Borderline Personality Research Articles

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

Dialectical Behavior Therapy in the Treatment of Trauma

The study aims to introduce Dialectical Behavior Therapy (DBT) as a viable approach to treating post-traumatic stress disorder (PTSD), as well as its comorbidity with borderline personality disorder (BPD). The paper refers to current studies conducted between 2017 and 2023 relating to DBT's efficacy in managing complex and relational early childhood trauma, including sexual abuse and violence. Analyses indicate that DBT helps to reduce PTSD symptoms in various age groups. An integrative approach, which combines DBT and methods such as Cognitive Behavioral Therapy (CBT), Cognitive Processing Therapy (CPT), or Eye Movement Desensitization and Reprocessing (EMDR), appears to enhance therapeutic effects. Therefore, it is recommended to implement programs based on DBT and evaluate their effectiveness in a group of Polish patients who have co-occurring symptoms of PTSD and BPD or PTSD alone.

Impulsivity: A Dimensional Perspective in PD and ED. Comparison of Results in a Case-Control Study.

IntroductionPersonality Disorders (PD) - specifically Borderline Personality Disorder (BPD), and certain Eating Disorders (ED) share common clinical features. One of these features is impulsivity, studied individually in each diagnostic group, and scarcely used to encompass specific profiles of these patients.Understanding the common clinical variables of this patient population would facilitate therapeutic efforts and enable greater precision regarding the prognosis of these patients.ObjectivesThis study aims to study impulsivity in a group collectively formed by BPD and ED, compared to a control group, in contrast to the individualized study approach typically conducted in the literature.MethodsA cross-sectional descriptive study is conducted to assess impulsivity as a common diagnostic variable in a group of PD and ED in comparison with a healthy control group. The sample was collected between 2016 and 2019 at the Hospital Clínico San Carlos, totaling 108 subjects.ResultsA statistically significant difference is observed (p<0.005 in all scales) in total impulsivity, cognitive impulsivity, motor impulsivity, and unplanned impulsivity in the cases group comprising patients diagnosed with PD and ED, compared to the control group from the general population.ConclusionsImpulsivity is closely related to the concept of borderline personality disorder. This analysis also includes eating disorders, with the difference from the control group still statistically significant.The presence of common clinical variables in these groups (PD and ED) may have clinical and therapeutic implications that differ from those pursued thus far. This allows moving away from the categorical model and understanding these disorders from a more enriching and advanced dimensional perspective.”Disclosure of InterestNone Declared

A randomized controlled trial comparing trauma-focused treatment with and without concurrent personality disorder treatment in patients with posttraumatic stress disorder and comorbid borderline personality disorder

IntroductionPosttraumatic stress disorder (PTSD) and borderline personality disorder (BPD) often co-occur. There is growing motivation among clinicians to offer trauma-focused treatments, such as Eye Movement Desensitization and Reprocessing (EMDR), to patients with PTSD and comorbid BPD. However, a large subgroup of these patients does not sufficiently respond to trauma-focused treatment and is more likely to be excluded or dropout from treatment. Dialectical Behaviour Therapy (DBT) for BPD is well established and although there is some evidence that DBT combined with prolonged exposure is twice as effective in reducing PTSD symptoms than DBT alone, the comparative efficacy of trauma-focused treatment with and without concurrent PD treatment has not been investigated yet.ObjectivesThe current study will therefore evaluate the comparative clinical efficacy of EMDR with and without concurrent DBT in patients with PTSD and comorbid BPD.MethodsAdult patients were randomly assigned to EMDR with (n = 63) or without concurrent DBT (n = 63). A wide range of clinician-administered and self-report assessments were conducted before, during and up to six months after treatment. The longitudinal change in PTSD severity as the primary outcome was measured using multilevel mixed regression in SPSS. The present study is part of the overarching Prediction and Outcome Study in comorbid PTSD and Personality Disorders (PROSPER), which consists of a second RCT comparing trauma-focused treatment with and without concurrent PD treatment in patients with PTSD and cluster C PD.ResultsResults, available in January 2024, will reveal which treatment works best for this difficult-to-treat group of patients.ConclusionsThis is the first study to compare the clinical efficacy of EMDR with and without concurrent DBT in patients with PTSD and comorbid BPD. Results will reveal which treatment works best for this difficult-to-treat group of patients.Disclosure of InterestNone Declared

Prison or treatment? Gender, racial, and ethnic inequities in mental health care utilization and criminal justice history among incarcerated persons with borderline and antisocial personality disorders.

Borderline and antisocial personality disorders are characterized by pervasive psychosocial impairment, disproportionate criminal justice involvement, and high mental health care utilization. Although some evidence suggests that systemic bias may contribute to demographic inequities in criminal justice and mental health care among persons experiencing these mental health conditions, no research to date has explicitly examined such differences. Women and White persons would be more likely to endorse internalizing symptoms and have a more extensive history of mental health service utilization, whereas men, persons from minoritized racial groups, and persons identifying as Hispanic/Latino would be more likely to endorse externalizing symptoms and have more extensive histories of involvement with the criminal justice system. This study examined gender, racial, and ethnic differences in symptom presentation, criminal justice history, and mental health care utilization in a sample of 314 adults with comorbid borderline and antisocial personality disorders enrolled in prison-based substance use treatment programs in the United States. Results suggested that men with these personality disorders were more likely to have early extensive criminal justice involvement, whereas women and White people had more extensive mental health treatment histories. Women were also more likely to endorse a range of internalizing symptoms, and White and non-Hispanic participants were more likely to endorse a history of reckless behavior. Notably, however, many associations-particularly, racial differences in symptom presentation and mental health utilization history and gender differences in symptom presentation-did not persist after we controlled for preincarceration employment and educational attainment. Results highlight a range of gender, racial, and ethnic inequities in criminal justice involvement and mental health utilization among this high-risk high-need population. Findings attest to the likely impact of societal, structural, and systemic factors on trajectories of persons affected by this comorbidity. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Title: Misdiagnosis in young females – Autism versus Borderline Personality Disorders

IntroductionThe diagnostic overlap between Autism Spectrum Disorder (ASD) and Emotionally Unstable Personality Disorder (EUPD), commonly referred to as Borderline Personality Disorder (BPD), presents a considerable challenge in psychiatric practice, particularly for young females. These complexities are amplified by gender biases in the healthcare system and can lead to misdiagnosis, affecting both treatment planning and long-term outcomes.ObjectivesThere are differences and similarities between ASD and EUPD/BPD which encompass its own challenges in diagnosis and treatmentThe presentation seeks to: 1.Offer an in-depth overview of the relationship between ASD and EUPD/BPD in young females.2.Evaluate the diagnostic challenges associated with distinguishing between these two conditions.3.Discuss the practical implications of misdiagnosis on treatment and quality of life. MethodsDrawing from a rich corpus of evidence, including longitudinal studies (e.g., Kerns et al., 2015; Gunderson et al., 2018), meta-analyses, and patient case studies, the presentation adopts a multidisciplinary approach. It utilises clinical interviews, validated diagnostic tools such as the Autism Diagnostic Observation Schedule (ADOS) and the Structured Clinical Interview for DSM-5 (SCID-5), as well as direct observation to provide a nuanced understanding of ASD and EUPD/BPD characteristics.ResultsShared Characteristics: Both ASD and EUPD/BPD manifest challenges in social functioning and mood regulation, supported by studies indicating sensory sensitivities and affective dysregulation in both conditions (Zanarini et al., 2019; Happé et al., 2019).Differentiating Factors: ASD individuals often struggle with verbal and non-verbal communication, whereas those with EUPD/BPD may excel in these areas but display emotional volatility and unstable relationships, substantiated by differing neurobiological markers (King-Casas et al., 2008; Minshew & Williams, 2007).Misdiagnosis Risks: The failure to correctly diagnose these conditions may lead to ineffective or potentially harmful treatment plans (Zanarini et al., 2013; Solomon et al., 2012).Necessity for Comprehensive Assessment: A multimodal and culturally sensitive diagnostic approach is essential for accurate clinical evaluation (Mandy et al., 2012; Betancur et al., 2009).ConclusionsThe complexities surrounding the accurate diagnosis of ASD and EUPD/BPD in young females necessitate a thorough and multifaceted approach. An incorrect diagnosis could have long-lasting implications, affecting not just the efficacy of therapeutic interventions but also the overall well-being and quality of life of the individual. This presentation underscores the critical importance of drawing from a robust body of evidence and utilising comprehensive diagnostic approaches to differentiate these conditions.Disclosure of InterestNone Declared

Inflammatory based psychotic symptoms: when psychosis means encephalitis

AbstractSchizophrenia, as one of the most common disorders from the psychotic spectrum is most commonly detected in the phase of first psychosis and may pose a diagnostic challenge, as commonly comprise a heterogeneous group of schizophrenias, with distinct clinical presentations. If it detected in its prodromal phase without clearly developed psychotic symptoms, the diagnosis is even more unreliable, as the transition to full blown psychosis in the next two years happens in 15-40% of more, depending probably on a variety of cumulative environmental risk factors (including childhood trauma, the use of high-potency cannabis, urbanicity, season of birth). Moreover, the first episode psychosis may underlie for example the first manic episode, brief intermittent psychotic symptoms in persons with borderline personality disorders, acute reaction to trauma, the use of cannabis and psychostimulants and different organics causes, such as endocrinologic disorders and autoimmune encephalitis. Therefore, in everyday clinical practice, the diagnosis of first episode psychosis always requires an assessment of possible causes of psychosis, and also factors that may influence prognosis and treatment. Usual assessment include detailed anamnestic and heteroanamnestic data, physical examination, standard blood laboratory findings, drugs in urine/ blood, EEG and CT/MR scan. The absence of typical risk factors for schizophrenia, as well as the absence of premorbid symptoms and developmental course typical for schizophrenia, abrupt course of psychotic symptoms, symptoms such as disorientation, catatonia, speech disturbances, alteration of consciousness, neurologic signs, autonomic dysfunction and laboratory aberrations may be especially indicative for organic cause and possibly encephalitis and require further confirmation with the analysis of cerebrospinal liquor with antineuronal antibodies.Disclosure of InterestNone Declared

A pilot Randomized Controlled Trial (RCT) study protocol for assessing physical activity in individuals diagnosed with Borderline Personality Disorder (PABORD)

IntroductionMost treatments for severe mental disorders involve either pharmacotherapy or psychological interventions, which show mild to moderate effectiveness and may not lead to complete remission. Physical activity (PA), effective in enhancing physical health among the general population, emerges as a potential adjunctive treatment option that can address the existing gaps.Borderline Personality Disorder (BPD) is a severe condition associated with profound psychosocial impairment, a heightened risk of suicide, and considerable burden on informal caregivers and mental health service providers. While there is a lack of approved medications for individuals with BPD, psychosocial interventions demonstrated good efficacy. However, the implementation of these treatments is limited by the demanded extensive training for staff. No studies have investigated the effectiveness of structured PA as an adjunctive treatment for individuals with BPD.ObjectivesThe primary objective of this study is to assess whether the intervention group outperforms the control group in terms of improvement on a standardized assessment scale evaluating BPD psychopathology, the Zanarini Rating Scale for Borderline Disorder. Secondary objective is to assess whether the intervention group can increase and sustain higher levels of PA. We hypothesise that a structured PA program will demonstrate superior results compared to the psychoeducation control group concerning PA levels upon completion of the intervention. Additionally, we hypothesise that the intervention group will exhibit enhanced outcomes in psychopathology, functioning, and sleep.MethodsThe PABORD Randomized Controlled Trial is designed for female outpatient individuals diagnosed with BPD aged 18-40 years. This trial will involve two distinct groups: (i) an intervention group (25 participants) that will engage in a 12-week structured PA program under the supervision of a sports medicine physician; (ii) a control group (25 individuals) that will undergo a 12-week psychoeducation program focused on PA and diet.Patients are assessed at three different time points. Standardized assessments include psychopathology, psychosocial functioning, sleep, menstrual cycle and nutrition data. Measurements are taken on the amount and intensity of PA and sleep patterns using a biosensor device (Actigraph GT9X), dynamometric measures and BMI. Biomarkers and hormonal cycles are examined through the collection of plasma and saliva samples.The trial is financially supported through donations (5x1000 fund), and has been submitted to the local Ethics Committee for approval. The trial registration process is also currently in progress.ResultsNot yet available.ConclusionsThe study will provide new knowledge which may enhance our treatment options with patients suffering from BPD.Disclosure of InterestNone Declared

The Epidemic of Non-Suicidal Self-Harm in Adolescents and Young Adults in the Kyrgyz Republic

Introduction During the last two years, many young people and adolescents in the Kyrgyz Republic started to visit specialists due to Non-suicidal self-harm. A significant rise in the amount of such cases allowed specialists from the Republican Center of Psychiatry in Bishkek to think about an “epidemic “of self-harming behavior. Non-suicidal self-harm (NSSH) is defined as repeated, deliberate, direct injury to the body without suicidal intent that is not socially acceptable (Nixon et al., 2002) to reduce psychological discomfort in the absence of a conscious intention to take one’s life (ICD-10 codes X60-X84, and ICD-11 codes PB80-PD3Z).ObjectivesTo determine the causes of NSSH among adolescents and young adults who approached specialists in mental health sphere at Institute of Behavioral Health at the American University of Central Asia.MethodsOver two years, forty-five adolescents and young adults under twenty-five who had committed self-harm visited specialists from the Behavioral Health Institute at the American University of Central Asia.All the patients received either dialectical behavioral treatment or cognitive processing treatment, medication (paroxetine) was used in three cases.ResultsThirty patients were girls under twenty-one, and fifteen were boys and young male adults. The overwhelming majority (40 people) had self-inflicted cuts, two had imposed burns with matches and cigarettes, and one had used self-suffocation without a bond. Reasons for self-harm were the following: releasing internal tension and anxiety, getting some rest from intrusive thoughts, relieving the inner pain, and a desire to “feel as a whole person.” All the patients underlined that they did not want to attract attention from their family members; moreover, they tried to hide the consequences of self-harm. Teens and young adults (twelve patients) from Kyrgyz traditional families visited a consultant or psychiatrist after a long drive through conventional or religious healers. All of the patients knew that they were addicted to self-harm, wanted to stop a problematic behavior, and could not stop it on their own. Ten patients have been diagnosed with borderline personality disorder. Two of them also had eating disorders. Five patients had PTSD, and five had social phobia. The others had recognizable anxiety symptoms.ConclusionsThe enormous rise of non-suicidal self-harm is a phenomenon that needs further research. Those cases often resist treatment due to the “addictive” component in the pathogenesis.Disclosure of InterestNone Declared

“Esketamine” in Borderline Personality Disorder: focud on suicide ideation

IntroductionBorderline personality disorder is often associated with comorbid conditions such as eating disorders, mood disorders, and substance use disorders. The prevalence of BPD and major depressive disorder (MDD) are about 5.9% and 8%, respectively, but up to 80% of patients with BPD experience one or more episodes of MDD in their lifetime. BPD is associated with suicidal behaviors and self-harm, thei are also fifty times more likely than the general population to attempt or die by suicide, Up to 10% of BPD patients will die by suicideObjectivesOur aim is to verify if Esketamine could be effectiveness in treating patterns of behavior that have proven to be socially disruptive like self harm, suicidal attempts in patients with BPD. Suicidal ideation is a major risk factor for suicide in patients with TRD and BPD. The interval between the onset of suicidal ideation and suicide attempt is often very short, highlighting the need for urgent intervention and the development of new rapid-onset antidepressant therapies.MethodsWe recruited 25 adult subjects referred to the outpatient clinics of Pavia suffering from TRD with current Moderate-Severe Depressive Episode (scoring ≥ 22 on the MADRS). Of them 9/25 patients has a BPD. Study duration was 8 weeks.The following evaluation scales were administered before the first drug administration (T0) and repeated after one week (T1), four weeks (T2) and eight weeks (T3) of treatment: Montgomery Asberg Depression Rating Scale (MADRS), Columbia-Suicide Severity Rating Scale (CSSRS), and The Zanarini Rating Scale for BPD subgroup patients. We also collected sociodemographic and clinical information. Dosages and frequency of esketamine administration during the study period, adverse events and reasons for discontinuation were also recorded.ResultsA significant reduction of depressive symptoms was found at T1 and T2 compared to T0. Suicidal ideation disappeared as early as T1 and was maintained at T2, expecially in the BPD group. In the subgroup with borderline disorder we saw more improvement in impulsive (Self-mutilation and/or suicidal efforts; two other forms of impulsivity) and affective categories ( Inappropriate anger / frequent angry acts; chronic feelings of emptiness; mood instability) in Zanarini Rating Scale.ConclusionsOur findings support the safety and tolerability of esketamine in TRD and BPD comorbidity sample. It is noteworthy that esketamine has an action on various pathways that are considered defective in borderline patients. Glutamate plays a key role in personality traits such as impulsivity, aggression, and suicidal behavior. Treatment with esketamine could reduce the number of suicide attempts and help reduce the self-harm of BPD.Disclosure of InterestNone Declared

Personality disorders and addiction A study of 54 patients

IntroductionPersonality disorders are very often comorbid with addictions and are known to have a negative impact on the development of substance use disorder.ObjectivesEvaluate the prevalence of personality disorder in patients with problematic use of psychoactive substances followed at Ar Razi hospital Determine the relationship between different personality disorders and the clinical aspects of psychoactive substance useMethodsThis is a descriptive and analytical cross-sectional study carried out among 54 patients followed at Ar-Razi hospital Salé in Morocco for problematic use of psychoactive substances from June 1 to September 15, 2023 (Diagnosis assessed by DSM 5) Data collection was done using a questionnaire including clinical and socio-demographic characteristics and data on addiction to psychoactive and behavioral substances. The psychometric scale used to assess personality disorder: Personality Disorder Questionnaire (PDQ-4+)ResultsWe recruited 54 patients with age ranges from 18 to 45 years, with a male predominance. The average age at the start of psychoactive substance use was 15 years. Tobacco is the most used substance followed by cannabis Antisocial, histrionic and borderline personality disorders were the most common in our population. There was a statistically significant difference between specific personality disorder and the presence of severe psychoactive substance use disorderConclusionsThe frequency of personality disorders is high among subjects with problematic use of psychoactive substances. It is necessary to take care of them simultaneously (integrated care) in order to improve the prognosisDisclosure of InterestNone Declared

Avoidance of Negative Emotional Contrasts as a Diagnostic Feature of OCD: A Receiver-Operator Characteristic Curve Analysis of the Contrast Avoidance Questionnaires

Introduction The Contrast Avoidance Model (CAM) was developed to explain pathological worry in generalized anxiety disorder (GAD). The CAM posits that those with GAD are sensitive to sharp increases in emotions, and use worry to maintain heightened states of negative arousal to avoid these emotional shifts. Research has widely supported the CAM in the conceptualization of GAD, and has extended these findings to other disorders, including major depressive disorder (MDD) and social anxiety disorder (SAD). Despite the utility of the CAM model in informing the etiology of these conditions, research has yet to expand these findings beyond GAD, MDD, and SAD. Specifically, obsessive-compulsive disorder (OCD), which co-occurs with GAD, MDD, and SAD in adults at a rate of 15.0%, 40.7%, and 14.7%, respectively, and shares many of their etiological features, has yet to examined in the context of the CAM. Thus, examining CA as a relevant mechanism and therapeutic target for OCD is an unstudied conceptual framework that may offer meaningful clinical utility.ObjectivesThe present study used receiver operator curve (ROC) analyses to examine the predictive utility of the CAQ-W and CAQ-GE in detecting probable OCD in a large undergraduate sample. We hypothesized that the CAQ-W and CAQ-GE would be higher in participants with probable OCD and would offer sufficient sensitivity and specificity in predicting probable OCD.Methods 1259 undergraduates were recruited for a mass University screening. Participants were included in the OCD group (N = 291) if they met diagnostic criteria for OCD (DOCS total score > 20). Participants were included in the nondisordered group (n = 249) if they did not meet diagnostic criteria for any of the screened disorders (SAD, MDD, GAD, OCD, panic disorder, post-traumatic stress disorder, OCD, borderline personality disorder), denied suicidality, and denied receiving mental health treatment in the last 12 months. ROC analyses were used to examine the accuracy of the CAQ-W and the CAQ-GE in detecting probable OCD.ResultsResults of ROC analyses are reported in Table 1. AUC values for the CAQ-W and CAQ-GE were significantly different from the null hypothesis (AUC = .50, p < .001), and demonstrated excellent (.89) to outstanding (.91) accuracy in predicting probable OCD (Figure 1), respectively. Optimal sensitivity and specificity to detect probable OCD (Table 2) was achieved at a cut off score of 67.5 for the CAQ-W (Sensitivity = 81.4%; Specificity = 82.3%) and a cutoff score of 43.5 for the CAQ-GE (Sensitivity = 84.9%; Specificity = 85.5%).Image:Image 2:Image 3:ConclusionsResults suggest that OCD can be accurately characterized by CA. Findings also highlight the utility of examining CA as a relevant maintenance factor for OCD symptoms. Future research should examine the impact of CA on OCD symptoms in-laboratory and ecological settings.Disclosure of InterestNone Declared

Mentalizing Abilities in Major Depressive Disorder and Borderline Personality Disorder: Measuring Hypermentalization and Implicit Mentalization with the Hungarian Version of the MASC

IntroductionBorderline Personality Disorder (BPD) is the most common personality disorder in psychiatric care. BPD often co-occurs with Major Depressive Disorder (MDD). Both BPD and MDD are associated with various impairments of social functioning. Among these, mentalizing disturbances are the most extensively studied.ObjectivesThe Movie for the Assessment of Social Cognition (MASC) is an ecologically valid video-based test, which is suitable for measuring both hypermentalization and implicit mentalization. Based on the literature, it is sensitive enough to detect mild deficits in mentalization capacities. In this study, we investigated mentalization deficits with a special focus on implicit mentalization and hypermentalization in patients with MDD and MDD+BPD with a set of well-established mentalization tests including MASC.MethodsWe examined patients with MDD (n=43) during the depressive episode. A subgroup of these patients was also diagnosed with BPD (MDD+BPD group; n=23), the other group had no comorbid personality disorder (MDD group; n=20). We assessed the patients’ mentalization abilities using the Hungarian version of the Reading the Mind in the Eyes test, the Faux Pas test, and the MASC test. Additionally, symptom scales (measuring the severity of anxiety, and depression), WAIS (Wechsler Adult Intelligence Scale), the Childhood Trauma Scale, as well as scales measuring affect regulation and attachment were used during the assessment.ResultsThere were no differences between the two groups in terms of age, IQ, or the severity of depression and anxiety. The MDD+BPD group exhibited significantly poorer performance in the MASC total mentalization score (MW U=118, df=1,41, p< 0,001), as well as in the hypermentalization score (MW U=98,5, df=1,41, p< 0,001). The MDD+BPD group achieved significantly lower results on the emotion recognition and mentalization measures in the RMET test (t=2,883, df=1,41, p< 0,001). The MDD+BPD group performed significantly worse on the Faux Pas test measuring mentalization (MW U=144,5, df=1,41, p< 0,001). In the whole sample, MASC performance correlated with overall IQ.ConclusionsThe MASC, RMET, and Faux Pas tests show a consistent trend and indicate significant differences between the mentalization abilities of MDD+BPD and MDD patients. Our findings are in line with data in the literature: BPD patients’ implicit mentalization with a predominance of hypermentalization is impaired. This impairment is detectable when we compare their performance with MDD patients without BPD. In the future, a larger sample size, additional tests, and the inclusion of a control group are needed to further investigate MDD and MDD+BPD patients’ mentalizing deficits. However, our results emphasize the significance of mentalization-based therapies in the therapy of patients with BPD and depression.Disclosure of InterestNone Declared

Avoidant personality disorder through the lens of ICD 11

IntroductionWith the new dimensional diagnosis of personality disorders in ICD 11, the categorical model has been abandoned. The types of personality disorders in the new dimensional model should show certain common characteristics. According to the recognition of the common characteristics of individual types of personality disorders, as well as determining the severity, a transition from the categorical to the dimensional diagnostic system can be made.ObjectivesTo analyze and present the trait domains specifiers in persons with avoidant personality disorder and to facilitate the adoption of the new diagnostic criteria.MethodsAn unsystematized literature review was made, with key words: avoidant personality disorder, ICD 11, ICD 10, traits; and a case was presented.Results This is the case of a 26-year-old student who has had no friends since his school days. During his secondary education, on the initiative of another person, he got together with several other people, but he was not fully accepted. During the studies, the communication with the colleagues took place only at the university and around the responsibilities. About a year ago, he had reduced willpower and suicidal thoughts, when he took antidepressant and adjuvant antipsychotic therapy for some time. He is now being examined due to severe tension, dissatisfaction, lack of friends, repeated suicidal ideation. According to researches, people with avoidant disorder have prominent trait domains – negative affectivity, detachment and reduced dissociality (Bach et al. BMC Psychiatry 2018; 18:351), negative affectivity, detachment and anankastia (Simon et al., Front. Psychiatry 2023, 14:1175425), negative affectivity and detachment (Bach et al. Borderline Personality Disorder and Emotion Dysregulation 2022, 9:12). In our case, assessments of trait domains were made with PSQ-11 and PiCD. On the PSQ-11, an increase in the negative affectivity, detachment and anankastia on critical score was obtained, while on the PiCD, an increase in negative affectivity, detachment, anankastia, and a decrease in dissociality was obtained. Mild personality disorder was scored on the Rating Scales for Severity of Disorder (SASPD, LPFS-BF 2.0).ConclusionsThe types of personality disorder can be represented by certain common trait domains specifiers, which will be useful in adopting the diagnostic criteria in ICD 11 for personality disorder. Assessment of the severity of the disorder provides additional information on treatment strategies and prognosis. The most significant features of avoidant personality disorder are negative affectivity and detachment, while anankastia is on the borderline score and has a reduction in dissociality.Disclosure of InterestNone Declared

Assessment of the Capability of Artificial Intelligence for Psychiatric Diagnosis

IntroductionPsychopathological exploration (PPE) involves an assessment of the mental state of patients, where psychological signs and symptoms are analyzed, which collectively form a syndrome. To conduct this assessment, the clinician must utilize their expertise to identify the presence and authenticity of a series of symptoms that, once recognized, allow for a diagnosis (1). The presence of this subjective component could explain why, despite the continuous growth of artificial intelligence (AI), its application in clinical psychiatry practice remains limited. However, the combination of the clinician's work with AI could enhance diagnostic accuracy and our understanding of diseases (2).ObjectivesThe objective of this study is to investigate whether AI can make accurate diagnoses through an initial psychopathological evaluation.MethodsA random sample was selected from our medical records of all patients admitted to our acute mental health inpatient unit through the hospital's emergency services in the year 2022. An anonymized database was created, including sociodemographic information, the results of the psychopathological assessment in the emergency department, and the diagnosis at the time of discharge. The psychopathological assessment conducted in the emergency department was provided to the AI chatbot ChatGPT, with a request to establish a diagnosis according to the DSM-5. Diagnoses such as brief psychotic disorder, schizophreniform disorder, and schizophrenia were considered, given their acute symptom similarities, as well as major depressive disorder (unipolar) and bipolar disorder. The level of agreement between both diagnoses was evaluated using the kappa coefficient.ResultsThe sample consisted of 15 patients, of whom 60% were male, with a mean age of 45 years (standard deviation = 15.6). 73.3% of the patients had prior mental health follow-up, and 66.7% had been previously hospitalized. Diagnoses included psychotic disorder in 33.3% of cases, bipolar disorder with manic episode in 26.7%, depressive disorder in 13.3%, delusional disorder in 13.3%, schizoaffective disorder in 6.7%, and borderline personality disorder in 6.7%. A kappa value of 0.561 was obtained, indicating a moderate degree of agreement between the diagnoses.ConclusionsDespite the inherent subjectivity in psychopathological assessment, this study suggests that AI, in the form of natural language processing chatbots like ChatGPT, can be a useful tool to assist mental health professionals in the diagnostic process. While AI shows promising potential, it should not entirely replace the experience and clinical judgment of mental health professionals. Instead, the importance of potential collaboration between AI and clinicians for achieving more precise and comprehensive diagnoses is highlighted.Disclosure of InterestNone Declared