Borderline Personality Disorder and Emotion Dysregulation最新文献

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.

Background: Neurological soft signs (NSS) are subtle sensorimotor abnormalities that have been observed in various mental disorders with neurodevelopmental origin. While NSS have been extensively examined in patients with schizophrenia (SZ), preliminary evidence also suggests that NSS are also present in patients with borderline personality disorder (BPD). However, a transdiagnostic examination of the severity of NSS in BPD compared to SZ is still lacking.

Methods: Here, NSS were examined with the Heidelberg NSS scale (HNSS) in three groups of female subjects: BPD (n = 45), SZ (n = 30) and healthy controls (HC) (n = 32). Multivariate analysis of variance (MANOVA) was conducted jointly for BPD, SZ, and HC and HNSS subscores. Post hoc tests were performed using linear discriminant analysis (LDA). In the BPD group, partial Spearman correlations (with age and medication as covariates) were performed between NSS scores and depressive symptoms (HAMD-21), impulsivity (BIS-11), dissociative symptoms (DTS), childhood trauma (CTQ), and borderline symptoms (BSL-23).

Results: BPD showed significantly higher NSS levels compared to HCs. For the BPD, significant associations between NSS and childhood trauma and depressive symptoms were found. MANOVA showed a significant group difference, LDA differentiated between HC, and patients with SZ and BPD, but not between the patient groups.

Conclusions: Patients with BPD have significantly higher NSS levels than HC. NSS in BPD showed significant associations with childhood trauma, supporting a "two-hit" model. Importantly, patients with BPD and SZ may show similar NSS patterns, suggesting that sensorimotor dysfunction is a transdiagnostic phenomenon.

Background: Emotion dysregulation is a transdiagnostic construct associated with mental health problems, including self-harm and borderline personality disorder (BPD). Although often targeted in clinical practice, the majority of psychometric assessment instruments of emotion dysregulation are developed for research purposes, and there is a need for an adapted version to be used in a clinical screening setting. The main aim of this study was to examine psychometric properties of a brief, pragmatic measure of emotion dysregulation, the Brief Emotion Regulation Scale - 5 items (BER-5).

Methods: The sample consisted of 60 young adults (mean age 28.1 years) who participated in a 12.4 years follow-up study of an RCT of Dialectical Behaviour Therapy's long-term effect. Cronbach's alpha was used to calculate internal consistency. Concurrent and convergent validity were examined using Spearman's correlation in comparison with other measures, and logistic regression as well as area under the curve to examine its ability in terms of differentiating between BPD diagnosis and trait levels. Optimal cut-off points were explored using Receiver Operating Curves.

Results: Our results indicated adequate internal consistency both in adolescence and in young adulthood, as well as high convergence with a gold-standard measure of emotion dysregulation, and moderate convergence with symptom measures of anxiety and depression. BER-5 was able to differentiate between participants with no BPD from subthreshold or full BPD diagnosis in adulthood, and a cut-off score of 5 was found optimal in terms of sensitivity and specificity in identifying individuals with BPD.

Conclusions: The BER-5 is a brief, pragmatic measure of emotion dysregulation with good psychometric properties and is potentially a useful screening tool for clinicians working in specialized health care settings.

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.