scholarly journals Bridging the Gap in Community Care for Patients With Borderline Personality Disorder: Protocol for Qualitative Inquiry Into Patient, Caregiver, and Clinician Perspectives on Service Gaps and Potential Solutions for Severe Emotion Dysregulation

10.2196/14885 ◽  
2020 ◽  
Vol 9 (8) ◽  
pp. e14885
Author(s):  
Laura Friesen ◽  
Graham Gaine ◽  
Ellen Klaver ◽  
Kirsten Klingle ◽  
Devashree Parmar ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Lived Experiences ◽  
Emotion Dysregulation ◽  
Care Pathway ◽  
Borderline Personality ◽  
Qualitative Inquiry ◽  
Future Research ◽  
Key Stakeholders ◽  
Clinician Perspectives

Background Borderline personality disorder (BPD) is characterized by severe emotion dysregulation that is often complicated by comorbid diagnoses, deliberate self-harm, and chronic suicidal ideation. Unfortunately, current care pathways for individuals with BPD are strained by limited resources, inadequate training, and an overuse of emergency departments and crisis teams. Such barriers result in delayed access to effective treatment, which increases risk of deterioration, disability, and morbidity. A first step toward addressing these limitations of the current care pathway is to understand key stakeholders’ lived experiences in this pathway and their perspectives on potential solutions. Objective The purpose of this paper is to present a protocol for a study that explores the lived experiences of the current care pathway from the perspectives of patients with BPD, as well as their caregivers and clinicians. Methods A qualitative approach is most appropriate for the exploratory nature of the research objective. Accordingly, 3 to 6 patients with a diagnosis of BPD, 3 caregivers of individuals with BPD, and 3 clinicians of patients diagnosed with BPD will be invited to participate in individual, semistructured interviews that focus on service experiences. Results It is anticipated that results will yield insight into the lived experiences of patients with BPD, caregivers, and clinicians and provide a better understanding of the perceived gaps in services and potential solutions. Results are expected to be available in 12 months. Conclusions This paper describes a protocol for a qualitative study that seeks to understand the lived experiences and perspectives of key stakeholders (patients, caregivers, and clinicians) on the current care pathway for BPD. Results will provide a basis for future research in this area and will have the potential to inform training, practice, and policy. International Registered Report Identifier (IRRID) DERR1-10.2196/14885

scholarly journals Bridging the Gap in Community Care for Patients With Borderline Personality Disorder: Protocol for Qualitative Inquiry Into Patient, Caregiver, and Clinician Perspectives on Service Gaps and Potential Solutions for Severe Emotion Dysregulation (Preprint)

2019 ◽  
Author(s):  
Laura Friesen ◽  
Graham Gaine ◽  
Ellen Klaver ◽  
Kirsten Klingle ◽  
Devashree Parmar ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Lived Experiences ◽  
Emotion Dysregulation ◽  
Care Pathway ◽  
Borderline Personality ◽  
Qualitative Inquiry ◽  
Future Research ◽  
Key Stakeholders ◽  
Clinician Perspectives

BACKGROUND Borderline personality disorder (BPD) is characterized by severe emotion dysregulation that is often complicated by comorbid diagnoses, deliberate self-harm, and chronic suicidal ideation. Unfortunately, current care pathways for individuals with BPD are strained by limited resources, inadequate training, and an overuse of emergency departments and crisis teams. Such barriers result in delayed access to effective treatment, which increases risk of deterioration, disability, and morbidity. A first step toward addressing these limitations of the current care pathway is to understand key stakeholders’ lived experiences in this pathway and their perspectives on potential solutions. OBJECTIVE The purpose of this paper is to present a protocol for a study that explores the lived experiences of the current care pathway from the perspectives of patients with BPD, as well as their caregivers and clinicians. METHODS A qualitative approach is most appropriate for the exploratory nature of the research objective. Accordingly, 3 to 6 patients with a diagnosis of BPD, 3 caregivers of individuals with BPD, and 3 clinicians of patients diagnosed with BPD will be invited to participate in individual, semistructured interviews that focus on service experiences. RESULTS It is anticipated that results will yield insight into the lived experiences of patients with BPD, caregivers, and clinicians and provide a better understanding of the perceived gaps in services and potential solutions. Results are expected to be available in 12 months. CONCLUSIONS This paper describes a protocol for a qualitative study that seeks to understand the lived experiences and perspectives of key stakeholders (patients, caregivers, and clinicians) on the current care pathway for BPD. Results will provide a basis for future research in this area and will have the potential to inform training, practice, and policy. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/14885

scholarly journals Identifying Core Deficits in a Dimensional Model of Borderline Personality Disorder Features: A Network Analysis

2018 ◽  
Vol 6 (5) ◽  
pp. 685-703 ◽  
Author(s):  
Matthew W. Southward ◽  
Jennifer S. Cheavens
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Network Analysis ◽  
Emotion Dysregulation ◽  
Interpersonal Problems ◽  
Borderline Personality ◽  
Future Research ◽  
Self Identity ◽  
Affective Intensity ◽  
Core Deficits

Researchers have proposed three core deficits of Borderline Personality Disorder (BPD): emotion dysregulation, interpersonal problems, and self-identity disturbance. Previous methods for testing these deficits rest on problematic assumptions (e.g., the assumption that observable/measured features of BPD, such as chaotic relationships and affective intensity, occur independently). A network model of psychopathology assumes that observable features of disorders directly interact, and network analytic methods quantify how central each feature is. We conducted a network analysis of core deficits of BPD features using a large ( N = 4,386) sample of participants with a range of BPD features. The most central features of participants in the High BPD group were loneliness, recklessness/impulsivity, and intense moods, supporting models of emotion dysregulation and interpersonal problems. The networks of BPD features did not differ between men and women. We provide directions for future research to enhance our understanding of how networks of BPD features change over time.

Identifying core deficits in a dimensional model of Borderline Personality Disorder features: A network analysis

2018 ◽  
Author(s):  
Matthew W. Southward ◽  
Jennifer S. Cheavens
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Network Analysis ◽  
Emotion Dysregulation ◽  
Interpersonal Problems ◽  
Borderline Personality ◽  
Future Research ◽  
Self Identity ◽  
Affective Intensity ◽  
Core Deficits

Researchers have proposed three core deficits of Borderline Personality Disorder (BPD): emotion dysregulation, interpersonal problems, and self-identity disturbance. Previous methods for testing these deficits rest on problematic assumptions (e.g., the assumption that observable/measured features of BPD, such as chaotic relationships and affective intensity, occur independently). A network model of psychopathology assumes that observable features of disorders directly interact, and network analytic methods quantify how central each feature is. We conducted a network analysis of core deficits of BPD features using a large (n = 4386) sample of participants with a range of BPD features. The most central features of participants in the High BPD group were loneliness, recklessness/impulsivity, and intense moods, supporting models of emotion dysregulation and interpersonal problems. The networks of BPD features did not differ between men and women. We provide directions for future research to enhance our understanding of how networks of BPD features change over time.

scholarly journals Mentalization and interpersonal problems in borderline personality disorder (BPD) traits

2020 ◽  
Author(s):  
◽  
Melanie Adamsons
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Emotion Dysregulation ◽  
Negative Emotion ◽  
Interpersonal Problems ◽  
Borderline Personality ◽  
Insecure Attachment ◽  
Future Research ◽  
Multiple Mediation ◽  
Convenience Sample

Difficulties in mentalization may be a developmentally based foundation for interpersonal problems in Borderline Personality Disorder (BPD). Fonagy and colleagues have developed a theoretical framework whereby relationships between difficulties in mentalization and other core characteristics of BPD (i.e., insecure attachment, intrapersonal emotion dysregulation and identity diffusion) may underlie interpersonal problems. However, most of the published work on these aspects of the framework have been theoretical in nature. The aim of the study was to investigate this framework and extend it by including interpersonal emotion dysregulation. Simple and multiple mediation analyses were performed with a convenience sample of 64 undergraduate students. Results indicated that hypomentalizing mediated the relationship between BPD symptoms and interpersonal problems. No significant mediators were found between insecure attachment and interpersonal problems or between mentalization errors and interpersonal problems. Limitations include the sample size and the lack of a negative emotion induction and recommendations for future research are suggested.

scholarly journals Dissociation in Borderline Personality Disorder: Recent Experimental, Neurobiological Studies, and Implications for Future Research and Treatment

2021 ◽  
Vol 23 (6) ◽  
Author(s):  
Annegret Krause-Utz ◽  
Rachel Frost ◽  
Elianne Chatzaki ◽  
Dorina Winter ◽  
Christian Schmahl ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Emotion Dysregulation ◽  
Inferior Frontal Gyrus ◽  
Superior Temporal Gyrus ◽  
Borderline Personality ◽  
Future Research ◽  
Post Traumatic Stress ◽  
Psychotherapeutic Treatment ◽  
Study Designs

Abstract Purpose of Review The aim of this review article is to give an overview over recent experimental neurobiological research on dissociation in borderline personality disorder (BPD), in order to inform clinicians and to stimulate further research. First, we introduce basic definitions and models that conceptualize dissociation from a transdiagnostic perspective. Then, we discuss recent findings in BPD. Recent Findings Stress-related dissociation is a key symptom of BPD, closely linked to other core domains of the disorder (emotion dysregulation, identity disturbances, and interpersonal disturbances). The understanding of neurobiological correlates of dissociation across different psychiatric disorders (e.g., dissociative disorders, post-traumatic stress disorder) is steadily increasing. At the same time, studies explicitly focusing on dissociation in BPD are still scarce. Summary There is evidence for adverse effects of dissociation on affective-cognitive functioning (e.g., interference inhibition), body perception, and psychotherapeutic treatment response in BPD. On the neural level, increased activity in frontal regions (e.g., inferior frontal gyrus) and temporal areas (e.g., inferior and superior temporal gyrus) during symptom provocation tasks and during resting state was observed, although findings are still diverse and need to be replicated. Conceptual differences and methodological differences in study designs and sample characteristics (e.g., comorbidities, trauma history) hinder a straightforward interpretation and comparison of studies. Given the potentially detrimental impact of dissociation in BPD, more research on the topic is strongly needed to deepen the understanding of this complex clinical condition.

Rumination in Borderline Personality Disorder: Meta-Analysis

2018 ◽  
Author(s):  
Mara J. Richman ◽  
Zsolt Unoka ◽  
Robert Dudas ◽  
Zsolt Demetrovics
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Emotion Dysregulation ◽  
Meta Analysis ◽  
Borderline Personality ◽  
Therapeutic Interventions ◽  
Sample Type ◽  
Moderator Variables ◽  
Analytic Review ◽  
Self Harm

Borderline personality disorder (BPD) is characterized by deficits in emotion regulation and affective liability. Of this domain, ruminative behaviors have been considered a core feature of emotion dysregulation difficulties. Despite this, inconsistencies have existed in the literature regarding which rumination type is most prominent in those with BPD symptoms. Moreover, no meta-analytic review has been performed to date on rumination in BPD. Taking this into consideration, a meta-analysis was performed to assess how BPD symptoms correlate with rumination, while also considering clinical moderator variables (i.e., BPD symptom domain, co-morbidities, GAF score) and demographic moderator variables (i.e., age, gender, sample type, and education level). Analysis of correlation across rumination domains for the entire sample revealed a medium overall correlation between BPD symptoms and rumination. When assessing types of rumination, the largest correlation was among pain rumination followed by anger, depressive, and anxious rumination. Among BPD symptom domain, affective instability had the strongest correlation with increased rumination, followed by unstable relationships, identity disturbance, and self-harm/ impulsivity, respectively. Demographic variables showed no significance. Clinical implications are considered and further therapeutic interventions are discussed in the context of rumination.

scholarly journals The neurodevelopmental trajectory of Borderline Personality Disorder: a review

2018 ◽  
Author(s):  
Siobhan R Edinboro ◽  
Tobias Nolte ◽  
Iris Vilares
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Brain Function ◽  
Emotion Dysregulation ◽  
Grey Matter ◽  
Neural Correlates ◽  
Borderline Personality ◽  
Therapeutic Interventions ◽  
Adult Onset ◽  
Neurodevelopmental Model

Borderline Personality Disorder (BPD) is a complex psychological condition characterised by affective instability, cognitive impairment, problematic behaviours and social dysfunction. Due to the variability in symptomatic profiles, efforts have recently been directed towards comprehending the disorder from a neurological standpoint within the aforementioned domains. Although adolescent-onset BPD is now reliably diagnosed as the adult-onset variant, a limited number of studies address the neural correlates of first presentation BPD. Moreover, research investigating the outcomes of therapeutic interventions on brain function and morphology is scarce. Preliminary findings consistently cite the involvement of grey matter deficiencies of the orbitofrontal cortex, hippocampus and amygdala in the neuropathology of BPD. Additionally, frontolimbic white matter deficits are thought to be implicated. Functionally, over-activity in limbic regions such as the cingulate cortices and amygdala are believed to partially account for emotion dysregulation, though the neural correlates of cognitive, social and behavioural impairments are relatively poorly understood. The present review will endeavour to evaluate the existing neurobiological evidence for BPD in adolescence as well as adulthood. Finally, a rudimentary neurodevelopmental model of BPD will be proposed.

Failures to Imagine

2016 ◽  
Vol 36 (3) ◽  
pp. 270-300 ◽  
Author(s):  
Reed Maxwell ◽  
Steven Jay Lynn ◽  
Scott Lilienfeld
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Mental Imagery ◽  
Emotional Regulation ◽  
Preliminary Evidence ◽  
Borderline Personality ◽  
Self Report ◽  
Future Research ◽  
Cross Sectional ◽  
Visual Mental Imagery

Although interest in the relationship between mental imagery and psychopathology has increased greatly over the last decade, few publications to date have examined relationships between personality-related psychopathology and mental imagery use, abilities, or both. However, we have reason to expect that substantive relationships may exist. For example, studies have consistently linked psychopathy and borderline personality disorder to problems in emotion experience and emotion regulation, and a growing number of studies indicate that deficits in visual mental imagery use and ability in particular may contribute to such problems. Using correlational data from multiple self-report measures of normal and pathological personality functioning and visual mental imagery, our study presents preliminary evidence for lower levels of self-reported visual mental imagery use, abilities, or both among noncriminal individuals with higher levels of self-reported psychopathy and individuals with greater emotional regulation difficulties, a core feature of borderline personality disorder. We also found significant relationships among self-reported visual mental imagery use, ability, or both, and personality variables shown to strongly predict psychopathy and emotional regulation difficulties. Limitations of the study, especially its reliance on a correlational, cross-sectional design, are discussed, and implications for future research are explored.

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