Borderline Personality Disorder and Emotion Dysregulation最新文献

Background: Impairments in mentalizing, the capacity for understanding mental states, are central to borderline personality disorder (BPD). This study examined a brief mentalizing intervention aiming to enhance the capacity and motivation for mentalizing in BPD.

Methods: Forty-eight adults with BPD (Sex: 81% female; Gender: 75% female) were randomized to a brief, single-session mentalizing or a control intervention. The mentalizing intervention involved prompts and practice in considering mental states underlying behaviors in interpersonal situations, while the control group involved an emotional sharing intervention. An observer-rated measure of mentalizing ability and a self-report measure of motivation for mentalizing were administered before and after the intervention. Self-report measures of subjective distress and the acceptability of the intervention were collected following the intervention.

Results: A significant improvement in mentalizing abilities was observed following mentalizing-enhancement (d = 0.69, p = .002), but not emotional sharing (d = -0.07, p = .64). Participants in the mentalizing-enhancement group reported significantly lower post-intervention distress than the emotional sharing group (d = 0.64, p = .03). Unexpectedly, the motivation for mentalizing decreased in both groups (mentalizing-enhancement/emotional sharing: d = -1.62/-1.16, respectively, ps < 0.001).

Discussion: Brief and focused mentalizing interventions may enhance mentalizing and reduce distress in BPD and could be utilized for tailoring interventions for specific BPD deficits.

Background: Extant data suggest that children of mothers with borderline personality disorder (BPD) are at risk for a variety of poor psychosocial outcomes, including psychopathology. One avenue for interrupting intergenerational transmission of psychopathology is through scaffolding parenting. The Mediational Intervention for Sensitizing Caregivers (MISC) has been used with other high-risk groups and holds promise for this population. The objective of the current study was to evaluate the feasibility and acceptability of MISC for mothers with BPD, and to identify key modifications for future adaptation of MISC for this population.

Methods: This objective was accomplished via three aims following a best-practice adaptation model for evidence-based psychosocial interventions. Aim 1 consisted of quantitative assessment (phase 1) of need for parenting support with n = 88 mothers with BPD and n = 195 without, and qualitative assessment (phase 2) of the lived experience of parenting among 15 mothers with BPD. Aim 2 consisted of integration of mixed methods results from Aim 1, and the decision to proceed with adaptation of MISC for mothers with BPD. Aim 3 consisted of focus groups and theatre testing of MISC, with n = 14 mothers with BPD.

Results: Aim 1 findings showed significant group differences on quantitative measures between mothers with and without BPD. Qualitative themes provided information about perceived need and desire for parenting support from the patient perspective. Aim 2 integration provided preliminary support for the feasibility and utility of MISC for mothers with BPD. Results of Aim 3 focus groups identified qualitative evidence in support of the acceptability of MISC for mothers with BPD. Additionally, participant feedback identified feasible and actionable modifications to MISC that can be implemented in future work with this population.

Conclusions: The current study suggests that MISC is a potentially feasible and acceptable alternative for mothers with BPD who are interested in receiving professional parenting support services.

Background: Numerous studies have demonstrated that the Alternative Model for Personality Disorders (AMPD) outperforms traditional categorical nosology (i.e., Section II) in predicting an array of salient clinical outcomes. However, despite the centrality of social-cognitive impairments in personality disorder, few studies have examined the superiority of the AMPD over Section II in predicting social-cognitive deficits. The current study addresses this gap by evaluating the incremental validity of AMPD-defined level of personality functioning (LPF) versus borderline personality features in predicting mentalizing - a social-cognitive construct proposed to underlie the development of personality disorder.

Method: Participants included 267 university students (M_age = 20.49, SD = 1.74) who completed self-report measures of LPF, borderline personality features, and two measures of mentalizing: the Reflective Functioning Questionnaire (RFQ) and the Mentalization Scale (MentS).

Results: Hierarchical regressions revealed that LPF explained additional variance in the RFQ beyond borderline features and internalizing psychopathology. Although borderline features also incremented LPF in predicting the RFQ, additional variance explained was less than half that contributed by the LPF over borderline features. LPF also incremented the variance explained in the MentS total score and subscales over and above borderline features and internalizing symptoms, whereas borderline features did not increment LPF in predicting any of the MentS variables.

Conclusions: These results strengthen the evidence base for the superiority of the AMPD over Section II and suggest that mentalizing deficits are better captured by LPF than borderline personality disorder symptoms. Findings support the extension of mentalization-based treatment to AMPD-defined personality disorder, which should be explored in future research.

Background: Even if it was first described in borderline personality disorder, emotion dysregulation (ED) is increasingly recognized as a transdiagnostic and dimensional construct, best understood along a continuum of severity rather than as a discrete category. Prior cluster-analytic studies have consistently explored heterogeneity within this continuum by identifying patient subgroups, but most were conducted in populations defined by specific diagnostic categories, limiting their generalizability. To better capture ED's core components, studies conducted in clinically heterogeneous adult populations are needed.

Methods: In this context, we conducted a latent profile analysis on 349 adults referred for ED-related difficulties at a specialized outpatient clinic. Profiles were derived from the six subscales of the Difficulties in Emotion Regulation Scale. Patients were assessed on sociodemographic variables, emotion regulation difficulties and strategies, mentalizing abilities, comorbid psychopathology, and well-being.

Results: A two-class solution was retained. Subgroups did not align with any specific diagnostic category but rather emerged along a severity continuum. Cluster 1 (n = 267) was characterized by more severe ED in every domain, higher use of non-adaptive regulation strategies, lower self-mentalizing abilities, greater comorbid psychopathology, and lower well-being. Cluster 2 (n = 82) displayed comparatively preserved emotion regulation abilities and strategies, higher self-mentalizing, fewer comorbidities, and greater well-being.

Conclusions: Our findings provide further evidence for the existence and characterization of subgroups in patients with ED, reflecting gradations along a severity continuum. While exploratory, they also suggest that core mechanisms targeted by DBT and MBT (i.e., maladaptive emotion regulation strategies and self-mentalizing abilities) may be relevant therapeutic targets across a broader transdiagnostic spectrum.

Background: Narrative speech production (NSP), i.e., the conceptualization, linguistic formulation, and articulation of a story, is a multifaceted process underpinned by cognitive functions and mentalization ability, often impaired in individuals with borderline personality disorder (BPD). This study examines differences in linguistic formulation between individuals with BPD and healthy controls (HCs), and explores how task type influences linguistic formulation, as well as how linguistic formulation relates to temporal parameters of speech uniquely in BPD.

Methods: Speech of 33 BPD and 31 HC individuals was recorded in three task types: telling their previous day, retelling a story, and picture sequences. Features of linguistic formulation were extracted with natural language processing methods, while temporal parameters were extracted using automatic speech recognition. Hypothesis-driven generalized linear mixed-effects models (GLMMs) were applied to test predefined group differences in four linguistic features (content words, first- and third-person singular verbs, and syntactic complexity). Additional exploratory GLMMs examined other linguistic features and task effects. Within-group Spearman correlations assessed associations between linguistic and temporal measures, controlling for task.

Results: Hypothesis testing showed that the NSP in BPD is characterized by fewer content words, more first-person singular verbs, and lower syntactic complexity than that of HCs. Exploratory analyses revealed that individuals with BPD used pronouns more frequently than HCs, particularly demonstrative pronouns (e.g., this) and first-person singular pronouns (e.g., I). In BPD, higher first-person singular reference (pronouns and verbs) correlated with fewer silent pauses, while greater syntactic complexity correlated with more filled pauses. Task modulated verbosity and the use of other pronoun types.

Conclusions: Findings suggest that NSP in BPD is characterized by dominant self-referential thought content, reflected in elevated first-person singular reference, and by qualitatively impoverished language use, marked by reduced content word production, increased pronoun use, and lower syntactic complexity. Heightened self-focus may hinder the efficient allocation of cognitive resources required for cohesive, listener-oriented NSP.

Background: While the effects of psychotherapy methods are being intensively researched, little is known about the clinical and neurobiological effects of specific psychotherapeutic interventions. This study examines the effects of experiential emotion-focused and cognitive interventions in schema therapy on emotion regulation in borderline personality disorder.

Methods: In a randomized, single-blinded, parallel group design, clinical effects and effects on resting-state functional connectivity in neural emotion regulation networks and neurotransmitter metabolism (Glx/GABA) in key regions of these networks are compared. The 9-week treatment protocol includes emotion-focused interventions such as chair dialogues, imagery rescripting, or mode role-playing in the test condition; these interventions are omitted in the active control condition (dismantling design). Resting-state functional MR imaging (rsfMRI) and MEGA-sLASER 1 H MR spectroscopy in the pregenual cingulate cortex (pgACC), anteromedial cingulate cortex (aMCC), and dorsolateral prefrontal cortex (DLPFC) are performed before and after the therapy interval and 6 months after the end of therapy and compared with the neurobiological parameters of healthy control subjects. The clinical effects are recorded using a comprehensive test battery and specified using the Reliable Change Index (RCI). Clinical and biological data are examined using mixed model analysis both longitudinally and in terms of their interactions.

Discussion: The aim is to show that different psychotherapeutic interventions have different effects on deficits in emotion regulation associated with specific effects on neural emotion regulation networks. This would contribute to a better understanding of the neurobiological effects and mechanisms underlying psychotherapeutic core interventions and to their more targeted use in BPD and other related disorders in the future.

Trial registration: ClinicalTrials.gov Identifier: NCT06367907, Retrospectively registered, April 2024.

The present paper takes a broad perspective on the psychosocial functioning in adult patients with personality disorders. We start with a working definition, then we report on psychosocial functioning in personality disorders from both categorical and dimensional perspectives of personality disorder. We add a section on assessment tools which may be used in this context. We then address the question of how problematic psychosocial functioning may be addressed in psychotherapy and other treatment contexts, when it comes to supporting the person's move towards sustained recovery. We add a lived and living experience perspective to psychosocial functioning and recovery. We end with recommendations for future research in the domain of psychosocial functioning.

Background: Borderline personality disorder (BPD) is a complex and severe mental health condition often accompanied by several co-occurring clinical problems. Posttraumatic stress disorder (PTSD) is one of the most common co-occurring disorders, with prevalence rates of PTSD reported to be between 25% and 58% among persons with BPD. The primary aim of the current study was to evaluate the association of a PTSD diagnosis and different forms of childhood trauma with changes in BPD severity, PTSD severity, and frequency of suicidal behaviors among suicidal individuals with BPD undergoing 12-months of standard dialectical behavior therapy (DBT).

Methods: This was a secondary data analysis that included individuals with BPD (N = 120) in the 12-month DBT condition. Participants completed measures of childhood abuse, PTSD severity, BPD severity, and frequency of suicidal behaviors at baseline as well as at 3, 6, 9, and 12 months. Generalized Estimating Equations (GEE) were used to examine both study hypotheses.

Results: Results suggested that the presence of PTSD did not predict reduced rates of reduction in BPD severity, PTSD severity, or frequency of suicidal behaviors. Results also revealed that higher severity of childhood sexual and emotional abuse was associated with quicker reductions in BPD severity, whereas higher severity of childhood physical abuse was associated with slower reductions. Similarly, higher severity of emotional abuse was associated with quicker reductions in PTSD severity, while higher severity of physical abuse was associated with slower reductions in this outcome.

Conclusions: Standard DBT appears to be comparably effective for both individuals with BPD without PTSD and BPD + PTSD. The addition of a PTSD diagnosis did not significantly predict slower recovery among those with BPD + PTSD. In addition, different forms of childhood trauma significantly affect the trajectories of individual treatment. Our findings suggest that DBT interventions may be particularly beneficial for individuals with higher levels of emotional abuse.

Trial registration: NCT02387736. Registered February 20, 2015.

Mothers with borderline personality disorder (BPD) are assumed to perceive difficulties in the relationship towards their children. However, a detailed and comprehensive investigation on how mothers with BPD reflect and speak about their children as an indicator for mental representations of the mother-child relationship is yet missing. In two articles drawing from a cross-sectional data set of a multi-center study, we examined these aspects in mothers with BPD compared with a healthy and a clinical control group comprising mothers with anxiety disorders, depression, or both. Using the Five Minute Speech Sample, we focused on Expressed Emotion (EE), Narrative Coherence (NC) - both in the primary data analysis - and an extended assessment of Mind-Mindedness (extended MM) in the secondary data analysis. This article mainly addresses the similarities and differences between the three constructs on a conceptual level and regarding the respective study results, and additionally discusses the overall results from both studies. When comparing the three constructs, we identified differences regarding the level of analyzed content (i.e., characteristics of speech vs. characteristics of representation) and the level of orientation (i.e., reference to the mother herself vs. reference to the child). Three aspects are assessed via all operationalizations: (1) reporting negatively about characteristics or behaviors of the child, (2) reporting weaknesses of the child, and (3) descriptions of relationship quality. Mothers with BPD were more likely to express overt criticism (EE) and express more mental attributes with negative valence (extended MM) than both the clinical and healthy control groups. Given that we found particularities in the parent-child relationship in mothers with BPD across all three coding systems, we assume the overlap to be grounded in a tendency towards greater disapproval of child characteristics and reports of challenges in relationship quality. Considering the results of both studies, this article provides the most a comprehensive examination of these relational aspects in mothers with BPD, including comparisons with both healthy and clinical control groups. These insights contribute to a deeper understanding of the complexities underlying mental representations of the mother-child relationship in the context of BPD.