Borderline Personality Disorder and Emotion Dysregulation最新文献

Background: Social decision-making poses challenges for individuals with Borderline Personality Disorder (BPD), which can lead to maladaptive interpersonal functioning. Although previous research on cooperative decisions in BPD has produced mixed findings, studies examining different aspects of cooperative behavior suggest that individuals with BPD may specifically show reduced reactive cooperation, while their active cooperation appears similar to that of healthy individuals.

Methods: To address these mixed results, we used a comprehensive battery of economic tasks in this preregistered study to assess different aspects of cooperation in 35 women with BPD and 50 healthy women.

Results: Consistent with our expectations, there were no significant differences between groups in active cooperation within the Dictator Game. However, contrary to our hypotheses, neither BPD status nor dissociality scores were related to reactive cooperation in the Ultimatum Game. To synthesize findings across studies, a mini meta-analysis was conducted, revealing no significant overall effect of group membership on rejection rates in the Ultimatum Game. Additionally, women with BPD showed similar social preferences, fairness perceptions and inequality aversion as the control group.

Conclusion: These results suggest that in the context of anonymous, one-shot economic games, individuals with BPD may not differ from healthy individuals in terms of cooperative behavior. This highlights the importance of using baseline variants of standard economic tasks when considering contextual factors that affect social behavior in BPD.

Background: Childhood maltreatment (CM) is a potent predictor of lifelong emotional and psychological difficulties. We investigated how CM affects intra- and interpersonal emotion regulation (ER) processes and explored the impact of these ER difficulties on daily life mood.

Methods: We explored the CM-ER association in two studies. Data and code are available at https://osf.io/cbkyj/ . Study 1 tested pre-registered hypotheses ( https://osf.io/2kt35 ) on the association between CM and self-reported ER difficulties in a web-based sample (N = 553). Study 2 used ecological momentary assessment data (N = 103) to examine how trait-level intra- and interpersonal ER difficulties predict momentary negative mood in pseudo-randomized daily assessments over seven days (3,973 observations), particularly in the context of momentary interpersonal stressors.

Results: We replicated a positive association between CM severity and intrapersonal ER difficulties and revealed differential effects of abuse versus neglect. Additionally, CM was associated with lower use of and more difficulties in interpersonal ER. In exploratory analyses, we found that intrapersonal ER difficulties predicted increased negative mood during interpersonal stressors, while interpersonal ER use showed no significant effects on momentary mood.

Conclusions: Our findings highlight a critical treatment target: intrapersonal ER impairments, which uniquely predict daily mood fluctuations beyond the effect of CM severity. Reduced use of interpersonal ER was also observed in individuals with more severe CM, which could be adaptive in certain environments where social support is unavailable or inconsistent. We emphasize the need to prioritize ER-focused interventions in clinical settings to address the enduring consequences of CM.

Background: Emotional dysregulation, impulsivity, and interpersonal difficulties are some of the severe and debilitating symptoms of borderline personality disorder (BPD). Parenting while living with BPD is associated with high levels of parental distress, which may exacerbate symptoms of BPD and contribute to parental struggles navigating their relationship with their child/ren. This can in turn influence the child/ren's attachment and behavioural patterns, contributing to the intergenerational transmission of BPD and/or other mental health difficulties. To date, no previous research has systematically reviewed qualitative studies of the experiences of parents with BPD. The aim of this meta-ethnography is to holistically interpret the findings of existing qualitative research and thereby conceptually understand the experiences of parents with BPD and propose supports that would benefit them.

Methods: Following a systematic search of peer-reviewed research, independent eligibility screening and risk appraisal, nine relevant studies were selected for inclusion. The reviewers read and re-read these papers and identified key concepts for translation. Relationships between the key concepts were identified by the primary reviewer using NVivo, and a synthesis of the translation was performed.

Results: Six papers focused on the experiences of mothers with BPD, one on fathers, and two included both. The review identified some key challenges, including the pressure parents with BPD feel to adhere to their own and others' expectations, their struggle with managing difficult emotions such as shame and uncertainty, a lack of social support, and difficulties accessing adequate formal support. Three papers reported findings on the same intervention (Mother-Infant Dialectical Behaviour Therapy) describing benefits of the intervention, subsequent improvements, and the importance of peer support.

Conclusion: Taken together, we determined that shame is a key driver underpinning many of the challenges experienced by parents with BPD. Mothers and fathers with BPD shared similar experiences, however, their conceptualisations of being a 'good' parent were differentially shaped by societal norms. Our review confirmed gaps in current practice, including the paucity of evidence-based interventions available for parents with BPD. Parents with BPD may benefit from interventions that help them to set realistic expectations and address shame as a specific treatment objective.

Background: Individuals with a borderline personality disorder (BPD) show impairments in their ability to mentalize. Particularly in the parent-child relationship, mentalizing is an important foundation for sensitive parenting and the quality of interactive behavior. Previous studies of parental mentalizing in mothers with BPD are scarce and have focused primarily on one aspect of the multidimensional construct. In addition, there is currently no research comparing different mental disorders on different aspects of parental mentalizing, leaving disorder-specific differences unclear. Aim of this study is to examine disorder-specific differences in reflective functioning and mind-mindedness, two facets of parental mentalizing.

Methods: We compared mothers with BPD (n = 156) with a clinical control group of mothers with depressive or anxiety disorders (n = 65) and with healthy mothers (n = 91) using non-parametric inference for multivariate data. Mothers completed the Parental Reflective Functioning Questionnaire (PRFQ) and participated in a five-minute speech sample (FMSS) in which they reflected on their child and their relationship with their child. Verbal transcripts of the FMSS were rated using an adapted manual for coding mind-mindedness with the FMSS that incorporates the assessment of additional characteristics of mind-related speech.

Results: Mothers with BPD showed the highest impairments in parental mentalizing compared to both other groups, as evident in both operationalizations: They made more maladaptive attributions (PRFQ pre-mentalizing) than the other two groups and reported lower interest and curiosity and certainty in mental states than healthy mothers. In addition, mothers with BPD used more mental attributes with negative valence when asked to describe their child and the relationship compared to both other groups and more self-related mental attributes compared to healthy mothers. Additionally, Pearson correlational analyses revealed that only the use of mental attributes with negative valence was associated with all three subscales of the PRFQ in the anticipated directions. This supports the idea that the two operationalizations target different facets of parental mentalization.

Conclusions: Our findings revealed impaired parental mentalization in several domains for mothers with BPD. Disorder-specific differences were observed in the amount of maladaptive attributions and in the negativity of mental state references. These aspects should be considered in diagnostic and therapeutic processes when working with mothers with BPD. As a limitation, it should be noted that the group comparisons did not control for sociodemographic variables, which may have contributed to some of the observed group differences.

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.