Is disruptive mood dysregulation disorder a precursor for borderline personality disorder?

Disruptive mood dysregulation disorder in children and adolescents is characterized by chronic irritability, in which outbursts of anger are manifested either verbally or through aggressive behavior. Before the last update of the Diagnostic and Statistical Manual of Mental Disorder (DSM-5), many severely irritable children were diagnosed with bipolar disorder. A borderline personality disorder is characterized by emotional instability, episodes of anger, impulsivity, and irritability; therefore, it is often misidentified as bipolar disorder. The behavior of disruptive mood dysregulation disorder resembles many characteristics of borderline, which diagnosis usually occurs in young adulthood. Is disruptive mood dysregulation disorder a precursor for borderline disorder?

Is Attentional Bias To Idiosyncratic Stimuli Related To Borderline Symptomatology?

Background: In borderline personality disorder, attentional bias to emotional stimuli may be a fundamental component in their origin and maintenance. However, the authors seem divided between the hypothesis of hypervigilance for negative stimuli and the hypothesis of over-reactivity against any type of stimuli. Aims: We aimed to observe the association between borderline symptoms and the allocation of attention to neutral, idiosyncratic negative and general negative emotional words. Method: We tested thirty-five portuguese university students, aged between 18 and 40 years old with an Emotional Stroop paradigm. Results: Our results suggest that a higher score of borderline symptoms are associated with a greater interference of idiosyncratic negative words in the colour identification task. Conclusions: These results support the hypervigilance hypotheses for idiosyncratic borderline stimuli. In other words, this study suggested that borderline sympotms is linked to an inability to disengage attention from negative words typically of borderline disorder. Based on these findings, mood-dependent therapeutic interventions focusing on attentional processes may represent a useful contribute to established therapies in patients with BPD.

Psychiatric Services and Teaching during the Covid-19 Pandemic in Romania

The Covid-19 pandemic has been declared in Romania on the 16th March 2020.The medical system reacted promptly: chronic patients had to be discharged within 48 h and further scheduled admittances were postponed, adequate epidemiological measures and circuits were organized. Anxiety, insomnia, frustration, binge eating, domestic violence were reported. The majority respected the general advises but soon, persons selected their information sources rather from social media, being victims of the infodemia and peculiar conspirationist theories. A new disorder has been described: coronaphobia. The psychiatric hospitals and outpatient settings had to reduce or innactivate their activity, switch as much as possible to TelePsychiatry. Psychiatry admittances were: onsets of psychosis, relapses of schizophrenia and alcohol, other psychoactive substances abuses, intoxications, and withdrawal states. Later, there were depressions, bipolar disorders, suicide attempts, self-harm in borderline disorder, dementia and delirium. Due to the closure of outpatient units for several months, patients visited the Emergency rooms. Personnel experienced burnout and new psychiatric pathology developed in the aftermath of Covid-19 infection. A big relief occurred with the initial vaccination of the medical staff and seniors, chronically ill persons, psychiatric patients being again left behind. Medical teaching shifted entirely to online and in 2021 the hybrid teaching system has been employed.

BORDERLINE PERSONALITY DISORDER WITH PARANOID ELEMENTS

The case of patient V is one you want to dig for, being an example in which a Cluster B disorder (i.e., borderline personality disorder) is also accompanied by elements from Cluster A (such as those in the paranoid area). Symptoms from the dependent personality can be involved. Objective: The presentation of a medical case of an 18-year-old young man, initially diagnosed at the age of 16 with Bipolar Affective Personality Disorder, and whose personality structure is better explained by a Borderline Disorder is the aim of the present article. Method: The patient was hospitalized involuntarily. He was under medical supervision and treatment. He also underwent specialized investigations (EEG, brain CT), psychological and personality tests, as well as daily monitoring. Throughout the procedure there have been a collaboration with his family and the authorities. Results: From the detailed anamnesis and the reconstruction of the significant life events, a borderline personality structure emerged, having a paranoid core that provided V the capacity of being goal-oriented. The personality scales also showed elements of an antisocial nature, manipulation and desire to be socially liked. Psychodynamic interpretations show an emotional flattening, avoidance of being in touch with he's own emotions and feelings, his unconscious mind housing an unbearable pain. Conclusions: The diagnosis of Bipolar Personality Disorder, sustained two years ago, is refuted, the patient being included in an axis II frame (i.e. borderline personality with a strong paranoid core and pathology of addiction)

Social Aspects of the Relationship between Narcissistic and Borderline Personality Disorder

Narcissism is a growing issue in modern society. Society values external, objective successfulness, overindulgence in hedonism, and superficiality more than inner emotional life. Individuals in modern society are faced with an inner emptiness, resulting in narcissistic, grandiose fantasies sometimes being the last defensive mechanism against that painful confrontation. Persons with borderline disorder are envious because they lack the strength of the narcissists, causing them to feel even more empty and powerless. When there is trauma and guilt between two groups of people, it is hard to deal with the issues directly and it is easier to take a narcissistic position projecting everything that is negative onto a person with borderline disorder. This creates a hot-and-cold relationship that constantly replays itself. This brings us to the social aspects of the relationship between narcissistic and borderline personality disorder, which is the topic of this article. Creating an environment and culture of forgiveness is a difficult, but not impossible path. It consists of healthy mourning, sublimating aggression, and encouraging good experiences and new interests. Additionally, it is important to encourage socialization and dialogue because this is the only way to achieve the empathy and altruism that we are trying to evoke and which lead to a better relationship.

Emotional regulation for adolescents: a group-based treatment pilot study through the STEPPS programme

Background:Borderline personality disorder (BPD) usually begins in adolescence and manifests itself in adult life. Early intervention can improve the prognosis or reduce its severity. Nevertheless, there are currently few studies of adolescent patients with severe emotion instability and borderline personality traits.Aims:To evaluate the effectiveness of the Systems Training for Emotional Predictability and Problem Solving (STEPPS) programme in a sample of 21 adolescents (aged 13–17 years) in the Child and Adolescents Mental Health Center of Tarragona in Spain.Method:We evaluated BPD traits using the Diagnostic Interview for Borderline Disorder-Revised (DIB-R) and the Global Clinical Impression Scale of Illness Severity for TLP (CGI-TLP). We compared pre- and post-treatment scores for the DIB-R, CGI-GI scale, general psychopathology using the Personality Inventory for Adolescents (PAI-A) and impulsivity with the Barratt Impulsivity Scale (BIS-11). The therapeutic objectives were evaluated with the Borderline Estimate Severity over Time (BEST) scale.Results:There was a statistically significant improvement in the scores for the affective area and in the total score of the DIB-R, a decrease in the percentage of patients who failed to meet criteria for BPD, and an improvement (although not statistically significant) in the scores of the BEST scale throughout the treatment. The results of the CGI-GI scale showed global improvement in almost 72% of patients.Conclusion:Our study suggests that STEPPS can be an effective treatment to improve BPD symptoms and is very useful in community settings with limited resources in which efficient treatment alternatives must be sought. However, this conclusion must be interpreted with caution, as there is no comparison control group.

M218. RELATIONSHIP BETWEEN JUMPING TO CONCLUSIONS AND OTHER COGNITIVE BIASES AND SOCIAL COGNITION IN PEOPLE WITH SCHIZOPHRENIA

Background Deficits in jumping to conclusions and social cognition have been described in people with schizophrenia. The aims of the study are to relate jumping to conclusions with social cognition and other cognitive biases in people with schizophrenia attended in rehabilitation services. Methods A descriptive study was performed. The subjects of our study were persons from 18 to 65 years old, attended in rehabilitation services, with schizophrenia diagnoses and other diagnoses with presence of psychotic symptoms (depression, bipolar disorder, borderline disorder, delusional disease, schizoaffective, and schizotypal personality). The variables included were JTC considered three beads tasks with different proportions: 85:15%, 60:40% and 60:40% salient task. Moreover, cognitive insight (BCIS), attributional style (IPSAQ), and Hinting Task -Theory of Mind (ToM) were assessed. A T student analysis was done in order to compare JTC with the rest of the quantitative variables. Results People who jump to conclusions in the salient task scored higher in self-certainty BCIS (p=0.028), in self attribution for negative events (p=0.036) and lower in attribution to other people of negative events (p=0.028). A tendency was found between the presence of JTC and ToM (p=0.051). In the task of 85-15 only a tendency was found between presence of JTC and higher scores in the personalizing bias (p=0.079). Moreover, in the task of 60:40 a tendency was found between presence of JTC and worse performance in the ToM test (p=0.051). Discussion We found a relationship between jumping to conclusions and self-certainty and self-attributions for negative events; as well as, it is a tendency that higher jumping to conclusions is related with worst ToM. There are important clinic implications of this, because we know that jumping to conclusions and theory of mind is related with the formation and maintenance of delusions.

DSM-V: major changes and overview on personality disorders with special reference to borderline disorder - DSM-V: principali modifiche e panoramica sui disturbi della personalità, con particolare riferimento al disturbo borderline - DSM-V: cambios mayores y visión general de los trastornos de personalidad con referencia especial al trastorno borderline

The purpose of this article is to describe the amendments made in the new version of DSM (fifth edition) as to understand not only main aspects of certain diseases and/or personality disorders, but also whether or not changes shifted focus to dimensional instead of categorical system or if in some aspects both are considered. Moving forward from a general overview of the handbook, the effective changes will be examined in detail. Attention will also be given to Personality Diseases, taking account of various studies on this subject and the most recent knowledge on “Borderline Disease” from a diagnostic standpoint. Considering the complex construction of such disease, will be firstly illustrated the assumption of first studies so as to cover the most recent clinical and theoretical contributions, together with a brief overview of some treatment approach such as psychodynamic, cognitive-behavioral and systemic-relational, principles of medical treatment, a summary on differential diagnosis and a representation of some clinical case as well. The article will be concluded by a brief discussion of future prospects able to provide the clinician with even more effective and safe operational strategies as to lead professionals towards more specific and less misleading assumptions for a better approach in any scope (therapeutic, forensic, etc.) and giving comfort to those who receive support as well. Everyone is a very unique individual, even if similar to others. That is why it is extremely important to clearly identify a disease and ensure an adequate treatment. RiassuntoL’obiettivo del presente lavoro, è quello di descrivere le principali modifiche apportate nella nuova versione del DSM (quinta ed.) rispetto a quella precedente, per cercare di comprendere non solo gli aspetti più significativi di determinate Patologie e/o Disturbi della Personalità, ma anche se nei suindicati cambiamenti, l’ottica si è spostata o meno ad un sistema dimensionale piuttosto che categoriale o se in alcuni aspetti, vengono considerati entrambi, partendo quindi da una panoramica generale sul Manuale, per poi affrontare nel dettaglio le reali modifiche. Verrà inoltre approfondita la tematica relativa ai Disturbi della Personalità, tenendo presenti i vari studi e ricerche sull’argomento e quindi le acquisizioni più recenti in termini di strumenti operativi utili da un punto di vista diagnostico-clinico, con particolare riferimento al “Disturbo Borderline”, decisamente complesso nel suo costrutto, partendo dall’assunto relativo ai primi studi sul tema, fino a giungere ai vari contributi teorico-clinici più recenti, unitamente ai cenni su alcuni approcci terapeutici quali ad esempio, psicodinamico, cognitivo-comportamentale e sistemico-relazionale, principi sulla farmacoterapia ed una sintesi sulla diagnosi differenziale, nonché la rappresentazione di alcuni Casi clinici. Concludendo con un sintetico excursus su quelle che potrebbero essere le prospettive future in grado di fornire strategie operative sempre più fertili e sicure per il clinico, sia a conforto dello stesso che di chi usufruisce dell’aiuto, guidando gli operatori verso ipotesi più specifiche e meno devianti, per un migliore approccio in qualsiasi ambito di applicazione (terapeutico, forense ecc..). Ogni soggetto è un individuo a se stante, pur evidenziando caratteristiche simili. Per questo è estremamente importante per quanto più è possibile, riuscire nell’individuazione di una precisa patologia su cui va applicato un mirato processo trattamentale. ResumenEl propósito de este artículo es describir las enmiendas hechas en la nueva versión del DSM (quinta edición) para comprender no solo los aspectos principales de ciertas enfermedades y / o trastornos de la personalidad, sino también si los cambios cambiaron el enfoque a dimensional en lugar de categórico sistema o si en algunos aspectos se consideran ambos. Avanzando desde una descripción general del manual, los cambios efectivos serán examinados en detalle. También se prestará atención a las enfermedades de la personalidad, teniendo en cuenta varios estudios sobre este tema y el conocimiento más reciente sobre "Enfermedad límite" desde un punto de vista diagnóstico. Teniendo en cuenta la compleja construcción de dicha enfermedad, se ilustrará en primer lugar la suposición de los primeros estudios para cubrir las contribuciones clínicas y teóricas más recientes, junto con una breve descripción de algunos enfoques de tratamiento, tales como psicodinámico, cognitivo-conductual y sistémico-relacional, principios del tratamiento médico, un resumen sobre diagnóstico diferencial y una representación de algunos casos clínicos también. El artículo concluirá con una breve discusión de las perspectivas futuras capaces de proporcionar al clínico estrategias operativas aún más efectivas y seguras para guiar a los profesionales hacia suposiciones más específicas y menos engañosas para un mejor enfoque en cualquier ámbito (terapéutico, forense, etc.). y dar consuelo a quienes también reciben apoyo. Todos son individuos únicos, incluso si son similares a los demás. Por eso es extremadamente importante identificar claramente una enfermedad y garantizar un tratamiento adecuado.