Borderline Personality Disorder and Emotion Dysregulation最新文献

Background: Increasing research has contributed to the destigmatization of sadomasochistic sexual preferences. Nevertheless, persons diagnosed with Borderline Personality Disorder (BPD) frequently report self-harmful masochistic sexual practice under the pretext of BDSM, especially those reporting experiences of child sexual abuse (CSA). Empirical research on sexual preferences in the context of BPD is scarce, although related sexual behaviors may matter particularly regarding dysfunctional and self-harming behaviors.

Methods: Women with BPD (n = 115) and age-matched healthy controls (HC; n = 115) were compared regarding experiences with BDSM and masochistic fantasies, as well as associated arousal and distress. Regression and moderation analyses were conducted on cross-sectional data to examine the associations between sadomasochistic sexuality and BPD symptoms, traumatic experiences, sexual risk behavior, and sexual motivation.

Results: Women with BPD practiced BDSM more often (last year: 34% vs. 15%; lifetime: 51% vs. 23%) which was associated with more autonomous, self-determined forms of sexual motivation but at the same time associated with higher BPD symptoms and risky sexuality. While a similar number of women in both groups endorsed arousal through masochistic sexual fantasies (77% vs. 74%), significantly more of those women with BPD reported associated marked distress (53% vs. 21%). Distress from masochistic fantasies was associated with less autonomous sexual motivation, in which sexuality is used in order to regulate emotions and self-esteem, and was predicted by the interaction of the severity of childhood sexual abuse and this regulation tendency.

Conclusion: Sadomasochistic sexuality and corresponding fantasies in women can be an autonomous, self-determined form of sexuality. However, in women with BPD they tend to be associated with BPD symptoms, risky sexuality, problems with self-regulation and traumatization and are thus associated with marked distress. Our findings highlight the importance of considering sexual preferences in clinical context and the need for specific treatment for this subgroup suffering from their preference or acting them out in a dysfunctional or self-harming way.

Trial registration: This analysis is part of a larger ongoing study and was retrospectively registered (Registration trial DRKS00029716).

Background: While the majority of personality disorder research focuses on adults, research shows that borderline personality disorder (BPD) often emerges in adolescence, highlighting the importance of early intervention for this population. Despite this, there are limited intervention programs tailored specifically for adolescents with BPD, and no research has explored the effectiveness of online therapist-assisted interventions for BPD in adolescents. As such, this pilot study aimed to address this gap in the literature by exploring the effectiveness of a therapist-assisted online intervention (AIR Therapy) with adolescents with BPD.

Method: The intervention involved 6 online weekly learning modules in conjunction with a weekly telehealth consultation session with a clinician. Modules included: introduction to AIR therapy, mindfulness and managing distress, emotions, self and identity, our interpersonal skills, and self-care. Participants were 12 adolescents (83.3% female, M age = 15 years) and 12 clinicians (100% female, M age = 34.3 years) recruited naturalistically from publicly funded mental health services located in rural and remote locations. Adolescents were compared on BPD symptom severity, mental health symptoms and quality of life at baseline and follow-up. Measures and semi-structured interviews were also completed evaluating the effectiveness and acceptability of the intervention at follow-up.

Results: Both adolescents and clinicians rated the intervention positively in terms of its effectiveness and acceptability. Paired-sample t-tests showed significant improvement in BPD symptoms, mental health and health satisfaction from intake to end of therapy. Adolescents' qualitative responses revealed themes of improving self-regulation and coping, ease of the online workbook, and the value of clinician interaction. Additionally, clinicians' responses highlighted themes of adding structure to therapy, the value of a brief intervention, enhancing self-insight and helping adolescents build skills that they can utilise in everyday life. Both adolescents and clinicians also highlighted suggested areas for improvement.

Conclusion: The structured online therapist-assisted intervention in the early treatment of BPD was acceptable and helpful for participants and their clinicians in this rural and remote real-world setting. This intervention may also be particularly suited for newer or trainee clinicians, providing structured tools for use with a challenging population.

Background: Dialectical Behavior Therapy's (DBT) well established effectiveness in reducing emotion dysregulation, and the growing recognition that parental emotion regulation is critical to effective parenting has led to increasing interest in the applicability of DBT skills to parenting. Efforts to integrate DBT and parenting interventions would benefit from an empirical examination of which DBT skills are most useful to parents with emotion dysregulation.

Methods: This study used clinician-rated observational coding of skill use examples that were provided by mothers with severe emotion dysregulation (n = 16) who participated in a standard 48-week DBT Skills Training (DBT-ST) program in the context of a larger randomized controlled trial (NCT03060902). Mothers described their use of DBT skills during the homework review portion of DBT-ST sessions and video-recordings were then examined and coded to identify which DBT skills mothers most frequently described using in parenting situations (vs. non-parenting situations) and which skills were used to either increase positive parenting behaviors or to decrease negative parenting behaviors.

Results: A total of 220 skill use examples were coded and approximately one-quarter described skill use in parenting situations. Mindfulness, Distress Tolerance, and Emotion Regulation skills were the most frequently described skills used in parenting situations, while Interpersonal Effectiveness skills were rarely coded. Mindfulness and Emotion Regulation skills were most often coded when mothers' parenting goal was to increase positive parenting, while Distress Tolerance skills were most often coded when mothers' parenting goal was to decrease negative parenting behaviors.

Conclusions: Results provide an empirical basis which clinicians and treatment developers can use when selecting DBT skills to apply towards parenting challenges.

Background: Attention-deficit/hyperactivity disorder (ADHD) is associated with emotion dysregulation (ED) and in ADHD, beyond ADHD and comorbidity severity, ED confers increased risk for negative outcomes. First- and second-line ADHD pharmacotherapy is effective at ameliorating core symptoms and improving cognitive functioning and accumulating evidence indicates primairly in children and adults, active ADHD pharmacotherapy has beneficial effects on emotional symptoms. Gaps in knowledge remain about whether in adolescents, ADHD pharmacotherapy has beneficial effects on ED or about the extent to which effects are apparent for discontinued/ past ADHD pharmacotherapy.

Methods: Examined, in N = 297 adolescents (M_age=15.77 years, SD = 1.06; 39.06% girls; n = 86 classified as with ADHD), whether accounting for depression and oppositional symptoms, concurrent and 18-month prospective measures of parent- and self-reported ED (1) differ across adolescents without ADHD, medication-naïve adolescents with ADHD, and ever-medicated (currently or previously) adolescents with ADHD.

Results: In case of parent-reported ED, ever medicated adolescents with ADHD exhibited a decline in ED over time whereas adolescents without ADHD and never medicated adolescents with ADHD exhibited no changes in ED over time. In case of self-reported ED, ever-medicated adolescents with ADHD exhibited lower ED than never medicated adolescents with ADHD and never medicated adolescents with ADHD exhibited greater ED than adolescents without ADHD. Currently and previously (but not currently) medicated adolescents did not differ in ED. Across parent- and self-reported findings, observed pattern of results held when analyses focused on adolescents who did not change medication status between baseline and follow-up.

Conclusions: ADHD pharmacotherapy may have a boosting effect on longitudinal changes in parent-reported ED and a normalizing effect on concurrent measures of self-reported ED in adolescents.

Background: Nonsuicidal self-injury (NSSI) is a prevalent and concerning behavior among adolescents, often triggered by negative interpersonal events. As social media is essential in the daily life of adolescents, gaining a better understanding of the impact of negative online events on NSSI urges and behaviors, distinct from that of real-life events, is warranted.

Methods: We recruited 25 adolescents with a history of NSSI and 25 healthy controls. Participants reported on their stress, affect, and NSSI urges four times daily over seven days using ambulatory assessment. We examined the immediate effects of negative events in real-life and on social media on these psychological outcomes.

Results: In adolescents who engage in NSSI, negative events on social media were positively associated with perceived stress, negative affect, and NSSI urges to a greater extent than real-life negative events. However, NSSI events during the sampling period were mostly triggered by real-life events. While the frequency of social media use was generally similar between groups, those with NSSI reported experiencing more negative events on social media.

Conclusions: Our findings highlight the significant impact of social media on the mental health of adolescents who engage in NSSI, possibly exacerbating stress and negative affect more than real-life events. These results underscore the need for targeted interventions addressing online interactions to mitigate NSSI behaviors and improve adolescent mental health.

Trial registration: This study has been registered at the German Clinical Trials Register (ID: DRKS00025905, https://drks.de/search/en/trial/DRKS00025905 ).

Background: Dialectical behavioral therapy (DBT) and repetitive transcranial magnetic stimulation (rTMS) are both effective in treating borderline personality disorder (BPD). Impulsivity and impaired decision-making are prominent features of BPD, and therapeutic interventions targeting these symptoms could lead to significant improvements.

Objective/hypothesis: We hypothesized that intermittent theta burst stimulation (iTBS), a modified rTMS protocol that targets the left dorsolateral prefrontal cortex, would enhance the therapeutic effects of DBT, leading to greater improvements in impulsivity and decision-making compared with sham stimulation.

Methods: We performed a single-blind, randomized, sham-controlled pilot study to evaluate the efficacy of iTBS as an add-on to an 8-week DBT program for BPD in a routine inpatient setting. A total of 53 BPD patients were randomly assigned to receive either iTBS (n = 25) or sham stimulation (n = 28) during weeks 4 to 8 of DBT, and 36 patients met the inclusion criteria for the present analysis (≥ 16 of 20 iTBS/sham sessions and assessment of delay discounting). The study endpoints were the Barratt Impulsiveness Scale-15 for impulsivity and the Monetary Choice Questionnaire for decision-making/delay discounting.

Results: A mixed model repeated measures analysis with a 2 × 2 factorial between-subjects design showed a significant overall improvement over time in impulsivity but not in decision-making/delay discounting. No significant differences were found between iTBS and sham, although post hoc tests revealed significant changes in impulsivity in the iTBS group (mean_diff = -4.7, p = .001, Cohen's d = 0.68) but not in the sham group (mean_diff = -2.1, p = .077, d = 0.31).

Conclusions: iTBS may offer long-term benefits as an add-on treatment to DBT for impulsivity in BPD, suggesting the need for further investigation in larger-scale studies.

Trial registration: Registered at drks.de (no. DRKS00020413) on January 13, 2020.

Background: Adolescents with low self-efficacy may exhibit borderline personality features. This study aimed to investigate the role of school adjustment and social support in the association between self-efficacy and borderline personality features among adolescents.

Methods: Questionnaires were distributed to 2369 adolescents to collect data including general demographic characteristics, borderline personality features, social support, school adjustment, and self-efficacy.

Results: (1) Adolescents' school adjustment and self-efficacy were negatively associated with borderline personality features. (2) The relationship between borderline personality features and self-efficacy was partially mediated by school adjustment. (3) The relationships among borderline personality features, school adjustment, and self-efficacy were moderated by social support. High levels of social support were associated with a stronger negative correlation between borderline personality features and self-efficacy.

Conclusions: School adjustment is a crucial link between borderline personality features and self-efficacy. Although social support can mitigate this relationship to some extent, adolescents with borderline personality features may still face challenges in developing a strong sense of self-efficacy, even in supportive environments.

Background: Subjective emptiness is a transdiagnostic clinical dimension related to suicide, distress, and other maladaptive outcomes. Although it is typically conceptualized as a symptom of borderline personality disorder, it has a different pattern of correlates than other symptoms of that phenotype and is present in individuals with other diagnoses. The goals of this study were to replicate and extend previous findings regarding the place of emptiness as a standalone construct within a relatively comprehensive array of personality features.

Method: A sample of 992 anonymous participants (M = 45.37 years, SD = 16.53) who were census-matched to the US population completed an online survey including measures of emptiness, normal-range and maladaptive trait domains and aspects, as well as interpersonal values and problems.

Results: Overall, the pattern of correlations suggests that people who report feelings of emptiness tend to have negative emotions, be socially withdrawn, and are low in energy.

Conclusion: These findings highlight the relevance of subjective emptiness beyond the borderline category, replicate previous findings regarding the personality and psychopathology correlates of subjective emptiness, and portray a particular profile of personality that represents a risk factor for the experience of subjective emptiness.

Background: Adaptive strategies of emotion regulation are important for adolescents, as maladaptive strategies of such can manifest as psychopathology that is sometimes severe. Individual biological characteristics and influences from peers have been shown to have an effect on the development of emotion regulation strategies in adolescents. Maternal factors, however, have received less attention in this age group regarding how they might predict emotion regulation in adolescents. Given that prior work has demonstrated that certain maternal factors, like emotion regulation and personality, play a crucial role in the development of emotion regulation strategies in early childhood, we sought to examine these associations in adolescents in our current study.

Methods: Adolescents and their mothers (n = 123) both self-reported data on their own emotion regulation, and mothers also self-reported data on their own personality dysfunction. We operationalized maternal and adolescent emotion regulation as emotion suppression, a maladaptive emotion regulation strategy that is commonly used by adolescents.

Results: Our data demonstrated that both maternal emotion suppression and interpersonal personality dysfunction were positively associated with adolescent emotion suppression. No associations among maternal intrapersonal personality functioning and adolescent emotion suppression were detected.

Conclusions: Maternal personality dysfunction and emotion suppression both independently predicted adolescent emotion suppression use. These results support the idea that maternal characteristics play a role in shaping emotion regulation in adolescence.

Background: Interpersonal impairments in patients diagnosed with borderline personality disorder (BPD) are characterized by the fear of being rejected and high levels of loneliness. Potential underlying factors are alterations in the processing of social interactions and the associated perceptions of social partners. In this regard, BPD patients tend to attribute the cause of negative rather than positive events to their own person and to perceive others as less trustworthy than healthy controls (HCs). To date, no study has investigated whether the effect of experimentally influenced causal attributions of social interactions on the perception of a social partner differs between BPD patients and HCs.

Methods: A new virtual reality paradigm was developed to investigate the perception of benevolence following the induction of social rejection and acceptance, while experimentally manipulating whether an external cause for this behavior was provided. The data of 62 participants (32 HCs, 30 BPD patients) were analyzed using linear mixed-effects models. Associations of benevolence ratings with attributional style, rejection sensitivity, self-esteem, childhood trauma, and loneliness were investigated via correlational and multiple linear regression analyses.

Results: Across both groups, a social partner was rated as less benevolent following rejection than following acceptance. An external explanation mitigated this negative effect of rejection. Overall, benevolence ratings were lower in BPD patients than in HCs. This group difference was stronger following acceptance than following rejection. Independent of acceptance and rejection, an external explanation was associated with a higher level of benevolence only in the HC group. No associations of the effects of the experimental conditions with attributional style, childhood trauma, rejection sensitivity, self-esteem, or loneliness were found.

Conclusion: Our findings indicate that acceptance and provided external explanations for rejection have a less positive impact on the perception of a social partner's attitude toward oneself in BPD patients than in HCs. More research is needed to identify predictors of benevolence perception and which steps of social information processing are altered. The therapeutic implications include the importance of strengthening the perception and enjoyment of being accepted as well as improving the mentalizing ability of BPD patients.