016/j.comppsych.2026.152671","url":null,"abstract":"<p><p>Difficulties in coping with the unknown, or intolerance of uncertainty (IU), has been established as an important risk factor for anxiety and other mental health problems. However, the conceptualisation so far is primarily based on self-report data from younger populations. Informed by theories on both anxiety and aging, the current study examined self-report IU and behavioural decisions made under uncertainty, across adulthood. A total of 300 participants between the age of 20-79 years were recruited from the community. They completed the self-reported Intolerance of Uncertainty Scale (IUS-12) and the behavioural Balloon Analogue Risk Task (BART). Results suggested that young adults had higher self-report prospective IU than older adults, and there were no differences on IUS-12 scores between middle-aged versus young/older adults. However, older adults had higher certainty-prone behaviours on the BART (less pumps and bursts) than both young and middle-aged adults. Exploratory modelling analysis on the BART responses suggested that young adults had both lower loss aversion and lower sensitivity to risk changes in the environment. The results are discussed in line with previous theories; whilst one's belief about their general ability to manage uncertainty in daily life increases with age, so does one's behavioural conservatism in the context of new (i.e., uncertain) situations. The results have practical implications for working with adults of various ages, in terms of needing to tailor uncertainty management and emotion regulation to the developmental stage of the person.</p>","PeriodicalId":10554,"journal":{"name":"Comprehensive psychiatry","volume":"146 ","pages":"152671"},"PeriodicalIF":4.2,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146131481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-29DOI: 10.1016/j.comppsych.2026.152669
Eleanor J Ong, Kuhanesan N C Naidu, Mervin Tee, Rayner Kay Jin Tan, Natasha Howard
Background and aims: Adverse childhood experiences (ACEs) are linked to poor behavioural and mental health outcomes, including substance use, and disproportionately affect sexual and gender minorities (SGM). However, the relationship between ACEs and substance use in this population remains underexplored. This review investigates associations between ACEs and substance use outcomes in SGM adults.
Design: Registered with PROSPERO (CRD42024493936), we systematically searched six databases from inception to 13 April 2025. Following PRISMA guidelines, two authors independently screened studies and extracted data comparing substance use outcomes in SGM adults with and without ACEs histories. Due to heterogeneity, we conducted a narrative synthesis. Risk of bias was assessed using the 2019 Mixed Methods Appraisal Tool (MMAT).
Participants and measurements: Included studies involved SGM adults (≥18 years) who experienced at least one ACEs before age 18. SGM status encompassed lesbian, gay, bisexual, transgender, queer, intersex, non-binary, and other identities. Outcomes included any substance use (drug, alcohol, tobacco), with ACEs exposure as the primary variable.
Findings: Thirty-two studies (N = 43,197) were included. Twenty-nine epidemiological studies showed consistent associations between ACEs and negative substance use outcomes across SGM sub-groups and substances. Three qualitative studies highlighted links between substance use and child sexual abuse, heterosexism, and intersecting oppressions such as racism and institutionalization.
Conclusions: ACEs are associated with adverse substance use outcomes in SGM adults. Further research is needed on how intersecting marginalizations shape these associations.
{"title":"Substance use behaviours among sexual and gender minorities with a history of adverse childhood experiences: a systematic review and narrative-synthesis.","authors":"Eleanor J Ong, Kuhanesan N C Naidu, Mervin Tee, Rayner Kay Jin Tan, Natasha Howard","doi":"10.1016/j.comppsych.2026.152669","DOIUrl":"https://doi.org/10.1016/j.comppsych.2026.152669","url":null,"abstract":"<p><strong>Background and aims: </strong>Adverse childhood experiences (ACEs) are linked to poor behavioural and mental health outcomes, including substance use, and disproportionately affect sexual and gender minorities (SGM). However, the relationship between ACEs and substance use in this population remains underexplored. This review investigates associations between ACEs and substance use outcomes in SGM adults.</p><p><strong>Design: </strong>Registered with PROSPERO (CRD42024493936), we systematically searched six databases from inception to 13 April 2025. Following PRISMA guidelines, two authors independently screened studies and extracted data comparing substance use outcomes in SGM adults with and without ACEs histories. Due to heterogeneity, we conducted a narrative synthesis. Risk of bias was assessed using the 2019 Mixed Methods Appraisal Tool (MMAT).</p><p><strong>Participants and measurements: </strong>Included studies involved SGM adults (≥18 years) who experienced at least one ACEs before age 18. SGM status encompassed lesbian, gay, bisexual, transgender, queer, intersex, non-binary, and other identities. Outcomes included any substance use (drug, alcohol, tobacco), with ACEs exposure as the primary variable.</p><p><strong>Findings: </strong>Thirty-two studies (N = 43,197) were included. Twenty-nine epidemiological studies showed consistent associations between ACEs and negative substance use outcomes across SGM sub-groups and substances. Three qualitative studies highlighted links between substance use and child sexual abuse, heterosexism, and intersecting oppressions such as racism and institutionalization.</p><p><strong>Conclusions: </strong>ACEs are associated with adverse substance use outcomes in SGM adults. Further research is needed on how intersecting marginalizations shape these associations.</p>","PeriodicalId":10554,"journal":{"name":"Comprehensive psychiatry","volume":"146 ","pages":"152669"},"PeriodicalIF":4.2,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146141365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-28DOI: 10.1016/j.comppsych.2026.152668
Robert Griffiths, Sara Tai, Chris J Sutton, Elizabeth Camacho, Jasper Palmier-Claus, James Dixon, Adam Jones, Ashma Krishan, Natalie Welsh, Susan Ormrod, Alison Dawber, Vicky Taxiarchi, Karina Lovell
The Method of Levels (MOL) is a theoretically-informed, transdiagnostic cognitive therapy that could improve service user engagement and recovery for individuals with early psychosis. We aimed to assess the feasibility and acceptability of training care coordinators in early intervention in psychosis teams to deliver MOL, and to assess the feasibility of conducting a two-arm parallel-group cluster-randomised controlled trial (C-RCT) with randomisation at the level of teams. Randomisation was in a ratio of 1:2 to either (1: control) treatment as usual (TAU); or (2: intervention) TAU plus support from a care coordinator who has received training in MOL. Clinical and health economic outcomes were collected at baseline, three, and six months. Fourteen early intervention in psychosis teams (117% of target), 31 care coordinators (129% of target), and 49 service users (51% of target) were recruited. Results suggest that some aspects of this study are feasible in their current form (e.g., care coordinator recruitment), other aspects are likely to be feasible with relatively minor adjustments (e.g., service user retention), and some aspects would need substantial changes to make the delivery of an evaluation C-RCT feasible (e.g., service user recruitment; MOL supervision for care coordinators). Progression to an evaluation trial would be justified if plausible solutions can be found to address the feasibility issues identified in this study.
{"title":"Care coordinator delivered method of levels therapy to improve engagement and other outcomes in early psychosis (CAMEO): A feasibility cluster-randomised controlled trial.","authors":"Robert Griffiths, Sara Tai, Chris J Sutton, Elizabeth Camacho, Jasper Palmier-Claus, James Dixon, Adam Jones, Ashma Krishan, Natalie Welsh, Susan Ormrod, Alison Dawber, Vicky Taxiarchi, Karina Lovell","doi":"10.1016/j.comppsych.2026.152668","DOIUrl":"https://doi.org/10.1016/j.comppsych.2026.152668","url":null,"abstract":"<p><p>The Method of Levels (MOL) is a theoretically-informed, transdiagnostic cognitive therapy that could improve service user engagement and recovery for individuals with early psychosis. We aimed to assess the feasibility and acceptability of training care coordinators in early intervention in psychosis teams to deliver MOL, and to assess the feasibility of conducting a two-arm parallel-group cluster-randomised controlled trial (C-RCT) with randomisation at the level of teams. Randomisation was in a ratio of 1:2 to either (1: control) treatment as usual (TAU); or (2: intervention) TAU plus support from a care coordinator who has received training in MOL. Clinical and health economic outcomes were collected at baseline, three, and six months. Fourteen early intervention in psychosis teams (117% of target), 31 care coordinators (129% of target), and 49 service users (51% of target) were recruited. Results suggest that some aspects of this study are feasible in their current form (e.g., care coordinator recruitment), other aspects are likely to be feasible with relatively minor adjustments (e.g., service user retention), and some aspects would need substantial changes to make the delivery of an evaluation C-RCT feasible (e.g., service user recruitment; MOL supervision for care coordinators). Progression to an evaluation trial would be justified if plausible solutions can be found to address the feasibility issues identified in this study.</p>","PeriodicalId":10554,"journal":{"name":"Comprehensive psychiatry","volume":"146 ","pages":"152668"},"PeriodicalIF":4.2,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146137216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Accumulating evidence suggests traumatic life experiences could influence the onset, symptomatology, and severity of Obsessive Compulsive Disorder (OCD). However, comprehensive insights into the relationship between trauma and OCD remain fragmented.
Objectives
To systematically examine the relationship between trauma and OCD across three critical domains: (1) the role of trauma in the aetiology of OCD; (2) the associations between specific trauma types and distinct OCD symptom dimensions; and (3) the impact of trauma on OCD severity and comorbid psychopathologies.
Methods
We conducted a systematic review following the PRISMA guidelines. Electronic searches were conducted in September 2025 using MEDLINE®, PsycINFO, and EMBASE, as it was forward citation tracking via Scopus.
Results
Twenty-eight studies met inclusion criteria from an initial pool of 157 identified papers. Evidence consistently indicated significant associations between traumatic life experiences – particularly emotional neglect, physical abuse, and sexual trauma - and the onset and exacerbation of OCD symptoms. Specific types of trauma predicted OCD symptom profiles. Interpersonal traumas were predominantly associated with obsessions of unacceptable thoughts and responsibility for harm, while non-interpersonal traumas were more strongly linked to contamination themes. Trauma exposure also increased OCD severity and psychiatric comorbidity risk.
Conclusions
Trauma seems to significantly amplify OCD symptom severity and influence symptom presentation. Trauma-informed clinical assessment and tailored interventions should be integral to OCD treatment.
{"title":"Trauma-related pathways in obsessive-compulsive disorder: A systematic review of aetiology, symptom dimensions and severity","authors":"Margherita Zenoni , Marina Rodriguez Lopez , Stephanie Archer , Amy L. Milton","doi":"10.1016/j.comppsych.2026.152664","DOIUrl":"10.1016/j.comppsych.2026.152664","url":null,"abstract":"<div><h3>Background</h3><div>Accumulating evidence suggests traumatic life experiences could influence the onset, symptomatology, and severity of Obsessive Compulsive Disorder (OCD). However, comprehensive insights into the relationship between trauma and OCD remain fragmented.</div></div><div><h3>Objectives</h3><div>To systematically examine the relationship between trauma and OCD across three critical domains: (1) the role of trauma in the aetiology of OCD; (2) the associations between specific trauma types and distinct OCD symptom dimensions; and (3) the impact of trauma on OCD severity and comorbid psychopathologies.</div></div><div><h3>Methods</h3><div>We conducted a systematic review following the PRISMA guidelines. Electronic searches were conducted in September 2025 using MEDLINE®, PsycINFO, and EMBASE, as it was forward citation tracking via Scopus.</div></div><div><h3>Results</h3><div>Twenty-eight studies met inclusion criteria from an initial pool of 157 identified papers. Evidence consistently indicated significant associations between traumatic life experiences – particularly emotional neglect, physical abuse, and sexual trauma - and the onset and exacerbation of OCD symptoms. Specific types of trauma predicted OCD symptom profiles. Interpersonal traumas were predominantly associated with obsessions of unacceptable thoughts and responsibility for harm, while non-interpersonal traumas were more strongly linked to contamination themes. Trauma exposure also increased OCD severity and psychiatric comorbidity risk.</div></div><div><h3>Conclusions</h3><div>Trauma seems to significantly amplify OCD symptom severity and influence symptom presentation. Trauma-informed clinical assessment and tailored interventions should be integral to OCD treatment.</div></div>","PeriodicalId":10554,"journal":{"name":"Comprehensive psychiatry","volume":"146 ","pages":"Article 152664"},"PeriodicalIF":4.2,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146024906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Secondary trauma exposure is associated with secondary traumatic stress and impaired mental well-being, but effects on physical health and behaviors are less understood. This study addresses this gap by examining associations between secondary trauma exposure and physical, mental and behavioral health outcomes six months after the October 7th terror attack in Israel, and whether these differed by sex.
Methods
We administered a population-based survey among n = 1128 Israeli adults (50% women). Secondary trauma exposure was assessed by source: professional activity, firsthand accounts, and media (television, internet/social media, newspaper, radio). Outcomes included self-reported worsening mental and physical health, worsening sleep, and initiation of ≥2 negative health behaviors. Overall and sex-stratified logistic regression models were used to estimate average marginal effects adjusted for sociodemographic factors, social wellbeing and direct/indirect trauma.
Results
Unexpectedly, profession-related exposure was inversely associated with worsening health behaviors; in sex-stratified analyses, this trend appeared only in men and extended across outcomes (8.3–19.5% lower predicted probabilities). Exposure to firsthand accounts was associated with worsening health behaviors in men and worsening mental health in women (12.0% and 14.6% increases, respectively). Media exposure via television and internet/social media was associated with worsening sleep; exposure to multiple media sources was associated with both worsening sleep and mental health. A cumulative media-exposure effect was observed only in women.
Conclusions
Secondary trauma exposure was associated with decline in mental health, physical health and health behaviors, beyond direct/indirect war-related trauma. Source-specific and sex-specific patterns highlight the importance of tailored strategies to reduce health consequences of secondary trauma during crises.
{"title":"Overall and sex-specific associations between secondary trauma exposure and health decline post October 7th, 2023: a population-based study","authors":"Liat Orenstein , Arielle Kaim , Bruria Adini , Sharon Stein Merkin","doi":"10.1016/j.comppsych.2026.152665","DOIUrl":"10.1016/j.comppsych.2026.152665","url":null,"abstract":"<div><h3>Background</h3><div>Secondary trauma exposure is associated with secondary traumatic stress and impaired mental well-being, but effects on physical health and behaviors are less understood. This study addresses this gap by examining associations between secondary trauma exposure and physical, mental and behavioral health outcomes six months after the October 7th terror attack in Israel, and whether these differed by sex.</div></div><div><h3>Methods</h3><div>We administered a population-based survey among <em>n</em> = 1128 Israeli adults (50% women). Secondary trauma exposure was assessed by source: professional activity, firsthand accounts, and media (television, internet/social media, newspaper, radio). Outcomes included self-reported worsening mental and physical health, worsening sleep, and initiation of ≥2 negative health behaviors. Overall and sex-stratified logistic regression models were used to estimate average marginal effects adjusted for sociodemographic factors, social wellbeing and direct/indirect trauma.</div></div><div><h3>Results</h3><div>Unexpectedly, profession-related exposure was inversely associated with worsening health behaviors; in sex-stratified analyses, this trend appeared only in men and extended across outcomes (8.3–19.5% lower predicted probabilities). Exposure to firsthand accounts was associated with worsening health behaviors in men and worsening mental health in women (12.0% and 14.6% increases, respectively). Media exposure via television and internet/social media was associated with worsening sleep; exposure to multiple media sources was associated with both worsening sleep and mental health. A cumulative media-exposure effect was observed only in women.</div></div><div><h3>Conclusions</h3><div>Secondary trauma exposure was associated with decline in mental health, physical health and health behaviors, beyond direct/indirect war-related trauma. Source-specific and sex-specific patterns highlight the importance of tailored strategies to reduce health consequences of secondary trauma during crises.</div></div>","PeriodicalId":10554,"journal":{"name":"Comprehensive psychiatry","volume":"146 ","pages":"Article 152665"},"PeriodicalIF":4.2,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146024905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-11DOI: 10.1016/j.comppsych.2026.152663
R. Vonderlin , C. Claus , S. Hanraths , A.S. Lerchl , B. Senyüz , N. Kleindienst , T. Boritz , S. McMain , T. Teismann , P. Kirsch , M. Bohus , S. Lis
Background
Loneliness is a pervasive and distressing feeling that characterizes social relationships in individuals with Borderline Personality Disorder (BPD). Previous research suggests that a misalignment between an individual's heightened prosocial self-view and their negative social expectations might contribute to loneliness. In the current quasi-experimental study, we investigated this discrepancy for social value orientation (SVO) and justice sensitivity (JS) and their relationship with loneliness.
Methods
A total of 120 participants (60 treatment-seeking individuals diagnosed with BPD, 60 non-clinical controls) assessed their SVO with the SVO-Slider-Task and their JS with the Justice-Sensitivity Inventory for experiencing injustice as a victim, observer, beneficiary and perpetrator. Additionally, participants rated their expectations about the SVO and JS of other people. We measured the individuals' level of loneliness with the UCLA Loneliness scale.
Results
Participants with BPD reported a stronger difference between self-view and social expectations compared to non-clinical controls for SVO (r = 0.18, p = .043) and other-oriented perspectives of JS (observer [r = 0.34], beneficiary [r = 0.48] and perpetrator [r = 0.27], all p ≤ .003). A greater difference in observer and beneficiary JS was associated with higher levels of loneliness in the BPD group (observer: r = 0.31, p = .017, beneficiary: r = 0.44, p < .001).
Conclusion
Alterations in self-views and social expectations in individuals with BPD might foster a vicious cycle of misunderstanding and disappointment in social relationships resulting in heightened feelings of loneliness. To improve interpersonal functioning and reduce loneliness, psychosocial interventions should target both the individual's heightened prosocial self-views and their negative expectations towards others.
{"title":"Loneliness in borderline personality disorder: The role of misalignments between self-view and social expectations in social value orientation and justice sensitivity","authors":"R. Vonderlin , C. Claus , S. Hanraths , A.S. Lerchl , B. Senyüz , N. Kleindienst , T. Boritz , S. McMain , T. Teismann , P. Kirsch , M. Bohus , S. Lis","doi":"10.1016/j.comppsych.2026.152663","DOIUrl":"10.1016/j.comppsych.2026.152663","url":null,"abstract":"<div><h3>Background</h3><div>Loneliness is a pervasive and distressing feeling that characterizes social relationships in individuals with Borderline Personality Disorder (BPD). Previous research suggests that a misalignment between an individual's heightened prosocial self-view and their negative social expectations might contribute to loneliness. In the current quasi-experimental study, we investigated this discrepancy for social value orientation (SVO) and justice sensitivity (JS) and their relationship with loneliness.</div></div><div><h3>Methods</h3><div>A total of 120 participants (60 treatment-seeking individuals diagnosed with BPD, 60 non-clinical controls) assessed their SVO with the SVO-Slider-Task and their JS with the Justice-Sensitivity Inventory for experiencing injustice as a victim, observer, beneficiary and perpetrator. Additionally, participants rated their expectations about the SVO and JS of other people. We measured the individuals' level of loneliness with the UCLA Loneliness scale.</div></div><div><h3>Results</h3><div>Participants with BPD reported a stronger difference between self-view and social expectations compared to non-clinical controls for SVO (<em>r</em> = 0.18, <em>p</em> = .043) and other-oriented perspectives of JS (observer [<em>r</em> = 0.34], beneficiary [<em>r</em> = 0.48] and perpetrator [<em>r</em> = 0.27], all <em>p ≤</em> .003). A greater difference in observer and beneficiary JS was associated with higher levels of loneliness in the BPD group (observer: <em>r</em> = 0.31, <em>p</em> = .017, beneficiary: <em>r</em> = 0.44, <em>p</em> < .001).</div></div><div><h3>Conclusion</h3><div>Alterations in self-views and social expectations in individuals with BPD might foster a vicious cycle of misunderstanding and disappointment in social relationships resulting in heightened feelings of loneliness. To improve interpersonal functioning and reduce loneliness, psychosocial interventions should target both the individual's heightened prosocial self-views and their negative expectations towards others.</div></div>","PeriodicalId":10554,"journal":{"name":"Comprehensive psychiatry","volume":"146 ","pages":"Article 152663"},"PeriodicalIF":4.2,"publicationDate":"2026-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146003117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-02DOI: 10.1016/j.comppsych.2026.152662
Omer Levy Kardash, Adi Arden, Hanit Ohana, Maya Benish-Weisman
Adolescence is a critical developmental period during which individuals form a coherent sense of identity -a process that can be disrupted by emotional difficulties. While general anxiety symptoms have been extensively studied in relation to identity formation, the specific contribution of social anxiety remains underexplored. This sixmonth longitudinal study examined how adolescents' social anxiety relates to three dimensions of identity formation: commitment, in-depth exploration, and reconsideration of commitment. The study also investigated the mediating roles of selfesteem and avoidance of speech situations. A multi-informant design was employed, drawing on self-reports from 186 adolescents aged 12–18 and their parents. Mediation analyses revealed that higher levels of social anxiety were indirectly associated with lower identity commitment and greater reconsideration of commitment, primarily through reduced self-esteem and increased avoidance of speech situations. For in-depth exploration, avoidance of speech situations emerged as the sole significant mediator. These findings were consistent across both adolescent- and parent-reported models. By identifying self-esteem and speech avoidance as key mediators, the study offers both theoretical insights and clinically relevant guidance for early identification and intervention strategies aimed at supporting identity development in socially anxious adolescents.
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Pub Date : 2025-12-31DOI: 10.1016/j.comppsych.2025.152661
Jiayi Zhu , Jianfei Xie , Gang Gan , Zitong Lu , Huiyi Zhang , Jingying Wang , Xiaoqian Dong , Qingcheng Zheng , Lijun Li , Yanan Zhang , Min Liu
Background
Depressive symptoms are common among kidney transplant recipients and are linked to adverse clinical and psychosocial outcomes. Chronotype may influence vulnerability to stress and emotional dysregulation, yet its psychosocial pathways to depression remain unclear. This study tested a stress process model to explain how chronotype, as a background factor, affects depressive symptoms through perceived stress, rumination, and sleep quality.
Methods
A multicenter cross-sectional study involving 508 kidney transplant recipients was conducted in southern China. Participants completed validated questionnaires assessing chronotype, perceived stress, rumination, sleep quality, and depressive symptoms. Structural equation modeling examined direct and indirect pathways among variables.
Results
The findings supported the hypothesized structural equation model. The total indirect effect of chronotype on depressive symptoms exceeded its direct effect. Significant indirect effects were observed through perceived stress (β = −0.14, 95 % CI [−0.28, −0.04]), rumination (β = −0.09, 95 % CI [−0.18, −0.01]), and sleep quality (β = −0.05, 95 % CI [−0.11, −0.03]), as well as sequential mediations involving perceived stress with rumination or sleep quality. In the extended model, the indirect pathways through perceived stress and reflection (β = −0.04, 95 % CI [−0.08, −0.01]) and through perceived stress, brooding, and sleep quality (β = −0.03, 95 % CI [−0.05, −0.01]) remained significant.
Conclusions
These findings highlight the need to incorporate chronotype assessment into post-transplant care. Interventions should emphasize circadian rhythm regulation, stress reduction, disruption of maladaptive rumination, and sleep improvement to prevent depressive symptoms among kidney transplant recipients.
{"title":"Depressive symptoms among kidney transplant recipients: Modeling stress-related pathways involving chronotype, perceived stress, rumination, and sleep quality","authors":"Jiayi Zhu , Jianfei Xie , Gang Gan , Zitong Lu , Huiyi Zhang , Jingying Wang , Xiaoqian Dong , Qingcheng Zheng , Lijun Li , Yanan Zhang , Min Liu","doi":"10.1016/j.comppsych.2025.152661","DOIUrl":"10.1016/j.comppsych.2025.152661","url":null,"abstract":"<div><h3>Background</h3><div>Depressive symptoms are common among kidney transplant recipients and are linked to adverse clinical and psychosocial outcomes. Chronotype may influence vulnerability to stress and emotional dysregulation, yet its psychosocial pathways to depression remain unclear. This study tested a stress process model to explain how chronotype, as a background factor, affects depressive symptoms through perceived stress, rumination, and sleep quality.</div></div><div><h3>Methods</h3><div>A multicenter cross-sectional study involving 508 kidney transplant recipients was conducted in southern China. Participants completed validated questionnaires assessing chronotype, perceived stress, rumination, sleep quality, and depressive symptoms. Structural equation modeling examined direct and indirect pathways among variables.</div></div><div><h3>Results</h3><div>The findings supported the hypothesized structural equation model. The total indirect effect of chronotype on depressive symptoms exceeded its direct effect. Significant indirect effects were observed through perceived stress (<em>β</em> = −0.14, 95 % CI [−0.28, −0.04]), rumination (<em>β</em> = −0.09, 95 % CI [−0.18, −0.01]), and sleep quality (<em>β</em> = −0.05, 95 % CI [−0.11, −0.03]), as well as sequential mediations involving perceived stress with rumination or sleep quality. In the extended model, the indirect pathways through perceived stress and reflection (<em>β</em> = −0.04, 95 % CI [−0.08, −0.01]) and through perceived stress, brooding, and sleep quality (<em>β</em> = −0.03, 95 % CI [−0.05, −0.01]) remained significant.</div></div><div><h3>Conclusions</h3><div>These findings highlight the need to incorporate chronotype assessment into post-transplant care. Interventions should emphasize circadian rhythm regulation, stress reduction, disruption of maladaptive rumination, and sleep improvement to prevent depressive symptoms among kidney transplant recipients.</div></div>","PeriodicalId":10554,"journal":{"name":"Comprehensive psychiatry","volume":"145 ","pages":"Article 152661"},"PeriodicalIF":4.2,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145921443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-26DOI: 10.1016/j.comppsych.2025.152657
Anna Szücs , Elizabeth Campbell , Katalin Szanto , Alexandre Y. Dombrovski
Background
Social defeat is often cited as a motive for suicide. The experience of defeat may arise from feeling dominated in a dyadic conflict or from losing status in a group. We hypothesize that sensitivity to dyadic defeat will be related to the onset of suicidal behavior in early or mid-life and sensitivity to loss of status, in late life.
Methods
The study's sample of 245 adults aged 50 years and older (mean = 63.2 years, SD = 7.4) comprised 42 early-onset and 32 late-onset suicide attempters (aged < 50 vs ≥ 50 years at their first suicide attempt), 114 depressed non-attempter comparisons, and 57 non-psychiatric comparisons. Using a validated rigged video game tournament task, we operationalized compensatory responses to the two forms of social defeat as point stealing from individual opponents (one-on-one defeat) and rank buying in the league table (loss of status in a group).
Results
Early-onset attempters increased point stealing the most over time (χ23 = 22.37, p < .001), whereas late-onset attempters purchased more rank after losing trials than early-onset attempters and non-psychiatric comparisons (χ23 = 9.47, p = .024). Each effect was robust to adjusting for age and sex, other effects of interest, and to the exclusion of long-string responders.
Conclusions
Our behavioral findings suggest that socio-behavioral processes leading to suicide vary across the life cycle. While vulnerability to dyadic defeat could be suicidogenic for people of any age, loss of social status could play a role in suicidal crises specifically occurring in later life.
背景：社会失败经常被认为是自杀的动机。失败的经历可能来自于在二元冲突中被支配的感觉或在群体中失去地位的感觉。我们假设，对二元失败的敏感性将与早期或中年自杀行为的发生以及晚年对地位丧失的敏感性有关。方法：该研究的样本为245名年龄在50岁及以上的成年人（平均= 63.2岁，SD = 7.4），包括42名早发性自杀未遂者和32名晚发性自杀未遂者（第一次自杀未遂年龄< 50岁vs≥50岁），114名抑郁的非自杀未遂者和57名非精神病学对照组。通过一个经过验证的电子游戏锦标赛任务，我们操作了对两种形式的社交失败的补偿性反应，即从单个对手那里偷分（一对一的失败）和在排行榜上购买排名（在小组中失去地位）。结果：早发未遂者的偷分率随时间增加最多（χ23 = 22.37, p 23 = 9.47, p = 0.024）。每个效应在调整年龄和性别、其他感兴趣的效应以及排除长串应答者后都是稳健的。结论：我们的行为研究结果表明，导致自杀的社会行为过程在整个生命周期中是不同的。对于任何年龄的人来说，双重失败的脆弱性都可能导致自杀，社会地位的丧失可能在自杀危机中发挥作用，特别是在晚年发生的自杀危机中。
{"title":"Responses to social defeat in early- vs late-onset suicidal behavior: An experimental behavioral study","authors":"Anna Szücs , Elizabeth Campbell , Katalin Szanto , Alexandre Y. Dombrovski","doi":"10.1016/j.comppsych.2025.152657","DOIUrl":"10.1016/j.comppsych.2025.152657","url":null,"abstract":"<div><h3>Background</h3><div>Social defeat is often cited as a motive for suicide. The experience of defeat may arise from feeling dominated in a dyadic conflict or from losing status in a group. We hypothesize that sensitivity to dyadic defeat will be related to the onset of suicidal behavior in early or mid-life and sensitivity to loss of status, in late life.</div></div><div><h3>Methods</h3><div>The study's sample of 245 adults aged 50 years and older (mean = 63.2 years, SD = 7.4) comprised 42 early-onset and 32 late-onset suicide attempters (aged < 50 vs ≥ 50 years at their first suicide attempt), 114 depressed non-attempter comparisons, and 57 non-psychiatric comparisons. Using a validated rigged video game tournament task, we operationalized compensatory responses to the two forms of social defeat as point stealing from individual opponents (one-on-one defeat) and rank buying in the league table (loss of status in a group).</div></div><div><h3>Results</h3><div>Early-onset attempters increased point stealing the most over time (χ<sup>2</sup><sub>3</sub> = 22.37, <em>p</em> < .001), whereas late-onset attempters purchased more rank after losing trials than early-onset attempters and non-psychiatric comparisons (χ<sup>2</sup><sub>3</sub> = 9.47, <em>p</em> = .024). Each effect was robust to adjusting for age and sex, other effects of interest, and to the exclusion of long-string responders.</div></div><div><h3>Conclusions</h3><div>Our behavioral findings suggest that socio-behavioral processes leading to suicide vary across the life cycle. While vulnerability to dyadic defeat could be suicidogenic for people of any age, loss of social status could play a role in suicidal crises specifically occurring in later life.</div></div>","PeriodicalId":10554,"journal":{"name":"Comprehensive psychiatry","volume":"145 ","pages":"Article 152657"},"PeriodicalIF":4.2,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145910707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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