Borderline personality disorder symptom networks across adolescent and adult clinical samples: examining symptom centrality and replicability.

BACKGROUND: Numerous theories posit different core features to borderline personality disorder (BPD). Recent advances in network analysis provide a method of examining the relative centrality of BPD symptoms, as well as examine the replicability of findings across samples. Additionally, despite the increase in research supporting the validity of BPD in adolescents, clinicians are reluctant to diagnose BPD in adolescents. Establishing the replicability of the syndrome across adolescents and adults informs clinical practice and research. This study examined the stability of BPD symptom networks and centrality of symptoms across samples varying in age and clinical characteristics. METHODS: Cross-sectional analyses of BPD symptoms from semi-structured diagnostic interviews from the Collaborative Longitudinal Study of Personality Disorders (CLPS), the Methods to Improve Diagnostic Assessment and Service (MIDAS) study, and an adolescent clinical sample. Network attributes, including edge (partial association) strength and node (symptom) expected influence, were compared. RESULTS: The three networks were largely similar and strongly correlated. Affective instability and identity disturbance emerged as relatively central symptoms across the three samples, and relationship difficulties across adult networks. Differences in network attributes were more evident between networks varying both in age and in BPD symptom severity level. CONCLUSIONS: Findings highlight the relative importance of affective, identity, and relationship symptoms, consistent with several leading theories of BPD. The network structure of BPD symptoms appears generally replicable across multiple large samples including adolescents and adults, providing further support for the validity of the diagnosis across these developmental phases.

Revisiting the seven pillars of RDoC.

BACKGROUND: In 2013, a few years after the launch of the National Institute of Mental Health's Research Domain Criteria (RDoC) initiative, Cuthbert and Insel published a paper titled "Toward the future of psychiatric diagnosis: the seven pillars of RDoC." The RDoC project is a translational research effort to encourage new ways of studying psychopathology through a focus on disruptions in normal functions (such as reward learning or attention) that are defined jointly by observable behavior and neurobiological measures. The paper outlined the principles of the RDoC research framework, including emphases on research that acquires data from multiple measurement classes to foster integrative analyses, adopts dimensional approaches, and employs novel methods for ascertaining participants and identifying valid subgroups. DISCUSSION: To mark the first decade of the RDoC initiative, we revisit the seven pillars and highlight new research findings and updates to the framework that are related to each. This reappraisal emphasizes the flexible nature of the RDoC framework and its application in diverse areas of research, new findings related to the importance of developmental trajectories within and across neurobehavioral domains, and the value of computational approaches for clarifying complex multivariate relations among behavioral and neurobiological systems. CONCLUSION: The seven pillars of RDoC have provided a foundation that has helped to guide a surge of new studies that have examined neurobehavioral domains related to mental disorders, in the service of informing future psychiatric nosology. Building on this footing, future areas of emphasis for the RDoC project will include studying central-peripheral interactions, developing novel approaches to phenotyping for genomic studies, and identifying new targets for clinical trial research to facilitate progress in precision psychiatry.

Ratings for emotion film clips.

Film clips are widely utilized to elicit emotion in a variety of research studies. Normative ratings for scenes selected for these purposes support the idea that selected clips correspond to the intended target emotion, but studies reporting normative ratings are limited. Using an ethnically diverse sample of college undergraduates, selected clips were rated for intensity, discreteness, valence, and arousal. Variables hypothesized to affect the perception of stimuli (i.e., gender, race-ethnicity, and familiarity) were also examined. Our analyses generally indicated that males reacted strongly to positively valenced film clips, whereas females reacted more strongly to negatively valenced film clips. Caucasian participants tended to react more strongly to the film clips, and we found some variation by race-ethnicity across target emotions. Finally, familiarity with the films tended to produce higher ratings for positively valenced film clips, and lower ratings for negatively valenced film clips. These findings provide normative ratings for a useful set of film clips for the study of emotion, and they underscore factors to be considered in research that utilizes scenes from film for emotion elicitation.

Individuals with single versus multiple suicide attempts over 10years of prospective follow-up.

BACKGROUND: The study attempted to identify characteristics that differentiate multiple suicide attempters from single attempters in individuals with personality disorders (PDs) and/or major depression. METHOD: Participants were 431 participants enrolled in the Collaborative Longitudinal Study of Personality Disorders from July 1996 to June 2008. Suicide attempts were assessed with the Longitudinal Interval Follow-up Evaluation at 6 and 12months, then yearly through 10years. Logistic regression was used to compare single attempters to multiple attempters on Axis I and II psychiatric disorders and personality trait variables. RESULTS: Twenty-one percent of participants attempted suicide during the 10years of observation, with 39 (9.0%) reporting a single suicide attempt and 54 (12.5%) reporting multiple suicide attempts. Although no significant differences in were found in baseline Axis I disorders, multiple attempters were significantly more likely to meet criteria for borderline personality disorder and to have higher impulsivity scores than single attempters. CONCLUSION: These results underscore the importance of considering both personality disorders and traits in the assessment of suicidality.

Long-term outcomes in borderline psychopathology: old assumptions, current findings, and new directions.

Borderline personality disorder (BPD) and historical variants of the diagnosis were long held to represent an intractable syndrome of psychopathology consisting of interpersonal, intrapsychic, and affective disturbances. For years, patients labeled "borderline" were regarded pejoratively due at least in part to the lack of effective treatments. Prospective data from recent naturalistic follow-along studies along with the development of treatments with empirically demonstrated efficacy have changed how BPD is viewed. It is now less common to hide the diagnosis from the patient, and BPD has become a useful label to guide the treatment process and help the patient make sense of his or her suffering. Although it is now accepted that BPD is a treatment-responsive disorder and that remission is the norm, more work is needed to help patients achieve a higher level of functioning, and targeting persistent trait-like features suggests new directions for future efforts in treatment development.

Prospective investigation of a PTSD personality typology among individuals with personality disorders.

This study investigated the replicability of a previously proposed personality typology of posttraumatic stress disorder (PTSD, and explored stability of cluster membership over a 6-month period. Participants with current PTSD (n = 156) were drawn from the Collaborative Longitudinal Personality Disorders Study (CLPS). The CLPS project tracked a large sample of individuals who met criteria for 1 of 4 target diagnoses (borderline, schizotypal, avoidant, and obsessive-compulsive) and a contrast group of individuals who met criteria for depression but no personality disorder. A cluster analysis using scales from the Schedule of Nonadaptive and Adaptive Personality yielded 3 clusters: "internalizing," "externalizing," and "low pathology." Using K-means cluster analysis, the results did not replicate previous work. Using Ward's method, the hypothesized 3-cluster structure was confirmed at baseline but did not demonstrate temporal stability at 6 months.

Development and environment in the National Institute of Mental Health (NIMH) Research Domain Criteria.

The integration of developmental processes is essential for a full understanding of psychopathology. The National Institute of Mental Health (NIMH) Research Domain Criteria (RDoC) provide a scaffold on which to organize the components and processes of psychopathology and to detail behavioral and biological disruptions in developmental processes gone awry. This special section on Integrating Developmental Psychopathology With the RDoC Framework provides the opportunity to comment on five extraordinary developmental psychopathology articles that report results and theory integral to RDoC. An introductory overview provides context for RDoC's approach to developmental issues. This is followed by brief summaries of each article and points regarding its particularly salient aspects, and concludes with broader comments about the import of the articles as a set. Collectively, the work by these eminent translational scholars illustrates how to conduct significant research on developmental psychopathology using RDoC, and simultaneously raises important questions and future directions to integrate development and environment in RDoC-framed research. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Association of Borderline Personality Disorder Criteria With Suicide Attempts: Findings From the Collaborative Longitudinal Study of Personality Disorders Over 10 Years of Follow-up.

Importance: Borderline personality disorder (BPD) has been identified as a strong risk factor for suicidal behavior, including suicide attempts. Delineating specific features that increase risk could inform interventions. Objective: To examine factors associated with prospectively observed suicide attempts among participants in the Collaborative Longitudinal Study of Personality Disorders (CLPS), over 10 years of follow-up, with a focus on BPD and BPD criteria. Design, Setting, and Participants: The CLPS is a multisite, naturalistic, prospective study of adult participants with 4 personality disorders (PDs) and a comparison group of adults with major depressive disorder and minimal PD features. Participants were all treatment-seeking and recruited from inpatient, partial, and outpatient treatment settings across New York, New York, Boston, Massachusetts, New Haven, Connecticut, and Providence, Rhode Island. A total of 733 participants were recruited at baseline, with 701 completing at least 1 follow-up assessment. The cohorts were recruited from September 1996 through April 1998 and September 2001 through August 2002. Data for this study using this follow-up sample (N = 701) were analyzed between March 2019 and August 2020. Main Outcomes and Measures: Participants were assessed annually using semistructured diagnostic interviews and a variety of self-report measures for up to 10 years. Multiple logistic regression analyses were used to examine baseline demographic and clinical risk factors, including BPD and individual BPD criteria, of suicide attempt assessed over 10 years of prospective follow-up. Results: Of the 701 participants, 447 (64%) identified as female, 488 (70%) as White, 527 (75%) as single, 433 (62%) were unemployed, and 512 (73%) reported at least some college education. Of all disorders, BPD emerged as the most robust factor associated with prospectively observed suicide attempt(s) (odds ratio [OR], 4.18; 95% CI, 2.68-6.52), even after controlling for significant demographic (sex, employment, and education) and clinical (childhood sexual abuse, alcohol use disorder, substance use disorder, and posttraumatic stress disorder) factors. Among BPD criteria, identity disturbance (OR, 2.21; 95% CI, 1.37-3.56), chronic feelings of emptiness (OR, 1.63; 95% CI, 1.03-2.57), and frantic efforts to avoid abandonment (OR, 1.93; 95% CI, 1.17-3.16) emerged as significant independent factors associated with suicide attempt(s) over follow-up, when covarying for other significant factors and BPD criteria. Conclusions and Relevance: In the multisite, longitudinal study of adults with personality disorders, identity disturbance, chronic feelings of emptiness, and frantic efforts to avoid abandonment were significantly associated with suicide attempts. Identity disturbance, chronic feelings of emptiness, and frantic efforts to avoid abandonment may be clinically overlooked features of BPD in context of suicide risk assessment. In light of the high rates of BPD diagnostic remission, our findings suggest that these criteria should be independently assessed and targeted for further study as suicide risk factors.

Brief report on the relationship between temporal discount rate and error related negativity for immediate versus future choice options.

It is well documented that individuals vary in their economic patience - their willingness to choose delayed larger rewards (e.g., $100 in a month) over immediate smaller rewards (e.g., $25 now) - and that high levels of impatience, or temporal discounting, can be behaviorally problematic. Using event-related potential (ERP) method, we investigated error monitoring, as indexed by the error related negativity (ERN) component, as a function of discounting behavior. This work builds on prior work on risky decision making that revealed that individuals have greater ERNs for trials in which they select a risky option over a certain one (Yu and Zhou 2009), especially individuals not inclined towards risk taking (Martin and Potts 2009). In the present study, participants completed a temporal discounting task (choosing between a fixed immediate reward versus a future reward that varied across trials) while electroencephalogram (EEG) activity was recorded. We found an asymmetric relationship between discounting and the ERN: the greater an individual's overall rate of discounting, the greater the ERN component of the ERP waveform on trials where the future reward was selected, but not on trials in which the immediate reward was selected. The ERN may reflect an early warning signal alerting high discounters to potential negative consequences of future-oriented choices.

Self-criticism versus neuroticism in predicting depression and psychosocial impairment for 4 years in a clinical sample.

The present study extended previous findings demonstrating self-criticism, assessed by the Dysfunctional Attitude Scale (DAS) (Weissman AN, Beck AT. Development and validation of the Dysfunctional Attitude Scale: a preliminary investigation. Paper presented at the 86th Annual Convention of the American Psychological Association, Toronto, Ontario, Canada, 1978), as a potentially important prospective predictor of depressive symptoms and psychosocial functional impairment over time. Using data from a prospective, 4-year study of a clinical sample, DAS self-criticism and neuroticism were associated with self-report depressive symptoms, interviewer-rated major depression, and global domains of psychosocial functional impairment 4 years later. Hierarchical multiple regression results indicated that self-criticism uniquely predicted depressive symptoms, major depression, and global psychosocial impairment 4 years later over and above the Time 1 assessments of these outcomes and neuroticism. In contrast, neuroticism was a unique predictor of self-report depressive symptoms only 4 years later. Path analyses were used to test a preliminary 3-wave mediational model and demonstrated that negative perceptions of social support at 3 years mediated the relation between self-criticism and depression/global psychosocial impairment for 4 years.

The construct validity of passive-aggressive personality disorder.

Although Passive Aggressive personality disorder (PAPD) plays an important role in many theories of personality pathology, it was consigned to the appendix of the fourth edition of the DSM. The scientific basis of this decision has been questioned, but several controversies persist regarding PAPD, including its structure, content validity, overlap with other PDs, and relations to validating variables such as personality traits, childhood experiences, and clinically relevant correlates. This study examined these facets of PAPD's construct validity in a large clinical sample. Results suggest that the construct is unidimensional, internally consistent, and reasonably stable. Furthermore, PAPD appears systematically related to borderline and narcissistic personality disorders, sets of personality traits, and childhood experiences consistent with several theoretical formulations, dysfunction, substance abuse disorders, and history of hospitalizations. Overall, results support the construct validity of PAPD.

Relation of depression symptoms to sustained reward and loss sensitivity.

Depression is characterized by altered sensitivity to rewards, with recent evidence suggesting that the ability to sustain responses to rewards across long experimental tasks is diminished. Most work on sustained reward responsiveness has taken a categorical approach and focused on major depressive disorder. However, impairments in reward sensitivity are also found at lower levels of symptom severity and may be relevant for understanding basic mechanisms linking reward processing abnormalities to depression. The current study took a dimensional approach to examine the relation between depression symptoms and sustained reward responsiveness by examining how early neural responses to rewards and losses change over a short time course (i.e., during the experiment). In a sample of 45 unselected undergraduates, changes in the amplitude of the reward positivity (RewP) and feedback negativity (FN) were examined over the course of a simple gambling task using multilevel modeling. Amplitude of the RewP was sustained and amplitude of the FN increased during the task. Unlike prior work focused on clinical populations, depression symptoms in this unselected sample were associated with enhanced RewP and FN responding over the course of the task. Results echo prior work that underscores the importance of examining changes in response to reward across trials and further suggests that sustained responses to both rewards and losses vary in relation to symptom level.

Advancing Translational Research Using NIMH Research Domain Criteria and Computational Methods.

The NIMH Research Domain Criteria (RDoC) can aid in the translation of integrative neuroscience. We argue that the RDoC framework, with its emphasis on integration across units of analysis, leveraged with computational approaches, can organize intermediary treatment targets and clinical outcomes, augmenting the translational stream.

New episodes and new onsets of major depression in borderline and other personality disorders.

BACKGROUND: In the context of much literature and conjecture about the relationship of personality disorders (PD) and major depressive disorder (MDD), this paper uses longitudinal data to assess the frequency with which PD patients, and especially those with borderline personality disorder (BPD), have recurrences (for patients with lifetime histories), or new onsets (for patients without lifetime histories) of MDD. METHODS: A sample of 478 PD patients received reliable repeated follow-up assessments over a period of 6 years. The rates of new onsets and recurrences of MDD in all PD patients, and in BPD patients compared to OPD patients were analyzed. Whether age, gender, GAF score, or the number and types of BPD criteria predict new onsets or recurrences of MDD was also examined. RESULTS: Eighty-five percent of PD subjects had episodes of MDD during the 6 year follow-up; of those with lifetime MDD, 85% had recurrences. Of the PD subjects without lifetime MDD, 44% had new onsets. BPD subjects were significantly more likely (p = .0036) to have recurrences of MDD but were about equally likely to have new onsets compared to OPD subjects. The number and types of BPD criteria were predictive of onsets and recurrences for all PDs, but were not more predictive for the BPD than OPD subsamples. LIMITATIONS: Longer term follow ups with a more epidemiologically representative sample of PDs would strengthen the generalizability of this study's findings. CONCLUSIONS: Having a comorbid PD confers significant risk for recurrences and for new onsets of MDD and confers a significantly negative effect on the course of MDD. BPD conferred more risk for recurrence than OPD.

A comparison of interview and self-report methods for the assessment of borderline personality disorder criteria.

Interview methods are widely regarded as the standard for the diagnosis of borderline personality disorder (BPD), whereas self-report methods are considered a time-efficient alternative. However, the relative validity of these methods has not been sufficiently tested. The current study used data from the Collaborative Longitudinal Personality disorder Study to compare diagnostic base rates and the relative validity of interview and self-report methods for assessing functional outcome in BPD. Although self-report yielded higher base rates of criteria endorsement, results did not support the common assumption that diagnostic interviews are more valid than self-reports, but instead indicated the combined use of these methods optimally identifies BPD criteria.

Gratitude intervention modulates P3 amplitude in a temporal discounting task.

Gratitude has been shown to reduce economic impatience. In particular, individuals induced to experience heightened gratitude are more willing to choose delayed larger rewards over immediate smaller rewards (i.e., they have lower discounting rates) than those in a neutral condition. Using the event-related potential (ERP) method, we investigated the relation between gratitude level and neurophysiological correlates. Of interest was motivated information processing, as indexed by the P3 component. Participants were administered a gratitude or a neutral mood induction followed by a temporal discounting task (choosing between a fixed immediate reward versus a future reward that varied across trials) while electroencephalogram (EEG) activity was recorded. Individuals in the gratitude condition had greater P3 amplitude, suggesting greater attention to the future-reward option (the choice option that varied across trials), even when this option was not selected, and providing the first evidence of gratitude-induced changes in electrophysiological activity.

Ethnicity and mental health treatment utilization by patients with personality disorders.

The authors examined the relationship between ethnicity and treatment utilization by individuals with personality disorders (PDs). Lifetime and prospectively determined rates and amounts of mental health treatments received were compared in over 500 White, African American, and Hispanic participants with PDs in a naturalistic longitudinal study. Minority, especially Hispanic, participants were significantly less likely than White participants to receive a range of outpatient and inpatient psychosocial treatments and psychotropic medications. This pattern was especially pronounced for minority participants with more severe PDs. A positive support alliance factor significantly predicted the amount of individual psychotherapy used by African American and Hispanic but not White participants, underscoring the importance of special attention to the treatment relationship with minority patients. These treatment use differences raise complex questions about treatment assessment and delivery, cultural biases of the current diagnostic system, and possible variation in PD manifestation across racial/ethnic groups. Future studies need to assess specific barriers to adequate and appropriate treatments for minority individuals with PDs.

Rumination is associated with diminished performance monitoring.

Rumination is a construct that cuts across a variety of disorders, including anxiety and depression. It has been associated with deficits in cognitive control thought to confer risk for psychopathology. One aspect of cognitive control that is especially relevant to the content of ruminative thoughts is error processing. We examined the relation of rumination and 2 electrophysiological indices of error processing, error-related negativity (ERN), an early index of error detection, and error positivity (Pe), a later index of error awareness. Consistent with prior work, ERN was negatively correlated with anxiety (i.e., more anxious individuals were characterized by larger ERNs). After controlling for anxiety, rumination-but not worry-predicted ERN attenuation. No significant relation between rumination and Pe emerged. Findings suggest that rumination may diminish resources early in the processes of performance monitoring and the recruitment of cognitive control. (PsycINFO Database Record

Personality and life events in a personality disorder sample.

Individuals with a personality disorder (PD) tend to experience more negative life events (NLEs) than positive life events (PLEs). In community samples, the Five Factor Model of personality (FFM) predicts both positive and negative life events. The present research examined whether FFM normal personality traits were associated with positive and negative life events among individuals with 1 of 4 PDs: avoidant, borderline, schizotypal, and obsessive-compulsive, and tested whether associations between the FFM of personality and PLEs and NLEs were similar across the 4 PD groups and a control group. Among aggregated PDs, neuroticism was positively associated with NLEs, whereas extraversion, openness to experience, and conscientiousness were positively associated with PLEs. Comparisons of each PD group to a control group of individuals with a major depressive disorder indicated that the FFM traits operated similarly across clinical samples with and without PD. Our findings indicate that normal personality traits can be used to help understand the lives of individuals with PD. (PsycINFO Database Record

Descriptive and longitudinal observations on the relationship of borderline personality disorder and bipolar disorder.

OBJECTIVE: The purpose of this study was to test whether borderline personality disorder is a variant of bipolar disorder by examining the rates of co-occurrence in both disorders, the effects of co-occurrence on a longitudinal course, and whether the presence of either disorder confers the risk for new onsets of the other. METHOD: A prospective repeated-measures design with reliable independent diagnostic measures and 4 years of follow-up was used to assess 196 patients with borderline personality disorder and 433 patients with other personality disorders. RESULTS: Patients with borderline personality disorder had a significantly higher co-occurrence of bipolar disorder (19.4%) than did patients with other personality disorders. However, this co-occurrence did not appear to affect the subsequent course of borderline personality disorder. Although only 8.2% of the borderline personality disorder patients developed new onsets of bipolar disorder, this rate was higher than in patients with other personality disorders. Patients with other personality disorders with co-occurring bipolar disorder generally had more new onsets of borderline personality disorder (25%) than did patients with other personality disorders without co-occurring bipolar disorder (10%). CONCLUSIONS: A modest association between borderline personality disorder and bipolar disorder is reported.