Pervasive Instability Research Articles

Diagnostic profiles among suicide decedents with and without borderline personality disorder.

Borderline personality disorder (BPD) is a debilitating condition characterized by pervasive instability across multiple major domains of functioning. The majority of persons with BPD engage in self-injury and up to 10% die by suicide - rendering persons with this condition at exceptionally elevated risk of comorbidity and premature mortality. Better characterization of clinical risk factors among persons with BPD who die by suicide is urgently needed. We examined patterns of medical and psychiatric diagnoses (1580 to 1700 Phecodes) among persons with BPD who died by suicide (n = 379) via a large suicide death data resource and biobank. In phenotype-based phenome-wide association tests, we compared these individuals to three other groups: (1) persons who died by suicide without a history of BPD (n = 9468), (2) persons still living with a history of BPD diagnosis (n = 280), and (3) persons who died by suicide with a different personality disorder (other PD n = 589). Multivariable logistic regression models revealed that persons with BPD who died by suicide were more likely to present with co-occurring psychiatric diagnoses, and have a documented history of self-harm in the medical system prior to death, relative to suicides without BPD. Posttraumatic stress disorder was more elevated among those with BPD who died by suicide relative to the other PD group. We found significant differences among persons with BPD who died by suicide and all other comparison groups. Such differences may be clinically informative for identifying high-risk subtypes and providing targeted intervention approaches.

The Therapeutic Role of Lamotrigine in Borderline Personality Disorder: A Comprehensive Review of Outcomes, Mechanisms, and Treatment Strategies.

Borderline personality disorder (BPD) is a severe mental health condition characterized by pervasive instability in mood, self-image, and interpersonal relationships, significantly impacting individuals' personal, social, and occupational functioning. Current treatment strategies primarily include psychotherapy and pharmacotherapy, but there remains a need for more effective and targeted pharmacological options. This review examines the therapeutic role of lamotrigine in BPD, focusing on its efficacy, safety, mechanisms of action,and practical treatment strategies. A comprehensive review of the existing literature was conducted, including clinical trials, observational studies, and relevant pharmacological data. Key focus areas included lamotrigine's impact on BPD symptoms, pharmacological profile, and comparative effectiveness with other treatments. Lamotrigine has shown promise in managing BPD symptoms, particularly in stabilizing mood and reducing emotional dysregulation and impulsivity. Clinical trials suggest that lamotrigine can effectively address core symptoms of BPD, with a safety profile generally comparable to other treatments. The medication's mechanism of action, which involves modulation of glutamate release and mood stabilization, aligns with the therapeutic goals for BPD. Lamotrigine represents a potential adjunctive treatment for BPD, offering benefits in mood stabilization and symptom management. Integrating psychotherapy and other pharmacological options should be considered within a multimodal treatment approach. Further research is needed to better understand its long-term efficacy and safety and its role in combination therapy.

NATO's 2022 Strategic Concept: Preparing for a More Complex and Interconnected World

In 2022, at the Madrid Summit, NATO Heads of State and Government adopted a new Strategic Concept to guide the Alliance’s adaptation in a world of strategic competition, pervasive instability, and recurrent shocks. The new Concept recognizes that many of the challenges and threats facing NATO, from growing pressure against the rules-based international order, to terrorism and climate change, are very much global in nature. Therefore, the Concept stresses the importance of adopting a global approach to security. This requires understanding the connections and interlinkages between different challenges and regions, but also actively investing in working with partners, near and far, in contributing to preventing crises and boosting resilience.

From static buckling to nonlinear dynamics of circular rings

The dynamic buckling of circular rings is a pervasive instability problem with a major impact in various fields, such as structural, nuclear and offshore engineering, robotics, electromechanics, and biomechanics. This phenomenon may be simply seen as the complex motion that occurs deviating from the original circular shape under, for instance, any kind of time-dependent forcing load. Despite the fact that this topic has progressively gained importance since the mid-20th century, it seems that the same points have not been made completely clear. In fact, even some subtleties in the derivation of classical static buckling load may still give rise to misinterpretations and lead to misleading results. A fortiori, research concerning the nonlinear dynamics of rings still suffers the inherent difficulties associated with different possible analytical formulations of post-buckling dynamics. Advancement in this respect would be relevant, both from a theoretical and a practical point of view, since the applications are endless, with countless possibilities, especially in the biomedical and biotechnological fields: buckling-driven transformations of thin-film materials for applications in electronic microsystems, self-excited oscillations in collapsible tubes and pliable fluid-carrying shells, vocal-fold oscillations during phonation and snoring, pulse wave propagation in arteries, closure and reopening of pulmonary airways, stability of cardiac and venous valves during vascular surgery, stability of annuloplasty devices, flow-induced deformation and ultimate rupture of a cerebral aneurysm, and much more. The present article, in the framework of a critical review of the classic formulation of elastic ring buckling, proposes a straightforward approach for the nonlinear dynamics of an elastic ring that leads to a Mathieu–Duffing equation. In such a manner, some possible evolutions of the system under pulsing loads are analyzed and discussed, showing the inherent complexity of its dynamic behavior.

Differential associations between childhood maltreatment types and borderline personality disorder from the perspective of emotion dysregulation

BackgroundBorderline Personality Disorder (BPD) is characterized by pervasive instability in a range of areas including interpersonal relationships, self-image, and affect. Extant studies have consistently identified significant correlations between childhood maltreatment (CM) and BPD. While exploring this CM-BPD link, a number of cross-sectional studies commonly emphasize the role of emotion dysregulation (ED). A better understanding of the associations between BPD and (1) CM and (2) ED are essential in formulating early, effective intervention approaches, and in addressing varied adverse impacts.MethodsThis cross-sectional study analyzed a subset of baseline data collected for a larger community-based longitudinal study. Given that our current focus on CM and ED, only those participants who completed the baseline CM assessment and ED measure (N = 144) were included for the primary analyses. We conducted stepwise multivariate linear models to examine the differential relationships between BPD features, ED, and multiple CM types. A path analysis with latent factors using the structural equation modeling (SEM) method was performed to test the indirect effect from CM to BPD features via ED.ResultsLinear regression models revealed that only emotional abuse (relative to other trauma types) was significantly associated with high BPD features. The SEM, by constructing direct and indirect effects simultaneously, showed that (1) ED partially mediated the path from CM to BPD features; and (2) CM played an important role in which the direct effect remained significant even after accounting for the indirect effect through ED.ConclusionsOur results highlight a most consistent association between emotional abuse and BPD, indicating its unique role in understanding BPD features in the context of CM. Further, shame-related negative appraisal and ED were found critical when examining the association between CM and BPD, possibly providing promising treatment targets for future practices.

Self-esteem instability might be more characteristic of borderline personality disorder than affective instability: Findings from an e-diary study with clinical and healthy controls.

Borderline personality disorder (BPD) is commonly characterized by pervasive instability. Affective instability, despite being a diagnostic criterion in the DSM-5, is commonly seen as a transdiagnostic feature, but recent studies have brought new attention to the importance of self-esteem instability as a potential defining feature of BPD. However, evidence is lacking regarding whether heightened self-esteem instability is a specific feature of BPD when patients with BPD are compared to clinical controls. Using ambulatory assessment, we examined self-esteem instability and affective instability in participants' daily lives. We assessed momentary self-esteem and affective state 12 times daily for 4 consecutive days in 71 patients with BPD, 121 patients with anxiety disorders (ADs), and 74 healthy controls (HCs). To determine group differences, we used established instability indices and analyzed multilevel models. Compared to HCs, patients with BPD and those with ADs exhibited heightened self-esteem instability and affective instability. Importantly, the clinical groups did not differ in affective instability, whereas self-esteem instability was significantly higher in patients with BPD than in those with ADs across all instability indices. Beyond the influence of mean self-esteem, patients with BPD had the highest general instability, the most frequent extreme changes, and the largest decreases in self-esteem, especially from high levels of self-esteem. Our results support previous findings on affective instability, which may constitute a transdiagnostic feature, and they provide the first evidence that heightened self-esteem instability is particularly prominent in BPD, underscoring the importance of self-esteem for the understanding of dysregulation in BPD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Corticolimbic Connectivity Mediates the Relationship between Adverse Childhood Experiences and Symptom Severity in Borderline Personality Disorder

The interaction between biological and environmental factors (especially adverse childhood experiences, ACEs) plays a crucial role in the development and maintenance of borderline personality disorder (BPD). These factors act influencing BPD core features such as pervasive instability in affect regulation, impulse control, social cognition, and interpersonal relationships. In line with this perspective, abnormalities in social cognition and related neurobiological underpinnings could mediate the relationship between ACEs and psychopathological manifestations in adulthood. In a sample of 14 females, functional connectivity (FC) analyses were performed modeling the interaction between ACEs and corticolimbic dysregulation during emotional processing and its relationship with BPD symptom severity. ACEs were associated with a dampening of the negative FC between (1) the right amygdala (Amy) and right dorsolateral prefrontal cortex (DLPFC) and between (2) the left Amy and bilateral DLPFC, right precuneus, left cerebellum and left dorsomedial prefrontal cortex during emotional processing. The connectivity between right Amy and DLPFC mediates the relationship between childhood adversities and BPD symptomatology. Furthermore, the negative FC between Amy and DLPFC, postcentral gyrus, the vermis of cerebellum and precuneus was also associated with BPD symptom severity, with a weaker negative coupling between Amy and these regions being related to a worse BPD psychopathology. Our results confirm the role of ACEs in contributing to social cognition impairments in BPD and related symptomatology from a neurobiological perspective.

Care of Individuals With Bipolar Disorders

Bipolar disorder (BD) is a severe mental illness that is characterized by chronicity, pervasive instability, and relatively high rates of recurrence and suicide. Current evidence supports that adverse circles among hereditary and genetic factors, neuroinflamation, and social rhythm constitute a crucial etiology. Pharmacological treatment is the first priority for BD patients during the acute stage. Pharmacological and psychosocial treatments should be combined during the maintenance stage in order to help patients self-manage medication, effectively control mood swings, enhance disease self-management and social functions, decrease the risks of relapse and re-hospitalization, and stabilize overall health. The present article firstly introduces the characteristics and etiological assumptions related to BD, the related evidence-based care models and their effects, and the early development of an evidence-based care model, the BalancingMySwing group, for BD patients in Taiwan. This article provides updated information to clinicians who are involved in caring for this population. Moreover, the existing data related to biological and psychosocial factors for BD in Taiwan is insufficient and developing individual-tailored psychosocial intervention is urgently needed. The authors hope that this article will elicit greater concern for this issue from policy decision-makers and healthcare providers.

Relationship between borderline personality disorder and migraine

IntroductionBorderline personality disorder (BPD) is characterized by pervasive instability in moods, impulsivity, intense and unstable or disturbed interpersonal relationships and self-image, and often self-destructive behaviour. BPD seems to be more common in patients suffering from migraine. However, typical migraine characteristics in this population remain partly unknown.Objectives & aimsTo present the specific clinical characteristics of migraine patients with BPD and to assess their response to migraine treatment.MethodsWe examined 10 patients with migraine and previously diagnosed with BPD (group 1), 10 patients with migraine and no history of BPD (group 2), and 10 patients with migraine and no history of BPD matched to group 1 for age, gender, and frequency of headache. Migraine was treated in group 1 and 3 and pharmacological treatment outcome was assessed after 6 months.ResultsThe group of migraine patients with coexisting PBD was associated with female gender, increased prevalence of medication overuse headache, higher rates of self-reported depression, increased migraine-related disability, and a decreased response to pharmacological migraine treatment.ConclusionPatients with migraine and previously diagnosed BPD can be regarded as a distinct population. They are more suffering from depressive symptoms, more disabled by their migraine, are more resistant to pharmacological treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Borderline personality disorder and regularly drinking alcohol before sex.

Drinking alcohol before sex increases the likelihood of engaging in unprotected intercourse, having multiple sexual partners and becoming infected with sexually transmitted infections. Borderline personality disorder (BPD), a complex psychiatric disorder characterised by pervasive instability in emotional regulation, self-image, interpersonal relationships and impulse control, is associated with substance use disorders and sexual risk behaviours. However, no study has examined the relationship between BPD and drinking alcohol before sex in the USA. This study examined the association between BPD and regularly drinking before sex in a nationally representative adult sample. Participants were 17 491 sexually active drinkers from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Logistic regression models estimated effects of BPD diagnosis, specific borderline diagnostic criteria and BPD criterion count on the likelihood of regularly (mostly or always) drinking alcohol before sex, adjusted for controls. Borderline personality disorder diagnosis doubled the odds of regularly drinking before sex [adjusted odds ratio (AOR) = 2.26; confidence interval (CI) = 1.63, 3.14]. Of nine diagnostic criteria, impulsivity in areas that are self-damaging remained a significant predictor of regularly drinking before sex (AOR = 1.82; CI = 1.42, 2.35). The odds of regularly drinking before sex increased by 20% for each endorsed criterion (AOR = 1.20; CI = 1.14, 1.27) DISCUSSION AND CONCLUSIONS: This is the first study to examine the relationship between BPD and regularly drinking alcohol before sex in the USA. Substance misuse treatment should assess regularly drinking before sex, particularly among patients with BPD, and BPD treatment should assess risk at the intersection of impulsivity, sexual behaviour and substance use. [Thompson Jr RG, Eaton NR, Hu M-C, Hasin DS Borderline personality disorder and regularly drinking alcohol before sex Drug Alcohol Rev 2017;36:540-545].

Pakistan: National Security Dilemmas and Transition to Democracy

Empirical evidence supports the notion that emergent and hybrid democratic regimes are often unstable and conflict-ridden. While these are important findings, the implication that instability is induced by democratic transitions provides a partial understanding of the dynamic. Pakistan’s recent return to a democratic system of government provides an opportunity to test this thesis and draw inferences about prospects for democratic consolidation. Using Pakistan as a case study, the research raises three important considerations towards a more comprehensive analysis of the dynamic of instability in democratic transitions. First, it emphasizes that a developing transitioning state is sometimes afflicted with protracted conflict conditions; hence the transition process per se may not have a direct or significant causal relationship with pervasive instability. Arguably, in the Pakistani context, conflict, chaos and instability are more a manifestation of pre-existing conflict conditions, more so than symptoms of democratization. Second, in considering the impact of the transition once it sets in motion, it appears to be an exacerbating dynamic, compounding the conditions of unabated conflict through social, political and economic tensions inherent in systemic change. In light of the above, a third consideration pertaining to the low capacity of transitioning systems to mitigate conflict is brought to the fore. This is significant as institutions are often weak and poorly equipped with conflict-resolution mechanisms and processes.

Can Epidemiology Translate Into Understanding Major Depression With Borderline Personality Disorder?

Can Epidemiology Translate Into Understanding Major Depression With Borderline Personality Disorder?

P02-78 Transcranial magnetic stimulation for borderline personality disorder: Rationale, stimulation site and methods

Borderline personality disorder (BPD) is characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior. This disorder is associated with a significant rate of suicide attempts and completed suicides (4 to 10%), a major impairment in social functioning and an increased healthcare utilization cost. Treatments available include psychotherapy and pharmacotherapy. Research has shown some efficacy of repetitive Transcranial Magnetic Stimulation (rTMS) on post-traumatic stress disorder and mood disorder which both share common biological or clinical features with BPD. It is then likely that rTMS might prove efficient on BPD symptoms.A review of the literature on neuroimaging and neuropsychology of BPD shows a hypoactivity of the dorsolateral prefrontal cortex which may be a potential target site for rTMS.We will conduct a pilot randomized sham-controlled trial on 30 BPD patients assessing the efficacy of a 10-day course of daily rTMS on neuropsychological tasks, BPD symptoms severity, risk taking behaviour, depression and general psychopathology.

Neurocognitive impairment as a moderator in the development of borderline personality disorder

Borderline personality disorder (BPD) is characterized by a pervasive instability of interpersonal relationships, affects, self-image, marked impulsivity, dissociation, and paranoia. The cognitive dimension of the disorder has received relatively little attention and is poorly understood. This paper proposes that neurocognitive impairment is a key moderator in the development of BPD and elaborates a possible pathway for the expression of the cognitive domain. Neurocognitive impairment is hypothesized to moderate the relationship between caretaking and insecure disorganized attachment and pathological dissociation in the formation of the disorder contributing to impaired metacognition and a range of cognitive difficulties. The empirical evidence from studies of cognitive processes, brain function, attachment, and dissociation that support this theory are reviewed and discussed. Areas for future research that might verify or refute this theory are suggested.

Worn, Damaged Bodies in Literature and Photography of the Great Depression

After seven years of unprecedented prosperity, the stock market crashed in late October 1929, precipitating the collapse of America's unstable economic system and the pervasive instability of the world economy. As unemployment grew, so did the lines for soup kitchens. People frantically withdrew money from local banks, causing thousands to close within few years. Inflated prices and farming speculation created surplus of agricultural goods that could not be sold at home or abroad. In short, chaos ensued. Out of this dust and despair emerged figure whose charisma, eloquence, courage, and disability galvanized destitute public. Paraplegic Franklin Delano Roosevelt, whose disabling bout with poliomyelitis occurred eleven years before presidency in 1932, possessed an unflagging optimism and strength that the public needed. Social responses to the disabled body were complicated by Roosevelt's illness and the Depression. Disability had typically been treated as something shameful, to be hidden away or stared at as spectacle in carnival sideshows and the freak exhibits of Coney Island. Throughout the national crisis of the 1930s, however, the public readily interpreted Roosevelt's battle with paralysis as ennobling. During the 1928 Democratic National Convention, he was described as a figure tall and proud even in suffering; face of classic profile; pale with years of struggle against paralysis; [...] most obviously gentleman and scholar. [...] This is civilized man (Franklin'' 12). This interpretation was possible in part because Roosevelt masked disability, and gubernatorial campaign marked the beginning of tacit agreement with the public and press about body: No movies of me getting out of the machine, boys (Gunther 239). Remarkably, the press obliged. Within few years, the public would need to see their leader as having the strength to lift America out of the Depression, and they could believe this more easily if Roosevelt appeared healthy. Though much was done to minimize disability, the public also found comfort in it, believing that Roosevelt's experiences with paralysis enabled him to empathize with their suffering. As historian Michael Parrish explains, his withered legs also gave the aristocratic Roosevelt something in common with those many Americans who saw themselves as outcast or marginal people because of physical handicaps, economic deprivation, or racial and religious prejudice (278). Part of appeal as leader, in other words, came from own experiences with physical hardships, and for millions of Americans, ability to overcome great adversity buttressed their own struggles. Roosevelt's paralysis may have made disability slightly more public issue, but need to appear healthy also reinforced widespread attitudes about disability as something shameful. In fact, freak shows, which had been popular since P. T. Barnum opened the American Museum in 1841, seemed to provide the only language for discussing the damaged body. As the physical and psychological costs of the Depression became increasingly visible on the body through illness, starvation, and physical injuries, the need to interpret the damaged body- to distinguish it from the freakish- intensified. In much of 1930s literature, for example, injured or ill characters often sought reassurance through discourse of freakishness (such as labeling one freak). They used this term to establish self-serving distinction between injury and spectacle- between being born with disability and coming by one through honest labor. Yet in the fiction of John Steinbeck, Tillie Olsen, and Nathanael West, these distinctions ultimately break down as individual hardships lead not to success and security, but to freakishness. Like Gregor in Franz Kafka's The Metamorphosis, working-class families in the 1930s were waking up to find that they had become monstrous- dehumanized by the economic and social crises of the Depression. …

Researchers Seek Explanations, Treatment for BPD

Researchers Seek Explanations, Treatment for BPD

Political Struggle and Institutional Reorganization in Yugoslavia

One of the most salient, if less remarked upon, characteristics of Communist regimes is the frequency with which basic political institutional arrangements are overhauled. Almost every Communist country has had at least two constitutions; some (such as the Soviet Union) have had three, and Yugoslavia is now under its fourth constitution since the Communists came to power. In most cases the leader, originally simply general-secretary of his respective party, later became premier as well, then dropped the premiership, retaining only the secretaryship. Finally, in most cases over the course of the 1970s, the leader would add the title of president (head of state). These and other analogous changes were usually explained as symptoms of the process of communism, a process that, apparently by definition, has to involve regular institutional adjustments. In reality, however, the changes have had almost nothing to do with building anything, and reflect rather the pervasive instability in monocratic systems. When there are no organizational alternatives, political competition-which might otherwise be expressed in the struggle between rival organizations is naturally transferred into the monopoly party itself and therefore expresses itself in part as a struggle over organizational forms. It is thus symptomatic of a popular misconception to believe that the most significant question in Communist succession struggles is: Who will lead? Quite the contrary; far more important is the intensification of the struggle over institutional forms that invariably emerges in conditions of political fluidity. The

Progressive Historians and the Historical Imagination in Austria: Heinrich Friedjung and Richard Charmatz

“ Alles flieβt ”—All things flow! Thus did the German-Austrian historian Richard Charmatz invoke Heraclitus to convey the sense of flux which characterized Austrian intellectual life before World War I. The sense of chronic, pervasive instability in late nineteenth-century Austrian society was the result of problems released by the solvents of liberal ideology, military defeat (in 1859 and 1866) and industrialization. In Danubian Europe, the discontents of modernity were experienced most acutely by the Germans, socially and culturally the most advanced of the nationalities of the Habsburg Monarchy. After 1848, the traditionally secure position of educated Germandom was threatened by the emergence of rival nationalisms, the growth of popular social protest, and the disintegration of a preindustrial value system. A culture accustomed to denying the Lebensfahigkeit of its neighbors was suddenly challenged by the need to demonstrate its own worth and capacity to survive. The Austro-German community reacted in a variety of ways; the result was a complex and extraordinarily rich cultural matrix which conditioned, on the one hand, the origins of psychoanalysis, logical positivism, musical atonality, and the philosophy of Wittgenstein, and nourished, on the other, the ideologies of Austro-Marxism, Christian Socialism, Zionism, and National Socialism. At the turn of the century, the capital of the backward “China of Europe” witnessed the birth of many of the major forces of contemporary history; cultural fecundity was the reflex of fear of decline and possible extinction.