Depersonalization and derealization in self-report and clinical interview: The spectrum of borderline personality disorder, dissociative disorders, and healthy controls

Abstract Background Patients with borderline personality disorder (BPD) experience difficulties in emotional awareness (alexithymia), and often develop dissociative symptoms, which may reflect broader deficits in interoceptive awareness. Whether this is associated with alterations in cortical processing of interoception is currently unknown. Methods We utilized an electrophysiological marker of interoception, i.e. heartbeat-evoked potentials (HEP), and examined its relationship with electrocardiographic correlates of autonomic nervous system (ANS) functioning (heart rate variability), and with self-report measures of alexithymia, dissociation and borderline symptom severity in patients with BPD. Results Individuals with BPD had higher HEP amplitudes over frontal electrodes compared to healthy controls. Sympathetic ANS activity was greater in BPD patients than in controls. Across groups, HEP amplitudes were associated with parasympathetic activity over central electrodes and correlated with alexithymia over frontal electrodes. Conclusions These findings support the idea that difficulties in emotional awareness in BPD are reflected in altered frontal electrophysiological markers of interception. Therefore, emotional awareness can be understood as failures of modulation between interoceptive and exteroceptive attention. Future research may aim to investigate whether altered interoception and its electrophysiological correlates are malleable by therapeutic intervention.

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Emotion-Oriented Coping Style Predicts Self-Harm in Response to Acute Psychiatric Hospitalization

Crisis ◽

10.1027/0227-5910/a000713 ◽

2020 ◽

pp. 1-7

Author(s):

Jacqueline M. Frei ◽

Vladimir Sazhin ◽

Melissa Fick ◽

Keong Yap

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

Psychiatric Hospitalization ◽

Coping Styles ◽

Psychiatric Inpatients ◽

Borderline Personality ◽

Self Report ◽

Therapeutic Interventions ◽

Coping Behaviors ◽

Self Harm

Abstract. Psychiatric hospitalization can cause significant distress for patients. Research has shown that to cope with the stress, patients sometimes resort to self-harm. Given the paucity of research on self-harm among psychiatric inpatients, a better understanding of transdiagnostic processes as predictors of self-harm during psychiatric hospitalization is needed. The current study examined whether coping styles predicted self-harm after controlling for commonly associated factors, such as age, gender, and borderline personality disorder. Participants were 72 patients (mean age = 39.32 years, SD = 12.29, 64% male) admitted for inpatient treatment at a public psychiatric hospital in Sydney, Australia. Participants completed self-report measures of coping styles and ward-specific coping behaviors, including self-harm, in relation to coping with the stress of acute hospitalization. Results showed that younger age, diagnosis of borderline personality disorder, and higher emotion-oriented coping were associated with self-harm. After controlling for age and borderline personality disorder, higher levels of emotion-oriented coping were found to be a significant predictor of self-harm. Findings were partially consistent with hypotheses; emotion-oriented but not avoidance-oriented coping significantly predicted self-harm. This finding may help to identify and provide psychiatric inpatients who are at risk of self-harm with appropriate therapeutic interventions.

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Faculty Opinions recommendation of Enhanced 'Reading the Mind in the Eyes' in borderline personality disorder compared to healthy controls.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1161894.623517 ◽

2009 ◽

Author(s):

Sabine Herpertz ◽

Alexander Lischke

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

Borderline Personality ◽

Healthy Controls ◽

The Mind

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Dyadic Emotion Regulation in Women with Borderline Personality Disorder

Cognitive Therapy and Research ◽

10.1007/s10608-021-10206-8 ◽

2021 ◽

Author(s):

Annemarie Miano ◽

Sven Barnow ◽

Stina Wagner ◽

Stefan Roepke ◽

Isabel Dziobek

Keyword(s):

Emotion Regulation ◽

Borderline Personality Disorder ◽

Personality Disorder ◽

Positive Emotions ◽

Male Partner ◽

Borderline Personality ◽

Self Report ◽

Negative Behaviors ◽

Support Seeking ◽

Threatening Situation

Abstract Background Emotion regulation (ER) and interpersonal dysfunction constitute key features of borderline personality disorder (BPD). Here, we tested if females with BPD show impairments in dyadic ER, that is in their support seeking and creation of closeness. We investigated if women with BPD might over-rely on their male partner by excessive support seeking and establishing of closeness, during conversations with personally and relationship-threatening topics. Methods Thirty couples in which the women were diagnosed with BPD and 34 healthy control (HC) couples were videotaped while discussing neutral, personally threatening, and relationship-threatening topics. Support seeking was rated by three independent raters, using a naïve observer method. The creation of closeness was rated using a continuous video-rating. Perceived emotions were assessed using self-report after each conversation. Results Women with BPD engaged in more support seeking than HC women, especially in more negative behaviors to elicit support, they created less closeness to their partner than HCs and reported a greater decline of positive emotions in both threatening conditions. Women with BPD displayed more fluctuations than controls between creating closeness and distance in the personally-threatening situation. They reported a larger increase in negative emotions after the relationship threatening conversation compared to female HC. Conclusions The present study indicates an increased demand of dyadic ER in BPD. Increased negative support seeking and less creation of closeness to the partner might reflect ineffective strategies to actually receive support from the partner.

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Shame in Borderline Personality Disorder: Meta-Analysis

Journal of Personality Disorders ◽

10.1521/pedi_2021_35_515 ◽

2021 ◽

Vol 35 (Supplement A) ◽

pp. 149-161

Author(s):

Tzipi Buchman-Wildbaum ◽

Zsolt Unoka ◽

Robert Dudas ◽

Gabriella Vizin ◽

Zsolt Demetrovics ◽

...

Keyword(s):

Systematic Review ◽

Borderline Personality Disorder ◽

Personality Disorder ◽

Meta Analysis ◽

Education Level ◽

Borderline Personality ◽

Healthy Controls ◽

Moderator Variables ◽

Core Feature ◽

Ptsd Symptomatology

Shame has been found to be a core feature of borderline personality disorder (BPD). To date, there is no existing systematic review or meta-analysis examining shame in individuals with BPD as compared to healthy controls (HCs). A meta-analysis of 10 studies comparing reported shame in BPD patients to HCs was carried out. Demographic and clinical moderator variables were included to see if they have a relationship with the effect size. Results showed that those with BPD had more reported shame than healthy controls. In addition, in BPD patients and HCs, higher education level was related to lower reported shame. In HCs, it was found that those who were younger reported a higher level of shame. Finally, among BPD patients, there was a relationship between levels of reported shame and elevated PTSD symptomatology. These findings emphasize the clinical relevance of shame in individuals with BPD and the need to formulate psychotherapeutic strategies that target and decrease shame.

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A meta-analysis of theory of mind and ‘mentalization’ in borderline personality disorder: a true neuro-social-cognitive or meta-social-cognitive impairment?

Psychological Medicine ◽

10.1017/s0033291721003718 ◽

2021 ◽

pp. 1-11

Author(s):

Emre Bora

Keyword(s):

Cognitive Impairment ◽

Borderline Personality Disorder ◽

Personality Disorder ◽

Theory Of Mind ◽

Cognitive Style ◽

Social Cognitive ◽

Meta Analysis ◽

Borderline Personality ◽

Healthy Controls ◽

Meta Analyses

Abstract Background It is widely accepted that borderline personality disorder (BPD) is associated with significant impairments in mentalization and theory of mind (ToM) which are considered as closely related concepts by many authors particularly in psychoanalytical circles. However, for understanding interpersonal difficulties in personality disorders, it is important to distinguish neuro-social cognitive impairment from the abnormal meta-social-cognitive style of patients. Methods The current systematic review aimed to conduct separate meta-analyses of ‘mentalization’ [reflective functioning (RF] and different aspects of ToM in BPD. A literature search was conducted to locate relevant articles published between January 1990 to July 2021. Random-effect meta-analyses were conducted in 34 studies involving 1448 individuals with BPD and 2006 healthy controls. Results A very large impairment in RF was evident in BPD [d = 1.68, confidence interval (CI) = 1.17–2.19]. In contrast, ToM impairment was modest (d = 0.36, CI = 0.24–0.48). BPD patients underperformed healthy controls in ToM-reasoning (d = 0.44, CI = 0.32–0.56) but not ToM-decoding. Increased HyperToM (d = 0.60, CI = 0.41–0.79) and faux pas recognition (d = 0.62, CI = 0.35–0.90) errors in BPD compared to healthy controls were most robust ToM findings in this meta-analysis. Conclusions BPD is characterized by very severe deficits in RF and modest and selective abnormalities in ToM. Interpersonal problems and difficulties in processing social information in BPD can be best explained by patients' maldaptive meta-social cognitive style and top-down effects of these abnormalities rather than having a primary neuro-social cognitive deficit.

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The Relationship Between Cognitive Abilities and Trait Clinical Features in Patients With Borderline Personality Disorder

Journal of Personality Disorders ◽

10.1521/pedi.2021.35.5.730 ◽

2021 ◽

Vol 35 (5) ◽

pp. 730-749

Author(s):

Martino Belvederi Murri ◽

Federica Folesani ◽

Silvia Costa ◽

Bruno Biancosino ◽

Luigi Zerbinati ◽

...

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

Clinical Features ◽

Cognitive Functions ◽

Borderline Personality ◽

Brief Symptom Inventory ◽

Structure Questionnaire ◽

Healthy Controls ◽

Personality Dysfunction ◽

The Relationship

Very few studies have focused on the relationship between cognitive functions and clinical features in borderline personality disorder (BPD). Subjects with BPD and healthy controls were administered the Repeatable Battery for the Assessment of Neuropsychological Status, Trail Making Test A and B, and the Wisconsin Card Sorting Test. The Brief Symptom Inventory (BSI-53) was used to assess the severity of current symptoms. Attachment style was assessed with the Experiences in Close Relationship Questionnaire, identity integration with the Personality Structure Questionnaire, and other domains of personality dysfunction with the RUDE Scale for Personality Dysfunction. Patients with BPD performed significantly worse than healthy controls in all cognitive domains. Cognitive functions, particularly delayed memory and visuospatial abilities, displayed meaningful associations with trait-like clinical features, above the effect of global cognition and state psychopathology. These findings highlight the need to evaluate effects of cognitive rehabilitation on trait features among individuals with BPD.

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Borderline Personality Disorder: Associations Between Dimensional Personality Profiles and Self-Destructive Behaviors

Journal of Personality Disorders ◽

10.1521/pedi_2018_32_346 ◽

2019 ◽

Vol 33 (2) ◽

pp. 249-261 ◽

Cited By ~ 1

Author(s):

Katharina Kolbeck ◽

Steffen Moritz ◽

Julia Bierbrodt ◽

Christina Andreou

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

Factor Model ◽

Five Factor Model ◽

Risk Preference ◽

Borderline Personality ◽

Self Report ◽

Personality Profiles ◽

Ongoing Research ◽

Destructive Behaviors

Ongoing research is shifting towards a dimensional understanding of borderline personality disorder (BPD). Aim of this study was to identify personality profiles in BPD that are predictive of self-destructive behaviors. Personality traits were assessed (n = 130) according to the five-factor model of personality (i.e., Neuroticism, Extraversion, Openness to Experience, Agreeableness, Conscientiousness) and an additional factor called Risk Preference. Self-destructive behavior parameters such as non-suicidal self-injury (NSSI) and other borderline typical dyscontrolled behaviors (e.g., drug abuse) were assessed by self-report measures. Canonical correlation analyses demonstrated that Neuroticism, Extraversion, and Conscientiousness are predictors of NSSI. Further, Neuroticism, Agreeableness, and Risk Preference were associated with dyscontrolled behaviors. Our results add further support on personality-relevant self-destructive behaviors in BPD. A combined diagnostic assessment could offer clinically meaningful insights about the causes of self-destruction in BPD to expand current therapeutic repertoires.

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