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Buhl-Nielsen B, Steele H, Steele M. Attachment and body representations in adolescents with personality disorder. J Clin Psychol 2024. [PMID: 38822751 DOI: 10.1002/jclp.23705] [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: 08/11/2023] [Revised: 01/20/2024] [Accepted: 05/07/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Attachment theory has served as an influential framework for understanding psychopathology, partly due to reliable assessment methodology. The influence of insecure attachment on attitudes toward the body and the impact this might have for the development of psychopathology is however less well elucidated. METHOD A total of 123 adolescents (35 with borderline personality disorder or BPD, 25 with other personality disorders [OPD] and 63 comprising a normative control group) were interviewed with the Adult Attachment Interview (AAI) and the Mirror Interview (MI). The MI questions respondents about how they feel about their bodies, as they look in the mirror. RESULTS The AAIs from the Borderline group were predominantly insecure-preoccupied and unresolved. These adolescents had significantly lower levels of a positive and integrated sense of self and body than the other groups. Regression results revealed a high loving relationship with fathers, low involving anger with father, high coherence of mind, slight derogation of mother & low levels of unresolved loss uniquely and additively predicted 55% of variance in the summary score assigned to MI responses, that is, the summary score for a Positive and Integrated Body Representation (PIBR). CONCLUSION Unfavorable attachment experiences and current states of mind regarding attachment may give rise to problems with establishing PIBRs, and thus play a role in the development of psychopathology, especially BPD.
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Affiliation(s)
- Bernadette Buhl-Nielsen
- Department of Child and Adolescent Psychiatry, Region Sjaelland and University of Copenhagen, Copenhagen, Denmark
| | - Howard Steele
- Psychology Department, The New School for Social Research, New York, New York State, USA
| | - Miriam Steele
- Psychology Department, The New School for Social Research, New York, New York State, USA
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Eyden J, MacCallum F, Bornstein MH, Broome M, Wolke D. Parenting knowledge and parenting self-efficacy of mothers with borderline personality disorder and depression: "I know what to do but think I am not doing it". Dev Psychopathol 2024; 36:648-659. [PMID: 36744536 DOI: 10.1017/s095457942200147x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Borderline personality disorder (BPD) is a complex mental health condition often associated with previous childhood adversity including maladaptive parenting. When becoming a parent themselves, mothers with BPD have difficulties with various parenting cognitions and practices, but unknown is whether they have appropriate knowledge of sensitive parenting. This study explored whether differences in parenting knowledge or self-efficacy are specific to BPD or also found in mothers with depression, and whether symptom severity or specific diagnosis better explain parenting perceptions. Mothers with BPD (n = 26), depression (n = 25) or HCs (n = 25) completed a Q-sort parenting knowledge task and a parenting self-efficacy questionnaire. Results showed mothers with BPD had the same knowledge of sensitive parenting behaviors as mothers with depression and healthy mothers. Self-reported parenting self-efficacy was lower in mothers with BPD and depression compared with healthy mothers, with symptom severity most strongly associated. A significant but low correlation was found between parenting self-efficacy and knowledge. Findings suggest that mothers with BPD and depression know what good parenting is but think they are not parenting well. Mental health difficulties are not associated with parenting knowledge, but symptom severity appears to be a common pathway to lower parenting self-efficacy. Future interventions should test whether reduction of symptom severity or positive parenting feedback could improve parenting self-efficacy.
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Affiliation(s)
- Julie Eyden
- Department of Psychology, University of Warwick, Coventry, UK
| | - Fiona MacCallum
- Department of Psychology, University of Warwick, Coventry, UK
| | - Marc H Bornstein
- Eunice Kennedy Shriver National Institute of Child & Human Development, Bethesda, MD, USA
- Institute for Fiscal Studies, London, UK
- UNICEF, New York, NY, USA
| | - Matthew Broome
- Institute for Mental Health, Department of Psychology, University of Birmingham, Birmingham, UK
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Dieter Wolke
- Department of Psychology, University of Warwick, Coventry, UK
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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Malafanti A, Yotsidi V, Sideridis G, Giannouli E, Galanaki EP, Malogiannis I. The impact of childhood trauma on borderline personality organization in a community sample of Greek emerging adults. Acta Psychol (Amst) 2024; 244:104181. [PMID: 38330732 DOI: 10.1016/j.actpsy.2024.104181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 02/10/2024] Open
Abstract
There is limited research on the role of childhood trauma in personality pathology according to Kernberg's psychodynamic model of internalized object relations. Because childhood trauma reflects the disruptions of these relations, it is expected to predict borderline personality organization, especially at the threshold of adulthood. Therefore, the main aim of this retrospective study was to examine the impact of childhood trauma on borderline personality organization in a community sample of emerging adults. Participants were 543 Greek individuals aged 18-29 (M = 21.45; 58.6 % females; 85.1 % university students). They completed the Greek versions of the Traumatic Antecedents Questionnaire (TAQ) and the Inventory of Personality Organization (IPO), which were tested for their factorial structure, reliability, and measurement invariance across gender, as few empirical data exist on the psychometric properties of these measures. Confirmatory factor analyses showed that the TAQ consisted of four factors, namely positive experiences, abuse, traumatic life events, and family chaos. The five-factor theoretical structure of the IPO, namely primitive defenses, identity diffusion, reality testing, aggression, and moral values, was confirmed. Low to moderate links between childhood trauma and borderline personality organization were found, with stronger links emerging for abuse and family chaos. Structural equation modeling showed that the various forms of childhood trauma across the age periods studied (i.e., 0-6, 7-12, 13-18) significantly and differentially predicted the dimensions of borderline personality organization. The finding that stronger links emerged when trauma occurred in older ages may be attributed to the retrospective method of the study. Gender differences were also found; for example, personality pathology was more likely in men when abuse and traumatic life events occurred in younger ages and abuse was a more important risk factor for personality pathology in women. This study highlights the impact of childhood adversity on personality pathology in emerging adulthood, provides empirical support for Kernberg's psychodynamic model, and has useful implications for trauma-informed early screening, prevention, and intervention regarding personality pathology in young people. Limitations of this study and suggestions for future research are outlined.
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Affiliation(s)
- Aikaterini Malafanti
- Department of Psychology, School of Social Sciences, Panteion University of Social and Political Sciences, Greece.
| | - Vasiliki Yotsidi
- Department of Psychology, School of Social Sciences, Panteion University of Social and Political Sciences, Greece.
| | - Georgios Sideridis
- Psychology Laboratory, Department of Pedagogy and Primary Education, School of Education, National and Kapodistrian University of Athens, Greece.
| | - Eleni Giannouli
- Personality Disorders Specific Sector, 1st Department of Psychiatry, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece.
| | - Evangelia P Galanaki
- Psychology Laboratory, Department of Pedagogy and Primary Education, School of Education, National and Kapodistrian University of Athens, Greece.
| | - Ioannis Malogiannis
- Personality Disorders Specific Sector, 1st Department of Psychiatry, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece.
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Uzar M, Dmitrzak-Węglarz M, Słopień A. Mentalizing in Adolescents with Borderline Personality Disorder. Brain Sci 2023; 13:1473. [PMID: 37891840 PMCID: PMC10605837 DOI: 10.3390/brainsci13101473] [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: 09/19/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
Mentalizing, recognized as the capacity to understand behaviors in the context of our own mental states and those of other people, is being researched more and more commonly in regard to various mental disorders. The research on mentalization focuses on, among other things, borderline personality disorder, which is at present perceived as an emerging problem in the population of adolescents. In order to summarize the currently accessible knowledge of mentalizing in adolescents with borderline personality disorder, we thoroughly analyzed relevant publications. Based on the available literature, it can be concluded that the mentalizing ability of adolescents with borderline personality disorder can be impaired. The evidence demonstrates that they are prone to hypermentalizing, defined as an overattribution of mental states to other people. However, this tendency has not been proven to be specific to teenagers with this disorder. Moreover, the existing data suggest that young people with borderline personality exhibit a reduced capacity to mentalize their own inner states.
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Affiliation(s)
- Magdalena Uzar
- Department of Child and Adolescent Psychiatry, Karol Jonscher Clinical Hospital, Poznan University of Medical Sciences, Szpitalna 27/33 St., 60-572 Poznan, Poland;
| | - Monika Dmitrzak-Węglarz
- Department of Psychiatric Genetics, Medical Biology Center, Poznan University of Medical Sciences, Rokietnicka St. 8, 60-806 Poznan, Poland;
| | - Agnieszka Słopień
- Department of Child and Adolescent Psychiatry, Karol Jonscher Clinical Hospital, Poznan University of Medical Sciences, Szpitalna 27/33 St., 60-572 Poznan, Poland;
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Cimino S, Tambelli R, Cerniglia L. The Role of Maternal Personality Organization and of the p Factor in Predicting Parental Distress, the Quality of Parental Care, and Offspring's Dysregulation Symptoms. Psychol Res Behav Manag 2023; 16:3963-3971. [PMID: 37780227 PMCID: PMC10540785 DOI: 10.2147/prbm.s423698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/05/2023] [Indexed: 10/03/2023] Open
Abstract
Background It has been posited that parental distress, the quality of maternal care and offspring's dysregulation can be predicted by maternal maladaptive characteristics. However, only a few studies have considered mothers' personality organizations and features of the p factor in mothers as possible predictors of symptoms in their children. Methods In a sample of N=524 subjects, this study evaluated the effect of mothers' personality organization and of the p factor on parental distress, parental care and offspring's dysregulation symptoms. Mothers filled out the IPO, the ASR, and the PSI-SF; children's teachers filled out the TRF; children were administered the PBI. Results We found that different mother groups (neurotic, borderline, psychotic organization) have distinct impact on parental distress, quality of care, and children's dysregulation, mediated by the p factor. Conclusion This study can contribute to the understanding of the key factors underpinning mothers and children's psychopathology.
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Affiliation(s)
- Silvia Cimino
- Sapienza. University of Rome. Department of Dynamic, Clinical and Health, Rome, Italy
| | - Renata Tambelli
- Sapienza. University of Rome. Department of Dynamic, Clinical and Health, Rome, Italy
| | - Luca Cerniglia
- International Telematic university Uninettuno, Faculty of Psychology, Rome, Italy
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Li Y, Huang X, Yuan M, Chang J, Zhang T, Wang G, Su P. Childhood maltreatment and homicidal ideation among Chinese early adolescents: The serial mediating role of borderline personality features and aggression. Aggress Behav 2023; 49:536-546. [PMID: 37243977 DOI: 10.1002/ab.22091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 05/29/2023]
Abstract
A large body of evidence linked childhood maltreatment (CM) to juvenile violence and delinquent behavior. However, little is known about the association between CM and homicidal ideation in early adolescents. This study aimed to examine that relationship and to explore the serial mediating role of borderline personality features (BPF) and aggression in that relationship in a large sample of early adolescents. A total of 5724 early adolescents (mean age: 13.5 years) were recruited from three middle schools in Anhui Province, China. The participants were invited to complete self-report questionnaires regarding their history of CM, BPF, aggression, and homicidal ideation. Mediation analyses were evaluated using structural equation modeling. A total of 669 participants (11.7%) reported homicidal ideation in the past 6 months. CM victimization was positively associated with homicidal ideation after adjusting for covariates. Furthermore, the serial mediation analysis showed a significant indirect effect of CM on homicidal ideation through BPF and subsequent aggression. Exposure to maltreatment in childhood is likely to manifest BPF and subsequently higher levels of aggression, which in turn are related to increased homicidal ideation. These findings suggest the need for early intervention for BPF and aggression in early adolescents exposed to CM to prevent the development of homicidal ideation.
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Affiliation(s)
- Yonghan Li
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Xiaoman Huang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, People's Republic of China
- Hefei City Maternal and Child Health & Family Planning Service Center, Hefei, People's Republic of China
| | - Mengyuan Yuan
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Junjie Chang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Tingting Zhang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Gengfu Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, People's Republic of China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, Hefei, Anhui, People's Republic of China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, Anhui, People's Republic of China
| | - Puyu Su
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, People's Republic of China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, Hefei, Anhui, People's Republic of China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, Anhui, People's Republic of China
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Williams K, Fleck L, Fuchs A, Koenig J, Kaess M. Mother-child interactions in adolescents with borderline personality disorder traits and the impact of early life maltreatment. Child Adolesc Psychiatry Ment Health 2023; 17:96. [PMID: 37563641 PMCID: PMC10416495 DOI: 10.1186/s13034-023-00645-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/24/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Early detection and intervention of borderline personality disorder (BPD) in adolescence has become a public health priority. Theoretical models emphasize the role of social interactions and transgenerational mechanisms in the development of the disorder suggesting a closer look at caregiver-child relationships. METHODS The current study investigated mother-adolescent interactions and their association with adolescent BPD traits by using a case-control design. Thirty-eight adolescent patients with ≥ 3 BPD traits and their mothers (BPD-G) were investigated in contrast to 35 healthy control dyads (HC-G). Maternal, adolescent and dyadic behavior was coded using the Coding Interactive Behavior Manual (CIB) during two interactions: a fun day planning and a stress paradigm. Additional effects of maternal and/or adolescent early life maltreatment (ELM) on behavior were also explored. RESULTS BPD-G displayed a significantly lower quality of maternal, adolescent and dyadic behavior than the HC-G during both interactions. Maternal and adolescent behavior was predicted by BPD traits alone, whilst dyadic behavior was also influenced by general adolescent psychopathology. Exploratory analyses of CIB subscales showed that whilst HC-G increased their reciprocal behavior during stress compared to the fun day planning, BPD-G dyads decreased it. Maternal ELM did not differ between groups or have any effect on behavior. Adolescent ELM was correlated with behavioral outcome variables, but did not explain behavioral outcomes above and beyond the effect of clinical status. DISCUSSION/CONCLUSION Our data suggest a stronger focus on parent-child interactions in BPD-specific therapies to enhance long-term treatment outcomes in adolescent BPD patients. Further research employing study designs that allow the analyses of bidirectional transactions (e.g. longitudinal design, behavioral microcoding) is needed.
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Affiliation(s)
- Katharina Williams
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Medical Faculty, University of Heidelberg, Blumenstr. 8, Heidelberg, Germany.
- Institute of Psychology, University of Heidelberg, Heidelberg, Germany.
| | - Leonie Fleck
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Medical Faculty, University of Heidelberg, Blumenstr. 8, Heidelberg, Germany
| | - Anna Fuchs
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Medical Faculty, University of Heidelberg, Blumenstr. 8, Heidelberg, Germany
| | - Julian Koenig
- Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Cologne, Cologne, Germany
| | - Michael Kaess
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Medical Faculty, University of Heidelberg, Blumenstr. 8, Heidelberg, Germany
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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Evans CM, Simms LJ. Do self and interpersonal dysfunction cross-sectionally mediate the association between adverse childhood experiences and personality pathology? Personal Ment Health 2023; 17:259-271. [PMID: 37395060 DOI: 10.1002/pmh.1588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 01/19/2023] [Accepted: 02/13/2023] [Indexed: 07/04/2023]
Abstract
Two primary limitations of research on the association between adverse childhood experiences (ACEs) and personality disorder (PD) are (1) failure to consider mechanisms of association and (2) inconsistent results due, in part, to inconsistent approaches to quantifying ACE exposure. The current study will address these limitations by examining the cross-sectional mediating role of self- and interpersonal dysfunction on the association between ACE and three PDs (antisocial, schizotypal, and borderline) using three quantifications of ACE exposure (cumulative, individual, and unique risk). Participants were 149 current or recent psychiatric patients, and data analyses were performed through estimation of a series of cross-sectional mediation models. Taken together, results suggest that (1) the association between ACE and PD is moderate, (2) self- and interpersonal dysfunction cross-sectionally mediate this association, (3) after accounting for variance shared among ACEs, associations between specific ACE subtypes and PD were negligible, (4) much of the association between ACE and PD is accounted for by general processes impacted by all forms of ACE and implicated in all forms of PD, and (5) emotional neglect may uniquely contribute to self- and interpersonal dysfunction and thereby, PD risk.
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Affiliation(s)
- Chloe M Evans
- Department of Psychology, University at Buffalo, Buffalo, New York, USA
| | - Leonard J Simms
- Department of Psychology, University at Buffalo, Buffalo, New York, USA
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Smith L, Hunt K, Parker S, Camp J, Stewart C, Morris A. Parent and Carer Skills Groups in Dialectical Behaviour Therapy for High-Risk Adolescents with Severe Emotion Dysregulation: A Mixed-Methods Evaluation of Participants' Outcomes and Experiences. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6334. [PMID: 37510567 PMCID: PMC10379026 DOI: 10.3390/ijerph20146334] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND There is an established evidence-base for dialectical behaviour therapy for adolescents (DBT-A) in the treatment of young people with severe emotion dysregulation and related problems, including repeated self-harm and suicidal behaviours. However, few studies have reported on parental involvement in such treatments. This study aims to explore the outcomes and experiences of participants of a dedicated skills group for parents and carers embedded within an adapted DBT-A programme in the United Kingdom. METHOD This study was conducted within a specialist outpatient Child and Adolescent Mental Health Services (CAMHS) DBT programme in the National Health Service (NHS) in London. Participants were parents and carers of adolescents engaged in the DBT-A programme. Participants attended a 6-month parent and carer skills group intervention and completed self-report measures relating to carer distress, communication and family functioning, at pre-intervention and post-intervention. Following the intervention, semi-structured interviews were also completed with a subgroup of participants to explore their experiences of the skills group and how they perceived its effectiveness. Quantitative and qualitative methods were used to analyse the data collected from participants. RESULTS Forty-one parents and carers completed the intervention. Participants reported a number of statistically significant changes from pre- to post-intervention: general levels of distress and problems in family communication decreased, while perceived openness of family communication and strengths and adaptability in family functioning increased. A thematic analysis of post-intervention interviews examining participant experiences identified six themes: (1) experiences prior to DBT; (2) safety in DBT; (3) experiences with other parents and carers; (4) new understandings; (5) changes in behaviours; and (6) future suggestions. DISCUSSION Parents and carers who attended a dedicated DBT skills groups, adapted for local needs, reported improvements in their wellbeing, as well as interactions with their adolescents and more general family functioning, by the end of the intervention. Further studies are needed which report on caregiver involvement in DBT.
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Affiliation(s)
- Lindsay Smith
- National and Specialist Child and Adolescent Mental Health Services (CAMHS), South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, De Crespigny Park, London SE5 8AZ, UK
| | - Katrina Hunt
- National and Specialist Child and Adolescent Mental Health Services (CAMHS), South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, De Crespigny Park, London SE5 8AZ, UK
| | - Sam Parker
- National and Specialist Child and Adolescent Mental Health Services (CAMHS), South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, De Crespigny Park, London SE5 8AZ, UK
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - Jake Camp
- National and Specialist Child and Adolescent Mental Health Services (CAMHS), South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, De Crespigny Park, London SE5 8AZ, UK
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - Catherine Stewart
- National and Specialist Child and Adolescent Mental Health Services (CAMHS), South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, De Crespigny Park, London SE5 8AZ, UK
| | - Andre Morris
- National and Specialist Child and Adolescent Mental Health Services (CAMHS), South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, De Crespigny Park, London SE5 8AZ, UK
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Vogel AC, Geselowitz B, Tillman R, Barch DM, Luby JL, Whalen DJ. Developmental trajectories of anger and sadness dysregulation in childhood differentially predict later borderline symptoms. Dev Psychopathol 2023:1-16. [PMID: 37340976 PMCID: PMC10733555 DOI: 10.1017/s0954579423000627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
Difficulties with emotion regulation are integral to borderline personality disorder (BPD) and its hypothesized developmental pathway. Here, we prospectively assess trajectories of emotion processing across childhood, how BPD symptoms impact these trajectories, and whether developmental changes are transdiagnostic or specific to BPD, as major depressive (MDD) and conduct disorders (CD) are also characterized by emotion regulation difficulties. This study included 187 children enriched for those with early symptoms of depression and disruptive behaviors from a longitudinal study. We created multilevel models of multiple components of emotional processing from mean ages 9.05 to 18.55 years, and assessed the effect of late adolescent BPD, MDD, and CD symptoms on these trajectories. Linear trajectories of coping with sadness and anger, and quadratic trajectories of dysregulated expressions of sadness and anger were transdiagnostic, but also exhibited independent relationships with BPD symptoms. Only inhibition of sadness was related to BPD symptoms. The quadratic trajectories of poor emotional awareness and emotional reluctance were also independently related to BPD. Findings support examining separable components of emotion processing across development as potential precursors to BPD, underscoring the importance of understanding these trajectories as not only a marker of potential risk but also potential targets for prevention and intervention.
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Affiliation(s)
- Alecia C. Vogel
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Ben Geselowitz
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Rebecca Tillman
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Deanna M. Barch
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- Department of Psychological and Brain Sciences, Washington University in St. Louis. St. Louis, MO, USA
- Department of Radiology, Washington University in St. Louis. St. Louis, MO, USA
| | - Joan L. Luby
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Diana J. Whalen
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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Developmental predictors of young adult borderline personality disorder: a prospective, longitudinal study of females with and without childhood ADHD. BMC Psychiatry 2023; 23:106. [PMID: 36793031 PMCID: PMC9930262 DOI: 10.1186/s12888-023-04515-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 01/02/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Research on the precursors of borderline personality disorder (BPD) reveals numerous child and adolescent risk factors, with impulsivity and trauma among the most salient. Yet few prospective longitudinal studies have examined pathways to BPD, particularly with inclusion of multiple risk domains. METHODS We examined theory-informed predictors of young-adult BPD (a) diagnosis and (b) dimensional features from childhood and late adolescence via a diverse (47% non-white) sample of females with (n = 140) and without (n = 88) carefully diagnosed childhood attention-deficit hyperactivity disorder (ADHD). RESULTS After adjustment for key covariates, low levels of objectively measured executive functioning in childhood predicted young adult BPD diagnostic status, as did a cumulative history of childhood adverse experiences/trauma. Additionally, both childhood hyperactivity/impulsivity and childhood adverse experiences/trauma predicted young adult BPD dimensional features. Regarding late-adolescent predictors, no significant predictors emerged regarding BPD diagnosis, but internalizing and externalizing symptoms were each significant predictors of BPD dimensional features. Exploratory moderator analyses revealed that predictions to BPD dimensional features from low executive functioning were heightened in the presence of low socioeconomic status. CONCLUSIONS Given our sample size, caution is needed when drawing implications. Possible future directions include focus on preventive interventions in populations with enhanced risk for BPD, particularly those focused on improving executive functioning skills and reducing risk for trauma (and its manifestations). Replication is required, as are sensitive measures of early emotional invalidation and extensions to male samples.
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12
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Wright B, Fearon P, Garside M, Tsappis E, Amoah E, Glaser D, Allgar V, Minnis H, Woolgar M, Churchill R, McMillan D, Fonagy P, O’Sullivan A, McHale M. Routinely used interventions to improve attachment in infants and young children: a national survey and two systematic reviews. Health Technol Assess 2023; 27:1-226. [PMID: 36722615 PMCID: PMC9900465 DOI: 10.3310/ivcn8847] [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: 02/02/2023] Open
Abstract
BACKGROUND Attachment refers to an infant's innate tendency to seek comfort from their caregiver. Research shows that attachment is important in promoting healthy social and emotional development. Many parenting interventions have been developed to improve attachment outcomes for children. However, numerous interventions used in routine practice have a limited evidence base, meaning that we cannot be sure if they are helpful or harmful. OBJECTIVES This research aimed to conduct a large-scale survey to identify what interventions are being used in UK services to improve child attachment; conduct a systematic review to evaluate the evidence for parenting attachment interventions; and develop recommendations for future research and practice. DESIGN AND METHODS We worked closely with our Expert Reference Group to plan a large-scale survey focused on relevant UK services. We then conducted two systematic reviews. One searched for all randomised controlled trial evidence for any attachment parenting intervention. The second searched for all research for the top 10 routinely used interventions identified from the survey. RESULTS The survey collected 625 responses covering 734 UK services. The results identified the 10 most commonly used interventions. The responses showed a limited use of validated measures and a wide variety of definitions of attachment. For the first review, seven studies were included from 2516 identified records. These were combined with results from previous reviews conducted by the team. Meta-analyses showed that, overall, parenting interventions are effective in reducing disorganised attachment (pooled odds ratio 0.54, 95% confidence interval 0.39 to 0.77) and increasing secure attachment (pooled odds ratio 1.85, 95% confidence interval 1.36 to 2.52). The second review searched the literature for the top 10 routinely used interventions identified by the survey; 61 studies were included from 1198 identified records. The results showed that many of the most commonly used interventions in UK services have a weak evidence base and those with the strongest evidence base are not as widely used. CONCLUSIONS There is a need for better links between research and practice to ensure that interventions offered to families are safe and effective. Possible reasons for the disparity include the cost and accessibility of training. There is also a need for improved understanding by professionals regarding the meaning of attachment. LIMITATIONS Although the survey had good geographical spread, most respondents were based in England. For review 2 we were unable to access a large number of papers; however, we conducted extensive reference checking to account for this. FUTURE WORK There is a need for robust research to test the efficacy of routinely used attachment interventions. Research could also explore why routinely used interventions are not consistently subject to thorough evaluation; how to embed dissemination, cost-effectiveness, fidelity and sustainability into research; and how to keep clinical practice up to date with research developments. STUDY REGISTRATION This study is registered as PROSPERO CRD42019137362. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 2. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Barry Wright
- Hull York Medical School, University of York, York, UK
| | - Pasco Fearon
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Megan Garside
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Eleni Tsappis
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Elaine Amoah
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Danya Glaser
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Victoria Allgar
- Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Helen Minnis
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
| | | | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Yuan Y, Lee H, Eack SM, Newhill CE. A Systematic Review of the Association Between Early Childhood Trauma and Borderline Personality Disorder. J Pers Disord 2023; 37:16-35. [PMID: 36723424 DOI: 10.1521/pedi.2023.37.1.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Borderline personality disorder (BPD) is a debilitating clinical disorder associated with adverse impacts on multiple levels. While a high prevalence of childhood trauma has been noted, the ways such trauma impacts the development of BPD symptomatology remain unclear. In this systematic review, the authors examine the literature from 2000 to 2020, focusing on the association between trauma and BPD, and offer a comprehensive synthesis of possible etiological implications related to either one specific or multiple trauma types. In addition, results are analyzed based on commonly tested trauma parameters, including repeated exposure, polytrauma, onset, perpetrators, and gender. The authors also note some limitations in areas of sampling, measurement, causal inference methods, and data analyses. Results of this review point to several parameters of trauma that can be used to inform training for practitioners as well as enhance current interventions.
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Affiliation(s)
- Yan Yuan
- School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Hyunji Lee
- School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Shaun M Eack
- University of Pittsburgh, Pittsburgh, Pennsylvania
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Franssens R, Giletta M, Vanwoerden S, De Clercq B. Bullying Perpetration and Victimization as Social Mechanisms in the Development of Borderline Personality Traits during Adolescence: A Longitudinal Study. Psychopathology 2023; 56:102-108. [PMID: 35294946 DOI: 10.1159/000522343] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 01/27/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Borderline personality features are often associated with toxic social relationships and problematic peer functioning. Less is known, however, about the extent to which bullying experiences may shape the development and maintenance of borderline-related traits during crucial periods of rapid normative developments in impulse and emotion regulation skills. Given the core interpersonal character of borderline personality pathology (BPP), such research focus may be relevant to better understand possible causal social mechanisms in the development of personality difficulties within the borderline trait spectrum. METHOD The current longitudinal study examined whether experiences of both bullying perpetration and victimization in pre-adolescence mediated the developmental course of BPP traits between childhood and adolescence. To examine these associations, a sample of children (N = 242; 57% girls; Mage = 10.87 years) was recruited and followed up 1 and 4 years later. RESULTS Mediation analysis indicated that the prospective link between child and adolescent BPP trait vulnerability was shaped by pre-adolescent experiences of bullying victimization, but not by bullying perpetration. DISCUSSION These results indicate that the continuity between child and adolescent borderline trait features are partly explained by exposure to bullying victimization, indicating that the impact of environmental invalidation on BPP development also extends to the peer context.
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Affiliation(s)
- Raissa Franssens
- Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
| | - Matteo Giletta
- Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium.,Department of Developmental Psychology, Tilburg University, Tilburg, The Netherlands
| | - Salome Vanwoerden
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Barbara De Clercq
- Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
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15
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Skabeikyte-Norkiene G, Sharp C, Kulesz PA, Barkauskiene R. Personality pathology in adolescence: relationship quality with parents and peers as predictors of the level of personality functioning. Borderline Personal Disord Emot Dysregul 2022; 9:31. [PMID: 36258261 PMCID: PMC9579636 DOI: 10.1186/s40479-022-00202-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 10/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The dimensional approach to personality pathology opens up the possibility to investigate adolescence as a significant period for the development of personality pathology. Recent evidence suggests that symptoms of personality pathology may change during adolescence, but the negative consequences such as impaired social functioning persist later on in life. Thus, we think that problems in social functioning may further predict personality impairments. The current study aimed at investigating the role of relationship quality with parents and peers for the prediction of the level of personality functioning across adolescence. We hypothesized that 1) relationship quality with both parents and peers will significantly account for the level of personality functioning in adolescence and 2) the importance of relationship quality with peers for the relation to impairments in personality functioning will increase with age. METHODS A community sample consisting of 855 adolescents aged 11-18 (M = 14.44, SD = 1.60; 62.5% female) from different regions in Lithuania participated in this study. Self-report questionnaires included the Levels of Personality Functioning Questionnaire to investigate personality impairments and the Network of Relationships Questionnaire to assess the quality of dyadic relationships. RESULTS Discord in the parent, but not peer relationships, was related to a more severe level of personality functioning across adolescence. Lower levels of closeness with parents accounted for higher impairments in personality functioning. The importance of closeness with peers for the explanation of the level of personality functioning increased with age. CONCLUSIONS During the sensitive period for the development of a personality disorder, relationship quality with the closest adults and peers both remain important for the explanation of impairments in personality functioning.
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Affiliation(s)
- Gabriele Skabeikyte-Norkiene
- Institute of Psychology, Faculty of Philosophy, Vilnius University, Universiteto st. 9, 01513, Vilnius, Lithuania.
| | - Carla Sharp
- Department of Psychology, University of Houston, Houston, USA
| | - Paulina Anna Kulesz
- Texas Institute for Measurement, Evaluation, and Statistics (TIMES), University of Houston, Houston, USA
| | - Rasa Barkauskiene
- Institute of Psychology, Faculty of Philosophy, Vilnius University, Universiteto st. 9, 01513, Vilnius, Lithuania
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16
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Chanen AM, Sharp C, Nicol K, Kaess M. Early Intervention for Personality Disorder. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2022; 20:402-408. [PMID: 37200874 PMCID: PMC10187393 DOI: 10.1176/appi.focus.20220062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Both the DSM-5 Section III Alternative Model for Personality Disorders and the ICD-11 have introduced a genuinely developmental approach to personality disorder. Among young people with personality disorder, compelling evidence demonstrates a high burden of disease, substantial morbidity, and premature mortality, as well as response to treatment. Yet, early diagnosis and treatment for the disorder have struggled to emerge from its identity as a controversial diagnosis to a mainstream focus for mental health services. Key reasons for this include stigma and discrimination, lack of knowledge about and failure to identify personality disorder among young people, along with the belief that personality disorder must always be addressed through lengthy and specialized individual psychotherapy programs. In fact, evidence suggests that early intervention for personality disorder should be a focus for all mental health clinicians who see young people and is feasible by using widely available clinical skills.
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Affiliation(s)
- Andrew M Chanen
- Orygen, and Centre for Youth Mental Health, University of Melbourne, Melbourne (Chanen, Nicol); Department of Psychology, University of Houston, Houston (Sharp); University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland, and Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany (Kaess)
| | - Carla Sharp
- Orygen, and Centre for Youth Mental Health, University of Melbourne, Melbourne (Chanen, Nicol); Department of Psychology, University of Houston, Houston (Sharp); University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland, and Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany (Kaess)
| | - Katie Nicol
- Orygen, and Centre for Youth Mental Health, University of Melbourne, Melbourne (Chanen, Nicol); Department of Psychology, University of Houston, Houston (Sharp); University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland, and Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany (Kaess)
| | - Michael Kaess
- Orygen, and Centre for Youth Mental Health, University of Melbourne, Melbourne (Chanen, Nicol); Department of Psychology, University of Houston, Houston (Sharp); University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland, and Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany (Kaess)
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17
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Herzog P, Kube T, Fassbinder E. How childhood maltreatment alters perception and cognition - the predictive processing account of borderline personality disorder. Psychol Med 2022; 52:2899-2916. [PMID: 35979924 PMCID: PMC9693729 DOI: 10.1017/s0033291722002458] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/24/2022] [Accepted: 07/18/2022] [Indexed: 01/05/2023]
Abstract
Borderline personality disorder (BPD) is a severe mental disorder, comprised of heterogeneous psychological and neurobiological pathologies. Here, we propose a predictive processing (PP) account of BPD to integrate these seemingly unrelated pathologies. In particular, we argue that the experience of childhood maltreatment, which is highly prevalent in BPD, leaves a developmental legacy with two facets: first, a coarse-grained, alexithymic model of self and others - leading to a rigidity and inflexibility concerning beliefs about self and others. Second, this developmental legacy leads to a loss of confidence or precision afforded beliefs about the consequences of social behavior. This results in an over reliance on sensory evidence and social feedback, with concomitant lability, impulsivity and hypersensitivity. In terms of PP, people with BPD show a distorted belief updating in response to new information with two opposing manifestations: rapid changes in beliefs and a lack of belief updating despite disconfirmatory evidence. This account of distorted information processing has the potential to explain both the instability (of affect, self-image, and interpersonal relationships) and the rigidity (of beliefs about self and others) which is typical of BPD. At the neurobiological level, we propose that enhanced levels of dopamine are associated with the increased integration of negative social feedback, and we also discuss the hypothesis of an impaired inhibitory control of the prefrontal cortex in the processing of negative social information. Our account may provide a new understanding not only of the clinical aspects of BPD, but also a unifying theory of the corresponding neurobiological pathologies. We conclude by outlining some directions for future research on the behavioral, neurobiological, and computational underpinnings of this model, and point to some clinical implications of it.
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Affiliation(s)
- Philipp Herzog
- Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, D-23562 Lübeck, Germany
- Department of Psychiatry and Psychotherapy, Christian-Albrechts-University of Kiel, Niemannsweg 147, D-24105 Kiel, Germany
- Department of Psychology, University of Koblenz-Landau, Ostbahnstr. 10, 76829 Landau, Germany
| | - Tobias Kube
- Department of Psychology, University of Koblenz-Landau, Ostbahnstr. 10, 76829 Landau, Germany
| | - Eva Fassbinder
- Department of Psychiatry and Psychotherapy, Christian-Albrechts-University of Kiel, Niemannsweg 147, D-24105 Kiel, Germany
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18
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Carreiras D, Cunha M, Castilho P. Trajectories of borderline features in adolescents: A three-wave longitudinal study testing the effect of gender and self-disgust over 12 months. PERSONALITY AND INDIVIDUAL DIFFERENCES 2022. [DOI: 10.1016/j.paid.2022.111577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Back SN, Schmitz M, Koenig J, Zettl M, Kleindienst N, Herpertz SC, Bertsch K. Reduced vagal activity in borderline personality disorder is unaffected by intranasal oxytocin administration, but predicted by the interaction between childhood trauma and attachment insecurity. J Neural Transm (Vienna) 2022; 129:409-419. [PMID: 35275249 PMCID: PMC9007810 DOI: 10.1007/s00702-022-02482-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 02/22/2022] [Indexed: 12/31/2022]
Abstract
Individuals with borderline personality disorder (BPD) show self-regulatory deficits, associated with reduced heart-rate variability (HRV). However, results on reduced HRV in BPD remain heterogeneous, thus encouraging the search for developmental constructs explaining this heterogeneity. The present study first examined predictors of reduced resting-state HRV in BPD, namely the interaction between self-reported adult attachment insecurity and childhood trauma. Second, we investigated if alterations in resting-state HRV are modified by intranasal oxytocin administration, as oxytocin may enhance HRV and is implicated in the interaction between childhood trauma and disturbed attachment for the pathogenesis of BPD. In a randomized, placebo-controlled trial, 53 unmedicated women with BPD and 60 healthy controls (HC) self-administered either 24 I.U. of oxytocin or placebo and underwent a 4-min electrocardiogram. Our results replicate significantly reduced HRV in women with BPD, explained up to 16% by variations in childhood trauma and attachment insecurity. At high levels of acute attachment insecurity, higher levels of childhood trauma significantly predicted reduced HRV in BPD. However, our results do not support a significant effect of oxytocin on mean HRV, and no interaction effect emerged including childhood trauma and attachment insecurity. Our findings highlight a complex interaction between reduced vagal activity and developmental factors in BPD.
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Affiliation(s)
- Sarah N Back
- Department of Psychology, Ludwig-Maximilians-University Munich, Leopoldstraße 13, 80802, Munich, Germany.
| | - Marius Schmitz
- Department of Psychology, Ludwig-Maximilians-University Munich, Leopoldstraße 13, 80802, Munich, Germany
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Julian Koenig
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Max Zettl
- Institute of Psychosocial Prevention, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Nikolaus Kleindienst
- Medical Faculty Mannheim, Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Katja Bertsch
- Department of Psychology, Ludwig-Maximilians-University Munich, Leopoldstraße 13, 80802, Munich, Germany
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
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20
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Armour JA, Joussemet M, Mageau GA, Varin R. Perceived Parenting and Borderline Personality Features during Adolescence. Child Psychiatry Hum Dev 2022:10.1007/s10578-021-01295-3. [PMID: 35013846 DOI: 10.1007/s10578-021-01295-3] [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] [Accepted: 11/28/2021] [Indexed: 11/27/2022]
Abstract
This study investigates the associations between perceived parenting and borderline personality disorder (BPD) in adolescents. The relations between components of parenting and BPD features were explored. Participants (N = 270; mean age = 15.3) assessed their own BPD features (Personality Assessment Inventory) and both of their parents' parenting practices (Parents as Social Context Questionnaire; Perceived Parental Autonomy Support Scale). SEM results suggest that controlling, rejecting and chaotic parenting all predicted global BPD, and all these parenting components were significantly associated with at least one BPD feature. Chaotic parenting, a relatively neglected construct in the BPD literature, seems to play an important role in early BPD.
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Affiliation(s)
- Jessie-Ann Armour
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Mireille Joussemet
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada.
| | - Geneviève A Mageau
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Rose Varin
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada
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21
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Novakov I, Kuruzović N. The relationship between attachment styles, psychopathology and quality of social interaction: A study on a clinical sample. PSIHOLOSKA ISTRAZIVANJA 2022. [DOI: 10.5937/psistra25-36956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The aim of this study is to examine the differences between four attachment styles in relation to symptoms of psychopathology and the quality of social interaction, as well as to determine the role of attachment and psychopathology in predicting positive and negative social exchange. A total of 57 participants from the neuropsychiatric department of the Service for Specialist-Consultative Health Activities of the Health Centre in Novi Sad took part in the research. Respondents were mostly female (61%), aged 17 to 68 (M=40.13, SD=12.35). The Relationship Questionnaire (RQ) was used for attachment styles assessment. Psychopathological symptoms were measured using the Cornell Index (CI-N4), and the quality of social relationships was evaluated via the Network of Relationship Inventory (NRI). The highest rate of symptoms was detected in subjects with a preoccupied style, followed by those whose style was identified as fearful. The same two styles showed the least positive social exchange. Statistically significant differences on most scales from CI-N4 were found mainly between the secure and preoccupied subjects, while subjects with the avoidant pattern did not demonstrate significant differences in psychopathology and social functioning compared to secure participants. Secure affective attachment and low aggressive-antisocial indicators (impulsiveness, aggression, and paranoia) were the most important predictors of positive social exchange. Understanding psychopathological manifestations of different insecure attachment styles can contribute to the efficiency of psychodiagnostic and psychotherapeutic processes. Furthermore, the fact that insecure attachment and aggressive-antisocial factor predominantly compromise positive social interaction can facilitate goal setting during psychological treatment within the clinical spectrum.
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22
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Fischer-Kern M, Tmej A, Naderer A, Zimmermann J, Nolte T. Failure to resolve loss and compromised mentalizing in female inpatients with major depressive disorder. Attach Hum Dev 2021; 24:503-524. [PMID: 34952561 DOI: 10.1080/14616734.2021.2015794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Attachment and mentalizing are central concepts in research on the etiology, course, and treatment of depression. The goal of this cross-sectional study was to clarify the unique value of these constructs in characterizing the presence, severity, and chronicity of depression. We examined 50 female inpatients suffering from Major Depressive Disorder (MDD) in comparison to 47 matched healthy controls regarding their attachment states of mind, mentalizing capacities, and clinical variables indicating depression severity and chronicity (e.g. illness duration, number of hospitalizations). In the group of depressed patients, unresolved attachment with regard to loss was significantly overrepresented. Dimensionally, patients were more disorganized and more insecure, whereas there was no difference on the dismissing-preoccupied dimension between the two groups. Mentalizing was significantly lower in patients than in healthy controls. Logistic regression analysis revealed attachment insecurity, mentalizing deficits, and unresolved loss to be incrementally relevant to predict MDD. Correlations with clinical parameters in the group of depressed patients showed positive associations between mentalizing deficits, attachment insecurity, and variables indicating illness chronicity. Our findings highlight the relevance of the inability to resolve or reappraise loss experiences in depressive states.
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Affiliation(s)
- Melitta Fischer-Kern
- Department of Psychoanalysis and Psychotherapy, Medical University Vienna, Vienna, Austria
| | - Anna Tmej
- Department of Psychoanalysis and Psychotherapy, Medical University Vienna, Vienna, Austria
| | - Andrea Naderer
- Department of Psychoanalysis and Psychotherapy, Medical University Vienna, Vienna, Austria
| | | | - Tobias Nolte
- University College London, Welcome Centre for Human Neuroimaging, Institute of Neurology, London, UK.,Anna Freud National Centre for Children and Families, UK
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Cruciani G, Boccia M, Lingiardi V, Giovanardi G, Zingaretti P, Spitoni GF. An Exploratory Study on Resting-State Functional Connectivity in Individuals with Disorganized Attachment: Evidence for Key Regions in Amygdala and Hippocampus. Brain Sci 2021; 11:brainsci11111539. [PMID: 34827538 PMCID: PMC8615787 DOI: 10.3390/brainsci11111539] [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: 09/30/2021] [Revised: 11/08/2021] [Accepted: 11/17/2021] [Indexed: 02/02/2023] Open
Abstract
Studies comparing organized (O) and unresolved/disorganized (UD) attachment have consistently shown structural and functional brain abnormalities, although whether and how attachment patterns may affect resting state functional connectivity (RSFC) is still little characterized. Here, we investigated RSFC of temporal and limbic regions of interest for UD attachment. Participants’ attachment was classified via the Adult Attachment Interview, and all participants underwent clinical assessment. Functional magnetic resonance imaging data were collected from 11 UD individuals and seven matched O participants during rest. A seed-to-voxel analysis was performed, including the anterior and the posterior cingulate cortex, the bilateral insula, amygdala and hippocampus as seed regions. No group differences in the clinical scales emerged. Compared to O, the UD group showed lower RSFC between the left amygdala and the left cerebellum (lobules VIII), and lower functional coupling between the right hippocampus and the posterior portion of the right middle temporal gyrus. Moreover, UD participants showed higher RSFC between the right amygdala and the anterior cingulate cortex. Our findings suggest RSFC alterations in regions associated with encoding of salient events, emotion processing, memories retrieval and self-referential processing in UD participants, highlighting the potential role of attachment experiences in shaping brain abnormalities also in non-clinical UD individuals.
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Affiliation(s)
- Gianluca Cruciani
- Department of Psychology, Ph.D. Program in Behavioral Neuroscience, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy
- Correspondence: ; Tel.: +39-(0)6-49917711
| | - Maddalena Boccia
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy;
- Cognitive and Motor Rehabilitation and Neuroimaging Unit, Santa Lucia Foundation (IRCCS Fondazione Santa Lucia), 00179 Rome, Italy;
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Via degli Apuli 1, 00185 Rome, Italy; (V.L.); (G.G.)
| | - Guido Giovanardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Via degli Apuli 1, 00185 Rome, Italy; (V.L.); (G.G.)
| | - Pietro Zingaretti
- Villa von Siebenthal Neuropsychiatric Clinic and Hospital, Genzano di Roma, 00045 Rome, Italy;
| | - Grazia Fernanda Spitoni
- Cognitive and Motor Rehabilitation and Neuroimaging Unit, Santa Lucia Foundation (IRCCS Fondazione Santa Lucia), 00179 Rome, Italy;
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Via degli Apuli 1, 00185 Rome, Italy; (V.L.); (G.G.)
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Borderline Personality Disorder: Risk Factors and Early Detection. Diagnostics (Basel) 2021; 11:diagnostics11112142. [PMID: 34829488 PMCID: PMC8620075 DOI: 10.3390/diagnostics11112142] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 12/13/2022] Open
Abstract
Personality disorders (PDs) exert a great toll on health resources, and this is especially true for borderline personality disorder (BPD). As all PDs, BPD arises during adolescence or young adulthood. It is therefore important to detect the presence of this PD in its earlier stages in order to initiate appropriate treatment, thus ameliorating the prognosis of this condition. This review aims to highlight the issues associated with BPD diagnosis in order to promote its early detection and treatment. To do so, we conducted a search on PubMed database of current evidence regarding BPD early diagnosis, focusing on risk factors, which represent important conditions to assess during young patient evaluation, and on diagnostic tools that can help the clinician in the assessment process. Our findings show how several risk factors, both environmental and genetic/neurobiological, can contribute to the onset of BPD and help identify at-risk patients who need careful monitoring. They also highlight the importance of a careful clinical evaluation aided by psychometric tests. Overall, the evidence gathered confirms the complexity of BDP early detection and its crucial importance for the outcome of this condition.
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Bohus M, Stoffers-Winterling J, Sharp C, Krause-Utz A, Schmahl C, Lieb K. Borderline personality disorder. Lancet 2021; 398:1528-1540. [PMID: 34688371 DOI: 10.1016/s0140-6736(21)00476-1] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/18/2021] [Accepted: 02/18/2021] [Indexed: 12/15/2022]
Abstract
Borderline personality disorder (BPD) is a mental disorder with a high burden on patients, family members, and health-care systems. The condition was previously regarded as untreatable, but progress in understanding and management has resulted in earlier diagnosis and better treatment outcomes. A coherent syndrome of BPD typically onsets during adolescence (after age 12 years). BPD is often preceded by or co-develops with symptoms of internalising disorders (depression and anxiety), externalising disorders (conduct problems, hyperactivity, and substance use), or both. BPD is associated with various poor outcomes, including low occupational and educational attainment, lack of long-term relationships, increased partner conflict, sexual risk-taking, low levels of social support, low life satisfaction, and increased service use. Psychotherapy is the main treatment for BPD; drug treatment is only indicated for comorbid conditions that require medication, or during a crisis if psychosocial interventions are insufficient. Awareness of BPD by non-specialists, as well as specialists, is key to appropriate early intervention.
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Affiliation(s)
- Martin Bohus
- Institute for Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Harvard Medical School, Boston, MA, USA
| | - Jutta Stoffers-Winterling
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany; Leibniz Institute for Resilience Research, Mainz, Germany
| | - Carla Sharp
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Annegret Krause-Utz
- Department of Clinical Psychology, Leiden University, Leiden Institute of Brain and Cognition, Leiden, Netherlands
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Klaus Lieb
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany; Leibniz Institute for Resilience Research, Mainz, Germany.
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26
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Izett E, Rooney R, Prescott SL, De Palma M, McDevitt M. Prevention of Mental Health Difficulties for Children Aged 0-3 Years: A Review. Front Psychol 2021; 11:500361. [PMID: 34777074 PMCID: PMC8579481 DOI: 10.3389/fpsyg.2020.500361] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 09/24/2020] [Indexed: 12/05/2022] Open
Abstract
The period of infancy and early childhood is a critical time for interventions to prevent future mental health problems. The first signs of mental health difficulties can be manifest in infancy, emphasizing the importance of understanding and identifying both protective and risk factors in pregnancy and the early postnatal period. Parents are at a higher risk of developing mental health problems during the perinatal period. An understanding of the evidence around prevention and intervention for parental anxiety and depression is vital to the process of prevention of early mental health disorders in infants and young children. Here we review the existing prevention and treatment interventions in the early years focusing on the period from conception to 3 years - the majority targeting parents in order to improve their mental health, and that of their infants. Elements of successful programs for parents include psychoeducation and practical skills training, as well as work on the co-parenting relationship, developing secure attachment, and enhancing parental reflective functioning. While both targeted and universal programs have produced strong effect sizes, universal programs have the added benefit of reaching people who may otherwise not have sought treatment. In synthesizing this information, our goal is to inform the development of integrated models for prevention and novel early intervention programs as early in life as possible.
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Affiliation(s)
- Elizabeth Izett
- School of Psychology, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Rosanna Rooney
- School of Psychology, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Susan L. Prescott
- The ORIGINS Project, Telethon Kids Institute and the Division of Paediatrics, School of Medicine, University of Western Australia, Nedlands, WA, Australia
| | - Mia De Palma
- School of Psychology, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Maryanne McDevitt
- School of Psychology, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
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27
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Fortunato A, Tanzilli A, Lingiardi V, Speranza AM. Childhood Personality Assessment Q-Sort (CPAP-Q): A Clinically and Empirically Procedure for Assessing Traits and Emerging Patterns of Personality in Childhood. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6288. [PMID: 34200700 PMCID: PMC8296064 DOI: 10.3390/ijerph18126288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/04/2021] [Accepted: 06/08/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Despite increasing research confirming the existence of childhood personalities, which are recognizable from a developmental perspective, controversies over the possibility to assess personality in childhood have continued. The purpose of this study was to provide initial data on the validation of the Childhood Personality Assessment Q-Sort (CPAP-Q), a clinician report instrument that can be employed to evaluate children's personalities and address the gap in the field of emerging personality in children classification. METHOD A sample of 135 clinicians completed the CPAP-Q to assess the personality features of 135 children (ages 4-11) who had been in their care between two and 12 months. The clinicians completed a clinical questionnaire to collect information on them, the children, and their families, as well as the Child Behavior Checklist (CBCL), to evaluate the children's behavioral problems and social competencies. RESULTS Q-factor analysis identified seven specific emerging personality patterns: psychological health, borderline/impulsive, borderline/dysregulated, schizoid, inhibited/self-critical, obsessive, and dysphoric/dependent. These patterns revealed good levels of validity and reliability. CONCLUSIONS These findings are preliminary, but seem to support the possibility of evaluating emerging personality patterns in childhood and their developmental pathways that may lead to personality disorders in adolescence and adulthood. The CPAP-Q promises to significantly contribute to less explored research areas and encourage systematic studies of children assessment, promoting best practices for individualized diagnoses.
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Affiliation(s)
- Alexandro Fortunato
- Department of Dynamic and Clinical Psychology, and Health Studies, “Sapienza”, University of Rome, Via Degli Apuli, 1, 00185 Rome, Italy; (A.T.); (V.L.); (A.M.S.)
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28
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Simonsen E, Vestergaard M, Storeb OJ, Bo S, J Rgensen MS. Prediction of Treatment Outcome of Adolescents With Borderline Personality Disorder: A 2-Year Follow-Up Study. J Pers Disord 2021; 35:111-130. [PMID: 33999658 DOI: 10.1521/pedi_2021_35_524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study examined prediction of various clinical outcomes in adolescents with borderline personality disorder (BPD) features. Of the 112 adolescents who participated at baseline, 97 were seen at 2-year follow-up, of which 49 (50.5%) had clinically improved, defined as a decrease in BPD pathology of minimum 12 points on the Borderline Personality Features Scale for Children (BPFS-C). Eighty-one adolescents fulfilled the diagnostic criteria for BPD and scored above clinical cutoff on the BPFS-C at baseline, of which 26 (32%) had remitted at follow-up by self-report on the BPFS-C. Results showed that adolescents with comorbid oppositional defiant disorder at baseline were less likely to have clinically improved or remitted at follow-up. Participants with increased self-reported depression and less exposure to physical abuse at baseline had increased odds of remission. Our findings suggest that more internalizing and less externalizing symptoms increase the odds of positive treatment outcome in adolescents with BPD.
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Affiliation(s)
- Erik Simonsen
- Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Martin Vestergaard
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark.,Department of Child and Adolescent Psychiatry, Psychiatry Region Zealand, Roskilde, Denmark
| | - Ole Jakob Storeb
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark.,Department of Child and Adolescent Psychiatry, Psychiatry Region Zealand, Roskilde, Denmark.,Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Sune Bo
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark.,Department of Child and Adolescent Psychiatry, Psychiatry Region Zealand, Roskilde, Denmark
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29
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Robin M, Douniol M, Pham-Scottez A, Gicquel L, Delvenne V, Nezelof S, Speranza M, Falissard B, Silva J, Corcos M. Specific Pathways From Adverse Experiences to BPD in Adolescence: A Criteria-Based Approach of Trauma. J Pers Disord 2021; 35:94-110. [PMID: 33999657 DOI: 10.1521/pedi_2021_35_523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Within the European Research Network on BPD (EURNET-BPD; n = 85 BPD adolescents, n = 84 healthy controls, aged 13-19), this study explored the combination of three types of adversity-maltreatment, stressful life events (early separation from parents, parental suicide attempt, parental chronic disease) and parental bonding-as predictors of BPD, on a criteria-based approach. Results indicated that cumulative traumatic experiences largely characterize borderline adolescent's history; and, in the multivariate regression models, all adversity experiences were likely to contribute to BPD symptoms. The role of emotional abuse, parental suicide attempt, and a decrease in paternal level of care were particularly prominent. Moreover, adversities combinations were different for each criterion, suggesting that specific sets of traumatic experiences are leading to BPD. These findings argue for a further criteria-based exploration of trauma in borderline patients, as well as a more accurate and efficient prevention.
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Affiliation(s)
- Marion Robin
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France.,Paris Descartes University, Paris, France
| | - Marie Douniol
- Medical Psychological Center, Odysseum, EPS Erasme, Sceaux, France
| | | | - Ludovic Gicquel
- Henri Laborit Hospital Center, Poitiers, URC, University of Poitiers, France
| | - Veronique Delvenne
- Queen Fabiola Children's University Hospital, Brussels, Free University of Brussels, Belgium
| | - Sylvie Nezelof
- Department of Child and Adolescent Psychiatry, Besançon University Hospital, Franche Comte University, Besançon, France
| | - Mario Speranza
- Versailles General Hospital, Le Chesnay, France.,Paris-Saclay University, UVSQ, CESP, INSERM U1178, Team PsyDev, Paris, France
| | - Bruno Falissard
- Paris-Saclay University, UVSQ, CESP, INSERM U1178, Team PsyDev, Paris, France.,INSERMU 669, Paris, France
| | - Jerôme Silva
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
| | - Maurice Corcos
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France.,Paris Descartes University, Paris, France
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30
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Katz C, Priolo Filho SR, Korbin J, Bérubé A, Fouché A, Haffejee S, Kaawa-Mafigiri D, Maguire-Jack K, Muñoz P, Spilsbury J, Tarabulsy G, Tiwari A, Thembekile Levine D, Truter E, Varela N. Child maltreatment in the time of the COVID-19 pandemic: A proposed global framework on research, policy and practice. CHILD ABUSE & NEGLECT 2021; 116:104824. [PMID: 33353782 PMCID: PMC7679113 DOI: 10.1016/j.chiabu.2020.104824] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 05/21/2023]
Abstract
BACKGROUND Child protection is and will be drastically impacted by the COVID-19 pandemic. Comprehending this new reality and identifying research, practice and policy paths are urgent needs. OBJECTIVE The current paper aims to suggest a framework for risk and protective factors that need to be considered in child protection in its various domains of research, policy, and practice during and after the COVID-19 pandemic. STRATEGY From an international collaboration involving researchers and child protection professionals from eight countries, the current paper examines various factors that were identified as playing an important role in the child protection system. THE INITIAL SUGGESTED FRAMEWORK Through the use of an ecological framework, the current paper points to risk and protective factors that need further exploration. Key conclusions point to the urgent need to address the protection of children in this time of a worldwide pandemic. Discussion of risk and protective factors is significantly influenced by the societal context of various countries, which emphasizes the importance of international collaboration in protecting children, especially in the time of a worldwide pandemic. CONCLUSION The COVID-19 pandemic has stressed the urgent need to advance both theory and practice in order to ensure children's rights to safety and security during any pandemic. The suggested framework has the potential to advance these efforts so that children will be better protected from maltreatment amidst a pandemic in the future.
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Affiliation(s)
- Carmit Katz
- Bob Shapell School of Social Work, Tel-Aviv University, Israel.
| | | | - Jill Korbin
- Department of Anthropology, Case Western Reserve University, Cleveland, OH, USA.
| | - Annie Bérubé
- Department of Psychology and Psychoeducation, University of Quebec in Outaouais, Quebec, Canada.
| | - Ansie Fouché
- School of Psychosocial Health, North-West University, Optentia, South Africa.
| | - Sadiyya Haffejee
- Centre for Social Development in Africa, University of Johannesburg, South Africa.
| | | | | | - Pablo Muñoz
- Departamento de Psicología, Universidad Nacional de Colombia, Colombia.
| | | | - George Tarabulsy
- Director of the University Center for Research on Youth and Families in Quebec City, Canada.
| | - Ashwini Tiwari
- Institute of Public and Preventive Health, Augusta University, GA, USA.
| | | | - Elmien Truter
- North-West University Vanderbijlpark Campus, South Africa.
| | - Natalia Varela
- Facultad Ciencias Sociales y Humanas, Universidad Externado de Colombia, Colombia.
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31
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Franssens R, Abrahams L, Brenning K, Van Leeuwen K, De Clercq B. Unraveling Prospective Reciprocal Effects between Parental Invalidation and Pre-Adolescents' Borderline Traits: Between- and Within-Family Associations and Differences with Common Psychopathology-Parenting Transactions. Res Child Adolesc Psychopathol 2021; 49:1387-1401. [PMID: 34021460 DOI: 10.1007/s10802-021-00825-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2021] [Indexed: 11/29/2022]
Abstract
The etiology of borderline personality pathology has consistently been framed as an interactional process between child vulnerability (i.e. emotional sensitivity and reactivity; Linehan, 1993) and invalidating parenting strategies, which evolves into increased emotion dysregulation and disinhibited behavior of the child and in turn activates more parental invalidation. Despite the strong theoretical base in support of these high-risk parent-child transactions, invalidating parenting behaviors have mostly been explored as a cause of child dysregulation and disinhibition, rather than as a result of child-driven effects. Also, most transactional research in this regard focused at differences between families, thereby not addressing potential changes within families across time. The current study therefore examines bidirectional between- and within-family effects of childhood borderline-related traits and maternal invalidation in the sensitive developmental phase of pre-adolescence (n = 574; 54.4% girls) along three assessment points. Cross-Lagged Panel Models and Random-Intercept Cross-Lagged Panel Models indicated detrimental parenting effects of invalidation on subsequent development in borderline-related traits of the child both between and within families, and additional child-driven effects for subsequent invalidating parenting strategies within families. Beyond these transactions between borderline-related traits and parenting, the current study also indicates significant differences in the direction of effects when exploring transactions between more common dimensions of child internalizing/externalizing symptomatology and parental invalidation, suggesting a more substantial parenting etiology in the developmental process of borderline traits throughout pre-adolescence. Future longitudinal research may explore to what extent the transactional nature of borderline personality traits during important developmental stages indeed holds unique aspects compared to more common manifestations of symptomatology at young age.
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Affiliation(s)
- Raissa Franssens
- Department of Developmental, Personality and Social Psychology, Ghent University. H, Dunantlaan 2, B-9000, Gent, Belgium.
| | - Loes Abrahams
- Department of Developmental, Personality and Social Psychology, Ghent University. H, Dunantlaan 2, B-9000, Gent, Belgium
| | - Katrijn Brenning
- Department of Developmental, Personality and Social Psychology, Ghent University. H, Dunantlaan 2, B-9000, Gent, Belgium
| | | | - Barbara De Clercq
- Department of Developmental, Personality and Social Psychology, Ghent University. H, Dunantlaan 2, B-9000, Gent, Belgium
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32
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Geselowitz B, Whalen DJ, Tillman R, Barch DM, Luby JL, Vogel A. Preschool Age Predictors of Adolescent Borderline Personality Symptoms. J Am Acad Child Adolesc Psychiatry 2021; 60:612-622. [PMID: 32950651 PMCID: PMC8056867 DOI: 10.1016/j.jaac.2020.07.908] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 06/08/2020] [Accepted: 08/27/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Developmental models of borderline personality disorder (BPD) have highlighted the interplay of psychological variables (ie, impulsivity and emotional reactivity) with social risk factors, including invalidating parenting and childhood trauma. Prospective longitudinal studies have demonstrated the association of BPD with social, familial, and psychological antecedents. However, to date, few of these studies have studied the interaction of multiple risk domains and their potential manifestations in the preschool period. METHOD Participants were 170 children enrolled in a prospective longitudinal study of early childhood depression. Participants completed a baseline assessment between ages 3 and 6 years. Psychopathology, suicidality, and self-harm were assessed using a semistructured age-appropriate psychiatric interview before age 8 and self-report after age 8. BPD symptoms were assessed between ages 14 and 19 by self-report. Adverse childhood experiences (ACEs) and peer relationships were reported by parents. Maternal support was assessed using an observational measure between ages 3 and 6. RESULTS Preschool ACEs accounted for 14.9% of adolescent BPD symptom variance in a regression analysis. Controlling for gender and preschool ACEs, preschool and school-age externalizing symptoms, preschool internalizing symptoms, and low maternal support were significant predictors of BPD symptoms in multivariate analyses. Preschool and school-age suicidality composite scores significantly predicted BPD symptoms. CONCLUSION These findings suggest that preschool factors may be early predictors of BPD symptoms. Findings demonstrate that preschoolers with internalizing and externalizing psychopathology, high ACEs, and early suicidality are at greater risk of developing BPD symptoms. However, further research is needed to guide key factors for targeted early intervention.
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Affiliation(s)
- Ben Geselowitz
- Washington University School of Medicine, St. Louis, Missouri
| | - Diana J Whalen
- Washington University School of Medicine, St. Louis, Missouri
| | - Rebecca Tillman
- Washington University School of Medicine, St. Louis, Missouri
| | - Deanna M Barch
- Washington University School of Medicine, St. Louis, Missouri
| | - Joan L Luby
- Washington University School of Medicine, St. Louis, Missouri
| | - Alecia Vogel
- Washington University School of Medicine, St. Louis, Missouri.
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33
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Borderline Personality Disorder and the Boundaries of Virtue. NEUROETHICS-NETH 2021. [DOI: 10.1007/s12152-021-09467-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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34
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Haltigan JD, Del Giudice M, Khorsand S. Growing points in attachment disorganization: looking back to advance forward. Attach Hum Dev 2021; 23:438-454. [PMID: 33890555 DOI: 10.1080/14616734.2021.1918454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
In this special issue paper we reflect on the next generation of attachment research with a focus on disorganization, a central but still poorly understood topic in this area. We suggest that progress will be facilitated by a return to attachment theory's evolutionary roots, and to the emphasis on biological function that inspired Bowlby's original thinking. Increased interdisciplinary cross-fertilization and collaborations would enable novel and generative research on some of the long-standing questions surrounding attachment disorganization. Accordingly, we present an agenda for future research that encompasses contributions of modern ethology and neurobiology, novel hypotheses based on the concept of adaptive decanalization, connections with neurodevelopmental vulnerability and risk for mental disorders such as schizophrenia, and the possibility of sex differences in the behavioral manifestations of attachment disorganization. We believe that these avenues of theory and research offer exciting potential for innovative work in attachment disorganization in the years ahead.
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Affiliation(s)
- John D Haltigan
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Marco Del Giudice
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Soha Khorsand
- Faculty of Science, Western University, London, Canada
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35
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Yang JH, Rhee SJ, Park CHK, Kim MJ, Shin D, Lee JW, Kim J, Kim H, Lee HJ, Ha K, Ahn YM. Self-Transcendence Mediates the Relationship between Early Trauma and Fatal Methods of Suicide Attempts. J Korean Med Sci 2021; 36:e39. [PMID: 33527782 PMCID: PMC7850863 DOI: 10.3346/jkms.2021.36.e39] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/22/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Early trauma is known to be a risk factor of suicide-related behavior. On the other hand, people who attempt suicide using a fatal method are reported to be more likely to complete suicide. In this study, we assumed that early trauma affects an individual's temperament and character and thereby increases the risk of a fatal method of suicide attempts. METHODS We analyzed 92 people with a history of previous suicide attempts. We compared the Temperament and Character Inventory-Revised scores between the groups with and without early trauma, and between the groups with and without a history of suicide attempt using fatal methods through an analysis of covariance with age, sex, and presence of a psychiatric history as covariates. A mediation analysis was conducted of the relationship between early trauma and fatal methods of suicide attempt with self-transcendence as a mediator. RESULTS Higher self-transcendence was reported in the fatal group (27.71 ± 13.78 vs. 20.97 ± 12.27, P = 0.010) and the early trauma group (28.05 ± 14.30 vs. 19.43 ± 10.73, P = 0.001), respectively. The mediation model showed that self-transcendence mediates the relationship between early trauma and fatal methods of suicide attempt. The 95% confidence intervals for the direct and indirect effect were (-0.559, 1.390) and (0.026, 0.947), respectively. CONCLUSION Self-transcendence may mediate the relationship between early trauma and fatal methods of suicide attempt. Self-transcendence may be associated with unhealthy defenses and suicidal behavior for self-punishment and may constitute a marker of higher suicide risk.
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Affiliation(s)
- Jeong Hun Yang
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Jin Rhee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
| | | | - Min Ji Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | - Daun Shin
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Won Lee
- Department of Psychiatry, Seoul Metropolitan Eunpyeong Hospital, Seoul, Korea
| | - Junghyun Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
| | - Hyeyoung Kim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
- Department of Psychiatry, Inha University Hospital, Incheon, Korea
| | - Hyun Jeong Lee
- Department of Psychiatry and Behavioral Science, National Cancer Center, Goyang, Korea
- Division of Cancer Control & Policy, National Cancer Center, Goyang, Korea
| | - Kyooseob Ha
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
- Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Yong Min Ahn
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
- Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul, Korea.
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36
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Lyons-Ruth K, Brumariu LE. Emerging child competencies and personality pathology: toward a Developmental Cascade model of BPD. Curr Opin Psychol 2021. [PMID: 32818836 DOI: 10.1016/j.co-psyc.2020.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The guiding principle of this synthesis is to organize research on predictors of BPD features within a developmentally specific framework (e.g. infancy, preschool, middle childhood, adolescence). In addition, studies are prioritized that have longitudinal and observational components. On the basis of current literature, a Developmental Cascade Model of BPD is offered in which specific difficulties during one developmental period contribute to specific difficulties in a succeeding period, resulting in increasingly broad areas of dysregulation over time. Furthermore, to address specificity, we contrast trajectories toward BPD with trajectories toward antisocial behavior, noting shared and divergent predictors. The review highlights the importance of locating research findings in relation to the competencies and challenges of particular developmental periods when modelling developmental trajectories toward BPD.
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Affiliation(s)
- Karlen Lyons-Ruth
- Department of Psychiatry, Harvard Medical School, Cambridge Hospital, 1493 Cambridge St., Cambridge, MA 02139, United States.
| | - Laura E Brumariu
- Gordon F. Derner School of Psychology, Adelphi University, 158 Cambridge Ave., Garden City, NY 11530, United States
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37
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Robin M, Belbèze J, Pham-Scottez A, Shadili G, Peres V, Silva J, Corcos M, Speranza M. Paradoxes in Borderline Emotional Dysregulation in Adolescence: Influence of Parenting, Stressful Life Events, and Attachment. Front Psychiatry 2021; 12:735615. [PMID: 34744826 PMCID: PMC8566741 DOI: 10.3389/fpsyt.2021.735615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/21/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Borderline personality disorder (BPD) in adolescents is characterized by emotional dysregulation, insecure attachment, a history of stressful life events (SLEs) as well as dysfunctional parent-child interactions. The respective contribution of each of these factors on BPD affective symptoms is not yet clear. The purpose of this study is to assess the distinct impact of parental adversity and SLEs on BPD affective symptoms and the role of attachment and alexithymia in such emotional processes. Method: This study explored parental dysfunction and SLEs as predictors of affective symptoms of BPD and of attachment insecurity in BPD adolescents (n = 85) and healthy controls (n = 84) aged 13-19 years from the European Research Network on BPD. The links between adversity and BPD symptoms were also investigated by emotional dysregulation assessment, as measured by alexithymia and hopelessness. Results: Dysfunctional parental interactions were linked to affective symptoms, hopelessness, and anxious attachment in healthy controls but not in BPD. Cumulative SLEs were positively correlated with affective symptoms and avoidant attachment in the control group but negatively correlated with both these variables in BPD. Multivariate regression analysis revealed that, in BPD, affective symptoms were independent of dysfunctional parenting but depended on attachment, whereas in controls, a maternal affectionless control style directly predicted affective symptoms. Moreover, increasing numbers of SLEs reduced affective symptoms in BPD, independently of parental interactions or attachment, and were associated with growing use of operative thinking. Discussion: BPD patients showed paradoxical emotional reactions: there was no increase of hopelessness and affective symptoms with an increased parental dysfunction, but a decrease in affective symptoms and hopelessness with cumulative SLE. Two pathways arose, one involving attachment as an emotional dysregulation process for parent-child interactions and a second one for SLE, with a more direct pathway to affective symptoms, independent of attachment but dependent on early interactions, and involving alexithymia. In summary, adversity factors have distinct effects in BPD, and attachment is partly accountable for affective symptoms independently of adversity. Our results suggest that in highly insecure conditions, cumulative adversity may produce paradoxical effects, including a lesser expression of affective symptoms and hopelessness.
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Affiliation(s)
- Marion Robin
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France.,Medical School, Paris Descartes University, Medical School, Paris, France
| | - Jean Belbèze
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
| | | | - Gérard Shadili
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
| | - Victoire Peres
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
| | - Jérôme Silva
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
| | - Maurice Corcos
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France.,Medical School, Paris Descartes University, Medical School, Paris, France
| | - Mario Speranza
- Versailles General Hospital, Le Chesnay, France.,Paris-Saclay University, UVSQ, CESP, INSERM, Gif sur Yvette, France
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38
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Perinatal foundations of personality pathology from a dynamical systems perspective. Curr Opin Psychol 2020; 37:121-128. [PMID: 33444894 DOI: 10.1016/j.copsyc.2020.12.003] [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: 06/30/2020] [Revised: 11/17/2020] [Accepted: 12/07/2020] [Indexed: 11/21/2022]
Abstract
The development of personality pathology is an interactive process between biologically based susceptibilities, interpersonal patterns, and contextual factors across the lifespan. In this paper, we argue that these interactions begin before birth. We describe the perinatal period (i.e. pregnancy and up to one year postpartum) as a sensitive developmental window during which regulatory and stress response systems that confer risk for personality pathology begin forming. In addition, we present converging evidence for significant associations between perinatal factors and later life personality disorders. Finally, we present this perinatal perspective through the lens of dynamical systems theory and emphasize the promise of this framework for guiding future personality disorder research, prevention, and intervention.
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39
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Madigan S, Eirich R, Racine N, Borland-Kerr C, Cooke JE, Devereux C, Plamondon AR, Tarabulsy GM, Cyr C, Haltigan JD, Bohr Y, Bronfman E, Lyons-Ruth K. Feasibility of training service providers on the AMBIANCE-Brief measure for use in community settings. Infant Ment Health J 2020; 42:438-451. [PMID: 33300631 DOI: 10.1002/imhj.21898] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The Atypical Maternal Behavior Instrument for Assessment and Classification-Brief (AMBIANCE-Brief) was developed to provide a clinically useful and psychometrically sound assessment of disrupted parenting behavior for community practitioners. With prior evidence of this tool's reliability and validity in laboratory settings, this study aimed to determine whether providers from family service agencies could become reliable in the use of the level of disrupted communication following a brief training. Providers (N = 46) from three agency sites participated in a 2-day AMBIANCE-Brief training and, at the end of the training, coded eight videotaped mother-child interactions. Novice participant coding was compared to expert consensus ratings using intraclass correlations. On average, participants' interrater agreement was good (ICCmean = .84, SD = 0.10), with 89% meeting the reliability standards of ICC ≥ .70. In response to queries, 100% of participants indicated that they would recommend the AMBIANCE-Brief training to their colleagues, 85% reported that the AMBIANCE-Brief measure would be useful or very useful for their clinical practice, and 56% of participant clinicians believed that parents would find the measure acceptable or very acceptable for integration into intervention or support planning. Altogether, these findings speak to the feasibility of using the AMBIANCE-Brief in community settings. Future studies are needed in diverse clinical and community contexts to evaluate whether use of this assessment tool can inform more targeted interventions tailored to the specific needs of families.
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Affiliation(s)
- Sheri Madigan
- Department of Psychology, University of Calgary, Calgary, Alberta.,Alberta Children's Hospital Research Institute, Calgary, Alberta
| | - Rachel Eirich
- Department of Psychology, University of Calgary, Calgary, Alberta.,Alberta Children's Hospital Research Institute, Calgary, Alberta
| | - Nicole Racine
- Department of Psychology, University of Calgary, Calgary, Alberta.,Alberta Children's Hospital Research Institute, Calgary, Alberta
| | | | - Jessica E Cooke
- Department of Psychology, University of Calgary, Calgary, Alberta.,Alberta Children's Hospital Research Institute, Calgary, Alberta
| | - Chloe Devereux
- Department of Psychology, University of Calgary, Calgary, Alberta
| | - André R Plamondon
- Département des fondements et pratiques en éducation, Université Laval, Quebec, Quebec, Canada
| | - George M Tarabulsy
- School of Psychology, University Center for Research on Youth and Families, Université Laval, Quebec, Quebec, Canada
| | - Chantal Cyr
- Département de psychologie, Université du Québec à Montréal, Montreal, Quebec, Canada
| | - John D Haltigan
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Yvonne Bohr
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Elisa Bronfman
- Harvard Medical School at Boston Children's Hospital, Boston, Massachusetts, United States
| | - Karlen Lyons-Ruth
- Harvard Medical School at the Cambridge Hospital, Cambridge, Massachusetts
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40
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Khoury JE, Zona K, Bertha E, Choi-Kain L, Hennighausen K, Lyons-Ruth K. Disorganized Attachment Interactions Among Young Adults With Borderline Personality Disorder, Other Diagnoses, and No Diagnosis. J Pers Disord 2020; 34:764-784. [PMID: 30785838 DOI: 10.1521/pedi_2019_33_408] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Theorists have suggested that attachment disorganization contributes to the development of borderline personality disorder (BPD). However, few studies have directly observed attachment-related interactions with parents. This study used a newly developed attachment-based coding system to examine whether individuals with BPD were more likely to exhibit disorganized interactions with their mothers than those with (a) other diagnoses (anxiety, depressive, or substance use diagnoses) or (b) no diagnosis. Results indicated that participants with BPD had a greater likelihood of disorganized attachment interactions than did both comparison groups. The odds ratio for disorganized attachment among BPD participants was almost 8 times that of participants without BPD. These results underscore the utility of observational assessments to capture the interpersonal features of BPD and highlight the potential value of examining the developmental trajectories of disorganized and controlling attachment behavior in order to identify pathways toward BPD.
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41
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Bozzatello P, Rocca P, Bellino S. Trauma and psychopathology associated with early onset BPD: an empirical contribution. J Psychiatr Res 2020; 131:54-59. [PMID: 32927365 DOI: 10.1016/j.jpsychires.2020.08.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 08/13/2020] [Accepted: 08/30/2020] [Indexed: 11/27/2022]
Abstract
Prodromal symptoms of borderline personality disorder (BPD) often arise in young age, especially in early adolescence. Several factors for early BPD onset have been identified to consent a precocious detection of high-risk population. The present study is aimed: (1) to identify what psychopathological, traumatic, and functional factors are significantly associated to early onset in a sample of BPD patients and (2) to evaluate what factors are associated to the time interval between symptoms onset and first psychiatric visit (Δ age). Participants were enrolled from BPD outpatients attending the Center for Personality Disorder of the University of Turin, Italy. Patients were tested with assessment instruments for specific BPD symptoms, exposure to traumatic experiences, global functioning, and perception of quality of life. All variables that were found significant at a bivariate analysis were included in two multiple regressions (stepwise backward), with the age of onset and the Δ age as dependent variables. Significance level was P ≤ 0.05. Seventy patients were included in the study (68 completers). Factors that were found related to age of onset were: CTQ-SF emotional abuse (P = 0.001); ACE-IQ bully victimization (P = 0.005), alcohol/drug abuser in the household (P = 0.001), and physical neglect (P = 0.006); BIS non-planning impulsivity (P = 0.005); and SOFAS score (P = 0.033). Factors that were found related to Δ age were: ACE-IQ total score (P = 0.001) and BIS total score (P = 0.001). Earlier onset of BPD is mainly associated to traumatic events, including abuse, neglect, dysfunction in household environment, and bullying. Earlier onset is also related to a worse social functioning. Among BPD symptoms only non-planning impulsivity was found associated to early onset. A higher number of traumatic events and worse impulsive dyscontrol induce a significant reduction of the time interval between onset and first psychiatric observation.
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Affiliation(s)
| | - Paola Rocca
- Department of Neuroscience, University of Turin, Italy
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42
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Macfie J, Kurdziel G. The Experience of Maltreatment in Young Children Whose Mothers Have Borderline Personality Disorder: Reflections in Their Narrative Representations. J Pers Disord 2020; 34:750-763. [PMID: 30742556 DOI: 10.1521/pedi_2019_33_407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Child maltreatment is an etiological factor in borderline personality disorder (BPD), which may be transmitted to the children of mothers with BPD. We assessed maltreatment in 36 children aged 4-7 whose mothers have BPD and in 34 normative comparisons. Children whose mothers have BPD were more likely to have experienced sexual abuse, physical abuse, and neglect than were normative comparisons. Mothers' self-reported borderline features were significantly correlated with children's maltreatment. Neglect was associated with mothers' affective instability, identity disturbance, negative relationships, and self-harm; sexual abuse was associated with mothers' identity disturbance, and negative relationships; and physical abuse was associated with mothers' self-harm. Maltreatment mediated the relationship between all four of mothers' borderline features and children's narrative representations of the caregiver-child relationship, which included fear of abandonment, role reversal, and mother-child relationship expectations. The authors discuss results in the context of risk for developing BPD in early adulthood and early preventive interventions targeting children's representations.
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43
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Brumariu LE, Owen MT, Dyer N, Lyons-Ruth K. Developmental Pathways to BPD-Related Features in Adolescence: Infancy to Age 15. J Pers Disord 2020; 34:104-129. [PMID: 32539619 DOI: 10.1521/pedi_2020_34_480] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The self-damaging behaviors central to borderline personality disorder (BPD) become prominent in adolescence. Current developmental theories cite both early family processes and childhood dysregulation as contributors to BPD, but longitudinal data from infancy are rare. Using the National Institute of Child Health and Human Development (NICHD) Study of Early Child Care and Youth Development database (SECCYD; N = 1,364), we examined path models to evaluate parent and child contributors from infancy/preschool, middle childhood, and adolescence to adolescent BPD-related features. In addition, person-centered latent class analyses (LCA) investigated whether adolescent BPD-related features were more strongly predicted by particular patterns of maladaptive parenting. Path modeling identified unique influences of maternal insensitivity and maternal depression on BPD-related features, first, through social-emotional dysregulation in middle childhood, and second, through continuity from infancy in maternal insensitivity and depression. LCA results indicated that early withdrawn parenting was particularly predictive of BPD-related features in adolescence. Results suggest multiple points of intervention to alter pathways toward adolescent borderline psychopathology.
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Affiliation(s)
- Laura E Brumariu
- Derner School of Psychology, Adelphi University, Garden City, New York
| | | | - Nazly Dyer
- Institutional Data Analytics, University of Houston-Downtown
| | - Karlen Lyons-Ruth
- Department of Psychiatry, Harvard Medical School at Cambridge Health Alliance, Cambridge, Massachusetts
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44
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Kaufman EA, Meddaoui B. Identity pathology and borderline personality disorder: an empirical overview. Curr Opin Psychol 2020; 37:82-88. [PMID: 32932110 DOI: 10.1016/j.copsyc.2020.08.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/07/2020] [Accepted: 08/14/2020] [Indexed: 11/28/2022]
Abstract
Pathological identity-related functioning is a core feature of borderline personality disorder (BPD) that is grievously underrepresented in the empirical literature. Burgeoning evidence indicates that identity pathology is multifaceted, influenced by transactions between social and endogenous processes, and associated with a wide variety of maladaptive outcomes. Although historically defined by patterns of instability (e.g. frequent and rapid changes to career goals, religious beliefs, core values, friend groups, etc.), accumulating research indicates that identity pathology also manifests as distress and functional impairment related to excessive rigidity (i.e. unrelenting negative self-evaluations; overidentification with a restricted role or group membership) and/or incongruous behavior (i.e. simultaneously holding discordant beliefs/values/attitudes, actions that are grossly contradictory with values, incoherent sense of self, etc.). Despite the complex nature of this construct, and its centrality to BPD, researchers often assess identity pathology indirectly, inadequately, or fail to measure it entirely. In this article, we briefly describe how identity pathology may fit into etiological models of BPD, highlight emerging themes from recent research, and identify important gaps in our knowledge. We also discuss limitations associated with current assessment practices, recommend alternatives, and articulate a research agenda for the future.
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Affiliation(s)
- Erin A Kaufman
- Department of Psychology, University of Western Ontario, 361 Windermere Road, London, ON, N6A 3K7, Canada.
| | - Brianna Meddaoui
- Department of Psychology, University of Western Ontario, 361 Windermere Road, London, ON, N6A 3K7, Canada
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45
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Emerging child competencies and personality pathology: toward a Developmental Cascade model of BPD. Curr Opin Psychol 2020; 37:32-38. [PMID: 32818836 DOI: 10.1016/j.copsyc.2020.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 07/02/2020] [Indexed: 02/06/2023]
Abstract
The guiding principle of this synthesis is to organize research on predictors of BPD features within a developmentally specific framework (e.g. infancy, preschool, middle childhood, adolescence). In addition, studies are prioritized that have longitudinal and observational components. On the basis of current literature, a Developmental Cascade Model of BPD is offered in which specific difficulties during one developmental period contribute to specific difficulties in a succeeding period, resulting in increasingly broad areas of dysregulation over time. Furthermore, to address specificity, we contrast trajectories toward BPD with trajectories toward antisocial behavior, noting shared and divergent predictors. The review highlights the importance of locating research findings in relation to the competencies and challenges of particular developmental periods when modelling developmental trajectories toward BPD.
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46
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Rosario M, Espinosa A, Gagnon G, Talhouk L, Neff B. Associations among parental and romantic attachment, personality disorder symptoms, and physical health. J Health Psychol 2019; 26:1609-1624. [PMID: 31789584 DOI: 10.1177/1359105319890027] [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: 11/16/2022] Open
Abstract
The relations of parental and romantic attachment with physical health symptoms and the mediating role of personality disorder symptoms in those relations were examined in an online survey of US young adults. Latent class analysis identified two groups: occasionally sick and healthier. Insecure attachment was related to being occasionally sick and to personality disorder symptoms (poor reality testing, primitive defenses, and diffused identity). Primitive defenses/identity diffusion mediated relations between insecure parental attachment and physical symptoms. Maternal and paternal attachment each provided unique information about these relations. Romantic attachment was not associated with physical symptoms after adjusting for parental attachment and personality disorder symptoms.
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Affiliation(s)
- Margaret Rosario
- The City College, The City University of New York, USA.,The Graduate Center, The City University of New York, USA
| | | | - Gregory Gagnon
- The Graduate Center, The City University of New York, USA
| | - Leila Talhouk
- The City College, The City University of New York, USA
| | - Brian Neff
- The City College, The City University of New York, USA
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47
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Crow TM, Levy KN. Adult attachment anxiety moderates the relation between self-reported childhood maltreatment and borderline personality disorder features. Personal Ment Health 2019; 13:239-249. [PMID: 31571424 DOI: 10.1002/pmh.1468] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 08/16/2019] [Accepted: 08/23/2019] [Indexed: 12/21/2022]
Abstract
Childhood maltreatment is one of many risk factors for borderline personality disorder (BPD). However, not all individuals with BPD report histories of childhood maltreatment. Therefore, it is necessary to identify factors that contextualize the relation between childhood maltreatment and BPD features. With its emphasis on the developmental origins of emotion regulation, attachment theory provides a useful framework to understand how people are differentially affected by early life stress. The present study examined self-reported adult attachment as a moderator in the relation between childhood maltreatment and BPD features in a large undergraduate sample (n = 1 033). Attachment anxiety, but not attachment avoidance, moderated the relation between childhood maltreatment and BPD features, and this relation was non-significant among participants low (-1 standard deviation) in attachment anxiety. These results support the hypothesis that secure attachment in adulthood may buffer against the otherwise deleterious effects of distal risk factors on personality pathology. Future research should continue to examine this question across risk factors and across disorders. Furthermore, we suggest that researchers who have historically examined attachment as a mediator cross-sectionally should re-examine their data for evidence of a moderation effect. © 2019 John Wiley & Sons, Ltd.
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Affiliation(s)
- Thomas M Crow
- Department of Psychology, Pennsylvania State University, State College, PA, USA
| | - Kenneth N Levy
- Department of Psychology, Pennsylvania State University, State College, PA, USA
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48
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Smith M, South S. Romantic attachment style and borderline personality pathology: A meta-analysis. Clin Psychol Rev 2019; 75:101781. [PMID: 31918217 DOI: 10.1016/j.cpr.2019.101781] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 09/13/2019] [Accepted: 10/15/2019] [Indexed: 12/24/2022]
Abstract
Borderline Personality Disorder (BPD) implies profound impairment in interpersonal relationships, particularly romantic relationships (Daley, Burge, & Hammen, 2000). Insecure attachment bears striking resemblance to BPD traits in both empirical and theoretical work (Levy, Johnson, Clouthier, Scala, & Temes, 2015) and may be particularly suited for understanding the BPD-related deficits in romantic functioning. Despite several qualitative reviews concluding that secure attachment is disrupted in those with BPD traits, no consensus has emerged regarding the form of this disruption (Levy et al., 2015), with most reviews focusing on whether BPD is best captured as high levels of attachment anxiety or attachment avoidance. The purpose of the current review is to provide a quantitative synthesis of the strength and direction of the associations between attachment insecurity and BPD traits. Searches on PsycINFO and Pubmed resulted in 27 effect sizes that measured BPD and adult romantic attachment on the two primary dimensions of anxiety and avoidance (Fraley, Waller, & Brennan, 2000). Results demonstrated that attachment anxiety correlates most strongly with BPD traits (r = 0.48); however, attachment avoidance also evinced a significant effect (r = 0.30). Findings from regression analyses indicate that attachment anxiety and avoidance interact, suggesting a particularly strong relationship between attachment disorganization and BPD traits.
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Affiliation(s)
- Madison Smith
- Psychological Sciences, Purdue University, 703 3rd Street, West Lafayette, IN, United States of America.
| | - Susan South
- Psychological Sciences, Purdue University, 703 3rd Street, West Lafayette, IN, United States of America.
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49
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Kaufman EA, Puzia ME, Crowell SE, Price CJ. Replication of the Self-Concept and Identity Measure (SCIM) Among a Treatment-Seeking Sample. IDENTITY (MAHWAH, N.J.) 2019; 19:18-28. [PMID: 31602176 DOI: 10.1080/15283488.2019.1566068] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Identity distress occurs within a variety of psychiatric conditions. Reliable tools for assessing identity-related functioning among clinical populations are greatly needed. The Self- Concept and Identity Measure (SCIM) is a brief self-report scale designed to assess healthy and disturbed identity dimensions. This measure has been validated within normative but not treatment seeking samples. The present study used an a priori confirmatory approach to replicate the SCIM's factor structure among disadvantaged women enrolled in treatment for chemical dependence (N = 216). The original three-factor structure and item loadings generally replicated within this diagnostically diverse, significantly impaired sample. Higher SCIM scores were also associated with other problems, such as emotion dysregulation and depression. Results support the SCIM's use and scoring with clinical populations.
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Affiliation(s)
- Erin A Kaufman
- Department of Psychology, University of Utah, Salt Lake City, UT
| | - Megan E Puzia
- Department of Psychology, University of Utah, Salt Lake City, UT
| | - Sheila E Crowell
- Department of Psychology, University of Utah, Salt Lake City, UT.,Department of Psychiatry, University of Utah, Salt Lake City, UT
| | - Cynthia J Price
- Biobehavioral Nursing and Health Systems, University of Washington School of Nursing, Seattle, WA.,Psychosocial and Community Health Department, University of Washington School of Nursing, Seattle, WA
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50
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Hiebler-Ragger M, Unterrainer HF. The Role of Attachment in Poly-Drug Use Disorder: An Overview of the Literature, Recent Findings and Clinical Implications. Front Psychiatry 2019; 10:579. [PMID: 31507461 PMCID: PMC6720034 DOI: 10.3389/fpsyt.2019.00579] [Citation(s) in RCA: 13] [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: 04/25/2019] [Accepted: 07/23/2019] [Indexed: 12/13/2022] Open
Abstract
Background: Substance use disorders (SUDs) represent a worldwide epidemic with extensive costs to the individual and to society. Occasionally described as an attachment disorder, they have been linked to various impairments in self-regulation and social functioning. However, while there have been significant advances in the development and validation of treatment strategies for SUD in recent years, the components of these treatment approaches have yet to be fully explored. The characteristics of polydrug use disorder (PUD) especially need to be addressed in more detail, as this diagnosis is highly common in individuals seeking treatment, while simultaneously being associated with poor treatment success. Aim and Scope: This review aims at further exploring the relevance of attachment in PUD and its treatment. To this end, this review provides a concise summary of relevant theories on the development and treatment of SUD in general, including related parameters of attachment, emotion regulation, and neuroscience. Furthermore, several studies focused specifically on PUD are described in more detail. These studies explored the connections between attachment, personality structure, primary and higher emotions (including spirituality), as well as structural and functional neural parameters in inpatients with PUD as well as in healthy controls. Most notably, the described studies highlight that insecure attachment and impairments in personality structure are present in inpatients with PUD. In addition, these characteristics are paralleled by extensive impairments in white matter integrity, especially in tracts connected to facets of emotion regulation. Conclusions: Based on our findings, we emphasize conceptualization of PUD as an Attachment Disorder, on a behavioral as well as on a neural level. Furthermore, we point out the importance of an integrated bio-psycho-social approach in this research area. Consequently, future studies might more closely focus on the influence of attachment-based interventions on emotion regulation abilities as well as a potentially related neuroplasticity. Neuroplastic changes, which are still rather unexplored, might represent important parameters for the assessment of treatment outcomes especially in long-term SUD treatment.
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Affiliation(s)
- Michaela Hiebler-Ragger
- Department for Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Austria
- Center for Integrative Addiction Research (CIAR), Gruener Kreis Society, Vienna, Austria
| | - Human-Friedrich Unterrainer
- Department for Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Austria
- Center for Integrative Addiction Research (CIAR), Gruener Kreis Society, Vienna, Austria
- Department of Religious Studies, University of Vienna, Vienna, Austria
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