Borderline Personality Disorder Problems Research Articles

Caudate hyperactivation during the processing of happy faces in borderline personality disorder

BackgroundEmotion dysfunction and anhedonia are main problems in borderline personality disorder (BPD). In the present functional magnetic resonance imaging (fMRI) study, we investigated neural activation during the processing of happy faces and its correlates with habitual emotion acceptance in patients with BPD. Methods22 women with BPD and 26 female healthy controls watched movie clips of happy and neutral faces during fMRI without any instruction of emotion regulation. To associate neural activation with habitual emotion acceptance, we included individual scores of the Emotion Acceptance Questionnaire (EAQ) as a covariate in brain data analysis. ResultsAll participants showed amygdala, temporal and occipital activation during the processing of happy compared to neutral faces. Compared with healthy controls, patients with BPD showed significantly more activation within the bilateral caudate. We did not find significant correlations with emotion acceptance. ConclusionsOur results indicate caudate hyperactivation in patients with BPD during the processing of happy faces. Although patients reported significantly less emotion acceptance of positive emotions, an association with neural activation was not detectable.

Self-other distinction and borderline personality disorder features: Evidence for egocentric and altercentric bias in a self-other facial morphing task.

Self-other distinction (SOD) refers to the ability to distinguish one's own body, actions, and mental representations from those of others. Problems with SOD are considered to be a key feature of borderline personality disorder (BPD). However, empirical studies on SOD in BPD are scarce. Here, we present a study providing preliminary support for the usefulness and validity of a self-other facial morphing task to capture the capacity for SOD in a sample of nonclinical participants high (n = 30) and low (n = 32) in BPD features. Participants had to watch a video sequence in which their own face was gradually morphed into the face of an unfamiliar other (self-to-other) or vice versa (other-to-self), requiring them to indicate at which point they judged the morph to look more like the target face than the starting face. Consistent with predictions, results showed that participants in the high-BPD group judged the morph to look like themselves for longer in the self-to-other direction (suggestive of egocentric bias), but only with a relatively more attractive target face. In the other-to-self direction, the high-BPD group had more difficulty recognizing their own face (i.e., an altercentric bias), but this time only with the relatively less attractive face. Further research is needed to replicate these findings in clinical samples, but overall they suggest that the current task might be suited to investigate SOD problems in BPD. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Emotion regulation difficulties and interpersonal conflict in borderline personality disorder.

Borderline personality disorder (BPD) is characterized by both emotion regulation (ER) and interpersonal difficulties. Although the link between ER difficulties and interpersonal problems in BPD is well documented, less work has examined the directionality of these associations. The present study examined the temporal relationship between ER difficulties and interpersonal problems among individuals with BPD features in daily life. Participants were 173 undergraduate students who completed daily questionnaires for 2 weeks. Participants were prompted to identify their most stressful events each day and report their use of maladaptive ER strategies (i.e., expressive suppression, worry/rumination, and avoidance) and interpersonal conflict behaviors (i.e., argue, hit someone/throw things). BPD features were associated with greater interpersonal conflict and ER difficulties. Unexpectedly, maladaptive ER strategy use did not predict next-day interpersonal conflict. Interpersonal conflict significantly predicted next-day maladaptive ER strategy use; however, this association was weaker among those with elevated BPD features. Implications of these findings for treatment are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Interpersonal Problems in Borderline Personality Disorder: Associations With Mentalizing, Emotion Regulation, and Impulsiveness.

Interpersonal problems are a core symptom of borderline personality disorder (BPD). This study investigated the relationship between emotion dysregulation, impulsiveness, and impaired mentalizing in the context of predicting interpersonal problems in BPD. A total of 210 patients with BPD completed the Difficulties in Emotion Regulation Scale (DERS), Barratt Impulsiveness Scale (BIS-11), Reflective Functioning Questionnaire (RFQ), and Inventory of Interpersonal Problems (IIP-32). The authors conducted three path models, with either mentalizing, emotion regulation, or impulsiveness as the exogenous variable. Emotion dysregulation and attentional impulsiveness predicted interpersonal problems directly, whereas hypomentalizing predicted interpersonal problems only indirectly throughout emotion dysregulation and attentional impulsiveness. The results suggest that these domains contribute significantly to interpersonal problems in BPD. Moreover, hypomentalizing might affect on interpersonal problems via its effect on impulsiveness and emotion regulation. The authors argue that focusing on emotion regulation and mentalizing in BPD treatments might have interlinked beneficial effects on interpersonal problems.

Negative evaluation of individuals with borderline personality disorder at zero acquaintance

Previous research suggests that individuals with Borderline Personality Disorder (BPD) tend to evaluate other people as untrustworthy or hostile, which could contribute to the marked interpersonal problems in BPD. In contrast, alterations in first impressions of potential interaction partners of those with BPD remain under-researched and poorly understood. Herein, we focused on how naïve raters evaluate BPD individuals, hypothesizing that raters would tend to evaluate them negatively. To test this hypothesis, we recruited 26 BPD and 26 healthy control participants (46% male) as targets in the ‘Thin Slices’ paradigm. Targets were video-taped while talking about their personal preferences (e.g. hobbies). Subsequently, these short videos (‘Thin Slices’) were presented to two rater samples (n = 92 and n = 44), who evaluated targets' likeability, trustworthiness, and cooperative behavior in an economic game. In both studies, raters evaluated BPD targets as less likeable and trustworthy, and in one study also as less cooperative. These findings are contrasted with results from an economic game, in which BPD targets behaved no less cooperatively than controls. We discuss limitations with regard to socioeconomic differences between the target groups and explore how negative evaluations by others may contribute to the interpersonal difficulties in BPD. We suggest that - given future replication with more strictly matched target groups- interventions aimed at improving impression management could be beneficial for BPD patients.

Mentalizing and interpersonal problems in borderline personality disorder: The mediating role of identity diffusion

Individuals with borderline personality disorder (BPD) are characterized by problems in interpersonal functioning and their long-term social integration often remains problematic. Extant theories have linked identity diffusion to many of the interpersonal problems characteristic of BPD patients. Recent theoretical accounts have suggested that identity diffusion results from problems with mentalizing or reflective functioning, that is, the capacity to understand oneself and others in terms of intentional mental states. In this study we tested these assumptions, i.e., whether identity diffusion plays a mediating role in the relationship between mentalizing difficulties and interpersonal problems, in a sample of 167 BPD patients. Highly significant correlations were found between mentalizing impairments, identity diffusion and interpersonal problems. Mediation analyses showed that identity diffusion fully mediated the relationship between mentalizing difficulties and interpersonal problems. This study provides preliminary evidence that impairments in mentalizing are related to identity diffusion, which in turn is related to interpersonal problems in BPD. Further longitudinal research is needed to further substantiate these conclusions.

Borderline Personality Disorder Features and Sensitivity to Injustice.

Hypersensitivity to injustice has been proposed to contribute to interpersonal dysfunction in borderline personality disorder (BPD). We investigated whether BPD features are related to sensitivity to injustice and whether justice sensitivity mediates the relationship between BPD features and aggressive behavior. In an online survey, subjects reported justice sensitivity from the perspective of a victim, an observer, a beneficiary, and a perpetrator as well as BPD features and their own aggressive behavior. Justice sensitivity was higher in participants with a clinically relevant degree of BPD features when they evaluated injustice from the perspective of a victim or an observer. Victim sensitivity partially mediated the relationship between BPD features and the frequency of aggressive behavior. The present study provides first data on the important role of sensitivity to injustice in those with marked BPD features. Particularly, victim sensitivity with its close link to angry reactions may contribute to interpersonal problems in BPD.

Interpersonal problems and negative affect in Borderline Personality and Depressive Disorders in daily life.

Theories of Borderline Personality Disorder (BPD) suggest that interpersonal problems in BPD act as triggers for negative affect and, at the same time, are a possible result of affective dysregulation. Therefore, we assessed the relations between momentary negative affect (hostility, sadness, fear) and interpersonal problems (rejection, disagreement) in a sample of 80 BPD and 51 depressed outpatients at 6 time-points over 28 days. Data were analyzed using multivariate multi-level modeling to separate momentary-, day-, and person-level effects. Results revealed a mutually reinforcing relationship between disagreement and hostility, rejection and hostility, and between rejection and sadness in both groups, at the momentary and day level. The mutual reinforcement between hostility and rejection/disagreement was significantly stronger in the BPD group. Moreover, the link between rejection and sadness was present at all three levels of analysis for the BPD group, while it was localized to the momentary level in the depressed group.

Preliminary Evidence for Emotion Dysregulation as a Mechanism Underlying Poor Sleep Quality in Borderline Personality Disorder.

Sleep disturbance is common in borderline personality disorder (BPD), yet the reasons for this association are not clear. The present study sought to extend prior studies by testing emotion dysregulation as a mechanism underlying this association. We administered self-report measures of sleep quality (SQ), emotion dysregulation, and borderline features to two cross-sectional samples of undergraduates (sample 1: N = 293; sample 2: N = 188). In addition to replicating prior studies linking BPD features to poor SQ, analyses indicated that BPD features related to emotion dysregulation were most strongly correlated with poorer global SQ across both samples. Further, bootstrapping techniques revealed indirect associations by total score on the Difficulties in Emotion Regulation Scale (DERS), as well as for several of its facets (lack of strategies, lack of emotional clarity, lack of awareness). We discuss the potential clinical relevance of emotion dysregulation in the treatment of co-occurring sleep problems in BPD.

A Preliminary Pilot Study Comparing Dialectical Behavior Therapy Emotion Regulation Skills with Interpersonal Effectiveness Skills and a Control Group Treatment

This pilot study examined the effects of dialectical behavior therapy (DBT) emotion regulation (ER) skills training for borderline personality disorder (BPD). To date, studies have yet to reveal whether specific DBT skill modules uniquely improve ER problems - one of the putative factors considered to underlie clinical problems in BPD. This preliminary examination aimed to characterize the effect sizes of DBT-ER compared to DBT interpersonal effectiveness (DBT-IE) skills training. Women with BPD (N = 19) were randomized to 6-weeks of DBT-ER, DBT-IE, or a control group. BPD symptoms, emotion regulation, and other BPD-relevant outcomes were assessed using self-report and laboratory-based measures. The DBT-ER group demonstrated large effect sizes for improved self-reported reactivity to an emotional stressor, generation of active rather than passive solutions to interpersonal problems, as well as self-reported distress tolerance, mindfulness, and BPD symptoms following treatment. At follow-up, DBT-ER training was also associated with large improvements in ER, social problem solving, and depression. Similarly large effect sizes, however, were sometimes also achieved in the DBT-IE and control condition. Significant condition x time interactions were detected for non-suicidal self-injury and mindfulness, with significant improvements occurring only in the DBT-ER group, whereas such interactions were not detected for other outcomes. These findings, although preliminary, can stimulate future research examining the specificity of DBT skills.

Psychiatric Comorbidity in Alcohol Dependence.

We review our clinical studies of psychiatric comorbidity in short-term and long-term abstinent and in treatment naïve alcoholics (STAA, LTAA and TNA). TNA ypically have less severe alcoholism than treated abstinent samples and evidence less severe psychiatric disturbance. Lifetime psychiatric diagnoses are the norm for STAA and LTAA but not for TNA. Individuals with alcohol and drug use disorders show greater antisocial personality disturbance, but do not show differences in the mood or anxiety domains or in borderline personality disorder (BPD) symptoms. The studies show that alcoholics can achieve and maintain abstinence in the face of ongoing mood, anxiety, or BPD problems. By contrast, for ASPD, LTAA essentially stop current antisocial behaviors in all seven domains of antisocial behaviors. We believe that ongoing antisocial behavior is not consistent with maintaining abstinence, and that LTAA modify their antisocial behavior despite continued elevated social deviance proneness and antisocial dispositionality. Abstinent individuals without lifetime psychiatric disorders and TNA show more (subdiagnostic threshold) psychiatric symptoms and abnormal psychological measures than non-alcoholic controls in the mood, anxiety, BPD, and antisocial domains. In summary, our studies show that although LTAA have achieved multi-year abstinence, they still report significant psychological distress compared to NAC. We believe this distress may negatively affect their quality of life. This suggests the importance of developing effective care models to address comorbid mental health problems in LTAA. We also show that antisocial personality disorder symptoms decline to the levels seen in normal controls, and that excluding individuals from research with a psychiatric diagnosis does not control for subdiagnostic psychiatric differences between alcoholics and controls.

Theory of mind in women with borderline personality disorder or schizophrenia: differences in overall ability and error patterns.

Although borderline personality disorder (BPD) and schizophrenia (SZ) are notably different mental disorders, they share problems in social cognition—or understanding the feelings, intentions and thoughts of other people. To date no studies have directly compared the social cognitive abilities of individuals with these two disorders. In this study, the social cognitive subdomain theory of mind was investigated in women with BPD (n = 25), women with SZ (n = 25) and healthy women (n = 25). An ecologically valid video-based measure (Movie for the Assessment of Social Cognition) was used. For the overall score, women with SZ performed markedly below both healthy women and women with BPD, whereas women with BPD did not perform significantly different compared to the healthy control group. A statistically significant error type × group interaction effect indicated that the groups differed with respect to kind of errors. Whereas women with BPD made mostly overmentalizing errors, women with SZ in addition committed undermentalizing errors. Our study suggests different magnitude and pattern of social cognitive problems in BPD and SZ.

Dissociation of explicit and implicit measures of the behavioral inhibition and activation system in borderline personality disorder

Patients with borderline personality disorder (BPD) suffer from various impairments in emotional functioning such as affective instability, inappropriate anger and unstable relationships. These deficits may influence two fundamental motivational systems, the behavioral inhibition system (BIS) and behavioral activation system (BAS). To investigate behavioral intentions and possible impairments in BPD we applied an implicit joystick task to measure implicit behavioral tendencies in response to facial expressions (happiness, sadness, anger, fear and neutral) in 25 patients with BPD and matched 25 healthy controls (HC). Additionally, we evaluated explicit approach and avoidance reactions to these social stimuli, emotion recognition abilities and subjective behavioral ratings. Our data analysis suggests that, although BPD patients accurately identified facial emotional expressions and reacted to them similarly as HC in the joystick task, they had significantly stronger avoidance tendencies in the rating task, especially for happiness and fear. On top of this they exhibited increased BIS sensitivity and decreased BAS sensitivity in the self-report measures. Possible influences are maladaptive cognitive schemas, high negative affect, insecure attachment style and a negative evaluation bias. The observed dysfunctional avoidance ratings may influence the appraisal of socially relevant stimuli and therefore adds further knowledge on social interaction problems in BPD.

EPA-1565 - Oxytocin response to social exclusion in chronically depressed patients

Objective Ostracism (social exclusion) has been found to be a remarkable stress factor to mentally ill people with difficulties in situations of social interaction. In an earlier study it was found that patients with borderline personality disorder (BPD) showed differences in oxytocin dysregulation by having lower oxytocin plasma levels during a social exclusion paradigm (Jobst et al., 2013, submitted). To our knowledge, this is the first study investigating neuroendocrinological changes of social exclusion in chronically depressed patients. Chronic depression (CD) is associated with poor social functioning and behavioral interpersonal problems which are considered to be based on the non-responsiveness of CD patients to environmental consequences. Methods To manipulate a situation of social exclusion we used the Cyberball Paradigm, a virtual ball tossing game which has been well validated and applied in numerous previous studies on the effects of social exclusion. 19 CD patients (according to DSM-IV) and 19 healthy controls matched for gender, age and education underwent repeated neuroendocrine measurements in a standardized laboratory setting during the Cyberball Paradigm. Assessments of psychological variables as well as measurements of oxytocin plasma levels were performed at baseline, 5 min, 15 min and 40 min after Cyberball. Results/Discussion As an association of interpersonal problems in BPD with oxytocin dysregulation has been found, we suggest differences in changes of oxytocin levels in a social exclusion situation in CD patients versus healthy subjects. The data will be presented and discussed in relation to specific interpersonal problems of patients suffering from CD.

EPA-1570 - Social exclusion leads to a reduction of oxytocin plasma levels in borderline patients compared to healthy subjects

Besides affective instability and identity diffusion, disturbances in social interactions are a core symptom of borderline personality disorder (BPD). Interpersonal problems in BPD have been suggested to be associated with oxytocin dysregulation. To directly address this hypothesis, we investigated oxytocin plasma levels during a social exclusion (ostracism) paradigm in female BPD patients. Twenty-two female BPD patients (diagnosed according to DSM-IV) and twenty-one healthy controls matched for gender, age, and education underwent repeated neuroendocrine measurements in a standardized laboratory setting during the Cyberball paradigm, a virtual balltossing game that evokes a social exclusion situation. Emotional reactions were assessed and oxytocin and cortisol levels measured at baseline and 5, 15, and 40 min after Cyberball. After social exclusion, oxytocin plasma levels were lower in BPD patients than in healthy controls, whereas cortisol levels did not differ between groups. BPD patients showed distinct differences in emotion regulation compared to healthy participants and reacted to social exclusion with an increase of other-focused negative emotions, particularly anger and contempt. Our pilot study suggests that the oxytocin system shows a differential response to social exclusion in BPD patients compared to healthy controls. This difference may be related to the high rejection sensitivity of BPD patients and their difficulties in resolving social conflict.

Social cognition in borderline personality disorder.

Many typical symptoms of borderline personality disorder (BPD) occur within interpersonal contexts, suggesting that BPD is characterized by aberrant social cognition. While research consistently shows that BPD patients have biases in mental state attribution (e.g., evaluate others as malevolent), the research focusing on accuracy in inferring mental states (i.e., cognitive empathy) is less consistent. For complex and ecologically valid tasks in particular, emerging evidence suggests that individuals with BPD have impairments in the attribution of emotions, thoughts, and intentions of others (e.g., Preißler et al., 2010). A history of childhood trauma and co-morbid PTSD seem to be strong additional predictors for cognitive empathy deficits. Together with reduced emotional empathy and aberrant sending of social signals (e.g., expression of mixed and hard-to-read emotions), the deficits in mental state attribution might contribute to behavioral problems in BPD. Given the importance of social cognition on the part of both the sender and the recipient in maintaining interpersonal relationships and therapeutic alliance, these impairments deserve more attention.

Perception of Social Participation in Borderline Personality Disorder

Interpersonal dysfunction is a key feature of borderline personality disorder (BPD). Distorted perception of participation in social situations and altered emotional responses could contribute to these typical interpersonal problems in BPD. Thirty patients with BPD were compared with a healthy control group (n = 30) in their perceptions and subjective emotional reactions to situations of social inclusion and exclusion. Participants played Cyberball, a virtual ball-tossing paradigm, in which social inclusion and exclusion are experimentally induced. Control participants reacted with an increase in sadness, anger and overall negative affect when excluded. In BPD patients, social exclusion also induced anger, while general participating in the game seemed to reduce levels of sadness. Compared with healthy controls, BPD patients felt more readily excluded independent of the condition of inclusion or exclusion. In conclusion, patients with BPD displayed a negative bias toward perceived participation in social situations. Key PRACTITIONER MESSAGE: Patients with BPD have a biased perception for exclusion. Virtual ball-tossing games can be used to induce anger in patients with BPD. Participating in a virtual ball-tossing game may reduce levels of sadness in BPD in the short term.

Women With Borderline Disorder Show Less Anger on Anticonvulsants

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessWomen With Borderline Disorder Show Less Anger on AnticonvulsantsAaron LevinAaron LevinSearch for more papers by this authorPublished Online:4 Feb 2005https://doi.org/10.1176/pn.40.3.00400044aWomen with borderline personality disorder who took the anticonvulsant topiramate displayed less anger compared with those on placebo, said German researchers. They also lost weight, an important consideration for a class of drugs that often provokes weight gain.The research extends evidence of the use of anticonvulsant medications like valproate and carbamazepine in the treatment of pathologic aggression, said lead author Marius K. Nickel, M.D., of the Clinic for Psychosomatic Medicine in Simbach/Inn, Germany. Earlier trials had tested topiramate's effects on aggression, but this is the first such placebo-controlled study, he said.“Anger and aggression are big problems in borderline personality disorder, so even a small trial like this is welcome,” said Frances Frankenburg, M.D., a psychiatrist at the Veterans Affairs Medical Center in Bedford, Mass., and an associate professor of psychiatry at the Boston University School of Medicine. “It's always nice to have studies from Europe to gain a different perspective.”Through general practitioners, the German researchers recruited volunteers who expressed feelings of constantly increasing anger in screening interviews. They were randomized in a 2:1 ratio to topiramate (n=19) or matching placebo (n=10). Eight weeks of topiramate treatment began at 50 mg a day and was titrated up to 250 mg a day at the end of six weeks. Subjects were seen weekly in the clinic and tested using the German-language version of the State-Trait Anger Expression Inventory (STAXI), a 57-item inventory that measures the intensity of anger as an emotional state and the disposition to experience angry feelings as a personality trait, according to its distributor.Topiramate resulted in statistically significant improvements on four out of five subscales of the STAXI, reported Nickel in the November 2004 Journal of Clinical Psychiatry. The women taking topiramate improved their scores on the STAXI stateanger subscale score (measuring their subjective state of anger) by 21 percent. Trait-anger, the readiness to react with anger, improved by 24 percent, while the tendency to direct anger outward, anger-out, improved by 23 percent compared with placebo. Anger-control, the socially desirable ability to keep anger under control, strengthened by 13 percent.There was a positive, but not significant, 8.5 percent change favoring topiramate on the scores for anger-in, the tendency to repress anger.Since the women were tested with the STAXI protocol every week, it was possible to see that the beneficial effect of the drug began modestly but produced a rapid improvement after approximately the fifth week, said Nickel.“No psychotic symptoms or other serious side effects were observed, nor did subjects in either treatment group engage in self-mutilation or suicidal acts during the study,” he said. Isolated cases of fatigue, dizziness, headache, and paresthesia were reported as side effects.However, the relative brevity of the trial may have also contributed to its apparent safety, cautioned Frankenburg.“Topiramate may be hard to tolerate over the long haul because it induces cognitive decline,” she said. She also expressed concern about the drug's safety in pregnancy, since anticonvulsants may cause birth defects. Women in this trial averaged 25 years old but were excluded if pregnant or contemplating having a baby.Other anticonvulsant mood stabilizers, like valproate or carbamazepine, can cause patients to gain weight. The patients in this trial lost an average of 2.3 kg during the course of the study, somewhat less than in previous tests of topiramate, said Nickel. “Reduced appetites and weight loss were observed and usually seen as beneficial.”Losing weight may seem like good news for patients and an incentive for compliance, but other drugs that cause weight loss early in clinical trials have evidenced problems later, said Frankenburg. “I'm a bit of a puritan,” she said. “The secret of weight loss is to eat less.”The researchers say their work now needs to be replicated among larger numbers of patients, among men, among more severely ill patients, and for longer periods of time. The brief, eight-week duration of this trial reduced the dropout rate, a problem that often undermines the validity of longer trials, they said.The authors reported no financial affiliation or other relevant conflicts of interest.An abstract of “Topiramate Treatment of Aggression in Female Borderline Personality Disorder Patients: A Double-Blind, Placebo-Controlled Study” is posted online at<www.psychiatrist.com/abstracts/200411/110410.htm>.▪ ISSUES NewArchived

Cognitive features of borderline personality disorder

Of 50 patients with borderline personality disorder, 100% reported disturbed but nonpsychotic thought, 40% (N = 20) reported quasi-psychotic thought, and none reported true psychotic thought during the past 2 years; only 14% (N = 7) reported ever experiencing true psychotic thought. Disturbed and quasi-psychotic thought was significantly more common among these patients than among patients with other axis II disorders or schizophrenia and normal control subjects; however, true psychotic thought was significantly more common among schizophrenic patients. While disturbed thought was also common among axis II disorder and schizophrenic patients, quasi-psychotic thought was reported by only one of these subjects, suggesting that quasi-psychotic thought may be a marker for borderline personality disorder.