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Cavelti M, Thompson K, Betts J, Fowler C, Luebbers S, Cottton SM, Chanen A. Young People With Borderline Personality Disorder Have an Increased Lifetime Risk of Being the Victim of Interpersonal Violence. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP10642-NP10660. [PMID: 33461382 DOI: 10.1177/0886260520986270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This study aimed to examine the lifetime risk of being the victim of criminal or violent offenses among young people with borderline personality disorder (BPD) features (1-9 DSM-IV criteria). Demographic and diagnostic data from 492 outpatients who attended a specialist public mental health service for 15- to 25-year-olds between January 1998 and March 2008 were linked with offending data from a state-wide police database, collected between March 1993 and June 2017, in order to establish victimization history. This included information on criminal offenses perpetrated against these young people and intervention orders implemented to protect them from being victimized by another person's violent behavior. Logistic regression analyses, adjusted for sex and co-occurring mental state disorders, were conducted on n = 378 who had complete data (76.5% females). As hypothesized, BPD diagnosis and number of BPD criteria were both significantly associated with an increased risk of being the victim of a violent offense and the complainant of a family violence intervention order. Anger and impulsivity independently predicted a higher risk of being the victim of a violent offense, while unstable relationships, impulsivity, and affective instability independently predicted a higher risk of being the complainant of a family violence intervention order. No significant association was found between BPD and the risk of being the victim of a nonviolent offense. These findings indicate that young people with any BPD features (even below the DSM diagnostic threshold) are at increased risk for victimization by interpersonal violence. Moreover, this risk increases according to the number of BPD criteria. This issue needs to be addressed by prevention and early intervention programs (e.g., by working on self-assertion and interpersonal skills, taking into account the possible influence of previous traumatizing relationship experiences).
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Affiliation(s)
- Marialuisa Cavelti
- Orygen, Melbourne, Australia
- University of Melbourne, Australia
- University of Bern, Switzerland
| | | | - Jennifer Betts
- Orygen, Melbourne, Australia
- University of Melbourne, Australia
| | | | | | - Sue M Cottton
- Orygen, Melbourne, Australia
- University of Melbourne, Australia
| | - Andrew Chanen
- Orygen, Melbourne, Australia
- University of Melbourne, Australia
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Abstract
Social interaction difficulties are amongst the most prevalent and pervasive adverse outcomes for children and adolescents with ADHD. Problem-solving strategies are impaired in affected individuals, according to the literature. This study aimed to investigate the social problem-solving skills of children and adolescents with and without ADHD, using objective quantitative measures provided by the Interpersonal Negotiation Strategies Interview (INSI). Because verbal communication skills and working memory may be impaired in ADHD, we investigated their contribution to the performance. Forty-three children and adolescents with ADHD and 27 clinical controls with clinical diagnoses other than ADHD completed the INSI along with measures of verbal communication skills (Verbal Comprehension Index [VCI]): Similarities, Vocabulary and Comprehension subtests from the Wechsler Battery, visual (Corsi Blocks) and verbal (Digit Span) working memory tasks. Groups performed similarly on measures of intellectual functioning, working memory, and verbal communication. For the entire sample, VCI scores were positively correlated with INSI performance scores. The ADHD group performed worse on the INSI than the clinical control group. Linear regression analysis showed that inattention and hyperactivity/impulsivity levels and Similarities predicted INSI's performance. Our findings indicate that interpersonal negotiation difficulties in ADHD are related to DSM-5 defining symptoms of the disorder.
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Affiliation(s)
- Tiago Figueiredo
- D'or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Felipe Sudo
- D'or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | | | - Gail Tripp
- Okinawa Institute of Science and Technology Graduate University, Okinawa, Japan
| | - Paulo Mattos
- D'or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
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Figueiredo T, Sudo FK, Serra-Pinheiro MA, Mattos P. Interpersonal negotiation impairment in ADHD: The critical role of comprehension processing. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01767-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Pizarro-Campagna E, Terrett G, Jovev M, Rendell PG, Henry JD, Chanen AM. Rapid facial mimicry responses are preserved in youth with first presentation borderline personality disorder. J Affect Disord 2020; 266:14-21. [PMID: 32056868 DOI: 10.1016/j.jad.2020.01.097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/27/2019] [Accepted: 01/20/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Empathy is a complex and multifaceted construct comprising cognitive and affective components. Abnormal empathic responses are implicated in borderline personality disorder (BPD). Specifically, unconscious motor mimicry (a primitive component of affective empathy evident from infancy) is theorized to be heightened and to contribute to the heightened emotional contagion often seen in people with BPD. Yet, no study has directly tested whether abnormally heightened unconscious motor mimicry is associated with BPD features or whether this is present early in the course of BPD. METHODS In the present study, facial electromyography was used to assess the rapid facial mimicry responses (a form of unconscious motor mimetic responding) of 32 outpatient youths (aged 15-25 years) with early stage BPD features and 47 demographically matched healthy control participants (HC). RESULTS The results showed no group differences in rapid facial mimetic responses to either positive (happy) or negative (angry) facial emotions. LIMITATIONS Co-occurring psychopathology and the potential impact of state affect on rapid facial mimicry were considered and discussed. CONCLUSIONS These data indicate that there is no evidence for abnormally heightened rapid motor mimicry in youth early in the course of BPD, suggesting that rapid facial mimicry is preserved in this group. It is thus unlikely that abnormally heightened unconscious simulation contributes to heightened emotional contagion in youth with first presentation BPD. Future research should explore alternative mechanisms for this phenomenon and also whether abnormalities in motor mimetic responses are evident in later stages of the disorder.
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Affiliation(s)
- Elizabeth Pizarro-Campagna
- Cognition and Emotion Research Centre, School of Psychology, Australian Catholic University, Melbourne, Australia.
| | - Gill Terrett
- Cognition and Emotion Research Centre, School of Psychology, Australian Catholic University, Melbourne, Australia
| | - Martina Jovev
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Peter G Rendell
- Cognition and Emotion Research Centre, School of Psychology, Australian Catholic University, Melbourne, Australia
| | - Julie D Henry
- School of Psychology, University of Queensland, Brisbane, Australia
| | - Andrew M Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
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Koster N, Hopwood CJ, Goodman M, Zanarini MC. Correlates between Five-Factor Model traits and the Revised Diagnostic Interview for Borderlines dimensions in an adolescent clinical sample. Personal Ment Health 2019; 13:197-204. [PMID: 31287247 PMCID: PMC6899891 DOI: 10.1002/pmh.1459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/29/2019] [Accepted: 05/28/2019] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Extensive evidence supports the association between Five-Factor Model (FFM) traits involving high neuroticism, low agreeableness and low conscientiousness and borderline personality disorder (BPD) characteristics, particularly among adults in community samples. However, studies supporting this link in adolescent samples are relatively limited, and few studies have examined the links between FFM traits and specific dimensions of BPD, such as those distinguished by the Revised Diagnostic Interview for Borderlines (DIB-R). In this study, we examined associations between FFM traits and BPD characteristics in a group of clinical and non-clinical adolescents. METHOD We evaluated the correlations between the FFM personality traits, as measured by the NEO-Five-Factor Inventory and BPD characteristics as measured by the DIB-R in a sample of adolescents (N = 162). RESULTS Consistent with previous research, BPD dimensions were highly associated with high neuroticism, low conscientiousness, low agreeableness and to a somewhat lesser extent with low extraversion. Specificity of associations between FFM traits and DIB-R section scores was limited, in part because of strong intercorrelations among DIB-R scores. DISCUSSION These results imply that evidence about trait-BPD associations in adult samples generalizes well to adolescents. Clinical implications of these findings are discussed.
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Affiliation(s)
- Nagila Koster
- Centre for Adolescent PsychiatryReinier van Arkel's‐HertogenboschThe Netherlands
- Developmental PsychologyUtrecht UniversityUtrechtThe Netherlands
| | | | - Marianne Goodman
- James J. Peters Veterans Affairs Medical CenterBronxNYUSA
- Department of PsychiatryIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Mary C. Zanarini
- Laboratory for the Study of Adult DevelopmentMcLean HospitalBelmontMAUSA
- Department of PsychiatryHarvard Medical SchoolBostonMAUSA
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Tay SA, Hulbert CA, Jackson HJ, Chanen AM. Affective and cognitive theory of mind abilities in youth with borderline personality disorder or major depressive disorder. Psychiatry Res 2017; 255:405-411. [PMID: 28667928 DOI: 10.1016/j.psychres.2017.06.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/01/2017] [Accepted: 06/04/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Theory of mind (ToM) is an important social cognitive ability that has been investigated in BPD, with inconsistent findings indicating impaired, comparable, and enhanced ToM in BPD. This study aimed to clarify and extend previous findings by investigating affective and cognitive ToM abilities in youth early in the course of BPD, by including a clinical comparison group of youth with major depressive disorder (MDD). METHODS Female participants aged 15-24 years diagnosed with BPD (n = 41) or MDD (n = 37) completed the Reading the Mind in the Eyes Test (RMET) and Happé's Cartoon Task, measures of affective and cognitive dimensions of ToM, respectively. RESULTS The BPD group performed significantly worse than the MDD group on the affective ToM task, even after controlling for age, intelligence and depressive symptoms. Results for cognitive ToM were not significantly different. CONCLUSIONS Finding of poorer performance on a measure of affective ToM, in BPD youth, relative to youth with MDD early in the course of BPD suggest a developmental failure of sociocognitive abilities needed for mentalising and which are theorised as giving rise to core features of BPD. Future research should employ more naturalistic paradigms to study social cognition and should assess individuals even earlier in the course of BPD.
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Affiliation(s)
- Sarah-Ann Tay
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Carol A Hulbert
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia.
| | - Henry J Jackson
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Andrew M Chanen
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia; Orygen Youth Health, Northwestern Mental Health, Melbourne, Australia
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Beck E, Sharp C, Poulsen S, Bo S, Pedersen J, Simonsen E. The mediating role of mentalizing capacity between parents and peer attachment and adolescent borderline personality disorder. Borderline Personal Disord Emot Dysregul 2017; 4:23. [PMID: 29204276 PMCID: PMC5701352 DOI: 10.1186/s40479-017-0074-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 11/08/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Insecure attachment is a precursor and correlate of borderline personality disorder. According to the mentalization-based theory of borderline personality disorder, the presence of insecure attachment derails the development of the capacity to mentalize, potentially resulting in borderline pathology. While one prior study found support for this notion in adolescents, it neglected a focus on peer attachment. Separation from primary caregivers and formation of stronger bonds to peers are key developmental achievements during adolescence and peer attachment warrants attention as a separate concept. FINDINGS In a cross-sectional study, female outpatients (Mage 15.78=, SD = 1.04) who fulfilled DSM-5 criteria for BPD (N = 106) or met at least 4 BPD criteria (N = 4) completed self-reports on attachment to parents and peers, mentalizing capacity (reflective function) and borderline personality features. Our findings suggest that in a simple mediational model, mentalizing capacity mediated the relation between attachment to peers and borderline features. In the case of attachment to parents, the mediational model was not significant. CONCLUSIONS The current study is the first to evaluate this mediational model with parent and peer attachment as separate concepts and the first to do so in a sample of adolescents who meet full or sub-threshold criteria for borderline personality disorder. Findings incrementally support that mentalizing capacity and attachment insecurity, also in relation to peers, are important concepts in theoretical approaches to the development of borderline personality disorder in adolescence. Clinical implications are discussed.
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Affiliation(s)
- Emma Beck
- Psychiatric Research Unit, Region Zealand, Fælledvej 6, 4200 Slagelse, Denmark.,Child and Adolescent Psychiatric Department, Region Zealand, Smedegade 16, 4000 Roskilde, DK Denmark.,Department of Psychology, University of Copenhagen, 2A Øster Farimagsgade, -1353 Copenhagen K, DK Denmark
| | - Carla Sharp
- Department of Psychology, University of Houston, Houston, TX 77204 USA
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, 2A Øster Farimagsgade, -1353 Copenhagen K, DK Denmark
| | - Sune Bo
- Psychiatric Research Unit, Region Zealand, Fælledvej 6, 4200 Slagelse, Denmark.,Child and Adolescent Psychiatric Department, Region Zealand, Smedegade 16, 4000 Roskilde, DK Denmark
| | - Jesper Pedersen
- Child and Adolescent Psychiatric Department, Region Zealand, Smedegade 16, 4000 Roskilde, DK Denmark
| | - Erik Simonsen
- Psychiatric Research Unit, Region Zealand, Fælledvej 6, 4200 Slagelse, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Sharp C, Venta A, Vanwoerden S, Schramm A, Ha C, Newlin E, Reddy R, Fonagy P. First empirical evaluation of the link between attachment, social cognition and borderline features in adolescents. Compr Psychiatry 2016; 64:4-11. [PMID: 26298843 DOI: 10.1016/j.comppsych.2015.07.008] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 07/13/2015] [Accepted: 07/15/2015] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Several developmental models of borderline personality disorder (BPD) emphasize the role of disrupted interpersonal relationships or insecure attachment. As yet, attachment quality and the mechanisms by which insecure attachment relates to borderline features in adolescents have not been investigated. In this study, we used a multiple mediational approach to examine the cross-sectional interplay between attachment, social cognition (in particular hypermentalizing), emotion dysregulation, and borderline features in adolescence, controlling for internalizing and externalizing symptoms. METHODS The sample included 259 consecutive admissions to an adolescent inpatient unit (Mage=15.42, SD=1.43; 63.1% female). The Child Attachment Interview (CAI) was used to obtain a dimensional index of overall coherence of the attachment narrative. An experimental task was used to assess hypermentalizing, alongside self-report measures of emotion dyregulation and BPD. RESULTS Our findings suggested that, in a multiple mediation model, hypermentalizing and emotion dysregulation together mediated the relation between attachment coherence and borderline features, but that this effect was driven by hypermentalizing; that is, emotion dysregulation failed to mediate the link between attachment coherence and borderline features while hypermentalizing demonstrated mediational effects. CONCLUSIONS The study provides the first empirical evidence of well-established theoretical approaches to the development of BPD.
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Affiliation(s)
- Carla Sharp
- University of Houston, Houston, TX, USA; The Menninger Clinic, Houston, TX, USA.
| | - Amanda Venta
- Sam Houston State University, Huntsville, TX, USA
| | - Salome Vanwoerden
- University of Houston, Houston, TX, USA; The Menninger Clinic, Houston, TX, USA
| | | | - Carolyn Ha
- University of Houston, Houston, TX, USA; The Menninger Clinic, Houston, TX, USA
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Sharp C, Fonagy P. Practitioner Review: Borderline personality disorder in adolescence--recent conceptualization, intervention, and implications for clinical practice. J Child Psychol Psychiatry 2015; 56:1266-88. [PMID: 26251037 DOI: 10.1111/jcpp.12449] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND The past decade has seen an unprecedented increase in research activity on personality disorders (PDs) in adolescents. The increase in research activity, in addition to major nosological systems legitimizing the diagnosis of borderline personality disorder (BPD) in adolescents, highlights the need to communicate new research on adolescent personality problems to practitioners. SCOPE In this review, we provide up-to-date information on the phenomenology, prevalence, associated clinical problems, etiology, and intervention for BPD in adolescents. Our aim was to provide a clinically useful practitioner review and to dispel long-held myths about the validity, diagnostic utility, and treatability of PDs in adolescents. FINDINGS AND CONCLUSION Alongside providing up-to-date information on the phenomenology, prevalence, and etiology, we also report on associated clinical problems and interventions for adolescent BPD. It is only through early active assessment and identification of youngsters with these problems that a lifetime of personal suffering and health system burden can be reduced or altogether avoided. A variety of evidence-based approaches are now available to treat BPD and related clinical problems in young people. Future research should focus on establishing optimal precision in the diagnostic processes in different treatment settings.
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Affiliation(s)
- Carla Sharp
- Department of Psychology, University of Houston, and The Menninger Clinic, Houston, Texas, USA
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, and The Anna Freud Centre, London, UK
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Sharp C, Vanwoerden S. Hypermentalizing in Borderline Personality Disorder: A Model and Data. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/15289168.2015.1004890] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Deckers JWM, Lobbestael J, van Wingen GA, Kessels RPC, Arntz A, Egger JIM. The influence of stress on social cognition in patients with borderline personality disorder. Psychoneuroendocrinology 2015; 52:119-29. [PMID: 25459898 DOI: 10.1016/j.psyneuen.2014.11.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 11/03/2014] [Accepted: 11/04/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Borderline personality disorder (BPD) is characterized by severe difficulties in interpersonal relationships and emotional functioning. Theories of BPD suggest that individuals with BPD have heightened emotional sensitivity, increased stress reactivity, and problems in making sense of intentions of others. In this study we investigated stress reactivity in BPD and its interference with social cognition, and tested whether any differences are specific for BPD or are inherent to personality disorders in general. METHODS We investigated 22 patients with BPD, 23 patients with Cluster C personality disorder (CPD), and 24 nonpatients on facial emotion recognition and social evaluation before and after stress induction based on the Trier Social Stress Test (TSST). RESULTS The results show that stress increased subjective negative emotions in the BPD group to a larger extent than in the other groups, whereas physiological responses were attenuated. Importantly stress induction increased negative evaluations about others, but surprisingly to a similar extent in the BPD and CPD groups as in the nonpatient control group. In addition facial emotion recognition performance was higher after than before stress, but no significant group differences were observed. CONCLUSION These results suggest that heightened psychological reactivity in BPD co-occurs with attenuated physiological responses to psychosocial stress and that stress affects social cognition to a similar extent in BPD as in others.
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Affiliation(s)
- Janneke W M Deckers
- Centre of Excellence for Neuropsychiatry, Vincent Van Gogh Institute for Psychiatry, Venray, The Netherlands; GGZ Centraal, Almere, The Netherlands.
| | - Jill Lobbestael
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - Guido A van Wingen
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Roy P C Kessels
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands; Department of Medical Psychology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Korsakoff Clinic, Vincent Van Gogh Institute for Psychiatry, Venray, The Netherlands
| | - Arnoud Arntz
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - Jos I M Egger
- Centre of Excellence for Neuropsychiatry, Vincent Van Gogh Institute for Psychiatry, Venray, The Netherlands; Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands; Pompe Institute for Forensic Psychiatry, Pro Persona, Nijmegen, The Netherlands
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Brunner R, Henze R, Richter J, Kaess M. Neurobiological Findings in Youth with Borderline Personality Disorder. Scand J Child Adolesc Psychiatr Psychol 2014. [DOI: 10.21307/sjcapp-2015-003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Abstract
This review summarizes recent neurobiological research into youth with borderline personality disorder (BPD) to better delineate the biological factors involved in the development of this disorder. Psychobiological studies when BPD first becomes manifest are of particular interest, because there are fewer confounding factors (e.g., duration of illness, drug abuse, medication, other therapeutic interventions) at this time. This article focuses on recent findings in the field of neuroimaging, neuropsychology, neuroendocrinology, genetics, and pain perception, and it aims to integrate these findings in a developmental psychopathology model of BPD. In studies of clinical samples of adults with BPD, structural imaging studies revealed abnormalities predominantly in the frontolimbic areas. Disturbances in emotional information processing—particularly involving negative stimuli—may mediate affective dysregulation as a core feature of BPD. Genetic studies could reveal that the stability of BPD traits in youth is largely influenced by a combination of genetic and non-shared environmental factors. Hyporesponsiveness to a laboratory stressor indicates an enduring alteration of the hypothalamic–pituitary–adrenal axis. Findings of a higher pain threshold indicate that pain processing is already disturbed during the early stages of BPD, which could contribute to the initiation or maintenance of self-injurious behavior. All biological factors, together with environmental risk factors, may contribute to the core symptoms of BPD: severe emotional and behavioral dysregulation. Further research should investigate the development of BPD in youth by using longitudinal designs to determine whether the neurobiological factors are a cause, an effect, or an epiphenomenon of BPD.
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Affiliation(s)
- Romuald Brunner
- Section for Disorders of Personality Development, Clinic for Child and Adolescent Psychiatry, University of Heidelberg , Heidelberg , Germany
| | - Romy Henze
- Section for Disorders of Personality Development, Clinic for Child and Adolescent Psychiatry, University of Heidelberg , Heidelberg , Germany
- Department of Radiology, German Cancer Research Center , Heidelberg , Germany
| | - Julia Richter
- Section for Disorders of Personality Development, Clinic for Child and Adolescent Psychiatry, University of Heidelberg , Heidelberg , Germany
- Department of Radiology, German Cancer Research Center , Heidelberg , Germany
| | - Michael Kaess
- Section for Disorders of Personality Development, Clinic for Child and Adolescent Psychiatry, University of Heidelberg , Heidelberg , Germany
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Abstract
Borderline personality disorder (BPD) is a common and severe mental disorder that is associated with severe functional impairment and a high suicide rate. BPD is usually associated with other psychiatric and personality disorders, high burden on families and carers, continuing resource utilization, and high treatment costs. BPD has been a controversial diagnosis in adolescents, but this is no longer justified. Recent evidence demonstrates that BPD is as reliable and valid among adolescents as it is in adults and that adolescents with BPD can benefit from early intervention. Consequently, adolescent BPD is now recognized in psychiatric classification systems and in national treatment guidelines. This review aims to inform practitioners in the field of adolescent health about the nature of BPD in adolescence and the benefits of early detection and intervention. BPD diagnosis and treatment should be considered part of routine practice in adolescent mental health to improve these individuals' well-being and long-term prognosis.
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Affiliation(s)
- Michael Kaess
- Section for Disorders of Personality Development, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany;
| | - Romuald Brunner
- Section for Disorders of Personality Development, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Andrew Chanen
- Orygen Youth Health Research Centre & Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia; and Orygen Youth Health Clinical Program, Northwestern Mental Health, Melbourne, Australia
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Abstract
PURPOSE OF REVIEW Phenotypic features of borderline personality disorder may first emerge during childhood, alongside symptoms of common externalizing and internalizing disorders. Children with these borderline personality features (BPF) are, therefore, likely to come into contact with clinical services prior to adolescence. This raises the question of whether BPF may be clinically informative with respect to the formulation and treatment of childhood psychopathology. RECENT FINDINGS BPF in late childhood appear to be highly heritable, while also predicted by environmental risk factors that overlap with those related to both externalizing and internalizing disorders. These risk factors include hostile parenting, maternal insensitivity to infant attachment cues, and early peer victimization, thereby implicating both family and peer processes that play out across early development. Children with BPF appear to be further characterized by social-cognitive factors including social perspective coordination deficits, a shame-prone self-concept, and hypermentalizing, which may represent potential therapeutic targets. SUMMARY Clinical research into the implications of BPF for the treatment of childhood psychopathology is a current priority. It is proposed that the research designs that have contributed to recent evidence for the clinical utility of childhood psychopathic traits may likewise aid in understanding the potential clinical utility of BPF in children.
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Knox J. The Analytic Institute as a Psychic Retreat: Why We Need to Include Research Evidence in Our Clinical Training. BRITISH JOURNAL OF PSYCHOTHERAPY 2013. [DOI: 10.1111/bjp.12047] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chanen AM, McCutcheon L. Prevention and early intervention for borderline personality disorder: current status and recent evidence. Br J Psychiatry 2013; 54:s24-9. [PMID: 23288497 DOI: 10.1192/bjp.bp.112.119180] [Citation(s) in RCA: 169] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Borderline personality disorder (BPD) is a leading candidate for developing empirically based prevention and early intervention programmes because it is common in clinical practice, it is among the most functionally disabling of all mental disorders, it is often associated with help-seeking, and it has been shown to respond to intervention, even in those with established disorder. Moreover, it can be reliably diagnosed in its early stages and it demarcates a group with high levels of current and future morbidity and mortality. Data also suggest considerable flexibility and malleability of BPD traits in youth, making this a key developmental period during which to intervene. Novel indicated prevention and early intervention programmes have shown that BPD in young people responds to intervention. Further work is required to develop appropriate universal and selective preventive interventions.
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Affiliation(s)
- Andrew M Chanen
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria 3052, Australia.
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Abstract
PURPOSE OF REVIEW This review summarizes recent neurocognitive research to better delineate the nosology, prognostication and cause underlying borderline personality disorder (BPD). RECENT FINDINGS BPD had marked clinical heterogeneity with high comorbidity. Executive dysfunction in this disorder was linked to suicidality and treatment adherence, and may serve as an endophenotype. BPD was also characterized by cognitive distortions such as risky decision-making, deficient feedback processing, dichotomous thinking, jumping to conclusion, monocausal attribution and paranoid cognitive style. Social cognition deficits recently described in BPD include altered social inference and emotional empathy, hypermentalization, poorer facial emotional recognition and facial expressions. In electrophysiological studies, BPD was found to have predominantly right hemispheric deficit in high-order cortical inhibition. Reduced left orbitofrontal activity by visual evoked potential and magnetoencephalography correlated with depressive symptoms and functional deterioration. Brain structures implicated in BPD include the hippocampus, dorsolateral prefrontal cortex and anterior cingulate cortex. Abnormal anatomy and functioning of frontolimbic circuitry appear to correlate with cognitive deficits. SUMMARY Frontolimbic structural and functional abnormalities underlie the broad array of cognitive abnormalities in BPD. Further research should espouse broader considerations of effects of comorbidity and clinical heterogeneity, and include community samples and, possibly, longitudinal designs.
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Abstract
This paper reviews recent studies of biological and environmental risk and protective factors and patterns of continuity leading to borderline personality disorder (BPD). It focuses on prospective studies of children and adolescents and studies of young people with borderline pathology, reporting findings from genetics, neurobiology, experimental psychopathology, environmental risk, and precursor signs and symptoms. Studies of individuals earlier in the course of BPD demonstrate relatively consistent environmental risk factors, but neurobiological and experimental psychopathology findings are still inconsistent. Also, temperamental and mental state abnormalities that resemble aspects of the BPD phenotype emerge in childhood and adolescence and presage the BPD syndrome in adolescence or adulthood. Further work is required to better understand the roles that all these factors play in the developmental pathways to BPD and to increase their specificity for BPD in order to facilitate prevention and early intervention.
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Affiliation(s)
- Andrew M Chanen
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, The University of Melbourne, Locked Bag 10, Parkville, Victoria, Australia.
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