Borderline Personality Disorder and Emotion Dysregulation最新文献

Background: Dialectical behavioral therapy (DBT) and repetitive transcranial magnetic stimulation (rTMS) are both effective in treating borderline personality disorder (BPD). Impulsivity and impaired decision-making are prominent features of BPD, and therapeutic interventions targeting these symptoms could lead to significant improvements.

Objective/hypothesis: We hypothesized that intermittent theta burst stimulation (iTBS), a modified rTMS protocol that targets the left dorsolateral prefrontal cortex, would enhance the therapeutic effects of DBT, leading to greater improvements in impulsivity and decision-making compared with sham stimulation.

Methods: We performed a single-blind, randomized, sham-controlled pilot study to evaluate the efficacy of iTBS as an add-on to an 8-week DBT program for BPD in a routine inpatient setting. A total of 53 BPD patients were randomly assigned to receive either iTBS (n = 25) or sham stimulation (n = 28) during weeks 4 to 8 of DBT, and 36 patients met the inclusion criteria for the present analysis (≥ 16 of 20 iTBS/sham sessions and assessment of delay discounting). The study endpoints were the Barratt Impulsiveness Scale-15 for impulsivity and the Monetary Choice Questionnaire for decision-making/delay discounting.

Results: A mixed model repeated measures analysis with a 2 × 2 factorial between-subjects design showed a significant overall improvement over time in impulsivity but not in decision-making/delay discounting. No significant differences were found between iTBS and sham, although post hoc tests revealed significant changes in impulsivity in the iTBS group (mean_diff = -4.7, p = .001, Cohen's d = 0.68) but not in the sham group (mean_diff = -2.1, p = .077, d = 0.31).

Conclusions: iTBS may offer long-term benefits as an add-on treatment to DBT for impulsivity in BPD, suggesting the need for further investigation in larger-scale studies.

Trial registration: Registered at drks.de (no. DRKS00020413) on January 13, 2020.

Background: Adolescents with low self-efficacy may exhibit borderline personality features. This study aimed to investigate the role of school adjustment and social support in the association between self-efficacy and borderline personality features among adolescents.

Methods: Questionnaires were distributed to 2369 adolescents to collect data including general demographic characteristics, borderline personality features, social support, school adjustment, and self-efficacy.

Results: (1) Adolescents' school adjustment and self-efficacy were negatively associated with borderline personality features. (2) The relationship between borderline personality features and self-efficacy was partially mediated by school adjustment. (3) The relationships among borderline personality features, school adjustment, and self-efficacy were moderated by social support. High levels of social support were associated with a stronger negative correlation between borderline personality features and self-efficacy.

Conclusions: School adjustment is a crucial link between borderline personality features and self-efficacy. Although social support can mitigate this relationship to some extent, adolescents with borderline personality features may still face challenges in developing a strong sense of self-efficacy, even in supportive environments.

Background: Subjective emptiness is a transdiagnostic clinical dimension related to suicide, distress, and other maladaptive outcomes. Although it is typically conceptualized as a symptom of borderline personality disorder, it has a different pattern of correlates than other symptoms of that phenotype and is present in individuals with other diagnoses. The goals of this study were to replicate and extend previous findings regarding the place of emptiness as a standalone construct within a relatively comprehensive array of personality features.

Method: A sample of 992 anonymous participants (M = 45.37 years, SD = 16.53) who were census-matched to the US population completed an online survey including measures of emptiness, normal-range and maladaptive trait domains and aspects, as well as interpersonal values and problems.

Results: Overall, the pattern of correlations suggests that people who report feelings of emptiness tend to have negative emotions, be socially withdrawn, and are low in energy.

Conclusion: These findings highlight the relevance of subjective emptiness beyond the borderline category, replicate previous findings regarding the personality and psychopathology correlates of subjective emptiness, and portray a particular profile of personality that represents a risk factor for the experience of subjective emptiness.

Background: Adaptive strategies of emotion regulation are important for adolescents, as maladaptive strategies of such can manifest as psychopathology that is sometimes severe. Individual biological characteristics and influences from peers have been shown to have an effect on the development of emotion regulation strategies in adolescents. Maternal factors, however, have received less attention in this age group regarding how they might predict emotion regulation in adolescents. Given that prior work has demonstrated that certain maternal factors, like emotion regulation and personality, play a crucial role in the development of emotion regulation strategies in early childhood, we sought to examine these associations in adolescents in our current study.

Methods: Adolescents and their mothers (n = 123) both self-reported data on their own emotion regulation, and mothers also self-reported data on their own personality dysfunction. We operationalized maternal and adolescent emotion regulation as emotion suppression, a maladaptive emotion regulation strategy that is commonly used by adolescents.

Results: Our data demonstrated that both maternal emotion suppression and interpersonal personality dysfunction were positively associated with adolescent emotion suppression. No associations among maternal intrapersonal personality functioning and adolescent emotion suppression were detected.

Conclusions: Maternal personality dysfunction and emotion suppression both independently predicted adolescent emotion suppression use. These results support the idea that maternal characteristics play a role in shaping emotion regulation in adolescence.

Background: Interpersonal impairments in patients diagnosed with borderline personality disorder (BPD) are characterized by the fear of being rejected and high levels of loneliness. Potential underlying factors are alterations in the processing of social interactions and the associated perceptions of social partners. In this regard, BPD patients tend to attribute the cause of negative rather than positive events to their own person and to perceive others as less trustworthy than healthy controls (HCs). To date, no study has investigated whether the effect of experimentally influenced causal attributions of social interactions on the perception of a social partner differs between BPD patients and HCs.

Methods: A new virtual reality paradigm was developed to investigate the perception of benevolence following the induction of social rejection and acceptance, while experimentally manipulating whether an external cause for this behavior was provided. The data of 62 participants (32 HCs, 30 BPD patients) were analyzed using linear mixed-effects models. Associations of benevolence ratings with attributional style, rejection sensitivity, self-esteem, childhood trauma, and loneliness were investigated via correlational and multiple linear regression analyses.

Results: Across both groups, a social partner was rated as less benevolent following rejection than following acceptance. An external explanation mitigated this negative effect of rejection. Overall, benevolence ratings were lower in BPD patients than in HCs. This group difference was stronger following acceptance than following rejection. Independent of acceptance and rejection, an external explanation was associated with a higher level of benevolence only in the HC group. No associations of the effects of the experimental conditions with attributional style, childhood trauma, rejection sensitivity, self-esteem, or loneliness were found.

Conclusion: Our findings indicate that acceptance and provided external explanations for rejection have a less positive impact on the perception of a social partner's attitude toward oneself in BPD patients than in HCs. More research is needed to identify predictors of benevolence perception and which steps of social information processing are altered. The therapeutic implications include the importance of strengthening the perception and enjoyment of being accepted as well as improving the mentalizing ability of BPD patients.

Background: Engagement in Non-Suicidal Self-Injury (NSSI) is high among adolescents with borderline personality disorder (BPD), but the trajectory of NSSI in the transition period from adolescence to adulthood is unclear, and studies that look at predictors of persistence are highly needed.

Methods: This study followed 111 adolescents aged 14-17 with BPD over a five-year period to observe the prevalence and predictors of NSSI. Information on NSSI was based on both self-report and clinician-administered interviews.

Results: At the outset, 92.8% reported a history of NSSI, with an average of nearly five different types of NSSI. Despite this high initial prevalence, the rates of NSSI within the past two weeks decreased over time from 48% at baseline to 26% after one year, and further to 10% after two years. After five years, 37% reported engaging in NSSI within the past six months. Notably, all but one participant who reported NSSI after five years had engaged in NSSI already at baseline. The study identified that higher adolescent-rated but lower parent-rated BPD severity was associated with engagement in NSSI at baseline. Furthermore, ongoing NSSI after five years was predicted by lower parent-rated BPD severity and externalizing behaviors.

Conclusions: NSSI is frequent in the early course of BPD, and persists in more than one-third after five years. Our findings highlight that baseline engagement in NSSI is a risk factor for persistence of NSSI in the transition period into early adulthood. Furthermore, the findings underscore the significance of integrating both adolescent and parent perspectives on BPD pathology in the assessment and management of NSSI.

Background: Insecure adult attachment has been associated with psychiatric disorders characterized by emotional dysregulation, such as borderline personality disorder (BPD), bipolar disorder (BD) and attention deficit/hyperactivity disorder (ADHD). However, little is known about the differences in attachment patterns between these diagnostic groups. The aim of this study was to identify clusters of adult attachment style in a cross-diagnostic group of patients with BDP and/or BD and/or ADHD and explore the characteristics of these clusters based on temperament profile, childhood trauma and psychiatric diagnoses.

Methods: K-means cluster analysis was used to identify subgroups, based on the Attachment Style Questionnaire Short Form dimensions, in a clinical cohort of 150 young adults (113 women and 37 men, mean age ± SD = 23.3 ± 2.1) diagnosed with BPD, and/or BD, and/or ADHD.

Results: Three distinct clusters were identified: a secure, an insecure/avoidant-anxious and an insecure/avoidant cluster. These three clusters differed in temperament profile and related psychiatric diagnoses.

Conclusions: The three clusters of attachment in individuals with BPD, BD and/or ADHD could support differentiation between the disorders as well provide information usable for planning of treatment.

Background: Perinatal borderline personality disorder (BPD) is a common condition in perinatal mental health settings with few specialised treatment options, and little is known about the enduring effects of available treatment programs. This study explored the follow-up experiences of women with BPD after completing Mother-Infant Dialectical Behaviour Therapy (MI-DBT).

Methods: Semi-structured interviews were conducted with eight women who had completed MI-DBT 3 years prior. Reflexive Thematic Analysis was used to analyse the interviews to gain a richer understanding of these mothers' lived experience.

Results: A thematic analysis generated four main themes which indicated that participants found that MI-DBT improved their ability to hold their child in mind, be aware of their own internal state and behaviours, manage their own emotional reactions and stay calm, and manage interpersonal interactions within adult relationships. Mothers with perinatal borderline personality disorder also highlighted the need for ongoing support in the context of parenting.

Conclusions: This study is the first of its kind to explore the longer-term experiences of mothers following such an intervention, giving voice to this vulnerable group of women. The findings of this study provide a greater understanding of the complex challenges experienced as part of parenting for mothers with borderline personality disorder, and provides both insight into mothers' experiences of life after MI-DBT and the impact of the program on their lives. The clinical and research implications of the study's findings are discussed.

Trial registration: This research was retrospectively registered on 07/03/2024, ACTRN12624000225516.