The course of borderline personality disorder from adolescence to early adulthood: A 5-year follow-up study.

BACKGROUND: Studies of the medium- to long-term clinical and functional course for treatment-seeking adolescents with borderline personality disorder (BPD) are lacking. This study aims to outline the psychopathological and functional status of participants, five years after being diagnosed with BPD during adolescence. METHODS: Participants were originally enrolled in a randomized clinical trial that compared mentalization-based group treatment with treatment as usual for adolescents with BPD. Semi-structured interview assessments at five-year follow-up included the Schedules for Clinical Assessment in Neuropsychiatry and the Structured Clinical Interview for DSM-5 Personality Disorders. Attention deficit hyperactivity disorder (ADHD), alcohol, substance and tobacco use, posttraumatic stress disorder (PTSD), complex PTSD, and general functioning were assessed using self-report instruments. RESULTS: 97 of the original sample of 111 participants (87%) participated. They were aged 19-23 years. The most prevalent disorders were ADHD (59%), any personality disorder (47%) of which half continued to meet criteria for BPD (24%), anxiety disorders (37%), depressive disorders (32%), PTSD or complex PTSD (20%), schizophrenia (16%), and eating disorders (13%). Only 16% did not meet criteria for any mental disorder. Approximately half of the sample were in psychological and/or psychopharmacological treatment at the time of follow-up. Their general functioning remained impaired, with 36% not engaged in education, employment or training (NEET), which is nearly four times the rate of NEET in the same age group in the general population. CONCLUSIONS: Although stability of the categorical BPD diagnosis is modest, adolescents meeting diagnostic criteria for BPD show a broad range of poor outcomes at five-year follow-up. BPD appears to be a marker of general maladjustment during adolescence and a harbinger of severe problems during the transition to young adulthood. Early intervention programs for adolescents diagnosed with BPD should focus upon a broad range of functional and psychopathological outcomes, especially social and vocational support, rather than the narrow BPD diagnosis.

Reconceptualization of borderline conditions through the lens of the alternative model of personality disorders.

Borderline (BPD) and schizotypal personality disorder (SPD) were introduced in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III). However, the clinical differentiation of the 2 diagnoses (e.g., psychotic-like features) was challenging for diagnostic classification and clinical management. With the introduction of the alternative model for personality disorders (AMPD) in DSM-5 Section III, a dimensional approach was proposed, which potentially holds promise for better future differentiation between BPD and SPD. The present study sought to examine the psychopathology using the AMPD model. A total of 105 patients were interviewed, 25 were excluded according to exclusion criteria, and the final sample comprised 80 patients who fulfilled the DSM-5 criteria for BPD (n = 35), SPD (n = 25), and comorbid BPD + SPD (n = 20), respectively. All patients were administered The Structured Clinical Interview for DSM-5 alternative model for personality disorders Modules I and II. One-way analysis of variance tests with planned contrasts were used. Results showed that for AMPD Criterion A, the BPD + SPD group had the most severe impairment of personality functioning, except for Identity, where the SPD group showed the most severe impairment. For AMPD Criterion B, the domain of Detachment and the facet of Eccentricity from the Psychoticism domain were most prominent for the SPD group relative to the 2 other groups. The differentiating between BPD and SPD manifestations of cognitive/perceptual disturbances does not seem resolved by the Psychoticism domain, which covers broader aspects of psychopathology. Future research should further investigate the construct of Psychoticism, especially to differentiate nonpsychotic symptoms (e.g., dissociation) and address thought disorder. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Assessment of personality functioning in ICD-11 posttraumatic stress disorder and complex posttraumatic stress disorder.

The newly added diagnosis complex posttraumatic stress disorder (CPTSD) in the 11th edition of the International Classification of Diseases (ICD-11) includes a domain of disturbances in self-organization (DSO), in addition to PTSD. The DSO construct appears to have definitional overlap with the dimensional personality pathology severity measure, personality functioning. This study investigated the association between personality functioning and ICD-11 CPTSD, and the associations between DSO clusters and personality functioning domains. The sample comprised 83 outpatients with ICD-11 PTSD or CPTSD. Personality functioning was operationalized with the Level of Personality Functioning Scale (LPFS) and assessed with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Alternative Model for Personality Disorders, Module I. Results showed an average level of moderate impairment in personality functioning (i.e., Identity, Self-Direction, Empathy, and Intimacy) for the whole sample. However, the levels of impairment in personality functioning were significantly more severe in patients with ICD-11 CPTSD, compared with patients with PTSD. Furthermore, the results revealed strong significant positive associations between the personality functioning domains and the DSO symptom clusters, except for the LPFS Identity domain and the DSO Affective Dysregulation cluster. Contrary to expectations, we found a significant positive association between the PTSD symptom cluster Avoidance and the LPFS domains Identity, Self-Direction, and Intimacy. Furthermore, higher levels of impairment in the Identity and Intimacy domain were associated with an increase in DSO symptom severity. New development in assessment of personality functioning may assist clinicians in differential diagnosis of PTSD and CPTSD. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Exposure to methylmercury and inorganic mercury in the food does not lead to trophic magnification in the sea star Asterias rubens.

Methylmercury accumulated at the top of aquatic food chains constitutes a toxicological risk to humans and other top predators. Biomagnification of methylmercury takes place among vertebrates at the higher trophic levels, but this process is less elucidated in benthic invertebrates at the lower trophic levels. Therefore, we investigated the accumulation from food and elimination of methylmercury and inorganic mercury in the benthic sea star Asterias rubens (L.) - a representative of trophic level ~3 - in laboratory experiments. Sea stars fed over 49 days with contaminated mussels (Mytilus edulis) accumulate methylmercury and inorganic mercury to the highest concentrations in the digestive glands, the pyloric caeca, less in stomach, gonad, tube feet, aboral body wall and not to detectable levels in the coelomic fluid. Concerning whole body contents, steady states were reached for both methylmercury and inorganic mercury during the 7-week feeding period and the sea stars reached approximately ½ and » of the concentrations in the mussel food for the two mercury forms, respectively. Half-lives for the elimination of the two mercury forms varied between 45 and 173 days in a 140-d elimination period following the feeding period; inorganic mercury was eliminated faster than methylmercury. Examination of total mercury concentrations in field-collected sea stars confirmed this lack of trophic magnification in relation to the major food items, soft parts of molluscs. We suggest that mercury is not trophically magnified in sea stars 1) because they eliminate methylmercury faster than larger fish and decapod crustaceans and 2) maybe more importantly, because inorganic mercury with its faster elimination constitutes a larger fraction of the total mercury in the food at the lower trophic levels - as opposed to methylmercury which dominates at the higher trophic levels.

Validation of ICD-11 PTSD and DSO using the International Trauma Questionnaire in five clinical samples recruited in Denmark.

Background: The 11th version of the International Classification of Diseases (ICD-11) revised the diagnosis of Posttraumatic Stress Disorder (PTSD) and introduced Complex PTSD as a sibling disorder to PTSD. As the Danish Health Authorities will implement the ICD-11 in 2022, it is more relevant than ever to introduce a measure that enables the identification of ICD-11 PTSD and CPTSD. Objective: The primary aim of the present study was to test the construct validity of the ICD-11 conceptualization of PTSD and DSO in five clinical samples using translated versions of the International Trauma Questionnaire (ITQ). Method: Data from existing studies of adult survivors of sexual abuse (n = 385), women in shelters (n = 147), psychiatric outpatients endorsing an ICD-10 diagnosis of PTSD (n = 111), a heterogenous sample of psychiatric outpatients (n = 178) and refugees and torture survivors (n = 385) was used for the current study. Confirmatory factor analyses were conducted to test the internal structure of the ITQ, and regression models were conducted to test the convergent and discriminant validity of the factor solutions for each sample. Results: Findings supported the ICD-11 formulation of PTSD and disorders in self-organization (DSO) as a representation of the latent structure of the ITQ across five Danish clinical samples. Uniquely for women in shelters, however, the model displayed an unacceptable fit. A revised operationalization of re-experiencing proved a better fit when 'recurrent nightmares' was exchanged with symptoms of intense emotional reactions to reminders of the trauma for women in shelter as well as ICD-10 PTSD psychiatric outpatients. Conclusion: This study supports the use of a Danish translated version of the ITQ to assess symptoms of ICD-11 PTSD and DSO for the introduction of ICD-11 in 2022. Future research is needed to further explore the operationalization of re-experiencing across different trauma exposed populations.

Antecedentes: La décimo primera versión de la Clasificación Internacional de Enfermedades (CIE-11) revisó el diagnóstico de Trastorno de Estrés Postraumático (CIE-11) e introdujo el TEPT complejo como un diagnóstico hermano del TEPT. Como las autoridades de salud danesas implementarán la CIE-11 en el 2022, es más relevante que nunca introducir una medición que permita la identificación del TEPT y el TEPT complejo de acuerdo a la CIE-11.Objetivo: El principal objetivo del presente estudio fue probar la validez del constructo diagnóstico de la conceptualización del TEPT y de las Alteraciones en la Auto-Organización (DSO por sus siglas en inglés) en cinco muestras clínicas usando versiones traducidas del Cuestionario Internacional de Trauma (ITQ por sus siglas en inglés).Método: Se usaron para el presente estudio, datos de estudios ya existentes de sobrevivientes adultos de abuso sexual (n = 147), pacientes psiquiátricos ambulatorios con diagnóstico de TEPT de acuerdo a la CIE-10 (n = 111), una muestra heterogénea de pacientes psiquiátricos ambulatorios (n = 178) y refugiados y sobrevivientes de tortura (n = 385). Se usaron análisis factoriales confirmatorios para probar la estructura interna del ITQ, y se aplicaron modelos de regresión para probar la validez convergente y discriminante de las soluciones factoriales para cada muestra.Resultados: Los hallazgos apoyaron la formulación de ls CIE-11 del TEPT y de los desórdenes en la auto-organización (DSO) como una representación) de la estructura latente del ITQ en 5 muestras clínicas danesas. Sin embargo, en el caso de las mujeres de los centros de acogida, el modelo mostró un ajuste inaceptable. Una operacionalización revisada de la re-experimentación probó ser más ajustada cuando 'pesadillas recurrentes' fue reemplazada por los síntomas de reacciones emocionales intensas ante recordatorios del trauma para mujeres en los centros de acogida así como a los pacientes psiquiátricos ambulatorios con TEPT según la CIE-10.Conclusión: Este estudio apoya el uso de la versión traducida en danés del ITQ para evaluar síntomas de TEPT y DSO de acuerdo a la CIE-11 para la introducción de la CIE-11 en el 2022.Se requiere futura investigación para explorar la operacionalización de la re-experimentación en diferentes poblaciones expuestas al trauma.

Differences between ICD-11 PTSD and complex PTSD on DSM-5 section III personality traits.

Background: The formulations of post-traumatic stress disorder (PTSD) and the newly included disorder complex PTSD (CPTSD) in the 11th edition of the International Classification of Diseases (ICD-11) have not been evaluated on a broad range of maladaptive personality traits. Objective: The aim of this study was to evaluate ICD-11 PTSD and CPTSD on maladaptive personality traits. Method: In a cross-sectional study of 106 Danish outpatients with ICD-10 PTSD, we used the International Trauma Questionnaire (ITQ) to identify patients with either ICD-11 PTSD or CPTSD (N = 84). We utilized the Personality Inventory for DSM-5 (PID-5) from the alternative model of personality disorders in DSM-5, section III, to evaluate personality trait differences between ICD-11 PTSD and CPTSD. Furthermore, PID-5 was also used to investigate relationships between personality traits and ICD-11 PTSD/CPTSD symptom clusters. The Life Event Checklist was used to assess traumatic experiences, and the MINI International Neuropsychiatric Interview was applied to assess comorbidity. Results: Patients with ICD-11 PTSD or CPTSD had elevated scores on personality traits indicative of internalizing psychopathology. However, higher impairment levels of the trait domains Negative Affectivity (d= 0.75) and Psychoticism (d = 0.80) discriminated patients with ICD-11 CPTSD from patients with PTSD. The PID-5 trait domain Detachment was moderately positively correlated to most of the ITQ symptom clusters and, the ITQ Negative Self-concept symptom cluster showed a relatively high number of significant correlations across all the PID-5 trait domains and facets. The PID-5 domain Negative Affectivity and almost all the encompassing facets were significantly correlated with DSO symptom clusters. Conclusions: The findings demonstrate the relevance of applying dimensional assessment of personality features to study the psychopathology of ICD-11 PTSD and CPTSD and potential differences. The results suggest that CPTSD is a more debilitating disorder than PTSD considering the severity of the personality features.

Antecedentes: Las formulaciones del trastorno de estrés postraumático (TEPT) y el trastorno de estrés postraumático complejo recientemente incluido (TEPTC) en la 11a edición de la Clasificación Internacional de Enfermedades (CIE-11) no han sido evaluados en una amplia gama de rasgos de personalidad desadaptativos.Objetivo: El propósito de este estudio fue evaluar el TEPT y el TEPTC de la CIE-11 sobre los rasgos de personalidad desadaptativos.Método: En un estudio transversal de 106 pacientes daneses ambulatorios con TEPT CIE-10, utilizamos el Cuestionario Internacional de Trauma (ITQ por sus siglas en inglés) para identificar a los pacientes con TEPT o TEPTC CIE-11 (N = 84). Utilizamos el Inventario de Personalidad para el DSM-5 (IPD-5) del modelo alternativo de trastornos de la personalidad en el DSM-5, sección III, para evaluar las diferencias de los rasgos de personalidad entre el TEPT de la CIE-11 y el TEPTC. Además, el IPD-5 también se utilizó para investigar relaciones entre los rasgos de personalidad y los grupos de síntomas de TEPT/TEPTC de la CIE-11. La Lista de verificación de eventos de vida se utilizó para evaluar experiencias traumáticas, y la Entrevista neuropsiquiátrica internacional MINI se aplicó para evaluar comorbilidad.Resultados: Los pacientes con TEPT o TEPTC según la CIE-11 tenían puntuaciones elevadas en los rasgos de personalidad indicativos de psicopatología internalizante. Sin embargo, los niveles más altos de deterioro en los dominios de rasgo Afectividad negativa (d = 0,75) y Psicoticismo (d = 0,80) discriminaron a los pacientes con TEPTC CIE-11 de los pacientes con TEPT. El dominio de rasgo Desapego del IPD-5 correlacionó moderadamente positivo con la mayoría de los grupos de síntomas de ITQ y el grupo de síntomas de autoconcepto negativo de ITQ mostró un número relativamente alto de correlaciones significativas a través de todos los dominios y facetas de rasgo IPD-5. El dominio IPD-5 afectividad negativa y casi todas las facetas que la abarcan se correlacionaron significativamente con los grupos de síntomas de DSO.Conclusiones: Los hallazgos demuestran la relevancia de aplicar la evaluación dimensional de las características de personalidad para estudiar la psicopatología del TEPT y TEPTC de la CIE-11 y las potenciales diferencias. Los resultados sugieren que el TEPTC es un trastorno más debilitante que el TEPT considerando la gravedad de las características de personalidad.

Thinking within the spectrum: schizophrenic thought disorder in six Danish pedigrees.

Formal thought disorder (FTD), a major symptom of schizophrenia, is known to aggregate in families. Our aim was to examine the specificity of FTD in the schizophrenia spectrum disorders and the hypothesized linear aggregation of FTD within pedigrees. Six individuals with a diagnosis of schizophrenia were identified in the Copenhagen High-Risk study and each pedigree was centered on one of the six original schizophrenic probands' nuclear families. The 329 pedigree members in the study were considered at risk for schizophrenia spectrum disorders because most were genetically related to the originating schizophrenic probands. The participants were administered the Copenhagen Interview of Functional Illness to determine diagnoses and the Thought Disorder Index (TDI) was used to assess FTD. Individuals with a schizophrenia diagnosis had higher global levels of FTD, exhibited more severe types of FTD, and had a qualitatively different type of FTD than did participants with other diagnoses or no mental illness. Individuals with Cluster A diagnoses exhibited more FTD and FTD similar in quality to participants with schizophrenia. These results support the construct of a spectrum of schizophrenia conditions. There was a generally high level of FTD in the pedigrees, in part due to assortative mating in this sample. However, there was no apparent pattern of linear aggregation of FTD within the families.

Linkage of eye movement dysfunction to chromosome 6p in schizophrenia: additional evidence.

Establishing the genetics of physiological traits associated with schizophrenia may be an important first step in building a neurobiological bridge between the disease phenotype and its genetic underpinnings. One of the best known of the traits associated with schizophrenia is a disorder of smooth pursuit eye tracking (ETD), which is present in 50-80% of schizophrenia patients. ETD is more than three times more prevalent in the families of a schizophrenia patient than is schizophrenia itself. Arolt et al. [1999] estimated LOD scores for ETD of 2.85 for D6S282 and 3.70 for D6S271, two markers on 6p21.1, as well as obtaining an indication of possible linkage for schizophrenia. Our sample comprised two large families in Denmark. Markers in the region that was implicated by the study of Arolt et al. [1996, 1999] were analyzed as part of a genome scan using the "latent trait (L.T.) model" for the co-transmission of schizophrenia and ETD that we had previously fitted to segregation analysis data from Norway. We obtained a LOD score of 2.05 for D6S1017, a marker within 3 cM of the positive markers obtained by Arolt et al. [1996, 1999]. We regard our results as independent evidence supporting the findings of Arolt et al. [1996, 1999] and also as support for the L.T. model as a way of combining the traits ETD and schizophrenia.

The phosphorylation pattern of human alphas1-casein is markedly different from the ruminant species.

Caseins are highly phosphorylated milk proteins assembled in large colloidal structures termed micelles. In the milk of ruminants, alphas1-casein has been shown to be extensively phosphorylated. In this report we have determined the phosphorylation pattern of human alphas1-casein by a combination of matrix-assisted laser desorption mass spectrometry and amino acid sequence analysis. Three phosphorylation variants were identified. A nonphosphorylated form, a variant phosphorylated at Ser18 and a variant phosphorylated at Ser18 and Ser26. Both phosphorylation sites are located in the amino acid recognition sequence of the mammary gland casein kinase. Notably, no phosphorylations were observed in the conserved region covering residues Ser70-Glu78, which is extensively phosphorylated in the ruminant alphas1-caseins.