Borderline Personality Disorder and Emotion Dysregulation最新文献

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.

Background: We recently published treatment outcome data of patients with severe Borderline Personality Disorder (BPD) after one year of Dialectical Behavior Therapy (DBT) in Integrated Care Borderline (ICB). ICB provides DBT in the structures of an Assertive Community Treatment (ACT), working with a multi-professional outpatient team located in a psychiatric hospital. It integrates all elements of DBT with psychiatric and social support as well as crisis intervention if necessary. Previous data demonstrated significant improvements in BPD pathology and psychosocial functioning after one year. Since treatment typically took longer than one year, we now present data of the two years follow-up.

Findings: In a sample of N = 31 patients with severe BPD outcome data after two years were compared to baseline data. Analyses show significant improvements in psychosocial functioning (GAF), BPD symptoms (BSL-23, SCID-II criteria), and other psychiatric symptoms (BSI, PHQ-9, PCL, suicidality), as well as a reduction of hospital days, and an increase in employment after two years of treatment. Effect sizes in most measures were medium to large, except psychiatric comorbidity (small effect) and anxiety (insignificant).

Conclusion: Effect sizes after two years of ICB-treatment are larger than after one year, indicating an additional benefit of longer treatment duration for severely ill patients with BPD. Results further support the finding that DBT can be successful in outpatient settings and that ICB seems to have additional effects on employment and hospital days. The ICB approach appears to offer a viable framework for multi-professional outpatient DBT-teams.

Trial registration: Registration number PV4920 - Integrated Care Borderline - Aerztekammer Hamburg, Germany.

Background: Personality disorders (PDs) have long been studied in adulthood, with relatively limited attention to their developmental course during adolescence. Recent research, however, underscores the importance of early identification and intervention in youth, as personality pathology can be reliably detected in this period and is associated with significant functional impairments. Grounded in the DSM-5 Alternative Model for Personality Disorders (AMPD), the present study explores potential intrapsychic mechanisms linking maladaptive trait domains to global personality functioning in adolescents. Drawing on developmental theories that emphasize the role of self-regulatory and reflective capacities in personality development, we examined whether emotion dysregulation and metacognitive difficulties help explain the relationship between pathological traits and functioning.

Methods: A sample of 470 Iranian adolescents aged 14-17 years completed validated measures of personality traits, emotion regulation, metacognition, and personality functioning. Data were analyzed using Pearson correlation coefficient and mediation analysis.

Results: All trait domains except antagonism were significantly associated with poorer functioning. Mediation analyses suggested that both emotion dysregulation and metacognition partially accounted for these associations, particularly for negative affectivity, detachment, disinhibition, and psychoticism.

Conclusions: These findings support developmental models of personality by highlighting the interplay between emotion regulation and metacognition in shaping adolescent personality functioning. While the cross-sectional design and reliance on self-report measures limit causal interpretations, the study emphasizes the importance of incorporating emotion regulation and metacognitive processes into early assessments and interventions. Future research should employ longitudinal and multi-method approaches to further clarify the developmental pathways underlying personality pathology in adolescence.