A preliminary study on the effect of trauma-focused therapies on sexual dysfunctions in women with PTSD after childhood abuse.

BACKGROUND: Posttraumatic stress disorder (PTSD) is often associated with female sexual dysfunctions (FSD). However, little is known about the impact of therapies for PTSD on FSD according to DSM-5 criteria. AIM/OBJECTIVE: To examine if sexual functioning diagnosed according to DSM-5 criteria improves after treatment for PTSD in women with a PTSD diagnosis after interpersonal child abuse. METHOD: FSD according to DSM-5 criteria were assessed with the structured clinical interview SISEX in N = 152 female participants (mean age = 36.5 years) of a large randomized controlled trial three months into treatment and after 15 months of receiving either dialectical behavior therapy for PTSD or cognitive processing therapy. Number of fulfilled FSD criteria and diagnostic status were compared from pre-to post-treatment using Poisson and negative binomial regression analyses and the McNemar test. The effect of treatment type on reduction of FSD symptoms and the association between reduction in PTSD symptoms and reduction in FSD symptoms were assessed. RESULTS: From pre-to post-treatment, the number of fulfilled criteria for each FSD decreased (Incident rate ratios between 0.60 and 0.71, p between <. 001 and <0 .05). Less women met criteria for genito-pelvic pain/penetration disorder at post-treatment compared to pre-treatment (11.8 % vs. 6.6 %, p < .05). No difference was found between treatments in reduction of FSD symptoms. Reduction of PTSD symptoms was associated with greater decrease in FSD symptoms. CONCLUSIONS: Our results suggest a positive association between effective PTSD treatments and improvements in sexual functioning of women with PTSD after child abuse.

Emotional dysregulation and its pathways to suicidality in a community-based sample of adolescents.

OBJECTIVE: Effective suicide prevention for adolescents is urgently needed but difficult, as suicide models lack a focus on age-specific influencing factors such as emotional dysregulation. Moreover, examined predictors often do not specifically consider the contribution to the severity of suicidality. To determine which adolescents are at high risk of more severe suicidality, we examined the association between emotional dysregulation and severity of suicidality directly as well as indirectly via depressiveness and nonsuicidal self-injury. METHOD: Adolescents from 18 high schools in Bavaria were included in this cross-sectional and questionnaire-based study as part of a larger prevention study. Data were collected between November 2021 and March 2022 and were analyzed from January 2023 to April 2023. Students in the 6th or 7th grade of high school (11-14 years) were eligible to participate. A total of 2350 adolescents were surveyed and data from 2117 students were used for the analyses after excluding incomplete data sets. Our main outcome variable was severity of suicidality (Paykel Suicide Scale, PSS). Additionally, we assessed emotional dysregulation (Difficulties in Emotion Regulation Scale, DERS-SF), depressiveness (Patient Health Questionnaire, PHQ-9) and nonsuicidal self-injury (Deliberate Self-Harm Inventory, DSHI). RESULTS: In total, 2117 adolescents (51.6% female; mean age, 12.31 years [standard deviation: 0.67]) were included in the structural equation model (SEM). Due to a clear gender-specific influence, the model was calculated separately for male and female adolescents. For male adolescents, there was a significant indirect association between emotional dysregulation and severity of suicidality, mediated by depressiveness (ß = 0.15, SE = .03, p = .008). For female adolescents, there was a significant direct path from emotional dysregulation to severity of suicidality and also indirect paths via depressiveness (ß = 0.12, SE = .05, p = 0.02) and NSSI (ß = 0.18, SE = .04, p < .001). CONCLUSIONS: Our results suggest that gender-related risk markers in 11-14-year-olds need to be included in future suicide models to increase their predictive power. According to our findings, early detection and prevention interventions based on emotion regulation skills might be enhanced by including gender-specific adjustments for the co-occurrence of emotional dysregulation, depressiveness, and nonsuicidal self-injury in girls and the co-occurrence of emotional dysregulation and depressiveness in boys.

Evidence for a shared genetic contribution to loneliness and borderline personality disorder.

Loneliness, influenced by genetic and environmental factors such as childhood maltreatment, is one aspect of interpersonal dysfunction in Borderline Personality Disorder (BPD). Numerous studies link loneliness and BPD and twin studies indicate a genetic contribution to this association. The aim of our study was to investigate whether genetic predisposition for loneliness and BPD risk overlap and whether genetic risk for loneliness contributes to higher loneliness reported by BPD patients, using genome-wide genotype data. We assessed the genetic correlation of genome-wide association studies (GWAS) of loneliness and BPD using linkage disequilibrium score regression and tested whether a polygenic score for loneliness (loneliness-PGS) was associated with case-control status in two independent genotyped samples of BPD patients and healthy controls (HC; Witt2017-sample: 998 BPD, 1545 HC; KFO-sample: 187 BPD, 261 HC). In the KFO-sample, we examined associations of loneliness-PGS with reported loneliness, and whether the loneliness-PGS influenced the association between childhood maltreatment and loneliness. We found a genetic correlation between the GWAS of loneliness and BPD in the Witt2017-sample (rg = 0.23, p = 0.015), a positive association of loneliness-PGS with BPD case-control status (Witt2017-sample: NkR² = 2.3%, p = 2.7*10-12; KFO-sample: NkR² = 6.6%, p = 4.4*10-6), and a positive association between loneliness-PGS and loneliness across patient and control groups in the KFO-sample (ß = 0.186, p = 0.002). The loneliness-PGS did not moderate the association between childhood maltreatment and loneliness in BPD. Our study is the first to use genome-wide genotype data to show that the genetic factors underlying variation in loneliness in the general population and the risk for BPD overlap. The loneliness-PGS was associated with reported loneliness. Further research is needed to investigate which genetic mechanisms and pathways are involved in this association and whether a genetic predisposition for loneliness contributes to BPD risk.

Is adherence to dialectic behaviour therapy for post-traumatic stress disorder (PTSD) and cognitive processing therapy related to treatment outcome in PTSD after childhood abuse?

Background: Literature on the association between therapist adherence and treatment success in the treatment of post-traumatic stress disorder (PTSD) is scarce, and the results are mixed.Objective: To examine the relationship between therapist adherence to dialectical behaviour therapy for PTSD (DBT-PTSD) and cognitive processing therapy (CPT) on treatment outcome in women with PTSD and emotion regulation difficulties after interpersonal childhood abuse.Method: Videotaped therapy sessions from 160 female participants of a large randomized controlled trial [Bohus, M., Kleindienst, N., Hahn, C., Müller-Engelmann, M., Ludäscher, P., Steil, R., Fydrich, T., Kuehner, C., Resick, P. A., Stiglmayr, C., Schmahl, C., & Priebe, K. (2020). Dialectical behavior therapy for posttraumatic stress disorder (DBT-PTSD) compared with cognitive processing therapy (CPT) in complex presentations of PTSD in women survivors of childhood abuse. JAMA Psychiatry, 77(12), 1235. jamapsychiatry.2020.2148] were rated. Adherence to CPT and DBT-PTSD was assessed using two specifically developed rating scales.Results: Higher therapist adherence was associated with a greater reduction of clinician-rated PTSD symptom severity. This effect was more pronounced in the CPT group than in the DBT-PTSD group. Adherence was also related to a greater reduction of self-rated PTSD symptoms, borderline symptoms, and dissociation intensity.Conclusion: Our results indicate that higher therapist adherence can lead to better treatment outcomes in PTSD treatments, especially in CPT.

Higher therapist adherence to cognitive processing therapy was associated with higher treatment gains in women with post-traumatic stress disorder (PTSD) after childhood abuse.Adherence was related to higher reductions in symptom severity of PTSD, borderline symptoms, and dissociation intensity.Adherence to dialectical behaviour therapy for PTSD did not show a strong association with treatment outcome.

Does treatment specific-, disorder specific- or general therapeutic competence predict symptom reduction in posttraumatic stress disorder?

Background: Literature on the association between therapist competence and treatment success in posttraumatic stress disorder (PTSD) treatments is scarce and results are mixed.Aims/Objective: The relationship between different types of therapeutic competence, therapeutic alliance, and PTSD symptom reduction in patients treated with Dialectical Behaviour Therapy for PTSD (DBT-PTSD) or Cognitive Processing Therapy (CPT) was assessed. Competence types were PTSD-specific competence, treatment specific competence, and general competence in cognitive behaviour therapy (CBT).Method: Videotaped therapy sessions from N = 160 women with PTSD and emotion regulation difficulties after child abuse participating in a large randomised controlled trial (Bohus et al., 2020) were rated. Three therapeutic competence-types were assessed using specifically developed rating scales. Alliance was assessed via patient ratings with the Helping Alliance Questionnaire (HAQ). PTSD symptoms were assessed at pre- and post-treatment via clinician rating with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and via self-rating with the PTSD-Checklist for DSM-5 (PCL-5).Results: No significant association between competence and clinician or self-rated PTSD symptoms was found. PTSD specific competence predicted clinician rated PTSD symptom severity on a trend level. Alliance predicted both clinician and self-rated PTSD symptom reduction.Conclusion: Our results provide a starting point for future research on different competence types and their association with PTSD treatment gains. Therapists were highly trained and received weekly supervision, hence a restricted competence range is a possible explanation for non-existing associations between competence and PTSD symptom reduction in our sample. More research in naturalistic settings, such as dissemination studies, is needed.

Three different types of therapeutic competence and their association to treatment gains in women with posttraumatic stress disorder after child abuse were assessed.Therapist competence was high in all three domains of competence.No association was found between any of the competence types and reduction in posttraumatic stress disorder symptoms.

Sexual Dysfunctions in Women with Posttraumatic Stress Disorder Following Childhood Sexual Abuse: Prevalence Rates According to DSM-5 and Clinical Correlates.

Many women with posttraumatic stress disorder (PTSD) after child sexual abuse (CSA) suffer from sexual problems. However, little is known about the frequency of female sexual dysfunctions (FSD) as defined by DSM-5 among women with PTSD due to CSA. Furthermore, factors related to FSD in this patient population are understudied. To assess prevalence rates and clinical correlates of FSD according to DSM-5 criteria in women with PTSD after CSA, a structured clinical interview for sexual dysfunctions according to DSM-5 criteria was administered in a sample of 137 women with PTSD after CSA. Participants also completed measures for PTSD, depression symptoms, and borderline personality disorder symptoms. The association between FSD, severity of abuse, PTSD-, depression-, borderline symptom severity, and age was examined. In a second step, the association between FSD and PTSD-clusters was assessed. Diagnostic criteria of female sexual interest/arousal disorder (FSIAD) were met by 2.6% of women in our sample. 5.2% met criteria of female orgasmic disorder (FOD), and 11.8% those of genito-pelvic pain/penetration disorder (GPPPD). PTSD symptom severity predicted number of fulfilled criteria of FSIAD and FOD, the cluster "negative alterations in cognition and mood," was associated with more fulfilled criteria in FSIAD and FOD. The majority of women reported sexual problems, but diagnostic criteria of FSD were met by only a small number of participants. PTSD symptoms, especially the cluster "negative alterations in cognition and mood," seem to be related to female sexual functioning after CSA.

Validation of the German version of the Short Health Scale - a brief, valid and reliable instrument to assess health-related quality of life in German-speaking patients with inflammatory bowel diseases.

BACKGROUND: Health-related quality of life (hrQoL) may be the most important patient-reported outcome for patients with chronic disorders. The Short Health Scale (SHS) is a brief four-item instrument to assess hrQoL in patients with bowel disorders. This study examined the validity, reliability and sensitivity of the German translation of the SHS in a cohort of outpatients with inflammatory bowel diseases (IBD). METHODS: The study was preregistered in April 2021 (https://doi.org/10.17605/OSF.IO/S82D9). Outpatients with IBD (n=225) in different stages of disease activity (as determined by the Harvey-Bradshaw index or partial Mayo score) completed the German SHS and the short Inflammatory Bowel Disease Questionnaire (sIBDQ) as an established measure of hrQoL to examine the convergent validity. To assess reliability, a subset of patients (n=30) in remission completed the same questionnaires after 4-8 weeks. Sensitivity to change was established from questionnaires of patients with either decreased (n=15) or increased (n=16) disease activity after 3-6 months. RESULTS: The internal consistency of the German SHS was high (Cronbach's α=0.860). SHS total scores correlated strongly with sIBDQ scores (ρ=-0.760, p<0.001) and disease activity (ρ=0.590, p<0.001). Retest reliability was high (ρ=0.695, p<0.001). Sensitivity to change was statistically significant for patients with decreased (p=0.013) but not increased (p=0.134) disease activity. CONCLUSION: The German version of the SHS is a valid and reliable tool to measure hrQoL in persons with IBD.

The five self-harm behavior groupings measure: empirical and thematic data from a novel comprehensive self-harm assessment.

Introduction: The Five Self-Harm Behavior Groupings Measure (5S-HM) is a novel assessment that evaluates behaviours which may go undetected by existing measures. Self-harm is formulated across directness and lethality spectra, including under-studied behaviors such as indirect self-harm, harmful self-neglect and sexual self-harm. Aims of the study were to: (1) empirically evaluate the 5S-HM; (2) to determine whether the 5S-HM generates relevant new information with respect to the forms and functions given by participants for self-harm within a clinical sample; (3) to test the utility and novel contributions of the Unified Model of Self-Harm and the 5S-HM by extension. Methods: Data were collected from N = 199 individuals (Mage = 29.98, SD = 8.41, 86.4% female), receiving specialized evidence-based treatments for self-harm, borderline personality disorder or eating disorders. Construct validity was determined via Spearman correlations, and internal consistency was established from Cronbach's alpha. Inductive thematic analysis was used to analyze and interpret qualitative data on reasons, forms and functions participants reported in relation to self-harm following Braun and Clarke's analytic guidelines. Thematic mapping was used to summarize qualitative data. Results: Test-retest reliability on a subsample of n = 24, tested 14 days after Time 1 was supported by a good intraclass correlation (0.68). Internal consistency (Cronbach's alpha = 0.75) was acceptable to good, as was construct validity comparing the 5S-HM total score to two validated self-harm measures (rho = 0.40, p < 0.01; rho = 0.26, p < 0.01). A thematic map depicting antecedents and consequences of self-harm over time suggests that self-harm is initiated by negative emotional states and self-intolerance. Novel findings in relation to sexual self-harm indicated that reasons for these behaviors were either to improve or worsen one's situation through being hurt by someone else. Discussion: The empirical analyses of the 5S-HM demonstrate that it is a robust measure for use in clinical and research settings. Thematic analyses proposed explanations for why self-harm behaviors are initiated and how they are reinforced over time. Sexual self-harm in particular requires further careful study.

Validation of the German version of the subarachnoid haemorrhage outcome tool (SAHOT).

Objective: The subarachnoid haemorrhage (SAH) outcome tool (SAHOT) is the first SAH-specific patient reported outcome measure, and was developed in the UK. We aimed to validate the SAHOT outside the UK, and therefore endeavored to adapt the SAHOT into German and to test its psychometric properties. Methods: We adapted and pilot tested the German version. We applied the SAHOT, Quality of Life after Brain Injury, Hospital Anxiety and Depression Scale, and EuroQol questionnaires in a cohort of 89 patients with spontaneous SAH after discharge. We assessed internal consistency by Cronbach's α, test-retest reliability by intraclass correlation, and validity by Pearson correlations with established measures. Sensitivity to change was evaluated following neurorehabilitation by effect sizes. Results: The translation of SAHOT resulted in a German version that is semantically and conceptually equivalent to the English version. Internal consistency was good regarding the physical domain (α = 0.83) and excellent for the other domains (α = 0.92-0.93). Test-retest reliability indicated a high level of stability with an intraclass correlation of 0.85 (95% CI: 0.83-0.86). All domains correlated moderately or strongly with established measures (r = 0.41-0.74; p < 0.01). SAHOT total scores showed moderate sensitivity to change (Cohen's d = -0.68), while mRS and GOSE showed no significant sensitivity to change. Conclusion: The SAHOT can be adapted to other health care systems and societies than the UK. The German version of the SAHOT is a reliable and valid instrument, and can be used in future clinical studies and individual assessment after spontaneous SAH.

Psychopathology, Protective Factors, and COVID-19 among Adolescents: A Structural Equation Model.

Since the outbreak of the COVID-19 pandemic in December 2019 and the associated restrictions, mental health in children and adolescents has been increasingly discussed in the media. Negative impacts of the pandemic, including a sharp increase in psychopathology and, consequently, reduced quality of life, appear to have particularly affected children and young people, who may be especially vulnerable to the adverse effects of isolation. Nevertheless, many children and adolescents have managed to cope well with the restrictions, without deterioration of their mental health. The present study therefore explored the links between COVID-19 infection (in oneself or a family member, as well as the death of a family member due to the virus), protective factors such as self-efficacy, resilience, self-esteem, and health-related quality of life, and measures of psychopathology such as depression scores, internalizing/externalizing problems, emotion dysregulation, and victimization. For this purpose, we examined data from 2129 adolescents (mean age = 12.31, SD = 0.67; 51% male; 6% born outside of Germany) using a structural equation model. We found medium to high loadings of the manifest variables with the latent variables (COVID-19, protective factors, and psychopathology). Protective factors showed a significant negative correlation with psychopathology. However, COVID-19 had a weak connection with psychopathology in our sample. External pandemic-related factors (e.g., restrictions) and their interaction with existing psychopathology or individual protective factors appear to have a greater influence on young people's mental health than the impact of the virus per se. Sociopolitical efforts should be undertaken to foster prevention and promote individual resilience, especially in adolescence.

Neurostructural associations with traumatic experiences during child- and adulthood.

Adverse experiences can lead to severe mental health problems, such as posttraumatic stress disorder (PTSD), throughout the lifespan. In individuals with PTSD, both global and local brain volume reductions have been reported-especially in the amygdala and hippocampus-while the literature on childhood maltreatment suggests a strong dependency on the timing of adverse events. In the present study, we pooled data from two studies to contrast the effects of reported trauma exposure during neurodevelopmentally sensitive periods in early life with trauma exposure during adulthood. A total of 155 women were allocated into one of six age-matched groups according to the timing of traumatization (childhood vs adulthood) and psychopathology (PTSD vs trauma-exposed healthy vs trauma-naïve healthy). Volumes of the amygdala and hippocampus were compared between these groups. Six additional exploratory regions of interest (ROI) were included based on a recent meta-analysis. Amygdala volume was strongly dependent on the timing of traumatization: Smaller amygdala volumes were observed in participants with childhood trauma and PTSD compared to the healthy control groups. In contrast, larger amygdala volumes were observed in both groups with trauma exposure during adulthood compared to the trauma-naïve control group. Hippocampal volume comparisons revealed no statistically significant differences, although the descriptive pattern was similar to that found for the amygdala. The remaining exploratory ROIs showed significant group effects, but no timing effects. The timing might be an important moderator for adversity effects on amygdala volume, potentially reflecting neurodevelopmental factors. Albeit confounded by characteristics like trauma type and multiplicity, these findings pertain to typical childhood and adulthood trauma as often observed in clinical practice and speak against a simple association between traumatic stress and amygdala volume.

Mental disorders at the beginning of adolescence: Prevalence estimates in a sample aged 11-14 years.

Objectives: This study aims to provide a deeper insight into mental disorders in early adolescence. We report prevalence rates (mental health problems, depressive symptoms, eating disorders, NSSI, STBs) to be used in future studies and clinical ventures. We also expected to find gender differences, with girls being be more affected than boys are. Study design: 877 adolescents (M = 12.43, SD = 0.65) from seven German high schools completed a series of questionnaires assessing their mental health (SDQ, PHQ-9, SEED, DSHI-9, Paykel Suicide Scale, FAS III). Methods: We calculated cut-off-based prevalence estimates for mental health issues for the whole sample and compared estimates between genders. Results: 12.5% of the sample reported general mental health problems. The estimated prevalence of depressive symptoms lay at of 11.5%. Additionally, 12.1% and 1.3% of the participants displayed relevant symptoms of anorexia or bulimia nervosa, respectively. A total of 10.8% reported engaging in non-suicidal self-injury (NSSI) at least once in their lifetime, of whom 5.6% reported repetitive NSSI. 30.1% of the participants described suicidal thoughts, 9.9% suicide plans, and 3.5% at least one suicide attempt. Girls were generally more affected than boys, except for bulimia nervosa, suicidal behavior, and partly NSSI. Conclusion: Our findings corroborate the established relevance of early adolescence for the development of mental health problems and suggest that a substantial proportion of young adolescents suffer from such problems early on. Considering the ongoing COVID-19 pandemic and reported negative mental health consequences, the current findings underline the importance of preventive interventions to avoid the manifestation of mental disorders during adolescence.

Is It a Gut Feeling? Bodily Sensations Associated With the Experience of Valence and Arousal in Patients With Inflammatory Bowel Disease.

Background: Previous studies have shown dysfunctional emotion processing in patients with inflammatory bowel diseases (IBD), characterized by a hypersensitivity to negative emotions and a hyposensitivity to positive emotions. Models of emotion processing emphasize the importance of bodily sensations to the experience of emotions. Since there have been no studies on whether emotion-associated bodily sensations are changed in IBD, we investigated the experience of bodily sensations related to valence and arousal, together with their links to emotional awareness, as one domain of interoceptive sensibility relevant to emotion processing. Methods: Using a topographical self-report measure, 41 IBD patients in clinical remission and 44 healthy control (HC) participants were asked to indicate where and how intensely in their body they perceive changes when experiencing emotions of positive and negative valence, as well as relaxation and tension. Additionally, we used self-report questionnaires to assess emotional awareness as one domain of an individual's interoceptive sensibility, gastrointestinal-specific anxiety (GSA), and psychological distress. Results: Patients with IBD reported higher emotional awareness but lower intensities of perceived changes in their bodily sensations related to valence and arousal of emotional processing. IBD patients reported less intense bodily activation during positive emotions and less intense bodily deactivation during negative emotional states in comparison to HC participants. Higher emotional awareness and psychological distress were linked to stronger experiences of emotion-related bodily sensations in IBD patients. Conclusion: Inflammatory bowel diseases patients exhibited alterations in how they link bodily sensations to their emotional experience. Such persistent changes can affect a patient's wellbeing and are related to higher levels of anxiety and depression among IBD patients, even in remission.

Abnormal processing of interpersonal cues during an aggressive encounter in women with borderline personality disorder: Neural and behavioral findings.

Inappropriate aggression is a prominent and clinically relevant interpersonal dysfunction of individuals with borderline personality disorder (BPD). Previous studies have shown that individuals with BPD interpret interpersonal signals in a hostile manner, but it is uncertain how this negativity bias impacts decision-making during aggressive encounters. In the present neuroimaging study, 48 medication-free women with BPD and 28 age- and intelligence-matched women played the Social Threat Aggression Paradigm (STAP), a competitive reaction time task in which the winner delivers an aversive sound blast to the loser. Crucially, in the STAP the alleged opponent displays either an angry or neutral facial expression at the beginning of each trial and selects increasingly loud blasts in order to provoke participants. Relative to healthy controls, women with BPD differentiated less between angry and neutral facial expressions, both in terms of aggressive behavior and of activity in medial prefrontal cortex, amygdala, and temporal pole. On the one hand, and contrary to our hypotheses, neural and behavioral responses to angry faces were reduced in women with BPD compared to healthy women. On the other hand, provocation heightened subsequent amygdala responses to neutral faces in BPD, and this was in turn associated with aggressive behavior, supporting a default negativity bias in BPD. The neurocognitive processes by which these alterations might guide aggressive behavior irrespective of interpersonal cues are presented and discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Borderline personality disorder and the big five: molecular genetic analyses indicate shared genetic architecture with neuroticism and openness.

Both environmental (e.g. interpersonal traumatization during childhood and adolescence) and genetic factors may contribute to the development of Borderline Personality Disorder (BPD). Twin studies assessing borderline personality symptoms/features in the general population indicate that genetic factors underlying these symptoms/features are shared in part with the personality traits of the Five Factor Model (FFM) of personality-the "Big Five". In the present study, the genetic overlap of BPD with the Big Five -Openness to Experience, Conscientiousness, Extraversion, Agreeableness, and Neuroticism- was assessed. Linkage disequilibrium score regression was used to calculate genetic correlations between a genome-wide association study (GWAS) in central European populations on BPD (N = 2543) and GWAS on the Big Five (N = 76,551-122,886, Neuroticism N = 390,278). Polygenic scores (PGS) were calculated to test the association of the genetic disposition for the personality traits with BPD case-control status. Significant positive genetic correlations of BPD were found with Neuroticism (rg = 0.34, p = 6.3*10-5) and Openness (rg = 0.24, p = 0.036), but not with the other personality traits (all | rg | <0.14, all p > 0.30). A cluster and item-level analysis showed positive genetic correlations of BPD with the Neuroticism clusters "Depressed Affect" and "Worry", and with a broad range of Neuroticism items (N = 348,219-376,352). PGS analyses confirmed the genetic correlations, and found an independent contribution of the personality traits to BPD risk. The observed associations indicate a partially shared genetic background of BPD and the personality traits Neuroticism and Openness. Larger GWAS of BPD and the "Big Five" are needed to further explore the role of personality traits in the etiology of BPD.

Reduced vagal activity in borderline personality disorder is unaffected by intranasal oxytocin administration, but predicted by the interaction between childhood trauma and attachment insecurity.

Individuals with borderline personality disorder (BPD) show self-regulatory deficits, associated with reduced heart-rate variability (HRV). However, results on reduced HRV in BPD remain heterogeneous, thus encouraging the search for developmental constructs explaining this heterogeneity. The present study first examined predictors of reduced resting-state HRV in BPD, namely the interaction between self-reported adult attachment insecurity and childhood trauma. Second, we investigated if alterations in resting-state HRV are modified by intranasal oxytocin administration, as oxytocin may enhance HRV and is implicated in the interaction between childhood trauma and disturbed attachment for the pathogenesis of BPD. In a randomized, placebo-controlled trial, 53 unmedicated women with BPD and 60 healthy controls (HC) self-administered either 24 I.U. of oxytocin or placebo and underwent a 4-min electrocardiogram. Our results replicate significantly reduced HRV in women with BPD, explained up to 16% by variations in childhood trauma and attachment insecurity. At high levels of acute attachment insecurity, higher levels of childhood trauma significantly predicted reduced HRV in BPD. However, our results do not support a significant effect of oxytocin on mean HRV, and no interaction effect emerged including childhood trauma and attachment insecurity. Our findings highlight a complex interaction between reduced vagal activity and developmental factors in BPD.

Pleasant touch perception in borderline personality disorder and its relationship with disturbed body representation.

BACKGROUND: Borderline personality disorder (BPD) is characterized by altered perception of affective stimuli, including abnormal evaluation of nociceptive input. However, whether or not perceptual alterations are present for its positive counterpart, i.e. pleasant touch (PT), has not yet been examined. METHODS: In the present study, we applied standardized PT stimuli to the hands of 25 patients with BPD and 25 healthy controls (HC) and compared their perception. We used the affect-modulated acoustic startle response as a physiological correlate of affective processing. We further explored the effect of PT stimulation on dissociative experiences in BPD. RESULTS: Compared to HC, BPD perceived PT as less pleasant and less intense. The effect on perceived valence of touch was large even after controlling for the effect of reduced perceived intensity of touch (ƞ2 = .29). We further found qualitative alterations in touch perception in BPD, who rated the touch as significantly rougher and firmer compared to HC. There was a positive correlation between perceived valence of touch and changes in dissociative experiences in terms of body ownership of the stimulated body part from pre to post stimulation, suggesting that a more negative evaluation of touch is associated with an increase in body-related dissociative experiences, while a positive perception of touch might be related to a reduction of these dissociative experiences. CONCLUSIONS: Our results confirm BPD-associated disturbances in the processing of affective somatosensory stimuli and indicate that not only pain perception but also pleasant touch perception is diminished in BPD. We discuss the role of altered touch perception for BPD psychopathology and its potential role for new treatment approaches.

Cerebral processing of sharp mechanical pain measured with arterial spin labeling.

INTRODUCTION: Arterial spin labeling (ASL) is a functional neuroimaging technique that has been frequently used to investigate acute pain states. A major advantage of ASL as opposed to blood-oxygen-level-dependent functional neuroimaging is its applicability for low-frequency designs. As such, ASL represents an interesting option for studies in which repeating an experimental event would reduce its ecological validity. Whereas most ASL pain studies so far have used thermal stimuli, to our knowledge, no ASL study so far has investigated pain responses to sharp mechanical pain. METHODS: As a proof of concept, we investigated whether ASL has the sensitivity to detect brain activation within core areas of the nociceptive network in healthy controls following a single stimulation block based on 96 s of mechanical painful stimulation using a blunt blade. RESULTS: We found significant increases in perfusion across many regions of the nociceptive network such as primary and secondary somatosensory cortices, premotor cortex, posterior insula, inferior parietal cortex, parietal operculum, temporal gyrus, temporo-occipital lobe, putamen, and the cerebellum. Contrary to our hypothesis, we did not find any significant increase within ACC, thalamus, or PFC. Moreover, we were able to detect a significant positive correlation between pain intensity ratings and pain-induced perfusion increase in the posterior insula. CONCLUSION: We demonstrate that ASL is suited to investigate acute pain in a single event paradigm, although to detect activation within some regions of the nociceptive network, the sensitivity of our paradigm seemed to be limited. Regarding the posterior insula, our paradigm was sensitive enough to detect a correlation between pain intensity ratings and pain-induced perfusion increase. Previous experimental pain studies have proposed that intensity coding in this region may be restricted to thermal stimulation. Our result demonstrates that the posterior insula encodes intensity information for mechanical stimuli as well.

[Implementation and evaluation of a telephone hotline for professional mental health first aid during the COVID-19 pandemic in Germany]. / Implementierung und Evaluation einer Telefonhotline zur professionellen Ersthilfe bei psychischen Belastungen durch die COVID-19-Pandemie in Baden-Württemberg.

BACKGROUND: The COVID-19 pandemic represents a significant psychological burden for many people; however, especially during the first wave of the pandemic in Germany, little acute professional help was available for people in need. OBJECTIVE: In southern Germany, a telephone hotline for psychological first aid for COVID-19-related burdens was set up under the lead of the Baden-Wuerttemberg Ministry of Social Affairs and Integration, opened to the entire population and evaluated in April 2020. MATERIAL AND METHODS: In the period from 22 April to 24 July 2020, 753 volunteer psychotherapeutically trained counselors from different professional groups answered a total of 8096 calls. RESULTS: Depression symptoms (36%), anxiety symptoms (18%) and psychotic symptoms (19%) were most frequently reported. Every second call was related to a previous mental illness. During the counseling sessions, which lasted 25 min on average, a variety of psychological acute interventions were conducted. In the presence of unclear symptoms, psychotic symptoms or severe personality disorder symptoms, the counselors were able to help significantly less compared to the remaining calls in which other clearly defined symptoms were present. CONCLUSION: The results point to both the benefits and limitations of hotline services. The major benefits relate to the fast availability and effective professional help for people with clearly characterized symptoms. In the case of unclear or complex symptoms, immediate help by telephone seems to be possible only to a limited extent, but it could initiate access to further help offers. Overall, the results of this study provide a first indication that hotline services for psychological first aid are feasible under pandemic conditions.