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Schurz M, Berenz JP, Maerz J, Perla R, Buchheim A, Labek K. Brain Activation for Social Cognition and Emotion Processing Tasks in Borderline Personality Disorder: A Meta-Analysis of Neuroimaging Studies. Brain Sci 2024; 14:395. [PMID: 38672044 PMCID: PMC11048542 DOI: 10.3390/brainsci14040395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/15/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
The present meta-analysis summarizes brain activation for social cognition and emotion-processing tasks in borderline personality disorder (BPD). We carried out two meta-analyses to elaborate on commonalities and potential differences between the two types of tasks. In the first meta-analysis, we implemented a more liberal strategy for task selection (including social and emotional content). The results confirmed previously reported hyperactivations in patients with BPD in the bilateral amygdala and prefrontal cortex and hypoactivations in bilateral inferior frontal gyri. When applying a stricter approach to task selection, focusing narrowly on social cognition tasks, we only found activation in prefrontal areas, particularly in the anterior cingulate and ventromedial prefrontal cortex. We review the role of these areas in social cognition in healthy adults, suggesting that the observed BPD hyperactivations may reflect an overreliance on self-related thought in social cognition.
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Affiliation(s)
- Matthias Schurz
- Department of Psychology, Faculty of Psychology and Sport Science, and Digital Science Center (DiSC), University of Innsbruck, Universitätsstrasse 15, 6020 Innsbruck, Austria
| | - Jan-Patrick Berenz
- Department of Psychology, Faculty of Psychology and Sport Science, University of Innsbruck, Universitätsstrasse 15, 6020 Innsbruck, Austria
| | - Jeff Maerz
- Department of Psychology, Faculty of Psychology and Sport Science, University of Innsbruck, Universitätsstrasse 15, 6020 Innsbruck, Austria
| | - Raphael Perla
- Department of Psychology, Faculty of Psychology and Sport Science, and Digital Science Center (DiSC), University of Innsbruck, Universitätsstrasse 15, 6020 Innsbruck, Austria
| | - Anna Buchheim
- Department of Psychology, Faculty of Psychology and Sport Science, University of Innsbruck, Universitätsstrasse 15, 6020 Innsbruck, Austria
| | - Karin Labek
- Department of Psychology, Faculty of Psychology and Sport Science, University of Innsbruck, Universitätsstrasse 15, 6020 Innsbruck, Austria
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2
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Mancinelli F, Nolte T, Griem J. Attachment and borderline personality disorder as the dance unfolds: A quantitative analysis of a novel paradigm. J Psychiatr Res 2024; 175:470-478. [PMID: 38823203 DOI: 10.1016/j.jpsychires.2024.03.046] [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] [Received: 04/28/2023] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 06/03/2024]
Abstract
Current research on personality disorders strives to identify key behavioural and cognitive facets of patient functioning, to unravel the underlying root causes and maintenance mechanisms. This process often involves the application of social paradigms - however, these often only include momentary affective depictions rather than unfolding interactions. This constitutes a limitation in our capacity to probe core symptoms, and leaves potential findings uncovered which could help those who are in close relationships with affected individuals. Here, we deployed a novel task in which subjects interact with four unknown virtual partners in a turn-taking paradigm akin to a dance, and report on their experience with each. The virtual partners embody four combinations of low/high expressivity of positive/negative mood. Higher scores on our symptomatic measures of attachment anxiety, avoidance, and borderline personality disorder (BPD) were all linked to a general negative appraisal of all the interpersonal experiences. Moreover, the negative appraisal of the partner who displayed a high negative/low positive mood was tied with attachment anxiety and BPD symptoms. The extent to which subjects felt responsible for causing partners' distress was most strongly linked to attachment anxiety. Finally, we provide a fully-fledged exploration of move-by-move action latencies and click distances from partners. This analysis underscored slower movement initiation from anxiously attached individuals throughout all virtual interactions. In summary, we describe a novel paradigm for second-person neuroscience, which allowed both the replication of established results and the capture of new behavioural signatures associated with attachment anxiety, and discuss its limitations.
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Affiliation(s)
- Federico Mancinelli
- University of Bonn, Transdisciplinary Research Area "Life and Health", Hertz Chair for Artificial Intelligence and Neuroscience, Bonn, Germany; Scuola Internazionale Superiore di Studi Avanzati, Trieste, Italy.
| | - Tobias Nolte
- Research Department of Clinical, Educational and Health Psychology, University College London, London,UK; Anna Freud National Centre for Children and Families, London, UK
| | - Julia Griem
- Research Department of Clinical, Educational and Health Psychology, University College London, London,UK
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3
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Preti E, Richetin J, Poggi A, Fertuck E. A Model of Trust Processes in Borderline Personality Disorder: A Systematic Review. Curr Psychiatry Rep 2023; 25:555-567. [PMID: 37889465 PMCID: PMC10654201 DOI: 10.1007/s11920-023-01468-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE OF REVIEW Unstable relationships are a core feature of borderline personality disorder (BPD). Impairments in trust processes (i.e., appraisal and learning regarding others' trustworthiness) can subserve interpersonal problems associated with BPD, but the determinants, mechanisms, consequences, and variations in trust impairments among individuals with BPD remain poorly characterized. Thus, a better understanding of such impairments could help target interventions that address the interpersonal problems of individuals with BPD beyond emotion dysregulation, impulsivity, and aggression. RECENT FINDINGS We conducted a pre-registered systematic review of empirical studies on trust processes and BPD features (k = 29). Results are organized around a heuristic model of trust processes in BPD comprising the following stages: developmental factors, prior beliefs and dispositions, situation perception, emotional states, trust appraisal, behavioral manifestations, and trust learning. Based on the synthesis of the findings, we recommended directions for future research and clinical assessment and intervention, such as managing trust during the early stages of therapy and considering improvements in trust processes as a central mechanism of change in treating individuals with BPD.
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Affiliation(s)
- Emanuele Preti
- Department of Psychology, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126, Milan, Italy.
| | - Juliette Richetin
- Department of Psychology, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126, Milan, Italy
| | - Anita Poggi
- Department of Psychology, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126, Milan, Italy
| | - Eric Fertuck
- City College of the City University of New York, New York, USA
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Ensink K, Normandin L. Trust in Therapeutic Work With Adolescents With and Without Personality Disorders: A Transference-Focused Therapy Perspective. J Pers Disord 2023; 37:580-603. [PMID: 37903024 DOI: 10.1521/pedi.2023.37.5.580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
Trust is central to successful therapeutic work with adolescents, but establishing trust can be challenging, especially with adolescents with personality disorders. We present our understanding of trust in working with adolescents with and without personality disorders. We draw on complementary and overlapping perspectives, namely the attachment model, Kernberg's object relations model, and Fonagy's mentalization model. In Kernberg's object relations conceptualization, difficulties in trust experienced by patients with borderline personality disorders result from paranoia associated with splitting and identity diffusion. In Fonagy's mentalization model, epistemic trust is rooted in early experiences of being responded to and understood. We outline how techniques used in transference-focused psychotherapy for adolescents promote the development of the adolescent's capacity to trust by facilitating identity integration, thus reducing paranoia. Finally, we use two clinical case illustrations to demonstrate how trust unfolds in working with adolescents with and without personality disorders.
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Affiliation(s)
- Karin Ensink
- School of Psychology, University Laval, Québec, Canada
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5
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Shapiro-Thompson R, Shah TV, Yi C, Jackson N, Trujillo Diaz D, Fineberg SK. Modulation of Trust in Borderline Personality Disorder by Script-Based Imaginal Exposure to Betrayal. J Pers Disord 2023; 37:508-524. [PMID: 37903023 PMCID: PMC11002460 DOI: 10.1521/pedi.2023.37.5.508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
Interpersonal and trust-related difficulties are central features of borderline personality disorder (BPD). In this study, we applied script-driven betrayal imagery to evoke mistrustful behavior in a social reinforcement learning task. In 21 BPD and 20 healthy control (HC) participants, we compared this approach to the standard confederate paradigm used in research studies. The script-driven imagery evoked a transient increase in negative affect and also decreased trusting behavior to a similar degree in both groups. Across conditions, we also replicated previously reported between-group differences in negative affect (increased in BPD) and task behavior (more sensitive to social cues in BPD). These results support the validity of script-driven imagery as an alternative social task stimulus. This script-driven imagery approach is appealing for clinical research studies on reinforcement learning because it eliminates deception, scales easily, and evokes disorder-specific states of social difficulty.
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Affiliation(s)
| | - Tanya V Shah
- Department of Psychiatry, Yale University, New Haven, Connecticut
- Pomona College, Claremont, California
| | | | - Nasir Jackson
- Department of Psychiatry, Yale University, New Haven, Connecticut
- Meharry Medical College, Nashville, Tennessee
| | | | - Sarah K Fineberg
- Department of Psychiatry, Yale University, New Haven, Connecticut
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6
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Meehan KB, Cain NM, Roche MJ, Fertuck EA, Sowislo JF, Clarkin JF. Evaluating Change in Transference, Interpersonal Functioning, and Trust Processes in the Treatment of Borderline Personality Disorder: A Single-Case Study Using Ecological Momentary Assessment. J Pers Disord 2023; 37:490-507. [PMID: 37903025 DOI: 10.1521/pedi.2023.37.5.490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
Transference-focused psychotherapy (TFP) is an empirically supported treatment for borderline personality disorder (BPD) that improves functioning via targeting representations of self affectively relating to others, particularly as evoked in the therapeutic relationship. If change in TFP operates as theorized, then shifts in patterns of "self affectively relating to others" should be observed in the transference prior to shifts in daily relationships. Using ecological momentary assessment (EMA), a patient with BPD rated daily interpersonal events for 2-week periods during 18 months of TFP; at 9 and 18 months these ratings included interactions with the therapist. Results suggest that positive perceptions of her therapist that ran counter to her negatively biased perception in other relationships preceded changes in her perceptions of others. EMA shifts corresponded to improvements in self-reported symptoms, interview-based personality functioning, and therapist assessments. Implications for assimilation of a trusting experience with the therapist as a mechanism of change in TFP are discussed.
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Affiliation(s)
- Kevin B Meehan
- Long Island University - Brooklyn, NY
- Weill Medical College of Cornell University, New York, New York
| | | | | | - Eric A Fertuck
- The City College and Graduate Center of CUNY, New York, New York
| | - Julia F Sowislo
- Weill Medical College of Cornell University, New York, New York
| | - John F Clarkin
- Weill Medical College of Cornell University, New York, New York
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7
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Miano A, Lustig S, Meyerding L, Barnow S. Accuracy and Bias in Facial Trustworthiness Appraisals in Borderline Personality Disorder. J Pers Disord 2023; 37:525-541. [PMID: 37903022 DOI: 10.1521/pedi.2023.37.5.525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
Individuals with borderline personality disorder (BPD) have shown a negativity bias, whereas the general population has shown a positivity bias in their trustworthiness appraisal of others. We tested if individuals with BPD are more negative but also more realistic with their appraisals. Trustworthiness was objectified on an external criterion. The influence of childhood trauma was investigated. Facial photographs of peace prize laureates and sentenced murderers were presented. Participants with BPD and healthy controls (HC) rated the trustworthiness of the targets. Bias and sensitivity were measured using signal detection theory. The BPD group was more negatively biased compared to HC, but not more sensitive in discriminating between the two groups. When correcting for experienced childhood abuse and neglect, the authors found that group differences in bias disappeared. Individuals with BPD might not be more sensitive in discriminating between, on average, more or less trustworthy targets, but they have developed a negativity bias to ensure the detection of untrustworthiness.
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Affiliation(s)
- Annemarie Miano
- Department of Clinical Psychology and Psychotherapy, Ruprecht-Karls-University, Heidelberg, Germany
| | - Sophia Lustig
- Department of Clinical Psychology and Psychotherapy, Ruprecht-Karls-University, Heidelberg, Germany
| | - Luca Meyerding
- Department of Clinical Psychology and Psychotherapy, Ruprecht-Karls-University, Heidelberg, Germany
| | - Sven Barnow
- Department of Clinical Psychology and Psychotherapy, Ruprecht-Karls-University, Heidelberg, Germany
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Fertuck EA, Stanley B, Kleshchova O, Mann JJ, Hirsch J, Ochsner K, Pilkonis P, Erbe J, Grinband J. Rejection Distress Suppresses Medial Prefrontal Cortex in Borderline Personality Disorder. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2023; 8:651-659. [PMID: 36868964 PMCID: PMC10388534 DOI: 10.1016/j.bpsc.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/25/2022] [Accepted: 11/17/2022] [Indexed: 12/10/2022]
Abstract
BACKGROUND Borderline personality disorder (BPD) is characterized by an elevated distress response to social exclusion (i.e., rejection distress), the neural mechanisms of which remain unclear. Functional magnetic resonance imaging studies of social exclusion have relied on the classic version of the Cyberball task, which is not optimized for functional magnetic resonance imaging. Our goal was to clarify the neural substrates of rejection distress in BPD using a modified version of Cyberball, which allowed us to dissociate the neural response to exclusion events from its modulation by exclusionary context. METHODS Twenty-three women with BPD and 22 healthy control participants completed a novel functional magnetic resonance imaging modification of Cyberball with 5 runs of varying exclusion probability and rated their rejection distress after each run. We tested group differences in the whole-brain response to exclusion events and in the parametric modulation of that response by rejection distress using mass univariate analysis. RESULTS Although rejection distress was higher in participants with BPD (F1,40 = 5.25, p = .027, η2 = 0.12), both groups showed similar neural responses to exclusion events. However, as rejection distress increased, the rostromedial prefrontal cortex response to exclusion events decreased in the BPD group but not in control participants. Stronger modulation of the rostromedial prefrontal cortex response by rejection distress was associated with higher trait rejection expectation, r = -0.30, p = .050. CONCLUSIONS Heightened rejection distress in BPD might stem from a failure to maintain or upregulate the activity of the rostromedial prefrontal cortex, a key node of the mentalization network. Inverse coupling between rejection distress and mentalization-related brain activity might contribute to heightened rejection expectation in BPD.
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Affiliation(s)
- Eric A Fertuck
- Department of Psychology, Clinical Psychology Doctoral Program, The City College of the City University of New York, New York, New York; Department of Psychiatry, Columbia University, New York, New York; Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, New York.
| | - Barbara Stanley
- Department of Psychiatry, Columbia University, New York, New York; Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, New York
| | - Olena Kleshchova
- Department of Psychology, University of Nevada Reno, Reno, Nevada
| | - J John Mann
- Department of Psychiatry, Columbia University, New York, New York; Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, New York
| | - Joy Hirsch
- Departments of Psychiatry, Neuroscience and Comparative Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Kevin Ochsner
- Department of Psychology, Columbia University, New York, New York
| | - Paul Pilkonis
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jeff Erbe
- Department of Psychology, Clinical Psychology Doctoral Program, The City College of the City University of New York, New York, New York; Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, New York
| | - Jack Grinband
- Department of Psychiatry, Columbia University, New York, New York
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Stopyra MA, Simon JJ, Rheude C, Nikendei C. Pathophysiological aspects of complex PTSD - a neurobiological account in comparison to classic posttraumatic stress disorder and borderline personality disorder. Rev Neurosci 2023; 34:103-128. [PMID: 35938987 DOI: 10.1515/revneuro-2022-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 06/25/2022] [Indexed: 01/11/2023]
Abstract
Despite a great diagnostic overlap, complex posttraumatic stress disorder (CPTSD) has been recognised by the ICD-11 as a new, discrete entity and recent empirical evidence points towards a distinction from simple posttraumatic stress disorder (PTSD) and borderline personality disorder (BPD). The development and maintenance of these disorders is sustained by neurobiological alterations and studies using functional magnetic resonance imaging (fMRI) may further contribute to a clear differentiation of CPTSD, PTSD and BPD. However, there are no existing fMRI studies directly comparing CPTSD, PTSD and BPD. In addition to a summarization of diagnostic differences and similarities, the current review aims to provide a qualitative comparison of neuroimaging findings on affective, attentional and memory processing in CPTSD, PTSD and BPD. Our narrative review alludes to an imbalance in limbic-frontal brain networks, which may be partially trans-diagnostically linked to the degree of trauma symptoms and their expression. Thus, CPTSD, PTSD and BPD may underlie a continuum where similar brain regions are involved but the direction of activation may constitute its distinct symptom expression. The neuronal alterations across these disorders may conceivably be better understood along a symptom-based continuum underlying CPTSD, PTSD and BPD. Further research is needed to amend for the heterogeneity in experimental paradigms and sample criteria.
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Affiliation(s)
- Marion A Stopyra
- Department of General Internal Medicine and Psychosomatics, Centre for Psychosocial Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Joe J Simon
- Department of General Internal Medicine and Psychosomatics, Centre for Psychosocial Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Christiane Rheude
- Department of General Internal Medicine and Psychosomatics, Centre for Psychosocial Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Christoph Nikendei
- Department of General Internal Medicine and Psychosomatics, Centre for Psychosocial Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
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10
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Biermann M, Schulze A, Unterseher F, Hamm M, Atanasova K, Stahlberg D, Lis S. Trustworthiness judgments and Borderline Personality Disorder: an experimental study on the interplay of happiness and trustworthiness appraisals and the effects of wearing face masks during the Covid-19 pandemic in Germany. Borderline Personal Disord Emot Dysregul 2022; 9:27. [PMID: 36324166 PMCID: PMC9629878 DOI: 10.1186/s40479-022-00193-x] [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] [Received: 03/12/2022] [Accepted: 07/13/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Judging positive emotional states or the trustworthiness of others is important for forming and maintaining social affiliations. Past studies have described alterations in these appraisal processes in Borderline Personality Disorder (BPD), which might have been exacerbated during the Covid-19 pandemic by the requirement to wear face masks. In the present study, we investigated in an online-survey a) whether social judgments are particularly strongly affected in individuals with BPD when they have to judge happiness and trustworthiness in facial stimuli covered by a mask, b) whether appraising a positive emotional state affects trustworthiness appraisals differentially in BPD and healthy individuals and c) whether social judgments are related to how individuals with BPD experience wearing masks during the pandemic. METHODS Participants (67 HC, 75 BPD) judged happiness and trustworthiness of faces with calm expression with and without masks. Additionally, data on participants' confidence in their judgments, the experience of the burden induced by wearing masks, the protective benefits of masks, and compliance to wearing masks were collected. RESULTS Happiness and trustworthiness were evaluated less confidently and less intense in the BPD group compared to HC. Masks reduced happiness and trustworthiness ratings in both groups. Lower happiness appraisals contributed to lower trustworthiness appraisals except for those with BPD and low levels of symptom severity. Lower trustworthiness ratings were associated with a higher burden, attributing a lower benefit to masks and lower compliance with wearing masks in BPD. CONCLUSIONS Masks do not exacerbate deficits in social judgments. However, lower trustworthiness appraisals in general were linked with more negative evaluations of wearing masks in the BPD group. TRIAL REGISTRATION The aims and hypotheses were preregistered together with the design and planned analyses ( https://aspredicted.org/f5du7.pdf ). For findings of an additionally preregistered research question on the impact of adverse childhood experiences see supplementary material.
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Affiliation(s)
- Miriam Biermann
- Department of Psychiatric and Psychosomatic Medicine, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany. .,Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany.
| | - Anna Schulze
- Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany
| | - Franziska Unterseher
- Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany
| | - Marie Hamm
- Department of Psychiatric and Psychosomatic Medicine, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany.,Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany
| | - Konstantina Atanasova
- Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany
| | - Dagmar Stahlberg
- School of Social Sciences, University of Mannheim, A5, 6, 68159, Mannheim, Germany
| | - Stefanie Lis
- Department of Psychiatric and Psychosomatic Medicine, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany.,Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany
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11
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Hien DA, López-Castro T, Fitzpatrick S, Ruglass LM, Fertuck EA, Melara R. A unifying translational framework to advance treatment research for comorbid PTSD and substance use disorders. Neurosci Biobehav Rev 2021; 127:779-794. [PMID: 34062208 DOI: 10.1016/j.neubiorev.2021.05.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 05/13/2021] [Accepted: 05/20/2021] [Indexed: 11/20/2022]
Abstract
We provide a unifying translational framework that can be used to synthesize extant lines of human laboratory research in four neurofunctional domains that underlie the co-occurrence of posttraumatic stress and substance use disorders (PTSD+SUD). We draw upon the Alcohol and Addiction Research Domain Criteria (AARDOC) to include executive functioning, negative emotionality, reward, and added social cognition from the National Institute of Mental Health (NIMH) Research Domain Criteria into our framework. We review research findings across each of the four domains, emphasizing human experimental studies in PTSD, SUD, and PTSD+SUD for each domain. We also discuss the implications of research findings for treatment development by considering new ways of conceptualizing risk factors and outcomes at the level of the individual patient, which will enhance treatment matching and advance innovations in intervention.
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Affiliation(s)
- Denise A Hien
- Center of Alcohol & Substance Use Studies, Graduate School of Applied and Professional Psychology, Rutgers University-New Brunswick, Piscataway, New Jersey, United States.
| | - Teresa López-Castro
- Psychology Department, The City College of New York, New York, NY, United States
| | | | - Lesia M Ruglass
- Center of Alcohol & Substance Use Studies, Graduate School of Applied and Professional Psychology, Rutgers University-New Brunswick, Piscataway, New Jersey, United States; Psychology Department, The City College of New York, New York, NY, United States
| | - Eric A Fertuck
- Psychology Department, The City College of New York, New York, NY, United States
| | - Robert Melara
- Psychology Department, The City College of New York, New York, NY, United States
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12
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Probing commitment in individuals with borderline personality disorder. J Psychiatr Res 2021; 137:335-341. [PMID: 33744513 DOI: 10.1016/j.jpsychires.2021.02.062] [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: 12/02/2020] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 11/23/2022]
Abstract
Interpersonal problems are a core symptom of borderline personality disorder (BPD). In particular, patients with BPD exhibit a heightened sensitivity to cues of acceptance or rejection in their relationships. The current study investigated the psychological processes underpinning this heightened responsiveness. In a between-subjects design, we implemented a reactivity induction designed to trigger either acceptance or rejection of a partner in two separate groups, and measured the effects which this manipulation had upon 49 patients with BPD, as well as 52 control participants. The experimental paradigm required participants to repeatedly choose whether to coordinate with their partner on a decision-making task. When both players coordinate on the same option, both are rewarded. The experiment probed participants' commitment to their partners: participants were sometimes presented with tempting opportunities to unilaterally defect from the coordination. The results show that participants in the BPD group were less committed than participants in the control group when exposed to the rejection manipulation.
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13
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Hanegraaf L, van Baal S, Hohwy J, Verdejo-Garcia A. A systematic review and meta-analysis of 'Systems for Social Processes' in borderline personality and substance use disorders. Neurosci Biobehav Rev 2021; 127:572-592. [PMID: 33865874 DOI: 10.1016/j.neubiorev.2021.04.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 02/10/2021] [Accepted: 04/12/2021] [Indexed: 01/12/2023]
Abstract
Deficits in social processing (SP) have been proposed to underpin interpersonal dysfunction in both Borderline Personality Disorder (BPD) and Substance Use Disorders (SUD). This study aimed to explore potential transdiagnostic cognitive and behavioral phenotypes of these disorders utilizing the NIMH Research Domain Criteria 'Systems for Social Processes'. A systematic review and meta-analysis of the published research was conducted on 134 studies identified through our database searches. Four meta-analyses were conducted, which revealed significant overlapping deficits in the ability to identify facial emotions and infer the mental states of others in both BPD and SUD. Further, people with BPD displayed a higher ostracism effect following perceived social exclusion. Systematically reviewed studies also revealed significant dysfunction amongst individuals with BPD and SUD across both self and other SP constructs, which were broadly similar in magnitude. Taken together, these results support the proposition that SP dysfunction may be considered a core transdiagnostic phenotype of BPD and SUD.
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Affiliation(s)
- Lauren Hanegraaf
- Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia.
| | - Simon van Baal
- Cognition and Philosophy Lab, Philosophy Department, Monash University, Clayton, Australia
| | - Jakob Hohwy
- Cognition and Philosophy Lab, Philosophy Department, Monash University, Clayton, Australia
| | - Antonio Verdejo-Garcia
- Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
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Fertuck EA, Dambreville N, Diamond D, Duggal D, Erbe JK. Referential Activity Differentially Mediates Expression of Positive and Negative Emotions in Borderline Personality Disorder. JOURNAL OF PSYCHOLINGUISTIC RESEARCH 2021; 50:155-167. [PMID: 33566312 DOI: 10.1007/s10936-021-09767-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/06/2021] [Indexed: 06/12/2023]
Abstract
Borderline Personality Disorder (BPD) is a high risk and prevalent personality disorder that is associated with increased negative emotions, decreased positive emotions, and impairments in symbolization and impaired reflective functioning. These dimensions, while they may impact one another, have not been investigated concurrently from qualitative, linguistic narratives. We hypothesized a BPD group would have lower expression of positive emotions and greater expression of negative emotions and less reflective function than healthy controls. Additionally, we explored the role of referential activity (an index of symbolic capacity) between BPD and healthy controls in the context of valenced emotional expression. An adult, female BPD group (n = 13) and a demographically matched healthy control group (n = 14) were recruited and administered the Adult Attachment Interview and/or the Object Relations Inventory. Computerized text analyses were used to assess positive emotion and negative emotion, the Weighted Referential Activity Dictionaries to assess referential activity, and the Computerized Reflective Function dictionary. On the Object Relations Inventory, the BPD group expressed more frequent negative emotions and less frequent positive emotions; on the Adult Attachment Interview, the BPD group exhibited less expression of positive emotions. There were no differences between BPD and controls on referential activity or reflective functioning on either interview. However, BPD status fully mediated the significant relationship between referential activity and negative emotion expression. The BPD group utilized more referential activity when expressing negative emotions than controls. Conversely, the control group utilized more referential activity when expressing positive emotions than controls. Referential activity seems to play an important role in explaining the BPD versus control difference in valenced linguistic emotional expression. Furthermore, these results suggest the object relations inventory elicits more robust linguistic features relevant to BPD.
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Affiliation(s)
- Eric A Fertuck
- Department of Psychology, The Graduate Center, City University of New York, New York, US.
- Department of Psychology, The City College of New York, 160 Convent Ave, New York, NY, 10031, US.
| | - Naomi Dambreville
- Department of Psychology, The Graduate Center, City University of New York, New York, US
- Department of Psychology, The City College of New York, 160 Convent Ave, New York, NY, 10031, US
| | - Diana Diamond
- Department of Psychology, The Graduate Center, City University of New York, New York, US
- Personality Disorders Institute, Weill Cornell Medical College, New York, NY, US
| | - Devika Duggal
- Department of Psychology, The Graduate Center, City University of New York, New York, US
- Department of Psychology, The City College of New York, 160 Convent Ave, New York, NY, 10031, US
| | - Jeffrey K Erbe
- Department of Psychology, The Graduate Center, City University of New York, New York, US
- Department of Psychology, The City College of New York, 160 Convent Ave, New York, NY, 10031, US
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Niedtfeld I, Kroneisen M. Impaired memory for cooperative interaction partners in borderline personality disorder. Borderline Personal Disord Emot Dysregul 2020; 7:22. [PMID: 33014377 PMCID: PMC7528496 DOI: 10.1186/s40479-020-00137-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/08/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Interpersonal disturbances in Borderline Personality Disorder (BPD) have been attributed to a negativity bias in social cognition. Adding to this literature, we experimentally tested whether those with BPD show altered memory for cooperative versus non-cooperative interaction partners. METHODS In a source memory paradigm, 51 female BPD patients and 50 healthy controls (HC) played a trust game with 40 different female target characters (trustworthy vs untrustworthy). In a subsequent surprise memory test, participants had to recognize those target individuals (vs distractor pictures), and had to recall whether they had shown cooperative behavior during the trust game. We hypothesized that BPD patients have better memory for uncooperative interaction partners as compared to cooperative interaction partners, and that a-priori expectations of untrustworthiness would influence recall. RESULTS During the trust game, BPD individuals invested lower amounts of money than HC for trustworthy targets, but no differences were found for untrustworthy targets. During the memory test, BPD patients had significant difficulties to remember cooperative targets, as compared to HC. More specifically, those with BPD indicated more often than HC that they had not previously interacted with cooperative targets of the previous trust game. We did not detect any differences between BPD and HC in source memory, or with regard to the effects of trustworthiness expectations. CONCLUSIONS The observed tendency to forget cooperative interaction partners in BPD is possibly caused by dysfunctional cognitive schemas. At the same time, it might also corroborate patients' assumptions that others are untrustworthy, thereby fuelling interpersonal disturbances in BPD.
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Affiliation(s)
- Inga Niedtfeld
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim / Heidelberg University, J 5, 68159 Mannheim, Germany
| | - Meike Kroneisen
- Department of Psychology, University of Koblenz-Landau, Fortstraße 7, D-76829 Landau, Germany
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Fareri DS. Neurobehavioral Mechanisms Supporting Trust and Reciprocity. Front Hum Neurosci 2019; 13:271. [PMID: 31474843 PMCID: PMC6705214 DOI: 10.3389/fnhum.2019.00271] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 07/22/2019] [Indexed: 01/10/2023] Open
Abstract
Trust and reciprocity are cornerstones of human nature, both at the levels of close interpersonal relationships and economic/societal structures. Being able to both place trust in others and decide whether to reciprocate trust placed in us is rooted in implicit and explicit processes that guide expectations of others, help reduce social uncertainty, and build relationships. This review will highlight neurobehavioral mechanisms supporting trust and reciprocity, through the lens of implicit and explicit social appraisal and learning processes. Significant consideration will be given to the neural underpinnings of these implicit and explicit processes, and special focus will center on the underlying neurocomputational mechanisms facilitating the integration of implicit and explicit signals supporting trust and reciprocity. Finally, this review will conclude with a discussion of how we can leverage findings regarding the neurobehavioral mechanisms supporting trust and reciprocity to better inform our understanding of mental health disorders characterized by social dysfunction.
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Affiliation(s)
- Dominic S Fareri
- Gordon F. Derner School of Psychology, Adelphi University, Garden City, NY, United States
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