Borderline Personality Disorder and Emotion Dysregulation最新文献

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.

Background: Mindfulness skills training is a core component of Dialectical Behavior Therapy and aims to improve emotion dysregulation (ED) in people with Borderline Personality Disorder (BPD). However, the underlying mechanisms of change are not fully understood.

Methods: A total of 75 BPD outpatients participated in a 10-week mindfulness skills training. Multilevel models with a time-lagged approach were conducted to examine the temporal dynamics between the proposed mechanisms and ED. Decentering, nonjudgment, body awareness and attention awareness as putative mechanisms and ED as outcome were assessed on a session-by-session basis.

Results: Greater nonjudgment and body awareness showed within-person effects; participants who reported higher nonjudgement of inner experience and body awareness than their own personal average at a given week showed improvement in ED at the following week. Notably, decentering moderated these associations, such that increased nonjudgment and body awareness predicted improvements in ED more strongly in those participants with high decentering ability. Lastly, a bidirectional relationship between the mechanisms and ED was found; when participants were more emotionally dysregulated than their usual state, they showed less gain in the mechanisms at the following week.

Conclusions: Knowing how mindfulness training works is relevant to optimize treatments. Clinicians may use strategies to increase these mechanisms when the goal is to improve emotion regulation difficulties in BPD.

Background: Traumatic childhood experiences are a major risk factor for developing mental disorders later in life. Over the past decade, researchers have begun to investigate the role of early trauma in impairments in personality functioning following the introduction of the Alternative Model of Personality Disorders in Section III of the Diagnostic and Statistical Manual for Mental Disorders 5. Although first studies were able to empirically demonstrate a significant link between early trauma and impairments in personality functioning, only little is known about the underlying mechanisms. One possible mechanism is body connection due to its involvement in self-regulatory processes and its link to both early trauma and personality (dys)functioning.

Objective: In the current study, we investigated whether body connection, which encompasses the awareness, integration, and utilization of one's own bodily signals, mediates the relationship between childhood trauma and personality functioning.

Participants and setting: A total of 1,313 adult participants recruited in Germany and Chile anonymously provided self-report data in an online survey.

Methods: Self-report data included the short form of the Childhood Trauma Questionnaire (CTQ-SF), the Scale of Body Connection (SBC), and the brief form of the Levels of Personality Functioning Scale (LPFS-BF 2.0) as well as demographic data (age, sex, education, clinical diagnoses).

Results: Traumatic childhood experiences explained 27.2% of the variance in impairments in personality functioning. Interestingly, 60.5% of this effect was explained by body connection, particularly body dissociation. Additional exploratory analyses revealed that body dissociation and, to a much lesser extent, body awareness, accounted for 64.41% of the variance in self functioning and 55.75% of the variance in interpersonal functioning explained by childhood trauma.

Conclusion: Body connection appears to be an important mediator in the association between early trauma and impaired personality functioning, underscoring the need for interventions specifically targeting the avoidance and ignorance of signals from one's own body in individuals with traumatic childhood trauma.

Background: Despite being one of the most popular measures of borderline pathology in adolescents, only one study has evaluated clinical cut-off scores for the Borderline Personality Features Scale for Children (BPFS-C) using a small sample without a healthy comparison group (Chang B, Sharp C, Ha C. The Criterion Validity of the Borderline Personality Features Scale for Children in an Adolescent Inpatient Setting. J Personal Disord. 2011;25(4):492-503. https://doi.org/10.1521/pedi.2011.25.4.492 .). The purpose of the current study was to replicate and improve on the limitations of the prior study conducted by Chang et al. to more definitively establish clinical cut-off scores for the self- and parent-report versions of the BPFS-C to detect clinical and sub-clinical borderline personality disorder (BPD) in a large sample of adolescents with BPD, other psychopathology, and no psychopathology.

Methods: A total of 900 adolescents ranging from ages 12-17 participated in this study. The clinical sample consisted of 622 adolescents recruited from an inpatient psychiatric facility, and the healthy control sample consisted of 278 adolescents recruited from the community. All participants completed the BPFS-C and were administered the Child Interview for DSM-IV Borderline Personality Disorder (CI-BPD).

Results: Using three-way ROC analyses, cut-off scores on the self- and parent-report versions of the BPFS-C distinguishing adolescents with BPD from those with subclinical BPD, and those with subclinical BPD from healthy adolescents were established.

Conclusions: These findings support the use of both versions of the BPFS-C to detect adolescents with BPD and sub-clinical BPD.

Background: Attributions are the processes by which individuals explain the causes of positive and negative events. A maladaptive attributional style has been associated with reduced self-esteem, psychosocial functioning, and mental health. Although many psychosocial interventions target an individual's attributional style in mental disorders, studies of its alterations in Borderline Personality Disorder (BPD) are sparse. This study aimed to investigate the attributional style in patients with BPD in comparison to healthy control individuals (HC) and its association with self-esteem and psychosocial functioning.

Methods: The participants (32 patients with a diagnosis of BPD, 32 HC, groups were balanced for sex, age and education) assessed their attributional style in regard to locus of control, stability and globality for positive and negative scenarios. Attributional style was compared between groups and linked to self-reports of self-esteem, loneliness and psychosocial functioning in different social domains while controlling for BPD and depressive symptom severity.

Results: Individuals diagnosed with BPD reported a maladaptive attributional style for both positive and negative events. This was found to be strongly related with lower self-esteem and higher levels of loneliness, but not with psychosocial dysfunctions assessed in different social domains. The severity of BPD and depressive symptoms did not fully explain the association of attributional style with self-esteem and loneliness. In contrast, correcting for acute psychopathology actually strengthened the relationship between self-esteem and maladaptive inferring causality for positive events.

Conclusion: The differential association of attributional style for positive and negative events with self-esteem and psychosocial functioning highlights the importance of considering the different facets of inferring causality during psychosocial interventions. Our findings suggest that the significance of cognitive alterations may change with remission of acute BPD and depressive psychopathology, depending on the valence of an event.

Background: Though Dialectical Behavior Therapy (DBT) and other treatment models for individuals with Borderline Personality Disorder (BPD) have shown to be efficient in inpatient and outpatient settings, there is a general shortage of these treatments. In Germany, most resources are spent on inpatient treatments and unspecific crisis interventions, while it is difficult to implement the necessary team structures in an outpatient setting. This study is testing an alternative approach focussing on outpatient treatment: Integrated Care Borderline (ICB) provides DBT for persons with severe BPD within the structures of an Assertive Community Treatment (ACT). ICB is team-based, integrating psychiatric and social support as well as crisis interventions into a DBT-strategy.

Methods: ICB was compared to TAU in a prospective, randomized controlled trial. This study is part of RECOVER, a comprehensive stepped care approach in Germany, which enrolled a total of 891 participants. 146 persons were diagnosed with BPD as main diagnosis. Of these, 100 were allocated to the highest level of severe mental illness (SMI) and randomly assigned to either ICB (n = 50) or TAU (n = 50). Data were collected at baseline and 12 months later. The main outcomes were psychosocial functioning (GAF), severity of BPD (BSL-23) and other mental symptoms (BSI, PHQ-9, GAD-7, self-harm), employment status (VILI), as well as hospital days and associated costs.

Results: Data show a significant increase of psychosocial functioning and a significant decrease of BPD and other psychiatric symptoms in both groups (r = .28 - .64), without any significant differences between the groups. The proportion of self-harming persons decreased in both groups without statistical significance. Patients were significantly more likely to be employed after a year of treatment in ICB (p = .001), but not in the TAU group (p = .454). Analyses showed a significant difference between the groups (p = .032). Moreover, psychiatric hospital days were significantly reduced in ICB (-89%, p < .001, r = .61), but not in TAU (-41%, p = .276, r = .15), resulting in a significant difference between the groups (p = .016) and in lower annual hospital costs in ICB (5,546€ vs. 10,726€, -48%, p = .011) compared to TAU.

Conclusion: Our results replicate earlier studies, showing that DBT can be efficient in outpatient settings. Furthermore, they indicate additional effects on employment and hospital days. The ICB-approach seems to offer a viable framework for multiprofessional outpatient DBT-teams. Future research will have to test whether the additional effects are brought about by the additional features of ICB compared to standard outpatient DBT.

Trial registration: Registration number with ClinicalTrials.gov (NCT03459664), RECOVER.

Background: Psychiatric medications are not efficacious for treating borderline personality disorder (BPD), yet many patients with BPD are prescribed multiple psychiatric medications. This study aimed to (1) characterize psychiatric medication prescribing practices in adolescents with BPD and (2) assess whether demographic features are associated with prescribing practices.

Method: This sample was N = 2950 pediatric patients with BPD (ages 10-19) across the U.S. Data came from the NeuroBlu database, which includes data from 30 U.S. healthcare systems and hundreds of hospitals. Poisson regressions and chi-squared tests determined whether gender, race, and ethnicity were associated with (1) number of unique psychiatric medications prescribed and (2) number of unique medication classes prescribed.

Results: Roughly two-thirds (64.85%) of youth were prescribed any medications. Of these youth, 79.40% were prescribed ≥ 2 unique medications and 72.66% were prescribed ≥ 2 unique medications classes. The mean number of unique medications was 3.50 (SD = 2.50). The mean number of unique medication classes was 2.35 (SD = 1.15). The most commonly prescribed medication classes were antidepressants and antipsychotics, which were often prescribed in combination. Poisson regressions showed that boys were prescribed more unique medications (M = 3.67) than girls (M = 3.47). Non-Latinx youth were prescribed significantly more unique medications (M = 44.12) than Latinx youth (M = 3.60, p = .01).

Conclusions: Results characterize psychiatric medication prescribing practices in youth with BPD. Prescribing practices vary by demographics, such that boys and non-Latinx youth are prescribed more medications than girls and Latinx youth, respectively. These demographic differences suggest that prescribers may treat BPD differently based on patient demographic characteristics.