Borderline Pathology Research Articles

Clinical cut-off scores for the Borderline Personality Features Scale for Children to differentiate among adolescents with Borderline Personality Disorder, other psychopathology, and no psychopathology: a replication study

BackgroundDespite being one of the most popular measures of borderline pathology in adolescents, only one study has evaluated clinical cut-off scores for the Borderline Personality Features Scale for Children (BPFS-C) using a small sample without a healthy comparison group (Chang B, Sharp C, Ha C. The Criterion Validity of the Borderline Personality Features Scale for Children in an Adolescent Inpatient Setting. J Personal Disord. 2011;25(4):492–503. https://doi.org/10.1521/pedi.2011.25.4.492.). The purpose of the current study was to replicate and improve on the limitations of the prior study conducted by Chang et al. to more definitively establish clinical cut-off scores for the self- and parent-report versions of the BPFS-C to detect clinical and sub-clinical borderline personality disorder (BPD) in a large sample of adolescents with BPD, other psychopathology, and no psychopathology.MethodsA total of 900 adolescents ranging from ages 12–17 participated in this study. The clinical sample consisted of 622 adolescents recruited from an inpatient psychiatric facility, and the healthy control sample consisted of 278 adolescents recruited from the community. All participants completed the BPFS-C and were administered the Child Interview for DSM-IV Borderline Personality Disorder (CI-BPD).ResultsUsing three-way ROC analyses, cut-off scores on the self- and parent-report versions of the BPFS-C distinguishing adolescents with BPD from those with subclinical BPD, and those with subclinical BPD from healthy adolescents were established.ConclusionsThese findings support the use of both versions of the BPFS-C to detect adolescents with BPD and sub-clinical BPD.

Minding mentalizing - convergent validity of the Mentalization Breakdown Interview.

Mentalizing difficulties are central to borderline personality disorder (BPD), have severe consequences, and are an explicit focus in mentalization-based treatment. The significance of mentalizing capacity as a predictor or mediator of change is however still uncertain due to a scarcity of research. The Mentalization Breakdown Interview (MBI) was developed as a time saving tool for studying psychotherapy processes and outcome in borderline pathology. This study aimed to investigate the convergent validity of reflective functioning (RF) ratings based on the MBI (MBI-RF) by a comparison with the gold standard, i.e., RF assessments based on the Adult Attachment Interview (AAI-RF). A secondary aim was to investigate how MBI-RF relates to core symptoms of BPD, levels of functional impairment and symptom distress compared with AAI-RF. Forty-five patients with BPD or significant BPD traits were included. MBI-RF and AAI-RF were rated using the Reflective Functioning Scale. Levels of MBI-RF and AAI-RF and the correlation between the measures were calculated, as well as their associations with the Difficulties in Emotion Regulation Scale, Levels of Personality Functioning-Brief Form 2.0, Work and Social Adjustment Scale, Patient Health Questionnaire, Depression, Generalized Anxiety Disorder-7, self-harm, suicide attempts, and PD diagnostics. The correlation between MBI-RF and AAI-RF was 0.79 (p<0.01), indicating high convergent validity. There were few significant associations between MBI-RF and AAI-RF and clinical measures. The study provides support for the convergent validity of the MBI as a BPD-focused RF assessment method. The MBI has the potential as a time saving, reliable and valid method to be applied in treatment research on patients with borderline pathology. The results indicate that measures of MBI-RF and AAI-RF are different from clinical symptoms. ClinicalTrials.gov ID NCT04157907.

Histopathological diagnoses revealed by indication-based renal allograft biopsies: a retrospective analysis

Objectives: Although there have been several advances in post-solid organ transplantation immunosuppression medications over the last two decades, the long-term survival of renal allografts did not significantly improve. Renal allograft biopsy is a helpful tool for determining the cause of graft dysfunction and adjusting patient management. Methods: Patients who received kidney transplantation and underwent allograft biopsy in Istinye University Hospital between January 2017 and January 2023 constituted the target population of this study. Demographic parameters, clinical data and biopsy indications, and histopathological assessment results of the patients were retrospectively analyzed. Results: Overall, 74 patients were included. The histopathology results included acute T-Cell mediated rejection (TCMR) (n = 15, 20%), tubular atrophy/chronic allograft nephropathy (IFTA) (n = 11, 15%), calcineurin inhibitor (CNI) toxicity (n = 2, 3%), chronic antibody-mediated rejection (ABMR) (n = 2, 3%), borderline pathology (n = 10, 13.5%), normal histology (n = 5, 6.5%), transplant glomerulopathy (TG) (n = 5, 6.5%), acute ABMR (n = 4, 5%), acute tubular necrosis (n = 7, 9%), polyomavirus nephropathy (n = 3, 4%) and non-specific changes (n = 10, 13.5%). The C4d was positive in 12% (n = 9) of the graft biopsies. In 73% (n = 54) of cases, the treatment strategy was changed based on biopsy results. Among all patients, 19 (25.6%) lost their grafts during follow-up. Conclusions: According to the histopathological analysis results, acute TCMR, IFTA, and borderline pathology were the most common causes of renal graft dysfunction. Renal allograft biopsy led to a remarkable change in treatment strategies in a significant number of cases.

Therapeutic alliance and dropout in patients with borderline pathology receiving residential dialectical behavior therapy

BackgroundThis study focused on the impact of therapeutic alliance on therapy dropout in a naturalistic sample of patients with borderline pathology receiving dialectical behavior therapy (DBT) in a residential setting. We assumed that low therapeutic alliance shortly after admission would be associated with elevated dropout.Methods44 participants with borderline pathology (≥ 3 DSM-5 borderline personality disorder criteria) in a residential DBT program completed a quality assurance questionnaire set assessing demographic information, pretreatment psychopathology and therapeutic alliance during the first seven days of their residential stay. Predictors of dropout were investigated using binary logistic regression analyses.ResultsThe dropout rate was 34.1% (n = 15). In binary logistic regression analyses with variables covering demographic and clinical characteristics, comorbidities and childhood trauma history, only the therapeutic alliance significantly predicted dropout (z = -2.371, p = .018).ConclusionsThis study supports the importance of therapy process variables, here the therapeutic alliance at the beginning of treatment, as predictors of therapy dropout in borderline pathology. If this finding is replicated, it shows the potential importance of monitoring the therapeutic relationship throughout the therapeutic process. ClinicalTrials.gov Identifier: NCT05289583, retrospectively registered on March 11, 2022.

Three-level containment model of hospitalized adolescents with borderline pathology: a holistic therapeutic perspective.

Borderline personality disorders account for 50% of adolescent hospitalization cases in psychiatry. The severity and psychopathological complexity of these symptoms indicate the need for inclusive models of understanding. Adopting a holistic approach allows for the consideration of not only the patient's environment, but also their position within that environment and their life history. In this article, a model based on the concept of therapeutic containment at three levels is presented. Global containment refers to the mindset and organization of the institution that provides care, which is itself a part of society at a specific time. Local containment focuses on understanding and therapeutic interventions within the immediate social environment of the individual. Lastly, individual containment encompasses the development of independent processes during the course of care. These three levels are integrated in the hospital treatment of borderline personality disorders, forming a trans-theoretical approach.

Revisiting the vulnerable dark triad hypothesis using a bifactor model.

Miller etal. (2010) previously suggested that borderline pathology, vulnerable narcissism, and Factor 2 psychopathy share a common "Vulnerable Dark Triad" (VDT) core. The present study (N = 1,023 community participants) aims to test that hypothesis using exploratory and confirmatory bifactor analyses. We found support for a bifactor model that obtained satisfactory fits and other adequate validity indices, which included a general VDT factor and three group factors (Reckless, Entitled, Hiding). The general VDT factor was mostly saturated with borderline symptoms items reflecting self-hatred and worthlessness, which did not form a group factor; these results add to previous research suggesting that features of borderline pathology may represent the core of personality pathology. The three group factors had distinctive relationships with Dark Triad traits, pathological trait domains, and aggression. In contrast with the three group factors, the general VDT factor more strongly incremented the prediction of negative affectivity and hostility; the group factors more strongly incremented the prediction of grandiosity, egocentrism, callousness, Machiavellianism, and direct (physical/verbal) aggression. Alignment of the retained bifactor model with influent models of personality pathology and conceptual/methodological implications of the present results for research on the hypothesized VDT are discussed, as well as some clinical implications of the findings.

How Can I Trust You? The Role of Facial Trustworthiness in the Development of Epistemic and Interpersonal Trust

Recently, researchers from developmental and clinical psychology highlighted epistemic trust (ET) as a key factor for personality disorders. ET is intended as the mental openness to information coming from others during social exchanges. ET develops from signals called ostensive cues, delivered through facial expressions during interactions in a secure attachment context. Similarly, interpersonal trust (IT) refers to the perception of others as not harmful, which is also developed through secure attachment relationships. Our purpose was to suggest a conceptualization of ET as a specific facet of IT. We hypothesize that positive experiences of caregiving promote IT development that includes a specific sense of trust toward others’ knowledge. Moreover, we suggest that the early ability to infer a judgment of trustworthiness from facial cues is the starting point for developing both IT and ET. This conceptualization supports the role of considering both IT and ET in the development of borderline pathology.

Feasibility and Safety of Laparoscopic Surgery in Large Ovarian Masses

ABSTRACT Ovarian masses are relatively common conditions, with approximately 5%–10% of women requiring surgical treatment for an ovarian neoplasm during their lifetimes. A laparoscopic approach is the primary choice in surgical management of benign small ovarian masses; however, concerns remain about the feasibility and safety of laparoscopic surgery for large ovarian masses. Causes of concern include difficult visualization, potential for damage to intra-abdominal organs, and risk of an unintended rupture of occult malignancy leading to intraperitoneal spillage requiring subsequent adjuvant therapy. This retrospective cohort study aimed to assess the feasibility and safety of laparoscopic treatment for large ovarian masses with benign features. Patients that underwent laparoscopic surgery between 2017 and 2019 at a tertiary care center were included. Only patients with a low risk of malignancy (risk of malignancy index [RMI] &lt;200 or increased serum cancer antigen 125 [CA-125] level with typical characteristics of endometrioma and mature cystic teratoma by ultrasonographic examination) were included. Women were divided into 2 groups based on ovarian mass diameter, with a large mass defined as ≥10 cm and a control group with ovarian masses &lt;10 cm in diameter. Demographic and oncology parameters were compared between groups, as were outcomes including operating time, postoperative day 1 hemoglobin concentration, intraoperative and postoperative complications, conversion to laparotomy, length of hospital stay, and histopathological results. A Student t test was used for normally distributed continuous data, and Mann-Whitney U test was used for data not normally distributed. A total of 260 women underwent laparoscopic surgery for ovarian masses during the study period, 64 of whom had a large mass with 196 in the control group. The demographic and clinical characteristics were similar between groups, as were the serum CA-125 and RMIs (P &lt; 0.05). Multilocular cystic appearances (45.3% vs 24.5%, P = 0.002) and intra-abdominal ascites (7.8% vs 1.5%, P = 0.024) were more common in the large mass cohort. The salpingo-oophorectomy rate (65.6% vs 44.4%, P = 0.003), conversion to laparotomy rate (7.8% vs 0.0%, P = 0.001), and aspiration of cyst contents rate (29.7% vs 5.1%, P &lt; 0.001) were all significantly higher in patients with large masses than without. No differences were observed between groups in terms of laparoscopy technique, operation time, complication rate, intraoperative cyst rupture rate, preoperative and postoperative hemoglobin levels, or length of hospital stay. Histopathology results varied between groups, with mucinous cystadenoma (25.0% vs 9.2%, P = 0.001) being the most common benign pathology in the large-mass group and follicular cysts (22.4% vs 10.9%, P = 0.044) the most common in the control group. A total of 5 patients in the large-mass group were found to have unexpected malignant or borderline pathologies on frozen section, whereas none were found in the small-mass group (P = 0.001). The results of this study demonstrate that laparoscopic surgery of large ovarian masses is feasible in large adnexal tumors presumed benign and had comparable operation time and length of hospital stay compared with the control group. Although the rate of conversion to laparotomy was higher among the large-mass group, this was due to intraoperative pathology confirming a malignant mass rather than technical difficulties. Appropriate selection of patients with low suspicion for malignancy is of critical importance.

A Psychosis Superspectrum in Borderline Personality Disorder?

Introduction The innermost relationship of the borderline concept and psychosis has been historically intertwined and can be traced back to the 20th century, but remarkably, to date, they have not been the focus of many empirical studies. Likewise, the contributions of empirical research on the DSM-5 dimensional approach to this topic are also uncommon. Objectives In this study the framework of psychosis superspectrum were put closely in relation to both DSM-5 psychoticism/detachment domains, personality traits and psychopathological symptoms features in borderline personality disorder (PD). Methods A cross-sectional study of a borderline PD sample of 58 participants (Mage=39.76 years, SD=11.37; Mschooling=9 years), mainly male (58.5%). Self-reported assessment: PID-5; BSI; NEO-FFI. A multiple linear regression was computed. Results In borderline PD, the PID-5 disinhibition (β=.51), BSI psychoticism (β=.43), BSI depression (β=-.24) and NEO neuroticism (β=.29) predicted psychosis superspectrum, explaining 94% of the variance. Also, stands out as a complement that, the BSI psychoticism was predicted by PID-5 detachment and PID-5 psychoticism, explaining 82% of the variance. Conclusions Evidence appears to be emerging for the underlying psychosis superspectrum trough borderline PD. There is a closer dialogue between the state-of-art view of a dimensional pathological personality-symptoms and the borderline pathology. Disclosure of Interest None Declared

Examining the Construct Validity of Borderline Personality Traits Using Familial Aggregation and Other External Validators.

Numerous studies have questioned the reliability and validity of borderline personality disorder's (BPD) categorical conceptualization. DSM-5 Section III's alternative trait-based model of BPD may better capture borderline pathology, but aspects of its validity should be further established. Thus, the authors examined whether a latent BPD factor derived from Section III traits exhibits (1) familial aggregation among siblings and (2) association with constructs related to borderline pathology. The authors also tested whether gender moderated associations. A total of 498 community-recruited adults completed the Personality Inventory for DSM-5, a behavioral assessment of risk-taking, and reported their history of childhood maltreatment, substance use, nonsuicidal self-injury, and suicidal ideation. Familial aggregation was assessed among 232 sibling pairs. Siblings' BPD scores were significantly correlated and most external validators were significantly associated with BPD, with the exception of risk-taking. Results did not vary by gender. Findings further support the construct validity of Section III's BPD trait profile.

Recruiting and exploring vulnerabilities among young people at risk, or in the early stages of serious mental illness (borderline personality disorder and first episode psychosis).

IntroductionMany gaps exist in our understanding of the developmental pathways to severe mental illness (SMI), including borderline personality disorder (BPD) and psychosis. However, those who have experienced adverse childhood experiences (ACEs) are at an increased risk and there is evidence to suggest that one of the earliest markers is emotional dysregulation. An area which has received relatively less research attention is the role neurodevelopmental disorders (NDDs) play. The aim of this feasibility study was therefore to explore the clinical profiles of young people early in the course of SMI, including their profiles of ACEs, emotional regulation difficulties, borderline personality traits and NDDs.MethodsA cross-sectional study of young people (aged 15–25) at risk of SMI, currently being seen within NHS mental health services, was conducted. This included those with early symptoms of psychosis and/or BPD as assessed by diagnostic interview. Eligible participants self-completed a battery of sociodemographic, clinical, and psychological measures in the company of a researcher. This included assessments of: symptoms of NDDs; borderline pathology traits; ACEs; and difficulties in emotional regulation. Statistical analyses included Mann–Whitney U tests and multiple regression.ResultsOf the 118 potentially eligible participants who were referred, 48 were ultimately included in the study. Young people early in the course of SMI reported a high prevalence of ACEs and deficits in emotional regulation. In total, 79% met criteria for attention deficit hyperactivity disorder (ADHD) and/or autism spectrum disorder (ASD). Emotional dysregulation was found to significantly mediate the association between both ACEs and the frequency of NDDs and borderline personality traits, however given the small sample size these results are preliminary in nature.ConclusionYoung people early in the course of SMI are at an increased risk of experiencing multiple childhood adversities and our results indicate a high prevalence of NDDs amongst them. Emotional dysregulation emerged as a potentially significant early marker of future clinical severity. We suggest that the clinical implications of our findings include routine screening for NDDs and ACEs and an increased recognition of the significance of emotional dysregulation. However, larger scale longitudinal studies are needed to investigate these preliminary findings further.

Adolescents With Non-Suicidal Self-Harm—Who Among Them Has Attempted Suicide?

We aimed to determine differences between adolescents with non-suicidal self-harm with and without a history of suicide attempt (SA). Sixty-eight adolescents with a mean age of 15.6 years (SD = 1.5) attending child and adolescent psychiatric outpatient clinics for repeated self-harm in Oslo, Norway, were included. A battery of instruments was used to assess sociodemographic information and psychopathology such as Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnoses, emotional and behavioral problems, borderline symptoms, depression, hopelessness, suicidal ideation, and history of SA. Twenty-six participants (38.2%) reported a lifetime history of SA. Compared to the participants without a history of SA, those with an SA history had used a higher number of methods of self-harm and methods with higher lethality and had higher degrees of emotional and behavioral problems. They also scored higher in depressive symptoms, borderline pathology, emotional dysregulation, hopelessness, and suicidal ideation. History of SA was independently associated with perceived moderate to high risk of death on the most severe episode of self-harm (adjusted odds ratio [aOR], 15.93; 95% confidence interval [CI], 1.96–129.66), a longer duration (months) since self-harm debut (aOR, 1.07; 95% CI, 1.01–1.13), and suicidal ideation severity (aOR, 1.05; 95% CI, 1.01–1.11). Parental report of behavioral problems associated with SA suggested a strong association with externalizing problems. A combination of having a high level of psychopathology, externalizing problems, an extended history of self-harm behavior and use of more lethal self-harm methods seems to entail a significantly increased risk for making SAs among adolescents with non-suicidal self-harm. HIGHLIGHTS Non-suicidal self-harm (NSSH) with suicide attempt may be distinctive from NSSH without suicide attempt. Adolescents with NSSH with suicide attempt had relatively greater psychopathology. Protracted/lethal self-harm methods and externalizing problems indicate comorbidity.

Trauma and Outcomes of Mentalization-Based Therapy for Individuals With Borderline Personality Disorder.

Recent meta-analyses suggest that many patients with borderline personality disorder have a history of complex trauma. Although trauma is central in mentalization-based approaches to the understanding of borderline personality disorder, surprisingly little is known about the effects of trauma on outcomes of mentalization-based treatment (MBT). This article investigates the prevalence and impact of childhood trauma among patients with borderline personality disorder participating in a randomized controlled trial (RCT) comparing day hospital MBT (MBT-DH) and intensive outpatient MBT (MBT-IOP). All 114 patients from the original multicenter RCT in the Netherlands were included in this study. Childhood trauma was assessed at baseline (with the Childhood Trauma Questionnaire), and its impact on symptom severity, interpersonal functioning, and borderline pathology was investigated through multilevel modeling for 36 months after the start of treatment. Childhood trauma was common among patients with borderline personality disorder referred to MBT, with more than 85% meeting cutoff criteria for substantial childhood trauma. Childhood trauma had little impact on outcomes of either MBT-DH or MBT-IOP in terms of improved borderline personality disorder features or interpersonal functioning. However, patients with substantial childhood trauma seemed to improve more rapidly with MBT-DH, as compared with MBT-IOP, in terms of symptom severity. In addition, patients with a history of emotional neglect showed more rapid changes in symptoms of borderline personality disorder with MBT-DH compared with MBT-IOP. Findings are discussed in the context of a social communicative approach to borderline personality disorder, with a focus on the need to address trauma in MBT.

Explicit and Implicit Measures of Identity Diffusion in Adolescent Girls With Borderline Personality Disorder.

The present study is the first to examine both the implicit and explicit self-concept of identity diffusion in a sample of adolescent patients with borderline personality disorder (BPD). A clinical sample of adolescent girls with diagnosed BPD (N = 30; M age = 15.9 years) and a sample of girls with a healthy personality development (N = 33; M age = 16.6 years) completed an implicit association test (IAT) that was adjusted to identity diffusion, the core of BPD. Common domains of child and adolescent psychopathology and core components of BPD were assessed using self-reports on the Strengths and Difficulties Questionnaire (SDQ), the Borderline Personality Features Scale for Children—11 (BPFSC-11) and the Assessment of Identity Development in Adolescence (AIDA). BPD patients scored significantly higher on explicit measures of borderline pathology than girls with a healthy personality development. A crucial finding for this study was that girls with BPD had a significantly lower implicit preference for stability than their counterparts in the control group. Moreover, explicit measures of borderline personality pathology were significantly correlated with an implicit measure of identity diffusion, the core of BPD. However, when looking at the predictive ability of implicit and explicit measures, only explicit identity diffusion was significantly associated with borderline features. Our data suggests that adolescent girls with BPD differ from healthy individuals not only in their conscious representation but also in their implicit representation of the self with regard to BPD related characteristics, which further advances the need for the identification of at-risk adolescents.

Psychoanalysis in the community in France

ABSTRACT There has been a long tradition of psychoanalysis in the community in France. The first psychoanalysts working in public institutions did so in places such as the network of the Offices publics d’Hygiène sociale (OPHS), initially intended to treat tuberculosis, infant mortality, etc., after the Second World War. The introduction of psychiatric care in the community mobilized a genuine interpenetration of psychoanalysis and psychiatry. In 1953, the SPP founded the Centre de Consultations et de Traitements Psychanalytiques, and in 1955 Victor Smirnoff created a children's centre. In 1958, Philippe Paumelle created the Association de Santé mentale du 13ème arrondissement de Paris (ASM 13), a pilot project, implemented in 1960 as “district psychiatry”, which is France’s national policy of community psychiatry. In the consultation centres of these psychiatric districts, called centres médico-psychologiques (CMP), psychotherapy is provided by clinical psychologists, who are largely psychoanalytic in orientation. In 1972, Pierre Marty and Michel Fain created what would become the Institut de Psychosomatique in 1978. In 1974, ASM 13 created its own Centre de psychanalyse with Jean and Évelyne Kestemberg, specialising in psychotic and borderline pathologies. The activities and theoretical contributions of these psychoanalytic public centres are presented in this paper, with attention to: the distinction between treatment and consultation; the introduction of a new approach to psychosomatics; the description of a psychotic relation to the object as fetish; the research about free treatment and its implications. Currently, the situation of psychoanalysis in France is divided between the medical authorities who reject psychoanalysis in the name of evidence-based medicine, and the persistence of psychoanalysis in both public and private practice. More generally, it appears that the central issue at stake is the conception of the ‘psychic human being’ and psychic causality in Western societies.

Therapists\u2019 emotional state after sessions in which suicidality is addressed: need for improved management of suicidal tendencies in patients with borderline personality pathology

IntroductionPatient suicidality is a frequently experienced topic for psychotherapists. Especially adolescents with borderline personality pathology (BPP) often exhibit suicidal tendencies. Previous research which examined therapists’ countertransference towards suicidal patients suggested that therapists are negatively affected and distressed by them. We hypothesize that this emotional response of the therapists is related to specific sessions in which suicidality came up as a topic. Accordingly, the objective of this study consists in examining therapists’ emotional state on a session level of analysis.MethodsThe sample consisted of N = 21 adolescents (age 13–19 years) with BPD or subthreshold BPD. Therapists’ emotional states were measured in n = 418 sessions using the Session Evaluation Questionnaire. Principal component analysis was used to reduce dimensionality of the therapist response. The emotional states were compared depending on whether suicidality has been addressed in the session (SS) or not (NSS).ResultsTwo components could be identified. Firstly, therapists were more aroused, excited, afraid, angry and uncertain after SS than after NSS. Secondly, therapists were more aroused, excited, definite and pleased after SS than after NSS. Discussion: Suicidality does not always have to be a burden for therapists: Both a “distress” and an “eustress” component occur in this context from which the latter is supposed to help clinicians master a difficult situation. Since countertransference feelings are often not fully conscious, it is necessary to do research on therapists’ emotional states after sessions in which suicidality is addressed. This is crucial to both prevent the therapeutic process from being endangered and preserve clinicians’ mental health. Clinical implications and limitations are discussed.

Chronic feelings of emptiness in a large undergraduate sample: Starting to fill the void.

Chronic emptiness in borderline personality disorder (BPD) has received little empirical attention. We sought to examine basic properties of a single chronic emptiness item, including prevalence, reliability, validity, the relation of the emptiness item to other BPD criteria, and measures of personality. Undergraduates enrolled in psychology courses over 12 years' time completed the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) (N = 22,217). Subsets of participants completed the International Personality Disorder Examination-Screening Questionnaire (IPDE-SQ) (N = 2732), The Revised NEO Personality Inventory (Anxiety, Angry Hostility, Depression, Positive Emotions [reversed], and Impulsivity facets) (N = 10,506), and the Depression Anxiety Stress Scales (DASS) (N = 1110) as validity indicators; 10.0% of respondents endorsed emptiness. Reliability indices suggested moderate levels of reliability between two emptiness items (r(2730) = 0.61, p < 0.001). Among BPD criteria, emptiness and identity disturbance correlated most strongly (r(22,215) = 0.81, p < 0.001). MSI emptiness was more correlated with depression on the NEO (r(10,504) = 0.43, p < 0.001) and DASS (r(1108) = 0.51, p < 0.001) than other facets of negative affect. Emptiness was more correlated with greater borderline pathology than any other MSI-BPD item (Sample 1, rtet = 0.87; Sample 2, rtet = 0.86). This criterion warrants further study and attention, especially related to assessment of BPD.

Evaluation of Sentinel Lymph Node Sampling in Complex Atypical Hyperplasia

<h3>Study Objective</h3> Primary objective - to evaluate safety and efficacy of sentinel lymph node (SLN) sampling during robot assisted total laparoscopic hysterectomy and bilateral salpingo-oophorectomy (TLH/BSO) of patients with complex atypical hyperplasia (CAH). Secondary objective - to determine the risk of endometrial carcinoma in patients with preoperative diagnosis of CAH. <h3>Design</h3> Retrospective chart review performed from May 2012 to February 2020 of CAH patients who underwent TLH/BSO. Demographic data, operative data, histopathology, SLN ultra-staging data collected. Intra-operative and 30-day postoperative complications evaluated using Clavien-Dindo classification. <h3>Setting</h3> Single institution. <h3>Patients or Participants</h3> Inclusion criteria was preoperative diagnosis of CAH, ages 18-90, robotic assisted TLH/BSO. 74 charts reviewed 57 patients included. <h3>Interventions</h3> Of 57 patients, 25 patients underwent SLN sampling under near infra-red light after cervical injection of indocyanine green dye. 32 patients in control group that did not have lymph node sampling. <h3>Measurements and Main Results</h3> Two-sided t-test, Chi squared test and Fisher's exact test used in data analysis. The incidence of cancer was 32/57 (56.1%). Thirteen (52%) patients in SLN group had cancer vs 19 (59.4%) in the control group. The rate of deep (>50%) myometrial invasion in SLN group was 30.8% vs 5.3% in control group (P=0.05). The map rate of SLN was 100% (76% Bilateral, 24% Unilateral). Zero SLN sampled were positive for metastatic disease. 30-day complication rate in SLN group was 0% vs 6.3% in control group (P=0.5). Sixteen (28%) patients had borderline (bordering on carcinoma) pathology on preoperative sampling. Eight (50%) had SLN sampling. Twelve (75%) had a postoperative diagnosis of cancer. There were no identified preoperative risk factors for cancer. <h3>Conclusion</h3> The incidence of endometrial cancer in patients with preoperative diagnosis of CAH was 56%. Zero patients had metastatic disease to SLN. SLN dissection was not associated with more operative time or complications. Patients with a preoperative borderline pathology seem to have a higher risk of cancer.

Psychometric Properties of the Italian Mentalization Questionnaire: Assessing Structural Invariance and Construct Validity

Mentalization is an important interpersonal ability, necessary for adaptive interpersonal relationships and emotion regulation. Deficits in mentalization have been associated with poor psychological outcomes and have been observed in patients with Borderline Personality Disorder. The Mentalization Questionnaire (MZQ) has been developed as self-report measure of mentalization deficit. The aim of the study was to investigate the dimensionality of the MZQ in a nonclinical sample composed of Italian adults from the general population and to analyze its performance in categorizing individuals with higher risk of borderline symptoms. A non-clinical sample of 1,015 adults (709 women and 306 men) was administered the Italian versions of the MZQ, the Reflective Functioning Questionnaire (RFQ), and a measure of borderline psychopathology. A revised single-factor solution fitted the data well and demonstrated metric invariance across gender. The internal consistency (Ordinal α = 0.87) and stability (r = 0.84) were satisfactory. The MZQ was moderately associated with the RFQ dimensions. The ROC curve analysis showed that the MZQ was able to discriminate satisfactorily people with higher risk for borderline symptomatology from those with lower risk. The MZQ may, therefore, be considered a reliable and valid measure of mentalization for categorizing people at higher risk for borderline pathology.

Negative self-conscious emotions in women with borderline personality disorder as assessed by an Implicit Association Test.

Shame and guilt are vital in borderline personality disorder (BPD), and previous research using explicit measures has consistently found elevated levels of these self-conscious emotions (SCE) in those with BPD. However, these measures cannot elucidate implicit processes that are equally important, as they guide the perceptions of the self and influence behavioral responses. Thus, we aimed to extend the research on SCE in BPD utilizing an indirect latency-based measure. A total of 29 female inpatients with BPD and 21 healthy women were assessed with a shame and a guilt self-concept Implicit Association Test (IAT). These two tasks use reaction time measurements to determine the relative strengths of associations between the self versus others and shame versus pride and guilt versus innocence. In addition, participants completed questionnaires capturing shame, guilt, and BPD symptoms. Women with BPD displayed significantly more shame- and guilt-prone implicit self-concepts than the control group (d = 1.2 and d = 0.7, respectively). They also scored significantly higher on explicit measures of shame and guilt. Although explicitly and implicitly assessed shame and guilt were strongly associated with borderline pathology, multivariate models indicated that solely self-reported, but not implicitly measured, guilt was consistently related to all BPD outcomes. Shame was only associated with the number of BPD criteria. This study extends previous findings on SCE in BPD, in that women with BPD do not only explicitly conceive themselves as more shame- and guilt-prone but also exhibit implicitly more shame and guilt self-concepts than healthy controls. Our results may hold clinical and therapeutic implications. (PsycInfo Database Record (c) 2021 APA, all rights reserved).