Borderline Personality Research Articles

Editorial

This spring we are facing a real weather rollercoaster and the geopolitical situation still triggers many concerns. I hope that lecture of the new issue of Archives of Psychiatry and Psychotherapy will feed our brains with new research update and bring some quality-relaxing time. In difficult times, we need to strenghten our skills to reinforce our general and mental health. The health- and resilience- oriented perspectives are investigated by Magdalena Gawrych et al. who draw our attention to the role of connectedness and coping strategies in the mental health model. In cases when traumatizing events appear, it is crucial to evoke one’s potential towards recovery and use evidence based treatments in case of negative health outcomes such as posttraumatic stress disorder (PTSD). Dialectical Behavior Therapy (DBT) has been established as one of the methods that can be successfully used in PTSD cases, also with co-occuring borderline personality disorder – for more information read the recent paper by Michałowska and Chęć.

Systematically Informed Literature Review: What is the Prevalence of Borderline Personality Disorder (BPD) in Adolescents, 13-17, using DSM-5 Criteria?

IntroductionIn child & adolescent mental health settings, borderline personality disorder (BPD) is a dominant and substantial condition with high occurrence rates seen in community, crisis, and in-patient settings. Previously because of multiple concerns, BPD diagnosis in adolescents was considered questionable and was perceived to be invalid. However, in light of the evidence, recent guidelines and diagnostic manuals affirm the diagnosis in the under-18 population.ObjectivesGiven its existence in adolescents and that DSM-5 (from 2013) allows diagnosing BPD in adolescents, a study was conducted in 2019 to explore what current literature had to say about its prevalence.MethodsTo answer this, a systematically informed literature review tried to look at the evidence. The hypothesis was that not many clinicians or researchers are aware of or using the opportunity to diagnose and thus manage BPD in adolescents, i.e., early in the course of this illness. Four databases were searched- PubMed, Embase, Medline, and Psycinfo- with the following inclusion & exclusion criteria: 1.Age: Adolescents (13-17).2.BPD (disorder not traits or features).3.Language – English, not just the abstract in English.4.Time limit & diagnostic criteria (2013 onwards, DSM-5).5.Full length articles not Abstracts alone.6.No geographical limit.7.Contacted academics personally for additional data.Following search terms were used: Borderline Personality Disorder, BPD, EUPD, Emotionally Unstable Personality disorder, DSM V, DSM 5, Diagnostic and Statistical Manual of Mental Disorders 5, DSM-5, Prevalence, Rate.ResultsAll searches yielded 525 results. Other sources didn’t identify any other records to be included. Out of these 525 results, 74 were duplicates. The inclusion and exclusion criteria were applied on the remaining resources. Of the remaining records, 133 were in language other than English, and thus, were excluded. Remaining 318 articles were assessed for eligibility. Of these, 196 had used diagnostic criteria or rating scales based on previous diagnostic criteria, and thus were excluded. Furthermore, 41 articles had focused on a totally other clinical question than ours. 79 articles had the wrong age range as per our diagnostic criteria. Thus, the total number of articles which met inclusion and exclusion criteria was 02. The results showed higher rates of BPD in adolescents, especially in those exposed to online sexual solicitation (OSS) (355 vs 13%) and in females (80% of cases).Image:Conclusions Despite the research and diagnostic allowance, there still seems to be reluctance among clinicians to diagnose BPD in adolescents. We advise consideration of BPD in adolescents if clinical picture indicates and application of the relevant criteria so patients can get appropriate treatment and support that they need.Disclosure of InterestNone Declared

Pharmacotherapy and psychotherapy interventions in patients with borderline personality disorder in outpatient clinical practice

IntroductionDespite the high prevalence of borderline personality disorder (BPD) in the population, the evidence regarding approaches to therapy for BPD is inconsistent. No psychopharmacological medications are approved for the treatment of BPD, yet most patients with BPD are treated with pharmacotherapy. Meanwhile, psychotherapy is the method of choice for the treatment of BPD. Little is known about the clinical practice of BPD treatment in Russia, since most studies have been conducted in Western countries.ObjectivesThe aim of the study: analysis of approaches to treatment of BPD in real outpatient clinical practice in Saint-Petersburg, Russia.MethodsFifty patients (72% female; n=36; mean age 22.4±4.3) who were treated in an outpatient community care were included in the study. Diagnosis was made according to the ICD-10 criteria (F60.31), as it does in clinical practice in Russia. Research methods included a clinical-catamnestic method.ResultsAll examined patients received pharmacotherapy. Twenty-four patients (48.0%) received monotherapy with a selective serotonin reuptake inhibitor antidepressant. The remaining patients (52.0%) received two or more psychotropic medications simultaneously. The most frequent combination of psychopharmacotherapeutic agents was a combination of an antidepressant and a mood stabilizer. Analysis of therapy revealed that antipsychotics (always of the second generation) as well as mood stabilizers were prescribed to target emotional instability and impulsivity as symptoms of BPD, as well as increased self-harming behavior in order to reduce impulsivity. Despite the assumption that the simultaneous prescription of several medications to patients with BPD was due to the presence of a comorbid psychiatric diagnosis, this was not confirmed (p>0.05). Most of the patients (n=42; 84.0%) received individual and group psychotherapy (cognitive-behavioral with elements of dialectical-behavioral therapy). It was found that patients who received psychotherapy had a faster response to pharmacotherapy (p<0.05).ConclusionsAn analysis of approaches to the treatment of BPD in outpatient clinical practice in Saint-Petersburg, Russia, showed a predominance of medication-assisted psychopharmacotherapy (selective serotonin reuptake inhibitors, antipsychotics, mood stabilizers) over the frequency of prescription of psychotherapeutic care. In none of the cases was a first-line psychotherapy method (with proven efficacy for BPD) used. An assessment of the availability of psychotherapeutic care for patients with BPD is required. An earlier initiation of psychotherapeutic care after the BPD diagnosis is recommended, which may lead to an increase in the effectiveness of psychiatric care for patients with BPD in outpatient clinical practice.Disclosure of InterestNone Declared

Impulsivity profile analysis and it’s potential role in the differential diagnostics of adult Attention Deficit Hyperactivity Disorder and Borderline Personality Disorder

IntroductionImpulsivity is a complex construct, having at least three factors: 1) impulsivity as a personality trait, 2) ismpulsive action – waiting and stopping impulsivity and 3) choice impulsivity. Impulsive symptoms are present in Attention Deficit Hyperactivity Disorder (ADHD) and Borderline Personality Disorder (BPD) as well, eventhough impulsvity profile significantly differs.ObjectivesOur aim is to describe the impulsivity profile in adult ADHD (aADHD) and BPD in comparison with the control group, and describe a characteristic pattern, which associates with these disorders.Methods aADHD (n=100) and BPD Patients (n=63) were included, based on DSM-5 diagnostic criteria. Healthy control subjects (n=100) were screened using the Derogatis Symptom Checklist (SCL-90). Comorbid psychiatric disorders were assessed by structured clinical interviews and those who have both aADHD and BPD were excluded from the study. Participants were further investigated with online questionnaires: e.g. Barratt Impulsiveness Scale (BIS-11) Difficulties in Emotion Regulation Scale (DERS) and neuropsychological tests, like CANTAB Rapid Visual Processing, Stop Signal Task, and the Rogers’ decision-making test.Results Based ont the BIS-11 results, significantly higher attentional impulsivity was present in adult ADHD compared to BPD (p<.001) and healthy controls (p<.001). Emotional regulation difficulties, measured by DERS were significantly higher in BPD (p<.001) than aADHD, but the impulse control problems were more pronounced in the aADHD group, compared to BPD (p<.001). Using CANTAB neuropsychological test battery, strategy formulation difficulties (p=0.16) and stopping impulsivity (p<.001) were only present in aADHD compared to HC. BPD patients did not differ significantly from the control group in strategy formulation and in Stop Signal Reaction Time, a measure of stopping impulsivity. The significantly higher level of total false alarms, reflecting on waiting impulsivity were present both in aADHD and BPD.ConclusionsAccording to our results these two disorders have different impulsivity profile characteristics, which can be useful in differentiating these two disorders, and in buiding treatment plans. Stopping impulsivity, measured by SST was found in aADHD, but not in BPD. In BPD impulsive behavior is more likely attached to emotional dysregulation, a trait rooted in childhood traumatization.This study was supported by the National Research, Development and Innovation Office grant K 129195 and K 135437.Disclosure of InterestNone Declared

Implementing policies and predictive stochastic models to attend to borderline personality disorder crises: the dysthymia-suicide cycle

IntroductionUK healthcare is undergoing significant challenges in facing borderline personality disorder (BPD) and accommodating the increased demand to allocate sufficient care and carers to deal with BPD’s growing number and emotional and suicidal crises.ObjectivesTo generate forecasting models and preventive policies to deal with BPD crises and improve the effectiveness of the UK National Healthcare Service in suicide prevention (NHS).MethodsThe underlying analysis framework is stochastic forecasting. We used current knowledge and data to complete systematic future predictions extracted from recent trends. A logical-mathematical model generated the required expressions. The software for logic prediction and annotation was Wolfram Alpha (Wolframalpha.com).Results Persons with BPD become suicidal because the team cannot comprehend and address the cycle of dysthymia, rumination and suicide. The BPD crises start from Stage 1 (α), assessing the comorbidity between BPD with dysthymia, cyclothymia, autism and ADHD. Teams shall avoid overmedication as ineffective. Stage 2 (β) is introspection and rumination, which do not respond to pharmacotherapy. The health carers establish if rumination is present and suggest distraction techniques. Stage 3 (γ) is when constant rumination with catastrophising leads to hopelessness. Stage 4 (δ) is when BPD starts feeling more anxious, depressed and unable to stop rumination. We suggest thought-stopping techniques and discourage social isolation, which triggers rumination. As BPDs use external locus of control and aim for higher dosages of antidepressants and anxiolytics with minimal effect, we explain that medication is not the only solution. Stage 5 (ε) is a crisis and panic attack because constant rumination brings back traumatic thoughts focused on the past, present and future. This is when BPDs self-refer to the hospital, attempt suicide, and feel that hospital admission is the only solution. The stages combined generated Model I. The Model II forecast Δ from this study is that we will observe a higher frequency (Δ) of hospital occupancy (Δbo = A), suicidal attempts (Δsa = B), and heavy service use (Δsu = C) by BPDs.ConclusionsThe predictive model algorithm has thus extracted (1) Model I (Analysis): [α → (β → (γ → (δ → ε)))] = Z; The truth density for Model I and its strength of prediction for stage progression is 96.87% in the dysthymia-rumination-suicide cycle; and (2) Model II (Prediction): Z implies (A And B And C), Z→A ∩ B ∩ C; the truth density for the Model II is 56.25% for predicting a national shortage of healthcare resources. The combined models predict a truth of 73.81% in the outcomes of BPD crises in the UK NHS due to the dysthymia-suicide cycle.Disclosure of InterestNone Declared

The feasibility of a combined approach including neuromodulation by tDCS and cognitive remediation for people with borderline personality disorder (BPD)

IntroductionBPD is a common and severe mental health condition. Longitudinal studies related to BPD show a reduction of symptoms related to the disorder but very little improvement in functionality. The betterment of executive functions of people with BPD after psychotherapy is very limited. The efficacy of those treatments on functionality appears to be mild with a small effect size. Based on previous studies, transcranial direct current stimulation (tDCS) can be used to improve impulsivity and emotional instability in patients with BPD. Moreover, cognitive remediation focuses on reducing neuropsychological alterations by re-educating patients and apply specific strategies to aid them long term on certain daily functions like developing healthy habits, executive functions, problem solving, attention, working memory and cognition.ObjectivesOur objective is to assess the feasibility and efficacy of the tDCS and cognitive remediation on BPD symptoms and functioning.MethodsThe open study includes 10 daily sessions of tDCS for 2 weeks and 8 weekly group meetings for the cognitive remediation. Based on studies conducted on people with BPD, the settings for the tDCS are as follows; 20 minutes of continuous current at the intensity of 2mA and the electrodes are placed on specific stimulation sites related to impulsivity. To verify the effectiveness of the combination on the symptoms and evaluate the cognition and functionality of the patients, questionnaires at neuropsychological texts are conducted at the beginning of the study, after the tDCS, after the cognitive remediation and 3 months after the end of the study. The expected results of this study are that the combination of the two treatments will reduce the symptoms of BPD and improve executive functions compared to the treatment as usual or tDCS alone. This study would allow the implementation of an efficient and low-cost first-line treatment and a better functional progression of BPD patients.ResultsThe expected results of this study are that the combination of the two treatments will reduce the symptoms of BPD and improve executive functions compared to the treatment as usual or tDCS alone. This study would allow the implementation of an efficient and low-cost first-line treatment and a better functional progression of BPD patients.ConclusionsThis study would allow the implementation of an efficient and low-cost first-line treatment and a better functional progression of BPD patients.Disclosure of InterestNone Declared

Exploring Transference in Borderline Personality Disorder: An Empirical Study of Facial Resemblance and Emotional Valence.

Transference is a psychological process where feelings and attitudes towards a familiar person are unconsciously redirected to another. This phenomenon can be activated by physical resemblance, including facial features. Despite its potential therapeutic significance, little research has investigated transference processes in individuals with psychiatric conditions. Here, we explored how patients with borderline personality disorder (BPD)-characterized, among other features, by unstable relationships, self-damaging impulsivity, and suicidal ideation-would exhibit transference of negative and positive attributes. We performed an experiment where BPD participants and a control group with no prior psychiatric history completed a face-rating task. The task involved an evaluation of images of strangers who resembled significant others in terms of facial features. Our results indicated that transference effects were elicited in both groups. Notably, there were significant differences in ratings assigned to significant others, whereby participants with BPD displayed transference of negative attributes more and positive attributes less intensely than healthy controls, which, in part, correlated with attachment anxiety. Our findings align with the tendency in BPD to perceive interpersonal relationships and emotions more negatively. They have potential implications for psychotherapeutic approaches in treating patients with BPD and our understanding of underlying pathophysiological mechanisms of BPD itself.

Implementing policies and predictive stochastic models to restrict borderline personality disorder’s access to restricted medications: comorbidity with factitious disorder, functional neurological disorder and medically unexplained symptoms

IntroductionWe are facing increased access to hospital beds and increased use of restricted medications by people with borderline personality disorder (BPD). Our former research shows BPD comorbidity with factitious conditions, functional neurological disorder and medically unexplained symptoms. We also registered that persons with BPD might craft or exaggerate symptoms to access restricted medications. In the worst cases, they might share these medications (benzodiazepines, hypnotics, and anxiolytics) with street values for profit or other recreational purposes.ObjectivesTo generate forecasting models and preventive policies to deal with BPD factitious disorders and improve the effectiveness of the UK National Healthcare Service (NHS) in reducing unnecessary admissions to general and psychiatric hospitals. More selective policies will capture and discourage BPD’s feigning and exaggerating symptoms for accessing restricted medications.MethodsThe underlying analysis framework is stochastic forecasting. We used current knowledge and data to complete systematic future predictions extracted from recent trends. A logical-mathematical model generated the required expressions. We identify four major model components to be introduced in the model: BPD (A), factious disorders (B), prescribing restricted medications (C), antisocial behaviours (D), and access to hospital beds (E).ResultsThe Boolean expression becomes [A then B then C then D then E], or [A ⇒ (B ⇒ (C ⇒ (D ⇒ E))] with a truth density of 96.875% (Figure 1).ConclusionsBPD should alert healthcare of the risks of symptom exaggeration and factitious mental diseases. These conditions are used to access often restricted medications, such as benzodiazepines, sleep tablets, and anxiolytics, for personal and communal use. Street sharing of these last increases local criminality. In worst cases, a hospital bed is granted without preventive triage. The risk is the indoor access to these medications. We advocate policies for the discontinuation of community prescription of these drugs.Disclosure of InterestNone Declared

Self-Hatred: The Unaddressed Symptom of Borderline Personality Disorder.

Individuals with borderline personality disorder (BPD) often report chronic, severe self-hatred. It is frequently experienced as immutable, seen as a barrier to recovery, and is associated with risk for self-injury and suicide attempts. Yet self-hatred remains a poorly understood, underdiagnosed, and undertreated presentation of BPD. In this concept article and review, we describe the nature of self-hatred in BPD and related disorders, propose a theory as to the development of self-hatred in BPD, review the assessments of and interventions for self-hatred, and consider next steps in the research, assessment, and treatment of self-hatred in BPD. Through increased awareness, understanding, and measures of self-hatred in BPD, new treatment paradigms can be developed to ensure more comprehensive recovery.

Use of Long-Acting Injectables in Borderline Personality Disorder: What Do We Know?

IntroductionPsychotherapy serves as the foundation of care for individuals with borderline personality disorder (BPD), with pharmacotherapy being regarded as a supplementary measure to be considered when necessary. In clinical practice, however, most of BPD patients receive medication.A major problem in the treatment of BPD is the lack of compliance derived from the pathological impulsivity of BPD patients. The use of long-acting antipsychotics (LAI) may be an option.ObjectivesThis work aims to address the use of long-acting injectables in borderline personality disorder.MethodsNon-systematic review of literature using the PubMed ® database, based on terms “Borderline Personality Disorder” and “Long-acting antipsychotics”. Only six articles were found.ResultsSeveral studies have shown promising results in the treatment of Borderline Personality Disorder (BPD) with long-acting injectable (LAI) antipsychotics. A six-month study using IM risperidone demonstrated significant improvement, while LAI Aripiprazole also exhibited positive outcomes in individuals with BPD and Substance Abuse. Additionally, Palomares et al. (2015) found that palmitate paliperidone LAI reduced impulsive-disruptive behaviors and enhanced overall functioning in BPD patients. Carmona et al. (2021) compared oral and LAI antipsychotics and concluded that LAIs may have a role to play in the management of BPD.ConclusionsTreatment with LAIs may play an important role in clinical and functional improvement in BPD patients.Disclosure of InterestNone Declared

Cognitive functioning of patients with borderline personality disorder

IntroductionThe neurocognitive deficit model as a characteristic of patients with borderline personality disorder (BPD) has been the focus of research for the past 20 years. However, no such studies have been performed in Russia.ObjectivesThe aim of the present study was to investigate the neurocognitive profile of patients with BPD.MethodsFifty patients with BPD (according to DSM-V criteria) in stable mental state (72% women; mean age 22.44±4.32) were examined. BPD symptom severity was assessed using the Borderline Personality Disorder Questionnaire (PBQ-BPD), which was validated in the Russian population (34 points or more indicated a higher probability of BPD diagnosis). The Brief Assessment of Cognition in Schizophrenia (BACS) was used to assess cognitive function (in order to use these data for differential diagnosis with schizophrenia spectrum disorders). The study was approved by the ethical committee of Saint Petersburg State University.ResultsOn the PBQ-BPD results, 38% of patients (n=19) scored over 34 points, despite being stable. BACS subscales T-scores (presented as median [Q1; Q3]) were within normal limits (Verbal memory - 49.81 [46.56; 53,06]; Working memory - 43.73 [38.0; 47.50]; Motor function - 44.08 [41.0; 47.25]; Coding - 45.56 [42.50; 48.63]; Verbal fluency - 48.14 [46.0; 52.0]; Tower of London test - 52.33 [47.0; 57.0]). A number of patients had low scores on the BACS subscales (T-score < 40), particularly working memory (33.3%), coding (20.8%), and verbal memory (18.8%). The BACS Composite T Score (46.02 [43.65; 48.39]) correlated with the PBQ-BPD score (32.00 [27.00; 36.00]; r=-0.316; p=0.028). To better characterize the cognitive functioning of patients with BPD, patients were divided into two groups: those who scored less than 34 on the PBQ-BPD (group 1) and those who scored more than 34 on the PBQ-BPD (group 2). Group 2 patients had a lower BACS Composite T-score (42.32 [38.06; 46.58]; 48.45 [45.87; 51.03]; p=0.009) and nominally lower mean scores on all BACS subscales, compared with Group 1 patients. We found significant differences in T-scores values on the Working Memory subscale (Group 1 - 45.0 [41.0; 49.0]; Group 2 - 38.0 [33.0; 43.5], p=0.003), Verbal Fluency (49.0 [47.25; 53.75]; 48.0 [44.0; 49.0]; p=0.047), Tower of London Test (57.0 [52.0; 57.0]; 48.0 [42.0; 57.0]; p=0.036).ConclusionsNeurocognitive impairment was detected in 33.3% of patients with BPD. The dominant cognitive impairments in the patients were decreased working and verbal memory and information processing speed. The severity of BPD symptoms has been confirmed to correlate with the neurocognitive functioning of these patients.Disclosure of InterestNone Declared

The effectiveness of emotion regulation training on behavioural and cognitive inhibition of teenagers with borderline personality disorder

Background and purpose: Adolescence is one of the most important developmental periods. Difficulty in emotion regulation, and coping, and the presence of borderline personality symptoms can lead to suicidal thoughts and a lack of control of aggression. This research was conducted to determine the effect of emotion regulation training on behavioural and cognitive inhibition of teenagers with borderline personality disorder. Research method: The current research is practical in terms of its purpose and terms of method, it is a semi-experimental study in which a pre-test-post-test design with a control group was used. The statistical population of this study consisted of juveniles from Mashhad Correctional Center with an age range of 14 to 18 years, who were suffering from borderline personality disorder, and 20 people were selected in an available manner and randomly replaced in experimental and control groups. The experimental group underwent 8 sessions of emotion regulation program and the control group did not receive any intervention. Before and after the intervention in the experimental group, both groups did the pre-test and post-test. SPSS-24 software and covariance analysis were used to analyze the data. Findings: The findings showed that emotion regulation training has a direct and positive effect on the behavioural inhibition of teenagers suffering from borderline personality disorder. Based on the findings, emotion regulation training has an effective role in reducing the problems of borderline people. Conclusion: Therefore, it is suggested that courses of self-regulation, emotional adaptation and emotion regulation be used as supplements to improve the conditions of this group.

The relationship between non-suicidal self-injury and suicidal ideation in patients with borderline personality disorder treated at the Arrazi psychiatric hospital in Salé

IntroductionNon-suicidal self-harm, i.e. the intentional self-infliction of bodily harm without apparent suicidal intent, is a powerful risk factor for suicidal ideation and behavior [1]. Although non-suicidal self-harm and suicidal behaviour are distinct concepts, the two forms of deliberate self-harm frequently coexist and share key instrumental functions, such as escaping aversive internal states, reducing dysphoria or communicating distress, especially in patients with personality disorders. [2]Some individuals also report using non-suicidal self-harm to ameliorate suicidal thoughts or urges [2].ObjectivesTo assess the relationship between non-suicidal self-harm and suicidal ideation in patients with borderline personality disorder followed at the Arrazi psychiatric hospital in Salé.MethodsThis was a descriptive cross-sectional study using a questionnaire including sociodemographic criteria, clinical criteria and the Beck suicidal intentionality scale to assess the relationship between non-suicidal self-harm and suicidal ideation in patients with borderline personality disorder followed and hospitalised at the Arrazi psychiatric hospital in Salé.The inclusion criteria were as follows: both sexes with a diagnosis of borderline personality disorder according to DSM 5 criteria.Exclusion criteria were current psychosis and severe intellectual disability.ResultsWe collect 63 participants.The average age of the participants was 23, and they were predominantly female (89%). About 85% were single and 97% had no occupation. The majority of participants had a substance use disorder.All participants had a history of non-suicidal self-harm and 36% had a history of suicide attempts.Suicidal intent was strong in 45% of participants who had already attempted suicide.Approximately 46% of participants reported that non-suicidal self-harm was intended to alleviate suicidal ideation and approximately 27% of participants reported having experienced suicidal ideation shortly after non-suicidal self-harm.Conclusions Non-suicidal self-harm is very common in patients with borderline personality disorder often considered to have a mitigating effect on the internal stress of these patients and sometimes even neglected. The relationship between non-suicidal self-harm and suicidal ideation is an important one, and may reduce suicidal ideation in the short term but subsequently encourage further self-harm, thereby increasing the risk of suicide.Particular attention must be paid to these patients and their self-harm, and specialised, comprehensive care is required.Disclosure of InterestNone Declared

Implementing policies and predictive stochastic models to attend to borderline personality disorder crises: rationalising ssri antidepressants prescription in suicide prevention

Introduction We are facing increased suicide attempts and deliberate self-harm from persons with borderline personality disorder (BPD) who are also on antidepressants, multiple antidepressant prescriptions and antidepressant augmentations. Our previous observations suggest that antidepressants might increase suicide attempts in those on this medication and who have BPD. The absent response to antidepressants is due mainly to the comorbid dysthymia, cyclothymia, rumination, autism and ADHD in BPD.ObjectivesTo generate forecasting models and preventive policies to deal with BPD crises and improve the effectiveness of the UK National Healthcare Service (NHS) in suicide prevention.MethodsThe underlying analysis framework is stochastic forecasting. We used current knowledge and data to complete systematic future predictions extracted from recent trends. A logical-mathematical model generated the required expressions. The software for logic prediction and annotation was Wolfram Alpha (Wolframalpha.com). The four parameters for stochastic predictions are, BPD (A), antidepressant No. 1 (B), antidepressant No. 2 (C), and suicide attempts (D). Boolean function metrics can help analyse the impact and truth of forecast modelling with truth density.ResultsThe logic expression for suicide prediction due to liberal antidepressant prescribing is Ψ = A intersects B, intersects C, intersects D; that is,. Ψ = A ∩ B ∩ C ∩ D, which yields a Boolean truth density of 6.25%. The truth table always has a positive outcome as long as any of the factors exist except when none is present.ConclusionsThe predictive Boolean function and truth table suggest that suicide presentation is predictable if there is a prescribing of one or more antidepressants in BPD and if there is an antidepressant augmentation or dose maximisation. We speculate that SSRI antidepressants block self-regulatory mechanisms of fear of death while triggering impulses to self-harm and suicide from overstimulation of SSRI receptors. Without fear mechanisms, death by suicide is felt as not terrifying.Disclosure of InterestNone Declared

The elephant in the room: Is betrayal trauma associated with borderline personality disorder?

Borderline personality disorder (BPD) has been found to be closely linked to childhood trauma, particularly betrayal trauma. In our study, we aimed to investigate the association between betrayal trauma and anxiety among young adults. We assessed a total of 305 young adults using a Google form utilizing three assessment tools: the 10-item McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD), the 12-item Brief Betrayal Trauma Survey (BBTS), and the 7-item Generalized Anxiety Disorder (GAD-7) to evaluate borderline personality traits, betrayal trauma experiences, and anxiety level. Our findings revealed that 22% [95% confidence interval (CI) 17.7 to 26.9] of the participants screened positive for BPD on MSI-BPD assessment; self-reported anxiety as reported by GAD-7 was observed in 27.9% (95% CI 23.1 to 33.2), while 82% (95% CI 77.3 to 85.9) reported experiencing betrayal trauma. A significantly higher proportion of individuals with BPD (97%) reported experiencing betrayal trauma compared to those without the disorder. High betrayal trauma [odds ratio (OR) 8.14, 95% CI 3.06 to 21.67] and medium betrayal trauma (OR 7.06, 95% CI 2.64 to 18.92) were significantly associated with the diagnosis of BPD. The associations held true across genders, although they were stronger in females. Our study highlights the strong relationship between betrayal trauma and BPD, with significant implications for the development of anxiety in young adults. These findings underscore the importance of recognizing and addressing childhood trauma, particularly betrayal trauma, in individuals at risk for BPD.

Sexuality in patients treated for borderline personality disorder at the Arrazi psychiatric hospital in Salé

IntroductionBorderline personality disorder is a severe mental disorder characterized by generalized instability of emotional regulation of interpersonal relationships and self-image, and marked impulsivity. Several features of this disorder are likely to be associated with problematic sexual health, such as impulsivity (impulsive sexual behavior), identity disorders (unstable sexual identity) and unstable and intense interpersonal relationships. In addition, childhood sexual abuse and violence are common in people’s histories.ObjectivesAssessing sexuality in patients followed for borderline personality disorder at Arrazi Salé psychiatric hospital.MethodsThis is a descriptive cross-sectional study using a questionnaire including socio-demographic criteria with a questionnaire on sexual behavior in female patients followed for borderline personality disorder at the Arrazi Salé psychiatric hospital. Inclusion criteria: women over 18 years of age diagnosed with borderline personality disorder. Exclusion criteria: psychosis, intellectual disability.ResultsWe collected 45 patients with borderline personality disorder. The average age was 22, 80% were single, 58% unemployed, 46% had dropped out of high school. The majority of participants were using psychoactive substances. 25% had attempted suicide. 83% were victims of childhood sexual abuse. The majority were significantly more likely to engage in sexual activity at a younger age than their peers. Over 60% had never used contraception 10% had their first pregnancy at a younger age, with termination. 15% have had genital infections. 53% were attracted to both sexes, and over 66% had more than one sexual partner. Over 73% did not experience sexual satisfaction (sexual satisfaction scale less than 10).ConclusionsThe results indicate that sexuality in patients with borderline personality disorder is present early in the course of the disorder, often at a young age, with significant physical, mental and social consequences. Primary care mental health, sexual health and sexual assault services need to be attentive to the clinical diagnosis of this personality disorder, as the nature of the disorder represents both a risk factor and a health threat.Disclosure of InterestNone Declared

Comparing The Effectiveness Of Mentalization-Based Therapy And Dialectical Behavior Therapy In An Adult Population With Cluster B Personality Disorders To Reduce Hospital Service Use

IntroductionMentalization-based therapy (MBT) and dialectical behavior therapy (DBT) are two treatments known to be effective for borderline personality disorder (BPD). However, head-to-head comparisons between those two treatments are scarce and their effectiveness in naturalistic clinical services, where BPD is often comorbid with other cluster B personality disorders (PD), needs to be further explored.ObjectivesThe study’s goal was to answer the following question: Is there a difference in emergency department visits, hospitalizations and dropout rates after one year of treatment in MBT compared to DBT for a clinical adult population with cluster B PD?MethodsWe compared the effectiveness of MBT and DBT in 288 patients between 2015 and 2019 with at least one cluster B PD by measuring their emergency services use and hospitalizations one year before and one year after beginning therapy. Drop-out rates for those two treatment modalities are also compared. Image 1 illustrates the patient distribution for the study.ResultsIn terms of reducing emergency room use, patients in each treatment group experienced a significant decrease with medium effect sizes (p < .001 for both, d=.768 for MBT and d=.640 for DBT).In terms of reducing hospitalizations, the MBT group had a significant decrease (p < .05) with a medium effect size (d=.568) whereas the DBT group had a non-significant decrease (p = .595) with a negligible effect size (d=.140).When we compare both therapies, no significant differences were found between them in terms of reductions in emergency room use (p = .358) and hospitalizations (p =.195), as well as dropout rates (p = .743). Image 2 further illustrates the dropout trends in the first year of treatment for both groups in intervals of 3 months.Hospitalizations were rare in our population, which may hinder the validity of results containing this variable. In absolute numbers, total emergency room visits decreased from 119 to 37, whereas hospitalizations were reduced from 24 to 12. Drop-out rates before entering treatment were high (20.6%), as it was during treatment for both therapies (around 30% in the first year of treatment).Image:Image 2:ConclusionsThis study emphasizes that both DBT and MBT are linked to a reduction in service use over time. Dropout rates in both treatments are also similar to other studies. Therefore, future research should investigate the factors that can help clinicians guide individuals with PDs towards the type of therapy that is most suitable for them.Disclosure of InterestNone Declared

A relational frame approach to perspective taking in persons with Borderline Personality Disorder

Perspective taking is important for effective interpersonal functioning. According to Relational Frame Theory (RFT), perspective taking is underpinned by deictic relational framing. It has been proposed that individuals with Borderline Personality Disorder (BPD) may have deficits in perspective taking. A mixed experimental design (N = 112) was used to assess whether individuals with a diagnosis of BPD displayed impaired perspective taking on a computerised RFT deictic relational task (DRT) and a self-report measure, compared to a control sample. There was no significant difference between groups on the computerised DRT. Within the clinical group, overall distress and relational distress were not found to be significantly associated with DRT performance or self-reported perspective taking. However, those with BPD self-reported significantly worse perspective taking ability compared to the control sample. This finding indicates a discrepancy between perceived perspective taking ability and direct perspective taking performance in persons with BPD.

Sense of Agency and Its Disturbances: A Systematic Review Targeting the Intentional Binding Effect in Neuropsychiatric Disorders.

IntroductionThe sense of agency (SoA) indicates a person’s ability to feel her/his own motor acts as actually being her/his, and through them to exert control over the course of external events. Disruptions in SoA may profoundly affect the individual’s functioning, as observed in several neuropsychiatric disorders.ObjectivesThis is the first article to systematically review studies that investigated intentional binding (IB), a quantitative proxy for SoA measurement, in neurological and psychiatric patients.MethodsEligible were studies of IB involving patients with neurological and/or psychiatric disorders. The research adhered to the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).ResultsWe included 15 studies involving 692 individuals. Risk of bias was low throughout studies. Eligible studies dealt with data from 357 patients with neuropsychiatric disorders matched with 335 HCs. Of included patients, 95 were with schizophrenia (SCZ), 30 with a putative prodromal psychosis (PP), 21 with borderline personality disorder (BPD), 66 with Parkinson’s disease (PD), 38 with an autism spectrum disorder (ASD), 29 with functional movement disorders (FMDs), 25 with Gilles de la Tourette syndrome (GTS), 52 with anorexia nervosa (AN; 22 with active disorder and 30 after they had recovered), and 10 with Cortico-Basal syndrome (CBS).Temporal binding was calculated in eleven studies using variations of the experimental procedure introduced by Haggard et al. (Haggard et al. Nat Neurosci 2002;5 382-385)(Figure 1, A), while four studies utilized a different paradigm named interval estimation (IE)(Figure 1, B).Image:ConclusionsAbnormally increased action-outcome binding was found in schizophrenia and in patients with Parkinson’s disease taking dopaminergic medications or reporting impulsive-compulsive behaviours. A decreased IB effect was observed in Tourette’s disorder and functional movement disorders whereas increased action-outcome binding was found in patients with cortico-basal syndrome. The extent of IB deviation from healthy control values correlated with the severity of symptoms in several disorders. Inconsistent effects were found for autism spectrum disorders, anorexia nervosa, and borderline personality disorder. Findings pave the way for treatments specifically targeting SoA in neuropsychiatric disorders where IB is altered.Disclosure of InterestNone Declared

Borderline personality disorder in adolescents as a predictor of social anxiety

IntroductionBorderline personality disorder (BPD) is a mental disorder characterized by unstable relationships, a tendency to self–destruction, affective and behavioral dysregulation and BPD are a clinical problemObjectivesEarly detection and timely intervention for BPD is becoming a new public health priority as it helps prevent the adverse personal, social and economic consequences of the disorder. Borderline personality disorder first manifests itself, as a rule, in adolescence, so it is easy to mistake it for manifestations of “difficult age” characteristic of the period of growing up. In this sense, the typical signs of borderline personality disorder are not original: low self-esteem, emotional excitability, impulsive behavior and sudden mood swings, to one degree or another characteristic of all adolescents. An alarming exception is, perhaps, only a tendency to self-harm and, the so-called, desocialization of a teenager, the loss of social skills and connections (for example, friendships). Recently, experts have increasingly mentioned desocialization in connection with the development of Internet technologies and gadgets that replace communication in real life for many teenagersMethodsAn anonymous survey of 57 older teenagers conducted. The degree of borderline personality disorder assessed using IPDE, STAI, and CDI. Statistical processing of the results carried out in Microsoft Excel using measures of the central trend (arithmetic mean, standard deviation) and correlation analysis. The significance of the differences between the groups was determined using the Student’s t-test (p < 0.05)ResultsOn average, the level of BPD among the respondents was at a low level of 9.81 (±4.43) points. The severity of personal anxiety was at a high level of 45.02 (±13.25) points, situational anxiety was also at a high level of 41.14 (±14.93). The severity of depression was above average and amounted to 55.84 (±14.33) pointsConclusionsTeenage girls are more prone to anxiety and depression than boys are. High anxiety causes a tendency to depression, and these two factors affect the occurrence of PRL. The average score does not affect the manifestations of anxiety, depression and the occurrence of BPDDisclosure of InterestNone Declared