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Blay M, Bouteloup M, Duarte M, Hasler R, Pham E, Nicastro R, Jan M, Debbané M, Perroud N. Association between pathological narcissism and emotion regulation: The role of self-mentalizing? Personal Ment Health 2024. [PMID: 38710596 DOI: 10.1002/pmh.1613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/27/2023] [Accepted: 02/18/2024] [Indexed: 05/08/2024]
Abstract
Pathological narcissism (PN) is a common psychopathological issue leading to maladaptive strategies to cope with self-esteem threats, including self-enhancement and exploitation (grandiose strategies) or internalized shame, depression, and social withdrawal (vulnerable strategies). Mentalizing is a key process for regulating self and other representations and their associated emotions. Patients with PN further struggle with emotion dysregulation (ED), which during development is intertwined with the growing capacity to mentalize. We seek to contribute to emerging empirical data documenting the associations between PN and ED and between PN and mentalizing, and to provide information on the nature of their mutual relationships. In the present study, we assessed PN, ED, and three mentalizing dimensions (mentalizing self, other, and motivation to mentalize) in 183 patients consulting in our outpatient unit specialized in ED. We found that narcissistic vulnerability was negatively associated with self-mentalizing and positively associated with overall ED, both even after adjustment for borderline and attention deficit hyperactivity disorder (ADHD) symptoms. However, the association with ED was not maintained after further adjustment for self-mentalizing or overall-mentalizing, which suggests that mentalizing may play a mediating role in this relationship. On the other hand, narcissistic grandiosity was positively associated with other-mentalizing and ED and negatively associated with self-mentalizing in bivariate analyses, but these last two associations were not maintained after adjustment for comorbid borderline and/or ADHD symptomatology. This study provides new information on the link between PN and ED and on key mentalizing dimensions meaningfully relating to PN, notably through a potential role of self-mentalizing processes between PN and ED.
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Affiliation(s)
- Martin Blay
- ADDIPSY, Addictology and Psychiatry Outpatient Center, Groupe Santé Basque Développement, Lyon, France
- Université Paris-Saclay, UVSQ, INSERM, Centre de recherche en Epidémiologie et Santé des Populations Team "DevPsy", Villejuif, France
| | - Margaux Bouteloup
- Service of Psychiatric Specialties, Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
- Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Miguel Duarte
- Service of Psychiatric Specialties, Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Roland Hasler
- Service of Psychiatric Specialties, Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Eleonore Pham
- Service of Psychiatric Specialties, Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Rosetta Nicastro
- Service of Psychiatric Specialties, Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Marlène Jan
- University Department of Child and Adolescent Psychiatry, Versailles Hospital Center, Le Chesnay, France
| | - Martin Debbané
- Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Nader Perroud
- Service of Psychiatric Specialties, Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
- Department of Psychiatry, University of Geneva, Geneva, Switzerland
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Blay M, Duarte M, Dessouli MA, Durpoix A, Rüfenacht E, Weibel S, Speranza M, Perroud N. Proposition of a transdiagnostic processual approach of emotion dysregulation based on core triggers and interpersonal styles. Front Psychiatry 2024; 15:1260138. [PMID: 38384590 PMCID: PMC10879599 DOI: 10.3389/fpsyt.2024.1260138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 01/19/2024] [Indexed: 02/23/2024] Open
Abstract
Emotion dysregulation (ED) has primarily been described in patients suffering from borderline personality disorder (BPD) and is an integral part of this diagnosis, but it is also a transdiagnostic construct that can be found in several other psychiatric disorders. The strong relationships between ED and BPD may lead clinicians to underestimate ED associated to other clinical contexts. This can lead to difficulties in diagnostic and treatment orientation, especially in the context of comorbidities. In this article, after reviewing the literature on the development and functioning of emotion dysregulation, and on the evidence for emotion dysregulation in eight disorders (borderline personality disorder, pathological narcissism with/without narcissistic personality disorder, obsessive-compulsive personality disorder, antisocial personality disorder, bipolar disorder, autism spectrum disorder, complex post-traumatic stress disorder, and adult attention deficit hyperactivity disorder), we present a transdiagnostic processual model of emotion dysregulation based on core triggers and interpersonal styles to try to address this issue and to provide a simple but technical tool to help clinicians in their diagnostic assessment and treatment orientation. By focusing more on typical patterns and interpersonal dynamics than only on categories, we believe that this model may contribute to the actual need for improvement of our current psychiatric classifications, alongside other well-studied and under-used dimensional models of psychopathology (e.g., HiTOP, AMPD), and may be useful to build more specific treatment frameworks for patients suffering from ED.
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Affiliation(s)
- Martin Blay
- ADDIPSY, Addictology and Psychiatry Outpatient Center, Santé Basque Développement Group, Lyon, France
- Centre de recherche en Epidemiologie et Sante des Populations Team ‘DevPsy’, INSERM, Universite Paris-Saclay, UVSQ, Villejuif, France
| | - Miguel Duarte
- Psychiatric Specialties Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - Marie-Alix Dessouli
- Department of Emergency Psychiatry, University Hospital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Amaury Durpoix
- Department of Psychiatry, University Hospitals of Strasbourg, Strasbourg, France
| | - Eva Rüfenacht
- Psychiatric Specialties Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - Sébastien Weibel
- Department of Psychiatry, University Hospitals of Strasbourg, Strasbourg, France
- U1114, INSERM, Strasbourg, France
| | - Mario Speranza
- Centre de recherche en Epidemiologie et Sante des Populations Team ‘DevPsy’, INSERM, Universite Paris-Saclay, UVSQ, Villejuif, France
- University Department of Child and Adolescent Psychiatry, Versailles Hospital Center, Le Chesnay-Rocquencourt, France
| | - Nader Perroud
- Psychiatric Specialties Unit, University Hospitals of Geneva, Geneva, Switzerland
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Pischiutta L, Garzitto M, Zamparutti G, Moratti E, Albert U, Colizzi M, Balestrieri M. Mentalization in young patients undergoing opioid agonist treatment: Implications for clinical management. Addict Behav Rep 2023; 17:100497. [PMID: 37249942 PMCID: PMC10212784 DOI: 10.1016/j.abrep.2023.100497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 05/08/2023] [Accepted: 05/13/2023] [Indexed: 05/31/2023] Open
Abstract
Background Mentalization is the ability to use internal mental states to manage and understand one's own and others' behavior. Inefficient mentalization has been associated to poor neuropsychological outcomes, including substance use disorder (SUD) and addiction. However, studies primarily investigating mentalization in SUD are lacking. Methods Using the Reflective Functioning Questionnaire (RFQ), the Measurements in the Addictions for Triage and Evaluation, version 2.1 (MATE-IT-2.1), and the Mini International Neuropsychiatric Interview, 7th edition (MINI-7), an outpatient assessment investigated inefficient mentalization (i.e., 'hypo-mentalization' or 'uncertainty': concrete thinking with poor attribution of mental states; 'hyper-mentalization' or 'certainty': rigid and biased attribution of mental states) and socio-demographic and clinical characteristics, including SUD-related symptoms and any other psychiatric comorbidity, among opioid addiction (OA) patients in Opioid Agonist Treatment (OAT). Results Thirty-seven consecutive OA patients in OAT (female, 45.9 %; age, M ± SD, 24.3 ± 3.55) were recruited. Patients' mentalization differed from normative data, in terms of higher uncertainty and lower certainty scores. Also, higher uncertainty score was found among younger patients and in those with the most severe SUD in terms of craving and need for care. Finally, lower certainty score was found in those with a more severe substance abuse, previous contacts with pediatric mental-health services, and receiving a therapeutic community support. Conclusions OA patients with inefficient mentalization present with a higher burden in terms of SUD severity, comorbidities, psychosocial disabilities, and service use, with important public health implications. Interventions targeting mentalization may have positive repercussions in preventing SUD, mitigating its severity, and containing its healthcare and social costs.
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Affiliation(s)
- Livia Pischiutta
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
- Drug Addiction Service, Department of Addiction, University Health Integrated Agency, 33100 Udine, Italy
| | - Marco Garzitto
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Giuliano Zamparutti
- Drug Addiction Service, Department of Addiction, University Health Integrated Agency, 33100 Udine, Italy
| | - Enrico Moratti
- Drug Addiction Service, Department of Addiction, University Health Integrated Agency, 33100 Udine, Italy
| | - Umberto Albert
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34149 Trieste, Italy
| | - Marco Colizzi
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Matteo Balestrieri
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
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Ruiz-Parra E, Manzano-García G, Mediavilla R, Rodríguez-Vega B, Lahera G, Moreno-Pérez AI, Torres-Cantero AM, Rodado-Martínez J, Bilbao A, González-Torres MÁ. The Spanish version of the reflective functioning questionnaire: Validity data in the general population and individuals with personality disorders. PLoS One 2023; 18:e0274378. [PMID: 37023214 PMCID: PMC10079014 DOI: 10.1371/journal.pone.0274378] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/26/2022] [Indexed: 04/08/2023] Open
Abstract
INTRODUCTION Mentalization or reflective functioning (RF) is the capacity to interpret oneself or the others in terms of internal mental states. Its failures have been linked to several mental disorders and interventions improving RF have a therapeutic effect. Mentalizing capacity of the parents influences the children's attachment. The Reflective Functioning Questionnaire (RFQ-8) is a widely used tool for the assessment of RF. No instrument is available to assess general RF in Spanish-speaking samples. The aim of this study is to develop a Spanish version of the RFQ-8 and to evaluate its reliability and validity in the general population and in individuals with personality disorders. METHODS 602 non-clinical and 41 personality disordered participants completed a Spanish translation of the RFQ and a battery of self-reported questionnaires assessing several RF related constructs (alexithymia, perspective taking, identity diffusion and mindfulness), psychopathology (general and specific) and interpersonal problems. Temporal stability was tested in a non-clinical sub-sample of 113 participants. RESULTS Exploratory and confirmatory factor analyses suggested a one-factor structure in the Spanish version of the RFQ-8. RFQ-8 understood as a single scale was tested, with low scorings reflecting genuine mentalizing, and high scorings uncertainty. The questionnaire showed good internal consistence in both samples and moderate temporal stability in non-clinical sample. RFQ correlated significantly with identity diffusion, alexithymia, and general psychopathology in both samples; and with mindfulness, perspective taking, and interpersonal problems in clinical sample. Mean values of the scale were significantly higher in the clinical group. DISCUSSION This study provides evidence that the Spanish version of the RFQ-8, understood as a single scale, has an adequate reliability and validity assessing failures in reflective functioning (i.e., hypomentalization) in general population and personality disorders.
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Affiliation(s)
- Eduardo Ruiz-Parra
- Department of Neurosciences, Faculty of Medicine and Nursing, University of the Basque Country, Bilbao, Spain
- Department of Psychiatry, Basurto University Hospital, Osakidetza Basque Health Service, Bilbao, Spain
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Madrid, Spain
| | | | - Roberto Mediavilla
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Madrid, Spain
- Department of Psychiatry, School of Medicine, Autonomous University of Madrid (UAM), Madrid, Spain
- La Paz Hospital Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Beatriz Rodríguez-Vega
- Department of Psychiatry, School of Medicine, Autonomous University of Madrid (UAM), Madrid, Spain
- La Paz Hospital Institute for Health Research (IdiPAZ), Madrid, Spain
- Department of Psychiatry, Clinical Psychology and Mental Health, La Paz University Hospital, Madrid, Spain
| | - Guillermo Lahera
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
- Department of Psychiatry, Príncipe de Asturias University Hospital, Alcalá de Henares, Madrid, Spain
| | - Ana I. Moreno-Pérez
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
- Department of Psychiatry, Príncipe de Asturias University Hospital, Alcalá de Henares, Madrid, Spain
| | - Alberto M. Torres-Cantero
- Department of Public Health Sciences, School of Medicine, University of Murcia, Murcia, Spain
- Department of Preventive Medicine, Virgen de la Arrixaca University Clinical Hospital, El Palmar, Murcia, Spain
| | - Juan Rodado-Martínez
- Department of Psychiatry, School of Medicine, University of Murcia, Murcia, Spain
- Department of Psychiatry, Reina Sofía University Hospital, Murcia, Spain
| | - Amaia Bilbao
- Research Unit, Basurto University Hospital, Osakidetza Basque Health Service, Bilbao, Bizkaia, Spain
- Health Service Research Network on Chronic Diseases (REDISSEC), Madrid, Spain
- Kronikgune Institute for Health Services Research, Barakaldo, Spain
| | - Miguel Ángel González-Torres
- Department of Neurosciences, Faculty of Medicine and Nursing, University of the Basque Country, Bilbao, Spain
- Department of Psychiatry, Basurto University Hospital, Osakidetza Basque Health Service, Bilbao, Spain
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Madrid, Spain
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Rafi H, Murray R, Delavari F, Perroud N, Vuilleumier P, Debbané M, Piguet C. Neural Basis of Internal Attention in Adults with Pure and Comorbid ADHD. J Atten Disord 2023; 27:423-436. [PMID: 36635890 DOI: 10.1177/10870547221147546] [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: 01/14/2023]
Abstract
OBJECTIVE To examine whether putatively atypical neuronal activity during internal attention in ADHD yields insights into processes underlying emotion dysregulation. METHODS We used a word processing paradigm to assess neural activations in adults with ADHD (N = 46) compared to controls (N = 43). We measured effects of valence, applied partial-least squares correlation analysis to assess multivariate brainbehavior relationships and ran subgroup analyses to isolate results driven by pure ADHD (N = 18). RESULTS During internal attention, ADHD, compared to controls, have (1) increased activation in the right angular gyrus (rAG), which appears driven by pure, not comorbid, ADHD and (2) diminished activation in the insula and fronto-striatal circuitry. Diminished activations were driven by negatively-valenced internal attention and negatively correlated with increased affective lability within the ADHD group. CONCLUSION Internal attention in ADHD is associated with increased rAG activation, possibly reflecting difficulty converging external and internal information, and diminished activation within emotion regulation circuitry.
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Affiliation(s)
| | - Ryan Murray
- University of Geneva, Switzerland
- University of Geneva, Campus Biotech, Switzerland
| | - Farnaz Delavari
- University of Geneva, Switzerland
- Institute of Bioengineering, École Polytechnique Fédérale de Lausanne, Switzerland
| | | | | | - Martin Debbané
- University of Geneva, Switzerland
- University College London, UK
| | - Camille Piguet
- University of Geneva, Switzerland
- University Hospitals of Geneva, Switzerland
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Kim B, Niu X, Zhang F. Functional connectivity strength and topology differences in social phobia adolescents with and without ADHD comorbidity. Neuropsychologia 2023; 178:108418. [PMID: 36403658 DOI: 10.1016/j.neuropsychologia.2022.108418] [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: 03/31/2022] [Revised: 11/04/2022] [Accepted: 11/06/2022] [Indexed: 11/18/2022]
Abstract
Social phobia (SP) is associated with changes in functional connectivity strength and topology. However, reported changes have been heterogeneous due to small sample sizes, inconsistent methodologies, and comorbidities, such as attention-deficit/hyperactivity disorder (ADHD), which has a high comorbidity rate with SP. Furthermore, there are few studies looking at SP in an adolescent population, a critical period for the development of the social brain. This project focuses on functional connectivity strength and topological differences in social phobia patients with and without ADHD comorbidity. We examined resting-state functional MRI images from 158 subjects, including 36 SP participants without ADHD comorbidity, 60 SP participants with ADHD comorbidity, and 62 healthy controls, with an overall average age of 14.16. We used a data-driven approach to examine impaired functional connectivity in a whole-brain analysis and higher-order topological differences in functional brain networks. We identified changes in the cerebellum and default mode network in social phobia patients as a whole, with the presence of ADHD comorbidity affecting various subsystems of the default mode network. Social phobia functional connectivity networks resembled random graphs, and local connectivity patterns in the superior occipital gyrus were different due to ADHD comorbidity. These alterations may indicate impairments in self-related processing, imagery, mentalizing, and predictive processes. We then used these changes in a linear support vector machine to distinguish between each pair of groups and achieved prediction accuracy significantly above chance rates. Our study extends prior research by showing that functional connectivity changes exist at adolescence, which are affected by ADHD comorbidity. As such, these results offer a new perspective in examining neurobiological changes in SP patients.
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Affiliation(s)
- Brian Kim
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, USA.
| | - Xin Niu
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, USA
| | - Fengqing Zhang
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, USA.
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Archer M, Shnyien A, Mansfield S, Draycott S. Mentalizing in first-episode psychosis: Correlates with symptomatology and traits of borderline personality disorder. Early Interv Psychiatry 2022. [PMID: 36181363 DOI: 10.1111/eip.13356] [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: 03/21/2022] [Revised: 07/13/2022] [Accepted: 09/18/2022] [Indexed: 11/28/2022]
Abstract
AIM To explore the associations between mentalizing, positive and negative symptoms of psychosis, and traits of borderline personality disorder, in a sample of patients with first-episode psychosis, and in a non-clinical sample. METHODS A quantitative cross-sectional design was employed. Thirty-two adults with first-episode psychosis and 148 non-clinical participants were assessed using the reflective functioning questionnaire. The questionnaire measures two dimensions of mentalizing, certainty and uncertainty about mental states. Traits of borderline personality disorder and symptoms of psychosis were measured using the self-report version of the Zanarini rating scale, the Community Assessment of Psychotic Experiences, and the Green et al., paranoid thought scale. RESULTS Patients with first-episode psychosis reported increased mentalizing impairments, characterized as hypomentalizing tendencies, compared to the non-clinical group. Regression analysis showed significant associations between higher scores on the uncertainty about mental states scale and negative symptoms of psychosis in both groups. No associations were found between mentalizing impairments and traits of borderline personality disorder in the clinical sample, although associations were found in the non-clinical sample. CONCLUSIONS The present findings suggests that impairments in mentalizing may be associated with negative symptoms of psychosis across both clinical and non-clinical samples. Mentalizing impairments was found to be associated with traits of borderline personality disorder, but this finding was only confirmed in the non-clinical sample. Mentalizing should therefore be considered in the early assessment and treatment of patients experiencing difficulties with negative symptoms of psychosis.
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Affiliation(s)
| | - Ali Shnyien
- University of Surrey, Guildford, England, UK
| | - Sarah Mansfield
- South West London and St George's Mental Health Trust, London, England, UK
| | - Simon Draycott
- University of Surrey, Guildford, England, UK.,West London NHS Trust, London, England, UK
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8
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Weibel S, Bicego F, Muller S, Martz E, Costache ME, Kraemer C, Bertschy G, Lopez R, Weiner L. Two Facets of Emotion Dysregulation Are Core Symptomatic Domains in Adult ADHD: Results from the SR-WRAADDS, a Broad Symptom Self-Report Questionnaire. J Atten Disord 2022; 26:767-778. [PMID: 34189990 DOI: 10.1177/10870547211027647] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Emotional dysregulation (ED) in adult ADHD is frequent but definition and tools for its evaluation are not consensual. Our aim was to determine the core ADHD symptomatic domains via the Self-Reported Wender-Reimherr Adult Attention Deficit Disorder Scale (SR-WRAADDS) following its validation in a large clinical sample of adults with ADHD and controls. METHOD Three hundred sixty-nine adult patients with ADHD and 251 healthy participants completed the SR-WRAADDS and questionnaires about ADHD, depression, and ED. We analyzed the psychometric properties of the SR-WRAADDS and a factor analysis yielded symptomatic domains. RESULTS The SR-WRAADDS has good reliability. The 30 symptoms were best organized in a four-factor solution: attention/disorganization, hyperactivity/restlessness, impulsivity/emotional outbursts, and emotional lability. CONCLUSIONS The symptomatic structure of the SR-WRAADDS includes two distinct dimensions related to ED: "impulsivity/emotional outbursts" and "emotional lability." The SR-WRAADDS is a reliable and clinically useful tool that assesses all ADHD symptom domains, including facets of ED.
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Affiliation(s)
- Sébastien Weibel
- University Hospital of Strasbourg, France.,Inserm U1114, Strasbourg, France
| | | | | | | | | | - Charlotte Kraemer
- University Hospital of Strasbourg, France.,Private Practice, Strasbourg, France
| | - Gilles Bertschy
- University Hospital of Strasbourg, France.,Inserm U1114, Strasbourg, France
| | - Regis Lopez
- National Reference Centre for Orphan Diseases, Narcolepsy- Rare hypersomnias, Sleep Unit, Department of Neurology, CHU Montpellier, Univ Montpellier, Montpellier, France; University of Montpellier, France
| | - Luisa Weiner
- University Hospital of Strasbourg, France.,Laboratoire de psychologie des cognition, University of Strasbourg, France
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9
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Bora E. A meta-analysis of theory of mind and 'mentalization' in borderline personality disorder: a true neuro-social-cognitive or meta-social-cognitive impairment? Psychol Med 2021; 51:2541-2551. [PMID: 34530941 DOI: 10.1017/s0033291721003718] [Citation(s) in RCA: 13] [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] [Indexed: 01/23/2023]
Abstract
BACKGROUND It is widely accepted that borderline personality disorder (BPD) is associated with significant impairments in mentalization and theory of mind (ToM) which are considered as closely related concepts by many authors particularly in psychoanalytical circles. However, for understanding interpersonal difficulties in personality disorders, it is important to distinguish neuro-social cognitive impairment from the abnormal meta-social-cognitive style of patients. METHODS The current systematic review aimed to conduct separate meta-analyses of 'mentalization' [reflective functioning (RF] and different aspects of ToM in BPD. A literature search was conducted to locate relevant articles published between January 1990 to July 2021. Random-effect meta-analyses were conducted in 34 studies involving 1448 individuals with BPD and 2006 healthy controls. RESULTS A very large impairment in RF was evident in BPD [d = 1.68, confidence interval (CI) = 1.17-2.19]. In contrast, ToM impairment was modest (d = 0.36, CI = 0.24-0.48). BPD patients underperformed healthy controls in ToM-reasoning (d = 0.44, CI = 0.32-0.56) but not ToM-decoding. Increased HyperToM (d = 0.60, CI = 0.41-0.79) and faux pas recognition (d = 0.62, CI = 0.35-0.90) errors in BPD compared to healthy controls were most robust ToM findings in this meta-analysis. CONCLUSIONS BPD is characterized by very severe deficits in RF and modest and selective abnormalities in ToM. Interpersonal problems and difficulties in processing social information in BPD can be best explained by patients' maldaptive meta-social cognitive style and top-down effects of these abnormalities rather than having a primary neuro-social cognitive deficit.
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Affiliation(s)
- Emre Bora
- Department of Psychiatry, Dokuz Eylul University Medical School, Izmir35340, Turkey
- Department of Neurosciences, Insitiute of Health, Dokuz Eylul University, Izmir, Turkey
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria3053, Australia
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10
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Raimondi G, Samela T, Lester D, Imperatori C, Carlucci L, Contardi A, Balsamo M, Innamorati M. Psychometric Properties of the Italian Mentalization Questionnaire: Assessing Structural Invariance and Construct Validity. J Pers Assess 2021; 104:628-636. [PMID: 34694942 DOI: 10.1080/00223891.2021.1991362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Mentalization is an important interpersonal ability, necessary for adaptive interpersonal relationships and emotion regulation. Deficits in mentalization have been associated with poor psychological outcomes and have been observed in patients with Borderline Personality Disorder. The Mentalization Questionnaire (MZQ) has been developed as self-report measure of mentalization deficit. The aim of the study was to investigate the dimensionality of the MZQ in a nonclinical sample composed of Italian adults from the general population and to analyze its performance in categorizing individuals with higher risk of borderline symptoms. A non-clinical sample of 1,015 adults (709 women and 306 men) was administered the Italian versions of the MZQ, the Reflective Functioning Questionnaire (RFQ), and a measure of borderline psychopathology. A revised single-factor solution fitted the data well and demonstrated metric invariance across gender. The internal consistency (Ordinal α = 0.87) and stability (r = 0.84) were satisfactory. The MZQ was moderately associated with the RFQ dimensions. The ROC curve analysis showed that the MZQ was able to discriminate satisfactorily people with higher risk for borderline symptomatology from those with lower risk. The MZQ may, therefore, be considered a reliable and valid measure of mentalization for categorizing people at higher risk for borderline pathology.
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Affiliation(s)
- Giulia Raimondi
- Department of Human Sciences, European University of Rome, Rome, Italy
| | - Tonia Samela
- Department of Human Sciences, European University of Rome, Rome, Italy
| | | | | | - Leonardo Carlucci
- Department of Psychological, Health, and Territorial Sciences, G. d'Annunzio University Chieti-Pescara, Chieti, Italy
| | - Anna Contardi
- Department of Human Sciences, European University of Rome, Rome, Italy
| | - Michela Balsamo
- Department of Psychological, Health, and Territorial Sciences, G. d'Annunzio University Chieti-Pescara, Chieti, Italy
| | - Marco Innamorati
- Department of Human Sciences, European University of Rome, Rome, Italy
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11
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Akça ÖF, Wall K, Sharp C. Divergent mentalization types in adolescent borderline personality disorder and attention deficit/hyperactivity disorder. Nord J Psychiatry 2021; 75:479-486. [PMID: 33635183 DOI: 10.1080/08039488.2021.1887349] [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: 10/22/2022]
Abstract
BACKGROUND Attention deficit/hyperactivity disorder (ADHD) and borderline personality disorder (BPD) have several similarities and it is difficult to distinguish these disorders in adolescents. We aimed to identify the unique correlates of mentalization abilities that may distinguish these two disorders, and to investigate the mentalization abilities of adolescents with ADHD, BPD and ADHD + BPD in an inpatient sample to determine the effect of co-morbidity on mentalization abilities. METHODS We have explored the relationship between Child Eye Test (CET) scores, Movie for the Assessment of Social Cognition (MASC) subscales, and ADHD and BPD symptoms in adolescent inpatients. In addition, we compared ADHD, BPD and ADHD + BPD groups in terms of their mentalization abilities. RESULTS Correct MASC scores were negatively associated with both ADHD and BPD symptoms in girls, and negatively associated with ADHD symptoms in boys. In addition, hypermentalization scores were associated with BPD symptoms in girls, and hypomentalization and no mentalization scores were associated with ADHD symptoms in girls. CET scores were negatively associated with ADHD symptoms in girls, but no relations with BPD were found. Group comparisons revealed no significant difference among groups. LIMITATIONS We included only inpatient sample without considering their medication condition, we did not compare the mentalization scores of the patient groups with healthy controls and we used self-report measures for several assessments. CONCLUSION Mentalization patterns in ADHD and BPD are distinct. ADHD may be related to hypomentalization, instead, BPD may be related to hypermentalization.
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Affiliation(s)
- Ömer Faruk Akça
- Department of Child and Adolescent Psychiatry, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Kiana Wall
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Carla Sharp
- Department of Psychology, University of Houston, Houston, TX, USA
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12
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Samela T, Innamorati M, Lester D, Raimondi G, Giupponi G, Claudio I, Contardi A, Fabbricatore M. The association between adult ADHD and food addiction: A mediation analysis. Appetite 2021; 167:105613. [PMID: 34332003 DOI: 10.1016/j.appet.2021.105613] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 07/22/2021] [Accepted: 07/25/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the association between food addiction severity (FA) and ADHD symptomatology. Furthermore, we investigated whether emotional distress, and the mentalization deficits could mediate this relationship. METHODS Three hundred eighty-five Italian adults (307 women and 78 men) participated in the study and completed the Italian versions of the Modified Yale Food Addiction Scale version 2.0, the Adult ADHD Self-Report Scale, the Depression Anxiety Stress Scales 21 and the Mentalization Questionnaire. RESULTS ADHD symptoms severity and general distress were significantly and independently associated with FA. Emotional distress partly mediated the relationship between FA and ADHD symptoms severity. In addition, mentalization deficits partly mediated this relationship only when evaluating the influence of FA on ADHD symptoms severity. LIMITATIONS This is a cross-sectional study and causal interpretations of the relationships among the variables are speculative. CONCLUSIONS It is important to assess emotional distress and mentalization deficits in individuals at risk of ADHD and FA because these conditions could increase the risk for the presence of disordered eating patterns.
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Affiliation(s)
- Tonia Samela
- Department of Human Sciences, Università Europea di Roma, 00163, Rome, Italy.
| | - Marco Innamorati
- Department of Human Sciences, Università Europea di Roma, 00163, Rome, Italy
| | | | - Giulia Raimondi
- Department of Human Sciences, Università Europea di Roma, 00163, Rome, Italy
| | - Giancarlo Giupponi
- Department of Psychiatry, Azienda Sanitaria Dell'Alto Adige, 39100, Bolzano, Italy
| | - Imperatori Claudio
- Department of Human Sciences, Università Europea di Roma, 00163, Rome, Italy
| | - Anna Contardi
- Department of Human Sciences, Università Europea di Roma, 00163, Rome, Italy
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13
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Euler S, Nolte T, Constantinou M, Griem J, Montague PR, Fonagy P. Interpersonal Problems in Borderline Personality Disorder: Associations With Mentalizing, Emotion Regulation, and Impulsiveness. J Pers Disord 2021; 35:177-193. [PMID: 30920937 DOI: 10.1521/pedi_2019_33_427] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Interpersonal problems are a core symptom of borderline personality disorder (BPD). This study investigated the relationship between emotion dysregulation, impulsiveness, and impaired mentalizing in the context of predicting interpersonal problems in BPD. A total of 210 patients with BPD completed the Difficulties in Emotion Regulation Scale (DERS), Barratt Impulsiveness Scale (BIS-11), Reflective Functioning Questionnaire (RFQ), and Inventory of Interpersonal Problems (IIP-32). The authors conducted three path models, with either mentalizing, emotion regulation, or impulsiveness as the exogenous variable. Emotion dysregulation and attentional impulsiveness predicted interpersonal problems directly, whereas hypomentalizing predicted interpersonal problems only indirectly throughout emotion dysregulation and attentional impulsiveness. The results suggest that these domains contribute significantly to interpersonal problems in BPD. Moreover, hypomentalizing might affect on interpersonal problems via its effect on impulsiveness and emotion regulation. The authors argue that focusing on emotion regulation and mentalizing in BPD treatments might have interlinked beneficial effects on interpersonal problems.
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Affiliation(s)
- Sebastian Euler
- Department of Psychiatry, University of Basel, Basel, Switzerland, Department of Consultation Psychiatry and Psychosomatics, University Hospital of Zürich, Zürich, Switzerland, and University College London, London, UK
| | - Tobias Nolte
- Research Department of Clinical, Educational and Health Psychology, University College London.,Wellcome Centre for Human Neuroimaging, University College London
| | - Matthew Constantinou
- Research Department of Clinical, Educational and Health Psychology, University College London
| | - Julia Griem
- Research Department of Clinical, Educational and Health Psychology, University College London
| | - P Read Montague
- Fralin Biomedical Research Institute and Department of Physics, Virginia Tech Carilion Research Institute, Roanoke, Virginia.,Wellcome Centre for Human Neuroimaging, University College London
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London
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14
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Onandia-Hinchado I, Pardo-Palenzuela N, Diaz-Orueta U. Cognitive characterization of adult attention deficit hyperactivity disorder by domains: a systematic review. J Neural Transm (Vienna) 2021; 128:893-937. [PMID: 33620582 DOI: 10.1007/s00702-021-02302-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/06/2021] [Indexed: 02/06/2023]
Abstract
Attention deficit hyperactivity disorder (ADHD) is reportedly the most frequent neurodevelopmental disorder diagnosed during childhood, and it is recognized as a common condition in adulthood. We review the evidence to help identify cognitive domains associated to deficits in adult ADHD. A systematic review with narrative synthesis was performed, assessing studies on adult ADHD, neuropsychology and research on involved cognitive domains in adults 18+ years old with an established diagnosis of ADHD, in seven electronic databases (PubMed, PsychInfo, WebOfScience, Embase, Scopus, OvidSPMedline, and Teseo), and Worldcat and OpenGrey grey literature databases. 93 studies were included for this review, encompassing findings from a total 5574 adults diagnosed only with ADHD, medication-naïve or non-medicated at the moment of the assessment and 4880 healthy controls. Adults diagnosed with ADHD may show, when compared to healthy controls, a cognitive profile characterized by deficits across all attention modalities, processing speed, executive function (mainly working memory and inhibition with emphasis on reward delay and interference control), verbal memory, reading skills, social cognition and arithmetic abilities. A cognitive characterization of adult ADHD by domains is established beyond the sole consideration of attention and executive function problems. Along with these, verbal memory, language (mainly reading), social cognition and arithmetic abilities may also contribute to a more comprehensive characterization of the cognitive profile in adult ADHD.
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Affiliation(s)
| | | | - Unai Diaz-Orueta
- Department of Psychology, Maynooth University, Room 3.11, John Hume Building, North Campus, Maynooth, Co. Kildare, Ireland.
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15
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Family Minds: A randomized controlled trial of a group intervention to improve foster parents' reflective functioning. Dev Psychopathol 2021; 34:1177-1191. [PMID: 33583462 DOI: 10.1017/s095457942000214x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Family Minds is a brief group psychoeducational parenting intervention designed to increase the reflective functioning (RF) and mentalization skills of foster parents. RF is important for foster parents who have to build relationships with children whose adverse experiences increase their risk for psychosocial challenges. A randomized controlled trial (RCT) for Family Minds was conducted in Texas with 89 foster parents. The main aims of this study were to examine whether the intervention could significantly increase the RF/mentalization skills of the foster parents and decrease their parenting stress. After 6 weeks, compared with the control group, intervention foster parents improved their RF via a lowering of pre-mentalizing and also significantly decreased parenting stress related to parent-child dysfunctional interactions. Other measures of RF and parenting stress showed no significant differences between groups. Foster child behavior was not significantly different between groups, although data at 6 months showed a possible lowering of internalizing symptoms for children of intervention parents. This RCT provides some encouraging evidence that Family Minds may increase RF in foster parents, improve parental sensitivity and their ability to emotionally regulate, decrease parenting stress related to challenging interactions with their foster children, and possibly decrease children's internalizing behavior.
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16
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Evald TA, Møhl B. Before the damage is done: Early childhood hyperactivity difficulties in adolescents with deliberate self-harm - findings from the DALSC cohort. Scand J Child Adolesc Psychiatr Psychol 2021; 8:176-188. [PMID: 33598440 PMCID: PMC7879016 DOI: 10.21307/sjcapp-2020-018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Deliberate self-harm (DSH) is a growing issue among Danish adolescents, and a dramatic increase in the incidence of DSH has been observed since the turn of the millennium. The importance of early childhood factors on later development has been established, but research on the trajectories of DSH is still scarce, and longitudinal studies are much needed. METHOD Participants were 3,291 children and their mothers from The Danish Longitudinal Survey of Children (DALSC), a Danish population-based birth cohort from 1995. Logistic regression and mediation analyses were used to examine significant early childhood determinants of self-harming behavior in adolescence. RESULTS The study found that 17.9% of the children had a history with DSH at the age of 18 years. A significant relationship was found between the likelihood of DSH at the age of 18 years and hyperactivity difficulties assessed through the Strengths and Difficulties Questionnaire (SDQ) at 3 and 7 years of age. Using a mediation model, it is documented that difficulties in peer relationships at the age of 11 years is a partial mediator explaining 19% of the variation. LIMITATIONS i) a vague definition of self-harm in the questionnaires; ii) lack of sample representation as children of lower socio-economic groups have lower participation rates, and only Danish-ethnicity children have been sampled; iii) possibility of omitted variable bias. CONCLUSION The adolescents engaging in DSH are experiencing a more complex range of psychosocial problems than those who do not have experience with DSH. The main finding of the study is that hyperactivity as a risk factor for the development of DSH in adolescence can be identified as early as 3-7 years of age. This relationship between the very early occurring hyperactivity and later DSH, to the best of our knowledge, has not previously been described.
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Affiliation(s)
- Therese A. Evald
- The Finance Committee, City Council of Copenhagen, Copenhagen, Denmark
| | - Bo Møhl
- Faculty of Humanities, Aalborg University, Aalborg, Denmark
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17
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Ilzarbe D, Lukito S, Moessnang C, O'Daly OG, Lythgoe DJ, Murphy CM, Ashwood K, Stoencheva V, Rubia K, Simonoff E. Neural Correlates of Theory of Mind in Autism Spectrum Disorder, Attention-Deficit/Hyperactivity Disorder, and the Comorbid Condition. Front Psychiatry 2020; 11:544482. [PMID: 33240117 PMCID: PMC7677232 DOI: 10.3389/fpsyt.2020.544482] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 09/25/2020] [Indexed: 11/18/2022] Open
Abstract
Theory of mind (ToM) or mentalizing difficulties is reported in attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), but the mechanism underpinning these apparently shared deficits is relatively unknown. Eighty-three young adult males, 19 with ASD alone, 21 with ADHD alone, 18 with dual diagnosis of ASD and ADHD, and 25 typically developing (TD) controls completed the functional magnetic resonance imaging version of the Frith-Happé animated-triangle ToM task. We compared neural function during ToM with two non-ToM conditions, random and goal directed motions, using whole-brain and region-of-interest analysis of brain activation and functional connectivity analyses. The groups showed comparable ToM task performance. All three clinical groups lacked local connectivity increase shown by TD controls during ToM in the right temporoparietal cortex, a key mentalizing region, with a differentially increased activation pattern in both ASD and comorbid groups relative to ADHD. Both ASD groups also showed reduced connectivity between right inferior lateral prefrontal and posterior cingulate cortices that could reflect an atypical information transmission to the mentalizing network. In contrast, with mentalizing both ADHD groups showed decreasing connectivity between the medial prefrontal and left temporoparietal cortices when compared to TD controls. Therefore, despite the complex pattern of atypical brain function underpinning ToM across the three disorders, some neurofunctional abnormalities during ToM are associated with ASD and appeared differentiable from those associated with ADHD, with the comorbid group displaying combined abnormalities found in each condition.
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Affiliation(s)
- Daniel Ilzarbe
- Department of Child and Adolescent Psychiatry, King's College London (KCL), Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, United Kingdom
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Clínic de Barcelona, Institute of Neuroscience, Barcelona, Spain
- Child and Adolescent Psychiatry and Psychology, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Department of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Steve Lukito
- Department of Child and Adolescent Psychiatry, King's College London (KCL), Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, United Kingdom
| | - Carolin Moessnang
- Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany
| | - Owen G. O'Daly
- Centre for Neuroimaging Sciences, King's College London, London, United Kingdom
| | - David J. Lythgoe
- Centre for Neuroimaging Sciences, King's College London, London, United Kingdom
| | - Clodagh M. Murphy
- Behavioural and Developmental Psychiatry Clinical Academic Group, Behavioural Genetics Clinic, Adult Autism and Attention Deficit Hyperactivity Disorder Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Karen Ashwood
- Behavioural and Developmental Psychiatry Clinical Academic Group, Behavioural Genetics Clinic, Adult Autism and Attention Deficit Hyperactivity Disorder Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Vladimira Stoencheva
- Behavioural and Developmental Psychiatry Clinical Academic Group, Behavioural Genetics Clinic, Adult Autism and Attention Deficit Hyperactivity Disorder Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Katya Rubia
- Department of Child and Adolescent Psychiatry, King's College London (KCL), Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, United Kingdom
| | - Emily Simonoff
- Department of Child and Adolescent Psychiatry, King's College London (KCL), Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, United Kingdom
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18
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Spitzer C, Zimmermann J, Brähler E, Euler S, Wendt L, Müller S. [The German Version of the Reflective Functioning Questionnaire (RFQ): A Psychometric Evaluation in the General Population]. Psychother Psychosom Med Psychol 2020; 71:124-131. [PMID: 33063306 DOI: 10.1055/a-1234-6317] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The concept of mentalization has attracted broad clinical and scientific interest, particularly because of its high clinical and therapeutic relevance. To make this concept accessible for empirical research, the 8-item Reflective Functioning Questionnaire (RFQ-8) was developed, which comprises 2 subscales tapping into uncertainty about mental states (or hypomentalizing), and certainty about mental states (i. e. hypermentalizing). Although first psychometric examinations have evaluated the RFQ-8 positively, these findings must be interpreted with caution for methodological reasons. The aim of this study was the psychometric evaluation of the German version of the RFQ-8 in a large general population sample (n=2477). Various confirmatory and exploratory factor analyses indicated that the originally introduced 2-factor solution is mis-specified. Instead, the RFQ-8 seems to cover a unidimensional construct. Having excluded 2 items due to their insufficient psychometric qualities, the 6-item measure (RFQ-6) showed high internal consistency (McDonald's ω=0,88) as well as significant rank correlations with depression, anxiety and bodily complaints. Considering the psychometric limitations of the RFQ-8, its use in clinical routine and research should be viewed very critically, particularly with respect to its ability to assess hypermentalizing.
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Affiliation(s)
- Carsten Spitzer
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsmedizin Rostock
| | | | - Elmar Brähler
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Universität Leipzig
| | - Sebastian Euler
- Klinik für Konsiliarpsychiatrie und Psychosomatik, Universitätsspital Zürich, Schweiz
| | - Leon Wendt
- Institut für Psychologie, Universität Kassel
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19
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Luyten P, Campbell C, Allison E, Fonagy P. The Mentalizing Approach to Psychopathology: State of the Art and Future Directions. Annu Rev Clin Psychol 2020; 16:297-325. [DOI: 10.1146/annurev-clinpsy-071919-015355] [Citation(s) in RCA: 162] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Mentalizing is the capacity to understand others and oneself in terms of internal mental states. It is assumed to be underpinned by four dimensions: automatic–controlled, internally–externally focused, self–other, and cognitive–affective. Research suggests that mental disorders are associated with different imbalances in these dimensions. Addressing the quality of mentalizing as part of psychosocial treatments may benefit individuals with various mental disorders. We suggest that mentalizing is a helpful transtheoretical and transdiagnostic concept to explain vulnerability to psychopathology and its treatment. This review summarizes the mentalizing approach to psychopathology from a developmental socioecological evolutionary perspective. We then focus on the application of the mentalizing approach to personality disorders, and we review studies that have extended this approach to other types of psychopathology, including depression, anxiety, and eating disorders. We summarize core principles of mentalization-based treatments and preventive interventions and the evidence for their effectiveness. We conclude with recommendations for future research.
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Affiliation(s)
- Patrick Luyten
- Faculty of Psychology and Educational Sciences, KU Leuven, B-3000 Leuven, Belgium
- Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 7HB, United Kingdom
| | - Chloe Campbell
- Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 7HB, United Kingdom
| | - Elizabeth Allison
- Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 7HB, United Kingdom
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 7HB, United Kingdom
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20
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Morosan L, Ghisletta P, Badoud D, Toffel E, Eliez S, Debbané M. Longitudinal Relationships Between Reflective Functioning, Empathy, and Externalizing Behaviors During Adolescence and Young Adulthood. Child Psychiatry Hum Dev 2020; 51:59-70. [PMID: 31309356 DOI: 10.1007/s10578-019-00910-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Reflective functioning (RF) refers to the understanding of one's own and others' behaviors in terms of mental states, whereas empathy entails the abilities to understand (cognitive empathy) and to share (affective empathy) the emotions of others. Low RF and low empathy have been previously related to externalizing behaviors, such as aggression and rule breaking. However, few longitudinal studies have simultaneously examined the relationships between these variables during adolescence. The aim of the present study is to investigate the longitudinal effects of both RF and empathy on potential changes in externalizing behaviors over time, in a group of 103 adolescents and young adults from the general population assessed repeatedly up to four times. We conducted multilevel analysis in order to examine the effects of RF and empathy on the initial levels and the trajectories of externalizing behaviors over time, while accounting for other variables previously associated with externalizing behaviors, such as age, gender, internalizing problems, and cognitive abilities. The results suggest that the ability to reflect on behaviors in terms of mental states predicted a sharper decrease in externalizing behaviors over time. Moreover, externalizing behaviors at the first assessment were associated with RF impairments and low affective empathy. Age, gender, cognitive abilities, and cognitive empathy were not associated with externalizing behaviors. We discuss how our results, based on a typically developing population, might inform primary or indicated prevention strategies for externalizing behaviors by focusing on socio-cognitive processes such as RF and affective empathy.
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Affiliation(s)
- Larisa Morosan
- Faculty of Psychology and Educational Sciences, University of Geneva, 40, Bd du Pont-d'Arve, 1211, Geneva, Switzerland. .,Developmental Imaging and Psychopathology Lab, University of Geneva, Geneva, Switzerland.
| | - Paolo Ghisletta
- Faculty of Psychology and Educational Sciences, University of Geneva, 40, Bd du Pont-d'Arve, 1211, Geneva, Switzerland.,Faculty of Psychology, Swiss Distance Learning University, Brig, Switzerland.,Swiss National Center of Competences in Research LIVES-Overcoming Vulnerability: Life Course Perspectives-University of Geneva, Geneva, Switzerland
| | - Deborah Badoud
- Faculty of Psychology and Educational Sciences, University of Geneva, 40, Bd du Pont-d'Arve, 1211, Geneva, Switzerland.,Developmental Imaging and Psychopathology Lab, University of Geneva, Geneva, Switzerland
| | - Elodie Toffel
- Faculty of Psychology and Educational Sciences, University of Geneva, 40, Bd du Pont-d'Arve, 1211, Geneva, Switzerland.,Developmental Imaging and Psychopathology Lab, University of Geneva, Geneva, Switzerland
| | - Stephan Eliez
- Developmental Imaging and Psychopathology Lab, University of Geneva, Geneva, Switzerland
| | - Martin Debbané
- Faculty of Psychology and Educational Sciences, University of Geneva, 40, Bd du Pont-d'Arve, 1211, Geneva, Switzerland.,Developmental Imaging and Psychopathology Lab, University of Geneva, Geneva, Switzerland.,Research Department of Clinical, Educational, and Health Psychology, University College London, London, UK
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Abstract
After participating in this activity, learners should be better able to:• Assess differences between adult patients with the diagnosis of borderline personality disorder (BPD) and healthy control subjects in terms of empathy and related processes• Evaluate the effects of empathy or related processes as factors contributing to abnormal social functioning in BPD ABSTRACT: We reviewed 45 original research studies, published between 2000 and 2019, to assess differences between adult patients with the diagnosis of borderline personality disorder (BPD) and healthy control subjects in terms of empathy and related processes (i.e., theory of mind, mentalizing, social cognition, and emotional intelligence). Thirty-six studies reported deficits of empathy or related processes in patients with BPD. Enhanced emotional empathy in BPD was also reported in eight studies, all of which revealed that patients had increased scores of personal distress on the Interpersonal Reactivity Index self-report questionnaire. Six studies did not find significant differences between patients with BPD and healthy control subjects in terms of empathy or related processes. No study reported enhanced cognitive empathy, social cognition, or emotional intelligence in patients with BPD. We postulate that deficits of empathy or related processes contribute to preempting the formation of stable interpersonal relationships, whereas enhanced emotional empathy might lead to personal (and interpersonal) distress, further contributing to abnormal social functioning in BPD.
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22
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Mazzeschi C, Buratta L, Germani A, Cavallina C, Ghignoni R, Margheriti M, Pazzagli C. Parental Reflective Functioning in Mothers and Fathers of Children With ADHD: Issues Regarding Assessment and Implications for Intervention. Front Public Health 2019; 7:263. [PMID: 31572704 PMCID: PMC6753962 DOI: 10.3389/fpubh.2019.00263] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 08/29/2019] [Indexed: 11/19/2022] Open
Abstract
Parental factors contribute to ADHD, partly in an etiological way and partly as moderators and mediators of child outcomes and treatment effects. An important aspect of parenting seems to be parental reflective functioning (PRF), defined as the parent's capacity to reflect upon his own and his child's internal mental experience. The studies on parenting factors linked to ADHD have not extensively investigated the role of PRF. Recent findings on interventions have begun to consider mentalization to promote empathy and emotion regulation in parents, but empirical studies assessing PRF are still scarce. The aim of this cross-sectional study was to compare specific familial and parental functioning characteristic between parents of children with attention deficit/hyperactivity disorder (ADHD) and parents of controls without ADHD. A clinical sample of 41 children with ADHD aged 8–11 years and their parents was compared with a matched, non-clinical sample of 40 children. Three aspects of parental functioning were investigated: parental symptomatology, parental alliances and PRF; children's differences in strength and difficulty profiles were also assessed. The results showed that families of children with ADHD had lower socioeconomic status, and both mothers and fathers of the same families reported higher scores for depression and lower PRF than did the control group; only mothers showed lower parental alliance. Logistic regression highlighted the fact that several of these familial and parental factors contributed to the increased risk of belonging to the clinical group, specifically both mothers' and fathers' depressive symptoms and lower PRF. These data represent new findings with potentially meaningful clinical implications for both assessment and intervention.
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Affiliation(s)
- Claudia Mazzeschi
- Department of Philosophy, Social Sciences and Education, University of Perugia, Perugia, Italy
| | - Livia Buratta
- Department of Philosophy, Social Sciences and Education, University of Perugia, Perugia, Italy
| | - Alessandro Germani
- Department of Philosophy, Social Sciences and Education, University of Perugia, Perugia, Italy
| | - Clarissa Cavallina
- Department of Philosophy, Social Sciences and Education, University of Perugia, Perugia, Italy
| | - Roberta Ghignoni
- Istituto Agazzi "Futurabile"-Outpatient Center of the Developmental Age, Arezzo, Italy
| | - Michele Margheriti
- Center for Clinical Neuropsychology of Developmental Age "Giorgio Sabbadini", Perugia, Italy
| | - Chiara Pazzagli
- Department of Philosophy, Social Sciences and Education, University of Perugia, Perugia, Italy
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23
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Rüfenacht E, Euler S, Prada P, Nicastro R, Dieben K, Hasler R, Pham E, Perroud N, Weibel S. Emotion dysregulation in adults suffering from attention deficit hyperactivity disorder (ADHD), a comparison with borderline personality disorder (BPD). Borderline Personal Disord Emot Dysregul 2019; 6:11. [PMID: 31360522 PMCID: PMC6637623 DOI: 10.1186/s40479-019-0108-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 06/25/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Emotional dysregulation (ED) is now considered as an important symptom of attention deficit hyperactivity disorder (ADHD). It is believed to have a considerable impact on the severity of the disorder, one's global functioning, and the prognosis. Our research aimed to evaluate and compare ED and cognitive emotional regulation strategies between ADHD and borderline personality disorder (BPD) patients. METHODS Four hundred six French-speaking outpatients (N = 279 ADHD, N = 70 BPD, N = 60 BPD + ADHD) were assessed with the Emotion Reactivity Scale (ERS), the Cognitive Emotional Regulation Questionnaire (CERQ), The Basic Empathy Scale (BES-A), the Adult ADHD Self-Report Scale (ARSV-v1.1) and the Beck Depression Inventory II (BDI-II). ADHD, BPD and comorbid patients were compared with each other and with samples of controls extracted from already published data. RESULTS ADHD patients, although having higher ED than samples derived from the general population, had less ED, better control over their emotions with higher use of adaptive cognitive strategies and lesser use of non-adaptive strategies than BPD patients. However, ADHD subjects had similar scores as BPD subjects when looking at difficulties in perceiving self and others. ED generated considerable distress in all groups and was also positively associated with ADHD symptomatology. ADHD patients with comorbid BPD had the highest scores of ED. CONCLUSIONS Our results suggest that there may be similarly inefficient cognitive emotional regulation skills leading to ED in both disorders (ADHD and BPD). However, ADHD patients showed a higher use of adaptive cognitive emotional strategies and a lower level of ED than BPD patients.
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Affiliation(s)
- Eva Rüfenacht
- TRE Unit, Department of Psychiatry, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, 20bis rue de Lausanne, Geneva, Switzerland
| | - Sebastian Euler
- Department of Consultation Psychiatry and Psychosomatics, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Paco Prada
- TRE Unit, Department of Psychiatry, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, 20bis rue de Lausanne, Geneva, Switzerland
| | - Rosetta Nicastro
- TRE Unit, Department of Psychiatry, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, 20bis rue de Lausanne, Geneva, Switzerland
| | - Karen Dieben
- TRE Unit, Department of Psychiatry, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, 20bis rue de Lausanne, Geneva, Switzerland
| | - Roland Hasler
- TRE Unit, Department of Psychiatry, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, 20bis rue de Lausanne, Geneva, Switzerland
| | - Eléonore Pham
- TRE Unit, Department of Psychiatry, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, 20bis rue de Lausanne, Geneva, Switzerland
| | - Nader Perroud
- TRE Unit, Department of Psychiatry, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, 20bis rue de Lausanne, Geneva, Switzerland
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Sébastien Weibel
- Pôle de Psychiatrie, Santé Mentale et Addictologie, University Hospital Strasbourg, Strasbourg, France
- INSERM 1114, Strasbourg, France
- FMTS, University of Strasbourg, Strasbourg, France
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Roles of age, gender and psychological difficulties in adolescent mentalizing. J Adolesc 2019; 74:120-129. [PMID: 31202040 DOI: 10.1016/j.adolescence.2019.06.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 03/10/2019] [Accepted: 06/10/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Adolescence is a critical period for the development of mentalizing - the imaginative capacity to understand one's own and others' behaviour in terms of underlying mental states. Yet, factors and mechanisms underlying individual differences in adolescent mentalizing remain poorly understood. This exploratory study examined whether and how a) age and gender and b) psychological difficulties correlate with mentalizing performance in adolescents from the general population. METHODS 89 adolescents from Geneva, Switzerland (54 females, age 12-17 years) completed a computerized task of mentalizing and a self-report measure of psychopathology. RESULTS Mentalizing performance improved with age. Males showed lower scores on the mentalizing task and made more hypermentalizing errors than females. The main findings revealed a negative association between mentalizing performance and self-reported attention problems. Post-hoc analyses further demonstrated that self-reported attentional difficulties were particularly associated with weaker scores on items requiring mentalizing about intentions, while self-reported withdrawal/depression symptoms were particularly associated with weaker scores on items requiring mentalizing about emotions and thoughts. CONCLUSION The present study highlights a negative association between attentional difficulties and mentalizing performance in community adolescents. Moreover, it provides preliminary evidence suggesting that age, gender and psychological difficulties can be distinctively associated with patterns of correct and incorrect mentalizing in community adolescents. Implications for future research and clinical practice are discussed.
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25
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Cosenza M, Ciccarelli M, Nigro G. The steamy mirror of adolescent gamblers: Mentalization, impulsivity, and time horizon. Addict Behav 2019; 89:156-162. [PMID: 30316141 DOI: 10.1016/j.addbeh.2018.10.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/06/2018] [Accepted: 10/01/2018] [Indexed: 10/28/2022]
Abstract
This study aimed to first investigate the role that general impairment in mentalization plays in gambling disorder and to analyze the interplay among mentalizing, impulsivity, and time perspective in adolescent gambling. Four hundred and ten late adolescents took part in the study. Participants were administered the South Oaks Gambling Screen Revised for Adolescents (SOGS-RA), the Reflective Functioning Questionnaire (RFQ-8), the Functional and Dysfunctional Impulsivity Scale (FDIS), and the 14-item Consideration of Future Consequences scale (CFC-14). The results showed that male adolescents are far more likely at-risk/problem gamblers than female adolescents. Furthermore, data indicated that the higher the gambling severity, the higher the dysfunctional impulsivity and the shorter the time horizon. Linear regression analysis showed that impairments in mentalizing represent a significant predictor of gambling severity. Finally, to clarify if dysfunctional impulsivity was on the path from uncertain mentalizing to gambling severity or if mentalizing was the mediator of the impact of functional impulsivity on gambling severity, data were submitted to path analysis. Results indicated that deficit in mentalizing has a direct effect on gambling severity and mediates the association between dysfunctional impulsivity and gambling involvement. The relation between gambling severity and RFQ-8 scores suggests that general impairment in mentalizing plays a key role in adolescent problematic gambling.
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26
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Weiner L, Perroud N, Weibel S. Attention Deficit Hyperactivity Disorder And Borderline Personality Disorder In Adults: A Review Of Their Links And Risks. Neuropsychiatr Dis Treat 2019; 15:3115-3129. [PMID: 31806978 PMCID: PMC6850677 DOI: 10.2147/ndt.s192871] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 10/23/2019] [Indexed: 12/12/2022] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) and borderline personality disorder (BPD) are particularly common disorders, that are highly comorbid in adult populations. The symptomatic overlap between adult ADHD and BPD includes impulsivity, emotional dysregulation and interpersonal impairment, which makes the differential diagnosis difficult. Our review aims at focusing on recent data on the comorbid ADHD+BPD form, as well as the risk factors involved in the emergence of the two disorders. While adult ADHD and BPD share some genetic and temperamental risk factors, adult ADHD is characterized by more severe trait-impulsivity compared to non-comorbid BPD; BPD patients display more severe trait-emotion regulation symptoms compared to non-comorbid ADHD. Patients with the comorbid ADHD+BPD form have severe symptoms in both dimensions. Early-life exposure to adverse events is a shared risk factor for the development of ADHD and BPD, but type and timing of adversity seem to play a differential role in the development of BPD and ADHD symptoms. Age of onset used to be a discriminative diagnostic criterion between ADHD, an early-onset neurodevelopmental disorder, and BPD, a late-onset psychological disorder. However, this distinction has been recently called into question, increasing the need for more research aiming at delineating the disorders from a developmental and clinical standpoint. Clinicians should carefully consider the comorbidity, and consider ADHD and BPD dimensionally, in order to provide more effective patient management. This might improve early preventive interventions, and treatment for comorbid conditions in adulthood.
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Affiliation(s)
- Luisa Weiner
- Department of Psychiatry, University Hospital of Strasbourg, Strasbourg, France.,Laboratoire De Psychologie Des Cognitions, University of Strasbourg, Strasbourg, France
| | - Nader Perroud
- Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland.,Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sébastien Weibel
- Department of Psychiatry, University Hospital of Strasbourg, Strasbourg, France.,Inserm U1114, Strasbourg, France
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Badoud D, Rüfenacht E, Debbané M, Perroud N. Mentalization-based treatment for adults with attention-deficit/hyperactivity disorder: a pilot study. ACTA ACUST UNITED AC 2018; 21:317. [PMID: 32913767 PMCID: PMC7451325 DOI: 10.4081/ripppo.2018.317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 10/04/2018] [Indexed: 11/23/2022]
Abstract
Recent literature suggests that, in addition to its core cognitive and behavioural symptoms, socioemotional difficulties represent key characteristics of adult attention-deficit/hyperactivity disorder (ADHD). Importantly, these deficits not only contribute negatively to the low social functioning and poorer professional achievements of ADHD patients relative to healthy individuals, they also respond poorly to medication and are not specifically addressed by current evidence-based psychological treatments. Mentalization-based treatment (MBT) is a psychological intervention focused on promoting the imaginative capacity to understand human behaviour as being driven by mental states. MBT has been shown to be effective in patients with chronic emotional dysregulation; it may therefore represent a valuable approach to address sociocognitive deficits and shape adaptive functioning in ADHD. In this study, we tailored the timelimited MBT program developed for borderline personality disorder to the specific clinical needs of individuals with ADHD. We report on the first eight patients with ADHD included in our programme at the Geneva University Hospitals. Preliminary results support the feasibility and relevance of the MBT model for ADHD. We discuss conceptual and clinical implications of the current data.
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Affiliation(s)
- Deborah Badoud
- Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Switzerland.,Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, Geneva, Switzerland
| | - Eva Rüfenacht
- Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Switzerland
| | - Martin Debbané
- Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, Geneva, Switzerland.,Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Nader Perroud
- Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Switzerland
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Ballespí S, Vives J, Debbané M, Sharp C, Barrantes-Vidal N. Beyond diagnosis: Mentalization and mental health from a transdiagnostic point of view in adolescents from non-clinical population. Psychiatry Res 2018; 270:755-763. [PMID: 30551321 DOI: 10.1016/j.psychres.2018.10.048] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 10/17/2018] [Accepted: 10/19/2018] [Indexed: 12/17/2022]
Abstract
An increasing volume of evidence suggests that mentalization (MZ) can be an important factor in the transition from mental health to mental illness and vice versa. However, most studies are focused on the role of MZ in specific disorders. This study aims to evaluate the relationship between MZ and mental health as a trans-diagnostic process. A sample of 172 adolescents aged 12 to 18 years old (M = 14.6, SD = 1.7; 56.4% of girls) was assessed on measures of MZ, psychopathology and psychological functioning from a multimethod and multi-informant perspective. Contrary to predictions, MZ was not associated with general psychopathology and comorbidity, even when explored from a broad, trans-diagnostic perspective. However, we observed a robust association linking MZ to functioning and well-being across many dimensions, involving social, role and several psychological indicators of adjustment and mental health. These results suggest that MZ may contribute to mental health beyond symptoms, not so much associated with psychopathology, but rather resilience and well-being.
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Affiliation(s)
- Sergi Ballespí
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain.
| | - Jaume Vives
- Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Martin Debbané
- Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Switzerland; Developmental NeuroImaging and Psychopathology Laboratory, Department of Psychiatry, University of Geneva School of Medicine, Switzerland; Research Department of Clinical, Educational and Health Psychology, University College London, United Kingdom
| | - Carla Sharp
- Department of Psychology, University of Houston, Texas, USA
| | - Neus Barrantes-Vidal
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; Department of Mental Health. Fundació Sanitària Sant Pere Claver, Barcelona, Catalonia, Spain; Centre for Biomedical Research Network on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
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Domon-Archambault V, Gagnon L, Benoît A, Perreault S. Psychosocial Features of Neurofibromatosis Type 1 in Children and Adolescents. J Child Neurol 2018; 33:225-232. [PMID: 29318935 DOI: 10.1177/0883073817749367] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
UNLABELLED Neurofibromatosis type 1 (NF1) is a common neurologic condition associated with a wide variety of developmental deficits that have an important impact on children and adolescents. OBJECTIVE This article aims to document the psychosocial features of NF1 and to report the interventions described to address the needs of pediatric patients with NF1. METHODS A literature review was conducted concerning the social life, mental health, and quality of life (QOL) of children and adolescents with NF1 as well as the psychosocial interventions addressed to this population. RESULTS Compared to unaffected children and adolescents of the general population, pediatric patients with NF1 have an increased risk of having social difficulties, mental health disorders, behavioral and emotional problems, as well as diminished QOL. Only 3 articles describe interventions within the NF1 population to address these difficulties. CONCLUSION There is a need to develop and assess psychosocial interventions for patients with NF1.
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Affiliation(s)
| | - Louise Gagnon
- 2 Department of Pediatric, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Amélie Benoît
- 2 Department of Pediatric, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Sébastien Perreault
- 2 Department of Pediatric, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
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30
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Weibel S, Nicastro R, Prada P, Cole P, Rüfenacht E, Pham E, Dayer A, Perroud N. Screening for attention-deficit/hyperactivity disorder in borderline personality disorder. J Affect Disord 2018; 226:85-91. [PMID: 28964997 DOI: 10.1016/j.jad.2017.09.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/21/2017] [Accepted: 09/21/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND A valid screening instrument is needed to detect attention-deficit/hyperactivity disorder (ADHD) in treatment-seeking borderline personality disorder (BPD) patients. We aimed to test the performance of the widely-used Adult ADHD Self-Report Scale v1.1 screener (ASRS-v1.1). METHODS 317 BPD subjects were systematically assessed for comorbid ADHD and completed the ASRS-v1.1. 79 BPD patients also completed the Wender Utah Rating Scale (WURS-25). RESULTS The prevalence of adult ADHD was of 32.4%. The overall positive predictive value of the ASRS-v1.1 was of 38.5%, the negative predictive value 77.0%, the sensitivity 72.8%, and the specificity 43.9%. Combining WURS-25 and ASRS-v1.1 improved sensitivity to 81.8% and specificity to 59.6%. LIMITATIONS Cross-sectional study on treatment-seeking patients. CONCLUSIONS We found a high prevalence of ADHD using structured interviews. The ASRS-v1.1 was not a sensitive screener for identifying possible ADHD cases in a BPD population, with a high number of false positives. When combined with the WURS-25, it offered improved screening.
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Affiliation(s)
- Sébastien Weibel
- Department of Psychiatry, University Hospital of Strasbourg, Strasbourg, France; Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland.
| | - Rosetta Nicastro
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Paco Prada
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Pierre Cole
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Eva Rüfenacht
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Eléonore Pham
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Alexandre Dayer
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Nader Perroud
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland
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