Borderline Personality Disorder and Emotion Dysregulation最新文献

Background: A hallmark of borderline personality disorder (BPD) is a disposition to anger, irritability and aggression. High impulsivity, particularly high emotional impulsivity (urgency), has been associated with aggression in BPD patients.

Aims: This study aimed to explore, in a sample of patients with BPD, the subtleties of the relationship between borderline symptomatology, different facets of impulsivity, and an aggressive disposition.

Methods: Two hundred and twenty patients with a DSM-5 (Sect. 2) diagnosis of BPD were assessed on measures of impulsivity (UPPS model), aggression (Brief Aggression Questionnaire, BAQ-12) and borderline symptoms (Borderline Personality Questionnaire, BPQ).

Results: Results showed: (i) there was a close relationship between BPD symptomatology and an aggressive predisposition measured by BAQ-12; (ii) emptiness and intense anger were the BPD symptom dimensions most significantly associated with aggression (iii) both negative and positive urgency, and to a lesser extent lack of premeditation and sensation seeking, mediated the relationship between borderline symptom dimensions and aggression.

Discussion & conclusion: Results suggest a close relationship between almost all dimensions of BPD, but especially anger, and impulsive aggression. They further suggest that urgency, particularly negative urgency, mediates this relationship. Future studies will need to parse aggression into motivationally distinct types.

Background: People with borderline personality disorder (BPD) often experience instability in their career paths. Previous studies have mainly focused on their challenges in work participation. There has been limited attention on their job tenure strategies. This qualitative study aimed to identify job tenure strategies of people with BPD who are currently employed.

Methods: Between November 2021 and March 2024, participants completed an online survey combining questionnaires and qualitative open-ended questions covering eleven themes, such as task management, adherence to workplace rules and self-perception of competence. The sample comprised 103 women, 22 men, and five non-binary persons, with an average age of 35. In addition to BPD, about half of the participants reported co-occurring diagnoses, such as anxiety disorders. For 54% of participants, their current primary job was aligned with their formal training. For 65%, it corresponded to their personal interests, and for 83%, with their competencies.

Results: To maintain well-being and performance at work, participants reported using strategies that involved balancing work and daily life through stable routines and health-supporting lifestyle habits. Key strategies enabling work functioning focused on self-regulation, cultivating positive workplace relationships, as well as task and time management. Organizing a calm work environment that facilitates concentration, using stress reduction and emotional regulation techniques, and seeking support from colleagues and managers were frequent examples.

Conclusions: The findings highlight a variety of self-directed, interpersonal and task-related actions that people with BPD use to maintain job tenure when employed. These personalized strategies can enrich the development of sustainable work reintegration interventions. Future research should examine the empirical effectiveness of these strategies and explore additional job tenure factors, such as work accommodations tailored to the needs of people with BPD.

Background: In clinical practice and research, self-report instruments are frequently used for assessing the severity of borderline personality disorder (BPD) symptomatology experienced by men and women. Men with BPD are often underrepresented in samples used to evaluate self-report questionnaires. Measurement invariance (MI) is used to examine whether self-report questionnaires determine the same latent construct across groups or varying conditions (e.g., measurement occasions).

Methods: The present study investigated measurement invariance for two self-report measures of BPD features: the Borderline Symptom List (BSL-23) and the Impulsivity and Emotion Dysregulation Scale (IES-27). An inpatient sample of N = 3507 individuals (n = 560 males) was used to test for measurement variance between males and females, and over time from pre- to post-treatment.

Results: Confirmatory factor analysis results supported a unidimensional structure for the BSL-23 and a three-factor model for the IES-27. Both instruments were found to be measurement invariant with regard to sex and time.

Conclusions: The results suggest that the BSL-23 and IES-27 can be used to assess BPD symptoms in men and women, as well as to assess treatment effects at admission and at the end of treatment.

Background: Contemporary models of personality assessment emphasize a dimensional rather than a categorical framework for measuring an individual's level of personality functioning. This viewpoint has also been incorporated into official diagnostic manuals, such as the Alternative DSM-5 Model for Personality Disorders (AMPD). Assessment instruments for personality functioning according to the AMPD are increasingly being developed and used, but controversies remain regarding the two-factor (vs. one-factor) structure and psychometric properties of such instruments in different countries.

Methods: To help fill these gaps in the literature, in this study we tested the internal structure, temporal stability, and construct validity of the Level of Personality Functioning Scale-Brief Form 2.0 (LPFS-BF 2.0), a convenient self-report screening questionnaire of the AMPD level of personality functioning, on a final sample of 482 non-clinical adults (369 females, 112 males, one non-binary; age range = 18-83, M = 34.6, SD = 16.4). Internal structure of the Italian LPFS-BF 2.0 was tested by Confirmatory Factor Analysis. Temporal stability and construct validity of the total score and of the Self and Interpersonal functioning subscale scores were tested using Pearson's correlations and Steiger's Test.

Results: A two-factor structure for the LPFS-BF 2.0 was supported, and correlation analyses provided convergent and discriminant validity evidence for the total and the two Self and Interpersonal subscale scores against external self-report measures of problematic self and interpersonal functioning, overall personality dysfunction, general psychological symptoms and lower quality of life. As such, the total score and the two Self and Interpersonal subscales yielded correlations with external criteria of medium to large effect sizes (i.e., Pearson's r), all significant at the p < .001 level. Finally, the present study provides the first empirical assessment of the LPFS-BF 2.0 temporal stability over an interval of 11.5 weeks, demonstrating a high temporal stability for both the total scale and the two subscales (rs above .70 for all three, ps < .001).

Conclusions: The Italian version of the LPFS-BF 2.0 yielded similar psychometric properties to the original scale and other international adaptations, suggesting its utility for personality assessment research and practice.

Background: Borderline Personality Disorder (BPD) is a severe mental health condition that requires intensive psychotherapeutic treatment. Dialectical Behavior Therapy (DBT) is a specialized treatment approach for BPD with broad empirical evidence. However, as with other disorder-specific treatments, the effect sizes of the standard DBT approach are only modest and access to treatment is limited. To enhance the efficacy of DBT, we developed an adaptation called Trauma-Focused DBT (TF-DBT), which is based on the principles, treatment modes, and functions of DBT. The goal was to (i) condense and accelerate the core therapeutic processes of DBT and (ii) expand therapeutic strategies for addressing BPD symptoms beyond Stage I of DBT (i.e., focusing on behavioral dyscontrol). TF-DBT adopts an accelerated experiential approach that is phase-based in its delivery. It emphasizes the processing of maladaptive emotions related to a wide range of developmental relational trauma (i.e., experiences of traumatic invalidation, emotional abuse, bullying, sexual abuse, or neglect in childhood or adolescence).

Aim: The primary aim of this study is to investigate the efficacy of this novel DBT adaptation (TF-DBT) compared to standard DBT (S-DBT) as developed by M. Linehan. We hypothesize that TF-DBT is superior to S-DBT on all BPD symptom measures. A second aim of the study is to investigate the efficacy of the delivery format of both treatments (i.e., online vs. face-to-face), with the hypothesis that online therapy is non-inferior to face-to-face treatment.

Methods: This study will enroll N = 260 individuals diagnosed with BPD according to DSM-5. Participants will be randomly assigned to 12 months of outpatient TF-DBT or S-DBT in an online or face-to-face format.

Discussion: The expected results might help to improve psychotherapy efficacy for BPD. Additionally, they will improve our understanding of the efficacy of online-delivered DBT treatments which might contribute to facilitating access to treatment.

Trial registration: German Clinical Trials Register: registration number DRKS00031808, date of registration 04 July 2023. WHO Universal Trial Number: U1111-1273-3381.

Background: Although Ecological Momentary Assessment (EMA) and physiological measurements provide a valuable opportunity to evaluate therapeutic interventions in real time, no study has used this approach to assess Dialectical Behavior Therapy (DBT) in autistic adults with high levels of emotion dysregulation (ED).

Methods: In this study, 26 autistic adults were evaluated before and after participating in a standard 5-month DBT program, using Ecological Momentary Assessment (EMA). The EMA included: (1) twelve evaluations per day over a 7-day period, measuring alexithymia, emotional states, subjective arousal and emotion control; (2) continuous physiological monitoring with a wristband to record heart-rate (HR), heart-rate variability (HRV) and skin conductance levels (SCL).

Results: Following DBT, no significant differences were found with respect to negative emotions and higher conflicting emotions, but increased rates of identified emotions, positive emotions and emotion control were found. Baseline autonomic responses remained unchanged, whereas subjective arousal was found to correlate positively with HRV. Overall, these results suggest that participants showed enhanced emotion awareness and emotion regulation capabilities following DBT.

Conclusion: Our study adds to previous research showing that DBT is efficient in treating ED in autistic adults, using real-time measurements of subjective and physiological markers collected through EMA. Specifically, alexithymia measures decreased post-DBT while positive emotions and emotion control increased. Randomized controlled trials should consider using these methods to improve the assessment of the impact of DBT in the daily life of autistic individuals with ED and/or suicidal behavior.

Background: Countries permitting assisted dying for mental disorder as the sole underlying condition (MD-SUMC) find that individuals with Borderline Personality Disorder (BPD) constitute a significant proportion of people requesting MAiD. In anticipation of forthcoming changes to Canadian MAiD legislation, clinical practise guidelines will be important in the decision-making process for eligibility to ensure that evidence-based treatments have been exhausted in making determinations of irremediability.

Aims: This is a systematic review of international, English-language treatment guidelines for BPD with two primary objectives: First, to identify areas of consensus and disagreement in best practise for the treatment of this disorder and second, to assess whether the guidelines offered insight into defining irremediable BPD and/or its management.

Methods: In accordance with PRISMA guidelines, we performed a systematic review of five databases and identified five clinical practise guidelines in the English language. Two authors independently performed data extraction on the core components of these treatment guidelines, which was synthesized into a narrative review.

Findings: Several conclusions may be drawn about the state of the evidence on BPD treatment. First, psychological therapies are broadly considered the preferred treatment modality for BPD but there is no consensus regarding whether any one intervention is preferable. Second, all guidelines suggest pharmacotherapy may have a role in the management of BPD, but the nature and extent of this is disputed. Third, there is no guidance alluding to, defining, or commenting on the management of irremediable BPD. Finally, there are no Canadian treatment guidelines for BPD. The implications of these findings for MAiD MD-SUMC are discussed.

Background: In adolescent Borderline Personality Disorder (BPD), interactions with caregivers often provoke dysregulation. Vagally-mediated heart rate variability (HRV), a physiological marker of regulatory capacities, shows alterations in BPD. Studies on individual and dyadic HRV in adolescents with BPD (BPD-A) and their mothers (BPD-M) are lacking. We examined 1) individual resting state -, reactivity- and recovery- HRV, 2) intrapersonal concordance of interactional quality with HRV, 3) mother-adolescent interpersonal HRV-synchrony and 4) the association of interpersonal HRV-synchrony with behavioral synchrony in a case-control design.

Methods: Thirty-eight (sub)syndromal BPD-A and BPD-M were compared to 35 healthy control adolescents and their mothers (HC-A/-M). HRV was assessed during a positive interaction, a stress task and resting before and after interactions (recovery). Behavior during interactions was observed and coded using the "Coding Interactive Behavior"- Manual. Data were analyzed using multilevel modeling.

Results: BPD-A showed a lower resting HRV than HC-A, while no group differences were found for mothers. From resting to positive interaction, BPD-A/BPD-M/HC-M showed a significant increase in HRV; this increase was not significant for HC-A. HRV-reactivity to stress was not significant in either group but influenced by general emotional and behavioral problems within both adolescent samples. Significant intrapersonal concordance of HRV and behavior could only be found for HC-M during the positive interaction (positive association). For BPD-M, a complete disconnect between behavior and HRV was observed. BPD-dyads and dyads lower in behavioral synchrony displayed HRV-synchrony during stress, in HC-dyads and dyads higher in behavioral synchrony during rest after dyadic interactions.

Conclusions: Our study is the first investigating altered HRV-reactivity, behavior-HRV-concordance and HRV-synchrony in adolescents with BPD traits and their mothers, adding new insight to physiological regulation and co-regulation in adolescent BPD pathology. Limitations and implications of these results are discussed.

Background: Sleep disturbances are common in patients with borderline personality disorder (BPD) and are associated with a poor prognosis and symptom severity. Research findings on sleep abnormalities in individuals with BPD have been inconsistent, with limited evidence linking subjective and objective measures.

Methods: We compared 44 women with BPD with 41 healthy controls. We examined differences (using ANCOVAs and ordinal logistic regression) and associations (using correlations) between objective sleep assessment (polysomnography) and subjective measures (Consensus Sleep Diary, Insomnia Severity Index, Pittsburgh Sleep Quality Index). We explored predictors of insomnia in BPD patients, including BPD severity, symptomatology, comorbid conditions, and medication use, via standard least squares regressions and ANOVAs.

Results: A total of 22% of patients with BPD had clinically significant insomnia (cut-off ≥ 15), 85% reported mild (subthreshold) insomnia (cut-off > 10) (Insomnia Severity Index; ISI), and 94% reported sleep quality disturbances (PSQI > 5). Compared with those in HC, PSG results in individuals with BPD revealed a longer duration in bed, longer sleep period, REM latency, wake after sleep onset latency, Stage N1 sleep duration, shorter N2 sleep duration, and, with age, more arousals and awakenings. The correlations between objective and subjective sleep measures were weak in both groups. In patients with BPD, a greater degree of insomnia predicted a reduction in total sleep time and increased awakenings and arousals on PSG. Clinical BPD severity, emotional reactivity and dysregulation, depression symptoms, posttraumatic stress symptoms, alexithymia, and presleep arousal were associated with greater insomnia in BPD patients.

Conclusions: Our study confirmed high rates of insomnia and sleep disturbances in individuals with BPD, which contrasted with relatively minor PSG alterations. Clinical BPD severity and symptomatology are associated with sleep abnormalities in individuals with BPD. Insomnia is a neglected yet important characteristic of the BPD phenotype, warranting more attention in future research and clinical guidelines.

Introduction: Understanding sex differences is crucial for improving diagnosis and treatment for personality disorders (PDs). This study aimed to investigate sex differences in personality dysfunction as per Criterion A of the DSM-5 Alternative Model of Personality Disorders in help-seeking adolescents.

Methods: The sample comprised 706 adolescent patients (mean age = 15.4 years; 80.88% females). Personality dysfunction was assessed using the Semi-Structured Interview for Personality Functioning DSM-5 (STiP 5.1).

Results: Females showed significantly higher overall personality dysfunction (Cohen's d = 0.36) compared to males, particularly in the self-functioning domain (d = 0.50), including identity (d = 0.52) and self-direction (d = 0.38). Sex differences in interpersonal functioning, particularly empathy, were statistically not significant, but females demonstrated greater impairments in intimacy compared to males (d = 0.23). Age did not moderate sex differences in personality dysfunction. Higher levels of personality dysfunction were associated with an increased likelihood of an alcohol use disorder and more severe psychosocial impairments in females compared to males.

Discussion: The findings indicate that female adolescent patients exhibit greater impairments in personality functioning than males, with the difference being more pronounced in self-functioning than in interpersonal functioning. Results highlight the need for further investigation of the biological, psychological, and social factors driving these differences and call for the development of sex-sensitive diagnostic and interventional approaches to PDs.