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Więdłocha M, Marcinowicz P, Komarnicki J, Tobiaszewska M, Dębowska W, Dębowska M, Szulc A. Depression with comorbid borderline personality disorder - could ketamine be a treatment catalyst? Front Psychiatry 2024; 15:1398859. [PMID: 38742125 PMCID: PMC11089186 DOI: 10.3389/fpsyt.2024.1398859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 04/15/2024] [Indexed: 05/16/2024] Open
Abstract
Borderline personality disorder (BPD) is diagnosed in 10-30% of patients with major depressive disorder (MDD), and the frequency of MDD among individuals with BPD reaches over 80%. The comorbidity of MDD and BPD is associated with more severe depressive symptoms and functional impairment, higher risk of treatment resistance and increased suicidality. The effectiveness of ketamine usage in treatment resistant depression (TRD) has been demonstrated in numerous studies. In most of these studies, individuals with BPD were not excluded, thus given the high co-occurrence of these disorders, it is possible that the beneficial effects of ketamine also extend to the subpopulation with comorbid TRD and BPD. However, no protocols were developed that would account for comorbidity. Moreover, psychotherapeutic interventions, which may be crucial for achieving a lasting therapeutic effect in TRD and BPD comorbidity, were not included. In the article, we discuss the results of a small number of existing studies and case reports on the use of ketamine in depressive disorders with comorbid BPD. We elucidate how, at the molecular and brain network levels, ketamine can impact the neurobiology and symptoms of BPD. Furthermore, we explore whether ketamine-induced neuroplasticity, augmented by psychotherapy, could be of use in alleviating core BPD-related symptoms such as emotional dysregulation, self-identity disturbances and self-harming behaviors. We also discuss the potential of ketamine-assisted psychotherapy (KAP) in BPD treatment. As there is no standard approach to the application of ketamine or KAP in individuals with comorbid TRD and BPD, we consider further research in the field as imperative. The priorities should include development of dedicated protocols, distinguishing subpopulations that may benefit most from such treatment and investigating factors that may influence its effectiveness and safety.
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Affiliation(s)
- Magdalena Więdłocha
- Department of Psychiatry, Faculty of Health Sciences, Medical University of Warsaw, Pruszkow, Masovian, Poland
| | - Piotr Marcinowicz
- Department of Psychiatry, Faculty of Health Sciences, Medical University of Warsaw, Pruszkow, Masovian, Poland
| | - Jan Komarnicki
- Leszek Giec Upper-Silesian Medical Centre of the Medical University of Silesia, Katowice, Poland
| | | | - Weronika Dębowska
- Department of Psychiatry, Faculty of Health Sciences, Medical University of Warsaw, Pruszkow, Masovian, Poland
| | - Marta Dębowska
- Department of Psychiatry, Faculty of Health Sciences, Medical University of Warsaw, Pruszkow, Masovian, Poland
| | - Agata Szulc
- Department of Psychiatry, Faculty of Health Sciences, Medical University of Warsaw, Pruszkow, Masovian, Poland
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Which complex PTSD symptoms predict functional impairment in females with comorbid personality disorder needs? Research and treatment implications. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2022. [DOI: 10.1016/j.ejtd.2022.100285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Tschöke S, Hund S, Bichescu-Burian D, Truöl S, Steinert T. [Deliberate Renunciation of Coercion in the Case of Persistent Self-Destructive Behavior]. PSYCHIATRISCHE PRAXIS 2020; 47:337-339. [PMID: 32688425 DOI: 10.1055/a-1182-3252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The clinical course of borderline personality disorder with persistent suicidal communication and self-destruction is often characterized by freedom-restricting interventions, long-term hospitalization, and a lack of commitment for disorder-oriented treatment. We present the course of a 31-year-old man who was offered the free choice between disorder-oriented treatment or discharge from in-patient treatment. The clinical decision to offer the choice to the patient was based on the judgment of given capacity of self-determination except for short periods of acute crisis. Deliberate refraining from the use of coercive interventions and demanding responsibility for change from the patient paved the way for psychotherapeutic treatment and the reactivation of his own skills.
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Affiliation(s)
- Stefan Tschöke
- Zentrum für Psychiatrie Südwürttemberg, Ravensburg-Weissenau, Klinik für Psychiatrie und Psychotherapie I der Universität Ulm, Ravensburg-Weissenau
| | - Susanne Hund
- Zentrum für Psychiatrie Südwürttemberg, Ravensburg-Weissenau, Klinik für Psychiatrie und Psychotherapie I der Universität Ulm, Ravensburg-Weissenau
| | - Dana Bichescu-Burian
- Zentrum für Psychiatrie Südwürttemberg, Ravensburg-Weissenau, Klinik für Psychiatrie und Psychotherapie I der Universität Ulm, Ravensburg-Weissenau
| | - Steve Truöl
- Zentrum für Psychiatrie Südwürttemberg, Ravensburg-Weissenau, Klinik für Psychiatrie und Psychotherapie I der Universität Ulm, Ravensburg-Weissenau
| | - Tilman Steinert
- Zentrum für Psychiatrie Südwürttemberg, Ravensburg-Weissenau, Klinik für Psychiatrie und Psychotherapie I der Universität Ulm, Ravensburg-Weissenau
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Lotfinia S, Soorgi Z, Mertens Y, Daniels J. Structural and functional brain alterations in psychiatric patients with dissociative experiences: A systematic review of magnetic resonance imaging studies. J Psychiatr Res 2020; 128:5-15. [PMID: 32480060 DOI: 10.1016/j.jpsychires.2020.05.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/15/2020] [Accepted: 05/10/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION There is currently no general agreement on how to best conceptualize dissociative symptoms and whether they share similar neural underpinnings across dissociative disorders. Neuroimaging data could help elucidate these questions. OBJECTIVES The objective of this review is to summarize empirical evidence for neural aberrations observed in patients suffering from dissociative symptoms. METHODS A systematic literature review was conducted including patient cohorts diagnosed with primary dissociative disorders, post-traumatic stress disorder (PTSD), or borderline personality disorder. RESULTS Results from MRI studies reporting structural (gray matter and white matter) and functional (during resting-state and task-related activation) brain aberrations were extracted and integrated. In total, 33 articles were included of which 10 pertained to voxel-based morphology, 2 to diffusion tensor imaging, 10 to resting-state fMRI, and 11 to task-related fMRI. Overall findings indicated aberrations spread across diverse brain regions, especially in the temporal and frontal cortices. Patients with dissociative identity disorder and with dissociative PTSD showed more overlap in brain activation than each group showed with depersonalization/derealization disorder. CONCLUSION In conjunction, the results indicate that dissociative processing cannot be localized to a few distinctive brain regions but rather corresponds to differential neural signatures depending on the symptom constellation.
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Affiliation(s)
- Shahab Lotfinia
- Department of Clinical Psychology, Zahedan University of Medical Science, Zahedan, Iran
| | - Zohre Soorgi
- Department of Psychiatry, Zahedan University of Medical Science, Zahedan, Iran
| | - Yoki Mertens
- Department of Clinical Psychology, University of Groningen, the Netherlands
| | - Judith Daniels
- Department of Clinical Psychology, University of Groningen, the Netherlands.
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Bilić SS, Moessner M, Wirtz G, Lang S, Weisbrod M, Bauer S. Internet-based aftercare for patients with personality disorders and trauma-related disorders: A pilot study. Psychiatry Res 2020; 285:112771. [PMID: 32000102 DOI: 10.1016/j.psychres.2020.112771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 12/13/2019] [Accepted: 01/05/2020] [Indexed: 01/03/2023]
Abstract
Preventing readmission after hospital discharge is a major issue with regard to the continuity of patients' recovery process and the financial burden on the healthcare system, but adequate aftercare services are lacking. Therefore, a pilot study was conducted to examine the feasibility and acceptability of an Internet-based aftercare program for patients with personality disorders (PD) and / or trauma-related disorders as well as to obtain a preliminary estimate of effects on symptomatology and readmission. Patients' satisfaction with the program and symptomatology (KPD-38, BDI-II) were assessed prior to hospital discharge (t1) and after three months of participation (t2). Log data on program utilization (i.e., logins, page hits, and chat use) were automatically assessed via server logs. N = 31 of 45 eligible patients consented to participate. 84% used the intervention at least once. The average duration of participation was 63 days (SD = 4.6). Patients attended on average 7.2 out of 12 group chat sessions (SD = 4.0). Findings indicate very high acceptance of and satisfaction with the intervention. Symptomatology on all outcomes was stable, no deteriorations could be observed. 20% reported readmission within the aftercare period. Efficacy and cost-effectiveness should be tested with a large-scale randomized controlled trial.
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Affiliation(s)
- Sally Sophie Bilić
- Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany.
| | - Markus Moessner
- Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Gustav Wirtz
- Rehabilitation Centre for Mental Disorders, SRH Hospital Karlsbad-Langensteinbach, Karlsbad-Langensteinbach, Germany
| | - Stephan Lang
- Rehabilitation Centre for Mental Disorders, SRH Hospital Karlsbad-Langensteinbach, Karlsbad-Langensteinbach, Germany
| | - Matthias Weisbrod
- Department of Psychiatry and Psychotherapy, SRH Hospital Karlsbad-Langensteinbach, Karlsbad-Langensteinbach, Germany; Department of General Psychiatry, Center of Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Stephanie Bauer
- Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany
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Abstract
PURPOSE OF REVIEW The purpose of this article is to review the most recent literature on psychotic symptoms in borderline personality disorder (BPD). RECENT FINDINGS Both auditory hallucinations and delusional ideation (especially paranoid delusions) are relatively common in individuals with BPD. It is still difficult to distinguish these and related phenomena in BPD from the corresponding experiences in psychotic disorders and schizophrenia, despite numerous attempts to do so. The terminology introduced to help with this effort has not been particularly useful. The presence of auditory hallucinations may affect the course of BPD negatively. Psychotic symptoms in BPD seem to be significantly related to the context (usually stressful events) and appear or intensify in response to situational crisis. The role of certain co-occurring disorders in increasing the risk of psychotic symptoms in BPD remains uncertain. SUMMARY Psychotic symptoms in BPD continue to be poorly understood. Further research should try to ascertain the relationships between hallucinations and delusions on one hand and the processing of trauma, emotion regulation, distress tolerance and interpersonal sensitivity on the other. Ultimately, such endeavor will contribute to developing more effective treatments for BPD.
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Kirsch A, Spang J, Schäfer SK, Pfaltz M, Krause R, Sachsse U, Michael T. Mimikveränderungen während einer Traumatherapie. PSYCHOTHERAPEUT 2017. [DOI: 10.1007/s00278-017-0228-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sack M, Spieler D, Wizelman L, Epple G, Stich J, Zaba M, Schmidt U. Intranasal oxytocin reduces provoked symptoms in female patients with posttraumatic stress disorder despite exerting sympathomimetic and positive chronotropic effects in a randomized controlled trial. BMC Med 2017; 15:40. [PMID: 28209155 PMCID: PMC5314583 DOI: 10.1186/s12916-017-0801-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 01/21/2017] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is a severe psychiatric disease accompanied by neuroendocrine changes such as adrenergic overdrive and hence an elevated cardiovascular morbidity. Current pharmacotherapeutic options for PTSD are less than suboptimal, necessitating the development of PTSD-specific drugs. Although the neuropeptide oxytocin has been repeatedly suggested to be effective in PTSD treatment, there are, to our knowledge, only three studies that have assessed its efficacy on the intensity of PTSD symptoms in PTSD patients - among them one symptom provocation study in male veterans. METHODS To evaluate for the first time how oxytocin influences the intensity of provoked PTSD symptoms and, furthermore, cardiac control in female PTSD patients, we assessed their psychic and cardiac response to trauma-script exposure with and without oxytocin pretreatment in a double-blind randomized placebo-controlled study. We used a within-subject design to study 35 female PTSD patients who received oxytocin and placebo in a 2-week interval. Furthermore, we performed a small pilot study to get an idea of the relation of the stress-modulated endogenous oxytocin levels and heart rate - we correlated oxytocin serum levels with the heart rate of 10 healthy individuals before and after exposure to the Trier Social Stress Test (TSST). RESULTS Intranasal oxytocin treatment was followed by a reduction of provoked total PTSD symptoms, in particular of avoidance, and by an elevation in baseline and maximum heart rate together with a drop in the pre-ejection period, a marker for sympathetic cardiac control. Furthermore, we found a positive correlation between endogenous oxytocin levels and heart rate both before and after TSST challenge in healthy control subjects. CONCLUSIONS This study provides the first evidence that oxytocin treatment reduces the intensity of provoked PTSD symptoms in female PTSD patients. The small size of both samples and the heterogeneity of the patient sample restrict the generalizability of our findings. Future studies have to explore the gender dependency and the tolerability of the oxytocin-mediated increase in heart rate. This randomized controlled trial was retrospectively registered at the German Trials Register (DRKS00009399) on the 02 October 2015.
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Affiliation(s)
- M Sack
- Technische Universität München, Klinikum rechts der Isar, Department of Psychosomatic Medicine and Psychotherapy, Langerstr. 3, 81675, München, Germany
| | - D Spieler
- Technische Universität München, Klinikum rechts der Isar, Department of Psychosomatic Medicine and Psychotherapy, Langerstr. 3, 81675, München, Germany
| | - L Wizelman
- Technische Universität München, Klinikum rechts der Isar, Department of Psychosomatic Medicine and Psychotherapy, Langerstr. 3, 81675, München, Germany
| | - G Epple
- Technische Universität München, Klinikum rechts der Isar, Department of Psychosomatic Medicine and Psychotherapy, Langerstr. 3, 81675, München, Germany
| | - J Stich
- Max Planck Institute of Psychiatry, Department of Clinical Research, RG Molecular Psychotraumatology & Trauma Outpatient Clinic, Kraepelinstrasse 10, 80804, München, Germany
| | - M Zaba
- Max Planck Institute of Psychiatry, Department of Clinical Research, RG Molecular Psychotraumatology & Trauma Outpatient Clinic, Kraepelinstrasse 10, 80804, München, Germany
| | - U Schmidt
- Max Planck Institute of Psychiatry, Department of Clinical Research, RG Molecular Psychotraumatology & Trauma Outpatient Clinic, Kraepelinstrasse 10, 80804, München, Germany.
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Shabb O. Considering psychoeducation on structural dissociation for dialectical behavior therapy patients experiencing high-risk dissociative behaviors. J Trauma Dissociation 2016; 17:55-66. [PMID: 26158659 DOI: 10.1080/15299732.2015.1053657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Dialectical behavioral therapy (DBT) programs, particularly for low-functioning individuals at the safety and stabilization phase of therapy, work with a variety of high-risk and often complex cases, with a curriculum consisting primarily of concrete skill acquisition and application. A significant subset of individuals in DBT programs, however, may suffer high-risk dissociative episodes in which skill application may be less available to them, contributing to further destabilization, demoralization, and thoughts of self-inefficacy in treatment. This article evaluates the potential benefits of complementing traditional DBT with psychoeducation on structural dissociation for such patients, acknowledging and addressing some of the concerns that might accompany such a consideration.
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Affiliation(s)
- Olivia Shabb
- a Independent Scholar , New York , New York , USA
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Trauma- und Gewaltfolgen – psychische Auswirkungen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2015; 59:28-34. [DOI: 10.1007/s00103-015-2259-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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11
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Anhaltender sexueller Missbrauch in der Kindheit und Langzeitfolgen für die Entwicklung. PSYCHOTHERAPEUT 2015. [DOI: 10.1007/s00278-015-0056-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Frías Á, Palma C. Comorbidity between post-traumatic stress disorder and borderline personality disorder: a review. Psychopathology 2015; 48:1-10. [PMID: 25227722 DOI: 10.1159/000363145] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 04/13/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Traditionally, the presence of post-traumatic stress disorder (PTSD) in subjects diagnosed with borderline personality disorder (BPD) has been the object of scant empirical research. The clarification of issues related to the different areas of study for this comorbidity is not only significant from a theoretical point of view but also relevant for clinical practice. The aim of this review is to describe the main theoretical findings and research conclusions about the comorbidity between PTSD and BPD. METHODS A literature review was carried out via PubMed and PsycINFO for the period between 1990 and September 2013. The descriptors used were 'post-traumatic stress disorder', 'borderline personality disorder', 'PTSD', 'complex PTSD' and 'BPD'. RESULTS Epidemiological studies show that the risk of PTSD among BPD subjects is not regularly higher than in subjects with other personality disorders. Furthermore, there is no conclusive evidence about the main aetiopathogenic mechanism of this comorbidity, either of one disorder being a risk factor for the other one or of common underlying variables. Concerning comparative studies, several studies with PTSD-BPD subjects have found a higher severity of psychopathology and psychosocial impairment than in BPD subjects. With regard to nosological status, the main focus of controversy is the validation of 'complex PTSD', a clinical entity which may comprise a subgroup of PTSD-BPD subjects. With regard to treatment, there are preliminary evidences for the efficient treatment of psychopathology in both PTSD and BPD. CONCLUSIONS These findings are remarkable for furthering the understanding of the link between PTSD and BPD and their implications for treatment. The results of this review are discussed, including methodological constraints that hinder external validity and consistency of referred findings.
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Affiliation(s)
- Álvaro Frías
- FPCEE Blanquerna, University of Ramon-Llull, Barcelona, Spain
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Richter C, Steinacher B, zum Eschenhoff A, Bermpohl F. Stationäre und teilstationäre DBT-Angebote für Patienten mit Borderline-Persönlichkeitsstörung - Ergebnisse einer deutschlandweiten Umfrage. VERHALTENSTHERAPIE 2014. [DOI: 10.1159/000369425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Brand BL, Lanius RA. Chronic complex dissociative disorders and borderline personality disorder: disorders of emotion dysregulation? Borderline Personal Disord Emot Dysregul 2014; 1:13. [PMID: 26401297 PMCID: PMC4579511 DOI: 10.1186/2051-6673-1-13] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 08/27/2014] [Indexed: 11/25/2022] Open
Abstract
Emotion dysregulation is a core feature of chronic complex dissociative disorders (DD), as it is for borderline personality disorder (BPD). Chronic complex DD include dissociative identity disorder (DID) and the most common form of dissociative disorder not otherwise specified (DDNOS, type 1), now known as Other Specified Dissociative Disorders (OSDD, type 1). BPD is a common comorbid disorder with DD, although preliminary research indicates the disorders have some distinguishing features as well as considerable overlap. This article focuses on the epidemiology, clinical presentation, psychological profile, treatment, and neurobiology of chronic complex DD with emphasis placed on the role of emotion dysregulation in each of these areas. Trauma experts conceptualize borderline symptoms as often being trauma based, as are chronic complex DD. We review the preliminary research that compares DD to BPD in the hopes that this will stimulate additional comparative research.
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Affiliation(s)
| | - Ruth A Lanius
- />University of Western Ontario, London, ON N6A 5A5 Canada
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Abstract
The aim of the study was to identify psychopathological similarities and differences in borderline personality disorder (BPD) and schizophrenia. We compared 23 female patients with a BPD and 21 female patients with schizophrenia according to auditory verbal hallucinations (AVHs), dissociation, childhood trauma, and additional psychotic symptoms. The character of AVH was similar with regard to commenting voices, location, and foreign voices. Major differences were found in the prevalence of negative symptoms, bizarre delusions, and formal thought disorder. These characteristics were more frequent in schizophrenia and negatively correlated with childhood traumatization. A history of childhood traumatization and dissociative symptoms was significantly more frequent in BPD. AVHs in BPD and schizophrenia are not distinguishable in terms of the historically grown criteria in Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision for diagnosing schizophrenia. Other symptoms such as delusions, negative symptoms, formal thought disorder, and dissociative psychopathology could help to differentiate between both groups.
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Abstract
Psychological trauma can have devastating consequences on emotion regulatory capacities and lead to dissociative processes that provide subjective detachment from overwhelming emotional experience during and in the aftermath of trauma. Dissociation is a complex phenomenon that comprises a host of symptoms and factors, including depersonalization, derealization, time distortion, dissociative flashbacks, and alterations in the perception of the self. Dissociation occurs in up to two thirds of patients with borderline personality disorder (BPD). The neurobiology of traumatic dissociation has demonstrated a heterogeneity in posttraumatic stress symptoms that, over time, can result in different types of dysregulated emotional states. This review links the concepts of trauma and dissociation to BPD by illustrating different forms of emotional dysregulation and their clinical relevance to patients with BPD.
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Affiliation(s)
- Eric Vermetten
- Department Psychiatry, Leiden University Medical Center, Utrecht, The Netherlands,
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Ford JD, Courtois CA. Complex PTSD, affect dysregulation, and borderline personality disorder. Borderline Personal Disord Emot Dysregul 2014; 1:9. [PMID: 26401293 PMCID: PMC4579513 DOI: 10.1186/2051-6673-1-9] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 05/18/2014] [Indexed: 12/23/2022] Open
Abstract
Complex PTSD (cPTSD) was formulated to include, in addition to the core PTSD symptoms, dysregulation in three psychobiological areas: (1) emotion processing, (2) self-organization (including bodily integrity), and (3) relational security. The overlap of diagnostic criteria for cPTSD and borderline personality disorder (BPD) raises questions about the scientific integrity and clinical utility of the cPTSD construct/diagnosis, as well as opportunities to achieve an increasingly nuanced understanding of the role of psychological trauma in BPD. We review clinical and scientific findings regarding comorbidity, clinical phenomenology and neurobiology of BPD, PTSD, and cPTSD, and the role of traumatic victimization (in general and specific to primary caregivers), dissociation, and affect dysregulation. Findings suggest that BPD may involve heterogeneity related to psychological trauma that includes, but extends beyond, comorbidity with PTSD and potentially involves childhood victimization-related dissociation and affect dysregulation consistent with cPTSD. Although BPD and cPTSD overlap substantially, it is unwarranted to conceptualize cPTSD either as a replacement for BPD, or simply as a sub-type of BPD. We conclude with implications for clinical practice and scientific research based on a better differentiated view of cPTSD, BPD and PTSD.
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Affiliation(s)
- Julian D Ford
- University of Connecticut Health Center MC1410, 263 Farmington Avenue, Farmington, CT 06030-1410 USA
| | - Christine A Courtois
- Independent Pactice, Washington, DC, Elements Behavioral Health, Promises, Malibu, CA USA
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