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Peschel SKV, Fürtjes S, Sigrist C, Voss C, Berwanger J, Ollmann TM, Kische H, Rückert F, Koenig J, Pieper L, Beesdo-Baum K. Tension and disordered eating behaviors in the daily lives of adolescents and young adults from the general population: Associations and moderating role of trait emotion regulation. Scand J Psychol 2024; 65:252-263. [PMID: 37850537 DOI: 10.1111/sjop.12971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 08/10/2023] [Accepted: 09/15/2023] [Indexed: 10/19/2023]
Abstract
Experiences of tension and difficulties in emotion regulation have been linked to eating pathology in clinical samples and are targeted in respective treatment approaches. The present study aimed to investigate the impact of tension on engagement in disordered eating behaviors (DEBs) and potential moderating effects of trait emotion regulation in young people from the general population. A subsample of 971 adolescents and young adults from an epidemiological cohort study reported on levels of tension and four different DEBs (skipping eating, restrained eating, eating large amounts of food, loss-of-control-eating) via ecological momentary assessment (EMA), as well as on trait emotion regulation via questionnaire. In multilevel models, momentary tension did not predict levels of subsequent DEBs. However, higher average levels of tension across the EMA period predicted higher levels of all DEBs. No interactions with emotion regulation emerged. Individuals experiencing overall higher levels of tension appear to be more prone to engaging in DEBs.
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Affiliation(s)
- Stephanie K V Peschel
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Sophia Fürtjes
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Christine Sigrist
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Catharina Voss
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Johanna Berwanger
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Theresa M Ollmann
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Hanna Kische
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Frank Rückert
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Julian Koenig
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lars Pieper
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Katja Beesdo-Baum
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
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Mazinan RG, Dudek C, Warkentin H, Finkenstaedt M, Schröder J, Musil R, Kratzer L, Fuss J, Biedermann SV. Borderline personality disorder and sexuality: causes and consequences of dissociative symptoms. Borderline Personal Disord Emot Dysregul 2024; 11:8. [PMID: 38500169 PMCID: PMC10949637 DOI: 10.1186/s40479-024-00251-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/05/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Sexual risk behavior in patients diagnosed with borderline personality disorder (BPD) is supposed to be associated with traumatic experiences and dissociative symptoms. Nevertheless, scientific research thereon is scarce which might be due to the high prevalence of sexual trauma and fear of overwhelming patients with explicit sexual content. METHODS We investigated a clinical sample of patients diagnosed with BPD (n = 114) and compared them to a sample of matched healthy controls (HC) (n = 114) concerning the dissociative symptoms derealization, depersonalization, and conversion in sexual situations. In a subgroup of patients with BPD (n = 41) and matched HC (n = 40) dissociative symptoms after exposure to an acoustically presented erotic narrative were assessed in the lab. Regression analyses were used to examine the associations between sexual trauma, post-traumatic stress disorder (PTSD), dissociation in sexual situations, and risky sexual behavior. RESULTS Patients diagnosed with BPD endorsed higher dissociative symptoms in sexual situations retrospectively and in the lab compared to HC. Regression analyses revealed that depersonalization and conversion symptoms in sexual situations were explained by severity of BPD, while derealization was explained by PTSD symptomatology. Impulsive and sexual behavior with an uncommitted partner were higher in the BPD group and explained by derealization, while conversion showed an inverse association. CONCLUSION Our findings highlight the importance of addressing distinct dissociative symptoms in sexual situations when counselling and treating women with BPD. In the long term, this could contribute to a reduction in sexual risk behavior in patients with BPD. TRIAL REGISTRATION This analysis is part of a larger ongoing study and was registered prior to accessing the data (Registration trial DRKS00029716).
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Affiliation(s)
- Rose Gholami Mazinan
- Social and Emotional Neuroscience Group, Department of Psychiatry and Psychotherapy, Center of Psychosocial Medicine, University Medical Center Hamburg- Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Christina Dudek
- Department of Psychiatry and Psychotherapy, Psychiatric Clinic of LMU, Munich Ludwig Maximilians-Universität München, München, Germany
| | - Hannah Warkentin
- Social and Emotional Neuroscience Group, Department of Psychiatry and Psychotherapy, Center of Psychosocial Medicine, University Medical Center Hamburg- Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Maja Finkenstaedt
- Social and Emotional Neuroscience Group, Department of Psychiatry and Psychotherapy, Center of Psychosocial Medicine, University Medical Center Hamburg- Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- Institute of Forensic Psychiatry and Sex Research, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Johanna Schröder
- Institute for Clinical Psychology and Psychotherapy, Department for Psychology, Medical School Hamburg, Hamburg, Germany
| | - Richard Musil
- Department of Psychiatry and Psychotherapy, Psychiatric Clinic of LMU, Munich Ludwig Maximilians-Universität München, München, Germany
- Oberberg Fachklinik Bad Tölz, Bad Tölz, Germany
| | - Leonhard Kratzer
- Department of Psychotraumatology, Clinic St Irmingard, Osternacher Strasse 103, 83209, Prien am Chiemsee, Germany
| | - Johannes Fuss
- Institute of Forensic Psychiatry and Sex Research, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Sarah V Biedermann
- Social and Emotional Neuroscience Group, Department of Psychiatry and Psychotherapy, Center of Psychosocial Medicine, University Medical Center Hamburg- Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
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Schulze A, Hughes N, Lis S, Krause-Utz A. Dissociative Experiences, Borderline Personality Disorder Features, and Childhood Trauma: Generating Hypotheses from Data-Driven Network Analysis in an International Sample. J Trauma Dissociation 2024:1-20. [PMID: 38497592 DOI: 10.1080/15299732.2024.2323974] [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: 05/30/2023] [Accepted: 12/22/2023] [Indexed: 03/19/2024]
Abstract
Dissociation is a multifaceted phenomenon that occurs in various mental disorders, including borderline personality disorder (BPD), but also in non-clinical populations. Severity of childhood trauma (abuse, neglect) plays an important role in the development of dissociation and BPD. However, the complex interplay of different dissociative symptoms, BPD features, and self-reported childhood trauma experiences is not yet fully understood. Graph-theoretical network analysis can help to better understand such multivariate interrelations. Objective: This study aimed to investigate associations between self-reported dissociation, BPD features, and childhood trauma experiences using a graph-theoretical approach. Data was collected online via international mental health platforms and research sites. N = 921 individuals (77.4% female) were included; 40% reported pathological levels of dissociation. Variables were assessed with established psychometric scales (Dissociative Experiences Scale; Personality Assessment Inventory Borderline Features Scale; Childhood Trauma Questionnaire) and analyzed within a partial correlation network. Positive bivariate correlations between all variables were found. When accounting for their mutual influence on each other, dissociation was predominantly connected to BPD features with effect sizes between rp = .028 and rp = .126, while still showing a slight unique relationship with physical neglect (rp = .044). Findings suggest close associations between dissociative experiences and BPD features. While childhood trauma plays an important role in the development of dissociation and BPD, its recall may not fully explain their current co-occurrence. Prospective studies are needed to shed more light on causal pathways to better understand which factors contribute to dissociation and its link to BPD (features).
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Affiliation(s)
- Anna Schulze
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Natasha Hughes
- Institute of Clinical Psychology, Leiden University, Leiden, The Netherlands
| | - Stefanie Lis
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Annegret Krause-Utz
- Institute of Clinical Psychology, Leiden University, Leiden, The Netherlands
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Kulakova E, Graumann L, Wingenfeld K. The Hypothalamus-Pituitary-Adrenal Axis and Social Cognition in Borderline Personality Disorder. Curr Neuropharmacol 2024; 22:378-394. [PMID: 37539934 PMCID: PMC10845078 DOI: 10.2174/1570159x21666230804085639] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/28/2023] [Accepted: 05/28/2023] [Indexed: 08/05/2023] Open
Abstract
Borderline personality disorder (BPD) is characterized by emotional instability, impulsivity and unstable interpersonal relationships. Patients experience discomforting levels of distress, inducing symptoms like dissociation, aggression or withdrawal. Social situations are particularly challenging, and acute social stress can reduce patients' cognitive and social functioning. In patients with Major Depressive Disorder or Posttraumatic Stress Disorder, which show high comorbidity with BPD, the endocrine stress response is characterized by Hypothalamus-Pituitary-Adrenal (HPA) axis dysfunction, which affects cognitive functioning. Compared to these clinical groups, research on HPA-axis function in BPD is relatively scarce, but evidence points towards a blunted cortisol reactivity to acute stress. Since BPD patients are particularly prone to social stress and experience high subjective difficulties in these situations, it seems plausible that HPA-axis dysregulation might contribute to decreased social cognition in BPD. The present review summarizes findings on the HPA-axis function in BPD and its association with social cognition following acute social stress. For this purpose, we review literature that employed a widely used social stressor (Trier Social Stress Test, TSST) to study the effects of acute social stress on social cognition and the HPA-axis response. We contrast these findings with studies on social cognition that employed Cyberball, another widely used social stressor that lacks HPA-axis involvement. We conclude that research on social cognition in BPD reveals heterogeneous results with no clear relationship between social functioning and HPA-axis response. More research is needed to better understand the psychophysiological underpinnings of impaired social cognition in BPD.
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Affiliation(s)
- Eugenia Kulakova
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Berlin, Germany
| | - Livia Graumann
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Berlin, Germany
| | - Katja Wingenfeld
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Berlin, Germany
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5
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Escamilla I, Juan N, Peñalva C, Sánchez-Llorens M, Renau J, Benito A, Haro G. Treatment of dissociative symptoms with opioid antagonists: a systematic review. Eur J Psychotraumatol 2023; 14:2265184. [PMID: 37860852 PMCID: PMC10591526 DOI: 10.1080/20008066.2023.2265184] [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] [Received: 01/12/2023] [Accepted: 08/10/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND The clinical guidelines for the treatment of dissociation focus primarily on psychotherapy. However, different psychoactive drugs are used in clinical practice. The use of opioid antagonists has been proposed as a therapeutic option based on the theory that dissociation might be a phenomenon mediated by dysregulation of the endogenous opioid system. OBJECTIVE To review and meta-analyse the available evidence on the efficacy of the opioid antagonists naltrexone, naloxone, and nalmefene as treatments for dissociative symptoms and disorders. METHOD The PRISMA guidelines were followed, and this review was registered in Prospero with reference number CRD42021280976. The search was performed in the PubMed, Scopus, Web of Science, EMBASE, PsycINFO, and PubPsych databases. RESULTS 1,798 citations were obtained. After removing duplicates and applying inclusion and exclusion criteria, we included 5 comparative studies with 9 dissociation measures that had included a total of 154 participants, of whom 134 had been treated with an opioid antagonist. The results of the meta-analysis showed a treatment effect for dissociation when using opioid antagonists [pooled d = 1.46 (95% CI: 0.62-2.31)]. However, the studies we included were very heterogeneous [Q = 66.89 (p < .001)] and there may have been publication bias. CONCLUSIONS Although more research is needed and the results must be interpreted with caution because of the limited amount of data and heterogeneity in the studies and their methodological qualities, opioid antagonists (particularly naltrexone) are promising candidates for the treatment of dissociative symptoms and showed a moderate - large effect size in reducing these symptoms.
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Affiliation(s)
- Irene Escamilla
- TXP Research Group. Department of Medicine and Surgery, Universidad Cardenal Herrera-CEU, CEU Universities, Castellón de la Plana, Spain
- Consorcio Hospitalario Provincial Castellón, Castellón de la Plana, Spain
| | - Nerea Juan
- TXP Research Group. Department of Medicine and Surgery, Universidad Cardenal Herrera-CEU, CEU Universities, Castellón de la Plana, Spain
- Consorcio Hospitalario Provincial Castellón, Castellón de la Plana, Spain
| | - Celeste Peñalva
- TXP Research Group. Department of Medicine and Surgery, Universidad Cardenal Herrera-CEU, CEU Universities, Castellón de la Plana, Spain
- Consorcio Hospitalario Provincial Castellón, Castellón de la Plana, Spain
| | | | - Jorge Renau
- TXP Research Group. Department of Medicine and Surgery, Universidad Cardenal Herrera-CEU, CEU Universities, Castellón de la Plana, Spain
- Consorcio Hospitalario Provincial Castellón, Castellón de la Plana, Spain
| | - Ana Benito
- TXP Research Group. Department of Medicine and Surgery, Universidad Cardenal Herrera-CEU, CEU Universities, Castellón de la Plana, Spain
- Torrent Mental Health Unit, Hospital General Universitario Valencia, Valencia, Spain
| | - Gonzalo Haro
- TXP Research Group. Department of Medicine and Surgery, Universidad Cardenal Herrera-CEU, CEU Universities, Castellón de la Plana, Spain
- Dual Disorder Program, Consorcio Hospitalario Provincial Castellón, Castellón de la Plana, Spain
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Cavicchioli M, Ogliari A, Maffei C, Mucci C, Scalabrini A. Dissociative Dimensions and Their Implications for Emotional Dysregulation Underlying Borderline Personality Disorder Features. J Nerv Ment Dis 2023; 211:742-751. [PMID: 37734116 DOI: 10.1097/nmd.0000000000001707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
ABSTRACT Emotion dysregulation is considered a core feature of borderline personality disorder (BPD). The role of dissociation in BPD has been discussed from different perspectives. Nevertheless, implications of dissociation for BPD features are not clear. The current study estimated mediation effects of dissociative dimensions on the relationships between several emotion regulation strategies (ERSs) and BPD features among 281 adults recruited from the general population. The online survey administered a comprehensive self-report battery for the assessment of maladaptive and adaptive ERSs together with dissociative dimensions. Borderline personality disorder features were also self-report screened. Results showed significant indirect effects of dissociation on the relationships between ERSs and BPD features. Dissociation was a full mediator of the relationship between deficits with problem-solving skills and BPD criteria. The study confirmed that emotion dysregulation is a core feature of BPD and that the dissociative dimensions should be included as relevant maladaptive mechanisms sustaining BPD emotional difficulties.
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Affiliation(s)
- Marco Cavicchioli
- Department of Psychology, University "Vita-Salute San Raffaele", Milan, Italy
| | | | - Cesare Maffei
- Department of Psychology, University "Vita-Salute San Raffaele", Milan, Italy
| | - Clara Mucci
- Department of Human and Social Science, University of Bergamo, Bergamo, Italy
| | - Andrea Scalabrini
- Department of Human and Social Science, University of Bergamo, Bergamo, Italy
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Graumann L, Heekerens JB, Duesenberg M, Metz S, Spitzer C, Otte C, Roepke S, Wingenfeld K. Association between baseline dissociation levels and stress-induced state dissociation in patients with posttraumatic-stress disorder, borderline personality disorder, and major depressive disorder. Borderline Personal Disord Emot Dysregul 2023; 10:11. [PMID: 36997956 PMCID: PMC10064785 DOI: 10.1186/s40479-023-00215-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/15/2023] [Indexed: 04/01/2023] Open
Abstract
INTRODUCTION Dissociative symptoms are highly prevalent in patients with trauma-related disorders such as borderline personality disorder (BPD) and posttraumatic-stress disorder (PTSD), and also occur in patients with depressive disorders. Acute dissociative states are theorized to be stress-related, and some individuals experience recurring patterns of dissociation. The relationship between the intensity of dissociative episodes (trait-like dissociation) and acute dissociative states, however, is incompletely understood. In the present study, we investigated how levels of baseline (trait-like) dissociation relate to changes in dissociative states during a laboratory stress induction. METHODS Our female sample comprised 65 patients with BPD and/or PTSD, 84 patients with major depressive disorder (MDD) and 44 non-clinical controls (NCC). Baseline dissociation was assessed at the start of the study using the Dissociation Tension Scale past week version (DSS-7). All participants underwent the Trier Social Stress Test (TSST) and a placebo version (P-TSST). Before and after the TSST or P-TSST, state dissociation was assessed using the Dissociation Tension Scale acute (DSS-4). We used structural equation models to estimate changes in state dissociation items (somatoform dissociation, derealization, depersonalization, analgesia), and to test whether these changes relate to levels of baseline dissociation. RESULTS We found significant increases in all state dissociation items in response to the TSST in patients with BPD and/or PTSD and patients with MDD, but not in NCCs. Increases in somatoform dissociation and derealization during the TSST were significantly related to higher levels of baseline dissociation in patients with BPD and/or PTSD, but not in patients with MDD or NCCs. Results indicate no significant changes in state dissociation during the P-TSST. CONCLUSION Our results replicate earlier findings that patients with BPD and/or PTSD report higher levels of stress-related state dissociation than NCC and extend them to patients with MDD. In addition, our findings indicate that baseline levels of dissociation relate to stress-induced changes in state dissociation among patients with BPD and PTSD, but not patients with MDD. In clinical applications, measures of baseline dissociation could be used to facilitate the prediction and treatment of stress-related dissociative states in patients with BPD and/or PTSD.
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Affiliation(s)
- Livia Graumann
- Department of Psychiatry and Neuroscience, Charité - Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt- Universitaet Zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Johannes Bodo Heekerens
- Department of Psychiatry and Neuroscience, Charité - Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt- Universitaet Zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Moritz Duesenberg
- Department of Psychiatry and Neuroscience, Charité - Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt- Universitaet Zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Sophie Metz
- Department of Medical Psychology, Charité - Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt- Universitaet Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Carsten Spitzer
- Department of Psychosomatic Medicine, Rostock University Medical Center, Rostock, Germany
| | - Christian Otte
- Department of Psychiatry and Neuroscience, Charité - Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt- Universitaet Zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Stefan Roepke
- Department of Psychiatry and Neuroscience, Charité - Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt- Universitaet Zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Katja Wingenfeld
- Department of Psychiatry and Neuroscience, Charité - Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt- Universitaet Zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany.
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8
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D'Aurizio G, Di Stefano R, Socci V, Rossi A, Barlattani T, Pacitti F, Rossi R. The role of emotional instability in borderline personality disorder: a systematic review. Ann Gen Psychiatry 2023; 22:9. [PMID: 36918920 PMCID: PMC10011773 DOI: 10.1186/s12991-023-00439-0] [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: 11/24/2022] [Accepted: 02/25/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND The emotional regulation process plays a pivotal role in daily-life functioning, modulating goal-directed and adaptive behavior. Conversely, altering this cognitive function can disrupt self-regulation and bring emotional dysregulation. Emotional instability could represent a core characteristic of BPD, also modulating the BPD symptom's onset. This systematic review aims to summarize the existing literature reporting the role of emotional instability in BPD to better define the role of the impairment of the emotional processes in the onset of the cognitive and behavioral symptoms of this complex mental disorder. METHODS MEDLINE, Scopus and Web of Science were independently searched for relevant studies. Eligible studies had to be identifiable through database searching, published and accessible. This systematic review was conducted according to PRISMA guidelines. The search period was from 2012 to 14 September 2022. RESULTS A pool of 120 studies was identified, out of which 11 met the selection criteria and were included. Overall, the studies confirm a relationship between emotional instability and borderline personality disorder. CONCLUSIONS The evidences retrieved seem to point out the role of the emotional impairment not only in worsening of the disorder, but could also be one of the risk factors for its onset.
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Affiliation(s)
- Giulia D'Aurizio
- Chair of Psychiatry, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio (Coppito 2), 67100, L'Aquila, Italy
| | - Ramona Di Stefano
- Chair of Psychiatry, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio (Coppito 2), 67100, L'Aquila, Italy.
| | - Valentina Socci
- Chair of Psychiatry, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio (Coppito 2), 67100, L'Aquila, Italy
| | - Alessandro Rossi
- Chair of Psychiatry, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio (Coppito 2), 67100, L'Aquila, Italy
| | - Tommaso Barlattani
- Chair of Psychiatry, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio (Coppito 2), 67100, L'Aquila, Italy
| | - Francesca Pacitti
- Chair of Psychiatry, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio (Coppito 2), 67100, L'Aquila, Italy
| | - Rodolfo Rossi
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
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9
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Störkel LM, Niedtfeld I, Schmahl C, Hepp J. Does self-harm have the desired effect? Comparing non-suicidal self-injury to high-urge moments in an ambulatory assessment design. Behav Res Ther 2023; 162:104273. [PMID: 36764164 DOI: 10.1016/j.brat.2023.104273] [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: 08/28/2022] [Revised: 11/10/2022] [Accepted: 02/01/2023] [Indexed: 02/05/2023]
Abstract
All theoretical models of non-suicidal self-injury (NSSI) posit that regulation of negative affect (NA) is a central motive for NSSI, and cross-sectional work supports this. However, previous ambulatory assessment (AA) studies that examined NSSI found mixed results. We investigated the affect regulation function of NSSI in 51 women with DSM-5 NSSI disorder in a 15-day AA study with five random daily prompts and self-initiated NSSI prompts. We extend previous work by i) comparing NSSI moments to moments of a high-urge for NSSI, ii) adding high-frequency sampling following NSSI and high-urge moments, and iii) including tension as a dependent variable. We hypothesized that NA and tension would show a steeper decrease following NSSI than following high-urge moments, if NSSI was effective in reducing NA and tension. Results showed that the significant linear NA decline following NSSI was not steeper than that following high-urge moments. For aversive tension, we found that NSSI was associated with a significant linear decrease in tension, whereas resisting an urge was not. High-urge moments were better described by an inverted U-shaped pattern, likewise leading to decreased NA and tension following the reported urge. In exploratory analyses, we provide visualized clustering of the NA and tension trajectories surrounding NSSI using k-means and relate these to participants' self-rated effectiveness of the NSSI events. Findings indicate that resisting an urge may also be effective in managing NA and tension and underline the utility of interventions such as urge-surfing.
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Affiliation(s)
- Lisa M Störkel
- Department of Psychosomatic Medicine, Central Institute of Mental Health, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany.
| | - Inga Niedtfeld
- Department of Psychosomatic Medicine, Central Institute of Mental Health, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine, Central Institute of Mental Health, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany
| | - Johanna Hepp
- Department of Psychosomatic Medicine, Central Institute of Mental Health, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany
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Fitzpatrick S, Varma S, Kuo JR. Is borderline personality disorder really an emotion dysregulation disorder and, if so, how? A comprehensive experimental paradigm. Psychol Med 2022; 52:2319-2331. [PMID: 33198829 DOI: 10.1017/s0033291720004225] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Leading theories suggest that borderline personality disorder (BPD) is an emotion dysregulation disorder involving lower basal vagal tone, higher baseline emotion, heightened emotional reactivity, delayed emotional recovery, and emotion regulation deficits. However, the literature to date lacks a unifying paradigm that tests all of the main emotion dysregulation components and comprehensively examines whether BPD is an emotion dysregulation disorder and, if so, in what ways. This study addresses the empirical gaps with a unified paradigm that assessed whether BPD is characterized by five leading emotion dysregulation components compared to generalized anxiety disorder (GAD) and healthy control (HC) groups. METHODS Emotion was assessed across self-report, sympathetic, and parasympathetic indices. Participants with BPD, GAD, and HCs (N = 120) first underwent baseline periods assessing basal vagal tone and baseline emotional intensity, followed by rejection-themed stressors assessing emotional reactivity. Participants then either reacted normally to assess emotional recovery or attempted to decrease emotion using mindfulness or distraction to assess emotion regulation implementation deficits. RESULTS Individuals with BPD and GAD exhibited higher self-reported and sympathetic baseline emotion compared to HCs. The BPD group also exhibited self-reported emotion regulation deficits using distraction only compared to the GAD group. CONCLUSIONS There is minimal support for several emotion dysregulation components in BPD, and some components that are present appear to be pervasive across high emotion dysregulation groups rather than specific to BPD. However, BPD may be characterized by problems disengaging from emotion using distraction.
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Affiliation(s)
| | - Sonya Varma
- Department of Psychology, York University, Canada
| | - Janice R Kuo
- Department of Psychology, Palo Alto University, USA
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11
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Dadomo H, Salvato G, Lapomarda G, Ciftci Z, Messina I, Grecucci A. Structural Features Predict Sexual Trauma and Interpersonal Problems in Borderline Personality Disorder but Not in Controls: A Multi-Voxel Pattern Analysis. Front Hum Neurosci 2022; 16:773593. [PMID: 35280205 PMCID: PMC8904389 DOI: 10.3389/fnhum.2022.773593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 01/17/2022] [Indexed: 12/01/2022] Open
Abstract
Child trauma plays an important role in the etiology of Bordeline Personality Disorder (BPD). Of all traumas, sexual trauma is the most common, severe and most associated with receiving a BPD diagnosis when adult. Etiologic models posit sexual abuse as a prognostic factor in BPD. Here we apply machine learning using Multiple Kernel Regression to the Magnetic Resonance Structural Images of 20 BPD and 13 healthy control (HC) to see whether their brain predicts five sources of traumas: sex abuse, emotion neglect, emotional abuse, physical neglect, physical abuse (Child Trauma Questionnaire; CTQ). We also applied the same analysis to predict symptom severity in five domains: affective, cognitive, impulsivity, interpersonal (Zanarini Rating Scale for Borderline Personality Disorder; Zan-BPD) for BPD patients only. Results indicate that CTQ sexual trauma is predicted by a set of areas including the amygdala, the Heschl area, the Caudate, the Putamen, and portions of the Cerebellum in BPD patients only. Importantly, interpersonal problems only in BPD patients were predicted by a set of areas including temporal lobe and cerebellar regions. Notably, sexual trauma and interpersonal problems were not predicted by structural features in matched healthy controls. This finding may help elucidate the brain circuit affected by traumatic experiences and connected with interpersonal problems BPD suffer from.
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Affiliation(s)
- Harold Dadomo
- Unit of Neuroscience, Department of Medicine and Surgery, University of Parma, Parma, Italy
- *Correspondence: Harold Dadomo,
| | - Gerardo Salvato
- Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Milan Center for Neuroscience, School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
- Cognitive Neuropsychology Centre, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Gaia Lapomarda
- Clinical and Affective Neuroscience Lab – Cli.A.N. Lab, Department of Psychology and Cognitive Science, University of Trento, Rovereto, Italy
| | - Zafer Ciftci
- Clinical and Affective Neuroscience Lab – Cli.A.N. Lab, Department of Psychology and Cognitive Science, University of Trento, Rovereto, Italy
| | | | - Alessandro Grecucci
- Clinical and Affective Neuroscience Lab – Cli.A.N. Lab, Department of Psychology and Cognitive Science, University of Trento, Rovereto, Italy
- Centre for Medical Sciences, CISMed, University of Trento, Trento, Italy
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12
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Fitzpatrick S, Kuo JR. Predicting the effectiveness of engagement and disengagement emotion regulation based on emotional reactivity in borderline personality disorder. Cogn Emot 2021; 36:473-491. [PMID: 34931942 DOI: 10.1080/02699931.2021.2018291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Improving emotion regulation is central to borderline personality disorder (BPD) treatment, but little research indicates which emotion regulation strategies are optimally effective and when. Basic emotion science suggests that engagement emotion regulation strategies that process emotional content become less effective as emotional intensity increases, whereas disengagement strategies that disengage from it do not. This study examined whether emotional reactivity to emotional stimuli predicts the effectiveness of engagement and disengagement emotion regulation across self-report, general physiologic (heart rate), sympathetic (skin conductance responses), and parasympathetic (respiratory sinus arrythmia) emotion in BPD, healthy, and clinical control (i.e. generalized anxiety disorder; GAD) groups. 120 participants (40 per group) were exposed to emotion inductions and then instructed to implement engagement (mindful awareness) and disengagement (distraction) strategies while self-report and physiological emotion measurements were taken. In the BPD and GAD groups, higher heart rate or respiratory sinus arrythmia reactivity, respectively, predicted improved mindful awareness effectiveness. Higher skin conductance reactivity predicted worsened distraction effectiveness in BPD. Higher reactivity may potentiate engagement emotion regulation, and exacerbate disengagement from emotional content, in BPD. Future research should examine other domains of emotion regulation that may be influenced by emotional intensity, and other forms of emotional intensity that may influence them.
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Affiliation(s)
| | - Janice R Kuo
- Department of Psychology, Palo Alto University, Palo Alto, CA, USA
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13
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Cavicchioli M, Scalabrini A, Northoff G, Mucci C, Ogliari A, Maffei C. Dissociation and emotion regulation strategies: A meta-analytic review. J Psychiatr Res 2021; 143:370-387. [PMID: 34592484 DOI: 10.1016/j.jpsychires.2021.09.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/24/2021] [Accepted: 09/01/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Clinical and neurobiological models posited that dissociative mechanisms might affect processes involved in emotional generation and regulation. However, there is a lack of a comprehensive theoretical framework that systematically includes dissociation within emotional functioning. METHODS The current study aims at conducting a meta-analytic review on the relationship between dissociation and emotion regulation in order to empirically estimate to what extent dissociation is related to emotion regulation processes. The meta-analysis was based on r coefficient as effect size measure, using a random-effect approach. RESULTS The meta-analysis included 57 independent studies for a total of 11596 individuals. Findings showed an overall moderate relationship between dissociation and emotion regulation (rw = .32; p < .05). The association between dissociation and emotion regulation was the same among clinical samples than non-clinical ones. Furthermore, dissociation showed moderate to large relationships with maladaptive domains of emotion regulation, namely disengagement (rw = 0.34; p < .01) (i.e., behavioral avoidance, experiential avoidance, thought and emotional suppression) and aversive cognitive perseveration (rw = 0.38; p < .001) (i.e., rumination, worry and nonacceptance). The analysis did not find significant relationship between dissociation and adaptive domain of emotional regulation (i.e., problem solving, mindfulness). CONCLUSION Dissociation in the context of emotion regulation might be viewed as a basic neuro-mental mechanism that automatically contribute to the over-modulation of emotional states through avoidance reactions from internal and external reality. Future longitudinal studies are needed to clarify the causal relationships between dissociation and emotion regulation.
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Affiliation(s)
- Marco Cavicchioli
- Department of Psychology, University "Vita-Salute San Raffaele", Via Stamira d'Ancona 20, 20127, Milano (MI), Italy; Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Via Stamira d'Ancona 20, 20127, Milano (MI), Italy.
| | - Andrea Scalabrini
- Department of Psychological, Health and Territorial Sciences (DiSPuTer), G. d'Annunzio University of Chieti-Pescara, Via dei Vestini 33, 66100, Chieti (CH), Italy.
| | - Georg Northoff
- Mental Health Centre, Zhejiang University School of Medicine, Tianmu Road 305, Hangzhou, Zhejiang Province, 310013, China; Centre for Cognition and Brain Disorders, Hangzhou Normal University, Tianmu Road 305, Hangzhou, Zhejiang Province, 310013, China; The Royal's Institute of Mental Health Research & University of Ottawa. Brain and Mind Research Institute, Centre for Neural Dynamics, Faculty of Medicine, University of Ottawa, 145 Carling Avenue, Rm. 6435, Ottawa, Ontario, K1Z 7K4, Canada
| | - Clara Mucci
- Department of Human and Social Science, University of Bergamo, Bergamo, Italy
| | - Anna Ogliari
- Department of Psychology, University "Vita-Salute San Raffaele", Via Stamira d'Ancona 20, 20127, Milano (MI), Italy; Child in Mind Lab, University "Vita-Salute San Raffaele", Via Stamira d'Ancona 20, 20127, Milano (MI), Italy
| | - Cesare Maffei
- Department of Psychology, University "Vita-Salute San Raffaele", Via Stamira d'Ancona 20, 20127, Milano (MI), Italy; Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Via Stamira d'Ancona 20, 20127, Milano (MI), Italy
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14
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Impaired impulse inhibition of emotional stimuli in patients with borderline personality disorder. Sci Rep 2021; 11:16628. [PMID: 34404887 PMCID: PMC8371102 DOI: 10.1038/s41598-021-96166-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 07/26/2021] [Indexed: 02/07/2023] Open
Abstract
This study was aimed to investigate whether BPD patients showed impaired impulse inhibition of emotional and non-emotional stimuli and to explore relevant neuroelectrophysiological mechanisms. A total of 32 BPD patients and 32 matched healthy controls were recruited. Self-reported scales were used to measure psychiatric symptoms. The event-related potentials (ERPs) were recorded when subjects were performing neutral and emotional Stop Signal Task (SST). Group differences in self-reported scores, behavioral variables and ERPs were compared. The BPD group scored significantly higher on impulsivity, severity of BPD symptoms, levels of depression and anxiety than the control group. In neutral SST, no significant group differences were detected in the amplitude and latency of ERPs components induced. In emotional SST, the P2 amplitude of negative emotion was significantly larger than that of neutral emotion in Go trials. In Stop trials, the P2 amplitude of BPD group was significantly smaller than that of control group, and the N2 amplitude of BPD group was significantly greater than that of control group. BPD patients showed impaired inhibition of emotional stimuli rather than non-emotional stimuli. The deficits of emotional impulse control mainly exhibit at the early attention, stimulus evaluation and conflict detection stages.
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15
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Law KC, Anestis MD. Testing Whether Suicide Capability Has a Dynamic Propensity: The Role of Affect and Arousal on Momentary Fluctuations in Suicide Capability. Front Psychol 2021; 12:590187. [PMID: 34385942 PMCID: PMC8353180 DOI: 10.3389/fpsyg.2021.590187] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 06/10/2021] [Indexed: 11/24/2022] Open
Abstract
To prevent suicidal behaviors, it is crucial to understand the mechanisms and processes that enable an individual to act on suicidal thoughts. Suicide capability, which involves an increased pain tolerance and fearlessness of death, is a critical factor that enables an individual to endure the physical pain necessary to make a lethal suicide attempt. Extant research has largely conceptualized suicide capability as developing linearly in response to painful and provocative experiences, but the emerging literature on the temporal dynamics of suicide has been challenging the notion of linearity in suicide risk. Few studies have directly measured and compared changes in suicide capability in response to rumination on different affective states. We sought to experimentally test if rumination in the context of low vs. high arousal emotions will prompt distinct changes in two core components of suicide capability: pain tolerance and fearlessness of death on two undergraduate student samples. In both studies, participants provided measures of subjective emotional state as well as pain threshold, tolerance, and persistence before and after completing experimental manipulations which included both emotion and rumination induction procedures. In the second study, measures of fearlessness about death and physiological arousal (heart rate) were added to the experimental procedures. We found significant decreases in pain threshold, tolerance, and persistence following the experimental manipulations but found no main effects of rumination or suicide risk. These findings suggest that suicide capability can fluctuate but these changes may occur through a different mechanism and/or differ between individuals at varying levels of suicide risk.
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Affiliation(s)
- Keyne C Law
- Department of Clinical Psychology, School of Psychology, Family, and Community, Seattle Pacific University, Seattle, WA, United States
| | - Michael D Anestis
- New Jersey Gun Violence Research Center, New Brunswick, NJ, United States.,Department of Urban-Global Public Health, School of Public Health, Rutgers University, New Brunswick, NJ, United States
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16
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van Zutphen L, Siep N, Jacob GA, Domes G, Sprenger A, Willenborg B, Goebel R, Tüscher O, Arntz A. Impulse control under emotion processing: an fMRI investigation in borderline personality disorder compared to non-patients and cluster-C personality disorder patients. Brain Imaging Behav 2021; 14:2107-2121. [PMID: 31321661 PMCID: PMC7647993 DOI: 10.1007/s11682-019-00161-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Impulsivity is a characteristic syndromal and neurobehavioral feature of borderline personality disorder (BPD). Research suggests an important interaction between high negative emotions and low behavioral inhibition in BPD. However, knowledge about the generalizability across stimulus categories and diagnosis specificity is limited. We investigated neural correlates of hypothesized impaired response inhibition of BPD patients to negative, positive and erotic stimuli, by comparing them to non-patients and cluster-C personality disorder patients. During fMRI scanning, 53 BPD patients, 34 non-patients and 20 cluster-C personality disorder patients completed an affective go/no-go task, including social pictures. BPD patients showed more omission errors than non-patients, independent of the stimulus category. Furthermore, BPD patients showed higher activity in the inferior parietal lobule and frontal eye fields when inhibiting negative versus neutral stimuli. Activity of the inferior parietal lobule correlated positively with the BPD checklist subscale impulsivity. When inhibiting emotional stimuli, BPD patients showed an altered brain activity in the inferior parietal lobe and frontal eye fields, whereas previously shown dysfunctional prefrontal activity was not replicated. BPD patients showed a general responsivity across stimulus categories in the frontal eye fields, whereas effects in the inferior parietal lobe were specific for negative stimuli. Results of diagnosis specificity support a dimensional rather than a categorical differentiation between BPD and cluster-C patients during inhibition of social emotional stimuli. Supported by behavioral results, BPD patients showed no deficiencies in emotionally modulated response inhibition per se but the present findings rather hint at attentional difficulties for emotional information.
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Affiliation(s)
- Linda van Zutphen
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, PO Box 616, 6200, MD, Maastricht, the Netherlands.
| | - Nicolette Siep
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, PO Box 616, 6200, MD, Maastricht, the Netherlands
| | - Gitta A Jacob
- Department of Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany
| | - Gregor Domes
- Department of Psychology, Laboratory for Biological and Personality Psychology, University of Freiburg, Freiburg, Germany.,Freiburg Brain Imaging Center, University Medical Center Freiburg, Freiburg, Germany.,Department of Biological and Clinical Psychology, University of Trier, Trier, Germany
| | - Andreas Sprenger
- Departments of Neurology and Psychology, University of Lübeck, Lübeck, Germany
| | - Bastian Willenborg
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Rainer Goebel
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, the Netherlands.,Department of Neuroimaging and Neuromodeling, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences (KNAW), Amsterdam, the Netherlands
| | - Oliver Tüscher
- Department of Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany.,Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Arnoud Arntz
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, PO Box 616, 6200, MD, Maastricht, the Netherlands.,Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
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17
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Bortolan A. Narratively Shaped Emotions: The Case of Borderline Personality Disorder. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2020; 45:212-230. [PMID: 32073620 DOI: 10.1093/jmp/jhz037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In this article, I provide a phenomenological exploration of the role played by narrativity in shaping affective experience. I start by surveying and identifying different ways in which linguistic and narrative expression contribute to structure and regulate emotions, and I then expand on these insights by taking into consideration the phenomenology of borderline personality disorder. Disruptions of narrative abilities have been shown to be central to the illness, and I argue that these disruptions are at the origin of a number of alterations of affective experience. In particular, I suggest that due to the narrative "fragmentation" characteristic of the disorder, the emotions experienced by borderline patients can be less differentiated and have a predominantly bodily and unregulated character.
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18
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Lynn SJ, Maxwell R, Merckelbach H, Lilienfeld SO, Kloet DVHVD, Miskovic V. Dissociation and its disorders: Competing models, future directions, and a way forward. Clin Psychol Rev 2019; 73:101755. [DOI: 10.1016/j.cpr.2019.101755] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 06/20/2019] [Accepted: 07/15/2019] [Indexed: 12/18/2022]
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19
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Use your words: The role of emotion labeling in regulating emotion in borderline personality disorder. Behav Res Ther 2019; 120:103447. [PMID: 31374483 DOI: 10.1016/j.brat.2019.103447] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/13/2019] [Accepted: 07/26/2019] [Indexed: 11/24/2022]
Abstract
Borderline personality disorder (BPD) treatments emphasize emotion labeling to decrease negative emotion and facilitate emotion regulation. However, no studies have examined emotion labeling in BPD or its impact on intentional emotion regulation. The present study examined the impact of emotion labeling on emotion and intentional emotion regulation attempts across self-reported and physiological indices (i.e., skin conductance response [SCR], respiratory sinus arrhythmia [RSA]) in BPD and healthy control (HC) groups. Participants listened to emotionally-evocative scripts and were either instructed to type the emotions that they were experiencing (labeling) or the objects they could imagine seeing in the script (control) into a computer. Following this, they were instructed to use either mindfulness or cognitive reappraisal to decrease their emotion. Self-reported, RSA, and SCR indices of negative emotion were collected throughout and analyzed using generalized estimating equations. Findings indicated that the BPD group experienced higher RSA during emotion labeling compared to the control task, but the HC group did not. HCs reported lower negative emotion after emotion labeling when implementing both emotion regulation strategies compared to the control task, but the BPD group did not. These findings suggest that emotion labeling may activate emotion regulatory systems in BPD and can potentiate intentional emotion regulation in HCs.
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20
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Peter M, Arntz A, Klimstra T, Vingerhoets AJJM. Crying in borderline personality disorder patients. Psychiatry Res 2019; 273:100-107. [PMID: 30640050 DOI: 10.1016/j.psychres.2019.01.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 01/03/2019] [Accepted: 01/06/2019] [Indexed: 11/28/2022]
Abstract
Emotion dysregulation and hyperreactivity are considered central features of Borderline Personality Disorder (BPD). We assumed that such emotion dysregulation is also reflected in increased crying behavior of these patients and, consequently, hypothesized that BPD patients (N = 62), compared to Cluster C personality disorder patients (Cluster C-PD; N = 25) and non-patients (N = 54), would show higher scores on crying measures. To evaluate crying behavior, we used a set of specially designed tools. Compared to non-patients, BPD patients showed the anticipated higher crying frequency despite a similar crying proneness and ways of dealing with tears. They also reported less awareness of the influence of crying on others. However, Cluster C-PD patients showed a very similar pattern of findings. Overall, our results suggest that the increased crying of BPD patients likely results from environmental factors or the misperception of situations, rather than from stable traits. Remarkable is that the observed discrepancies in crying behavior compared to non-patients seem to be similar for Cluster-C PDs and BPD.
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Affiliation(s)
- Mathell Peter
- Department of Personality Disorders, GGz Breburg, Lage Witsiebaan 4, Tilburg, the Netherlands.
| | - Arnoud Arntz
- Department of Clinical Psychology, Faculty of Social and Behavioral Sciences, University of Amsterdam, Nieuwe Achtergracht 129, Amsterdam, the Netherlands
| | - Theo Klimstra
- Developmental Psychology, Tilburg University, Warandalaan 2, Tilburg, the Netherlands
| | - Ad J J M Vingerhoets
- Department of Medical and Clinical Psychology, Tilburg University, Warandalaan 2, Tilburg, the Netherlands
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21
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Kramer L, Sander C, Bertsch K, Gescher DM, Cackowski S, Hegerl U, Herpertz SC. EEG-vigilance regulation in Borderline Personality Disorder. Int J Psychophysiol 2019; 139:10-17. [PMID: 30796933 DOI: 10.1016/j.ijpsycho.2019.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 12/05/2018] [Accepted: 02/15/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Borderline Personality Disorder (BPD) is characterized by emotional instability, impulsivity, disturbed cognition, sleeplessness and states of high inner tension. Altered arousal regulation which is regarded as a higher domain of functioning according to the research domain criteria of the NIMH and which has previously been reported in several psychiatric disorders, such as mania or major depression could be involved in these features of BPD. METHODS 40 unmedicated patients with BPD and 42 matched healthy volunteers participated in a twenty minute resting-state EEG measurement with closed eyes. EEG-vigilance regulation was assessed with VIGALL2.0 (Vigilance Algorithm Leipzig), which allows a classification of consecutive 1-s segments in different vigilance stages ranging from high alertness/relaxed wakefulness (stages 0, A1, A2, A3) to drowsiness (B1, B2/3) and sleep onset (C). RESULTS Across 20 min, both groups showed a similar decline from higher to lower vigilance stages, but patients with BPD remained in higher stages of vigilance compared to healthy volunteers across the whole measurement (p = .013). Contrary to this, pre-experimental ratings indicated enhanced subjective sleepiness but no differences in self-reported sleep quantity in the previous night in patients with BPD compared to healthy volunteers. CONCLUSIONS The results of an elevated arousal regulation (in combination with increased subjective sleepiness) might reflect several symptoms, such as aversive inner tension and impoverished sense of self in patients with BPD. As arousal is linked to the noradrenergic system, further investigations in this field seem to be promising.
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Affiliation(s)
- Lucas Kramer
- Department of General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Germany.
| | - Christian Sander
- Department of Psychiatry and Psychotherapy, University of Leipzig, Germany
| | - Katja Bertsch
- Department of General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Germany
| | - Dorothee Maria Gescher
- Department of General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Germany
| | - Sylvia Cackowski
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
| | - Ulrich Hegerl
- Department of Psychiatry and Psychotherapy, University of Leipzig, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Germany
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22
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Schauer PA, Rauh J, Leicht G, Andreou C, Mulert C. Altered Oscillatory Responses to Feedback in Borderline Personality Disorder are Linked to Symptom Severity. Brain Topogr 2019; 32:482-491. [PMID: 30689144 DOI: 10.1007/s10548-019-00700-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 01/17/2019] [Indexed: 11/28/2022]
Abstract
Several studies using electroencephalography (EEG) demonstrate that the processing of feedback in patients suffering from borderline personality disorder (BPD) is altered in comparison to healthy controls. Differences occur in the theta (ca. 5 Hz) and high-beta frequency-ranges (ca. 20 Hz) of oscillations in response to negative and positive feedback, respectively. However, alpha (ca. 10 Hz) and low-beta (ca. 15 Hz) oscillations have also been shown to be involved in feedback processing. We hypothesized that additional alterations might occur in these frequency ranges in BPD. Eighteen patients with BPD and twenty-two healthy controls performed a gambling task while 64-channel-EEG was recorded. Induced oscillatory responses to positive (i.e. gain) and negative (i.e. loss) feedback in the alpha and low-beta frequency range were investigated. No significant differences were found in the alpha frequency range. Regarding the low-beta frequency range a significant Group (i.e. BPD vs. healthy controls) × Valence (i.e. gain vs. loss) interaction in the time frame between 600 and 700 milliseconds after feedback was found. This effect showed a significant correlation with symptom severity (assessed with the BSL-23). The results indicate that feedback processing in BPD could be more heavily altered than previously expected, with more severe symptomatology being linked to stronger alterations in oscillatory responses to feedback in the low-beta range.
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Affiliation(s)
- Paul Alexander Schauer
- Psychiatry Neuroimaging Branch, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Jonas Rauh
- Psychiatry Neuroimaging Branch, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Gregor Leicht
- Psychiatry Neuroimaging Branch, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Christina Andreou
- Psychiatry Neuroimaging Branch, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg Eppendorf, Hamburg, Germany.,Center for Gender Research and Early Detection, University of Basel Psychiatric Clinics, Basel, Switzerland
| | - Christoph Mulert
- Psychiatry Neuroimaging Branch, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg Eppendorf, Hamburg, Germany. .,Department of Psychiatry and Psychotherapy, UKGM, Justus-Liebig University Giessen, Giessen, Germany.
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23
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Ginzburg K, Biran I, Aryeh IG, Tsur N, Defrin R. Pain Perception and Body Awareness Among Individuals With Borderline Personality Disorder. J Pers Disord 2018; 32:618-635. [PMID: 28902571 DOI: 10.1521/pedi_2017_31_316] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Studies indicate that individuals with borderline personality disorder (BPD) often demonstrate attenuated pain perception, termed hypoalgesia. This study examines the hypothesis that body awareness moderates the association between BPD and pain perception. Participants consisted of 46 women diagnosed with BPD and 47 healthy controls. Sensory testing included the measurement of heat-pain thresholds, ratings of suprathreshold stimuli, measurement of temperature evoking moderate pain, and temporal summation of noxious mechanical stimuli. Body awareness was assessed by a self-report questionnaire. As hypothesized, among subjects with low levels of body awareness, those with BPD demonstrated hypoalgesia as manifested in their lower suprathreshold pain ratings and moderate pain evoked by higher temperature, in comparison with the controls. Among those with high levels of body awareness, BPD subjects demonstrated increased reactivity to pain as manifested in their higher pain ratings and moderate pain evoked by lower temperature, in comparison with the controls.
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Affiliation(s)
- Karni Ginzburg
- The Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Iftah Biran
- Division of Psychiatry, Sheba Medical Center, Ramat Gan, and The Division of Neurology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Itay Goor Aryeh
- Pain Management Center, Department of Anesthesiology and Intensive Care, Sheba Medical Center, Tel Hashomer, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noga Tsur
- I-Core Research Center for Mass Trauma, The Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Ruth Defrin
- Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, and Sagol School of Neurosciences, Tel Aviv University, Tel Aviv, Israel
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24
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Willis F, Kuniss S, Kleindienst N, Lis S, Naoum J, Jungkunz M, Neukel C, Bohus M, Treede R, Baumgärtner U, Schmahl C. Stress reactivity and pain-mediated stress regulation in remitted patients with borderline personality disorder. Brain Behav 2018; 8:e00909. [PMID: 29484266 PMCID: PMC5822574 DOI: 10.1002/brb3.909] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 11/22/2017] [Accepted: 12/03/2017] [Indexed: 11/28/2022] Open
Abstract
Objective Patients with borderline personality disorder (BPD) use nonsuicidal self-injury (NSSI) to cope with states of elevated inner tension. It is unclear to what extent remitted BPD patients experience these states and whether the experience of pain still regulates emotion. The purpose of this study was the investigation of baseline stress levels, stress reactivity, and pain-mediated stress regulation in remitted BPD patients. Method Subjective and objective stress parameters were assessed in 30 remitted BPD patients, 30 current BPD patients, and 30 healthy controls. After stress induction, a non-nociceptive tactile stimulus, a tissue-injuring, or a noninvasive pain stimulus was applied to the right volar forearm. Results Baseline stress levels of remitted BPD patients lie in between the stress levels of current BPD patients and healthy controls. Urge for NSSI increased significantly more in current than remitted BPD patients. The experience of pain led to a greater decrease of arousal in current compared to remitted BPD patients and healthy controls. Conclusions States of increased tension still seem to appear in remitted BPD patients. The role of pain-mediated stress regulation appears to be reduced in remitted patients.
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Affiliation(s)
- Franziska Willis
- Department of Psychosomatic Medicine and PsychotherapyMedical Faculty MannheimCentral Institute of Mental HealthUniversity of HeidelbergMannheimGermany
- Department of General, Visceral and Transplantation SurgeryUniversity Hospital HeidelbergHeidelbergGermany
| | - Sarah Kuniss
- Department of Psychosomatic Medicine and PsychotherapyMedical Faculty MannheimCentral Institute of Mental HealthUniversity of HeidelbergMannheimGermany
| | - Nikolaus Kleindienst
- Department of Psychosomatic Medicine and PsychotherapyMedical Faculty MannheimCentral Institute of Mental HealthUniversity of HeidelbergMannheimGermany
| | - Stefanie Lis
- Department of Psychosomatic Medicine and PsychotherapyMedical Faculty MannheimCentral Institute of Mental HealthUniversity of HeidelbergMannheimGermany
| | - Janina Naoum
- Department of Psychosomatic Medicine and PsychotherapyMedical Faculty MannheimCentral Institute of Mental HealthUniversity of HeidelbergMannheimGermany
| | - Martin Jungkunz
- Department of Psychosomatic Medicine and PsychotherapyMedical Faculty MannheimCentral Institute of Mental HealthUniversity of HeidelbergMannheimGermany
| | - Corinne Neukel
- Department of Psychosocial MedicineUniversity of HeidelbergHeidelbergGermany
| | - Martin Bohus
- Department of Psychosomatic Medicine and PsychotherapyMedical Faculty MannheimCentral Institute of Mental HealthUniversity of HeidelbergMannheimGermany
- Faculty of HealthUniversity of AntwerpAntwerpBelgium
| | - Rolf‐Detlef Treede
- Department of Neurophysiology, Centre of Biomedicine and Medical Technology MannheimMedical Faculty MannheimHeidelberg UniversityMannheimGermany
| | - Ulf Baumgärtner
- Department of Neurophysiology, Centre of Biomedicine and Medical Technology MannheimMedical Faculty MannheimHeidelberg UniversityMannheimGermany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and PsychotherapyMedical Faculty MannheimCentral Institute of Mental HealthUniversity of HeidelbergMannheimGermany
- Department of Psychiatry, Schulich School of Medicine and DentistryWestern UniversityLondonONCanada
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25
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Prada P, Zamberg I, Bouillault G, Jimenez N, Zimmermann J, Hasler R, Aubry JM, Nicastro R, Perroud N. EMOTEO: A Smartphone Application for Monitoring and Reducing Aversive Tension in Borderline Personality Disorder Patients, a Pilot Study. Perspect Psychiatr Care 2017; 53:289-298. [PMID: 27439663 DOI: 10.1111/ppc.12178] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 06/16/2016] [Accepted: 06/17/2016] [Indexed: 11/27/2022] Open
Abstract
PURPOSE We developed a smartphone application (App; EMOTEO: emotion-meteo [weather forecast]) to help borderline personality disorder (BPD) patients to monitor and regulate their inner tension. The App proposes targeted mindfulness-based exercises. DESIGN AND METHODS We assessed the usability and efficiency of this App for monitoring and reduction of aversive tension in 16 BPD participants over a 6-month period. FINDINGS We recorded a mean of 318.1 sessions (SD = 166.7) per participants, with a high level of satisfaction. There was a significant decrease in aversive tension (p < .05) and the App was mainly used around 10 a.m. and 9 p.m. PRACTICE IMPLICATIONS EMOTEO was user-friendly and efficient in reducing aversive tension in BPD patients.
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Affiliation(s)
- Paco Prada
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Ido Zamberg
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Gérald Bouillault
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Naya Jimenez
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Julien Zimmermann
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Roland Hasler
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Jean-Michel Aubry
- 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
| | - Nader Perroud
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
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26
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Petri-Kelvasa M, Schulte-Herbrüggen O. Disinhibited Exposing Behavior, Hypersexuality, and Erectile Dysfunction as a Consequence of Posttraumatic Stress in a 42-Year-Old Male Patient. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:2197-2205. [PMID: 28484862 DOI: 10.1007/s10508-017-0985-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 03/25/2017] [Accepted: 03/26/2017] [Indexed: 06/07/2023]
Abstract
Research into sexual dysfunction and its explanations within a cognitive behavioral framework in patients with posttraumatic stress is sparse. In this report, we present the case of a 42-year-old male with severe posttraumatic stress symptoms who displayed apparent exhibitionistic behavior, hypersexual behavior in the form of excessive masturbation, and erectile dysfunction. Differential diagnostics showed that the presented exhibitionistic behavior could be more accurately classified as non-paraphilic disinhibited exposing behavior. Functional behavioral analysis of his sexual behavior suggested that disinhibited exposing and hypersexual behavior served as dysfunctional coping strategies for trauma-associated negative emotions. Erectile dysfunction seemed to be the result of trauma-associated hyperarousal and excessive masturbation. Within the context of operant learning processes, we propose that his sexual behaviors became highly automated and were used as the main strategies to regulate trauma-associated negative emotions. Implications for the diagnoses and suggestions for the conceptualization and incorporation into a cognitive behavioral therapy treatment of posttraumatic stress disorder are made.
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Affiliation(s)
- Mirja Petri-Kelvasa
- Department of Psychiatry and Psychotherapy, Charité-University Medicine, Charité Campus Mitte, Große Hamburger Straße 5-11, 10115, Berlin, Germany.
| | - Olaf Schulte-Herbrüggen
- Department of Psychiatry and Psychotherapy, Charité-University Medicine, Charité Campus Mitte, Große Hamburger Straße 5-11, 10115, Berlin, Germany
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27
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Baczkowski BM, van Zutphen L, Siep N, Jacob GA, Domes G, Maier S, Sprenger A, Senft A, Willenborg B, Tüscher O, Arntz A, van de Ven V. Deficient amygdala-prefrontal intrinsic connectivity after effortful emotion regulation in borderline personality disorder. Eur Arch Psychiatry Clin Neurosci 2017; 267:551-565. [PMID: 28039553 PMCID: PMC5561271 DOI: 10.1007/s00406-016-0760-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 12/13/2016] [Indexed: 02/05/2023]
Abstract
Emotion instability in borderline personality disorder (BPD) has been associated with an impaired fronto-limbic inhibitory network. However, functional connectivity (FC) underlying altered emotion regulation in BPD has yet to be established. Here, we used resting-state fMRI to investigate enduring effects of effortful emotion regulation on the amygdala intrinsic FC in BPD. In this multicenter study, resting-state fMRI was acquired before and after an emotion regulation task in 48 BPD patients and 39 non-patient comparison individuals. The bilateral amygdalae were used as a seed in the whole-brain FC analysis and two-way mixed ANOVA to test whether BPD patients exhibited weaker post-task increase in the amygdala intrinsic FC with the prefrontal cortex (PFC), compared to non-patients. Subsequently, we explored whether the results are common for personality disorders characterized by emotional problems, using additional data of 21 cluster-C personality disorder patients. In contrast to non-patients, BPD patients failed to show increased post-task amygdala resting-state FC with the medial, dorsolateral, ventrolateral PFC, and superior temporal gyrus, but surprisingly exhibited decreased FC with the posterior cingulate cortex and increased FC with the superior parietal lobule. In BPD patients, the emotion regulation task failed to increase resting-state amygdala FC with brain regions essential for effortful emotion regulation, which suggests: (a) altered cognitive control typically used to indirectly alleviate distress by reinterpreting the meaning of emotional stimuli; (b) impaired direct regulation of emotional responses, which might be common for personality disorders;
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Affiliation(s)
- Blazej M Baczkowski
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Max Planck Research Group for Neuroanatomy & Connectivity, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Linda van Zutphen
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Nicolette Siep
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Gitta A Jacob
- Department of Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany
| | - Gregor Domes
- Department of Psychology, Laboratory for Biological and Personality Psychology, University of Freiburg, Freiburg, Germany
- Freiburg Brain Imaging Center, University Medical Center, University of Freiburg, Freiburg, Germany
- Department of Biological and Clinical Psychology, University of Trier, Trier, Germany
| | - Simon Maier
- Freiburg Brain Imaging Center, University Medical Center, University of Freiburg, Freiburg, Germany
- Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg, Freiburg, Germany
| | - Andreas Sprenger
- Departments of Neurology and Psychology, University of Lübeck, Lübeck, Germany
| | - Alena Senft
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Bastian Willenborg
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Oliver Tüscher
- Department of Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Arnoud Arntz
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Vincent van de Ven
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, The Netherlands
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28
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Scalabrini A, Cavicchioli M, Fossati A, Maffei C. The extent of dissociation in borderline personality disorder: A meta-analytic review. J Trauma Dissociation 2017; 18:522-543. [PMID: 27681284 DOI: 10.1080/15299732.2016.1240738] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Several authors have studied dissociation within the borderline personality disorder (BPD) population and postulated 3 dissociative subgroups. Conversely, other authors suggest that dissociation may play a central role in the development of trauma-related disorders and specifically in BPD. Nevertheless, the role of dissociation in BPD seems to be controversial. Our aim is to perform a meta-analytic review of the literature to evaluate the extent of dissociation in BPD compared to other psychopathological disorders to clarify its role in this specific condition. Ten eligible studies resulted in a total of 2,035 subjects. Results show that levels of dissociation are higher in BPD than in other psychiatric disorders in general, although this difference is moderate and the heterogeneity of effect sizes is large. In particular, individuals with BPD seem to show higher levels of dissociation than those with several psychiatric and personality disorders but not dissociative disorders or posttraumatic stress disorder. These findings support the fact that dissociation is not specifically a core feature of BPD and, in addition, sustain the existence of a continuum of severity within the psychiatric population. Nevertheless, the current work has several limitations related to the paucity of studies included, the heterogeneity of control groups, their clear definition, and the statistical robustness of the results. In addition, our conclusions require future research in order to explain the role of different forms of dissociation and their etiological factors among the psychiatric population. Eventually, we invite clinicians and researchers to systematically evaluate dissociation in order to reach a better diagnosis for a more specific treatment indication.
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Affiliation(s)
- Andrea Scalabrini
- a Department of Neuroscience, Imaging and Clinical Science , University G. D'Annunzio , Chieti , Italy.,b Unit of Clinical Psychology and Psychotherapy , San Raffaele Hospital (Ville Turro) , Milan , Italy
| | - Marco Cavicchioli
- b Unit of Clinical Psychology and Psychotherapy , San Raffaele Hospital (Ville Turro) , Milan , Italy.,c Department of Psychology , University "Vita-Salute San Raffaele," , Milan , Italy
| | - Andrea Fossati
- b Unit of Clinical Psychology and Psychotherapy , San Raffaele Hospital (Ville Turro) , Milan , Italy.,d Department of Human Studies , LUMSA University , Rome , Italy
| | - Cesare Maffei
- b Unit of Clinical Psychology and Psychotherapy , San Raffaele Hospital (Ville Turro) , Milan , Italy.,c Department of Psychology , University "Vita-Salute San Raffaele," , Milan , Italy
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29
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The role of seeing blood in non-suicidal self-injury in female patients with borderline personality disorder. Psychiatry Res 2016; 246:676-682. [PMID: 27829508 DOI: 10.1016/j.psychres.2016.10.066] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 08/18/2016] [Accepted: 10/30/2016] [Indexed: 11/24/2022]
Abstract
Patients with Borderline Personality Disorder (BPD) often engage in non-suicidal self-injury (NSSI), to reduce arousal levels under stress. However, the importance of seeing blood for the effect of NSSI is yet unknown. The present pilot study examined 20 female BPD patients and 20 healthy controls (HC) to assess the role of seeing blood on arousal, pain, urge for NSSI (ratings) and heart rate (continuously measured). Participants completed two sessions consisting of stress induction (forced mental arithmetics with white noise), followed by a seven second non-invasive pain stimulus with a blade to the volar forearm. At one session, only the painful blade stimulus was applied, at the other, artificial blood was added. For arousal, a significantly stronger decrease was revealed in the BPD than in the HC group, however with no significant effects between blood and non-blood conditions. Concerning urge for NSSI, the BPD showed a significantly greater decrease in blood condition over time than the HC group. Interestingly, heart rate decreased stronger over time in the HC group during the blood condition than in BPD. For tension relief by non-damaging mechanical painful stimulus the addition of visible blood showed neither subjective (arousal, urge for NSSI), nor objective (heart rate) advantages.
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30
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Paret C, Hoesterey S, Kleindienst N, Schmahl C. Associations of emotional arousal, dissociation and symptom severity with operant conditioning in borderline personality disorder. Psychiatry Res 2016; 244:194-201. [PMID: 27491014 DOI: 10.1016/j.psychres.2016.07.054] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 07/25/2016] [Indexed: 10/21/2022]
Abstract
Those with borderline personality disorder (BPD) display altered evaluations regarding reward and punishment compared to others. The processing of rewards is basal for operant conditioning. However, studies addressing operant conditioning in BPD patients are rare. In the current study, an operant conditioning task combining learning acquisition and reversal was used. BPD patients and matched healthy controls (HCs) were exposed to aversive and neutral stimuli to assess the influence of emotion on learning. Picture content, dissociation, aversive tension and symptom severity were rated. Error rates were measured. Results showed no group interactions between aversive versus neutral scenes. The higher emotional arousal, dissociation and tension, the worse the acquisition, but not reversal, scores were for BPD patients. Scores from the Borderline Symptom List were associated with more errors in the reversal, but not the acquisition phase. The results are preliminary evidence for impaired acquisition learning due to increased emotional arousal, dissociation and tension in BPD patients. A failure to process punishment in the reversal phase was associated with symptom severity and may be related to neuropsychological dysfunctioning involving the ventromedial prefrontal cortex. Conclusions are limited due to the correlational study design and the small sample size.
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Affiliation(s)
- Christian Paret
- Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Germany; Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Germany.
| | - Steffen Hoesterey
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Nikolaus Kleindienst
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Germany
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31
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Kirtley OJ, O'Carroll RE, O'Connor RC. Pain and self-harm: A systematic review. J Affect Disord 2016; 203:347-363. [PMID: 27323296 DOI: 10.1016/j.jad.2016.05.068] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 05/28/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND A growing body of research has explored altered physical pain threshold and tolerance in non-suicidal self-injury (NSSI) and suicidal self-harm. The evidence, however, is inconsistent such that the nature of the relationship is unclear, and whether or not this effect is also present in suicidal self-harm is equivocal. METHODS A keyword search of three major psychological and medical databases (PsycINFO, Medline and Web of Knowledge) was conducted, yielding 1873 records. Following duplicate removal and screening, 25 articles were quality assessed, and included in the final systematic review. RESULTS There is strong evidence for increased pain tolerance in NSSI, and some evidence for this in suicidal individuals, but notably, there were no prospective studies. The review found a lack of substantive focus on psychological correlates of altered pain tolerance in this population. Several candidate explanatory mechanisms were proposed within the reviewed studies. LIMITATIONS The current review was a narrative systematic review; methods used to assess pain were considered too heterogeneous to conduct a meta-analysis. CONCLUSIONS The evidence suggests that there is elevated pain tolerance among those who engage in NSSI. Future prospective research should determine if altered pain tolerance is a cause or a consequence of the behaviour. The identification of psychological correlates of increased pain tolerance is a neglected area of research. It could provide opportunities for treatment/intervention development, if mediating or moderating pathways can be identified. Too few studies have directly investigated candidate explanatory mechanisms to draw definitive conclusions.
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Affiliation(s)
- Olivia J Kirtley
- University of Glasgow, Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, United Kingdom.
| | - Ronan E O'Carroll
- University of Stirling, Division of Psychology, School of Natural Sciences, University of Stirling, Stirling FK9 4LA, United Kingdom
| | - Rory C O'Connor
- University of Glasgow, Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, United Kingdom
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32
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Body plasticity in borderline personality disorder: A link to dissociation. Compr Psychiatry 2016; 69:36-44. [PMID: 27423343 DOI: 10.1016/j.comppsych.2016.05.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 04/08/2016] [Accepted: 05/02/2016] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Patients with borderline personality disorder (BPD) often report an unstable sense of self, which is further enhanced in dissociative states. As one consequence, BPD patients show a labile body percept, which might result in a higher degree of body plasticity. However, experimental data on body plasticity in BPD are not yet available. MATERIALS AND METHODS The rubber hand illusion (RHI) probes the plasticity of one's body by inducing the feeling of ownership for an artificial limb. We tested the proneness to perceive the RHI in female patients with current and remitted BPD compared to healthy controls, and related their perceptions to state and trait dissociation. RESULTS Participants with current BPD, compared to healthy controls, reported higher proneness to perceive the RHI (p<.05, with an effect size [Cohen's d] of 0.68). Remission was associated with a stabilization of perceptions. RHI vividness was positively related to state and trait dissociation across the groups, and specifically in current BPD when controlling for symptom severity (all Pearson's r≥.30, p<.05). DISCUSSION These results indicate enhanced body plasticity related to dissociation in BPD, point to shared neurobiological mechanisms, and might help to elucidate the body-related perceptual disturbances associated with BPD. CONCLUSION The results provide initial empirical evidence for significant alterations in body ownership processing associated with a current BPD diagnosis, resulting in enhanced body plasticity. Dissociation significantly correlated with illusory limb ownership experiences, making body plasticity a marker for BPD.
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33
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Kolar DR, Hammerle F, Jenetzky E, Huss M, Bürger A. Aversive tension in female adolescents with Anorexia Nervosa: a controlled ecological momentary assessment using smartphones. BMC Psychiatry 2016; 16:97. [PMID: 27068217 PMCID: PMC4828844 DOI: 10.1186/s12888-016-0807-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 04/06/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Current models of Anorexia Nervosa (AN) emphasize the role of emotion regulation. Aversive tension, described as a state of intense arousal and negative valence, is considered to be a link between emotional events and disordered eating. Recent research focused only on adult patients, and mainly general emotion regulation traits were studied. However, the momentary occurrence of aversive tension, particularly in adolescents with AN, has not been previously studied. METHOD 20 female adolescents with AN in outpatient treatment and 20 healthy adolescents aged 12 to 19 years participated in an ecological momentary assessment using their smartphones. Current states of aversive tension and events were assessed hourly for two consecutive weekdays. Mean and maximum values of aversive tension were compared. Multilevel analyses were computed to test the influence of time and reported events on aversive tension. The effect of reported events on subsequent changes of aversive tension in patients with AN were additionally tested in a multilevel model. RESULTS AN patients showed higher mean and maximum levels of aversive tension. In a multilevel model, reported food intake was associated with higher levels of aversive tension in the AN group, whereas reported school or sport-related events were not linked to specific states of aversive tension. After food intake, subsequent increases of aversive tension were diminished and decreases of aversive tension were induced in adolescents with AN. CONCLUSIONS Aversive tension may play a substantial role in the psychopathology of AN, particular in relation with food intake. Therefore, treatment should consider aversive tension as a possible intervening variable during refeeding. Our findings encourage further research on aversive tension and its link to disordered eating. TRIAL REGISTRATION German register of clinical trials (DRKS): DRKS00005228 (Date of registration: September 2, 2013).
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Affiliation(s)
- David R. Kolar
- Department for Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Florian Hammerle
- Department for Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Ekkehart Jenetzky
- Department for Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany ,Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Michael Huss
- Department for Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Arne Bürger
- Department for Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany ,Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
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34
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Rosenthal MZ, Neacsiu AD, Geiger PJ, Fang C, Ahn R, Larrauri J. Emotional Reactivity to Personally-Relevant and Standardized Sounds in Borderline Personality Disorder. COGNITIVE THERAPY AND RESEARCH 2016. [DOI: 10.1007/s10608-015-9736-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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35
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Paret C, Kluetsch R, Zaehringer J, Ruf M, Demirakca T, Bohus M, Ende G, Schmahl C. Alterations of amygdala-prefrontal connectivity with real-time fMRI neurofeedback in BPD patients. Soc Cogn Affect Neurosci 2016; 11:952-60. [PMID: 26833918 DOI: 10.1093/scan/nsw016] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 01/28/2016] [Indexed: 11/12/2022] Open
Abstract
With the use of real-time functional magnetic resonance imaging neurofeedback (NF), amygdala activitiy can be visualized in real time. In this study, continuous amygdala NF was provided to patients with borderline personality disorder (BPD) with the instruction to down-regulate. During four sessions of NF training, patients viewed aversive pictures and received feedback from a thermometer display, which showed the amygdala blood oxygenation level-dependent signal. Conditions of regulation and viewing without regulation were presented. Each session started with a resting-state scan and was followed by a transfer run without NF. Amygdala regulation, task-related and resting-state functional brain connectivity were analyzed. Self-ratings of dissociation and difficulty in emotion regulation were collected. BPD patients down-regulated right amygdala activation but there were no improvements over time. Task-related amygdala-ventromedial prefrontal cortex connectivity was altered across the four sessions, with an increased connectivity when regulating vs viewing pictures. Resting-state amygdala-lateral prefrontal cortex connectivity was altered and dissociation, as well as scores for 'lack of emotional awareness', decreased with training. Results demonstrated that amygdala NF may improve healthy brain connectivity, as well as emotion regulation. A randomized-controlled trial is needed to investigate whether amygdala NF is instrumental for improving neural regulation and emotion regulation in BPD patients.
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Affiliation(s)
- Christian Paret
- Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Rosemarie Kluetsch
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Jenny Zaehringer
- Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany, Department of Neurophysiology, Centre of Biomedicine and Medical Technology Mannheim (CBTM), Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Matthias Ruf
- Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Traute Demirakca
- Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Martin Bohus
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Gabriele Ende
- Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
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Winter D. Attention to emotional stimuli in borderline personality disorder - a review of the influence of dissociation, self-reference, and psychotherapeutic interventions. Borderline Personal Disord Emot Dysregul 2016; 3:11. [PMID: 27713819 PMCID: PMC5050674 DOI: 10.1186/s40479-016-0047-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 09/27/2016] [Indexed: 12/19/2022] Open
Abstract
Interactions between attention and processing of emotional stimuli shed light on both sensitivity to emotional stimuli as well as emotion dysregulation. Both of the latter processes have been proposed as central characteristics of altered emotion processing in those with borderline personality disorder (BPD). This review first summarizes the conflicting behavioural, psychophysiological and neuroimaging evidence for the hypothesis that emotional dysregulation should be reflected by higher distractibility through emotional stimuli in those with BPD. Dissociation, self-reference, as well as symptom severity modulated by psychotherapeutic interventions are proposed to help clarify divergent findings. Data suggest an association of dissociation with impaired task continuation during the presentation of interfering emotional and neutral stimuli, as well as high recruitment of neuronal attention networks together with a blunted emotional response. Considering self-reference, evidence suggests that negative rather than positive information may be more self-relevant to those with BPD. This may be due to a negative self-concept and self-evaluation. Social or trauma-relevant information attracts more attention from individuals with BPD and thus suggests higher self-relevance. After psychotherapeutic interventions, initial evidence may indicate normalization of the way attention and emotional stimuli interact in BPD. When studying attention-emotion interactions in BPD, methodological heterogeneities regarding sample, task, and stimulus characteristics need to be considered. When doing so, dissociation, self-reference, and psychotherapeutic interventions offer promising targets for future studies on attention-emotion interactions in those with BPD. This could promote a deeper insight into the affected individuals' struggle with emotions.
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Affiliation(s)
- Dorina Winter
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, PO Box 12 21 20, 68072 Mannheim, Germany
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Pfaltz MC, Schumacher S, Wilhelm FH, Dammann G, Seifritz E, Martin-Soelch C. Acoustic Emotional Processing in Patients With Borderline Personality Disorder: Hyper- or Hyporeactivity? J Pers Disord 2015; 29:809-27. [PMID: 25710735 DOI: 10.1521/pedi_2015_29_176] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Earlier studies have demonstrated emotional overreactions to affective visual stimuli in patients with borderline personality disorder (BPD). However, contradictory findings regarding hyper- versus hyporeactivity have been reported for peripheral physiological measures. In order to extend previous results, the authors investigated emotional reactivity and long-term habituation in the acoustic modality. Twenty-two female BPD patients and 19 female nonclinical controls listened to emotionally negative, neutral, and positive sounds in two identical sessions. Heart rate, skin conductance, zygomaticus/corrugator muscle, and self-reported valence/arousal responses were measured. BPD patients showed weaker skin conductance responses to negative sounds than controls. The elevated zygomaticus activity in response to positive sounds observed in controls was absent in BPD patients, and BPD patients assigned lower valence ratings to positive sounds than controls. In Session 2, patients recognized fewer positive sounds than controls. Across both groups, physiological measures habituated between sessions. These findings add to growing evidence toward partial affective hyporeactivity in BPD.
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Affiliation(s)
- Monique C Pfaltz
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, Switzerland
| | - Sonja Schumacher
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, Switzerland
| | - Frank H Wilhelm
- Division of Clinical Psychology, Psychotherapy, and Health Psychology, Department of Psychology, University of Salzburg, Austria
| | - Gerhard Dammann
- Psychiatric Clinic Muensterlingen, Switzerland.,Psychiatric University Hospital Basel, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Switzerland
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Arntz A, Stupar-Rutenfrans S, Bloo J, van Dyck R, Spinhoven P. Prediction of treatment discontinuation and recovery from Borderline Personality Disorder: Results from an RCT comparing Schema Therapy and Transference Focused Psychotherapy. Behav Res Ther 2015; 74:60-71. [PMID: 26432172 DOI: 10.1016/j.brat.2015.09.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 09/12/2015] [Accepted: 09/14/2015] [Indexed: 11/26/2022]
Abstract
Knowing what predicts discontinuation or success of psychotherapies for Borderline Personality Disorder (BPD) is important to improve treatments. Many variables have been reported in the literature, but replication is needed and investigating what therapy process underlies the findings is necessary to understand why variables predict outcome. Using data of an RCT comparing Schema Therapy and Transference Focused Psychotherapy as treatments for BPD, variables derived from the literature were tested as predictors of discontinuation and treatment success. Participants were 86 adult outpatients (80 women, mean age 30.5 years) with a primary diagnosis of BPD who had on average received 3 previous treatment modalities. First, single predictors were tested with logistic regression, controlling for treatment type (and medication use in case of treatment success). Next, with multivariate backward logistic regression essential predictors were detected. Baseline hostility and childhood physical abuse predicted treatment discontinuation. Baseline subjective burden of dissociation predicted a smaller chance of recovery. A second study demonstrated that in-session dissociation, assessed from session audiotapes, mediated the observed effects of baseline dissociation on recovery, indicating that dissociation during sessions interferes with treatment effectiveness. The results suggest that specifically addressing high hostility, childhood abuse, and in-session dissociation might reduce dropout and lack of effectiveness of treatment.
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Affiliation(s)
- Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, The Netherlands; Department of Clinical Psychological Science, Maastricht University, The Netherlands.
| | - Snežana Stupar-Rutenfrans
- Department of Clinical Psychological Science, Maastricht University, The Netherlands; International Media and Entertainment Management Academy for Digital Entertainment NHTV University of Applied Sciences, Breda, The Netherlands
| | - Josephine Bloo
- Department of Clinical Psychological Science, Maastricht University, The Netherlands; Community Mental Health Center Virenze RIAGG, Vaals, The Netherlands
| | | | - Philip Spinhoven
- Institute of Psychology, Leiden University, Leiden, The Netherlands
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Reitz S, Kluetsch R, Niedtfeld I, Knorz T, Lis S, Paret C, Kirsch P, Meyer-Lindenberg A, Treede RD, Baumgärtner U, Bohus M, Schmahl C. Incision and stress regulation in borderline personality disorder: neurobiological mechanisms of self-injurious behaviour. Br J Psychiatry 2015; 207:165-72. [PMID: 25906795 DOI: 10.1192/bjp.bp.114.153379] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 11/02/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Patients with borderline personality disorder frequently show non-suicidal self-injury (NSSI). In these patients, NSSI often serves to reduce high levels of stress. AIMS Investigation of neurobiological mechanisms of NSSI in borderline personality disorder. METHOD In total, 21 women with borderline personality disorder and 17 healthy controls underwent a stress induction, followed by either an incision into the forearm or a sham treatment. Afterwards participants underwent resting-state functional magnetic resonance imaging while aversive tension, heart rate and heart rate variability were assessed. RESULTS We found a significant influence of incision on subjective and objective stress levels with a stronger decrease of aversive tension in the borderline personality disorder group following incision than sham. Amygdala activity decreased more and functional connectivity with superior frontal gyrus normalised after incision in the borderline personality disorder group. CONCLUSIONS Decreased stress levels and amygdala activity after incision support the assumption of an influence of NSSI on emotion regulation in individuals with borderline personality disorder and aids in understanding why these patients use self-inflicted pain to reduce inner tension.
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Affiliation(s)
- Sarah Reitz
- Sarah Reitz, MD, Rosemarie Kluetsch, Inga Niedtfeld, PhD, Teresa Knorz, MD, Stefanie Lis, PhD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Christian Paret, Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Peter Kirsch, PhD, Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Andreas Meyer-Lindenberg, MD, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Rolf-Detlef Treede, MD, Ulf Baumgärtner, MD, Department of Neurophysiology, Center for Biomedicine and Medical Technology, Medical Faculty Mannheim/Heidelberg University, Mannheim; Martin Bohus, MD, Christian Schmahl, MD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Rosemarie Kluetsch
- Sarah Reitz, MD, Rosemarie Kluetsch, Inga Niedtfeld, PhD, Teresa Knorz, MD, Stefanie Lis, PhD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Christian Paret, Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Peter Kirsch, PhD, Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Andreas Meyer-Lindenberg, MD, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Rolf-Detlef Treede, MD, Ulf Baumgärtner, MD, Department of Neurophysiology, Center for Biomedicine and Medical Technology, Medical Faculty Mannheim/Heidelberg University, Mannheim; Martin Bohus, MD, Christian Schmahl, MD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Inga Niedtfeld
- Sarah Reitz, MD, Rosemarie Kluetsch, Inga Niedtfeld, PhD, Teresa Knorz, MD, Stefanie Lis, PhD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Christian Paret, Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Peter Kirsch, PhD, Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Andreas Meyer-Lindenberg, MD, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Rolf-Detlef Treede, MD, Ulf Baumgärtner, MD, Department of Neurophysiology, Center for Biomedicine and Medical Technology, Medical Faculty Mannheim/Heidelberg University, Mannheim; Martin Bohus, MD, Christian Schmahl, MD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Teresa Knorz
- Sarah Reitz, MD, Rosemarie Kluetsch, Inga Niedtfeld, PhD, Teresa Knorz, MD, Stefanie Lis, PhD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Christian Paret, Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Peter Kirsch, PhD, Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Andreas Meyer-Lindenberg, MD, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Rolf-Detlef Treede, MD, Ulf Baumgärtner, MD, Department of Neurophysiology, Center for Biomedicine and Medical Technology, Medical Faculty Mannheim/Heidelberg University, Mannheim; Martin Bohus, MD, Christian Schmahl, MD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Stefanie Lis
- Sarah Reitz, MD, Rosemarie Kluetsch, Inga Niedtfeld, PhD, Teresa Knorz, MD, Stefanie Lis, PhD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Christian Paret, Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Peter Kirsch, PhD, Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Andreas Meyer-Lindenberg, MD, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Rolf-Detlef Treede, MD, Ulf Baumgärtner, MD, Department of Neurophysiology, Center for Biomedicine and Medical Technology, Medical Faculty Mannheim/Heidelberg University, Mannheim; Martin Bohus, MD, Christian Schmahl, MD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Christian Paret
- Sarah Reitz, MD, Rosemarie Kluetsch, Inga Niedtfeld, PhD, Teresa Knorz, MD, Stefanie Lis, PhD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Christian Paret, Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Peter Kirsch, PhD, Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Andreas Meyer-Lindenberg, MD, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Rolf-Detlef Treede, MD, Ulf Baumgärtner, MD, Department of Neurophysiology, Center for Biomedicine and Medical Technology, Medical Faculty Mannheim/Heidelberg University, Mannheim; Martin Bohus, MD, Christian Schmahl, MD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Peter Kirsch
- Sarah Reitz, MD, Rosemarie Kluetsch, Inga Niedtfeld, PhD, Teresa Knorz, MD, Stefanie Lis, PhD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Christian Paret, Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Peter Kirsch, PhD, Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Andreas Meyer-Lindenberg, MD, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Rolf-Detlef Treede, MD, Ulf Baumgärtner, MD, Department of Neurophysiology, Center for Biomedicine and Medical Technology, Medical Faculty Mannheim/Heidelberg University, Mannheim; Martin Bohus, MD, Christian Schmahl, MD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Andreas Meyer-Lindenberg
- Sarah Reitz, MD, Rosemarie Kluetsch, Inga Niedtfeld, PhD, Teresa Knorz, MD, Stefanie Lis, PhD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Christian Paret, Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Peter Kirsch, PhD, Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Andreas Meyer-Lindenberg, MD, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Rolf-Detlef Treede, MD, Ulf Baumgärtner, MD, Department of Neurophysiology, Center for Biomedicine and Medical Technology, Medical Faculty Mannheim/Heidelberg University, Mannheim; Martin Bohus, MD, Christian Schmahl, MD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Rolf-Detlef Treede
- Sarah Reitz, MD, Rosemarie Kluetsch, Inga Niedtfeld, PhD, Teresa Knorz, MD, Stefanie Lis, PhD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Christian Paret, Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Peter Kirsch, PhD, Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Andreas Meyer-Lindenberg, MD, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Rolf-Detlef Treede, MD, Ulf Baumgärtner, MD, Department of Neurophysiology, Center for Biomedicine and Medical Technology, Medical Faculty Mannheim/Heidelberg University, Mannheim; Martin Bohus, MD, Christian Schmahl, MD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Ulf Baumgärtner
- Sarah Reitz, MD, Rosemarie Kluetsch, Inga Niedtfeld, PhD, Teresa Knorz, MD, Stefanie Lis, PhD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Christian Paret, Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Peter Kirsch, PhD, Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Andreas Meyer-Lindenberg, MD, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Rolf-Detlef Treede, MD, Ulf Baumgärtner, MD, Department of Neurophysiology, Center for Biomedicine and Medical Technology, Medical Faculty Mannheim/Heidelberg University, Mannheim; Martin Bohus, MD, Christian Schmahl, MD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Martin Bohus
- Sarah Reitz, MD, Rosemarie Kluetsch, Inga Niedtfeld, PhD, Teresa Knorz, MD, Stefanie Lis, PhD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Christian Paret, Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Peter Kirsch, PhD, Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Andreas Meyer-Lindenberg, MD, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Rolf-Detlef Treede, MD, Ulf Baumgärtner, MD, Department of Neurophysiology, Center for Biomedicine and Medical Technology, Medical Faculty Mannheim/Heidelberg University, Mannheim; Martin Bohus, MD, Christian Schmahl, MD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Christian Schmahl
- Sarah Reitz, MD, Rosemarie Kluetsch, Inga Niedtfeld, PhD, Teresa Knorz, MD, Stefanie Lis, PhD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Christian Paret, Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Peter Kirsch, PhD, Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Andreas Meyer-Lindenberg, MD, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim; Rolf-Detlef Treede, MD, Ulf Baumgärtner, MD, Department of Neurophysiology, Center for Biomedicine and Medical Technology, Medical Faculty Mannheim/Heidelberg University, Mannheim; Martin Bohus, MD, Christian Schmahl, MD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
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Sajadi SF, Zargar Y, Mehrabizade Honarmand M, Arshadi N. Designing and Testing a Model of Some Precedents and Outcomes of Borderline Personality Disorder in High School Students of Shiraz. INTERNATIONAL JOURNAL OF SCHOOL HEALTH 2015. [DOI: 10.17795/intjsh-26742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Anderson JL, Sellbom M. Construct Validity of theDSM–5Section III Personality Trait Profile for Borderline Personality Disorder. J Pers Assess 2015; 97:478-86. [DOI: 10.1080/00223891.2015.1051226] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Sajadi SF, Arshadi N, Zargar Y, Mehrabizade Honarmand M, Hajjari Z. Borderline Personality Features in Students: the Predicting Role of Schema, Emotion Regulation, Dissociative Experience and Suicidal Ideation. INTERNATIONAL JOURNAL OF HIGH RISK BEHAVIORS & ADDICTION 2015; 4:e20021. [PMID: 26401490 PMCID: PMC4578319 DOI: 10.5812/ijhrba.20021v2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 08/06/2014] [Accepted: 08/17/2014] [Indexed: 06/05/2023]
Abstract
BACKGROUND Numerous studies have demonstrated that early maladaptive schemas, emotional dysregulation are supposed to be the defining core of borderline personality disorder. Many studies have also found a strong association between the diagnosis of borderline personality and the occurrence of suicide ideation and dissociative symptoms. OBJECTIVES The present study was designed to investigate the relationship between borderline personality features and schema, emotion regulation, dissociative experiences and suicidal ideation among high school students in Shiraz City, Iran. PATIENTS AND METHODS In this descriptive correlational study, 300 students (150 boys and 150 girls) were selected from the high schools in Shiraz, Iran, using the multi-stage random sampling. Data were collected using some instruments including borderline personality feature scale for children, young schema questionnaire-short form, difficulties in emotion-regulation scale (DERS), dissociative experience scale and beck suicide ideation scale. Data were analyzed using the Pearson correlation coefficient and multivariate regression analysis. RESULTS The results showed a significant positive correlation between schema, emotion regulation, dissociative experiences and suicide ideation with borderline personality features. Moreover, the results of multivariate regression analysis suggested that among the studied variables, schema was the most effective predicting variable of borderline features (P < 0.001). CONCLUSIONS The findings of this study are in accordance with findings from previous studies, and generally show a meaningful association between schema, emotion regulation, dissociative experiences, and suicide ideation with borderline personality features.
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Affiliation(s)
- Seyede Fateme Sajadi
- Department of Psychology, Shahid Chamran University of Ahvaz, Ahvaz, IR Iran
- Young Researchers and Elite Club, Shiraz, IR Iran
| | - Nasrin Arshadi
- Department of Psychology, Shahid Chamran University of Ahvaz, Ahvaz, IR Iran
| | - Yadolla Zargar
- Department of Psychology, Shahid Chamran University of Ahvaz, Ahvaz, IR Iran
| | | | - Zahra Hajjari
- Department of Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Rosenthal MZ, Fang CM, Chapman AL. Ambulatory measurement of emotional dysfunction in borderline personality disorder. Curr Opin Psychol 2015. [DOI: 10.1016/j.copsyc.2015.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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A comprehensive examination of delayed emotional recovery in borderline personality disorder. J Behav Ther Exp Psychiatry 2015; 47:51-9. [PMID: 25482953 PMCID: PMC4324164 DOI: 10.1016/j.jbtep.2014.11.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 10/21/2014] [Accepted: 11/09/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Despite growing attention to emotion processes in borderline personality disorder (BPD), little research has examined delayed emotional recovery (i.e., long-lasting emotions after the termination of an emotionally evocative stimulus) in this population. The extant data on delayed emotional recovery in BPD are limited by a lack of assessment across a range of indices and emotions. The present study addresses these gaps by comparing emotional recovery between individuals with BPD, social anxiety disorder (SAD), and healthy controls (HCs) using a multi-modal assessment approach. METHODS Participants underwent fear, anger, and sadness inductions followed by a 5-min "washout" phase wherein emotional recovery was assessed via self-report, respiratory sinus arrhythmia (RSA), and skin conductance responses (SCR). RESULTS After controlling for state dissociation, the BPD and SAD group exhibited decreases in RSA, while the HC group showed no changes in RSA after the anger induction only. Groups did not differ in rate of emotional recovery across self-report, RSA, or SCR after fear and sadness inductions. LIMITATIONS The present study is limited by a solely female and small sample, and the short time frame in which emotional recovery was assessed. CONCLUSIONS Findings indicate that individuals with BPD generally do not exhibit delayed emotional recovery, but may show decreases in parasympathetic activity during the recovery period after experiencing anger. However, this pattern may not be specific to this disorder.
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Sauer C, Arens EA, Stopsack M, Spitzer C, Barnow S. Emotional hyper-reactivity in borderline personality disorder is related to trauma and interpersonal themes. Psychiatry Res 2014; 220:468-76. [PMID: 25066960 DOI: 10.1016/j.psychres.2014.06.041] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 05/30/2014] [Accepted: 06/22/2014] [Indexed: 11/28/2022]
Abstract
Heightened emotional reactivity is one of the core features of borderline personality disorder (BPD). However, recent findings could not provide evidence for a general emotional hyper-reactivity in BPD. The present study examines the emotional responding to self-relevant pictures in dependency of the thematic category (e.g., trauma, interpersonal interaction) in patients with BPD. Therefore, women with BPD (n=31), women with major depression disorder (n=29) and female healthy controls (n=33) rated pictures allocated to thematically different categories (violence, sexual abuse, interaction, non-suicidal self-injury, and suicide) regarding self-relevance, arousal, valence and the urge of non-suicidal self-injury. Compared to both control groups, patients with BPD reported higher self-relevance regarding all categories, but significantly higher emotional ratings only for pictures showing sexual abuse and interpersonal themes. In addition, patients with BPD and comorbid posttraumatic stress disorder showed higher emotional reactivity in violence pictures. Our data provide clear evidence that patients with BPD show a specific emotional hyper-reactivity with respect to schema-related triggers like trauma and interpersonal situations. Future studies are needed to investigate physiological responses to these self-relevant themes in patients with BPD.
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Affiliation(s)
- Christina Sauer
- University of Heidelberg, Department of Clinical Psychology and Psychotherapy, Hauptstrasse 47-51, 69117 Heidelberg, Germany.
| | - Elisabeth A Arens
- University of Heidelberg, Department of Clinical Psychology and Psychotherapy, Hauptstrasse 47-51, 69117 Heidelberg, Germany.
| | - Malte Stopsack
- University of Heidelberg, Department of Clinical Psychology and Psychotherapy, Hauptstrasse 47-51, 69117 Heidelberg, Germany.
| | | | - Sven Barnow
- University of Heidelberg, Department of Clinical Psychology and Psychotherapy, Hauptstrasse 47-51, 69117 Heidelberg, Germany.
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Brand BL, Lanius RA. Chronic complex dissociative disorders and borderline personality disorder: disorders of emotion dysregulation? Borderline Personal Disord Emot Dysregul 2014; 1:13. [PMID: 26401297 PMCID: PMC4579511 DOI: 10.1186/2051-6673-1-13] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 08/27/2014] [Indexed: 11/25/2022] Open
Abstract
Emotion dysregulation is a core feature of chronic complex dissociative disorders (DD), as it is for borderline personality disorder (BPD). Chronic complex DD include dissociative identity disorder (DID) and the most common form of dissociative disorder not otherwise specified (DDNOS, type 1), now known as Other Specified Dissociative Disorders (OSDD, type 1). BPD is a common comorbid disorder with DD, although preliminary research indicates the disorders have some distinguishing features as well as considerable overlap. This article focuses on the epidemiology, clinical presentation, psychological profile, treatment, and neurobiology of chronic complex DD with emphasis placed on the role of emotion dysregulation in each of these areas. Trauma experts conceptualize borderline symptoms as often being trauma based, as are chronic complex DD. We review the preliminary research that compares DD to BPD in the hopes that this will stimulate additional comparative research.
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Affiliation(s)
| | - Ruth A Lanius
- />University of Western Ontario, London, ON N6A 5A5 Canada
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Krause-Utz A, Veer IM, Rombouts SARB, Bohus M, Schmahl C, Elzinga BM. Amygdala and anterior cingulate resting-state functional connectivity in borderline personality disorder patients with a history of interpersonal trauma. Psychol Med 2014; 44:2889-2901. [PMID: 25066544 DOI: 10.1017/s0033291714000324] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Studies in borderline personality disorder (BPD) have consistently revealed abnormalities in fronto-limbic brain regions during emotional, somatosensory and cognitive challenges. Here we investigated changes in resting-state functional connectivity (RSFC) of three fronto-limbic core regions of specific importance to BPD. METHOD Functional magnetic resonance imaging data were acquired in 20 unmedicated female BPD patients and 17 healthy controls (HC, matched for age, sex and education) during rest. The amygdala, and the dorsal and ventral anterior cingulate cortex (ACC) were defined as seeds to investigate RSFC patterns of a medial temporal lobe network, the salience network and default mode network. The Dissociation Experience Scale (DES), a measure of trait dissociation, was additionally used as a predictor of RSFC with these seed regions. RESULTS Compared with HC, BPD patients showed a trend towards increased RSFC between the amygdala and the insula, orbitofrontal cortex and putamen. Compared with controls, patients furthermore exhibited diminished negative RSFC between the dorsal ACC and posterior cingulate cortex, a core region of the default mode network, and regions of the dorsomedial prefrontal cortex. Last, increased negative RSFC between the ventral ACC and medial occipital regions was observed in BPD patients. DES scores were correlated with amygdala connectivity with the dorsolateral prefrontal cortex and fusiform gyrus. CONCLUSIONS Our findings suggest alterations in resting-state networks associated with processing of negative emotions, encoding of salient events, and self-referential processing in individuals with BPD compared with HC. These results shed more light on the role of abnormal brain connectivity in BPD.
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Affiliation(s)
- A Krause-Utz
- Department of Psychosomatic Medicine and Psychotherapy,Central Institute of Mental Health,Mannheim,Germany
| | - I M Veer
- Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin, Berlin,Germany
| | - S A R B Rombouts
- Leiden Institute for Brain and Cognition (LIBC),Leiden,The Netherlands
| | - M Bohus
- Department of Psychosomatic Medicine and Psychotherapy,Central Institute of Mental Health,Mannheim,Germany
| | - C Schmahl
- Department of Psychosomatic Medicine and Psychotherapy,Central Institute of Mental Health,Mannheim,Germany
| | - B M Elzinga
- Leiden Institute for Brain and Cognition (LIBC),Leiden,The Netherlands
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Chapman AL, Walters KN, Gordon KLD. Emotional reactivity to social rejection and negative evaluation among persons with borderline personality features. J Pers Disord 2014; 28:720-33. [PMID: 23130813 DOI: 10.1521/pedi_2012_26_068] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The present study examined the emotional reactivity of persons with heightened borderline personality (BP) features to social rejection and negative evaluation in the laboratory. Individuals with high levels of BP features (n = 30) and controls with low levels of BP features (n = 44) were randomly assigned to a condition involving negative evaluation based on writing (negative evaluation/academic), or a condition involving negative evaluation based on personal characteristics as well as social rejection (negative evaluation/social rejection). Hypothesis 1 was that high-BP individuals, but not low-BP controls, would show greater emotional reactivity to the negative evaluation/social rejection stressor, compared with the negative evaluation/academic (writing) stressor. Hypothesis 2 was that high-BP individuals would specifically show greater reactivity of shame- and anger-related emotions to the negative evaluation/social rejection stressor compared with the negative evaluation/academic stressor. Findings indicated that high-BP individuals showed heightened emotional reactivity to the social rejection stressor but not to the negative evaluation stressor, but the opposite pattern occurred for controls. In addition, there was evidence for heightened reactivity of irritability, distress, and shame for the high-BP group, specifically in the social rejection condition.
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Kolar DR, Bürger A, Hammerle F, Jenetzky E. Aversive tension of adolescents with anorexia nervosa in daily course: a case-controlled and smartphone-based ambulatory monitoring trial. BMJ Open 2014; 4:e004703. [PMID: 24760350 PMCID: PMC4010818 DOI: 10.1136/bmjopen-2013-004703] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Monitoring and reduction of aversive tension is a core issue in dialectical behaviour therapy of patients. It has been shown that aversive tension is increased in adult borderline personality disorder and is linked to low emotion labelling ability. However, until now there is no documented evidence that patients with anorexia nervosa suffer from aversive tension as well. Furthermore the usability of a smartphone application for ambulatory monitoring purposes has not been sufficiently explored. METHODS AND ANALYSIS We compare the mean and maximum self-reported aversive tension in 20 female adolescents (12-19 years) with anorexia nervosa in outpatient treatment with 20 healthy controls. They are required to answer hourly, over a 2-day period, that is, about 30 times, four short questions on their smartphone, which ensures prompt documentation without any recall bias. At the close out, the participants give a structured usability feedback on the application and the procedure. ETHICS AND DISSEMINATION The achieved result of this trial has direct relevance for efficient therapy strategies and is a prerequisite for trials regarding dialectical behaviour therapy in anorexia nervosa. The results will be disseminated through peer-review publications. The ethics committee of the regional medical association in Mainz, Germany approved the study protocol under the reference number 837.177.13. TRIAL REGISTRATION NUMBER The trial is registered at the German clinical trials registration under the reference number DRKS00005228.
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Affiliation(s)
- David Raphael Kolar
- Department for Child and Adolescent Psychiatry and Psychotherapy, Johannes-Gutenberg-University Mainz, Mainz, Germany
| | - Arne Bürger
- Department for Child and Adolescent Psychiatry and Psychotherapy, Johannes-Gutenberg-University Mainz, Mainz, Germany
| | - Florian Hammerle
- Department for Child and Adolescent Psychiatry and Psychotherapy, Johannes-Gutenberg-University Mainz, Mainz, Germany
| | - Ekkehart Jenetzky
- Department for Child and Adolescent Psychiatry and Psychotherapy, Johannes-Gutenberg-University Mainz, Mainz, Germany
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
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Cavazzi T, Becerra R. Psychophysiological Research of Borderline Personality Disorder: Review and Implications for Biosocial Theory. EUROPES JOURNAL OF PSYCHOLOGY 2014. [DOI: 10.5964/ejop.v10i1.677] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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