Functioning In Borderline Personality Disorder Research Articles

Psychotic Experiences and Daily Functioning in Borderline Personality Disorder and Schizophrenia.

Psychotic experiences have been shown to be comparable in borderline personality disorder (BPD) and schizophrenia. Preliminary evidence suggests differences in the impact of psychotic experiences on daily functioning. Therefore, in this study, we aimed to investigate the role of psychotic experiences in daily functioning in BPD compared with schizophrenia. We performed post hoc analyses on data from 23 inpatients with BPD and 21 inpatients with schizophrenia, for whom results from the Psychotic Symptom Rating Scales were available. No differences were found in frequency, intensity, and disruption of life in relation to auditory verbal hallucinations and the amount of preoccupation and conviction with regard to delusions. Significant differences were found in the disruption of life due to delusions. The results emphasize that the quality of psychotic experiences in BPD and schizophrenia is comparable, but the impact of delusions on daily life is different, which may improve differential diagnosis.

The role of thyroid function in borderline personality disorder and schizophrenia: a Mendelian Randomisation study

BackgroundGenome-wide association studies have reported a genetic overlap between borderline personality disorder (BPD) and schizophrenia (SCZ). Epidemiologically, the direction and causality of the association between thyroid function and risk of BPD and SCZ are unclear. We aim to test whether genetically predicted variations in TSH and FT4 levels or hypothyroidism are associated with the risk of BPD and SCZ.MethodsWe employed Mendelian Randomisation (MR) analyses using genetic instruments associated with TSH and FT4 levels as well as hypothyroidism to examine the effects of genetically predicted thyroid function on BPD and SCZ risk. Bidirectional MR analyses were employed to investigate a potential reverse causal association.ResultsGenetically predicted higher FT4 was not associated with the risk of BPD (OR: 1.18; P = 0.60, IVW) or the risk of SCZ (OR: 0.93; P = 0.19, IVW). Genetically predicted higher TSH was not associated with the risk of BPD (OR: 1.11; P = 0.51, IVW) or SCZ (OR: 0.98, P = 0.55, IVW). Genetically predicted hypothyroidism was not associated with BPD or SCZ. We found no evidence for a reverse causal effect between BPD or SCZ on thyroid function.ConclusionsWe report evidence for a null association between genetically predicted FT4, TSH or hypothyroidism with BPD or SCZ risk. There was no evidence for reverse causality.

What predicts psychosocial functioning in borderline personality disorder? Investigating the association with reflective functioning.

The aim of this study was to investigate factors associated with functioning in participants with and without borderline personality disorder (BPD). In particular, we were interested whether mentalizing and related social cognitive capacities, as factors of internal functioning, are important in predicting psychosocial functioning, in addition to other psychopathological and sociodemographic factors. This is a cross-sectional study with N = 53 right-handed females with and without BPD, without significant differences in age, IQ, and socioeconomic status, who completed semi-structured diagnostic and self-report measures of social cognition. Mentalizing was assessed using the Reflective Functioning Scale based on transcribed Adult Attachment Interviews. A regularized regression with the elastic net penalty was deployed to investigate whether mentalizing and social cognition predict psychosocial functioning. Borderline personality disorder symptom severity, sexual abuse trauma, and social and socio-economic factors ranked as the most important variables in predicting psychosocial functioning, while reflective functioning (RF) was somewhat less important in the prediction, social cognitive functioning and sociodemographic variables were least important. Borderline personality disorder symptom severity was most important in determining functional impairment, alongside trauma related to sexual abuse as well as social and socio-economic factors. These findings verify that BPD symptoms themselves most robustly predict functional impairment, followed by history of sexual abuse, then contextual factors (e.g. housing, financial, physical health), and then RF. These results lend marginal support to the conceptualization that mentalizing may enhance psychosocial functioning by facilitating social learning, but emphasize symptom reduction and stabilization of life context as key intervention targets.

Causes and Treatment of Borderline Personality Disorder in Light of Genetic and Environmental Influences

Borderline personality disorder is a common and serious personality disorder, and it has been one of the hotspots of clinical research because of the severe and incurable impairment of social functioning in borderline personality disorder. Based on this issue, this paper summarizes the influencing factors for the formation of bpd through reviewing previous literature, including the intra-individual factors (genetic, biological, gene-environment interaction) and environmental factors (upbringing, parental emotional instability, childhood abuse, low education level, diverse childhood trauma). In addition, relevant treatments including medical and non-medical treatments (psychodynamic therapy, supportive therapy, cognitive-behavioral therapy) are also discussed. It has been found through research that the etiology of borderline personality disorder is complex, has an extremely profound impact on the patient, and is highly debated in terms of treatment. Some of the current psychotherapeutic methods are more effective, on the basis of which some treatments about medical and pharmacological treatments can be added, or the combination of psychological plus pharmacological dual treatments and the combination of different psychological treatments are necessary for further research in order to obtain better treatment results. The summary in this article is intended to give mental health practitioners some suggestions and inspiration for treating borderline personality disorder.

A Commentary on “Can Neuroscience Provide a New Foundation for the Rorschach Variables?” (Jimura et al., 2021)

A Commentary on “Can Neuroscience Provide a New Foundation for the Rorschach Variables?” (Jimura et al., 2021)

Potential Therapeutic Possibility of Oxytocin for Borderline Personality Disorder

Many symptoms of patients with borderline personality disorder (BPD) involve deficits in socioemotional functioning, such as hypersensitivity for social threats and reduced trust. Standard psychopharmacological medications regarding treatment of this usually chronic disorder have only limited benefit. During recent years, scientists have developed interest in oxytocin, generally known as prosocial hormone, as a possible modulator of socio-emotional functions in BPD. Many patients with BPD report experiences of adversity early in life, and insecure attachment is a common finding in these patients. These factors may have lasting effects on the brain, including the oxytocin system. BPD may be strongly related to dysregulations in the oxytocin system, and oxytocin may have the potency to pharmacologically ameliorate symptomatology of BPD. This article reviews the most salient information available about oxytocin in relation to pathophysiology and potential treatment of BPD. [ Psychiatr Ann . 2021;51(3):141–146.]

Key themes in recent research on interpersonal functioning in borderline personality disorder.

We provide an overview of new ideas and directions of research on interpersonal functioning in borderline personality disorder (BPD). We highlight the following key themes emerging in recent and ongoing research: investigation of the cognitive and motivational mechanisms which underpin impairments of interpersonal functioning in BPD, tracking BPD across the lifespan with earlier interventions and longitudinal studies, expansion of the scope of interest to family members of individuals with BPD and to people in the general population with levels of BPD traits, and investigating BPD online, not only by using internet-based testing platforms but also by studying the social media use of individuals with BPD. The concise discussion of recent research on BPD provided here, together with the identification of key themes emerging from this work, provides a snapshot of ongoing work devoted to better understanding interpersonal functioning in borderline personality disorder.

Investigation of the effects of childhood sexual abuse on disease severity and cognitive functions in borderline personality disorder

Objective: The aim of this study is to investigate the effects of childhood sexual abuse (CSA) on decision-making, facial emotion recognition, and clinical presentation of borderline personality disorder (BPD). In addition, it was examined whether certain cognitive impairments could be worsened by the presence of CSA. Method: Eighteen sexually abused BPD patients, 18 patients with BPD without CSA, and 35 healthy controls were included in the study. The Borderline Personality Inventory (BPI) and the Childhood Trauma Questionnaire (CTQ) were administered to BPD patients. The Cambridge Neuropsychological Test Automated Battery (CANTAB), which is used to examine decision-making and emotional recognition, was administered to the patients and healthy controls. Results: In the emotion recognition test, the mean percentages of correct fear recognition were 33.5±14.6 for patients with CSA, 25.89±9.8 for patients without CSA, 26.8±7.4 for healthy controls. The mean percentage of correct fear recognition was higher in patients with CSA than in the other groups. There was no difference in the correct recognition of other emotions between the groups. The probability of risking a 10% chance of winning in patients with/without CSA and healthy controls averaged were 0.71±0.26, 0.33±0.28, and 0.25±0.20 respectively. The average risk-taking propability in patients with CSA was significantly higher than in other groups. A significant correlation was identified between BPI and CTQ scores. Conclusion: The present study supports the fact that CSA has significant effects on the clinical presentation and neurocognitive profiles of BPD.

The association between reflective function and global functionality in patients with borderline personality disorder.

To examine the association between reflective function and global functionality in borderline personality disorder (BPD) patients, controlling for symptomatology and defensive style. Thirty-nine female inpatients were evaluated employing a sociodemographic questionnaire, the Structured Clinical Interview for Personality Disorders-II (SCID-II), the Self-Reporting Questionnaire (SRQ-20), the Reflective Functioning Questionnaire (RFQ), the Defence Style Questionnaire-40 (DSQ-40) and the Global Assessment of Functioning (GAF). Functionality was inversely associated with the reflective function uncertainty score (-.458; p < .01) and neurotic defences (-.335; p < .05). Symptom severity (SRQ-20) was associated with the use of immature defences (-.445; p < .01). The association between functionality and the reflective function uncertainty score remained significant, even when controlled for symptoms and defensive style (p = .002). The ability to mentalise seems to play a central and somehow independent role in BPD psychopathology.

Dysfunction of Empathy and Related Processes in Borderline Personality Disorder: A Systematic Review.

After participating in this activity, learners should be better able to:• Assess differences between adult patients with the diagnosis of borderline personality disorder (BPD) and healthy control subjects in terms of empathy and related processes• Evaluate the effects of empathy or related processes as factors contributing to abnormal social functioning in BPD ABSTRACT: We reviewed 45 original research studies, published between 2000 and 2019, to assess differences between adult patients with the diagnosis of borderline personality disorder (BPD) and healthy control subjects in terms of empathy and related processes (i.e., theory of mind, mentalizing, social cognition, and emotional intelligence). Thirty-six studies reported deficits of empathy or related processes in patients with BPD. Enhanced emotional empathy in BPD was also reported in eight studies, all of which revealed that patients had increased scores of personal distress on the Interpersonal Reactivity Index self-report questionnaire. Six studies did not find significant differences between patients with BPD and healthy control subjects in terms of empathy or related processes. No study reported enhanced cognitive empathy, social cognition, or emotional intelligence in patients with BPD. We postulate that deficits of empathy or related processes contribute to preempting the formation of stable interpersonal relationships, whereas enhanced emotional empathy might lead to personal (and interpersonal) distress, further contributing to abnormal social functioning in BPD.

Social cognition and executive function in borderline personality disorder: evidence of altered cognitive processes

Introduction. Social cognition (SC) and executive function (EF) research in borderline personality disorder (BPD) has proven to be controversial and lack of sufficient information about deficit patterns. Objective. Assess the contribution of SC and EF in the socio-emotional and cognitive patterns in BPD, as well as investigate the possible relationships between SC, EF, and clinic features in BPD. Method. The study evaluated 20 females with BPD in ambulatory hospitalization and 20 healthy women in social cognition (“Reading the mind through the eyes” and the IOWA gambling task) and executive function (with the Wisconsin Card Sorting Test, verbal fluency tasks; digit spam test and numbers-and-letters of the WAIS-III, Trail Making Test Form A and B). Results. The results show statistically-significant differences for the tasks evaluated in social cognition, the theory of mind (u: 181, p &lt; .001**), and the IOWA gambling task, score IOWA 4 (p &lt; .004*), and IOWA 5 p &lt; .003*); and executive functioning, for example in the Wisconsin card sorting test, WCST1 were found (p &lt; .003*), WCST2 (p &lt; .004*), WCST3 (p &lt; .018*) or WCST4 (p &lt; .003*). Digit span test and verbal fluency had significant differences compared to controls. Discussion and conclusion. The subdomains evaluated would be good endophenotypes as well as specific cognitive processes for research and rehabilitation.

Consider others better than yourself: Social decision-making and partner preference in Borderline Personality Disorder

Background and objectivesPatients with Borderline Personality Disorder (BPD) suffer from interpersonal difficulties. They have been shown to be distrustful and yet involved in abusive relationships. In this study, we want to examine whether the perception of fairness and partner preference are altered in BPD. MethodsWe employed a coalition formation game in which a participant can choose whether to interact in dyads or triads, thus exclusion or inclusion of a third potential interaction partner. Furthermore, triads get a higher endowment, such that dyads are not only unfair to one partner, but also economically inefficient, as the participant reduces the overall amount of money available for distribution. Subsequently, we compared how participants predicted another person's game strategy (inclusive, exclusive, or mixed) and rated its fairness, and which partner the participant would select. ResultsThe majority of the BPD group (n = 26) as well as of the healthy group (n = 29) preferred triads over dyads and offered a near-to-equal split to their interaction partners in the first two rounds. In contrast to the healthy group, the BPD group did not show a drop of the average level of investment in the final round. In both groups, the inclusive strategy was perceived as the fairest strategy. Most interestingly, despite a similar perception of fairness, half of the BPD group preferred an interaction partner with an exclusive or mixed strategy while the majority of the HC group would choose an interaction partner with an inclusive strategy. LimitationsThis is a preliminary study which needs further replications before strong conclusions can be drawn. ConclusionsOur study demonstrates no differences in fairness perception but an alteration in partner preference of patients with BPD which might contribute to unfavorable partner choices and impairments of interpersonal functioning in BPD.

Characterizing Couple Dysfunction in Borderline Personality Disorder.

Relationship dysfunction is a key criterion of borderline personality disorder (BPD). Nevertheless, little is known about the characteristics of romantic relationship functioning in BPD. In this study, couples in which the women were diagnosed with BPD (BPD couples) and healthy control couples (HC) were compared in their perceived relationship characteristics (e.g., relationship quality) and interpersonal experience variables (e.g., attachment). The hypothesis was tested that insecure attachment styles account for group differences in relationship characteristics. Variables were measured by self-report. Romantic relationships were appraised as more negative and conflictual by both members of BPD couples compared to HC. The perception of women with BPD was often more negative than that of their male partners, indicating potential biases in BPD patients' relationship evaluation. Insecure attachment styles only partially explained group differences in relationship characteristics, showing that attachment style is one, but not the only predictor of decreased relationship functioning in BPD couples.

Dialectical behavior therapy skills training affects defense mechanisms in borderline personality disorder: An integrative approach of mechanisms in psychotherapy

Objective: Borderline personality disorder (BPD) is characterized by immature defense mechanisms. Dialectical behavior therapy (DBT) is an effective treatment for BPD. However, understanding the underlying mechanisms of change is still limited. Using a transtheoretical framework, we investigated the effect of DBT skills training on defense mechanisms. Method: In this randomized controlled trial, 16 of 31 BPD outpatients received DBT skills training adjunctive to individual treatment as usual (TAU), while the remaining 15 received only individual TAU. Pre–post changes of defense mechanisms, assessed with the Defense Mechanism Rating Scale, were compared between treatment conditions using ANCOVAs. Partial correlations and linear regressions were conducted to explore associations between defenses and symptom outcome. Results: Overall defense function improved significantly more in the skills training condition (F(1, 28) = 4.57, p = .041). Borderline defenses decreased throughout skills training, but not throughout TAU only (F(1, 28) = 5.09, p = .032). In the skills training condition, an increase in narcissistic defenses was associated with higher symptom scores at discharge (β = 0.58, p = .02). Conclusions: Although DBT does not explicitly target defense mechanisms, skills training may have favorable effects on defense function in BPD. Our findings contribute to an integrative understanding of mechanisms of change in BPD psychotherapy.

Interoception and Its Interaction with Self, Other, and Emotion Processing: Implications for the Understanding of Psychosocial Deficits in Borderline Personality Disorder.

We review evidence for the potential importance of interoception, i.e., the processing of signals arising from inside the body, for deficient psychosocial functioning in borderline personality disorder (BPD). Evidence suggests that variability in interoception interacts with higher-order psychological functions such as self, other, and emotion processing. These domains are characteristically impaired in BPD, suggesting a likely causal role of disturbed interoception in the etiology of the disorder. The inability to identify and describe one's own emotional states represents a proxy of impaired interoception which might further mediate between the perception of inner physiological conditions and psychosocial functioning in BPD. There is preliminary evidence explaining how early life stress might adversely affect central interoceptive representation and psychosocial functioning in BPD. Based on these findings and the specific pattern of disturbances in BPD, we propose the crucial role of interoception in an integrated biobehavioral model for BPD.

Identification of mental states and interpersonal functioning in borderline personality disorder.

Atypical identification of mental states in the self and others has been proposed to underlie interpersonal difficulties in borderline personality disorder (BPD), yet no previous empirical research has directly examined associations between these constructs. We examine 3 mental state identification measures and their associations with experience-sampling measures of interpersonal functioning in participants with BPD relative to a healthy comparison (HC) group. We also included a clinical comparison group diagnosed with avoidant personality disorder (APD) to test the specificity of this constellation of difficulties to BPD. When categorizing blended emotional expressions, the BPD group identified anger at a lower threshold than did the HC and APD groups, but no group differences emerged in the threshold for identifying happiness. These results are consistent with enhanced social threat identification and not general negativity biases in BPD. The Reading the Mind in the Eyes Test (RMET) showed no group differences in general mental state identification abilities. Alexithymia scores were higher in both BPD and APD relative to the HC group, and difficulty identifying one's own emotions was higher in BPD compared to APD and HC. Within the BPD group, lower RMET scores were associated with lower anger identification thresholds and higher alexithymia scores. Moreover, lower anger identification thresholds, lower RMET scores, and higher alexithymia scores were all associated with greater levels of interpersonal difficulties in daily life. Research linking measures of mental state identification with experience-sampling measures of interpersonal functioning can help clarify the role of mental state identification in BPD symptoms. (PsycINFO Database Record

Loneliness, social networks, and social functioning in borderline personality disorder.

Persistent loneliness is often reported by patients with borderline personality disorder (BPD). However, empirical studies investigating this aspect of BPD psychopathology are sparse. Studies from social psychology revealed that social isolation and low social functioning contribute to loneliness, that is, the subjective feeling of being alone. The aim of the present study was to contribute to the understanding of loneliness in BPD by investigating its relation to social isolation and functioning in different domains of life. Subjective experience of loneliness was measured in 80 women (40 BPD patients, 40 healthy controls) with the UCLA Loneliness Scale. Social isolation and social functioning were assessed with the Social Network Inventory and the Social Functioning Scale. In addition, we assessed global functioning with the Global Assessment of Functioning. BPD patients reported stronger feelings of loneliness compared to healthy participants. In general, the level of loneliness was linked to network size, social engagement, and prosocial behavior. Diversity of social networks and functioning in the domain of interpersonal communication were associated with the level of loneliness only in BPD. A reduced variety of roles in social life together with impairments in interpersonal communication were particularly relevant for the experience of loneliness in BPD, suggesting an indirect path to target this psychopathological feature in therapeutic interventions. However, both social isolation and social functioning were not sufficient to explain the severely increased loneliness experienced by these patients, stressing the need for further investigation of determinants of loneliness in this clinical population. (PsycINFO Database Record

Differential symptomatology and functioning in borderline personality disorder across age groups

There is increasing research aimed at addressing whether patients with borderline personality disorder (BPD) may exhibit variations in symptomatology and functioning according to their chronological age. The current study consisted of 169 outpatients diagnosed with BPD, who were divided into four age groups as follows: 16–25 years (n = 41), 26–35 years (n = 43), 36–45 years (n = 45), and 46 and more years (n = 40). Age groups were compared for symptomatology, normal personality traits, psychiatric comorbidities, functioning, and treatment-related features. The younger group had significantly higher levels of physical/verbal aggression and suicide attempts relative to the older group. Conversely, the older group had significantly greater severity of somatization, depression, and anxiety symptoms. In addition, the older group showed significantly greater functional impairment overall and across physical/psychological domains, specifically when compared to the younger group. Overall, these findings may suggest that age-related symptoms should be considered when diagnosing BPD. Also, functional impairments should be the target interventions for older BPD patients.

A resting-state fMRI study in borderline personality disorder combining amplitude of low frequency fluctuation, regional homogeneity and seed based functional connectivity

BackgroundThis resting-state fMRI study investigated thebrain function in patients with borderline personality disorder (BPD) with three data-driven algorithms. MethodsForty BPD patients and thirty-five controls were enrolled and scanned with a 3.0T Philips Ingenia scanner. Rs-fMRI and structural images were preprocessed by DPARSF based on SPM8 on the MATLAB platform. To evaluate BPD related brain function alterations comprehensively, we analyzed the amplitude of low frequency fluctuations (ALFF), regional homogeneity (ReHo), and seed based functional connectivity (seed-based FC), three data-driven algorithms of rs-fMRI. Results were multiply corrected by REST AlphaSim program at the level of p<0.05. Meanwhile, the correlation between imaging and psychological data was also performed in BPD patients. ResultsCompared with control group, BPD group showed decreased ALFF and ReHo both in the right posterior cingulate cortex (PCC) and adjacent precuneus. With these two areas as seeds, disturbed functional connectivity mainly distributed in the frontotemporal and limbic structure in BPD group. There were no significant correlations found between imaging variables and psychological data. LimitationsThe sample size was relatively small, and no significant correlations were found between imaging variables and psychological data, which might limit the clinical application of these results. ConclusionsBased on data-driven analysis, we discovered that the right PCC and precuneus were altered in resting state function in BPD. Combining with our previous Voxel Based Morphometry (VBM) study which has found increased gray matter volume (GMV) in the right PCC and precuneus, we confirmed that these two areas were core brain regions altered both in structure and function in BPD.

Dissemination of DBT for borderline personality disorder in Egypt, facts and challenges

BackgroundDBT proved to be effective in reducing suicidal behavior, non-suicidal self-injury, psychiatric hospitalization, treatment dropout, substance use, anger, and depression and improving social and global functioning in Borderline personality disorder. As a step towards increasing utilization of evidence based treatments in the Egyptian healthcare system, the team at Alexandria university started a comprehensive DBT program.AimTo describe the implementation and dissemination experience of DBT in Egypt.MethodsThe implementation of DBT is examined quantitatively. Numbers were calculated retrospectively from the records at the implementation start in December 2013 and after 3 years in September 2016.ResultsNumber of therapists increased from one team of 2 therapists and one observer to 16 therapists organized in 3 teams plus 4 observers. The initial team, 7 psychiatrists and 2 clinical psychologists, could host and attend the first DBT Intensive Training in the middle east in 2014. DBT intensive training is the official training model developed by Dr. Linehan. We started with 8 clients one group for adults in Alexandria at 2013, increasing to 150 clients in 12 groups for adults, adolescent and SUD patients in 2016 with an average increase of 18.75 folds. The team participated and presented about DBT in 23 local and regional scientific meetings and hosted two workshops in collaboration with BehavioralTech, the official training institute.ConclusionsAlthough the DBT implementation in Egypt represented a great challenge, results are showing a promising increase in the number of trained therapists and participating clients.Disclosure of interestThe authors have not supplied their declaration of competing interest.