Borderline Personality Disorder and Emotion Dysregulation最新文献

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.

Background: Borderline personality symptoms are often associated with social-cognitive impairments, but the impact of childhood trauma on emotional processing remains poorly understood. This study explored the moderating role of childhood abuse and neglect in the relationship between borderline traits and emotion recognition.

Methods: A total of 216 non-clinical adults first completed self-report measures, including the Borderline Personality Disorder subscale of the Coolidge Axis-II Inventory and the Childhood Trauma Questionnaire. They then performed a facial emotion recognition task involving five expressions-neutral, anger, happiness, sadness, and fear-with all but neutral shown at low and moderate intensity levels. Emotion recognition was evaluated in terms of accuracy, response latency, and misattribution patterns.

Results: While no direct associations emerged between borderline traits and recognition accuracy for specific emotional expressions, higher trait levels were linked to increased misidentification of neutral faces and greater misattribution of anger. Additionally, childhood neglect and abuse moderated the effects of borderline traits on emotion recognition, with neglect altering responses to neutral and low-intensity happy cues, and abuse to subtle anger. A general pattern of emotional hypersensitivity was observed among participants who reported low levels of trauma, reflected in greater misinterpretation of neutral expressions and improved recognition of subtle emotional cues; as self-reported trauma levels increased, this pattern tended to diminish or even reverse. Considered alongside response time and misattribution patterns, the findings suggest avoidance and disengagement tendencies in emotional processing under severe trauma.

Conclusions: In conclusion, when childhood abuse and neglect accompany BPD symptoms, emotion processing may demand nuanced clinical attention tailored to trauma-related dynamics.

Background: There is a need for a parenting intervention that specifically addresses the concerns for parents with borderline personality disorder (BPD) due to the challenges that these parents experience and the stigma that surrounds parenting with BPD. Such interventions may also prevent intergenerational transmission of psychopathology and support clinicians to provide care within a personality disorder framework. This study aims to evaluate the effectiveness of a brief parenting group intervention for parents with BPD.

Trial design: The design was a parallel randomized controlled trial (RCT) with two arms: the brief parenting intervention group and a treatment as usual (TAU) group.

Methods: Participants were parents with a diagnosis of BPD who were parenting at least one child between birth and 5 years old. Participants were randomised to either the brief parenting group intervention (Coming up for AIR (CUFA)) through a public mental health service or to TAU. Participants, clinicians, and researchers were not blind to the allocation. It was hypothesised that the CUFA parenting intervention would reduce self-reported parenting stress (primary outcome) and improve parental mental health (secondary outcome) compared to TAU.

Results: Participants (N = 93) were randomly allocated to the parenting intervention (n = 45) and TAU (n = 48). For the analyses of the per protocol sample 25 participants in the CUFA parenting intervention and 21 participants in the TAU condition were included. Multi-level analysis on the intention to treat sample indicated that the CUFA parenting intervention (d_pre-post = 1.29) significantly reduced parenting stress compared to TAU (d_pre-post = 0.01). This finding was replicated in the per protocol sample.

Conclusion: A brief parenting intervention can have a positive effect on reducing parenting stress and improving parental mental health. Offering a parenting intervention needs a supportive and integrated approach to lower barriers for service attendance. Future research may investigate the effect on child wellbeing. It is important and in line with treatment guidelines to offer a parenting intervention to people with BPD.

Trial registration: Trial registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), number ACTRN12620001257954.

Background: Emotion dysregulation is a central feature in trauma-associated disorders such as posttraumatic stress disorder (PTSD) and borderline personality disorder (BPD). However, it remains unclear whether emotion dysregulation is a transdiagnostic phenomenon closely linked to childhood trauma, or if disorder-specific alterations in emotion processing exist. Following a multimethodological approach, we aimed to assess and compare the reactivity to and regulation of emotions between patients with BPD and PTSD, as well as healthy controls, and identify associations with childhood trauma.

Methods: A total of 135 women, 43 healthy controls, 43 with BPD and 49 with PTSD, took part in a multimethodological assessment of emotional reactivity and regulation. Self-report measures were used to assess childhood trauma and emotion dysregulation. Additionally, participants performed a classic emotion regulation (ER) paradigm. Subjective emotional valence ratings and neurophysiological responses (P3 and late positive potential, LPP) were measured in response to negative, positive, and neutral pictures (emotional reactivity) and during active regulation vs. passive viewing of negative pictures (ER).

Results: Regarding emotional reactivity, during the experimental paradigm both patient groups reported lower emotional valence after viewing positive or neutral pictures compared to healthy controls. Furthermore, P3 amplitudes in response to neutral pictures were reduced in both patient groups and in response to negative pictures, specifically in patients with PTSD. Regarding ER, while both patient groups self-reported significant disturbances in ER, neither valence ratings nor neurophysiological responses assessed during the ER task (P3, LPP) differed from healthy controls. Across groups, childhood trauma was related to decreased emotional valence ratings on neutral and positive pictures and higher self-reported emotion dysregulation.

Conclusions: Patients with BPD and PTSD exhibited a reduced emotional reactivity in response to positive and neutral information. Specifically, patients with PTSD demonstrated hypo-reactivity to neutral and trauma-unrelated negative stimuli, which might be due to altered attentional resource allocation following trauma. Although patients reported using adaptive ER strategies less frequently in daily life, they effectively implemented them when instructed to, highlighting important clinical and theoretical implications.

Background: The tendency to forgive is associated with traits such as agreeableness and neuroticism, mental well-being, and interpersonal functioning. Given documented associations with interpersonal conflict and aggression in borderline personality disorder (BPD), forgiveness (or, lack thereof) may be particularly relevant for BPD symptomatology but remains understudied. This study examines forgiveness in BPD compared to a heterogeneous clinical control group without personality disorder (CC), exploring its associations with aggression and interpersonal dysfunction using both direct (self-reported) and indirect (implicit) measures.

Methods: Fifty-one female BPD patients and fifty-one CC participants completed self-report measures of forgiveness (Transgression-Related Interpersonal Motivations Inventory, Tendency to Forgive Scale) and a Forgiveness Implicit Association Test (F-IAT), alongside assessments of borderline symptoms, aggression, and interpersonal problems. Independent-samples t-tests compared the two samples, while Pearson correlations explored associations between clinical characteristics within the BPD sample.

Results: Both groups revealed largely comparable scores in both explicit and implicit forgiveness, with no significant differences across measures. Within the BPD group, higher TRIM-Revenge scores were associated with greater aggression, particularly anger, while TTF scores showed negative associations with overall aggression, physical aggression, and hostility. Circumplex analysis indicated that the F-IAT aligned with nonassertive, TRIM-Revenge with cold and competitive, and TTF with warm and non-dominant interpersonal styles, whereas TRIM-Avoidance and TRIM-Benevolence exhibited limited interpersonal relevance.

Conclusions: Despite limited prior research suggesting reduced forgiveness in BPD, the present findings indicate that women with BPD exhibit forgiveness tendencies comparable to those of the CC. Notably, explicit forgiveness was systematically associated with aggression and interpersonal difficulties, whereas implicit and explicit measures showed limited convergence. These findings underscore the utility of a multidimensional approach to assessing forgiveness in BPD, revealing distinct clinical and interpersonal correlates across forgiveness dimensions.