Borderline Personality Disorder and Emotion Dysregulation最新文献

Background: Borderline personality disorder (BPD) is often underdiagnosed in Malaysia due to limited specialized training and validated screening tools. Although the McLean Screening Instrument for BPD (MSI-BPD) is a well-established measure, it lacks validation in Southeast Asia. This study evaluated the MSI-BPD's psychometric properties in a Malaysian context.

Methods: Two samples, including a clinical sample of psychiatric outpatients (N = 101; mean age = 28.02 years; 74.3% female) and a healthy control group (N = 314; mean age = 29.75 years; 74.8% female), were recruited from a public hospital in Kuala Lumpur, Malaysia and a private university in Malaysia, respectively. Participants in the clinical sample completed the MSI-BPD along with other self-report psychological symptom measures, and BPD diagnoses were confirmed through a semi-structured clinical interview. Psychometric analyses were conducted on the clinical sample to assess the scale's internal consistency, convergent and discriminant validity, factor structure, and predictive validity concerning BPD diagnosis. Both the clinical and healthy control samples were included in a known-groups validity analysis to further evaluate the scale.

Results: The MSI-BPD exhibited good internal consistency (Cronbach's α = 0.82) and convergent validity, as evidenced by significant correlations with related psychological symptoms. The scale also demonstrated good discriminant validity and predictive accuracy (area under the curve = 0.91), with an optimal cut-off score of 8. Confirmatory factor analyses supported a four-factor model (with factors identified being affective disturbances, impulsivity, unstable relationships, and disturbed cognition) as the best fit among the five evaluated models. The study also established the known-groups validity of the MSI-BPD, demonstrating its ability to distinguish clinical samples from healthy controls, with clinical participants scoring significantly higher than controls.

Conclusions: The MSI-BPD is a valid and reliable tool for screening BPD in Malaysia. The findings enhance our understanding of BPD's construct validity and factor structure in Southeast Asia, which leads to a more universal and cross-cultural understanding of BPD. Validating the screening instrument is crucial for improving mental health assessments and interventions, as well as strategies to better identify individuals at-risk for BPD for early intervention optimizing outcomes in a low-resource Southeast Asian context.

Background: Borderline Personality Disorder (BPD) is a complex mental health condition characterized by pervasive instability in mood, interpersonal relationships, self-concepts, and behavior. A reliable assessment of BPD symptom severity is essential for effective treatment planning and evaluation. This study introduces and evaluates the Borderline Symptom List Interview (BSL-I), a semi-structured interview designed to assess the severity of BPD symptoms comprehensively.

Method: The BSL-I is a freely accessible 31-item interview designed to assess BPD symptom severity. It evaluates (a) the frequency and subjective distress associated with BPD-specific and typical psychopathological symptoms, (b) the behavioral consequences of these symptoms, (c) functional impairment, and (d) facets of positive mental health. The items were developed through an iterative process, incorporating feedback from international experts and individuals with lived experience of BPD. Psychometric properties of the BSL-I were examined cross-sectionally in different samples of clients meeting DSM-5 criteria for BPD (n = 171), clinical controls (n = 89), and healthy controls (n = 43).

Results: The BSL-I demonstrates good internal consistency within the BPD sample (Cronbach's α = 0.82) and good interrater reliability (ICC = 0.768). It significantly discriminates between BPD clients and clinical controls (Cohen's d = 2.02) and healthy controls (Cohen's d = 3.88). High correlations were observed with other established BPD symptom measures, including the number of IPDE criteria (r = 0.70, p < 0.001) and the BSL-23 (r = 0.83, p < 0.001).

Discussion: Our findings indicate that the BSL-I is a reliable and valid multidimensional instrument for assessing the severity of BPD. Both clinical experts and clients found the application of the BSL-I acceptable and feasible. Future research might explore its sensitivity to change resulting from psychosocial treatments and assess its utility for treatment planning and outcome measurement.

Conclusion: The BSL-I is a practical and psychometrically sound instrument for assessing the severity of BPD symptoms in clinical and research contexts.

Background: Borderline personality disorder (BPD) is characterized by instability in interpersonal relationships and fear of abandonment, which intensify during stress. Social stressors seem to activate the hypothalamic-pituitary-gonadal (HPG) axis in healthy controls (HC), but this has not been investigated in patients with BPD. This study aimed to investigate the effects of social stress, i.e., social exclusion on changes of progesterone and estradiol levels in women with BPD compared to HC.

Methods: 82 women with BPD and 82 HC were randomly assigned to either an exclusion or overinclusion condition of the Cyberball paradigm. Saliva samples were collected at baseline (T1), immediately after Cyberball (T2) and 15 min post-Cyberball (T3). Two 3 × 2 × 2 repeated-measures ANOVAs were conducted with time (T1, T2, T3) as the within-subject factor, and group (BPD vs. HC) and condition (exclusion vs. overinclusion) as between-subject factors.

Results: On progesterone change, the analysis revealed no significant main effects of group or condition, but a significant group × condition interaction. Post-hoc tests showed that within the BPD group, change of progesterone levels at T3 i.e., after Cyberball, were higher after exclusion than overinclusion. For changes of estradiol levels, no significant main effects for group, condition, or their interaction were found.

Discussion: This study provides initial evidence that women with BPD exhibit distinct hormonal dynamics in progesterone after social exclusion versus overinclusion. Further research is needed to better understand this hormonal pattern and its implications for social functioning in BPD.

Background: In this study, network analysis technique is applied to dissect the links between personality organization, reflective functioning, attachment security, primary affective traits, childhood trauma and psychopathological symptoms.

Methods: A total sample of 498 (77% female) participants from the general population was investigated. A cross-sectional network between personality organization [IPO-16], hypomentalizing [RFQ-6], attachment [ECR-RD8]), primary affective traits [BANPS-GL], depression, anxiety and somatization symptoms [BSI-18], addiction [WHO-ASSIST] and childhood trauma [CTQ] was estimated via the EBICglasso and relimp algorithm. Regularized partial correlation edge weights, node centrality, predictability, bridge centrality, relative importance and stability coefficients were analyzed.

Results: We observed personality organization, SADNESS and hypomentalizing as the most influential personality constructs within the investigated network. Personality organization and hypomentalizing were also observed as nodes with the highest bridge centrality, signifying their potential relevance as mediator between trauma, affect and psychiatric symptom severity.

Conclusions: The results enable a data-driven, in-depth examination of the complex and often reciprocal relations among psychopathological symptoms, childhood adversity and psychodynamic personality constructs. Our observations highlight critical interconnections among childhood trauma, primary affects, personality functioning and psychopathology and pinpoint personality organization, hypomentalizing and SADNESS as central psychodynamic personality constructs.

Background: In a similar way to depression, the development of borderline personality traits seems closely linked to the experience of Stressful Life Events (SLEs). This study examined the extent to which emotion regulation and personality traits simultaneously mediate and significantly attenuate the direct path between SLEs and depressive symptoms.

Method: Parallel and serial multiple mediation models were employed to analyze a sample of 196 adolescents assessed twice over a 12-month period. A regression-based path analysis approach was employed to simultaneously estimate the specific indirect effects of emotion regulation and borderline traits on the direct relationship between SLEs and depression.

Results: In a parallel multiple mediation model, both borderline traits and emotion regulation fully mediated the direct relationship between SLEs and depressive symptoms. The serial multiple mediation model also showed complete mediation. In this model, the indirect pathway from SLEs to depressive symptoms, first through borderline traits and subsequently through emotion regulation, accounted for 70.8% of the total indirect effect. In contrast, the indirect effects via borderline traits and emotion regulation accounted for 24% and 5.3% of the total indirect effects, respectively.

Conclusion: To strengthen clinical practice, early identification of borderline personality traits combined with targeted interventions to address specific symptoms may enhance emotional regulation and reduce the risk of depressive symptoms in vulnerable adolescents.

Background: Nonsuicidal self-injury (NSSI) has been identified as one of the most important predictors of suicidal ideation and attempts. Nevertheless, previous research on NSSI has been limited, with different experimental designs leading to inconsistent findings regarding its underlying factors. This is especially true for time-related processes of NSSI. To address this, a standardized set of symptom-specific emotional stimuli was developed (Emotional Picture Set of Self-Injury Images, EPSI), depicting differing stages of NSSI. This study offers a first evaluation of the EPSI picture set as a measurement of emotional reactivity by using emotional self-reports and psychophysiological measures in a sample of healthy participants.

Method: The EPSI picture set, which includes images with neutral objects, self-injury objects, and self-injury scenes, was presented to N = 64 (age: 22.42 (1.4) years, sex: 18 m/ 46f) healthy participants. Emotional reactivity was assessed using emotional self-reports (Self-Assessment Manikin, SAM-Rating) for valence and arousal dimensions. Additionally, psychophysiological measures including skin conductance response, heart period, and the acoustic evoked startle response were recorded.

Results: Overall, the intraclass correlation coefficient and item-total correlation were sufficiently high, indicating good reliability at both the picture and category level. Participants rated self-injury pictures as significantly more unpleasant and arousing compared to pictures showing objects of self-injury and neutral objects. The skin conductance response to pictures with scenes of self-injury was significantly increased compared to pictures with neutral objects, as was heart period deceleration.

Conclusions: This initial evidence suggests that EPSI elicits distinct emotional responses and may serve as a valid measure for studying the process of NSSI. Future research could investigate the EPSI as a standardized measure, particularly in patients with NSSI and borderline personality disorder, to validate its clinical utility and gain insight into its psychophysiological mechanisms.

Background: Difficulties in emotion regulation are a key transdiagnostic factor in mental health disorders. While much research has focused on emotion regulation difficulties as stable, trait-like constructs, emotion regulation is inherently dynamic, unfolding over time. This highlights the need for state-like measures to capture these temporal dynamics in both laboratory and real-world contexts, such as the State Difficulties in Emotion Regulation Scale (S-DERS). The present study aimed to (a) translate the S-DERS into German, (b) validate its psychometric properties, and (c) provide novel examinations whether state-based emotion regulation difficulties share an underlying general factor or are interconnected but distinct sub-components, complemented with an exploratory network approach.

Methods: A sample of 214 participants, predominantly young females, completed the 21-item German version of the S-DERS following a negative mood induction procedure. Participants also completed a broader battery of psychological assessments. Factor structure, reliability, and construct validity were examined using confirmatory factor analysis and exploratory structural equation modeling (ESEM) with cross-loadings. These were compared to bi-factor, higher-order, and network models.

Results: The German S-DERS demonstrated a robust four-factor structure, high reliability, and strong construct validity, consistent with the original English version. ESEM indicated that extensive cross-loadings were necessary to achieve good model fit. A four-factor correlated model outperformed both bifactor and higher-order models, suggesting that emotion regulation difficulties are best conceptualized as four distinct but interrelated constructs without a shared general factor: (a) Non-acceptance of Current Emotions, (b) Limited Ability to Modulate Current Emotional and Behavioral Responses, (c) Lack of Awareness of Current Emotions, and (d) Lack of Clarity about Current Emotions.

Conclusions: The German version of the S-DERS is a reliable and valid tool for assessing state-like difficulties in emotion regulation. The extended factor models highlight the multidimensional nature of emotion regulation difficulties, with complex interrelations among distinct but related constructs. These insights can inform future research on emotion dysregulation and support efforts to validate the S-DERS in clinical populations.